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"^ . Co-ma. of V\eiA'<^ 

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ComplimentB of 



Commonwealth of Penniylvt 





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Letter of TraDsmittal, 3 

Ninth Annual Report of the Commissioner of Health, 

OrgBnizBtlOQ S 

Important Changes, C 

Department o( Health, U 

General Division, 11 

DiTi«ion of Medical Inepection, 11 

Coontj Medical Inspectorg 13 

Medical Deputies, li 

Railroad Medical Inspectors, IS 

Township Health Officer 18 

School Medical Inspectors, 26 

DiTision of Statiadca 39 

Local B^^istiara, 36 

Division of laboratories and Experimental Station 62 

Diviaion for the Control of TubercnloBis, 53 

SubdiTiaioD of Tuberculosis Diapeaaaries, 53 

Dispensaries: Location and Staff 64 

SubdivisioD of Tuberculosis Sanatoria, 58 

Pennsflvania State Sanatorium tor Tuberculosis No. 1, Mont Alto, 58 

Pennsylvania State Sanatorium for Tuberculosis No. 2, Cresson, 65 

^ PennsylTania State Sanatorium (or Tuberculosis No. 3, Hamburg, 69 

{^ Division of Distribution of Biological Products, 71 

' Distributors of Antitoxins 72 

Division at Sanitsry Engineering 81 

, Division of Accounting and PurcboHing, S3 

•^ DiviaioD of Supplies, 83 

Comment on the Reports M 

^ Correspondence with the Economy and Efficiency Commission, 84 

"' Report of a Committee on School Medical Supervision, 90 

Summary of the Statistics of the Sanatoria and of the Upfollow of former 

~l patients, 88 

' Summary of the Dpfollow of former patients of the Dispensaries, 105 

r^ The Wassermann Test made available to the Dispensaries, 113 

First Aid Service of the Department daring the Transfer of the Blags, 115 

a A Paper on a Substitute for the Permanganate of Potash in disinfection with 

^ Formaldehyde. 117 

' ^ A Paper on the Duck as a Preventive against Malaria and Yellow Fever 120 

J Bulletins and "Talks" of the Jear, 121 

J Addresses, Conferences, Conventions, etc., 133 

1 Special Reports 127 

J Annual Report of the General Inspector, 129 

. The ITnderlTlng Factors in the Spread of Tnbercnlosia— Bjr Dr. A. P. Fran- 


3 ■ TABLE OF O0NTBNT8, Off. Doc. 

The Devebpment of the Tuberculofds GampBign in Pennsylvania, with a 

Discuaaion of its Principles, Bj Dr. A. P. Francine IM 

Keporte of the DivisioD of Medical Inspection 187 

OrganiEstion and AdministratiTe Work, ie» 

PrSTalence ot Certain DiseaBea, 17fl 

Special Reports Concerning Medical iDspections 182 

On the Inspection of Schools and School Children, 326 

Abfltracta of the Reports of the Count; Medical Inspectors, 349 

Summaries of the Work of Inspectors and Health Officers 518 

Report of the Division of Statistica 621 

Mortality 523 

Births ezi 

Morbidity, 6t9 

Marriage, 689 

Report of the Division of Labors toriea and BiperimeDtal Station 677 

Reports of the Division for the Control of TubercaloslB, 697 

Report for the Tuberculosis Dispensaries 6S9 

Report on former Dispensary Patients traced in 1914, 732 

Report for the State Sanatorium at Mont Alto, 757 

Report on Results obtained at Iilout Alto with the use of the Biol<^ical 

Products of the Tubercle Bacillus, 778 

Report on the Condition of former patients of the Mont Alto Sanatorium 

as determined in 1B14, 790 

Report for the State Snnatorium at Cresson 806 

Report on Results obtained at Cresson with the nae of the Biological Pro- 
ducts of the Tubercle Bacillus, 825 

Report on the Condition of former patients of the Cresaon Sanatorium as 

determined in 1914 S27 

Report for the State Sanatorium at Hambarg, S41 

Report of the Division of Diatributian of Biological Products, 8S5 

Report of the Division of Sanitary Engiueeriag S7T 

OrganiMtion and Administration, 

Office Work , 88! 

EjOginecring (Waterworks and Sewerage), 891 

Designs and Construction 

Tests of Water and Sewage Treatment Planta, 

Special Work 

Fidd Inspection (ImprovemeDt of Watersheds, General Sanitation) 


Cases referred to Special Counsel, 


Report of the Division of Accounting and Pnrdnriin 

Report of the Division of Supplies, 122) 

ov Google 



CommoDwealth of PeuDE^Ivania, 

BepartmeDt of Healtb, 

State Capitol, Harriabarg, 

Febrnary 1, 191.1. 

To His Excellency, Martin Q. Bnunbaagh, Governor of Pennsylvania: 

Sir: The Act of Assembly by which the Department of Health 
was created prescribed that the Commiasioner shall annoally report 
on the vital statistics and sanitary conditions and prospects of the 
State, and set forth the action of the Department and of its ofBcerg 
and agents, and the names thereof during the past year Sach a 
report for the year 1914, being my ninth annual report, I have now 
the honor to transmit. Other work done by me as a servant of the 
State in positions which I have held ea> officio (State Quarantine 
Board, Water Supply Gommission, Dental Connci], and Bnrean of 
Medical Edncation and Licensure) is given in the reports made by 
these bodies respectively. 

Commissioner of Health. 







Ah Commissioner of Health for this Commonwealth of Peno^l- 
ania I can assure you it is gratifying to me to snbmit this, my Minth 
Annual Report of my activities as executive of this Department 
and as a servant of a people, who have through their members of 
the General Assembly and the Governor appropriated more mon^ 
to health than any other state of the Union. The responsibilities are 
necessarily commensurate with the means that have been provided 
to carry on this work upon which the prosperity of the State and 
the happiness of the people so largely depend. 


The year 1914 has brought numerous changes in many of the Di- 
visions of the Department of Health. A full enumeration of those 
who held positions in the past twelve months vill appear below. 
Concerning some of the changes a brief comment may be made. 

On the first of March the death of Dr. Paul A. Hartman deprived 
the Department of the services of one of its most efBcient County 
Medical Inspectors. He was bom at Lebanon, December 24, 1850, 
as the son of the late John Joseph and WUhelmlna Steever Hartman. 
Later the family lived for a time in Lycoming Coonty, but whm 
young Hartman was nearly fourteen they removed to Harrisbui^. 
After attending the public schools, Panl Hartman studied in the 
State Normal School at Kutztown, and was then enrolled as a student 
of Dickinson College. His medical studies were b^un under the 
direction of the late Dr. Robert P. Seller, and later continued in the 
Jefferson Medical College of Philadelphia, where he took his degree 
in 1874. He at once eatablished himself as a practitioner at Harrls- 
barg and there he continued to practise the rest of his life, almost 
forty years. 

<») , Cooglc 


When the State Board of Health made a new inspection district 
by joining Cnmberland and Adams Countiee with Franklin and 
Perry, the "Susquehanna District," thus reduced to Dauphin, Lan- 
caster, and York Counties, was placed in charge of Dr. Hartmon, 
bis appointment being made July 13, 1887. In this office he con- 
tinued to serve until early in 1895 when the system of County Medical 
lospectoFB was adopted by the Board and Dr. Hartman accepted an 
appointment as Medical Inspector of Dauphin County. When the 
new Department of Health was established in 1905, many of these 
Connty Medical Inspectors were retained in the. new organization, 
among them Dr. Hartman. In July, 1907, I b^an the development 
of our syst^n of State Tuberculosis Dispensaries, purposing ulti- 
mately to establish at least one in each county. At iirst we had to 
feel our way, and progress was slow; consequently it was not until 
the end of March, 1908, that the Dispensary in Harrisbnrg could be 
opened. I placed Dr. Hartman in charge of this work and under 
his direction the Dispensary produced good results. 

Dr. Hartman was well known to the community in which be lived, 
and enjoyed a reputation as a diagnostician in skin diseases, espe- 
cially in cases of smallpox. He was esteemed by his professional 
brethren as "a man whose word was as good as his bond." He was 
a member of the Dauphin County Medical Society, its President in 
1885, and for twenty-one years its Secretary. On two occasions he 
was sent as a delegate to the meeting of the American Medical As- 
sociation. He was also a member of the Harrisburg Academy of 
Medicine, and of the staff of the Harrisburg Hospital, and for some 
years he served the County as physician to the County Prison, and 
also the city in various official capacities. 

On the last day of February, 1914, in the midst of his work at tiie 
Dispensary, Dr. Hartman was stricken. Snch was his condition that 
removal to bis home was quite out of the question, and tiiere in 
the Dispensary he lingered until the afternoon of the next day 
when the end came. 

Late in the year the Department lost the services of another 
County Medical Inspector by tbe death of Dr. Bonbrake in the 
Markleton Hospital, on the twenty-second of November. Henry X. 
Bonbrake was bom in Washington Township, Franklin County, 
March 31, 1843. the son of Daniel and Margaret (Stoner) Bonbrake, 
He was educated at what was then Mercersburg College, and began 
the study of medicine under the preceptorship of Dr. J, J. Oellig 
and later of Dr. James Brotherton, both of Mercersburg. In the 
spring of 1866 he graduated from the Bellevne Hospital Medical Col- 
lege of New York, and presently b^an practice in Leitersbni^, Mary- 
land. Here he remained bat a short time and then removed to 



Mont Alto in Pranklin County where lie practised for nearly twen^- 
flve yeare. Daring a large part of this time he was manager of the 
Iron Company's Pot^ at Mont Alto, serving also as chemist and 
physician of the company. In 1889 Dr. Bonbrake removed to Cham- 
beraburg vhere he speedily became a successfnl practitioner. He 
was a visiting physician to the Chambersburg Hospital and the 
Franklin County Almshonse, and was the county coroner from 
1890 to 1894. He was an active member of the Franklin County 
Medical Society, serving in due time as its president, and was also 
a Fellow of the American Medical Association. In 1903 he became 
the County Medical Inspector for the State Board of Health and 
was retained in that position when the present Department of Health 
was organised in 1905. On the establishment of the Tuberculosis 
Dispensary at Chambersbni^, in November 1907, I placed it in charge 
of Dr. Bonbrake. 

The vacanciea in the County Medical Inspectorships I filled by the 
appointment of Dr. Clarence R. Phillips of Harrisbnrg, for Dauphin 
County, and Dr. Pan! P. Allen of Chambersburg, for Pranklin 
CoDuty. Dr. Phillips was also appointed chief of the Dispensary at 

Among our Health Officers there were nine deaths and sixty resig- 
nations. I made forty-nine new appointments to this body. The 
deaths were as follows: — ^in February, Milton Huston of Portland, 
Northampton County, and Henry Deisenroth of Freeland, Luzerne 
County; in July, Thomas E. Morthimer of Lehighton, Carbon County, 
and E. C. Shoemaker of Meyersdale, Somerset County; in August, 
P. P. Brown of Allentown, Lehigh County; in September, John 
McBride of St. Marys, Elk County, Henry A. Kolbe of Doyleatown, 
Bucks County, and C. H. Wilton of Marienville, Forest County; 
and in December, B. J. Bchlosser of Schwenksville, Montgomery 

In the Division for the Control of TuberculoaiB there were many 
changes among the more responsible officials of the otQce staff of 
the Bnb-division of Tuberculosis Dispensaries. Dr. Edward B. 
Bbellenbei^r, who had been Deputy Medical Inspector of Dispen- 
saries since October 1913, resigned on the first of June to take up 
again the psychiatrical work which had formerly been his chief 
interest In August I appointed Dr. Karl Scbafile, an assistant phy- 
fdcian in one of our Philadelphia Dispensaries, to fill tiie vacant 
position in Harrisbnrg. Early in October in view of the prospective 
opening of the new Sanatorium at Hamburg, I chose Dr. Thomas H. 
A. Btites to become the Medical , Director at Hamburg when that 
institntion should be actually ready for service. Dr. Stites had been 
tiie Medical Inspector of Dispensaries ever since this work was es- 
tablished in 1907. On the first of November I advanced Dr. 


Schaffle from the position of Deputy to that of Acting Medical In- 
spector of Dispenaaries, and one month later I filled the vacant 
position of Depnty by the appointment of Dr. Prank P. D. Reckord 
of HarriabTirg. Hias Margaret McGannon was added to the office 
staff aa stenographer. 

The death of two of oor Coonty Medical Inspectors, Dr. Panl A. 
Hartman and Dr. H. X, Bonbrake, already elsewhere noted, deprived 
the Departmental Tuberculosis Dispensaries at Harrisburg and 
Cbambersburg of valuable chief medical officers. As elsewhere shown 
these vacancies were promptly filled. Only one other transfer was ■ 
made during the year, Dr. B. A. McDermott, who, after serving for 
some time in one of the Philadelphia Dispensaries of the Department, 
wati made Deputy Medical Director of the Hamburg Sanatorium. 

Other physicians also retired from the Dispensary service as fol- 
lows: Dr. D. P. Bay (Johnstown), January 13; Dr. C. W. Sample 
(Pittsborfh), February 1; Dr. G. A. Stock (Danville), March 24; 
Dr. J. P. Kennedy (Columbia), March 2i; Dr. L. N. Beichard 
(Brownsville), April 1; Dr. J. T. Rimer (Clarion), April 1; Dr. J 
L. Wame (Pottsville), June 10; Dr. W. C. Hogan (Bradford), August 
4; Dr. Charles Weber (Philadelphia), November 1; Dr. A. L. Shearer 
(Harrisburg), November 14; Dr. S. P. Hakes (Tioga), NovRmber 
14; Dr. E. E. Shifferstine (Tamaqua), December 8; Dr. H. C. Kinzer 
(Lancaster), December 31. 

Among the Dispensary Nnrses transfers occurred in the sense 
that Miss Jessie G. Barclay, Miss Anna Grafe, Miss Eosa McClin- 
tock. Miss Sara A. Crooks, and Mrs. Jane P. Miller, each attached 
to several Dispensaries, had their duties concentrated in a smaller 
number of places as appears in the list below, and the following 
retired during the year: Miss Carolina M. Anthony, Miss Alice M. 
Chubb, Miss Mary G. Connelly, Miss Hannah P. Guthrie, Miss Louise 
E. Koenig, Miss Anna F. Kutzer, Miss Rosa McClintock, Miss Marga- 
ret McMabon, Miss Mary G. Maloney, Miss Mary E, S. Miller, Miss 
Kathpyn Shepard, Miss Frances Swope, Miss Emma J. Watts, Miss 
Marie Williamson, Miss Flora Wilson, Mrs. 0, A, Wordinger, as well 
as Miss Mary F. Bryan and Miss Nettie B. Campbell who had 
served as clerks. 

In the Dispensaries affected by the deaths and resignations al- 
ready noted certain changes in the staff were made, in the nature 
of promotions, as appear in the detailed list. The following appoint- 
ments of Dispensary Physicians were made in the course of the year: 
Dr. A. H. Davisaon (Ardmore), March 15; Dr. Cameron Shnltz 
(Danville), March 24; Dr. Richard Reeser (Columbia), March 24; 
Dr. P. P. Phillips (Clarion), April 1; Dr. Isaac H. Jones (Phila- 
delphia), April 1; Dr. C. H. Grimes (Philadelphia), April 1; Dr. 



Carl Brovn (Scranton), May 1 ; Dr. F. 8. Hoover (Brownsville), May 
14; Dr. J. W. E. Ellenbei^r (Pittsburgh), Jane 1; Dr. James B. 
Heller (Pottaville), Aagnst 1; Dr. Wade Faton (Bradford), Angaat 
i; Dr. J. P. Frantz (Philadelphia), October 1; Dr. Pred B. Harding 
(Tamaqaa), December 8; Dr. C. W. Webb (Wellsboro), December 
22 (after having charge of the Tioga Dispensary since November 

The foUowing were made Dispensary Nurses: Miss Mary E. Bma, 
Mrs. Carrie P. Butler, Miss Eleanor CaCfrey, Miss Carolyn E. Ell- 
wanger, Miss Margaret FothergUl, Miss Delia A. Olenn, Miss Elda 
QraybiU, Miss Bess M. Hepburn, Miss Bess Johns, Miss Looise E, 
Eoeuig, Miss Helena O'Hara, Miss Maynie A. Peck, Mrs. Florence 
Peter, Mies Anna Prather, Miss Sara E. Trimble, Miss Mary E. 
Walsh, Miss Marie Williamson, Miss Marie E. Witt^; and Bobert 
A. Brandt, Miss Mary F. Bryan, and Miss Agnes Bonder were ap- 
pointed Dispensary Clerks. 

For the SaDatorium at Mont Alto the following changes are 
notable: At the end of August Dr. Edwin R. Vander Slice retired 
after acting as assistant physician for two years and a half to be- 
come the Medical Superintendent of the State Tuberculosis Sana- 
torium of Nebraska. At the end of November Dr. Samuel C. 
Jaspan gave up the position as assistant physician which he had 
filled for eighteen months and entered upon private practice in New 
, Jersey. As assistant physidaus on the medical stafF I appointed 
Dr. Joseph Aaronoff and Dr. Herman Schlaff. Early in September 
Mrs. Laura B. Cleaver resigned her position as Head Nurse at the 
Children's Hospital and in her stead I appointed Miss Catherine 
I. Cobb. 

At the Cresson Sanatorium the medical staff lost the Deputy 
Medical Director, Dr. S, H. Rinehardt, who retired to establish him- 
self in private practice at Bittsburgh. Resignations also came from 
the Assistant Physicians, Dr. Samuel Gross and Dr. J. W. E. Ellen- 
berger, who wished to take op private practice in Philadelphia and 
Wilkinsburg respectively. Another Assistant Physician, Dr. R. V. 
Zabarkes, was transferred to the Hamburg Sanatorium late In the 
year. In the course of the year I appointed two new members of 
this staff: Dr. D. S. Brachman who came on du^y in Jon^ and 
Dr. M. E. Cowen who entered the service in November. 

In the Division for the Distribution of Biological Products sev- 
eral changed have taken place. At the end of last year the position 
of Chief of the Division became vacant by resignation. For the 
next ten weeks or so the practical work of the Division was carried 
on by the ofBce staff under my personal supervision. I then named 
Dr. J. Moore Campbell of Philadelphia to fill the vacant^. Dr. 


Campbell had been in service in onr departmental laboratories in 
Phlladelptua for about tvo years and a half and poaseaaed mnch 
familiarity vith the technical and medical aspects of oar prepara- 
tiOBB besides other qnalifications of a good bnrean chief. Under his 
control the work of the Division has ondergone a carefol revisloii 
and many improvements have been introduced to increase the ef- 
fectiveness of onr distribution of biological products. In June, Mrs. 
Imcj a. Thompson resigned to take a more lucrative position at a 
distance after being an exceptionally valuable asset of the DividoD 
from its establishment in 1905. 

In the Divisioa of Sanitary Engineering important changes hare 
occurred. E^rly in the year F. Herbert Snow, who had efficiently 
served as Chief Engineer since August 25, 1906, resigned his position 
to become Chief of the Bureau of Engineering under the Public 
Service Commission. I then appointed as acting Chief Engineer 
Charles A. Emerson, Jr., who since October, 1910, had filled the 
position of Principal Assistant Engineer in charge of Design and 

A few new appointments were made. On July Isl^ A. J. Smalsbaf 
was appointed as Assistant Engineer for Designs and Construction, 
and October first, L. M. Fisher and Joseph A. Tinsman as Assistant 
Engineers for Waterworks and Sewerage Investigations. On March 
31 the En^neering Assistant Wilson W. Bitter, resigned. On May 
5th Charles T. Maclay was transferred from the position of an En- 
gineering Assistant to that of Sanitary Inspector, a position which 
he resigned on the first of December. On July 30, H. M. Walter re- 
signed from the draughting room. On May 1, Miss M. Irene Cuenot 
resigned her place as stenographer, as on October 1, did also Miss 
Jane Gilbert, to take positions as stenographers in other depart- 
ments at larger salaries. These vacancies I filled by the appointment 
of Miss Margaret Small, on September Xi, and Miss Bulah L. Koona 
on the first of December. Among the Sanitary Inspectors resigna- 
tions came from Robert M. Courtney, February 1, W. S. Hood, March 
31, Lester L. Pierce, November 1, and Charles H. Spelker, November 
30; and on the first of July Charles L. Baucher was appointed a 
member of this body. 

ov Google 

N«. 15. C0MM18S10NEI^ OP HEALTH. U 

As required by law I hereby fnrnish a list of ofBcers and agents 
of the Department during the year 1914. 

CommUtioner of Seaith: jSjmuel Q. Dixon, M. D., LL. D., 
Bryn Mawr, McatKomftry County. 
Advisor; BoBrd—Charles B. FeDroee, M. D., PbilndelphiiL. 

Adolpli KoeniB, M. D., PittaborKh, AUegbenr County. 
B. H. Warren, M. D., West Chester, Cbeeter Coanty. 
Lee Masterton, O. E., Johnetown, Cambria County. 
QeoFBe W. Guthrie, M, D., WUkea-Barre, Laaema Coontr. 
Clarence J. Marshall, T. M. D., PhUadelpbia. 

Assiatant to CommUsioner, Joseph W. 'Warrpn, M. D., Bryn Mawr, Montgomery 

Secretary, Harry Lindley Hoaford, PhJlsdelphia. 

Auditor, Miaa Ivy E. Huber, HarrisbutB, DaupMn Coanty. 

General Inspector, Charles W. Webtwrt, Boiliue Springs, Cumberland County. 

Stenographers — Arias Edna Hosier, Carlisle, Cumberland Coanty. 

Hiss Miriam B. .lenkyn, Dnncannon, Perry Coanty. 
Messenger, Edward F. Eisely, Hnrrisburg, Dauphin County. 
Night Qerk, Roy G. Miller, New Kingston, Cumberland County. 
Multijraph Operator, R. K. Styer, Perkiomenvillp, Montgomery County. 
Janitor, John B. Sample, Harriaburg, Dauphin Oonnty. 

OMe/ Meiicai Intpector, B. FranJtUn Roger, M. D., 
Pbiladelphia. - 
Aseociate Chief Medical Inspector, C. J. Hunt, H. D., Pbiladelphia. 
Assistant Chief Medical Inspector, Jobn J. MuHowney, M. D., Philadelphia 
Chief Olerk, Jobn G. Ziegler, I^banon, Lebanon County. 
Stent^raphera— -Miss Fannie A. Houseknecht, Muncy, Lycoming County. 
Mrs. Nell Dalzell Buch, Reading, Berks County. 
*Hlss Emma Leib, Harrieburg, Daupbin County. 
Mies Nettie J. Hippie, Marysrille, Perry County. 
Miss Nora C. Cnntwell, Williamsport, Lycoming County. 
Miss M, Florence Ketfer, Reading, Berks County. 
Clerks — Mrs. Rosa Tan Horn, Harrisburg, Dauphin County. 

Miss Maude Van Ormer, Harriaburg, Daupbin County. 
■Misa Mnry Weigle, Harrisburg, Daupbin County. 
Hiss Aida Beauter, WeUsboro, Tioga County. 
Mias Bess Fairbank, McGees Mills, Clearfield County. 



Mlsa Irene McCaUey, Harrisburg, Daapbiii Conntr. 
MiM Florence Eckert, LaDcaater, Lancnster Count;. 
MiBB Caroline Grove, Harrisburg, Dauphin County. 
Misa Adn M. HartmnD, Mifflintown, Janiata Conu^. 
Mrs. Edna P. Rockefeller, Erie, Erie C^onty. 
Mifls Kathrjm A, Stalley, Liverpool, Perry Connty. 
Miss Katherine WilliamB, ICverett, Bedford CountT. 
Temporary Clerks— Mrs. Alice Johnson, Uont^mery Cotmty. 

Miss Nan McCanley, York County. 

Uias Lucetta F. Eckert, Lebanon Comity. 

Mfn Alice H. Miller, Lycoming County. 

Miss Eatherine Darby, Daupbin Coun^. 

Miaa Eatherine UcAlevy, Danphin County. 

Miss Mary E. Seldel, Dauphin County. 

Mrs. Helen Brown, Dauphin County. 

Miss Mildred Rittcr, Dauphin County. 

Mrs. Sara Kink, Dauphin County- 
Mrs. Sarah ComiiiKi Dauphin County. 

Miss L. Leans Teeter, Franklin Coooty. 

MiM Carrie F. Reichert, Dauphin County. 

Miss Katherine Williamn, Bedford County. 

Miss Mary C. Foltz, 'Dauphin County. 

Mlsa Helen E. Wbitemnn, Dauphin Conntr. 

Mrs. H. C. Schimmelfeoe, Douphin Coun^. 

Miss Ethel O. Bratton, Dauphin Coiinty. 

Miaa Elsie Yount, Dauphin County. 

Miss IsabeUc C. Hoffman, FbUadelphia. 

Miaa Helen Campiicld, Crawford County. 

Miaa Elmyra R. Stahley, Lebanon County 

Hiss Edith K. Leahy, Lebiinon Connty. 

Miss Blanche Bower, Columbia Gonnty. 

MisB Marie Helrille, Dauphin County. 

Mrs. Virginia Beidleman, Daupbin Countf' 

Misa Annetta L. Altmaier, Daupbin County. 

Mrs. J. S. MeCftleb, Cumberland County. 

Mrs. Scott Wrifht, Dauphin County. 

Min Edith Dunner, Dauphin County. 

Miaa Sara E. Miller, Dauphin County. 

Miss Marcella O'Gorman, Dauphin County. 

Hias Eilla Sharoaky, Dauphin County. 

Miss Mary C. O'Boyle, Schuylkill C-^nnty. 

Miss Knthryn McCloaky, Schuylkill County. 

Hiss Martba Boudman, Dauphin County. 

Hiss Ellen F. Rynn, Dauphin County. 

Mi« Fannie C. StaUey, Bedford County. 

Miaa Anna M. Shelly, Juninta County. 

Hiss Marie Toomey, Dauphin County. 

Miaa Mildred WilllBmn, Bedford County. 

Miss M. M, Kennedy, Philadelphia. 

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Dt. ^ A J^».i. 








S5?-i«i.i ■:::;::::::::::;::::: 

^i-SH^."; .::;■:: 


Dr. 0. J. UdIUd 

^S^' i::::::-:;;-"----:-:: 


Dp. W, I. rcnnel 


Dr. O. B. Bindi 

I drputliied ftojD tim? t 

e Conntr Uedlal laipeclari 

ov Google 


(Commissioned b; the CommissioQer of Health but not paid by tbe State. T 


Penosrlvania Railroad ComiMiij. 
. W. Latta, Cbiel Medical EzamiDer, Philadelphia. 

Dr. A. D. 
•Dr. J. U 
Dr. J. T>. 
•Dr. J. D 
Dr. D. Vf 
Dr. J. B. 
Dr. S. M 
Dr. A. T. 
Dr. 0. C. 
Dr. W. G 
Dr. R. H 
Dr. R. e 

VenDyke, Philadelphia. 
. Wells, Trenton, N. J. 

Bower, Philadelphia. 

Shiill, Baltimore, Md. 
. Nead, Reading. 

Lincoln, Columbia. 

. Crawford, Barrisbiirs. 

PoffenberKer, SuDbur; 

Troutman, Williamaport. 
. Morehouse, RenoTO. 

Wrttht, Brie. 

Moore, HuutiiiBdoii. 

Dr. H. W. Pownall, Tyrone. 
Dr. W.'B. Diefenderfer, Altoona. 
Dr. W. G. McKinney. Cresson. 
Dr. C. R. BankB, Derry. 
Dr. D. M. Ea»ter, Yoiintwood. 
Dr. W. K, T. Rnhm, Pittrtturgh 
Dr, J. n. Hileman, Pitcaim. 
Dr. I. H. Boyd, Oil CltJ. 
•Dr. J. B. Grier. Olesn, N. Y. 
•Dr. A, R. Johnson, Buffalo, N. I. 
Dr. H. R. Weathaeffer, Elnma. 

Philadelphia and Reading Railway Company. 
Dr. Caspar Morris, Chief Medical Examiner, Philadelphia. 
Dr. Frederick R, Brister, New Britain. Dr. J. Henry OrlT, PhUadelphia. 
Dr. Francis 8. Ferris, Philadelphia. Dr. Thnmna F. Heebner, Port Carbon. 
Dr. NorriB S. McDoweU, Philadelphia. Dr. Albert E. Bronaon, GlrardvlUe. 
Dr. Charlea F. Detweiler, Reading. Dr. Hsrry B. Klase, Harrisbnrg. 

Baltimore and Ohio Railroad Company. 
*Dr. J. F. Teamey, Chief Medical Examiner, Baltimore, Md 
*Dr. E. V. MilhoUand, Asaiatant 
Dr. C. W. Pence, Philadelphia 

. F. H, D. Biser, Rochwood. 
Dr Roy C. Potter, Rockwood. 
Dr. M. B. Koehler, Connellsrille. 

Chief Medleal Examiner, Baltimore, Md. 
Dr. H. H. Mcfntire, Connellayille. 
Dr. J. P. [jwlor, Pittsburgh. 
Dr. R. J. Gnealein, Pittsburgh. 
Dr. E. M. Parlett, New CasQe Juncticn. 

'District Extends Into Pennsylrania . 


tSew AppoidOOMil. IDHaKd. 

Health Oa«r. 

]. J. KoW, 

Oliarin Adflapmer, .. 

D.' C.'KrlK.' '.'.'.'.'.'.'.'.'.'. 

T. O. Ooaker 

C. B. HoffauD,* 

J. H. P«b*r. 

J. Chcilcr BM.i '.'.'.'.'.'. 

wmua H. ritHtr, .. 
WUIlsn 1. lleI.A(i(hllD, 
Bslpb T, Plttoek 

W. P. Andrei"!!!;;!.'!! 

I. U. EdmandMn 

J. B. UcMlcbMl 


littlHtOWB, . 

FiliieM. ".'....' 
R»t B«llii. . 
Oetlrilnirs, ■ . 

BharHborr. ... 
Unltr Statin. 
PlltAusb, ., 





John a. Yolton, , . 

M. c. Sbubflrt. .. 
C. IL 1 

" ~ " —f, ■_■■- 


I. 0. 

0."2* Kntwi 

Township Health Ofiicen— Conf d . 

McKeca Roeka, . 



:«.\ :: 


I. H. Ullrd 

Albert ll»n, ^.... 

Hlnin llcK«e, ". 

1. Lewli 

W. ficolt BH^Bei, 

Dt, B. L. Smitb,' . 

ciiaTlea Walt. .... 
C. W. BnUtT, ... 
r. Ony BlTiiir»r, . 

, Pukpn lABdins, 

Mwrl* Spilx 

John K. todwls. .. 
Dr. Daalel Ud^in 
W. 8. Sleowl, .... 
I. W. Sebwiiru, .. 

Frank OirliDd, . 
T. a. BHtnrt, . 
I. mnk MintMT. 


. I«Dbirt>TlIle. . . 

! DooglM»TnV!!!! 


oflrlDff Spring, . 


Brad Card. ^ 

I doogic 

Township Health Offlcen— Coufd. 

HhIUi OMcef. 



g^Tgafe :::::::::::::::::::::;:::: 






















Oenri' 0. Loiett 

F. B. Wl»t 





L. L. Brown,' 


M.r. ■. 


H. 6. Hlndmii 

J. ■. Womer. 

w3i'!;-' '■■■■■■■■■■■■■■■■■■■■■ 

Uinj H«berlln« 


UbUod BerkeUle 


Jotm B. Mwen. 

D. L. OweoB. 

W. C, Perrr 

Robert Cowin 

John Kline. .?'^. . 1 . ^V^'.'.'.'.'.'.'.'.'.'.V.'.'. 










Bprtan^Mtm. 'l.^'.'.'.V.V.V.W.V.W'." 

8. U. Sinker 

8. R. Princli 

W. D. Port: 

a. M. Coon»r 


Irnuttori DeWin.' 

WlllUm J>"btnreiiyV/^\y/".'.'.'.'.'.'.'.'. 



S; S-. fc^SSS: :::;::::::;:::::::;■ 

S::3 i. K'-j::::::::::::::::: 

I. B. BaidviB,* 



Township Henlth Officers— Cont'd . 

Btaltb omeer. 








Co»l« {JefferWD Co.) 






Ouli.^; B. D. No- S. 


A. K. Zook. 


TowDBhip Health Officen— Gonfd. 



8t MarT*. .. 





Brockpnt, . , 

Nortb Olrard. 

8. a! Btwpc/. .. 


rnok Ooitello, .. 
A. H. PnmiiKt. 

Bt>r Jnnetloa. 
FareCM 0IC7. 


NonulTlllc. . 


Hombergtoo, . 
nmliiiitiHi. . 

Our T*B Hon, . 
B. U SMlft. .. 

W. H. Ibrk«7, .. 

Snlllc I McCoonellibarc. 

' I* P«k I NndmoR 

Jtttitr, Hknn 

. BtrlOD I CrjtUl Sprlni, . 

John L. Bl». . 

■ A. WIN*. 

. 3*l««, 

B. P. BmlXh lf»pl»t™ 

DC. J. a. Spu(l(f, Hmptclou 

D. B. QDKTr. ' KnlrikM 

A. P. Mcnwiln Rnntligfdon, R, I 

I. C. Tnnpl* I Pflenburc 

J. B. Irrln MQAlrrji Fort. . 

H. B. HonaMialjar OnfloD, R. D., 

D' J- K7I* '..'. Cturtor Oak, .... 

3. B. LibD«D, ' WiiTlots Huk, 

TownaUp Hulth Offican— Cont'd. 

Hc^th OBetr. 












j^nittj, K. i>. iio. i 




5ii.rrjfra^' H.' ii 



New CutiF, ii. b. No. i 

New aBlIlH, B. D. No. 1 

N*w Otatt*. U vi'lier W17. 




Township Health Officers— Gonfd. 

Heal a Offlccr. 



A Bowden 



I^^COOl Df. 

sUndj'ilfc'f "■ " 



^ " 




TownaUp Health Officera— Cont'd. 





PotUCCDT* (NgrttiDBbHUDd Co.). .. 





Koston, il D, No. », 








bSSKS.. ,...;.::;;:::::;;:::::::;:::: 







oww p. anj^tt,; 



B. F Aorud. 




Ht i^eWDt MIDI 

> Goot^lc 

Township Health Officers— Cont'd. 

Hoiltti onnr. 

D. K. H«h>t>tler, . 

OtTlU« Vikt. 

H. U ««ii 

CbarlM L. Bngl«, .... 

H. V. FmI*, 

WUlUm Lone 

J.' h; HeaU^ '..'.'.'.'.'. 

CslYln l^lCon. 

W. M. Qoba 

Dr. H. A.' ZLdim«niii 
K. C. Sb«inDk«,t 

j' B, 'Bird, '..'.'.'.'".'.' 
WlUltm N. HarrlKHi 

Uirry Goold,* 

1. L. Ulller.f 

F, W. Beebt.' 

C. L. Tyler 

Rldura Fonn.< ... 

L,*B.' WhltneJ."!!! 
T. B. Dlmmlck 

li. A.' HobbUw.'"-'-'' 

H. S. ConkltD 

F. S. OKcavHid, . 
H. C. ITQrui.T 

N'ltbaa tJIlM, 

J. W. Stulir* 

J. A. V»nil»ntl(t, . 
1.. G. Aoitln, ....... 

R. G. Horlcr 

P, J. Brtriw 

B. C. Howei\,"'.'.'.'.'. 

r.'w.'Otri. '..'.'.'.'.'. 
WllUim Reooftt, . 
Dr. B. B, Clnrt, ... 

a! Lk Kemp. '.".'. 

Dr. 0. a. JiiM|Demli] 
J. A. Splgflmrrr, ... 

1. R, McCDrtP7, '■■- 
1. S. McCnlfbt, ... 

A. J, Homnr 

a. w. nSie. ..:!!:; 

Jovrili Raliimuin,* . 
J. B. Orme. ....... 

A. E. BlDflctoB 

»r. O. P. SDjdcr, ... 

J. A. RMdlr. 

1. II. Cnvrord, ... 

B. t>. Howe, 

Oris E. Roofi 

rv'E: ;::;::: 

Willlum H. MinltbJ 
Ror n. HeDDwell, . 

W. u. NeuM, 

Dr. a". L. Bnnlon,'..! 
J. n. rb>inb«r1ln. . 

j'. A.' dno". .".'..; 
Jobn a. lAwer*. ... 

ObldH R. Wlllork. 
Dr. B. E. rnncb, " 

SiDd Patcb 


F.1rhope, It' D.'No.'i." 




Munej ^•"^' "■ 


N'ew HUCord 

Hallatead. '.".'.'.'.'.'.'.'.'.'.'.'. 



ij?ii, ..'..;;::"::::;::::: 




WplUlKin, R. D. No. I, 
Offdeiubun, ............. 


Welltboro." r'. ' ii! ,"!!!"! ! 
WsUhlaro, R. D. Nu. 2, 






«rnfM. ..'..!.'."!::!!:?;;] 
fraokKi', '!!:::!!:;;";!:: 

poiii. '..!!!;!!:!;!'.;!!!!.";! 
Oiwe citT 

rrmiKiLe™ viiii/.' ''-^i 



'Jrind V.IW 


CKOoatbort. '".'.'.'.'.'.'.'.'.'.'.'.. 

Mlltibont. '....'.,..'.....'.. 
EUiwortb , 






. . jafelnctso. 


Township Health OffiMis— Confd. 

Health Offlm. 







L*»fwood. n. D 


Bora'" Mills 

Dr. 8. Am» W.rt 

CbtriM B. Boyfl,' 

S'tSt ;;;:::;;:;;:::;::::::::: 

lAccblran (Arautroos Co,) 

^ZT'- ■■: 


Tnonellon (Indiana Co.) 

B*Ubl«iwn "" ■"*"■ ' 

W I 



rt-iM. H. 6. No. ( 




:- Smrtj CnniBd, .. 

W. F, BalllnnT. . 
. LcRoT UcntmiB. 

r. uforgc L. Rite, 

\ dame H. 8Hkl. . 

J. S. Cmwfwfl. .. 
U C. Crelghtca, 

r. A. H. E«fn 

r. 1. W. srigilcnlMrger, 

;. I,awlg 

5. M»l»r 

\ John MrAnlPj, ... 
'. millam 1. McO« 

r. I««K Wlllud. . 

r. S. B. AmbroM, . 

r. Rmcm DHDur, ■ 

r. J. I* Miller, , 

York SprlDfi, . 



Eut B«I&, ... 


N»« Oifo. 




Bdf*wood (PltM>dr«b|, 

Al «ffb«ii/. 



Norib Side, Plttabaqib. 
UcKee* Rocki 

S»Hii» (W«tnion 





BoTd B. SiiodgnM 


B. C. B™nb.»«h 



ed ord 

vd srd 
B«] ord 


f||a :;::::::;:::;; 







GMrJf W. r»hreiili«cii, .. 

C. p. Hert»e 


D. B. UrLnn 


H. W. Ban 

J- !■ SSK"' 


f^^:^- ■■■■■■■■■ 


J. U. WlltoTD 

Ctiirla D. Werlff. 

O. T. DindDli 

H SiF ■■■■■::■:; 

T. L. Wtlnon 

H. A. Wright. 

M. B. BalUrd 

w. R. c«iiiiibeii.*'i----i--" 







(\-8. M^. :::::::;:::::: 


School Medical Inape|foF--Contd. 





0. ^ SWtMU^ 















pS .;;::;:;::::;;;;:;:;;;:: 





tl M. Oarler 







CartWV- . I_ 



ti.'iKi^ ::;:::;::;;:;:;:::;: 

RiM Hdieh Chunk: ...::...:.::::; 


School Medical Inspectoi^-Ooiifd. 

, 000(^10 

Scbool Medical iDBpector—Oont'd. 




Dr a B ArDKDt 








K- ^ll^imVSifS 


School Uedical iDHptctor-^Goufd. 






Dr: M. M. EMAIn 

K' 1' c wSSito ■■■:::::::::::::::;: 


No th H.«t 

g?^^'°- :::■.:::;::::::::::;:::;:; 







WttU CltT 









n _ . , 


anriTiiie (P. 0. Btmr*i 


gf- j*-,|°„*'*£J' 

Saiton (Bfitma Comtj) 


School Medical Inapectoi^-Coafd. 








Studp G«p 


SKa .::::::::::::::::::::::::::::: 







V>11» Cr«k (OInriMd ci:) 




J ^ 


Fowst CltT (Husqaeh.iin. Co.] 

Df. T, H. irwlB. '. !" 


School Medical InB[»ector-~Goiit*«i. 












\ M , Bi » t» 


nr. W. U E«lm. Jr. 

aiitlncton, ..' 


Whll B>T«I 






Laat<».K ( .00( 

School Ucdictil Inspector—Cont'd. 






Mureer. " i!.:.:;:. ...::.:.::: 

Wnt Jillddiael 

B.^ atF«ulMMr. 




Nortb Wil» 



Scbool Hedtcftl Inapectof— Cont'd. 





W«T.rTiU( (Siiifried B. D.i 





Haiion HBlgtati (Ut. CanDCl). .... 





?S?,S.ia"r.Si'.- Si-.-:;::::: 




SchDjltll . 

Rchojim , 


IfcAdoo, .'. 


JiS'Si^ :;■■■ 

msS3S7'. :::::::::::::::; ::::::::: 

Scbool Hedical Inspector— Cont'd. 






BomnrMt. , 

lAcervlllB (W7«nliif Co.) 




Roarlns Btancb (Ucamliit Co.), .. 

III l== 

BlMBbOriV ■■■■^-■-- ■■■■■■■■■■"■■ "w: 




School Medica] Inspector — Cont'd. 





VfB ■ 


{?'■ *■ '■ «'=*•'{ 



WMh ngloa 

Wub Dat« 


Wstb D«[oa 
Wub nctoD 

Wub ngioo 

Wt.b D^tOI 


W«ih Dctoa 
WjMi niton 


Ws«h ii(t<n 
Wlib aKloD 
WB«b nutoa 



l!r B B ^GlTrttte 

Alle Mllli", 








School Medical Inapector— Cont'd. 

Dr. F. B. Hear;, 

. K. N. Lewli, 

t. MllditU, . 


. I. U. Porwer, 

I. Todd 

[. Wdmun, . 
■. wesni, ... 

. BardweU, . 

:. J. C. AtWni, 

■. J* R.' Brndbcck."!' 
■. W. I. Cfswfonl, .. 

O. HlIdebniDd, . 

A. Hoofer 

H. Bonlnrt 

Dr. B. E. Pbinipa. .. 

Br. A. C- Wenu. . 

ViBdnnltt H<Ut>t*i < 

New Aleundil* 

LigonieF^ ......... 

Hcrwlu {Apaiio)," 



WestmoreUi^ . 





North Hcta<»p«nj, 


ov Google 



StaU Reffittrar, Wilmer R. Butt, if. D., 
Chief Clerk, E3iner W. Rhler, Harrisburs, DanpbiD County. 
ClanrlScatioti Clerk, William H. BHees, Foleom, Delaware Count?. 
Retams Oerk, Eli^h B. Jenl[};ii, Tower City, So'bnylklll CoDDty. 
Stenographen— Miii Ernia K. T>ODEene:?ker, Middletown, DanpbiD Count?. 
Miu Lila H. Connolly, CaTlisIe, Cumberland County. 
Uisa Caroline S. Sprenjrer, Creasoua, Si^hviylkill County. 
Misa May S. Hope, Pottavnie, Schuylkill rx)nnty. 
Mrs. Ellen McK. Cboate, Bloomabiirg, Colnmbia County. 
MiM Carolyn M. Lindley, Canton, Bradford County. 
Clerka— Mrs, Bdith I>, M. Huber, HarriBburtc, Dauphin County. 

MisH Martha E. MtKiranngan , Harriahurg, Dauphin Coanty. 
Mias Marie B. McCalley, Harrisburg, Dniiphlo County. 
Mise Thereaa Neupert, Lewistown, Mifflin County. 
MIm Erailie N. Charteria, Norrlstown. MontRomery County. 
Miaa Margaret R. Eooney, Benovo, Clinton County. 
Mra. Amy Brown, Harriatiurg, Dauphin County. 
Mrt. Daisy H. Knhn, Johnstown, Cambria County. 
Miee Fannie McCamant, Harriaburg, Dauphin Connty. 
HisB Mary C, Kulp, Mtfflintown, Juniata County. 
Mias Carrie Ttsko Tunis, Harriaburg. Daapbin County. 
Miaa Helen Sloat, Harriaburg, Daupbln County. 
Misa Bdith Snyder, Pittaburgb, Allegheny County. 
MisB Mary A, Cleckner, Harriaburg, Dauphin County. 
Miss Florence B. Dyer, Harriaburg, Danphin County. 
Miss Alice Hepford, Harrisburg, Danpbin Connty. 
Charles N. Fry, HarriahnrK, Dauphin County. 
Intpector— R. J. Brauner, Carlisle, Cumberland County. 


Local Beglstnr. 

po.t on 

fa Addren. 








r^uss'"^' ■ 

Hew OlCont, ' 
York SpriM.. 

Dr. C. L. Mrtn 


Local EegtatparB— Cont'd, 

'. Obarica 0. Halt, . 

Idwun] Feltoo 

O. MeDiTltt. 

I «., 

. I UomatMid. 
. . Domoot, ■ . 

. w«u 

• ISewlckltj, 

W. A. nibMB. . 
L. R. Sprawli, . 
T. J. llffilM. ... 
Bobart 6. Wllion 
~ "tK. EW*r. 

Dr. P. D. I 

:* M. n™™ 

[, jM-tler,". 

Pred 8. I 

r. J. P. I 

I Dipn 

JtiDH A. PHter, , 

J. Onl. n<>iiT(r, 

Turatam, - 

Rait Mckceiport, 
Eut Plttr- — - 

Braddodl. . 
RtwIcMer, " 

Alllfoo Park, 


Pnnl city!" 




Corhnn Ulllii. 

ro^nniivllle. It. D. I«i>. 1, 

' AnoatTODr. 

Local B«gia(r>iB— Confd. 

Local Beslitnr. 

Port OflU™ Addreu. 


















Thu #^eu' 

Uargetlttown. B. D. Ho. I "t! 


Comberloiul Valiej 



atmy R Bbertr 

T. P. Helu. 

jHntauf .,"'....::::::::::::::::::;::: 

wmi«in»biiic,'"'!;;:;:!;":;;: :;.■.";;.:;: 








i ?i^ 



Local ReKistran— Cont'd. 

L«*l Redttnir. 

P«t OBoe AMru. 







- , 



Dr. iL r. wKiSi.-:::::;::::::::;: 


ass ..,T^ 

Local RegiBtran— Confd. 

Local B(«latnr. 

Mlw AllM P. Tkt* 

Dr. J. B. a. AUIfoo. 

W. H. HolMr 

P. H, Banpt. 

Tbonaa O. Uccin^iimii'," 

Ixrlat I^ FoaUr. 

B. W. Sb^lu 

W. A. SIckel 

J, Frank Rernolda 

WiUlBm C. Ulckej 

Dr. B. B. WJIUauu 

Dr. H. V. Feanell 

8. U, LenmoD 

Jo*. R. auleklmd. 

F. I. UacDoBiilil. 

Mn. Bmiu R. Boltmui. .. 
Suancl Jackaui. 

Dr. J. C. llnrtiiBiief 

Dr. 0. B. WoKlmnl. .... 

Anxntu YuBBll 

M*arl« 8. Lord 

Dr. U. H. UMla 

I>r. <;«Ttn)d* Iawho, .... 

Dr. R. J. Oreor, ".'.'..'.'.'.'.v.; 

F.'C. CorlUtt '■'...,. 

Dr. C. W. HoDiuii 


/.' J.'wrtK. .:..'.'.'.'.'.'.'.'".'.'. 
WllUiim B. JooH. 

W. P. Gtf, '..'.'.'.'.'.'.'.'.'.'.'.'. 

O.M. B*™|l* 

Joiin ScDlllaa, '■ 

8. K. Aoei, 

8. C. Kirk 

B. H. B.U, 

R. C. Ifarkl* 

Adim Bretb 

W. W. Boom 

oiant J. Weber."!!!!"'!" 
J. S. UrKee 

F.'w. ouiiunit. !!!!!!!!!!!! 

lira. BIlititMtb McDonald, 

Z. H. Peten,* 

O. K. Ulller, 

8. W. Oudur 

J. C, Warner, 

J.'Br"liher, ...,'..;;.'!!!.'! 

A- G. Catbonn, 

Mr*, raxe B. fllou 

C. L. Hlrleman, 

P. L. Klaae 

W. 0. Vooibt, 

■ Solwrt U. OnlUD, 

lUrr WtKh. 

SoDimlt Hill. .... 

weiaiHwit.' !!!!!!! 



Otabt HaU 

HiiHtmri. '!!!!!!!! 

FtaUipatnrsV' !!!!!! 


SUI« Collet* 



CwteaTllle, '*!!!..'.' 
DownlaftDvD. .... 
Honef bjook. ...... 

Kannet't B^un," 



SprlDf CItT 

Weat Cheater, ... 

Weat Grort, 

POttllOVD. R. D., 




Knoi. ".,.■..!!!!! 

Mew B«ttalebem. ■ 
No* BoUiletaam. . 




OrtrnplaSr', !!!!!!! 

latuiffej, .^!..!!! 

New wiaiiiii'^mV 

TrontvgiB. '!!!!!!!! 

Morrladale Mine*, 

PeDOeld. '...!!'.!!!! 

Beeo'h c™k,"'!!!!! 

HiS'Ha^, !!!!!!!! 

lock Baren 

Berwlek." "!!!!!'.!! 





Local R^ifltrars— OcHifd. 

Local Begtitnr. 

Poit Oa» Adaren. 



D B J DIekw 






0*mi> Hill 











a T UacFuiMd 



iKsr .°^:..::::::::::::::::::: 

Jowfi)! B. Qnlnln',* ..„ 



Bhtnjn HJll 


[^XS..''fe: :■:■■■"■■■■■■■■■ 

nrandjwint SnmntE 



Local K^jatrara— Cont'd. 

Loal Bcflitnr. 

Pint Offlce AldnsL 





B 11 ™n 






C. H. RntHniii?, 



n inob 

H tlniiT 


..uiSS, -.,.,. 

Local R^;iBtram— Oonfd. 

« T. 8tnl«, 

T. U. CiniilUD, ■■ 

Cb>Tle> B, Finit, 
}. Cllrk Bpecdr,* 
Bllitui Or«en 

I. U. TbamMOD, .. 

Drfw. W. Oiiilerr. 

F. T. Slockdeie 

Harrr Trnnuii 

Dr. J. FcBnk Baloe. . 

w' KBtSitr'.". 

Henrr B. Cleppar, 
C. O. Rmh 

Jtaib B. tvlof.". 
Dt. 1. S. Beamcud 

Jobn ' E. HoDh'.' 
Dr. J. A. Hoffmsa, 
J. AUin Kirk, .. 
Dr. OForie B. S( 
Dr W. Q, Btokltj 
Dr. J. U. Shartle, 
Wlllbiin B. UkrtU 

Pom Oflk* Addnu, 

Jitnes OiMk 

Rockklll Piiruc«, ... 
Three SpAiif* 

KcAiBTM Kfft; ■;"! 



Kent. !.!!!!!!^!:ii!! 

Mlriiw Outre 

SalUburt, ..'.."!!!!! 






Brook^I^' ?'...'.'.'.". 
PunxBDtAvnflr, .. 

IVeM RnMldiTiUa," 


P«tl* Creek 

Nortli Point, 



ElHt wilertord 

PerkTUto', '.'.'.'.'.'."'.'.'.'. 



Moamw,' .'.'.'.'.'.'.'.'.'.'.'.'. 

FtctotTvuii, ".'.'.'.'.'.',','. 

Uwilc. '..'".'.'.'.'".'.v. 


Old Forge 


Wavwl-r.' .'.'."'.'".'.'.v. 






Mmnt ioT','".'.'.. 
New HoUend, . 






Local RegiatrtirB— Cont'd, 

Ltttl BttKtnr. 

P«t Office Addnn. 







D«"«». --■ 

Plrnoiu ! 

Lt Inc 




rSTihSi-r'!??:..;;;:: :::;:::::::: 

Mwmt 'iei^ 


Local R^istian— G<»lfd. 

IflMl IWftatrmr. 

FMt OOm AddKtt. 








' ' 




11 Hf ::;;:;;::::;::;::::::: 


GrMD Lana 

Houtli l{>tBeia, 





-I Pen Argjl 

'.\ TUmmj 

!j wind Omp 

! Wtlnooori' "'.'.'. 
.1 Soutb BcthUbea 



Locsl Regiiitran-<!ont'd. 

Local Rcglitnr. 

Henrr B. VoMzioM, 

N. J. StelahUbtr. 

F. H. 8(«tl«r, 

0. B. W«DU 

Dr. J. A. Cllncer, 

F. W. HoDhun, 

t>r. StoddiTd S. Bttg 

B. B. Blnl 

T. O. BoberCi 

5.7. Hwkcrt' '.'.'.'.'.'.'.'.'.'.'.I 

B. I.. IJODS, 

Dr. W. B. Autb 

D. B. ItaDm 

Dr. J. 8. Unnl 

Onxte P. BeS 

SinbenH. KeU 

D. C. Kcll 

D«tM Bora 

D. B. Dromgold --.^-. 

Aaum A.Ober, .'..'.'.'.'.'.'.'.'.'.'. 

B. A. Joliu(m, 

Qcorft W. Atbcrtiolt.' .. 
N«T« E, I>B«nlorir 

JohnV. KOMbi, '..'.'.'.'.'.'.'.'. 

a«>r» W. Stcnier, 

B07 li Orvutt, .-.....-.--. 

B. M. DicUoMO 

Pomer K. Lana. ^ 

Bonell WIIhh 

r. P. NletoH 

Un. Bmnui B. Oo(irtii«lit. 
rnd H. HnoH 

I(riin F. Dene* 

1. W. Bmlth, .'..'.'.'.'.'.'.'.'.'.'. 

Uaarlca H«7wc»a 

IcbB 3. Uonia 

Dr. W. J. Monuluia 

W. 8. DnnnhB^r, 

Dr. I., a. WtttoruB 

Jiiut H, KlRtanir 

J. SUmd BuKt. 

Jotm H. PhUlH, 

P. 8. OuOtld, 

Dr. Ost.. B. lAibwsw 

W. H. Bdnrdi 

h'sitt W. Buiti, '.'.'.'.'.'.'.'.'.'. 

O. W. Rankle 

Dr. B. J. Bcrliala 

C. A. liner. ...l.."""" 

Thomtoa H. 8b»t, 

Imlf R. Uttlc, 

Vt. 3'. W. Schilti,""!..i!ii 

R. r. Hartnun 

Rktiud Q. Bdwacda. 

Ow Hnbler 

W. P. Hon 

H. H. OiBKn-. 

Dr. R, J. Hafflej,* 

One* Bufl* 

H. BeU VdOMT. 

Dr. V.a. llonnUIn 

Dr. R. T. Pnliud 

IttIlP. Don, 

4— 1&-1916 

PMt Offlct AddiH*. 




anfduMwn. ■■ 


Hendon, . 
P. O. K«b 



MorravUli. ' '.'.".'.'.'.'.'.'.'.'.'.'.'.' 
Nev Bnllilo, '.'.'.'. 

PhllKdalpbla, Oltr Hdl. 
PblUdelpbl*. dtf HaU, 


Cnm Fork'.''.'.'.'.'.'.'".'.'.'.'.'. 
8talDiIe B«i» 

Ronlette. ' '^' ".'.'.'.'.'.' '.'.'.'.'. 




SbhanoT PlAoe, ........ 

1« nfllDffruie," !!"!!";.' " 




New RiDgcMd 



Pine Qrore. 

Port Cirliaii 


St. Clair. 

ScktU'tklll HiTcn. 

iwer citj.";:::;:;!"::: 

sbeppton !!!..!!!!!! 





BcbnrlkU . 
Bchnxtkll . 
Bctawikt L 
HchDTlkl . 
8chDr1k1 . 
Schnrlkl . 
Bchnrlkl , 
8<«Drlkl . 
Scbnrlkl . 


Local RegietranK-CMifd. 

Lml B«slrtnr. 







Uttle UfOOK* 











fc.B.V'paSW ::;::::::::::::::;: 

b, Google 

Local B^ietrftrs— Confd. 


P«t Offlee AddiHi. 



We.t BrowMVlUe. B, D. No. 1, ... 


















Local BeglstTMB— Coafd. 

Loaa Sctlwtm. 

POM OOloo «ai««. 

















gn. 5; Sit;:::::::::::;::::: 


Director of Laboratoriet , Jamn B. Rucker, Jr., M. D., 
Lansdowne, Delaware County. 
Bacteriologist, Alexander Garcia, Philadelphin . 
Pathologtet, Frederick C. Narr, M. D., Philadelpbia. 
Technical Asaistnat, Herrer L. Bate«, M. D., Gennantom, PhBadelphii. 
Serologiat, Henry M. Wise. M. D., Philadelphia. 
8tenographei>~Mls8 Dais; B. Gery, Philadelphia. 

MiB« EsteUe L. Hecht. PhUadelphia. 
ClericB— Hn. Mary Q. Aodreea, Phlladdphia. 
Mira Aioy E. EnKelbert,* Philadelphia. 
Miss Etbel Miller, PhiladelphU. 
Miss Erma R. Staley, Philadelphia. 
Hiu Margaret H. Coombe, PbiladdphlB. 
Mlaa Helen Gunderaon, PhUadelphia. 

ov Google 


Helper»— I.«OD J. Ban-U, Philadelphia. 
Calvin HariiH, Philadelphia. 
Andrew Keenan, Philadelphia. 
Lewis Brown, Philadelphia. 
Miu Boaalie H&iria, Philadelphia. 

'Besigued . 




Uedicallntpeclor of DUpentariet, 'Tftomai H. A. Btitet, M. D., 

Scrautou, Lackawanna Conntr- 

Karl Bchdffh, M. D.. fActmff), 


Deputy Medical Inipector ot Dinpensariea: 

fEd«-ard B. Shellmberfccr, M. D., Warren, Warren Connty. 
Frank P. D. Reckord, M. D,. Harrisbiirg, Daaphin GonDt?. 
Lecturer and Manager, Tabcrcalosla Exhibit— William C. MiUer, H. D., Bedtoid, 

Bedford County. 
Statistical Inspector— Perclval Herman, M. D., Krntzerville, Snyder CotrntT. 
Chief VisitiDg Diepenearr Niirae— MIsa Alice M, O'Etalloran, PUladelpIilE. 
Aasintant Chief Visitine Dispensary Nnrac — Miss Margaret 0. Paraona, PhfladelpUa. 
Stenographers—Miss Olive E. Jamlaoa, Ingram, Allegheny OotintT. 

Miss Florence L. Plyte, Willinmsport, Lycoming Oonntr. 
Miaa Margaret McGanoon, Punisutawney, Jeffernon Coontr' 
Clerks— Mrs. T.innie K. Hiestcr, Harrishnrg, Danphln Conntr. 
Miss Anna M. Hartley, Bloomsburg, Columbia OonntT. 
Miss Alma O. Ernest, Mifflintown, Joniata Gonmy. 
Assistants with Tuberculosis Exhibit: 

Willinni M. Colvln, Bedford, Bedford County. 

Ulsa Ida J. T.,o<;kett, (Nurse), FrackvUle, RchuylhUl Oonntj. 

'Appointed Medical Director of Hamburg State Sanatorium. tRetlred. 

ov Google 



buifi!, tUccesBHl. •llctlred. |Tru»f< 




».„. „. c,^ 

tUlH Flonncc UittluwL 


:MJ»« Jeuit- Q. B»rei«r. 



Dr. B. M. Binpbnrt.C 

t» N. C. .V«lM. 

m I^oreni Bofd. 
!■■ Ellubetb Uolmei. 

Dr. J. H. SlccifOi 

Id LonlH E. KhoK.* 

UlH Mirlorie Slemrt 


Dr. J. W. e. ElleDberger, .. 

SI: fw'-.a"'" 

Mlu Nan p. Hunt 


Dr. J. M. McNall.O 

Ulu OeMmde H»1L. 
MlM Blanclie MmWhlBwr. 


Ulu VloU C. Lawoon. 

Barer FWl 

Dr. Bni™ H. SotBjgrsJiii.C .. 

tMlM Alice U. Mkel}. 

tUI« Allfl, M. NWU. 

Dr. W. it 1. M. imi.C .... 

tMlxa Uirr Salllvu. 

Dr. Thomi. H. A. S<H«.,C 

Ul» Bll. B. Ile«]. 

Ur. IBHU-I Clf»Ter.C 

Dr. ClurlM V. Uenij 

Dr. W«ller II. Bertolel 

Ulu Anoa U. lafferlj. 



UlK* I. Uat Wharton. 

Dt. W. S. Unner.C 

(m;.. Fnnrei Swop..* 
tMlM Ua;tne P»c». 

Dr. T. BeD JoIidhui. Jr..C 

%T. ^.Vl^"lthn».n 

Dr. J. d* fl. AbbotLC 

UU<. I„ Glllkk. 


Dr. I. 8. Plrinlr,-.0 

tMlM BU«t»(li Blltert. 

Dr. n. D, Uoclconbcrn.C 

Ulo Kxe Bradf. 

I>r, W. 0. Tumbull.c 

Mi« rii», c. Aiu™. 

Ula> Nell Uorptar. 


T. W. B. M»lthew.,C 

as K-s;s„™-- 





Nnne* ud Otoiki. 



tMim Bdllh B«tarr 

MlKli Cliimk 

Dr. B. Q. Bni.C 

mi— Ada Bl>tw. 


as sss S.J™-- 




Df. ■, A. G«y«,0 

Wte Oertnoa Kup. 

W«t Cbealer, .... 

una a«tro<]> BsDp. 

in. »■■. P. pmmji.o 

Dr. 8. C. Ste>inrt.C 


Lock HlTCD 

Dr. B. B. W.uon.a 


Dr. C, I. Fnllner.O 

Dr. B. B. Araent.O 


Wlw Uanuat MFlUbon.- 
mua Bmma Wttt*.* 
UfJu Aou PrmtHer. 

dI. if. itsi^^t: '.:..:::. 


tUlH Anna Qrsta.t 
till.. a.» A. croak,.' 

^l- flier-"' ;■: 


Wot nimew 

Ur. H. B. Blrtloie.Ct 


Dr. P. A. Hurtmso.Ct 

Dr. C, R, PhLlllii.,110 

1 1; 1. S&.x-i!;;; 

ill °S: i\Ss:^'E 

Ub Satharisg HlUtr 

Dr. J. A, KalMr (Olerk.) 


Ute KaUiiFhie DoiinaMr. 


^- i li JT*:°. ■■:■■■ 


tUlH Sdhui HcVedr. 

rvttf. ..■-..... 


Dr. L. N. Belchsnl.C 


Uflia Mary AUtB. 

Dr. 0. B. Altnun.C 


Ufla. Ifarr AUan. 






NurHH ud Olttkt 

Dr. H. X. ItoDbnka.Ot .... 
Dr. Ptal P. AUen.AO 


mim nofme. HttHwn. 

— — — 

-p -J ^ J — ■ ■ 

Imim J 1 m i 


Dr H C FtMO 

Ula JBIU BLiek. 

Dr. W. A. Slnip»ii.O 

lUIu Cirrle A. HenwL 

till.. CBirle A. HcDKl. 


Ula BlM ADker. 

D,: lo/n^Sii^::::::::: 

aOM Alice M. Cbobb.* 

gJ: k ^.k^iK^-.?..:::: 

MlS cS55U^B.^lw.,wr. 

gf- ss-Sr^r^- ■■■•■■■■ 

gU,£;5«tt:j :::::::: 

UUb BKIe HitOeld. 

Dr. J. U Vowen.C 

iSis g:!? ?"a''.',i-,M 

Mln Janet Landl* (Clert.) 

New CutU 


SIS as'" "s MS''' 

Dr. B. BL uaViir. ...'::::. 



MlH lbrl« OMd. 

Dr. C. B. Bnuutt.O 

MIM Bntlu M. Mot«ui. 

ii!:'i.VSsr° :.:::: 



Dr. R. h. WidUnK 



WUlli import 

RE "..^SSET-;" :::::: 

Mlu Annie Odfiiud. 

K' wdPpf""'^* 

tUlH Sin A. Onoki. 



tMln ADO. Pr>tb«. 


l>r. C. H. artabin.O 

Hlaa H. L. Felker. 


Dr. W. K AneL.O 

tUn. hat P. IftUw. 







Hdtki IDd Cllriti. 

HostconeiT. ... 


Dr. A. H. DaTl««i,l3 

FlwHi™ Peter 

I>r. W. B. Itmeson.C 

tMI» Ellubelh eilkert. 

Dr. H, H. Whltfomb.O 

tUlB Ulilin Brown. 

K: a.i™"S'.iS,o ■:::;:: 


Dr. A. A. Bflem.O 

Dr! W, P. ■nmrniiMi,"!::!! 
nr. W. H. Mcnhinej 

Dr. W. D. CbMe.O 

UlH Kitbarlne B. I^ncb. 


Mt. C«ra«l 

Dr W. T. WIDImnp.O 

Dr. T. L. WlUlimt 

UlH Emnu H. ClMnence. 

SIS SKS'.'i.'wr.r 

Dr. R. H. BiDiDHii.O 

Dr 0. M. Mulonp. 

Dr. J. B. OrpMln»«r,0 .... 

NnBlooufleld. ... 

nn«4elptta, .. 


n'r F- 1 T'^b*-" 

MJ» M.r7 A. Dojfe. 

Phlladalptilii. lew 
PopUr et. 

Mi« M""^"! a- "y^- 

uIh m"t "a'^'fl/iilrle 

dJ; ni't's 1,^^^: :;;::::: 

Dr. I«» H. Jonei 

UlH H. CUlr Bmno (Clerk) 

8. anil St. 

Dr. a. J. Hrppllfr.O 

Dr. 0. M. Moiuotner, 

UI» H.QD.h p. Ontbrlc* 
IH I«i E. Tiiuler. 
In BTH/n prr. 

Dr. A. T. MeNeniei 

1.. Jfary B. W.l.r 
t ni. Floreocfi Peter. 

UlH Agnn Sonder (Olei*.) 

H. 0. 

Dr. H. H. Articroft.O 

3. 0. 



Dr. I,. T. Kmamj.a 

Ultn Clan Kantner. 

Dr. J*m« B. -atf\]^. :..": 

SJ: ^.- ^^■^^..:v.z-: 

Uln Veronica D. Kiuke- 

UlH Lney Sbeetar. 


Dr' FVwi'b. H™ln5t*C '-' 

tUlH Ada Blel«. 

Dr. H. r. Wie*iiK4lpr,0 .... 

tHlH Marr a. Connellr.* 
JMIM ElOa anrbDI. 








Nuns taa Clnk,. 


Dr. P. Q. BlddU.0 

tMlH LOl. Llll*r. 

ain. ClOBHitlu TinAnkn. 



Dr. 8. P, Bikei.C* 

Dr. C. W. W>U),.AO 

H. O. 


Dr. C. W. W«bb,AO 

H. 0. 



Dr. H. F. UcDowdU.C 

Dr. J. P. StnT«r,C 

IHlH Anu Qnf*. 


Wiihlnttan, .... 

Dr B W^O 



Dr. E. M.«t.C 




Dr. I^ B. Nl»lMD,0 

MllM Allcf U. GbDtiii.* 

Dr. I. M. Port«r.C 

UtJH C*»llii. Kllu. 

HE. FleiHDt 

Dr. M. W. HoTDcr.C 

tMlu CinlLiie Kline. 


Dr. M. 1. Cnmer.G 

UlH Ihrle Witn. 



Dr. H. L. McKowB.C 

HlH J«.Le L. Boa. 



"ibdT "" "^^' 

E: Si'SS? 

UlH Mini Keller (Cleft.) 

R: 7; °«.'Sn£..; ::::. 

Dr. B. P. Pirkrr. 




ITedtDoI Director, Frvd. C. JohntoH, 11. D., 

Bradford, McKesn Cknmtr- 

D^mtr Mediod rHrector, John Berry, M. D., Philadelphia. 

First AMtetant Phrsidan, William T. Dnvleii, M. D., Bradford. HcEcan Oonnlr. 

AsslBtant Phyalolaiia. 

JOKph AaroDoff, H. D., PhllnddpUa. 

Hmry A. Carskadden, M. D., WUliamnport, Lypoming Conntr. 
Oeorte W. Farquhar, M. D., Pottmille, Scbaylkill Conntr. 
WUllan) U. Gay, H. D., WindBor, Venaont. 
HpDrj A Gorman, H. D., PhDadelpbla. ^ 



*Samuel C. Jaspan, M. D., Philadelphia. 

Joseph A. Stockier, M. D., PhiladelphiB. 

Samuel A. SUk. M. D., Phfladelphia. 

Hennan Schlnff,-M. D., Philadelphia. 

Thomas A. Stcvena, M. D., Baltimore, Maryland, 

Leon J. Tunitxk;, M. D., Philadelphia. 

■Edwin H. Vender Slice, M. D., Philadelphia. 
ConfiultlDg SuFgeoB, George B. Knukel, M, D., HarriahnrK, Dauphin CouDty. 
Gonaulting Laryn^loKist , Gharlea Rebuck, M. D., Harriaburg, Dauphin County. 
BacteriologiBt, Elmer E. McKee. M. D., Phaadelphia. 
Druggist, Robert K. HemminKcr, Carlisle, Cumberland County. 
Superintendent of Grounda and Building, Jnhn H. Patterson, PhUadelphia 
Clerk, L. Walter Garrett, West Chester, Chester County. 
Stenographers— Miss Mabel C. Johnson, Harrisborg, Dniiphlo County. 
Miss Jane B. Kenyon, Carlisle, Cumberland County. 
"MisB Nelle M. Kissinfrer, Carlitde, Cumberland County. 
Sanatoria Statistician, Miss Anna Ij. Hiirt, South Bethkhem, Northampton CountT. 
Steward, Louis Sorg, Chambersburg, Franklin County. 
Storekeeper, Harry Kunkel, Glen Rock, York County. 
Matrons — Mrs. Annie M. Klee, Cbnmbersburp, Franklin County. 

Mrs. Annie R. Yenger, Chambersburg, Franklin County. 
General Foreman, J. T. Stnlcy, Fnyetteville, R. D., Frnnklin County. 
Mechanic, Arthur Yeager, Chambersburg, Franklin County, 
Head Nurse, Miss M. Agnes Lowf-ll, Lnncsster, T^noiiRter Cflnnty. 
Head Nurse at Hospital, Mifa SInry A. Weir, WiJkes-Barre, Luzerne County. 
Head Nurae at Children's Hospital: 

"Mrs. Laura B. ClenTpr, FJysburg, Northumberland County, 

Miss Catherine I. Cobb, Scrantou, Lackawanna County. 

Augusta Buhl Margaret Heslin, 

Grace Bailey. Onroline Hall. 

Frances Black. Mary S. Holden, 

Hilda Boyle, Kllen J. Hughes. 

Sarah V. Burkert. Helen Kenney. 

Eleanor C. Brooks. "Viola Kennedy. 

•Margaret M. Bell. Catherine Kann. 

Dorothy Carter. F^na Keefer. 

■Olia Si. Cooper. 'Alma I.utz, 

Anne D. CockeriUe. Vinetta T>. Larson. 

CatberlDe Cadden. Florence TS, I.^skowBki. 

Anna Cummings. Nellie Lynch. 

•Maude B. Clark. 'Eleanor E. Lehman. 

•Mary B. CUver. Elizabeth A I^rrah. 

Anna L. Dowling. Ella McKeon. 

■Margaret I. Doolan. *Ci. MrNemey. 

'Anna M. Dunleavy. "Anna M. Morgan. 

Cnihcrine B. Fitstgerald. Florence Magdeburg. 

Helen Gibb. 'Hr^en Mflguire, 

Ruth M. Greer. *Anine Monck. 

"Mnreoret Haakell. .^Kues D. Mar<nis. 

Broide Hughes. •Lillie Maxwell. 

•Ruth Hicks. 'Anna E. O'Neill. 

> Google 

•A. M. O'Dwyer. 
"Mollie O'MoraD. 
"IwOoiBe pQtteraon. 
•Mary C. Vam. 
Eliinbeth Price, 
Edith Peightal. 
■Jennie PhlUips. 
•EUsabetli Rupert. 
*SueRQ Stewait. 
Ethel Storrett, 
Eflta Stewart. 
"Edith B. Smith: 
*MaiT G. Silk. 

'Charles Becker. 
Sarab Bratton. 
F. C. Buck. 
*Edna CarbauKb. 
'CRtberine Clark. 
"MnrLi Ciumc. 
•Sophia Cresnle. 
•Anna Chilcot. 
•Elizabeth Fralldi. 
•Fapnle R. Grovet. 
■Eliwibeth Gill. 
Mnra GnrbaczeHka. 
Anna Hutton, 
•Thomas Iveoon. 

Ella Adama. 
•Rnth BaEer. 
Jane Baker. 
Ida Bamea. 
Pearl Benachoff. 
•Lillian Baker. 
'MaiT Beck. 
'Blorence Beii. . 
'Anna Baka. 
Eliaabetb Bolton. 
Margaret Bolton. 
•Bella Baker. 
Martcaret Burkert. 
Kathnv Bovman. 
•Mariel Dincan. 
•Grace Dmui. 
■Esther Dillon. 
•Isabel I>iinbar. 
•Re rah Dunbar. 
•Eatella D<dl. 
•Helen DeOoor, 
•Irrae Dnnkelbenv. 
•Myrtle Ealinser. 
Ida EdlniN. 


Ella Singles. 
'Blanche Siufineere. 
ilnry Verdier, 
Adu Waiha;. 
Lydie Williams. 
Margaret M. Ward. 
PhyUU Williams. 
Mary Wilson. 
•Kathleen A. Wilson. 
•Mary E. Walker. 
Etta E. Xander. 
•Eliaabetb Zimmer. 
•Elizabeth Zortmnc. 
Laundry Help. 

■Sophie Kresuie. 
■Pauline ICrasnoslika. 
•Mabel Mathewaon. 
•Siflta Mitnet. 
Enn Panaeazyuk. 
"Albert PowderhUl. 
S. H. Bhoads. 
Kjjda Stryezka. 
Lillian Stout. 
Jamea Stoley. 
•Nellie .W. Singlet. 
Anna Tdlczuk. 
"John C. Wurflein, 


Evelyn Ewing. 
Mary Ewing. 
"Catharine Etnoyer. 
'Jennie Eveland. 
Margaret Fiaber. 
■Lottie Funk. 
JcBBie Fetrow. 
•Emily Praim. 
fiertnide Farrldy. 
'Catherine Groiner. 
"Hplen Gehring. 
•Aldn E. Gnibb. 
•Laucetta Gregory. 
Esther Hobday. 
Margnrpt Hacker. 
Bertha HaU. 
•Nellie Hall. 
"Mary Hurd. 
LilliaD Humphreys. 
Harriet Harris. 
Mary A. House. 
Tillie Heisbley. 
Mary Hall. 
Mary Hill. 


No. 15. 

Ethel HiU. 
'Mattie Howurd. 
*L>;di& H. Jones. 
*BeniBdeiie Jacoby. 
jlertha KauSmcn. 
*H«naeiua Katosu^. 
'ItoBC Kntotdck. 
■Mnrgaret Keller. 
•Uaiuy Kyle. 
Lnlu Lowrtj. 
"Ora Leonaid. 
Vioia IjQwrey. 
E'loreoce Lehman. 
Irene Luckenban^. 
Catherine Martin. 
UniT MiMrae. 
Tillie Mnurer. 
"Mjiry MnthDer. 
'Ada May. 
■■Mary Motter 
Daisy Miller. 
Flcda MartiD. 
Marian Matchncn. 
Nellie McCann. 
■Mary McMackin. 
'Hftbel McNamee. 
'JoRephinc McDermitt. 
"Agnes Nitchman. 
Irene Nye. 
MEnerra Nye. 
Ailcflna Ottenberger. 
•Bridget O'Oara. 
•[.illian Oberdlck. 
Ruth O. PhiUlpa. 
Mae Palmer. 


Muriel Pittenger, 
Anna M . Palmer. 
■Alaiua Quickie;. 
'Roae Bodgers 
'Florence BobiuBon. 
•Frances Ujan. 
*.iQna RobinsoD. 
Bessie Kosenberry. 
■Mirion Sundy. 
'Bertha Slmms. 
"Louise Smith. 
Virgie Steluberger. 
Qrace Steinberger. 
•M. E. Shataer. 
"EUen Smith, 
'lliirgoret Sp\irrier. 
*Qlla Strouse. 
"Mildred Seilhamet. 
Mabel SeUhamer. 
'Emma Seilbamer. 
'Flureuce Shanjfeltier. 
Mildred Shart. 
■Nettie Snyder. 
Louise Tolaod, 
•Anna E. XJhrfch. 
'Margaret Weibley, 
Hilma Weeklcj. 
Laura Weekley. 
•Evelyn Warren. 
Beryl Warren, 
■liertha Weibley. 
•Edith Wells. 
Helen Winicert. 
•Rebecca Wellla. 
•Pansy Teager. 

'DorMto Alterl. 
•Joseph Altierl. 
"Victor Adami. 
•Dominick AntondU. 
John Brett. 
•Joseph BnroB. 
•Harry Chase. 
'John Carr. 
WHliam Campbell. 
■Tames Cincinnato. 
Michael Doheney. 
William K. DransfieM. 
W. J. Duffy. 
Alexander Derenney. 
Ocoree Reltherd. 
William DeKraR. 

I:'<dirick Kozmicrick. 
John Koch. 
Patrick KeUcy. 
•John Duffy. 
•Nathan Empole. 
I^eroy Foley. 
•James French. 
Norman Franklin. 
•Jameo Flannlgan. 
"Benjamin Feldman. 
•John UcntHe. 
Edward Rillespie. 
•Andrew Hertcom. 
"John C. Hagger^. 
Hogh Johnson. 
•Edward Kelley. 

ov Google 


ChnrleF Maybue. 
•Ocorge Maaspeaker. ■ 
Cliarles Moore. 
'Stanle; J. McCunner. 
John Koprowske. 
'Charles Mdleo. 
Joseph Mulligan. 
•William Margolf. 
Joseph UcDoDAld. 
Edward McKeoo. 
Cftri Ness. 
•Grover Noon. 
Willinm O'Donnell. 
Gez Palchak. 
Antonio Perniche. 
•Willinm Riblett. 
Joseph Bipley. 

'Milton Ruth. 
'Harold Hcmington, 
'George Reid. 
•FmDk SchinJdgall. 
Joseph Sanatonics. 
•Joseph Senko. 
Jamea Squtllace. 
■Wiliinm SetUes. 
John Schulte. 
'Thomas Smith. 
"Adam Tolocsko. 
'I*on VnnLacken. 
•William WEstwater. 
Horry Weiss. 
'Jamca Walls. 
•Edward Weekley. 

'DeMie Rrunton. 
Margnret Bdrbour. 
'Harriet Bryant. 
•Helen Roland. 
Aliae Baronl. 
Sarah Bramer. 
•Bridget Connors. 
TUIie Cook. 
Mabel Clifford. 
•Mary Conway. 
Tjetbia Cantlin. 
•MoUie Chester 
•Florence Defibangli. 
Edith Davis. 
•Mary Dwyer. 
Mary Dank. 
Mary Davlea. 
Mary Doheney. 
Edna DuCEy. 
'Cnrrie Esrey. 
Gertrude Eberenie. 
Elizabeth %ater. 
Pearl Fox. 
F.dlth Friel. 
RoKe Fields. 
•Miiry Fprgiison. 
•Berlhn Fowler, 
•Mnri" Frabfelder. 
'Florenre Haberstroh. 
Annie Hnrdtck. 
■Antin n.nwk. 
•M.Triiin Haberstroh. 
"Minnie Hnfner. 
*Anne ITolTman. 

'Ida Huber. 
Anna Hirs. 
'Marie Johnson. 
Helena Johnson. 
"Catherine Kelly, 
•r.etitia Kennedy. 
Mnry Kirwin. 
Gr.nce A. Laue. 
•Johanna Ligtermolt. 
'Celia Morton. 
"IJIIlBn MoKnight. 
Ainics McGee. 
•Clara May. 
■Rose Marks. 
■Prances McDevltt. 
•Catherine McMallen. 
Anna Papp. 
' Anna Pone. 
'Anna Rachael. 
Mnrenret Rogan. 
•Esther Sedman. 
T'Ucy Strawabaugh. 
"Bertha Siehles. 
Martha Scwell. 
•S.VU-I.T Tome. 
•Rvelyn Turner, 
•Adn Tnylnr, 
Clara Wnoley. 
Tint Wi^Tpr. 
Helen Worrell. 



Uu7 Bm. 
PawUna Borsuk. 

■Katie Dudai. 
Ena Dzioba. 
'Anna Gtusda- 
Zorka Georffe. 
Kyjda GtBimka. 
'Annie GtHuiikn. 
I^dia Giuutno. 
*Mar; Hnatuik. 
Mary Kraitoacu. 
■Pauline Krasnotlika. 
Tdka KrasnoaUka. 

'Margaret ] 
Margaret Toner. 
Mamie Downea. 
■Mat? WiTih. 
Harr Hnatuik. 
'Hattie Howard. 
■Mary KraatBKV. 
DiiA Hnatuik . 
Anna tTnterberger. 

Julia Boyle. 
Joiiie Oarbcr. 

Sadie Funk. 
Mary HaTeratiiA. 
•Uory Hater. 

■LontM tiraol. 
Daii7 Uaber. 
Johanna Maker. 

Michael Joaepk 
George EHtzgerald 
*Aldo Hotune. 

Mina Krasnostika . 
Emiliae L^wickoi. 
Ssdia Mitnic. 
tjuphie Nedelco. 
Anna Neatelco. 
Mary Olejnik. 
Una OaCap. 
Autoinlna OBtap 
Enti Papp. 
■AgnyB Sskodo. 

Mary Skoc^as. 
Alexandria Waaniia. 

Ivit(;h(m Bclp«ra. 

•Mary Wosnisa. 
■ICUbs Moore. 
■Mary Misaraa. 
Mery G, Slatcbner 
*Antonina Oatop. 
John Olejnik. 
Ena Pytlowona. 
•Mike Wieraorck. 
■John Gtuanka. 

Ignotz HaiAoa, Ohaf. 
■Bndolph HartDUg, Ghef. 
■Rudolph Hartman, Chef. 
•W. M. Madden, Chet. 
■Albert Plant, Ohaf. 
Pit Brrbo, Chef. 
Srtif Fryoka, An't. OM. 
Alice Butterfield. 
■Mre. PMe Dey. 
*Mar Dmm. 

Anna Sulsbaugh. 
Mary Stambangh. 
■Agnea SnlliTan. 

Talephcme Open ton. 

■■Cathpruie MeCalTerj. 
Fannie TontUnioii. 


•Felii G. Strickd. 
Levi Wagaman. 


■Benne Saretakf . 
Annie Orady. 
Mra. Elale WoUgang. 
Frpd Haneon. 
Mrs. Aids Rodgen. 
'Jnaeph Stolarosnk. 
\i<m Gramori. 
"B. I. Gensen. 
■Mike WiMjyorek. 

ov Google 


E. Schiller. 
Maurice Croeby. 

Laura Folk. 
AiU« Franlclin. 
■Sadie Oaliu. 
Kyjda HaUiiwics. 
Witka KoBOwaka. 

■Thomaa O'Neill. 
■Walter Gtuanka. 
•Joseph Null. 
■Clarence Kanffman. 
George John. 

Thomas CoUiua. 
John Duffy. 
■J. B. May. 
•William Muthord. 
Jamea Whalen. 

Nic Nedelco. 
■Arthnr WaUaoe. 
■Cnlvin WalUce. 

'D. Metykowaki. 

TegeUble Peelers. 

■Mary Ijrnch. 
•Euliana Nudladan. 
Mary Fytlavanna. 
Telha WuBwyn. 


John Brett. 
Harry Stac. 
Joaeph Symkir. 
John Skoorylas. 


John Whitney. 
John Wilwn. 
Michnel Boyle. 
Harry Hoffman. 


•David Bntler. 
Arohie Wapiman. 
Oscar A. Carbaugt. 

Ueorgc Loncka. 
•Edgar Dey. 
'Arthur McDonald . 
Henry Bieharda. 
■Roland Waldbeiser. 
■Clarence Ijobar. 
■Joaeph Connell. 
GuB Elseaaer. 
J. J. Purcell. 
Frank Crowe. 
•William Gehrlnc. 
•HDrrj- Nicholaon. 
•Richard Owens. 
Harry Remington. 
Clark Michael. 
James Candfo. 
'Jnbn Monagban. 
William Sorg. 
.Tohn Argenbright. 
Ben Carbntigh. 
John Frnnhlln 
Robert Feldman. 

■Philip GiUespie. 
Richard Gibson. 
Walter EauKnan. 
■Frank McGlade. 
Edward Nangle. 
William Nangle. 
•Harry Nicholson. 
Grover Naugle. 
John Ostop. 
C. M. Rapert. 
Theodore Schiick. 
George Sebruary. 
"■Arebie Smith. 
Arthur Verdier. 
Willinm Wagnmsn. 
David Wnfaman. 
■Enoch W.igamaa. 
DflDiel McCarthy. 
John O'Shea. 
•Gambed H. Kasanbian. 
Penrose Smith. 
•Frank Dech 




Medical Director. William G. TurnbvH, M D., 

Depnty Medical Director, '8. H. Kinuhardt, M, D,, Wnshiivtoii, WuBhjiixton 
County , 

Agsiatant Pli;aiclaiu. 
O. S. Brachmen, M. D., Philndtdphia. 
M. E. Cuwen, M. D., Gtmdh Panns, Conn. 
•J. W. E. Ellenberger, M. D.. Tyrone, Blair Ckmntj. 
'S. Gross, M, D., FhiUdelpbia. 

CbarleB S. Gracey, M. D., Everott, Bedford Coanty. 
SB. T. Zabai^ea, M. D., Philadrlpbia . 
Gonstiltitig Surgeon, Joeepli D. Fiadloy, M. D., AlCoonn, Blair Coaoty. 
Visiting Fjiryngologist, S. I'. Glover, M. D., Altdina. Blair County. 
Storekeeper, George O. Uetzgar, Phlladelpbia. 

Master Mechanic nnd General Foromaii, W. L, Fry, Bidgway, Elk Countj'. 
AssiBtant Master Meehaaic, Joseph Bulger. 
Stenographers— M iss Cecelia Conrad, fxiretto, Cambria Couuty. 

Miaa Mary E. Ervin, Waynesboro, Franklio County. 
Matron and Stewardess, Miss Romi P. Cninpbell, Philadelphia. 
Assifltant Matron— 'Miss Nellie M. Muriihy, Philadelphia. 

Mias Mary Cbealock, Gallitxln, Cunbrla County. 

Head Narae, MUs E. C. AUlwn, Philadelphia. 

•Kntbryn Bredc. Mpry A. Kelly. 

•Annette Cope. Ronie M. Keratetter, 

'Mary Rckhardt. "Ohriatian I.aurcnce. 

•Margaret A. Elliott. Maude Leffier. 

Mny Agnes Borley 'Margaret T^oug. 

I'Sizabeth Fowler. RliKnbeth H, Moore. 

*Joi>ephiiie F. FaTbaugh. T.illitm B. Noone. 

Marian K. Forf. Jfury G. O'D.mnell. 

•Olive D. Hartlore. Louise R. K. RoHe. 

'Katherine Hanaer. •Caroline K. Shny. 

'M. E. HauMdman. Nellie M. Tidd. 
Gertrude B. WljN. 

Rose Adams, Manager. 'Rose Killinger. 

'Earl F. Gladding, Manager. •Mi'ry Eillingcr. 

■Vincent Bllletdoax. MeH Kocban. 

Chnrles Adams. •Ziiri Suocs. 

'Usnde Adama. •Mary Stiielnyok. 

•Verne AntoUch. "Mnrgaret Smith. 

Emma Banks. •Anna Anderson. 

•EIU Killinger. •Rose Bahod. 

5—15—1916 ■ [:,qm.o= by Google 

'Pauline Cumatock 
Onrj M. CheslDck 
Bra. Dnma. 
Annie Szielsko. 
"Viola Horan. 
Kleidy Himel. 
Jkleri HovanJciB. 


''Minnie Eoellner. 
'Eliza Koellner. 
*Ludja Kamara. 
'Marian Reed. 
'Martha Stewart. 
'Mnryanua SleTSga. 

•Milka Boici. 
"iSya Clapsadle. 
'Uai? Chacka. 
'Rose Conway. 
Helen Deeoskey. 
Morsarct I. DouelasB. 
Constance Donohue, 
'Grace Dunn. 
'Evelyne Houpt. 
Jleri Hroca. 
'Floi'ence Uorun. 
'Anlni Hocbiska. 
'Mat tie Sokoaky. 
Mary Guap. 
.Tulia Hianik. 
Ida Mount! . 
Agnefl SottoD. 
Iva Sutton. 
Julia Thomaa. 


Mary Woua. 
Mar; Kriston. 
Annie Plumber. 
Mary Stephens. 
Jiary Vnngreen. 
Annie WulasKok. 
■Tennie Bertram. 
'Alverta Iiuckenbaugh. 
'Kathryn Livingston . 
Annie LaSerty. 
"Ijiura Moorehead. 
Vera Moorchend. 
Ilasel Moorehead. 
•Theiesa O'Brien. 
Mary Pietzscll. 
Alice Stefanowiee, 
Cepflin Slierick. 
•Anntp Wliite. 


*JuliuB Baat. 
'Oscar Bender. 
'William lireth. 
rliarleu Banks. 
Herman Blocb. 
Castner Bowers. 
James Corry. 
Ralph Dull. 
'David Evaan. 
Chnrles rike. 
Joseph Fera. 
Gi«rge Fulmer. 
* James Glenn. 
'John Geader. 
Frank Hawk. 
H.)l)ert Hoehl. 
*Ro7 Kelly. 
•John EilduQ. 
*E:arl Kline. 
'Anthony Kariik. 
*Ro; Leasnre. 


*B. W. Lindsay. 

Andrew LayBhock. 
'Harry Lukehart. 
Fanl Melissa. 
*Pat McDonough. 
'Elmer Moorehead. 
•Carl Mottey. 
•Frank O'Rourke. 
'Moaes Oatheimer. 
Lawrence OTool. 
James Parker. 
Max Polonsky. 
Clarence Stuck. 
'John Smitli. 
•Emil Teichert. 
•Charles Tyson. 
f:dwDrd Walters. 
■John Watson. 
'Robert Tomw. 

ov Google 

*Mary Boboixe. 
'Alaniie Brown. 
Feru B.?llea. 
Maf Cbapman. 
■Lulu DcihI. 
'Delia DeaiTiuige. 
'Stella Dobbins. 
P'loreQKC Dawson. 
"Katie Vox. 
'Ellen Hemw. 
'Clara. Hobaogh. 
'Minnie Hawl^. 
Iva HintOD. 
Clara Kirkpatrick. 
'Anna Mainej. 

HuM;i Aegas. 
SarHti Keyes. 
tMUt Porter. 

Arbita Baltniska. 
Anicla Borowa . 
'Aniela Bashleda. 
Suri Dzamba. 
Pauline Fuller. 
Anuie Gutak. 
'Pataada Burer. 
•Mary Krall. 
*Mar7 Erinston. 
•Deri Ledia. 

Willinm Burke. 
Mlie Crynock. 
■John Conrad. 
John Gubale. 
'Julian Oosot. 
Joseph I boat. 
Stanley Koaa. 
■G^rge Kowaekzyb. 
Frank Mflgoz. 
•John Mogoz. 
•John Janusz. 

Alice Hastings. 
■Emilj Beckler. 
EKa HcEean. 


Marie Nimlis. 
•Gertrude Osteia. 
•Marcia Patterson. 
Kmnia Kainey. 
•Anna Rock. 
•Matilda Steuer. 
•Ruth Schaffer. _ 
•Heten Siatek. 
ICmma Seigriat. 
Uramn Steele. 
Hebeccn TUl. 
H<'1en Walsh. 
Edna Ward. 
■Hattie Touug. 

Narses' Aasistants. 

•Bess Summervilte. 
•Ethel M. Thompson. 

Scrubwomen . 

Auuie Mesarch. 
Anna Miller. 
Mary Nigbborowic. 
•Aniela Ohrolak. 
Mary Obula. 
•Victoria Rakowaka. 
Mnry Sinkowakl. 
Verouika Sihelnib. 
•Anna Soundaz. 
Mary Thomaa. 

Kitchen Helpers. 

'Alex Ma(±awicz. 
'Micbele Panacbella, 
Anna Prantll. 
•Marie Prantil. 
•Annie Rashick. 
Michnel Sweeney. 
John Sweeney. 
•Cba'rles Skupin. 
MuryannH Sietzega. 
•Joe Skupin. 
•Joe UlmsDeb. 


■Helen Tencell. 
•Clara Ziebold. 

Cha mberams ids . 

Kthel r^nhart. 
IjOrena Thompson. 


*HaEel Adama. 
Helen Clegg. 

Thomaa Howard. 

Telephone Operators. 

Ndlie Fljim. 
Alma Oyler. 


Cbarles Tyson. 

ChHrlea H. Ttiompson, Chef, 
Anna Brnaington. 
•Charlotte Brown. 
•May Dnnu. 
*BDlab Eger. 
•Tirgioia Haapt. 

■Hilbert Hovey. 

'Mabel Johnoon. 

*Ua« McDowell. 

■Cora Neir. 

Mae Bamsey. 

D. C. Burke, Butcher. 

■John C. Thomaa. 
WiUIani Conilin. 
Nels Johnson. 
■Lawrence OTooI. 
■Floyd Farren. 
Mortis JobnaoQ. 
•M. B. Miller. 
•M. P. Murray. 
■Lewis Schatzinger. 
■William P. Sheppard. 
S. Stevena. 
Bernard Btter. 
1 othar Heym. 
'Dick Condron. 
Neil McOool. 
C. J, Delozier. 
•Joseph Bolger. 
M, T. McDonough. 
•Frank O'Frell. 
•Harry Tliomperai. 
Thomaa Bradley. 
Edward P. Shannon. 
Jnmea Uniry. 

•WiDiani H. Poj. 
•Joseph Qutterrtdge. 

J. A. Benden. M. Hertzo;. 
A.J. McCarty. 
W. B. TubbB. 
Lottie Martin. 
•Vincent Billetdeos. 
■Daniel Carney. 
Tony Chessoci. 
■John Ivone. 
S. Stevens. 
•F. M. Beed. 
•John Mack. 
•Arthur Mtilhem . 
Juhti M. Bryaon. 
•Edward Eger. 
Hichnrd Etter. 
Thomaa Eger. 
C. J. Freidhof. 
•Mike Oednokl. 
J. A. Nagle. 
•Paul Spati. 
H. E. Stenk. 
•B. H. Reihard. 


'Midiad Moyer. 

ov Google 



Medical Director, Thomas E. A. 8tiU», M. D., 
Natareth, Northampton County. 
Depot? Medical DireMor, B. A. McDermott, M. D., PhiladdphU. 
AKBiBtaat Phyaicians. 
P. E. Schwara, M. D., Baeton, Northampton County. 
Abraham Epstein, M. D., PhiUdelphia. 
Ray D. Saul, M. D., HnirisburK, Dauphin County. 
a«y Vera Zabarkea, M. D., Philadelphia. 
Conanlting Surgeon, *J. Harry Sweriug, M.. D., Fottsville, Schuylkill County. 
Conmlting Laryngolo^at, Charles S. Rebucb, M. D., Harriaburg, Deuphin.Cotinty. 
StenoBraphers—Miss NcJlio M. KissinEfir, Carlisle, Cumberland County. 

Miaa Viola MacOpWDn, Bryn Mawr, Man^omery County. 
Mstron, Mm, Mary A. Mi^ntz, WilliamspoTt, Lycoming County. 
Master Mechanic, Walter E. Wanner, Ridgway, Elk County. 
Aniatant MaBt:>r Mechanic, W. II. Addams, Harrisburg, Dauphin County. 
Head Norse, Miaa EDa E. Read, Philadelphia. 

Staff Nurses. 

EmCy M. EllU. 

Julienne Schlegel. 

Mary S. Eckhardt, 

Fraucen Hinton. 

Mary R. Dougherty. 

Viola Kennedy. 

Alice N. Cwhnm. 

Bertha B. Henry. 

SeliiiB WUder. 

Sara Sailer. 

EUsabeth Rnppert. 

Mary Alice Roberta. 

Adele Macquilken. 

Elizabeth Bamsden. 

Chriatian T^iwrence. 

Gertrude S, r.*e. 

Ha 8. Ix»ngacre. 

tiaty McMoneagle. 

Coni'^lia U. Parker. 

Rthel G- Brown. 

Nunies' Helpers. 

rinra Ziebold. 

Marcia Patterson. 


Victoria Veaavagc. 

Agnes Lipaky, 

Mary Sbncko. 


Knthryn Lee. 

Carrie Berey. 

TSoac (»8borne. 

■roimie M. Kline. 

Iptltia Kennedy. 


R. W, Undnay. 

0"lntiis A, Sourwint 

John J. CBBCy. 

A<hm Tolnrrko. 

John Smith. 

Alvtn Koppenhaven. 

Wtllinm J. MargoH- 

JiimpR W. Cotter. 

tteorjre V. Penwa. 

Frank Ooglltore. 


Walter Schultz. 
Warren Towsen. 
JamcB R. Carson, 

Neil Shnnnon, Chet 
HHsie McdoBkey. 
Mary L. Sculley. 
Srimuel Dimklc. 
Mar? Soaders. 
Itlnrenret Poland. 
Ella BmuB. 

Gottlieb Ruggaber. 


Tbomae O'Neil. 

Leon Matzger. 


Pasquale Tabaol. 
Tliomoa Emnniicl. 
Dotnenico Crezinco. 
John J. White. 
Peter Agazzino. 
Samuel Gentile. 
George Santi. 


Pjctro DiluTio. 

Joieph A. Anders. 
George W. MuIUns. 
Kathryn I-ivingston. 
Ijizzle Fesig. 
Louisa Altwrt. 

Mae Brown. ' 

Mra. Albert Klminich. 
AmanclR Arnold. 
Lucf ThompeoD. 

Jennie Sellers. 
Mary Bryneraliy. 
Helen Mnlinowshy. 
Mary Prank . 
Minnie Koellner. 

Helen Tnncofskj-. 
Suaic PincaTQge. 
Bertha Strenkofsky. 
Clara Mogel. 
Helen Lciby. 
Mary Bruzas. 
LiUlan Wink. 
Anna Starr. 

Anna L'jfsky. 
Mary S. Fesig. 
Miiry Ryan. 
Annie Bematonis. 
Mary Fisher. 
Adell.i Takonis. 

Helen Chubby. 
Stella Faleskl. 
Carrie ZelinHkie. 
Mary Palcskia. 
Lillian Oberdick. 
Helen Wells. 
Viola Crinsmao. 
Ellie Korsnk. 
KPlie Zagrocky. 
Hebecca Radel. 
SaUie Rentschler. 
Edith Wells. 
Ella Pincnvage. 


Mary Ziankucky. 

Margaret Samnaia, 
Tillie Heishley. 
Mnry Wyrhiiiis. 
Pauline Knonioseliki , 
TucWe.v MillnBliuskey. 

JflbD R. Meharg. 
Charles Epler. 


Albert J. Dunble. 

ov Google 

No. 15. 
Homer J. Hag;. 
Wellington Beim. 
Frank V. richthorn. 



Hcbert Gehringei-. 

Coal PasBen. 

Clarence Romberger. 

At DiBposal Plant. 

Michfiel Ginty. 

B. B. Myers. 

8. P. Setp. 

J. W. AllnmoDK. 

W. H. Confer. 
Milton J. Wolfinfer. 


A. Heni7 Sliall«nbenc»r. 


D. S. Wnpicr. 

JOAepb Sberidau. 
ThoDUB Dobmin. 

Pump RuDuers. 

Cbarlea McOcud 

Telephone Operators. 

Rntb Buikett. 

Harry PowderhtU. 


Joha Freeman. 


Chief, J. Moore CampbeU, .If. D., 
Bookkeepei^-'Mrs, Lucy A. Thompson, Williamsport. Lyeominfc County. 

Miss Mabel E. Thorn, Gettysburj;, Adnma County. 
Stenographera— Miss Edna M. Kniscly, Eberly'H Mil!, Cumberland Conntj. 

Miss Manon Ijlngie, Penbrook, Dauphin County. 
Oerk, Mm. Bella Weible, Tidioiite, Warren County. 


ov Google 


NOTB.— Tbe ■Uslriballon of TETAKDB AKTITOSIH li 

Itat Wb»e B.ra« ar.. u..rt«i >vUh »» 




All h 





u'Uo U. HMinsifr ft Commrnj 




etoneoii ft U»n^ 


•F. W. Joriw, Jr. 






DiatribDtorB of Diphtheria Antitoxin— Cont'd. 

















&i "'■""'■■■■-■■■-■■■ 


Edwim r^alir.''v^y^'.'^v.'^'.'.'.'.'.'..'. 





?;fhSS:. C-.OOQ 

•liindi Cli«ni"pil«™s^'. "-'■■■' -'■- 

B-»t Mmitb CTinim 

MBDCh Cbank 

Diatribators □( Diphtheria Antitoxin— Cont'd. 











DanpblD. '^ 



Distributors of Diphtheria Aatitoiin — Cont'd, 




















Cjindl bub 

Hnnllnjtrlon. ' ^ 


"; S: J^ir;;:::;::::::::::::::;::: 

M«plet™ Depot 

Distribnton of Diphtheria Antitoxio— Cont'd. 










M A Foot 








aEi 'Slc 

Distributora of Diphtheria Antitoxin— Cont'd. 















J>ck»D Center, R. n. No. IS 





A StOtl 


Pistributocs of Dipbtberia Antitoxin— Cont'd. 












N- h 


Nelson Ij Yeatel & Coiiii«iny ., 

SoutH Betblshem 

J S K b. 


5^»^' "•P 


_^ h'. ciiru™ * c«op^'," ::::'.: 





Thomu B. ailpln, Jr 







c^™', ■::.■" 

SctioylH I 


Sctaurik u 
SrboTlk II 
ScbOTlk i: 


B. F. Jao» 

Port C.rboi. !..; 

DIstributoFB ot Diphtheria AnUtoxin— Cont'd. 



•Willi B fV 

SK : 

lob"5 ■ 













G«T(e D. *iigsii».il<.,- 

J J Brmlllw 





Hr. T. D. BikEF 







Distributors of Diphtheria Antitoxin— Cont'd. 

Dlitrlbalon. ■ 




H mim 


L, Obier, .'..'.'.'■'■"','■ [ West II 

Cbarlea Beeteder, 

T M. tltiwfU.'".'.'.'.'.'.'.'.'. 
. Vortnrg ft Brotlicr. . 
(# ateat 3. Re^noldi'. . 



J, Google 


Chief Engineer, *F. Berbert Snou>, 

Harrisbure, Uaupbin County. 
(AatingJ, Chartct A. Emerson, Jr., 
PbiladelpUa . 
Asaistant Engineer in Cbarge of General Oflice Work— O. Howe CumminKS, Phila- 
delphia . 
First AsBiabint Engineer on Waterworks and BewfiraEe— Puul Hooker, HarrisbuTg, 

Dauiihiu ConnC;, 
Assistant Engineer on Waterworks nnd Sewcmge— William H. Ennia, Philadelphia. 
Assistant Engineer in Charge oF Design and Construction^Iolui M. Mahou, Jr.. 

Harrisburg, Dauphin County. 
Assistant Engineer ou Teals of Water and Sewage — Halpb E. Irwin, Meadville, 
Crawford Count;. 

Asaistant EngiDcer«~L. M. Fisher, Heme, Uerba County. 

Charles R. Fiirbes, Quarrjviile, Lancaster County. 
J. W. Fottcnbnugb, Hariiaburg, Dauphin County. 
I. M. Glace, Hiirrisburg, Dauphin County. 
C<ilemHn B. ilark, I^bauon, Iiebanon County, 
Howard B. Miwes, Hurrisbure, Dauphin County. 
Snmucl B. Parke, Jr., Philadelphia 
William C. iliddle, Lauenatcr. I-ancaster County. 
M, E. Shaughnessy, l.«wisburg, Vaion County 
C. I.. Siebert. Pittsburgh, Allegbeny County. 
A. J. Smalshaf, Pottatuwn, Montgomery County. 
Roland B. Styer, J.anaister. Lancaster County, 
Joseph A. Tinsman, Philadelphia. 
L. K. Wickcraham, Hurrisburg, Dauphin County. 
Ira F, Zelgler, Carlisle, Citmberland County. 
Chief Field luspeetor— lloaea K. Ely, Do>leBtown, Bucks County, 
Engineering AaalBtanta— 'Charles T. Ikfaday, Chambersburg, Frtiaklin County. 

•Wilson W. Uitter, Liverpool, Perry County, 
Draaghtamen — J. W. German, Jr., Harriahurg, Dauphin Countj-. 
G. Douglas Andrews. Hnrrisburg, DHuphin County. 
C. A. Eckhort. CurwenavUle, Clearfield Coimtj. 
C. R. Krall, Harriaburg, Dauphn County. 
P. M. Sourbeer, Jr., Harriabut^, Dauphin County. 
■H. M. Walter. Harrlsburg, Dauphin County. 
O. E. WilllaniR, HnrriabiirK, Dauphin County. 
Clerks— Harry C- Beckley, Catnwissa, ColurobSa County. 
Andrew J. Bohl, Harrisburg. Dauphin County. 
R. E. Einstein, Harrisburg, Dauphin County, 
Howard M. Haines, Harrisburg, Dauphin County, 
■John K. Miller. Harrisburg. Dauphin County, 
Daniel V. Ness, Manchester, York County, 
Mrs, Nellie Prett.v, Chester, Delaware County. 
Miss F.dith Kourke. Rnrrixhtirg. Dauphin County. 
Ray E. Stpw.ird, Hurrisburg. Dauphin Counly. 
Mra. Lila H. Traee. Harrisburg. Dauphin County. 
Stenographera— 'Miss M, Irene Cuenot, Hnrrisbunt. Dauphin County. 
Misa M. Tjiuise Eckels, Carlisle. Cumberland Cniunty. 
Miss Helen S. Ettinger. Carlisle. Cumberland County. 
Miss Elizabeth R. Flcisher. Newport, Perry County, 
'Hiss Jane Gilbert. Harrisburg, Dauphin County. 
Miss Jjeola Hannah, Meadville, Crawford County, 
Miss Bula Tj. Konns. Penbrook. Dauphin ('ouutv. 
HIsB Clara V, Mabaney, Mont Alto. Franklin County. 
Miss Anna E, Moore, Harrisburg. Dauphin County. 
Hias NHIe J, Rhnira. HarriBliurg. Dauphin County, 
Miss Margaret Small. York, Ynrk CountT. 
Mlaa Fronccg W. Smith, Harrisburg, Da'upbin County. 
Mrs. M. K. Soiirbenr, Harrishure. Dauphin Cotlnty. 
Sanitary Inspectors — Henry Andrews. Ardmore. Mnrtenmpry County, 
James B. Aursnd, Ijewistown, Miffiin Coun^. 
Berkey H. Boyd, Scottdnle. Westmoreland County. 
Charles L. Baucber, Wilkes Barre. Luz"rne County 
Jnracs M. Clark, New CasUe, I.owrence County. 
W. K. Claypoole, PhUadelphia, ^ , 

b CooqIc 

6—16—1916 " 


Charles W. Collins, Bntler, Butler County. 

E. i. Confer, Millmont, Union County. 

A. W. Cunrad, NicbolHon, Wyomins County. 

Juseiili S. Couch, Oil City, VenaoBO County- 

■Hobert M. Courtney, Mt. Penn, Berks County. 

William Davia, Pittsburgh, Allegheny County. 

William Ellis, Phoeniivflle, Cheater County. 

Simon B. Engle, Philadeluhia . 

E. H. Evans, Philndelpbia. 

E. A. Falter, Harrisburg, Dauphin County. 

M. Z. Frederick, West Telford, Montgomery County. 

L. S. Haldemau, Marietta, Lancaster County. 

Robert S. Haoaburj, Philadelphia. 

J. M. HeUines, PhUadelphia. 

E. I.. Hill, New Milford, Susquehanna County. 

'W. S. Hood, Philadelphia. 

Toner A. HugE, Milesburp, Cpntre County. 

L. S. Imler, Imler, Bdlford County. 

D. M. Irwin, Oreenaburg, Westmoreland County. 

Charles P. Jorrett, Norristown, Montgomery County. 

Frank H Lnnnrd, PhUadelphiu. 

Fred C. IJdle, Philadelphia. 

SofflucI S. Long, York, York County 

J. A. McCleury, Altoons, Blair County. 

D. J. Marshall, New Castle, Lawrence County. 

H. A. Miller, Lebanon, Lebanon County. 

W. H. Morris, Uunciinnon, Perry County. 

T. P. Nicholson, North Wales, Montgomery County. 

Otto F. Nickel, Johnstown, Cambria County. 

J. B. Nightingale, Doylestown, Bucks C'Ounty. 

•r.*alpr Ij. Pierce, Towandn, Bradford County. 

W. W. Keno, Rochester, Beaver County. 

W. E. Rice, Duneannon, Perry Counbr. 

J. W. Roebuck, PhUadelphia. 

Augustus i^cbrink, Pottaville, Scbuvlkill C'Ounty. 

J. H. Silliman, Tamagua, Schuylkill County. 

Roy M, Soudor, Lancaster, Lancaster Coun^. 

'Charles H. Spelker, Pituburgh, Allegheny County. 

Louia Stevens, Philadelphia. 

J. H. Stewart, Pbiladclphin. 

W. B. Teats, Buruham, Uifflin County. 

W. H. Varaick, Phihidelphia . 

R. R. Waddy, Pbiladelpbia. 

W. I. Waugaman, Sykesvtlle, .TefFerson County. 

Timothy Whelan, Clifton Heights, Delaware County. 

H. W. Whitman, TitusvUie, Crawford County. 

CLnrlps E. Wirt, Suubury, Northumberland County. 

J. C. Yeager, Lewlstown, Mifflin County. 

Daniel Zi'llers, Lebanon, Lebanon County. 

DEPUTY FIELD OFFICERS, so caUed because, while in the employ of a pri- 
vate w)rp"ration, tliey are dciiutizrd to represent the Commiwioner of Health in 
InMpcctiug the sonitnry couditions ot propcriiea and reporting results to him. 

H. N. Blunt. Palmerton, Corbou County. 

Williiim fi. Edmunds, NuDticoke. Luzerne County. 

Howard Scabold, Cotiisnuiiua, Lehigh County. 

B. M. Stark, Scronton, Lnckawnunn County. 

John Brown, Sernnton, I.nckawnnnn County. 

Dnvld Decker, Rtdeway, Elk County. 

Rcott Bailey, I>uHois. Cli.nrficld County. 

F. D. Rntrle, HuIIpt, Butler Counlv. 

D. M. Watt, Butler, Bullcr C.uuty 

John CuRlctt, Scrnnton, L!n-k:iw:irna County. 


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Chief of Diviiion. E. I. Simpnoo, 

Bookke«i«rB— Clinton T. WilllaniB, Wellsboro, Tioga County. 
Mis« Bertha W. Knuke, PhUudelpbia, 
Miss Liiliun MoCart.v, Muiicy, I.ywiiiiiiig County. 
Miss Margaret C. Mahei, PhUudelpbia. 
Stenographers— Miss M. FMith DeNcgre, I.ansdowne. Delaware County- 
Miss Pauline C. Simon, PbUadetpbia. 
MiHS Lulu F. Prescott, Miitamoriis, Pike County. 
Mrs, Adele M. Henderson. Pbiladelphis . 
Miss Emily T, Wilson. PhUudelpbia. 
Miss Helen H. Irwin, HnrriKburjj, Dauphin County. 
liss Edna E. Hockstein. Pbilndriphui . 
Miss Katharine Itreunnn. Pliiludolphia . 
Miss Isabel S. Magowan, f'bil;tdelphia- 
Miss Amy S. Weil. Philadelphia. 
Vj. Roebuck, Philadelphia. 
a«rkB— Mrs. Elizabeth R. Norton. Philadelphia. 
Miss Susan A. Pike. PhUadelphiii . 
Miss Margaret J. Hackett. Philadelphia. 
Miss Florence B. Tome, I-Husdowne, Uelawnre County. 
Miss Agnes L. Devlin, Pbiludeipbia. 
Miss Cclla M. Cottingham, PhUadelphia. 
Miss Elianbeth G. Haines, Philadelphia. 
Miss May R, Taylor, Ijinsdowno, Delaware County. 
Miss Horence K, SheeCz, Philadelphia. 
Miss Maude E. Uhler, PhU.idelphia. 
Miss Adele M. Sterr. PhUndelphia. 
Miss Adelaide lltus, Phikdelpbio. 
Miss Mary Macintosh, Philadelphia. 
Misa Emma L. Kniinsu, Hnrri^Iiurg, Dauphin County. 
Miss Belle MeClnin, PhUndelphia. 
Miss A!i(^ W. Mather. PhUadelphia. 
■Miss I.illinn KendnU Philadelphia. 
Miss A. Adessa Fry, Harrishurg, Dauphin Countr. 
Miss l.nuise Spnngler. Chamberaburg, Frnnklin County. 
Miss Katherine A. Mullin. Harrisbuc^. Dauphin County. 
Miss Marthn T. Reck, Hnrrisburg, Dauphin County. 
MUs M. EmUie Pattereon, York, York County. 
Miss Katharine L. Hood, Duncanaon, Perry County. 
Charles H. Clnppier, Philadelphia. 
, Enrl Bachman, Philadelphia, 
Harry Hackman, Philadelphia. 


Stenographer— Miss C. L. Blanning, Williamstown, Dauphin County. 
*Miss C, S. Pntsi^hka, Lebanon. I.ebanon County. 

CleriiB—Miss S. J. Kiegel, Steelton. Dauphin County. 

Miss B. C. Mailey, Harrishurg. Dauphin County, 
I*elie D, Seiders, PottsvUle, SchnylkiU County. 
*ThomaB D. Straugbn, Shenandoah, Schuylkill County. 

■Retired . 

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In the report of the General Inspector appear data that indicate 
material progress throughout the' State in the local supervisioii of 
eanitary affairs throngfa the Boards of Health. During the past 
;ear new boards to the number of one hundred and twenty-nine were 
established in boroughs or townships of the first class, leaving nearly 
as many, or one hundred and seventeen, manicipalities in which the 
citizens are not thus protected. Among these borou^s are many 
email commanities, such that it is difScult if not impossible to find 
suitable persons to fonn a Board of Health or to persuade them to 
serve. The law authorizes the Commission of Health to take charge 
of places of this kind which have no boards at all or when existent 
boards are found to be lax or inactive. The hope that all these bor- 
oughs and townships may be persuaded to find a way to create and 
maintain their own boards has made me unwilling to take any dras- 
tic action in the matter. In twenty-seven boroughs, however, local 
conditions made it necessary to put our district health officers in 
charge, but in eight of these places it presently became possible to 
withdraw this special supervision, the boroughs having established 
efficient Boards of Health. 

The General Inspector also calls attention to the interesting fact 
that in Pennsylvania there are nearly six hundred villages quite 
comparable with the boroughs as to population and in some other 
respects, but which are under the direct control of the Department 
of Health because they are unincorporated. The population of the 
places in qnestion ranges form three hundred to three thousand; 
two-fifths of them are villages with more than five hundred inhabi- 
tants. In many of these places the dwellings and the public utilities 
are similar to those found in the boroughs. The General Inspector 
makes the suggestion that there be established a systematic inspec- 
tion of villages by our health officers in the various districts, as soon 
as the funds at the disposal of the Department shall permit. 

In the Bpring the Economy and Efficiency Commission, created 
by the General Assembly of 1913, asked me to prepare a detailed 
statement relative to the employees and expenditures of the Depart- 
ment of Health. This proved to be a task of considerable magnitude, 
as the material had to be gathered from many memora'nda and ac- 
counts on file in our offices at Harrisburg and Philadelphia. - Much 
time was given to compiling the data called for by the Commission. 
It is estimated that the clerical labor involved in the preparation of 
this report represented an expenditure of at least six hundred dollars. 
As quickly as practicable the information was brought together and 
pr&iented to the Commission in three large volumes. The correspon- 
dence bearing on this episode follows, and needs neither explanatloD 
nor comment 


April 11, 1914. 


Commissioner of Health, 
Harrigbtit^, Pa. 
Dear Sir: The Economy and EfBciency Commission, appointed 
under the provisions of a Joint Itesolution of the Ceneral Asspmbly 
of the Commonwealth of Pennsylvania, approved the twenty-ftfth 
day of Jnly, 1913, copy of which is sent you herewith, requests the 
following information: 

1. Reference to the Acts of Assetbbly, giving the 
years and page numbers, creating and relating to your 
Department; also copy of rules and regulations, if any, 
pertaining to or relating to the same. 

2. The name, compensation received, and duties ac- 
tually performed by each employe. In answering this 
question, please do not confine yourself to the general 
idiraaeology of the Act under which the employe has 
been appointed, but state in detail the duties actually 

3. Please state after the name of each employe 
whether or not the position was created by statute, or 
ia a temporary employment, made by appropriation 
from session to session, or appointed and paid for out 
of the fund commonly known as the Contingent Fund. 

May I request that you give this matter your earliest attention 
and oblige. 

Respectfully yours, 

(Signed) haret s. McDBVITT, 


May 22, 1914. 


Commissioner of Health, 
Harrisburg, Pa. 

My Dear Dr. Dixon: It gives me great pleasure to acknowledge 
receipt of a report concerning your Department in answer to my 
inquiry of April 11th. 

After a thorough examination of the contents of the three volumes, 
I wish to congratulate you upon the same. It is only another 


demonstration of the efficiency that has marked the admiaistratioD 
of the Department of Health since its creation and yoar appointment 
to the oflQce of Commissioner of Health in 1905. 

The report contains all the information that we desire in as snc- 
cinct a form as it is possible to prodnce. 
I beg to have the honor to remain, 

Most respectfully yonrs, 

(Signed) harry s. McDEVHT, 


Fortunately the past year has not brought us large epidemics of 
communicable diseases,' but the reports of the Division of Medical 
Inspection and the Division of Sanitary Engineering contain a 
number of illuminating narratives which clearly show how the De- 
partment endeavors to take hold of situations suggestive of serious 
trouble and by fitting precaulions to limit impending dangers. 
Necessarily, not having the gift of prophecy or omniscience, we 
come on the field only when a certain amount of harm has already 
been done and nothing can possibly remove that particular damage, 
but even then it is important to have it determined whether further 
trouble is to be expected and prevent the further poisoning through 
whatever may be its sources. Even when an outbreak of Uphold 
fever, for example, is already fully established much, very much, 
remains to he done to ensure a rational care of the patients and 
to provide a supervision tliat precludes the further spread of the 
disease such as comes through careless nursing, insufBcient disin- 
fection of excreta, and the neglect of other precautions that often 
seem to the uninformed quite secondary and unimportant. 

Instructive reading is the story of the epidemic of typhoid fever in 
Montgomery County along the Skippack Pike. This was clearly 
caused by milk, but the full appreciation of the situation when an 
investigation was undertaken was hindered by a lack of frankness 
on the part of the families to which attention was first directed. The 
infection of the milk came apparently from a sick man living in 
a part of the house occupied by a milk producer whose premises were 
far from sanitary and who, early in August began to deliver Ms 
milk on a route which he had recently acquired. In the course of 
a couple of weeks reports of illness along this route began to come 
in. Then and in the succeeding months one hundred and seven 
caaes of typhoid fever, involving eleven deaths, were traced directly 
or indirectly to the first case although for it no cause conld be 
determined. It is even probable that the number of persons ac- 
tually infected was larger yet, for the milk in question went also to 
two small hotels on the Pike which were much frequented by aato- 


mobile parties from far and near. It ifi of conrse impossible to tell 
how maujr persons may have acquired tlie disease in this way, but 
the outbreak as it stands has many interesting episodes. 

Worthy of some attention is also the account of an outbreak of 
typhoid fever among the students of Lehigh University in Sooth 
Betlilehem. When the cases were carefully reviewed it became evi- 
dent that the persons affected must have been infected in the Com- 
mons, the dining place maintained by the Universi^. There was 
little difBcolty in excluding other places and in showing that the 
milk and other food supplies were probably nncontaminated when 
brou^t to the storerooms of the Commons, and that the water 
could not be made responsible for the outbreak. It seemed probable 
that a "carrier" had introduced the infection, and among the kitchen 
help was finally found a person whose medical history as well as 
his occupations suggested that he was the presumably innocent 
cause of the trouble. Only he among tbe persons that frequented 
the Commons or were employed there, after having had typhoid 
fever some time ago, gave a positive reaction to the test of Widal. 
This drcumstance of itself would indicate that he still harbored 
the typhoid bacillus from the original attack which appears to have 
occurred about two years before. It was not, however, possible to 
demonstrate the organism in such samples of the excreta as were 
obtained from him at South Bethlehem and at Lewes where be was 
later followed. The opportunity was not altogether favorable to a 
Ireatment of excreta such as would facilitate the examination, and 
ic is by no means certain that this man wtie not a caiiier. 

Another, but smaller, outbreak at Swissvale also illustrates tbe 
difllcully of a dear demonstration of the actual participation of a 
carrier even when such an agency seems very probable. 

The report of the inspection regarding typhoid fever in Kittanning 
is also instructive because it well illustrates the utter lack of any 
sense of responslblli^ or moral obligation manifested by some of 
the companies engaged in supplying water to the pukUc. In this 
particular instance the water company put its filters out of com- 
mission pending certain repairs and improvements, but took no steps 
to notify the consomers and to warn them that the water should be 
boiled in order to be safe to drink. Only after the lapse of some 
days did the County Medical Inspector leam what the situation 
was and even then it required some effort to bring the superintendent 
to issue a warning notice to the ptiblic 

Attention may also well be given to the reports on the severe out- 
break of dysentery followed by typhoid fever at Grove City, which 
are furnished by the Division of Medical Inspection and the Division -. 
of Sanitary Engineering. This very instructive story well shows 
how neglect of proper precautions regarding sewage disposal may 


reeiilt in serious damage tlirough a defect in the system of water 
supply Buch that its presence and dangerous influence could hardly 
be atiticipated. 

During the past year another case of leprosy has come under the 
supervision of this Department and among the Special Reports of 
the Division of Medical Inspection may be found a history of the 
case and an account of the visit by the Chief Medical Inspector for 
a personal examination of the patient. The patient is a Syrian vfao 
has resided for some eight years in Wilkes-Barre. The symptoms 
developed in the Spring of 1913 and were attributed by the patient 
to exposure incident to his employment in a steel mill where he had 
woi ked aB a wire drawer for several years. The studies made in our 
Laboratories demonstrate the presence of leprosy and syphilis. 

The Chief Medical Inspector presents a detailed report of the 
medical inspection of the pupils of the schools in the Fourth Clasa 
School Districts and the results shown in his tabulations are full 
of interest. The number of districts included in the inspection of 
this school year was 2,159, nearly three times the 767 districts in- 
spected in the school year 1911-1912, tiie first period of medical in- 
spection under the School Code. The total number of pupils ex- 
amined is 469,199, which is nearly three and a quarter times the 
number examined three years ago. Only a trifle over nine per cent, 
of the Fourth Class Districts declined to have a medical inspection 
of their schools, and many of them did this without a clear compre- 
hension of what the inspection really is and of the benefit to be de- 
rived from it. Formerly it was my custom to print a list of the 
districts inspected, but the nnmber has become so large that I now 
enumerate in the proper place only those districts in which the 
boards have voted not to have medical inspection, as the code permits 
them to do, and this list may be expected to grow smaller year by 

The general result of the last inspection was that nearly seventy- 
two per cent, of the pupils examined were found to have defects 
such as we undertake to look for. This percentage is somewhat 
smaller than in the previous years. In 1913 almost seventy-three 
per cent, were defective; in 1912 the number was close to seventy- 
five per cent. ; and in 1911 it was almost seventy-seven per cent. How 
far this improvement is a direct result of the inspections and due 
to the removal of individual defects which would have reappeared in 
successive years, it is hard to- tell. It would be futile to try to 
draw conclusions regarding this point, not to speak of a possible 
influence on the community in general, until our inspection covers 
all the districts of this class, or at least until only the same scbools 
are examined for a series of years. 


The good done by these inepectioDs is not capable of direct esti- 
mation. They are important because we are able throngh them to 
leam more definitely what the condition, physically and mentally, 
of these school children really is, and often an unexpected explana- 
tion of the backwardn^a of a child comes to light. The information 
which we send to the parents often leads to an effort to correct the 
defects. For this year it is reported that at least eighteen per cent. 
of those having defects underwent some kind of treatment looking 
to their removal or amelioration. This ia a distinct gain over last 
year when only a little over eleven per cent, were thus treated. The 
percentage of improvement resulting from the treatment of these 
children is also larger than last year. A most interesting case of 
this kind is recorded in the summary, that of a school girl who 
was backward and almost "stapid," but after treatment of her 
tonsils and teeth made astonishing progi'ess in a short time. This 
is by no means an isolated instance of the good done by a medical 

The report of the Chief Medical Inspector regarding school medi- 
cal inspection su^ests interesting queries as to what may yet be 
done to supplement onr work. We nneover a iarge number of de- 
fects among the less well to do and the communities often have no 
adequate means of caring for these children. Here is a very serious 
problem a jnst solution for which wUl bring lasting credit to those 
who find the means which shall enable us to care for such as much 
need good advice and proper treatment for thdr eyes, ears and teeth. 
The report carries the suggestion that much might be done by the 
development of travelling clinics or similar agencies to aid along 
these lines. The suggestion touches fields of endeavor the cultiva- 
tion of which has already often appealed to those who have acquired 
an interest in these and related problems of social welfare. 

In the report is included a brief summary of the inspection carried 
on in the Third Class School Districts. There are one hundred and 
eighty-nine such districts and in fifty-six of them inspections were 
made, but not under the supervision of the Department. From 
twenty-one counties certain returns were made to the Department of 
Health but not in sufficient detail to permit more than a very general 
comparison with the pupils of the Fourth Class Districts in which 
approximately about ten times as many pupils were examined. 
The percentage of defectives found was nearly sixty-nine, about three 
less than tiie percentage discovered by the departmental medical in- 

In connection with the inspections carried on in the Fourth Class 
School Districts our School Medical Inspectors and Health Officers 
were directed to gather information concerning the presence of feeble- 

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minded and epileptics in these communities who are not ander In- 
stitutional auperviaion. The reports include 1098 feeble-minded per- 
sons, of Tchom 558 attend school, and 345 epileptics, of vhom 107 
are in the pnblic schools. Of these 1,443 persons 589 are over or 
nnder the school age. 

For several years I have been chairman of a committee appointed 
to report on School Medical Supervision to the Conference of State 
and Provincial Boards of Health of North America. Varioos reports 
of a more or less preliminary character have been made from time to 
time, but a detailed and final form of onr recommendations was 
presented on June 19 at one of the meetings in Washington. Aa 
the material of the report stands in close relation to onr work in 
Pennsylvania, the entire document is here reprodnced. 

JUNE 19-5I), 1914. 

Tour Committee on School Medical Supervision begs leave to 
submit the following report: 

History: About twenty years ago the first systematic medical 
supervision of public schools was begun in Araercia. Medical super- 
vision of schools in Europe only antedates our American educators' 
activities by a few years. The earliest school medical supervision 
in this country was done more from the standpoint of the indiiAdwil 
child aa a unit and from the standpoint of preventing and leaaening 
illness from the acute communicable diseases and more because of 
the desire of the Health Officer to cut down the mori>idity from com- 
municable diseases among children of school age than from the 
higher and better motives of improving the race. Enropean workers 
in this field, however, seem to have started with the viewpoint of the 
school as a unit by striving to improve the physical condition of 
school children, to promote more regular attendance upon school 
work and for the purpose of rearing a sturdier stock of school chil- 
dren. Neither view was sufficiently broad. Each group of workers 
considered medical supervision from their own particular viewpoint 
ond failed to grasp the broad gauge view of combining the lessening 
of morbidity rates and the increasing of school attendance with con- 
servation of child life. However, each gronp of workers were pion- 
neers in the field of School Medical Supervision and we should 
commend them for the results obtained. , , 


The American Idea. In America the public health worlcer 
to-day is as much concerned with the conservation of child life and 
with the building up of a sturdier race of Americans as he is with 
the immediate remits of lessening communicable disease and les- 
sening mortality rates. We may safetly predict that in this country 
to-day health authorities will be quick to grasp the broad gauge 
view and to pursue Medical Inspection of Schools with the thought 
in mind that, though lessening of communicable disease is neces- 
sarily to be kept in mind while performing the work, by far the most 
important phases of medical supervision are those of dealing with 
the broad problems of school hygiene by practical teaching and by 
medical inspection of the individual pupil and the giving of proper 
advice or treatment to those found defective; this may be carried 
even to the segregation of certain groups of diseased children while 
continuing their school work; to providing separate schools for the 
defective and incorrigibles ; to providing free medicine or dental 
care to the poor; to surrounding the child with proper sanitary pre- 
cautions in buildings and grounds, with a safe water supply; and in 
some instances even to supplying proper nourishment. 

Your Committee is of the opinion that this broader outlook of 
School Medical Supervision represents the view of the modem public 
Health OtBcer and of the modem educator and that public health 
legislation and school legislation should be so combined that the 
Medical Health OfBcer and the educator should work shoulder to 
shoulder both in the medical supervision of school children and in 
the sanitary supervision of school premises. 

The value and importance of school medical supervision during 
the long hours of the day and in the most important period of child 
life are beginning to seep into the minds of our citizens in both city 
and country and, with the appreciation of its benefits, it is being 
demanded in every state and territory. It remains for those of ua 
actively engaged in the work to determine what methods may best 
be pursued to bring about the most satisfactory results. It is not 
a matter of very great moment, except for the compilation of sta- 
tistics and the securing of uniform methods and results, whether 
medical supervision be brou^t about through local municipal ordi- 
nances or by state legislation. 

Opposition. School Medical Supervision, originating in the 
minds of medical philanthropists in this country and promotM by 
them until municipalities and states have been prepared for its uni- 
versal adoption, has been antagonized in certain quarters by an 
organization calling itself the League of Medical Freedom. This 
organization is composed largely of patent medicine manufacturers 
(who seem to contribute all the financial assistance required!, as- 
sisted by other organizations, some of the members of which arei ^ 


wdl inteDtioned and in many instance splendid citizens, namely; 
Christian Scientists, antivivisectionists and antivacciuationists. The 
League of Medical Freedom has taken desperate measures to defeat 
the application of advanced medical science as applied to scliool 

A numbcT of American States have passed laws within recent 
years permitting medical inspection of schools in all districts. Many 
municipalities have made medical inspection mandatory. The Com- 
monwealth of Pennsylvania, during 1911, in the adoption of a new 
School Code, set a new standard for medical inspection, makliig it 
mandatory in districts of the first and second class, that is, in dis- 
tricts having a population of 500,000 or more and in districts baring 
from 30,000 to 500,000 respectively. Had it not been for the activi^ 
of the League of Medical Freedom, mandatory medical supervision 
would also have been provided for districts of the third and fourth 
class, that is, municipalities with a population of 6,000 to 30,000 
and municipalities of rural sections having a population of 5,000 or 
less, respectively. 

In the same Code it is provided that school children shall be 
inspected at least once each school year by physicians having at least 
two years experience in the practice of medicine and that these phy- 
sicians shall make the sanitary inspection of school grounds and 
school buildings; provision is made for the teaching of physiology 
and hygiene, iuoludiii'i reference to alcoholic drinks and especial 
reference to tuberculosis and its prevention, to all pupils of all 
grades. The Code also provides for tbe establishing of open air 
schools and schools for the aniemic and tubercular and for the ex- 
clusion from school of those having tuberculosis of the lungs, whether 
a pupil, teacher, janitor, or other employee. 

Activities of the League of Medical Freedom. The activitira 
of the League of Medical Freedom and their followers during 
the passage of the School Code brought about some modified 
action on the mandatory provision referring to districts of the third 
and fourth class, an optional clause being inserted giving School 
Boards the right to decline (by resolution) medical inspection of 
schools in third class .districts before the first day of August of 
each school year, and in fourth class districts before the first day 
of July. 

The activity of this League did not end with having the optional 
clause inserted in the Act, but, as many of yon know, they extended 
their campaign to the school authorities in every municipality in 
the United States having medical inspection or contemplating taking 
it up. In Pennsylvania prior to the printing and circulation of the 
new School Code in 1911, their literature was sent to the SecretaricB 
in the various districts, many of whom were readily deceived by their 


claims aud tvo-tbirds of the rural (fourth class), districts schools 
"vere deprived of medical inapectioa and supervision during the first 
school year. The eyes of the public seem to have been soon opened, 
hovever, bo that for the second school year, instead of two-lhirdB 
of the districts having elected not to have medical inspection, only 
about one-third of the districts passed such resolution and more than 
foDr-flfths of all of the pupils in the public schools of the Common- 
vealth received the advantages of medical inspection. Careful sani- 
tary inspection of school premises wns carried out by Health Officers 
of the Department in fourth class districts where medical inspection 
was refused. The provisions of the Bchool Code for the teaching 
of applied physiology and hygiene were, of course, carried out every- 

During the summer of 1913, the same activity was continued by the 
League of Medical Freedom, letters, literature, and blank forms being 
sent to the school directors, and yet with no opposition to this cam- 
paign pat forth by the Department of Health, 362 additional school 
districts declined to pass resolutions against medical inspection, and 
a total of 1,831 school districts was inspected during the third 
year of the wortt. 

Your Committee believes that the Conference of State and Pro- 
vincial Boards of Health might consider taking definite action to ofi'- 
set the irrational teachings of this League and should counteract the 
efforts of these medical pretenders where their influence in greatest. 

Constructive Program, Your Committee is of the opinion 
that medical supervision of schools should be the joint responsibility 
of public Health Officers and educators. The functions of the former 
should be devoted to those problems which only persons trained in 
medical and sanitary science can solve. The functions of the latter 
should be in the administration of correctional measures other than 
medical, su^ested by the investigations and advice of the former. 
To this end supervision may be considered under five subjects. 

(1) Inspection and correction of remediable defects in pupils, this 
to include an examination of the pupil's eyes, ears, nose, month, 
throat, superficial lymphatic glands, gross deformities, general nu- 
trition, and evidences of disturbances of the nervous system, such as 
epilepsy, chorea, and tic. 

(2) The prevention of communicable disease. The underlying 
principle is to protect public health and to this end the seiTices 
of the inspector are to diagnose the disease and to take measures 
to detect carriers. 

(3) Begr^ation in special schools of tubercular, mentally de- 
fective, and incorrigible pnpils. The segregation of tubercular pu- 
pils is a demonstrated success in many municipalities throughout 



America and the improvement in tbose of poor natritioD demonstrates 
its importance. The legii^Iature which excludes from schools chil- 
dren known to have tuberculosis should also provide for their edu- 
cation. Special classes of schools for the mentally retarded and 
the defective are no longer in the experimental stage. Where neces- 
sary or practicable schools of these classes should be organized. 

(4) The recognition of faulty position or postural habits or 
mental or physical fatigue in relation to study and recreation periods, 
of faulty kinds and sizes of types in text books, all should be made 
by one familiar with the individual needs of the pupil and should 
be based upon a well founded knowledge of anatomical relations and 
of normal and pathological physiology. 

(5) Sanitation of school buildings and school groauds. We are 
of the opinion that medical supervision sboiild extend to the sanitary 
inspection of the school buildings and grounds, and should indnde 
the problems of air space, lighting, ventilation and heat, water supply, 
ground drainage and sewage disposal. It should also include tbe 
arrangement of the play grounds and outside points of sewage dis- 
posal in so far as they influence the moral tone of the pupil. 

■ In such a systematic supervision of schools the Medical Examine 
occupies the position of investigator and adviser. It should be his 
duty to notify the health authorities of the existence of communicable 
diseases; to exclude carriers, to advise school authorities of the de- 
fects found in pupils and premises and to outline the eorrectlTe 
measures to be taken not only in relation to the individual pupil 
but to tbe pupils as a class. The duties of the school authorities 
should be purely administrative and shonld be made effectual and 
economical by closer cooperation with the Medical OfScer. 

The end attained by such investigations and administration will 
not be limited to the education of tbe child but will extend to the 
education of the parents. One of the great ends attained by the 
Kindergarten method is tlie lesson carried home to the mother by 
the child. For tbis reason we believe the teaching and enforcement 
of personal and school hygiene to the child to be one of the effectual 
methods of teaching its advantages to the parents. 

We further believe that pedagogists should constantly be nrged 
to keep in mind that it is their duty to help build a perfect human 
tabernacle; that they should continually keep before them the thought 
that education is but the adornment of the tabernacle and Is most 
valuable only when developed in a good physique. 

With the exception of segregation or exclusion of those suffering 
with communicable diseases, the power exercised by health and school 
authorities is purely recommendatory. Under a representative form 
of government it is obvious that close supervision cannot be mab- 



datoiy, hence, it is recommeadeil tltat the ineaiiing and importance of 
defects found in the pnpil should be interpreted to the parents in 
a terse note of advice. 

We beg leave to recommend that methods for the collection and 
compllatioD of statisticB should be made uniform by using stand- 
ardized forms simUar to those now in use in Eansas, Vermont, and 
Pennsylvania. We would further recommend that standardized 
forms should be designed to secure statistics of the results obtained 
for each pupil through records which should follow the pupil from 
year to year. The uniform adoption of some such method will fur- 
nish a basis for accurately estimating the value of medical inspec- 

In its proper place will be found the report of the State Registrar. 
An inspection of his tables reveals many interesting vital statistics of 
the past year. 

The sickness of the year, in so far as it presraits itself in the re- 
ports of communicable diseases, shows certain striking changes. 
The total number of such cases dropped to something over 140,000. 
For the years 1906 to 1912 the reported cases had ranged between 
70,864 and 141,739 with an annual average of 113,933. In 1913 the 
number jumped up to 195,015 largely due to a very marked increase 
in measles. The drop this year is also largely due to the pro- 
nounced decrease in the number of cases of measles, this disease 
being less common than in any year since 1907. As compared with 
1913 the decline in measles is over 66,000 cases, or nearly seventy- 
two per cent, of the cases reported for 1913. On the other hand 
a veiy striking increase of German measles is noted, the cases being 
5,912, or much more than twice the 2,575 of 1913. Here there is 
probably some confusion as to distinguishing scarlet fever from this 
disease. Chicken pox, mumps, and whooping cough each went up 
twenty-five to thirty per cent. The cases of whooping cough far 
exceeded the record since our statistics began. For scarlet fever the 
report is much greater than any we have had and exceeded Hiat of 
1913 by eleven per cent. Pneumonia showed a drop of eleven per 
cent, but it is doubtful if this disease be reported with any com- 
pleteness. There is a notable decline in the reports of typhoid 
fever — nearly thirty per cent, from those of a year ago. The cases 
are fewer than in any year of our series being less than one-third of 
those reported in 1906 (really thirty-one per cent,). 

The deaths of the year numbered 114,832. The population of Penn- 
sylvania is estimated as 8,246,018 which gives a death rate of 13.9 
(or every thousand. The decrease from 1913 by cases is 3,163 but 



but on the basiB of the death rate of 1913 the decrease from tbe 
expected deaths would be 4,735. 

The decrease ahows itself in all the groups of the IntmiatioDal 
Classification except diseases of the circulatory system (of which 
nearly three-fourth is heart disease) and malformations. The puer- 
peral diseases also show a very slight increase of mortality. 

Particularly gratifying is the drop in the deaths attributed to 
typhoid fever which reached the lowest figures known in the statistics 
of Pennsylvania. 

This is also true of diphtheria although the decline is less marked. 
Practically all the gain in diphtheria was for patients under t«i. 
The remarkable decline in the prevalence of measles ^owed itself 
quite as marltedly in the mortality from this disease. Notwithstand- 
ing this drop the fatality of measles was somewhat hi^er, assuming 
the cases to be as fully reported as in other years. Of the children 
reported as having measles slightly over two in every hundred died, 
and DO one knows how many more were enfeebled and thus prepared 
to fall a prey to other diseases. This is the disease which many 
think "every child should have." In scarlet fever the fatality was 
also exceptionally low although there were nearly two thousand 
more cases than a year ago, but here also death is by no means the 
only damage done by the disease. In whooping cought the death rate 
fell slightly. 

The mortality from tuberculosis showed a slight increase over last 
year but still remained lower than for any other year of the series 
covered by our records. 

Deaths from cancer and other malignant tumors numbered 5,997 
or 102.4 per cent, of those of 1913. The rate of increase is less tiian 
it has been since 1911 when the rate was only a little over the per- 
centage increase of population. The 143 cases by which 1914 ex- 
ceeded 1913 are more than covered by those charged to the buccal 
cavity, breast, and skin which one is tempted to suppose mi^t 
have been early recognizc'd and accessible to operation. 

As to births the repoits do not awaken apprehension regarding a 
falling rate. In fact the rate of each thousand of the population 
went up from 25.7 to 26.6, and was the highest of our records. For 
the years 1906-1913 the birth rate has ranged between 23.4 and 26.6 
with an average of a trifle over 25.4. In 1914 there were bom in 
Pennsylvania 219,542 living children, of which 113,180 were boys and 
106,362 girls, or 106.4 to 100, a slightly smaller proportion of boys 
than last year. The twin births rose from 2,149 to 2,409, and there 
was one set of triplets more than in 1913. The number of ill^timate 
children fell to 4,001, a drop of 487, more than a tenth. 

The marriage contract received the personal attention of 67,567 
conples during the year, thirteen per cent, of them choosing June 


for this purpose. Of the brides aiiietj-two were under fifteen, and 
seventeen were seventy or older, while a hmidted and fifty-one grooms 
of this age period are recorded, and to thirteen of these connabial 
felicity was said to be a new experience; one made this venture for 
the fourth time. 

During the year the construction of the new buildings at Ham- 
burg went on, and »uch was the progress that late in October we 
were ready to take patients into the Pennsylvania State Sanatorium 
for Tuberculosis No. 3. On Saturday, October twenty-fourth, the 
entire establishment was opened for public inspection and I had 
the honor to show His Excellency, Governor Tener, every part of the 
plant. Together we visited the administration building, the dining 
room, the kitchen, the east and west wards, the power house, the 
laundry, the waterworks and filter beds, the sewage disposal plant, 
the farm and its buildings, and finally the roof gard^is with their 
beautiful view. 

No attempt wau made to hold a formal reception, but a general 
invitation was given to the members of the General Assembly and 
to the physicians of Pennsylvania as well as the public, more par- 
ticularly residents of Berks County, neighbors of the new Sanatorium. 
Another opportunity to examine the building was afforded the gen- 
eral public the next day and on both days, all day long, a steady 
stream of visitors and an extraordinary parking of automobiles 
demonstrated a widespread interest in our new undertaking. All 
our visitors seemed much pleased by what they saw. 

Although the wards and other parts of the buildings were practi- 
cally finished, much outside work on the grounds remained to be 
done. This, however, involved no delay in the reception of the pa- 
tients that had been assigned to this Sanatorium and they began 
to arrive on Monday, October 26, when the formal opening took 

In anticipation of this event I had appointed as Medical Director 
Dr. Thomas H. A. Stites, who for some years had been the Medical 
Inspector of the system of Tuberculosis Dispensaries of the Depart- 
ment. As Deputy Medical Director, I had named Dr. Bernard A. 
McDermott, wbo had been in the service of the Department as a 
physician to one of our Tuberculosis Dispensaries in Philadelphia. 
Later in the year, as elsewhere noted, I strengthened the staff by 
the transfer of Dr. Zabarkes from the Sanatorium at Cresson. Other 
appointments appear in the detailed lists. 

Since the opening the Hamburg Sanatorium has quite justified our 
expectation of its usefulness as appears in the report made by the 
Medical Director and reproduced on a later page. 

7—15—1916 f^ I 



lu tbe older Sanatoria there have been no important changes in 
the buildings or equipment such as to call for consideration in this 
place, except that the Cresson Sanatoriani has acquired a dozen 
tents for special purposes. Ten of these were provided by an aaso- 
ciutioQ of friends of tbe Pittsbni^h Dispensary and two by friends 
of that at Monessen, that needy patients of these Dispensaries may 
come under treatment at Cresson before they could otherwise be 
regularly admitted. When their turns come these persons are trans- 
ferred to the Sanatorium and their places in the tents are filled by 
others. The benefit to be derived from this opportuni^ to accomp- 
lish an early removal from exceptionally unfavorable snrronndinga 
has been amply demonstrated. 

The reports from the Sfinatoria contain the usual tables to show 
the changes among the patients and indicate the results attained 
during the year. It will be profitable to summarize some of the 

ThG cases treated in 191* were grouped as fuUows: 

At the beginniDS of the year there were under treatment: 

lorlplent. Mod. Advsncwl. Pir Adnnc 

i aa follows: 

There were discharsed alive: 

The deaths iu the Sanatoria were these: 

Incipient. Und. 

There remaioed at tbe eod ot the year: 



The tabolatioBS of the Sanatoria permit the following combina- 
tion of results regarding the cases discharged during the year. 

1. Jacipieut, discharged as: 

II, Moderutely Advanced, discharged as: 

III. Far Advanced, discharged aa: 

4PB«Kiillj iTOrnl i=- 0.3% 

From an examination of these figures it appears that of the iu- 
cipients discharged in 1914, nine^-siz per cent, had derived distinct 
benefit from a sojouro in a santorium, and for seventy-two per cent, 
the outlook was exceedingly favorable, they being discharged as "ap- 
parently cured" or "arrested." Among the moderately advanced 
cases eighty-two per cent, had been helped, and for forty per cent, 
the prognosis was very favorable. For the far advanced cases not 
so much is to be expected, but even here thirty-eight per cent had 
gained by their stay, and nine per cent, bad a very good prospect 
of remaioing in good condition. 

It is also worth while to glance at the results attained in our 
three Sanatoria since the establishment of this service in 1907. In 
the report from Mont Alto we have a tabulation of the discharge of 
12,074 patients for the period 19071914. For Creeson we have in the 
last annual report and in this records of 1913 and 1911 relating to 
1316 cases. For Hamburg we have of course only the relatively 
insignihcant figures of the^last two months of 1914. Concerning 
these 14,487 patients, of whom 1,808 were incipient, 6,218 moderately 

ov Google 


advanced, and 7,461 far advanced cases, a aummary of the resalts 
with the percentage in round numbers is here presented. 

I, Incipient. 
discharged as: 

Moot Alto. CrtinoB. HKinburj. Tothl. 

Apparently cored OT = IT % » - 10 « — * J SS ~ iS 5 

Arrwl€id. S88=.I7 % ai=M % 0~ % T20=-<0 "i 

ImproiHl SK — B % 71^M % . i = » * ffll ^ 37 -i 

DeS, 1= 0.2% S- 1 * «= « % 6- e.»» 

II. Moderator Advanced, 
diacbarged as: 

[8 '= 44 % at '^ u % 

M= I % 6— 1 % 

1- ! % 

in. Far Advanced: 
discharged as: 
ApiurfnllT cnn>a 18= tt.aji. »= e.B% 0— 9 % 22— 0.*t 

iMsd I.MS ... IS rt IBS — JT % » = « ft i.m — M '.-o 

T.7M «1S ' n 7.461 

In the statistical tables of the Mont Alto Sanatorium appears a 
small innovation which will tie of increasing interest as the fignres 
grow yearly larger. It has been the custom to group the patients 
by certain social groups aa "single," "married," etc. This practice 
has apparently been developed with the expectation that ultimately 
some deduction will be possible as to the relation between matrimony 
and tuberculosis. Any such detlnction will of course need to be 
based on homogeneous material. Our statistics include a number 
of yonng persons who are in no proper sense of marriageable age, and 
a simple grouping of "single" and "married" must fail to distingnieh 
whatever influence is to be attributed to connubiality. 

Among the patienta discharged the past year from the Sanatorium 
at Moot Alto were two hundreil and thirty-one persons under fifteoi, 
something over a fifth of all tliose discharged from that place. For 
Cresson, which does not specialize in children to the same extent as 
Uont Alto, tbe proportion of such young persons was smaller, being 
only an eighth of the entire number discharged. When we classify 
our discharged cases merely as single and married the "singles" 
are in exces.s at Mont Alto and Cresson for the year by about nine (o 
ten per cent. For the entire period of the existence of the Mont Alto 
Sanatorium the single persons are yet more in excess, that is by 
nearly fourteen per cent. If, however, we deduct the single persons 
who are under fifteen, as a convenient limit, tbe relation of the 
state of niiilrUiioiiy appents in a soniewlint dilTerent light, and the 
married persons discharged from Mont Alto and Cresson the past 
year exceed the single persons who might have been married, as a 


matter of reasonable age, by sixteen to twenty per cent. Among those 
disctuiTged from the Hamburg Sanatorinm the married persons were 
slightly in excess, but the flgnres for that Sanatorium are as yet 
too small to make any consideration of them profitable. 

In the reports of the older Sanatoria are included tabulations of 
the condition of former patients as determined from the memoranda 
made by the Dispensary nurses who tried to trace such patients. 
The late opening of the Hamburg Sanatorium of course preclndes 
its patients from consideration. The tabulations contain much 
material for a study of the results which may be attributed to a stay 
in one of our Sanatoria. The figures presented require some con- 
sideration before any valuable conclusion may be drawn. 

In this npfollow for 1914 there were traced 1,608 patients that 
had been at Mont Alto and 293 that had been at Cresson, 1,901 
in all. The npfollow of 1912 tabulated 2,867 patients that had been 
traced and that of 1913 included 2,306 patients traced in &at year. 
The decline to 1,901 patients traced in 1914 is due to the fact that 
our staff of nurses is not large enough to carry on the regular and 
proj)er work of the Dispensaries in supervising patients now on the 
roll and also to trace with any attempt at completeness those persons 
who have been at the Sanatoria. Then, too, aa will be seen in the 
report of the Medical Inspector of Dispensaries, there has been under- 
taken the past year a new upfollow of persons who have been patients 
of the Pispensaries but have not -been treated at Mont Alto or 
Cresson- That all this work may be well done our corps of nurses 
should be much enlarged. It is not mere curiomty, nor is it merely 
the statistical result which gives value to an upfollow of patients 
that have been under treatment for tnbercnlosis. However important 
the outcome may be as a demonstration of the good done by our Dis- 
p^isaries and Sanatoria, or as a guide to the conduct of these estab- 
lishments, the upfollow has other results which are even more im- ■ 
portant. The tracing nnrse finds many who need direction and 
encouragement as to the conduct of their lives and the management 
of the household. The "word in season" is very helpful to the 
tnberculons v/ho may be backsliding from the truths that have been 
taught them. Many former patients who ought to be found and 
looked after live in places remote from the Dispensary and the dis- 
tance to be travelled increases the work of the" tracer. For some 
of our Dispensaries the problem may be solved by an enlai^ement 
of the staff. This would be the ideal solution everywhere, as the 
best HKfollnwers would he nurse.') of the Dispensary to which' the 
patient belongs. For certain neighborhoods where the tracing of 
patients is peculiarly difficult or the distances are particularly great 
it may be desirable to utilize a number of nurses who for a time shall 
devote, themselves exclusively to this service. ,o|c 


The 1,901 patients traced id 1914 included 394 admitted to the 
Sanatorium as incipient and of vhom 387, or 98 per cent., were 
atill alive at the last inspection; 846 moderately advanced cases of 
which 760, or 89 per cent., were still alive; and 661 far advanced 
cases with a survival of 375, or 57 per cent 

The returns made for these 1,901 former patients are not com- 
plete. In the tables 210 persons are noted as having "no data." 
This means that the tracing nurse has not turned in enough informa- 
tion to make possible a conclusion regarding the present status 
of these patients. This is not necessarily any reflection on the 
nurses but it is in very many cases due to the difficulty of getting 
intelligible replies from those to whom English, or whatever other 
language the nurse happens to know, is a foreign tongue. Some 
patients who were traced were unwilling to give any information 
whatever. The result is that among our 1,901 persons there are 
210, or 11 per cent., concerning whom we know only that they were 
alive at the last visit. Statistically these cases are otherwise of no 
value at ail as we are unable to place them in any attempt to com- 
pare the present condition and that on leaving the Sanatorium. 

In former discussions of the upfollow of 1912 and 1913, it has 
been proposed to consider those who left the Sanatorium as "ap- 
parently cured," "aiTested," or "improved" as discharged with a 
"favorable prognosis" because such persons might be expected to re- 
main well or yet further to gam, provided they followed at home 
the instructions already given them as to the proper way to live. 
On the other hand a discbarge as "progressive" was to be considered 
as a di.scharge with an "unfavorable prognosis" because these patients 
are likely to decline, and to decline rapidly when at home ^gain. 
Even some of those do well, as a study of the tables will e^ow. 

The time that had elapsed at the last visit reported appears in 
the subdivision of the tables. As that Sanatorium was opened at 
the beginning of 1913 the intervals since discharge from Creason 
iiie small. Only nine are in the column under "1824 months," and 
for them the interval is probably not over twenty months. For Mont 
Alto the reports are spread over much longer intervals. In both 
tabulations a certain number, more exactly 172, and all dead, have ' 
an interval "less than six months," but most of these are persons 
who left the Sanatoria with little hope and died soon; a much smaller 
number evidently relapsed speedily at home although disdiarged 
with an outlook which was not unfavorable. 

As in the other upfollows the returns are classified, and the 
present status of each patient is determined and tabulated as "im- 
proved," "stationary," "progressive," or "dead." These conditlonii 
have been grouped by putting the first two together as showing the 


patients to be doing well or at least to be no worse after the interval 
in qaestion; (or the last two it snficea to say that theae patients are 
not doing well. 

On the basis of these terms, and combining the tables of Moot Alto 
and Creason, it appears from the reports of 1914, that: — 

Of 347 cases admitted as incipient and discharged with a favorable 
prognosis in the sense above explained, 309, or eighty-nine per cent., 
after various periods ranging from less than six months to more than 
forty-two months were doing well or showed no retrogression; while 
of ei^t cases of this class discharged with an unfavorable prognosis, 
seven, or slightly over eighty-seven per cent., showed improvement 
or were no worse. 

Of 638 cases admitted as moderately advanced and discharged with 
a favorable prognosis, 472, or seventy-fonr per cent., were still in 
good condition after similar intervals; and of 102 cases of this class 
discharged with an unfavorable prognosis, twenty-five, a little over 
twenty-four per cent.j showed improvement or were no worse. 

And in the third class, or among the far advanced cases, of 336 
persons who left the Sanatoria with a favorable prognosis, IBS, or 
forty-seven per cent., were reported to be doing well or to be no worse 
after the same series of intervals as in the other two classes; while 
of 259 persons of this class wiili an unfavorable prognosis, twenty, 
or nearly eight per cent., showed improvement or were no worse. 

In the table below these results are set forth more fully and with 
the elaboration that the cases discharged as "apparently cured" or 
"arrested" are put together (A), apart from those discharged as 
"improved" (B), or "progressive" (C). The classification on ad- 
mission is indicated by Roman numerals. 


OUH. FOOBd to bit 

Doinc Well. m>t Dolut Wen, 

r. A. no as — M ^ ss -- i % 

B. Tt u — a% a~n % 

The upfollow classification "stationary" will seem to some to pre- 
Bcut a difBcnlty in the interpretation of the reports, and such criti- 
cism is just. As we cannot compel a former patient to come to the 



Dispenaary again for a new examination and a more precise deter- 
mination of his rondition we must flo the best we can with anch in- 
formation as tbe narses are able to gather. As the reports indicate, 
some of thfsp patients do return and enable ns to nerfect the record 
but these are few. Any effort further to individualize the records 
wonld probably only add to the difficulty of interpretation. The 
term "improved," although somewhat elastic, is snflinently definite 
for onr pnrpose and no objection can be made to "propreaelve" and 
least of all to "dead." except that it wonld be desirable to know 
whether tbe deaths were really due to tabercnlosis, bat snch knowl- 
edge is not easy to get. 

It is perhaps worth while to inquire what our tables show and 
if we count only "improved" as indicating a satisfactory condition 
of the person traced. This is of course making about the worst pos- 
sible interpretation of the tlgares since the "stationary" cases of 
certain groups really denote a most excellent outcome of the treat- 
meut. For some of the tables the exclusion of the interval "under 
six months" is desirable because here are noted many persons for 
whom an early death was clearly probable when they went home. 
Limiting our tables in this fashion the results are as follows: — 

IrrlpEpnl ovK irVtb ■ rtiTonihlF |iro(iuM>i ^ Ml 

h rttornf^ u "Inipnndl," -.Wf-e4S.l« 

.'.. «.T% 

nnble pro^orii, 
anfsroraUe prnin< 

orrePtnl .-> ».*' 

In the reports many other details concerning these patients will 
be found. Particular interest attaches to the figures which give 
general information as to the extent to which these persons were 
found to be at work, but with no details as to the kind or change of 
occupation. This information for the two Sanatoria may be mim- 
marized thus: 

I. Inripionta. 




Of Ift.'i mm of f.<viipf«ttonBl ag< 
Of 129 women of otvupational 

■. 81, 


77%. nr. 



II. Moder&Cel7 Adruiced. 

Vaatr oecnpBtloDal tfr.' ..','.'.'.'.'.....'.'....." 

Not formerlj Dccnpled, 

0( S92 men at octnipatiaDnl age, 187, or Oi%, are occupied. 
Of 317 wamen of occupational age, 190, or 00%, are occupied. 

III. Far Advanoed, 

w occuplM. . 

Of IBS men of occuiiational are, K, or 39%, are occupied. 
Of 133 women of occupational age, 02, or 47%, are occupied. 

It appearB then that of the persons here traced and found to be 
still alive after eanatorial treatment as incipient or moderately ad- 
vanced caaes, 76% of the men and 86% of the women have been>able 
to resume their occnpatioua or to be otherwise employed. And for 
these two classCB, 55% of the men and 36% of the women not formerly 
occupied, although of occupational age, are now occupied. The pro- 
portions for those of the far advanced group are shown in the sum- 
mary above. 

The report of the Medical Inspector of the Tuberculosia Dispen- 
saries gives many particulars concerning this important work of the 
Department. At the beginning of the year the roll of the Dispen- 
saries carried 8,252 patients under treatment for tuberculosis. The 
admissions were 11,102, and 9,716 persons were discharged, so that 
at the end of the year the enrollment included 9,638 persons. 

A new Dispensary was established at Ardmore in Montgomery 
County, and another was opened in connection with the Sanatorium 
at Hamburg. Late in the year the Dispensary at Tioga was trans- 
ferred to Wellsboro in the same county. 

The biological products of the tubercle bacillus were increasingly 
used in the treatment of selected cases, and with pronounced success. 
Some detaUs r^arding the doses administered in various Dispen- 
saries are presented in extensive tabulations. 

Much interest attaches to a special report of the Medical Inspector 
of Dispensaries on the endeavor to trace former patients of the Dis- 
pensaries that have not entered our Sanatoria, and to dpfprmine their 
present condition. This upfoUow is the result of directions given 
by me some time ago that all such patients should he traced at in- 




tervaU of six months for two years after discharge. This Is no small 
undertaking in view of the size of the territory covered and tbe 
limited number of nurses available for this worli. This year the 
tracers were able to picii up some information abont 5,463 such 
persons, some times, to be sure, merely the information that the pa- 
tient sought was still alive or already dead. This is, of course, only 
a small part of the patients who have been "discharged" after treat- 
ment in tbe DispensarieB, but no marked increase in this npfollov 
work Is to be expected with the force of tracers which we are now 
able to provide. 

The cases traced have been out of the Dispensaries for various 
lengths of time and are tabulated according to the six-month intervals 
since discharge as the cases from the Sanatoria are tabulated in 
their upfoUow. The Dispensary cases are grouped according to the 
nature of the discharge which is also an indication of the opportunity 
which the patients had to derive benefit from their treatment. Thus, 
the cases discharged because of progress towards recovery, going 
away as "apparently cured" or "arrested" form one group ; those 
which removed beyond the district of the Dispensary form another 
group; and yet other groups contain patients who went to "institu- 
tions" in great variety outside the supervision of the Department of 
Health, patients who were able to put themselves in care of a family 
physician, and finally sucb patients as were dropped because of non- 
attendance or were excluded because of unwillingness to follow the 
directions given by the Dispensary physician as good discipline re- 
quires. Each of these groups is worthy of study and their tables 
illuminate various phases of the dispensai? treatment of tuberculosis. 

In the group of patients discharged as apparently cured or ar- 
rested the nurses reported concerning 1,181 persons for whom the 
interval since discharge ranged from less than six months to forty- 
two months and over. Of these, fifteen were dead, or one and three- 
tenths per cent., all being arrested cases, and three of them having 
been out over forty-two motiths. For 113 cases, rather less than ten 
per cent., the data were insuflScient for a final estimate of their con- 
dition beyond the fact that these persons were still alive, some of 
them as much as two years and a half after dischai^e. We have 
then in this series 1,068 persons whose present status is so tabulated 
that comparisons are possible. 



Table A, in the detailed report, shows that concerning these 1,0 
persons it may be said, that: 

with ■ f»aniU» prcfnoali u:— Were dotni wsU u:— 

ImproTed or StAttomtrr 

■. AppanDliT ciir«d U *4 + a — 63 — 100% 

■Dd arnMcd 1U tU + IM ^ TIS — M% 

■vonble protMXla »:— 

Altogether, then, 1,006 persons of this series, or ninety-foar per 
cent, are doing well and the remaining 62, or six per cent, had become 
progressive or were dead. 

In this table are included 108 visits made less than six monthg 
after the cases had left the Dispensaries, bnt the removal of these 
figorea improves the resnlts only by abont one per cent, or less. 

As Series B are tabulated 621 cases which were referred to the 
family physician because it developed that the patients were able 
to pay for medical service. In this series is included one case of tu- 
berculous glands, with a favorable outcome but which will be 
omitted to simplify the calculations, and we shall consider the re- 
maining 620 cases, of which ninety, or fourteen and a half per cent., 
are dead. 

The reports of Series B have 158 records with "no data" beyond the 
fact that the patients are still alive, or at best too little information 
for a final classification. This obliges us to limit onr comparisona to 
162 persons of this series, and of these it may be said, that: — 

Wltb u onriTonbla pcofDoali:— 
c Pnsmire 

0( tlw B-HodnaUlT AdTsnced n 
WUh ■ fiTOrlble pmnula «:— 

b.' ImptovMJ. "^\l'.\^yM''.'."\"" 
• + b - 

With Hn anCBT«iflbl» protDtM\Mt— 





Iq this Series also the removal of intervals "less than six mouths" 
makes do significant change in the percentages. 

In comparing the state of the patients of the B series wfth those 
of the A series we may utilize only the cases discharged as "appar- 
ently cured" or "arrested" and of these the Table B has only twenty- 
seven while Table A has 1,068. 

In Table C will be found the report of the cases which entered "in- 
stitutions" (Hospitals, County Homes, Insane Asylums, or even Jails) 
not directly under the supervision of the Department of Health, 
and were "discharged" for this purpose. This table deals with 272 
persons almost exactly half of whom (135) are huown to be dead and 
over four-fifths of these left the Dispensary service with a bad out- 
look. This report also carries many incomplete records which ob- 
scure the result. Because of incomplete data eighty, nearly fiiree- 
tenths of the cases, are not available for further comparison. 

From what remains it appears, that: 

In Table D appear 41fl patients who moved out of the district of the 
Dispensary in which they were enrolled and did not present them- 
selves at another Dispensary of the State Department of Health, 


as they had been urged to do. Oor nurses traced 419 such persons 
of whom 135, nearly a third, were dead. These 419 form only about 
one-ninth of all the cases of "removal." In this aeries our informa- 
tion vas u'nuBually complete and only fourteen cases need to be re- 
moved because of "no data," Removing these and also a glandular 
case, which although doing well constitutes a statistical inconveni- 
ence, 404 cases are available for a comparison which shows, that; — 

Of Oie D.Iaclplent CIIKI 
WIUi ■ tiTonble pnfnoili h:— Were do'nii writ ■>;— 

«. AiTMted, T 4-Ht"«=K% 

b. ImprSTcd 127 N -t- 31 = 110 — n% 

i + b " m «+b-ii6-SI% 

Of the D-MDi]erat«]j Advanced cflftcs 
Wilh ( ttvornblt prOKOoaij ««;— 

b. lnQit«T«d. . 

i - li - 7S» 

1 = S = IWKt 

With • (•TonblB piofoosls >»:— Wfro dolni! wrll «■;— 

1. Arrntcd, o+o— *=■»% 

b, Improred, . 
Wltb aa QiifBTDnblo procnoals:- 

In Table E are presented reports concerning 2,744 patients whose 
relation to the Dispensaries was terminated because of "Non-Attend- 
ance." Of the patients traced, 243, or eight and eight-tenths per 
cent., were dead. The reports are remarkably available for compari- 
son as only forty-six, less than two per cent, are noted as having 
"No data/' leaving 2,698 persons of whom it may be said, that: — 

-If Ih* ElDclpInt nM 

Iiiiptoied or eialionopj 

■. AriM»ntir fored 1 _ 1+0=1^ loin. 

h. Tmnnxn] Ml «T5 + :«S = »lfi = W;. 

» -I- b — l.»S » + b — l.oa = 33% 

With ID nnfaTOrablc pngnoali:— 

f. ProitrpHlvc SU 1«8 + 8J-.255=S1% 

of Ibr E-Mo4cnteIT Adnnctd cufs '> 

«a 851-|-l(M-.6SS~B3^ 

711 « -^ 1 



(svonible ppogmmli;— 

S — :3£ •. 6>% 

roved DT gUttoni 

With aa DOfiiorable prognorti:— 
e. ProgHulT W s + H = a - 14% 

Our last Table, F, deals with 226 patients who did not follow the 
directions given them and consequently were dismissed. Twenty- 
five, just over eleven per cent, were found to be dead. It ia not 
surprising that fifty-three, or nearly twenty-four per cent, have "Ko 
data" records, leaving only 173 cases for consideration. Of these 
it may be said, that: 

Ot tbB F-lnc]plent ukb 
With . ..vo»ble pro„.o.i. m:- '^tVrS^^ ^^S^t^^ 

b." iuproied'. .'".v^'.'^'.'.v^'.'-'^'.'■'■'■'■'■'■'■ «i a+»-n=-t*^ 

Wllb ao nofaTomble profDOfll* ai: — 

c KMoOeralolj Advaui-od i».i-» 

II a FaTorable pfngnoili ai:— Were doJDf wall ai 

Wltb an iiDt*Tanblc prognoii* as:— 
c. PrOfrealTe M « + IS — 

P-F»r AflTa: 

I. Arretla*. 

Impfovcd or StaMonur 

I + 1 - 

For a more convenient survey of the figures presented above the fol- 
lowing conspectus of the six series has been prepared. It permits the 
reader to make an easy comparison of the returns from various points 
of view. In this summary the conditions are noted as percentages of 
the cases belonging to each subdivision and all cases with "no data" 
are excluded because their relation to other cases cannot be deter- 
mined. The term "favorable prognosis" is used for persons for whom 
the discharge classification was "apparently cured," ''arrested" or 
'improved." Cases discharged as "progressive" are reckoned as hav- 
ing an "unfavorable prognosis." Comment on the tabulation will 




Doing wta u: 


II. HsdcntaU 
With ■ fa 



or In mil, '. 

III. Far Adninr«d 

•In<Hiidt« enlT "aiipireDtlj cuird" mul "■ireitnl" neei. 

In making anj inferences from this summary it shonld be remem- 
bered that in only two series is the total number of cases large; in 
some of tbe subdivisiouB the numbers are aofortanately very small. 
Any comparison is limited by the fact that Series A is altogether 
made up of "apparently cured" and "arrested" cases. In Series B the 
showing for the persons referred to the family physician is exceed- 
ingly good and indicates that the patients were for the most part well 
treated. The progressiTe of the far advanced class did not do well 
and this was to be expected. Tbe patients of Class G did not get 
on well in such "institutions" as they entered, with the exception of 
the small group of incipients and here the numbers are very small. 
The incipient cases of the D-Seriee did much better after moving 
away from the supervision of the Dispensaries than would be ex- 
pected, but among the moderately advanced and the far advanced an 
ussatisfactopy outcome becomes more and more marked. The series E 
and F give a most interesting result for the patients who closed their 
relations to the Dispensaries voluntarily but against advice and for 


tbe small group whose treatment was terminated for disciplinary rea- 
sons. The persons of Series E bad been in tbe Dispensaries on en 
average of something over fourteen months and evidently had learned 
the lesson taught there. With a willing spirit mncb may be learned 
in fourteen months. Evidently they felt themselves benefited, and 
were actually not only benefited but able to practise what they had 

While the nurses traced these cases information was obtained as 
to the working ability of many of them. This is presented in a 
couple of tables which deal with Series A and Series E. As these 
tables carry a number of entries with "no data," a certain amount of 
correction must be made before rational comparisons become possible.' 
Thus corrected they show that among the cases regularly dischai^ed, 
Series A, and of occupational age, 

Appear 173 mpn aa fonnprly opciipied of whom arc now occupied, — ' 167 = 96.5% 
And 359 women an formerly occupied of whom are now occupied, — 344 = 95.8% 
AJtogether, of 532 such are now occupied, 511 =96 % 

And also 
Appear 53 men as formerly not occapied, but of whom are now occupied 41 ^77.3% 
And 99 women fnrmerW not oocupied. but of whom are now occupied .12 = 52.5% 
Altogether, of 152 auch are now occnpied 93 = 81.2% 

or 684 peraoDB belonEing to Series A, beinii of occupational age and haTing the 
neceaeaiT data, are employed 6G4 = S8.3%. 

For those discharged because of non-attendance, Series E, there is 
also a table in which, after similar revision, 

Appear 654 men as formerly occupied of whom are now occupied, 667 = 86,7% 

And 923 women rh formerly occupied of whom are now occupied 862 = 93,4% 

AltoRPther, of 1577 auch are now occupied 1428 = 90,6% 

Appear 91 men an formorlv not occupied, but of whom are now occupied 00 = 85,9% 
And 170 women as formerly not occupied, but of whom are now occupied 70^41.2% 

Altofcether, of 261 such are now oi-cupied 130^50 % 

Of 1S3S peraiin)' beloDninf! to Seriea E, heine of occupational age and having tbe 
neoesaary data, are now employed 1550 = 84. S%, 

In two of the series it was possible to gather some data relative 
to the returns from the employment of the persons traced. To on- 
derstand the details a careful examination of the tabulated material 
is necessary. Summarily it may be said here that among the patients 
regularly discharged from the Dispensaries, Series A, 183 men had 
had an average weekly income before admission of |9.50, while for 
188 men at the time of the upfollow the average weekly income was 
reporiied to be 110.16. For tbe women of this series the average 
weekly income of 112 was 15.05 before admission, while 137 declared 
it to be t6.20 when they were traced. Among tbe cases discharged 
for non-attendance, Series E, the average weekly income of 627 men 
had been $10.71 before admission, but for 567 who reported their in- 
comes it had fallen to flO.25 at the time of the upfollow. For the 
womeoi of this series the average we^ly income of 271 bad been 
$6.37 before admission, but when upfollowed 254 declared it to be 
♦6.71. /- I 


The Medical Inspector of Dispenaaries has prepared a table in 
which are classified the persona discharged from ttie Dispeasarie« 
of the Department from 1907 to the end of 1914. It appears that in 
ronnd numbers sixty-two thousand such discharges took place, nearly 
seven thousand of them because of death while still enrolled. Over 
fourteen thousand patients have been transferred to the State Sana- 
toria and are to be traced as having belonged to these establishments. 
Some three thousand of those discharged in 1914 had probably been 
oat of the Dispensaries too short a time to be subject to an upfollow. 
After making these deductions from the figures we hare about thirty- 
eight thousand cases, more or less, to be traced as Dispensary pa- 
tients, but not even the most enthusiastic could possibly expect to 
find them all. For nearly nine thousand, almost a quarter, informa- 
tion has been secured. Some of the information is very scanty and 
merely sntBces to show that further effort is nseless, as in the case of 
many who are now too far removed to be reached. In view of our 
very limited forces to be utilized in a search of this kind such a re- 
sult is good. 

Among the special reports I have included two papers read by Dr. 
A. P. Francine before the Collie of Physicians of Philadelphia. In 
one of tjiem the general problem of the spread of tuberculosis is pre- 
sented with a discussion of the factors on which is based the attack 
now making and yet to be made by the various forms of oi^nized 
effort. In the other paper will be found an interesting historical 
summary of the antituberculosis campaign as hitherto conducted by 
public and semi-public institutions in Pennsylvania and also some 
reflections on the principles on which such a campaign should be 
founded in order to be successful. Both papers are informing and 
well worth a careful perusal by those who may take up this report. 

In response to the wish expressed by many of our Dispensary phy- 
sicians, I decided to make the Wassermann test available to them 
through the Laboratories of the Department, It often happens that 
the complications presented by a. case of tuberculosis are strongly 
suggestive of the presence of syphilis, but with such an obscuration 
of the symptoms as to make the diagnosis difficult. The test itself is 
of such a character that our physicians cannot undertake to make it 
with such facilities as we are able to provide in the Dispensaries and 
recourse must be had to a properly equipped laboratory. In June 
the new line of work was taken up. I considered this service to be 
largely an experiment because it was by no means certain that 
satisfactory tests could be made with such material as tbe staffs of the 
Dispensaries would be able to send in. Up to the end of the year 
nearly a hundred specimens had come to tlie Laboratories from this 
source and only eleven of them proved to be unfit for examination. 




Such reenlts demoostrate verj clearly that this method of making the 
teat available is altogether practicable and it may be expected to be- 
come increasingly usefal as time goes on. A tabnlation of the speci- 
mens with the outcome of the examinations appears in the report 
from the Laboratories. 

The report of the Chief of the Division of Distribution of Biological 
Products shows that the number of our distributiDg stations for 
Diphtheria Antitoxin has now become six hundred and seventy-aix. 
Ten stations were added during the year and one was discontinaed. 
Two stations were transferred to places which seemed better suited 
to the purpose. The stations which also distribute Tetanus Antitoxin 
were again increased by one, so that they now number sixty-nine. 

The tables presented indicate an increase of 2^7 fringes of Diph- 
theria Antitoxin used for curative or immunizing purposes. The 
number of persons treated went up by 122, to 10,562, for those ac- 
tually ill, and by 1,121, to 10,896, for those that received immunizing 
doses after exposure to the disease. For both groups the increase 
is smaller than for the preceding year. No stress should be laid on 
these variations from year to year since they are largely dependoit 
on the varying prevalence of the disease and also upon the character 
of the outbreaks as they occur. The number of immunizing doees is 
of course altogether dependent on the number of incidental ex- 
posures. Our figures do permit the interpretation that there is an 
increasing willingness on the part of the parents among tie poor 
to have their children receive a treatment which has proved to be ho 
efficacious in the cure of this disease. The value of the antitoxin in 
this regard is shown anew by our tables in which the percentage of 
deaths has again dropped to a shade under nine, having been equally 
close to ten a year ago. It also appears that had all the cases, in- 
stead of a little over three-fifths of them, received adequate doses on 
what is reported to have been the first day of the disease the fatality 
for those thus treated would have been well under seven per cent. 
How much less the fatality might become were all cases actually wen 
and properly treated in the early stages it is hard to say, but there is 
no question that a very great reduction is possible. The lai^ gen- 
eral table shows that in some 41,000 cases treated on the "first day" 
the fatality has been a trifie over 5.6%, but this figure would have 
been yet smaller had larger doses of the antitoxin been freely used. 
A student of these figures will naturally ask how it happens that the 
results given in the general table are so distinctly less good for the 
first and second day in the years 19121914 than those which the 
results of the years that immediately precede them would lead as lo 
expect. An explanation is not altogether easy. The mortality from 
diphtheria throughout the State was somewhat higher in 1913 but in 
1912 it was lower than for the two years before. I am inclined to 



seek the explanation, at least in part, in the fact, which an inspection 
of the divisional records has brough^t oat, that in the years 1912 and 
1913 there had been marked carelessness in making the retnms from 
some of the distribntora and from many of the phyricians asing our 
antitoxin, and these irregnlarities were only partially corrected in 
1914. If this explanation be correct then the improvement in the 
results presented in the report of thia year shonld be even more mani- 
fest next year. We have no right to expect completely to eliminate 
death from diphtheria, for each child, each adnlt for the matter of 
that, has its own peculiar susceptibility to all the influences which an 
attack of diphtheria brings with it and also its own peculiar power of 
resistance which is not altogether the same thing. 

The tables relative to Tetanus Antitoxin show that this agent is 
increasingly helpful to the commnnities reached by our distributors. 
The fatality of tetanus treated with the antitoxin from our supplies 
has dropped steadily from eighty-seven per cent, in 1910 to fifty- 
ei^t per cent, in 1911. The quantity of antitoxin used was much 
greater than a year ago and the cases were a littie more numerous, bat 
these things depend of course upon accidental conditions and have 
no general significance. Our results are as good as we may expect 
to have under existing circumstances, or until the disease can be 
recognized more promptly and receive immediate treatment. 

By a Joint Besolation of the General Assembly, approved by His 
ExcellCTcy, Governor John K. Tener, the fifth of June, 1913, (P. L., 
1913, 438), a Commission was created "to arrange for and anpervise 
the transfer, from the Library and Museum building to the cases in 
the rotunda of the Capitol building, of the flags of Pennsylvania com- 
mands in the War of the Suppression of the Rebellion and the Span- 
ish-American War, and other flags of historical value, and to arrange 
a proper and fltting patriotic ceremony in commemoration therof." 

In due time the oi^anization of this Commission was completed, 
and it was announced that for the transfer of the flags the day widely 
known as "Flag Day" had been chosen, which in 1914 would be 
observed on the fifteenth of June. 

As the nature of the ceremony became known it was apparent 
that old soldiers woald forgather in Harrisburg in large numbers 
on that occasion, and that a hot day, or a series of the hot days that 
June sometimes brings, might mean an exposure such as aged vet- 
erans are ill-fitted to endure. Considerations of this kind led to a 
conference of the Governor and Adjutant General Stewart, the Secre- 
tary of the OommisBion in charge of the transfer of the flags, with 
the Commissioner of Health. In this conference it was decided that 
the CommisBioner of Health should be placed in charge of such ar- 
ranganents as seemed to be needed properly to care for any attending 


the ceremonj wbo might require medical assistance eitlier in the 
form of first aid or by removal to a hospital for more prolonged treat- 

Acting in this capacity I called upon the medical members of my 
ofBce force and a portion of the stafE of the Harrisburg Tubercnlosis 
Dispensary to fill positions in the relief hospital which I proposed 
to establish in the Capitol on that day. I also summoned the Medi- 
cal Director of the Mont Alto Sanatorium for active service and di- 
rected him to loan us his ambulance for use in the parade at Harris- 
burg or for the rapid transport of any serious case to the Hospital. 
The officials of the Harrisburg Hospital readily agreed to provide for 
the prompt reception of any persons coming under our care during 
the procession or at the Capitol for whom hospital facilities seemed 
desirable. The Chief Visiting Dispensary Nurse was called in to 
take charge of the nurses who were on duty in the procession or at 
the Capitol. Cots were put in suitable places on the main floor of the 
Capitol. Emergency outfits were provided so that we should be 
prepared to succor even a considerable number of persons. Stretdi- 
ers were at hand for the removal of any wbo could no longer walk. 

In the actual transfer of the fiags the carriers and many other vet- 
erans marched in procession for a few squares through the town be- 
fore reaching the platform in front of the Capitol where the formal 
addresses were to be made. In this procession also went our ambu- 
lance carrying a departmental physician, a nurse, and two orderlies. 
In two automobiles I was accompanied by two more physicians and 
two nurses, all ready for any emergency which might arise. When 
the march was finished the ambulance was stationed near the north 
entrance to the Capitol that a speedy journey to the hospital could 
be made with any case of exceptional seriousness. The medical men 
went from the parade to special duty in the Capitol or were stationed 
about the grand stand on the lookout for any veterans who should 
be in need of medical help. Eight orderlies were on duty, but as 
the demand for their services was small they were mainly employed 
in carrying pails of drinking water Which was ranch weicoraed on the 
grand stand. 

The day was not excessively warm nor had it been immediately pre- 
ceded by very hot weather. The result was that our first aid outfits 
were not much called into service. Into the waiting room by the 
front door, the nearest of our stations, came one elderly veteran from 
a neighboring county, a litle disturbed by a change to a metropolitan 
diet, a member of the Htate Police with a mild headache, and two 
ladies showing some slight need of restoratives and repose. Outside, 
on the stand or near it, three veterans received light analeptic treat- 
mrait declaring themselves too little affected to enter the building to 
be cared for. One of these platform cases was a well-known ofBcer 


of high rank, well up in the ei^tieB, whose sudden death at home was 
annonnced only twelve days later. This I take to be a good illoBtra- 
tion of the nairowDess of the path along which many of our viBitors 
walked that day. A little more heat, or a little more hamidi^, would 
have meant much more harm to our old soldiers. We may well be 
glad to have had so little to do, but to have been ready for any emer- 
gency is also something to be proud of. 

The dlspoeition of our sanitary corps was this: — In the pro^'ea- 
sion: — the first of our automobiles carried the Gommissioaer of 
Health, Dr. Samuel G. Dixon, in charge, accompanied by tlie Chief 
Medical Inspector, Dr. B. Franklin Eoyer, and the Chief Visiting 
Dispensary Nurse, Miss Alice M. O'Halloran. The other untomohile 
lurried the Medical Inspector of Dispensaries, i>r, Thomas H. A. 
Ktites, and a nurse. Miss Butler. On the departmeiUal ambulance 
was the Associate Chief Medical Inspector, Dr. Oharled J. Hunt, 
with a nurse. Miss Sbellenberger, and two orderlies. After the parade 
all these were on duty in the Capitol, or about the stand outside, or 
with the ambulance stationed near the north door. 

In the Capitol our Consulting Surgeon, Dr. George B. Kunkel, 
was stationed in the main office of the Division of Sanitary Engineer- 
ing with one of the nurses from the parade and a couple of orderlies, 
ready to be anrnmoned for any surgical emergency. In the north 
corridor, near at hand, were placed several cots, ready for immediate 
use, in chaise of the Chief of the Division of Distribution of Biologi- 
cal Products, Dr. J. Moore Campbell, and the Assistant Chief Medi- 
cal Inspector, Dr. John J. Mullowney, assisted by the nurses Miss 
Zjewis and Miss Both. The waiting room near the main entrance, 
equipped with two cots and several reclining chairs, was in charge 
of the Assistant to the Commissioner, Dr. Joseph W. Warren, as- 
sisted by the nurse Miss Doyle. 

Outside, on the stand or near at band, were also the State Begistrar, 
Dr. Wilmer B. Batt, the Medical Director of the Mont Alto Sanator- 
iom, Dr. Fred, C. Johnson, and the County Medical Inspector, Dr. 
Clarence R. Phillips. As orderlies served Messrs. Braugher, Butter- 
worth, FoTsythe, Heister, Miller, Myers, Seiders, and Shindler. 

Very soon after the beginning of the war in Europe it became evi- 
dent that a most serious interference with our supplies for disin- 
fection purposes was to be expected. The generally acceptable 
method for the di^nfection of rooms which have been occupied by 
cases of communicable diseases involves the development of formalde- 
hyde gas from its aqueous solution. This process requires the use 
of a certain quantitj- of the permanganate of potash. The amount 
of this substance needed for the fumigations made by our Health Of- 
ficers is enormous. In the year 1913 our storekeeper had to supply 
1S61 "units" of disinfectants each including twenty-two poanda,iof^ 


tbe permanganate, making a total supply of over fort; thoasand 
pounds for tiiat year. The price of tbiB chemical immediately started 
to soar and there was even reason to fear that the supply mi^t be al- 
together cnt off unless the war came to a speedy end, 

I at once began to look about for some other substance which conld 
replace the permanganate of potash, at least until the price should 
fall again within reasonable limits. With the aid of our consulting 
chemist experimental studies were undertaken to find a satisfactory 
substitute. Our search was more rapidly successfnl than we bad 
dared hope, and we were soon able to announce that the dichromate of 
sodium could replace the permanganate of potash in disinfection out- 
&ta such as are used by ne and elsewhere. The development of the 
gas by the use of the dichromate proved to be even more rapid than 
when the permanganate is employed. It was also found desirable to 
add a certain proportion of sulphuric acid to the solution of formalde- 

As soon as the new method was fully demonstrated to be prac- 
ticable, I arranged for its utilization in our disinfection work, and 
made it known by the following brief publication in the widely read 
Journal of the American Medical Association (Sept. 19, 1914; vol. 
Ixiii, p. 1025). 

Bomttcl O. Dii^n, U . D.. LL. D. 
Commissioner of Henlth, Comn)oDW«nltli of FpnnnylvHiiia. 

Almost immediately after the declaration of war by Oermany I 
requested the department's chemist, Mr. Charles Lawall, to proceed 
at once to find a substitute for potassium permanganate that^tvoald 
liberate formaldehyde gas from a water solution for the purpose of 

In the literature no mention of any other specific snbstance was 
found except in an English patent application (4885, J. 8. C. I., 1908, 
915), where a combination of sodium bisulphite and formaldehyde 
solution was acted on by potassium permanganate or other perecid 
salt, and the fumigation formula; 

E^ht ounces of this solution are used to 1 pound of lime to 1,000 
cubic feet 


Dr. George Bofiengarten suggested aodium dichromate as a cheap 
oxidizing agent, and hydrochloric acid to increase its energy. Lawall 
foQDd on experimenting that sodium dichromate was more energetic 
and satisfactory in the presence of sulphuric acid. 

Numerous experiments, confirmed by calculations on the relative 
oxidizing power of potassium pormanganate and sodium dichromate, 
and also working out the optimum proportion of sulphuric acid, led 
to the conclusion that the following proportion gave the best re- 
sults, which are in every way comparable to those with potassium 

Sodium dichnimBte 10 oiiDcee avoirdupois. 
Saturated solution o( formaldehyde gaa 1 pint. 
Sulphuric aeid, commercial, Ij fluid oudcch. 

The sulpharic acid and formaldehyde gas form a stable solution. 
This after it cools should be poured over the crystals of sodium dich- 
romate spread out in a thin layer over the bottom of a vessel having 
ten times the capacity of the volume of ingredients qs^. 

It was found that the process was more rapid than^^l potasdnm 
permanganate. This would necessitate the healtb^Bew's with- 
drawing promptly from a room in which the process haooe^i started. 

Ijawall, when working on a small scalej found in every case a corro- 
sive residue. Much to his surprise the residue in ten minutes was dry 
and pulverulent, and a galvanized bucket which had been used showed 
very little effect of the reaction after washing out with soap and 

He made a quantitative determination by both the permanganate 
and dichromate methods to determine the amount of volatile material 
given off and found that in each case it approximated eight ounces 
avoirdupois (or about half the weight of the formalddiyde solution 

As formaldehyde solution contains between thirty-five and forty 
per cent, of gaseous HCOH and as the residue in each case was 
found to be dry and particularly devoid of odor after two hours' 
standing, Lawall concluded that the two methods are equally effective 
from the quantitative standpoint. 

Formaldehyde solution and commercial sulphuric acid may be kept 
in stock and shipped in the mixed form (ten parts of formaldehyde 
solution and one part sulphuric acid, both by volume). Lawall found 
the solution would be perfectly safe. 

The solution would have to be handled with more care than the 
plain formaldehyde on account of the acid making it slightly corro- 

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The eliminatioii of mosquitoes ia a problem of perennial interest to 
Banitarians. This can be accompliBhed only by the deatmction of tbe 
larvae or pupae which are fonnd on the surface of streams or may 
occur in any open receptacle containing water. In Btreams and ponds 
certain small fish are known to be active destroyers of the larvae 
and other forms of aqnatic animals are believed to be similarly effi- 
cient. For some time I have looked upon the dach as likely to be an 
important aid in this matter. Observations made on my farm have 
confirmed this opinion and led me to present my conclusions in a 
brief article in the Journal of the American Medical Associatioii (Oct. 
3, 1914; vol. Ixiii, p. 1203) which I reprint below. 

Samuel O. Dixon. M. D., LL. D. 

CommltigioDer of H<-altb, Cnmnionwcitltb of Ppnunylvnnia . 

The duck is one of the greatest known enemies of the mosquito, and 
therefore of yellow fever and malaria. It has possibly one of the 
widest geographical ranges of any of the birds. It is even found in 
the Arctic and Antartic regions; also in Australia, where bird life 
is 80 peculiar. 

After trying the ability of fish to devour larvae and pupae of mos- 
quitoes, with varied success, I built two dams near together on the 
same stream, so that each would have the same environment for the 
breeding of mosquitoes. Each covered nearly 1,400 square feet In 
one, twenty mallard ducks, Anaa platyrhynohoa, were permitted to 
feed, while the other was entirely protected from water fowl, but well 
stocked with goldfish, Caraasius auratua, variety americaims. 

The one in which the ducks fed was for several months entirely free 
from mosquitoes, while the pond protected from ducks and stocked 
with fish was swarming with young insects in different cycles of life. 

To the infested pond ten well fed mallard ducks, Anaa platyrhyn- 
choa, were then admitted, and as they entered the pond they were first 
attracted by the larval batrachians, tadpoles. They, however, soon 
recognized the presence of larvae and pupae of the mosquito and im- 
mediately turned their attention to these, ravenously devouring them 
in preference to any other foodstuff present. At the end of twenty- 
four hours no pupae were to be found and in forty-eight hours only 
a few small larvae survived. The motion of the water, made by the 
ducks, of course drowned some of the insects— what proportion can- 
not be estimated. 



For some years I have been using ducks to keep down mosquitoes in 
Bwampa that wonld have been very expensive to drain, but I never 
fully appreciated the high degree of efBciency of the duck as a de- 
stroyer of moequito life until the foregoing test was made. 

In the work of Howard, Dyar, and Eiiab, entitled "Mosquitoes of 
North and Central America and the West Indies," will be found" 
an essay on the destruction of the mosquito and house fly by Mr. Wil- 
liam Beateumueller, who expreesea the opinion that aquatic birds 
could be used for the purpose of destroying mosquito larvae. 

Mr. William Lockwood of Boston, an artist, who made a hobby 
of raising aquatic fowl, also expresses an opinion that the spoonbilled 
duck is particularly adapted to the destruction of mosquito larvae 
resting on the surface of the water. 

Mr. McAtee of the Biological Survey found mosquitoes in the giz- 
zard of the mallard duck. While other birds, fish, spiders, batra- 
chians, arthropods, and reptiles are aU enemies of the mosqnito, 
none of them have such a wide geographical range and a capacity of 
devouring large numbers of the larvae and pupae o'a land and water as 
the duck. 

Ducks can be used in ponds and swamps, both open and in jungles, 
and can be driven from place to place. Not only can they be gen- 
erally used to keep down mosquito life but tbey also fnmish a deli- 
cious and valuable foodstuff. 

The practice of utilizing the newspapers for the dissemination of 
information concerning the work of the Department has been con- 
tinned. In weekly "Talks" I have briefly discussed questions per- 
taining to public and domestic sanitation and in simple language have 
commented on the conduct of life from the point of view of one who 
would encourage sane living among his feUowa The press notices 
which have been brought to my attention and the very numerous 
letters which have come to me indicate that these talks have been 
widely read and approved. 

The monthly "Health Bulletins" bearing the year 1014 as a dale 
areas follows: — 
No. 54, JanucuT' The Waters of Pcnnsylvaula, An AiWress before the 

State Board of Agriculture. 
No. B5, February. R^roducUon ajid Race Betterment. 
No, 56, March. Tlie Service TuberculoBie Dispensary aa a Social Service. 

No. 28 revlBed, Aprtl. The Preparation rf Oie Biological Products dis- 
tributed by the Pennsylvania Department erf Health. 
This Bulletin was an extensive renrlaion o( the Bulletin 
bearing the same title and originally Issued In October, 


I FKderifli Krdb;— Ufwqtilloea of Nwth ind Centnl jt 



No. 57, Maj. Insanitary Bathtubs and Lavalories. 

No, 6S, June. On Housing. 

No. 59, July. Medical un<l Sanitary Inapecllon of Schtwla ot Fourth 

Class Districts In Pennsylvania. 
No. 60. August Progress In Preventive Medicine lu PenoBylvnnla since 

tlie Creation of a State Department at Health. 
No. 61, September. Certain Standards fof TubiiidlloaU DlspoDsacies. 
No. 63, October. On the Upfolloii' of Sanatorium PatlenU. 
No. 63, November. Effeetlve Rural Sanitation. End Results. 
N^. 64, December. Pennsylvania's System of Tuberculosis Dispensaries. 


As usaal the year has brougbt many requests for addresses or 
papers to be given at the meetings of clubs and societies interested 
more or less definitely in the problems of public health and sanita- 
tion. Whenever possible snch requests have been granted and I have 
attended the meetings or, when unable to appear in person, have 
sent a suitable representative. Meetings of this kind furnish an op- 
portunity, which no farsighted ofBcial willingly neglects, to sow the 
seed of personal reBponsibility and social obligation regarding public 
health,even though some of the seed fall where the soil seems neither 
deep nor rich. I have also endeavored to give practical expression 
to my desire to cooperate with State and National Associations deal- 
ing with the general welfare along lines which touch the work of this 
Department. At many such gatherings I or a delegate have been 
present for active participation in the conferences and discosBions 
as will appear below. 

On January 19, the Chief Medical Inspector, Dr. B. Franklin 
Royer, attended a meeting of the Civic Club of Harrisbui^ and 
spoke on "School Hygiene." 

On January 28, by invitation of the State Board of Agriculture I 
was present at one of the sessions of its meetings in the Capitol at 
Harrisburg and made an address on "The Waters of Pennsylvania." 

On January 29, the Medical Director of Dispensaries, Dr. Thomas 
H. A, Stites, spoke to the Civic Club of Steelton on "Tuberculosis 
and the Work of the State Department of Health." 

On February 9, Dr. William G. Turnbull, Medical Director of the 
Cresson Sanatorium, spoke in a gathering of medical students, mem- 
bers of the Undergraduate Medical Association of the University of 
Pennsylvania, on the "Sanatorium Treatment of Tuberculosis." 

On February 11, the Chief Medical Inspector represented the De- 
partment at a meeting of the Philadelphia Pediatric Society and par- 
ticipated in a discussion in the "Symposium on Measles." 

On February 19, Dr. B. Franklin Royer made a public address be- 
fore the Rorosis Club of Langhorne, sjwaking on "Kugenics." 



On Febrnary 25, Dr. John J. Mullowney, Assistant Chief Medical 
Inspector, made an address in the High School at Hummelstown be- 
fore the students of the Bchool, the Parents Association, and the 
- School Directorfl, His sabject was, "The Progreae of Civilization 
depends largely on the Health of the People." 

On April 21, the Chief Medical Inspector attended a meeting of 
the Lackawanna County Medical Society at Scranton and made an 
address on "The Activities of the State Department of Health of 
Pennsylvania, with a E48iim6 of its moat striking Results." The 
next day be attended a meeting of the Health OfBcers with the Connty 
Medical Inspector la the departmental Tubercolosis Dispensary at 
Scranton, and on the following day was present at a simUar meet- 
ing of the County Medical Inspector and the Health OfBcers of Wayne 
County at Honesdale. 

On April 26, Dr. Eoyer went to Erie to speak to the Women's 
Club of that city on School Hygiene. On one evening a lantern 
demonstration was given, followed the next afternoon by a talk before 
the Club. 

At the reqaest of the York County Medical Society that the De- 
partment be represented at its annual meeting on May 7, I dele- 
gated tbe Associate Chief Medical Inspector, Dr. C. J. Hunt, to go 
to York for this purpose. Dr. Hunt addressed the Society on "The 
Activity of the Department." On the evening of the same day Dr. 
Hunt spoke in a meeting of an association of women at Camp Hill 
in Cumberland County. 

On May 6, by my direction Dr. Royer attended a part of the meet- 
ing of the American Sanatoriom Association held at the Maryland 
State Sanatorium at Sabillasville. 

The annual meeting of the N'ational Association for the Study and 
Prevention of Tuberculosis at Washington, May 7-9, 1 was able to at- 
tend for only a very limited time and requested Dr. B. Franklin Royer 
and Dr. Thomas H. A. Stites to represent the Department in as many 
sessions as possible. In the Historical Section Dr. Boyer read for 
me a paper on a "Discussion of the Department's Plans of Operation 
in the Tuberculosis Campaign." 

On May 27, by invitation of the Philadelphia County Medical So- 
ciety, the Department of Health made an exhibit of relief maps, 
models, photographs, and charts illustrative of its work. These 
were displayed in a hall of the building of the College of Physicians 
of Philadelphia for some hours and were explained to visitors by a 
corps of demonstrators. At half past eight on the same day there 
began what had been announced as "An Evening by Department of 
Health, Commonwealth of Pennsylvania." On this occasion I made 
an introductory address on the general work of the Department and 


then spolce represeatatives of tbe various Divisions to whom special 
topics tiad been assigned as follows: — 

Dr. Wilraer R, Bntt, Harrishiirg, "Vitiil Stiitintira;" Dr. B, FrBuklio Royer 
Hnrrisburg, "Medicnl IHvicinn ;" Dr. IMgiir M. (ireen, Faxton, "County Medical 
Work" i, e. Work of tlie Couiity Mfdiail Inspit-lor: Dr. C. J. Hunt. Harriiiburg, 
"Adminfstratiou in Typboid Epidemics;" Mr. C. A. Emerson, Jr., Harrisburg, 
"EnEineerlDg Diviaioo:" Dr. J. 11. Ruckor, Jr., Pbilndi^lpbia, "r^aborBtoriea ;" Dr. 
A. P. FrandQe, Philnddpliiii , "DiKpenBiiries;" Dr. W. G. Tiirnbnll. Creason, 
"SanatoriH ;" Dr. S, M. Riiii'liiirt, PittsburKh, "PhUniithropic CuoperatioD with 
State Tuberculosis Work;" Dr. R.i.t Vera Zubnrkpa, Crcsaon Sanatorium. "Ei- 
periencea as nn Intirne in a Stiitc Kfliuitoriiiin ." 

On the whole this preaeiitutirm of the worit of the Deportment to the profession 
at lan[« was emiiienlly BilrccusfHl . At the requpat of the County Medical Society 
the medical mou of Philadelpbin hud lieca invitt-d to inspect the exhibit and hear the 
addresses. The nttendnnce was larse. 

For June 9, I was invited to present a paper in the "State-wide 
CJonferenee on Public Health conducted by the School of FolitiCB of 
the Progressive Clnb of Greenwich, Connecticnt" Despite my ear- 
nest desire to aid in this very influential development of interest in 
the problems of public health I could not see my way to attend this 
conference, and I asked Doctor Royer to act as my representative. 
Dr. Royer accordingly went to Greenwich and read a paper on the 
"Progress in Preventive Medicine in Pennsylvania since the Oreatiou 
of a Department of Health." 

At the annual meeting of the American Medical Association held 
this year at Aflaodc City, June 23-25, the Department was repre- 
sented in many of the sections by Dr. B. Franklin Royer and Dr. C. 
J. Hunt. 

At the annual meeting of the Medical Society of the State of Penn- 
sylvania, held at Pittsburgh, I was represented, on September 22d, 
by the Chief Medical Inspector who took part in a discussion on pro- 
longed infectivity in Scarlet Fever. 

On September 24, I was again represented by the Chief Medical In- 
spector at a meeting of the nom<popathic Medical Society of the State 
of Pennsylvania, in annual session at Galen Hall in Weraersville. 
In this meeting Dr. Royer spoke, dwelling on some of the more impor- 
tant results attained by the State Department of Health in its work. 

On October 7, the Associate Chief Medical Inspector delivered an 
address before the Lancaster County Medical Society, and on the same 
day acted as my representative nt the meeting of the State Federation 
of Charities at Carlisle. 

By a Committee in charge of a "Suburban Tmprovera«it Day," to be 
held on October 0, at Bristol, with the cooperation of nine boroughs 
and eight townships of southeastern Bucks Counfy, I was invited to 
be present and make an address on "Suburban Health Problems." 
Departmental duties precluded my personal attendance at this gather- 
ing and I was obliged to ask my Secretary to go to Bristol and read 
my pai)er for me. 

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On November 16, in response to an invitation of the Civic Clnb of 
Harrisburg, I attended a meeting of the Club in the aaditorium of the 
new building of the Young Women's Christian Association. Here I 
was able'to show a large number of iustnictive lantern slides to il- 
lustrate a talk on certain aspects of the bousing problem. 

On November 19, I joined in the Second Annual Penn^lvania In- 
dustrial Welfare and EfHdency Conference, in the Capitol at Harris- 
bui^, and read a more formal paper on "Housing" before the Wel- 
fare Section. 

The Annnal Meeting of the American Public Health Association, at 
Jacksonville, Florida, December 1-4, was attended by the State 
R^strar, Dr. Wilmer U. Batt, who presented the report of a com- 
mittee in the Section on Vital Statistics. 

By invitation the Medical Inspector of Dispensaries Dr. Karl 
Schaffie gave a talk befoi-c the Board of Charities of Tamaqua, De- 
cember 9th, on the "Value of the Tuberculosis Dispensary to a Com- 
mnnity and the Relation between Dispensary and Sanatorium." In 
the evening Dr. Shiiffle gave a similar talk in the Reformed Church of 
Tamaqua. In both talks emphasis was laid on the proximity of the 
new Sanatorium at Hamburg. 

In the winter by invitation of the Ladwick Institute Committee on 
Instruction, free public lectin cs were given in the lecture hall of 
**The Academy of Natural Sciences of Philadelphia," January 26, by 
Dr. B. Franklin Royer, Chief Medical Instructor, on "Plaguea and 
their Prevention," and on February 2, by P. Herbert Snow, Chief 
Engineer of the Division of Sanitary Engineering, on "Danger in 
Bad Water." 

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During the first four months of the year 1914 the time of the Gen- 
eral iDspector, other than that devoted to general office work, an- 
swering of correspondence, examination of Touchers, etc., was largely 
taken up assisting in the preparation of testimony for the case of the 
Woodman Lumber Company which was instituted in the courts of 
Danphin County on July 18, 1913. Several trips were made in con- 
nection with this case to the Philadelphia office, to Cresson, Pitta- 
burgh, and other points. This case came up for trial in the courts 
of Dauphin County in the month of April, 1914, Hon. Charles V. 
Henry, President Judge of the courts of Lebanon County, specially 
presiding. The Commonwealth was represented by James Scarlet, 
Esq., Deputy Attorney General J, E. B, Cunningham, and P. H. Hart- 
man, Esq., specially employed to assist in securing testimony. The 
plaintiffs — Woodman Lumber Company — were represented by ex- 
Governor William A. Stone, John T. Brady, Esq., Hon. M. C. Wat- 
son, and Brace Campbell, Esq. About one week was taken up with 
the introduction of testimony on behalf of the plaintiffs. The case 
opened for the defendant and the Commissioner of Health was called 
as a witness. No further testimony on behalf of the Commonwealth 
was introduced, and €»n April 25th the case was concluded, the 
Jury rendering a verdict in favor of the plaintiffs in the sum of f3S,- 
000. The contract price in this case was f249,497,00 subject to a de- 
duction on account of change of plans amounting to |1,436.35, leaving 
a net contract price of 1248,060.65 on which had been paid the amount 
of f211,474.26, leaving a balance due plaintiffs of 136,586.39, which 
with interest from the 1st of January, 1913, the date when the con- 
tract was practically concluded, would have amounted to {39,330. 
In addition to this amount the plaintiffs claimed large sums amount- 
ing to about 180,000.00 for alleged extras and damages. The verdict 
was a decided victory for the Commonwealth and supported fully the 
contention of the Commissioner of Health that the claims of the plain- 
tiff were not justified and that nothing was due the contractors 
other than the unpaid balance of the contract price- 
In the latter part of March, 1914, George W. Atherholt, local regis- 
trar of the registration district of the city of Philadelphia, who was 
also occupying the office of Chief of the Division of Vital Statistics of 
the Department of Public Health and Charities of the ci^ of Hiila- 
(129) ,- I 

9—16—1916 I LnOOgIc 


ilfilphia, was dismiBsed from his city office and Nera B. Deardorfl wag 
appointed by tlie Acting Director of Public Health and Charities to 
succeed him, thereupon the question arose between the Commonwealth 
and the city of Philadelphia as to whether or not nnder the provi- 
sions of Section 4 of the Vital Statistics Act of May 1, 1905, the ap- 
pointee to the city office of Chief of the Division of Vital Statistics 
became ex-offlcio local registrar for the registration district of Phila- 
delphia. In the meantime the appointee of the Commissioner of 
Health, Qeorge W. Atherholt, secured offices outside of Cil^ Hall and 
continued to act as local registrar. In order that this question might 
be determined and unnecessary duplication of work avoided, quo 
warranto proceedings were instituted by Attorney Qeneral John C. 
Bell against !Neva E. DeardortT to show by what authority she at- 
tempted to exercise the duties of local r^strar in and for the regis- 
tration district of Philadelphia. This case was heard in the courts 
of Dauphin County before Hon. George Kunkel, President Judge. An 
opinion was rendered on the case by Judge Kunkle upholding the con- 
tention of the Department of Health and Charities of the city of 
Philadelphia and confirming the right of Neva B. Deardorff to be 
continued as local registrar. From the decision of Judge Konkel an 
appeal has been taken and is now pending in the Supreme Court 

During the year 1914 there were very few reported violations of 
quarantine laws and only two prosecutions were ordered: one in 
Westmoreland County for a violation of quarantine restrictioua for 
diphtheria, and one in Lancaster County for the failure of a physi- 
cian to report cases of diphtheria. The Lancaster County caM is 
of special interest. The defendant, Dr. W. W. Evans of LItitB, was 
prosecuted in 1912 and fined for similar offenses. In the present case 
the child he was treating died and considerable public sentiment 
was aroused against the physician because of his failure to report 
the case as diphtheria and have the premises quarantined and because 
he had neglected to administer antitoxin. This case was heard be- 
fore a magistrate in the city of Lancaster and the defendant was fined 
the maximum fine of one hundred dollars and the costs of prosecu- 
tion. An appeal was taken to the court of Common Pleas of Lan- 
caster County and the case was reviewed by the Common Pleas court 
and the judgment of the magistrate affirmed. The defendant, Dr. 
Evans, has appealed from the judgment of the Common Pleas court to 
the Superior Court of Pennsylvania in which court the case Is now 

In the month of February, 1914, a complaint was received from 
citizens of Torresdale, Philadelphia, alleging that a cemetery had 
been established just outside the city lines in Bucks County in Ben- 
salem Township and in dangerous proximity to Poquessing Creek 
which empties into the water supply of the city of Philadelphia a 


short distance above the Torreedale intake. An inspection was made 
by the General Inspector vbich confirmed the statements of the peti- 
tioners, the proposed location of the cemetery being on a tract of 
sloping land draining directly into the said creek bat a few hundred 
feet away. This matter was taken up with the owners of the ceme- 
tery plot and a stipulation was entered into by the several owners 
to the eBect that no burials should be made in that part of the tract 
definitely designated by meets and bounds which was on the slope 
toward the creek, but that burials should be restricted to another 
part of the tract sloping in an opposite direction and at a more re- 
mote distance from the stream. This agreement was entered of 
record in Bucks County and was an adjustment satisfactory to all 

Daring the month of June notices from fourth-class school dis- 
tricts to the effect that resolutions had been adopted not to have 
medical inspection for the ensuing year were received by the Gen- 
era! Inspector, tabulated, indexed, and filed. The number of these 
notices received added still greater enconragement to Uia work of 
medical inspection, only 219 fourth-class districts having voted 
against medical inspection in contrast with 585 districts in 1913, 
Sa in 1912, and 1,617 in 1911. It is quite aparent that the medical 
inspection of schools generally is meeting with favor among the people 
of the State. 

Daring the year the General Inspector visited and was in confer 
ence with th^ following County Medical Inspectors regarding condi- 
tions in their several districts, viz: — 

Dr S. Meigfl Beyer, Jefferson Co. Dr. T. N. McKee, Armstrons Co. 

Dr. S. M. Kinehart, Allegheny Co. I>r. S. C. Stewart, Clearfield Co. 

Dr. W. B. Matthews, Cambria Co. Dr. J. C. Heifanjder, Lackawanua Co. 

Dr. C. H. Miner. LuBerne Co. Dr. H. L. McKown, Wyoming Co. 

Dr Josepii Scattercood, CbpHterCo. Dr. C W. Toungmnn, Lycoming Co. 

Dr. I. M, Portaer, Westmorelacd Co. Dr. S. P. Hakes, Tiojta Co. 

Dr Edgar M. Green, Northnmpton Co. Dr. J. T. Inma, Greene Co. 

Dr. Israel Cleaver, Berks Co. Dr. C. B. Wood, Washington Co. 

Dr. W. A. Simpson, Indiana Co. Dr. H. H. Whiteomb, Montgomery Co. 
Dr. J. L. Mowery, Lancaster Co. 

and also was in conference in the office at Harrisbnrg with 

Dr. J- R. Dickson, AdiimH Co. Dr. J. T. Bute, Lehigh Co. 

Dr. Walter de la M. Hill, Bedford Co. Dr. P. P. Fisher, Mercer Co. 

Dr. Joseph Findley, Blair Co. Dr. R. H. Simmons, Northumberland, 

Dr. H. D. Bsshore, Cumberland Co. Pa. 

Dr. 8. B. ArniBDt, Columbia Co. Dr. A. R. Johnston, Perry Co. 

Dr. C. R. Phillips, Dauphin Co. Dr. J. L. Christina, Sullimn Co. 

Dr. H. C. Frontz, Hnntingdon Co. Pr. J. S. Miller, York Co. 

Dr. A. J. Riexcl, Lebanon Co. 

Sixteen special inspections were made during the year relating 
to the work of Health Officers of the Department, three inspections re- 
lating to the work of Stream Inspectors, and three inspections re- 
gart^g the work of Medical Inspectors of Schools. 

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The General Inspector during the year visited the CressoD Sana- 
torium three times, Hambui^ twice, and Mont Alto once. 

The following boroughs and flrst-class townships were visited dur- 
ing the year by the General Inspector inquiring into the work ot local 
Boards of Health, viz: — 

ALLEQUENY COOIfiTY. lieu Avuu HeightE, Braddock, Carrick, Cruftou, 
Elisabeth, North Braddock, Turtle Greek, and W«at Elisabetb; and Braddock, 

Cbartlera, Mt. Lebanon, and Shaler Towaahiiiii. 




CHESTER COUNTY. Avoudale and Kennett. 




LUZERNE COUNTY. Duryea, Nantieoke, Nuangola, Pittston, and Sugar Notcb. 

MERCER COUNTY. FarreU and Cwve City. 

NORTHAMPTON COUNTY. Naiareth and Wilson Townabip. 




WASHINGTON COUNTY. Buntettatown and Charleroi. 

WESTlfORELAND COUNTY. IrwiD and Moneesen. 

At the beginning of the year there were two hundred and forty-sii 
boroughs and flrst-class townships in the Btate in which there were no 
Boards of Health, or if Boards of Health had been appointed they 
were inactive and not properly executing the health laws. Daring 
the year new Boards of Health have been established in one hundred 
and twenty-nine of these boronghs and townships, and are active and 
efficient. The majority of the boroughs not having Boards of Health 
are small, running considerably under five hundred in population, and 
in many instances the Councils have made repeated efforts to secure 
citizens to serve on a Board of Health, without success. New Boards 
of Health have been established in the following boroughs and town- 
ships, viz; — 

ADAM8 COUNTY. BUclerrille, Littleitown, and McSherryatown. 

ALLEGHENY COUNTY. Dnquesne, East Pitmburgh Edgewood, GlasBport, 
Haysrille, North Braddock, Versailles, and West Eliiabeth; and Collier aad Mil- 
Bin TowDshipa. 

.IRifSTRONO COUNTY. Freeport, 

HR.AVF.R COUNTY. DnrtinKtnn, and Sbippiiigr'ort. and Borough TowuHbip. 

BRADFORD COUNTY. CantoD, Monroe, and WynlusinK. 

BUCKS COUNTY. Dublin, LnnRhorne, Ijingborne Manor, and Nt>«town. 



CAMBRIA COUNTY. Cheit SpringH. Dare, Hasange, Oakhurtt, Patton. and 
CARBON COUNTY. BowmaiiHtown, RsHt Side, and Pairyville. 
CENTRE COUNTY. State College. 
CLINTON COUNTY. Flpmington, and T^ganton. 
DAUPHIN COUNTY. Faxtang, and Penbrook. 
DELAWARE COUNTY. Gienolden, and Afltdn Township. 
ERIE COUNTY. East Springfield. 

FAYETTE COUNTY. Bellevemon, Smithfield, and South Browuavtlle. 
GREENE COUNTY. Jefferson. 

HUNTtNODON COUNTY. Graysrille, Mount Union, and HoclcTille. 
INDIANA COUNTY. Chenytref. Snltsbiirg, UDd Shelot-ta. 

LACKAWANNA COUNTY. ClnrltB Summit, Dirkson City, and Dunmore. 
LEBANON COUNTY. Myeratown, and Palmyra. 
LEHIOH COUNTY. Albiirtis, and BmauB. 

LVZERNE COUNTY. Conyogham, Eipter, 1.rfirkst-i]1e, and Swoyereville. 

MERCER COUNTY. ClaricRville, Paro'll. Sharpsville, and Whealland. 
yORTBAMPTON COUNTY. Northampton, and Roaeto. 
PERRY COUNTY. Blain, and Newport. 
SCHUYLKILL COUNTY. Mfddleport. and St. Clair. 
S03IF.RSET COUNTY. Addison, New Centervllle, and Paint. 
TIOGA COUNTY, r^wrenceville. 

W.ifHINOTON COUNTY. BcflllHville, Finlejville, Midway, New Eagle, and 

WAYNR COUNTY. Honeadale. 

WESTMORET.AND COUNTY. Export, Irwin, North Rpllevemon, Pamasaus, 
Suterville, and Youngstown. 

YORK COUNTY. Delta, Fnwn (Jrove, North York, Wellnville, and York New 

The foUowing boroagbs and townsbips were without active Boards 
of Health on the 31st of December, 1914, viz:— 

ADAifB COUNTY. New Oitord. 

ALLEGHENY COUNTY. Ben Avcm Hoiithr«. Rrnddook Township. CheKwipk. 
^^iwbl•'h. '-"' T''wnBliio. Lower St. Clair Township. Mt. Lebanon Township, and 
Sooth Veniailira ToWDdhip. 

ARMdTRONO COUNTY. Atwood, Johnettn. and Wiokboro. ' 

BEATER COUNTY. Frankfort Springs, Glasgow, Hookatown, and SMpping- 

BEDFORD COUNTY. Pleasnutville. SchPlIshiirE. nnd Woodbury. 
BERKS COUNTY. Bernville, and RechtelByillf. 
BRADFORD COUNTY. Alba, and Monroe. 

BUCKS COUNTY. Attleboro, Chalfont, T^nfihome Manor, and Silverdale. 
BUTLER COUNTY. Cherry Valley, Evausbiire. Portersvilir, West Liberty, and 
Wert Sunbnry, 
CAMBRIA COUNTY. CaaBaadra, Daisytown, Ebensburg, and Loretto. 

> Google 


CLARION COVNTY. Callensbarg, and Strattanville. 

CLEARFIELD COUNTY. Bumslde, Chester Hill, Glenhope, Grampian, Ma- 
haffey, TroutvUIe, and Wallaceton, 



CRAWFORD COUNTY. CentervUle, Spartansburg, VennnRO, and Woodcock. 

CUMBERLAND COVNTY. Sbiremanstowo . 

ERIE COVNTY. Albion, Elgin, Girard, Bud Platea. 

OREENE COUNTY. Ricea LandtaR. 

HUNTINQDON COVNTY. Broad Top City. CaasviUe, Mill Creek, SaltUlo, and 
Shade Gap. 

INDIANA COVNTY. JacksoDvilk, and Mechaniceburg. 

JEFFERSON COUNTY. Big Run, Falla Creek, and SummervUle. 


LAWRENCE COUNTY. Eooo Volley, and Sooth New Cnstle. 

LEBANON COUNTY. Jonestown, and Myeretown. 

LUZERNE COUNTY. Duryea, and Newport Township. 

LYCOMING COUNTY. Hughesville. 

MERCER COUNTY. Sandy Fjike, Stoncboro. and West Middlesex. 

MONTOOMERY COUNTY. Bala, Pennsburg, and Wpst Telford. 

NORTHAMPTON COUNTY. TValButport, and Wilson Township. 


PERRY COUNTY. New Buffalo. 

PIKE COUNTY. Milford. 

SCaUYLKILL COUNTY. GirardTHle, Port Clinton, and Westwood. 

SNYDER COUNTY. Middlpburg. 

SOMERSET COUNTY. Bentmn, Now BnltimoiP, Paint. Sbankaville. Soraer- 
field. and Stoyestnwn . 

aULLIYAN COUNTY. Engles Mere, and Laporte. 

fUSOUEHANNA COUNTY. Little Mendows. 


UNION COUNTY. Hartleton, and New Berlin. 

VBNANOO COUNTY. Polk, and Siverly. 

WARREN COUNTY. Clarendon, and Grand VbIIpy. 

WAfiniNGTON COUNTY. DeemRtnn, East Wasblneton, I^ng Branch, Speew. 
and West Middletown. 

WESTMORELAND COUNTY. AdamabnrB. Arnold. Bolivar, Doneftnl. Enut 
Vnndprirrift. Livermore, Madison, New Alexandria, North Bellcvernon, and S^mth- 
west Greensburg . 


YORK COUNTY. Croas Roads, Felton, Jefferson. Iy>iniiville, Railroad, Stew- 
artstown, and Winteratown. 

The Act of Jane 12, 1913, authorizes the Commissioner of Health 
to take charge of boroughs and first-class townships not having ac- 
tive Boards of Health, and while no general action assaming charge 
of all borongbs not having health boards was taken during the year 



1914, as necessity arose the following boronghs were placed under the 
JQPisdiction of the Department's local health officers^ via: — 

Hookatown, Beaver Comity. 

Stoyeatown, Homerspt County. 
Shploc-ta, Indiana County. 
(Jirurdville, Schuylkill County, 
r^retto, Cambria CouDty. 
Mechanirsburfc, Indiana County, 
Bear Ijike, Warren County. 
Columbus, Warren Counta'. 
Mill Creek, Hnntinjidon County. 
Cpatprville, Crawford County. 
Jonestowii, Lebanon County. 
Broadtop City, Huntinmlon County. 
Shippingpcirt, Beaver Coanty, 
MyerstoWQ, Lebanon County. 

Roseto, Luzerne County. 

Avoca, Luzerne County. 

Duryea, Ijuneme County. 

Girord, F>ie County. 

Fort Clinton, Schuylkill County. 

North Bellevernon, Weatmoreland Co. 

Lnnghorne Manor, Bucks County. 

PleHBontville, Vcnanifo County. 

Nuongola, Luzerne County. 

Becbtelsville. Berks County. 

Elverson, CheKter County. 

Monroe, Bradford Coun^. 

ntgin, Erie County. 

and efficient Boards having been appointed and qualified in the bor- 
oughs of 

North Bellevernon, Weetmoreland Co. 
Jonestown, Lebanon County. 
Shippingport, Beaver County. 
Myerstown, Lebanon County. 

Roseto, Northampton County. 
Langhome Manor. Buoha County. 
Nuangola, Luieme County. 
Monroe, Bradford County. 

charge of health affairs was again handed over to the local authori- 
ties and the Department's health ofBcer relieved from farther dutr 

There are in the State about 575 villages ranging in popniation 
from three hundred to three thousand, which are not incorporated 
and which are regularly under the jnriBdiction of the Department of 
Health and Its district bealtfa officers. These villages are located ae 
follows: — 











^£k ■:::x:::::::;::::: 



aaDFOSD oovSTT. 


UtUe Olej 

"..DoaSi» ■.■..■.■.■.■..:■.■;..:..;■.....■.■.::■,■. 



BRADFOBD covsrr. 


...Ruki niK-k mil. . 


I, Goo'^ic 




BMnrdil*. ... 
UlaBdbars, ... 


''.'Cmofl.' ■■■■' 





Port KutUdi 

PDtWn Mill* 

Sprla« UIU*. 

ohkbtbk oovkty. 


mmoaat Otj. 





BTfe. ■:;:::::::::::::: 



c..™» ,:..„.. 

».„^™ <,..„,. 

BolllDK epriM- 


Unlim Ueuoatt. 'll'l[l"\'li 






BIX COfA Tl-. 

^"■■■■■•■■■■■■■■■■' '■' 




EBiB aovKTi 

LdBdn luw Blk Cnrel 

McKam McK«D. 

N. Olnrd, air«rt, . 



..XorUi UdIoo, . 


Bait Hlrt«7 









....Sootli Ablotlm 



Rant PetcnlHrg, 




N*w Tripoli, '. 



Tttmtii™. ...: 

i*wi^ .; 





, Gooi^lc 



:-iiSS:SS- ;; : 

Vt Wuhlnctod 

Sr "."!■..:::::;:;:::;::: 

Upper H.110™. 








Lickawai»D „ 


■..W«t li^blDOT 



tSttltJMJ PhlD«, 

Hesliui, . 
Went UtI 




...Middle Crack, 




\y.^\y.'/".'.'.'.'.'.'.'.'.aiiieT' "'.['^,v.'.'.'^'.'.'^'.'. 
Emfitm', '^v^\v/^]V^"y/"^'.'.'^v^Balmgroya.'v^\v.\v^v.'.'.'. 





VENAnao covxTY. 

...Siig«r Ctttt, 


North Wima.' 

H. 0. P<»ittl«- 





HlckoTT Ml. I^«i 

WHtUnil. Cliartlen. 

Lock No. *, Jidlowfle 

WArsa CODftTl 

Bli!nTl[la ill 

llcCuncc, . . . 
PlesMDt nnll 
Wbltnor, .... 
Calumet. ... 

Rnir* Dlfc, " 

B. RDDtlDgllwi, 


'.'.'.'.Voitt',' . 

...Sewlrtlej. , 


II Oftr. 
rtH Mel 

Nora McbO(V>iV. 

..liCwrr WlndHT, 
..Lower WlBdaor. . 
..Lower WlBdur, ,. 

TheBe villages do not differ materially from the borong^B of like 
population except in thrir municipal government. Many of than 
have public water supplies and lighting systems and their streets 
and ddewalks are kept up in about the same manner aa in the boi^ 
onghs. The General Inspector would respectfully suggest that, if 



the appropriations made by the Legislature for the next two yeara 
n-ill justify SDch additional expenditures, a system of sanitary 
iuspection of villages be inaagurated, and that the Health OfBcer)) 
la the various districts be instructed to make these inspections and 
report to the Department concerning the care of the water supplies, 
the methods of disposal of sewage and garbage, sanitary conditions 
of streets, alleys and surface drains, housing conditions and such 
other matters as in the opinion of the Oommissioner of Health might 
be necessary or advisable. 

Late in the month of December the General Inspector made a pre- 
liminary investigation of housing conditions in the eighth ward 
of the boroagh of Nanticoke. This ward is detached from the bor- 
ough proper and formerly known as the village of Hanover. The 
residents of the ward are largely coal miners in the employ of the D. 
L. & W. Railroad Company. This investigation was prompted by the 
result of the medical inspection of schools in this ward which showed 
about sixty tuberculous children in the schools and others whose 
condition was suspicious and was made at the request of the school 
authorities and the Board of Health of Nanticoke. Housing condi- 
tions in this ward were found to be in a uniformly congested condi- 
tion. The buildings are all built about upon the same general plan — 
two-story frame cottages containing from four to six rooms. Out of 
286 single dwellings three of these houses were found to be occupied 
by three families each, forty-two by two families each and forty-four 
were occupied by only one family but accommodated boarders or lodg- 
ers ranging in number from two to nine in each house. The highest 
census found in any one dwelling was twenty-seven while many of 
them ranged from fifteen to twenty. The houses in most instances 
are owned by some individual living in the house, the D. L. & W. Kail- 
road Company some years ago having opened up a plan of lots which 
were sold on easy terms to the miners and encouragement given to 
them to build their own homes. It wonld appear to the eyes of a lay- 
man that this generally congested condition might easily be respon- 
sible for the unusual prevalence of tuberculosis in the children of 
the public schools. The crowded conditions are due lai^ely to the 
demand for labor in the immediate vicinity at the coalbreakers and 
the lack of a sufficient number of dwelling houses properly to acrom- • 
modate those so employed. About forty or fifty additional dwelling 
houses and a half dozen or so houses especially adapted for lodging 
and boarding detached men should be provided in this immediate 
vicinity for the relief of these congested conditions. 

During the year the General Inspector was absent from the Harris- 
bnrg otBce on businera of the Department 103 days, twenty-two of 
which were spent in the Philadelphia ofQce assisting in the prepara- 


tion of the Department's inFentory, Reports to the Dependents Com- 
miasiou, to the Economy am] Efficiency Commission, and to the GoTr 

During the year the General Inspector traveled 12,704 miles and 
the expense incident to these inspections amounted to f637.61. 




There are two broad phases in the commnnicability and spread 
of tuberculosis, which in orderly procedure are best discassed sepa- 
rately, the social and economic side of the problem, and the more 
strictly medical side. 

In placing the responsibility for the spread of infection, we must in 
the last analysis begin with the individual, rather than the iostitn- 
tion. It is, theoretically, more the fault of the people than the fault 
of their surroundings. It is the tanit of the people who make the 
homes. This great plagne lives and flourishes in the homes of the 
ignorant, amid poverty and sqnalor; bnt, as has been well said, it is 
not alone the buildings which make the slums, bnt the people who 
live in them. Of course, bad housing conditions play a profound 
rAle in the endemiciiy of tuberculosis, but even could we give every 
family an airy, clean house, so long as there were ignorance, careleas- 
ness, filth, dissipation, and alcoholism we would still have sloms, in- 
fected houses, and tuberculosis. 

It is perfectly apparent, that belter housing conditions would be an 
enormous stimulus to better living and better home management; and, 
therefore, while the first remedial step is education and apllfting 
among the poor and ignorant themselves, the second corollary need 
which is of equally pressing importance is to improve physical condi- 
tions of living, improve housing conditions. The problem of pro|>er 
housing conditions for wage earners and others of small income is 
of vital importance to every community and the baneful effects of 
basement housing and overcrowding are In no way more apparent 
than in the spread of infections of ail sorts, particularly of tubercu- 
losis, and the entire physical and moral health of a community is ad- 
versely afifected by bad housing conditions. Next in importance In 

•Bnd Ixtnt tl>* CMtf of PbrilcUu of Fhllidelplilo, Umtdi t, UU. 


this relation, comes the snbject of conditions of labor or occapation 
For, aside from family ways of living and bad places to live in, there 
are many vile conditions of labor which reduce the health and weaken 
the resistance of the individual, making him sneceptible to infection 
and making him and his descendants less and less likely and able to 
bring into the world and rear healthy, robust children. 

In mentioning conditions of labor, however, as an important ele- 
ment in the prevalence of tuberculosis, we must think clearly and 
undersatnd that the many bad conditions which exist are lai^y 
predisposing factors only, and their true significance relates to the 
demoralization of the health, morals, and social status of the indi- 
vidual; and to home conditions from inadequate wages. Because 
the morbidity from tuberculosis is high among a certain class of wage 
earners, we must not jump to the conclnsiou that kind of work speci- 
fically "causes" tuberculosis. What it really does is to reduce the 
general health and resistance of the individual, and if sach workers 
have the seed of tuberculosis in their bodies, as is often the case, un- 
due fatigue, confinement, low wages, give rise to the physical condi- 
tions necessary for the flourishing of the seed. There is no specific- 
ity of labor as a "cause" for tuberculosis. It is an enormous factor, 
bat never a cause (eliminating infected workshijm). It comes the 
nearest to being a cause where certain forms of dust are constantly 
inhaled, which act (in one way at least) by reducing the tone and re- 
sistance of the lungs themselves, and so predispose to the pulmonary 
localiEation and activity of already existing infectioti, or of a fresh in- 

For ethical and hygienic reasons the common drinking-cup must go, 
but tuberculosis is the least likely of the infections (so far as adults 
are concerned) to be engendered in this way. Whether this should 
be made to include the common Communion cup may be answered, 
perhaps, in the afBrmative on account of the danger of certain infec- 
tions, but so far as the spread of tuberculosis is concerned, this Is a 
negligible factor. 

It is thus recognized that the problem of tuberculosis is in e large 
sense a social and economic one. With such factors to contend with, 
having their roots deep down in the very basis of modern life and 
condition, aflfecting millions of people, is it not right that we should 
at least pause to appreciate the vastness of our undertaking, and from 
its very vastness should we not draw resolve to pursue our aim 
indomitably and to be patient in demanding too immediate results, 
though it should be stated in passing that resnlts are becoming 
strikingly apparent. 

Thus let us neither forget nor be dismayed by the fact that our 
problem is to combat, one might .almost say, the drift of the times, to 
raise through education, sanitary laws, medical hygiene, and phllan- 

1« NINTH ANNUAf. ni^PORF Vi THF. Off. Uoc. 

thropic effort the proletariat from their condition of dense Iter- 
ance and poverty, to enable them to get suitable homes and teach 
them how to live in and manage them, and to improve the conditiooB 
of their labor — that there may be cleanliness and light, aaitable care 
of the children, sufficient food and clothing, necessary hours of rest, 
provident and good habita and self restraint; and available medical 
supervision. But having said this much, we have not said all, for 
we must do this same Augean task for the thousands of immigrants 
arriving hourly from Europe to swell the ranks of this great army of 
ignorance and poverty. 

But there is one great satisfaction to be taken in the very breadth 
and vastness of this phase of the problem, nnmely, that it is not 
merely tuberculosis work, but public health work in whatever form 
of activity this shows itself. Antituberculosis work, and all forms 
of public health work in general, bear an increasingly apparent 1d- 
terdependence. It 18 not alone strictly antituberculosis measures 
which may be confidently looked to for results, but all the associated 
movements for the public welfare in health, morals, and conditions, 
which are essentially allies. This is now fully recognized and with 
the well organized tuberculosis crusade pointing the way, other 
movements have followed along similar lines and the crusade of en- 
listment and prevention of disease is becoming more and more a 
unit in its methods, aims, and interrelationships. 

It is necessary next to consider certain salient features of the dis- 
ease itself, bearing on the question of the spread of infection. Two 
great factors in its comrounicability stand out. 

Infection takes place from close personal association or contact 
with open tuberculosis, as by living with a consumptive or from liv- 
ing in a room or house contaminated by a consumptive. The great 
source of the infection lies in the carelessness of the individual con- 
sumptive in contaminating his surroundings, by spitting about or not 
properly disposing of his sputum; or by spray infection from cough- 
ing {equally dangerous) without guarding the mouth with a paper 
napkin. His towels, bedding, talile utensils, etc., are also a source of 
infection. The pferiod at which a consumptive is most dangerous 
covers, of course, the second and third stages of his disease when the 
lung is breaking downi and the sputum contains large numbers of liv- 
ing tubercle bacilli. 

The age at which infection is most likely to take place is childhood. 
It should be borne in mind that adults, particularly healthy adults, 
have a very considerable resistance or immunity to tuberculous infec- 
tion. Without discussing the question of the sources of this rela- 
tive immunity, it may be staled as a fact that it requires a prolonged 
exposure and iniplnn^ation to give rise to pulmonary tabercnloeiB In 


No. 18. COMMiaaiONKR OF HEALTH. 146 

an ordinary healthy man or woman. In proportion as bad stitTouo<]- 
inga, faulty personal hygiene, bad conditions of labor, other infeo- 
tions, dissipation, etc., play a part in the life of the individual, by 
jnst 80 much is this natural or acquired immnnity impaired or even 
broken. Bat the fact remains tliat the chance inhalation of tubercle 
bacilli as they may float in the dust of the street, or in public meet- 
ing places, or the occupancy for a night or two of an infected room or 
sleeping berth, could hardly give rise to pulmonary tuberculosis in 
an adalt. 

This must not be misinterpreted as in any sense condoning infected 
dust OP infected places. No inference can be drawn from this that 
spitting in public places, street cars, or on the sidewalks should be 
tolerated. On ethical grounds and because of the dangers of catar- 
rhal infections, spitting should be (and is in many -communities) a 
misdemeanor punishable by law. The danger of infection of chil- 
dren by such conditions is a very possible one. 

For the time at which this natural resistance is weakest is in child- 
hood, and for this reason and because of intimate and prolonged con- 
tact with open tuberculosis in their homes, children furnish the great 
soil for implantation. For physiological reasons, which would lead 
Uh too far afield to discuss, this infection during childhood does not 
as a mle develop into pulmonary tuberculosis at that time, hut lies 
dormant in the lymphatic system or is latent until adult life, when it 
breaks forth or manifests itself in pulmonary localization. It is 
largely children infected by contact in their homes who furnish later 
the ever on-coming crop of consumptives. 

Milk and meat from tuberculous animals also constitute a source 
of infection. Infection from cow's milk has been variously estimated 
as being responsible for from one to ten per cent, of cases in in- 
fants. Infection may also be hereditary, the direct transmission of 
the tubercle bacillus taking place from mother to the fetus bj placen- 
tal circulation. This has been shown to occur in mothers with ad- 
vanceil pulmonary or military tuberculosis, but has recently been 
shown aa also possible where the lesion in the mother is in the inci- 
pient stage OP even latent or non-active at the time of the birth 

During childhood and early adolescence this early tuberculous 
infection, glandular in type, may not manifest itself at all, or only 
in anffimia, underdevelopment, etc., these chiJdreu being generally be- 
low par physically and delicate. These children react to tuberciilin 
and oftwi have enlarged lymphatic glands, but there is no other way 
in the majority of instances of telling that they are tuberculous. 
But this is quite suflRcient for the diagnosis, which is to be under- 
stood to mean that the moment a child reacts to tuberculin, it is con- 
duBive evidence that it has been sensitized by the tubercle bacillns 


and tbat the moment a child ia thaa taberculized it becomes potoi- 
tiaUy at least a future case of pulmonary tubercoloaia. 

Not only the general trend of expert opinion beare out the above 
view in relation to time of infection, but there are many clinical and 
pathological statistical data to confirm it. The results of the tubei-- 
cnliu test, which when properly performed and repeated ia recognized 
as being specific, in large groups of children in hospital practice, as 
reported by von Pirquet, Calmette, Hamburger, Prantz, and others in 
widely different cities, warrants the statement that most children 
of the working class, are sensitized by the time they reach fourteen 
or fifteen years of age. All authorities admit that at least seventy- 
five per cent of the population will react to tuberculin. From post- 
mortem findings, evidence has been clearly accumulating as to the 
frequency with which the disease is found at necropsy among the 
poorer classes; and, with increased refinement in postmortem work, 
the percentages are getting significantly greater. Niigeli reported 
definite signs of tuberculosis in ninety-seven per cent, of all bodies ex- 
amined consecutively. Hamburger, in a large group of children, re- 
ported postmortem findings of sixty-three per cent, with tuberculous 
lesions between the ages of seven and ten years and nine^-five per 
cent, in those between eleven and fourteen years of age. Qbon's post- 
mortem statistics from St. Elizabeth's Hospital in Vienna show that 
by the end of the third year six to eight per cent, are infected, the 
percentages rapidly rising until by the fourteenth year the infection 
reaches ninety-two per cent. It goes without saying that by no 
means ail these cases would have developed pulmonary tuberculosis 
clinically had they lived; indeed, this early infection is by many 
looked upon as a aource of immunity to subsequent reinfection, but 
such statistics furnish valuable evidence of the time when primary 
infection takes place. 

There arises here an interesting paradox, for while we know that 
infection with tubercle bacilli is so largely universal in chilhood 
among the poorer classes in our cities, yet we also know that the 
death-rate from tuberculosis among urban populations haa been stead- 
ily decreasing. To what is this due? Ia it dne to strictly antitu- 
berculosis measures, iu association with preventive and curative 
measures against disease in general; is it due to institutional care 
aud improved conditions of living? Or is it due to some deeper 
cause, a development of iucreased resistance, specific immunity or al- 
lergy (von Pirquet) in urban populations themselves? Recent dia- 
cusfsion has concerned tlsclf very much with this phenomenon, and 
authoritative opinions diflfer. 

Thus Xewsholme points out that while the death-rate from tuber- 
culosis is nearly always greater in urban than in rural diatricts, the 
'countries showing the most urbanization have secured the greatest 


rednction Id, and the lowest death-rate from tubercaloaia. The con- 
clusion that he draws from this fact is that the death-rate from tnber- 
cnlosis has declined to the greatest extent in those conntries in viiich 
the ratio of institutional to domestic relief has been highest A 
consideration of all the facts, he says, justifies the conclusion that 
the substitution of institutional for domestic relief for the consump- 
tive poor has been historically the main factor in the reduction of this 
death-rate, and in a later paper he repeats that had it not been for the - 
steadily increasing extent of institutional treatment of the tick, 
and especially of the consnmptive sick, which has characterized most 
of our great centres of population, we should have experienced not 
the decline of tuberculosis which has occurred, but a great increase in 
its prevalence. With this view I am in entire accord. Hermann 
Biggs says "in the judgment of those who have most experience in the 
study of the problem, no other measure for the prevention of infec- 
tion compares in importance to the treatment of advanced cases in 
hospitals and sanatoria." 

On the other hand no less a distinguished investigator than Karl 
Pearson has suggested that the selective process of many years of 
heavy mortality from tuberculosis has left us with a more immune 
and resistant population. He vrould have ua change our views as to 
the value of hospitals and sanatoria in the prevention of tuberculosis, 
and devote all our efforts to raising the resistance of the individual 
and the race. In brief, he denies the value of our general campaign, 
says that we are all tuberculized, and that the only efficient source 
of prevention lies in developing this communal or race immunity, 
which is largely a matter of environment and heredity. T. D. Lister . 
goes so far along these lines as to say that were it for a moment 
to be granted that it is possible to control tbe spread of tuberculosis 
by preventive measures, then the service rendered to urban popula- 
tions would be dangerous instead of beneficial, because the develop- 
ment of what he considers the only important factor, namely, in- 
creased communal resistance, would be ignored; and he further adds, 
that in his opinion the adult death-rate from tnberculosis may be 
taken as a measure of the loss of resistance to latent tahercolosis 
acquired in childhood. 

A phase of this latter view is seen in much recent literature based 
en the studies of Roemer, Hamburger, von Firqnet, Baldwin, and 
others^ which has been recently emphasized by the last-named in- 
vestigator, who believes that a primary infection in childhood is 
of value as a protection against subsequent reinfection by the pro- 
duction of a specific allergy or changed condition. This corresponds, 
of course, to what we know in regard to the increased resistance 
to reinfection in experimental animals from a primaiy inoculation. 


As an illastration of this view, ma; be cited bis belief that the de- 
velopment of a strong allergy is at least one reason why millBry 
tuberculosis is not more frequent during relapses and ezteosloDB 
of pulmonary tuberculosis, particularly since we know that the 
bacilli themselves are often free in the blood-stream. Applying this, 
he feels that most adult tuberculosis is not due to a new infection 
or reinfection from contact, becanse the allergy of a childhood in- 
fection, BO universally present, has protected against this, bat that 
most adult tuberculosis is due to a lighting up of the disease from 
the spread of autogenous superinfection brought about by eztraneoas 
conditions of environment. Thus he argues that adults are very little 
endangered by close contact with open tuberculosis and not at all in 
ordinary association — childhood is the time of infection, youth the 
time of superinfection, and that from extension of the primary dis- 
ease. With which view, except as it might imply a rdaxfltion of 
any of our usual precautionary measures against the possibility of 
infection among adults by contact, I am largely in accord as stated 
above. Such theories inevitably lead back to the fundamental prin- 
ciple of eugenics, which lie not strictiy in the survival of the fittest, 
not strictly in an attempt to rear a race of men and women whose 
resistance Is attuned to living and surviving in a germ-laden world 
and who are capable of withstanding an utterly vile and vicious eu- 
vii'onmeut; but rather in forming a pure, healthy, and happy environ- 
ment, in making the world a flt place for all to live in, and then in 
producing the best and ablest race both physically and mentally to 
inhabit that purified environment (Moore), 

Certain phases of the views quoted above appear radical and 
peHiJiiis unwise gL'ueral leaching (see Pearson), but whatever the 
element of error or of truth, and the truth probably involves a 
middle course, these views have at least served the purpose of call- 
ing the attention of those inteii>ste«l in the crusade to this very im- 
portant element of racial and communal resistance whether natural 
or acquired by early infection, which we have perhaps been inclined 
to overlook and neglect; and the practical necessity for directing 
every effort by good food, rest, and recreation, by airy schools, play- 
grounds, inspection and sui)ervision, to raising this quality of re- 
sistance, particularly in childhood and early adult life. 

It may ije stated as a fact that tuberculosis is the most common 
infecliou of childliood. and, as well pointed out by Philip, we must get 
rid of the artificial diHtinction between so-called medical and surgical 
tuberculosis. From tlie scientific standpoint, the most slender seed- 
ling of tuberculosis is potentially significant. It is impossible to 
say which luherculous RtMHl will be cast off and which will mature. 
Inoculation may occur through the mucous membrane of the gaatro- 
inlestinal or respiratory tract, or the skin, and whether it will spread 


from the lymphatic system, which 1b the first site of this early in- 
fection, and develop into pulmonary tuberculosis later, depends 
largely on the child's vitality, and resisting powers through its living 
tisane cells, and upon its environment. In other words, this quality 
of natural op acquired immunity may hold the infection dormant; 
may heal an active lesion in its incipiency, or localize it in the glands 
or bones; or may give way with resulting meningeal, miliary, or 
pulmonary involvement. The course of events which supervenes, is 
dependent largely on extraneous circumstances, on the amount and 
character of the tuberculous infection, on the number and character 
of the acute infections to which the individual is exposed ; on enforced 
environment and to a considerable extent on inherited qnalities. 
Philip Bays: 

"The problem can only be solved effectively by a better under^ 
standing of the physiological needs of developing life and a cor- 
responding renovation of the nurseries and school-rooms of the nation. 
It is folly to dream of transferring all tubercnlons cbildren to pre- 
ventoria or sanatoria. This plan is to plead ignorance of the es- 
sential needs of the problem. The home of the poor man must be. 
made the nursery of healthy children and cease to be the breodinjf 
ground of tubercle-tainted wastrels. Bach recreated home is an 
effective preventorium against tuberculosis." 

It will thus be seen that the problem of prevention to be effective, 
even as limited to the medical aspect of the communicability of 
tuberculosis, must not only take into account the care and isolation 
of the consumptive himself, but also the care and development of 
the children who have already been infected or who may be exposed 
to infection, and probably the development of a specific racial im- 
munity. But when we consider as essentially one, as we must do, the 
two broad phases of the problem, which I have attempted to outline 
above, namely, the social and economic conditions, and the more 
strictly medical conditions responsible for the prevalence and spread 
of tuberculosis, the point previously emphasized is brought forcibly 
apon us— how very apparent is the interdependence today of the 
tuberculosis campaign and all efforts looking to the common welfare! 
Let me repeat, that it is not alone from the strictly an ti- tuberculosis 
campaign that we may confidently expect to control tuberculosis, 
but from all allied movements looking to idiprovement of th£ health, 
morals, or condition of the people. Folks says "If our task is the 
more difBcult because it is bound up with every phase of modem 
civilization, it is equally true that every substantial advance in 
other lines assists our cause." 

For instance it has been pretty conclusively shown (Reincke) that 
wherever the death-rate from typhoid fever is reduced, through the 
introduction of pure water, numerically by one; there is a simul- 



taneoQS reduction in the general deatb-rate of from two to three. 
What is true in this case, is equally or even more strikingly so in 
relation to other infections. Think of the vista of accomplishment 
■which opens up before us, when we know, as we do know, that more 
than eighty per cent, of all deaths are due to preventable causes! 
Thus it is apparent that the movements against infant mortality, 
venereal diseases, alcoholism, the infectious fevers, cancer, procrea- 
tion of mental defectives; and the correlated campaigns for better 
housing conditions, better hours and conditions of labor, child wel- 
fare work, etc.; all these movemenfs, public or private, of whatever 
scope and by whatever methods they proceed, are all working to a 
common end, the welfare of the race, and as snch are prototypes 
and allies of each other and of the greatest of them all, the tuber- 
culosis campaign. They are all campaigns of preventive medicine, 
based on scientific development, and attempting, largely by educa- 
tion, to carry the message of health and ri^^t living into the li 
and very hearts of all the people. 



The development of the anti-tuberculosis movement in Pennsyl- 
vania began in Philadelphia in the decade following the discovery 
of the tubercle bacillus in 1882, and may be considered to have passed 
through three successive phases or stages. The first conristed in 
pioneer effort to arouse the public and the profession itself to a 
sense of the importance and extent of this f^eat scourge, its economic 
position as a destroyer of human life, its relation to domestic and 
community assets, and the possibility of its eventual control. That 
epoch-making discovery furnished a scientific basis upon which to 
proceed, and gave the needed impetus to the propaganda of education 
whidi in the two succeeding decades laid tbe foundation and largely 
made possible the second stage of the tuberculosis movement, i. e., 
that of the establishment of institutions for the treatment of tuber- 
culosis by public philanthropy. 

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In responae then to this preaching of tubercnlosis in season and 
out of season a few scattered and disaasociated institutions due to 
private philanthropic effort made their appearance, too few io num- 
ber and too limited in scope to be in any sense effective in handling 
the tuberculous sick of the common vealth, but promising as an in- 
dication of aroused public interest. These institutions were free 
or partly free, but were maintained iu some instances with the 
assiBtacce of State mouey both for new buildings and running ex- 
penses. The majority of them were established in or about Phila- 
delphia, as will be seen from the appended list of institutions or 
assodfltions dealing with tuberculosis prior to the year 1907, when 
the State Department of Health took up this work, inaugurating 
the third stage of the movement, i. e., that of the official campaign. 

The first permanent institution* was the Protestant Episcopal 
City Mission in Philadelphia, which b^an caring for a few advanced 
consamptivea as early as 1876, bnt only became an important factor 
In the crusade in 1886 when it opened the Home for Consumptives 
at Chestnut HUl. At the earlier date a few rooms were fitted up in 
the Mission House, the House of Mercy, at 411 Pine Street, for 
temporary hospital purposea Where practicable, however, consump- 
tiveB were cared for In their own homes, the mission securing for 
them medical attendance, clothing, food from its diet kitchen, and 
often paying a member of the patient's household to stay home and 
nurse the patient. It also b^an sending a few cases to the con- 
valescent retreat at Glen Mills in 1884. This, however, was given up 
upon the opening of the Home for Consumptives at Chestnut Hill. 

The next institution made its appearance fifteen years later, 
namely, the Rush Hospital for Consumptives in Philadelphia, which 
opened its dispensary in June, 1891, and its wards in January, 1892. 
and a Country Branch at Malvern, Pennsylvania, in June, 1892. 
It moved to its present handsome building at Thirty-second and 
Lancaster Aveune in January, 1895. The Free Hospital for Poor 
Consomptlves and Wbite Haven Sanatorium Association was or- 
ganized in Philadelphia in 1895. From 1895 to 1903 it cared for a 
limited number of advanced consumptives by placing them In the 
wards of general hospitals at a weekly rate of five dollars, but gave 
up this work in 1903, having in 1901 opened the White Haven Sana- 
torium for early cases at White Haven, Pennsylvania, In 1913 it 
again took up the care of advanced cases of tuberculosis in the De- 
partment for Diseases of the Chest, of the Jefferson Hospital, where 
it contributes to the support of free beds. In 1908 the Department 
of Tuberculosis of the Philadelphia General Hospital was opened, to 



care for the city's indigent consumptives. In 1900 the Lacien Hoss 
Home of the Jewish Hospital, Philadelphia, was established, a free 
service for consumptives of the Jewish faith. 1903 saw the estab- 
lishment in Philadelphia of an important and far-reaching institn- 
tion for the study, treatment, and prevention of tnbercnloBis, the 
Henry Phipps Institute at Third and Pine Streets. This institu- 
tion became a department of the University of Pennsylvania in 1910 
and formally opened its splendid new hospital at Seventh and Lom- 
bard Streets, in May, 1913. 

The first institutions outside of Philadelphia were the Small Camp 
for Consumptives on South Mountain, opened by the State Depart- 
ment of Forestry in 1903, and the West Mountain Sanatorium at 
Scranton in the same year, followed by the Grandview Sanatorium at 
Oil City in 1904. Previous to 1906 Pittsburgh had absolutely no 
provision for its tuberculous sick, but in that year were established 
the Tuberculosis League of Pittsburgh and the Pittsburgh City Home 
and Hospital. The WIlkes-Barre Tuberculosis Dispensary was 
opened in 1906 and was taken over in 1907 by the State Department 
of Health, and became the first of the chain of State Tuberculosis 

Other antituberculosis associations, whose activitieB were prin- 
cipally educational in character, were organized ptevioos to 1907, as 
follows: The Pennsylvania Society for the Prevention of Tubercu- 
losis, in Philadelphia, in 1892; the Scranton Society for the Preven- 
tion and Cure of Tuberculosis, in 1903; the Antituberculosis So- 
ciety of Hairisburg and vicinity, in 1905; the Wyoming Vall^ So- 
ciety for the Prevention and Treatment of Tuberculoeis, in 1906. 

The above includes all the free or public institutions caring for 
cases of indigent consumptives in Pennsylvania prior to 1907. In a 
number of them a minimum charge was made, thou^ there were 
some free beds in all. Throughout the rest of the cities and towns 
of the State and in the rural districts there was no provision what- 
ever for the free treatment of consumptives. Thus the total provision 
for the State consisted in 1907 of 687 Hospital beds,^ free or partly 
free {of which 522 were in Philadelphia); 319 Sanatorium beds,** 
and 7 Tuberculosis Dispensaries, 5 in Philadelphia, 1 in Pittsburgh, 
and 1 in Wilkcs-Barre, There died from tuberculosis in Pennsyl- 
vania in 1907, 10,825 persons. 

It is perfectly apparent how inadequate this armamentarium was 
against a disease so widespread and so largely confined to the poorer 
classes, pitiably inade<iuate not only in regard to treatment of the 
sick themselves, but in relation to the effective work of prevention 


by segregation and education in tbe homes of the poor. It may 
properly be noted alBO that it had taken twenty yeara of the hardest 
kind of individual eflfort to get this much — not a very ppomleing 
outlook for the future at that time. 

It was thus not a theory but a distressing fact which confronted 
the Btate Department of Health created in 1905 under a law drawn 
up by Dr. Oharles B. Penrose, literally tens of thousands of indigent 
consumptives uncared for and without the facilities existing to care 
for them, and correspondingly little real effective work along the 
broader lines of prevention. The situation was so pressiog that 
when the General Assembly met in 1907 tbe Commissioner of Health 
had a big practical question to solve, which under the law he was 
called upon to solve, not to theorize and temporize about, but to 
show how suitable measures for prevention and treatment of this 
great army of consumptives could be supplied most economically, 
most efQciently, and most expeditiously. The brilliant and original 
answer came at once — a free tuberculosis dispensary was opened in 
every county of the Btate, in the more populous centres more than 
one, and in a sbort time there were a hundred and fourteen State 
dispensaries so distributed that there could not exist in any comer 
of the State, however remote, an indigent consumptive who could not 
receive near at hand free medical supervision for himself and family 
of the bighest standard. One large State sanatorium was at once 
opened and two others planned, one of which has been open for 
several years and the other is about to be opened. The effldenoy of 
thia gyatetn lies to th^ close relationship between dispensary and 
aanatorimn, so that every indigent consvMiptive in the State and his 
family can not only secure treatment at home and in the home, 
but sanatorium treatment as well; and icftot is quite as important, is 
foUoioed up and kept under observation or treatment upon his dis- 
charge from the sanatorium. 

Within five years the State had treated over 75,000 patients in 
its dispensaries, housed over 10,000 patients in its sanatoria, and 
through its trained nurses paid over 600,000 visits to the homes of 
its patients. The educational and preventive effect of this system 
alone is singly amazing. 

But there were not wanting critics of this system, and to para- 
phrase an idea in one of the admirable historical papers of Sidney 
George Fisher, the eloquence of the minority was raised in opposi- 
tion. It is one thing to be eloquent in your idealism and advocate 
a theory when your are not responsible for results, and quite another 
to act for practical ends when you are in power. I want to discuss 
Pennsylvania's official system with you not only as to its absolute 

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meritB but specifically iD relation to conditions existing in Penuayl- 
vania (which I have already outlined) at the time the State took 
Dp this work. 

The gist of this criticism, which is by do means conatmctiTe, ie 
about as follows: it wonld have been better for Ae State to have 
continued to foster by State money both for new buildingB and 
maintenance the few private institutions which were struggling so 
bravely to carry their uneqnal burden. It would have been better 
to encourage the principle of local care, through the eBtablishment 
by counties or groups of counties, of many small local sanatoria, 
because it would appear that it was the duty of local communities 
to care for their own tuberculous sick, and because consumptives 
would prefer to go to local institutions, where they could be near 
home and see their relatives and friends. Parenthetically, so far 
as Pennsylvania is concerned, I may say that I believe this to be a 
fallacy ou every count; execpt in so far as it applies to far-advaoced 
consumptives, that is, those so sick as to be unsuitable for strictly 
sanatorium care. It is manifestly the duty of local commnnitiee who 
can afford to do so to provide local hospital care for this group of 


1. The principle of the State's granting large subsidies to private 
institutions for new buildings that they may extend their work, and 
then being called upon in addition for large subsidies for maintenance 
that they may keep up this work, needs no discussion here. Besides, 
it must be plain to everybody, (a) that under no conditions could 
private institutions have cared for the tuberculous sick of the Com- 
monwealth, and (b) that once the State undertook to do this work 
itself on a gigantic scale it conid not dissipate its resources in this 
way. It was seen that the tuberculosis problem was not a matter 
for public philanthropy but of public business, as much a part of 
the State's business as any other great work for the welfare and 
advancement of its citizens. Private philanthropy could do much 
to help, but it could not furnish the means, facilities, woi^era^ or 
corelationshlp needed in this field. The State was 0ad of the exist- 
ence of such admirable institutions (few in number as they were), 
and welcomed most heartily their cooperation and assistance, but 
it could no longer continue largely to build and support tiiem, in 
those instances where this was the case. 


2. Next as to the possibility of getting local communitiea, parti- 
cularly the counties, to act; and let us keep in mind tlie pressing 
need there was for definite effective action. It has been pretty con- 


clusivel; demonstrated that as a rule commnnities, whether they 
be coanties or townB, have neither the means nor the avakened in- 
terest which will lead them to build and maintain even with State 
aid local sanatoria. In certain States, in order to encourage Aia 
plan, a per capita grant, usually five dollars a week for each patient 
in such institntiouB, is allowed by the Legislature. The law has 
usually been mandatory, and yet there has been little response and 
the situation has drifted on unrelieved. It has been freely acknowl- 
edged, by ibom interested in this plan in some other States, that 
this kind of legislation accomplishes little; the pressure for local 
Institutions mast come from within the community itself. Let us see 
how this plan applies to dispensaries. A law in Massachasetts of 
1911 made it mandatory on every local community of 10,000 or over 
to open a local tuberculosis dispensary, but there have been very 
few so established as a result of this law. The secretary of the 
Trustees of Massachusetts' Hospitals for Consumptives has publicly 
stated that this kind of l^slation is a failure. How much more ef- 
fective is Pennsylvania's centralized system, where at the fiat of one 
man and his Advisory Board a hundred and fourteen dispensaries 
were opened in every section of the State. 

A special committee of the Massachusetts Legislature appointed to 
investigate the best means and methods to check the spread of tober- 
colosis has, after a year's deliberation and consultation with the best 
experts in the country, recently made among others the following 
recommendations: "1. The need of a central authori^ to supervise 
the control of tuberculosis is apparent, and has been pointed out by 
commission after commission. This Committee recommends a single- 
headed Department* • • • 

"5. So many communities complained to this committee of finan- 
cial inability to buUd tuberculosis hospitals that it is recommended 
that the debt limit be extended for this purpose so that the hospital 
law on the statute books may be complied with. 

"6. The State Board of Health should be given power • • • • to 
provide a State-wide system of visiting nurses." 
- Certainly the first and last recommendations look as if Massa- 
chusetts were anxious to take a leaf from Pennsylvania's system, 
and the other recommendation endorses my contention of the finan- 
cial inability of counties to build liospitals and the futility of at- 
tempting by statute to compel them to do so. 

New Jersey passed a law in 1910 grautiog counties or groups of 
counties the right to establish local sanatoria, and this was made 
mandatory in 1912 ; but as a result of that law there have been (I 
am credibly informed) just two county institutions opened with a 
combined accommodation of forty beds. How much better, because 



more economical and effective, is a ^Btem ttaat gives as a thousand 
sauatorium beds in a few years and two thousand witbln seven years. 
It is only fair to say tiiat the State ot New York has proceeded 
largely on the principle of local care and with much sacceBs, and it 
is no doubt due to this fact that this system has been bo widdy ex- 
ploited. New York has been able to get the local commnnitieB to 
respond— but money seems to be earner to obtain in New York and 
the people seem to move more quickly. At any rate the fact remains 
that New York City has 4,500 beds for tuberculosis (1914) as against 
589 in Philadelphia*^-a far greater number proportionately to its 
population than Philadelphia. In strictly sanatorium beds the State 
is not proportionately better oflf than Pennsylvania, though in addi- 
tion to the State Sanatorium at Ray Brook, twenty counties in New 
York State have erected or planned to erect local tuberculoais 


3. There is also the question of economy to be considered. It is 
perfectly apparent that it is more economical to build and administer 
a sanatorium of 1,000 beds than five sanatoria of 200 beds each. This 
view is generally accepted or at least must be gaining ground, as 
witness the new Sea \'iew Sanatorium on States Island of the New 
York City Department of Charities just opened with 1,000 beds. 
Otisville, the Sanatorium of the New York City Department of 
Health, has 600 beds and plans are on foot, I am told, to increase this 
to 1,000.§ 

The plan of the Department of Health of Pennsylvania has been 
to build a few large institutions rather than many small institutions, 
because the larger iut^titutions are more economical and can give 
(lie paticiilK };ieater advantages than small sanatoriums can afford. 
"At Mont Alto Sanatorium, where at present we have 1,058 beds, the 
per capita cost is but |1.15 per day, which figure will likely be re- 
duced. Taking the other charitable institutions in the State haud- 
lin;; hiliciiuldsis and filming out tlieir cost for all classes of patients 
handled it is more than |1.65 per day, • * • * You will readily 
see an economy on two thousand beds between fl.15 and fl.65 of 
just fifty cents a day, or the saving to the State of an even thonsand 
dollars a day. The department's view is that it is wiser to bnlld 
each sanatorium of sufficient size to reach the maximum economy 
in management and to' save the available funds for other lines of 
tulici't'ulosis work ralhcr llian to fritter away State funds in a large 


No. 13. COMMiSSlONKlt OP HEALTH. 161 

series of small institations at a much greater cost for maintenance. 
A thousand dollars a day means |365,000 a year, more than {700,000 
tor a period of two years. (Royer)." 

Further, the segregation and care pf these cases can be as well 
accomplished from a public health point of view, in the larger as 
in the smaller institutions ; and even a good deal better if the smaller 
institutions are continually cramped for means, as is apt to be the 
case with county institutions. 


4. It is presumable that the' standard of excellence would vary, 
nay, must vary in a number of smaller institutions under separate 
and different management. It is self-evident that under the coun^ 
commissioners, or whatever the local boards of management may be, 
the interest and efficiency of the boards would vary in different lo- 
calities, either for political or other reasons. It does not stretch 
the imagination unduly as to where to look for and expect the best 
standard of management, in a local board with individual responsi- 
bility merged in a group management, or from one man, a State 
official, directly and personally responsible to the public, for a public 
institution in which the whole public is interested and concerned 
and for which he gets the entire credit or the blame. This point of 
difference in efficiency of the management of different local hospitals 
for the care of consumptives has been investigated wiHi results 
strikingly confirmative of what I say by a committee of the National 
Aseociation for the Study and Prevention of Tuberculosis. This 
committee shows that in a relatively lai^e number of the institu- 
tions investigated (twenty-five in all), no sputum or urine analyses 
were made; no re-examinations of the patients were ever made; no 
record of the patient's first examination was kept; no records of 
tonperature nor nurses' records were kept and when kept were in- 
complete; no record of wei^t was made except when the patients 
weighed themselves. In seventeen institutions there were no patiente 
receiving open-air treatment at the time of the inspection. In eleven 
institations there were no rules observed in regard to keeping the 
windows open day and night, and the matter was left more or leas 
to the discretion of the patients, and at the time of the visit the 
windows of the wards and rooms were tightly closed, etc 


5. Do indigent consumptives object to going to a sanatorium 
at a distance? Let me answer this from an experience of eight 
years in the largest tuberculosis dispensary in Philadelphia. They 
do not; they prefer it. Nearly every consumptive has a desire to 




"go away" for a cure. It is easier to get them to go to a sanatoritun 
at a distance ttian to one near at hand. This is psychologically a 
natural view-point, and I have not nncommonly seen patients (in 
some instances really unsuitable to send away) refuse to go to an 
institution nearby, who veve quite willing and anxious to go to 
Mont Alto or Cresson, where the change of climate and mountain 
environment appealed to their hope of a new grasp on health. 
Further, it is difficult to sever local coanty institutions from con- 
nection with pauper institutions and with poor board officials. This 
again interferes with the willingness of many to go to anch insti- 

6. Patients who go to sanatorium at a considerable distance from 
their homes seem better contented and do remain longer than those 
in institutions near home. We find that at Mont Alto patients stay 
in direct relation . to the distance from which they come. Those 
who live farthest away stay the longest. This we have shown to 
be, as a rule, geometrically true; and as au illustration, in a series 
of one year's cases, 418 in all (investigated by me), who went to Mont 
Alto from Philadelphia llie average length of stay was seven and 
a half months, while the average length of stay of all cases for the 
same year was four and a half months. So striking is this that the 
medical director of Cresson Sanatorium, who has investigated it 
for his institution, and who finds it equally true, has suggested that 
patients would stay longer aud even better results be obtained if 
Mont Alto took the cases from the western part of the State and 
Cresson those from the eastern part of the State. 

The above I think are convincing practical arguments against the 
efficiency of small local sanatoria, even granting for the sake of 
argument, that this system ever really would have amounted to any- 
thing or could have supplied the immediate need of Pennsylvania. 
It never could possibly have done so, for in Pennsylvania the coun- 
ties are too poor. Had Pennsylvania attempted to handle the prob- 
lem in this disassociated aud incomplete manner we could not have 
had in twenty-tive or in fifty years the facilities we have today; 
and, indeed, we could never have developed the cohesive* interrelated, 
and effective system in the close relationship between dispensary and 
sanatorium that we have today. 


7. There is just one phase of the problem where the principle 
of local care does hold good for self-evident and practical reasons. 
Everybody admits and desires that local communities shoald ppo- 


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vide acoommodation for their far-advaneed toxic t'onsiiinptives, for 
those cases that are not suitable foi- strictly sanatorium care. More 
than fifty per cent, of the cases sent to the State Sanatoria are far- 
advanced cases, many of thein only suitable for infirmary care. The 
State sanatoria must provide accommodation for these cases, be- 
cause there is, speakinfi; broadly, no other accommodation for them, 
but it should not have to take care of this class of cases. Certainly 
the larger centres of population nhoiild have -Huitahle hospitals for 
these cases, bnt even they cannot be got to supply these. The pres- 
sure for such hospitals mnst come from within, legislative enact- 
ment accomplishes little, and there is ample authority under the 
law for such communities to build these institutions, and it is de- 
voutly to be hoped that they will see their duty and do so. It 
■ is not fair to send dying consumptives to Mont Alto and Cresson, 
and yet there is no other place to send most of them, and many 
insist on going. The State stands ready to care for all classes 
of cases in its sanatoria, because there do not exist adequate fa- 
cilities for the care of the advanced toxic case at home, where it 
belongs. I wish particularly to emphasize the distinction I make 
between local hospitals and local sanatoria. I do not believe that 
counties or groups of counties should be called npon to build local 
sanatoria, even in theory; and iwactically the counties are much too 
poor in Pennsylvania ever to attempt to do so. Many of them have 
not even got almshouses and cininot take caie of their indigent 
poor; many of Ihem haveiio general and uo isolation hospital for 
their contagious diseases and are too poor to provide these. The 
counties outside the few larger centres of population are very poor, 
they have practically no money for public inii»rovements or for pur- 
poses of philanthropy. They cannot even supply themselves with 
pure water, it is (piixotic to ask them to fake care of their tuber- 
culous sick. But I do believe that the richer and more populous 
centres, say all cities of 50,000 or over, could and should provide 
special tuberculosis hospitals (or special wards in general hospitals 
if the hospitals can be prevailed on to agree to this) for the local 
care of their toxic advanced consumptives. But even these larger 
and richer centres will not provide this evident and pressing need; 
witness Philadelphia and I'itlslmrgh, It is for this reason that the 
State must stand ready to take care of all classes of consumptives, 
and it should do so until local jirovision of the kind indicated is 
made — very much on the same principle and for the same reasons 
that it should take care of the insane, because local communities 
cannot afford to bear the g:eat burden of this expense, and yet 
namerically the iiisaue are insignificant as compared with the tuber- 

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To sum up, I have shown that previone to 1907 facilities in Peno- 
Bylvania for getting close to the people both by way of education 
and treatment of the sick were wholly inadequate, and farther 
lacked interrelationship or cohesiveness. There were a few indi- 
vidnala working manfully for the advancement of the cauae, but they 
were handicapped by lack of means and official power, misconstmc- 
tion of motives, and too often by working at cross-purposes. The 
antituberculosis movement had not yet found itself; it was UQt on a 
scientific basis. To express it somewhat fancifully it had began 
by the preaching of a holy war, which had been followed by a dis- 
organized crusade; and this in turn was finally followed by the 
strategic investiture and attack of scientific warfare. The enemy 
is not yet conquered, but is yielding. 

We have now in Pennsylvania, all inside of seven years, since the 
State itself took up the work a far-reaching and active campaign of 
education, Statewide social service, adequate sanatorium beds for 
strictly sanatorium cases, adequate dispensary service, and the stand- 
ard of all branches of the service is of the hi^est; but an ^■ 
sential and important link in this admirable chain fot^;ed by the 
Commissioner of Health, Br. Samuel G. Dixon, has not yet been 
added. It is plainly the duty of local communities of 50,000 or 
over to forge that link for themselves in providing local care for the 
far-advanced consumptive, who is unsuitable for strictly sanatorium 
care. Did there but exist in the more populous centres, strategicaUy 
placed, twelve fairly large hospitals for this group of cases, for there 
are twelve cities of the class specified, Pennsylvania would be ade- 
quately equipped for this branch of the service, so fundamentally 
important in the prevention of the spread of infection. 

Deaths in Pennsjlvanui frum .411 Forms of Tnbpri^ilosla from 1906 to 1913 Inclusife 

' PotmU- Dutlm. 

Previous to the law of 1905, Pennsylvania as a State had no r^s- 
tration of births and deaths and no mortality statistica The ac- 
companying table and chart explain themselves and show the steady 


and marked reduction in the death-rate from tuberculosis since the 
State took up this work, and the position of the State Sanatoria 
and State Dispensaries.* 

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Vhiff Medical Intpeclor. 


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Official document. 




Field Work, 

Intant Welfare Work. 

Special ComiDunlcationB, 



Tvphoid Fever:— Gio\e City, C. J. Hiiut; Ki-w Uollnud, C. J. Hunt; Scott- 
- dale, C. J. Hant; Worren, C. W. ScbraeH r MnrysviUe, JoUn J. Mul- 

lowney; Skippackville , B. Franklin Rojer; l^high Univoraity, 0. J. Hunt; 

Tower Oty, C. J. Hunt; Hershpy, C. J. Hunt: Monesaen, C. J. Hunt: 

SwiHrale, C. J. Hunt; KittannlDe and Ford City, T. N, McEee; Radnor 

Townahip, H, M, Hiller; Drexel Hill, H. M. Hiller. 
Diphtheria.— Ql«a Mills Schools, C. 3. Hunt; Allentown, C. J. Hunt. 
Scarlet Feter.-— Donora, C. 3. Hunt. 
D|fienIerv.-~-Freeland, C, J. Hunt, 
Anthrax; — Berwick, O. B. Amjent. 
Leprojy .■—Wilfees-Barre, B. Franklin Royer. 
Foot find Mouth Diieaiec—Sadehury Townahip, Lancaster Count;, C. J. 

S>naIIi>O0.-— Belief on te, C. J. Hunt; Harrisburg, C. J. Hunt; North East 

and Erie County, J. W. Wright; Billmeyer, J. L. Mowery and John J, 

Mullowney ; Jamestown, 0. J. Hunt. 


Medical Inapection in Fourth Class School Districts. 
Sanitary Inapeetion in Fourth Class School Districts, 
Medical Inspection in Third Clnae School Districts, 
Feeble Minded and Epileptics in Fourth Cliiss School Districts. 





No change has taken place in the general organization of the Di- 
vision of Medical Inspection since filing the last annaal commoiiica- 

Snch minor changes as have taken place in the corps of steno- 
graphers, permanent clerks, and the entire list of temporary clerks 
will be found in the general report of the Commissioner of Health. A 
slightly larger nnmber of temporary clerks was required in the Sab- 
Division of School Inspection, owing to the increased nnmber of dis- 
tricts accepting medical inspection, and further, because it was nec- 
essary to vacate early in December committee rooms occupied tem- 
porarily prior to the banning of the session of the Legislatnre. 

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We have been fortunate during tbe year 1911 in having bat few 
lai^e epidemics of communicable disease throughout the Ck»mmoQ- 
wealth, and the asBistance of the officers in the Medical Division haa 
been required less frequently than in previous years. 

In a number of instances, the Chief Medical Inspector, the Asso- 
ciate Chief Medical Inspector, or the Assistant Chief Medical In- 
spector rendered assistance in various communities for the purpose 
of establishing a diagnosis in doubtful cases of communicable dis- 
eases, or in determiniDg the source of infection in epidemics. The 
field work of this sort of greatest moment was in connection witli 
epidemics of typhoid fever in Grove City, Mercer County, in March; 
in Scottdale, Westmoreland County, Warren, Warren County, and 
Marysville, Perry County, in August; in Skippackville, Montgomery 
Countj-, and Coatesville, Chester County, in September; in Johnstown, 
Cambria County, Lehigh University, Northampton County, Monessen, 
Washington County, Tower City, Schuylkill County, and Hershey, 
Dauphin County, in October; in Kittanning and Ford City, Arm- 
strong County, in December. 

lu September a severe outbreak of diarrhoeal disease in Preeland 
and vicinity, Luzerne County, required assistance botb from the 
Medical Division and the Engineering Division. 

Assistance was rendered communities for the purpose of estab- 
lishing or reversing the diagnosis of smallpox at State College, Centre 
County, in January; in Harrisburg, Dauphin County, and Lewis- 
town, Mifflin County, in February; at Kennett Square, Malvern, and 
Tougbkenamon, Chester County, and Billmeyer, Lancaster County, 
in March; in Gettysburg, Adams County, in April; in York, York 
County, in August; and in Jamestown, Mercer County, in November. 

Help and advice were given the town of Donora, Wadiington 
County, in October on account of an outbreak of scarlet fever; All^i- 
town, Lehigh County, and the Glen Mills Schools, Delaware County, 
in November, on account of an undue prevalence of diphtheria. 

In August the Department removed a National Guardsman, while 
suffering from diphtheria, from the State Encampment at Mt. Gretna 
to his home in Lewistown, 

In September_the Chief Medical Inspector visited Wilkes-Barre 
for the 7>urpose of establishing the diagnosis of leprosy in a Syrian, 
long a citizen of the United States, apprehpnde<l in Philadelphia and 
transferred to his home in the city of Wilkes-Barre. 

Considerable detail concerning the larger of these epidemics and 
the larger i)ieces of field work will be found in the section of this com- 
mnnication devoted to special reports. 

The various officers of this Division represented the Department 
in different capacities in meetings of local, state, and national asso 


datioBB, and gave public addreeaes on a variety of eabjecta on nu- 
merous occasions in the course of the year. Reference to these con- 
ferences, and other instances in which officers of this Division repre- 
sented the Department, will be found in the General Report of the 
ConLnuBsioner of Health. 


The Medical Division has continued to aid the various active 
agencies throughout the Commonwealth looking toward the lessening 
of infant mortality and improving conditions influencing the healtli 
of young children. Form 20, the circular entitled "Save the Babies," 
had already become popular in seven different languages, and during 
the summer of 1914 we were fortunate in having a social worker 
connected with the Associated Charities of Johnstown, Miss Etelka 
Weiss, translate this circular into Magyar, 

The interest in Baby Saving Shows persists and a nnmber of com- 
munitim not having had an active campaign, or at least not having 
organized exhibits, have solicited the help of the Department. Among 
the more important Exhibits that may be mentioned was one in 
Erie on the 26th of April under the auspices of the Women's Clnb 
of Erie, in cooj^ration with the local health authorities. The Chief 
Medical Inspector made several addresses. The major portion of the 
Exhibit of the Department was afterwards carried to a number of 
commnnity houses and local recreation centres in the city of Erie 
where nurses and doctors gave numerous demonstrations and prac- 
tical talks. 

In June from the 8th to 12th inclusive, an active welfare exhibit 
was conducted in Oil City, Venango County, under the auspices of 
the Women's Club, the Y. W. C. A., the Y. M. C. A., and the Venango 
County Medical Society. The Assistant Chief Medical Inspector 
spent several days there and gave a number of practical talks. 

A very active campaign was conducted in a series of towns in the 
Anthracite Coal regions, where by request of the local authorities 
and social workers, we merged the School Hygiene Exhibit with the 
material usually loaned for Raby Saving shows and also a good por- 
tion of the material ordinarily used with the Traveling Tuberculosis 
Exhibit These combined materials were shown in connection with 
excellent local additions from the 16th to 20th of June in Shenandoah, 
22nd to 27th of June in Mahanoy City, June 30th to July 3rd at 
Pottsville, and from the 13th to the ISth of July at Williamstown. 
In all of these towns the Visiting Nurses Association and the local 
County Anti-Tubercnlosis Society actively cooperated, while in the 
Lykens VallCT exhibit at Williamstown, practically every one in the 
community cooperated in an active way in making the Exhibit a 
success, lat^ numbers of persons traveling from Lykens and Tower . 
City by trolley to see tte exhibit and listen to the lectures. '8 


The Assistaut Chief Medical Inspfictor and the Lecturer of the De- 
partment's TubercalosU Exhibit gave freelj of their time in each of 
these towns. Tlie Chief Medical Inspector visited Williamstovn and 
made the ope^ng address. 

A very active baby saving show was organized at Johnstown ex- 
tending from the 20th to 29tli of Jul;. The Assistant Cbief Medical 
Inspector and the Lecturer with the Department's Tuberculosis Ex- 
hibit both assisted the citizens of this town. Dr. W. G. Tumboll, 
the Director of the Tuberculosis Sanatorium at Cresson, his deputy, 
Dr. 8. H. Einehardt, and one of the resident physicians, Dr. R. V. 
Zabarkea, each gave lectures at frequent itttervals, Dr. Zaharkea 
talking in a number of foreign languages. 

Requests have continued coming from time to time during the year 
from points outside of the State for the bulletin on "How- to Organ- 
ize a Baby Saving Show" and for samples of the literature which we 
distribute in connection with our infant welfare campaigns. For a 
very well organized "Pure Food and Better Baby Exposition" in 
Dallas, Texas, the Department was requested to send material and 
did exhibit all that portion of our loan display that we have blue- 
printed and samples of all of the literature which we distribute here 
in Pennsylvania. 

This Infant Welfare work of the Division might well be extended 
and the campaign might be organized more actively with profit. 


Forms 4, 8, 10, 11, 14, 17, 18, 47, 48, and 49 were re-edited and re- 
published during the year 1914, the changes in each being so slight 
as not to Justify their reproduction in this communication. 

Form I-A promulgated during 1913 was given widespread circnla- 
tiou throughout the Commonwealth during the early months of 1914 
and accomplished a great deal of good in the line of abolishing pab- 
lic drinking cups, and has resulted in the reporting of a number of 
cases of scabies and impetigo contagiosa. 

During the latter part of the summer and early autumn the Euro- 
pean war caused a tremendous advance in the selling price of {wtaB- 
Rium permanganate and at times made it almost impossible to secure 
a Eufficient supply for use of the Health Officers in the field in per- 
forming room disinfection. As soon as the Department's chsDlats 
worked out a substitute formula (referred to in detail in the Com- 
missioner's section of this report) a supplement to Foi'm 16 was 
issued and sent to the County Medical Inspectors and Health Officers 
and Tuberculosis Dispensaries of the State, outlining in some detail 
the mefhods to be followed and calling attention to a special commn- 
Tiication issued by the Commissioner to field officers throughout the 
State as to how sodium dichromate might be used as a substitute. 
The revised supplement to Form 16 reads as follows:— 


Porm 16-A 


Reviied Supplement to Form IS. 

An equally efficient method ul releasiug Formaldehyde gaa, and sIdcc the price 
of PotAsaium Fenuatmauikte has gaue so high, a more economical plan, is to 
take teu ounces by weight of Sodium Dichromate to one pint of Formaldehyde 
solution, and one and one<half fluid ounces each of Cummercial Sulphuric Acid 
and Glrcerine . 

The Formaldehyde aa shipped to Department Health Officers in cold weather con- 
taina the commercial sulphuric acid and glycerine. The Sodium Dichromate is to 
be spread la a thin layer over the bottom of disinfecting pans exactly as was 
done with the Potassium Permanganate, then tbe formaldehyde will be poured into 
tbe vessel and s quick departure mude from the room. 

The resction resulting from the release of tbe guaes is a little more rapid than 
with Potassium Permangaiiute and the deposit rcmaiiiing in the contuiuer is a little 
more corrosive. For thia reasOQ all containers should be removed from the room one- 
half hour after starting the disinfection process, and tbe deposit should then be 
removed and the veasel thorouglily washed out with soap and water. 

In all other ways the dUia feet ion may be performed exactly as outlined in Circular 
10 under tbe Permauganute method. For each 1,000 cubic feet of apace to be disin- 
Eected, one pint plus three ounces (19 ouuces) of the solution will be used with, one 
and one-third measures (10 ounces) of sodium dichromate. 

Samuel G. DiiOD, M. D., 
Oommiaeioner of Health. 
Jan. 11, 1915. 

N. B. Avoid storing in cold places, ft should be kept in a moderately warm 
iriRce always above freezing point. 


In Janaary a letter waa sent to the registered nsrses of the Com- 
moDvealth calling attention to the regulation of the Advisory Board 
forbidding the use of the common drinkicg cup. This letter reads as 
follows : — 

To the Kegistered Nurses of Penusylvanie: 

I am forwarding to each registered nurse iu the Commonwealth cettain of the 
Department's literature, together with the Act for the prevention of blindness, an 
act which places additional duties and responeibiliticH on uurscs and midwives, and 
a new regulation of the Advisory Board of the State Department of Health. 

Nurses will be especially interested in the new rules and regulations forbidding 
the use of the common drinkiog cup, tbe common roller towel, and certain other 
pernicious practices, and cau render great assistance because of their splendid op- 
portunities to convince the public of the sanitary reason for providing individual 
towels or single service towels, and individual drinking cups, single service cutis, 
or bubbling fountains. 

Nurses and physicians fulty appreciate bow frequently Impetigo Contagiosa, 
Syphilis, and other infectious diseases of the mouth ai-e transferred from individual 
to individual by means of tbe common cup, and have seen nbvindant evidence of the 
vicious roller towel transmitting the virus of Trneboma, Pink-eye and other com- 
municable eye affections. Nurses keenly appreciate tbe possibility of transmittinji 
communicable disease affecting the bunds or other surfaces of the body through 
having several individuals uee the same towel. 

I know it will give every licgistered Nurse in Pennayivaoia a great deal of satis- 
faction to assist in wiping out these vicious practices, 

Samuel O. Dixon. 

In August a communicatioQ was sent to the physicians of the 
State calling their attention to the prevalence of trachoma thron^- 



oat the Commonwealth and urging prompt and early reporting of 
every case coming nnder their obserration. This commaoication 
reads as foUovs: 

Dear Doctor:— 

.Triichomn hn« bepn a reportable disease En this Commonirenltli alnce IBOJ. The Act 
of May 14, 1B09, placed it definitely among the diseases requiring reDorting forth- 
with ID writinK to the bealtb authorities. 

Rrcent investigatioQs made in various Bections of the Commonwealth lead us to 
believe that a good many cases of trachoma are not being reported as required by 

I make this appeal for you to report your cases immediately. If the profeaBion 
does not respond to this re<iiiest to comply with the law, it will be my duty to n- 
port the guilty to the Legal Division for action. 

Verr tnilj yonrs, 

Samuel G. Dixon, 
Commissioner of Health. 

In July the nsnal letter was sent to the Department's Health 
Officers in second class townships calling their attention to the great 
redaction in the death rate from typhoid fever and urging the estab- 
lishing of more rigid preeaatious on every infected premises, aud also 
calling attention to the slogan of the Department, "Wipe out typhoid 
fever by killing the germs in the bed pan" and a further slogan, 
"Prevent secondary cases by disinfecting the hands of the attendants, 
and by disinfection of utensils and bedding." 

In August a letter was sent to the trained nurses and midwives 
throughout the Commonwealth, together with Forms 34-A and 34-B, 
providing an easier method for midwives and narses to report in- 
flammation of the eyes, and a snitable commuuication was sent to 
the Secretaries of Boards of Health throughout the State, enclosing 
copies of these Forms sent to tbe midwives aud nnrses. 

Form 34 A. District No 

Commonwealth of Pennsylvania. 


(Report to Health Authorities), 
In compliance with an Act of Assembly, approved the Sth day of June, 1913, I 

beg til report that the infant 

of Mr. aud Mrs , residence 

Ilnrough or City of or Towuship of 

Cuiinly of is now siifFering with inSammation of the 

In iidditiou to forwarding this rpport to the proper health nuthorides I for- 
warded H similar report to Dr residence 

on 191.... 

■pVo*!!!' !'!!"!!!!"!;;!!!;;!!;;!;;; !!:;;;:::"";:;; 

N, R. Midwives, nurses, and other persons having the care of infants, whose eyes 
become inflamed or swollen or reddened within two weeks after birth are required 
by law under penalty to report tbe same in writing within six hours after the dis- 
covery thcrpof ti' the pro|ii'r health aiithnrlties and to some regularly qualified prac- 
ticing physician in the district. 

Commissioner of Health. 

, Goot^lc 


form 34-B. CummoD wealth n( Pennsr'vBaia . 


(Report to Physicians). 
Dear Doctor:— 
Id compliaDce witb en Act of Assembly, approved the 5th day of Jtine, 1913, I - 

b« to report that , the infant 

of Mr. and Mrs residence 

Boroagb or CiV of or Township of 

County of , is now suffering with inflaiiimation of the 

N. B. Midwives, nurfies and other jM-rsons having the care iit infants whose eyes 
become inflamed or swollen or rrddcned within two weeks after birth are required 
by law under pemilty to rep')rt the sump in writing within six hours nfter the dis- 
covery thereof to the proper health niilhorities auil to some regularly rjunlifieil peae- 
tidng physidan in the district. 

In December, in each county where any considerable number of 
casef) ot smallpox developed, notably in Erie, Mercer, Tioga, and 
Warren, a letter was sent to the Secretary of each School Board in 
the connty urging rigid enforcement of the vaccination laws, the com- 
munication reading aa follows: 

Dear Sir:— 

There has been widespread contact with mild cases of smallpox in the vicinity 

•>' County , 

During the course of the Department's investigations it was found that in aeveral 
school districts the observation of the vacdnatlou law has been totally or Id part 
neglected . 

In order to prevent the continuance of the disease and to prevent an epidemic, it 
is abaolutely necessary that your Bnart] instruct the teachei-s to observe the law 
strictly, not only now but at all times, 

Fleasp direct your teachers to exclude from thp schools of vour district every 
child who has not been succcHsfully vaccinated or who bus not filed a certifigate to 
that etfpct, and to readmit them only when certificates arc presented showing that 
they have been sucocEsfully vaccinated. 

Very truly yours, 

Samuel G, Diion, 
Commissioner of Health. 

A communication was sent at the same time to every doctor In 
the county advising that the County Medical Inspector would see 
every case of chicken pox reported, for the purpose of confirming the 
diagnosis, eliminating any possible errors that might occur through 
failure promptly to recognize the case, and further, urging every 
physician having charge of patients presenting symptoms resembling 
grippe to continue his visits to such patients for several days after 
the fever had subsided and to discontinue his visits only after satis- 
fying himself that no eruptive disease had developed. 

Copies of each communication were sent to the Boards of Health, 
of the counties affected, together with a recommendation to tbera to 
have a medical officer see and confirm the diagnosis of every case of 
chicken pox. 


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Typhoid Fever shows a most gratifjing decrease, both in the 
Dumber of cases sickming during the year 1914 and in the 
number of cases dying. A total of 7,653 cases of typhoid fever 
were reported to the Department during the year for the entire 
State, a few over two thousand less than were reported in oar pre- 
vious best year, 1912. The deaths for the year reached the low figure 
of 1,075, by far the smallest number of deaths from this disease 
recorded in the history of the State Department of Health. This low 
figure completes a decline beginning with tbe organization of the 
State Department of Health, both for morbidity and mortality, 
making a total reduction of nearly seventy-five per cent in nine 
years. The most notable outbreaks of typhoid fever occurring during 
the year will be only briefly referred to in this portion of the annual 
communication. More extended notice of each such outbreak wUl 
be found in the section devoted to special reports. 

Typhoid Epidemics. In January and February an outbreak of 
typhoid fever occurred among the students and citizens of Grove City 
and the college bearing the name of this municipality. A detailed 
investigation made by the Associate Chief Medical Inspector and 
r^reaentatives of the Engineeering Division proved the outbreak 
to be due, in all probability, to the pollution of a well through a 
defective casing. Two hundred and one cases were reported in this 
epidemic, some of the students being traced with diflBculty to their 
homes in various sections of the State. 

In JanuaTy and February a very Interesting outbreak of typhoid 
fever occurred in the vicinity of New Holland, Lancaster County, a 
total of fifty-six persons succumbing to the infection. This outbreak 
seemed to he proven fairly definitely to be due to [iolluted oysters. 

In June and July a milk-borne epidemic of typhoid fever occurred 
at Clymer, Indiana County, and small outbreaks occurred at Drexel 
Heights, Delaware County. In each instance investigations were 
made by the Department's County Medical Inspector. 

In June and July twenty-one cases of typhoid fever were investi- 
gated by the Associate Chief Medical Inspector and representatives 
of the Engineering Division at Scottdale and vicinity, in Westmore- 
land County, where it seemed altogether probable that water had 
caused the epidemic. 

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Ib September a noteworthf outbreak of typhoid, milk-borne in 
origin, occarred throughout the scattered villages of SkippackviUe, 
Cedars, and Worcester, Hootgomer; Couuty, the outbreak extending 
for five miles along the Skippack Pike. 

An outbreak of forty-eix cases occurred in Johnstown in Decem- 
ber that was in all probability milk-borne in origin, as was also an 
outbreak in the borough ot Warren where seventy cases were reported. 
Both of these epidemics were investigated by the Associate Chief 
Medical Inspector. During the same month an outbreak of twelve 
cases, probably due to poUuted water, occurred at Dudley, Hunting- 
don County, the investigation being made by the County Medical 
Inspector and a representative of the Engineering Division. 

Daring the early autumn months a small outbreak occurred at 
Monessen, Westmoreland County. An investigation made by the 
Associate Chief Medical Inspector seemed to prove this epidemic due 
to polluted local water supplies. 

A very interesting epidemic occurred among students who boarded 
in the Commons of Lehigh University shortly after the autumn 
semester began. This outbreak was due in all probability to the 
employment of a carrier in the Commons dining room, the only link 
in the chain of evidence needed to make the line of proof positive 
being the finding of the germs in the excreta of the suspected car- 
rier. Details of the investigation made by the Associate Chief Medi- 
cal Inspector and representatives of the Engineering Division will 
be found in an extensive report further along in this communication. 

An epidemic of twenty-seven cases in Swissvale, Allegheny County, 
was investigated by representatives of the Engineering Division and 
reviewed by the Associated Chief Medical Inspector and the County 
Medical Inspector in October. The source of infection in all prob- 
abili^ was polluted milk. 

In November an outbreak of forty cases of typhoid fever was in- 
vestigated at Hershey and vicinity by the Chief Medical Inspector, 
the Associate Chief Medical Inspector, aud the County Medical In- 
spector, the origin of the epidemic remaining indeterminate. 

In September, October, and November a milk-borne epidemic oc- 
curred at Tower City and vicinity. Rchnylkill County. An investi- 
gation was made by the Associate Pliief Medical Inspector, repre- 
sentatives of fhp Engineering Division, and the County Medical In- 
spector of the Department. Near the end of the year two outbreaks 
occurred in Armstrong County, one at Ford City and the other at 
Kittanning. These outbreaks were investigated by the Associate 
Chief Medical Inspector and representatives of the Engineering Di- 
vision, and are reported in full detail by the Department's County 
Medical Inspector. 


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Scarlet fever was unduly prevalent during tie year, a total of 
17,190 casea being reported. The disease was not especially vimlent 
in type, and this may be the reason wby the number of deaths vas 
not excessive, a total of 860 deaths being recorded for the entire year, 
less than for the year 1913, when 915 deaths occurred, or in 1908, 
1909, and 1910, when considerably more than 1,000 lost their lives 
each year through this disease. 

German measles was exceptionally frequent in certain sections of 
the State and it seems entirely probable that the two exanthems 
were not infrequently confused, in some instances cases being re- 
corded as scarlet fever that were actually German measles, in others, 
mild cases of scarlet fever passing for German measles and th^r 
too early release and return to school may account for other mild 

The prevalence of scarlet fever has remained excessive near the 
great manufacturing settlements in and around Pittsburgh and 
throughout the greater portion of southwestern Pennsylvania. As 
the year ends, however, there is a notable lessening of the prevalence 
of this disease, and it seems as though health regulations were be- 
ginning to show some signs of controlling the epidemic. 

The only outbreak that was investigated extensively by the Depart- 
ment was that at Donora, Washington County, where the Depart- 
ment's local representatives made several studies with the health 
authorities and where later the Associate Chief Medical Inspector 
investigated the entire outbreak. 

Clarion, Clarion County, and Hidgway, Elk County, at one time 
during the year showed an unusual prevalence of the disease. Schools 
were closed and special assistance was rendered by the County Medi- 
cal Inspectors of the Department. 


Diphtheria has continued in about the same number throughout 
the State, a total of 16,070 cases being reported, as against 16,867 
in 1913, the total number being fewer tlian was reported in any year 
since 1911. One thousand nine hundred twenty-five deaths occurred 
from this disease, being less than at any time since the creation of the 
Department of Health. 

During November the diphtheria situation became so serious in the 
city of Allentown, Lehigh County, that a si>ecial investigation was 
directed by the Department. The Associate Chief Medical Inspector 
reviewed the work of the local authorities and studied briefly the 
history of all the cases occurring during the calendar year — twi 
hundred and eighty-five in all — and determined that laxity of quar- 
antine regulations was in good part responsible for the undue preva- 
lence of the disease. ,o[^^ 

Nil. 15. C0MMIS8I0NEK OF HBALTH. 1^ 


Smallpoz has been alniOBt aB prevalent In Pennaylvaiiia daring 
19M as during an; previous year since the organization of tbe De- 
partment. This is not surprising as the usual ten year cycle has 
more than expired and the time is overdue for the epidemic that 
should have occurred had the nsnal cycles been reproduced. 

The greatest prevalence of this disease was in Erie County, the 
epidemic starting at North East and sweeping throughout the larger 
part of the county, even to the city of Erie. The earliest cases were 
not recognized as smallpox and were not even reported as chicken 
pox. The infection probably came from the state of Washington. 
A good section of Erie Ctounty and vicinity is intluenced by the anti- 
vaccination teaching emanating from the city of Erie and from 
Niagara Falls, and as a result, we have in Erie County a large ud- 
vaccinated and unprotected population. The total number of cases 
in Erie County alone was considerably in excess of three hundred. 
It is perhaps true that the epidemic has done some good in that we 
now have a larger protected population in the towns and rural dis- 
tricts of this county than we have had in a good many years. Should 
a severe outbreak develop now many individuals who have accepted 
vaccination would be spared. 

Bmallpos was introduced during the year at West Chester, Malvern 
and Toughkenamon, Chester County, Bilbneyer, Lancaster County, 
Gettysburg, Adams County, York, York County, Jamestown and 
various points in Mercer County, and in Tioga and Warren Counties, 
and at other scattering places throu^out the Btate. At no place, 
however, except in Erie Coun^, and Jamestown, did the disease reach 
anything like epidemic proportions. 


A special investigation made by the County Medical Inspector for 
Columbia County of two cases of anthrax is of enough interest to be 
included in the section of this communication devoted to special 
reports. Other cases occurred in the Commonwealth but no unusual 
conditions merited special reports. 


Two cases of leprosy were reported during the year. The first 
case, F. 8., an Italian, was reported from Oil City, Venango Coun^, 
in March, the diagnosis at flrat being in doubt. The attending phy- 
sician, Dr. J. F. Davis, forwarded specimens of tissue to the Lab- 
oratory for extended study, resulting in confirmation of his diag- 
nosis. The leper was immediately placed under absolute quarantine 
on the grounds of the Home for the Indigent of the county. Later. 
this afflicted person escaped into New York State, where he was for 
a. time under observation, but he again disappeared. 'vIl' 


The second case was reported to tbe Department from the ci^ of 
WUkes-Barre just after having been transferred back to his place 
of residence from Philadelphia. InvestigatioaB by the Chief Medical 
Inspector, together with a complete study of specimens forwarded 
to the Laboratory, resulted in confirmation of the diagnosis. This 
person is tiow under absolute quarantine in his own home in Wilkes- 
Barre. A report giving some details will be found among the special 
reports of this communication. 

In neitber case could we determine the source of infection. 

Measles was much less prevalent during 1914 than during the 
preceding year, a total of 26,000 odd cases being reported for the 
entire year, the total number being considerably less than any year 
since 1907. A correspondingly low death rate from measles was also 
noted, a total of 549 deaths being recorded, this being several hun- 
dred fewer than have occurred any year since tbe creation of the 
Department of Health and over a thousand less than for the year 


In the course of the year 24,811 morbidity reports were forwarded 
to the Department Health Officers in the field and quarantine, either 
absolute or modified iu character, was established on 19,021 premises. 
In a tabulated summary in another section of this communication 
will be found details concerning the number of rooms disinfected, 
the number of bouses placarded, and the number of the various 
forms received and issued by health otGcers. It is of some interest 
to note that 40,S76 rooms were disinfected by means of formalde- 
hyde gas. 

County Medical Inspectors made important field investigations 
for the purpose of establisliing diagnoses and enforcing proper 
qnarantine r^ulationa for the various communicable diseases as 
follows: — 

SmnllpnT, 724 Hpidpinic Meninptis, 4 

Trphnld (pver 340 Cbic-kPn pox, 960 

Diphtheria, 683 Whonping coubU, StS! 

Rcnrlpt fevpr, 674 Meaelea 1,4OT 

The same custom has been continued in having the County Inspec- 
tor establish rigid regulations on dairy farms where premises were 
quarantined for typhoid fever, diphtheria, scarlet, epidemic menin- 
gitis, or smallpox. Such regulations were established on dairy prem- 
ises as indicated for the following diseases, and in the number of 
instances set opposite the name of each disease: — 




h GoVy^lc 


In 227 iostances it was possible to make satisfactory arraQgemeutH 
for some one not residing in the house with the infected case to con- 
tinue the work about the dairi^ and to do the marketing of the milk, 
often one of the well members of the family, having been given an 
antiseptic bath and donned disinfected clothing, removed from the 
house and remained out of it. In some instances neighbors came on 
the premises and did the work, washing the containers, etc. , 

In 292 instances the sale of milk was discontinued because tio sat- 
isfactory arrangements could be made for handling the milk safely. 
In dfty-two instances the herd was transferred to a neighbor's prem- 

In 420 instances onr County Medical Inspector found on making 
field investigations that children infected with various communicable 
diseases had been in school during the infectiens stage and for this 
reason these schools were closed until disinfected. 

In the performance of all of these various duties the County 
Medical Inspectors traveled a total of 56,560 miles. 

A more extended summary of the important work of Health 
Officers in handling communicable diseases will follow the abstracts 
of the County Medical Inspectors, 





Pursaant to your instructions, I proceeded to Grove CiJj, Mercer 
County, on February 28th, in order to review the diagnoaes and 
give an opinion relative to an epidemic of acute dysentery and ^plioid 
fever in that borough. 

Assistant Engineers H. E. Moses and R. E. Irwiu had gone to this 
place on February 6th, soon after the prevalence of dysraitery be- 
came knoll's. Between the time of their arrival and March 1st a 
large number of cases of typhoid tever were reported, in the diag- 
nosis of which there had bee'a disagreement among a few of the 
twelve physicians practising in the borough. A census of all cases 
of typhoid fever had been made before my arrival; this was con- 
tinned for cases which developed subsequently and the total flgnres 
are here presented in the usual tabulated form. This work was car- 
ried out under the direction of Mr. Moses, by seven Sanitary In- 

Grove City is located in the south-eastern corner of Mercer ' 
County on the Bessemer and Lake Erie Railroad. It is approxi- 
mately fifty miles due north from Pittsburgh and in 1913 had an 
estimated population of 4,504. The borough is divided into four 
wards. The line dividing the First and Fourth Wards from the 
Second and Third Wards patallels the eastern bank of Wolf Creek. 
The latter bisects the city, its course being due south, and is tribu- 
tary to Slippery Ro/^k Creek which tlows into Beaver River, The 
tracks of the Bessemer and Lake Erie Railroad bisect the city at 
right angles to the creek and approximately parallel the ward line 
separating the First and Second from the Third and Fourth Wards. 

The growth of this borough has been constant, increasing from 
1,160 in 1890 to 3,674 in liHO, according to Federal census. The 
occupation is chiefly educational although there are a number of 
industries of local importance. The latter are: — the Bessemer Gas 
Engine Company, the Besaemer Foundry, the Grove City Planing 
Mill Company, the King Planing Mill and Supply Company, the Grove 
City Broom Works, and the Montgomery Broom Works, 



Orove Cit; Colle^, devoted to academic courses and having an 
enrollment for the entire year of nearly eight hundred, is located on 
the west shore ol Wolf Creek in the First Ward. The actual enroll- 
ment at the time of the epidemic was about four hundred. 

The general sanitary conditions are good, the streets, though irre- 
gularly planned, being well drained and a targe nnmber of properties 
being connected with the municipal sewer system which was in- 
Btalled during the past two years. 


Up to the date of making this report, a total of two hundred and 
one cases of ^phoid fever have been reported. The history as to 
Boorce of the typhoid infection differs in no way from that of the 
dysentery infection. For that reason and because of the difftcul- 
tiea in securing accurate data for the many cases, only the diief 
features of the typhoid cases are presented. 

Distribution. The distribution for purposes of simplici^ is based 
on residence at time of infection: 

187 cases resided in Grove Ci^, 

9 cases resided in Pine Township, Mercer Connty, 

2 cases resided in Irwin Township, Mercer County, 

2 cases resided in Wolf Creek Township, Mercer County, 

1 case resided in Mercer Township, Butler County. 

Certain cases, students in the College, were taken ill at home on 
vacation visits or were removed to their homes after the onset of 
clinical symptoms. 

It has been shown that the non-resident cases visited Grove City 
and obtained food or drank water there during the period between 
January 28th and February 6th. 

Water. A description of the water system is included in the report 
of the engineering division. In view, however, of the peculiar dis- 
tribntioD and the necessity for a correct epidemiology, it is necessary, 
for purposes of clarity, to ontline certain features. 

The water supply is from four drilled wells located on the west 
branch of Wolf Creek within the borough. 

There are two pumping stations, each procuring water from two 
wells. The upper pumping station, with wells 1 and 2, is located in 
tJie nortliern part of the borough and the lower pumping station, 
with wells 3 and 4, is located in the southern part. The water from 
the upper pumping station is distributed practically entirely to the 
Third and Fourth Wards, north of the tracks of the Bessemer and 
Lake Erie Railroad. There are, however connections with the other 
Wards and it is possible for water from wells 1 and 2 to mingle In 
the mains with water from wells 3 and 4, The lower pumping sta- 


tion Buppliee the water to the southern part of the borougb, made 
of the First and Becond Wards, south of the Besaemer and Lake 
Erie Railroad tracks. 

The vella are free flowing but not enough so as to farnish a supply 
sufBcient for the increasing population. The Qse of well 1 had been 
discontinned and well 3 was out of service. For that reason the 
northern portion of the borough was supplied almost exclusively 
from well 2 and the southern portion from well 4. 

A suction pump had bees in use at the latter but in order to in- 
crease the water supply, air pressure had been introduced on or 
about Novonber 1, 1913. Coincident with the rise of the waters 
in Wolf Creek on November 22, there occurred an outbreak of dysen- 
tery, the number of cases of which is not known. ' Though it is not 
definitely shown, it is evident from local reports atid from the record 
of precipitation that the waters did not again reach such a hei^t 
until January 28, 1914. Coincident with this rise there occurred a 
second outbreak of acute dysentery which was at its maximum about 
the second of February. The cases continned to be reported for two 
weeks with many recrudeseaces of original cases, the physiciaUR 
reporting 1,084 cases as seen by them during this second outbreak, 
but the actual number of persons having dysentery was possibly at 
least twice as many. The first cases of typhoid fever were reported 
on February 17. The estimated dates of onsets of these cases of 
dysentery, which were treated by physicians alad of the cases of 
typhoid fever are shown in the plotted curves on the accompanying 

The water of the creek had previously been frequently higher 
than the recorded flood heights occurring on November 22, 1913 and 
January 28, 1914. Changes in flow of this stream are exceedingly 
variable, as is commonly noted in deforested r^ons. 

It is evident that air pressure on well 4 was in some way respon- 
sible. Investigation showed that the water of the creek had ingress 
through erosions into the well casing at such times as the height of 
the creek level was above a wasteway pipe, placed for ground drain- 
age. Under ordinary conditions, such aa existed prior to November 
22, pollution of the well water would not occur. But, the addition 
of air pressure overcoming the resistance of the outflow through the 
wasteway, led to a direct introduction of creek water. 

Records of precipitation and of flood heights secured by the engi- 
neers show that the water of the creek was high enough for this 
to take place on but two dates subsequent to the use of air pressure — 
namely, on November 22, 1913 and January 28, 1914. As stated 
above the outbreaks followed only these two changes of flow of Wolf 



AdditioBal evidence that water was the means of infection is 
found in the distributioa of cases. It has been noted that the water 
from wellfl No. 3 aBd No. 4 was distributed almost entirely to the First 
and Second Wards. Well No. 3 had not been in service for a consid- 
erable period of time, though the date could not be exactly ascer- 
tained. It is, however, evident that practically all of the water snp- 
plied to the First and Second Wards came from well No. 4 alone, 
The distribution of cases in relation to Ward lines was aa follows: 


Cfutaide. o£ borongh, . 

The distribution of persona suffering with acute dysentery did not 
differ from that of the cases of typhoid fever. A census of the 
dysentery cases was not made but the evidence of physicians and of 
common report was that residents living "above the tracks," or north 
of the Bessemer and Lake Erie Railroad, in the Third and Fourth 
Wards for the moat part escaped infection, 

A tabnlation of the water supplies used by those infected with 
typhoid fever showed that that of the waterworks of the borough had 
been generally drunk by them, about a fifth having used also water 
from other sources. 

On- Be- 

Mt. port. 

On- Re On- 

■el, ^ port, nt. 


•'^''- S-::::-' \ g 

^e::::. \-e 

'i-::r ■'■--::- 


April e,'.'.'.'.'.'.'.'.'.'. '.'.'.'.'.'. 


I?:::::::;:: :::::. t 

iZ. 1 s 

jl ; 1 

, , 


Despite the alleged reluctance on the part of certain physicians 
to establish a diagnosis of typhoid fever, it should be noted that the 


maximum number of cases were reported at a time when it ia eridoit 
tliat the clinical manifestatioDs were first apparent. Also, the occnr- 
rence of the maximum Homber of cases during a period of ten days 
indicates the abruptness of infection, water-borne and common to 
Age and Sex. — A tabulation of age and sex shows the following: 

The table shows no unusual departure from the common sosc^tl- 
bility ag^ unless it is that lower age groups are somewhat predomi- 
nant This is readily accounted for by the large number of students 
in school and college exposed in the area of distribution of polluted 

Oocwpation. A tabulation of occupations shows the following: 

Students, 117 

HuaiewKe, 32 

ChUd, 9 

At home 7 

DomcBtic '■ 7 

All other 29 


The fact that one hundred and seventy-two, or more than four- 
fifths of all cases, were for the most part persons in domestic rela- 
tions indicates a transmitfing agent of wide distribution. No one 
occupation exposed residents to infection unless it was that in stu- 
dent life. One hundred and seventeen, or 58.2 per cent, of the cases 
were students. 
* Of these, fifty-three were students attending flrove City College. 
At this time there were three hundred and ninety students on the 
rolls, two hundred and fifty girls and one hundred and forty boys. 
It is the college requirement that all female students shall be honsed 
in one of the three dormitories: The Colonial, Cunningham Hall, and 
Pelton Hall. These are all on the College Campus in the First Ward. 


The male etudeuts room in private houses throoghout the town, bat 
table board is provided for them iu the Commons on the Campus. 
For these reasons the expected morbidly of students, but especiall? 
of female students, would be high. It turned out, however, that thirty 
of the boys and twenty-three of the girls became ill, which means a 
general morbidity rate of 21.4% for the boys and 9.2% for the girls. 
The occurrence of disease among the students was naturally a matter 
of great concern and the studies made at the'time of the investiga- 
tion were important for the guidance of the authorities of the Col- 

Of the hundred and seventeen persons recorded as students, satj- 
four were in attendance at the public schools. Thirty-nine of these 
were students in the Central School Building in the Second Ward 
and twenty-one belonged to the Lincoln School in the Third Ward, 
and four went to township schools outside the boron^. 

Analyses of the water supplies were, of course, made in the De- 
partment's Laboratories. These proved negative for sewage oi^an- 
isms in every instance. No specimens were collected before treat- 
ment of the water was b^un by the engineers. The mass poUution 
probably occurred on January 29, 30 and 31 with a much diluted 
bat continuing pipe pollution until February 7th. The engineers 
arrived on February 6th and within twenty-four hours the entire 
water system had been efficiently treated with the sulphate of copper. 
The bacteriological analyses of specimens collected on February 7th 
would naturally prove negative. This point will be referred to later 
as it was a matter of comment that bacteriological evidence was not 
furnished to the public. 

SJtellfiah. The only other factor of serious consideration was the 
use of oysters. No other kind of shellfish had beeu in use. Tbt 
oysters on sale were the so-called "tub" or "loose" oysters and were 
purchased from the local dealers as noted in the following table: 

None used 113 

AJlro Grocery only, 2 

Bluir & Holatein 9 

Blair & Hnlstein and Killian & Co 1 

tJraham'a Grocery only, , fl 

Caldwell Grocery only, — 2 

Uber Grocery iind Hunnii Grocery, 1 

Ohew'i, Bluir & HolHtein, and Killian & Co 2 

Chew's and Killiun & Co. 16 

Ri>8s & Bennett Grocery, 2 

Uber's Grocery, 4 

Craig'H GroKry only, 1 

Craijt and tJber, 1 

Robins and Turk Grocery 2 

Hougb Gro(«ry only 1 

MeCSiy'i Groeery 1 

Hart's Grocery only, 1 

Unstated 8 




This table was compiled before the iiivestigatioiL was completed and 
about twenty-Beven of the total number of cases are not included. 
When the table was submitted to you there was also reported a list 
of the wholesale shippers who had supplied the ojstera in question 
and a summary of the information then at hand concemiug the lab- 
oratory examination of certain samples of oysters. In this memora'D- 
dum was included the following tentative statement regarding the 
relation of oysters t6 the epidemic at Grove City: — 

"You will note that the jB, typhosua was recovered from the oyster 
juice of J. W. Chew & Company, shipper, Baltimore, Maryland, The 
bacterial form obtained from the Parks, Wenzel & Company, Balti- 
more, Maryland supply, has not been definitely determined, but is 
probably a pathogenic form of the intermediate group. 

"It should be noted that definite data as to whether or not oysters 
were eaten raw or cooked were not obtained except in the supply 
at the Girls' Dormitory, which was, in part, from J, W. Chew & 
Company and, in part, from W. H. Killian k Company; these oysters 
were always cooked. This, of course, eliminated twenty casea from 

"There is no evidence that oysters supplied prior to the explosive 
outbreak of February were the cause of illness in that borough." 

An abstract of the laboratory report and related data follows: — 


Chaised AgiLnti. 


Tot.l B.C. 
pet o.c. 



PilbocMilc F0rni. 

V 1 




(Onlj MakM ojmun 

W. B. kilVun ft Co.. Bittlmure, Hi.. | 

J. l/. Bj'ril. Creiuieid. Md'.. onlV , 


Canes usinf! infected oyBWrs (Mmked) 20 

CuBPB using infected nysters iuustutpd) 6 

CnseB lining lininfec'ti'd or iin pi h rained ojnterB, 23 S2 

Casex not using oysters, 113 

Total 174 

The figures obtained later after studying the total number of cases 
(201) did not alter the conclusion presented in this preliminary 
report, and it was still the opinion of yonr representative that oysters 
had not been the source of any one case. 


MUk. The milk used by the patients came from the following 
dealers: — 

Thompson, 7 Criblie, 17 

Thompson & PriUKl? 1 Stoae ;> 

Ftingle, E Campbell, 10 

Priugle & Young 1 Kiilling Bros., 4 

YounB, 18 lilutk 1 

S. YuuuK, 6 Knuisey, J 

YouuK & CoadeDsed, 1 Pearaon, 4 

CoudeaBed, 4 Zeilera, 3 

UaviB, 11 Jordan, 8 

Davis & Nye, 1 Miller, 2 

Nye, 10 Fryman, 1 

Nje&Comig 1 Oxford Club 1 

Putter 4 Wilson 1 

Hushes, 14 Flatt 2 

Kicuardson, 17 UnslatGd 4 

McDoweU 3 

Hunter, 39 

Own Supply, 14 Total, 201 

It cannot be shown that any cases of ^hoid fever, primary or 
secondary, were traceable to the milk supply. Shortly after the 
arrival of Engineers Moses and Irwin it was recommended to the 
local Board of Health that the distribution of milk by bottles should 
be temporarily discontinued. This was immediately carried into 
^ect and milk was sold directly from large containers and received 
in household containers set out by the patrons of the various dairies. 

Ice Cream. The information regarding this possible source of in- 
fection is as follows: — 



The use of Ice cream, as of oysters and milk, gave negative evidence 
as its being a tralismitting agent, and the use of other food stuffs 
was similarly negative. 


The difference of opinion on this point probably originated prior to 
November 22. Before the instaliation of air pressure, during the 
early part of November, a suction pump had been in temporary use. 
Lubricating oil found entrance to the water supply and the oil, 
while disagreeable in taste, did not cause gastrointestinal symptoms, 
Certain of the medical profession and the general public were, how- 
ever, of the opinion that the outbreak of dysentery on November 22, 
1913, and again on January 29, 1914, was due to this cause. This 
error was followed by differences of opinion as to the nature of the 
febrile disease which began to attract attention about February ITth. 

The first cases were described in a letter from one physician, dated 
February 23, as "simulating typhoid fever but no cases with 
tibte characteristic symptoms." Another physician "considered it to 



be a paratypUold fever" did not report the caBes, peoding receipt of 
your opinion. Another physician criticized the Department for not 
making the water analyees public and one denied that the outbreak 
could be due to the water supply. Each had his following among the 
laity, including certain municipal officers. 

For these reasons it was of paramount importance to establish a 
diagnosis of many cases and to meet the objection relative to the 
announced source of infection. 

No difficulty was met in doing this work. The physician witiiout 
exception cooperated in the work for which you detailed your medi- 
cal representative. It was made possible to study upwards of half of 
the cases and to secure blood serum for studies of fifty-five cases. 
These studies were made between the first and sixth of March, at a 
time when most of the cases were in the second week of the disease. 
Variations of onset were studied in cases in the incipient stage and 
in those that had had continuous dysentery following an onset in 
the last days of January. 

Clinically, the majority of eases preseuted the usual picture of 
typhoid fever. The ditferenre iii diagnosis probably arose in not 
eliminating the clinical symptoms and signs of acute dysentery in 
many cases in which tliese pajjsed into those of typhus fever. 

Blood sera from fifty-five cases and feces from three were studied 
by Dr. J. B. Eucker, Jr., in tlie Department's Laboratories. The blood 
sera in dilutions of 1:40 and higher (in positive cases) gave the fol- 
f owing results: 

Affi/luHnalion Heaclioni. 

Positive: — B. typhoiiDi only, 33 

B, iyphuiti», B. and paratyfihoatu A. aild B. paraeoU,.. 2 

B. Inphriaua mid II . paratjiphoiiiii A. 2 

B. lyjihvsni nwd B. i-ateritidin, 10 

B. paratyphwiHt A. only 1 

It is in harmony with both the clinical evidence and the semm 
reaction that an infection with B. typJwsus predominated. 

As is usual in water-borne typhoid outbreaks which are preceded 
by epidemics of dysentery, there was evidence of infection by other 
members of the typho-colon group. This was, however, much less 
marked thati in previous epidemics studied by the Department 

The interesting feature was the oceurren<'e of positive a^Iutinins 
for B. enteritidis. Studies with the several strains of B. dysenteritB 
in subacute cases gave negative results. The^e two findings har- 
monize with histories of dysentery cases as given by local physicians 
and the subacute cases studie<l by your representative. The evidence 
indicates that the dysentery cases sutTered witli markedly abrupt 
onsets, pain, nausea, and vomiting, prior to or coincident with liquid 



mOTementB of the bowels; and that intestinal haemorrhage, proatra- 
tion, and delayed convalescence were common. In other words, the 
^^drome was the expressioa ot a rapidly absorbed toxin and not 
that of an endotoxin. For these reasons it is probable that a strain 
of B. enteritidia was the causative microorganism of the outbreak of 
dysentery at the end of January, 

An investigation of the relation of dysentery and typhoid morbidity 
was made r^arding patients having both infections and others ex- 
posed in the same premises. The tabulated results are as follows: — 

Cases having both iufections, 171 83.1 per cent. 

Cases btiviDg typhoid fever ouly, 17 8.4 per cent. 

No data, 13 6.5 per cent. 

It was not possible to learn the number of subacute cases of dysen- 
tery but many having typhoid fever gave such a history. 

The dysentery morbidity in the families in which typhoid subse- 
quently developed totalled 547 cases. Excluding the fifteen families 
in which no data could be obtained, there were only twenty-two per- 
sons who escaped dysentery infection in premises subsequently hous- 
ing cases of typhoid fever. This bigh morbidity rate (ninety-six per 
cent.) for dysentery indicates the large number of the total popula- 
tion, who must have been infected in the two wards in which the pol- 
Inted water was distributed. 

The three specimens of feces were negative for pathogenic bacteria 
No attempt to recover pathogenic forms from water supplies was 
made because of the treatment for sterilization. 

The mortality to May 1st is as follows: — 



Address. ot 

flmve Cltsl - 
Ciwe Cltj, . 
OnrtP ClU. . 
cnxf OUT. . 

IrwlD Twp., V 

™'T. .?".■;.. 

Grove CI 17, 

Of these fourteen had suflfered with acute dysentery from which 
th^ bad not recovered before the appearance of clinical evidence of 
^hoid fever. 

13 i:i,.,b, Google 



Enginea-ing. The special report of the abatemeot of the source of 
the infection, treatment of water supplies and the control of the milk 
supply is submitted by the Engineering Division. 

Board of Health. The local Board felt that under the circnm- 
stances their action was limited. The usual placarding of premises 
vas carried out as soon as reports of cases were filed. Circulars of 
instruction were not ordinarily distributed nor was verbal notice of 
preventive measures given. It has been customary to depend upon 
physicians for such instructions. A meeting of the Board was held 
on March 5th. This was attended by various ofBcers of the borough 
government, physicians, and others. The work performed by your 
representatives and the relation of cause and effect were detailed in 
respotise to requests for such information. 

Hospital, The hospital in the borough having a normal capacity 
of not over twenty was efficiently administered by Miss Blanche 
Fleming, Superintendent, with an average of between thirty and forty 
patients. The organization" of an Emergency Hospital was co'nsid- 
ered by three bodies, the Board of Hospital Managers, the Civic Com- 
mittee of the Commercial Chih, and the Ladies Hospital Auxiliary. 
By request, your representative met with the first named on March 
3 and 5 and the last on Maich 4. Because of the rapidly diminish- 
ing reports of new cases and the estimate of a continuance of the 
epidemic, both organizations were advised that the opening of 
another hospital would be unnecessary. It was further pointed out 
that economic conditions did not warrant the expenditure of money, 
which by reason of the location and transportation would make th<* 
per capita cost far in excess of the usual Emergency Expense, It 
was advised that a District Nurse Service would furnish ada)nate 
assistance to all who needed it and could be administered by Miss 
Fleming. This method was adopted. 

The College. By request of Dr. A. T. Ormond, President of Grove 
City College, a description of the soarce of the infection and its 
abatement together with a statement concerning the outlook was 
made in Chapel on March 3. 

As alt problems of a medical and administrative nature had beea 
adjusted, I withdrew by your instructions on March 6. 

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In accordance with your instructions I proceeded to New Holland, 
Lancaster County, on February 5, 1914, in order to investigate the 
conditions causing the nnasual prevalence of typhoid fever in that 
borough a'nd vicinity. An earlier investigation had been made by 
Dr. J. L. Mowery, Coonty Medical Inspector, who accompanied me 
in performing the work here reported. 

The censoB and the collection of water aainpleB were made under 
the direction of Assistant Engin^r M. B. Shaughnessy, assisted by 
Sanitary Inspector H. A. Miller, and Health Officer H. B. Slack, 
District No. 539. Much information was furnished by the Board of 
Health of New Holland Borough. The officers of tiiis Board are 
E. H. Burkholder, President, P. D. Hess, Secretary, and John Mentzer, 
Health Officer. 

New Holland Borough is a centre for the surrounding townships 
of Lancaster County. The occurrence of cases of typhoid fever dur- 
ing every month of the year was a matter of concern to the Board of 

During the year 1913 and in January 1914 fifty-six cases had been 
reported in the district in which cases were traced. It was not pos- 
sible or necessary to investigate all and this report is based on 
studies of forty-eight cases, for which a census was made. Of these, 
twenty-flve developed the disease during 1913 and twenty-three dur- 
ing Jannaiy, 1914. 

New Hollijnd Borougb, 4 Upper Tieooock Irtwnship, 4 

Earl TownRliip 7 Rphrata Township, 2 

Weet Eari Township 7 8 aliabury Township 5 

Gaat En rl Township S Caernarvon TowDHhip, 3 

LtacorM Township 11 '- — 


The wide distribution of the cases excluded a factor common to 
the group unless the infection was acquired in some centre such as 
New Holland Borough or by transportation to them. 

The use of a common transmitting agent in New Holland was 
possible but was readily excluded in the negative history obtained by 
our census. Even a small group could not be traced to ice cream, 
local water, or foods in the Borough. The latter had a population of 
1,106 in 1910 and this has probably been increased. The occurrence 
of four cases in the Borough was not found to be traceable to a 
local factor. 


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The data obtained b; ce'nsus, wbea tabulated, gave the following 
results : 


Own dug well and Keading ., I case. 

Own dug well and Ephrata, I case. 

Own dug welland New Hollnnd Public Supply, 8 cases. 

Own dug weU and Lancaster 4 cases. 

0\«i dug well only 18 cases. 

Own drilled well nnd Lancaster, .' 2 cases. 

Own drilled well and spring 1 case. 

Artesian well and New Holland Public Supply, 1 cose. 

Spring and own dufi well, 3 cases. 

Spring and Bpbratn 1 case. 

Spring and own well 1 case. 

Spring and dBtem, 1 case. 

Spring only. 3 cases. 

(^terti, 1 case. 

Water waa excluded from consideration by the distribution of c 
and the great variety of the sources of water supply. 


Purcbaaed from five sources 9 cases. 

Own supply only 36 cases. 

Various, 1 case. 

None used, 2 cases. 

Mo typhoid fever was reported on the premises of the five sourcei) 
of milk for the cine cases. 

Ice cream, ice, and uncooked foods were excluded by similar evi- 

The time of the year and the low temperature excluded flies. 

The use of oysters was, however, common to a large number of 
cases. This is shown in the Case Tabulation following: 











; No, 

rwoembdr IS, 1913 







DpMmbw IT, 1913 

:; -g 

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Soqrws at SupoU. 


















Dtccmber 35, 1>II 


Januiry 1, im 


W K 

S£ i; ii :::::::: 


«' Md. 


J T M rlt] 

PranWln ClCj, Mfl. 

January IS, Uli. 

December SS. 1»1», 


All n» o( itft, dulcd 

M 1 WIS, 

Uiii«lll«I d>U or no Ubtotj 

&%.^'..:: ::;::: 


April 7, isw; 


I""" 1" ?SJ 


■'"'■? *"7'ras 


J.nMr, U. !«*. 



Cases QBinB oysters from Stnckton, Md. 

Cosps uning oysters from Frnnklin City, Vs., 

Cfises iisinic oysters from botb points 

Cnses usinK ao oysters, 

Cases with history of use undetermined 

The oyster beds which were the sources of the suspected supply are 
said to be bat three miles apart, located on the Eastern Shore of 
Maryland and Virginia. All beds are in the Chiucoteague Bay (on 
the branch of the P. B. & W. R, R. from Harrington, Delaware) , This 
line terminates at Franklin City after passing through Stockton, 

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Of the seven wholesale dealers referred to in the above table, four 
are said to operate their own beds, namely: H. C. Ellis, Franklin City, 
Va., M. H. Price, Stockton, Md., T. F. Dlsbaroon, Stockton, Md., and 
I, J. Hancock, Stockton, Md. Information was not obtained relative 
to J. T. Merrill, William Krouse, J. H. Toole, and the unnamed dealer. 

With the thought in mind that the oysters may have been infected 
by feeding with a polluted water, subsequent to their arrival in 
Lancaster County, the retailers were visited and the following in- 
formation procured : 

Dealer No. 2, of Salisbury, a saddler, handled twenty-one barrels 
of oysters during the holidays, wholesale, by the barrel, and retail, 
by the hundred. Barrel lots were sold to the following. 

John G. Diller, Ledger, 1 barrel. 

Martin ^^>Zc Gap. 1 barrel. 

nenJBmln Blank, Gap *2 barrels. 

J. J. Shirk. Gap, 1 barrel. 

C. U. Stoltsfus, Gap, 1 barrel. 

Solomon Stoltzfua, Onp, 1 barrel. 

J. W. Martin. Gap, - J barrel. 

Robert Baldwin, Hanes, *2 barrels. 

Colcmnn Kurtz, Hanes, 1 barrel. 

Sitmirel Kannon, Hanea, 1 barrel. 

'Blank and Baldwin sold these by retail. 

which would leave nine and a half barrels that he sold by the hundred. 

He did not float these oysters. 

Dealer No. 3, of Bareville, Lancaster County, buys oysters of W. H. 
Price, Stockton, Md. He had from ten to twelve barrels before 
Christmas, culls, and because sales were slow he fed them com meal, 
salt, and water. 

Dealer No. 4, of Gordonvillei handled 2(H),000 oysters, bought from 
H. C. Ellis, a planter and shipper of Franklin City, Va., and from 
T. F. Disbaroon, Stockton, Md., getting from eight to ten barrels 
a week, received Tuesday and Friday. He does not "float them in any 
manner; they cost about $2.00 a barrel for culls, and about seventy- 
five cents a hundred for primes. 

Dealer No. C, of Vogansville, has sold about forty barrels of oysters 
in the holiday time, not only in barrel lota but by the hundred. He 
never floated them. He purchased direct from W. H. Price, Stockton, 
Md. at $2.00 a barrel phis sixty cents freight. He sold a barrel to 
Daniel and Edwin Hoover, David Newswanger, Walter and Milton 
Ess] inger. 

Dealer No. 7, of Cedar Lane, buys o;^8ters from William Krouse, 
Stockton, Md. Ho does not float or feed his oysters. 

Dealer No. S, father of Oscar Thomas, of Beartown, buys oysters 
from -T. T. Merrill & Son, dealers in oysters of Franklin City, Va. 
He does not feed or float his oysters. 

Dealer No, {) buy.<i nil his oysters from J. T. Merrill & Bon. He 
uses only primes costing $3.00 a barrel plus sixty cents frei^t. He 



does not float oysters but turns barrel on bead bo tbat tbe brine in the 
bottom of the barrel may flow back over tbe oysters. He buys but 
one barrel at a time. 

Dealer No. 10, of Early Township, Lancaster Connty, buys entirely 
fromT. F. Disbaroon, of Stockton, Md., and the week before Christmas 
he bought a carload of one hundred and fifty barrels, one third being 
primes costing f3.25 a barrel and the balance were culls which cost 
f2.00 a barrel. The culls average from six hundred to nine hundred 
to the barrel. At other times he handles from ten to fifteen barrels 
a. week — the quantity depending upon the weather. He feeds com 
meal, salt and water. The water is taken from a well in tbe barn- 
yard, a sample of which was taken February 18, 1914. At that time 
the old wooden stock was worn out. A coal scuttle, a wooden bucket, 
a sprinkling can, are left filled with water, all upon a filthy wooden 
and leaking pump floor. Chickens were roosting on these vessels. 
The contents of the coai scuttle were poured down the old pump 
stock to "get it started" ; then the water was pumped off to "get the 
fresh water." 

Dealer No. 11, restaurant keeper in Ephrata Borough, sold oysters 
to Jacob Messmer, which were bought from F, Mettfitt & Brothers, 
Lancaster, who bought In part from Franklin City. He handles about 
three barrels a week and gets them by the barrel as he uses them. 
Whether Messmer bought shell or shucked oysters was not stated. 

Dealer No. 12 purchased a barrel direct from T. F. Disbaroon, 
Stockton, Md., for his own use at $2.20 a barrel plus sixty cents 

Dealer No. 13, who sold oysters to Wenger Groff in Earl Township, 
obtains his oysters from H. C. Ellis, Franklin City, Va., and sold 
fourteen barrels to diffei-ent parties about two weeks, before Christ- 
mas. They were never floated while in his possession. 

Dealer No. 15. of Gordonville, buys only culls from T. F. Disbaroon, 
Stockton, Md., and retails them at sales. They cost f2.00 a barrel 
plus freight; he uever feeds his oysters but wets a bag and places it 
over the barrel. 

Dealer No. ] 6. Gordonville, buys only culls from T. F. Merrill and 
Son, Franklin City, Va., which cost him |2.00 a barrel, plus freight. 
He never carries a large stock, but frequently throws water over 
them from the well in front of Levi Lauch's Hotel in Gordonville, 
where a sample was taken oti February 12, 1914. 

Dealer No. 17, of Bareville, buys Morris River Cove oysters from 
Col. -T. E. Yeats, of Bivalve, N. J. After J. E. Myers was taken sick 
he bought oysters from N. S. GrofT. 

Dealers (15), fl6), and (17), had no patients on route (corrected 
to March 7th). No investigations of Dealers (1), (5), and (14) were 

1 Goot^lc 


The use of water for feeding, as is noted above, is not practised 
except iu a few instauceB; Id these the analysis of the water snpply 
made at the time of investigation was n^ative. Small size carloads 
had been purchased by two dealers but no cases of typhoid fever were 
traced to these carload Jots. The oysters purchased were of the 
cheapest grades and all purchased from beds in one locality. 

Amos Detrick, whose sales included the largest number of cases, 
had not used water except from a well on his own prwnisee; this 
water is in constant use for drinking purposes by his own family and 
other residents in ^''ogansville. It should also be noted that oysters 
sold by hucksters and other dealers were always sold in the shell 
and that contamination with polluted water used for "floating" 
would not be a menace in this particular outbreak. 

The following exceptions to the oyster infection are to be noted : 

Exception 1. Case 11 was a direct contact employed on the prem- 
ises of Case 1 who was taken ill with typhoid fever o'n M&y 1, 1S13. 
Case 1 Buffered with phlebitis during convalescence and there is 
reason to believe that she was a carrier for some period following 
her recovery from the disease. No laboratory studies were permitted. 

Exception 2. In the family of Cases 32 and 35. Case 36, the father, 
had developed typhoid fever on September 20, 1913. At the time it 
was believed that his case was secondary to another member of the 
family who had had the disease some eighteen months previously. 
Following his illness, Oases 32 and 35 became ill on January 20 and 
23, 1914, respectively. On the same date. Case 37, aged one year and 
seven months, was taken ill but was diagnosed as "catarrhal disease," 
died and was buried on Febmai-y 6. A brother of Case 36, Case 34, 
resided on the second neighboring farm and visits were frequently 
exchanged, particularly at the time of the illness. A child of Case 
34 became ill on January 20. Among other visitors to the premises 
was Case 49, who developed the disease on January 11, 1914 and 
who at the time was living on the Gillerbortz farm now occupied 
by Harry Bean. Secondary to the case of Case 49 but subseqnent 
to his removal occurred Case 33, whose onset was January 17, 1914. 

At the time of the preliminary investieation by the County Medicnl 
Inspector, the analvses of the water at Beiler's School, which was In 
use by those in the immediate neighborhood, showed large numbers 
of B. Coli. It was not shown, however, that cases were directly 
traceaile to water supply used in this school. 

Exception S. The line of contact which led to the ready transmis- 
sion of the disease is noted in the history of rases occurring in 
the family of Harry Myers and others. These are not included in 
the cases for which a census was made, nor is the disease traceable 
to oyster transmission but is presented in order to show bj what 


meana the endemicity of the disease io such a section may io part be 
maintained. In the family of Harry Myers there occurred the follow- 
ing cases: 

Case 38, aged 11; Case S9, aged 20; Case 10, aged 7; and Case 41, 
aged 26, the onsets of all occurring between April 4 and 7, 1913. The 
immediate source was not discovered although there Is reason to be- 
lieve that the infection was water-borne. The trained nurse in charge 
of the cases was Case 42, a resident of Leacock Township. She 
finished her work, returning to her borne on May 10, She showed 
the early symptoms of typhoid fever on May 20. Two weeks after 
her return, her brother. Case 43, developed the disease and on July 2, 
a brother-in-law, Case 44, liviug in the same house, became ill. On 
Jnly 3, her sisters, Case 45, aged twenty-one, and Case 46, aged nine- 
teen, were taken ill. On July 6, Case 47, aged seventeen, became ill. 
Somewhat later, her sister, Case 48, developed the disease. 

It would seem that contact and infected foods, particularly oysters, 
account for the morbidity herewith detailed. No factor other than 
oysters was found for thirty-two cases. These were handled in Penn- 
sylvania in such a way as to make it appear that the infection occurred 
at the points of collection. 

The investigation was not extended beyond the boundaries of the 


In accordance with instructions issued by you, I proceeded to Scott- 
dale, Westmoreland County, on August 12, 1914, in order to review the 
circumstances relative to typhoid fever morbidity in that Borough. 

The investigation of cases reported before August 13th and of the 
water supplies to the Borough had been made by Assistant Engineer 
8. R. Parke, Jr. 

It had been alleged by representatives of the Citizens Water Com- 
pany that the disease in question was not typhoid fever and that 
errors were being made in diagnosis. 

Eight cases were studied, those selected being, for the most part, 
cases in which the diagnosis had been questioned. All presented the 

lKl>i fom... 



clinical pictare of typhoid fever. The onsets varied between ftftees 
and thirty days prior to the visit of yoar representative. Blood 
collected from five cases gave the following agglutination reactions: 



B. TypbMU.. 


1 B. pantniliwu B. B. p»n 





.. Nwllte. 


Pod tire 

... iNcgBIlre 


.. Nentlx. 

.. Nen>i«-.- 

Case 14 whose blood seratn was n^ative in one examiuatioQ with 
all the forms noted above, was seen about foar weeks after the onset 
and presented every feature of mild typhoid fever. Case 9 was seen 
forty days after onset and was still confined to bed, but convalescent; 
the history and the temperatare record confirmed the diagnosis made 
by the attending physician. 

Of the twenty-one cases reported up to August 13th, eight were 
studied and were undoubtedly infections by B. typhosus or allied 
pathogenic members of the typhocolon group. In all probability more 
than one pathogenic form was responsible and in conformity with the 
regulations of the Department, persons so infected had been reported 
as typhoid fever. Since this occurs more commonly by means of water 
transmission than by other means of transmission, the source of the 
outbreak was to that extent determined. A detailed study of data 
obtained by Assistant Engineer Parke was made in the field. This 
was supplemented by reports furnished by the Citizens Water Com- 
pany and the Scottdale Board of Health, No method of transmission 
other than water could be discovered. The report of the Engineering 
Division is confirmed in all details relating to the epidemiological 


Pursuant to your request of recent date I submit the following 
report of an epidemic of typhoid fever in Warren Borough in 1914, 
July to November inclusive. 

Warren Borough, an industrial and residential town of 14,500 
estimated population, is situated at the confluence of the Alle0ieny 


River and Gouevango Greek, streams of considerable size which divide 
the town into three sections linown respectively aa the East, West, 
and South Sides. The chief industries are oil reflQing, tanning, and 
the allied wood trades. The general sauitarj conditions are good, 
a lively spirit of civic pride and endeavor prevails and the town wears 
an aspect of general prosperity. Insanitary domiciles are few. 

The public water supply is furnished by the Warren Water Co., 
owned and operated by the American Water Works and Electric Co. 
The daily consumption is a million gallons and is obtained from two 
sources, viz,,' by impounding Morrison Run and from the All^heny 
Kiver. The same ec|nipment filters both supplies. An alum coagulant 
is nsed followed by sedimentation for two hours and a half. The 
filters are of the rapid sand filtration type and are rendering satis- 
factory service. During the winter months when the Morrison Bun 
supply is sutScient, which is ordinarily the case, this water is qaite 
constantly used and for weeks serves aa the sole source of supply. 
With the onset of the dry season resort must be had to the river water 
as a sole or partial supply depending upon the amount of precipita- 
tion. The results of the daily analyses made in the laboratory of 
the Water Company are filed in the office of the Board of Health at 
the end of each week. These records show a satisfactory filter effi- 
ciency for many months prior to the epidemic. Agar plates for 
the count and lactose-bile tubes for B, Coli are used exclusively in 
tbese tests. As a precautiouai? measure hypochlorite of lime was 
nsed betwen August 28th and October 26th. 

Apart from that portio'n of the Sixth Ward annexed from Glade 
Township in 1913 the borough is well provided with sewers which dis- 
charge their untreated contents into the Allegheny River. It is 
noteworthy that the unsewered parts of the town were relatively 
exempt from the disease, nine tenths of the cases occurring in 
sewered portions. 

Prevalence: Fairly reliable data are available as to the typhoid 
morbidity in previous years. 




InfMWd »bro«d. 
iDfwted *brMd. 

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Epidemilogy. The firat intimation that a:Q event of ncuaual im- 
portance had occurred in the development of typhoid fever in Warren 
was on the 21th of August when on inquiry I learned that an excessive 
namber of admissions to the Warren Emergency Hospital had been 
made or were in prospect The practising physicians of the town 
were promptly interviewed with the result that within the next 
twenty-four hours it became apparent that twenty-three persons had 
sickened since August 1st of a febrile disease strongly suggestive 
of Uphold fever. As usual the diagnosis had been held in reserve 
in many cases. A preliminary census made at this tinie directed at- 
tention to the uniformity with which users of the product supplied 
from a local milk-station, conducted by E. E., were stricken with the 
disease. On the morning of August 26th I communicated my findings 
to the President of the Board of Health, Mr. T. M. Greenland, who 
ordered immediate suspension of sale of the product of the vendor in 
question and the nine dairymen supplying him, pending further in- 
vestigation, which action was confirmed at a meeting of the Board held 
on the evening of the same day. In response to an appeal to the State 
Department of Health the Associate Chief Medical Inspector, Mr. S. 
R. Parke, Jr., of the Division of Sanitary Engineering, and Mr. J. 8. 
Couch, Sanitary Inspector arrived on the morning of August 28th. 
An independent survey and census of thirty cases by these otBciala 
on August 28th and 29th confirmed the earlier findings. Dr. Hunt 
and Mr. Parke after rendering invaluable service departed on the 
evening of August 29th. 

Distribvtion: The localization of cases in the adjoining Fifth, Sixth 
and Eighth Wards of the East Side and the western littoral of the 
Conewango Creek was one of the striking features of the epidemic. 
Examination of the map will enable the reader to visualize iiuite clear- 
ly the coincidence of cases with the route traversed by E. E. Five 
non-users of the E. E. milk in four houses resided well outside of the 
limits of the main group and are regarded as sporadic cases. 

Character of the Epidejnic: The epidemic lacked the explosive char- 
acter so often observed in water-borne infections. A very considerable 
number gave a history of the sudden onset of definite symptoms which 
as a rule mark milk-borne infection. 

Clinical course: There was unanimity of opinion among the local 
physicians as to the nature of the prevailing disease. The cases 
generally prerffeated in a typical way the usual clinical features of 
typhoid fever. Blood samples from a considerable proportio'n of 
patients were submitted to the Widal test and a large proportion of 
the specimens examined were reported to give a positive reaction with 
the typhoid organism. 

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2eth, 914 


2nd, 1914 

4th, 1914 



2Sth, 914, 



4th, 914. 

7th, 1914, 


15th, 914 



14th, 1914 

1st, 914 


16th, 1914, 


17th. 1914, 

7th, 1914, 

mh. 1914, 

12th, 1914, 

2l8t, 1914 

23rd, 1914 

22nd, 1914 

26th. 1B14, 



Mth, 1914. 

LocstioD of Cases Hj Wards- 

Second Ward, 4 c 

Third Ward, I c 

'F'l'Trth Ward 2 cases. t.Vot Wurren lease. 

§Fifth Ward 21 case*. 

71 cases. 

(■> Non-users of infected inilk. 

(t) This is the only known out-of-town case, eiclusive of Case No. 3 which was 
treated in Jamestown, N. Y. The former was treated iu the Warren Emergency 
Hospital. The latter was credited to the Sixth Ward where he resided at the 
time of probable infectioa. Both used the infected milk. 

(§) Adjacent Wards. 

Distribution Bj Houses. 

1 house had G cases. 

2 houses had 3 cases each , 

S houses had 2 caaee each . 

•45 houses had 1 case. 

Total houses, 50 

Total population of above households. 268 

O Including ooe out-of-town case probably infected in Warreu Borough- 

Use of Water. 

Used city water solely 7 

TjBed city water principally 23 

Used cily water occasionally, 10 41) 

Used Thomas well water, comer Conewnngo Ave. and JefTcraon SI . 11 

OiWHl Miller weU water. No, 16 South Si . 4 

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Use of Water— Continued. 

Used well water. No. 10 South St 3 

Used Hnmmond Iron Works well, 3 

Used Thomas Well, Jnckson St. 2 

Used Punsky well, No, 14 South Carver St 3 

Used well in Conneeticut Ave., 2 

Used well No. 120 Oat St 2 

Used well iD Folkman Block, 2 

Used well corner Carver St, and Pennsylvania Ave., 2. 

Used well at Seneca Oa Worts 2 

Used well of Santord, No. 211 Prospect St., 2 

Used well of Giegerieh, No. 3m Beech St 2 

Used well at No. 1211 Pennsylvania Ave., East 2 

Used spring in Connecticut Ave 2 

Used Crystal Cray water 2 

Used Allegheny Springs water 2 

Apart from the seven using only the public supply, but inclnding the 
above private sources furnishing water to two or more patients each, 
we have a balance of sixty-four patients who had used water from 
seventeen difEerCnt private and public sources of supply. 

Use of Ice. 
Not used 40 Artificiallce Co 22 Phillips Ice Co., 9 

I. X, r„ only 

I, K. h. and O. K.. 

O. K, only 

Various out-of-town s 
Not used, 

Use of Sbell-fisb. 
Local oyster house i Nut used, , 

Use of Vegetables and Fruits (uncooked). 

Home KBrden, (S sources), 12 Fruits 

flrcieery 4 Not stated, 

Market, i Not used, 

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Vm of Milk. 

Supplied bj E. E. Milk Station solely 25 

Supplied by K. E. Milk Station prindpally, 22 

Supplied by E. E. Milk Statiou octasioaully 10 57 

•Supplied by Dairyman T. It 3 

Used eundensed milk only, 3 

Othera not using E. B. milk, B 1* 


*Id part purcbascd from E. E. 


Pn)fei8ional ball pluyers, 2 

[lineman 1 

Cbnuffeur and garage employers :i 

Street railway conductor I 

Washerwoman 1 

Milli BtatloQ helper, 1 

Waitress (lea room) 1 

Conteetioner's clerk 1 

Butcher, I 

Grocery clerk, 1 

MachiDuit, 1 

Bank clerk. 1 

Drygooda clerk, 1 

Poata! clerk 1 

Merchant, I 

Superintendent Aie Works, 1 

Telephone operator, 1 

StenoRrapher, 1 

Silkmill worker, 1 

Dreasinaker, 1 

Laborer 6 

Boilermaker, 2 

Houaewlfe. 14 

No occupation, 27 


Secondary eases and Contacts: Five cases fall into tiiis group. 
The circQmstance that thirty one of these patients or forty-four 
per cent, were treated in the Hospital is regarded as an important 
factor in limiting the spread. The remaining forty were cared for in 
their homes, for the most part under the care of non-professional 



Sex and Occupation: The disease was somewhat more prevalent 
among females to the number of forty cases, or fifty-Bix per cent., 
which taken in connection with the fact that forty-one, or fifty-eight 
per cent., spent most of their time at home furnished added reasons to 
suspect milk of being the distributor of infection. 

Uncooked Vegetables and Fruits, Ice and Shellfish: Our impresnon 
is that vegetables and fruits took little part in the epidemic. For^ 
patients, or fifty-six per cent,, gave a history of having used no ice. 
whatever. The Artificial Ice Co.'s product is manufactured from 
distilled water obtained from a private source of undoubted purity as 
confirmed by analyses made at the time of the epid^nic. The fact tiint 
sixty-seven had not partaken of shellfish obviously negatives infection 
from this source. The epidemic was well under way before the 
opening of the oyster season in Warren, 

Ice Cream: Fifty seven, or four-flfths of the patients, had at some 
time or other used ice cream manufactured by the I. X. L. a local 
concern with a very large output. This company's product is Tery 
extensively used in Warren atid is manufactured from pasteurized 
cream as is also the O, K. article. Nineteen persons, or twenty- 
seven per cent., had used no ice cream whatever. 

Well Water: Apart from the well at No. 126 Conewango Ave. there 
did not appear to be any unusual grouping of cases about any sudi 
private source of supply. Eleven patients had used water from this 
well which tested as follows: 

Milk: Pifty-seven or four-fifths gave a history of having used milk 
from the E. E. milk-station in sufiBcient quantity to account for the 
Infection. Two others had used the product of T. R., a dairyman 
vendor who purchased a part of his supply from E. E., but it could 
not be established that they had received the E. E. milk. The re- 
maining twelve patients gave a definite history of not using the 
product distributed by E. E, Four of the latter had used water from 
the well at No. 126 Conewango Ave. and five others resided well 
beyond the limits of the E. E. milk-route 

Milk-station of E. E. This owner of a milk-station located in the 
Sixth Ward is supplied by nine dairymen to the amount of 450 quarts 
of milk and cream daily which he sells to 240 customers, the great 
bulk of his trade being confined to private families residing in the 
Fifth, Sixth, and Eighth Wards or what is popularly known as the 
"East Side." He also sells some seventy quarts to five eating places 
find restaurants and to five private families on the west side of the 
town. With the exception of thirty-five quarts of bottled milk which 


lie purchases from a dairymaa located just outside the borough limitB, 
all the milk which he sells is mixed and uot separable as to source 
after receipt. The bulk of his trade is in bottled milk in which work 
he is assisted by H. M., age fourteen, who also washes the bottles. This 
lad sickened with typhoid fever in the third week of August, twenty- 
four days after the date of onset of Case No. 2. The corrected date 
of onset of H. M. places him as No. 26 in the list. It is improbable 
that he was at work during the febrile stage of the disease for on 
August 17th, the date of corrected onset, he was well enough to make 
a visit of a week to a neighboring city. He returned feeling ill and 
in consequence did not go to work again. Prom the forgoing cir- 
comstaoces it is improbable that he initiated the epidemic bnt rather 
is he to be r^arded as a victim of the milk purchased by B. E. To 
what extent he was responsible for subsequent cases is problematical. 
The agglutination test was positive in his case. 

As soon as it became evident that the epidemic was mllk-bome 
aU inspection of the nine dairymen supplying £. E. was made by me 
and again by Dr. Hunt on August 28th without, however, disclosing 
any suspicious febrile or diarrhoea! disease in the families of the 
dairymen or among their hired help. 

The probability of carrier-infection was next considered. Four 
visitors to the dairy of A. Y. in mid-July and two milkers in the 
dairies of L. H. H. and M. M. said to have had typhoid fever in 
previous years were subjected to the usual tests but all reacted 

Forty-four other dairies supplying residents of Warren were in- 
spected between the first and the ninth of September with the result 
that fourteen had their licenses revoked by the Board of Health and 
three others were given five days in which to complete changes satis- 
factory to the Board. Copies of reports of these inspections have been 
filed with the State Department of Health. 

Summary and Conclusions: It did not appear that these patients 
had any considerable social ties as a group nor had they partaken of 
food or drink at any public or private function. Indeed there was a 
destitution of evidence in this respect. The r^onal distribution, 
the coincidence of cases on the milk route of E. E., the lack of any 
explosive character of the epidemic, the preponderance of cases 
among housewives and children, the relative purity of public and pri- 
vate water supplies as shown by tests previous to and during the 
continuance of the epidemic, the virtual elimination of all other 
food stuffs and drink, adequately sustain the assumption of milk-borne 

The mode of conveyance of the infective agent remains to be con- 
sidered. The lack of an explosive character as shown by the conse- 
cutive trend of onsets assuming more or less of a desultory aspect, the 


relative paucity of patients to the number of users of the particular 
product under gnspidon, awaken a justifiable doubt as to the prob- 
ability of bulk-infection such as for instance contamination of one of 
the cans of milk supplied to E. E. This finds further partial coofirma- 
' tion in the absence of a suspect op carrier in the dairies supplying 
the rendor. 

In view of the foregoing the epidemiological picture of bottle- 
infection is discernible and indeed oSers the most acceptable solution 
of the escape of the infection and its subsequent distribution. In 
this relation Case "No. 1, sickening in the first week of July about 
thirty days before the onset of Case No. 2 of the main gronp, would 
fulfill the requirement in point of priority to the later cases. The 
patient was treated in the local hospital between July 10th and 24th, 
returning to his home on the latter date. The premises were fumi- 
gated but no time was gi\en for the placing of quarantine owing 
to his removal before the diagnosis was definitely made by the physi- 
ciaU in charge. He was not a patron of the E. E. milk route nor 
could it be established that the latter had collected bottles from the 
premises of Case No. 1. The evidence, however, in this respect 
is inconclusire. It did appear that promptly on his return from the 
hospital on August 21th an extra sii])ply of milk was purchased from 
unidentified passing vendors and E. E. may have been one of these. 
This was some ten days before the corrected date of onset of Case No. 
2, a relatively short incubation period fur the latter. 

The practice among dairymen of purchasing milk and cream en 
route in case of aliortage is well known and offers ample opportunity 
for the interchange of bottles apart from the normal exchange incident 
to the conduct of any dairy business. It is not improbable that 
three cases giving a history of non-use of the E. E. product were thus 
infected. With the exception of one dairyman, whose product was 
not under suspicion, sterilization of bottles was not required or 
practised by the milk dealers of Warren, thus affording opportunity 
for the survival of the virus of this disease. 

Examination of Ihe dates of onsets of cases No. 1 to No, 57 in- 
clusive permits the eieclion of a main group, allowing twenty-five 
days from the date of closure of the milk-depot of E. E,, on August 
26th. The subsequent fourteen cases resided in nine homes, one 
of these having five cases and another two. If from the latter 
group we eliminate three possible contact or secondary cases 
we have a balance of eleven oaKps in six liouses infected subsequently 
to the closure of the milk depot and sterilization of the equipment 
Inadequate sterilization of bottles, the collection of outstanding 
bottles after the resumption of sale by E. E. on September 2nd, pos- 
sibly secondary bottle infection, any or all these factors, permitting 
bacterial survival, niav be assumed to be responsible for the later 
cases. Id view of tbe failure of dairymen generally to comply with 


the order of the Board of Health requiring roatiue sterilizatioa of 
bottles, at least tempoi-ary suspeoBion of bottle service would seem 
desirable, under similaF conditions. 

Assuming the agency of bottle infection to have been the chief 
means of dissemination (the great bulk of the patrons of the E. E. 
route having been so served), and adding to these the three non-users 
of the E. E. product served in bottles, we have a remainder of nine 
cases of whom three used condensed milk exclusively and six others 
were supplied in cans from five sources other than the E. E. milk. 
These nine cases are then unaccounted for. 

With only six previously reported cases in the first three months 
of the calendar year 1914 and an average annual morbidity of about 
nineteen cases for thirteen years, it ia not improbable that the nine 
uncheckable cases weie sporadic cases, or possibly cases of fly-borne 
infection, distributed as they were over a period of fifty days during 
the time of greatest prevalence of typhoid fever in Warren Borough. 

"Present methods of inspection do not prevent the occurrence of 
numerous epidemics of typhoid fever, diphtheria, and scarlet fever. 
The Health Officer should investigate the milk supply, and other pos- 
sible sources of infection, of all reported cases of these diseases, and 
keep a record of their distribution with reference to the various dairy- 
men. When a dairyman shows a suspicious number of cases, due 
consideration being given to the size of his business and the general 
prevalence of the disease, the matter should be investigated. Pasteur- 
ization (and sterilization of milk bottles) seems to be the only way of 
preventing outbreaks of milk-borne diseases," 

"Bacteriological examinations are not available for anticipating 
milk-borne trouble, nor usually for demonstrating the presence of the 
organisms in the milk. The technical difficulties are too great to take 
up the search for the typhoid organism in the hope of obtaining de- 
cisive useful results. The same bold true of the examination of 
water, in connection with a typhoid epidemic. In the case of both 
milk and water, one difficulty lies in the fact that the organism may 
not be preset at the time suspicion is aroused. The facts most be 
determined by epidemiological evidence" (Ward). For this purpose 
the census cards in use by the State Department of Health were found 
most useful. 

Tn the investigation of this epidemic, the writer acted in the dual 
capacity "' Secretary to the Board of Health of Warren and County 
Medical Inspector for the Pennsylvania State Department of Health. 




According to instructions from the Chief Medical Inspector, the 
writer proceeded on the morning of August 5th to Maryaville, Perry 
County, to investigate a complaint made to the Department that there 
were a. considerable number of cases of sickness in that borough which 
had been called "biliousness," but, in the opinion of some, were cases 
of typhoid fever. 

The Borough of Marysville is situated on the west bank of the 
Susquehanna Klver, in Perry Connty near the Cumberland County 
line, having a population of l,5d3, according to the census of 1910. 
It is made up largely of an industrial population whose chief means 
of support ia employment in the Pennsylvania Railroad yards, situ- 
ated at that point. The borough has a public water system, but no 
adequate sewerage system. There are many open privy vaults !□ 
different parts of the town. Rubbish and garbage dumps are found 
in many places within the borough limits ; one such dump is direcUy 
on the bank of the Susquehanna River ; so that, altogether, the sani- 
tary condition of the place is at a very low ebb. 

To ascertain the exact number of suspicious cases of disease in Uie 
borough, the writer proceeded first to interview all the physicians 
residing there and got from each of them the names and addresses of 
all persons with a continuous fever under treatment during the last 
twelve months. He then visited each one of these patients personally 
and inquired carefully into the character of their illness. 

Water Supply.— Mt. Ennis, of the Ehigineering Division, in the 
meantime, investigated the sources of the water supply, for the pur- 
pose of making a report. 

MarysvUle is supplied with water by the Marysville Water Com- 
pany. It receives its supply from three sources: from Trout Run, 
Lambs Gap Run, and Sittcrly Run. Each stream rises in the foot- 
hills to the west and northwest of Marysville. The water from each 
is conducted separately to a storage reservoir on a hill west of the 
borough. It is important to note that certain houses in the borough 
receive water directly from the mains previous to their emptying 
into the storage reservoir. None of the households affected, however, 
receive water from the intake mains leading from Trout Run or Lamb' 
Gap Run, but the cases are all situated along the intake main leadin* 
from the Sitterlv Run supply, or in close proximity thereto. Th*. 
Pepartment's field inspector found that the water^eds of the Troat 

le Troal 


Bud and Lambs Gap Bun are free from human habitations and polla- 
tion. Od the othei- iiand the writer made a personal inspection of the 
Sittei-lj Kun supply and fonad a gang of eight of ten lumbermen at 
work there which had been working on the water shed of this stream 
since the last of Febiuaiy or first of March, 1914. No provision has 
been made for the sanitary disposal of their waste and garbage. 
While no history of diiiease could be discovered, the writer did learn 
that two or three men who formerly worked there had left. Specimens 
of water were taken by him both from the intake mains and from taps 
in different parts of the borough, and forwarded to the Laboratory 
for analysis. 

ilUk Supply. — An Investigation was next made of the milk supply. 
It was found that the milk supply for the borough is handled by 
three vendors. All of the suspicious cases of illness had bought 
milk from milk vendor Q. H. ; none of them had received milk from 
other two milkmen. An intensive study was therefore made of the 
dairies from which Mr. H. procured his milk. It was found that Mr. 
H. himself did not own a dairy or produce any milk. On the other 
hand he bought milk from four dairymen, all of whom live in Bye 
township, adjoining the borough of Marysville. An inspection of these 
dairies showed no source of infection. 

Ice Supply. — Practically all of the households in which saspicious 
cases of illness had occurred were supplied with ice by one, B., and, 
as the writer had beard several complaints concerning the insanitary 
condition of the pond from which this ice was harvested, he made a 
personal investigation of the pond and had specimens of the water 
from it, and of the ice that is being sold in the borough by Mr, E,, 
sent to the Department's Laboratory for bacteriological examination. 
This ice pond is in a very insanitary location. Surrounding it for 
about two-thirds of its circumference is a much traveled highway, 
from which all the surface drainage flows into the pond. The Intake 
of the pond is from a little creek, which rans through an inhabited 
region. An inspector investigated the course of this creek and found 
no direct indication of pollution. On one of the banks of flie ice 
pond was found evidence of garbage disposal ; at one point, a pile of 
oysters sheila. 

Batter Supply, — Investigation brought out the fact that a certain 
dairy farm conducted by E. B., situated in Rye township, produced 
butter which was sold to the citizens of Marysville. It was found that 
two children living on the B. farm had been confined to their bed 
for three or four weeks in December, 1913, and the first part of 
January, 1014. and were under treatment of Dr. fi., who called their 
diRease "biliousneBs." T^e B. f-nmilj nssiT-ed the writer that while 
milk vendor H. had received milk from them at times, he had not 



received whole milk from them for over two yeara. OccaeionaUy a 
little buttermilk was supplied, but iaasmuch as the dairy supplied 
butter to Marysville, the writer thought it worth while to send a 
specimen of the butter to the Laboratory for examination. 

Ice Cream. — It was also discovered that practically all of the sus- 
picious cases had eaten ice cream which had been purchased from a 
certain dealer, Mrs. C, who has an ice cream restaurant in Marysville. 
A specimen of the ice cream waa provided the Laboratory for bacterio- 
logical examination. 

So far as can be ascertained, there is only one active typhoid fever 
case in the borough of Marysville at present, and this one is nnd^ 
the treatment of Dr. G,,who correctly diagnosed the case and properly 
reported the same. As a matter of precaution the writer took a 
sample of this patient's blood and sent it to the I^aboratory to as- 
certain the presence or absence of the Widal test. Returns show that 
this patient, Richard H., age thirty years, whose onset was on July 
22nd, gave a positive reaction to the Widal test 

Investigation, however, showed that there have been ifl the borough 
of Marysville several persons, all of whom have been under the treat- 
ment of Dr. S., who had said that there condition was due to "bilious- 
ness." There is no doubt in the writer's mind that they were casef: 
of typhoid fe\'er. Two or three of these persons were interviewed late 
in the convalescent stage. My opinion that these patients were ill with 
typhoid fever is strengthened by the fact that specimens of blood 
which the writer took from them and sent to the Department's Labora- 
tory, showed a positive reaction to the Widal test. The individual 
history of thcRe suspicions cases and convalescent patients, which 
bad been treated by Dr. S. as cases of biliousness, it is as follows: 

Cases No. 1 and Ko. 2. — Mrs. H. R. G., age twenty-seven, housewife, 
date of onset March 29th, under treatment of Dr. S., who called ^hc 
disease "biliousness," Mrs G. gave a history of malaise, headache, 
gradual weakness, and slight diarrhoea previous to taking to her bed. 
Patient was confinwl to her bed for about two weeks. In the fourth 
week, about May 1st, while she was convalescing, her three year 
old daughter, A. G., sickened with what Dr. S. diagnosed as pneu- 
monia. It was impos.sible to elicit a'ny definite history of the child's 
illness except that the mother knows that she had fever following rest- 
lessness and vomiting. Shortly after the child sickened, Dr. S. called 
into constiliation a Harrishnrg physician. The patient, Mrs. G. told 
the writer thiil the Ilarrisbnrg jjhysician diagnosnl the disease as ty- 
phoid fever, and Dr. B. admitted to the writer that the Harrisburg 
physician gave typhoid fever as his diagnosis. Dr. S. stated that when 
the consulted doctor made Hie diagnosis of typhoid fever he placarded 


the house, but the patient, Mre. G., says that the house was not 
placarded nur put under <iuarautiue. A blood specimen takea from 
Mrs. G., sent to the Department's Laboratory by the writer, gave 
a u^ative reaction to the Widal test. This, however, is not surprising 
when it is remembered that the date of onset of the patient is given 
as March 2dth, and the writer took the specimen on August 6th. We 
might not obtain a positive reaction after such a long interval from 
the date of onset. The child's case undoubtedly was due to secondary 
infection by the mother. The mother refused to allow a specimen of 
the child's blood to be sent to the Laboratory. 

Case JTo. 3. — Female, E. S,, age nineteen years, occupation house- 
work, date of onset March 30th. She gave a history of having pro- 
dromal symptoms of typhoid :-~headache, pain in back, weakness. 
This i>atient was treated by Dr. S, at the same time he was treating 
Case No. 1, and he gave the same diagnosis, namely r "biliousness." 
Even after being in consultation with the physician from Harris- 
bui^, he did not change his diagnosis, although the patient is not 
entirely convalescent and her parents say that her condition was 
exactly like that of Case No. 1. A specimen of this patient's blood, 
taken by the writer August 6th, also shows negative reaction to the 
Widal test. 

Case No. 4- — Female, P. M., age tiventy-eigbt years, housewife; 
date of onset May 20th, The patient gives a history of being con- 
fined to her bed for three weeks with fever, after two or three days 
of malais^ vague pains, chills, and nausea. Rhe was treated by Dr. 
S., who called her disease "biliousness." A specimen of her blood 
sent by the writer to the Laboratory shows a negative reaction to the 
Widal test. 

Case No. 5. — Male, C. B., age tliirteen years, occupation school- 
boy; date of onset May 30th: treated by Dr. S., who called it "inter- 
mittent fever." The mother said that the boy had not been well for 
a week before he toot to his bed. He complained of headache, slight 
diarrhoea, weakness. The cliild was in bed between four and five 
weeks. He is now in a convalescent state, just beginning to go out. 
A specimen of his blood sent to the Department's Laboratory showed 
a positive Widal reaction. 

Case No, 6. — Female, E. M., ; jice seventeen years; date of onset 
June lOfh, occupation, waitress at the Central Hotel at Marysvillc 
where she first began to feel ill and returned to her home which is 
in Marysvtlle. She also gives a history of having had the prodromal 
symptoms of typhoid fever: malaise, headache, gradual weakness, 
and vague pains. She was treated by Dr. S. for "intermittent fever" 
and was confined to her bed three or four weeks, and is now feeling 
ratfier weak ; she is not able to go to work, but convalescing. A 



Bpedmen of her blood taken by the writer and sent to the Depart- 
ment's Laboratory also showed a positive reaction to the Widal test. 

Case No. 7. — Mrs. T. F., age thirty-six years; housewife; date of 
onset July 8th. She gave a history of having had headache, chills, 
gradual weakness previous to being confined to her bed. She was 
sick in bed three or four weeks, treated by Dr. S. for "biliousness." 
The writer saw her at her home where she admitted that she still felt 
very weak; was not able to do her wort about the house, but was 
able to sit up; in other words, she is in the convalescent stage. A 
specimen of her blood sent to the Department's Laboratory by the 
writer showed a positive reaction to the Widal test. 

None of the patients could give any reliable information concern- 
ing the degree of fever or its character. No chart was kept during 
their illness, nor could Dr. S. give but vague generalities concerning 
this important factor in diagnosis. 

Diagnosis of Cases. — While of course it would not be fair to accept 
the word of patients in preference to the diagnosis of a practitioner 
of medicine, the writer is of the opinion that most of the cases treated 
under the name of "biliousness," "intermittent fever," or "bilious 
fever," were aflBicted with typhoid fever. He believes that this diag- 
nosis is substantiated by the fact that all the recent patients, speci- 
mens of whose blood were sent to the Laboratory by him while they 
were still in the convalescent stage, have given a positive reaction 
to the Widal test. 

Source of Infection. — After carefully investigating the water, milk, 
ice, ice cream, and butter, and other possible sources of infection, 
the writer's opinion is that the infection was carried to the victims 
through the water primarily, and, possibly, to one or two cases by 
the house fly. The sanitary inspection of the dairies revealed no 
history of typhoid infection, nor did the bacteriological examina- 
tion of the milk, ice cream, or butter show any marked cotitamina- 
tion. The ice dam is unsafe and the specimen of ice sent to the 
Laboratory showed the presence of four B. coli to the cubic centi- 
meter, but the restricted location of the cases rules out the ice as 
well as the milk as the medium of the infection — both being dis- 
tributed in all parts of the Borough. 

Probaltle Source of Polhitwn. — In view of the fact that all the 
households affected received water from the Bitterly Run main and 
because of the results of bacteriological examination of this water, 
the writer believes the source of infection to hav% been the 
pollution of Ritterly Run stream by one of the men in the lumbering 
gang, who possibly may have been a typhoid fever carrier. It is not 
impossible, however, in view of the fact that these cases were treated 
as "bilious fever," with no instructions given to have the patient's 



stools properly disinfected before throwitig into open privy vanltB, 
that the house fly may have been or may yet be the medium of trans- 
mitting the infection in Marysville. 

Supplementary Note. — To show more clearly the character of the 
water supply of the infected district, and by the courtesy of the 
Division of Sanitary Engineering, the writer appends the following 
extract from the report of Mr, Ennis to the Chief Engineer: 

Bitterly Farm Run has its source in Rye Township less than two 
miles northwest of the borough on the Sitterly Farm. The drainage 
area above the water company's intake comprises approximately one 
square mile of wooded land, which is not cultivated and was not in- 
habited prior to the first of March, 1914, at which time a lumber 
camp comprising about ten men was established on the shed. 

The minimum flow of the stream is reported to be in the neighbor- 
hood of 75,000 gallons daily. .The intake consists of a dilapidated 
stone catch basin built in the bed of the stream a short distance 
above a considerably travelled road. From the catch basin 
water flows by gravity throu^ a four inch main about 5,000 feet 
in length to the borough equalizing reservoir. The elevation of the 
intake basin is approximately fifty feet above the water level of the 
reservoir and there are ten or twelve taps on the line supplying water 
to dwellings. 

Samples of water from this supply examined at the Department 
Laboratories gave the following results: 

1)1 1*. 





tt»rl7 Rq 




rr r»ld«n 

•* "" ^'""'^ 


line, .. 


All consumers along the gravity main were warned to boil all 
water used for domestic purposes. A plug was inserted in the out- 
let end of the supply main where it discharges into the reservoir so 
that this water would not get into the general distributing system. 
The water company was notified to discontinue the use of this water 
and not to use it again as long as there should be any lumbering 
operations upon the water shed, and until the Department was sat- 
isfied of the purity of the supply. This condition still exists, but 
the water company intends ultimately to supply these consumers 
with water from another source, unless it is found that the Sitterly 
Run supply can be protected against all possibility of contamination. 

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One of the most disastrous milkborne epidemics of typhoid fever 
the Division of Medical Inspection has been called upon to handle 
occurred during August, yeptember, and early October, 1914, along 
a retail milk route extending through the villages of Skippackville, 
Cedars, and Worcester, in Montgomery County, a distance of abont 
five miles along tlie Skippack pike. Tlie facts concerning the epi- 
demic are as follows: 

About the middle of July one E. N,, a tetiant occupying half of the 
farm house of H. T., near BkippackviUe, sickened with typhoid fever, 
the source of his infection being indeterminate. This man, who un- 
fortunately lost his life from the disease, was already so ill when 
the epidemic was investigated that we could not secure an interview 
with him. Through his wife and friends we traced his movements 
as fully as possible. He was a laborer, the bulk of his work being 
that of an assistant to stone masons and at times hod-cariying. Ue 
had worked in many sections of the country and had partaken of 
water and food from many different sources during the period when 
he must have ingested infection. A report of his illness was mailed 
to the Department's Health Officer by his physician Dr. W. J. Wright, 
at the end of July, and the house was placarded by the township 
Health Officer on the first day of August. The required household 
regulations were then established and the usual instruction waB 
given for the disposal of excreta. 

The dwelling occupied by the patient and his family was one end 
of the farm house with separate outside entrance, and to all intents 
and purposes the equivalent of one end of any two-family dwelling. 
It was allied by the patient's family that no communication what- 
ever took place between the farmer's family and that of the tenant, 
the milk producer's family asserting that none of them ever entered 
the tenant's dwelling. The source of this infection being indeterm- 
inate, and probably not on the farm, the sale of milk from the 
farmer's premises was not discontinued. 

Subsequent eventu, however, showed that not all of the facts were 
given to the Health Officer, and that if given they would have led to 
the establishment of very different regulations. For instance, it was 
not intimated during the Health Officer's interview that the heads 
of the families were Broth ers-in-law or oven friends, nor was he in- 
formed that the attending physician had immuni7,ed the other mem- 
bers of the patient's family and the members of the farmer's family 


in tlie other end of the building. He was distinctly given the im- 
pression that the families were not friendly ; that they did Hot enter 
each other's dwelling, etc., and he bo reported the situation to Dr. 
H. H. Whitcomb, the County Medical Inspector. The fact that Mr. 
T., the owner of the dairy, at some time earlier in July had suffered 
with an illness characterized by fever and extending over a period 
of several days, had also been withheld. It is but fair to say, how- 
ever, that the illness of Mr. T. was not suRlciently marked to coti&ue 
him to hia bed for more than a few hours each of several days. 

The products of the T. dairy had been shipped to the creamery in 
Cedars near Skippackville until about the first of Augnst, when the 
proprietor of the dairy farm bought out the retail milk route of one 
B., an organized milk route extending for about five miles along tb^ 
Skippack pike through the villages of Skippackville, Cedars, and 
Worcester. Late in the third week and during the early part of 
the fourth week of August, less than a month after Mr. T. began to 
deliver milk along this route, numerous reports of typhoid fever 
were made to the Department's Health Ofncers in the townships of 
Worcester and Skippack. A preliminary investigation made the lat- 
ter part of Angnst by County Medical Inspector Whitcomb brought 
out information that pointed strongly toward milk as the probable 
source of the disease and also brought out the fact that a good many 
other persons were ill with fever of an indefinite type not yet diag- 
nosed by the attending physicians. Further visits were made by the 
County Medical Inspector on the 26th and 29tb days of August and 
again early in September. The Chief Medical Inspector went over 
the district with Doctor Whitcomb on the 11th and 12tli days of 
September. These investigations and further studies all tended to 
confirm the suspicion that the T. milk was the source of-infection. 

A complete analytical study was made of each case of typhoid 
fever as soon as practicable after it was reported by the physician. 
The detailed study was checked against each possible source of in- 
fection in the way of contact, food, and drink. It was very readily 
proven that no common source of food obtained other than the T. 
milk which had been used by all who sickened along the route. A 
number of persons who visited the N. family on the infected dairy 
farm and took food or drink there, and several who were employed 
on this farm, also sickened with the fever. Clams had been used by 
a few of the sick, but a lai^ majority had had no kind of shell fish. 
Water from wells showing sewage organisms had been drunk by some, 
but in many instances the only water used tested pure and no one 
well was used by a number of individuals. Many of those sickening 
fnve no history of contact, either recent or remote, with persons 
known to have the disease. For this reason, we do not include with 
this report a tabulation against the various food supplies. All the 



primary cases could be traced directly or indirectly to the one com- 
mon source of infection on the dairy farm, and all secondary cases 
could easily be traced to sources mentioned furtiier along in this 
report where each type of secondary case is more fully discussed. 

It would appear from these studies, baaed on clinical evidence, 
that milk sold by Mr. T., during the greater part of the month, was 
infected with typhoid germs. The epidemic first came to our notice 
early in the fourth week of August and was already so far advanced 
and so large a number of the consumers of this milk bad apparently 
been infected that the efforts made by the Department and by tie 
attending physicians to save some of the consumers were of no avail. 
Numbers of those who were already in the prodromal stage of the 
disease continued to come down n^ith the fever. Consumers of the 
milk, resident in the district or temporarily boarding there, were re- 
ported as ill in various sections of the county and in adjoining coun- 

The epidemic, so far as we were able to trace the pati^its, con- 
sisted of ninety-one individuals whose infection was directly trace- 
able to milk or to immediate contact with the sick on the T, prem- 
ises; of six secondary cases in homes where intelligent nursing could 
not be secured ; of a series of seven interesting secondary cases, due 
to pollution of water during the epidemic; and of three other sec- 
ondary cases probably due to the development of a "carrier" in one 
of the families. 

Several interesting and, for a time, baffling cases were found. In 
one instance a hostler, employed in one of the hotels in the village 
of Bkippackville, denied absolutely having drunk milk or having 
used it in coffee or with desserts; although the hotel where he worked 
and ate was supplied with the T. product. On visiting his home 
we obtained a similar history, together with a report that he not only 
took no milk in his coffee at home, should he by chance r<ike a meal 
there, but at no time drank or ate deserts with raw milk or cream. 
The family milk supply, however, was the T, supply. On very care- 
fully questioning the housewife, whose two little girls had sickened 
about the same time the husband developed the disease, we learned 
that a little more than two weeks prior to the illness of the three an 
unusual supply of T. milk had accumulated in the home, and, in 
order that it might be used as food, it had been frozen into ice cream. 
The husband, who consumed no milk at the hotel where he worked 
and also consumed no milk with coffee or desserts at his home, had, 
together with the children, eaten heartily of this ice cream. 

In two or three other instances persons were found who took no 
milk in desserts or as a beverage but did use considerable quantities 
of milk or cream in coffee. 



+ July 20, mU 


DutCB o 


.E 1. 



September 1 


t Secondary to carrier 

+The N. case. 
•Infected on dairy form. 

to well pollution. 

Cases Grouped By Place of Residence. 

Kkippecic Township, 55 Mnrlboro Townsliip 2 

Worcester Township, 28 Upper Sulford Township, 2 

Towamcndn Township, 6 [rfiusdale Borough 2 

Hatfield Township 2 City of Philsdelphln 5 

Hatfield Borough 1 t^ty of Norristown 2 


It will be noted that two cases skkeDed less than two weeks after 
the milk route began to be served from the T. dairy farm. The two 
persons sickening on the 9th and llth of August respectively, were 
in all probability infected on the T. farm where E, N. had been sick 
since the 20th of July. One of these persona admitted having par- 
taken both of food and water on the T, premises; the other, a rela- 
tive of the dairyman, would not admit having been on the prem- 
ises, but reports reaching our inspectors showed that the statement 
could not be relied upon, as they learned of his having been there. 

Over two-thirds of the cases sickened between the 14th day of 
August and the 8th day of September. The sale of T. milk was 
ordered discontinued by the County Medical Inspector on the 27th 
day of August although some of this product was served, in violation 
of the order, nntil the 29th. Counting the extreme period of twenty- 
five days from the date when the last of this milk may have been 
used, would enable ns safely to include all persons sickening as late 
as possibly September 24th. This could account for all cases in- 
duded in the primary infection, , 



Off. Doc. 

It may farther be noted that the perBons sickening ehowed aboat 
the Dsoal age and sex distribution with a slightly greater frequency 
of the early age periods than is common iu water-borne epidemics. 
This, of course, would be expected in a milk-borne epidemic because 
the use of milk is more common amotig children than among grown- 

Age and Sex. 

Meen. I Mnlp. . F«nia1p. i TaUl. i Ycuni. | Mule. ' Ftoalc. ' ToUL 


The sketch on the opposite page shows the general character of 
tbB dairy premises and the diagram below indicates the relation of 
the buUdings to the T. dwelling occupied by the dairy farmer and by 
his tenant Buffering with the disease, a relation which is very inter- 
esting. The dwelling house stands across the private entrante from 
the wagon shed converted into a bottling house. The bottling houBe 
is immediately adjacent to the barn yard and bam privy. 

Infected Dairy 
Relation of Farm Buildings to 
Milk House, Manure Pile, and Privy 





1 1 

J, Google 



We were soon convinced that tbe outbreak would be one of con- 
siderable size and that great care would have to be taken to protect 
the local and public water supplies. Tbe district through wfaidi 
the cases were distributed is for the most part a red shale country with 
water supplied almost entirely from shallow wells and springs. The 
ground waters tapped by tbe wells are found comparatively near the 
surface and at certain seasons of the year the hills and elopes near 
many of tbe dwellings literally ooze water. 

The map for the section of country extending some five miles along 
tbe Skippack Pike is On the opposite page and shows graphi- 
cally the relation of many of the infected dwellings to small streams 
and springs in the community. The villages were for the most part 
settlements of retired farmers. Many of the citizens owned tbe bouses 
in which th^ lived and were in comfortable financial circumstances. 
Tbe bouses at which practically all the infections occurred, save a 
few secondary cases, are indicated, together with tbe number of cases 
in them, and tbe location of the polluted A. spring, responsible for the 
secondary cases occurring in January, 1915, and due to polluted 
water, is shown in relation to the A. dwelling. 

Strict precautions were taken with all excreta. Every individual 
householder was carefully drilled in methods of disinfection and 
instructed as to the danger of allowing itifected material to get into 
the ground without being rendered innocuous. We constantly im- 
pressed upon individuals and upon the entire community tbe danger 
of polluting their own local water supplies, and called their atten- 
tion continuously to tbe danger of polluting the small streams flowing 
by numerous properties, often within twenty or thirty feet of tbe 
dwellings. These streams 'flow into tbe Skippack Creek, which in 
turn discharges into the Ferkiomen Creek some few miles above the 
intake of the Norristown water snpply. It was considered advisable, 
as a preventive measure, to have two representatives of the Engineer- 
ing Division patrol tbe district and frequently give detailed instruc- 
tions in the care of stools and urine. They visited every infected 
premises several times a -week and watched carefully that the dis- 
posal of all excreta was in compliance with our printed instructions 
and done in a way that would protect wells and streams. 

The water supplies on the T. farm were sampled on the 5th day of 
August, the well showing a hundred and twenty-eight colonies of 
ordinary bacteria and eight colonies of B. xoli to the cubic centimeter. 
The water from the spring showed forty-eight colonies of ordinary 



bacteria and twelve colonies of B. coli to the cubic c«itimeter. 
Advice was given for disinfection of botli of these sources of snpply. 
This advice was- followed and subsequent analysis showed improve- 

There is a possibility that excreta from the N. household pollated 
the water prior to this time and that the water thus polluted 
may have contaminated the milk cans and containers, and thas caused 
the epidemic alotig the milk route, although it seems quite as likely 
that the pollution of the milk may have been done by flies carrying 
the infection directly from the excreta to the bottles exposed all 
day long in the bottling house by the barn yard. N. probably used the 
barn privy until he took to his bed. Neighbors claim to have seen 
excreta and wash water thrown on the dung hill immediately adjacent 
to the milk house during the illness and it is possible that infection 
may have reached the milk house in this way. 

At a later date, about the last day of August, two samples of 
water collected at the T. premises, one from the spring and the 
other from the dug well, showed a higher bacterial count; that of the 
spring 2,T6d colonies of ordinary bacteria and 96 colonies of B, coli 
and that of the well 1,440 colonies of ordinary bacteria and 144 
colonies of B. coli to the cubic centimeter. The ice was melted, 
however, when the samples reached the laboratory and these high 
counts may have been in part due to the multiplication of bacteria 
after the ice melted. On the 24th of September, subsequent to an 
alleged disinfection, samples were again taken from the T. water 
supplies, and the dug well at the house then showed Bo B. coli and 
but 54 colonies of ordinary bacteria ; the spring, no B. coli and 1,500 
colonies of ordinary bacteria. 

In addition to studying the samples of water taken from the 
various supplies on the dairy premises, the Department representa- 
tive, who were watching the disposal of excreta and enforcing pre- 
cautions throughout the district, collected samples of water from 
forty-two different supplies in the community and in each instance 
where any sewage organisms were found, or where the total bacterial 
count, exclusive of sewage organisms, was high, the householder was 
urged to clean and disinfect the well and was given the following 
extract from the Health Officer's Manual: 

D1KI\FEC1'H>N OF WKr,I.a. SPlllNti.S, ClSTBBNil. ETC. 

"Tbe cheapest and best disinfectant for tbe purpose ia freslilf burned, unslaked 
lime. For tbe ordinary well, one-half burrcl of lime sbould be emptied into the 
same and the walls above the water level tlioroughlj Hrrubbed with the resultini" 
milk lit lime hy means of a stilT bruxh. The well should be pumped dry, allowed 
to refill and a like amount added. It should then be permitted to stand for twenty- 
four hours snd Chen suifesf'ivi'ly oxhaiisted and allowpd to refill until the lime 
can no longer be detected in the wnter. The water ia then purified and should be 
drawn through the pipes and fisturcs until they are thoroughly washed out. In 
the case of springs or cisterns an adequate amount of lime should be uaed, and 
their sides end bottoms should i)e thoroughly scrubbed." 


At the same time, theee officers required the emptying and cleaning 
of privy vaults, the removal of stable-refose, and tlie abatement of 
fly breeding nuisances, and corrected such insanitary conditions as 
were found on the various properties. 

A special placard was designed to warn the citizens of the com- 
munity and the many touring parties which go through the villages by 
automobile as to the probable danger from drinking water in this com- 
munity. The placard read as follows; 




and was placed on aU tel^raph poles, shops, stables, weigh scales, or 
such other public places where it might in any way warn those ap- 
proaching weUs not on private property, and these placards were kept 
in place until long after the epidemic subsided. 

Norristown, only twelve miles away, was, of course, kept fully 
advised as to the progress of the epidemic and great care was prac- 
tised io purifying the water there, not only during the epidemic bat 
for a long time thereafter. 


It was impossible to secure a satisfactory nursing service for the 
many persons sick in the district. Untrained nurses were in charge 
of most of these cases of typhoid fever until the disease was well 
developed and the diagnosis established and, in many cases, through- 
out the illness. Unfortunately, several untrained nurses became in- 
fected, either prior to our instructing them in details of personal 
care and in the care of excreta or subsequently to it. One poor woman 
who assisted in the running of her faousdiold and shared in nursiug 
her hnsband, two children, and the landlord, succumbed to the ill- 
ness. Her aged mother who helped with the nursing also contracted 
the disease. 

In one family where a little daughter had visited the original case 
with her father and later became ill with the disease at her home 
in a remote rural section, three brothers contracted the disease from 
two to three weeks after this little girl sickened. 



Another secocdarj case occurred in the family of a bridge builder 
who received bis infection at the S. boarding house in Skippackville. 
His wife, who nursed him at his home at Sunmeytown is another sec- 
tion of the county, unfortunately also became infected. 

As this report was being prepared word came to the County Medical 
Inspector of a family outbreak of typhoid fever in Worcester Town- 
ship on the premises of J. C A. An investigation revealed an in- 
terteting situation so far as probable 6ource of infection was con- 
cerned. Mr. A. during the severe drought in the autumn of 1914 
built a concrete wall about a point from which a spring emerges 
during many months of each year and arranged for drawing this 
water through pipes to his dwelling and barn, during such months 
of the year as the spring might flow. The introduction of this water 
to the farmer's premises took place early in January, 1915, and within 
three weeks from the time the use of this water was b^nn seven 
members of the family came down with typhoid fever. In the map 
showing the distribution of cases along the Bkippack pike the spring 
will be noted as wjthin two hundred feet of certain privies and 
grounds where typhoid fever occurred in the autumn of 1914 and as 
the formation of the ground is entirely shale it seems altogether likely 
that the spring may have been polluted, ai; soon as the ground waters 
rose and began to ffow, by typhoid excreta not properly handled in 
the autumn. Bacteriological analyses of the water from this spring 
showed sewage organisms and it was accordingly placarded and the 
honseholder warned as to the danger from its use. 

The appended sketch shows very well the relation of the premises 
wherein typhoid fever was treated in September and the farm spring 
causing the family outbreak in January, 

The most interesting group of secondary cases, however, occurred 
in the S. family. Mrs. 8. kept a boardinp; house and was served with 
T. milk. She herself and a number of her boarders became infected. 
The boarders were scattered in various sections of the county, hence 
an accurate census was difQenlt to obtain. Mrs. B. was nursed at her 
home by an eighte<^n -year-old daughter, who had no special training 
as a nurse, but when an investigation wan made by the Chief Medical 
Inspector, she was found to be prartisint; the precautions advised in 
the circular of the Bepartraent as intelligently as a trained nnrse 
would have been expected to carry out such precautions, and she was 
especially commended for her care. She escaped infection. The 
mother had a tedious recovery and apparently from subsequent history 
became a "carrier case." They moved, some time after the mother's 
recovery, from Skippackville to Wnahintrtonville, Montgomery County, 
and E. H., who had been so succesafnl in nursing the mother through 
her illness, sickened about the first of January. 1915, with typhoid 
fever. Her younger sister, a little girl of six. and a cousin, a little girl 

Skippdck Pike 

How the PremlBea of A. 

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of ^gbt, seemingly contracted tbe infectios at about the same time. 
All three were probably infected from Mrs. S. and after she was 
supposed to be entirely well. 

The infection was particnlarly virulent in type; the original case, 
E. N., died on the 11th of September, during the height of our in- 
vestigation. Eleven additional persons are known to have died from 
the disease, a mortality of twelve in a total of one hundred and eight 
cases, giving a fatality of eleven and one-tenth per cent. 

It is possible that yet other persons were infected in the community 
because the two hotels were popular eating houses frequented by auto- 
mobile parties and, prior to the time the Department b^an handling 
the epidemic, abundant opportunity for infection was afforded to such 
patrons of the hotels as partook of milk or milk products. 

The following interesfing letter from Dr. W. J. Wright, of Skippack, 
referring to the number of persons immunized in the infected district 
and the results of the immnnizatlon, his attempts at immunization 
in persons who were presumably infected, his comments upon 
treatment with typhoid vaccine, and some details concerning E. H. 
sickening subsequent to immunization, are of sufficient intereet to 
justify quotation: 

"I immiiDized forty-H(>veD jwraoDS in hciRicfl tint infertfd nrd rone o! 
the forty-seyen developed typhoid. I immunined Ubirty-throe iu infected 
hompa where one or iiiore of tlie tiimily hod typhoid aud only one of 
these developed typhoid— E, H. Six othira received one or two in- 
jections before developing typhoid. In ull the cnses Mulford's In>- 
muDizinE three syringe pnckagp was used, giving the doses ot periods 
of seven to ten doya. Most of tbe doses were ten days aport. In tbose 
who had received the immunizing doses nnd developed typhoid, two were 
rather of an abortive type, three rnn the usual course, one was a pro- 
longed type with aeveml small hemon-hugCB. I rather thought it 
hurried the onset where they were nlready infected when the vaccine 
was given. Reactions were very severe, chills, high fever, and Bore 
Anns In three wibps I gnve amiill donef (230 millions of killed bacteria) 
at five to six days Intervals during the course o( the disease. In one 
of these I had a severe reaction when the third dose whs given. The 
other two were not helped and both seemed as if the fever remained 
longer thnn the usual course. My conclusions were that when infection 
baa occurred vaccine hurries on the approaching onset and reacts very 

"During attacks the doae should be vci? am^ill and is of very doubtful 
value. I am heartily in favor of its use before infection aa a 
prophylactic. In the N. family I immunized Hts. S. and daughter, 
also in the same house tbe T. family consisting of Air., Mrs. and baby. 
None of these developed typboid. E. H. received three inlectiona 
(Mulford's Immunizing PnchaRe) given at ten day intervals In September. 
She nursed her mother through a Inng attnck of typhoid (beginning in 
September, 1B141, covering a period of twelve weeks. She developed 
typhoid at Washington Square in .Taniinry following. About the time 
her mother began to ook nitd take care nf the house. Her sister 
nnd cousin In the same house d.''veli>ped typboid about the same time." 


The entire outbreak, then, not including the N. case occurring in 

July, consisted of ninety-one typhoid fever infections due as nearly 

as could be ascertained, to conditions on the T. dairy farm or to the 

use of milk served from the farm, and sixteen secondary cases. Of 




the Becondary caBea Bix were honse contacts or due to persons assistiag 
with the nursing; seven were water-borne cases of typhoid fever, 
the water having become infected and the use of it having began some 
three months after the original outbreak; and three cases were 
secondary to a "carrier case" saccumbing to infection more thati 
three months after the person who originally contracted the disease 
had returned to work. And finally one of the last meitiotied 
secondary cases contracted the disease less than four months after 
being giv^ the usual immnniaing treatment. 


In accordance with your instructions I proceeded to South Bethle- 
hem, Northampton County, on October 12, 1914, in order to determine 
the cause of the prevalence of typhoid fever in Lehigh University. 

I was associated in this work with Assistant Engineer W. H. Ennis, 
particularly In the investigations of mi\k and other food supplies and 
of the water supplies on dairy farms. The details are set forth in 
this report. 


The morbidity among Lehigh University students relative to the 
community as a whole was so high and the dates of onsets limited 
to such a brief period that a study of other than university cases, is 
presented separately. During 1914 the following cases of typhoid 
fever were reported in the health districts mentioned: 

Nineteen of these twenty-four cases became sick prior to JnUe; 
the five developing the disease during September represent a very low 
relative morbidity as contrasted with the occnrrence of the disease 
during September in previous years. Infection of these patients 

•TtifB report l> mppltmroleO bj' 9«tloo 30 of the report of the Dlrlilon of SaolMrj ■nftn- 


was traceable to varied factors, the only tbiug ia coDimon being tbe 
nse of water anpplied by the Bethlehem City Water Company. 

The Bethlehem City Water Company suppliee water to a lai^ area 
extending from the eastern limits of East Allentown to sections east 
of Bethlehem and South Betbl^em boroughs reSpectiTely. I^e 
estimated population as based od increases during the period between 
1900 and 1910 would show the following: 

South Bethlehem Ilorough (includiiiE T.«bisb UniTeraity) 22,35S 

Fountain Hill Boroiigb 1,«I 

NorlhatDptoo HeightB Boronich, 1,037 

Weet BetWehem BorouRh (estimntpd) 4,G00 

Haaover Township. Lehish County (esdmnted) 2,000 

Saliabarr Towusibip, T^high County (eBtimntcd). 4,700 

Tiower Saucon Township. Northamptnii County (eetimntedt 4.300 

Bethlehem TownNhip. Northampton County (pstimntedi 3,200 

State Homteopatbic Hospital for tbe loeanc, RittersTiUe, 1,150 


The September morbidity from typhoid fever in the townships 
supplied by the Bethlehem City Water Company consisted of two. 
cases, both of which were isolated and were traced to.factors having 
nothing in common with the Lehigh University gronp. 

The distribution of twenty-four cases of typhoid fever throughout 
such a large and populous water area and extending over a period of 
Dine months would indicate that a water-borne infection could be 
excluded as the explanation of the cases in Lehigh University. The 
prelimtaary investigations of the water supplies ity Engineer Ennis 
had already confirmed this point as set forth in his report. 

If water were the transmitting agent the pollution of the water 
supplied to the University would have been limited to the University 
Campus. The import of this will be considered later on. 


The University is located wiihin the limits of South Bethldieoi 
and Fountain HiU. The enrollment during September, 1914 was up- 
wards of seven hundred, the usual percentage of fluctuation taking 
place incidental to late registration, entrance requirements, and re- 

Lodging for the students is found in two large dormitories on the 
Campus and in fraternity and private houses throughout the towns 
near by. Meals are purchased at the Commons (a dining hall estab- 
lished and maintained under the direction of the University), in a 
number of restaurants in South Bethlehem, in fraternity houses, and, 
to a much less extent, in local boarding houses. Water for all 
purposes (except Are control) is purchased from the Bethlehem City 
Water Company; sewage is discharged into the municipal sewerage 
system of South Bethlehem, the outlets for which are into the Lehij^ 



At tbe time of the infection the students had not become full; 
settled in rontine work and th^ were, for the most part, a floating 
population, particnlarly in the parchase of meals. This was less 
true of those dining in the Commons. The latter, located on the 
Campus, provided meals for over three hundred students, the noon 
meal averaging three hundred during the period of the probable in- 
troduction of tTphoid fever, the average census for the morning aud 
evening meals being somewhat less. Tickets were provided, the use 
of which gave single meals at a lower cost but "extras" were served, 
for which a small additional charge was made. The popularity of 
this method is shown by the large percentage taking advantage of 
the service. 

The official opening of the University took place September 16th, 
and the first case of ^phoid fever came to the attention of the local 
physicians during the first week of October. Your assistance was 
requested on October 10th, by Dr. W. L. Estes, Burgeon in Chief of 
St. Luke's Hospital and Lecturer on Hygiene and Physiology in 
Lehigh University. 

Owing to previous prevalence of typhoid fever in the valley of 
the Lehigh Kiver it was suggested that the disease might be water 
borne. Accordingly, Assistant Engineer W. H- Ennis'was detailed, 
his investigation dating from the evening of October lOfli. 

Your medical representative arrived in South Bethlehem on October 
12th and a detailed census was at once made, whidi, with the ex- 
clusion of the public water supplies on October 13th, led to the 
establishing of a tentative conclusion that the infection was due to 
conditions existing in the Commons and limited to it. The investiga- 
tions are not presented in chronological order since this tentative 
opinion was fully confirmed by the results as finally developed. 


It was possible to secure very accurate information on the points 
which could not be learned at the University by sending a census 
form and additional questions (pertinent to the customs of each 
patient) to his parents or physician. By this method a complete 
census of all cases e^ccept one was finally obtained. This included 
studies of the detail of use of food, water, and contact of fifty-four 
cases, fifty-three students (males) and one waitress (in the Com- 


IS ypfirs, 12 msM. 24 years, 3 caaea. 

Iff yenra 14 case*. 25 ypdrs, 1 ease. 

21 yenn', 6 caBes. Uustated', Scum. 

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'inK thp <nil,v jHissiblp pprind of trHnBrnifwimi ^V o mmer, 

ifl the I'orliifst Bnrt liitfst date nf nnnH by [ourtfpn dii)-s. The irvprtod 
the xbHtled areus indU'Utc nn byputhcticnl break iu the truoKinistnoD . 

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The age periods cohicide with the accepted sasceptible age and 
the age of the major number of students; the average age of the 
Lehigh students is somewhat over nineteen. Professors and in- 
structors occasionally purchase the noon meal in the Commons but 
the number in proportion to the total number of students was so small 
that the absence of morbidity among them {providing the method of 
transmission was by means of the commons) is easily understood. 

The residence of the cases was as follows: 

DrowD Hall (Campus), 1 

Taylor Hall Dormitory (Campus) '2i 

"Die Alte Brauerei" Dormitory (Campus), S 

South Bethlehem Borough , IT 

Deita Tau Delta Fraternity House, 1 

West Bethlehem (Bethlehem Borough), 1 

Unatated, 5 

The principal conclusion drawn from this distribution is to confirm 
the localization of the infection to the Campus and to limit the pos- 
sibility that students living in boarding houses were commonly in- 

All cases purchased all or most of this meals in the Commons. The 
dates on which they began to dine in the Commons and the dates 
of onsets were important in order to establish the particular time 
of infection. These dates were as follows: 

' Date ot Reporting at Commons, 

September It 30 September IB 1 

Seiitember 19, 8 September 22, 1 

September 16, 4 Unstated 6 

September 17, 2 

Septem'oer IB ^ 2 54 

Date of Onuet of Typhoid Fever. 

September 28 2 October 7 B 

September 2fl 1 October 8, 6 

September 30 2 October 8, 4 

October 1 6 October 10 6 

October 2 8 October 11, 1 

October 3 4 October 13 1 

October 4 1 Unstated 1 

October S 2 

October fl, B 54 

The Commons opened for service on Monday morning, September 14. 
It was evident that if the infection was transmitted through some- 
thing in use in the Commons it must have been subsequent to that 

In order to show that no other source of food supply was common 
to this group of patients, information as to the use of food was 
obtained from each. 

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Sources of Food Taken Elsewhere. 

Williamsport and the Uelnware Water Gap 

Reading and Asbury Park, ., 

Culumbia, South Carolina 

Pittsfield , Mass . , Hartfonl and Preston , Cunn . , and Fraternity 

AllentowQ, Reading, and UettyBburg, 

Muhlenburg Collpge, AUentown, 

Boarding Houae, South Bethlehem 

MerchantB Hotel, South Bethlehem 

Bethlehem Preparatory School, 

Slime's Restaurant, South Bethli»hi>m 

Lehigh Restaurant, South Bethlehem, 

Same's Restaurant and I-ehigh Reatuurnut, 

Same's Restaurant itnd Narberth, 

I*bigh Restaurant and Andover, New Jersey, 

Same's Restaurant and Kuthardt's Itestnunint 

Oppelt's Restnuron t , 

Oppelt's Restnurnnt and Bek's Restnuraut, 

Various Reatauraots, 

Various other houses 

Home (West Bethlehem), 

None other than the Commons 


All had food ifl the Commoas. The only other sources common to 
more than two of the cases were in the Lehigh Restaurant (five cases) 
and in Same's Restaurant (nine cases). 

The only place in which rtudents commonly purchased refreshments 
was the confectionery store of Oppelt on Fourth Street, ^outh 
Bethlehem. Tn this store soda water, ice cream and light Inndiea 
were sold. From the census it was shown that the purchase of re- 
freshments in this restaurant was as follows: 

Use within incuhatiou period 36 cases. 

None, 10 cases. 

UiutBtcd, 8 cases. 

The kinds of purchases could not be accurately determined but 
it was apparent that but a small proportion purchased ice cream 
or drinks in which milk was part of the mixture; only three purchased 
meals and it is likely that all other purchases were soda water. 

The service in the store consists of H. J. Oppelt, Miss Bert Oppelt, 
two waitresses, two kitchen maids, and two errand boys. All gave 
negative histories except Miss Bert Oppelt, who had a mild attack of 
typhoid fever about six years ago. A specimen of blood was collected 
and forwarded to the Laboratories, a positive a^lutination with B. 
typhosus being secured. Feces were not submitted. Miss Oppelt acts 
as manager of the restaurant and has nothing whatever to do with 
the preparation of the food. The serving of milk and ice cream 
preparations at the fountain is practically always done hy Mr, Oppelt. 
Assuming Miss Oppelt to be a carrier, it seems impossible that she 
should be the means of infecting fifty-four persons within a period 
of seven to ten days through the medium of foods handled by her 
in this restaurant. , ~ ■ 


Ice cream waa parcbased from M. E. Abel, Easton, who sells very 
large quantities throughout the Leliigh Valley, Typhoid fever was not 
prevalent in the districts throughout which the ice cream was deliv- 
ered. Milk was purchased from the Ritzman Dairy, a local dealer, ^o 
gives a n^iative history of typhoid fever on his own dairy and on 
the sonrcea of supply. The bread and rolls were obtained from a 
local dealer. 

The use of materials which would transmit the disease in the 
Commons seems to offer the most probable means of establishing a 
definite diagnosis. The following facts were obtained relative to 
each vehicle by means of which the typhoid bacillus is commonly 

Water: Water, of course, was common to all students, to the 
teaching .staff of the University, and to the various employees. It 
is obtained from the Bethlehem City Water Company, the University 
having a pipe system extending throughout the grounds, and is 
pumped from a sixteen inch diameter pipe belonging to the Water 
Company through a three inch diameter suction pipe, directly into a 
force main leading to two tanks which are located on a high point 
on the University property. 

The tanks are of wooden constraction, have removable wooden 
covers, and together have a capacity of thirty thousand gallons. The 
supply in the tanks is kept at a constant level of three feet; when 
it falls below this level this is automatically recorded in the pump sta- 
tion and pumping is resumed. From the tanks the water flows by 
gravity to the dormitories and other buildings on the Campus. It 
was thought that misdemeanors might have been committed by boys 
from the nei^boring communities; it had previously been observed 
that the covers had been removed and waste material and broken 
glass were found in the tanks. Such a condition was found just 
prior to the opening of the University during this fall. 

The Commons is located about one hundred and fifty feet below 
the level of the tanks and the water supply is directly from the force 
main and only indirectly from the tanks ; owing to the large use of 
water, pumping is kept up practically constantly and it is probable 
that during the daytime the water is always directly from the force 
main. The distribution of cases bears no particular relation to the 
use of water from the tanks. This is noted in the table riiowing the 
distribution of cases; twenty-three of the fifty-three cases residing else- 
where than on the Campus did not use this water except in the 

There is an additional water supply from springs which is used for 
fire protection and was the original source of supply to the former 
Mountain Water Company, There is no connection between the 
two systems on the University grounds. An investigation made 



ot the source of euppl; and the distribation of the Uonntain Water 
CcanpaUy resnlted in negative 'findings relative to transmission of 
typhoid fever. 

To recapitulate, if water supplied by the Bethlehem City Water 
Company were the transmitting agent, the morbidity woiild have 
been correspondingly great outside the University; this has been 
shown not to be the case. 

If the water were infected in the storage tanks, the higher mor- 
bidity would have been in the buildings receiving water by gravity 
from these tanks. Not only was the distribution of cases not based 
on such water distribution but also it was shown that twenty-three 
never had water delivered into tbe University piping system except 
in the Commons. It has been shown that back ■flow from the tanks 
to the Commons conld not occur because of the automatic control of 
water levels in the tanks. It is a safe coticlusion, therefore, that 
water was not the transmitting agent. 

Milk: All the patients having typhoid fever in the University used 
milk at the Commons in some way. The method of use is shown in 
the following table: ' 

Use of Milk. 

Aa beverage only None 

In tea or coffee only, None 

On cereate only, ; . 9 

Ad a beverage and on ocreuls, 3 

As a beverage and in ten or iMlfee 26 

As a beverage, on cereals and in tea or cofFpe 11 

Unstated , 8 

Because the great fluctuation of demand made it economically im- 
possible to purchase from local dealers on any other basis, the milk 
supplied to the Commons is obtained from a middle-man. The latter, 
Andras Kocsioiky, who has the contract for the s^sion 1914-1915, 
is a Hnngarian having his milk station on Fifth Street, South Beth- 
lehem. He purchased his milk supplies from four dairymen, one 
of whom obtains his supply from five others. The four principals 
will be referred to as Nos, 1, 2, 3 and 4 respectively. 

Andras Kocsiczky, the middleman, sold thirty-five to forty gallons 
directly to the Commons and to other dealers in bulk and to station 
patrons in small quantities. The daily supply to the Commons was 
from No.'s 1 and 2 regularly, in their own cans, and without transfer. 
On only one occasion, September 22nd, was an additional supply 
delivered, at which time a can containing twelve gallons of original 
milk from dairy farm No. 3 was delivered during the afternoon. He 
{•rated quite positively that milk from dairy farm No. i was never 
delivered to (he Commons, that transfers from can to can or additions 
to cans delivered to the Commons were never made. The record of 


Bales from dairy farma and of purchase and sales on each day from 
September Ist to October 15th were compared. The resnlts confirmed 
the statements made. 

A carefnl study was made of all persons residing in and of those 
who had recently visited the premises of Andras Kocaiczky, the results 
being entirely negative. 

At source of supply, No. 1, the dairy farmer himself had had a 
suspicious Ulness about siz or eight years ago and a mild attack of 
diarrhoea during May, 1014 ; all other persons residing on the premised 
gave negative histories. Esaminatiou of the physical conditions 
surrounding the source of water supply was negative and a serological 
examination of the blood of the dairy farmer was negative. Bacterio- 
logical examination of the, water gave the following rraults: 

Spceitneru collected 
October It, 19U. 

Bacteria per c.c, B. Coli per c.c. 

Wtil BOO 

Cisteru 3« 32 

October U, 1911. 

WeU, « 

The datem waa used fur cooling purposes only. 

At source of supply No. 2, a negative history r^arding ^phoid 
fever was obtained. The physical conditions surrounding the spring 
milk house were suggestive of possible pollution. The cans were 
placed in the water for cooling and it was possible for tlie cans to 
have been open to contamination by manure from the barn yard. 

Bamples of water taken for bacteriological examination gave tJie 
following resnlts: 

October It. 

Bacteria per c.c. B. Coll per c.c. 

Spring 1320 

Orerflow from spring, 80 

Surface Hpecimen from spriiii;, IMO Cl 

Deep BpecimeD from spriog, 780 

October H. 

Surface Bpecimen from spriog, IVi 

Deep speciinen from spring 66 

At source of supply No. 3, the history of the dairy farmer diows 
that he personally was the only one who had suffered previously 
with typhoid fever and that was thirty years ago. An examination 
of his blood was negative. The examination of the water supply was 
negative both so far as the physical conditions were concerned and 

Boarce of supply No. 4 was a local vendor, who sold a portion of 
his milk to Andras Eocsiczky. He purchased milk from five different 
dairy farmere. These were investigated in the same manner as the 
snpplira noted above and were uniformly negative. ' 

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If milk carried tiie infectioa to the patients in the UiuTerai^, it 
seems aitogether probable that infection of the milk supply did not 
occur before it was delivered to the Commons. Evidence is lacldng 
which would show that typhoid "carriers" handled the milk sapply 
on dairy farms No.'s 1, 2, and 3, and in order for infection to hare 
come from dairy farm No. 3, it would have been necessary for all 
patients to have been infected from one can of tniik delivered on 
September 22nd and used at the evening meal. The morbidity as 
indicated in the dates of onsets does not confirm auch a method of 
transmission. Were the latter true it would seem improbable that 
the dates of onsets should have extended over so long a period and 
likewise it would seem improbable that the earliest cases would have 
developed the onset of illness prior to October 1st with clinical mani- 
festations earlier than October 7th or 8th. Source of supply No. 4 
was excluded from consideration. 

To attribute the outbreak to milk transmission infected before 
delivery would mean that the milk had been infected practically daily 
between September 16th and 26th and possibly over a longer period 
of time. There is no evidence that polluted water or vessels or tiiat 
"carriers" existed at the places of prodaction or on the premises of 
the local dealers. 

At the Commons, tlie original containers were placed in ice-boxes 
and the contents dipped for use. It would seem improbable that 
repeated infection at this point should have occurred. 

No person suspected to be a carrier served milk from these con- 
tainers and milk as a transmitting agent was accordingly from 

Ice Cream: The census showed that all the patients had eaten Ite 
cream at some time within the period of transmission. All ice cream 
used in the Commons is made by its employees in the kitchen, UBuaDy 
by the baker and his helper. The cream is purchased from Helm's 
Creamery Company, who sell over o'ne thousand gallons of cream 
a week in the Bethlehems and vicinity. The method of handling 
was investigated ; all milk supplied to the Creamery is paetenrized by 
the "holding" method. The cream is then separated and is graded 
according to fat content. The cream is then pasteurised by flie 
"flash" method (212°F.) The best grade of cream (No. 1) was 
purchased for use in the Commons. 

From the history given it is possible that ice cream may have been 
infected itj the flavorings in the process of manufacture; the only 
flavoring handled by the kitchen employees was peacb. Peaches were 
purchased from a local dealer and were served in ice cream on three 
occasions, half a peck being used for flavoring on September 17th, 
half a peck on September 19th, and one peck ob September 24th. In 


the ordinary routine of making ice cream the peaches were first 
scalded by the baker and his assistant in order tQ r^uove the skins 
and these were then hand sliced by pantry girls. The distinct history 
was obtained from two colored male employees (silver polishers) 
tiiat th^ had assisted in slicing peaches on one or more of these dates. 
If the ice cream were infected by a kitchen carrier it must have been 
through the medium of peaches on September 17 or 19th. A careful 
review of the methods of making shows it to be very improbable that 
an infection of ice cream had occurred through any other channel. 

Ice: -Ice is manufactured in the basement of the Commons from 
water supplied by the Bethlehem City Water Company. A moderu 
equipment has been installed. Ice is never placed directly in beverages 
or foods; the water is colled by coils, which pass directly from the 
ice-plaut to the kitchen and dining room. 

Oysters: The use of oysters is shown in the following table: 

Casea. CaBen. 

On September 18th S Elsewlierc, 2 

On October 2nd, 4 Unstated 8 

On both dates 21 None used, IS 

Oysters were purdiased twice after the opening of the Commons 
and before ihe date of investigatiou. These were seal-shipped in 
eleven gallon lots from one source in Baltimore, Md., aod were served 
"panned" on September 18th and "fried" on October 2nd. In both 
instances they were served for the evening meal only, a time whein 
the dining room census was lower than at any other meal. Because 
the steward insisted that they should be well done, oysters on both 
occasions were over-browned and fliere was no difficulty in having 
the date of use identified by each patient who had eaten oysters. 
Because of this and the fact that only twenty-seven of the flfty-four 
cases are shown to have eaten of these oysters, it would seem impossi- 
ble that the oysters served "panned" on that date transmitted the infec- 
tion. The oysters served "fried" on October 2nd were used by twen^- 
flve cases, this date of use corresponding to the appearance of the 
disease clinically. For tjiis reason,' oysters were eliminated from con- 
sideration. Other shell fish had not been served. 

Bread: Bread supplied to the Commons was for the most part 
purchased from the Freihofer Baking Company, Philadelphia, and 
a partial supply from the Sober Baking Company, Bethlehem. The 
possiblility that bread had carried the infection unless infected at 
the Commons itself was minimal and an investigation of ihe Friehofer 
plant seemed to be unnecessary. 

The Sober Baking Company employed twelve bakers, one night 
watchman, and seven drivers. All handled the bread and for that rea- 
son were studied wifli reference to previous attacks of typhoid fever. 
The only person found to have had a suspicious illness was one driver 


who delivered bread to the Commons and to St. Luke's Hospital and 
who waa reported as being ill for several weeks with a diagnosis of 
"stomach trouble." The family physician assured me that the patiwt 
was snffering with recurrent gastric ulcer. This driver likewise de- 
livered to other customers throughout the Bethldiems and it seems 
unlikely that he should have been the cause of so high a morbidity 
of typhoid fever in the University without having a similar morbidity 
on other portions of his routes 

If bread was the transmitting agent it was In the Commons service. 
Only pantry maids sliced (by machine) and served the bread. 

Butter: Butter was porchased from Swift and Company's local 
warehouse. The latter receives several kinds of butter, but the 
supply sent to the Commons is shipped from the Chicago distributing 
house, known as Brookfield Butter. A carload is sent east each week 
and, of this, nine hundred to one tliouBand pounds are distributed 
in the Bethlebems by the local agency; two hundred pounds are 
delivered weekly to the Commons. At the latter place it is cut and 
placed in iced water from which it is served by the hands of the pantry 
maids to individual butter dishes. 

Meat: Meat is purchased entirely from Swift and Company. All 
beef is shipped from Chicago and veal is purchased locally. Roast 
veal was served at the Commons. Other types of meat such as veal 
loaf and cooked meats were not served prior to the clinical appear- 
ance of the disease. If veal were responsible, it is probable that the 
infection would be by one of the paratyphoid forms or by the bacUlns 
of Gaertner. Clinically and serologically the cases were infections 
witli B. typhosus only. 

Uncooked Fruits: These consisted of cauteloupes, oranges, bananaa, 
peaches, and apples. The first three were served as "extras" and 
it is shown by the records of dealers from whom the purchases were 
made and also appears on the books of the Commons that but two 
dozen of each had been purchased up to the time of the reporting 
of cases. ' 

Peaches were used for Havoriag ice cream and were served sliced. 
It is stated that two baskets were served sliced but once, i. e., on 
October 12th. The use of sliced peaches was this: Tea 17, No 26, 
Unstated 11. They were obtained from many sources, some of them 
being shipped from Phillipsburg, New Jersey, and other points near, 
hy, others being purchased from local farmers by green-grocers in 
fk)uth Bethlehem. 

The only apples used were purchased from G. E. Smith, truck 
farmer in Salisbury Township, Lehigh County. Reference will be 
made to this below. 

Uncooked Terjciahlcx: These consisted of celery, lettuce, tomatoes, 
and cabbage. Celery was not served prior to September 24tli and 


then only on one Sundaj ev^ng in potato salad. Lettuce was ased 
only for garnishing potato salad which (withont celery) was served 
once each week. The use of potato salad (with lettuce) was as follows: 
Yes, 32, No, 14, Unstated, 8. 

Sliced tomatoes were served frequently, an accurate record not 
being obtainable. The use of tomatoes was: Yes — 38, No — 8, Unstated 

Cabbage was served but once (with fried oysters Oa October 2nd) 
as pepper-hash, with a nse reported as: Tea — 13, No — 32, Unstated 

These vegetables were purchased in the local markets, particularly 
from one dealer who in turn secured his supply from Philaddphia, 
and also from local truck farmers. Corn was purchased on one oc- 
casion from G. E. Bmith, of Salisbury Township but, of course, was 
cooked before serving. 

Nigkt Soil: The steward had purchased apples and com on several 
occasions from G. E. Smith, truck farmer, Salisbury Township, Lehi^ 
County, who it was allied had used night soil on bis farm. 

The information obtained from Mr. and Mrs. Smith, from a tenant 
farmer, from the steward himself, from the engineer of the water 
plant (located at the lower end of the farm), and from H. W. Repshnr 
and Lester Bachman, who had contracted to remove the ni^t soU, 
indicated that it was deposited only on the low lands at the lover 
end of the farm. During 1913 corn and during 1914 oats only were 
planted on this land. The tenant, a Hungarian, raises truck for his 
fomily using night soil for fertilization. He did not sdl prodnce, 
either to his landlord or to local dealers. Had he done so the 
sales would have consisted of tomatoes and cabbage only. The dates 
of hauling and the addresses from which night soil was removed 
were checked agai'nst the use of products from this farm and it . 
seems improbable that there was a relation of cause and effect between 
night soU on the Smith farm and the morbidity in Lehigh Uni- 

The Commons, a single large building, includes the dining hall, 
kitchen, pantry, bakery, ice and ice cream freezing plant, livii^ 
quarters for the steward and family and also for certain of the 
employees, and the necessary store rooms. The building is heated by 
steam, is well ventilated, and thoroughly screened. 

The equipment is modern in every detail with the exception (at the 
time of investigation) that the method for protecting users against 
polluted milk had not been installed. Transmission of infection by 
dishes has been rendered altogether improbable by a modem dish- 
washing machine and sanitary plumbing, protected garbage cans 
(removed daily), facilities for hand washing, individual towels, wash- 


able white uniforms, bread cutting machines, aud coil-cooled water 
and refrigeration provide adequate measures of protection. The 
' steward, Mr. Smith, with his wife and daughter, occupy apartments 
OB the second floor of the building. Mr. Smith has been ragaged in 
such work on railroads and steamships and privatdy during most of 
his life. The skill with which he develops and conducts his work is 
evidence of his experience. His medical history and that of Ilia 
family are entirely negative in so far as acute infections of the tyi^oid 
type are concerned. 

The highest daily census in the dining room was two hundred and 
'sizty-flve, which number represents nearly the average meal censns 
during the week when the infection was probably transmitted. Among 
these only one student was found who had a history of typhoid fever. 
Mechanical transmission from one diner to a lai^e group was physi- 
cally impossible but a careful review of all diners was made as a 
. precaution and to set at rest rumors of such means of tranamlsBions. 

There are twenty-five waiters employed in the dining room, all 
of whom were members of the student body. The medical history of 
these with one exception was negative as to intestinal infections. 

The employes were as follows: 

rook 1 Raker 1 

Oonk's h«1p«r I Baker'H helper, 1 

•Dish waahere 2 Pnutry help 1 

'HUver and glaSM vaBbera, 2 fPantr; asalBtants, 3 

Pot washer, 1 

Of the above employees eight were colored. In addition, the foUow- 
. ing had been employed between the dates mentioned: 

Pantry boy, rrom Sept. 22 to Oct. 6. Pantry boy from Sept. 11 to Oct. J. 
Pantry boy, from Sept. 10 to Sept. 17. Pantry girl from Sept. S to Sept. 18. 
Pantry boy, from Sept. 10 to Sept. 22. 

A carefully detailed history was obtained from each employee, the 
. <iuestioning covering all conditions simulating or likely to be mistaken 
for typhoid fever; specimens of blood were collected from each person. 
This work required several weeks as the former employees had re- 
moved to various other places. The results of the study were uniform* 
ly negative with the exception of one. 


The elimination of all factors other than "carriers" was well defined 
early in the coarse of the investigation. The separate study of 
persons having had infections of the intestinal tract was made as 
early as possible. 

Among the diners but one was found with a history of prerteuB 
typhoid fever. F. J. Q. developed the disease three years ago. The 
eKamination of his Wood on October 14, was negative. He had habit- 

D (or MrvlM. 


ually dined with ooe group of students, two of wbom had developed 
typhoid fever. There is no evidence that he was the means of in- 
fecting these patients. 

Of the twenty-five waiters all but one had negative histories as to 
typhoid fever. The exception, L. H., aged twenty-seven, had been in 
Porcupine, Canada, during portions of 1909, 1910 and 1911. During 
1910 he suflFered with epidemic dysentery lasting ten days. Typhoid 
fever had been epidemic in Cobalt, an adjacent town, during the 
previous year and in Porcupine during the same year. In both in- 
stances it was preceded by an epidemic of baciUary dys^tery. His 
blood, collected on October 13, 1914, was n^atlve with pathogenic 
members of the typhocolon group. The students developing the dis- 
ease were not served by him. The distribution of morbidity in the 
dining room showed no marked localization. 

Of the kitchen and bakery ^nployees, only oUe gave a postive his- 
toi7. B, A„ colored, twenty years of age, employed as a silver and 
glass washer and also as an assistant in preparing food, reported for 
duty to the Commons before its opening on September 14th, and 
was continuously employed up to the time of my investigatioti. He 
gave a history of an attack of iyphoid fever during September of 1912 
and a dfarrtioeal disease associated with chilliness and fever lasting 
several weeks during September of 1913. During Ihe early part of 
September, 1914, he again suffered with symptoms similar to those 
of the previous year but in a milder form and was not absent from 

The physical examination showed him to be an under-developed 
male negro, under weight, probably having secondary anaemia, mod- 
erate exophthalmos associated with subacute conjunctivitis, enlarge- 
ment of the lymphatic glands of the groin and axilla, bnt n^atlve In 
every other particular. 

The blood serum reacted as follows on the days named: 

Oct. IS. Oct. 23. Nov. 24. 

B . lyphoiut, -I- + + 

B. paratypiotu* A — — — 

0. paratvphoius B, + + + 

B. paracoU — — — 

B . enteritidit — — — 

B. d)iien1eriae (Ehiga), — — — 

Feces and urine were shipped from South Bethlehem on October 
19th and 22nd and from Lewes, Delaware, on November 24th and 
December 12th. Pathogenic forms were not found. 

It is evident from the accumulated evidence that food and water as 
originally delivered to the Commons were free from infection. 



This outbreak of Ij^phoid fever, which ended as abruptly as it began, 
was distinctly limited to persouH associated with the University and, 
among these, to those dining in the Commons only. It is to be oc- 
counted for only on the assumption that food or water was infected 
after its receipt or at the time of preparation in the Commons. 

Of two hundred and sixty-five diners (including twenty-five wait- 
ers), fifty-three and of sixteen persons living or employed in tlie build- 
ing, one developed the disease within a period of fifteen days. 

All these patients had become patrons of the Commons before 
September 23rd. The Commons had opened for service on September 
14th. The dates of c^nsets were between September 28th and October 

Based on these data it is apparent that all cases were probably 
infected between September lith and September 29ti; that an in- 
termission in transmission occurred as is indicated on the morbidi^ 
curve shown above; and that but one person was the factor in infect- 
ing the entire group. 

Of all persons in the Commons, R, A. is the only one with a positive 
history of typhoid fever showing a positive agglutination reaction with 
B. typJiosus and B. para-typhosus B. The persistence of the reactioba 
in high dilution (1:100) two years after the allied attack of ^hoid 
fever would lead one to suspect that he 9till harbored the pathogenic 

His relation to the outbreak give striking confirmation to this 
assumption. He was on duty when the Commofis opraied on Sep- 
tember 14th ; fourteen days later the onset or the first case of tyi*oid 
fever occurred among the students. The kitchen work was oi^nized 
and adapted to the large number of patrons before October Ist On 
or about that date the use of silver and glass washers for food pre- 
aration became less necesRary. The onset of the last case was October 
15th. R. A. was removed from kitchen ser\'ice on October 20th, as 
soon as the report of a positive agglutination of his blood serum was 

That this man was a carrier has not been finally proven by the 
recovery of pathogenic forms from his blood, feces, and urine. A 
blood culture was made in Lewes, Delaware, on November 24th with 
n^ative results. It was not possible to make fecal and urinary cul- 
tures on proper media either in South Bethlehem or Lewes. If patiio- 
geuic forms were present they were destroyed while in transit to tiie 
laboratory for examisation. It is altogether probable that had it 
been possible to study his discharges under proper conditioBS, the 
micro-organisms would have been found. 

Recent evidence in serological studies indicate tiiat agglntininB 
continue to be present in the blood a long time after recovery from 
the clinical disease only when the patient continues to be the host of 


living bacilli. In tlie case of B. A. two years elapsed between the 
diagnoBia ot ^boid fever and the serological studies here con- 

Positive findings in dlschai^s are obtained as a rule only after 
repeated search. Yonr attention is called to the writer's report on 
the epidemic in Bellersville, Bucks County, during September, 1913. 
In this outbreak the carrier gave a positive serum reaction with 
B. paratyphoms B., while the feces were positive only on repeated 
examinations. The history of recurrent diarrhoea in that case during 
each of seven summers following the clinical manifestation of the 
disease has its analogy in the recurrent diarrhoea of R. A. in the two 
Septembers following his original attack. 

A.'8 relation to food was intimate. While in his stated employ- 
ment as a silver and glass washer he also assisted in the preparation 
of food, the most important of which was slicing of peaches for the 
manufacture of ice cream. As noted previously in the report peach 
ice cream was served on Beptember 17tb, 19tb and 24tb, dates included 
with the transmitting period of the infection. 

In accordance with these findings, the epidemiological conclusion 
is the transmission of B. typhosus from a chronic typhoid carrier by 
means of food served in the Commons. 


The measures taken to prevent infection of further cases were 
limited to the Commons. The special action was to exclude the 
suspected carrier from further service, to establish a more rigid 
enforcement of rules regarding the personal hygiene of ^nployees, 
and to install a temporary appliance for pasteurizing the milk. The 
last named was subsequently replaced by a modern pasteurizer. 

The fortunate proximity of St. Luke's Hospital relieved the Uni- 
versity from the need of establishing a temporary hospital or resort- 
ing to Dormitory treatment. Of the fifty-four cases, twenty-seveB re- 
ceived treatment in St. Luke's Hospital. All others were able to 
travel to their homes during the prodromal stage. 

The diagnosis was confirmed by studies on twenty-five cases made 
by the Hospital Pathologist; with his consent the following results 
are presented. 

Total cflies studied, 25 

Agglutination ruction positive 17 

AlcglntinHtion reaction n^ative 8 

Blood culture positive, 4 

Blood culture necative 3 

Blood culture not msde, 18 

All other pathological studies were made in the laboratories of 
the State Depariment of Health. 

16— 1&— 1916 



There vere no secondary cases ; primary cases ceased after the elim- 
inatioD of the carrier. 

Your representative recommended the use of anti-typhoid vaccine 
as a prophylactic against future exposure to infection. Its ase was 
adopted by the Universi^ authorities and recommendations made 
to all students. With the consent of parents or guardian, all students 
presenting themselves were vaccinated by the Consulting Physician 
to the University, Dr. William L. Estes, Jr. Your representative 
assisted in the first inoculations. 

Under the direction of the Department of Physical Education, 
it is required that each student shall give his previous and present 
medical history and submit to a complete physical examination. 
The previous incidence of typhoid fever is noted. These records will 
probably prove valuable in future preventive work. A positive history 
in a student who is an applicant for service in the Commons will make 
it necessary for him to submit to serological and bacteriological ex- 

An order was issued requiring that similar examinations must 
be made of every applicant for kitchen, pantry, or other service in 
the Commons. In this Lehigh University is the pioneer among edu- 
' cational institutions. Correspondence with all other American Uni- 
versities, with colleges, seminaries and schools shows that such super- 
vision has Hot heretofore been exercised to protect student healtb. 
These activities result from the deep interest and initiative of Dr.' 
Henry 8. Drinker, President of the University. 


In accordance with instructions I proceeded" to Tower City, Schuyl- 
kill County, on November 6, in order to review the factors giving rise 
to an epidemic of typhoid fever in that place. There is no record of 
cases reported in this community prior to September 21, 1914, On 
Friday, September 25, Dr. R. H. Stutzman, the medical member of 
the Board of Health in Tower City, telephoned to you, stating that 
a number of cases of typhoid fever had been reported, that fae had 
reason to believe that the source of infection would be found in the 
water supply, and as a member of the Board of Health, he would meet 
an engineer if one were assigned to make an investigation. 


Replying to this request, a preliminary Investigation was made by 
Assistant Engineer R. B. Btyer, beginning on the morning of Septem- 
ber 28. Subsequent investigations were conducted by Mr. S^er and 
Assistant Engineer R. E. Irwin, the census and watershed work being 
performed by Sanitary Inspector T. B. Nicholson. 

Ihe history of the factors giving rise to the epidemic and of the 
present disquietude .which exists in Tower City began with the infec- 
tion of one fJorman Bohr, aged eleven years, the son of Henry Bohr, 
living in Porter Township, Schuylkill County. The source of the 
infection for this particular case could not be discovered. The history 
of his illness shows the onset to have been on or about July 7. The 
clinical history of the case indicates that the course was decidedly 
atypical and probably presented one of the milder forms of ambulant 
lyphoid, the usual clinical evidences, such as are given the greatest 
amount of consideration by rural practitioners, apparently being ab- 
sent. He was first seen by Dr. B. H. Stutzman on July 31, who states 
that he failed to recognize the nature of the illness. 

A brother, Amos Bohr, aged sixteen years, became HI on or about 
September 15 and was first visited by Dr. Stutzman on September 21. 
He established a diagnosis of typhoid fever and at that time became 
convinced that the case of Norman had been one of atypical typhoid. 
He states that at once be reported both cases to Health OtBcer Sutton, 
who had been temporarily assigned to have charge of that district 
In a r^mrt dated November 10, Health Officer Sutton states that 
he has not received a report of the case of Norman Bohr. 

In the meantime, cases of typhoid fever had been reported in Toww 
Ci^. In his capacity as medical member of the local Board of Health, 
Dr. Stutzman made, on Sept^nber 23, an investigation at the premises 
of Henry Bohr in relation to the water supply to the borough. The 
Water Company, in consideration for the use of the Bohr land, sup- 
plied water directly to the Bohr premises. 

The pump station and well of the Water Company were located on 
this farm, the pump receiving water from two small streams flowing 
through an uninhabited watershed. In addition the Water Company 
was taking water directly from a stream which had its origin in 
Rush Township, Dauphin County, the shed of which had ten occupants 
with a considerable number of pollutions. 

Dr. Stutzman had heard of an unreported case of ambulant lyphoid 
fever some two miles distant on the banks of this same stream. The 
patient, a son of Jacob Gehres, Bush Township, Dauphin County, 
had visited his father's home while sick during April and May, coming 
from North Carolina. 

In view of the history of tie Gehres ambulant typhoid case, the 
evidence that direct pumpage was made from the stream by the Water 
Company, and the fact that the first two cases of typhoid fever coming 



to his attention had occurred on the Bohr premises, Dr. Btutzman 
was led to the opinion that the infection was transmitted by water 
and Qiat the Water Gompanj' shoold discontinue this source of supply 
as it was probably polluted, A demand to this effect was complied 
with on or about Wednesday, September 23. The Water Company, 
however, contended that the water was not the source of the infection. 
InTestigatlons made by Mr. Styer at first led him to the conclusion 
that water might be the source but later he demonstrated that the 
infection had been transmitted by milk. This opinion was concurred 
in by Dr. Stutzman and apparently has been the opinion entertained 
by the residents since Mr. StyeHs conclusion became public. 

The Buperintendent of the Water Company and his social and 
business associates were incensed because of the public attitude result- 
ing from Dr. Stutsman's requirements, resulting and this led to a 
longer continued discussion thB:a would otherwise have followed. This 
was augmented by the taste given to the water by hypochlorite of 
lime and by the appearance of dead tadpoles and fish in the reservoir 
and taps. 

It would appear Uiat Dr. Stutzman has been treated with as the 
secretary of the Board of Health and has been placed in the light 
of an ezecuUTe officer. The officers and members of the board are: 
President, George Seesholtz; secretary, Robert Heintzleman; Tim 
Bemey, Dr. R. H. Stutzman ; Health Officer, Daniel Grim. 
- Dr. Stutzman has vague ideas of general and local administration. 
This work was investigative and his reports were apparently made to 
the Board, for they seemed familiar with the essential features. 

To recapitulate: Dr. R. H. Stutzman failed to recognize a case 
of typhoid fever occurring on a dairy farm first seen by him July 31. 
The occurrence of a secondary case on the same premises first seen by 
him September 21, led to a reconsideration of the first case and, ac- 
cording to his statement, the report of both to the Health Officer on 
September 21. The Health Officer, however, states he has not received 
a report of the first case. 

On the day of placarding the premises, September 23, Br. Stutzman 
made a preliminary investigation and on September 25 made an appeal 
to yon for assistance. 

The infected milk was discontinued on September 22, not by issu- 
ance of orders but by reason of previously announced plans of the 
milk vendor to discontinue his business on tliat date. In confirmation 
of this are the statements of customers relative to notices served some 
weeks prior to September 22 and the report of the Health Officer 
made on September 23 that milk aUd milk products were not sold from 
the Bohr farm. 



The eridence indicates that Dr. StutzmaD has not sought to avoid 
reporting cases, but that he failed in hia diagnosis and that he is tlie 
only person in Tower City who promptly initiated and worked to 
control the sources of infection. 


Id accordance with yoar instructions ancL accompanied by Dr. C. 
R. Phillips, County Medical Inspector, on November 2, 1 reviewed the 
factors responsible (or the morbidity from typhoid fever in Health 
District 427, comprising Derry, East, West, and South Hanover Town- 
ships, Dauphin CouDty. 

Between February 1th and October 30th,. there occurred forty cases 
of typhoid fever; of these thirty-five were in Derry, three in Sooth 
Hanover and two in East Hanover Township respectively. The popu- 
lation of tile principal portion of Derry Township, which includes the 
village formely known as Derry Church and now known as Herahey, 
is estimated to be twelve hundred. This high morbidly in an unin- 
corporated community and also by reason of the only industry, the 
Hersh^ Chocolate Company, gave peculiar importance to the preval- 
fflice of typhoid fever. 

The transmission of the infection was apparently entirely local. 
A directory of all cases in the order of dates of onsets was as 
follows : 
















, Google 















j i^j;™^^ 

ill iiiijii; 




AdM^'Orolt n 



! tm^ti 

(Om in IDA B) 


J!?ftJ- ■- 

....| OMobcr 

::::| ^,^1 

It will be observed that typhoid fever has been continuously preseit 
in Hershey BJnce June 14th, when Gaae 3 developed the disease. 
Where this patient acquired the infection has not been definitely de- 
termined. She is not known to have visited any other section than 
the neighboring borough of Palmyra but did use water from a well 
on the premises which, from all physical evidences was bdieved to 
have been polluted with eewage. The analysis of this water was 
not Made until August 25th, on which date the total bacterial count 
was seventy to the cubic centimeter with no B, coU; subsequent 
analyses were not made. 

It is apparent that all cases reported subsecjuently to Case 3 may 
be included in two chief groupR, the one nbowing onsets during July 
sind Angust, the other late in September and continuing throughout 
October. In studying the conditions common to these two groups, 
there is considerable overlapping and a careful review of available 
data does not make the picture clear. The evidence depends upon 
statements made by many who failed to recall the circumstances 
existing during earlier months and upon analyses of water suppHea 
made long subsequent to infection. 

First Group. Early important were the insanitary conditions 
existing on the premises of Case 3, in relation to ordinary hygiene and 
to the care of fecal matter from the patient. The excreta were not 
disinfected and were exposed to insects in such a way as to lead 
to the inference that fly infection may account for the first group of 

The analysis of all the cases from three to twenty-three incln^Te, 
who became ill up to and including September 24th, shows that with 

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few ezceptlODS the only commo'n factor was the use of ice cream. 
The latter was handled by a local dealer, J. C. Heea, who eold in the 
portion of Hershey known as Derry Church, and to CCTtain persons 
whose asnal resid^ice was in settlements some two and one-half miles 
distant, known as Union Deposit and Sand Beach. Of the twenty 
cases, fifteen had used this ice cream. The supply came oitirely from 
Buss Brothers, Harrisburg, whose principal sales were throng^ont the 
city of Harrisbnrg as well aa in a large number of the adjacent bor- 
oughs and villages. Mo other cases are traceable to this ice cream. 
If that sold by the local dealer was responsible, it was from fly infec- 
tion carried from Case 3. 

The source of infection of cases 8, 9, and 22 remains undetermi'ned. 
Case 21 was secondary to Case 10 on the same premises, and Case 23 
occupies the adjoining property to Case 10 and Case 21. There is 
reason to believe that the infection was transmitted throngh social 
relations and Case 23 may therefore be considered as secondary to 
Case 10. The remaining case (Case 22) liyed on a farm in the lower 
part of Derry Township, a finale, twenly-two years of age, for whom 
no definite source of infection conld be found. The well water on the 
premises was analyzed in the Department's Laboratories, the total 
count of bacteria being thirty-six with fifteen B. coli to the cubic 

It is important to note that of the twenty-one cases, from Case S 
to 23 iaclusive, nine had received their milk supply from a dealer in- 
Derry Church, one C. H. Wolf. 

Second. Oroup. The second group of Cases 24 to 40 inclusive^ show- 
ing dates of onsets between September 26 and October 30, hare nothing 
in common except the use of the Wolf milk. The exceptions to this 
are Case 32 in South Hanover Township, unaccounted for, and Case 
40, which was secondary to Case 39. The cases of this group were 
reviewed in the field by yoor representative in order to decide whether 
or not the infection had been transmitted by the milk sold by C. 
H. Wolf. 

There are two milk vendors in Hershey: Shetter and Wolf. R. H. 
Sbetter, Campbellstown, delivers about one hundred gallons a day 
and sells in the western end of Palmyra and in Hershey, Pour cases 
of typhoid fever occnrred in Hershey among the patrons of this rontg 
and are included in the first gronp. C. H. Wolf, of Hershey delivers 
two hundred to two hundred and fifty quarts a day. If the estimated 
population be correct, Mr. Wolf sells to about three-fourths of the 
total population or about seven hundred and fifty persons who nse his 
milk supply. His sources of supply are: 

Don M. Stout, Derry Church, /Morning deliveiy. gHllonfi 7 

(Rvening dplivery, Ballons A 

Job. Cromtt, Derry Charch /^f^)^nin5 delivery, pilloii 

^Eveni— ■■-'■ — ..-- 

niUB deliveiT, gallons 22 t" 


The evening supply from both sourceB is mixed together and de- 
livered early the next morning. The morning Bupply is deliv^^ in 
the later hours of the same morning. On this second trip (with 
the morning aiipply) lie delivers some forty quarts to a setQem^t 
of foreign-bom families livi'ng at the eastern extremity of Swatara, 
tw^ity-flve quarts to the Y. M. C A. at Hershey, and the balance to 
the general trade. 

In addition he received an occasional supply from J. A. Baumgard- 
ner, of Derry whose sales are as follows: Nearly one-half is takoi 
to the Hershey Btore Company, bottled, and sold to trade; about 
one-third of his total supply goes to the Hershey Cafe; a'ad there is 
an occasional sale of fifty to sevaity-five quarts to 0. H. Wolf. What 
may be left of a daily supply, runniug as high as a hundred and 
twenty-five gallons, is shipped to the Hershey Cramery, A history 
of l7|riioid fever existing on the dairy farms supplying Mr. Wolf 
could not -be obtained. 

Ten of the cases studied lived in a restricted area to which Mr. 
Wolf delivered his mUk each day on the first trip, at about 7 to 8 
A. M. Assuming that the Wolf milk was the transmitting agent it 
would sewn necessary by reason of peculiarities in distribution of 
patients and of the handling of Mr. Wolf's supply, to find a factor 
which would infect the milk delivered to him in the afternoon, bottled 
during the same afternoon but not delieverd until the followed morn- 
ing. With a negative history for the persons employed at (he sources . 
of supply nnd for Mr. Wolf himself, who alone handled his milk, but 
two possible factors were to be considered, i. e., a fiy infection or a 
bottle Infection, both of which were reasonable in the li^t of the 
evidence discovered! 

The Wolf milk depot is located at the rear of his home in Derry 
Church. Within ten feet of the bottling room, the discharges of one 
of the cases of typhoid fever infected during Hay had been deposited 
for some two or three weeks. During the prodromal and early ambu- 
lant stage no attempt to sterilize the dejecta had been made, and in 
soon as she had recovered this custom bad been resumed. An unused 
cesspool insufBciently covered with rails was situated in the yard 
adjacent to the bottling establishment and in it had been deposited 
the garbage and wastes of houses near by. No cases of typhoid fever 
occurring On such premises could be discovered. The bottling room 
was inefficiently screened and for all practical purposes might as well 
not have been screened at all. The bottles were cleaned with luke 
warm water and brnBhea, If flies transmitted infection from the 
vault of the adjoining premises to the milk bottles, only those bottles 
nsed for the early morning or first trip were so infected. No case was 



reported to which milk had been delivered during the second trip, 
either through the restaurant or the Y. M. C. A., or among the foreign- 
bom familiea near Swatara. 

Approximately equal quantities, thirty to thirty-two gallons, we^ 
delivered during each trip but the first trip was for the most part to 
indiridnal families. 

On the other hand, among the first group of cases occurring between 
June 14th and September 24th, nine patients received the bottled 
milk from the Wolf dairy and with the inefKcient method of cleansing, 
it ie possible that the infection might have been transmitted through 
a bottle infection. This assumption would not account for the same 
peculiar distribution of cases noted above and in addition there 
would be the r^note relationship between the group of cases occurring 
over a long period to the relatively lai^er group occurring during 
the mouth of October. 

AH other possible sources of infection for the unusual morbidity 
were excluded from consideration. Only those reasonable to entertain 
are presented. 

It is impossible to give an exact opinion as to the source of infec- 
tion but there is no doubt but that the first group was tra'nsmitted 
through the medium of ice cream handled under insanitary conditions 
by the local dealer and that the second ^oup was transmitted through 
the medium of milk delivered by C. H. Wolf, and the findings of Dr. 
C. R. Phillips, County Medical Insector, are herewith confirmed. 


In accordance with your instructions I studied on October 24, 26 and 
26, 1914 the conditions alleged to he responsible for an outbreak of 
t3rphoid fever in Monessen Borough, Westmoreland County, which 
occurred between August 5th and October J 2th, 1914. 

The relation of the water supplied to the public by the Tri-Cities 
Water Company had been studied during September and October by 
A«8i8ta*nt Engineer C. L. Siebert. His investigations, terminated 
abruptly because of other and urgent work, showed that the public 
water supply was not at fault and indicated that private water sup- 
plies were the principal cause of infection. The public water supplies 
being excluded, other methods of transmission only are considered in 
this report. 


Fifty-nine cases were studied which for the purpose of presenting 
details in relation to more than one source have been divided into 
two groups, the smaller one in the eastern portion of the borough, for 
tor Hie most part in tbe Second Ward, and a larger one in the western 
portion in the First Ward. 
Honessen was organized as a borongh during 1898. The popnlation 

. iD 1900 was 2,197 and in 1910, 11,775, an increase of 436 per cent in 
ten years, and the place is still growing. This rapid growth was dae 
to the establishment of large steel, tin plate, and wire mills, em- 
ploying large numbers of foreign bom males. The number of cases 
of typhoid fever bore no relation to the population except as a measure 

- of excessive morbidly. 

The distribution of popnlation in accordance with nativity at the 
time of the census of 1910 was 

The Slavish, Polish and allied tongues predominate in the languages 
spoken. This is indicated in the nativity of those having ^phoid 

Freucb 3 Ijtbuanlan, 3 

Belgiaii 1 Croatian 2 

German, 1 HungBrian, 3 

Eluoisb 2 Italian 8 

Russian 4 American 3 

Austrian 6 

Slavish, 17 : I ' 

Polish, 10 ' ■ m 

Attention has been previously directed to the aversion which for- 
eigners have for piped water supplies. This characteristic accounts 
for the typhoid outbreak here reported and the distribution according 
to country of origin, as noted in the above table, is in part confinn- 
atory of this view. 

The territorial distribution of cases is not to be accounted for on 
the basis of poblic water or of transmission by flies. When plotted 
on a map of the borough the cases appeared as forming two groaps. 
One of these in the western section was fairly compact, ^e other 
in tbe eastern part contained fewer cases and they were more scat- 

The Eastern group is as a whole less readily accounted for. Foods 
were excluded as none were found which were either common to all 
cases or common to typhoid patients and not to the community as 
a whole. 

Of all other methods of transmission, only contact, milk, and in- 
dividual water supplies remain for consideration. 



The dates of onsets in the Eastern group were : 

AuRUit 2S, 1 September 19, ... 

Septembur 4, 1 October 1, 

September 7, 2 October 2, 

September 12, 1 October 7 

September 15 3 October 11, 

September 18 1 

The onsets wonld indicate a possible transmission b; contact bnt 
this was not verified b; a study of the relation of the patients. Eleven 
premises housed single cases, two housed two cases each. 

Thirteen received milk from seven milk vendors, while two had used 
only milk from their own cows. 

The relation of water is shown in the following: 

Tri-Citiea and various, .' 7 

TrlCltieB Water Co. and well at Ul ThinJ St. ,1 

TrlCitiea Water Co. and well at 120 Seneca St. 1 

Tri-Citiea Water Co. and well on Knoi Ave., 2 


Of those classified as "Tri-Cities and various," three were secondary 
to other cases and three had visited the homes of cases in the Western 
group within the incubation period ; one was not accounted for. 

The analyses of the wells named was as follows for Ihe dates «/ 
collection noted: 

1« Third St. Total Bacteria B. Coll. 

October 3, 4320 o 

October 15, 7B80 

The physical conditions indicated intermittent pollution from privy 
vaults to each well. 

The Western group included forty-four cases, the dates of oUsets 

Aupirt 5, 1 Si^pteuibcr 'il S 

Aiiguit IS 1 Rcpterabei- 2-t 1 

AuBUBt 20 1 September ZH, 3 

September 1, 1 September 26, - 2 

Septemlier 4 1 September 27, 2 

September 5 1 September 28, 1 

September 6 1 September 28, 1 

September 12, 2 October 1 1 

fleptember 13 2 October 2 3 

September 14, 3 October 9, 1 

iiieptember 1.5, 3 October 8 2 

September 18 2 October 10 3 

September 17 1 October 12, 1 

September IS 1 

Of these twenty-eight cases resided on Highland Avenue within 
the limits of one square and ten cases within less than one square 

of that group. njlc 


In tbis district the housing conditions, briefly referred to above, 
were moat marked, contact was promiscoous, and infection in board- 
ing houses by food were probabl; factors in transmiasion. 
Uillc was supplied as follows : 

Nine individual dealers, 9 e 

CoodeoBed only, 8 c 

Own cow or goat, .-. fi o 

Wanco Dairy, U a 

Guerison Dairy, 8 a 

U ciBca. 

The Wanco Dairy was investigated with negative results. In addi- 
tion, all of the fourteen cases using from his milk supply had also 
used well water known to be polluted and in use by other cases, 
while four cases are accounted for as secondary to other cases in the 
same houses. 

The Oueriso'n Dairy may have been responsible for a. small group; 
of the eight cases using the Querison milk, three had used polluted 
water. The onsets of two were prior to infection in the Guerison home 
at 1067 Highland Avenue. 

On Beptember 27 Case No. 30 became sick in the Oaerison house, 
was nursed by Mrs. Guerison who also milked the cows and cooked for 
other boarders. 

Mrs. Mary Querison kept two cows averaging fifteen quarts daUy 
and sold to twenty customers residing on Highland and Morgan 
Avenues between Tenth and Twelfth Streets. Among these five cases 
of the disease developed with onsets between October 5th and l(HJi 

The use of well water is the prominent characteristic for all cases. 
In addition to the supply of the Tri-Cities Water Company, the wells 
at 1021, 1029, 1041, 1045, and 1049 Highland Avenue bad been used 
by twenty-fonr cases, while for twelve cases it was stated that they 
had used water promiscuously from many wells in the neighborhood. 

The analyses of wells at 1029 and 1049 were not made. All of the 
cases, however, which used these wells had also used water from other 
wells in the group studied. The analyses of those in use by all of 
the twenty-four were as follows: 

Total Bacteria. B. Coli. 

lOSl HiEhJnnd Are., October 3 900 37 

1027 Highland Ave., September 30 2230 120 

1041 Highland Ave., Reptember 30, 720 13 

104S Higbland Ave. , September 30, 1080 

Following recommendations made by Engineer Biebert, many wells 
were closed pending bacteriological analysis. The typhoid morbidity 
lessened within the incubation period following this action. 

By request of the Board of Health I met with the members in the 
office of the Secretary, Dr. D. C. Farquhar. The powers and duties 
of a borough Board of Health were discussed and the suggestioDa for 
methods of local application were requested. 



In accordance with your instructiou I proceeded to Swissvale, 
Allegheny County, on October 27 ia order to determine the eau»e of 
the typhoid fever existing in that borough. The preliminary inspec- 
tion had been initiated by Sanitary OlGcer K. M. Souder in charge, 
the field work being perfoimed by Sanitary Inspectors J. D. Mar- 
shall and D. M. Irwin. 

The borough of Swissvale, iriegular in outline, is surrounded to the 
west by Tittsburgh, to the north by the borough of Edgewood and 
Braddock Township, to the east and south by Braddock Township 
and the boroughs of North Braddock and Kankln. The population, 
according to the census of 1910, was 7,831, Since that year there has 
been a relatively small increase but for epidemiological purposes 
this is a negligible factor. 

The Board of Health consists of: Tresideut, T, C. Rankin; Secre- 
tary, M. E. Beyneke; Clyde Campbell; Dr. L. N. Smith; E. H. Was- 
muth; and Health Officer, M. C. Buterbough. The work which was 
performed in the borough was the result of a formal request on the 
part of this Board and the details wei-e carried out in conference 
with them. 

A review of the usual census data follows: 

Water. Water is supplied to the borough by the Pennsylvania 
Water Company. Plana filed in 1914 Indicate that the following 
territory is served by this company, the total consumption averaging 
about eight and one-half million gallons daily: The Twelfth, Thir- 
teenth, and Fourteenth Wards, Pittsburgh City; the boroughs of 
Pitcaim, Wilmerding, North Braddock, Swissvale, Wilkinsburg, 
Turtle Creek, East Piltsburgli, and Edgewood, and the Fourth Ward 
of Braddock; and in addition, all or portions of the following town- 
ships: Wilkins, North Versaille.s, I'atton, Penn. and Braddock. There 
has been no unusual prevalence of typhoid fever throughout the dis- 
tricts mentioned, particularly none coincident with the period of 
the outbreak in Swissvale. All of the persons having typhoid fever in 
Swissvale used the Pennsylvania Water Company supply exclusively. 
By reason of the wide-spread distribution of this water supply with- 
out peculiarities of source of supply in relation to given points of 
distribution, water as a transmitter of infection was excluded from 

Milk: The borough has never adopted ordinances relative to the 
milk snpply- Data relative to the number of vendors and the sources 


of their supplies were not recorded. After an investigation it was 
found that eleven or twelve indiridual vendors or milk companiefl 
distributed daily upwards of two thousand quarts of milk. Of this 
quantity some three hundred and for^ quarts or at least one-sixth 
of the total supply to the borough was delivered by one vendor. 

This vendor, C. H. Beighley, supplied the milk to upwards of three 
hundred and twenty-five families by means of two wagons, each cover- 
ing a separate route. In addition he sold to the following: 

UdIoh Switch and Signal Worlia (employee), 16 to 18 quarla. 

A. A. Redmna, Bakery S quarEs. 

H. A. Riddell, Urofery, 10 quarts. 

ChriBtopher Capo, Groi^ry, 3 quHrts. 

Hamilton Groterj Store 4 quarts. 

lu hia own Store, S to 12 quarts. 

BishoS & BUhotl, oecasioanl aalea, 40 to 80 quarts. 

All the milk except the sepcial supplies just named was bottled 
and was delivered by the two wagons to the following points: 

Swissvale borough, very generally, the routes covering many streets 
in each of the districts. 

Bankin borough, eleven or twelve quarts, for the most part oa 
Milnor and ChartierB Streets. 

Edgewood borough, five quarts, for the most part on Duquesue 
Avenue, Dewey Street, Maple Avenue aud Elm Street- 
Pittsburgh. — Black Hawk, Whipple, aud Homestead Streets. 
C. H. Beighley conducts a grocery store near the centre of the 
borough and is assisted by his daughter and two sons, aged fifteen 
and seventeen years resi»ectively. A son Kalph, aged nineteen years, 
had also assisted up to July 25. Ralph bad typhoid fever during the 
spring of 1906. In addition, Dewey Duquay, Duquesne Street, Swiss- 
vale, had been employed from July 25 to October 18, 1914, There is 
no history of gastro-inteNtinal infectio'n in any one employed since 
July in the dairy service at this store. 

The milk is bottled in the basement of tlie store from a five gallon, 
open-top, spigot tank. On receipt from the sources of supply, the 
shipping cans are placed in a cooler devised for the purpose, the day's 
supply being bottled, with the exceptions noted below, during the 
afternooti and are delivered during the next day. 
The sources of supply have been as follows: • 

James Hood, St. Clair Township, Westmoreland County, who had 
supplied milk for three years, discontinued on account of train service 
on October 4, 1914; J. M. Hood, Rt. Clair Township, Westmoreland 
County, discontinued September IS. 1914. for the same reasoti; D. 
M. Fink, H. F. Berlin. W. H. Bush and J.' J. Fink, all in Penn 
Township. Wostmoreland County ; Harry and Ralph Townsend, Unity 
Township, Westmoreland County; and G. W. Qeiger, Franklin Town- 
ship, Westmoreland County. 


An inapectiou of these souices of supply, with the exception of 
James Hood and J. M. Hood, had been made on October 16 to 20 
inclusive; the results were negative except on the premises of H. F. 
Berlin where a history that Mrs. H, F. Berlin had had typhoid fever 
was obtained.- The millt from the two Hoods being discontinued on 
September Id and October 4 respectively, a new source of supply 
from G. W. Qeiger was contracted for on October 4. 

All of the milk from theee sources of supply was delivered by traiu 
to fiwissvale where it was handled in the following manner: The 
Bnah and Geiger milk was received at 8:29 A. M., was bottled eind, for 
the most part, delivered to the Union Bwitch and Signal Works em- 
ployees. What was left was added to the milk from all other sources 
which was received at 10:15 A, M. The J. J. Pink milk was always set 
to one side in order that the cream might accumulate and be skimmed 
tor salfc This was practically an invariable rule. - 

The milk was bottled in the following manner: 

The surplus from the Bush and tieiger supply and the Townsend 
Brothers supply was bottled first; as the container was emptied, the 
Berlin and Fink supply was added. The bottles were cased in wood^i 
containers and distributed between the two wagons irregularly, no 
choice being made in the selection. 

The important points are that the Hood and, subsequently the 
Bush and Geiger milk was, fox the most part, delivered to the Union 
Bwitch and Signal Works employees in a sufficiently large quantity 
to give rise to the usnal morbidity among its users employed in that 
works, if this milk were at fault; that the Fink milk was used for 
the purpose of securiog cream; and that the handling of milk from 
all other sources was such as to have distributed infection from 
any one source throughout the entire milk route of the two wagons 
in use. 

Of the thirty-two to forty persons using the Hood and subsequently 
the Bush and Qeiger milk at the Union Switch and Signal Works, 
only two (Cases 17 and 25) developed typhoid fever. These received 
bottled milk at home delivered by 0. H. Beighley's wagons. 

If the infection was transmitted by milk it was evidently from 
ttie Townsend, Fink, or Berlin supply. As the only premises on 
which a history of typhoid had been obtained was that of H. F. Berlin, 
a reinvestigation was made by your representative on October 28. 

The dairy farm of H. F. Berlin is located in Penn Township. The 
family consists of Mr. and Mrs. H. F. Berlin, four small children 
and the following employers: Mabel Kemmemer, aged seventeen, 
three years in service, with a negative history; Cal. Geoi^e, aj^ 
unstated, three years in service, negative history; Albert Opela, aged 
nineteen years, was employed during the summer and left the farm 
just before September 7, 1914. Efforts were made to locate lilg. 


employee without results and his history must remain in doubt on- 
less his whereabouts can be learned. G. W., a graduate physidan in 
falling health, had worked for Mr. Berlin for two weeks during the 
latter part of August and first part of September. He waa located 
in his present plaoe of employment at Mrs. Hart's in Export, Penn- 
sylvania. According to a report from the County Iledical Inspector, 
subsequent to the investigation, he is a graduate of the Western Re- 
serve Medical School in 1905 and had typhoid fever in Cleveland in 
1906, since when his health has been impaired. He developed appen- 
dicitis in 1912 and was operated on at the 6t. Francis Hospital in 
Pittsburgh for an abscess prior to that date. Whether or not tiiis 
was a typhoidal abscess could not be learned. He gave a positive 
refusal for specimens of both blood and feces. 

This history of all members of the family and of occasional visitors 
was negative with the exception of Mrs. Berlin, who states that she 
had what was alleged to be typhoid fever during July 1912. During 
her illness she was under the care of Dr. J. F. Sylvis of Harrison 
City. The premises were not placarded and were not disinfected, 
A specimen of blood was obtained on October 28 and forwarded to 
the departmental laboratories. The director reported that the Widal 
test was negative for B. typhosus, B. patatyphosus A, B. paratypJiosus 
B, B. paraeoli, B. dysenttriae, and B. cnteritidis. She agreed to 
ship a specimen of feces to the laboratory; a container was provided 
but the specimen was not received. 

The use of milk by patients in Swissvale is as follows: 

C. H. lloinhtpy and MeKcnley Store, 

C. H. BeiBhlny nnd Snydpr 

C. H. Beighley nud Fredcricli, 

Prederirh and rondenaed, 

M. L. Spott dairy, 

M, T.. Sfo(t dnir.v nnd David Slitphell, 
UcJunkin dairy, 

Twenty-three cases used the Beighley milk alone or (three easel 
in combination. The four who denied using it cannot be accounted 

The dates of onsets of the cases studied were as follows: 

DatPS of OuRPta. 

S"ptpmbpr 7, 2 ScptPiiihcr 'i", 3 

Spptpinber 9, 1 Xptifcmhcr ys j 

SoptpmhcT 19, 3 Scptfmber 30 4 

SpptPinhpr 20 5 Octuhpr I, 2 

September 22, 4 October 10 1 

ov Google 


Assuming that the Berlin milk was tbe sole source of infectloit the 
two groups of dates of onsets are accounted for. The probable carrier 
was Dr. C. W. whose period of employment on the Berlin dairy farm 
was such as to account for incubation periods of two groups of cases. 
The four patients who denied the use of Beigbley milk had onsets 
between September 20 and 30. 

The study of all other possible conditions bearing on the transmis- 
sion of infection by milk gave little in confirmation. The occupation 
of twenty-one (seventy eight per cent.) was distinctly in home rela- 
tions, only six being adult males having work away from home. 

There was an even distribution between tbe two sexes. Nine or 
thirty-three per cent: were under the age showing the greatest sus- 
ceptibility which, taken in consideration with the occupation would 
suggest that the transmitting agent was something used commonly 
in the home rather than abroad. Of such agentE^ water, of course, 
has been excluded. 

A atndy of ice cream demonstrated that fifteen (fifty-five per cent.) 
had not had it within thirty days before illness. Twelve purchased 
from five sources. 

The ice- in use was purchased from dealers who sold nothing but 
manufactured ice. Ten denied the use of ice. None had used oysters 
and only three had had uncooked vegetables and fruit. 

Because of the exclusion of all other possible agents of transmission 
the diagnosis of the source of infection was limited to milk. The 
results of inspection indicate that the product of H. F, Berlin's 
dairy farm in Penn Township, Westmoreland County, was the trans- 
mitter and that one Dr. C, W., now of Export, is a probable typhoid 
carrier. It is possible tliat a small number of the later cases may have 
been secondary cases. 

Details necessary to give a concise opinion, an outline of additional 
administrative measures and recommendations for the adoption of 
milk ordinances were presented to the members of the Board of Health 
on October 28, 1914. 


Concerning the recent outbreak of typhoid fever in Kittanning 
Borough, Armstrong County, I beg to report that a total of eighty- 
nine cases of the disease came under my observation, tie dates of 
onset being as follows: 

Oct. 4 1 Oct. 10, 1 Oct TS ]_ 7 

Ort. T Ort. 12 I Nov. 2 '.'.'.'.'.'.'.. \ 

, Goo'^lc 



Nov. U 3 

Not. IB. 1 

Not. 18 3 

Nov. 17, 4 

Nov. 18, i 

Nov. 18 6 

Nov. 20 2 

Nov. 21 2 

Nov. 22, 3 

Nov. i 

2. 2 



In addition to the above, nine ea&es of the disease in Manor, Ray- 
bum, KittatmiDg, and East Franklin Townships and included in 
my annual report, were traceable to the same Bonree. 

In a further study of the eighty-nine borough cases they were 
found to be quite evenly distributed thronghout the town. 

The age and sex follow, and bear out the usual ratio with tiie excep- 
tion of a slight excess between the ages of five and nine and from 
ten to fourteen years. 



Scbool child, 48 Bnibrr. 

(S^^ntirt Wfini 22) ConI Mibpr. 

(Fourth Ward, 18) Rx)ireiis Ae«nt 

(Hieh Krhool SI F«remnn Brick Plant 

(St, Marys, 3) Class Worker 

House wife, 8 Installer , 

Ijtborer, 7 No ocenpation 

Child 5 Shoemnker ■. 

DomMtlc. 3 Slcnocra|>her 

Potter 3 Trnvpline Snlesmnn ., 

School Tencher, 2 Wuitw. 

(Hirt Rehnol li 

(Fourth Ward 1) Tat:il 80 

CsriH-nter, 2 

The High School building adjoin.^ the Second Ward building iU 
North McKenn Street, and its pupils come from all parts of the town, 
St. Mary's School is located in Xorth Jefferson Street, and likewise 
draws from all parts of the town. 

The death rate in the epidemic was lower than the average mortality 
from this diseafie, but corresponds very closely to the rate in private 



practice to which ail these cases belong. The ag^ sex and day of 
i on which death occurred is given below: 

Ta searching for the cause of the epidemic, the use of ice cream, 
sh^l fish, uncooked yegetables, and other occasional carriers of in- 
fection, was found to be so limited aa to be safely eliminated. 

Ice was used by hut nineteen of the eighty-nine patients. Of these 
Kenuer Brothers had supplied fifteen, the Elk Brewing Company 
three, and the Kittanning Brewing Company one. All these firms 
manufacture their ice from distilled artesian well water. 

The relative frequency among children would naturally direct 
suspicion tojnilk as a causative factor, but a careful inspection of 
the various sources of supply, coupled with the data as to distribution 
given in the following table, fully exonerates it also: 

Foeter Bros., 17 A. Mi^Cullough, 3 

a. M. Walters 14 S Hlsglc 3 

rondensed 10 Georite Cupps, 2 

H. Run, 8 .Tne Fritz 2 

PtMt Rau 7 C. W. Morrow, 2 

Mrs. Bowser, 4 Armstronn Bros., 1 

Nonp 4 W. Dowlins, 1 

M. A. rntDpbeil .1 W. A. Puster 1 

,T. Dodds 3 W. J. Rodgera 1 

Wiu. finllagher, 3 

This brings us up to the etndy of the water supply used by these 
patients for a period of thirty days prior to their illness which was 
fonnd to be: 

City only 30 City and Sli^ridjiu wpU 1 

City and BprioKS, 3 <'ify nnd Nulton spiing, 1 

Pity and school wpUs, 41 Citj' and spriuR at Ford City, 1 

City and Sloan well 1 

The water designated as "City" in the above table is supplied by 
the Armstrong "Water Company and drawn from the Allegheny Kiver. 
Description of the Water Company's plant, borough sewerage system, 
and all engineering factors in connection with the epidemic, will 
be dealt with in the report of Assistant Engineer Parke, who was 
detailed to work in conjunction with this office, so it is unnecessary 
to touch on them here. I might say, however, that the school wells 
are drilled and properly protected, and repeated examination have 
invariably shown them to be free from pollution. 

Two of the early cases included in the foregoing tables were em- 
ployed during the day, for sometime prior to their sickness, at the 


plant of the All^heny River Miaing Company in North Buffalo 
Township, and in common with other employees used water from some 
of the five springs on their property, near the plant. Samples were 
collected from all f\ye of these springs September 27th and again 
on October 15th. Of the first series, one showed the presence of 
colon bacilli, and they were found in three of the samples collected 
on the latter date. 

During the latter part of the first week of November members of 
my household complained about the condition of the water, parti- 
cularly Saturday evening. November 7th, when I was at home for 
dinner. After my return to the office T was about to call up the 
Water Company's office when Mr. H, H. Weylman came in to complain 
about the water and said he understood the filtration plant was out 
of commission. T immediately called the Water Company on the 
telephone and was answered by the bookkeeper. Miss Hague, who after 
Korae hesitation admitted that the filters were shut down, and eaid 
that the superintendent, Mr. Turping, would be in the office in a few 
minutes and she would have him call me. He did not do so, but in 
the course of about twenty minutes presented himself at my office 
and seemefl very much surprised that T should complain about the 
quality of the water as "the river was nice and clear and he did not 
see how the water could possibly be bad." In the course of further 
talk along this line he ndmitte<l the filters had been out of service 
for over a week, (he later fixed the time as beginning October 30th 
and ending \ovcmber HOfh). When I nsbed him why he had not 
notified iis ftlie consumersl of the fact he replied by saying that he 
had mentioned such procedure to the General Superintendent, Mr, 
Walker, when he was heie, and Mr. Walker replied "what the public 
does'nt know won't hurt them." The indifference of Mr. Turping. 
hacked up bv the expressed disregard of his superior for the welfare 
of their patrons, seemed to make further talk on the subject useless, 
hut T took occasion to tell him rather pointedly that their negligence 
irntiJd hu-t the public and probably their company, in the form of an 
eridemic of typhoid fever within the next three or four weeks, and 
su!»!resfed that the make an efl'ort to rectifv their mistake by notify- 
ing the public of the exact condition of affairs at ortre. This he 
promised 1o do. but delnved. doubtless to communicate with his 
snnerior at Rcranton. nnttl tlie followins Wednesday, November 31th, 
when there appeared in the local dailv press this. 



trrniE Wiitpr 
rt nf IN ntni 
<< hfinit tikPT 

■ilinc'th'" ™i 

it nil tlip 
1 tn iiiik> 


V in now rank 
hiil. nnil whi 
■ thr Wiit.T ah 
niifi'-n tlint t\ 
fit Ihr aboTP 

paper in nhniit tpn clnjB. 




After Mr. Turping left mj office Saturday eveniag I called Mr. G. 
K. Leard, Secretary of the local Board of Health, oo the telephone and 
apprised him of the existing conditions, and suggested that the Board 
advise the public of the state of affairs, together with instructions 
for protecting themselves. In this connection it is gratifying to note 
the rapidity with which infections ceased as soon as the public found 
the danger they were in, and were advised of precautions to be 
taken. Prom this time forward I had frequent conferences with the 
members of lite Board of Health and gave them every possible 

On the evening of Decnuber 10th in company with your Associate 
Chief Medical Inspector, I attended a joint meeting of the town 
conncii. Board of Health, burgess, and borough solicitor, when Doctor 
Hunt went over- the situation in detail, basing his ronarks on the 
eigh^-one cases that had been properly tabulated and studied at 
that time. I)r. Hunt remained until Sunday evening, assisting in 
stamping oat the epidemic, and will make special report of his 

That this epidemic was tie direct result of gross n^ligence on the 
part of the officials of the Armstrong Water Company is without a 
doubt in my mind, and their monumental indifference to the health 
and lives of their patrons was shown by their refusing to notify the 
public of the truth so the people might take care of themselves. 


On Saturday morning, ]ffovember 28, I received a telegram from 
your Chief Medical Inspector, directing me to investigate the unusual 
prevalence of typhoid fever in Ford City borough, Armstrong County, 
and immediately proceeded to that place. 

Ford City is a thriving industrial town, laid out by the J. B. Pord 
Glass Company, in 1888, and owned by that corporation and its 
gucceasor, the Pittsburg Plate Glass Company, until 1896, when the 
sale of lots was commenced. It was incorporated as a borough in 
1898, and has a population of about 5,000 people. 

On the west the borough line is formed by the Allegheny River 
for a distance of one and one-half miles. The south, east and north 
lines describe an irregular semi-circle following in the main except 

1 Goot^lc 


on the north an abrupt bluff which rises to about a hundred and eighty 
feet. The northern boundary is a broken line running from the bluff 
to the river, a distance of eighteen hundred feet. 

The Pennsylvania Railroad parallels the Allegheny River at an 
average distance of four hundred feet from its east bank. The im- 
mence works of the Pittsburg Plate Olaes Company, are located 
between the railroad and the river. 

The entire building area of the borough is low bottom-laud having 
been at one time the bed of the river. The extreme eastern portion 
is a swamp, at present obliterated in places by recent fills. It is 
subject to frequent overflows from the river, the worst being in March, 
1913, when the entire town, with the exception of a small area in the 
vicinity of Fourth Avenue and Eleventh St., was inundated. 

At places the water was upwards of twenty feet in depth and 
flooded the second floors of buildings. Immediately after the flood, 
under the direction of this office, a vigorous, systematic, town-wide 
clean-up campaign was inaugurated and carried out so successfully 
that in the succeeding weeks not a single case of illness was traceable 
to the disaster, 

Mr. 8. R. Parke, Jr., Assistant Engineer, having been detailed 
to work in conjunction with this office, a description of the water 
supply and sewerage systems will be made by him in his own re- 

Records of the occurrence of typhoid fever in the borough are only 
available back as far as August 1st, 1912. The record by mout^a 
from that date follows: 

The health officer is an employee of the American Natural Gas Co., 
and by reason of his occupation is personally acquainted with almost 
every resident of the borough. He is al.>!0 quite familiar with condi- 
tions in and about the homes, and the occupation and habits of the 
residents so that he was able to give me a very comprehensive des- 
scription of the situation. In going over the matter with him, 1 
found he had a list of ten cases of typhoid fever recently reported in 
writing by physicians. In addition to these he had a list of twenty- 
four names of persons that had been reported to him verbally by 
various persons as having the disease. He was instructed to see 
that all cases of typhoid fever, and other communicable diseases, 
were reported in writing, as required by law. This instruction he 
carried out promptly. From the information obtained from the health 
officer, suspicion was directed to the nninicipal water supply as the 
cause of the present outbreak of typhoid fever. , , 


The Board of Healtb is constitated as follows : D. H. Houston, Presi- 
dent; William Swigart, Charles Hutchison, John Bower, Dr. D. I, 
Gairth, P. H. McNntt, Secretary; H. E. Piatt, Health Officer. 

On visiting the office of the secretary it was found the board had 
not met since Jolj*25, 1914. At my request a special meeting Vas 
called for that evening which was attended by Messrs. Hutchison, 
Swigart, and Gairth. The secretary and' health officer were also 
present. By reason of the sudden death of a near relative I was 
not able to attend the meeting, but the following suggestions given to 
the secretary and health officer received the favorable consideration 
of the board; That the municipal water supply was the probable 
source of infection; that notice be given the public through the news- 
papers and by hand-bills to boil all water used for domestic purposes; 
to see that all cases of communicable disease were reported in writing 
by the attending physician ; to placard in accordance with the regula- 
tions of the Department of Health and to supply the householders 
with proper literature; to have the sanitary conditions at the various 
homes carefully investigated when placarding and to have defects 
remedied promptly; carefully to supervise the sale of milk in the 
borough; and finally, to hold frequent meetings and inaugurate a 
general clean-up movement. They were also told that a representative 
of the Engineering Division would probably soon be on the ground, 
who would advise them and the borough council in installing at least 
a temporary hypochlorite plant, and regarding such other mattera as 
should be revealed by a further investigation. 

By the time Mr. Parke and two inspectors of the Engineering Di- 
vision arrived the health officer had got in a sufficient number of 
reports so that the work of making a census and study of the individ- 
ual cases could be taken up. This study was based on a total of 
flfty-six cases reported up to and including December 3rd, the dates 
of onset being as follows: 

ScptKmbnr 26 1 N"venil)er * 1 \'-v(-mVr IS 2 

Ortohpr 7 1 Niivembrr 1 X'^'vpi-ibcr 19 2 

OftnbiT 10 1 >)'ivpmber 7 H v-v.-mhir 21 2 

Oetober 13 1 Nitvpinbpr 8 7 Ni.vrnilipr 2,1 1 

Ocroly>r20 1 Nnveml)er 9 2 N ivpmli-r 2i 1 

Ortnher 21 1 NovpinbPr 10, S N'ovrmlipr 2R 1 

OrtPbT 22 I November 11, 1 Mlt-ihIht 27 1 

(Mober 27 1 Novrraber 12 5 N-'vi-mlur 20 1 

Ortoher 30 1 Nfvpmbcr 13, 1 X'-.v-mher rm 1 

Novembfr 1, 3 Novpmher 14 1 ''■"^■mbpr *! 1 

November 3 2 NovemlM-r 17 1 IV'pmbitr 3 1 

The water supply of these patients was found to be derived from 

six different sources and confirmed our suspicion as to the source 

of infection, as indicated by the following summary: 

MnnifiTid dupTiiT in!'- pt 

Miiri-iiinl i.,i„nlv nnH fnimlJiin Bi.riiiir (P. P. G. Oi.) 21 

Unnicipal supply and school well (public), .'.'.'.".' ji 

MunicipHl Bupply Bini well nt Hi R^viith Avp 1 

MiinicipBl h'idpIt Hnd well nt Fnurfh Ave. und Thirteenth St ,,.. ,I 

Municipal supply and Armstrong Water Co., (Kittfltining), ..^ n-CLTOOWlt 


Samples of water were collected November 30th and forwarded 
to the Laboratory of the Department for examination. 

Water troin Public ScLool well, 120 

Water from Founbiin (I'. P. G. Spgl, 4 

Woter from Tap, No. 602— fourth Ave., 144 12 

Water from Tup, No . 501— t ifth Ave . , ISO a> 

Water from Tap, No.' lU3a~Fi«h Ave., 2,500 27 

Water from Tap, No. 1201— Sixth Aie., ? 4JW 16 

The foar tap samples are from the municipal supply. 
The milk supply was found to be derived from twenty-five different 
sources viz; 

Koj Bowser, 11 Dliinont 

Campbell, 9 Augustine, 

HrouftndGk, 5 Rebak, 

1". Iseman, * ('amp 

Own. ijUpply, 4 Trouan, 

Coadeused i Petroaki, 

UnkDoivu 3 Miller 

Mike IJeek 2 Heilmun, 

Mokar, 2 Pei-au 

Po[iehek, 2 None, 

The above sources of supply were all investigated with nc^tlve 

The use of ice, ice cream, shell fish, raw vegetables, etc., by the 
patients prior to their illness was so limited as to eliminate them as 
causative factors. 

A study of the age and sex gave the following interesting data: 

Age. Mule, Female. Total. 

0-4, 4 4 8 

5-9, SOU 

10-14, 2 6 8 

lS-19 2 2 4 

2024 4 3 7 

25-29 7 1 8 

30-34 1 2 3 

S-T-Sa, 1 1 2 


45-49 , 1 1 

50,up, 1 I 

The occupations of the several patients were found to be: 

Puhlie ach.ioJ chiDreii 13 

t'liildren under selinol age 12 

r.tnss workers 8 

Housewives 6 

Ijiborerp, 5 

Sr, Marv's Seho->l 3 

Domestic 3 

fierman Sehrxil 2 

Bridge worker, 1 

Carpenter I 

Clerk, 1 

No ni'eiiiMition, ,' J 

In addition to the fifty-six cases embraced in the forgoing study, 
by calling on the physicians of the town and having them go over their 
visiting lists, I found that they had treated a total of twenty-eight 



cases of intestinal infection of more or less severity but not diagnosed 
as typhoid fever. All were treated during the latter part of October 
and the month of November. All have fully recovered and an invest^a- 
tion of the individual canes was not undertaken, but the physicians 
were advised of the ruling of the Department in reference to reporting 
Paratyphoid to the health oiBcials. 

As you will, no doubt, be advised in the report of the Engineer that 
a tonporary plant for_ the treatment of the water supply was in- 
stalled, I am of the opinion that the citizens will be in constant danger 
of a repetition of what they have juat passed through until tlie water 
system has received a'comjilele overhauling, and the installation of a 
plant constructed along modern lines. 

inspectio:n of typhoid fever in kadnor township, 
delaware copnty. 

In accordance with yonr itistructions received on Novembw 10, 
1914, I made an investigation of typhoid fever in Radnor Townshij*, 
Delaware County, the results of the investigation being as follows: 

John Henry, of Wayne serves about two hundred quarts oi milk in 
St. David's, Wayne, and Mount Pleasant in Montgoniey (bounty. 
He buys his supplies from four dealers, namely; McKinley, Brown, 
Jaquette and I'.sher. There have been four cases of tyjihoid fever 
on his route in Wayne since August 1st. 

Mr. Henry's spring house has a tenant living over it. His whole 
.system is second class and the water analyses made in the Phihidel- 
pbia Clinical Laboratories show that his spring water is grossly 
polluted. His milk is served in bottles but, so far as I can determine, 
bottles were not removed from typhoid infected bouses. 

Of the sources of supply, Mr. McKinley has an antiquated spring 
cave. The water for his house, which also passes into this cav^ 
comes from a spring located on the premises of Mr. French, half a 
mile away. This water is allowed to flow in and out of the cave and 
into it floWB the drainage from the kitclien which is emptied on the 
surface of the ground. It ia true that this has no bearing on the 

Mr, Brown's dairy farm was entirely negative from examination. 




Mr. Jaquett'a farm was not investigated by me as it had already 
been investigated by Dr. C. W, Lincoln, with liegative results. 

Mr. Usher lives near King of Prussia Id Montgomery Connty. His 
field is traversed by Martin's Dam stream and somewhere along the 
stream a run is taken off in order to bring the water down to his 
kitchen door and also to a small dam or pond near the house in which 
he operates a ram. The water is raised by the ram into the house of 
Mr. Rahn, which in probably all a matter of record since there are 
now five cases of. typhoid fever in this house of abont a month's 
standing, under the care of Dr. Miller of Wayne ■ 

At the Usher house they have a cave with a sink and at one 
time this Martin's Dam Kun supplied water for cooling purposes. At 
tiie time of my visit it was stated that they used water from the pump. 
This pump water comes from a deep well some twenty feet from the 
side of the stream. The stream, running by the door yard is much 
more convenient than any pump and on two occasions of which we 
have record, the farm boy was seen washing his bands there and this 
is probably a frequent occurrence. 

I understand that one of the engineers of the Department made 
an investigation of the pollutions of the Martin's Dam stream. 

The outbreak at Wayne had been only an occasional infection aa 
the four cases extend over a period of almost as many months. Th^ 
are in no way contact cases and are all on Henry's milk route. There 
are no other cases along any other route in Radnor Township. With 
the occurrence of five almost simultaneous cases in the family of Mr. 
Rahn who use the stream water from the front of Mr, Usher's house, 
with the possibility of cattle wading in this susjiected stream, with 
farm hands washing their bauds in the stream and imperfectly drying 
them before going to the stable to milk, as I saw yesterday I think 
we can believe that the transmission came from this source. 

I have required the following reffulationa to be observed : All cans, 
straiuers, cloths, buckets must be boiled and nothing but boiled 
water is to enter any of the,se containers. I have also required that 
Mr. Usher use boiled water at the barn with which to wash the cows* 
udders aiid the milkmen's hands. Mr. Henry has promised to put 
in a bottle sterilizer, but this, of course, would not help much with 
the milk polluted at the source. 

I believe a thorough investigation should be made of lie Martin 
Dam stream through the Engineering Division. A report of previous 
inspections showed the presence of two pollntions on this water-shed, 
both of which were ordered abated. 



On November 16th I received your reply stating the following: 

"Your r^poit TOinrUI-s with n rpfiort made by Dr. Wbitcomb reldtivp 
to an iuvpstisotion at Kins oE Prussia on account of typboid fever 
occurring iu a family wtr:-. draiD;ige runs direetlj- into Mnmns 
The mnrttr oC ftirther iiivontipitioD and correction of dtainacfl into 
Martin's Dura atwani h.^s hK.:D referred to the Chief Lngineer for biF 
inimcdiite action." 

Pour months later, Dr. Lincoln reported tbat they had no other 
cases of typhoid fever in Radnor Township. 


On September 4th I received instructionB from your office stating 
that Agnes and Harry E!och had been sent from Drexel Heights, 
Upper Darby Township, to the Presbyterian Hospital, Philadelphia, 
on August 3l8t, suffering with typhoid fever. Upper Darby is a 
first class township, the Secretary of the Board of Health being 
■William Pendlebury. 

On September 8th I reported the results of my first inspection, 
stating that I had found five unplacarded cases of typhoid fever, one 
of which lived in a spring house on the dairy farm of Mr, Burnley, 
a local milkman. At the time of the inspection this patient had been 
removed to the home of his mother on Clifton Heights. 

A recapitulation of the cases is as follows: 

Mrs, Agnes Koch was sent to the Presbyterian Hospital on August 
Slst, followed in a day or two by her son Harry, and later by her 
sister, Mrs. Ella Kunkle. Previous to this, Jessie Warren, aged eight 
years, at the time living at the home of her grandfather, Mr. Huhn, 
but who had been visiting back and forth between points in New 
Jersey and Drexel Heights, had been ill, being I believe the first case 
of typhoid fever among those studied. Her illness was followed in 
a short time by that of the Koch family living across the street. The 
last case was that of Howard Burnley, aged thirty years, milkman, 
who was removed from the spring house meutioned above to the 
home of his mother oB Diamond Street, Clifton. Mr. Burnley at one 
time served all these people with milk but I was informed by Mr. 
Hahn that he had not served them for three weeks; and Mr. Burnley 
informed me that he had not served Mr. Huhn for six weeks. I do 
not know which is correct 

I, Coogic 


Mr. Buruley also served milk ia bottles and had recraitl; been 
serving a Mrs. Jarvis "wlio was ill with typhoid fever at the time. 
From all of the inv^tigations made it would seem that he could 
easily have got his bottles infected both there and at the Warren pr^n- 
Ises, because he had served milk in bott)es at both premises. He 
handles about two hundred quarts of milk a day. If his general 
milk supply had been infected he would in all probability have had 
a great many more cases on his route. No other local sourfe of infec- 
tion could be found. 

On October 1st I received from you a letter written by the secretary 
of the Board of Health for Upper Darby Township reading as fol- 

"During the lout two op throe weeks there nppennt to be dome kind of 
nn cpidrmif of typhoid in Unptr Hiirby Township in the Urexel Hill 
dictrict chiefiy, aiid up to this writing, we have been unable to locate 
the source. 

"Somp of tbp pnnems havp hppn sent nway to the hospital. I hnvc 
been authorized by tbia Board if you could poaaibly help ua out in this, 
or siiftgeat sonietbinK or some pl:iD we miicht be nble to follow out, oi' 
send nn expert tt> the district wp would npprei'inte it very muph, 

"Tery few of these cBBea have been reported to db by the doctors In 
chitrKC,. but hiive bpen reiiorti'd by the citizens vcrboUy. We are of 
the opinion that tlie doctorn in chilrgc nre in n great measure to blunie 
for not reporting tliPHp ciisps in writing immedintely nfCer bpiiig called on 
any case. Our Heiilth Offit'Cr is doing nil ho eiiu to trace the cause of the 
disease. We, therpfore. await your advipf in the mnttpr." 

On October 2nd I made a report on the situation as it had de- 
veloped to that date, and have quoted it in part below. There were 
ten cases in Brexel Hill as follows: 

"Henry W, Koch, sent to n Philiidelphia Hospital (Prpsh.vtorinn) ; Hairy Koch, 
n son of thp nbovp. r.!so in n Pl.ilrid"1n1.i,i TTosniUI: Kiln Kniiklp. n sistcP of M«. 

Koch, also in a Philadelphia Hospital; Jessie Wart«n, Kntnd-dnughter of Hr. 

Hulin, »t hix home in D.i-.'sel Hill: Hownrd Rnpnlpy. removi-d to tli- home of his 
mother in Clifton: Miss Cannon, now in n Philndelnhin Hospitnl (Presbvtprinnl : 
Arthur Milipr, sis ypiirs. now in the Women's CoUpep H™pitnl (Philadplphia) : 
Jack Hower. b child, .^t the home of his p.'irpnt:-. IJrpvel Hill: Mr. l.irhtfoot. at 
the Mpdico Chirurgicnl Flospital, Philiidelphin ; Mrs. Arthur Qarret, at her home 
in Drexel Hill. 

"I also wiHh to reconJ the cnsc of Miss Jarvis. of I.nnsdownc. who mnv also be 
a factor in th» DreiPl HH! outbreak, since stie Wiih also sei-vi-d with milk by Mr 
Bumlpy. of Drexol Hill." 

Suspected Sources of Infection from Data Accumulated. 
First. Water. Water is supplied by the Springfield Water Com- 
pany. This is under the constant surveillance of the State Depart- 
ment of Health and covers so large a territory that the distribution 
of water alone would exclude it from suspicion as the means of trans- 
mission. Samples of water from the spigots in the infected homes, 
aa well as from the spring, the run, and the ice pond at Burnley's 
should be examined for B. coli. There were twelve dead ends on the 
water supply but the water analyzed from the spigots in each of the 
eleven infected houses shoned a moderately low bacterial count with 
no B. coli. The examination of the water supply about Mr. BamIli{y'B 
dairy farm, made on two different dates, showed the following: 



October 20. November 2. 

Bnclcria B.CuU Bactf^rin li.Coli 

Upper spring, 61 2 11 t 

Miik bouse 44,280 144 

Pond, 1,200 780 30 

Lower spriag 112 20 

KuQ beluw Bpring 1,500 13 3,5a) 9 

HuuM supply, weU 26 4 

The ground below this Bpring was connected with a branch which 
drained the springy ground near the post office. 

Second. The Milk Supply. There are three milkmen who served 
most of the inhabitants: — Woolman, who serves pasteurized milk; 
George Burnley, who serves to about fifty customers in Drexel Hill, 
and to an indeterminate number of persons in Lansdowne ; and finally, 
Qeoi^ Qaul, who serves about fifty quarts in Bresel Hill, about one 
hundred quarts to Burn Brae and tiie remainder of bis daily output 
to the McKisseck Brothers at Yeadon, 

TMrd. Ice Cream. The local dealer, Mr. Slack, purchases all of 
his supply in Philadelphia. He also takes from five to ten quarts 
daily from Mr. Burnley for housdiold and "milk shake" ase, while 
the local druggist uses as much as fifteen quarts of Ur. Burnley's milk 
in making miik shakes. It does not appear that these patients had 
been infected by drinking milk shakes and cases did not occur in the 
families of Mr, Slack or the druggist. 

Fourth. Sewage Disposal. There are no sewers in this part of the 
township. There is complaint that some of the people are careless 
about emptying their cesspools when they are filled. There were 
recently some instances of overflowing cesspools and of the use of 
the contents for fertilizing purposes, principally on gardens and 
shrubbery. This was admitted on one premises. It does not seem, 
however, credible to me that the occasional use of this material on a 
private garden or lawn could have caused the outbreak. The cess- 
pools in the immediate neighborhood should be inspected and those 
overflowing should be emptied and all parties warned against tbe 
use of night soil as a fertilizer. 

I quote from a report on the cesspools to show how easily the run, 
based on facta referred to above, and which travels through Mr. 
Bumley'a meadow, could become infected with sewage: "I learned 
yesterday that Upper Darby has made one attempt and is now abont 
to make another attempt at tbe coming election to vote upon the ques- 
tion of sewers, but if they do not succeed in getting a sevage system 
for Drexel Hill at the November election, th^ will need some more 
practical method of handling their sewage than they have at present. 
All this hill top ia so constituted that when the ground is thoroughly 
Roaked, the cesspools become active wells and some of them overflow. 
Tn other words, there are not any tight cesspools in this neighborhood, 
so far as I can ascertain by inquiry. This is the explanation of the 

reports concerning the overflowing cesspools." 



I have instructed Mr. BUrDley that he most make other tha'n the 
present arrangements for the handling of his milli and have BUggested 
that the local authorities close his spring house pending further in- 
vestigations by that body. It is not likely that the milkmen at Bum- 
1^'s are carriers as they have acted in that capacity for many years 
without being under suspicion. 

The Lansdowne Board of Health has stopped the sale of Mr. 
Burnley's milk, there being three cases of typhoid fever in tliat 
borough. He now sells his milk In bulk to a pasteurizing firm in 
Philadelphia, bat has conformed to the regulations imposed, paiding 
fnrtber investigations. 

On November 4th I made a final report of this outbreak, the sub- 
stance of which ia as follows: 

"With the data we have collected we feel we are justified in r^ard- 
ing Hr. Burnley's milk supply as being the source of transmission and 
the sale of bis milk has been stopped both in Lansdowne Borongh 
and in Upper Darby Township. The date of the last ease of which 
we have knowledge was September 21st, and in view of these facts, 
we feel that the epidemic is under control so far as the ori^nal source 
of infection is concerned. 

Mr. Burnley has been given permission to renew the sale of his 
milk under conditions which we think will saf^^ard the consumers, 
namely, that hia milk must be cooled at the spring house whidi fae 
has erected at a new spring called the "lower spring," and that 
his cans must be washed and scalded at the farm house; that under 
no conditions is he to use the old spring or bouse until the water 
analyses establish the fact that the water is free from pollution, and 
that his cattle must be kept from the field in which the ice pond and 
the run are situated until the questions of pollution are finally de- 
termined and the necessary action taken; that he must sell his milk 
in bulk unless he will install a sterilizer by which his bottles can be 
made sterile. He proposes to clean the ice pond and admit water 
to it through pipes to come only from his new spring house. The 
spring house above the road is to be cleaned and the sewage from 
the village will be prevented from entering the run at points above. 
The old spring house at the present time is unoccupied, but as it is 
a large house it will doubtless soon be occupied by tenants. It, 
therefore, remains not only a source of danger to the individual 
tenant but also to the dairy farms along the course of this atreama 

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In accordance with yoar instructions I proceeded, accompanied by 
Dr. J. William Wood, Deputy Cotinty Medical Inspector, to Glen 
Mills, Thornbury Township, Delaware County, on November 20th, 
in order to investigate the continued occurrence of diphtheria in 
the boys' department of 'The Glen Mills Schools." Previous in- 
TOstLgations between the dates of October 9th and November 15tb 
had been made by Dr. Wood, and, at his suggestion, the County 
Medical Inspector, Dr. H. M. Hiller, had requested that additional 
investigations be made. 

The, boys' department is a training school for the care of boys be- 
tween six and sixteen years of age who may be committed by the 
Juvenile Division of the Quarter Sessions Court from districts in 
the eastern part of the Commonwealth of Pennsylvania. At present 
there are seven hundred and twenty-five boys on the enrollment, the 
average age being fourteen years. The administration is based upon 
a military system, adapted to the purposes of a specialized training. 

To this end the distribution for housing and instruction is conducted 
on the family plan, each family having an average membership of from 
forty to sixty boys. The families numbered from one to fourteen are 
domiciled in twin cottages ; those numbered fifteen and seventeen are 
housed in separate cottages. The general domestic and social conduct 
of each family is separate and distinct, even play grounds for each 
family being provided. 

The common points of contact by means of which disease may have 
been transmitted in this instance were in the school rooms, during 
assembly for "detail" and, to a less extent, in work. Transmission 
by means other than contact was limited to the milk supply, which 
was common to all of the cottages, and to the misuse of water spigots 
in ibe school building. 

The attendance at schools is by grades and hours, school being 
constantly in session from 7:30 to 11:15 A. M. and from 1:15 to 
5 P. M. In the basement of the school an assembly is held three times 
each day for assignment to "detail." At this time there is an op- 
portunity for contact of a more intimate nature and the distribution 
of infection could be accounted for in part by such gatherings. "De- 
tail" takes about ten minutes, the boys being in family formation. 
As family assignments are not based on age, the school detail for each 
room includes boys from more than one family; in like fashion the 
details for shop, house, or farm service include hoys from each family. 



The contact in the shop and farm service was probably a negligible 
factor in transmission except in relation to dairy work. The hoase 
service gave opportunity for transmission both by contact and by 
food aa a medium. 

Attendance at chapel is daily and by families. Very little contact 
conld occur during this period. 

In the school building, the common drinking cups at the various 
spigots had been lost and a boy obtained water only by putting his 
lips over the spigot at the time of drinking. This has been a constant 
practice for an indefinite period. 

An important factor was the occurrence of undiagnosed diphtheria. 
A record of all cases of inflammatory' disease of the nose and throat 
under observation from October 1st to the date of investigation was 
studied. The dates of onsets of cases diagnosed as pharyngitis or 
tonsillitis and of those diagnosed as diphtheria' are noted in the 
following table: 


Onufl of milk bnj. 

In addition to a hospital, a "sick call' service is maintained under 
the direction of the Resident Physician, Dr. I, P. P. Hollingsvorth, 
with the assistance of two nurses. A portion of the work is performed 
by the head nurse at a ilxed honr each day. The minor treatment 
necessary for the average case is administered by her, the diagnosis 


and treatment of special cases coining to the attention of tlie BesideDt 
Flijslcian. 80 it occurred that the many cases of "sore throat" in 
the dispensary records were not studied by this officer. 

Most of the cases placed under quarantine were mild and recovered 
promptly after receiving; relatively small doses of antitoxin. All casee 
in isolation on the date of my investigation were convalescent. There 
had been but one death, a fatality of 5.9 per cent. This alone would 
seem to indicate the degree of virulence and one would expect many 
minor cases of nasopharyngeal inflammation "without distinctive 

After carefully reviewing all the features of this occurrence of diph- 
theria, it seemed justifiable to assume that many of the cases diag- 
nosed as "sore throat," tonsUlitis, pharyugitis, and "cold" were in 
reality mild expressions of an infection by B. diphtheriae. No attempt 
is made in the table forming a portion of this report to exclude cases 
which were probably not diphtheria. 

It is noted that the first case of diphtheria was reported on October 
1st The record of cases of "sore throat" prior to that time bad not 
been noted althoagh the school was in continuous session. Between 
September 21st and October 1st, there had been eighteen admissions 
from many points in the eastern district of Pennsylvania. It did not 
aeem practicable at the time of the investigation to attempt the 
diagnosis of carriers who had arrived prior to the onset of the first 

Milk. Owing to the peculiarities of daily contact, a factor leading 
to general dissemination did not occur until after the onset of October 
11th of a boy whose daily work was in the dairy. Within ten to twelve 
days after the onset of his iUness came the onsets of the larger 

This patient, reported in the Dispensary on October 11th as having 
a sore throat, was studied by Dr. Hpllingsworth on October 30th 
among others on the dispensary list. A culture made on this date 
from a serious nasal discharge showed the presence of B. diphtheriae. 

During the inter^'al he had continued in his employment, milking 
cows each day. Then census data show that every person included in 
Table 1 had used milk, either as a beverage or on breakfast foods. 
The school maintains its own dairy farm. 

School Contact. The distribution in relation to school attendance 
is indicated in the following: 

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TABLE II.—CoDtmued. 

A. M.IT. I) I'. M.IT. 1! 

f D. i iD.a 

'(d'.o ' 'lu'.t 

A. «,JT. 1 p. M.(T, i, 

t D. J I If. I 

A. M.IT. a P. M.JT. I, 

ID. 1 |I>. 1 

A. M.IT. I P. M.IT. » .^ 

ID. B (D. I 


A. M.tT. p. M.IT. ). 

I D. 1 1 U. 1 

A. M.1T. 2 P. M.IT. 1, 

ID. e ID. I 

'iD.e ' id'.i 

A. M.jT.O P.M.jT,*, 

A. M.TT. S P. M.IT. t. 

JD. ID. « 

A. M.iT. 1 P. M.fT. *. 

Id. a ID. 1 

A. M,1T.» P.M.1T.1 

) D. 1 I D. 

Bach boy attended school during either morning or afternoon on!;. 
The giades are arranged as In the Commonwealth's Public School 
System. It is apparent from the ditttribution as shown that contact 
in school was relatively unimportant. 

Family Contact. The possible transmission Within the family life 
is indicated in the morbidity noted in each cottage. 


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It IB possible that a few secondnrj eaaee were infected by sach. 
contact. Its importance is negatived b; a study of the onsets in 
relation to each family's morbidity. 


It is possible that all cases in Family 7 resulted from the case 
reported as tonsillitis on October 20th, that all in Family 8 resulted 
from the case reported as diphtheria on October 3rd and i^ the other 
families the sequence may have been similar. But the character of 
tile curve of onsets, when the total number is charted, indicates an 
epidemiological factor more general in its relation and a shorter time 
period when contrasted with inter-family means of transmission. 

ConchttUma: The outbreak came in all probability as the result of 
contact from an as yet undiscovered case with a mild infection or 
a carrier; the first group of thirteen cases occurred between October 
let and 13th inclosive; of these, one was a dairy boy, onset October 
11th, who disseminated the virus by means of milk to a larger group, 
the members of which had onsets between October 23rd and November 
16th ioclusiye. No doubt direct contact was responsible for a few 
cases and, at least, two subsidiary factors played a smaller part; two 
of these were the illness of a cook (diagnosis, diphtheria) in Family 
3, onset October 16th; and the gymnasium instructor (diagnosis, 
diphtheria) undiagnosed and untreated for three days, onset October 

Diicuision: The occurrence of outbreaks of communicable disease 
in this and similar institutions is altogether preventable. It has not 
been proven in this instance that diphtheria was introduced by means 
of a boy committed while ill, but the exclusion of all other avenues 
open to investigation would strongly indicate such introduction. 

Isolation of new arrivals during a period of incubation for the 
various communicable diseases has not been practised; a laboratory 
for the Resident Physician has not been provided; the hospital 
consists of a portion of one building, bonsing Families 13 and 14, 


with convertible rooms od the other "floor for isolation of existing 
cases of commanicable disease. Isolation of contacts with new cases 
has not been provided for. 

Fortunately, appropriations for the construction and equipment 
of a separate hospital building were made and the building is now 
nearing completion. Adequate laboratory equipment and provisions 
for the isolation of new arrivals are included. 

The school house spigots were inverted, converting them into bub- 
bling fountains; disinfection was carried out in detail ; the Resident 
Physician inspected every boy and took cultures from all with a 
suspicious history or any discharge. 

Dr. F. H. Nibecker, Superintendent, and Pr. I. P. P. HolUngswort}i, 
Resident Physician, expressed their appreciation and in every way 
cooperated toward eliminating the sources of infection. 


In accordance with your instructions I have made a reinvestiga- 
tion relative to the continued pi-evalence of diphtheria in the city 
of Allentown, Lehigh County. This work was begun on November 
24, 1914. 

The city of Allentown adopted the Commission form of government 
during 1913, the new goi'ernment becoming operative on January 1, 
1014. The personnel of the executive staff in the Bureau of Health. 
Department of Public Safety, remains, however, the same as under 
the Board of Health during the investigation of November, 1912. 

The reasons for a new investigation on this occasion were the same 
as in 1912. The record of cases, from January, 1909 to the date of 
investigation, based upon the dates of reports to the Allentown 
authorities, is as follows: 



The 265 caEses reported between January 1st and November 24tli, 
1914^ inclusive, were studied iu relation to general methods of trans- 
mission. It is, of course, obvious that iiner details in which a tem- 
porary, accidental factor was responsible could not be studied since 
a census of particular relations was not to be obtained. The broader 
picture would seem, however, to be of more value, since the disease 
baa been continuously prevalent for at least Kix years, 

It appears in Table I that the highest morbidity occurred during 
the months of October and November altbougti it continued- at a 
relatively high rate during December, January and February. A 
general reduction occurred during March with no noteworthy in- 
creases until September. This conforms to the State Statistics on 
diphlheria morbidity. 

The age and sex of the 1914 c 

s follow ; 

In contrast with urban morbidity rates at various age periods 
for the entire State, several sugg^itive variations may be noted; first, 
the proportion of the number under school age to the number in school 
attendance is increased and suggests that school was relatively a 
less important factor in transmission; second, the unusually high 
morbidity of adults suggests the importance of home transmission. 
This is emphasized by the increased ratio of females to males, over 
three-fourths of all cases orer nchnol age. being females. Of the total, 
149 or fifty-six per rent- were in domestic relation as contrasted with 
school and the few other relations. 



The occupations of all cases confirm these fiodiDga : 


HeOKwire. ' 

School attendance la required from the first week of Septemba* to 
June 25th. 

The distribution of cases by wards and months of occurrence, as 
corrected, shows how general the distribution was thoug^ont the 




















Ezaminatlou of the table shows that exceptionally large numbers 
in any one month occurred but three times, viz: January in the Tenth 
Ward, 10 cases; November in the Eighth Ward, 18 cases; November 
in the Twelfth. Ward, 15 cases. 

The factors operative in these three excesses were probably domestic 
in the Tenth Ward and school in the Eighth and Twelfth Wards. 
This is suggested in the following table which outlines the distribntion 
by wards, school, and time of actual occurrence, showing, in addi- 
tion, the Illation of school cases to enrollment. 

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2 1 I ? ^ '^ s i 5 I il i :\n 

With tbe exception of the Jefferson School Groap daring November, 
the diBtribntion of the Bchool cases is so general that school children 
were obviously infected for the most part in relations other than con- 
tact in school. 

The daily inspection service (outlined in the Report of 1912) has 
been increased in efficiency through the interest and activity of the 
Board of School Directors and the School Medical Inspectors, Drg, 
Thomas A. Weaber and Frank Boyer. As the result of careful in- 
vestigation of the promptness in excluding cases and contacts and 
the active administrative measures, it is possible to state that factors 
other than school contact must have been responsible for the unnsual 
prevalence of diphtheria. 

The distribntion of cases in relation to Sunday School and Church 
attendance could not be obtained except by special census. 



A census of all cases was collected by the Sanitary Inepectora at 
the time of placarding. Prom this the source of milk supply was 
compiled and tabulated. 

Millt from Beventvonp separate sources 2Sn cohpb 

MUk from unstated sources, 18 cases 

Milk coDdCQSeil, 8 cases 

The largest number of cases on any route was twenty-eight of which 
twenty-four occurred during the following months: 

August 4 caMH 

Septi'mbar, 4 coaea 

October 10 casei 

November, 6 case* 

The dealer in question is one having the largest number of patrons ; 
the cases on his route were, for the most part, in two wards but the 
distribution did not conform to careless methods in delivery. 

A study of the distribution of diphtheria in relation to the density 
of population was based on the «rea and population of each ward, 
recent increases being worked out on data furnished by the City 
Engineer, Charles T>. Weirbach. The ward density is contrasted 
with the cases reported in each ward fusing the average city density 
as one hundred) and expressing numerically the relation between the 
various ward densities. The average city density of one hundred and 
the average number of cases in each ward of twenty show an average 
relation of one to five. 


Wnrd Popiilntion Ward PniHiiy No. of Cn-WB. 

1 4,125 m 30 

S n,822 138 11 

.1 .1,^»H ■ 111 21 

4 2,531 183 7 

5 2.1.W ITJ 8 

B. .■>.077 m IS 

7 a..^l5fi Iflb IS 

8 7.lrt8 m M 

n 4.3r,o 17.1 12 

10 7,230 1-12 38 

11 4,iiii7 :n IS 

12 1.874 U 27 

13 1,8.'57 S5 B 

14, 2,5i«) Ifl 16 

If is readily observwl that a consistent ratio between the ward 
density, ward population, and morbidity does not exist. In other 
words, crowdinc was not a factor appreciably contributing to the 
continued prevalence of the disease. 

In the local administration certain features essential to control 
in a large citr were not operative. Reporting by local physicians was 

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considered to be as prompt as possibla The reports of many cases 
were delayed because physicians were called in consultation at varying 
dates af tei" the onset. 

Tonsillitis, "sore throat," and many other inflammatory lesions 
of the upper respiratory tract were considered to be very common, 
and it is the belief of the City Health Officer and of other physicians 
consulted that cases of diphtheria without distinct membrane are 
not reported. 

The Bureau of Health does not study contacts nor does it keep 
them under observation, and it is not customary to inspect contacts 
in quarantined premises prior to release. Notice is given to the 
poblic and parochial schools and to libraries of all reported cases, 
but not to superintendents of Sunday Schools. 

Prior to November 1, 1914, the physicians were without a free 
laboratory service, and but few cases were studied bacteriologically. 
Modified quarantine was always established and disinfection at the 
end of twenty-one days was performed by one of the methods of 
using solidified formaldehyde. At the time of placarding, a circular 
of "Information for Quarantined Families" was handed to the family. 

It is believed that the rules were not observed but no investigations 
were made except in those instances in which sufficiently credible 
evidence was first offered. Schools were closed long enough for the 
purpose of disinfection but not long enough to cover incubation of 
the disease in contacts. The exclusion of the latter was carried out 
to a limited extent through School Medical Inspection service. 

It is apparent that the usual channels of transmission were not 
responsible for the prevalence of disease in Allentown but that weak- 
ness of administration contiibuted to a certain extent; the direct 
results were violations of quarantine regulations. Transmission from 
persons with undiagnosed mild infection probably played an im- 
portant but secondary part. The fi'udings detailed in the report of 
1912 were operative in November, 1914. 

The following suggestions were made to the Secretary, City Health 
Officer, and Sanitary Inspectors: 

That notices for exclusion be sent to Sunday School authorities. 

That inspection of all contacts in quarantined premises be made 
prior to release. 

That the morbidity from mild inflammatory lesions of the upper 
respiratory tract be noted by conference with physicians. 

That a circular letter be issued to physicians relative to the pre- 
valence of undiagnosed mild cases. 

That the laboratory service be extended as rapidly as possible. At 
the time of investigation only a few cultures from the private practice 

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of a few physicians had been studied. The adTertisemeDt of tiie 
laboratoi7 and its use for tbe Burean of Health administration was 

That, in the event of any violation of the provisions of mo'dified 
quarantine, its privil^es should be witiidrawn and absolute quaran- 
tine be enforced. 


Pursuant to your instmctions I proceeded to Donora, Wadiington 
Coun^, on October 23rd in order to comply with a request for an 
InvestigatioD as to the causes underlying the continuance of scarlet 
fever in that boroogh, 

Donora is one of the more rapidly growing mill towns of the 
MonoDgahela Valley district, the population in 1910 being 8,174; 
it probably exceeds 10,000 at the present time. There is no basis 
for a comparison in estimating the present population as the borough 
was organized subsequent to 1900. Approximately fourflfth^ 
of the population are foreign-born or the immediate offspring of 
foreign-born parents. 

The cases studied were those which have occarred since January 
1, 1914, and constitute two groups. The first group of six cases, 
occurring between January 1st and January 20th, was quickly elim- 
inated by the prompt action of the local Board of Health. The second 
group of a hnndred and seventy-four cases began with a case reported 
on April 20th, the date of onset being April ISth. The origin of this 
case remains in doubt, but the clinical history of many cases and the 
findings subsequent to the inspection here reported seem to indicate 
that the disease had been prevalent in a mild form during the months 
from April to the date of my investigation. 

The dates of onsets are important as showing the constant occur- 
rence of new cases despite the active measures tsken by the local 
Board of Health. 

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Jan. Fvb. Mcta. Apr. Mar. June. ImIj. Ang. Bvpt. •Oci 

Two factors of importance are noted in the above tables: first, 
the predominant age affected was under six years, and second, the 
highest morbidity was during the summer mouths. 

The age and sex of all cases were as follows: 


As already noted, fifty-one per cent, were under six years of age. 

No other noteworthy feature ia indicated except the slight excess 
morbidity of females, which, in connection with other factors, led 
to the formation of an epidemilogical opinion. 

Because of the time of occurrence, and to a less extent, the pre- 
dominant age in relation to the morbidity, the usual avenues of trans- 
mission were apparently not largdy responsible. 

Direct contact only was considered the method by meana of which 
.^e prevalence was broadly to be stndied. For this reason inanimate 
objects such as food stuffs and fomites, though included in the in- 
vestigation, are not detailed in thia report. Indeed, except in a few 
isolated instances, no method except direct contact could be dis- 

The nsnal probable avenue in school and particularly during cold 
weather was notably absent. The schools were closed about May 15th ; 
the greatest number of cases for that month were reported after that 
data They were reopened the first of September. 

It ifi evident that the majority of the casea occurred during a period 
when schools were closed. The distribution of those attending the 
Allen School after the reopening of achools was studied and will 
be mentioned lat^. 

To Octobtr ard lacInlT*. 



There are four school buitdi'Dgs known respectively aa the First 
Street (in which is located the superintendent's office), the Allen, 
the Fifth Street, and tlie Van Castner Schools. 

A local census shows 2,507 school children in the borough between 
six and sixteen years while the average attendance at the public 
schools is two thousand and in the Parochial Schools abont three 
hundred; the latter are St. Joseph's (Foli^) and St Charles Paro- 
chial Schools. Seventy per cent, of the children in both public and 
parochial schools are the oEfspring of foreign born parents. 

In confei-ence with Mr. Edgar E. Reed, Superintendent of Public 
Schools he stated that he received all reports from the Health Officer 
and notified teachers by posting a notice on the bulletin board of the 
school. The Health Officer's notification was both by telephone and 
in writing. 

Medical inspection of schools has never been adopted by the borough 
nor does the school board employ a physician for inspection pur- 

After receiving the Health Officer's notification, the particular 
school is dismissed, the room is disinfected by the borough Health 
Officer, and is usually reopened on the first school day following 
the disappearance of the gas. 

The patient is not permitted to return to school until a written 
release is received from the Health Officer for both patient and 
contacts in the. same family at the end of the quarantine period. 

Cotitacts in school are not determined, hence isolation during 
possible incubation periods is not practised. 

Pencils are individual but are collected at night in a special rack 
in which they are more or less in contact. All of the material used 
in the kindergarten work and in tlie primary grade is common to all 
the children in the grade. Individual seats are in use in every 

During tie week of my investigation, there were twenty-four absent 
from school, of which seventeen suffered with severe attacks of acute 
tonsillo-pharyngitia. Skin lesions were not found. As some of these 
occurred in families previously quarantined because of scarlet fever, 
it seems to be indicated that mild, undiagnosed scarlet fever was 
unusually prevalent. 

Studies of the cases occurring in the Allen School, after tiie re- 
opening of the public schools, showed that while two cases had been in 
attendance at school after the development of scarlet fever, they conld 
not, according to the dates of onsets of the cases, have been responsible 
for the infection of the entire group. No discoverable responsibility 
for the group attending the Allen School at this time could be found, 
which fact seems to emphasize the point made in the prerions 
paragraph relative to mild, undiagnosed cases. . - r 


NotiflcationH are not iasued to Sunday School authorities. There 
are twelve religious organizations in the borough but the dlstiibn- 
tioD of cases in these was not studied. A census for this purpose 
would have required many days. Changes of residence are frequent; 
differences of language would have required an interpreter. That 
Suuday Schools played some part in tiansmission is probable, but 
in this epidemic the chief factor would not have been entirely con- 
trolled even had Sunday School supervision been carried out. 

Data relative to motion picture shows and other places for public 
assembly supplied even less evidence of transmission by promiscuous 

Of all inanimate methods of transmission, milk would seem the most 
likely. The distribution of cases was not parallel with the route of 
any one distributor. 

Mortality, Among the hundred and eighty cases studied, there were 
twenty-seven deaths, a mortality of fifteen per cent. This is a 
relatively high mortality when contrasted with that of other epi- 
demics. Accordingly to reports, the mortality varies from four per 
cent, to fifteen per cent. *ith an average of 8,1 per cent. 

In the age group under six years, there were twenty-two deaths, 
a mortality of twenty-four per cent. This is well below the highest 
mortality recorded in previous epidemics for that particular age 
group. Of the eighty-two cases between six and fourteen years, the 
mortality was six per cent. 

It is interesting to note but remains unaccounted for that the 
mortality of males was twenty-four per cent, and that of females only 
seven per cent. It is probable that the reasons were in part sociologi- 
cal. Fifty-four per cent, of the patients were females. Studies of 
population showed for the total age group a slight excess of females. 
In the opinion of local physicians there was no difference in degree 
of physical resistance bet^'een males and females. The fact remains 
that the mortality of males greatly exceeded that of females, while 
the morbidity among females slightly exceeded that among males. 

The unusually low mortality in those over six years of age em- 
phasizes the idea that mild cases were largely responsible and as 
those of the older ages have a wider range of contact, it would seem 
that the prevalence of such mild and atypical cases accounted for the 
long continued morbidity. Parallel studies of the morbidity from 
measles, chicken pox, mumps, whooping cough, and diphtheria were 
made during the same investigation. These studies confirm the 
opinion that the usual methods of administration were enforced. 
Absolute quarantine with guards had been in use since July; the 
cost of this service bad approximated f2,000.00. It was apparent 
that the rfforts of the Board of Health had been constant in relation 

19 - 



to all usually practical methods. However, a medical iuspector to 
stndj contacts at the time of leport aud before release from quaran- 
tine was not employed. 

In a special meeting of the Board of Health these evidences were 
presented ; the Health OfRcer was advieed to continue absolute quar- 
antine until the present cases had been released. It was pointed out 
that the services of an expert medical inspector would cost far less 
and that the sickness prevented and the lives saved would more than 
remunerate the borough for the expense of such service. It is to be 
greatly regretted that medical inspection of schools has not been 
. adopted by the school authorities. 

The plans outlined by your representative were adpoted, a medical 
inspector was employed by the Board of Health, all cases of acnte 
inflammation of the nasopharynx were temporarily isolated, and lees 
important points in administration were more closely supervised. 
During the weeli following November 2nd, not one case of scarlet fever 
was discovered and reported. 


In accorda:uce with your instructions I proceeded to Fredano, 
Luseme County, on August SO, 1014, iu order to investigate the pre- 
valence of a diaiThoeal dii^ease wbtoh Itad been reported to you by 
residents of that borough. I was associated in this work with Samuel 
R. Parke, Jr., Assistant Engineer. The work of inspection and ceusas 
taking was performed by ISanitary Inspectors Simon B, Engle, Morris 
Z. Frederick, Frank H. Lanard, and E. L. Hill. Peter Lntz, of Free- 
land was employed as interpreter, j^dvice and material assistance 
were given by the officers and members of the Board of Health and 
the local registrar for the State Department of Health, John B. 
Hanlon. The Board consisted of William McCarron, President, H. 
W. Fackler, Secretary, Dr. Roy Truckenmiller, S. 8. Hess, D. D. S., 
Joseph Q. Sarracks, and Rowland Jones, Health OfBcer. 

Freeland borough is located six miles northeast of Hazletou, with 
which it is connected by an electric railroad, and is also on a branch 
of the Lehigh Valley Railroad. The population by the censns of 
1910 was 6,107 and has probably not changed materially during the 
last four years. Freeland is one of the old established mining toimsof 
the anthracite coal r^on, the variation in population being one of 

*Thli icrtmnl In ■dpplnwnlcd 17 SfFtlon !P of tkc njnrt of tiM DlrUton ol flaalUiT 


Datiooality ratiier than of numbers. The early settlers were from 
Great Britain, but the dominant portion of foreign bora at the present 
time is of Slavonic and Latin derivation. Sixty-nine per cent, of the 
population in 1910 vere eitber foreign born or of mixed foreign and 
American parentage. This influenced the methods of investigation, 
requiring careful consideration of every detail, including the services 
of an interpreter. The men are for the most part employed in or 
about the mines, none of which are in the borough. The women are 
employed in relatively limited numbers in hosiery, silk, and overall 
indnstries, mainly within the borou^. 


Mine hundred and sixty-five cases were studied, having the following 


1lpp«r I.ebigh 29 Swamptown i 

y;.iid)- iluu, 12 MiddletowD 1 

Freehind. 711 Hurleigjij 


Butler TowQship,' ".\\'.'.'.'.'.'..\'.'.'.'.\.'. 2 

137 Foster Township 8 

9 Beaver Meadow, 17 



Pink Aah, . 

Japan la 

Of these Freeland, Jeddo, and Beaver Meadow only are incorporated 
as boroughs. All cases outside the borough of Freeland were traced 
directly or indirectly to Freeland as the place of infection. Tbls 
fact, and because nearly nine-tenths of the cases appeared in Free- 
land and Drifton, are the reasons for presenting the total figures 
for all epidemiological details. The study of the 711 cases occurring 
in Freeland is the basis on which the epidemiological opinion was 

The dates of onsets of all the cases are shown in the following table: 










































TABLE II.— Continued. 






1 ^ 










g 3 













1 1 

Ttiat the primai? fociiH was in Freelnnd seems to be demonstrated 
b7 the above table. Drifton, in which a haadred and thirty-six cases 
occurred, is immediately adjiicent to the borough of Freeland. It is 
approximately one mile by public and electric road from the ceotre 
of Freeland to the centre of Driftou, but by cross lot pathvaya tbe 
business centre of Freeland is as accessible to residents of Drifton 
as it is to residents of the outlying districts of Freeland Itself. Each 

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has its own separate water supply, but the religious, social, and busi- 
ness activities of the residents of Drifton are largely centred in Free- 

It appears in Table II that with the exception of three, all cases 
reported during the first two weeiis of August were located in Free- 
land, and that with the increasing prevalence of the disease in that 
borongh cases were reported in ontlying communities. These cases 
acting as local foci were followed in several of the villages (by means 
of direct household transmission) by local excesses. Because of its 
easily accessible location, Freeland during the summer season is the 
centre of a number of public entertainments, such as picnics, festi- 
vals, etc. These were largely attended by non-resident cases. 

The clinical diagnosis was bacillary dysentery and the evidence on 
whidi this was based is found in the bacteriological findings and epi- 
demiological data. The transmission of the cause of bacillary dys- 
entery would be the same as in typhoid fever, cholera, or any other 
disease, the causative agent of which Is found in excrement. 


Clinically, the patients showed the phenomena of an acute ileocolitis 
in widely varying d^irees of severity. Two or more cases in the 
same family presented different degrees of reaction, in one a mild 
diarrhoea, in another a severe membraneous e'nterocolitis with haemor- 

The onsets were sudden, ushered in with cramps, diarrhoea, and 
tenesmus; the stools, at first feculent, became seromncous in the 
majority and in a large proportion were htemorrhagic. In ma:ny, 
shreds of the pseudomembrane were observed over periods of time 
varying from a few days to two weeks. After two to seven days 
the blood disappeared. In those in whom necrosis was evident the 
clinical course remotely simulated typhoid fever. 

The febrile course was irregular; in very mild cases, no increase of 
temperature was uoted. Enlargement of the spleen and liver was 
not seen in any case, although pain on deep respiration in the left 
upper abdominal quadrant was reported in a few cases. Roseola 
was observed in the more severe cases. Tympanites did not occur. 
Headache was relatively infrequent. 

The most prominent complication was arthritis^ This was mul- 
tiple, painful, and usually diagnosed as "acute rheumatic fever." As 
the result of careful clinical studies, it is justifiable to state that 
these patients suffered with an acute infectious arthritis in which 
the etiological factor of the epidemic was the cause. 

Complications of the cardiovascular and nervous system were not 
reported within a month following the subsidence of the epidemic; 
likewise involvement of the liver did not occur. 

19-15-1916 „„„„,., Google 


Reaction of blood sera witb the following m^nbers of the typho- 
colon 8erie8 was studied in the Department Laboratories under the 
direction of Doctor J. B. Eucker, Jr.: — B. typhosus, B. paratyphosua 
A., B. paratyphosua B., B. paracoli, B. dysenteriee (Shiga), B. enteri- 
tidia (Qaertner), B. coU (Laboratory stock culture), a B. ooli form 
recovered in Erie during the epidemic of bacillary dyeentery 
in 1911, and a B. coli form recovered from a case of bacillary dysen- 
tery during an epidemic in Bethlehem in 1912, which was similar 
in all characteristics to the form described by Poehls; in addition, 
the blood sera of eight cases were studied with two forms recovered 
from the feces of a typical, severe case of dysentery in Freeland and 
called for convenience B. coli (Freeland). 

The results of the agglutination tests were as follows: 

Asslutlnafinn with B. roli (BHe) only', 3 can« 

AgBlutlnotion with B. typho»a» ft D. coli (Erie) 1 cose 

Agglutination with B, (j//iAo»n« only" 1 tnse 

AggI ad nation with B. coli (Freeland) only S cases 

Agglutination with O. coli (Freeland) uiul 1!. coli (Brie), ... 2 csBes 

Negative to all forme, 1 oiie 

Studies of ei^t specimens of feces were made, seven witb negative 
results, one being positive. The only organisms isolated from feces 
having characteristics which could possibly give rise to the bdief 
that they were pathogenic were recovered from the feces of a lad 
of seven years suffering with lia;morrbagic membranous dysentery. 
Two atypical bacilli, designated J-101 atid J-113 respectively, were 
recovered. The characteristics of these were as follows: 

'■j-ini— r..ltra-like morphologj, firum tifCiKivc, m-til^. 

roIoTtipB on Bcnr-aRnr: prsyish- white, tmnslucent, eiiv^ilar, pntire, pleveted, 
stightlf onnvpx, homoeenoiin. soft. 

Agar xlant: Colnn-like growth whole length of ntreak, white, traDaliKVQt. 

(ielntin Btnb--Not liqiieR(>d. 

Potiitci— lipnyinh-brown, good growth. 

I.itiniis mllh: Ac'<i In twenty-fonr hoiim. In wventy-two hours, soft eongulum. 
In 120 hnuw rediictinn of litmus. No dlppf'tion of mRein, 

Acid nnfl gnu in ■l>nxtn)S'>, I,nctosp, .Mnltose, MnnnitP, Iniilin. No chnnge in 
Snivhnrose or RaflinoRe. 

"J -II 3— Motile, colon like in morphology and stnining. 

PolnnieB on npnr-ninr like U. coli. 

Aenr alnnt: ("nlon-liko. grnyinh-white, tninahioent whole length of streak. 

(Jeladn st-h: Not liquified. 

Potato: C)myinh-brown . 

T.itmi's Milk: Acid in twenty-fonr hours. Firm congiilum in irventy two hours. 
Later reduction of litmus occurred. 

Acid and gns in neitroBe, I-iictoso, SHcchiiroxe, Maltose, M.nnnit", and Raffinose, 
No chingp 111 Iniilin. 

Inrtnl is produced. 

Agglutinates with serum of host, but not with serum of rahbits Immnntied with 
B. tupknmia. fl. tinnitiiiihnxHii A, nr li. rntcritidia. 

".T.ini docs not si'lit;ir<.BP whil" .1-113 dofs. 

"There is bIso a difference in the spIittinB of inulin and raffinose. J-US splitn 
raflinoBe Hnd dors not split inulin." 

It was fnrtber noted that both strains of bacilli agglutinated with 
the sera of other patients from Freeland, which in tnm did not 

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agglotinate with membws of the typho-colon series. It U concluded 
that J-101 IB a typical B. coU except for the soft coagulum produced 
iD milk and in the splitting of inulin ; J-113 is a B. coli conamtnior 
type, atypical only in that it does not split ratBnose. 

Forms which could be classified under the dysentery group were 
not recovered. The only evidence that the two described forms may 
hare been pathogenic is found in their biochemical and, to a some- 
what greater extent, in tiie agglutinating reaction with Bera from 
all of tbe Freeland patients with which they were studied. 

Different strains of the colon bacillus are not identical in their 
agglutinogenic receptors. A serum which agglutinates one strain 
will not a^lutinate all strains. According to Paltauf and others 
the reaction is largely individual and the serum of a patient with a 
colon infection will agglutinate the strain causilig the disease (epi- 
demic) but will probably not affect other strains. Hence, for diagnos- 
tic purposes the test must be performed with a strain recovered from 
a patient infected during the same epidemic. 

The relation of strains belonging to the colon group with epidemics 
of enterocolitis has long been noted. This was first discussed by 
Escherich prior to the recovery and identification of the B. dyaenteri<B, 
but the view that an actual "colitis contagiosa" came from colon 
forms was sharpened rather than minimized. Pfaundler states in 
reference to enterocolitis (the colitis contagiosa of Esdierich) that 
if other infections can be excluded and if the sera of patients give 
the agglutination reaction in dilutions of one to fifty with the bacUlus 
which has been recovered from the feces, colon infection is indicated. 
This has been confirmed by Paltauf. 

With these dicta the findings in Freelatid apparently harmonize 
sufficiently to suggest that the microorganisms recovered from a case 
of membranous enterocolitis (contagiosa) were, at least, the principal 
etiological factors in this epidemic. 

The eight specimens of feces were searched for amoebae with n^a- 
tive results. Three specimens of sediment from the reservoir were 
likewise examined with negative resnlts. The specimens, particularly 
the feces, were carefnlly shipped with precautions relative to the nec- 
essary temperature. It was not to be expected that amoebae played 
a part in the etiology. Whether the amoeba stands in direct casual 
connection with acute dysentery is still a matter of investigation. 
At present the trend of opinion seems toward a view that it is a 
secondary factor and that it is not the primary agent, especially in 
the acute forms. 


In the OT^anized communities all preventive measures were carried 
out by the Boards of Health. In townships of the second class the 
Health Offlcer of the State Department was in chai^ The disin- 



feetion of the entire system of water supply in Preeland was carried 
out by employees of the Preeland Water Company under the per- 
sonal direction of Engineer Parke. 

The most noteworthy difficulty was in securing the intelligent co- 
operation of householders. All principles of domestic hygiene were 
not merely disregarded but absolutely violated, even after carefully 
detailed instructions relative to the disease were given in appro- 
priate languages. The continuance of the reporting of secondary 
cases was less, however, than had been forcasted by your representa- 
tive to the local authorities. In order to overcome these difficulties 
the Board of Health in Preeland made unsuccessful efforts to secure 
authority to employ nurses for district service. The disease con- 
tinued apparently until the material available to infect bad been ex- 

In Drifton, which is an unorganized community, the District Nurse 
Berviee, maintained as one of the private philatithropies of Mrs. 
Eckley B. Ooxe, became an important factor in the prevention of 
secondary cases. Two nurses assigned to this service by Mrs. Coxe 
rendered commendable and unusual service with the result that the 
proportional morbidity in Drifton was far below that noted in other 
communities. The details relative to the services of Health Officer 
James Collins in securing the cooperation of the various Bailroad 
and Goal Company interests are filed in the archives of the Depart- 
ment. It is probable that as a result of the campaign carried on 
through these agencies, the insanitary conditions chronically preva- 
lent in and about the homes of these people reached a stage of reduc- 
tion which has never heretofore been attained. 


The results of epidemiological studies were negative so far as every 
possible agent was concerned except water. The data follow: 

Milk: — The largest portion of the milk and cream supplied to the 
residents of Preeland came from daily farms located in Butler and 
Poster Townships, Luzerne County. There were eight vendors in 
Preeland. Six were dairy farmers residing in Butler Township, who 
vended their own and additional purchased supplies; and two resided 
in Preeland purchasing their supplies from farmers in Poster Town- 
ship exclusively. 

The eight vendors of milk and all their sources of supply were 
thoroughly inspected. The sanitary conditions and the medical his- 
tory of the various dairies were investigated with a view to acquiring 
all possible information concerning the cows and the households 
which could have any relation to the epidemic. The examination 
included not only the establishments and dairies of such of the 
vendors as were themselves producers but also some thirty-five other 


producers from which milk came to them. The result of the iuspec- 
tioQ indicated that nooe of this milk could have played a part in 
causing or prolonging the outbreak. 

In common with the custom prevailing in communities of tbis 
character, some residents maintain cowa on their premises and to a 
small extent sell milk to neighbors. The use of milk b; patients 
was as follows: 

TABLE in.-USB OF MILK. (Freelnud). 

Dealer No. 1, 

Dealer No. 2, 

Dealer No. 3, 

Defller No. 4 

Dealer No. 5 

Dealer No. 6, 

Denier No. 7 

Denier No, 8, 

CumbiDutione nt ubore, 

(Joat milk onlr 

Own cov only, 

45 residents 3<^UiiiB to neighbors, . 
Condensed and evaporated onlf, .. 

Three hundred and seven cases, or 43.2 per cent, ased milk produced 
in places remote from the borough. 

These were supplied by the eight vendors, each having different 
sources of supply, the maximum number of cases on any one vendor's 
route being eighty-two. There is reason to believe that very little 
trading was practised between vendors; local purchases were em- 
phatically denied by each one. Two hundred and forty-five, or 34.4 
per cent., nsed milk produced on their own premises or purchased 
from neighbors. Based on negative results on dairy farms and the 
use of milk, a negative finding was deduced and milk was excluded 
from further consideration. 

Ice Cream: — The use of ice cream is indicated in the following 



The data are conclusive so far as they could be obtained. It mny 
be that to some extent children did have ice cream within the incu- 
bation period. This being short, however, the history is probably 
more accurate than is ordinarily obtained during an epidemic. 

Ice: — The ice supply for the most part was artificial. Its use by 
patients is indicated in the following table: 

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JoLnsoD lee Co., 61 cases Own supply, 1 case 

j'reeliind ice Co., 68 cases None used 698 casex 

Julms-ju End othera, 2 cnsea 

Joiiu Trevaski lease Total 711 caaea 

It is apparent from the histoiy of the few patients using ice that 
the evidence offered does not warrant an opinion that it was the 
traDBmitting agent 

Uncooked Vegetables and Fruits: — It was common report that 
hucksters as well as local dealers of fresh fruits and vegetables, vended 
their supplies through the borough and collected old iron, rags and 
bones on the return trip. This was alleged to be responsible for the 
epidemic, probably through infection by bananas. An effort was 
made to inspect the grocery and other stores in which vegetables, 
fruits, etc., were liept for sale. Eighteen such places were examined 
and nothing was found to indicate a connection between these sup- 
plies and the outbreak, or to explain the existence of 711 cases of 
acute dys«»tery extending over a protracted period of two months. 
The itinerant vendors of fruit, celery, and so on, wlio proved not to he 
very numerous, were also sought out, and it was found that at least 
two such hucksters did sell their goods along the road from Hazleton 
to Freeland, a distance of six miles, and picked up Junk and rags 
on the way back. The number of persons thus supplied between these 
places exceeds those trading with these hucksters in Freeland Bor- 
ough, while the moT-hidily of flnit district is negligible and shows 
that this source of infection may be left out of account. 

A new census of j)ntients using uncooked foods was made. The 
data obtained were as follows: 

None, 662 cases I'^miinas from vendor, 2 cases 

On this basis the conclusions previously entertained were consid- 
ered confirmed. 

Meat: — It was likewise alleged that meat sold during special Mon- 
day sales by a store of the town was responsible because the meat was 
unfit for use. The store in question was one of a "chain." It was 
found that the supply for the Freeland, as for the Hazleton and other 
stores, was the usual class of meat sold at all times by these stores 
and known as "prime meats;" it was furnished by well known whole- 
salers, but because of an excess supply coming in car-load lots, waa 
sold weekly at what appeared to be sacrifice figures. It could not be 

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shown that illneBg occurred among the pnrchasers of such meat in 
Hazletoa and in other communities where the patronage was much 
larger than in Preeland. 

Of meats likely to transmit pathogenic bacteria, which would have 
been sold in this store, veal would probably be the principal offender; 
in order to act as a transmlssive agent it would have to be insuffi- 
ciently cooked. Where diarrhoeal disturbances have been traceable 
to meat supplies, it has nsnally been shown to be due to underdone 
roasts of veal, the paratyphoid bacillus and the QaA-tner types of 
bacilli being the pathogenic forms found. Prolonged cooking is, 
however, characteristic of the foreign-born and it would seem im- 
probable that the bacterial forms contained in veal or any other 
meat could escape destruction. It will be shown later that nearly 
one-sixth of all patients were children under &ve years of age; it 
would seem unlikely that so large a number of small children would 
be given heavy meats even by the foreign bom. The result of all 
Investigation in this direction was uniformly negative. 


Among the influences alleged to be responsible for the epidemic, 
diurnal changes in temperature were persistently cited as a possible 
factor. Of course, this is not a tenable theory in relation to the 
morbid processes presented. In Freeland, however, the data were 
collected in order that the argument advanced might be properly re- 
futed. The record of maximum and minimum temperatures taken in 
Fredand from June Ist to September 15th inclusive is as follows: — 


» «e; 00 i,^ e4 «:; nl a 


« 70 Hi JS 63 78 j 70 H 


Si Ml ES SS «2 SS' (8. It 


M SIM K 60 n si'ra 

» Hi S6 JS 82, SO! 6» M 

I u S(i CO t» $* M n » 

» " M la, so 70 M « S4 

»■ 58 W TO 16 7t M W, » 

»■ '» M| ■ 69| 6J JO H. 8S H 

a 1 a s!j H 81 S3 si; u ' k 


-. " "1 " " "if. i.Cllxmd- 

TAISLE VII.— Continued. 

I 2 1'. il. 3A. Sf 3 P.M. SA. U. I tP. H. 

It appears that radical changes in temperature did not occur dar- 
ing the period of the epidemic. 

The data on which to base the limits of incubation periods were 
meagre A few cases led to the belief that at least seven days 
elapsed before the clinical signs and symptoms were in evidence. 
The majority of cases, however, developed within forty-eight hoars. 
It is not apparent how wide variations in temperature could reason- 
ably account for the morbidity. 

It is conceivable that depression of the sympathetic nervous sys- 
tem, followed by "colliquative diarrhoea" might occur following pro- 
longed high barometric pressure, but this would not give rise to the 
severe primary enterocolitis, which marked the cases in this epidemic. 
There is however, no record of severe or prolonged atmospheric 
changes of this character ; in fact, Freeland occupies such an altitude 
that increase of pressure is largely nullified by the active air move- 

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Water: — The history of the use of water by the Freeland patients 
is showD in the following table: 


FrwluDd Water Co. only 6J8 casiM 

Freoland Water (_'i>. uud SprinES, II eases 

Freelund Water Co, uud Liriltun Biipii:..- 13 caseB 

Freelaud Water Cu. lod Miirklo Btipjil.v 20 cases 

Freeland Water Co. and Upper Lehigh supply, 5 cases 

Freeland Water Co. uud drilled wHi I Ciisu 

Freeliiud Water Co. and Jeddo Bupply. 8 cases 

Freelund Water Co. and Spring-Keiper Coal Co. 1 case 

Freeland Water Co. and Various 2 cases 

Freeliiud \i'ater Co, aud DriEton and Upper Lehigh 1 case 

711 cases 

It is to be noted that every patient used the water furnished by 
the Freeland Water Company and that 648, or over nine-tenths, used 
that water only. 

The history and description of the Freeland Water Company's 
system and operation are contained in the special report of 8. B. 
Parke, Jr., Assistant Engineer. As, however, the distribution of in- 
fection parallels the water distribution and as all other possible 
agents of transmission were excluded from consideration, it is neces- 
sary to show the relationship between infection and the use of water 
by detailing certain features included in his report. 

The water was obtained from bored wells in two locations, one. 
Pump Station No. 1, being located at the Eastern border of the central 
section of the borough, and the other, Pump Station No, 2, located at 
the extreme Northern and Eastern border of the borough. 

According to drainage and to water distribution the borough may 
be divided Into two portions. The drainage north and northeast is 
directed toward Station No. 2 from a maximum elevation of probably 
two hundred or more feet above the station. This portion of the 
borough is not sewered, the higher portions being covered with closdy 
set dwelling houses and sewage disposal being for the most part into 
leaching cesspools. Near the lowest portion of this section several 
wells have been abandoned as sources of water supply since the boring 
of the Water Company's wells at Station No. 2 In 1906 and 1909. 
The history of the loss of water from these private wells Is clearly 
given by property owners. On at least three premises the wella 
were converted into cess pools, the most recent being in June, 1914. 
The drainage of the southern portion of tlie borough is less precipi- 
tous. This section is sewered and the well history negative. 

On the western border of the central portion of the borough (on 
Walnut St.) a reservoir is maintained for the rsceipt of surplus water 
from the distributing system and providing for night consumption 
and fire service. It has a capacity of approximately half a million 
gallons. . ~ I 

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The principal distribution mains from both pump stations become 
parallel at the eastern end of Walnut Street and continne parallel to 
the reservoir at the western end. Laterals to the southern portion 
of the borough are taken oS from Station No. 1 Main and to the 
northern portion from Station No. 2 Main. There are three connec- 
tions between the parallel mains. 

The period of pumping from Station No. 1 is nsnall; from noon 
to five or six o'clock and occasionally for two hoars more during the 
evening. From Statio'n No. 2 the period is from seven o'clock in the 
morning to three or four in tbe afternoon. The head maintained is 
snch as about to equalize the pressure in the two piping systems. 
From these data it would seem that there are marked diflferences of 
supply to the two portions of the borou^, using Walnut Street as a 
dividing line. Water from Station No. 1 alone would supply the 
Southern portion daring the afternoon and from Station No. 2 the 
Northern portion alone from seven in the morning to four in the 
afternoon. During the night and morning the Bonthem portion 
woald receive a mixed supply from the reservoir and probably in 
part during the morning by connection with the Northern portion 
from pump Station No. 2. From about four in the afternoon to seven 
in the morning the northern portion would receive only the mixed 
supply from the reservoir. It was inferred that the northern dis- 
trict woald thus get a larger proportion of the water from Pump 
Station No. 2 with whatever danger was involved, because the water 
of this station was apparently more subject to pollution. 

A study of the population based on the number of dwellings and 
the average size of the family showed practically an even distributioD 
north and south of Walnut Street. 

On the contrary the distribution of patients was markedly unequal, 
two-thirds of the cases residing north of Walnut Street and for the 
most part receiving water from Station No. 2. This is shown graphi- 
cally in the chart, and may also be made evident by an examination 
of the times when the infection manifest^ itself in these two parts of 
tiie town. 

The dates of onsets of cases in accordance with their resid^ice 
north and south of Walnut Street are as follows: ■ 

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Dntes o( Onsets By Districts of Water Diatribution. 

It \ t \ I 

i i a I ^ I I ■=* 

It is noted that two-thirds of the patientB were north and one- 
third were south of Walnut Street, This is somewhat more dis- 
tinctly shown in the tabulation by weeks. 


AuTUNt . North . Smith . 

First wi*k SI onses 1 eiars 

PeiMtid WL-ck M) cm^-i 10 fnaes 

Tliird WPPk aa <■«("•!■ ?1 P1I8PB 

Fourth wei-k. ([■icirilinK fcirtioul, 194 ens i< 110 ciises 


First week W cases 54 cnsea 

SMvmd wpek, 37 cnsfH 1ft fniwa 

Third w«ek SO cases 13 cases 

FoTirth week (incliidirf; fraction) 8 mses II ciiscfi 

Sociological. Notable diCFerence» in housing conditio'os in the two 
portions of the borough were not found. The types of homes and 
the apparent financial resources of the occupants, while varying to 
a co'nsiderable extent, seemed to be equally apportioned to the dis- 


tricta north and south of Walnut Street. The saaitary conditions 
likewise bore no relation to primary cases. 

In fact, a plotted curve of primary cases brought out somewhat 
more sharply the predominence of casea north of Walnut Street and 
the parellelism between water distribution and date of onset with 
lines of case distribution. The well-to-do a^d the poor alike con- 
tributed to the morbidity. Nationality was of no influence. 


Ameripan born (incliKlliig chUdren of PuJlsh ]3B 

forpign bom pareots) 290 Slnvist, 117 

English 13 Himeniian 2 

Irish 5 ItaliHQ M 

Welsh 1 (JrcPb. $4 

Germna *5 RiiBKiiin rt 

AuKtrion, 5 Hebrew 7 

Dutch, 2 LithuoniiiL 4 

Totnl 711 

This table shows that 421, or 59.2%, were of foreign hirth. It has 
already been stated that 69% of the total population in 1910 was 
either of foreign birth or of mixed parentage. In Table XI the 
children of foreign born parents are included under "American bom." 
If this increment were added to those of foreign or mixed parentage, 
it would donbtless increase the 59% morbidity to 69%, in this way 
balancing the ratio of foreign bom to American bom in the mor- 
bidity of foreign born to that of American bom. 

The distribution of cases by households empbasisses the suscepti- 
bility to the cansative bacteria. 


1 Mise eiich in ISO h<itiHe!i aw 

2 cflHW enoh In 72 houses IM 

3 canes ench in «i htnisea 114 

4 cnses each in II hoiispe 44 

5 cnxes cnch in 13 bniisei ft^ 

8 cHBi^ ejich in 7 houses *'l 

T casps each is 3 hniixps 21 

9 cnacs each in 2 hniiiietl IK 

13 eases each in 1 hniise |3 

307 hminni 711 cflseii 

Of 397 households 147, or 37 per cent, had two or more cases. It is 
unusual to find one-third of all infected premises having more than 
one case presented, except in a true bacillary dysentery. A review 
of this point aa occurring in previous epidemics in Pennsylvania 
would seem to confirm this statement. 

The more important point, however, developed by the above table 
is confirmation of tbe nature of the morbid process. Inorganic 


No. 15. 


poisons have never been known to have so general a distribution. 
Only the presence of pathogenic bacteria or their toxic prodncts 
would explain the outbreak. 

Daring this epidemic it was necessary to develop this evid^ce 
because of the widespread variety of ideas as to the canse, some of 
which originated with the medical profession and were harmfnl to 
investigative and administrative measures. 

The susceptibility at various ages is indicated in the following 












1 J, 












11. 1 


Taul popnlaUoD «.lt7. 

Kgures for the five year periods after the twentieth year were not 

By the above the morbidity is shown to have been 11.5 per cent. 
of the total population, being evenly apportioned between males and 

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females. The highest degeee of susceptibilitj was shown by duldren, 
especially those under five years of age. In confirmation of the 
opinion that the focal point was in Freeland, a discrepant^ will lats* 
be shown between the susceptibility by age periods of cafies occurring 
In Freeland and Drifton respectively. 

The occupation of patients is shown in the following table: 


Unemployed (majority under 6 ; rs.), 190 maes 

Scbool , 139 CBaeu 

Houaeworh, 154 c 


Unemployed adults lover SO yre.), , 

Various, (males, Dl; females, 23}, 

The striking feature in this table is that 489, or 69 per cent of 
all cases, vere women and children whose activities would not take 
them from home or school except on the occasions of picnics and fes- 
tivals. For the most part the latter are held under the auspices of 
reli^ous organizations or by families speaking a common tongue. 
Even had infection been acquired during such gatherings it would 
be necessary to have daily outings attended by the greater part of 
the population in order to give rise to such a series of onsets as is in 
diown in Table II. 

In addition, Table XV tends to confirm the opinion that the in- 
fection was transmitted by water. As estimated, upwards of nine- 
tenths of all males of a suitable age in Freeland are ^nployed in or 
about the mines. There are approximately over two thousand males 
of working age but only ninety-six men employed in or about the 
mines developed the disease, and a fairly large proportion of these 
ninety-six were classed (from census studies) as secondary cases. 
■ It is the custom for miners to carry cold tea to work and to use 
malt beverages when off duty. Also, it is noted that of the estimated 
ten per cent, of all males employed in the borough as merchants, 
clerks, teamsters, etc., ninety-three de\eloped the disease. This dis- 
proportion seems to mean but one thing — that those employed iti civic 
or mercantile pursuits were more frequently exposed to the infection, 
or that they used some transmitting agent more constantly. Noth- 
ing except water could be found by means of which these differences 
by occupational groups could be accounted for, 

Diqmze'c by Google 


Secondary Cases. About fourteen per cent, of the total numt>er 
of cases were counted as secondary cases, the record being as follows; 


lufeeted by visits to otber cases W cases 

Infected by cases on the same premises: 

Infected in 15 bouses bavms 2 cases eacb, IS 

Infected in 11 houses baving 3 (Uses eacb, 18 

Infected in 3 bauses baviag 4 cases each 1 

Infected iu 4 bunses buving 5 cases each, 4 

Infected in 2 houses having 6 cases each, 2 


Unnccoanted for , 43 casw 

100 cases 

Fifty-seven of the secondary cases occurred north of Walnut Street, 
and forty-three in the district south of Walnut Street, 

This high rate of secondary infection was easily explained by the 
wretched domestic hygiene of the households in which the; mostly 
occurred. Isolation of patients was not undertaken except by tiie 
most intelligent and not always even by tbis class; disinfection of 
discharges was not practised until after the arrival of your repre- 
sentatives, and then only in a few families. 

Mortality. In Freeland Borough there were flfty-six deaths, a 
fatality of nearly eight per cent. The deatbs of the entire epidemic 
numbered eighty-one, which means a fatality- of 8.4 per c«it. of the 
965 cases. The distribution by age and place follows: 


Freeland. ' Dilttra. Ublgb Jcddo. ' Townibli 

h Goot^lc 


In Preelflnd there were forty-three deaths of persons under five 
years of age, or 76.S per cent, of the total mortality for that borongh. 
These were distributed as follows: 

TJucier one year, 18 or 41 ,9 per ceni 

I'Tum one to two yenra, 16 or 37. 2 per cenI 

From two to three years, 6 or 13.9 per 

From tbree to four yenre, 2 or 4.7 per 

Fi-om four to five j-ears, 1 or .- 2.3 per 


Only the essential features of cases occurring outside of Freeland 
Borough are presented. The necessity of detailing all of the ^idem- 
iological data seems to be so slight that they are not I'ndnded in 
the report but are on record in the flies of the Department for refer- 
ence. The distribution of the total morbidity is detailed in Table I. 
Two hundred and fifty-four cases occurred in places other than Free- 
land, including twelve villages or boroughs and two townships. 
Freeland is immediately accessible to all of these with the exertion 
of Beaver Meadow Borough, Carbon County, 

Freeland is a social and business centre and visitors to the bor- 
ongh who later developed the disease were found to constitute the 
majority of the outside primary cases. The epidemiological studies 
of these cases did not give data which would in any way change the 
conclusions drawn from the studies in Freeland; in fact, where it 
was possible to secure accurate information from the foreign bom 
(among whom the morbidity for the most i«irt occurred), the disease 
could be traced to Freeland or to contact with cases from Freeland. 

Drifton. Certain striking features were found in tabulating the 
Drifton eases. The residents of Drifton use water from entirely 
different sources of supply. (.A. report on the Upper Lehigh, Drifton. 
Jeddo, and other water supplies was made by Engineer Parke. It is 
sufficient to relate that all findings regarding these water supplies 
were n^ative,) Early cases in Drifton were for the most part 
adults or children old enough to visit frequently in Freeland. The 
age and sex of the Drifton cases are noted in the following table: 


Age Rrd Sei. 


20 24, 
30 34. 

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TABLE XVIII— CoDtintied. 

It is seen from this that the age groups mostly affected were thoBC 
of the mobile class who visited Freeland frequently, and is in direct 
coDtrast vith the table on the ages of Freeland cases. The occa- 
patioB of Drifton cases confirms this point: 


Uuemploynl (majority uniler 6 years), 23 

School, 15 

Housework 22 

Mines 36 

Various, 6 

All possible local Drifton agents of infection were negative. These 
same findings were noted in varying proportions in the tabTtlatioti 
of cases from every otber community. 


Xo agent of transmission was developed during the investigation 
which mig^t be considered responsible eiicept one. This agent 
(laialleled the distributing lines of the Freeland Water Company's 
supply, and in particular the distribution from Pump Station No. 2. 
The analysis of water specimens made in the Department Labora- 
tories gave low total counts; of forty-eight specimens, the highest 
count was ninety-six. B. coli were uniformly absent except in a 
dipped specimen from the basin at Station No. 2, which gave a count 
of one to each cubic centimeter. Hypochlorite of lime treatment 
became operative on August 31st. By refeiTing to the table it will 
be obser\'ed that the onsets decreased rapidly after that date. 

Freeland is built upon a hill which extends upward through sur- 
rounding coal measures and continuous with tlie sub-strata found 
below the coal and rock common to that section of the state. The 
pump stations are located within the borough but on lower levels 
than the m9.jor portion of the town. At station No, 1 the only well 
in use is 380 feet deep, the casing extending sixty-two feet below the 
surface. Another well, not in use, but in the shaft of the dug well in 
which both bored wells are located, is 280 feet deep, cased to sixty- 
two feet. It is probable that both wells take water from the same 


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level, the flow entering at 191 feet. The geological record notes 
"24 feet hardpan, 187 feet green saDdstonc, and 16ft feet red ehnle 
in order mentioned from the surface." 

At Station No. 2 there are two wells in nse, 380 and 485 feet deep 
i-espectively. The records note, "8 feet quicksand, 32 feet hardpan. 
. and the remainder red shale." The wells are cased to fifty-six and 
seventy-eight feet i-espectively below the surface. The flow is ob- 
tained at the two-hundred foot level and it is believed from pumping 
data that the wells are connected by a Assure. 

Other sources previously in use are dewciibed in the Enginet^r'tt 
report. They wete of no importance in connection with the present 
HOUi'ce» as factors in the epidemic. 

The topography of the drainage area surrounding Station No. 2. 
the presence of cesspools and privies and the historj- of wells made 
useless by the iDstallation of the Water Company wells would seem 
to indicate a constant menace to water pumped at this Station. 

It is known that the ground was saturated during the early sum- 
mer months, some owners of property measuring the saturation by 
the overflow of leaching cesspools. The records of precipitation for 
this region were carefully examined. They indicate large ratnfatlH 
early in June and again in the fourth week of that month. In July 
there were heavy rains on the tenth, fourteenth, and twenty-seventh, 
all within brief periods of time. 

Ou September lllh. Dr. W. H. Meeker, Chemist, and Dr. Joseph 
McFarland, Bacteriologist, Htudied the water system, topography, 
and water supplies for the Freeland Water Company. The lesnlts 
of their analyses represent the conditions found ten days aftei- the 
use of hypochlorite of lime was begun. They state that the "water 
(from Station No. 1) proved to be perfect in quality and puiity." 
Prom Station No. 2, "the water proved distinctly inferior" to the 
other. It "contained a very few colon bacilli. The number is so 
small that no colonies could be found upon the plates, though fer- 
mentation was induced when one cubic centimeter of the water \,a» 
added to sugar media. This is, however, sufficient to condemn this 
water in the eyes of roost sanitarians, as there should be no colon 
bacilli in pure water, and none discoverable in less than ten cubic 
centimeters of a presumably potable water." "The results are that 
the water fi-om Station No. 2 seems to have some slight contamina- 
tion. With regard to jmssible sources of contamination from what 
I saw and learned while in Freeland, would conclude after a study 
concerning the location of privies and of the apparent geographical 
condition, that the rock strata sloped from the town toward the wel!i« 


and especially toward well No. 2; that the privies and cesspools 
accompanied from the surface drainage are to blame." 

The reports of the Department Laboratoiies and the investigators 
mentioned are consistent and agree in so far as they correspond in 
melliod. It would not be practicable for the State to make more 
tban the usual bacteriological determinations. It is possible, how- 
ever, by finer methods of analysis to determine minute tracee of 
.pollution, siidi as would be discoverable during a rapid and>auto- 
matic correction following chance pollution. 

To recapitulate: the epidemic of hacillary dysentery in Freeland 
and vicinity had its origin in the Borongh of Freeland, the evidence 
being found in the appearance of cases tirst and in maximal numbers 
in that Borough, according to the data set forth in this report; it 
was not due to transmission by any agent likely to become polluted 
with excrement except water. The only evidence against the diagnosis 
of a. water-borne infection would be based ou negative bacteriologi- 
cal findings in the Department Laboratories. As has already been 
indicated, this alone is insufficient to form more than a presumptive 
opinion in the presence of a rapidly subsiding pollution of surface 
OP sob-surface origin. 

The evidence that the-walei- was the transmitting agent is found 
in the history of the rainfall and giound saturation in an uusewered 
drainage area in which is located the probable source of the sus- 
pected public water supply ; in the gradual but constantly increasing 
morbidity, in consonance with supersaturation, aud the abrupt de- 
crease in morbidity coincident with water disinfection; in the dis- 
tribation of cases in location and in sequence parallel to water dis- 
tribution from the suspected source; and in studies of age, occupa- 
tion, and susceptibility of patients. To this may reasonably be added 
the fiDdingB of investigators employed by the water Company itself. 

The epidemiological opinion, thei-efoie, is bacillary dysentary 
transmitted by water supplied from Pump Station No. 2 by the Free- 
land Water Company. 


In accordance with your telegram of Thursday evening, and your 
letter received Friday last, I visited the home of John Galle, in 


Bervick, who as I understaod lias been dia^osed as having Anthrax. 

After a careful examination in conjunction with Dr. Hen^l, I was 
not entirely satisfied on account of my inability to understand him 
and I thoaght the physician and nurse made many guesses in ex- 
plaining his replies, etc. Therefore, the next day I went to his home 
with an interpreter, but elicited bat little more information, except 
that he washed his hands twice each day at the works before going 
to his home. 

The story of the patient is that a hot rivet fell on his left hand 
while at work making what are called screens, that are made of 
Dftw pine lumber and new nails and are used to ])revent accidents 
to the workmen while building steel cars where a padding of hair 
is used for insulation made by a firm in Trenton, New .Tersey, called 
the Johns Manviile Co. and consists of hair quilted between two lay- 
ers of muslin, but from whom or where the New Jersey firm gets the 
hair I am unable to say. 

I would also state, John Galle worked for three days after receiv- 
ing the bum and then brushed the scab from the wound on his Left 
hand when it itched and bothered him in some way. 

He denies that he used any of the hair as a scrub brush in clean- 
ing his hands, and on my visit to the plant it was stated that the men 
nev^ used anything of the kind, although I found a piece of cotton 
waste that bad been used in that way on the sill of the car door op- 
posite the wash stand where John Ualle aod others washed them- 

I could not learn he had handled any phosphates or burlap bags 
or other material which might have contained the germ of anthrax, 
but he surely has a very bad arm, much inflamed, purple in color to 
a great extent. No pus but much induration, etc., and very unlike 
any case of ordinary infection I have ever seen. 

In the case of Reuben Shuman, of Cafawissa, I found not so marked 
and extended infiltration and swelling, but the same lack of pus. 
dark purplish red infiltration, elevation very marked on the parts 
affected, which consisted of two spots an inch and a half or more in 
diameter in the right hand with an elevation of probably a quarter 
of an inch above the suiTounding surface, while the spot on the 
chin was about the size of a dime with the same characteristics. 

He bad skinned a dead bull for Mr. Henry J. Miller, of Cata- 
wissa Township, which he thought had died of acute indigestion, 
as both stomachs were fllLed with the refuse of timothy bay, which 
had been left from the machine used in bailing all the hay they sold 



from the farm, and it was judged that he had overeaten of the headaj 
etc., as there was no mark of any kind on him accordingly to the state- 
ment of Mr. Shnman. 

I am also informed that James Terwilliger, of Bloomsbnrg, helped 
Reuben Rhoman skin the dead bull. He had cuts on his hands, as 
I understand, the same as Mr. Shuman from corn husking, but had 
had no trouble of any kind and as I hear, is perfectly well, but I have 
thus far been unable to see bim. 

Dr, 0. H, Welliver, the vetei-lnary suigeon informed me that there 
was no evidence of anthrax on Mr, Miller's farm and the two bogs 
that had died, one before and one after the death of the hull had died 
of hog cholera, and he stated the bull had been buried at least three 
hundred feet distant from the source of any water supply and four 
feet below the surface. 

If I had not expected to be able to see James Terwilliger, T would 
have reported earlier, but I cannot wait longer to see him, and I 
judge from reports it would do no good anyhow. 


Pursuant to your instructions I went to Philadelphia on Sept- 
ember 18 and, after obtaining supplies at the Laboratories of the 
Department, proceeded to Wilkes-Barre to examine a man thou^t 
to be a leper, and to learn what facilities existed for taking care of 
him if he proved to have lepro-'sy. I beg to submit the following 

The patient, J. N., a Syrian, aged thirty-one years, fourteen yeara 
a resident of the Unitpd States, eigbt years a. resident of Wilkes- 
Barre, married, by occujiation wire drawer in a steel mill, residence 
No, 117 Blackman Street, Wilkes- Barre, gives the following histoiy: 

Personal and Famihf Hixtorif: So far as he knowa. he was bom 
of parents in good health, about thirty-one years ago in the little 
farming village of Matin (?) in central Syria, The family followed 
farming and lived in tiie village as is the custom in that section of 
Syria going to and from the farm fields each day. 

An elder sister states that in his early infancy he was very frail 
and that for about thiee months he was kept wrapped iu cotton; 



a series of sores ai'e said to have developed at that time, and certain 
lesions to be described later may i>erhapt4 date back to that period. 

He is said to have had two sisters and two brothers who lived to 
grow up, and one brother who probably died in early childhood. 
Of the remaining brothers and sisters, one is now living in the 
Argentine Republic, South America, one is in Syria ; one sister and 
one brother live near him in WilkesBarre. All are believed to be 
in good health. His father died when J. N. was a young man; his 
mother is living in Syria and is well so far as known, and has reached 
the age of eighty years. 

No histoi-y could be obtained of any disease in any way resembling 
leprosy in any relative on either th« maternal or the paternal side. 
Nor could J. N. give auy information concerning any serious ill- 
ness except that mentioned in infancy. 

Leaving the farming village in Syria at the age of seventeen, be 
came to America some time during 1000 and soon began work in » 
tannery at Sayre, Pennsylvania, handling bides and devoting a g*>o.l 
part of the time for a year to the clipping of hair from the hiden. 
working in the tannery for about two years. For several year-i 
fbereafter he worked as a laborer in a railway construction and 
repair crew. Eight years aro he came to n steel mill in WilkesBarre, 
the Hazard Wire Rojie Works, and obtained employment at" wire 
drawing, an occupation which he followed for nearly seven years, 
and which biiugs the fnce and bauds of the worker into the presence 
of intense heat and in a direct current of air from an electric fan. 

Environmetit: The home in Syria is said to have been a humble 
one; at Sayre he lived in a company house near the tannery with rhe 
usual surroundings of a company house, bat so far as be knows the 
community enjoyed good health and his neighbors, as he asserts; 
were all in good health. Coming to WilkesBarre eight years a^, 
he resided at No. McGarragher Street for several years in a fairly 
good house of cheap construction; from there he moved to No. 17S 
High Street, re.'*iding in this dwelling but a month and a half. He 
then moved to No. 109 Btackman Street, remaining there for more 
than two years, when he purchased the house and removed to hih 
present address. No. 117 Blackman Street. 

He is quite sure that they have been troubled with bed bn^s in 
each of the three hnnses in WilkesBarre in which they lived and .also 
in Rayre, the wife reporting that she burned her mattremea on an 
average once in every two years. 

Both of the WilkesBarre houses in which he recently lived have 
been infested with rats, many of them having been trapped by the 

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householder, but so far as be is aware Boae of them have showii anj 
areas denuded of hair or auy sigD of disease of the skin. 

No domestic animals or pets of any kind have ever been . kept 
about the dwelling. 

No history of body lice could be obtained and a history of head 
lice was denied althongh the denial did not seem to come from the 

Conjugal History: Eleven years ago he married Martha G— ' , 

daughter of a Byrian desfende<l from healthy parents — no hfstory 
of anything resembling leprosy being obtainable in the families of 
either her father or mother. 

Two children have been born of this union, Leo, February 25, 1909, 
and Qeoi^ie, January 21, 1912. Both children present the appear- 
ance of good health. George has an interesting webbing of the second 
and third fingers of each hand. 

The wife presents every appearance of good health and denies 
ever having had miscaiiiages. Venereal disease is denied by both 
husband and wife. ' 

Present Illness: About two years ago, sometime during the early 
summer, he noticed a series of small haid lumps d'Bveloping over 
the forehead near the eyebrows approaching the root of tlie nose 
and a little above it, the skin lesions apparently coming on after 
an acute cold affecting the nose and was believed by him to be the 
result of the excessive beat at his work with an electric fan blowing 
directly in his face. The eruption on the forehead and about the 
eyebrows is said to have Increased during the first summer and to 
have largely disappeared during the following winter, and he ap- 
parently believes that the eruption during the second summer was 
not as marked as it was a year earlier. There is no history of an 
acute urticaria preceding the present eruption. One year ago he 
discontinued work largely because of the facial involvement. 

Treatment: About a year and a half ago he consulted Doctor 
Ernest, of Wilkea-Barre, and was told he would have to take treat- 
ment for a long white. For a short time he took what was yirobably 
mercury. The patient thought the skin enintion improved while 
taking it but complained of severe abdominal poin« and never con- 
sumed all of the tablets. 

About six months ago he consulted Doctor Butler both for the 
akin lerions and for some trouble with his nose. The physician nrob- 
ablT removed something from his nostrils under a local anesthetic. 
An interview oonld not be obtained with the physician so we are not 
sure what was done. 

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He visited Doctor McLanghlin at one time for treatment of the 
nose. About a week ago, Doctor McLaughlin told him to go to 
Pliiladelphia where it was thought he conld secure treatment in the 
City at the Pennsylvania Hospital, It appears that the only diag- 
nosis made by the physicians in Willtes-Barre was that of sypliilis 
and that he was sent to Philadelphia more to get expert advice and 
free treatment than for any other reason. He was probably advised 
to tell the Hospital authorities in Philadelphia that he had been 
living in the City for six months, otherwise, he'would not be admitted 
for treatment. 

He is said to have gone from Willies-Barre to Philadelphia by the 
Lehigh Valley line, leaving Wilkes-Barre in the morning of Septem- 
ber 10th. He was refused admifision to the Philadelphia Gteneral 
Hospital on the llth of September, and on the 12th of Septemner 
applied for admission at the Pennsylvania Hospital where a diag- 
nosis of tubercular lejirosy was made. He was detained and later 
in the day removed to the Philadelphia Hospital for Contagious 
Diseases, where the diagnosis was again made,' both on clinical evi- 
dence and, it is said, on a Laboratory study of sections of tissue. 
He is also said to have given a mildly positive Wassermann reaction. 

Physical Condition: A dark skinned, well nourished male about 
five feet, eight inches in heiglit, weighing al>out a hundred and sixty 
pounds erect in carriage, well formed head with good growth of 
black hair, showing a slight sprinkling of gray; forehead and eye- 
brows show numerous tubercles slightly elevated and varying in 
size from circular elevations an eighth of an inch in diameter, pit>b- 
ably coalescing from smaller elevate*! lesions, to nodules of from a 
quarter of an inch in width to half an inch or more in length — one 
such nodule almost merges into another large or small one as seen 
in the right eye brow. They show well in the photograph now in 
the file.s. The brows are thickened and beginning to overhang 
There are several tubercles of varying size above each cheek and 
several on the front part of the neck, one especially pronounced 
under the chin, and two smaller ones are seen on the posterior 
dependent portion of the lobe of the right ear. One of these ear 
lesions somewhat resembles a small wart. Eight or ten tuliercles. 
varying in size from an eighth to a quarter of an inch in diameter, 
with smooth surfaces and one having an umhilicated centre are vis- 
ible on the back of the neck, as are also several loose papillomata. On 
the hacks of both wrists and on the lower forearms also are a number 
of stnall flat tubercle*', and on each i^-rist is a scar of recent origin 

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said to be the site from which tubercles were removed Id Philadelphia. 
The skiD over these tubercles ia generally narmal iu color, but iu a 
lew it is dusky red, 

A series of scars resembling healed ring worms are present over 
each hip, some of them are as large as a silver dollar in diameter, 
others slightly depressed, all varying iu size down to that of a dime, 
believed by the patient to have existed since infancy, andare possibl^r 
a result of cha&ng when he was kept in cotton for three months in 
his babyhood. 

The skin over the crest of each shin is a darker brown than Would 
be expected in a Syrian, is thin, slightly scaly and lifeless; along 
the external plantar surface of each foot is a series of reddish-brown 
pigmented areas of skin a quarter of an inch in diameter. 

The cervical glands are slightly palpable, the epitrochlear glands 
are much enlarged, the axillary and inguinal glands are not palapable. 

Rough tests of the skin by means of pin pricks, pinching, etc, 
fail to show any areas of anesthesia. The eyesight seems to-'b* 
good although no careful tests were made. The mouth presents no 
abnormalities and the teeth are faii"ly well preserved. ' There ii a 
completely denuded raw surface on each side of the nasal septum, 
somewhat irregular in shape, each being about as large in diameter 
as a cent. The septum is so thin that Ught shinen through it 
readily. Some bleeding occurred from these areas while I was 
securing smear preparations from them. A rough physical examina- 
tion of the heart and lungs showed no particular deviation from the 

The left ulnar nerve is distinctly palpable at the left etbow, and 
when rolled under the finger seems to have twice its normal thick- 
ness. The right ulnar nerve appears to be normal in the same lo- 

For the purpose of seinring specimens for laboratory study, I in- 
jected a weak solution of novocain and removed from the left eye- 
brow a somewhat isolated friable tubercule fully half an inch long 
and a quarter of an inch broad and a similar tubercle fully an eighth 
of an inch in diameter from behind the right ear. These were dropped 
into a formaldehyde solution especially prepared by Doctor Bucker. 

Blood was taken for smears on slides and for smear cultures, 4t 
each incision and also from tubercles which were constricted and 
punctured so as to make the blood ooze directly through them. About 
five cubic centimeters of blood were removed from the external cep- 
halic vein and submitted for a Wassermann test. 

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Scrapings from the tongue and from denuded nreas in each nasii-fl 
carefully spread on slides and cultures from the nose were delivered 
to the laboratory with their blood and tiasue. 

Photographs were secured of the various areas of the patient pre- 
eeoting tubercles and of the man himself with the expectatl<H) that 
they would hare scientific interest and might be helpful in following 
treatment or in locatitig him should he escape quarantine. 

Pbotc^raphs were also secured showing liis wife and two children 
grouped with him, and of the other four inmates of the house — his 
brother-in-law, Abraham G , his wife, Barbara, and two chil- 
dren, Mary and Barah. Rough descnptive note« of emh uf these in- 
dividuals were made to accompany the photographs in caee they 
should escape the parole supervision of Wilkes-Ban-e authorities. 

Doctor B. S. Wadhams, deputy county medical Inspector, of Wilkes- 
Barre, assisted in the examination and in removing tissue, and vill 
retiim to take out the few skin stitches inserted where tubercles were 

Disposition of Patient: After going over the question of immediate 
care and and quarantine with Mr. Edwin B, Morgan, suj^erintendent 
of public safety, it was determined that the brother-in-law, Abra- 
ham G and family, ail of whom present the picture of health, 

migiit safely have au antiseptic bath, have their clothes disinfected, 
an^-be removed to the house of a lelative near by who is willing to 
house them, and that the wife and two children of X. might be simi- 
larly treated, and that the house owned and ocupied by N. shouid 
be placed under absolute quarantine for the present. An effort had 
alieady been made to disinfect this house with sulphur. 

While in the office of the director of public safely, wc coufeiiod 
with the poor directors and found fheni very much agiiinst having the 
patient removed to som£ isolated spot on the county poor farm, but 
had no difficulty in persuading them to ofl'er to give the usual indigent 
allowance for food maintenance. Arangements were made to have 
the matter brought before the poor board for a more extended discus- 
sion at a meeting to be held within a few days. 

Clinically, the condition i-osembles that of mild tubercular leprosy 
of about two years duration. The glandular stigmata simulate con- 
ditions se^i in syphilis, and the laboratory tests show him to be syphi- 

Dr. J, B. Rucker's report from the laboratory is as follows: — 

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"The case ol J. N., leper, Wilkes-Bnire, Pa.:— 

"Smeara from tbe ecrapinga trom tlie nose, tongue, eur, end eye-brow were 
received and stained with uurbol-tiichsin, decolorized with tea per cent, nitric acid 
-in alcohol unci counCer-s tallied with IjoelQer's solutiuD. Examined under the micro- 
bcope there appeared nmong the detritus and micrococci, numemua aggregation a 
o( acid-fast, rod shaped miurooi'gBiiisms, about tlie siie of a tubercle baciUuH, if 
anything a little shorter tban the human type of this orguiiiRm, muny of which 
were crowded together inside an epithelial cell or endothelial leucocyte -the bo- 
called leprosy globi — while others occurred single scattered throughout tbe smear. 
Moat of these rod slmped, acid-fast bacteria possessed a homogeneous protoplasm 
but many were also seen which had from one to four dark granules in their 
protoplaam . 

**TheiSe ur^nlsma took the red coloration with Uaumgarten's differeatinl method 
of staining as well as with the Ziehl'Nielsen carbol-fuchsin stain. 

"Parafbne sectiona of tuberclen excised from the eye-brow and left ear, stained 
as were the smenra atuve, showed tbe leprosy bacilli in great numbers within the 
epitbelial cells in bunches as well as free within tbe tissue. 

"Sections stained with eosin and haematosyliu presented the following picture: 

"Section from tbe eyebrow shows an opidi'rmis which has largely lost its papillary 
arrungemeiil. There is a break in its continuity, witb tbe corium beneath densely 
ioHllrutcd witb mononuclear tpucocytes. On the surface of the ulcer is a tbin layer 
of red blood corpuscles. Growing over tbe ulcer trom the niut^n is a rather dense, 
fibrODB tisBut;. 

"The corium is divided into smell Islands by a network of dense fibrous tissue. 
These islands consist of loose fibrous tissue, fut cells, iymphoc3'tes, and endothelial 
cells. Throughout the specimen there are lar.i^e numbers of hair follicles, almost 
all being surrounded by a thin band of dense .fibrous tissue. 

"Section from Che ear shows tissue entirely surrouuded by a thin layer of 
epithelium. Just beneath tbe epidermis is n dense Qbrous tissue layer which in one 
or two small areas has undergone hyaline degeneration. Tbe body of the specimen 
consists of fibrous tissue witb j'uung blood vessels and hnir follicles and leucoci'tes. 

"The complement deviation tests on the blood fram the right external cephalic 
V'>in vf iwsitlve, with the use of the three following antigens: Alcoholic Extract 
of Syphilitic Liver ; Ether soluble and Acetone ineoluble Lipoid ; Lipoid from 


Ib a«-cordan(e witb your instructions I proceeded to Sadabury 
Towiiehip, Lancaster County, on December 20th, in order to investi- 
gate the reported cases of "Hoof and Mouth" disease in human 
beings. The diagnosis had been established by Dr. George B, Her- 
shey, Qap, Lancaster County, and reported by him to County Medi- 
cal Inspector, Dr. J. L. Mowery. 

In company with these two physicians a careful study of the clini- 
cal features and the collection of specimens for laboratory analyses 
were made on the date mentioned. The family consists of Abner 
Boose, Mrs, Abner Boose, and five children, post-ofBce address, Para- 
dise, R. D. No. 1. T 


Mr. Boose stated that on a date nbich be cannot name he pur- 
chased seveial young cows from a stock yard in Lancaster and that 
on or about Ifovember 12th he noticed an eruption on the udder of 
one of them. This condition was relieved with home remedies. 
Shortly afterward several other animals became sick, practically 
stopped feeding, showed marked salivation, and developed similar 
lesions on the udders. A diu^iosis of Hoof and Afonth disease was 
established by agents of the State Livestock Sanitary Board on Nov- 
ember 23, and on November 30th, eighteen head of cattle, eight hogs, 
and two dogs were destroyed. 

Previous to November 23id, Mr, Boose had sold all of his milk 
supply, amounting to from nine^-flve to one-hundred pounds a day, 
to the Smyrna Creamery, Smyrna, Lancaster County. The Smyrna 
Creamery is one of tbe collecting points for Robert E. Powell, Dairy- 
man, 884 North Foityeigbih Kueet, PhiladeliAia. 

The first member of the family to show evidence of the disease 
was Beatrice, a child of three years, who developed her onset on or 
about November 20th. The next was Elsie, aged nine years, who 
became sick on December Ittb ; and then Ethel, aged sixteen mouus, 
on December 11th. It was imposaible to secure an accurate de- 
scription of all subjective phenomena which manifested themselves 
in the two younger children, but it is alleged that clinically the 
behavior of all three children was much the same. The history of 
Elsie, the oldest, shows that the onset was abrupt and marked by 
headachy aching of tbe extremities, difficulty in swallowing, and 
recurrent mild vertigo. It was evident that she had a considerable 
rise of temperature, noticeable particularly in the evening, associ- 
ated with chilliness and, during the first we^, mild delirium. The 
exact date of the appearance of lesions on the mucoua membrane 
and skin cannot be fixed, but appaiently it was .within a few days 
after the development of the subjective symptoms. Ptyaliam was 
a marked symptom, first observed at the (inie of tlie appearance of 
lesions. The latter are described as having been vesicular from the 
beginning; on the mucous membrane they lost their covering within 
a few days, leaving slight ulcers, wliich in every case healed with 
difficulty. They were observed oil the buccal mucous membrane and 
tbe gums, on the margin of the tongue, and on tbe lips. They were 
not observed on the pharyngeal wall, uvula, or tonsils. In two of 
the cases there was a bloody discharge from tbe nose. The lesions on 
the skin ocurred about tbe moutb, the alae of the nose, inner canthus 
of the eye, on the tips of the fingers — in one case simulating onychia — 
and in one case on the dor.Bum of the left wrist. Th^ were not ob- 
served elsewhere. 

ov Google 


On the date of the examination the first case, Beatrice, had en- 
tirely recovered. In the two other case^ the lesions on the mucous 
membrane were practically healed and on the skin they were cov- - 
ered with an encrustation, yellowish to dark brown in color, vai-ying 
in iiize from a split pea to a Rtnall soup bean, with inegiilar niargius 
and, after removal of the crust, leaving an area of granulat'on 
ti^^sue covered with a puriform dischai^e aud but little fre? bleednig. 
The crusts were homogenous, not having a granular or fiakey forma- 
li'in. The history of the lesions indicates that an iuljauuuatory 
areola was not observed. 

The clinical picture presented was that of an eruption on the 
bfcin and the mucous membrane of the oral cavity, appearing in fairly 
well nourished children, all having abrupt onset with severe consti- 
tutional symptoms, marked by cephalalgia and myalgia, increase 
of temperature, and ptyalism. 

The lesions on the skin with the exception of the type of encrusta- 
tion, resembled those of impetigo contagiosa. The crusts lacked 
the sulphur-like or granular character commonly seen in impetigo. 
The history of the lesions would seem to indicate, particularly if 
ptyalism be a guide, that those on the mucous membrane occurred 
prior to the greater number on the .skin. Impetigo would seem to be 
excluded by the severe subjective .symptoms, the marked disturbances 
of the mucous membrane in all cases, the type of the crusts, and the 
associated increase of salivary secretion. Ecthyma and the impetigi- 
nous pemphigus were thought of but were readily excluded by the 
history. The diagnosis made by Dr. Hershey was tentatively con- 
firmed ]>ending the studies of material collected aud shipped to the 
laboratory. Separate specimens from the nose, pharynx, mouth, fac- 
ial lesions, aud finger lesions were collected. Owing to the advanced 
stage toward convalescence it was diftieult to secure more than the 
most minule quantities. The laboratorj' report for each of the five 
8]>ecimen8 was "staphylococcus present in pure culture." 

Dr. Hershey staled that he had considerable difficulty in treating 
the children, suc(eM.s being observed fairly rapidly after the exhibi 
tion of iron, quiuine and strjchnine with arsenic. The lesions were 
treated topically with sulphur and glycerin in jjetrolatum and some 
ten days ago with argentic nitrate. 




On January 11, by your direction I proceeded to Bellefonte, Centre 
County, in compliance with tlje request of Dr. tj. M. Huff, County 
Medical Inspector, and Dr. James L. Seibert, to establish a diagnosis 
of an eruptive disease, euspeoted to be smallpox. 

The patient in question, a male, aged thirtj'-two years, employed 
by the Bellefonte Lumber Company, develoi>ei;l the onset on the night 
of January 1st and the eruption on Jijnuaiy 5th, Believing he had 
chicken pox he did not call a physician and was lirst seen by Dr. 
Seibert in the evening of January 9th. Dr. Iliiff siiw the patient on 
the following day. The diagnosis of smallpox was confirmed by your 
representative on January lltb. 

A conference with the local Board of Health was at once requested. 
It appears that the Board of Health had been inactive for upwards 
of four years but Ibe ofiice of Secretary was iu a sense held in per- 
petuity by H. C. Quigley, Secretary. Reorganization of the Board 
had not been effected since January, 1011. 

A search of Council Hecortis was made with the approval of Mr. 
Hariy Keller, President, and W. T. Kelly. Clerk. The following ap- 
pointments had been inade: — Dr. J. L. Seibert, appointed January 
1908, for Ihree years. Dr. W. J. Locke, appointed April li)09, to fill 
unexpired term of i>r. G. F. Harris (deceased) ; Dr. David Dale, ap- 
pointed December 1909; Dr. G. H. Haye.s, apiH)inted November 1910, 
10 fill unexpired term of Dr. J. L. Seibert (resigned) ; John Blan- 
chard, Esq., appointed July lfl]2, for five years. 

With the exception of Dr. Seibert who had formally resigned, it 
would appear that the persons legally qualified to organize a Board 
were; John Blanchard, Esq., Dr. R. Q. H. Hayes, Dr. David Dale, aud 
Dr. W. J. Locke. A meeting with these gentlemen and H. C. Quigley, 
Esq., was held on January 12th. The reasons for the inactivity of the 
Board seemed to be the failure of councils to adopt and to incor- 
porate into an oi'dinnnee the codification of health rules and regula- 
tions devised and assembled by the Board. The latter believed it 
could not operate successfully unless the rules and regulations were 
adopted as enactments by councils. This body refused to expend the 
Borough money for necessary advertising, which, it was estimated, 
would amount to $180.00. 

The attention of the gentlemen was called to the language of the 
Acts of Assembly establishing the ofQce of the State CommisFioner 


No. 15. COMMISSION]: It OF HE,VLTH. 318 

of Heallh, tlie Rules and lic^lations promulgated by liim, and the 
Act of May 14, 1909. They at ouce took steps to perfect an organiza- 
tion jind to enforce all tJie usual ineasureij. 

It is to be noted that the public health had uot been unduly en- 
dangered by reason of existing conditions. Through the efficient 
work of the Secretary and the Chief of Police, the usual quarantine 
had been established. The latter was employed by councils as Health 

With the authoiity and by the request of the Secretary, your repre- 
sentative with the County Medical Inspector, made a study of local 
conditions. The principal work was in relation to smallpox. In ad- 
dition to the case, mentioned above, one other case was diagnosed— a 
female, aged twenty-eight years, onset January 3rd. The almost 
coincident onsets in two persons of dissimilar social and other rela- 
tions and the current rumors that other cases existed, made it advisa- 
able to investigate further. 

The earliest case found was a male, aged thirty-five, in Axemann, 
Spring Township, onset I>ecember 25tli, 1913. This patient had been 
in Niagara Falls, New York, until December 30th, when he proceeded 
directly to his present address. Smallpox had been epidemic in 
Niagara Falls for a full year. 

This patient had been in contact with others on the date of anival 
but it would obviously be impossible for him to have been the source 
of infection of cases occurring in Bellefoute on January 1st and 3rd. 

There were frequent visitors between the rural sections of Centre 
County and Niagara Falls. Through such a channel may easily have 
come the infection of two cases of smallpox at the time just released 
from quarantine for "chickenpox" which were studied in Spring 
Township, the onsets being December 17th, 1913. 

No other cases were discovered. 


On February 20, 1914, in accordance with your instructions I pro- 
ceeded to the premises of David C. Good, 1 027 Market Street, Harris- 
burg, Dauphin Coimty, with Dr. J. M. Raunick, City Health Officer, 
in ordei to review the diagnosis of cases alleged to be smallpox. 

The husband, David C, Good, supposed to have been infected in 
Altoona, developed the eruption of smallpox on February 1st and 



vas removed to llie Pacitarj' Hospital on Februaiy 8th. The premises 
were placed nndci' :ibsolute quarantine on th£ same date. 

On reinspection in order to release the premises at the end of 
parole quarantine period, Dr. A. Z. Ritzman, Metlical Officer in charge 
of the Sanitary Hospital, established a diagnosis of smallpox in the 
case of Mrs, D. C. Good, This diagonsis was combatted by the at- 
tending physician, as it was alleged that she had been successfully 

An investigation of all persons on the premises developed the fol- 
lowing facts: — 

Bobert F, Good, a brother of David C. Good, aged twenty years, 
had been visiting in Barnesboro, Cherrytree and Cresson, and Spang- 
ler during the latter part of November and early part of December, 
1913. He then returned to Altoona, the home of his sister-in-law 
on December Iflth or 20th and found the premises under quarantine 
for smallpox. He resided with Walter McCreary at 8th Avenue and 
19Ui Street, until the release of the premises of Joseph Good. He re- 
mained at the latter place until January 14th, developing an eruption 
about Januaiy 10th. On January 14th he proceeded to the home of 
David C. Good, in Harrisburg. 

There is a history of a well defined rash, supposed at the time to be 
chicken pox, which appeared on Virginia, agetl thirteen years, dau^- 
ter of David C. Good, on or about December 15th, 1913. There had 
been iutimat^e contact between the family of Joseph (!ood in Altoona 
and the family of David C, (Jood in Harrisbui^. Virginia had been 
unsucces.sfully vaccinated on February 9, following the diagnosis of 
smallpox in her father. 

Mrs. David 0. Good gave birth to a son on February 4th and an 
eruption apjieared on February 7th. Tlie eruption was not noted 
and she was vaccinated on February Uth, without success. She had 
been unsuccessfully vaccinated ten years previously. The cicatrix 
from this attempt found on the inner aspect of the left leg is prob- 
ably the i"esult of the trauma, not of a reaction. The prodromal 
Hj'mptoms of smallyKix were confused with the symptoms of the 
puerperal state, and for (hat reason a diagnosis of smallpox was neces- 
sarily based on the emi)tion. The latter appeared first on the face, 
somewhat later on the hands and feet, its entire time of appearance 
covering thirty-six hours; the lesions were distributed on the face, 
scalp, and exti-eniities, a few le.«ions apitcaring on the cheat and the 
upper portion of the back. They were much greater iu number at 
the distal points of all extremilies and were found on the soles of 
both feet and the palms of both hands. The description of the erup- 
tion as given by the patient indicated that they were at first papular, 
becoming vesicular after twenty-four hours and then rapidly pustular. 



It would seem from the time of coiitact with Robert Good, the evi- 
deoce of unsuccessful vaccinatioo, aud the character and distribution 
of the skin lesions that the patient was suffering with mild smallpox. 

The baby, David, Jr., bom on February 4th, developed an erup- 
tion on February Sdi. At the time of examination the lesions were 
in the pustular stage and were associated with a marked erythema 
particularly over the lower extremities. A diagnosis of smallpox 
was made in the cases of Robert F. Good, Mrs. David C. Good, and 
David Good, Jr., aud a probable diagnosis of smallpox in the case of 
Virginia. This opinion was given to Dr. J. M. Raunick, City Health 

The attendiug physician was indicted for negligence in not report- 
ing the cases of Robert F, Good, Mrs. D. C. Good, and David C. Good, 
Jr., and for delay in reporting the case of David C. Good. A hearing 
was held on February 27th. Your representative was subpoened. 
By agreement, the case of Robert F. Good was dismissed. The physi- 
cian pleaded guilty and was fined f20.00 and costs iu the case of 
David C. Good, and |30.00 in each of the cases of Mrs. D. C. Good and 
David C. Good, Jr. 


On the 12th of January, I was called to North East to investigate 
what was reported to be a suspicious eruptive disease in North East 
township, jnst outside (he borough limits. The investigation showed 
a patient suffering from smallpox. I was informed by the parents of 
the child that, if my diagnosis was correct, there were a number of 
other persons ill with the same disease in the Borough of North East. 
On investigation, I found several cases of the malady within the bor- 
ough limits, all of which were at once quarantined. I also discovered 
that a number of other persons who had been ill during the previous 
month, but had fully recovered, had suffered from a disease which was 
undoubtedly smallpox. As a result of this, the Board of Health of 
North East was informed as to the existing state of affairs and a sys- 
tematic canvas of the town made with a view of ascertaining if any 
other persons were or had been afflicted with this ailment. Through 
this investigation, it was discovered that in a family by the name of 
Armink, residing in North East township, j'u-Ht beyond the borough 
limits, there had been entertained late in the autumn of 1913 a rela- 

21—19—1916 iv^lc 


tive from tbe State of Washinffton, who was ill on his arrival in 
XoTth East with what was sii|iposed to be grippe. This was followed 
by a rasb, whicb the attending physician called a "fruit rash," result- 
ing from eating grapes which had been frost-bitten. Following thin, 
all members of the family had a similar disease which gradunllr 
spread throughout the community. 

Unfortunately, iu connection with this outbreak, chicken pox was 
also epidemic in tlie community and there was a great deal of trouble 
in differentiating between the two diseases. It was also difficult to 
convince the people that both maladies were existent in the com- 
munity. By the exercise of a little diplomacy and considerable brute 
force, the Boards of Education and Health were convinced, however, 
that they must comply with our rej:ulations ; unvaccinated children 
were excluded from the public schools ; all suspicious cases were quar- 
antined until a definite diagnosis was obtained; and. after one hun- 
dred and sixtj'-eight cases of smallpox had occurred witliin the bor- 
ough limits, the disease was stami)ed out. As a result of the exposure 
before the disease was diagnosticated eighty-six cases of smallpox 
developed in North East township. 

It is interesting to note in connection with this outbreak eight rases 
coming under my personal' observation of children who had suffered 
fioni chicken pox during llie fall of 1013, whose parents insisted Chat 
no sniiilljiox existed hut tbe two ailments were the same, and hence 
i-pfnsed vaccination. Later these were attacked by the more severe 

While much pas.«ive resisfnncp was met with in connection with 
quarantin.e and vaccination in (his community, only one case of actual 
breaking of quarantine occurred; prosecution was instituted and a 
conviction obtained. 

Twenty-seven cases of smallpox also appeared in Wa.shington town 
ship during April and May. The source of infection in these cases 
was ascertained to have been brought into this community by a per- 
son living near the village of McLane, who had contracted tbe disease 
while on a visit to one of the western states. 

A systematic following np of all persons who had been exposed in 
any way, and the closing of one of the township schools, soon re- 
suMed in eradicating the disease from this neighborhood. 

Twenty-two cases of smallpox occurred dnring the year in Venango 
township, tlie source of infct-tion being an ontlireak in the borongfa 
of Tnion City. The sonne of infection in that borough was trace- 
able to the visit of the patient to Ripley, N. Y., where she contracted 
the dLsease through coming in contact witb what was supposed to be a 
case of chicken pox. Through this medium a number of persons were 
exposed and thirty-six cases in all developed from this exposure. 



Smallpox was also noted io Greenfield, McEean, and Waterford 
townships. Four casea also developed in a family in Elkereek town- 
ship, the source of iofecliou betug relatives of the family who lived 
in Gonaeaut, Ohio. 

An outbreak of this ailment also occurred in Springfield township, 
the source of which was tj-aced to Cleveland, Ohio, It is needless to 
say that, in all instances, rigid quarantine was established and vac- 
cination urged, with the result that no other cases appeared. 

Twenty-six persons suffered from smallpox in the City of Erie dur- 
ing the year, five outbreaks ftom as many different sources occurring. 
Vaccination was ordered in the public schools and a number of vaccine 
physicians appointed. As the result of this effort, forty-thi-ee hun- 
dred school children were vaccinated, a very large percentage success- 
fully. Much opposition was mimifested, however, and an Anti-Vac- 
cination movement organized, which later became permanent under 
the name of the "Erie Anti Compulsory-Vaccination Society." This 
oi^anization has taken the case into court with a view of testing the 
vaccination law, and, at the present writing, no decision has been 

There were also three cases of smallpox in the City of Corry, all 
occorring in one family, the source of infection being due to the visit 
of one of the members to friends in New York State. I may say that 
Erie County is an Anti-vaccination centre, and we have not only those 
wbo are opposed to vaccination in any form, but those who are op- 
posed to compulsory vaccination. In addition we have those who ob- 
ject to vaccination as ordinarily applied and believe its administra 
tion internally to be the proper means of obtaining protection from 
smallpox. It is needless to say that the tatter belong to the ultra- 
homeopathic school. 


In compliance with instructions received through the Chief Medical 
Inspector, I proceedpd on March 17th. to investigate an epidemic of 
smallpox at BiHmeyer, Oonoy Township, Lancaster County. 

Billmeyer is a small village situated on the main line of the Penn- 
sylvania Railroad where the Dolomite Quarry Company has its head- 

I, Coogic 


The rnmpany employs about three hun«lrefl men at these quarries, 
prnctically all of the employees being foreiffnera or ne?rocs. They 
live at Billmeyer or at Bainhridee, a Ini^r town on the PennRV'lvania 
R. It., about a mile and a qnarter north of Billmeyer. 

Doctor J. L. Mowery, the rountv Medical Inspector, had established 
the rtiaenosis of smallpox. The investigation showed that the first 
case was (hat of a colored woman — Carrie Robinson — who is re- 
ported as havinp come to nainbnd(!:e from Virginia a few days before 
the onset of the disease. 

A summary of the cases is briefly as follows: — 

C«m, Itobln«fm 



Hefty TlmMBk 



Barret TlmhUlt 



John I>lrkpr»r, 



AlbPTti Tlnblnli 


.>. Rnlnhrirtiw 

Mitohcl) Itiinka 



ppnrt TlmhUt 



Lllllnn TlmWiik 



Mm. A. WwHlarf 



Alllf Pri« 



Kramt Hitebm 



With the hearty co-operation of the manapremcnt of the Dolomite 
Qnarrv Company, and under the supervision of the Oonntv Medical 
Inspectoi- — Doctor J. L. Mowerey — it was arranged to do a whole- 
sale vaccination of the employee's at the Tlillnieypr Quarries. 

By a happy coincidence it was payday and everv employee was at 
the Quarries, but no man received his pay e"nvelopc until he sub- 
mitted to vaccination. All employees, includinft the office force, or 
about three hundred and five persons were vaccinated. 


In accordance with instructions I proceedwl to Jamestown Bor- 
ouph, Mercer County, on November 2S, in order to investigate the oc- 
currence of an eruptive disease for which a definite diagnosis had not 
been made, 

Jamestown is located on the Tittsburgh and F,rie Division of the 
rennsylvania lines west, ninety miles north by west of Pittsboreh; 



and also on ths Lake Shore and Michignn Southern Hailway. By the 
latter, the residents have easy access to points in Ohio. The popula- 
tion in 1890 and 1910 was 822. Xo indnstrial or social factors have 
been introduced within five years which would lead to any notable 
change in population. 

The local Board of Health is officered by Tir. O. H. Bailey, Pi'esident, 
and D. W. Burnett, Secretary and Health Officer. The Board has 
been very inactive, not moi-e than two nieetinps hnving; been held dur- 
ing the past year. According to the statement of many residents 
there have been but few cases of communicable disease during the 
past fteveral years. 

The history of the present outbreak began with the onset of one 
Muriel Whaley, aged seventeen, whose home is in Oonneaut, Ohio, and 
who visited Jamestown first on August IT. The Ohio State reports 
show that mild smallpox, frequently undi!tgiio.sed or diagno.sed as 
chicken pox, has been continuously present in Ashtabula County, 
Ohio, since th^ early summer months of the present year, the larger 
number of cases occurring in the towns of Ponneant and Ashtabnla. 
There were nimored visits of other persons from this same county 
to Jamestown and vicinity but, during the course of tiie investiga- 
tion, evidence of any other visitor with an eruptive disease was not 

The onset of Muriel Whaley did not occur until thirty-five days after 
her arrival in Jamestown and the only evidence that she was the first 
case is that hers was the tirst discovered case with an enipfive dis- 
ease and that she had been in indirect contact with her home in Oon- 
neaut, Ohio. Tn .Jamestown she visited the home of an uncle, John 
Wier, the four members of which subsequently developed the disease. 
The onset of Mrs. C H. Monger, a neighbor, was on September 19. 
This indicates that some other case was the common source of infec- 
tion for both Miss Whaley and Mrs. Mun^r. Xo snch case could be 
found at the time of my investigation, two and one half months after 
the onset of the earliest cases so diagnosed. 

The data furnished by the local physicians and Dr. P. P. Fisher, 
County Medical Inspector for Mercer Conntr. sliow that the signifi- 
cance of the eruption was not suspected until November 19. There 
arebut two physicians in active practice in the Borough and the ma- 
jority of i>ersons found to have shown the eruption between the ill- 
ness of the first and the twenty-first cases were not seen by either 
physician. Such persons as were seen by them were apparently not 
examined in detail and in the absence of a definite history of prodro- 
mata the diagnosns of impetigo contagiosa was made in several cases. 
On November 19 a few sufficiently well developed cases were seen 
by the local physicians who called in consultation Connty Medical In- 
epectOT, Dr. P. P. Fisher. In his report, dated November 25, he 

^ ...fTc 


stated that he did not establish a dtagDosis bnt in the same report 
gave a description of clinical features which are undoabtedly thoBe of 

At the time of his visit the cases of the patients in two families 
were tentatively diagnosed as chicken pox and the premises were so 

The clinical history of twenty-one cases studied on December 3 and 
4 by your representative was as follows: — abrupt onset with general 
headache and fever in all cases ; anorexia, aching of the back end ex- 
tremities; chilliness and sweating in varying combinations in the ma- 
jority of the cases; the disappearance of all subjective symptoniH 
within thr£e to four days after the onset ; the appearance of a papular 
eruption in all cases on the face and distal portions of the extremi- 
ties within twelve to fourteen hours after recovery from subjective 
symptoms. The legions rapidly passed through the morphol<^cal 
changes of the usual classical picture of smallpox, the time iietween 
the first api>earance as a papule and the stage of encrustation averag- 
ing less than five days. 

Tn addition to these features the history pertinent to the diagnosis 
was as follows: — 


VHCclMled Con- 



Chli-keo Poi. 

tacH K.™Hnf 

Ton tacts 4i- 




qairlDf UtKBH. 






























Twlcf UOBUC. 





• Tc» 







The striking features are that twelve of the twenly-one cases were 
more than twenty j-ears of age; that only two of the twenty -one had 
previously been auocessfully vaccinated; that no person vaccinated 
after recovery from the disease in question gave successful resultR: 
that thirteen gave distinct history of chicken pox infection during pie- 
vious years; and four were uncertain but believed they had had 
chicken pox during childhood; and finally that all in household con- 



tact who had previously been succ^sfully vaccinated escaped the dis- 
ease while all unvaccinated contacts are included in the list of cases. 

A diagnosis of smallpox based on these findings nas established 
and this opinion given to the members of the Board of Health who as- 
sembled in special session on Kov£mber 4th. The Board was not 
equipped wilh the necessaiy outfit to institute the proper quarantine 
and for that reason the placards on smallpox and the circulars on 
vaccination were furnished for distribution by the Department. 

The hi8toi7 of contacts was obtained by Dr. C. II. Bailey, President 
of the Board of Ilealtb, who supplied the County Medical Inspectors 
in Crawford and Mercer Counties with a list, and who notified secre- 
taries of Boaids of Health in Boroughs to which cases were alleged 
to have gone while ill with the disease. 

It was stated by Dr. M. A. Bailey of Jamestown, a member of the 
School Board, that the vaccination law had not been rigidly enforced 
for a period of six or seven years. By his request I met with him 
and one other member of the School Board to consider this question. 
Following the visit of County Medical Inspector Pisher, all school 
children had been vaccinated with the exception of two or three who 
were excluded from school. As these had been in contact with 
known cases of smallpox the premises occupied by them were placeil 
under absolute quarantine for a peiiod of eighteen days. 

Certain patients were employees of the two railroads. The super- 
intendents of the Divisions were notified by telephone, with subse- 
quent confirmation by letter, advising them of the occurrence of the 
disease and advising immediate vaccination of all employees. This 
was at once and fully complied with. 

The County Medical Inspecfors in Crawford and Mercer Counties 
were instructed by your representative to make special investiga- 
tions in districts in which known cases were alleged to have visite"! 
and to make an inspection relative to vaccination in the township 
schools in their respective counties, immediately contiguous to the 
Borough of Jamestown. The report fi-om Mercer County shows that 
of an enrollment of ninety-nine children in seven rural schools only 
twenty-four were vaccinated. The attention of the school teachers 
and directors was called to the necessity of enforcing the Act of As- 

ov Google 




Inspection PraeUcally Completed at the end o/ 19H. 

J, Google 




School Medical Inspection lias continued as during the lasl three 
years and it is very gratifying to note tlie change coming over the 
various communities where inspection has been carried out and to 
note the growth of the work as set forth in the following tables. 


It will be seen that beginning with 145,490 pupils during the first 
inspection under the School Code the work has increased rapidly each 
year so that now practically 470,000 pupils are examined in a single 
inspection period; and during this inter\'al of four years since the 
adoption of the School Code there has been a physical inspection of 
more than a million and a quarter school children. A few districts 
continue to deny children the benefit of school inspection, usually 
through a misunderstanding of the law or through some undue influ- 
ence in the community. 

It will be noted that (his year 2,159 of the 2,377 Fourth Class 
School Districts accepted school inspection, that is, they did not 
pass resolutions informing the Commissioner of Health that they did 
not desire it. Not a district in the eight counties of Cameron, Clar- 
ion, Klk, Lackawanna, Montour, T^nion, Wayne, and Wyoming denied 
school children the privilege of medical inspection, and in each of the 
following twelve counties but a single district placed itself on record 
as being unprogressive and backward: — Bradford, Chester, Clinton, 
Delaware, Forest, Lawrence, Lycoming, McKean, Monroe, Pike, Pot- 
ter, and Venango. 

As in previous years the Department directed the Health Officers 
throughout the various counties to make a sanitary survey of such of 
the 218 Fourth Glass School Districts as were located in Second 
Class Townships, and this year for the first time sent the County Medi- 
cal Inspectors to make sanitary surveys in districts of the Fourth 
Class that included boroughs in the various countie.". In this way 

dlitrlcU not eHcdnluc tfaali npUOB 



sanitary inspection was extended to every district of the Fourtli 
Class and medical inspection to a very much larger number of dis- 
tricts than has ever been reached in the history of tlie Commonweal th, 
Xof only la the table showing the various defects and the percentage 
of the more important defects one of considerable interest; but when 
certain of the importaut defects are placed in parallel columns for 
the pui-pose of bringiug out the improvement that has occurred, the 
value of the work is made to appear in a very graphic way. 

Perhaps a word of explanation maj' be required for the percentage 
of defects of vision — 17.8 per cent, in 1914 as contrasted with 29 
per cent, in 1911 and with 24.2 per cent, in 1913. There was un- 
doubtedly some gradual reduction in the percentage of eye defect^, 
found ; our figures each year are 

mil, 29 percent. IMS '. 24.2 p*r wnt. 

1912. 27 percent. I8H, 17.8 p« cent. 

and a good part of the reduction may perhaps be attributed to educa- 
tional work both by the Department of Health and by the various 
ophthalmological societies throughout the Commonwealth. A small 
portion of this reduction, perhaps two or three per cent., may have 
been due to a slightly different method of classifying errors of vision 
adopted in tabulating results. 

The extended statistics for the year 1914 covering 469,199 pupit» 
are grouped by normals and defectives, by sex and by nativity, the 
table being arranged by counties. No material difference occurred 
in any one county as contiasled with other counties. The same tabu- 
lation of single defects and of single defects associated with other 
defects is carried out as in previous years; the total number of de- 
fectives at this time grouped in this table covers 335,427 pupils. 

It is somewhat inter.esting to note that during the entire school 
year, (or which we are reporting physical examinatioUs in 469,199 
pupils in the Fourth Class School Districts by Department Inspec- 
tors, in the city of New York a total of 305,665 pupils received such 
inspection. In other words, the Department lusirectors iu Fourth 
Class School Districts examined over 160.000 more school childreu 
than were examined in Aruei'icR's greatest metropolis. 

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Letters to Parents. Tlie work of forwarding notes to parents call- 
ing attention to defects found in their children by Department ex- 
aminers was changed a little in order to comply with certain rnlings 
of the post-office authorities. The letters in blank were sent to the 
teacher, and duplicate copies with the names of pupils and the defects, 
with the request that the teacher mail iu stamped envelopes furnished 
for the purpose the various notes which she was instructed to make 
out. This method has not been quite as satisfactory as that used dur- 
ing the preceding year and it would seem as tliough it were better to 
do all the clerical work in the Department's ofiBces and send tlie notes 
to the teachers to be forwarded through the pupil found to be de- 
fective, having this pupil hand the note to the parent or guardian. 
This'would be in compliance with the postal regulations and relieve 
the teacher of considerable clerical work, and perhaps bring about a 
litUe closer cooperation. 

Returns from Teachers. Notwithstanding the additional clerical 
work placed on the teacher by the change in methods a very much 
larger number of them returned records of pupils at the end of the 
season than in former years. Out of the 17,697 school rooms in the 
schools having complete medical inspection, with of course the same 
number of teachers, 13,863 sets of records were returned to us 
by that number of teachers at the end of the school year — in other 
words, seventy-eight per cent, of all the teachers of the Fourth Class 
Districts whose schools have been inspected are so actively interested 
in school medical inspection that they readily comply with our re- 
quest to return records for the various pnpila The follow-up reports 
are of much interest in that they show twenty-two per cent, of the 
pupils reported as defective getting some sort of treatment and that 
ninety-flve per cent, of pupils receiving treatment are reported by 
the teacher at the conclusion of the school year as being distinctly 
improved by treatment. 

Letters are received from time to time from teachers volunteering 
information concerning certain of their pupils. The following note, 
appended to one of the return reports, is but one of many; 

"Reed No. 12 School— Mil loroek Township, Erie Co. 

•'The majority of children einmined were benefited by it. The trouble 
and expense ot the eiamination of the school was more than repaid in 
the beDefit derived by one child, No. 61,730. She was positively ttupid 
in her recitations and was failing in her grade. 

"Upon the i-epoi-t of the Medical Insaector of our school she was 
operated on in our lociil hospital and notwithstanding hor loss of time, 
Bbe baa completed with ease two year's work in Icat than one year's 
time; proving that a bright mentnllty cup be figged by special conditions 
that CDD b« remedied and the helpfiilneHS of this work. 

"MBS. C. M. SHARP, Teocher.- 



Home change in noted fi-oni year to year in the sanitary conditions 
of the schools and }'ct as our ideas of school hygiene advance and as 
the school ihspeclors become more and more interested in the work 
our standards are set a little higher so that while the percentages of 
insanitary coaditious as pre^nted ate high, had they been placed 
on the same basis as in pievious years yet greater improvement would 
have been noted. Insanitary methods of sweeping seem to have 
been reduced from sixty to fifty-one per cent.; insanitary dusting 
from forty-three to thirty-two per cent. ; insanitary water containers 
from thirty-seven to twenty-five per cent.; improper method of clean- 
ing water containers from fifty to forty-four per cent. The common 
drinking cup remains in use in thirtyseven per cent, of the schools, 
and the common towel in thirty-eight per cent of the schools. In- 
sanitaiy conditions in connection with the various outbuildings 
have improved in a great many instances. The same custom has 
been followied of notifying school directors of each insanitary con- 
dition found by the school examiner and a complete copy of the 
sanitary survey for each room and building is sent to the School 

laapection practiciillr completed at the end oE 1911. 

Number of gcbool buildiDga inspected, 11,006 

Number of st'LooIs inspected, l?,flB7 

Number pupils inspectiid 409,190 

Number pupils defective, 335,427 71.5% 

Niunber pupils not defective, 133,772 

Number having single detects 184,900 

Number having multiple detects, 150,527 

"Total number of defects, 551,671 

Total pupils, treatment advised by letter 304,619 9". 8% 

'Counting both defective eyes or both defective ears as two defects, the total 
number of defects reaches 618,133. 


Pupils having defective vision, 83,748 17.8% 

Kight eye, 13,184 

Ij^ft eye 14 ,750 

Both eye 65,814 

Pupils hnving other eye nlTpctious, 5,612 

Curnciil scars, 1,717 

DIf phHritis 1,400 

Conjuuctivitis simplex 1.337 

Conjunctivitis folliculariH, 1 7 

IriUs 1 

Triicbomn , 4 

Strubismus, 1,001 

Astigmatism (spenal tests not made), 55 

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FupitB heTing d^Fective licarms> 

Right ear 2,181 

Ijitt ear 2,791 

Both ear* 10,fl*8 

Otorrhoea aiFe<rtiiig hearing, 


Pupils having defective breathini; 

Slidht impairment 15.009 

Serious impairment. 3,244 

Mouth breathing, 4,584 

Papils having AdpnoldB (mispected) , 

Pupils having Uoitre 


Pupils having defective teeth, 

Dirty teeth, 3S,48B 

Decayed teeth 212,708 

Gums d isoased , 


Piiplts having enlarged tonstlB 

Slightly enlargt-d 78.260 

Greatiy enlarged 43,548 

Acutely inflamed tonsils, 1,414 

Pupila having enlarged cervical glands. 


Pupils reported hb hairing tuberculosis, 

Tuberculosis of lUDgs, 2A4 

Tuberculosis of glands, 4CB 

Tuberculosis of bones, 57 

Tuberculosis of joints 63 


Pupils having nervous diseases of grave import 

Chorea, 648 

Epilepsy , 107 


Pupils having skin affections. ., 

Scabies, 57 

Impetigo ContB^oaa, 293 

Fnvus 5 

RingwoTm 46 

Head Lice 4,878 

Body Lice, 4 

Eciema, 369 

Acne 345 

Other miscellaneous skin aHectiona 301 


Pupils reported as having defonnitieB, 

Hunchback , 20 

Club-foot, 76 

Curved spine, 185 

Ankylosed joint, 31 

Hnrelip 42 

aeft palate 140 

MiBcellaneoua deformlUea, I.ISI 


Pupils with BUb-normal nutritiiMi 

Sight, 7.S44 

Marked 1,034 


Piinil<< in school that should have been in quarantine, 

Chicken pox 3* 

Whooping cough, 22 

• Kmatin thf VIfLod <Mrt\f w«« (ound op. t-ip" Wind In l">th rjr*. 

2-52,174 53.7% 



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lEAU, 1914-1915. 

Total nuiuber of schaola iuapectcd 17,8D7 

Totnl iiumb-T of pupils iuspecti'd, 4U!), lUB 

Tutul iiuinber ur pupils, UeutiQi'ni; udviMed by leittT jOi.ilia 

TeatliFrs returning; reports :ic cud of trrw 13,8G3 78.3% 

PupilH iududeti iu rtturu reports, 242,512 

Pupils reported Created, 04,9!1 f22.a% 

Pupils reported not treated, 100,248 06.1% 

FupQs, reported with do ret-ord ol treatmcut 27,:i45 11.2% 

Pupils died during term, 107 

Pi'pilH reiMTted imprnyed bj treotmeut 52,405 

Per cent, of treated pupils, improved S5.4% 

PupilH rtporCi'd unini;irijved by Lrentmeiit, 525 

Per cent, of Irented pupils, unimproved 0.9% 

Pupils, ri^ults of trentmcut nut stated by teacher 2,011 

Per cent, of treated pupils, results not stated, 3.7% 


Total. Improved. Unimproved. 

Vision 10,0il 0,860 503 

Heurinit, 1,321 782 182 

llreathing, 1,190 724 7B 

TePth ■, 45,119 45,110 

Tonsils 0,»M 4,373 2UB 

Cecvioil elands , 1,153 665 40 

Tabercutosia — Lungs 89 37 17 

-Glands 92 54 II 

—Bones, 6 3 

— J&inte, 20 7 1 ■ 

Nervous Dieeosee, 168 88 34 

Sliin Diflenses 150 116 8 

Deformities, 12 5 1 

Malnutrition, 178 107 20 

Miscellaneous Defects 2,641 2,506 43 

Total, PerCt. 

Total Fourth Claaa School District' in Stnte 2,377 

DistrictH inspectPd by State Inspectors, 2,353 

Ry Sehool Medical Inspectors, 2,134 

r.y tlealtb Ofliccts or County Medical Inspectors, ... 219 


Total roomp- inspncted bv State Inspectors 19.892 

r.y H--\,t..] Slnditnl In spec to re 17,S23 

By Benltb Officers "r County Medical luspeetars 2,' 

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Rooms luivmi:: 

Less than 13 sq. ft. floor surface per pupil, 1,416 7.1 

i.fsa thun 2U0 cu. ft. nir ap:icc pt'r pupil, 2,72S 13,7 

lusauitar; aweepiug prnctiaed, lO.lH 51.2 

Dry dusting pruetiKed 6,387 3S.I 

Light admitted frum the fruut of wnted pupilu l.OSS 5.S 

Light area less thnn 20% of fluor surfnce 8,368 42.1 


Tiital Sehool BuildiuKR inBper-tf^ by KtiitP luspni'tora, 12,5!S 

By Hchoo! Medioal Inspectors, 11,036 

Hy State Health OfTicers 1,-I«J 

Single room buildings inspected 10,020 

Multiple room buildings innpiitod 2,50.) 

Ituildings sanitary in nil partii'i'liirs, 180 l.S 

lluildiiigH itiivtnitary in one ur inure ixiiuLi 12,336 9S.5 

Ituildings having; 

No nd juBtnblp seats or foot stm-la in use, 8,843 70.8 

Ordinnrj stoves In use, unjaclieted 4,812 38,6 

Modern single room ventilating lientfrs in use, 2,705 21.6 

No therraometpr in use, 4.877 37.3 

No provision to keep warm nir muiHt, 7,996 63.8 

No fresh air inlets nt stove or furnace 8.48.'! 67.8 

Fresh nir inlets subjcr't to eontiirainatiou, 332 2.6 

Merhnnionl (fant s.vatem of vrntiliition in use 146 1.2 

Windows the only means of vrntiliition, 8,315 74.1 

Not open during HeRHion. 003 7.2 

Ventilation boards or shields not in ukc, 7,033 S6.I 

RuiLnixn)^ OF MORE Til Ay oyi-: t^ronw 

Eiit doors do not open outward, 214 

No iron fire escapes provided 1,371 


Unsafe 1. 015 8.1 

Menneed by surface drainage, 928 

Menaced by privy vault, cesspool, or manure 

wep'ige, 261 

Insanitary wntcr container in use 3.140 25,1 

Container not pn^ierly elennnl and relilled, 5,587 44.6 

Public or municipal water supply in use, 1,188 8.6 

Sanitary drinking fouDtnin in use 1.162 9.S 

Common drinkini; eu|> still in use, 4,664 ST. 2 

Common tnwcl in use, 4,8U 38,4 


Insanitnrj-, 1 ,568 12,5 


Separate accommodations not provided for ™cl> sex 64 05 

Kntrances not legally screened 5.R03 46,3 

Privies nneleun 2.816 22,."! 

liase not tifthtly riosed 6,401 ."il ,3 

Insanitary vaults, 9,000 71.8 

Vaults full S.RW 3(1 H 

lime or other disiutectiint not used, 6,1.)2 49.1 


SIiHipm flush dosi'ts in use 601 

Flush closets unclcnn 10 

Flush elosets improperly trapped and vented, 81 

The followinfi two liundred and ninetwn Fourth Class School Dis- 
tricts exercised their option under Section 150;^ of tlie School Code not 
to have Medical Insipeclion of Schools. 
ADAMS COrXTY. Toir„>hip*: fJcrmaiiy. L.'itimore, Bending. Stmban. Ty 



BEAVER COVXTY. Tuicntkipt: Ohio, Raeeoon. 

Borough: Itonring Spring. Toxnatkipi: Catharine, Nortli 

BRADFORD COUNTY. Townihip: Omnville. 

BUCKS COUNTY. Borough: Trumbauersville. ToKii»h%pa: Fails, HiiitowD. 
Rirbluiid . 

BUTLER COUNTY. Boratigh: Harmony. Totonthipi: Adams, Ciinton. Ven- 

CAMBRIA COUNTY. Boro«gh»: Asbville, EbeoBbiirK, Soutii Forlt. Touinthip: 

CARBON COUNTY. Borough: Weatlieriy. Toicinhip: East Pciin. 

CENTRE COUNTY. Bbrovgh: Howard. Toanihip*: Gregg, Howard, Liberty, 

Potter, Union. 

CHESTER COUNTY. Townaftip.- South Coventrj-. 

CLEARFIELD COUNTY. Borvnphi: Kurrside. TroutvUie. Tovnahipn: Boggn, 
Brady, Covington, Girard, Goslipn, Murrix, Union. 

CLINTON COUNTY. Borough: Beecli Creeli. 

COLUMBIA COUNTY. Toicnihipi: Cleveland, Jnclioon, .Mt. Pirasant, Orange. 

Totonakipi: BlooraGeid, Rreen- 

. Newton, 

DAUPHIN COUNTY. Totcnthipi: East Hanoyer, Bush. 

DELAWARE COUNTY. Township: Bethel. 

BRIB COUNTY. Borough: Middleboro. Pleasant Hill Ind. 

FAYETTE COUNTY. Borough: Point Blarion. Toatishipt: BrownsTille, Frank- 

liii. NichnlKon, Springhill. 

FORECT COUNTY. ToKnship: Tionexta. 

FRANKLIN COUNTY. Tov-nthipi; Antrim, Greene, Qiiinoy. 
FULTON COUNTY. Totcn»hipi: Belfast, I-icking Creek. 
OREENE COUNTY. ToicMhip): Franklia, Jackson, Spriiighill. 

JUNIATA COUNTY. Toicnihipa: Ijick, Spruce Hill. Tiisenrora. 

LANCAS^TER COUNTY. Borough*: Akron. Marietta. Mt. -Toy. New Milltown 
lud,, Strnsb'iri. TTFe nill. Toirtiahips: Brecknoclt. Colerain, Epbrnta, Little 
Britain, Manheim. Paradise. 


LEBANON COUNTY. IToicrufti/n; Bethel, East Umiover, Swatara, West Corn- 

LEHIGH COUNTY, Boroughi: Coplny, South Allenlo 



LUZERNE COUNTY. Itorough: West Wjoming. Townthip: Slocum. 
LYCOUINO COUNTY. Tnwnthip: Woodward. 
ilcKEAN COVXTY. loicnthip: Libertj-. 

iifksuu, }tli11 Cri-ek, Pjma- 

MIFFLIN county: Uorough: ISuiDhoni. Totenship: Union. 
itONKOE COUNTY. Township; Pulk- 

NOUTIIAMFTOX COUSTY. Touxiahipi: Upper Mt. liethel. Williams. 

PERRY COUNTY.' Ilurough: Ijiudisbuvg, Tvwnahipt: NortUeast IMadison. PleHB- 
nnt VnQey. 
PIKE COUNTY. ToicnMp: Delaware. 

Boroughs: CieKnoiia, New Rlugcold. Totcnship: 

SNYDER COUNTY. Townships: Perry. Mpi-ing. West Beaver. 

SULLIVAN COUNTY. Toicn:ihipa: ElMnnd^ Forks. IJiporte. 

Taicnihip»: Brooklyn, Clifford, Franklin. New 

TIOGA COUNTY, liormigh: LawrenceyHle, Totm>'hi,>: flyme-, 

VEN.ANnO COUNTY. Uorough: Rouwville. 

WARREN COVXTY. ToicnshipK: F:ir[niiiBt'>D. Frr'ehild. Sh-fP.'ld. 

WASHINOTON COr\rV. ISoroaffhs: Cross R.'-rt-. T..<i . Opem-itin, Finler- 
vHl", North (TmrTr-n-i, Tiviti-rlif , West AlpxHiider. We-I Aririmi-ton-n. T'>iriifhip»: 
Ituffnio, Cnnton. Clinrlirrs. IV.-.-rl, TlMjwwell. .Tcfrprson. Union. Wpst Finley. 

WFPT}rOh'EI AM) roUNTY. Roroaglts: Ariirld, Vnnder«rift. 

YORK cnuxrr. lt:,->n-jh<,: S'Tinn r.roTc WriEhtKville. TovnnhipK: WnrHnit- 

The Dppnrtmont was infoiiiied that a mcdiral inspprtion of pupils 
was made in certain Third Class School Distrirts in which th« board 
of school diTPctors had not voted apiinst inspection, as the School 
Code provides. The fifly-six districts of this class thus inspected 
were as follows: 

ALLF.miENY rOVNTY: rinll.'vnp, I[rnrt(Io..k. Cani.>eic. Rtiin . KnoxTllle. Mun- 
hnll, Nordi Ilniddor^k. Ponii T-'wn«hiii. T'lrpnfin . B' lAff COVNTY: -Iiinlntji, 
Tvronp, mCKtl rnUNTV: Urietnl rnvKTRll rnVNTy; ("o«t"nvi!1e, Pbomix- 
villi-. WPKt Cliesti-r n./yTOX rdlWTY: I.<H'k fhv.'ii , miUMIilA COUNTY. 
Wn-t PpFwirk, rU.UIiriff..\\'n rorvrv: r,rli=lp, nAUrillN COUNTY: Sno- 
«-elif>nnn Townshiji, nUL.lWAHE COUNTY: Darhv. Kndnor Townahip. ELK 

.N'o. 15. COMMISSrONKi: OF HEALTH. 813 

rOUNTY: Ridew:!!-, St. Mnrvs. PAYETTF, COU^VTY: Kortb Uuion Township. 
tXDIAXA COVXTY: ludian.n. LACKAWAXyA OUXTY: Dickson City. Old 
Forcj. Clypliiint. I.iNCASTEK COUMY: CoiimliiM. LKIIANON 
rOUSTY: Lebanon. I.EIIIfHI COUNTY: Oatnsauqiin . I.UZiSJtSE COUNTY.- 
N'mitinilie, Newjnrt Townahip, SwoyprBvllIe, WillieB-Bnrre, KingBtou. MONT 
QOMERY COUXTY: AblnrtOD Towoahip, Ohellenliom Township, CoDHhohocken, 
I^wcr Merion Township. NorriRtown. XOItTIlAMPTfUf COUXTY: Bethlehpm, 
Nortliiimpton. XOnTHUMBERI.AXD COUXTY: Ton! Townnhip, Milton. Mt. 
Ci^rmr.] Township, Sh.imukin, HCHUYI.KIU, COVXTV: Mnhnnov Citv. Mnhnnoy 
Tnwnsbip, ShpimmJo.ih, VK.VA.VOO COUXTY: Frnuklin. WARREN COUNTY: 
Wnrrrn. WESTMORBLAXD COUNTY: Ji-nnnptte, Monossen. ScottdaJe. 

The board of school directors of each of these districts was asked 
to report the results of tiie inspection on blank forms provided by 
the Department in order that a comparison might be made of the de- 
fects found in the two ^oupa of school districts. The returns made 
this year in compliance with this request are not sufBcienily explicit 
to permit a complete tabulation or any extended comparison. 

We have returns from twenty-one counties. The number of pupils 
reported as inspected is iS-TST. Of the pupils thus medically in- 
Bpected 15.235 are noted as normal and 33,552 as defective in the sense 
used in these examinations. The defectives of the Third Class School 
Districts form sixty-eight and eight-tenths per cent, of the pupils 
examined, or nearly three leas than the percentage which obtained in 
the Fourth Class Districts in which approximately fen times as 
many pupils weie inspected, In the two classes of Districts the 
proportion of defectives by sex varies only one-half of one per cent., 
but there is a striking difference in relation to nativity. -In the 
Ponrth Class School Districts 16,i>43 defectives, or five per cent., are 
entered as "foreign" while the 2,492 in the group of figures for the 
Third Class Districts make up seven and four-tenths per cent, of all 
the defectives. This is probably due to some peculiar distribution of 
the population with reference to the schools in question, 

A classification of the normal and defective pupils by sex and na- 
tivity in the Third Class School Districts for each of these twenty- 
one counties follows: — 



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A new departure was made in the Inspection of Schools in the 
Fourth Class Districts by making provisions for School Medical In- 
spectors and Health Officers to.collect information concerning feeble- 
minded children and epileptics not under public care in Institutions. 
Instructions were issued to each of the School Medical Inspectors in 
compliance with modern cI;issiflcatiou setting fo:th the usual under- 
standing of morons, imbe<'iles, and idiots, together with a record 
form upon which to give the number of those who could distinctly be 
grouped in each class. This circular of instructions and the blank 
form designe<l follow, as well as a tabulation of the various groups 
of children found by these inspectors in (heir assigned work. It will 
be noted that the inspccto:s collected information conceding 1,098 
feeble-minded persons, 674 of whom are believed to be morons, and 
that 345 epileptics weie lejiortcd, 172 of whom have convulsions very 


SppUmber 1, 1914. 
Dear Doctor; — 

We lire iiDiioua to iiwertuin tlie number of ppiloiitk-a nud mciitiilly dcfeotive ppr- 
Bona who may reside in the toui'th eliisB school districts of tlit Ciimm on wraith nnd 

With thia end in view the nL-eompnnyinR record sheet is being sent to nil School 
Meclicnl Inspectors nnd Health Offii^rB with directions ti) forwni-d thireon nil ob- 
tniniible informitCion conceruing udnlts and ehi]<]l-en so nfHicCed who reMiile in the 
districts where mediral or sHuitnry inapcf'tions of schools will bi" miidi'. 

There is great lack of reliable informiitiou in legurd to the uiimber of feeble- 
minded and epileptics, and every elTort which ,vou expend in helping to ohtiiin re- 
liable diitn in rplerence to tliose so unfortunately iitHietcd will aid in planning for 
their c«re. 

Tenehera will undoubtedly know of nil feeble-minded or epileptics who have at any 
time been reelatered HS pupils iind will also Icnow of adnlta and children bo afflicted 
reaiding in the homes of the patrons of the scboola. The information will only be 
used for statistical purposes. Ity interviewing the teacbera sufficiently accurate in- 
formation may be secured for this purpose. 

li'or your guidnuee the following brief dcsci'iptions of mentally defectivea and epi- 
leptiea are given: — 


The mentally defective or feeble-minded may be divided into three classes accord- 
ing to the degree of mental deficicni-v— idiots, imbwiluH ami morons. 

Idiot*: — An idiot ia a peraon bo defective in mind from birth, or from an early 
age. that be is unable to guard himself from common physical dangers. 

Imbecile): — An imbecile is one who by reason of mental defect existing from 
birth, or an early nge, ia iucaiKible of earning hia iiviug, but ia capable of guard- 
ing himaclf against coramiin physical dangera. 

Moroni:— A moron is one who is capable of earning a living under favorable 
(drcumstances, but. who, owing to mcutal defect from birth or from early age, is 
not capable of mmpetiTig on equal terms with his nonniil Bssi>ciates. or of uanag- 
ing himself or hia property with ordinary prndence. 

With RoM environment Miited to their ment^il enimcity morons mny become entirely 
self-supporting. Some morons mny be handled in the public scboola, others are 
best taught in special day schools, but the vast majority do very much better with 
institution core. | . 

346 NINTH ANNUAL liBPOBT 01' TUt: Off. Doc. 

The feeble-minded girl of child beai'ing nge, to nhoin bo mui^b attentioa is now 
being directed by aucial workers uud cliurity organizations, is usuallr of tbe moron 
class. Buckward children at schoul may be either imbeciles or morouB; but tbej 
also may be suffering from some pbynicnl conditiuna, such sa deafnesB, optical de- 
tects or adenoids, lu some cuKes, the urreat of nieoiat development may not be 
perrannent, aod aiich children, when placi>d under better couditious, in one of our 
training schools, or even in a special class for backward children at the pnbllc 
school, may recover rat'utal power to a suflicient oitent to develop into self-sup- 
porting and useful members of society. These cases, however, are ot comparatively 
rare occurrence, and in the overwhelming majority of instauces tbe arrest of develop- 
ment is permanent, and tbe cbild-type of mind continues through the remainder 
of life. 

Epileptics . 

Epileptics nre persona who are subject to periodic sudden lapses of consciousness 
usually associated with convulsions ("fits"). TLe unconsciousnesti is often preceded 
by A peculiar local sensation beginning in tbe lingers or toes, gradually extendiDg 
until the whole body i» involved nnd tbe patient falls with or without a scream, con- 
vulsion iind unconsciousness rapidly developing. 

If you Clin leiirn of any foeUe-mindcd or epileptic persons through your interview! 
with the school teachers, you are respectively requested to give all the data you 
can acquire concerning them on tbe record sheets furnished for tbe purpose, • 
separate sheet tor each township or borough, appending your name and addreas 
prior to forwarding it when you have concluded your inspcrtions. 
Yours very truly, 


In accordance with these instructions the School Medical Inspector 
or Health Officer gathers snch iufoiraatiou as he can and turns it in 
.on Form 97, of which a copy is api>en(Ied. 

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Rfpoftml br heani'i offlci 



(ArrnDgpd ncoording to frequency of convulBions.l 


(Arrnngpd nceordinit to frrquPDcy of couvulsions.) 

1^ clanBinrd PgillrptlH. 

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YEAR 1914. 


Ur, John R. Dickson, C. M. I. I hereby submit a brief summary of 
work done for the State Department of Health in Adams County for 
the year 1914, Fi-om the following table it will appear that much 
less disease existed in our territory than in other recent years. 

We have nine Healtli Officers in the County, who are generally ac- 
tive and eificient, each having at least one Township under his juris- 
diction, one having four. 
















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Dialrlrt 157; Cum- 
twriiad. Slnlun. 




blstrirl IH: -Oet- 


J, H. Picher 

l.lhwlT, Hamlllon- 

S. 0. Gonrher, 

DIslrlct 15S: UdLoq. 
Udniiiny. UI. Joy. 

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— — . 


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Our chief attention is givfn to typhoid fever, and particularly to 
the preventiOD of its spread rhrough the medium of dairy and other 
food products. We have considerable trouble to get prompt diagnoses 
and prompt reports from physicians. The long period elapsing be- 
tween the initial malaise and the plainly developed disease gives much 
chance for its conveyance by water, food, and flies prior to the use of 
such precautions as are advised by the State. 

Diphtheria and scarlet fever are quite generally reported promptly 
by the physicians, all precautions taken, and advice followed. For- 
tunately there has been but little of either disease to handle this year. 
Whooping cough occasions very Httle disturbance, beyond the neces- 
sary fumigation on recovery which is not popular. Seventeen cases 
of pneumonia and tuberculosis combined ia a large total for pulmon- 
ary disease, compared with totals for other communicable diseases, 
and fifteen of these, six of pneumonia and nine of tuberculosis, have 
been in the higher altitudes and mountain districts of the county. 
Nearly two-thirds of all cases of typhoid fever have existed in the two 
districts, 154 and 912, which embrace New Oxford Borough, Oxford 
Township, and the territory drained by the Conewago Creek and its 
tributaries, a creek which practically sewers Hanover, New Oxford 
and East Berlin. 

In Reading Township a farm was discovered which had evidently 
been the source of infection of about six oases of typhoid fever, the 
discovery being made in an investigation following a report made by 
Doctor Edgar Miller of a case of typhoid fever which came into his 
hands from the practice of another physician who had removed from 
the locality, and which had not been reported to the Health Officer. 
On my visit to that infected house I learned that in a period of four 
months these six cases had worked on or about this farm, and were not 
reported by the physician. No member of the family contracted the 
disease who had lived on the farm. The premises were clean and well 
and neatly liept. A bacteriological examination of the water in the 
well showed six B. coli in one cubic centimeter. This suggested the 
value of water examination in connection with the scrubbing bm^. 

Thirteen dairy farms were stopped from selling milk or butter on 
account of typhoid fever, and five on account of diphtheria. 

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Dr. 8. M. Bineiiart, C. M. I. On March 17th, I made an investiga- 
tion of a reported scarlet fever epidemic in Wilkinsburg Borough. 
Charges had been made that many cases existed and that the local 
Board of Health had failed to take even ordinary precantions to pre- 
vent the spread of the disease, the schools being infested with it, schol- 
ars being allowed to attend although under suspicion. 

I found that thirty-five cases had been reported in January and 
twenty-four cases in February and during March, up to and including 
the 16th, sixty-four cases. Nine of the latter were secondary to others 
in the same household. 

Although the number of scarlet fever cases was large, I did not find 
it greater in proportion to the number of residents than had occurred 
in other communities throughout the county. Tli* spread of scarlet 
fever was no doubt at least in part due to the Sunday revival meet- 
ings which were held in Pittsburgh in January. People from all over 
the county assembled in the Tabernacle, and distribution of com- 
municable diseases was wide-spread. 

After going over the conditions I found nothing to criticize in the 
woik of the Wilkinsburg Board of Health. The epidemic subsided 
very shortly after my visit of the 17th. 

Scarlet Fever: — A complaint concerning scarlet fever in Fair Oaks. 
Leet Township, was found to be without basis in fact. I had Health 
Officer J. H. D. Gray visit Fair Oaks and make an investigation. 
Quarantine had been observed as rigidly as the law required. 

With the exception of the above, I made no special investigations 
during the year, the rest of my work having been confined to giving 
advice and instruction concerning local conditions to those who came 
to my oflBce. The general health in the county has been good, as is 
well attested by the reduction in the number of reports of communi- 
cable diseases. In 1913 this office received 1,595 reports and 1914, 

General Summar; of Couoty Medical lospectioD for Year 1S14. 

Formi 36 received, 785 

Forms 37 received, 625 

Ezaoilned cases alleged to bo,:— Exnmiued cases fouad to be 

Smallpox Smallpox 

Typhoid (ever Typhoid fever. 

Wphtherld Diphtberia 

Scarlet fever Se.irlct fever 

ChickeD pox, Chieben poi 

Measles Mraisloa 

Mumps, Mumps, ....; 

Tetanus (By Dr. Koenig), 1 Tetany (By Dr. Koemg), 1 


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Hffllth otHwrs instructed — 

InvestientioQS of o|iidpniicfl in boroughs, 

TovratiKntinns of drainnKC coraplniots 

Investigations of pomplninls of iinsanitnry conditions, .. 


Dr. T. N. McKee, C. M. I. I beg to submit the following summary 
ot the activities of youi- Medical Inspector for Armstrong County for 
llie year ending December '.Hat. 1914. As detailed repoita of all work 
done liave been sent to jour Chief Medical Inspector from time to time 
during tlie year, and in order to make this i-eport as brief as possib'e, 
it will be confined to statistics tabulated from tiie records of the 
office with such comment thereon as seems necessary in the way of ex- 
planation or comparison. 

Theie has beeu uo cbange in uiunicipal lines during the year, and 
little, if any, in the township population. The population given the 
sevB. al towiisliips in a table to be found later in tliis report is taken 
ironi the census of 1910, and gives a total of 40,371, but industrial de- 
\elopment, particularly iu Brady's Bend, Cowaushannock, East Prank 
lin, Madison, Mahoning, North Buffalo, Ked Bank, and Wayne Town- 
shiiis, since that time has brought it up to probably i5",000. 

During the year 900 peisons, alleged to be sulfeiing from com- 
muuicable diseases, weie examined for the purpose of establishing the 
diagnosis. This is a decrease of 252, or 21.9% from last year. 

In order to check outbreaks of twarlet fever, it was necessary to ten schools and have the rooms fumigiited. Six of these were in 
one building. The same proceduie was necessary on account of diph- 
theria in live instances, measles six, and chicken pox two, making a 
total of twenty-three schools diatributed in twelve townships. I am 
glad to be able to jeport that the school boards of the county are 
awakening to a realization of the imiKirtance of school room disinfcc 
tion, and are not so prone to look iijton it as an entirely useless pro- 
cee<iiug and waste of public funds. Some of the boanls have even 
come to Iho point of keeping a stock of chemicals on hand and not 
infrequently fuini;;atc rooms under their care without notice from 
health officials. 

Eight dairy fainis were inspected on account of onlbreaks of tv- 
phoid fever, live for scarlet fever and one for diphtheria. The stock 
was transferred from thiee of these farms, and tlie sale of milk and 
milk products wns lemponirily discontinued from the eleven other 

No. \b 


lii»pectioDs were made at various times in nineteen of tiie twenty- 
seven townships, and under special instructions from your office, 
Paiker City, and Kittanning and Ford City Boroughs, were visited 
for the same puriiose. This, with otlier business of the offlce, net-s- 
sUated traveling 1,223 miles by rail and 812 by livery. 

The eleven disuict Health Officers sent iu 807 reports of placarding 
(Form 36) and 704 reporls of disinfection (Form 37), making a total 
of 1,511 leports leeeived, copied and forwarded to the Department. 
There was a decrease of 356, or 31.5%, from last year in the number 
of communicable diseases reported. By a study of the following 
tables you will observe that they came from evei-y township in the 
county; it will also be noted that but twelve of the thirty-five dis- 
eases, which tlie laws of the Commonwealth j-equire physicians to re- 
{toi t to the health officials, were brought to the attention of this office. 

Table Showing Towuship population ond Disrribution uf C»mmuiii(>uble DiseaEes. 

I I 

8 "i .... 
■ w .... 

b' 1 '.'.'.'. 

Bait FruDlinD. ... 


.... 2.3W 

^TriS "?!':°:..::: 

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Table Showing tbe Occurrence of Communicable DiseaaeH b; ModUu. 




















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Chicken Pox: — This disease was reported from nine townships and 
in eight monllis, none being reported in May, July, Augnst or 8eptem- 
l>er. A total of ninety cases, an increase of nineteen over last year, 
weie reported. An outbieab in Perry township, which spiead into 
Brady's Bend before it was brought to the attention of this office, was 
responsible for flfly-six cases during November and December. Tn 
order to check this outbreali it was necessary to close two schools and 
ha\e the loouis fumigated, Hiliville and Criaswell, in Perry Town- 

Diphtheria: — There was an increase of nineteen, or a total of one 
hundred and four cases of diphtheria reported during the year. These 
came fiom nineteen townships. East Franklin leading with twenty- 
seven cast's, and ranged from one in July to twenty-six in October. 
Among other measures to checlt outbrealts, it was necessary to stop 
the sale of millt and milk prodtKts from one dairy farm, and- fiye 
schools, two in East Franklin, and one each in Kittanning, Red Bank, 
and South Buffalo townships, were closed and the rooms fumigated. 

Eri/sipcl a 8 :~Oj\]y four cases of this disease were reported, one 
each in Marcli, April, May, and August. Two of ttiese developed in 
Manor township, and one each in Bnrrell and West FranlUin. Ko 
causal .relation was discovered. The respective premises were fumi- 
gated by the district Health Officers after recovery of the patients. 

Impetigo Contagiosa: — Three eases of this disease were reported 
from East Franklin township in February. All developed in the same 
family and requiied no special action by this office. 

Mvaslcs: — Including the milder tj'pe, or Oermiin Measles, there 
was a total of 2^9 cases reported as against 716 in 1913. The disease 
developed in eighteen townships, Brady's Bend leading with eighty 
cases, and was reported in every month, but July, October and Novem- 
ber. The greatest number was in February, when 123 were reported. 

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la order to check outbceaks six Bcbools, tvo each in Burrell and 
Manor, and one each in Madison and Kiakiminetas townships, were 
closed and the rooms fumigated. 

Mumps: — ^Thia disease developed in Burrell, Gowanshannock and 
Manor townships, and was reported in January, February, March, 
April and November, a total of sixteen cases, or two less tban last 
year, being reported. 

Pneumonia: — Only two cases of this disease were reported. Both 
were from Bethel Township and in the month of Febmary. Both 
premises were fumigated by the district health officer after recovery 
of the patients. 

Scabies: — Three cases of scabies were reported. All developed in 
the same family in Bed Bank township and were reported in February. 
The premises were subsequently fumigated, and there was no spread 
of the disease. 

Scarlet Fever: — This disease developed in nineteen townships 
Madison leading with thirteen cases, and was reported in every month 
in the year but July and September. A total of seventy-six cases 
were reported, being an increase of three over last year. Five dairy 
farms were inspected on account of the disease. The stock was trans- 
ferred from one of these premises and the sale of milk and milk pro- 
ducts temporarily discontinued from the remaining four. Ten 
schools, six in Brady's Bend, two in Bethd, and one each in Mahoning 
and South Buffalo townships, were closed and the rooms fumigated in 
order to prevent further spread of the disease in the several districts. 

Tuberculosis :~TheTe waB a total of seventy-three, or an increase of 
fourteen over last year in the number of cases of tuberculosis reported. 
These reports came from fourteen townships and during every month 
of the year. The above table sets forth quite plainly the results of 
seasonal housing conditions. The several health officers have been 
frequently reminded to see to it that all premises occupied by tuber- 
culous individuals in their respective districts aire thoroughly disin- 
fected immediately after being vacated. 

Typhoid Fever: — There was an increase of fifteen over last year, or 
a total of ninety-nine cases of typhoid fever reported. They came 
from eighteen townships, and in every month in the year but March. 
Nineteen of these cases are directly traceable to the pollution of a 
water supply by the indiscretion of men in a construction camp in 
North Buffalo township, and eleven to the water supply in Eittanning 
Borough. In a number of other cases similar causes are suspected 
but the evidence is not concluMve. It would appear that the preven- 
tive measures of the Department, as well as special instructions from 
this office in certain cases, have been pretty generally observed, as we 
do not find a single secondary case among those reported. It is equally 



gratifying to note that not a single caae is traceable to any of the ei^i 
dairy farms inspected and placed under special r^ulations. 

The outbreaks in Kittanning and Ford City Boroughs are each the 
subject of a special report. 

Whooping Cough; — A total of a hundred and thirty-four cases of 
this disease were reported as against eighty-one last year. They came 
from thirteen townships, and in every month but June, July and 
December. Red Band township leade the list with fifty-seven cases 
and Brady's Bend township has twenty-eight. 

The work of the eleven district health oflicers has been uniformly 
prompt aind careful, and as was said last year, "much of the success 
in controlling outbreaks of the various communicable diseases has 
been due to their constant watchfulness," is again applicable. 

The past year brought increasing demands upon your representa- 
tive for advice by Health Boards, school otQcials, and. citizens gener- 
ally in regard to health and sanitary matters of various kinds and 
the nniformity with which our suggestions have been followed is a 
matter of no little satisfaction. 

In looking back over the year, I am again reminded of the uniform 
cordiality existing between the physicians of the county and your r^ 
resentative, and this report would be incomplete without an acknowl- 
edgement of the many courtesies extended to me by my fellow praeti- 


Dr. Bruce H. Suodgrass, C. M. I. 

Chicken Pox: — Forty-flve cases of chicken pox were reported by 
the physicians of Beaver County in 1914, twenty -six of these cases oc- 
curred in Moon Township in the months of January, Febniary, and 
March. Oilier soatlei-ing cases appeared in seven olher townships 
duiing (he year. 

Diphtheria: — Twenty-nine cases were reported in thirteen town- 
ships. The greatest number in any one month was six in January, 
but it was present in the county eleven months in the year. 

Eiysiiiclas: — Only four cases of this disejise were reported. Two 
in Big Beaver Township in March and June, one in Rochester Town- 
ship in May. the other in Independence Township in December. 

ifranlrs: — Twenty-seven cases were reported — fonrtcen cases oc- 
cuned in Hopewell Township in October, Novemlier, and Deeember. 


Scattering cases in five other Towuships during tlie jear, jirincipally 
in Janaai7, Uarch and April. 

Mumps: — Forty-seven cases were reported in eight townships, 
seventeen cases in March, twenty-two cases in December. Other cases 
appeared sporadically in January, April, and November. 

Pneumonia: — Only two cases of this disease were reported by the 
{Aysiciaus this year. 

Scarlet Fever: — This was the most prevalent contagious disease in 
this county in 1914, eighty-one eases being reported. It was present 
more or less constantly throughout the year, 

Tubf^culosis: — Only two cases reported. Pliysicians seem to be a 
little careless about reporting tuberculosis and pneumonia. 

Whooping Cough: — Thirty-one cases reported in four townships, 
fourteen in Greene Township in February and March; eleven in New 
Sewickley Township in March. The rest were scattering. 

nealth Officer, W. M. Millei', of Hojkstown resigned during the 
year and his district was added to the district of Health Officer Wil- 
liam Lance. 

Health Officer, George Young, resigne<l during the year and Stephen 
Nicely of Dariington was appointed his successor. 

Forms 36 received, 313 Dairy farme inspected for; 

Forms 37 received, 2*7 DiphlberU 3 

Typhoid fever, 4 

InspectioDS made by C. M. I for Scurlet fever, 3 

cases alleged to be 

Cbicbeu pox 10 Siiie of milk stopped from sir dairy 

iJuupa 46 fiirms. 

Scarlet terer, i Miles traveled b; railroad and trolley. 


Miles traveled bj livery, 415, 


Dr. Walter de la M. Hill, C. M. I. The year 1914 was ushered In 
with the presence of smallpox in Hopewell township. An epidemic of 
some thirty-flve cases appeared in this township in December 1913, 
bat by the latter part of January, 1914, it was checlied, no new cases 

In February I was called to check up an epidemic of whooping 
cough in Broad Top township. Six cases were found and ordere*! 

On the 17th day of March Dr. Fawcett, of Rainsbnrg, telephoned m^ 
of the presence of a case of smallpox at Ohaneysville, Routiiampton 
township. On the 18th of March I visited (^lianeysville with Dr. Fi|w[^> 


cett and examined the case, H, A., and found a typical case of dis- 
crete smallpox. The disease had been present in this commTinit; for 
some weeks prevloua but as it was very mild, not much attention had 
been paid to it. 

The first case known was fl young man who in December, 1913, 
came to Everett and thence to Cumberland, Md., where he spent two 
or three days. He then returned to Chanejsville by way of Everett 
and about a week afterward developed a skin eruption without any 
constitutional symptoms. He soon recovered and his brother, who 
taught school in the village, contracted the disease but not feeling 
badly, continued to teach school with scabs on him. From this time 
on the disease began to spread throughout the community by way of 
the school, church, and two funerals which were held in the church 
and were attended by a number of persons who had the disease at the 
time. I was only able to find eighteen cai^es at the time and these 
cases were immediately quarantined. The epidemic gradually died 
out, although there were a number of cases conceaSed. which fact came 
out a long time afterward. All the schools were closed in this sec- 
tion of the township and practically every one iii the community was 

In May I was again called into Southampton township in rej^rd to 
small poi and found four cases and a history of more having had the 
disease in a very mild form. These four cases were quarantined 
and no farther cases developed. 

In October, having been notified of a suspicious skin eruption in 
Broap Top township, I visited that section and found seven cases of 
scarlatina, part of whom had been going to school. After quarantin- 
ing these cases and closing the school in the neighborhood, the disease 
ceased to spread. 

Health Officer Blymyer notified me that there was an epidemic of 
chicken pox In Cumberland Valley township, near the Maryland line, 
and after investigating I found six cases of the disease traceable to 
the failure of a Cumberland physician to notify the health authorities 
in this State of a child whom he examined in his office and sent borne 
into Pennsylvania. 

Ill November Health OiBcer Blymer, of Bedford, notified me of a ens- 
picious case of skin eruption in Cumberland Valley township. On 
investigation I found a case of scarlatina which was quarantined. 
No other cases developed. 

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Dr. Israel Cleaver, 0. M. I. Herewith please find report of County 
Medical Inspector'a work for the County of Berks for the year 1914. 


Card fonm received: No. 30. 763; No. 37, 872. 

Number of commiiDicable diseaiieB Alleged caeeB, no attending phyai- 

reported in order of freqoency; cinn, eicept for emallpoi: 

Whooping cougli, 157 Chicken pox, M 

Chicken poi 14B MumpH, 22 

Mumps 120 Smallpox. 15 

Typhoid fever 103 Diphtheria S 

Diphtheria, 82 Typhoid fever 18 

iScarlet fever 75 Whooping cough fl 

Ueaalee, 31 Measles, 1 

Smailpoi , _ . 

TuberculoHis, (pulmonary), 1! Dairy farms inspected for : 

Erysipelas 10 Typhoid fever 

Fneumoola 3 Diphtheria 

German measles 2 Scarlet fever 


Snip of milk stopped, 

758 Stock transferred, ... 

From tie above it may be noticed that of the thirty-three report- 
able diseases, only twelve appeared in the County. 

A feature differing from the experience of previous years is that 
while the variety of the diseases has been less, there was not a single 
township that escaped entirely. 

Cumru had the largest number, viz., 130, and Upper Bern and 
Greenwich the smallest, viz. ; one each. 

The numerical proportion was of very unequal division. Thus 
whooping cough, chicken pox, and mumps totaled fifty-six per cent. 
of all the cases, and it is to be observed that these represent almost ex- 
clusively the disease^ of children, the kind of ailments popularly re- 
garded of no significance from the point of being severe, and still less 

Chicken Pom: Of tiiis disease Cumm township had the largest 
nnmber, viz., thirty-six; Muhlenbnrg next with twenty-two; and 
Spring, twelve; a total of seventy, or nearly fifty per cent, of all cases 
reported. These three townships have closer and larger inter-com- 
munication with the city of Beading than any of those with which 
it is girdled, and it is fair to presume that there was mutual help- 
fulness in spreading the disease in the City and these suburbs. A 
large alien population occupies Cumru in the section known as MiU- 
mont and Oakbrook. Any person familiar with the conditions under 
which these people live will understand the difliculty of enforcing 
quarantine and isolation among them, and it was in this class that 



the affcotioii was most prevalent. Tn those instances to which the 
C. M. I. was called, the history of probable contact was either so 
indetei miaate or conflicting that a decision could rarely be made. 
In almost every instance where a section was affected, tlie origin 
came from families that employed no physician and sent the childi-en 
to school befoie quarantine was lifted, and the teacher had to notify 
the Health OflBcer of the outbreak in his school. Twenty-two town- 
ships were visited by this disease. 

Whooping Cough: Whooping cough appeared in twenty-two town- 
ships, Cumru leading with sixty-one; next Muhlenberg, twenty-two. 
and Spring, twelve, a total of ninety-five, or sixty per cent, of all 
cases reported. What has been said of chicken pox in the relation 
of these townships to the City of Reading is equally applicable to 
whooping congh. The Department makes it optional for the C. M. I. 
to investigate these cases, but there are a few in which the conditions 
were such that the parents involved desired an investigation. One 
instance will illustrate how this disease may he disseminated in an^as 
not contiguous: 

On October 27th I visited cases of whooping cou^ in two families 
in Penn Township, viz., Ira Bashore and Jerome Bagenstose, the 
latter employing a physician and through his report the Health 
OflScer obtained his first knowledge of the existence of the cases. 
The first case appeared in the Bashore family, the contact being as 
follows: The child visited his grandfather in Bethel township on 
or about September 1st, where there was a child having a cough not 
recognized at the time as pertussis. After returning home, the 
Ba^ore child developed a cough with a pronounced whoop, and soon 
after information came that the case in Bethel township was whoop- 
ing cough. In the meantime the Bashore and Bagenstose children, 
as adjoining neighbors, played together, three cases showing in the 
latter family while there was but one affected in the former. 

Mumps: Mumps visited sixteen townships; Washington, Marion, 
Lower Heidelberg, and Maxatawney reporting the majority of the 
cases. Spring was a close follower and the only one likely to exchange 
with the City of Reading. The mode of propagation prevalent was 
very similar in this to that found in all these milder diseases, viz.. 
from aflfected families without a physician, with a return to school 
before the end of the quarantine period, and then through the school 

One interesting investigation deserves record in this connection. 
On January 23rd, after certain leports made by Health OfiBcer 
Stengel, regarding cases of alleged mumps in Washington townsh;p, 
I made a visit of investigation, discovering eighteen cases in ten fam- 
ilies. All charged the Haydt school as the source of contact, bat 
there seemed to be a combination of ignorance as to whom the first 


cases could be assigued. I had sufficient evidence, however, that some 
cases developed in the school and closed it for disinfection. At one 
house all^^ to have cases I could not discover anyone at home, 
though Mr. Staigel saw the lady of tbe house and two children the day 
previous and vas sure of the existence of the disease on the premises. 
Consulting the Commissioner, 1 was instructed about my authority 
given by his office to make forcible entiy into the house to perform 
my mission, but policy indicated thj use of a locul constable with a 
warrant to do this violence. The constable refused the job, saying 
he knew the woman and that a pot of boiling water was likely to be ■ 
the greeting when the door was forced open. Furth* conference 
with the Commissioner per telephone secui ed permission to have one 
of the State Constabulary to accompany me and let him storm the 
pi-emises. On our way this officer said my case was a civil offense 
and he doubted his right to act except it came under the class of 
felony. We went to the place to find it locked and apparently de- 
serted. The officer expi'essed willingness to act if armed with a 
warrant and the nearest Justice of the Peace was then visited. He 
doubted his authority to give such a warrant, whereupon communi- 
cation was again opened with the Commissioner who "read him the 
law." Still doubtful, he called up our County District Attorney, 
who told him a warrant was not necessary, seeing that by virtue of 
my official position under the Department, I had right to force 
admission in my own person. We returned to the mumps citadel, 
instructing the officer that I would "bust" that door myself, and 
should that pot of hot water develop, he had a good case for his 
service. Calling the lady from the outside, I proclaimed my name, 
office, and purpose of visit and said I would break in her house if 
not opened in a civil manner. Immediately the door was opened, 

and Mrs. cordially invited us to enter, without the boiling 

water being in evidence, and I was able to perform my whole duty 
without protest. The only thing to mar this happy issue was the 
charge of Dr. Royer that he heard the rumblings of my voice in 
Harrisburg. H. O. Stengel says the appearance of the State Con- 
stable was valuable because he has not since had protest to his work 
in a community not in full accord with Department rules. 

Typhoid Fever: Typhoid was unusually prevalent in rural Berks 
this year and appeared in thirty-three townships. Bethel, Colebrook- 
dale, Earl, Muhlenberg, and Union seemed to be the storm centres 
of the malady. In the majority of instances coming under my notice, 
the source of origin was a polluted well or spring from which the 
family obtained its water supply. There were also a number of 
cases developed by contact, negligence in isolation, and ose of 
eating utensils. One report from Bethel township will illustrate 
this. This family consisted of nine members, who, with a married 

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danghter and her husband, dwelt under the same roof, a household 
of eleven persons. The married dau^ter had gone to nurse an 
acquaintance in a village near by, who the attending physician said 
had bronchitis. She relumed home August 8th. On the 25th she 
was taken ill with lumbar pains but no maiked fever until October 
Ist. On October 13th she miscarried a supposed six months foetus. 
A boy, aged five years, commenced with fever October 1st. Another, 
aged thirteen, took sick with like symptoms on the 18th; another, 
aged twenty, on tiie 26th. The father was affected on the 22nd, 
but was not ill enough to take his bed and continued his farm 
work. The sixth case had onset on 28th, and the seventh the same 
day. The eighth, husband of the first case, came down November Ist, 
another on the third, and the tenth and eleventh cases were seized 
a few days later ; the last being the mother of the family. My visit 
to this famUy was made on November 12th, the husband taking to his 
bed the day previous. I met the attending physician, who said the 
first three cases were so atypical that he hesitated to call them 
typhoid fever and no precautions were taken to prevent spread to the 
other inmates. I had Widal tests made of every one of the cases, 
including the person in neighboring village diagnosed as bronchitis, 
and each gave a positive reaction. The well showed no pollution on 
Laboratory examination. 

In Colebrookdale townsltip five cases followed dilatory diagnosis 
in the first two, and no precautions taken. Two deaths occurred 
from the disease in one family. 

;.n Earl township three cases were traced in their origin to a pol- 
luted well on the premises of the first, who died. The well was so 
situated that its waste, and probable percolation from the well itself, 
poisoned a creek entering a mill dam, which in turn infected another 
well from which five other cases developed. 

Diphtheria: Diphtheria visited twenty-six townships; Bethel, Max- 
atawney, and Muhlenberg being pronounced as to numbers. The 
most prominent feature in my inspections of infected families has 
been my inability to trace the source of contact. Barely could any 
one give me a history with definite pointing in this respect. With 
the fact that many cases of aU^ed tousiUitia to which no physician 
is called, and possibly diptheritic germs existing in the upper air 
passages without causing illness of the host, also that in positive 
cases the microorganisms may live in these same passages longer 
than the admitted quarantine period, it seems to me that the only 
efficient preventative measure will be to allow no case under guise 
of tonsillitis, or symptomatic recovery from diphtheria, to mingle in 
society and especially attend school, until a laboratory trial sbowa 
that the KLebs bacillus is not to be found on the throat or oareq 

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BechtelBville, Washington township, presents an interesting diph- 
theritic history. This borough was progressive enough to have a 
Board of Health, at least nominally. In December, 1914, complaint 
was made to the Department that diphtheria was prevalent in the 
borough and not taken care of by its health officials. I was instructed 
hy the Chief Medical Inspector, to investigate the matter and if neces- 
sary take charge of the work with the Health OfiBcer of the district. 
My first visit was made on December 30th, 1914. I found conditions 
as charged, except that a properly organized board had no existence. 
Eight cases in as many families were found and the premises 
placarded and quarantined. The burgess said he thought he could 
complete the organization of his board and take up the worfe to relieve 
us. This, however, seems to have been a failure up to the present 
and the Department officers are still in control. Only four additional 
cases appeared after our first quarantine work, whereas I had expec- 
ted that a full score would follow. 

Smallpox: Smallpox was the ending of the epidemic which struck 
the City of Reading and adjoining townships in October, 1913. It 
was imported by a walking case from a neighboring county, infor^ 
matioa of which was given ns by the Chief Medical Inspector. 

The townships affected were Upper Alsace, Cumru, Exeter, 
Muhlenberg and Ruscombmauor, representing in all fourteen cases. 
I visited every one when first reported and again the premises when 
quarantine was withdrawn. All the rules of the Department were 
enforced and no case presenting anything unusual, detail is not 
necessary. There was, however, an aftermath deserving of more 
extended remark. In December of this year (1913) I was duly 
notified by Dr. Sunday, of Hyde Park, that he had two cases which 
' he believed were varioloid, on the premises of John Rothermel, 
Muhlenberg township, and wished to meet me there to establish 
diagnosis. I pronounced them positive cas«e. At this visit the 
mother of the children, Mrs. John Rothermel, said she thought the 
disease was brought to the family by a relative, Moses Rothermel, 
living with them as one of the family. I met him and saw upon his 
face and hands the peculiar spottings of varioloid familiar to those 
having experience in this infection. Besides he gave a history of 
illness and symptoms characteristic of this infection. He said he 
consulted a physician in Reading when the eruption first appeared, 
who told him it was due to some impurity of his blood. On the 
strength of this advice he continued his work of a parapatetic watch 
cleaner and carpenter. He thus, as I believe, carried the disease 
to a family in Ruscombmauor township from which several neigh- 
bors also became victims. Last March (1914) he brought suit against 
me for (5,000 damages by reason of holding him in quarantine for 
twenty-seven days, thus depriving him from earning a livelihood for 


that period. By attorney 1 ackuowledged service and have been wait- 
ing the calling up of the case ever since. It in to be hoped that the 
Department oilice is as little worried over the prospect as I am. 


Dr. Joseph D. Findley, C. M. I. 

I beg to submit the following summary of the work done in Blair 
county during the year 1914. 

Two hundred and forty -seven cases of communicable diseases 
were reported as follows. 

Diphtheria, 44 Smallpox, . 

T.vpBoid fever, 49 Whoopiog cough, 

MeusJes 45 Pulmonary TiibercuIoHis, 

Scarlet fever 62 CcrebroMpinal MeningitiH, 

ChickeD poi, 14 Afaliir 

These cases required one hundred personal investigations by th« 
County Inspector for purposes of diagnosis or prevention of exteosioQ 
of the disease, divided as follows i 

In making these investigations it was necessary to travel 594 
miles by rail and 2G8 miles by livery. The eight district health 
officers forwarded 187 reports of placarding and lft6 reports of prem- 
ises disinfected. 

Smallpox: The smallpox epidemic in the latter part of 1913 
extended into 1914, and during the (iist six months of the year this 
disease was more or less pi"evalcnt in Hellwood and vicinity and in 
the city of Altoona. An investiijation was made in Bellwood in 
December, 1913, and ten c!tst>.< wore found in three families. Two 
of these families had not employed a physician, in the other the 
attending phy.iician diagnosed chicken pox but failed to report the 

On January 11th I made a s'^ond investigation in Bellwood and 
vicinity and found eight houses under quarantine for smallpox and 
seven where there had been- smallpox but the patients had all re- 
covered. The infpclion he-run iit (hiee different points, all from 
contacts with the W. ca.-se in Altoona. and had been going on ever 
since under the impression that it was chicken p6x. The disease 
was of a very mild typo which made its detection difflcnlt and many 
of the cases were not attended by physicians, hence- no quarantine 
was established. 



Fifty-five personal investigations were made in connection with 
smallpox during the first six months of the year. At HoUidayebui^ 
it was found that the school authorities were not enforcing the 
vaccination law. I directed the Board of Health to have representa- 
tives visit the schools, examine all children and send the unvacclnated 
home. One room had only one child who had been vaccinated. The 
same condition was found to e.'sist at Gaysport and in many of the 
township districts, where the school boards were ordered to enforce 
the vaccination law to the letter. In Altoona the local authorities 
did everything in their power to reach all contacts, but with cases 
in the active stage attending moving picture shows and bar rooms 
it was impossible to reach all contacts. By July the epidemic had 
subsided and we had no further trouble. 

Two dairy farms were inspected on account of typhoid fever and 
diphtheria. Sale of milk was stopped on two dairy farms and four 
schools were closed on account of outbreaks of communicable diseases 
among the pupils. 


Dr. T. Ben Johnson, Jr., C. M. I. 

Again it is my pleasure and for the fourth time since doing De- 
partment of Health workj to submit to you from records on file in 
this office, a brief report of the work as done by me and the Health 
Oflacers of this county for 1914. 

As County Medical Inspectoi^ very often it has been necessary 
for me personally to investigate communicable diseases, reported 
to me direct from the Health OfRcer in whose district the diseahes 
may exist. In summing this report, I find that it has I>een very 
necessary for me to visit twenty-two individual townships and to 
do this properly, it was necessary for me to travel by railroad and 
also by livery to say nothing of the miles walked on foot. By raQ 
I covered six hundred and fourteen miles, and by livery, one thousand 
one hundred and twenty miles. 

During the year there have been received in this office, forms No. 30 
to the number of four hundred and thirty-eight. These have been 
for eight of the diseases as required by law and is a decrease over 
the number reported 1913, in both cards and cases. Forms No. 37 
show a total of two hundred and eighty disinfections as performed 
by the twelve Health Officers, doing the work in the county. All cards 


are carefully examiued immediately upon receipt, being properly 
entered upon the memorandum record and then forwarded direct to 
the Harriaburg Office. 

In 1914, I personally investigated eeventy-two individual cases; 
and whenever poasible several cases of the same disease were exam- 
ined in one trip. Cases as inspected by me, are as follows: 
■^' Measlea:. During the months of March April, May and December, 
this disease seemed most prominent in several of the townships over 
the county and our records show a total of one hundred and nintty- 
two cases, as reported by Health Officers and physicians. Ont of this 
number I personally inspected sixteen cases in but three townships. 
In one of them there was an epidemic which led me to close the Terry 
School for disinfection; there was another in Athens township, wb,.aw 
diphtheria and measles existed in the East Athens School, which was 
also closed pending disinfection. This disease existed in twenty- 
three different townships and is a considerable increase over 1913, 
I am sorry to note this, as 1913 report was rather favorable in 
wiping out this di-sease to an extent. 

Chicken pox: Thirty-foui- cases of this disease were reported by 
physicians and householders in seven of the thirty-seven townships, 
the greater number pre\ailing in December. It was made necessary 
for me to visit two townships to check a diagnosis in eighteen cases. 
On one of these trips, I closed the West Burlington School for fumi- 
gation, the health officer performing the work, when the school was 
reopened at the end of the usual school closure period. This is a 
decrease in the number leported for 1913. This disease seems very 
spasmodic, prevailing strongly one year and then subsiding the 

Diphtheria: During the year there were reported to me forty- 
eight cases of this disease in eighteen different townships, and out 
of this number I personally investigated twelve cases in ei^t town- 
ships. Nine of the cases were on a dairy farm on which restrictions 
were established and the «,tle of milk prohibited, unless taken care 
of from without the infected house. Quarantine rules and r^ula- 
tions were lived up to in all instances, the general public is fast 
learning the necessity of such. On November 12th I went into 
Armenia, where I diagnosed two cases of diphtheria on a dairy farm 
where the children had been taken ill at school. This school, Covert 
School, was closed for disinfection. 

On December 17th, I went into the Athena district, where diph- 
theria had existed at tiie l']ast Athens School. This school was 
also closed for fumigation, the fumigation being preformed by our 
health officer. This di>iease seemed iimst prevalent in the month of 
October and exceeds the number of cases reported in 1913, to the 
number of thirty-four. 


Mumps: The total Dumber of cases reported in 1914 was for^- 
uioe and occurred in seveu different townslups. Out ol ttuB number 
it waB ueceeeary tor me to make a personal inspection in Terry town- 
sliip. On February 20th I went to Wyaiuaing, after receiving a 
telephone meesage from the health officer, to inveetigate mumps in 
Terry town^ip. On account of the non-appearance of the health 
ofBcer, and extremely bad roads, I was forced to return to Towanda 
and report no trip. On February '2'ArA, I again returned to this dis- 
trict and, after makiug a complete investigation, I was unable to 
find anything of a definite character and so reported my findings to 
the Department of Health or Division of Medical Inspection. This 
disease was most prevalent during February and March and shows 
a decrease from the number reported for 1913. 

Soarlet Fever: Twenty-nine cases of this disease were reported in 
eleven different townships and from card reports received from the 
health officers, it was necessary for me to investigate several cases 
personally. 1 inspected seven cases in five townships, and after es- 
tablishing proper restrictions, no epidemic, was feared. This disease 
occurred on three daii'y farms, and the householders were cautioned 
to have milk and herd taken care of. This was done properly, there 
being no contact with the occupants of the house in any way. The 
greater number of cases of this disease were reported in the Athens 
and Wyalnsing districts, and occurred during the months of January, 
March and April. In 1913, we had a greater number of cases than 
in 191i, when thirty-nine cases of scarlet fever were reported. 

Tubefculosis: During the yeai" of 1914, thirty-three cases of this 
disease were reported in eighteen different townships, and I feel 
gratified that physicians are learning to re^tort this as communicable. 
By order of the Medical Inspector of Dispensaries, I made four trips 
to enter patients on roll at this Dispensary No. 44, and on one of 
these occasions, on June 30th, I inspected a dairy farm at Loroy 
for this disease. The usual restrictions were made and to my own 
personal knowledge were lived up to in every way. On December 
Bth, by order of the Chief Medical Inspector, I also made a trip to 
Athens, and in company with Dr. Stevens, went to examine the 

B children of that village. There had been some controversy 

about the children going to school on account of tuberculosis, this 
occuring when Dr. Btevens examined the school, excluding all cases 
of communicable or suspicious diseases. I found the children to be 
in the active stage of the disease, confirming Dr. Steven's diagnosis. 
Most ol the cases reported are, or have been, patients at this Dis- 
pensary during the past year. 

Typhoid Fever: This disease in tliis county has totaled a number 
of thirty-three in seventeen separate aud distinct townships of the 
district, and occurred in nearly every month during the year. Out 


of this number it was neceBsary for me to make thirteen personal 
inspections, diagnosing twelve cases and examining the dairy con- 
nected with each case, except in one instance. This trip was made 
January 4th, into Wyalusiug township, when I was unable defini- 
tely to diagnose the character of the disease. On this trip I also 
looked up Malarial Fever, but nothing definite was found. Typhoid 
fever seemed most prominent in the vicinity of Troy or aronucl 
.through the districts of that section, where the Troy epidemic occurred 
about three years ago. Water containers were requested from the 
Department on several occasions, which proved more than benefi- 
cial, water pollutions showing the direct cause of disease in two or 
three instances. Rigid restrictions were made in connection with 
dairies, the sale of milk ordered stopped until some one from without 
the infected house could care for the herd and milk products, and 
I firmly believe that in each instance the law was lived up to. In 
1913, forty-five cases of this disease were reported, twelve more than 
in 1914. I trust my report for 1915 may still show a smaller 
number, or, better yet, that I may hope to have no report on this 
disease at all. 

Special Inspections: On March 16fh, I went to Athens upon 
order of the Department, relative to the Gibbs violation of qnaran- 
tina Conditions at this time were so positive and the violation so 
flagrant that an arrest was ordered. Mr. Gibbs was brought into 
Justice's Court and afterward paid his costs for his misdemeanor. 
This is the only case in which legal action was taken during the year, 
which I recall at the time of this report. 

May 25th, upon your order, I went to Wyalusiug for a conference 
with the Borough Health Board relative to their quarantine and rare 
of cases of communicable diseases existing there at that time, there 
having been considerable controversy relative to the reporting of 
many cases of mumps. I went over this situation with Dr. Cham- 
berlain and Dr. Bosworth, both members of the Board, and after 
considering the situation from all standpoints it was amicably agreed 
that they were doing very well under the circumstances. No fur- 
ther complaint was received by me and no further procedure was 

On June 28th, at the request of the Division of Engineering, I 
again visited the creamery known as the N. Abramson & Company's 
Creamery, at rister, and found conditions to be most deplorable. 
A report of my findings was immediately sent to Harrisburg, bnt no 
action was ever taken. This was tlie third or fourtli inspection 
ordered by you without any appreciable or desirable results and 
probably the same insanitary conditions would have existed to this 
date had not the building, together with its entire contents, been razed 
to the ground by fire, on or aliout Se])tember 21st. 1914. This caused 
complete and entirely satisfactory abatement of the existing nuisaure. 


Daring the year of 1914 the work of Medical Inspection for the 
Count; has not been as extensive an in some of the previous years. 
However, it has requiied my personal attention for several and 
pi-actically all the months duiiug the year and some of tUe trips 
have been extremely long and tedious, and, upon one or two occas- 
ions, I was forced to give up the intended trip owing to bad weatner 
conditions and impassable roads. The work has been shortened 
and made much easier by use of the automobile, and. in this manner 
the Department has been saved a great deal of expense with refer- 
ence to time. 

This community has been practically free from epidemics of any 
kind, with tbe exception of small localized conditions of the minor 
diseases which have existed in a few of the school districts. It has 
been my pleasure to call on a great many of the physicians in the 
county and to be of service i-elative to the regulations of the State 
Department of Health. Tlie pbysieians have always been extremely 
courteous to me and have extendetl all possible aid in every manner, 
with but one or two exceptions, these having been reported to the 
Department by letter at tliat time. 


Dr. I. Swartz, Plymire, C. M. I. I beg to submit a summary of the 
work in Bucks tounty for the year 1014, during which time the duties 
of the County Medical Inspector required risits to the different town- 
ships for the inspection of outbreaks of communicable disease; in- 
spection of dairy farms during tbe course of typhoid fever, diph- 
theria and scarlet fever; and the examination of alleged cases of 
communicable disease not under the care of a physician. 

I have traveled 974 miles by railroad, 1117 miles by horse and 
bnggy, and 2,596 miles by automobile; a detailed report for each 
day's work was forwarded to your Chief Medical Inspector for fur- 
ther instruction, guidance, and filing. 

During the year 637 reports of placarding for communicable dis- 
ease (Form 36) were received from the eleven district health officers 
in the thir^ townships in the county. These officials also sent in 
663 reports for disinfection (Form 37). All reports weie carefully 
examined, and, if incomplele, (!iey wore returned to the proper 
health officer before being entered on the records of this office. 

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Typhoid Fever: On March 19th, I inspected two cases of typhoid 
fever in Langhorne and Middletown townships adjoining with the 
co-operation of the Langhorne Board of Health. 1 suspected an 
infection of a local retail milk service, and followed the discontin- 
tinuance of the sale and delivery of all milk products from G. W. 
R.'s dairy farm, where the disease had recently existed, no addi- 
tional cases developed. Bacteriological examinations of specimens 
of water from this dairy farm used for washing dairy utensils showed 
the presence of B. coll, and the supply was ordered abandoned until 
disinfection and subsequent examiuatious should prove a pure supply 
of water. On May 13th I inspected three cases of typhoid fever in the 
village of Wycombe (Wrightstown and Buckingham townships), 
made two additional inspections, had specimens of the well water 
supplies examined in the Department's Laboratory, studied every 
avenue of a possible source, and finally was well satisfied that a 
certain supply of raw oysters which the three men had purchased 
and eaten at a local restaurant were infected and were possibly 
collected from infected beds. It was the last barrel of the season; 
careful note of dates was taken, the incubation period was carefully 
considered from the time of eating the oysters and the onset in the 
individual case, etc; after the supply was exhausted, plus two weeks, 
no additional cases developed. It was learned the three patients 
were the only persons who ate any of the oysters in their raw state. 
I should add, however, one further case of the disease to the three 
cases, making four in all, i. e., the local physician (Dr. L,), the prop- 
rietor of the local newspaper, a mechanic, and the wife of the restaur- 
ant proprietor. I inspected one case of typhoid fever in Falls to»Ti- 
&bip, adjoining Morrisville borough, where the disease is known 
to exist. The filthy raw water used in this neighborhood from the 
Delaware river is at least unfit for drinking purposes. I inspected 
one case of typhoid fever in a recently unoccupied tenant house in 
Middletown township. About four years ago five cases with three 
deaths were investigated and noted on adjoining premises. The well 
of water was placarded and specimens were collected for laboratory 
study. On September 5fh I inspected four cases of typhoid fever, 
with one death, in Middletown township on the border of Langhorne 
borough. With the assistance of Dr. H. L. and Dr. J, B. H. it was 
found that these patients had been drinking from an old hole along 
the roadside (uncovered, etc.) into which spring water was flowing 
together with drainage, I ordered specimens of water collected 
for laboratory study and the box which held the water torn out or 
blown out of the ground. I inspected four cases of typhoid fever 
on October 12th in three households in Spriugfleld township. The 
first patient was possibly an ambulatory case and recognized late. 
I could not learn where be was infectaed. The three additional 


patients were secondary cases due to close friendship, lack of care, 
and no disinfection of the excreta and sick room utensils. 

During the year I have inspected ten dairy farms when typhoid 
fev£r was reported to exist on the premises, and ordered such regu- 
lations in each instance as were necessary to safeguard the public. 

Diphtheria: On April 27th I inspected a case of diphtheria on 
the premises of F, A., in Bristol township. A sister had had a sore 
throat about four weeks earlier, but was without medical attendance. 
April 29th I examined, with Dr. J. R. U., an alleged case of diph- 
theria on the premises of D. F. S., in liichland township. The diag- 
nosis was positive with marked laryngeal involvement, but a source 
of the disease could not be learned. The teacher of the local school 
gave a history of a number of children having had sore throats during 
the previous month. I examined five or six of them but could make 
no positive diagnosis at so late a ])eriod; three of them showed evi- 
dence of a recent infiammation of the pharynx and tonsils. 

On May I4th I examined an alleged case of diphtheria on the 
premises of A. C, Lower Makefield township, whose wife was iU. 
Positive diagnosis and absolute quarantine were established since 
the husband had been treating the woman with medicine from a 
Trenton drug store. Collected swabs from tonsils, pharynx, and 
uares, and on the 18th of May the laboratory report confirmed the 
diagnosis. The explanation of the apparent neglect on the part 
of the husband was that he could not alford to have a doctor more 
than one time. 

On May 22nd I inspected two cases of diphtheria on the premises 
of M. T., Middletown township. A child of F. W., living at the J. W. 
Works in the same township, had been sitting with one of the T. 
girls in school while the former had a sore throat without medical 
attendance. The second case in T's household contracted the disease 
from the earlier patient in the same house. 

On November 30th I was called to Upper Black Eddy, in Bridgton 
township, on account of an epidemic of sore throats, a few of them 
being attended by the local physician, who made a diagnosis of 
diphtheria, and others by a Kew Jersey physician who did not report 
any cases. I saw se\en positive cases and collected swabs from the 
nose and throat of ten additional children f0t laboratory examina- 
tion. The local school board cooperated readily, and the Upper 
Black Eddy schools were disinfected thoroughly and closed until 
further advised. On December 3rd I collected specimens for labora- 
tory examinations from the nose and throat of four additional school 
pupils in Upper Black Eddy, Bridgeton township. Later reports 
from the Department's Laboratory confirmed my positive diagnosis 
of the four cases, bringing the total number of cases of diphtheria 
in the \illage to eleven. Strict orders were issued to the health 


officer that be must maiataiu effective quarantine at eacfa of tlie homes 
placarded and that all public places luust be kept closed nntil advised 
from this office. The symptoms in most of the cases were mild in 
character, and, therefore, thfij were not recognized early. Laboratory 
findings confirmed the diagnosis in every instance where placarding 
was ordered by your Medical Inspector. During the year I have 
inspected ten dairy farms wheu diphtheria was reported to exist on 
the premises and in each Instance effective regulations were estab- 

Scarlet Fever: On Jauuary 5th I investigated two possible cases 
of scarlet fever at Feindale, Nockamixon township, not reported by 
the attending physicians. Mrs. A. F. told me that her daughter 
D. developed an extensive eruption prior to December 20tb, 1913, 
and the doctor who attended the case told her it was a "stomach 
rash." The mother also statetl voluntarily that recently when the 
child's underclothing and stockings were removed the "pieces of skin 
would fly about the bedroom." I did not examine the child, but called 

on Dr. and the latter refused to admit a diagnosis of scarlet 

fever — said the child did noj have sufficient fever to cause the ex- 
tensive desquMna tion ; the mother told me she saw when the child 
undiessed. On the same date Mrs. F. S. at Ferndale, told me that 
her daughter R. had au extensive rash jtiior to December 10th, 1913. 

Dr. attended the case and made a diagnosis of "stomach rash." 

N. S. and his small son F. who had beeu visiting at this place in Fern- 
dale later had scarlet fever at N. B's home in Doylestown {reported 
by attending physician). Femdale had further been the source of a 
reported case of scarlet fever in I'lumstead township, the family 
having been visiting in Ferndale during the early holidays. 

On January 22ud I inspected four cases of scarlet fever in three 
households in Falls township. On flnding that they were pupils in 
' the Morrisville Borough schools'I communicated with the Morrisvllle 
Board of Health and learned that scarlet fever existed within the 
borders of the borough. The Board again orderded the Morrisville 
schools closed for a more thorough disinfection. I discussed methods 
with the President and Secretary and it was agreed that the local 
schools would be kept closed for a pei'iod to cover the incubation 
days of the disease. 

February 2nd I examined three alleged cases of scarlet fever among 
pupils of the Kiegelsville schools, Durham township, and made a 
positive diagnosis of two cases. On the same dale I also investigated 
three alleged cases of scarlet fever in Duiham township not reported 
by the attending physician. Mrs. C, wife of C. T. C. at Riegelsville, 
Durham township, told uie lier dauslilcr J. became ill on or about 
-lanuary 4th with vomiting, high fever, and an eruption and sore 
throat. Her sou A. became ill on or about January 10th with sore 


throat, Toniifiiig, liigh fever, followed by an emption. Dr. at 

, New Jersey, had been attending professionally and had 

diagnosed the first case as "roseola." When the boy sickened Mrs. 
C. (who say9 she had been a professional nurse) told the doctor 
she "knew what was the matter, she had seen many cases before, 

it is scarlet fever," etc. Dr. replied "I guess you are right." 

Dr. had been examining specimens of urine from both children 

daring the illuess, and had permitted the husband to go from Kiegeht 
ville to Philadelphia on the train and retum daily, simply telling 
the mother and father to be careful. February 2nd Mrs. S. C. B, 
at Hiegelsville, told me that her son C, a pupil of the school, sickened 
on or about January Ist with sore throat followed by an eruption. 
The mother told me before I asked for the information that each morn- 
ing after the boy arose from bed during the latter part of a three 
weeks period she used a dust pan and brush to collect the pieces of 
«kin (scales) from the side of the bed ; that desquamation included the 

hands, ears, and feet. She further told me that Dr. attended 

professionally and made a diagnosis of "roseola." The physician did 
not report the case. I issued strict orders to the Department's health 
officer to follow up every suspicious illness promptly through 
cooperation with teachers in Durham and Nockamixon townships, 
and if additional cases of scarlet fever were found, I intended to take 
up with school directors the matter of closing schools for a time 
covering the incubation period of the disease. 

On March 8th I examined an alleged case of scarlet fever in Spring- 
field township and another alleged case in Richland township, and 
made a positive diagnosis of both cases. March 4tb I inspected four 
vases of scarlet fever in Bensalem township and ordered the school 
in Eddington closed for disinfection. The apparent source was 
Bristol borough where a number of. cases of the disease exist. On 
March 18th I inspected two cases of scarlet fever amoug the pupils 
of Bpinnerstown school, Milford township. On March 6th there was 
a visitation of school children in a sleigh from Richlandtown School 
to the Spinnerstown school, and with oflScial consent, as I have been 
reliably informed, while scarlet fever was epidemic in Richlandtown 
borough, with one or two deaths. A boy examined on the evening 
of the 5th of March was permitted to go along and this boy sickened 
in the Spinnerstown school room during the visit the next day, was 
covered with an extensive eruption, and was taken back with the 
party of children to Richlandtown, where he was ill with scarlet 
fever. In consequence of the contagion thus brought to the Spinners- 
town school, M. R., a Spinnerstown pupil, subsequently became very 
ill with the disease and F. M., another pupil, also contracted the 
disease. March 22nd two additional cases of scarlet fever were 
inspected among the pupils of the Spinnerstown School, due to the 

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viait o( the school children from BichlaDdtowii while scarlet tever was 
epidemic in the borough. On March 27th I examined two allied 
cases of scarlet fever in Nockamixon township, making a positive 
diagnosis in both oases. I ' also inspected seven cases of scarlet 
fever in Durham township and five cases of scarlet fever in Nocka- 
mixon township, adjoining townships. More carfi in studying earlier 
cases in the community in January when two physicians over- 
looked the proper diagnosis might have prevented the contagion 
spreading in this manner. Local schools were closed for a definite 
period through cooperation with the directors and a thorough dis- 
infection of school rooms was ordered. 

On April 13th I inspected seven cases of scarlet fever with three 
deaths in Middletown township, the teacher of the Edge Hill school 
being one of the number who died from the disease. South Langfaome 
Borough, where the disease was recognized before cases developed 
in Middletown township, had two deaths. By co-operating With the 
school boards, Boards of Health, and the churches of Langhome 
borough, Soath Langhorne borough, and Langhome Manor borongh, 
all public places in these boioughs and the portion involved in 
Middletown township were thoroughly disinfected and were kept 
closed for a time to cover the incubation period of the disease. A 
malignant type of scarlet fever in Sonth Langhome boronj^ and 
Middletown township was found, but was early controlled by absolute 
quarantine and strict regulations, and the disease was promptly 
stamped out. On -June 6th I inspected three cases of scarlet fever in 
the Edge Hill School, Lower Makefield Township, and on June 29th I 
inspected two additional cases among pupils of the same school. The 
source of infection was possibly Trenton, N. J., on the opposite aide 
of the Delaware river, where the disease was known to exist with 
lai^e numbers of cases. On November 7th I inspected three cases 
of scarlet fever on premises of L. S. and C. H., near Trevose, South- 
ampton township. The source of the disease could not be learned, 
but it is posible that Mr. M's child in the home of B. H. had recently 
been a victim of scarlet fever and, no physician being in attendance, 
not under r^^lations. The children who then had scarlet fever were 
frequent visitors in the R. H. household. During the year I inspected 
twenty-two dairy farms when scarlet fever was reported to exist in 
premises, and effective regulations on each dairy farm were estab- 

Measles: During the first five months of the year I examined 
eighty-live alleged cases of measles not under the care of physicians, 
the mothers frequently persisting in the belief that it is a harmless 
disease if the child is kept warm during the early part of the illness. 
I carefully instructed such families whenever possible, for I found 
that a talk with them was frequently appreciated when a false con- 


stmction had beeD placed upon the Department's work. On Jan- 
uary 26th I inspected three cases of measles in Lower Uakefield town- 
ship. February 6th I inspected eighteen cases of measles among pupils 
of tlie Edge Hill School atid four cases of the same disease in Oxford 
Valley school, Middletown township. Most of the cases were not 
nnder the care of a physician. Some of the older children in these 
school districts had attended the Langhorne Borough High School, 
and had recently returned to their homes in Middletown township ill 
with measles, only to infect their younger brothers and sisters. Feb- 
ruary 3rd I found three additional cases of measles in Middletown 
township not attended by a physician. February 28th I made a posi- 
tive diagnosis of four cases of measles among pupils of Parkland 
School, and eighteen cases of measles in the Edge Hill school dis- 
trict, Middletown township, many of the children from the latter 
district attending school in Langhorne borough, March 11th I made 
a positive diagnosis of two cases of measles among pupils of Shady 
Retreat school, in Doylestown township, March 14th I found two 
additional cases of measles in Middletown township not under regu- 
lation. March 25th twelve cases of measles were inspected in the 
villages of Andalusia, Cornwells, Edingfon, and Bridgewater, Ben- 
salem township. All cases were either adults or very young children. 
The source was possibly Philadelphia where many of the older 
patients were employed. March 30th I inspected five cases of measles 
in Bristol township, just outside of Bristol borough, having as a 
source Bristol borough where many cases exist. On April 20th I 
found eight cases of measles among pupils of the Church School, 
Springfield township. The school authorities were readmitting chil- 
dren to school just as soon as the eruption began to fade and without 
regulation, in violation of (he law. During the month of April I 
found German measles to the number of seven cases in the Richboro 
school, Northampton township; six cases in Shaw's school, Richland 
township; eight cases in the Chalfont school, New Britain township; 
four cases in the Wrightstown school, Wrightstown township; 
and three cases in Falls township. May 22nd I made a positive 
diagnosis of four cases of measles in Falls township. During the 
latter part of May I found five cases of German measles in the Maple 
Point school, Middletown township, and four cases of the same disease 
in Milford township. 

Chicken pox: During January I inspected eleven cases of chicken 
pox among pupils of the Taylorsville school, Upper Makefleld town- 
diip; Ave cases in the Sunny Side school, Bedmi'nster township; 
three cases in the Fairview school, Warwick township; fifteen cases 
among pupils of Roeder's school, Milford township; and one case 
in Haycock township. During February I inspected fifteen cases 



of chicken pox among pupils of the Itiegelsville school, Durham 
township; eight cases in the Tobickou school, Richland township; 
nine cases in the Spinnerstown school, Milford township; five cases 
in Winners school, Richland township; and eleven cases in the 
Steinsburg school, Milford township. March dth I inspected four 
cases anjong pupils of the Bridge Valley school, Warwick township. 
March 22nd I made a positive diagnosis of five cases in Richland 
township. October 2tst I made a positive diagnosis of seven cases 
of chicken pox among pupils of Gerhard's school, Milford township. 
November 28th I made a positive diagnosis of four cases in Bpring- 
field township. December ith 1 made a positive diagnosis of seven 
cases of chicken pox among pupils of Kauffman's school, Richland 

Mumps: April 2Tth I made a positive diagnoms of three casies of 
mumps in Lower Makefield township. 

Whooping Cough: On February 20th, as directed by the Depart- 
ment, I examined pupils of the Pineville school, Wrightstown town- 
ship, and made a positive diagnosis of eight cases of whooping congh. 
On December 19th, according to orders from the Department, I 
examined pupils of the Almont school. West Rockhill township, and 
made a positive diagnosis of ele\en cases of whooping cough. 

Statistical Sumraary of thp Work ot the Year. 

Biamincd caaeB alleged to be: DuirieH inspected for: 

Smailpoi 2 Tvpboid fever, 10 

GhiekcQ pox, 157 Sc.iriet fever, 22 

Scarlet (ever 27 Diphtheria 10 

Dipbtberin 25 

Meaalca 85 Stuck traoBferrfd on one premises. 

German mcosles, 48 .Siile of milk Btopped from 21 premises. 

Mumps. 3 

Whooping cough, 26 

Sixty-one schools ordered closed for disinfection ou account of 
scarlet fever, diphtheria, measles, German measles, or chicken pox. 

Two health officers were instructed at office; ten elsewhere. 

Your County Medical Inspector has been cousulted during the year 
by Boards of Health and School Boards, teachers, business men, civic 
clubs, welfare associations, and many citiz.ens with helpful and grati- 
fying results. Preventive medicine conserving child life is being ap- 
preciated, and measures with this end in view are often demanded by 
our people. 

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Dr. H. D. Hockenberry, C. -M. f. I hereby present a summary of 
the work o( Medical Inspection ia the County of Butler for the year 

From the several health officers representing the eleven districts 
into which Butler County is divided, there were received of Forms No. 
36, 232; of Forms Mo. 37, 222; representing the various contagious 
diseases as follows : 

Measles: — There weie but eleven cases reported, which was a 
marked contrast to the wide spread epidemic of lyiy. 

DipMh&ia: — There were sixty-two cases in the entire County, with 
but few fatalities. This was no doubt owing to the general use of 
antitoxin, and the tendency among the physicians to give large and 
frequently repeated doses. It has seemed to the writer that, in some 
cases, there has been an extravagant use of this agent, — not that the 
life of the patient is to be sacrilied to a mistaken sense of economy, 
bat It has been his experience that after the second dose of antitoxin 
has been given, after twelve hours in Ihe great majority of cases the 
acute symptoms subside, the spread of the false membranes is arrested 
and convalescence sets in. The use of immunizing doses on those who 
have been exposed to Infection has produced very satisfactory results. 

Scarlet Fevci:~~Ot scarlet fever tliere were forty-nine cases, distri- 
buted ovjcr the entire County. In no section did this appear as an 
epidemic; neither has it taken on a virulent form. 

Mumpg; — Sixteen cases were reported. 

Chicken Pox: — Twenty-lhiee cases reported. 

Whooping Cough: — Eleven cases. 

The thiee last named diseases are looked on by the laity with such 
indifference that it is difficult to get a very full i eport of all the cases. 
Many families will attempt to conceal the presence of such cases in 
their homes for the purpose of getting rid of the little inconvenience 
of a quarantine. 

Typhoid Fever: — Typhoid fever numbered in all forty-two cases. 
The fact that in some families secondary cases developed would seem 
to indicate a neglect or carelessness on the part of the physician or 
attendants. All such are cases that might have been prevented by 
the exercise of ordinary care. 

Tuberculosis: — Eighteen cases were reported. 

Pneumonia: — Two cases. 

Erysipelas: — One case. 

This completes the totality for the year 1914. 



Visits of inspection made by the County Medical Inspector were ss 
f oUowa : 

The first was occasioned by the development of a case of mumps 
in the Borough of Callery. The Health Board of that Borough not 
being properly organized, having no Health Officer, the case vaa re- 
ported to Dr. George Mathiott of Mara, Health OfBcer of Adams 
township, in which the Borough of Callery is located. Dr. Mathiott 
placarded the house in which this case resided and established the 
form of quarantine prescribed for such cases. A disagreement having 
arisen as to the diagnosis I was instructed by the Chief Medical In- 
spector to visit Callery, assist in making the diagnosis, and endeavor 
to effect an organization of the Health Board. This doty was per- 
formed January 8. 

As complaints had been made to the Department at Harrisbni^, of 
negligence on part of the Health Board of Harrisville Borough as to 
quarantine of cases of whooping cough, I was instructed by the Chief 
Medical Inspector to visit that Borough and insist that the Health 
Board perform its duties. May 18th, I made the visit of inspection, 
met with the Health Board, and explained to them their duties in the 
matter of protecting the public against the spread of contagious dis- 

A case of typhoid fever was reported to me by Joseph Criswell, 
Health Officer of Centre township, on the dairy farm of Harry Ralston 
of said township. I made a visit of inspection to this farm September 
2, according to the regulations as set down in such cases. The milk 
produced on this farm had been shipped to Butler. As there was no 
means by which this milk could be protected from contamination, I 
ordered the shipment closed until privilege to resume shipment should 
be given. 

On September 28, I made a visit of inspection to the home of G. W. 
Hicks, Forward township, by reason of a case of typhoid fever in his 
family; this being llie second case within a few weeks. A careful 
examination of water supply showed nothing of water pollution, and 
the difference in time between the cases led me to think the second 
case had been infected from the first case, and as the first patient 
bad been in a number of different localities, it seemed impossible to 
locate the source of his infection. 

This completed my duties as Medical Inspector for the year 1914 — 
a very unfortunate year for me, as I sustained a fracture of tibia and 
fibula on January 28th, and again, the last of the year, was laid up for 
repairs at the Johns Hopkins Hospital — Yet it is a good thing to live. 

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Dr. W. E. Matthews, C. M. I. During the year of 191i I have 
visited many of the townships in Cambria County and have also done 
special work in the boroughs, being deputized to do so by the Health 
Commissioner or by the Chief Medical Inspector, I have kept in 
close touch with the fourteen different health officers, especially dur- 
ing an epidemic. 

During the year 1,060 reports of placarding for communicable dis- 
.asea, Form 36, were received from district health officers, against 
1,006 in 1913. Also 820 reports of disinfection, Form 37, were re- 
ceived. After record of them was made they ^lere mailed to the De- 
partment at Harrisbui^ every Monday morning. 

Of the thirty-five reportable diseases we received reports as follows: 
Smallpox, cerebrospinal meningitis, erysipelas, penumonia, typhoid 
fever, diphtheria, measles, chicken pox, and mumps. 

Typhoid Fever: — Fifty-six cases of typhoid fever were reported, 
the same number as reported in 1913. March and May were free 
from the disease, September having the greatest number reported. 
The sanitary conditions are improving every year. As a rule I have 
fouDd the majority of persons willing to correct all unsanitary condi- 
tions. In September typhoid fever developed in the orphanage at 
Cresson where there were a hundred and fifty children. Eight cases 
developed in all. I advised the Health Officer to have the water 
boiled, as well as to look into the milk supply. Samples of water 
were sent to be analyzed and were found to contain bacilli coli. 

Diphtheria: — ^Two hundred and fifty cases of diphtheria were re- 
ported, October having fifty-five, the greatest number for any month. 
It was necessary to close many schools, have the rooms thoroughly 
fumigated, and establish a better observance of regulations before the 
disease could be stamped out. At Beaverdale the disease was of such 
a malignant type that not only schools but also places of amusement 
were closed until the disease was checked. 

Scarlet Fever: — Cases of scarlet fever were reported every month 
during the year, a hundred and twenty-four in all, March having nine- 
ieeu cases, the greatest number. In order to establish a diagnosis and 
inaugurate measures to check the disease, I found it necessary to visit 
some of the infected places, order schools closed and fumigated, and 
to instruct health officers to make quarantine absolute, using guards 
if necessary. Four cases developed in St. Francis College, Loretto, 
.\ iiere there were in all two hundred persons. But one new case de- 
veloped in the borough after the outbreak. A strict quarantine waa 
established and no new cases developed in the College. , - ■ 

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Measles: — Three hundred flfty-flve cases of measles were reported, 
fifty-eight less than last year. They were distributed throughout 
the county. 

Erysipelas: — Seven cases of erysipelas were reported. They re- 
quired no special Investigation, were widely separated geographically 
and bore no relation to each other. 

Cerebrospinal Meninigitis: — Five cases were reported. All were 
in the care of family physicians and required no action oo the part 
of the Uedical Inspector. 

Whooping Cough: — Two hundred cas^ of whooping cough devel- 
oped during the year, forty-one in July. In September I visited West 
Taylor township and found as reported a number of cases. A diag- 
nosis was made, quarantine established, and schools and Sunday 
schools closed for a time. The epidemic was of such a malignant type 
and the number of cases so great, two deaths having occurred, that 
I felt this was the only way to stop the spread of the disease. No new 
cases developed. 

Chicken Pox: — Eighty cases of chicken pox were reported in 1914. 
Quarantine rules were enforced and the disease was checked. 

Mumps: — Seventeen case.s of mnmps were reported and required 
no action on the part of the Medical Inspector, 

Pneumonia and Tuberculosis were rei)orted from difTerent districts 
in the county, but were cared for by family physicians. 

During the year my attention has been called by telephone, letter, 
etc., to a number of cases of nuisances, such as dead animals, drain- 
age of sewers, etc., into public streams. These calls have received 
prompt attention. 

In addition to the brief summaries I hare made every effort to keep 
close watch on all reports of commnnicable diseases. I have endeav- 
ored to make my work educational and to teach the people the princi- 
ples of health and how properly to care for its maintenance. 1 be- 
lieve the work of the Department is being appreciated more e\'ery 
year as the people are more willing to have their premises iflacarded 
and under quarantine. There is splendid co-operation of the greater 
number of Cambria county physicians and the health officers see 
the necessity of being moderate yet positive in their instructions to 
the people with whom they have to deal. 

Statiaticol Summary of Work Performed During tbe Year. 

Forms 37 received 820 Examined cbbps alleged to be 

Forms 36 received, 1,060 Typhoid fever EO 

Diphthpria, 250 

Chicken poi 80 

MefiBlPs 350 

Whoopinn cough 200 

Mumps IT 

Scarlet fever 134 

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Dr. H, S. Falk, C. M. I. I hereby submit my report for Cameron 
County for year 1914. 

No. 38 No, 37 

were reported:— 


1^.' :::::::::::::: 





The foUowing caseB 


Whoopine coogh, 

Chicken Pol 



Typhoid Fever 

During the year I inspected and cheeked diagnosis in KXty-nine 
cases and traveled 257 miles as follows: — 

Daring Marcti I traveled seventy-two miles and checked thirty-nine 
cases of measles. 

During April I traveled eighty-eight miles and checked thirteen 
cases of measles. 

During May I traveled twenty-eight miles and checked two cases of 

Daring June I traveled sixty-six miles and checked fifteen cases 
of measles and three cases of mumps. 

During October I traveled three miles and checked six cases of 
chicken pox. 

On April 26th, I received a (el^ram from Harrisburg concerning 
two residents of Sinnemahoning who were in contact with smallpox 
io Erie. I immediately went to Sinnemahoning and vaccinated one 
of the contacts; the other case was that of an old lady that was 
brought home with a broken hip and was not in condition to stand 
vaccination. I had a health officer fumigate all of their belongings 
and vaccinated all who were in contact with the old couple. No 
cases of smallpox developed. 

On August 7th, I received a letter in reference to whooping cough 
in European Borough and on investigation found that the health 
officer had quarantined all cases that were reported and investigated 
all cases he hieard about. 

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Dr. E. Q. Bray, C. M. I. AoDual report aud statistical summai? 
for the year 191i. 

Carbon Count; had no epidemics during the past year. Measles 
and diphtheria were more prevalent than other diseases, bnt at no 
time did these diseases get beyond control. 

Typhoid fever seems to be endemic in the lower end of the County. 
It was reported as having occnfred in fourteen cases. 

It has been found that some of the physicians of the county do not 
always report cases of contagious disease under their care, although 
there is improvement in this condition over other years. It is to be 
hoped that the time is not far distant when our morbidity reports 
will he accurate indicators of the prevalence of disease in the county. 

Diphtheria: — With the exception of March and June diphtheria 
was always with us. The cases were sporadic in character, and the 
disease was kept under control by careful quarantine and disinfection. 

Typhoid Fever: — Of the fourteen cases of typhoid fever which were 
reported during the year twdve were in the lower end of the district. 
Each year this part of the county furnishes nearly ail the cases of this 
disease and as yet no means have been devised to prevent this annual 

Weatherly School Survey (Sanitary): — Because the school board 
of Weatherly absolutely refused to have made a medical inspection 
of their school children, the State Health Authorities exercised their 
right and ordered a sanitary survey of the school premises. Although 
they have a large and commodious school building it was built many 
years ago and it was found to lack some of the modern improvements 
essential for the health of the children. It is to be hoped that next 
year the directors of the school will ask the State to make a medical 
inspection of their school children. 

Stfltistical Summary of the Work of the Tear. 

No, FormB— 36 received 201 Dniry (anus Inspected, 1 

No. Forms— 37 receded 178 Sale of milb stopped, 1 

Health Omcen inBtructed, 3 

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Dr. 8. M. Huff, C. M. I. I beg to submit the foUowing enmrnary of 
tbe work done through the office of the County Medical Inspector of 
Centre County for the year 191i. 

During the year it was found necessary to make two visits to the 
Borough of State College, two to Snow Shoe Township, one to Penn 
Township, and one to Gre^ Township. 

Four hundred and eighteen reports of placarding for communicable 
diseases (Form-36) were received from tbe nine Health OfBcers in the 
county. These officers also sent in three hundred and eleven re- 
ports of disinfection (Form-37). 

Of the reportable diseases, there were reports on ten during the year 
as follows: — 

Chioken Pox; — Fourteen cases of this disease were reported by 
physicians during the year. 

Diphtheria: — Thirty-four cases were reported during the year from 
ten townships. 

Oerman Measles: — One case of German Measles was reported from 
Huston Township. 

Measles: — There were three hundred and fifty-four cases of this 
disease reported during the year, the greatest number occurring in one 
Township was eighty-seYen iti Gregg; Snow Shoe had sixty-three; 
Harris fifty-five; Potter thirty-eight; College twenty-seven; Worth 
thirteen; Rush twelve; Union eleven; Penn eleven; Huston eight; 
Ferguson seven; Spring seven; Fatten fiix;Boggs four; Curtin two; 
Bumside one; Half Moon one; and Tayl'or one. 

Mumps: — There were sixteen cases reported from nine townships. 

Pneumonia: — One case of this disease was reported from Gregg 

Scarlet Fever: — Thirty-one cases of this disease were reported from 
seven townships. 

Tuberculosis: — There were four cases reported from Rush, Potter, 
and Penn townships. 

Typhoid Fever: — Twenty-three cases were reported, ten of the 
twenty-five townships being represented. ' 

Whoojnnff Cough: — Eighteen cases of this disease were reported 
from two townships. 

25— 15— 1916 

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Dr. Joseph Scattergood, C. M. I. As is the yearly costom, your 
County Mjedical Inspector herewith submits bis report of the work 
done in Chester County for the year 1914. 

There has been leas sickness of an epidemic form than in preTions 
years, and I believe the work of our Health Officers has been of a 
higher grade. With one exception, they have been prompt and 
efficient in their work. There have been but two changes among 
them through resignations. 

Chester Connty has an area of 777 square miles with eleven bor- 
oughs, total population approximately, 50,000; and fifty-six townships 
with a total population approximately of 58,000, and an approximate 
area of 750 square miles, which latter territory comes immediately 
under the care of your County Medical Inspector. 

The borough of Elverson has been incorporated within the past few 
years, but, so far, has failed to comply with the Act of Assembly 
and has as yet established no Board of Health. Owing to an epidemic 
of chicken pox in the Borough, it was necessary for the Department 
of Health to look after health matters here. On October 6th, I 
was authorized to visit the borough to investigate some cases of ty- 
phoid fever which had not been reported by the boroagh authorities. 
After an interview with members of Council, in which the necessity for 
their action was explained to them as to the establishment of a local 
Board of Health, no action being taken, the Department of Health 
took charge of health matters in Elversion according to the provisions 
of the Act of Assembly, placing the same in my charge, and I have 
deputized the health officer of a nei^boring township, Mr, Essicks, to 
look after matters until such time as the borough authorities aee 
their way clear to fulfill the provisions of the Act of Assembly. 

It has been necessary in the performance of official duties at differ- 
ent times during the year, to visit practically all the townships and 
to travel a distauce of 1,257 miles by automobile or livery and 662 
miles by railroad or trolley. 

Health Officers have reported placarding 576 premises (Forms 36) 
and disinfecting 524 premises (Forms 37). All of these reports were 
carefully examined and, if incomplete, returned for additional in- 
formation. There were twenty-eight occasions to interview Health 
Officers regarding their work, either at this office or elsewhere. 

Of the total number of reportable diaeases, this office has had to do 
with thirteen; -as follows: — 

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Erysipelas: — Sixteen cases have been reported, all under the care 
of pbjsidana, and reqairing no action on the part of yonr Coonty 
Medical Inspector. 

Chicken Pox: — A hundred and one cases were reported by physi- 
cians and householders, an increase of twenty-Btiven over last year. 
This does not, however, I believe, give a true picture of the prevalence 
of this mild disease, as many families did not employ a physician, nor 
have the householders reported the cases to the Health Officers. Yonr 
County Medical Inspector was called in to make a differential diag- 
nosis in six cases where smallpox was suspected. 

Diphtheria: — This disease occurred in twenty-six townships — sixty 
cases being reported in the entire county. In no district could it be 
called "epidemic," The largest number of cases occurred in Tredy- 
flFrin Township, which had ten cases. In the country districts reqiote 
from more built up neighborhoods, I believe many cases of "sore 
throat" were probably of a diphtheritic origin, but, in the absence of 
cultures, the more severe diagnosis was not mada 

Measles:— This disease, which was epidemic in our county last 
year, did not make its appearance in many of our townships. There 
were a hundred and forty cases in all reported. The greatest num- 
ber was from Cain Township, which reported eighteen cases. This 
does not in any way represent the entire number of cases throughout 
tbis county, as many householders, in order to avoid quarantine, have 
kept under cover this disease. 

Mumps: — Eighty-nine cases are recorded. This is more than three 
times as many as were reported last year; there being an epidemic 
pretty generally over the county during the later months of the year. 
In certain districts, in order to avoid the quarantine requiring school 
exclusion, the cases, io many instances, were simply reported as 
"swollen glands." It was necessary for your County MedicGd In- 
spector to visit several territories to explain to the school authorities 
how they were being imposed upon and that if exclusion in all these 
cases from school was not consistently carried out, more drastic meas- 
ures would be necessary. Following the advice given, I believe, in 
every instance the school authorities immediately tightened up on 
these evasions of the law and excluded all suspicious cases. 

PneumonUt: — There were no cases of pApumonia reported; the 
physicians evidently overlooking the regulations of the Department 
requiring its being reported. We know that many cases did exist. 

Scarlet Fever: — There were double the number of cases this year 
over the same period of 1913, the greatest number occurring in West 
Cain Township, which bad twelve cases in all. The other cases were 
rather evenly distributed among twenty-thrjee townships. I believe 
the law regarding the reporting of scarlet fever was very much better 
carried out this year than in previous years. 

I Goot^lc 


Smallpox: — In the early part of the year (March), a email epidemic 
of smallpox developed in aod around the village of Tonghlienamon 
in New Garden Township. In all nineteen cases were reported ; the 
firat one developing in a colored man who had been working at Brandy 
wine Springs, Delaware, but who traveled back and forth on the 
trolley car to his work. This man lived in a miserable shack with 
three other colored persons; the shack being situated in a small 
settlement of the coloted race. Immediately absolute qnarantine, 
with guards, was put over the place, all the neighbors were vaccinated 
and those with whom we had any season to suspect he had come in 
contact. The officials of the West Chester, Wilmington and Kennett 
Klectric Railway were notified of the fact of this man's traveling on 
their cars, and a general vaccination was done among their employees. 
It was impossible to trace the exact car on which this man traveled, 
80 all of the roUing-sfock was fumigated, and instructions given to 
the Company to have the same fumigated every nig^t when turned 
in, which instructions they promised to carry out. 

Seven days following the first case, two other colored pereons were 
taken down with smallpox, living about a mile and a half distant 
from the first case. We finally were able to get an admission from 
them that an old colored woman made daily trips between these 
houses and carried the infection from the first case to the subsequent 
ones. The other cases in this epidemic were ail white, and absolutely 
no connection could be made between the two colors, excepting for the 
fact that this same trolley line through Toughkenamon and all 
unvaceinated persons traveling theieon would have the same oppor- 
tunity to contract the disease. All of the other sixteen cases, either 
traveled on the trolley or lived immediately alongside the track and 
would necessarily come in contact with trolley passengers. Absolute 
quarantine was placed on all these premises where the disease existed 
and guards placed over them. The Pennsylvania Railroad Company 
was notified of the disease, and it was thought advisable by their 
medical council to prohibit the stopping of trains at Toughkenamon 
Station, which worked quite a hardship on the people of the village, 
but, nevertheless, they submitted with more or leas good grace. The 
trains resumed their service after about two weeks. 

In all, about 1,100 vaccinations were performed on the persons liv- 
ing along the White Clay Valley from Kennett Square to West Grove. 
Rome considerable alarm was felt at the beginning, but your County 
Medical Inspector had an opportunity to be present at several pnblic 
meetinp and satisfied the citizens that the health of the commnnity 
was being well guarded, that no alarm should be felt over thefie few 
cases. At the same time the opportunity was used to advise and urge 
complete vaccination of all school children and in fact of all persons 
upon whom the operation had not been performed within the last five 


years. Considerable resistance was felt in and- around Kennett 
Square, bat when it was made plain that the Department would insi^it 
on either vaccination or the closing of the schools and the manufac- 
turing plants, the workmen finally consented and, with very few ex- 
ceptions, all were vaccinated. I>uring this entire epidemic, there were 
no fatalities. The public school in Toughkenanion was closed for a 
period of three weeks after it had been learned that several of the 
childi*eD who developed smallpox had been in attendance only a few 
days before the rash broke out, and only opened after all had been 

On the 7th of July, we had one family in TJwchlan Township where 
the householder developed smallpox, presumably from mingling in a 
bar-room in Downingtown with some "hobo" train riders who had 
come from an infected district near the centre of the State. Follow- 
ing this case, in exactly fourteen days, four of his children went down 
with the disease. The entire family, including the wife and seven 
children were removed to the pesthouse at Embreeville. They all 
made a satisfactory recovery. 

After we first became aware of the existence of the disease, most 
prompt and drastic measures were instituted in each Instance to pre- 
vent its spread. Vaccination of all contacts, without exception, wag 
insisted upon and performed. The results show that our efforts 
were not in vain as there were no other secondary cases. 

Tetanus: — Three cases have been reported, which required no ac- 
tion on the part of this office. 

Tuberculoais: — Seven cases were reported from that many town- 
ships. Many cases developed in the boroughs which were probably 
reported through the local health boards. In West Chester, Coates- 
ville, and Phoenixville, a great many cases have been treated at our 
dispensaries, and it has been the practice to send all those who wished 
to go to one of the State sanatoria. I think that the physicians and 
the people of the county are appreciating and realizing the advantages 
to be derived from the better facilities for caring for these unfortunate 
at our State hospitals. It is unfortunate that the necessity for re- 
porting them is not appreciated more, both by physicians and patients, 
as no doubt many cases have been contracted through carelessness 
and ignorance on the part of households where this disease exists. 

Typhoid Fever: — Our county has been reasonably free from this 
disease. Eighty-eight cases have been reported. Of these nine came 
from East Pallowfield and twelve from Valley township, which are 
immediately contiguous to Goatesville, where typhoid has been un- 
duly prevalent for some years. It has been scattered in small num- 
bers throughout practically all the other townships. It was neces- 
sary for your County Medical Inspector to visit a number of farms 
on which the disease existed to see that quarantine regulations were 



properly carried out. It is a pleasure to report that in every iostance 
my visit was received cordially and with apparent satisfaction, as 
the farmer was anxious not to have his milk shipments cat off and 
also to protect his customers from any risk of infection. The un- 
sanitary conditions, to which were traced a Dumber of cases in the 
townships around Goatesville, were created by the throwing of night 
soil, taken from the privies in Coatesville over the meadows which 
drained into the creeks through the farmland where dairies were kept 
in this neighborhood. 

Whooping Cough: — There were fewer cases than during the pre- 
vious year, but fifty-two cases being reported as against a hundred 
and twouty-eight cases last year. An epidemic was again present in 
Tredyffrin and Easttown Townships, where thirty-two cases of the 
entire number were located. The school authorities of these two 
townships were exceedingly careful not only to exclude the children 
on whose premises the disease existed but also to see that the 
health authorities were notified, thus enabling quarantine to be 
promptly e-^itablished. 

Impetigo: — One case of impetigo contagiosa has been reported to 
this office. Evidently the disease is not recognized by many of onr 
physicians or else it is not reported. 

Summarj at the Work of the Year. 

Reason, Smnllpox, meael«8 and chicken poi. 

There have been no complaints to this office of misconduct on the 
part of any of our sixteen Health Officers and, with one exception, be- 
fore spoken of, all have done their work promptly and intelligently. 
It has been my endeavor in recommending names for health officers 
to replace those who have resigned for any reason, to obtain men of 
intelligence and education in order that the work may be done wift 
tact and discretion. 

Numerous consultations have been had with school boards, teach- 
ers, physicians, and boards of health of boroughs, and my office seems 
to have become almost a bureau of information on health matters, as 
daily numerous calls by telephone or in person or by post have come 
for advice regarding health and sanitary matters. Complaints are 
numerous and are attended to with promptness and, I trust, satis- 
factorily to those who have made them. Some unjust ones have been 
made, to which, after investigation, no attention was paid. I believe 
the work of the Department and the efforts of its officers are being 
more appreciated every year by the public as well as by the physicians. 
When necessary to visit various sections of the county on official 
business relating to any case of disease, it has been my practice, as 


much as possible, to call in the attending physician and go over the 
health and sanitary sitnation with bim, which, I believe, has in- 
creased considerably the good feeling of our physicians toward the 


Dr. P. P. Phillips, C. M. I. Clarion County has an area of 600 
square miles and is divided into twelve borouRhs and tw«nty-two 
townships. The population of the coonty in 1910 was 36,638; that of 
the borouphs was 10,827. This leaves 25,811 coming under the super- 
vision of the County Medical Inspector, The nomber of square miles 
coming under the supervision of the County Medical Inspector is 
approximately five hnndred. The county is conspicuous by the ab- 
sence of street car lines and macadam roads. It is also conspicuous 
by the presence of bad roads during five months of the year, it only 
being practicable to use an automobile seven months out of the year. 
I mention the area, the population and the conditions of travel, in 
order to give the Department some idea of the difficulties met by the 
County Medical Inspector. 

The twenty-two townships are divided up for supervision by sixteen 
health officers. The work of the health officers has been satisfactory, 
with the exception of several who are practising physicians. I find 
that where practising physicians are health ofRcers, they frequently 
incur the enmity of the physician who reports the case, probably be- 
cause th^ in some cases doubt the diagnosis instead of attending 
strictly to their bnsiness and doing their duty as laymen health officer. 

During the year 1914, three hundred and nine cases were reported. 
Of this number the County Medical Inspector himself reported more 
than one-third. Since we have forty-two practising physicians in the 
county, it would loolt as though the physicians are rather negligent, 
or that a great many families treat reportable diseases without em- 
ploying a physician. The following are the discuses with, which the 
C/Ounty Medical Inspector had more or less to do. 

Chicken Pox: — There were thirty nine cases of chicken pox reported. 
March 17th I visited cases of chicken pox in Redbank township owing 
to the report that quarantine laws were not being obeyed. This I 
fonnd not to he true. 

DiphtJieria: — During the year there were twenty-two cases of diph- 
theria reported. June 18th, at the suggestion of Dr. Clarke, of Ship- 


penvDle, I investigated a auepicioos case of sore throat in Paint 
township and made a positive diagnosis of diphtheria. I immunised 
those who bad been in contact and established qtiarantiue. July 18th 
at the snggestlon of Dr. Cookson, of Veous, I visited a saspicions 
case of sore throat at Venus, Washington township, and made a posi- 
tive diagnosis of diphtheria. I immunized seven persons who had 
been in contact and quarantined them. 

November 1st I visited a suspicious case of sore throat in Elk 
Township, at the suggestion of Dr. Clarke, of Shippenville, and made 
a very positive diagnosis of diphtheria and immunized the contacts. 
I also advised heroic doses of antitoxin to be given to the sick child, 
but it died a few hours later. As this child had been attending the 
Pine City school, while suffering from the disease, I ordered the 
school room to be fumigated and the school closed for one week to 
make sure there should not be an outbreak. 

German Measles: — December 2nd I investigated two families in 
Farmington township, whose children were ill with a suspicions rash. 
Made a positive diagnosis of German measles and had the Station 
school, where they had been attending, fumigated. 

Measles: — During the year there were eighty-four cases of measles 
reported. April 10th, at the suggestion of Health Officer Sayera, I 
made a canvas of Redbank township in the vicinity of the Himes 
school, found three cases of measles and quarantined each case. 

October 18th, at the suggestion of Health Officer Brown, I made an 
investigation of measles at Foxburg, Richmond township, where 1 
found and quarantined twenty-two cases. The schools were closed 
and fumigated. On November 10th, I made a further investigation of 
measles at Foxburg, where I found and quarantined eleven cases. 

Mumps: — There was only one case of mumps reported during the 
year. On January 6th I examined children at Uillerstown school, 
Washington township, who were reported by the teacher to be suffer- 
ing from mumps, making the diagnosis is of enlarged lympathic 

Scarlet Fever: — There were ninety cases of scarlet fever reported 
during the year. February 27th, as ordered by the Department, I 
made an investigation of a family in East Brady borough, which was 
reported as having not observed the quarantine law. Found careful 
obsepvance, and also found an epidemic of German measles which 
the borough had not been looking after. 

July 13th, as ordered by the Depai'tment, I investigated observance 
of scarlet fever quarantine laws at Vowinckle, Farmington township. 
On July 24:th, as instructed by a telegram received from the Depart- 
ment, I fumigated the mails at the Vowinckle postoffice, Farmington 
Township, owing to the report seut to Harrisburg that the Postmis- 
tress was taking care of a case of scarlet fever and handling the 


mail. For the past few years there had been quite a number of oases 
of scarlet fever reported from Licking town^lp and owing to the re- 
port from Health Officer Meala that he believed there were a good 
many cases not under quarantine, I made a thorough investigation 
and a bouse to bouse convass of a large part of that township. On 
April Slth I found and quarantined six cases; on April 26th fifteen 
cases; on April 27th twenty-one cases; on April 30tb thirteen cases. 
I am glad to report that aftei" the house cleaning I gave Licking 
township there has not been a case since. 

Typhoid Fever: — During the year there were twenty-three cases 
reported. On July 22nd upon receipt of card From 36, affirming the 
sale of milk from a home in Farmington township where typhoid fever 
existed, I investigated the place and stopped the sale of milk and 
milk products, inasmuch as the wife who looked after the milk and 
milk products also attended the patient. 

On Sept. 26th, upon receipt of card Form 36, reporting the sale 
of butter by a family in Limestone township, where typhoid fever 
existed, I investigated and stopped the sale, as the housewife at- 
tended patient and made butter. As ordered by the Department, on 
July Idth, I made an investigation of probable source of typhoid at 
Bitnersburg occurring each year. Detailed report was mailed August 

Whooping Cough: — During the year card Form 36 was received for 
forty cases, but evidently the health officers did not make out Form 
36 for each case, as I have memorandum sheets showing more cases 
to have been investigated. On March 10th, Dr. Houston, of Knox, 
was deputized to investigate whooping cough at Monroe, Beaver 
Township, and found four cases in the school and two cases in two 

On Jan. 29th, upon receipt of a report from health officer McLaugh- 
lin, of Knox township, that whooping cough was prevalent and not 
reported, I made an investigation and quarantined fifteen cases. 
On Feb. 6th, I made a further investigation and quarantined thirty 
cases, and on the 7th, eighteen cases. On March 5th, upon receipt of 
report from health officer Seigworth, of Farmington township, that 
whooping congb existed and was not quarantined, I investigated the 
affair and found seven cases, which I quarantined. 

Statistical Summary of Work Done Dnring the Tear. 

Forma 38 received, 300 Examined cases alleged to be 

Forma 37 received 217 

Diphtheria. S 

Scarlet Fever 60 

German meealea 3 

Meaales, .. 35 

Wboopiag cougti, 78 

Mumps, t 

Stopped aale of rnOk on two 




Dr. S. C. Stewart, C. M. I. I beg to submit the following Teport 
of wort done in Clearfield County daring the year 1914. 

Clearfield County lias an area of 1,142 square miles, is divided into 
twenty borongbs and thirty townsliips, with a popolatioD of approxi- 
mately 60,000, coming under the direct supervision of your County 
Medical Inspector. 

Dnring the year 343 reports of placarding (Fonns-36) and 337 re^ 
ports of disinfection (Form-37) were sent in by the fourteen health 

Of the thirty-five diseases requiring report to the Department of 
Health, this office had to do with but nine during the year, 133 cases 
being reported aa follows: — 

MeaaleH 162 Chicken pox, U 

Diphtheria 142 Tuberculosis 8 

Typhnid (ever 44 Mumps, 5 

Swirlet (ever 24 SmaUpox, 3 

Wbooping cough, 33 

With the exception of smallpox no special investigations were made. 
On January 5th, I was called by Doctor McGirk with reference to a 
resident of Chester Hill, who had been visiting in Altoona at a honae 
where smallpox was developing. He refused vaccination nnd the 
premises were placed under absolute quarantine for eighteen days. 

On January 7th, a report reached me that a case of smallpox 
existed in Sandy Township. This case is interesting to me and the 
following represents in a manner the efHcient work done by our State 
Board of Health. About December 20th, 1913, Mr. L. of DuBois, 
had been to Fittsbui^h. After his return he had an eruption which 
was mistaken for chicken pox. He had a relative living in Bandy 
Township who had a child die. The child was brought to Hr. Logan's 
home in DuBois for burial. After the burial of the child the mother 
of the child went to Warren with a relative who had attended the 
funeral. On her return from Warren to Randy Township she wa-f 
taken with smallpox. Bhe stated that the woman. whom she had gone 
to Warren with was ill when she left. I got the address of the 
woman in Warren and wired the State Department of Health at 
Harrisbnrg and had the Warren case quarantined by eight o'clock on 
the same day. This was all done within less than nine houni from 
the time I received notice of the case in Sandy Township. I at once 
ordered -absoltite quarantine of the premises and deputized two physi- 
cians to vaccinate all contracts in Sandy Towntihip and DoBois. 
Only one case occurred from contact with thb patirat. ^ , 

I, Cockle 


Jannaiy 11th, I was called b; Doctor Miller to see a case suspected 
of being Hmallpox in Penn Township. A definite diagnosis could not 
be established. We, however, considered it an indeterminate case 
and placarded the premises for smallpox and establiahed absolute 
quarantine. Ordered vaecinatioQ of all contacts and fumigation of 
school room where patient taught. Later this case proved to be a con- 
fluent smallpox. 

In November, I made an investigation at Allport and Morrisdale 
where it was reported that an epidemic of diphtheria was threatened. 
Found no evidence of irregularities and the attending physician 
seemed to have his people in good control. 

November 9th, I made an investigation of the Glen Kichej school 
premises where ten cases of diphtheria had occurred. The school 
was closed and fumigated and ordered to be kept closed until the 
premises were put in a more sanitary condition. 

StatiBtical Summary of the Work of the Xeai. 

Kiamiaed cases alleged to be: 

Forma 38 re<«ived 343 Smallpoi, 8 

Forma 37 received 337 Chicken poi, 12 

Schools ordered cloaed, — 

Dairy farms inspected, 

Miles traveled b; railroad. 


Dr. E. B. Watson, C. M. I. As County Medical Inspector of 
Clinton County, I respectfully submit the following as a summary of 
the sickness among the thirty-two thousand inhabitants of our county 
which came under my snperviaion in the year 1914. 

Smallpox: — On February 4th, the attending physician of four cases 
of an eruptive fever which he had diagnosed to be smallpox, tele- 
phoned and asked me to go and see the cases with him and confirm 
his diagnosis, which I did, but could and did not agree with his 
diagnosis. They much to our satisfaction proved to be chicken pox 
and after hearing the history of the exposure, the character of the 
eruption and its development, &c., there could be no mistake. 

On November 26th, the Health Board of Benovo sent for me to 
come up and see two suspected eases of smallpox. I went and found 
two brothers, one a fireman running between Benovo and Kidgway, 
the other an employee in the Benovo shops. The supposition was that 
this fireman had contracted the disease either at Kane or Bidgwnr, 



as th«re was some smallpox at Kane at that time, and his brother 
contracted the disease from him. The Renovo Health Board promptly 
quarantined both houses putting a guard upon each. I vaccinated 
all the inmates of both houses and the local physician promised to 
see that all contacts were vaccinated and the disease was prevented 
from standing. These two cases were the only ones in our county in 

Diphtheria: — We had twenty-six eases in various townships dur- 
ing the year. The death rate was low owing to the prompt use of 
antitoxin. Six of these cases occurring in Greene Township coold 
be traced to a child coming home from Pine Creek where he had been 
exposed to the disease. In a few days after his arrival at home the 
disease was developed and five of his brothers and sisters contracted 
it from him. 

Scarlet Fever; — Of this disease there were ten cases reported to 
the County Medical Inspector during the year, and most of these cases 
occurred in Porter and Lamar Townships. 

Measlea: — Measles also apeeared in Porter and Lamar Townships 
with some eases in Piue Creek. I was not called to make an in- 
spection in any of these cases. They were generally quarantined 
and the houses placarded, and the instructions of the Health Officer 
were pretty well obeyed. 

Typlwid Fever: — There were only seven cases reported which was 
quite an improvement over 1913, just one-half as many. 

Mumps: — We had nineteen cases of mumps but I feel satisfied there 
were quite a number of cases occurred that were not reported. 

Chicken Pox: — We had nine cases reported in the county. 

SummHrr of DiHeaaee lu Clinton County id 1£U, 

FonnB 36 received, 129 Diseaaes— 

Forms 37 received, 112 

Scarlet fever, 10 

Diphtheria 28 

Typhoid (ever 7 

CtLicken poz, 9 

Mumps, U 

Meusies M 

Rmnllpni .,.. 3 

Krysipdaa 1 


Dr. S. B. Arment, C. M. I. I have the honor of reporting the fol- 
lowing RQmmary report of Columbia County for the year 1914. 



The year was ushered in with a comparative cleau bill of health as 
there was no epidemic of any aeeount left over from the year before. 

It was soon evident, however, that, with the inhabitants living 
within doors, contagions diseases began to spread as evidenced by the 
reporting of over a hundred cases of contagious disease throughout 
the county by April 1st. with a subsidence in July, August and 
September, when they again began to multiply. 

, During the year three hundred and ten cases of contagious disease 
have been reported by the health officers doing work outside the bor- 
ough, of which your county medical inspector diagnosed twenty-four, 
the most of them being chicken pox. 

I would also state that two cases of Anthrax were inspected, one in 
Berwick and the other Catawissa. Details concerning each will be 
found among the special reports of the Medical Division. Of the 
above diseases, there were: — 

D pox, IS Measles, 

Scarlet fever 36 Gcrmnn raeaHles, 

WhoopiuK cousb, 127 Diphtheria, 

Pneumonia^ 2 Typhoid fever, . 

TuberculoslB 7 Aliimps 

TctauuB, 1 Krysip«laa 

Two hundred and twenty-four reports were received from the ei^t 
Health OfQcers of disinfections performed by them for these diseases. 

Chicken Pox: — This disease was well scattered throughout the 
county, no one health officer reported any large number and almost 
every one reported one or more cases. 

Scarlet Fever: — This was confined to the southern portion of the 
County and no case reported to your Medical Inspector on the north- 
ern side of the Susquehanna River. 

Whooping Cough: — As usual this disease spread over the most of 
the county with the greater visitations in the lower and middle sec- 

Pneumonia: — But two cases were reported, and they both oc- 
curred in the northern section of the county. 

Tetanus: — The one case of this dread disease occurred in the lower 
section of the county. 

Mca»l€6: — This year the visitation of this disease was very light as 
but twelve cases were reported. 

Diphtheria: — Diphtheria was reported In forty-seven cases, many 
of them (twenty-three) in Oonyingham Township — quite a number in 
Hemlock, with six in Madison, and a few scattered over the rest of the 

Typhoid Fever: — There would appear to be a great falling oflf in 
this disease. I am glad to be able to say this, as I believe that all 
rural cases were reported this year, and only seven cases in all. 

Mumpt: — Mumps has a record of seven ca'ses scattered throughout 
&e couDty. 




BryaipeUts : — Erysipelas has but three victims to its credit, all 
in the upper sections of the county. 

Travel: — In the past year your inspector has traveled by rail fifty- 
two miles and forty-two miles by livery, with an expenditure of 
thirty-eight hours time used in traveling alone during the year. 

Sctiools: — Two schools were requested to disinfect on account of 
scarlet fever in Locust Township. 


Dr. J. K. Roberts, C. M. I. The medical inspection work of Craw- 
ford County for the year Iflll has been less than last year. There 
have been two hundred and ten eases of contagious diseases reported 
to me in 1011 and seven hundred and twelve in 1913. 

The work in many respects is more satisfactory as the physicians 
throughout the county are helping to avoid epidemics by reporting 
their contagious diseases more promptly and otherwise cooperating 
with me iQ the work in helping to suppress disease. 

There also has been less difficulty experienced by the Health Offi- 
cers throughout the county in enforcing quarantine and less disposi- 
tion on the part of those infected to keep the disease from being known 
and not to call a doctor to diagnose the case. This condition has im- 
proved not only in the country districts but also in the two cities and 
the boroughs in the county. 

Smallpox: — This disease has caused more trouble than any other 
this year. There was an epidemic of this disease in Union City and 
some other parts of Erie County in the first part of the year which 
caused a few cases to develop in the adjoining townships of Cam- 
bridge, Bloomfleld, and Sparta, and in the last part of the year there 
was an epidemic in Jamestown, Mercer County, which caused two 
cases to develop in West Fallowfield Township, also one case in 
West Mead Township. All these cases were carefully quarantined 
and contacts hunted up and vaccinated with the result that the dis- 
ease was kept under control. There were nine different homes quar- 
antined in five difi'erent townships in the county with nineteen cases 
which shows the good results of quarantine and vaccination. 

Typhmd Ferer: — The ejiideniic of typhoid fever in the small bor- 
ough of Hydetown in the eiistem part of Crawford County was re- 
ferred to me by the Department for investigation. I visited all the 
premises infected made ont census cards for each and forwarded 



tliem to the Department. I found the general sanitary conditions 
of this Borongh to be bad. Tbey were corrected and the disease 
stopped, no other cases developing after my visit. I concluded that 
flies had spread the disease, the first case having been infected outside 
of the Borough and the other infections coming from this one. The 
first case had not been reported and quarantined, and, therefore, the 
discharges were not properly taken care of. 

This was the only epidemic of typhoid fever in the connty this 
year, the other cases being scatered throughout the rural districts. 
It was difficult to trace the origin in most cases. 

Diphtheria: — There was a small epidemic of diphtheria in one of 
the school districts of Venango Township resulting in ten cases and 
two deaths. This was cansed by a child visiting in this vicinity from 
Erie. City, who had this disease but without diagnosis or quarantine. 
The other infectious diseases reported to me have been as a rule mild 
in character and with the quarantine restrictions which were prop- 
erly enforced were kept under control and the spread of the disease 

Statistical Summar; of Work Doae in Crawford County in ISli. 

Fonntt No. 37 received 1S9 Cases examined alleged to be: 

FonUB No. 36 received, 210 Measles, 3 

Mamps 2 

Dairies Insneeted for; Typhoid fever 3 

SmalI[>oi S Scarlet fever, 1 

Typhoid fever, t Chicken poi 8 

Diphtheria 4 Smallpox M 

DiphUerie , 8 

Inspection of smallpox before lifting quarantine, 7. 


Dr. H. B. Bashore, C. M. I. Cumberland County has an area of 
about five hundred and thirty square miles and is divided into twelve 
boroughs and eighteen townships. According to the census of 1910, 
the County has a population of 54,479. The boroughs contain about 
27,000, leaving a township population of 27,000, which is directly 
under the supervision of the County Medical Inspector. 

During the year I visited every township, except one, and traveled 
1,243 miles by rail and 461 miles by team. During the year I received 
134 reports of communicable diseases, and 118 reports of disinfection. 
Of the reported diseases I had to do with the following: 

> Goot^lc 


Chicken Pox: — Thirty-two cases were reported by physicians and 
parents during the year. There is still considerable tendency for the 
parents to secrete cases of this disease, although they almost invar- 
iably keep them out of school. 

Diphtheria :~'T]uii disease appeared in almost every township with 
a total of twenty-two cases. There was no soggeation of an epidemic, 
but only isolated cases cropping out from time to time. When a 
case appears iu a school, your Inspector makes it a role to visit thia 
school and examine the throats of all the pupils, eliminating, of 
course, any suspicious cases. By this method the danger of an out- 
break is diminished and school work is not interrupted by subse- 
quent closing of the school. 

Measles: — During the year twenty-one cases of this disease were 
reported, occurring only as isolated cases. It is quite likely that in 
very many of these cases the parents do not employ a doctor and the 
case is not reported, but the sick oiie is always kept out of school. 

Mumps: — Only five cases reported during the year. 

Scarlet Fever: — Three cams reported during the entire year, ocur- 
ring in widely separated districts and having no intercourse with each 

Typhoid i^ever;— Fourteen cases were reported during the year. 
About half of these cases occurred in Penn township, in a little moun- 
tain settlement known as BniEbtown. It seemed as though there 
might be a wide spread epidemic in this locality, but the people very 
readily accepted advice and began using boiled water for drinking 
purposes, with the result that the disease failed to spread. The nurse 
of the Huntsdale Visiting Nurse Association visited all the families 
of the sick and demonstrated her efficiency, with the result that there 
was not one "secondary" case, although sanitary conditions were 
very poor. A visiting nurse in a rural community like this does s. 
great deal of good. 

Whooping Cough: — Twelve cases reported in various places in the 
County. I feel certain that there are still a certain numl>er of eases 
of this disease not seen by a doctor and, of course, not reported. 

Dairy Farm Inspections: — During the year I inspected twelve dairy 
farms on account of the presence of scarlet fever, typhoid fever, and 
diphtheria. On five farms the sale of milk was discontinued, as the 
owners were unable to take the precautionary measures required by 
the Department. On the other seven farms, arrangements were made 
for a neighbor to do the milking and market the milk. 

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Dr. C. B. PhiHips, C. M. I. Daring the year 191i there were 428 
cases of communicable diseasos reported to the County Medical In- 
spector, Of these cases 197 occurred in smnll epidemics of varions 
diseases in different parts of the county, well distributed as to time, 
throughout the year. 

In March there were seventeen cases of scarlet fever in Upper Pai- 
ton township, which from the letter file of Dr. Paul A. Hartman, 
whom I succeeded March 2 as County Medical Inspector, I am in- 
clined to believe developed from a daughter of a Mr, M. 

who safFeKd from the disease while on a visit to Philadelphia and 
who returned home after an absence of nine weeks, Shortly after her 
return sii other members of the family developed the disease. 

In January there was a small epidemic of measles in Susquehanna 
township, thirty-seven cases being reported. 

Running steadily througt July, August, and September into Octo- 
ber there was an epidemic of typhoid fever in Derry township in the 
towns of Derry Church and Hershey, Of this epidemic I shall make 
further report. There were in all forty cases. 

Susquehanna township had forty-four cases of diphtheria in the 
fall and early winter, and Derry had two periods of infection, one of 
ten cases in March and another of nine cases in September. 

I am reporting these 197 cashes in this particular way because it 
seems to me that they point to a disregard of quarantine regulations 
and to carelessness as to early diagnosis and prompt isolation of 

By direction of the Department I went to Hershey Tuesday even- 
ing, March 17th, to see a patient of Dr. H. Found a young man, aged 
seventeen, with a papular eruption over face, chest, upper arms and 
tttighs. Discrete, superficial, no tendency to vesiculation or postula- 
tion. Patient not sick. Excluded variola, varioloid, and varicella. 
Diagnosis erythema papulatnm confirmed by Dr. C. J. Hunt, Associate 
Chief Medical Inspector. 

Typhoid Fever: — August 1st, upon information of a case of typhoid 
fever on the milk farm of J. M. D., near Deodate, Conewago town- 
ship, I made investigation. Arranged as the Department always in- 
sists shall be done, that the person doing the milking and attending to 
the milking utensils, should take an antif^eptic bath and move out 
of the house, and that she should live outside the quarantined prem- 
ises nntil quarantine was removed. Such an arrangement was made 
witli a daughter of the patient, 

26-16-1916 t,,,,,,,,, ,, Google 


On September 20th, I went to the 8. dairy farm, in HnnunelBtowi), 
to quarantine for typhoid fever and establish quarantine regulations. 
Found that farmer was UQwilliug to arrange for milking and butter 
making as laid down in the quarantine regulations of tlie Department. 
Said he would prefer to feed the milk to the hogs and only make 
enough butter for his family during the quarantine. We pointed 
out that even then he was espoeing his family to danger of infection. 
His remark, "The Lord is able to take care of us. I have fall confi- 
dence in Him," was decidedly at variance with his next words, which 
were a request that we take a sample of the well water "To see if there 
was any fever in it." 

During July and September, an excess of typhoid fever occurred in 
Derry township. I made investigation on August 5th, studying fif- 
teen cases, and during October and early November, studying twenty- 
five, A report of one of these two outbreaks may be found among the 
Special Reports of the Division of Medical Inspection. 

Diphtheria: — February 2ith, Dr. Ilartman, C. M, I., deputised Dr. 
0. J. B. Flowers, of Harrisburg, to examine some alleged cases of 
measles at Hershey. This he did and while there learned of sevei'al 
cases of diphtheria at Cassiday's quarries, between Derry Church 
and Palmyra. He investigated and found a deplorable coDdition of 
affairs. In one "shanty" he found sixteen men with the man who 
was suffering from diphtheria. These men were working, going from 
one 'shanty" to another, and visiting Palmyra without 'let or hin- 
drance." The patient was isolated, qnarantine was explained to the 
men, and the Superintendent of the quarries gave assurance that all 
instructions would be carried out. 

When quarantine time had elapsed, the bedding was burned and 
the provisions for sanitary cleaning, Fprm 18, were carried ont, 
as it was deemed impossible to disinfect by ordinary methods becanse 
of the cracks in the building. 

On Sfiptember 26th, received notice of death from diphtheria of 
Jonas H., infant son of Charles H., of Piketown, Hanover townsliip. 
The same mail brought Form 36, regarding this disease. Investi- 
gatioD showed that Health Officer Allwine had received notice of 
case and death same day; that he had instituted qnarantine and had 
stopped the sale of butter from the premises. I gave fall instruc- 
tions as to quarantine requirements. Harry S. P., farm hand, ar- 
ranged to eleop in the barn, take hia meals at the home of a neighbor- 
ing farmer and care for the milking and making of butter. Under 
these conditions sale was resumed in due time. 

Daring the fall and early winter there was a succession of caoes 
of diphtheria in the Pleasantview school. It was unquestionably 
a condition of school infection. We Hosed the schools one week, 
with the result that the number of cases immediatdy lessened odI^ 


to increase again, however, upon the opening of the schools. A week 
before the Christmas holidays we closed t)ie schools again, disinfected 
all the rooms from which pupils with the disease had been taken 
and kept the schools closed sixteen days, with the result that tlie 
epidemic was wiped out. 

German Measles: — On March 18th, at the request of Dr. Hotten- 
stein, of Millersburg, I Investigated with him five cases of German 
measles in adults, Three of the physicians of Millersburg concurred 
in the diagnoEds. These patients had not l>een sick and in each 
case had consulted a physician because of the rash which was annoy- 
ing to them. Two of the cases had enlarged jiostauricular lymjA 
nodes on the upper part of the mastoid process. Four of these 
patients worked in one of the factories of the town. Quarantine 
was ordered. Several days later, we were informed that the quaran- 
tined patients were at work. Investigation proved information to 
be correct. Attention of the local Health authorities was drawn 
to the condition and the factory ordered closed until disinfected 
and the patients strictly quarantined until expiration of quarantine 
period. These regulations were carried out at once. 

Scarlet Fever: — On April 30th, at the request of the Department, 
I went to Pillow to investigate rumored unreported cases of scarlet 
fe%'er. I found that two physicians from a neighboring county had 
been attending cases with sore throat and a rash in a number of 
families in Pillow. In some of the families I found children in the 
stage of desquamation from scarlet fever. In some cases two and 
three children to the family. There had been a death from post- 
acai^latinal nephritis. My information was that the cases started 
from an unreported case in the K. family living with Mr. H. in Pillow. 
One of the members of the family, while suffering from the disease 
worked in the shirt factory of the town. 

The factory and school were ordered disinfected. The Secretary 
of the local Board of Health promised to disinfect all the premises 
where suspicious cases had existed. 

The conditions as found were reported to the State Department 
of Health. 

StatiaticBl Suiuidbi? ot Work Performed Duriog tlie Year 1914. 

Forms 34 received 440 E^.tmiiiPd onaea allied to be:— 

Forms 36 received, 428 Sinollpoi, 3 

Forms 37 received 302 Typhoid fever, 33 

Diphtheria, 27 

CerebroHpinal meainKitis, 3 

5 Tuberculous meningitis 2 

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Dr. HlFam M. Hiller, G. M. I. We can again report a decrease in 
the Dumber of contagious diseases from Delaware county, as will be 
seen from our summary; we had but one hundred and ninety-flve 
compared with three hundred and three in 1913. 

Diphthena: — There were thirty cases of diphtheria. Of this num- 
ber twenty were from the Boys' School at Glen Mills. The cases 
appeared in several different cottages and occasioned some difficulty 
in tracing the source of the contagion. There were about eight 
hundred and flf^ boys in the school and the rigid quarantine and 
careful methods employed by the school authorities prevented any 
occurrence of contact cases. Eventually the food supply was Bua- 
pected and carriers sought for among those pupils distributing the 

Bj prolongation of the isolation period of the convalescents and 
their further .i^egregation, the outbreak was ended with only twenty 
cases. Dr. Wm. Wood was asked to assist the school physician in 
his efforts to control the outbreak and the following is a summary 
of bis report: 

"The infection originally appeared about the last week in Sep- 
tember, being imported to the school through contact from Upper 
Darby. The first case occurred about the first of October and since 
then, there has arisen on an average a new case every ten days. The 
total number of cases up to the 15tb of November is twenty.' Of 
these twenty, ten are in quarantine, the other ten having been released 
at the expiration of the quarantine peiiod. The last case occured 
on the 15fh of November. These ten cases are isolated in the Hospi- 
tal with a nurse in charge, who is also isolated, and careful disinfec- 
tion of linen, remnants of food, tableware, etc., is being carried out. 
There was no source of contact discovered with the isolated cases. 

"In addition to this, Dr. HoUingsworth, who is in charge, has 
caused to be sent into another Department in the Hospital, all throat 
cases which are studied and cultured. The ten cases released at the 
e-cpiration of the quarantine period were not studied culturally. 

"I have made the following sii^re^stions : That these ten cases 
released and any other occupant who has had diphtheria in the last 
six months be segiegated in a cottage and not allowed to attend school 
or any other place where the remainder of the boys congr^ate, that 
they be segregated for at least two weeks, after which time cultures 
be made and the negative ones released. Also that the cases released 
from quarantine be segregated for two weeks longer from these 
other boys and released on negative cultures. 

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"I have requested the Doctor to chart the cases and to remove 
any boy from contact with the food supply, including the dairy, if 
such boy be amoug those having had diphtheria within the last six 
months, and also advised that none of the boys infected be allowed 
to come in contact with the food supply for an extended period of 

In May I received a card from one of the Philadelphia hospitals 
reporting nasal diphtheria in a child, with the address, "Darby Creek, 
near West Chester," neither township nor county being given- The 
following excerpt from my letter of May 29th gives the further history 
of the case. 

"I enclose the correspondence relative to the inepectioD of nasal 
diphtheria, reported from Drexel Home, in Philadelphia to you, via 
Board of Health of Philadelphia and back to me by the way of Health 
Officer Moorhead. 

"As I wrote you, Darby Creek is at the minimum twelve miles from 
West Chester, but I felt that this case must be near the crossing of 
Darby Creek and the West Chester Turnpike. As such, it proved 
to be, the parent being C. P., who works in the saw mill at the above 
mentioned place. The father was perfectly frank in giving me the 
complete history of the case. They did not think it was diphtheria, 
so took it to Dr. I. B. Roberts, of Llanerch, who diagonsed foreign 
body in the nose, but was unable to remove it. He in turn sent it 
to the Childreu's Hospital, in Philadelphia, but they referred it 
back to Dr. Moore, Llanerch, who is on the staff at the Children's 
Hospital. He, as you wiU see by this letter, removed a piece of paper 
from the child's nostril and thus ended the case." 

Chicken Pox: — There were thirty-two cases of chicken pox and 
sixteen of these occured in the Sandy Bank School, Upper Providence 
township. The health officer reported a number of cases out of school 
on account of this disease and in only one case had a doctor been seen 
to verify the diagnosis. I sent the following letter to the secretary 
of the school bonrd for Upper Providence. 

"I bad Dr. J. Wm. Wood, of Chester, inspect all of these cases of 
alleged chicken pox, who had beeu out of the Sandy Bank school on 
account of illness during the last month. He has confirmed the 
diagnosis in every case and none of these children can legally return 
to school until their premises are disinfected. Some of these chil- 
dren have been allowed to return already but they will be excluded 
from this date until the health laws are complied with," 

No further cases ocurred after the premises and school were dis- 

Smallpox: — We had but one case of smallpox this year, a colored 
man, B. H., escaped from quarantine, unvaccinated, after being 
exposed to smallpox in Cincinnati, about the middle of May. He 



beat his way on freight trains to Cleveland, Buffalo, Allentown, and 
Bethlehem, before he came to Chester. Here the fever and pustnles 
developed aiid he went to the office of Dr. Thomas who diagnosed the 
case and notified this oiBce. As he was a tramp without a home or 
anj means of support, it became our duty to arrange for his care 
and with the consent of the State Quarantine Board, he was removed 
to Marcus Hook, where he recoveied without incident, and no other 
cases developed fiom exposure to him. 

We examined one case suspected of having smallpox but estab- 
lished the diagnosis of a pustular dermatitis resembling the drug 
rashes, but of unknown origin. 

Measles: — There were sixty four cases of measles reported to this 
office. Theie were nineteen cases in the Boys' Department of the 
Glen Mills School, but the prompt isolation of suspects and prohib- 
ition of general gatherings soon bronglit the outbreak to an end. 

Frequently the cases are mild in character and in the country 
districts the doctors are not called, with the result that the children 
return to school as soon as the rash disappears, without disinfection 
or adequate quarantine. The following letter illustrating such a caae 
was sent to the Health Officer for Bethel township. 

"I have just learned that there is one case, if not two or three cases, 
of measles at the home of H. T., living in Bethel township. Will yon 
please go to this place on Monday and ascertain the facts in regard 
to the report If you find that the hired man first, and then lattf 
one or more of his children have had what they think is measles, 
and they have had no doctor, you will please let me know and I will 
confirm this diagnosis. We do not want a repetition of the occur- 
rence at Booth Corner school. 

"While you are in that neighborhood, please .visit the school that 
is situated about half way between Chelsea and Booth Comer, and 
find out from the teacher how many pupils she has had absent with 
what she supposed was measles. I am told that out of about twaity- 
one pupils, she bad about twenty absentees." 

After having the Health Officer's report I sent you the following 

"Yesterday I went to No. 1 School, Bethel township, and ascer- 
tained fliat they had had seventeen absentees on account of measles, 
three pupils had stayed out because of fear of getting the measJes, 
and only one pupil attended school for a whole week. There was no 
doctor in any eaw and all were readmitted without certificates. 

"I met the secretary of the school board, who was then visiting 
the school and we had a very long heart to heart talk. The school 
board realizes the importance of the situation and are perfectly wil- 
ling to cooperate with us and are going to endeavor to bring the 
farmers to a thorough realization of the situation." 

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When we came to investigate further, we were told by the parento 
of these children that at times quarantine was not lifted promptly 
and in- some cases not at all, and for that reason they avoided call- 
ing a doctor. Our Health Officers replied that they could not disin- 
fect until they had orders from the doctors, and the doctors informed 
us that they often never saw minor illnesses except the one time 
when they reported them. To obviate this complicated situation, 
the following letter was sent to our health ofBcers: 

"I have the Oommissioner'a sanction to issue the following instruc- 
tions to you in order to obviate the difficulty which is constantly 
arising as to the raising of quarantine in cases where you have no 
notice from the doctor in charge that the case is concluded, and where 
tlie period of quarantine has expired. It has unfortunately occurred 
that in such cases the placard remains unremoved until the wind 
and rain destroy it and the children wander back to school without 

"There can be no blame attached to the attending physician in 
certain of these oases, for the reason that he may have only seen the 
case but the one time when the diagnosis was made, and no one pays 
him to return at the expiration of the quarantine period to ascertain if 
there be new cases or if the child has fully recovered. 

"Therefore, you are hereby instructed, in all cases in which your 
records in the Health Officer memorandum indicate that it is time 
to disinfect a case of contagious disease, you will if possible get in 
communication with the physician, who has reported the case, by 
telephone in order to save time, by letter if this is impossible, in- 
quiring from him if the case is ready for disinfection. If he has no 
knowledge of the case further than to have first notified you, it will 
he your duty to notify this office, so that a record of the case may be 
obtained, and you will then be instructed to proceed to the premises. 
If you find no further cases have occurred and in your judgment it 
is safe to do so, you will be instructed by the County Medical 
Inspector to raise quarantine and issue school permits. I wish in this 
way to make it obligatory to- have Health Officer's permits before 
children can go back to school, but unless we are prompt in our 
disinfections we cannot consistently hold parents responsible, if in 
their eagerness to get their children back to school they infringe 
the quarantine laws." 

Scarlet Fever: — We had five cases of scarlet fever reported and one 
that was transported to Philadelphia, where it was sent to the 
Municipal Hospital and reported from there. We were unable to 
establish criminal neglgence in this instance and did not prosecute 
the offender although the offence was grave and there were strong 
snspicioDS that the parents had transferred the patient to Philadel- 
phia with full knowledge that they were doing so in defiance of the 
Boards of Health. '^^Ic 


Typhoid Fever: — We had thirteen cases of typhoid fever reported 
to this office. This does not include the caaes comprised in the 
special reports od the outhrealiB in the borough of Marcus. Hook, 
and at Drexel Hill in Upper Darby township. 

As our cases occurred sporadically and in all parts of the county, 
we were not able to trace the oi'igin of the infection, and none of 
them caused us any difBculty in the matter of quarantine. 

The Marcus Uook outbreak amounted to half a dozeu cases before 
it was called to our attention, and there were in all sixteen cases 
reported to various Boards of Health between April 21st and July 
Ist, all emanating fiom this one source. 

It was ascertained that (i., the retail milkman, was obtaining his 
milk supply from the dairy farm which we had occasion to inspect 
last year when Chester had a large number of typhoid fever cases. 
By stopping this milk supply we had no more typhoid after the 
anticipated incubation period had expired. The last case reported 
was in the person of the local milk dealer himself. 

Repeated efforts were made to find the carrier on this dairy farm, 
but no satisfactory data were obtained from either stools or urine, 
although one young woman, who was never known to have had the 
disease, gave a positive AVidal reaction at each examination. 

Statisticnl Summary of C-ootagioue Diaeaaes Reported During the Year of 1914. 

Dipbtberia 30 Mumpa, 13 

Chick™ pifi, 32 Whooping cough, 23 

SmaJllKix, Erysipelna 2 

Measles, M Germaji meiialea, 10 

Scarier fever, B Pneuraonia, 1 

Tjphoid fever, 13 

TuberculoBis, 13 Total, 195 

Forms 36 received , 185 Number of dairy farme iaspected for 

Fornifi 37 received, 202 Measles 2 

TVphoid fever 8 

::lk conNTT. 

Dr. J. G. Flynn. C. M. I. On March 19th, at tie request or E. W. 
Mosey, Ilealth Officer. District 441, I took charge of an epidemic of 
scarlet fever in neighborhood of Bymedale. Nine families were af- 
fected before complete control was obtained. 

On September 15th, the superintendent of Johnsonburg Water Com- 
pany complained of contamination from outbuildings of fttrms on 
headwaters of Powers Bun, from which stream the Borough obtains 


part of water eapply. This is located in Beozinger Township. Went 
there by automobile, sixteen miles, and investigated and tad them cor- 
rect the conditions, making report to Commissioner. 

October, Had a considerable outbreak of scarlet fever in Ridgway 
Borough and Ridgway Township. It was so extensive that I was 
compelled to close Borough, Township, and Parochial Schools, besides 
chnrches, Sunday Schools and places of amusement. These were kept 
closed for six weeks before the epidemic was under control. 

Oct. 29th. At the request of E. W Mosey, Health Officer, District 
441, and the School Board of Jay Township, I took charge of an 
epidemic of scarlet fever in the neighborhood of Byrnedale, Ten 
families were quarantined ; schools and chnrchs were closed for short 
time to control its spread. 

Not. 11th. At the request of B. G. Metis, Health Officer, District 
435, I took charge of an epidemic of mumps in the village of Arroyo, 
where no physician is located. I closed schools for several days 
and had them thoroughly fumigated. 

Dec. 18th. At the special request of the Ridgway Borough Board 
of Health I examined and vaccinated a family coming from Kane, 
where they had lived in the house with smallpox and had been ex- 
posed to it. I was compelled to isolate this family in the house 
of friends where they were visiting and to quarantine and place 
guards on the house. I kept them isolated and visited them daily 
during the period prescribed by rules of State Board, but fortunately 
vaccination was successful and no outbreak occurred, 


Dr. J, W. Wright, 0. M. I. I have the honor to submit the follow- 
ing report of my work as County Medical Inspector of Erie County, 
for the year 1914. 

Erie County has an area of 772 square miles, of which about 750 
are rural. There are two third-class cities with a population of 
about eighty-two thousand inhabitants, fifteen borough with approx- 
mately fifteen thousand people living therein and a rural population 
of about thirty thousand which is divided among twenty-two town- 
ships. Active Boards of Health are existent in both the cities and 
in four or five boroughs. In three boroughs the town^ip Health 
Officer acts as Borough Health Officer but in the remainder of the 
boroughs little or no attempt is made to look after health affairs 
in any way. , - . 

I doogic 


CommaDicable diseases to the number of four hundred fifty-&lz 
occurred in twenty of our twenty-one townships. These have been 
taken up under their respective headings as follows: 

Four hundred cases of smallpox were reported in the citiea of 
Corry and Erie, the boroughs of North East and Union City, and 
eleven townships. Of these, by far the greater number occurred in 
the Borough of North East ; a brief history of this outbreak is given 
among the special reports of the Medical Division, 

One hundred and five cases of chicken pox were called to my atten- 
tion in fourteen townships. There were also numerous cases of 
this disease in the City of Erie and in the City of Corry, and three 
in the Borough of Girard. All rural cases were checked up becanee 
of the prevalence of smallpox. 

Fifty-seven cases of whooping cough were reported from seven 
townships. This ailment was also prevalent in the City of Erie. It 
also appeared in the Borougb of Platea, one case being reported there- 

Forty-one cases of scarlet fever in thirteen townships, also one 
in the Borough of Platea, were reported by the Township Health 
Officers having charge of those districts. ■ 

Twenty-two cases of measles were noted in eleven townships and 
two boroughs. Twenty-four cases of diphtheria developed in ten 
townships, twenty cases of mumps in eight townships, and five cases 
of erysipelas in three townships. 

Twenty cases of typhoid fever were reported from eight townships, 
in connection with which I would say that one-half, or ten, of this 
number occurred in that part of Millcreek township adjacent to the 
City of Erie. Investigations were made in each of these Instances 
with a view to ascertaining the source of infection. In several it 
was found to be the local water supply; in others, however, the source 
could not be discovered. 

One case of poliomyelitis was reported, the details of which were 
gone into with a great deal of care. No definite source of infection 
was, however, ascertained. The case developed in the month of 
August. The patient lived ou a farm and had not been away from 
home during the whole summer, nor had he been visited by anyone 
outside of his immediate relatives or near neighbors. His residence 
was situated on one of four corners of a much traveled highway and 
he had been engaged in farm work on his own premises. 

This was the only case of this disease reported to me during the 
year, with the exception of one case in the City of Erie, which was 
that of a child who had recently removed to that city from Buffalo. 
His removal to Erie had occurred within the incubation period of 
the disease and it is probable that the ailment bad been acquired 
in the former city. 


In addition to the work above referred to, I visited the town of 
Warren, Warren County, to determine the natnre of an ernptive 
disease existent in that place and, in conjunction witb the County 
Medical Inspector, visited several persona afflicted therewith. In 
each of these cases, Dr gchmehl'a diagnosis of smalli>ox was con- 
firm ed- 

An outbreak of. what was popularly called sore throat occurred 
in Springfield township in January. An inspection of the cases and 
an examination of smeara therefrom showed the disease to be diph- 

Numerous complaints have been made to me regarding insanitary 
conditions existing at Waldameer Park and vicinity, the location 
being in Millcreek township, about four miles west of the limits of 
the City of Erie. The shore in this section is occupied in the summer 
months by campers who live in tents, shacks, cottages, and, in some 
instances, rather elaborately constructed bungalows. 

The water sapply is obtained from wells and springs in the neigh- 
borhood. Garbage is disposed of in a primitive fashion, being 
dumped out on the ground and left to rot on the surface, partially 
burned, or, in a few instances, thrown into shallow pits. Toilet 
accommodations are outdoor privies, which are open to flies and ver- 
min of all kinds. I have already referred this matter to the Engineer- 
ing Division of the State Department of Healthy and I believp they 
have the matter in hand. In addition to this, the water from a number 
of wells and springs has been examined bacteriologically and when 
found to be unfit for drinking purposes, condemned. 

In the month of May, Mr. J. A. A. Le Prince, a sanitary expert 
connected with the United States Public Health Service came to this 
City for the purpose of making a sun-ey of Presque Isle Peninsula 
and the lake shore adjacent thereto, with the view of eliminating 
our mosqnito nuisance in this vicinity during the summer months. 
Mr. Le Prince found many places where this insect was breeding 
and among other varieties found many larvae of the Anopheles. He 
stated, however, that he failed to find any live mosquitns of this 
variety. The location of the principal breeding place of this variety 
of this insect was on the farm owned hy A. C. TCelso, jnst west of the 
Waldameer Park, above referred to, and one on which a large number 
of campers have their quarters located. I have interviewed Mr. 
Kelso with a view of having him drain or fill in the ponds on his 
premises, but he, however, is averse to taking any action in the matter. 
It would seem that he should be forced to eliminate these ponds at 
an early date during the coming year. 

With reference to the B. & L. E. Traction Company, which owns 
Waldameer Park, I would say that, acting on the suggestion of Mr. 
Le Prince, thqr established several drains communicating with ponds 

3 1 



on their premises; they also removed a large quantity of bmsh and 
rushes and did a great deal toward placing their property in a condi- 
tion unfavorable to the breeding of moaquitoes. 

I have referred the matter of insanitary conditions on the Kelso 
Farm to the Engineering Division of the Department for action. 


Dr. 0. B. Altniau, C. M. I- Fayette County during the year 1914 
recorded 1,222 cages of reportable diseases, returned by the twelve 
Health Officers, who represent twenty-four districts. Of these, 658 
were of the form of contagious diseases generally considered notably 
dangerous to life ; that is, scarlet fever, typhoid fever, and diphtheria. 

Typhoid Fever: — One noticeable thing in the reports of 1914 is 
the number of cases of typhoid fever; there being two hundred and 
ten cases reported as compared to three hundred and four cases for 
the year 1913, During the year 1914 it was not necessary to make 
a single inspection for typhoid fever; there was no epidemic and the 
cases were widely scattered. 

This can be partially explained in this way: the H. C. Frick Coke 
Company have made a special effort to do away with all springs and 
wells. This was done after the water had been analyzed several times, 
and in nine-tenths of these examinations the springs and wells were 
found to be infected with colon bacilli. At the same time the Trotter 
Water Company, whose water lines are distributed throughout the 
County, has been furnishing water to the greater part of the coal 
towns, as well as to a number of boroughs. This Company has been 
treating the water and has taken particular pains to keep their 
reservoirs and lines in flrst-clasa condition. 

Scarlet Fever: — Two hundred and thirty-seven cases of scarlet 
fever were rejtorted. Seventeen insi)ections were made. The first 
inspection was made January 15lh, by order of the Department, at 
the Uniontown Hospital, where two nurses had contracted the disease 
from a child that had been accidentally sent to the Hospital from 
near Republic, Menalleu township. 

February 14th an inspection was made at the home of John Zaccbi, 
Shamrock Works, Menallen township. Four cases were found in 
this family, one having died the day before. 

February 19th an inspection was made at the home of Hazel Lytle. 
Gallatin, Nicholson township. They had previously lost two cbD- 
dren, and there were two other cases in the family. 


May 29th au inspection was made at Uledi, South Union township, 
where they had a small ejiideinic of scarlet fever with about thirty 
caaes which have been reported in full to the Department. On June 
2nd, the second inspeetion was made at Uledi, and on June 26th 
the third inspection, 

July 16th, 17th and 18th inspections were made at Filbert Works, 
where they had a severe type of scarlet fever. A number of families 
were suffering from the disease and no physician had been called. 
Several children died and some twenty cases were found and quar- 
antined during these inspections. In all, over one hundred families 
were visited. The Frick Coke Company placed the town under strict 
quarantine and put guards on duty, who were in charge until the 
disease was finally controlled. 

Other inspections were made at Filbert Works during this epidemic, 
on August 7th, 12th, and 25th; also on September 17th and 21st. 

Angnst 29th, the Frick Company at Lemont Furnace, North Union 
township, notified me that several children were sick and that they 
suspected scarlet fever. On investigation, eight children ^ere found 
suffering from scarlet fever in the homes of Pete Semanehick, Guy 
Weidmeyer, and Joe Kcrnoszak. 

September 14th, an inspection was made at Mt. Braddock, North 
Union township, where Laura Fullmer was found suffering from 
scarlet fever, and on investigation it was found she had left House 
No. 12, Filbert Works, late at night, jumping the quarantine. 

October 12th, by request of the School Board an inspection was 
made at the homes of James Jenkins, Smithfield, and Philip Saylors 
of Ruble Mills, Springfield township. Each of these families had 
scarlet fever; there being two cases in the Jenkins family and one 
in the Philip Saylors family. These inspectioDS were reported in 
fall to the Department. 

Diphtheria: — One hundred and eleven cases of diphtheria were 
reported for the year 1914 as compared with two hundred and forty- 
two cases for the year 191S. Two inspections were made. 

The first inspection was made May 29th, A case of diphtheria 
was reported at Uledi. This was in the same district and practi- 
cally in the very house where another case was quarantined for 
scarlet fever. The diphtheria was associated with scarlet fever con- 
sequently the placard was not changed at that time, and I have my 
serious doubts whether there was any diphtheria present. 

The second inspection was made September 29th., and was reported 
in full on October 5th. 

Snmllpox: — Two cases of smallpox were reported for the year 

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Jannaiy 6th, I was called in consultation with Dr. W, W. Warren, 
of Dunbar, to a small coal town between Dunbar and ConnellsviUfe 
Found Frank Keuish suffering from a well developed case of EunaU- 
poz. This case was found recently to Iiave returned from Ner 
Kensington and from the same district where several cases of small- 
pox were under quarantine. 

On February 16th and 19th, Davidson Works near Connellsville 
was visited where William Brown, a colored man, was found in an 
old deserted coke oven suffering with smallpox. This patient was 
placed in an isolated building in the outskirts of Connellsville and 
properly taken care of; detailed reports were sent to the Department 
on the succeeding days. 

On January 71h, an inspection was made in consultation with Dr. 
L. K. Reichard, of Brownsville, to see J. Johnson. This was a 
suspected case of smallpox and proved to be chicken pox, A second 
inspection was made in this case on January 9th as I tboufi^t it 
best to be absolutely sure of the diagnosis. 

On February 10th, was called in consultation with Dr. Bitenonr, 
of Uniontown, to see a suspected case of smallpox in the home of 
O. B. Wassaw, Berklet St., Uniontown. This case proved to be a 
case of chicken pox. 

December 16 and 16, I investigated a suspected case of smallpoz 
at No. 14 Penn Street, Uniontown, reported by Dr. Whitson, colored. 
After two visits to this man a positive diagnosis of chicken pox was 
made and the case looked after accordingly. 

Whooping Cough: — A hundred and eighty-tlnee cases of whooping 
cough were reported for the year 1914 as compared with a hundred 
and forty-four cases for the year 1913. The majority of these cases 
were reported from two districts, there being a hundred and eleven 
cases reported by Health Officers A. M. Provance and Casper Hast. 

One inspection was made on January 7th at Bitner Works, Frank- 
lin township, in the district of Casper Haut. In this small coal 
town between thirty and forty cases of whooping cough were found, 
this only being a portion of the cases as reported later. 

Measles: — The County was peculiarly tree from measles through- 
emt the year as compared to the year 1913. A hundred and fifty- 
seven cases were reported for the year 1914 as compared with nearly 
twelve hundred (1,181) for the year 1913. These cases were widely 
scattered, two-thirds of them being reported from two districts under 
the supervision of Health Officers Frank Costello and John Hostetler, 

Mumps: — A hundred and eighty-eight ca^eii of mumps were reported 
for the year 1914 as compared with sisty-five cases for the year 1913. 
These cases were reported from nine districts, two districts having 
one hundred and seven cases. 

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Erygipelaa: — Teti cases of erysipelas were reported for the year 
1014, one less thau tbe year 1913; there being eleven cases reported 
in that year. 

Summarr of Inspectioo Work for tbe YonrB 1013 aod 1914 rollons: 

ifln iflH 

Forma 37 received during jenr from Hetillh Offioers 1,892 1,042 

Forms 36 receivivi during ypnr frrim HPalth Officers 2,145 1,1(M 

Total time couxiimpd in wnrh for the Medical DiviaioD, boiirs, 3951 3^ 

Schools ordprpd plfwed during the yeiir 14 5 

Distance traveled by afreet car, milea, 297 234 

Distnnce traveled by livery, milea IDS 236 

Distance traveled bj train, mil«a, 40 42 

DiHtnnce wnlked, miles 32) 19 

Heal tb Officera instructed in office during year, 32 16 

liealtb Officera instructed by phone 40 41 

Following is a short review of work of Health OITicerB of Fay- 
ette County; it bavinfi; twenty-four townships, which are divided into 
districts, each of the twelve districts being in charge of a Healtli 
Officer. There have been reported through Health Officers the fol- 
lowing cases: 

inn 1914 1913 1914 

Meaales 1,1S1 1.T7 Cerebmspinnl meningitia 4 . 3 

Typhoid fever .irM 2in PnlmnuHry tuberculosia 36 38 

Rcnriet fever. 140 237 Pneumonia 6 5 

Diphtheria 242 111 Smnllnox 1 2 

Mnmps 65 188 Tetnnua 1 

Whooping couph 140 !S3 Imppitgo CcintHgiosa, 1 

Cblchea pox «) 72 Not listed, 4 

Erysipelas 11 10 


Dr. T. J. Bovard, C. M. I. During the first half of 1914 Forest 
County had but few cases of communicable diseases. 

In June there were reported several cases of measles in Jeiiks 
Township, July and August had a few unreported cases. At the 
begisning of school there was a rapid increase in the number. There 
was a quite general disregard of the Health Law in Jenks Township, 
both as to the report of cases and as to the observance of quarantine 
regulations later. Except for a few cases nnder the care of phys- 
icians there were no reports made. At this time the prolonged sick- 
ness of the health officer further complicated the situation. There 
is very little inter-commnnicntion between that end of tbe county 
and the western end and no direct railroad route. 

I personally inspected the condition of affairs on September 19th. 
I visited and reported about fifty cases of measles and ordered the 
schools closed. More cases developed and a report of laxity in the 



observance of the quarantine regulations caut^ed me again to visit 
MarioDville on the 22d, and I then reported about twenty-five new 
cases. Although these cases had not been reported there seemed to 
be more a listless disregard or ignorance of their duty than any 
objection or antagonism to the inspection or quarantine. Churches 
and a tent "movie" were clo.sed at this time. After this the epidemic 
subsided rapidly. 

One other Inspection was made at West Hickory in December in 
response to the complaint that there were several cases of unreported 
chickeu pox. One was found and placarded. 

Otherwise conditious have been healthful. Nuisances reported 
were corrected by the health ofBcer without further recourse. 


Dr. H. X. Bonbrake, C. M. I. and Dr. Paul Allen, Acting C. M. I. 
T assisted Dr. Bonbrake in the duties of County Medical Inspector 
and at bis death, November 22, succeeded him as Acting County 
Medical Inspector. 

Of the thirty-live couimnuicable diseases requiring report to the 
Department of Health, only eight were brought to the attention of 
this offlce, a total of four hundred and sixty cases being reported 
during the year. The six district health officers sent in two hundred 
and nineteen reports of placarding and two hundred and seventeen 
reports of disinfection. 

In matiug the necessary investigations throughout the county it 
was necessary to travel about eight hundred miles by railroad and 
seven hundred miles by livery. 

Typhoid Fever: — Ninety-six cases were reported during the year. 
Thirty-six dairy farms were inspected on account of the existence 
of typhoid ; four in Montgomery, five in Greene, five in Guilford, two 
in Washington, seven in Antrim, seven in St. Thomas, three in Letter- 
kenny, two in Hamilton, and one in Lurgan Township. On twenty- 
four of these farms the sale of milk was temporally discontinued, on 
the remaining eleven arrangements being made to carry out the 
Department's rules and regulations concerning the handling and Bale 
of milk from such premises 

In Greene Township seven cases occurred on one farm, two on an 
adjoining farm. The water supplies on these two farms, also that 
at Red Bridge Park, were examined at the laboratory and found 
to be grossly polluted. People were urged to boil all vater need 


for domestic purposes, and where surroandiDg surface conditions 
warranted it, to have the welU thoroughly disinfected with lime. 

In several instances tliere was a history of formei' typhoid on the 
premises, but for the most part the cases were scattered and no parti- 
cular source of infection could be determined. 

Diphtheria: Sixty-four cases were reported. Twenty-five special 
investigations were made ou account of the existence of diphtheria in 
Montgomery, Let terkeuny, Ilamiltonban. Guilford, Antrim, Quiiicy, 
and Lurgan townships, eighteen of which were on dairy farms. On 
teu of these farms the sale of milk was discontinued, on all others 
arrangements being made for the milk to he handled by i)ersons living 
outside the infected premises, or by tTansferring the stock to other 
premises. Eight schools were closed on account of threatened out- 
breaks where children were taken ill while in school. In every in- 
stance where schools were close<l, disinfection was ordered before re- 

In November an outbreak was investigated in Chambersburg. 
Schools were closed and it was recommended that all children be 
examined and that all who had previously had sore throat be medi- 
cally certified as free from infection before returning to school. 

In December a second investigation was made in Montgomery 
township. Twenty-one pupils were examined who gave a history of 
previous sore throat. The quarantine period had expired in many 
of tliese cases and the health officer was instructed to disinfect all 
such premises. 

During December a widesju'ead outbreak occurred in Letterkenny 
township. The source of infection was traced to a case which had 
occurred during the previous summer and was not properly diagnosed, 
until after patient had been removed to her home in Chambers- 
bai^. Later several contacts of this case contracted sore throats, 
all being diagnosed as "quinsy," "tonsillitis," "bad sore throat," etc., 
and no quarantine whatever having been established, the infection was 
spread throughout the community. 

Scarlet Fever: — Pour dairy farms were inspected for this disease 
and r^ulations established for the sale of milk. All these cases 
were widely separated with no connection between them. Six cases 
of scarlet fever were reported during the year. 

Chicken Pose: — Twelve cases were reported from two townships. 
In January an outbreak occurred in Montgomery township. The 
school was ordered closed for one week and disinfection to be per- 
formed before reopening. 

In December, according to instructions from the Department, I 
investigated an outbreak of chicken pox in the borough of Orrstown, 
The Board of Health was inactive, having no materials whatever 

27— 1&— 1916 I Google 


with which to carry on the work. BuggestioDs were given relative to 
organizing a new Board to comply with the law. 

Measles: — Two hundred and nineteen cases were reported, one 
hnndred aPd seventy-eight occurring in Greene Township daring 
March and April, 

One case of cerebrospinal meningitis was reported from Bhade 
Grove. This patient died before the diagnosis could be confirmed, 
■ but as the clinical history pointed to cerebrospinal meningitis (epi- 
demic) the house was ordered disinfected and placarded for ten 
days. Only one other case was reported during the year, 

StatiBtienl Summarj of Work Done During the Tear. 

Schoola dosed IS Sonrlnt fever 

Coops einmined alleged to be: Kniilemie meningitis, 

TvphnW fever 2 Chicken poi, 

niphiheris 16 


Dr. J. W. Mosser, C. M. I. I beg to snbmif the following report 
of work done in Fulton County, during the year 1914, by the repre- 
sentatives of the Department of Health. 

Fulton County has an area of four hnndred and two square miles 
and is divided into eleven townships and one borough, the entire 
county, wilh the exception of the boroush of McConneUsbnrg, com- 
ing under the direct supervision of the County Inspector. 

Of the thirty-five reportable diseases, only nine were brought 
to the attention of this office, the total numlwr reported dnring the 
year being ninety-five, as follows: 

Twenty-nine cases of measles were reported by physicians and 
householders. The disease was reported from four townships, the 
largest number, twenty-two, occurring in Taylor township. 

Twenty-five cases of chicken pox were reported, from three town- 
ships, thirteen from Ayr, ten from Dublin, and two from Todd Town- 

Fifteen cases of tyj>hoid fever were reported from five townshipa, 
six in Wells, four in Belfast, two each in Ayr and Bublin, and one 
in Taylor township. 

Three cases of diphtheria were reported, two from Dublin and 
one from Bethel township. One dairy farm in Dublin township was 


inspected on account of the existence of this diseases and the sale 
of milk diacontinned until after the quarantine period had expired 
and the premises were disinfected. 

Two cases of scarlet fever were reported, one each from Taylor and 
Ayr townships. 

Three cases of whooping cough were reported. 

Four cases of tuberculosis were reported, three from Bethel town- 
ship, one from Union township. 

Eleven cases of pneumonia were reported from five townships 

Three cases of cerebrospinal meningitis were reported, (wo from 
Dublin, one from Wells township. On February 14th, following 
instructions from the Department, I made an investigation of con- 
ditions at Burnt Cabins where it was reported that a man had died 
of spotted fever. I found that one J. H. M. became ill on February 
Ist. Two physicians were called on February 4th, one of whom 
diagnosed cerebrospinal meningitis. The patient died the next day 
and a public funeral was held on the 8th. the physician stating that 
the condition was not contagious. On the 7th another man, W. G., 
was taken sick with severe earache, chills, and high temperature. 
This case was diagnosed as cerebrospinal meningitis on the 9th by 
the attending physician, and the house placarded by Health Of- 
ficer Deaver, This patient died on the 10th. The other case re- 
ported to the Department was found to be lobar pneumonia. Peo- 
ple were somewhat panicky and I was called into eight or ten 
homes for the purpose of examining persons who had slight head 
ache or back ache but found no symptoms of meningitis. No other 
cases were reported from this locality. 

Statiatical Sutnmary of Work Done During the Year. 

(Q Eiamined cases alleged t 
M Chicken poi, 


Dairy farms inspected, 

Sale of Bilh stopped, 

Schools closed 

Number of miles traTeled by livery, . 


Dr. John T. lams, C. M. I. The past year has been a relatively 
unimportant one owing to the low proportion of contagious diseases 
and the absence of any marked epidemics. The credit for the latter 

, Goot^lc 


18 due Id a measure to the prompt and efBcient work of the local 
health officials as wc have had two threatened outbreaks, id which 
quick action aborted any further developments. In August smallpox 
was reported at Xeltle Hill, Greene County, but absolute quarantine 
and thirty vaccinations limited the cases to the initial one. 

In December two cases of diphtheria apiieared in a public school 
of Morgan township. Immediate closing of the school and complete 
disinfection held the total number of infected cases down to three. 
These subjects will be mentioned further under their respective head- 

Greene county continues to hold its position as one of the four 
pillars on which the State of Pennsylvania stands. We have some- 
what less than 600 square miles of farming lands with an acreage 
of perhaps 367,360, but only a population of about 29,000, and like 
Pike County, the similarly located County in the northeast part of 
Ihe State, we have none of these railroad facilities which make 
Health Department work so easy, as do those two other pillars, 
Philadelphia and Erie Counties, southeast and northwest respec- 
tively. These 600 square miles of Greene County, however, will 
eventually change these adverse conditions. Many rich mineral de- 
posits underlie (his entire district. Three of the largest gas produc- 
ino; companies in the country have a sufficient supply of natural gas 
10 bring about the erection of some of the larj^est compi-essing sta- 
tions in the world. We have three veins of virgin coal underlving 
the county, one of which veins is the famous Pittsburgh Coking Coal. 
These valuable mineral deposits must necessarily convert this terri- 
tory sooner or later into a vast centre of industry with the accom- 
panying element of foreign labor and new fields of fertile soil for the 
development and spread of contagious disease. When, this time comes 
the rate of these diseases will probably multiply as will also the 
work of the County Medical Inspector and Health Officers, 

Typhoid Fever: — Five cases of tj'phoid fever were reported in 
1014 as against fourteen in 1013, a marked decrease. Four of these 
cases were reported in September and one in October, but all were 
scattered cases and no epidemics threatened. Two cases alone were 
reported in one family in Jefferson Township. All of these cases re- 
covered, not a death being reported during the entire year. 

Diphtheria: — Eleven cases of diphtheria were reported, an in- 
crease of seven over the preceding year. The cases were scatteied 
with the exception of three of which I have already referred to. In 
December, Dr. R. E, Brock, of Waynesburg. reported two cases of 
diphtheria in Westland School, Morean Township. The County- 
Medical Inspector immediately ordered Health Officer Virgin to cins? 
the school and thoroughly disinfect it. Exposed cases were given im- 
munizing doses of antitoxin and the total number of cases were lim- 
ited to three with recovery in every case. One death was reported 


from diphtheria in Kichhill Township on February 20th. No other 
deaths wei'e reported from this disease during the year 1914. 

Smallpox: — Early Wedueaday morning, August Iflth, the County 
Uedical Inspector was called by l)r. S. T, Williams, of Nettle Hill, 
who stated that he had visited a suspicious case the day previous 
and was afraid it might be smallpox. The County Medical Inspector 
immediately visited the case in company with Doctor Williams and 
Health Officer Rice. On examination he found a well developed case 
of smallpox. The patient gave a history of having visited Pitts- 
burgh, bnt was unable to give any definite place of infection not 
knowing of any smallpox in or around Pittsburgh, The County 
Medical Inspector established absolute quarantine and ordered vac- 
cination and isolation for all parties who had been in contact besides 
the usual treatment. Thirty exposed cases were vaccinated and kept 
under supenision for the required length of time. No further cases 
developed and the patient mode a complete recovery. 

Measles: — Eight cases of measles were reported as compared with 
eighteen in 1913. Ko serious results were experienced. 

Mumps: — Two cases reported. 

Whooping Cough: — One case of whooping cough. No death. 

Stntistical Summary ot Work Dooe During the Year. 

Totnl Form B 36 received, 33 Eiominod cases alleged to be; 

Total Forma 37 received, 3fl Smallpoi, 1 

Typhoid fever B 

Diphtheria 11 

Scnrlct fever. 5 

Menslea, 8 

Dairy farms inspected for contag- Miimpa, 2 

iouB disease— NoLe. Whooping wujtb 1 

Health Officers instructed at the office, 2. 

health Officers instructed elsewhere, It. 

Schools ordered closed (nn occonuC of diphtheria), 1. 

J!b1c of milk stopped— None , 

Total distouce truveled — W miles. 


Dr. H. C. Frontz, C. M. I. 

Mumps: — Received information from Health OfiBcer H. that Mrs. 
C. G. had mumps, that no physician was in attendance, and that the 
case developed about May 26, 1914. Investigated the case and found 
the information correct; as quarantine time had expired, I ordered 
the house to be fumigated. 

Scarlet Fever: — Received information on July 13, 1914, that there 
were two cases of suspected scarlet fever at the home of E. H., in 


Shirley Township. On July H, 1911, I visited the premises of E. H. 
With Dr. C. A. E. M., and fonnd two boys, ages four and seven 
respectively, convalescent with the disease. Date of onset July i, 
1914, Reported the case on form 3i and had them regularly qaar- 

Measles: — Received information on February 7, 1914, that measles 
were in the home of J. N., Warriors Mark Township, and that no 
physician was in attendance. I visited the home and found two chU- 
dreo sick with the disease. I reported them on form 31 and th^ 
were quarantined in the regular way. 

Smallpox: — I received information January 13, 1914, from the 
Board of Health of Huntingdon that Miss F. B,, of Henderson Town- 
Bhip, this county, came from Bellwood on train No. 24, Pennsylvania 
Railroad, January 13, 1914, and that she was a contact of a smallpox 
case by name of Miss B. McD. of Bellwood, a school teacher, she hav- 
ing slept with Miss McD. the night before. I went to Henderson 
Township to the residence of G. B., father of Miss B., where she 
had gone on the morning of January 14, and found her there, and 
learned that the information I had received the night before was cor- 
rect. I took Health Officer McE, with me and had her submit to 
vaccination, as also the father and mother and a brother and sister 
in the same household, and directed Miss B. to come to my office 
for observation every other day for eighteen days, which she did. 
I had the Health Officer fumigate her clothing and the rooms she 
had occupied since coming to the home of her father. Miss B. is 
a school teacher in Antis Township, Blair County, and said that the 
School Board told her she might as well go home, I immediately 
notified the Railroad Company of the train and car in which she came 
to Huntingdon from Bellwood and they at once had the ear fumi- 
gated, as well as Bellwood and iluntiugdon stations in which she 
#as on the way to her home. 

I received information relative to smallpox existing in family 
of O. R., Warrior Ridge, Logan Township. C. B. was qnarautinod 
on the 9th of December, 1913 for smallpox which bad its onset on 
November 30, 1913. After my arrival home from St. Louis I learned 
that several of the other members of the family had also contracted 
the disease and on December 29, 1913, I visited the premises again, 
and found B. R., M. R. R. and W. W. all suffering with the disease. 
The date of the onset of the last case was December 14. One mem- 
ber in the same house by name of F, W., husband of W. W., did not 
contract the disease. January 14, I again visited the place, examined 
all who had the disease, found that they bad entirely cleared up, 
and also sent form 39 to Health Ollicer T., as well as word about 
some animals on premises which I directed to be exterminated. 

1 Goo'^lc 


Fumigation was not done antil late on Jannary 16 and they were 
released on ttiat day. No other cases developed. I had two efficient 
guards ou duty, one for day and one for night. 

On January 16 I received information from Dr. H. L. D. in Dudley 
that he had a. suspicious case in that borough which he believed to be 
smallpox and asked me to coiue up to see the case. I directed him 
to quarantine the premises until my arrival. On January 27 I went 
to Dudley, looked the case over with the physician, and found W. 
M. of Dudley, aged 59, a miner and Justice of the Peace, suffering 
with a marked case of smallpox. He bad pustules all over his body, 
gave a history of "grippe" from January 9 and did not work until 
January 10, could not work that day and went home. The eruption 
came out January 11. He said he was vaccinated when he was a 
boy but I could see no mark of successful vaccination. I ques- 
tioned him as to his movements, and he informed me that the only 
place he had been in for several months was Huntingdon on Decem- 
ber 26 and 27, and that he was at the National House for a short time 
on the 27th. 

The National House had a case of smallpox develop in the person 
of the proprietor's child about Januai-y 6. The only contact of 
. this case out of Dudley was Mrs. E. M. of Portage, sister-in-law of 
W. M., she having left for her borne January 16, Mr. M. having ac- 
companied her to the station. January 29 I telephoned lo J. B. M. 
of Portage who is connected with the Portage Board of Health, 
giving him the information relative to Mrs. M., asking him to treat 
her as a contact. Met several members of the Board of Health and 
School Board of Dudley while there, and directed them to take all 
precautions agJiiust the spread of the disease. Learned January 28 
that a joint meeting of the Board of Health and School Board was 
held, decided to close the schools for one week for those children to 
be vaccinated who had not been successfully vaccinated within five 
years. Reported the case January 28 to Dr. H. 

On March 21, I received information from Dr. E. H. G, of Mill 
Creek that, J. K., age nineteen, son of J. K., was suspected of having 
smallpox. We went over the case; the eruption seemed to come from 
some application to the chest and back and justiiled no definite diag- 
nosis. It was not smallpox and we could get no history of any con- 
tact with such a case. The patient died next day and I think his dis- 
ease was pneumonia. 

From the Health Officer of Union Township I received information 
of a number of marked smallpox cases in that vicinity. I visited the 
suspected places with Dr. S. I found that Mrs. 8. M., aged seventy- 
two, had mild attack of the dLsease, with a date of onset about April 
20. Her daughter, It. M., aged forty-five, also developed it about the 
same time. On going to the home of W. M. I found two of his chil- 


dren aick with smallpox, viz. L. M., age five, with a date of onset 
March 20, 1914, and E. V. M., age six months, with a date of onset 
April 10. After recovery they showed distinct poi marks on the 
face. I also visited J. D., wife, age forty-two with a date of onset 
March 20, 1914; baby D., age two months, having a date of onset 
March 18; L. D., age two years, with a date of onset March 27; G. 
D., age seven, with an onset on April,2 ; D. D,, age five, with a date 
of onset April 2. None of these were vaccinated ; three others in the 
house had been successfully vaccinated and did not take disease. 

Going to the home of W. C. B., I found his son, W. H. B., age 
thirty-one, with a marked eruption of smallpox. The date of the on- 
set was April 25. This man is a grandson of Mrs. M. S. M., and 
boarded in the vicinity of these other cases, and had never been vac- 
cinated. W. M. is the son of Mrs. M. S. M. and he and his wife and 
one daughter had had smallpox seven years ago and only two of the 
children, who have been bom since, contracted the disease at this 
time. The cases were all quaranlined and two sets of guards em- 
ployed. Mrs. M. 8. M. was visiting her daughter, Mra L. C. C, 
in Juniata Township, and went to her home on a P. R. R. train April 
27. I directed Mr. L. C. C. to have all his family vaccinated who 
had not been successfully vaccinated within the last five years. I 
directed Health Officer H, in Juniata Township to fumigate clothing 
and premises of Mr. C. which was done; all were kept in observation 
during incubation period. 

I received information that on May 2 Miss E. M., a trained nurse, 
who was home from Philadelphia at her mother's, Mrs. M. 6. M., had 
got past the guards and had come to Huntingdon, contrary to our 
orders, being under quarantine. She was quite defiant and said she 
would do as she pleased. Dr. S. telephoned me about the case and I 
telephoned Dr. Hunt May 2, who directed me to have Health Officer 
S. issue a warrant for her arrest, the hearing to take place after quar- 
antine. This was promptly done and submission followed. 

I went to Maplcton again on May 3 and found A. R. living in the 
immediate vicinity, age thirty-four and afflicted with smallpox, with 
a date of onset March 27, and not vaccinated. I also found M, R., 
age three months, with a date of onset April 18. All the cases were 
promptly quarantined. I also found F. D., age eighteen, daughter 
of D. D,, living near by, with suspicious eruption, and decided that 
she had smallpox. Date of onset was April 4. T directed Health 
Officer S. to fumigate house and make report of the case as having 
existed. None of the rest of the family had any suspicion of the 
disease. This disease seems to have originated from the D. family 
who moved from Lewistown the latter part of January, 1914. 

On May 6, I went with Dr. J. O. S., Health Officer, Union Town- 
ship, to D. C's Lumber Camp on Terrace Mt, in Union Township, aod 



found J. C, son of D. C, ill with discrete smallpox, rather mild. Date 
of onset was April 28. He was infected by cases in Union Town- 
ship near Mapleton. I established absolute quarantine but could 
only get one guard, the pi-emises being on the mountain, and em- 
ployed W. A, C. at |2.50 a day, to work fourteen hours. 

On May 8 I sent Health Ofttcer Dr. S. to the Coder Lumber Camp 
to vaccinate contacts in the camp and vicinity, fumigate shanties, 
and completely isolate J.. C. from the rest of the camp. He vaccinated 
seven and arranged affairs so that work could go on. He also learned 
the names of contacts at Calvin in Trough Creek with J, C. May 
3, in his automobile; and investigated the place on May 10, finding 
ten persons who were contacts. He vaccinated them and fnmigated 
the house where J. C. had been. It was found that W. W. W. of Col- 
fax was also a contact. He was vaccinated and treated as a contact. 

No other cases developed in that part of Union Township. May 2T 
I revisited the camp with Health Officer Dr. S. and found that none 
of the contacts had developed the disease. The patient having en- 
tirely recovered, I fumigated shanty and released the quarantine. 

May 13, I went to Mapleton and released from qnarantine the fami- 
lies of J. D, and W. M., all having recovered. 

On May 15, I received information from Health Officer S. that D. 
D., age sixty, Union Township, had developed smallpox. I ordered 
absolute qnarantine and, as he was in close proximity to other cases, 
it was possible to use the same guards. I went to see this case on 
May 16. 

Having received information from Dr. G. W. S. of Mill Creek of 
a case of smallpox, I found E. F., age six, daughter of W. F. in Mill 
Creek Borough with mild case of smallpox, I established absolute 
quarantine and day and night guards at |1.75 a day. This patient 
was infected from D. D., who was at her home about ten days be- 
fore and whose daughter F. had been reported as having had it and 
who was practically over it when the cases in Union Township were 

May 17, I went to Mapleton and with Health OfBcer S. vaccinated 
all persons in houses wmr the D. D. premises. The houses being so 
close together the whole community were contacts. We vaccinated 
twenty-one persons. Three families refused vaccination, I estab- 
lished absolute quarantine and the next day they were willing to be 
vaccinated by Dr. S. 

May 19, I went to Mapleton, and released from quarantine M, 8. 
M., R. M., A. B., and M. B., all having recovered and the quarantine 
period having expired. 

I withdrew the charge against E. M., the trained nurse arrested 
for breaking quarantine, on condition that she pay costs of $3.12 



which had been incurred. This she did when she found that she 
would be fined if she had a hearing. 

May 16, Dr. S. and I directed all churches, Sunday Schools, and 
Moving Picture Shows to be closed in Mapleton for two week."! on ac- 
count of the proximity of smallpox in their borough and the careless- 
ness of the people. 

May 24, I investigated with Health Officer S. three other cases of 
smallpox in the family of W. B., Union Township. The father, 
mother, and .son R. developed the disease May 18, all refusing vaccina- 
tion. The mother permitted the three daughters to be vaccinated and 
none of them developed smallpox. Those under quarantine were E. 
F., D. D., W. B., Mrs. W. B., W. B. Jr., and R. E. 

June 10, r went to Mill Creek and released from quarantine E. P.. 
he having fully recovered and no other cases having developed in 
that house. 

June 14. I went to Fnion Township, and examined D. D, who had 
recovered from smallpox. Thirty days from onset having elapsed, 
I ordered bis release .June 15, 1914 which was done. No other casea 
developed in that bouse. 

June 17, 1 went again to Union Toimship, and released from small- 
pox quarantine W, B., Mrs. W. B., W, B., .Tr. and R. B., they having 
fully recovered and thirty days quarantine having elapsed from the 
date of onset of last case. M'e are now free from smallpox in Hunt- 
ingdon County. 

Typhoid Fever: — May 2, I investigated the dairy farm of M. F., of 
Entriken, Lincoln Township, on whose premises was a case of typhoid 
fever, his daughter V, Mr, and Mrs. P. had charge of the milking 
and a son and daughter had charge of the milk and butter making. T 
permitted them to continue the sale of butter on condition that F, 
and his wife had nothing to do wilh the milting and butter making. 
On May 8, I again inspected this dairy farm. 

June 25, as requested, T investigated the source of infection of 
three cases of typhoid fever at Three Springs, with Dr. H, O, H. I 
found that in the family of C. P., in Three Springs Borough, three 
cases had developed: — M. age seventeen, date of onset June IS; R. 
age sixteen, date of onset -Tune 20 ; L. age eleven, date of onset June 10. 
Positive Widal reaction was obtained in the cases of M. and R. The 
family consisted of three other bora and three girls. Miss P., a sister 
of Mrs. P. and two nieces. Of the children affected only R. and 
H. had been away from Three Springs, having been in Orbisonia, six 
miles awny. one month ago. The water snpply consisted of a well and 
a cistern, which had not been used for drinkine puriwses at nil. and 
a spring about ten feet away from Three Springs Creek, which runs 
through the premises, but seemed not in any way tp be contaminated 
\ij tbfl Crerit. Thejr Becared their drinkinf meter aod water for oook- 


ing pnrposeB from this spring. The spring is lime stone water, with 
apparently no surface drainage into it. The water from Saltillo 
Creek is piped to the premiges from a mill raee near by and this water 
is used for washing purposes. As the buckets used to carry water 
which came through the pipes may also have been used to secure drink- 
ing water from the spring, infection seemed possible. The water 
from Saltilio Creek did not seem very good jndged by an inspection of 
the creek a mile and a half from the mill. Saltilio is one and one half 
miles from Three Springs, and I found that about seven sewers from 
Saltilio emptied into the creek. The ice used was secured from the 
dam of Saltilio Creek, about three quarters of a mile above, and this 
also mi^t be the source of the infection. 

Hr. P. runs a dairy farm consisting of ten cows and supplies the 
nei^borhood of Three Springs with milk. When these cases devel- 
oped eight of the cows were transferred to another farm, two cows 
being kept for the use of the family. Milk cans were cleaned with 
water from the spring and no contamination seemed to come from 
that source. There were no flies of any kind and conditions about 
the premises seemed sanitary. I sent samples of water taken from 
the spring, well, and water pipe to tbe farm, from the mill race sup- 
plied by SaltUIo Creek, and also samples of town water to the Labora- 
tory for examination. No other cases were found in the vicinity. 

July 16, 1 received information from Health Officer J, B, L, of 
Warrior's Mark, that Mrs. M. K., age thirty-three, from Pennsylva- 
nia Furnace, had typhoid fever at the home of her sister, Mrs. H. G. 
in Franklin Township, Dr. L. M. H. of Pennsylvania Furnace being 
the attending physician. My information stated that milk was sold 
from the premises. I visited this place, July 17, and investigated the 
dairy farm, as well as the probable source of infection of this patient. 
I found that they had fifteen cows and sold milk to the Creamery at 
Pennsylvania Fnmace about half a mile from the farm. I found 
that Mrs. O. had taken every precaution as to discharges, washing 
of bed clothes, and protecting herself against infection. Mrs. G. had 
nothing to do with the milking or care of cows, milk, cooking or otlter 
household work, taking entire charge of the patient. The persons 
handling tbe milk did not come in contact with the patient. I ex- 
amined the water snpply and privy but found no source of infection. 
Mrs. B. having spent most of the winter and spring in the vicinity of 
Bellwood and Altoona, I permitted the sale of milk to continue. 

On September 10, I investigated the dairy farm of M. K. in Smith- 
field Township where his son H. had tjphoid fever. Milk was sold 
from premises. Milk from four cows was sold to D, S. who sells 
milk in Huntingdon. Mrs. K. the mother had full charge of the 
patient. Mr. K. had full charge of the cows and milking and did not 



come in contact with the patient I allowed him to continne the 
sale of milk on condition that he remain in full charge of milk and 
milking and that Mra, K. be kept entirely away from it. 

September 27, I took a census of the typhoid fever in Dudley Bor- 
ough and Carbon Township immediately adjacent. Eighteen cases 
were reported and investigated. Seven of the cases were sent to the 
Blair Memorial Hospital, Huntingdon. The water seemed to be the 
cause of the trouble; I directed samples of water to be sent by Health 
Officer G. and Dr. H. L. D. to be examined. A sign was put ou the 
Big Spring and J. R'a well and I gave other placards to Health 
Officer G. to use when a report on the water was received. There 
were no requests for financial aid or help by the Department in fur- 
nishing nurses, and from personal observation I saw no need for 
it at this time. Two cases of typhoid liever are at this time in the 
Hospital at Huntingdon and there are two or three suspected cases. 

October 2, I visited the premises of M. K. and W. McK., both of 
Smitbfield Township, living on adjoining farms and Belling milk. Mr. 
K. had one case of typhoid fever and Mr. McK. had two cases and he 
subsequently developed it himself. Mr, K. arranged for another 
dairyman to take charge of his cows and the milk, and the sale of 
milk was permitted to continue. Mr. McK. could not make such an 
arrangements and the sale of his milk was discontinued. 

An epidemic of nineteen cases of typhoid fever developed in Hunt- 
ingdon Borough about this time and also in Dudley Borough, and 
it was difficult to determine one particular source for all cases. Mr. 
H. E. Moses of the Engineering Division spent considerable time in- 
vestigating the source of infection and thought that the public water 
supply of the borough may have been a source of infection.* This 
is problematical, however, as the outbreak was hardly wide spread 
enough to have been caused by a commodity that is so generally need. 
Also the water company was constantly dosing the water with 
chlorinated lime. As only a portion of the water is filtered Mr. 
Moses thought that the infection might have appeared in the distribat- 
ing system in a more or less attenuated form and thus be the means 
of infecting some persons whose physical condition predisposed tbem 
to snch disease germs. This was more or less theoretical of course 
as there were no defluite facts to back it up, Mr. M. summed up the 
nineteen cases as follows: — 

Cases CascK 

Imported, 5 Dnknnwn, , 

Unthinn in river, 2 lusanitiiry surruundingi, 2 

Sei^ndiiry, 1 

Handlini; row vegetables 1 

'•HcitlDD forrnn wcllon No. » Id tbr nrmt of thr I>li1it«» •[ 

NBItarx KnilncPiinf- 

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In the last item the two cases were more or less isolated and in 
each household there was only a single case, hut the surroundings 
were such that persons living thus would be more or less predisposed 
to infection. 

Received information from Mr. Moses of the Engineering Division 
as to the typhoid fever outbreak at Dudley.* He seems to think it 
largely a case of neighborhood infection. There were eighteen cases 
studied in Dudley and Baroettstown twelve of which were in Dndley 
and- six in Carbon Township, in which township the village of Bar- 
nettstown is located. Out of twelve cases eleven are grouped in four 
houses near the intersection on Dndley Hill and here the primary 
case in the town occurred. He believes that this case was infected 
flt Robertsdale and became a.source of infection for some of the other 
cases in the immediate vicinity in whicb this case lived, the infection 
being spread primarily by means of flies. In this locality there were 
also secondary cases in some bonseholds. For the cases occurring 
outside of Dudley the source of infection is not evident, but the history 
of two of these cases shows contact with other cases over in Dudley. 

October 24 I received information from Health Officer T,, sent on 
Form 3C, that Mr, P. M, had typhoid fever on" the premises of O. B. 
in Porter Township and that milk was sold from the premises. I in- 
vestigated with Mr. Moses of the Engineering Division who was in 
town at that time. We fonnd that milk was not being sold and that 
the patient was practically over the fever. 

I received information that M. I. B. of McConnellstown in Walker 
Township had two children ill with typhoid fever and that he sold 
milk in Huntingdon. I visited the premises on October 29, and in- 
spected the dairy farm on which they had ten cows. Mr, B. and 
daughters do the milking; neither of these daughters was infected. 
The probable source was the drinking water at the McConnellstown 
School. I directed Mr. B. to discontinue the sale of milk until he 
conld secure some one to buy it wholesale and then only on condi- 
tion that the buyer send some person there with cans to do the milking 
and immediately take the milk away. 

Kovember 16, I received information on form 36 from Health 
OflQcer J. L. reporting M. C, age thirty-two, as having typhoid fever 
on the premises of P. C, Bprnce Creek Township, and that butter was 
sold from the premises. I visited farm of Mr. C. and inspected the 
dairy, I found that they milked seven cows, the milking being done 
by Mr. C. and two boys, and that butter was made by Mrs. H., an 
aunt, who also helped nurse the patient They have not sold butter 
since the diagnosis was made. Directed them to discontinue the sale 
of butter until case was reported off as the cows could not be trans- 
ferred to another place. The premises were fumigated. 

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StatisticBl Summary of Work Done During the Tear. 

Forma 36 received, 3tM Cases eiamioed alleged to be 

Forms 37 received, 2*5 Scarlet fever, 3 

MeaaleH 3 

Miimcw, 1 

Typhoid fever, 31 

Smallpox, 33 

Two boroughs investigated on accouDt of typboid fever epidemic. 
Two borougbs investigated od account of two cases of smaUpos. 


Dr, Wm, A. Simpeou, C. M. I. A Bummary of the work done by 
■ your County Medical Inspector for the year 1914 is as follows: — 

Indiana County's total area is 829 Bqaare miles and is divided into 
twenty-four townships with eisteen Health Officers and fifteen bor- 
oughs. The County had in the last census a population of 66,210. Of 
this population, 16,454 reside in boroughs ; leaving a rural population 
of 49,756, which comes under the direct supervision of the County 
Medical Inspector. 

During the year, it has been necessary for me to visit three of the 
townships and two of the boroughs and to travel by rail a distance 
of eighty miles and by livery sixty-two miles. 

This office has received during the year 645 reports (Form No. 36) 
for the placarding of premises where a communicable disease exists. 
We also received during the year 591 rejiorts (Form No. 37) for disin- 
fecting premises. All of these reports were carefully filed. Last 
year we received 846 of Form 36 and 706 of Form 37, showing quite a 
considerable decrease. 

Of the thirty-two communicable diseases only twelve were reported 
by the seventy-two practicing physicians of the County, and are as 
follows : 

Anterior PoliomycJitis:—We received one report of this disease 
from Rayne township in October. Last year no report of this disease 
was received at this office. 

Cerebrospinal Meninottia. -^One report of this disease was received 
from West Mahoning township in May. Last year no report of this 
disease was received. 

ChicJccn Pox: — Forty-eight ca.'ies were reported as against flf^y- 
three cases last "year. This disease occurred in eight of the town- 
ships and in every month of the year except August, 8eptem1>er, and 
Decnnber. Twenty-six cases occurred in Center township atdne. 




Diphtheria: — One hundred and seventy forms for placarding this 
disease were received this year, as compared with one hundred forma 
clurlDg 1913, and seventy -one during 1912. This disease was prevalent 
throughout the County, only four of the townships being free from it. 
With the exception of fifty-five cases which occurred in Montgomery 
township, the disease was well scattered. Beports were received every 
month of the year, with aeventy-six casea alone being reported during 
October, November, and December. 

Erysipelas: — Fifteen cases of this disease were reported this year. 
Seven of these occurred in Montgomery township. 8ix cases were 
reported last year. 

Measles; — Of this disease 171 cases were reported aa compared 
with 387 reported last year. This disease was found in all but six of 
the townships. The only epidemic reported was in Pine township, 
where seventy-six cases occurred. The disease was most prevalent 
during the month of February, when sixty-two cases were reported to 
this office. 

Mumps: — Twenty-eight cases were reported as compared with forty- 
seven reported last year. These cases were reported from seven town- 
ships. Thirteen cases occurred in Canoe township alone. 

Pneumonia: — One case of this disease was reported from Rnyne 
township in February. Last year no report of this disease was made. 

Scarlet Fever: — Ninety-six cases of (his disease were reported to 
this office during the year as compared with 157 cases last year. Thia 
disease occurred in all months of tbe year, excepting June and 
August. It was necessary for me to visit three townships in regard 
to this disease. My first trip was to South Mahoning township in 
January, where it was necessary to enforce the Department's quar- 
antine rules on the twenty-seven cases which existed there. In Febru- 
ary it was necessary for me to establish a diagnosis in a case of 
scarlet fever in Center township. In November I visited West Wheat- 
field township for the purpose of enforcing quarantine in this dis- 

Tuierculoais: — Eight cases were reported as against three in pre- 
ceding year. Apparently only the terminal cases of this disease were 
reported and only then for the purpose of disinfecting. 

Typhoid Fever,; — In this disease fifty-two cases were reported as 
compared with a hundred and twelve reported last year. This dis- 
ease occurred in every month of the year and in all but fire of the 
townships. With the exception of thirteen cases, which occurred 
la Green township, the disease was well scattered throughout tho 
County. In February I visited Aultman in Center town^^hlp to 
establish a diagnosis of eight casea suspected to be typhoid. In June 
it was necessary for me to visit the Borongh of Clymer to trace Hie 
Bonrc* of infectisn which hod caused ten cases in that Boroarti. 


OH. Doc. 

Whoaping Cough: — Fifty-four cases of this disease were reported 
this year as compared with seventy-three cases in the previous year. 
This disease occurred in all bat one month of the year, and thirty 
cases alone were reported from Montgomery township. 

The chart will, I think, give a clear idea of the number of caseb 
in each of the twenty-four townships and also the number of cases 
occarring during each of the twelve mouths. 

















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Dr. S. Meigs Beyer, C. M. I. 

Measles: — On January 9th at the request of Health OIBcer F., we 
visited the Albion School District, it having been reported that a 
rash existed among the pupils of these schools, and that the children 
were untreated and the disease unqnarantined. We visited the scbools 
first and definitely learned that an infectious disease existed among 
the pupils. We then visited a large number of homes, finding in one 
family five children suffering from measles. This family resisted 
quarantine severely but were placed under quarantine finally without 
any serious trouble. In three families the disease was entirely over 
and the children had returned to school. These pupils were excluded 
from school until the homes were fumigated. A number of homes 
were visited where no disease had been manifest prior to this time. 
We notified the Secretary of the School Board to fumigate the entire 
school building. This was done. We instructed teachers to ezclnde 
from school all pnpils coming from infected homes or on suspicion 
that infection existed in the home pending our further investigation. 

On January 15th we further Investigated this District as a result 
of reports made to Health Officer F, that new cases bad developed and 
that quarantine was not being carried out. We visited six homes, 
in all of which we found children suffering from measles. Proper 
quarantine measures were established in all of these homes. 

Smallpox: — On January 11th by direction of Doctor Hunt of the 
Department of Health I investigated the employees of the Miller Con- 
struction Company, an employee of the Company having been in con- 
tact with a case of smallpox thereby exposing the members of the of- 
fice force and others to the infection. I visited the homes of all the 
office employees and vaccinated all the members of the families. The 
offices were fumigated at my direction and also the room occupied 
by the exposed employee in the T. M, C. A. Building. These cases of 
vaccination were kept under observation for fourteen days. No fur- 
ther infection resulted. By order of Dr. Hunt all cases of chicken pox 
existing within the county or developing within the next thirty days 
were to be examined. This order was carried out. 

CTticken Pox: — On January 31st I investigated a number of fami- 
lies SQffering from chicken pox at Cloe, Bell Township. The diag- 
nosis was confirmed. Several families were placed under quarantine. 
All these cases were untreated by physicians. 

February 2d I inspected two cases alleged to be chicken pox at 
the home of D. G. at Cloe, Bell Township. The diagnosis was con- 




firmed. The head of the famil; objected to qoarantine but after ex- 
plaining the necessity he yielded to quarantine measures but objected 
to fumigation of his house later; this however, was accomplished 
without any difficulty. 

Ocrman Measles: — On February 4th instructed the Health Officer 
relative to violation of quarantine for German Measles in the family 
of L. O. D. in Bell Township. 

On Pebmary 11th I visited this home and found the children in 
school in violation of our quarantine. The teacher was aware ttaat 
the family had German Measles and that on this account they were 
under quarantine at the time, but had accepted the statement of the 
householder that he had fumigated the house. The patient sufTering 
from measles was not in school but two other children from the family 
were. The infected case was not isolated and the children came di- 
rectly to school from the infected home. This violation of quarantine 
was an absolute defiance on the part of the householder. These chil- 
dren were promptly excluded from school, and after a great deal 
of difficulty the family consented to obey the quarantine. The teacher 
was instructed. Ko further complaint was made. 

Chicken Pox:— On February 27th I investigated and placed under 
quarantine three families in which chicken pox existed. These fami- 
lies attended school at the Chestnut Grove School, Gaskill Township. 
No other case found. 

Scarlet Fever: — On March Cth I investigated a report of two cases 
of scarlet fever in Young Township in the family of P. Mac C. The 
diagnosis was confirmed and quarantine established. I ordered the 
fumigation of the Adrian Church. This was done by the Depart- 
ment Health Officer. 

Garbage Disposal Plant: — April 7th, by order of the Department. I 
investigated the garbage disposal plant (dump) allowed to exist hy 
the Reynoldsville Borough in Winslow Township. Complaint bad 
been made by C. W. P. These grounds were in a frightfully insani- 
tary condition owing to the improperly buried dead bodies of animals 
of all kinds. The ground was strewn with every conceivable form of 
filth and rubbish. Springs near by and in use by the public were 
being infected by dogs that ate of the carrion and then drank the 
water and waded in it. The odors emioating from this dump were 
very fonl and the surface water from this dump drained about a 
hundred feet into Red Bank Creek thereby infecting this stream. I 
recommended an incinerating plant to dispose of this material and 
stop the infection of these water supplies. 

Water Supply: — April 16th I instructed Health OfficeF M. to in- 
vestigate the complaint of Dr. B. that the water supply of Wishaw, 
Winslow Township, was in a filthy condition. The result of this 
investigation was the abatement of such nuisances as were responsible 


for the infection of the water. This was done to the satisfaction 
of the complainaot. 

Diphtheria: — April 4th I investigated a report of Dr. E. C. G. of 
violation of quarantine of diphtheria hy an employee in the family 
of F., under quaraittiuc in Punxsutawney, the contact having gon* 
to McCalmont Township. After considerable difficulty this girl was 
found and placed under fourteen day quarantine pending develop- 

Alleged Bmallpox: — On May 11th at the request of a physician and 
in company with Iiim I investigated a case in Punisutawney Borough 
suspected of being smallpox. The diagnosis was not confirmed. 
Provisional quarantine was established pending a clinical report on 
the WassermanD reaction, which gave positive results. 

Scarlet Fever: — May 15th by order of the Department and at the 
request of a Health Officer I investigated an epidemic of scarlet 
fever in Kno£ Township. I visited seven cases and confirmed the 
diagnosis in all. This epidemic involved the Italian colony largely. 
Through an interpreter I instructed the families involved and 
warned them of the danger of the spread of the disease in the colony. 
Mo further cases were reported. 

Diphtheria:- — On September 19th I investigated the family of H. 
H. in Bell Township, suspected of having diphtheria and of being re- 
sponsible for spreading the infection to families of relatives, two of 
which were under quarantine for diphtheria the result of the visiting 
back and forth of these families. This family resisted examination, but 
after a conference with the family physician and a threat to exclude 
the wage earner from employment, permission was granted to make a 
culture from the throat of each member of the family and to estab- 
lish a provisional quarantine pending the result of the examination. 
The Laboratory reported three of the children of this family infected 
and the quarantine was continued for twenty-one days. The result 
of this examination or investigation doubtless prevented the infection 
of the entire Fairview School District. 

lAipetigo Contagiosa: — September 21st, Dr. T. reports to H. O. 
Kyle a case of scarlet fever in Kose Townrfiip. Also the presence of 
a rash in Pine Creek Township, Britton School District. I investi- 
gated and found a number of pupils suffering with Impetigo contag- 
iosa. These were excluded from school. Epidemic promptly checked. 

Whooping Cough: — July 17th, in company with H. 0. Kyle, I 
investigated a case suspected of being whooping cough in Belgum 
town district, Pinecreek Township. A number of cases were placed 
under quarantine and no further infection was reported. 

Meatles: — December 21, I made an inspection of an epidemic of 
nnquarantined measles in the Britton School, Pinebrook Township. 
The diagnosis was confirmed in twenty-one cases and proper sanitary 
protection enforced. ^<\i^ 


On December lOth, at Emmerickville — I made an inspection of an 
epidemic of nnquarantined measles in Pine Creek Township ; twenty- 
three cases were foand and placed under quarantine. One case of 
mamps in Union Township was placed under quarantine. 

StatiaUcal Summary of Work Done During the Tear. 

The following diHeaaea were reported d 

ring the year: 
Scboola doaed and 

Chii relies fumigated 





Dr. W. H. Banks, C. M. I. 

Diphtheria: — January 31, I was asked by Dr. Willard of Mexico 
and several School Directors of Turbett Township to investigate a 
sudden outbreak of diphtheria in that townsbip. I found that Shelley 
H,, wife, and three children, had gone on a visit to a friend, a few 
miles from their home, and while there one of the children took sad- 
denly ill and died, with a diagnosis of tonsillitis. The family theo 
started home, stopping over night at the residence of Allen K,, who 
with his wife and ten children occupied a three room, one and a hnlf 
story bouse. While at K's, H's wife and two children took sick and 
in a few days died. About this time the diagnosis had been made and 
quarantine established. When I visited the E. home I found that 
two of the K. children had contracted the disease. These subsequently 
recovered and no further cases developed either in this family or in 
the community. 

September 1, while examining one of the patients at the Tubercu- 
losis Dispensary, a girl of sixteen, I found that she had a well 
developed case of tonsillar diphtheria. Bhe was immediately sent 
to her home and the family visited. Five cases were found in this 
family and four cases in an adjoining family, and a little later two 


other families were foatid to have the disease. Antitoxin was ^ren 
to all the members of these different households. The schools were 
also closed for two weeks and disinfected. 

November 7, at the request of Dr. Longacre of Fremont, I visited 
Susquehanna Township and with him examined ten undiagnosed cases 
of sore throat. These had been going on for several weeks and had 
been carelessly called tonsillitis and quinsy. The disease was im- 
mediately pronounced diphtheria and quarantine established. The 
school was closed for two weeks and also disinfected. There were 
twenty-four cases in this outbreak and six deaths. 

Scarlet Fever: — There have been numerous cases of this disease, 
usually in a very mild form, and this is a great temptation on the 
part of the parents to evade quarantine. 

April 9 I visited Van Wert in Walker Township and found nine 
cases in three families. These were so mild that a physician had not 
been called for some of them. One of the very mild cases subse- 
quently developed nephritis, from which she died. 

Smallpox: — We had two families under quarantine with this dis- 
ease. Cora S., while working in a hotel in Snyder County, contracted 
the disease and was immediately sent to her home by the landlord 
of the hotel. She communicated the disease to all of her family, con- 
sisting of father, mother, and ten children. By careful quarantine 
and an efBcient guard, the trouble was limited to this one family. 

December 24, at the request of Dr. Quig of East Waterford, I 
visited that place and confirmed the diagnosis made by him a few 
days previous. The patient Elmer D., the rural mail carrier, had 
purchased a fur coat from a firm in Chicago, and had been wearing It 
about three weeks when the disease developed. His family was im- 
mediately vaccinated as well as all the contacts and a very effective 
quarantine maintained by a reliable guard, and in this way the trouble 
was confined to the single family. 

Typhoid J'ever:— We have had fewer cases of this disease than in 
any year of my service as County Medical Inspector. There have 
been seven sporadic cases and in no instance has there been more than 
one case in a family. 

The following diseases have been reported during the year: 

Scarlet fever, 21 Typhoid fever, 7 

Diphtherie, 65 Whooping coagh, 2 

Measlefl, 21 SniHlllpoi, 13 

Mumps, 13 I _ .. ' , '.LJ 

J, Google 



Dr. J. C. Reifspyder, C. M. I. I have tie honor to report on my 
work for the year 1914 and include abstracts of letters reporting 
communicable diseases in Lackawanna County. 

Bmallpox: — March 3, I was called to Mayfield yesterday by the 
Secretary of the Board of Health to verify a diagnosiB of smallpox, 
and found three cases in the family of Paul J., none ever vaccinated. 
These cases are traced to Samuel and Joe C, brothers of Mrs. J., 
who came here from Niagara Falls the latter part of January. Small- 
pox has been raging during the winter in Niagara Falls and the broth- 
ers have returned to Niagara Falls. I could not learn with whom 
they were in contact while in Niagara Falls before coming to May- 
field. I have carefully looked up all Mayfield contacts. Dr. Martin 
is Health Officer for the Board at Mayfield and has carefally looked 
up contacts and the vaccinating. 

April 27, I was called to Jermyn by Dr. Davis to see one George 
H. in contact with Paul J. of Mayfield where there were three ca^es 
of smallpox in March. I could not diagnose smallpox and asked Dr. 
Davis to hold the man in temporary quarantine. 

April 30. Referring to euepjcions cases in Jermyn, wish to rep«rt 
it as a light case of smallpox, George H., aged 32, successfully vacci- 
nated in childhood, anBiiccesafuUy vaccinated in January, 1914. 

fieptember 11. Following instructions from the Chief Medical In- 
spector, I met Dr. Kenworthey of Milford at Blooming Grove Town- 
ship, Pike County. Going by rail would have necessitated several 
days travelling, so I went to Blooming Orove by automobile. The 
case of Mrs. John V. is undoubtedly smallpox. She never was soc- 
cessfully vaccinated. The onset was September 2. She had left 
Scranton where she visited August 15th going home by way of the Erie 
Railroad, and spending the greater part of the day in Hawley, Wayne 
County, so that the source of her infection must have been on this 
trip. I have a list of the houses she visited while in Scranton and 
those while in Hawley and shall carefully look np the contacts. Dr. 
Kenworthey will look up the contacts in Pike County. 

Septeml>er 14. Learning that Mrs. John V. of Pike Connty, small- 
pox case, had visited the home of Edward S. of Factoryville, I yes- 
terday visited Factoryville and vaccinated all in the house. I could 
learn of no suspicious cases. 

Infectious Diarrhoea: — I wish to report that after a talk with the 
men of the Lackawanna County Medical Society that they agree with 
me that there have been a great number of cases of enterocolitif^ be- 



ginning about July 20tli. Just previous to that time ^e bad a nam- 
ber of very severe storms and our water supply was very muddy. 
Tlie City Bacteriologist found an unusual number of colon bacillus 
and the Scranton Water Company closed and subsequently cleaned 
the Koaring Brook Eeservoir. The water furnished the northern part 
of the city comes from a different shed and did not seem to be af- 
fected. There were no cases in North Scranton. These physlciana 
all reported many cases of intestinal infection beginning the latter 
part of July. Their description agrees with mine; from simple diar- 
rhoea of a non-febrile course of four or tive days, to enterocolitis, with 
fever, cramps, mucous stools, and a paratyphoid condition, though in 
none of these cases were microscopical examinations made. The 
later cases ran some ten days. Onset: — diarrhoea and cramps; 
stodU: diarrhoeal with streaks of mucus and, in a few instances, a 
little blood. Fever running from 99° to 100." Soreness over abdo- 
men. Weakness and prostration out of proportion to Illness. Stom- 
ach not affected. Recovery beginning the sixth to the tenth day with 
tendency to relapse. The local registrar assures me, however, that 
there have been fewer deaths from diarrhoeal diseases this sum- 
mer than in many seasons. Certainly my own observation would lead 
me to think that we have had less disease of that character save In 
the period mentioned, July 20 to the middle of August, and then only 
in the central city. It seems clear that the infection was from the 
Roaring Brook reservoir and that the condition was promptly cleared 
by the Scranton Water Company. 

Typhoid Fever: — ^In September I investigated a case of typhoid 
fever on a dairy farm in West Abington Township, Walter W., aged 
21, with onset about September 12. AU precautions are being taken. 
Instructed those having anything to do with the milk or with the 
cattle to leave the house. Young W. was taken sick while working 
for J. C. Korthup about one mile distant. I investigated the house 
of Northup and found a poorly installed closet which was connecTed 
with a stream nearby. The sewage pipe had burst about September 
1 and young W. had cleaned the cellar. I ordered Northup to abate 
the nuisance and install a cesspool. I also inspected Charles G. ill of 
typhoid fever in West Abington. 

October 14. I investigated a case, reported as tyi*oid fever, at the 
Concord Hotel, Moosic Lake. The case was brought in from outside. 
The water supply and sanitary conditions appeared to be all right 

October 4. I inspected the house of H. W., West Abington ; a nega- 
tive case. 

Scarlet Fever: — January 3, I inspected a case of scarlet fever at 
the dairy farm of Art S., Newton Township, and arranged that the 
cows be taken care of by neighbors. Strict quarantine was estab- 

b, Google 


Diphtheria: — April 3. On telephone call from Dr. Bowers of 
Scranton, I inspected a case of diphtheria in the honse of John B. of 
Chinchilla, South Abington Township. John B., Jr., aged siz years, 
had undoubtedly diphtheria. Dr. Bowers had been dischai^ed and 
another phyeician from Clarks Summit called in who diagnosed the 
case as simple sore throat Placarding and quarantine were objected 
to, but a threat of summoning the police brought the family to reason. 

April 6. The father, John B., was taken eick April 3, and a diag- 
nosis of quinsy was made by the Clerks Summit physician. B. died 

May 17. I inspected the house of W. B., Benton Township, finding 
one case of diphtheria. Milk workers do not live on the same farm. 

Inspection of Court House: — March 5. According to your letter of 
March 2, I this day inspected the Jury Rooms in the Court House. 
My recommendations are as follows ; — 

First. That all four rooms be cleaned, the walls and ceilings painted 
or recoated, and the floors painted or covered with linoleum. That 
liquid soap be provided with a proper container at each washstaud. 
That closets be painted. That paper drinking cups be kept at each 
stand in proper containers. That air ventilators be provided for 

Secondly. That the janitor be instructed to arrange the windows 
in all rooms when occupied at frequent intervals so as to provide 
adequate ventilation, with a daily airing and cleaning of rooms. 
That, although he says he at present furnishes two clean sheets and 
pillow case each day, all bedding be aired daily and all bedding be 
disinfected when there is any change in the jury. That one or more 
shower baths be installed in Boom No. 1, which is generally used, 
i-oom for this to be gained by encroaching on tipstave's room adjoin- 
ing. That another washstand be added and provision be made for 
hot water heated by gas to serve washstands and shower baths. That 
Room No. 2, if it is ever to be used, have a shower bath and one more 
stand, the same equipment as for Room No. 1. 

The sleeping rooms are cramped as regards size; have no com- 
fortable chairs nor conveniences, and are not properly cleanied. 


Dr. J. L. Mowery, C. M. T. In order properly to perform the duties 
of County Medical Inspector for the year 1914, I traveled 1,956 miles 
by rail and 420 mites by livery. ■ 


I received at this office 770 rejwrts of placarding for communicable 
djjeases (form No. 36) and 664 reports of dlBiufection (form No. 37) 
from the fifteen district Health OfBcers in the Connty and tabulated 
them on sheets No. 69. These reports were carefully examined and 
proved complete before being entered upon the records at this office. 

Of the reportable diseases this office had sixteen to do with, as fol- 

Chicken Pow: — One hundred and sixty-six cases were reported dur- 
ing the year, every month being represented except May; August and 
September each with one case reported ; while December, November, 
and January had the greatest number, December having fifty-one cred- 
ited to it The disease was confined throughout the year to limited 

Diphtheria; — ^This disease made its appearance during every month 
in the year, a hundred and one cases baring been reported to this 
office, November having the largrat number, and March the smallest. 
This disease did not assume any extreme epidemic form at any time 
during the year, although it was found necessary to close several 
schools in order to check the spread of the infection. 

Erysipelas: — Of this disease fifteen cases were reported during the 
year to this office, generally widely distributed and none bearing 
any relation to another. 

Measles: — There were exceptionally few cases of measles reported 
during the year, and owing to the fact that they were reported 
promptly by physicians so that the Health Officer could avail them- 
selves of quick action in controlling the spread of the disease, forty- 
eight cases made the total number reported to this office. The great- 
est number appeared during March and April with none during July, 
August, and November, and only one each for September and October. 

Mumps: — There were only eight cases of mumps reported to this 
office during the year, three in January, two in June, one in September 
and two in December. 

Pneumonia: — There were twelve cases of pneumonia reported to 
this office during the year occurring only in five months of which 
March and December each had four cases. They were all widely dis- 
tributed geographically and none having any apparent relation to 
any other. 

Scarlet Fever: — There were sixty cases of scarlet fever reported 
to this office during the year, every month being represented in this 
report October had the largest number, fourteen; with February 
a close second, thirteen cases ; July, Angust, and December having 
each one case; the other months of the year had a pretty even distribu- 
tion. I found it necesary on several occasions to close* the schools 
and have the rooms disinfected for the purpose of controlling the 



Spread ot the disease in certain localities. This, with other precaa- 
tionary measures, was eflfective in preventing the spread of the disease 
in districts presenting its developmetit. 

Tuberculosis: — Id an area of nine hundred and sixty square miles 
with a population of ninety thousand coming under the direct super- 
vision of this office there were only twelve cases of Tuberculosis re- 
ported during the year, seven months being represented in this sum- 
mary report: March and AprU — each one case; June — two cases; 
August — two cases; October — two cases; November — two; and De- 
cember — one case. This is the smallest number received at this ofRce 
for any one year during the time that I have served as County Medical 
Inspector, and a very small number in proportion to the population. 

Typlioid Fever: — One bundred and Ihlrty-one forms No. 36 were 
received at this office during the year noting that Typhoid Fever 
existed. Every month in the year was represented in the reports. 
The greatest numbers were reported in January, March, April, 
August, September, and October with January leading — twenty-nine 
cases being recorded during this month. It was my privil^e to visit 
many of the premises whei'e the disease existed in order to establish 
safe regulations for the disposition of the dairy products. I always 
took notes of the sanitary conditions existing as well as the probable 
source of infection. The bulk of the cases during the months of 
January, February, March and April, about forty in number, were 
confined to the townships in the eastern side of the county known as 
the New Holland District. It was then assmed that a special factor 
common to this district should be responsible for this unusual num- 
ber of cases developing at a season of the year in and around the holi- 
days. Upon investigation and by obtaining a complete census of the 
cases, it was found that a great many oysters were brought by resi- 
dents of this district from local dealers. It was, therefore, assnmed 
that oysters may have been a common transmitting agent over thJs 
territory, and a special report on this subject was prepared by the 
Associate Chief Medical Inspector, 

Whooping Cough: — There were two hundred and thirty-one cases 
of Whooping Cough reported to this office during the year, having 
rather a wide distribution and covering every month of the year, 
November having the greatest number. I usually have the Health 
OtDcers cope with this disease without my assistance. 

Malaria: — There was but one case of Malaria reported during the 

Smallpox: — Eleven cases of smallpox were reported during the year, 
one in January, seven In February and three in March, all confined to 
the Billmeyer district, Conoy Township. Billmeyer is a small river 
town where the Dolomite quarries are being operated with about three 
hundred employees, mostly foreign and negro, in constant attendance 

Ho. 15. 00UUI8SI0NER OF HEAI/TH. M3 

OH the works. By a wholesale vaccination and absolate quarantine, 
ve sacceeded in boldiog the disease od three premises with no later 
outbreak. A fuller report on this subject by the Assistant Ghie/ 
Kedical Inspector will be found among the special reports accompany- 
ing this commanication. 

The fifteen district Health Officers of the Gonn^ have done service 
dil^iently and faithfully in the discharge of their duties; no com- 
plaint in regard to their action has reached this office. The lai^ 
generally have shown a disposition of acquiescence in matters per- 
taining to health and sanitary conditions. Physicians throughout 
the County show an appreciation of the doings of th£ Department of 
Health. School Boards, teachers, and Health Boards hare repeatedly 
asked for my presence in matters pertaining to health and sanita- 


Dr. Jesse D. Moore, C. M. I. I beg to submit to you at this time a 
short and incomplete r^sumS of work performed by your Medical 
Inspector and Health Officers in tbis district (Lawrence County) 
during the year 1914. We deem it not necessary to go into details 
as to times and manner of doing this work, having heretofore from 
week to week sent reports to the Department fully setting forth what 
was done in the performance of our several duties as either requested 
or required by you. Believing this will be satisfactory to you, our 
report now will be almost altogether statistical. 

During the year I received at this office reports of placarding com- 
municable diseases (Form 36), 322. I received also reports of dis- 
infection and fumigation (Form 37), 214. These forms were for- 
warded to your office promptly at the end of each week, after having 
been entered as records at my office. Of all reportable diseases as 
designated by your ruling, we have been necessitated personally to 
inspect but forty-eight cases, and these were, without exception, of 
what are usually termed minor troubles, namely: 

BeportaUe diHeaBCB throughout the diiiirict were as fi 

Typhoid fever 30 Diphtheria, ... 

Scarlet fever, 37 Menslee, 

Whoopiog coQKh, 137 Chicken poi, 

UampB, 32 Cancer , 

Pulmottar)' tuberculoalB 6 BrjBlpelas, .. 

Pnemnonia 8 



All of these cases were looked after and given carefal and tborongh 
attention by your Health Officers until released from quarantine after 
tborough fumigation and disinfection. In fact, I believe we have 
in this district, a thoroughly proficient and competent force of Health 
Officers, I have, from time to time during the year, namely, on fifty 
occasions, deemed it necessary to call in and instrnct your Health Offi- 
cers on different matters pertaining to their duties aa snch. These 
occasions, together with dates, have been fully set forth in my monthly 
reports to the Department. These short conferences between your 
Medical Inspector and Health Officers seems to me to be of very 
gr£at importance. I have found that we all work In greater harmony 
and with better results on this account. 

Again speaking of diseases reported to me during the year, that 
yon may more thoroughly understand the distribution of such, I will 
now enamerate them by districts, together with the name of the 
Health Officer presiding over such, namely: 

Littie and Big Beaver TowDsfalpe, H. O, 8, W. Wilson reported: 
Diphtheria 2 Typhoid fever 4 

Bbennngo TownsMp, H. O. E. N. Hink reported: 

Ghichen poi 6 Pneumonia 1 

Scarlet lerer, 6 Typhoid fever 2 

Mumps, i Diphtheria 9 

Slippery Bock and Perry TowDshipa, H. O. Andrew Glasser reported; 

WlImln^OD and Hirkor; Townships, H. O. Mebard Neal reported: 

NeahaDDOck Township, H. O. A. S. Moore reported: 

Scnrlet fever, 3 Measles, 

WhooidnK cough, IS Mumps 

Chicken pox 1 

North Beaver TowDsfalp, H. O. J, G. Bright reported: 

Typhoid fever 8 Mumps 

Scarlet fever, 6 Measles 

Chicken poi, 2 Tuberculoais, 

Wayne Township, H, O. Frank D. Allen reported: 

Scarlet fever, 6 Mensle 

Tuberculosis, 1 Diphtheria. . 

Erysipela 1 

Pulaski TowDsbip, H. O. Harry Torrence reported: 



Scott, WaahiustoD, and Plain Orove Townships, H. O. J. A. Uagee reported: 

Scarlet fever, 5 Mejisles, 1 

Typhoid fever, 6 Diphtheria, 2 

Inieumoaia 4 

Taylor. Mahoning, and Union TowoEhipH, H O. I^wis H. Hawthorne reported: 

Senrlet fever, 4 Erysipelas, 3 

Wboopine cough 20 Dipbthi-rin, 18 

Tuberculosis, 3 Pueuiaouia 3 

Typhoid fever, 9 Mumps, 24 

Chicken pox IG Menales, 2 

You will notice from this i-eport tlie distribution of the different 
reportable diseases over our entire district, which, taking into con- 
sideratioB the population of each district, would seem to be a fair 
and even distribution. In each and every one of these instances, I 
have been careful to see and know that your Health Officers were not 
allowed, in any instance, to neglect any measure deemed to be right 
and proper to curb any further outbreak of disease, and believe that 
on the whole we have been entirely successful. The doctors practis- 
ing medicine in this county ai^e, with few eictptions, diligent, care- 
ful, and prompt in reporting communicable diseases to your Health 
Officers. It has on two or three occasions during 1911 seemed neces- 
sary for me to see three physicians, that I might have a personal talk 
with them in regard to their duties in reporting to us. In every 
instance they have taken this kindly and I believe, as they state, their 
actions will be such that criticsm will at no time again be required. 
During the year 1 have been consulted very frequently by Boards of 
Health in boroughs, etc., as to their duties as required by the State 
Department of Health, and in each instance I have endeavored to 
give to them any directions that I believed to he of use that they 
might comply fully with the laws governing such matters. This fact 
appears to me to show not only a willingness but » desire to comply 
with rules governing our Department. During tne year, in no case 
have we had any friction between township, cities, or incorporated 

I believe this short r^snm^ will be all that is necessary and every- 
thing required by you at this time. 


Dr. A. J. Biegel, C. M. T. The year 1914 has had no epidemic of any 
kind, the beginning of the year having ended the smallpox epidemic 
of 1913, during which time there had been reported about eighty cases 



of smallpox. The medical inspection of this county, conducted by 
the five Health Officers and the Medical Inspector, was carried on 
carefully, without any frictiou or troubles of any kind from the public. 

Our work has been done on the educational plan, carried on with 
firmness, promptness, and in a business like manner, as required by 
the State Department of Health. 

The Health Officers have been in perfect harmony with the Medical 
Inspector in th£ir work, having performed their duties faithfully and 
promptly in their districts, asisting the Medical Inspector wherever 
possible and whenever called upon, thus making the work pleasant 
and effective for our mutual results. 

Statistical Summary of Work Dooe During tbe Year. 

218-Exnmined cascB alleged to be: 

217 Scarlet fever 1 

Diphtheria 1 

Dniries inBpeeted for: — Whooping cough 8 

Typhoid fever 10 Chicken poi 2 

Scarlet tever, 7 Mumps, 5 

Smnllpor 1 

Diphtheria 8 , ■ . i ' . !! i — ■ 2 " 

Sale of milk stopped from three premises. 
Number of sehoola closed from diphtheria. 1. 
Number of Health Oflicers instructed, 1. 
Number of miles traveled by livery, 480. 
Number of mllea traveled by railway, 304. 


Dr. J. Treichler Butz, C, M, I. This summary of work done for the 
year will be largely statistical with only such brief comment aa may 
be necessary to make the same clear. 

This county has an area of 344 square miles, and is divided into 
one city, ten boroughs, and fifteen townships. The population is 
about 127,000. The city, boroughs and one first class township con- 
tain about 03,000, leaving the population o( the townships 34,000, 
which has to do with this report, coming under the direct supervision 
of the County Medical Inspector. 

The distance traveled by rail was 538 miles and 25 miles by livery. 

During the year 732 reports of placarding for communicable dis- 
eases (Form 36) were received from the seven district health officers 
in the county. These ofiicials also sent in 493 reports of disinfection 
(Form 37). All these reports were carefully examined and if in- 
complete or additional information desired, they were returned to 
the proper Health Officer before being entered on the records of this 


Of the thirty-five reportable diseases, this office had to do with 
but fourteen during the year, as follows: 

Anterior Polio7nyelitis:—T'WO cases were reported. 

Chicken Pox: — Fifty-two eases of this disease were reported by 
pbyaiciana and householders. The disease appeared in seven town- 

Diphtheria: — One hundred and four cases of this disease were re- 
ported, Salisbury township having the greatest number of cases. 

Dysentery: — One case was reported. 

Erysipelas: — Three cases reported. 

Oerman Measles: — Five cases reported. 

Measles: — Two hundred and seventy-seven cases of this disease were 
reported by physicians and householders during the year. It ap- 
peared in twelve townships, the greatest number of cases, one hundred 
and three being reported in North Whitehall Township in the month 
of March. 

Mumps: — One hundred and twenty-eight cases were reported by 
physicians and householders. It appeared in nine townships, the 
greatest number in Upper Milford township, sixty-one cases. 

Ophthalmia Ji'^eonatorum: — One ease was reported in South White- 
hall township. 

Prt«umo7iia.-— Three cases of this disease were reported, 

Bcarlet Fever: — Tbirty-eight cases were reported and appeared 
in nine townships. Two dairy farms were inspected. 

Tuberculous: — Eleven cases were reported. 

Typhoid Fever: — Forty-one cases were reported during the year. 
The disease appeared in eleven townships, the greatest number of 
cases, ten, being reported in South Whitehall township. Nine dairy 
farms were inspected during the year, 

Whoopin{f Cough: — Forty-eight cases of this disease were reported 
by physicians and householdeis during the year, appearing in nine 

The seven health officers of the county have been uniformly prompt 
and careful in the discharge of their duties. During the year Healfli 
Officere Mr, P. J. Brown, of AUentown, and Mr. B. J. Schlosser, of 
Schnecksville, died. 

I cannot close this report without calling attention to the splendid 
support given me by the physicians of the county in our work and in 
reporting their cases promptly. 

Statistical Samiuar; of Work Done During tbe Year. 

Forms 3a received, 732 Verified, 

Forma 37 received, 4B3 Chicken poi 1 

Dniry farms laapected: Mumiw 1 

Typhoid fever B Milea traveled by rail C38 

Dipbtlieria 3 fty livery, 25 

Scarlet fever, 3 Stock transferred on account of ty- 

phoid fever. 




Dr. Charles H. Miner, C. M. I. During the year 1914, 1,045 repDrts 
of communicable diseases (Form 36) were sent in bj sixteen dia- 
tpict Health Officers in the county, and 840 reports of disinfection 
(Form 37), The reports of communicable diseases far exceed those 
of 1913 when only 724 reprots were received. 

Chicken pox: — During the year one hundred and eight cases of 
chicken pox were reported by physicians and bouseholders. The 
disease occurred in fourteen townships, and the greatest number re- 
ported in any one township was iu Hazle Township, where thirty- 
two cases developed, twenty-six cases in Nescopeck and Salem 
Townships, sixteen in Black Creek and Sugar Loaf Townships, twelve 
in Kingston Township, and an average of two iu the other Townships, 

Diphtheria: — This disease occurred in twenty-five of the Town- 
ships during the year, a total of one hundred and sixty-seven cases 
being reported; Kingston Township having the greatest number, 
forty-four cases; Hazle and Foster Towusliips, twenty-two cases; 
PittBton and Jenkins Townships, twenty cases; Lehman, Lake, Dallas, 
and Franklin Townships, twenty-one cases; Black Creek and Sugar 
Loaf Townships, seventeen cases; Plymouth Township, twelve cases, 
and an average of three or four cases in the other Townships. 

Erysipelas: — Four cases of erysipelas were reported during the 

Measles: — Measles heads the list of all the communicable diseases 
reported during the year when four hundred and seventy-one cases 
were reported. Epidemics of this disease developed in Black Creek 
and Sugar Loaf Townships where they had thirty -eight cases; in 
Duryea Borough during September, October, and November when 
fif ty-flve cases occurred ; in Hazle and Foster Townships, where one 
hundred and forty-eight cases developed. On May 27th, I wrote 
the Secretary of the Black Ci-eek Townaliip School Board and di- 
rected him to close the schools until they were thoroughly fumi- 
gated and he complied with our instructions. On June 8th the 
schools at Humboldt, Hazle Township, were ordered closed and 

Whoopitifj Cnuf/h: — Sixty-five cases of whooping cough were re- 
ported from twelve of the townships, the greatest number occnring 
in Kingston Township, twenty-five cases, eighteen in Bear Creek 
Township, and ten in Jackson Township, and of one or two in each 
of the other Townships. 

I, Goo'^lc 


Cerebrospinal Meningitis: — Two cases of eerebroBpinal meuingitia 
were reported, one case in Jackson Township and one in Hazle 

Tuberculosis: — Ten cases of tuberculosis were reported to the 
Health Officers where fumigation was required after the removal op 
death of the patients. 

Mumps: — One hundred and eleven cases of mumps to the Health 
Officers during the year in twelve of the Townships. 

Scarlet Fever: — One hundred cases of scarlet fever developed. 
There were thirty-three cases in Hazle Township, the greatest number 
reported in any one Township ; eleven in Kingston Township, and an 
average of three and four in the other Townships. 

Typhoid Fever: — Only tw^enty-three cases of Typhoid fever were 
reported during the year, which shows a marked difference from 
1018, when fifty-three cases were reported. The diseases occurred in 
ten of the Townships; eight in Jenkins and Pittston Townships; 
five in Foster and Harris Townships, and an average of one and two 
in the other Townships. 

Smallpox: — Only one true case of smallpox was reported in the 
county for the year 1914. 

On January 8th I was requested by Dr. Davis of Glen Lyon and 
Dr. Meyers of Wanamie, to come to Glen Lyon to see a suspected 
caae of smallpox. On visiting Glen Lyon I found the patient, a man 
about sixty-five years of age, lying on a conch in a kitchen of the 
house behind a very hot stove. He was covered with a very light 
rash which the attending physician stated had appeared on December 
24th. I did not diagnose the case as smallpox, but told the phys- 
icians I thought the rash was due to some toxaemia, which it proved 
to be. 

Besides the contagious diseases reported under the different head- 
ings I had reports of two eases of membranous croup ; two cases of 
pneumonia; nineteen cases of epidemic dysentery, which were re- 
ported during September in Hazle and Foster Townships and person- 
ally investigated by Doctor Hunt. Five cases of scarlatina; and one 
case of German measles. 

On May 6th I was called to Black Creek Township by Health 
Officer Smith to diagnose suspected cases of measles. After visiting 
the homes of three families where the disease was suspected I was 
unable to make a diagnosis as the children were entirely well. 

May 8th, I made a trip to North Avoca to interview Mr. J, Walters, 
President of the Borough Councils of Duryea Borough and Dr. 
Symthe of Avoca Borough about organizing active Boards of Health 
in Duryea and Avoca Boroughs, but thus far no permanent organi- 
zations have been made and the Department is looking after the 
work in both Boroughs. 

29-15-1916 , Google 


On June 11th, I was summoiied by Dr. Lake, of Kingston, to go 
to Luzerne Borough to see a suspected case o( smallpox. I fonud 
the patient, a boy of four years, suffering with smallpox. The child 
had been brought by his mother from Detroit, Michigan, ten days 
before and evidently contracted the disease in Detroit as the family 
occupying the next apartment to tbem had had smallpox. The child 
recovered and with strict sanitary precautions and isolation no other 
cases developed. 

On June 18th, I went with Mr, B. B. Styer, of the Engineering 
Division, to investigate conditions at the Patterson Grove Gamp 
Grounds where there had been an epidemic of typhoid fever after 
the encampment of 1913. On the grounds we had interviews with 
four members of the Camp Ground Association and gave them 
instructions as to how the Grounds were to be renovated ; new closets 
built and the old ones closed, and a new water supply dug for. Our 
instructions were carried out as we found later on July 15th, when 
the grounds were reinspected by the I>eputy Medical Inspector who 
reported that everything was in first class condition. 

On July 22d, I went to Dorrance Township with Health Officer 
Good to investigate a case of typhoid fever, where it was reported 
that milk was being sold from the premises. After visiting the 
home I found that the case was probably not one of typhoid fever, 
but all precautions in regard to the care of the milk were taken. 

During the latter part of July six cases of typhoid fever were 
reported in Kingston Borough on the milk route of one of the local 
dealers. Dr. Lake, a member of the Kingston Borough Board of 
Health and the Deputy County Medical Inspector, investigated the 
farms of the producers from whom the Kingston dealer secured his 
milk, but no source of typhoid contamination was discovered, although 
dirty and unsanitary conditions were found. Through the cooper- 
ation of the Chief Medical Inspector every effort was made to find 
the source of the typhoid infection, water analyses made, etc., but 
nothing was determined. Fortunately, however, no new cases de- 
veloped, and the cases made a good recovery. 

On September 28th I was called by Doctor Long of Hnnlock's 
Creek to visit Hunlock Township to diagnose three cases suspected 
to be typhoid fever. On examination the cases proved to be true 
typhoid fever. Water specimens were secured and sent to the State 
Laboratories for analysis, and the water in one of the wells and a 
spring were found fo be contaminated. The Health OfBcer saw that 
the well and the spring were both thoroughly cleansed. 

On December 8th. the Chief Medical Inspector directed me to visit 
a family in Hanover Township, where there had been six cases of 
typhoid fever. After getting in touch with Doctor Davis, of the 
Hanover Township Board of Health, we made a careful investigation 



and found that the father of the family had posaibly infected the 
entire family, as he had been ill during the months of September and 
. October with every symptom of typhoid fever, although a diagnosis 
of typhoid had not been made and no sanitary precautions whatever 

On December 12th, I was called to Glen Lyon by Drs. Meyers and 
Davis to see a case suspected of being foot-and mouth-disease. The 
man, a foreigner, aged forty-five, had been sick for six weeks and 
was treated by four different physicians at first for typhoid fever, 
then for kidney disease, then for inflammation of the month, and 
necrosis of the alveoli. Dr. F. E. Davis, a veterinarian, was also 
called to see the case. After a careful examination of the patient 
and the history of the case I diagnosed it as a severe case of scnrvy. 
We did not establish any quarantine. 

It is evident that the knowledge of the rules of the State Depart- 
ment of Health are being eagerly sought for as I was interviewed 
on twenty-one occasions by officials of First-Class Townships and 
Borough Boards of Health, and forty-nine times by physicians, 
eleven times by individuals, and on thirty-three occasions by the 
township health ofBcers. 


Dr. C. W. Youngman, C. M. I. Lycoming County during the year 
1914 was fairly free from epidemic diseases. As County Inspector I 
was not called for often as nearly all emergencies were met by our 
Health Officers. A few schools were closed for fumigation but not 
many as exposures in the schools were few. 

Measles were the most prevalent disease and in June from an ex- 
posure in Hepburn Township it spread all summer and fall through- 
ont the adjacent townships and seemed to be most frequent in the 
neighborhood of Sunday Schools and after church festivals as no 
public schools were open at this time. One hundred and seventy- 
seven cases occurred. Twenty-seven cases of typhoid fever occurred, 
nearly all of these sporadic cases occurring on farms or in small 
villages from local infection. No epidemics resulted, due entirely 
to the attention given to the dejecta from the patients. There were 
thirty-nine cases of mumps; two German measles; nine tuberculosis; 
sixty-eight diphtheria; fifty-six chicken pox; eighty-five whooping 
congh; seven erysipelas; one trachoma; one puerperal sepsis; one 
cerebrospinal meningitis; and one anthrax. The anthrax was from 



a local tannery handling South American hides and was treated at 
the Williamsport Hospital where they have cured a nnmber of cases 
by the local injection of carbolic acid. 

In all, 517 oases of contagious diseases occurred, eighteen less than 
in 1913. 


Dr. P. Wade Paton, C. M. I. I succeeded Dr. W. Clyde Hogan. 
as County Medical Inspector of McKean County on Aufcust 4th, 
1914, and beg to submit the following summary of the work done 
during the year. For the most part this report has been made op 
from office records in the Department and from the County Medical 
Inspector's mpraorandiim sheets. 

Two hundred cases of communicable diseases were reported during 
the year, only four of them requiring special investigations by this 

On June Iftth, following instructions from the Department, an in- 
resfig.itioTi was made at Ludlow on account of an epidemic of scarlet 
fever in that borough. I found four houses placarded and the (jnar- 
antine repiila tion.i strictly enforced. Xo further investigations were 
necessary and the outbreak was soon under control. 

In November a case of scarlet fever was reported as existing on a 
dairy farm in Wetmore Township. A careful Inspection was made 
of tho premises and as no satisfactory arrangement could he made 
for the handling of milk its sale was discontinued until after the 
premises were disinfected. 

One dairy farm was inspected on account of the existence of 
diphtheria. As all work connected with handling of the milk wa» 
done in a dairy house separate from the residence it was allowed to be 
continued by persons living outside the dwelling. 

During October an outbreak of whooping cough was reported in 
the Marshhurg School. As all the pupils were found to have the 
disease the school was closed for several weeks and disinfection or- 
dered before reopening, 

RtntiFtiml Summnry o( Work Done During the TpHr. 

Formo 3fl r<"»li'wl, lOS Dniry rnrms Inrip*rtpd J 

rorms 37 rcMvod 226 Cnifn PTmninnl uVegti to b*: 

Scho-.l(i rloarf 2 Vnrmin S 

DiphthPrin 1 

ScnrM fi-ver \ 




Dr. P. P. Fisher, C. M. I. I submit to you the following report 
lor 1914. There were reported to me by the thirteen Healtli Officers 
on Form 36, one hundred and aixty-seven contagious and infectioos 

Typhoid Fever: — There were thirty cases of typhoid fever reported. 
Fourteen of them were in close proximity to Grove City and followed 
the epidemic there in the fall of 1913 and the early winter of 1914; 
the other sixteen cases were scattered throughout the country, very 
few of them along the Sbenango River. It was necessary to stop the 
sale of milk products from four farms. One was shipping his milk 
to Youngstown, Ohio, the others were selling their milk to the various 
towns in close proximity to their homes. 

Diphtheria: — Thirty-four cases were reported. In four families 
milk and milk products were sold. They W£re ordered to discontinue 
selling until the quarantine period was over and the house disin- 
fected. They were all very willing to comply with the request 

January 3d, Dr. G, of Clarks Mills telephoned me that he was called 
to see a child in Fairview Township. The child did not appear to 
be very sick at the time and no throat trouble could be seen. The 
Doctor told the parents if tbe child did not seem all right to telephone 
him the next day. He heard nothing from them the next day, but 
the day following a hurried call came that the child was dying. When 
the doctor reached (he home the child was dead. The doctor thought 
from the f^ymptoms he got from the parents it was diphtheria, there- 
fore, he wished me to come and make an investigation. I did so and 
performed a post-mortem. I found the throat entirely filled with 
a diphtheritic membrane. Tliere were several children in the family ; 
I ordei-ed anitoxin used on all the contacts, also a private funeral 
and di^nfection of the house. There were no more oases in the family 
or neighborhood. 

Scarlet Fever: — There were twenty cases reported. Five caae^ 
were in one family iu Delaware Township. They had called no 
doctor and a neighbor telephoned me that be thought there was 
scarlet fever in the family and asked me to come and see what the 
trouble was, I made an insiiection and found five cases, most of 
them were in the stage of desquamation. I had the house placarded 
and all the other necessary precautions taken, A few daya laier 
I learned from reliable sources that they were breaking quarantine, 
I made an investigation and found that they were going and coming 
just aa they pleased; even would go to the store after I told them 
it would be necessary to post a guard if they persisted in going out. 



Th^ promised to observe the quarantine. After that I had no fur- 
ther complaints. It was necessar; to stop the sale of milk from one 
farm until the quarantine peiiod was over and the bouse disinfected. 

Smallpox: — I was called to diagnose a case of smallpox in Parrell, 
the attending doctor being in donbt about the case. I fonnd a well 
marked case in a colored child. We had the child removed to the 
pest house and the contacts vaccinated and all other precaations 
taken. There were no other cases developed from this one. I am 
satisfied, from the history I got that the infection in this case came 
from Virginia. 

In November, Doctor B. of Jamestown, telephoned me to come up 
and make a diagnosis in some cases that he bad been called to see 
and which he thought resembled smallpox. I made an inspection 
and found that for a month or so they had been having a diseaKe 
Thicb the 'patients thought was grippe, with a little eruption, and 
bnt a few of them had called a doctor. I made an inspection and 
found there had been a good many cases, perhaps twenty or more and 
many contacts. I did not care to assume the whole responsibility 
so I wrote the Department and Doctor Hunt came on and I went over 
the cases with him, and we were of the opinion that it was smallpox. 
Doctor Hunt remained a few days to see that the proper precautions 
were taken. It was confined to Jamestown. I visited the schoolfi 
in close proximity to Jamestown to see if the pupils had been vac- 
cinated. I also saw members of the school board and they agreed 
to enforce the vaccination law. Dec. 21st., Dr. E, of Sharon asked 
me to see a case and make a diagnosis, as be was in doubt what it 
was. I made the inspection and found a well marked case of small- 
pox. I had all the contacts vaccinated and all the precautions taken. 
No other cases developed from this case. 

In the evening of Dec. 11th, Dr. H. of Mercer, telephoned me to 
see and diagnose a case in JefTerson Township. I saw the case the 
following forenoon. It was a well developed case of smallpox. The 
patient had came fom an Ohio town, reaching Sharon on the trolley 
from Youngstown; he ate dinner with a family in Bharon and went 
to Greenville in th^ afternoon on the steam cars, going to a sister's 
where he remained until the next morning; from there he rode to 
Predonia on the Bessemer B. R. and was in a sister's house there in 
the afternoon, and then went to his home in Jefferson TownBhip. 
I had the contacts in Rharon vaccinated and then went to Green- 
ville where his sister lived in a double house. There were flftero 
contacts there. I vaccinated all of them and then went to Fredonia 
and vaccinated the eleven contacts at his home. No othw caws 
developed from this case. 

Cerebrospinal Meninf/ith: — One case reported. The only action 
necessary was to stop the sale of milk from the premises. 



Erysipelas: — One case reported. No action necessary on tbe part 
of the C. M. I. 

Whooping cough. Chicken pom, Measles, and. Mumps: — Nearly 
eighty of the above diseases were reported, respectively aa follows: 
Thir^ (30), Ten (10), Twenty-five (25), and Twelve (12). There 
was no trouble in having the Department regulations carried out in 
these cases. The people are coining to realize the necessi^ of taking 
the proper precautions in these diseases. 

Statistical Summarr of Work Performed During Tear 1914. 

1 received, 31 

Dairy famiB inspected tor: Examined caiea alleged to be: 

-Trphoid fever, i Diphtheria 

Diphtheria, i Scarlet fever, 

Cerebrospinej meDinglds, 1 Chicken poi, 

W hooping c 
gmiillpoi, . 

Sale of milk Btopped on nine premiat 
Twenty Health Officers instructed e 


Dr. C. H. Brisbin C. M. I. During the year 1914 one hundred and 
seventy-nine cases of reportable diseases were recorded at tbia otBce 
for Mifflin County, reported by the five health officers. 

Seventeen inspections were made by me of infected premises where 
milk products were sold: Typhoid fever, two; diphtheria, seven; 
scarlet fever, five; measles, two; and smallpox, one. 

Typhoid Fever: — April 16th I inspected the home of J. M., Wayne 
township, and discontinued the sale of milk. 

December 12th I inspected the bome of F, A., Derry township, and 
discontinned the sale of milk. 

Diphthera: — ^March 1st I visited the home of H, K., Decatur town- 
ship, where a case of diphtheria was reported by neighbor. The 
diagnosis was not confirmed. 

May 20tb I inspected the home of 6. K., Decatur township. I 
arranged to have milking done by Mr. K, who left the infected 

August 17th I inspected the home of 8. 8., Brown township, and 
then arranged to have the milking done by a neighbor. 

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August 27th I inspected the home of J. B., Decatar township, 
where a child bad been sick for several days without a doctor. I 
made a diagnosis of diphtheria and ordered quaraDtine. 

September 6th I called on school directors of Decatur township 
to arrange for a famigation of the school where diphtheria had been 

September 23rd I inspected home of 8. H., Union township. Ar- 
rangements were made to have his stock transferred. 

October 15th 1 inspected the home of 8. R., Brown township. The 
sale of milk was discontinued. 

Oct. 25th on receipt of a telephone message from Dr. Frontz, County 
Medical Inspector, Huntingdon Colinty, reporting diphtheria in 
Wayne township, I visited this township and found three cases. 
Quarantine regulations were established. 

Nov. 20th I inspected the home of B. P., Armagh township, and 
discontinued the sale of milk. 

Scarlet Fever: — Jan. 20th I received a telephone report of a sup- 
posed case of scarlet fever at the home of I, A., Decatur township. 
The diagnosis was not confirmed. 

Jan. aOth I received a report by telephone of a supposed case of 
scarlet (ever at the home of E. S., Decatur township. I could not 
confirm the diagnosis. 

Feb. 1th I inspected the home of W. 8., Granville township. The 
sale of milk was discontinued. 

April I3th I received a note from a teacher that the child of E. 
M., Derry township, had been sent home from school with some kind 
of a rash, I inspected the home and diagnosed scarlet fever. Quar- 
antine was establisheil and the school room fumigated. 

May 12th I inspected home of H. M., Brown township. The stock 
was trasf erred. 

Measles: — .Ian. 7th I was notified by a P. R. R. Surgeon that a 
case of measles existwl in a family at Lewisfown Junction, Oian- 
vltle township. I made an investigation at this home, and found t-xo 
cases, and ordered iiuarantiue. 

Smallpox: — Feb. 6th 1 was called to Lewistown lock-up with Dr. 
Willison to see a case of suspected smallpox. Ordered the man taken 
to the Almshouse and had the lock-up fumigated. I requested Dr. 
Hunt, Associate Chief Medical Insjtector. to see the case with na. 
which he did, but could not confirm the diagnosis. 

On May lllh I receive<l telephone rejiort from Dr. Mahr, Newton 
Hamilton, Wayne township, of a case .suspected to be smallpox. 
Visited the case with the doctor and confirmed liis diagnosis. I estab- 
lished quarantine and vaccinated twenty contacts. 

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StatdstiCBl Summary of Work Doae Durius the Year. 

Forma 36 received, 171 Cases einmined alleged to 

Forms 37 received, 164 Typhoid fever 


Scarlet fever 


Chicken pox 

Whooping cough 




Dr. Walter L. Angle, C. M. I. During the year 1914 one hundred 
and thirty-two cases of communicable diseases were recorded by me, 
returned liy three district Health Ofilcers, fourteen townships being 
represented. No reports were received from two townships. Seven 
medical inspections were made during the year, two being made by 

Typhoid Fever: — Five cases were reported during the year, all 
being sporadic cases. No inspections were asked for or required. 

Diphtheria: — Thirteen cases were reported, ten of them occurring 
in Tunkhannock Township. Difficulty was encountered in having 
the occupants of the house under quarantine obey quarantine in this 
township. After repeated warnings the occupants agreed to obey 
quarantine. I was unable to procure guards and the closing of the 
schools in the township was met with opposition by many of the 
people of the town^ip. This was the only epidemic of diphtheria 
during the year. From the physician in attendance npon all the 
cases I learned that many cases existed prior to his first visit There 
being no physician in attendance the cases were not reported. This 
ofBce was called upon to inspect but one case during this year. -Dr. 
G. S. T. of East Stroudsburg requested me to confirm his diagnosis 
of a case on the premises of H. Y. in Middle Smithfield Township. 
The other two cases reported occurred in separate townships. 

Scarlet Fever: — Five cases were reported during the year, four 
being reported from one township. Quarantine in these cases was 
strictly observed. 

Measles: — Eighty-four cases were reported during the year. It 
was necessary to make sir inspections, reports being received that 
the disease existed and not under quarantine. The disease was found 
to exist on the premises of all the cases reported. Owing to my 
- being quite remote from the premises, two inspections were made by 
Br. G. McKay and Dr. Rodgers in Barret Townahip, three eaaea bei^g 


reported by them. I made iDspectioos id eight cases. The disease 
was rather widely scattered although the majority of the cases were 
reported from three townships. 

Chicken pox: — Five cases were reported during the year from four 
townships. No investigations were necessary. 

Whooping Cough: — Ten cases were reported during the year from 
four townships. 

Erysipelas: — Two cases were reported during the year from sep- 
arate townships. 

Mumps: — Three cases were reported during the year from separate 
townships. No investigation was necessary. 

Tuberoulosis: — Six cases were reported during the year. Where 
known to have existed the premises are always thoroughly disin- 
fected. The county seems to be particularly free from tnherculosis. 
The disease unfortunately is not reported in many instances. 

Other than measles and diphtheria this county was strikingly free 
from contagious diseases during the year. During the coarse of the 
year it was necessary for me to travel sixty-sii miles to make the 
required inspections. 


Dr. H. H. Whitcomb, C M. I. I beg leave to present a summary of 
health conditions in Montgomery County during the year 1914, just 

About all the nsual contagious diseases to be reported bave pre- 
vailed in the County during this year, mostly in a mild form, so mild 
usually as to escape the attention of physicians, they not being called 
upon to treat them. This is especially tme of scarlet fever, when 
the rash was so slight and of so brief duration as not to be observed, 
and only recognized when some member of a family was more indis- 
posed and a physician called. This, of coarse, caused a rather vide 
spread of this disease in some communities. We investigated a num- 
ber of such outbreaks and in all cases when the history was clear, 
quarantined the premises. We did not find any case where the 
physician avoided his responsibility intentionally. Scarlet fever and 
German measles seem to have been the most difficult for oar people 
to recognise, and with a few exceptions the children were bo slightly 
ill it was difficult to enforce any quarantine until threats were made 
to shut up the hoQse in absolute qoarantine, which was done In ■ 


I investigated outbreaks of scarlet fever at Jeffersonville ; German 
measles at Perkiomen; tTphoid fever in Skippack; chicken pox In 
WMtemarsh; and saw suspected cases of smallpox in Hatboro which 
was really chicken pox. I deputized Dr. Jamison to see a suspected 
case of smallpox at Willow Grove; he reported chicken pox. Dr. 
Benner was deputized to see German measles in Perkiomenville, but 
he and the Health Officer were refused admission in one house. I 
then went there myself and was pleasantly received, so that a suit 
was not necessary for resisting an offlcer. 

I investigated the sale of milk where there was diphtheria in ten 
dairies, and stopped the sale or transferred the handling of it in each 

Examined and confirmed diagnoses in ten cases of scarlet fever, 
and stopped the sale of milk in three dairies where there was scarlet 
fever. In one case reported as scarlet fever by the physician in 
charge, on dairy farm and boarding house of Mr. Lambert, in Lower 
Providence township, I went personally to see that the milk was 
properly cared for, only to find that the mck child had been removed 
to Philadelphia before the Health Officer had quarantined premises. 
I quarantined the place by absolute quarantine of thoBe remaining, 
stopped the sale of milk, and by telephone notified Dr. Cairns of 
Philadelphia, the place to which the child had been removed. Dr. 
Cairns notified me next day that this child did not have scarlet fever. 
Quarantine was immediately raised to the relief of every one con- 

I investigated an outbreak of chicken pox in Whitemarsh and had 
the places placarded. 

On request of Dr. CainiB of Philadelphia, by direction of the 
Chief Medical Inspector, I investigated cases of scarlet fever supposed 
to be in Montgomery County, but fonnd to be in Philadelphia and 
under jurisdiction of Dr. Cairns. I also investigated in Springfield 
township (first class) the presence of diphtheria, where quarantine 
was not properly maintained and fumigation very imperfectly done. 
The local Board was notified of its laxness. 

In all, I stopped sale of milk or transferred its care on account 
of diphtheria, scarlet fever, or typhoid fever, in thirty-two dairies. 

I'ennsburg borough was reported for laxness in placarding and 
fumigation for chicken pox and mnmpe. The Chief Medical Inspector 
instructed me to investigate, which I did and found that practically 
no attention was being paid to these diseases. I so reported to the De^ 
partment and instructed the local Health Board as to its duty and the 
consequences that would follow disobedience of the law and neglect 
of its enforcement 

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I was called upon to vaccinate a man who had been a contact case 
with smallpox in Philadelphia but escaped to Montgomery County. 
I found that he had been vaccinated the day before by a competent 

My observation has been during this year that in diphtheria in this 
County, either the type has been more severe, the use of antitoxin 
too long delayed or too Bmall doses, or for some other reasons the 
percentage of mortality has been much higher than in previous yeara 

The saddest story concerning illness in Montgomery County for 
the year 1!)14 is told in considerable detail among the special reports 
of the Medical Division and deals with the extensive millc-bome 
epidemic of typhoid fever at Skippackville and in Cedars, Worcester 
township, and along the Bkippack pilie. Altogether ninety-one 
persons were infected in this community directly by milk coining 
from a single farm or by taking food or drink of this farm. In addi- 
tion there resulted four secondary cases in houses in which the disease 
developed, three secondary cases which occurred several months later, 
persons infected from oue of the original cases who became a "carrier'* 
and the illness of several patients whose infection came about throu^ 
a pollution of water from the premises where a considerable family 
outbreak developed. A total of one hundred and eight patients liins 
suffered from the disease and twelve individuals lost their lives from 
the attack. 

StatiBticul Summary of tie Work of the Tear. 

Form 34 reraised, 40 Cases examined alleged to be: 

Form 36 received 742 Smallpoi, 1 

" " ■ ■ — "■ hthei' 

received, 588 Diphthe . 

Scarlet fever, 

All diagnoses confirmed except the case of smallpox, which was 
chicken pox. 


Dr. Cameron Shultz, C, M. I. Whooping cough, having been preva- 
lent to the extent of epidemic during the early months of the year in 
Mahoning and Cooper Townships, continued to give the Health Of- 
ficers no little annoyance as but a vei'j' few facilies employed a phy- 
sician, and the pareuts in mo.«t casea protested saying it was simply 
« cold. This condition kept up pretty well during the summer with- 
out much spreading to adjacent districts. . . , 

I LnOOt^lC 


Chicken pox: — On April 3d two cases of suppoeed chicken pox 
were reported in a family in Cooper Townahip, no physician in atten- 
dance. I investigated these cases and confirmed the diagnosis. 

December 19th, chicken pox was again reported in a family in 
Mahoning Township, without a physician. Upon investigation the 
diagnosis was established, and as a number of children in the im- 
mediate neighborhood had been in attendance at school with the 
disease in evidence, the Mechanicsville School was ordered closed and 

Measles: — December 22d, Health Officer Patton forwarded Form 
34, reporting the existing of measles in Mahoning Township, no 
physician. I visited the home and confirnied the diagnosis. While 
in the neighborhood I learned of a number of suspects near by. I 
visited these homes and found measles at each place. The honses 
were placarded und the Mechanicsville School again fumigated. 
During the remainder of the month a number of inspections were 
made for measles in this district. 

Diphtheria:— Ou December 3d, H. O. Kobbins reported diphtheria 
in the family of William R., Liberty Township, who sold butter in 
Milton. I visited the premises, and upon the householdfr's sugges- 
tion discontinued the sale of butter or milk during the period of 

December 26th, I was notified of the existence of diphtheria in the 
family of Charles L., Anthony Township, a dairy farmer who sold 
butter to a huckster. I visited the premises and arranged for the 
discontinuance of the sale of butter until quarantine was raised. 

Typhoid fevCT'.'— October 16th, upon the report of the existence 
of typhoid fever in the home of Lloyd M., Anthony Township, who sold 
butter, I visited the home. The case of typhoid fever had been 
brought in from an adjoining county, the young lady being employed 
in Muncy. As the family could not make satisfactory arrangements 
the sale of butt«- was stopped. 

Statistical Summary of Work Done Duricg the Nine Months. 

Forms 36 received, 93 Cnaps exnmined allcgMi to be: 

Farma 37 received, 61 Chicken poi, S 

Menales U 

Dairy farms inspected for; German meaale 1 

Diphtheria, 2 

Typhoid fever 1 

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Dr. Edgar M. Green, C. M. I. During the year 1914, health condi- 
tions in Northampton County were even better than in the year 1913. 

One hundred and fifty -eight cases of measles were reported to the 
County Medical Inspector and this is by far the largest number 
of any infectious diseases reported. Other cases were as follows: 

Typhoid fever, 28 Dipbtheria, S2 

Whooping cough, 55 Mumps, 21 

Chirken poj 20 Smrlet fevor, 14 

Smallpox, 1 EryHipelas 10 

Pneumonia 1 Cerebrospinal menitiEitis, 1 

TubermilosiB, 8 

There were no formal inspections needed and I am glad to report 
that the Health Officere attended to their work well throughout the 

One case of small pox was reported from Lower Saucon Township. 
Although this case occurred in a boarding house and was brought 
from Philadelphia, strict quarautiQe regulations prevented any fur- 
ther outbreak and no secondary cases occurred. 

I am glad to report that the boroughs throughout the County are 
observing State regulations with regard to quarantine and disin- 
fection much more thoron^ty than heretofore. 


Dr. K. H. Simmons, C. M. I. I beg to submit the following sum- 
mary of work done in this county during the year 1914. 

Of the thirty-five reportable diseases only seven required special 
investigations from this office. Two hundred and eighty-two cases of 
communicable diseases were reported as follows: 

MesHlps, 88 Wbonping cough W 

Diphtheria, 3i Chicken poj 9 

Tjphoid fever, 25 Senrlet fever, 7S 

Smallpox 1 Tuberculoaia, B7 

Mumps 19 

Typhoid Fever:— Foot dairy farms were inspected^ all in Point 
Township, on account of the existence of typhoid fever, one on March 
IBtb, three during October. Samples of the water supplies on the 
last three farms were sent to the Laboratory for analysis. On Nov- 
ember ^rd I investigated a family outbreak in Upper Angaita 


township. The father developed typhoid and died, and sabsequently 
three of the children sickened with the diseasa These were prob- 
ably secondary cases due to carelessness of the mother. The water 
supply, however, which supplied five families in th£ vicinity was 
examined at the Laboratory, 

Scarlet Fever: — Seventy-three cases were reported from twelve 
townships, twenty-one of these occuring in Mt. Carmel township. 
Four dairy farms were inspected o