(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The rise and fall of disease in Illinois"

/ 




L 1 B RA R,Y 

OF THE 

UNIVERSITY 

or ILLINOIS 






?. 



llUMfllS IWSTORJCAl'SURm 



\' S "-i!;. 




ILLINOIS HISTORICAL SURVEY 



The Rise and Fall 
of Disease 



in 



Illinois 



IN TWO PARTS 



Printed b) authorily of the Slate of lllinoii 



LIBRARY 

UWIVERSiiy OF ILLINOIS 

UREANA 



The Rise and Fall 



of 

Disease in Illinois 

by 

ISAAC D. KAWLINGS, M. S., M. D. 

in collaboration with 

WILLIAM A. EVANS. M. D., D. P. H.. 
GOTTFRIED KOEHLER. M. D.. and 
BAXTER K. RICHARDSON. A. B. 



PUBLISHED BY 

THE STATE DEPARTMENT OF PUBLIC HEALTH 

IN COMMEMORATION OF ITS FIFTIETH ANNIVERSARY 

1927 



ILLISTRATEU WITH GRAPHS DEVELOPED AND DRAWN 

BY A. F. DAPPERT. AND WITH PICTURE REPRODUCTIONS 

OF MANY PERSONS ASSOCIATED IN ONE WAY 

OR ANOTHER WITH THE STORY. 



INDEXED Br CLARA BREEN 



IN TWO PARTS 



^isJS g ipaa- 



ScHNEPP & Barnes, Printers 
Springfield, III. 






PREFACE. 

rrcifound changes have taken place during the last one hundred years 
in all departments of civilization but in none has the transformation been 
mure fundamental nor more nobly crowned with advantage than in the field 
of health. At the beginning of this period man was little short of a helpless 
victim to infectious diseases that frequently swept over whole cities and 
nations in great lethal waves. Today he is able to exercise a marvelous con- 
trol liver the factors involved in health, adding strength to his years and 
years to his life. 

The need for genuine jirogress in the conquest against disease was 
essential to the healthy contiiuiity of human life amid the growing complexity 
of modern existence. Swifter means of communication have brought all 
men closer together for good or for evil. Disease respects neither wealth 
nor social rank, becoming a universal hazard when the human carrier of 
infection mav he thrust across a continent between the rising and setting of 
the sun. When automotive ])ower unites a nation into one great social and 
commercial commingling, obliterating political boundary lines and increas- 
ing enormously the range of individual contact between fellow beings, there 
can be no compromise with comnumicable disease. When days have been 
reduced to hours and hours to minutes in measuring the travel distance be- 
tween points man has no choice but to conquer or succumb to the agents of 
epidemic infections. That he has subdued one after another of these ancient 
enemies is a signal manifestation of man's superiority over all living things 
and a splendid evidence that humanity is sweeping onward toward that great 
millenium which has lived in the aspirations of men since the beginning of 
time. 

The story of how man has triumphed over disease in Illinois ought there- 

~~'" fore to be of common interest to every person in the State. Life is as dear 
..to the beggar on the street as il is to the lord in the mansion, b'actors that 

?"; tend to preserve or destroy- health in the one operate toward like ends in the 
' other. Both may rejoice in the advancements of medical and sanitary science 

J^^ which have made possible the remarkable improvement in health conditions 

that are described in this volume. Both have inherited a score of \ears from 

1 the wisdom that led sanitarians and doctors to apply their knowledge for 

.^-tke public good. 

1 hat the State created, dexelujied and maintains an official agency 
charged with the duty and responsibility of participating in a moxeiuent so 
pregnant with jiossibilities for individual and public benefit ought to stim- 
ulate jjride and confidence in the character ol our government. 

•■^:) 



It is the dut\' nf Stale officers in rt-cord the ini]Hii-tant features of the 
public health inovenieiit as has been (Imie in tliis vdiunie. It is the ])rivilege 
of inchviduals to read and study these records, iioth processes will prove 
helpful in guiding future activities to even greater triumphs than the ])ast has 
witnessed over the enemies of human health. 

Lex Sm.\ll. 



FOREWORD. 

The title of this vohiiiie expresses a very gratifying actuaHty with 
greater approximation to the whole truth than might he surmised at first 
tihish. It may not be universally known that since the coming of white men 
into Illinois a considerable number of diseases have been kindled, flamed into 
constiming plagues and were then extinguished altogether or have left only 
the dying embers of what may soon be transformed into the ashes of history. 
Cholera, malaria, smallpox, yellow fever, typhoid fever, dysentery and per- 
haps diphtheria may be included in that group. Tuberculosis, the diarrheal 
infections and scarlet fever were once far more deadly and widespread than 
they are now. 

These and other diseases were not introdticed into Illinois in keeping 
with some predestined program prescribed by fate to pursue the particular 
group of people who elected to make the prairies their home. On the con- 
trary they came when conditions created by man himself invited, and they 
began to disappear when conditions created by man began to be intolerable 
for them. Most of the conditions which invited disease were in that respect 
created unconsciouslv. Xearl\- all of the factors which have influenced the 
waning strength of infections were consciously and deliberately employed to 
improve health conditions. 

Thus we have two very definite periods in the health history of Illinois. 
One embraces the time when communicable diseases played havoc with the 
public, finding nothing to check them in their gruesome business but the 
natural limitations of time, space and susceptible material. The other in- 
cludes the years since the public first began to employ scientific metlmds of 
prevention which h;ive played havoc with disease. 

.Accordingly \.h\> volume is divided into two parts. The first relates ihe 
story of health conditions from the very earliest times, so far as records per- 
mit, down to 187 T when the State began its attack ujion disease with the 
organization of the State Board of Health. The second relates to the fifty 
year period between 18TT and 1927, during which time a strong pulilic health 
service developed with telling results. 

There was no purpose to make this an exhaustive accoimt of all the 
factors involved in the field of health improvement. Such an ambitious un- 
dertaking would lead into the paths of medicine, bacteriology, chemistry, 
agriculture, economics, engineering, etc. .\n effort has been made to trace 
the history of communicable diseases in broad outline and to describe the 
origin and develo])nient of organizations devoted entirely or in some sig- 
nificant and direct way to the promotion of ])ublic health. Il is believed 

CM 



10 KOKI!\VORI) 

that some reference may be found in this vcjUiiiu- to all important events bear- 
inji upon the subject t)f ])ublic liealth in ihc State, thus bringing together in 
one ])lacL' many valuabU- recnrds that were widely scattered before. 

It was the original plan tn include cha|)tcrs relating to the organization 
and develo])ment of municipal lioards and departments of hc'alth in the State. 
This scheme was abandoned at the last moment, after account had been 
written (if e\ents in sexeral cities and muiu' had been put into t\pr. hicause 
cif limited time and s|iace. The hojie tmw is that another vohnne will fol- 
low thi> one. pro\iding s]iace {(U' a fuller story about local public health 
work than this \dhtme could ever have accommodated. 

Aside from the collaborating authors much credit for liringing this ma- 
terial together is due to Miss Clara Breen, wdiose untiring efforts in searching 
records, collecting photographs and cross checking source liiaterial and to 
Miss Elin Berg whose services in classifying the source material and man- 
aging the stenographic work have made the task easier. Credit is also due 
to the chiefs of the various divisions of the State Department of Public 
llcalth who furnished the records embraced in the account of the divisions 
and to 1 )r. Carl lUack of Jacksonville who very generously supjjlied the jjlates 
of several photographs that would otherwise have been difficult to secure. 

The Editor. 



CONTENTS. 

Pakt One. 

PAGE 

Preface by Governor Small 7 

Foreword U 

Introduction 13 

General 1 lealth History Prior to 18" 15 

The Indian 15 

The French Regime '■^2 

The British Regime 2G 

The Spanish Influence 27 

The American Regime 27 

History of Certain Diseases Prior to 187^ 35 

Cholera. 43 ; Consum|.)tion, (iO ; Cynanche, 55 ; Diarrhoea and Dy- 
sentery, 83 ; Diphtheria. 55 ; Erysipelas, 50 ; Gonorrhea, (in ; 
Malaria. 35; Measles, 54; Meningitis, 5() ; Milk Sickness, >U'< ; 
Nursing Sore Mouth, (iiJ ; Ophthalmia-Epidemic, 57 ; Pneumonia 
and Influenza, 62 ; Puerperal Fever, 65 ; Scarlet Fever, 53 ; 
SmalljKix. 49 ; Snake P)ite, 47 ; Syphilis, 58 ; Tuberculosis. 60 ; 
Tyjihoid I'^ever, (ill ; Typhus Fever, 47 ; Yellow Fever, 46. 

Infant Mortality SG 

Deaths of L'hildren Lender Five 88 

Seasonal Distriliuti(in nf Disease 8i) 

\"ital Statistics and Mortality from All Causes !)(i 

Health in ."some Cities Prior to 1877 101 

Chicago 101 

Springfield 115 

Kaskaskia 1 1 (; 

Shawneetown 11 S 

X'andalia 118 

(11) 



12 con'thnts 

Part Two. 

i'ac;e 
Public llt-alth Admiiiistraiidii 127 

Genesis (if Public 1 U'alili 1 .:i\v 127 

l^evel(i])iuciit cif Stale 1 IcaUli Service i;i;? 

Stall' Health Machinerv l;ii; 

Rauch Regime 1 'Mi 

Mgau Regime 1 .")!) 

1 )rake Keniiue 1 ; 4 

Rawlini;^ Regime I'.ii 

lutra-De|)artnieutal < )r,i,fauizati(in 208 

luifnrcenient of Medical Practice Act 2T3 

Auxiliary 1 lealth At^encies 2S7 

Mealth C'onditious After is:: 304 

Cerebrospinal Fever. ;5:(); Cholera. 3'2() : Diarrhoea! Diseases, 3TT ; 
Pneumonia. 3S: ; Polionivelitis, 380 ;' Scarlet Fever, 348; Small- 
])ox, 3o: ; Tuberculosis. 3(il; Typhoid Fever, 338; Whooping 
(.out^h. 3!M); \'ello\v Fever. 3-^: ; Infant Mortality. 393. 
Sitniniar\ and Conclusion 39G 



INTRODUCTION. 

Acccirding to traditimi the first dcciqiants of the llliiKiis terrii(ii\- were 
the mound builders. 

They were followed by the Indians. W hence they came to the Illinois 
territor)- is a matter of surmise. 

The rather acccjited opinion is that the first Indian occupants of the 
territory came from tiie west. Tribes generally accepted as being of west- 
ern origin occu])ie(l tjie region at the time when the jiressure of white men 
in the countr\- to the westward caused a migration liringing some more east- 
erly trilies of Indians into conflict with the tribes of western origin. 

At the time white men began coming into the territory the conflict be- 
tween the eastern and western tribes had not ended. To the south of Illi- 
nois there lay a great lumting grovnid which served as a barrier against the 
southern Indians. From Pickett's History of .Alabama we learn that one 
tribe migrated from Mexico north-eastward to the Illinois territory but they 
did not remain long. Thev soon moved southward across Kentucky and 
Tennessee, to come to rest in .\labama, and tiie\' never ventured north again. 

If the Indians of the south had malaria and (jther fevers the\' had little 
oii])ortunit\- to spread them in Illinois. If there was anv transmission of 
disease from one Indian tril)e to another such transfer was from east to 
west or west to east. 

The first French and French-Canadians came into the territory in llwO. 
From KiTO to ITCi^l. practicalK- one hundred vears, the so-called French 
period, the territory was occupied liy Indians and French and lialf breeds 
in varying proportions. 

The first French invaders were trapjiers. These were soon followed 
by missionaries. Next came the traders and tinally the settlers. There was 
a moderate amount of inter-inarriage between the French and the Indians. 
Abj..i of tlic half ])reeds, many of whom remained in the territory after the 
Indian> left, were thi' results of French and Indian unions. 

Tlu- sources of information as to heaUh concHtions in tlie French period 
;ire few. I'he missionaries wrote voluminous reports, but thev dealt with 
such subjects as religion, the geography of the countries, the routes of travel, 
the .'iltitudc of the Indians with almost no reference to healtli. 'Ihe trap- 
pers did not write at all. .V few of the traders wrote but they gave scant 
space to health. 

In ITG:! the l-'rench ceded the territory' to the ilritish who relaiued sonic 
control until Claik wrested it from them just prior to \]S{). in the British 
period of less than seventeen years, the governing nation (bd lillle more than 
occupy the garrisoned forls with a few troops and piomote intrigue wilh 

(13) 



14 IXTKODI'CTIOX 

tlu- liiiliaiis. Tlu' |)(i|iulali(Jii (luring- tlic l-lrilish in-iiiid were Indians, I'Voncli 
and niixfd hrcrds, a few American settlers and a few British settlers and 
a few inMi|i,-.. 'rin- I'.ritish did not mate with tlu- Indians as the French fre- 
<Hicntly did. 

A small Spanish expediti<in cmsscd fmm .Missnuri tu Saint josuiiii, 
Michigan. This incident was too hricf and inconsccjuential to be designated 
as a Spanish ])criod. 

In KSO. after L'lark had ca|itnre<l the llritish fort in the sonlhern end 
of the lerriiory the Americni c(jlonists began to settle the Stale especially 
the sonlhern ]iart thereof. 

The Territorial period heginniug in l'.S4, ran until the State was taken 
inlii the I 'nion in 181S. 

I'dr the purposes of this histor\- (jf the Slate as such, ihe _\ears hetween 
ISKI and r.('.'^, are divided into two ]>eriods. I^^IS to ISTT. hfty nine years, 
the perio<l of invasion and spread of disease, and 1877 — the year of the or- 
ganization of the State Board of Health to l!i"27 — fifty years— the period 
of the control of disease. 

The first srctioii of the book shows how the settlers and their descend- 
ants suffered from the hardships occasioned by disease. To combat this there 
was no state health department .ind no local health de])artment capable of 
coping with situations, except in t liicago, and then not until the decade of 
the Civil War, 

The number of physicians was not large and there were no hospitals 
outside the cities. 

During the jieriod a few diseases declined principally because the land 
was cleared and drained. Others becaiue worse liy reason of the increasing 
density of population. 

The srcniid section deals ])rincipally with the development of the State 
Department of Public Health. There are sections, however, which deal in a 
more fragmenlar\- way, with some of the extra-governmental health agencies. 

Since the State l-)oar<l of Ilealth licensed physicians and regulated the 
practice of medicine between Is7; and 1!II7, the control of medical practice 
is given some attention. 

The second jieriod. 1S77 to ]'J'i'i, is one in which disease has been grad- 
u.alK- coming under control. This is particularly true of the diseases whicli 
pre\ail especiallv in summer, of the iliarrbeas and (Jysenteries of ailults, 
the disorders of infancy and early ciiildhood and particularly of the digestive 
distiu'bances of babies, the contagious and infectious diseases and a few 
others. The programs of health ilepailiuenls fur the future contem])late control 
of man\' disorders now not under control, or even under lire, as well as the 
promotion of bodily growth and \igor. The title, "period of disease control" 
does not exaclK lit the facts but the discrejjancies are not of major importance. 



GENERAL HEALTH HISTORY PRIOR TO 1877. 
The Mound Builders. 

1'he mound builders whoever they may have been were in Illinois before 
the Indians. The State abounds in mounds. Even in that day there seemed 
to have been some separateness between the inhabitants of the north end of 
the State and those of the south end, between whom there lay the neutral 
largely unoccupied prairie belt. The mounds (if the north are of a ditt'erent 
type of construction and had a ditTerent ])urpose. While there are some 
exceptions the rule is that the mounds of the north end of the State were 
ceremonial structures not used for burying or for utilitarian purposes, while 
most of those of the south end of the State were used for the latter purposes. 

There is no proof that the moimd builders passed on any diseases to the 
Indians or contributed m any way to the health history of Illinois. However. 
Zeuch' suggests that the mound builders were wiped out by pestilence. If 
so. the disease seems to have destroyed itself in destroving its host. .-\n 
allusion to syphilis and the mound liuilders will lie found in the section de- 
voted to syphilis. 

The Indians. 

The opinion of the times is that the Indians came from .Asia arri\ing 
on the northwest coast and gradually spreading southward and eastward. 
In their slow march across latitudes and longitudes, across climates and up 
and down elevations they acquired habits and customs, religious observances 
and diseases, disorders, health and ill health, strength and weaknesses that 
were more or less peculiar to them. 

The Indians remained in Illinois for a centm-y and a half after the 
white man invaded the .^tate. They had their own villages and the\- did not 
often remain long in the white man's towns. The rule was that these \illages 
were moved with great frequency though for manv \ears there might lie a 
village at a given location at some time during a part of each \ear. .Sfldom 
did a village remain constantly in one location. 

.S(ime white men lived among the Indians as captives and some as s{|uaw 
men. They were responsible for large numbers of half breeds. The 
captives and S(|ua\\ men frequentl\- returned to live with the white men. but 

' Zeucli (lli.'^t.iry of .M.-di.-al Practice in llHnoi.s, vol. 1, I'.iL'T. T.ucius H. Zeuch). 
(15) 



IC) (Jli.NEK.M. lli;.\I.ril 11IST0R\' TRIOR TO \S',', 

tlu-ir Indian \vi\-c's and thi'ir mixed hrct-d projjenv did not ahvaj's follow 
them in this mnvc. W'lu'n the Indians mo\'c'(l dul nf the State thev tucik with 
them most of these half hreeds. 

Dnring the more than one hnndred years of ccmtaei in the district nn- 
questionahly the Indian in some measure modified the health of the white 
man and the white man modified that of the Indian hut the influence was 
sur]irisinsjly small. 

The Indian constitution was the result of many influences. Because of 
his lack of thrift, foresight and energy he was subjected to periodic lean 
years. In consequence of liis life lie had a cajiacity for great and sustained 
effort and an abilit_\' to withstand hunger. He had a fine stature on the 
average and great physical vigor. To those diseases which threatened him 
in the wild state he had a fine resistance and yet he was short lived. He died 
at an average early age and there were few children in the average Indian 
family. It is not easy to understand why so fine a constitution went hand 
in h.ind with a short life span and small families with children spaced far 
■d]>:in. History would indicate that wars and famines furnished the expla- 
nalion. 

The historv of Indian medicine contributes little to the answer. To 
l)e.i,'in with the Indians had n<i literature, medical or other. They had a very 
elaborate medical machinery, but it was largely religious and ])olitical and 
it was medical in little more than name. Thuugh medical in name, it was 
magic in fact, l^ven that part called medical was princi|jally magic. 

l>e\ond a slight knowdedge of medical plants and medicinal waters the 
Indian medicine men had no medical knnwledge. They knew almost no 
ianitarv science. The tribe knew enougli to move a camp when the soil 
became badly fouled but there is nothing to show that the medicine men 
knew any more about this than the others did. 

As to sanilarv science in general the Indians never knew a tithe of what 
th;' Jews did in the lime iif Moses. 

Though the\- had ikj books and no written history, they did have legends 
of outstanding occurrences. Had there been great epidemic disease waves 
among ibem some tradition of these nnist have survived. It is altogether 
possible that the scanty ])opulation, the short life and the small family were 
qualities for which war, and famines were ])rinci|ially responsible. 

This e.\j)lanation does not undermine our regard for the Indian consti- 
tulion. but the matter is of small consequence since the Indians removed 



GENERAL HEALTH HISTORY ruinu 



1S7' 



l: 




from the State leaving behind as progenitors of future citizens not very 
nianv mixed breeds and still fewer straight bloods. 

Hrdlicka- says. "The traditions of the In- 
dians, the existence among them of elaborate 
liealing rites of undoubtedly ancient origin, 
their plant lore in which curative agent's prop- 
erties are attributed to many vegetaljle suli- 
stances and the presence among them of a 
innnerous class (if professed healers, honored, 
feared, and usually well paid would seem to 
indicate that diseases were not rare, but actual 
knowledge and even tradition as to their na- 
ture are wanting. The condition of the skele- 
tal remains, the testimony of early observers 
,ind the present state of some of the tribes in 
this regard warrant the conclusion t'nat on the 
whole the Indian race was a comparatively 
healthy one. It was probably spared at least 
Some of the epidemics and diseases of the old world such as smallpox, 
rachitis, while other scotu-ges such as tulierculosis, syjihilis (pre-Columbian) 
tvphus, cholera, scarlet fever, cancer etc.. were rare if occurring at all." 

It would be difficult to ini|jrove on this statement. It was written Ijy a 
man who know, well the literature on Indian health written prior to his day 
and wild has had years of opportunity to study the jiroblem at first hand. 
It is in general accord with all references found in the literature. The state- 
ments he make■^ are a skeleton on which some further comment can be hung. 
While the majoritv of Indians lived in villages, these villages were 
changed at rather short intervals. 

Black Hawk spoke of ;i village on the Rock Ri\er which his tribe was 
occupying in 1816, saying (.)f it that it was in a good location and had an 
abundant pure water sup])ly. "Our village was healthy", he said. The point 
he was making was that they had a village there for fourteen years ; there- 
fore, they wanted to be regarded as having ownershi]) and being fixtures in 
the Rock River X'alley. But even at that the population periodically moved 
in and out of the village returning to it for some part of the time in each 
year of the fourteeiL The Illinois Indians did not have organized commun- 
ity government and town stability as it was known among such southern 
Indians as the (hickasaws and Mobilians. 

This type of Indian village or cani]i had no organized excreta dis])osal, 
the nearliy cover speedily became befouled, whereupon the Indians moved 
their camp to a clean terrain. 



■ HrcUicka (Bur 



!>luB> 



It 1. p. 



Ales HriUicka). 



li-i (;i-:nki;ai. iii-.ai.tii iiistokv tkiiik tcj |sT7 

.Mcxaiukr Ros.s-' has a diffeicnt explanation, lie .say.s, "But anolhcr 
cause and perhaps the best that can be assigned for their abandoning their 
winlcr doiniciles as soon as the warm weather sets in is the immense swarms 
of rit'as thai bri'rd in them during that season.'' 

If there was such a disease as typhoid fever in that day. there is no evi- 
dence thai the Indians had ii. The sparseness of tine population (and there 
were hut fi'w Indians) the ci'stom of frequent renioval of their villages to 
new and clean locations wimld have been sonn- protection against typhoid 
fever had theri' been such a disease. llnllick,-i writer that even toda\' t\i)hoid 
is ver\' rare among Indians. 

The Indians had [ilenly of diarrhocal troubles. .M(.)st of the writers 
sjieak of digestive difficulties probal]l\ including in the term indigestion due 
to poor food, constipation and diarrhoea and dysenter}-. Some go into more 
details. Koss wrote in ISKi as follows: "The diseases most fre(juent 
among these Indians are indigestion, fluxes, asthma, and consumption. In- 
stances of longevity are found, liut not often. Babies suckle their mothers 
until they are old enough to feed themselves (on the Indian diet). The in- 
fant is generally robust and healthy but the mother soon becomes an old 
woman." .Mexander Henry ( KiKt-Kii-l) said "The Indians were in general 
free from disorders and an instance of their being subject to dropsy, gout or 
stciie never came within ni\ knowdedge. Inilanniiations of the lungs are 
among the most prevalent disorders." 

Father i\lar(|uette died from a chronic d\senterv which had manv of 
the earmarks of amoebic dysentery. It is difficult to see how his disorder 
could have been other th,-m th.it. 

In Parkman's account of .Marcpiette's illness and death it is stated that 
on one nn'ssion he went far down the Mississippi (as far as the Arkansas) 
an<l that somewhere on that trip he contracted dysentery. He and his party 
turned northward traveling up the j\lississi]ipi ;ind Illinois. Somewdiere in 
the Chicago area he became too weak to travel. His companions left 
him in ;i cabin and went back to Canada, b'tuher Marquette lived in the 
vicinity for al)out three years after he got dysentery, becoming better and 
almost well at limes, but always relapsing. He was alile to travel consider- 
ably during this jieriod in the territory of Illinois and uji on the Wisconsin 
River and to Green Bay. I-'inally he had a relajise, Iiecame verv ill and h;id 
hemorrhages. Realizing that his end was near he started anrand the foot 
of Lake Michigan and the .Michigan shore, dying enroute. If this was a case 
of amoebic dysentery it would be diflicult to think that he did not infect some 
Indians during these )-cars of illness. 

= P.nss r.ArlvonOire.s of the Fir.st Settlers on the Oieprim or Columbia River, edited 
with historical iiitroduelion and notes by Mile Milton (.iuait'e. . . . t'hieago, R. R. Don- 
nelley & Sons Conipanv, 192.'!. Alexander Ross). 



GENERAL HEALTH HISTORY PRIOR TO 187? 19 

That the infant mortality rate among Indians was not exterminating^ is 
explained bv their custom of keeping the baby at the breast until it was well 
over one year of age and often for months or even years longer. This cus- 
tom, however, was in part rc^jjonsiljlc for their comparatively low birth rate 
and their stationary populalicm. An Indian woman bore and reared few 
children as compared with the while woman of the day. The children came 
far apart. 

It is altogether jirobable that the Indian did not have any form of ma- 
larial fever to an extreme degree. There were m()S(|uitoes but they were 
not infected. 

,\lexan<ler Henry writing of IMO-lltJf said "MMS(|uitiie^ and a minute 
species of lilack fly aljounded on this river. Sickness was unkiKiwn." In 
three places in his reports Henry refers to clouds of mosquitoes, but the 
mosquitoes ciiuld not have been infected. There is no report of malaria or 
fevers and here is the statement frt)m Henry that sickness was unknown 
coupled closelv with his report on the abundance of mosquitoes. 

The Indians lived along the streams and yet the writers do not refer to 
any disease which could be malaria. Contrast their rejiorts with ihnse of 
malaria among the colonial settlers who in later years followed the Indian 
custom of settling along the rivers and in the bottoms. It appears that even 
today the Indians are fairly immune to malaria. 

Hrdlicka says that aiiKJUg the "^'umas malaria is the must prevalent dis- 
ease. That the ( )i>atas and Tarahumares have much malaria. A. B. Hol- 
der wrote in is'.i".": "In the Indian territory and among a few trilies else- 
where malaria l)ecomes of greater importance than consumiition." 

I'lUt such reports were not made until the Indian had been long in con- 
tact with the white man. How much disease did the Indians contriliute to 
the early history of the State? To what diseases were they suliject? What 
did they pass on to the whites? let us answer the question as to a few 
diseases. 

Consitmpfioii. 

Hrdlicka says if consumption existed at all among prehistoric Indians 
it was extremely rare. It was seldom seen up to a ci'iUury ago. It is grad- 
ually becoming more common. \Mien he wrote this he was reporting on 
the Indians of the southwest ( l!H),s), but he knows the Indians elsewhere 
and their history as well as any man. He also wrote, ".\mong the uncivi- 
lized tribes pneumonia is the worst hu''g infection, but among the civilized 
tribes consumi)tion begins to rival it." 

However, Drake wrote in ISI:!, "The mosi prevalent disease of the In- 
dians is scrofula. It almost annihilated the I'eorias." V,\ scrofula he meant 



'New York Mi-dii-al Record, Any. !.■!, is;i2 



20 GKXKUAL HEALTH IlISTOUY PRIOK TO 1S7? 

liiherculosis of the glands, hmu-s and lnn,<;s. At the time he referred to, the 
I'eorias were at least ai)])r(iaehinL; the cla>s whicli ITrdlicka calls the civilized 
trilies. It is also to he rcineinliereil that the Indians had heen in con- 
tact with whites since soon after the year UidI). Dr. Esmond R. Long is 
my authoiit\- fur the statement that the J 'nritan fathers sufl'ered heavily 
from coii>tiniiiiiiin the lirsi year> ihe_\- >])ent in America. They niay have 
infected >ome Indian^ wlm later carried infection westward. It i^ not proh- 
ahle that the Indians ni the early days in Illinois gave the white man much 
consnniptioii. 

Piiriinniiild. 

^\w\\ lecnrds as are availahle. indicate that the Indians had a great deal 
of inieunKiiia and pleurisy, llrdlicka referring to the Indians of the south- 
west twentv years ago says: "I'neumonia has appeared in epidemic form." 
'Hiis disease was epidemic rather freiitu-ntly among the white settlers in 
Illinois. If anything saved the Indians from similar epidemics it was the 
s[iarseness of the population, the >mall size uf the villages and the open air 
living. 

Ditinliixd (iinl Di/si'iifrni. 

That digestive disorders including diarrhdcas and dysenteries were ])rev- 
alent among the Illinois Indiana i?. certain from the records. Ne.xt to the 
rheumatic di.-orders the diarrhoeas and dysenteries are mo>t frei|ueinly al- 
]ud.-,l to. 

A iHdihic Difsi iiti 1)1. 

l''ather .\lan|uette contracted what ajipears to have been amoebic dysen- 
tery while goiug down the Mississippi associating all the time with the In- 
dians. Ill' then returned to the Illinois territory where he remained an in- 
fectious i-ase or infective carrier all of the time until his death. 

Tllllhni,!. 

llrdlicka savs. "Contrary t(j all expectations typhoid is rare." The 
essav bv Louis which established ty])hiiid as a separate disease was not writ- 
ten until eight \ears before the Indian-, were moved from Illinois. It was 
not generallv known in Illinois until after the Indians had gone, but the prob- 
abilitv is that typhoid \va> not prevalent among the Illinois Indians. They did 
not seem verv --u-^ceptible to fevers of any sort. 

MdldiKl. 

.Malaria i^ thdUgbt U< li.ive pretty will wi|)ed tint the Nez Perces. It is 
\er\- prevalent among some trd)e> in the southwest, but the writings do not 
show that Illinois Indians suH'ered heavily from it if at all. 



GENERAL HEALTH HISTORY TRIOR TO 1877 21 

VoiiTcal Disca,sc. 

^o far as cuiicenis venereal disease in general the Indians seem lo have 
snlYered far more from the white man than the white man did from the In- 
dians. X'enereal disease was said lo j)revail anmng the drinking, degraded 
[ncHans who camped near while men's towns, hut not among Indians who 
kepi away therefrom. Tile Irihal reguhitions were aimed at protection of 
the Indians against venereal disease among the whites. Their attitude in- 
dicated their fixed conviction that the white man was the source of the vener- 
eal infections of every kind that the Indian found among his people. 

Jiecause of the interest in the discussion of pre-Columbian s_\phili- a 
separate heading is given to the history of svphilis of the Indians. 

Blicillliilfisill. 

It is certain that rheumatism troubled the Indians greatly. It is im- 
possible to say where they got it, who brought it to them, if anybody, where 
it originated or came from. The Indians seem to have recognized that 
ex])(isure played a part in causing it. They also seem to have recognized 
the \alue of hot baths in curing it. Most of the hot s])rings enjoying wide 
vogue today were handed (jver to the white man from the Indians as health 
resorts particular! \ in rheumatic disorders. Wandering a little afield, the 
fact that the Indians ai)preciated the value of .Sulphur Springs in skin dis- 
orders is some ]jroof that they suiTered from parasitic skin disorders. 

Rheumatism is known to have existed among the l\gvptians as proven 
by the lesions in mummies. .\lso among the cave dwellers of France and 
.Sp.nin king liefore the Egyptian period. In fact the skeletons of wild ani- 
als found in caves in Europe jjrove the j)re\alence of rheumatism among 
animals in prehistoric times. This is s<ime indication that the Indians had 
rheumatism before the white man came. 

Schoolcraft (llistoiw of the Indian Tribes of the United States ]S51 
and IS.')!) publishes a letter on the Indians written by Dr. T. S. William- 
son of ( )hio, after this phvsician had lived among the Dacotas iov many 
vears. The hulian withers at the touch of civilization but not because of 
fevers or other sickness. Dr. Williamson said: "The)- know nothing about 
the proper treatment of fevers." There is no reason to think they had had 
much ex])erience with malaria or typhoid. "The summer of ISliT is rettdered 
memorable in Indian history b\- the ravages of smallpo.x." ( )ne reason as- 
signed for the deadlv character of this disease among Indians was ihat it 
was realK' a fever and the Indian.s knew nothing ;ibout the treatnu-nt of 
fevers. The\- were more experienced in treating diarrhoeas and diseases call- 
ing for jnirgation and rheumatic disorders. 

I le said, "Dacota females are far less subject to wdiat are termed "female 
disorders'." Miscarriage was infrequent. The infreqtiency of female com- 



22 ciCNickAi. III;. \i. Ill iiisr(iK\ rkidk m l.sTT 

plaints anil iui>carria,L;cs wdiild >cciii lu indicate that ihc Indians did not 
sutTer nuu-li I'mni xcntTcal (li>casr, cither gonorrhea or sy])hiHs. 

'Idle siatenieiit liiat "the liuHan witliers at the tcuich of civilization" sug- 
gests so far as Illinois is concerned thai the while intruders into this territory 
gave nuich disease to the Indians ihere and recei\ed lnu little from them. 

Schoolcraft (History of the Indian Trihe^ (jf the United States 185T) 
agrees witli the opinion that tin- Kjw liinh rate nf ilu- Indians was the reason 
tor ilu'ir lewne^s, savins^-, "It i> a wfll known fact thai the Indian tribes do 
not increase in the ratio of other nations. The average number of children 
to each family does not exceed two." Other contributing causes given by 
Schoolcraft were laziness, lack of thrift and ])rudence, lack of will or even 
desire to ])o]iulate, occupy and u.se the laml. ,iiid their addiction to alcohol. 
In his \-i-ry extensive writings on the subject he refers to no disease as being 
very hannfnl to the Indians in a racial way. except smallpox. This disease 
did at tiin^s almost wipe out villages and even tribes. He specifically states 
thai pe--iilence was of minor importance as compared with low birth rate 
and alcohol in wiping out the Indian poinilations. 

Slim iiinrji. 

Summing it all up it appears that the Indian during his residence in 
contact with white men in the Illinois territory from the incoming of the 
wliitc man about IGIO until the de]iarture of the Indian in l!-i37, contributed 
but little to the white man's diseases — scarcelv more than he contributed 
to the constitution of the racial stock, composed of several white bloods 
and a \ery small infusion of Indian blood. 

The French or French-Canadian Regime. 

TiiK Fiii:.\(ii-( '.\x.\iii.\.\ TitAPrKiis, ^Lis.^^ioxakies .\xd Tk.uiers. 

Soon after the whites came to America they began to find their way 
among the Indians. Some of these were captives, some were squaw men 
and some lived among the Indians because they loved the life. 

llowcNcr, these were of little significance from the social stand]>:>int. 
They had little intfuence in the methods of living of the Indians, nor is there 
any evidence that they altered the lieallli problems of the Indians materially 
for either the ln-tter or worse. 

On the otlier hand, the fairly definite French-Canadian- trapper- trader- 
missionary iiioNcmcnt in Illinois was of social significance. It altered the 
religious life of the Indians and .also their habits and customs in some degree. 
The bio,grapliy of ( iurdon .s. Hubbard contains nianv allusions to the heavv 
drinking of the ln<lians and considerable fighting occasioned therel))-. It 
is interesting lo noti- that 1 lubbard gives an account of the shooting of Alexis 



GENERAL HEALTH HISTORY PRIOR TO 1877 23 

St. Martin and of Dr. llcauniDntV trcalnicin uf him. Tlie lir'-t u])inion was 
that St. Alarliii wDuhl ilir InU then as the jialitnt inipruvc-fl liuljliard wrote 
"about this time the doctor announced that he was treating his patient with 
a view to experimenting on hi.s stomach being satisfied of his recovery." 

There is evidence that French-Canadian trappers, traders and mission- 
aries added very little to the health problems of Illinois. They were almost 
exclusively ymmg and hardy men. There were no children among the immi- 
grants, nil women and Ud nld men. When an immigrant loecame enfeebled 
he went l)ack to Canada or tried to do so. 

By ]7".'il out of this movement an off-shoot had grown. Some of these 
immigrants had fnunded communities with the intention oi remaining. 
Father j\Iarijuetle had fdunded Kaskaskia on the lnw ground at the junction 
of the Kaskaskia I^iver with the Mississii)|)i. .V few months earlier the 
same type of settler had founded Cahokia in the .American Bottoms al:)Out 
opposite a jiart (if ])resent St. Louis .and abdut ."id miles up the river from 
Kaskaskia. 

The settlers in these villages were some twenty to ime hundred French- 
Canadians. Many of them had married Indians; s(ime had luarried women 
from Canada and from the French settlement in Louisiana carried there for 
the purpose of supplying wives. 

These imported indentured women were ipiickly spoken f(.ir when they 
were reasonably cnmely but the record shows that when the instalhuent in- 
cluded the lame, tlie halt, the blind, the prospective benedicts passed them by 
and took up s(|uaws. The Parkman account of Kaskaskia recites the 
rapidity with which the cabins of these luarrying immigrants "began to 
swarm with children." 

If the Indian women lived in a lent, wandered with her lord, kept her 
baby at the breast for two or three years and bore liut few children and those 
at long intervals, they were not always emulated by their sisters who mar- 
ried squaw men. tudk up their residence in houses and brought forth half- 
breeds. In additicin td these settlements there were a number of b'rt'nch- 
Canadians who settled up and down the Kankakee, along its tributaries, the 
Illinois and the Mississippi, Most of the half-breed children in time grew 
U]:) rather more Indian than white. These went with the Indians when they 
mo\-ed out of the .'~lt<ate. .V few remained. 

Thf distinctly b'rench towns were inhabited b\- the descendants of the 
all white marriages and the half-breeds; in mind ,ind manner> more white 
than Indian. In time these towns were abandoned or lost their iM-encb 
flavor. The I'rencb system (jf laying out towns and even farms, the French 
law, customs and language did not persist. lUit in some of the rural dis- 
tricts in v.allevs like the Kank.akee .and its ii-iliui;iries there is cunsiderable 



'^4 (;i:.\i;iv.\i. iii;.\i.tii iiisToin' I'uiou to IS" 

French Havor ami iradilidii cvtMi today. I lie h't'cnch-Canadian infliU'iice 
was more eiiduriiiy in the conntry than ii \va> in the tdwii. 

But there is no evidence that t'itlier ut' these French niovenients, if the 
last one can he termed as >ncli. added significantly to the health prohlem of 
the Illinois territory. There was some disease; principally venereal disease 
and I'onsiiniption in the \icinity of the posts as has elsewhere been indicated. 
It is more possible that smalljHi.x was introduced to the Indians here and 
tliere bltt there is no record of ijreat pestilential outlireaks of any sort or of 
detinite change in disease t\|ie i r of an\- dift'erence in the health and \i,ijor 
of the [K'ople in the wake of this series of intrusions. 

1 lowever, there is not much health history of the period on whtch to go. 
riie Indians were not waiters — neither were the trappers. The earlv trad- 
ers of the period wrote nothing, though later traders were more prolific. 
The explorers and the mis-;ionaries were prolific writers, considering the 
times, but they wrote about adventures, conflicts, battles, attitude of the 
natives toward foreigners, geogra])hy. tojiography and religion. In none 
of the reports of the period i> there any reference to the prevalence of ma- 
laria or any other disease that is comjiarable with conditions as they were 
described b_\' writers who observi'd from about 1800 onward. Some of the 
dilTerence nia\' be ascribed to the different interests and viewpoints of the 
writers, but not all of it can l)e mi interjjreted. 

It is not believable that conditions such as were described by these later 
writer^ could have existed and lieen overlooked or have gone unrecorded by 
the Jesuits. The conclusion mu-^t be that the health and vigor of the In- 
dians ;in dthe traders and trappers, and the French-Canadian settlers be- 
tween l(;S(i ;ind 17S0 was about the same as that of French-Canadians and 
lndi;in> in .MoiUreal and along the St. Lawrence in about the same period. 
Just how dilTereiil was the pictin-e soon after llsi) will appear in the next 
chapter. 

In the records of the earlier \ears of the I'rencb regime there are few 
alhtsions to ,an\- disease which can be recognized ;is m.'ilaria. There are some 
references lo endemics and ejiidemics but these cannot be interpreted as 
being ni,al.iri;i. In f.ict. it is difiicult to guess what the\' were. 

/euch ' says, "In the year KiiO. the settlements in the American P>ottoms 
bad, in spile of the stigma that had lieen placed upon them by sickness, 
reached the size of .a consider.ible colon)'." .Most of the colony were I'^rench. 
.Most of the sickness was ni.alaria. 

A I'"rencli religious order was forced to .abandon their h<ime in this 
region because of mal.iria. ^'et the o]iinion is genei-al that the l*'rench 

"Zeuch, Ibid. 



GENERAL HEALTH IIISTOKV I'RIOR TO ISTT "^3 

settlers in Illinois did not have malaria and one writer is (|U(>te(l (elsewhere) 
as saying the French were immune. This was not true ; that the l'"rench 
have no immunitv to malaria was shown in Panama. 

LaKlanc said to de Lesseps in ISSl, "If you try to build this canal 
(Panama) there will not he trees enough on the Isthmus to make crosses for 
the graves of your laborers." In lS,s,s, a jnurnalist wrote "Death is con- 
stantly gathering- its h.arvest about me. Since the ad\-ent "f de Lesseps on 
Fdiruary v'S, Issl, thousands upon thousands have been buried here." 
Gorgas estimated thai the I'"rench lost a tntal (if one third (if all their white 
employees. "We estimate<i deaths at "^O.dOd. .\ \ery large pari nf these 
deaths were from malaria." 

The reasims fur the low malaria rate in ihe I'rench regime in Illinois 
were several. The earl_\- settlers came frdin a nmi-malarial country ;md 
brought in no infecli(.in, the country was sparsely (iccujiied, there were 
ni(is(|uit(ies but the\- were iKil infected. .\s iiiimigranls increased in number 
and in sinirce Idward the latter jiarl (if the regiiiK- malaria increased, l.'y 
the lime the Urilish lodk charge, the inos(|uitoes had become rather generally 
infecud. 
Olln r Diseases. 

The I'Vench-Lanadians in lllinnis had pneuiiKinia. rheumatism, diarrhoea 
and dysentery. ( )f these diseases the\' had an abundance. It is probable 
that they had siiialljKix. whooping cough and dlher forms of contagion. 
lldwe\er. these did not abound because most of the pdpulatidii were adults 
and hardy, vigorous, resistant adults at that. In additidii, the towns, forts 
and garrisons were small and not crowded. Communication was infrequent. 
Such other disorders and diseases as prevailed anidiig adults in Canada along 
the St. Lawrence and the L:ikes in llu' period were brought lo the Illinois 
terrildiy. Ibiweyer, the b'rench made mi great CdiUribution Id the problems 
of hcillh in Illinois. 

\\ lun the ISrilish Uidk (i\er the go\enunenl, man\- of ihem iiKived away. 
Later when ihe Cdldiiists took charge olhers departed. Then came the great 
wayes of settlers from other states. Whereupon must of ihe b'rench de- 
parted and thdse w h(i remained herded Id themselves in rather small Cdldiiies. 

.''^ince the\' did Udl man\ much wilh ihe invaders thev made but lillle 
Cdiitributidn to the conslitulidn df the ]ie(iple. They left behind them no 
dUtstanding di'-eases df l'"rench impdrtation. 

The tendency In inbree(l and ui that way lo li.x certain dysgenic (|uali- 
lies which is ibduglu to be m.irked amung the iM-ench descendants in Illi- 
nois at the present day, was iiiil in e\idence during the I'rencb regime. In 
so far as it has been ,i Cdiitribnlidn to Illinois' health or lack (if health it is 
chargeable to the l-'rench. th(inL;b diily indirectly td the b'rencli df the b'rench 
retrime. 



26 GEXERAL JllCAI.lll IIISTdUV I'KIOK TO 1877 

The British Regime. 

I'lu' I'.ritisli l.ccaiiie ])oIitically responsible for Illinois in KG:!. l!_v K'G 
the coloni^■^ were in a war to dispossess them. By 1780 British control of 
the region \\a> ended, 'rhert'forc. they can he held responsible for only 
seventei-n years of the history of the Illinois rej^ion. During that time they 
di<l littK' more than occupy a few garrisons with small bodies of soldiers. 
I'lit the diseases and especially the malaria which had been rolling up dur- 
ing tile latter ])art (jf the l'"rench regime continued to mount while the British 
were in charge. 

The following cpiotations relating to sickness in the Illinois district dur- 
ing the British regime are from Zciich's tlistory of Medical Practice in Illi- 
nois, Vol. I. 

"Between 1763 and 1778, almost all of ihe journals of several British 
officers give harrowing accounts of the battle with their old enemy, malarial 
fever." 

.Morgan's Journal ( ITGS) says: "Ague and fever has been remarkably 
prevalent in so nuich that few of the garrison and inhabitants of Fort Char- 
tres and Kaskaskia have escaped. He told them that no native there was 
hfty years of age and few were forty. Neither has any French native been 
known to have lived to an old age." 

The Indians complained that small]iii.\ was transmitted to them b\' the 
b'nglish saying ■'They ga\-e us smallpox which made all our children die." 

Colonel Wilkin.s wrote in KllS. "l'',ver\- officer and private is violently 
ill with fever." I,ater Abn-gan re|iorted "I'ilty men are now fit for duty 
and the tlisorder has greatly abated." 

.Vdjutant Ihitlerick rej)orted, "Three officers, twenty-four men, twelve 
women and fifteen children were sent to their graves since September 2!). 
and manv more are in a dangerous wa\- though 1 am in hopes the cold 
weatlu'r wdl soon help us." 

In i;s!). Major Hamtramck wrote to (ieneral J. Harmon, "The garri- 
son at b'orl Knox is very sickly .and disease had caused luore havoc than the 
savages. Forty-nine men are ill with intermittent fever." 

Zeuch quotes Croghan'', as writing — ".\11 in the garrison are ill, including 
myself. Out of fifty men tln're are not abo\e three officers tit for duty." 

.Morg.an' wr(,ite of Vnr{ (_'li;irtrt's lliis "b'.very officer and private is 
violenth- ill with fe\er." liuttrick" "Thrt'c olficers, twenty-tive men, twelve 
women ;md liftern children were seiU to their graves since September 3f), 
and many more are in a dangerous way". 

"Cl-oglKUl (inillc.i.s Hist..ii.nl ('..ll,-.l ion. .\l \ nid-CaiU-r. vul. XI). 
'Trade ;ina I'oHtii-s, 17G7-17(;;i, Illinois Hisloiitvil Collection, Alvord-Carter, vol. 
XVI. 

"Alvoi-d-Carter, Ibid. 



GENERAL HEALTH HISTORY TRIOR TO 1877 27 

At tliat the l'>ritish left the jieople and the country about as they found 
them, just sucli a gradual increase in disease as is to he expected when 
nothing is done to prevent it. 

Since the British of the period did not settle and did not intermarry with 
the Indians they made no conirihution tn the character of the racial stock. 

The Spanish Influence. 

The Spanish made a moderately efteclive effort to cajjlure and hoUl the 
west bank of the Mississippi in the region of St. Louis. In 1780 they sent 
a company of sixty men to St. Joseph. ^Michigan, across the southern end 
of what is now Illinois. lUit neither they nor any other Spaniards remained 
long enough in the territory to alter health conditions for better or worse. 

Zeuch", rjuotes the following from the minutes of the Court of Quarter 
Sessions held at Cahokia in r;!)'.i. "In order to keep off the plague of the 
smallpox that now rages on the S])anish side no one was allowed to cross 
the river and goods brought from the Spanish side were to be confiscated." 

The American Regime. 

Pkiikji) 1780 TO 1S77. 

There had been some immigration into Illinois territory from the other 
states prior to 1780, but it was not until Clark occupied southern Illinois in 
that year that the American colonists began to dominate the picture. By 
1800 the po])ulation. which had immigrated from other states, though few 
in number and widely scattered, were numerous enough to control the social 
life, the customs, habits and religion and to shape such political jioiicy as 
there was. 'J'hey shaped the disease history even more markedly. 

ISetween 1800 and ISKi, the ])opulation increased in numbers but 
the increase was gradual. After ISK; it was more rajiid. There were 
two great gateways through wdiich the poinilation entered. The north end 
of the State was settled by people, the great majority of whom came through 
Chicago. Many of these settled in the immediate Chicago area; manv others 
radiated northward, northwestward and westward. \"ery few went south 
of the Kankakee and the fllincis rivers and a line running westward from 
where the latter river tin-ncd southward. In the earlier years, the great 
majority of those who entered the State through the Chicago gatewav came 
from New b'.ngland. New ^'ork and the states west thereof. Few came 
from those states that bordered the Mason-Dixon line on the north tltereoi 
and fewer .still from south of that line. There was little European immigra- 
tion. 

"Zeuch, Ibid. 



28 (;i-:.\i:rai. uiiai.iii insidin rkiou td is;; 

1 lie Miuiln'in <;atc\\ay was less a porlal in a physical way. It included 
tlic W aliash basin sciulh froni \'incenncs and the Ohio valley. Those who 
i'i-i>sM(l these borders ]iiisheil across the State, l^oing westward, to the brink 
(if llie l''rench settlements alnnt; the .Mississippi and north and northwestward 
until they reached the threat prairies. 

I'lClwecn the iriet;ular frinyedikc north li(nnidar\- of this immigration 
wave and the simil.ar xayut' sonth lMiinidar\- of the Chicago immigration, 
there \\,is ,i bidad neutral belt a no nian'> lami. The wel. stiff-soil prairies 
made liei-e a natural geiigra]ihic barrit'r. 

The waterways were the great .arti'ries of trans])ortation and the lode- 
stones of settlements. It wa> along the vtdleys that the people settled al- 
most altogether in the --oulh. and to a large extent in the north. In the 
prairie si-ction there were no large rivers and no great valleys. Besides the 
immigrants were a [leojjle who knt'w the soil of valleys and who did not 
know how to judge nor how' to break or to cultivate prairie land. The bear- 
ing of .all lhi> on heallh will appear shortly. 

There were few finx-ign boin .among thii~e wlvi came in through this 
galewaw The Poles who pariicipateil in the kt'\ci]ntionary war were given 
large laud grants in Indiana tow.ird the north end of this sweep of invasion, 
but tlie\ did not come into Illinois, .\niong the colonists wdio crossed the 
\\':di.c.h were some luiglish groups who formed settlements concerning which 
some rt fcrences will be made. Willi few exceptions there were no social or 
religious or communistic colonies from foreign lands in this southern liiinois 
territory. 

The majoritx' of those wdio came through this portal were from the Ohio 
v.ille\ stales lo the east: 1 'eiinsyl vania and \irginia beyond the Ohio valley 
and l\(utuck\- on its -nuth. Hut not all were from these states. They 
liruugbl with them malaria ;ind some other diseases of the states from whicli 
they came to add to the slock of malai-i.i ;nid dysentery with which the coun- 
try was alri'ady provided. 

The (.'oloni.d period had a heallh history that is even more distressing 
than tliat of the latter end of the b'rench regime anil of the British regime. 
In the writings of llio.se who knew Illinois .liter i;si) and ])articularly after 
ISOO. the allusions to beallh oi' r.ilber ill heallh are fre(|uent and illuminating. 
Ilc.dtli or kick of it was pidmineiu in the ])ublic and private mind. 

The tirriloix liecauie a Stale in ISIS, but the newly organized State 
ilid nothing for the heallh of the peopU'. The political change in 1S18 made 
no cli.ange in hi;ilth coiidilioiis. Tlierefort'. the health story will be told 
'v\itlionl p.irlicukir notice of the |Hililic;il idi.angi- which occurred in ISIS. It 
will be co\(.red in the main by sep.arate treatment of several of the more im- 
portant diseases. 



GENERAL HEALTH HISTORY PRIOR TO 18TT 29 

With the exception of a few Germans along the Ohio and Mississippi 
rivers, some Freneh who were ah"ea(ly here and some IndiaiLs who had re- 
mained, the population of the State jiridr to the latter part of tlie thirties 
decade were almost exclusively English. \\ elsh. Scotch and North Irish stock. 
Almost all were born in the states to the east and southeast. 

l"(.)ward the latter part of the decade, the first great South of Ireland 
wave began to roll in. In the forties decade the first great German wave was 
in evidence. The Swedes and Norwegians began with settlements in Cook. 
Henry and Vermilion Counties. Their first great wave began to arrive in 
the middle of the seventies decade. The Poles first tried some settlements in 
Cook County and along the Illinois Central road well to the south and in Ogle 
County, but their great w'aves of immigration did not start umil well after 
the close of this so-called pre-health department pi-riod |)ri(ir tn IST^. 

These incoming people may have bniught with them some of the dis- 
eases of the countries from which they came but there is no evidence that 
they brought anything new in that line. The peculiarities of |ihvsical vigor 
and weakness, of strength and (if what is termed cunstitutiDU. were much 
the same as those of the people df the liritish Islands and of the mirthwesi 
fringe of Europe, the soiux-es frnm which the Illiiidis of that dav was in- 
directly populated. 

GeNER.\L ITNHE.\LTHKt:LNES.S. 

During the French-Canadian regime, the Illinois terrilor\- did not have 
a reputation for unheallhfuhiess. Prospective settlers were deterred from 
settling b\- the reputation of the country for danger from Indians and for 
hardships due to extreme ciild and lack of conveniences but ihix were not 
held back by the rumors of disease in the land. 

By the year ISDO the story was different. Disease had come to be re- 
garded as more of a menace than tlu- Indi.an--. and ihc reputation of the coun- 
try for unhealthfulness was both widesjiread and juslihed. The settlers of 
this jieriod include<l the women and children as well as the men of the family. 

The birth rate was high but the death rate approached the same level. 
The Indian had a low birth rate and a high death rate and no immigration. 
In consequence he increased very slowly in numbers, if at all. Certain tribes 
grew, others waned but there were never enough Indi.ms to occupv the coun- 
try. The white settlers had a high birth rate, a high death rate and a great 
immigration rate. 

The increase of ]iopnlation due to excess of births over deaths was not 
great. In fad. had these two population factors opi-rated alone the white 
man would have had considerable ditliculty in holding his own in combat or 
even in competition with iIk- Indian. Hut the enormous immigration rate 
made it ]iossible for him to drixc out the Indian, lo occuin- the land, to clear 



30 r.KNi-.HAi. II i;ai.i II lIls^(ll;^ rKioK to ISTT 

it, drain it, improve il, to (Icwlop lln' resources ami rmally make the State 
healthy and ])rosperous. 

The heavy death rate was due to malaria, diarrhoea and other diseases 
of infancy and childhood, diarrhoeas and dysenteries of adidts, pneumonia 
and a few other diseases. 

Malaria so conifiU'lelv dominated the lieahh ])iclure and its effects were 
so ajjpareni that most of the earlier writings referred to malaria as heing 
synonomous with ill health. Therefore, the quotations of opinion and ob- 
servation found in this section will occasionally be found to say something 
about malaria, and in the section on malaria the writers quoted will speak 
often of the bad general health conditions. 

Boggess'", wrote, 

"One wlio settled in Illinois at that period (1790 to 1S09) came through 
danger to danger for Indians lurked in the woods and malaria waited in the low- 
lands. In 17S0 the garrison was sick and starving and the abandonment of the 
post seemed imminent. One of the earliest visitors to Illinois to record his im- 
pressions was an Englishman named Birkbeck. He wrote, 'Buried in the depth of 
a boundless forest, the breeze of health never reaches these poor wanderers, 

* * * The man, his wife, his son and three daughters. * * * They are 
tall and pale-like vegetables that grow in a vault pining for light; a squalling 
tribe of dirty brats that are of one pale yellow, without the slightest hint of a 
healthful bloom. The blood, 1 fancy, is not supplied with its proper dose of 
oxy.gen from their gloomy atmosphere, crowded with vegetables growin.g almost 
in the dark, or decomposing, and in either case, abstracting from the air this 
vilal principle.' " 

JUane", wrote, 

"The settlement has shared the fate of all the neighborhood with regard 
to sickness: two of the immigrants having died and several others being very ill. 
I rode to Palmyra. This most miserably dirty little village was once the county 
seat of Edwards County, an honor which it lost in consequence of the superior 
healthtulness of Albion. Albion is not at all times free ti'om the prevalent 
autumnal disease of ague accompanied with fever. * * * Wherever else I 
traveled the people complained of illness. * * * But the great objection is 
the general unhealthfnlness of the neighboring country for if Illinois were as 
healthy as England it would soon etiual all that Mr. Birkbeck has written in its 
favor." 

Speaking of St. Lnuis. located immediately across from the American 

Bottoms, he said : 

"St. Louis was once the great emporium of all the fur trade but of late years 
it has declined both in prosperity and population partly owing to the dreadful 
sickness." 

lUane, speaking (if the .\merican Bottoms, eight miles before coming to 

the Mississippi River, said: 

"This fertile district is rendered almost uninhabitable by its unhealthiness 
and will require a great deal of draining before many persons will settle upon it. 

• * * The French are by no means so liable to be attacked by fevers as the 

■» Bogrgess (The Settlement of Illiiiiiis, 177S-l,s:iO. Arthur Clinton Bogges.s 

Chicago, 1908. Chicago Historical Society Collection, vol. V). 

"Quaife (Pictures of lUinois One-Hundred Year.s Ago. Edited by Milo Milton 
tjuaife. Tart 2 — "A Tour in SoiHhern Illinois in 1822," from William Blane. R. R. 
Donucllev .t H.ms Coinpany. Cliicago, UllS). 



GENERAL HEALTH IHSTOKV PKUIK TO IS^^ 31 

English or Americans. This is attrihuted to tlieir very different and much more 
temperate mode of living. * * * x am persuaded that no people on the face 
of the earth consume so much animal food as the Anglo-Americans: tor at break- 
fast, dinner and supper, hot meat is always eaten, even by the poorest class. 
* * * Even during the burning months of summer and autumn they continue 
to eat the same immense quantity of meat and grease, which last article is a 
favorite in their cookery." 

Henry R. Schoolcraft'-, said: 

"The appearance of the inhabitants has corresponded with the opinion 
before expressed of the uuhealthiuess of the country. Pale and emaciated coun- 
tenances; females shivering with ague, or burning with intermittent fever, 
unable to minister to their children, and sometimes, every member of a numer- 
ous family suffering from the prevalent malady at the same time. * « * in 
this country life is at least fifty per cent below paj- in the months of August and 
September. I have often thought that I ran as great a risk every season which 
I spent here as I would in an ordinary battle. I really believe it seldom happens 
that a greater proportion of an array falls victims to the sword during a campaign, 
than there has of the inhabitants of Illinois to disease, during a season that I 
have been here. That time and cultivation will remove the causes of unliealthi- 
uess is a prevalent opinion. 

"There are two months of the year when the inhabitants are exposed to 
fevers and agues which render life irksome." 

Mrs. Sarah M. Worthington'". said: 

"By the first of September there was scarcely a well family to be heard of. 
and in many cases not one individual able to assist another. * * * a few 
became discouraged and sought refuge in timbered localities." 

Tillson'^ : 

"A great responsibility which rested upon the women was care of the 
family in time of illness. An illness native in the prairie country was fever and 
ague. There was a burning fever following chills which left the patient so weak 
he could not work. It came with perfect regularity." 

By Haines'"', reference is made to central lllinuis durint; the time f(jllii\v- 

ing the Black Hawk War : 

"Time had but little softened grief for those slain by Indians when the 
cholera spread a funereal pall over the same territory lately stricken by war. The 
swift flying messengers on horseback in pursuit wherever to be found dotted the 
prairies with omens of dread. For when the fell disease struck its victim no time 
could be lost before remedies were applied. Death was the quick result if potent 
relief was not found within the early hours of attack. In my family four were 
fatally stricken in as many days. Many who were not at once attacked fled their 
homes, only to meet death a little later in the lonely prairie or unsettled forest. 
Bereavement and sorrow was widespread, almost universal over a great part of 
the West. Typhoid and other fevers followed this dreadful visitation, swelling 
the death list generally from those who escaped the cholera. Indeed, the 'cholera 
year' as it was long referred to. was a period of gloom from which memory turns 
in horror. From this period may be dated most of our country graveyards, being 
then set apart for burial of our first dead." 



'^Quaife, Ibid. Part 3 — "A Journoy L'l) the Illinois Miver in 1S21" from Siliool- 
craft. 

" Worthingrton (Origrinal Letter of Sarah M. 
a collection of Stories of Pioneer Mothers in lUi 
Historical Library, Springfield. lUinoi.s). 

" Tillson (Reminiscences of a Pioneer Woman.) 

"Haines (Social Life and Scenes in the Early Settlement of Central Illinois, p. 35. 
Publication number 10 of the Historical Library, Illinois, 1905. James Haines). 



32 (lENKUAL HKAi.Tii msToin rNKiR xn !STT 

Governor John l\c\ niilds"' says. "In ISOO to ISO.") the idea ])revailed 
that Illinois was a i;ra\x' yard. 'I'liis retarded its settlement. The Trapijist 
Monks abandoned their hrst IncaliDn in the .\nierican I'.oUonis in IS^'i be- 
cause it was near some lakes and tlu\ bad bad health." 

'I'lu- llist(ir\- iif .Medical I'raclice in Illinois. \'ol. 1. coni])iled and writ- 
ten b\- Dr. I.ncins 11. /eiicb. and ]inlili>lic(l b\ the Illinois .Medical Society, 
has. as ils major (]l)iecli\ e. the bi(i.i;ra|)hics i)f medical men and the history 
oi ihv ])ractice of nie<licine. 1 luw cwr. it ma_\- be fairly said to have the tell- 
ing- of llie Mi)v\ of (be health (if the ]ieo])le as one of ils ])urposes. Volume 
1 brings the history down to IS.MI. 

The general tinhealthfulftess of the ret;inie and the effect of such a repu- 
talion on the develo]inient of the Cdunlry in the early days is indicated by the 
following; i|notations taken from \'olnme 1 of thi> History, as follows: 

Tlii^altc's Jcsiiil I\i-hifi()iis: "\ plague bmke ciut amonsj the Indians near 
Cairo. ll.alf the tribe dieil and ibe survixiir^ fled in every direction." 

In Aiin-rictui Xolrs ( 1 S p.' ) Dickens describes Cairo as a detestable 
morass. The followinL,r is cpioled from .Martin Chuzzlewitt (Dickens), "A 
native of Cairo (or I'^den) when asked to help Mark Tapley and Martin 
Cbux/.lew itl with their luggage replied, 'My eldest son would do it if he could 
but tiKla\ he has his chill tipon him and is lying wrapped up in blankets. 
.M\ \nungest son died last week. * * * We buried most of 'em here. 
the rest have gone away. * * * Tlu' night air aim c|uite wholesome. 
Its deadly ])oison.' " 

Zeuch'' sa\s, "There were two reasims why colonization took place in 
the Kaska^kia and C'ali(il<ia regions rather than in the more healthy Starved 
Rock region. .\n epidemic had seized the denizens of the mission. The 
frosts did not arrest the progress of the contagious malady, but just the 
opjiosite happene<l." (The reference is to an epidemic of unknown nature 
in the 1 Uh centin-y. ) 

In IMH. Flagg wrote from Edwards\il]e. "The princij^al objection to 
this ciunury is its unhealthfnlness." In is-.'o, Flagg wrote from the same 
>ection, "Several towns ha\e been ver\ sickl)' this season especially those 
situated contigumis to rivers nr mill ponds." 

On the otlier hand bordham wrote about the same time and from the 
same section that the cou)itry was about as healthy as England. "Consump- 
tives are almost unknown, liilious fevers are rather ])revalent but not dang- 
erous when attended to early." 

The fdUowing references to disease in Illinois are taken from Zeuch's 
History. 

'"Reynolds (Mv own 'rinu-s. fiiilir:u-iiiK al.'ii) tin- history of my life, .lolin Rey- 
nolds, 17Sfl-lS65, Brll.ville, Illinois. 11. H. I'eirynien and 11. I... Davison, printers, 
ISoo). 

'■ Zeueh, Ibid. 



GENERAL HEALTH HISTORY PRIOR TO 18TT 33 

"The stigma of unhealthfulness was fastened upun this region." f77;c 
reference is to English Prairie, i8ig.) 

"The unhealthy state of the region taxed these vaHant Knights of 
Aesculapius to the utmost." (The reference was to Bond County in 1844.) 

'Tn 1820 a sickness prevailed in Pike and Calhoun Counties, the nature 
of which was not determined." 

Writing of Ouincy in 1848, Dr. Frances Drude said. "There was an 
alarming mortality among the physicians due to their exposure to contagious 
and infectious disease." 

"The bad reports contiimalh' made concerning the state of health in the 
west created a fear that resulted in great economic loss in immigration and 
business." "A good settler must have withstood the ravages of malaria." 
(The references are to Will Cminly.) 

"No other town in the county suffered as much from sickness as did St. 
Charles." (The reference is to Kane County.) 

"The year 1839 was known as the sick year for so nuich illness was prev- 
alent along the Mississippi River that few coulil lie induced to locate any- 
where near it." (The reference is to Tiiltuii County.) 

"On the other han<l Mcllenry County was reputed as distressingly 
healthy." 

Dr. S. P. Hildreth'" writing of Washington County. Ohio, says: "Since 

the first settling of the County in 1788, many of the diseases have changed 

their type and character." According to Hildreth from 1788 to 1807 most 

disease originated in expo.sure to cold, hunger and fatigue. The prevailing 

diseases were rheumatism, the pleurisies, pneumonias, scarlet fever and 

smallpox. Eye troubles were sometimes epidemic. In 1797 to ISO] jiallor 

anemia and consumption prevailed. Since 181."). when t\'i)hoi(l-i)neuni(inia 

was so prominent, consumjition has been increasing. 

"The outstanding diseases were pneumonia, ophtlialmia and malaria: ISOT 
was our siclvliest year. From 1S07 to 1S13 the fevers were mostly typhoid. In 
1823 the fevers were mostly typhus. This typhus. I expect, was the same disease 
called typhoid in the earlier reference. So general was the sickness that in the 
general election of 1823 only 35)0 out of a possible 1200 to 1400 votes were cast. 
Measles and whooping cough appear at intervals of eight to ten years. Scarlet 
fever has appeared twice in twenty-three years." 

All of these statements relative to our sister state lying in the same 
parallel apply to Illinois at least in a general way. 

In reporting to the American Medical Association in isd: on the c])i- 
demics of Illinois, Dr. K. C. Ilamill wrote, "The testimony 1 ionic by the early 
explorers and settlers was :inyihing but llattcring its ( lllinoi>) characler for 
healthfulness and salubrity." 

'"Hihli-eth (Amfrir:ni .Ii.in-nal Mfdiual Science, l.S2tl, Hr. .S. F. Hildreth). 



34 GENERAL IIICALTII 1II.ST0K\- I'KIOK TO 1 S^ T 

In 1S19 the 1 Hindis legislature passed an act authorizing a lottery to 
raise funds for the ])urposc of "draining ponds and lakes in the American 
Bottoms and of improving the health thereof." In its introduction, this law- 
says, "these ponds and lakes stagnate and annoy the health of the inhabitant 
of said bottom by producing autumnal fever." It appears that no drawings 
were held under this law until 1838. Tt was planned to hold the first draw- 
ing on July 1 of that year, "hut ihc sickness of the contractor and the gen- 
eral ill hcahh (if the whole country, etc., h:ive caused this unlocked for de- 
tention and dcl.iy." Tlic first dr.iwing took place November 17. 1839 at 
ITarrisonvillc. There was a weekly drawing thereafter for some time. The 
eighth took place at .\.llon, January ."), 1839, and the tenth at Harrisonville, 
January 19, 1839. 

'The lottery did not prosper. Professor George W. Smith''', wrote 
"Little was accomplished by the lottery system." 

In (Jctober \S'M, J. .\. Townsend, Manager of the .\merican Bottoms 
Improvement .Association asked the owners of land to ])av a voluntary tax 
of $1.0(1 an acre to ])ay for drainage. In .\pril •21, 1S3S \V. C. Greenup, 
President, l-ioarcl of Managers, sent a cummunication to Congress ask- 
ing that the Board be given the v;icant land in the .\merican Bottoms to be 
used to raise money to pay for the ci)nteni|jlate<l drainage. The following 
extracts are taken from that communication — 

"It is Ijelieved that in tlie year 1812 tlie population of the American Bottom 
was greater than it now is. This is attributed to bad liealth arising from the 
stagnant ponds and lalves. The once flourishing villages of Fort Chartres, St, 
Philips and Prairie du Pont are only known by the ruins and the inscriptions 
over the dead. Cahokia. Town of Illinois, Harrisonville and Prairie du Roche are 
in great dilapidation: Kaskaskia seems not to advance although it is reputed to 
be the most healthful of any other place in the bottom." 



"Smitli (Histoiy nf Illinois and Hcv Pci.ple, vol. 2, Hi27. Prof. Oeurge W. Smitli). 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877. 

Malaria. 

The dominant disease as early as IISO in the Illinois territory and for 
about seventy years thereafter was some form of iiialaria. It went by many 
different names such as the "ague", the "shakes", the "chills", "bilious fever", 
"intermittent or remittent typhoid and typhus", "autumnal fever", and vari- 
ous combinations of these names. As early as 1816 Drake is found adding 
the term "typhus" to several of the malaria terms. He used the word typhus 
sometimes alone though usually in combination. He did not mean typhus 
as the term is used now and probably not typhoid in the modern sense of the 
word, but he did mean a slow form of malarial fever with oftentimes a col- 
lateral typhoid infection that probably was about what Woodward ]iiipular- 
izecl as "typho-malarial fever" sixty years later. 

In the main, malaria was brouyht into the state through the southern 
gateway and by immigrants from the southern and border states. Whether 
it came to them from Africa as a result of the slave traffic as some say is 
not a direct part of this story. Some came in through the Northern gateway 
brought by immigrants from elsewhere than the south, but most of it was 
brought in as stated through the Southern gateway. How it was carried 
north and south in the state as well as east and west will be referred to pres- 
ently. Once it entered, malaria found conditions fit for its spread. The 
country was undrained, much of it was heavily wooded, and mosquitoes 
were ])lentiful. 

In IS-?!) ](>hn AlacCulloch wrote a book cm malriria. There is no proof 
that he had Illinois in mind, but what he wrote of the region along the Missis- 
sippi river in the south and possibly north would apply to this State. He 
said : 

"In many place.s in the southern States malaria has been rapidly increasing 
as almost to threaten the abandonment ot the land. And in the newly settled 
or uncleared lands along the Mississippi and its endless tributary streams the 
same plague is found to prevail very widely to the surprise and serious grievance 
of the settlers. What the fate of this new country may be ultimately in this 
respect is difficult to foresee. It is to be suspected that no changes and no culti- 
vation will ever bring it into a state ot salubrity." 

Mrs. Tillson, writing of Pike County in Illinois in 1821, said: 
"Your father had a shake of the ague. * * * Feeling that he was in 
fer a smart grip of agy he rode seven miles toward Edwardsville where he stayed 
to have another shake. The next day being intermediate day he rode twenty- 
five miles to Mr. Hoxie's where he waited over there fer another shake which 
Mrs. Hoxie said "beat all the shakes she ever see. He shuk the hull cabin.' " 

(35) 



3G IIISTOUV OF CICRTAIN DISEASES PRIOR TO ISTT 

In Pioncrr Health Conditions by the- Norwegian-, Vimricaii History So- 
ciety is t\)Uii(l tlu' fcilldwing statement: 

"Evorywhero in the West the ague attacked the settlers more or less severely 
during the first development of the country. * * * Wherever new land was 
broken in swampy regions the ague harried the people with the most disastrous 
results. * * * Malarial fever prevailed in the Rock River valley to the Mis- 
sissippi River in Illinois. At this time (IS.SD) malaria ravaged Chicago very 
severely and especially many of the poor hard working immigrants who were 
poorly fed and lived in miserable huts, fell victims to the disease. When fall 
came only a few were alive. Most of them had succumbed to the unhealthy 
climate. * * * " 

Sandburg-" says : 

"Fall came with miasma rising from the prairie, and chills, fever, ague, for 
Tom Lincoln and Sally Bush; and many doses of 'Barks,' a Peruvian bark and 
whiskey tonic mixture, bought at Renshaw's general store in Decatur, was 
administered." 

By long odds the best informed man of hi^ day in the liealth nf the 
people of the Mississippi \'alley was Dr. Daniel Drake of Cincinnati. In 
183T he wrote that in \><'io, IS'^7, l,s28 and 1830 malignant fevers were un- 
usually prevalent in the \N'estern territory. Dr. Drake gathered his informa- 
tion through travel, through correspondence and through articles sent his 
j(iurn;il. There is no proof that he had visited Illinois so early as IS'lo to 
is;i0. He had one regular correspondent in the State, Dr. J. F. Henry of 
Blooniington. 

Through Drake's travels and his correspondence he gathered the fol- 
lowing re])orts on m.ilaria in different sections of Illinois, particularlv how- 
ever, in the basin of the Illinois River. 

In 183o-3(; Drake made a trip to St. I.ouis, writing of the American 
Bottoms opposite St. Louis, he said ; 

"It is among the most fertile spots in the whole earth, but at present it is 
infested with mosquitoes and intermittent fevers, the latter followed by enlarged 
viscera and dropsical infiltrations." 

"Bloomington — Autumnal fever prevails annually. One of the citizens in- 
formed me that he had resided where I found him three years before a member of 
his family was seized with that fever. Such instances are not uncommon though 
difficult to explain. Drs. Colburn and Henry were convinced that an extensive 
plowing up of the soil of the prairies for the first time had been followed by fever 
especially in those who resided on the northern or leeward side of such tracts. 
They had rarely seen malignant cases. 

"Adams County — We have here in aiUumn bilious diseases more or less for 
instance the ague, the intermitting and bilious fever. In very rare cases do these 
diseases prove dangerous. Fifteen or twenty years ago the hepatical diseases, 
hypohondriasis and jaundice held such a formidable sway that they spared but 
very few, especially of the immigrants. 

"Woodford County — In summer miasniatical fevers prevail. In moist springs 
the inhabitants of the prairie suffer from them. In fall and winter the abdominal 
typhus fever sometimes occurs, but never real typhus. 

"Pckin — Intermitting fevers reappear after the lapse of some two, three or 
four weeks. The best remedy is acid sulphuric Peruvian bark in doses of from 
2 to 4 grains at intervals until 10, l.'i or 20 grains are taken. Tuberculosis (con- 
sumption) is very rare. Acute inflammations of lungs occur in winter. * * « 



' SandbuiK, (Life of Lincoln, Carl Saiullmrgr. Vol. 1, p. 106). 




^^J^^^es^^T'te^-^, ^^^^^ 



38 HISTORY OF CICRTAIN DISEASES TRIOR TO 1ST7 

"Peru — In some casps of fliills :uul fever *■■:■* ^ few outward applica- 
tions of soap and water no ilouhl would have relieved the patient. * * » 
People drink surface water. 

"Tazewell Count y — They plowed up the prairie near their residences and in 
the following autumn experienced a decided invasion of remittent fever, while 
the surroundins population remained healthy. At lengtli a colony arrived and 
establishins themselves near each other enjoyed excellent health the first year; 
but the next spring they broke up a large extent of prairie near their dwellings 
and suffered severely in autumn from fever, while the country around remained 
comparatively healthy. Dr. Prye lias remarked what has been noticed elsewhere 
that in low and wet timbered spots tlie intermittent form of fever is more prev- 
alent than the remittent — also that in some autumns every kind of locality is 
affected, while in others some places suffer and escape." 

Speaking of the especial iirevalence of the disease in the \aUeys of ihe 
Wabash Dr. Drake said : 

"Between these wet, marsliy prairies which will be made dry by cultivation 
and the bottoms the whole of this extensive and fertile portion of the Wabasli 
basin is infested with autumnal fever, of which many cases assume a malignant 
and fatal character. The people who live in the hills are healthier and live longer. 

"From what can be collected of the travels of Lewis and Clark, Pike Long, 
Catlin Preemont an dGregg not less than from fur traders and Santa Pe mer- 
chants malaria is almost unknown at a distance of more than 300 miles from the 
west boundary of Missouri and Iowa and above the 37tli parallel. To the north 
it does not prevail as an epidemic beyond the 44th parallel and it ceases to occur 
even sporadically at the 47th parallel. It came in from the south and it pushed 
up the valleys to the north." 

Daniel Drake-' writing of his observatii.ms on the distri1)iition of ma- 
laria along the Illinois river and points not far tiierefroin in ihe period Ije- 
tween 18-10 and 1845 made the following statements: 

Kuskaskia — "Such a surface must of necessity give rise to severe autumnal 
fevers whicli are known to prevail throughout the whole Ivaskaskia basin." 

Lower Illinois Valley around Mereclosia — "It seems almost superfluous to say 
that the population along such a valley are subject to grave autumnal fevers." 

Jacksonville and Moryan County — "Prom Doctor Jones I learned that all the 
forms of autumnal fevers occur at this place. Dr. Prosser informed me the 
prevalence of these fevers is much less than formerly. Dr. Smith thought them 
not more frequent or more fatal than ho had seen them in the basin of the Ohio 
River in Kentucky. Dr. English had found them more malignant than in the 
lower valley of the Great Kanawha in Virginia." 

Sprinyfield and Hanyamon County — "Doctors Todd. Henry, Merriman and 
Jayne all of Springfield assured me of the presence of malaria and they afforded 
me an opportunity of seeing intermittents as malignant as those on the banks 
of the Tuscaloosa and Pearl Rivers (Alabama and Mississippi!." 

ilaekinaw — "Dr. Burns told me that there was autumnal fever here and 
there." 

7'cor/a— "In 1833 the Anglo-American town of Peoria contained not more 
than twenty-five families. But it was the site of an old French mission and in 
1779 it began to be a village of Indian traders, voyagers and hunters. 

"Although so old a settlement its autumnal diseases are substantially the 
same as those of the more recently settled territory. From Doctors Dickinson, 
Rouse and Frye, I learned that in and around the town intermittent and remit- 
tents prevail every year." 

" Drake (A Systematic Treatise, Historical, Ktiological and Practical on the Prin- 
cipal Di.seases of the Interior Valley of North America as they appear in the Caucasian, 
African, Indian and lisciiiimaux Varieties of its Population. Cincinnati, 1S50. Daniel 
Drake, M. D. Winthrop B. Smith & Co., pub.). 



HISTORY OF CERTAIN UISEASES PRIOR TO 1877 39 

Peru and LnSaHr—'-DT. Whitehead said in a residence of eight years he had 
seen epidemics of autumnal fever in only two years and then chiefly in immi- 
grants from the north and in Irish laborers on the Canal." 

Ottawa — "From Doctors How.land, Schermerhorn and Hurlbert I learned that 
autumnal fever is common in this locality. The Irish laborers on the Canal had 
suffered greatly." 

Ottawa to .Jolirt— "From the best information I could obtain malarial fever 
is both rare and mild." 

JoJie/— "Doctors Schoolfleld and Bowen told me that Joliet is annually in- 
vaded by autumnal fever but it is neither widespread nor of a fatal character." 

In 1883 Dr. J. Murph}' of Peoria wrote: 

"When I first settled in Peoria some thirty-five years a.ao (about 1S4S) the 
entire prairie was saturated with malaria. In fact, the entire area of central 
Illinois was a gigantic emporium of malaria." 

In 1842 Dr. Snuck-- of Darwin, Illinois, Clark Connty, wrote: 
"We have more or less of every grade of fever from the simplest intermit- 
tent to the most remittent every year." 

In ISIo Dr. R. Robson-^, New Harmony, Imliana, wrote of the fevers 

of White County, Illinois, and Posey County, Indiana: 

"When I commenced practising in 1830-31 the country (except the town of 
New Harmony) was Infested with fevers of almost every grade. During the 
summer of 1834 very few families escaped a visitation of fever and many of the 
most respected citizens were carried off." 

in 1843 and 18-1:'± Dr. Drake visited Illinois, including Chicago and the 
north part of the State, a considerable part of Wisconsin and the lower 
Missouri in his itinerary. After he had left St. Louis and gone up the 
Mississippi to Alton, Illinois, and some distance uj) the Missouri, he wrote 
of the autumn fevers, "which prevail not only on its banks (Alissouri) but 
far and wide in all directions from them." 

"I can hear of no spot high or low, wet or dry. wood or prairie, village, town 
or city socalled that Is not invaded. To find a sin.s;le family some member of 
which has not had a chill or two. would be a curiosity. In one village every 
inhabitant except one negro boy had had the disease." 

Of Galena and vicinity he saiil : 

"The people on the Fever River are as free from fever as their neighbors; 
meaning that they had as much malaria, but no more. He discusses three possible 
origins of the name of this river; one was that it got its name from a Sac word 
meaning smallpox; another that it came from the name of a local French trader 
LaFevre and the third was that it was derived from the French word "feve" 
meaning bean. He did not state his opinion, InU he did say 'the name is not 
undeserved.' " 

In l<s.")(i the Illinois Medical Society was formed. In the coiistiUition 
of this societ\- there was provision for a standing committee on "pr,Lcti':al 
medicine to report annually on the prevalence of epidemics and other matters 
of interest." The committee reported the experiences of their members in 
their practices, the answers from correspondents, about disease ])revalence. 

= Snuch (WfKtern iMedical and r'liy.si<al .lounial. is 12). 

» Uob.son (Western Jledical and I'hy.siial .loiinial, IS!:;, li. ll(ilisoii). 



-to 



IIISTOKV OK CKRTAIN DISEASES I'KIOK TO 1877 




X. S. Mavis 



and what tliey could k-ani fnini reports before medical societies and medical 
iournals. 

In the ciininiitlee repurt I'ur 1^")1 occurred the I'ollowing statement: 
"TIk- levers of ciur alhnial fnrniatinii, interniitteiu and remittent with their 
various relatives claim the precedence." They especially referred to articles 
on the congestive fevers which appeared in the 
St. l.ouis Medical and Surgical journal. Jan- 
uary. 1849. and January. IS.M). In the \^'>\ 
report are found eight references to the several 
tvpes of malaria. In the 1852 report written 
l>y X. .S. Davis and 1.. Hall, there are four 
leferences to forms of malaria, and one "Isth- 
mian I'^ever." 

In 18.'")4 Dr. X. S. Davis reported to Chi- 
cago Medical Society on conditions in Cook 
(, ounty : "The attacks of ordinary intermit- 
tent and remittent fevers were more frequent 
during September than for several years past." 
lie also wrote that around Ottawa malaria out- 
ranked other diseases in importance. In 1835 
Dr. Thompson's report on practical medicine 
had eight references to the prevalence of malaria. The report from Van- 
dalia furnished by Dr. Haller read: "The Okaw river l)ottom is two miles 
wide and it is subject to inundation. In conse- 
quence bilious, remittent, intermittent and con- 
gestive fevers prevail." 

Dr. H. R. I'a\ne nf Marshall reporting 
for Clarke County said: "1-lvery family was 
attacked l:ist year." 

The ls.")S repurt said ".Since the conipleticm 
of the Illinois and Michigan canal in ISi; the 
health of the Des Plaines valle\- has been an- 
nually imjjroving, by reason of the better 
drainage. This is es].eciall\' true in loliel." 

The l.s(i() report by Dr. (iuddbrake con- 
tains four references to ni:ilaria. In 1S(m 
ma'aria is referred to b\ ihrie ])liv>icians in 
the Re hart on Practical Medicine. In the ISd!) 

' . Dr. Cooilbrake. 

rei)ort there are seven reports (jf malaria. 

.-\fter that year the subject was not often referred to. -Such discussion 
of malaria as persisted shifted to new l);ittlefields — to wit : Is there a typho- 
malarial fever, and. the relation of t\phoid to malaria? 




HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 



41 




In the 1864 report appear the following stateineiits for which Doctors 
J. S. Jewell and N. S. Davis appear to divide responsibility: "From 1855 
to 185' there was little of disease except malaria. After 1S5T a transition 
from the periodic to the continued type of fever occurred. In two or three 
years continued fever almost entirely su])planted the autunmal type." Just 
how much of the continued fevers referred U> 
was typhoid it is not easy to guess. 

In 185G Dr. Gerhard wrote an immigrant's 
compendium of information entitled "Illinois 
as It Is." One chapter was devoted to health. 
He did his best to answer adverse criticism of 
Illinois such as "When people speak of Illinois 
in the eastern states they will often express 
their fears in regard to the fever and ague said 
to prevail there." He said : "Everybody 
knows that of all diseases the ague occurs most 
frequently in Illinois * * * that it depends 
very much upon the particular plan of abode 
or manner of living whether the fever is to 
visit a family or not. Whosoever resides in 
the Bottoms or close by swamps or in districts 

where the water cannot rapidly flow off. will be more e.xposed to the fever. 
* * * One-half of those who are down with fever have to ascribe this to 
nothing but their own imprudence and the use of improper food. Causes — 
drinking stagnant water ; too immoderate use of fruits, lard, eggs or fish. 
Nobody should expose himself needlessly to night air." 

He had some ground to talk since unciuestionably there was less malaria 
in 1856 than there had been thirty years before that date. He quoted from 
laymen who were very enthusiastic as to the healthfulness of the State. The 
six physicians quoted were more reserved. Dr. Daniel Slahl of .\dams 
County said, "There is some malaria but not as iinich as formerh'. Diarrhoea 
in adults prevailed somewhat." Dr. j. (i. l.iller of Woodford C'ounty said 
the people of that county had some malaria in the summer and some typhoid 
in the autunni. Dr. T. .\. Hoffman of I'eardstown. Cass County, said they 
had some malaria but not as nuich as formerly. Dr. l\ Borendel of Peoria 
County said that countv had some malaria and typhoid and the last epidemic 
of cholera affected them. They had very little consumption. Dr. V. Wenzel 
of Belleville, St. Clair County, said, "The time in which southern Illinois 
was deni)unce<l as the fever country had long since passed by." Dr. C. Hoff- 
man of I'ekin said that they had some malaria but it was n(.)t bad. They 
were almost free from consum])tion. 



42 IIISTOKY OF CERTAIN DISEASES PKIOR TO 1877 

y.vnch'-' skives the fiilldwiiitj references to the prc'valenc ni malaria in 
many of the ccmnlies in Ihinciis. The citations i;i\c' the ^■ear in which the 
presence of the (Hscasc was alkuled to in the orit,'ina! sources of the mater- 
iaL In some instances hrief comments are r|Uote(l. 

Shelby County in ISSO: Moultrie and Ed.nar (^unities "in the early clays"; 
Sangamon County "prior to ISoO." 

Vermilion County, "It sought out and attacked every new comer for twenty- 
five years in the form of fevers, fever and ague and bowel complaints. 

"A colony of Norwegians on Beaver Creek was stricken with the prevail- 
ing illness of the lowlands and fifty of them perished. The survivors abandoned 
the settlement. 

McLean. Kankakee. Tazewell. Will Counties: "The building of the Illinois 
Michigan Canal was stopped at times because of the inroads the disease (malaria) 
had made on the laborers at work upon it. 

Kane County. "Intermittent and remittent bilious fevers sorely afflicted the 
pioneers." Putnam and Marshall Counties, "particularly in 1838 and in 1849." 
Stark County, "In 1846 Doctors Hall and Chamberlain treated 1500 cases of fever 
and ague." "Up and down the Rock River," 1839. DeKalb County 1839. 

Carroll County. 1837, "The pioneer of early Illinois had to suffer much from 
malaria before he learned the lessons of elevation and of restraint of the rampant 
waters." 

Dr. X'ictor C. A'aughan-' skives a graphic description of malaria as he 

and his family encountered it in .Montgomery County Illinois in the summer 

of 1865. 

"In 1865 every man, woman and child in southern Illinois, at least within 
my range, shook with ague every other day. * * * That summer I saw enough of a 
people held in bondage by malaria to make a lasting impression upon a boy's 
mind." 

Dr. X'aughan describes a family named Trelaw-ney as representing the 

abyss of degeneracy and general incompetence which he inferred was the 

result of chronic malaria. Continuing the theme he wrote: 

"How much the present dwellers in southern Illinois owe to the open eyed 
and keen witted Jesuit who penetrated the interior of Peru and to his patroness 
the Princess Chincon I will not attempt to estimate, but if quinine has clothed 
and regenerated the recent generations of Trelawneys I am willing to pronounce 
it a gift frinii Heaven." 

Dr. t_'. r>. Johnson'-'' writing of Bond C'iiunt\ and other regions in cen- 

tr;il Illinois >ai(l : 

"lS(i6 yielded abundant crops of all kinds including malaria in all its 
forms." Of the last great endemic wave of malaria in Illinois he wrote: "To- 
ward the close of the summer of 1872 came the last general extensive epidemic 
of malarial fever in central Illinois. The epidemic lasted from the last days 
of July till the coming of a killing frost and within the bounds of my practice 
I think almost no one escaped an attack. All suffered sooner or later from the 
infant at the breast to the ohl man tottering to his grave." 



=«Zeucli, Ibid. 

^■■'Vaughan (A Docloi-'s .MpiiiDiie.s). 

^John.son (Sixty Year.s in Medical Harness; or, Ttir Stuiy of a r.diis Mftlical Life 
1S65-1925. Charles Beneulyn Jolinson). 



HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 43 

Clark Carr,-" writing of northern Illinois in 1850 and thereabouts gives- 
at least one reason why the fevers of southern Illinois were spread to north- 
ern Illinois. 

"Large numbers of inhabitants ot southern Illinois went to the Galena 
district to work in the mines after they had made their crops and then returned 
home for the next crop. The roads in Henry and Knox County were filled with 
people emigrating, every day movers passed our house." 

This was a jK-riod uf active building of railroads and canals and duubt- 
less a great deal of malaria, dysentery and typhoid was spread through labdr 
cani]>s. 

Before leaving this subject the following two references from Bartlett's 
"Classical Work on Fevers" as to the malarial fevers and particularly the 
element of periodicity therein are referred to. lie writes: "What reason is 
there to believe or hope that the thick darkness which has ever wrapped and 
which still wraps this fever so full of mystery and wonder will ever be dis- 
pelled." In less than fcirt)' years thereafter all of the nivstery had lieen 
cleared up; in eighty years after Bartlett wrote, malaria had been banished 
from all but twelve counties in Illinois and it should be easy to banish it 
from those. He also reports that Dr. Oliver Wendell Holmes once wrote 
a prize essay on the disa|)pearance of malaria from Xew England. 

Cholera. 

Hirsch-* gives the dates of the pandemics of cholera as fi^illows : first, 
1817 to 1823; second. 1826 to 1837; third, 1846 to 1863; fourth. 186.-, to 
187--). The first pandemic is not sujiposed to have reached America. The 
second pandemic reached Illinnis. 

In 1832 there were no vital statistics, but a Chicago Health Department 
Report says that forty-eight soldiers and several citizens died of clmlera. 

In is:il Daniel Drake wrote of the cholera epidemic: "Illinois has suf- 
fered but little. The Eastern portion of the State has suffered most. Some 
villages have been scourged." 

The following in regard to Central Illinois, folldwing tb.e Black Hawk 
War, is qunted froni the Social Life — Early Settlement of Illinois, Haines: 

"Time had but little softened grief for those slain by Indians when the 
cholera spread a funereal pall over the same territory lately stricken by war. 
The swift flying messengers on horseback in pursuit wherever to be found dotted 
the prairies with omens of dread, for when the dread disease struck its victims 
no time could be lost before active remedies were applied. Death was the quick 
result if potent relief was not found within the early hours of attack. In my 
family four were fatally stricken in as many days. Many who were not at 
once attacked fled their homes, only to meet death a little later in the lonely prairie 

=' Carr (The lUini, a Story of the Praii-ies. Clark E. c:arr. Chiiago, A. C. iri:ClurK 
& Co. 1904). 

=*Hirsch (Handbook of Geographic and nistorkal Patholog.v). 



44 niSTOKV OK CKKTAIN DISILASES PRIOR TO 18TT 

or unsettled forest. Bereavement and sorrow were widespread, almost universal 
over a great part of tlie West. Typlioid and other fevers followed this dreadful 
visitation, swelling the death list generally from those who escaped the cholera. 
Indeed, the 'cholera year' as it was long referred to. was a period of gloom from 
which memory turns in horror. From this period may be dated most of our 
country graveyards, being then set apart tor burial of our first dead." 

r^arrish''", wriliny; of the Black Hawk War, l8;iS, said: 

"Cholera which had appeared among General Winfield Scott's troops had 
detained them at Detroit, Chicago and Rock Island. * * * Nearly one-fourth of 
his entire detachment of one thousand men having died of the pestilence. * * * 
Beyond this the entire American loss in the war was probably not in excess of 
two hundred and fifty." 

I'arrish. writing of the Swedish Cniony at Bishop Hill, Henry Cnuiity, 

ill llliniiis s;iid : 

"During the cholera scourge of 1S49-52 men would go to work in the morning 
in good health and be dead before sundown." 

Imoiii is;!; (or 1838) until IS 1(1 liirsch says: "Europe. Africa and 
America were ccnnpletely free frcmi chcilera." 

In the third pandemic the disease was widely prevalent and highly fatal 
in Illinciis. It is mentioned in the A'c/ioc/.s- on Practical Medicine in 18."51, 
1852, 1853, 1854, and 1855. In sduie nne of these reijorts Jerseyville is 
quoted as congratulating itself in escapint;- the epidemic, attrihutintj it to 
having appointed a local hoard of health and to the excellent woik done hy 
the board. Chicago also appointed a new l)oar(l of health whenever cholera 
was seen coming down the road (or down the lake or up the river), Imt it 
was not so fortunate as Jerseyville. 

The Transactions of tlic Illinois Medical Society reported cholera in 
lS(;ii-lSiM and IStiS. It was also present in 1S';3. By somewhere toward 
the end of ISC.'. the fourth pandemic was at hand and cholera was again in 
Illinois. 

The Committee on Practical Medicine reported its wide prevalence in 
l.s()G and 18GT. Dr. P. AI. Cook, reporting in 1868 said, there were 1582 
cases, 970 deaths in Chicago in Isii; : 1082 ca.ses were reported in October. 
October 10th, 175 cases were re|)orted. The population of that city in that 
year was given as 200,330. In 1868 the disease still prevailed. 

Zeuch^' gives the following instances of epidemics in several counties: 

White County, in 1832, 1S4S, 1856, 1866 and 1873. 

St. Clair County, 1832. Governor Edwards died of the disease in this epi- 
demic in Belleville. 

Sangamon County, 1849. 

Morgan County, lS:i3. "Thi' little village of .Jacksonville received a set 
back when cholera took a toll of fifty-three deaths." 

Greene Couuty. 1S44. "An epidemic of cholera destroyed fifty of the 
stru.ggling colony (Carrollton)." 

» Parrish ( ilisloiic iniiiois. tlie i-(imance of the earlier days. Randall Pni-rish. 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 45 

Adams County. 1S49. 1S50-1S51. 

Vermilion County. 1S34. 

Fulton County, 1S49. 

Henderson County. 1S49. 

Tazewell County, 1834. 1S44. 1849. 

Will County. 1844 to 1854. "The epidemic left in its wake a case mortality 
of 60 per cent. 

Kane County. 1849, "The Colony of Swedes at St. Charles was almost deci- 
mated by it." 

Putnam and Marshall Counties in 1849. "Cholera killed 143 in the Swedish 
colony at Bishop's Hill." 

"In 1832 cholera was mostly in the cities, but by 1834 it had reached the 
rural populations." 

Short's History of Morgan Caitiily rciiurted an epidemic of cholera last- 
ing six weeks in Jacksonville in the summer of 18o3. "In ISol cholera 
visited Morgan County; the path of the scourge was a narrow strip south- 
ward as far as Belleville." 

The Springfield Journal published a letter Alay 26. 1852. from Cairo 
which said "Cholera has been prevailing here for the past two weeks prin- 
cipally among recent German immigrants. Ten or twelve have died.'' June 
]4:th the same paper printed a letter from Walnut Crove which said. "There 
had been some fatal cases of cholera in Woodford County." 

The Bloomiugton Intelligencer corroborated this report of the death 
from cholera in that city of a man who had recently returned from a visit 
east and on the river. June T.)th chcilera was reported in LaSalle, Illinois, 
but reputed as under control. 

June 22nd the Monmouth Atlas re]iorted that cholera which had lieen 
under control in Warren County had reappeared. Dr. Wright who had been 
attending the cholera cases was one of those who died of the disease. 

The Springfield Journal on May ISth reported cholera at Cairo and at 
Peoria. 

The ligyplian Republican {]\mii i;i, l'J27) writing of Williamson 
County said : 

"Cholera made its first appearance in July. 1849, but caused only a lew 
deaths. It reappeared in 1866 and lasted for six weeks during which over twenty- 
five persons were taken away and the city of Marion vacated. Among the de- 
ceased were the three beautiful Ferguson girls, ladies without parallel in all 
the area for beauty and refinement." 

In 1867 the Illinois Medical Society had a red hot debate on the eating 
of fruit during an epidemic of cholera. Those who participated in the debate 
were Doctors J. Adams Allen, who introduced the motion, David Prince, 
W. S. Edgar, E. Ingals, T. F. Worrell, 1). W. ^■.lung, 11. A. Johnson and 
N. S. Davis. The resolution was aimed at the authorities of St. Louis who 
had tried to .stop the eating of fruit during the prevalence of cholera. The 
resolution which tinally carried, re.id ;is follows: "The moderate use of 
ripe but not stale or decayed fruit, taken at the ordinar_\- meals, is not ob- 



4G IIISTOKV OK CKUTAIN DISEASES PRIOR TO 1877 

jectionable as tending to produce cholera, hut ratlier is conducive to the pres- 
ervation of health during the hot season." 

L. T. Ilcwins of Loda (Committee of Practical ^Medicine) reported 
cholera jircsent in IS(ir) in Alexander, Coles, Champaign, Cook, Iroquois, and 

])r()lial)lv other ciiuiilies. 

Yellow Fever. 

The mos(iuitoes which act as vectors of yellow fever are found in the 
southern end of the State, yet there are only two records of epidemic of 
yellow fever in the State. In August, September and October 1878 yellow 
fever prevailed in Cairo, Illinois. In all there were eighty cases of the dis- 
ease with sixty-two fatalities. In that year an extensive and highly fatal epi- 
demic prevailed in the lower Mississippi River Valley. The nearest point to 
Cairo reached by the disease prior to its appearance in Cairo was Hickman, 
Kentucky. By a strange irony it appeared first in the household of the 
Cairo Bulletin whose editor had been active in stimulating the authorities 
to clean up Cairo and simultaneously in trying to caln; their fears. 

So far as the record shows the disease prevailed solely among residents 
of the city of Cairo and it did not spread to any nearby city nor to the sur- 
rounding country. Just who brought it into the city was never known. The 
first case w"is the father of the publisher of the Bulletin and he died in the 
Bulletin office. Later the editor and two printers of the Bulletin died with 
it. The disease abated in September and the schools opened, but it reap- 
peared in October and lasted until the frost came in the latter part of the 
month. r)n October (ith there were six deaths from it. 

Perhaps this epidemic was sent as a baptism of fire for the infant State 
Board of Health. 

On several occasions cases of yellow fever have developed among ref- 
ugees in Chicago. There have never been any secondary cases. 

An accnunt of a small outlireak at Centralia is found elsewhere in 
lhi> volume. 

Dengue. 

Jn 18'2.S there was almost a iiandemic of dengue called by some the 
Spanish fever. It travelled a long distance u]) the Mississippi River but 
there is no evidence that it w-ent north of the 3-lth parallel, and Illinois prob- 
ablv escajied. There is no record that the people of Illinois ever suffered 
I'n.ni dengue. Since the mosquito which spreads this disease is closely re- 
lated to the varietv which sjireads yellow fever and since this type of mos- 
quito is onlv found in the southernmost part of the Slate, dengue should 
never menace Illinois. 



history of certain diseases prior to 18 i 7 47 

Snake Bite. 

In the early Illinois days snake bite was frequent. [Many fatalities re- 
sulted. 

In the Reports of the Committee on Practical Medicine snake bite was 
reported on in 1852. In 1854 Dr. Daniel Brainard made snake bite the 
subject of his presidential address before the State Medical Society. He 
did a great deal of scientific research work on the subject. He said Indians 
used rattle snake venom on their poisoned arrows. He showed that the 
whiskey cure was worse than useless. He advocated local treatment with 
iodine. 

Snake bite figured in other discussions before the medical societies. As 
the country became more densely settled and the land better cleared snake 
bite as a menace to health and life disappeared. The favorite remedy for it, 
whiskey, remained as a menace for a long time afterward though its use 
(as a remedy for snake bite) is about to become legendary. 

TvPHus Fever. 

llirsch"- makes the statement that he never found a single reference to 
typhus fever in the Mississippi Valley. It is probably true that European 
typhus never invaded Illinois. In about 1916 there were a few cases among 
Mexican laborers along the Santa Fe railroad within the State but the au- 
thorities prevented it from spreading. It is also true that cases of Brill's 
disease or modified typhus have been reported from Illinois but it is a state- 
ment of essential fact to say that in the period of Illinois history, now under 
consideration, typhus was never present. 

Drake''^ says that Indians were infected with typhus from a ship at 
Nantucket in 1763, but no evidence is found showing that typhus ever 
reached the Indians of the Illinois regimi. Drake writes abinit Irish immi- 
grant fever, but mentions no cases in Illinois and Indiana. -Vnd yet the 
disease is rather frequently referred to in the writings of physicians and 
even in the reports from the Chicago Health Department. It must be re- 
membered that Louis did not difTerentiate typhoid fever from typhus until 
1s-.':i, and his views were not generally known in Illinois until at least ten 
years later. Som.e of the references to typhus in these earlier reports re- 
ferred to typhoid and some of the low delirium .stages of malarial fevers and 
other diseases. 



' Hirsch, Ibid. 
I Drake, Ibid. 




First health officer of Chicago, appointed in 1S37. He 
was probably the first municipal health officer reg- 
ularly appointed by a board of health in Illinois. 



HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 



49 



When the controversy over t}-phoid was warm. Dr. E. P. Cook of Men- 
dota said he had seen typhus in Ireland and what he saw in this country that 
was called t^■phus was not the disease he saw under that name in Ireland. 
Mirsch probably overlooked the definite re- 
ports of tv])hiis "jiven in some instances by 
street location found in the Rrports of the 
Chicago Health Dcpartninit in 18(3T, 1868 and 
isd!). The diagnosis in these cases was prob- 
dblv erroneous but Mirsch had no way of 
kn(}win<;- that. 

( )ne sometimes wonders how llirsch 
tailed to read the so-called Ranch Report of 
thi Chicaf/o Health Department made in IS'io 
or IS'Il. Hirsch's Handbook is encyclopedic. 
He seems to have had access to nearly all the 
literature of the world, yet somehow he seems 
to have missed this Ranch report and in spite 
of some of the mistakes found in it we know 
of no American re]iort of the {:)eri(.i(l which 




compares with it. 



Smallpox. 



Smallpox was a disease of the Indians. It was brought to them by 
white men, but just when is not known. It may have been among the Illi- 
nois Indians at the time of the French-Canjidian occupation, but there is no 
proof of the fact. It was elsewhere and it is not easy to understand why 
the Illinois Indians escaped if they did. 



Drake ■' wrote : 

"Smallpox has penetrated far into the wilderness and proved extremely 
mortal among the Indian tribes. Ross tells us the chief remedy used by the 
Indians for smallpox was to pour cold water over the patient. It was a period 
in which smallpox was very prevalent and highly fatal among the Illinois popula- 
tion. It came in periodic epidemics and most of these were due to a violent 
virus. Vaccination was not general." 

Catlin-'"' says ; 

"Trade and Smallpox were the prin<-ipal destroyers of the Indian tribes." 

Hrdlicka, writes of the Southwest Indians of our times what has been 
true of Indians for a hundred years or more. "Smallpox is the most dan- 
gerous contagious disease." This disease has plagued the white man ever 
since he landed in America and for that matter long before. 



"Drake, Ibid. 

3'Catlin (North American Indian.s 



nin:!). I'lil). 



50 



HISTORY OF CERTAIN DISEASKS PKIOK TO 1877 



1 iirsch'-'', spcaUinsj of smallpox in America says to whatever places the 
Euro])ean inimisjrant camr ami scttU-cl. everywhere thev carried the disease 
willi llieni and i^axe it to the natives. i5ut a still mure lerrihle sdurce for 
.America \\a> tin- ini])iirlatii>n ot' nciiin sla\es. livery fresh outbreak of 
smallpox could he traced tn importalinn fmm Africa. 

Table I. 

Deaths fko.m Smai.li'ox — City of Chicago. 

Rates Per 100,000 Population. 

1S6T-19-26. 



1867 
1868 
1869 

IS70 

1S71 
1872 
1S73 

1S74 



1876 
1877 
1878 



1881 
1882 
1883 
1884 
1883 



1887 
ISSS 
1889 
1.S90 

1891 
1892 
1893 
1894 
1895 



1898 
1899 
1900 



1901 
1902 
1903 
1904 
1905 



1911 
1912 
1913 
1914 
1915 

1916 
1917 
1918 
1919 
1920 

1921 
1922 
1923 
1924 
1925 



0.04 
0.14 



Wherever it came from and whatever the source of reinforcement small- 
pox was present somewhere in the State practically all the time after 1S40 
and it was epidemic somewhere in many of the years. 

The Reports of the Cominittee on Practical Medicine refer to the dis- 
ease in 1S,')2, 1855-1857, 1858, 1869, lS7v. and 1875, as being epidemic in 
one or more counties in the State. 



'Hirsi'h, Ibid. 



HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 51 

The Annual Reports of the Chicago Healtli Dcparlincnt shows that the 
disease was prevalent in that city in every year lictwecn ISG? and ISSS (See 
Table No. 1.) It was present in epidemic prujiortions in many years jjrior 
to 1867. 

Among the reports of smallpox epidemics in lllinnis found in Zeuch's 
History of the Practice of Medicine are: 

Henderson County in 1854 and 1855 and Kankakee County in ]8.'!7-;iS. 
The account says: "Smallpox ravished the settlements during the winter 
of 1837-38." A history of Williamson County (Egyptian Republican June 
JJ, ig^y) says, "The smallpox has visited the county on several occasions but 
never resulting in nu'un- deaths until 1S7 3 when a good many died in the 
south side of the cuunty." 

Erysipel.\s. 

The student who considers the prevalence of the different diseases in 
Illinois in the first seventy-five years of the nineteenth century is struck by 
an apparent relationship of a group of diseases now known to be due nr in 
some instances suspected of being due to members of the streptococcus group. 
The diseases referred to are erysipelas, scarlet fever, puerperal fever. se])ti- 
cemia and rheumatism. In the early days these diseases were very prev- 
alent. In many cases they swept over communities in epidemic proportions. 
Furthermore, their case fatality rates were higher than in the present day. 
One of the significant improvements in the last half century is the lessened 
prevalence and the lowered virulence of most members of this group. 

In Ma\-, l'.i".'7, R. M. Atwater-'", writing of the relatii)nship of this group 

of infective disorders, said: 

"When rheumatic fever is compared with scarlet fever, chorea, erysipelas. 
septicemia and puerperal fever, it is seen that the trends, as well as the yearl.v 
oscillations of these diseases, are alike. Acute rheumatic fever appears to be 
related to the family of streptococcal infections. There is a community of rela- 
tionship between these diseases. This correspondence appears in the United 
States, as well as in the English records where it may be traced back as tar as 
seventy-five years." 

In the early history of the State erysipelas was l)oth freipient and fatal. 
At times it swept over the country in well marked epidemics. In spite of the 
fact that the sick were generally cared for in their homes and hospitalization 
was rare, the disease was regarded as contagious at least in certain epidemic 
outbreaks. Some relations to puerperal fever and hospital gangrene and 
perhaps other infections were guessed at here and there and at intervals. 

A study of ei)idrmic erysipelas made by Dr. l'',ihnund Andrews in Chi- 
cago in 1808 will be fnund in the section dealing with Chicago. He made 

^'Atwaler (American Journal of Hygiene). 



52 1IIST0R\' OK CERTAIN DISEASES PKIOK TO 1877 

spot maps of the disease and tried to show its relation to the very foul 
stretches of the Chicago River and to badly sewered sections of the city. 

in ls|;; and ISII their \\a> a ^real epidemic of erysipelas which was 
rc])oited by Doctors J. 1*". IKnry, and Lnlliurn'^ of i!loomin<;;ttjn. 'i"he\' re- 
ported that the disease came from the Mast and that the ejiidemic extended 
far beyond the boundaries of the Slate. 

One of the names by which erysipelas went in that early day was "Ijlack 
tongue". Dr. Meeker-'" of Rush Medical College wrote a paper in May, 
ISKi, on black tongue or eijidemic erysipelas, as it appeared in LaPorte 
County. Indiana. He said the epidemic first appeared in Canada. During 
the \\ inter of 1842 notice appeared in the public papers of an epidemic pre- 
vailing along the Illinois River called the black tongue. It was extensive 
and highly fatal in Lal'orte County in isi.'). In 18 Ui Ur. l-'itch''", reported 
the ])revalence of the same epidemic in Logansport, Indiana. 

In Drake's" writings erysipelas is fre(|ueiitly rejjorted under the name 
"Black tongue". 

In 18(11 Dr. N. S. Davis, in reporting for the committee on practical 
medicine said: "Those epidemic diseases chiefly worthy of mention are 
erysipelas and cerebrospinal meningitis. Coincidently with the presence of 
erysipelas, typhoid and typhoid-pneumonia were unusually prevalent. There 
was a wide-spread epidemic influence of a tophus ty])C." At that date Dr. 
Davis could not get awav from the use of the word typhoid in describing 
ciinditions of low vitalit\- regru'dless of llie disease which caused them. He 
more or less connected together all diseases in which <leliriuni and other 
sym|)toms of that class were present. 

In the Report of Ihc Committee on Practical Medicine of the Illinois 
.Medical ."^ocietv there are reports on erysipelas in 18.")1. 18.").j, 18li(). 1803, 
isd I. iscii an<l is:);. 

The 18ii:i i-eporl treated especi.alh' of hosijital erysipelas in connection 
with g;uigrene and suppur.ition and olln'r ettects of crowding in war hos- 
pitals. 

Dr. Sanuiel Thomi)son t Committee on Praclieal Medicine 'Sj^i) said 
"Krysipelas the fatal nialailv made ils a]ipear;uice in l*"d\\ards and neighbor- 
ing counties in 1844-4."i". 

»Cc>lbiirn (W.stirii .M,di,-.il ami I •|i.\ sii:i I .Iciirual ). 
:»Dr. Mi-ckir (III. :in<l liid. :Mi.<lii:il .iiiil SiiiKiral .l..miiMl). 
"Fitch (111. .-nirl liul. .M.di.al anil SinKiral .loiiiiial). 
" Drake-, ibid. 



HISTORY OF CERTAIN DISEASES PRIOR TO 18?7 



53 



Dr. Nance of Lafayette said an e])i(leniic 
town in 1859. 



if erysipelas prevailed in his 




Dr. Win. Massie of Grand View, Edgar 
lllunt^• I Cdiiniiittcc on Practical Medicine 
iSjf)) (|U(itecl Dr. j. S. \\hitniure of Aleta- 
ninra. Wdddfnrd (.dunty. as saying erysipelas 
and puer])era! fever go hand in hand. With 
this he agreed. 

Zeiich'- quiites a plivsician as saying of 
Kane CiunitN' when it was first settled. "Ery- 
sipelas was nuire malignant than it was in 

is;,s." 

In isii; Dr. I laniill told the American 
.Medical .Vssociaticm ahont two great epidemics 
of erysipelas in Illinois. One was the great 
Chicago epidemic of l<S(i3 reported hy Dr. 
L)r Wm Massie ^- Andrews and referred to elsewhere, the 

other was a report by Dr. McV'ey (if an epi- 
demic in Morgan County in 18(14 of which McVey said, "Erysipelatous fever 
which has far exceeded in fatality even cholera itself." 

Scarlet Fevkk. 

Drake^^ says : 

"Between 1791 and 1793 scarlet fever invaded the settlers in Kentucky and 
Ohio. It was called 'putrid sore throat'. From 1793 to ISOS I do not know that 
any form of scarlet fever appeared in the Ohio Valley. Since 1S21 for twenty to 
twenty-five years at no time has evidence of scarlet fever been absent from the 
Valley of the Mississippi and the Lakes. The epidemics in the north are more 
frequent and more fatal than those of the south." 

Parrish^'' cjuotes Davidson and Stntvcs History as saying: 

"In the year 1797 a colony of 125 persons, the largest which had yet arrived, 
was fatally stricken with disease at New Design, (Monroe County, near Burks- 
ville). A putrid and malignant fever broke out among the new comers attended 
by such fatality as to sweep one-half of them into the grave before the coming 
of winter. No such fatal disease ever appeared before or since in this country." 

It is doubtful whether this wa-. scarlet fe\'er. In the quotation pre- 
ceding this one scarlet fever is called "putrid fever." However, the term 
"putrid fever" is generally used as a synonym for di])hlheria. In all prob- 
ability this fearfully fatal epidemic was either diphtheria or scarlet fever. 

1 Irdlicka*'' says, "The Indians of the Southwest now have very little scar- 
let fever. However, scarlet fever in that section is comiiaratively rare among 
the whites." It seems probable that scarlet fever was found at times among 
the Indians and whites in the French regime. 



' Zeuch, Ibid. 
' Drake, Ibid. 
' Parrish, Ibid. 
= Hrdlicka (Uur 



ui of EthnoIoKy, Bunetin :!4, lOOS). 



54 HISTORY or CKKTAIN DISEASES PIUOU TO ISTT 

In tlu- earl)- ])art of this (.■unltii-y w lu-n ihe otlier stn-plncoccic diseases, 
naiiK-ly, erysipelas, puerperal fe\rr, I'alal siii)purati(ins in eumpcmnd wounds, 
and ]ierhaps pneuinoiiia and meningitis were so prevalent, fatal scarlet fever 
niu^t have prevailed extensively. Even fifty years ago the case fatality rate 
of scarlet fever was far higher than it is liidaw 

Scarlet fe\-er is found re])orted in the TraiiSdrlidiis of tlic Illinois Medi- 
cal Society in J.s.-)1, 1852, 185:, 1858, 18(iO, IS(;!), ls:o, 18-5, 18: G, 18:1 and 
1888. 

The Decennial Census Reports for Illinois for J8(i(l to 1880 show the 
scarlet fever death rates as follows: 

J .SCO ls:0 1880 1890 

US.: 85.1 44.4 11.5 

Rates per 100,0(1(1 population. 

The Chicago Health l)e]iartnient Ke])orts show the death rates from 
scarlet fever during the census }ears as follows: 

1S51 ISdO ]8:o 1880 1890 

50. IM.T !1!).,-, g:.4 16.1 

Rates per 1 00,000 pojjulation. 

Me.\sles. 

Drake""' says: "Measles was brought in by the immigra.nts. It af- 
fected white, black and red population in an equal degree. The people of 
that da\- recognized the need of isolation as a method of controlling measles." 

-Measles was reimrted ]iresent in the State in the Traiisaclioiis of the 
State Medical Society for 1.S51, l,s5-.\ l,s55, l,s5:, ISGH, is:-? and ls;(;. 

Zeuch^^ refers to measles as being epidemic in Hardin County in 1S18 
and in Henry County (Prophetstown) in 1835. 

Measles then, as now. was accepted as inevitable. It was iirobably 
endemic at all times in the State, though it was only repiorted on at intervals. 
Probably there was nothing out of the ordinary for the reporter to say. 

The following statistics show the trend of the disease: 

Death Ratic Per 100,000 PoruLATioN. 

1851 1800 is:0 ISSO 1890 

Illinois (i.:i •.':.(; 10.5 8.3 

Chicago (L PC: ;!0.9 25.6 5.5 

" Drake, Ibid. 
•' ZciHli. n)ifl. 



HISTORY OF CERTAIN DISEASES PRIOR TO ISTT 55 

DlPHTHEKIA. 

Hirsch*^ thinks the honor (if first describing diplitheria belongs to 
"Areteus the forgotten" one of the distinguished physicians of the later 
Greek period. However, he credits Bretonneau with naming the disease and 
really establishing it, in 1835. However, in ]855 and even ninch later great 
confusion prevailed relative to it. Hirsch calls attention to the fact that 
diphtheria was confounded with scarlet fever in the United States in the be- 
ginning of the Nineteenth Century, l^^lsewhere attention is called tn the pos- 
sibility that epidemics of so-called ])utrid sore throat among early llliiKiis 
immigrants mav have been either diphtheria or scarlet tever. 

Hrdlicka says that among the Indians of the Southwest epidemics of 
diphtheria have been known to prevail at times. There is nothing on the sub- 
ject in the literature as to either whites or Indians in the French Canadian 
regime. In the Transactions of the Illinois Medical Society diphtheria was 
late in making its appearance. It was rejiorted in ls.")7. lS(i(i. iscl. IsT'i. 
187G, 18T8. 

The trend of the disease once it became recognized is shown ])\ the fol- 
lowing mortality rates per lOO.OOO: 

l.soo 1870 1880 181)0 

Illinois : . ."lil . 1 v'".' . M 93 . 



1870 


1880 


."lil.O 


Iv'-.MI 


.-.3.4 


184.S 



Chicago UO.!) .-.3.4 184.S :-^.8 

Dr. C. H. Johnson'-' recounting some of his trying experiences with 
diphtheria in Central Illinois in the early da\s ijuotes Henry Ward I'.eechei 
as saying "When a case of diphlheria occurs the family is apt lo attribute 
it to a visitation of Providence. .\ dispensation of Providence! W hw it 
is nothing in the world but rotten cabbage and turnips in the cellar!" 

Zeuclr'" says of Kane County; "After 1856 diphtheria di -place 1 ty- 
phoid fever. Diphtheria made man\- a household desolate." 

(.'VXANCHE. 

The death of Ceneral (jeorge Washington was caused b\' cynanche in 
the opinion of the physicians in attendance. This was in UIM). l<"or three 
quarters of a century thereafter Washington was not the subject of i-rilical 
inquiry. About that time tlie habit of inquiring into everything and r\er\- 
body was developed. 44un tlu' almost sacred traditions and myths about 
Washington came under the microscope. Somewhere in the s;imc gciiei'al 

"Hirscli, UjuI. 
■"•Johnson, U.iil. 
"■Zeueh, Ibid. 



5() IIIST()K^• OK CICKTAIN DISICASES PRIOR TO ]8TT 

period bleeding as a Ircatnirni for disease having lieen aliandoned, was in for 
some condemnation, 'i'his nuani a hattle of tiie pros and cons. The cons 
alleged among other things that (ieorge Washington had 1jeen hied to death. 
This opened the subject of Cjeorge Washington's last illness, l^jst mortem 
and (|uite bi'latcd diagnoses of di])btbcria. pnruinmn.i and other diseases 
were m;ide. 

( )ne ri-a^on for the inicertainl\' un the nature of General Washington's 
la.st ilhu'ss lay ni the cause of death as gi\en by the attending ]jhysicians. 
It was CNiianche. The disputants had never heard of cynanche. They could 
not lind it in the books. The way was cleared for attributing death to what- 
ever the contenders might claim. 

In ]r)2G, Dr. Waller A. Wells of Washington reviewed the evidence and 
proved that George Washington was not bled to death nor was there any 
kind of malpractice. He agreed that the ex-President did not die from diph- 
theria or pneumonia. His death resulted from an inflammatory oedema of 
the larvnx due to some unknown infection and the accepted name for the dis- 
order in that day was cynanche. 

Whether the name cynanche was coined b_\- the Edinburgh School of 
Medicine or not does not a])pear, but the great medical lights of that city 
wrote much about the disorder calling it cynanche. Cynanche might be 
called a creation of h^dinburgh. In that da)- Edinburgh was the fountain 
head of medical lore. Two of Washington's three physicians were ardent 
students of the lMlinbtu"gh school. 

The diagnosis of cynanche was a ])ro]:)cr one in that tlay. There are a 
few rei)orts on it by jjliysicians of the upper Mississippi Valley in the medi- 
cal journals of the early day. 

The 1S(;!) Rcpoii of the Chiciujo Ilrallh Jh-partuiciit which carried vital 
statistics by causes of deaths f(u- each year after IS.") I, contained reports of 
deaths due to this disease yearly from IS.V^ to lS(i7, inclusive, except in 1X56 
and ISti,-). 

Presumaldv death certificates giving cynanche as the cause of death 
were being bled elsewhere in the State as late as ISi'i.j. 

It nia\- be that c\nanclie has ceased to trciuble the [leople of the state, or 
it ni.av be th.at the disorder still exists but that it goes by other names. 

Ali';.\i\(;iTis. 

Hirsch'' sa\s: "1 he e;niie^l infurniatiim mi epidemic meningitis dates 
fidin isii.'i in wliich year tlie disease was prevalent in Geneva. Switzerland." 

In the L'nitcd ."^i.'ites the disease ap|ieared first in New Hampshire and 
Massachusetts in abotU ISo;. I!y is Hi it had spreafl td the western and 

•••' Hir.sih (Hamllxiiik of lludsraphic and 1 li.stniical l'atli.ilof;v, vol. III). 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 57 

southern States. It seemed to spread from centers. That first epidemic in 
the United States came to an end in about 1816. 

In 18-16 Gray reported an epidemic in JeiTerson County. Illinois, and 
elsewhere in southern Illinois occurring in LS45. 

Hirsch says that from 1857 to 1871 the United States was again the 
chief seat of epidemic meningitis. Scarcely a year passed without its being 
seen over a larger or a smaller area, its diffusion from first to last covering 
the whole of the country. 

In lS(i;!-()l it was ei)i(lemic in the southern and central [larts of Illinois. 
Hirsch quotes from Davis"'-' and AlcN'ey'''. "I'.ut in the winter of 186.") it 
broke out anew in various parts of Illinciis. In 1S72"' it was epidemic at 
Edwardsville, Crawford and other parts of Southern Illinois." 

Hirsch says from 1805 to 1830 the disease was in isolated epidemics at 
various places in Europe but was more general in the United States. From 
1854 to 1875 the malady reached its widest dilTusion throughout most of 
Europe and the L'nited States. In Illinois under the names of spotted fever, 
meningeal fever and meningitis, cerebro-spinal meningitis prevailed with 
considerable frequency. At times definite epidemics were recognized. 
Oftentimes meningitis was confused with other diseases in spite of the fact 
that the disease loomed large in the minds of the physicians of the .State. 
It is referred to in the Reports of the Coiinniltcc on Practical Medicine of 
the State Medical Society in ls.")-i, l.s."i5, isiil, ls70, ISM, LS^I, ]S76 and 
1878. . 

In the report for lS(il Dr. X. S. Davis as chairman wrnte "Those epi- 
demic diseases chiefly worthy of mention are erysipelas and cerebro-spinal 
meningitis." The report for 1873 said "Meningeal fever rapidly extended 
over the valley of the Wabash." 

Zeuch's Historv of the Practice of Medicine refers to an epidemic of 
it in Kane Cnunty in 1856. 

Epidemic Oi'iitiialm i a. 

In 183o-3G according to Drake, a widespread epidemic of oi)hthalmia 
prevailed in the territory in which Illinois is embraced, l^rake wrnte "It 
would be interesting to discover its cause." In the same [laper he wrote 
"Neuralgias, dyspepsia and chronic hepatites are common." 

In 1861 in the Report of the Conniiittee on Practical Medicine, N. S. 
Davis wrote "iM-om 1S5-.' in |s.'i5 erisiiiel.-ilous (j[ihthalmia prevailed." 

The references to ophllialniia in the literature of the period were many. 



== Davis (Transat-tion.s, lU. .\liil. .Soc, 1SG7). 

» McVey (Transaeti()n.s, 111. Med. Soc, 1S67). 

"Southern Illinois. (Pliiladelphia Med. & Surgical llpts 



58 IllSTOKV or CICUTAIN niSKASKS I'UIOR TO 1ST7 

W'l- (if this (la\- wciuhl like lu broailcii iIk' ([uei')' of Drake and say "It 
would !)<-■ iiilcrrsliiiij tu Icani what was tliis oiilithahnia which so plagued the 
people of that rnvly day, wliat was its eatise and why has it disajjpearcd." 

SvPIilLIS. 

The venereal diseases were recognized as of puhlir lu-alth inipurtance 
in the earl\- medical history of Illinois in sjiile nf the fact Uiat tin- pupulatidu 
was lari^cK- rural. The 'rraiisarliDiis of tltc SUilc Mftliral Society tor the 
year prinr t(i Isil ccmtain a small numliei" nf ]iapers on the subject. Some 
of these papers prdpuM-d laws and otln-r connnuuity actiim fur their coutriil 
in view of their social and paUinlni^dc inijmrtance. However, action was de- 
layed for many years. 

Syphilis is of especial interest in this health history nf Illinois because 
the early settlers w-ere in contact with the Indians for a long time. There is 
a wide belief that syphilis was of Indian origin and that the Spanish sailors on 
the expeditions of Columbus contracted the disease and carried it to Europe 
where the}- spread it somewhat. Europe according to this theory was syplii- 
lized bv invading armies from the Mediterranean district, these armies hav- 
ing themselves been syphili/.ed by people infected by Culumlius' sailors. The 
current seems miw to In- running away from that theory. The present trend 
of opinion is thai the Eurcipeans brought syphilis to America rather than that 
they carried it in the other direction. Since syphilis had a tendency to cause 
bone lesidMs this disease lends itself unusually well to speculation of this 
character. 

On tins pdini llrdlicka'-'' says :"Syphilis exists in the Indians as it does 
in the whites, therefore, if syphilis existed before the Spaniards reached 
this country signs of it should be at least occasionally discovered in the an- 
cient burials. But the bones of the old burial places are as a rule free from 
any sign of the disease and this is true of the Ijones from ancient graves in 
California, tlie northwest coast and other localities e.\clusive of some 
mounds. It is diftieult tn see if the disease existed before the whites came, 
how, with the well known wide intercourse among the ln<lians wdiole regions 
could escape it. It may be remarked that it is also absent in the older burials 
in Peru and olher localities in South .\merica." 

W itli this Joseph Jones'"' who investigated the skeletons of mound build- 
ers in the ( )liio \'alle\- principally in Kentucky, Tennessee and the states to 
the norlh of the ri\er, does not agree. 

lie fonml esidence of sy|)hilis in the bones of the mound builders. 
Based on lhi> linding he t'xpressed the opinion that syphilis was one of the 

MHrdlifk.T (.Icuirnal, Am. Jledical Assn., Mar. Id, run;). 

M Joseph .tonus (X. (). Ih-d. & Sni-Rical .loiirnal, .June, 1S7S). 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 59 

pestilences which destroyed vast numbers of the aborigines. It is not cer- 
tain from the reading of the text whether he meant to say that syi^hilis among 
Indians was a pestilence pri(jr to the Cdming of the white man. liut it is cer- 
tain that he was sure that the bones he examined showed that the mnund 
builders had syphilis of the bones prior to the discovery of America. His 
report supported the Columbian theory of the origin of syphilis. 

Jose])h Jones was an able scientist and a learned jiathologist for hi^ day 
but he could easily have been in error. It will be recalled that at one time 
the lione lesions found in the l^gyjitian mummies were thought to be syphi- 
litic and this was given as proof that the Columbian theory was wrong. It 
was not until a very capable modern British pathologist, Ruffier examined 
these Egyptian mummies that it was proven and accepted that the lesions 
were not syhilitic. Probably a review of the evidence in the case of the 
mound builder's bones might lead to a reversal of Joseph Jones' opinion as 
it did in the case of the Egyptian speciinens. 

Dr. Michel Gandolphe''" says the origin of sy])hilis is one of the most 
controverted points in medical history. The epidemic of the disease which 
prevailed so widely in Europe about 1900 acts like a curtain in shutting out 
all the history of syphilis which preceded that conflagration. He says the 
research in the literature made by Notthaft of Munich exhausted all the pos- 
sible ties of solution on the literary side and came to no conclusion. There- 
fore, he advocated trying tn solve it b}' study of the bones of ancients. 

Lortel found what he thought was evidence of syphilis in the skull of 
an Egyptian nnmimy. (iandolphe examined this specimen and disagreed 
with Lortel. 

But in 1111 1 Raymond sent Gandolphe two bones from a skeleton found 
in a cave in the .Marne region in France. These bones were from ]ieiiple 
who lived before the days of Christopher Columbus, (iandolphe and also 
Raymond thought these bones were syphilitic. 

Whether or not the Indians infected the whites with syphilis originally, 
or vice versa, it is nevertheless true that this disease was moderately prev- 
alent among the whites during the period covered by this history. They 
doubtless brought some of the infection into the State with them. The 
several army posts located in the area nnist have contributed to its spread. 
However, the great majority nf the people were males. They lived isolated 
lives. Syphilis was not a major health problem. 

Kramer holds that the Indians had syphilis in the pre-Columbian period. 
He bases his opinion on the relative freedom of the Indian from general 
paresis. This he thinks is because they went through that jihase in the evo- 
lution of the disease prior to 1.')(|(). The while European became suliject 

"Gandolphe (Lyon Medicul, Aug. i, 1U1L>. In-. .Miclu-l i laminlplic ). 



60 HISTdin' OF Cr.KTAIN DISEASES PRIOR TO 1877 

to it aluiut loDii. Al)()ui i;i)() lu- lie,<,'an tn (k'velop nerve syi)liilis. Since 
1IU)0 he has Ijeen passinsj mil uf tlir .stai;x- of nerve syphilis. 'The black man 
is following in his footsteps about two huniired years bchinil the white man 
just as the red man preceded him. 

There are many accounts of the presence of syphilis and other venereal 
diseases ainong the Indians at later periods. Ross names the venereal dis- 
eases as being among the more common com])laints of the Indians in the 
eighteenth and nineteenth century. 

Hrdlicka", speaking of modern Indians says "V'enereal diseases, while 
predominant among the more degraded Indians, are more or less effectually 
guarded against by others. The Indians tried hard to prevent the whites 
from infecting their people with venereal diseases. 

I. W. Hunter''" who lived a captive among the Indians from 1796 to 
181(1 re])orts "They had no syphilis until they contracted it from the whites." 
So far as it is possible to conclude from so little evidence the conclusion is 
that syjjhilis was in France long before Columbus sailed from America. 

GoXORPtHEA. 

Gonococcal infections are supposed to be far older than syphilis. They 
are mentioned in the Bible in several places. For all that is known they were 
present in Egypt before the Hebrews were there. \\'hen these infections 
came into Illinois is not known, nor where. Armies of some sort and army 
posts were always in evidence in the State. There were French. Spaniards 
and British to iic fought and the Indians were a constant menace. All in 
all there were enough sources of infection. 

Fortunately the peojjle were hard-working and they lived in rural com- 
nnmities in the main. Gonococcal infections never constituted a major 
health prolilcm. 

("OXSI'MFTIOX AND ( )THEI{ FoKMS Ob' TuiiERCl'LOSIS. 

In 18 13 Daniel Drake''" wrote "The most ]M'evalent disease of the In- 
dians is scrofula. It almost annihilated the Peorias." His description of 
scrofula shows that he includes tuberculosis of the lungs and bones with 
tuberculosis of the glands and lungs. lUit this oi)inion was not the general 
<ipinion. It may ha\r been true of the Peorias as Drake Imd heard but if so 
it was for some s])rcial reason. Although the Indians of the period had 
tuberculosis the general opinion coincides with that of Hrdlicka that Indians 
living under primitive conditions are not wiped out b_\- consumi)ti(in. To 

'»Hi-<incka, 11. ill. 

'■"Hunter (Nrw Voik .Mfd. & I'liy.siial Journal. JSS2, 1-174. I. \V. Hunter). 

""nrako. Tbid. 



HISTORY OF CERTAIN DISEASES PRIOR TO l.STT 



add to the improbability that Drake's opinion held for all Indians the physi- 
cians of the State at that time did not regard consumption as very prevalent 
among patrons. 

In IS-I I Drake travelled acros.s tlie State to St. Louis and up the rivers 
to Chicago westward to Galena and south down the river. He wrote in his 
journal "The physicians from Jacksonville to Joliet tell me that consumption 
is one of the rarest diseases in Illinois." He recommended that the State be 
investigated as to its advantages as a tuberculosis resort. x\s late as 1873 
Dr. Harrison Noble included in his Report on Practical Medicine to the 
Medical Society this statement "I have never seen a case of consumption 
in Illinois that could not be traced to Xew England soil." 

In 1859 Dr. G. W. Phillips of Di.xon wrote: "It is a fact that con- 
sumption is rare in the prairie State of llhnnis." 

Gerhard^' said that the consum])tion death rate in Illinois was only 13G 
per 100,000. That rate was the lowest in a list of consum])tion death rates 
in twelve states given by the writer. 

The only references to consumption found in the Reports of the Com- 
mittee on Practical Medicine were found in the reports of 1S52, 1.S55, 185'J, 
186!), 1873, 1874 and 1875. 

_ In his Report on Practical Medicine to the 

.American .Medical Association in ISCiT, Dr. 
R. C. Haniill wrote "The opinion is entertaine<l 
by some of the oldest practitioners that con- 
sumptives emigrating from the New England 
.States have found length of days by residence 
in our ijroad prairies". But he did not accept 
their opinion for he wrote: "Consumption 
heads the list of diseases that consign to early 
graves the youth and promise of tjur Country." 
In a second report on epidemics in Illinois 
made to the same association in l.s;o. Dr. 
Hamill ipiotes Dr. Haller of A'andalia as writ- 
ing "Pulmonary consumption is increasing 
here at a fearful ratio. Nearly all the land in 
the count}' is drained". There were man\- who 
thought malaria due indirectly to ])oor drainage protected against con- 
sumption. 

The general trend of these references was that the disease was of small 
consequence in the State. Occasional articles were devoted to the explana- 
tions of and reasons for the comparatively small amount of consumjition in 




It Is. IS 



K As 11 Is; its llistiirv. Cec.si-ipliv, 
Fri'deriek Gerliarrt, Cliicago, lU.). 



6"2 IlISTOm' OF CKKTAIN DISICASES I'KIOK TO ISTT 

Jlliiicn\. Tlu- (Icalli rates fniin ihc disease as ^'iveii l]y the Census Office 

wiTe per 10(1.(11)0 ]i(>piilali(iii : 

18,-)0 J SCO 18T0 isso is'.iO 
114.5 145.0 i:i|.-l 14s.!( 

Tile death rates in Chicago as shown hy the Cliicatjo Health }1cpar;incni 
Krf'ovt were : 

IS51 l,S(iO 1870 1880 IWiU 

123.5 25,2.8 i:(j.s 1G9.5 16:5.2 

The figures do not suhstantiate the opinions of the pliysicians of the 
time. It is not necessary to discuss the reason for their error. It is enough 
to say tlie error is a common one. I-'.veryw-here in the [leriod when the 
general opinion is that consumption is a rare disease it is fnund that the 
deatli rate from it is around 280 jier 100.000. .Vs attentinn is directed to 
it. the consumption deatli rate conimimly declines. The limits uf this de- 
chne is ahout 1 10 per KJO.OOO. 

During this period the causes indirectly respimsilile lor the decline are 
certain changes in customs and attitudes. The cases are recognized and 
some effort is made to prevent them from sjireading infection. Careless- 
ness in spitting gives way to some degree of care. Sleeping with consump- 
tives becomes less general. Ventilation is im])roved. Wages go U]). Stand- 
ards of living are raised, food is more abundant and of lietter quality. Pro- 
found fatigue is less general. These are illustrations of the kind (if change 
in custom, habit and attitude which reduces the consumptioit death rate 
from about 280, the level of no information of facts nor interest in them, 
to about 140, the level at which specific work against the disease is generally 
added to the program. These added features called specific work against 
the disease, consist in such procedures as reporting cases of the disease, build- 
ing and operating tuberculosis hospitals, sanitaria and dispensaries, main- 
taining centers and nin^ses. enforcing sjiitting regulations and other nrdi- 
nances and laws. 

The decline in this period of systematic control is from about 1 10 to 
abnnt ^0. This epuch was entered in Chicago in 190^ and in the remainder 
of the State about five to ten years later. 

PxKfMOXI.V AND Txi''H'EXZA. 

In the hisi(ir\ of disease in llliniiis. it is im])ossible to separate the pneu- 
monias from intlueiiza at all times and with certainty. The former were 
always ])resenl aii<l ]irobalily alwavs will be. The Indians were unquestion- 
ably subject til the iJiieumonias and so were the French-Canadian settlers 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 63 

during their regime. In the earlier writings the disease was uflen called 
pleurisy. Still other names were employed. 

Dr. L. C. Taylor, late president of the State Board of Aledical iCxamin- 
ers and of the State Medical Society, was accustomed u< lell of an epidemic 
of pneumonia which ])revaik'd about fifty years ago near Williamsyillc in 
the northern end of Sangamon County. He described it as sweeping as 
an epidemic wave through the community and presenting some eyidence 
of being contagious. It was his opinion that the disease was ordinary en- 
demic ])neumonia which had become epidemic. 

Many of the older phy.sicians were of the opinion that (jrdinary endemic 
pnetmionia at times became epidemic. In tlie light of the i)resent-d-i\- opin- 
ion it seems probable that the epidemic wayes rc])orted in the literature were 
really epidemics of influenza. On this account no sustained effort will lie 
made to keep the diseases separate. 

The year by year reports as foimd in the Reports of tlic Counnittcc on 
Practical Medicine jirobably refer in the main to endemic jmeumonia; the 
reports of epidemics refer in the main to outbreaks of influenza. 

The Transactions of the society for the following years contain refer- 
ences to pneumonia: 18.51, 18.52, 1855, 1857, 1858, 18G0, ]8(;9, 1870, 1872, 
1874, 1875, 1878. 

Hirsch"- says that the year 1807 witnessed a great pandemic of influenza. 
"In October of that year it was in the Western States (that is the upper 
Mississippi and the Ohio Valleys) but we have found no record that the 
sparse population of the Illinois territory suffered from it." However, they 
probably did. 

In 1815-11) it was again pandemic. It was generally diftused over North 
America. However, there are no specific reports of it in the Illinois terri- 
tory. In 1833 Silas Reed"-' wrote of the Western Reserve region saying 
"Typhoid pneumonia prevailed in 1813-14 in the Western Reserve." The 
probability is that the Illinois territory also suiTered from it. 

In 1817 the Medical Repository of Original Essays. I'ol. Ill, ran a ser- 
ies of fourteen articles from eminent clinicians on the great epidemic of 
winter pneumonia which ran through several years from say 1812 to 1816. 
Of the fourteen clinicians, at least three regarded the disease as influenza. 
The clearest thinking in this series of papers was that of Dr. Singleton of Vir- 
ginia. He recognized the disease as influenza and referred to epidemics of 
it in America in 1733, 1775, and 1770. At the conclusion of his paper he 
propounded the inquiry "Could the disease have been brotight to this country 
by the British soldiers?" 

"'Hirsch, Ibid. 

«2 Reed (Western JIeait-;il &• I'liy.sical .Ihuii.-lI ). 



G4 IIISTOln' ()!■' Cl'.kTAlX DlSI'-ASl'lS I'KKIK TO 1877 

No one cm read llu- ^yni])()siuni willKJiu CDiu-huliiin- that a hiijli gen- 
eral sickness rate went with the epidemics of iiitlnen/a and |int'nniiinia. (_'er- 
tain of the sickness and nia\he of the ejiidemics were cerebros]iinal ineninL;itis, 
tlien a newly descrilied and hnt poorly recognized disease. 

C'aiil. 1. n. lulgar''' says: "In December, 1.S12. and January and ■•'eh- 
rnar_\-, I s I ■">, a \ery severe and fatal epidemic of pneumonia appeared in 
both the arni\' and the civilian popnlatidn." lie refers to the e]iideniic at 
French Mills in which 1 7 ])er cent nf the command were sick. Of the sick 
52 per cent had dysenterj', 24 per cent pneumonia, 8 per cent typhoid, while 
IR per cent had ergot paralysis attributed to bread made from flour which 
contained fundus material. 

"An epidemic of influenza prev:iiled in Shawneelown in the very early 
days." 

Hirsch says influenza was again in pandemic proportions in 1824-26. 
It was generally present in N'orth .\nierica and was reported from the west. 
An account of a limited eiiidemic in the Wabash \'alley found in Drake's 
magazine""' refers to a part of this epidemic. In 1843 he reported another 
pandemic in North .\merica. In this ejiidemic influenza was reported from 
Illinois. 

Drake wmte, "Influenza prevailed in 1.S43 in Xew Orleans and St. 
l.ouis and in all the intervening towns." 

In IS I!) a report on pneumonia in Illinois credited the gaseous emana- 
tions from the school stove as a cause of the prevailing disorder. The the- 
ory that carbon monoxide from stoves is a contributing cause of pneumonia 
is being revived today. In 18."),") Dr. Crothers of Bloomington reported an 
epidemic of pneumonia in McLean County. Dr. Spalding reported a simi- 
lar epidemic in the same year from Galesburg. 

In is."")? Dr. Thomas Hall of Stark County wrote: "Last winter Dr. 
Chamberlain and I treated 7(i cases of jineumonia." 

Dr. C. P>. Johnson of Cham]iaign writing of his practice in Chatham, 
Sangamon Coiint\- about ISCS to 1S7(1, s.aid "During the two and a half years 
that I ])racticed in this loeality 1 .saw more cases of pneumoni.a (lung fever) 
than I have seen in many 3'ears of practice since." 

Dr. Forry, the Surgeon General of the Army, and Dr. Cuolidge gave very 
good accounts of epidemics of pneumonia particularly in the army, in the 
Nc7i- York Journal of Medicine and in the Army Statistical Reports. 

The p.andemic of Is7-") was said to have been "univers.al in America." 
It was highly fatal in Illinois. It was peculiar in that it was shortly followed 
if not accompanied by a jiandemic of epizootic among horses. The great 
])an(lemics of 18S!l-'.il and r.tl8-2() are matters of more recent history. 

"'Edgar (Jlilitary SurRi-on, Ifarc'li. Itt27). 
"■'■Draltc (WL-Ktcni .M<<n.al & Pliysir.il .roiirnal). 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 65 

Some statistics as to the prevalence of pneumonia are taken from the 
census reports for Illinois in 1850 and 1860, 1870 and 1880. These are 
presented in Tables -1 to 8. No others for the State outside of Chicago are 
available. In addition there are given in Table 15 the mortality rates for 
pneumonia in Chicago from 1851 on. In these figures pneumonia, broncho- 
pneumonia, bronchitis and influenza are combined. 

Puerperal Fever. 

In the second volume of Hirsch's Handbook, these statements are found : 
"Under the title of infective traumatic diseases we may place together three 
nosological forms — erysipelas, puerperal fever and hospital gangrene which have 
this much in common that they bear the characteristics of an infective process 
and are in their origin dependent on the existence of some breach of continuity 
in the external or internal surfaces of the body." 

He (|U0tes Leasure"'' as saying that when malignant erysipelas was prev- 
alent in New Castle, Pennsylvania, in 1852 all the maternity cases in his 
own and another physician's practice got puerperal fever. He refers to 
similar rejjorts by Holsten, Galbreith, Ridley and other American ])ractition- 
ers of the period of the great erysipelas epidemic. 

The discoveries in liacteriology since Hirsch wrote have furnished fur- 
ther proof of what in his time was largely speculation. Hirsch especially 
stresses hospitals in the history of ])Uerperal fever, saying that its j)osition 
of importance was not assumed until the development of ho^i)itals and hos- 
pitalization. 

Hirsch quotes Leasure'" as saying. "In this c<iuntry we have fortunately 
but little experience of the alarmingly fatal epidemics that have spread their 
devastating influence over different sections of Great Britain." The article 
bv Hildreth'''" elsewhere referred to says, "Puerperal fevers are much less 
common than in more populous places." 

The opportunities for the spread of i)uerperal fever are 1)ellcr in hos- 
pitals, ])Ut even in the rural districts this infection has always found a way 
to travel from household to household and from patient to patient at times, 
while some of it is due to the presence in households and persons of the 
causative bacteria. A parallel is seen in tetanus infections. 

Some of the aljove quoted literature refers to puerperal fever and even 
epidemics of it in rural districts. 

The reports in the Transactions of the Illinois Aledic.al Societ\- make 
frequent reference to the prevalence of the disease in the rural communi- 

™ Leasure (American Journal Medical Sciences, 1S56). 
"' Leasure (American Medical Journal, 1835). 
«*Hilrtretli < A iiieiii>;in Jonrn.-il Medical Sciences, 1830). 



c,r, 



HISTORY OF CEUTAIX DISEASES PKIOR TO IS" 



ties anil tnwns i:f llic Stale. 
Haull tlir cluiinnaii, w i-nU', 
variabl\- fatal." 



In the Practical Mcdiiinc Rcf^ml for IsTi:;. Dr. 
I'm-rjieral fever was rife and 1 tliinl< it was in- 




In Dr. R. I. 1 lannll's Report on Prac- 
tical Medicine made to the Aniericati MecUcal 
.Associatirm there is an account of an e]M(leniic 
(if j)uer])eral fever in County Hospital which 
beijan in June. Isds, reported by Doctors H. 
W. j'ines and \\'. E. Ouine, the latter an in- 
terne was later President of the State Hoard 
of Health. Doctors Jones and Ouine clearly 
connected the prevalence of the disease with 
two sources of infection. 

The obstetrician of the hospital doubled 
as pathologist there. He alternated jobs be- 
tween the obstetric wards and the autopsy 
table. The internes, students and physicians 
iM K.ii.iTt c. Haniin. were allowed to exaiuine jjarturient women al- 

most withnut limitation. 
In 18 K). Dr. Oliver Wendell Holmes wrote, "The disease known as 
puerperal fever is so far contagious as to be frequentlv carried from patient 
to patient by physicians and nurses." He had in mind childbed fever as it 
was ill hospitals, Ijut there is proof that the disease was sometimes conveyed 
bv persons who have no hospital contacts. 

It is the custom now to say that there is no decrease in the mortality 
rate from puerperal fever. The statement may be true when the present 
day is compared with say twenty to tvventy-tive years ago. But it is not 
true W'hen the present day is comjiared with the period between fifty to one 
hundred years ago. 

In s]iite of the distance between homes and the almost total absence of 
hospitals for maternity cases in that earlier period puerperal fever prevailed. 



Milk Sioknes.'^. 

In the Report an Practical Medicine made to the Illinois Medical Society 
in 1S.")1, this statement is found "ll seems singular that a disease s])ceially 
lielonging to one soil, the fear of which has turned back man\- an immigrant 
from settling in our State should ha\e found so few historians." 

.Milk sickness, while not spccialh' belonging to the soil of Illinois was 
very prevalent in the State in the early days and may have prevented many 
prospective settlers from entering or remaining in the State. 



HISTORY OF CERTAIN DISEASES PRIOR TO liSTT 07 

Drake w rote of milk sickness un(k'r the name "Indian trembles". He 
says "Hennei>in first wrote of the trenililes according to this version. The 
Indians kiKiw of it and snlTered from il. It is difficnlt to understand how 
llie\- could have esca|)e<l il. Thev ma)- not have had any cow's milk hul they 
ate the flesh of animals which doubtless suffered from 'ireiiil lies'." 

.Drake sa\s, "To escajK' it whole communities broke up liefore they had 
well acquired a linn footinsj. Ahmy fruitful tracts of country stood long 
unoccupied on account of it." 

|ohn Reynolds, in a 1 'ionecr History of Illinois, writing of conditions 
prior to ls:!:i. said: 

"The stock of Col. Judy was injured by the mysterious disease known as the 
milk sickness. It made its appearance in early times in his stock and remains 
to exist, there is no doubt. The human family, as well as animals, are destroyed 
by it. I had a sister whose death it was supposed was caused by it. It is known 
that the disease is a poison. Dogs and other animals die with the poison when 
they eat the dead bodies. The victims of this disease, the human beings who die 
by the disease, derive it from the milk, butter or meat of the animal infected with 
the poison. The name of the disease arises from the milk the victims eat. This 
much is a.scertained; but what is the poison is not so well known. It is the general 
approved opinion that the poison is emited from some poisonous mineral sub- 
stance in the earth. It rises in a gaseous state, falls back on the vegetation, is 
infused in the water and in the morning before the dew is evaporated the animals 
eat the poison with the vegetation and thereby die. The disease only appears 
in the fall of the year and in shady, damp localities. A vegetable cannot 
cause the disease because it would have been discovered, and in some cases animals 
that are kept up and eat no green food die by the use of the water impregnated 
with the poison. It makes its ravages on stock in many parts of the West. Some- 
times for many years it almost disappears and afterwards returns and assumes 
its former virulence." 

Another reason other than its prevalence which draws attention to milk 
sickness is the fact that a number of people connected with men of promi- 
nence died of it. .Vmong these was Nancy Hanks Lincoln the mother of 
Abraham Lincoln. A sister of Abraham Lincoln and several members of 
the Hanks family died of it. It caused the death of the mother of (iovernor 
Chase O.sborne of Michigan. It caused the deaths of several members of 
the family of Dr. A. J. Clay who for many years was a local health officer 
of Hoopeston. Dr. Clay was stimulated by his family and personal ex- 
periences to sludv the cause of milk sickness. No one diil more than he 
did to establish the fact that eating while snake root was the cause of the 
disorder. 

A considerable part of the interest in milk sickness grew out of the 
difticull\- in deciding what caused it. the various theories about it, the dis- 
cussicni of those theories and a certain amount of myster)- which attached 
to the disease and its cause. 

In IS-U Dr. Daniel Drake wrote that the first good descri])tion of the 
disease was that of Dr. Thos. Barbee who saw it in Bourben County, Ohio, 
in ISOO. 



G8 IllSTOUV OF CKKTAIN DISKASES PRIOR TO 18TT 

In l.s;!S John Rowe a farmer announced the theory that milk sickness m 
animals was duf to their havinsj eaten a plant eupatorinm ageratoides. 
Soon afterwards Dr. McGarragh advocated the R<iwe theory before the 
Highland Medical Society. 

In Is 10 Dr. Barbee of Marshall, Edgar County. Illinois, (possibly a 
relative nf the Thos. Barbee of Ohio) reported several cases of milk sick- 
ness that he had treated in Edgar County where the disease was very preva- 
lent. He gave it as his opinion that the disease was caused by animals eating 
a plant eurpatorium ageratoides. However, instead of crediting John Rowe 
and Dr. McGarragh with the discovery, he gave the credit to Dr. Dale Owen, 
state geologist of Indiana. Dr. I'.arliee says Dr. Owen made a decoction 
from the plant and gave it to a calf, causing the disease. Dr. Barbee was 
of the opinion that milk sickness in cattle may be caused by their eating any 
one of several plants. Human beings were poisoned by drinking milk or 
eating meat from affected animals. 

In 1S41 Dr. Daniel Drake made a trip to the vicinity of Washington, 
Ohio, to study the disease. He accejited the general opiiiinn of the day that 
the disease was related in some way to the type of soil, the trees and the 
[jlant life. His reports on all of these are exhaustive and thorough. He 
investigated various types of plants including eupatorium and rhus and came 
to the conclusion that milk sickness was a form (if food poisoning that sev- 
eral plants could cause: that rhus was the most imiiortant, that many dift'er- 
ent animals including man, cnws. hog>. dugs and liuzzards cijuld contract it 
and that carnivemus animals such as men. dogs and buzzards got it from 
drinking milk or eating meat from poisoned animals. 

It was not until very recent times that milk sickness in Illinois was 
proven to be caused by animals eating white snake root. Vnr this discovery 
Dr. Clay of Hoopeston was largely responsible. Other plants can cause it 
and in other sections of the country they are the principal cause of it. Rowe 
and other farmers, Barbee. Drake, McGarragh and other physicians were 
not far wrong in their speculations and experiments made between 183S and 
]s.'i,s. Had they and their successors stuck to their lead the cause of the 
tniuble shdiilfl have been discovered at least a ([uarter of a century earlier 
than it was. 

The fiilliiwing quntations are from Zeuch's History of tin- Practice of 
.Medicine: 

"Even as late as 1855 mucli distress was created by tlie appearance of milk 
sickness near Albion." 

"Dr. Joseph Gates of Marine was called all over the State to treat milk sick- 
ness which had an extensive prevalence. This was in 1830 and for several years 
thereafter." 

"Many people died from this worse than the plague." (The reference was 
to milk sickness in Crawford and Clark Counties.) 



HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 G9 

"The milk sickness lay in wait for man and beast along nearly all streams 
throughout the county and often proved as fatal as the horrible malarial." ( This 
is quoted from some pioneer as being descriptive of conditions that were rather 
wide-spread in the State.) 

"Milk sickness was frequently reported from Edgar County." 

The disease, if it can be properly called such, began to diminish in im- 
portance early in the history of the State. In 1851 the Report an Practical 
Medicine contains one reference to milk sickness. That of 1855, devoted 
considerable space to the subject and quoted a fair amount of literature deal- 
ing with it. That of 1858 discussed milk sickness extensively. After 1858 
it was seldom alluded to at meetings of the State Society. Of all the promi- 
nent diseases of the early days of Illinois history milk sickness was one of 
the first to diminish in importance. 

Nursing Sore ^Iouth — (Possibly Sltuvy). 

Somewhere about 1856 a peculiar malady prevailed. It was called 
nursing sore mouth. It affected mothers who were nursing babies and some 
of the reports refer to nursing babies having the same malady. 

Nursing sore mouth is found covered in the Practical Medicine Reports 
for 1857. It may have been that this sore mouth was scurvy. In 1858 Eaily 
devoted much of the Report on Practical Medicine to a discussion of scurvy 
as a source of illness in Illinois. Among other things he held that it was a 
factor in the prevailing sore mouth of nursing mothers. 

The literature does not record the acceptance of Dr. Baily's opinion that 
scur^'y underlay many of the ills of the people of the State. Dr. E. P. Cook 
of Mendota, in an earlier Report of the Committee on Practical Medicine, 
had referred to scurvv as being in part respon>il:jle for the continued fevers 
of the period. 

Dr. J. H. Hollister reported on the prevalence of nursing sore mouth 
in Illinois in 1859. 

Typhoid Fever. 

The travellers, historians and other lay writers who wmte incidentally 
or otherwise of health in Illinois in the first half of the nineteenth century or 
prior thereto, made no mention of typhoid fever. 

The medical men who wrote in the same period wrote rather frequently 
of continued fevers of one sort and another calling them by different names. 
When they began to refer specifically to typhoid fever by that name, about 
1S50 and for several years thereafter, they spoke of the disease as having 
rather definitely in\aded the State though they do not state 1)y what means 
nor from where. 



70 HISTORY OF CERTAIN DISEASES PRIOK TO IST? 

In IS.jl, Dr. N. S. Davis told the Chicago Medical Society: "Typhoid 
fever tirst became e])i(lemic in 1848, and was highly fatal. Since then it has 
been milder." 

In ]S.")I), Dr. Roe of Hloomington wrote: "Typhoid fever is now first 
in inipiirtance. I'erhaps not even cholera exceeds in the number of its vic- 
tims this fell disease. It is almost as yesterday this disease made its first 
appearance among us." 

In 1851 the Report of I he L'oiiuiiittrc uii Practical Medicine of the Illi- 
nois ]\Iedical Society, contained this statement: "Much has lieen written on 
the extension westward of typhoid fever." 

In 186:3, Dr. Noble told the State Medical Society: "Typhoid first came 
to McLean County in 1846 and 1841." 

In 1864, Dr. J. S. Jewell wrote: "In two or three years after 18.57 
the continued fevers almo.st entirel}' supplanted the autiuunal fevers." 

Dr. J. K. Reeves"-' gives an account of the first appearance of typhoid 
fever in \'irginia in 184;3. "It seemed to have suddenly appeared in that 
year. By 1X45 it was one of the major epidemic diseases." 

I think it is a f;iir assumption that the general opinion about 1S60 was 
that Ivphoid came into Illinois .-ibout 1815. 

Htstorji of Steps In llic Estdlilislinniil of Ti)i>Jiiiit! Fcrer as a 

Specific Disease. 

Physicians everywhere li:id such great difficulty in recognizing t)'phoid 
as an entity that it is interesting td trace the ste])s by which this disease 
emerged from the fug which (il)scured the entire field in the first quarter of 
the nineteenth century. 

To travel this path properlv it will be necessary to begin far away from 
Illinois and j)ri(ir to the date of Illinois statehood. However, the place of 
Illinois physicians in the world wide controversy will be established before 
the story has been cdmpleted. 

It seems pirdbable that typhoid fever has always existed, though the dis- 
ease was not clearK established as an entity until the study by Louis ap- 
peared in I S3!). 

Dawson"" s;i_\-s : "The low fevers of Hippocrates and (/ialen may have 
been ty|)hoid." 

Dr. C. (i. Cumston'' thinks typhoid fever a very old disease. He (juotes 
Thucydides' description of a fever which prevailed in the Greek army in the 
Peloponnesian wars and gives his opinion that the disease was typhoid. He 
says: "Petechial fever — what we now suppose was typhoid — ravished the 



^^ Reeves (Practical Treatise on Enteric Fever, lS5it). 

'"Dawson (Western Medical Medical and Physical Journal, 1S44). 

•'Gumston (N. Y. Medical Journal and Record, Feb. 16, 1927). 



HISTORY OF CERTAIN" DISEASES PRIOR TO 1877 71 

island of Cyprus at the end of the fifteenth century, and Italy in l.Vll during 
the expedition of Louis XII against Naples. Hence it appears to nie that 
typhoid fever was not a new disease ajipearing at the end of the 15th cen- 
tury." 

Murchison'- says: "Some of the descriptions of the Greek writers 
I^robahly referred to enteric fever." He quotes from the writings of Hip- 
pocrates and ( ialen. Spigelius speaks of this fever as comiuon in various 
jiarts of Italy. With this statement, however, Hirsch'^ disagrees, saying: 
"I do not agree with Murchison that Spigelius wrote of typhoid fever in the 
17th Century." However, Hirsch says: "In the writings of the Hith and 
17th centuries there are accounts of certain forms of sickness which can 
hardly be interpreted than as referring to typhoid." 

Among those who wrote of what Hirsch said was typhoid were : Syden- 
ham ( IGGl) ; Welles (1682) which description Hirsch pronounces "the first 
clear description of typhoid": Lancise (1718) ; Hoffman (1728) ; Strothers 
(172!)): Gilchrist (1735); Chirac (1742); Morgaginni (1761) and Hux- 
ham (1781). 

He also gives a large numljcr of citations from the French, Genuan 
and Italian, all of which show that a considerable amount of accurate knowl- 
edge of typhoid fever was known to Europeans prior to 1800. In most 
instances the literature cited by Murchison is the same as that cited by Hirsch. 

Bardett says that the first good description of the pathology of typhoid 
fever was that of Prost (1804). Ahirchi>on quotes Prost as having made 
])Ost mortems on 200 cases of typhoid. 

In thi> connection the year 1804 should be kejn in mind. It will be 
referred to in discussing the American doctrine of the unity of fevers as put 
forth by Benjamin Rush. 

Hirsch savs : "Petit and Serres (l.Ml) gave an accurate account of 
typhoid fever." .Murchison says of Petit and Serres (1813) : "They were 
the first to regard typhoid as specific." 

These are a few citations of tlic literature prior to that of 182U. In that 
year Louis wrote the treatise which fixed the name "typhoid" and secured 
general recognition of the disease as an entity. In the period prior to 182'J 
tv])hoid was frecjuently confused, es])ecially with tyi)hus. Lois' pupils, 
drawn from all over the world, returned ti^ their homes carrying the teachings 
of the master. 

It was Gerhard of Philadi-lphia, an almost yearly visitor to European 
hospitals during this period, who liroiiglu b;ick to .\merica definite ideas as 
to typhoid and spread them over the country, hut particularly along the At- 
lantic seaboard. 

■MClontinued Fevers, 1.SG2). 

"Hirsch (Handbook of Hist. & Geog. P.ith.. ISSl). 



72 iiisTiiin Hi- I i:rtai.\ diseases pkiok to 1ST? 

Subsf(|ia'iU ti] the yt-ar IS'ili mcisi of ihc coiilincntal writers of ])romi- 
nence raii.i,R'(l iheniselves lirhind I.Duis. ( )!i the (ither hand the I'.ritish were 
verv iinieh (Hs])i)se(l to huhl that ly]>lui> ami tyi)h(ii(l, and other forms of 
continued fever, were due to the same yroup of causes. 'I'heir scientists, 
Sydenham, lluxjiam. \\'elles, Strothers and Erasmus had contrihuted valu- 
able information sustaining the position ultimately taken by I.ouis. but this 
they seem to have disregarded. In adopting what might have been called 
the British doctrine of the unity of fevers, they may have been under the 
influence of |)atriotism growing out of the Xajioleonic wars. Who knows? 

It was not until Sir W. jenner wrote in ISH) to ls.")l that the British 
tinallv abandoned this position — the doctrine of the unity of fevers. 

In 1804 Benjamin Rush was an outstanding figure politically and in 
American medicine. He had signed the Declaration of Independence, mean- 
ing American independence of Great Britain, but in his views on the con- 
tinued fevers he was anything but independent of British contemporary 
opinion. It was in that }ear. or ISO."), that he wrote his views on fevers as 
follows : 

"The usurd forms of the disease produced by the miasmata from the 
sources of them which have lieen enumerated are: 

1. Malignant, or bilious yellow fever. 

2. Inflammatory bilious fever. 

3. Mild remittent. 

4. Mild intermittent. 

5. Chronic, or what is called nervous fever. 

6. Febriculi. 

7. Dysentery. 
S. Colic. 

9. Cholera morbus. 
10. Diarrhoea (morbus)." 

Dr. Ix-njaniin Bush had just passed througli a great epidemic of yellow 
fever in Philadelphia, aiul some jian of this opinion was founded on his 
experience there and then. P>ut much of it was due to his reading of British 
medical literature. Thereafter, as will be seen, this doctrine became known 
as the .American doctrine of the unity of fevers. I'erhaps one statement by 
Rush in the pajier quoted is enough to absolve him for the hann he did by 
advocating this theory. It is: 'T look fin- the time when our courts of law 
shall punish cities and \-illages for iiermitting any of the sources of bilious 
and malignant fevers to exist within their jurisdiction." 

About this time (1T0!I) Xoali XW'bster contriljuted to the same grave 
error of a common meteorologic and miasmatic origin of contagion in his 
otherwise great work. "A Brief History of Epidemic and Pestilential Dis- 
eases." 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 73 

But not even the name of Webster could dis[)lace that i_if Rush. The 
(liictrine of the unity of fevers travelled under the mantle uf fame nf Rush 
until it reached the Northwest Territory embracing Illinois and the contig- 
uous states. In the East, Nathan Smith, Jackson, Gerhard and Hale, and 
probably Oliver Wendell Holmes were doing their best to spread the facts 
about typhoid, but they were not wholly equal to the task of overcoming the 
influence of the \iews of the signer of the ncclaratiim of Independence. 

J. W. Monette uf .Mississippi attacked the ihenry that yellow fever was 
caused Ijy the cause uf malaria in a series of articles, most of which appeared 
in the jrrstcni Mfilicul and Physical Journal, and the Aiiwricaii Journal of 
the Medical Sciences. Dr. Munette's jiapers were masterpieces and left Rush 
with nnthing to stand cm. 

In these earl\- days the princijial tliscussion was over the separateness 
of typhus and typhnid. In 1842 Bartlett published his magnificent, clear- 
cut study entitled ".-/ llislory of Continued Fevers". After that the opinion 
of Rush as regards the oneness of typhus and typhoid was without founda- 
tion. The same may be said of the oneness of typhoid and malaria though 
il was more than two decades before the notion that these two diseases or 
groujis of diseases were related some way or other came to an end. 

.\nd now. let us move from the Atlantic seaboard to Ohio, Indiana and 
Illinois. 

The (jutstanding medical man of influence in this region from aliout 
ISl.') to about IS.'id. was Daniel Drake of Ohio. lie lectured in Cincinnati 
and Lexington, he wrote a textbook, he conducted the first medical journal 
in the region, and he carried on an extensive corresijondence with physicians 
in all parts of the Mississippi X'alley. There was scarcely a section that he 
did not visit. His ac(|uainlance was wide and his influence was great. 

Drake was very much under the influence of Rush. Roth he and his 
correspondents believed in miasmata and telluric influences as heaig able to 
cause malaria and other fevers, perhaps typhus. He showed a marked ten- 
dency to hold that the typhoid state, or a fever of the type of t\iihoid could 
be the outcome of these miasms. 

If Drake had read any of the contributions which paved the way for 
Louis in that year, there is no evidence that they changed his views: nor is 
it certain that be read Louis or Gerhard anywhere soon after ls2!i. 

luniy in the IlHh century the ]ihysicians of the U])i)er Alississipjii \alley 
seemed to have accepted the opinion that the slow fever in that region was 
not typhus. After about 1830 the difficulty in this region on this question 



74 HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 

seemed to lie liniilL-<l tr) difterentialing between the low fevers caused by ma- 
laria and those caused liy typhoid. 

In following;" the difticulties in distinguishing; between these various dis- 
eases at this time, the limitations of the equipment of the [ilixsicians i.'f the 
period, must be taken into consideration. rhe\' hail n(j W'idal examinations, 
no bacteriologic examinations of the blood, nci microscopic examinations for 
malaria. In fact, it was not known that there were either bacteria or plas- 
moilia. I'hey had no clinical thermometers, no nurses, no hospitals, and no 
autopsies, or almost none. 

There were no medical societies. The Aesculapian Society of the Wa- 
bash \'alley was not established until 1S4(J; the Illinois Medical Society was 
not organized until 1S.")(I. Fur a long time Drake's journal was alone in the 
field. Sending jounials through the mails was expensive. 

Oliver Wendell Holmes once wrote to Dr. William Osier: 'T am 
pleased to remember that I tfiok my ground on the existing evidence before 
the little army of microbes was marched up to support my contention."' He 
had reterence to his article on the contagiousness of puerperal fever, writ- 
ten in isi;!, Ijnt the men whd majiped out tvjjhoid from typhus and malaria 
could ])ride themselves on a similar accomiilishiuent. 

From about 1S.">() for about fortv vears the nidst intlueiuial member of 
the Illinois profession was Dr. N. S. Davis. In 18,")5 Dr. C. X. Andrews of 
Rockford spoke to the Illinois Medical Society as follows: "Several 
articles on fever w-ritten by Prof. N. S. Davis have appeared in the North- 
zvcstcni Medical and Surgieal JournaL He advocated the American doctrine 
of the unity of fexers. which doctrine I regard as truthful as nature itself. 
It has been advanced and supjiorted by the most able and distinguished of 
American ]ihysiciaiis and. above all. Dr. Benjamin Rush." 

Flere comes this doctrine of the unity of fevers again. It was of British 
ancestry. Then the signer of the Declaration of Independence made it 
American. His name almost became a part of its name. And. at last, we 
find it here in the Northwestern Territor\- aliuost become tlie Illinois doc- 
trine of the unity of fevers, and even the Davis of Illinois doctrine of the 
unity <;)f fevers. 

Dr. N. .S. Davis said: "I do not think that all tyjihoid is caused l:)y a 
specific cause. The disease can lie caused bv an\' one of man\- causes." 

In a discussion of fever before the Illinois Medical .^ociet\- in is; I, Dr. 
Crawford said: "The whole famil\ of the coiuinued fevers are from the 
same cause. The cause is miasmatic.'' 



HISTORY OF CERTAIN DISEASES PRIOR TO ISTI 



But Dr. Cook of Mendota said he differed from Dr. Crawford: "We 
are all in error in considering these fevers as a unity. 1 have seen typhus 
fever in Ireland. I never saw a case here." 

In IS-I-l one of the ablest physi- 
cians in llliniiis moved tn Jacksonville, 
.Mnvi^an Cdunty. This was Dr. David 
I'rince. In Xovember, 1846, Dr. F'rince 
read a jiaper on the fevers of .Morgan 
Liiunty''. He named four kinds uf 
malarial fever as prevailing in that 
riJiintv. The third of the series of four 
was called typhi lid fever. He said the 
icvers of one tyjie tend to run into 
annther type. There had been some 
change in the fevers of Morgan County 
since is:5:. Those of 1837 to 1.S40 were 
more sthenic and stood bleeding better. 
Those of 1S41 to 1846 inclusive, and 
especially 1S44 to 1846, tended to be 
of a lower type with more tendency to 
typhoid, stood bleeding and active treat- 
Dr i>ivi<i Fiin.e meut Icss wcU, and called for supportive 

treatment. 

Dr. John Wright of Clinton said : 

"Typhoid is not caused by the same cause as 
ordinary malarial fever. There are those who be- 
lieve they have one common origin and cause but 
the evidence to my mind is not convincing." 

In the report on the diseases of Iowa .'i 
Missouri made liy Reyhurn'"' this statemein is 
made : 

"The terra typhoid is used (in this region) to 
designate an autumnal epidemic fever of a periodic 
type which is ultimately lost in the continued febrile 
movements. An exact distinction is not made in 
this part of the country between those different 
types of fever, so far as the terms used to designate 
are concerned." 

The authorities which have been quoted 
show that the paper by Louis was a consummation 
of a trend of opinion that had been forming for 
some time. 





'Prince, (Illinois and Indiana .Medical and Surgical .lournal, April. 1S47). 
iReyburn (Trans. A .\I. A.. ISoti). 



76 IIISIOKN' OF l-KKTAI\ DISi;,\SI-;S I'NIOK TO ISTT 

Anders"'' says: "Althnui^li lyplioiil fever was known beyond the reach 
of tracHtion, it was not nniil isVli that typhnid fever was clearly distinguished 
from typhus fever The decade from 1S4() to IS.IO witnessed the over- 
throw of the erroneous n(]tii>ns concerniniL; the similarity of tv]>hoid and 
lyi)hus." 

In ISlv! I''.lisha iiartlett's wonderfully clear cut text on fevers a]3peared. 
While an eastern \\(irk. it had some western circulation, and it made the 
picture clear. After it appt'ared, the onlv job that remained was to get the 
])hysicians to read, observe and think. 

In 1843 Carroll"" reported what seemed clearl\' to have been a detinite 
outbreak of ejiidemic tx'phoid fe\er in I .ane Theological Seminary. Cin- 
cinnati. 

However, the old Rush influence, i)articularly as regards malaria and 
tvphoid, was not entirely ready to die, jiarticularly in Illinois and Indiana. 
The great leader of medical opinion in Illinois was Dr. N. S. Davis. The 
yearly transactions of the Illinois Medical Society show that he was a be- 
liever in the theory that the same basic cause, moditied one way. caused ma- 
laria : modified another, caused typhoid. 

Cp to the middle of the decade of 18.")()-]8(i0 this was the prevailing opin- 
ion of the physicians of the State, though the minority who thought other- 
wise was increasing year after year. By I860 the majority seems to have 
swung the other way. Dr. Davis himself changed his views gradually, 
though still holding to some part of his basic belief. We find him stating 
his adherence to ^ome part of tliis basic belief as late as the year 1S';4. Dr. 
Davis said: "1 do not think that all tyjihoid is caused by a sjiecitic cause. 
The disease could be caused liy any one of many causes." 

In the 'ryaiisaclioiis we find him reporting cases of typhoid in the fifties. 
In ISCil he rep<n-te(l having treated 113 cases of "definite ty])hoid fever." 50 
in his private ])ractice and (13 in the wards of nearliy hospitals in the previ- 
ous si.x months. 

.\t the 187 1 meeting of the Illinois Medical Society. 13r. b". I'. Cook of 
Mendota said: "Typhoid is not caused by the same cause as ordinary ma- 
lai'ial fe\er. Tliere are those who lielie\'e they have one common origin, 
and that one can be converted into the (jther. lUu the arguments have never 
satisfied me." .\t the same meeting. Dr. Crawford said: "The whole 
family of the continued fevers are from the same cause. The cause is mias- 
matic." 

In 18^"i Dr. Cook again reporting for the Committee on Practical Medi- 
cine, of the ."^tate Medical .Society, said that typhoid was a si)ecific disease. 
He predicted "we will yet find a specific living virus for t_\phoid fever." 

■"Anders (Piactui- of jre.li.iiuO. 

"C.irroll (Wt-st.Tli .Mt-di.:il .iiid l'liysi.-:il .Imiiiuili. 



HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 77 

Some of the physicians of Illinois began to recognize typhoid fever when 
they saw it as early as 1845. By 1850 the number of these men able to diag- 
nose typhoid in spite of their limited equipment was fairly large. By 1860 
almost every physician in the State recognized the typical cases at least. How- 
ever when the possibility of malaria was great, definite diagnosis was diffi- 
cult or impossible. In fact it was not until the Widal test for typhoid and 
the microscopic test for malaria came into general use that accurate differen- 
tiation between these diseases became the rule. This was not until later than 
1880. The confusion in the minds of the medical profession relative to 
typhoid and malaria was the result of several factors. In the first place it 
was not an easy matter to differentiate the one from the other prior to the gen- 
eral use of laboratory methods although the popularization of the clinical 
thermometer was a great aid. 

The therapeutic test for malaria, namely the use of quinine, was of great 
value in the diagnosis of intermittent fevers but these were not confused with 
typhoid after the clinical thermometer came into use. In remittent fevers 
and particularly in the more continued types of malaria quinine lost much 
of its value as a diagnostic agent. When the diagnostic laboratory pro- 
cedures came into general use this factor in causjni;- confusion became un- 
important. 

Other factors which contributed greatly to the confusion were the 
various speculations as to the relationship between the diseases. 

One of these speculations was that typhoid evolved out of malaria. 
Some believed that cases started in as malaria and ended as typhoid. Some 
believed that typhoid was a disease evolved out of malaria. 

Another speculation or hypothesis was that there was antagonism be- 
tween the two diseases. One idea was that the antagonism related to agents 
which directly caused them, the other was that it related to the environmental 
influences which indirectly caused them. ,\nd finally there was a theon- 
that the two diseases could and did exist simultaneously in the same patient 
each influencing the other. It is not to be wondered at; that under the in- 
fluence of so nnich speculation and hypothesis unchecked by procedures for 
exact determination confusion arose and continued general for nearly four 
decades. 

In Bartlett'** appears this statement : "Typhoid is probablv less com- 
mon in those portions of the U. S. which are visited by the various forms 
of intermittent and remittent fever, though further observations are neces- 
sary to settle this point." The view that there was some antagonism between 
these diseases was rather general, even as late as the middle nineties of the 
last century. Physicians were reading papers in medical societies, principally 

"Bartlett, Ibid. 



78 lllSTOUV OF ri'.KTAIN DISEASES I'KIOR TO 1STT 

in the southern states, denying the existence of typhoid in malarial section ; 
as late as 1900. No longer ago than 1910, there was discussion in the medi- 
cal idurnals nf the <(ucstion whether typhoid exists in the lro])ics. It took 
niuiiiir W idal tr^is and the routine hlood examination to cstahlish the ques- 
iIdu in IJK' aHiinialiv c. 

'Hk- ihcnr\- that there was an antagonism hctw ct-n lyiihoid and malaria 
Hirsch says was first proposed hy Boudin. In ISK the Illinois and Indiana 
Medical and Surgical Journal quoted an article by Dr. Boudin from the Lan- 
cet of lS4(i. In this. Boudin had argued there was an antagonism between 
typhoid fever and malarial fevers. This view was advocated by many 
authorities. In fact, it was the accepted opinion of the times. .\ustin 
Flint'" supported it, as did Daniel Drake in the same year and for many 
\x'ars. Drake showed that as malaria waned t_\'i)hoid increased. 

There was and is a great deal of o|)inion to the effect that a change in 
enviroinnent was responsible for the subsidence of malaria and the develop- 
ment of t\"].)hoid. An early traveller in Illinois wrote: ".\> the country was 
cleared up the trees were cut away and the air could circulate, malaria less- 
ened and typhoid appeared." 

1. .\. I'.gair", Secretary. State Board of Health, Illinois, said: "The 
]ieople of the early day were compelled to meet chills and fever, cholera, 
smallpox and other scourges as best they could. .\t first there were the 
diseases of the wilderness, plasmodial diseases, cholera, dysentery and other 
ailments which gradually disappeared with the cultivation of the jirairies 
and the destruction of the forests. Rut in the jjlace of these came the sani- 
tarv prolilems of denser population." 

Hirsch wrote: "That the prominence of typhoid as malaria wanes is 
because the ]:)opulation grows crowded in proportion as the sources of ma- 
laria disappeared from the soil by drainage and cultivation." There is no 
statement that better expresses the relation of environment to the two dis- 
eases. 

The theorv that t\i)hoi(l grew out of malaria was also jiopular toward 
the middle of the nineteenth ceiuury. 

1 )r. W. L. I'elder", descriljed a fever which he said was originally iiUer- 
miltent and lapsed into tv|ihoid. Mettaurer"-, writing of the fevers of \ ir- 
ginia, lM(i to ISv!'.). described a continued fever which was of malarial origin. 
Of this fever there were three varieties: synochia, or ordinary malaria, 
tyi)hoid and typhus. 

•"Flint (HiilTalfi .Medical .Tcuiriial. 1S47.) 

»" Eg-an (Jlilitary Tract Medical Society, 1906). 

»' Felder (Trans. A. M. A., 1852). 

s^Mettauer (Amer. Jour. Med. Sc, 1S43). 



HISTORY OF CERTAIN DISEASES PRIOR TO 187' 



79 



S. H. Dicksoir' says: "In the long protracted cases of ordinary re- 
mittent fever of the mahirious region, there is a tendency of the fever to 
continuousness, the whole ap])earance is I hat met with in continued fever — 
simple, nervous or typhoid. In cnniniiin ]ir(ifessii)nal parlance, such cases 
take nn the 'typhoid character.' " 

W. \\ Veatch**"* wrote: "In Sangamon County, Illinois, there are three 
classes of tviiho-malarial fever, tw" nf wliich .are i)rc:)lial)ly malarial and one, 
tj'phoid." 

T jijilni-Malarial Fever. 

It was in \s',i\ that Dr. Woodward of the 
I'nited States .\rmy read a paper before the 
Intern.-itional Medical Congress on the subject 
of iypho-malarial fever. This paper served 
to fix "t\']!ho-malarial fever" in the literature. 
It also served to precipitate a great volume of 
discussion on several phases of both the ma- 
larial (juestion and the typhoid question. The 
view of Dr. Wdodward met with a mixed re- 
ception from the .\rmy Medical Corps. Ur. 
Charles Smarl^' says: "Ilefi.re the introduc- 
tion of the term the .association of typhoid 
svmi)toms with malari.al fever and of malarial 
sym])toms with tvphoid fever was well recog- 
nized." 

If it he contended that \\"oodward's p;i])er 

was a piece of s]iecial ])leading for typho- 

nialarial fever, it can lie .answered that Smart's 

discussion in the Medical and Siiri/ical History of the War of the RcbcUioii 

is special pleading against it. 

\'aughan^'' says: "Early in our Ci\il War medical officers re|iorted 
fevers which, in their opini(jn. diffcreil from typhoid fever as seen in the 
north. The first board appointed I ISdl i to investigate the matter reported 
the lever prevalent among the soldiers was bilioiis remittent fever (malaria), 
which not having been controlled in its primary stage, has assumed that 
adynamic type which is present in enteric fever. The second board was 
convened ( \S{;2 } for the purpose of revising the sick report. Major Wood- 
ward, the chief of this staff insisted that the prevailing fevers of the Armv 
of the Potomac were hvbricl forms resulting from the combined influences of 




» Dickson (Trans. A. 11. A., 1S52). 

"Veatch (Chicago Medical Examiner, 1866). 

*» Smart (Medical and Surgical History of tlie W.ir of tlie 

""Vaughan (Epidemiology and Public Health, V^r in. 



80 HISTORY OK CKKTAIN DISEASES PRIOR TO 187 T 

iiKiIarial puisoniiii; ami the causes of lyplmid fever; and he insisted they 
should be reported as typlm-nialarial fever. This designation became official 
July 1. isr,-..', and fmni that lime until June "-'It. ISCG. ."):,40() cases with ."),;!60 
deaths were re]i(irled under this name." 

Tin- aclion taken by the Army Hoard in ISli'^ under the influence of 

\\" Iwanl. ]ir(i(luced a great amount of discussion, scime of which was 

acrimonious. It was asserted that the adoption of the term "typho-nialarial 
fever"' was a recurrence to the badly discredited and well nigh abandoned 
doctrine of the unity of fevers. Some said it provided a way down for 
some men of eminence who had allowed themselves to become stranded on 
that dead limb, the unity of fevers. It is said that there is a way out for 
those who had denied the existence of typhoid fever. Also that it furnished 
a new wav for men who wanted to co\-er uj) antl hide the ])revalence of 
typhoid fever in their regions and connnunities. 

The same statement was made in the reverse, nanielw that the term was 
used as a camouflage for malaria. 

It was said that its use led to sloppy diagnoses, lack of care in sanita- 
tion and hygiene, and to wrong treatment of the patient. It was said to be 
unscientific, as well as incorrect. 

The hre and heat was so intense that the term fell into disuse. To this 
doubtless the decrease in malaria contributed. In time the theory that there 
may be simultaneous infection with a bacillus and a plasmodium will be re- 
vived, though there may never be a great, impelling reason for reintroducing 
the term tvpho-malarial fever into the popular vocabulary. 

There is no reason win' an individual may not be simultaneously in- 
fected with the ])rotozo,an of malaria and the bacillus of typhoid. The two 
organisms can exist side l)y side in the same individual either with active 
sym])toms of each, or with one or both latent, or in the latent or passive 
carrier state. 

Dr. C. B. lohnson"' who liegan practice in Illinois soon after isii."), and 
who has practiced widely since in central Illinois, ex])resses the opinion 
which was aluKjst universal among the rank and file of practitioners of the 
period. It was that there is a fever which should he called (and was so- 
called) typho-malarial fever — "the result of a double infection." 

Dr. Breed of Princeton held that t}])ho-malarial fever was due to three 
causes o])erating simultaneously in the same ])atient. These were the cause 
of malaria, the cause of ty]ihoid and the cause of scurvy — typho-malarial 
fever was a combination of typhoid fe\er, malarial fever and scurvy — all 
three of these diseases abounded in Illinois in the same general ])eriod in the 
early day. 

<■■ Johii.son. Ibid. 



HISTORY OF CERTAIN DISEASES PRIOR TO 18TT SI 

The Transactions of tlic Illinois Medical Society for 18T.5 show that in 
that year typho-malarial fever was both attacked and defended. Dr. E. P. 
Look of Mendota said : "1 think there is no donbt Init what the malarial 
poison and the typhoid fever poison can and do affect the system at the same 
time, giving typho-malarial fever." 

F<i<)(l P()is<iiiiii<i as (I Source of Coiif nsmii. 

Some confusion as relates to ty]ihiiid has always existed because of 
speculation as to some forms of food poisoning as a cause of this fever. 

A knowledge of bacteriologj' has lent something to the confusion. There 
are cases which are clinically typhoid but which do not give the serologic or 
bacteriologic tests for typhoid. These are called cases of para-typhoid. 

Recent research work liy Savage and White"* tend to show that the 
tv])hoid bacillus is a member of the great Salmonella family. Some of the 
members of this family produce food poisoning, some typhoid and some 
other disorders. Largely as a matter of speculation they suggest that the 
typhoid bacillus may evolve into other members of the group and possibly 
that tvphoid lever may have a similar relationship to food poisoning and 
the allied disorders. 

If these theories are correct then ty])hoi(l may have evolved. And it 
may have done so in Illinois. In fact, it may have done so in 181.") and it 
may be doing so now. On the other hand typhoid bacilli may be evolving 
back into the Salmonella group, to |iroduce food poisoning, or even harm- 
U>s bacilli right now and every day, and here. 

If somewhere between one and three per cent of all convalescents from 
typhoid become chronic carriers, or intermittent carriers, and remain so for 
life, what becomes of all the carriers? Why are thev spreading so little 
typhoid? If ]iractically the entire mature population of thirty years ago 
h.id had typlKiid, if ninety-two per cent of those who had the disease re- 
co\-ered. and 'i per cent of those became chronic carriers, the carrier popu- 
lation of the country must have nKJunted to more than a milli(jn. Why is it 
they infected so few people? Could their typhoid l)acilli have lost the spec- 
i;i] (|ualities of the bacillus tyiihosus? These are cjuestions t(.) which there 
can be no answer now. In the inyestigalion of ty[)hoid among troops in 
the Spanish-American \\'ar, the tyi)lioid commission found, among other 
conclusions, two that have a bearing on this discussion. 

( )ne was that typhoid was often inaugurated by a diarrhoea which de- 
viloped during the incubation period of the disease. The other was that of 
the troops who had diarrhoea some weeks prior to the onset of the e|)ideniic of 
typhoid, very few subsequently developed typhoid and. converseh', ninety jier 
cent of the men who developed typhoid had no preceding intestinal disorder. 



' SavaKe and White (Briti.sli Research Council l!i2i; Spec-ial Report.s ill, ;i2, lO.'?). 



88 iiisrom- oi-- ckktain ihskases prior to 18T? 

'1 he bru-lfrial causu df ihcsc diarrhoeas was not (k-tL-nnincd. Tlierefcire, what 
they .'-hiiw either fur or against the Savage and White theory is purely sjjec- 
iihiti\e. 

Coiiclii>;iaiis as hi Tjiithanl in lUiiHiis prior lo 1S77. 

A reasonable interpretation of the evidence with due regard to what is 
known of the hahits and customs (if the peciple and making use of what is 
nciw known ahunt malaria and lyplmid leads t" the fcillowing conclusions 
as to typhdid fe\er in Illinois jirior to liS^i : 

1. Txphiiid was hrouglu to Illinois by [leojile who were carriers, and at 
times. l)y a ty])ical and incubatory case. 

•i. In the earlv days the sparsity of the population operated against 
great prevalence of the disease. 

.'i. Its presence was obscured liy the overwhelming prevalence of ma- 
laria. 

4. ?\luch of it was unrecognized because of the meagre facilities for 
diagnosis. 

■). \\\t\\ the increase in density df ])opulation the disease became more 
prevalent. 

(!. With the decline of malaria and the inipro\ement in the methods of 
diagnosis recognition became easier and more certain. 

T. It is possible that some typhoid evolved out of the diarrhoeas and 
food poisonings which were so much in evidence amimg the early settlers. 
It is possible that such evolutiun, backwards and forwards, is going on all 
the time but that fact is not proven. It is purely speculative. 

Increase ill T fijilidid . 

In the earlv da\s. according to all autbcirities, the conditions were right 
for the increase of typhoid once it found entrance. Flies abounded; water 
was poor and frequently polluted; tuilet facilities were meagre. The salva- 
tion of the people was then isolation. By the decade lS10-lS."iO there was a 
tendency towards the building of cities. 

Railroads were being built and canals dug. There was travel. Some 
congestion was in evidence and isolation no longer ilominated the [)icture. 
Tyiihoid fever began to be recognized as a menace. 

Dr. C. B. Johnson*" said: "In most instances when a case of typhoid 
occurred in a family where there were young people, all would be apt to be- 
come infected before the disease had spent its force." 

I'reraleiiee iif I'l/plioid Fever After 1S-'>0. 

The earlier decennial reports of the V. S. lUireau of Census did not in- 
clude inortality reports. The lir>i u> inclu<le such data was that for isr)0. 

''^ Jolinsoii, n:ii<l. 



HISTORY OF CERTAIN. DISEASES PRIOR TO ISTT 83 

In that year, according to the census report, IlHnois had a population 
of 851,470. The numlier of deaths reported as due to typhoid fever was 
Gl."). This corresponded to a rate of 71. T per 100,000. 

In isilO the census report gave the number of deaths in Illinois as due 
to typhoid and probable typhoid as 1188 or a rate of fjy.o per 100,000. In 
1870 as 1888 or a rate of 75.5. In 1880 in Illinois outside Chicago as 1187 
or a rate of 1:9.5. As the third decade of the "JOth century draws to a close 
this rate is close to 4. 

Ti/pJioiil Fever in CJiiear/ei. 

The Chicago record began in 1S5'2, The yearly death rates per lOO.OOO 
]i(ipulati(in by years are as given in Table l"i. 

The record is so inccunplete that deducing from it is risky. .Vcknowl- 
edging this it is found that the typhoid rate for both Illinois and Chicago 
about lS.-)0-lS5v; was somewhere about 70 to 100. It would seem that even 
at that date the disease was so widespread as to suggest that it had been in 
the area for some time. Between ISOO and 1870 what was being done by 
the communities to protect themselves against typhoid was about an otifset 
to the natural tendency for it to increase as population increased. The coun- 
trv outside the city did a little better than the city in the decade 1870-1879, 
though a portion of the good showing of the countiT is more apparent than 
real. 

However, neither the county nor the city was making well considered 
effort to bring the disease under control. 

In another part of this volume is shown how Chicago liegan its master- 
ing fight against typhoid soon after 1890, and the results of that tight and 
how th^ State followed a few years later, and how it in turn succeeded 
in conquering the disease. 

. - — I)i.\RRHOEAS AND Dysenteries. 

There is no fjuestion but that diarrhoeas and dysenteries were ])ronii- 
nent in the disease history of Illinois. The writers are agreed that this was 
true of the Indian regime. Their food habits and their water supplies both 
contributed to the diarrhoea! diseases. They affected both adults and children. 
The same was true of the French-Canadians, during their regime. Father 
Marquette suffered from a chronic form of diarrhoea and finally died from 
it. The literature of the period makes it plain that diarrhoea and dysentery 
of both adults and children were prevaleiu. 

The literature of the .\merican period deals largely with the diarrhoeas 
and dysenteries of adults. All information is that the death rate among 
babies was very high. The importance of the high infant mortality rate 
came to be recognized very early. The very first mortality reports from 



84 HISTOK'i' OF CERTAIN DISEASES PiUOR TO 18T7 

Chicago had deaths of children under live years of age as its only division 
except that by months. However, the physicians of the period did not sepa- 
rate of diarrhoeas of children under separate headings. Their reports did 
not analyze this heavy child death rate with its contributory causes. 

Ditinlidrd (iiiil Di/sciitcr/i in Adults. 

The Zcuch's HisUiry iif the Practice of iMcJiciiw makes the following 
references : 

In Union County. 1S50. There was "an epidemic of diarrhoeal diseases wliich 
proved fatal to many." 

In Jo Daviess County. 1S27. "An epidemic of dysentery prevailed to an 
alarming extent. Many deaths occurred." 

Dysentery was epidemic in Sangamon County and Springfield. 1849. 

In Stark County in 1840. "Dysentery of a very fatal type prevailed." 

In Kane County. "Dysentery was more malignant and fatal among the early 
settlers." 

In the Medical and Surgical History of the War of the Rebellion Wood- 
ward tabulates and analyzes 259,000 cases of acute dysentery and diarrhoea 
and 28,000 cases of chronic dysentery and diarrhoea and yet in the two 
volumes of Drake's Principal Diseases of the Interior J 'alley of North 
America (18:^0 and 18^4) neither dysentery nor diarrhoea are treated except 
as incidental .symptoms of three disorders. 

What is the reason for these apparent cimtradictinns ? It is rather easily 
unikM>t(iiid. 

Diarrhoea and dysentery were very common disorders. In most cases 
they were treated by domestic medicines and by refraining from eating. 
When a physician was called he generally treated the disorder symptomat- 
ically. Not much was known about either diarrhoea or dysentery. Most 
cases got well with simple treatment. In order to account for the serious 
cases the doctor fre([ucntly attributed the disorder to some other malady. 
Malaria was the generally ascribed cause. In IS.'i-^ Dr. Thomas Hall of 
Toulon. Stark County in the Report of the Committee on Practical Medicine 
said physicians all acce]ited the view that : 

"The dvsenter\- is the very fever itself, with the particularity that it is 
turned inwards up(in the intestines and discharges itself that way." Dr. 
Hall was correct. Physicians either accejited diarrhoea and dysenteries as 
incidents of the day's work and gave them no special thought or else they 
ascribed them to malaria and wrote of what they regarded as the basic dis- 
ease. 

In 1S.")1 Dr. Samuel Thompson, Chairman of the Committee on Prac- 
tical Medicine, Illinois Medical Society exj^-esses it as his opinion that diar- 
rhoea, dysentery, typhus fever, cholera and milk sickness were modifications 
of the same disease. lUit whatever ma_\- have been their opinions of the 



IIISTOR'l' OF CFRTAIX DISEASES PRIOR TO 187T 85 

cause, from time to time the malady would be so widespread and so fatal 
that the physicians writing papers would mention it one way or another. 

Dr. S. H. Shoemaker of Columbia, Monroe County, wrote in the Si. 
Louis Medical Journal, March. iSfjo: "Almost every physician in the course 
of his practice in 1848 and 18-1:!) must have remarked a great proclivit\- in 
almost every disease to diarrhoea." 

In 185"i Dr. N. S. IJavis in the Report on Practical Medicine. Illinois 
Medical Society, says Dr. S. H. Shoemaker of Columbia reports an ei)idemic 
of dysentery of a very severe type in southern Illinois. Dr. J. T. Stewart 
of Peoria wrote Dr. Davis. "The most prevalent disease in this locality was 
diarrhoea. It showed a tendency tci run into cholera." Dr. Thomas Hall of 
Stark County wrote. "Early in August diarrhdea was jirevalent in some lo- 
calities. C)n September !)th dysentery broke out." 

In IS."):; Dr. Thomas Mall of Toulon rc]iorted to the State Medical So- 
ciety an epidemic of d\senler\' which followed one of diarrhoea and which 
was followed l.iy an ei)idemic of typhoid. 

In 185?. Dr. L'. X. Andrews of Rockford reporting for the Committee on 
Practical Medicine told of an epidemic of "spasmodic cholera" near Rock- 
ford in September and October. 

In 1S5S Dr. V. K. Baily of Joliet reporting for this Committee wrote 
of an eiiidemic of dysentery in his practice. He described one case — a ladv 
who came from "a place where a severe and fatal form of dysentery ap- 
peared about the time she was taken sick." 

In 1S()() Dr. C. ( loodbrake of Clinton, Chairman of ihe L'ommittee 
quoted Dr. R. G. McLaughlin of lleyworth as saying (h'-enter\- was one of 
the most ])revalcnt diseases. Dysenierv ^vas (|uite prevalent during August 
and September. 

Dr. J. W. Coleman of LeRoy, McLean County, reiiorteil an epidemic of 
dysentery which ap]}eared in August. "No class, age or sex were exempt. 
About one patient died out of each fifteen sick but five miles from LeRoy on 
the Bioomington road twenty cases developed of whom six died." 

In ]SU) Dr. W". II. \'eatch reported an epidemic of dysentery at Rood- 
house, Greene County. It appeared suddenly July 1. 1S7 5, and lasted sixty 
days. There were 300 cases and man}' deaths. b\'w families escaped. 

In ISS'.l I^r. 11. \\. Chapmrm re|iorled an epidemic of dysentery at White 
Llall. "It started in June. Iss'.i. lly the middle of the month the epidemic 
was on. It lasted until llie last of ( )ctobcr. There were 5'.1 deaths from 
dysentery. My dealli rate was 1 in 11." 

in discussing Dr. Ch.apman's paper Dr. J. 1'. .Matthews of C;irlinville 
said he had seen Xwo such ei)i(lemics. One was near Corinth. Mississi]3pi, 



8G HISTORY OF CERTAIN DISEASES PKIOR TO 18?7 

ill tliL' army in lsi;:i. The other was in Bird eight miles west of Carhnville 
in 1 M.i I. In that epidemic 25 died in a radius of five miles. 

Dr. \V. J. Chenoweth reported that in an earlier day he had heen in a 
similar epidemic in Decatur in which one tenth of the ca.ses died. 

Dr. ^V. L. (ioodell of Effingham reported an epidemic between 1850 and 
18G() in which he saw 27 cases. Dr. Stahl of Grandville said fluxes were 
very prevalent in his section. Dr. E. P. Cook of Mendota reported an epi- 
demic in which he had served in 1864. 

In 18(;; Dr. L. T. Hewins of Loda (Coiiiiiiillrc an Practical Medicine) 
reported "Dysentery in an epidemic form has not prevailed in the eastern and 
southern parts of the State except in Edgar County and some parts of Coles 
County." However, Dr. George Ringland reported an epidemic that year 
in a town of 600 inhabitants. The first case appeared June 2S and the last 
in September. There were abovit 100 cases and 13 deaths. 

Silas Reed'"' wrote that typhoid dysenteries were especially prevalent in 
the Western Reserve in 1824, 1826 and 1828. In those years Illinois was 
drawing heavily on the Western Reserve for accessions to its population. 
The annual reports of the Committee on Practical Medicine of the Illinois 
Medical Societ\' (there were years in which no reports were made) contained 
reports on the prevalence of diarrhoeas and dysenteries in 1852, 1853, 1855, 
1857, 1858, 1860, 1867, 1869, 1872 and 1876. Some of these referred to 
diarrhoea in children, some to the disease in adults. Some referred to epi- 
deiuics of diarrhoea and dysentery tlmugh in most of them the disease is re- 
ported as endemic. 

Infant Mortality. 

( Especiallv that due tn diarrhoeal diseases.) 

Every jierson who wrote of health conditions during this period placed 
especial stress on the sickness rate and esiiecially on the diarrhcieal disease 
rate among babies. 

If there was confusion as to the causes of the different kinds of di- 
arrhoea among adults there was more of it as to the same symptom or disease 
among babies. 

Diarrhoea, sumiuer coni]ilaint, cholera morbus, cholera infantum and 
dysentery were terms used more or less interchangeal)ly. 

In 1858 Dr. F. K. P)aily of Joliet ]iroposed that the term cholera in- 
faiuum aiuericana be used since the disease was so prevalent in America. 
He said that it was often confounded with ordinary diarrhoea. He said one 
of the i|uestioiis which he had asked related to cholera infantum. Nobody 
replied to that (|Uestioii \m{ he knew the disease was prevalent liccause he had 
seen much of it in his praciice in joliet for four or five years. 

"' Heed, Uiiil. 



HISTORY OF CERTAIN DISEASES PRIOR TO ll^TT 



87 




III 1S71 Dr. D. W. Young of Aurura quoted Dr. A. Jacobi as saying 
that chiilt-ra infantum was the rcsuh of paralysis of the nervous system 
caused by heat. 

In 1.SS3 Dr. L. H. Corr of Carlinville 
said cholera infantum was a neurosis. Many 
writers thought it a manifestation of malaria. 
Dr. I. Alurphy uf Peoria told of his success 
in pre\-enting it by giving prophylactic doses 
of i|uinine in the summer time. 

In IS.M Dr. C. X. .\ndrews of Rock ford 
( Cdiiuiiittcc (III Practical Medicine) reported 
diarrhoea and cholera mcirbus were also s(.ime- 
what prevalent ])articularly among the children. 
In l.sriS Dr. Hiram Mance of Lafayette 
wrote "Cholera infantum prevails every sum- 
mer in this vicinity." In 1859 Dr. J. O. Harris 
of Ottawa wrote "During the summer months 
i,,. |_ I, ,.,,,. J. diarrhoea among children was extremely prev- 

alent." In 1S7 1 Dr. O. W. Young gave this 
oi)inion : "It is generally conceded that mi)re children die annually from 
cholera infantum than from any other disease." 

In is:'.) Dr. L. H. Corr of Carlinville said "Nearly one half the children 
born die before reaching 5 years of age and nearly one half of these deaths 
are from bow^el troubles commonly called cholera infantum or summer com- 
plaint." 

In the Transactions of the State Medical Society either through papers 
or through references in the report of the Committee on Practical Medicine, 
cholera infantum was covered in 1858, 1860, 1869, 1871. 1876 and 1878. 

Diarrhoea and dysentery usually referring to these diseases in children 
were covered in 1852, 1853, 1855, 1857, 1858, 1860, 1867, 1869, l.s;v' and 
is: 6. 

For twenty-seven years 1813 to isii!) inclusive the Cliicac/o Health De- 
partment Annual Reports carried a table in whicli was shown the total num- 
ber of deaths at all ages and the total number occurring in children five years 
of age and younger. Table 2 shows the percentages of the total deaths in 
each vear which were in children as aforesaid. 

Twice in the period the number of deaths of children was less than :ln per 
cent of the whole. Six times it was between 30 and 40 per cent of the whole. 
Six times between 40 and 50 per cent. Eleven times it was between 50 and 00 
per cent. Twice it was over 60 per cent. It seems almost inconceivable 
that in any vear the deaths of young children should nmre th:in eipial, should 
even a]j]3roximate two thirds the total deaths at all ages. .\nd yet thai h.-ij)- 



H,S IIISTOUV OF CERTAIN- DISEASES PRIOR TO 1877 

jK'iK'd in ("hicaj,'ii and ])rohalily also in those other pcn'tions of the State in 
wliich n(] fecord was ke])t. in those years llie total <leath rate was hiiijli. 
niakini^' tlie child death rale ver\- lii^h. 

In Tlir llishiry of the I'mcticr oj Medicine Zeuch says: "By ISTS the 
death rate from infantile diarrhoeas had fallen to one-fourlh the nninher 
in 1845." 

The graphs shown in Figures I to i showing the high mortality in the 
summer months in the early years also iioint to a high child death rate in that 
period. The great ])art of the death rate of ])ahies was due to digestive dis- 
orders. 

Deaths of Children Under Age Five in Relation to Deaths at 
All Ages. 

In view of the fact that the Chicago vital statistics tahles had shown 
since 1SI"> the relation hetween deaths under •"> and all deaths Dr. N. S. 
Uavis was interested in that suhject. In ls;:i he told the Illinois Medical 
Societx' that in Xorwa\- the deaths of children under live years of age were 
onlv 1 •'> i)er cent of the total deaths ; in Alassachusetts 'ill per cent : in Bavaria 
."iD per cent. It would he interesting to know whether Illinois was in the 
class with Norwa\- or with that of kJavaria — or was somewhere in between, 
hi all prohabililv it was nearer liavaria than Norwa} hut there is no way 
of knowing for certain since Illinois was not keeping hooks in terms of vital 
statistics at that time. 

But Chicago was and the figures are available for coiuparison. While 
the death rate of children imder -"i years of age down-state was not quite 
equal to that of Chicago the difference was not great. Table "2 shows the 
[M-o])ortion of deaths of children imder five years of age to total deaths in 
Chicago from lsi:i to isll inclusive and for purposes of comparison the 
]jroportion for lii^o, a typical \ear in the present period is also shown. This 
table shows that Is; I had the worst record with a ]3ercentage of 70.7. In 
1873, the year in which Dr. Davis made the slighting reference to Bavaria, the 
proportion in Chicago was •")!•. •'!. in Ba\-;iria .")(). The average for all the 
years l.sbl to 1S7; was I'.i.l, the average for the ten \ears 1S(!-1: to 187:! in- 
clusive was 'il."!. Compare this with Chicago's iiresenl day |iroiiortion \' A 
and Norway's l-'i. 

In I8;!i Dr. L. II. Corr of Carlinville said one half the children born 
ill Illinois died bt'fore reaching five )'ears of age. 

In the C. S. Registration .\rea in r.iv'."i, the intmber <d" deaths 
aniony children under live \ears of age per 100(1 total deaths was 187.0. 
The number in ])ersons over five years of age was 812..'). or a ratio of ".^3 
jier cent. 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 



89 



Seasonal Distribution of Disease. 

As early as IcSfiT there were plnsicians who I'nund the menace of respira- 
tory diseases in winter ahnost as niucli as that of digestive diseases in summer. 
In LS67 Dr. Haiiiill told the American Medical Association that in Illi- 
nois three-fifths of all the deaths fnini lung diseases occurred in March, 
.\|)ril and November. The least murtality occurred in July and August. 

'ra1)le •') and Figures 1 to 7 show the radical change in the monthly dis- 
trihutiun of disease which has occurred in Chicago since 1843. It is reason- 

abl\' certain that a similar change has occurred 

elsewhere in the State though the statistical 
data to establish the fact are not available. The 
figures given and used as a basis for the 
charts are ten-year averages and therefore tem- 
j)orarv epidemic influences are eliminated. 

'i'he exceptions to the statement that the 
figures show ten-year averages are the charts 
made by Dr. Michael Mannheinier lor Chicago 
in 18(;: and 18(i8, the chart for ^'yi■^ and the 
line for 184;3-4lt. The charts made by Dr. 
Mannheinier are included because they show 
the seasonal distribution of fatalities in that 
day and alsn because they were pioneer pro- 
Dr .Mirhaei Mannheimer (luctiims and iif superiiH' excellence. It was 

nearly thirtv years after 186!) before the Chi- 
cago Health Department resumed the plan of charting disease. 




1 able V!. 
Ratio df Deaths .\-Moxg CiiiLDRirx Less Tii.\x Fim-: to All Deaths. 



1843 

1844 


28.5 

41.6 


1845 . 


40 


1846 


33.3 


1847 

1848 


37. 

41.6 


1849 


26.3 


1850 . 


36 7 


1851 


42 7 


1852 


33 9 


1853 


48 5 


1854 


... 32 9 


1855 


44 5 


1856 


52 7 


1857 

1858 


58.5 

57 3 


1859 


56 6 


1860 


55 7 


1861 


54.S 



Chicago 1843- is;; axd I'.i-.'." 

1862 

1863 

1864 

1865 

1866 

1867 

1868 

1869 

1570 

1571 

1872 

1873 

1574 

1575 

1S7« 

1877 



55. 

50.7 

51.4 

52.7 

48.8 

57.5 

42.2 

54.4 

62.8 

70.7 

45.2 

59.3 

61. 

61.2 

57. 

56.2 



90 



HISTORY OK CERTAIN DISEASES TRIOR TO 18T7 



The single year \'*'i'i \^ i.liarted as a sample year in the present unex- 
pired decade. The chart f(]r the forties represents an incomplete decade he- 
cause the figures for 1840-11 and -12 arc not a\':iilahlc. 

The charts illustrate total deaths rather tlian rales and in consequence 
the scale has had to he changed. In order to i)revent visual misconception 
as to the relative summer rise in isi:) to 1841) Fig. 7 is inserted. In this 
chart the scale is different from that used for 1843-]S4ii in the chart shown 
in Fig. ;5. 

The striking features disclosed by these charts are the summer peaks in 
the earlier charts and the winter peaks in the later one. 

The summer peak which was the outstanding feature of the sickness rates 
prior to 18S0 gradually declined thereafter. Some slight tendency to decline 
was noticed several years before 1880 in Chicago where the health depart- 
ment began to be somewhat efficient in the latter part of the decade 1860-1869. 
By 1920 this peak had wholly disa]5peared. The disappearance of this peak 
is due to the disappearance of malaria, the near disappearance of typhoid and 



Table 3. 
Average Deaths in Chicago— 



■By Months — Decades. 



Decade 


























ending. 


Jan. 


Feb. 


Mar. 


Apr. 


Ma.v. 


.Iinie. 


.luly. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


1849* 


26 


27 


26.3 


27.1 


49.9 


42.6 


92 


80 


64 


44 


38 


29 


1859 


92.6 


84.4 


93.6 


95.6 


96.6 


117.9 


272.5 


386.7 


273.5 


156 


107.4 


102.2 


1869 


279.3 


263.9 


274.4 


253.8 


240.5 


224.9 


499.8 


583.3 


454.5 


405.3 


296.9 


302.4 


1915 


2938.6 


2836.2 


3158. 


2934. 


2803.7 


2362.4 


2527.5 


2686. 


2539.6 


2457.9 


2483.7 


2964.4 


1925 


3254.9 


3263.4 


3436.5 


3125.7 


2926.1 


2459.1 


2417.8 


2475.9 


2413.3 


3290.6 


2673.1 


3343.3 



* 7 years only. 

the great decrease in the diarrhoeal diseases and other causes more or less 
related to the work of health departments and physicians. The winter peak 
began to a|ipear in the decade 1870-T9. It was fairly in evidence in 1880-89. 
Since 18!i() it has been the striking feature of the picture. Its eminence is 
in ])art due to the recession of the summer peak. However, that does not 
tell the whole story. 

During a part of the time the sickness rate of this ])eak period has been 
absolutel)- higher as well as relatively higher than it was during the pre- 
winter ])eak period. The contribution of the pneiinioni.is and influenza to 
this result has been elsewhere discussed. In older to draw conclusions from 
statistics of the acute kniL; infections which >hall not be \ery misleading it 
is necessary to combine lobar and broncho pneumonia, bronchitis and endemic 
influenza (either actual or so-called). It m;iy be possible to separate in- 
fluenza in great epidemic years without radical statistical error but not at 
other times. This has been referred to in the section dealing with pneumonia 
and influenza. 



Sc«leof 
Noiitlily 
Morlalitv 






rar^irrjis^.iiraficryov. v^::3o: j^ ,:i::x::mt^\ Tzr^ax 



25?; 



9 « 



TTTTTill? 





RAIN 

B.WI-ND 

W.WINE. 

ClUR DAYS 

CLOUDY DAYS 



nduAo 



FOLDOUT BLANK 



THE COURSE OF THE TOTAL MORTAIITYAND THE CHIEF FATAL DISEASES IX CHICAGO FOR 18G«. 

(with Mcl(H)rological Observations for the same period made by J.G. LANGGUTH JR at 117 Randolph St.) 
Prepared by M.MAXXHEIMER.M. I), under the direction of the Registrar of Vital Statistics. 




-lIumidity.Moisliireof Atmosphrrc,(Foint uf Saluraliuii 100) 
' liaroiiicter.WVi^t or Alniositiiere. 
■ " -ofr 



-• Uiicheat and Luweitt Raniic oi Barometer. 



Thermometer. Temperature of Atmosphere. 
Highe.st and Lowest Rai^e of Thermometer. 



Fig. 2. Second Mannhelmer chart. 



THE C^OURSE OF THE TOTAL MORTALITY AND THE CHIEF FATAL DISEASES IN CHICAGO FOR 1867. 

(with Mctooiological Observations for tlie same period made by J. G. LAXGGUTH JR at 117 Randolph St.) 
rrepared by M.:^L\XXHEI^^^:R.^^.D. under- the direction of the Resistrar of Vital Statistics. 




Fio. 1. First Mannheimer chart. 



HISTORY OF CERTAIN DISEASES PRIOR TO ISTT 



91 



'-J_JI 1 . . 


""^ 


3 


^^ 


it'' 


£. **s 


L ^-^ 


cT - ^^0-" 


<' — ^^ 


hE -^^ 


Et *> - It 


^ — !- r ■ ■ ■ 1 




Qj 1 ■ N^ 


c: 1 * ' 1 


oi ' 


" It ^^'' "- 


* m I '5^ 


' int i ^»«^ 


=--*■ 


'^ ^<«* 


*t di ^^ 


^s 


V T 


X ^ m 


1 1 


"*.^ -^ 


Z^ 


f 


^---' 


"" ■ " ^ ^^"^ 


I ^^-^ 


1 ^""s 


= " ^*" 


4^ 


^s^ 


7 






O '^ _l 


1 


^^ 


^a" 


^t 


I "■*»-• = 


± i *■» T 


^ J. I __ 


It A 


z 4^ 


)► 


- I " " "" '"^ 


i i _i 1 


a 1 _^ 


z 1 ^ 


O I 1 _l_ ^' 


" *\^ 


< ' ^^ 


>•! f _f*"-i» 


■° —L " "'*t^V 


^ 1? 


< t\ 


gl 1 _J 1 11 


u 1 1 1 ' ^ 1 J_ 


■> 1 1 11 1 111 



o d 






92 



HISTORY OF CERTAIN DISEASES PRIOR TO 1877 




Jan. Feb. Mar. Apr. Hay June July Au^. Sept. Oct. Nov. Dec. 



Fui. 4. Moiitlily mortality rates in Chicago showing the change fifty years have wrought 
in seasonal distribution. 



HISTORY OF CERTAIN DISEASES PRIOR TO 187 



93 



Chicago (lortality Rate for Acute Respiratory 
Diseases by Decades 



27 
26 
25 
24 
23 
22 
21 
20 
19 
18 
17 
16 
15 



' \ 1 

J 



1870 1880 1690 1900 1910 

Fig. 5. 



94: 



IIISTOUV OF CEUTAIX DISEASES PRIOR TO 1ST7 



30 
19 
Z8 
27 
26 
25 
24 
23 
22 
21 
20 
19 
18 
17 
16 
15 
14 
13 
12 



\ 

\ 










\ 




^"" 






\ 

1 


< 










\ 










\ 

\ 










\ 










\ 
\ 










\ 

« 












\ 










\ 

\ 








/^ 


o, 






/ 


/ 


\ 






/ 




\ 


V 








1 


\_ 






























s 


N 










s 



1870 



1860 



1890 



1900 



1910 



Pig. 6. Sliowing tleceniiial ninrtality rates frmii all causes in 
Chicago for .Tamiary, February and March cuntrasted with that 
for July. August and September. 



IIISTORV OF CliKTAIN DISEASES PRIOR TO 1877 



95 




Jan. Feb. Mar. Apr. May June July Aug. 5epl. Oct. Nov. Dec. 



Fig. 7. Note the difference in seasonal peaks. The autumnal rise in the 
1916-1925 decade was due to the influenza pandemic of 1918. 



96 HISTORY OF CEKTAIX DISEASES I'KIOK TO 187? 

Bat in ackliliun to intiueiiza and tlie pneumonias the winter ])eak is made 
up of contributions of other diseases less easily related to respiratory infec- 
tions. The death rates from smallpox, measles, scarlet fever and diphtheria 
— all important diseases of the winter peak period — h;ive declined without any 
decided or certainly without a pari passu decline of the winter peak. Some 
of the few health students who have studied the development of this winter 
peak ha\-e attributed it to the great influenza wave which prevailed in Illinois 
during a peridd which began about December, bS'.ill. Iklt the tables and the 
charts show that whatever was operating to change bacteria or people or en- 
vironment or several of these combined was in operation prior to 1890. 

The solution of this problem is bequeathed to the Illinois Department 
of Public Health during the next few years. The solution will require their 
best thought. It will require research, planning and strategy because it is 
possible that the people may need to change many of their social methods 
and customs before they can enjoy good health and low death rates during 
the winter and early spring. 

Vital Statistics atid Mortality Rates From All Causes. 

The Seventh Census, that of lS."iO was the first to give anv vital sta- 
tistics and what it gave was limited to ]>opulation .gain, tn ])opulation figures 
and gross death and liirth rates. 

The introduction to the report of this census contains the following 

statements ; 

"The tables ot the census which undertake to give the total number of births, 
marriages and deatlis in the year preceding the first of June, 1S50, can be said to 
have very little value" — "Upon the subject of deaths no one can be deceived by 
the figures of the census since any attempt to reason from them would demon- 
strate a degree of vitality and healthfulness of the United States unparallelled 
in the annals of mankind and would overthrow the best established principles of 
statisticians and contradict all science and experience. The truth is but a part 
ot the deaths have been recorded varying for sections from a very small to a 
very large part of the whole" — "In the form in which these deaths are published 
they are of no value, yet in the opinion ot medical gentlemen in different parts 
of the Union of high reputation who have been consulted and whose testimony is 
now on file in the census office and in the opinion of the National Medical Conven- 
tion (American Medical Association) who are equally aware of the precise char- 
acter of the data, the publication of the names of the diseases for each of the 
counties of the United States, the period ot sickness, the age, birth-place and 
occupation of the deceased, the exact time of death, defective in many respects 
though the returns maybe, would essentially subserve the interests of the medical 
profession of the country and tend to the promotion of public health." 

'fhe death rate as given l)y this census for Illinois was 13. G — this is the 
death rate that was esteemed impossible because it "would demonstrate a 
degree of vitality and healthfulness unparallelled in the annals of mankind 
and would o\ertlirow the best established |)rinciples of statisticians and 
contradict all science and experience." 'fhe statement was true in I80O but 



HISTORY OF CERTAIN DISEASES PRIOR TO ]ST7 



97 



by i;ilu the death rate had fallen below 13. G and it has been below that tigure 

every year since except in the influenza epidemic period. What was thought 

to be impossible in 1850 is now more than achieved and being achieved 

is accepted as a matter of fact and alnmst without cumnu-nt to say nothing 

of praise. 

By 1860 most of the standards referred to in the introduction t(3 the 

rejiort in the Seventh Census had Iteen adopted. Nevertheless, the actual 

returns nf death were far from satisfying as the Sui)erintendent of the 

Seventh Census had warned. In the introduction to the report of the Eighth 

Census are found the following statements : 

"It is manifest that neither in 1S50 nor in ISSO was tlie entire mortality of 
any state ascertained and reported nor was even such an approximation obtained 
as will permit any reliable calculation to be made of the rate of mortality. The 
same holds true of the deaths reported as due to the several causes of death such 
as consumption." 

In Tables 4 to 10 are presented some excerpts from the V. S. Census 
reports of 1S,-)0-1,S80 relating to mortality in Illinois and the population of 
the State. 

Table 4. 

Deaths from all Causes and Certain Diseases in Illinois — Decennial 
Years 1850-1880 — From U. S. Census Reports. 



Illinois. 


1850. 


1860. 


1870. 


1880. 




n,619 
13.6 


19.300 
11.2 


33,672 
13.2 


45.017 
14.6 




Doath rates under 1 yr. per I.OOO births 






51.4 
87. 

4.1 
113.7 

128.8 

70. 

66.9 

6.3 
65.7 

41.2 

98.7 
.4 
22.3 
10.6 
I. 


50.3 

123.8 

1.2 
145.6 

188.3 

59. 
35.5 


43.4 


Bronchitis 1 




Pneumonia .•.. 1 


168.2 


Influenza 1 




Pleiirisv J 







150.9 




















148. 






Teething: 




Bowels, disease of 






122.9 


Mahiria 1 






36.1 


Remittent 




Tvphoid anrl Tvnhus 
Meninnifi'* 




70.3 53.6 


CephiilitK 


77.8 

85.1 
6.7 




Cerel.n. -^imMl 


28.3 


Meiiir«in- 




Enceilnllu.- 




Scarlet Fever 


44.4 


Smallpox 








i-'u 






10.5 10.7 


Yellow Fever 




Tvphus Fever 

















98 



IIISTOKV OF CEUTArX DISEASES PRIOR TO 18T' 



Tabic 5. 

PorULATlON AND NuMBICR OF DeATHS ILLINOIS 

U. S. Census Report 1850. 

Total Population 851.470 

White 846,034 

Free Colored 5.438 

Number died during year 11.619 



Table 6. 

Number of Deaths from Certain Diseases — Illinois 

U. S. Census Report 1860. 

Population 1,711.951. 



Deaths 19,300 

Bowels, disease of 26 

Bronchitis 75 

Cephalitis 701 

Cholera 70 

Cholera infantum 315 

Consumption 1,948 

Croup 1,158 

Diarrhoea 607 

Diphtheria 41 

Dysentery 845 

Enteritis 329 

Fever intermittent 464 

Fever remittent tJS2 



Fever typhoid 1,1 S3 

Infantile 373 

Influenza 14 

Measles 109 

Pleurisy 46 

Pneumonia 1,357 

Scarlet fever 1,698 

Smallpox S 

Teething 198 

Deaths under 1 year 4.407 

Deaths under 5 years •. . 9.928 

Whooping cough 3S2 

Yellow fever 1 



Table 7. 

Number of Deaths from Certain Causes — Illinois 

U. S. Census Report 1870. 

Population -i.S.-iO.SOI. 



Deaths all causes 33,672 

Cholera infantum 1,869 

Croup 886 

Whooping cough 640 

Measles 702 

Pneumonia 2. 882 

Smallpox 170 

Diphtheria 603 

Scarlet fever 2,162 

Malaria 888 

Meningitis 43 

Typhoid 1,758 

Typhomalaria 17 



Typhus 131 

Meningitis 1.932 

Diarrhoea 1,284 

Dysentery 664 

Enteritis 603 

Bronchitis 219 

Under 1 year, Total 9,215 

Under 1 year. Females — 4,149 
Under 1 year. Males — 5,066 

Under 5 years. Total 16.953 

Under 5 years, Females — 7,836 
Under 5 years. Males — 9,117 



IIISTORV OF CERTAIN DISEASES PRIOR TO ISTT 



99 



Table T — Continued. 
Illinois — 1S70 — Deaths. 



Disease. 


Male. 


Female. 


Total. 




2 
19 
12 
2 
139 
688 
472 
28 
131 



13 
5 
3 
125 
522 
414 
12 
157 


2 




32 


Tvphonialarial 


17 




5 




264 




1210 




886 




40 




288 







Table 8. 

Number of Deaths fro.m Certain Causes — Illinois .\xd Chicago 

U. S. Census Report 1880. 

r'o])ulation :!.07 ;,871. 



Number deaths 45,017 

Bronchitis 709 

Cholera infantum 1,884 

Cholera morbus 169 

Consumption 4,645 

Diarrhoea 770 

Diphtheria 2,403 

Dysentery 698 

Enteritis 988 

Fever 77 

Meningitis 278 

Enteric fever 1,652 

Malarial fever 1.114 

Scarlet fever 1,.369 



Typhus fever 23 

Yellow fever 5 

Whooping cough 488 

Measles 603 

Meningitis 594 

Pneumonia 4,378 

Smallpox 45 

Erysipelas 334 

Yellow fever, group 2 2 

Yellow fever, group 3 3 

Bowels Ill 

Croup 1.370 

Pleurisy 91 



Table 8 — Continued. 
Census — 1880 — Illinois. 



Living 1 yr. of age 87,859 

Death per 1000 births (males) . . 94.1 
Death per 1000 births (females) 75.8 
Total deaths under 1 yr 10,96S 



Deaths under 5 19,667 

Percent of total deaths (males) . . 44.8 
Percent of total deaths (females) 41.9 



Deaths — Ciiic.\(;o — Certain Causes — Under 1 Ye." 



Per 1,000 births (males) 166.7 

Per 1.000 births (females) 122.4 

Total under 1 year 3,533 



Under 5 years 5,871 

Percent of total deaths (males) . . 57.3 
Percent of total deaths (females) 54.8 



100 



IIISTORV OF CERTAIN DISEASES I'UIOR TO l.ST 



Table 9. 

Population' ok Illinois — Census Years Frdm U. S. Census Reports 
1810-1888. 





Population. 


],K,ease. 


Year. 


Per cent. 


Numeriial. 




U,282 

85.211 

155,455 

476.183 

851,470 

1,711,951 

2,539,891 

3,077.871 








349,52 
185.16 
202.44 
78.81 
112.8 
48.36 
21.18 


32,929 


1830 


100,244 


1840 

1850 

1860 


320.72S 
375.287 
860.481 
827,940 




537,980 







Table 10. 

Increase of I'oI'ulation by Census Years From U. S. Census Reports 
1810-18.511. 



Year. 


Whites. 


Increase. 


Free 
Colored. 


Int-rease. Slaves. 


Increase. 


Total. 


Percent. 






613 

457 

1,637 

3,598 

5,436 






12,282 
55,211 
155.445 
476,183 
851,470 




1820 53,788 
1830 155,061 
1840 472,254 
1850 846.034 


367.68 
188.28 
204.56 
79.14 


20.44 1 917 
258.2 i 747 
119.79 331 

57.08 


445.83 
18.53* 
55.68* 


349.52 
185.16 
202.44 
78. SI 













HEALTH HISTORY PRIOR TO 1877 OF SOME OF THE 
CITIES, IN ILLINOIS. 

Chicago. 

In a health history of Illinois, Chicago anil the Chicago area deserves 
especial consideration. It was the portal of entry for that great part of the 
population which now dominates the State ancl which has been prominent in 
the State since 1840 at least. They or their parents or grandparents en- 
tered Illinois at Chicago and remained there or somewhere else north of the 
center of the State. This population has been a health factor differing some- 
what from that of other parts of the State. 

Chicago is the largest center of population in the State. It had a health 
department many years before the State organized one and this example 
helped the medical profession to get a state health department. At times it 
has contributed diseases to other parts of the State and at times other parts 
of the State have contributed disease to Chicago. 

The great Irish wave of immigration of the thirties and forties, the great 
German wave of a little later period, the great Scandinavian wave of the 
seventies and the lesser immigration waves from other lands, all these great 
masses of people influenced the health of the population among whom they 
settled. 

The immigration into the State from other states which came through 
this portal, speaking in a general way. came from diiYerent states than that 
which settled in the prairies and to the south thereof. 

The great aggregation of people, several millions in number near the 
Chicago River, by their very congestion, created health problems that difl:'ered 
in quantity and to a degree in quality from those of the other parts of the 
State. 

The location of Chicago did not jjresage good health. There were no 
currents in Lake Michigan by which sewerage and soil pollution could be 
kept awav from the water supply and the city was near the lake head where 
these forces are most potent for harm. The country was flat and drainage 
was not possible. Mosquitoes abounded. Long John Wentworth makes the 
statement that there were no mosquitoes in the Chicago area prior to the 
opening of the Illinois-Michigan Canal but in this he was mistaken. This 
statement is found in his address on the early days in Chicago made in his 
later life long after the opening of the canal. Doubtless his recollection of 
things political and economic was correct but lie forgot the mosquitoes. He 
is contradicted by a number of witnesses who wrote when the matter was 
fresh in their minds. 



102 HEALTH IX SOME CITIES rUIOK TO 1877 

(j'ordDii Salstciistill liuljl)ard writinL; nf his first ])(irtage through Mud 
l.akc. C'liicagii. in < )ct<il)cr, iSlS, says. "'I lie lake was full of these almniin- 
aliit- Iliads iilagues (leeches or hlnod suckers) and they stuck so tight t<i the 
skin that ihey hroke in pieces if force was used to remove them. The use 
of tobacco lo remove tliem was resorted to with good success. Having rid 
ourselves of the hlood suckers we were assailed by myriads of mosquitoes 
which rendered sleep hopeless." 

In spite of all this the indications are that U]i to 1,S()3 or thereabouts 
the people of the Chicago area had ratlier better than average health. There 
is no record of great departure from normal iieaUh among the Indians of the 
area or among the b'rench-Canadians nor among the other inhabitants ]irior 
to the beginning of immigration from the other states. The travellers of the 
period who visited Chicago generally referred to the lake water as healthy 
though one statement to the contrary was found. 

In 1.S(I4 Surgeon Ceneral Forry of the U. S. Army wrote of the Cliicago 
Region — "This position is one of our most salubrious stations." But right 
at this ])oint the story changes. Ouaife"' says, "Soon after the arrival of 
troops ( ISOli) they sutiered nnich from bilious fever." 

\\ histler reported "that in one year after I-'ort l/)earborn was occupied 
more than one-half the men had been ill." 

In lSv!() Dr. Alexander W'olcott came to the fort as an Indian agent. 
He wrote. "The fevers of that season were unusually rapid, malignant and 
unmana.geable." The reports of this period indicate that lualaria was very 
prevalent. Excerpts from records and writings of the period as chronicled 
by Ranch''- and Koehler''^ are here presented to show the major facts relat- 
ing to the health and sanitation of Chicago from IS-^'.i to ls;(i: 

1829. Fort Dearborn troops. 

Man strength of the garrison 01 

Diseases, intermittent fever 17 

Respiratory organs 11 

Digestive organs 30 

1S30. Man strength of the garrison 90 

Deaths from remittent fever 15 

However, in tiiat year the Canal commissioners wrote, "Tiie inhabitants 
say the site is decidedly healthy." 

183"2. In this year cholera attacked General Scott's troops en route 
to the 151ack Hawk War. The rate was -.'(lO ])er lOOO. There were forty- 
eight deaths, llecause of the ejiideniic these troops never got to the front. 

1833. The first sanitarx; ordinance was jiassed. 

»' Quaife (Chit-ago ami the Old Northwest). 
•2Rauch (Sanitary History of Chicago, Chicago, ISTl). 

''Koehler (Annals of Health and Sanitation Octennial Report of Department of 
Health, Chicago, years 1911-18, Chicago, 1919). 



HEALTH IN SOME CITIES PRIOR TO 1S7T 103 

1834. A temporary board of health was formed and also a cholera 
vigilance committee. These activities were inaugurated in order to fight 
cholera which threatened. When cholera did not appear all this lajjsed. 

183j. Another board of health was appointed consisting of seven 
members. 

183;. Chicago was incorporated and a board of health was appointed. 
They appointed a health officer. 

1838. Nearly all who resided along the line of the canal excavation 
had malaria as did the laborers digging the canal. ".\ very deadly and 
strange epidemic appeared; it was called the canal cholera." 

1840. City got a water supply from the lake. 

1841. "An ordinance recjuiring reports of deaths was passed hut was 
not enforced for several years." 

1843. One hundred and twenty-nine deaths were located by means of 
inquiries of undertakers. (This was Chicago's first mortality record.) 

1844. "Inquiry among undertakers discovered 306 deaths. A violent 
epidemic of scarlet fever was responsible for many of these." 

1S4.J. Scarlet fever still prevailed. Board of health practically de- 
funct for several 3'ears. 

1S4S. Chicago had a smallpox scare. 

ISIil. In April forty-five district health officers were appointed. 
Cholera appeared in that month. In that year there were 087 deaths due to 
cholera. In one month there were 1000 cases and 314 deaths. Great activity 
in sewer building. Smallpox also prevailed. 

1850. Cholera again appeared. In one month 41 li persons die<I from 
the disease. Smallpox still prevalent. 

18.")!. .X new city charter gave much larger powers in health matters 
to the city council. A committee of the Chicago Medical Society reported 
the mortality rates 184(i to 1850. That of 1850 was 40. C per 1000. Small- 
pox and cholera present. 

1852. Cholera was present. The number of deaths caused by it was 
030. From 1849 to 1852 inclusive, 1!)44 died from cholera which represents 
one death per each 04 of the population. Smallpox prevailed. The Marine 
Hospital was opened. During the first three months the hospital treated 
20 cases of malaria. The city health ofticer's salary was $500 per year. 

1853. Smallpox more prevalent. 

1854. There were 1424 deaths from smallpox. Cholera present. 
Cholera and smallpox hospitals were maintained. 

1854 and 1855. There were 1571 deaths from cholera or one for each 
92 of the population. 

1855. Deaths from smallpcjx 30; from cholera 147. 



104 IIF.AI.TII IN SO.MK CITIKS PRIOR TO 1877 

1S.")(;. (lencral liraltli licttcr. Xo deaths from chulc-ra but Ivplmid 
was on tliL- increase. lyphoid ver\- ijre\alent in September. 

1S.")7. iioard of health went out of existence. Malaria death rate 
was oS.Ct per 100,000, the highest rate shown by the records. .Also an epi- 
demic of dysentery which was very fatal. 

1.S5.S. Scarlet fever still prevailed and dysentery was \ery prevalent 
in children during the summer months. Tuberculosis death rate was 31I2.2 
l)er 100,000, highest in the history of the city. 

IS.")!). .Scarlet fever still prevalent. The death rate from scarlet higher 
than that from any other disease. Many sewers built. 

ISCO. I!oard of health abolished. Raising of the city grade completed. 
The term typhus fever disappears from the mortality records this year. 

isi;-.'. Policeman Perry appointed acting health officer. Diphtheria 
and smallpox prevalent. Increase in deaths from all causes. Typhoid and 
scarlet fever increased especially. P>ridgeport sewerage pumps started. 

]S(i;5. Death rate increased. There were 94? cases of smallpox. Epi- 
demic of erysipelas present. This outbreak was studied by Dr. Edmund 
Andrews who showed how the disease prevailed along the filthy Chicago 
River and in the unsewered parts of the city. 

1864. The result of the almost total neglect of sanitary laws during the 
past five years in addition to the fact that the construction of sewers did not 
keep pace with the increase of population is apparent from the great mortality 
of this vear. Compared with 18()3 there was a great increase of cholera 
infantum and cholera morbus. Erysipelas and the low grades of fevers 
almost doubled and smallpox trebled. There was a great increase in diar- 
rhoea and dysentery. There were nearly five times as many deaths from 
measles and a great many more from pneumonia. 

.\nother remarkable fact is that only 164 more died in the last si.x 
nioiilhs than in the first. Erysipelas continued to be epidemic until July. 
This vear witnessed the first great increase in pneumonia and the first 
tendency to a change in the seasonal distribution of fatal disease from a 
summer to a winter peak. The tendency was scarcely perceptible for sev- 
eral years. 

]8t).-). The high pneumonia rate continued. The efi:'ect of the heat and 
sudden change increased the mortality particularly among the children. 
Fear of cholera stimulated owners of property to make sewer connections. 
Cholera was reported on its way and Dr. T. B. Bridges was appointed health 
officer. 

1866. A total of 1,581 cases of cholera occurred. Health officer was 
given ;52 assistants. The death rate was 32.55 per 100.000. The death rate 
of chilclren under 5 was high. '"The heavy rainfall from July to October in 



IlKALTII IN SOME CITIES PRIOR TO IS'!'; 105 

connection with the localities in which cholera occnrred goes far toward cor- 
roborating- the ground water theory of I'ettenkofer", says Dr. Ranch. 

186T. Chicago organized a board of health which followed the lines 
of the Metropolitan Board of Health of New York of which Dr. Stephen 
Smith was the moving spirit. The Chicago board made Dr. Hosmer A. John- 
son president and Dr. J. H. Ranch, a former surgeon in the Civil War, 
as its executive officer with the title sanitary superintendent. Dr. Ranch 
was an unusual health officer for his day. Dr. Arthur R. Reynolds, formerly 
commissioner of health of Chicago, has written a good short sketch of the 
life of Dr. Ranch. (Three Chicago and Illinois Public Health i fficers. J. 11. 
Ranch, Oscar C. Dewolf, F. W. Reilly, lUdletin Societ\- ^Medical History of 
Chicago, August 1912.) 

The only diseases which prompted municipal action were sniallpo.x and 
cholera. Little attention was jiaid to health ordinances until ISp.i, when 
the city was threatened with cholera. 

Drainage was inaugurated after the great cholera epidemic nf 1854. 
Sewer building lagged from 1856 to 18GG wdien cholera again started sewer 
building. The agitation against privy vaults began. 

.\n epidemic map by Dr. Mannheinier in the report of the dejmrtment 
for this vear shows the distribution of an epidemic of erysipelas in 18fi3 and 
one nf cholera in 186G. Erysipelas followed the river and lia<l sanitatiun. 
povert}- and congestion more closely than cholera did. 

1868. Dr. Mannheimer's second chart appeared ; showed the seasonal 
distribution of disease and correlated the weather changes with the death 
rate. The report contains an elaborate study of Texas tick fever. Smallpox 
continued, with 1,286 cases and 150 deaths. 

1869. "Owing to the low. wet and le\el ])lain upim which Chicago is 
situated its proper drainage is me of the sanitary problems of the age. When 
the population was sparse and the winds had free access to every portion 
of the city the general health was good, but as the j)opidation grew dense 
with its necessary c(jncomittants of tilth and ofl'al and Iniildings covered 
the ground and the wind was cut off. the city became unhealthy. It was 
not until the cholera visitations of 184;) to 1S55 that the citizens began to 
realize that without better drainage they would be constantly liable to epi- 
demics. Public meetings called in 1854 passed good resolutions but it was 
not until after suffering six successive epidemics, five of cholera and one of 
dysenterj^ that this conclusion was arrived at", says the annual report for 
this year. 

Idle re]X)rt also gave the number (:}f sewers built each year from 1856 to 
1S69, inclusive. A study was made between the death rate of the different 
wards and the iiroportion of sewer main and sewered homes in each. 



1()() Ill-.ALIII I.\ SOME CITIES I'lUOK TO IS" 

riiL' VL-ars i)t L;reat scarlet fever epidemics were given as lSt4-45; 18."J^- 
IS.jS and lS(iS-l,S(;;i. 

"I'^rc in the results of drainage and other sanitary measures it may he in- 
ferred that the ju(Hcious expenditure of money for sanitary purposes is a 
sound maxim of municipal economy. From past experience I am satisfied 
that the mean annual death rate can he reduced to IT hy continuing the 
present sanitary and drainage regulations and therehy making Chicago one 
of the healthiest cities in the world." I'his ])rophec\- h)- Dr. J. H. Ranch, 
was made in ISC'.I. The rate fell below li many years ago. 

ls;o. Hi^li mortality among children: !llii died from cholera infan- 
tum : (i"2..S percent of all deaths in children under .'> years of age. 

ls;i. This is the year of the fire. Records of the health department 
burned. Smallpox present. Death rate high. In this year appeared an 
extraordinarily good report from the (^'hicago health dejjartment. most of 
the copies of which were burnt in the fire. 

\X',2. 15eath rate "JI.Cil. ".'.-'is^ cases of smallpo.x. (/leneral death rate 
27. (34. Death rate of children under 5 high. 1,150 horses died of e]>izootic. 

1873. Cholera appeared. 48 deaths, 1.7<>(i cases of smallpo.x. Dr. 
Ranch resigned as sanitary superintendent on .\ugust 5, and was succeeded 
by Dr. Ben S. Miller. 

1874. Smallpox present. 

1875. City chartered under Cities and Villages Act. This provided for 
a board of health. 

187li. De])artment of health with a commissioner su])erseded the board 
of health. Greatest scarlet fever epidemic in the history of the cit\' occurred 
this year. 

The health history of Chicago as set forth in the annual reports of the 
health department show the rather rapid development of great health prob- 
lems. The seriousness of the situation was appreciated rather early. The 
raising of the datum to make drainage possible was begun. This work was 
undertaken because it was thought to be necessarv for health. .\ desire for 
health was one urge though not the jirincipal one behind the digging of the 
Illinois and .Michigan Canal, .-\lniost from the beginning Chicago had some 
sort of a board of health. In times of great fear of cholera or smallpox 
the board was supported: at other times it was neglected. This board was 
not of great imjiortance so far as prevention or even sustained study of health 
problems was concerned until the organizatitm of a real health department 
in 18fi7. 

The iei)ort of the lioard of health ISC;, Isds and ISdl) is a very v:du- 
alile (locnment. It indicated that during those years sustained studv of health 
prolilenis w;is made. 



HEALTH IN SOME CITIES PRIOR TO ISTT lOT 

This report gives the total number of deaths all ages and ages under 5 
and 5 to 10 years, each year from 1843 to 1851. These statistics were gath- 
ered from undertakers' and sextons' reports and from clippings from news- 
papers and medical journals. Dr. Ranch supplied correctixe factors which 
when applied made these figures approximatelv accurate. 

Aiiiiuid Diath luiti's. 

From July, 18ol t(j LSiill the vital statistics are given with increasing 
detail and are probably increasingly accurate. A study of these figures sup- 
plies the following data : 

Table 11. 

Annual IJeatii Rates per l.OOO Population — Chicago, 1S1::3-18T7. 



Year. 


CJeneral 
death rate. 


\esir. 


General 
death rate. 


Year. 


General 
death rate. 


1843 


18.60 


1855 


27.26 


1867 


21.21 


1844 


33.04 


1 856 


24.8 


1868 


23.74 


1845 


28.46 


1857 


27.56 


1869 


23.17 


1846 


27.81 


1858 


25.06 


1870 


23,88 


1847 


33.93 


1859 


21.59 


1871 


20.87 


1848 


31.86 


1860 


20.73 


1872 


27.64 


1849 


73. SO 


1861 


18.99 


1873 


25.15 


1850 


48.96 


1862 


20.52 


1874 


20.30 


1851 


27.26 


1863 


25.83 


1875 


19.72 


1852 


46.70 


1864 


26.26 


1876 


21.03 


1853 


22.41 


1865 


22.57 


1877 


18.67 


1854 


64.02 


1866 


32.55 







While recognizing the inaccuracy of the figures they are sufficiently 
complete to show a general picture of the health conditions at the time. Tak- 
ing out certain years for reasons presently to be stated, the average death 
rate for what is left of 1S43-41I inclusive, is found to be :il.(i'.' per l,(i()() 
population. For lS."iO-.3!» inclusive, it is •-' l.o:! : LsGO-Cl) inclusive it is •.'•J..")(i; 
for ls7()-7!) inclusi\e it is 1!).^* ; 1S|:; is withheld because it is obviously 
inaccurate; Is I!) is reported as having a death rate of 73. NO, more than twice 
that of any jireceding year. It is withheld because it is freakish. One of 
the outstanding causes of the great death rate of that year was the prevalence 
of cholera. In the next decade, 1S.")(l with a rate of 4S.!Hi and IS.")-..; with 
one of 4U.7U are withheld. IS.")!) was a cholera year. Is.ji was a cholera 
year. 1866 is held out as being abnormal. It will be noted however that ISIil! 
had a death rate that was only a fraction higher than the prevailing rate 
in 1843 to 1849. ]S()6 was a cholera year. In the decade 187(l-:!>, 1S7-.' 
and 1873 with rates of '.^7.64 and ■,'5.1.") are held as being abnormal. The 
great influenza pandemic was the princi])al cause of the abnormalit\- though 
both cholera and smallpox prevailed. 



108 



HEALTH IX SOMK CITIKS PRIOR TO 1S7 



This study shows a I airly satisfactory decrease in the a\"erage death 
rate hetween 18-13 and l.'-^so but the decrease was occasionally interrupted 
1)V great epidemic \va\es. I'he increase in efforts to promote health more 
than equalled the increasing tendency toward bad health due to poor drain- 
age, water polhuidn. sewerage, contamination, crowding, \totn- liousing and 
ra|ii(l immigration. 

'I'l/jjlinid Mortaliit/. 

An interesting item of the general health picture is the yearly death 
rale from tv[ilioi<l fever. It was as shown in Table 12. 



Table 1-2. 

Annual Death Rates from Typhoid Fever per 10(.),000 Population- 
Chicago, LS52-18T9. 





Tvphoid 




Tvphoid 


Year. 


Tvphoid 


lear. 


ileath rate. 




death rate. 


death rate. 


1852 


152 


1862 


61 


1872 


142.6 


1853 


59 


1863 


99 


1873 


71.6 


1854 


164 


1864 


128 


1874 


53.4 


1855 


62 


1865 


106 


1875 


51.7 


1856 


109 


1866 


106 


1876 


41.2 


1S57 


120 


1867 


73.3 


1S77 


37. 


1858 


61 


1868 


79.3 


1878 


33.4 


1S59 


61 


1869 


65.3 


1879 


42.3 


1S60 


44 


1S70 


87.4 






1861 


61 


1871 


61 







In the eight years ]8,")2-.")9 inclusive the typhoid death rate per 100,000 
poi>ulati(in was ItS.-j. However, in this period there were at least two years 
1852 and 1854 that were much aliove the average. They were abnormal 
for some reason. 



I)il,llfln I Id MniUllitll. 

During the years 1.S52-59 the average diphtheria death rate was lOG.l 
])er 100,000 population. During the decade ISGU-GD it was 15G..S. During 
18:0-:9 it was 112. OS. In this ])eri(id of 28 years for much more than half 
the time dii)htheria outranked typhoid as a cause nf death. The great wave 
which >tarted in l,s5:, while it tluctuated, di<l nut yield materially until 
ISdT. The great wave which started in is^i; did not let up until l.sii5. 



HEALTH IX SOME CITIES rUKIU TO 187T 



loa 



Table 13. 
Annual Death Rates from Dii'iiTiiEKrA per KiO.Ooo Population- 
Chicago, 1852-18T'J. 





Diphtheria 




Diphtheria 


Year. 


Diphtheria 




death rate 




death rate. 


death rate. 


1852 


78 


1862 


133 


1872 


97.2 


1S53 


57 


1863 


203 


1873 


62.1 


1854 


82 


1864 


150 


1874 


44. 


1855 


62 


1865 


230 


1875 


67.2 


1856 


35 


1866 


115 


1876 


184.5 


1857 


172 


1867 


79.1 


1877 


135.8 


1858 


193 


1868 


77.4 


1878 


120.2 


1859 


168 


1869 


91.8 


1879 


196.9 


1860 


269 


1870 


139.3 






186! 


220 


1871 


73.6 







Scarlet Fever Morfalif//. 

The average annual mortality rate from scarlet fever of five years be- 
tween 1852 and 1859 was 61. 8 per 100,000 population; of seven years be- 
tween 1860-1869 was 61.6 ; of seven years 1870-77 was 44.3. 1855 was with- 
held because the rate was abnormally low. 1858-59-62-63-69-7 6 and 77 be- 
cause they were abnormally high. The disease increased in the late fifties 
and in the early sixties. It is probable that the decrease in scarlet fever 
began in 1870 but the very bad epidemic of 1876-1877 must not be lost sight 
of. It is proper to say of scarlet fever that the efforts put forth to control 
the disease just about balanced the tendency of the disease to spread and 
grow worse with increasing pi ])ulation. The great waves of the disease 
generally lasted two years. There w ere maii\- years when scarlet fever was 
responsible for a higher death rate than that of typhoid fever. 

Table 14. 

Annual Death Rates from Scarlet Fever per 100,000 Population — 

Chicago, 1852-1879. 





Scarlet Fever 




Scarlet Fever 


Year. 


Scarlet Fever 




death rate. 




.leath rate. 


death rate. 


1852 


117 


1862 


294 


1872 


34.8 


1853 


59 


1863 


260 


1873 


30.3 


1854 


3S 


1864 


43 


1874 


26.6 


1855 


6.2 


1865 


52 


1875 


51.4 


1856 


13 


1866 


63 


1876 


198.9 


1857 


82 


1867 


44.9 


1877 


190.5 


1858 


243 


1868 


72.2 


1878 


30.3 


1859 


262 


1869 


204.6 


1879 


79.1 


1860 


113 


1870 


99.5 






1S61 


40 


1871 


37.1 







Piirinii())iia)<. 

Cnder this head are grou])ed all the deaths reported as due to pneu- 
monia, pleurisy, bronchitis and broncho-pneumonia and influenza although 
the last term was just coming into use at the end of the period. 



110 



IIEAI.TII IN SO.Ml-: CiTllCS TKIOK TO IS?? 

Table 15. 



Annual Death Rates FRt)M Acute Respikatorv Diseases per 100,000 
Population — Chicago, 1852-1879. 



Year. 


Rate. 


Year. 


Kate. 


Year. 


Rate. 


1852 


87 


1862 


67 


1872 


174 


18S3 


31 


1863 


125 


1873 


171 


1894 


63 


1864 


135 


1874 


134 


185S 


70 


1865 


99 


1875 


172 


1856 


62 


1866 


119 


1876 


137 


1857 


71 


1867 


86 


1877 


122 


1858 


93 


1868 


165 


1878 


152 


1859 


64 


1869 


134 


1879 


140 


1860 


49 


1870 


143 






1861 


54 


1871 


146 







The death rates from acute respiratory diseases from 1852 to 1879 are 
shown in Table 15. 

In the 1S52-5U decade the wiirst year was 1858 — 95; the best 1853 — 
■"il ; the average was ;o. In the ne.\t decade the worst year was 1S()8 — l(i5 ; 
the liest lS(.;(i — 19; the avera^je was 111:!. Tile acute resjiiraforv disorders 
were getting worse. Xo exjilanation was fduiul for the great upward jump 
in 186;5 and a similar jump in 18G8. in tlie next decade the worst year was 
1812 — 174; the best was 18; T — 122; the average was 119. The fatal acute 
respiratory infections were rapidly increasing. In less than thirty years 
the a\erage for a ten year |)eriod had more than doubled. The increase 
continued until the early part of the twentieth century since which time there 
has been a slight decrease except in the years (if the great 1918 influenza 
].)andemic an<l its recurrence in 1920. The high rates of 18T2 and 1873 
w( re due to the pandemic of influenza wliich prexailed in those )'ears. 

('(iiisiniiiifidii. 

'i"he deatli rate from cmisumiitidn li\' \ear> is shdwn in Table lii. 

In spite of I lie repeated statement that there was no consum])tion in 
Illinois, (ir but little, the rate the first year the record was begun in Chicago 
was 299 per 100, OOO pojiulatinn. It is ikiw in the vicinity of 75. The worst 
record in Chicago's bisliir\' was :;70 m l.s;5S. The average for the decade 
was 298. The worst year in tlie next decade was 18(;9, 2(19. the best 1865, 
187. The average was 2:11.5. Ccinsumptidu apjieared to be mi the decline. 

In the next decade the ^yorst year was \s]0 with 281 ; the best 1879, 
173; the average was 22S. a fuitbur decliiu- thciugh a small one. This de- 
cline showed a disposition lo slop in the early part of the twentieth century. 

I'nder ilie impetus of a new type of activity in control it began again. 
.\t tlie time of writing (in l!i2;) it has again come to a stop. There has 
bei n no decline for several years. 



HEALTH IX SOME CITIES PRIOR TO 187' 



111 



Table 16. 

Annual Death Rates from Consumption per 100.000 Population- 
Chicago. 1853-1880. 



Year. 


Death rate. 


Year. 


Death rate. 


Year. 


Death rate. 


1853 


299 


1863 


188 


1873 


244 


1854 


324 


1864 


242 


1874 


218 


1855 


201 


1865 


187 


1875 


219 


1856 


341 


1866 


203 


1876 


217 


1857 


288 


1867 


240 


1877 




1858 


370 


1868 


24S 


1878 


196 


1859 


274 


1869 


269 


1879 


173 


1860 


251 


1870 


281 


1880 


195 


1861 


265 


1871 


248 






1862 


247 


1872 


274 







Siiiifil po.r Miiitalifij. 

The years 18-52-n had an average smallpox death rate of 3(i.l ; ]8(jO-(59 
an average of -j^.HG ; 1870-7!) an average of i:).17. In 1857 there was a bad 
small])! IX (intljreak and it extended into 1S5!». But ls5l) was the only \"ear in 
the earh history of Chicago ^ter 1S5-.' that did not record a death fmni the 
disease. lS(i:; and 1804 were years of l)ad epidemic conditions but there 
was a low rate (i.l in 18(il); 187"2 and bS'o were bad epidemic years, is;;) 
had a rate of onlv .5. The disease wa> more than holding its own against 
society until ISiili. Frdin that time on it lost ground though, in ls;-J and 
is;:! it again more than held its own. The epidemic waves were farther 
apart and in the low years the disease was near the vanishing point. 



Table 17. 

Axxu.\L Death Rates from Smallpox per lOO.doO Population — 
Chicago. 1853-1879. 



Year. 


Death rate. 


Year. 


Deatli rate. 


Year. 


Death rate. 


1852 


23 


1862 


36 


1872 


178.3 


1853 


32.1 


1863 


76.6 


1873 


136.1 


1854 


18.2 


1864 


166.6 


1874 


22.8 


1855 


37.5 


1865 


317. 


1875 


2.5 


1856 


19. 


1866 


45. 


1876 


7.1 


1857 


114. 


1867 


54.7 


1877 


10. 


1858 


55. 


1868 


57.9 


1878 


4.8 


1859 


0. 


1S69 


6.1 


1879 


.2 


1860 


27. 


1870 


4.9 






1861 


25. 


1871 


21.8 







Measles Mortality. 

Between 1852 and 1851) the yearly average death rate from measles was 
33 per 100,000 population. 18C0-G9 it was 37.5 ; 1870-79 it was 18.44. 1S53- 
1854 and 1857 were bad measles years whereas 1859 had a low death rate 



112 



HEALTH IX SOME CITIES I'KIOK TO 1 S ^ 1 



of 1(1.';. Ill tin- iifxt decade iSG-t and ISCti were bad measles years. 1865 
was low with II. 'J'he rate in 18C6 was the highest Chicago ever knew. 
18T1 had an epidemic but scarcely comparable with that of 1866, 1874, 18T6 
and 1878 had rates well under 10. The records show that untiljl876 measles 
was winning its fight against society. Since then society has been gaining 
the upi)cr hand but backslides occur occasionally. 



Table 18. 

Annu.al Death Rate from Measles per 100,000 Population — 
Chicago, 1852-1879. 



Year. 


Death rate. 


Year. 


Death rate. 


Year. 


Death rate. 


1852 


34.6 


1862 


28.5 


1872 


10. 1 


1853 


52.1 


1863 


18.6 


1873 


27.6 


1854 


69. 


1864 


78.3 


1874 


3.8 


1855 


11.5 


1865 


11. 


1875 


29.2 


1856 


19. 


1866 


83 


1876 


3.7 


1857 


43. 


1867 


39.1 


1877 


13.7 


1858 


24.2 


1868 


42.5 


1878 


8.2 


1859 


10.7 


1869 


38.9 


1879 


10.4 


1860 


13.6 


1870 


31. 






1861 


21.6 


1871 


46.7 







Wltnnji'nui (.'i)ii<iJi Miirfdiiti/. 

The average annual innrtalit\ from whooping cough for is.j2 to 185!) 
was 23.7 per 100,000 population. IS(JO-Gl) was 33.5; 1870-1871) was 20.19. 
The years 1854, 1863, 1866, 1869 and 1878 were bad whooping cough years. 
There is no evidence that Chicago was gaining in the control of this disease 
lirior to 1880. 

Table 19. 

Axnual Death Rates from W'hoopixc^ Cough per 100. ooO Population — 
Chicago, 1852-1879. 



Year. 


Death rate. 


Year. 


Death rate. 


Year. 


Death rate. 


1852 


18 


1862 


21 


1872 


33.8 


1853 


29 


1863 


62 


1873 


40.8 


1854 


52 


1864 


11 


1874 


27.1 


1855 


24 


1865 


8 


1875 


26.5 


1856 


n 


1866 


92 


1876 


32.6 


1857 


22.5 


1867 


27.6 


1877 


12.1 


1858 


20.5 


1868 


25 


1878 


53.8 


1859 


12.5 


1869 


46.8 


1879 


6.7 


1860 


21.6 


1870 


29.7 






1861 


20. 


1871 


18.8 







HEALTH IN SOME CITIES PRIOR TO 187' 



113 



Malaria Moiialify. 

The average malaria annual death rate 1853-9 was 51.1 per 100,000 
population: 18G0-(i!) it was 20.8; ] 870-79 it was still falling. It was not 
until 1909 that malaria disappeared from the causes of death in Chicago 
but it was plain by 1880 that the disease was coming under control and would 
eventually disappear. 

Table 30. 

Annual Death Rates from Malaria, Congestion, Intermittent and 
Remittent Fevers per 100,000 Population — Chicago, 1852-1879. 



Year. 


Death rate. 


Year. 


Death rate. 


Year. 


Death rate. 


1852 


102 


1862 


15.5 


1872 


15.5 


1853 


57 


1863 


18. 


1873 


16.5 


1854 


10.5 


1864 


18. 


1874 


7.8 


1855 


37.5 


1865 


17. 


1875 


11. 


1856 


26.5 


1866 


37. 


1876 


15.2 


1857 


55. 


1867 


19. 


1877 


4.8 


1858 


16. 


1868 


22. 


1878 


13.5 


1859 


10. 


1869 


27. 


1879 


9.0 


1860 


22. 


1870 


15.9 






1861 


12.5 


1871 


10.4 







Baby Death Rates. 

It would be interesting to know what has been the improvement in the 
health of babies as shown by the infant mortality rate since 1833. But this 
will i)rove impossible, because in some years there were no vital statistics, 
while in other years the groupings were not uniform. 

Beginning in 1843 such statistics as are available show that the health 
authorities understood the relation of the health of the children tn the wel- 
fare of the community. In that year there is a record of 139 deaths all ages 
(it whom .'37 were of children under 5 years of age and 10 of children 5 to 10 
\ears nf age. No other data are given. This is the classification that was fol- 
lowed until l.s.")4. In that year a group "above 70 years" is added. This 
was the age grnuiiing made use of for many years. The present classilica- 
tiiin into deaths from all causes of babies under 1 and deaths from tliar- 
rhoeal diseases in children under 3 was not employed for manv years. 
I"'iiially the number of births as a basis for determining baby death rate was 
not available in Chicago until very recent times. There is a mass of testi- 
mony from health officers and physicians that the infant mortality in these 
early years was excessively high but there is no statistical data from which 
the exact facts can be adduced. 

The earlier records do not separate deaths from diarrhoeal diseases into 
deaths of children and deaths of adults. It is known from health officers 



Ill 



IIKAI.TII IN SOMI'". fiTIF.S I'UIOk TO 1 S , , 



and j)h_\sicians tlial in the early (la\s the death rates of aduhs from diarrhoea 
and dysentery were heavy. These have disappeared as a cause of death of 
adults, hut there are no statistics on the suhject. 



Tahle 21. 

.\nnual Death Rate erom Erysipelas per 100, ()()() T'opul-vtion — 
Chicago. 1852-1869. 



Year. 


Death rate. 


Year. 


Death rate. 


Year. 


Death rate. 


1SS2 


13 


1858 


4.4 


1864 


20.5 


1853 


17 


1859 


4.3 


1865 


11. 


1854 


10.5 


1860 


3.6 


1866 


10.5 


1855 


4. 


1861 


2.5 


1867 


7 


1856 


1.2 


1862 


3.6 


1868 


10. 


1857 


6.8 


1863 


12. 


1S69 


11. 



Erijsipclas Mdiialilii. 

1 he avera,L;e annual death rale from erysipelas lS.12-i) was 1.* per 
100.000 population. ISCO-U was !l.i;. Prior to 18,0 this disease was 
gaining. 

The earlier health authorities of Chicago were very much under the 
influence of the Pettenkofer doctrines. They devoted nidsi of their atten- 
tion to raising the city datum and building sewers, the suppression of vard 
l)rivics. removal of slaughter houses and other nuisances — cleaning the 
streets and private i)remises, improving the filthy condition of tlie (.'hicago 
River and the water supplies. 

In times of great epidemics they became interested in reporting and 
quarantining but at all other times they were working at sanitation, the im- 
provement of environment. Of course this was before the days of the germ 
tiieory and the doctrines of Pettenkofer were paramount everywhere. The 
work they did along these lines educated the people and established a sani- 
tary conscience as well as a sanitary intelligence, which contributed to the 
control of disease. Sanitation also contributes greatly to such control. It is 
necessary ground work for such control, but knowing what is known now, 
one can well understand why disease did not come un(k'r cmitrol as rapi(ll\ 
in those old Pettenkofer days as men hoped for. 

The records show that further im|)rovement followed the aiiplication of 
melhn(l> leased on liie germ theorj- of disease. 



HEALTH IX SO^[E CITIES PRIOR TO ISTT 115 

Springfield. 

The lirst settlement on tlie present site of Springtield was made in 1818, 
the year IlHnois entered in Union. The town was not regularly surveyed 
and laid out until 1833. in which year Elijah lies and Pascal P. Enos j)er- 
formed the necessary service. At first it was called "Calhoun," in honor of 
the great nullifier of South Carolina, but the name proved to be unpopular 
and few people used it. They preferred the name Springfield, which was the 
name given the postuffice in the embryo city of Calhoun. 

Earlv in the career of Springfield, burn Calhoun, the nnniicipality began 
acquiring ])iilitical lumors, a haiiit wliich it shows no tendency to forsake. 
In 18-,'l, two years before it was officially laid out, it acquired the title of 
CDUntv seat of .Sangamon County. This was in spite of the fact that it was 
not incori)or,-ited until 183"^ 

In 1^3^, as the result of a rather strenuous political contest, it became 
the State cai)ital. and the first session of the legislature to meet there as- 
sembled in ls:!lt. Abraham Lincoln, as a niember of the long-nine, had much 
to do with the removal of the State capital from X'andalia to Springfield. 
.\mong the manv rumors of reasons for removing the capitol from \'an- 
dalia to Springfield were two that relate to health. 

One was thai the legislature had grown tired of the preponderance 
of venison, wild turkey, wild duck and other game meats supplied them at 
\'andalia, and thev moved the cai)ital to Springfield where they could get 
more pork ami beef. 

Another is that the Kaskaskia l)oltoms around N'andalia made the lo- 
cation so highly malarial that the legislature wanted a healthier site for 
the State capital. 

Sangamon County was so near the geographical and population center 
of the State that it was a popular prospective location for the Capitol as soon 
as the people began thinking in terms of the State as a whole. There is a 
story that the plan was to place the Capitol at Illiopolis, a town in Sanga- 
mon Comity, about ten miles to the east of Springfield. The name was 
cut to fit. So were the i)lans, but dame rumor, or is it scandal, says, some 
parties high in power bought up the land around Uliojiolis, whereupon the 
indignant many not in on the deal "kicked the fat into the fire'' and threw 
the Capitol into the willing lap of Springfield. 

Among the books and papers of the late Dr. A. \\ . I'rench, DDS. ,''■'' of 
Springfield, was found an old blank book, the binder's title on the back of 
which is "Minutes of Springfield, Illinois, 1832-1840." On the fly leaf of 
the book is written: "Minutes of Board of Trustees of the \'illage of 



il lUinois HLsturiial Society, Vol. 2). 



116 



HEALTH IN SOME CITIES PRIOR TO 18T7 



Springfield, Illinois, of ils meetings from A]iril is:',-.' ( lirst meeting) to the 
organizing of a city in ls:!!i.'' 

On July 19, 1832, at an extra meeting of the lioarcl, the following pre- 
amhle and some resolutions were read and passed : "Whereas, we have 
information that the Asiatic cholera is now prevailing in Chicago, and where- 
as, it becomes the duty of the trustees to guard the town from infection 
from that source,", etc. The usual orders were then made as to the clean- 
ing of the town. On November 14, orders were given out that the court 
house be fitted up as a hospital in case it was needed for the cholera pa- 
tients. Some indication of the improvement in the health of Springfield 
is indicated by Table 22. 

Table 22. 

Annual Death R.-\tes fro.m all Causes and Certain other Diseases — 

Springfield, III., 1875-78 and 1923-1926. 

Per 100,000 Population. 





1875 


1876 


1877 


1S78 


1923 


1924 


1925 


1926 




18.553 


18.791 


19.074 


19.357 


61.833 


62,715 


63.923 

17.5 


64.700 




Death rate all causes, per 1.000 popula- 
tion 










15.3 


14.5 
















Death rate per ICO.OOO poinilation— 
Typhoid Fever 
Starlet Fever 


26.5 


26.6 
74.2 
26.6 
85.1 
190.8 
127.2 
26.6 
339.2 


78. 
88.4 
36.4 
26. 

239.2 
72.8 
10.4 

332.6 


56.1 
30.6 
10.3 

102. 

265.2 
56.1 
15.3 

285.6 


4.8 


6.3 

1.5 
4.7 
14.2 
57.4 


6.2 
4.8 
3.1 
4.8 
89.6 


6. 


"WTioopiii!; f.iiiMli 
Diphtheria- 


5.3 

164.3 
275.6 
153.7 
15.9 


6.4 
12.8 
92.1 
41.6 


16.5 
4.6 






.Malaria.- 








Infant Deaths Under 1 Year .Age 


174.6' 


156.2 


156.1 


75.2 







Springfield's bad year for typhoid since the keeping of records began 
was 1881, with a rate of 171.5 per 100,000 population; for scarlet fever, 
1879; with a rate of 230; whooping cough, 1877 with a rate of 36.4; diph- 
theria, 1875, rate 164.3; tuberculosis, 1881, rate 303.8; infantile diarrhoeas 
1875, rate 153.7; baby death rate, all causes, 1880, rate 433.5; malaria, 1881, 
rate 29.4. 

Kaskaskia. 

This town located at the jjoint of junction of the Kaskaskia or Okaw 
Ri\er with the Mississippi, was founded by Marquette in 1672. The earlier 
French settlers married Indians or girls brought to Kaskaskia for wives 
from Canada and Louisiana. These earlier French half-lireeds and Indians 
enjoyed good health in spite of the location of their town. The Knglish 
took possession in 17(5."). ."-'ettlers began to come in from the South in 1770; 
Clark was there in Ills and 17^9 to about 1783. A military garrison there 



lIEAr.TlI IX SOME CITIES PklOU TO 



sut'lcred severely from disease iluring some of this time. There was a United 
States land office there in I sol. In ISO'.i the Territorial Capitol was located 
in Kaskaskia and there it remained until the State was organized in 1818, 
wheren])on Vandalia became the capital city. 

Although in the later years of its existence the health of the people of 
Kaskaskia was ])ii(ir that was not the reason fur the removal of the capital. 
Overflows and the caving banks of the adjoining rivers brought that about. 
However, had Kaskaskia retained a large population between 1818 and 1877, 
it would inevitablv have become a liotbed of malaria, typhoid, dysentery and 
pestilence general!}'. 

Shawneetown. 

The principal reason for writing especially 
of Shawneetowm is the fact that it was the seat 
of (ine of the land offices through which the 
colonists of other states who located in the 
south end of the State secured their lands. 

In his article on a Pioneer Medical School 

Dr. C E. Ijlack'"' of Jacksonville, says: 

"When Illinois became a state in ISIS most 
of its inhabitants were south ot the mouth of the 
Illinois River." 

.Ml of those who owned land in this sec- 
tion had entered their land through the Shaw- 
neetown office. Many of them had been there 
in person taking their diseases with them and 
'"■ ''■ !'"■ Biaik. swapping diseases while there. 

In "rictures of Illinois, One Hundred Years ago"' — (Lakeside Classics, 
1!)1S) we read: 

"Shawneetown enjoyed something of a real estate boom in 1S14. but due 
to the annual inundation of the Ohio River and to the general unhealthfulness 
of the place the boom speedily collapsed." 




Vandalia. 

\'andalia became the State capital in 1818 and retained this honor until 
some date between 1837 and 1839. It is located on the banks of the Kas- 
kaskia River, which river was sometimes called the Okah. Elsewhere iti 
this narrative are accounts of malaria and other forms of disease at \'andalia. 
Most of the reports were taken from communications from Dr. F. Haller. 
While the low ground of the Kaskaskia bottoms made Vandalia a malarial 



'Black (III. Histc 



HEALTH IN SOME CITIES PRIOR TO 1877 119 

location in the early days that disease does not appear to have influenced 
the legislature to remove the capital. One account says the change was made 
because the only meat available in Vandalia was turkey and venison, of 
which the members of the legislature had grown tired. They ])ref erred hug 
meat and they moved the cajjital t<i .Springfield where this luxury was 
available. 

\'andalia is a prosperous city having withstood the loss of the capital 
better than other cities have done. The eradication of malaria from the 
Okah bottom has greatly increased the health futures. It is in the midst 
of the belt in which white snake root grows and therefore milk sickness long 
remained a menace. 



PART TWO 



Public Health Administration. 



Medical Practice Act. 



Voluntary Health Agencies. 



Health Conditions After 1877. 



Summary and Conclusion. 



MEMBERS APPOINTED 

^levjiy Cratoi Illinois State ho2xi of Health. 



*» ^s 








KoibmLuitlani. %.r, 

/S77- IS9<2. 




AftJottL.ClacIi,9Il.D. 

IS7T- 1S93 




JohuH.Kaiu:lvJl.r. 

t$71 • JSdl 



Wiikt.Cbte,t.P. 
/srr '!ssi 




J.m.Gtt^oy^LlD. 






tP 




Horace \l^attbw.t.9Il.l), 

/S7 7 - jss: 









The first lioard of Heallh in Illinois, organized July 12, IS" 



Newton Batcniun, I.L. D. 

XEWTOX BATEIIAN. Galesburg:; was born July 27. 1S22, Fairfielfl, Npw Jersey. 

Taken l.v iiMi-.-nts t.. Illinois in ls;!:l CriuliKiterl from lllin..is c.ll^a,. :if .lii.Ksi.nville 

in ISI:: ,inil slinli..! tli.' id h.wmL' v.-.n :it ].:,!<,■ '|-|i..il,,i;j, ;,l s.-niin,H\ |;.-.:inie a 

teacli.'i in IMi: ,111.1 li.'l.l .. iniinli.r -r 1. ,-|m .n^ilil.' |M.sin..ii> m iml.lh ,iimI i.iivate 

schools lllllll IN.^N. wllell lu- «;is .1, . l,',l lo III. oil!,.' ol .S|:il,. .SM|i.in iMil o| I ■ublio 

Instruellun, a posillull lie lieUI lor loin leell .Vcal.s. I'le.sulent ol Kno.^. Collii;,, CaleS- 

burg-, 1875-1S93. Member State Board of Health, ISTT-lSai. Author ot numerous 
historical books and publications. Died in Galesburg, October 21, ISII". 



Reuben l.udhim. M. D. 

mo, lioin ii.-tober 7, 1.S31, Camden, New Jersey, Orad- 

, ol 111, Iniversity ot Pennsylyania, lsr,L> ;mm1 went to 

Cbirasi., l,s.5:i. .M.inli.i :iiel .1. in r,oiilty Hahnemann Medical (•oll.■l;.^ ImiI-1S99. 

President of uunnioiis iii..lio,il oi t;,i n i7,:i I ions. Author of several me(li,:il 1 ks and 

editor of professional journals. Member of State Board of Health. 1S77-1S!I2. 



An.son L. Clark, M. D. 





AX.S( 


IX 


1 


:.. ci 


Wa; 


s take] 


11 1 


ly 


IKU-f 


at 1 


\:i\, si, 


or 


■^ 


III r 


assi 


1 S 1 : 1 1 1 1 




1 L 


o'. in 


Ben 


U. 1 1 .\ 


I.I 


ll. 


.ll 1- 


1911 


1. .\1 e 


jii 


he 


I 271 


1S7' 


:-isi)3. 




A I 


ithor 



1S36, Clarksburg-, Massachusetts. 
Craduated from Lombard College 
.\l..li.;il liisiitute in 1S61. First 
\il W.ii .111. ..r the founders of 
[ ii.>ni lis ..i i;.i nization in 1S70 to 
.M.inl.ii St, lie Board of Health, 
' Died April 11, 1910. 



William M. Chambers, M. D. 

WILLIAM M. CHAilBEPLS. Charleston; born April 11, ISH, Cynthiana, Kentucky. 
Gradn.itiil fr.mi McdirnI (^.ll.qe of Transylvania University, Lexington, 1S43. Went 
to Col. s i'..iiiii\. llliimis ill \s:,:. Ih-igade surgeon, U. S. Army, 1861 to close of Civil 
War w h. II In u.is i.i.\.ti..l I'oi.ni.l for meritorious service. President of numerous 
merii.nl ..rL:niiiz,iii..iis, .M.niil.. r .■^inle Board of Health, 1S77-1SS1. Died in Charleston, 
November 12, 1.MI2. 

John Milton Gregory, LL. D. 

JOHN MILTON GREGORY, Champaign; born July 6, 1S22, Sand Lake, New York. 
Graduated ITnion College, 1S4B, A. P.. Studied law, Schenectady, New York, 1S4B-47. 
Pastor Hnptist I'hvir.h H..osi,k Falls, New York. lS47-l.'iSO and Akron. Ohio. 1X50-1852. 

Prill, innl I ■l,-.-sn;il Si 1 1, |..-lri.il. 1 s,".2-l s,".:i : .-.11 1 . .r n ii.l piil.l isli. i , .Mi.lii^nii ,l..nrnal 

of |.:.lin,iii..n l-,-,Ms,-.;. S r 1 1. 1 . in l.ni I ..I I'lil.li.' InsliM.I , .MlIiil:.!!, I--,..-1S64. 

Presi.i. ni Is.il I tii.iz ■i.ll.^.-. K.ilniiinz...., .\l I. li I ij , i ii , 1m;,'.-1s.;t I;. -. ni il-i.sident) 

lUin..ls lli.lnsliinl riilMlslU-. ISDT'ISMI r S .■i.innilssi I, \nMn,i i; \ | .. .si t l,,n, 1S73. 

lllin..is Si,iii- c- ,iissi..ii.-i' to l',iiis i;m...^ii loll, 1^T^ .\l.ni.l..-i hhI |.i.sident (ISSl- 

lSs:ii ..r si,ii., r,..,.i.l ..t Health. IsTT i ' : m. mi., r I' S i'i\il S. I X n . c'ommission, 
lSS:i-l,^,^,'., I'l ..i.-ss..r Emiretus of I'l.liii.,.! i: ..ni.x. riu\.nsii,\ ..I lllin..is. Author 

of numerous peiiafiogl.al works. l>ie.l In W ash i n^ I. .1 1, 1 1. C, Lletohel 211, 1S9S. 



John Henry Ranch, M. 1). 

JOHX HENRY RAUCH, Chicago; born September 4, 1S2S, Lebanon, Pennsylvania. 
Graduated University of Pennsvlvania, lS4i). Meniher faculty Rush Medical College, 
Chicago, 1S57-1S60. "Sanitnrx' snl .. i i nl .ni.l. n l oT i 'li i. ,i i;. ., 1SI;7-1S73. Chief medical 

officer under General Gimiii m l.n- T.nin ,.ii.l \iiliiiii i n mpnigns. At close of 

Civil War he was brev.ii..! I.nni.n, '..[.in. I i..i nniii is services. Member, 

president and secretary of Sini.- I;..,.i.i ..i ll.ilih, 1,^7.-In!i1 i>i.-.l in Lebanon, Penn- 
-sylvania, March 24, 1S!I4. 

Horace Wardner, M. D. 

IKiIlAi'E WARDNER, Cairo; horn August 2.t, 1829, Wyoming County, New Ymk, 
Studied at CavuKn A.ademv ami .Mfred University and graduated in medicine fnun 
Rusli .Medical' «'.. 11. i;., ilinn;;.. in l^,.r. r..i;nii practicing medicine at Libertyville. 
Illinois in 1S5S. i;. itiin..! i.. ihn.u.. I.. i..i. ihe year was up and opened a private 
anattunieal room wini. In i,in:;lii nn.ln,.! ,-iii.liiits. Elected member faculty Chicago 
Medical College, l.s.j;i. .Suiyeon 12tli Illinois Volunteer Infantry and staff-surgeon 
in Grant's Tennessee Army during Civil War. Brevetted Lieutenant Colonel for 
meritmious services. Located in Cairo, Illinois in 1SC7. Appointed superintendent 
Anna State Hospital, 1878. Member State Board of Health, 1877-1881. 




Dr. Cadwell was a prominent citizen during tlie 
early period of Illinois history and participated in 
the first efforts to secure laws relating to the prac- 
tice of medicine and to public health. 



PUBLIC HEALTH ADMINISTRATION IN ILLINOIS. 

'J'hc uiganizatioii of the Stale Jloanl uf llealth in isT^, niarkb the lime 
when the conservation of the pnhhc liealth was first nndertaken by the State 
oi Illinciis, and when a department of the State government was first charged 
with liiis fnnction. 

Prior to that time, the local lownsliip and numicipal governments in 
the State had been given the power, either by special charters, or general 
legislation such as the Cities and \ illages Act of 1S7:.! to protect the public 
health, in their respective local communities, in some of the larger cities 
of the State, this authority had been exercised, and local lioards of health 
or cit\- physicians appointed to attend to this duty. Such action was usually 
taken during some epidemic of cholera or smallpox and after the danger 
from the epidemic had passed, the sanitary measures instituted lagged, the 
enthusiasm of the officials waned, appropriations for the work lapsed and 
were not renewed, with the result Ihal it was discontinued, only to be re- 
newed again with the next a])pearance of an epidemic. 

This was the general history of the local health organizations in ihe 
State. Even Chicago was not an exception; there the board of health was 
aliolished as late as 1860, "on account of the absence of any alarming con- 
ditions", but was reestablished in ISii; when cholera had visited the city 
and smallpox was reaching epidemic jiroporlions. 

The local medical societies took an active interest in instituting measures 
for ihe protection of their communities against pestilential diseases and in 
some localities attended to this work, without any form of health organiza- 
tion. Active members of these societies often served as members of the 
local boards of health. In this work as well as in their jiractice they came 
across the numerous unc|ualified jiersous who were jiracticing medicine, be- 
cause as yet. there were no laws t(] prohibit this. It was this state of affairs 
that brought on the movement which resulted in the organization of the State 
Hoard of liealth. 

Genesis of the Public Health Law. 

Public health work as a permanent function of the .^tate go\ernment 
was first established iij, Illinois in ItSTT. < hi |nl\- 1 of that year two laws, 
one known as the State Board of Health Act and the other as the Medical 
Practice Act, became effective. The former was aiij>roved by the Ciovernor 
on May 25 and the latter on May 2'J, is: ;. Both laws had the same ultimate 
purpose in view and the State Board of Health, which was organized on July 
12 of the same year, was charged with the responsibilities and duties in- 

(12:) 





Shelby Moore Cullom. Governor of Illinois 
1S77-1SS3, who signed the first public health 
law enacted in the State and the first perma- 
nent law regulating the practice of medicine. 



PUBLIC HEALTH ADM I MSTRATIOX 139 

volvfd ill the enforcement of both. This dual responsibility of regulating 
the practice of medicine and promoting sanitary and hygienic activities ordin- 
arily referred to as public health service was a new thing for a state board 
of health in the United States, and it provoked considerable interest among 
sanitarians and the medical profession throughout the country. 

The passage of these two public health laws was not an expression 
of a sudden burst of enthusiasm for more healthful conditions but rather 
the belated fruition of an idea that took root and provoked agitation among 
the people, especially the medical profession of Illinois in territorial days 
sixty years and more before. Proof of this is the fact that an ordinance or 
law regulating the practice of medicine was enacted by the territorial Genera! 
Assembly in 1817 and duly signed by Ninian Edwards who was the terri- 
torial governor at the time. Furthermore the first State General Assembly 
passed a medical practice act in 1819 and another was passed by the General 
Assembly in 1825. Both were promptly repealed, however, by the next legis- 
lature succeeding the enactment. Bills introduced in later sessions of the 
General Assembly failed to become law until 1877. 

Dual Co)U-('pfioii of FiihUc HeaJtIi Worli. 

The idea of public health service as it was finally expressed in the 
first permanent statutes grew out of two very definite conceptions which 
have not always promoted harmony of action in this field of endeavor. One 
conception was and still is that good doctors are the dominant factor neces- 
sary to good public health and to secure the latter the state can best function 
by bringing about the former. This idea was expressed very well by Dr. 
Horace Wardner. as president of the State Board of Health in isso, when 
he said, 

■•Through the work of the Board the profession has deliberately said to the 
people: 'Your greatest danger is from ignorance and the iniquity of pretending 
physicians, and we have sought, and are seeking, to protect the people at this 
point, by subjecting the tjualiflcations of all persons desiring to practice medicine 
to reasonable and satisfactory tests;' " 

and again by a committee of the State Board of Health appninted in 1880 to 

inquire into requirements for "good standing" of medical colleges which 

concluded that. 

"We shall only fulfill our duty as a State Board of Health by promoting to 
the utmost that largest and most potential force in sanitary science and in public 
hygiene — a well trained and thoroughl.v educated medical profession." 

The other conception was and is that sanitation, quarantine and hygiene 
are things the application of which will produce significant results in pre- 
serving and improving public health hexdiul the capacity of private medical 
practitioners, be the profession ever so efficient and well trained. Advocates 
of this conception believed that regulating the practice of medicine was in- 



130 I'UliLIC IIKAI.TII ADMINISTKATIOX 

cidental or subordinalc to other j)ul)lic' lii'alth futictit)iis of the Siatu. A yno.l 

expression of this conception is found in a paper read Ijy Dr. I'".. W". ( .ray 

of Bloomington, hefore the Ilhnois State Medical Society in May. ls:(), 

which reads : 

"The people need to be enlightened; they need to be directed: in many cases 
they need to be restrained. A board of health organized, and provided with means 
to collect information, and diffuse among the people a better knowledge of the 
laws of health, and to discover to them the dangers to which they are exposed, 
would save thousands of poor victims from untimely death." ' 

The "good doctors" conception is much the older. It was the only one 
expressed in the territorial law of ISH. In the law of ISli) a section re- 
quired the reporting- of hirths, deaths and diseases Imt otherwise it was 
concerned only with providing "good doctors." The \><2'i law was con- 
cerned with nothini:; but the regulation of the practice of medicine. Dr. 
George t/aduell, a ])rominent and useful citizen who came into Illinois he- 
cause of his bitter animosity toward slavery, championed the law of LSI!) 
while Dr. Conrad Will was the moving spirit behind the act of \x2o. Dr. 
George Fisher was Speaker of the House of the territorial .\sseml)ly in IS 17 
and presumably had considerable t<i do with the law enactetl then. 

In isr](; and again in 18(11 a connnittee was appointed b_v the Aescu'a- 
pian Society of the Wabash Valley, which had originally been organized in 
184G as the Lawrenceville Aesculapian Society, to go before the State legi.s- 
lature asking for a law creating a State Board of Health to regulate the prac- 
tice of medicine and to collect birth and death certilicates. 15(>th attem])ts 
failed to produce the desired results. Very likely the matter was agitated 
and brought before the General Assembly at other times during the fifty year 
period between 1827 and 1877. 

The "good doctors" conception was revived by the Jersey County Med- 
ical Society in a communication addressed to the Illinois State Medical 
Society and read before that organization at its annual meeting in May, 187G. 
It advocated the organization of a State Board of Health for the purpose 
of regulating the practice of medicine and of collecting statistics of births 
and deaths. This communication was an important factor in crystalizing 
sentiment which resulted a year later in the Medical Practice Act of 187;. 

It was not until after the Civil \\'ar that the sanitary and hygienic con- 
ception began to take root in this country. There is record of four meet- 
ings known as Xatioiial Sanitary Conventions which were held in 1S.")7, 1S.")8. 
185'J and iscd in Philadelphia, Baltimore, New York and Baltimore but 
these were abandoned with the outbreak of hostilities and nothing f mi her 
was done on a nation.al scale mitil is;-.' when the .\merican Pn'nlic Health 
Association was onj.ani/.ed. 



Sl;ite Mertii-al Snrioty, 1S7G. 



PUBLIC HEALTH ADM I MSTKATION 131 

The very first public utterances on sanitation as an important factor in 
healthfulness took place in this country about ISoO when Lemuel Shattuck 
published lii> report on sanitary conditions in Massachusetts. It was 1S57 
before I'asteur. wcjrking in France, published his first report which opened 
up the field of bacteriology and it was ten years later before Lister, the cele- 
brated English physician and pupil of I'asteur, began to attract public notice 
by his great success in the [jractice of antiseptic surgery. Prior to Pasteur 
and Lister, whose work related to bacteriology, was the German, Max von 
Pettenkoft'cr, founder of modern hygiene, lie it was who recognized more 
fully than had ever before been recognized that health is impaired by factors 
not in ourselves lint in our environment. This a])ostle of cleanliness was 
prominent enough in ISCi.") to be appointed head of ihe first institute for the 
study of hyL;iene which in that year was inaugurated at the L'niversity of 
.Munich. It was doubtless the works of this man that stinuilated the first 
agitation in .\merica for sanitation as a public health activity. Bacteriology 
developed later and began to be apjireciated on a significant scale in this 
countiy toward the closing \Tars of the nineteenth century. 

I'lorn in luiro|)e and finding ready disciiiles along the Atlantic seaboard 
in this country the new ideas of samtar_\' control over diseases began rapidly 
t(] lilter into Illinois. Dr. John W. Ranch of Chicago manifested interest 
enough in the new movement to attend the organization meeting of the 
American Public i lealth .\ssociation which took place in New York on 
April IS. l,s;->. By ISTti Dr. E. W. (iray of Bloomington had become 
enthusiastic enough to prepare a paper on the sul.)ject addressed to the people 
of the State, which he read before the annual meeting of the Illinois State 
Medical Society in May. In thi> |japer Dr. (iray advocated the establish- 
ment of a State Board of 1 lealth. .\s .a result of this pajier he was ajipointed 
chairman of a comnn'ttie to memorialize the legislature on the Miljject of a 
state bo.ird oi health. That the work of this committee was crowned with 
success shows that Dr. (iray and his colleagues carried their enthusiasm for 
sanitation to pr;ictical account. 

While both the "go(jd doctors" and "sanitation" conceiitions of public 
health ser\ice pie\aile<l among the medical profession the majority of opinion 
favored the former. The latter, however, appealed to the legislature strongly 
enough to bring forth a law creating the State Board of Health to which was 
incidentally delegated the power to regulate the practice of medicine. Indeed, 
provision was made in the Medical Practice .\ct for another tv]je of admin- 
istrative m.achinery and the Board of llealth fell heir to that duty as ;i result 
ol the success of the s.anitarv law. 

This dual conception concerning public health service was important. 
It exercised a i)rofoi\n(l infiuence t)ver the functions of the State Board of 



132 I'l'IiMC HF.ALTII ADMIMSTKATIOX 

Health; it also exercised a profound iiiHueiice over the relalidiis between the 
medical profession and the State health authorities. 

As a result of the conmuniication from the Jersey County Medical 
Society and the paper liy Dr. (Ivay the Illinois State Medical Society passed 
the following resolution ; 

"Rt'solvpcl. — That a Committee be appointed to memorialize tlie next legisla- 
ture on the subject of the appointment of a State Board of Health: and that with 
proper modifications, the act by which the Board of Health of Massachu-setts was 
inaugurated be submitted to the same as a basis for the Illinois State Board. 

"Rc.iolvrd. — That as members to the State Medical Society, each one shall 
consider himself bound to urge the propriety of a State Board of Health upon the 
i-epresentative from his district." 

This niovenient led directh' to the enactment of the ?vledical Practice and 
Slate Hoard of Health laws in is;7 which vested in one body the attthoritv 
and duties prescribed bv both. 

I'rciponents of the "good doctors" conception knew exactly what they 
wanted. Thus the Medical Practice Act was very definite, specifying what 
should and what should not be done tinder its provisions, giving the admin- 
istrative agency reasonable discretion on technical points. 

I'rorisloiis licUilniii in Saml ai laii. 

.Vdvocates of sanitation had little of a tangible nature, except the de- 
sire for vital statistics, which the}' could recommend in language that the 
average legislator could understand. Accordingly the first public health law- 
grants to the State Board of Health the following powers : 

"The State Board of Health shall have general supervision of the interests of 
the health and life of citizens of the State. They shall have charge of all matters 
pertaining to quarantine; and shall have authority to make such rules and regu- 
lations, and such sanitary investigations as they from time to time may deem 
necessary tor the preservation or improvement of public health, and it shall be 
the duty of all police officers, sheriffs, constables, and all other officers and em- 
ployes of the State, to enforce such rules and regulations, so far as the efflcieucy 
and success of the Board may depend upon their official cooperation." 

This is the second of the fourteen sections of the original State Hoard 
of Health .\ct and it is the only section that deals with sanitation or hygiene. 
Six of the sections deal with vital statistics and the remainder with incidental 
matters relating to penalties, technique of the P>oar(rs procedures. a]ipropria- 
tit}ns. etc. 

The sweeping authority — "i^enera! ■-uiierxi^ion of the interests of heaUh 
and life of citizens" and "authority to make ■'Ucli ru'e> and regulations and 
such sanitarv investigations a> they from time to time may deem necessary 
for the preser\;uioii and improvement of jutblic health" — granted to the 
State Hoard of I K-;dth in the original law was a recognition liy the legislature 
that public lualtb work is highly technical in cb.aracter and requires specially 
trained personnel. I-'rom this position the lawmakers have never retracted 



ri'BLlC HEALTH ADMINISTRATION 133 

SO that ihe laws are still bniad, niakini; the rules nf the present State health 
organization tantanmunt to law. Time and ai;ain from the very outset the 
State health offieials ha\'e found it eiin\enient and necessary to initiate activ- 
ities oi an arbitrar\- character under the authority granted in this generalized 
section and the courts have generally ui)liekl these measures. 

It will be seen that the compromise of the General ;\.ssembly, which 
vested in one board the powers and duties representing two distinct scIkkiIs 
of thought was not destined to unite and harmonize the two and that even 
a State Board of Health cannot serve two masters. Ultimately the State 
Board of Health lost its identity as an integral part of the State government 
and in its place were created two departments, the one to devote its full 
energy and resources to sanitary and hygienic activities and the other to 
regulate, among other things, the practice of medicine. 

Development of State Health Service. 

Three Periods. 

State public health service in Illinois falls conveniently into three r.'ither 
well defined periods. The first ended with the century in IDOO, It may be 
described as a sort of probationary exjjerience for the State ooard of 1 lealth. 
During that time the State health organization was on trial, so to speak. 
It faced the problem of justifying its existence. Governors and lawmakers 
suffered it to continue through a sort of kindly tolerance. They were never 
warmed with sufficient enthusiasm for this new venture to unlock the treas- 
urv vaults for its benefit. The first appropriation was $.'J()()U for the bien- 
nium. For the last fiscal year of the century, ended Jtuie 30, 1899, the appro- 
priation to the State Board of Health for ordinary expenses was $9250. A 
contingency fund of $10,000 was available to draw on under specified condi- 
tions during a number of years in this period but those conditions rarely 
arose — at least not in the opinion of the Governor whose judgment in the 
matter was a lock on the purse strings. 

The second period started out with the new century and terminated in 
mil. For the State Board of Health these years may very properly be called 
the period of expansion and recognition. In 1901 the legislature approjjri- 
ated a sum of S-1.J,300 per annum for expenditure through the State Board 
of Health. For the fiscal year ended June 30, liMl, the available apjiropria- 
tion amounted to $l(iri.."iS9. Alanifestly the people of the State and the 
legislature found in ihe State P.oard of Health something for which they 
were willing to ]jay considerably more than had been the case twenty-five 
years before. The 1901 appropriation amounted to ^t^'.t ])er 1000 persons per 
year while that drawn upon for the fiscal year ending June Mi), lull, amount- 
ed to nearly $2.'). The changes that took place in the amount of mone\ made 



134 I'l^BLIC HEALTH ADMINISTRATION 

available lor health service make a good measure for the amount of ])ublic 
interest in that work during those years. 

The third and last period to date began with the adoption of the Civil 
Administrative Code by the Illinois state government and continues to this 
writing in 1!)2T. It is called the period of maturity not in the sense that the 
State public health organization represents what might be considered a ma- 
ture or adecjuate agency for combating disease and promoting health to the 
fullest practicable extent under present condition^ but rather in the sense 
that it now is regarded as an essential factor in the State government and 
functions on a jjlane commensurate with that of any other department. The 
dominant characteristic of this period is the divorcement in practice of the 
"gooil (ioclor>" from the "sanitation and hygiene'' conception of public health 
service, r.oth contiiuie to be important activities of the State administra- 
tion but all matters relating to the registration of physicians and regulation 
of medical ])ractice repose in the State Department of Registration and Edu- 
cation, while those concerned with sanitation, hygiene and vital statistics are 
in the hands of tiie Slate I )e]);irtnient of Public Health. 

Four PcrsdiKilifics. 

The three ]x-riods of development of the public health machinery in the 
State are dominated by four personalities. About each of these revolve the 
policies, the character and the color of the State's participation in public 
health service during the period in which each was active. Each made sig- 
nificant contributions to the [lublic health movement in Illinois. 

The first of the four was Dr. John H. Ranch, moving s])irit in the 
period of "probation." As his contribution he coni])leteIy justified the exist- 
ence of a State public health service. l-"ew men have even accomplished so 
much with such meagre resources. Blessed with a rare faculty for organiz- 
ing, driven by an overwhelming enthusiasm for getting things done, guided 
by a wealth of meilical and sanitary information which a passionate curi- 
ositv led him to sei'k. balanced by a ca])acity for sound judgment and endowed 
with tact 'and diplomacv Dr. Ranch literallx' ni;ide the public heilth service 
of his time. A disci])le of sanitation ami hygiene he also had a ])rofound 
belief in the importance of good doctors so that under his influence the dual 
functions of the State P.oard of Health jmigressed harmoniously during the 
fourteen years of his service and carried over for several years afterward. 
The "probationar\" period might very properly be called the "Ranch" period. 
Dr. Ranch's name will appear frequently on pages to follow that relate to 
the early health machinery of the State. 

The second in chronological order of the four jiersonalities was Dr. 
lames A. Egan. lie became the executive secretary of the State Hoard of 
Health in 189" and belongs to and was largely responsible for the "period 



PUBLIC HEALTH AUM INISTRATIOX 1-^5 

of recognition." Money getting was his unique contribution to the jiuhlic 
health machinery of the State government. Before Egan's time, $l-4 .()()() per 
year, besides a contingency fund, was the largest appropriation that the leg- 
islature ever granted to the State Board of Health. The last General Assem- 
bl\- to meet during Egan's tenure appropriated $120, G25, besides a conting- 
ency fund, for annual expenditure by the State Board of Health. As an 
opportunist. Dr. Egan took advantage of the phenomenal developments in 
sanitary and medical sciences that were taking place immediately before and 
during his time and turned them to good account for public health service in 
the State. Based upon highly scientific knowledge, successful ptiblic health 
services requires highly trained technical personnel and this requires money. 
Dr. Egan made a splendid contribution to public health service in Illinois, 
when he got the legislature in the habit of granting significant apjjropriations 
to the State Board of Health. 

The third of the four personalities was Dr. C. St. Clair Drake. He 
became the executive officer of the State public health organization in l'-)H 
and continued until 1921. His tenure was therefore partly in two of the 
major periods. By nature a propagandist, in the best meaning of that term, 
Dr. Drake poptilarized public health work in the State. He was a man who 
radiated enthusiasm. Endowed with a resourceful imagination, he managed 
to create ingenious mechanical models that carried fundamental public health 
messages into every part of the State. This exhibit material which was suf- 
ficient to fill one thousand square feet of display space was in demand at 
local fairs everywhere and it never failed to command attention and it left 
indelible impressions upon those who saw it. Furthermore, Dr. Drake in- 
itiated the Better Baby Conference movement in Illinois. He developed a 
motion picture library from which health films are circulated in the State. 
He inaugurated the "Health Promotion Week" idea that has come to be an 
annual event and one that has always attracted wide attention and a fine 
response. Under Dr. Drake the State Board of Health was reorganized into 
the State Department of Public Health and it was Dr. Drake who drew 
up the plans of organization which still characterize the Department. This 
movement, however, was initiated by Governor Lowden in his Civil Ad- 
ministrative Code scheme and was only incidentally a part of Dr. Drrike's 
achievements. Dr. Drake was primarily a publicity expert. His donation 
was an educative method. He popularized public health activity. 

Dr. Isaac D. Rawlings, appointed in 1921 as Director of the State De- 
partment of Public Health and the last of the four personalities brought 
system into the service. Vital statistics were far from satisfactory, and 
had been a bane to State health officers since the days of Ranch. .Mor- 
tality returns were complete enough to be acceptable to the United States 



136 ITin.lC JIEALTII ADMINISTRATION 

bureau of the census but no compilations or analyses of consequence were 
made by the State registrar before his coming. Birth reports were too in- 
complete to meet the federal requirements for recognition. Dr. Rawlings 
went methodically about the task of improving vital statistics, arranging 
for every division of the Department to cooperate to that end so that within 
eighteen months Illinois had been admitted to the United States birth regis- 
tration area and fairly satisfactory annual compilations were forthcoming 
from the State registrar. Under Dr. Rawlings, regular staft meetings of 
division heads were started, the first board of public health advisors was 
appointed and met regularly, a central filing system of Department cimi- 
munications was installed, the official bulletin was established on a monthly 
basis in fact as well as in name, newspaper publicity w^as supplied regularly 
each week to the press of the State, a scheme of supplying local health offi- 
cers w-ith weekly morbidity reports was established, the method of record- 
ing morbidity reports was simplified and made much more serviceable, the 
routine investigation of every reported case of typhoid fever and smallpox 
was started — in short the work of the Department was systematized. 

Each of these four sanitarians did other important public health serv- 
ices. Other executives of the State public health organization accomplished 
many things of importance and value. Justifying the existence of a board 
of health, wringing money from a skeptical legislature, popularizing health 
on a large scale and systematizing the public health service are the larger 
achievements that have marked the progress of officially organized pre- 
ventive medical activities in Illinois and for these significant contributions 
Ranch. Kgan. Drake and Rawlings were respectively responsible. 

State Health Machinery. 

Rarely may one find in history circumstances more favorable to the 
launching of a great public health movement than those w'hich prevailed 
in Illinois in the "seventies". The severe losses of the Civil War in which 
disease caused far greater mortality than shot and shell was still fresh 
in the minds of men and especially in the memory of the medical pro- 
fession. Disastrous waves of cholera had swept the country in lS.j-3 and 
1867. Highly fatal and widespread epidemics of diphtheria and scarlet fever 
came and went with the seasons while helpless communities sat grimly 
by until the infections burned themselves out by natural limitations. Ty- 
phoid fever was frightful, frequently striking whole families simuitaneously. 
Yellow fever broke out periodically in the lower Mississippi Valley and was 
a perennial source of paralyzing fear to the citizens of Illinois. Immigration 
into the State from abroad was very heavy, establishing dangerous contact 
with European foci of smallpox, cholera and other infections that often in 



PUBLIC HEALTH ADM I MSTKATION ] li? 

that day cleijopulated great areas of land, especially in foreign Cduntries. 
Quackery was rampant in the State because the field was fruitful. 

On the other hand an awakening to the possibilities of preventing and 
controlling communicable diseases through sanitation and hygiene was be- 
ginning to manifest itself here and there among research workers. P"or- 
ward looking members of the medical profession and others in Illinois were 
already beginning to appreciate the significance of what Pettenkoffer. Pas- 
teur and Lister were doing aliroad. \'accination as a preventive against 
small])Ox was an estaljlished medical procedure. 

BdunJ of Ifcdill/ Orfiaii'iK (1. 

If the time was oppiirtuiu' the members of the first State Board of 
Health, ajtjjointed liy Governor Culldm were e(iual to the occasion and fully 
worthv of the confidence and trust rejiosed in them. Thev were Newton 
Bateman, LL. D., of Galesburg. intimate friend of Abraham Lincnln and 
an eminent educator and author, president of Knox College at the time 
of appointment; Reuben Ludlam, M. D., of Chicago, dean of the faculty 
of Hahnemann College and author of numerous medical treatises; Anson 
L. Clark, M. D., of Elgin, assistant surgeon in the Cnion Army, moving 
spirit in the organization of Bennett Medical College of which he was 
president for many years, president of a number of medical organizations 
and member of the Elgin Board of Education ; William Al. Chambers. Al. D., 
of Charleston, brigade surgeon in the Union Army where he was brevetted 
Lieutenant Colonel and Colonel successively for meritorious services, jiresi- 
dent of a number of medical organizations and member of the American 
Public Health Association ; John Milton Gregory, I^I^. D., of Champaign, 
ordained minister of the Baptist faith, eminent educator and author and 
many times commissioned by state and federal governments to fill important 
posts at home and abroad and president of Illinois Industrial University 
at time of appointment; John H. Ranch, M. D., of Chicago, highest rank- 
ing medical director on General Grant's staff in the Army of Tennessee, chief 
of the medical staff under U. S. Grant in his Virginia campaigns, sanitary 
superintendent for the board of health in Chicago ; Horace Wardner, M. D., 
of Cairo, assistant medical director on General Grant's staff in the Army of 
Tennessee, member of faculty of Chicago Medical College, While not a 
member of the Board, Dr. Elias W, Gray of Bloomington, who had partici- 
pated in the Civil War as an assistant surgeon, was elected the first executive 
secretary of the Board. 

First Jpjiiojiriafiniis. 

With an .-qiprojiriation of $.j,()OO.U0 for the first liiennium and author- 
ized to spend moneys collected for license fees al the rate of -tl.Dd each 



KiS 



ITlil.lC IIKALTIl ADMINISTRATION 



from practilidiKTs lidliliiis^ hoiia lidc (liplonias and •$."). 00 each from those 
wild had to In- L-.\amiiK-d, the State lioanl of Hcahh, duly organized on 
luly \'i. l^^i wiih Dr. Ranch as president, set itself energetically to regu- 
lating the practice of medicine — the most olnious t;isk at hand. 





ORGAniZATlOn OF 

STATE BOARD OF HEALTH 

1677 

STATE BOARD OF HEALTH 

7 Members 

Members participatinq in 
the enforcement ot riedicaK 
Practice Act with aid ot extra 


1 
1 


















Clerical Service 

2 Clerks 




1 Executive Secretary 

















Vw.. N. Woi'kint; strength (if tlie lirst SUite health organization. 

/''//■,s7 Jrlirillrs. 

During the lirsi six months of its existence the memhers of the Board 
of Health and it^ executi\e secretary, with very limited clerical assistance, 
made u].} the entire strength of the State's puhlic health organization. The 



PUBLIC HEALTH ADMIXISTUATIOX 131) 

iiiagnituile of the job of certifying doctors and the extreme meagerness 
of resources practically prohibited any signilicant attention to sanitary and 
hygienic matters. Presumably chafing under what he regarded as a neg- 
lect of its sanitary duties by the Board, Dr. Gray resigned as secretary on 
December 20, 1S7 7. In accepting his resignation the Board emi)hasized its 
appreciation of Dr. Gray's interest in sanitation. Dr. Ranch acted as secre- 
tary from December, 187; until May, IS^S. Then Dr. Clark was secre- 
tary for about a year. Dr. Ranch then became secretary again in .\pril 
1S7U and served continuously in that cajiacity until Is;)]. 

At the beginning the resources of the State Board of Health were 
its own membership; such help as it could afford to enii)l(iy with the sums 
appropriated by the legislature plus suius collected from aiiplicants fur li- 
cense ; all police officers, sheriff's and constables who were required b\' law 
to enforce the rules and regulations of the State Board of Health in so far 
as success depended thereon; vnUmtary assistance from interested citizens; 
the National Board of Health; such assistance as might be derived from in- 
terstate voluntary agencies; such active support as it was alile to secure 
from comiuercial and industrial interests indirectly through legal authority 
to (juarantine. etc. 

The Rai^cii Rkgime. 

Dr. Ranch's amazing ability to utilize these resources to a remarkable 
degree constitutes the story of public health service in Illinois for the first 
fifteen years after its foundation. The legislature was never generous in 
providing funds. That body deemed it wise to clothe the Board of Health 
W'ith extensive power and a small purse, h'or the first two years it allowed 
$5000 plus fees collected by the Board which amounted to less than $15000. 
For the next four years the appropriations amounted to $5500 per year ex- 
clusive of a standing contingency fuml nf $5()()() that cfiuUl be used imly in 
the face of .serious epidemic outlireaks. In I.SS5 the legislature granted the 
Board $9000 ])er year for the ordinary expenses and the usual $5000 con- 
tingency. For the next two years the apjjropriation soared to $2-1,000 for 
the biennium and a $40,000 contingency fund. This liberality was actuated 
by fear of a cholera epidemic. When the outbreak failed to materialize the 
annual grant fell again to $9000 but with the annual $20,000 contingency 
remaining. In 1889 the appropriations made for the ensuing biennium were 
$9000 per year for ordinary expenses and $5000 per year for emergency use. 

The money appropriated during this period was scarcely enough to pay 
the necessary expenses involved in collecting and compiling vital statistics 
and in meeting the expenses of the P)oard which met as often as thirteen 
times in one year for the convenience of those who wished to be examined. 



SECRETARIES 

lliaoLS State Boacd of Hcaltli 




Ellas ^ Gray. m.D. 





JohixH.UaucK/m.D. 




AnsoaLClack.m.D. 

ji/jTS' 1S7S --.^PK-mp 



\Viiv.R.7ll^Keii3UL,m.D. 

^U(S. 4.1391 - iSPTa-f. ISi>l 



No photosraph of Dr. Cray was available. 



PUBLIC HEALTH ADM IXISTRATIOX 141 

Dr. Rauch was ambitious to raise the standard of medical practice to the 
highest possible level. He was no less an.xious to put into operation every 
possible sanitary and hygienic measure calculated to prevent and control dis- 
ease. Too energetic and resourceful to allow the lack of funds to thwart him 
in his purpose he set about \\-ringing from the other resources at his c(jm- 
mand every ounce of activity and ciKipL'ratinn which was available. 

General J'ieic of P roll (in. 

It will be well to bear in mind that Dr. Rauch looked at sanitary prob- 
lons from a national and even a world ])oint of view. He would have 
gloried in the League of Nations because of its possibilities as an interna- 
tional health agency. He recognized, from a sanitary standpoint, no 
political lines of demarkation but only the great boundaries established by 
nature herself — the great oceans that .separate whole races of people. He 
had a passion for inaugurating such things as immigrant inspection service 
at the ports of entry and for the requirement of a clean bill of health as an 
essential factor in a "passport" from abroad. "Concert of action" was a 
phrase dear to his heart and furnished the basis for most of his achieve- 
ments. Perhaps his national point of view was too far reaching to be appre- 
ciated by the average State legislator and maybe that explains to some de- 
gree his inability to secure adequate appropriations for the execution of his 
plans. Even when he succeeded in alarming the lawmakers about the 
dangers from Asiatic cholera in 18ST the stupendous grant of $40. (KH) was 
so guarded with contingent clauses that it was not available for any practic- 
able purpose. 

Collecting vital statistics was the problem that led the State Board of 
Health first to connect itp with the State's health machinery resources out- 
side of its own immediate organization. In the law county clerks were re- 
quired to collect certificates of births and deaths and to make returns to the 
State Board of Health. The Board put the cotmty clerks to work on this 
job in the first year of its existence so that at the end of twelve months the 
functioning State health machinery consisted nl the .State 15oard of Health, 
which had met 13 times, and the comity clerks, .Small sums had been spent 
fur the laboratory examination of drinking water su])]>lies. In a few places 
local boards of health had been organized under the Cities anj X'illages Act 

of is;2. 

(Jiithr((ik (if YeUdiv Fcicf Siails Macliincri/ far ('(nilidl of 

E iii(l( lines. 

I)arl< clouds of epidemics and rumors of epidemics of yellow fever, 
.Asiatic cholera and smallpox began to hover above the health horizon in 
the ^nmmer of 1ST8 and the yellow fever thre.it actually materialized into 



142 mii.ic iii:.\i.Tn ad.m inistkatiox 

:i disastnnis cuitlircak that worki-il its way ii]) the Mississippi Valley as far 
north as llhinii-.. invading C'aini. 'IIk'sc' amditions concentrated the thought 
ol hralth ciflicials everywhere upon sanitary matters. In Illinois the State 
r.uard (if I iealth wanted U> make the ])remises of every household clean and 
drv. It wanted tii make every puhlie and private water supply safe for 
diinkin';. Ii wanted everv iiersnn in the State vaccinated against smallpox. 
Il wanted ever\liiid\' to l)e1ie\'e in the cleanliness of environment as a pre- 
ventive of disease and to practice it. It wanted immigrants inspected and 
vaccinated. 

Iliiw to hring these things to pass was the question. The State Board 
of 1 Iealth h.-iil no funds availahle to undertake such stupendous tasks with 
its own emjikives. A way out was found hy the diligent and resourceful 
Ranch. 

The vellow fever crisis ol IS'iS, as it was regarded at the time, led the 
Slate I'loard of Health to test its power granted under that clause in the law 
w hich read : 

•• and sliall liave authority to nialce such rules and regulations, and such 

sanitary investigations as tliey may from time to time deem necessary for tlie 
preservation or improvement of public healtli " 

The Pioard made some rigid ([uarantine and sanitary regulations con- 
cerning the rail and steamlmat iraflic coming into the State from the lower 
Alississippi and it put the transpniialinn mteresls to work at complying with 
these rtgulations. A few inspectois, lempor iry at first, were employed by 
the Txiard lo >ee that the rules were carried nul. Thus il was discovered 
lli.it in making a rule, which had the weight of law, the State Hoard of 
lle.ilth could increase enormously the health machinery without any material 
increase in expenditure. This was ihe beginning (if "rules and regulations" 
and we shall see how Dr. Ranch, with the su])])ort of the Board, turned this 
earlv e\]urience to good account in carrying out his sanitary and vaccina- 
tion plans. 

('nilf( rl nf Actinll. 

W hen Dr. I\auch was elected secretary in the spring of 18T!) the ambi- 
tions of the .State ISoard of Health to "sanitate" and vaccinate the State 
began lo resolve into plans and ]iraclical application. Cherishing his national 
])oinl of viiw he took aihantage of e\ery opportunity and created oppor- 
innilit'- li> m.ake Cdni.acl with (Uilside .igencics. Thus in April, 18T9, almost 
iinnudi.aleK .after be became seeielary of ihe State Board of Health, he 
went 1(1 .\bniphis .and gdl himself elected secretary of the Sanitary Council 
I if the Mississi]ipi \alley, an iiUerstale \dluntary organization created at 
lli.il lime. Its function wa^ tn keeji member health officers informed of all 
epidemic oiubreaks. t-speckill}- of yellow fever, and to draw u]) uniform sani- 



PUBLIC IIICALTIl ADMINISTUATION 143 

tary rules and regulations which all nieniliers agreed to adopt and enforce in 
their several states. This strengthened the i)u1)lic health, machinery in Illi- 
n(.iis bv adding the weight of group opinion to propcjsed plans and by pro- 
viding timely information serviceable in promoting pr(]mpt action on local 
plans. 

How an effective working contact was made with the National ISoard 
of Health, a federal agency created by Congress in ISIS with a $.")()0,()00 
appropriation, in May and with transportation interests in July of 1879 is 
best described by Dr. Rauch himself who gives this acc(]unt in the second 
annual report of the State Board of Health: 

"While the Illinois State Board, through its executive officer, was thus 
exerting its influence, beyond its own boundaries, to secure such a general sani- 
tary reform throughout the entire valley as would prove the best safeguard against 
the Introduction of epidemic disease from without, the National Board of Health, 
in anticipation of the act of Congress increasing its powers and resources, was 
seeking trustworthy information upon which to base such actions as the law might 
empower it to take in the discharge of its duties.* 

"In response to a telegraphed invitation, received May 2S. the Secretary re- 
paired to Washington, for conference with the National Board, and on June 1 pro- 
ceeded to New Orleans, under confidential instructions from the executive com- 
mittee of that body. These instructions involved, among other matters, a report 
upon the general sanitary condition of New Orleans, and an inspection of the 
Mississippi quarantine station, seventy-five miles below the city. Returning to 
Washington, on June S. two da.vs were spent in consultation with the executive 
committee: and during this conference the situation in the Valley, from St. Louis 
to New Orleans, was thoroughly discussed, the various available sanitary agencies 
were duly canvassed, and divers plans were suggested for most efficiently extend- 
ing the cooperation and aid of the National Government, through this organization, 
to 'State and municipal boards of health, in the execution and enforcement of 
the rules and regulations of such boards to prevent the introduction of contagious 
and infectious diseases into the United States from foreign countries, and into one 
State from another.' 

"A code of rules and regulations was also prepared, and recommended for 
adoption, for ports designated as quarantine stations: for securing the best sani- 
tary condition of steamboats and other vessels: also, the best sanitary condition 
of railroads, including station houses, road-beds, and cars of all descriptions: and 
the precautions to be enforced in a place free from inspection, having communica- 
tion with a place dangerously infected with yellow fever; and when .yellow fever 
is reported or suspected to exist in any town or place in the United States. As 
the general adoption of this code would tend to secure uniformity of practice 
throughout the Valley, and thus promote efficiency in preventive measures, the 
agency of the Sanitary Council, through its secretary, was invoked to attain this 
desirable result. The Sections relating to island quarantine were subsequently 
referred to a committee composed of Drs. H. A. Johnson, of Chicago, R. W, 
Mitchell, of Memphis, and S, M, Bemiss, of New Orleans, members National Board 
of Health. Representatives of other sanitary organizations, among them the Sec- 
retary of the Illinois State Board of Health, were invited to confer with this com- 
mittee. The report is as follows: 

"By invitation of the committee appointed to confer with the representatives 
of the railroad and steamboat interests of the Mississippi Valley, representatives 
of these interests met in the city of Memphis, July 2, lS7fl, and organized by elect- 
ing Dr. R. W. Mitchell, Chairman, and Dr. John H. Rauch, of Chicago, Secretary. 
The following lines and companies were represented: Mr. James Montgomery, 
Louisville and Nashville Railroad; Mr. J. D. Randall, Memphis and St. Francis 

* The act referred to was not approved until .June 2. but the iiiemher.s of the 
Board, realizing the gravity of the .sitiiati m, louli sueli iireliniinary steps as were 
possible at this time. 



141 ITI'.I.IL lll;AI.rll ADM IMSTKATIDX 

River Packot Company; Mr. W. E. Smith, Memphis anil Little Rock Railroad 
Company; Mr. M. S. Jay. Memphis and Little Rock Railroad Company; Mr. M. 
Burke, Mississippi and Tennessee Railroad Company; Dr. J. I!. Lindsley, Chatta- 
nooga, Nashville and St. Louis Railroad Company: Mr. T. S. Davant, Memphis 
and Charleston Railroad Company: Capt. Ad. Storm, St. Louis Anchor Line Packet 
Company: Mr. R. A. Speed, Memphis and Arkansas River Packet Company; 
Captain Lee, Memphis and Friar's Point Packet Company: Capt. R. W. Lightbarne, 
Memphis and Cincinnati Packet Company. The 'rules and regulations for secur- 
ing the best sanitary condition of steamboats and other vessels, also the best sani- 
tary condition of railroads, including station-houses, road-beds and cars of all 
descriptions,'* were read separately, discussed, and unanimously approved. Assur- 
ance was given of the cordial cooperation of the railroad and steamboat interests 
in all measures adopted by the National Board of Health in their efforts to pre- 
vent the spread of contagious and infectious diseases. All that was asked was 
that all rules and regulations adopted by the National Board of Health be made 
uniform at all places and ports. The representatives also approved the recom- 
mendations made by the Mississippi Valley Sanitary Council as a special measure 
of protection to the Mississippi Valley, that stations of insiirction be established 
at Vicksburg. Memphis and Cairo." 

Thus by iniilsuinnier of ISID ;l fmir cuniered tirgaiiizatidii fur lighting 
disease in Illinoi.s had been jjerfected. It incktded the State Board of Heahh 
and such voluntary assistance as it was able to stimulate within the State, 
the Sanitary Council of the Mississippi \'alley which furnished morbidity 
intelligence, the Xatinnal Board of Health which formtilated interstate sani- 
tary requirenit-nts ;ui(l the conference of Sanitarians and Transportation 
Inlerests which ]iut into cM'ect, through the resources of the common car- 
riers, the sanitary measures agreed upon. 

By titilizing every ounce of ])o\ver that could l)e S(|ueezed from these 

sources by means of persuasion and threats. Dr. Ranch was able to e.xtcnd 

the influence of his sanitary ideas throughout the length .'ind 1)readth of the 

Mississippi Valley. \\ ithin a few months from the time when the Sanitary 

Council was organized he was able to report : 

"At the beginning of this section, 'Yellow Fever in 1S79' there is given a 
comparative statement of freight movements over the Illinois Central railroad in 
187S and 1879, showing an increase of plus 37 per cent in the latter as compared 
with the former years. In this statement will be foinid an illustration of the 
effect upon commerce by the different systems in vogue in the management of 
yellow fever in the respective years. In 1S7S there was a quarantine practically 
excluding ever.vthitig that came from the south, while in 1S79 it was one of sani- 
tary inspection, including only dangerous articles. This result could not have 
been brought about without the cooperation of the National Board of Health, 
since neither the Illinois State Board nor the Cairo Local Board, without this 
cooperation, could have permitted the immense amount of material to be brought 
into the State from the south during the months of July, August, September and 
October. It required the constant presence of the Secretary at Cairo (especially 
in July I, and repeated assurances to the local authorities that every precaution 
was being e.xercised by the National Board and the Louisiana State Board of 
Health at New Orleans, and other organizations along the entire route, to prevent 
the introduction and spread of the fever northward, to allay their fears, as this 
year a majoi-ity of the citizens of Cairo were favorable to a quarantine of exclu- 
sion. Such was the feeling of apprehension that fully one-third of the population 
of Cairo, from July 15 to September 1, was ready to leave the moment the first 
case appeared, no matter whether it was of foreign or local origin." 

uloptprl by the S;init,iry Cciincil at Atlanta, witli 



PUBLIC HEALTH ADM I .\ ISTKATIOX 143 

How he played one force against another is suggested in a telegram 
sent by Dr. Ranch on October 3. ISIK, to the secretary of the National 
Hoard of Health. It read: 

"I am almost constantly advised by telegraph, no matter where I am. of 
the condition ot affairs throughout the whole Valley and 1 am. therefore, in posi- 
tion to judge intelligently of the situation." 

The intelligence set forth in this coninnmicatiun was obtained ihroiigh 
the operation of the Sanitary Council of the Mississippi Valley and the pur- 
pose of the message was to bring the National Board of Health to support 
Dr. Ranch's plan for combating yellow fe\er at the moment. Everywhere 
in the records of his work it is patent that Dr. Ranch kept well informed 
of epidemic outbreaks all over the world, so far as that was possible. Time 
and again he went before the national congress, the State legislature and 
other organizations with his jilans and invariably he would recite stories 
of epidemics abroad, naming foreign cities with the familiarity of a native 
and quoting figures and relating circumstances like a local observer. Small- 
jiox, cholera and yellow fever — these were the diseases he was fighting. 
When sanitarv interest and activity in the State tlireatened to grow sluggish. 
Dr. Ranch would begin to search the skies for ei)idemic clouds. Invariably 
he found them, usually an Asiatic cholera thundercloud that flashed and 
rumbled with deadly threats. 

Still catering to his national viewiioint Dr. Ranch resorted again to his 
"concert of action" idea in 1881 when smallpox outbreaks in the State be- 
gan to take on serious aspects. Tlds time he took it uijon himself to call a 
conference which again is best described in his own words, taken from the 
fourth annii.'d report of the State Board of Health, which reads as follows; 

"Early in the following June. (ISSl), the Secretary — convinced by past 
experience of the futility of independent preventive measures, confined to States 
and municipalities, while the disease was increasing in the chief European ports, 
and thousands of unprotected immigrants were pouring into the interior, and 
after consultation with leading sanitarians — issued a call for a conference of 
health authorities. National, State, and local, with a view to co-operative action 
by all interested, and especially with reference to the arrest of further introduc- 
tion of the contagion from abroad. This Conference, which was held in Chicago. 
June 29-30, was attended by representatives of the National Board of Health, and 
of eighteen other health organizations in fourteen different States. After full 
deliberation the Conference recommended that Congress incorporate into the 
laws regulating immigration, a provision requiring protection from smallpox by 
successful vaccination ot all immigrants: that the National Board of Health con- 
sider the propriety of requiring the inspection of immigrants -at the port of de- 
parture, the vaccination of the unprotected, and the detention of the unprotected 
exposed until it was certain that they were not carrying the germs of the disease 
on shipboard for the infection ot the vessel and the transportation of the disease 
into the United States: that measures be taken tor the quarantine detention of 
steamships bringing immigrants not provided with proper evidence of vaccinal 
protection; that local health authorities inspect all immigrants arriving in their 
respective jurisdictions, and enforce proper protective and preventive measures 
when necessary; and that, 'to meet present emergencies,' the National Board of 
Health secure the inspection of all immigrants, and the vaccination of the unpro- 
tected, before landing at any port of the United States." 



PRESIDENTS 

llUaols Stala £)oard. of Health, 




isrr - • W79 




mJtm 


M'^>§/f?.s^-^L.D. 




Hocace ^acdnct,9Tl.D. 

ISZ9-/SSI 







9Uvi'toa BaUiiiau.lL.D. 



PUBLIC HEALTH ADXr INISTRATION 147 

As an outcome of the Chicago Snialljiox Conference the National Board 
of Health inaugurated an Inmiigrant Inspection Service in June of 18iS2. 
It iivovided physicians, stationed at railway terminals throughout the coun- 
try, will' examined immigrants and vaccinated all of those susceptible to 
sniallpnx who were enroute to territory over which the inspector had charge. 
1 )r. Ranch was appointed chief inspector for the western district. The in- 
spection service continued oidv seven moinhs liut during that brief period 
ll.j.O.'iT iinniigrant> liound fdr Illinois werr examined and ".M.illS vaccinated 
against smallpox. \\'hile this service lasted the tive inspectors located at 
Chicago and the two located at St. I.cmis and Indianapolis respectively, added 
great strength to the health machinery in Illinois and doubtless led to the 
coast cjuarantine service which subsecjuently relieved states from work and 
apprehension covering the health of immigrants to this country. 

('(1)11 prcli cits') vc State S)i )')'(' t/. 

While working with interstate ami national agencies for the sake of pre- 
\enting the introduction of disease from the outside, the State Board of 
Health, through its secretary, was not idle in promoting sanitary activities 
widiin its own state boundary lines. In December of 18T8 the Board 
adopted a form for use in making sanitary surveys. Plans for the use of 
these forms and what was expected to be gained therefrom are expressed 
in the first annual report of the Board as follows : 

"This schedule of ciuesticns embraces everything appertaining to the sanitary 
interests of any city or town, and it can be carried out without a great deal ot 
expense, as the local medical men or societies will no doubt cheerfully answ'er all 
the queries contained therein. The information asked for is necessary to a cor- 
rect understanding of what is needful to be done to improve the sanitary condi- 
tion of any city or town in this state. While this information is being obtained, it 
at the same time stimuJntes the siudij of sanita)-y scirnrc all over the State. It is 
therefore very important that this survey should be made." 

The first survey forms were sent out to 8 communities in southern 
Illinois during the spring of ISV-K After yellow fever brc.ike out in the 
lower Mississippi Valley during that summer the forms were sent t<i -!' 
other inunici])alilies. The percentage of response was rather disappointing 
but the idea of making sanitary surveys through local people continued to 
grow until it culminated during iss.'i in over Mimi.ikhi inspections in o'.l."j 
cities, towns and villages in '.HI of the ll)-J countie-. This stU|iendous task 
was made jxissible through services voluntarily rendered by hundreds of 
local phvsieians. school teachers and others who had been interested in the 
matter bv fear of a cholera epidemic. Dr. Ranch himself had inspired this 
fear when he recited to the Board at its i|uarterly meeting in July bssl, 
the storv of cholera in Europe during two preceding years, suggested that 



14S pviu.rc iii;ai.tii administration 

the disease ^eciiR-d to l)c snicmldcriiij^ ready for a disastrous flare-up that 
might possibly leap the Atlanlie and concluded that: 

" my own experieiue aiui observation lead to this conclusion tliat it is not 

judicious to place entire reliance on quarantine measures, no matter how admin- 
istered, should the disease become epidemic in countries or points with which this 
country has close commercial relations. As Asiatic cholera, although it may 
Invade places of good sanitary conditions, finds its most congenial habitat where 
filth in any form abounds, the best attainable sanitary condition; clean streets and 
premises; the prompt and proper disposal of organic refuse, night-soil and all 
forms of sewage; well ventilated habitations, with dry clean basements; a pure 
and sufficient water supply; and good individual hygiene, including personal 
cleanliness, proper diet and regular habits of life — these are the best safeguards 
against Asiatic cholera, as they are against most diseases." 

This was the idea underlying the sanitary survey which brought to 
thi' State I'xiard nf llealth detailed records of the environmental conditions 
of iixvv .KMi.dUd premi>t-s and much information concerning local epidemics 
.■uid famiU lu-:dih histories. The achievement of this stupendous task is 
signilicanl here llecau^c it shows hiiw the Board was al)lc to bring into action 
hundreds of l(ic;d peii|ile lh;U ])Ut the State's ln'alth machinery int(i im- 
mediate li.uch with praclicalU" e\er\ household in lllin(iis. 

Vaccinal Kill (if School ('hihlnii llc([iiiri'(l. 

Another illustration of the same means for expanding the health ma- 
chinery of the State was based upon a resolution passed by the State Board 
of Health on Xovember 'i'i. is.si. which reads; 

'•RRSOU'llD. That by the authority rested in this Board, it is hereby 
ordered. Ihiif on and after January I. iSSj. no f^upil shall be admitted to any 
pnblie sehotd in this State 7vithouf pi-esentin;/ satisfaetorv e^'idenee of f^roper 
and siieeessfnl I'aeeination." 

Acting upon this authority Dr. Kauch. as secretary of the Board, made 
ready such fonus as were necessary for i)roviding children with vaccina- 
tion certiricates and for collecting the desired reports for office records 
ami study. Then he plunged into the task of communicating the order to 
all school officials and teachers in the State. So energetically was the iob 
prosecuted that by January 2-i, 1882, he was able to say: 

"1 doubt if the people of any other state of equal age are as well protected 
against smallpox as those of Illinois at the present time." 

In a comiilete report that was jniblished later ap])ears the assertion 
that ; 

"Nearly 500 Individuals, embracing attending physicians, and municipal, 
town and county officers, have contributed, each in his proper capacity, to the 
Information furnished as to the introduction of the contagion, its mode and ex- 
tent of propagation, the measures resorted to for its suppression and their result, 
the cost, actual and constructive, and other noteworthy features. In like manner, 
the vaccinal history of 304.586 public-school children — based upon physicians' 
certificates of vaccination — has been furnished by over 8.000 teachers; 49.3 
physicians have reported the results in 187.22:5 vaccinations at all ages; and the 
vaccinal status of 1<S.70S inmates of public institutions, private and parochial 
schools, colleges, academies, etc.. has also been given — making an aggregate of 
5111.517 individual vaccinations and revaccinations." 



PUBLIC HEALTH ADMINISTRATION 



149 



This shows an amazing increasL- in ihe i)uhlic health machinery which 
accomphshed its purj)osc within sixty days alter it was started resuhing 
in an increase in vaccination of fr(im I.") Ui !il per cent of all school children. 
Power to so enlarge the health niachiner\' was, of course, hased upon an 
interpretation of the law giving the Slate Hoard of Health "General super- 
vision of the interests of the health and life of citizens of the State.'" 



Conpcrat i(iu iritli Loral Aiilhnrlilrf;. 

Another means employed by the State Board of Health to augment the 
available machinery for getting health work done in the State was the pro- 
motion of the organization of local boards of health, in the smaller munici- 
]ial antl rural communities. Nearly all the large cities had health organiza- 
tions at the time. Ijut it re(|uire(l stimulation to keep them going. Under 
pressure of local epidemic outbreaks and iiropaganda featuring possible 
dangers from cholera, smallpox and yellow fever, boards of health came 
into existence here and there from time to time. 

Available records show that local organizations were formed in the 
larger communities in Illinois as follows : 



Cairo 1S18 

Belleville 1S19 

Alton 1S21 

Urbana 1833 

Chicago 1835 

Ottawa 1837 

Bloomin.gton 1839 

Danville 1839 

Decatur 1839 

Quincv 1839 (As a town 

inlS25) 

Peltin 1839 

Peoria 1839 

Springfield 1840 

Jacksonville 1840 

Galesburg 1841 

Marion 1841 

Rock Island 1841 

Blue Island 1843 

Joliet 184.5 

Canton 1849 

Collin.sville 1S50 (town) 

1872 (city) 



Lasalle 1852 

Wauke.gan 1852 

Aurora 1853 

Elgin 1854 

Preeport 1855 

Kankakee 1855 

Moline 1855 

Freeport 1857 

Lincoln 1857 

Centralia 1859 

Mattoon 1859 

Champaign 1861 

Rockford 1862 

E. St. Louis 1865 

Murphysboro 1867 

Kewanee 1872 

Streator 1874 

Maywood 1881 

Chicago Heights 1892 

Harvey 1895 

Granite City 1896 

Herrin 1898 



By l.ssti enough local interest in sanitary matters had been stirred 
up t(j bring 39 representatives of as manv local municipalities to a sanitary 
conference called by Dr. Ranch to meet in S])ringfield on May 21st. Of 
those in attendance 1-3 were registered as health officers, 13 as members of 
local boards or committees of health. ■; as mayors and the other tour as city 
engineer, town trustee, city attorney and city treasurer respectively. \\ hat 



150 ITIil.Jt' lll-,.\l.in ADM IMSTKATION 

traiispin-'d at \hc amivrvucv may In- siirniisccl I'luni llic rcpurt of a com- 
mittee oil roolutions which rca<ls : 

"1. That to insure the proper sanitary condition, it shall be the duty of the 
health officers to require a prompt special inspection o£ all buildings and premises 
within the corporate limits of town, village or city, to report same to proper 
authorities, and to cause all nuisances to be abated as tar as practicable. 

"2. All town, village, or city authorities should be informed toucliing the 
influence of sucli sanitary supervision of domiciles and places of labor, on sick- 
ness and death rates, and tliey are hereby requested to make a prompt and proper 
appropriation of means for tire performance of this work. 

"3. The registration of births and deaths liaving been too greatly neglected 
in the past, it is urged that ordinances and rules be made by the proper authori- 
ties on this sub,iect, both for the procuring of necessary information, purposes of 
identification, and also to inform the sanitary authorities of the condition of the 
health of the neigliborhood. 

"4. The importance of vaccination and re-vaccination should be impressed 
upon all school authorities, and the laws of the State thereon should be promptly 
and vigorously enforced." 

How primitive the ideas ]irevailini,' then ;il)oul sanitation were, is 
shown in a ([uestion put hcl'orc the conference l)y Hr, T. M . -Mcllvaine, 
heahh officer of Peoria, who wanted to know if j)ii;-peiis should V)e called 
a nuisance and in what towns they had hecn aholished. 

This conference never resulted in a closely knit organization but it has 
contir.ue.l to this d,-i\- under \arious names; meeting sometimes regularly 
but more frequently with a lapse of some years between. Its purpose 
was nianifestlv to bring into etTective cooperation the State and local 
health ;igcncies h)- mutual discussion and understanding of common prob- 
lems, 

Il/th s mill liriinhil iiiiis. 

The very hrst use of the power vested in the Stale Board of Health 
''to make such rules and regtilations .... as thcv may from time to time 
deem necessary . . . ." was jieremptorily exercised by the president of 
the Board, Dr. John W. Ranch, at Cairo (.m July 2!), 18T8 when yellow- 
fever threatened to invade the Slate. His action placed an absolute embargo 
on freight and |)assengers from the epidemic region into Illinois. In this 
action the I'oard later concurred. 

l''roni lh;u lime forward new rules were nKidc and old ones modified 
as occasions arose until ISs.'i found the I'.oard with a set of regulations 
which rcqniicd all children in the public schooK lo be vaccinated against 
smalljiox : (|uarantine, isolation, etc. of persons sick with smallpox, di|)h- 
thcria, scarlet fever, t\-j)hoi(l fever. Asiatic cholera and yellow fever: the 
rejiorting of cases of contagious disease directly to the secretary of the 
State Hoard of Health: prohibition of tr;uisp(ining dead bodies of per- 
sons who ha 1 died from smallpox, cholera and yellow fever and any other 
dead bodies during the summer nioiilhs except under siiecilicd conditions. 



PUBLIC HEALTH ADMINISTRATION 151 

These rules and regulations, the development of which i^ recited in another 
chapter, have always formed the back bone uf the State's health machinery. 
Schemes for making them work have always been the task that confronted 
executive officers whose duty it was to provide the niaximnm in sanitation 
and hygiene with the rescurces at their command. 

Law?, relating to he:ilih crept into the statute books from the very 
outset of organized government in Illinois. The e were changed, rejiealed, 
modified and added to from time to time as the divi>ion of labor brought 
whole groups of persons to depend more and more ujjon other individuals 
and groups for supplies, the utilization of which had a direct influence over 
health and as sanitary and hygienic knowledge increased. By 1885 there 
were laws authorizing cities and villages to establish boards of health and 
making the supervisor, assessor and town clerk of every town a board of 
health to function outside of incorporated cities ;ind villages. There were 
also numerous laws relating to food, milk, nuisances, etc. To promote 
desirable sanilar\- practice and uniformilv of procedure throughout the 
State the State Board of Health drew up what wa> termetl a Model Sanitary 
Ordinance and recommended its adoption. In this ordinance an attempt was 
made to codify all existing laws relating directly to lu-ilth as well as the 
rules of the State Board of Health that had to do with ipiarantine, report- 
ing of contagious disease, and sanitary conditions. It also embraced articles 
on vital statistics, burial permits, etc. 

Jiti'iifinii fn U'dfcr Siipiilii's. 

Water supplies attracted the attention of Dr. Ranch throughout the 
whole period of his association with State health service. Never was he too 
busy to think and talk about the importance of safeguarding drinking water 
from pollution. l-'re(|uentlv he found time to make extensive held studies 
himself. (Jften he arranged for others to do it. Scarcely a rejiort came 
from his office that di<l not present data collected relative to some new 
investigation of water supplies. The very first annual statement of the 
Board contained an expenditure item of >i^l!).2o for costs involved in '.he 
collection and analysis of samples of water taken from the Chicago River. 
During the \'ears that followed samjdes were fre(pientlv taken from many 
other streams as well as from jntblic and private supplies. Studies and 
observations. frei|uently carried cnit by Dr. Ranch himself, were often con- 
ducted for months at a tinie. Even after leaving the State Board of TIealtli 
as its secretary. Dr. Ranch was employed by the Board to study the water 
supply question. Tie had nuich to do with proxiding a jiotable water in 
Chicago just i)rior to tin- (ireal World's hair in that city. 



lo2 ri'iii.ic iii:ai.tii admixistkation 

Ediiratioiial ^Ictiril ics. 

I'^ducaliiin >>i llu- juililic thruugh the inililiLaiidii aii.l (listri1)Ulii)n of 
special iiampliU-lh and through the newspapers was recognized from the 
outset as a \alualilc means for extending the pubhc health machinery of 
the State. The early annual reports of the State Board of Health are 
rejjlete with lengthy dissertations, reports and quotations on sanitation. 
Education was one of the chief purposes of the great sanitary survey 
which really began in Is'IS. In 1881 a circular entitled "Concerning the 
Pre\;entinn of ."-Smallpox" was published and distributed widely throughout 
the State. I'.v lss."i circulars on smallpox, diphtheri.i, scarlet fever and 
t\])hoid fever had lieen published ami hundreds of thousand'- of co])ies 
distributed. Correspondence on these and other sanitary m.'Uters was 
\oluminous. 

The sanitary ideals toward which the first State health officials strove, 
and ]iarticularlv Dr. Ixauch whose ideas dominated the activitv of the 
Hoard e\'en before he became its executive secretary. wei"e two-fold. On 
the one hand, the desire was to so educate the people that they could and would 
vo'untarily, through personal action and local health officers, put into prac- 
tice the sanitary and hygienic measures calculated to preserve and promote 
health and thereby make imneccssar\- a large corps of State health workers. 
( )n the other hand the desiie w;is to bring into existmce interstate, national 
and international m.achinerv which woidd function so as to ])revent the 
introduction of diseases from without and to keej) the State health officials 
informed of world health conditions. 

To the end of realizing these ideals the contacts heretofore referred 
to were made and the activities mentioned were undertaken ])rior to 
the close of ISS."). This general scheme continued wi'di but few- and not 
\-ery important exce]itions, to govern the plans, policies, organization and 
])erform,-inces of the State ])ublic heallh machinery in Illinois until the close 
of the nineteenth century. 

Dr. Ranch continued as executive .secretary of the Stale Boanl of Health 
until June :il). ls!il, when he resigned and was succeeded ])\ Dr. Frank 
W. Reilly of Chicago on ."^ejitember 21, If^iH, Dr. \\\ R. AlacKenzie of 
Chester, a member of the Board, lilling in ihe iiUerim. 

Arc()i)ij)lislniiiiif.s. 

Throughoru the 1 1 ye.ars of his connection willi the State Board of 
Health, m<isl of which lime w;is s])ent as its secretary. Dr. Ranch was 
easily the central ligure of public health machinery and thought in the State. 
He exercised no insigniticani iulluence over the s.anitary and hygienic policies 
and practices in the nation ruirl atlractc-d notice of foreign countries. His 



PUBLIC HEALTH ADM IN ISTRATIOX 153 

idras alxiut yellow fever made an especial appeal in Europe and were made 
the suhject of a lengthy and favorable editorial in the December lo, IS.ss, 
edition of the London Lancet. The extent and character of Dr. Ranch's 
activities as a sanitarian are succinctly ex])ressed in a resolution, adopted 
by the State Board of Health when his resis^nation was accepted, which 
reads : 

WiiEBE.\s, Dr. John H. Ranch, after fourteen years continuous service, has 
severed his connection with the Illinois State Board of Health, having on the 30th 
day of June last, tendered his resignation as its Secretary, the following resolu- 
tions are hereby adopted, as in some degree expressing the sentiment of the 
individual members of the Board toward their friend and colleague: 

Resolved. That Dr. Ranch's services in the cause of sanitary science and of 
the best interests of the medical profession have given the State of Illinois a grati- 
fying pre-eminence not only in this country, but wherever the sanitarian and the 
physician are known and recognized as useful members of society. 

Resolved. That Dr. Ranch's eminent attainments as a practical sanitarian, 
illustrated in his management and control of epidemics, his reformation of the 
theory and practice of quarantine, his establishment of a system of immigrant 
inspection on sea and land, his conservation of the purity of food supplies and 
products and his work in the domain of preventive medicine, place him in the 
front rank of those who devote their lives to the material welfare of their fellow 
men. 

Resolved. That to Dr. Ranch's untiring energy, to his vigilance and to his 
intimate personal knowledge of the profession, both in his own State and in the 
country at large, are chiefly due the establishment of a body of efficient legis- 
lation, regulating the practice of medicine — legislation whose precepts and adjudi- 
cated cases have been copied, adopted and endorsed by older commonwealths. 

Resolved. That his wise aggressiveness, his forethought, sagacity and per- 
sistence, in the face of manifold obstacles, have nowhere been more strikingly 
displayed nor more usefully employed than in his successful efforts to elevate the 
standard of medical education. 

Resolved. That Dr. Rauch's personal sacrifices in the discharge of his duties 
as member. Secretary and President of the Illinois State Board of Health — sac- 
rifices known to every member of the Board — are deserving of grateful recogni- 
tion and substantial reward by the people of the State for whom he has so long 
and so faithfully labored. 

Resolved. That the individual members of the Board, whose names are hereto 
appended, are unable adequately to express the regret caused by Dr. Rauch's 
resignation and the esteem in which he is held by them. They earnestly enter- 
tain the hope that he may lon.g be spared to counsel and advise with them and 
their successors in matters touching the lives and health of the people of the 
state. 

W. A. H.\SKi.;ix, A. M., M. D., Harv. 
Nkwtojs' B.\tem.\n, LL. D. 
An.son L. Clark, M. D. 

R. LUDL.VM, M. D. 

WuAAAM R. M.\cKi':xziF.. M. D. 
D.\.\iel H. "Williams, 1\I. D. 
B. M. GuiFFiTiis, M. D. 

The things of noteworthy niagnitudi,- which had come to pass during 
I)]-. Ranch's incumbency and which brdught into action the available health 
ni;icliiner\- of the State were brielL' a,^ fullows: 

1. The State had been clean>i'd of uni|ualilicd practitioners of nu-di- 
cine. I'hysicians who ■were allowed to piactice held bi>n,-i tide credennals. 



154 rUHI.K' HEALTH ADMIXISTKATION 

and medical education had been raised to a considerably higher levi-l. This 
work was achieved largely by the State Board of Health itself whdse mem- 
bers served without pay and met frequently in all parts of the State. 

2. Practically every household in the State had been inspected from a 
sanitary point of view. This was accomplished through tlie voluiilary serv- 
ices of local people. 

.■>. Nearly every school child in the State had been vaccinated against 
smallpox. The law making it the dulv of local officials to carry out the 
orders of the State Board of Health and that empowering the Board to make 
rules and regulations were invoked to bring success in this case. 

I. \'ital statistics such as reports of births and deaths were collected, 
comiiiled and published in great detail for the years of 1880 to 1886 in- 
clusive. While estimated to be about 48 \k-v cent incnniiilete for births 
and 31 per cent for deaths, the machinery for collecting them was set in 
motion and even in so incomplete a condition Ihev furnish valuable data 
for comparison with present day conditions. This task was accomplished 
li\' putting county clerks to work, at this task as the law required, and 
b\- utilizing the limited clerical resources availaljle to the Board. 

"i. Rules and regulations concerning (|iiarantine and sanitation had 
been adopted, their enforcement wa^ i)riini(ile(l through ;i law creating local 
boards of health throughout the Stale. 

(i. Exhaustive studies of stream ijolluiinu in the State and of water 
supplies and sewer facilities, e^pecialh' in L hicago had been luade. 'Ibis 
had been accomplished largely ])y the jjcrsonal etTori of Dr. Ranch himself 
and the analytical laboratory service which was ]iaid for out of the general 
office exjiense fund. 

7. The phvsical exaiuinalion of immigiants for the specril purpose 
of ])reventing smallpox, cholera and yellow fever was in general ]iractice 
along the .Vtlantic seaboard and sjioradicalh' inl.ind. This had coiue about, 
to ^ome exteiU at least, because of contact with outside agencies. 

S. 'J'he influence of the foremost s.anilarian^ all oxer the country had 
made itself felt in Illinois. This had resulted from the prominent |)art 
taken bv Hr. Ranch in organizing and parlicii)ating in .-i dozen national 
sanitary movements. 

r.ven after his resignation as secretary. Dr. Ranch contiiuied to ex- 
ercise a direct influence over the sanitary thought of the State and the 
policies of its health machinery. Indeed he was time and again called back 
to duty b\- the ISoard of Health in the cajiacitx- of Sanitarv Counsel. ( )nly 
death, which clo-ed the career of thi^, uni([ue ligure in the public health 
history of the countr\- in March of ISKI, could eliminate him as a luaster 
figure in the sanitar\- thought and activities of his Slate. 



PRESIDENTS 

llliaois State Jboatd. of Hcaltk 




W.A.HaskdX.m.D. 

/ssr ' IS 93 



JoKaA.Vlnar\t,9U.D. 

/S93 " 1894 




V^.E.QuuuL, m.D. 

l&9-^ - /S9<S 



B.m.GdffltK.m.a 



1S9S- IS9r 



15G rUIiLIC HEALTH ADMiMSTRATION 

Dr. luillji Sicyrlarij. 

Dr. keilly liad Iktii closely associated willi the State Board of Health 
since JiSlS whrii he was employed l)y it to work as a medical inspector in 
the yellow fever zone. I'or many _\ears lu- was assistant secretary nnder 
Dr. Ranch. Dnriny his I'imr years in otttce he carried forward the policies 
and activities that had l)een [)reviouslv eslahlished. There was one notahle 
exception in the coniinnity of iiolicy. In 1S92 an attempt was made 
to divorce the work relating- to re,2;nlating the practice of medicine and 
that inviilved in sanitation and hygiene. The Hoard anthorized Dr. Reilly 
to work with the legislatnre tcjward that end. The idea was to create a 
board of medical examiners and leave the Slate Board of Health to fnnciion 
only in the field of sanitation and hygiene. 

\'erv rajiid progress had been made in the science of bacteriology dur- 
ing the eighties and apparently Dr. Reilly was more inclined to put faith 
in the discoveries made in this held than was Dr. Ranch. It is easy to nn- 
derstand how a health officer with limited resources who believed in the 
possibilities for service disclosed by bacteriological discoveries would grow 
restive under conditions that required most of his time and eflfort to license 
doctors. An active imaginatinn even in that early day (if liacteriology could 
foresee opportunities for expending nnlioinided resnurces in prosecuting 
sanitary jirogranis. 

Dr. Reilly tended mcire tnward the idea of building up a .^tate health 
organization than did Dr. Ranch. Trying to get rid of the Medical Prac- 
tice Act indicated this attitude. He also managed to employ out of the con- 
tingency funds a corps of immigrant inspectors which he stationed at C hi- 
cago. Dr. Ranch looked to the federal government for such service and 
probably regarded the matter as a principle. The immigrant inspectors 
constituted the onlv ini])ortant change in the health machinery of the 
State under Dr. Rt-illy and this was discdntinned when Dr. J. W. Scott 
of Chicagc: was elected secretary to succeed Dr. Reilly on Jnlv 5, lSl);j. 

Dr. ,1. II'. ScoH Srrrrtari/. 

Under Dr. Scott the visitation of a general smallpox epidemic revived 
the cominilsory vaccination rule that applied to school children which had 
been allowed to fall iiUo disuse. This time its enfurcement was accompan- 
ied by considerable litigation. Two suits are udteworthy. One was an 
action against a school board in Wayne Louniy which was dropped upon 
advice of the Slate's attorney who felt that conviction was impossible. The 
other, a luandamus proceeding against a school hoard in Lawrence County 
went to the Supreme Court where the decision handed down in November 
1895 was against the school board. This is important because it declared 



PUr.LIC HEALTH ADMINISTRATION 1 "i ^ 

that the rule of the State Board nf He'ihli requiring evidence of vaccina- 
tion before admitting children to tlu- puhlic ^chonls could be enforced only 
when smallpox threatened or \va^ ininiinenl in a particular community. 
Henceforth the public health machinery which this rule had ])reviousIy 
set in motion could be utilized (nilv when smallpox ajipeared in a commun- 
ity. 

Under Dr. Scott the conference (if State and local health officers in 
Illinois was revived under the name of the State Board of Health Auxiliary 
Association. The fact that 10<S representatives attended the meeting in 1S!)4 
shoW'Cd that local health organization had grown considerably since the 
first meeting of this kind was held in ISSS — when :50 representatives had 
responded to the invitation. At the meeting in 1S!)4 a strong sentiment 
in favor of uniform procedures was manifested and to that end the Model 
Ordinance was reviewed and modified and its adoption recommended. So far 
the (piarantine rules and regulations of the State Board were general, leav- 
ing specific matters to the discretion of local authorities. 

In 1895 the means for enlarging the State's public health machinery 
were enhanced when the legislature a])i)ropriated $3,000 for the establish- 
ment of a vaccine farm and ^o.Odi) foi- a water laboratory, both to be lo- 
cated at the State University. More detailed discussion of these projects 
appears in the chapter on laljoratories. 

Ur. Scott continued as the secretarv nf the Slate Board of Health 
until May "i I, ISDI when he was succeeded by Dr. James .\. I'^gan of Chicago 
who occupieil that position until his death in March 1!)13. 

There was no material change in the health machinerv of the State 
l)etween ISlin and 1!)00 except the beginning of the laboratory work. The 
strength of the State Board of Health was shifted from one problem to an- 
(jiher. At one lime a staff inspector was em]iloyed lo examine immigrants 
as they came into the State. At another time a milk inspector would be 
put to work. Then attention W'ould be conceiilraled nil yellow fever with 
all hands Inisy in Cairo, making inspections of jiassengers and freight from 
the South. Again the examination of public water supplies and streams 
Wduld iiilerest those in charge and ex])erls would be emphjyed to can'}' 
out studies in that held. Smallpox flared up occasionally and stinmlaled 
field activitv that involved expenses. Law suits developed from the en- 
forcement of rules and this led to the eniplo\inent of legal talent. 

All of the personal service emjiloyed by the State Board of Health 
was temporary in nature, however, excejit that (}f the secretary, an assistant 
secretary and a small clerical staff'. The total apprt)]iriation for the routine 
expenses of the State Board of Health during the last year of the nineteenth 
century was only $9,250. Of that sum $3,000 was for the salary of the 



158 PUP.Lic iii:ai,iii ahm i xisiration 

sc'crctarw The i>ay of a chii-f clerk rfiluced the tutal by .$l.,S()U more. 
'I'wo clerks were entitled by law U< gvl -l^-.M .".0 tiiyether. 'i'his left $2,350 for 
travel and other expenses of the Board members antl secretary, printing, 
general office expense, other ])ersc:nal services not regularly employed, etc. 
There was a five thonsand dollar contingency appropriation \yhich the vari- 
ous secretaries tried to utilize froni time to time. Ilow successful they were 
dr|.eu(k'd upon the whim of the particular governor in oflice at the time 
and upon the ability of tlu' seeietar\- to jiicture imminent danger from any 
of a group of diseases listed in the appropriation law. 

Thus on July 12, IIKK), the State's official ])ubHc health organization 
was 2-i years t)ld. During that time this infant governmental function 
had survived apjiarently by reason of its stubborn refusal to die and a 
tenacious gri]) on life. From then on its growth was considerably acceler- 
ated. 

Ecu II inc. 

.\t the beginning of this short cjuarter of a centurv there was a 
State Board of Ilealih with an executive secretary and a small clerical 
staff. .\t the end of it there was a Board, an executive secretary and a 
clerical .^taff a trifle larger. .At the beginning the Board members met 
frequently — thirteen times the first }ear — but they received no remunera- 
tion except travel exi)enses. .\t the end of this period the Board members 
received a ])er diem pay, their tra\-el expense and met less frec|uently, rarely 
more often than quarterly. Thus it is clear that the health work of the 
State devolved more and more upon the executive officer of the Board. 
An annual contingency fund made possible a medical and sanitary field 
service under epidemic conditions while sporadic work of this kind could 
be accomplished out of the routine funds. 

During the ''■'' years the Board of Health had indulged the authority 
vested in it by law to make "rules and regulations" and a number of these 
efforts had been tested in the courts. Thus the limitations of the health 
machinery had been pretty well estal)lished, the courts leaning to the view- 
that dangerous disease must be present in a community before drastic 
quarantine or sanitary rules ma\' become operative. 

Nearly everybody in the .State had come into eon'.act with the .State 
health organization thi-ougb the vaccination and sanitary survey projects 
so that the idea of doing i)ublic health work had l.aken root. Local boards 
of beihh had more than doul]k-<l in number during ihe period. At the 
same time the prexailing ])opular notion fixed the work of health officers 
to ])urel\- enxironmeiUal cleanliness — collecting dead .animals, causing abate- 
nienl of nuisances, garbage renioyal, etc. 



PUBLIC IllCALTII ADMIXISTKATIOX l.li) 

Sporadic efforts to collect vital statistics had been made. County clerks 
knew that it was their job to handle certificates of birth and death. Doctors 
knew that the law required these reports. The State Board of Health 
knew that it was legally required to receive and compile and preserve the 
statistics. This system never operated successfully enough to bring reason- 
ably complete returns and no time was found by the State agency to compile 
and publish these records except for the years of 1880 to 1886 inclusive 

Contact with outside agencies had been established and cultivated. This 
added the advantage of national and world intelligence of epidemic con- 
ditions as well as sanitarv and hygienic developments to the State's machin- 
ery for doing health work. 

This closed the probationary or Ranch period. Health work had be- 
come established in Illinois. Machinery for doing it was now regarded 
as an essential and permanent factor in the State's government. From now 
on it began to expand, take on new activities and developed into a strong 
agency relying more and more on its own resources to keep diseases under 
control and to preserve and promote good health. 

The Egan" Regime. 

The predominating characteristic of public health service under Dr. 
James A. Egan, who became secretary of the State Board of Health in July 
1S9T. was expansion. Regulating the practice of medicine and allied i)rofes- 
sions had reached a fairly satisfactory stage and still consumed 1.") or SO 
per cent of the time and energ)- of the State Board of Health. Dr. Egan 
wanted to get rid cjf it. He saw large possibilities for growth in the 
field of sanitation and hygiene. He began to examine the resources at his 
command and to plan for ibeir enlargement. 

Dr. Egan championed from the outset of his incumbencv tlie idea of 
separating the regulation of the practice of medicine from the sanitarv 
work and to this end he sought to create separate State machinerv. He also 
wanted a larger State sanitary staiT and better local health machinery. 
In a paper read before the State Medical Society at Galeslnn-g on Mav !S. 
1898. Dr. Egan declared that the jicople were indis|iosed to ])ass laws 
or spend money for sanitarj- improvement and the ])revention of disease. 
This, he thought, was because of wide differences of opinion among sani- 
tarians. In the same paper he advocated legislation, providing for the 
establishment of local boards of health and the separation of the State's 
functions relating to "medical practice" from those concenied with sani- 
tation and hygiene. There was scarcely a meeting of the State Board of 
Health after Dr. Egan became secretary but the matter of getting relief 
from the duties involved under the I\Iedical Practice Act was discussed. 



]IW VVlU.ir IIKAI.TII ADMIXISTUATIOX 

I iicrcdsi-d A pjii'ijirKilidiis. 

'l"hi' nu'ctiii^^ III" i1k- ( icneral Asseiii1)lv in 1S!)9 gave Dr. Egan his first 
opportuiiit)' to begin liis expansion inMgram ilirough legislation. What he 
wanted is outlined in a report from him U> the Governor in Januai-y 
of that year which set forth seven specific requests. They were: 

"First: The creation of a State Board of Medical Examiners to examine and 
license physician.s and midwives. 

Second: The creation of a local board of health in every city, village and 
town, and in every connty not under township organization, certain duties to he 
imposed upon such Boards. 

Third: The forbidding of the interment or cremation of a body dead from 
any cause, in any portion of the State, except upon a legal permit, the burial or 
cremation permit to be issued by the nearest health officer who shall be required 
to report monthly to the State Board of Health. 

Fourth: Granting to the State Board of Health supervision over the sources 
of public water supplies and of sewage disposal throughout the State. 

Fifth: Granting to the State Board of Health an appropriation commensurate 
in a degree with the sanitary duties the Board is expected to perform. 

Si.rtti: Requiring that owners of cattle condemned tor tuberculosis, should be 
adequately compensated by the State tor the loss of the same when it can be shown 
that the owners were ignorant of the fact that the cattle were diseased when the 
purchase was made. Requiring also severe penalty against owners who fail to 
promptly report sick animals to the inspectors, or who oppose any attempt to the 
inspection of their herds. 

Seventh: Amending 'An Act to Create and Establish a State Board of Health 
in the State of Illinois, approved May 25, 1877, in force July 1, 1S77.' As under 
the recommendations outlined above, the majority of the sections of this Act will 
be amended, I would recommend that the entire act be amended. Section 2. (The 
Power and Authority of the Board), especially needs careful revision. In the 
opinion of the Attorney General, this section is weak and may often be found 
inoperative for a time at least." 

Out of this ambitious program. Dr. Egan succeeded in getting an in- 
crease of $'250 per vear in appropriations and that went to the salary of 
two cleiks. He had asked for an increase of >(;2."i.(i()o. That was the be- 
ginning but Dr. I-!gan was de>tine(l to learn how to gel the ear of the law- 
makers and how to mani])ulate their purse string pulse. 

But there were (Jther resources. There was tlie contingency fund 
of $5,000 i)er year. It could be spent with the consent of the Governor 
"in case of an outbreak, or threatened outbreak of any epidemic or lualignant 
diseases". To get it the task was onlv to convince the Governor that a 
malignant disease had appeared or threatened to appear in the St.ate. This 
Dr. Egan could do. Prior to his time the contingency fund usually went 
back into the treasury untouched. Im-oiii now on a year r.arely passe. 1 when 
it was not drawn ujum. It was usvd to ji.ay ]ihysicians and quarantine 
officers appointed for s])ecial duty in connection with yellow fever alarius, 
smallpox outbreaks, ty])hoid fever and other disea^i-s and for sanitary 
service in flooded areas along the Oliio, Illinois and Mississi]i])i river bot- 
toms. 



PUBLIC HEALTH ADII IXISTRATIOX Ibi 

Pdi/iiK-iif for Field ^Yorl^ Still Undecided. 

But the State's machinery for getting sanitary work clone was liap- 
hazanl at best. jNIembers of the Board of Health as well as the executive 
and clerical staff were heavily burdened with licensing doctors, midwives, 
pharmacists, etc. Then there were vital statistics to be collected and com- 
piled. Epidemics more often invaded than threatened the State. Everyl>ody 
agreed to the need of expert medical and sanitary services wherever infec- 
tious diseases became epidemic but nobody agreed upon who should pay for 
such services. A law required counties to pay for medical services in in- 
stances where the patients were unable to do so even though not classed 
as paupers. Another law appropriated money to the Board of Health for 
use in such emergencies. Who finally paid seemed to be a decision arrived 
at largely by skill in "buck passing". In December of 1898, for instance, 
a smallpox panic at Griggsville caused the secretary of the State Board of 
Health to employ Dr. Isaac D. Rawlings for duty in that area and Doctor 
Rawlings reported great difficulty in collecting his compensation and that 
of nurses employed in the emergency from the county commissioners. At 
another time a group of nurses employed a lawyer who appeared before the 
State Board of Health in October 189!) and jiresented a claim for pay for 
services rendered to smallpox patients in St. Clair County. In this case 
the Board paid the bill. Again the minutes of the Board at its January, 1!HI0 
meeting show that it paid claims aggregating $210 for work done in con- 
nection with smallpox quarantine in East St. Louis but refused to pay a 
supplemental claim of $159.50 for expenses incurred in the same procedure. 
This indicates that the public health machinery of the State was still so 
chaotic that nobody had a clear conception of whose duty it was to per- 
form the sanitary work necessary to suppress disease and a still more con- 
fused notion about who should pay for it once the work had been done. 

Miscellajt eons A cfi vities. 

This confusion expressed itself in other ways. The State Board of 
Health had power to make rules and regulations. So did cities and villages. 
The one should not conflict with the other but in the face of alarming 
outbreaks when State help was not forthcoming the local people took mat- 
ters in their own hand. Thus "pest houses" and "shot gun" quarantine 
came into vogue, especially where smallpox appeared and that disease seemed 
to pursue health officers in those days like an evil spirit. 

An insatiable reader, Dr. Egan knew what was going on in the held 
of sanitation and he began to transform his information into plans as soon 
as he found himself in a position to be heard. 



SECRETARIES 

lllnois State Board a^ Health. 




Amos Sawyer acted as secretary for fourteen months piior to the 
appointment of Dr. Drake. 



PUBLIC iii:ai.ti[ aomixistkation lfi3 

At the quarterly meeting ^)i the State Board of Health in October, 
1S98, Dr. Egan presented a report concerning a recently established state 
tuberculosis sanitarium in Massachusetts. It was so favorably received that 
the Board instructed Dr. Egan to take n]) with the next legislature the mat- 
ter of constructing such an institution in Illinois. The 1S!)!I (ieneral .\s- 
semlily declineil to provide for the construction of a sanitarium but it did 
l)ass a jnint resolution directing the State Board of Ilealth to inxestigate 
the matter and report back to the Governor for that body. This indicated 
an awakening interest in sanitary matters. The leaven was at work. 

In June, 1899 Dr. Egan arranged to spend $4,000 for making stream 
pollution investigations. His ]ilan was to establish ■,'() observation stations 
along the Illinois River, hire an engineer to kri']i tluni functioning and pay 
for laboratory tests on the volume plan. This scheme was carried out, add- 
ing considerable volume to the State's health niacbiner)-. This piece of work, 
it may be observed, ultimately had an imj)ortant bi'aring on the outcome of 
litigation between Illinois and .Missouri over the (piestinn of stream pollu- 
tion and very probably was undertaken with that end in view. 

Tuberculous cattle offered a lield for expansion and Dr. Egan consid- 
ered taking upon the State ISoard of Ilealth the tuberculin testing of herds. 
He asked the opinion of the .\ltorney (ieneral in IS!)'.), whether the Board 
had power to so do and received a favorable leplw rmbablv the reasnii he 
did not go into that work was lack of funds so he cnntented himself with 
agitating legislation on the suliject. 

The work of tuberculin testing herds started in .Ma\-. 1S!I9 by the State 
Board of Live Stcick Commissioni'rs and has since been continued under 
that agency which later lost its identity, becoiuing a part of the State De- 
partment of .\grieulture created under the Civil Administrative Code in 
1917. 

The operation of the State's health machinery was simplified some and 

the power centering in the secretary of the Huard considerably iticreased 

on January 17. IS'.)!) when tin- State Board nf Ilealth passed a resolution 

which reads : 

'■Ri'nohwd, That the Secretary of the Board, Dr. James A. Egan, is liereny 
appointed executive officer of the Board and is empowered to act for and in the 
name of the Board when the same is not in session." 

A similar resolution was ])assed the next year but was made unneces- 
sary later by an amendment to the law in 11(01 ])ermanentl\- jmixiding the 
same thing. 

This largely oln-iated the necessity of called n)eeliiig> and .it the same 
time gave the secretary a free hand to exercise his faculties. Health machin- 
ery in the .^tate is drifting toward ( ne man control. 



IG-t PUBLIC HEALTH A1)M*I N LSTKATION 

L']) to this time, about ]!)00. nearly all requests and complaints reach- 
ing the State Board of Health had concerned the practice of medicine. Such 
expressions as : 

"Three petitions, signed by fifty pliysiciaus, asking for an investigation 
of tlie unprofessional conduct, etc." and 

"Charges of unprofessional conduct have been received by the Board against 
nearly 100, etc." 

appi-ar in the early annual reports but lew references are made to petition-' 
begging for investigations of outbreaks and endemic iirevalence of diseases 
and of insanitary conditions. 

beginning in the nineties the Board is called upon more and more fre- 
quently tur help in sanitary matters. By 1899 every meeting of the State 
I'nard iif lleallli brings questions about water supplies, milk, stream pollu- 
tion, nuisances, infectious diseases. The deplorable sanitary conditions in 
penal and charitable institutions of the State are aired in the press. A com- 
mittee of the Board investigates and reports. Floods at various places in the 
Stale at jieriodic intervals bring requests for sanitary investigations espe- 
ci;dly of water supplies. The public conscience is beginning to awaken. 
I'dsiibilities of preventive medicine are j)laving upon the popular imagina- 
tion. I'he time for exiianding is opportune. 

Ltiihlhifi lliiii.sr Iiispcclioii. 

A law making certain sanitary regulations concerning lodging houses 
in cities of 11(0,000 or more, which confined it to Chicago, was passed by 
the legisl.itnre in 1S99 and placed under the State Board of Health for en- 
forcement. The liill carried an emergency clause so that it became operative 
upon a])]ircival on April '^1, IcSliH. No funds were appropriated for carry- 
ing out the provi>iuns which enumerated minimum air space, maximum ca- 
paiily, elc, for sleeping rooms. The enforcement of this would necessarily 
require ihe constant ser\-ices of a considerable staff" of inspectors. Work 
was started in a small waw hdwexer. when Homer C. Fancher and Al. M. 
Jonas Wert' appointed as chief inspecldr and a^sistanl, respectively, on July 
I"). IS'.l!!. their ]ia\- tu lie dr;i\\n \vn\\\ ihr conlingenc\- fund. It was stipu- 
lated ibal iheir services sh(inl<l teiniinaic on (_)ct(iber l-'iih of the same year. 
.\ri angenunts were made at thai lime to continue ihe wurk. 

b'ancber died during the aulumn of ISIi'.l and b'-dward J. Smejkal took 
bis place as chief bidging JKiu^e inspector. Aljciut ibis time Smejkal also 
bec.inu' .atlorney \i>v llie Stale Board of llealth. lie was. iberefore, brought 
inlii iiilim;ite conlacl wilh the njieratidn nf the llu.iril. .\s chief lodging 
hnn>e inspi'ctoi- be experienced the ini;i\iiidab]e dilVicultx' of getting pay 
prom])tly fur lii-^ own servici'> .ind \\ui^v ni hi; slaff. This was because 
no funds had been speciliealh pvuxided fur that pmjiose and each claim 



PUBLIC HEALTH ADMINISTRATION 



165 



for pay had to be passed on by the Board and sometimes by the Governor 
when contingent money was used. Delays of from three to six months were 
common. 

By C)clol)er of lUiiO a staff of 10 inspectors were emi:iio_\ed in Icnlging 
house work and this increased the ]kiv difficuhies. Under these circum- 
stances Smejkal managed to lend material aid in securing for lodging house 



ORGAFilZATIOn OF 

STATE BOARD OF MEALTM 

!90l 




STATE BOARD OF HEALTH 

7 Nembera 

Members porticipolina in 
the enforcement of riedical 
Pracfice Act with oid of extra 
V help 


1 












Chief clerk 
Z clerks 




1 executive Secretary 




todqinq House 
Inspection Service 

1 Chief Inspector 
3 Reqular Inspectors 
1-20 Temporary Inspectors 









Fig. fi. Effective streiiKtli at tlie end of twenty-five years of existence. 



inspection an appropriation of $J"^,.")00 per year from the tieneral Assembly 
in 1901. 

The next year Smejkal was elected to the General Assembly and .soon 
became an influencial member of that body. This established an important 
connection between the State Board of Health and the appro]iriating body 
which doulitless had considerable significance over subse(juent events. 



KKl ITr.I.ll- III'.AI/Ill ADM INISIKATION 

Colli III uiiicdhli' Disidsi' (' II rail re Measures. 

In his annual rcpurt lo the (lovcnior for the year of I'.IOO Dr. h's^aii 
reconnuended virlnallv ihv same lei^ishitive pri)L;rani that was outlined two 
years hefore, addinj; the item of a state luliercul(]si> sanilariuni. 

This time the outeome was more favorable. The a]]i)i'oprialiiin junijied 
ficim -^H.'-^Ml to $•.'",'. "il 10 per annum for routine ex|iendilures while the con- 
tingencN tyrant increased fmm ^ri.iilio to .$1().(I0|) per year. These funds l)e- 
canie availahle on lul\- 1. I'.Kll, shortly after the adji urnment of the (ieneral 
Asseml)ly. 

Of the $■.'■.'. :>tMI a sum of $l-.',:)iiO had l)een set aside in the law for 
lodging hoii.'r'e inspection. This left hut ^lO.dOii f(ir genei'al work. ( )n the 
other hand there was the $10,000 conlin.gency. This justified a plan, at least. 
for liuildiniL; u]i the health machinery. 

In July 1!M)1, Dr. I{gan reported to I'ae Board at its regular (piarterly 

meeting that ; 

"Despite the faet tliat there is no available appropriation availaljle for 
laboratory purposes, the necessity for a bacteriolosic laboratory for the prompt 
diagnosis of tuberculosis, diphtheria and typhoid fever has become so ui-gent that 
the Secretary has diverted sufficient funds from the appropriations for investiga- 
tion of contagious diseases, to equip a laboratory which is now in operation. Suit- 
able quarters could not be obtained in the Capitol Building and offices were con- 
sequently taken in the Odd Fellows Building, in Springfield, the best equipped 
building in the city and convenient to the offices of the Springfield physicians. 
A limited but adequate equipment has been installed and the Board is now mak- 
ing diagnostic examinations of specimens for the physicians of the state witliout 
cost to them." 

This is e\idence that plans were maii-rializing. .\lioul this time a plan 
for s\stcniatic ^ervice in connection with epidemic outl)i-eaks was also 
evolved. A corps of physicians, located in \arioUs convenient jila.ces through- 
out the .State, was selected. Arrangements were made to call ui)on anyone 
of them at anv time when necessity ref[uired. Remuneration was on a per 
diem hasis. .Money cotild legally he drawn fi'om the contingency fund to 
defray such expjn.cs. The annu.il financial statements of the Board indi- 
cate thru this was done. The system \yas sonn \\ h;it like the reserve scheme 
in the national military organization. 

No workahle system for securing jirom])! and complete rejiorts of com- 
nuinicahle disease incidence had been evolved hy the State Board of Health 
in UK)-.'. During .\ti,gnst of that year when ( hicago found itself in the 
ihri es of a >e\ere txphoid fever (Uithreak, the cil\' health comnussioner. Dr. 
.Arthur R. RcAUoUls, re(ittested from the secretar\- of the Stale P>oard of 
Jleallh, Dr. JCgan. information concerning tlu' down stale prevalence of the 
disease. Dr. ICgan dispatched telegrams to health otTicers in :!."i towns to 
get the desired information. The rules of the I'.oard still rei|uired nofih- 
cation of diseases luu the ni;ichiner\- w ;is loo feeble to enforce it. 



PUBLIC HEALTH ADMINISTRATIOX 167 

Progress Made 

But with all of its inadequacy the health niacliinery was Ijeginning 
to impress itself upon puhlic men who were ni a ])usition to help it grow. 
The plan which worked best seemed to lie that (if starting something and 
then initting the matter uii lu the legislature for support. Thus the lodging 
house in^])ection work began. Now a diagnostic laboratory had begun. 
A chemist and a sanitary engineer had been employed sporadically and 
their investigations in stream pollution promised to be valuable in pending 
litigation between Illmois and Missouri. .\ enr[)s of physicians known as 
sanitary inspectors were organized ready fur duty when called upon. The 
machmery was there and it was too valuable to be without. How the po- 
litical leaders felt about the situation in \SWi is expressed in a speech by 
Governor Yates, delivered at Anna on ( )ctober Mth. Amung other things 
he said : 

"The sanitary work done by the Board must interest every citizen ot the 
state. The Board now has, as tor two years past, a corps of competent medical 
inspectors distributed throughout the state, prepared to investigate promptly all 
epidemics and all reports of any undue prevalence of disease. During the pas't 
four years the Board has had to contend with three epidemics of smallpox. 
Although, until the last year, handicapped by an inadequate appropriation — only 
$5,000 annually having been appropriated tor this purpose, against $25,000 annually 
in the neighboring states of Indiana and Wisconsin — the Board has accomplished 
results of the greatest benefit and importance. Through its efforts, acting with 
the local authorities, the epidemic of smallpox has been kept well under control 
during the past year, notwithstanding the fact that the disease had reached an 
epidemic form in adjoining states. Smallpox is now widely prevalent through- 
out the Union, but there are comparatively few cases in the State of Illinois. 

"Particular attention must be called to the sanitary investigations made by 
this board during the past three years, ot the waters of the Illinois River and its 
tributaries, with special reference to the effect of the sewage of Chicago. Most 
exhaustive and elaborate tests and analyses of the waters have been made and 
the results, up to the summer of 1901. published in two comprehensive and com- 
plete reports. A report of the investigations made during the past year will be 
published within a month. Those disinterested and independent reports of a 
thorough chemic and bacteriologic analysis of water, the condition of which has 
excited so much controversy, have received unusual attention at home and abroad 
owing to the fact that they contain testimony ot an unimpeachable character, 
given by a body which has but one object in view, namely, the truth. This testi- 
mony is of inestimable value, not only to the people of Chicago, but also to the 
people of the entire state. It demonstrates that the Illinois River, into which 
four-fifths of the sewage of Chicago is now turned, purifies Itself through natural 
causes; that the influence of Chicago's sewage ceases long before the Mississippi 
is reached and that, notwithstanding the enormous pollution 800 miles above, the 
Illinois River at its junction with the Mississippi is in better sanitary condition 
than the Mississippi at that point. 

"This is the most important work ever accomplished by the State Board of 
Health. Not only has the Board demonstrated to scientists the self-purification 
of running streams and thus vindicated the wisdom of the people of Chicago in 
undertaking one of the greatest engineering projects of the century, but also, 
to use the language ot a leading Chicago daily newspaper, 'has furnished the 
most conclusive testimony in favor of the contention of Illinois in the suit brought 
by the State of Missouri in the Supreme Court of the United States, that has ever 
been presented.' Through the expenditure of a few thousand dollars in scientific 
research, the State Board of Health has saved the tax-payers of Illinois very 



KiS l'i;i!l,lr IN'.ALTII ADM IXISTkATlOX 

many thousands of dollars and lias prevented years of litlKation. Tlii" r(>ports 
made by the State Board of Health on the effect of the drainage canal, the only 
published reports on the subject extant, will undoubtedly be accepted by the 
Supreme Court of the United States as trustworthy and conclusive testimony 
that there is little or no contamination in the water supply of St. Louis which 
can be attributed to the sewage which passes through the Chicago Drainage 
Canal." 

This show.s that the liailrrs were hci^iniiiiiij tu apjirccirilc sanitary de- 
velopments hut science iiad lra\ele(l too fast for the puhhc at large. Bac- 
teriology had been horn during the preceding fifty years but it had grown 
tremendously and es[iev-ially toward the close of the nineteenth century. The 
causative, organisms of tuberculosis, typhoid fever, diphtheria, malaria, dy- 
sentery, tetanus and other diseases had been isolated and described ])rior 
to 1900. Diphtheria antitoxin had been made available. Typhoid vaccine 
could he purchased. The means by which yellow fever, malaria, typhoid 
fever, diphtheria and a luimber of other infectious diseases sj)iead had Ijeen 
clarified. Laboratory diagnosis of diphtheria, typhoid fever, tul)erculosis 
and other diseases had been perfected. Great things in the control and pre- 
vention of diseases were possible. The practical application of knowdedge 
at hand was the only necessar\' rei|uirenient. This depended upon jiublic 
appreci.-.tion and su])])ort. 

The pul)lic still clung to its traditional idea about disease, however, and 
indulged its consummate fear about some, such as smallpox, but calmly tnjer- 
ated others as a necessary evil. Those who heard about the new scientific 
procedures were still skeptical. Otherwise funds for interpreting the scien- 
tific discoveries into practical terms and for a])plying ])reventive measures 
would have flown more ([uicklv and more freel\- from the aijpropriating 
agencies. 

The (ieneral Asseiubly in ]'.)():] raised the appropriation for State health 
work ■''I,:; 10 above lliat of 1!H11 but the items specified were still general 
exce])l for lodging bouse inspection and clerical work. It is probable that 
the health officials had no very definite ])lan of organization and the mem- 
bers of the General Assembly had still less, fn the year of I'.HK) uvw items 
find their wav into the ajiprojiriations law. Assistant secretary, laboratory, 
registrar of vital statistics, bacteriologist were terms that appeared then 
fill' the lirst time. The total vearly sums granted, exclusive of contingency 
which remains at $1(1,0(1(1 have risen from Sp26,8f)0 to $:i2,860. The plan 
of giving birth to an idea, mu"sing it a'ong as an infant function and then 
turning it over to tlu' ( ieneral .\sstm1)ly who had to accejit the respoiasibility 
of feeding it or allowing it to ]>t'rish is working well. An assistant director 
had been employed in 10(1 1. During the same \ear the registrar of vital 
statistics had been jilaced in eh.irge of the bacteriological laboratory. The 
expansion program is picking up moiueiUuni. 



PUBLIC HEALTH ADMINISTRATION 169 

Aiititoxiii Distributed and Pasteur Treatiuents. 

Beside the enlargement of ai)])ropriation tn the State Bciard of Heakh 
for sanitary purposes the VMKi ( ieneral .Vssembly passed two other ini]wjrtant 
laws which enlarged the health machinery considerably. One made it the 
duty <if the State Board of Health in ai)puini one or more agents in every 
ciiunt\- who were required to keep on hanil at all limes a supply of diphtheria 
antiloxin, certified to by the State Board of Health. This law further pro- 
\-ided that the price charged for antitoxin should be reasonable and that 
the i)0(ir could have it at the exjjense of counties. The State Board of 
Health ihus found itself in a iiosilion to exercise considerable influence 
in the choice of agents throughnut the State and over manufacturers nt 
biological products. 

The other law appropriated $2. 000 fur ihe I'asteur treatment of poor 
people bitten by rabid animals. Supervision over the expenditure of this 
sum, which was lo be handled through hospitals, was given to the State 
Board of Health. This was another public recognition of a feature of ])re- 
ventive medicine. 

The antiloxin agents were dul)- appointed in IIHK! but this arrange- 
ment did not satisfy the health authorities. Before a meeting in Springfield 
on October 18, 1906, of the State Board of Charities, at which (iovernor 
Deiieen was piesent. Dr. deorgr W. Webster, president of the State Board 
of Health, advocated the manufacture .and free distribution of diphtheria 
antitoxin bv the State. Xew ^'ork and Massachusetts had already begun 
that practice. Difficulty over the clause in the I'.H).') law wdiich required 
counties to pay for antitoxin issued to poor pemile had already developed, 
the idea that the State was to pay, having prevailed generally. Thus in his 
annual report to the Governor for the year of 1906 Dr. Egan strongly recom- 
mended the free distribution of dijihtheria antiloxin. This led in ll^'T lo 
an appro])rialion of -$15,(1(10 per annum for ih;it imrpose and ihereb\- es- 
tiblislied a new and important jiiece of pulilic health machinery. The law 
(lid not ])ro\ide for the manufacture of antiloxin but for its purchase. I his 
prcvi'inn has cnnlinued from year to vear .■md ])revails to this day. 

MiHitli!// HuIIi till PilhlisliriJ. 

.\ni)llu'r im]i(jrlant function lh.it started in I'.MIi; was the publication of 
a monthly bulletin by the State Boanl nf 1 le.illh. The advantage of such 
an educational medium had been apiireci.aied fur nian\- year^ and attempts 
h;i<l ]ir(viouslv been made to start ii but ihev had pro\-en lemporarv until 
nciw. l'"r(im this time on some sort of m(inihl\' publication was ])rinteii .-md 
distributed with more or less regularity, it was distributed chiefly to phy- 
sicians and health officers. 



1T0 rrr.i.ic iikaltii aiimimstkatiox 

I) lilies of Board Extended. 

Like Dr. Rauch, Dr. Egan realized the ini])()rtaiice of safe water sup- 
plies and always found means to keep this subject ])rominent among activi- 
ties undertaken. If he was unable to employ the technically trained per- 
sonnel from the reg^ilar appropriation he managed to get hold of contingency 
money for that purpose. While the funds for ordinary expenses lasted 
he would draw upon them, calculating that the contingency pur.se string would 
be loosened for any necessary expenses involved in emergency epidemics. 
Later the State Water Survey of the University of Illinois offered an op- 
portunity to get sanitary engineering work done and in 1906, an agreement 
was perfecteil. whereby the Slate P>nard could call upon the Water Survey 
Bureau of the L'niversity, to make investigations of water supply and 
sewerage systems as reque^te<l. Whatever the difficulties, the fact remains 
that Dr. Egan managed to keep this matter of safe water supplies and 
sewage disposal before the public. The litigation l)etween Illinois and Mis- 
souri had ended favorablv to Illinois in that year. The State Board of 
Ilc.ihh hail engineiMed and paid for the stream piilhition investigations 
which had been an imimrlant factor in the court decision and had received 
ample credit for that work. This added considerable prestige to the Board 
of Health as a sanitary agency, l-'roni this time on until it established a 
peimanent sanitary engineering service of its own the Water Survey was 
largely depended ujjon to do that sort of work. 

Again the appropriation for the State Board of Health went up at the 
hand of the General Assembly in IDUT, the chief item of increase being 
•$15,000 per year for the free distri1)ution of diphtheria antitoxin. But this 
was not the most important extension of public health machinerv in that 
year. A law ameinling the original .^tate ISoard of Health .\ct was passed. 
It specified that the State Uoard of Health had supreme authority over 
quarantine matters in the State. It ma<U' it the dut\- of the State Board 
of I-Ieallh to investigate the cause of dangerourlv contagious or infectious 
diseases. It ga\e the Board power to make such rules and regulations as 
the Biard deemed advisable and rei|uired local health and other officials 
to enforce the rules. bTirtbernioie. it gave the exi'cutive officer of the State 
B(jard of llealtii ]iower t(i take charge of the situation w liere\-er local health 
officials lefn-ed or neglected to take proper steps in coinbaling an epidemic 
and to colk'ci from the local coniniuiiit\- wliatex'cr expenses were involved in 
li.nidling the situation. Tbi-, same law g:i\e the l>oard of Health specific 
anlboriiy to e-tablisb and maintain a cluniical :iuil ])acteriological lalioratory. 

'flii'- l.iw' clarilied matters cnn>ider;dil\ .ami establis'ied the State 
Hoard iif llealtb \ery definitely as the supreme lieallli organization in 
tin- State, kroni this time forth no rule, rculatiun or acti\it\- of local 



PUBLIC HEALTH An^^ I N ISTRATION 171 

health nfficials relating' to sanitation and quarantine couKl legalh' he in 
eontliet with those of the State lioard of I k-allh. To lieconie a powerful 
anil adequate at;ency for comhating- diseases in the State the Boar<l now 
needed nnl\- the necessary funds with which {o build up an or,a;anizatioii. 
'Jdie total annual appropriation in l!Mi: was $:i!),SOO. Of this $i:),OnO 
were for lodging house inspection in Chicago and another $l."i,()(M) for 
the distribution of diphtheria antitoxin. This left but •$•<!;), 800 for other 
actixities and $10. noil of that had the "contingency" string tied to it. 
\\ hen analyzed it is found, then, that less than $10,000 a year were 
easily a\ailahle for field ser\ ice of .a really scientific nature and one-half 
of that was made u]> of the salaries of tlu' secretar}- and assistant. 

This same condition |ire\ailed in \'J\:) when Dr. Egan died while 
still the executive secretary of the State Hoard of Health. The biennial 
appropriation to the l.ioard in that year anKunited to $5 t;).;M9."^"). Hut 
this enormous sum. compared with the $"28,(iOO for the bienninm when 
Dr. Egan came into office, did not change the complexion of the State's 
machinerx' inr doing sanitary and hygienic work as much as might be 
expected. Potential resources were axailablc but tlie organization of 
these resources was poor. A diagnostic ]al)orali ir\-, the lodging house 
ins])ection ser\ice in Chicago, the distribution nf antituxin and the \ital 
statistics service were the only units in the State's public health inachin- 
erv, except that in\-ol\-ed in the regulation of the practice of medicine, 
which functioned systematically as a routine business in lilb!. .V cor])s 
(if plnsicians located at convenient ])oints in the State who accepted 
temporary dut\- when called u]ion were depended upon for field ser\ice 
in connecti(in with epidemic outbreaks. There was no machinerv opera- 
ti\e for c(illecting reports of communicable diseases. The Water Sur- 
\ey at the l/niversity of Illin.ois was <lepended u|)on for lield and labora- 
tory wcuk Concerning water and sewer systems. 

Ciiiijxrdl inn With Other Aficiicws. 

W bile manifesting primary interest in the expansion ()f the State's 
orticial ]inl)lic health ser\ice. Dr. Ivgan did nut neglect outside agencies 
of inli.'rstate and national character mir did he o\erlook the im])ortance 
of local health machinery in his own St.ite. lie preserved fa\drable 
contai't with the .\merican I'ublic 1 U'.ilth Association and with the 
organi/.atiou which is now called the I'onference of .^tate and I'rii\incial 
Health .\uthi irities. lie also maintaimd cout.act with cither \dluntar\- 
interstate organization which had cciuie intu beim; but for the miist part 
died liUt after some specific ])r(ibleni h.id been MiKeil. That was the 
experience (if the Sanitary C'liuncil of the Mississippi X'allc}', long time 
defunct, and of the Conference of Western lioards of Health. These 



1T2 PUIll.U' IIICALTII ADMI.NISTUATIOX 

ag'encit's j,'a\c way to better organized and better supported national move- 
ments. 

In liH)'. tbe Congress of the United States created the U. S. I'ublic 
lleailh and Marine llospital Service. This had a direct influence over 
the State health machinery in two ways. It provided an inspection 
service of immigrants at ports of entry into the coinitry and it was made 
a part of its duties to call at least annnall}- a conference of state and ter- 
ritorial health officers to meet with the Surgeon (ieneral. This latter 
jiroxided a splendid means for the interchange of ideas, the dissemina- 
tion of information concerning new discoveries and procedures, uni- 
formit}- of practice throughout the country and harmonious cooperation. 
State health officers took advantage of this new piece of national health 
machinery when thc\ initiated a meetiu'^" called l)y the Surgeon General 
in Washington on January I!), I!i0-'l, to consider jiroblems brought before 
the c<iuntr3- because of an outbreak of plague in Mexico and San Fran- 
cisco. Dr. ]""gan ])articipated in this conference and subsequent ones. 
He maintained close contact with this new federal agency, frequently 
calling iq>on the Surgeon ( iencral for ad\ice and assistance, especially 
in regard to \ello\v fe\'er outbreaks. 

Lucal Boards in liural Disfricfs. 

Largel\' tlirough Dr. F,gan's efirorts there came into existence a law 
in 191)1, which was amended in 1i)0.'!, that created local boards of health 
in the rural districts throughout the State. In township organization 
the superx isor, assessor and tnwn clerk of e\er\- town was made a local 
lioard (if health to functiim outside incoriiorated \illages and cities. 
The County connnissioners in other counties constituted the board of 
health. This provided a definite local authority through which tlie State 
Board of Health could function. It remains to this day the macliinery 
through wdiicli the State healtli officials work in rural areas. 

Dr. Egan tried hard to get a law making it compulsorv on cities and 
villages to appoint boards of health and also to get a state tuberculosis 
sanitarium but failed in both. A large number of sanitary and hvgienic 
regulations in which Dr. Egan was interested and for which he worked 
was written into law. These related to stream pollution, free distribu- 
tion of biologies, \ital statistics, pure food, dair_\ ].iroducts, common 
drinking cups, etc. There was a law passed in UJOS which enaliled cities 
to establish public tuberculosis sanitaria. 

h'rsionc. 

Dr. l\gan found the State Board of Health jtretty well organized to 
enforce the ^ledicil Practice Act and he left it so. This work increased 



PUBLIC HEALTH ADMINISTRATION 173 

enormously during his time but so did the resources. Fees collected 
for licenses could be used by the Board for expenses involved in re!:;'u- 
lating medical practice. These fees amotnited to $10,000 or more per year. 
The work was performed largely by the Board members themselves with 
the necessary clerical and legal assistance. When Dr. Egan began, an attor- 
ney was chosen and paid for in accordance with the amount of work done. 
When he left there was provision in the appropriation law for hiring an 
attorney and a law clerk. 

W'hen Dr. Egan first took office there was no trained corps of sani- 
tarians steadily employed to promote preventive measures against dis- 
ease. At the end of his incumbency the same condition prevailed. 
There was this difference — Dr. Egan had a little larger ajjpropriation for 
that sort of work and he had learned how to get hold of the contingency 
fund on the one hand. (_)n the other hand he had designated a certain 
number of physicians throughout the State and upon whom he could call at 
will for temporary duty. 

When Dr. Egan came into State health service there was practicall}- 
no work being done on vital statistics. .At the end of his time there was 
a state registrar of \-ital statistics and clerical assistants. The law had 
been changed several times, apparently from bad to worse, and was 
still unsatisfactory. But a considerable volume of records were secured 
and they were compiled and preserved in good shape for each }ear after 
1902 until 191 ;;. 

At tlie beginning of Dr. Egan's term the practice was to emiiloy 
sanitar}' engineers antl chemists when studies of water supplies, sewer 
systems, etc., were desired. At the end of his time the University of 
Illinois had established a sort of bureau called the State Water Survey 
and arrangements were made for that agency to do the santiarv engin- 
eering work of the Board. 

No quarantine officers were steadily employed when Dr. h^gan 
began and none were so employed when he quit. 

During his time a lodging house inspection service, confined to 
Chicago, began to function and an embryonic diagnostic laboratory 
was established. 

A .system of agents through whi}m diphtheri.i antitoxin \\a^ dis- 
tributed free throughout the State was estalilished. .\ nioulhh bulletin 
devoted to sanitation, hygiene and the practice of medicine was pub- 
lished with consiclerable regularity. 

This was the machinery which the ."^tate h.'.d built up b\- 1!)!.'! for 
the |.)rimar_\- purpose of combating disease. It had exp.anded enormous- 
1\- since 19. m. It was busv all of the time. Its mone\ resoiu'ces had in- 



174 rULil.U' illCALTIl ADMINISTRATION' 

creased over 700 jjct cent Init it was ])i)(iiiy urtiani/cfl. It was withmit 
form ])ut certainlN' imt \iiiil. 'I'lic iimst iiii]i()itaiit cniuiihutinn nf the 
F.gan reijiinc to |)iil)lic lu-altli st-rvice in the State was tlie enlti\ ation 
(if tlu- lialiit aninnt; k\i;"islat(irs to i^ranl nKJuey fur tliat ])nr|Mise. 

TtiE Drakk Rkciimk. 

After a lapse of a little nmre than a year fnmi the time when Dr. 
l'".gan (lied in March, lUl;!, dniinL; which period -Mr. AnidS Saw'_\er, chief 
clerk of the Board for many years, acted as secretary, Dr. C. St. Clair 
Drake of ChicaLji) was appointed hy (loxernor Dunne to take <.)\er the 
executive w ( irk nf the Stale Fxiard of llealth. Dr. I3rake was appointed 
in Alay of lUl I aii(.l to(jk active charge mi the first of June. 

Several visits prior to that time had familiari/ed him with the situa- 
tion, h'evv sij^nihcant ch.anges liad taken place since Dr. h'-gan's death. 
The llnancing (if the l>(iard at that time was con<lncted (Hi the folldwiiig 
basis. Availalile nmney v\as drawn out (if the .^tate treasnrv. placed to 
the credit of the Hoard in a hical liank and drawn updii while it lasted 
fur whatever expenses were deenie(l necessary td incur. This jiractice 
had prevailed for IJ7 years. \\ hen the nidiiey apprnpri.ited fdr (irdinary 
expenses was g'one the Pxiard either stopped functinning in sanitarv" and 
hygienic services or else mana,v,ed to get luild nf cdntin,L;ency funds 
vvdiich were likewise drawn diit in lump sums and placed in the hank 
for expenditure as nccasidU demanded. 

E('or(/aiiiz(ilinii ami Hiiihict. 

\\'hen Dr. Drake arrived at the Ca])it(il in June he hrdught witli him 
a plan of organizatidii, the hrst ci imprehensiv c scheme that had ever 
been intr(i(luce(l. Dr. Drake had lieen witli the ( hicaL;d health depart- 
nient for many years. It was well organized, lie had ohserved the 
systems employed elsewhere. He ])atterne<l his own jilans of organiza- 
tion after that which prevailed in C hicagd, making" such inddilicatinns 
as the diriereiit circumst.iuces demanded. h'dlldwing this, there were 
bureaus under the .'-^tate I'mard df llealth each with s])ecihc duties and 
responsibilitii's and each alldlled a s|)ecihc sum of nidney. In short a 
budget system had been add]iled. 

Manifesilv the new scheme cmild (iper.atc as planned tn diily a lim- 
ited degree niitd recognized by the ( leneral .Assembly in the sha]ie of 
appropriations fur full time |i(.'rsdnnel. 'khis is exactly what happened 
within a \ ear after Dr. Drake took charge. In a law enacted in the 



PRESIDENTS 

ILlinois State Board of Hcaltk 




G(:oc^eW.Vcb5to,9It.D. 



J0lllt.#£rt 101)15011,1.0, 

/9/'t-i9ir 



lT(i I'll'.I.IC illCAl.TH ADMIXISTUATIOX 

spring' (if IIM."), makini; a|)|)r()])riali(nis for tlie State Board of Health. 

these per aiimiiu ilcnis are fouml : 

Executive office $1S,680 

Bui-eau of Medical Sanitary Inspection 16,300 

Bureau of Vital Statistics 5,500 

Laboratory (salaries) 2,640 . 

Laboratory ( supplies ) 9,684 

Laboratory ( Branch Laboratories ) 3,600 

Vaccines, Sera and Antitoxins 38.000 

Travel 21,750 

Lodging House Inspection 11,075 

Bureau of Sanitary Engineering 10.850 

Miscellaneous including extra help, per diem for Board mem- 
bers, rent, etc 23,860 

Contingency 4,650 

Total $166,589 

All this was something distinctly new in Illinois health service. It 
represented a sjilendid step toward systematic prosecution of sanitary and 
hygienic work. The most significant feature was the provision for full 
time employment of personnel and the allocation of funds for specific pur- 
poses. Under each bureau the per annum salaries for a definite number of 
positions were itemized. In the biux-au of medical and sanitai"y inspection, 
for instance, there were listed the salaries for four district health officers 
(this is the first ajjpearance of that term), one epidemiologist, three dairy 
inspectors — two j)art time — and four clerks and stenographers. The bureau 
of vital statistics had a registrar and a clerical statt of four provided for 
while the laboratory drew a bacteriologist and messenger with extra funds 
for equipment. For the bureau of sanitary engineering there were listed 
a chief and two assistant sanitary engineers, one stenographer and mis- 
cellaneous supplies. For the executive office there were itemized the secre- 
tary, an attorney, a clerical staff of 10 and a messenger. This force was 
subject to duty involved in both branches of the Board's activities — those 
concerning licensure and those concerning sanitation. 

Eilucdf iininl I'rdjxif/diiila. 

Splendid as was the step toward organization and system. Dr. Drake's 
best efforts were in another direction. He was at heart an educational jn'opa- 
gandist. The faculty for stimulating popular interest was his to an extra- 
ordinary degree. This faculty he put to work at once after coming into 
State health service. 

At the Illinois State Fair helii at .'^prin^lield in ilie autumn of ]!n4. 
a few brief months after his a])])ointment, Dr. Drake put an exhibit in the 
space which had been occupied by the State Board of Health in previous 
years but it was a new kind of exhibit. It attracted the public eye with 
sufficient force to provoke front page newspaper comment. The exhibition 



PUBLIC HEALTH ADMINISTRATION lii 

was built up around six mechanical models of ingenious design and was 
graphTc, impressive, fascinating. 

Another feature of the exhibit eiiuipnicnt was its mobility. It could be 
transported, installed and dismantled easily. Year after year it increased 
both in size and popularity and was displayed many times in alniDst every 
county of the State with the exception of the extreme southern ones. 

By January 1915 the monthly publication, which had been allowed 
to lapse after the death of Dr. Egan, was resumed under a new name, 
in a new stvle and for a new audience. What the jiurpose was and what 







ORGAniZATIOn OF 
STATE BOARD OF HEALTH 
1915 










STATE BOARD OF MEALTO 

7 riemters 

fnlorcrment S^rtST^Pr^ (« e 
^t ^th aid of crtro help 






EXECLTTiVE OFFCt 






























LABORATORY 




BUREAU OF 
VITAL 5TAT1SIK. 


5 


iUREAU or ncoiou. a 

SAHTAIW mSPECTOfT 




BUREAU OF 
3AniTARV EMGinttRinG 




LODGinG MOUSE 

nsPEcnon service 




Bocleriolocyst 


^^. 




|tnSirop»W' »yJ 





















Fig. 10. This was the effective strength during the two years terminating 
on June 30. 1917 when the State Board ot Health went out of existence. 



subsequently was the character of the new i)ul)licatioii that was named 
HEALTH NEWS are very well set forth on the title ])age of the first edition 
in these words : 

Health News is a continuation ot" the BULLETIN which, for several years, 
has appeared as the official organ of the Illinois State Board of Health. The 
change in title and the change in style foreshadow the new methods and new aims 
of the publication. The Bulletin sought to attain better health conditions through- 
out Illinois by the discussion of more or less technical subjects with the medical 
profession as its audience and. in addressing sucli an audience, the Bulletin very 
naturally contained many details of the activities of the Board and much material 
which would prove of interest only to physicians and persons of technical training. 



178 I'l'liLIC HEALTH ADM INI.STUATION 

Health Nt'ws, with tlie same general purpose, seeks a new and larger audi- 
ence. It hopes to bring the essential facts relative to "the promotion of health and 
the prevention of disease" to the men and women of Illinois; to reduce the tech- 
nical science of preventive medicine to terms of practical application for the 
individual and the community. 

Health News is merel.v a part of a definite campaign ot popular, public health 
education contemplated by the State Board of Health. This program includes, aside 
from this monthly publication, the use of a public health exhibit which is now 
being employed and which is creating much interest throughout the State. There 
is also being operated a bi-weekly press service through which short, readable 
public health articles are published in the newspapers of Illinois. The various 
pamphlets and circulars of the Board, devoted to the prevention ot the .several com- 
municable diseases, to the care of infants and kindred subjects, are being rewritten 
and made more acceptable to the public demand. The efforts of the individual com- 
munities to increase interest in public health affairs will be encouraged by public 
lectures by members of the State Board of Health and the office and field staff and. 
in many instances, these lectures will be illustrated by nujtion pictures and the 
stereopticon. 

The policies set forth in this expression characterized the whole Drake 
regime, lie followed it persistently and it popularized public health service 
in the Slate. 

By autumn of l'J15 Dr. Drake had struck upon another means of large 
potentialities for stimulating popular attention to sanitary and hygienic mat- 
ters. This was the well baby conference. At the State Fair in that year 
was conducted the hrsl baby conference in which the state government 
had ever participated. :\s a magnet for attracting public interest the baby 
conference was more than a match for the mobile exhibit. (3ne careful 
look at a mechanical model satisfied more or less permariently the curiosity. 
Interest in a baby is immortal. The idea of helping him to keep well is 
appealing. Looking through spacious glassed openings at phy.sicians and 
nurses busily engaged in examining babies is a sight of which the eyes never 
tire. The baby conference had come to stay and to grow. Soon it w-as a 
common feature of local fairs and other community events. Stafif members 
of the .':^tate Board of Health were called upon lo assist in this work. Thi- 
practice added a cotisiderable strength to the ln;iltli niachiiicry since it 
brought the idea of jireventive medicine directly to tlmttsiunl'- n\ mothers 
through personal contact. 

Alotion pictures and stcreoi)ticon slides were not overlooked as nieditmis 
through which to stinutlate public iiUerest in health matters. In llilii a few 
motion [licture films were purchased and a loan lilirary started, 'i'his grew 
in popiil.irit\' until now nearly lOll reels are maintained in the library and 
circulated widely. 

The popularity of the exhibits promoted liy 1 )r Dr.ikc xion led to 
exjjansion. Before be left the state health service in ID''! the sjiacc allotted 
to the heahh exhiliition ,it the State l'"air embraced more than I.OIH) square 
feet and in it was a motion picture theatre, specially constructed lialiy e.x- 
amination i[tt;irters atid a score of liootbs. The mobile exhibits had traveled 



PUBLIC HEALTH ADM I X ISTKATIOX 179 

throughout the State and had hccn faxoiably received. Around thcni and 
the exhibits supplied by the city licahh department of Chicago and other 
heahh agencies had Ijcen buih a nianinioth exhibition known as the Pageant 
of Progress which (h'ew humh-eils of thousands of visitors to the CoHseum 
where il was staged. 

.\ (jroject called "Health I'roniolion Week" was another nielhud in- 
itiated l)y Dr. Drake fcir cultivating public thought on preventive medicine. 
This idea materialized in a slate-wide program in the spring of l!)l!t. It 
was a new thing so the press of the .State gave il generoirs space. It was 
perfectly planned. The General Asseml)lv endorsed it with a joint resolution. 
The Governor certified that the movement ])leased him. Endorsements were 
secured from a score of the most powerful civic and professional organiza- 
tions in the S'.ate. A specific task for each dav was descriljcd in the pro- 
gram which terminated with the item "Pageant". The idea was new in 
the h.ahh iield •-•(> the ]iress contributed sjjace g^enerously. Traveling re]ire- 
sentatives visited practicallv all comnumiiies in the State effecting local 
organizations. 

The project was a tremendous success. Few if any other deliberate 
attempts to create juiblic thought on health matters at a given time ever 
achieved its jiurpose so completely. It led to a permanent annual e\'ent 
b)- the same name l)Ut somewhat difl'erent in character. Health Promotion 
Week has come to be a sort of instiiutidn in Illinois. It is an occasion 
looked forward to by health workers all o\er the .State as a time for starting 
new cam])aigns or for reporting to the public. It is a sort of revival project 
for liic d health workers. 

I III poi'taiit Il( (ilfli Lans Kiuutid. 

.\ number of iiuportant health laws were i>assed during the Drake 
regime. In PH.") a satisfactory vital statistics statute came into being, pro- 
viding for the first time the legal machinery necessary to the collection of 
reasonably complete returns id" birtli and death records. .\t the same 
meeting of the legislature a bill known as the ( .lackin Law, which author- 
ized counties to levy a tax and spend the re\emie therefrom for constructing 
and maintaining tuberculosis sanitaria was passed and signed bv the Gov- 
ernor. Still am ther law of 1!)].") provided for the establishment of 
health districts in one or more adjacent towns or road districts, making 
it possible to lev\- taxes and maintain modern local health organizations. 
Advantage of this law has lieen taken in (Juincv and Berwvn while a 
privately endowed health department serving PaSalle, r)ulesb\' and Peru 
exercises legal authority under it. 



ISO PUBLIC HEALTH ADM 1 X ISTUATION 

These three laws had a tremendous influence over the puhHc heaUh 
machinery of the State. This is especially true of the san-tarium law. It 
and the vital statistic statute are discussed in detail in another chapter. 
The district health law appeared to have come int(.) existence more as a 
nieaiLs of legalizing the LaSalle, Oglesby and Peru organization than any- 
thing else. It has never been regarded by State health officers as the best 
plan upon which to promote local health units. To make it apjily in more 
than one town or road district the proposition nuist carry by poj)ular vole 
in each. This makes it very difficult to work on a county basis and hence 
the county has I)een regarded by the Department as the most practical po- 
litical unit in which to develop full time modern health dejiartments for 
rural ^-ervice. The larger cities are legally able to take care of themselves 
in health matters. 

Neic Rules for Ilaudlhifi Coufagious Diseases. 

One of the very important things that Dr. Drake did early in I'.M") was 
to revise the rules and regulatior.s of the State Board of Health concerning 
communicable disea.se. Since the very early days of the Board's existence 
there had been rules re(|uiring the notification of certain epidemic diseases 
but these had been general on the one hand and there had existed no local 
machinery through which they could be enforced on the other. Dr. Drake 
codified the rules and made a s])eciric list (if re]iortal)le diseases. He speci- 
fied a time limit within which the diseases should be reported. He 
specified to whom they should be rejjorted locally — health officer, health 
commissioner, chairman of the board of health, mayor, village president, 
supervisor, county commissioner, etc., co^-ering every case. These officials. 
in turn, were required to forward the reports to the State F>oard of Health 
within specified time limits. 

The rules also covered matters of quarantine, specifying time limits for 
isolation of jiatients and thev sjiecilied sanitary and h\gienic ])recautions 
that were recjuired on (piarantined ]iremises. 

(iciiciiil I'liiii (iii'l I'crsdinii'l. 

it will In- ^een, then, that Dr. Drake |)r()])ose(l to bring sanitation 
and hygiene into ]iopulai fa\iir through educational channels and to 
appl_\' moilt-rn disease control methods as rigidly as public sentiment 
would ]iermit through an adecpiate organization. Prompt notification 
of comnnuiicable diseases was essential to the functioning' of the State 
organizatiiin >o lar as e]iidemic outbreaks was concerned, so he ])ro- 
vided for this continL;('ncy with bis new rules. He was andiitions to 
concentrate all State health work mider the Hoard of Health. This 
would include food, drnL;s, (lair\- inspectinn, tuberculin testing of cattle 



PUBLIC HEALTH ADM I XISTRATIO.V 1X1 

and stream pnllutinn Avhich were under \'ariiius boards and cunimis- 
sions. He was e\'en willing- that the retjuhitiiin of medical practice 
remain under the State ISoard ol" Health l)nt this he would have sep- 
arated intn a (lejiartment of its own, distinct from another department 
that would function only in the field nf what mi^ht be called iH-eventi\e 
medicine. 

As soon as the lUl.j approiiriation law became effective Dr. Drake 
set to work organizing the health service in com]iliance therewith. This 
was slow for several reasons. In the first place the personnel had to 
be employed under civil service regulations and that took time. Sec- 
ondly , it was difficult to locate suitablv trained persons to fill the tech- 
nical ])ositions at the salaries proxided. Furthermore there was lack 
of space in the capitol Ijuilding to house the new machinery. 

By early spring of litjii, however, tlie difficulties had l:)een largely 
o\erc(inie and there was in existence the lic.^t organized force that the 
State liad e\'er employed for dning straight ])ublic health wcirk. There 
were fi\e full time physicians in the bureau of sanitary and me(lical 
inspection each assigned to one nf h\t^ districts into wliich tlie State 
had been dixided for that ])iu'i)ose. In the same l)ureau there were milk 
inspectors and a clerical staff. There was a bureau of sanitar\- engineer- 
ing made up of a chief and two assistant engineers and a stenograjiher. 
A bureau of \ital statistics, headed by a registrar under wIkjui was a 
corj)s of clerks, was functioning and had already ])ut into operation the 
new law which required many new procedures. There was a central 
diagnostic lal)oratory. manned by a small staff, located in Springfield 
and two l)ranch laboratories, the latter being ojierated on a contract 
liasis with [irixate laboratories already in existence. The agency sys- 
tem for the distribution of biologies now made easily available to every 
(hictor in the .State diphtheria antitoxin, typhoid ^■accine, smallpox vac- 
cine, silver nitrate for the ])revention of blindness, mailing containers 
for laboratory specimens and circulars of information. In tlie central 
office there was a considerable clerical staff that (H\ided its time between 
duties relating to health service and to licensure. There was the educa- 
tional work of publishing a monthly bulletin and supplying copv to the 
press. .Ml this was a splendid organization compared with what had 
g'one before. 

In the meantime national diplomatic difficulties with Alexico had 
led to a military complication which resulted in the mobilization c;if the 
National tluard. This incident in\ol\ed the State Board of Health in 
camp sanitation activities and it is worthy of note that Governor Dunne 
twice dela}'ed mol)ilization orders upon the recommendation of Dr. 



182 PUBLIC IlKAI.TIl ADM I XISI RATION' 

Drake- because sanitary facilities were iiici unplete. I'liis was an expres- 
siiin nf ciinlidence in the State healtli autln irities. ['"urthernKire, the 
State I'xiard dl' lU'alth furnished sniaili)ox and tyi)hoid fc\er \-accine 
with which the trciups were iniuninized against those diseases. 

With the new \t-ar nf I'.ti; cauie the I.owden administration with its 
reorijauizaliiin plan that prn]Hised tn substitute a few departments, each 
headed b\ a (hrecinr, fur the manifnid hoards and commissions that con- 
stituted the Stale l;i ivernnieut and to put all governmental activities upon a 
budget system. Xuthing could have pleased Dr. Drake better, lie had an 
organization scheme already started. This (ippdrtunity allowed him tn elab- 
orate on it. Me presented to the administration a plan that would have 
retained the State Board of Health to reign over two great departments — 
the one tn dn ])ublic health service and the other to regulate the j^ractice of 
medicine. The administration clmse to drop the Bcjard, make two dejjart- 
ments to carry cm the wurk- and incnrpnrated the Drake ]ilan for health 
service into the C'i\il .\dniinistrati\e Lode as the l)e])artment nf I'ublic 
Health and which still gn\erns the nrganizatinn as it functi<ins today. 

SIdlf DrjKirtiiK'ut (if I'uhlic llcdifli Ornanizcd 

\\ hile piil)hcit\- was the wnrk in which Dr. Drake excelled his -suc- 
cess in that helil was nnt the most important event, so far as the pubhc 
health machinery was concerned, that transpired during his administration. 
The most signihcant single event was the adojition of the I.owden Civil 
Administrative Code by the State government in I!M,. This con\erted 
the State Board of Health into two departments, the one to devote itself 
henceforth io sanitary and hygienic work alone and the other to handle 
all matters relating to licensures not only of physicians but of all other 
])rofessions that required it. The State Department nf I\iblic Health was 
created by this division and it began to funclinn in the held of sanitation 
and hygiene with an appropriation of nearh- nne half million dollars for the 
hrst biennium, ;i sum far in excess of an\tbing that had ever been granted 
to the State Bn.ird nf Health. 

The adnptinn of the (_i\il .\dministrative Code divorced public health 
si'i vice anil the regidalinn nf medical practice. It established straight health 
wnrk as nne nl the major de])artments nf the State gn\ernment and bv 
lining so lirnught tn ;in end the secnnd period in the de\elnpnient of |)ulilic 
health machinery in Illinois. 

The new Stale I )ep,irlnunt of I'ublic Health which came into legal 
existence |ul\- 1, I'.M;, fell In ir to all the |)ul)lic health duties, powers and 
responsibilities that were fnrmerK vested in the Slate Pioard of I lealth and 
had new ones added. I'nder ihe old law Ihe res|)onsibility for policies, rules, 
regulations, etc., was in a boanl of seven members. Lndcr the new it was 




lOM 




Prank O. Lowden, Governor of Illinois, 
1917-1921, whose Civil Administrative Code 
brought an end to the State Board of Health 
and put in its place the State Department of 
Public Health. 



18-i ruiii.ic mcALTii administkatiox 

in one man, the dirc-ctur ul the department. The Code prnvides fur an ad- 
visory board Inil its f unctions, in a lesral sense, are literally what llii' name 

. . t ■ 

implies — advisory. All decisions must ultnnately be" made by the director 

and upon him rests all the responsibility of the department. 

The powers and duties of the State Department of Public ilealih under 
the Civil .Administrative Code are, briefly as follows: 

(h'licrdi I'hni (iiiil I'l rsoinicl . 

"I. Prescribed by the Civil Administrative Code. 

1. To have general supervision of the health and lives of the people. 

2. To advise relative to public water supplies, water purification works, 
sewerage systems and sewage treatment works. 

3. To exercise supervision over water and sewerage nuisances and to make 
rules concerning same. 

4. To conduct sanitary investigations for the improvement of public health. 

5. To investigate nuisances and questions affecting public health. 

G. To maintain chemical, bacteriological and biological laboratories and to 
conduct examinations of milk, water, sewage, wastes, etc. 

7. To diagnose diseases when necessary for public protection. 

S. To purchase and distribute, free of charge, diphtheria antitoxin, typhoid 
vaccine, smallpox vaccine and other preventive and curative agents. 

9. To collect and preserve useful information relative to public health. 

10. To investigate the causes of disease. 

11. To keep informed of the work of local health officers and to assist local 
health authorities in the administration of health laws. 

12. To inform the general public in matters of health. 

13. To enlist the cooperation of physicians and health agencies to improve 
the public health. 

14. To make inspections of the charitable, penal and reformatory institu- 
tions and normal schools and to inspect all hospitals and other public institutions 
and to report their needs to public authorities. 

15. To print, publish and distribute documents, bulletins, etc.. relative to 
public health. 

IC. To exercise the rights, powers and duties vested in the former State 
Board of Health. 

II. Powers under the State Board of Health Act. 

1. To declare, modify or relax quarantine. 

2. To prescribe rules and regulations for sanitation. 

3. To regulate the transportation of tlie dead. 

4. To investigate the cause of communicable diseases, especially during epi 
demies, and to take proper measures to suppress dangerously communicable dis- 
eases when local authorities fail to act promptly and efficiently. 

5. To prepare forms for the record of births, marriages auil, deaths. 

6. To inspect lodging houses, boarding houses, inns and hotels in cities of 
100,000 population or more. 

7. To prescribe rules and regulations concerning the distriljution and sale 
of antitoxin. 

III. Duties under the Vital Statistics Act. 

1. To keep records of births, stillbirths and deaths. 

2. To establish registration districts and to appoint local registrars. 

3. To prescribe the form of register or record to be kept by cemeteries and 
to proscribe all forms of reports for births, stillbirths and deaths. 

4. To supply local .registrars with blank forms and to issue instructions to 
secure uniform enforcement of the Act. 

5. To arrange and permanently preserve certificates of births, stillbirths 
and deaths. 

6. To luiblish annual reports of births and deaths. 



PUBLIC HEALTH AD.M I X ISTKATIOX 1 So 

7. To certify to county clerks tlie luimber of births, stillbirtlts. and deatlis 
registered in the county. 

S. To furnish certified copie.s of records of any births, stillbirths or deaths. 

IV. Duties under the Ophthalmia Neonatorum Act. 

1. To provide all obstetricians with a prophylactic for opthalmia neonatorum. 

2. To publish and distribute literature on the dangers from ophthalmia 
neonatorum. 

.3. To report violations of the Act to prosecuting attorneys. 

V. Duties under Miscellaneous Acts. 

1. The County and Township Board of Health Act authorizes the depart- 
ment to discharge the duties of local Boards of Health in case of failure or refusal 
to act in time of epidemic. 

2. The Sanitary Health Districts Act requires the department to conduct 
competitive examinations for health ofiicers. 

3. The Barbers' Act requires the department to approve sanitary rules for 
barber shops. 

4. The Lodging House Act requires the department to formulate sanitary 
rules for inns, hotels and lodging houses. 

5. The Occupational Diseases Act requires the department to furnish blanks 
for e.xaminations for vocational and occupational diseases and to transmit such 
reports to the Division of Factory Inspection. 

6. The Rabies Act requires the department to select institutions for I he 
treatment of poor persons suffering from rabies. 

7. An amendment to the Military and Naval Code authorizes the department 
to assume sanitary and health supervision over zones surrounding military camps, 
ranges or buildings used for military purposes." 

For the ptirposes enumerated the General Assembly granted the State 
] Jeparmient nf 1 'ublic Ile;dtli $ I l:i.'.' 1\^ with which In tunctinii durini; its 
first hicnniuni and the (nivernur a])puintc<l Dr. C. ."^t. Clair Drake as the hrst 
director. Dr. George Thomas Palmer was nia<le assistant director. 

Seven divisions were named in the I!H7 appropriation iaw with prox'ideil 

funds for each. The names of ihe (li\isiiins and the number and character 

of the persdunel jirovided for were as tnlluws: 

I. General Office. 
1 Director. 
1 Assistant Director, 
1 Chief Clerk. 

5 Clerks and Stenographers. 
1 Messenger. 

II. Communicable Diseases. 

1 Chief and Epidemiologist. M. D.. 

1 Supervisor of Field Service, 
r, District Health Officers. 

2 Public Health Nurses. 

2 Quarantine Officers, 

i) Clerks and Steno.graphers. 

III. Tuberculosis. 
1 Chief. 

n'. Sanitation. 

1 Chief Sanitary Engineer, 

3 Assistant Engineers, 

1 Supervisor Surveys and Rural Hygiene, 
1 Farm Sanitation Advisor, 
3 Clerks and Stenographers. 



181) ruTiLic iii:A[.Tn adm ixistnation 

V. Diagnostic Laboratory. 

1 Chief Hat-teriologist and PatliolOKist. 

1 Bacteriologist. 

1 Laboratory Helper. 

\1. Vital Statistics. 
1 Registrar. 
1 Assistant Registrar, 
9 Clerks. 

VII. Lodging House Inspection. 

1 Superintendent, 
!i Inspectors. 

2 Clerks and Stenographers. 

The Civil .Adniiiiistrative Code made possible a de|iartniein fcir health 
wurk only. Dr. Drake organized that department in a way that gave it the 
capacity to partiei])ate in practically every phase of pnhlic health service ;ui(l 
to extend its activities to all ])arts of the Stale. The rules and regulations 
[lertaining to morhidity reports and ([uarantine which Dr. Drake had ]int 
into effect in l'.M-"i linked together the State and local health machinery in 
a tiniform, workable manner. The vital statistics law of I'.il.'i provided a 
satisfactory means (jf collecting birth and death reports, llealth had be- 
come popular through the educational activities of voluntary and ot^cial 
organizations. The stage was all set for the .^tate to embark upon a splendid 
program of disease control and prevention. ( )n July 1, I'M], the law which 
established the new order (if things became etTective. 

War Activities. 

A new contingency develo])ed in lull when the nation had become em- 
broiled in the W'cndd \\'ar a few months before the new health jirogram 
w.as schecluled to start. This had a profound influence over every State 
go\ernmental function. It brought new health problems for the new State 
health agencv to sohe. .\ number of new military camps sprang up over- 
night, almost. an<l old ones t<.iok nn new life. This resulted in congested 
population at points where sanitary facilities were extremely iuade(|uate 
giving rise to grave he.illh dangers. Social hygiene became a problem. In- 
dustries, such ;is coal mining, started to operate at high speed and thus 
attracted an inthi.x of labor in many communities and thereby introdticed 
unusual health hazards. The call to arms beg.an at once to deplete the slat'ts 
of organizations of ;ill kinds and the newly created health (le]iartment did 
not escape. Salaries ;md wages went soaring .above the ordiuar_\- in all tlex- 
ible concerns but for the health (le])artment the maxinuim rate of pay for 
every position was specified by law and the legislature would not meet again 
for two year.s. 

Under these cmiditii n< the ch.aracter and volume of public health service 
was considerablv tlilVerent from what mi^bt otherwise h:ive been the case. 



PUBLIC HEALTH ADM I X ISTKATK ).\ 187 

Instead of deliberately proiuotin^- ci intact with local ]jeace time machinery it 
was lit primary importance to line n]) with the military. Sanitary zones 
ahnnt the camjjs and cantonments were established and in these were con- 
centrated most of the staff of the department. Careful sanitary surveys 
were undertaken in nearly all of the communities located near military posts 
and in a numljer of the minini;- towns. Thus the State Department of Public 
Health found itself under wartime pressure in a way considerably different 
from what had been anticipated. Instead of going deliberately into local 
communities, making contact witii local officials, investigating water and 
sewer systems, promoting birth and death registration, stimulating close 
observance of quarantine and notification rules and regulations and encourag- 
ing the establishment of efficient local health organizations, the field staff 
was largely concentrated in the immediate vicinity of military camps and 
busily engaged in handling the emergency problems there. 

.\nother event that modified both the course of public health service and 
the function of its machinery was the outbreak of epidemics of infantile 
paralysis in 1916 and 111 IT. The infectious natvu-e of the disease made it a 
public health problem. Its crippling character made it the subject for sjje- 
cialists. To meet the situation. Dr. Drake arranged for a member of his 
medical staff. Dr. C. W. East, to go to Harvard Medical College for a spe- 
cial course in infantile paralysis. 

Infantile paralysis in epidemic form was a new experience to many 
physicians and its wide prevalence made it of considerable public concern. 
This situation created a demand for instructive lectures. Dr. East was 
assigned to the task. He toured the State, disseminating the knowledge he 
had gained at Harvard, illustrating much of it with lantern slides. 

The lectures led to a demand for clinics. Many jihysicians wished to 
bring patients in order to establish a diagntjsis and for technical advice con- 
cerning s])ecial cases. Parents wanted to bring their children who were 
afflicted. .Accordingly clinics were established at various points throughout 
the State and soon absorbed practically all of the strength of the division of 
child hygiene which had but a limited stall. Thus instead of devoting its 
strength largely to edttcational acti\itirs the Department found itself labor- 
ing with an acute problem that invoKx-d clinical service. 

Venereal diseases constitute another subject that moditieil the course of 
public health service in the State. Cnder >tress of the W ar the federal gov- 
ernment launched against venereal dise;ises a tremendous program which 
reached every soldier in the army and spread over into the civilian population 
through the state governments. .Since drying up the source of infections is 
a basic activity in this field the federal government appnipriated large sums 
for the establishment of clinics. The iilan of the federal government antici- 



188 I'ur.i.u' iii;ai.tii admixistkatiox 

])aicil hdili cilucaliiiiial and curativt- activity. It ])r(i])(ise(l to funii>h iiuiney 
witii which ti) start ihc wurl-: as a ilcnumstratinn and then U> witinh'aw as 
state and local agencies took owr the matter. 

Illinois joined in the plan and added a division of social hyt;iene to the 
organization of the .State 1 )e|)arlnient of I'nhlic Health on July 1, 11)18. 
Funds which were ])rovided 1)\' the federal government, became available 
November 1 of that year and the new division started to function at that 
time. Within a year five clinics had been established at as many different 
])oints in the State. These were of a jiermanent character, the equipment 
and the pay of the director, who was always a local physician, were furnished 
out of funds allotted to the State by the federal g(ivernment. 

l'ltimatel\' the number of clinics grew to more than a score and the 
State's go\ernnient pr<i\ided funds for continuiug the work. An appropria- 
tion of $111(1,0(1(1 for that ])urpose was luade by the General Assembly in 1919. 

Here again the .Slate Department of Tublic Health found itself involved 
in ;i task that rei|uired clinical service in order to fulfill the requirements of 
its program. 

These clinical activities are important because they have been used to 
promote misunderstandings and conflicts between the medical jjrofession and 
the State health officials. 

If the great Wdrld War frustrated the carefullv devised program for 
jjublic health service in Illinois during the period of that emergency it pro- 
duced compensating influences. The \\ ar gave to sanitarians the opporttmity 
of an age of marvelous achievement. Soldiers were being mobilized in great 
numbers and were subject to rigid disci])line. The civilian population was 
subject to unusual demands and was in a mental attitude that made easy the 
practical application of official dictates and suggestions in all fields of activity. 
Health was recognized by everybody as a predominating factor to success 
in the jirosecution of the War. 

Sanitari;ms were not slow to take advantage of the situation. Every 
soldier .and e\er\' sailor was xacciiialed ;igainst stnallpox and against typhoid 
fe\er. b~ver\ liooper heard ;i lectuie on social hygiene, ^^'here safe water 
supply s\stems were not ;iv;iil;il)le the troojis dr.ank water from Lister bags 
that was well clilorinated. Wherever at .ill practicable water and fly tight 
latrines were constructed for troops. Food supjilies were rigidly inspected. 
Sanitarv officers inspected kitchens often. .Medical officers inspected the 
men frequently. 

These were new things to the great m.ajority of soldiers who still cher- 
ished the idea tli.at dead .animals, maloderous gas and filthy alleys gauged the 
vo'ume of work re([nired of ;i he.alth officer. These new ideas were carried 
back home with the soldiers. 



PUBLIC HEALTH ADMINISTRATION 189 

In the meantime the federal agencies at \\'ashintjton were busy pro- 
moting health programs. The childrens' l)ureau had been created and had 
stimulated a lut of popular interest by carrying out a national baby week 
project. An inter-departmental social hygiene board had been created and 
given plenty of money with which to prosecute a vigorous anti-venereal dis- 
ease campaign among ci\ilians. 

Post-War Acfirifics. 

Thus when the Illinois General Assemblv met in 1!)19 it looked with 
greater favor upon public health jjrograms than many such bodies had done 
in the past. This time Dr. Drake was alile to get an increase in the biennium 
appropriation of $182,698 above that two years before. Of the increase 
$100,000 went to the support of the division of .social hygiene, created a 
few months earlier through federal resources. The remainder went to the 
creation of four new small divisions. These included the divisions of 
biologic and research laboratories (which were from the outset combined 
with the diagnostic laboratory for practical purposes), child hvgiene and 
public health nursing, surveys and rural hygiene and public health in- 
struction. All of these divisions except that of the biologic and research 
laboratory had actually come into being on a small scale in 1917 through 
a legitimate manipulation of the funds appropriated for the Department, hut 
the 1919 General Assembly was the first to recognize them officially. 

This gave the State a well rounded puliHc health organization. The 
total appropriation, which amounted to less than a nickel per capita per 
year, was not as^ unstinted as that which prevailed in some states. Hut it 
was nnich larger than anything that had gone before in Illinois and there 
was now authorized by law a staff, howexer small, to function in jiractically 
every department of the public health field. 

While applying an organization plan and budget system to the (itticial 
State health machinery Dr. Drake did not neglect either national or local 
agencies for adding strength to the public health movement. He maintained 
the favorable contacts that had been established with what were now great 
national organizations and made new ones whenever desirable opportunity 
arose. 

W ithin the State Dr. Drake injected life into the legallv established local 
health machinery — at least so far as rejiorting communicable diseases was 
concerned. There were laws that provided local health machinery in every 
community of the State, naming specific officials for the responsibilitv ex- 
cept in cities and villages where the appointment of boards of healtli was 
authorized. There was another law requiring all police and other officials 
to aid in carrying out the rules and regulations of the State health officials. 



DIRECTORS 

State Depautmeat of Public Health 




1^ 



m 



C.StClaicDciiiJc/ 

/&/7 - 1921 



.D. 




!9'Z1 - 



C. St. Clair Drake. M. U. 
V. ST. CLAIR DRAKE, Chicago: born January 2?,. 1S70. St. Thomas. Ontario. 
Graduated Chicago Homeopatliy Medical College, 1891. Statistician Chicago 
Healtli Department, 1895-1914. Member, secretary and executive officer. State 
Board of Health. 1914-1917. Secretary, Conference of State and Provincial Health 
Authorities, 1919-1922. Director, State Department of Public Health, 1917-1921. 
Member numerous medical and extra-governmental organizations. 



Isaac D. Rawlings, M. D. 
ISAAC D. RAWLINGS, Chicago; born April 29, 1869, Carrollton, 111. B. S. and 
M. S., Illinois College at Jacksonville, 1890 and 1895 respectively. M. D., North- 
western University Medical School, 1893. Two years of graduate medical study 
in the universities of Vienna. Berlin, London and Dublin. Appointed instructor 
in bacteriology and director of the bacteriological laboratory in Northwestern 
University Medical School in 1895. From 1S97 to 1918 held various positions on 
faculty at Northwestern University Medical School. Medical inspector, Chicago 
Health Department, 1899-1904; assistant chief medical inspector, 1904-1921. Di- 
rector State Department of Public Health. 1921 to date. Member numerous 
organizations. 



PUBLIC HEALTH ADMIXISTRATIOX 11)1 

Under these laws Dr. Drake found ample authority tor specifying certain 
persons in every community who were to receive reports of communicable 
diseases and to transmit them to the State health officer. He had field stafT 
sufficient to stimulate the operation of this process. Dr. Drake also got 
himself appointed collaborating epidemiologist of the U. S. Public Health 
Service. This gave him the privilege of supplying local health officers with 
postage free cards for making reports. Then by 1!M'.) the process of com- 
municable disease reporting was functiunrng in a reasonably satisfactory 
degree. The vital statistics law of IDl.j had created local registrars in ])rac- 
tically all townships in the State and brought into operation new local ma- 
chinery as well as greater facilities in the collection of birth and death 
re])(u-ts. 

Outside of official circles the old conference l^etween State and Idcal 
heakli officers was revived. This time it included extra governmental agen- 
cies and took on the title of "Illinois Public Health and Welfare Assucia- 
li(in." This was organized as a means of bringing together all the pulilic 
health agencies in the State so as to coordinate, as much as possible, the work 
of all, and to kei'p some uniformity of practice. The organization never 
developed vitality emaigh to create a significant infiuence over matters in 
the State. 

The great influenza epidemic in ]'MS brought into local service a large 
number of public health nurses in the State who owed allegiance to the 
American Red Cross and the Illinois Tuberculosis Association. These nurses 
found such high favor in comnnmity life that they became permanent in 
manv places and constituted a very large factor in the ])ublic health machin- 
ei\' of the State. In 1 !•".'(! a plan for effecting a close cooperation between 
all of these public health nurses under the general supervision of the State 
Department of Public Health was perfected when Dr. Drake managed to 
secure a signed working agreement between the agencies concerned. This 
agreement was based on a national ]5olicy adopted by a conference between 
the National American Red Cross, the National Association for the Study 
and Prevention of Tuberculosis and the Conference of State and Pro- 
vincial Health Authorities. It held great ])ossibililies for extending the 
.State's health machinery in ;i s])lendi(l way but ne\er accomplished its full 
purpose becHUse ;i State su|iervising nurse was never employed with regu- 
larity enough to di'xelop and carr\ out a significant program. 

I here w a> also a i)lan to conduct schools ol various >orts — one s\stem 
for local health oftict'rs at regional points and another for ])tiblic health 
nurses. The ])lan for the latter was to hold the school at S]>ringlield during 
the summer when field work, ])articularly in the schools, w.as light. Xeilher 
jiroject ever grew into anything of magnitude or permanence. 



19'^ ITIiMC 111;. \1. Ill ADM I NISI NATIIIX 

With all (if llic s]ilriuli(l ]inii;iH->s in (ir^anizaliini and magnitude nf 
service since ll'l 1 llieri- was. at the end ol" the Drake it-mux' in l-'el)ruarv 
1!)31, a distinct lack of ccxjrdinatiim hetween the varinus divi>i()ns in tjie 
State Department uf I'nhlic 1 lealth. It was iidt innisiial, tdr instance, for a 
new staff nienilier in he with the l.)t-i)artnienl for niontiis hefore he knew 
the other divi>ion chiefs with whom he was supposed to work. A district 
liealth sujierintendent minlit \isit a town lime and again where some recal- 
citrant local registrar olistiucted jirompt and complete returns of vital statis- 
tics without knowing of the dilVicnlty. The field staff did not always know 
that the l)e|iartment operated a free motion ])icture library or that Health 
News was availaljle free to any citizens of the State who wantetl it. The 
niachinerv for collecting and compiling vital statistics was all set up and 
functioning" more or less satisfactorily hut no comprehensive mortality sta- 
tistics were forthcoming nor had the ."-^tate been admitted to the L'. S. hirtli 
registration area. 

hurthennore. Dr. Drake never felt the need (.)f official advisory council 
in determining policies and pro.grams. The Civil Administrative Code jiro- 
vided for an Advisory Board of five members. Xone was ever a])])ninted 
during Dr. Drake's time as State Director of Health. .\ staff meeting of 
division heads was never held. Husiness with each was transacted 
indixidually. 

The divisions were located in half a dozen different places. C)ne was 
in the arsenal, another occupied rented quarters down-town in .Springfield, 
some were on one floor and some on another in the State House. Division 
chiefs made no reports of their activities except for copies of correspondence 
and the annual re])ort. Discipline concerning work hours, time off, etc., for 
enijjloyes was a matter for the chief clerk to keep u]> with if he could. 

Even Health Nezvs fell into the most irregular publication although the 
newly created Division of Public Health Instruction had the prei)aration of 
this bulletin as a princi])al function. In early December of I'.IPI ;i Chicago 
nevvs]japer columnist humorously observed: "Xow come to b.-md the ( )c- 
tober and Novembt'r numbers of Doc Drake's 'Illinois Health .\'e\vs.' There 
is a chance for the printer to catch u|) this year, so here's ho|iing for the 
Dect-mber number before Jan. 1." When Dr. Drake left the Department in 
h'ebruarv r.i".M. Hcallli A'iTi'.v was fully six months behind, according to 
records in the oHice. 

SminiKini. 

When Dr. Drake cann' to the Capil.al as the State's chief health oflicer 
he found a r.oar<I of Health clixiclinj; its time between regulating the jiractice 
of medicine ,and doiui; sanitar\ and b\i;ienic work -.about two-thirds to 
the f(jrmer .and one to the latler. When he left there w.as a Sl.ale Depart- 



PUBLIC HEALTH AD.M I X ISTKATIOX lil3 

nient uf I'uhlic Health, heack-d Ijy mie man who was responsible lur it-- puli- 
cies and activities, which devoted its entire resources to straight piililic health 
service. 

At the heginning of Dr. Drake's tenure practically all the field personnel 
of the State Board of Health was on a per diem employment basis and there 
was nothing in the way of specialized iK-ad(|uarters service Init a smaU diag- 
nostic laboratory, a small staff for handling vital statistics and the general 
office force. At the end of his lime all stalT memliers and employes in the 
health service of the State were on a full time basis, functioning under a 
splendid plan of organization which divided the wurk of the Department into 
ten divisions. 

When Dr. Drake became Secretary of the State IJoard of Health the 
rules and regulations of the Board concerning quarantine and nn)rbidit}- re- 
ports were general and indefinite and the reports were incomplete and de- 
lin(|uent. When he gave up the office of Director of I'nblic Health all the 
rules and regulations had been simjilified and codihed. Reporting ol dis- 
eases was reasonably prompt and fairl\- satislactory due in part to the cddi- 
fication of the rules, in part to the free mailing privileges granted by federal 
authorities who utilized the reports thus gathered and in part Id the larger 
field staff that stimttlated better reporting. 

In l!ll I the collection of vital statistics had fallen into a deplorable con- 
dition and there was no satisfactory law for helping matters greatly. Hong 
befiire l'.i"'l a siilendid law was in effect and the necessary State and local 
machinery for collecting and compiling prompt and complete returns was in 
existence. 

'I'he number of public health nurses em])loyed in the State outsiile Lhi- 
cago in 1914 was inconse((uential. More than .'iOO were at work in ^'^^l] and 
a plan for coordinating their services under the general supervision of the 
State Department of I'ublic Health had been agreed upon b)- all concerned. 

In r.M-l the State Board of Health operated a small diagnostic l.aboratory 
in .'^jiringfield and distributed a limited amount of biological products. At 
the close of l!l'.'(l there were h.alf a dozen bianch diagnostic laljoratories be- 
side the central one in Springlield which had broadened out to take on re- 
search work and the l)iological products <lislril)nled had increased cousider- 
abh in number and volume. 

In IMll preventive medicine was little thought ol or a]i]ireciated in the 
])opu!ation at large. By 19"^1 it had become p(rpular enough to leail news- 
papers, household ])eriodicals and other |)ublications to devott' much space 
to it. In Illinois Dr. Drake had played a leading part in popularizing the 
subject. 



194 i'ri;i.u' iii-..\i.rii adm i ^■IS■I'RAT10^• 

I ictw reii lull and ID'v'l llic Slatf had discarded a ciinilKTSdiiK' I'oard of 
Ik'allh willi il> t'lianlic \va\> of |ir(jni(itinL; public health and in its place 
had imt a llcalth I )cpai tnum, ranking with aii\' mhrr di-partmiMit of the 
Stale i;(i\eninient. wilh a splendid organization plan for systematic, co- 
ordinated, well balanced and up-to-date service. The main trouble was that 
the "system" and "coordination" were lacking. 

The Kawi.incs' Reoime, 

A political change in the administration of the State government took 
])lace in J.anuary, l'.)21. It l)rought to the Department of Public Health its 
second Director, Dr. Isaac D. Rawlings, who took office on February 1. 
Like most of the executive officers of the State health service who had pre- 
ceded him. Hr. K.awlings hafl been with the city health department in Chi- 
cago. Indeed he had s])ent over twenty years in the public health service of 
tha.t city and had been closely associated with all of the great sanitarians since 
l!i(i() who had built up in Chicago one of the finest municipal health depart- 
ments in the country and given to the city an envialile record for good health 
conditions. 

In education and experience. Dr. Rawlings was better trained than any 
man who had precedeil him with the possible exception of Dr. Rauch, who 
lived, of course, before the day when preventive medicine came into its own. 
Dr. Rawlings was a graduate of Northwestern University Medical School, 
one of the best in the country. Later he spent considerable time at the great 
medical educational centers in Germany, Austria and England. Then he 
taught for a number of years in Northwestern University Ale.lical School 
and subsequent 1_\- ])ul in twentv years at pulilic health work. He was, there- 
fore, thoroughly familiar with the problems both medical and sociological, 
the It-chnical procedures and the difficulties to be encountered in the field of 
p)ulilic health service. 

.\s native e(|uipment. Dr. Rawlings had a love for routitie system, a 
thirst for details, a passion for work and a tenacity of purpose that led him 
to carry ovu jilans and policies in letter and sp.irit alike. If the law provided 
for a board of public health advis<irs which should meet (|uarterly he wanted 
a bo.ard apjiointed and he wanted it to meet on the first Tuesday of ever}' 
third month and he wanted it to advise, li occasion required him to go be- 
fore a legislative committee he was no man to say "Mr. Chairman, contagion 
is rampant in the State. We need twice the money we now get to make 
headway against it." X'o. lie had to b.ave with him a ]iicce of paper bear- 
ing official statistics and with its help say ".Mr. Chairman, smallixjx left its 
scars on S,.');3(i persons in this State last year. That's too much. It's costing 
us close to a million dollars a year. In youi' own district. .Mr. Chairman, 



PUBLIC HEALTH ADMINISTRATION 195 

there were 33.") cases, a ratio much lartjer than that for the Stale." To 
satisfy this craving for system and this desire for details wliich were tlie 
tools of his mind that brought out his mental faculties to best advantage he 
was willing to begin before the sun rose and work far into the night, day 
in and dav out. He was determined that his organization should put in 
hiinest hciurs and function so that results could lie reduced to tangible records 
ihat wiiuld be available at any time for any necessary purpose. 

The General Assembly was sitting when Dr. Rawlings assumed office. 
He asked for an enabhng law that would permit counties to employ trained 
medical health officers to organize and direct county health departments. 
This the general assembly declined to do but did provide for 25 instead of 
7 district health superintendents to work under the State Department of 
Public Health. Never before had so large an extension of the State health 
machinery lieen arranged for by any legislature. 

Cixirdiiiatioii of Force's. 

.\s pointed out heretofore there was in existence v.'hen Dr. Rawlings 
arrived a splendid organization plan for the State Department of Public 
Health. The finances were budgeted and so were the functions. .\pi)ro- 
priations were made for specific purposes and personnel, most of which was 
well ([u.-ilified to perform the duties rec|uired. was divided into divisions to 
which special types of services were assigned. The main trouble was that 
the divisions were like so many independent units functioning under a gen- 
eral head. Coordination and systematization were necessary to make the 
Department produce maximum results. 

As the first step toward unifying the health machiner)-. Dr. Rawlings 
started the practice of holding .staft' meetings of division chiefs each week. 
He laid before them his policies and mapiied out his program. To every 
di\ision was assigned the routine iirocedures which it was technically pre- 
])ared to handle and such other duties as it might be able to perform in con- 
nection with general projects undertaken by the Dejiartment. This ])rac- 
tice. which still continues keeps all members of the Department informed 
abiiin activities within the 1 )ep:irlniem and this greatly enhances the co- 
onlinatiiin of elTort. It i> ])articulaiiy heliiful In those employees wdio travel 
about the State and are frei|nentl\ iniestinned about health matters. 

B\- May K, P.)21. Dr. Rawlings had arranged for a meeting of all the 
field staff, consisting of 7 or S physicians with the division chiefs in Spring- 
field. That was another step toward unification. Questions of policy were 
discussed, luich divi.sion chief outlined the services which he was prepared 
to undertake. .\ci|uaintances were made for the first time between many 
of those ])resent. This general conference of Dejiartment members became 



IDG I'lnii.ic iiicAi/rii admimstkatiox 

an annual alTair and constitutes an ini|"irtani factor in tlic systematic oper- 
ation of the Stale's health machinery- 

A/lrisiiri/ BiKiiil. 

Then there was the matter of an advisor)- hoard. The Ci\il Adinin- 
istrati\e I'ode provided for one, luade up of live meinhers. that should meet 
;is fre<|uently as deemed necessary hut not less often than quarterly. The 
matter \\a^ laid hefore the Governor who appointed to the board on Septem- 
ber •.;■;;, II''.' I, the full complement of members. It consisted of Dr. W. A. 
I'^vans and Dr. John Hill Robertson of Chicago. Dr. E. P. Sloan of Bloom- 
inSton. Dr. C. W. l.illie of ICasl St. Louis and Mrs. l'.. N. ^Monroe of Quincy. 
h'rom the outset the board has met rcLjularly and has participated energetic- 
ally in the business of reiiderini,' advice about tlie health policies and prob- 
lems of the State. Its contact with the jirofessional and public life of the 
State enaliled it to not onl\' interpret public sentiment but to exercise con- 
siderable influence o\er the trend of sentiment concerning; health matters. 
It has, therefore, proved to be an important factor in welding together the 
lualih niat-biner}' and of guiding the activities of the State Department of 
I'nlilic 1 le.ilth along a course that was both sound scienlihcalh' and wise 
sociologicall) . 

Alh ii///fs to Inipnirc Locul Ih alfli MiuIi'iik iij. 

Local health machiner\- was another iniporlant tactor in the program 
of unihcation. The lars^er municipalities had fairly well organize<l health 
departments but the remainder of the State, divided into some 5.;00 dis- 
tricts, had for health officers persons upon whom the law im])0sed this re- 
sponsibility by \iitue of some other office to which they had Ijeen elected — 
such as coimt\- sU])ervisor, assessor, town clerk-, village president, etc. Not 
only were these men untrained in public health work, generally s]ieakin,g, but 
they fre(|uenlly ch.mged with local elections and the State Director of Health 
had no means of knowing about it. 

Dr. Kawlinns w ,is ambitious to substitute the count\ for tlie township 
as the unit for local he.ilth organization and to create a deiuaml for well 
trained niedie.il he.ilih officers. The ( leneral Assembly turned down an 
en;ibliiig hill in IH'JI. .Xevertheless Dr. Kawlings jnished forward his plans. 
I'i\- the end of lie.' I 1,^ had created sentiment favorable to a count\- health 
service in .Morgan t.'ouiity. With some lin;incial helji from the International 
Health lio.ird and some from the Si.ite, .Morg.m C'ount\' inaugurated the first 
full time connt\' he,-dlh service in Illinois in the spring of 1'.I32. This Dr. 
Rawlings pl.inned to use as a deiuonslralion project both to other counties 
and to the ( leneral .\sseml>l\'. It h.as pleased Morg;m C'ounl\ well enough 
to be continued on ,i |)ermanent basis. 



MEMBERS 

First Boaud of Public Health Advisors 

cpj^oinied S'epicml'cr 'ZQ. /P2/. 





E. P. Sloaii,m.D. 







-T^t 







V">A.EvaJis.9IL.D. 

Chaio/Ut/i 




;^f^ 



^^^.. 



\amV.miiM.D.* \ 

Sccce.ta.ry 

*"•" ! *Dt'.EAS'-D I ' 



JoHiiDilltolwtson.lIl.D. 



198 I'UP.LIC IIICAI.Tli ADMIXlSTRATinx 

An enabling bill authorizing counties to establish health <le[)artment3 
failed again to pass the General Assembly in 1923 but a bill re(|uiring county 
clerks to rejwrt annually to the State Department of l\iljlic llcalih the names 
anil addresses of all local officials concerned with public health duties did 
become law. This linked up the ne])artnient more closely with local com- 
munities than any other one thing since the law creating local health ofticers 
was enacted. 

In I'lVI another attcni])t was niade to stimulate the development of 
county health departments. This time arrangements were made with the 
United States Public Health Service and the International 1 lealth Board to 
help finance a certain number of units and Dr. Thomas Parran. Jr., sur- 
geon on the staff of the Utiiled States Public Health Service, who had had 
a wide experience in the development of rural health service, was detailed 
to work in Illinois under the State Department of Public Health. Dr. Par- 
ran started to work' in June and bv Juh- 1, Crawford County had emjiloyed 
a full titne health officer and organized a de])artment. ."Shortly afterwards 
Wabash Coutit\' decided to do the same but difficulties arose over local au- 
thority to appropriate funds so that the plans didn't materialize. The de- 
partment in Crawford was short lived. The attorney general c;f the State 
expressed the opinion that counties could spend money for the control of 
diseases in the face of epidemics but that they were unauthorized to do so for 
preventive activities when contagious infections were not present. This 
opinion settled the matter. -\n enaf)ling law was necessary before j^rogress 
could be made in building U]) count\' health departments. So far no such 
law has been enacted. 

.\ full time rural health service was established in Cook County in 1924 
and one in DuPage in 192.J as a result of efforts of the Department. Both 
have continued to date and appear to be ])ermanent. 

Dr. Kawlings now gave his attention to the improvement of municipal 
health service in the State. Under Dr. I^arran a surve)' of the 1.") cities 
ranging between oO.OOO and PIO.DOO population was undertaken. It was 
certainly a different project from the Ranch survey just l(t years before. 
The Ranch survey considered alleys, back vards, cellars — cnvironmeiU. The 
Rawlings' surve_\- measured the character of health service by the results 
ol)lained. It is interesiiuL; to note th.at both were patterned after the teach- 
ing of the American Public Health .\s>ociation in their time. 

.\s a means of creating interest in local health .'idministration. the 
Kawlings' surxey wa^ the most successful single acti\it\- the State Depart- 
ment of Pitblic Health t-ver undertook. Pach city was rated on a percentage 
iiasis as ;i result of the fnidings and the newspapers devoured the reports. 
National magazines interested in the pnl)lic health lield coiumented exten- 



PUBLIC HEALTH ADM I XISTRATIOX 



lOil 



sively on it. More important still, the cities concerned took steps to make 
the improvements recommended. Evanston, for example, replaced a part 
time with a fnll time health officer. Other of the cities built isolation hos- 
pitals. ])ut on public nursing services, started infant welfare projects and 
added such other improvements as seemed practicable imder local circum- 
stances. 

In January. TJ"24 a system of clinics which the State Department of 
Public Health had been conducting for a number of years for the benefit 
of crijipled children was discontinued. These clinics involved a consider- 



OR&AniZATIOn OF 

5TATE DEPARTHEnT OF PUBLIC HEALTH 

1927 



GBIERAL OmCE 



57ATI OF ILLinOIS 
DEWRTrtm" OF PUBLIC HEALTh 

Director of Public Mealth 
A55i5tant Director 



mxns Of LABoiiAiaxs 



iL- 



.|f=°^^ 






Ilk. 







L. 



Fig. 11. Showing the available strensth of the State Department of Public 
Health on July 1. 1!I27. 

able amount of curative or correctixe practice and this had caused some 
unfavorable feeling in the ranks of the medical profession. The work was 
continued under the atispices of vdlnut.nry agencies but its divorcement from 
the State service left the lleallh Dcparuiicnt free to engage in purely pre- 
ventive activities. 

MdtcniH 1/ and Cluhl lli/fiiciic. 

To stimulate activitv in the field of niatcrnit\- and chikl hygiene. Dr. 
Rawlings took advantage of the fmancial ^upiiurt offered by the federal 



200 ri'iii.n 111-;. \i. Til ahm ixisi ration- 

government thi(iiiL;li llu- children's hurcau under what is ordinarily called 
the Sheppard- I uwiKT Act. A (h-;ift (ni the federal treasury in favor of the 
State of Illinois to the amount of over $1!),000 was forwarded to Dr. 
Rawlings during the summer of 1922 but the State auditor had no legal 
authority to accept the funds and the legislature declined to ever grant 
that authority. Thus the State's child hygiene program had to he worked 
out with no outside tuianctal snp|i(irt. 

This was undertaken by the furniation in li)25 of a State advisory com- 
mittee on child hyt;iene. ( )n it are represented the Illinois State Medical 
Society, tile Illinois State Dental Society, the Illinois Federation of Women's 
Clubs, the Illinois Council of I ';irent-Teacher Associations and the State 
Department of Public Health. Through this committee, which has before 
it plans and programs concerning maternity and child health, a considerable 
amount of strengfth has been added to the State health machinery. It func- 
tions by informing the several ori;anizations concerned about the programs 
and special campaigns undertaken by the State health officials and exercises 
no small inlluence in putting oxer definite projects. Thrc'ugh it, for instance, 
direct contact was made with club women and parent-teacher associations 
in every countv of the State in connection with a diphtheria eradication cam- 
])aigii in llt2(i. 

Another link in the chain that systematized health work in the ."-^tate 
was welded wlu'ii Dr. Rawlings succeeded in interesting the Uliiniis State 
Dental Society in a mouth hygiene program. The Illinois Stale and Chicago 
Dental Societies agreed to pay the salary of a dentist to work uiuler the 
State Department of Public Health as a temporarv demonstration of what 
could be dene. The Illinois Tuberculosis .\ssociation contributed some funds 
to this ])roject. The plan was carried out beginning in August. 192(i. It 
culminated on Julv 1. lli"3; when appropriations made by the li)2T General 
.Assembly became available for continuing the |irogram. 

Ollirr Activities. 

In l!)2.j arrangements were made to open a branch diagnostic lalxn'atory 
in C arbdiidale and in \'J'>', amither was opened in Chicago. Prior to these 
dates branch l.al.oraldries had been establislied and maintained at various 
points but their wcnk was conlined to diplitheri;i. These two new branches 
were e(|uip|)ed ti> handle pr;iclically exery l^in(l of procedure common in pub- 
lic health L-ilmratiiries. This step provided dia,i;ni'stic laboratory facilities 
in easy reach nI every part of the .^tate so tli.it physicians and the public 
could profit by prom])t service whenever nee<le(l. 



PUBLIC HEALTH ADMINISTRATION 201 

rifdl Stiltisfirs. 

When Dr. Rawlings was apimintcd State director of Public Health in 
lii-'l the most obvioits shorten niing- of the Department concerned statis- 
tics. ISirth registration was 'iO jjer cent deficient and accordingly was not 
recognized l)y the federal bureau of the census. To get Illinois into the 
United States Ijirth registration area was the first extra-routine task that 
Dr. Kawlings undertook. 

lie went about the matter melluKlicall)-. The subject was thoroughlv 
aire<l at staff meetings. A communication requesting cooperation and citing 
the birth registration law was directed to every practicing physician in the 
State. The 1,K)0 odd local registrars were advised of their duties and re- 
sponsibilities. Birth records in the office of the State registrar were analyzed 
so that the amount of delinquency in every county and in all the larger mu- 
nicipalities was closely estimated. The Illinois Federation of Women's Clubs 
was prevailed u])on to partici])ate in the campaign by appointing local club 
women all nver the .State to make birth registration surveys. .\11 the field 
personnel nf the Department from whatever division were informed of 
registration (lelin(|uencies so that each could \isit doctors and registrars 
in his district or along his itinerary. Local state's attorneys were called 
upon freely to handle the few legal cases that appeared unavoidable with 
recalcitrant offenders, ^\'ithin eighteen nKJiiths birth registration was so 
nearly complete and returns were so prompt that Illinois was admitted tii the 
United -States birth registration area and the lil-J'.' statistics accepted by the 
federal Ijureau of the census for that purpose. 

The chief significance of the birth registration campaign was its effect 
on the State health machinery. It had knit together the various divisions 
of the Department in a common purpose above that encountered in ordinary 
routine. It had brought into acticn a great potential strength for doing 
local health work and influencing public opinion — the women's clubs. It had 
aw-akened a li\ely interest among physicians. It had introduced the official 
legal talent of local comnnmities to the laws governing public health service. 

I'.ut birili registration was only one of the statistical problems that 
faced 1 )i'. Raw lings. No detailed mortality rates had e\'ei been computed 
in the .State for official publication. Figures that were availalile had been 
compiled on a fiscal year basis so that they were incomparable with those 
of other states. This situation was remedied when Dr. Rawdings introduced 
into the Department a system if nionihlv and semi-annual reports from 
divisions and insisted on having the annual report when it was due. Bv 
the end of his first year in office Dr. l\awlings had succeeded in getting 
for publication a detailed infant mortality statement covering every county 
and every principal city in the State, the first report of the kind ever issued 



202 PUm.ll' IllCAI.l'll ADMINISTRATION" 

by the Deijartnient. IJy tin- middle of \'J-12 nicirtalily tables showing the 
cause of each death in the Slate, ptierjieral <le,Tths by counties and cities 
and detailed infant mortality fates for IK'.'I were available. This progress 
was continued fri)m year to year, time limits being set for the delivering 
of similar reports, until 19".^^ linds taliulatioiis and analyses of the State's 
mortality records in practicall\- all standard forms. 

Comnumicahle disease re])ort.' likewise needed much improxement. 
They were incomplete on the one hand and not easily availalile for utiliza- 
tion on the other. Dr. Rawhngs iiUroduced a system of daily reports from 
the division chiefs to his own office. Then he put into eft'ect a system of 
cross checking between iiKirtality records and case reports. Furthermore 
he had brought together into one tabulation the cases and deaths from the 
principal reportable diseases for every county and city of lO.lXK) or more 
in the State. Then he began the practice of sending a field physician to 
investigate every reported case of smallpox, typhoid fever and chickenpox 
in adults. These procedures revealed the weak spots of notification and 
led not only to a distinct improvement in the completeness and promptness 
of reports from the field but also to the utilization of the data collected. 
To operate the system inaugurated records had to be kept m good shape 
and that is just what happened. By every available test it appears that 
communicable diseases are reported now (l!)".^';) in Illinois as satisfactorily 
as the)' are anywhere in the country. 

Safe Mill: Stipplirs. 

The ])roblem of safe mill< furnishes another illustration of the system 
which Dr. Rawlings introduced into the operation of State health machinery. 
Sanitarians everywliere recognize the safety of milk supplies as scarcely 
second tcj safe water supplies in importance to general health conditions. 
With the exception of tuberculin testing, little had been done to promote 
the .safety of mil'iv outside of Chicago in Illinois prior to \'J2\. In that 
year the ."^tate Department of Public Health set to work on the problem. 
Dr. Rawlings apjiointed a committee representing several <li\isions to stud} 
the i|iie^ti(in. After cimsulting with experts in the Department cf .\gricul- 
ture and at the L'nivcrsit\- of Illinois the committee drew up an orcHnance 
suitable fur ado]>lion 1j\' munici]jalities. In .\ugust \'.)2'2 the ordinance 
was brimght before and thoroughlv discussed by a group of the most repre- 
sentative .sanitarians and milk dealers of the State, gathered in Chicago at 
the Pageant of I'rdgress In ccmsider imjiortant public health problems, and 
received a vote of ajiprcxal by thai body. The ordinance was evidently 
about right. 



MEMBERS 

Present Board of Public Healtli Advisors 



{i ■'^■ 



€ 




W? A.Evaivs/l.D. 






Via - C/iMr/rutK 



Tlws.D.I'oaa.t.D. 

Chairman 




E. P. Sloaa.l.P. 



Hecniii]i''Lliatuksf,ti,t,l). 

Seccettif^ 



204 iTiiijc iii:.\i/rii adm ixisiratiox 

'J'he next step was to get the ordinance adopted by local immicii)alities. 
'iliis task was approached in the same way that proved successful in birth 
registration. Communications went out to mayors. Traveling representa- 
tives of the Department from whatever division who had opportunity to 
promote the idea were given assignments to meet with local officials, leaders, 
civic organizations etc. By 1927 a total of (iO cities with a combined popula- 
tion (if cSJJO.OoO had adopted the ordinance. 

P>ut adopting an ordinance wotild not in itself provide safe milk. It 
had provoked thought, however, and soon the Department began to get 
requests for information abtiut various municipal supplies. This led to 
a survey of all milk pasteurizing ])lants in the State by the division of 
sanitary engineering. The First survey was made in 1921 before much agi- 
tation for improvement had begun. Then in 1924 a sanitary engineer was 
assigned to do nothing but milk work. In 1925 a law that required the cer- 
tification li\- ihc ."^tate I'eiiariment of Public Health of all plants pasteuriz- 
ing milk was passed. .\t the same time pro\'ision was made for em])loying 
a milk sanitarian and a milk bacteriologist and the pmxhase of a mobile 
laboratoi\- to be used in that work. Thus bv I!i2; the De])artment of Health 
had ciinsiderabh' broadened its safe milk program and was m a position 
to jirosecute the undertaking in earnest. 

This milk project brought the State health machinery to ojierate syste- 
maticalh" in a lield thai had lieen entered before onlv spi radicallv and in a 
haphazard kind of way. It lirnught milk deak-rs and producers into contact 
with health work more delinitely than they had before experienced. Under 
Dr. Rawlings milk dealers became acti\e agents of the State Department 
of Public Health because it would In- an unwise business man indeed who 
could ignore a bad report on his milk pasteurizing plant and especially so 
when he was informed that responsiliilit\' fur e|ii(lemic outbreaks that might 
be traced to his products would be put >(|uarel\ up to him. 

jlpitrccidtiiiii (if Di'jiinl nil lit (il Jin/iilat miis. 

In 192"i, following the development of a rather unusual incidence of 
tvphoid fewr attributed to contaminated oysters, an order was issued by 
])r. Rawlings jirohibiting the sale of oysters in the State for raw consump- 
tion. The effect of the order was nation-wnde in magnitude and disastrous 
for the ovster industry ( )nc conference between representatixes of the 
oyster in<histr\' and |>nlilic health officials followed fast upon the heels 
of another. With the Illinois Director of k'nlilic Health as the central 
figure the affair soon eame to the attention of the United States Public 
Health Service and nearly e\ery state health olVicer in the country. The 
result was a general sanitary iniiiros enienl in the production and distribution 



PUBLIC HEALTH ADM I X LSTRATION 205 

of shell fish, made necessar)- to meet requirements laid down by Dr. Raw- 
lings and the Illinois Oyster Committee for any oysters allowed on the 
markets of Illinois. Indeed a couperative slate and national system of 
certifying oyster jjroducing concerns was created and continues to operate 
under the general supervision of the United States Public Health Service. 

This oyster business represented a new use of the authority granted to 
the State Department of Public 1 lealth t(i make rules and regulations con- 
cerning health matters. Bv such action the .^tatc health machinery extended 
its influence from coast to coast, causing a general sanitary adsancement in 
a great industrial field. 

Again in 19"36 use was made of the same type of authority. This 
time the action related to stearate of zinc toilet powder. A few deaths of 
infants had been attributed to the accidental inhaling nf this kind of pow tier. 
All cases, it appeared, could have been prevented had the powder containers 
been e(|uipped with automatic safety caps. Accordingly it seemed wise to 
prohibit in Illinois the sale of stearate of zinc toilet j)Owder except in safety 
containers. This was done and again the effect was nation-wide because 
the large manufacturers, engaged as thev were in inter-state commerce, 
[preferred to turn out a uniform product to ,ill of their trade, including 
Illinois. Thus again was demonstrated the f.ir reaching influence i.if the 
power of the ."-^tate l)ei)artment of Public Hcaltb to make rules and regula- 
tions. 

Ediicdlioiial and Mu^cclluiicoiis Aitu'ltics. 

Another activity that strengthened and extended the influence of the 
State's health machinery related to health education. In l!)2.j arrangements 
were made between the State Department of Public Health, the .^tate De- 
partment of Registration and Education .and the five State Normal schools 
to introduce courses of health instruction in the curricula of the institutions. 
The object of these courses, which ha\e been introduced and expanded as 
rapidly as facilities permit, is to provide prospective teachers with the sort 
of sanitary and hygienic knowledge necessary for their personal health bene- 
fit and to ecjuip them to not only impart knowledge to children but to exer- 
cise intelligent supervision over their health in the school room. This links 
up a great educational system with the State's health machinery and plants 
the seed of sanitary knowledge where \\u-\ ai'e apt to \ield the greatest 
returns. 

The foregoing references to projects imdertaken by the State Depart- 
ment of Public Health under Dr. Rawlings by no means exhaust the field 
of activities which might be drawn upon but they are sufficient to illustrate 
very well the process of welding together the resources of the State for doing 



200 



PUHLIC IIICAI.TH ADMINISTRATION 



public health wdik uhii-h has characterized his entire administration. In 
every divisiim the vdhimc of work done has expanded very noticeably. On 
all sides a greater degree of codrdination than had hithertu existed has 
prevailed. 

\'ery few ciianrjes in the organization plan were made by Dr. Rawlings. 
During his lirst year he eliminated the division of surveys and rural sani- 
tation, transferring the work and personnel to the division of sanitary 
engineering. Otherwise the divisional arrangement was unmolested. Each 
division grew in size and enlarged its volume of work but '■emained in the 
organization scheme as thev were under the organization plan which ])re- 
vailed when Dr. Rawlings liecanie State Director of Public Health. 



\ 



^StaTEDept'^vPublicHealth' 



.. ..'.I r.':NTflL ADVICE ■ !-•■ 




A line o( 25 to 100 deep constantly flanked the entrance to the adult 
examination booths at the 1925 State Fair. 



^l /ijiid/iruit ion. 

'I'lie last ap|)rnpriati(in made to the State Department of Public Health 
prior to tin- ap|iiiiitnu lU (if Di'. Rawlings, that made b\- the (ieneral Assem- 
bly in I'.tP). amiiuntt'd to $120,810 for the bicimiuni. In I'.tvll the biennial 
appropriaiiiin jumped to -$1, 119, 7 12. After that it changed but little up to 
the pre-ent lime .\ugust 1!12:. it fell liack to $!)85,o8? in 1!)23, due to 
;iiui-adminisiratiiin pdliiical nianiu\ers but 1II2.J found the grant back u]) to 
$1,138,88;. In 1!)2; ihe ( ieneral Assembly voted $1,187, 684 for the gen- 
eral expenses of tlie .^tate De])artment of Public Health during the ensuing 
twd fiscal vcars. This is a substantial incri-ase of money compared w-ith 
the modest sum of -t.'i.ooo approjiriated fifty years before to carry the infant 



rUBLIC HEALTH ADM I X ISTKATION 



20? 



State Board of Health* along through its first two years of life. Com])ared 
with funds provided by many other states, including Xew ^'ork, Pennsyl- 
vania and Massachusetts, for public health purposes the amount appro- 
priated by Illinois in 1!)2T is relativel\' small as she ranks twentieth among 
the States in her jier ca])ita expenditure for health although she is tliird in 
wealth and population. 

The organization of the State Department of Public Health in 1!)2T is 
graphically shown bv the illustration in Fig. 11. How this differs from the 
organization in 1i)lT. the first year under the Civil Administrative Code, in 



AnnUAL APPROPRIATIONS 



1879-1927 

fAPPROPRiATIOnS MADE BIEnniALLY) 




F:g. 12. 



IIM."). the last year under the State Board of Health and in is;:, the first 
year under the State Board of Health mav l.)e observed bv reference to Figs. 
8, 9, and 10. 

H iiuniKini. 

When Dr. Rawlings became State Director of Pub'ic Health in 1!I2 1 
he found the Department functioning under a well devised organization plan 
with facilities for ])articipating in practically every phase of public health 



208 ruiu.ic iii:ai.tii ahm i n isi i.:Ari().\ 

stTvict liUt it was Idciscly linuiid together. At the time this is written in V.)27 , 
wiiii Dr. i\,i\\ lings still in oi^ce, the variuns divisions are coordinated intu 
a nnilicd Department which is capable of moving swiftly and efficiently to- 
ward the at liievenKiit nl' any general purpose and at the same time each di- 
vision takes care of the routine ]irohlems within its own i)articular field with 
all other divisions fully informed of the work being done. 

When Dr. Kawlings assumed office most of the divisions in the De- 
[lartnieni w ere \eiy small and several of them were scarcely more than skele- 
ton units. By !!:»•<;? all of them had been materially strengthened, giving 
the Department the capacity td perform jiromptly and elYectively all of the 
activities in which it professes to engage. 

The foregoing statements concerning the health machinerv in the State 
suggest the way emjiloyed by Dr. Rawlings in binding it together into a 
systematic whole so that every unit of the State Department of Public Health 
and every other agency engaged on a significant scale in public health work 
meshed together in their programs and eft'orts like gear wheels that drive 
mechanical machines, b'vidence that the job was well done is found in the 
accuracy, magnitude and [iromptness of returns of statistical data dealing 
with births, deaths and disease. Another evidence is found in reports of 
local participation in various campaigns inaugurated by the Department. A 
still more important evidence is the freedom which the State has enjoyed 
from epidemic diseases and the steady decline in infant mortality and the 
prevalence of such diseases as smallpox, typhoid fever and diphtheria. 

Much detailed information concerning the organization, functions and 
activities of the various divisions may be found in the chapter on each di- 
vision's history. 

Intra-Departmental Organization of State Health Machinery 

b'roni the time when the State Board of Health was cre.'ited until IS'.M) 
there was no distinct division of labor among the regularly employed per- 
sonnel. In julv of that year two men were appointed to devote their full 
time to the inspection of lodging houses. While these appointments were 
originally made on a temporary basis they proved to be permanent in char- 
acter and became established as a distinct unit of the State health machinery 
when the General Assembly made a specific appropriation for lodging house 
inspection in 1:m)1. This then was the first step toward a .State health ser- 
vice organized into specialized units. 

.Along about 1902 or 1903 one member of the office staff of the State 
Board of Health was designated as State registrar of vital statistics but in 
1904 the same man. W. !I. Hoyt, was also designated as State bacteriologist 
and given charge of the small diagnostic laboratory which started then. Then 



rUBLIC HEALTH All-MIXISTKATION 209 

ill VJO'j the General Assembly included "registrar of vital statistics", "bac- 
teriologist" and "laboratory" as items for whicb specific appropriations were 
made. Yet it appears that no marked division of labor took place but that 
the technical and clerical employes were subject to routine duties of what- 
ever character might be most pressing at the moment. 

Subsequent to 1905 there appears to have been little or no attempt at 
organizing the resources of the State Board of Health into specialized units 
until 1915 when a definite plan of organization was adopted and five bureaus 
were created. These included "medical and sanitary inspection", "vital sta- 
tistics", "laboratory", "sanitary engineering" and "lodging house insjjection". 
Each of these was the forerunner of what became a division of the State 
Department of I'ublic Health under the Civil Administrative Code adopted 
in 191 T. 

The first appropriation under the Civil Administrative Code, made in 
1917, specifically, provided for seven divisions. These included "general 
office", "communicable diseases", "tuberculosis", "sanitation", "diagnostic 
laboratory", "\ital statistics" and "lodging house inspections". As a matter 
of fact 1(1 divisions were created in \'M]. including besides those listed above 
"child hygiene and public health nursing", "surveys and rural hygiene" and 
"public health instruction". To these was added the division of "social 
hygiene" in 1918. In 1927 the divisional designation was the same except 
that the division of "surveys and rural hygiene" had lost its identity in 1921 
and the division of sanitation changed its name to "sanitary engineering". 
Details concerning each division are enumerated under its own title on the 
following pages : 

Gener.\l Office. 

The general office is made up of the Director, assistant director, chief 
clerk and corps of clerks. Up until 19i; the general office was about synon- 
ymous with the State Board of Health so far as sanitary and hygienic work 
was concerned. Sanitary engineering, diagnostic laboratory services and 
field medical activities were centralized under different heads and the first 
two occupied independent quarters. There was also a registrar of vital sta- 
tistics but this work was done in the main office and came under the imme- 
diate supervision of the chief clerk of the State Board of Health. 

Since 1895 the general office has been presided over by a chief clerk 
Prior to the introduction of the division plan the chief clerk actually directed 
the office personnel employed in the State health service with the exceptions 
mentioned, .\fter the introduction of the division .system in 1917 the gen- 
eral office has been a headquarters unit through which divisional contact is 
maintained. Technical matters are left entirely to the division chiefs who 
are responsible to the director for matters of a scientific and technical nature. 



211) 



'UBLIC IM'.AI.TII ADM IMS'IUATION 




Mr. Chas. Ry 



All department records and correspondence are hanilled by the general 
office. Through it all accounts are settled including payrolls. In it is lo- 
cated the central filing system which was introduced by Dr. Rawlings in 
192G. All personnel records are also ke])t there. 

Although it was customary to have one person in 
charge of the clerical force prior to that time, specific 
provision for a chief clerk was first made by the legis- 
lature in 18!)."). Mr. F. A. Treacy was the first man 
a])pointed to hold that position, he being already in the 
employ of the State Board of Health, at the time the 
jsition was first recognized by the legislature in the 
appropriation law. He was succeeded in May, ISDT, 
Mr. Charles Ryan who in turn was succeeded on 
Mav I, 1 !)()!, bv Mr. Amos Sawyer. Mr. Sawyer has 
filled the office of chief clerk cimtinunu^ly from the 
time of his appointment to date. 

Divi.sioN OF Communicable Diseases. 

The work of this division, as the name implies, is concerned directly 
with the control of contagious and infectious diseases. It has charge of 
morbidity reports, quarantine, rules and regulations relating to reporting 
and quarantine, epidemiological investigations, 
promotion of local health machinery and the 
distribution of biologies such as antitoxin, vac- 
cine, silx-er nitrate, etc. 

While activities of the character of those 
performed by llu- <li\isi(in have been partici- 
jiated in by the State health agency since its 
creation in ls77 the work was not centralized 
nor carried on in a systematic way until l!)ir) 
when the bureau of medical and sanitary in- 
spection was established. Prior to that time 
the field work was done by the secretary him- 
self or ])h\sicians or lay quarantine officers 
emploved on a per diem basis. Sometimes 
the physicians so eiuployed were members of t>'- ■'■ ■'■ iiiSiiMne. 

the State Board of Health. More often they 

were not. Beginning about 1!)00 a scheiue was devised whereby a number of 
])hv>icians. located at convenient jwints in the State, agreed to accept appoint- 
ment for temi>orar\- dutv whenever called upon and receive therefore remun- 
eration at a sti])ulatt(l per diem rate. This method of handling communic- 




PUBLIC HEALTH ADMINISTRATION 211 

able diseases continued until July, HH."). when it was converted into the 
bureau of medical and sanitary insi)ection with a definite amount of money 
appropriated sufficient for eniplo}ing- a medical staff of five and specific 
duties assigned to it. 

By early spring of 1916 the necessary civil service examinations had 
been held and the five appointments made. They included Dr. E. S. God- 
frey, who was designated as State epidemiologist. Dr. C. E. Crawford, Dr. 
C. S. Nelson, Dr. Clarence W. East and Dr. I. N. Foster. These physicians 
were assigned to field duty, each covering one of five districts into which 
the State was divided for that purpose and all were placed under the general 
supervision of Dr. Godfrey. Besides these district health officers, as they 
were called, there were attached to the bureau three dairy inspectors, one on 
a full and two on a part time basis and a small clerical staff. 

In r.iK, with the adoption of the Civil Administrative Code by the State 
government and the consequent reorganization of the health service, the 
bureau of medical and sanitary inspection became the division of communi- 
cable diseases which title it has retained. Funds sufficient to employ one 
chief, one superintendent of field service, six district health officers, two 
nurses, two (|uarantin_e officers and a clerical staff" of five were appointed to 
the division. All of these positions were filled although the two nurses and 
one physician were utilized in another type of service and formed what de- 
veloped into the division of child hygiene and public health nursing. Dr. 
J. J. AlcShane became the first chief of the division, on August 1. T.>1 i. as 
a result of a civil service examination. Dr. McShane has continued in that 
capacity to date. 

During the ten years ended with June -W. \'.^'i]. the field personnel of 
the division varied considerably, dtie to small salaries provided in the early 
part of that period and fluctuations in the appropriations made from time 
to time. In I'JIO a total of $16,000 per year was granted for the employment 
of district health officers, with maximum salaries specified at $2500. The 
next General Assembly, that of 11)21. raised the appropriation for medical 
field personnel to $100,000 per year, set $1,800 as the maximum salary and 
changed the title of the positions to district health superintendents. Tlie 
difficulty of securing trained men delayed the filling of these places, how- 
ever, so that the field strength never exceeded abotit 20 men. Then in 11>2;) 
the sum apjiropriated for district health superintendents was set back to 
$30,000 per year and raised ag.iin \n ^:,{).()\ut in 1'.I2.''). In l!t2; it remained 
at $50,000 with the maximum salary placed at $l,<iii(l, which had been set 
in 1923. 

The amount of strength actually em])loyed v.aried about as the ap])ro- 
priations but ne\er up to the maxinnim i)ro\i(led for. ( )n Jidv 1. ]'.<'!] there 



213 PUBLIC iii;altu ahmixistratiox 

were 13 district lu-alth superintendents, including a chief, at work, in addi- 
tion there werr the- (li\ ision chief, an assistant epidemiologist, two quarantine 
ofificers, one industrial hygienist and a clerical staff of ten. 

All (if the ])crsonnel of the division is employed on a full time basis. 
The State is divided into districts equal in number to the number of district 
health superintendents employed. Each of the latter maintains headquarters 
in tile district to which he is assigned so as to facilitate field service. 

It has been the practice since 1921 to hold meetings of the field staff 
periodically in order to increase the efificiency of the force by permitting gen- 
eral discussion of their problems and bringing to them the proper interpre- 
tation of policies, plans, programs and procedures included in the De- 
partment's services. These conferences are held at least annually and some- 
times oftener. 

Bill IS (uid Ixcgulatious Pro))iiih/afcfL 

When the State Department of I'ulilic Ik-alth was created in IHK the 
division of communicable diseases was charged by the Director of I'ulilic 
Health with making rules and regulations governing quarantine and re- 
porting of diseases, with the collection and compilation of morbidity reports 
and with epidemiological investigations. It was also made responsible 
for the distribution of such biological products as the Department furnished 
to the citizens of the State. Its duties also included the promotion of local 
health service. 

The history of the rules and regulations dates back to liSI] when 
health work first began as a function of the State government. For. 38 
years, however, there was nothing very specific about them except in special 
cases. When yellow fever threatened ; rules were promulgated in regard 
to quarantine at Cairo. When smallpox broke out there were rules that 
required isolation of patients. At one time, prior to ls'.i."i. rules reciuired 
the vaccination of all school children but this was later annulled liy a coin-t 
decision. Furthermore, and of great importance, there was no machinery for 
enforcing rules once they were made. Cities and villages had authority 
to make rules and regulations concerning disease control and the same 
power was granted to counties later. Up until j!K)3 the local regulations 
fre(|uentlv conflicted with those of the State and then confusion arose. 

.\bout the only rule that really operated satisfactorily before I'.M.") was 
that relating to the liiuMal of dead. This rule reciuired permits from local 
registrars before bin'ial and its purpose was to primiote conqilete filing of 
death notices. 

In fDl.") all the quarantine rules and regulations were codified, and the 
pro])er local officials specified as the person to whom reports should be made 



PUBLIC HEALTH Al ).M 1 X ]STK ATI! )X "J J o 

This step clarilicd the air of confusicsn making it plain what the rules were 
and to whom reports should be made. Length of quarantine, sanitary pre- 
cautions on quarantined premises, diseases for which quarantine should be 
established and like matters were detinitely specified. 

Under the early system there was difficulty in getting reports of con- 
tagious diseases. Altogether some 2,700 local officials were included in the 
list of those who should receive reports. Many of them did not know it. 
Others who received rejiorts had little inclination to pa_\' the postage neces- 
sary to send them in td the State Board of Health. At times the State 
Board of Health sent out communications asking for the required informa- 
tion. Sometimes it was returned and sometimes not and its reliability was 
questionable at best. 

In ]!)]? two things happened that helped matters. The State Director 
of Public Health was ajijicinted collaborating epidemiologist for the U. S. 
Public Health Service w itb jirixilcge of supplying local health officers with 
postage free report cards. The other thing was the establishment of the 
division of communicable diseases with its held staff on ;i full time basis. 
Reports began at once to improve. 

There was still the difficulty of knowing who the Ideal health officers 
were. This was corrected by an amendment to the State Board of ITealth 
Act in l!l■^3, new sections being added as follows: 

"Section 21. Tlie county clerk of ever.v county under townshiii or,s;anizatioii 
shall, annually before the first of May furnish the Department of Public Health 
the names and postofiice addresses of the supervisor, assessor and town clerk of 
every township in the county, the date when their terms of office expire and the 
township of which each is an oiflcial. The county clerk of every county not under 
township organization shall, annually before the first of December furnish the 
Department of Public Health the names and post otfice addresses of the county 
commissioners and the date when their terms of oflice expire. 

Section 22. The clerk of every city, incorporated town and village shall, 
annually before the first day of May furnish the Department of Public Health the 
name of the mayor or president of the board of trustees, the clerk, the health offi- 
cer and the members of the board of health and this list shall indicate which 
person is charged with the enforcement of quarantine regulations. 

Section 23. The county, city, incorporated town or village clerk shall 
promptly inform the Department of Public Health of vacancies in the ofilces 
named in sections 21 and 22 of this Act and appointments or elections to fill such 
vacancies." 

From 19"2;) on reiiorts have steadilv im])rovc(l in lioth jiromptness and 
completeness. 

\\'ith improvement in the character of municij>al health departments 
it appeared wise to permit a wider use of local di.scretioii in connection 
with quarantine than the strict letter of the rules would permit in all cases. 
Thus in 1923 a system of wdiat is known as modified cjuarantine regulations 
was inaugurated. By means of this arrangement local health officers wdio 
are able to satisfy the State Director of Health that they have the facilities 



214 PUBLIC HEALTH AIIM I X ISTUATIOX 

for adequately handling; the local situation may receive permission to prac- 
tice moditied quarantine. This system permits the isolation of a ])atient 
in a room to himself with attendant and the free use of the remainder of the 
house by other members of the ([uarantined premises. 

Another instance of the changing character of the rules was the in- 
clusion of carriers of disease within their scope. Thus persons found to lie 
chronic carriers of typhoid fever are required to stay out of occu])ations that 
bring them into direct contact with food supplies of other people. 

('<ii/l(i(/i(iHs Di.srasc Bi ports. 

Subsequent to 1915 when the rules were first codified and made specific 
they have been revised many times i:i order to conform with the ever in- 
creasing knowledge about handling disease and with the changes in habits and 
customs of the people. The scope of the rules has increased also, new 
diseases being added to the notifiable list from time to time and new uses 
being made of the rules as preventive measures. Thus in VJ'io a rule pro- 
hibiting the sale of oysters for raw consuinption in Illinois was placed in 
effect and another in VJ26 prohibiting the sale of stearate of zinc toilet 
powder in any but safety top containers. 

Reports received at the office are immediately coiui)iled on forms ar- 
ranged for that purpose so that daily totals are made showing the incidence 
reported by counties, principal cities and the State. These daily reports in 
turn are compiled into weekly, monthly and annual summaries. The filing 
system enables reference to be made to counties, cities arid townships. This 
office system was started in ISf.'l so that reliable data are axailablc back 
to that time but figures for prexious years are more incomplete. 

A system of spot maps and weekly ])revalence charts was ado])ted 
in 1U24 and a systeyi of notifying local health officers of the prevalence of 
disease in the State was started in 1926. The latter is a weekly service which 
keeps local health officers informed of all reported cases of the principal 
diseases ;md the foci of iiift-cticjns as well. 

Liiirs A jijil jiiiifi In Willi,' (if DirisiiDi. 

The inqiortant laws affecting the activities of the division are not many. 
First in importance was the .State Board of Health .\ct of ISTT, which reads 
ill jjart, as amended in liJOT, as follows: 

"The State Board of Health shall have the general supervision of the inter- 
ests of the health and lives of the people of the State. They shall have supreme 
authority in matters of quarantine and may declare and enforce quarantine when 
none exists, and may modify or relax quarantine when it has been established. 
The board shall have authority to make such rules and regulations and such 
sanitary investigations as they may from time to time deem necessary for the 
preservation and improvement of the public health, and they are empowered to 
regulate the transportation of the remains of deceased persons. It shall be the 



PUBLIC HEALTH ADM I N ISTKATIOX 215 

duty Of all local boards of health, health authorities and officers, police officers, 
sheriffs, constables and all other officers and employees of the State or any 
county, village, city or township thereof, to enforce the rules and regulations 
that may be adopted by the State Board of Health. 

It shall be the duty of the State Board of Health to investigate into the causes 
of dangerously contagious or infectious diseases, especially when existing in 
epidemic form, and to take means to restrict and suppress the same, and when- 
ever any dangerously contagious or infectious disease shall become, or threaten 
to become epidemic, in any village or city and the local board of health or local 
authorities shall neglect to refuse to enforce efficient measures for its restriction 
or suppression or to act with sufficient promptness or efficiency, or whenever 
the local board of health or local authorities shall neglect or refuse to promptly 
enforce efficient measures for the restriction or suppression of dangerously 
contagious or infectious diseases, the State Board of Health or their secretary, 
as their executive officer, when the board is not in session, may enforce such 
measures as the said board or their executive officer may deem necessary to 
protect the public health, and all necessary expenses so incurred shall be paid 
by the city or village for which services are rendered." 

Prior to this, in point of clironology, wa.s the Cities and Milages Act 
of 1872 that gave these mtinicipalities authority to establish boards of health. 
Then came the law of 1901 that created boards of health in rural districts 
by making countv c( inmissioners, stipervisors, assessors and town clerks 
constitute boards of health. 

A law was enacted in 1911 which reijuirctl employers of labor to protect 
employes from undue exposure to poisonous chemicals used in manufactur- 
ing processes. 

The State health officials were required to receive reports of occupa- 
tional diseases under this law and to transfer the notice to the State factory 
inspector for disposition. This same law requires monthly physical exaitiina- 
tions of all em])loyees engaged in certain occupations where they are exposed 
to lead and other ])ois()nous chemicals. 

In 1917 there was enacted a law authorizing the ■'establishment of local 
health departments by popular vote in one or more adjacent towns or road 
districts. Under ibis law taxes may l)e levied, collected and spent for lu-.-ilth 
purposes only. 

In I'.iD.j a law was enacted providing free I'asteur treatment f(ir poor 
people bitten by rabid animals and in the same year the Stale i^oard of 
Health Act was amended st) as to require the appointment of antitoxin 
agents in every county. Then in T.i()7 a clause was added to the a|iprnpria- 
tion law providing for the free distribution of antitoxin. In 1911 t\i>lioid 
vaccine was added to the free list and silver nitrate in 191.'). Later the law 
on this subject became general so that the Department is in a position to pur- 
chase and distribute whatever biologies may be deemed necessarv for the 
preservation and improvement of the public health. 



216 ri'iii.u; health admi.nistkatiox 

In i;i|5 what is known as the Ojjhlhahnia Nennaturuni Law was en- 
acted. This law defines ophthalmia neonatorum and makes it the duty of 
physicians and niidwives to report all cases immediately upon discovery. 

Dist rihiiUdii (if Biologies. 

The (li>Iriliution nf free state biologies began in IDOl, when the legis- 
lature aijpropriated $15,000 to the State Board of Health for that purpose. 
Diphtheria antitoxin was the only product included at that time. 

l)istrihutii)n was accomplished through a system of agents, usurdly a 
local druggist. This agency system began in 1905 when a law was passed 
requiring their appointment and providing that they shall handle antitoxin 
approved by the State Board of Health. Then after the 1907 act they be- 
came the agents for distributing diphtheria antitoxin supplied free by the 
State. By 1927 these agents, who number 477, were handling antitoxin, 
toxin-antitoxin, silver nitrate and typhoid vaccine. 

The biologies provided by the State in 1922 included the following: 

Diphtheria Antitoxin, in both immunizing and curative doses. 

Diphtheria Toxin-Antitoxin, for active immunization against diphtheria. 

Schick test material to determine susceptibility to diphtheria. 

Silver Nitrate Solution to be used in new born babies' eyes, as a preventive 

of Ophthalmia Neonatorum. 
Typhoid Vaccine tor immunization against Typhoid Fever. 
Smallpox Vaccine as a preventive o£ Smallpox. 
Antirabic Vaccine for prevention of rabies In humans. 

The antirabic treatments are available free to poor people only but the 
other products are free to every citizen who needs any of them for therapeu- 
tic use. 

Table 23 shows the amounts of biologies distributed during recent years. 



PUBLIC HEALTH AD.M I XISTRATIOX 



217 





1 


38.416 
39,306 
60,409 
75,811 
79.500 
41.907 
29.047 
30.565 
16.630 


s 




til 


450 

730 

1,078 

1,717 

3,289 

295 

412 

870 

93 


s 






1,550 

839 

1.197 

1,886 

2,483 

407 

437 

805 

365 


! 




o S( 




1 


i 




5 


7.474 
8,995 
16,586 
21,863 
24.590 
13,589 
10.109 
10.069 
5,340 


1 


z 

o 

H 


it 


10,528 
9,717 
16,564 
20,504 
20,437 
10,774 
5,752 
6,342 
3,640 


'A 
< 


il 


llli 




S 




°-3 


13,501 
14,166 
22,539 
29,844 
28,701 
16,842 
12,337 
12,479 
6,740 


S 
















s 




July 1, 1918-June 30 
July 1, 1919-Junc 30 
July 1, 1920 June 30 
July 1, 1921-Jiuie 30 
July 1, 1922-Juuc 30 




1 



2I« 



I'UliLIC lllCALTH AD.MIXISTKATION 



PUBLIC HEALTH ADM IXISTRATION 

Table 2'■^ — Continued. 
Toxin- Antitoxin. 



219 





St.vle A 
sinsle tr. 


Style B 
three tr. 


St.vle C 
ten tr. 


Total. 




4,106 
588 
793 

1,089 
212 




2,433 
1.147 
2.513 
2.679 
2,053 


6,539 






1,735 






3.306 






3,748 




5,929 


8,194 








6,768 


5,929 


10,825 


23,522 







Schick Test Material. 





No. pkgs. 


Total tests. 


July 1 1923 .lune 30, 1924 . 


181— 50-tests ea. 
128— 50-tests ea. 
285— 50-tests ea. 
295— 50-tests ea. 


9,050 




6.400 




14.250 




14.750 








889 pkgs.— 50-tests ea. 


44,450 







Smallpox Vaccine. 





No. pkgs. 


Total points. 




1,443— 10-points ea. 

1,464— 10-points ea. 

202— 10-points ea. 


14.430 points 




14,640 points 




2.020 points 








3,109 


31.090 points 









A 


\TIRAIilIC 


Treatment. 






No. pk'.s. 


Total. 


lulv 1, 1924-June 30, 1925 


56 

90 paiil 

77 pai.l 


for In- .statu, 31 jiaiil for personall.v 
for b.v state, 19 paid for personally 


56 


Inlv 1, 1925 .Jime 30, 1926 


121 


Jul.v 1, 1926-l)ec, 31. 1926 




96 


Total distribution 


223 paid 


for by state, 50 paid for personally 


273 



I'Uin.lC lllCAI.lll ADMINISTRATION 




DniSIO.N ()!■' TrBERCULDSIS. 

'I'lu' division of tulnTculosis has never been more llian a skeleUm unit 
of the State Uepartmenl of Public Jlealth, Lii<e most of the others it came 
into being with the organization scheme that was adopted July ], 1917. From 
the beginning it has been inseparable from the gen- 
eral office, having as its titular head, the assistant 
directcjr and occupying space in the main office. 

In IHK a salary of -$2,800 per year for a chief 

of ilu- division was appropriated. That was dropped 

in 1 !•!'.• and an item of $],o"^0 per year for a sit- 

|ier\ising nurse took its ])lace luit no nurse was 

v\iT ;i|ipi)inted. the entire sum lapsing back into 

ilic treasury. In lH'il there were two items in the 

;ip|iro|iriation — one of •$.'), 000 per year for a su- 

n ■ r ■■ . Ti I pervisor of sanatoria and one of ^],"i!oo for a 

i'"'""^''- stenographer. From that time on there was no 

change made in the a])propriations for the di\ision initil I'.^'i', when an item 

of -$1,800 ])er year was added for a (|u,irantine officer ancl investigator. 

The princiiial activities of the di\ision have been rather of a liaison 
character between the State Department of I'ub- 
lic Ilealth and other agencies. There is a strong 
\iiUnUar\- tuberculosis association functioning in the 
."^tate, forty-eight counties having taken ad\antage 
of the law authorizing a tax levy for the construc- 
lion and maintenance of sanatoria. In the fol- 
lowing counties the Glackin Law has l)een ado])t- 
ed b\' .a referendum vote. In lifteen of these 
counties sanatoria have been built. In the others, 
with few exceptions, there is a fund for the care 
ami treatment ( f the tuberculous: 




II. t.c'onard. 



Adams 

Alexander 

Boone 

Bureau 

rhanipaign* 

Christian 

Clark 

Clay 

Coles 

Cook* 



Crawford 

DeKalb 

DeWitt 

Douglas 

Fulton 

Grundy 

Henry 

Jackson 

•Jefferson 

Kane* 



Knox 

I^aSallc* 

Lee 

Livingston* 

Logan 

McDonough* 

McLean* 

Macon* 

Madison* 

Marion 



Menard 

Montgomery 

Morgan* 

Ogle 

Piatt 

Pike 

Randolph 

Rock Island* 

Sangamon 

Scott 



Shelby 

Stephenson 

Tazewell* 

Vermilion 

Whiteside 

Will* 

Winnebago* 

Woodford* 



■ Count! 



PUBLIC HEALTH ADMIXISTKATIOX 2'U 

This being the case it has been unnecessary for the State Department 
of Pubhc Health to maintain a strong organizatiiui for service in that par- 
ticular field. 

Dr. George Thomas I'ahner. assistant director of the State Department 
of Public Health from 1!JK to lll'.'l acted as chief of the division diu'ing that 
period. In August V.)2l. Dr. I'almer was succeeded in his dual capacity 
1)V Dr. Thomas H. Leonard who has continued to date in the piosition. 

Divisiox OF !Saxitai;v Excixei-^rixg. 

Previous to the establishment of the division of sanitary engineering, 
the State Board of Heahh carried on occasionally in a limited way some of 
the phases of public health work which are now handled by the sanitary 
engineering divisions of modern health departments. 
These activities relating to sanitary engineering 
were carried on almost entirely by engaging tem- 
porary outside assistance or by cooperative arrange- 
uKui with State or outside agencies. 

In 1S7!) the State Board of Health gave some 
attention to the pollution of the Illinois River 1)\- the 
city of Chicago. In 1880 the Board had stream- 
pollution investigations made at Chicago, Peoria, 
Springfield, Ouincy, Rock Island, and Rockford. 
The records indicate that in 1883 some further 
sanitary inspections of streams were made. The i^aui Hansen. 

legislature in 1885 appropriated a contingent fund to engage servico of 
analysts, observers, and other assistants for examination of water sui)plic> 
and polluted streams in the State. In 18SS an analytical study was made of 
the quality of the larger rivers in Illinois that were more or less ]3olluted, 
the samples being collected over a [)eriod of si.x months. In 19i)U engi- 
neers, not regular employees of the Board, were engaged to investigate the 
contamination of Mississippi I\i\-er at Chester by sewage from the Southern 
Illinois Penitentiary. 

The need for sanitary water, sewage, and stream-pollution surveys 
apparently becoming more and more realized and the procedure of engag- 
ing part-time occasional outside assistance proving not sufficient, the Board 
adopted a resolution in 1894 favoring an apisropriation by the legislature 
of money to the University of Illinois for making analyses of sam])les of 
water and polluted streams at the laboratories of the Universitv. As a 
result such analytical studies were undertaken at the L'niversitv in KS!).") 
tmder the supervision of Prof. Arthur William Palmer. The approi)ria- 
tion to the Universitv at that time for additions and imijrovements to the 




'i'i'i VVV.LH' UI'.AI.ril ADMINISTRATION 

clu-mical lahnratory was -^ojioii. 'Hic chemical studies of the waters of 
llliiidis at the L'liivcrsily ])ossil)ly ikjI fully meeting the needs of the State 
Board of Health, the Board in IS'.il) adojited a resolution ])reliminary 
to the en^^^as^enicnt of the services of I'rof. John II. I.onL,f. of .Vorthwest- 
crn I'niversity .Medical School and lac(]h A. llarnion. a ci\il cnt^ineer of 
I'coria. to investigate the (|uality of the w.atcrs of lllimiis River. l're\ious 
to this time the Board had some stream-jwllution 
studies made by Professor Long and the results 
of these investigations of the Illinois River are 
included in a report of the Board issued in 1901 en- 
titled "Saiiftiirv IiiZ'cstifiatioiis of the Illinois River 
(iiiil I'rihiilarics". 

The decision of the United States Supreme 
Court in favor of the State of Illinois and the 
.Sanitary District of Chicago in the action brought 
li\ the state of Missouri because of the discharge 
of sewage from Chicago into a tributary of Mis- 
sissippi River was handed down on February 19. 
studies made by Professor Long and his associates 
at the reipiest of and by arrangement with the State Board of Health 
were major items of evidence in this litigation and the favorable outcome 
of the State of Illinois, was based to (|uite an extent uiion these investiga- 
tions. 

In a further eft'ort to increase the extent and value of chemical studies 
of waters and streams of Illinois, the Board in 19U(.! entered into a co- 
ojjcrative agreement with the State Water Siu'vey located at the Uni- 
versitA-. and which had developed into a separate unit although administered 
bv the L'niversitv trustees since the chemical studies (jf the v\ aters of Illi- 
nois were started in 1S!L3. 




Harry F. Ferguson. 

T.IOC. The report and 



Siniitdii/ EiiijiiK I riini Iiiir(<iii EslahVislHi}. 

I!v llM.'i the need of full-time systematic engineering activities became 
so apparent that the legislature in that year appropriated funds for the 
estalilishmenl of a sanitarv engineering bm'cau under the State Board of 
llealth. An integral part of modern pii])lic health activities is sanitation, 
espet'iallv that relating to w.ater supply, sewerage, and stream pollution, 
and experience appareniK li.id ^ho\\n that full etticiencv and effectiveness 
could not be olit.ained. I'speciallv to nu'ct increasing demands caused by the 
increase in po]>ulation m the St.ate, bv the engagement of outside occasional 
services and cooperative agreements with otiier agencies located miles away 
from the l!o,u-d headquarters. 



PUBLIC HEALTH ADM I XISTRATIOX 



2 2;? 



The first appropriations for the sanitary engineering biu-eau provided 
for a chief engineer, an assistant engineer for field studies, an assistant 
engineer for a water and sewage laboratory, and a stenographer. Paul Han- 
sen was a])pointe(l by tlie Board of Health upon the reconimenchition 



160 


- 




140 


- 


/ 


120 


- 


/ 


100 




5cweraqe and stream poUvilon / / 


6t> 
60 




— — " " Scwerat^e \\ / , 




/ /' 


40 




V^' / 


20 


. 


Strcom pollution 











■" 


1 1 1 J 1 1 



151819 \9l9-aO 192021 I92RZ 1922-23 1923-2'^ 1924-25 1925-26 1916-27 
FISCAL VEAR5 

Fig. 13. Number investigations made b.v sanitary en,aineer relative to 
existing and proposed sewerage installations and stream pollution. 



400 


r 


J50 


\ ^^ 


300 


r /""^ 


tSO 


: y 


100 


\ ^~~~~~~^ 


150 


- ^^^ 


100 


^^^"^^ 


50 


'- 




; 



Fig. It. Xumber of investigations made by sanitary engineers ot existing 
and proposed public water supplies by fiscal years. 



224 



PUBLIC HEALTH ADMINISTRATION 




I9?l-2i mZ-23 1923-24 19Z4Z5 

nSCAL YEARS 



Fig. 15. Niiml)er of inspections made by sanitary engineer.s for all pur 
poses by fiscal years since July 1, 1918. 




Fig. Ifi. Number of water analyses. 



PUBLIC HEALTH ADM IXISTRATION T40 

of Dr. C. St. Clair Drake to serve as chief engineer to organize the new 
bureau, and later Mr. Jrlansen agreed to continue in that position and the 
aiijiointmeni was conhrnied by the civil service commission after hold- 
mg an examination. He resigned in 1 !»";;() and was succeeded on Alay !•") of 
that year by Harry F. Ferguson, then principal assistant engineer, who has 
continued as chief sanitary engineer to date. 

That the establishment of a sanitary engineering bureau by the 1!»15 
legislature was a sound step and the sanitary engineering activities inet a 
need throughout the State is perhaps best evidenced by the fact that the 
following legislatures have from time to time increased the appropriations 
for that division so that on July 1. 192T the positions in the division 
had increased from three engineers and one stenographer to seven engi- 
neers, three bacteriologists and chemists, one supervisor of rural sanita- 
tion, two milk sanitarians, six clerks and stenographers, and f(.iur other 
assistants. 

Previous to the adoption of the Civil Administrative Code in IHIT. 
the actixities of the bureau of engineering were regulated by the law cre- 
ating the State Board of Health as amended and especially that portion 
of the law' which provided that the State Board of Health shall have 
■'general .supervision of the interests of the health and lives of the citizens 
of the State" and "authority tu make such rules and regulations and such 
sanitary investigations as ihev may from time to time deem necessary 
for the preservation and improvement of the pulilic health". 

In accordance with this law the Board in IDIO adopted the following 

rides and regulations relative to water and sewerage installatioits : 

"(1.) No municipality, district, corporation, company, institution, person 
or persons, shall install or enter into contract for installing, waterworks oi sewers 
to serve more than 25 persons until complete plans and specifications fully describ- 
ing such waterworks or sewers have been submitted to and received the written ap- 
proval of the State Board of Health and thereafter such plans and specifications 
must be substantially adhered to unless deviations are submitted to and receive the 
written approval of the State Board of Health. 

'■(2.) No municipality, district, corporation, company, institution, person or 
persons, shall make or enter into contract for making, any additions to, or changes 
or alterations, in any existing waterworks serving more than 25 persons, when 
such additions, changes, or alterations involve the source of supply or means 
for collecting, storing or treating the water, until complete plans and specifica- 
tions fully describing proposed additions, changes or alterations have been sub- 
mitted to and received the written approval of the State Board of Health and 
thereafter such plans and specifications nnist be substantially adhered to unless 
deviations are submitted to and receive the written approval of the State Board 
of Health. 

"(3.) No municipality, district, corporation, company, institution, persons 
or person, shall make or enter into contract for making, alterations or changes 
in or additions to any existing sewers or existing sewage treatment works, serv- 
ing more than 25 persons, until complete plans and specifications fully describing 
such alterations, changes or additions have been submitted to and received the 
written approval of tlie State Board of Health and thereafter such plans and 



2'H> iTiu.ic iii;ai.tii admimstkation 

specifications luiist be substantially adhered to unless deviations are submitted 
to and receive the written approval of the State Board of Health. 

"(■1) Any municipality, district, corporation, company, institution, persons 
or person, owning or operating a water purification works or sewage treatment 
works shall submit to the State Hoard of Health monthly records showing clearly 
the character of effluents produced. 

"(T).) No municipality, district, corporation, company, institution, person or 
persons, shall offer lots tor sale in any subdivision, unless within the boundaries 
of an area incorporated as a municipality or sanitary district, until complete 
plans and specifications for sewerage, drainage and water supply, have been 
submitted to and received the written approval of the State Board of Health and 
thereafter such plans and specifications shall be substantially adhered to unless 
deviations are submitted to and receive the written approval of the State Board 
of Health. 

"(6.) No natural Ice shall be furnished or vended to the public for domestic 
purposes until the source of the ice supply has received the written approval of the 
State Board of Health, which approval is revocable upon evidence being pre- 
sented or discovered of undue contamination entering the source." 

The Civil Administralive Code placed upon the Department of Public 
Health all of tlie dtttie.s and powers of foniier Iniards of health in^-ofar as 
the sanitary engineering- activities were concerned, and in addition provided 
more delinile duties relruive to \vater-su])])lv and sewerage installations by 
providing that the ])epannient of Public Health shall have authority as 
follows: 

"To act in an advisory cajiacity relative to pulilic water sttpjilies, water- 
])urillcation works, sewerage systems, and sewage-treatment works, ;uid to 
exercise supervision over ntiisances growing out of the operatimi of such 
water and sewage works, and to make, pronudgate. and enforce rules and 
regulations relating t(j such iniisances : 

"To m.iini.ain chemical and biological laboratories, to make examinations 
of mills, water, sewage, w.iles. ,ind other substances as may be deemed neces- 
sary for llie prolcclion of the people of the State". 

The w.ater supply and sewiTage rules adopted in 111 1(1 h.ave never formal- 
ly been rein-aled, but ihey are jiracticall)- \<iicl in A'iew of the pr(n-isions of 
tile Civil Ailminisiralive Act of I'U]. In accordance with that .\ct rules 
and regidaiions relating to sewage nuisances have been adopted. 

In l!)".'"i (he Department of I'ublic Health adopted a Railway Sanitary 
Code in confdinruice wilh a Standard Railway Sanitarv Code i)repared and 
recommended by the Conference of State and Territorial Health Ofiflcers 
in cooper.iiion with the Cnited States Public Health Service. 

The legislature in 1 !••.'•") enacted a law relating to milk-pasteurization 
])lants and instructing the Department of Public Health to adopt and enforce 
nn'nimum i-ei|uirements for ]iasieurizalion (ilants in accordance with the law. 
These mininnnn re(|uirements have been pre])ared and the wnrk rei|uired by 
the law and the en forci'uient nf the re(|uirenients have been carried on In- tlv.' 
sanitar\- I'nt'ineerini'" di\isi(in. 



- J 




238 l'l"!!l,K lli.AI.llI \IIM IXISTRATIOX 

PrhiciiHil Arf'irilirs. 

']'1h' tiilldwini; art- tin- iirincipal activities ol' the division of sanitar\' 
enginecriiif^ : 

1. Investigation and appnival of proposed new or improved public water- 
supply projects and examination of and advice relative to existing public water 
supplies, including water-purification plants. 

2. Investigation and approval of proposed new or improved public sewer- 
age projects, including sewage-treatment plants, and examination of and advice 
relative to existing sewer systems including sewage-treatment plants. 

?<. Investigation of stream pollution. 

4. Investigation of methods for the purification of water, sewage, and other 
liquid wastes. 

5. Water and sewage laboratory service. 

6. Examination and certification of water supplies for use on common 
carriers in cooperation with the United States Public Health Service. 

7. Investigation and advice relative to rural sanitation including water 
supplies, sewage disposal, camps, summer resorts, fairgrounds, country schools, 
etc. 

8. Examinations of and advice in regard to swimming pools and liathing 
beaches. 

9. Investigate and report on the prevalence and control of mosquitoes, 
especially in those areas where malaria is a public health problem. 

10. Investigate milk-pasteurization plants and issue certificates to those 
plants complying with the State law. 

11. Advice relative to municipal plumbing ordinances. 

12. Advice relative to local nuisances and insanitary conditions. 

13. Investigation of diseases that may be water-borne, such as typhoid fever 
and enteritis, in cooperation with the division of communicable diseases. 

14. Investigation of sanitary condition of school buildings. 

15. Investigation of sites for tuberculosis sanatoria with special reference 
to water supply, sewage disposal, and drainage, as a basis for approval of such 
sites as required under the State law. 

16. Studies of city waste collection and disposal and street cleaning. 

17. Filtration and distribution of State House drinking-water supply. 

IS. Educational work by means of publications, addresses, exhibits, and 
correspondence. 

The luiniher ol' total investigations made hy the staff of the division 
since slalistical records were keiH are graphicallv shown in Figures 13 and 
I I. and the number ot' investigations made relati\-e to different subjects in- 
cluded in the divisional activities, are illustrated in h'igures l.'i to IS. 

No atteni]it will be made to indicate any otitstanding activities of the 
division during the twelve year^ that it has been functioning as a ])art of fifty 
years of ]iit])]ic health work' by the .'-itate of Illinois because some activities 
which nia\ ;i|i|iear to be moi'e iniportant possiblv are less important tli;in 
some other a])])arentlv minor aclixilies of the dixision if all the restllts ob- 
tained cciuld be definitelv measured, b'or examjile. the acti\-ities of the di- 
vision during floods and tornadoes which have occurred in dilYerent parts of 
the Stale are more or less siiectacular ])ut the net result frcjin the standpoint 



PUBLIC HEALTH ADMINISTRATION 



229 




Fi(i. 17. Public water supplies installed by years in iiuinic 
Illinois. 




DECADES 
Fig. is. Population served from public water supplies in Illinois. 



230 



I'UHLIC HEALTH ADMIXISTRATIOX 



of lowered morbidity from ])reventable diseases and better and more health- 
ful (.-onditions may be acuially less than that resulting- from routine work 
and what might be tt-rmcd by some as "minor activities" such as bringing 
about the abandonment of cross-connections between ])ol!uted and safe water 
su])plies here and there as they are found, the rcjulinc checks on the ([uality 
of public water su])plies and sanitar\- disposal of sewage, advice and assist- 
ance relative to rural sanitation, routine insj)ections of milk plants, and other 
features making up the daily activities of a modern sanitary engineering 
dixision. 

The installation of public water supplies in nninici|)alities and the popu- 
lations served from such su|)plies during the early jieriotl compared with 
the later decades are an index of the advance in sanitation and the civil and 
sanitarx- engineering activities throughout the State during the period since 
and fvcn j)re\-ions to the establishment of the Board of Health. 

In a chroiiological record or history of jniblic health activities accom- 
panying this treatise on fifty years of public health in Illinois some of the 
activities of the division of sanitary engineering arc included, but as stated 
above the net ronlt in the decrease in the niorbiilit\- and mortality rates from 
certain diseases and the general improvement in public health may not be as 
great from some of these items as from the routine activities which have 
not ])efn listed but which would be too numerous to include in a chronologi- 
cal rec<ir(l of that kind. 



Divisio.x ()!•' Vital Statist^ics. 

The registration of births and deaths was from the very beginning an 
im]iortam factor in the agitation for State public health service. It has, 
therefore, been a matter of concern to the State health officials since the 
creatioti of the State Board of Health in 1S7T. 

I'robabh- no other problem has been so complex 
.iinl imzzling and few things in the whole history 
of pulilic he.'dlh service have been the object of so 
nuicli legislation. 

Mow to grt complete and ]irompt returns of 
liirtbs and deaths has been the ])erpetual question 
that pursued the executive officer of the .State health 
ser\ice vi-ar in and year out. Some made valiant 
atteni|)ts to collect and compile the statistics while 
Av. II, ii.,yt. others appear to ha\-e regarded the task as too great 

to justif\- the expenditure of eti'orts necessary to 
its achievement and let it go at that. 




PUBLIC IlKALTll ADMIXISTKATIUX 



2■^] 



The law i-c(|uirr(l all 




Eaiii) Ejf()ii.s to Collect Records of Births ami Dcailis. 

Thus at the very beginning in 18^7 an honest effint was made to col- 
lect vital statistics. In Deccml cr of that year forms were preiiarcd liy the 
State Board of Health ami vent out to county clerks 
certificates of births and deaths to be liled with the 
county clerks whose duty it was lo make summaries 
of their records and forward them to the State 
Board of Health on forms su[i[ilie(l for that pur- 
pose. 

'J'he whole business was new so that it re(iuired 
some little time to get the procedure started with 
any degree (jf satisfaction. The indomitable and 
indefatigable Ranch, who was secretary of the 
Board for most of this early period, kept steadfast- 
ly- at the job, however, until he was able to get suf- 
ficient returns in 1881 lo publish the data collected Orin Diiiy. 
for that year. The tables list death statistics for '.)■') of the 103 counties for 
1881 and for 78 in both 1882 and 1883. There were 80 counties listed in 
the tables for 188J: while the returns for 1885 and 1886 presumably repre- 
sented registration from all of the counties. Birth reports were published 
for some of these years. 

But registration was far from complete during any of this time. In 
188.") the secretary of the State Board of Health estimated the deficiency 
in birth registration was abotit 48 per cent and that for deaths about ol. 

\fter 1886 no birth or mortality statistics were prepared for publication 
until \'.Hri. In the meantime there' seems to have developed the attitude that 
it was practically impossible to get reliable data under the law and little time 
was lost in trying. Dr. Ranch recognizing the weakness in the law, reported 
to the Board in l88(j that he had been too busy with other matters to engineer 
an amendment or a new law through the legislature. 

.\t the quarterly meeting of the State B(jard of Health in January, 

l.s'.)'.t the secretar}'. Dr. Egan, reported: 

"Under the law now in force, all physicians and accouchers are required, 
under penalty of ten dollars to be recovered in any court of competent jurisdic- 
tion in the State, at suit of the County Clerk, to report to said clerks all births 
and deaths which may come under their supervision. The County Clerks are 
required also to report to the Board all births and deaths reported to them. 
This system of collecting statistics is so imperfect as to make the returns of 
no practical value. The law has been inoperative for over ten years. When an 
attempt was made to enforce it, it was found that very few physicians com- 
plied with the statutes, and that this Board has no power to compel them to do so." 

There were two principal factors that operated against satisfactory 
registration of vital statistics during all of the>e \ears. One was an in- 
adequate law and the other was lack of clerical machinery. 



2-3-> 



I'l'BI.ir lll.AI.III ADM IMSTKATinX 



H'o/Vr Lnffft. 

Tlui^ ihc opc-ninj,^ o\ i\\v ninct(,-cntli century fiiunil lioth the system 
and the registration of vital statistics in a rather chaotic condition. About 
that time matters began to take on a brighter aspect. Dr. Egan, secretary 
III ilic St;ite lioard of iieahh, managed to get a new law enacted in 1901. 
It re(|uired burial permits friim county or town clerks, according to the 
type of governiueni organization in the counties. It also provided a fee 
of So cents each to go to the person making the report to the local registrar. 
The burial jiermit feature was the backbone of the system and its enforce- 
ment would ha\e the desired results. 

About this time Dr. I'.gan also employed W. 11. Hoyt to have charge 
of the \ital statistic work of the Board. In r.Hi.'i an item for "registrar 
of \ital statistics" appeared in the aiipropriation law and from that time 
forward jirovision was regularly made for a regis- 
trar. 

l)r. I'lgan went further. He sent Mr. Hoyt to 
study the vital statistics system employed by the 
State Board of Health in Michigan, which was con- 
sidered verv good. .\s a result of this study a satis- 
factory method of handling the statistics was intro- 
duced in Illinois. 

The 1!HI1 law oi)erated with a fair degree of 
satisfaction to the State bioard of Health but it 
provoked formidable ojjposition in the counties not 
under township organization where burial permits 
could be issued only by county clerks. That often entailed considerable 
hardship and delay in coimection with funerals so that a general jiolitical 
movement to repeal the law entirel_\- was set in motion. This movement was 
strong enough to force a revision so a new law was enacted, one drafted by 
the secretar\- of the State Board of Health. 

This law pro\ided for birth reports to Lie made direct to count\- clerks, 
except in cities of .Mi.ooo cr more where the\- should go to the health 
comnussioner, and for deaths to lie reported direct to the State bSoard of 
Health exce]it in municipalilies enforcing a burial permit ordinance. A 
fee of ■^") ceiUs each was paid to the one making the report. 

Under this law statistics were complete enrugh to justif)' comiiilations 
and rejiorts for the years IIH)',' to I'.ii:; iticlnsi\'e. 

The last law afTecting vital statistics, the one now operating and known 
as the model vit.al statistics law. was enacted in l!M-i after having failed 
in two |ireceding attemjits. It provick s for a system of local re,gistrars 
located at convenient places in all parts ( f the .State. b'ees of 25 cents 




Slieldon L. Howard. 



PUBLIC HEALTH AD.M 1 \ ISTRATIOX 'i'.V^ 

each are paid to the local registrars while physicians and others are re- 
cjuircd to make reports as a luirt of their professional duty to society. 

Up until julv. !'.)()•.' \ital statistics received hy the State Board of 
Health were summaries compiled liy county clerks on forms sent out by 
the Board. Such analysis, recordint;' and fdinj; as was possible from these 
records was a relatively simple matter and reiiuired a relatively small 
amount uf clerical work. 

( )n August "2S, 190"2, a communication was directed to the count\ 
clerks making a change. It requested the county clerks to send the original 
certificates to the State Board of Health specifying that this would be con- 
strued as fulfilling the re(|uircments of the law. This change was effective 
July 1, 19U2. 

Manifestly the new method made necessary a much larger amount of 
clerical work on the part of the State Board of Health and required some 
one to supervise the classification, compiling and recording of the cer- 
tificates. Thus a registrar of \ital statistics was employed. He began 
to function in the spring of ]!)():!. The man chosen for this work was \V. II. 
Iloyt who was given charge of the bacteriologic laboratory started in VM)\ 
and was referred to in the dual capacity of registrar and bacteriologist in the 
minutes of the Board for July liHiJ. 

Air. Hoyt continued as registrar of \ital statistics imtil Alav 1."), I'.iln 
when he was succeeded by Dr. C. C. Ellis who was followed in turn 
on March I, I'.Hl. by Dr. T. H. D. Gritfitts. He occupied the position 
until llil."i when ( )rrin Dillv took' over the work. Mr. Dillv was suc- 
ceeded in IIMI by .^beldon L. Howard who has continued to date as regis- 
trar of \ ital statistics. 

Thus it is seen that the work of the dixisinn of vital statistics is as 
old as the State public health service itself. -Vbimt I'.Ki:! it Ijecame suffi- 
ciently systematized and \r)luminiins enough to re(|mre a special corps of 
workers under the supervisicm i-f a regislr.ir. Tlicn in li'l.") it liecame an 
important unit (if the original organization pl.ni uf the sl.Ue heilth service 
and received a special appropriation of •t.'j.~)l)t) per \ear a> the bureau nf \ital 
statistics. That amount provided for a registrar and four clerks. 

hiijirdnnifiii Afti'r Xcir Lair ]]'(is I'fissrd. 

The bureau of \ital statistics became the <li\ision of vital statistics in 
]'.>]: with the creation of the State Department of I'ubHc I le.dtli and fared 
well in the ap])riipriations. A registrar, and assistant registrar and nine 
clerks were proxided with $12,800 per year as total salaries. This cdutinned 
to grow until Jii-i7 found the division with a stat'f of 2fl. including the 
registrar, assistant registrar, medical assist.ant. twn fulil agents and clerical 
staff. 



234 



I'UIil.lC IIICAI.ril ADMINISTRATION 



Stalislics thai wcro mt conipklL' aiul never so reijarded luu which were 
euiuplete enough in show llie s^eiieral trend of lieahh ccin(Hliiin> were eul- 
lecled. compiled and jjuhlislied for the _\ears ni UK)-.' tn I'.Mo inckisive. 
After thai a perind (if cnnfnsinn and inicerlainty set in. due tn the death of 
the secrelar\ of the State lliiard nf 1 li'ahli in Ahirch. IIMM. and the change 
in the vital statistics law in l!)lo. .\cc(n(lin>;l\- im cnnipilations were made 
f(ir the intervenins; years hetween IIM;; and I'TlCi. Summary statistics for 
liirth> and deaths were made nj) f(ir IDlii and I'Ji; Iml nu analyses were 
made. 
Illinois Adnnlliil liila Itcf/islratioii Ana. 

Hv I'.M.S the registration system was working satisfactorily enough to 
justifv the federal bureau of the census to accept Illinois into the U. S. 
registration area for deaths, a minimum nf IMi per cent completeness being 
required for that purpose. 

It was slower for hirths liiu tifter a long drawn out camjiaign the State 
w-as admitted to the L'. .'-^. hirth registration area in IM'.'-.'. 

Detailed statistics are available from the mortality reports of the bureau 
of the census for I'.M.s and subsequent years. The division has published 
detailed statistics of its own sinct- \'Xl\. Infant mortality rates have been 
published by the division aiuuially >ince IH'^'I and the tables include tigures 
for l!l'.'(l. The federal reports include these figures for \'Xl'l and suljse(|uent 
years. 

Division oI'' ('iiii.u IIygiexe and Public Health Xursixg. 
This division was officially created by the legislature in 1!M!) but like 
several of the others it had come into existence 
prior to that time. An effort had been made to 
secure an appropriation for work of that type 
in l!il."i, hut it failed in the General .\ssembly 
In 1!IK an item providing for a chief of a divi- 
sion of child h_\-giene and ]iublic health nurs- 
ing |)assed the legislature hut was vetoed l)\- 
the (lovernor. 

Xecessit\'. however, was the governing 
factor in bringing together a staff that real!)' 
betian child hygiene and nursing work as early 
as i;il(i. In the late summer of that year at) 
epidemic of infaiuile paralysis appeared in the 
State and caused the State Board of Health 
nr. 1. . w. Ka.-t. ^^^ begin work that was calculated to relieve 

the children alTected. .A recurrence of the ejiidemic in liiK led to the definite 




PUBLIC HEALTH ADNr IXISTRATIOX 235 

creation of a division of child hygiene and ])ubHc heahh nursing with Dr. 
C. W. East as chief and two nurses on the staff, all df whom were Ixirmwed 
from the division of communicable diseases. 

This arrangement continued until July I. liMH, when an approiiriation 
of $22,480 for salaries and wages for two yearN hccnm- available for the 
division. In 1921 an equal sum was appropriated tn meet the salaries and 
wages of the division during the ensuing two years, in lic^'i there was granted 
$45,600 and in 1925, the sum of ii^lT.dlo. The appropriation in J'.f>: for 
salaries and wages in the divisiim for the ensuing biennium was $12:'),S-30 
and provided for a staff' of four iihysicians. sixteen nurses, ime dentist, one 
dietist and three clerks. 

The infantile paralysis wdik which ])recipitated the creation of the di- 
vision involved the establishment of clinics at more than a score of points 
in the State. The staff' traveled from one jilace to another, holding clinics 
weeklv or less often as circumstances permitted, and giving such aid as 
could be provided for cripples of all kinds and particularly the victims of 
poliomyelitis. This work soon began to necessitate considerable curative or 
corrective service. 

Demands for crippled children's work increased instead of diminishing 
after the epidemic subsided and formed a major part of the work of the di- 
vision until February 1. l!i-M, when it was taken over by the [Hindis Crippled 
Children's Society, a voluntary organization. 

The ])urposes of the division of child hygiene as set forth in the organ- 
ization scheme of the Department are td combat tht- high mortality among 
children by promoting child health service in the various communities 
throughout the State, establishing infant welfare stations and visiting nurse 
service; to promote medical inspection of school children; to disseminate 
information and advice on the care of children and investigate local condi- 
tions aft'ecting child life. .\lso. to have general supervision of the nursing 
service maintained l)y communities and by extra-governmental agencies ; to 
investigate orphanages, homes and hospitals for children ; to assist in the 
management of baby health conferences, b.-iby week programs, etc., and to 
supervise the practice of midwivcs with special reference to the prevention 
of blindness from infection of the eyes of the newborn. 

Dr. ('. W. East who had served the State Board of Health in the capacity 
of district health officer and as acting chief of the division of tuberculosis 
initiated the child Ingienc work and served as the chief of the dix'isidn unlil 
Februarv, I'.i'.'l. Dr. R. t'. Cudk was acting chief from l-'ebruars- td jul\- 
1.") when Dr. b'.dith H. Dowry was ap]idinte(l tcmjiorarily to the pdsitinn. In 
October. \'>'i'>. Dr. (irace S. W'ightnian of Cliicagd liecame chief of the di- 
vision as a result of the civil service e.NaminatidU lu Id fur the purpuse of till- 



2'3() l'\JUL\C HEALTH ADMIN ISTUATIOX 

iiiij the ]in>^itinn on a ]K'rniaiK'nt basis. She has continued to fill the place 
to (late. 

X II I .^1111/ Srrrirr. 

In IIM'.I a slate siiperxisur dt' pulilic health niu'ses was first employed. 
Two more cities were added to the list of cities having a piihlic health nurs- 
ini;- st-rvice. A movement I'nr the standardization of public health nursing 
service was initialed in I'.i'.'O. This initial step tonk the fcjrm of an agree- 
ment lietween Slate agencies and private and local governmenial agencies 
employing public health nurses. 

r.\- this time the division had influenced and assisted nine cities in 
establishing well organized public health nursing services. In addition to 
this a large number of visits were made by the dilterent members of the 
division to nursing associations for demonstrations and instructions. It was 
not easy to measure specifically the value of this service but face to face con- 
tact and personal service was found to be the very strongest agenc}- avail- 
able in liuilding up the public health throughout ihe State. 

In lUV'i the pulilic health nurses in the Slate were organized into dis- 
trict associations through the activity of the Slate supervising nurse. Twelve 
new communities wei-e infiuenced to establish public nursing services. 

The next vear a survev of public health service in the State was car- 
ried out and a successful campaign for enlarging this service was conducted. 
E\-er}- cilv in Illinois with S. ()()() or more population with the exception of 
two had some form of acli\e nursing service in the ])ul)Iic schools in ^'.)^i3. 

In l!i-^L the Slate was divided into foiu" pulilic health nnrsing districts 
and a State mirse assigned to e;ich. The policy of the Department was 
that the State nurses shculd \-isit the counties in turn in a consulting and 
advisorv capacitv. Realizing that the various communities had somewhat 
different jjroblems, the division allem])te<l to help select and establish the 
])articu!ar service best suited to the local needs. 

.\11 public health nurses were encouraged to communicate freely with 
the Department relali\e to local problems, so that e\ery possible assistance 
might be rendered. Thai \ear Iwenly-lwo counties had m public health 
inirsing ser\ice of an\- character. .V sin-\ey in IH'^I showed that the itum- 
ln'r of counties with public health nursing service totalled l'^. while 60 
counties had rural ]inblic health nursing serxice. The total number of pub- 
lic health nurses in the Stale was IIS. 

lir/hr liilhfl ('nilfrri'liri'S. 

The lirst better baby conference held by the State Beard of Health 
was in 11)1"). when ">'-'iO children wert' examined. With ih.e inauguration 
of the division this work natiiralh- fell under its supervision. 



PUBLIC HEALTH ADM I X ISTKATIOX 



237 



In VJ21 the holding of better liaby conferences, which had previously 
lieen confined largely to the State fair was extended to include any point 
in the State where demands existed. I'hysicians and nurses assisted in 
thirteen such conferences in as man\- cmnities during that \'ear. 

The next few years showed a rapid development of this acti\ity. In 
1922 a physician from the division organized and directed 65 better baby 
conferences in the State with a total of l.iii; children examined. In li)23 
seventy-nine conferences were held at which i,S.")l children were ex- 
amined. 

In a number of wavs the l!t2(i conference at the State Fair differed 
from those held in former years. In (inler tii do l)Oth careful and painstak- 




The State Fair Better Babv Conference in action — 1925. 



ing work the number of children entering it was definitely limited. The 
Illinois State Medical Society cooperated in selecting a pediatrician who 
acted as consultant to mothers whose babies presented defects and fault\' 
habits about which they should be especially advised. A total of (ilM chil- 
dren were examined against 1,485 in 1925. The limitation of numbers did 
not appear to produce the advantages anticipated, however, so that in 1921 
the conference was again thrown open to as many as desired to come. 

The opportunity for research and investigation was unexcelled in con- 
nection with these conferences. In order lu determine the relative health 
conditions prevailing among rural and urban children, an analvsis was 
made in 1923 of the babv conference records which "ave sufficient detail 



V.'iN ITIll.ir lll-.AI.rii ADM I MSTRATION 

to hv classiTicd. As a rusull of this undrrtakini^r il was found thai a ,u;r(jup 
of .'i.ilt:! rural i)r(.'-school-a,ne children had a total of li.sdii hii^rniticant 
physical defects, while a t,n''"il' "'" '-.l-i" e'il\ children of similar age had 
a total of onlv :'i.lSS defects. This indicates that children in rural areas 
ha\e ,i,nealer net-'d for an extension of the pnhlic health service than do 
their city consins. 

Mali ri/il // (iiul I njtuil II i/iiii iir Sciricf. 

Althoui;li the State of Illinois did not accept the provision of the 
Shepherd-Towner Act. maternity and infant hytjiene services were not neu;- 
Iccted. In r.)".'l a special maternity and infant hygiene program involving 
the promotion of public health nursing ser\ice and infant welfare stations 
was inaugurated. In 11)33 four new infant welfare stations were opened, one 
at Wilmington, one at Steger, ami two at I'reeport, one of the latter was 
for white children and the other for colored. A series of nine prenatal 
letters were i)repared covering the important phases oi ])renatal care, and 
sent to any prospective mothers in the State who made application or were 
listed for the series. 

The first "Young Mother's Cluh" was formed at St. Charles and the 
]ilan is to form similar clubs in e\ery county in the State. The object of 
these cluhs is to bring to young mothers the very best scientific informa- 
tion available on the subject of child care and to stimulate frequent examina- 
tion of baljies b\' the familv physician. 

Eight additional _\oung mother's clubs were organized the same vear ; 
two at Duquoin, two at Alounds and others at Hamilton, Dallas Citv and 
I'lowen. 

Medical K.idUiiiKitiiiii (if Sclioiil ( 'li/hl It'll. 

The medical examination of school children was a logical se(|uence 
of the work done at the better baby conferences. In lic.'l a unif(irni "school 
record card" lor this work was adopted. The next vear members of the 
staff assisted with the medical examination of the .")(), 0(10 rural school chil- 
dren, while the nnnil)er in I'.i'i:! reached 60,000. 

In 1!'".'"), the uniform record card was somewhat modified to assist 
in obtaiiiiiig tin- ci rrection of delects. This class room health card was 
designed to meet the request of teachers for a record to be left in the 
School room and also to impress upon the children the imjiortance of ob- 
taining and maintaining a clehnite standard. .\n especirdh- designed button 
having on it "Illinois 1 lealth lit'.'.")" was presented to the children coming u[) 
to the standard requirements. 




Gloria June Esper. 

The first of the two children who were each stiven a one hundred per 

cent perfection rating at the Illinois State Fair. Examined in 192:!. 



240 ruiiLic iii;.\i,Tii adai ixisikatiox 

P.i cause of a ^ap l)L't\vi.cii ilii' l)etler l)al)y conferences and the examina- 
tion of school children, in nc.'-"i ihc jjre-school examination of children was 
inanj^'u rated. 

A |)re-scho! 1 examination card was adopted after careful consideration 
hy a committee from the Illinois Stale Aledical Society, Illinois State Den- 
tal Society. Illinois [''ederation of Women's Chihs and rejjresentatives from 
the division. ! )nrini; the year I'.r.'C, more than 40,000 cards were requested 
hv public health mn-ses. club women and parent-teacher association groups. 

.\ ri\e ve.ir pre-school health campaign was undertaken jointly by the 
Illinois Federatic-n of Women's L'Inbs, Illinois State JMedical Society, Illi- 
nois State Dental Society and the Illinois State Department of Public Health. 
Up tf) date members of the disision ha\'e assisted with the examination of 
over :,(KI0 pre-school age children ;nid abotU 10,000 school children. 

K(l iirciKiudl Act I rifles. 

The educational acti\itics of the division of child hygiene and public 
health nursing h;i\e been numerous and dix'erse. Very early in its history, 
the (li\ision prejiared literature on a variety of subjects much of which is 
still being distributed .-ifter m;iny reprinlings and re\ision. 

Demonstration work naturally centered around the public health ex- 
hibits and in connection with special health programs in local communities. 
At the State fair in I'.Us a total of aSO consultations were given to mothers 
b\ the chief of the (li\ision ;tnd the medical assistant and in 1923 this num- 
ber reached '.H)(). Similar consultation work was conducted at ])ractically 
every fair and exposition where better liaby conferences were held. 

j\ very imjiortant and rather new activity w'as the inauguration in 1037 
of a breast-feeding demonstration in McLean County. This was done under 
the aus])ices ami with the full coo]ieration of the McLean C'ountv Medical 
Society and is intended to function for two years. A nurse from the di- 
vision especiallv trained for the work was assigned to work in the county. 

Lectures assumed a large place in the educational work. Either with 
or without moving picture reels and lantern slides, members of the divi- 
sion wvvf in ,great demand not onl\- in connection with fairs and expositions 
lint ;it meetings of women's clubs, parent-teacher organizations and the 
like. The subjects included in these lectures covered a wide range, such 
as child hv.giene :ind nursing problems and allied subjects such as the 
model milk' ordin;inci- and tln' toxin-antitoxin campaign. 

Courses of instruction to nurses and teachers seemed to be especially 
popidar. An t-ight wt'eks course for graduate nurses in commntiit\- nurs- 
ing service was conducted in IHL'^. 





'<.r* 



i 




James Robert Craycrott. 

The second of tlie two children who were considered perfect in pliys- 

ical development at the Illinois State Fair. Examined 1924. 



242 rUBLIC HKAI.TIl AD.MIMSTKATIOX 

In l!>"?.j an infant mortality survey was made in the counties rejjorting 
an infant iK'ath rate for 1923 of 100 or more, 'i'here were nine such 
counties. Personal visits or addresses at county medical society meetings 
afforded the opportunity to present the matter to physicians, women's clubs, 
parent-teacher associations, etc. 

A goitre survey was made during 11)27 in the Western lllin(jis Univer- 
sity at Normal, Illinois; also at Decatur among both high schocil and grade 
school pupils. In this survey over 3,000 pupils were examined. 

.\ child hygiene committee consisting of Dr. Harold X. Smith. Chair- 
man, representing the Illinois State Dental Society, Dr. B. \'. McClanahan. 
Galesburg, representing the Illinois State Medical Societ)% Dr. Lena K. 
Sadler, Illinois Federation of Women's Clubs and Mrs. Blanche Buhlig, the 
council of Illinois Parent-Teacher As.sociations met with the chief of the 
division once every month to discuss ways and means, policies, cooperative 
plans and other important measures related to child health needs in Illinois. 
Among the specific accomplishments of this committee was its work in 
promoting the toxin-antitoxin campaign. 

The chairman of the educational committee of the Illinois State Medi- 
cal Society sent letters of information to the officers of the county medical 
societies. The Dental Society through letters and its official journals urged 
the cooperation of dentists in distributing literature. The president of the 
parent-teacher association sent out over 700 letters to officers of her or- 
ganization asking their help in distributing 80,000 circulars on toxin-anti- 
toxin to the membership. 

The child welfare chairman of the federated clubs wrote letters 
to the child welfare chairmen of the 750 component clubs, outlining the 
plans of the State Department for the toxin-antitoxin campaign and jilacing 
80,000 educational leaflets for distnliiition to parents of young children. 

Of Jut Adivitics- 

In 11123 pnictical demonstrations in oral hygiene were carried out in four 
of the largest cities in the State, namely Mattoon, Decatur, Elgin and Spring- 
field by a federal field service unit working at the request of the State 
Department of Public Health. The unit consisted of Major Butler (who 
died during his stay in Mattoon) and Miss Verna Thornhill. From 200 to 
300 children were examined in each city. 

In connection with these demonstrations the staff' of the dental unit 
carried out a very definite educational program in the schools and gave 
talks on mouth hygiene before organizations wherever opportunity was pre- 
sented. 



PUBLIC HEALTH ADMINISTRATION 



•^43 



An important expansion of the activities of the division in 1926 was the 
creation of a section on dental hygiene. This new undertaking was financed 
tor one year by the IlHnois State and the Chicago Dental Societies. The 
major emphasis of the program was educational, aiming at prevention of 
dental disease through fundamental requirements for securing the develop- 
ment of hard, durable teeth. The State Dental Society through letters and 
its ofiicial journal urged the cooperation of dentists in distriljuting literature. 
The 1927 General As.sembly provided for taking over tiiis work by the 
State. 

Among the many miscellaneous activities of the division was the render- 
ing of emergency nursing service in the area devastated by the tornado in 
Murphysboro and West Frank fcrt in 192o. Nurses were stationed in this 
territory for niunths and assisted in the prexention of epidemics, school 
ins])ections and made home visits. 

Division of Sukveys and liCHAL Hygiene. 



The division of surveys and rural hygiene came into lieing in IHI ; w lien 
the sanitary zones established around military posts created a demand for 
sanitary surveys of an intensive character. Its functions included the mak- 
ing of house to house sanitary sttidies of communi- 
ties that expressed a desire for that sort of research as 
a jireliminary step toward improving local health con- 
ditions. Such sttidies were carried on in Rockford, 
I'^reeport, Waukegan. East St. Louis, .Mton, Moline, 
and Ouincy in the order named, the first being done 
in 1!M; and the last in 1921. The surveys were ex- 
liau>ti\e in character requiring from four to six 
months in one community. 

Personnel attacjied to the division was never 
P:uii L. .Skoog. large. Sometimes the division chief bad an assist- 

ant and sometinies not. fie aKva)'s had a steno- 
grapher. Field work was accomplished on a cooperative plan, the local 
community ])r(ividing ;i corps of five to ten investigators. 

1';hi1 L. Skoog b;id rli;irt;e of thr division from llie time it was created 
uiiiil .\birch. 192n. JM-om that time until the divisi(]n lost its identity, being 
fused with the division of sanitary engineering in tlie spring of 1921, B. K. 
Rich.'ii'dson acted ;is its chief. 




2i-k 



PUBLIC liF.ALTII AD.M IMS I KATIOX 




IjABOKATOKY W()I!K. 

The year l.STT has a double significance fur lUinuis. When the State 
Board of Health was established one of the first undertakings was the 
laboratory examination of water supplies, — an activity that later grew into 

the modern laboratory. The same year at Urbana 

I'rof. Thomas J. Burrill introduced into his course 
of Ijotany at the Uni\ersit\- of Illinois the study of 
bacteria. Prof. Burrill was the first teacher in the 
United States to officially recognize bacteriology by 
including it in a college course and thus initiate what 
was to develop into an entirely new science having 
a profound influence on pulilic health ])ractice. 

The foundation of jiublic health laboratory 
work was laid by Pasteni in France in the period 
of 1SG."> to JS7(). when he demonstrated the germ 
theorv of disease. In England Lister began his 
studies on aseptic surgery in 1867 transforming surgical methods "from 
a purgatory to a paradise". In 1875 Koch first grew the anthrax bacillus 
in pure culture while other investigators were working with other diseases. 
In 1881 Koch discovered the poured plate method of isolating bacteria, 
following which in rapid succession came the demonstration of the bacilli 
of tuberculosis (1882), Asiatic cholera (1883). diphtheria, tetanus and 
better recognition of the typhoid bacillus (1884) followed by many others. 
Development in the United States was not rapid at first. In 1870. 
the year before the founding of the Illinois .'-^tate Board of Health, Bow- 
ditch pul)lished a Cciitciiiiial Surrey af tin- State of Public Hyciienc in 
Auurica in which no mention of bacteria was made and Imt one reference 
to the germ thenry of disease which was in connection with yellow fever. 
Allhough Burrill liegan teaching his students about bacteria in 187 1. it 
was appariiitly un{ until 1884 that the term "bacteriology" was cdined. In 
1.S84 and 1885. several colleges and universities began teaching the new 
science as a separate course. 

TIk- lirst nniiiicipal ])ublic health laboratory was opened in 1888 in 
Pro\ idence, R. I. liul for several years this devoted it.self entirely to the 
study of water sup])lies. Credit for the first modern municipal diagnostic 
laboratory, therefore, goes to New York Citv in 1S!>:1, followed closelv 
bv the laboratory of the (liicago health deparlnieiit in ISiM. The first 
state public health laboriitory was that of KIicmIc Island established the 
same vear. 



I'URLIC HEALTH AD.MIXISTRATIOX 



245 




Lalxirafori; ]\'iiiJi hi/ Illinois Stoic Boar/I of Health. 

The liistor\- uf lal(()rator\- work uf the IlHnois State Board of Health 
begins with the estahHshnient of the Board. In ISi;. the linancial state- 
ment of expenditures included an item of $19.85 for collecting water samples 
which were submitted for analysis to Prof. BI. 
.\. Weber, chemist of the Industrial Univer- 
sity of Champaign. In 1880 the records of 
the Board mention the investigation of water 
supplies at Chicago, Springfield, Peoria. 
Quincy, Rock Island and Rockford. In 1885 
the legislature appropriated a contingent fund 
to secure the services of analysts, observers 
and other assistants fur examination (jf water 
supplies. The same year a systematic obser 
vation of tlie varying character of the water 
su])])ly of Chicago was made under the direc- 
tion of the ]-5oard. Chemical examinations 
were made weekly by Dr. John H. Long. Pro- 
fessor of Chemistry, Northwestern University in. w aitt-i o. Bam. 
Medical School. For the next fifteen years Prof. Long conlintied to analyze 
water at intervals for the State Board of Health, culminating in the siud\ 
in ]s;)!l and lilOO in connection with the Chicago Drainage Canal. Dr. V . 
Robert Zeit, Professor of Bacteriology and Dr. Gustav Friitcrrer, Pro- 
fessor of I'athology. at the Northwestern L^niversity Medical School also 
look jiart in this in\estigation. 

Since no laboratory was available in the earlv days for the routine 
anah'sis of water samples, citizens were given a method wherebv thev 
could test their own sample. Report of committee on school hygiene min- 
utes of State Board of Health, 1894. 

"For examining water by a simple method take a sample of the water in a 
bottle cleansed by boiling water and provided with close fitting glass stopper, 
and a lump of loaf sugar and place it in summer temperature in the rays of the 
sun. if the water becomes turbid after a weeks exposure organic matter has 
decomposed and bacterial multiplied, the water cannot be regarded as whole- 
some and must be boiled or filtered." 

( )n Decemljer (!. 1S!M the committee on legislation of the Slate B)oard 
of Health .\uxiliary Sanitary Association prepared a report on "needed 
legislation", and, among other recommendations, passed the following reso- 
luiions ; 

"Whereas. It is a fact of familiar knowledge, that certain diseases of great 
fatality are caused by elements of poUuIioii in drinking water: 

"Whereas, Such diseases are plainly ineventable by proper attention to the 
purities of the sources of supply: 



246 I'UBLIC' lllLAl/ril All.MIXlSTRATIO.N 

"Whereas, Such attention can be given with maximum efficiency anil mini- 
mum expense by the I'niversity of Illinois, under the direction and authority of 
the State Board of Health; therefore, be it 

"Resolved, that the Illinois State Board of Health and its Auxiliary Sani- 
tary Association, earnestly recommend the legislature of the State to make suit- 
able appropriation for the establishment and maintenance of work of this kind 
in the Institution." 

Also the following resolution : 

"Resolved, That any question as to purity of food and medicines, be also re- 
ferred for analysis to the authorities of the University of Illinois under the 
direction of the State Board of Health." 

While there is no record of any action taken on the latter resolu- 
tion, the legislature in 1895 provided -^.j.OOU to e(|uii) and maintain a water 
laboratory at the State University. Professor A. W. Palmer of the De- 
[lartnient nf chemistry was put in charge. The .^tate Water Survey, as 
it was known, continued as the agent of the State Board of Health until 
1915, working in close co-operation with the State and local boards of 
health. In the latter year the bureau of sanitation and engineering of the 
State Board- of Health was formed, which took over the analysis of water 
for the Board although the Water Survey still continued sanitary examina- 
tion for many local boards of health. 

Food analysis ap])ears in the records of State Board of Health in 1885, 
when on July ol. I'rof. John H. Long reported the results of a chemical 
analysis cf meat in a ])tomaine poisoning outbreak causing the death 
of one person .ind the illness of lhirt\-se\en others. He also made micro- 
scopical examination of sections of the meat, reporting the presence of 
bacteria. 

Food laws had been on the statute liooks since IS IT. In 1885 the 
legislature passed an additional act to protect the ]iul)lic from im])osition 
in relation to canned or preserved foods. Since no laboratory facilities 
were a\ail:il)le. the resolution i|uote(l abo\e in regard to analysis at the 
State L'niversitv was recommended, jjut a]>i)arently not accejited bv the 
legislature. 

In the earl\- nineteen hundreds the .^tate food commission was or- 
ganized with a lal)oratory in Lhica';ii. In 1!)()7 this Commission was re- 
organized with bro;'.d powers concerning ftod control and ample laboratory 
facilities. Co-o])eration between the food commission and Stale lioard 
of Health was intended by Section 32 of the jnire food law, which reads: 

"The State Board of Health may sulimit to the superintendent or any of 
his assistants samples of food and drink for examination or analysis, and shall 
receive special reports showing thr n suits of such examination or analysis". 

The first mention of the examination of di])htheria cultures appears 
in the recor(l> of the Hoard for 189 1. ( )n the program of the State Board 



PUBLIC HEALTH ADMINISTRATION 



247 



of Health Auxiliary Sanitary Association for Nov. 14, of that year, ap- 
peared the name of Dr. Adolph Gehrniann, bacteriologist of the newly 
formed laboratory of the Chicago health department. In his paper on the 
"Bacteriological Diagnosis of Diphtheria" he ])resente(l the feasibility of 
establishing in every city and town which has a board of health, facilities for 
the prompt and positive diagnosis of every case of diphtheria, at trifling 
expense. Demonstrations of his method were carried on in the laboratory of 
St. Johns' Hospital at Springfield. 

In 1S95, according to the Board minutes for January, 18'.>6, measures 
had lieen adopted in the city laboratorx- in C hicagd fur the pr(jnipt and 
accurate diagnosis of all cases of diphtheria as soon as reported, and stations 
established where a supply of diphtheria antitoxin could be promptly ob- 
tained, free of charge to those unable to pay. This work was started in 
September of the preceding year. 

The above incidences naturally stimulated a demand for laboratory 
assistance in the diagnosis of diphtheria in other conmiunities, for the fol- 
lowing item is found in the minutes mentioned above : 

"Requests were received from Dixon and Grayville, III., for bacterial ex- 
amination of membranes from typical cases, from diseases prevailing in those 
cities, with a view to settle the dispute as to their character. As is known, the 
Board has no facilities for making such diagnosis, but through the kindness 
ut Dr. L. C. Taylor, Bacteriologist of St. John's Hospital. Springfield, your secre- 
tary was enabled to furnish the desired information." 

Ldbiinitniics Esta1)HsJit'(J. 

In I'.MII the State diagnostic laboratory 
was organized, and in 19] 5, the first branch 
laboratory was established. 

In inn, when the division of sanitation 
and engineering, as it was then called organ- 
ized as part of the State Department of Public 
Health, a water and sewage laboratory was 
created which has worked in close connection 
with the diagnostic laboratory, but as a sep- 
arate unit. 

The biological and research laboratories 
were e-tablished in liJli). 

In lli'^l, the division of social hygiene ob- 
tained money fcir additional laboratory service, 
whereby the services of three technicians for 
venereal disease work in Chicago were made 




Dr. Thomas i 



available to the Chicago health department. 



248 I'UHI.IC HF.AI.TIl AD.MIMSTKATION 

Tlie lalmratiiry work of the State I X'liarlniciit of I'uhlic Health is 
(hvided as follows : 

Division of diagnostic laboratories. 

This includes two branch and eight diphtheria diagnostic laboratories. 
Division of biological and research laboratories. 

For the purposes of convenience the above are referred to as the di- 
vision of laboratories and administered under the direction of the 
chief bacteriologist of the biological and research laboratories. 
Division of engineering. 

Water and sewage laboratory. 
Division of social hygiene. 

Three laboratory workers loaned to the Chica.go health department. 

Laics ruder Which the Laboratories Operate. 

The original Act of the legislature creating the State Board of Health 
in IST', did not specify the maintainence of a laboratory. In \'M)' the fol- 
lowing was enacted by the legislature: 

"The State Board of Health may establish and maintain a chemical and 
bacteriologic laboratory for the examination of public water supplies, and for 
the diagnosis of diphtheria, typhoid fever, tuberculosis, malarial fever and such 
other diseases as they may deem necessary for the protection of the public health." 

\\'hen the Department of Public Health was formed in lUlT, the Civil 
Administrative Code (Sec. 55, p. 39) included the follow-ing: 

"To maintain chemical, bacteriological and biological laboratories, to make 
examinations of milk, water, sewage, wastes, and other substances, and to make 
such diagnosis of diseases as may be deemed necessary for the protection of the 
people of the State; 

"To purchase and distribute free of charge to citizens of the State diphtheria 
antitoxin, typhoid vaccine, smallpox vaccine and other sera, vaccines and prophy- 
lactics such as are of recognized efficiency in the prevention and treatment 
of communicable diseases; 

"To make investigations and inquiries with respect to the causes of disease, 
especially epidemics, and to investigate the causes of mortality and the effect 
of localities, and to make such other sanitary investigations as it may deem neces- 
sary for the preservation and improvement of the public health." 

Bit)l(i(/ie<iJ ami Bcsearch Latxiratorics. 

( )ne of the great developments in the application of bacteriology to 
])ublic health occurred in the period of ISIK) to IS'.)."] wiili the production of 
diphtheria antitoxin. Attention was focused on the ])hen<imenuii of imnnni- 
ity obtained through the use of vaccines and serums in ]ire\enting and cur- 
ing disease. Smallpox vaccine had been known since K'.Kl, ;nul it^ efiicacy 
well established by the time the State Board of Health was formed. Its 
use was continually reconniiended by the Board and in ISS!) there was an 
item of $500 to be expended for free vaccination against smallpox. 

Reliable smallpox vaccine was not available at that time ho\\e\er. The 
science of bacteriology was barely in its infancy and the aseptic lechnic of 
Lister had not been ado])ted by veterinarians. Sujiervision of biological 
products was not attempted by the federal government till l')02. Hence 



PUBLIC HEALTH AUM I X ISTKATION 249 

niucli uf the vaccine of that period was lacking in both putenc_\- and purity. 

An interesting report depicting the conditions of the times was nia<le 
liy Dr. (ieorge Thilo to the State Board of Health concerning an inspection 
in June. 1S!I4, of the Oak Park Vaccine Farm. 

"The stable in which the heifers are kept during the incubation period 
is a common country stable for about twenty animals, presenting a low ceiling, 
unplastered and uncoated walls, with a few small windows and a wooden floor 
with two outlets for stable refuse. Special provisions for ventilation, flushing or 
disinfecting the stable are not to be seen there, but on the other hand, no accumu- 
lation of filth is noticeable. In other words, the broom seems to rule there ex- 
clusively 

"Tlie operating room contains an apparatus of two planks and a strap for 
wedging in the animal while standing. In one corner was an ice box for stor- 
ing lymph in the warm season; some pieces of soap were lying on a window 
and some rags hanging on a rope. 

•'In the storing room on one side a wooden box filled with clean points in 
frames; on the other side, an open place (or drying lymph on the points and two 
paper boxes with vaccine points, one 6 bladed rusty knife for sacriflcation, one 
kitchen knife, a crystal vase, two hair brushes and a fruit jar. No disinfectants 
could be shown 

"Test of lymph just collected frcnii two lieifers showed by microscopical 
examination, broken down tissue, cell detritus, abundant micrococci, some soli- 
tary bacilli and a multitude of non-pathogenic micro-organisms frequently ob- 
served in the dejecta of the human body." 

Included with this report were stiggested rules for the application and 
sale of vaccine virus in Illinois, but no record a])i)ears of the Board adopting 
them. 

The State Board of Health Auxiliary Sanitary Association in 1894 
voted to ".\sk the legislature to make provisions for the establishment of a 
vaccine farm in connection with the University of Champaign, under the 
controlling supervision of the State r.oard uf Health." 

l')V an act of the legislature, approved June i"). is'.i."). and in force 
Inly 1, lSI)."i. it was made the (lut\- of the trtislees (if the University to est;ib- 
lish and manage "a laboratory in connection with the .'^tate L'niversity for 
the propagation of pure vaccine virus," It was pruxided in the .Act that 
"the State I'.oard of Health sh.all exercise super\isi(in uf the methods of 
propagation and certify to the pm-ity of ibe ]iniducls." .\n a])])niprialion 
of $3000 was made to establish and ni.iintain the laboratory. Dr. Thomas 
J. Btirrill, Professor of 15otaii\ .uid I lurtictilture and Dr. Donal Mcintosh, 
Professor of X'eterinary Science, both Umk an active interest in the m;in;ige- 
ment of the ])lant. 

On Oct. ;!(!. lS9ii, Dr. Edgar 1'. Cook reported the results of an inspec- 
tion of the plant to the State Board (if lie.ilih. It read in ];arl as fdllnws: 

"We indorse the following excerpt taken from a recent ciroular letter sent 
out from the laboratory; 'The laboratory, an isolated building to be used for no 
other purpose, has been provided and properly equipped to attain the purposes 
of the law. The most careful attention has been given to everything which can 
facilitate freedom from contamination. The ceilings, walls and floors of the 
operating and animal rooius are so fluished that they can be frequently washed 



SoO I'riii.ic m;.\i.Tii ahm ixistnation 

Willi liujc ;iii(l scruhliiug l)i'ush iuul otherwise thoroughly (lisiiit'ecteil. A crematory 
is provided for burning all litter and other organic matter. .None but animals 
bred by the University, or of well known parentage, and selected with great 
care, will be used. Everything is being done to secure bacterial cleanliness and 
insure the preservation of the virus in a state of reliable purity. 

"Careful examination verified the correctness of the above statement. The 
building had been constructed for and used by the Veterinary Department. Some 
necessary changes were made in its arrangements adapting it very well to the 
purpose of a vaccine laboratory. It is very pleasantly located in a grove nearly 
equi-distant from the I'niversity Hall and the buildings of the University Experi- 
mental Farm. In its exterior it has the appearance of a neat cottage being ex- 
tended in otie of its dimensions by that part of the structure that is the tempo- 
rary home of the juvenile bovines in whose living laboratory is produced an 
animal immunizing agent — vaccine virus. The grounds, like all others about 
the University, are neatly kept. The interior of the building is pleasing. It is 
a model of neatness: with office, operating room and room adjoining, equipped 
with modern facilities for sterilizin.t;, etc. The rooms for the heifers — we can 
not call them stalls — are convenient, well lighted and ventilated. The degree 
of cleanliness of all approaching very nearly that of one of our modern hospitals. 
The heifers selected are the best obtainable, and their care and treatment the 
best possible. 

"Their preparation for inoculation, the operation, subsequent care and pro- 
cess of securing and preserving the lymph are as aseptically done as possible. 
We only need to add that Sec. 3 of the Act establishing the Laboratory reads: 
'That the product of the Vaccine Laboratory shall be furnished all physicians and 
health officers within the State at the cost of propagation." " 

.\p|iaretilly the wicciiU' hil>iir:it(ir\ w aN j^ivcn up Minti alter this, fur there 
IS HI) furthet" record nf it in the miimles of the I'.dard. The jnirchase i.if 
smal'pn.x vaccitie is noted fnini time lo time, itiitii in 1 !•".':> it was itichided 
iti the sjiecificatidns for biolciyical products lu be purchased under contract 
and disttihuted free of charge. 

Diphtheria antitoxin, dating from ISiMI, catiie into general use after 
18!)4. In IS'J.j the L'hicago HeaUh Deiiartment jiroNided stations through- 
out the city where it could he ohtained without delaw and where it was giveti 
free of charge to those unaMe to pa\'. 

In 11)11.") the legislature atuended the Act of IS^; creating a Board vi 
}leallh. providing that "it shall he the duty of the l'o;ird of Health of the 
State of Illinois to appoint one agent in the count}- seat of each county in the 
State who shall lia\e for (rslrihulioii ;i supph' of diphtheria antitoxin, certi- 
hed to hy >aid Itoarcl, etc." and finllier proviilin;; for the sale at a reasonable 
])rice or for the free distribtttion lo ])oor persons on certilicate of the over- 
seers of the poor. In l!i()'.) ;nitiloxin was given free to all. .Massachusetts 
was the on'y state up to this time which distribuled diphtheria antitoxin in 
this manner. 

In IDL), tNphoiil vaccine and silver mtrate weie added to the free list 
to In- distributed by agents. Smallpox vaccine in IDl."), Schick test material 
in lIMii. diphtheria toxin-antitoxin in l!):^! and antirabic vaccine to poor per- 
sons in l!lv;i. came in turn. 



PUBLIC HEALTH ADM I XISTKATION 251 

Provision for the free treatment of jKior persons bitten by rabid animals 
was provided for as early as UK),"), when the legislature passed "an act to 
provide for the treatment and care of poor persons afflicted with the disease 
called rabies." It was necessary for >ucb persons tci £;(i to a hospital with 
which the State had a contract for the administration of anti-ral)ic material. 
the long trip often being inconvenient to the patient as well as expensive to 
the county in railroad fare and maintainence (d" patient and attendant. In 
1923 the distribution of the vaccine to the local i)hysician who could admin- 
ister it to the patient at home was inaut;urated and proved a great saving in 
expense to all concerned. 

In l!il!i the biological and research laboratories were established to 
manufacture the various biological products which heretofore had been pur- 
chased under contract and to investigate problems pertaining to public health 
work. Because of the lack of proper personnel and quarters, this idea has 
never been fully realized. 

In 1!)20 quarters were tibtained in the plant of the former hog cholera 
serum laboratory five miles from the Stale House and i)reparations made 
for the manufacture of typhoid vaccine and some other products. It was 
later decided however, to continue the purchase of these materials. The 
(juarters there were used for a few years for W'asserniann work. ]ire]iara- 
tion of mailing containers, housing of animals and the like, but later 
gi\en up because of inaccessibility. 

RESE.\RCH work: The necessity for research has always 1)ecn recog- 
nized. In the Annual Report uf llu Stati- Baanl of Health in I'.KIO the 
following statement is made. 

"It is the belief of tlie Board that, had the laboratory not accomplished, in 
its two years existence, anything more than it has done in placing aerial disin- 
fection upon a sound and scientific basis, tlie time and money devoted to it would 
have been well spent." 

Research activities have been somewhat limited due to inade(iuate 
personnel and quarters. It has been necessary to use the personnel of the 
biological and research laboratories largeK- for routine diagnostic work, 
devoting wliat little time was available lo iirolilems that could lie jiicked 
u]i and dropped according to pressure of routine. In fact, a stud)' made 
in V.m by the Carnegie Foundation on research facilities of the State of 
Illinois recomtnended that all research acti\ities of the State be confined to 
the State University, while other branches of the State government devote 
themselves strictly to routine activities. This of course, was impossible to 
put into practice. 



'dij'/i I'UIiLIC lil'.ALTII ADMIMSTKATIOX 

The first result of research was pubhshed in 1920, since which time 
eighteen other contributions have appeared, as shown by the following list: 

IXVKSTKIATIOXS CoNDt'CTEl) IX THE BlOLOGICAL AND ReSEAECH 

Laboratories. 

1SI20. The Sachs-Georgi Test for Syphilis. 

Thomas O. HiiH and Kva E. Faught. 
Journal of Immunology, Xov, 1920, J, 521-527. 
This was an attempt to make more workable one of the ea^'ly preeipitation 
tests for syphilis. 
1U22. Anthrax in Shaving Brushes. 
Thomas C. Hull. 
Fifth Annual Report. 

Illinois Department of I'ublic Health, p. inO-191. 
Ten cases of human anthrax led to a study •<{ shaving brushes. AVhile the 
more expensive brushes showed no contamination, many cheap brushes 
were found to be badly contaminated. 

1922. A Study of the Typhoid Epidemic at Kewanee, 111. 

Thomas G. Hull and Kirby Henkes. 
Illinoi.s Health Xews, 1!]22, S, 196-199. 
Twenty-five cases of typhoid fever on one milk route led to the detection of 
a carrier on the farm. 

1923. Preserved Cultures in the Widal Test. 

Thomas C!. Hull and Hugh Cassiday. 
Abstracts of Bacteriology, 1923, 7, 3. 
A report presented to the Society of American Bacteriologists to the effect 
that dead cultures were not as reliable as living typhoid cultures in the 
performance of the Widal test. 
1923. The Widal Test in Tuberculosis. 

Thomas G. Hull and Kirby Henkes. 
Abstracts of Bacteriology, 1923, T, 28. 
.\ report presented to the Society of American Bacteriologists that persons 
afflicted with tuberculosis sometimes gave peculiar and characteristic re- 
actions with the Widal test. 
1923. Intracutaneous Reactions in Pertussis. 

Thomas G. Hull and Ralph W. Nauss, 

Journal of American Medical Association, June 23, 1923, SO, 1S40-1S41. 
The intracutaneous injection of a dead culture of pertussis bacilli was found 
unreliable for the early diagnosis of whooping cough. 

1923. Agglutination of the Flexner Dysentery Bacillus by the Blood Serum of 

Tuberculous Persons. 

Thomas G. Hull and Kirby Henkes. 

American Review of Tuberculosis, Xov. 1923, S, 272-277. 
Persons in the incipient stage of tuberculosis, apparently carry in their blood 
stream a substance capable of agglutinating the Flexner dysentery bacillus 
while persons in the advanced stage of the disease do not. 
1921. Another Milk-Hc.riu- Typhcul Kpidemic, 
Thomas G. Hull. 

Illinois lleallh .News, .luly 1924, in, 1117-201). 
A lyphoid outbreak at Litchlidd. 111., where two carriers were found on the 
dairy farm. 

1924. The Control of the Public Health Laboratory. 

J. J. McShane and Thomas Ci. Hull. 

American Journal of Public Health, Xov. 1924, r.}, 950-953. 
The report of a committee appointed by the advisory board to study methods 
emi)loyed in other states of co-operating with or controlling private labora- 
tories doing public health work. 



PUBLIC HEALTH ADM I XISTRATION 2i)3 

1924. The Effect of Heat on the Staining Properties of the Tubercle Baoillvis. 

Thomas G. Hull, Kirby Henkes and Luella Fry. 

Journal of Laboratory and Clinical Medicine, Nov. 1924, 10, 150-153. 
Steam pressure at 15 pounds for S hours or dry heat at 150° for one hour and 
forty ininutes did not cause the tubercle bacillus to lose its acid-fast stain- 
ing properties. 

1925. Agglutination Reactions of the Paratyphoid-Dysentery Group in Tuberculosis. 

Thomas G. Hull, Kirby Henkes and Hugh Cassiday. 
American Review of Tuberculosis, Mai'ch 1925, 11, 7S-S4. 
Agglutination reactions with blood serum from persons in various stages of 
tuberculosis were obtained with certain members of the paratyphoid — 
dysentery group. 

1925. The Schick Test and Scarlet Fever. 

Thomas G. Hull. 

Journal of L.aboratory and Clinical Medicine, Dec. 1925, II, 260, 2ril. 
An attack of scarlet fever appears to destroy the diphtheria antitoxin in thi- 
blood streani, causing the Schick test to become positive. 
192(i. Laboratory Differentiation of Smallpox and Chicktnpox. 
Thomas G. Hull and Ralph W. Nauss. 

American Journal of Public Health. Feb. 1926, 1«, 101-106. 
Smallpox may be differentiated from chickenpox by the intracutaneous in.iec- 
tion of iininune rabbits with serum from the pustule of the patient. 

1926. The Widal Test as carried out in Public Health Laboratories. 

Thomas G. Hull. 

American Journal of Public Health. Sept. i;i26, 16, 901-905. 
The Widal test needs standardizing according to a study of methods used 
in 53 public health laboratories. 

1926. The Control of Private Laboratories. 

Thomas G. Hull. 

The Nation's Health, Dec. 1926, s, SII9-10. 
A discussion of certifying private laboratories doing public health work. 

1927. Undulant Fever as a Public Health Problem. 

Thomas G. Hull and Luther A. Black. 

Journal ol the American Medical Association, Feb. 12, 1927, 88, 463-464. 
Among 70 serums tested with bacillus abortus antigen, 5 reacted positively 
in high dilutions, indicating infection with bacillus abortus. 
1927. Twenty-six Thou.sand Kahn tests compared with the Wassermann. 
Thomas G. Hull. 

Journal of the American Medical ^Association, June 11. 1927, N8, 1S65-1S66. 
The two tests gave relative agreement in about 9S percent of instances. 
Treated cases of syphilis' gave the inost discrepancies. 
1927. Seasonal Prevalence and Control of Rabies. 
Thomas G. Hull. 

The Nation's Health, June 1927, !>, 21-24. 
Rabies is on the increase throughout many portions of the United States. 
March is the montli of greatest prevalence in many communities. 

I>i<ifiiiiisf ic Ldhiinif'iri/. 

In August uf liJUl. Dr. James .\. I'.gan, secretary of the State Board 
of Health was successful in aci|uirino funds originally intended for sani- 
tary investigations and using thcin for opening a laboratory. This was 
located in the Odd Fellows' Building in Springtield and Mr. W. H. Ht)yt 
a medical student was put in charge. Specimens for the diagnosis of di]ih- 
iheria, typhdid, tuberculosis and malaria were examined. 



'■ioi l'l,l!l.|i HEALTH ADMINISTRATION" 

In l'.)()o, an appro]jriation of $1,200 was secured from the General 
Assembly for the services of a bacteriologist and $1,800 per annum for "ex- 
penses of laboratory for investigation of diseases." 

The one room in the Ofld Fellows' building soon became inadequate 
to house the rapidly developing work and on Nov. 15, 1906 quarters were 
secured in an apartment house located within (jiie block of the State House 
and directly opposite the site of the Supreme Court building. Here a 
six room apartment was shared with the bureau of vital statistics. 

'i'hc next change in location was made to the State House where the 
laboratory remained for a number of years in a small room on the second 
floor. In 1917 it was moved to the sixth floor where it shared quarters 
with the division of .sanitary engineering which were suppo.sed "to be ade- 
quate for many years". So^ rapid was the increase of laboratory examina- 
tions however, that the space soon became cramficd and an attempt was 
made to relieve congestion by moving some of the work to the former 
plant of the hog cholera serum laboratory five miles north of the State 
House. This division of work did not prove practical and gradually the 
workers were re-called and the cjuarters at the serum laboratory were given 
up in 1925. Additional space on the sixth floor of the State Hou.se was 
acquired in \'.)ii<>, which made jjossible the neces.sary expansion of activities. 

In the 2'-i years that the laboratory has existed, ten dififerent individ- 
uals liave been in charge as follows: 

W. H. Hoyt 1904- 5 

H. C. fJlankenmeyer, M. D 19f)5- 7 

Wallf^r a. Bain, M. D 1907- 9 

Flint MoiKlurant, M. D 190!) 

W. a. Crowley, M, U 1909-10 

N. E. WagBon, M. D ...1910 

W. H. HolmeH. M. D 1910-11 

Geo. F. Sorgalz, M. D 1911-18 

.Martin Uijpray. M. S 191K-19 

TboniaH G. Hull. I'h. U 1920-to date 

111 l!»i)l when the laboratory was first started fjiijy IT! examinations 
were made during the fall months, covering dijjhtheria cultures, sputum 
examinations for tubercle bacilli, blood examination for malaria parasites 
and Widal tests for typhoid fever. The volume of work increased very 
markedly during the next dozen years, especially in sputum examinations 
l)Ut with almost no increase in scope. Unfortunately no records are avail- 
able for the years I90H and \'.)W). 

In 1917, came the war with its venereal disease program and free 
Wassermann tests and gonorrhea examinations, and general em])hasis on 
all things of a laboratory nature. With the return of physicians from 
military service the demands on the laboratory for all kinds of work in- 




A section of the main laboratory at Springfield where general diagnostic 
service is done free for the citizens of Illinois (1924t. 



2-)(; 



iTKi.u iii;ai.iii AHM I XISI KATKIN 



creased markedly, lu V.y^O routine exaiiiinatidns for all contagious diseases 
for which laboratory tests were availalile wen- Ijeing made, including the 
complement tixation tests for gonorrhea and luhcrculosis. 

In \[>'iij. after considerable experimentation, the Kahn ])reci])itation 
test for s\ philis was adopted as a routine in addition to the Wassermann 
test. In June 1927, the Wassermann test was dropped as a routine pro- 
cedure ; except where there was a special request for it. It was soon 
found that there were no such re(|uests. 

The interest of veterinarians in j)ulilic health laljoratory work had been 
confined mainly to rabies for some years. In 1924 the contagiousness 
of bacillus abortus of cattle for man was sliown in several human cases 
in Illinois. A demand u])on the laboratory for routine testing of cattle 
for contagious abortion was immediately made by veterinarians. Since the 
Department had neither the facilities nor personnel for this additional bur- 
den, only a small number of blood specimens from cattle were examined. 
In all matters relating to animal diseases, the closest co-operation was 
maintained with the division of animal pathology at the University of Illi- 
nois. 

* Table 24. 



Diagnostic 


L.-\BORATC>RY- 


—Total Examin.\tions, 1904-27. 


Main laboratory 
Springfield. 


Branch 
laboratories. 


Social hygiene. 


Total. ■ 




171 
1.425 
2.370 






171 


Iil05 






1,425 






2,370 


111 - 






3,275 








?? 


1909. 1 ■'? 
1909- 10. 1 4.024 






?? 






4,024 






4,037 


1911-12 
1912-13 
1013 14 
1014-lS 
1915 Ifi 


4,249 
4,442 
4,222 
4,611 
7.579 
6.013 
10.499 
12.003 
31.494 
52.008 
83.630 
82.840 
84,104 
78,311 
99,259 
134,200 






4,219 












4,222 








1,409 
2.429 
2,399 
3.05S 
3,412 
7,691 
8,442 
4,576 
5,520 
4,611 
9,037 
5,845 




8.988 




8,482 


' ' 




12,898 


I'.llv VI 
19l!l '211 
,,,.„ -Ji 

i!i:i ;- 

19L':; :•! 
1921 -'.■) 
192.-, 21. 
192fi 27 


4,628 
84,749 
20.205 
27,128 
27.893 
79,736 
93,726 
52.725 
84,749 


15.061 
39.543 
79.904 
119,200 
115.309 
169.360 
176,648 
161,021 
221,794 



I'UBLIC HMALTII ADMINISTRATION V.)i 

TliL' lollDwinsj; is a list of exaniinalions made by the diagnostic laboratory 
showing the }'car when they were begun: 

Diphtheria cultures 1904 Dysentery cultures 1918 

Sputum for tubercle bacilli 1904 Meningococcus cultures .... 1918 

Widal tests 1904 Pneumococcus typing 1918 

Malaria examinations 1904 Tuberculosis fixation tests 1920 

Kabies examinations 1909 Gonococcus fixation tests 1920 

Wassermann test.s — blood and spin- Colloidal Gold tests. ... 1920 

al fiuid 1:117 Diphtheria virulency tests 1920 

Pus for gonococci 1917 Kahn precipitation tests 1926 

Treponema pallidum Iill7 Vincents' angina 1927 

Typhoid cultures feces, urine and 

blood 1918 

Occasional examinations have been made since the period lltlT to 
I'i-'o of specimens which have not been numerous enough to list as "routine", 
but classed under miscellaneous, including examinations for anthrax, chan- 
croid, glanders, streptococcus, sore throat. \'incents' angina, alscj the Weil- 
Felix test for typhus fever, blood cultures, oyster examinations, food poi- 
.soning investigation, etc. 

Previous to 1920 a certain number of routine urine analyses was done 
as were also blood counts, together with an occasional tissite examination. 
Since that time these activities have ]jeen confined to instances where a 
communicable disease was involved, leaving the routine specimens to clin- 
ical laboratories. 

Previous to lii'iv' very few milk examinations were made. In that 
year in conjunciimi with the milk campaign, bacterial plate counts and sefli- 
ment tests were made in several cities and since then milk specimens have 
been examined at irregular intervals in considerable numbers, culminating in 
the use of a mobile milk laboratory in 1927 for field work. 

BR.\NCH LABOR.ATORiEs: In 1915. it .seemed advisable to establish branch 
laboratories to improve the service, especially in diphtheria work. Accord- 
ingly, contracts were drawn up with the Burdick-Abel Laboratory in Chi- 
cago and with Dr. W. H. (iilmore in Mt. Vernon, to examine diphtheria 
cultures for diagnosis ,it the rale of 50 cents each. Cultures for quarantine 
release or for sur\ry \\(irk as in schools, were sent to Springfield. Similar 
contracts were later m.ule with other laboratories to includi; not only diph- 
theria diagnosis but al.-o Widal tests, malaria and gonorrhea specimens. 
Because of lack of funds the scojie of the branch laboratories was confined 
to diphtheria diagnosis. Later in l'.i2-.', instead of paying for each culture 
examined most of the l;il)oraliirics were paid a stated .sum each month on the 
basis of the ainoinil of wt>rk |)re\iiiuslv dcjne. 

In l!»2.j a definile change in br.anch laboratory policv occurred when 
the Palestine l.abor.-itory. connecte<l with the C'rawfnnl Couiit\- Health 



258 I'UBLIC IlKALTU ADMI NISTKATIO.X 

Unit and the southern branch hibdratory at C'arl)iintlale were openeih All 
procedures connected with public he.dlh work were provided for. The 
Palestine laborator)-. under Dr. J. A. llkeinire, was later discontinued when 
the Crawford Count_v Health I'uit was given U]). The t'arbonda'e labora- 
tory esiabli.shed in an emers^jency was made permanent to till the demand 
for service as the result of work done by the field laboratorv sent to south- 
ern Illinois for tornado relief. When the rest of the Department activitic'^ 
were discontinui-d the laboratc ry remained as the southern branch. 

In I!)'.'; airangemcnts were completed for a branch laboratory in L'hi- 
cago at the Slate Research 1 lospiial with Dr. Lloyd .Vrnold in charge. 
While the laboratory is indei)eadent of the medical school and hospital, 
certain material from the lal)oratory will be used for teaching purposes. 

Following are tlie branch laboratories which the IJepartnient has main- 
tained since 1915: 

Diphtheria Diagnostic Ladoratories. 

Chicago Theodore C. Abel. M. D.. 7 W. Madison St 1915-1927 

Mt. Vernon W. H. Gilmore iril5-1922 

Urbana V. W. Tanner, Ph.D., University ot Illinois l!)l6-to date 

Galesburg S. G. Winter, M. S., Galesburg National Bk. Bldg. . . .llUC-to date 

Rockford W. H. Cunningham, M. D 1917-li)lS 

Moline Maude Vollmer, M. D., Lutheran Hospital 191S-to date 

Ottawa R. T. Pettit, M. D., Illinois Valley Laboratory 1920-to date 

East St. Louis Karl Brennan, M. D., City Health Department 1922-to date 

Decatur Decatur & Macon Co. Hosp., B. S. Shackford, M. D. .. 1924-1925 

('. R. Smith. M. D 192.5-to date 

Kankakee -t. Mary's Hospital 192T-to date 

Branch Laboratories — All Examinations. 

Palestine Crawford County Health Unit, ,). A. n<emire, M. 1 ). . .U.i2.i-192li 

CarbonJale Holden Hospital, Eva Taught 192,5-to date 

Chicago Research Hospital, Lloyd Arnold, M. U 1927^ 

FIELD LAi!oK.\roRV WORK: The field laboratory was instituted to satisfy 
the demand for laboratory service during epidemics in comniunities where 
no local laborator\- existed and where it was found inconvcu'ent or impos- 
sible to send s])ecimens a distance to the main laboratorv. 

In \U\'>, a chest was built combining the minimum necessities for mak- 
ing diphtheria, txphoid, and meningitis cultures. Several trips each \ear 
were made with this eciuipment with very distinct advantage. Not onlv 
were tyjilioid. diphtheria and meningitis epidemics solved, but also other 
work such as glanders and venereal disease diagnosis, milk bacteriology and 
general kdioratorv work taken care of. Among the towns visited were 
Litchfield. .\una. C'arbondale. Peoria, Rock Island, Rockford, Kev^-anee, 
Marshall, Taylorville, Belleville, East St. Louis, Granite City-, Streator. 
Belvidere and Galena. 





Equipment and personnel for setting up a field diagnostic laboratory are 
ready at all times to respond to emersency calls. The picture shows 
the Hold unit about to be off from the fapilol Huildins; to Rook Island 
in litl':;. 



2(i0 I'l'iii.ic iii:ai,tii Ai)Mixisri;A iihn 

An interesting trip was made in IH".':i in ]\(k]< Islanrl. A fi-w days be- 
fore Christmas a telephone call |-e(|iiesied urgent help in eontrnUinij a 
diphtheria outbreak. While the branch laboratory \\a>^ available at .Moline. 
supplies for several thousand cultures were not at hand nor could they be 
shipped b\- train because of the tremendous congestion of Chrislmas i)ack- 
ages in both ])osi office and express office. In but a few hours culture media 
for the entire work was ready and loaded into the laboratory car. P.y driv- 
ing all night two l.iactericlogists with necessary supplies and equipment were 
on the scene the next morning. 

The tornado of li>v!-j in southern Illinois caused an acute situation 
making the presence of laboratory ser\ice indispensable. Equipment suf- 
ficient to take care of any emergency that might arise was dis]-iatched Ijy 
automobile and installed in the I'dks' C'lul) at Carbondale. 

Through the co-nperation of the National Guard, the laboratory equip- 
ment of the IdSth Medical Regiment was pooled with that of the State De- 
partment of I'ublic Health and placed at the disposal of the Department. 
While the main laboratory was maintained at the Elks' Club ni Carbondale, 
sufficient technicians were a\ailable from the National Guard to establish 
sub-lal)oratories in the various emergency hospitals in Alurphysboro, West 
Frankfort and at Ifolden Hi sjiital in Carljondale. With th'_' closing of the 
emergency hospitals and the withdrawal of the Natimial (iuard, the labora- 
tory was mo\'ed from the Elks' Club tn the temporary oftices of the State 
Department cd' Public Health at ■.'■-'■.! ' 2 South Idimiis Street. So well did 
this laboratory function during the next tew months, not only in the storm 
area but all over the soinhern part of the State, that its abandonment was 
out of questiin. Definite arrangements were made with the Holden Hos- 
pital where commodious ijuarters were provided and the southern branch 
laboratory was thus established. 

The field laboratory equipment was angmentetl from time to time to 
take care of special emergencies s;i that it eventually consisted of more 
than half a dozen chests, packed ready with sterilizers, incubator, acetylene 
gas tanks for burners anrl other necessary materials. (Jne o-, ail the chests 
were taken according to the n.ature of the emergency and amoimt of equip- 
ment that might be found locally. 

The milk campaign initiated in l!l"25 resulted in various milk sur\eys 
in different communities. These were disci iitinued because of lack of 
laboratory personnel and funds to satisfy the demand. The campaign 
resulted in the pa>sage of the milk pasteurization law, the enforcement of 
which require<l a com[]lete laboratory. -Such a laboratory has been installed 
in an ;iutomi bile bus. with a milk bacleriolooist in charge and is now ready 



PUBLIC HEALTH AD.M I X LSTRATION ^Gl 

to Start nut un a tuur of jjasteurizatiun plants. Wliile this mobile laboratnrv 
was built primaril}- for milk work, it was so constructed and e(]ui])ped that 
it can take care of any emergency that may arise. 

Status (if Lahdiaiin II Wark ni Illinois. 

The activities i^f the State Department of Public Health are so closely 
interwoven with innumerable other agencies that it is difficult to disen- 
tangle the relationships. The laboratories of the State Ilealth Department 
are by no means the only ones doing laboratory work of a public health 
nature. X'arirus municipalities maintain laboratories while hospital and 
pri\ate clinical laboratories do a large amount of work. 

The Chicago health department established the first public health diag- 
ni^stic laboratory in the State and the second in- the countrv in IS\H. Since 
that time eleven other cities have provided for lalmratory work, some with 
technicians on a full time basis, some part time and some by contract 
with clinical laboratories. I'-vanston equipped its laboratory in 1908, El- 
gin in l!)lv!. Rockford in 191.5 and Oak Park in 191T. 

Following is a list of cities making provision for laboratory work : 

Chicago he.ilth department, til'ty wmker.s, fiiU time, alwut 375,000 examinations 
in 1926. 

Rockford healtli department, one worker, lull time, about .S.500 examinations 
in 1926. 

Oak Park liealth department, one worker, full time, about 1,700 examination.? 
in 1926. 

Aurora health department, one worker, full time, aliout 2,500 examinations in 
1926. 

LaSalle, Peru and Oglesby Hygienic Institute, one worker, full time. 

Elgin health department, one worker, full time. 

Evanston health department, one worker, part time, about 2,000 examinations 
in 1926. 

Easti St. Louis health department, one worker, part time. 

Peoria health department, one worker, part time. 

Joliet health department, contract with local laboratories. 

Quincy health department, contract with local laboratory. 

Decatur health department, contract with local laboratory. 

The modern clinical laboratory dates almost from the same time that the 
]iublic health laboratory does. In lS!il there were very few clinical labora- 
tinies. in the modern sense of the word, in existence either in hospitals or 
under private auspices. The (■(ihinibus Lal)oratories in Chicago, one of the 
oldest, was founded in 1893. .\ few hospitals had labdratories, but their 
activities were apparently not numerous. In Is'.i-") St. John's Hospital in 
Springfield employed Dr. L. C. Taylor as bacteriologist. 

At the present time there are clinical laboratories as follows : 

Hospital laboi'atorles — Chicago 52 

Hospital laboratories — Downstate 72 

Clinical laboratories — (private) Chicago 53 

Clinical laboratories — (private) Down-State 13 



262 la'iu.ic uicALTii admi.xistkation' 

Mdsl (if tlu- clinical lalioratciries arc ]irc]iarc(l tn carry out many (if the 
procedures of a public health nature, such as milk, water and communicable 
disease control. Because of the competition of the free nmnicijial and State 
laboratories, however, there are a good many instances where speciinens re- 
ciuiring more elaborate ])rocedure, as the culture of stock s])ecimens for 
typhoid and even the Wassermann test, ;ire not attem])ted by the clinical 
laboratorv but sent to the nearest public health laboratory or to the State 
laboratory. 

The competition of municipal and state lalioratoi'ies ha> been the basis 
of much critici.sui b_\ many clinical lalioralory workers. The controversy 
has centered largely around the Wassermann test. In l'.)','.') the Illinois 
Medical i^aboratory Association attempted to turn more \\(irk to the private 
l.'iboratoiy by passing a resolution re(|uesting the Director of the State De- 
partment of Public Health to re(|uire the name and address of the patient 
with every Wassermann specimen done in the state laboratory. The Director 
referred the matter to the .^tate Medical Society where adverse action was 
taken upon it. 

'I here are four groups into which lalioratories in Illinois fall. 

1. Clinical laboratories m.-iintaim d by a competent clinical pathologist with a 
rncdica! dej;rce. 

2 Hospital laljoratories, either in charge of a competent clinical pathologist or, 
as is the case with small hospitals, a laboratory technician suijervised by a physician. 

■',. t'ublic health laboratories either in charge of a competent pathologist, bac- 
terioloErist or chemist, or a laboratory technician supervised by a medical heal h officer. 

4. Clinical laboratories outside of hospital.s in charge of technicians which have 
no medical supervision. 

Laboratories falling in the first groui.) are at present eligible for approval 
by the .\merican Medical .\ssociation. The program of the Illinois State 
Department of Public Health includes groups one. two and three. The two 
organizations, however, try to co-ordinate their activities so that a laboratory 
is not approved by one which does not meet the requirements of the other. 

The following lal)or;itories have been issued certificates of a])proval by 
both the .\merican Medical .\ssociation and the State Dejiartment of Public 
Health. 

ChicaKo L.aboratory — Chicago. 

Lincoln-Gardner Laboratory — Chicago. 

Medical Research Laboratory — Chicago. 

The Murphy Laboratories — Chicago. 

National Pathological Laboratories — Chicago. 

Dr. Homer K. Xicoll's Laboratory — Chicago. 

Quincy Clinical Laboratory — Quincy. 

Rockford Hospital Laboratory — Rockford. 

nockford Laboratories for Medical Research — Rockford. 



2Gi PUHI.lt' HEALTH AD.MINIS'l'RATION 

ill additiiin t(i the ahdvc list tilt' t'lilhiwiiig lahoralnrics havf lifen ccrti- 
fietl for certain procedtires by the State Department of I'liMie Health; 

Kiiekford HL-alth Dyiartnient Laboratory — Rockford. 

Decatur and Macon County Hospital Laboratory — Utcatui-. 

Lake View Hospital Laboratory — Danville. 

Our Saviors Hospital Laboratory — Jacksonville. 

Lutheran Hospital Laboratory — Moline. 

Klgin Municipal Laboratory — Klgin. 

Aurora Municipal Laboratory — Aurora. 

Brokaw Hospital Laboratory — Bloomington. 

Pre.scription Shop Laboratory — Joliet. 

Holden Hospital Laboratory — Carbondale. 

Illinois Valley Laboratory — Ottawa. 

St. -Anthony's Hospital Laboratory — Rockford. 

St. Mary's Hospital Laboratory — Kankakee. 

Methodist Hospital Laboratory — Peoria. 

St. Francis Hospital Laboratory — Peoria. 

St. .lolin's Hospital Laboratory — Springfield. 

In lli'M. the State Department of Public Health took an active part in 
the formation of the Illinois Public Health Laboratory Association. The 
name was later changed to the Illinois Medical Laboratory .Association as 
being more descriptive, but the objects of the organization remained the 
same. Dr. Thomas G. Hull, chief of the diagnostic laboratory, served as 
president for two years and then as secretary. 

One of the tibjects was to reach the technician isolated in a laboratory 
in a small cit\', who if a member of a national technical society, rarely 
obtained the opportunity to attend. P^recjuent meetings in different ])arts 
of the State were intentled to interest and stimulate these technicians to 
better work. 

The certilicatit)!! of laboratories by the State Department of Public 
Health came about in lU'iii when the Illinois Medical Laboratory Association 
passed a resolution requesting the Director of the State Department of 
Public Health to issue certificates of approval to laboratories found com- 
petent to do jnihlic health laboratory work after proper inspections had been 
made. The Director agreed tii this arrangement, limiting inspections only 
to lalicr.-itories fr<im whieli re(|uests hatl been receivetl. Many conferences 
were held with the committee on education ;ind hospitals of the .\merican 
Medical Association, which was also carrying out a national program of 
certif_\in^ clinical lal)oratories. The program of the Department of Public 
Health went farther than that of the .American Medical Association, how- 
ever, ill that frecjuent insi)ections were made, "unknown" specimens for 
examinatlnii submitted and reports returned, certain biological reagents fur- 
nished and the advice tjf a bacteriologist offered in times of necessity. The 
local laboratory, on its part, agreed to use only approved methods, to make 
annual statistical reports to the Department and to assist in certain ways in 
times (jf epidemic. 



PUBLIC HEALTH ADM IN ISTKATIOX 2(55 

Drv'isiox OF Hotel and Lodging House Inspection. 

The inspections of lodging houses, taverns, hotels and inns began in 
1899 as a result of a special law enacted in that year for the purpose of pre- 
venting serious overcrowding and gross insanitation in the poorer hostelries 
operated in Chicago. At that time the city vv'as growing very rapidly and 
deplorable conditions existed in some quarters where persons of small means 
were given shelter at low rates. The wnrk ni inspecting these places was 
confined to Chicago by making the law appl\- only to cities of 100, ()()() or more 
population. 

The duties and responsibilities of the lodging house inspectors are all 
specifically enumerated in the law and the division maintains headquarters 
in Chicago. The number of employees and the money provided are specified 
in the law. The work is associated with the State Department of Public 
Health principally because the law puts it under the general supervision of 
the Department. 

.\t the outset, July, 1899, two inspectors were employed. Homer C. 
Fancher was designated as chief and paid out of the general funds granted 
to the State Board of Health. Air. Fancher was succeeded bv Edward J. 
Smejkal in December of 1S99. He managed to get a staff of 10 insjiectors 
at work during 1900 but most of them were on a temporary basis. 

In 19(11 an appropriation of -$12,500 per year was set aside for the 
inspection of lodging houses and from that time on the service was known 
in appropriatif)n laws as '"supervision and inspection of lodging houses" 
etc. until liU; when along with all other units in the State health machinery 
it was designated as a "division". Mr. .^mejk.il was succeeded as chief 
inspector by William (i. I.anb in the fall of 19(il who was succeeded in 
1904 by J(jhn W. I'tesch. George Delvigne began as chief ins]iecti>r on 
October 1. 191:) and continued until 191T when the position of chief insjiec- 
tor was abolished and in its jilace, as the head of the division of lodging 
hijuse inspection, was established the position of su]ierintendent of lodging 
house inspection. To that place was appointed W. W. AlcCulloch. In 
October 1923 he was succeeded by .\rch Lewis who has continued to date. 

The work of this division has changed very little during the long |)eriod 
of its existence except in volume. Funds provided for carrying the scr\- 
ice have increased from $12,500 per year in 1901, to $35,G75 in 192;. 



:iUU 



I'Um.lC IIKALTII ADM I. MS I RATION 




Earl B. Searcy 



DlNISION 111' I'lT.l.lC I 1 I;aI,I1I 1 XSllilC'IKiX. 

Ediicalii 11 ill 1k;i1i1i matters was re.t;ar(lc<l as a ftiiidaiiK'ntal activity 
of the State health service from the time of its creation and every executive 
officer of that service gave to it as iinuh time and thought as possible. The 
])iibhcatioii and ihstrihntion of circuhu's was a fa- 
\orite \va\' i>f handhiig the matter from the outset 
and ciiiitiinirs to lie important. 

Ivhicatiiin was always stressed by Ur. Ranch 
as one of the most important resuks of his survey 
of the State during the middle eighties. He also dis- 
tributed millions of leaflets on smallixix and large 
numbers on other diseases. 

Vhv annual rejiorts of the Pioard which were 
issued with more regularitv than almost anything 
else that it ever undertook were prepared with a 
\iew til their educational \alue. 
I'rdiu lime til time attempts were made to publish a ]icnrdical bulletin 
jirior to 1110(1. The few numbers that came from press were called ,S"/(;/i' 
Alcdiciiir. This idea was revived in IIH):; when two numbers, the March 
and .\pril. nf a monthlv publication called the "Biil- 
Icliii" were issued. Ai^ain it dni]iped out of the 
acti\ities .:nly to be re\ived in I'.ioii on a permanent 
and more or less regular basis. I'rom that time un- 
til Uecember IHIS a number cif the "Bulletin" w;is 
published for everv month and bound by years. 

Then the publication succumbed to another 
lapse and was revived again in 1915 under the title 
of "Heal III A'c<e.T". From that time until li)2U it 
was issued for each month but quite irregularly 
at times. Beginnins' with lli"^M and cuntinuini;" to 

^ " . Dr. ttenry B. Hoim'inva\. 

date Hcallli News has i.-i-me t mm press and been i 

mailed during the month of its date with but one or t\\ii exceptions. 
Prior to lill."i the |iulilicatiiin was prepared for a medical audience 
and dislributed among plnsiciaus alnmst exclusively. Since that time it has 
been pnpular in cbar.icter. ( )ii ihe mailing list the laymen out-number 
physicians and iiiclmle teachers, farm ;;il\isers. meniliers of women's chiljs, 
nurses, sc cial workers, lncal nfficials, etc. 




PUBLIC HEALTH ADM I X ISTKATIOX 



■Itu 




All ut the ];ul)licit\- work was handled directly by the secretary nr his 
assistant imtil 1!IK when an item providing ^l.'-idO fur a medical editor 
appeared in the api)r()priati(in law. (_)n the basis of that fund a division 

of public health instruction was created and con- 

sisted of o:ie individual in the person cf I'.arl B. 
Searcy who was a newsjiaper man and began \\or\-. 
on September '.M, I'.lK. His jolj was to edit 
Health Xcics and prepare material for the news- 
papers. 

Mr. Searc\- went to war on -\pril l'^, I His and 
Dr. Henrv B. Ilemenwa\- acted as editor of Health 
News untd Mr. Searc\- returned on .\\m\ 'IX . 1!)19 
.After the brief period of three mi nths he took a 
six months lea\e beginning- lidv 1. i:M!i and ne\er 

^ & .' . • Samuel W Kis'~iii_. i 

chose to return. He was succeeded on July -!■>, l!)li) 

by Sanuiel ^^'. Kessinger wdio received a temporary appointment. As a re- 
sult of civil service examinations, B. K. Richardson was appointed to suc- 
ceed Mr. Kessinger on December 1, I'.c^O. Mr. Richardson has continue<l 
in the capacity of chief of the division to date. 

The division staiT has never been large. At first it cjas!ste<l of one 
person who was trained to do jniblicitv work. Then in l!il!l a stenographer 
and exhibit helper v^-ere added. Another stenc:grai)lK'r was addc<l in l!l"23. 
In i;i'^; the staff consisted of these four members. 

Beginning in 1!)H the work done by the 
division relieved the Directur nxire and more 
!if the detailed activities inciilental to the prep- 
aration of publicity material and at the same 
time the scope of the publicity service was 
graduallv increased. 

Thus by li)'.i7 the division had the resjjons- 
ibility of securing and preparing for the printLT 
material stiitable for publication in Health 
Xcics. It is published monthlv and usuall\- 
runs 'A2 pages to the number. 

It was preparing as a weekly rdutinc func- 
tion a story and a sheet of pointed paragraphs 
for the newsjiapers (if' the ."^tate. This service 
B. K. iiiiiiarci.son. bis ciintiuued >niinterrupted]\' since fanuarv 

1, l!i-,'l. 
It exercised snp-er\ision over a moiinn pictiu'c librar\- in which are 
maintained xmie eighty odd films un health subjects. These are luaned free 
throughout the .'-^laie. and are found very useful in health educational work. 




'ids 



I'l'lil.lC IIKAI.lll AliM I.MSI KA'I'IO.V 



The ili\isi(:r. was arraiiyint;' prugraius and haiuUinj^r jmbliciiv for spt-cial 
events like I lealtli riiinidtiou Week, diphtheria eradication and other cam- 
paigns: alscj the better baby conferences at the State fair. In addition 
it managerl the mobile (-■xhibil c<inipnient maintained by the Department. 

I'^urthermore the di\ision exercised snpervisicjn o\er the publication 
of educational pamphlets. 'I'hcse have been issued in large (|uantities, cov- 
ering more than a score of subjects. It also acce])ted responsibilit\- for edit- 
ing the various reports of the Department. 

Division' ok Si)ci.\l IfvciF.XK. 
There is but little doubt that the division of social hygiene came into 
existence as a result of tlie startling figures given out by the government 
showing the alarming prt'valence of \enereal diseases among recruits mobil- 
ized for military duty in the World War. 
Records reaching the Adjutant General's office 
at Washington showed that three per cent of 
I he first million men mobilized had a venereal 
disease when they reported at their respective 
camps. Those from some of the states showed 
an even higher percentage. It was a part of a 
general effort to control, suppress and eradicate 
venereal disease that the division was created 
July 1. 1!US. It actual'y began to function on 
\n\cmber 1, of that year when the first federal 
funds became available. 

\\ ith a subsidy from the government of 
■tci;, .•)():. .""lO for the year ending June 30. 19 111, 
Dr. r, c Ti\i.,i the second year allotment howe\-er was condi- 

tioned upon an appropriation by the State legis- 
lature to be matched dollar for dollar with an equal amount of federal funds. 
The Tjlst General Assembly ajjpropriated for the use 
ni ihe division of social hygiene the sum of $lt)0.0()0 
for twi) yi-ars ending June .30, lilvJl. This was 
inalclud ])y an all(.)lment of $.")(), 0(10 for the second 
\ear's work from the federal go\-eniment, so that 
llu're was .available for the \ear ending June 30, 
i:»v'o ihc xum ('f >t5lOO,0()O.UO. The work of the 
li\isioii has proceeded along lines established tlur- 
iiig ihe lirst year conforming in gcner.il to the 
\iiureal disi'.ase progr.im suggested b\ the Inter- 
de|)arlnu'nlal I-^ocial ll\gieiU' I'xiard, which was cre- 
ated bv act of coiiiiress. 





PUBLIC HEALTH AD.Ml XISTRATIUX 'ibV 

Treatment nf Disease Carriers. 

Duf m the acct-ptfil fact thai there exists a lack of i)rni:ei- inf(jrniati(in 
concerning the serious character of the comphcation and seque'lae wrought l)y 
venereal disease carriers, an endeavor was made to place before the public 
facts pertaining to these diseases, and along these lines, clinics were opened 
in the following cities : 

Chicago — 2 Decatur 

East St. Louis Springfield 

Rock ford 

In the year 1!J".'() there were in addition to the aljo\e named clinics 
the following: 

Alton Chicago Heights Rock Island 

Cairo Litchfield Waukegan 

Carlin\ille jMoline West Hammond 

Chicago — 5 Peoria 

The following year clinics were in operation at Princeton and (Juincy- 
Later clinics were opened at DuQuoin and Robinson. 

Froiii the year lil'.'l it has been the policy of the division t(.) operate 
clinics in such a manner as nut to pauperize the public or infringe u])Oii 
the legitimate practice of any ])hysician. This is obviated by ha\ing the 
endorsement of local medical societies before taking action upon applica- 
tion of city or county oflicials requesting that clinics be opened. Clinics 
are established whenever the Department is asstireil that for every clollar 
of State funds subsidized, there will lie (k'ulilc the amount appropriated 
from city, or county funds. 

Repressire Measures. 

It is a known fact that in order to prevent the sjjread of venereal disease, 
it is necessary to render non-infectious the carriers of the disease. In 
order to carry out such a program, it is essential to have the coo]ieration 
of city and county officials. In order to acquaint officials of the respective 
communities as to prevalence of these diseases, vice investigations ;ire 
made, and the results of such surveys are confidentiallv given them. In 
a number of instances, the city oflicials have seen fit to p;iss local ordinances 
which deal with male offenders .is well as pnisiilntt-s. From a public 
health viewpoint, every rednciion of the amount of irregular sexual in- 
tercourse means just so rnucli le>s exposure to veneri-al disease. Due of 
the main methods of reducin;; ihest- exposures is the |in'\entini; of pro- 
fessional prostitutes and loose women of all kinds from anv opportunil)- 
to do business, as these women are the most ])rolilic carriers of venereal 
disease. 



2,(1 PUHLIC HEALTH ADMINISTRATION 

Eiliicdl ion. 

Svpliilis, i;<incinliea, chancruicl, ilic chief \fiu-n'al diseases are caused 
by germs whicii can he identified through means of the microscope. I'^or 
these diseases there' is a definite curative treatment which, if hegun promiitly 
is usually successful. The most serious results come from im]jroper or 
delayed treatment. The cnnncctiou of these dangerous communicable 
diseases with .^e.\ual immorality has prevented pro]jer discussion of the 
means of pre\eniing and curing them and has delayed the building up of 
effective prevention and treatment in the interest of public health. 

The social and economic loss caused b\- the>e diseases mark them as 
one cif mankind's greatest scourges. When it is taken into consideration 
that fre(|uentl}' moi-e cases of venereal disease are reported than that of 
measles, it may gi\e the pulilic a general idea as to the prevalence of venereal 
disease. There ha\<.' lieen reported in Illinois from ])hysicians and clinics, 
1!)4,8(1S cases of venereal disease during the period July 1, I'JIS to July 1, 
lli?(i, while the number of cases treated at the clinics showed a stupendous 
total of oi'.i.fti;. 

The number of lectures given during this ]ieriod was I. Sit. The 
educational measures used to combat these diseases are carried on by the 
Use of placards, pamplilets. motion ]iictures, exhibits and lectures. 

To show the interest manifeste<l liy soci.al workers and others inter- 
ested in the venereal disease prolileni, there was held in Chicago during 
March l-'!-lS, lit".''.', a \'enereal Disease Institute. This was conducted 
under the auspices of the I'nited States Public Health Service and the 
liiinois Department of Public I Icalth. The attendance was over one thou- 
sand. 

The audience was composed (}f re])resentatives from every walk in 
life and incluik d doctors, nurses, educators, social workers, judges, busi- 
ness nun, mothers of families, clearlv showing that the efforts to arouse 
interest in the subject of venereal disease had been successful. 

(kncrally this subject has been of interest only to doctors, but on this 
occasion the lecturers recognizing th.at a general know kdi^e of the medical 
side of veneral disease is necessary to tlvse who would lit;ht it, so pre- 
sented the subject that it could be ,t;raspcd by all in attendance. 

( )ne of the best fcitm-cs of the program was the series of noonday 
luncheons, at which prunnnetU ri'presentativ es of the various agencies In- 
tel esli'd in combating vmereal disease'. ])resented their views as to how the 
work could best be carried on. The e'hurch press and various social wel- 
fare' org.ani/.atieins were' re'prese'ute'd. anil suygeslieins vvere made and cein- 
cliisioiis reaclu'd which will be of inestimable value' if put into |iractice 
iu the' elille'rent communilie'S. 



PUBLIC HEALTH ADM I X ISTRATIOX ■.'7 1 

A Striking tealurc ui the Insiitutc was the changed attitude of the 
audience. A short time ago it was iniimssihle to frankly discuss social 
diseases and allied suhjeets hetore so \aried an audience, hut those present 
at the conference showed l)y their whole attitude that the time has come 
when it is no longer necessar\- to \cil the matter under a cloak of false 
UKjilesty : that it can he apiiroached with unalTecteilness and ease. 

The Social Hygiene Bulletin which had heen puhlished monthly since 
Sei)tenil,er 1, ID'.'O, was discontinued after the June issue in ]'■>''■'> due to 
decrease of appropriations for the hienniuuL 

Two very important bills relating to venere;d disease were passed hv 
the rtord General Assembly. The one aiiprt>\'cd jtme 'il. l!)v!3 amends 
section ~u of the Criminal Code to pro\ide that anv one who keeps, 
leases, or patronizes any disorderly hi use shall lie hned ncjt more than 
■$200.00 or imprisoned not more than one \ear. 

The other, approyed June "27. l!l".'.'l. amends section 1 of the Divorce 
Act by adding as a ground for <li\i)rce the fact that one spouse has infected 
the other with a communicable \ enereal disease. 

Sniiniuir//. 

The following chronology is given for the purpose of presenting 
the activities rendered by the diyisiiju in a more precise manner: 
r.tlS. l)i\ision ci social hygiene was created on a hfty-hfty federal subsidy 

basis. 
1IM'.>. The establishment of \ enereal disease clinics at various parts of the 

.State was begun. Six were established during this year. 
lliv!o. .\(l(liiional venereal disease clinics establidied in State, sufficient in 

number to bring the total to nineteen. 
lifl'i. A one week intensive coiu'se relating to social hygiene was con- 
ducted in Chicago. Alore than l.ooo persons registered as being 
in attendance on the K'ctnres. 
lilS;!, Stand.nrds of infecti\ity in reference to \enei'eal diseases, which 
were created by a special committee of experts at the re(|uest 
of the State Director of I'ublic I U'altb were adopted and put 
into effect. 
A stringent law jiertaining to vice v\as enacted. 
The "Social Hygiene Moiitlily" publication which began in I'.f.'d 

was discontinued diu'ing this year. 
.\ bill providing for the acceptance of federal aid to almost the 
amount of .$1 l.iiiKi.uo in social lugiene service, failed to nass 
the legislature. A decrease of $i!S.O((0 from the last ])receding 
appropriation limited the activities of the division for the biennium. 



272 ruuLic health admixistratiox 

l9"2o. Law passed, jiiiHiuliiig Scctinn .')" of the Criminal Code, and which 
is directed at the very center of the venereal disease evil. Law 
provides heavy hnes and inipris' nnient for patrons, owners, leas- 
ors, proprietors or other persons directly influencing the opera- 
lion of houses or quarters for prostitution. If enforced, this 
will reduce very greatly the possibility of venereal disease in- 
fections. This, in turn, would make niore and more unneces- 
sary a large number of clinics for treating such diseases. 
Standards of infeclivity. relatixe to the treatment of venerally in- 
fected ])ersons, worked out by a committee consisting of Doc- 
tors W. A. Evans, Herman N. Bundesen. Louis Schmidt. C. C. 
Pierce and others. 
Standards of infectivity jiertaining to venereal diseases officially 
adopted as a jKU-t of the rules mk\ regulations of the Depart- 
ment. Standards printed in pamphlet form and available to phy- 
sicians, heallh officers, social w<irkers, lawyers and judges of the 
comis. 



PREVALENCE 

OE 

VENEREAL DISEASE IN ILLimiS 

,SE '.T.:^ CA5L5 

6665 

.9.');o^^i^^ 9957 

SYPHILIS ^^.^^^^^__ ,^r^A-, 

iKozi^l^^HHi 10.043 

12,715 

12.965 

15,159 

15.115 

I 17,727 




i9i6i9|BB^^^^Hl^HI^^ 19.630 



30,442 



MEDICAL PRACTICE ACT. 

Instinctively the ])eople look to their state government lor protection 
against trands of all kinds and especially for protection against quacks and 
culls. Unless the state measures up to its responsibilities, many incompe- 
tents and some rascals, as well as the trained ethical physicians use the title 
"Doctor." The public, unable to dicriniinate, and believing all are using the 
title legally, are liable to fall into inconi])ctcnt hands, when in case of illness 
they come to select their medical advisor. 

The ethical, trained physicians of Illinois, recognizing the public need 
for this protection, and being ever the guardians of the health and welfare 
of the ]ieople. early began to agitate the need for medical practice laws. 

The Practice Act of 1817. 

The Third General Assembly of the Territory of Illinois, elected in ISUi, 
met at Kaskaskia on December 2 and adjourned on January 11, isK. .\ 
second session of the same assemblv began December 1. LSIT, and ended 
on January 18, 1818. It was but a few years before that an Act of Congress 
dividing Indiana Territory into two separate govemments, revived the name 
of Illinois which bad officially disajjpeared after the organization of ths 
Northwest Territory in IISD, and only five years previous had the Territory 
Ix-en given actual governmental powers. 

The House of Representatives that sat at Kaskaskia in the Third Clen- 
eral .\ssembly was made up of but seven members, and was presided over 
by Dr. George Fisher, a physician who had migrated from \'irginia in 1800. 
This was the same Dr. Fisher who had been Speaker of the First General 
Assembly of the Territon' of Illinois, which met in Kaskaskia in 1S12. 

This little handful of lawmakers was brought together, however, by the 
stern necessities of the infant Territory, and their sessions, informal as they 
were, placed an indelible imprint upon the future government of Territory 
and State. Perhaps no member of the .\ssembly appreciated so keenly as 
did the S])eaker of the House, Dr. I-'islier, the necessity for the restriction 
of itinerant and ignorant medical jiractitiuners throughout the Territory, and 
if he did not cause the introduction of ibe territorial Medical Practice Act, 
it is certain that he lent his influence to it. 

.\mong the important laws passed by this Third General .-Vssembly was 
one regulating the practice of medicine. This pre-state Medical Practice 
Act, bearing the signature of Dr. George Fisher, Speaker of the House, and 
Pierre Menard. President of the Legislative Couttcil (which corresponded to 
our present Senate) and the approval under date of December 31, ISIT, of 
Xinian Edwards, Governor of the Territory of Illinois, read as follows: 

(2T3) 



874 EXKOKCE.MK.N'T OF iMEDICAL rKACTlCK ACT 

"LAWS OF ILLINOIS TERRITORY— 1817-1818. 

"A.\ Act to iiirorjioratt' Medical Sucictics for the purpose of regulatinij the practice 
of Phyxics and titirpcry in this Territory. 

"WHEREAS. Well regulated medical societies have been found to contribute 
to tlie diffusion of true science, and particularly the knowledge of the healing art, 
therefore be it 

"Enacted. By the Legislative Council and House of Representatives of the 
Illinois territory, and it is hereby enacted by the authority of the same, that this 
territory be and is hereby divided into two medical districts, and shall be called 
the eastern and western districts; the eastern district shall be composed of that 
part of the territory lying east of the meridian line running due north from the 
mouth of the Ohio; and the western district of that part lying west of said line. 

"Section 2. Be it further enacted. That it shall and may be lawful for the 
following persons: J. D. Woolverton, J. E. Throgmorton. Thomas Shannon, Henry 
Oldham, James Wilson, John Reid. Amos Chipp. Samuel R. Campbell. Harden M. 
Wetherford in the eastern district, and Joseph Bowers, Dr. Todd of Edwardsville, 
Dr. Hancock of St. Clair, Caldwell Carnes, George Fisher, William L. Reynolds, 
Dr. Heath of St. Clair, George Cadwell and Dr. Paine of Kaskaskia, to meet to- 
gether on the first Monday of May. in the year of our Lord eighteen hundred and 
eighteen, at the towns of Carmi and Kaskaskia, in their respective districts, and 
being so convened as aforesaid, or any of them, being not less than five in number, 
shall proceed to the choice of a president, vice-president, secretary and treasurer, 
who shall hold their offices for one year, and until others shall be chosen in their 
places; and whenever the said societies shall be organized as aforesaid, they are 
hereby declared to be bodies politic and corporate, in fact and in name, by the 
names of the 'Medical Society of the district," where such society shall be respec- 
tively formed; and by that name shall in law be capable of suing and being sued, 
pleading and being impleaded, and answering and being answered unto, defend- 
ing and being defended, in all courts and places, and in all matters and causes 
whatsoever, and shall and may have a common seal, and may alter and renew 
the same at pleasure; and the said medical societies shall and may agree upon 
the times and places of their next meeting, which shall thereafter be the anni- 
versary day of holding their respective meetings. 

"Section 3. Be it further enacted. That the medical societies established as 
aforesaid are hereby respectively empowered to examine all students who shall or 
may present themselves for that purpose, and give diplomas, under the hand of the 
president and seal of such society, before whom such student shall be examined; 
which diploma shall be sufficient to empower the person so obtaining the same, 
to practice physic or surgery, or both, as shall be set forth in the said diploma, in 
any part of the territory. And the person receiving such diploma, shall upon the 
receipt of the same pay to the president of said society, the sum of ten dollars, for 
the use of said society. 

"Section 4. Be it further enacted. That it may be lawful for the medical 
societies established as aforesaid, at their annual meetings, to appoint not less 
than three nor more than five censors to continue in office each year, and until 
others are chosen; and it shall be the duty of each one of them, carefully and 
Impartially to examine all students who shall present themselves for that purpose 
before each of them, and report their opinions respectively in writing to the 
president of said society, and upon such report of any one of said censors, if favor- 
able, the president is hereby authorized to license such student to practice physic 
or surgery, or both, until the next annual meeting of the medical society; and 
for such license, such student shall pay one dollar to the president for the use of 
the society. 

"Section 5. Be it further enacted. That from and after the organization of 
the said medical societies in the respective districts, no person shall commence the 
practice of physic or surgery in either of the aforesaid districts, until he shall 
have passed an examination and received a diploma, or license as aforesaid; and 
if any person shall so practice without having obtained a diploma or license for 







Where the remains of Dr. George Fisher rest in undisturbed peace on 
a bluff near Modoc in Randolph County near St. Leo's Church, 
enacted in Illinois in 1817. (Illustration usid by coiirtesy of Dr. 
Lucius H. XiKch.j 



27G KXKOKCKMKNT Ol" MEDICAL PRACTICI-: ACT 

that purpose, ho shall t'orever thereafter he di squall tied from collec'ing any debt 
or (Ichts incurred Ijy such practice, in any cuurt, or before any nuigistrate in the 
territory. 

"Section 6. 15c it further enacted. That it shall and may be lawful for the 
medical societies which shall be established by virtue of this act, to purchase and 
hold any estate, real and personal, for the use of the societies respectively; Pro- 
vided, such estate as well real as personal, which the said societies are hereby 
respectively authorized to hold, shall not exceed the sum of twenty thousand dol- 
lars. 

"Section 7. Bs it further enacted. That it shall be lawful for the respective 
societies to be established by this act. to make such by-laws, rules and regulations, 
relative to the affairs, concerns and property of said societies, relative to the 
admission and expulsion of members, relative to such donations and contributions, 
as they or a majority of the members at their annual meetings shall think fit and 
proper; Provider}, the by-laws, rules and regulations be not contrary to, nor in- 
consistent with the ordinance, and laws in force in this territory: nor the Consti- 
tution and law's of the United States. 

"Sections. Be it further enacted. That the treasurer of each society estab- 
lished as aforesaid, shall receive and be accountable for all monies that shall come 
into his hands, by virtue of any of the by-laws of such society; and also for all 
monies that shall come into the hands of the president, for the admission of mem- 
bers or licensing students; which monies the said president is hereby required 
to pay over to the said treasurer, who shall account therefor to the society at 
their annual meetings; and no monies shall be drawn from the treasurer unless 
such sums and for such purposes as shall be agreed upon by a majority of the 
society at their annual meetings, and by a. warrant for that purpose, signed by the 
president. 

"Section 9. Be it further enacted. That it shall be the duty of the Secretary 
of each of the medical societies to be established by virtue of this act, to provide 
a book, in which shall be made an entry of all the resolutions and proceedings, 
which may be had from time to time; and also the name of each and every mem- 
ber of said society, and the time of his admission, and also the annual report 
relative to the state of the treasury, and all such other things as a majority of the 
society shall think proper, to which book any member of the society may at any 
time have recourse, and the same together with all books, papers, and records, 
which may be in the hands of the secretary, and be the property of the society, 
shall be delivered to his successor in office. 

"Section 10. Be it further enacted. That it shall be lawful for each of the 
medical societies to be established by virtue of this act. to cause to be raised and 
collected from each member of such society, a sum not exceeding ten dollars, in 
any one year, for the purpose of procuring a medical library and apparatus, and 
for the encouragement of useful discoveries in chemistry, botany, and such other 
improvements as the majority of the society shall think proper. 

"Section 11. Be it further enacted. That nothing in this act containe.i, shall 
be construed to prevent any person coming from any state, territory or country 
from practicing physic or surgery in this territory; such person being duly author- 
ized to practice by the laws of such state, territory or country, and having a di- 
ploma from any such medical society. 

"Section 12. Be it further enacted. That it shall be in the power of the 
legislature of this territory, and of the legislature of the state, to be formed 
out of this territory, to alter, modify and repeal this act. whenever they shall 
deem it necessary or expedient. 

"Section 13. Be it furCier enacted, That this act shall be and hereby is de- 
clared to be a public act, and to take effect from and after its passage. 

"GEORGE FISHER, 

Speaker of the House of Representatives. 
"PIERRE MENARD. 

President of the Legislative Council. 
"Approved — December .31. 1S17." 



EXFORCEMEXT OF MEDICAL PRACTICE ACT 277 

The law required each gnuip to nicei on the first Monday in May, ISIS. 
The eastern group met at C'aniii, ilie western group at Kaskaskia. It re- 
quired five to make a i|U()nini, and the officers consisted of president, vice- 
president, secretary and treastn-er. 

It is generally supposed that Dr. George Fisher was the father and ]irime 
mover in the various steps necessary to place this Medical Practice Act on 
the statute books. 

Practice Act of 181 !•. 

When this legislation came to a natural death with the termination of 
the territorial government, it is reasonable to believe that this group of 18 
men, who constituted the memhershiij of the two boards for enforcement of 
the provisions of the early pre-state Medical Practice Act. knowing from 
experience the great need for the control of medical practice, were largely 
instrumental in having the first State legislatiirt- in isl'.i pass an "Act for 
Establishment of Medical Societies," among the ] in visions of which were the 
licensing of physicians and the rcjiortin^ of birihs and deaths. Indeed, 
the 1S19 Medical Practice .\ct in man\- particulars is ([uite similar to the 
territorial law nf 1817. 

So it would seem that he who, in later years, spoke of Illinois as "the 
j)ioneer in practical mecHcal education," but who was unaware of the jjrecocity 
of the State in the control of medical practice, placed his words of praise 
upon a commonwealth which, piobal)l\' earlier in its history than any other 
^tate, enacted medical piactice hiws for the protection of its jeople. 

The -\ct of ISK, which died with the termination of territorial govern- 
ment, but which was resurrected in ISII), to die again after an unsuccessful 
attempt to enforce its provisions in a land ni unmeasured prairies and wddd- 
lands, and of sparsest settlement, is of more than passing interest to the his- 
torian. It was the initial law, the blazed tree in the trail of melical advance- 
ment, and it served a practical purpose in directing the policies along thi-^ 
line for later general assemblies. It indicated that during the earli::'st in- 
fancy of the State, the contiol (if me(lical |)r:iclice was regarded as essential 
to llie best government, and that impression h;is remained to bear fruit in a 
later day and .generation when the enforcement (if law is a far simiiler matter 
than .'il the time when Illinois dexeloped "fmni ,ui Indiana ci>uiU\ into a 
lerritoi)- of the second .grade." 

Kepeat, ok Til K I SI!) Act. 

In [>■>]. the Act id' ISl!), which pro\ ided f(ir the urganizalion of medi- 
cal societies, with certain powers to regulate the jiractice r\ medicine, with 
the object of providing improved medical st.andards and attention to public 



278 ENFOUCEMICXT OF MF.niCAI. PKACTICK ACT 

hcallh. was ri-|icaK(l. This was a Ircnu-iidoiis back-set to the regulation of 
iiirilical praclicr in lllinnis. An attenipt tn pass a law similar to the one that 
had been repealed was made in ls■^•), hul did not suecced. A second law. 
known as "an Act prt'scriliini; ihe nio(k- nf licensing; physicians" was jjassed 
in \!^'!'i. hnl was promptly i'e|iealed at the next session ol' the legislature. 

I low liadly a law rei^nlatinn medical practice was reallv needed is sug- 
gested by this stalenunt by William lUane in his "A d'our in Southern Illi- 
nois," published in Is;"-'; : 

"Persons who have not visited the western states cannot have any idea of 
the general ignorance ot the practitioners of medicine. A young man, after an 
apprenticeship of a year or two in tlie shop of some ignorant apothecary, or after 
a very superficial course of study at some school or college is entitled to cure 
(or kill) all the unhappy backwoodsmen who may apply to him for advice. To 
become a doctor it is only necessary to have a caliin containing .jO to 100 dollars 
worth of drugs." 

The foll( w inij partial statement fiiim Zeuch's "History of Medical Prac- 
tice" indicates ib.it wholes.ile barter in certificates to practice medicine de- 
veloped in the .Stati- in the absence of law> re^ulatint; the piactice of medi- 
cine : 

"When this Thomsonian system was at its height a great number of cer- 
tificates were sold, 

"Joseph Chapman was the holder of the certificate, which shows one of 
the methods employed in the olden times in creating a practitioner of medicine. 
When the tide of the Thomsonian school was at its flood, a large number of 
these certificates were sold, giving the holder thereof the right to practice medi- 
cine. Without any medical study except such as was furnished vi'ith this cer- 
tificate, any man who would pay the price was permitted to prescribe for the 
sick and administer such remedies as were endorsed by this particular cult, 
which was founded on the use of remedies ot vegetable origin only, discarding 
all remedies which belonged to the mineral Ivingdora. 

"No. 1398 Seventh Edition 

"This may certify that we have received of .liiseiili Chapman. Twenty Dollars. 
in full for the right ot preparing and using, for himself and family, the Medicine 
and System of Practice secured to Samuel Thomson, by Letters Patent from the 
President of the United States; and that he is thereby constituted a member of the 
Friendly Botanic Society, and is entitled to an enjoyment of all the privileges 
attached to membership therein, 

"Dated at Alton this 19th day of 1839. 

"R. P. Maxey. Agt. for Pike, Piatt & Co., .Agents for Samuel Thomson." 

I'jAiii.v EFi''(nri's TO (ii'.T .V Mi';iiic.\L Practice Act. 

That there rcm.iincd the hop.- of ^ecitrins; a medical society as the nn- 
cleits for pnnnotini; a ^nccessfid campaign for ;i Medical Practice Act, is 
indicated ]iy the I louse Records of the ( ieneral .\ssemblv for February 
■']. l.s:;:). which >;iv ".Mr. Webb of While C'ountv ])re.sented the i)etition of 
J'. 11. I>r;idv, tor tlie incorporation ol a medica.l society, wl.icli on a motion 
was referred to C rnnnitlee on I'.ducation." 



EXFORCEMEXT OF MEDICAL PRACTICE ACT 279 

Again in ISl".' efforts were made to get a Medical Practice Act passed. 
The reports of the General Assenibly show that: 

"Mr. Aiulerson from the select committee, to which was referred the pe- 
tition of sundry physicians of Shawneetown praying for the passage of a law 
regulating the practice of medicine, etc., made a report at length on the subject, 
and reported a bill for "An Act to incorporate the Illinois State Medical Society' 
which was read the first time, and a second time by its title. 

■'Mr. Logan moved to amend the bill by striking out all after the enacting 
clause; and inserting the following: 'That no physician, surgeon or lawyer shall 
hereafter be entitled to sue for, or recover by action of law. his or their fees 
for services rendered as such physician, surgeon or lawyer.' 

"The report, bill and proposed amendment were laid on the table by yeas 
and nays; 55 yeas; 50 nays." 

The Illinois Aledical and Surgical Jotirnal in October, 18-14. in an edi- 
torial commenting on the ajiproaching meeting of the State Legislature re- 
specting medical jiractice. said in part as follows: 

"As the period for the session of the Legislature approaches we perceive 
a disposition of many members of the profession to agitate the subject of medi- 
cal legislation. * * * There is at present no special legislative enactments re- 
lating to the practice of medicine in the State of Illinois. Every one is entitled 
to assume to himself the title of 'M. D.' to prescribe any or all substances in the 
three kingdoms of nature to any who call on him for advice. * * * *" 

.\dded impetus to the agitation for a Medical Practice Act resttlted from 
the organization in 18,50 of the Illinois State Medical Society at Springfield 
in the lihriiry of the Capitol I'.uililing. The Chicago .Medical Suciety was 
organized the same year. 

In 1856 a cominittee was aiJiiointed by the .\esculapian .Society of the 
Wabash Valley from among its membership to go befcjre the Illinois legis- 
lature and urge upon that body the ])ruiiriety of enacting a law creating a 
State Board of Health regulating the practice of medicine and providing for 
the registration of births and deaths. The committee did the duty assigned 
to it, but its work was without immediate tangible effect. Early in ISiil a 
second committee was selected for the same ptirpose and consisted of Doctors 
D. W. Sterniont. \\'illiani M. (chambers and John Ten Brook. But the la- 
bors of this committee, bke that of it-, iiredecessnr, liore no immediate per- 
ceptible reports. 

However, at a meeting of the Illinois State Medical .Society held at 
Champaign in ]S1(i, a committee was appointed for a purpose similar to 
those of the .\escula])ian in Is.'iii and Isdl. The sentiment 'inr a n:edic,".i 
practice act expressed in ls5() did not ciystalli/e into concerted action by the 
medical profession until a (|uarter of a century had passed. Apparently 
the organized medical profession of that da\- finally became convinced that 
to enforce adequately a medical practice act. if secured, a State Board nf 
Health would be required. At least the following indicates that these two 
subjects were jointl\- in the minds of some oi the members of the State 



VSI) K.XFORCKMICXT Ol" M KDICAL I'RACTICK ACT 

Mrdical Society, 'riie Transactions of the 'iUh Anniversary Meetinjj of 
Illinois Meilical Societ)' in 1877, page 255, says: 

"The Jersey County Medical Society of Illinois sends greetings to the Illi- 
nois State Medical Society, pledging our vigilant exertions in helping to secure 
the enforcement of such laws as you may be able to secure the enactment of. by 
either the State or National Legislature, looking to the e.5tablishment of: 

"A State Board of Health. 

"Causing the registration of births and deaths and certificates as to the 
cause of the latter. 

"Preventing those persons unqualified to practice medicine from doing so 

"Creating a State Board of Medical Examiners." 

( )n the twenty-first day of ]\Iay, 1S7T, the legislature — after a lapse 
of over fifty years from the date of the repeal of the short, imperfect Acts 
of ISI!) and IS-.','), placed upon the statute hooks an act to regulate the prac- 
tice of medicine in the State of Illinois, approved May '''K 1M17. and m force 

July 1. is;;. 

'rh:it the Medical rr;ictice Act came none too soon and that the jjatient 

of is;; who c.'ime into the hands of the manv suh-standard practitioners of 

medicine fared none too well, are deductions that may well be permitted by 

the ideas exiiressed in the following quotation from the December 17, is;;, 

elition of the Chicago Inter-Ocean daily: 

"It is hardly necessary to say that the city of Chicago has become noted, 
not only for the immense number of villainous quacks, but for the ignorant 
and imperfect manner in which the register of births and deaths has been kept. 
The infant who was reported as having died of 'canker rash, diphtheria, dysentery 
and consumption.' and another whose cause of death was returned as 'five doc- 
tors,' doubtless had good reason to die; and 'delicate from birth.' 'infancy.' 'stop- 
page.' 'fits.' 'Colerafantum.' 'collocinphanton.' 'cholry fanton.' 'bled,' 'direars' 
(, diarrhea), 'billirm (delirium) fever,' 'artry lung busted.' 'feusson.' (effusion), 
'canker on brane,' and 'infermation lungs,' probably convey some ideas to the 
persons who write the terms; but such returns cannot be of much use from 
a statistical point of view. The importance of correct and intelligent registra- 
tion cannot be underestimated, as modern sanitary science owes its existence 
to the registration of deaths and the localization thereby of insanitary conditions. 
It is right that the enforcement of the two bills, passed by the Legislature of the 
State, that will make such radical change both in medical profession and the 
method of registering births and deaths, should demand considerable attention." 

(io\ernor (^'ullom prom|itl\' appointed a ISoard i f llealth in confovmitv 
with the new law ot is;; and the appointees met in Springfield on julv 1"^ 
of that year when tlu-y organizeil with Dr. John H. Ranch as ])resident. 

The State i'io:ird of 1 le:iUh, imme(liatel\ after its apjiointnun'. weighed 
the urgencv of the duties and i lilii^ations placed ujion it In- the newly enacted 
laws and decided that its first dul\ was to enforce tin- Medical Practice 
Act. The knowledge tJKit o\er half of the ;.I00 |iersons jiracticing medi- 
cine in is;; were non-graduates (about :i.s()i)) and that 4!l(J were practicing 
medicine uncU-r fr;mdulent credentials, or even under assumed names, made 
this decision iel;ili\el\' easv. 



ENFORCEMENT OK MEDICAL PRACTICE ACT 281 

Not only did the Board of Health decide first to center its chief atten- 
tion .on the enforcement of the Medical Practice Act, but a careful peru>al 
of the minutes of the Board of Health from IS" down to IHK. indicates 
clearly that this feature of their legally prescribed duties ciMisnmed fully 
three- fourths of the time, energy and resources of the Board, 

()n Xovember l.'>, is;;, the following resolutions were adopted by the 
State Board of Health, 

"That on and after July 1, 1S7S the Board will not consider any medical 
college in good standing which holds two graduating courses in one year. 

"Also, that on and after July 1. 1878 the Board will not recognize the diplomas 
of any medical school which does not require of its candidates for graduation 
the actual attendance upon at least two full courses of lectures at an interval 
of six months or more." 

This was the first oflicial ste]) taken by the Board for higher medical 
education. 

During the first year (1S77) cei-tificates totalLng 5,3 74 were issued by 
the State Board to practitioners and midwives. By 1880, enforcement of 
the Medical Practice Act had materially reduced the number of ([uacks and 
itinerant vendors. Likewise the number of graduates in Illinois who were 
from reputable medical schools had increased from 3, 600 to 4,s-J,"), 

In the Annual Report of ISSl. the Board printed for the first time a 
com])lete ofitcial register by counties of physicians registered to practice 
medicine, also a directcry of medical societies in Illinois in 1881, and a roster 
of midwi\-es registered, listed by counties, .\n alphabetic index of physi- 
cians is also printed in this report. 

By 1882 the certificates issued to practitioners and miil\\i\es totalled 
7,7GG, an increase of 2,392 since the md of is;;. 

Standards for Mkdicai. Education. 

In ISSl minimtmi standards for preliminar\- education of entrants into 
medical schools and requirement> for medical colleges in good standing were 
established. An examination of all candidates with diplomas from medical 
schools not meeting these re(|uirenients, w;is reiinireil, 

,\t the ckjse of the year ISS,"i. ilu-re were in round numbers (),U1)U |)rac- 
titioners of medicine in the State. The < )fiicial Register, published and re- 
vised to February 10, 1886, contained the names, addresses, etc., of 5,11] 5. 
to which are added some 150 others, exempt from the clause requiring cer- 
tificates. Of this number 454 were added during the year; 114 applicants 
for certificates failed to comply with the law and were refused: and the 
certificates of eight practitioners were re\(iked fur unprofessional and di.-- 
honorable conduct. 



282 



ENFORCEMKNT OF MKDUAl. I'kACTiri': ACT 



ReVTSKU MkDK'AL I'liACTUE A("r Anol'TED. 

'I'hc Aci 111 l\cL;iilaU' the Tractice (it .Medicine, addpli-d in ISTl, was 
amended mi June lii. l^s;. and in liree Jnly 1. l.^S^. Tile amendments 
strucl\ imt llie |ir(i\isinns dl' tiie (iriLjinal act relating tii the appointment 
of boards of examiners i)_\- State medii-al sdcieties, provided for three classes 
of certilicates instead of twu. The third class applied to [lersons who were 
licensed ti.i practice on accunnt nf lo vears ]irevi()ns exi)erience. It also 
pnixided that snch certilicates slidnld he applied for within six months after 
the act went intu el'feci, and that all pt-rsims hnldini; certilicates on account 
of It-i years (if previous practice, slujuld be subject to all re(|uirements and 
discijjline of the act. 

The fee for the issuance of certificates without examination was raised 
from line di liar tn h\e dollars, and a iirovision was made f(ir the issuance 
of certihcates to midwives, for a fee of two dollars. 

.Minimum requirements for schools of midwifery were adopted May 24, 
IS.S!). 

.\ comparative table published in 1S!I0 gives the status of the enforce- 
ment of the Medical Practice .\ct and the registration of jihysicians as fol- 
lows ; For purposes of comparison, the following totals from each of the 
five registers are here presented : 





Jan. 14, 
18S0. 


Dec. 29, 
1881. 


Dec. 1, 
1884. 


Feb. 9, 
1886. 


Jan. 1, 
1890. 


Total number engaged in practice 

Graduates and licentiates of medical insti- 


6,029 

4,282 

191 
948 
•608 


6,037 

4,488 

183 
896 
•470 


6.148 
4,882 


6,115 
.5.098 


6,215 
5,524 


Licentiates upon examination of State Board 
of Health 


139 145 
757 672 


116 




575 




lO 













"* Since the completion of this Register, a careful examination has disclosed the fact that 
there were about fift.v more non-graduates in the state than were supi-oseii, consequently this num- 
ber has been addixl in the above tabic to the nuiuber of 'e.vempls, not certificated' for each of the 
years 1880. 1881, 1884, and 1886. 

"i No exempts under the law at this tune— and no teiliHciites ba.-<cd on vears of practice, will be 
issued hen-after." 

From the abiixe tabular statement it will he seen that the number of 
those engaged in medical practice in the lirst 10 years of the Hi ardV activi- 
ties is nearl\- the same, notwithstanding that there was marked increase of 
population: also while the aggregate number of ]iractitioners has not nia- 
tei'iallv varied, there were some noticealile changes in the numbers of the 
dili'ereiit classes. Thu>. there was a gain of 1.1 li; graduates aiiil licentiates — 
these fiiiniing HI per cent of the total number in ISilO, as against about 7G 
per cent in Issii; the number of licentiates upon examination of the State 
Board was lar^elv diminished — mainl\- bv their transfer to the number of 



ENFOUCIiMEXT OK MEDICAL I'KACTICE ACT 383 

graduates, very many of them having subsequent to their examination, at- 
tended lectures and ol)tnined diplomas ; also to the fact th:it few are added 
to this class owing to the increased severity of the examinations given by 
the Board. 

The following summary, from the first Register, and ciirresponding fig- 
ures from the 1S!H1 report, exiiibit these changes for tlie whole period since 
the Aledical Practice Act went into operation: 

July 1, 1877. .I:in. 1, 1S90. 

Tutal iiiiinlier ensas'ecl in practice 7,400 6,215 

<:i:i.luntes anil licentiates 3,600 5,640 

Non-grrailiiates - - 3,800 575 

Percentaf^e of graduates and licentiates in 1877 - - "18 

Percentage of gra<lliiites and licentiates January 1, 1890 91 

Percentage of nun-graduates in 1877 52 

Percentaee of non-sraduates January 1, 189D - 9 

DurinsT the lieriod yf its existence or up to January 1, 1890, the Board has issued certificates to 

physicians - 10,453 

To i^raduates and licentiates of medical institutions 8,949 

To exempts on years of practice 1,228 

To licentiates uiion examination, State Board of Health 246 

"Diplomas or licenses have been presented by those now in practice in the state from 151 medical 
colle£es and licensim; bodies in tlie United States, from 18 in Germany, 18 in Great Britain and Ire- 
land. 13 in Canada, 8 in Switzer and, 6 in Russia, 4 in Austria, 2 in Sweden. 2 in France. 1 in Denmark, 
1 in Norway, 1 in Maderia, 1 in Slain. 1 in Bolivia, 1 in Italy. I in Bclsinm, 1 in UruRuay— making a 
tnlal of 230 graduating or licensing bodies represcnti'il." 

In 1.S92 the State Board of Health recommended lor the consideration 
of the legislature, the desiraliiliU' of reheviiig the Board from the enforce- 
ment of the Medical I'raclice .\ct by the creation of a I'xiard uf Medical 
Examiners, wh(jse duty it should lie to determine the fitness for the practice 
of medicine in the State, by examination of candi<Iates, without reference 
to when, where or how they attained their fitness. 

A res(jlution was also adopted pro\-iding that all applicants for a State 
certificate to practice midwifcr\' in Illinois must pass a satisfac1t)ry examina- 
tion given l)y the Board. 

The proposition of establishing a separate licensing board was again 
taken up in ISiKi, when a committee was appoimed representing the Illinois 
Stale Medical Society; the liomeoiiathic State Society; iht Illinois State 
Eclectic Medical .'Society, and the State Board of Health, for tlie purpose of 
considering a plan to be iireseiited to the legislature to .amend the Medical 
Practice Act so as to require an examination by an impartial board, of all 
applicants to practice medicine in the State of Illinois. At the same time, 
the committee on administration of the Medical Practice Act submitted the 
rules and regulations governing the recognition of schools of midwifery. 

.\ resolution was adoiited that no medical college sh.ill be recognized as 
in good standing for the ]nirpose of the Illinois Medical Practice Act, that 
fl( fs not rri|uire of all matriculates, after January 1, PSUT, as a condition of 
grailuation, a four years' course of lectures in four separate years. 



284 ENKOUCICMl'.XT 0¥ MEDICAL PRACTICE ACT 

An investigation of nit-dical colleges made in 1897, revealed the necessity 
for a law prohibiting issuance of State charters to educational institutions, 
or giving them i)ower to cnnfer degrees initil inspected and approved. A 
new >clu'ilule nf niininiuni re(|uircnients for the regulation of medical ccil- 
leges was also adopted. This year a hill was ])assed providing for the regu- 
lation of the practice of o.steopathy in the Stale of Illinois, hut ( iovernor 
Tanner vetoed this measure, because the "act is clearly in the nature of class 
legislation." 

The Hoard also agreed hereafter not to recognize any foreign diploma 
as a basis upon which to issue a certificate to practice medicine and surgery 
in the State, and that all a|iplicants holding such di])lonias shall be required 
to pass an examination. 

Interstate reciprocity was ailopted in 1899. The ;Medical Practice Act 
was amended again this year ;uid broadened so as to provide for the examina- 
tion and licensing of persons who desire to practice any other science or 
system of treating human ailments. 

At the annual meeting of the Illinois State Medical Society held at 
Quincv, Mav ■Jii--.'-j. Wwri, a proijosed Bill for an Act to Establish a State 
Board of Medical b-xaniiners was presented and received ai)]iroval of the 
Society as a whole. 

The Medical Practice Act was further amended in 19UT by embodying 
a i)rovision empowering the State Board of Health to determine the stand- 
ard of lilerarv and scientific colleges, high schools, etc.. to be accepted for 
prelinnnarv etlucation of medical students, and to require the enforcement 
of a standard of i)reliminary education by medical colleges; also providing 
for reciiirocitv and granting of the compensation to members of the examin- 
ing biard f(jr their services. 

In 19 1."i a law was passed amending the Medical Practice Act by giving 
the Hoard jurisdiction over certificates issued to all physicians licensed in 
the .'-^tatc under the various medical laws. 

( )tiikk PiiAcrrnoXERS. 
Xeitlur the .\le<lical Practice Act of is;; nor tliat of iss; ni.ake any 
UK'nlion of or give provision for licensing "other (jractitioners." 

hi ihe llMi:! report of the Board of Health on page XLlll v,-e bnd the 
following: 

-REQUIREMENTS FOR 'THOSE WHO DESIRE TO PRACTICE ANY OTHER 
SYSTEM OR SCIENCE OF TREATING HUMAN AILMENTS.' 
Iii.'<trniti(ni.s lit Apiiliidnts. 
"Stale Certiticates autliori/.iiis piTsons who do not use medicines internally 
or externally and who do not perl'orni .surgical operations, to treat human ail- 
ments, are issued by the State Board of Health, on complying with certain re- 
(luirements. based upon the Act to Regulate the Practice of Medicine in the 
State of Illinois, in force .July 1, ISSCJ." 



EXFORCEMEXT ill- .Ml;iiU \L I'KACTICE ACT 385 

Mi/lirlre.s. 

While the 1<"^T; Medical Practice Act referred onl_\- to persons pracliciii .; 

medicine in anv of its departments and made no reference to niid\vi\es, the 

State Board of Health at a Cairo meetini; on Nmeniber 1."), Is7;. made 

the following statement : 

"The Board in entering upon the enforcement of the medical practice act, 
considered it imperative to attend to the demands made upon it by general prac- 
titioners, and paid little attention to midwives. Four hundred and twenty four 
certificates have however been issued to midwives. a comparatively large number, 
taking into consideration that owing to the amount of time and labor needed for 
issuing of certificates to medical practitioners, the systematic work of licensing 
midwives did not begin till a very recent date. In many counties of the state 
the proportion of midwives to general practitioners of medicine is very large — 
and much remains to be done to secure their complete licensing and registration." 

And again at the first annual meeting January 10, ls;s, we note th.s 

comment : 

"By vote of the Board it v/as resolved that midwives be placed upon the 
ranie basis under the law, so far as the requirement for certificates to practice are 
concerned, as practitioners of medicine." 

The 1S,S7 Aledical Practice Act makes no specific recjuirements for li- 
censing midwives but under Fees for Examination says : 

"The fees for the examination of non-graduates shall be as follows: Twenty 
($20) dollars for examination in Medicine and Surgery. Ten ($10) dollars for 
an examination in midwifery only." 

The l^iDU Act in the second section pru\ides: "No person shall here- 
after begin the practice of medicine or an\ nf the branches thereof, or mid- 
wifery in this State without first ajiplying fur and nbtaining a license from 
the Slate Board of Health to do so." 

The official register of midwives h;iving a State certificate issued by the 
Board since ISTT totalled 1,470 in IS!i(i. 

Eiiihnliiicrs. 

The official rules of the State' Board of Health for the transportation 
I if the dead based on an "Act providing for the Regulation of Embalming 
and the disposal of deail bodies" apjiroved Mav l'>, l!H).j, were promulgated 
and gi\en wiile pulilicitv in 11107, and all ciincerned were informed: 

"It is the duty of every Embalraer in the State of Illinois to thoroughly 
familiarize himself with every provision of these rules, the rigid enforcement 
of which is essential to the proper operation of the law under which they were 
created." 

REeujLATiox OF !Meiih'al PKA("ri( k Transferred to Department of 
Rkcisthatiox and Education. 

Through the enactment in 1'.I17 of tlu' .\dministrative Code, the re- 
sijonsibility for "the rights, powers and duties vested liv law in the State 



2S6 KNFORCKMK.N'T OF MKDICAL PKACTICE ACT 

Board of Health relating to the practice of medicine, or any of the branches 
therrof, or midwifery, * * * * the regulation of the embalming and disposal 
of dead bodies, and for a system of examination, registration and licensing 
of enibalmers," was transferred to the Department of Registration and Edu- 
cation. Thus for the first tiiue since LSVT, the State Department of Public 
ilialth which w.is created Ijy this Act, was free to give the important sub- 
ject of jiulilic health the fair share of the attention it merited. 



AUXILIARY HEALTH AGENCIES. 

Jn the ])ninii tiiin of ln-alth in Illinnis the State and local dejiartmenls 
of health ha\e had the aid of nian\- health agencies. Some of these are 
arms of government and some are not. .^ome are known as health agencies 
and act directly as such. Others are known 1)\- other names and their con- 
tribution is more indirect. Some are naticjnal and some are local. 

The legislature in providing health laws and the courts in interj)reting 
them have made their contribution. The collateral administrative officers 
in other departments have made theirs. The contribution of go\-ernors and 
of the heads t'f the de])artments of education, agricultiu'e. imblic welfare 
and labor, have been outstanding. Among the national organizations that 
have helped to jjromote health in the State are the United States I'ublic 
Health .Service. Children's Bureau. U. S. Department of Labor. U. S. De- 
partment of Agriculture, the International Health Board, American Public 
Health Association, American Child Health Association, National Tubercu- 
losis Association and National Educational Association. Among the more 
active agencies operating principally within the State are those, some of 
the activities of which are detailed on the following j)ages. 

Quasi Public Health Agencies. 

Ilt.ix(ii,s Mkduwl Sdciktv. 

The Illinois Alcdical Society has been in continuous existence since 
1850. While their main objective is the education ui ].)hysicians in the 
methods of curative medicine, keeping them abreast of the times and other- 
wise piromoting the professional interest of their mem1)ers. thev have not 
been unmindful of the duties of the medical profession in the field of pre- 
vention. For many years one of the sections of this Societv has been - 
that of preventive nie<licine. The journal of the .Society carries the papers 
read in this section to the oftices and homes of all the memliershi]). There 
are those who hold that in the di\ision of labor in the held of ])re\entive 
medicine the medical societies can justifv themselves in a policy of limiting 
their work to education of physicians in preventive measures and kee]i- 
ing them al)reast of all ad\-ances in this held. This activity the Illinois 
-Medical Society does through the .Section on Preventive Medicine, but 
they do other work as well. 

Their large share of credit for the law creating a State public health 
service is referred to elsewhere. Their committee at Springfield has lent 
its support to legislation for the public health at e\erv session of the 

(28:) 



288 .\U.X11.1.\K\- lllCAI.TIi AGENCIES 

GeiR-ral A.ssi-niljly for many years. The expense of tliis is home in part 
nul uf Sceiely funds and in ])arl out nf snh>cri])tiijns and dnnatidus hv 
iu(Hvidual nienil)ers of the profession. 

In llMi:; the Chicago Medical Society organized a course of lectinx's 
on hc:dih suiijrcls for lay hearers, 'i'hese lectures were held in the ])uhlic 
lihrary weekly for ahout two years. 

In 111-.'-.' ilu- Illinois .Mt-dical Society ])ro\ided tor a similar activit\- 
under ihe auspices of an h'.dncation Committee. This Committee began 
work in \'.>->'-\. Their report for January 1 to 'Mux 12. i'JT, made in Mav 
111",'^ indicates the nature of tlu-ir slate wide activities. 

Seven counties in the State have made definite use of the service offered 
through the Educational Committee during these four and one-half months. 
The other counties have made use of the st'r\ice indirecth'. 

Eighty-eight requests for sjieakers have been tilled to date. The 
members of the speakers' Inirean have a])peared before such groups as 
Kiwanis, Lions, Rotary, Optimist clubs, women's clubs, churches, parent- 
teacher associations, teachers' institutes, home bureaus, Y. M. C. A., Y. \\'. 
C. A. groups, and boy and girl scouts. 

A speakers' bureau of colored physicians and another of foreign speak- 
ing physicians ha\e been organized in order to widen the circle reached 
through health talks. 

Thirty-nine new'spapers are using the health articles release;l from 
the office of the Educational Committee as a regular feature. These articles 
ai>ix'ar in all cases imder the signature of the local medical societies. Eight 
hiiudrt-d health articles ha\ e been released to the newspapers in the State. 

b"ifty-nine radio ])rogranis have been arranged for o\er stations, V\'CiN, 
WllT, W'l.S, W-MAO and WQ]. Reports have come from Wisconsin, 
Iowa, Michigan and Indiana as well as from manv parts of Illinois com- 
mending these programs most highly. 

Forty-tw'O moving picture films have been scheduled for use by lay 
groups. These have been obtained from the State Department of I'ublic 
Health, the American Dental Association, the University of Wisconsin, and 
the Society for Visual Education. 

Fi^■e communities have had splendid poster exhibits in connection with 
s])ecial health i\a\ |)rogr,ims through the courlesv of tlie lulucational Com- 
mittee. 

Coojieralion has been given to certain projects of the .^tate Depart- 
ment of Public Mealtli. such as furnishing speakers, films and posture 
exhibits for various groups during Health Week, 

The Connnittee has worked with the Illinois Federation of Women's 
Club^ in urging clul) women to cooperate with county medical societies in 



AUXILIARY HEALTH AGENCIES ^8!) 

all health activities. Letters have been sent out empliasizing the import- 
ance of educating the pubhc on the subject of cancer. 

.\l)proach has been made to all county societies where baljy ci infer- 
ences ha\c been held in cooperation with the child hygiene dixision of 
the State Department of Public Health. Through this introduction comity 
societies were enabled to work out their own plans with the State Depart- 
ment of Public Health. 

TIk' committee ser\cs as a clearing house in making ci^ntacts with 
la\ organizations. 

During National Baby \\'eek ])rograms were arranged and speakers 
supjilied for several department stores in Chicago. Special radio talks 
were also given by physicians and dentists. 

( )ne hundred dentists were given complete [ihysical examinations at 
the amiual meeting of the Chicago Dental Society in V.'i'i'i. Twenty-five 
physicians were examined at the meeting of the Illinois State Medical 
Society at Aloline in May of the same year. 

The promotion of periodic physical examinations has been one of the 
more recent public activities of the Illinois Medical Society. 

Illinois Fkdeeation of AVomex's Clvbs. 

This organization has been of material sup])ort in furthering health 
measures. .\boiU 1012 when the war < n consumption down-state was in 
need of friends, the Federation through its local clubs and district or- 
ganizations made a survev of tuberculosis throughout the .State. The facts 
revealed by this survey and the local interest stimulated by it was largely 
res])onsible fcT the County Tuberculo>is .Sanitarium bill and for support of 
the county sanatoria throughout the State. At this time they are especially 
interested in promoting the physical and mental examination of children of 
preschool age. 

Illinois SoriExy for the Pkevention of Blindness. 

In I'.ilo in Chicago ten babies became blind as a result of neglected 
ophthalmia neonatorum. This led to the formation of the Illinois Society 
tor the Preventicn of Blindness. Before 1915 only 30 cases a year of 
ophthalmia neonatorum were reported. During 1926 nearly 600 such cases 
were reported. This does not mean that there is more of the infection. 
It means only that the cases are now recognized and properly treated. There 
has been a marked reduction in the mnnber made blind }earl\- and also in 
the number of graxe infections. 



290 AUXII.IAUN mCAl.TH AGENCIES 

TIk' Society's lirst task was lo promote the juissagc of a law requiring 
that gonococcal infections of the eye be prevented by the compulsory use 
of nitrate of silver and that cases of the disease lie reported. They have 
helped in the enforcement of the law. The preventive is now supiilied free 
by the State Department of Public Health. 

The Society has promoted trachoma surveys and clinics, also examina- 
tion of children for usual defects. They have conducted work in Chi- 
cago and in the State outside Chicago. 

The other interest of this Society is in the poor vision found among 
school children. The Society works down-state as well as in Chicago, in 
making surveys of existing conditions, securing relief for those who are 
handicapped by eye defects and in helping them to useful occupations, and 
also in educating and interesting people in the prevention of poor vision. 

Chicago Tuberculosis Institute. 

The present Chicago Tuberculosis Institute had its begmning in the 
Visiting Nurses Association in 1902. Miss Fulmer, the superintendent of 
nurses wrote her board calling their attention to the gi'eat amount of time 
and money spent by their organization in nursing and otherwise helping 
persons sick with consumption. She suggested that some money, brains 
and energy spent in jirevention would eventually save something in money, 
brains and energy spent in care and occasional cure. 

As a result of this communication the Visiting Nurses Association 
called a meeting of physicians and other interested persons, members of their 
board to convene in the rooms of the Association on January 21, 1903. 
This meeting organized a committee on tuberculosis. The Association voted 
$2,000 as a part of funds necessary to start the work. The plan of activities 
adojjted was that proposed by Dr. A. C. Klebs. In ]\Iarch, 1903. this Com- 
mittee began to function in rooms adjacent to those of the Visiting Nurses 
Association. By October, 1903, the Committee reported 67 cases of con- 
sumption under their direction. In November, 1903 it was reported that 
a course of lectures on tuberculosis had been arranged for. 

In March 1905, this Committee sent a letter to the \'isiting Nurses 
Association proposing that the Tuberculosis Committee form a separate 
organization. The \'isiting Nurses Association replied that they consid- 
ered that the time had come to consummate that. 

At the third annual meeting of the Tuberculosis Committee of the 
\'isiting Nurses Association held January 27, 1906, the Chicago Tuliercu- 
losis Society was fonned to take o\er the activities of the Committee. This 
was in efTect nothing more than creating a new form and selecting a new 
name for the old Committee and its work. The change was made with the 



AUXILIAK^ iii:ai.tii agencies ^91 

appnival of tlie Xisitint,^ Xiirses Assuciation ln-cause it was thought the 
wurk could be hcttur tlonc by a separate org'anization. Most of the old com- 
mittee members continued active in the new organization and two of them, 
Mrs. E. C. Dudley and Dr. W. A. livans have been in continuous service 
since and are still active. 

March 1, li'06, the name was changed to the Chicago Tuberculosis 
Institute. It was chartered March i;. 1 !(()(!. 

.\t first the Society did nothing except educational work, study and 
propaganda. 

On September 1. l!t()(i, they established a temporary sanitorium or camp 
on the grounds of the Dunning institutions. It was known as Camp Nor- 
wood and it served the jniljlic in a small wav from that date tmtil IMarch 
31, 1907. 

The Institute inaugurated a free dispensary service on May 15, 1907. 
This was gradually extended as to the number of dispensaries operated 
and the variety of service given until .September 1. 1010 on which date 
the service in its entirety was handed over to the Mimicipal I'uljcrculosis 
Sanitarium. 

On May 27, 1907, after an interruption <jf about two months the In- 
stitute went back into the Ijusiness of operating a philanthropic sanitarium 
through their acceptance from Mrs. Keith Spalding of Edward Sanitar- 
ium at Nai)erville, Illinois. 

In the beginning the acti\ities of the Committee, Society and Institute 
were supported by funds from the \isiting Xnrses Association and dona- 
tions from the public at large. 

In 1908 the system of raising money by the sale of Christmas seals 
was inaugurated. This has been the principal, in fact almost the sole means, 
of raising money since that date. Seals ha\ e been sold each December 
with the exception of 191S in which \-ear bv special arrangement the funds 
were supplied out of the nation-w i<le conmumity chest collected for the 
purpose of suppirting all |ihilanthi-()pic home activities in war time. 

( )n .\pril 1(1, 1910, a meeting to organize a State Tuljerculosis Society 
was held in the offices (}f the Chicago Tuberculosis Institute. Ihis meet- 
ing was attended by Doctors Sala of Rock Island, Hardesty of Jacksonville 
and Wallace of Peoria and a number of persons from Chicago: it was 
voted to organize a new Society out of the old State Society for the Pre- 
vention of Tuberculosis. The Chicago Tuberculosis Societv agreed to stand 
.all the preliminary expense of this reorganization. On June 10, 1910, the 
new .^tate Society was organized (out of the old Societv) (taking over 
its charter). It was then voted that the offices of the new society should 
be in the rooms of the Chicago Tuberculosis Institute and that the superin- 



292 AUXILIAI-Cl' IIKAI.TH ACE.VCIES 

tciidcni of the liistiuitf also st-rNc llu- State Society as its superintendent 
witlmnt t'xiieiise to the Stale Society for either rent or salary of the super- 
intendent. At a later date the State Society (•cctii>ied se|iarate rooms hut 
adjacent to those of the luslilnte. Later on thev employed a full-time suix-r- 
illtendent. still later the offices were removed to S|)rin£;tield. 

Decemher :)(i, I'.MS, the officers of the llliniiis Society for the Pre- 
vention of Tuherculosis completely se])arated the (.'hicago 'fuherculosis Insti- 
tute from affiliation with them creating Cook County as a separate juris- 
diction for the sale of Christmas seals and the doing of tuherculosis work. 
On Jannar\- 11. JItl!), this action of the Slate Society was ap]iro\ed by the 
executive comiuittee of the National Tuberculosis Society. 

.Among the acts and activities of the Chicago Tufjerculosis Institute 
found recorded in the minutes in addition to those narrated above are the 
following : 

Propaganda lie fore the legislature for a State sanitarium and for a 
tulierculosis bureau in the State Department of Health. Propaganda in su]i- 
port of the Glackin law for a municipal sanitarium in 1909. Activity in 
the camiiaign on the referendum under this law which vote established the 
i\Tuiiici])al Tuberculosis Sanitarium. Council in the organization of the 
sanitarium activities under that act. 

On Inly 17, 19ijT. the Chicago Tuberculosis Institute turned over 
to the city health de])artment their street index file of tuberculosis and the 
filing cabinet in which this was kept, the city health department promis- 
ing to keep this file alive. 

They helped in the passage of the Glackin county sanitarium bills, 
the pastt-urization ordinance and various laws for the repression of bovine 
tuberculosis, they organized stud\ classes for tuberculosis in industry and 
for the scientilic and clinical sliuh- of the disease. the\- conducted exhibi- 
tions and issued leaflets and ]iamphlets. Their present major activities 
are as follows : 

A general nursing service in more than one-half the countv. This 
service is acti\e in the control of all forms of contagion. 'J'his service 
is rendered in coo])eration with the county and local health departments. 
A health service rendered by physicians attending a number of health 
centers. A follow-np service for persons who have arrested tuberculosis. 
A health sur\-ey service. A course of leclnres I'li public health for nurses 
in training. .\n eniplo\nient agencv for nurses trained in tuberculosis \\(irk. 
An educational and propaganda service. A srniilarium service and ojier 
miscellaneous services. 



auxiliary health agencies 293 

The Illinois Tuberci'losis and Health Assoclvtiox. 

The \oluntary organization which has done more to prumote general 
public health inijirovement than any other non-official agency in the Stale 
is the Illinois Tuberculosis and Health Association. Originally estalilished 
for the purpose of concentrating its efforts against tuberculosis this organi- 
zation became in time a [jowfrful factor in the general held of public health 
service through the stimulation of local public health nursing ser\ices. It 
changed its name three tinus but its functidus, while emphasizing tubercu- 
losis work in particular, ha\e included general activities for the greater part 
of its life. 

Through the sale of Christmas seals this organization has had more 
resources than any other volnntarv agency for doing health work in the 
State at large. These haye been used to gocd advantage, residting in the 
establishment of local voluntary health organizations, local nursing services, 
tuberculosis sanitariums and the promotion of health education. Always 
the policies and activities have conformed with standard practices set up 
by the organized medical profession and the public health authorities. 

The organization had its beginning in 1 !)().'! when Dr. J. W. Pettit of 
Ottawa, Illinois, read a paper on consumption before the lllimiis State Medi- 
cal Society. Following this he was appointed by the Society to the chair- 
manship of a committee on tuberculosis with instructions to carry out what- 
ever plans seemed practical and advisable. 

The National Tuberculosis Association had just been organized in New 
York and encouraged with the interest of the State Medical Sijciety, Dr. 
I'ettit sent out a letter on December li, IHO-I, calling a meeting for the jjur- 
pose of organizing an Illinois tuberculosis association. This meeting con- 
vened at the Great Northern Hotel. Chicago, December 14, I'.)(i4. Seven- 
teen attended. The outcome was a plan, which later materialized into 
reality, to organize an association t(.) function on a state-wide scale. 

The organization was called the Illinois .Xssociation for the I'reven- 
tion of Tuberculosis. Dr. .\. C. Klebs was elected ])resi<Ient and Dr. N. A. 
Graves, secretary. 

The first work of the organizalinn was concentrateil on legislation look- 
ing toward the establishment of a State tuberculosis sanitariiun. The 
further objects were to stimulate the formation of ancl provide assistance 
for local societies in all the towns of the State and to cooperate with the 
national association f(jr the study ami prevention of tul)erculosis. 

Funds were secured through the sale of Christmas seals. The lirst sale 
was conducted in IIMI,") and the total amount raisi-d was *?1,'.'ihi. ['resident 
James of the L'niversitv of Illinois was elected president of the Association 
in 1905. 



294 AUXILIARY IIKAI.TH ACKNCllCS 

( )n April 1(1. 1!M<). ;i rcorgaiiization iiiiH-tiiii; was held, using the fild 
charter which \\a^ dati'd l*"chruary 7. ItH)."), ])r. W. A. Evans, Chicago was 
elected president and Mr. Frank E. Wing of Chicago, secretary. 

I'uur local organizations ap])licd for affiliation. The purpose of the 
organization was again stressed emphasizing educatinnal work and nursing 
service instead of material relic'f for consumptives. 

In 191J: the .Modern I ieallh Crusade niii\enieiU was launc!ie<l as tile 
outcome of a sur\ey made in \\ idle Cciunly. 

In IIM I the organization cooperated with the State Department of Pub- 
lie 1 Ieallh in .a health exhibit at the Illinois State Fair, a practice that has 
Cdutinued Ui dale. 

In December IHIS. Cook Counlv was createil as a separate org.iniza- 
tidu for the sale of Christmas seals, and earl\- in llMii the office of the Illi- 
nois .\ssociation for the Prevention nf Tuberculusis. as it was called at that 
time, was moved to Springfield and the name was changed to the Illinois 
Tuberculosis Association. 

Some of the tangible results of acli\ities for which the .\ssociation 

was entirely or largely responsible, according to records a\ailable in August 

]!)'^^, include the following: 

Public health nursiiiK services in V2 counties. 

Tuberculosis sanatoria in 16 counties. 

Affiliated or.i^anizations in 104 dilferent localities. 

Modern health crusade functioning in S7 count ie.'^. 

Two summer camps operating for undernourished children. 

Christmas seal sale organizations in every county. 

In IDl'.i the executive secretary cjf the Illinois Tuberculosis Association 
was employed by the imitate Department of Public Health to direct a state- 
wide project known as Health Pronu)tion Week. Hoth organizations i)iU 
a very large share of their joint resources behind the undertaking which 
resulted in a very general public response. This ])roject developed into an 
annual affair, conducted by the State Department of Public Health, which 
has doubtless exercised considerable influence on the volume of public 
health educational achievements in the State. 

' liber activities of the As.sociation include the jmblicatiou of a monthlv 
be.ilib educational btdletin called ihe ".\irow", the promotion of legisla- 
tion calenl.'ited to result in substantial impro\ement of ])ublic health, the 
carrying cut of tuberculosis sur\eys (such surveys have been made at least 
once in e\ery county), the launching of "open window" and anti-spitting 
campaigns .anuu.alh- and con])eralion with legitimate public health moxements 
generally. 

For examijle of ihe latter, the .Xssoci.alion contribtited $"350 tovvaixl the 
salary of a dentist who was I'luployed by the <lental profession of the State 



AUXILIARY IIEAI.TII AGENCIES 295 

and placed on the staff of the State Department of PubHc Health in 1026 as 
a demonstration of what could be done by promoting dental hygiene. This 
demonstration resulted in legislative provision for carrying on the work by 
the State De])artment of Tublic Health. 

Paeent-Teacher Associations. 

This is an organization composed of teachers in the grade schools and 
the parents of the pupils therein. It is a liaison organization between the 
schools and the home. Its plan is to have a local society for the parents 
and teachers of each school to consider everything that makes for the phy- 
sical and mental welfare of school children. A recent amendment to the 
[ilan pro\ides for the preparation of children for the school by having them 
examined physically and mentally, having their physical defects corrected 
and having them vaccinated against such diseases as diphtheria and small- 
pox all before they reach six years of age in order that they may enter the 
first grade in the best possible state of health and bodily vigor. 

National, Safety Council. 

The National Safety Council calls Illinois its home state. The pre- 
liminary meeting to organize this Council was held in ^Milwaukee in 11112. 
The first meeting under a completed organization was held in Chicago in 
lit] I under the presidency of R. W. Campbell of the Illinois Steel Company. 

Today the Council has 4,312 members and spends more than half a mil- 
lion dollars annually. 

The preliminary meeting in 1912 was addressed on the subject of "The 
Illinois System of Factory Inspection" by Edgar T. Davies. It was prin- 
cipally by virtue of the Health, Safety and Comfort Act that this Illinnis 
department was able to function. 

The National Council stimulated the formation of a Chicago Industrial 
Safety Council to function in Chicago and elsewhere in Illinois. 

The principal work of the Safety Council is to lessen the number of 
industrial accidents, through propaganda and education of the employers 
and employees and promotion of the general use of safety devices and safety 
methods. They have devoted some time to an objective not quite so directly 
in their field, namely, the prevention of public accidents such as accidents 
on the streets and public highways and in the home. 

They likewise promote better first aid service. Since 191-1 there has 
been a \ery marked decrease in industrial accidents both fatal and non-fatal 
in the State. The Safety Council feels that this field of need is being 
coxered in a way that is satisfying. Not so the field of street or public 
accidents. The fatal accident rate composed principally of public or street 
accidents is now one of the leading causes of death. 



296 AU\ii.iAi<\ in:AMii aiikni'iks 

(_'iiK'A(i() IIkakt ^VssOt'IATIOX. 

'I'he Chiccigci Heart AssocialiDii was orijanizecl in < )ctiil)ci", llf.'".'. the 
pui'ixjses being stated as follows — educatinn nf the jjublic. second — coordina- 
tion of all organizations having to do with heart diseases and the establish- 
ment of new organizations and ])ninuitiiin of research in the problems of 
heart disease especially as it relates to pulilic health. Since 1922 twelve 
cardiac clinics have been develojied and 15,000 to 2.").()()() pamphlets have 
been distributed yearly ; 2500 numbers of a quarterly bulletin are sent out 
four times a year. 

The Association has assisted in prucuring facilities for the care of 
cardiac convalescents and vacation canip^ f(ir cardiacs. In r.f.Ti they made 
a study of cardiacs in industry. 

While the greater part of the present program relates to the care of 
those already having heart troubles it is preventive in that it plans to pre- 
vent incapacity due tn heart disease by reason of broken establishment. The 
Association plans to try prevention of heart disease as soon as the basic facts 
are established. 

State Heakt Society. 

There is a State Heart Society, of whicli Dr. C 11. Diehl is ])resident, 
hut it has not functioned yet. 

TiiK C'lncAGO League for the Hard of Hearing. 

The Chicago League for the Hard of Hearing was founded in January, 
liiHi. It now has a meiubership of seven hundred and sixteen. The activ- 
ities of the League are, teaching lip reading, testing apparatus for the aid 
of hearing, making surveys of the degree of hearing of school children, the 
conditions of ears, nose and throat in school children and securing care for 
sch:Hil children who have infections of the ears, nose and throat. 

St.\te and L()(.'al Dental Societies. 

The State and lucal denial societies have contrilnited something to the 
imi)rovement of health and physical vigor by aiding health departments and 
schools to seciu-e dental clinics in the schools and elsewhere and by educa- 
tional and projiaganda cam|)aigns. 

IjAP.OIiATOIMKS AND rxiVKUSITIKS. 

The lahoratories and universities ha\'e contributed to the bettenneiil of 
health liy re^cnrch wurk and by teaching and by education of the public. 

The health (lep.arinients eagerly seize on every fact l■slabli^lK•d l)\ re- 
search either in labora.tury or in hosiiital or in universities whether in Illinois 



AUXILIARY HEALTH AGENCIES 297 

or elsewhere. Some part of the improvement is due tn iiuHrect aid frum all 
institutions of these types. 

The universities and colleges further contrihute by maintaining a health 
service for students which service is largely in fact princi])ally ])reventive in 
character. 

Industrial Physicians. 

The industrial physicians have an opportunity to apply preventive medi- 
cine to large bodies of men and women under the very best of circumstances. 
Their reconmiendations of changes in methods and in environment made to 
the management are generally heeded. Their advice to employers made both 
directly and indirectly through foremen carry weight and influence. The 
industrial physicians have helped the health camjiaign. 

Practicing Physicians. 

Xo other group renders so much service as an auxiliary agency as do 
the practicing physicians. They are constantly rendering service in pre- 
vention through their direct contacts with their clients. They periodically 
render such service indirectly through their local medical societies. 

Illinois Society for ^Iental Hvoikne. 

The Illinois Society for Mental Hygiene was founded in 1'.)i>li. Its 
first stafT consisted of one nurse who had a desk in the wom.an's club in 
Chicago. In 1!M1 some adililional perse nnel was availed of hv means oi 
funds set aside for the purpose by the Lountv judge of Cook County. This 
work in the Cook County courts was taken over bv the court in 1!»1."). In 
]'J'i-) the need of definite practical training in mental hygiene for social 
workers was demonstrated to the social service agencies in Chicago. A 
(healthj demonstration of the relation of meiUal hygiene to personality 
difficulties was made in a Chicago high school. Local meiUal h\giene com- 
mittees were organized in two Illinois communities. 

A survey was made of the mental hygiene conditions in the schools 
of LaSalle. Illinois. 

The .'Society helped to firing about the organization of the State In- 
stitute for Child Ivesearcb. Much of the energy of the Si;ciety is ex- 
pended in popnlar education and proijaganda for menial health. 

American Hkh Cross. 

The .\merican Red Cross first entered the field of rural nursing in I!)!".'. 
Their actiyities in home nursing were increased when the State troops 
were called to the border in I'.iKi. A program of dexelopinmi on a large 
scale was adopted in l!ll!». \\'hile most of the work of the rural nurses 



298 AUXILIARY HEALTH Ar,i:NCIES 

takes the loriii of Ijedsidc luirsiiin- of the sick much of it is preventive in 
character. 

In April !!,•"-'■;, pubhc heahh nurses were employed in 1 V counties as 
county, school or community nurses. In lifly-nine of these counties the 
American Red Cross participated in inaugurating the service. There were 
seventeen Red Cross chapters employing public health nurses. Eight of 
these nurses are financed entirely by the Red Cross and nine jointly by the 
Red Cross and otlur agencies. The Red Cross conducts nearly five hundred 
classes yearly in home hygiene and care of the sick — issuing certificates 
to about 11,000 persons yearly. 

The following are some of the (jrinciijles of the nursing service: "The 
protection of the jjublic lualth is fundamentallv a governmental problem 
but at the same time, it is i ne that re(|uires the intelligent and active co- 
O])eration of the iiuli\idual citizen. The function of the Ived Cross is the 
pronK)tion of indi\i<lual and coninnmity health through ])ersonal service, 
group instructii n and general health propaganda." The duties of these 
nurses are given as — "eradication of communicable diseases, health educa- 
tion, nursing care of the sick, of mothers, of new born babies, of the 
tulieiculous and school nursing." 

Amkhicax Soc'ikty fok the Control ok Cancer. 

The American Society for the Control of Cancer was organized at the 
Clinical Congress of Surgeons held in New York City in 1912, (about). 
Soon after that an Illinois branch was formed. Dr. Gilbert Fitz-Patrick. 
present chairman of the Illinois branch, sets September. 19<;(i as the time 
of rejuxenation of that branch. At that time he appeared Ijcfore the coun- 
cil of the State Medical Society and secured their endorsement. Since 
then sixty-three county branches have been organized and ,500 meetings at- 
tended by 150,000 people have been held. "The camjiaign has for its prime 
objective teaching the people ways of checking their disease liabilities 
against the health assets through the jdiysical examination yearlv." Cancer 
.has pro\en the best wedge and the worst topic with which to open for 
discussion the to])ic of better lu'alth. 

Illinois Sihm.nl IhciKxt: TjEaole. 

( )n July ]■'. nnil. three Chicago men, Budd C. Corbus, .M. D., Mr. 
.Samuel Carson and Mr. Roger Sherman received articles of incorporation 
for an organization whose objective was defined as "devoted to the scien- 
tific observation ;ind study of diseases and cures therefor." but whose 
constitution limited its work "to the study, jjrevention and treatment of 
venereal diseases." 



AUXILIARY HEALTH AGENCIES 299 

At the first annual meeting; Robert H. Gault, professor of criminal 
law and criminolog}- at Northwestern University was elected president. 
An active campaign of prevention and education, particularly in the camps 
at Fort Sheridan, Camp Grant, Grant I'ark. Great Lakes and Municipal 
Pier, was carried on. 

Prophylactic stations were opened at the League's first permanent 
home, an old house of prostituticn at 118 West Grand Avenue, Chicago 
and at the Xorthwestern depot. Cooperative relations were established 
with the Illinois State Council of Defense, the British Recruiting Mission 
and the United States Examining Boards. 

Exhibits were installed, lecturers trained and sent out, hundreds of 
thousands of pamphlets printed, and lantern-slides made. 

A comprehensive survey of the hospitals and dispensaries of Chicago 
with reference to the facilities for the diagnosis and treatment of the 
venereal diseases was made in behalf of the League by i )r. Mary L. Lin- 
coln and published, April S-t, 1917. 

The name was changed to the Illinois Social Hygiene League e.irl\ in 
1919. Since then the yearly expenditures for charitable treatment and 
education have grown to nearly $50,000 and the nimiber of treatments given 
yearly from 3,302 to 28,222 in 1926. 

When Professor Gault left Chicago, Mr. Charles S. Dering became 
president and under his wise leadership and that of Dr. Louis E. Schmidt, 
who succeeded him, the constructive contrilmtion of the League to the wel- 
fare of societv increased materially. 

In April, I'J'i',. the League moved into its (jwn building a com^iara- 
tively new four-story Ijrick business structin"e ideallv located and con- 
structed for teaching, treating and training purposes. This piuxhase was 
made possible by contributions from the president, Mr. E. S. Me\er, a 
member of the board of directors, Mr. Albert Knppenheimer of Chicago 
and other generous Chicago citizens. 

Here the League conducts separate clinics for venereally diseased men. 
womeu and children, an exhibit room and lecture hall, with one floor 
devoted to education and preventive work. I'^jur full-time jilnsicians ]iro 
vide the service in return for post-graduate instruction jjIus an honnrarium 
while ten or twelve medical men and women of experience and abilit\' 
provide the instruction and me<lical supervision. 0\ev 100 jiatients ;i da\ 
are treateil here for sypliiHs and gonorrhea while nwv loo.ooo instruc- 
tive pamphlets are distributed vearlv bv the education.il ilepartnient. TOO 
lectures given and many exhibits set up. The League has a lilni librar}- 
of 35 reels of educational films which is in constant u.se. Research work in 
cooperation with the U. S. Public Health Service has been organized and 



300 AUXII.IARN HEALTH AGEN'CIKS 

an (.•llicienl lahoraldry i)r()vi<lr(l where it is carried on wiili tlie assistance 
ol the League staff and students from \'(H-tii\\t'stern L'ni\ersil\- Medical 
College. 

Plans are afoot for a further increase of activity lookins; toward a 
coniprehensi\e program for the uUimate i-radicalion of the \enereal disease 
il >iich a thing is possihle. 

The work done in Illinois outside of Chicago is liiuiled to propaganda 
and edticalional acti\ities. 

Citii.niM'.N "s I Iiisi'i I'Ai. Socii'-.TV A.xn Mii.k Commission. 

In Decemlier 1!hi-^. folUnving the \isit of Dr. A. Lorenz of X'ienna, 
a movement was set on foot liy the WHnian'.s lluh reform de].)artinent 
to provide Chicago with facilities for sick children. 

This meeting resulted in the organization of the Children's Hospital 
Society of Chicago. Dr. Frank Billings was elected president. Mrs] Harold 
McCormick. secretary. Mr. E., G. Keith, treasurer and Mrs. Flora G. Moul- 
ton. chairman of the Membership Committee. 

In .May, lIMi:;, this Society organized the Milk Commission of Chicago. 
This .Milk (.ommission remainerl active thereafter although the parent 
society (the Children's llcjspital Society) appeared to have lapsed. 

Mr. and Mrs. Nathan Straus of New York donated to this Society 
a pasteiuizing ]ilain which through the conrtesv of the Chicago Board of 
liducation was located in the basement of the Thomas Hoyne .'School, Cass 
and Illinois streets. Chicago. 

Dr. 1. .\. Alit was chairman of this ( cinimission and Mrs. I'lummei 
anil .Mrs. .Moulton were in control of tlu' plant. They began distrilniting 
nnlk 1 n July ;, i:to:!. and continued until .\o\ember 28, 1!)03. In this time 
tbe\- distriliuted ■.'■.'■.'.( mm) bottles of pasteurizecl modified milk. It was sold 
below cost thiough thirt)-one milk stations. 

The lal)or.itor\ work on this milk was done without cost by the C'olum- 
bus Medical l.ahuratorv through Dr. .Vdolph ( lehrman. -\t a public meeting 
to promote this acii\it\' helfl at the Chicago Woman's Club. May 21i. 
1903. speeches \vere made b\- Mrs. Chas. Henroten, Dr. V. Billings, Miss 
Jane Addams, .Mrs. Ceo. I'lunimei-. Mr. Steve Sumner of the milk drivers 
union. Mr. 11. B. Farmer of the milk shippers union, j. E. Allen, Chicago 
and North Western Railroad, Professor IC ( ). Jordan. Dr. -\. R. Reynolds. 
Dr. I. .\. Abt. James Cheeseman, Dr. W. S. Christopher, .Mr. II. 1'.. ( lurler 
;ind Dr. Kosa lutgelnian. 

In l!Hi:') the C'ommission continue<I distributing nnlk. Thev inaugurated 
inspection of farms, visitation of babies in the Immes. mothers' meetings and 
a series of educational articles in the Chicago rribune. The secretary pro- 



AUXILIARY HEALTH AGEXCIES 301 

nounced the work of the Commission as "An educative benexolent one of 
instruction, example and protection where no mere law can reach." In 
their minutes we read that Northwestern University medical schmil estab- 
lished a diet kitchen in December, 1902. 

Alsd that as the years passed bv St. Louis and other cities established 
ciiniiiiissidus modeled after that of (/hicai.;(). 

In Alav ]!H)1, one of the educational articles was on the sul>iect ol 
Stale supervision of milk b_\- E. i\. Eaton. 

Erom this article we learn that the Illinois legislature passed a law 
in 1S74 which prohibited the adulteration of milk under a penalty of $")(HI 
In 18T!) they passed a law prohibiting the selling of impure milk and also 
the selling of milk from diseased cows. The penalty was $10(i. 

In 1S97 they provided for State standards for milk. In IS'.MI another 
law created the office of State food commission and ga\e them some control 
over milk. 

An interesting report on the wi.rk of I'.KKl is a report of the home 
and dairy visits of a field worker. .Much of her time was s|)eiit in in- 
structing mothers how to keep their babies well. 

This t}-])e of actixitv was continued for sexeral vears. ( In |ul\ 'i I, l!t()S, 
the Commission was chartered. In its year book fur December -'11. 191! 
the Milk L'ommission says, "l""or eight \ ear> (since 19(i;!) the Milk Com- 
mission for Chicago has sitccessfully carried on its work." 

Chicago Infaxt A\'hlkai!e Society. 

On March 10, 1911, the Infant Welfare Society was foimed li\' a 
reorganization of the Milk Commission. The milk stations were closecl 
and the new organization continued the policy uf instructing mothers in the 
iiome and in stations, but stressing this type of activit\ especialK . 

Judge Julian Alack resigned as president Januarv '■'>]. 1911. and Mr. 
Lucius Teter succeeded him. Two im|)ortant conferences with represen- 
tatives of the Chicago Medical Society are referred to in the minutes. 
On December 28, 1908, a joint mei'ting was held to discuss the confusion 
which seemed to be arising relative to the use of the terms medical com- 
mission, milk and certitiefl milk, commission milk. This seems to have 
l:.een adju>ted by having the Milk Connnission rccoinniend some persons 
to membership of the Milk Certifying L'ommission of the Chicago Medical 
Society. 

This source of friction was cntii-ely rcmo\ed little more than two 
years later when the Milk Commission changed its name and stopped sup- 
[ilving milk'. 



302 AUXILIARY HEALTH ACENCIES 

Another consultation willi rc]>rcsfiitativcs of the Chicago Medical So- 
ci(.-l\- was hclil l'\;hru,ir\ '.'. i:i<i!i. This was will) reference to the system 
of consultation days and hours for mothers and habies. The plan appears 
to have met the approval of the representatives of the medical society. 

On March ]."), ]li|(i. a joint meeting of the Milk Commission and the 
Children's Society was held to work out a ])lan for infant welfare stations 
that would he more eomprelu'nsive than that in use. 

( )n March ■.".•, l!»l(l. Dr. W. .\. livaiis, health commissioner of Chi- 
cago asked the Milk Commission to participate in a city wide "Save the 
Babies Campaign" during the .summer of 1910. This campaign was to 
operate through infant welfare centers as agencies. The Society accepted 
and participated. 

In Decemlier llHt). the superintendent. Miss Ahrens. made a report 
hast'd on a four months study of the local situation. She recommended 
a reorganization of the w^ork of the society under a medical director. This 
was done. 

The final transformation of the Commission into the Infant Welfare 
Societv in I'.M 1 has been referred to aho\e. 

The Society has functioned since on that basis. 

Its objects are stated as: — "To reduce the infant death rate and im- 
prove the health of the coming generation by keeping the baby well, before 
Its biitli bv caring for the mother and after its l)irth by teaching her how- 
to feed and care for her child." 

'I'lie ty[)es of care gi\en in I'.f.'ii are prenatal care, infant care, care 
of pre-sch( ol children. 

The number of infant welfare stations operated in l!C2l! was given as 
twenty-three. < )f these nine stations ga\e all three kinds of work. Seven 
gave service onl\ to preschool children. Si.\ served infants only and one 
gixcs prenatal and infant care only. 

In llf.'Ci ])renatal care was given to 1 .'JUS mothers, infant service was 
gi\ui to l''.!H)l b:il)ies, an<l preschool service to 2,129 children. 

.\ pari of the service rendered since ( Ictober 1925 is in mental hygiene. 

Kl.lZ.vr.K'PII Mcl'oKMU'K MkMOKLVL Fdt'NDATIOX. 

The ILIizabetb .McCormick .Memorial I'oundation specializes, in jiro- 
motiiig health work among cliildri'ii. 1 laving observed the operation of open 
window schools in the (iraham school in lIMis and 1909 they spent several 
vears in active propaganda for fresh air and o|ien window schools. 

Thev ne.xt lucanie active in jiropaganda and prcuiotiun of the Emer- 
son plan for improving the nutrition of school children. More recently 
thev have been promoting more general procedure's ])rincipallv aimed at 
improving the nutrition of school children. 



auxiliary health agencies 303 

Orgaxizatioxs of Professional. Health ATorkers. 

Since the time of Dr. J- H. Ranch there has always been one or more 
State health societies in the State. Most of the times these societies have 
been paper organizations. At times they have functioned satisfactorily. 
At the present time there are three of them. The health officers have an 
organization which meets annually to discuss methods of doing health work — 
its principal function is to promote the efficiency of health officers and to 
better the work of prevention done by them. 

The Illinois Tuberculosis and Public Health Association has some 
general health work in addition to their tulierculosis work. They hold 
an annual meeting and issue a periodical. 

The Illinois Health Society has some funds in the treasury and main- 
tain an organization. 



HEALTH CONDITIONS IN ILLINOIS AFTER 1877. 

Few chanj,'es in the history of illinoi> have heen so i)ronouiicc(l as the 
differences between lieaUh con(htiiins that ])revailed fifty years before and 
fifty years after b'-;;';. I'rinr to that date tlie territory inchided \viliiin the 
boundary hues of ilir Stale went throULjh a ])erio<l wiien it rii,dul\ provoked 
the reputation of beint; one of the most nnheahiifnl ])orlion> of the L'nited 
States. I'racticaily no ini])ro\enK-nt in niortahty and siei<ness rates tooi< 
place before 1877 althou,<,dT malaria, the ])redominating factor in the early 
evil reputation. Iiad begun to decline noticeably. Indeed the prevalence of 
such infections as iy])hoid fever, tuberculosis, diphtheria and most of the 
otlier c(.inimunicable diseases grew worse. The fertility of the soil and other 
economic resources such as coal made so strong an a]ipeal to settler> that 
immigration poured in regardless of health liazards. It was true, further- 
more, that the diseases which beset humanity in Illinois after the plague of 
malaria became more tolerable were common everywhere so that there was 
no point in avoiding the State because of them. 

At the end of the first fifty years subsequent to \S]~,, Illinois enjo_\ed the 
re])Utation of being one of the most healthful commonwealths in the L'nited 
States. Mortality statistics uphold this reputation. While many factors 
are present that ]irevent mortality statistics from portraying an absolutely 
accurate picture of health conditions they do, nevertheless, reveal what may 
be accepted as ajiproximately correct information. The factors present in 
the Illinois statistics are, moreover, to be reckoned with in the data from 
every other State so that comparisons are justified. 

The mortality records iniblished by the United States Bureau of Census 
give lllinoi> a lower death rate for 1!)'26 than the United States and a rate 
lower than an\ other of the seven states with an estimated population of 
4, ()()(), <M)0 (ir more. I'nrlhermore. the a\'erage annual death rate in Illinois 
for the six years ended with IM'.'ii was lower than the average for any 
other of the same group of states for the same period. The figiu'es are: 

MoKT.M.ITV TEK 1,000 Pol'UL.VTION. 

(U. S. Bureau of the Census.) 



states'. 


1921. 


1922. 


1923. 


1924. 


1925. 


1926. 


Average. 


Califonii-i 


13,2 

11 1 

12 2 
116 
12 .3 
11 3 
12-4 
11.6 


14. .1 

11 3 

12 8 
11 3 

13 
11.3 
12.3 
11.8 


14 3 

12 

13 .0 
12 4 
13.0 
12.3 
13. 3 
12 3 


14. 5 
11.2 
12. .0 
11. .6 
12.7 
11 2 
12.3 
11. -S 


13.6 

11 .5 

12 .5 
11. ,") 
12 .8 
11. .4 
12 4 
11..7" 


13.6 
11.8 

12. 6 

12. 7 
13.4 
12.3 
12.7 
12.. 1« 




IllilK.is 

.MillliK^li 


11 5 

12 
11. S 




11 6 




12 5 




11 9 







' With 4.000.000 o 
' rrovisidiial figu 



jitcd iioimlation 



(304) 



HEALTH CONDITIONS AFTER 18TT 305 

Texas comt-s within the ])o]nilation chissification indicated in the table 
hut that state was not included in the United States death registration area 
during the period for which statistics are given. 

The data cited show that health conditions in Illinois were cciual to it 
not hetter than those which prevailed in the country at large after lli'-iO. 
Similar statistics for earlier jieriods are not available but there are other 
evidences of a profound change for the better after 1877. For one thing 
the average length of life increased very noticeably. Only four and seven 
tenths per cent of all deaths recorded in 1SS0 were among persons over 75 
years uld. In l!i"^5 the percentage was tifteen and three tenths. In actual 
numbers the deaths among the older than 75 age group went u]i from 2131 
in 1880 to 12,545 in 1925, an increase of nearly six fcjld during a period 
when the total population only doubled. Furthermore, deaths among chil- 
dren less than five years old fell from about forty-five per cent of all mor- 
tality in 1880 to about fifteen per cent in li)25. Again, the experience of 
industrial insurance companies, who pay more regard to dollars and cents 
than to theories, shows an increase of about 11 years in the average span 
of life of policy holders between l!)lii and l!)2(i. 

Another evidence of increasing longevity is the greater number of peo- 
ple who cHe from old age diseases. Heart disease, cancer, nephritis and 
cerebral hemorrhage, particularly the first two, caused a far greater per- 
centage of deaths in 1926 than they did twenty, fifty or one hundred years 
before. In 1880 mortality from heart disease was less than three per cent 
of the total deaths and that from cancer was scarcely more than one per 
cent. In 1925 heart diseases were credited with more than seventeen and 
cancer with more than eight per cent of the total mortality, or twenty-five 
percent together. This is clear proof that people live longer because these 
diseases are insignificant catises of death for people under forty. 

Then there is the seasonal phenomenon of mortality. All statistics ap- 
plving to death rates in Illinois prior lo l!"i() show unmistakably that the 
hot months were the most liazard(.)us for life, .\ugust and Septcml)er were 
nearlv always the months of heaviest mortality. .\bout 1900 a gnidual 
transformation became noticeable. 1-ong before 1921 August and Septem- 
ber had become the period of lowest morialily and the time when people 
were freest from sickness. This chan.ge resulted from a diminution in the 
I>revalence of such diseases as cholera, typhoid fever, diarrhea and other 
intestinal disturbances. 

There are no general mortality data a\ailable which furnish a reliable 
basis for comparing health conditions in Illinois during the various |)eriods 
referred to. All of the statistics relating to the State as a whole are frag- 
mentary for the years prior to 1918. Th.-ii was the dale when Illinois was 



SOfi IIKAI.TII CD.NIHTIONS Al'TKU 1877 

ailniiltrd to tlu- I'nitcd Slates death re,t,dstrati(in area, a manifestatinii that 
iiiniialil\- repdils were suflieieiitlv edinplete ti) warrant federal reeiif^iiition. 
Before that date they had ranged front sixty to eighty per cent ineomplete. 
That much disere]>ancy make unreliable any conclusion that might be drawn 
from general mortality rates based upon the published records of death. 

With all of their inc(]nipleteiiess, however, the statistics for specific dis- 
eases iiroviile \aluable basis for conclusions regarding the public health. 
These data, together with inforni.ition collected from other sources, iuniish 
material for tracing the trend of man's con(|nest of disease in Illinois and 
the success that has attended his eli'ort>. This is set forth in tln' chapters 
that follow. 

The two factors which contriiiUted more than any other to the fall of 
communicable diseases in Illinois after bs7; were the requirements of case 
reports and the development of bacteriological laboratory service. Quaran- 
tine and the isolation of patients helped, but nowhere in the wdiole category 
of infectious ailments was progress toward eradication so pronounced as 
it was with those diseases for which laboratory facilities provided aids in 
diagnosis and specific products for cure or prevention. Alalaria is a possible 
exception and in this case the great change in'environiuent that drove out 
the disease might be thought of as the unconscious operation of a great 
sociological laboratory. Smallpox is perhaps another exce])tion but here by 
a happy circumstance of clever observation man was able to employ a jiro- 
cedure stripped of s|)ecihc bacteriological information which in relation to 
another disease would have waited for the results of laboratory research. 

Tuberculosis, typhoid fever and diphtheria are the three diseases against 
which the luost phenomenal progress toward eradication w^as made. The 
marked receding prevalence of each set in after the introduction of labor- 
atory^ service concerning each. Toward the end of the period covere<l by 
this volume, the laljoratory developed facilities helpful in controlling scarlet 
fever and jiiieumonia. Time had not periuitted any considerable results 
from these processes although scarlet fever had already responded indirectly 
to laboratory procedures in that milk supplies were subjected to sanitation 
thereby. 

\ encreal diseases can be diagnosed in lalioratories and that fact con- 
tributed enormously to such success as attended the efforts of control but 
the peculiar sociological connection of these diseases ])revented their decline 
in degrees characteristic of some others. 

No infectious disease endemic in Illinois, again with the exception of 
malaria, declined to any signihcant degree until health antlmrities i-e(|uired 
the notification of cases and develojied machinery for enforcing the reijuire- 



HEALTH CONDITION'S AFTER 1S7T 307 

ment. Knowledge of location of cases ])erniilte(l the applicatii)n of all the 
ciintrcil measures available to health officers. 

In the summer of 192? a general revision of the rules and regulations 
relating to communicable diseases was made by the State Department of 
Public Health. A more general de])endeiice on laboratory procedures, a 
more rigid requirement of case reports and a substitution of indeterminate 
for specific long-time quarantine periods featured the revision. Results r)f 
laboratory examination of specimens and clinical evidence were the factors 
specified to determine length of isolation rather than dependence on an arbi- 
trary time period. 

Smallpox and Vaccination. 

Smallpox is a disease for which preventive measures, such as vaccina- 
tion and revaccination, isolation of cases and the ob.servation and quarantine 
of susceptible persons who have come in contact with a case, are absolutely 
effective. The usefulness of these measures was generally recognized by 
sanitarians when the State Board of Meallh was organized in ISTI. but ])ub- 
lic ojiinion had not been awakened to the necessity of carrying out these 
simple [irocedures. As a result, vaccination was neglected, and local au- 
thorities, upon whom falls the responsibility for the enforcement of i)ul}lic 
health regulations in this State, were often negligent in carrying out the 
oilier preventive measures referred to above, such as isolation and (juaran- 
tine, e\rn in the presence of a local outlireak. 'I'his was the state of affairs 
when the Hoard was organized in is;;, but it did not long remain that way, 
for in ISSI to 1882 there occurred an epidemic of smallpox of such iiropor- 
tions that the entire State was roused to action, so that it Ijecame relatively 
easy for the .State Board to enforce general vaccination. 

Bui in time, especially when a feeling of trani|uility began to iprevail 
on account of the relative al>sence ot -mallpox, these measures were neg- 
lected and later even attacked in the courts w itli the usual result, that con-, 
ditions soon 1)ecame rijie again tor another oullireak. 

The history of smallpox in the Slate is ^raphicallv shown \)\ the chart 
in iMi^m-e IN-A. which shows the course of the disea>e from ISiiil in d.ite. as 
indicated by the decennial or animal mortality rales as far as these are avail- 
able. 

Hninllpox Not Preraloit. 

Smallpox, not being especialK- pie\aleiil during the first two \ears of 
the Board's existence, did not demand any special attention. L'ondilions 
soon changed, however. Immigration into llu- State from liurope was 
heavy. The population was umaccinaled. The apjiearaiice of an e]iideinic 



308 



IIILALTII COXDITIOXS AKTEK 1ST' 



was only a niallrr nf time. This time arrived about 1880. P.y 1.^81 tlie 
situation was eom])le;ely beyond control. Small]>ox was rampant. 

General conditions as well as tho.se in the State were grave enougli to 
lead Dr. |ohn 11. Kancli. .Secretary of the State Board of Health, to take 
it upon hiinsclt' to call a .t;eiieral conference to be held in Chicago on June 
29-;iO, 18SI, to consider the smallpox situation. In answer to his call 18 
health organizations from 14 different states responded. The federal gov- 
ernment was represented by members of the National Board of Health, 
an organization that was in existence at that time. The meeting was held 




SMALLPOX 

in ILLINOIS 
1860-1926 



STATISTICS UNAVAILABLE FOR OPEfl YEARS 




at the a|i])ointe(l time, and after full delilieiation, the Conference recom- 
mended that Cull!.; less incorporate into the laws regulating immigration, a 
provision reciuiring protection from smallpox by successful vaccination of 
all immigrants, also that the National Board of Health consider the pro])riety 
of re(iuiring the ins]iection of iinmigrants at ])orts of departure, the \accina- 
tion of those unprotected, and the deteiiiion of ;d] unprotected |>ersons who 
hatl been exposed; that measures be taken fur ihi- (|uarantine, by the deten- 
tion of all steamships bringing immigrants nut pi(i\ideil with proper evidence 



HEALTH CONDITIONS AFTER 18T7 



309 



of vaccinal protection ; that local health authorities also inspect all immigrants 
arriving in their respective jurisdiction and enforce proper protective and 
preventive measures when necessary, and that the National Board of Health 
take steps to secure the inspection of all immigrants and the vaccination of 
the unprotected hefore landing them at any jiort in the United States. A 
considerahle part of this program was carried out later. An immigrant in- 
spection service, fnr instance, was established in the United States for 
the six months of July U> December ISS-^. Physicians were posted at rail- 
way terminals thniughi ut the country. Dr. Raucli was superintendent for 
the Western District and caused the insiiecliun nl' 115.057 and the vaccina- 
tion of 21,618 immigrants bound for Illinois. This wi)rk was done largely 
at Chicago and St. Louis, the railway terminals leading into the State. 

Table 25. 







c 


ASEs OF Smallpox Reported in 


Illinois. 








Year. 


.Jan. 


Feb. 


Mar. 


Apr. 


Ma.v 


June 


1 
Jul.v Aug. 


Sei t. 


Oct. 


Nov. 


Dec. 


Total. 


1917 


1 

S56 


910 


526 


657 


811 


411 


312 


114 


148 


168 


93 


292 


4,996 


1918 


742 


744 


645 


557 


571 


189 


103 


73 


26 


42 


36 


114 


3,842 


1919 


322 


284 


465 


567 


5-4 


442 


183 


135 


232 


260 


648 


779 


4,871 


1920 


776 


842 


748 


1,063 


1,232 


909 


383 


212 


198 


326 


553 


1,294 


8,536 


1921 


1,900 


1,659 


1,760 


1,204 


1,027 


412 


102 


29 


23 


39 


120 


261 


8,536 


1922 


3,3 


360 


228 


197 


238 


115 


175 


40 


8 


75 


176 


133 


2,118 


1923 


369 


121 


64 


50 


69 


128 


39 


24 


9 


28 


15 


21 


937 


1924 


37 


46 


95 


HI 


164 


242 


168 


46 


42 


187 


58 


166 


1,362 


1925 


210 


299 


220 


215 


150 


194 


46 


30 


20 


30 


79 


137 


1,630 


1926 


177 


164 


108 


165 


135 


105 


93 


21 


26 


5 


25 


51 


1,077 


1927 


172 


118 


213 


113 


150 


63 


67 
















1 


1 ' 







Oiifhreal- nf 1SS1 and 18S2. 

The a\-eraj.;e pre\alence of sniallp(.)x during the _\ears 1S7T to ISSO was 
relati\ely lew, but early in ISSl it began to increase, and by the mil (if the 
year a tcjtal of :i.(iOO cases was reported, of which nunilier l.lso dccurred 
in Chicago. 

At a special meeting of the .^tate Board of Health, in November l.SS], 
the notihcatinn uf smallpox or other epidemic disease was made compulsory. 
Local health officers were required to collect the rep(jrts from practicing ])hy- 
sicians and transmit them |)rnnii)tly to the Board. It cannot be said, how- 
ever, that either cases or deaths were reported with any large degree of 
completeness because no machinery for collecting reports existed. There 
were very few local health officers. 

The situation was serious and re(|iiired vigorous action. Recognizing 
school children as a large section of the population which coujd easily lie 



310 



IIMAI.III CO.NDITIOXS AFTKK 1ST7 



reached with the least etitirt and in the <|uickest time, the Board ordered 
that no child be admitted to ]nil)lic scimuls in the State after January 1 with- 
f)nt .yiNinij evidence of successful \accinaliun or a histor\- of >inanpox. 

The plan worked. Within sixlv days aftt'r the order went into effect 
the percentasie of \accinalcd school children rose from al)out l-"i to !i I jjer 
ci'nt. A consideralilc inimlier of adtills, particularly t-mployees of lar^e in- 
dnstrics like the railway companies and inniatt-s of State institutions were 
als<i \accinated. Th" epidemic snhsided. The peo])le became absorbed in 
other problems and promptly forgot all about the com])ulsory vaccination 
order an<l ignored it although the Hoard had put it into effect as a permanent 
jirocedure. 

Eyents ran true to form so that in the course of time neglect of vaccina- 
tion resulted in widespread outbreaks of smallpox again as soon as the m- 



Talile 2(!. 
Deaths from Smalli'dx in Illinois by Months. 



1 ! 
Year. I .Jan. Feb. 

i 1 


Mar. 


A,-r. 


May. 


June. 


Jul.v. 


Aug. 


Sept, 


1 
Oct. Nov. 1 Dec. 


Total. 


I9I7 


1 








1 
1 


i 


i 1 
1 1 


10 


1918 


4 

1 
1 
4 


1 
1 
2 
2 
5 


4 

2 

■"i"' 

6 


3 
1 






1 


1 


1 




2 


14 


1919 








5 


1920 


1 
4 
I 


1 
4 




1 


2 


1 
2 


3 

5 


16 
26 








23 


1923 










I 


2 


1 




■■■^■■■ 


2 
2 


6 
2 
3 


2 
6 
2 


2 


1 






16 






I 






23 


1926 1 I 






1 





8 



















fluence of the wholesale \accinations of ISS'i began to wane. In the early 
nineties the situation had again grown serious and again the Board altem])ted 
to handle the matter bv demanding compnlsorv- vaccination of school children. 
This time the outcome was not so happ\- for sanitarians, luiough pu])ils were 
vaccinated to check the epidemic but Iwo law suits were started bv parents 
who objected to the coerci\e character of the \ accination procedure. (Jne 
against a school board in \\a\iie C ount\ wa^ drop|ied b\- the defendants. 
The members of the sclinol Ixiard had been lined bv a justice of the peace 
and appealed at twii dillerent times. Both suits were dropped, howxwer. up- 
on advice of the local state's attornev who opined that a reversal of decision 
was improbable. 

.\ m.andanius suit was started in Lawrence C'onnl\' against a school 
board, to compel it to admit the children excluded from the schools be- 



HEALTH CON'DITIOXS AFTER 18T7 311 

cause they were not vaccinated. The case was first decided against the 
school board. The decision was affirmed liv the circuit court of Lawrence 
County, and appealed to the apiiellate court. It was then taken to the 
Supreme Court, which rendered a decision against the school board in No- 
vember, 1895. This decision declared unconstitutional the requirements of 
vaccination as a contingent to attendance on public school so that the rule 
of the Board was voided. The subsequent ]iractice. which has been upheld 
by the courts, has been to recjuire either vaccination or quarantine of all 
school children during the period of immediate danger after smallpox has 
actually appeared in a conuiiunit}-. 

Table 27. 
Deaths and De.ath Rates from Smallpox in Illinois. 

Riite per Rate per 

100,000 100.000 

Year. No. lieatlis. pii|nilation. Year. No. deaths, population. 

1850 

1860 



1882 2,641 

1883 103 

1884 U 

1885 63 

1890 

1900 -.. 25 

1902 67 

1903 --..- 135 

1904 - 242 

1905 131 

1906 2 

1907 5 

1908 - 1 



By an act of the legislature, in force Julv 1, IS'.i.j. it was mack- tlu- duty 
of the tnistees of the Uni\ersitv of Illinois to establish and maintain a State 
vaccine propagation station. The law also provided that the State Board of 
Health should exercise supervision of the methods of propagation and cer- 
tify to the purity of all products manufactured at this plant. An appropria- 
tion ol $.'?.(ll)(l was made to establish and maintain the vaccine farm in con- 
iH-ction with the State University. This pruject was short lived, however. 

.Ml the troops sent from Illinois for dutv (luring the S]>anish-.\nierican 
War in 1S!),S were vaccin.-iled against smallpox ihrough tin- acti\it\' of the 
State Hoard of Health. 





1909 

1910 .. 


8 

8 


14 


0.4 


0.14 


6.7 


mil .. 


8 


0.13 


1.4 


1!I12 . 


12 


0.20 


54,6 


1913 


3 


0.05 


Sl.S 


1914 


20 


0.03 


3.1 


1915 


5 


0.08 


.32 


1916 


6 


0.09 


1.8 


1917 - - 


10 


0.02 




191S 


14 


0.23 


.51 


1919 ... 




0.08 


1 3 


1920 ... 


16 


0.23 


2 6 


1921 ... 


26 


0.37 


4 7 


1922 ... 


23 


0.34 


2 5 


1923 ... 


2 


0.03 


0.03 


1924 .... 


16 


0.23 


09 


1925 


23 


0.31 


0.02 


1926 -.- 


8 


0.11 



312 TIF.AI.TII COXDITIOXS Al'Tl.k ISTT 

Smallpox in 19UH and After. 

In 1903, a total of 1,6G1 cast-s of smallpox were rrpuili-d and it was 
estimatc'<l liy tlu- Board that this number rejjrcsentcd pnil)alil\' ikiI over 
two-thirds of tlu- cases occurring- in the State. 

Another law suit .^rcw o\\\ of a smallpox epidemic at Hyde Park, Chi- 
cago in llMi;. 'rhi> inviihcd a cit\- ordinance which required vaccination 
as a contingent upon school attendance. Here again the Supreme Court de- 
cided in fa\iir of the plaintitf, holding that neillier local health ollicers 
nor cities had the authorilv to make or enforce such oi^dinances. 

Thus it was made very clear that compulsory vaccination w^ould not be 
tolerated in Illinois under prevailing laws. It was up to health officials to 
fnid some other wa\' to control smallpox. 

This situation resulted in the practice of requiring either vaccination or 
(|uarantine of exposed persons in a conimunit\ where smallpox was actually 
present. The courts have generallv uplield this procedtu'e. It is still in 
vogue and operates fairh- satisfactorilv when the .^tate health officials are 
alert. Practically ever^nne in a comnnuiitv ma\' l)e regarded as exposed 
to ^mall])ox when the disease is |iresent so that the method jjractically 
amounts to com])ulsory vaccination on the installment plan, the nistallments 
coming due when epidemics threaten. 

Since 190.J smallpox has Huctnated with the \eais, \ar\ing with the de- 
gree of .success that attended \arioirs schemes for stinnilating \accination. 
In general the disease has been mild although m.alignant cases were intro- 
duced into Illinois in lie.'".' and again in 111'.' I. Mortalitv has steadfastly 
remained below one death ])er loo.ooo peoi)le, howe\er, dm'ing the period. 

The last significant ste]i toward jirevenling smallpox in Illinois was 
taken in l!i'21 when the State Department of Public Health imder Dr. Isaac 
IX Rawdings began the practice of making a personal investigation of every 
reported case of smallpo.x and everv reported case of chickenpox in adults. 
Field physicians are assigned to these duties as they arise from time to time 
so that the control methods described aliove can be applied ])rompllv and ef- 
fectively. 

.State and local ln'altb offici-rs have indulged in sporadic campaigns agi- 
tating voluntary vaccination ,inil these efforts result in considerable success. 

P)y combining the last three methods mentioned the he.ilth officials have 
been able to m.inage smallpox aliout as satisfactoril)' as could be expected 
under existing conditions. .\o alarming outbreaks developed Uj) to this 
writing subse(|uent to \'.)'i\. 



HEALTH CONDITION'S AFTER 187 T 



.313 



History of the Chicago Smallpox Epidemic of 189;1, 1894 and 181)5 
With Side Lights and Eecollections. 

[Bi/ Arthur R. KriiiioMs-, M. £».*] 

A serious epidemic of snialljiox occurred in Chicago during the years 
1S'.)3. 1894 and 1895. Not the most serious in the city's history, for three 
great epidemics had previously occurred, one in ISCl, another in 18T2 and 
a third in 1SS2. All were much nnjre serious 
than that of 1893-1S9"). Each had more cases 
C(inii)ared with the population, all were more fatal 
and nunc of them were so speedily suppressed. 
During the ])revalence of smallpox in 1880, 1881 
and 1882, a total of (i,835 cases were reported. In 
the 1893-1895 epidemic the cases numhercd 3,754 
in a population more than three times greater 
than ill the early eighties. 

There was no smallpox in Chicago during 

1890 and 1S91. In the following year eight cases 

were reported, two in May, one in June, three in 

Se])temher and four in December. Concerning 

these the chief medical inspector. Dr. Garrott. in h\^ annual report, wrote 

"We were ahle in every instance to trace the source of contagion to other 




Oi/srt of Epi/Iiiiiir and Varciiiatidii. 

In January, 1S93. there were three cases fi)lli)wed liy three in I'^ehruary 
and live in Aijril. The onset of the epiilemic of 1S!)3-1S1)5 has ordinarily 
been given as June 12, 1893, because from that time un there w;is a contin- 
uous monthly occurrence of cases. Undoubtedly the disease had been 
smouldering for two years previously in the form of unrecognized cases for 
on July 6, cases w-ere found in three widely separated localities and none 
could be traced to their origin. In .\ugust there were nine cases, in Septem- 
ber three, October nine, November thirty-five and in December sixty-six. 

It was the year of the World's Fair. Throughout 189g the b'air was in 
course of Iniilding. Thousands of workmen and others came to the city 
and (if course they brought whatever contagion they had with them. Ex- 
hibitors and others from every country were coming for a year liefore the 
Fair opened in 1893. Indeed the formal opening of the h'air was in ( )ctober, 
1892. It is, fair to assume that smallpox was one of lln' things the Fair 
brought to Chicago. 

• Dr. Arthur R. Reynolds vva.s appointed Conimis.sioner of Health for Chicago by 
the elder Mayor Carter H. Harriwm, .April 17, lS(i:!, and served until .lune 13, 1SS5. 
He was aRain ai)pointed by Carter H. Harris. ni. .!r.. April 1 M. 1S!i7. and reappointed 
every two years until ,Iune 27, IftO.";. 



31-1 nicAi.iii KiMinioxs after 18TT 

There had hucn ,t;rcat iic.l;1<.-cI of vaccinaticm fcir K) years previously. In 
the last six months of IS!i;i nearly one hundnd thousand vaccinations were 
done bv the department and that was more than had been done in several 
years l)efore, all told. Mranwhile every means that the department could 
devise was employed lo arou>c the ])uhlic to the necessity of vaccination. 
Letters were written to the Miptrintendents of public schools, to the parochial 
schools, to private schools, to the head of btisiness concerns, factories, the 
railroads, etc., ur^int; that they see lo it that those whom they em])loyed or 
were under their control wvvv \accinated. h'roni all came hearty responses 
and pnmiises of cooprratii in. In newspaper inter\ie\\ s the necessity for 
vaccination was constantly stressed. The foreiijn lani^nage press was a])- 
pealed to and innumerable local publications were also addressed and from 
all valuable help and cooperation was obtained. 

By January 1, 1894, the public was thoroui^hly aroused. livery jihy- 
sician in the city was vaccinating;. This valuable start was m;i(le without 
any increased expense to the department cxcejit for the vaccine that was 
distributed free to all who would use it. 

The covtntry was in a period of ^reat llnancial stringency Repeated re- 
quests for a])propriations of money br(.night no results. I'inally the mayor 
told me to cut loose and do whatever was necessary. It was realized that 
the entire cit\' nnist be vaccinated immediately. Several hundred physi- 
cians and senior medical students were employed to vaccinate. The city 
was divided into districts and those again into sub-districts and men put to 
work until the entire cit\- was covered by \'accinators who went from house 
to house and from group to gmu]). h'ive hundred were employed at one 
time and more than half a million vaccinations were done in three or four 
months. 

.\mong this ccn'ps of vaccinators were some of the city's ablest medical 
men, others who later became ]jrominent practitioners. Dr. |iihn Dill Rob- 
ertson was a vaccinator for the department in 1894. In llil."> he became 
ce-mmissioner of health for Chicago and held the office seven years with a 
good record. He is still ])rouil of having been a vaccinator for the depart- 
ment in bis early career. 

Later the city council a|)propiiated $l()(),(ll)() but a rough estimate of ex- 
peiidilurt'S revealed that the enlire sum had l)een sjient or contracted for 
when ihe a|)iiropriation was made. 

Prcif/rcss, II (isjiitu'iintniii aii'l Oilier / iiciilnifs. 

.\n emergency hospital was ert-cted and soon beds were available for 
everN- patient and thereafter every case was hospitalized. Ly May, 1S94. 
the backbone of the epidi'mic was broken, b'rom then on there was a dimin- 



HEALTH COXDITIO.XS AFTER l!ST^ 315 

ishing number of cases each nKintli. The last case Dccurred in December, 
1895. 

It must nut be jjresumed tbere was no faultfindint; nr criticism nf tlie 
(iepartmciit and its head. There was jjlenty of it and it was persistent but 
we knew that we were on the right road and tliat the pubHc as a whole were 
with us and stood firmly behind us. There was in fact great apprehension 
in the city as there always is in time of peril, but it ha<l to be faced. 

The department was fortunate in gathering together a force of men 
who knew no hours but worked unceasingly, who did as much as the com- 
missioner and other otlicers. They all worked as partners in the enterprise. 
Among these nnist be mentioned the late Dr. b'rank W. Keillv who was 
appointed assistant commissioner in January, IMM. to whom 1 give all 
praise for wise guidance throughout the rest of ni\' ser\ice which ended in 
June, 1905. Credit is also due to the late Dr. Erasnnis (iarrott an<l the late 
Dr. Heman Spalding. 

The late John P. Hopkins, then Mayor, stood like a rock behind us. 
In no way did he interfere witli the selection of the force of employees. 
He attended every meeting when requested and there were manv of them. 
They were called to fliscuss features of the work when it seemed to clash 
with xime interest or another. 

Hon. .Martin ]!. Madden was then an alderman and chairman of the 
finance committee of the city council, he had great courage and furnished 
a wise balance in many a cl.ash. 1 le then largely controlled the city's finances, 
held a firm hanil over them but was generous as could be expected. For 
many years he has been in the Congress of the United States where he now 
keeps a wise and restraining hand upon National expenditure. 

The details of the epidemic are told in the reports of the department and 
need not here be recounted. There are, however, manv side lights of that 
time remaining in my memory that may be told. 

In lS'.):i the appropriation of money for the department of health was 
only about one-tenth of the amount in recent years when compared on a per 
capita basis of population. There were S-t peojile all told employed in the 
department: 44 of these were connected with smtike, tenement house and 
factory inspection, 10 weie meat inspectors, 10 fumigators, 8 medical in- 
spectors and 4 were funeral directors. From the distribution of these assign- 
ments to various duties may be seen the status of public health work and 
disease prevention in the jniblic mind of tli.at time. Sewer gas was the great 
bugbear to be combated, although venti'ation ami cleanliness of homes were 
always stressed. Ten fumigators fumigated infected rooms or houses by 
burning sulphur after sealing up all cracks about windows or doors. .After 
24 hours the windows and doors were opened and instructions given for a 
thorough scrubbing of the floors and a general house-cleaning. 



316 lUCAI.TIl fOMHTIOXS AI-TKR 1877 

Contagious diseases were reijorled Ijv physicians in a rather desuhory 
way and warning cards were placed on the front door of houses where the 
disease was present. An investigation of the fate of these warning cards 
revealed that they were sunu'tiines laki-n from the front door and tacked up 
on the hasenient duor wiiere thev could not be seen, .\nother trick was to 
take the card frmn the fnmt diKir and ]jlace it (}n the back door. Another 
was to taki' it from the otitside (li the dcxjr and put it on the inside of the 
same door and \erv frei|iientl\- they were destroyed altogether. The de- 
p.-irtnicnt of health was generalh' considered the fifth wheel of the munici- 
pal iharidt. The ])resent (la\' elticienc\' and standing of jiulilic health wurk 
had not even dawned when the city council made the appro])riation Inr 
is'.t.'i. i'.efore the year was (Uit and the pul)lic awakening was nu. it was 
fretjuently pointed out to the commissioner of health that he had the power 
to command the entire resources of the city if necessary to control smallpox. 

The inadequate smallpox hospital was soon overcrowded. Walled and 
floored, tents heated and fully equijiped were set up in the rather spacious 
hospital groimds, but soon these were tilled. .\ new teni])orary hos])ital was 
quicklv built and equipped with an am])le supply nf tents f(ir summer use, 
and from that time on there were beds for all. The new hospital was not 
ready until the time when the new cases came in decreasing numbers. 

When the smallpox hospital became crowded there was puldic clamour 
demanding that another building be fitted U]i for teniiiorary use as a hos- 
pital. .A school building was suggested and a public meeting was held in the 
rooms of the Board of Education. .\ discussion jiro and con was ha<l. 
Tliose in the neighborhood of the school objected, and some one said the 
building was too good for such purpose. The late Mr. Thomas Brennan. 
presiding, answered: "Xo building w;is too good for the care of the sick." 
But it was soon found that the idea was not ])racticable for several reasons, 
the chief of which was that the relitting would be too expensive. 

Mrs. Dudley, wife of Dr. \\. C Dudley of Chicago, was then at the 
be.id of the N'isiting Nurse .\ssoci,ation. She came and offered to furnish 
the nurses for the new hospital and pay their salaries. The otf'er w,as 
promptly accepted. The nurses were retained until the hospital closed in 
1895 and after that the city paid the salaries of the nurses. 

Smallpox was prev.alent in a section of Chicago where there were fac- 
tories for read\- made clothing. .\t a meeting of the clothiers it was sug- 
gested tb.it clothing ship]ie(l shouM h:i\e a label saying the goods were free 
from smallpox cont.agion. Dr. Reilly at once protested that such a lal.iel 
cast suspicion on the goods and would be ruinous to the trade. It was 
.announced th.at no infected goods of any kind would be shipped from Chi- 
cago or sent to any place within the city. 



HEALTH CONDITIONS AFTER 18TT 3IT 

At another meeting of the clothing industry a representative of the 
State demanded that the department of health burn all clothing that had 
been in the hands of home workers where there might be contagion. The 
dei)artment of health agreed to burn everything that the State recommended 
for such fate, provided the State guaranteed to indemnify the owners for 
anv unnecessary loss that subsequently might be proven. '1 hat ended that. 
There was much speculation on the danger of infection in the factories 
of the ready-made clothing industry and several meetings of those interested 
were held. At one of these meetings at which Mayor Ho])kins was present 
Mr. Hart of Hart. Shat?ner & Marx offered to raise $5,000 and present 
it to the city to battle the contagion. After the meeting the Mayor was 
asked what he tlu)ught of Mr. Hart's offer. He answered, "The city cannot 
afford to accept the offer although it is most generous." 

In the winter of 1894 communities and states surrounding Chicago 
were concerned about the spreail of smallpox from Chicago. Frequent 
visits were made to Chicago by health officials and finally a meeting was 
called in Chicago of state and city health officers. Ouarantining against an 
infected city, town or state was then in vogue though not so popular as 
formerlv and an officer who would "slap on a (luarantine" was clispla\-ing 
great erudition and efficiency. 

.\s we met in conference it was plain that our visitors were imbued 
with the thought that there was something wrong with Chicago in its trials. 
The discussions w-ere inane. There were no suggestions of assistance or 
help of any kind. One illustration will suffice. The secretary of the con- 
ference who was also the executive officer of the State Board of Health of 
Illinois, when asked what the State was doing said — 'A\'hen any community 
in the State fails to stop an epidemic, then the State steps in." What it would 
step into or any word of what should be done was not mentioned. 

There was one notable exception. Our great crusade to vaccinate the 
entire city was then in full swing. It was explained to the visitors. Finally 
Dr. Ernest W'ende, Commissioner of Health of Huttalo, New York, arose 
and said: "Gentlemen, there is just one thing that will stop smallpox and 
that is vaccination, from what I have heard today. The ^cope and system of 
vaccination in Chicago covering the entire population is without ])arallel in 
the history of previous epidemics. I am satisfied the disease is now prac- 
tically under control. I am going home and will make an effort to do the 
same thing in Buffalo." 

Disiiifi'ctioii. 

Mattresses, comforters ami other things of small value that could not 
well be otherwise disinfected were Inirned anil the owners paid for llu-ni. 



318 HEALTH coN'nrrioNs aftf.r ISTT 

if tlit'v had any value. C'i)ttnn snoods were Ijoiled and the rooms suhjected 
to >ul|iliur funii,i;atii)n. 

Durini^r the eoin'se nt the epidemic the flepartment was offered the use 
of a Ions; tuhiiiar steel chaniljer in a convenient location ihat had lieen used 
for (Iryinii hiniher. It was fitted with steam pipes, so that the interior could 
he raised to a high temperature and was therefore suitahle for use as a dis- 
infecting chamber. It had a conveyor that carried its load from the entrance 
to the exit at the other end: the front was fitted so that live steam could be 
turned in. This plant was accepted and tised for the disinfecting; of bed- 
ding, clothing and similar articles. 'I'he goods were hauled to it, put in the 
steam chamber and were taken <iut from the other end by clean hands, put 
into a clean conveyance and sent back to the owners. 

11 <tsj)itaht(i1 ion. 

Hospitals in JS'.lli were not as popular as they are now and smallpox 
hospitals generallv designated as "'jiest houses" were to be avoided at all 
hazards. Xo himian being would then or now \dluntarily go to a pest 
house. Xo department rules or statiU(ir\' l.iw could overcome the horrur of 
a pest house, bear of the pe.-^t house led to the secretion of cases. Sick 
children were wra])])ed ti]) and carried tlu'ough the Mux to a neighboring 
house when the fann'lv saw the health department conveyance arrive for 
their removal. < 'pen \iolence was earl)' ibreatened and occasionally attempt- 
ed. An ambulance was also a thing to l)e avoided. Jvenmval, however, was 
logical and necessary. 

Familiarity with these facts nattu-ally led to the consideration of other 
methods than force to bosjiitalizc the sick. Xicely upholstered carriages 
drawn by a pair of horses were ptirchased and put to tise in the work, 'fhat 
helped some. 

In the better neighborhooils the argument tb.it non-removal left the 
family in more danger from their neighbors than from the authorities was 
very effective. The common sense of the difficult situation was that there 
was some influence, some |)erson or ])ersons in every community that could 
overcome the fear or the iirejudice of every terrified or recalcitrant individ- 
ual or family in an\ proposition that was right, just and humane. These 
influences were sought and found .and put to good ])iirpose in the removal 
of the sick to the hospital when lin.alK .ample hospital facilities were pro- 
vided. Difi'ereiit connmmiiies and ditfereiit nationalities required different 
management. In one foreign speaking communitv Sisters of Charity were 
of the greatest help. They acted as interpreters and pointed out the advan- 
tage of remo\;Ll so the sick could have s]iecial care and the premises cleaned 
up. 'l'he\' helped seciu'e v.accin.-ition ;ind in every way were efficient helpers. 
.■\ .group of la\- brothers who were teachers in a jiarochial school gave the 



HEALTH COXDITIOXS AFTKR 18TT 319 

same special and efficient service, livery ease of smallpox was removed to 
the hospital when there was nuini idr them. Mothers of small children 
were taken along to the hospital when they would go. Telephones were 
installed so the sick could talk to the folks at home. 

Tliis e])idemic occurred nearlv one lumdred years after the immortal 
Jenner had discovered vaccination htit there was a woeful lack of accurate 
knowledge as to what constituted a true vaccination. It was not generally 
known that a true vaccination left a typical scar unlike that from any other 
cause. The patient's word was generally accepted as to whether he was vac- 
cinated or not. Those upon whom \accination had ever been attempted con- 
sidered theuLselves vaccinated. Anvone with a scar on the arm at the site 
of vaccination considered themselves vaccinated and the bi.g.ger the scar the 
more certain the\' were. 

There was litle knowtledge e\xn in the profession of what constituted a 
true Jennerian scar. Jenner it is true had painstakingly described it, but med- 
ical colleges had not taught it and jenner's works were not studied. 

Before the e])idemic was over the large number of cases reported in vac- 
cinated persons and the freijuent use of the word varioloid, meaning small- 
])ox modified by vaccination caused incphry to be made, together with a 
careful study of the scar, following vaccination. It was ultimately found 
that ]iersons with a typical jennerian scar did not contract smallpox at all, 
not even varioloid, b'rom that ilay to this there was little, if anv smallpox 
reported in the truly vaccinatetl. It was found too that the large scars were 
made by some extraneous infection and that in such cases there was often no 
true vaccinal result. It was prior to the day of glyeerinated vaccine Ivmph. 
The vaccine used was dried on lione jioints and naturalh' there were some 
sore arms, not, as we then pointed out, due to the vaccine but as a result 
of infection either on the point or introduced afterward bv the fingers of 
the patient. 

Large groups were afraid to be vaccinated, others objected on religious 
grounds and anyway nol'.ody wanted to be meddled with. Then there were 
those who called themselves antivaccinationists, who made a sort of cult of 
it and worked themselves up into a line frenzy of in lignation over it. How 
they got that way is hard to understand. They were the most unreasoning 
and cantankerous of the lot. fbnvever thev generally fafled awav when 
danger of small]>ox was imminent. 

One \erv eharming lady visited the commissioner of health to \dice 
the objection of the religious organization in which she was a leader. .She 
said her people had other means of preventing disease and that they did not 
(|uail before smallpox. She also said she and her church w^ere law abiding 



320 IlICAl.Tll IDNDITIONS AFTER 18TT 

I'Ut wanted tn talk ii (i\xt. AnKini,' others (if lu-r art;'uniems she said thai 
C'hrist did not sav anything about vaccination. She was told, with sacri- 
ligious ri>k, that vaccination was not known till Dr. Jenner discovered it 
less than one hundred years a.^n hut that nearly all the followers of Christ 
were in favor of it now. Later it was learned that her organization gave 
instructions to snlmiit to vaccination when the authorities demanded it but 
prayed that it might do ihem un harm. 

The department was frequently m-ged by this group or that to forcibly 
vaccinate the objectors. The fact was wi- never had the authority to vac- 
cinate b\' force nor does that power exist now. We did have the authority 
of law to quarantine any who refused to lie vaccinated. That ])ower was 
used in one notable instance where a hotel full of a religious grou]) were shut 
in for weeks. 

A total of 3754 persons had smallpo.x during the two and a half years 
of its reign. Of these IvKi dietl. The survivors had their usefulness im- 
paired in many instances. Many were seriously poc-marked and their faces 
less lovely to look upon. The ex]jense to the city was great. I'he imjiair- 
nient to traffic and commerce was, however, rendered almost nil. There 
was the toil and trial of thijse in the department who cared for the sick and 
suppressed the disease. Had it any influence on the jiresent or any lesson 
for the future? We think it had ami that not only Chicago Init the world 
learned a useful lessi.ui. 

The Lesson. 

The epidemic was due to the neglect of vaccination. It demonstrated 
anew that none who were truly vaccinated contracted the disease and that 
a successful vaccination left a scar typical of vaccination and unlike any 
other scar; also that in cases of skin eruplinn. where a diagnosis was difficult, 
the presence of a typical Jennerian scar, made the decision that it was not 
sm.allpox iiractically certain. It showed that everybody could be vaccinated 
when it was properly presented and hence vaccination by force was poor 
])olic\- and unnecessary. 

Experience showed that vaccination with jnire vaccine did not cause a 
bad sore and left only a small scar and that large scars were due to extrane- 
ous infection and as a rule did not |)rotect. 

Cholera 

During the .")() years since the establishment of the .State I'oard of 
Health, a jjeriod which may be designated as one of suppression and control 
of disease, there is no better illustration of a comprehensive campaign car- 
ried on for the prevention of an epidemic by a state health department than 
the safeguards and sanitary [jrecautions taken by the Illinois State Board in 



HEALTH CONDITION'S AFTER 18T7 321 

1884 and 1885, in its efforts to prevent the invasion of Asiatic cholera. Tliis 
disease had frequently invaded Illinois prior to 18;^. the year in which the 
State Board was estahlished. 

The ('Jidlcra Duiiijir in 1SS4. 

.\s early as July. 1883, the danger of an invasion of Asiatic cholera into 
the United States and Illinois was noted hy the State Board, and preliminary 
action was taken with reference to measures necessary to resist its introduc- 
tion and til prevent its sjjread. 

The safeguards determined U])on as the most promising for success 
were two- fold. The first was an intra-state measure and was to take the 
form of a state-wide sanitary survey to determine the sanitar\' needs, and a 
sanitary "clean-up" if data ohtained through the surve\' indicated that this 
was needed. 'Ihe second was inter-state and related to aiding and insist- 
ence upon enforcement of quarantine requirements and insjiection methods 
along the Gulf and Atlantic coast, together with efforts to secure inqjroved 
sanitation and cleanliness of the various neighboring states. 

'ihe cleanliness campaign was based on the prevailing theorv in regard 
to origin and spread of cholera, and was possibly also conducted with a 
view that it would have a good effect in the saving of lives from other tilth 
diseases far in excess of the mortality from the cholera itself, unless it shonld 
spread beyond all expectation. 

The Board inaugurated this campaign witli the following statement to 
the public: "An epidemic spread of Asiatic cholera now seems inniiinent. 
Mention is m;ide of cases in hjigland and I'rancc Whether the disease will 
cross the .\tlantic fr(]m the luist will depend iqion the efficac\- of measiu'es 
emjiloyed to confine contagion to the ]iresent localities." 

To guard against the invasion, the secretary of the State B( ard made 
the following statement and recommendation: 

"My experience and observation lead to tlie conclusion that it is not judicious 
to place entire reliance on quarantine measures, no matter how administered, 
should the disease become epidemic in countries or points with which this country 
has close commercial relations. As Asiatic cholera, although it may invade places 
in good sanitary condition, tinds its most congenial habitat where filth in any 
form abounds, the best attainable sanitary condition; clean streets and premises, 
the prompt and proper disposal of organic refuse, night-soil, and all forms of 
sewage; well ventilated habitations, with dry. clean basements; a pure and 
sufflcient water supply; and good, individual hygiene, including personal cleanli- 
ness, proper diet, and regular habits of life — these are the best safeguards against 
Asiatic cholera. 

"I have to respectively recommend that a thorough and svstematic sanitary 
survey of the State be inaugurated by the first of January. 1SS5." 

The results of the efforts made in 1 .siS4 to secure a general inspection 
and improvement of sanitary eonrlitioiis were as follows: 

Reports Irom •.':>() cities, towns, and villages were received in re|iiv to 
the circular seiu out, and an innnense amouni of work was acconi])lished 



32"3 iiEALTii coxnrTioxs akteu 1877 

in remedying the detects disclosed by the inspections. The secretary per- 
sonallv inspected a number of the State institutions, and found them in as 
good sanitary condition as could be expected in view of faulty construction, 
or location, from a hygienic standijoint. Suggestions for imi)rovement were 
given and carried out as far as practicable. 

s.\.\iT.\RY survey: At the next meeting of the Board, the secretary by 
rcsdkniiin \\a^ auilmrized "'I'd prepare the necessary l)lank> and in>tnu'tii in>. 
and til distriljute the same to the proper authorities of cuunties. tii\\ii>hips. 
and municipalities, tdr a thorough and systematic sanitary survey of the 
State, to be begun by January 1. 1885, or as soon thereafter as iiracticable." 

The secretary explained that it was proposed to l)egin work in the 
southern portion of the State, and to work northward as rapidly as the 
weather would permit, so that by May 1 the sanitary condition of every 
dwelling in all of its parts, of all premises, outhotises. wells, cisterns, and 
other belongings should be made known, the remedy of defects be pushed, 
and the authority of the State Board be exerted wherever necessary in su])- 
plemcni the efforts of the local authorities of the State to reust the threat- 
ened invasion of Asiatic cholera. 

A much greater share than u^ual of the labor of the Pmard in ISS.") was 
devoted to purely sanitary work and efforts to prevent the invasion and 
spread of cholera. The records show that a total of 300,000 houses and 
premises were inspected in 395 cities, towns, and villages. These inspec- 
tions were made from March to December, 1885, and embraced '.Hi of the 
102 counties. 

The thoroughness of these inspections made at that early ]X'riiid wnuld 
do credit to any state-wide sanitary survey, and the relati\-elv Inw cost of 
this survey is remarkable for even that period. 

These inspections embraced every material condition affecting health, 
individual and public ; site of house ; its age, material, ventilation, condition, 
especiallv of Ijasement or cellar, of cesspools, sinks, drains, outhouses and 
water supply; of the yard and stables, barns, etc.: tlie vaccinal status of 
occu])ants ; the occurrence of certain diseases, etc. They disclosed in 382 
places from which reports were received at the end of the \ear. a total of 
474,831 defective conditions and nuisances prejudicial to health, of which 
number 441,593, or over 90 per cent, were reported abated or remedied. 

The sanitary surveys of cities and towns were begun early in June, and 
the house-to-house inspection was resumed in the extreme southern ]Kirtion 
of the State as soon as the weather permitted, and was In- midsummer, suc- 
cess full v prosecuted throughout its entire area. 

These surveys were at first largely tentative and experimental; but 
they were the means of discovering, in many cases, a multitude of defects 



HEALTH CONDITION'S AFTER ISTT '323 

and evils, the dangerous importance (if which had heen overlooked or whose 
existence had not been suspected. They gave a distinct impetus to the Ikiusc- 
to-house inspections. They aroused communities to the importance of their 
sanitary conditions. The series of circulars prepared by the secretary, and 
the Schedule of Questions — revised fium that originally prepared by a com- 
mittee of '28 prominent sanitarians under the direction of the American 
Public Health Associatii)n were, in not a few instances, the first sanitary 
instructidn to receive a practical application. 

The surveys included all data necessary to a complete descri])tion of 
the city or town as to its location, population and climate; topography, water 
supply; drainage and sewerage; streets, alleys and public grounds; habita- 
tions; gas and lighting; disposal of garbage and excreta; markets and food 
supply ; slaughter houses and abattoirs ; manufacturies and trades ; hospitals 
and public charities ; police and prisons ; fire establishments ; cemeteries and 
burials; public health laws and regulations; municipal officials; registration 
and statistics (.)f deaths and diseases; municipal sanitary expenses; and 
public schools; the whole embracing nearly 000 separate questions grouped 
under 19 general heads. 

The total cost of these insjiections was estimated at about $."iii,(l()() for 
everything except the work actually done or caused to be done bv the house- 
holder, tenant, or owner. In Chicago it was a little less than 1 T cents for 
each inspection, including pay of inspectors, wages of laborers, hire of teams, 
cost of disitifectants, printing, stationery, etc. 

Dr. Oscar De Wolf, health commissioner of Chicago, reported that 
the death rate from the filth diseases in Chicago was reduced 1') jier cent, 
and stated that there can be no (|uestion that much of this decrease in the 
preventable mortality was due to the house-to-house inspection and kindred 
efforts which were made jiossible ihrmigh the sjiecial a])pro]iriaiion in the 
anticipation of cholera. 

Il is believed to be entirely within the bounds to sav that at the close 
of ISS.") the State was in a cleaner and. consequently, healthier condition 
than any ei|ual poinilation liad ever been before at the same iieriod of occu- 
pancy of the Soil. 

During 188G the Board was still in feai" of invasion of .\siatic cholera. 
The work of the sanitary survey was continued. The house-to-house in- 
spections were completed where nol fnii'-Iicd the year before, and exlciided 
to new territory, so that they embraced an ;iggregale of nearly half a million 
inspections and reinspections of houses and premises, in .ibout hiu cities, 
towns, and villages. 

While the lioard had been thus successful in organizing and promoting 
sanitary work by nuuiicipalities and individuals, it continued the effort to 



324 lll'.Al.TII CONDniONS AKTI'-.K 1ST* 

supplenifiit ^^cll local aciidii by ])r()>cciilin.L; the investigatiim iiitci tin- writer 
su])plies of the State, the (lis])iisal of se\\ai,'e. and ])olluti(in (if streams. 
These were matters alTecliiig large areas uf trrritury in eommcin, and yet. 
ill the nature of the case, they were such as cnnlil nut he cnntrnlled hy the 
independent action of the communities. 

At the close of the year, an at;i;ret;ate of 41)11, S:i';! ins])ections and ri'in- 
spections had been made, emhracini; e\ery importrml item pertaininij; to the 
sanitary status of li.'l."!..") n premises in :!1IS cities, towns and vill.ayes. with .an 
aggregate population of 1. <!;■;. ;:>! inh.ahitants. In all hut three of these 
places \\(irk was lieytm prior to issi;, hut at the close of the previous year, 
the aggregate niimlier of inspections — exclusive of Chicago — was onh' 
224,2()0, so that the increase (hiiing l.s.Sd was considerably o\er HIO per 
cent. A large number ( 1(1 1. '.'S-")) of these, however, were rt-inspections. the 
actual number of additional jiremises inspected, amounted to ll.'i.Kl-i. 

QUAK.\.\Tj\i-: .Mi-:.vsuRi''s I'LAXM-.ii: While this extensixc sanitary sur- 
vey and clean-tij) was going on within practicalK- e\ery comity of the ."^tate. 
the Board was also energetic in trying to keep cholera from entering th:_' 
United States and especially Illinois. 

Provision was made for guarding against any introduction of the dis- 
ease, by defining a system of border quarantine inspection, b'or this purpose 
the Thirty-fom-th Cicneral Assemlily made a contingent a])propriation of 
$40, OIK) to be used, upon the recommendatii n of the Board, in case of tlie 
outbreak or threatened outbreak of any epidemic or malignant disease, such 
as Asiatic cholera, smallpox, yellow fever, or to defray the expense of pre- 
venting the introduction of such diseases, or their spread froi.i ]ilace to place 
within the State, and suppressing outbreaks which might occur, and in inves- 
tigating their causes. 

In the event of such outbreak or thieatened outbreak, it w.is planned to 
establish quarantine inspection stations at '.'I designated points of enlranc-" 
of important railroad lines along the eastern and southern boimdaries of th;' 
State, and at points upon the Ohio and Mississippi Rivers — or at so many 
of these as mi'^ht be necessary — for ins])ecting. (piarantining. di.infecling 
and cariuL; lor cases ol e|)idemic disease. 

.\l the meeting of the .Sanitary Council of tlie .Mississippi \ .alley, similar 
action was urged u|ion the health ntficials of neighboring states. Satisfac- 
tory action was t.alsen b\' the CHuncil upon this recommendation, and thus 
another step was taken in perfecting the protection of the State agaiu'-t an 
epidemic of imported cont.a^iotts or infectious disease. 

Cliolcra liiradcs ['nit, ,1 States in 7W7. 

In the fall of Iss;. Asiatic cho'era was introtluced into the I'nited 
States, a disaster which had been feared by the State Hoard since 1 S,S;_J. 



HEALTH CONDITION'S AFTER 1877 '325 

These cholera cases arrived late in the year ( end uf September) and a tulal 
of 34 cases had been recorded in New "S'ork and vicinity by October I 1, iss;. 
It is uncertain hnw nuich credit shdulil lie ijiven the Board and its activ- 
ities in preventing Asiatic cholera in the State, bnt it is nevertheless a fact 
llrit the Itical epidemic in the Xew ^'()rl^ (|uarantine zone did not reach Illi- 
nois. 'I he I'.oard toijk no chances, but made a determined effort to protect 
the health and lives of the people by maintaining a state-line quarantine by 
insjiections of passengers on railways coming from infected cities. 

CJiulrra Iiiradcs UiiltctI Stales in IS!):?. 

In IS!)-.' a conference of Western State Floards of Health was called, 
which met and drafted seven agreed rules for inter- and intra-state pro- 
cedure to be followed in the then existing emergencv in regard to elmlera. 

Dr. F. W. Reilly was elected to act as secretarv of the conference. He 
was authorized to act for the Hoard in the case of a threatened jiandemic of 
Asiatic cholera, in the interim pendmg the next meeting and to call an 
emergency meeting of the members at his discretion. 

After the adjournment the secretary engaged in a telegraphic corre- 
spondence with the Xew ^'ork City Hoard of Health and with Dr. John H. 
Ranch, who was at the time in that city. As a result of the information 
thus obtained, and after consultation with Dr. C/riftith, the secretarv fur- 
nished the following statement for publication: 

"Chicago. September 14, 1S92. 

"While the intelligence of five deaths from Asiatic cholera among residents 
— not immigrants — of New York City, one of these eight days ago, was a most 
unpleasant surprise to Western health officials, still there is nothing in the situa- 
tion to cause panic or even excitement. The delay in admitting the existence 
of the disease was natural, but it does not appear that any precaution has been 
neglected on this account. From tlie first suspicion the cases have been treated 
as it it was known that tliey were genuine Asiatic cholera. Premises have been 
disinfected, inmates kept under strict surveillance and the most rigid care has 
been exercised. 

"In its own interest New York cannot afford to have any spread from these 
cases, nor from others which may be now reasonably anticipated before the advent 
of cold weather. 

"As to any immediate danger to the country from these sporadic cases, there 
are these facts to be considered: 

"1. The cases have occurred among a class of persons not likely to start 
an exodus from the localities and so to spread the infection. 

"2. As already recited, reliance may he placed on the natural interest of 
New York to make every effort to prevent any spread. 

"3. Every day brings us nearer the season when cholera, at least in this 
country, is cliecked by a low temperature. 

"4. The history of the disease on this continent shows that, while it has 
repeatedly effected a foothold on the mainland in the fall of the year, it has 
never been until repeated introductions that it has spread as an epidemic. In 
the epidemic of 1854 it took eighteen months after the first cases on the mainland 
to effect a lodgement and become epidemic. 

"5. The sanitary defenses of the country were never so well organized to 
battle with and suppress an epidemic of any preventable disease. 



32G llEAl.TIl COXDITIOXS AKTKU 1S7T 

"Tlic practiciil (IctUution from these considerations is that, as already said. 
there is no occasion for panic or even excitement. 

"What remains, as the lesson of the situation, is that every community and 
commonwealth should realize in practical effort, that its immunity from cholera, 
as from other preventable disease, rests with itself. It must work out its own 
salvation and not rely upon any vicarious protection of quarantine. Every source 
of filth, of pollution of water, soil or air, must receive prompt and effective atten- 
tion, and not only must municipalities exert themselves, but every householder 
for himself must put his own house and premises in order. 

"No cleanly city, town or villa.s;e — with a proper disposal of excreta and with 
a pure water supply — need apprehend a visitation of cholera. In all human prob- 
abilities there remains from now until next spring in which to perfect the work 
of sanitation already well under way throughout the length and breadth of Illi- 
nois. With the present warning, the municipality which fails to utilize these 
intervening months will be culpably criminally derelict in an obvious and im- 
perative duty. 

"The Illinois State Board repeats: There is no occasion for panic — there 
is every occasion for a general cleaning up." 

Ill view of this situation, it was decided to keep a strict check mi all 
iiiiiiiigrants enlering^ the State. In pursuance to this plan, all immigrant-car- 
rying transportaliciii cnnipanics were iintiticd in September, 189'2, not to bring 
into the State of lllinnis any inimigrant, imr the ])ersoiial effects and be- 
longings of am- immigrant, without first receiving satisfactory assurance 
that such immigrant and his or her personal etfects and belongings are free 
from the danger of introducing the contagion of an epidemic, contagious or 
infectious disease. 

The companies were further instructed to accejjt only, as satisfactory 
assurance, the certificate of an inspector of the L'nited States Marine Hos- 
pital Service, setting forth that the individual immigrant has been under 
observation long enough to determine that he or she has not the germs of 
cholera in the svstem, and that he or she is vaccinally protected against 
sniallpcjx : that all the ])ersonal effects and belongings of said immigrant have 
been sttbjected to ])roper disinfection; and, furthermore, that, in the pro- 
fessional jtid^menl of the inspector, the individual immigrant referred to 
and his or her belongings are free from any danger of conveying contagion 
or infection to others. 

At the December. 1S!)"2. meeting, the l:>oard ])assed a resolution reipiest- 
ing the legislature to provide a contingent fund to be used in case of the in- 
vasion or threatened invasion of cholera. 

.\t the lanuarv. 18i)3. meeting of the lioard. much concern was ex- 
pressed bv the secrctarv, Dr. F. W. Keilly. concerning Chicago's financial 
inability to coiuinue to inspect all trains carrying inniiigrants, in order to 
])rotect Chicago and Illinois against invasion of cholera and smallpox. On 
March '^3, 18!);5, he wrote a letter to Governor Altgeld, informing him of 
this condition, and in reply received instructions to contintte the immigration 
inspection as ;i ])reventive measure against cholera, etc., the expense to be 
defrayed out of the contingent fund appropriated for kindred purposes. 



HEALTH CONDITIOXS AFTER 1877 327 

The health commissioner of Chicago was duly advised of the Gov- 
eriKirV apijrnval. and was authorized to select and appoint eight inspectors, 
who should receive pay at the per diem rate of two dollars and a half ( $-2.r)0) 
for each day of actual service, the expense to be defrayed out (if the con- 
tingent fund of the State Board of Health. This service was cnntinued 
until the end of the following June. 

Thus ends the history of cholera in Illinois. In fact it was not a history 
of cholera at all, since the State Board was established in 1877, but a chron- 
icle of measures instituted to prevent the invasion of the State by this disease. 
No cases of the disease occurred in the State during this period. Twice 
chnlcra invaded the United States, once in 1887, and again in 1892. 

The elaborate precautions which were started by the State Board of 
Health in 1S83, under Dr. Rauch's direction, apparently helped to prevent 
the spread of cholera into the State in 1887, when immigrant inspection and 
the machinery for tlie control of epidemics, was not perfect or so well 
organized on a national basis as in later years. This was a time when every 
state- and community had to be on guard for such natiimal invasions of 
pestilence. 

The 18!)3 invasion of cholera and its prompt restriction and check at 
the vicinity of the port of entry, is evidence of the effectiveness of modern 
methods of disease control, based on accurate knowledge of the causes and 
mode of transmission of infectious diseases and augurs well of what would 
occur should the State again be threatened with the invasion of any such 
pestilential disease, now or in the future. 

Yellow Fever 

The panicky situation concerning yellow fever in the South in 1878 was 
the first big public health problem to divert temporarily the attention of 
the State Board of Health from its activities in the enforcement of the Med- 
ical Practice .Act. 

.\ description of the yellow fever epidemic of 1878 at Cairo, the puint 
of greatest incidence in Illinois, can best be visualized by quoting from Jdhn 
M. Lansden. a resident of Cairo at the time and an eyewitness of the out- 
break. In his history of Cairo, Illinois, he writes in part as follows con- 
cerning the epidemic : 

"The ten days begiuning with July 9. 1S7S. were probably the hottest ten 
successive clays in the history of the City. During that time the writer was kept 
at home by an attack of illness and was treated by Dr. W. R. Smith, whom most 
of us remember as one of our most prominent citizens and physicians. On enter- 
ing the room one of those days and while wiping the perspiration from his face, 
he said. 'John, we are likely to have yellow fever in the south within a month or 
two.' The doctor's prophecy came true. The first case occurred in the south about 
the first of August. It moved on nortliward and soon appeared at Nachez, Vicks- 
burg, -Memphis, and Hickman, and reached Cairo September 12. It is said by 



328 HEALTH CONDITIONS AFTICK 1ST? 

miiiiy persons that Mr. OlKTly. the father of the Hon. John H. ()l)erly, died of the 
fever a few days before the 12th. On the 12ih there were two deaths; one of them, 
Mr. Thomas Nally. editor of the Bulletin, and the other, Mr. Isaac Mulkey, a son 
of Judge John H. Mulkey, and also of the Bulletin office. Those deaths caused a 
panic in the city, and the afternoon and evening of that dav witnessed the de- 
parture of hundreds of people from the city. 

"For some three or tour weeks prior to that time there had existed in the 
city an unseemly controversy as to whether the fever would probably reach Cairo 
or not. Were one to turn to the files of the Bulletin and the Cairo Evening Sun 
for the last half of August and the first twelve days of September of that year, 
he would see what a state of feeling existed in the city; the one party insisting 
that there was little or no danger and the other that there was very great danger 
and that every possible efl'ort should be put forth to keep the dreaded disease out 
of the city. The Bulletin led off as was its custom and criticised with unnecessary 
severity every one who chose to differ with it. It was strongly supported by a few 
of our prominent citizens who felt that it was their duty to maintain our supposed 
immunity. 

"I can best describe that peculiar state of things preceding September 12th by 
saying that it was not quite as bad as the yellow fever itself. I had been attending 
court at Jonesboro and was told by the conductor, on offering to go aboard the 
train at Jonesboro to come home, that he could not take 'me on account of the 
quarantine at Cairo. I prevailed upon him and came, and on reaching the northern 
part of the city I saw the levees patrolled by armed guards. One or two of them 
went through the train to ascertain who might and who might not be permitted to 
go on into the city. 

"When 1 reached the city, 1 was surprised beyond measure to see the state 
of things prevailing. On every hand were seen all kinds of vehicles carrying 
trunks and every other description of baggage to the railroad stations. They 
were driven, some of them, almost at furious rates of speed. In a word — there 
was a panic, which I need not attempt further to describe. 

"I left on the same Illinois Central train about eight o'clock that evening, 
on which were Mr. Oberly and hundreds of other citizens of the town. I remained 
away until the 2d of October, when I returned home, having seen in the Cairo 
Evening Sun, of September 24th, the following notice: 

"The Cairo public schools will open on Monday, September 30th under the 
superintendency of Prof. G. G. Alvord.' 

"The schools opened at the time announced, but were discontinued October 
4th. On Sunday and Monday, October 6th and 7th. there were six deaths, among 
them Miss Marie Powers, one of the public school teachers. These deaths occa- 
sioned another exodus, not quite so panicky nor quite so large; and it was not 
until the latter part of October that the people began returning home, and it was 
not until far into November that all had gotten back. 

"The Bulletin had suspended publication with its issue of September 12tli, 
and did not resume publication until the first day of November. Mr. D. L. Davis, 
the editor of the Cairo Evening Sun, and his family had also gone from the city, 
and had left Mr. Walker F. McKee in charge of the paper. Walter, for most of us 
were accustomed to address him by that name, remained at his post and gave 
the city a very faithful account of what was daily taking place. As bad as the 
news often was which it contained, the residents were eager for its appearance 
in the evening, and most of them forwarded copies to their friends who had gone 
from town and who were anxious to know the state of things at home. Mr. Davis 
removed from Cairo to Chicago a few years afterwards, and kindly handed to 
me all the numbers of the 'Sun' which covered the yellow fever period. 

"The facts are just as above given. There were about one hundred cases 
and about fifty deaths. 

"I have devoted these few pages to the epidemic of the fever because it was 
an era in the city's history. One-third of the people left the city. Many remained 
who could and should have gone. Their reasons for remaining were various; and 
sometimes they could give none at all. It was a simple disinclination to leave 



HEALTH COXniTIOXS AFTKU ISTT 3'i9 

lionie. There was a cuntmuing hope that the danger would soon pass, but it per- 
sisted instead. To some it was a question of means; for to go and remain away 
even for a short time required money for the trip and board. Many had no friends 
or relatives to whom they could go. Pew persons from the surrounding country 
desired to see any from Cairo. Many whole families would not go because they 
could not decide who should remain, and they feared leaving their homes unpro- 
tected. 

"Business was suspended; only just enough done as seemed actually necessary 
for the people at home. The days were unusually bright, in sharp contrast with 
the doubly dark and silent nights. Part of the time persons could not be abroad 
at night without passes of some kind from the authorities. In a word, everything 
spoke plainly of the reign of pestilential disease. 

"The city government of course went on. It had to. Mayor Winter was 
equal to the occasion, and to be equal to such an occasion seems capability for al- 
most anything, but he seemed made for it as for some special occasion. Jack, like 
so many public men of the country, liked to do things in a kind of showy way, 
not exactly spectacularly, but that word expresses something of the idea. Jack had 
been so harrowed by the Bulletin and others about the fever, that he seemed some- 
how to be glad that they and not he had proven false prophets; and when the 
fever came he met it with an undaunted face. He could not rescue its victims; but 
he and the few trusty men he had, buried them in the shortest possible time and 
yet with all the care and ceremony of which the deadly situation would admit. 
But it must not go on further or attempt to describe the pestilence that walked 
in darkness or the destruction that wasted at noonday. 

".lack Winter was no better than many of the rest of us; but if at the 
end of all things there is a balancing of accounts for every man. Jack's account 
will have opposite September and October, 1878, a very large credit. Of the rather 
few persons on whom he relied for attention to families in need and for other 
aid to the city authorities, I may mention Mr. William H. Schutter. I do so be- 
cause of my personal knowledge of much of his work. Of the many persons who 
remained out of a sense of duty to those who could not go or did not choose to 
go, I may mention the Rev. Benjamin V. George, of the Prebyterian Church and 
Father Zabel of St. Joseph's Catholic Church, of whose constant care and devotion 
to the stricken families of the town it would be impossible to say too much. Doc- 
tor Roswell Waldo, of the Marine Hospital, gave up his life in the work he did, 
which extended alike to all persons needing his service. He died at St. Mary's In- 
firmary October 18th, after a long illness which kept the community alternating 
between hope and fear for his life. The Sisters of St. Mary's Infirmary did every- 
thing in their power, as they always do. It may not be so. but it sometimes seems 
that they take pleasure in such times as those were. They look upon every 
opportunity for doing good as a blessing to themselves. Did not this happiness 
come to them, how could they devote their lives to such work? 

"The Sun of Monday, November 25, 1S7S, gives an account of the presentation 
to Dr. J. J. Gordon of a gold medal in recognition of his very faithful services 
during the prevalence of the feveV. The presentation took place at the Arlington 
House, afterward The Illinois, and now The Marion. It gives the names of the 
thirty-five donors, and speaks of Mayor Winter, the Rev. Mr. George and other 
persons present." 

A yciifral rcpcirt on the yellow fever epidemic of is^s at Cairo \\;is 
made by Dr. Wm. R. Smith, .Sr., (.)f Cairo, Illinois, to Dr. John R. Ranch. 
President of the State Board. Dr. Smith was a practicing physician in 
Cairo at the time of the epidemic, and speaks from experience inasmnch 
as In- reni.iined in the infected territiu-y thron^hont the entire ontljri'.-il^ .-md 
took ;i lu-KJic ]iart in administering to the sick, and later as an inspector at 
Station :! in the Cairo district. 



330 



IIKAl.Tll CONDITIOXS AKTF.K 1877 



In >uiiiiiiint; u]) liis (ilisurvaliuns in regard to the eindcinic. Dr. Smith re- 
jiortcd in part, as I'ulliiws : 

"Cairo is situated at the confluence of the Mississippi and Ohio Rivers 
at an elevation of 325 feet above the sea, in latitude 37, longitude S9.12. Its site 
is from eight to 15 feet below high-water mark, and to protect it from overflow. 
is surrounded by a levee. During high-water in either river, all the low ground 
within the levee is covered with "seep water' from one to six feet deep. To prevent 
th collection of rain water and to remove the 'seep water,' large sewers underlie 




Commerial and Washington Avenues, with outlets Into the Ohio River. Opposite 
Cairo, on either side, are extensive swamps, and all the land for eight to ten miles 
is subject to overflow. 

()i Aii.v.NTi.NK: "On July 29, 1878, the city Board of Health established a quar- 
antine by visitation. All steamers from the South were visited by a physician, 
and if all were well, were permitted to land. Also all trains were visited. Dur- 
ing the quarantine, the steamer 'Porter,' from New Orleans, landed here and dis- 
charged her crew, shipped another, and went to St. Louis. One of the crew died 
at the hospital on Walnut Street, (see map), August the 12th. 



HEALTH CONDITION'S AFTER 18T7 



331 



"In about a week the 'Porter' returned from St. Louis with several cases 
of yellow fever on board. Part of her crew again left her here and she went 
up the Ohio River, spreading death wherever she touched. After the fever became 
epidemic at Memphis and Granada, no steamers were permitted to land and all 
trains were stopped at Cairo. There were two violations of quarantine by steam- 
ers the 'Jas. D. Parker' and 'Ratesville.' One of the passengers on the 'Parker,' 

a Mr. C , landed here and died of the fever at C, on Poplar Street, August 

24th (see map). 

METEROLOGicAi.: "The year ISVS will be in after years reverted to by 
'the oldest inhabitants' as 'the hot year.' Its winter was very mild and we had 
a summer temperature during its spring. The summer was excessively hot. And, 
furthermore, the high temperature was distributed over a wider belt than usual. 

"The following table shows the mean and highest thermometer, humidity, pre- 
vailing winds and rainfall at Cairo during the months of June, July, August, Sep- 
tember, and October, 1S7S: 





Thermometer. 


Humidity. 


"Wind. 


Rainfall. 




Mean. 


Highest. 


June 

July 


74 
83 
81 
76 
59 


89 
96 
94 
88 
81 


69 
■79 
70 
70 
69 


S. 

N. 

S. W. 

s. 

S. 


4.6 inches 
2.81 inches 
3.45 inches 


September 


2.99 inches 
2.59 Inches 







"The above table shows that we had for four months a temperature and 
just about enough moisture, to maintain 1 if not generate) yellow fever. 

"Although the quarantine was as perfect and as stringent as it was possible 
to make it, w^ith so much shore line to guard, violations of it by individuals were 
quite frequent, 

thp: begixnixc; "The first local case of yellow fever was J. M taken 

on September 7; next T. N September 8; next J. C September 12: 

next J. S September 13. T. N was editor of the Bulletin, and the 

other three were printers who worked in the same building (see B. B. on map). 

There were no more cases until the 21st. when M. H. M was taken at 1, 

The fever then gradually spread from the Bulletin center B. B. to 2, 3, 4, 5, 6, 
7, 8, 9. On the 25th of September a case occurred at M. on 21st Street, and from 
that center the fever spread so fast that it is impossible to give names or location 
of cases, but the black on map will show the extent of territory it took in. 

"From whence came the fever? T. N visited C who died on 

Poplar Street, and 15 days afterward M was taken with the fever, and in 

16 days afterward N was taken, and in 20 and 21 days C and S 

were attacked. They were all employed on the Bulletin and worked in the same 
room. 

"So we may safely say that the yellow fever was brought from Memphis by 
the steamer 'Jas. D. Porter.' " 

The quarantine establi.shed b\- ihe State I'.nard oi 1 lealtli practically 
exckided everything that came from the south unless it passed inspection. 
The transportation of freight and jiassengers across the Ohio River, between 
Fillmore, Kentucky, and Cairo was also subjected to the same regulations. 

Thousands of fugitives fnmi Mrinph.is and below were allowed to come 
into Illinois and Missouri, and althoui;h :iS ni these died of the disease in 
Illinois, there was not a single case Cdutracted from refugees nor their ctTects 
outside of Cairo. 



33"^ iiicAi.rii coMiriio.Ns aft:;r 18TT 

'l"lu- r(.-ii(irls lu the SiaH' I'.danl ni Health sIkiw that li'i otiieially report- 
ed deaths tnmi \ellii\v fe\-er neeurred ihiriiii; the oulhreak at Caird. I''ivc 
cases and three deaths friiin l"e\er occurred at Centraha. 100 miles north 
of Cairo, anioni; those who were t-n^a.^ed in transhiijjjini^ hides from Siireve- 
]>ort. Louisiana. ( )ne fatal case was reported from Rockford. Illinois. The 
history of this case was that the hnshand C(]ntracted yellow fever and died 
in Mecattir, ,\lahama. 'The wife niu'sed him, ami the day after he died she 
riiiirned to h.er home in Rockfoiil and died in one week of yellow fever, con- 
tracted in Decatur, .\lahama. 

After Ihr Cairo Oiithrnih. 

Follow ini; this tragic experience in IS^S. the Board of Health was al- 
ways on iLjuard in suhst'{|Uent \-cars, to ]}revent the recurrence of this dread 
disease. In ls;it. Dr. |ohn 11. Ranch wa-- ap]>ointed delegate from the Illi- 
nois State r.oard of Health to attend tln' meetin;j; at Memphis on .\])ril :iO, 
of the various state hoards of health in the S(juth. to consider the hest 
methods for the control of the yellow fever scourge. 

Rules and regulations recommended hy the National Hoard of lledth 
were aclopted to secure the hest sanitary condition of steamboats and other 
ve.ssels, railroads, their station houses, cars, freight, and passengers. 

.\ system of sanitary ins])ection was maintained in the southern part 
of the State. One sanitarv policeman was stationed at Mound L'ity, and two 
at C'airo. One medical inspector w.as a|i|"iinleil to assist in carrying out the 
rules and regulations of the State llo.ird of Health. Dr. Frank \V. Ixeilly 
was appointed sanitary inspector July 28 and stationed at East Cairo. Dr. 
\\". R. Smith of Cairo was ajipointed insjiector and assigned to Station Xo. 3. 
Cairo, July I. 

Dr. |ohn 11. l\auch was electe 1 secretary-treasurer of an interstate 
organization, known as The Sanitru'y t/ouncil of the Mississippi \'alley. The 
function of this organization was to kee]) health officers in all states within 
the \ello\v fever zone informed concerning outbreaks of epidemic diseases, 
particularly of yellow fever, and to make rules and regulations which 
w-ere expected to be adopted liy all the member health officers. 

The Hoard adopted rules and regulations concerning yellow fever, re- 
(|uiring critical inspection of health certihcates of passengers on trains and 
boats. The regulations concerning the inspection of boats were strictly en- 
forced. In regard to these the ca])tain of the "Belle St. Louis" remarked: 
"H it wasn't for these insj)ections, boats wouldn't be paying expenses — 
they'd be shut off of so many ports, now open to them on account of their 
health bills." 



HEALTH COXDITIONS AFTER 18TT 333 

The report of a single case of mellow fever in the south caused a shrink- 
age of the provision market in Cliicago alone, which amounted to a million 
dollars within 24 hours. 

.\ sunimarv of the (juarantine measures taken against yellow fever in 
liSTIt, is contained in the following letter to the Mayor of Cairo, giving in- 
structions as to necessary precautions: 

"Sir: 

"In transmitting the accompanying summary statement of inspection and 
other service at the Quarantine Inspection Station. Mississippi River, below Cairo, 
during the season this day closed, the Illinois State Board of Health begs to ex- 
press its appreciation of the aid, both material and moral, which the National 
Board of Health has rendered it in protecting the State, possibly not from an 
invasion of yellow fever, but most assuredly from such interruption of travel 
and traffic as have hitherto uniformly followed a threatened invasion of that 
disease. Precisely what such interruption amounts to it would be difficult to 
state in dollars and cents; but an inkling of it is given in the figures in the sum- 
mary statement, from which it will be seen that, whereas the average vessel 
tonnage arriving from below at the time the inspection system was begun, amount- 
ed to only 967.66 tons per diem, it had risen to 2.166.67 tons per diem during the 
last 31 days, and this in spite of an unusually low stage of water. La^t year the 
commerce of the port at Cairo during the month of October amounted to only 
48,967 tons northwise and eastwise as well as southwise. while this year it amounts 
to 87.127 tons for the same period. (The tonnage of barges, lighters and Hats 
is not included in these figures, while it is in the figures in the summary state- 
ment.) 

"During the period while the Inspection Station was in commission this year. 
1.162 vessels of all kinds (exclusive of barges, lighters and flats) entered at the 
port of Cairo: as against only 707 vessels during the same period last year: and 
notwithstanding this quarantine of exclusion in 1S7S, yellow fever obtained 
access to the port with a total mortality of 62 recorded deaths. This year not a 
single case of the disease has developed among the 3,098 persons allowed to come 
into Cairo, nor among the 20,776 persons passed through the Inspection Station 
from below, notwithstanding fever prevailed at 43 distinct points in the Valley 
during the period. 

"Intercourse with all ports below Tiptonville. Tennessee. 120 miles south 
of Cairo, was practically suspended at the port when inspections were begun; but 
as confidence in the system was established by observation of its workings and 
results, one by one the interdicts were removed, until by Sept. 1 the sole require- 
ment for entry of passengers or freight into the State of Illinois from southern 
ports, was a clean bill of health (or certificate of inspection) from the station. 
A comparison of the figures shows the steady restoration of river business from 
below. In August. .56 vessels, with an aggregate capacity of 44.966.87 tons, pre- 
sented themselves for inspection; in September. SO vessels, with an aggre ate 
capacity of 57,824.50 tons; and in October. 100 vessels, with an aggregate capacity 
of 69.667.85 tons." 

The sum of 'toOO.OOO was appropriated in is;;) and placed at the dis- 
posal of the Xational Board of Health for the control of vellow fever, of 
which sum $!()(), 000 was wisely and successfully emploved in c(.imhaling the 
epidemic that year. 

Measures to prevent the introduction of yellow fever from the South 
were continued in the summer of l.ssi. The Board ordered that after July 
1. Dr. W. R. Smith, inspector at Stati(m No. :), helow- Cairo, put 
into commission said station and that after said station had been put into 



33-1- iiiiAi.rii (oxiirnoxs ai't;:k ISTT 

cnmniissinii llu- M-crt-larx of llic Slalr I'.oanl (if llcallh be directed to notify 
tlie aiuiinrities cif all jxirts in ihi^ Stale noi to alUiw hoats to land from points 
below Cairo, iniless upon ])rcscntation of a clean certificate of inspection as 
to caryo. officers and crew. 

Till' Yi llnir Frrrr Srarr of ISSS. 

In tile fall of ISSS it was reported that yellow fever had develo]ied in 
the south. The secretar\- of the Hoard of Health found it necessary to 
niaUe active etforts to check the public alarm that developed immediately. 
The \ellow fever epidemic h.id occurred in Florida, but it was late in the 
b'all. .\e\-ertheless, millions df dollars were lost from foolish quarantines, 
interference of travel and a general feeling of apprehension, all unnecessary 
even in the li.i;hi of the then known facts aljout yellow fever. 

It is worthy of note that a status of public panic developed in southern 
Illinois, esjjeciallv in the vicinil\- of Cairo, as a result of reports of yellow 
fe\er in Decatur, Alabama, and th.il the secretary of the Board spent several 
days in that vicinitv resiorins^ public eonlidence and preventitig a costly 
qtiarantine from being- uimecess;iiily set u|). The secretary's stand was 
based upon meteorological gimtnds that were sound and were proved so by 
subsequent develojMiients. iianiely lh:it yellow fever does not spread to the 
North with the advent of cold weather. 

Till' Srarr ill 1807. 

The next vellow fever scare was in the fall of IS'.);. The first official 
information of the existence of yellow fe\'er in the south, reached the State 
I'xiard of Health on the morning of Se];tember 7. Under the circum.stances 
it was deemed urgently necessary to establish immediately an inspection ser- 
vice at Cairo. Upon reporting the matter to ( ioxenior Tanner, he advised: 
"Secure services of as many comiietenl medical men as may be necessary 
and use every endeavor to kee]> \ellow fever out of the State, and to control 
its spread should a case appeur in the .State. I'ayment of all expense incurred 
will be approved by me." 

On .September '-K 1 'r. I'hillip S. Do.ine. Chicago; A. 11. .Maini. .S|iring- 
fK-ld ; and Dr. \\ . V. ( irinslejid, (',iiro, were ,appointe<l as inspectors to co- 
operate with Dr. John 1!. Xeeh of (hicigo, surgeon in charge oi ins|)ec- 
tions, stationed at Cairo. 

.\ rigid system of inspection was inaugurated by these officials. All 
bo.'its aii<l trains coming into Cairo day and night were met and every pas- 
senger from infected districts inspected. During the period of Cairo's quar- 
;uuine, tr.iin inspt'ction was c.nrried out in Chicago chiefly as related to thor- 
ough disinfection of tr.ains from the South, with chief attention to those of 
the Illinois Central Railroad. 



HEALTH COXDITIOXS AFTER ISTT 335 

Quarantine and inspectinn service in Cairo was maintained frdui Sej)- 
teniber 9 to September 30, l.S'.i;, ti) prevent the sjjread of and danger from 
infection of yellow fever, which was at this time very prevalent at the var- 
ious southern ])oints, chiefly New Orleans, jMohile. and Atlanta. From Sep- 
tember ■; to 30, 14T trains, ri.lOT passengers on trains; ]2 steamboats, and 
57(1 passengers on steamboats, were insi)ected. On Sejjtember 1!). Dr. C. S. 
Nelson. Springfield, and Dr. J. C l'"ults. Waterloo, were appointed as sani- 
tar\' insiiectors to assist Dr. Neely in enforcement of quarantine against 
velliiw fever. 

( )n September 1!) two cases of yellow fever were reported at Cairo, and 
two more on the following day. The fliagnosis of yellow fever in these cases 
was disputed by the ])eople of Cairo, and liy a majority of the local physi- 
cians. Man\- citizens and a few physicians also, declared that yellow fever 
ciiuld not exist in Cairo at that lime n\ year. That there was no analogy 
between the appearance of this disease and the season of the year did not 
occur to those taking exception to the diagnosis. .\ case of yellow fever can 
occur in anv ])art of the State of Illinois at any period of the year. The 
(li^ea^e will not spread. h(iwe\er. at certain lemperatm-es, and parenthetically, 
ii will not spread under the climatic cnndiiidus most favorable to its propa- 
gation if ])roper sanitary conditions are fouiKl ,ind the patients are kept 
isolated. 

The following statement seems to remove all duubt that true cases of 

vellow fever existed in Cairo in lSi)7 : 

"Dr. John Guiteras. of the Marine Hospital Service, arrived in Cairo from 
Mobile on Sunday, September 19th. After an examination of the patients, P. J. 
Reynolds and M'ichael Ryan, he pronounced the disease yellow fever. Dr. Guiteras 
stated that the disease prevailed in a mild form, and as the patients were convales- 
cing and- all precautions to prevent the spread of the malady had been taken, 
he was of the opinion that there would be little danger of infection. He advised 
a continuance of the quarantine effected until the patients were entirely well." 

It is of more than jjassing interest to muc that higli temperatures exist- 
ed in ISD; as well as in l.ST<S, as proven by the following telegram dated 
(.)ctober 'i sent to the Secretary by ex-Sui'geon of the Marine Ilosjiital Ser- 
vice, Mr. John K. Hamilton, of Chicago: 

"I advise sticking to present regulations until lower temperature. Cairo is 
still the danger point, and refugees from infected districts cannot with safety 
be allowed to enter the city." 

The following comment would indicate a yellnw fe\er scare in ISilS: 
"The appearance of yellow fever in Ocean Springs, and its rapid spread to 
other cities of the south gave rise to well-grounded apprehensions that the disease 
might reach Illinois, and notwithstanding the lateness of the season, prevail in 
epidemic form in the cities of the southern part of the State, Cairo especially. * * *" 
"The danger to which the state was exposed in September. 1S7S, was not 
fully realized until too late. Even the distinguished President of the State 
l?ourd of Health, apparently saw little reason to apprehend danger at this time, 



33G HEALTH fONllITJONS AFTF.K 18TT 

ami confident that the lateness of the season also precludeil the possibility of an 
outbreak of yellow fever in Illinois, he counseled against the very quarantine re- 
strictions which one year later during the same month of the year he strongly 
advised. Even while the disease was at its height in Cairo early in September, 
1878, he pronounced 'the panic unwarranted' and expressed the opinion that 'the 
end must be near.' " 

Sanitary iii'-prctor. Dr. Jaiiie.s de Courcy. was detailed for duty at Cairo 
on October 1. to enforce (|iiarantine regulation.s against passengers and rail- 
roads in the vicinity of C airo. 'I'he (luarantine restrictions were raised and 
insjjection service was terminated on October IS, 1,S!)8. 

'Jlic Scare of 1!i().'>. 

b'fnni lS!i,s 1(1 i;((i."i. tbe Illinois State Board of Health records are free 
of anv ^care of ycUnw fever until 1905. Late in July, l!i()5, yellow fever was 
reported in iiKirc or less epidemic form at New Orleans. The secretary. Dr. 
James .\. I'Lgan, left at once for Cairo, where he investigated the sanitaiy 
condition of the city and proceeded to Memphis where he ascertained that 
a qnarantine against New Orleans had already been established and thnt 
the situation was far more dangerous than comnionly supposed. 

The secretary determined to establish a train inspection service, and 
from the first of August every train antl steamboat coming from the sotith 
was boarded, and every ])assenger ins])ected. and only those permitted to 
land in tbe southern part of Illinois who could present proper credentials 
from health authorities and evidence as to his recent whereabouts. Com- 
]ieteiit medical men were employed for this service. 

Within a short time after the establishment of train insjjection, the con- 
ditions in the south grew so much more seriotis, that the City Council de- 
clared a rigid quarantine against the south and admitted travelers only upon 
the presentation of permits issued at Cairo. Anticipating the invasion of 
the city by yellow fever patients, a well-ec|uipped isolation hospital was estab- 
lished in a houseboat, and under the care of a com])etent attendant, the boat 
was ready to be taken to a point of safety in midstream. It was not neces- 
sary to use this boat. 

Rigid t(uaratitine was maintained from August .'i until October K. 
Nine inspectors were employed and several watchmen. During this time 
hundreds of ]:ersons coming from infected points were diverted in other 
direct ioii>. ;ind in this manner, the State was saved from an invasion of fever. 

It is gr;itifving to report that regardless of the inconvenience and conse- 
quent de])re>sion of trade, the people of Cairo were in sympathy with the 
erf<irts of the State Hoard and expressed appro\al of the work and the man- 
ner in which it was conducted. 

Dr. George Thomas I'almer, stmitary a->.^istant of the Ho.ard, was placed 
in charge of the qtiarantine service at Cairo, dtiring the enforced absence of 



338 IIKAI.TII fOXDI TKINS A I- '1' i: K ISTT 

the sccrt-tary. In rcs])()nse to the \erv e\i(leiit need of such an officer who 
could relieve the secretary of sonii' of the details of the work of the of^ce, 
the General Assenihlv had made an a|ii>ro|)riation tor an assistant secretary, 
which went into effect on July 1, llio.".. In order that Dr. I'alnier niitjht have 
greater anth( rity in the performance of his duties at Cairo, the secretary 
ai)[)ointed him as assistant secretary to the State Hoard of Health and asked 
for the apj^roval of the luiard, which was L;ranted. 

Typhoid Fever. 

In followint; the history of the rise and fall of t\'i)hoid fever in Illinois, 
the theorit's prevailing,' at various times in regard to its cause must he kept 
in mind. 

The views as to the origin of the disease, and the early theories in re- 
gard to its cause, are set forth in the preceding part of thi> volume. For 
au understanding of the preventive measures taken to control typhoid fever 
since the establishment of the State Board of Health in is';?, reference is 
here made only to the theories and facts in regard to its course and transmis- 
sion of the disease, generally accepted for varying periods since that time. 

When the Board was first established, typhoid fever was tmiversally 
looked upon as a filth disease. The typhoid bacillus was not discovered until 
ISso, when it was first found in the tissues, by Ebert, and was not isolated 
until four years later, when GafYky grew it in pure culture. Although this 
and the other great discoveries in liacteriology were made in the early eight- 
ies, they were not generally accepted, nor did they modify the prevailing 
views in regard to the control of communicable diseases to any great extent, 
until the middle nineties, 

W hat the prevailing views of practicing physicians were during the first 
1.5 vears of the Board's existence is shown from the following statement in 
regard to typhoid fever bv Dr. X. S. Davis in his Lectures tni the Principles 
and Practice of Mecliciiie. published in ISSl : 

"A careful adherence to well ascertained facts concerning the etiology of ty- 
phoid fever will require us to accept the three following propositions: 

" 'First, that cases of typhoid originate in dwellings or buildings of any kind 
in which, from either overcrowding the number of occupants, or the neglect of ven- 
tilation and cleanliness, the air, furniture, and walls, become strongly impregnated 
with the organic matter exhaled from the skin and lungs of the occupants, * * * * 

" 'Second, that the more the soil of any given locality becomes impregnated 
with the intestinal and urinary excretions by progressive increase of the density 
of the population provided the two conditions of drainage and water supply remain 
the same, the more frequent and severe will be the cases of typhoid among the 
inhabitants of such locality. * * * 

" 'Third, cases of genuine typhoid have occurred and are still occurring occa- 
sionally in every civilized community, in persons who have had no traceable com- 
munication with previous cases of that disease, or with any of the recognized or 
suspected sources of infection. * * * • 



HEALTH CONniTIONS AFTER 187 7 339 

" 'Probably no fact is better established than that the disease under consider- 
ation generally originates from the use of air or water impregnated with some 
one or more of the products derived from the decomposition of organic matter. 
It does not follow, however, that such prodiict of organic change must necessarily 
be formed outside of the human body.' " 

Dr. Davis was a leafier of the liical medical profession at the lime, and 
had heen active in many movements for sanitary reform in the city n\ Clii- 
cago and the State, conseqnenth- it may Ije ])resume(l that his views are rep- 
resentative of the time. 

The views held were doubtless Ijased on those expressed by Dr. Charles 
Murchison in 1.S62, as enunciated in his famous theory of the pythogenic 
origin of typhoid, which held that it is "generated and probably propagated 
by certain forms of decomposing matter." In the succeeding 25 years the 
facts were tortured in every conceivable manner to fit this theory. Some- 
times the incubative period of the di.sease was shortened to a few hours when 
it "immediately followed" exposure to certain fetid contaminations. A 
favorite way of accounting for an epidemic was the finding of defective 
drains or nearby privy vaults, cess ]i()oIs or decaying matter of any kind. 

Some, who had been im])resse(l with Pettenkofer's observations on 
cholera, leaned strongly towards ground water and deteclivc drainage of 
the soil as a factor in the jiroduction of i\|ihoid. -\n examjile of such a 
view is that expressed by Health Commissioner Ware of Chicago in explain- 
ing the cause of the greatest typhoid e])idemic in the history of the city, 
namely that of 1S!»1 and 1S!I2. In his annual rejMrt to the mayor for the 
year 1SI)2, he says: "We have typhoid fever, and always will have so long 
as there remains so much tmdrained projjerty." 

In the Sanitarian, a leading British publication on sanitary science, ap- 
peare<l the following statement in ISSO: "Typhoid fever is traceable to 
tilth with as nnich certainty as smoke is to fire." 

Imliueil with these ideas, Ranch, as secretary and executive officer of 
the State Hoard of Health dotlbtless believed that in prosecuting his great 
scheme of a general sanitary sur\cy of the ."^tale, sl.irted after the threatened 
invasion of cholera in ISS:!, that Ik- was killing a whole flock (if Ijirds with 
one stone. 

rulilic sentiment favored, and in fact, demamled that something be done 
to ]ire\ent tlu- invasion of cholera. Approprialii ns were imgrudgingly given 
by the .'^tate and local authorities for such work, and thus Ranch had the 
op])ortimity of his lifetime to do what to him nuist have seemed an effective 
drive to rid the State, net only of cholera, but of all filth diseases. 

The following comment of the .Vcti' )'(irk Medical Board is ])eninenl 
to this i|uestion : 

"There is no doubt tliat the extra clcanlinet-s produced by the cholera scare 
(1878) will effect a saving of life from other filth diseases, far in excess of the 
mortality from cholera itself, unless it should be spread beyond all expectation." 



340 



IIRALTH COXIHTIOXS Al"n'.U 1877 



TiiphduJ IliUuUid (IS a Filth Disease. 

lln- tiiiK' (luring- wliicli ivplinid fever was considered a filth disease 
and measures for its control were conducted with ihi> end in view, includes 
the pericd of activities of the State Board of llealth frcmi its estahlishnient 
in 1877 to approximately the time of the World's Fair in Chicago, in 1893. 

The official records of the Board prior to 18S)U, show that no special 
attention was given to the cintrol of ly])h()id fe\-er, outside of the extensive 
general campaign waged to clean u]) the State. 



Tahle 28. 
C.^SEs OF Typhoid Fever Reported in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


.Tune. 


Jul.v. 


Aug. 


Sept. 


Oct. 


Xov. 


Dec. 


Total. 


1917 


115 


132 


109 


253 


91 


73 


186 


405 


637 


193 


94 


55 


2,342 


1918 


89 


82 


55 


52 


51 


64 


212 


241 


286 


102 


24 


86 


1,344 


1919 


33 


33 


39 


47 


32 


64 


265 


294 


306 


346 


251 


183 


1,893 


1920 


124 


80 


88 


115 


103 


138 


162 


211 


284 


257 


198 


109 


1,869 


1921 


96 


74 


83 


89 


72 


152 


336 


443 


419 


392 


185 


82 


2,423 


1922 


79 


73 


81 


74 


135 


116 


182 


255 


254 


273 


173 


103 


1,798 


1923 


65 


31 


89 


52 


54 


68 


99 


233 


320 


259 


315 


277 


1,862 


1924 


159 


72 


43 


59 


63 


63 


124 


168 


191 


176 


125 


231 


1,474 


1925 


119 


71 


62 


58 


71 


124 


217 


298 


297 


310 


206 


297 


2,130 


1926 


111 


50 


44 


44 


34 


65 


106 


214 


303 


386 


203 


113 


1,677 


1927 


52 


62 


39 


40 


52 


70 


141 


1.. 










. 




I 









1 



Tahle 29. 
Deaths fro.m Tvpiuud Fever in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


July. 


Aug. 


.Sept. 


Oct. 


Nov. 


Dec. 


Total. 


1918 


26 


37 


24 


21' 


33 


27 


37 


84 


75 


86 


44 


39 


533 


1919 


29 


IS 


19 


9 


22 


13 


35 


37 


52 


41 


45 


41 


383 


1920 


35 


24 


22 


12 


15 


IS 


38 


34 


53 


58 


47 


24 


380 


1921 


23 


19 


17 


10 


15 


32 


43 


33 


56 


65 


40 


23 


396 


1922 


18 


15 


16 


12 


23 


10 


21 


33 


33 


38 


32 


29 


282 


1923 


17 


12 


13 


12 


14 


8 


28 


45 


48 


43 


31 


46 


317 


1924 


33 


9 


13 




10 


6 


22 


23 


17 


37 


23 


43 


241 


1925 


24 


5 


11 


7 


11 


19 


32 


60 


55 


43 


31 


29 


327 


1926 


9 


4 


5 


9 




6 


24 


30 


37 


44 


41 


14 


230 



The mortality records that were collected from 1880 to 1886, incom- 
plete a^ lhe\- adniilledh- are, show an annual average of 1,335 deaths from 
t\pli<iid in the entire State. \\ hen from this numhcr are deducted 418, which 
is the a\erage aiinii.il nunilier (jf t\phi;id ileaths recorded in Chicago, it is 
fouiul that li-.".' deaths were recurded f(ir the other .sections of the State, a 
figure so small as to lie hardlv prohahle, in \ iew of the fact that other evi- 
dence shows that typlioid fever was (|uile prevalent in Chicago as well 
as (lownstate during this time. 



HEALTH CONDITION'S AFTER ISTT 341 

In ISST conditions dnrinu; the sunmu'r caused the Board to express 
grave solicitude in reijard to tile liealth outluok for the State. Intensely 
licit weather in July and the prolontjed (lrnn.i;ht were among the more im- 
jiortant causes of this fear. The great [irevalence of diarrheal diseases and 
numerous outbreaks of typhoid fe\er, the former directly due to high tem- 
perature, and the latter intensified hv water supplies affected bv the drought, 
were noted during the summer. 

.\n outbreak of typhoid occurred in February and March, ISSi), at Con- 
cordia College. Springfield, resulting in "^'1 cases and two deaths among 
students. The cause of the outbreak was altriliuted to the use of drinking 
water taken from a well located near a privy. 

Twenty cases of the disease with four deaths occurred in IS'.KI among 
students of Augustana College, Rock Island. The outbreak was reported 
due to defective drainage and plumbing. An especially virulent typhoid 
infection in a family of eleven near Urbana, with nine deaths, was reported. 
Also another instance in the same locality of seven cases in one family of 
nine children, with two deaths. 

Bacteriologic Period. 

Bacteriology was pretty well estalilished in the early nineties. From 
this time on typhoid fever was no longer considered as a necessary evil. /Vt- 
tention was given to gross pollution of w'ater supplies in the handling of 
epidemics. The disease was also made reportable. A more accurate means 
of diagnosis was offered by the Widal test. 

These illustrations indicate ver\- well how widelv jirevalent typhoid 
fever was prior to 1900 in Illinois. Xeiiher cities nor rural districts es- 
caped although the cities suft'ered worse because of common water supjilies 
through which the disease was transmitted. In Cliicago. for instance, a long 
drawn-out epidemic stretching over three years began in 1890, resulting in 
no less than 4,494 deaths. It attracted particular attention because of the 
World's Fair scheduled for IMKi. \'er\- exh;ui<tiye investigation of the water 
suppK' followed, bringing about such elTorts at purification as was possible at 
the time. 

Situations like these were common and iire\'ailed continuously until 
sanitarians and the ])ublic came to recognize and appreciate the liacteriolog- 
ical character of typhoid fever. As soon as clear conception of these facts 
became established typhoid fever started to decline in Illinois. 

These activities were reflected at once in substantial declines in tyi>hoid 
fever rates. How rajiid the rates fell is illustrated in Figure 19. 

I'roni about 1900 on outbreaks of typhoid fever drew attention first to 
local water supplies. Mimicipalilies (klayed the insl;illation of adequate 



342 



IIEAI.TII CONDITIONS AFTF-K IS,, 



ptililic watiT sii]i])lv .sati-t;uar(ls, as a rule, uiilil an i-|>i(lcinic fell upon them 
and then, alter the enuditioiis were pointed ntit hv a sanitarian, permanent 
improxements were made. 'I'liis is ahuut the hi>tor\- of typhoid fe\er until 
about nijd. L']) to that time polluted water had i^jrown to he rei^arded as 
the chief olt't'iidini; assent in the S])read of typhoid. ( )ne city after another 
went throut^h disastrous or very serious experiences and came ont with im- 
jjroved water su])|)hes that jjrevented recurrence on a large scale. 



H-. TYPMOID FEVER 

in ILLIhOIS 



HIi 1860-1926 

STATISTICS LTIAVALABLE fDR OPEd YEARS ^ 




Period III Stisfi'iiKit i< ('inilrnl. 

With the increasing knowledge of typhoid fever and the study of many 
outlirealo in all parts of the world, the time arrived arouiiil lUin when seri- 
ous efforts were made to control all of the factors which pla_\-ed a role in the 
transmission of the disease. 

The si)read hy milk was found to be frequent, and pasteurization was 
inaugurated to check it. Flies were given a great deal of attention, and were 
tomid to play an im[)ortant ]:iart especially in rural coinmunities. 

lliiman carrier-, were detected as causes of certain outbreaks, and when 
the iinp(]rtance was fully recognized, steps were taken to prevent this source 



HEALTH CONDITIONS AFTER 18T7 343 

of infection by the exaniinatidii df siouls and urine of convalescent cases. 
Contact infection was also controlled. especialK' 1)\ in-innniization and more 
general hospitalization of cases. 

One of the most otitstanding^ features of typhoid control durint; this 
period was the development and ajiplication of epidemiologic methods for 
the detection of epidemics, and tracing them to their sources, d'hus this 
])eriod is characterized by a chronicle of one small local outbreak after an- 
other, discovered, traced to its source, and sto]iped, with the result that the 
typhoid mortality was low. yes, l."! or ",!() times lower than in the previous 
periods, during wdiich such occurrences were much less frequently heeded, 
or correctly traced to their origin. 

Table ;?(). 
Deaths and Death Rates from Typhoid Fever in Illinois. 

Riite I.or 
100,000 
No. deaths. iiopuliitioii. 

917 16.5 

1,039 18.4 

893 15.5 

744 12.7 







liate per 








103,000 




Year. 


No. deaths. 


population. 


Year. 


1860 


1,183 


65.7 


1909 


1870 


1,758 


70.3 


1910 


1880 


1,652 


53.6 


1911 


1881 


2,082 


66. 


1912 


1882 


1,424 


44.1 


1913 


1883 


1,054 


31.9 


1914 


1,884 


1,066 


31.5 


1915 


1885 


1,379 


39.9 


1916 


1886 


1,689 


47. S 


1917 


1890 


1,700 


44.4 


19IS 


1900 


1,897 


39.3 


1919 


1902 


1,882 


37.7 


1920 


1903 


1,578 


31. 


1921 


1904 


1,300 


25.2 


1922 


1905 


1,047 


20. 


1923 


1906 


1,061 


19.7 


1924 


1907 


1,119 


20 . 5 


1!I1'5 


1908 


914 


17.2 


1926 









Water supplies came under close bacteriologic scrutiny, and were only 

1 iften found showing evidences of fecal jiollution. .V great step was 

taken in the ])urification of such water supplies around \'J\'> and after, by 
the use of chlorine in minute quantities as a disinfecting agent. 

Steplike declivities in the rate are noted following the adoption of the 
various measures. These are notetl es])eciallv in the death rate from this 
disease in Chicago, where the effects are more striking because the measures 
were effective in the whole ;irea, while in ihr St.ite, they were ailopted at 
various times in ditf'erent localities. 

.\nti-lyplioi<l inoculation was ad\dc;ili-d b\ the Secretar\' of the State 
Board of Health in liMl and the columns of the Biillctiii were devoted to 
ex])lainin,g its merits. 



34-1 III;. \i. Ill foxiii iinxs aI'Ti:k ISTT 

AiiiiiluT iiux-sliyaliciii wiiicli rrllci'Icd crc-ilit u])iin tlic l'>n;iril aiul its 
orgnnizalidii was llial of the I'.M:! lyplmid t\-vrr c'|ii(leiiii(.- al Kockl'dni. 
When ill tlu' jii\-\iiui> \rar, huiuhcck of cases (if tlie (hsease sU'ldeiily ilc- 
velopcd ill liial eit\-, an in\-esli.i;aliiin iiide]ieiident (if tlie StaU' Pjnard (if 
Heahh was made h\' ihe eil\- aiulKirilies aided hy outside experts, and at an 
expense of several thousand dollars. Impure water was assi^jned as the 
cause of the outhreak. When, however, in the late summer of 11)13 another 
epidemic of txiihoid threatened, the service of the Board was requested for 
the purpose of detennininsj the cause of its recurrence. Almost all the 
cases were traced t(j milk and hread from dairies and bakeries in which 
cases of typhoid fever had existed. The sale of milk and hread from 
these dairies and bakeries was st(i]iped and the epidemic ceased. 

F.xperiences of this kind attracted attention to milk su]i]ilies. This 
mitjht have been anticipated. As water supplies came to be more and more 
sanitary tliere remained considerable typhoid fever and investig-ators lie.gan 
to look for other media of transmission. Milk was next to water in im- 
portance so that it was logically the next in line to be sanitated. From li)15 
onward a considerable number of typhoi(l fever outbreaks were traced to 
milk on the one hand while the sanitary ([uality of municipal milk supplies 
improved through the increasing use of ])asteuri/-atioii on the other. 

.\fter 1;M."i reliiieiiient in control lechni(|Ue was the dominating feature 
in efforts directed toward the eradication of typhoid fever. Free distribu- 
ti(Mi of anti-tviihoid vaccine was started in r.il4 but it was after the World 
\\"ar. during which emergency the efficacy of this pro])hylactic was adniir- 
ablv demonstrated li\' the military, before it was used to any significant ex- 
lent. Its use was promoted successfully after that time and it was generally 
appreciated and utilized subsequent to emergencies like the devastating tor- 
nado that swept southern Illinois in l!i-.'."i and the many floods that inundated 
considerable populated areas almost annually. 

An emergency sterilizing ontlit serviceable for temporary use in con- 
nection with local public water supplies was made available by the State 
Department of rublic Health in I'.M;. It was used from time to time. 

.\ field lal)orator\- outlit serviceable for the examination of sjiecimens 
helpful in the diagnosis of cases and in the location of carriers was made 
a\-ailable about this time. 

About r.i'.'l tw(i other iin|iortaiit rehnemeiits took jilace. One was a 
deterniiin-d campaign to locate and su]iervise carriers, 'flu" other was a 
revision in tlu- i|uarantine rules which among other things re(iuired negative 
lab(irator\- examinations of specimens i.aken from typhoid patients before 
raising (|uarantine. 'i'he ]irosecutioii of these ]irocedures had a very pro- 
nounced fa\(irable intluence over the trend of ty|ihoi(l prevalence in Illinois. 



HEALTH CONDITIONS AFTER 1S7T 



345 



The two following tables include most of the important outbreaks that 
occurred during the period covered. It is noteworthy to observe that the 
number of cases involved in epidemics grows smaller as the date become? 
more recent. 



Some Water-Borne 


Typhoid Fever 


Epidemics in Illinois. 


Count}-. 


Locality. 


Year. 


Monlhs. 


Cases. 


Deaths. 


Remarks. 


Winnebago 

Menard 




1912 
1915 
1916 

1916 
1918 

1920 

1920 

1922 
1923 

1924 
1925 

1923 

1925 
1925 


Jan.-Feli - 


185 
200 
200 

130 
125 

300 

10 
200 

12 
3,000 

13* 
14 


15 
20 
20 

? 
24 

24 

3 

20 

2 

3* 

3 




Old Salem 


.Si'iit.-Oct 

Aug:ust 


|.uM„ -uirl- «ell. 

Kl Iiiiu ni i.iililic water sup- 

pl\ utllt, ami no sterilization. 




Tuscola 

Moline 

Maywood 

Bloomington-... 


tion in Elgin Watch Factory 
between safe and polluted 
supplies. 


Rock Island 




Pumping of raw river water 

through a bypass. 
Spvop. .li^fntrrv ,\w tn leaky 


October 

Jan.-Feb 

Apr.-May 




I.,.:,; X , ,,,---, M.Hir. M..ri l.t-tWCeU 




ii,.lii-ln;il Mi].|.l\ .ni,l the 
ilvnikinu water supply. 
K'lood of wells duruig high 




Chicago 

Sterliif^r _. 

(ireenville 

Winona (Ind.).. 


water. 
K.\cessive pollution at the 68th 


Whiteside 

Bond 


Dec.-Ja.i 

January 

.June 


.St. pumping stations minus 
a sufficient increase in chlori- 
nation. 

Leaky valve in factory cross- 
connection between safe and 
polluted water supiilies. 

Severe dysentery and para- 
typhoid due to tile water 
ii;,ni[ .i)i-i.iMiiu sewage from 

Spii (.1 ml.. ' ii:lit states from 




AUK.-Sept 


liiijliiii.l \v:ii.-i supply used by 
ciuivention delegates". 
Polluted public water supply. 









s cases and deaths. 

Outbreaks of AIilk-Borne Typhoid Fever in Illinois. 



Locality. 



Year. 



Months 



Winnebago... 

Cook 

Macon 

DuPage 

Rock Island.. 

Morgan 

Douglas 

Madison 

Coles 

Hancock 

Carroll 

Macon 

Kane 

Bond 

Morgan 

Bond 

Henry..- 

Douglas 

Montgomery. 



Rockford 

Park Ridge.. 

Decatur 

Wheaton 

Molii 



Jacks 



Decatur 

Compto 

Twp. 



ille 



St. Charles 



19111 
1920 
1919 
1920 
1920 
1921 
1921 



M,i 



Aug., Sept.. 
Sept.-Oct.... 
June, July.. 
Jul,v, ,\ug... 
December... 
June, July.. 

.Uignst 



Bottle 
Polluted w 
Milk bottle 



Iter at dairy 



Convalescent 

Carrier 

Carrier 



34G 



iii:altii co.mhtions aftkk li-i" 



As water and milk supplit's in recent \'ears became inure and more gen- 
erally of good sanitary (|naiity (itlier faclois in the s]jread of typhoid fever 
began to lake ])r(iminence. 

'I'iuis in lli'.'i an unllireals. contined principally to Chicago and environs, 
was traced Id the eating ni raw nysters. This discovery uUimatelv led to 
drastic actinn in relation to shell lish. The State Director of Public Health 
issued an order in the early part of I If.'"), fin-bidding the sale of oysters for 
any except cooking purposes. This action in turn resulted in a general sani- 
tary reform of the oyster industry, referred to elsewhere in this volume. 

Little of significant importance concerning typhoid fever in Illinois has 
tran.spired since the sanitary reform of the oyster industry. Automobiles 
have become a larger and larger factor in the spread of the disease. This 
was demonstrated in liJSo when touring parties brought typhoid back from 
an Indiana town and caused mild outbreaks at Freeport and Polo. It is also 
indicated by the fact that foci of the disease are more and more widely dis- 
tributed and a growing diminution in the average number of cases involved 
in any one epidemic. 

With increased facilities for managing the disease mortalit}' has tended 
downward although it has fluctuated from year to _\ear as it always will so 
long as typhoid remains upon the earth. 

Indeed severe outbreaks will occur from time to time where preventive 
sanitary precautions are neglected lor any reason. This was demonstrated 
in 1037 when Montreal, Canada, experienced one of the worst epidemics 
ever rejiorted on the North .\merican continent. It involved more than 
5,1)00 cases and nealv 30(1 deaths and extended over a period of more than 
six months. 

In Illinois the mortality and sickness from typhoid fever in lUiii was 
the most favorable ever recorded. Only 330 deaths were reported. 

The favorable record in 1930 was sim])ly another step forward in the 
improvement that has been going on fairly constantly since the opening of 
the century. As ultimate extinction of the disease approaches, the degree 
of annual decline grows smaller, but no less significant and valuable. Since 
l!Ms the decline in the mortalit}- rate has amounted to slightlv more than tSO 
jier cent. 

MORT/\LITY FROM Tvi'IIOID FeVER IN ILLINOIS. 



Ye:ir. 


!9I8. 


1919. 


1920. 


1921. 


1922. 


1923. 


1924. 


1925. 


1926. 


Number l>«iths 

Rate per 100 000 


519 
8.2 


383 
5.9 


380 
5.8 


396 
5.8 


282 
4.0 


317 
4.7 


239 
3.5 


327 
4.7 


230 
3 2 







The fly in the ointment of the splendid 1936 experience is the bad record 
of the 3-1 counties which make up the extreme southern tlJrd of the State. 



HEALTH COXniTlOKS AFTKK IS, , 



347 



These 3-1 couiitifs. with Ixit httle mure than one iiiilHon people, lost 116 in- 
habitants to typhoid fe\er, whereas the uther 68 counties with a population 
of fully six million, lost nnly 111. There is some evidence that warm cli- 
matic conditions favor the projiagation of tyi)hoid. The fact that mild 




weather prevails much longer in southern than in northern Illinois ma\- he 
a factor in the unfavciralile typhoid rate in the sdutheni section. 

The rate per lOd.OiMl was only 1.:) in the -'i:! cuunties that make up the 
extreme northern third (if the State. Here nearly five million ])eople are 
concentrated. 



3-1-S III-.. \l. Ill C'O.NDITIONS AFTEK 1ST7 

In tlio central ihird. the rau- was ".'i. A little less than one and one 
(|iiarler million people dwell in the .'io counties here concerned. 

rile \rr\- faxorahle record in Cook County influenced the good showing 
in the north. In that ci niU\- where the estiniate<l population is 3,-186,600, 
tlu-re were oiiK' ''*'> di.-aths recorded I'rcjni l}-])hoid. That gives a rate of 0.7. 
'The rate for the other :>■,' northern countie.-^ was 'i.]. considerahly more 
fav(n-ahle than either the cenlral or southern sections. 

There were ■.'0 cities of 10,0(10 (ir more population, and ''] counties 
from which no deaths at all from typhoid fever were reported. Indeed the 
inortalitv was confined largely to the small communities aitd rural areas. 

Tliese data jioint directlv to the wholesome influence of public health 
activities. Typhoid fever death rates ilecline as volume of jiublic health serv- 
ice increases. 

Scarlet Fever. 

When the State Board of Ilealth came into existence in ISTT, Chicago 
was passing through the greatest epiilemic of scarlet fever in its history. The 
<leath rate from the disease in that citv was 1 '.)(),.") per IdO.OOo j.ioptilation that 
year. 

Doubtless the disease also spread into the neighl.».jring territory and was 
more or less iirevalent throughout the State, yet this situation received 
practicallv no attention from the Koard. The reason for this is not difficult 
to apprehend if the problems and resources of the Board at that time are 
considered. Furthermore there is the fact that no special precautions were 
taken against the disease by health authorities in the seventies. 

Even in a city the size of Chicago, which had a population of about 
.'jiKi.ooii. the reporting and placarding of scarlet fe\er cases was not enforced 
until is::, and then it brought forth violent protests from the people. Phy- 
sicians referred to it as the "Yellow Card Nuisance." 

In is.so. a census vear, 1,364 deaths from scarlet fever were reported 
fur the State, which is a rate of a little over 44 per 100,(10(1 population. 
X'ever since that year has the reported mortality rate exceeded 3'2 per 100.000. 

The course of scarlet fever from 1860 to date, is showni in Figure 21, by 
the decennial and annual records, as far as these are available. 

4'his chart shows that mortality from scarlet fever declined ra])idly 
afur (he hit; epidemics of is;; and ISSO. 4"he reason appears to be found 
in the .iciixiiies of health officers. Xo noteworthy advancement was made 
prior to \'.i\:> in meilical knowledge concerning scarlet fever. A great deal 
was undertaken bv the public health .-i^eiicies. however, and ])articularly in 
Chicago where the best local organi/alion in ihe State was at work. 



HEALTH COXDITIOXS AFTKR 1 S 1 "i 



349 



The control measures einpU)yed included public etlucation, the retiuire- 
ment of case reports, the isolation of patients and the quarantine of premises, 
the medical inspection of school children and, to a less extent, the hospitaliza- 
tion of jiatients. None of these things developed uniformallv in the State 
nor were all of them begun simultaneously. The educational propaganda 
started first, about 1880, when the .'-^tate Board ])ublished and distributed 
literature freely. The Board also made the disease reportable but few notifi- 
cations were received except in Chicago where local ordinances were em- 
ployed. 



9ol 


Mji'l'MM!! 1 


Tl'i 11 Ili^^TII TTIT 


1 1 1 M 1 


"1 1 ■ ■ "" ' 


» 




lyjiJ^d-Lii-l^i^ 


, , ' 






I 1 1 ■ ' 1 °^ 


fT^! ,' ! '-Ttl- 


iMtbCAKL" 1 r LVLk: 
















- ~ -Lii-4-^-^ 


^" IPi 


ILLIhOIS"-^- 






1 1 I 1 














■w 


" ^-rt 


: ,! : :' 1 


louw I7CD :: 






1 _;_ li^^^b"ATIbTIC5 UnWAILAtSLL hOW OCtn YLAK5 . 




: ! ; i ' 1 1 


ir_ _ _: 1 :::.±_t 








r_ ^ __T ,__ 




F -^ 


' ! 1 1 ll 


if- W-— +4^ 




< 






^ ^— — — ■ — — ^— --— -'-rrr 














1 ' ' < 




o ■" 




+ ITi-^- --T 




d 






























1-^ , 1 't " ^ 




































fY 20 
















_r 












Q. 






1 '1 l' 
























S " 


J ' ' • 1 










i 1 1 : i 1 
















l-r 












1 i 




^ i f iiC 














Ui. 










' M 




N -1 




^^^m 




















1 i 


^^^^H f 1 1 r 








II ^^^^^^^^^^^H i 1 1 ! 1 1 



Shortly before liJOO it became the practice of the Slate Board of Health 
to send medical inspectors to epidemic foci. These men promoted isolation 
of patients as their chief control measure and this appears to have been ac- 
companied by favorable results in reference to the spread of the disease. 
Scores of communities suffered from outbreaks during the first decade of 
the twentieth century so that the reports of the State Board are filled with 
accounts of investigations and resultant control measures, usually in the 
form of i|uarantine. 



3:)ii 



lir.AI.rii tDNDITIONS AFTF.H IS" 



Another very impurtaiit factor in controlling scarlet fever began to 
assume importance about lims. This was the iiromotion of milk pasteuriza- 
tion. Dining the previous year Chicago went through a serious epidemic 
of scarlet fe\er and evidence gathered by the epidemiological investigators 
indicat^■d tile milk sup])ly as the means through which the disease was spread. 



2Z0O 


- SCARLET FEVER CASE REPORTS Ih ILLlhOIS 


2000 


_ LEIGEHD 




"^---..^^ 7 Year Adjusted Median 1919-1923 — o^^^^^o-" 




\^ 1924- Cose Reports —o—^.-O-— ^ 


1600 


— \ 


1400 


--... m. 


1200 




1000 




800 


Va. ~~q /' 




X- '^ /'' 


600 


\, '\^ Jl 


400 


\\,^/>' 


200 


1 1 1 1 1 1 1 



Jan. Feb Mar Apr May June July Auq 5ep Oct. Nov Dec. 

Pic. 22. Note tlie sliarp upward swing of the 1924 line for December. 

Table :'.]. 





C.ASES OF Scarlet Fever 


Reported 


BY Months in 


Illinois. 




Vfur. 


.liin. 


Feb. 


Mar. 


.\pr. 1 May. 
1 


June. 


JU1.V. 


Aug. 


Sept. 


Oct. 


Nov. Dec. 


Total. 


1916 


1,878 


1,891 


2,281 


1,564 


1,547 


893 


416 


239 


488 


933 


1,264 1 1,682 


15,076 


1917 


2,284 


2,625 


3,403 


2,488 


2,230 


1,329 


699 


351 


528 


401 


232 j 648 


17,220 


1918 


758 


611 


561 


505 


362 


148 


150 


101 


231 


189 


2C1 i ros 


4,025 


1919 


440 


588 


662 


586 


495 


289 


99 


97 


304 


656 


893 1 1,101 


6,210 


1920 


2,449 


2,235 


2,335 


1,708 


1,456 


862 


429 


293 


715 


1,385 


1,972 


2,637 


18,476 


1921 


3,116 


2,525 


2,241 


2,113 


1,629 


710 


330 


412 


857 


1,569 


1,77S 


1,743 


19,023 


1922 


1,967 


1,817 


1,388 


936 


671 


465 


240 


370 


526 


1,143 


1,419 


1,314 


12,256 


1923 


1,556 


1,071 


1,066 


816 


739 


475 


241 


227 


444 


768 


1,008 


1,123 


9,474 


1924 


1,435 


1,317 


1,508 


1,148 


1,003 


780 


383 


208 


396 


891 


1,105 


1,516 


11,690 


1925 


2,064 


2,103 


2,384 


1,772 


1,682 


909 


351 


261 


377 


755 


1,279 


1,755 


15,692 


1926 


1,847 


2,129 


2,051 


1,507 


1,397 


947 


488 


297 


376 


816 


1,124 


1,265 


14,244 



This disclosure led the health commissioner of Chicago to require the pas- 
teurization of milk supplies ottered for sale in that city. The order became 
effective in linis but it was r.)l.'i bi'fore f;icilities were available to make 
the entire su|iply of the city coniplcteU p;isteurized except two percent which 
was certitied. 



HEALTH COXDITIOXS AFTER 187' 



351 



Observation of the inijjrovenieiit brought about in Chicago as an ap- 
parent result of pasteurization led to the gradual extension of this procedure 
throughout the State. It was ])ronioted with vigor by the State Depart- 
ment of I'ubHc Health subsequent to ID'-il, a fact referred to elsewhere in 
this volume. 

The medical insijection of school children doubtless was an important 
factor in controlling scarlet fever and other diseases as well. It has never 

Table -.Vi. 
Deaths FROii Scarlet Fen'er ix Illixois by AIoxths. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


Ma.v. 


June. 


Jul.v. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total. 


1918 


28 


17 


22 


23 


11 


8 


5 


4 


2 


10 


13 


6 


149 


1919 


19 


27 


29 


23 


18 


13 


6 


6 


4 


18 


29 


33 


225 


1920 


50 


53 


55 


29 


33 


22 


8 


4 


13 


24 


41 


30 


370 


1921 


45 


49 


51 


47 


34 


32 


11 


12 


17 


30 


38 


47 


413 


1922 


57 


48 


37 


31 


16 


13 


7 


15 


9 


18 


21 


30 


305 


1923 


36 


28 


42 


15 


23 


13 


7 


7 


10 


11 


10 


27 


229 


1924 


27 


27 


25 


27 


18 


10 


8 


4 


6 


9 


15 


30 


206 


1925 


34 


28 


59 


34 


32 


11 


6 


9. 


5 


10 


20 


20 


268 


1926 


34 


23 


38 


31 


26 


21 


10 


10 


6 


11 


14 


9 


233 



Table 33. 
Deaths and Death R.\tes from Scarlet Fever in Illinois. 



Rate per 
100,000 
No. deaths. population. 







Rate per 






100.000 


No 


. deaths. 


population. 




516 


9.2 




575 


10.1 




608 


10.5 




694 


11.9 




1,022 


17.2 



1860 


1,698 


1870 


2,162 


1880 


1.369 


1881 


856 


1882 


687 


1883 


1,048 


1884 


832 


1885 


802 


1886 


743 


1890 


442 


1900 


643 


1902 


735 


1903 


519 


1904 


368 


1905 


177 


1906 


602 


1907 


S8() 


1908 


533 



83.1 


1910 


44.4 


1911 


27.1 


1912 


21.2 


1913 


31.7 


1914 


24.6 


1915 


23.2 


1916 


21. 


1917 


11.5 


1918 


IS. 3 


1919 


14.7 


1920 


10.2 


1921 


7.1 


1922 


3.3 


1923 


11.3 


1924 


16.3 


1925 



been practiced with a large degree of systematic regularity except in Chicago 
but infiuc-nce on communicable diseases there always has a pronounced effect 
on the iirexaleiice rates in the State. Manv other places enijiloyed |)ublic 
health nurses for work in the schools, especially after the \\'orld War. and 
tlu-ir work ])roduced marked improvement in the communicable disease in- 
cidence in the communities which they served. 



3.V2 inc. \i. Til coxDrno.Ns ai-ti;k ]8TT 

The year of \'W, marks the heginnint;- of the jicrioil when statistics 
of a rcHable character became available fur the State i^enerall)'. In that 
year means for securing fairlv complete rejjorts of cases of scarlet fever, 
along with otln-r diseases, were employed. This enabled State health oili- 
cials to keep informed about the situation at all times and to be in a j)osition 
to exercise control measures. 

The most important step forward toward the control and ultimate elim- 
ination of scarlet fever came from bacteriological research in 1921. It is of 
especial interest here because two Illinois physicians, (ieorge F. and (Gladys 
H. Dick, working together in the McCormick research laboratories in Chi- 
cago, discovered that a certain strain of streptococcus is responsible for scar- 
let fever and that toxin from these organisms may be used to determine 
through skin tests susceptibility to the disease. Prophylactic and therapeutic 
agents were also developed from the toxins. 

The fundamental scientific facts in regard to the etiology of scarlet 
fever had been known for some time. The first was that some one or more 
of the streptococci were concerned in its symptomatology. As to the causa- 
tive relations of the streptococcus there were two schools. One held that 
the streptococcus was the cause of the disease. The other held that strep- 
tococci were so nearly ubiquitous and caused so many diseases that they 
could not be the specific cause of scarlet fever. This school held that the 
specific cause was some unknown organism, but that the streptococci con- 
tributed materially to the symptoms. The theory upheld by Bristol that the 
rash of scarlet fe\er was an anaphylactic phenomenon for which streptococci 
was the bacterial cause, lent more su|ii)ort to this side of the (luestion than 
it did to ethers. 

Dr. A. R. Dochez, by the use of certain culture methods, demonstrated 
the one variety of streptococcus which he claimed could i)roduce the disease, 
and in that wav seemed to establish tlit' priniac\- of tlie stre])tococcus as the 
ctiologic agent and, at the same time, to answer the i)(jint made by Jochmann 
that an organism which was so witle-spread and caused so many diseases 
eonlil not Ije the s]iecitic cause of scarlet fe\er. 

It reniained for the Dicks in l'.)"?1 to jirove experimentally that a certain 
strain of streptococcus grown from throats of persons having scarlet fever, 
when injected into suscejitible human beings, produced the disease. The 
Dicks extracted a toxin from this streptococcus which is now being used 
to make a skin test for determining the susceptibilit\- of persons to scarlet 
fever. This ])r()cednre. called tin' Dick ti'st. is done the same as the Schick 
test in reference to diphtheria. .\ toxin for ]ireventing scarlet fe\er has 
also been developed. It is given in mnch the same wav as to.xin-antitoxin 



HEALTH COXDITIOXS AFTER 18T7 SoS 

for the prexcntion of diphtheria. Not only that but there is now availal)le 
an antitoxin for the curative treatment of scarlet fever. 

The outlook for ridding the country of scarlet fever is therefore promis- 
ing. 

The greatest prevalence of scarlet fever is almost always experienced 
in mid-winter, usually in January or early February. Greatest freedom 
from it is enjoyed in August. The disease runs almost as true to this 
course as vegetation does to the seasonal changes which govern floral life. 

For some reasin which is not altogether clear, scarlet fever lost a 
good deal of its \irulency during the second and third decades of the twen- 
tieth century. In lil2G, for instance, there were 14,24-1: cases reported with 
only 233 deaths whereas 19,825 cases in 191T left TUl dead. Fatalities 
mounting to l.uOO or more per year were evidently common in Illinois prior 
to liliiO but it seems im])robable that the number of cases was correspond- 
ingly large. 

The trend of the disease both as a cause of death and sickness ma\- be 
observed from tables 31, 32 and 33. Its seasonal beha\ior is illustrated in 
Figure 22. A graphical illu.stration of the mortality record from scarlet 
fever is given in Figure 21. 

Diphtheria. 

The State Board of Health, in the years immediateh- after its organiza- 
tion in 187T, was especially concerned with the regulation of the practice of 
medicine, and the suppression of epidemics of yellow fever, cholera and 
smallpox. The other contagious diseases, including diphtheria, which were 
then attributed to filth and bad sanitation, \yere left largely under the con- 
trol of local health organizations or practicing physicians. 

There are no statistics available showing the prevalence of diphtheria 
or the death rate from the disease in Illinois for the years 18T7, 18';8 and 
18:!). 

In l.^sl). the United States cen>us >h(iws thai in Illinois, with a jjupula- 
tion of a little oyer three million, there were M,7s:; deaths from diphtheria, 
or 123 for each 100,000 inhabitants. Chicago, too, in this \ear recorded a 
rate of 2!)0 per 100,000 jxipulatiim, the highest d:j)htheria death rate ever 
recorded for the city. The diphtheria death rate continued high in 1881, 
18S2 and 18,s;i. 

In 18S3 the State Hoard of llcalih (li>trihuted an educational circular 
on the prevention anil control of diphtheria from which the following para- 
graph is quoted : 

"Diphtheria I'as so often appeared where uncleanly conditions have prevailed, 
when it could not be traced to continuous propagation b.v contagion that its rela- 
t'.n to tilth a? a cause may he assumed for sanitary purposes. It is immaterial 



3:. 4 



mCAl.TIl CONDITIONS AFTKR 1877 



whether this tilth exists in visible and disgusting form such as the garbage heap, 
the cess-pool or the privy vault or in the invisible and possibly inodorous gases 
from an illy constructed sewer; from decaying vegetables in the cellar or in the 
poisonous exhalations from the human breath and body in unventilated rooms. All 
these undoubted causes of ill health should be at once abated." 

Tlii.s .same circular also stated that diphtheria frequently caused mure 
deaths' than tyi)hoid fever, smallpox, scarlet fever, and measles combined. 
During the first 10 years of the State Board of Health, from 1877 to 188(), 
Chicago anmially averaged i(i8 deaths fn>m diphtheria for each loii.ooo of 
population. 

Diphtheria was indeed a terrible disease, and today it can readily he ap- 
preciated how fuiile were the efforts, made at great expense, in trying to 
combat its sjjread b\- re-laying sewer pipes and drains, on the theory that it 
was a filth disease. 

In 1887 the health department of the city of Chicago declared that di]ih- 
theria wa-- not a filth hut a contagious disease like smallpox. 



Table U. 
Dii'iiTin:Ri.\ Including Croup, Chkaco Cases and Deaths, ]89:i-lS99. 



1897 . 

1898 . 
1899 



Keporterl. 




1,4S1 
1,406 
1,632 
1,098 



Another step away from the filth theory took place in 18!)] when the 
State Board of Health ordered that bodies dead from diphtheria could no 
longer be transported by common carriers because of danger of sjireading 
the disease. 

In Chicago, diiihtheria was made a reportable contagious disease in 18!)2 
Init this order was not comjilied with very extensively because neither the 
medical ]n-ofession nor the public was ready to accept the germ theory. Table 
;!l, compileil from the annual reports of the health deiiartnient. shows how 
far shiut the ( tTori lo collect morbidity reports fell. 

.Meinl)rani'iis croup \\;is m.ade reportable in 1898. ' 

The filth ilieorv of the origin of diphtheria gave way completely before 
bacteriological research >o th;il by is'.i.'i the whole problem of prevention was 
regarded by forward looking sanitarian> m a new light. In that year anti- 
toxin as a sjiecihc cur.ative agent was introduced. On September iMh, Chi- 
cago opened (>0 stations at convenient points in the cit)- from which this new 
product could be bought at reasonalile prices and had free by the pocir. 



HEALTH COXDITIOXS AFTER ISTT 



355 



Althini.t,'h Uiere wcrt- nianv cases cif diphtheria and many deaths, and 
talk (if clcising simie nf the pnlihc schiidls because of e])idemic conthitions, 
yet not a single vial of the serum was called for at any station until October 
5, ISII.'). This was true in spite of wide publicity given through the public 
press and illustrates the skeptical attitude of physicians toward the new treat- 
ment for diphtheria. 

Because physicians were slow to use the new remedy, and especially be- 
catise of the many deaths, the health department used all available mem- 
bers of its medical staflf in administering antitoxin, and in teaching the medi- 
cal profession the methods of using it. This practice soon made necessary 
36 additional supply stations while 434 drug stores were authorized to act 
as agents for the distribution of diphtheria culture outfits. 

Between October 5, 1895, and April 1, 189(i, there were l.liis true cases 
f bacteriologically verified) of diphtheria treated with antitoxin of which 
number 1.3T4 recovered and 94 died, a fatality of U. 1 ])er cent. 

An analysis of 805 of the true cases referred to aljuve shows: 



Treateil on. 


Total. 


Recovered. 


Died. 


Death rate. 
(Per cent) 


1st day - - 


61 

187 
372 
1C9 
76 


61 





0.00 


3rd (ia.v 

4th da.v 

Over 4 days. 


3e2 10 
02 17 
54 22 


2.6S 
1.5.60 
2S.91 




803 


753 52 


6.46 



By Xdveniber. is:)."), antitoxin administrations were being used to such 
an extent that it was s|)iiken of as (jcucrallx adopted. 

The use of antitoxin as a preventive of di])htheria in Illiniii> began dur- 
ing the autumn of ISIl"). It was argued that a drug which could cause so 
prompt and complete recovery from diphtheria ought to be heliiful in its 
prevention. This proved to be the case so that the practice of injecting anti- 
toxin into susceptible persons exposed to di]ihtheria expanded coextensively 
with the use of this ]iroduct as a curative. 

Collecting Case Bcjiart.s a Pnihlctii. 

Once started the use of antitoxin became rouline practice and caused 
far less trouble for health officers than the matter of case reports. In the 
State at large very little pressure was brought upon the local doctor to get 
reports because there were no local health organizations of conseqiience but 
in Chicago first one expediency and then another was em])loyed to promote 
reporting. The medical profession was more or less recalcitrant on the 
whole so that Chicago was one of the last of the large cities in the countrv 
to reach the point where diphtheria quarantine was handled in an efficient 



356 



HEALTH COXniTIONS AFTER 18TT 



way from a pulilic lu-allh staiKl])<}iiit. Table '■'>') indicates hy the relatively 
small (liffereiice lietween case and death re])(irls that ndtilication was li_\- no 
means com])lele during the period. 

After llHi; im])rovement in case reports began to \iv noticeable tirst in 
Chicago and later throughout the State. This was stimulated by the activity 
of health officers, local and state, and the completeness of registration in- 
creased in direct ratio to the increase in public health facilities for enforc- 



Table ;i5. 

Diphtheria and Ckoup — Illinois and Chicago. 

Number of Cases and Deaths 1900-1907 and Death Rates per 100,000 
Population. 





Entire 


State. 


Chicago. 


Year. 


Death.s. 


Rate. 


Cases 
reported. 


Deaths. 


Rate. 


1900 







3,033 
2,237 
2,760 
3.300 
2,607 
2,901 
4,457 
5,338 


840 
615 
627 
637 
409 
433 
654 
655 


49.5 


1901 






29.4 


1902 


1,079 
1,175 
881 
825 
1,022 
1,015 


21.6 
23.1 

17.1 
15.7 
19.2 
18.9 


34.8 


1903 


34.4 


1904 


21.5 


1905 


22.2 


1906 


27.7 


1907 


27.1 







Table 36. 
Mortality from Diphtheria in Illinois. 



Year. 


1921. 


1922. 


1923. 


1924. 


1925. 


1926. 


\i 




1,478 
22.3 


1,181 
17.6 


811 
11.9 


470 
6.8 


409 
5.7 


411 


R: 


te pel' 100.000 , 


5.7 









ing the notilication requirements of health otticers. I'airlv satisfactoi")- case 
registration dates from ]!)(•; in Chica,go and from 191 1 for down-state. For 
all jn-actical pur])oses the case re|iorls were complete subse(|uent to these 
ye;ir.^. 

Free A)itil o.vni. 

( hicago introduced a system for snp]>lying antitoxin at reasonable i)rices 
from convenient stations in is'.Ki. A -imilar >ystem was created for the 
State in l!H)."i by a legislative enactment. In I!Hi; iJu' State Board of Health 
began the free distribution of antito.xin to all citizens. I'or this purpose an 
a]5propriation of !i^l.'),0()0 was made in ihai \ear. 1 )istvibution was effected 



TiEALTII COXUITIOXS AKTRR ISTT 



:3:>: 



through a system of agents, usuall_\- hjcal druggists, one of whom was located 
in every county seat with two or more in all of the larger communities. 

This practice [irevailed continuously and is still in vogue. It was satis- 
factory except that unforseen epidemic conditions from time to time prior 
to l!i"M exhausted the funds apiiropriated and created a shortage in the anti- 
toxin >upply. This resulted in hard>hips the character of which may l)e 
readily surmised. An emergency ajipropriation was made hv the General 



Table 3T. 
Cases of Diphtheria in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


.\l.r. 


1 
May. 1 


June. 


Jul.v. 


A,., 


•Sept. 


Oct. 


Nov. 


Dec. 


Total. 

■ 


1916 


973 


810 


736 


559 


1 
640 1 


643 


471 


525 


797 


1,564 


1,627 


1,337 


10,682 


1917 


1,263 


1,072 


1,312 


1,124 


1,141 


930 


890 


722 


1,212 


814 


2,046 


1,161 


13,687 


1918 


1,028 


649 


751 


665 


565 


566 


487 


362 


604 


990 


703 


705 


8^075 


1919 


731 


769 


665 


635 


668 


470 


541 


528 


992 


1,898 


2,050 


1,505 


11,452 


1920 


1,139 


93S 


1,058 


778 


793 I 


656 


624 


454 


904 


1,907 


2,700 


2,343 


14.294 


1921 


1,874 


1,364 


1,350 


1,215 


1,085 1 


944 


744 


848 


1,613 


3,667 


3,503 


2,584 


20,793 


1922 


1 1,918 


1,361 


1,211 


863 


820 i 


793 


576 


•654 


880 


1,844 


2,297 


1,945 


15,162 


1923 


1 1,697 


1,090 


1,032 


727 


678 1 


532 


392 


411 


607 


1,114 


1,318 


1,118 


10,716 


1924 


1 1,007 


790 


671 


577 


464 


378 


367 


269 


416 


557 


693 


664 


6,853 


192,5 


1 584 


438 


439 


391 


370 


323 


287 


266 


273 


490 


584 


541 


5,0C6 


1926 


486 


392 


357 


327 


300 


367 


232 


204 


273 


493 


381 


519 


4,531 



Talile ;3S. 
Diphtheria — Morciditv, Mortality and Fatality Rates. 





Po|mlati..n. 


Cases. 


Ilea Ills. 


Per 100,000 people. 


IJeaths 




Cases. 


Deaths. 


i;er 100 
cases. 


1917-18 

I91S-19 - 

1919-20 

1920-21 

1921-22 

1922-23 


6,310,856 
6,398,068 
6,4,S5,2S0 
6.572,492 
6,659.704 
6,746,916 
6,834,126 
6,921,344 
7,092,000 


11,000 
8,060 
12,876 
16,764 
19,901 
13,883 
8,853 
5,330 
4,666 


1,527 

979 

1,061 

1.243 

1.25S 

989 

647 

400 

410 


174.3 
125.9 
198.5 
255.1 
298.9 
205.8 
129.5 
79.9 


24.1 
15.3 
16.3 
18.8 
19.2 
13.3 
9.5 
5.8 


13.8 
12.1 
8.2 
7.4 
6.3 


1923 24 




1924-25 

1925 26 


-2 









Assembly early in 1!)21 to cover immediate needs and subsequent to that time 
the biennial grants were ample to meet all requirements. 

With the discovery and use of diphtheria antitoxin ilic deaih rate 
throughout Illinois declined very rapidly. The rate of s.") per Kiii.ood i)opu- 
lation in 1886 was cut to only 1~, by lUO"^. This marvelous drop in the death 
rate caused many of the enthusiastic special workers in the field of preven- 
tive medicine anil public health to prophesy that the year of 1925 would find 
di])hlheria wijied oli' the face of the earth. Thev based this forecast on the 



358 



IIKAI.TH COXniTIONS AI-'TKR IS'l^ 



facts ihal cdinpl'lc in I'uniiation existed in rei^anl lu the causative at^ont of 
fliphtlieria. tlial anlituxin wniild cure it and that anliluxin wuuld t;i\'e tem- 
[lorary inmnniiiy id exiiii>ed person^. 

A >tU(ly iif the Chicago tii^uro and alsd the State ligures (see Fig. 23) 
show tiiat Ironi 11)()",> to \'J22 the rechicticm in diplitheria mortality was very 
small. The failure to lower the diphtheria death rates cluriniL;- the two de- 
cades may he t-xplained in part hy the following factors: 

I. Ignorance (hiring ])art of this time of the role ]>layed h_\- diphtheria 
carriers in sjjreading the disease. 



Tahle :;!!. 
Diphtheria Carriers. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


Ma.v. 


June. 


Jul}-. 


Aug. 


Sept. 


Oct. 


Xov. 


IJec. 


1921 1 1 1 








179 
136 
346 
340 
242 
118 


174 
117 
227 
2S9 

ISl 
67 


292 
257 
286 
262 
167 
92 


480 
429 
432 
337 
2=9 
145 


516 
676 
522 
417 
310 
164 


420 


1922 


1 270 


239 
306 
383 
207 
119 


235 
255 
327 
259 
134 


165 
249 
285 
186 
122 


139 
3.;3 
284 
287 
126 


214 
288 
227 
244 
89 


477 


1923 


455 

527 


577 
292 






137 


1926 


148 


242 



Table 4U. 
Deaths from Diphtheria in Illinois bv Months. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


July. 


Aug. 


Sept. 


Oct. 


NOV. 


Dec. 


Total. 


1918 


146 
100 
121 
137 
181 
133 
83 
47 
38 


105 
92 
108 
122 
108 
88 
34 
23 
37 


100 
91 
68 
93 

120 
74 
41 
29 
35 


94 
63 
83 
88 
74 
59 
38 
33 
32 


83 
69 
76 
92 
88 
36 
36 
29 
26 


66 
44 
47 
84 
45 
27 
32 
27 
24 


66 
60 
44 
56 
43 
26 
33 
23 
32 


53 
48 
47 
81 
46 
36 
16 
25 
14 


77 
89 
64 
92 
75 
45 
31 
24 
24 


159 
135 
126 
231 
132 
89 
37 
46 
53 


102 
141 
181 
223 
130 
107 
44 
51 
52 


91 
112 
165 
179 
139 
91 
55 
52 
44 




1919 
















1923 

1924 


811 
480 


1925 













2. Self-medication of illnesses regarded as nothing more serious than 
severe sore throat. 

;). Delayed medical service in cases of diphtlieria. 

4. Too >mall doses of antitoxin. 

5. Inahility to produce in susce])til)le persons anything hut temporary 
immunity. 

The ne.xt great ste]) toward controlling diphtheria hegan in l'.)i:l when 
Schick di^co\■ered tlu' skin leM that hears hi^. name and which nia\' he used 
to determine which persons are >u^ceptihle to di])htheria and which are not. 
In the same year I'.ehring started to using a mixture of toxin and antito.xin 
as a pernianmi pre\enli\e against diphtheria. In tlie course of time hoth 



HEALTH CONDITIONS AFTllR 187^ 359 

of these procedures came to be part of the routuie practice in fighting diph- 
tiieria in lUindis and it is to the prdnidtiim and practical appHcation of these 
two things that credit is given for tlie remarkable decline in diphtheria since 

P(ipiil(iri-iiif/ T nxiu-Antitoxin . 

Like anlitoxin at first toxin-antitoxin was regarded with distinct skepti- 
cism (in the part of doctors and the public so that it came into more or less 
general use (|uite gradually. The Schick test required time and considerable 
skill but its empldyment before administering toxin-antitoxin was advocated. 
This was ruKither ditticully in the wav nf generalizing immunization against 
diphth.'ria. 

Table 41. , 
Deaths and Death Rates from Diphtheria in Illinois. 

Rate per 
100,000 
Year. Xo. ilealhs. iiopulatiiin. Year. 

I860 1,109 70.0 1009 --- 

1870 1,1S9 59.0 1910 

1880 3,7S3 122.9 1911 

1881 2,924 92.7 1912 

1882 ---- 2,172 67.2 1913 

1883 2,2111 66.6 1914 

1884 2,J19 68.6 1915 

1885 - . 2,7;5 79. ,S 1916 

1886 .- 3,997 113.3 1917 

1890 3, .561 93. 191.S 

1900 2,067 42.8 1919 

1902 - - . 1,076 21.6 1920 

1903 - ... 1.175 23.1 1921 

1904 - .--- . 884 17.1 1923 

1905 825 15.7 1923 

1906 1,022 19.2 1924 

1907 1,015 18,9 1925 
190S 979 17.8 1926 





Rate per 




100,000 


. .leaths. 


population 


1,001 


18. 


1,332 


23.8 


1,302 


22.7 


1,414 


23.4 


1,347 


22.8 


1,092 


18.2 


1,130 


18.5 


1.356 


21.8 


1,725 


27.7 


1,142 


17.9 


1,044 


16.2 


1,128 


17.2 


1,478 


22.2 


1,181 


17,4 


811 


11.9 



Experience came tn the rescue. .\ few pioneers all over the cnuntry 
began giving toxin-antitoxin t(i all children under their cniitrol without ref- 
erence to the Schick susceptibility test. One nf these was the medical offi- 
cer of the fraternity school at Mooseheart, Illinois, where more than l,t>(i() 
children are constantly enrolled. Beginning with 1 '.(•;;() all children in the in- 
stitution have been immunized with toxin-antitoxin, newcomers getting the 
immunizing doses upon arrival. No case of diphtheria developed there to 
date subse(|uent to V.)'M although the previous history showed Ki to .'iD cases 
annually. 

Statistics al'-o came in with helpful suggestions. Thev pointed out that 
by far the heaviest losses of life from iliplitheri:i were among children less 
than si.x ^-ears old. 



3fi0 



IIKAI.TII COXDITIOXS AKTKR ISTT 



TIius aboul \'>'i'i the Slati- IX-parlmcnt of Public Health began to ad- 
vocate tbe use of toxin-antitoxin in children under eight without regard to 
the Schick test, A mnnber of voluntary and professional organizations 
elected lo lend ibeir influence to the cause of diphtheria eradication and some, 
like the federation of women's clubs and the parent-teacher associations be- 
came quite active in the campaign. 

In the meantime the State had beyun to distribitte material for making 
the Schick test and toxin-antitoxin without local cost to any citizens who 
desired to use either or both. Previously a field laboratory equipment had 



! rnTrnrriTrrinT'r 

diphtheria; 
in iLLinois 

1860-1926 




Fk; 



been ])urchased and the .Slate I'mployed bacteriologists who were prejiared 
to go at once to the scene of ontiireaks which had got beyond local control. 
Not onl\- so but branch laboratory service had been developed liy the State 
for tbe i)uriK)se of expediting the diagnosis of diphtheria. 

.Ml of these factors counted in the manifest success toward ridding the 
State of diphtheria. The first step was the realization that diphtheria is con- 
tagious and is spread from person to person. That took place about ISOO. 

1 lien came antitoxin, placed on the market in lsii."i. The next imiiort- 
aiit iiieaMue was tbe laboratory diagnosis of diphtheria. This Ijegan as an 



HEALTH COXDITIOXS AFTER ISTT 3(51 

official function of the State in I'JOi when the laboratory was started. It 
developed until five branch laboratories located at convenient points offered 
prompt service in diphtheria cases to all parts of the State without local cost. 
In liilT a field diagnostic laboratory ovitfit was put into service also. 

Following the introduction of free laboratory service came the free 
distrilnuion of antito.xin, undertaken b_\' the State in I'.H)', and continued. 
Then came the Schick te>t and toxin-antitoxin in IDl.'! and the adoption of 
both by the State about lii-20. 

The downward trend of di])htheria was due to the organized use of these 
factors. As each came into prominence a nt-w advantage over the disease 
was gained and a new declevity in mortality from diphtheria dated from its 
use on a considerable scale. 

Reference to Figure ^^i and the various tables accompanying this article 
tell the story of how rapid the progress against diphtheria has lieen. Not 
only has the prevalence ftnd mortalitv declined but the jiercenlage of fatal 
cases has gone down. 

After l!i-2i improvement in the mortality rate from di])htheria was phe- 
nomenal. The number of deaths reported for li)26 in Illinois was less than 
one-third of the number reported in I!I51. Figures for the intervening years 
are shown in Table ;)ii. 

Tuberculosis. 

Tuberculosis in Tllimiis subsei|uent to is;;, may be viewed in two per- 
iods, the one prior to 1!M0, during which time n<it nnich was accomplished 
in lowering the death rate, and the other from I'.HO to date, during which 
the trend of mortality was definitely downward as a result nf the systematic 
control measures instituted. 

The period prior to 111 1(1 may be cunsidered in two phases, the one be- 
fore and the other after the time, in the early nineties, when the tubercle 
bacillus became generally accepted as the causative agent. Although the 
tubercle bacillus was discovered in 1882, it took approximately another de- 
cade for this fact to become accepted generally enough to aft'ect the manner 
of handling the malady in curative and preventive medicine. 

The course of tuberculosis in Illinois, as shown by the annual death 
rates, as far as these are available, is illustrated in Figure 24 

This chart shows that in the first period, the rate remained practicallv 
stationary for 10 years. Then for another decatle it manifested a ten<lency 
to increase. Toward the end of the period there was a slight fall. 

The second period is marked by a pnmnnnced initial decline that ccmtin- 
ned until about 1917 when the nicirtalit\' rate jumped up again u> the level 
which characterized the diseases during the first decade of the twentieth cen- 



3G2 



lli:\l,rll CONDITIONS AI-'TI'l; \s',', 



tun'. This iiKTcase probribly had some rflaticui tn the Wdvld War. 'I'he 
strain of that ciiiergency together with deprivatimis in food, high pressure 
working cmiilititins and new kinds of cx])osures pr(ihal)ly caused a rekindhiig 
of tuiierculdsis in inaii\' people in whom il had lieen arrested or quiescent. 

.\t an\- rate I'.Ms was the jieak ninrtality year in the second period. 
After lliat dale a stead\' dechne marked the mortahty from tuberculosis. 
Not oni\- had tlie time arri\ed when resuUs from eonlrnl measures were to 
be expected hut a new zeal and added mdinenlum characterized anti-tuber- 
culosis campaigns in the Slate. Good economic conditions also prevailed. 




TUBERCULOSIS-ALL FORnS 

in iLLinas ,n 

1860-1926 ^^ 

C STATISTIC? UrtAVAILABLE FOR OPEh YEARS) 



making pussible the extension of pre\enti\e work on a larger scale than 
would otherwise have been the case. 

Earlij Altitii'lr. 

The carK \iilumes of the annual reports of the State Moard of Ilealtb 
contain practicalK- no reference to tuberculosis. This is evidence thai the 
disease pro\dkeil little thoughl among saniiarians then. The efforts of health 
officials concerned |iidhlem-, which were regarded as more urgent at that 
time. These included the protection of the inhabitants against the invasion 



HEALTH CONDITION'S AFTER 187 



363 



of such pestilential diseases as cholera, yellow fever, and smallpox, and li- 
censing of practitioners of medicine. 

Furthermore, the fact that the infectious nature uf tulierculusis had not 
been definitely proven, while the sanitary precauliun to ])revent the spread 
of cholera and similar diseases had apparently been effective where they 
had been carried out, gave everv cause for the Board to proceed along these 
established lines at the time. 

Table 53. 





Cases of Tuberculosis Reported bv Months 


IN 1 


LLINOIS. 




Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. June. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total. 












L.._...L_.... 




1 1 
; 


1917 


172 


2,485 2,415 


1,976 


1,720 2,249 


2,619 


2,495 


2,484 


892 


311 1 4,111 


23,929 


1918 


1,840 


1,142 1,722 


1,446 


1,602 1,353 


1,.563 


1,182 


973 


891 


1,208 1 637 


15.559 


1919 


1,390 


1,397 1,430 


1,923 


1,586 1,723 


1,720 


1,447 


1,627 


1,719 


1,693 1 1,580 


19,241 


1920 


1,433 


1,164 1,.S20 


1,320 1 1,295 1,46.S 


1,065 


729 


1,209 


1,012 


938 1 1,114 


14,563 


1921 


989 


1,103 1,366 


1,253 


1,208 


1,283 


1,508 


1,003 


1,237 


1,100 


1,142 1,235 


14.427 


1922 


1,153 


1,111 1,685 


1,229 


1.640 


1,417 


1,464 


1,171 


1,164 


1,429 


1,634 1,386 


16,483 


1923 


1,775 


1,161 1 2,489 


1,403 


1,610 


1,351 


1,151 


1.122 


1,096 


1,385 


1.083 886 


16,512 


1924 


1,328 


1,077 1 1,111 


1,482 


1,239 


1,223 1 1.582 


1,799 


1,135 


1,2.37 


880 1 925 


15,018 


1925 


907 


1.182 1 1,143 1,101 


1,151 


1,190 1 1,051 


825 


1,166 


1,015 


1,332 1 1,941 


14,004 


1926 


954 1,132 1 1,359 1 1,755 


1,853 


1,793 1,463 


1,738 


1,291 


1,399 


1,131 1 1,129 


16,997 


1927 


1,518 1.175 1 1.329 1 1.414 


1,157 


1,362 1.040 



































Table 'A. 





Deaths 


FROM Tuberculosis in I 


LLINOIS BY Months 






Year. 


1 

Jan. ! Fell. 

1 


Mar. 


Apr. 


May. 


June. 


July. 


Aug. Sept. 


Oit. 


Nov. 


Dee. 


Total. 


1916 


' 












1 






1 


1917 


























1918 


724 


677 


876 


939 




818 


671 


596 


585 


581 


742 


720 


650 


8,579 


1919 


728 


721 


756 


768 


712 


612 


610 


553 


454 


509 


459 


513 


7,395 


1920 


639 


737 


631 


626 


628 


563 


524 


468 


450 


423 


431 


448 


6,568 


1921 


506 


455 


571 


505 


548 


428 


447 


444 


449 


435 


375 


456 


5,617 


1922 


492 


477 


576 


551 


547 


468 


445 


440 


384 


408 


395 


437 


5,620 


1923 


489 


506 


559 


542 


527 


474 


448 


421 


410 


410 


408 


378 


5,572 


1924 


544 


469 


560 


505 


543 


482 


446 


416 


409 


420 


424 


424 


5,642 


1925 


505 


433 


555 


504 


502 


511 


470 


386 1 415 


407 


408 


441 


5,537 


1926 


454 


407 


579 


531 


556 


486 


441 


410 1 408 


438 


347 


438 


5,495 


1927 






































1 i 









At the beginning of the semi-centennial period in the year 1877. little 
was known about the cause and prevention of tulierculo^is. Ihiwcver. as 
early as ]S(i], France had established h(>si)itals for the poor tuberculous 
children of Paris. In I.S(i.") it was demonstrated that ttiberculosis could be 
transmitted to the lower animals by inoculating them with diseased tissue 
from tuberculous luini,-ni lungs. 

The attention of the people of Illinois was first attracted lo the serious- 
ness of this disease bv the high death rate at .state instiuuioits, .\s earlv 



364 iii:.\Lii[ lO.vDiTioxs a1'-ti:k 1<ST" 

as l.s;n, thr death rate I'nim iul)ercul()>is at llie State iieiiilentiary Ijegan to 
concern the inaiia.i,'enieiit nl' that iii>tituticin. A rejjort made in 1899 showed 
a 10-year averat^e nicrlaHly of Jii.o per thuusand inniates ; the average age 
of inniate> lieing ;)"i years and the average term of commitment being two 
years. Warden Mnrphy's re])ort in 1(S9.') showed 'A) cases of tuberculosis, 
29 deaths, and ■.'(; discharges; and of those sulTerinL; from lul)erculosis as 
high as ^'-i ]jcr cent had died from this disease in this institution. 

Unfortunately there are no accurate records available during this early 
]>eriod showing the [Prevalence of tuberculosis in the State as a whole, except 
the I'nited States decennial census reports of deaths. These give the 

Table 55. 

Anxu.vl De.vtiis .xNii De.atii Rates from Tuberculosis in Illinois. 
— All Forms. 







Rate per 






Rate per 






100,000 






100,000 


Ycir. 


No. ilciths. 


jiopulation. 


Ycav. 


No. deaths. 


population. 


1860 , 




113.7 


1906 


6,899 


129.8 










7,142 




1S70 




145.6 


1908 


6,944 


126.8 








1909 


7,078 




1880 


4,645 


150 '.. 


1910 


7,049 




1881 - 


3,624 


111.7 


1911 


6,509 




1S,S2 


2.385 


73.8 


1912 .- 


6,212 


106.5 


ISS'i 


3,2.55 


98.5 


1913 


6,371 


107.6 


ISM 


3,452 


102.5 


1914 


6,521 


104.8 


ISS.i 


3,S66 


111.9 


1915 


7,816 


128.1 


1SS6 - 


4,472 


126.7 


1916 


8,408 


135.6 








1917 


8,065 


129.4 


1890 . 


5,69S 


14S.9 


1918 


8.579 


128.7 








1919 .- 


7,395 


114.7 


1900 


6,7S8 


140.7 


1920 


6,568 






6,S95 


138.3 




5,617 




1902 _. 


1922 -- 


5,620 


83.8 


1903 - 


7,032 


13S.7 


1923 






1904 .... 


7,234 


140.5 


1924 






1905 .- 


6,.S91 


131.7 


1925 


5,537 










1926 


5,495 


76.2 



deaths from tuberculosis as follows: I,<il5. in ISSO, and 5.fi98. in 1890 
representing a rate of 150.9 and 14:S.9, per 10(1,0(10 respectively. 

Siiicf DiscdriTfi nf Cause. 

It was the discovery liy Koch in ISS".', of the bacillus of tuberculosis as 
the causative agent of the disease, that elicited the interest and study of the 
medical profession, and subsequently, the attention of laymen, to the spread 
of the disease and the measures necessary for its prevention. 

( >n May 'i2. ISIKI, Dr. ('. W. Olson of Lombard, Illinois, read a paper 
on "School Hygiene an<l Sanitation" before the State Board of Health in a 
joint meeting with tlie Slate sanitarv association, in which he recommended 
that tuberculous teachers and pupils be excludeil from the public schools. 



HEALTH CONDITIONS AFTER 187 7 365 

Thereupon Dr. Scott, Secretary of the State Board of Heahh otTercd a re'io- 
lution as follows : "Resolved that a committee be appointed by the State 
Board of Health and the Sanitary Association tu confer with the State 
Superintendent of Pubhc Instruction and the county superintendents of 
schools to draft such needed amendments to the school laws of the State a- 
will render it necessary that teachers Cjualify physically as well as mentall\- 
before receiving certificates to teach, and that a thorough knowledge of 
school hygiene be included in the recommendations of all teachers ; also to 
formulate such other amendments as will place all public schools directly 
under medical supervision and inspection." 

In accordance with a joint resolution by the General Assembly the State 
Board of Health made an investigation of tuberculosis in the State in liiiU). 
The report to the Governor recommended the establishment and maintenance 
of a State tuberculosis sanatorium. This report after reviewing the tuber- 
culosis situation and citing figures to show its economic ini])ortance, pre- 
sented the following as part of arguments for a sanatorium ; 

"Sanatoria, are institutions designed for the open air treatment of consump- 
tives under medical direction, embodying ideal hygienic and educational methods. 
viz: the isolation of the patient, the destruction of sputa and morbid excretations 
which contain bacilli, thus removing from him the danger of infecting others or of 
reinfecting himself. Under the constant supervision of a medical officer, he is edu- 
cated in hygienic principles, there is a strict regulation of his daily life and such 
measures are enforced as may be indicated by the needs of the patient. There 
is a systematic regulation of rest and exercise according to the varying condition 
of the patient, a carefully chosen dietary, an abundance of wholesome food, and 
constant exposure to fresh, pure air and sunshine, promoting oxygenation of the 
tissues, together with special remedies administered for symptoms as they may 
arise. 

"To quote a prominent clinician: 'A patient outside the sanatorium is dis- 
inclined to accept the yoke of a rigid and severe discipline. In the sanatorium 
nothing is left to his caprice, he never receives recommendations more or less 
vague, but rest, exercise and alimentation are measured and even the cough is dis- 
ciplined. This almost military education creates an influence very favorable to the 
evolution of recovery and assures success of therapeutic means, and the patients 
rapidly acquire habits of hygienic discipline which they continue in their homes.' 

"At the International Medical Congress for the consideration of tuberculosis, 
which met in Berlin in May, 1S99, the world's most prominent investigators of the 
disease were present. It was tlie unanimous conclusion of this notable assemblage 
that all means of controlling tuberculosis, preventive and curative, were combined 
in the conception of the sanatorium. 

"As far back as can be remembered, consumptives have sought localities 
where they could have the benefit of a mild sunny climate possessing either a high 
altitude or a marine atmosphere. The cure of consumption by climate has be- 
come traditional, but experience in sanatorium work has proven that the value of 
any special climate or altitude or atmosphere has been exaggerated. Weber, who 
can speak with higher authority on this subject than any other writer, says: 'The 
blind confidence that has existed in climate influence has caused neglect of other 
necessary hygienic measures and has frequently caused an aggravation of the 
disease.' It is now conceded that there is no climate possessing immunity from 
consumption. Climatic conditions are tar from exercising the salutary influence 
attributed to them, and excepting in the extreme zones of the earth, the cure 
can be effected wherever the air is pure without extreme changes of temperature." 



3(^Cl IIEALTT! rr)\I)ITIONS AFTER 187? 

'I"he State Hoard of Hcallh Uv>[ dfclared tubcrculiisis to he a contagious 
disease in IIMIl . 

A second report was siilmiilleil lo the (iovcrnor in I'.H)-.'. recommending 
the estabhslnnt'!ii of a Stale sanatorinm. .Vttenlion was calle(l to the fact 
tliat the records of the State showed from 7,()t)U to 8,t)()0 deaths ])er year from 
tuberculosis and that there were tnore deaths from tuberculosis than from 
typhoid fever, whoopiing cougii, measles, scarlet fever, and smalliiox com- 
liined. 

Numerous attempts were made to gi't pu1)Hc appropriations for a State 
sanatorium but these efforts failed. 

Tuberculosis was the suljject of a symposium on the occasion of the 
annual meeting of tiie Illinois State Medical Society held at Bloomington, 
Illinois, in I'.iOI. This was participated in li\' members of tlie State Board 
of I lealth. {'"ollowing this a circular was printed liv the Board entitled 
"Cause. Prevention and Cure of Tuberculosis." 'i'his was distributed in 
July, and during the year it was necessary to turn out four editions, the 
last consisting of lOO.OOii cojjies. '{"his circular was distributed freely dur- 
ing the following year. It was in 1IK)1 also that Dr. T. B. Sachs published 
the report of his intensive studies on the incidence of tuberculosis in the 
Jewish district on the west side of Chicago. The cases found in a house- 
to-house survey and through dispensary records were shown on a spot map. 
and were so numerous that the study attracted a great deal of attention. 

The report and charts a|)iiealed especially to State Senator Edward J. 
Glackin. himself a resident of the district, and his interest later found ex- 
]>ression in the drafting of bills for sanatoria which he introduced in the 
legislature. The first of these was for a .State sanatorium, in 1!)05. which 
failed to pass. The next one provided' for the establishment of municipal 
sanatoria which will be referred to later. 

^1 iili-t ilhi iciildsis E If arts Oriidttizcil. 

A meeting was held at Chicago on December 1."), 1!H)4, for the purpose 
of bringing together all of the organizations activeU- engaged in the pre- 
vention of tuberculosis in Illinois. This meeting was attended by represent- 
atives of the State Board of Health, of the State Board of Charities, the 
Chicago Medicrd Society ;in<l the Chicago \'isiting Nurses' Association. 
The object of the meeting was to concentrate the forces engaged in the work 
of ])reyenlin,g tuberculosis in Illinois, and to torm an association for this 
])urpose. 

Ileretofore. three distinct mo\cmenls against tuberculosis had been car- 
ried forw.ard in Illinois. The C onnnittt'e on tlu' Prevention of Tuberculosis 
of the \isiiing .Xurses' .Association of Chicago had for more than two years 
been at work in Chica.go. The State Board of I lealth had been active in 



HEALTH CONDITIONS AFTER ISTT 3()~ 

educational work. The State Medical Society had been active as far as its 
facilities permitted. 

At the preliminary meeting- of the conference, a committee on organ- 
ization was ajjpointed with instruction.s to prejjare the necessary ]iy-la\\ s for 
a new society, and to iKjininate a hoard (if directors to report to a general 
meeting to be called later. 

The committee met on December 1(1. 1!H)4, and prciceeded to efifect an 
organization to be known as the Illinois Association for the Prevention of 
Tuberculosis, in which all of the groujis interested would be represented. 
A constitution and by-laws were drawn up, in be sulimitted at the first an- 
nual meeting scheduled for January I'.i. I'.i((-"i. at the Public Librar\- Building, 
Chicago. 

From that time on this Associatic n, under varinus titles, was a dominat- 
ing factor in anti-tuberculosis work in the .'~'tate. Due largely to its efforts 
every county felt the influence of organized effort referred to at greater 
length in the chaijter on auxiliary health organization. Its best work was 
done after 1910, however. 

Organized efforts from the outset was directed toward legislation and 
education. The voluntary agencies and the .State Board (if Health j(.iined 
forces in both directions. At each meeting the ( leneral Assembly was be- 
seiged with lobbysts and appealed to with bills, the first of which usually 
asked for a state sanatoriiim. Exhibits graphically portraying the ravages 
of tuberculosis were displayed upon every opportunity. They were shown 
before medical meetings, teachers' conventions, farmers" institutes and even 
the General Assembly. 

Having been agitated the subject (if tubercuUisis anKmg ])risnners wmild 
nut down. The situation at Joliet attracted especial attention because of 
interest manifested liv the warden and because nf the paucity of medical 
service in the institution. 

The agitation about tuberculdus prisoners was important chiefly because 
of its liearing upon the general situati( n. It brought the subject into the 
press. It made the lawmakers take notice. It helped t(j create a ])ublic o])in- 
ion about tuberculosis. The reforms in prison construction and prison man- 
agement that resulted were good measures for applicati(.in everywhere, so 
far as the principles involved were concerned. The publicity brought 
on 1)\- the iuMilvement of the jienitentiarv carried these relations home to 
large blocks of the ])0|)ulation in an eas\, (|uick way. 

.\nother dehnite step was taken by the State Board of Health in lllOli. 
l.aboralory facilities for the exaniinati('n of sputum specimens were put 
into operation. This off'ered a means for the accurate diagnosis of tubercu- 
losis in many cases, and led to the treatment at ;i more oiiportune time in 
the ciurse of the disease. 



368 iii;ai.iii ((iMurioxs aI'TI-k li>',', 

It was in l!HMi alsn that llir iiKivcnu'iil against tutjerciilusi.s in the 
schools began. Tliis started in Chicago where nursing services, mechcal 
examination and \entilaling facihties were proniuteil. 

The Chicago Tuhereuhjsis Institute secured the consent uf the ccininiis- 
sioners of Cook County in the summer of 1906, for the estahhshnient of an 
open-air camp for consum])tives at the Dunning institution. 'i"he camp 
was designed for poor consuni|)tives and particularly for those living 
in the congested poorer quarters of the city. A great deal of interest at- 
tached to the results attaine<l, as the [jroject was undertaken to i>rove that 
out-of-door treatment was therapeutically and economically sound. 

The developments mentioned thus far had their effects. One commmiitv 
after another began to pass ordinances re(|uiring case reports and move- 
ments resulting in the establishment of sanatoria, preventoria, open-air 
school rooms and dispensary service began to take cii momentum. 

Thus in liidii. I'eoria passed an ordinance requiring case reports. The 
same year Sangamon County appropriated $200 for providing tents in which 
local hospitals could isolate tuberculous patients. Abovtt the same time the 
Illinois Homeopathic ^ledical Association established an open-air sanatorium 
at Buffalo Rock in LaSalle County. A little later, about 1908, the State 
Board of Health attempted to stimulate reporting by requiring the names 
of persons from whom s]iuluni was collected f(n' examination at the State 
diagnostic laboratory. 

Lcfjishifiiin Si'ciirciJ. 

All (jf these things brought ])ressin'e en(.)Ugh on the Ceneral .\ssembly 
to result in a law enabling cities to build and maintain sanatoria. This 
took ])lace in 1908 after faihu"e had ])ursued all efforts to secure a State 
tuberculosis sanatorium. 

The act, known as the "Glackin Law", jirovided that u|)on the ado])tion 
of the propositon Ijy a referendum vote by any city a tax of not to exceed 
one mill on e\erv dollar of the assessed valuation might be levied to defray 
the cost of establishing and maintaining such sanatoria, and for the care 
and treatment of jjersons suffering from tuberculosis. 

The citv of Chicago took advantage of the law in 1909, proceeding at 
once to build a s;inatorium. The same year Lake Count\' estaljlished a 
tubercti'osis sanalorium, to lie maintained by the county, which meant that 
indi,'.;eni pi'rson> (jnl\- could be admitted \\ilhont charge. The (.'li'icago I'resh 
.\ir Hospital, a piixale inslilution conducted li\- Dr. L.than .\. Cray, was 
opened this year. 

In 19(i;i and 191 L bills were .again iiUrodnced in the legislature jinnid- 
ing for the establishment of a State sanatorium, but were not enacted. Thus 



HEALTH COXDITIOXS AFTER 1877 



369 



the establishment of niuiiicipal -sanatoria had td he rcHed upim uniil ll)l."i, 
when the legislature passed a law providing for the estatjlishment of such 
institutions by counties. 

The movement against tuberculosis gathered considerable momentum by 
the work done in Chicago between 1907 and 1911. Under Health Commis- 
sioner Evans an ordinance prohibiting the sale of milk from tuberculous 
cattle was passed, the requirements of case reijorts was rigidly enforced, 
disjiensaries for diagnosis and treatment were e^talilished, and a ^pecial- 
ized nursing service was inaugurated, an anti-spit crusade was conducted 
and withal a general public sentiment against the disease was created and 



Will You Become a Crusader? 




In the interests o! Health, Gleanlinpss and 

The La>v, you are earnestly requested to co-operate 
m enforcing the reasonable and- sanitary regulation 
embraced in the City Ordinance, Number 1493; 

"Spitting is prohibited upon sidewalks, in 

public conveyances, theatres, halls, assembly 

rooms, public buildings, or buildings where any 

considerable number of people gather or 

assemble together, and in similar places " 



^{ZuT. /^^irz^f^A^^ 



Commissioner of 
Chicago .\ii«i-S|>;Hiiiii I.ea)!ue 



Reproduced from a circular used in Chicago's anti-spitting campaign. 



ptit to wijrk. Alortality began to decline and this made other folks take 
notice. 

The Association fur the Prevention of Tuberculosis took on new life 
and reorganized in l'.)|n with Dr. W. .\. Evans as president. From that 
time forward a close cooperation between voluntary and official agencies was 
observed with telling results. The law enabling counties to erect and main- 
tain sanatoria came in 191.5. After that the story is one of increasing fa- 
cilities for fighting tuberculosis and ultimately a long anticipated and wel- 
comed decline in mortality which gave evidence of iiermanent advantage. 

Following a well-established rule, the rate of progress in tuberculosis 
control did not conform to a straight line. Ijut was interrupted bv a break 



370 iii:al]ii co.nditioxs akthk 187T 

or st(.'|) liackward in l!)ll. Thai year llu- milk (irclinancc, unik-r which 
Chicas,'c) was making- stu'h hcadwav in its li^ht a.i;ainsi tuhnauldsis, was in- 
validated, hy an act iil' the leijislatuie which iiruhiliited am niiiihcipahty 
in the\Stale from re(|uirini; a tuhercnHn test for tiie cattle I'mtn which its 
milk supply was derived; the so-called "SliurtlelT I-aw." 

After a year's delay, another ordinance was passed which provided that 
nnlk sold must he of a jjrade defined as "inspected," or else be pasteurized 
according to methods set forth in the ordinance. No tuberculin test could be 
required for cows usetl f(]r the production of inspected milk, but the standard 
for this class of milk was so hi.<,di, that the real elTect of the ordinance 
was general pasteurization. 

But the elTect of the State law as a win le was that dela\- and pro- 
crastination occurred in the purification of the milk snppl\- of the largest 
city in tin- ."^tate ; in fad comiilete pastetirization of the milk sujiply was not 
obtained until nearly li\e years later when Dr. John Dill Robertson, on 
July "i".', r.iHi. issued an order dnrini;- an epidemic of infantile paralysis, 
definitely rei|uiriiig the pasteurization of all milk except certified. 

L'pon the recommendation of Dr. John Dill Robertson, Comnfissioner 
of Health i f Chicago, the Municijjal Tuberculosis Sanitarium in I'.ilG made 
a house-to-house survey for tuberculosis, in the central district of Chica.go. 
.\ total of 1 Ci."),'; 0(1 persons were examined, of wliich number l^.G per cent 
were found to be tuberculous. .V total of ll.'.'S'i unregistered cases were 
found and listed for superxision. 

In l:i|(i the sanitarium .-uigmented the school inspection service of the 
luallh department by adding "id doctors and ."lO nurses to the force, with 
the understanding that a |iart of the wi rk of the entire force would be 
devoted to the diagnosis and ])re\ention of tuberculosis among pupils in the 
schools. 

A comprehensive program for the fintling and reporting of all cases of 
tuberculosis ; and the segregation of all open cases not under the care of 
familv physicians ; and the jirevention of the ex])osure of open cases of tuber- 
culosis to children under 1(1 \ears of age, was also instituted at this time 
in C hic;iL;o li\- Dr. Robertson. This resulted in the lowering of the tubercu- 
losis (K-ath rate i;f tlu' city to such an extent that it attr.acted the attention 
of health ofiicers in man\- cities in the Tnited Slates, and health from for- 
eign countries who \isileil C'hicago to stiuh the methods of tuberculosis con- 
trol followed there. 

beginning in l'.M."i. at KO.d per loo.ddd population, the death nite from 
tuberculosis (all forms) dropped year b\- \ear to ;s.:! in \'^'''i. a reduction 
of "i I |ier cent in se\en years, 'Ihis showed wh.il could be accomplished 
by com])rehensi\(.' and \ igoroiis elTorts to control the disease. 



HEALTH CONDITIONS AFTER ll^TT 371 

A health survey of White County was made in 1 '.)]."'). under the auspices 
of the Illinois State Association for the freventicm of Tuljercuhjsis. and 
the Illinois State Board of Health. The work was done by Dr. I. H. Foster, 
inspector tor the Board of Health, and Miss Harriet Fulmer, R. N., exten- 
sion secretary of the Association f(jr the Pre\-ention of Tuberculosis. 

The tuberculosis cases and deaths from the disease in White County in 
lOl.j are shown bv the spot map. reproduced in I<"isj;ure '^'>. 

Three progressive steps were taken by the State in the campaign against 
tuberculosis in IDlo. The one was an order making tuberculosis a reportable 
disease, the second the promulgation of rules and regulations for the control 
of pulmonary tuberculosis, and the third was an enactment of the county 
sanitarium law, also introduced by Senator Glackin of Chicago. 

In the November election of llUti, Adams. Champaign. Morgan. Mc- 
Lean. Ogle, Livingston and LaSallc Counties, voted to buikl sanatoria. 
At the next regular election the counties of Boone, Bureau, Christian, Clark, 
Clay, DeWitt, Coles, Crawford, DeKalb, Douglas, Fulton, Grundy, Henry, 
Jackson, Jeft'erson, Kane, Lee, Logan McDonough, Macon, Madison, Mar- 
ion, Piatt, Pike, Randolph, Scott, Stephenson, Tazewell, Vermilion, White- 
side, Will. Winnebago, and Woodford took ailvantage of the tuberculosis 
sanitarium law. 

Since the Ori/cnnzaf inn nf flir Stdic DrjKutiiifiif nf Puhlic llcditli. 

"\\'hen the State Civil Administrative Code was passed in IIHT, and the 
State Board of Health was abolished and the State Department of Public 
Health created, in the Department a division of tuberculosis was established 
as a sjiecial unit. The assistant director of the Department, Dr. George 
T. Palmer, was assigned as acting chief of the division, a clerk and steno- 
grapher were employed and the division of tuberculosis began to take an 
active ])art in the state-wide anti-tuberculosis campaign. 

( )n accoimt of shortage of nurses for tul)erculosis and other health 
work, the State Deiiartment of Pu1)lic I lealth, the State Department of 
Welfare, and the Illinois Tuberculosis Assn-iation as it was now called, 
established a school for public health ninses, gi\ing brief l)Ut comiirehensive 
courses several times a year. 

To secure a more definite idea of the extent of the tuberculosis jiroblem 
in Illinois the division of tuberculosis outlined a plan of sur\ey to be em- 
plii\(.(l by nurses and others engaged in this work. Through this plan a 
large numljcr of tuberculosis surveys were made in \arious localities in the 
State. 

Shortly after the United States engaged in the World War, there was 
created a subcommittee of the State Council of Defense, devoted to tubercu- 



WHITE COUNTY, ILLINOIS. 

/V- 2 J 052 - /9/0 Census. 




• L/W//70 Cases of7udern//os/s-/S/S a/7TJ^ y j: . r ■ 
■ Dea^fys- from Tu^erca/os/s /9/47/S c^ses ma/f//?/i/ ^mm <j^/fys /;^ /c 



HEALTH COXDITIONS AFTER 18? T 373 

losis. of which the assistant director of the State Department of I'uhhc 
Heakh was made chairman. 'J'his suhcommittee was coorcHnated with the 
division of tnliercidnsis nf the State l)e]iarlment of I'nhHc IleaUh. and w itli 
the IlHni.is Tnljercnlosis Association. It ceased to fnnctiim after the .\rmis- 
tice was sitjned. 

(.)n account of the importance of exchiding tuberculous individuals from 
military service and the necessity for greater medical knowledge in the care 
of returned tuhercidous soldiers, the State Department of Public Health, in 
conjunction with the Illinois Tuberculosis Association, conducted clinical 
conferences on the diagnosis and treatment of tuberculosis, utilizing the best 
known teachers of this sidjject in the Middle West. Conferences were at- 
tended by physicians from all jjarts of the State. Special tuberculosis clin- 
ics were also given before county medical societies. 

To meet the needs of returned tuberctilous soldiers, who on account 
of inade(|uate facilities for care of the tuberculous in Illinois, were subjected 
to neglect, a working agreement was entered into between the State Depart- 
ment of Public Health, the American Red Cross, and the Illinois Tubercti- 
losis Association, whereby the Department and the Association provided for 
scientific examination and medical direction of returned soldiers. 

At the beginning of li)18, the War Department advised the State De- 
partment of Public Health of the return of about 1,T0() tuberculous soldiers. 
This number was increased to 1,800 at the time of signing the .\rmistice. 

It was fortunate that the establishment of county and municipal tuber- 
culosis sanatoria was continued through the war period, for these sanatoria 
served a useful purpose in hospitalizing the service men who returned af- 
flicted with tuberculosis. 

I'larly in lit I!.), the LaSalle and .McLean county sanitariums were o])ened. 
In addition to Chicago, the cities of Rock Island. Peoria and Pockford were 
maintaining tuberculosis sanatoria at that time. 

The .\dams Countv tul)erculosis sanatorium began o];)eration alter the 
end of the \'ear. .\ small sanatorium w;is in operation in DeKalb Count), 
and iil;ins were being made fur UKire extensive buildings. Tazewell, Mc- 
Donough, Woodford, and Kane tuljerculosis sanatoria were under process 
of construction. 

The tulierculosis death rate in the State in Pi'i:> was Sl.S jier liH),000 
population, and tuberculosis stood liftli fr(ini the top of the list of causes of 
death. 

Ouestionnaires were sent in I'.i'.^'i to all private, county and municipal 
tuberculosis sanatoria in the Slate to obtain up-to-dale data fur a revised 
directory. Stn-v(\s weri- m;ide of iul)crculosis cases on record in the coun- 
ties of the Stale with the object of pmviding befter home c:nv and In protect 



3'i'4 iiicAi.rii coxniTKiNs aftiik IS*? 

others frcim infcctinii. 'Ihr suivcv> slmwrd that iciL;ular and periodic tuber- 
culosis clinics wcic in dpcralion in IM conniics and that 1 o county sanatoria 
with 1,3T5 l)cds \\cic in operation. 

The Mel Idnout^h and Madison county tulierculosis sanatoria were 
ojK'ned in i:i".M). 

Tliree ini]>orlant hills relating to the control of tuljerculosis were enacted 
by the legislature in 1 '.)".' "i. 

One nia<U' the maximum tax for numicipal tuberculosis sanatoria two 
instead of one and mu-ihird mills on the dullar of assessed valuation. 

The >ecoiid was a law regulating the pasteurization of milk and requir- 
ing a permit from the State Department of Public Health. 

The third law api)ropriated -Isi.OOU.OOii for the purpose of imiemnifying 
owners of tuberculous cattle destroyed under the provisions of the law of 
1!)1!), which autliorizcs the slaughter of domestic cattle found to be infected 
with tuberculosis. This had been practiced before but never Ijefore had so 
much been appropriated at one time. 

The latter was the so-called "Tice Mill" which ])rovided for the tul)er- 
culin testing of cattle, the establishment of accredited herds, and for the en- 
rollment of counties under the county-accredited plan, under which it is 
obligatory for the remaining herd owners to test, whenever rnore than 
seventy-live per cent of the cattle in any county have been tested, and proper 
certitication of this fact has been made to the county authorities, in accord- 
ance with the provisions of the law. 

Tuberculosis eradication among dairy cattle had progressed very rapid- 
ly, and by the end of 1926, the situation was approximately as follows: 
Sixty-five counties were under federal and State supervision for the eradi- 
cation of bovine tuberculosis; 21 counties had herds T5 per cent free from 
bovine tuberculosis ; ;uid one county was IIH) per cent free from bovine tuljer- 
culosis. 

Miscellaneous Ccmvnunicable Diseases. 

The comprehensive sanitary surveys made in apitroximately four hun- 
dred cities and villages duritig the years 1882-1885 indicate in a general way 
that very little attention was given by local authorities in these municipali- 
ties at that period to control, su]i])ress or jireyent the so-called minor 
contagious diseases such as measles, whoo|iing cough, chickenpox, etc. 

The statistical data available for that early period are given in the spec- 
ial comments under I'ach of these diseases (ir in the chart accompanying each. 

In fact the data mi these .so-called mincir diseases are very fragmentary 
until about IIMI-.'. In all sections of tlu' ."^taie exci-pt Chicago they were far 
from com])lele until \ery recent years. ( )nly since l!i"iO have the statistical 
data 1)\- moiuhs been made accessible in tabular t(n'in Ijv counties. 



HEALTH COXDITIONS AFTER 187 7 



3r:i 



Table 56. 
Cases of Cerebrospinal Fever Reported in Illinois. 



Year. Jan. Feb. 


Mar. 


Apr. May. 


June. 


July. 


Mxg. Sept. Oct. 


Nov. 


Dec. 


Total. 


1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 


12 1 14 1 2S 1 42 
4S 1 5S 1 69 62 
16 [ 15 14 12 
31 1 33 1 28 12 
20 1 25 1 25 11 
19 ] 22 1 26 27 
15 1 8 1 25 17 
11 1 2 1 9 j 7 
9 ! 9 1 S 3 
7 1 SI 7 1 11 


65 
33 
18 

14 
18 
15 
9 

4 
15 
32 


57 
19 
12 
13 
15 
15 
6 
4 
5 
8 
41 


61 
26 
14 

19 
6 

11 
5 


36 37 

14 16 

11 16 

12 15 
12 16 
11 11 
11 1 3 
11 1 8 


36 
8 
27 
16 
21 
6 
11 
9 
8 


29 
4 
22 
20 
18 
6 
11 
6 

a 


33 
12 
9 
9 
19 
14 
4 
2 
26 
14 


450 

3S9 
186 
210 
219 
178 
131 
81 
SO 


1926 


13 
20 


3 11 


8 ; 12 
...| 


117 












1 




1 



Table 57. 
De.'vths from Cerebrospinal Fever in Illinois. 



Year. 


i Jan. 

1 


Feb. 


Mar. 


Apr. 


May. 


1 June. 


July. 


.\ug. 


Sept. 


Oct. 


Kov. 


Dec. 


Total. 


1918 


i 
51 


47 


67 


S9 


46 


35 


^:^ 


37 


24 


39 


27 


33 


500 


1919 


30 


27 


36 


22 


23 


16 


30 


22 


16 


23 


18 


26 


239 


1920 


29 


29 
15 


23 
9 


22 
4 


17 
3 


19 
6 


21 
7 


21 
6 


18 
4 


18 
7 


18 

7 


13 
5 


248 


1921 


3 


76 


1922 


4 


3 


6 


10 


H 


6 


4 


2 


2 


2 


2 






1923 


8 


5 


9 


HI 


6 


1 * 


2 


7 





4 


4 






1921 


3 


? 


5 


8 


6 


3 


4 


2 


3 


2 


4 


1 1 


43 


1925 


1 3 


5 


9 


2 


9 


3 


1 


4 


5 


4 


4 


1 <' 


56 


1926 




1 


6 


5 


9 


6 


6 


» 


3 


3 


6 


3 


58 







Table 58.* 

Deaths and Death Rates from Meningitis, Cephalitis, Cerebrosimnal 
Fener a.m) Encephalitis in Illinois. 

















Rate per 




















lOO.OOO 






Year 






Xo 


.leatl 


^■ 




lopulation 




Year. 


I8fin 








701 






41.2 




1910 


1870 








1,975 






77.8 




1911 .... 


ISSIl 








872 






28.3 




1912 


1881 








2,863 






90.8 




1813 


1XS2 








2,310 






71.5 




1918 ----- 


1K83 








1.535 






46.4 




1919 --- 


1X,S1 








1.97! 






58.3 




1920 - 


18W 








2.1C6 






60.9 




1921 


1886 








2.276 






64,5 




1922 


190(1 








1.195 






31.0 




1923 - 


1907 








06S 






17.91 




1924 


19(18 








782 






14.28 




1925 -- 


1909 








744 






13.38 










ni\i 


of diseases 


has 


been 


included 


becau 


<e of the I 


tity 


of an 


V ii 


the earlier 


part 


of 


th 


e period 


■overed 





Rate per 

100,000 

population. 



11.9 
10.8 
11.1 



5.99 
5.68 
4.62 



that confused the ide 



3:(! 



m-.Ai.Tir cnN-iMTUiNS aftkr 187' 



llnw prevalent most of these diseases were in Illinois prior to about 
11M; can only be guessed at from circumstantial evidence, 'i'bey were tirst 
nia<k' re|«irtablc to the State Hoard of Health in ^'M'>. .Machinery for col- 
Icclini;' rc|ioris with any satisfactory dcj;;rec of completeness was not estab- 
lished until r.in. Case reports from l!)"il) on sj;ive a fair conception of 
prevalence trends. l'"rom mortality records one may gather some idea of 
epidemic cycles but the ratio of deaths to cases has doubtless declined in 
reference to several diseases so that the actual number of deaths is not al- 
ways a reliable index to prevalence. 

'I'liere follows a brief mention of these various diseases so far as any 
interesting facts are obtainable. 

C'KKi'-.iiiiospix.M. Fkver. 

Long before i'^'i'i cerebrospinal fever had ceased to be an imjiortant 
cause of death in Illinois. By that \ear mortality had dropped to less than 
1 per 100,00(1 while evidence pointed toward total disappearance. Fifty 
years earlier, as shown liv the graph in b^igure 'ia. this disease was one to 
be greatly dreaded and a frequent cause of death. 




Figure 25. 



HEALTH CONDITIOXS AFTER 1ST7 3TT 

Prior t(i ]8<S0, especially in the census returns, many acute diseases of 
thf hrain and meninges, were classed under such indefinite headings as in- 
flammation of the lirain. dropsy of the brain, convulsions, meningitis, both 
nonspecific and tubercular, and many other brain affections such as abscess 
and tumor; also a certain number of cases of anemia and intoxications with 
convulsions or coma were included under meningitis and similar brain af- 
fections. 

Tubercular meningitis was first recognized as an etiologic entity in the 
years just ])rior to the first great epidemic of cerebrospinal meningitis, which 
began in 1S7;.'. During this epidemic cerebrospinal fever began to lie rccdg- 
nized as a distinct disease. 

The next great epidemic occurred in is.si -iss:!. It was this outbreak 
that was largely responsible for the high death rate recorfled from this 
disease in Illinois during the early eighties, although it cannot be assumed 
that all of the deaths recorded under this rubric at that time were true 
cases of this disease. The same confusion anil uncertainty in diagnosis still 
existed due in part onlv to unqualified practitioners of medicine but largely 
to the fact that the finer and later bacteriologic methods of diagnosis had 
not been developed. 

Knowing that cerebrospinal fever. ])revailed extensively over the whole 
United States duriuL; the epicleniic of lSSl-s:i, it ma\- be assumed that a 
large per cent of deaths attriliuted to this cau>e in the early eighties as 
shown on the chart, were reallv due to the true form of this disease. 

'J"he next nation-wide eijidemic occurred in ISU.S-T.mhi. This manifested 
itself in Illinois by a death rate of a little over 3 per IdO.iiiMi population. 
By this time the disease was well established as a clinical and etiulngic entity. 
The rate recorded is one obtained from the census returns and is therefore 
probably not very accurate. Nevertheless, it shriws that Illinois was swept 
by the epidemic at that time. 

Another outbreak was recorded in I HI".' and .an increased incidence wa-^ 
shown beginning about 1'.)".'."), but insignificant in ci)m|iarison to the jireva- 
lence <.f the disease in the first decade of this .Ml year period. 

Diarrheal Dise.ases. 

Nomenclature for diseases of the intestinal tract was so thoroughly 
abused that it is difficult to arri\-e at any satisfactory conclusions concerning 
the prevalence of what are usually referred to as diarrheal disorders. In 
the mortality returns for 1880, for example, there were listed cholera in- 
fantum, cholera morbus, diarrhea, dysentery, enteritis and bowels as the re- 
sponsible agents for 1.(10(1 out of l.'i.on fatalities registered from all causes. 
This corresponded to a rate of about 118 deaths ])er l()l),()(i() population. 



3T8 TIKALTII COXDiriO.NS Al-'ll-K 1S77 

AnothiT chu' 1(1 what may have heen the case is found in the high fatal- 
ity rates aninnt^ chihh-cn. It is common knowledge that intestinal difticul- 
ties constitute cmc df the greatest hazards to child life. It is easy to believe 
therefore, that an excessively high mortality ann mg children is evidence of 
a high prevalence of <liarrheal diseases. There were lO.iHiS deaths among 
children lf>s than one year old and lil,(i()T less than five, reported in ISSO. 
These figures amounted to twenty-four and forty-three percent respectively 
of all registered mortality in that year. 

Using mortality figures found under the same nomenclature referred to 
above it is found that the incomplete returns for the years ISSl to 1886 in- 
clusive give an average mortality rate of iri.'i.K per lOO.OOo pojjulation. Stat- 
tistics for the five years ended with r.f.'."i give an average mortality rate of 

Table 39. 
De.vtiis and Death R.\tes from Diarrheal Disea.ses in Illinois. 



Year. 

1860 


X.). ileatlis. 
2,320 


Rate per 

100,000 

population. 

128. 8 

1SS.3 

148. 

ISl.o 

107.7 

109.7 

110. 

106.5 

119.9 


Year. 

1905 

1906 

1907 

1908 

1909 


Xo. ileatlis. 

4,552 
4,612 

4,S57 
5,224 
5,6S6 


Rate per 

100.000 

population. 

87. 

86.8 

90. 


1880 




95.4 
102.3 


1881 


5,723 
3,478 
3,624 


111.8 


1882 


1911 


4,973 


86.5 


1883 


1912 -- 

1913 

1918 

1919 

1920 

1921 

1922 

1923 . 

1924 - 

1925 .- 


4.970 
5,520 

4,2S4 
2,993 
3,532 
3,250 
2,241 
2,369 
1,938 
2,208 


85.2 


1884 




93.2 


1885 

1886 - 


3,677 


67.4 


1S90 




46.4 
54. 


1900 




49.1 
33.4 


1902 

1903 

1904 


3,967 

4,296 

4,320 


79.5 
84.7 
93.9 


34.8 
2S.1 
31.1 



3o.3 from diarrhea and enteritis. This classification includes practicall)- all 
mortality of the period that might be called "diarrheal" in character. 

Still another evidence that diarrheal diseases were highly prevalent dur- 
ing the last (|uarter of the nineteenlh century is the fact that summer was 
the most unhealthful season of the _\ear then. Year after year the great- 
est number of deaths monthly occurred in .\ugust and September. Diseases 
of the inteslin;il tr;ict ;ire ahva\s prune to reach highest prevalence in the 
warm weather. 

Ini])r(ivenu-nt in ihe sanitary (luality of milk supplies and especiallv the 
introdiutiim and extension of pasteurizatinn. the development of refriger- 
ation, the ])virilic;uiiin of water supplies, the advancement in personal hy- 
gienic habits, the screening against flies and the general improvement in 



HEALTH COXDITIOXS AFTER 187' 



379 



economic conditions have all been important factors in bringing about more 
favorable mortality rates from diarrheal disorders. The substitution of the 




Fig. 26. Deaths due to diarrhea, dysentery, cholera infantum, cholero mor- 
bus, enteritis, teething and bowel complaint are included in the statistics 
illustrated in this figure. 

automobile for the horse, a change that roblied the hnuse fly of his most pro- 
lific breeding ])lace, doubtless was an important factur in preventing the 
spread of diarrhea. 

IxFANTiLE Paralysis. 

Infantile paral)'sis first appeared on the vital statistic records of Illinois 
in 1912. In that \ear -"iS deaths were charged against it. This does not 
imply that the infection never existed or that it never proved fatal in the 
State prior to that time. Public attention however had never been specifical- 
ly called to the fact that it was an infectious disease and doubtless its jires- 
ence in the early acute .stage was often overlooked by physicians. It is alto- 
gether likely that cases developed from time to time without ever assuming 
alarming epidemic ijvoportions for the crippling ;ifter effects of this disease 
were frequently seen. 

After 19i;i jjoliomyelitis went down into recorded obliviim with the con- 
fusion that prevailed in Illinois vital statistics until 191(i. In that \ear over 



■i'^iO IIICAI.TH CONDITIONS AFTMK IST" 

ri, 000 cases wtTc rL-])ortc(l in Xrw ^'ork and about l.niX) in Illinois. A gen- 
eral panic prevailed. In \'J\: a reL-urrenee of the epidemic dceurred result- 
in.c^ in S3() deaths. Since that time mortalit\- fidni infantile parahsis has 
\-aried from •.'■") in ll)"2(l, ihe Idwest to 1-Ml in l!)-*l. 

1 he crippling etiects nf the disease created a grave problem in curative 
medicine that recpn'red the services of specially trained physicians. So great 
was public demand for this type of work that the State Board of Health, 
later the State Department of Public Health, established cHnics at various 
piiints in the State in 1916 for the benefit of victims of poliomyelitis. New 
and old patients continued to demand this type of service so that it remained 
a fimction of the State Dei)artnient of Public Health until l'.i-.'."> when the 

Table (;ii. 
De.\tiis and Death Rates from ruLioMVELiTis in Illinois. 





Rate per 








Rate per 




100,000 








100,000 


Su. .leatlis. 


population. 


Year. 


Xo. 


deaths. 


population. 


58 


.99 


1922 




52 


0.8 


236 


3.8 


1923 




48 


0.7 


113 


1..S 


1924 




26 


0.4 


73 


1.2 


1925 




41 


.57 


57 


.9 


1926 




23 


.34 


150 


2.3 











Year. 

1912 
1917 
191S 
1919 
1920 
1921 



curative clinical work was taken over liv the Illinois Society for Crippled 
Children. 

In the meantime poliomyelitis continued to occur from year to year in 
cyclic waves that characterize almost every communicable infection. Sub- 
sequent to 191(5 and 1917 the outbreaks were less extensive in magnitude and 
the disease appeared to lie generallv mibler in character, the percentage of 
f.atal cases being lower. 

Poliomyelitis is another of the warm weather infections. Case reports 
for September are usually greater in numlier than for any other month. It 
rises quickly to its maximum incidence once it begins to spread. Indeed the 
prt'v.ilence in .Sejitember is fre<piently double that in .\ugust. 

Malart.\. 

Few diseases demonstrate more fully than malaria the power man can 
acquire over comniunicable infections. I'rdni ,i \eritable plague that few 
inhabitants of the Slate escaped and of which many died in the early days, 
malaria has come to be one of the most insignificant causes of mortality in 
lllniciis. Registered deaths per joo.nno population fell from (ir,.9 in 1S(i(l, 
when mortality reports were very iiicunqilete, to less than O.ii in 19'Jii. 



HEALTH COXniTIOXS AFTER 1S7T 



381 



Even liefore Ross discovered in 1S!I7 tliat malaria is sjiread fmni one 
person to another only through the anopheles nmsiiuitd the prevalence of 
and mortality from malaria was on the wane in Illinois. \'ery early I'cople 
recognized that drainage was important as a preventive of malaria hut drain- 
age was promoted more for agricultural than for health reasons. Thus the 
decline of malaria was incidental tn the Imilding up nf cities and the develop- 
ment of agricultural pursuits rather than the result of a conscious attack on 
the disease. 









66 

35 




oii-^ 


1 


1 !i 




1 ' ! ' 


Hi 11 1 ... _ lliiil 


; 1 1 1 1 






4t 


1 










riALAWA 

n iLLimi 


"■' 


I 




j-^=j 










' 1 1 


! ! ! j i ' ■ 1 1 I I ■ 






1 












1 ! 


' 1 ' ' '1 


^ 'Vi 




1 










J~ 


1 1 ii 1 F 1 > ' . . - ' ■ ' 












T T 


1 


1 1 ■ 


lAAD-iqPA 


. - "^l 'X 














30 

E 

p 

i ^^ 
i" 

in 

r 
























f 


, ,1 ,1 


1 1 ■ ■ 




1 1 












il"X 


1 1 ill ' II 


i 


1 


1 


_i_ ' T 












U- t 


1 1 ' 


1 1 ! 


















1 




! 




















1 IP 




1 


















1 I M 1 




















i 


i 1 i : i i ill! 


















1 j 


1 1 !; 11 


RTir+ "^ 




















;i 1 |l 1 1 1 1 i 


St+"- 






















li' 










































I j |!|| 


^rti'i 










































1 M ' 


j 1 




















j 1 1 1 


; 




















1 1 ' 1 ' F h 1 


.:iL_:_: 




















ii iii'i 


1 1 








































jl 


1 j \\j\\ 


1 ' ' 
















1 


■■ 




1 , 1 1 ; 1 1 




1 




1 








^H~ 


1 ' 1 1 1 


' ' ' ' 1 


+u 














^H 


1 ' i ' 1 


'''ill 


T+ ill 












^H 


til ' 1 ; 1 


' ' ' ' 1 ' ' 1 i 


I 


,< 










^H~ 


til ;' 1 


■ ■ ■ ' ' ' I ■ ' 


I T 


'q 










^H 




' ■ ■ ' 1 ■ 




|0 5 


T T 






^H 




i_i ' ' r ■ ' h ' 




1 


T T 






SH-' 


J 


■ 1 ' ' M ' ' 1 1 




1 


i~ \ 






:^^B; 


■ 


B ' ' ' ' 1 1 1 ' M 1 


1 1 




— ttt 








. . ■ 




Tiafl^ 


2i:±::::"" 




I ;±i 






_^Hii 


1 ■ 


IIBi^»*fTTi-rT 




i i i i i i i i i i 1 8 i i 





Figure 



.\ftcr it Ijecame known that nio,-,(|uit(ies are the carriers of malaria, pre- 
veiitixe work was directed against that insect. Undertakings of this kind 
have been confined largely to the extreme southern counties of the State. 
There alone does malaria still exist to any significant extent. Elsewhere 
drainage destroyed the breeding places of the malaria-bearing mos(|uito and 
with his disappearance the disease vanished. 

In lillG the chief sanitary engineer of the .Stale Department of Public 
Health called attention in an article in llcaltit Sews to the heavv economic 
losses caused bv malaria in -.duihern llliudis. No systematic malaria-preven- 



382 



IlKALTll COXniTlOXS AFTI'.K 1S7T 



'I'able C>\. 
Cases of Malaria Reported in Illinois. 



Year. .I.in. 


Feb. 


Mar. 


Apr. 


May. 


June. 


.Iw!y. 1 Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total. 


1917 


60 


81 


30 


49 


53 


121 


162 
2 


102 
1 


121 
3 


11 



89 


1,510 


2.389 






1919 


18 


20 


55 


97 


2 


1 


417 


294 


265 


170 


97 


63 


1,499 


1920 


59 


112 


84 


114 


142 


194 


171 


279 


117 


132 


87 


123 


1,614 


1921 


80 


14 


82 


44 


68 


138 


257 


148 


129 


66 


63 


37 


1,156 


1922 


50 


60 


22 


30 


60 


54 


43 


78 


61 


11 


22 


9 


500 


1923 


3 


3 


26 


6 


4 


5 


11 


14 


10 


2 


4 


3 


91 


1924 


1 


2 




1 


I 


4 


12 


11 


13 


3 


4 


6 


58 


1925 


5 


18 




2 


12 


8 


20 


6 


6 


2 


1 


34 


114 


1926 


7 


5 


4 




8 


6 


8 


7 


15 


10 


5 


11 


86 


1927 


5 


1 


1 


9 


16 


4 


U 



















1 i 









Table V>->. 
Deaths from Malari.\ in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


Ma). 


June. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total 


1918 


3 


4 


3 


6 


8 


7 


12 


14 


11 


8 


2 


3 


81 


1919 


4 


2 


8 


4 


2 


6 


15 


10 


9 


17 


6 


6 


89 


1920 


6 


2 


3 


3 


4 


8 


14 




8 


11 


8 


2 


76 


1921 


4 


5 


3 


3 


1 


5 


12 


14 


10 


15 


3 


3 


78 


1922 


3 


1 


2 


3 


1 


5 


S 


7 


9 


9 


8 


4 


60 


1923 


7 


4 


3 


4 


5 


3 


9 


4 


9 


5 


2 


4 


59 


1924 


4 


1 


4 


5 


6 


6 


3 


16 


11. 


6 


2 


3 


67 


1925 


2 


2 


1 


2 


3 


10 


9 


9 


10 


4 


4 


6 


62 


1926 


1 


1 


2 


2 


4 


1 


8 


7 


6 


' 


3 





42 



1S60 

1870 

1880 
1881 
1882 
1883 
1884 
1885 
1886 

1890 

1900 

1902 
1903 
1904 
1905 



Table G3. 
Deaths and De.\tii Rates from Malaria in Illinois. 



1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 

1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 



deaths. 


Rate per 

100,000 

population. 


1.146 


66.9 


9.030 


35.5 


1,114 


36.1 



23.8 
11.3 
11.3 



19.1 
10.3 



Rate per 

100.000 

populalion. 



HEALTH CON'DITIOXS AFTER ISTT 383 

tion \v(irk by mosquito eradication was undertaken, however, until li)22, but 
in thf meantime the matter was given consideration by the Southern Illinois 
Medical Society, and as the result of a resolution of that society, studies of 
mosquito-breeding places and the types of mosquitoes prevalent in some 
southern Illinois communities were made b_\' entomologists of the State Nat- 
ural History Survey. 

Proposed and recommended by the State Department of Public Health, 
sponsored by the Lion's Club of Carbondale and receiving financial assistance 
from that club, the International Health Board and the Illinois Central Rail- 
road, and directed by the sanitary engineering division of the State Depart- 
ment of Public Health, Carbondale carried cm systematic mosquito-control 
work for the season of 1922, and for the first time in history of the city en- 
joyed practically complete relief from the pestiferous insects. The results 
from the standpoint of reduction in malaria cases were equallv gratifying. 
\'ital statistics and house-to-house canvasses had shown that prior to 1!)22 
the city suffered an average of over 250 cases of malaria a year (267 during 
11121 ). Following the close of the mosquito-control work for 11122 it was 
found by a house-to-house canvass that onlv 1 i) cases of malaria had occurred 
during that year in the entire citv. 

This was the beginning of mosquito-malaria control work in snuthern 
Illinois which has continued at Carbondale and extended into half a dozen 
other counties with increasingly satisfactory results. 

During the first fifty years of the existence of State public health service 
in Illinois medical research workers discovered the causative organism of 
malaria, found out how the disease is spread and prescribed very positive 
methods for its prevention. Thus so far as practical possibilities are con- 
cerned it may be said that malaria was cunqjletely conquered during this 
[leriod. 

^Ieasles;. 

Measles was very generally ignored in reports concerning epidemic con- 
ditions in Illinois during the last quarter of the nineteenth century. It was 
included in a list of diseases for which epidemic information was requested 
in the sanitary surveys of 1882-188.5 but practically none of the local re- 
ports mentioned it. Account was given of outbreaks of typhoid fever, chol- 
era, diphtheria and scarlet fever but never a word about measles. Evidentlv 
it was regarded either as too common or too insignificant to mention. To lie 
sure it appeared in the mortality tables where these were supplied but withnut 
comment. 

In the general mortality statistics available for Illinois, measles is credit- 
ed with 10!) deaths in 1860 and T02 in 1870. These figures give rates of 6.3 
and 2;.() per 1(10.000 population for the two years respeclivelv. For the six 



384 



IIKALTII COXDITIOXS AFTICR 1877 



years of ISSd-lSS,") the avcrasix- annual nidrtalily rate, as n-pnrtc-d in the sta- 
tistics which were regarded at the lime as alxjul III per cent ineoniplele. was 
i;3.5 per TOO.OOO people. 

Measles is distinctly seasonal in character. More cases occur during the 
three months of March. Ai^ril and May than during all the rest of the year. 
September is ordinarily the month of lightest prevalence in Illinois. The 
number of deaths per 100 eases, however, is greatest when the prevalence is 
least. 




Figure 2S. 

Measles also travels in epidemic c\cles. Thns every three or four years 
there are general outbreaks of major proportions. This e.x]ierience is gen- 
eral. It is attributed to the probable fact that practically all susceptible 
persons get the disease during the big epidemic years and another wide- 
spread outbreak must necessarily await a new croj) of susce])tible children. 

.\lthinigli verv little ad\aiu-emenl in knowledge concerning measles 
took place imlil the second decade of the twentieth century, progress in 
medical science generallv was very rapid toward the close ot the nineteenth 
century and this imiirovemeiit probably explains wli\- the a\erage yearly 
death rate from measles was only .'i.-.' for the six year period ended with 



HEALTH CONDITIONS AFTER 1877 



385 



Table 64. 







Cases 


OF M 


EASLES Reported in 


Illinois. 








Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dee. 


Total. 


1917 


4,959 


6,483 


11,106 


10,534 


9,415 


4,255 


1,331 


312 


189 


122 


389 


417 


49,512 


1918 


1,150 


939 


1,237 


1,278 


1,501 


641 


273 


121 


56 


141 


67 


IVl 


7,575 


1919 


711 


1,073 


2,453 


5,754 


5,204 


3,142 


1,110 


255 


118 


342 


706 


1,727 


22,594 


1920 


4,366 


4,610 


4,982 


5,343 


5,542 


4,434 


1,573 


542 


233 


510 


1,280 


1,985 


35,400 


1921 


3,932 


4,527 


5,911 


5,894 


4,854 


2,435 


531 


129 


85 


164 


271 


560 


29,293 


1922 


918 


1,340 


2,167 


2,658 


3,285 


2,744 


1,182 


373 


141 


205 


606 


921 


16,540 


1923 


2,154 


4,011 


6,604 


10,345 


12,055 


6.320 


1,420 


306 


125 


363 


1,053 


1,953 


46,709 


1924 


2,475 


2,296 


2,659 


3,606 


3,825 


2,693 


926 


205 


120 


181 


343 


815 


20,144 


1925 


1,575 


2,664 


4,615 


5,985 


6,237 


4,010 


982 


169 


151 


273 


682 


868 


28,211 


1926 


1,825 


3,337 


4,514 


4,299 


5,095 


4,813 


1,980 


499 


236 


615 


1,368 


2,930 


31,511 


1927 


6,041 


8,469 


11,126 


7.622 


4,562 


2,084 


562 




















1 



Table 65. 
Deaths from Measles in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total. 


1918 


22 
12 


22 

29 


42 
30 


60 
49 


74 
70 


30 

37 


14 
27 


6 

14 


5 
5 


17 
5 


12 
6 


13 
22 


317 


1919 


306 


1920 


47 


112 


72 


59 


59 


37 


22 


9 


4 


15 


25 


35 


496 


1921 


33 


47 


XO 


49 


50 


20 


12 


3 


3 


2 


4 


6 


309 


1922 


10 


13 


27 


30 


30 


26 


21 


9 


9 


6 


13 


12 


206 


1923 


24 


29 


79 


116 


165 


87 


31 


20 


3 


9 


2 


11 


576 


1924 


19 


25 


39 


54 


32 


26 


9 


7 


1 


1 


4 


11 


228 


1925 


11 


19 


36 


28 


52 


25 


13 


7 


4 


7 


3 


12 


217 


1926 


22 


28 


50 


78 


68 


33 


16 


11 


5 


2 


16 


17 


346 







Table 66. 
Deaths and Death Rates from Measles in Illinois. 







Rate per 






Rate per 






100,000 






100,000 


Year. 


No. deaths. 


poiiulatiuTi. 


Year. 


No. deaths. 


population. 


1860 


109 


6.3 


1907 


413 


7.6 








1908 


336 


6.1 


1870 


702 


27.6 


1909 - 

1910 


385 
549 


6.9 

9.7 


1880 - 


603 


19.5 


1911 


325 


5.6 


1881 


625 


19.4 


1912 


191 


3.2 


1882 . 


451 


13.9 


1913 . 


63S 


10.7 


1883 


148 


4.4 


1914 


217 


3.6 


18S4 


629 


18.6 


1915 ...- 


286 


4 6 




191 


5.5 






4.6 








1917 - 


766 


12.3 


1890 . 


314 


8.2 


1918 . . 

1919 -. 


317 
306 


5.6 
4.8 


























1902 


180 


3.6 


1922 - 


206 


3.1 


1903 


593 


11.7 


1923 - 


576 


S.5 


1904 


393 


7.6 


1924 


228 


3.3 


1905 


340 


6.5 


1925 . 


217 


3.0 


1906 


230 


4.3 


1926 


346 


4.8 



386 }ii-:alth conditions aftek 1877 

!!»()■;. l*'oi- the six \(.ars ciulcd with 192G a still more favorahlc rate, an 
average of 1.1, prevailed. Better medical care of patients ciiu|)led with 
better public health service are the only two factors to which the improve- 
ment mav reasonably be attributed. 

While mitliing has transpired that jjrovides mankind with means tor 
preventing and controlling measles on a large scale, research work charged 
with hoiieful premise has been done. In 1914 Hermann suggested the ac- 
tive immunization of infants by inoculating the nasal mucosa with the 
fresh swabbings of the nasal mucus of patients just coming down with 
measles. The purpose was to introduce the virus at a time when the infant 
was still carrying a certain degree of inherited immunity, .\lthough he 
apparently had good success with the method on seventy-five children so 
treated, it has never been considered practical for general use. 

In 1918 Nicolle and Conseil first reported favorable results with the 
blood serum of convalescent measles patients. Such serum given subcu- 
taneously or intramuscularly in amounts of 5 cc to 10 cc as soon as possible 
after exposure is quite effective in preventing the disease. Passive 
immunity is established for three to six weeks. In some cities ettorts have 
been made to collect a supply of convalescent serum taken usually five or 
more days after defervescence of the fever. Since at best such supplies are 
limited, some attempts have been made to use blood serum or whole blood 
of adults who have had the disease some years before. Much larger 
amotmts must of course be used and the results have not been so uniform. 

In 1921 Zingher recommended the production of active immunity by 
delaying administration of convalescent serum till the fifth to the eighth 
day from time of exposure. Symptoms of the disease arc nut jire vented 
but the attack is very mild and the immunity established is permanent. 
W hen the serum is delayed till symptoms appear, no beneficial results are 
obtained even with large amounts. 

In 1926 Tunnicliff and Hoyne produced a serum in goats by repeated 
inoculation of Tunniclifif's green producing diplococcus. The goat serum 
is ap])arently as efficacious as human convalescent serum in preventing 
measles and has the added advantage of unlimited supply. Degkwitz in 
Germanv has used sheep instead of goats, injecting them with the Berkfeld 
filtrations of nasal secretions and simtum of measles patients. 

The ])re\ention of measles by immune serum or the production of per- 
manent immunity b}- a mild attack have been demonstrated as important 
factors in measles control. For the treatment of the established disease 
no curati\e agent has been discovered. 



HEALTH COXniTIOXS AFTER 18TT 387 



Pneumonia. 



Pneumonia was prohahlv nioix- prevalent fifty years ago than is indi- 
cated by the 1880 rate of ll'ir! per 100,000 inhabitants. There was consid- 
erable confusion at that time in classification of deaths from the disease be- 
cause of such nomenclature as typhoid-pneumonia and typhoid-malaria. 

While the 1890 rate of 1"2S.;) seems to indicate some progress, we 
note that ten years later (11)00) the rate of 113.9 was higher than in either 
1880 or 1890. 

.-\gain the pneumonia rate in I'.Mo was higher than ever before recorded 
as far as available recrrds bear evidence. In fact, tlie 1910 rate is the high- 
est ever recorded in Illinois with the exception of that for 191S, the great 
influenza }'ear. 

It is of passing interest to note that never in the historv of Illinois 
was the recorded pneumonia death rate under lOK [ler UIO.OIIO of i)o]Hilatinn 
prior to 1921. Since 19'^0 the a\erage annual death rate from pneumonia 
has been iSi.5. and only once in the si.x years ended with l't2(i did the rate 
reach imi. The excejrtion was 192:5 when the rate was 1(18.8. Whether we 
can say that we have finally reached the point when we are making ])erma- 
nent ]irogress against this major agent of death, the future must determine. 
The rather elongated period of waning mortalitv at least lends encourage- 
nunt to hope. New [jrocedures employed against pneumonia only since 1913 
and principally since l!''2u include t\ping of the causative organism, the use 
of vaccines and sera and quarantine. 

Tjfpiiiff. 

Var many years the ]irobIem nf pneumnnia wa^ ci:implicated 1)\- the 
fact that organisms indistinguishable frcmi virulent pneumococci were found 
in the months of normal persons. In 1!M:! wurkers at the Rockefeller In- 
stitute for Medical Research in New York found that all pneumococci could 
be divided into four groups, types I. 11. Ill and I\". This wa.s of tremendous 
assistance not onl\- in stimulating the use of six'cific antiserums in established 
cases of ])neumiinia. but of soKing prubknis (jf epidemidlogv and control 
( f the disease. 

The determination of ]ineumococcus lyjies was \ery [lojiular during the 
])eri(i(l r.ill to 1M2(I, but fell off so that it was almost unused in ci\il life 
after that. The reason for this was the fact that the physician could do 
only a very little more for the patient if the t>])e was known and the pro- 
cess was considered a useless e.xjjense. In 1 '.)■.'.") the State Department of 
Public Health jjronuilgated rules and regulaticjns for the control of pneu- 
niduia \\hereb\- all cases should be "typed" where facilities for such a ]iro- 
cedure were available, and release from (|uaranline should be allowed onlv 



388 



ili'.Al.ril CO.NDITIDNS AFTKK IS" I 



Tabic Cr. 
Casks ov Pneumonia Reported in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


AP... 


May. 
612 


June. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 1 Total. 

1 


1918 


602 


560 


1,242 


1,409 


163 


142 


68 


225 


10,375 


2,274 


2,596 1 20,298 


1919 


1,160 


820 


890 


600 


562 


355 


308 


185 


233 


451 


601 


1,275 1 7,440 


1920 


7,012 


4,049 


1,655 


1,066 


936 


485 


282 


215 


266 


335 


604 


980 1 17,885 


1921 


1,568 


1,222 


1,345 


992 


738 


429 


319 


305 


334 


614 


541 


824 1 9,231 


1922 


1,250 


2,629 


2,942 


1,621 


1,113 


548 


433 


820 


448 


736 


989 


1,659 1 15,189 


1923 


2,687 


3,508 


3,205 


2,439 


1,497 


718 


388 


330 


471 


814 


1,012 


1,239 1 18,308 


1924 


1,713 


1,798 


2,048 


1,643 


1,217 


738 


815 


822 


559 


677 


747 


1,440 1 14,217 


192o 


1,715 


1,681 


2,100 


1,718 


1,228 


767 


451 


380 


413 


687 


1,031 


3,044 1 15,215 


1926 


1,819 


2,028 


4,208 


1,961 


1,470 


1,223 


897 


531 


477 


684 


987 


1,344 1 17,629 




1,787 


1,515 


1,802 


1,609 


1,240 


959 


418 
















i 




1 



Table 68. 
Deaths from Pneumonia in Illinois. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


July. 


Aug. 


Sept. 


Oct. 


Kov. 


Dee. 


Total. 


1918 


984 


902 


1,181 


1,348 


683 


232 


185 


171 


453 


5,197 


1,571 


1,548 


14,455 


1919 


1,235 


1,027 


1,192 


697 


453 


268 


199 


158 


190 


278 


461 


Vb/ 


6,915 


1920 


2,218 


2,169 


893 


678 


583. 


267 


179 


171 


177 


273 


479 


643 


8,730 


1921 


857 


743 


691 


500 


389 


196 


178 


171 


195 


319 


432 


545 


5,216 


1922 


758 


782 


1,053 


712 


482 


242 


179 


171 


195 


357 


471 


740 


6,142 


1923 


1,105 


1,301 


1,02B 


798 


589 


278 


212 


186 


230 


315 


469 


558 




1924 


764 


748 


812 


699 


459 


322 


182 


150 


231 


323 


385 


655 


5,730 


1925 


792 


763 


906 


630 


488 


290 


198 


188 


196 


326 


560 


573 


5,900 


1926 


780 


742 


1,473 


824 


540 


295 


194 


161 


206 


295 


460 


657 


6,627 



Table 69. 
Deaths and Death Rates from Pneumonia in Illinois. 







Rate per 






Rate per 






100,000 






100,000 


Y'ear. 


No. deaths. 


population. 


Year. 


No. deaths. 


poitulation. 


1860 .- . 


1,357 


79.2 


1905 


5,877 


112.3 




2,8S2 


113.4 


1906 


6,136 


115.5 




1907 


7,386 


136.9 




4,378 


142.2 




6,008 


109.7 


1880 


1909 


7,327 


131.8 




3,723 


118. 
92.7 


1910 

1911 . 


8,938 

S,06S 


158.5 


1882 


2,994 


140.4 


1883 


2.51S 


76.2 


1912 . 


8.141 


139.5 


1884 ..- 


2.671 


79. 


1913 - 


S.237 


139.1 


1885 


2.764 
3,438 


80. 
97.4 


1918 . 

1919 . 


14.445 
6.915 






247. 






107.3 


1890 


1,912 


12S.3 


1920 . 


S,730 


133.7 








1921 . 


5,216 


78.8 


1900 


6,492 


143.9 


1922 


6,142 


91.6 








1923 


7.067 


104.1 


1902 


6,888 


138.1 


1924 


5,730 


83.3 


1903 


6,830 


134.7 


1925 


5,900 




1904 


6,887 


133.7 


1926 


6,627 


92.5 



HEALTH COXDITIOXS AFTER 187T 



389 



upon the absence of imeumococci of that type from the throat of the patient. 
Standard laboratory methods were ch-awn up for the use of private laliora- 
tiiries, 1)ut Httle demand has come from the i)hysicians for aid in this con- 
nection. 

Vaccines. 

The jirevention of pneumonia by prophylactic \accinatinn with killed 
cultures of the organisms was placed upon a practical Ijasis with the dis- 
covery of the various types of pneumococci. During the World War and 




Pig. 29. For the years prior to 1900 the death figures used in this illustra- 
tion included pneumonia, influenza, pleurisy and broncliitis. 

immediately folldwing the value ( f the process was definitelv established. 
It is recommended for those people who are especially susceptible to pneu- 
monia because of age, undue exposure or other causes. Since immunity will 
last only about eight months, the time nf choice for administration is at 
the beginning of the pneumonia season eacli year. Under certain cimdi- 
linns. however, the State Department of Public Health has provided in 
il> rules and regulations on pneumonia, for the compulsory immunization of 
individuals. 



390 iJiiAi.iii coxuiTioNS Ai-Ti:u 18T7 

Seriiins. 

Aiili>cniiii 111 'Jy|ic I inicumococinis has xielded very encouraging re- 
sults, 'lliis tyiir causes more than a third of all cases of pneumonia with 
a mortality of ".'.J to 2!) per cent withdut serum. The administration of 
specilic antiserum has reduced the mortality to less than 5 per cent. Un- 
fortunately many cases of pneumonia go untyped, hence do not get the 
benefit of serum. I'mhaliK- •,;,0(M) lives which are now lost annually in 
Illinois could be sa\ed 1)\ this agent alone. 

.Antiserums for Types 11 and 111 lia\e ii<il been of service in treating 
pneiiinonia in man. 

Isnldlio)!. 

Tin- transfer of the emphasis in pneumonia from the clinical aspect 
to the public health field has had a marked effect upon the problem of the 
control. Isolation and quarantine of the patient has been a factor of no 
little importance in preventing not only secondary cases among those in 
direct contact with the patient, but also pneumococcus "carriers" who in 
turn go out and infect others. The rules and regulations of the Illinois Ue 
partment of Public Health (1925) called fur isolation for a period of 14 
days after the patient's temperature returned to normal, unless negative 
cultures were obtained before this. 

Whooping Cough. 

Fifty years ago whooping cough was a disease which was apparently 
widely prevalent but one that received very little atteiuioii from the State 
Board of Health or the local health officers. 

With the im])erfectly classified and incompletely recorded statistics, we 
find an average death rate of Id. 3 per IdO.ddO ])opulation for the years 1S80- 
188G inclnsixe. 

The tendency to waves of whooping cough epidemics even then is indi- 
cated by a total of 9.") 1 deaths recorded for years 18S0-1881 while but .")U 
were registered fnr ISSI and 1883. Then followed ISSG with another 
marked increase when oS."> fatalites were recurded. 

.\ luore peculiar phenomenon than the epidemic waves of this disease is 
its uiiii|ue seasonal character. Instead of reaching one ])revalence peak dur- 
ing the year it climbs to a secondary high point in February, then recedes 
and rises again to the maximum high level of the year about July first. 
Whether the incidence is great or small the case re])orts follow this un- 
usual seasonal course Iroiu \ear to Aear. 

After twenty-live years of State health supervision, we find no improve- 
ment in the luiniber of deaths from whooping cough. The average annual 



HEALTH CONDITIONS AFTER 187(' 

Table TO. 
Cases of Whooping Cough Reported in Illinois. 



391 



Yc-ar. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


1 
Jnly. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 1 Total. 
















618 
1,650 


802 
1,214 


723. 
929 


554 
957 


818 
1,059 


1,206 4,721 


1920 


1,143 




1,222 


2,061 


1,204 


1,460 


1,464 


1,290 1 15,653 


1921 


1,530 


1,327 


1,482 


1,440 


1,466 


1,821 


1,928 


899 


606 


341 


378 


343 1 13,561 


1922 


412 


442 


551 


610 


657 


1,153 


1,H5 t 


1,069 


747 


563 


621 


786 1 8,756 


1923 


1,103 


973 


1,214 


1,095 


947 


892 


953 1 


694 


490 


488 


494 


501 1 9,844 


1924 


579 


620 


680 


550 


528 


524 


847 


782 


662 


641 


875 


950 8,238 


1925 


1,191 


1,04S 


1,121 


1,352 


1,184 


1,172 


1,149 


767 


547 


478 


453 


. 612 11,074 


1926 


739 


804 


939 


870 


827 


801 


894 


717 


714 


1 773 


958 


838 9,874 




779 


S96 


1,015 


850 


906 


1,089 


1,224 


















1 




1 



Table 71. 
De.\ths from Whooping Cough in Illinois by ^Months. 



Year. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total. 




48 
26 
44 
45 
15 
45 
32 
26 
30 


65 
11 
83 
57 
20 
76 
43 
28 
36 


76 
25 
50 
43 
22 
68 
48 
24 
52 


83 
15 
43 
57 
22 
42 
48 
40 
58 


68 
21 
66 
68 
23 
44 
24 
33 
27 


58 
23 
29 
50 
13 
40 
19 
27 
19 


|53 
1 44 
47 
58 
18 
1 45 
31 
37 
23 


44 
35 
47 
39 
29 
45 
26 
36 
29 


41 
23 
22 
27 
15 
34 
25 
20 
21 


71 
21 
35 
18 
24 
33 
15 
22 
14 


58 
11 
41 
22 
16 
19 
19 
15 
35 


31 
15 
56 
11 
22 
30 
23 
7 
23 


696 


1919 


270 




553 




495 




239 




1 .-21 




353 




315 




367 







Table ;2. 
Deaths and Death Rates from Whooping Cough in Illinois. 



1S60 
1.S70 



Rate per 






Rat? per 


100,000 






100,000 


population. 


Year. 


No. deaths. 


l»->pulation 


22.3 


1905 


692 


13.2 




1906 


496 


9.3 


25.2 


1907 


530 


9.8 




1908 


491 


8.9 






448 


8. 


14.7 


1910 


393 


6.9 






281 


4.8 


7.2 


1912 


402 


6.8 


8 2 




388 


6.5 


7.5 








10.8 


WIS 


.. . 696 


11. 




1919 


270 


4.2 


9.3 


192(1 


553 


8.5 




1921 . . 


495 


7.5 


10.3 


1922 


239 


3.6 




1923 .. . 


521 


7.7 


10.9 


1924 . 


353 




14.2 


1925 


315 


4.4 


6.7 


1926 


367 


5. 



392 



IIKAI.TH CONDITIONS AKTKR IHTT 



rate for 19()"*-II)07 was lo.T. The rate twenty-five years earlier was about 
the same. 

Here ai^ain lluciuatidn in nidrtalitv is shown with ','-H) deaths in 1903 
and l)iit 34S in I lid I. At lliis time pnlilic health authorities were busy with 
attempts at eontnilliiii;' diphtiieria. snialliiox. typhoid and even in a large 
city like C hicago did little or nothing tnwards isolation of whooping eough 
patients. 

While it is generalK- considered that results are not yet satisfactory in 
our efforts at control of whooping cough, progress is apparently lieing 



^ti^^WMOopinG ^ cougH 
'^mv^ in iLLinois ' 




Fui. 30. ( The 1S60 Hue should indicate a rate of 22.3. ) 



made. ( ertainly the death rate has declined. Control measures have 
included isolation of cases, control of contacts, exclusion of cases from 
school and some use of prophylactic serum. 

The average annual death rate for years 1921-192G was 5.5. It was 
10.3 fifty years earlier and 10.6 about the turn of the century. Marked 
fluctuations in the annual mortality from whooping cough are still charac- 
teristic. There were twice as many deaths in 1921 as in 1922, the 1921 
figures being 195. against 238 for 1922. 



HEALTH CONDITIONS AFTEK IS^T 3il."i 

At this writing we are still relying on early quarantine and isolation 
as chief means of control. How much, if any, credit should be given to 
vaccine treatment for the improved death rate or as a prophylactic measure 
is uncertain. The results of the use of vaccine are conflicting. Workers 
are agreed that the product should be freshly prepared, — preferably not 
more than two or three weeks old. As a prophylactic measure, vaccina- 
tion has shown considerable promise in the hands of several investigators. 
Less can be said of it as a cure, once the disease has become established. 

In 1022 Orgel reported a method of intracutaneous injection of vaccine 
bv which the disease could be diagnosed in its early stages and thus pre- 
ventive measures taken before the appearance of the characteristic whoop. 
Hull and Nauss and others, however, had no success with the method. 

Infant MoirrALiTV. 

A considerable numlier of sanitarians regard infant mortality rates 
as indexes to general health conditions. Some go further, expressing the 
opinion that infant death rates reflect the character and efliciency of public 
health service. The facts fit the retiuirements in either case so far as 
Illinois is concerned. 

Fifty years ago infant mortality in Illinois was fully twice what it 
is now. At that time puljlic health service had scarcely survived the labors 
of birth and it remained an infantile organization for twenty-hve years. 

Neither birth nor death registration was complete fifty years ago but 
there is abundant evidence that infant mortality was high. In 1881 there 
were 218.8 deaths among infants under one year of age for every 1,000 
l>irths re]iorted. Birth reports were estimated to be from -JO to 50 per 
cent incomplete and death reports from :iO to -10. In r,i2G there were 69. IJ 
infant deaths registered for each 1000 births recorded. Statistics for births 
and deaths were complete for all practical purposes. 

In ISSl a irifle more than 2 I per cent of all deaths recorded were among 
infants less than one year old. In 1l»2(i a irifle less than 11 per cent of all 
deaths were among persons of the same age group. This is positive evidence 
of substantial improvement in infant mortality. 

Then there is the evidence of actual numbers. For the six years ended 
with 188G. when the population of Illinois was about half what it was in 
li)2T. there were ()';,iSll infant deaths reported. For the six years ended 
with l!i2() there were onlv G0,.")2.') infant deaths re])orted. The ratio to 
population in the more recent vears is less than one-half of that for the 
earlier period. 

Probably the greatest single factor in the saving of infant life was ihe 
improvement that took place in the sanitary quality of municipal milk sup- 



3SI4 lir.AI.I II CONDITIONS AFTER 1877 

plifN (luring tlic lilty year peridd. rp unlil IH^I there is no record of less 
than 1 ],(•()() infant deaths pi'r annum cxce])! in the years prior to 1884. Since 
1!)"-^1 tile ]X'riod during which the safe milk campaign has been stressed, the 
total numher of infant (k-aths has never reached 11,000 in any one year 
while for each of the three years ended with 1926 it was less than 10,000. 

The ptriod during which the most improvement in infant mortality 
occurred is ihe saiiu' period in which tlie greatest improvement in the sanitary 
ipi.ditv cif municipal milk supplies took place. 

The danger to infants and children of using a poor milk supply is well 
known. Tliere are two factors concerned — the presence of disease produc- 
ing hacteria .and the presence of enormous numbers of other bacteria, not 
necessarily iiathogenic. hut which ii\er\\helm the digestive tract of the infant 

Table 73. 
Dk.\ths of Infants* and R.vtes per 1,000 Births Reported in Illinois. 



1880 10,968 1911 

1881 n,.S26 218.8 1912 

1882 -... 10,772 229.2 1913 





Kate per 


Infant 


100.000 


leaths. 


population. 


10,968 




11,.S26 


218.8 


10,772 


229.2 


10,3K2 


224.8 


11.305 


246.4 


11,277 


237.5 


12.749 


215.3 



1S84 11.305 246.4 1916 

1885 11,277 237.5 1917 

1886 12.749 215.3 1918 

1019 
1890 1920 

1921 
1900 - .- 1922 

1923 

1907 11,947 140. 1924 

1908 11,774 154.3 1925 

1909 11,49-1 144.7 1926 

1910 - 12,281 149.1 





Rate per 


Infant 


100.000 


leaths. 


population. 


11.113 


124. 


11,155 


108. 


11,607 


109.8 


14,518 


119.9 


14,029 


118.9 


13,109 


105.7 


11,148 


94.4 


11,641 


87.5 


10,644 


76. 


10.187 


74.9 


10,810 


78.9 


9,743 


69. 


9,S44 


71.8 


9,297 


69.3 



* Less than one year of age. 

Ijy mere numbers. In the summer time, especially when the weather is hot 
and ice difficult to obtain in sufficient (|uantities, infant diarrhea due to bad 
milk has been in the ]iasi extremel)- ]ire\aleiU. 

The i)asteurization process was tirst prjicticed secretly by milk men to 
improve the keeping ([uality of the milk. Its merits however were soon 
recognized. As early as JSItV Nathan Straus began the distribution of 
pasteurized milk in New York City, .\lthough the process passed through 
a long experimental stage with much faulty technic and unreliable apparatus. 
there was a marked improvement in milk supply with a consequent reduction 
in the infant death rate. 

In IIM)8 Chicago passed a law re(|uiring compulsory pasteurization of 
milk except that received from tuberculin tested cows. This was the first 
large city in the country to pass such an ordinance. In HMii by an executive 



HEALTH CONDITIONS AFTER I .S , 



395 



order pasteurization was extended to all milk in Chicagu and snK\- then it 
has been strictly enforced. Other cities in the Stale likewise have gradually 
been supplied with more and more pasteurized milk. 

In 1922 the State Department of Public Health initiated a pasteuriza- 
tion program with so-called model milk ordinance intendetl for the imjjrove- 
ment of milk supplies in the State. During the next five years 60 cities adopt- 
ed this ordinance. An outgrowth of the campaign was the ])asteurization law 
of 1925 which required all plants selling pasteurized milk in Illinois to ol)- 




Figure 31. 



tain a license from the State Department of Public Health. Not onlv was 
the quality of pasteurized milk imijroved but there was a large increase in 
amount. In 1927 there were 352 such plants in the State (not counting the 
plants supplying milk to Chicago) pasteurizing 390.702 gallons, an increase 
of 59,000 gallons over the previous year. It is estimated that 50 per cent 
of the people downstate drink pasteurized milk, while all of Chicago receives 
it, or a total of more than four and half million of the seven million people 
in the State. 



SUMMARY AND CONCLUSION. 

Since the year 11)".'^ ends a liflv year jieriod in the Hfe of the Board 
and Deparlnieni of l'nl)lie i leaUh of the State of Illinois, it is proper that 
the Department should use the occasion to gather together some of the out- 
standing events in the hi alth history of the State to make them easily 
availal)le for those interested. To those who have an interest in studying 
the suhjici more exhaustively, this histiiry may stimulate inquiry and offer 
suggestions as to soin-ces of material. The narrative and ap]iraisal of 
what has l)een done was written in consultatii'n with a few of the men who 
have had something to clo with the effort. It is to be regretted that it was 
not possible to ha\e had the advice of man\- who did not jiarticipate hut 
time and tide do not wait. Mow valuable the apijraisal would ha\ e 1)eeil 
had it been possible to summon to the Boar<l men like Ranch, Reilly. John- 
son and Chambers, the men who planned the earlier health work in the 
State. Hut they are gone, except Johnson who is advanced in years, and the 
best that can be done is to judge of their plans by the effects those plans 
wrought, immediate and remote. 

It is also an appro]iriale time to speculate somewhat as to what the 
future holds. In this, however, what is said must be regarded as general 
and indic;ili\e rather than specific. 

The I )irector has a rather definite program for the Department of 
Health for a ten year ])eriod. There is no uncertaint}- in his mind as 
to what sbnidd lie done nor as to his intention to accomplish this program 
to the linut of his strength, influence and opportunity. Such uncertainty 
as he has relates to the vicissitudes of place and position and the uncertain- 
ties of the pulilic mind. It is not deemed advisable to state that prograip. 
in this place. 

Sniirci's (if Mai( I'liil. 

Those who wrote about conditions in the upper ^Mississippi Valley prior 
to one hundred and fifty years ago had but little interest in health. It 
wiiuld lie f.iirt'r to s.iy tb.it the reports they inade were on subjects other 
than health. When he;ihh is mentioned at all the reference is brief. There- 
fore the health record of the perioil is not worth nnich as a record. 

l'"rom about KSO uulil alxmt IS.'iii iju' rt'Cord while more xnluminous 
and more detailed than tli.il of the preceding period is onlv of relative 
value. So long as there were forts in and ne.ar the Illinois territory, re- 
ports on the health of the troops stationt-d in them were made periodically. 
But these are of limited value. Prior to the War of 1812 and even during 

( ;!!)i; ) 



SUMMARY AXD CONCLUSION SflT 

that war the medical department of the United States army was poorly 
organized. Surgeon General Forrv was the first of the army medical officers 
to grasp the possibility of evaluating the healthfulness of different sections 
of the country through the opportunities of the military posts. The lay 
writers who told of health conditions in the territory and state when they 
lectured and wrote books, magazine articles, newspaper articles and letters 
back home supplied a considerable part of the record prior to 1850. Soon 
after the beginning of the century. Dr. Daniel Drake established the Medi- 
cal and Physical Journal in Cincinnati. Before long the physicians of Illi- 
nois began writing for this Journal. .\ little later Dr. Drake made the first 
of at least two voyages of discovery in health matters in Illinois, reporting 
at length and in detail in his Journal. 

A little later other medical journals were established, in St. Louis, 
Louisville, Buffalo and Chicago, and Illinois physicians began writing for 
these Journals and occasionally for the American Journal of the Medical 
Sciences in Philadelphia and in other eastern journals. In 1846 the forma- 
tion of medical societies was begun at Lawrenceville, Illinois. In 1848 the 
American Medical Association was formed with the cooperation of Illinois 
physicians. In 1850 the Illinois Medical Society was formed. The Chi- 
cago Medical caine in the same year. Much of such record as there is of 
health conditions in Illinois is found in the pages of these journals and the 
transactions of these societies. However, all of this record, including that 
of the physicians is opinion, on evidence and subject to the limitations of such. 

The Federal Government began making its decennial census reports in 
ITiMi. Prior to 1850 these reports contained no demographic material ex- 
cept number of population, increase in numbers during the previous decade, 
distribution of population geographically and as to se.x. age. color, racial 
stock and special classes. In 1850 a little vital statistics was given. In 
1860 still more. But these incursions into vital statistics were timid and 
halting and oftentimes inaccurate and misleading. The introduction to the 
report of ]s.")(i said: "The tables of the census wjiich undertake to give 
the total number of births, marriages and deaths in the year preceding 
the first of June 1850 can be said to ha\-e very little value". Xevertheless 
the policy was continued. Each census year the reports were increasing!}- 
accurate and detailed. In lltuo the policy of reporting vital statistics an- 
nuallv was adopted. Chicago began reporting vital statistics in a very 
limited wav in 1843. These were inaccurati- as well as incomplete. In the 
]cS70 report Dr. Ranch gave an estimate of the degree of incompleteness 
and applied a corrective factor for all of the earlier reports. 

Nevertheless the record from somewhere about 1843 to 1850 on is a 
statistical record as well as one Ijased on testimony of (ipinicm. In all jimlia- 



.SOS SrMM.\l<\ AM) COXCI.USION 

bility Ijctwci-ii l.st;i anil IS<i3 the icslimony of ojiiniim was Ijuttur and more 
dependable than the statistical. Since about the latter d;ite the statistical 
source of material has been the more dcpend;d)le. 

Since the l-'rench-Canadians and the Indians left few descendants 
in the Slate, they can be eliminated from an estimate of the physical vigor 
of the stock. Likewise since they made no outstanding' contribution of a 
disease they can be eliminated from this limited study of the diseases of the 
State. When malaria became so prevalent and deadly soon after 1780 it 
made a smoke screen beyond which it is not easy to see any im|iortant disease 
in the prixeding period. Therefore, it must be assumed that there were 
none of outstanding importance though rheumatism. ]ineinuonia and the 
diarrhoeas must have been much in e\i(lence. 

Ural til J7S0 In is; 7. 

There is no record for the State of Illinois prior to 1ST7 as to the 
physical \igor of the people, the birth rate, the size of families, the aver- 
age length of life, the endurance, presence and absence of physical and men- 
tal defects, average stature, physical prowess, positive health so-called and 
prevalence of non-report.nble diseases either fatal or non-fatal. This state- 
ment i> onK |iarti;ill\ true as to ^uch items as ph\ sical \ igor. birth rates, 
size of families, length <if life, endurance and physical prowess, as to each 
of these items there is a limited amount of evidence of opinion, most of which 
is very general and but little circumstantial. In collecting material for this 
narrative it seemed best to base the jiresentation on those items as to 
which the evidence was best. That almost limited it to the major forms 
of Communicable diseases commonU' known as the reportable diseases. 

\\ hen the ])eriod prior to 187 7 is comjiared with that since, the record 
shows an almost unbelievable gain. In brief statements relative to each 
of several diseases and as to general unhealthfulness and general death 
rates opinion will be gi\en as to what in a general was has been the con- 
tribution of the state ;md local health dejiartmrnts to that end, 

(Icinriil I ' iilicaHlif iilurss. 

This heading is used liecause it was used in reporting health prior to 
187 7. in the early da\ s the geuer.al re[)utation of the state as to health 
was bad. It is now good. The death rate is low not onlv as compared with 
that of other states but as conipart'd with l'"uropean countries. So far as 
the gross or imcorri'cti'il death rate from all causes is concerned the yearly 
records Irom this and the European countries is accurate and dependable. 

The Illinois raci.il stock is exceptionally heterogeneous. By reason of 
immigration between this and other countrit's. between the states and between 
the urban and the rural districts the poimlation is exceptionally unstable 



SUMMARY AND COXCLUSION 3!)9 

Statistically. However the contrast between then and now is so great that 
minor variations do not obscnre it. In less than one himdred years a most 
unhealthy region has become one where health is of the best. In effecting 
this change several factors have operated. One has been the change in the 
country itself especially improvements which liave resulted from clearing 
the land and draining it. Another has Ijeen the change in the people 
such as growth in intelligence and knowledge, elevation of the standards 
of living, increase in earning power measured in purchasing power of the 
dollar and learning how to live among their neighbors as well as with 
their families and the individual with himself. Another has been the im- 
proved service rendered by the medical profession in its various divisions 
of doctors, dentists, nurses, druggists and hospitals. And a fourth is the 
preventive medicine agencies principally the state and local health depart- 
ments and also in some measure the cooperating agencies for prevention of 
disease. For the general improvement in health and the reduction in the 
death rate between the period prior to 187? health agencies are eiuitlefl 
to half the credit. In order to establish that claim they credit themselves 
with the generalship, strategy^ and leadership in the health campaign, with 
their activities in education <.if the jnihlic in health, their propaganda to 
interest as well as to inform the public as well as with their more direct 
and specific activities in health promotion and disease control. They claim, 
moreover, that even after crediting other factors with their half of the ac 
complishment the health agencies show a return of improvement and iiene- 
fit of and to the people which can not be approximated by any other arm 
(^f government. This is because the\- ha\e made prevention their field 
and prevention is economically sound. 

Mdhnid. 

Malaria was the great menace to lllimiis in the period when its verv 
existence was in the balance. It wa^ escrywhere in the State. It was 
^aid to be endemic and periodicalh' became so prevalent that it was said 
to be eijidemic. 

The last great epidemic wave was in IS?-^. The territory in which it 
is endemic has gradually been lessened until now some of the mosquitoes 
and .some of the people are infective in only aliciut fifty foci located in about 
twelve counties. Shortly there will be no endemic malaria in the State. In 
making this transformation the largest single factor has been drainage. The 
health department using the term in its inclusive sense can only claim a 
minor ])art in this great achievement: yet they have contributed and are 
continuing to do so. 



•100 SUMMARY AND CONCLUSION 

Tiqihii'iil Fen r. 

Ill all ]inil],iliility llu-n- was suiiic typhoiil fe\cr in thi- slate from its 
early settleiiuiU. As the I'o.t^ of malaria was lifted typhniil came to he 
recognized. The disease increased as did the density of impulalioii. I'^ir this 
increase proijressive ])ollnti(iii of water supplies was the principal factor. 
The prevalence of the disease was at its ])eak in tin- first half of the 
nineties. 

It has now become a dist-ase of minor importance. For this improve- 
ment the health agencies can claim the larger part of the credit. To do 
so however they must absorh the water and sewage departments claiming 
them as ]}arts of the health machine. 

Y cUoir Fi'rcr. 

This disease is scarcely a memorv in this State. Xe\ertheless, the 
health machinery did its full duty in the few epidemics that occurred and 
it has fiuictioned in throwing a w.ill of protection around the State when- 
ever danger threatened. They can claim credit for whatever of securitv 
was added to that which the location and relative freedom from vellow 
fever mos(|nitoes supplied. 

Cholera. 

This disease lias not reached within li\e hiuuhed miles of Illinois since 
1877. The only credit the ."^tate Board of Health can claim is that they 
have added to the securitv of the pieople when the disease has threatened 
on a few occasions. The local health departments are entitled to more 
credit. They were active in every epidemic wa\e which swept over the 
state after 1S3:>. 

At times cholera caused conditions to be \ery liad but just how Ixid 
they might have lieen had the local health departments and the indi\i<lual 
doctors failed to function is bey<ind the imagination. 

TjiiiliKs <iii(l Plague. 

Illinois has been spared e[)idemics of these diseases. Since no great 
epidemics of them have prevailed in .Vmerica no particular eti'ort has been 
required to protect the state. 

Milk SicJaiess. 

This form oi poisoning once of major interest in Illinois is now unim- 
portant except in iwo or three counties and for about two months in the 
year. 

In this transformation clearing the woods and im]iroving the pastures 
has been the controlling factor — the health departments have contributed 
notbiiiL''. 



SUII.MAKV AXD COXCLUSION 401 

Siuil'cliitr. 

'I'liis f(irm lit animal ])oi>(>nini; once ranl<L-(l with milk sickness, a form 
of vegetable poisoning, in iniiwrtance. Jt is now trixial causing no deaths 
and almost no sickness. Clearing the countr) is entitled to credit for the 
improvement. 

Smallpox. 

This disease was a very great nienuce priur td is;; and for at least ten 
years thereafter. It was fairly prevalent during the following ten years. 
J'\ir thirtv vears it has been a ];otential rather than a present danger most 
of the time. Jts relative control is one of the sanitary achievements of the 
century. However, the record of the L'nited States as regards the control 
of smallpox when compared with that of the countries of northwestern 
Europe is disgraceful. It is conunonly cited as proof that something more 
than the gradual growth of jniblic intelligence is necessary to prevent ejii- 
demics of this disease. P'or the achievement in lessening the prevalence 
of smallpox the health agencies can claim much the largest part of the credit. 

Scarh'l Fever. 

Scarlet fever has become a disease of secondary importance. In spite 
of the increased density of population and the increased frequency and 
intimacy of contact of people the disease has declined in pre\alence. The 
theory is that the greatest decline in prevalence was that which occurred 
])rior to IS'.i; and that the princi|)al decline since then has been in the \iru- 
lence of the disease — the case fatalit)- rate. This is in great measure true. 
For this latter improvement the better service of the medical profession 
and the elevation of the general standards of cleanliness have been the 
[irincipal contributing factors. For the lessened prexalence of the disease, 
the health departments can claim most of the credit. Taking the field in 
its entirety the health agencies are entitled to somewhere near half (if the 
credit. 

I)i [lilt In rui. 

Ibe \ei"\- great decrease in the pre\:ilence and in the fat;i]it\- of diph- 
theria is one of the achiesements of which society can be proud. I'rior 
to the discovery and general use of antitoxin the treatment of di|ilitheria 
was symptomatic. Health departments can claim the credit for having 
popularized the use of this remedy. The medical ]irofession are entitled 
to the credit for using it intelligently. I'^ollowing its introduction and use 
the death rates from diphtheria fell markedly. Due to the fairly general- 
ized and increasing use of vaccination against the disease, diphtheria is 
rapidly shrinking in imjjortance. Within a decade diphtheria will be of 



402 SUM.MARV AM) COJ'CLUSION 

st'Coiiilary im|icirlaiKH-. TIk- licahli a.L;riK-ic^ arr riititkd to imich more 
than half thi' crc(ht t(ir this improNx-mcul parliciilarly if tliey admit to 
iiH-nihcrsliip the ix-si-arcli workers. 

W}ioupir,g CoHfili. 

The decrease in this disease has hei-n marked thoiij^di in it there lias 
been nothing spectaenlar or dramatie. The health agencies claim si me 
of the credit though much of it belongs to the gradual growth of public 
iiUelligence. 

Mraslrs. 

The best that can be said for the measles tight is that the disease has 
been held in check. That the people from the cities are now in a better 
position as regards measles when emergencies develop is somewhat to the 
credit of health agencies. Within the last ten or fifteen years it has been 
discovered that the secondary infections in measles are of more importance 
than the primary disease, that something can be done to prevent these 
secondary infections and that the bacteriology of these secondary infections 
is hable. The credit for these discoveries belongs to the medical pro- 
fession and to the research men. It seems that the bauterial cause of 
measles, an antitoxin, and a vaccine have been discovered or are about 
to be discovered. Should these supposed discoveries be established the 
stage will be set for the control of measles. It will then be up to the health 
agencies acting as boards of strategy to lav and to execute i)lans for the 
control of measles. For what has been accomplished the health agencies 
can not claim a major credit. 

Eri/sljxias. 

This disease once prevailing always as endemic and occasionally break- 
ing out into epidemics, at least one of which was almost if not quite pan- 
demic, has become a fairly unimportant disease. The recent discovery of 
an antitoxin for it promises still further improvement. A part of the 
importance of erysipelas in the I'ast was due to its close relationship to 
puerperal fever and scarlet fever and its relationship albeit less close to 
meningitis and pneumonia. Ihe principal factor in the decrease in ei"y- 
sipelas is the elevation of the general standards of cleanliness and other 
general standards in some meastn-e. The medical profession are doing their 
work better and that is contrilnuing to the end. The health agencies 
claim some of the credit though they are not in the first rank. 

Puerperal Fever. 

It is customary to sav thai the niorialit\- rate of mothers in childbirth 
has not inipro\i-(l. Tliis ma\ be true when comparison is ma<le between 



SUMMARY AXD CONCLUSION 403 

present day conditions and those of the recent ])ast. It is not true if com- 
parison is made between the period before ISTT and that after ISTT. There 
is less puerperal fever than there was; princi])ally because of the elevation 
of standards of general cleanliness and application of the discovery by 
Oliver Wendell Holmes that puerperal fever is contagious. Better medical 
service is a factor. The Chicago Health Department under Dr. A. R 
Reynolds inaugurated a midwife and obstetric service in the °arly part of 
the present century. 

Me)ii)i(iitis. 

Meningitis was once a periodically epidemic (Hsease causing a heavy 
death rate. It is rarely epidemic now. In fact, very rareh' — almost nc\cr. 
This improvement is partly due to health departmem work and partl\- due 
to knowledge of the danger of cmwding, particularK' in sleeping (piarters. 

Infant Mortaliti) and Mortal if ij of Children Under Fire. 

In no other division is the im])r()\ement in health more definitely indi- 
cated than in that whicii relates to young children. The statistical proof 
of decrease in the death rate of babies under one year of age from all causes 
is not so easily arrived at in Illinois as elsewhere because the State has not 
been long in the Birth Registration Area and Ijirths are not yet all registered. 
In other states the registering of births is better incorporated in the uiorcs. 
Nevertheless, there is proof enough to establish the fact that the inse- 
curity of baby life and child life which was accepted as ine\itai)le three 
quarters of a century ago would provoke remonstrance if n(.it rebellion 
today. Little of this im]>ro\ement came before 187 T. The great era of 
betterment l)egan about I'.Ho. Tiie health agencies can justly claim credit 
for half of the gain, the other part being divisible between better medical 
service, elevations of standards and improvement in environment. 'i'he 
largest single factor in bringing about the improvement was the improve- 
ment in the milk supply which stimulated improvement in other foods and 
a decrease in the prevalence of flies. The health agencies fought the bat- 
tle for better milk. 

Diarrhoeaf: and Difsenterles In Adults. 

'i'hese disorders were responsible for heavy deatli rates and sickness 
rates among the Indians, the French-Canadians and the .American settlers 
living in Illinois. This continued up to and after is:; but not very long 
thereafter as an important ailment. They have \irinall\- disajjpeared. Im- 
provement in standards of living and in food and water supplies and better 
medical service are the principal factors which have brought about this 
improvement. The contril)Ution of health activities consisted in impro\ing 



i04 Sr.MMARV AND C'dXCI.USION 

water ami iuod supplies, in i-(lm-aliiii; the people and ccnitrilniting indirectly 
to the elexalion of stan<lards. 

Decrcdsr ill I III' SiniiiiK r Sickness lUtics. 

Summer time was formerly four to six times as unliealthful as it now 
is. The pre\ailin{^ illnesses of the period were malaria, typhoid and the 
diarrhoeas. l'"or this improvement the health agencies are largely due the 
credit. Their campaigns against flies and filth generally, their milk fights 
and ljal)\ sa\ing campaigns are directed principally against those disorders 
which prevail in summer. Ileltei- medical service, impro\e;l saniiation 
and higher si.-r\ ice have coutrilnUed to the end. 

Cdiishiii jit inn. 

Tn the earl\- davs Illinois enjoyed but (Mie good reputation for health. 
That related to consumption. When the figures became available soon 
after 1850 it was found that at least at th;it date the reputation was not 
deserved though it may possibly have been earlier. Between 1850 and llioo 
there was a considerable reduction in the ])revalence of ctmsumption. '1 his 
was the result of elevaticn of standards more than any other single cause. 
Recognition of the contagiousness of the disease was a related cause that 
was helpful in effecting the improvement. The Chicago figures show that 
just pric r to HHi^ there was a slight increase in the disease. Between 1907 
an<l i;i"i- there was a second great decrease. T^'or this decrease the activities 
of health agencies are entitled to most of the cre<lit. The decrease has 
come to a stand still since 1922 just as it did soon after 1900. 

hifiicnza. 

There has been no success in comb.ating influen/a. 

Till' I'ni'iiinoiiKis. 

The pneumonia rale was comparatis eh low prior to 1S7T. It rose 
intermittently until ;ibout 192n, although the intercurrent influenza pandemics 
and endemics make interpretation of the pneumoni.a figures difficult and 
even impossible at times, h'or some reason the disease or group of diseases 
seem to have been on the decline since about 1920. It is difficult to intcr- 
])ri't the meaning of this or assign thi' credit for it. 

Till' Stall- Ilnillli Drjxirliiiinl: 

The credit for establishing the ."^tate Health Department lielongs to 
the Illinois Medical Societ\ though the Aesculapian Society of the Wabash 
Vallev first pn■^hed the proposal before the General Assembly. It was a 
resolution passed b\- the .'^tate Society which sent a committee to the legis- 
lature to insist upon the necessary legislation, llowexer, the good repu- 



SUMMARY AXD CONCLUSIOX 405 

tation enjoyed by the Chicago Health Department made friends for the jjro- 
posal. The Chicago Heahh Department owed its existence to the Chicago 
Medical Society and to the individual efforts of strong medical men who 
belonged to that society. The same general statement applies to ntlu-r 
local health departments. The Municipal Tuberculosis Sanitarium in Chi- 
cago owes its existence to the Chicago Health Department aided by the Chi- 
cago Tuberculosis Institute. 

Ixcfinlatiuit of the PracHcf of Midicnir. 

No part of this narrative has more jieculiar angles than that which 
relates to the proposals to regulate the practice of medicine and to i^romote 
medical societies as post-graduate medical schools than the reference to acts 
of the territorial legislature and several legislatures thereafter. 

The proposals to establish a State Health Department which came from 
the Aesculapian Society and later from the State ]\Iedical Society provided 
for two objectives. One of these was regulation of the practice of medi- 
cine. In 187 T and for nearly forty years thereafter this was the chief ob- 
jective of the Board of Health. 

Between 1900 and 1905 the State Medical Society became greatly in- 
terested in separating this objective from the other objective, the promotion 
of health. However, it was not until I'.in that this was accofplished. The 
society was right in its judgment as experience si on demonsrrated. Cnder 
the old order too much of the Department's energy and time was taken up 
with regidating the practice of medicine and too little of resource remained 
for promoting health. There was some advantage in ccnsolidating ihe 
great professional army engaged in curing disease with the small but com- 
pact army engaged in fighting it. But in practice it has been found that the 
practice of medicine is better regulated in the Department of Registra- 
tion and the Dejiartment of rublic Health is left some energy and en- 
thusiasm for ])lanning to pre mote health. 

rhitfitrm. 

This chapter and narrative is brought to a close bv turning from the 
jiast to the future and giving some objectives for the next ten years and 
also projecting aspirations and possibly hopes for a fifty-year period. In 
doing this it is advisable to state a platform reciting the basic principles upon 
whicii the Department stands and hopes to stand. 

The State Department of Public llealth is the centralized agencv for 
health promotion and disease prevention in the ."^tate. It is not an agency 
for the cure of disease or for the custodial, remedial or rep;irati\e care 
of the sick or convalescents. \Mien perchance it becomes necessary to care 
for the sick as a measure for protecting others against contagion it will 



40() SUM.\1\K\ AM> lO.VCr.l'SION' 

^\\v till' iiu)>l huiiKUK- and scienlil'ic care it can. lint snch assnniption of 
(Inly as tlic care nf tlir >>ick implit-s is merely a tiMiiporarN- expedient and 
one from which it is seekint;- al\va\s to esra])e. 

The \arioiis schemes for heahii insniance so cahed are reall\- i)knis 
for the economic cru'e of the sick. Soini' of them have some excellent fea- 
tures for the pre\eniion of disease. llo\ve\er, curative care is their chief 
objective and snch heint;- the case the\- are lie\'ond the domain of this De- 
partment. If this Deiiarlment shonld he called on to cooperate with such 
a scheme it w i uld hold that it was its dut\' to do so in so far as the pre- 
vention part of the proj^'ram is concerned. .\ few years ago the De- 
partment found itself jjiving reparative or after care to persons wIkj had 
recovered from infantile paralysis. Since these persons were not infec- 
tive the problem of giving them reparative care w-as beyond the held of 
the Department. Forttmately, the State Rotary Clubs and the Sb.rin^-rs were 
found willing to assume the duty of giving this after care. 

The Department stands on the same platform with relation to su[)ply- 
ing drugs free. It is its duty to supply vaccines and nitrate of silver so- 
lution and other drugs fir pre\ention. It should not supply any drug for 
cure. The State Dejiartment of Public Welfare maintains a line of hos- 
pitals and other institutions for the care of those who are mentally or 
phvsically sick. 

The I'epartment of Public Idealth has no dut\ that calls it to intrude 
into the field cf the Department of I\iblic Welfare. When cjuestions of 
prevention arise in that field the Department of Health is willing and anxious 
to assume its full measiu'e of responsibility. The law establishes educa- 
tion of the ])nblic and ])ropagan(la for health as among the duties of the 
Department of Public Health. This is a pro])er prox'isicn above all in a 
democracw It is a fundamental factor in prevention. The State Depart- 
ment of Public Health is an ad\isor of the legislature in matters of health 
promotion. This is a recognized function of a 1 )ei)artnient and is the 
basis of (he relations between it and the legislative branch of government. 

."^ince the meaning and force of laws are determined by the judiciary. 
the Department carries some responsibility for keeping that bocly informed 
as to what is coninion information on health subjects an 1 giving it 
information more dirt-clly when called in to do so. 

Tin- Stale Department of Public Health considers that the duty of 
j/lanning campaigns against disease and promoting health rests on its should- 
ers. .Much of tlu' attack and defense is commanded and executed by local 
health departments. The State Department of Public Health promotes 
the interests if local lu-altb departnn'nts where\-er it can do so. It lends 
them all the aid it can. It ba^ the right to interfere localp- onl\- when 



SUMMARY AM) CONCLUSION -107 

the local department is so derelict that tlie people of other coinniunities 
are endangered. A breakdown in Icical adniini.stratiun ilial has local effect 
only is a local matter calling; for nci State interxentiun. The people pro- 
gress fastest when thev reap their own rewards and snft'er their own 
punishments. But if the local department is inefficient to such a degree 
as to imperil the State generally the State Department has the right to 
intervene. If the enemy is jiouring through a certain gaj) and over the 
State generally the State has the right to stop the gap regardless of where 
it may lie. 

The same princi])les apply tn the relati( n i)f the Department to the 
practitioners of medicine. In the battle line against disease tlie indi\idual 
is in the outermost skirmish line. Next comes the home and then the 
school. Then comes the first professional line of defense, the doctors and 
the hospitals. Still further back are the first line of Ilealth Department 
workers. The service rendered by physicians and hospitals is constant — 
never ending and valuable. The State Department of Public Health never 
interferes in the domain of any practising physician or hospital except where 
it becomes necessary for the protection of society. In almost all cases a 
satisfactory adjustment between these cooperating agencies is matle and 
it is of a kind that works efficiently, economically and satisfactorily. 

The Fiitiiir. 

This narrative may give the impression that the ultimate in attain- 
ment has been reached and that health can nut be further improved. It is 
largely to correct any such tenilencv that this \cnture in forecasting the 
future is made. 

Some i)roblems have been met and solved. Some diseases have been 
eradicated and more are (-n the wa\- toward eradication. Some diseases 
are satisfacturiK under control and some are certainly headed that way. 
But there will lie new diseses to take the place of some old ones. Some 
diseases not now under control nnrst be brought to heel; some diseases 
now disregarded must be tackled: the span of human life and efficiency 
must be increased: the solution of new problems and old problems long 
neglected must be undertaken. 

The etfect which should follow the reviewing of the battles of the jiast 
is to gird us for those of the future. It is hope.l that the Director of 
Public Health in ]'.•:;; ean promote the health of the people and the de- 
velopment of health departments. hi> own .md llie local de|iartnienls, with 
even greater satisfaction, than now pre\ail> in the mind of present Di- 
rector. 



4()S SUMMAKV AND CONCLUSION 

Till- I'uriher (lr\ rliii)iiuiu iii cviTy division now in the Department 
and ilu- inansjuralion of several iu-\\ divisions can be foreJeen within the 
next few years. There must be a dix'ision to promote what is sometimes 
erroneously called positive heahh. Such a (Hvision would begin operation 
by promoting periodic ph\sical examinations at lirst in large groups of in- 
dustrial workers which is called closed groU])s ; later in more open groups 
and thiallv among the general population. In time this division would 
take on such activities as the promotion of winter sports, the promotion of 
all sports regardless of season; the planning of vacations for the renewal of 
hddilv vigor; the promotion of play for adults as well as for children, the 
])rnniiitinn of some movement such as the Turner and vcrein of Germany 
and the Swedish societies for cooperative physical development and finally, 
the advancement of the knowledge and practice of the rules of health. Such 
a division would have for its motto "Keep the Adult Well" — parodying 
"Keep the Well Baby Well" — the slogan of infant-welfare work. 

Somewhere in the Department, genetics will Ije undertaken licfore 
manv years. 

(!iii<rics. 

The next step will be au increase in the amount and \aiiety of in- 
formation given on the Ijirth certificate. That <locument now gives some 
information that is valuable from the legal standpoint. P'or the health 
department it serves to kicate the babies for purpose of education and 
training of mothers and for statistical pur])0ses. It will be enlarged so as 
to give information that is compar.ible in scope with that given on the 
death certificate. Such registration wnuld contribute to a solution of the 
problems of |irenalal care of the parturient and of the baby during the first 
thirty da\s of life. The certificate will contain some information which 
can ser\e for studies in genetics. 

licsjinitl iirjl Dis( uses. 

The diseases not now engaging the ;itteinion of the Department which 
must be studied and planned agamst are the ]ineunionias and the other respir- 
atory infections of the winter and s])ring such as Cdlds and bronchitis, also ve- 
nereal diseases, cancer, heart disease, kidney di.^eises ;'.nd rlu-uniatisui. 
Within ten vears we will be approaching the time when another great pan- 
demic "f inlluenza is due, Ddubtless the Health Department by 11>3: 
will ha\r ;m outlined plan of cani|iaign for repressing or at least harrow- 
ing this I'uemy, which plan cumplele en general lines will be in a pigeon 
hole re.aclv for use as soon ;is ihe disease appears. 



SUMMARY AND CONXLUSION 409 

So III I' Ciiiis'idcratidii of DcatJi Bates. 

At the present time the crude or uncorrected death rate is unnatur- 
ally low. \\'hen the calculated death rate hased on the average age at 
death is compared with the death rate as calculated on the basis of re- 
ported population, the two are found in marked disaccord. This is prin- 
cipally because of the instability of the population, migration back and 
forth between counties, between the states and between the urban and rural 
districts. Industrial changes have come to be large factors in this. Within the 
life-time of men now living a good part of this instability will have ended. 
There will be a better accord between the death rate indicated by the 
average age at death, the average age of the jitipulation and the death 
rate calculated on population. This will nut mean a death rate materially 
lower than the present one. It will mean the prevalence of one that is 
nearer an index of sanitation, hygiene, health work, freedom from disease, 
bodily vigor and good heredity than the present one is or can lie corrected 
to be. 

Old Age as a Cause of Death. 

In the earlier vital statistics old age was given as a cause of death 
with great frequency. As employed in that period the term was loosely 
used and it served as a catch bag for deaths in people fifty years of age 
and older from a multitude of causes. Because its use prompted loose 
diagnosis vital statisticians and health officers brought enough pressure to 
cause its partial abandonment. Before many years, old age as a cause 
of death will be used with the approval of health officers because it will 
then have a scientific meaning. 

Deaths from heart disease, apoplexy, Bright's disease and such occur- 
ring among old iieople will be properly recorded. The disorders due to 
bacterial and other causes likewise. There will remain a large number 
of people who will die because of senility and tlu-y will lie pnrperly classi- 
fied under that head. 

Bv that time the direct and the ultimate eft'ecls of bacterial infec- 
tions will be so well understood and so many nf these infections will iit 
wiped out or will be avoidable that the jimblems of senectitude can be 
studied. 

Many of the bacterial disurders which now- threaten men will have 
been brought under contrn]. This does not mean, bnwever, that there will 
be none such. Even then disorders which are endemic and mild in cer- 
tain regions will periodically break out and swfep n\er the world. \'ellow 
fever once existed on this basis in Cuba and jieriodicallv broke a\\a\- lo 
sweep as a highh fatal disease (j\er parts of the L'nited States. Inlluenza 



410 SUMMARY AM) I'ONCI.USION 

made a grrat swct'p ovtT the world as lati- as lOlS. IVriodic waves of dis- 
orders of the saiiU' type ina\ still he expected. 

There will l>e ehaii.i;es in vinileiire of the existint,' haeteria in the 
territory which the\- nrniially inhahit. And there will lie new hacterial 
diseases esolved to lit new conditions. All in all there is no reason for 
thinking- that we shall soon see an end of the age-long strife between 
man and germs. 

I ii(r((isii/>/ SiKiii (if Lilc 

Tin- average age at death is said to he ahont .")S years now. This is 
interpreted as the average span of human life. In the pioneer days in 
Illinois few men were over 41) )ears of age. Men "lO years of age were 
regarded as old. It is said that somewhere in that early [jeriod. the average 
span of life was about 33 years. If men were occupied with preparation for 
work for twenty years only thirteen \ears were left for productive work. 
When the average span of life is 58 there are about thirty eight years for 
productive \vork. Before long the average span of life should l)e at 
least seventy. This would mean fifty years for productive work. W hen 
the average span of life reaches seventy years there will be large num- 
bers of men and women working i)rotitahly at eighty years of age and of 
centenarians there will be many. 

The State Department of rnblic Health has no thought that the future 
will be free from health problems. Such ])rol)lems will alwavs be present. 
They will not be those of yesteryear, nor those of today. The}- will be new 
in man\ of their aspects but they will be ini]>ortant to the happiness of the 
individual and the welfare (if the State. When the Department Ijegan 
in 181 7 health standards were low. An individual was satisfied with rather 
poor health because neither he nor his neighbor knew of the ]3ossibilities 
of a better standard. The ,-anie w-as true in even greater measure of collec- 
tive health called the health of the State, l^iday. the standards of individual 
and community health are far higher. It has been one function of the De- 
partmeiit to create reasonable discinitent with low standards. This will 
continue to be one of its functions. In time, health standards will be 
far higher, ^len will be discontented with conditions that now satisfy. 
Out of this, improveiuent will flow. .\ survey of the past gives us ground 
for facing the future with confidence. 



EXECUTIVE OFFICERS AND MEMBERS OF STATE BOARD OF HEALTH. 

Presidents. Date.' 

John H. Rauch. M. D 1877-1S79 1877 

H. Wardner, M. D 1S79-1SS1 1877 

J. M. Gregory, LL. D 1881-1884 1877 

Newton Bateman, LL. D 1884-1887 1877 

W. A. Haskell. M. D 1887-1S93 1881 

John A. Vincent, M. D 1893-1894 1893 

Wm. E. Quine, M. D 1894-1896 1893 

B. M. Griffith, M.D 1896-1897 1890 

L. Adelsberger, M. D 1897-1898 1897 

A C Corr M D 1898-1899 1898 

C. b'. Johnson, M. D 1899-1902 1897 

Geo. W. Webster. M.D 1902-1914 1900 

J A. Rcbison, M. D 1914-1917 1913 



Secretarys. 

E. W. Gray*. M. D., (from July to Dec.) 1877-1877 1877 

John H. Ranch, M. D., Act. Sec— Dec. to May 1877-1878 1877 

Anson L. Clark, M.D 1878-1879 1877 

John R. Rauch, M. D 1879-1891 1877 

Wm. R. MacKenzie, M. D Aug. 4 to Sept. 24, 1891-1891 1883 

F. W. Reillv, M. D. 1891-1893 1891 

J. W. Scott*, M.D 1893-1897 1893 

J. A. Egan, M. D 1897-1913 1897 

Amos Sawyer*, Act. Sec 1913-1914 1901 

C. St. Clair Drake, M. D 1914-1917 1914 



:>t the Board. Dr. Egan h< 



iber of the Board 



Board Members. Date.' 

R. Ludlam, M.D 1877 

W. M. Chambers. M. D 1877 

John McLean, M. D 1881 

R. L. McCain, M.D 1SS2 

Wm. R. MacKenzie, M. D., Sec. 

August-September, 1891 1883 

Geo. N. Kreider, M, D 1884 

A. W. H. Reen, M. D 1884 

H. V. Ferrell, M. D 18S7 

D. H. Williams M. D 1888 

Geo. Thilo, M.D 1893 

Sarah Hackett Stevenson, M. D.. ..1893 

J. B. McFatrich, M, D 1893 

Julius Kohl, M.D 1893 

Oscar O. Haines, M.D 1895 

D. R. Brower, M. D 1896 

Florence W. Hunt, M, D 1897 

P. H. Wessel, M. D 1897 

M. Meyerovitz, M. D 1897 



Board Members. Date.' 

G. R. Schater, M. D 189fi 

E. P. Cook, M.D 1896 

Z. D. French, M, D 1897 

C. H. Starkel, M.D 1896 

R. P. Bennett, M. D 1898 

J. C. Sullivan, M. D.. . 1901 

W. Harrison Hipp, M. D 1901 

Wm. 0. Forbes, M.D 1901 

Henry Richings. M. D 1902 

R. E. Niedringhaus, M. D 1905 

W. R. Schussler, M.D 1907 

C. J. Boswell, M. D 1909 

Adam Szwajkart, M.D... 1913 

! 1 Luster, M, D 1913 

T. B. Lewis, M.D 1913 

Thos. O. Freeman, M.D 1914 

J. J. Hassett, M.D 1914 

Enos S. Spindel, M. D 1914 

Felix Kalacinski, M.D 1916 



(•ill) 



ILLUSTRATIONS. 

PAGE 

Adult physical examination, Stat.- l;iii 208 

Annual appropriation, 1879-192" 207 

rerebro-.spinaI fever, meningitis 37C 

Chicago mortality rate, acute respiratory diseases, 1870-1910 93 

course of the total mortality in Chicago, 1867, 1SG8 90 

decennial mortality rates — all causes — Chicago, 1S70-1910 94 

mortality rates — Chicago — 1871-1879, 1922 91. 92 

Diarrhoea and Enteritis In Illinois 379 

Diphtheria rates in Illinois 360 

Field laboratory equipment 259 

Dr. George Fisher's neglected grave in Randolph County 275 

Health exhibit at fair 227 

Malaria in Illinois 3Sl 

Map — typhoid mortality in Illinois 347 

Map — White County, Illinois, on tuberculosi.s 372 

Map — Yellow fever districts in Cairo 330 

Number inspections all sanitary purposes 224 

.Number investigations proposed sewerage installations 223 

Number investigations public water supplies 223 

Number water analyses 224 

Organization State Board of Health, 1877 138 

Organization State Board of Health, 1901 16.t 

Organization State Board of Health, 1915 177 

Organization State Board of Health, 1927 199 

Population served from public water supplies 229 

rrevalence of venereal disease in Illinois 272 

Public water supplies installed 229 

Scarlet fever case reports 350 

Scarlet fever deaths in Illinois 349 

Seasonal distribution of deaths, 1843-1925 95 

Section of main laboratory at Springfield 255 

Smallpox in Illinois 308 

State fair better baby conference in action 237 

Tuberculosis deaths in Illinois 362 

Typhoid fever deaths in Illinois 342 

PHOTOGRAPHS. 

Adelsbers'i', Dr. l^oui.s, Waterloo 176 

Bain, Dr. Walter O., Springfield 245 

Bateman, Newton, LiL. D., Galesburg 124, 146 

Black, Dr. Carl E., Jacksonville 1". 1 1 ■'* 

Brainard, Dr. Daniel ■"' 

Bundesen, Dr. Herman N., Chicago 203 

Burrill, Prof. Thomas J., Urbana 244 

Cadwell, Dr. George, Kaskaskia 126 

Chambers, Dr. William M., Charleston 124 

Clark, Dr. Anson L., Elgin 124, 140 

Copeland, Dr. C. C Springfield 26S 

Cook, Dr. E. P., Mendota '19 

Corr, Dr. A. C. Carlinville 1^'^ 

Corr, Dr. L. H., Carlinville S7 

Craycroft, James Robert, first 100 per cent boy 241 

Cullom, Governor Shelby Moore 128 

Davis, Dr. N. S *" 



(412) 



PHOTOGRAPHS -ll-> 

PAGE 

Dilly, Orrin. Springflelcl 2S1 

Doan, Dr. Thomas D.. Palmyra 203 

Drake, Dr. C. St. Clair, Chicago 162, 190 

Drake, Dr. Daniel 37 

East, Dr. C. W., SprlngHeld 222 

Egan, Dr. James A., Chicago 1*2 

Esper, Gloria June, first 100 per cent girl 231) 

Evans, Dr. William A., Chicago 19", 2»3 

Ferguson, Harry F., Springfield 222 

Goodbrake, Dr. C, Clinton 40 

Gregory, John Milton, L.Ii. D., Champaign 124, 14G 

Griffith, Dr. B. M., Springfield 155 

Haller, Dr. F. B., Vandalia 61 

Hamill, Dr. Robert C, Chicago 66 

Hansen, Paul, Chicago 221 

Haskell, Dr. W. A 1S5 

Hemenway, Dr. Henry B., Springfield 266 

Howard, Sheldon L., Springfield 232 

Hoyt, W. H., Chicago 230 

Hrdlicka, Dr. Ales, (Washington. D. C.) 17 

Hull, Dr. Thomas G., Springfield 247 

Jewell, Dr. J. S., Evanston 41 

Johnson, Dr. C. B., Champaign 175 

Kessinger, Samuel W., Litchfield 267 

Leonard, Dr. Thomas H., Springfield '. 220 

Lillie, Dr. Charles W., East St. Louis i:t7 

Lowden, Governor Frank O., Oregon 183 

Ludlam, Dr. Reuben, Chicago .... 124 

MacKenzie, Dr. William R., Chester 140 

Mannheimer, Dr. Michael, Chicago 89 

Marquette, Father 117 

Massie, Dr. William. Edgar County 53 

McShane, Dr. J. J., Springfield 210 

Monroe, Mrs. E. X., Quincy 197. 203 

Palmer, Dr. George Thomas, Springfield 220 

Prince, Dr. David, Jacksonville. . 75 

Quine, Dr. William E., Chicago 15.t 

Rauch, Dr. John H., Chicago 124, 140, 14 6 

Rawlings, Dr. Isaac D., Chicago 190 

Reilly, Dr. Frank W., Chicago 162 

Reynolds, Dr. Arthur R., Chicago 313 

Richardson, Baxter K., Springfield 267 

Robertson, Dr. John Dill, Chicago 1 :i7 

Robison, Dr. John Albert, Chicago 175 

Ryan, Charles, Springfield 210 

Sawyer, Amos, Hillsboro 162 

Scott, Dr. John W., Springfield 162 

Searcy, Earl B., Springfield 266 

Skoog, Paul L., (California) 243 

Sloan, Dr. Edwin P., Bloomington 197, 203 

Small, Governor Len, Kankakee. ... 4 

Taylor, Dr. G. G.. Chicago 26S 

Vincent, Dr. John A., Springfield ' 155 

Wardner, Dr. Horace, Cairo. 124. 146 

Webster, Dr. George W., Chicago. . . 175 

Woodward. Dr. J. J.. (Washington. D. C.) 79 

Wright, Dr. John, Clinton 75 



INDEX. 

PACK 

— A — 

Abel, Ur. Theodore C, Chicago 25S 

Adelsberger, Dr. Louis, Waterloo 175, 411 

Advisory Board, members of 192, 196, 197, 203, 252 

Ague 2G, 35 

Allen, Dr. J debate on cholera 45 

American Bottoms 19, 23, 24, 30, 32, 34, 36, 41 

Amei'ican colonists 14, 403 

American Regime, The 27 

Amoebic dysentery, see Dysentery. 

Anders, Dr Chicago, on typhoid fever 76 

Andrews, Dr. C. N., Rockford 74, S5, S7 

Andrews, Dr. Edmund, Chicago 51, 53, 104 

Anemia 30, 33 

Anthrax 244, 252, 257 

Antitoxin distributed and Pasteur treatments 169, 215, 217, 219 

see Vaccines. 

Appropriations 133, 135, 137, 13!i, 143, 166, 169, 171, ISl, 185, 206, 207. 211, 216, 26S 

division child hygiene and public health nursing 235 

communicable diseases 211 

lodging house inspection 165, 265 

sanitary engineering 223 

tuberculosis t 220 

vital statistics 233 

for State Board of Health 133, 137, 157, 160, 168 

for State Department of Public Health 189,206 

graph on 207 

for vaccine farm. University of Illinois 157, 249, 311 

for water laboratory. University of Illinois 246 

for yellow fever epidemic 143 

Arnold, Dr. Lloyd, Chicago 25S 

Asthma 18 

Atwater, Dr. R. M 50 

Autumnal fever 34, 35, 36, 39 

Auxiliary health agencies 14, 171. 191, 220, 2S7-303 

— B — 

Baily, Dr. F, K., Joliet 69, 85, 86 

Bain, Dr. Walter G., Springfield 245, 254 

Baines, Dr. Oscar O., Chicago 411 

Barbee, Dr. Thomas, Marshall 67, 6S 

Bartlett, Dr. Elisha on typhoid fever 71, 73, 76, 77 

Bateman, Newton, LL. D., Oalesburg: 124, 125, 137, 146. 153, 411 

Beaumont, Dr 23 

Bemiss, Dr. S. M., (La. ) 143 

Bennett, Dr. R. F., Litchfield 411 

Berg, Elin, Springfield 10 

Better baby conferences 137, 178, 236, 267, 2S9 

Bilious fevers 32, 35, 3 6, 72 

Births 40S 

and infant deaths 113 

rales 19, 23, 29 

registration drive in Illinois 201, 234 

Black, Dr. Carl E., Jacksonville 118 

Black, Dr. Luther A., Chicago 233 

Black fly 19 

Black Hawk War 17, 31, 43, 102 

Black tongue 52 

Ulanc, William . . . .' 30, 278 



(414) 



INDEX 415 

PAGE 

Blankenmeyei-, Dr. H. C, Spiingfield 254 

Board of Health, see State Board of Health. 

Boggess, 30 

Bondurant, Dr. Flint 254 

Borendel, Dr. F., Peoria County 41 

Boswell, Dr. Chas. J., Mounds ■ill 

Boudin, Dr., , on typhoid fever and malaria 78 

Bovine tuberculosis 369, 374 

Bowen, Dr Joliet 39 

Brainard, Dr. Daniel 47, 48 

Breast feeding demonstration 240 

Breed, Dr Princeton SO 

Breen, Clara, Springfield 2, 10 

Brennan, Dr. Earl, East St. Louis 25S 

Bridges, Dr. T. B., Chicago 104 

British Regime, The 13, 26, 28 

Bronchitis 65, 90. 109, 408 

Brower, Dr. Daniel R., Chicago 411 

Buhlig, Mrs. Blanche, Chicago, committee on child hygiene 242 

Bundesen, Dr. Herman N., Chicago 203, 272 

Burns, Dr Mackinaw 38 

Burrill, Prof. Thomas J., Urbana 244,249 

Butler, Jlajor, (Washington, D. C. ) on dt-ntal hygiene 242 

— C — 

Cadwell. Dr. George, Kaskaskia ,. 126, 130 

Cahokia .' 23. 32, 34 

Cairo 32, 141, 172, 212, 377-338 

Cancer 17, 298, 305, 408 

Carr, Clark E., (1S50) 43 

Carroll, Dr , on typhoid fever. . . . .' 76 

Cassiday, Hugh, Springfleld 252 

Catlin, Dr. George 38, 49 

Cerebrospinal fever 64, 375 

graph on 376 

Chamberlain, Dr Kane County 42 

Chambers, Dr. William jr., Charleston 124, 125, 137, 279, 396, 411 

biography of 125 

Chancroid, see venereal diseases. 

Chapman, Dr. H. W., Whitehall 85 

Cheneoweth, Dr. W. J., Decatur 86 

Chicago, chronicle health and sanitation in ., 101—114 

fire (1S71) 106 

DeWolf, Dr. Oscar C 105,323 

drainage canal, sewage from 168, 245 

Evans, Dr. W. A 2, 196. 197, 203. 272. 291, 294, 302, 369 

health department 43, 44, 47, 50, S9, 247. 250, 261, 405 

annual reports of 87, 105 

Health history prior to 1877 101-114 

Mannheimer, Dr. Michael, charts by 89 

milk 300,301 

prohibiting sale of from tuberculous cattle 369 

Ranch, Dr. John H., appointed sanitary superintendent 105, 106, 107 

Reynolds. Dr. Arthur R 105. 166. 313 

Statistics 50, 51, S3, 87, 89. 90, 99, 102, 103, 104. 106. 107-114, 313, 320, 397 

annual death rates (1843-1877) 107 

consumption Ill 

diphtheria 109, 354. 356 

erysipelas 114 

malaria 113 

measles 112 

pneumonia 110 

respiratory diseases 110 



4:16 INDEX- 

PAGE 

Chicago, chrdiiuk- lu-:iUli ami sanitation in — Concluded. 

scarlet fever 103, lOi), 348 

smallpox Ill 

typhoid fever S3, 108, 16G, 33i). 340. 351 

whooping cough 112 

annual reports of, deaths all ages 87, il9 

deaths under 1 1)9 

deaths under 5 87, 89 

first death rates from 83 

graphs on , 89 

survey, tuberculosis 370 

Will you become a crusader, chart 369 

Chi.kenpox 253, 374 

investigation every reported case of 202, 312 

Chills 31, 32, 35, 38, 78 

see Malaria. 

Chirac (1742) on typhoid fever 71 

Cholera ■ • • • 

9, 17, 31, 53. 70, 78, S4, S5, 103, 105, 127, 136, 139. 141. 244. 305. 339. 353, 363, 383, 400 

death of Governor Ninian Edwards from 44 

debates on 45 

epidemics in Illinois • 321-327 

infantum 86, 104, 106 

morbus 72, 86, 104 

pandemics of 43 

prohibit transportation of bodies dead from 150 

rules and regulations for control of 150 

Civil Administrative Code, adoption of 134, 135. 182, 1U2, 207, 211, 225 

powers and duties under '. 184 

Clark, Dr. Anson L,, Elgin 124, 125, 137, 139, 140, 153, 411 

biography of 125 

Clark, George Rogers 13. 14 

Clay. Dr. A. J.. Hoopeston 67. 68 

Colburn. Dr Bloomington 3 6. 52 

Coleman, Dr. J. W., LeRoy 85 

Colonial pei-iod 28 

Communicable diseases, rules and regulations concerning 

132, 148, 150, 156, ISO, 185,210 

curative measures for 166 

Consumption IS, 19. 20, 24, 32, 41, 60, 97. 404 

annual death rate from, in Chicago llo 

Cook, Dr. K. P.. Mendota 49, 69, 75, 76, 80, 86, 249, 411 

Cook, Dr. P. M., Chicago 44 

Cook, Dr. Robert C, Springfield 235 

Coolidge, Dr (Washington, D. C.) 64 

Copelan, Dr. C. C. Springfield 268 

Corr, Dr. A. C, Carlinville 175,411 

Corr, Dr. Lucinda H.. Carlinville 87. 88 

County health departments 195. 196. 198, 257 

deCourey. Dr. .lames, assigned to Cairo 336 

Crawford. Dr on typhoid fever 74, 75, 76 

CrawforO. 1 ir. ('litis !•:., Koekford 211 

Crippled rhildren's cliliii-s ilisciintinued 199. 235. 380, 406 

Croghan 26 

Crothers. Dr Bloomington 64 

Crowley. Dr. W. .S 252 

Cullom, Governor Shelby Moore, Springfield. 128, 280 

Cunningham, Dr. V\'. H.. Rockford 25s 

Cynanche. death of George Washington caused by 55 



Pappert. A. F.. Springfielil 2 

Davis. Dr. X. S 40, 4.t. .")L>, o7. 70. 74, 7fi. 8.5, SS, 3SS 

debate on cholera . 45 

Dawson, Dr on typhoid fever 70 

Deaths, see Mortality 

deLiesseps 2n 

Deneen, Governor Charles S., Chicago 169 

Dengue, pandenic of 4fi 

Dental demonstrations 200. 242 

Development of State health service 133 

three periods 133, 13S, 16.t, 177, 199 

four personalities 134 

DeWoIf. Dr. Oscar C. Chicago 103, 323 

Diarrhoeal infections 14, IS, 20, 21, 25, 30, 41, 72, 81, 85, 90, 305, 377, 398, 403 

among Indians - S3 

annual death rates, Chicago 104, IDS, 354 

in adults 84, 86 

infant mortality due especially to S6— S8 

mortality from 377 

graph on 379 

Dickinson, Dr Peoria 39 

Dickson, Dr. S. H on typhoid fever 79 

Diehl, Dr. C. H., Effingham 29 6 

Dilly, Orrin, Springfield 231,233 

Diphtheria 9, 96, 136, IGS, 247, 250, 253, 304, 3S3 

among Indians 55 

Annual death rate.s, Chicago 104, 108, 354 

cases of 357 

carriers , 358 

distribution of antitoxin for 216, 217, 244, 353, 401 

mortality from 353, 357, 360 

graph on 360 

outbreak at Rock Island 259. 260 

phenomenal progress in eradication of 3{ 6 

prohibit transportation bodies dead from 150 

rules and regulations for control of 150 

Directors, State Department of Public Health 182, 190 

Division of child hygiene and public health nursing 189, 199, 231 

committee on child health needs in Illinois 200, 242 

of communicable diseases 185, 210 

of general oflice 185, 209 

of laboratories, biological and research 189, 247 

diagnostic , 181, 186, 193, 245, 247 

of lodging house inspection 164, 171, 173, 186, 265 

of public health ins ruction 189, 192. 286 

of sanitation 185, 221, 243, 247, 381 

of social hygiene 188, 247, 268 

of surveys and rural hygiene 189, 206, 243 

of tuberculosis 185, 220 

of vital statistics 186, 230, 254 

Doan, Dr. Thomas D., Palmyra 203 

Doane. Dr. Phillip S., Chicago 334 

Drainage, see American Bottoms 

Drake, Dr. C. St. Clair, Chicago 135, 162, 225, 411 

appropriations under 191 

biography of 1 9(i 

regime 135, 174-194 

Drake, Dr. Daniel 19, 36, 37, 38. 39. 43, 47, 52, 54, 57, 60, 64, 67, 6S, 73, 78, S4, 397 



41 S INDEX 

I'AUK 

Dropsy IS 

Driide, Dr. Francis. Quincy 33 

Dunne, Govermir lOdward F., Chicago 174, 181 

Dupray, Martin . 254 

Dysentery '.I, 14, IS, 20, 21, 2r.. 2S, 30, 72, 78, 86, lis, IGS 

annual deaths and rates in Chicago 104, 114 

mortality from 84 

Dyspepsia 57 

— E — 

East, Dr. C. AV., Springfield 1S7, 211, 2:!4 

lidgar, rapt. I. D., (Washington, D. C.) .«4 

Edgar, Dr. W. S. debate on cholera 45 

Educational propaganda ... 135, 176. 206 

Edwards, Governor Xinian, death from cholera 44, 129 

Egan, Dr. James A., Chicago 78, 177, 232, 253, 336, 337, 411 

appropriations under 135 

regime 134, 159-174 

Egyptian mummies 21, 5» 

Ellis, Dr. C. C, Moline 233 

Embalmers, law passed regulating practice 2S5 

English, Dr Jacksonville 3S 

Epizootic, horses died from in Chicago lOG 

Krasmus. scientist, on t.vpho'd fever 72 

Ergot paralysis 64 

Erysipelas 50, 52, 54, 65, 104, 1C.5, 4I12 

annual death rates in Chicago 114 

Evans. Dr. Wm. A.. Chicago 2, 1!16, 197, 203, 272, 2!)1, 294, 302, 369 

Exhibits 135, 176, 178, 206, 267 

Eye troubles 33 

— F — 

Fancher, Homer C, Chica.i^o 1*14. 265 

Faught, Eva E., Carbondale 252, 25S, 263 

Felder, Dr, W. Ij , on fevers 78 

Ferguson, Harry F., Springfield 222 

Ferrell, Dr. H. V., Carterville 411 

Fisher, Dr. George, Kaskaskia 130, 273, 275 

Fitch. Dr (Ind.) 52 

Flagg. Dr Edwardsville 32 

Flint, Dr. Austin on typhoid fever and malaria 7S 

Fluxes 18, S6 

Food poisoning 81, 24(1, 257 

Forbes, Dr. Wni. ()., Chicago 411 

Fordham, Dr (England) 32 

Forry, Dr. . .' (Washington, D. C.) 64, 102, 397 

Fort Cbartres 26, 34 

Foreword 9 

Foster, Dr. I. H., Chicago 211, 371 

Freeman, Dr. Thomas O., Maitoon 411 

French-Canadian Regime, The 13. 15. 22. 28, 29, 49. 53, 39S, 403 

French, Dr. A. W., Springfield 115 

French, Dr. Z. D., Lawrenceville 411 

Fruterrer. Dr. Oustav, Chicago 245 

Fry, Luella, Springfield 253 

Frye. Dr. J. C. Peoria 38, 39 

Fults. Dr. J. C, Waterloo 335 

— G — 

Callhrieth. Dr un pui-rp.ral fever 65 

(landr.lphr, Tir. .Mi.hel mi ..ligin of syphilis 59 



INDEX 419 

PAGE 

Ganott, Dr. Erasmus, Chicago 315 

Gates, Dr. JoseiJh, Marine 68 

Gehrmann, Dr. Adolph, Chicago 247 

General health history prior to 1S77 15 

Genesis of public health law 127 

Genetics 408 

Gerhard, Dr (Penn.) on typhoid fever 71, 73 

Gerhard, Dr. Frederick, Chicago 41, 61 

Gilchrist, Dr. (1735) on typhoid fever 71 

Gilmore, Dr. "W. H.. Mt. Vernon 257 

Glackin, Senator Edward J., Chicago 179, 220, 291, 366 

law for tuberculosis sanatoria 163, 172, 179, 365, 368, 371 

Godfrey, Dr. E. S., (Xew York) 211 

Goitre sufvey 242 

Gonorrhea ^ -'-'. 24. 60, 254, 270, 298 

Goodbrake, Dr. C, Clinton 40, 85 

Goodell, Dr. W. L., Effingham 86 

Gorgas, General William Crawford 25 

Gout 18 

Graphs, see Illustrations 

Graves, Dr. X. A , Chicago 293 

Gray, Dr Jefferson County 57 

Gray, Dr. Elias \V., Bloomington 130, 131. 132, 137, 139, HO, 411 

Gray, Dr. Ethan A., Chicago 368 

Gregory, Dr. John Milton, Champaign ' 124, 125, 137, 146, 411 

biography of 125 

Griffiths, Dr. B. M., Springfield 153,155,411 

Griflitts, Dr. T. H. D 233 

Grinstead, Dr. W. F., Cairo 334 

Guiteras, Dr. John (.Ala.) 335 

Gumston, Dr. C. G on typhoid fever 70 

— H — 

Haines. James 31, 43 

Hale, on unity of fevers 73 

Hall. Dr. L, , Kane County 40 

Hall. Dr. Thomas. Toulon 64, 84, 85 

Haller. Dr. F. B., Vandalia 40, 61, 118 

Hammill, Dr. Robert C, Chicago 33. 53. 61, 66, 89 

Hamilton, Dr. John B., Chicago 335 

Hamtranmck, Major 26 

Harmon, General J 26 

Hansen, Paul, Chicago 221 

Harris, Dr. J. O.. Ottawa 87 

Haskell. Dr. W. A., Alton 153, 155, 411 

Hassett, Dr. J. J., McLeansboro 411 

HauU, Dr on puerperal fever 66 

Health conditions in Illinois after 1S77 304 

promotion week 135, 179, 294 

Heart disease 305, 408, 409 

Hemenway, Dr. H. B.. Springfield 266 

Menkes, Kirby, Springfield 252 

Hennepin, Dr on milk sickness -. 67 

Henry, Dr Springfield 38 

Henry, Dr. Alexander 18, 19 

Henry, Dr. J. F., Bloomington 36, 52 

Hepatites, chronic 57 

Hewins. Dr. L. T., Loda 46, 86 

Hildreth. Dr. S. P., (Ohio) 33, 65 

Hipp, Dr. W. Harrison, Chicago 411 



420 INDEX 

PACE 

Hiisch, Dr 43. 14. 47. 49, 50, 55. 56. 57. 63, 64, 65, 71, 7S 

History of certain diseases prior to 1S77 35 

after 1S77 304 

steps in establishment of typhoid fever as a specific disease 70 

Hoffman, (1728) on typhoid fever 71 

Hoffman, J3r. T. A.. Heanl.stown 41 

Holder. A. H 19 

Hollister, Uv. .1. H., on niir.sing sore mo\ith '69 

Holmes. Dr. Oliver Wiiulcll ..43, 66, 73, 74 

Holmes, Dr. \V. H 254 

Holsten. Dr , on puerperal fever 65 

Howard. Shehinn b . SpriMSfiekl 232 

Howland, Dr Ottawa 39 

Hoyt, W. H., Chicago 20S, 232, 233, 253 

Hrdlicka, Dr. Ales, (Washington, D. C.) 17, IS, 1!), 20, 49, 53, 55, 58, 60 

Hubbard, Gordon S., Chicago 22. 23, 102 

Hull, Thomas G. Springfield 247, 252 

Hunter. Dr. I. \V.. on origin of syphilis 60 

Hunt, Dr, Florence W., Chicago 411 

HurUiert, Dr Ottawa 39 

Huxhaiu (17S4) on typhoid fever 71, 72 

— 1 — 

Ilkemire, Dr. J. A.. Palestine 258 

Illinois and Michigan Canal 40, 42, 101, 106 

Illinois Medical Society formed 39 

debates on cholera 45 

Immigrants 29, 35, 47, 66, 101, 136, 142, 147, 154, 172 

measles brought in by 54 

smallpox carried by 50 

Indians 13, 15, 17, 19, 21, 39, 53, 39S 

diarrhoea! diseases among S3 

high death and low birth rates 29 

smtillpox, disease of 49 

syphilis among 58 

Indigestion IS 

Infantile paralysis 187, 234, 370, 379 

clinics for 199, 235, 3S0, 406 

table on 3S0 

Infant mortality 19, 30, S6-8S, 242, 393, 403 

among Indians 19 

annual death rates in Chicago 113 

detailed rates on 201 

Infants, diseases among 14 

Influenza 90, 96, 191, 404. 40S 

and pneumonia, epidemics of 62 

mortality from in Chicago 109 

Ingals. Dr. E debate on cholera 45 

Intermittent fever 26, 35, 36, 40, 72, 78 

annual death rates, Chicago 113 

Intra-departmental organization 208-272 

Introduction 13 



Isthmus of I": 



on unity of fe 
Jayne, Dr Springfield. 



Jenner, Dr. Edward, (England) . . 320 

Jenner, Sir U., (1849) (England), on unity of fevers 72 

Jesui's 24. 32, 42 

Jewell, Dr. .1. S.. iOvanston 41, 70 



INDEX 421 

PAGE 

Johnson. Dr. C. B.. Champaign 42. .->5. 64, SO, 82, 17.">, 390, 411 

Johnson, Dr. Hosmer A., Chicago 10.5, 143 

debate on cholera 45 

Jonas, M. M., Chicago 1C4 

Jones, Dr Jacksonville 3S 

Jones, Dr. H. W.. Chicago 66 

Jones, Dr. Joseph, (Ohio Valley) .").S 

— K — 

Kalacinski, Dr. Felix, Chicago 411 

Kaskaskia 23, 26, 32, 34, 273, 277 

bottoms 115. lis 

removal of capital from ^ US 

survey of prior to 3 877 116 

Kessinger, Samuel W., Litchfield 267 

Klebs, Dr. A. C, Chicago 2S0, 293 

Koch discovery of anthrax and tuberculosis bacillus by 244, 364 

Koehler. Dr. C.ottfried, Chicago 2, 102 

Kohl, Dr. Julius, Belleville 411 

Kramer on origin of syphilis .59 

Kreider, Dr. George X., Springlield 411 

— I. — 

Laboratoi-ies, branch 258 

certificates of approval for 262 

diagnostic, biological and research 1S6, 1S9, 193, 247, 24S, 254 

examination of water supplies 244 

equipped tor making diagnostic examinations 166, 173, ISl 

investigations conducted by 252 

total examinations, table on 256 

LaFeve French trader 39 

Lakes and ponds, stagnant 34 

Lancise (171S) on typhoid fever 71 

Laub, Wm. G., Chicago 265 

Leasure, Dr (Penn. ) on puerperal fever 65 

LeBlanc, on malaria 25 

Legi-slation 129, 130, 132, 133, 198, 215, 24S, 311, 404 

important health laws enacted 179, 214, 216, 271, 272, 374 

medical practice acts 273—286 

organization of State Board of Health 127, 137, 404 

regulating practice osteopathy 284 

requiring pasteurization of milk 204 

Leonard, Dr. Thomas H.. Springfield 220 

Lewis, Arch, Chicago 265 

Lewis, Dr. T. B., Hammond 411 

Liller, Dr. J. (',., Woodford County 41 

Lillie, Dr. Charles \V., East St. Louis 196, 197 

Lincoln, Abraham 67, 115, 137 

Lincoln, Nancy Hanks, death from milk sickness 67 

Lister, Lord, (England) 131, 244 

Local boards of health, creation of 172, 1S9 

attempts to improve 196 

Local health district and law providing for establishment of 179, 215 

Lodging house inspection 171, 173, 208 

act creating 164 

chart on 165 

Long, Dr. Esmond H on consumption among Puritan fathers 20 

Long, Prof. John H., Chicago 245 

Lortel on origin of syphilis 59 

Lot.ery, see American Bottoms 

Louis (1829), treatise on typhoid fever 20, 70, 71, 73, 75 



422 INDEX 

PAGE 

Lovvden, Oovcrnor Frank t)., Oregon 135, 179, 182, 183 

Lowry, Dr. Kdith H., St. Charles 236 

Ludlam, Dr. Reuben, Chicago 124, 137, 153, 411 

biography of 125 

Luster, Dr. R. D., Granite City 411 

— M — 

MacCulIiK-li, .IcliM (1S2!1) 35 

MacKenzie, Dr. Wni. R., Chester 140, 152. 153, 411 

Malaria 

9, 13, 19, 20, 21, 24, 25, 26. 28, 30, 33. 39, 12. 47, 73. 74. 77. 78. 84. 90. 118, l(i8, 254, 399 

and typhoid fever 69-83 

annual death rates in Chicago 104, 113 

cases of 382 

French no immunity to 25 

history of prior to 1877 35 

mortality and rates 382 

graph on 381 

noticeable decline in 304 

Mann, A. H., Springfield, inspector at Cairo 334 

Mannheimer, Dr. Michael. Chicago, concerning charts by 89, 105 

Manse, Dr. Hiram, Lafayette 87 

Marquette, Father IS, 23, 42. S3. 117 

Marriages 13. 23, 26, 397 

Massie, Dr. Wm., Grand View 53 

Maternity and child hygiene 199, 238 

advisory committee on 200 

Sheppard-Tovvner Act 200, 238 

Matthews, Dr. J. P., Carlinville 85 

McCain, Dr. R. L 411 

McClanahan, Dr. B. V., Galesburg, committee on child hygiene 242 

McCulloch, W. W., Chicago 265 

McFatrich. Dr. J. B., Chicago 411 

McGarragh, Dr , on milk sickness 68 

Mcllvaine, Dr. T. M., Peoria 150 

Mcintosh, Dr. Donal, Urbana 249 

McLaughlin, Dr. R. G., Heyworth 85 

McLean, Dr. John. Pullman 411 

McShane. Dr. John .1., Springfield 210-219 

McVey, Dr Morgan l^>unty 53. 57 

Measles 33. 96, 366. 374. 383. 402 

annual death rates in riiicuRo 104, 112 

brought in by iiuniigiants 54 

cases of 385 

Medical examination of school children 238 

Practice Act, The 127, 130, 132, 156, 159. 273 

acts of 1817, 1819, 1877 273-286 

divorced public health service and I'cgulation of 182 

minimuin retiuirements 282 

standards for medical education 281 

Meeker, Dr , Chicago 52 

Members, State Board of Healt^h 124, 137, 411 

biographies 125, 137, 190 

Menard, Pierre, ^TCaskaskia 273, 276 

Meningeal fever 57 

Meningitis 56. 64, 375, 403 

graph on 376 

Merriman. Dr , Springfield 38 

Mettaurer, Dr , (Va.) on fevers 7S 

Meyerovitz, Dr. M., Chicago 411 

Midwives, certificates to practice required 2S5 



INDEX 423 

PACK 

.Milk 164, ISl, 202, 204, 227, 2.52, 257, 260, 301, 342, 350, 369 

niudel ordinance for 202, 204 

pasteurization of 202, 226, 260, 395 

sickness 66, S4, 400 

mortality from 67 

prevalence of 66 

Miller, Dr. Ben S., Chicago, appointed .'ianilary .supeiintendent 106 

Missionaries 13, 22 

Mitchell, Dr. R. W., (Tenn.) 143 

Model milk ordinance adopted 202, 204 

Modern health crusade 290, 294 

Modified Quarantine 213 

Monette, Dr. J. W., (Miss.) 73 

Monroe, Mrs. E. N., Quincy 19(1, 197. 203 

Morbidity, decrease in summer sickness rates 404 

general unhealthfulness , 29, 39S 

see various diseases. 

Morg-an, (176S), on ague and fever 26 

Morgaginni (1761) on typhoid fever 71 

Mortality 25, 62, 202, 230, 234 

all causes 96, 97 

certain causes, Illinois and Chicago, tables on 96, 304 

children under 5 years, table on 88, 89 

cholera 43-46 

diarrhoeal infections 377, 378 

diphtheria 55, IDS, 353 

increasing span of life 410 

infant 19, 30, 86, 113, 201, 242. 393, 394, 395, 403 

measles 43, 385 

milk sickness 67 

pneumonia and influenza 62, 388 

population and number deaths, tables on 98—100 

rates 29, 304, 398, 409 

all causes 96, 343, 351, 354. 364 

annual, certain diseases 107 

infant . 394 

Springfield 116 

tuberculosis 364 

typhoid fever 108 

see Chicago statistics 

scarlet fever 351 

smallpox 310 

tuberculosis 361 

typhoid fever 82, 108, 338 

see illustrations, Chicago statistics 

Mosquitoes 19, 25, 35, 36, 46, 101, 381, 400 

Mound builders 13, 15, 58 

Murchison, Dr. Chas. (1862) on typhoid fever 71, 339 

Murphy, Dr. J., Peoria ! 39, 87 

— N — 

Nance, Dr Lafayette 53 

Nauss, Dr. Ralph W 252 

Neely, Dr. John B., Chicago 334 

Nelson, Dr. C. S., Springfield 211,335 

Neuralgias 57 

Niedringhaus, Dr. R. E., Uranite City 411 

Noble, Dr. Harrison, Bloomington 61, 70 

Notthaft (Cermany) on origin of syphilis 59 

Nursing service 230 

Nursing sore mouth 69 



451 INDF.X 

PAGE 

— o— 

Olson, Dr. (_'. \V., I, ..ml. aid 364 

Ophthiilmiu neonatoitnii 33, 289 

epideniif ^'^ 

Osborne. Governor Chase (Xrii-h.) ^1 

Osier, Dr. Wm "•• 

Outbreak of yellow fever starts machinery for control of epidemics 141 

Owen, Dr. Dale, (Ind.) 6S 

Oysters, typhoid fever .-ittributed to 204, 214, 257, 34C 

— P — 

Palmer, Prof. Arthur Wra., Urbana 221, 246 

Palmer, Dr. George Thomas, Springfield 1 S5, 220, .■!36, 371 

Panama canal, deaths in 25 

Paralysis, ergot 6* 

Parkman IS, 23 

Parran, Dr. Thomas, .Ir., (Washington, D. C.) 198 

Parrish, Randall 44 

Pasteurization, law passed re(iuiring 202 

milk supplies 164, ISl, 260, 301, 342, 350, 395 

Pasteur (France) 131, 169, 244 

Payne, Dr. H. R., Marshall 40 

"Petechial fever" (typhoid) 70 

Petit (1814) on typhoid fever 71 

von Pettenkofer, JIa.x, (Germany) 105, 114, 131, 137, 339 

Pettit, Dr. J. W., Ottawa 293 

Pettit, Dr. Roswell T., Ottawa 258 

Phillips, Dr. G. W., Dixon 61 

Physical examinations, annual 206, 242, 298 

scientific examination of returned soldiers 373 

Pickett (Ala.) 13 

Pierce, Dr. C. (".. I Wasbiiiut.in. D. ('. ) 272 

Plague 400 

Pleurisy 33, 109 

Pneumonia 19, 20, 25, 30, 33, 62, 96, 387, 398, 404 

and influenza • - • 62 

annual death rates in Ghicag.. 109 

cases of .* 3 8 S 

graph on 389 

Poles, in Illinois , 28 

Poliomyelitis, see infantile paralysis 

Ponds and lakes, stagnant 3 4 

Population of Illinois, increase in 100 

and number of deaths, tables on 9S 

Powers and duties, under State Board of Health Act 184 

under ophthalmia neonatorum act 185 

under vital statistics act 184 

under miscellaneous acts 185 

Preface 7 

Presidents, State Board of Health 146, 155, 175, 411 

Prince, Dr. David, Jacksonville 75 

debate on cholera 45 

Prosser, Dr Jacksonville 38 

Prost, (1804), on typhoid fever 71 

Public health administration in Illinois 127-272 

intra-departmental organization 208-272 

Puerperal fever 50, 51, 53, 54, 74, 202, 402 

epidemic of 65 

Puritan fathers, suffered from i.insumption 20 

"Putrid fever" 53 



IXDEX 425 

PAGE 

— Q— 

Quaife 31. 102 

Quarantine, during: yellow fever epidemic 142, 327, 3:i0 

modified 213 

rules and regulations pertaining to 132, 150, 180, 210, 212 

yellow fever committee appointed 143, 334 

Quine, Dr. W. E., Chicago G6, 150. 411 

Quinine 42, 77 

— R — 

Rahie.s 215, 251, 253, 256 

vaccine for 219 

Ranch, Dr. John H., Chicago 

102, 105, 106. 107, 124, 125, 131, 231, 266, 2S0, 303, 339, 396, 411 

appropriations under 137, 139, 141 

biography of 125 

general State sanitary survey ■. 147, 198, 339 

regime 134, 139-159 

resignation of 153 

yellow fever outbreak at Cairo 141, 327 

Rawlings, Dr. Isaac D., Chicago 2, 161, 190, 312, 407 

advisory board appointed 196, 197, 203 

appropriations under 206