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

THE UNIVERSITY

OF ILLINOIS

LIBRARY

fc 14.09
PiQr

llUNOtS niSTORICAl SURYn

-.^lv.:^J^:| .

IJLLJNOJS HISTORICAL 8UBVET

The Rise and Fall
of Disease

Illinois

voi.i >ii: li

Local Health Conditions antl Public llenlth >Vork

ISAAC 1). KA\VLIiN(;S. M.I).. Director of I'ublic lloaltli

The Rise and Fall

Disease in Illinois

ISAAC D. RAWLlXiS. M.S., M. D.

in oollnhorHtion with

WILLIAM A. EVANS. M. D., D. 1*. H..
GOTTKKIED KOEHLER. M. D., and
HAXTER K. RKHAHDSON. A.I!.

PUBLISHED BY

THE STATE DEPARTMENT OF PUBLIC HEALTH

IN COMMEMORATION OF ITS FIFTIETH ANNIVERSARY
1927

ILLUSTRATED WITH C.HAPHS DEVELOPED AND DRAWN

BY A. F. DAPPERT. AND WITH PICTURE REPRODUCTIONS

OF MANY PERSONS ASSOCIATED IN ONE WAV

OR ANOTHER WITH THE STORY

INDEXED BY CLARA BREEN

PHILLIPS BROS. PRIST
SPHIXGKIELD, ILLINOIS

6 19-. 2

ACKNOWLEDGMENTS.

The author and collaborators are indebted to local
health officers, physicians and others for the collection
of much of the material upon which the stories in this
volume are based. For the many courtesies and ser-
vices extended in that \va}', grateful appreciation is
herewith expressed.

66474G

CONTENTS

Introduction 9

History of Local Health Service 12

Down-State ^iunicipalilies

Alton 15

Aurora 26

llelleville 37

rSlooniinqton 48

Cairo 62

Carbondale and Jackson County 71

Champaign- L'rbana 82

Cicero 95

Danville 101

Decatur 107

East St. Louis 118

Elgin 132

Evanston 143

Freeport 159

Galesbvirg 166

Jacksonville 173

jolict 188

Kankakee 199

Kewanee 207

LaSalle. Ogleshy and Peru 216

:\foline 228

Oak Lark 238

Peoria 247

Ouincy 262

Rockford 280

Rock Lsland 303

Springfield 314

Chicago 326

The Sanitary 13istrict ^^lovenient 394

The Chicago Sanitary District 595

The North Shore Sanitary District 409

Other Sanitary Districts 409

(7)

The Tiilicrculosis Sanilariuni Movement 413

Rural Ilealtli Service 421

Sanitarv Supervision of Milk 426

A]>])endi.\ 433

Annals of Health, Sanitation and Public Health Service 435

index 455

INTRODUCTION

By IT'. A. Evans

In this \ Illume there hns lieen gathered as much of tlie histories of
local departments of health as could be found. The nmre general histor\-
of health in the State should be supplemented by the health histories of the
larger ami more important communities. This has been done insofar as
was possible. The history of local health departments has been more uneven
than that nf the State health department. The curves of those histories
run parallel to a surprising degree and in doing so illustrate some of the
moti\es which originate health department work.

The Chicago health department was organized after a fashion about
as soon as that of any local government. This organization came about
as a measure of protection against some form of contagion. As the years
went by the type of organization, the degree of organization and the support
rose and fell with prevalence of contagion. In most cases the health de-
partment was little more than a paper organization during times of com-
parative safet}- and was either revamped and electrified into life or discarded
and replaced once the town woke up to the presence of contagion. These
sporadic outbreaks of health work were sometimes governmental exclusively,
sometimes they were wholly voluntary, a resumption of the basic rights of
a people to protect themselves, and sometimes they were combinations of the
two in \arying proportions.

As a rule these outbreaks of interest in health followed the spread of
epidemics. However, in the case of cholera and smallpox in a few instances
the community recognized the danger before it arrived and organized in
ruhance of the coming of the epidemic. Such sanitation as was done was
usually closel_\- related to the prevention of the disease that then threatened,
according to the ideas of causation of disease which then pre\ailed.

This is a brief statement of the health work done in Chicago and the
philosophical basis thereof between 183.i and 18(i6. one-third of a century.

It is the basis of such other local health department work as was done
in the ."-^tate during that period. The State had no health department but
many cities, towns and villages did have — albeit such departments alternately
sle|)t and worked. The work periods were principally the result of epidemic
disease waxes such as cholera waves and smallpo.\ wa\es. There was some-
thing of a revival of local health work subsequent to the Civil War. The
returning army surgeons and e\en soldiers of the line had learned something

(9)

10 INTRODUCTION

of sanilalion from their army experiences and they were inthiential to y>nie
extent in c^alvanizinj,'^ tlicir local heallh ilepartments into work.

Fortunately the great pliilanthropic agency which had functioned a-- a
civilian aid in Illinois during war time had incorporated the word sanitary
into its name. This had a marked effect in creating a suhstitution for lualth
work.

Chicago at this time came under two strong influences, one was the
personal and professional influence of Dr. John IT. Ranch, a returned army
surgeon and other ex-army surgeons. The other was the example set by
New York City where Dr. Stephen Smith, ex-army surgeon, and his asso-
ciates had persuaded the people to scrap their existing heallh department
and form a metropolitan board of health.

The Chicago health department report of 1869 remains an outstanding
public document. Few if an}-, equalling it are found in the field of public
health of the period.

From that time until the early eighties local public health work in the
State, when there was any, followed the Chicago lead. About 1880 Dr. John
H. Rauch transferred his services from Chicago health department to the
Illinois Board of Health. Soon thereafter he made a health survey of
Illinois. This survey was in part, by way of preparation for an epidemic.
It followed the lines of the periodic health surveys made in the face of
epidemics in Chicago several decades previousl)'. However, it had great
merit of its own and was no inconsiderable measure since never before
nor since has a health survey comparable in magnitude to it been made in
Illinois. The State Department of Public Health survey made in 1926 was
far more complete and detailed, in so far as it provided data upon which to
appraise local public health facilities, but it related to only fifteen cities.
The 1882-1883 survey of housing was much more complete so far as it went,
liut it related to housing only and it extended to but few communities. Other
surve\ s, such as the Springfield and Chicago sur\eys, have been limited each
to one community.

Thus followed a period of revival of local health work in the State
partly ;is a result of stimulation from the State Board of Health. By the
early nineties the movement for local health work had begun to wane. Some
revival after the World's Fair of 1893 is noticeable. This was partly a
result of an epidemic of smallpox in that year. It was also partly the result
of the awakening in many lines which resulted from the \\'orld's Fair.

iMom the waning of that wave until 1908 local public health work in
the State did not prosper. Some local health departments were abandoned
and some were starved into innocuous desuetude. Smallpox, malaria and
cholera had decreased to the point where the people were no longer afraid

INTRODUCTION 11

and therefore vinwilling to pay for protection. At the same time the new
standards and new concepts out of which present day health departments
grow had not been born.

Soon after the revival of the Chicago health department in 1907 the
influence of that department on local health departments elsewhere in the
State was noticeable. The year 1908 inaugurated the third era of domina-
tion of the Chicago influence in local health work in Illinois. Throughout
the State a noticeable tendency to reorganize health departments, to build
contagious disease hospitals, to fight consumption and other contagion and
to protect the milk supply is recognizable.

This third Chicago era lasted until about 1922 or 1923. About this
time was begun the second period of State intluence — the first having been
the Rauch era of the early eighties.

For about five years now the tendency toward the growth of local
health departments along fairly uniform lines can be seen. These depart-
ments are establishing divisions of vital statistics, securing laboratory facil-
ities, having work of sanitary engineering done, building contagious disease
and tuberculosis hospitals, doing infant welfare work, promoting school
inspection and in other ways building up health departments along lines
proven to be right by large experience. The formation of county health
departments has begun.

Without in any way belittling the courage, lirains and initiative of the
local communities in these matters the fact remains that this is a period in
which the leadership is at Springfield, rather than in Chicago. The State
Department of Public Health finds its source of strength in well-developed
local health departments. It will not stop until every city and every county
separately or in effective combinations will have efficient local health work.
When that day arrives the State Department will be a coordinating agency,
but as matters now stand it must function as a local health department over
most of the State and for most of the people.

This is true at least in times of emergencx . For a State agenc\- to
function as a local agency and often as the only local agency is unscientific
and makes for inefificiency and waste.

The incompleteness of this treatise as a series of local histories of
health and public health service in the State is recognized. It is hoped that
one good effect of the publication will be the stimulation of local interest
in local health histor\- and conditions to an extent that will make available
many facts that are not now available and a splendid improvement in health
conditions.

GENERAL VIEW

Public health service is fuuml in e\ery (k-i;i-L-e nf efiiciency in Illinois.
Chicatjo. I'lvnnston, Rockford and a district (.-inljiTiciny LaSalle, (Jglesby
and Pern liaw health departnimls thai ciini|iarr faxorahU' in organization,
personnel and activities with the best municipal health departments in the
wdrld. A few communities elsewhere in the State provide too meagerly
for health protection to escape the other extreme in efficiency and adequac)'.
Most of the incorporated municipalities maintain official public health organ-
izations strong ehough to function with reasonable satisfaction under stress
of emergency but not many are provided with health departments commen-
surate with the constant public needs and qualified to apply modern sanitary
and h_\gienic principles on a scale that approaches the maximum for profit-
able retiu'ns.

There are several types of municipal he;dth departments in the State.
Some cities have boards of health authorized under the general laws. Usually
these boards function only as technically legal agents leaving administrative
matters largely in the hands of an executive officer employed for that pur-
pose. Other cities have the commission form of government where the
city council has supreme authority in all municipal matters and public health
service comes under the jurisdiction of one of the commissioners. In still
other places, Berwyn and Quincy at present, public health districts embracing
the township have been erected by popular vote and while the districts are
coextensive with the city boundaries they are managed independently of the
municipal government. There is one privately endowed health department,
the Hygienic Institute, which serves LaSalle, Oglesby and Peru. In Jack-
sonville the city public health service is provided by an organization jointly
supported b\' the cit\' and the countx'. a single health officer directing activi-
ties for both.

Um-al health service is not so well developed as the municipal. .\t this
particular time three counties, Cook, Morgan and Pulaski, are maintaining
full time, well manned health departments capalile of serving to a satisfactory
degree all of the rural population in each. Three or four other counties
have underfaken to do likewise but Iia\c abandoned the project after Iirief
periods. .\ lack of legal authority to appropiiale funds for whole time
permanent public health organizations seems to be one of the main reasons
wh\- rural Illinois is backward in providing a reasonably adequate public
health service for itself.

(12)

GENERAL VIEW 13

There is, ho\ve\er, legally established pulilic health machinery in every
rural political unit in the State. A law enacted in 1901 prescribes that the
board of county commissioners in counties not under township organization,
and the supervisor, assessor and town clerk of every town in counties under
township organization, constitute boards of health for all territory outside
the corporate limits of incorporated cities and villages. This system, mani-
festly weak in that the personnel is subject to frequent changes and depend
for office upon political success rather than upon technical knowledge of
sanitation, hygiene and public health practices, does nevertheless provide a
definite means of contact between the State Department of Public Health
and the rural population. This contact makes notification of communicable
diseases from rural districts possible. It permits State officials to render
timely service in emergencies. It provides a local organization that can be
brought into useful action under medical supervision in times of stress.

The 1,107 cities and villages in the State are all authorized by law to
maintain either boards of health or commissioners of public health and
safety where the commission form of government prevails. When the local
officials fail to appoint a board of health then the duties and responsibilities
thereof fall upon the ma}or or village president. Out of the 1.107 cities
and villages only 300 or 400 have medical health officers. Health officers
in all the others are non-medical.

There are 16 counties which have the commission form of government.
In these the 3 count\- commissioners constitute the board of health and under
them are designated certain other officials like the overseer of the poor to
act as precinct health officer. In the 16 counties there are 175 precincts.

In the other 86 counties there are 1.448 local officials who constitute the
legal health machinery for the unincorporated territory. Practically all of
these are non-medical.

Thus we find that Illinois has 2,720 local health officers, less than 400
of whom are trained in medical or sanitary science. This volume is con-
cerned chiefly with the story of how the municipal health organizations of
today came into being.

There are, of course, a number of other important organizations, both
official and voluntary, at work in the State in the field of public health.
Among the officials are the municipal and county tuberculosis sanitariums
and the sanitary districts. There are now two municipal and 17 county
tuberculosis sanitariums operating in the State at public expense and several
other counties that collect taxes under the sanitarium law but use it to rent
sanitarium space as needed. These sanitariums have had a ver_\- important
influence over local health conditions.

In nearly every municipality there are voluntary organizations of various
character which contribute to the local public health service. Indeed these

14 GENERAL VIi:\V

agencies are usually responsible for a larger volume of work than that done
b\' the official organization. Often the voluntary agency has initiated activi-
ties that later were turned over to the local government for continuity.

The municipal histories iiKlu(k-il in this volume are presented in two
groups. Those concerned with communities of less than 100,000 and those
with larger communities. Each group appears in alphabetical order, the
smaller commimities coming first.

DOWN-STATE MUNICIPALITIES

Alton

One of the oldest communities in Illinois, Alton is located in Madison
County (in the eastern bank of the Mississippi River just above the junction
with the Alissouri. It stretches from the water's edge back across the
bluffs that skirt the river. It was organized as a city in 1821, although
settlers arrived there much earlier, and it has lived through many experiences
of rich historical and romantic interest to the State. It was there that the
Lovejoy tragedy was perpetrated. There Lincoln and Douglas held one
of their famous debates. It was across the river from Alton that Lincoln
made a hoax of a duel in which he was involved to the great relief and satis-
faction of all concerned.

E\en so Alton ne\er grew to be a very large city. It lies within one of
the most densely populated counties in the State, excepting Cook, but its
own municipal boundaries encompass something less than 30,000 people.
Beginning with 1890 the decennial census returns showed the population to
be 10,294, 14,210, 17,528, 24,682 respectively, the last figure being that for
1920. Of the 1920 population 21,302 were native born whites, 1,670 or
something over 5 per cent were foreign born whites while 1,707 or nearly
7 per cent were negroes. There were 5,695, a little more than 23 per cent,
in the age group of 45 years and over, suggesting a longer average span of
life than prevails in many other municipalities of Illinois.

Hi'ALTii Machinery.
Official attempts to control and prevent sickness in Alton began as a
result of emergency epidemic conditions that provoked sufficient public
concern to stimulate action on the part of local officials. The situation was
first met, at some early date in the city's history,
by creating from the membership of the city
Council a committee on health. This committee
was given power to perform work and to order
activities ordinarily vested in a board of health
but its range of service was limited by lack of
funds, which could be secured only upon action
by the council since there were no appropriations
for health work, by lack of popular interest ex-
cept during epidemic outbreaks or rumors of out-
breaks and withal by a lack of the fundamental
knowledge of preventive medicine. From time

A. P. Robertson, M. D.
Health Officer, 1917-1920

(15)

1)0\V N-STATE M V N I C I I'M. I Tl KS

Mrs. Daisy C. Rice

Inspector of Hygiene

Alton Public Schools

lOlO to date

to time the cdinmittee e.xerted its intluence through quarantine powers and
by ordering the abatement of nuisances and the cleaning of streets but these
activities were hmited largely to times of epidemic stress when ])ul)lic alarm
demanded something as a palliative.

Later an nrdinaiice was adopted which created
a board of lieaUh. 1 1 consisted of a numl)cr (if
aldermen. app(jinlcd by the ma\or, and of the
chief of police and the pcjlice nialron who were
made e.x-oflTcio inemhers. The health (jfficer,
designated by the ordinance to lie a regularly
licensed physician, is not a member of the hoard.
^^1 '/'T^^^B -"^ peculiar feature of the health machinery in

^m^^ 11 jl '^ x'Mton is the part played b\- the police. .\ number
^1 utm^ °^ ordinances, purely public health in character,

^tL. t mitm I are placed under the jurisdiction of the police
department. An ordinance provides for a milk
and food inspector, for example, and makes him
a part of the police department. The board of
health ordin:ince itself makes two of the police
department members and leaves the health commissioner off. .V more under-
standable practice would be to make a part of the police dep.'irtnient respon-
sible to the health commissioner.

Vokmtary agencies and such public agencies
as the school board and the county tuberculosis
board have provided Alton with a larger volume
of health service than the city government itself.
The facilities for doing health work in Alton, as
they existed at the close of 1925, and very little
change has since occurred, are summed up very
well in a report of a survey made by the State
Department of Public Health in the earl\' part
of 1926. It reads, in part, as follows:

"With the score of only 420 or 42 per
cent of what is regarded as standard, it is
manifestly apparent that according to the

findings of the survey, Alton provides less than one-half of the puljlic
health services which might be reasonably expected from that city.

■'The health department normally consists of a part time physician.
Tinder pressure of epidemic conditions, it is permitted to employ tenipor;-
arily professional and untrained assistants. In addition to this the city
pays $1,200 a year toward the support of a social hygiene clinic. No
public health laboratory work is done in the city at all, the State furnish-
ing the only services of this sort to be utilized.

Mrs. Anna Most
School Nurse, 1919 to date

DOWN-STATI': .M i;.\ Kl PALITIKS

Mrs. Oscar Becker
(nee Frances Robertson)
School Nurse, 1916-1919

"The Ixiard of education employs two fuil time nurses aiul a part
time dentist. The State, county and city jointly employ a part time phy-
sician for the social hygiene clinic. The associated charities employ two
full time nurses hut their function is more
largely bedsirle than public health nursing.
Two full time nurses on the staff of the
county tuberculosis board spend part of
their time in Alton. The only clinical ser-
vice of any character consists of a general
(■lluic al the local hospital where indigent
l)atients of all kinds are admitted, and a
dental clinic for indigent school children.
The county operates a tuberculosis clinic
in Kdwardsville to which patients from
Alton are admitted.

"The city normally spends directly
alxnit $:!,iiiiO i er year for public health
service. All other agencies including the
board of education, the county and State
and the Visiting Nurse Association spend
about $12 000 a year. Last year (1925) the city actually expended about
$5,800 for public health work, a matter of 21 cents per capita, while the
combined e.xpenditures of all the other agencies lirought the total to some
$1S,500 or a little more than 68 cents per capita.

"The city clerk acts as the local regis-
trar of vital statistics. While he does his
work with great care and thoroughness, he
attempts nothing more than the law re-
(jv.nes — the collection and recording of re-
ports and their transmission to the county
and State officials.

"The total personnel in the city em-
ployed in any way directly with the public
health activities, consists of 12 persons, s
of whom are part time and 4 full time.
Two of the four, however, are nurses of
the associated charities and spend only part
of their time in actual public health work."

Mrs. Geo. D. Pfeiffenberger

(nee Charlotte Todd)

Director, Visiting Nurse

Association 1915

This quotation comes from a report of sur-
\cy of lieatth service facilities made in \92U.
More detailed surveys that embraced sanitary inspections in considerable
■detail were made on two former occasions, once in 1886 and again in 1919.
Moth were supervised by the State health officials. Thq first was undertaken
with a view of educating the public in the importance of sanitary matters of
supplying the State officials with data valuable in efforts to combat threatened
invasions of cholera. The 1919 project which involved a house-to-house
inspection and a very careful inquiry into every health feature of the city was
a preliminary effort toward improving the local health service. Its purpose

Public Si;hool Dental Clinic at (larlii-ld S.liuol, Alton

DOWN'-STATK MUNICIPALITIES

D. F. Duggan, M D.
Health Officer, 1920 to date

was to provide accurate data on the sanitary problems of the city and thereby
supply tangible grounds for a program and for creating a service commen-
surate with the needs. Local economic conditions prevented the carr\ ing out
of the recommendations based upon the 1919 survey.

One unusual feature of the voluntarv public health activities in Alton
has been the interest manifested and the service rendered by the medical
profession. This is particularly true of the Madi-
son County tuberculosis program. The county
medical society has from the beginning taken a
very active part in the anti-tuberculosis work and
has been in a large measure responsible for the
splendid success of the movement in the county.
Alton, of course, has profited by the county work
against this disease. The great interest and activ-
ity of the medical profession in tuberculosis work
was largely inspired and cultivated by Dr.
Edward W. Fiegenbaum, of Edwardsville, long
time secretary of the Madison County Medical
Society.

The list of health officers who have served Alton include :
1885-1887 Dr. Robert Gibson 1903-1917 Mrs. Sophia Demuth

1893-1895 Dr. J. H. Fiegenbaum 1917-1920 Dr. A. P. Robertson

1901-1903 Dr. W. R. Smith 1920 to date Dr. D. F. Duggan

\\ati;r Supply.

The Alton public water supplx' has always been obtained from the
Mississippi River and the waterworks s_\stem has alwa\s been privately
owned. The Alton Water Company was formed and the original water-
works built in 1898. In 1906 the franchi.se of the company was extended
for 25 years and provided simply that the water must be filtered and sufficient
pressure maintained at the highest point in the city. Because of the con-
siderable range in elevation in different portions of Alton the pressures in
the lower portion are higher than normal if adequate usuable pressures are
maintained in the higher portions of the city. The Alton Water Company
is now controlled by the American Water & Electric Company with head-
quarters in New York City.

The original plant, which included tub filters and appurtenances, was
not very efficient and improvements to the plant have been made from time
to time. .\t the close of the period covered by this history there are still
some further improvements necesary if the plant is to be made equal to
modern water-purification plants. The pumping station and filter plant are
located in a narrow strip between the river and the limestone bluffs and the
restricted site has made additions and improvements to the plant difficult.

ALTON 21

The waterworks now comprises two intakes extenclint; a little over 200
feet from the shore, mixing and settling basins, filters, chlorination equip-
ment, clear-water basin, low- and high-lift pumping equipment and appur-
tenances, and a distribution system which extends to practically all the built-
up portions of the city. At different times difficulty has been experienced
with the intakes because of the formation of sand bars or ice.

There is no municipal sewer outlet into ^Mississippi River for a con-
siderable distance above the intakes. During the past decade land outside
city limits on the bluffs upstream from the waterworks has been developed
for residential purposes and private sewers from these properties discharge
into limestone sink holes, which on the basis of geological studies, it is known
connect or discharge into the river above the waterworks intake. This is an
important item of possible local pollution which at the close of this period
was still being studied.

Lime and iron were originall\' used as a coagulant and later a change
was made to alum and lime. Local lalioratorx- control was established during
the last decade.

Because of the location of the clear-water basin immediately adjoining
Mississippi River and the non-water type construction, the water has always
been considered as subject to possible contamination after filtration and,
therefore, the chlorine used as a sterilizing agent is applied to the water as
it is drawn from the clear well and pumped to the distribution system.

Although the water-purification plant has never been a good example
of a well planned, efficient purification plant and there have been periods
when the water supply has been of questionable qualit}', there has never
been any definite record of any illness caused b\' the public water supply, and
the waterworks system has been an important factor toward better sanitary
and health conditions in the city.

Sewer.\ge.

The city is served with a combined system of sewers, additions and
changes to which have been made from time to time so that public sewers
were available at the close of the period in most of the built-up portions of
the city. Many of the city sewers were installed to provide for immediate
needs without full regard of future needs and the growth of the cit\'. Con-
sequently some of the sewers have from time to time proved inadequate
and in addition to the need of public sewers in the remaining areas not now
sewered there is need of other sewers to relieve some of the existing over-
loaded sewers.

Through the city Piasa Creek flows to Mississippi River, portions of
which creek have been covered. This creek receives sewage at several points
and has for many years been more or less polluted and the subject of con-

DOW N -STATI-; M t ■ N 1 1 I I'A LI T I ES

Table 1.
AlokTALi'iY I-"k()m C':-.kt\in Causes.

VKAll

■X

'X
•>

]

11)07
1908
190!)
1910
1911
1912
1 9 1 :i
1914
191.->
191(i
1917
191S
1919
19.i0
1921
1922
1923
1924
192:-.
1926

194
194
217
248
248
239
222

499
371
301
2«0
308
367
38:-)
390
397

2
1

."!

i
i

3
2

■7

i-i

1
'3

'8
3
9
6

4
4
3

86
22

"s.

13
13

24
9
29

•

26
29
28
33
41
49
39
23
11
23
14
13
13
20

59
36
40
17
IS
21
26
18
25

Table 2.
Mortality Rates From Certain Causes.

1907
1908

190:)

1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926

11.7

36.

11.5

12.6

14.1

13.6

12.6

11.3

35.

26.7

Hi.

1.5.1

14.1

10.3

15.

12.0

14.1

14.6

14.5

14.6

■

33.3
16.0
36.0
23.8

358 . 3
89.0
88.0
31.7
50.7
.lO.O
92.3
33.5

132

142.2
132 . 7
151.2
182.7
204.1
137.8
100.0

245.8
145.7
160.0
67.3
58.5
80.7
100.0
67.1
91.9

per I.OIIO iiopuluticm; all other.';, per 100.000 pnpuhi

siderable complaint. Projects for enclosing" the creek llirou,i;h practically
the entire city so as to make it a larj^'e comliined sewer have been proposed
and discussed several times, hut without any definite action having' been
taken.

The sewage is discharged into Mississippi River, below the waterworks
intake, through two main outlets and several smaller outlets. At the close
of the period there was need at Alton of an inventory of all existing sewers
and the development of a comprehensive plan for additional sewers to relieve
some existing sewers and to serve unsewered areas so as to abate local
nuisances, especially along Piasa Creek. Because of the large dilution
available by the river, treatment of the sewage at Alton has not been neces-
sary and priihably will not be necessary at least for a great many \'ears.

Table 3.
Births and Infant Dkath-s.

Infant Deaths

YE.Mi

[

Number

Rate"

Number |

Rate*

1917

95 . 3

li)ls

58 1

96.2

una

34 1

1!)20

583

23.3

47 1

80.6

in-21

ri9.5

25.6

30 1

45 . 5

fi05

23.. 8

59.5

1<I23

(!4-i

25.1

84.1

1H24

Ii80

25.7

91.2

192:i

r,;-,r,

24.5

60 1

91.6

]<)2G

72S

26.8

00 1

82.4

•Deaths of infants undi
••Per 1000 ijopulation.

of age per 1000 births reported.

Hkai.tii Conditions

The earliest references to health conditions in Alton center ar( imd tlic
"pest house." That implies smallpox. For some reason not e:isily understood
people in Alton, like those who inhabit the rest of North America, calmly
accepted as more or less a part of normal life such costly diseases as typhoid
fever, tuberculosis and diphtheria but shrank in mortal fear from smallpox
and doubtless cholera too. Of course, smallpox is dramatic and sudden in
its action. Folks knew positively that it spread by contact. Accordingly
patients and those who had been exposed were regardcil with the utmost
apprehension.

Thus we tind the "pest house" in .service as late as 190,^. In that year
several hundred cases of smallpox occurred in the city. Tbiis, it seems, was
not ])articularly unusual ho\\f\cr. In I'HIl a malignant oulbre.ik so al'irmecl

DOWN-STATE MUN ICI I'AI.ITIES

the [)iil)lic that it was ami still is referred tn as the "hlack-siiiallpox epidemic."
Again in l')()3 the disease reached epidemic proportions and then the big
outbreak of 1905 followed. This has been the history of smallpox since
that time and doubtless was prior to 1900. As late as the winter of 1918-
1919 there were some four or five hundred cases in the city and again in
1925 there were one hundretl and seventy-two cases rejjorted.

Typhoid fever has been anoiliei' nt the chrcmic problems and it remains
til be banished from the cnninninity. I'ricjr [n I'KlO the disease reached epi-
demic proportions almost annually and since that time the prevalence and
mortality has been high until 1926. Periodicallx'

epidemics occurred. The \ear of 1901 and 1905
are designated as dates of typhoid epidemics of
[tarticular se\erity.
The ])robleni of tuberculosis was attacked on
a county basis and carried out with success
enough to culminate in the building of a sani-
tarium at I'.dw ar(ls\ille. Results appear to have
fully justitie<l the effort. The work got well
underway about 1920. ."^ince then the number of
deaths from tuberculosis, down to 1927, has

averaged 17 per year. For seven years prior to
1920, the average number per }ear was 35. Sta-
tistics for earlier years are available but it seems
probable that tuberculosis was one of the major causes of death and sickness
over a long period.

The sanitarium was opened en May (>. 1926, under the able supervision
of Dr. D. D. Monroe who is not only carrying forward the fight against
tuberculosis with the same spirit and sound judgment that animated Dr.
Fiegenbaum in starting it but he follows Dr. Fieg-
enbaum also as .secretary of the Madison Count\-
Medical Society. Prior to the opening of their
own sanitarium the county secured for its tuber-
culous citizens sanitarium care which it p.iiil for
at prescribed rates.

The inlluetiza-imeumonia epiilemic of 1918
was moderately severe in Alton, relatively speak-
ing. Mortality from both diseases amounted to
145, of which 86 were attributed to influenza,
giving a rate of 6[)4 per 100,000 population.
About 15 municipalities of the State had higher
rates and a dozen experienced less loss.

D. D. Monroe, M. D.
Director Madison County
Tulierculosis Sanitarium

E. W. Fiegenbaum, M. D.

Infant mortality in A!t(in runs higher than in many other places and

higher than for the State at lart;e. In 1''26 the rate was 82.4 per 1.000

births reported in Alton and only h'll in the State. The rate in Alton was

higher than that in 28 of the 44 cities of Illinois

with 10.000 or more inhabitants.

The general mortality rate is somewhat higher
in -\lton than in some of the other communities.
This is due partl\- to the fact that Alton is an
uld city with a larger percentage of old people
than a lot of mid-western municipalities. Young,
rapidly growing communities are populated with
yi.ung, active people among whom the death rate
is very naturall\- l(.iw. Alton is old. compared
with most communities of Illinois, and has ex-
perienced a slow growth. Consequently, the city
has a relati\ely large number of people who have
passed middle age and therefore contribute to a
higher mortalit\- rate than prevails in younger, more rapidly growing

Helen Heighway, R. N.
Tuberculosis Nurse. Madi-
son County, 1919 to date

municipalities.

Table 4.
Cases of Certain Diseases Reported.

1 191fi

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

T.\iihoi(I Fever

Jfalaria

Smallp.ix

720

172

Mea,>ile:i

283

22')

109

131

460

453

Scarlet Fever

4".

101

195

Whoop. Cough

160

Diphtheria

135

Influenza

1200

235

172

ruIinniVHlili,

M.-niii-iti.

'iiilnTi nlii-i^'

I'lii-iiiH.iiiia-

3')

3fi

.S.vjihilis

123

106

201

218

132

Gonorrhea

110

209

229

197

203

165

135

175

123

Chancroid

•All forms.
Note : Case reports

Reference:

Data furnished b.v Dr. A. P. Robertson, Alton, Illinois.

Annual Reports, State Department of Public Health, SprinijflcM, Illinois, v
Dr. Thomas H. Leonard, data furnished through personal interviews v.-ith ju-i
U. S. Census Reports, Washington, D. C, various dates.

ous dates,
inent citize

Aurora

Settlfiiiciit first slartfd at Aurora in IS.^4. A \ear later the tirst ph\s-
ician to permanently locate in the new comniunitv arrived in the person of
Dr. Daniel Eastman. He found the rolling terrane watered by the beautiful
Fox I\i\-er a pleasant place for a home and lie felt that the fertile alluvial
sciil well drained by the river and its trilnitarics would furnish an am])le
basis for prosperity through agricnUural and industrial development.

Doubtless he discovered also that the underlying strata of rock overlaid
with gravel would make a solid foundation for the thrifty city that now
spreads itself upon both banks of the river.

Aurora like all of the towns on the Fox River in that vicinits suffered
severely from the cholera epidemic of 1849-52. Public concern that grew
into alarm and culminated in panic followed the first appearance of the
disease which prevailed more or less until 1854. It is "estimated that
from 300 to 350 victims yielded to the cold embrace of the destroyer in that
period of time." This was the opinion of a Kane County historian who adds
that "it seemed to be much more fatal to foreign immigrants among whom
two-thirds of the cases occurred."

Dr. Nicholas Hard, who located in Aurora in 1845 delivered an address
on cholera at the meeting of the Fox River Medical Association at Elgin,
F'ebruary 1st, 1850. He emphasized the contagious character it manifested
in the Aurora epidemic of 1849, pointed out the fallacy of specific cures
and described the unusual symptoms that characterized many patients whom
he saw.

In the summer of 1851, he contracted cholera and with impaired health,
an attack of dysentery caused his death on October 16, 1851. A colleague
wrote of him : "Professor Hard maintained a good character as a pleasing
and instructive lecturer during his connection with the medical schools at
LaPorte, Indiana, and Keokuk, Iowa, and enjoyed a high reputation as a
practitioner in Aurora. He has been cut down in the prime of life and in
the nndsi of usefulness."

( )llicr pin sicians who served the conimunitx' of that time were Doctors
S. c;. llui.liard, r. D. H. Coff and .\. R. Cilman.

Aurora was incorporated as a city on I'ebruary 11. 1857 and on March
7th, 1887 was reorganized under the general incorporation law governing
cities and \ illages.

(26)

AURORA 27

During the ten years beginning with 1830. the population of iVurora
jumped from 1,895 to 6,011 and by the end of the next decade (1870) it had
ri.sen to 11,162. The 1920 U. S. census gave it a population of 36,397 of
which 29,289 were native born whites and 6,476 foreign born whites.

Health AIaciiinery.

Any organized public efforts at sanitation and hygiene during the early
life of the community is either shrouded in oblivion or buried in the dusty
council records of that period. We may surmise that the cholera epidemic
in the middle of the nineteenth century inspired an almost religious zealous-
ness for clean streets and premises, the usual precautionary methods em-
ployed in those days, and that some sort of an organization, probably official,
was created and functioned during the emergency. It is altogether probable
that a board or committee of health was appointed.

However that may be, the best records availaljle show that the first reg-
ularly established board of health which became a permanent part of the
city government was appointed on March 2, 1863. It consisted of three
members, L. W. Gray, E. R. Allen and Charles Earle. From that time for-
ward until 1894 there was constantly maintained a board of health, usually
with three members, sometimes including a physician. Then came a lapse
of 12 years during which there apparently was no board of health, the health
officer performing the functions of tlie hoard as well as those of his own
position.

In 1906 the board of health was revived witli K. J. Fenton, John P.
Kartheiser and J. H. Pompa as members. From tliat }ear until 1920 the
board never lacked a full membership of three.

With a change from the aldermanic to the commission form of govern-
ment in 1920 the board of health went out of existence and its duties, func-
tions and responsibilities fell automaticall)' upon the city council and upon
the department of pulilic health and safety. Lender this ch.mge \\^ E. I'ar-
clay was elected to a commissioner's place on the city council and was as-
signed to the department of public health and safety. He was re-elected in
1927 and assigned again to the same department.

During the early period of its existence the board of health spent aliout
$.^00 annually. $100 of which went to the chairman who. Ijy \'irtue of his
capacity as chairman, was also health officer. Like most boards of health
this one was endowed with the broad if vaguely expressed power "to do
what it ma\- deem necesary to preserve the public health." Likewise in
conunon with similar boards elsewhere the great possibilities implied in that
blanket authority so unreservedly thrust upon it was practic.illy vetoed by
a carefully inserted pursj-string clause. No budget was provided and all
expenses incurred had to Jiave the api)ro\al of liie council.

DOWN -STATIC Ml'N ICIPALITIES

Tin- (iriliiiance umltr wliicli tin- l)i);iiil functioned at that time rcquireil
it to investigate alleged nuisances that were reported, to quarantine or remove
to the "pest house" every case of smallpox, to retiuire the registration of
births and deaths in the office nf the ciu clerk, who was also the clerk of
the board, and to prevent the ]i(illutinn (if tlir ii\er. Apparently nntilication
for no disease except smallpox was rei|uired because no other one was men-
tioned in the ordinance.

Ai)parently the fortmies of the boanl i>f health provoked very little
public thought until rather recently. There is no evidence that it did. ( )r(li-
nances relating to it and its duties are few. Detailed history of activities is
wanting. Expenditures were meagre. As late as 1913. for example, in the
course of a year the health department spent $8,715 of which $7,488 went
for garbage removal, $408 to the health officer, $6..S0 for laboratory service
and the remainder to two part-time inspectors and for such ordinary mis-
cellaneous matters as fumigation, quarantine, etc.

The next year, 1914, a laboratory was established, however, with C. R.
Hixson in charge and an automobile was provided for the use of the de-
partment.

AURORA

[%i-

VITAL STATISTICS §

conn. DI5. comROM

VEh. DI5. COhTROLH
TUB. COMTROL l^'j
HEALTH CHILD.-
HEALTH 5CH.CHILD=*'
SAMITATIOH "?--[=
MILK COMTROL
LABORATORY
POP. HEALTH IHST

PfRCEtlT OF STAMDARD SCORE
FOR EACH OF TEM MAJOR HEALTH ACTIVITIES

I9Z3

Figr. 1. This graph illustrate.s the strong and weak points in Aurora's
public health service, official and voluntary, as it existed in 1925. It is
based upon a personal survey and rated upon the standards evolved by the
American Public Health Association. The total efiiciency rating in Aurora
was 52 per cent of the standard perfection requirement.

Al'RORA 29

A se\ere oiitlireak uf scarlet fe\er in the winter of V>\7. coming as it
dill upon the heels of an epidemic of whooping cough, and accompanied by
an unusual amount of pneumonia led to the employment of a school nurse.
The personnel of the health department was also strengthened at the same
time b)- the addition of a full time meat inspector. The same influences
operating to strengthen the health department at this time were doubtless
responsible for the building of an isolation hospital that was started in 1917
and opened the following year.

By 1926 the health department had grown into an organization involving
the full time services of a nurse, a laboratory technician and an inspector
and the part time service of a director (the medical health officer), a veter-
inarian and a clerk. In addition to the activities provided by this staff the
city was at that time enjoying the services of two nurses employed by the
two school boards and four nurses supported bv the Visiting Nvirse Asso-
ciation.

-\t the beginning of the pulilic health mo\ement in Aurora, the idea of
making the community disease proof or rather epidemic proof v\-as com-
pletely divorced from the idea of practicing medicine. .Sanitation was re-
garded as a matter of physical and environmental cleanliness in the most
superficial meaning of that word and the functions of the health officer
were principally concerned with clean streets, garbage removal and the like.
Consequent!}' health officers were not chosen because of any knowledge
of medicine or hygiene. Once in a while a physician happened to be selected
for the office but his professional equipment was coincidental and not the
cause of his appointment.

This continued to be the situation in Aurora until 1888. liy that time
sufficient knowledge of bacteria and disease germs had been discovered and
disseminated and medical knowledge had progressed far enough to give
leading citizens the notion that disease prevention
depended upon the application of technical know-
ledge. This created popular distrust in the
capacity of laymen to render effective service as
health officers and led to a demand for physicians
to fill that post. As a result Dr. G. F. Allen
was appointed health officer of Aurora in 1888
and since that time the position has always been
filled by a meml)er of the medical profession.
Dr. George W. Haan, present incumbent, has
the distinction of having served the city as health

officer over a longer period than any other person
George W. Haan, M. D. , ,,,,-.•

Health Officer, 191S to date wlio ever held the position.

DOW .\ -STATE MUNICIPALITIES

The list of healtli oflicers of Aurora, toijctlu-r with the dates when each
tilled the nt'lice, follows:

March 2, 1863 to 1S65 A. A. Dexter

1865-1866

18G6-1S71
1S71-1S72
1872-1873
1873-1874
1874-1878
1878-1881
1881-1884
1884-1888
1888-1889

Dr. W. Young
Geo. 0. Fish
E. S. Day
Geo. 0. Fish
J. D. Andnis
J. D. Andrus
A. C. Graves
Dr. C. Smith
H. G. Gable
Dr. G. F. Allen

l.ss!i-lS!il Dr. H. Reder

1S91-1S!I4 Dr. W. S. Johnson

1894-1902 Dr. J. W. MacDonald

1902-190G Dr. F. J. Coughlin

190(;-1908 Dr. C. W. Geyer

1908-1909 Dr. A. L. Anderson

1909-1910 Dr. A. R. Reder

1910-1914 Dr. W. H. Uehren

1914-1918 Dr. G. B. Schwachtgen
1918 to date Dr. Geo. W. Haan

The loeal dental soeiet_\- has established the practice of making gratui-
tuush an annual dental examination of all school chiklren while a group of
local physicians give their services in diagnostic conferences of infants and
preschool children. The city also benefits by clinical services and sanitarium
care provided by the Kane County Tuberculosis Sanitarium Board which
was established by popular vote under the Glackin law.

A clear picture of present facilities for doing public health work is
found in a report of a survey made in l')26 by the State Department of
Public Health. In it, we read:

"Earning 521 points out of a possible 1,000, Aurora takes ninth place
among the fifteen cities on the health service score sheet. Operating
under the commission form of government, the mayor and commis-
missioners constitute the municipal board of health. The part time
health officers get $1,000.00 per year plus an allowance on about the
same scale toward clerk hire. He provides official quarters in his own
office where vital statistics and morbidity records are handled. A
diagnostic laboratory with a full time technician is maintained. There
is a full time nurse employed who works in the private school and a
part time veterinarian who inspects food handling establishments.

"Each of the two school boards employs a school nurse. Tuber-
culosis diagnostic clinics are held by the staff of the county sanitarium.
The Public Health Nursing Association is responsible for infant health
clinic, tuberculosis, prenatal, infant and preschool age field nursing
service. There is no public clinic for indigent venereal disease patients.

"The official expenditures amount to 26 cents and the total, includ-
ing those of voluntary agencies, to 60 cents per capita per year.

"Complete tabulations of vital statistics data are not made, although
some rates are determined and published in the local papers.

"No communicable disease nurse is employed. A policeman, who is
detailed as a quarantine officer, placards premises and releases all
cases. Complete epidemiological information is not collected. When an
unusual prevalence of disease occurs the health officer himself visits
cases in an effort to determine the source. Only a small proportion of

AURORA 31

diphtheria and scarlet fever cases are hospitalized. The health officer
estimates that about 500 children received toxin-antitoxin, g;iven by
private physicians, last year (1925). Only about 33 per cent of the
grade school children are vaccinated against smallpox.

"Two new cases of tuberculosis were reported last year for each
death. The personnel of the Public Health Association is insufficient to
render as much field nursing service as is desirable. Tuberculosis
clinics are held twice each month, total attendance for the year bein?
225, which is much less than the standard. Hospitalization of tuber-
culous patients is up to standard and approximately one-half of the cases
admitted were in the incipient stage. This is a much higher percent-
age than the average in similar institutions. One open air classroom
with an attendance of about sixteen children is in operation.

"There are two school boards in town. The grade school popula-
tion is about equally divided between the private schcols and each of
the two public school districts; one nurse works in each of these
groups. The nurses weigh, measure, test vision and make physical
inspections. Each of the nurses operates independently of the other
with no uniformity of records or reports. The public school nurses
cooperate with the health department in the control of contagion, but
more satisfactory routine procedures should be worked out. Local den-
tists made a complete dental inspection in the public schools last year.
There is no medical supervision of school children.

"It was estimated that about 94 per cent of the dwellings are con-
nected with the city sewers. A sanitary district has been voted, which
will provide treatment of the city's sewage.

"Food handling establishments are not licensed, but are inspected
by a part time veterinarian.

"The health officer who personally inspects the milk depots esti-
mates that 98.5 per cent of the milk supply is pasteurized. No lab-
oratory examinations are made of milk before pasteurization and the
bacterial counts after pasteurization are high. Only one producing
farm is regularly inspected.

"A very good laboratory is maintained by the health department
with a full time technician. The examinations made approximated or
exceeded the standard quotas except for tuberculosis and venereal
diseases.

"The health officer has done a considerable amount of educational
work."

Water Supply.

The public water supply, in-stalled in 1886 at a cost of $137,0(10, com-
prised an intiltration gallery on an island in Fox River about 1>^ miles north
of the center of the city. The original pumping station constructed on the
east bank of the river, although substantially enlarged, is still in service.

In 1902, due to repeated contamination, the infiltration gallery was
abandoned and four deep wells bored in the vicinity of the main pumping
station, penetrating Potsdain sandstone at a depth of 2,250 feel. These wells

32 nowN'-STATi-: MrMcii'Ai.rriES

are all operated b_\' air-lift. A colleclinj,' reservoir was also constructed, into
which the output of the wells was discharged.

In l')ll a fifth well but of somewhat larger l)ore was constructed at the
same site.

In l'J14 the increased demand for water made it necesary to develop the
abandoned Esser quarry pit, located in the south part of the city, as an aux-
iliary source of supjjly. A hypochlorite treatment plant was installed to
treat the water thus secured. In the meantime, the city had adopted an
isolated deep-well system to meet the ever-increasing water demands, and
during 1915 two wells were completed, one in the southeast and the other
in the southwest part of the city. A third well located on an island in the
river near the central part of the cit\ was placed in service in 1917.

Since the three additional wells were placed in service the quarry supply
was entirely abandoned. An additional well was constructed in 1923 and
another in 1925.

In 1913 the waterworks were investigated and attention called to several
possible sources of contamination, namel)', in the open shallow discharge
basins of the several wells and in the leak\- and open collecting reservoir.
Due to the close proximity of the collecting reservoir to Fox River, there
was danger of seepage into the reser\'oir. The open condition of the reser-
voir further made it possible for the supply to be accidentally or maliciously
contaminated.

On later investigations attention was called to the existence of several
dangerous cross connections between the city and river supplies.

The present supply comprises the first five drilled wells constructed
near the main pumping station and the five drilled wells that have been pro-
gressively constructed between 1915 and 1925. In 1*^19 a concrete covered
collecting reservoir was constructed to supplant the old open and leaky
reservoir. An emergency chlorinator is kept available. One cross connec-
tion is still in existence, but the cross connection involves an artesian well
and is not regarded as particularly dangerous although such cross connections
are regarded as objectionable. The w^ater supply is regarded as being of a
safe sanitary quality.

In 1921 there were 84 miles of 4- to 16-inch mains. 8,325 services, and
the average daily water consumption was 71 gallons per capita.

Sewer.'^ge.

In 1880 there were no sewers and liquid sink wastes were discharged
through cesspools. The houses depended on privies, with but few exceptions.

Prior to 1893 some sewers were installetl and from time to time addi-
tional areas were sewered.

The present system is of the combined type carryinij lioth sanitan- sew-
age, industrial wastes and storm water. There are four major outlets
. sei-ving about 85 per cent of the population and nine minor outlets which
serve the remaining 15 per cent. These outlets are located along Fox River.

The discharge of the present sewers, particularly during low-water
periods creates a nuisance in Fox Riser which has been the occasion for
several complaints.

In 1926 the Aurora .Sanitary District was organized, embracing the
city of Aurora, and with boundaries following in general the boundaries of
the city. Thorough investigation and study of the sewerage needs of the
city were made in 1927 and recommendations made for the construction of
an intercepting sewer to carry the dry-weather flow to a point well below the
city and the construction of sewage-treatment works comprising grit cham-
bers, sedimentation tanks, separate sludge-digestion tanks, pumping station.
sludge beds, sprinkling filters and secondary sedimentation tanks. .\ bond
issue was recently passed which assures that the improvement will lie in-
stalled in the immediate future.

Table 1.

Mortality From Certain Causes.

£■

£.

■2?

VKAll

■ Jo

3 5

= i;

■ffl

&£

1 =

—

z~ -^

189.5

28.5

1896

...

'.'.'.

1897

280

'io

"■3

1898

272

' '4

1899

:::

1900

384

' i

'32

'39

1901

370

1902

319

1903

322

1904

353

190o

1906

368

' 4

" i

' '4

" '2

'3.5

'29

1907

410

1908 ,

379

4 1 ...

1909 '

422

' 3

1910

433

1911

413

1913

462

19U

461

1911

466

...

1915

471

' 3

1916

471

' i

1917

.516

1918

740

125

138

1919

.563

1H20

.576

' -2

' i

1921

493

1922

529

1923

521

1924

499

1923

527

. "i

1926

594

DOW N -STATE M L' M CI PA L 1 TIES

Tabic 2.
MoKTAi.iTv Rati-.s 1"ki>m C'irtain Causes.

YEAR

=
S

1 =

1893

11.4

86.7

36.4

54 . 7

41.0

54.7

82.0

189(i

18H7

16.6

43.7

26.3

13.1

56 is

43!7

isys

9.7

21.4

8.0

17!2

98.9

141.9

189!)

1900

ih.i)

70 '.4

i'.i

'i'.i

siis

24.'8 ".'.'.

132!. 5

leiis

1901

14.9

48.8

4.0

12!2

24.4

26 '.3

20.3

170.7

146.4

1902

12.7

39.9

3.9

7.9

111.8

107.8

1903

12.6

15.7

■y.9

3.9

'.'.'.

113.8

129.3

1904

13. G

46.3

3.9

50.1

7.'7

134.9

111.8

1905

11.. "i

7.4

liis

14.8

7.4

125.7

77.6

1906

13.7

14.9

3". 7

14.9

3.7

14.9

7.5

130.6

108.1

1907

14.5

17.7

39.0

3.5

17.7

14.2

88.6

156.0

1908

13.7

14.4

7.2

32 . 5

43.3

162.3

72.2

1909

14.4

20.4

10.2

l6!2

3.4

20.4

3.4

126.1

115.8

1910

14.5

16.7

3.3

16.7

6.7

120.2

120.3

1911

13.2

22.4

3.2

22.4

9!6

102 . 4

102.4

1912

14.5

3.1

i'.i

3.1

1.5 .'7

22.0

6.3

110.0

135.1

1913

14.2

21.6

3!i

12.. S

6.2

21.6

9.3

12.3

123.3

120.3

1914

14.1

33.3

3.0

15.1

112.0

136.3

1915

14.0

20.8

8.'9

3.0

17.9

8.'9

122.0

157.7

1916

13.7

11.7

2.9

•i!*

2.9

23.4

131.5

105.3

1917

14.8

8.6

2!9

8.6

31.6

14.4

23.0

106.3

172.4

1918

20.8

8.5

11.1

13.8

5.3

347.2

152.7

383.3

1919

15.6

2.7

i'.i

13.8

88.8

119.4

161.1

1920

15.7

8.1

.5.' 4

2.7

5.4

102.7

94.5

172.9

1921

13.2

16.1

.5.4

2.7

37.5

10.7

67.0

83.1

1922

13.9

13.2

16.' 5

5.3

7.9

31.4

18.4

58.0

89.6

1923

13.5

2.0

2. ,5

23.3

12 . 9

57.1

144.3

1924

12.6

2.5

.5.6

12.5

55.0

107.3

192f>

13.0

7.5

2.5

9.9

9.9 2.5

62.1

96.7

1926

12.9

2.1

21.0

8.4

i'.l

4.3

14.7

34.8

108.9

Health Conditions.

Of prevailing' health condition.^ in Aurora subsecjuent to the devastating
cholera epidemic of 1849-50 there is little or no record until 1881, In that
}ear a severe wave of smallpox crossed the State but Aurora escaped with
only eleven cases and two deaths. Dr. Courtney Smith, president of the
board of health at the time, had vigorously enforced the regulation of the
State Board of Health that required all school chihlren to be successfully
vaccinated. This work provided the whole community with a degree of
immunity sufficient to almost escape the deadly epidemic entirely although
the infection was introduced into the population on seven different occasions.

At the opening of the twentieth centur\' t\[)hoid fever was endemic in
the community on a scale that gave Aurora one of the highest mortality
rates in the State from that cause. Typhoid fever was charged with 17
deaths in 1900, giving the unusually high rate of 70.4 per 100,000 population.
There were probabl}' about 170 cases that year (this estimate being calculated
upon the usual experience of 10 cases per death), a severe and costly volume

of illness for a city of 24,000 people. That one season of typhoid probably
cost the community at least $1,000 per capita in economic losses without
regard to the expense of life itself.

This is a fair sample of what the people in Aurora doubtless went
through with from year to year for a decade or so prior to 1900 and for
five years afterward. Typhoid came and went like the seasons and was re-
garded as almost inevitable. Shallow wells furnished a large percentage of
the local water supply and the absence of extensive sewer facilities made an
ideal situation for the perpetuation of the infection. After 1905 the number
of deaths in the city from t_\'phoid never reached 10 in any one year except
1911 when an epidemic carried off 11 souls, and in 1926 only one fatality
was recorded, giving a rate of 2.1 per 100,000 population.

Few places in the State have had more happy results from efforts
directed against tuberculosis. Only six out of the 44 municipalities of
10,000 or more population had a lower mortality rate from tuberculosis in
1926 whereas Aurora suffered one of the highest rates in 1900. During that
period the rate in Aurora fell from 132.5 to 34.8 per 100,000 population and
the actual number of deaths went down from 32 to 16. In 1927 the number
of deaths climbed back up to 26 but even so the rate was only 55.8, a figure
far below that for earlier years and equalled but twice before.

With the other ordinary infectious diseases, Aurora has had her ups and
downs like other communities. Epidemics have come and gone in the mys-

Table 3.
Births and Infant Dkath.s.

YEAR

Niililber

Rate**

Number

Rate*

1906

1907

1908

1909

1910

1911

1912

1913

1914

1915

1916

5.5

1917

1918

1919

1920

827

22..')

70.1

1921

894

23.9

76.1

1922

881

23.1

72.6

1923

928

24.1

61.4

1924

1002

•25.3

54.9

192:-)

1025

25.5

71.2

1926

1091

23.8

56.8

"Deaths of infants under 1
"I'er 1000 population.

of age per 1000 live births reported.

l)()\V\-STATi-. Mr.VUirAI.ITIES

'I'al.lr 4.
Cases OF Cer'iaix 1)isi:asi:s Ki i'orted.

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

3«

9»

Smallpox

Ifi

ir>

103

Measles

gr.

51.-I

i.ii

187

367

374

342

995

Scarlet Fever

101

231

110

281

124

Whoop. Cough

101

164

107

142

Diphtheria

iry

263

287

Inthienza

2500

268

26(5

Poliomyelitis

Meiiinjjitis

Tuberoiilosis*

109

112

118

105

l*nevimonia*

162

6fl

100

125

109

189

141

Syphilis

126

Gonorrhea

112

Chancroid

*A11 forms.
Note: Case reports are never complete, but they have been niuch more so since l!t20 than before in
Illinois. This table indicates improvement ili notification moie tlian aiiytlling el^^e.

terious cvclcs peculiar {<> ihenLseKcs, iinw fiL-rce and dcadh. now mild and
harmless. The general trend of diphtheria has been down although the mor-
tality rates in 1921, 1922 and 1923 soared to 37.5, 31,4 and 23.3 respectively,
figures far in excess of the State rates for those years. Lately, a rathei
determined campaign against the disease has been conducted in the cit\-
with the end in view of preventing the recurrence of such heavy fatalities.
Apparently the efforts are hearing fruit. The number of deaths in 1926 was
only two and the same for 1927.

The great influenza epidemic of I'US hit .Viirora hard. Only seven
others of the 44 chief cities in the State suffered losses so heavy. Influenza
and pneumonia together accounted for 263 deaths in that year, giving a rate
of 730 per 100,000 poiiulation. a fiyure that stood from 200 to 300 points
higher than the rates in niaii\- other conimuiiities. It is estimated that 5,000
people had the disease during the e]iideniic which hovered over the citv
from September to Decembr.

The general mortality rate of the city suggests distinct improvement in
the prevailing health during recent years but the average is still above that
of the State and somewhat higher than .i number of other comparable
municipalities.

Refkrexces.

dates.

ual Deports .if the Oity
.\nimal Reports of the State

>f Aurora, various dates.

Bi.anl of lleallh, .I.ihn H. Hauch, .M. 11.. Secveta

History of Medical Practice in Illinois, Vol. 1, Lucius H. Zeuch, II. IJ., Cliicago
Report on an Appraisal of Health Senice for the Year 1925 in Fifteen llli
Kawlings, M. 0., Director of Public Health, State of Illinois, Springfield.
Illinois Health News, May-.hme, 1926.
U. S. Census Reports, Washington, D. C, various dales.

, Sprint-fleld,
1927.

Belleville

Belleville owes its very existence to the unfortunate location of another
community. If Cahokia had escaped the frequent inundations that periodi-
cally flooded the American Bottoms, leaving marshes, boggs, mosquitoes and
malaria to make life miserable for the hardy settlers, and if choice of space
for a house or a city had not been almost as free as the air that bathed the
lungs of the pioneers, a commission would liket\ never have been appointed
bv the court of common pleas to select a more advantageous and satisfac-
tory piece of ground upon which to build the county seat of St. Clair Count) .
Having made a mistake, however, in choosing a site for a town and a seat
of their county government the people now corrected tlieir error by choosing
a piece of rolling territory, known as Compton Hill and l\ing midway be-
tween the Kaskaskia and Mississippi Rivers, for a new home and city. The
transaction took place in 1813, five years before Illinois became a state, and
the new community was christened Belleville.

But even the new location was not spared from ponds and boggs. Occa-
sional overflows of Richland Creek, which cuts through the southwestern
part of the city, left low places filled with water and the wells generously
diluted with seepage. The terrane could he drained, however, and this sub-
sequently took place, leaving the community less apt to sufl^er from the
vagaries of the weather.

A court house wa> built in 1S14 and the ccjnimunity was incorporated
as the town of Belleville in ISl'i.

When the community was incorporated as a city in 1850 the population
was 2,941. The end of the next decade found the municipality with 7,320
people and this number grew to 8,146 in the next ten years and mse to
10,683 by the time of the census in 1880. During the next forty years the
population increased to 24,823 and was made up in 1920 of 22,250 native
born whites, 2.393 foreign born whites and ISO negroes.

Hkaltu Service Machinery.

Just when !'ielle\ille first passed an ordinance creating a board of lu-alth
is not clear from available records. It is pmhablc that steps to that end
were taken at an early date. If so. no particular vigor was attached to the
health service organization for there is practically no record of its activities.
If a board was actually organizerl it doubtless fell promptly into a dormant
paper institution, a common custom at the time.

(37)

38 DOWN-STATE MUNICIPALITIES

There is evidence of a Ixiard of health existing in the place about the
time of the Civil War. It appears to have had seven members, plent\' of
power, no money and no executive officer except its chairman. Its chief
function seems to have been the investigation of nuisances, findings being
referred to the mayor when action was deemed necessary.

According to Dr. Charles H. Starkel,* who made a careful sanitary
survey of the community under the supervision of the State Board of Health
in 1885, there were practically no facilities for carrying on public health
service at that time. In his description of the situation we read:

"There is no special board of health: the alder-
men in each ward act as health officers. The Ijounds
of their authority are confined to the city limits. The
:ildernien receive no pay for such service. There are
no physicians among them, and they have no execu-
tive health officer. The police act also as inspectors.
All of them have police powers. Inspections are
seldom made unless complaint is tiled. No meetings
of the aldermen are held as a health body. Their
powers are not specifically defined or limited by law
and have no authority independent of the city council.
They can only define a nuisance, but have no author-
ity to abate. No notice is taken of defective house

TT^'^if^ r\ai ''■'"I'on'o inir' drainage unless complaint is made, and so of all in-
Health Officer, 1892-1915

sanitary conditions.

■In cases of contagious diseases, especially smallpox, patients are isolated,
more, however, through the influence of the attending physician than that of the
e.\-officio health board. It has power to remove persons sick with contagious
diseases to a special hospital. Vaccination is not compulsory. Births, marriages
and deaths become matters of record only through reports to county clerk's office."

A few years later things began to mend, however, for in the autumn of
1892 an ordinance creating a board of health was passed and Mayor Herman
A. Weber appointed Louis Kemp and John Green to serve as members of
the board until May 1, 1893 and Casimir Audel and M. W. Wier to serve
until May 4, 1894. These gentlemen constituted what is now regarded by
local officials as Belleville's first board of health.

From that date f)n to the present Belleville has had a definitely organized
board of lieahh but the practice of appointing members to overlapping terms
gave wa\- to the custom of annual appointments in all cases and the city
council now e.xercises the appointive privilege instead of the mayor.

Soon after the organization of the board of health in 1892 Dr. C. H.
Starkel became health officer and continued in the capacity until 191, r He
was succeeded in office by Dr. B. H. Portuondo who has filled the place

Ninth All. R|.t. INSd- HI. SI. r.il. 11. , page 28-41, bv Dr. Charles

BELr.EVILLE

B. H. Portuouclo, M. D.
Health Officer, 1915 to date

continuously to date. Xo other municipality in Illinois has allowed tlic health
officer to remain in office over so long a period Even in those places wdiere
the power of the office is not particularly attractive and the remuneration
small there have been more frequent changes,
jierhaps for that very reason.

The very fact that the health officers tenure
has escaped the whims of political spoilsmen
suggests that neither the remuneration nor the
duties of that position are such as to excite envy
or heciime liunlen^ome. Indeed there is little
done in the way nf public health service, the only
extragovernmental activity being a nurse who
works in the public schools.

Subsequent to the board of health ordinance
in 1892 there appears no further legal references
relating to health until 1923 when an ordinance
regulating the sale and sanitary quality of milk supplies vk^as adopted. At
the same time there was some sort of executive interest manifested in the
general health affairs because we find Belleville listed in the United States
registration area for deaths in 1900. Few cities in the State were keeping
vital statistic records carefully enough at the time to share this distinction.
Consequent!)-, we have carefully compiled mortality records for Belleville
over a longer period than for most of the other cities in Illinois.

Another factor of influence over the health machinery in Belleville is
that this cit}- was made the headquarters for State public health activities in
the southern section of the State. Here a district health superintendent on
the field medical staff of the State Board and later the State Department of
Public Health, has been located. Dr. Henry Reis was active as a State
district health superintendent from 1920 to 1925,
inclusive. Dr. E. P. Stiehl was appointed in
1926 and still holds the position.

Water Supply.

.\ waterworks was established about 1873.
The supply was obtained from Richland Creek,
which is supplied by springs and surface water.
The water was first delivered into a large pond,
where it was allowed to settle. From the reser-
voir, the water passed through a large fitter com-
posed of drain tiling and gravel, into a smaller
pond from which it was conducted about one-
quarter of a mile to the distributing pond. Here

Henry Reis, M. D.
District Health Superin-
tendent, 1920-1925

DOVVX-STATK .MUXICirAI.lTIKS

it was iJiiniped into a stone tower 125 feet high from which it passed througli
two Hyott pressure filters and then to the distributing; system. These filters
were installuil in 18S6 and constituted the first water-purification plant in
the State.

A majority of the inhabitants continued the use of well or cistern water.
These private wells were from 20 to 60 feet in deptli.

The waterworks installed in ISOO were dependent upon Christine Lake,
a small body of water east of tlie cit\ , for its source of supply. This proving
unsatisfactory, a number of tubular wells 400 feet deep were sunk at the
south edge of the city. These wells supplemented
1 \ tile lake constituted the source of supply until
I'lOS, l)nt the yield was always more or less
ina(lri|natc.

.\])oin this time, tile waterworks was taken
over hv the American Water Works & (juarantee
Coiiipanx . which company owned and operated
the waterworks in the near-by cities of East St.
Louis and Granite City. The company sank five
wells in the Mississip])i River bottoms at Edge-
mont, about seven miles northwest of the city.
'i'lie water from these wells was harder and con-
tained coiisidera];le iron, consequently it did not
[jrove very popular.
In 1912, the supply became inadecjuate and a L) inch ])i]ie was laid fr( in
East St. Louis to Edgemont, a distance of about li\e miles. After this the
pumps at Edgemont pumped filtered Mississippi River water from the P^ast
St. Louis supplv. .Since that time the suppl\- has been adequate and safe for
drinking purposes.

E. P. Stiehl. M. D.
District Health Superin-
tendent, lii2H to date

Sewicrage.

There was no general system of sewerage in 1880. Small drains were
laid in a few streets in the lower part of the city to drain the cellars. These
emptied into Richland Creek and its branches. The\- were built and paiil
for bv the owners of propert\- (jn the streets in which tlie\ were laid.

In 1886 underground drains constructed by the owners drained about
one-fourth of the city's area. There was one outlet sewer discharging into
Richardson Creek below the waterworks. Main Street had the only under-
ground .sewer, and the surface drainage passed into it.

Ninetv per cent of the houses depended win illy nn privy vaults. Thev
were required to.be water-tight and cleaned ai the linuseholder's expense.
About 25 per cent of the houses had cesspools into which kitchen and laundry
waste water was drained.

BELLEVILLE 41

In the fall of 1916. the State Water Survey made an investigation of
Richland Creek. At the time of inspection, pollution by sewage was notice-
able for six- miles below the city. Septic tanks installed at the main sewer
outlets removed only a part of the suspended solids. It was also found that
industrial wa.^tes played only a minor part in the pollution of the creek.

Since that time the septic tanks have been abandoned, and many nuis-
ances have been reported downstream from the cit}'.

In a report on sewerage by Pearse, Greeley & Hansen in 1924. complete
treatment of the sewage was recommended.

Health Conditions.

As may be surmised, malaria was an important health problem in Belle-
ville during its early history and continued to be a source of considerable
annoyance and economic loss in that community long after it had ceased to
be a problem in most of the places further north. This, of course, was due
to the n-.ore salubrious climate that prexails in that section, the low, flat
terrane that favors stagnant pools which encourage mosquito breeding and
the lack of adequate drainage facilities. Malaria was noticeable enough in
the early days to bring from Governor Reynolds, in his Pioneer History of
Illinois, this statement:

"The disease (bilious- fever with the ague) attacked the people in
the latter part of the summer and in the fall, and was very common hvit
not often fatal."

As late as 1923 we find malaria pre\^ailing in Belleville to an extent
sufficient to impel local civic organizations to join in a voluntary mosquito
abatement project which has practically cleared the communit\- of both a
nuisance and an expensive disease.

Cholera managed to complicate health matters in Belleville as it did in
so many other places during the nineteenth century. It introduced itself to
the community in 1832 through the agency of a traveller who was attacked
while camping near the town and who was compelled to find refuge and
shelter in the court house after being refused accommodations at local inns
and hotels.

The incident brought out the fine spirit of the medical profession which
has for so long a time made that calling one of the noblest and most admir-
able of the human family. While the public generally shunned the poor
stranger like a leper. Dr. William H. Mitchell of \'irginia, who had settled in
Belleville, gave to him every care and comfort that his training and skill per-
mitted. The patient died, however.

Jf^

Willi;iiii Henry Mitchell, M. D.

BELLEVILLE

Thus the uinvclconied stranger soon vexed them no more but tlie disease
lingered to plague the people for many months. Indeed the epidemic lasted
until late in 1833, carrying off, among others. Governor Ninian Edwards.
Here again we find a vivid description of conditions from the pen of an eye
witness. Governor Reynolds, whose personal knowledge of Belleville and
Governor Edwards led him to say :

"While the cholera was raging at Belleville he (Governor Edwards)
was out attending night and day to the afflicted with the scourge. With
his knowledge of medicine and his -true benevolence, he was a kind and
efficient friend to the sick. It was his great anxiety and exertions in
time of the cholera to save the disti'essed that caused him to take the
disease. He was aged and his constitution some shattered, so he fell
a victim to the disease a few hours after it seized him. He died in
Belleville, July 20. 1833."

Table 1.
Mortality From Certain Causes.

YEAR

U-,

.2&

.2 -

1'^

£■

■^

5 "

S-z

1877

1S78

■ii

1879

1880

1881

1882

1883

1884

188:>

1894

209

1895

187

'■'.

1896

269

1897

204

1898

248

'■'.

1899

1900

267

i-i

1901

270

190-2

284

1903

318

1904

377

19Dr)

190S

342

i.5

1907

334

■ ■

1908

333

1909

272

1910

312

1911

310

1912

276

1913

326

1914

304

1915

260

1916

312

.^,

1917

3.51

1918

481

lis

1919

317

1920

321

1921

317

1922

317

1923

373

19S4

332

192.5

345

1926

372

■

DOVVN-STATK MUNICI I'AI.ITIKS

Table 2.
Mortality Katf.s I'"rom Ckktain Causes.

■&

'£

Ce.

- 2*

■^'7

a'i

YEAR

'i.

§ c

■^

s-^

J3-0

3 "

1877

10.0

30.0

1878

50.0

10.0

30.0

16. '6

380.0

aioio

70.0

1879

36.3

63.6

100.0

163.6

118.1

1880

27.2

.54.5

90.0

100.0

63.6

1881

81.8

27.2

9!o

isii

81.8

72.7

34 . 3

1882

9.0

36.3

9.0

200.0

45.4

1883

72.7

9.0

<).0

g^o

72.7

209.0

63.6

1884

63.6

16.6

9.0

18.1

72.7

36.3

IK.S.-)

16.6

33.3

58.3

16.6

1894

12.8

189r>

11.8

57]6

h.h

82.3

1896

16.6

74.4

1».B

24.8

74.4

161.2

1897

12.3

42.5

6.0

115.4

1898

14.7

163.1

77.3

148.7

1899

1900

15. '2

68 .'7

22.9

.5 .'7

5. '7

o7i2

5.7

1.54.5

97.2

1901

13.3

57.0

5.6

11.3

45.2

11.3

135.6

67.8

1902

15.9

39.1

28.0

h'.6

55.9

22.3

173.1

89.3

1903

17.6

77.3

16.6

sl'.s

leie

22.1

5.5

11.0

160.1

132.3

1904

20.1

49.1

10.9

262.9

10.9

21.8

5.5

10.9

196.4

120.0

190r>

16.9

51.4

11.4

5.7

28.6

11.4

125.7

57.1

1906

18.2

26.7

i6!7

'.'.'.

26.7

21.3

10.7

149.3

85.7

1907

15.8

37.9

i'.i

4.7

33.2

9.5

151.5

71.1

190S

14.0

43.8

30.7

4.4

13.1

4.4

17.5

170.8

83.2

190H

12.9

61.6

14.2

9.5

156.3

66.3

1910

14.7

18.9

14^2

14!2

is] 9

4.7

14.2

156.2

75.7

11)11

14.4

28.4

9^5

4.7

9.5

0.5

4.7

18.9

160.9

66.3

lill.;

12.6

56 . 8

4.7

14.2

4.7

122.0

37.9

11113

14.6

47.3

37^9

9.5

14.2

4.7

151.4

75.7

1914

13.4

37.8

4!7

'.'.'. 4.7

61! 5

18.9

9.5

123.0

66.2

19i:>

11.3

9.5

9. 5

4!7

37.8

4.7

141.9

75.7

1911;

13.3

19.0

4.7

38.0

23.6

137.2

137.1

1917

14.7

42.5

4.7

14! 2

47.3

9.5

165.5

137.1

1918

19.8

23.8

4.7

14.2

28.5

561.9

119.0

333.3

1919

12.9

12. i

48.0

113.3

89.0

1920

12.8

8.'6

4.0

24.0

28.0

80.0

116.0

92.0

1921

12.5

11.8

sio

11.8

3.9

82.7

90.6

1922

12.2

15.5

3.h

11.6

27.2

69.9

81.5

1923

14.3

7.6

k'.i

3.8

15.3

10.2

76.9

57.6

103.8

1924

12.3

3.7

7.3

7.5

81.4

55 . 5

1925

12.8

3.7

7.4

37.0

59.2

1926

13.6

3.6

s.'c,

7.2

7!2

3.6

58.4

54.7

rate from .\11 C:i

per 1.000 i)cM>ulatii

all others per 100,000 population.

Cholera invaded the city again (luiin.i;- the epidemic \va\e that swept
over the country during the middle years of the nineteenth century. This
outbreak was im less severe than the mie twenty years earlier, causin.i; tnll\
fifty deaths and niakint; so IiarrnwiiiL; an impressidii uimn the puimlar mind
that the idea of [nihlic health ser\iee became synonymous with the idea of
chdleia pre\ention for main- \ears in that community That outbreak, which
occurred during- the jieriod of 184')-52 was the last disastrous experience
of the community with cholera and it is probable that this deadly infection
will never again sadden the households of that or any other American city
so long as the present standard of civilization remains.

BELLF.VILLE

A. L. Reiiss, M. D.

While tlie re>t of the State was distressed from time to time by loath-
some and deadly epidemics from smallpox Belleville enjoyed a rather distinct
freedom from that disease up to 1900. Intelligent foresight led the local
school board to adopt a ruling in 1858 which required all childret: to present
a certificate of successful \accination before being admitted to the class
rooms. This regulation remained in force for more than thirty years and
while it did not prevent smallpox from gaining entrance into the community
it did establish a degree of public immunity suffi-
cient to prevent an outbreak of the serious magni-
tude common elsewhere, especially during the
eighties.

In spite of this early immunity, however, a
lapse in the practice of vaccination made possible
the advent of a most fatal and alarming outbreak
of smallpox in 1903. The outbreak raged for
three years. There were 6 fatalities during the
first }ear and 46 the second, the mortality rate
from smallpox climbing from 34.3 per 100.000
in 1903 to the extraordinarily high point of 262.9
in 1904. The next year the rate fell to 11.4,
marking the last fatality from smallpox in that cit_\- to date.

Belleville was one of the cities in Illinois where the influenza-pneumonia
epidemic of 1918 pla\ed grim and deadly havoc on a grand scale. IMortality
from the two causes combined amounted to 895 per 100,000 population, a
figure surpassed in only three other cities of the State. Influenza was
charged with 118 deaths and pneumonia with 7(). Never before nor since
has any other communicable disease approached such fatal proportions in
that niunicipalit}' as did influenza in 1918.

With regard to other diseases, Belleville has gone through no particu-
larly unusual experiences. Tuberculosis was bad enough up to about 1920,
since which time it has steadily declined. Typhoid fever has been and still
remains an endemic problem although the annual mortality rate has declined
from a maximum of 81.8 per 100,000 population to an average of about 3.5.
Scarlet fever and diphtheria have visited the city in epidemic cycles peculiar
to those diseases, sometimes virulent and fatal, sometimes mild and less
mortal. Both infections exacted a considerably heavier toll of life in Belle-
\ille in 1926. in proportion to the population, than they did in the State at
large.

The general mortality rate in Belleville now averages considerably
higher than that for the State at large and for many of the comparable cities
luU it must be remembered that Belleville is one of the oldest communities
in Illinois. This gives it a higher ratio of elderly people than the .State liut

DOWN-STATE MUNICIPALITIES

Table 3.
BiKTiis AND Infant Deaths.

Bir

ths

Infant Deaths

YEAR

Number

Rate**

Number Rate*

18Y7

2 20.0

1878

41 410.0

1879

554.5

1880

463.6

1881

472.7

1882

436.3

1883

381.8

1884

2.)

208.3

1906

1907

1908

1909

1910

1911

1912

1913

1914

1915

1916

1917

1918

1919

1920

479

19.1

64.7

1921

540

21.3

70.4

1922

493

19.1

40.6

1923

501

19.2

91.8

1924

466

17.5

79.6

1925

504

18.7

43.6

1926

501

18.3

61.9

per 1000 live births

Table 4.

Cases of Certain Diseases Reported.

1921

1922

1923

1924

1923

1926

1927

Typhoid Fever

Snmllpo.x

Measles

Scarlet Fever

2.)

153

127

Whooping Cough

Diphtheria

Influenza

Poliomyelitis

Tuberculosis*

Pneumonia*

Syphilis

Gonorrhea

Chancroid

*AU forms.
Note: Oiise reports are never complete, but they hnve been muth m
Illinois. This table indicates improvement in notification more tha

BELLEVILLE 47

the difference in age distribution is not as great as the difference in the
mortahty rate. According to the 1920 United States census report, 21.5 per
cent of the population in Ilhnois was over 45 years old, while in Belleville
23.2 per cent fell into that age group. In 1926, the general mortality rate in
Illinois was 11.8 while that for Belleville was 13.6. About the same differ-
ence has prevailed for several years.

References.

Annual reports of the State Board of Health, Springfeld, Illinois, various dates.
Bulletins of the State Water Survey, Urbana, Illinois, various dates.
Pioneer Histoo' of Illinois. John Refolds. Belleville, Illinois, 1852.
U. S. Census Reports, Washington, D. C, various dates.

Bloomington

One of the largest and finest of the isolated groves in the great prairie
region of the Sangamon basin adorned the hills of what later became McLean
County. Early settlers called it Blooming Grove. It covered between 40
and 50 square miles of land area, making the locality very attractive. As
the settlers pushed back from the vicinity of the navigable rivers, the_\- very
naturally gravitated to this beautiful spot and made their abode in its vicinity.
The community grew into the thriving municipalities of what are now called
Bloomington and Normal.

One of these early settlers was Dr. Isaac Baker, a veteran of the War
of 1812, who came to McLean County in 1827. This versatile physician,
who was doctor, architect and civil engineer by turns, helped to lay out the
town of Bloomington on July 4. 1831, locating it on the north edge of the
Blooming Grove.

Dr. Baker was clerk of the county commissioner's court for fifteen
\ears. During this time a young man wished to secure a marriage license
and having no money offered to pay for it in maple sugar the following year.
A historian who says that the doctor accepted the proposition adds the com-
ment that it was a "sweet transaction for all concerned." This incident sug-
gests the scarcit}- of cash during the days when Bloomington \va^ in the
making.

The communit}- was organized into the town of Bloomington in 184o
and incorporated as a city in 1850. To show their temper and disposition
to manage public affairs the board of trustees at its first meeting in 1843
passed an ordinance requiring a license fee of $25.00 each from grocer \-
stores doing business within the town limits.

During the twenty years between 1850 and 1870 the iHi]iulati(in grew
from 1,594 to 14,590, an average increase of 650 per annum. That was the
period of most rapid growth. In 1880 the number of people was 17,180 and
in 1890 it was 20,484. The 1920 United States census report shows a total
population of 28,725 which was made up of 25,053 native born whites, 2,831
foreign born whites, 799 negroes and 42 persons of other races. Persons
45 \ears of age and over constituted 27. ii per cent of the population in l')20.

Health M.actiinery.
It is probable that the people in I'locimington were among the first in
the State to realize in a significant way. the possibilities of what we under-
stand today as public health service. Dr. Llias ^^'. Gray lived there during
the seventies and he was exceptionally active as an advocate of sanitation

(48)

r.LOOMI.NC.TON

and hvgiene. His efforts (see volume 1 of this history) were an important
factor in causing the legislature to establish the first permanent State Boani
of Health in Illinois. Doubtless his influence was felt in Bloomington. It
may even be that his conceptions and activities were inspired by citizens of
Bloomington and that his championship of the
public health cause was but a reflection of mature
sentiment among thinking citizens there.

In either event there must necessarily have
been mi inconsiderable sentiment there in favor
of organized public health service of a high
order for that day. This attitude was manifested
in 1885 when the Mayor Benjamin F. Funk of
Bloomington exercised a pronounced personal
interest in the house to house sanitary survey
inaugurated by the State Board of Health, taking
time enough to visit Springfield for a conference
on the subject with Dr. John H. Rauch, secre-

Benjamin F. Funk,
Mayor

BLOOniMGTOM

(St

VITAL STATISTICS

conn. DI5 coriTROL
VEM discohtrol:

TUB. COMTROL
HEALTH CHILD-i''
HEALTH 5CH. CHILD ^
5ArilTATI0M^^5.r^"
MILK CONTROL
LABORATORY
POP HEALTH mSTZ

PERCEMT OF STANDARD SCORE
FOR EACH OF TEH MAJOR HEALTH ACTIVITIES

Fig. 1. This graph illustrates the strong and weak points in Blooming-
ton's public health service, official and voluntary, as it existed in 1925. It
is based upon a personal survey and rated upon the standards evolved by
the American Public Health Association. The total efficiency rating in
Bloomington was 46 per cent of the standard perfection requirement.

DOWN-STATIC .MUXICIPALITll-.S

tary of ihc hoard, and causing tlie project to l)c carried nut with great
thoroughness in his city.

Again, in later years we find a legislator from lilooniingtun, leading a
successful movement in the General Assembly to enact a law permitting
counties to establish and maintain tuberculosis sanitariums and that McLean
(."ount\-. with the help of Bloomington, took
ad\antage of this law rather promptly.

Furthermore, there was, in 1880. a health

committee of the city council. It consisted of

three aldermen and the mayor and functioned as

a board of health. It employed a health officer

at $40.00 per month whose chief duties were the

j'^K k abatement of nuisances and the enforcement of

.^^^M J^^^L^ garbage removal regulations. He had police

^^^^W ^KgyBAk powers and he was responsible for removing to

^^^* ^B^^^BS fi^ie "pesthouse" persons found in the community

with smallpox. It is interesting to observe that
the medical profession was not represented on
the committee nor did it participate officially in the sanitarx' efforts of the
public.

The list of health commissioners who have served Bloomington include :

Hiram Greenwood
Health Officer, 1885

188.-..

Hiram firecinvood

1898-1801

Dr. Dwight 0. Moore

1901-

Dr. F. J. Welcli

1901. 1906

1912

Dr. A. W. Mever

1902-1904

Dr. J. E. Kundler

1913-191.1

Dr. H. H. Griffin

1915-

Dr. J. J. Coniion

1915-

VV. T. Williams

1915-1919

Dr. F. C. Vandervoort )

Dr. H. H. Griffin ^ Serve.

together

Dr. F. H. Godfrey )

1919-

.Jacob Meeth

1919-1921

Dr. James M. Fiirstman

1922-1923

Dr. Harold B. Wood

1923-1927

Dr. Charles E. Schultz

By 1898 the board of health had grown to
include fourteen aldermen in its membership and
the influence of the medical profession had
caused the appointment of Dr. Dwight O. Moore
to the position of health commissioner, the title
of the board's executive officer. Under Dr.
Moore was a sanitary policeman in the person of
John F. .\nderson. The expenditures of the
board of health in 1898 amounted to $11,991.55
but $10,473.81 went for scavenger service.

Dr. Moore died in 1901 and was succeeded
by Dr. F. J. Welch who remained in office for a
short time only but he appears to have been re-

Dwight 0. Moore, M. D.

Health Commissioner

1898-1901

BLOOMINGTOX

sponsible for inaugurating the keeping of vital
statistics in tlie city. Prior to that time report?
of births and deaths had been recorded by th^
county clerk only. The city clerk now began
to exercise that function and continued to
ilo so under Dr. A. W. ^Ie\-er who became
health commissioner before the end of 1901.
])r. J. E. Kundler followed Dr. i\leyer as health
commissioner and drew a salary of $600.00 per
\ear for his services in that capacit}'.

In 1915, when the city adoptetl the commis-
sion form of government, an important and
unique change was made in the administrative
organization of the health department. By ordi-
nance the public health activities were placed in
the hands of three men, known as health com-
missioners, under the commissioner of public
health and safety. Three physicians, Doctors
F. H. Godfrey, H. H. Griffin and F. C. Vander-
voort, were appointed to these positions and they,
in turn, employed two inspectors, one for foods
and one for sanitation.

John F. Anderson
Sanitary Policeman, 1S9S

F. H. Godfrey, M. D.

Health Commissioner

1915-1919

The commissioner of public health and safety
and the three health commissioners constituted a
board of health while the food inspector acted as
its secretary. Three men on one job apparently
worked out but little better than the proverbial eft'ort of one man to serve two
masters for we find the triumvirate abandoned by 1919 when arrangements
were completed for reverting to the one man
s\'stem and he was placed on a full time basis.

Public confidence in the potential benefits of
public health service had grown too, so that ap-
propriations to the health department had soared
to $12,600.00 for the fiscal year ending April 30,
^pf^ i^w. '^''"^ ^""^ *-'^^ matter of garbage disposal had been

^•■^^^HBfcH transferred to another department. At that time
^^^^^^^^M l^r. J. JNI. Furstman was the full time health com-
^^^I^^^^^H missioner, one of the first to be employed in
Illinois outside Chicago, and he was assisted by
three nurses and one or two inspectors.

k'^iLfe.

H. H. Griffin, M. n.

Health Commissioner

1915-1919

DOW N -STATK M L' N ICl PALITI 1

James M. Furstman, M. D.

Health Commissioner

19191921

In 1922 the city abandoned the commission
form of government but the full time health com-
missioner was retained, Dr. Harold B. Wood suc-
ceeding Dr. Furstman in that capacity. His
budget amounted to 810,830.00 per year and his
staff included one food and one sanitary inspector
and one public health nurse. He maintained a
-small amount of laboraton- equipment which
enabled him to make tests for diphtheria and
examine samples of water and milk.

The strength of the health department staff
in 1925 had changed but little, embracing the
commissioner. Dr. C. E. Shultz, three nurses and
two inspectors, all on a full time basis. A clear
picture of public health administrative machin-
ery in the cit_\- at that time, which still prevails in
much the same character, is found in the report
of a survey and appraisal made by the State
Department of Public Health.

It reads, in part, as follows :

"The public health services carried out in
Bloomington during 1925 were evaluated at 461
points, giving to that city fsvelfth place among the
fifteen included in the appraisal study.

It so happened that the position of full-time
health officer was vacant during several months last
year (1925). causing a lower score than might other-
wise have been the ease. All of the health department personnel, consisting of the
health officer, three nurses, two inspectors, and a clerk are appointive by the mayor
except for one nurse who is employed by the school board. The county tuberculosis
board employs a nurse whose travel expenses are paid by the county tuberculosis
association. Volunteer agencies do less in Bloomington than in any of the other
fifteen cities. Last year (1925) a board of health was organized, an emergency
measure brought on by a smallpox outbreak.

'The city spends thirty cents per capita per year for public health work,
funds from other sources raising this figure to 47 cents.

'■Notification of contagious diseases measure up satisfactorily to the standard
required. A good system of eiiidemiological record keeping is in use although the
cards are not completely executed and no spot maps or charts of contagion are
kept. No communicable disease nursing service is provided. The sanitary inspec-
tor quarantines and releases all cases not seen by the health officer. The health
officer himself devotes much of his time to visiting cases of contagion. There are
no communicable disease hospital facilities in the city or county. Very little has
been done to stimulate the immunization of children against diphtheria. Due to
an epidemic of smallpox last year, however, it is estimated that more than one-

Harold B. Wood, M. D.

Health Commissioner

1922-1923

BLoo>riN'c;To.\' 53

half of the population, including 98 percent of the school children of the city was
vaccinated against that disease.

"There is no venereal disease clinic. Case reports are not up to standard
appraisal requirements.

"Cases of tuberculosis are well reported. The tuberculosis clinics are well at-
tended although the total number of visits is slightly less than the quota. A county
tuberculosis sanatorium is maintained. At this institution a total of nearly
14,000 patient days treatments were given. About 14 percent of the cases were in
the incipient stage of the disease on admission. There are no open-air classrooms
or prevenforia.

"There are no prenatal, infant or preschool clinics. Only about 300 home
visits were made by nurses in behalf of this age group. There is a very active
Day Nursery with a trained public health nurse as director. She has done a con-
siderable amount of educational work in prenatal and infant hygiene through
mothers clubs. Tonsil clinics are held occasionally at the Day Nursery.

"There is no medical inspection of school children. The nurses weigh and
measure all children and test the vision and hearing of some. The only correc-
tion of defects of which there is a record is the tonsil and adenoid operations at
the Day Nursery. The nurses made a large number of home visits in behalf of
school children, the numbers being about double the standard appraisal require-
ment. Considerable attention is given to the teaching of hygiene in the schools,
fifty minutes per week being devoted to it in all grades. Health classes are also
held at the Day Nursery.

"A good sanitary and food inspection service is maintained although food
establishments are not licensed. The city water supply is of good quality and is
distributed, it was estimated, to S5 per cent of the homes. It was estimated also
that 80 per cent of dwellings are connected with sewers. An accurate survey of
the privies in the city was made three years ago.

"Ninety per cent of the milk supply is pasturized, one plant supplying 80 per-
cent and the two others 10 per cent of the total. No inspections are made of dairy
farms except of 13 which are located close to the city. Periodic inspections of
distributing plants, and a large number of sediment tests are made of both raw
and pasteurized milk. Shipments of dirty milk when discovered are excluded from
the market. These tests give a fair index as to the sanitary quality of raw milk
but are of little use in determining the quality of pasteurized milk. Bacterial
counts are not made.

"A small laboratory is maintained by the health department, the city health
officer himself making the examinations. About the only tests made last year
were for diphtheria and gonorrhea, the remainder of the laboratory credit being
due to the examinations made at the Springfield State Laboratory."

Water Supply.

The public water supply was installed in 1875 and comprised one dug
well 40 feet in diameter and 38 feet deep, located on the banks of Sugar
Creek within the city of Normal, which adjoins Bloomington. The main
water supply has ever since been derived from wells penetrating the glacial-
drift deposits in that vicinity, but different wells have been installed from
time to time.

54 DOWN-STATE MUNICIPALITIES

111 1885 the dug well was enlarged and deepened by installing an ellip-
licii pit 26 by 32 by 16 feet deep below the bottom of the original well,
making the total depth 56 feet. The yield became inadequate to meet in-
creased demands and in 1894 twelve 10-inch tubular wells were installed
and the water pumped from them by air lift into the original well, which
then served as a receiving reservoir until the installation of the present
10-million-gallon reservoir about 1905.

The supply again proved inadequate and in I'JlO the former tubular
wells were replaced by three shafts about 42 feet deep in the bottom of each
of which several tubular wells with strainers were extended 30 feet deeper
into water-bearing glacial drift. At the same time the pumping station was
rebuilt, electric pumps replaced air-lift equipment for the wells and direct
pumping pressure in the distribution system was established.

During warm weather when the use of water increased and the yield
of the wells decreased the supply continued to be inadequate to meet the
growing needs of the city and the inadequacy of the supply has continued
to be a topic of discussion and consideration up to the close of the period
covered by this history. In 1915, one of the 1910 wells was abandoned, the
others were improved, and one additional well and unit was developed by
installing in the bottom of the original dug well eight tubular wells and a
pumping unit.

In 1920, after a study of possible ground-water resources by the local
officials, it was decided to install additional wells at some distance from the
main pumping station in the vicinity of which all the previous wells were
located. One tubular well with strainer was sunk into the glacial drift
about l'/2 miles southwest of the main station and a pump house and
188,000-gallon concrete collecting reservoir built. This well was also along
Sugar Creek which flows westerly through the northern portion of the city.
In 1921 two more tubular wells were sunk at the western station where ten
acres of land had been secured for water-works purposes and another high-
service pumping unit installed.

About 1921, consulting engineers were engaged to make a study of water
resources, possible impounding reservoir sites, the mineral and sanitary
quality of the various possible supplies and the costs of development. The
engineers recommended the development of a surface-water supply by means
of a dam on the lower portion of Money Creek. There had already been
local differences as to whether the future supply should come from wells
or a stream, and following the consulting engineer's report this controversy
among the residents of the city continued. Some contended an adequate well
supply covdd be developed ; others that a well supply would always be inade-
quate as it had been most of the time since the original waterworks was
installed ; still others that even though an adequate well supply could be de-

BLOOM INGTON 55

veloped the water \\oul(J continue to be very hard and of unsuitable mineral
quality for domestic as well as for industrial purposes, as in the past, and,
therefore, an adequate softer filtered surface-water supply was the best pro-
ject for the cit\-.

The supply, continuing to be inadequate and of unsatisfactory mineral
qualit}', in 1926 a group of men and their consulting engineers favoring an
impounding reservoir on Mackinaw River submitted a project to the city
which included the development of such a supply and the wholesaling of the
water to the city. Another group and its consulting engineers made a some-
what similar proposition to the city, hut the source proposed was an im-
pounding reservoir on Money Creek. A citizen's Water Committee was
organized to make a comprehensive stud_\' of the development of an adequate
satisfactory water supply for Bloomington and Normal, which committee
comprised officials of both cities, representatives of the chambers of com-
merce, civic organizations, etc. This committee held many hearings, reviewed
the two projects submitted, studied the question of softening a well-water
supply and studied the possibility of other impounding reservoirs.

The work of the Citizen's Committee convinced practically everybody
that the softening of the well-water supply was impracticable because the
water would still be highly mineralized after it was softened even though it
could be made adequate, which was very doubtful. About everyone was
agreed that the only suitable sites for an impounding reservoir were either
on Mackinaw River or Money Creek, but an agreement as to which was the
better could not be reached, and the Citizen's Committee closed its activities
by submitting the facts gathered to the city councils of Bloomington and
Normal but without recommendations as to impounding reservoir sites. At
the close of the period covered by this report, a water company to develop
an impounding reservoir had been formed by local persons subscribing stock,
and the officials of this Citizen's Water Company had undertaken the task
of deciding whether to develop the Mackinaw River or Money Creek pro-
jects and then to make plans to develop and finance the project decided upon.

The original distribution s\stem comprised about ^y2 miles of mains
which were put in by bond issue. Since then additional mains have been
laid from time to time by special assessment, and at the close of this histori-
cal period practically all the property in the city has access to the public
water supply.

The water obtained from the wells has been of varying quality and after
drawn from the wells it is subject to contamination in the open storage
reservoir. No epidemic has been caused by the public water supply, but the
State Department of Health has for the last several years at least regarded
it as of doubtful quality, especially because of possible contamination in the
reservoir. ,\nah ses have at times shown conlaniinalinn.

56 DOWN-STATIi MUNICirAl.ITIES

A watcr-bonie epidemic did occur in 1920 when a conlaminalcd indus-
trial supply maintained by the Chicago iV Ahon railroad entered through a
cross connection the piping carrying the cit\ water within the Chicago &
Alton railroad yards. Fortunately the consumjjtinn witliin the railroad
yards was sufficient to take care of the polluted water that was passing
through the cross connection, and thus the polluted industrial supply did not
get out into the street main and cause an\- primary typhoid cases among
those not working and drinking water at the railroad shops. This epidemic
comprised many hundred cases of diarrhea, about 200 cases of typhoid fever
and at least 24 deaths although some of the mortality was returned as due
to other causes. This epidemic, in one sense, was the indirect result of the
inadequacy and unsuitable mineral quality of the public water supply, be-
cause if the public supply had been adequate and suitable for the railroad
shops the polluted industrial suppl\ probably would not ha\e been estab-
lished or at least maintained.

At the close of this historical period the liloomington supph' was being
derived from the two groups of glacial drift wells, and storage of the well
water until i)umping into the mains was furnished by the open 10-million-
gallon reservoir and the covered 188,000-gallon reservoir. The water supply
was the hardest and one of the most highly mineralized public water supplies
in the State, which has tended to keep the consumption low because it is not
even satisfactory for general domestic purposes.

Sewerage.

Sewers, principally eif the enmbined t\pe. have been installed from year
to }-ear in accordance with the immediate demands. Many of the sewers have
been built with open joints, resulting in excessive ground-water infiltration.
The sewers all drain north and westward into Sugar Creek, there being in
1920 seven such sewers ranging from 15 to 96 inches in diameter. A small
section of Bloomington known as the Miller Park district was sewered on
the separate plan and discharges through an Imhoff tank constructed in 1915.

In 1919 the Bloomington and Normal Sanitary District was organized,
including all of the corporate area of Normal and most of the city of Bloom-
ington and some adjoining territory. The Miller Park district was not in-
cluded. An intercepting sewer w-as constructed to carry the ordinarx- dry-
weather sewage flow and a portion of the storm flow from the area to a
point southwest of Bloomington. A sewage-treatment plant designed to
serve 54,000 people is under construction, comprising bar screens, grit cham-
bers, pumping station, Imhoff tanks, sludge-drying beds, dosing tanks,
sprinkling filters and secondary settling tank. This jilaiit will be placed in
operation in the immediate futiu'e.

BLOOM INGTON

Health Conditions.

Charles E. Schultz, M. D.

Health Commissioner

1923-1927

\\ liat seems to be the very earliest reference concerning health matters
among- the settlers of Bloomington relates the story of how Dr. John F.
Henry, a local physician, took into his own house an eight year old girl
•who was suffering from smallpox to save her from being exiled by a terrified
public. The girl's mother also came down with
the disease and shared in the benevolent care of
Dr. Henry just as otherwise she would have
shared the helpless exile of her daughter, a con-
summation fraught with the gravest dangers to
life itself.

Another glimpse at health conditions in and
around Bloomington during these early days
Comes down to us through Dr. Daniel Drake,
medical observer, author and traveler, who visited
the town in 1844. From Dr. Henry he learned
that autumnal fever was both infrequent, rela-
tively and mild in that vicinity. This opinion was
shared by a brother practitioner. Dr. Colburn.
These same two physicians described to Dr. Drake an extensive epidemic
of er\si]X'las that occurred during the winter of 1843-44. Strangely enough
both (locti)is stiiutly maintained the opinion that this disease was not con-
tagious.

Apparently erysipelas caused no particular alarm, although it swept the
community in a rather thorough-going fashion, while smallpox, which could
be prevented by vaccination, created such violent fear that a helpless girl
and her mother whose only fault was illness, would have been summarily
exiled upon the desolate prairie with a sanction of the public that touched
upon religious fervor.

Thus we see already in the infant municipality the manifestation of
fears and prejudices that will lead Bloomington straight into the "pesthouse"
period when smallpox was less welcome than leprosy in the popular imagina-
ti<in while typhoid fever, tuberculosis, scarlet fever, diphtheria and other
deadly infections were condoned as unhappy visitations of an angry provi-
dence. Accordingly we are not surprised to find a vi\ id report of a smallpox
outbreak that occurred in 1882. Tramps, immigrants antl new-comers came
under the ban of epidemiological scrutiny at this time and. as usually hap-
pened, local officials pinned the blame of starting the epidemic upon a couple
of tramps, an immigrant and a family of new-comers who Jiappcned to be
still within the limits of the hone_\moon period of their matrimonial exjjcri-
ence. The bride and groom escaped the "iiesthouse" because of their ad-

DOWX-STATi: MUNICIPALITIES

Table 1.
Mortality From Certain Causes.

'S ^

YEAU

1 '

•=£

i 1

■g

£~

c*<

■i

'•~

E-

>■

1900

340

1901

333

'.'.

1907

425

1908

395

1909

399

] *

1910

425

1911

408

1912

445

1913

41S

1918

527

■5

1919

407

1920

460

1921

430

1922

412

1923

403

1924

406

1925

434

1926

432

Table 2.
Mortality Rates From Certain Causes.

■, ^

^£4

.S s

YEAR

•s.

- fc

'= Z.

■^

■~

E i""

= *-

■r.

■^ "=5

= <

1900

14.5

1
. 1 17.2

8.6

1901

14.2

. 17.0

8.5

1907

16.9

31 '.9

6 4!n

sio

14^2

139!6

iii.'i

1908

15.4

1909

15.6

1910

16.4

1911

15.6

;

1912

1G.8

1913

13.6

33!7

18!7

loiii

1918

18.'o

7.'i

'. 3.5

17.' 8

296.' 4

13.5.7

203^2

1919

14.2

3.4

4 3.4

3.4

94.4

83.9

1920

16.0

34.1

6.8

106. S

82.0

144. S

1921

14.8

3.4

•i 3^4

10.3

24.0

82.3

96.1

1922

14.0

3.4

20.4

37.4

68.0

118.9

1923

13.6

3 '.'.

23.5

63.9

80.8

1924

13.5

3.3

sis

13.2

50.0

86.6

1925

14.3

3.3

sis

8 3^3

13.1

29.5

.52.5

101.9

1926

14.0

3.2

35.2

; , 32.1

78.1

iite from All C.nises is per 1,000 populatit

uU others per 100,000 populatic

BLOOMINGTON 59

vanced convalescence but the unhappy vagabonds paid for their indiscretion
by a solitary residence in that isolated institution which probablv woukl have
welcomed a thief or burglar as an honored guest.

From the date of that experience down to the present time Bloomington
has elected to treat smallpox as an emergency matter rather than as
a constant danger that could be averted through the practice of systematic
vaccination during quiet }ears. Consequently the infection has visited the
city from time to time, now mild and inconsequential, now loathsome and
costly. About 1900 an epidemic cost the municipality about $400.00 for
specific control measures. Another outbreak smouldered in the community
during 1921 and 1922. Again in 1925 an epidemic of some 109 cases em-
barrassed the commercial and business interests of the city bv creating a
disturbance on the very eve of the holiday shopping season. This led to the
vigorous application of control measures, wholesale vaccination, and the
happy suppression of the outbreak before irreparable damage had been done
to holiday merchandizing. Ordinarily these periodic epidemics result in such
general vaccination that smallpox is of no consequence again for several
years.

Toward the end of the nineteenth centvny, in common with forward
looking citizens all over the country, the people in Bloomington began to
regard scarlet fever, diphtheria, typhoid fever and other infections as com-
municable from person to person and therefore subject to prevention by
quarantine. Accordingly the practice of case notification and the placarding
of infected premises came into vogue about that time. More and more fre-
quently do reports of outbreaks appear in the records and doubtless the\- are
more and more complete.

In 1898, for example, 18 cases of scarlet fever and 15 cases of diph-
theria were recorded with a notation that all cases had been quarantined and
the premises fumigated after termination of the illness. Again, in 1900 seven
cases of diphtheria and 20 of scarlet fever were reported. This is about
the way these diseases behaved from year to year with but few exceptions,
the mortality tending downward with the wider use of antitoxin, the con-
stantly growing improvement in the qualitv of medical practice and the in-
creasing efficiency of local health service. One outbreak of diphtheria in
1925 is noteworthy because of its extensive proportions, involving 374 cases.
It was fortunately of a mild character and the efficiency with which physi-
cians and health officials handled the situation saved all but one of the
patients. In an orphanage 14 out of 61 people got the disease hut none
were lost although the institution went through the inconvenience of a con-
tinuous quarantine for three months.

60 DOWN-STATE M U N I CIPAr.TTIES

llloomington. like so many other communities of the State, has had
a long and unpleasant experience with typhoid fever but mortality statistics
arc too meagre to furnish any clear notion of whether the disease has been
relative!}- more severe there than elsewhere. It appears that the city escaped
with a loss of from two or three to ten or twelve lives a year without going
through any particularly widespread or disastrous outbreak until 1920. In
that year a valve that separated the safe public water supply from a contami-
nated private supply in the Chicago and Alton railway shops sprang a leak
and because the water pressure on the private supply side was greater, pollu-
tion was driven into the drinking water that quenched the thirst of hundreds
of workmen. An epidemic involving about 1,000 cases of severe diarrhea
and some 200 or 300 cases of typhoid fever resulted. Public resentment ran
high, expressing itself in a belligerent mob attitude that threatened the life
of the 'local health officer. This was a manifestation of radical change in
popular sentiment concerning typhoid fever from that which had prevailed
twenty-five years earlier. Subsequent to 1920 Bloomington went through
one year. 1923, without a fatality from typhoid but lost one person to that
infection in each of the others down through 1926.

Influenza struck Bloomington with moderate severity during the pan-
demic of 1918. The mortality rate per 100,000 population from influenza
])r(iper was 296 and that from pneumonia 203, the latter being a trifle more
than twice the ordinary per annum. One-half dozen of the other communi-
ties embraced in this volume esca|ieii with losses as light as those experienced
in Bloomington. Mortality rate.-i from influenza and pneumonia higher than
the usual prevailed during the next two years but this was common through-
out the State.

Tuberculosis appears to have been the captain of the forces of mortality
during the earlier years in Bloomington, ordinarily accounting for more
fatalities than any other disease. In 1907 tuberculosis was credited witli
35 out of 425 deaths from all causes, a matter of eight per cent. From that
time down to 1920 the mortality \acillated between 20 and 40 but subse-
quently the death rate has declined with splendid continuity. For the three
years ended with 1926 the average annual mortality rate was less than 40
per cent of what it was in 1918 while the number of deaths, 47, in three years
combined was scarcely 25 per cent higher than that, 38, for 1918 alone. The
community appears to be well on the road toward the complete eradication
of tuberculosis as a particularly dangerous health hazard.

The general mortalit_\- rate in Bloomington has persistentl\' been some-
what higher than that for the State and higher than those for some of the
other municipalities. It must be remembered, however, that Bloomington
is an old residential community in the center of an agricultural district and
that the age distribution of the population is different from that in many of

BLOOMINGTON

the younger places and those devoted more to industries which attract young
people. A population with a considerable group of elderly people experi-
ences a higher mortality than one with few old people although health condi-
tions may be unusually good.

Table 3.
Births and Infant Deaths.

Births

Infant Deaths

YK.XR

Number

Hate**

Number Rate*

1918

1919

1920

448

15.5

80.4

1921

495

17.0

90j-9

1922

530

18.2

84.9

1923

578

19.5

69.2

1924

545

18.1

73.4

1925

597

19.6

80.4

1926

553

18.0

75.9

^Deaths of infants under 1 ye
*Per 1000 population.

of age per 1000 births reported.

Table 4.
Cases of Certain Diseases Reported.

1920

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

Smallpox

139

105

140

Measles

522

751

224

428

771

383

Scarlet Fever

181

135

Whoop. Cough

135

155

168

139

Diphtheria

Influenza

Poliomyelitis

Tuberculosis*'

100

111

10.1

131

202

199

Pneumonia"*

Syphilis

105

Gonorrhea

9.5

*An outbreak of 130-150 cases of intestinal disturbance which it was possible was typhoid fever, was
reported to the city health department.

**A1I forms.
Note: Case reports are never complete, but ihey have been much more so since 1920 than before in
Illinois. This table indicates improvemnt in notification more than anything else.

References.

.\nnual Reports of the City of Bloomington, various dates.

Annual Reports of the State Board of Health, John H. Rauch, M. D., Secretar;

Springfield, variou.s

History of Medical Practice in Illinois, Vol. 1, Lucius fl. Zeuch, M. D., Chicago, 1927.
Report on an Appraisal of Health .Service for the Year 1925 in Fifteen Illinois Citii
vlings, M. D., Director of Public Health, State of Hlinois, Springfield.
Illinois Health News, JIay-June, 1926.
U. S. Census Reports, Washington, D. C, various dates.

Cairo

Located on the most southern point of land and the lowest above sea
level in the State, Cairo faces the Ohio River where her front yard is lined
with docks that furnish anchorage for river vessels while her back yard is
walled off from the Mississippi by a levee upon which a railroad enters the
city. Cairo was incorporated as a cit\- on January 9, 1818, several months
before Illinois was admitted to the Union, and was chartered as a city second
only to Shawneetown among municipalities within what are now the bound-
aries of Illinois.

To the south of the community a few acres of swampy marsh land sink
down into the waters of the two great rivers. To the north a considerable
acreage of reclaimed land protected from Cash Creek and the Ohio River
by levees, lends itself splendidly to the cultivation of cotton.

Where Cairo got its name is a matter of some dispute. One theory is
that the community was christened for Louis F. Cairo, a man who settled
there in 1780 and became the father of the first white person born in that
localit\'. M. B. Harrell, a local historian, contends that the name was taken
from the ancient and widely famed city of the Nile delta. At any rate, that
whole vicinity is vulgarly known as "Egypt", a term that has gradually come
to embrace the whole southern end of Illinois.

Sharing whatever advantages may have accrued from being near the
center of population of the State, during the early days, Cairo likewise
suffered later, in common with neighboring communities, from a shift in
population density that carried with it the great industrial and agricultural
interests of the State to the north, centering in Chicago. From 1850 to 1870
Cairo experienced the greatest period of growth in her history. During
that time the population increased from some 150 souls to about 10,000.
Subsequently, growth has been exceedingly slow and the rate has declined
in recent years. For the census years of 1900, 1910 and 1920, the number
of inhabitants was 12,566, 14,548 and 15,203 respectively. Of the 1920
population 9,779 were native born whites, 411 foreign born whites and 5,000
negroes. Few, if any, other places in Illinois have such a heavy negro popu-
lation. There were 3,280 or about 2\yi per cent in tlie age group of 45 years
or more. This suggests a relatively short average life span since Cairo is
an old community and the percentage of people 45 years of age and over
is scarcely greater than that for the State at large.

(62)

Health AIaciiinery.

Frightened into action b_\- an epidemic of smallpox, Cairo passed an
ordinance creating a board of health in 1857. The board membership con-
sisted of the mayor and a committee of aldermen. A little later, provision
was made for the employment of a health officer, whose qualifications and
duties were those of a sanitary policeman, but this office was abolished in
1869 and the duties were transferred to a policeman.

A revival of interest in health matters took place in 1866 when rumors
of an impending outbreak of cholera alarmed the public. Again a board of
health was organized, this time composed of three physicians headed by
Dr. Horace Wardner, and a health officer in the person of Dr. James
Summerwell was appointed. With the subsidence of the outbreak, which
arrived on anticipated schedule time, and the return of tranquilit\- in public
thought the board of health fell again into a more or less dormant state
only to be aroused again in 1869 by another visitation of the smallpox.

These experiences together with the increase in river traffic from the
south which opened the community to danger from imported diseases
prompted the city to adopt what might be called a sanitary code in 1871.
The text of this ordinance or code reads as follows:

"If any person in charge of a boat shall permit any person suffering
with a communicable disease to land or come ashore in Cairo or within
five miles of the city in Illinois without a permit he shall pay a fine of
$50 to $500. Such permit shall be passed upon by a physician of respect
and standing of city of Cairo. Any captain or master of a boat con-
cealing a passenger subject to same fine.

"Any person having a communicable disease leaving their premises
or place of abode without permit shall be subject to a fine of from $10
to $100. The city marshal shall post quarantine signs on houses during
illness of any person or pay a similar line.

"The mayor of city and one member of the city council from each
ward shall constitute a board of health which shall exercise general
supervision of the public health of the city and they may report to the
city council from time to time such sanitary rules as may be necessary to
promote health and prevent contagious disease. It shall be the duty of
the householder or occupant of any house to report any communicable
disease to the mayor or city marshal or be liable to a fine of $25 to
$100. Any medical doctor who shall have any patient within the city
of Cairo shall forthwith make report to the mayor or city marshal of all
communicable diseases subject to a fine of $20.

"It is lawful for the board of health to establish a hospital for con-
tagious diseases and to remove patients thereto when necessary in
their opinion. Approved Nov. 25, 1871, John M. Lansden, Mayor, M. J.
Hawley, City Clerk."

64 DOWN-STATK M I'.X I( I PAMTIl-.S

It ina\' be observed from the ordinaiu'c tliat another chan.t,fe was made
in the provisions governing membership on the Imard and that it again be-
came Ia\' in cliaracter. For the next year or two we find tlie Ijoard exer-
cising its authoritx in a number of ways, employing physicians to vaccinate
against smallpox all non-immune citizens, hiring special policemen to exe-
cute quarantine regulations, constructing a "pest house" for isolating the
unfortunate victims of smallpox and participating in many other activities
calculated U> control diseases, especially smallpox.

From 1871 on there seems to have been no further change in the legal
provisions for maintaining an official public health organization until 1913
when the commission form of government was adopted. During that period
there were, however, many and at times violent changes in the character,
size and activities of the board of health and its employes. The fact that
Cairo was an important transportation point in those days, receiving and
passing on heavy tonnage by rail and water, brought constantly to the city
the hazard of smallpox and this disease was an almost perpetual source of
annoyance and even alarm to the inhabitants. Then there was the matter
of yellow fever which actually invaded the cit}- once and caused no end of
anxiety and apprehension among the natives whenever it prevailed in the
South. These factors made busy seasons for the health officials who some-
times dropped out of the public picture for a few months only to come back
into action as the most important agency in the city. At one time there were
no less than eight mounted guards besides a staff of medical and sanitary
inspectors supplemented by medical and sanitary officers of the State Board
of Health at work while the mayor closed his business in order to devote
his full time to matters of public health. Sometimes appropriations amounted
to several thousand dollars and again they fell to a negligible sum. Some-
times a health officer was employed and clothed with arbitrary powers and
again there were times when nobody was emploAed in health work. Some-
times the board of health was made up of physicians and at other times its
membership was entirely la\-. Now a doctor would serve as health officer
and again a sanitary inspector would till the job.

The barometer that governed health activities was the presence in the
city of some dreaded disease — smallpox, yellow fever or cholera — or the
fear that one of these diseases might be introduced from areas where it did
prevail and with which Cairo maintained commercial communications. This
continued to be the case until about 1900 when smallpox, yellow fever and
cholera began rapidly to lose their place as alarming diseases and ceased to

CAIRO

give health officials more than casual interest. The men who served Cairo
as health officers during this period include tiie following:

Dr. James Summerwell, 1S66 — during cholera epidemic

W. W. Wooten— April 22, 1S73. also 1S79

William Brown

Dr. W. R. Smith, medical quarantine officer — Aug. 1S80

January, 1SS5 — board of health employed five assistant health officers

S. M. Orr, 190.3, 1905, 1907

George E. Atcher, 1S97-1S99

Dr. F. J. Fitzgerald, 1911-1912

In 1013 Cairo adopted the commission form of government and that
automatically dissolved the board of health, transferring its responsibilities
and duties to the commissioner of public health and safetx". I'rom that date
forward to the present time no further adminis-
trative change has been made. A medical health
officer on a part time basis has been in office con-
tinuall}' during that period while several ordi-
nances relating to sanitation, milk, contagious
disease and the like have been adopted. Regular
appropriations, ranging from $5,000 to $9,000
per year have been made to the health department
but these sums included funds for garbage col-
lection and disposal. Charles Fentcher was the
first commissioner of public health and safety
and the physicians who have filled the position of
health officer include :

B. S. Hutcheson, M. D.
Health Officer, 1921-1927

Dr. W. C. Clark. 1913 to May, 1921

Dr. B. S. Hutcheson, 1921 to May 1927

Dr. Charles Webber, May 1927 to date.

Other public health service facilities that have developed in the city
include a venereal disease clinic established in 1920, financed jointly b}- the
State and the city and operated by the local medical society ; a school nursing
service established in 1917 and financed by the school board; a county tuber-
culosis association organized in 1918; a general clinic for children supported
by the Kiwanis Club and a clinic for crippled children maintained by the
Rotarians through the Illinois Society for Crijjplcd Children.

Water Supply.

The public water supply was first installed by the Cairo Water Com-
pany in 1886. The supply was obtained from the Ohio River and provision
was made for filtering the water. The plant was improved from time to time
until the present purification plant was installed aliout 190,3.

66 DOWN-STATE MUMCIPALITIKS

The original franchise expired in 1915 an<l a new one was not granted
until 1925. During that period few improvements were made. Since 1925
plans have been made to improve and enlarge the plant which will practi-
cally amount to the construction of a new purification plant.

Analyses of samples of water have been made in the laboratory of the
State Health Department since 1917 and with few exceptions, these indicate
that the water has been safe, although the supply has until recently been
classed as doubtful because of cross connections at the waterworks and in
industrial plants which cross-connections have now been removed.

Sewerai;e.
The city is served by a combined system of sewers discharging into Ohio
River. Becau.se of the large dilution furnished by the Ohio and Mississippi
Rivers which join at Cairo no treatment of the sewage is necessary.

Health Conditions.

Nowhere in Illinois have health conditions created greater public excite-
ment, alarm and agitation than in Cairo. Nowhere have more drastic and
arbitrarv measures been employed to deal with emergency situations.
Nowhere have these things been more fully justified by prevailing circum-
stances.

Subject to inundation and surrounded by swampy territory, Cairo is
located in the midst of an area ideal for mosquito breeding. This condition
introduced the malaria problem at the time when the very first settlers
arrived and was later responsible for a harrowing experience with yellow
fever. As early as 1700 Father Jaccjues Gravier observed that two members
of his exploring party came down with "tertian fever" while stopping on
the delta at the junction of the Ohio and Mississippi Rivers. Doubtless from
that time onward the travellers and settlers who stopped or remained at
Cairo was harassed by malarial infections that soon became endemic in
that part of the State and remain so to this day. Records on that matter
are exceedingly meagre, however, for the reason, perhaps, that malaria was
too common a subject to inspire written comment. It was more or less like
the weather — a thing to be talked and joked about but never reduced to
historical manuscript.

During the middle Aears of the nineteenth century, Cairo was one of
the most important transportation points in the Mississippi Valley. River
traffic from the Gulf and intermediate points found Cairo a convenient ter-
minal and transfer station. Railroad facilities were inadequate to handle
the freight business and the Mississippi steamboat interests were at the peak
of their prosperity. Both passenger and freight service used Cairo as a
terminal and transfer point for destinations north and east. Thus the in-
habitants of this thriving little port were open to all the hazards of health

that constant contact with the travelhng' pubhc and with steamboat and rail-
road crews could provide.

We are not surprised, therefore, to learn that the cholera epidemic that
swept the country during 1848-1852 spared not its fatal fury upon the
citizens of Cairo. Commercial activities were practically paralyzed while
the outbreak prevailed. Even the local newspaper, the Cairo Delta, sus-
pended publication although a half sheet edition, carrying President Taylor's
proclamation exhorting the public to pray for rehef from the awful cholera
plague, was printed and circulated. Just how severe mortality was in Cairo
is a matter for conjecture, however, since no statistics relating thereto have
been preserved.

Another wave of cholera swept over our country during the sixties and
a mild epidemic frightened the people in Cairo and vicinity into strenuous
preventive efforts. This experience was followed in 1873 by another out-
break of the disease which carried off a number of persons and resulted in
the usual feverish sanitary activities. There is no evidence that cholera

Table 1.
]\loRT.\LiTY From Certain C.\usi:s.

fc.

r°.

•;S

.2 =

—

- 1-

■^

■s

f -S

5*-

3
S

1918

396

1919 .

299

.-)S

1920

321

.-.2

1921

23.5

1922

262

1923

262

1924

275

192.-.

301

1926

297

2.T

Table 2.
Mortality Rates From Certain Causes.

■S

YEAR

■3

S c

•p

"oj

E°

fi.
5

1918

26.2

24.6

37.0

12.3

469.1

382.7

271.6

1919

19.7

40.0

20.0

6.6

20.6

126.6

386.6

80.0

1920

21.1

39.3

6.5

19. C

6.5

124.6

341.2

183.7

1921

15.4

6.5

26.1

6.5

32.7

241.8

98.0

1922

17.0

19.5

13.0

52.0

201.7

156.1

1923

17.0

19.4

25.9

12.9

110.3

207.7

103 . 8

1924

17.7

25.7

6.4

19.2

6.4

70.9

187.0

192.5

19.3

38.5

19.2

6.4

38.5

199.1

83.3

1926

19.0

6.4

12.8

6.4

70.4

160.2

185.2

Note: The rate from All Causes is per 1,000 populate

all others per 100.000 population.

68 DOWN-STATE iMUXICIPALlTIKS

ever again letunied lo plague and terrorize the citizens of Cairo but a
smouldering fear of it, ready to flare up into frank alarm at the slightest
rumor, never ceased to repose in the public mind until the generation which
had witnessed the disastrous outbreaks had passed on beyond the vale of
mortal existence.

Smallpox was another prolific source of jjublic iiv'xei in Cairo. It is
probable that no other city in the Middle West went through a more exas-
perating e.xperience with that disease. Year after year the infection was
brought to the gates of the community by steamboat and railway crews, by
passengers en route to more distant terminals and by new or temporary
settlers. Of what occurred during preceding years there is no authentic
record but in 1857 an epidemic burst upon the community with fury enough
to send local officials scurrxing awa_\- to the task of organizing and putting
into operation a board of health. How fatal or disastrous the outbreak
proved to be can only be surmised. It is probable that wholesale vaccina-
tion was resorted to and this protected the permanent population, so far as
that applied in those early days, for the time being. Rapid growth, an extra-
ordinary temporar}' character of residents and the rising generation soon
built up a heavy unvaccinated element, however, so that in 1869 the disease
returned in a virulent character and the scenes of 1857 were again enacted
although apparently less extensive and complete.

At any rate we find malignant smallpox again present in 1872 and the
city officials, evidently at their wits end to control the disease and calm the
public alarm, built a "pest house", employed a special corps of police to
maintain rigid rjuarantine of premises where patients were housed, ordered
the disinfection of houses where patients had been and the burning of clothes
and bedding, and passed, withal, an ordinance, requiring all susceptible per-
sons to be vaccinated. .V year later when the epidemic had subsided a
report showed that 71 patients had been sent to the "pest house", 29 of whom
died; that 55 were non-residents and 56 colored; that 75 patients had been
quarantined in their homes and that 23 of these died ; that operating the
"pest house" had cost $2,508.77 and that the city had spent $1,034.00 in
other wa\s incidental to handling the outbreak. No wonder the citizens
were sensitive about epidemics and felt strongly- concerning quarantine and
immigrant inspection !

Even that experience did n(jt end their troubles with smallpox. Three
years later, 1875. a new and malignant epidemic broke out. Two pupils at
Loretta Academy died. Judge Baker moved his court into the fire engine
house to escape exposure from prisoners among whom the disease had
started. What to do again agitated the unhappy minds of mayor and alder-
men. ( )nce more they tried everything. An ordinance forbidding anyone
to house a patient sick of contagious disease without a permit so to do

was adopted, arrangements were made with St. Alary's Hospital to care
for the sick, general vaccination was ordered, the city paying the bills where
necessary, and a full time health officer in the person of William Brown was
employed. \\'hat more could they do? Surely that was enough had the
population been stable but the constant shifting and the coming and going
made sporadic control measures effective for only temporary periods and
soon the disease was up to its mischief making again. Another outbreak
occurred in the early eighties, a rather severe epidemic in 1885 and re-
current epidemics more or less .severe from year to year down to the present
time. Never has the municipality succeeded in ridding itself of this loath-
some disease. In 1927 there were 47 cases reported.

But yellow fever was the disea.se that overshadowed every other human
affliction in the public mind. A kind of morbid romance enshrouded the
disease. It not only breathed fear, alarm and dread into the hearts of men
but it drove them from their homes. Citizens of Cairo lived in constant

Table 3.
Births and Ixf.-^xt Deaths.

Births

1
I

nfant Deatl

YE.iR

Number

Rate**

Number

I
1

Rate*

1920
1921
1922
1923
1924
192S
1926

233
247
229
219
262
225
251

1.5.3
16.1
14.9
14.2
16.9
14.4
16.0

1
1
1

26
34
34

37
29
29

I
I
1

107.3
10.5.3

148.5
1.55.3
141.2

128.9
115.5

•Deaths of
♦♦Per 1000

infants
populati

under 1 year

B per

1000 births

report e<

Table 4.
Cases of Certain Diseases Reported.

1916

1917

1918

1919

1920 1921

1922

1923

1924

1925

1926

1927

Ti-phoiil Fever

Malaria

Smallpox

Measles

665

Scarlet Fever

AVTloop. Cough

Diphtheria

Influenza

1443

. 2

I'olioinvelitis

Menirr-ilK

Tubcn iil-.i.-

1 ^

PneuHiMM.-

242

Svpliili-

1 181

8.5

Gonorrhea

Chancroid

•AH forms.
Note: Case reports are never complete, but they have been much mon
Illinois. By comparing the figTires in this "Uible with those showi
specific causes it is manifo.st the notification is even now far from c
ticularly noticeable in the case of n.alaria and tuberculosis,
No figures for 1920 available.

1!>20 than before in

iniber of deaths from
I C-Aira. ThU is par-

70 DOWN-STATIC MUNICIPALITIES

(Ireail of yellow fever. Outbreaks that often grew into harrowing epidemics
occurred during the late summer and early autumn almost annually in the
lower valley. Communications were very close between Cairo and points
as far south as New Orleans, the very heart of the yellow fever area.

In 1878 the thing that Cairo greatly feared actually happened. Yellow
fever came to town. Death and disaster stalked through the empty streets.
F-verybody who could deserted the city. Over 100 cases and some 62 deaths
were enough to justify the public panic which prevailed. This outbreak, one
of the ver}' few if not the only one that ever occurred in Illinois, is decribed
at length in volume I of this history, beginning on page ^^IT .

Other health problems and experiences have cast their lugubrious
shadows across the public life of Cairo but those of cholera, smallpox and
yellow fever have submerged them into relative insignificance so far as
thought anil action were concerned. At the same time some of the other
diseases cost the people more dearly in health and life than did these three
more notorious ones. This is manifested in the general mortality rate which
rarely descends below 17 per 1,000 people and frequently rises to 20 or more.
Tuberculosis has always been widely prevalent there, causing a mortality
rate considerably in excess of what prevails in most communities of Illinois.
It was 160.2 per 100,000 in 1926 and 382.7 in 1918. T\phoid fever, likewise,
has been endemic in Cairo throughout the years, rarely falling in prevalence
to a point even remotely comparable with that in the State at large and that
found in municipalities generally. The influenza epidemic of 1918 hit Cairo
hard, causing one of the highest mortality rates registered anywhere in the
State. Other diseases such as diphtheria, scarlet fever, pneumonia and the
like have not overlooked the place but have varied in intensity from time to
time.

The fact that Cairo has a heavy negro population explains some of the
unfavorable features of health conditions here. It has a bad influence over
the infant mortality rate, always high, and it adds a marked increase to the
death rate from tuberculosis. In 1924, for example, the 5,000 negroes lost
118 of their number by death, 17 of which were due to tuberculosis, while
the 10.000 white people lost only 157 by death and only 12 of these were due
to tuberculosis. Even then the mortality rates among the white population
appear to be somewhat more unfavorable than that generally found in
Illinois. This, however, might be expected in view of the fact that Cairo
has grown slowly in recent years, thus causing an age distribution among
the whites that wdiild result in a higher death rate than would ordinariU
be found in a rapidly growing city of reasonable healthfulness.

Rf.ferences.

I.:m,i;J..i|-- lllstorv.

lii.i.n "I s. Hllic"m Illinois—George Washirifrton Smith — 1912.

Ill tMt\ -if M.xander, Pulaski and Union Counties.

Ill, lli.>tiias II. Leonard's personal interviews with various citizens of Cairo.

Carhondale

Lying close to the foot of the Ozarks, Carbondale shares with Murphys-
boro, the county seat, the municipal honors of Jackson County. The rail-
road shops of the Illinois Central and a State teachers' training college are
two of the principal factors in the industrial, commercial and social life of
the place. The density of the population is moderate, about 65 per square
mile, being less than some of the neighboring coal mining counties and con-
siderably more than the strictly agricultural regions in that vicinity. Coal
mining is of no consequence in the immediate vicinity of Carliondale although
there are 26 active mines in Jackson County.

Carbondale itself is a small community with about 7,000 inhabitants.
It grew up around the railroad station which was located there in 1852 be-
cause of the easy access to coal and it owes its name to the terrane which
suggested a dale on the one hand and was underlaid with coal on the other.

There is nothing particularly eventful about the health history of either
Carbondale or the county except the prevalence of malaria which was re-
sponsible for a vigorous anti-mosquito project that started in 1922 and the
occurrence of a devasting cyclone in 1925 which resulted in the establishment
there of a State public health laboratory. About 1885 the municipality
adopted an ordinance creating a board of health and this continued in force
until 1911 when the commission form of government replaced the alder-
manic, automatically dissolving the board of health and transferring its
duties and responsibilities to the commissioner of public health and safety.

Health officers have alwa}'s been employed on a part time basis. At
first a physician was chosen to act in this capacity but later, upon the death
of Dr. H. E. Lightfoot while holding the office in 1917. his wife was ap-
pointed to fill the place and she was later succeeded by another non-pro-
fessional woman. A nurse to work in the public schools of the county was
employed in 1919, being paid by the county board and the tuberculosis asso-
ciation and later by the Red Cross only and .she spends some of her time in
Carbondale.

With the exceptions mentioned above, there has been little of an un-
usual character in the health conditions which have prevailed at Carbondale.
Available information centers around outbreaks of smallpox that alarmed
the public from time to time. Occasionally somebody has started the rumor
that trachoma is rampant there and that a general epidemic of blindness is
consequentl\- imminent l)ut careful investigations have never substantiated
these alleged facts. T\]ihoid fever has been endemic for \ears, providing

(71)

DOWN -STATE MUNICIPAl.ITIKS

one of the most expensise health problems of the community and county.
'ruheiculnsis has run a lillle higher than for the State but that is perhaps due
to the inxsiMice nf a cmisiderable negrci population. Other diseases have
Clime and gone in e|ii(Iemic cycles uf more or less ordinar\ experience.

Due to the unusual nature of the malaria-mosi|uito eradication project
and the destructisc character of tin- cyclone which led to a concentration of
a considerable amount of public health work in the area, the stor_\' of these
events will be delineated in some detail. An account of the development of
a ])ublic water suppl\ and sewage disposal system is also included in what

Mosquito Control.

In November I'd.s.
before the Southern lllin

H. C. Mitchell, M. D.

)r. H. C. Mitchell of Carbondale, read a paper
. Medical .Society at Mt. \'ernon, entitled "Malaria
;md Mosquito Control in Illinois".

In lOU) attention w.as called b\ the State
I 'epartment of Public Health to the heavy eco-
nomic losses from malaria in southern Illinois.
In I'd/, the Southern Illinois State Medical So-
ciety, aflt-r reflecting upon a paper presented by
Dr. 1. W. Harrow of Carbondale, adopted a
resolution asking that studies of malaria and
m(Jst|uitoes in southern Illinois be made. In
I'dS. I'd'' and 1920 investigations were carried
on by b'.ntomologist S. C. Chandler of the State
Natural History Survey and the findings were
publisheil.
Simu'lrmeously and following the southern Illinois malarial investiga-
tions, the ([uestion of systematic malaria-mosciuito eradication was presented
on several dilVerent occasions, as opportunity offered, by the division of sani-
tary engineering of the State Department of Public Health to the cit\'
officials and interested civic organizations and citizens at Carbondale. It was
considered that Carbondale presented, for various reasons, the best place to
demonstrate what could be done in the \va\- of mosquito eradication and
that other cities would lienefit by such work.

As a result the Lion's Club of Carbondale went on record on January
27, 1922, guaranteeing to raise a fund of $2,000 in order to carry on syste-
matic malari.i-mosquito control during l')22. The International Health
Board had pre\iously tentatively agreed to furnish $1,000 and the Illinois
Central Rriilroad had given f.iMirahle consideration to the project of drain-
ing m;my ;icres of sw<amp land adjoining the city on the north. The State
Ue]>artmenl of Public Health had agreed to provide the services of a sani-

74 DOWN-STATK MUNICIPALITIES

tary engineer to supervise the work, and the assistance of the State Natural
History Survey and the I'nited States PubUc Health Service was also
assured.

Proposed and recommended by the Stale Department of I'ublic Health,
sponsored by the Lion's Club of Carbondale and receiving financial assist-
ance from that club, the International Health P)oard, and the Illinois Central
Railroad, and directed by the sanitary engineering division of the State
Department of Public Health, Carbondale carried on systematic mosquito-
control work for the season of 1922, and for the first time in the history
of the city enjoyed practically complete relief from that pestiferous insect.
The results from the standpoint of reduction in malaria cases were equally
gratifying. Vital statistics and house-to-house canvasses had shown that
prior to 1922 the city suffered an average of over 250 cases of malaria a year
(267 during 1921'). Following the close of the mosquito-control work for
1922 it was fdund Iiy a house-to-house canvass that only 19 cases of malaria
had occurred (hiring tliat year in the entire city. It is quite probable that
some of those few cases were recurrent (ir may have recei\e(l their infections
elsewhere.

The results were so satisfactory to the city officials and ci\ic organiza-
tions that had participated in the work, and the economic saving to the
community was so apparent that arrangements were made to carry on similar
control work in 1923. During 1923 the city was again practically free from
mosquitoes and only 11 cases of malaria were found by a house-to-house
canvass.

The work at Carbondale lias comprised major and minor drainage,
stream clearing, utilization of top minnows, oiling control of rain barrels.
open wells and cisterns, house inspections, paris-green treatment, and edu-
cational measures. The control work in Carbondale, by reason of its tre-
mendous success has been repeated annually with profitable results. 1927
marked the sixth year of continuous malaria mosquito control in Carbondale.

The 1927 legislature passed an act jtermitting the creation of "mos-
quito-abatement districts" and Carbondale in the fall of 1927 voted by a 10
to 1 majority to create such a district. In the future malaria-mosquito
control in Carbondale will be financed by funds collected by tax ]ev\- against
the properties within the district.

In addition to the Carbondale malaria-control project, campaigns were
conductt'd at Alurphysboro and (mrham following the tornado of \'>2S.
These projects were financed jointly li\ the .State of Illinois and Interna-
tional Health Boanl. and resulted in reduction of 220 cases of n:alaria at
Murphysboro and 33 cases in (iorham. according to estimates based u]ion
cases prevailing in those two cities prior to the introduction of control work.

CARBON DALE

Table 1.

Mortality From Certain Causes in Carbondale.

From Local Records.

'i s

YEAR

3 i

■3

•^

'SJ

^■M

1
IS

1902

...

1903

1904

190ri

1606

1907

1908

ecords des

troyed

11 l!l09-191(i, inclusive.

1917

:>7

i .. . 1

...

1918

103

1919

1920

1921

1922

125

1923

127

1924

139

' i

1926

148

1926

114

Table 2.

Mortality Rates From Certain Causes in C.vrbondale.

„

•5

^„

■- S

6 £

YE.\R

—

Is.

■^

E-

•s^

S =

^>..

=>■<

"f.

c/:

£.

!--^

0.^

1902

11.5

53.5

133 . 8

133.8

1903

7.3

25.3

76!6

50.6

126.7

1904

15.4

48 .'i

72^2

361.0

120.3

1905

13.7

68 .'7

22^9

4.5.8

297.9

114.6

1906

11.1

65.6

21.8

174.9

109.3

1907

13.1

41.8

26 .'9

188.2

125.4

1908

12.0

100.2

46!6
Recon

s de.strr

26;6

ycd fro

n 1909

191(i]

liclusivi

120.2

80.0

1917

9.4

33.3

...

10.6

199.8

166.5

1918

16.9

16.4

82! 6

131.3

525.3

1919

8.7

li'.i

143.7

129.5

1920

9.7

31.9

1.5!!)

is! 9

liiig

105.3

1921

1922

17.5

42.6

14 '.6

84.6

1.54! i

ii2!i

1923

16.7

13.2

26.4

145.3

171.7

1924

17.3

24.9

12 '.4

12^4

12!4

24.9

124.9

199.9

1925

17.5

23.7

71.1

237.0

1920

12.8

22.5

li.'i

67." 6

112.7

157.8

Note: The rate from All Cau

per 1.000 population; all others per 100,000 population.

76 DOWN-STATE MUNICIPALITIES

Recapitulating, the combined expenditures for malaria and mosquito
control in Jackson County during 1922-1927 inclusive have been $12,150,
exclusive of the supervisory service of a State sanitary engineer. The ex-
penditure of this sum of money has resulted directly in the prevention of
1,273 cases of malaria according to what appears to be reasonable estimates.
If an economic loss of $100 per case is assumed, the return upon the invest-
ment for the county has been $11.%150 or an average of $19,190 per vear.

Storm Disaster Brings Laboratory.

Thv c\cl(inic storm that spent its wrath mainly in Jackson County on
iNlarch 18th, 1925, was one of the most devastating weather phenomena that
ever occurred in Illinois. Homes, barns, school houses, store buildings,
automobiles, everything were swept before it, leaving ruin, death and de-
struction in its path. The death toll reached 850. About 3,000 persons
were more or less severel}' wounded. Twent\- thousand were made homeless.
The wreckage played ha\-oc with water snppl\- and sewage disposal systems
both public and private.

These conditions introduced a very grave public health situation as
well as emergenc}' relief problems. A\"ith temporary living quarters neces-
sary for the comfort of those made homeless, and with all ordinary means
of handling food supplies, securing water and disposing of wastes completely
disorganized a condition favorable to disastrous epidemic outbreaks was
created. Not only so but the rehabilitation of the homeless presented health
problems requiring for solution considerable time and professional skill.

For these reasons the State Department of Public Health promptly
joined forces with the relief agencies that established headquarters in
Carbondale on the morning following the stoiTn and participated in the
relief work, taking particular notice of sanitary and public health conditions
and utilizing ever}- possible resource to prevent epidemic outbreaks. Among
other things the department established a laboratory for making all the
tests ordinarily performed in jnililic health laboratories.

The laboratory proved to be so beneficial to the local medical profession
and indirectly to the public that a strong demand for its permanent location
there was manifested. Accordingl\', arrangements were made for maintain-
ing in Carbondale, in quarters supplied by the Holden Hospital, a branch of
the State diagnostic laboratory. A full-time technician is assigned for duty
there and the laboratory serves all of southern Illinois, offering facilities for
doing all tests ordinarily done in a ])ublic health laboratory. The report for

CARBONDALE

the month of September 1927, given below, suggests the character and
volume of the work done at the Carbondale laboratory.

Positive Negative Doubtful Total

Diphtheria 3 70 73

Tuberculosis 1 15 16

Gonorrhea ^ 12 17

Widals (typhoid) 12 78 7 97

Widals (paratyphoid) 7 86 4 97

Kahns 85 245 6 336

Malaria 10 10

Rabies 6 2 8

Typhoid cultures 28 28

Miscellaneous 9 9

691

Daily average 23 plus

Urines 38

Miscellaneous blood counts 2

Complete blood count 1

X-Ray examinations 7

Containers sent out :

Wasserniann 276

Microslides 18

Diphtheria 48

Widals 126

Sputum IS

Fecals 20

Tlie list of health officers who have served Carbondale include :

1891 Dr. A. M. Lee

1891-1893 Dr. John Keesee, member anil health officer

1893 Dr. .T. T. McAnally

1892-191G Dr. T. C. McKinney

1906-1912 Dr. M. Etherton

1912 Dr. W. A. Brandon

1912-191G F. M. Hewitt, commissioner of piililic health and safety

1917-1919 Dr. A. S. Caldwell

1917-1920 Dr. H. E. Lightfoot

1919-1921 Rev. J. S. Merrill

1920-1924 Mrs, H. E. Lightfoot

1924

to date Mrs. Cora Black

Table 3.

Casi:s of Certain Diseases Reported in Carbondale

From Local Records.

1923

1924

1923

1920

1927

Tvphoid Fever

Smallpox

Measles

Whooping Cough

Scarlet Fever

Diphtheria

PoIiom\elitis

Tuberculosis*

Pneumonia*

Syphilis

*A11 forms.

Note : Manifestly diseases have been more prevalent in Carbondale than figures in this table suggest.
T.vphoid fever, scarlet" fever and diphtheria are more completely reported than any others.

DOWN-STATE M UN ICIPAI-ITIES

1st row, left to right: General D. H. Brush, plotted the town of Carbondale; Dr.

J. Ezra Blanchard; Dr. John Keesee, health officer and member of board of

health, 1891-1893;
2nd row: Dr. A. M. Lee, health officer, 1891; Dr. J. T. McAnally, health officer,

1893; Dr. T. C. McKinney, health officer, 1892, 1916.

Table 4.
Mortality From Certain Causes in Jackson County.

._^

fc.

V,^

.2 «

YKAH

§1

•|

■s

1919

454

1920

342

1921

40S

1(5

■ 41

1922

431

1.-.

192.'!

471

1924

423

•192,";

707

1926

472

■'

rtality due to cyclone storm.

CARDOXUALE

1st row, left to right: Dr. M. Etherton, health officer, 1906-1912, and member
present board of health; Dr. W. A. Brandon, health officer, 1912; Prank
N. Hewitt. Commissioner of public health and safety, 1912-1916.

2nd row: Mrs. Cora Black, health officer, 1924 to date; Major Robert W. Davis,
president, present board of health; Joseph K. McGuire. member city council,
1920-1923 and publicity director of campaign that made Carbondale the first
mosquito abatement district in Illinois.

Table 5.
^loRTALiTY Rates From Certain Causes in Jackson County.

jj.

YEAR

>
&

■3

„

'ii

■s

£^

Tube
(All

1919

12.3

1920

9.2

1921

10.8

26.7

5.3

32.1

42.7

2.6

109.fi

6i..5

1922

11. .5

31.9

7.9

29.2

85 . 1

111.7

39.9

192:!

12.5

7.9

2.6

23.8

10.5

23.8

108.4

71.4

1924

11.1

5.2

26.3

7.9

21.1

2.6

115,1

89.4

1925

18.5

23.5

10.4

2.6

7.8

2.6

34.2

75.9

114.2

1926

12.3

10.4

2.6

33. S

7.8

13.0

52.0

99.0

80.7

Note: The rate from All Causes is per 1,000 pnpulation ; all others per 100,000 popul.iticn.

IX)\V.\ -STATE MUNICIPALITIES

Delia Caldwell, M. D.
Merllcal Advisor. Southern
Illinois Normal Univer-
sity. 1920 to date

A public liealth service is maintained for the benefit of the students in

the Southern IlHnois State Normal University located in Carbondale. The

activities connected therewith, which are and have been under the direction

of Dr. Delia Caldwell since 1920, doubtless have

an iinportant influence over comnutnity health in
(."arbcindale.

Water Supply.

The waterworks were first installed in 1898
1)\ a private corporation which obtained a fran-
chise in 1902 for a period of thirty years. Water
was secured, first from two wells, later from
three, four, five and still later six wells. These
ranged in depth from 200 to 650 feet, two of
which were 410 and 416 feet respectivel}-. The
estimated maximum yield of all wells was about
135,000 gallons per day with a reservoir capacity
of about 260,000 gallons. The demand for water
during the dry season was usually greater than the supply. The supply was
considered by the State Department of Public Health to be periodicall\- con-
taminated. The water had a strong saline taste and on account of the peri-
odic contaminatiiin had been chlorinated. There are about ten miles of
cast iron pipe ranging in size from ten to four inches.

In 1924, a new water system was proposed and plans for the same were
approved by the State Department of Public Health. In 1925. the people
of Carbondale voted to install the new system, construction of which was
completed in 1026. The present supply consists of the following: — An im-
pounding reservoir of 400,000 gallons capacity, with a drainage area of
2,400 acres, located about one mile south of the city limits, covering an area
of sixty acres and ranging in depth from ten to twenty feet, a gravity pipe
line to the city, and a modern water-purification plant. The water is treated
by coagulatiuti and sedimentation, filtration and chlorination and is distri-
buted through the former water mains. At the present time the water is
regarded as of safe sanitary quality and suitable for all domestic and indus-
trial purposes.

Sewerage.

Carbondale sewerage s\-stem, about twelve miles in length, has been
built a portion at a time without any definite plan and mostly for sanitary
purposes with only a few storm sewers. The s}'stem discharges without
treatment northeast of the city into Crab Orchard Creek, a tributary of Big

CAKIiONDALE

Aluilih River. Sewerage is available for alioul four-fifths of the population,
but not more than one-half of the population are using the system. Improve-
ments to the sewer s\stem are necessary if proper sanitary conditions are to
be maintained.

Table 6.
DiKTiis AND Infant Deaths in Jackson Countv.

VK\i;

1 Number
1

Rate**

Number

Rate*

1919

]

1920

«14

21.1

lOS.l

1921

783

20.9

80. fl

1922

772

20.-1

89.4

1923

819

21.7

7.i.7

1924

810

21.3

79.0

1925

804

21.0

112.2

1926

830

21.6

97.6

•Deaths nf infants under 1 ,
•Per 1000 population.

of age per 1000 births reported.

References.

.\nnunl Reports of the State Board of Health, Springfield,
History of Jackson County, Newsonie.

Bulletins of the State Water Survey, Urbana, various dates.
U. S. Census Reports, Washington, D. 0., various dates.

Charnpaigri'lJrbana

The twin cities, I'rbana and Chamiiaign. are officially two separate cor-
porations but in realit}- they are one communitx'. They are in Champaign
Countv, the third richest agricultural county in the United States (census
1920) and are 126 miles south of Chicago and 187 miles northeast of St.
Louis. In Urbana is located the great State university which accommodates
more than 10.000 students, a distinguished seat of learning that lends to the
community a distinct collegiate atmosphere.

Champaign County was formed from the western part of Vermilion
County in 1833. Urbana became the county seat and was organized under
a charter in 1855.

The city of Champaign began in the earl\- fifties when the Illinois
Central I\ailwa\- laid a track through that section and built a station about
two miles west of Urbana. calling it West L'rbana. In 1860 the name was
changed to Champaign and a community government set up under the city
plan.

The fact that the main line of the Illinois Central ran through Cham-
paign gave that part of the future community a tremendous advantage in
potential growing power. Then in 1867 Urbana managed to balance thing
up somewhat when it succeeded in getting itself chosen as the site for the
State university. Urbana has remained under the aldermanic form of gov-
ernment but Champaign changed over to the commission form in 1917.

Both together the two incorporations include a population that compares
favorably in size with the leading cities of the State. The census figures for
the three most recent decennial periods are:

Champaign 102.511 12421 909S

Urbana 10244 8245 o72S

Eighty-eight per cent of the population are native whites, 5 per cent
foreign born and about 7 per cent negroes. So the community is made up
principally of a well-to-do middle class American people.

The University has an enrollment of 10,700 students and a faculty
of 1.200. '^Tfi

(82)

CHAMPAIGN-URBAN A

Health IMachinery.

The first niovenient toward providing official public health service in
the community got under way when Champaign adopted in 1864 an ordi-
nance relating to the abatement of nuisances and to general sanitary condi-
tions. A somewhat similar but more all-inclusive
ordinance was adopted by Urbana in 1880.

Since city ordinances like amendments to the
Constitution of the United States refuse to en-
force themselves, both municipal governments
soon found themselves facing the necessity for
creating machinery with which to carry into ef-
fect the mandates of the city fathers. Thus we
find a new ordinance, adopted by Urbana in
1882, creating a board of health made up of the
mayor and one alderman from each ward. Cham-
paign followed in 1884 with an ordinance creat-
ing a committee of the city council, known as the
health and sanitation committee and made up of
three members.

W. E. Schowengerdt, M. D.

Health Officer, Champaign.

1S99-1900: various times

since and present

Health Officer

Apparently the committee in Champaign was created simply to provide
a means for handling sanitary and health problems with greater dispatch
and ease whereas the board in Urbana was endowed with all the powers
and authority that it might deem necessary for
controlling disease and to it was assigned for
duty the city marshal as quarantine officer. It
even had authority to establish an isolation hos-
pital during emergencies.

In 1888 Champaign went a step further. An
ordinance adopted then created a board of health
and the position of city health officer. The board
was formed by simply transforming the commit-
tee into a new legal status and adding to its mem-
bership the mayor, the health officer and the city
clerk. The ordinance required the health officer to
be a licensed physician. These changes came to
pass under the influence of Dr. L. S. Wilcox,
mayor at the time, and Dr. Chas. B. John-
son, a public spirited physician of the community,
with the usual broad powers and authorit\- that have alwa\s characterized
such official agencies and the police department was made subject to its

H. A. Sim.s.

Commissioner of Public

Health and Safety,

Champaign. 1927

to date

The board was endowed

IX)\V.\-STATI-: MrNIClI'Al.ITIKS

command so far as ciuarantine, abatement of
nuisances and similar activities misjht require.

The trend toward medical influence in pub-
lic healtli matters in Champaign really began with
tlic arrival of Dr. Chas. B. Johnson, still living
and active at the age of 84, who located in that
cniiinniniiy in 1879. In 1888 he was a member
(if ilu- hoard of education when reports started
cuniini,' in about children being absent from
school with a rash, .^ome reports were confus-
ing so Dr. Johnson was appointed by the school
hoard to take the matter up with the mayor, at
that time Dr. L. S. Wilcox. He did this and
Dr. Wilcox called his attention to the fact that
this came under the duties of the health commit-
tee of the council.
After Dr. Johnson had talked to the mayor regarding the importance
of having a medical man as the health officer, the mayor consented. A few
days later Dr. Johnson was n<itified of his appointment as health officer and
instructed to confer with the city attorney on an appropriate health ordi-
nance. {Sec "Sixty )'t'i}rs in Medical Harness'' pp. 188-189).

Dr. John.son is still carrying on as president of the county tuberculosis
sanitarium board and an officer of the Champaign County Anti-Tuberculosis
and Public Health Association.

Charles B. .Johnson, M. D.
First Health Officer. Cham-
paign. ISSS Chairman,
County Tuberculosis
Sanitarium Board,
1921 to date

Chnmjiaisn County Tuberculosis Sanitarium, "The Outlook"

CHAMPAIGN -URBAN" A

Somewhat later Urbana gave up the cumbersome board of health made
up of an alderman from each district and put in its stead a board of three
members, one a physician or sanitarian who. by virtue of that fact, is chair-
man of the board and city health officer. The section of the ordinance relat-
ing to the personnel of the board reads :

"Section 2. Appointment. The Board of Health shun be appointed by the
Mayor ot said City by and with the advice and consent of the City Council m
the same manner and at the sinie time as other officers are appointed. At the
time of the appointment tlie Mayor sliall designate one of said members to be
Chairman of said Board, who shall also be Health Officer and said Chairman
shall be a legally licensed rractiiioner of medicine or trained in sanitary
science. All of said members shall ho'.d their office from the date of appoint-
ment to the end of the municipal year and until their successors are duly ap-
pointed and qualified."

The present board in Urbana is made up of Dr. D. T. Cole, chairman
and health officer, ]\Irs. Blanche Gladding and Mrs. Doris Carpenter.

A final change came in Champaign when the commission form of gov-
ernment replaced the aldermanic in 1917. This dissolved the board of health
leaving its duties and responsibilities in the hands of George B. Franks, first
commissioner of public health and safety. The
health department continued to be in medical
hands, however, with Dr. W. E. Schowengerdt
as health officer.

In the meantime there developed public de-
mands for various specific types of public health
service that were not being supplied by the city
government. Consequenth' we find the board of
education in 1010 feeling its way into a new ven-
ture by employing a nurse to work among the
school children during a month or two. Evi-
dently the experiment was popular for 1911
found ^liss Frances North at work as a full time
nurse in the schools under a board of education
presided over by Dr. W. L. Gray. The immediate
inciting^ cause which led to the full time nursing
activities was an outbreak of diphtheria in one of
the schools. A doctor at the helm — an epidemic
— sick children — a nurse. Nothing could have developed with more logical
sequence. A second nur.se was employed for full time service in 1918 and
both continue in the work to date.

Mayor George B. Franks

Commi.ssioner of Public

Health and Safety,

Champaisn,

1917-1927

DOWN-STATIC M U X I CI PALITIES

P. W. Wright
President, Urbana-Cham-
paigu Sanitary District

Urbana subsequent!}- provided medical su-
[jervision over children in the public schools Mvhcu
Dr. .Mnucl E. Nichols was employed in 1918 to
il(i lliat work. She is still active in that capacity.

N'oluntary agencies got busy also in the early
part of the second decade of the twentieth cen-
tury. Thus the Family Welfare Society of
t'hampaign-Urbana was organized in 1911. It
did little that could be classed as public health
service during its early existence but beginning
in 1918 it has participated in such activities as
public health nursing, infant hygiene etc. It
sponsored an orthopedic clinic for the after-care
of infantile paralysis victims. It established an

infant welfare clinic in 1921 with Dr. C. George
Appelle in charge and a child guidance clinic,
under the direction of the Institute of Juvenile
Research, in 1923.

The Champaign County Anti-Tuberculosis
League was organized in 1912 and carried on a
ver\- active campaign with its field service en-
trusted first to Dr. Carrie Noble White and later
to Dr. Maude E. Nichols. Still later two nurses
were employed to do the field work, the construc-
tion of the county tuberculosis sanitarium in 1920
and the employment of a medical staff in 1921
making it unnecessary for a voluntary organiza-
tion t(j maintain such professional talent. The
^.'iiiilarinni 1i:in m r:iii;i(

C. George Appelle. M. D.

Director. Infant Welfare

Clinic, Champaign,

1921 to date

Robert G. Bell, M. D.
Medical Director and Sup-
erintendent, County Tub-
erculosis Sanitarium,
1927 to date

f 48 patients.

A \ery important factor in the health ma-
cliincr\- of the communitx' is the Cniversity
1 lealth .'service. This was organized in 1916
iin<lfr the able supervision of Dr. J. Howard
Heard. This service not only uses every facility
pnixided by modern knowledge of .sanitation, hy-
j^ieiK- ami medicine for the suppression, control
and jjrevention of communicable diseases, but it
undertakes to promote positive health by giving
to every pupil enrolled a thorough physical exam-
ination. It also teaches subjects of importance in
personal hygiene and preventive medicine. This
it is able to do in a very satisfactory manner be-
cause of the happy arrangx'mcnts which make the

CHAMPAIGX-URBANA

first doctor to settle there.

A. M. Lindley. M. D.

First Health Officer, Ur-

bana, 1S91-1922

Staff of the health service faculty members as well. \'aluable data of import-
ance in research have been collected by the health service.

^ledical influence was first introduced into the twin-city community
with the arrival of Dr. J. G. Saddler who located in Urbana in 1839, the
He was followed the next year b}- Dr. Winston
Somers and Dr. William D. Somers. From that
time on the medical profession increased in num-
bers until 1859 found a dozen doctors there, or-
ganizing themselves into the Champaign Count}"
Medical Society. W'hile guests of this society in
1876, the Illinois State Medical Society passed a
resolution favoring the establishment in Illinois
of a State Board of Health. As a consequence the
first permanent public health legislation was writ-
ten into the laws of the State.

The parent-teacher association movement,
which involves considerable health activities, was
organized in 1914.

The most recent movement took place in
1926 when the various voluntary and official agencies participating in public
health activities were brought together into a cooperati\e organization known
as the Champaign County Public Health Association. At first this organiza-
tion showed signs of inanition but lately it has gained a splendid degree' of
vigor and under the chairmanship of Dr. W. E. Schowengerdt, Champaign
health officer, gives promise of leading to pro-
nounced improvement in the public health affairs
of the county.

\\-ATER Supply.

Waterworks were first installed in 1885 by
the ^NIcKinley interests and operated by them
until 1893 when it was taken over b>- the Union
Manufacturing Company. On June 27, 1899 the
present compan}-, known as the Champaign &
Urbana Water Company, bought the property
and was granted a franchise. This franchise
called for the installation of filters to remove at
least 50 per cent of the iron.

The supply is obtained from a number of wells, all of which are about
150 feet deep. The well water is rather high in iron, but part of it is re-
moved b\- aeration, chlorination and filtration.

T. C. Sullivan,

Treasurer, Urbana-Cham-

paign Sanitary District

DOWN-STATE MUNICIPALITI KS

J. C. Dodds. M. D.

Vice-President. Urbana-

Champaign Sanitary

District, 1921 to

date

The University of Illinois campus is about
midway between the two business districts and
the public supply is available, but it has its own
private supply. Water is obtained from wells
similar to those of the water company and
|l immpcd inlii llie mains witlnnit treatment.

Si:\\EKA(;i;.

The iirst system of sewers was installed in
both cities about 1895. The sewers were designed
on the separate plan. Each cit\- had a septic tank
and its own outlet into Salt Fork.

The systems soon became inadequate and the
llow through the septic tanks exceeded that for
which they were designed.
In 1921 the L'rbana & Champaign Sanitary District was ort;ani/.ed and a
new sewage-treatment plant was constructed in 1*'24. At that time new
sewers and interceptors were constructed and at present buth cities are ade-
quately sewered.

Health Conditions.
Like the pioneers in general those who settled in Champaign County
took the ordinary hardships of life as they came, accepting common diseases
as a necessary evil that deserved little discussion
and less notice in the record of important events.
Perhaps epidemics of common infections were
the temporary subject of neighborhood gossip
but it took an outbreak of cholera to stir up pub-
lic 'fear and alarm sufficient to get the story re-
corded in the traditions and history of the com-
munity.

Thus the earliest reference to unusual health
conditions in Champaign-Urbana relate to a chol-
era epidemic brought back from Chicago by trad-
ers who had visited that outpost of civilizatimi.
Soldiers garrisoned at Ft. Dearborn had started
the disease there. How disastrous the epidemic
in Champaign proved to be can be surmised only.

The very fact that the story has been preserved ^^ |

suggests that it was bad enough. j.,>, |^

Cholera was again the unwelcome visitor in

the community in 1854 when introduced by ,^^ ' i'i^''*-\'„'^' '^

■' , .^,1- • ^ 1 T^ -1 J Health Officer, Clianipamn,

laliorers workmg on the Illmois Central Railroad 1S97-1899; 1911-1913

CIIA.MPAIGX-URl'.AXA

Table 1.
Mortality From Certain Causes in Champaign.

./.

fc^

/. ^

"5 ^

YEAE

■^

'- r

1913

168

1918

.57

1919

192

1 1

1920

224

1921

203

1922

227

1923

202

1924

216

1925

236

1926

217

...

Table 2.
AIoRT.M.iTY Rates From Cert.\in C.\uses in Champaign.

YEAR

I'.na

1918
1919
1920
1921
1922
1923
1924
1925
1926

12.4

17.4
12.3
13.9
12.3
13.2
11.5
12.1
12.9
11.7

liis

6.1

ii!4
i6!9

6.4

5^8
5.7

l6!9

12.8
6.2
12.1

7.4
0.5

n'.i

6.1
29.1

16!7

13
19
6

8
4

375.4
96.6
93.4
12.1

39!9
16.7
10.9
21.6

74.3

92.2
109.4
80.9
42.6
34.9
28.5
67.4
60.4
59.4

237.1
57.9
99.6

103.6
87.2
51.3
44.4
82.4
75.6

Note: The rate from All Causes is per 1,000 population; all ulliers pei- 100,000 populatii

Table 3.
Mortality From Certain Causes in Urbana.

„

tf'

YEAR

„

"3 'C

^'7

a
o

1913

1920

120

1921

1922

1923

108

1924

147

...

1925

147

1926

133

■'

DOWX-STATE MUNICIPALITIES

Table 4.
Mortality Rates From Certain Causes in Urbana.

.=:

■^

YEAR

'- =

u o

£- O

1913

1 9.0

11.3

56.4

1920

11.7

19.5

68.3

48.8

1931

7.5

i'.i

9.4

9^4

85.2

28.4

1922

7.9

IS. 6

9.3

18.6

37.2

1923

9.8

9!i

27.4

54.8

100.4

1924

13.2

9!6

80.3

90.0

116.8

1925

12.9

s'.s

!;;

irc

8.8

44.1

32.7

61.7

192G

11.6

17.4

87.0

43.4

1927

s'.h

8.5

...

17.0

sis

76.8

42.7

Note: Tlie rate from All Causes is per 1,000 poi™l;itiuii ; M others per 100,000 population.

which was under crjiistniction at the time. I'ulilic alarm and panic prevailed

until the disease burned itself out.

Strangely enough the people generally gave little heed to more common

disease, less dramatic but far more costl\' in suffering and life than cholera

in the long run. It took a medical observer to remark that :

"The permanent scourge of the people ot Champaign County which
mowed down its victims, young and old for a period ot fifty years was
represented by the miasmatic diseases caused largely by undrained
sloughs and swamp lands. These troubles largely disappeared with
systematic drainage."

Later typhdid fc\-er came under the ban of "suspicious character" as
the public learned to believe it a preventable
disease. Consequently more and more notice of it
found space in tradition and recorded history.
Di". Johnson loves to tell of an outbreak that
disturbed Ihe traiK|uilit}- of health conditions in
Champaign in 1884. A young man came home
sick- from Kansas and presumably infected his
relatives and friends. Shortly thereafter the di-
sease had attacked 17 persons, leaving 6 dead.
The absurd notions that even the medical profes-
si(}n entertained alxiut the disease during those
days is set forth in a quotation that appears in
Johnson's Sixt\' ]'cars in Medical Harness. It

neoif,( Ua\ M 1) reads:

He 1 1th Oiruei I rbin i,
1'i.';-1<)2j

"Typhoid fever is never communicated from person to person.
"The disease never comes up spontaneously; no amount of filth and
no de.ijree of docompcsition can originate the disease.

CHAMPAIGN-URBANA

"Typhoid fever is a miasmiatic infectious disease. The poison from
within the body of a person suffering with typhoid must pass through,
in the process of development, a nidus outside of the body before it be-
comes capable of propagating the disease.

"The discharges from the bowels of a patient affected with typhoid
in a few hours after they are voided pass through some process by
which they become infectious and when allowed to enter wells or
cisterns cause those who drink the water to have the disease.

"The susceptibility to typhoid deiiends largely upon the age of the
person exposed, those under thirty being most liable to contract it."

The last two paragraphs expressed ideas that proved to be true under
scientific observation.

Another illustration of how disastrous typhoid fever was prior to 1900
took place near Urbana in 1890 when every member of a fatnily of 11 came
down with the disease and nine never recovered. In another family of 9,
seven cases developed with two fatalities.

Twenty-fiye years later, in 1915, medical and bacteriological knowledge
had progressed far enough to enable the chief sanitary engineer of the State
Department of Public Health, Paul Hansen, to trace an outbreak of typhoid
fever in Champaign to the consumption of con-
taminated raw oysters. This outbreak, involving
some 25 cases, is apparently the first instance on
recoid when typhoid was traced to contaminated
oxsleis and it led to investigations which uncov-
ered three more epidemics at widely scattered
points, all of which originated with oysters
shipped out of Baltimore.

Alore recently typhoid has practically di.sap-
peared from the community. No death was
registered in Champaign in either 1926 or 1927
Professor Stephen A. Forbes, and onlv one in Urbana.

'Tut-^tUor/r'^SuSunf- statistics Of all n.ortality are meagre but it

Board. Ut2i to date is safe to presume that tuberculosis inflicted

heavy losses upon the population in days before
modern methods of control came into vogue. At any rate the citizens saw
fit to organize a campaign against it and under the splendid leadership of
Professor Stephen A. Forbes and Dr. Johnson erected a sanitarium in 1920.
The disease continues to be a problem of no insignificant magnitude, as may
be observed from Tables 1 and 3, but the campaign against it is progressing
in the right direction and perserverance will surely result in ultimate success.
The mortality rate in the whole conimimity is no less favorable than that for
the State at large.

Diphtheria has carried many children to an untimely grave in
Champaign-Urbana but liai)pily it is now yiekling to preventive measures

DOWN-STATE MUNICIPAI.ITI F.-S

Table 5.
Cases of Certaix Diseases Reported in Champaign.

1021

1!I22

1!I23

1024

102:-.

1926

1927

Tvplioiil Fever

Sniallprix

M(<:islrs

134

223

1S2

115

s,iil.-t Fever

«h K Cc.ush

r,e

l>i|>litli.'iin

3 3

hillii.-ii/.i

l'..li..r„velilis

Mfiiiiiuitis

'rulM'Mtllo^is*

100

S\l.llilis

Conorilie t

r.o

ChalK-n.i.l

•AH forms.
Xote: Case reports are never complete, but notification in Champaign and Urbana i>;
give a fairly good index to prevailing health conditions.

Table 6.

Cases of Certain Diseases Reported ik Urrana.

1921

1922

1923

1924

1925

1926

1927

Typhoid Fe^er

Smallpox

Measles

;■)

269

178

Scarlet. Fe\ev

WhoniiiiiK Cough

l)iphll,..,in

Iiillil.Mi/a

McniiiKilis

Tubcroiilosis*

Pneumonia*

Svphilis

(iouorrhea

•

Table 7.

Births and Infant Deaths.

City of Champaign.

Infant Ueatli!

1919

1920

291

18.1

109.9

1921

368

22.4

70.6

1922

331

19.3

75.5

1923

356

20.3

58.9

1924

390

21.8

92.3

1925

409

22 4

236

92.9

1926

407

22.0

56.5

•Deaths of infant*
MVr innn pnpulati

of age per 1000 births reported.

CHAJIPAIGN-URBANA

which have been puslied lately in the coniniiinit}'
and county. The whole county escaped without
a sinijle fatality in l'J26 and lost but one citizen
to diphtheria in 1''27.

Smallpox seems to have avoided this univer-
sity community in general. At least there are no
traditions or written accounts tilled with vivid
stories and conunents about "pest houses" an<l
heroic re.t;ulations that make up the principal
early health history of other municipalities in the
Judge J. O. Cunningham, '^^ate. Recently the disease has ventured to put
President, Champaign Coun- in its appearance once or tw'ice but the university
'^ llagTie'^Tft™'"^'^ ^"•' municipal health machinery went into action

with such prompt thoroughness that the out-
breaks amounted to little except a general vac-
cination of susceptible people.

The influenza epidemic of 1918 was severe
in the community. Mortality from this cause
alone rose to 375 per 100,000 population while
combined with pneumonia it soared to 631. These
losses stood well up toward the top of the list of
municipal rates.

The general mortality rate of Champaign
County was among the most favorable in the
State in 1927. It was a trifle higher for Urbana
than Chamjiaign. The rate in neither place was ^- -^. Earnest

high for the combined community it was unusu- Ser.-Treas. Champaign Coun-

ally favorable,
palities.

comjiared with other numici-

tv Tuberculosis Le:igue,
]912-]927

Mayor W. F, Burres, M. D.
Acting Healtli Officer, Ur-
bana, 1925-1927

Infant mortality, considered by many sani-
tarians as a sensitive index to health conditions
in general, suggests favorable public health con-
ditions in the community. For the county, the
rate was 57.4 infant deaths per 1,000 live births
in 1926, a figure nearly 18 per cent below that
for the State. The rate in Champaign was even
lower than that for the county, but in Urbana it
w;is considerably higher. Of course the loss of
one infant more or less makes a very pronounced
difference in the rate of a community where the
total number of births is 165. It appears, furth-
ernujre, from the rather high birth rate attributed

DOWN-STATE MUNICII'AI.ITIKS

to Champaign that a good many babies of Urbana parents are born in
Champaign. This would give Champaign the advantage in calculating rates.
At all events the combined rate for the two municipalities was but little more
than 62, relatively quite favoralile.

Table 8.

Births and Infant Deaths.

City of Urbana.

YEAR

Birtlls

Infant Deaths

Number

Rate**

Number 1 Rate*

1920

Not

ivaibble, prior to 192

1
1. Included in county.

1921

162

15.4

61.7

1922

126

11.7

55.6

162

14.8

1924

210

IS. 8

66.6

207

18.2

147

12.9

1926

165

14.3

78.7

•Deaths of
•Per 1000

infants under 1 y(
population.

of age per lUUU births reported.

References.

Ordinances and Reports, City of Urbana, various date.s.
Ordinances and Reports, City of Champaign, various dates.

History of Champaign County— J. R. Stewart (Lewis Pub. Co., N. Y. & Cliicago, 1918).
Medicine of Champaign Count.v — Chas. B. Johnson, M. D.,
Si.\tv Years in Medical Harness — Chas, B. Johnson, M. D.,

Reports of Trustees & Officers of Urbana and Champaign Sanitary District, various dates.
Reports of Board of Education, various dates.
U. S. Census Reports, various dates.

Personal interviews by Mr. Thomas J. Brophy, wlio collected the data, with various officials,
dty faculty members, physicians and others in Champaign-Urbana.

Cicero

Cicero is one of the largest coninumities in Illinois, except Chicago,
but technically it is not a city. It has retained the township form of gov-
ernment, never having been incorporated under the Cities and Villages Act.
In 1920 the census returns showed a population of 44,995 but there is evi-
dence of very rapid growth since that time so that current estimates vary
from 70,000 to 100,000. The estimate for 1927 made by the federal bureau
of the census is 68,500. It is one of the newer communities, suburban to
Chicago. There were only 1,272 inhabitants in 1860 and only 16,310 in 1900.

Even in 1920 the character of the population was distinctly that of a
rapidly growing community and it was unique in other ways. There were,
for example, only 5,770 persons or a little more than 12 per cent, in the 45
years and over age group. This is scarcel_y more than one-half the i^atio in
other municipalities of the State. Then the number of men was greater
than the number of women by a wider margin than prevails in the State at
large. There were but four negroes listed in the 1920 census but the foreign
born whites accounted for 34.4 per cent of the whole population.

Furthermore, Cicero is really a part of the great metropolitan area of
Cook County, enjoying and utilizing many of the municipal facilities of
Chicago so that the mortality and morbidity rates returned for Cicero do
not reflect actual conditions as accurately as might be desired.

He.'vlth Machinery.

The story of public health service in Cicero is simple and complete. One
day in August, 1904 Dr. J. J. Hood, the only resident practicing ph\sician in
the communit\- at the time, happened to be walking down the main street.
In front of the old Weare building he met George
Comerford, town president, and George Engel,
police magistrate. They greeted each other and
fell into conversation. Somebody remarked tliat
Cicero needed a health officer. Comerford rather
banteringly put in : "Dr. Hood is our health offi-
cer from now on". And he was.

The matter was no more complicated than
that because no salary was attached to the job
and the work required and done was about equal
to the emoluments of the office. When for any
reason it was necessary to call upon the health
officer for service he was paid a fee on time basis.

J. J. Hood, M. D.
Health Commissioner
1904-1912; 1924 to date.

(95)

96 DOWX-STATK ML-NKIl'ALITIKS

This CDiUinued to be the pohc\ until V>\Z wlien Dr. B. Shulek was
appointed to succeed Dr. Hood hut the fornirv ([uit after a year in office
on the plea that the health officer's (kitics interfered w ith his practice. Then
followed a couple of years where Cicero managed to get along without a
health officer but in 1916 the officials decided that the coinmunit>- needed
a health officer badly enough to make some contribution toward the livelihood
of the one chosen for that position and, attracted by the small remuneration,
if not by the honor. Dr. James Shinglmen accepted the place. For two years
he exercised some active interest in efforts at controlling communicable
diseases.

Then came a radical change. A new town administration headed by
Joseph Z. Klenha came into office in 1918. It made a substantial appro-
priation for public health work, appointed Dr. Bert L. Vilna as health officer
and instructed him to organize an effective health department. He did so
and gave to the communit}- its first health service of consequence.

The administration went further. It adopted an ordinance creating a
board of health made up of the health officer or commissioner of health as
he was now called, town president, supervisor, attorney and captain of police.
This board was clothed with all the power and authority ordinarily vested in
such bodies and with the health commissioner as ex-officio chairman it con-
centrated the official public health service in a very workable shape.

Dr. Vilna kept things growing and expanding until his death in 1924
when he was succeeded as health commissioner by Dr. J. J. Hood who has
continued to date the splendid work inaugurated by Dr. \llna.

Ordinances relating to sanitation, h_\giene and other matters of health
interest were adopted from time to time so that the board and commissioner
of health have been able to execute such policies and plans as their tinancial
resources and initiative have permitted.

Shortly after the reorganization of the municipal health department that
inaugurated a new day in health service for Cicero, voluntary agencies
became active. On January 28th, 1919, the Cicero Welfare Center was or-
ganized. Its prime object was to afford emergency relief to the distressed
and to hold weekly clinics where mothers might receive proper instructions
as to the diet and care of their babies.

Through and with the cooperation of the health department this work
has steadily increased until today it ranks with the best services of that type
found in Illinois. With the added cooperation of the Chicago Tuberculosis
Institute, the anti-tuberculosis program has developed in a no less satisfac-
tory way.

The scope of work covered by the Center, including its social service
department and baby clinics both at the Center and in the Hawthorne sec-
tion, has necessitated the employment of two full time nurses, a clerk and

CICERO 97

an executive secretarx- besides the services of the physicians in attendance
at the cHnics. Over one hundred babies a week attend these clinics.

The Cicero day nursery was ordinarily for the purpose of affording to
the children of wage earning mothers the proper environment and care dur-
ing the absence of their mothers. An average of twenty-seven children are
taken care of dail}-.

These efforts gave to Cicero in 1925, a public health service that occu-
pied a commendable place among the fifteen leading communities of the

CICERO

VITAL 5TATI5TIC5 "^l
COm.DISCOhTROL^^I
VEri. DI5. COMTROLo"
TUB. CONTROL S
HEALTH CHILDs."-..
HEALTH 5CH. CHILD
SAMITATIOh -"«"
MILK COMTROL M
LABORATORY
POP HEALTH iri5T>^^

PERCEMT OF STAMDABD SCORE
FOR tACH OF TEN MAJOR HEALTH ACTIVITIES
1925

This graph illustrates the strong and weak points in Cicero's public
health service, official and voluntary, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in Cicero was 53 per
cent of the standard perfection requirement.

State. This fact was determined by a study of the municipal facilities pres-
ent in these places which was carried out by the State Department of Public
Health. The report on Cicero, which gives a good conception of facilities
then, reads, in part, as follows :

■A total of 526 points gives Cicero eighth place on the health service
apijraisal schedule of the fifteen cities ranging from 30,000 to 100,000
in population.

"With a part-time health commissioner this city enjoys a coordina-
tion of public health activities that is rare in Illinois. Practically all

98 DOWN-STATE MUNICIPAI.ITIES

sucli worli attemiited is direfletl ;inti supervised liy tlie licallli depart-
ment, to wliich. for oxaniple. the boai-d of education pays $>i.O(iO per year
for application on the costs of school hygiene service. A clinic at the
infant welfare center maintained by the Infant Welfare League is under
the direction of a physician paid by the city. One half of the salaries
of two nurses engaged in tuberculosis work is also paid by the city, the
remainder coming from the Chicago Tuberculosis Institute. These
'financial connections give the municipality a directing influence in all
the public health affairs which results in harmonious coordination.

"There are no contagious disease hospital facilities nor public clinics
for treating venereally infected indigents. Nor is there a iiublic health
laboratory. Proximity to Chicago, with an abundance of all sorts of
medical and public health advantages, seems to make less acute the need
for some services indispensable elsewhere.

"Expenditures in the city for public health work amount to .51 cents
per capita per year, 3.5 cents of which comes out of the niunicipal
treasury.

"The health commissioner acts as local registrar. Records are
checked for completeness and a brief statistical report is pul)lished.

"A comprehensive system of epidemiological record keeping is main-
tained, cards of different color being used for each disease on which are
entered all essential data. An up to date siJot map is kept of the major
contagions but there are no chronological charts showing the current
prevalence. Communicable disease control practices are excellent. All
cases of contagion are placarded by an inspector. A physician from the
health department visits all doubtful and all other cases of contagion
except measles, whooping cough and mumps in order to establish defi-
nitely the correctness of diagnosis. A communicable disease nurse also
visits each reported case as a matter of routine, the record of each visit
being entered on the case card. There are no local facilities for the
hospitalization of cases, altliough some patients are sent to Cook County
Hospital. No immunizations a.gainst diphtheria are performed by the
health department. A survey of the school children shows SO per cent
vaccinated against small pox.

"Three cases of tuberculosis were reported for each annual death
from that cause in Cicero. This ratio would be lower if cases of tuber-
culosis from Cicero who die in outside sanatoria could be computed.
The two nurses made a total of nearly 4.700 visits to tuberculous pa-
tients and contacts. The attendance at clinics both as regards number
of patients and number of visits made is satisfactory. Information as
to the number of hospital days of Cicero iiatients could not be accurately
determined, although 40 cases were sent to various nearby sanatoria.
There are no open-air classrooms or preventoria.

"The Infant Welfare League sponsors the hygiene pro.gram for
these age groups. The infant clinics are well attended, 370 babies mail-
ing a total of 2,257 visits last year. There is practically no field nursing
visits to prenatal, infant or preschool cases and there are no prenatal
or preschool clinics. Many births are attended by midwives, it being
estimated at 60 per cent of the total occuring within the city. The mid
wives are not supervised locally.

"Routine weighing and measuring of all children is done by the
nurse once each year. Four part-time school physicians are employed
to examine all grade school children every year. No records of this
work, however, are assembled. Each physician uses his own standards
as to what constitutes a defect, and in general, there is no uniformity
of iirocedure.

"The regular staff of sanitary and food inspectors is supplemented
by the school nurses during summer months. Food establishments are
visited and scored on their sanitary conditions. The city water supply
is secured from Chicago and is distributed to 100 per cent of the homes.
It was stated, also that all of the dwellings in the city are connected
with the sewer system.

"The health officer states that 100 per cent of the milk supply Is
pasteurized although no inspection records of any kind are available to
verify this assumption. Most of the milk comes through the Chicago
market.

"No local laboratory service is maintained, although many diph-
theria cultures are examined at the State branch laboratory in Chicago."

Water Supply.
Cicero owns and operates the distribution system and booster pumping
stations, but water is obtained from the city of Chicago. A description of
the supply will be found under Chicago.

Sewerage.
The town is in the Chicago Sanitary District. Sewers are built on the
combined plan and discharge into an interceptor which will take the sewage
to the ^^'est Side sewage-treatment plant, now under construction.

Health Conditions.

Health conditions in Cicero are difficult to appraise. The general death
rate is very low. Doubtless the very low percentage of old pecjple in the
population is one important factor in this situation.

The infant mortality, on the other hand is rather high. Deaths among
children less than one year of age averaged about 87 per 1,000 births reported
during the seven years ended with 1926. This is a higher figure than that
for the State during the same period and considerably higher than that of
several other suburban communities in Cook County. A good many sani-
tarians regard infant mortality as a more sensitive and accurate index to
health conditions than the general death rate.

It is probable that Cicero enjoys good average health for a _\oung,
rapidly growing community. It is doubtful that health there is as superior
as the exceedingly low mortality rate might suggest.

Table 1.
]\IoRTALiTY From Certain Causes.

YEAR

»-

191S

412

."ifi

1919

307

1920

331

2."i

1921

321

1922

32S

' i

.')

1923

295

1924

282

192.5

349

1926

360

2.->

'28

100

DOVVN-STATK .MUMCIPAI.ITIES

Table 2.
Mortality Ratics From Certain Causes.

YEAR

'?.

M ■

"5 £

111! 8
1SI19
19-20
1921
1922
1923
1924
1925
1928

10.5
7.3
6.2
6.5
6.2
5.3
4.8
5.6
5.5

i'.i

...

4.7
4.4
4.0

12.5
1.6

i'Ji

...

4.7

...

4.0
1.9
3.5
1.6
8.0
3.0

5.1

sis

8.0
1.9
5.3
3.3
3.2

17.9
42.9
28.8
46.3
26.5

7.1
10.1
12.8

1.5

143.9
40.5

"i.'o

9.5
16.1

5.1
17.6
16.5

97.6
33.3
66.6
47.1
41.0
58.9
33.8
36.9
38.2

213.3
90.5
80.0
70.4
60.6
51.8
59.2

42. 'S

im All Causes is per 1,000 populnt

Table 3.

Cases of Certain Diseases Reported,

11 others per 100,000 populatic

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

Smallpox

Measles

333

102

798

267

289

423

Scarlet Fever

117

158

120

Whoop. Cough

173

103

164

Diphtheria

257

185

lO.-i

Influenza

Poliomyelitis

Meningitis

Tuberculosis*

113

Rfi

Pneumonia*

105

Syphilis

Gonorrhea

;)

Chancroid

*AU forms.

Xote : Case reports are never complete, but those shown
I of how prevalent the diseases listerl were during the per

Table 4.
Births ano Infant Deatfis.

Infant Deaths

YEAR

Number

Rate**

Number

Rate*

1918

100

1919

1920

1921

1922

681

12.9

100.0

1923

095

12.4

90.6

1924

615

10.4

87.8

1925

608

9.8

84.0

1926

522

8.0

74.7

of ase per 1000 births reported.
Rl-ZFKRENCES.

Municipal Records of Cicero.

Health Survey of Fifteen Illinois Cities in 192.'). Health News. May-Ju
Annual Reports of the State Department of Health, various dates.
U. S. Census Reports, various dates.

Danville

Danville was incorporated as a city in 1839 and the United States census
returns listed 503 inhabitants in the community the next year. During the
ensuing decade that number increased to 736 and grew to 1,632 by 1860.
Between that date and 1870 the population nearly doubled, reaching 4.751,
and then the community settled down to a gradual, substantial growth that
brought to the city 33,776 inhabitants b\' 1920. Of this number 29,471 or
87 per cent were native born whites, 1.916 or nearly 6 per cent were foreign
born whites and 2,366 or about 7 per cent were negroes. There were 8,192
or about 24 per cent whose age was 45 years or more.

Health M.-xciiinery.

The development of a pulilic health organization to combat epidemic
diseases has been very gradual in Danville. Emergency situations like epi-
demic waves of cholera and smallpox, made im-
perative some sort of official agency to require
cjuarantine, sanitation and vaccination. This need
was met at first by giving to a committee or
board iif health power to perform whatever func-
tions a given situation seemed to require. Often
it was necessary at such times to employ profes-
sional and non-professional persons to carry out
plans regarded as necessary in the control and
prevention of epidemic infections.

This practice continued until rather recently
when the size of the city and the tremendous ad-
vancement of the possibilities of preventive medi-
cine made it necessary as well as desirable to
secure the services of a qualified physician to act as health officer and as such
to be subject to duty at any time.

The list of medical health officers who have served Danville include:
1895-1900 Dr. S. W. .Jones 191G-191S Dr. George Cass

1918-1922 Dr. William C. Di.xon
1922-1924 Dr. J. B. Hundley
1924 to date Dr. William C. Dixon

In the meantime public demands for health service outran the official
facilities for supp]\ing it so that \oluntary organizations sprang up and
began to function. Indeed, tliev soon overshadowed, in volume of work
accomplished, the cit\ health di-ii.artment. Accordingly, we find, at the close

(101)

William C. Dixon. M. D.

Health Commissioner. 191S

1922; 1924 to date

1900-1906 Dr. F. A. Baumgart
1906-1910 Dr. H. F. Becker
1910-1916 Dr. S. L. Laundfr

102

nOWN-STATE ML".\U;iPALITIES

of 1925 a siluation described in the quotations below taken from a report
of a survey made by the State Department of Public Health in 1926:

"With a score of 44S points, corresiiondins to an efficiency rating of
44. S per cent, Danville ranks tliirteenth among the 15 cities in whicli
public health activities were appraised.

"In some respects the health work in Danville is unusually well
organized although many important activities have either not been un-
dertaken at all or are incompletely developed.

DANVILLE

VITAL STATISTICS @
COnM.DIS.COnTROLko
VEin. DI5. COMTROL N
TUB. COriTROL M
HEALTH CHILD
HEALTH 5CH. CHILD ra
SAniTATIOn
niLK COhTROL
LABORATORY
POP. HEALTH iriST

PERCEMT OF STAMDARD SCORE
FOR EACH OF TEN MAJOR HEALTH ACTIVITIES

1925

This graph illustrates the strong and weak points in Danville's public
health service, official and voluntary, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in ]I)anville was 45
per cent of the standard iierfectiou requirement.

"The health officer is on a part-time schedule, drawing $1,200 per
year as salary. He is assisted by two sanitary inspectors, appointed by
the mayor, and a part-time clerk. It is necessary for him to provide
quarters for the health department in his own office. He acts as reg-
istrar of vital statistics, handles quarantine and sanitary problems
through the inspectors and exercises some supervision over pasteuriza-
tion plants. The Vermilion County Tuberculosis Association is sup-
ported partly by the city. It does field nursing service, prenatal and
infant hygiene work iind bedside nursing. The board of education em-
ploys two nurses.

"Last year (1925) the city government contributed 15 cents per
capita toward the expenditures for public health work, funds from other

DANVILLE 103

sources making a total of 3G cents per capita tor sucli purposes. Dan-
ville and one other city were the only two out of the fifteen that spent
so little for public health service."

Water .Supply.

Waterworks were first installed at Danville in 1883 by the Danville
Water Co. The original plant consisted merely of a pumping station, dis-
tribution system and elevated tank. Raw water from the North Fork of
\'ermilion River was used.

As the river water was found to be very turbid at times, a 6,000,000
gallon settling pond was excavated near the station, and the water stored
in this pond was used only when the river was very muddy.

In 1902 ver\- extensive changes were matle including new mains, con-
struction of a concrete dam to replace the wood dam, increase in pumping
capacit}- and the installation of a rapid sand filtration plant. The filtration
plant comprised 8 units only 4 of which were equipped at the start but in
1915 all 8 filters were in service.

In 1912 a laboratory was provided and treatment with calcium hypo-
chlorite was begun. In 1913 the name of the company owning the plant was
changed to the "Inter-State Water Co."

The impounding capacity of the dam was found to be inadequate even
with flash-boards raised to the maximum height and a ground-water supply
was investigated. In 1913 six wells were drilled but the water was not con-
sidered satisfactory and a new dam was constructed about four miles above
the old dam. The new reservoir was put in service in 1915.

In 1916 chlorine replaced hypochlorite as a sterilizing agent.

In 1920 another shortage of water caused the company to use the wells
previously drilled. A new^ and much larger dam was constructed in 1925
forming Lake \'ermilion which now furnishes an ample supply of water.

Sewerace.

The sewerage system of Danville is built part on the comliined plan and
part on the separate plan. The first sewers w^ere installed in 1885, and have
been extensively added to since. At present there are 5 outlets, varying from
36 to 84 inches in size, discharging along creeks and into the \'ermilion River.

Healtit Conditions.

Cholera arrived in Dansille before the comnumitx' was organized into
an incorporated municipalit}-. It appeared in epidemic form in 1832 when
there were fewer than 500 people in the village and again during the great
national wave in the late forties. \'er\' likely it struck the city again during
the sixties.

104

DOWN-STATE M UNICIPAI.JTIES

"Milk sickness" appears to have made a more vivid impression upon the
minds of early settlers than any other disease. Old inhabitants still talk of
it and refer to it as a disease greatlx' feared.

.Mal.iri.i mthis to h.'ive heen \er\ common in
the early (la\s, nid residents still recalling that
in llie years cif llieir yciuth everybody expected to
ha\f chills and fever. Epidemics of meningitis
locally known as "spotted fever" or "spinal
fe\er" also left unpleasant memories upon the
minds of some citizens who are still alive.

Like every other city in the State smallpox
ajipeared at intervals sometimes frequent, some-
times less often, depending upon the vaccinal
status of the population and the exposure to the
disease from outside sources. Diphtheria, scarlet
fever, whooping cough, measles and other com-
mon infections have run a course similar to that elsewhere in the State.
Each came and went in epidemic cycles peculiar to itself and varying in
\irulencv with factors that even now are no less mx'sterious than formerh'.

E. B. Cooley. M. D.

Active in promotiiis lor:il

lioiltli service

Table 1.
Mortality Erom Certain Causes.

■B

■„

YE.\R

■2

'c S

s—

.§■

■5

— ir"-'

1300

2ii:i

...

1901

400

. . .

1902

366

1903

36S

1904

370

1905

563

1906

574

' i

1907

541

1908

552

1909

4S9

::; i 2

1910

487

1911

469

1912

480

1913

492

■'

1914

443

' 4

1915

450

1916

524

18fi

1917

512

250

1918

710

9 1

147

1919

545

1920

583

' 's

1921

531

1922

498

1923

607

1924

.519

1925

571

1926

620

28
1

105

Table 2.
Mortality Rates From Certain Causes.

YEAR

3
<

2
B
S

Tuberculosis
(All forms)

1900
lilOl
1902
1903
1904
190.",
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1910
1917
1918
1919
1920
1921
1922
1923
1924
192.->
1921!

17.9
22.8
19.6
18.5
17.6
2.5.4
24.6
22.1
21.6
18.3
17.4
16.4
16.5
16.5
14.6
14.6
16.6
15.9
21.6
16.3
17.2
15.4
14.1
17.0
14.3
15.4
16.5

61.2
51.4
10.9
6.0
4.7

•i.-i

65 . 5
15.6
7.4
3.5

sis

37.1
13.2
6.4
6.S
3.1
27.2
11.8
20.6
17.3
5.7
19.5
24.7
5.4
20.8

18.3

s.'s

2.9
2.9

'.::
'.'.'.

'.'.'.

6.1
5.7
16.0
10.1
4.7
4.5
8.4
4.1
7.8
7.4
3.5
7.0
6.8
13.4
6.6
6.4
9.5
S.l
6.6

li'.e
i'A

2.7

8.1

6.1
11.4
10.7
10.1
4.7
9.0
12.8
4.1
11.7
11.2
7.0
10.5
3.3
6.7
3.3
9.7
6.3
6.2

.5.' 8
2.9
2.8
5.5
5.4
2.7
5.2

ii!4

5.3

10.1
4.7
9.0

12.8
8.1
7.8

11.2
7.0

10.5
6.8
3.3
6.6
9.7
6.3
3.1

21.2

23! 5
23.1

isis

5.4
18.2

42.8
17.1
10.7
5.0
4.7
9.0
4.2
36.8
11.7
7.4
7.0
3.5
13.7
40.0
23.1
9.7
6.3
6.2
12.1
2.9

sii
11.4
22.3

2. '7
2.6

24!5

29.' 6
21.5
28.1
34.4

13!2
19.4
592.0
781.1
445.4
210.6
111.7
17.3
31.3
134.0
27.4
40.6
67.6

2!6

256.8
228.5
203.6
186.7
167.0
158.3
128.9
286.7
156.4
157.2
147.1
130.0
120.4
158.5
142.2
113.5
108. 2
87.4
136. S
118.6
88.2
98.3
144.9
78.2
71.4
97.2
74.4

61.2
85.6
96.4
100.9
104.9
108.5
107.4
94.2
105.6
112.3
100.4
101.8

1021.5
107.0

95.4
134.3
178.7
106.8
155.8

69.4
110.8
128.4

54.9

83.7
148.9

is j.er l.Ono poi.uhitioii ; ;ill oth<

1110.0(10 popiiliiti^

Typh(.)i(l fever has l)een a more stubborn health problem in l^aiiville
than in many other places. As late as 1926 there were eight deaths from the
disease there, yielding a mortality rate of 20.8 per 100,000, a figure far in
excess of that for the State at large. ( )nly twice since 1918 has the rate
dropped below 10 and it stood above 20 in four of the years of that period.

Tuberculosis, on the other hand, has yielded ground in the face of an
aggressive program at a \ery satisfactory rate. In 1900 the community
lost 42 inhabitants to tuberculosis, making a mortality rate of 256.8 per
100,000 from that cause. The number of deaths in 1926 was 28 and the
rate 74.4. a remarkable improvement.

Influenza struck Danville moderately in 1918. It caused 147 deaths,
yielding a rate of 445.4 per 100.000. This was heavier than the rate attri-
buted to influenza in most other municipalities of Illinois but there were
only 5') tlcaths charged against pneumonia that year, bringing the combined
mortal! t\ rate to 624 which stood about midway between the high and low
rates in the State.

The general death rate in Danxillc has averaged considerably higher
than that for the State.

106

DOW N-ST ATI-: M U M CI PALITI ES

Table 3.
Cases of Certain Diseases Reported.

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

T^i)hoid Fever

173

168

116

Measles

2211

361

694

121

226

Scavlet Fever

•^

324

125

109

Whnop. Cough

'rt

128

101

Diphtheria

144

Influenza

1500

1121

150

437

2->

Poliomyelitis

■r

Meningitis

Tuberculosis*

172

Pneumonia*

250

Syphilis

157

189

Gonorrhea

117

199

Chancroid

*A11 forms.
Note : Case reports are never complete, but they have been much more so since 1920 than before In
Illinois. This table indicates improvement in notification more than anything else. In 1926, lor
example, there were S deaths reported from tvphoid fever and only 13 cases. The average is 10 cases
per death.

Table 4.
Births and Infant Deaths.

Births

Infant Deaths

YEAR

Number

Rate**

Number

Rate*

1916

651

20.7

1917

634

19.8

1918

715

21.9

111.8

1919

808

24.3

84.1

1920

771

22.0

90.8

1921

787

22.7

99.1

1922

810

22.9

77.8

1923

855

23.9

1924

768

21.1

1925

837

22.0

105.1

1926

870

23.1

93.1

♦Deaths of infants unde
♦Per 1000 population.

1 year of age per 1000 births reported.

References.

Miniifiiial Records of Danville. Illinois.

r.-is,.ii:il Interviews with Dr. William C. Dixon, Health Commis
Il.iillli Survev of Fifteen Illinois Cities in 1925, Rawlings, Isaac
of Illinois. Health News, May-June, 1926.

.\nnual Reports of the State Department of Public Health, varin
U. S. Census Reports, various dates.

D.. Director of Public Health, State

Decatur

A namesake of the famous American naval officer, the cit}- of Decatur,
seat of justice in Alacon County, is one of the }oungest of the more import-
ant municipahties in IlHnois. Laid out about 1825 the communitx' became
the county seat in 1829 by an act of the General Assembly and was organized
into a village in 1836.

Mingled with the early history of this prairie settlement are stories of
romance and leadership involving the immortal Lincoln and such well known
names as Oglesby, Hanks, Love, Crissey and Chenoweth. Lincoln is said
to have nursed a pair of frozen feet which detained him for several days
at the Warnick home where he went a courting, thus connecting him with
the health history of the place. Richard Oglesby, uncle of the war gover-
nor, was the first village president, while Andrew Love, who later became
a bishop in the Mormon Church at Salt Lake City was the first town clerk.
Dr. William Crissey, one of the first physicians to locate in the vicinit)-,
was a member of the first board of trustees. The character of these men
who accepted the responsibilities of leadership in the infant city doubtless
gave birth to the principle or policy of denying license to liquor dealers. At
any rate Decatur never in its history permitted saloons to operate within
her limits and this fact had a profound influence over health conditions there.

Decatur is located near the banks of the Sangamon River in the very
heart of the great prairie region of Illinois. Slightly rolling in the immediate
vicinity of the city the terrane is characteristically fiat and fertile.

The city has never experienced a phenomenal growth but the rich agri-
cultural resources of the surrounding country and the substantial character
of the industries that have been established there have provided a solid
foundation for the community that might well be the object of envy in less
favored places. Thus the population which numbered about 1,000 in 1854
when Dr. J. W. Chenoweth, latel_\- graduated from the L'niversity of
Louisville, settled there has increased steadily. It had grown to 3,839 by
1860 and went up to 7,161 during the next decade. In 1880 it was 9,547
and reached 16,841 by 1890. The new century found 20,754 souls residing
in Decatur and these had increased to 31,140 ten years later. In 1920 the
population returns of the United States bureau of the census showed 43,818
people in the city and of these 40,041 or 91 per cent were native born whites.
There were 2,590 or about 6 per cent, foreign born whites and 1,178 or a
little less than 3 per cent negroes. About 23}^ per cent, a total of 10,309,
were listed as being 45 }ears old or over. In Illinois 21^ per cent of the
population was in the 45 and over age .group.

(107)

108 DOWN-STATE .MUNICIPALITIES

Hi:ai.tii Maciiineky.

Alllnniyli licit a pulilic liealtli (irLjanizalion, the Alacim County Mcclical
Socifly. organized in 1S53. (liiulitle>s had an influence over jinhhc heahh
in that it afforded the medical jirofession a niechum through whicli in ex-
change experiences and information concerning successful therapeutic and
preventive practice and the nature and prevalence of disease. It also pro-
\ ided an official mouthpiece for the medical profession, giving a legitimate
outlet to the expression of their professional influence.

The lirst legislative step taken liy the city government toward creating
a pui)hc health organization came on Jul\ 9, 1886, when an ordinance creat-
ing a board of health was adopted. Prior to that time a committee of the
board of aldermen managed the public health affairs which consisted chiefly
of investigating and abating nuisances. Evidently the committee had been
called upon to face a number of complicated problems associated with epi-
demic outbrealcs for the ordinance reads like an instrument concei\ed b\'
gr;i\'e experiences. The new board, for instance, was clothed with the broad
powers implied in the term "general supervision over the health and welfare
of the people." Specifically, the board was invested with authority to abate
nuisances; to establish hospitals for the prevention of commimicable
diseases ; to employ nurses to work in such hospitals ; to require all citizens
to be vaccinated against smallpox under penalty of fines ranging from $5 to
$25 ; to require reports of all communicable diseases ; to require the quar-
antine of patients sufl:"ering from contagious diseases; to exercise sanita\'y
control over food, milk, slaughter houses, soap factories and the city
generally.

The first board, which began at once to e.xercise vigorously its sanitary
regulatory powers, was made up of the mayor, the town clerk and three com-
missioners including Dr. C. Chenoweth, Ira N. Barnes and B. F. Lilley.
It was, however, like so many similar organizations elsewhere, reduced to
tlie necessity of doing its work principally through the force of moral
suasion because of the paralyzing complex always introduced by an empty
exchequer. In times of emergency the board could and did get monev by
special acts of the city council and thus it employed inspectors and technical
talent from time to time as occasion required.

This practice appears to have prevailed throughout the life of the board
of health system, which expired in 1909 with the adoption of the commis-
sion form of government b\' the city, and even continued until 1911 when
\\'. J. Harding was employed as full time health ofiicer. Four years later
a milk inspector was appointed and in 1916 a full time sanitary inspector
was added to the staff. Then in 1919 a social hygiene clinic, financed jointly
by the city and .'^tate, w;is established and Dr. I. H. Neece was employed
as its medical diicctor and at the same time he was given general supervision

DECATUR 109

over the public health acti\ities of the city. The lav health officer and the
two inspectors were retained but Dr. Neece was given general supervision
over all medical and technical activities and engaged personally in such
things as the examination of school children, the investigation of epidemio-
logical problems and the like.

The \ear 1''24 marked the beginning <.if distinct advancement in the
public health organization of Decatur. In Alarch of that year arrangements
were made by the State Department of Public Health to establish a labor-
atory service in the local hospital for doing diphtheria tests. It was but a
step from that point to a rather complete local laboratory service and the city
took advantage of the opportunity in October of that year, paying the hos-
jiital a contract price for public health work done for the local physicians.
Earl\- in the \ear Dr. Xeece gave up the health superintendency, opening the
way for a fidl time man in that capacit\'.

After a lapse of several months, the public grew restive, provoking a
pronounced sentiment in favor of a well organized modern health depart-
ment manned and equipped in a way commensurate with the needs and
dignity of a thriving up-to-date community. Ac-
cordingly the officials looked about until they
struck upon Dr. William S. Keister of Charlotts-
ville, \'irginia, a man of superior training and
considerable experience in public health work,
who was tendered and accepted the position of
lull time medical director of health on September
first, 1924. Under him a splendid cooperative
program unifying all public health service in the
city, both voluntary and official, under his direc-
tion was worked out and put into operation. A

William S. Keister, M. D. picture of the public health machinery that was

Medical Dn-ector of Health. ... T t^ t^ ■ , , <■

1924 to 1927 tunctionmg under Doctor Keister at the close of

1925 is found in a report of a study and appraisal

of the service conducted b}' the State Department of Public Health in 1926.

B}- consulting that report we learn :

"Appraised on the basis of the 192.5 records of public health service.
Decatur, with a score of C95. ranks third among the fifteen cities sur-
veyed. Much progress has been made in this field of community effort
since 1924 when the municipal health department was reorganized. En-
joying an excellent relative standing, of even greater interest is the
spirit of progress that permeates public health activities in Decatur, a
demonstration of which is found in the addition of new activities and
the e.xtension of existing ones during last year.

"The health work in this city is unique in demonstrating the ex-
cellent coordination which is possible between the city, board of educa-

110 DONVX-STATE MUNICIPALITIES

tion, county tuberculosis sanatorium board and tlie volunteer lieallli
agencies under the leadersliip of a city health officer. While many in-
fluences may have been present to bring about this coordination, that
of the county medical society deserves special mention. In 1924. a
central committee of public health was formed, composed of the ines-
ident of the county medical society, su))erintendent of Decatur-.Macon
County Hospital, su])erintendent of schools, city commissioner of health
and safety, the directors of the venereal, orthopedic, tuberculosis and
other clinics, the president of the Visiting Nurse Association and other
interested persons. One of the first results of this committee's efforts
was the appointment of a full-time health officer by the city, part of
whose salary is paid by the tKj;ud of education. In addition to occupy-
ing these two positions the health officer also directs the work of the
Visiting Nurse Association. The health department conducts com-
municable disease control, sanitation, food and milk control activities.
The city clerk is local registrar. A venereal clinic is held at the hos-
pital, the expense being borne jointly by the city and the State. Tuber-
culosis clinics are held by the medical superintendent of the county
sanatorium, but the field work for these clinics is done by the Visiting
Nurse Association. This same organization also renders bedside care
and field service for prenatal and infant hygiene.

"School health work is under the direction of the city health officer
(as noted above), who is assisted by! three nurses and a part-time
dentist. Laboratory work for the city is done by contract in the Decatur-
Macon County Hospital. Two baby welfare clinics are maintained and
one nurse divides her time between these several clinics.

"The city itself spends $13,310 for health service or 2G cents per
capita and expenditures by all agencies totals $29,G79 or 50 cents per
capita. Seven cities spend more than Decatur for its health depart-
ment and in seven the total exiienditures by all agencies exceed Deca-
tur's total.

"Facilities for the hospitalization of contagious disease patients are
not present.

"A special tax for anti-tuberculosis work has been voted by the
county under the tuberculosis sanitarium law. A sanitorium has
been built and is operated under contract with the Decatur-Macon
County Hospital. The sanitarium board pays the Visiting Nurse Asso-
ciation for field tuberculosis service throughout the county. Decatur
takes first place among the fifteen cities in its field nursing service for
tuberculosis. The amount of hospital service provided is adequate.

"No prenatal clinic was in operation in 1925 although one has been
started recently at the Decatur-Macon County Hospital. Two infant
clinics were operated but the total attendance in these was low.

"School hygiene work Is financed by the board of education, which
employs three nurses and a part-time dentist and pays one thousand
dollars per year to the city health officer who acts as director of
hygiene. Decatur is surpassed only by Peoria in its school health work.

"The sanitary inspection service is conducted by two full-time in-
spectors.

Ill

"Prior to October iy:i5. there was no free public healtli laboratory
service except that furnished by the State Laboratory at Springfield and
facilities for the diagnosis of diphtheria at the Decatur-Macon County
Hospital. Since that date, however, the city is paying .$100 per month
to the hospital for laboratory service."

VITAL 5TATI5TIC5 m
C0nn.DI5. COhTROL^^

DECATUR

' i ° ' i ° ^f -^^f—

VEn. DI5. COriTROL^
TUB. COMTROL m
HEALTH CHILD--"^«^

HEALTH 5CH. CHILD WM
SAMITATIOM
MILK CONTROL
LABORATORY ^

POP HEALTH in5T.^

PERCEMT OF STAMDARD SCORE
EACH OF TEM MAJOR HEALTH ACTIVITIES
1923

Fig. 1. This graph illustrates the strong and weak points in Decatur's
public health service, official and voluntary, as it existed in 1925. It is
based upon a personal survey and rated ni)on the standards evolved by
the American Public Health Association. The total efficiency rating in
Decatur was 70 per cent of the standard jierfection requirement.

With a change in the political fortunes of the municipality that took
place in 1927, Dr. Keister resigned and Dr. Geo. W. Haan, Jr., was ap-
pointed in his place. The official personnel of the health department re-
mained the same in strength but some of the voluntary agencies as well as
the school board withdrew froiii the cooperative agreement that previously
prevailed and began again to plan and direct their activities independent of
the health department.

Voluntary and Other Agencies.
Public health nursing, which began in 1908 through resources provided
by the Civic League and the Woman's Club, has been an important factor
in the health services of Decatur. During the second year of this work the

112 DOWX-STATK MUNICIPALITIES

school board paid one-half of the salary of the one nurse emplo}ed because a
considerable amount of her time was spent in the schools. Later the school
board undertook to pay all of the nurse's salary and in 1911 employed two
nurses. This beginning ultiniately led to the employment by the school
Ixiard (if three full time nurses, a part time dentist and a contribution toward
the salarx of the health officer during the tenure of Doctor Keister and gave
Dt'catur one of the linest school health services in Illinois.

In I'M 7 tile Macon l'ount\- Tuberculosis and Visiting Xurse Associ-
ation was organized and began at once to function. It participated in the
health activities of the city and county in a large way, exercising a predomi-
nating influence in the successful campaign that resulted, through popular
vote, in the opening of a splendid tuberculosis sanitarium during the summer
of 1923. This sanitarium proved to he the nucleus about which has sprung
up that remarkable institution known as the Decatur and Macon County
Hospital which concentrates under one administrative head a very large per-
centage of the medical and public health facilities of the city and county.
All of the dispensary and clinic activities of a public character, except those
carried on in the schools, are conducted in the institution and supervised
by it.

A clinic for crippled chihh'en was started in the city in 1919 b_\' Dr.
George LVon. Later it was affiliated with the hospital and upon the death
of the orthopedic surgeon in charge it was turned over to the Illinois Society
for Crippled Children in 1926.

W.A.TER Supply.

The first water supply for Decatur was placed in service in December
1870, drawn from a well in the city. Scarcely a month later it proved to be
inadequate. In 1871, therefore, a pumping station was built on the banic of
Sangamon River.

It was soon found that the river water was too turbid for use during
high water and in 1874 an infiltration gallery was constructed.

In 1877 the suppi}' again became inadequate. The gallery was enlarged
and a dam constructed to raise the water level at the gallery.

Later it became necessary to pump water directly from the river to meet
the demand and the supply was again unsatisfactory. In 1894 a filter plant
was constructed.

In 1910 and 1911 a new pumping station was built and the wooden dam
was replaced b}" one of concrete. In 1914 a new and modern filter plant
was built. This plant is still in use.

In 1920 and 1921 another dam was constructed which formed what is
now called Lake Decatur. This lake will supply ample water to meet the
needs of the citv for manv rears.

DECATUR 113

The Sanitary District has adopted an ordinance for the sanitar\' control
of the lake. The outline for the ordinance was prepared by the State Depart-
ment of Public Health, and it was the first ordinance of its kind to be adopted
in Illinois. .\n inspector is maintained to police the lake and its tributaries.
With this control of the lake and proper operation of the treatment plant the
water should be of excellent quality.

SEWi:R.\r,E.

Sewers were constructed as needed until by l'J12 the cit\- was rather
completely sewered on the separate plan. There were four outlets, all of
which were below the water-supply intake on Sangamon River.

Soon after the Sanitary District was organized in 1917. an interceptor
was constructed to collect the sanitary and storm sewage.

In 1922 a modern sewage-treatment plant was constructed. The plant
receives wastes from the Staley starch works. After the plant was finished
the wastes from the starch works increased enough to overload the plant.
An agreement was reached whereby the starch works would decrease its flow
and the city would enlarge the treatment plant.

He.^ltit Conditions.

References to prevailing health conditions and even to epidemics in
Decatur prior to 1900 are particularly meagre. If the community suflfered
extensively from cholera during the outbreaks of 1833 or 1849 it kept the
matter to itself. If smallpox ever alarmed the public or carried off any
considerable number of citizens, those facts were likewise regarded as private
affairs. If these two notorious diseases escaped historical mention we are
not surprised to find no records of other and less spectacular factors in the
community health.

(^n the other hand the city introduced an effective vital statistics system
at an early date, the city clerk being the local registrar. The system was
working well enough in 1900 to justify the United States bureau of the
census in admitting Decatur along with one-half a dozen other Illinois cities
into the United States registration area for deaths which was established at
that time. Requirements for admission into that area include an effective
law or ordinance and proof that at least 90 per cent of all deaths are being
reported and recorded.

just wlien the ordinance was passed in Decatur is not clear from ma-
terial available. The mortality statistics for these early years are doubtless
preserved somewhere but they were never analyzed and compiled and they
are not accessible for a study of the kind herewith attempted. Accordingly
we must be contented here to surmise that conditions prevailing after 1900

114

DOWN-STATK M U .\ Ul PAI.ITILS

were but a continuation of those that existed before that time and thus con-
clude that the city experienced its full share of epidemic visitations which
came and went in periodic waves peculiar to infectious disorders. The con-
stantly- high niortalit_v rates from tuberculosis, typhoid fever and diphtheria
during the first decade of the twentieth century leads to the reasonable pre-
sumption that these diseases as well as diarrheal and other communicable
disorders were severely endemic for some considerable time before 1900.

Scanning the mortality sheets we observe an unmistakable evidence of
(lisiinct iniprovcnient in the public health measured by the impeccable terms
of declining fatalit\- rates from specific causes. Deaths from typhoid fever,
for instance, fell from 48.2 per 100,000 population in 1900 to 1.8 in 1926.
The progi-ess of this descent was not unbroken but rather it was interrupted
by fluctuations which varied in intensity with the changing combination of
the innumerable factors invohed in the spread of this disease. At the same
time the downward trend was pronounced, the marked increases grew more
infrequent and the public conscience became more and more sensitive to
outbreaks of typhoid fever.

Table 1.
Mortality From Certain Causes.

■B

YE.\ll

■3

■|i

•^

■g

fcitS

£•2

ArS

"ea

■2*5

■3

t,--:-

1897

1898

245

'. . .

1S99

332

' i

1900

351

. '. '.

1901

303

"■2

1902

331

1903

280

1904

323

' 2

1905

271

7 1 ..

1900

300

1907

344

1908

345

' i

1909

327

l.->

1910

412

1911

400

1912

433

.">

1913

476

' i

1914

400

... 1 ..

191.">

458

4:!

1910

509

1917

581

1918

686

103

1919

556

1920

649

' 2

1921

601

1922

594

".3

1923

647

' i

1924

609

1925

660

1928

755

14 1

Table 2.
Mortality Rates From Certain Causes.

115

YEAR

i .3

.33

g £

ft. ^

1897

1.5

15.3

5.1

10.2

20.4

1898

12.3

25.0

10.0

lO.'o

5.0

205.2

1899

16.3

19.6

iig

4.9

49!i

181.7

176 ! 8

1900

16.9

48.2

19.3

9.G

43.4

24.1

192.7

134.9

1901

14.4

42.8

9.5

23.8

33!2

4.7

38.

156.7

109.2

1902

15.4

14.0

913

51.2

9.3

46.6

9.3

172-.3

97.8

1903

12.8

18.4

36.7

9.2

45.9

23.0

128 . 6

59.7

1904

14.6

40.8

9!6

4.5

22.6

4.5

13.6

194.6

81.5

1905

10.8

18.5

11.1

29. G

111.0

74.0

1906

12.1

20.2

28.3

16.2

149.7

80.9

1907

12.0

10.5

3.5

27.9

14.0

104.7

80.3

1908

13.6

11.8

3.!>

19.7

11.8

110.3

90 . 5

1909

10.7

23.0

3.3

6.6

19.'7

6.6

118.1

49.2

1910

13.1

16.0

22.4

12.8

gie

22.4

12.8

143.8

102.2

1911

12.4

9.3

12.3

37.0

12.3

98.8

43.2

1912

12.3

28.1

2.8

5.6

14.1

109.7

70.4

1913

13.1

21.9

2!7

2.7

11.0

2.7

8.2

123.2

90.3

1914

12.4

18.7

2.7

10.7

125.2

77.3

1913

12.0

7.8

2^6

20.8

7.8

2!6

80.5

111.0

1910

13.0

10.1

5!6

32.8

2 . 5

15.1

5.0

88.3

93.4

1917

14.2

41.0

2.4

7.2

9.6

7.2

110.8

137.4

1918

16.3

6.8

2.2

9.0

15.9

234.0

95 . 4

165.9

1919

12.8

9.1

2 .2

9.1

25.1

66.2

98.1

60.2

1920

14.6

8.8

13.6

i.i

8.8

15.8

1C6.8

118.1

122.7

1921

12.9

19.3

2!l

6.4

43.0

19.3

70.9

94.6

1922

12.5

4.2

e'.i

6.3

27.4

80.0

94.8

1923

13.4

4.1

20^6

(S.l

8!2

14.4

63.7

66.1

78.5

1924

11.5

3.7

S.7

5.6

9.4

71.7

75.4

1925

13.1

11.9

3.9

4.0

2.0

17.8

71.6

102.0

1926

13.7

1.8

l.S

16.2

1.8

25.2

i.8

63.6

72.7

The r.ite fro

.\11 Causes is per 1.000 population; all others per 100,000 populatio

Table 3.
Cases of Certain Diseases Reported.

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

Tvphoirt Fever

Smallpox

163

Measles

9.56

181

183

188

927

662

242

286

Scarlet Fever

217

121

204

156

135

Whoop. Cough

133

168

102

140

341

174

Diphtheria

132

309

139

Influenza

1566

1563

919

Poliomvelitis

Meningitis

Tuberculosis*

133

218

133

110

232

185

Pneumonia*

132

179

116

154

178

123

S.vphilis

188

136

172

150

141

Gonorrhea

154

248

112

202

195

188

189

Chancroid

*AI1 forms.
Note: Oase reports are never complete, but they have been much more so since 1920 than before in
Illinois and they are more complete in Decatur than in many other communities and cities of the
State. This table indicates improvement in notification more than anything else.

116

IxnVN-STATK MUNICIPALITIES

Table 4.
Births and Infant Deaths.

Infant Deaths

YKAU

Number

Kate**

Number

Rate*

1900

206

9.9

276.6

1901

250

11.4

228.0

1902

502

SI. 9

139.4

1903

549

23.0

92.8

1904

535

21.4

110.2

1905

615

23.7

55.2

1906

635

23.5

80.3

1907

1004

35 . 8

45.8

1908

929

31.9

62.4

1909

1015

33.7

46.3

1910

1047

33.6

51 . 5

1911

1081

33.3

53.6

1912

1114

33.1

51.1

1913

1115

31.9

54.7

1914

1183

32.6

57.4

19ia

1150

30.6

50.4

1916

907

23.4

82.6

1917

840

20.9

85.2

1918

971

23.5

78.1

1919

908

22.7

80.5

1920

1089

24.5

65.2

1921

1124

24.6

80.1

1922

1045

22. 2

72.7

1923

1068

22.0

85.2

1924

1091

22.1

77.0

1925

1126

21.3

65.7

1926

1275

23.2

72.9

of age per 1000 births reported.

Experience with tuberculosis has been no less favorable than that with
tvphoid fever. Mortalitv declined from 192.7 in 1900 to 63.6 in l'»26. The
resources and energy utilized in fighting- this disease appear to have produced
results of the most satisfactory character.

Several unhappy epidemics have marred the story of general improve-
ment in health conditions during the first quarter of the twentieth century.
Scarlet fever, for example, reached alarming proportions in 1915. Condi-
tions were regarded with sufficient gravity to lead the State Board of Health
to go into the city and by virtue of authority vested in it by law take
complete charge of the situation. Some 300 cases and 8 deaths occurred
during the epidemic. Never before nor since, so far as the records dis-
close, has scarlet fever caused such disastrous havoc in the city.

Likewise diphtheria cast its unwelcomed shadow across the community
on more than one occasion liut its wide prevalence and fatal character in
1921 makes it particularly noteworth\' for that year. There were 309 cases
and 20 deaths reported. Somewhat similar outbreaks occurred in 1900,
1902, 1903 and 1911.

Again, 1917 marked the occurrence of the worst typhoid fever epidemic
which the cit\- has experienced since 1904. About 120 cases, 17 of which

DKCATUR 117

terminated falrilK , fullowed tlie conlaniiiiation of a milk supply by a lyphoid
carrier who was at work on a dairy farm.

Again, Decatur felt the grievous sting of the influenza pandemic which
spared not the State in 1918. Fatalities from that disorder jumped from
an average of 4 or 5 per year to 103 while deaths from pneumonia went up
from an annual average of about 25 or so to 7?i. Even so the mortality rate
from these two causes combined was quite moderate compared with what
it was in most of the other municipalities in Illinois. The rate in Decatur
was 400 per 100,000 population while Elgin alone out of all the other cities
embraced in this volume reported a lower rate. It has been suggested that
the sobriety of Decatur may have been an important factor in the moder-
ation of the epidemic there.

The periodicity of these epidemics in recent years and the very fact
that thc\- cause profound public concern which expresses itself in the appli-
cation of sound preventive measures are evidences of substantial advance-
ment against the communicable diseases. Public concern over the presence
of a preventable disease and public support of preventive programs are mani-
festations of a healthy public mind and so long as that condition continues
the interruptions in health improvement caused by epidemic outbreaks will
serve only to stimulate the city to more adequate and more vigorous efforts
against the invasion of disease.

Ri-:fi:rences.

Reports of Commissioner of Health. Decatur, -various dates.

Macon Coinitv History.

History of Medical Practice in Illinois, Vol.

U. S. Census Reports, Washington, D. C, i

East St. Louis

Reckoned from the date when the white man first settled in that vicin-
ity, East St. Louis is one of the oldest communities in Illinois. French mis-
sionaries, arriving from the north by way of Canada and the Alaumee-
Wabash portage, established themselves there in 1700, calling the settlement
Cahokia. After surviving many vicissitudes of fortune a plan for building
a city was evolved in 1817 when the site was platted and given the name of
Illinois Cit\-. Instead of adding his benediction to the project, Lewis Beck,
a prominent citizen and sagacious observer of the day, prophesied that the
land laid out would never be valuable except for cornfields and potato patches
because it had no advantages.

This gloomy forecast, notwithstanding, the community had acquired suf-
ficient importance by 1859 to secure a charter from the General Assembly
in which it was called Illinois Town. Two years later. April 1, 1861, the
name was changed to East St. Louis and a new charter was granted by the
legislature.

The city is located almost in the very center of the "American Bot-
toms", the extensive low-lying area that beguiled pioneers by its fertility
but complicated its marvelous harvests of grain with great crops of mos-
quitoes which carried malaria to rob the settlers of their blessings. East
St. Louis is separated from ."^t. Louis by the Mississippi River from which
both municipalities have always drawn their water supplies.

When Illinois became a sovereign state in 1818, East St. Louis was a
communit}' of about 500 souls and was still known as Cahokia. The com-
munity never grew very raj^dly until late in the nineteenth centur\-, bidding
fair for a long time to live out the doleful forcast of Lewis Beck. By 1870,
how-ever, the population had reached 5,644 and a decade later it was 9,185.
During the ten years between 1890 and 1900 the population grew from
15,169 to 29,655 and then to 58,549 by 1910. Reports of the United States
census show that there were 66,767 people in East St. Louis in 1920. Of
this number 52,522 or 79 per cent, were native born whites while 7.437. or
about eleven per cent, were negroes. There were 12,212 or about 18.2 per
cent, who were 45 years old or over.

Hr..M.Tn M.-\CMIXERY.

If the origin;il cmnniunity of Cahokia is included in the history of East
St. Louis. t(i that city f;dls the distinction of having had the first health
officer and (luarantine regulations in Illinois. Strangch' enough this first

(118)

EAST ST. LOUIS

119

health officer was a woman. Madame I-]euHeu, of whom Governor Reynolds

in The Pioneer History of Illinois, says :

"She was the director-general In moral and medical matters (at Ca-
hokia). This lady was educated and intelligent. She possessed a strong,
active mind and was a pattern of morality and virtue. She was the
doctoress in many cases and the sage femme general for many years.
She was extremely devout and an exemplary member of the Catholic
church. This, together with her merit generally, enabled her to fix up
many of the male and female delinquencies of the village. She was
sincerely entitled to the praise due a peacemaker. * * * * She lived a
long and useful life, and died in Cahokia in 182G, eighty-four years of
age, much lamented by all classes".

Reference to the first quarantine regulation of which we have record
appears in the minutes of the court of quarter sessions of Cahokia, July 2,
1799. It reads:

"Ordered in order to keep off the plague of the smallpox, that now
rages on the Spanish Side, that any one crossing (the river) to be fined
$6.00 for the first offense, $12.00 and ten days imprisonment for the
second offense and remain in prison until he or they shall pay the final
fine. Goods brought from the Spanish Side shall be confiscated."

These good beginnings failed to provoke popular support, however, be-
cause they soon fell by the wayside. At any rate the records are singularly
free from further references to any kind of official public health activities
until June 3, 1867, when a board of health made up of Edward Barrett,
Alex Fekete, Patrick jMcCormick and Angus Gillis, one from each ward of
the city, was established by ordinance. Just how the board functioned, if
at all, is not clear since evidence of an executive officer is wanting. Not
onl) so but in 1881 reports of smallpox cases were transmitted by the mayor
to the State Board of Health, a fact that there
was no health officer active at that time.

From the annual reports of the State Board
of Health, it appears that medical and sanitary in-
spectors and nurses were employed from time to
time to handle emergency situations arising in
F.ast St. Louis as the result of epidemic outbreaks
and floods. Frequently these inspectors were
temporary employes of the State Board of Health
and the State Board paid for nursing services
rendered in the city on at least one occasion prior
to 1900. These records suggest that the local
public health facilities were either ijnitc unor-
ganized or too meagre to be of particular value
under stress of emergencies.

JI. R. Doyle. M. D.

Health Commissioner,

1901-1903

120

DOWiN-STATK MUNICIPALITIES

Later it became the practice to employ a health inspector who investi-
gated nuisances, placarded premises and fumigated sick rooms. He seemed
to have worked under the police department. Al>out 1900, however, there
was a revival of local interest in the puljlic health re(|uirements of the city
and it became the practice to employ a physician as health officer on a part
time basis. The first to serve in this capacity- w-as Dr. M. R. Doyle, who filled
the office during the period of 1901-1003. He was succeeded by Dr. A. A.
McUrien who retained the position until l''ll when he was replaced by Dr.
L. D. Short. In 1915 Dr. .Short was succeeded by Dr. R. X. McCracken who
turned the office over to Dr. C W. Lillie in 1919.
East St. Louis adopted the commission form
of government in May 1919 so that Dr. Lillie was
after that date responsible for his duties to the
commissioner of public health and safety who had
fallen heir t<i all the powers, duties and responsi-
bilities formerly vested in the local board of
health. Dr. Lillie continued a> health officer
until his death in 1922 when the co.nmissioner
of public health and safety undertook to manage
personally the administrative functions of the
health service. This executive custom has pre-
vailed to date.

Apparently the health officer made up the
epartment in East St. Louis during the early years
hut assistants in the capacity of inspectors were
added from time to time until we find the personnel including the health
officer, and assistant health officer in charge of
garbage collection, a sanitary inspector, a hospi-
tal matron and a bacteriologist (part time) in
1919.

.\bout this time a wave of enthusiasm for
health improvement flooded the cit\". Through
the interest manifested by the War Civics Com-
mittee, which found itself with considerable un-
expended funds after the Armistice had stopped
W'orld War .hostilities, an exhaustive sanitary
and health study involving a house to house can-
vass and a careful analysis of the statistics, laws.
facilities for health work, etc., was undertaken in
1919. This task, supervised by the .State Depart-
ment of Public Health was initiated with the view of discovering the exact
nature and magnitude of the sanitary and h\gienic problems of the city and
then creating a ])ublic health organization commensurate with the needs.

L. B. Short. M. D.

Health Commissioner.

1911-1915

entire staft" of the health
of ihe twentieth centurx

R. X. JlcCracken. M. D.

Health Commissioner,

li)l.i-1919

EAST ST. LOUIS

121

Charles W. Lillie, M. D.

Health Commissioner,

1919-1922

The project turned out to be a case of the
"Sjjirit is wilhiig but the pocket book is empty".
Ilxerything went fine until the question of financ-
ing an adequate health department came up but
for this problem their seemed no solution. The
municipality was already taxed to the legal limit
and no other financial resources were open to the
oflicials.

Although no general reorganization of the
health work followed fast upon the heels oi the
survey, improvements and new activities were
added to the service from time to time. Scarcely
before the study was completed in 1919 a social
hygiene clinic with Dr. W. C. Wilhelmj in charge,

was. established under the joint financial support of the State and count\-.

Shortly afterward a medical examination system was inaugurated in the

schools.

I^iubscciuently two other studies of an entirely different type were made

(jf the public health equipment in East St. Louis. (Jne was carried out in

V)2? \i\ the American Child Health Association

and the other in 1926 by the State Department

of Public Health. Each was initiated by the

agencN- that did the work. In each case the

object was to discover how much public health

service was actually being done in the city by all

official and \'oluntary agencies and to relate the

whole volume of such service to the needs of the

numicipality as measured by the practices found

profitable in a hundred American cities. The

findings in each ca.se w-ere reduced to an arith-
metical \alue based upon 1,000 possible points

and in each case the results were much the same.

Quotations from the report made by the State

Department of Public Health give a clear concc])li<in of the public health

services available in l-'.ast St. Louis at the close of \')Z5. We read :

"As indicated by a score of onl.v 41,') out of a ijossible luMO points,
public health activities in East St. Louis fall far short of what may be
regarded as standard practice. Although the city commissioner under
whose supervision the health deiiartment falls, manifests a keen in-
terest in and devotes a considerable part of his time to this department,
the health service is poorly organized and not well bilanced. The city
employs no nurses. The field staff consists of one quarantine officer
and three inspectors, the latter devoting their attention chiefly to grocery

A. P. Lauman

Commissioner of Public

Health and Safety.

1927 to (l;ite

122 nowx-STATi-. iri'xiriPALiTiES

and moat stores, restaurants ami nuiKance coni|)laints. A part-time
physician does tlie laboratory work and is available for settling ques-
tionable diagnoses although his actual field activity is negligible. Vital
statistics are collected and tonii)iled by cause and by groups for the local
registration area which is larger than the city but no rates are com-
puted and no analyses made. The princiiial short-coming of the health
department under the present iMidget is a lack of trained personnel. As
organized it functions well.

"Four part-time physicians employed by the school board, a medical
director of a social hygiene clinic supported from state and county funds,
a nurse employed by the tuberculosis association and seven nurses on
the staff of the Visiting Xurse Association make up the remainder of
the city's public health workers. In so far as recreation may be con-
sidered a public health activity, the park board does a splendid service.
The Visiting Nurse Association is easily the most vigorous and best
organized of the health agencies. Between the various agencies there
seems to be no close contact.

"East St. Louis spends money enough, through official and voluntary
agencies combined, to enjoy a much more satisfactory health service
than it obtains. The city, however, spends directly only 16 cents per
capita per year, other agencies contributing enough to bring the grand
total up to about 51 cents per capita per year. A reasonably adequate
city health department requires at least 50 cents per capita per year
and this must be supplemented by a considerable voluntary agency
strength in order to provide a service commensurate with minimum
needs.

"The records collected and compiled by the health department are
for the local registration area, which is larger than the city and no
analysis showing the city proper is made. None of the records are
indexed and while tabulations by cause are made, these compilations
are in alphabetical order without reference to the International Classifi-
cation.

"Activities directed toward the control of communicable diseases
are handled by the city commissioner under whose supervision the
health department comes. He is assisted in this by a quarantine officer
who placards premises and fumigates at the termination of quarantine.
No nurses are employed and the part-time physician on the staff does
very little field work. Smallpox cases are usually isolated in a 'pest
house' but there are no hospital facilities for isolating contagious disease
patients. Advantage is always taken of epidemics to stimulate vaccina-
tion against smallpox.

"Efforts directed at combating venereal diseases constitute the most
efficient official public health service in East St. Louis and as such stand
out in strong contrast to the weakness in other activities. A clinic is
operated under first class supervision and patients are kept under good
control.

"A county tuberculosis nurse spends a considerable part of her time
in the city and the Visiting Nur.se Association does a limited amount
of tuberculosis work. No tuberculosis clinics are held in the city nor
are there any hospital facilities for tuberculous patients.

EAST ST. LOUIS

123

"The Visiting Nurse Association conducts two baby welfare clinics
per week, one for white and the other for colored. Last year the total
number of visits to these clinics was 952. The same oi'gauization did a
large volume of field nursing work. There is no prenatal or preschool
clinic. With limited strength and financial resources, the Visiting
Nurse Association is doing a splendid service in a broad field.

"Because of intense interest in health matters on the part of the
city superintendent of schools, some very good work is being done
among the pupils. The good points are the systematic weighing and
measuring and the use of this procedure to stimulate interest of the
children, the regular use of text book instruction and the splendid
recreational system. Four physicians devote time each school day morn-
ing to the examination of inipils. A fairly complete examination is given
to all children during their first year. Those with gross defects are
kept under more or less supervision. Examinations are made of other
pupils only when some manifestation of departure from the normal is
observed by the teacher and reported to the physician when he pays
his routine visits to the school. There was some evidence that these
physical examinations result in consideralile good.

EAST 5T. LOUIS

[St

VITAL 5TATI5TIC5S
conn. DIS.COMTROL"
VEIH. DI5. COMTROL^^
TUB. COMTROL
HEALTH CHILD
HEALTH 5CH. CHILD
5ANITATIOM™s.^S"0
MILK COMTROL
LABORATORY
POP. HEALTH IMS

^ — I

FOR

PERCENT OF STAMDARD SCORE
EACH OF TEM MAJOR HEALTH ACTIVITIES
1925

Fig. 1. This graph illustrates the strong and weak points in Fast i-"t.
Louis' public health service, official and voluntary, as it existed in 1925.
It is based upon a personal survey and rated upon the standards evolved
by the American Public Health Association. The total efficiency rating in
East ?t. Louis was 42 ])er cent of the standard perfection requirement.

124 nowN-STATi-: .muxich'ai.ities

"The water siiiiply is sood and apjiears to be on tap in most homes
and all business houses. While no actual, up-to-date records are avail-
able, there appear to be grounds for believing that a considerable num-
ber of dwellings have no sewer connections. Three sanitai'y inspectors
pay especial attention to food establishments, nuisances and the like
so that this phase of public health w'ork is more adequately covered by
oflicial activity than most others.

"About 85 per cent of the milk supply is pasteurized. This is dis-
tributed by three large (oncerns while the raw milk, none of which is
certified, is handled by 14 small producers. License is required of all
milk dealers and satisfactory ordinance provisions for adequate con-
trol sui)ervision are in force. No bacterial analyses of samples are made,
however, and no systematic inspection activities prevail. Perhaps it is
not amiss to add that the estimated daily consumption of milk, about
one-half pint lier capita, is the lowest of the 15 cities studied."

While not a [)art of the heahh machinery in the narrower sense, there
were I wo other official organizati(jns the wurk of which resulted in consider-
able luihlic health improvement. P'irst came the organization of the sanitary
district in l'X)n. It caused the strengthening of old levees and the building
of new ones which have i)rotected the cit\' from periodic inundations so
C(]mmon during earlier \ears. These improvements relieved the locality
from marshy areas and stagnant pools which had once been the prolific
breeding grounds of mostjuitoes. Malaria disappeared also with the passing
of the mosquito.

Then came the park district organization in 1''08. Including a part
of adjacent townships under its iurisdicti(jn this organization has built niun-
erous parks, playgrounils, one open air swimming pool and promoted in other
ways wholesome outdoor life. Doubtless these activities have contributed
to the health assets of the community-.

Furthermore, there was an isi)lation hospital authorizeil antl purchased
by the city in 1904. It was somewhat superior to what was ordinaril}- re-
ferred to as "pest house" but it did not measure up to the modern conception
of an i-solation hospital. At any rate, it provided a place where patients suf-
fering from contagious diseases might be cared for in a way to prevent
spreading the infection.

W.\ti-;k Supply.

The waterworks were established in 1885, when a 30-_\ear franchise was
granted to certain St. Louis interests. The properties were later bought by
the American Water Works &■ Ciuarantee Company (now American W'ater
Works & Electric Co., Inc.) a holding company with headquarters in New
York City, which also now supplies Granite City, Belleville, Venice, and
Madison from the Ea.st St. Louis plant. The old local company name of
East St. Louis & Interurban \\'ater ("om])any is still used.

EAST ST. LOUIS 125

The supply has always been from the Mississippi River. The first water-
works included a settling basin. Later a secondary settling and coagulating
basin was added and eighteen Jewell pressure filters installed to operate
under a low head as gravity filters with an dutlet to a filtered-waster basin.
The next addition was ten steel tub gra\ ity filters, and four concrete gravity
filters were added in 1913, and eight more in I'HS.

At present the water is taken from the riser, allowed to settle for about
53-2 hours, then agitated to mi.x it with the coagulants, and allowed to settle
again for Syi hours before filtration, .\fter filtration, chlorine is added as a
sterilizing agent before it is pumped to the distribution system.

Since filtration and chlorination of the river water was started, the
supply has been considered as a safe sanitary qualit\ and no illness has ever
been attributed to the water suppl\'. Improvements to assure water of good
sanitary quality have been made from time to time and a local laboratory
was established at the plant for bacterial and chemical analyses in 1914.
In addition to the local analyses, check analyses have been made in the engi-
neering laboratories of the State Department of Public Health since June
1918. "

In the East St. Louis industrial district there are a large number of
private water supplies that obtain writer from the alluvial sand and gravel
deposits in Mississippi River bottom land known as the American Bottoms.
This water is harder than the public water supply but during warm weather
is cooler and thus better for certain purposes, such as for condensers.

Although at the close of the period covered by this history there were
quite a number of private wells still in u.se in the East St. Louis district, the
water mains are accessible to nearly all the built-up territor}-. The company
has a total of about 325 miles of mains and distributes from the East St.
Louis plant about 20-million gallons a day.

During 1926-27 a new intake and supply line was established upstream
but the old intake opposite the treatment plant is maintained for emer-
gency use.

Sewerage.

The land comprising the site of East St. Louis was low and quite flat
and land drainage was one of tlie earliest needs. The first permanent or
public sewers were installed in 1873 and since that time numerous extensions
and additions have been made, but without regard in any comprehensive
plan and with limited thought of future needs.

All of the sewers are of the combined t\pe to handle stcirm water as well
as sanitary sewage. There is one main outlet with a pumping station south-
west of the city, and several other smaller outlets discharging either directly

126 DO\V.\-STATF. MUNICIPALITIES

inid Mississippi River or indirectly to the river through Cahokia Creek,
whieh Hows through the western portion ot' the cit)' and discharges into
^Mississippi River at the western city limits.

No treatment of the city sewage has been necessary because of the
dilution afforded by the river, and because there is no water-supply intake
for a great many miles downstream. The sewage from the public and some
private and industrial sewers has caused very objectionable pollution of
Cahokia Creek and Schoenberger Creek, a tributary of Cahokia Creek, which
flows westerly through the northern portion of the city.

In 1907 the East Side Levee & Sanitary District was established, which
district includes not only East St. Louis but a large territory surrounding
the city, and was formed for land drainage and not to provide sanitary
sewerage facilities. Many projects have been planned by this district, some
of which have been carried out, others only partly carried out, and others
abandoned or not started. Politics have entered considerably into the func-
tioning of the district and has somewhat hindered the development and
carrying out of good plans based upon sound engineering and finances. The
delays and uncertainties of the district's work have hampered somewhat the
proper development of tnain sewers serving parts of the citw

A report was prepared for the district by Alvord & Burdick, consulting
engineers, giving recommendations and general plans for drainage for the
district, and in 1924 a report on sewerage was prepared by Black & Veatch
for the city. Since the city's consulting engineer's report the city has
planned some rather extensive sewerage improvements for the northern
portion of the cit}', but unfortunatelx* more or less disregarded their own
engineer's recommendations. The project thus planned by the city was un-
sound and was defeated in the courts.

IMany sewers in East St. Louis are now inadequate and relief sewers,
as well as extensions to unsewered areas, are badly needed. The city has
been advised several times by the engineering division of the State Depart-
ment of Public Health to adopt a sewerage plan looking toward the future,
such as that recommended by the city's own consulting engineers, and that
an}' relief or new sewers that are built should take into consideration the
land adjoining the city which drains to and through the city, much of which
is building up and will sooner or later be a part of the cit}-.

Health Conditions.

Writing in 1852 concerning health conditions which had prevailed in
the American Bottoms, Governor Reynolds in The Pioneer History of
Illinois, said :

"Tlie I'omitry :it that day was more siclily tlian it is at present: liut
the only disease then was the bilious fever witli tlie pleinM.sy at rare in-

EAST ST. LOUIS

127

tervals. The bilious attaclvs showed themselves mostly iu the form of
fever and ague. The fever without the ague or some chill with it was
not frequent. These diseases attacked the people In the latter part of
summer and in the fall, and were very common, but not often fatal.
The sickness at this time i.s not so common, Init more malign-:int and
dangerous.

"Many in olden times w'cre siik in the fall, Ijut few died. By im-
provements or by some otlier means the diseases of the country have
changed within the last fifty years to be much fewer in the number of
cases, but more fatal.

"The remedies to cure the bilious fever and ague in the first settle-
ment of the country were tartar-emetic, calomel and jalap and Peruvian
barks. These were the uniform and universal remedies and they gen-
erally succeeded. When the ijatient was weak after the fever, the
doctors prescribed stimulus of wine, etc."

While this autumnal disease, duubtless malaria, was so uncommonly
common among early settlers that it attracted attention there were a few
other ailments that found space for themselves upon the meagre health
records of the time either because of public alarm which their appearance
inspired or because of their extraordinary rarity. Milk sickness, smallpox
and cholera were chief among these. Governor Reynolds believed that his

Table 1.
Mortality From Certain Causes.

„

_, £.

•~

•-^

„

YE.Ul

3 £

'11

"•S

J=T3

;::

■«

-3

■§§

2 "

•^

f-w

1894

278

1895

298

1896

285

' 4

1S97

276

1!I04

nK)7

914

101

190S

831

won

777

'.'.'.

1!)10

908

1!)U

865

llll-i

S5S

1913

804

...

'is

'si

UIKi

931

110

1917

965

104

191S

1217

207

109

173

1919

874

.">

(Mi

102

1920

827

1921

753

1922

741

1923

938

'2.3

'.'.'.

1924

840

192.".

890

' i

1920

924

■'

128

DOWN-STATE MUNICII'AI.lTiES

Table 2.
Mortality Rates From Certain Causes.

YEAR

1
d

|2
P

2 "

1894
18!).-.
1890
1897

1904

1907
1908
1909
1910
1911
1912
1913

1916
1917
1918
1919
1920
1921
1922
1923
1924
192.)
1920

13.1
13.1

11.8
10.9

18.3
15.7
13.9
15.5
14.5
14.1
14.1

14.6
15.0
18.6
13.2
12.3
11.1
10.8
13.4
11.9
12.5
12.8

26 ."i
20.7
300.0

36.0

3i!i

25.2
10.8
17.9
10.4
5.9
7.3
2.9
11.4
2.8
5.0
1.3

12 . 6
7.7
3.8
2.9
4.4
2.9
2.9
1.4
1.4
1.4
...

2.4

i!2

10.0
13.0

36.0

li.-i

9.4
34.2
3.8
7.4
23.3
1.5
1.5
18.6
9.9

]8!2

i.i
14.0

S.l

1.5
4.0
1.2
2.9
2.9
4.4
2.9
1.4
5.6
2.fi
12.4

4^4

s.ii

6.3
3.1
16.4
7.4
11.9
25.0

32 .'9
9.9
1.4
5.2

Kh'.-i
37.3

13.0

.so.o

29! 4

42.3
34.2
15.3

5.9
11.9
22.0
14.5
12.9
11.3

2.8
22.1

20.0

342!3
129.8
68.6
10.3
33.4
60.2
25.5
33.2
49.0

iii

S4!6
53.8
102.7

184.3

vii'.i

173.2
161.7
139.7
98.5
91.0
76.4
85.6
70.3
90.6
103.0
73.3

202.4

22i;7
152.2
140.2
97.0
70.9
142.0
104.8
109.2
120.3

per 1,000 populatit

all others per 100,000 populatU

.sister died of milk sickness and his historical reference to the disease sug-
gests that it probably occurred with some frequency in the .\merican Bottoms
where he lived during the early nineteenth century.

Alarm and terror marked the progress of smallpox wherever it appeared
in those days so that the suffering or escape of a communit\- from that dis-
ease was deemed a matter worthy of record. Consequently we are not
surprised to find Governor Reynolds observing that Cahokia escaped an
outbreak which fell upon the community across the river in 1801. He adds,
furthermore, that the application of preventive medicine saved the folks on
the Illinois side at that time. Reading from his history we continue:

"In 1801, that dreadful scourge, the smallpox, made its aijpearnnce

in St. Louis. Many of the citizens of Cahokia, were innoculated by Dr.

A. P. Saugrain of St. Louis and were lodged in his hospital in that city.
"It never came to Cahokia so as to sweep entirely over the village.

* * * * This disease did not reach the American settlements at all. The

smallijox never raged through the country and at last was rendered

harmless l)y proiier vaccination."

In connection with this same worthy Doctor Saugrain, Zeuch adds:

"In a business notice, he announced that the first vaccine had been
brought to St. Louis and would be given gi'atuitously to indigent per-

EAST ST. LOUIS

129

sons (May 2C, 1S09). We know, from the history of a contemporaneous
writer, that he made good his word, giving vaccine not only to those
living on his side of the river, but also to the inhabitants of the Illinois
villages, during the smallpox epidemic."

Thus we discover that the first clear cut piece of preventive meiHcine
ever successfully emploxed on a community scale in Illinois and the first
free distribution of preventive biologies were the good works of an outsider,
truly a good Samaritan, whose concern for the health of others and whose
love for his fellow beings recognized no political boundary lines, knew no
religious creeds and were unhampered by economic considerations.

East .St. Louis seems to have been no less fortunate in 1833 when cholera
swept over the surrounding communities but apparently missed this little
town. This is a conjecture based upon the lack of any records, however,
rather than a clear cut statement relating the good fortune of that place. It
seems probable though that some inention of it would be found had cholera
visited the community at that time. For its escape only fate or happy cir-
cumstances of chance can be credited because no method of prevention was
known then.

Next time East St. Louis did not fare so well. Cholera swept the
country again about the iniddle of the nineteenth centur\-. spending its wrath
upon this quiet little river town leaving death and sorrow in its path. Again
in 1866 this dreaded malady visited the place alarming the people with its
disastrous progress. How large a percentage of the population was affected
nobody can say. Statistics were neither collected nor recorded. References
are vague and general. We may rest assured, however, that the havoc
wrought was bad enough.

Table 3.
Cases of Certain Diseases Reported.

1918

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

Malaria

Smallpox

537

191

398

129

'io

Measles

1S2

5.5.')

125

371

301

653

Scarlet Fever

191

213

119

340

Whoop. Cough

Diphtheria

327

222

111

173

111

135

164

Influenza

629

Poliomyelitis

Meningitis

Tuberculosis*

122

Pneumonia*

108

119

139

105

Syphilis

214

176

157

135

139

Gonorrhea

282

311

306

309

189

Chancroid

*A11 forms.
Note : Case reports
Illinois.

iiplete, bvit they have been

IJt'iO than befo

130

DOWN-STATE MUXICIPALITIES

Table 4.
PjIktiis and Infant Deaths.

Births

Infant Deaths

YEA 11

Number

Hate**

Ninnber

Kale-

1016

1192

IS. 7

174

145.9

1917

1023

15.9

167

163.2

1918

992

15 . 2

201

202.6

1919

155

1920

1374

20.4

157

114.3

1921

1364

20.0

128

93.8

1922

1296

19.9

103

79.5

1923

1358

19.5

147

108.2

1924

1457

20.6

154

105.6

1925

1434

20.4

138

94.9

1926

1471

20.3

147

99.9

per 1000 births reported.

It was the same with smallpox. The immunity established by general
vaccination in 1801 did not last forever and with the passing of immediate
danger human nature was uj) to its time honored trick of casting precaution
to the winds. Thus epidemics recurred from time to time, brought in from
first one source and then another. St. Louis was a great immigration terminal
which made it the source of constant danger. An epidemic threatened in
1881 but prompt conti-ol activities together with the fact that many inhabi-
tants had been vaccinated at the time of previous outbreaks, kept the disease
down to a dozen cases and one death.

Even as late as 1921 East St. Louis experienced one of the worst small-
pox epidemics in her history. The outbreak got beyond control before effec-
tive control measures were put into practice so that 461 ca.ses occurred.
Wholesale vaccinations rendered the city practically immune to the disease
so that it has not yet experienced any further serious difilcult\ from small-
pox.

The influenza pandemic of 1918 was decidedly the worst epidemic ex-
perience of the city during the twentieth century to date. Deaths from in-
fluenza and pneumonia combined caused the mortality rate for the year to
rise five or six points above the annual average. At the same time East St.
Louis escaped with less severe losses than many other municipalities in Illi-
nois. In ratio to the population the number of deaths from influenza and
pneumonia in 1918 ranked about midway between the highest and lowest
mortality from those causes in Illinois communities.

The infant mortality rate in East St. Louis has been persistently high.
Deaths per 1.000 live births have seldom dropped below 100 and at times
have reached twice that figure. In 1926 deaths among children less than
one year old constituted about 16 per cent of the total mortality in East St.

EAST ST. LOUIS 131

Louis, whereas in the State at large it accounted for less than 11 per cent.
Mortality among children less than five \ears old has averaged more than
20 per cent of the total mortality in the city during recent years and about
IS per cent in the State. A relatively large negro population has contributetl
materially to the high child mortality.

In other respects health conditions in East St. Louis have varied but
little from that which has prevailed elsewhere in the State. Tuberculosis
has been and remains a big problem but mortality from it has declined
materially of late. Diphtheria has come and gone in epidemic cycles common
to that disease. Scarlet fever likewise has varied in prevalence from season
to season. Infantile paralysis seems to have struck the city a trifle more
severely in 1917 than it did some other communities.

With sanitary improvements, including the public water suppl\-, the
sewage disposal system, the sanitary district, the pasteurization of milk, and
with the hygienic work done by voluntar\' agencies, the health department
and the park district, the mortality rate in East St. Louis has declined
noticeably, indicating more favorable health conditions than prevailed twenty
years ago, but the city does not enjoy facilities for combating communicable
diseases and promoting health equivalent to those active in most munici-
palities of its size.

References.

Annual Report of the Health Department of East St. Louis, East St. Louis, 1921.

.\nnual Reports of the State Board of Health, John H. Kauoh, Secretary, Springfield, Illinois,
various dates.

History of East St. Louis, East St. Louis, 1875.

Report on an Appraisal of Health Service for the vear 1925 in Fifteen niinois Cities, Isaac D.
Rawlings, Director of Public Health, Illinois Health News— May-June, 1926.

Hi^tcirv of Medical Practice in Illinois, Vol. I, 1927, Lucius H, Zeuch, Chicago.

The Pioneer History of Illinois, Belleville, 1852, Gov. John Reynolds.

U. S. Census Reports, Washington, D. C, various dates.

Elgin

l'"oun(le(l (luring the first half of the nineteenth century and located on
the Ijanks of the beautiful Fox River amid a group of splendid hills Elgin
was incorporated mi IV-hruary 28. 1854. under a special charter granted by
the legislature. W liilc ihe region is fertile enough to make it a rich agricul-
tural area, dairying predominates among rural activities while the city itself
depends largely upon industry for its economic wellbeing. Elgin shares the
municipal honors of Kane Cinmty, (ine of the most densely populated of the
State, with Aurora.

Elgin is a city of gradual development although the population more
than doubled during the decade between 1880 and 1890. It was first listed
in the United States census returns in 1870 when 5,441 people resided there.
This number had increased to 8,787 by the end of the next decade and had
jumped to 17,823 by 1890. An influx of foreign immigrants accounted for
the growth at that time, less than 40 per cent of the population in 1910 being
of native parentage. The opening of the twentieth century found Elgin with
22,433 people and the next decade witnessed a growth that brought the count
to 25,976 in 1910. The 1920 census returns show-ed the presence of 27.454
souls in the city, of whom 22.278 or about 81 per cent were native born and
5,055 or about 18 per cent, foreign born whites. There were only 116 ne-
groes in the municipality. A total of 8.224 nearly 30 per cent of the whole
population, were listed as being 45 or more years of age. This as well as a
number of other unusual features of the health history of Elgin is explained
i)y the presence in the city of a large State hospital for the insane.

H i:.\LTII ^L\CII I XERV.

On October 18. 1880, Elgin gave up its special charter and reorganized
under the Cities and Milages Act. The statute authorizing the change con-
ferred upon the municipality powers to create a board of health and to make
such local ordinances and regulations as were deemed necessary for the
l^rotection and preservation of the ])uljlic health.

Advantage of this authority was taken in 1883 when an ordinance
creating a local department of health w;is adopted. The first section of the
ordinance reads :

"Sec. 1. There is hereby established a department of health, which shall
embrace the committee on health, the city marshal, the city jihysician. a
health officer and such employees and assistants as the city council may pre-
scribe and establish: Provided, that until otherwise prescribed by the city
council the superintendent of streets shall be ex-officio the health officer of
said city."

(132)

ELGIN

133

While tliis appears to l)e the first legislative action towartl providing
the city with an ot^cial pubUc liealth organization it gives, in the section
quoted, evidence of a pre-existing agency. "The
committee" and "the cit}' phxsician" are clearly
terms imjjlying tjiat the city council had been
accustomed to exercising its powers concerning
public health through a committee from its own
membership and that a local doctor had habitually
been designated as city physician. These prac-
tices had continued over a period long enough to
establish both as familiar agencies in the city.
I~)oubtless the city physician was called upon
whenever medical services were required to

Dwight E. Burlingame, M. D. handle an emergenc\' and surely inspectors were

City Physician, 1875- ^ ^ ,,■"'. ' , u ■ -i

IcSSG. 188S P"t to work when occasion arose, each bemg paid

according to the time consumed and the charac-
ter of the cmplownent. No appropriations were made for health work but
expenditures, which the committee were authorized by the council to incur,
usually amounted to about $300 per year.

The term "a health officer" certainly indicates that no ofScial had been
so designated in the past and the council shrewdly steered clear of financial
complications by providing that the superintendent of streets should be ex-
oflicio health officer. This choice had a deeper
significance, too. It manifestly betrays the close
association in thought of environmental cleanli-
ness with preventive medicine and it indicates
how inferior the work of city health officer was
considered at that time when compared with the
practice of medicine. A doctor would have felt
and rightly so, that he was disgracing his profes-
sion, had he engaged in the sort of work expected
and required of a health officer in small com-
munities diu'ing the eighties.

If the city council had displayed mature
skilfulness in financial maneuvering when they
discovered a health officer who cost them nothing,
the newly created health department showed n
that direction when it designated, through the council, the cit\' clerk as local
registrar of vital statistics. He seems to have performed this work with an
unusual degree of care and faithfulness for the death certificates were
recorded in extension. The health department exercised an interest in the
statistics exactly commensurate with what the clerk cost it. No compila-
tions nor anah'ses were made.

Alljan L. Mann. M. D.

City Pliysician. 1889-1891;

1912 to date

insignificant ajititude in

134

DOWN-STATE M U X ICIPALITIES

The city physician was a doctor designated by the ordinance and named
by the mayor to be an integral part of the health department, which to all
intents and purposes was a board of health. His function was to perform
whatever medical duties arose in connection with public health emergencies
and give advice on medical problems that arose. He usually was elected
chairman of the health department and in that capacity had opportunity to
color the public health policies of the municipality with medical influence.
He was remunerated for actual services rendered but drew no specific salary.
Dr. D. E. Burlingame, for instance, who was chairman of the department
and city physician during the early eighties when a great epidemic wave of
smallpox swept the State, was responsible for a rigid enforcement of the
vaccination requirements of the State Board of Health and by performing
much of the vaccination work himself and by isolating and disinfecting
patients he was able to protect Elgin from serious invasion. The danger
past, Dr. Burlingame dropped the roll of public official, taking up again his
private practice of medicine and leaving the "health officer-superintendent
of streets" and the public to take care of themselves until a new emergency
appeared on the horizon.

The system prescribed by the ordinance of 1883 continued in operation
until 1907 when a new ordinance reorganizing the health department was
adopted. It provided for a health department and created the offices of
"city physician" and "health officer," fixing the
salary of the city physician at $150.00 per year
and that of the health officer at $720.00. This is
the first evidence of anything like a regular bud-
get for the health department.

J. Forrest Bell, M. D.
City Physician, 1S92-1895

Manifestly, from the lengthy ordinance made
up of 43 sections, the functions of the city phy-
sician were largely advisory in character while
those of the health officer were executive. This
is suggested by the specified rate of pay and by
the enumeration of duties as well. The adoption
of the ordinance was a mark of distinct advance,
however, for it created an independent ann of
the cit}- government for health service onl\'. This indicates a growing respect
for the possibilities of preventive medicine even though the character of the
organization created betrays only juvenile notions abmit the fundamental
principles of sanitation, hygiene and bacteriolog}'.

A few _\ ears later, I'Ul, I'Hgin adopted the commission form of gov-
ernment and this brouglu on ;i third change in the legal basis for the public
health organization of the cit\ . All powers, duties and responsibilities for-

ELGIN

135

O. L. Pelton, :\I. D.
City Physician. 1S9C-1S97

merly vested in the cit\- council, departments or
boards of health now fell upon the shoulders of
the commissioner of public health and safety.
Under him the cit\' physician and the health
officer cunlinued to be two distinct officials, the
one CI intending to be the superior health au-
thiirit\ in the communit}' by virtue of his medical
trainint; and a more ancient life of the position
while the other declared that the office of "health
officer" carried with it superior authority in all
save medical questions upon which he would re-
quest aid from the city physician if and when it
was needed or desired.

TW]> uncertain and ctinfused arrani^ement continued to feature the
official agenc}- for conducting public health work in hdgin until V>ZS. In
that year the city council pas.sed another and tinal ordinance relating to the
health department. This ordinance created a lioard of health, specifying
the maxor, the commissioner of public health and safety, the health officer,
the city physician and another resident physician as members of the board.
The board was given power among other things, to make rules and regula-
tions as it deemed wise and necessary without conflicting with State laws
and regulations. l.'nder this provision the board adopted a set of rules, one
section of which specified unequivocally that the city physician should be
the executive officer of the health department and that he should have all the
powers and authority of the board while not in session. Thus we see the
health service finally placed firml\- in the hands of the medical profession
where it belongs and still remains.

By 1927 ]-"lgin had reached the point where
adequate degree of public health service although
a considerable part of it was supplied by volun-
tar\- agencies. In the health department there
were the city physician, practically a full time
officer, a sanitary inspector, a laborator\' which
had been established in 1912 and which had lie-
cnme a \er\- useful and important part of the de-
jiartmcnt and a clerk. The city clerk was doing
the \ital statistic work.

There were four school nurses and three
iither public health nurses at work in the com-
munil\. Thniugh their efforts and the support of
the org.mizations back of them a health center
for infants, prenatal patient> and children was

she was enjoying a fairly

H. .1. Gahagan, M. D.

Citv Plivsician, 1898-1903;

1911-1912

136

DOWN-STATE M I" i\ ICIPAI.ITIES

niaiiilaiiird. 'riiese scrsiccs combined with those provided by the city proper
and li\ tlic Kanr C'nuni\ Tuberculosis Sanitarium Board gave to Elgin a
]nihlic hraltli |)r()i;rani that compares favoral)ly with those in other communi-
ties of comi)arable size in t!ie State.

The diictcir^ who have ser\ed I'd^in in the cajiacitN' of cil\' ph\sician
inchide tiie follow int; :

I). E. Biirlinsanie, M. I).,
Howard L. Pratt. M. D..
Alban L. Mann, M. D..
John F. Bell, M. D..
O. L. Felton, M. D.,
II. .1. (Jahagan. M. D.,
A. B. Sturm, M. D.,
F. C. Schurnieier. M. I).,
H. C. WatUlell, M. D..
L. W. DiKllev, M. D.,
H. J. Gahagan, M. D.,
Alban L. Mann. M. D..

A list of the la\nien whc
virtue of another job, such
appointment, include the following:
William Rundquist 1.S97-1N!)9

1.ST.5-1SN(.; and IsSN

1S87

1SS9^]891

1S92-1S95

lS9i;-1N97

ISMS iiHi:;

i:mii 190.5

I'.iim; I9II7
l!HI\- i:mi9
1910-1911
1911-1912
1912 to date

held the place of health officer, either by
s su]jerinlcndent oi streets, or li\ direct

.John W. Mink
Georse E. Allen
Adolph Fischer
A. J. Volstorff
Herman Vierke
George Reber

19(111 19111

1902-19(15 and 190.S-1909

19(l(;-19!i7 and 1910-191:1

1914-1922

1923

192:3 to date

This apparentK' strange dual system of carrying on the city's public
health work is not unique of Elgin nor is it difficult to understand, when
the background is examined somewhat closely. Until c[uite recently, about
the beginning of the twentieth century, the ac-
tivities of a health officer, according to popular
((inception as well as in practice, were limited
];irgely to abating nuisances, weed cutting, fumi-
gation, alley inspection, pest house supervision,
placarding quarantined premises and the like.
.Such menial duties were beneath the dignity of
the ancient and honorable profession of medicine.
But the introduction of bacteriology into the
world of science and the consequent potentialities
of preventing diseases by medical processes raised
the level of public health service to a plane equiva-
lent and in some respects superior to that of treat-
ing the sick. Still further developments, such as those relating to nutrition
and hygiene, have added one dignity after another to public health wdrk until
now it embraces a multitude of highly technical professions, such as bacteri-

Arthur B. Stin-m. M. D.
City Physician, 1904-1905

137

L. C. Volberdiug.
Commissioner of Public
Healtli and Safety,
1923 to date.

ologists, sanitai'N en,i;ineers, statisticians. piil)lici>ts, milk sanitarians, nurses,
dentists and doctors and offers an hnnnralile and worthy calling for am-
bitious physicians with executive al>ilit\. Indeed public health service is
now a highly technical profession of its <.>wn, in\ol\ing scientific knowledge
of wide scope.

Thus the very requirements of the service, highly technical as they are,
have eliminated untrained la\ men from executive control over reasonably
adequate health departments while the pressure
of long standing custom and the love of public
office ha\e inspired the vanishing la\- health olfi-
cer wliu in truth was a sanitary policeman to
cling tenaciously to whatever authoritv and
power he was able to reach. l-"or the sake of
political peace and expediency it has often been
necessary to beguile him with titles, leaving him
with whatever glory the term "health officer"
nia\ gi\c him, while clipiiing from his creden-
tials practically all administrative authoritv and
vesting it in medical men designated as "city
phvsician," "director of public health," "commis-
sioner of health," "executive ofticer," or some
such title.

\\".-\ti:r Supply.

In 1887 a water supplv was installed with Fo.\ River as the source,
fn 1888 a water-puritication pl;mt u>ing Jewell pressure filters was
installed. This supply continued until \\>05 when, owing to popular
adverse opinion as to the advisability of procuring water from the
river which had become gradually more and more polluted, a series of
artesian wells were installed. Four wells, 16 inches in diameter, were sunk
at depths ranging from 1,300 to 2,000 feet deep on land bordering Fox River
about two miles north of the city. The wells were interconnected by means
of a 9-foot circular shaft 120 feet deep with 9-foot circular tunnels leading
off to each well at the bottom. Water from the wells was pumped into two
circular reservoirs, each having a capacity of one million gallons. To su|)-
plement the well supply, a low dam was constructed across the river below
the waterworks plant to impound water for emergency purposes and t<<
maintain depths suitable for the intake. The old filters were used when any
water was drawn from I'V)x River.

In VU4 an addilicmiil v\ ell was sunk on the (iriginal >ile, ,uioilu-r in
l'n8, audther in l')21, another in 1022. and another in l'i2(). It has been
necessary- at various time> up to the present to supi)lenient the well water
supply from Fox River.

138 nOWX-STATK MUMCII'AI.ITIES

At the present time, four deep wells ami three shallow wells are in
service, all located in the vicinity of the pumping station, with the exception
of one shallow well which is situated in the south part of the cit> . Ki\cr
water is used only when the yield from wells becomes inadequate ainl at
such time is coagulated, filtered and chlorinated before discharge to the dis-
tributing reservoirs.

Routine analyses of pul)lic waler-sui)])l\ samples have been made since
July, 1920.

The present w^ater consumption is ab(jut 05 gallons per cajiita daily.
Cross connections in existence between the river water and well supply
necessitate classification of the water as doubtful in sanitary quality.

Sewage.

As late as 1890 privy vaults were very common, especially in the large
area of the city which was not sewered at that time.

In 1894 Samuel M. Gray, consulting engineer of Proxidence, Rhode
Island, was engaged to prepare sewerage plans for the city. The plans were
adopted and a number of sewers built in accordance with them. Subse-
quently, however, changes were made in the basis of design. Mr. Gray rec-
ommended a separate system of sewers and the early installations adhered
to this principle. Recent districts, however, have been built on the combined
plan.

I'^ox River at Elgin has been polluted for many years by sewage from
l"llgin and other neighboring cities. A few years ago the Fox River Con-
servancy District was organized and residents in the valley have been keenl\-
interested in the matter of removing pollution from the ri\er.

In 192,3 comprehensive studies were made of the sewerage needs of the
cit\ for the Sanitary District of Elgin, w^hich was organized in 1922.
Recommendations were made and plans prepared for an intercepting sewer,
pumping station, and sewage-treatment plant, comprising oil and grit cham-
bers, Imhofif tanks, sprinkling filters, sludge beds and secondary sedimenta-
tion tanks. This improvement was completed in 1926 and the sewage-treat-
ment plant placed in operation.

The Elgin Sanitary District includes 5,320 acres. The entire citv is
now well served with about 80 miles of sewers. The condition of Fox
Ri\er has been \ery materially improved since the project has been com-
pleted.

Health CoxniTioxs,

Information on the state of public health in Elgin prior to 1900 is
meagre enough. A relatively new community, heavily populated with immi-
grants not altogether homogeneous, facing economic problems at once fasci-

139

nating and defiant, tender with growing pains, the inhabitants had plenty to
do besides quietly marking down every wave of sickness tliat chanced to
befall the place. Folks had always suffered from sickness and always would
so far as they knew. Why should they spend time and effort in laboriously
recording things that everybody knew had existed since the beginning of
time and would evidently continue to the end?

At any rate people took their diseases as private affairs and tried to
combat ill health as well as they might with the resources at hand, accepting
the results of their efforts as matters of good or evil fortune. Consequently,
we know but little about what transpired in this tranquil community, so far
as health is concerned, prior to 1900. Tradition has it that Union soldiers,
home on furlough, infested the cit\- with smallpox in 1864. Citizens still
living declare that malaria plagued the inhabitants, frequently in epidemic
proportions, for }ears and did not begin to decline until 1870 or thereabouts.
Surely tuberculosis, t\'phoid fever, scarlet fever, diphtheria and the whole
family of communicable diseases shared with one another the inglorious
task of heaping hardship upon the local people but they soon forgot their
sufferings and sorrows, drowning past defeats and griefs in the success of

Table 1.
MoRT.\LiTY From Certain Causes.

VE-\R

•2

2
s

a "

■^

189.5

207

1896

312

1897

262

1898

228

1901

278

1902

219

1903

232

1904

226

1905

229

1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926

399 I

376 I

423

476

507

407

423

231

. • ■ - ■

16
1.".

13
16

17
11

17
15

...

70
19

47
44

"•2

...

4
7
10

' i

14U

DOW X-STATK -M U X I CI I'Ar.ITl KS

Table 2.
JMouTAi.iTY Rates From Certain Causes.

•A

YEAR

■?.

■a

'^ 3

e.^^

1895

13.2

14.9

19.8

79.2

9.9

1896

15.1

38.8

4.8

48.5

53.4

1897

12.4

...

7C.0

01.7

1898

10.5

23.2

18.5

13.9

1901

12.2

30.7

4.3

122.8

131.0

1902

9.4

12.9

4.3

8.0

09.1

95.0

1903

9.8

29.7

4.2

85.1

76.6

1904

9.4

10.7

120.2

41.9

190;-)

9.4

4.1

01.9

90.8

1900

1 9.4

... N

3 KecoF'^'i

1907

12.'0

8.0

4.0

8.0

'2b'.b'

192.7

72.2

1908

14.8

3.8

61.5

50.0

1909

16.3

i'.e

sis

3.8

57.0

61.5

1910

18.3

11.5

3.8

7.0

100.0

80.7

1911

19.4

19.2

3.8

23.0

05.3

1912

17.7

11.5

3.8

3]s

42.3

57.6

1913

10.1

11.4

15.2

11.4

22.' 8

174.3

58.8

1914

8.7

7.5 ...

3.7

14.8

::;

94.3

64.1

1915

8.1
7.3

Reoor

1910

89.1

3.7"

3.7

83.0

"79!2'

1917

11.5

3.5

10.7

3^5

53 . 5

07.8

1918

25.2

3.4

17.2

k'.i

241!. 3

102.0

141.3

1919

19.8

7.2

10.9

09.3

160.5

124.0

1920

21.1

3.6

'.'.'.

sio

lo'.k

3 '.a

14.5

61.7

196.1

239.7

1921

19.2

3.6

7.2

14.4

28.9

140.8

104.8

1922

20.4

sie ...

...

7.2

28.7

179.7

129.3

1923

23.3

3.5

3.0 10.5

14.2

00.7

107.8

146.4

1924

21.5

3.5

3 . C 3.5

i'.o

14.2

110.6

121 . 4

1925

24.9

7.1

3.5

24.7

s.'s

102.5

97.0

1920

22.3

5.8

'.'.'. 2.9

5.8

29.0

73.5

135.2

is per 1,000 populati.

all others per 100,000 population.

the present ami the luipL-s of the future, lea\ing for the historian nothiiii; hut
the fragmentary mortality statistics lahoriously copied by the city clerk.
These are practically worthless for one who has not the time to study and
analyze hundreds of records in great detail.

Likely enough cholera spared not the city in 1849-53. .Smallpox, which
nearly always provokes a shower of publicity, seems to have been prett\' well
averted during the great epidemic of the earl}- eighties. Evidence of other
factors in the health conditions of the community in the earl_\- }ears is ahnost
whdily lacking. From such data as are available it appears that typhoid
fe\'er was ne\er the serious iiroblem in Elgin that it has been in so many
other communities of the State, although an outbreak of 216 cases resulted
in .some 24 deaths in 1916. Diphtheri,-i, on the cither hand, has time and
again visited the place in severe epidemic foi'm. In 18'',\ for instance, there
were ](> deaths charged against that disease and ten and sixteen in the ne.xt
twd years, respectively, the wave stretching over a full triennium. Since
1900 the number of deaths has never been so high in an\ one year but out-
breaks of varying intensity ha\ e come and gone.

141

Tuberculosis became a very grave danger to public health there in the
nineteenth century but liegan to recede during the second decade of the twen-
tieth century in the face of a determined effort at eradication. During its
ascendancy mortality rates from that disease climbed to a maximum of
almost 200 per 100,000 population but the downward trend in recent }ears
brought it to 73.5 in 1926.

The only noteworthy epidemic of scarlet fever listed is one that occurred
during the winter of 1925-26. It caused nearly a thousand cases of illness
but the disease was mild and resulted in but two or three deaths altogether.
Doubtless other epidemics have visited the city from time to time since the
first settlements there but records of the facts are wanting.

The intluenza outbreak of l')18 while severe encjugh. was relativeh- verv
mild in Elgin. On!}' three other cities embraced in this volume experienced a
lower mortalit\- from influenza proper while Elgin had the lowest rate of all
from influenza and pneumonia combined.

If a stranger should scan the general mortality records of lilgin he
would surely conclude that the city is a mo.st unhealthful community. Deaths
from all causes rarely fall below 20 per 1,000 population per year, a figure
fully 75 per cent higher than that for most other municipalities in Illinois.
To one familiar with local conditions, however, these otherwise alarming
statistics indicate nothing more sinister than the location of a large State
hospital for the insane in Elgin. Patients confined in the institution experi-
ence a mortality high enough to make a distinctl}- unfavorable aspect on the
general rate for the cit\-.

Table 3.
Cases of Certain Diseases Reported.

1 3916

1917

1918

1919

1920

1921

1922

1S23

1924

1925

1926

1927

Typhoid Fever

218

Smallpox

Measles

647

300

806

405

180

1232

Scarlet Fever

•>9

307

418

Whoop. Cough

250

268

279

268

200

Diphtheria

Influenza

1399

173

314

Polioniyeliti.s

Meningitis

Tuberculosis*

5*?

Pneumonia*

125

111

123

Sy-philis

196

187

171

185

Gonorrhea

Chancroid

*A11 forms.
Note: Case reports are never complete, but they have been much more so since 1920 than before in
Illinois. This table indirntes improvement in notification more than anything else. Elgin is anion;?
the cities where notification is comparatively good, practically complete repnrt.s being the rule for
the more serious diseases.

142

DOWX-STATE MUNICIPALITIES

Table 4.
BiKTiis AM) Infant Deaths.

Infant Deaths

YEAR

Number

Kate**

Number

lial..."

1913

1914

19ir,

lillli

32:)

12.3

86.1

1917

372

13.3

91.4

1918

4«8

16.7

60.1

1919

390

13.9

nS.S

1920

472

17.1

76.3

1921

646

19.7

44.0

1922

553

19.1

43.2

1923

539

19.3

48.2

1924

621

22.1

58.0

1825

636

22.4

48.8

1926

619

18.2

71.1

•Deatiis of infants under 1
**Per 1000 population.

of age per 1000 births reported.

References.

Annuiil Reports, City of Elgin, Illinois, various dates.

Annual Reports of the State Board of Health, John H. Ranch, M. D., Secretary, Springfield, Illinois,
IS dates.
Bulletin of the Illinois State Water Survey. Edward Bartow, Director, Urbana, Illinois, various

"Elgin Today — 1904," published by Lowrie and Black, Elgin, Illinois.
U. S. Census Reports, Washington, D. C, various dates.

Evanston

Settled originall}- as a residential community and built into a uni\ crsitv
city of comfortable homes, Evanston has always enjoyed the enviable repu-
tation of being the healthiest city in Illinois. This reputation was and is not
without foundation on fact whether unqualifiedly true or not.

It seems that a man named Samuel Rohrer was the first to choose what
is now h'vanston as a place of residence. Pie left Chicago in 1839, at that
time a communit}- of only a few hundred souls, in search of a more healthful
and what he probably had in mind was more air lanes or rather bigger and
wider and better air lanes on all sides of his house. The location of Evans-
ton satisfied his requirements and he started a community that was destined
to perpetuate his ideals of home environment although there were man\-
factors other than his notions involved in the matter, his ideas probaliK'
being indeed the least influence of all.

For one thing, Chicago was by natural location destined to be the heart
of commercial and industrial life in that vicinity. This caused a centralizing
of business activities there, leaving the magnificient lake shore territory now
occupied by Evanston for other purposes. Covetous eyes of successful and
enterprising men were not slow in recognizing in this locality a splendid
place for homes, free from the noise, smoke, turmoil and excitement of a
rapidly growing city and with great possibilities for beauty and contentment.
Consequently many of the more financially able were attracted to Evanston
where the}" settled, adding a tremendous influence to the character and
wealth of the communit\-.

Another factor of tremendous influence in the character of Evanston
was the founding there of Northwestern University. This great institution,
organized in 1851 and located on a campus of 379 acres in the very heart of
Evanston, brought to the municipality the wholesome and perpetual atmos-
phere of dignity and learning. It did more. It secured from the legislature
a charter which, among other provisions, prohibited the sale of intoxicating
liquors within a radius of four miles of the university. This made Evanston
a dry town.

Furthermore, it will be seen hereafter that the municipality began very
early, relatively, to spend money freely for public health service. While
other communities contented themselves with providing boards of health
clothed with broad powers but starved to death financially, Evanston was
appropriating real money to the health department. No wonder this com-
munity was reputed to be the healthiest in the State.

(143)

144

DOWN-STATE MUNICIPALITIES

Tile Old CoUese Buildins. Northwestern rniversity

F.vanston was organized as a township in 1857 and was incorporated as
a ti)wn in 1863. The village of South Evanston was organized in 1873 and
annexed to Evanston on February 20, 1802. A month later, ]\larch 20tli.
Evanston was established as a city under the Cities and \'illages Act and tlie
first cit\- officials were duly elected on April 19th of the same \ear.

In 1860 the population of Evanston was 831. As might be expected of
a residential and universit\- conimunily, gruwtli was never rapid but substan-
tial, so that by 1900 the number of inbabitanls was only 19,25' ». This figure
rose to 24,978 in 1910 and to 37,234 in 1920. Approximately 7S per cent of
the population in 1920 were native born whites, nearly 18 per cent were for-
eii;n bcirn white> and something over 6 per cent were negroes. There were
8,714 |)ers()ns, .snniething over 23 per cent, returned as being 45 or more years
of age.

Health Maciiine.ry.

It seems ihat the first board of health was app(.)inted in Evanston in
1874, three \ears befure the first State F.oard of Health was created and at
a time when Fvanstun was still a small village. Contrarv t(j customs gen-

EVANSTON

145

erally prevailing elsewhere the whole membership
of the board was made up of physicians from the
outset. Apparently, the chairman of the board
acted as its executive officer during the first few
\ears but the ordinance was amended in 1882 so
that provision was made for the employment of a
health officer to execute the policies and plans of
the board.

It is probable that a sanitary inspector was
emplo\ed shortly after the revision of the ordi-
nance in 1882 and that he exercised the authority
of health officer, although the administrative head
of the work done was a physician, the chaiimian
of the board. At any rate John Corney was at
work as the health officer in 1883 although Dr. O. H. Mann, a member of
the board is shown in the records as filling the place of village health officer
from 1882 to 1888.

The complete list of village health officers includes the following:

Webster, M. D.
Board of Health,

1SS5

Dr. 0. H. Mann
Dr. M. C. Bragdon
Dr. W. A. Phillips
Dr. E. P. Clapp

1SS2-18SS
188S-1S90
1890-1891
1891-1892

When the village was reorganized into a city in 1892 a department of

health was created and its executive officer, subject to appointment by the

mayor, was called the commissioner of health. Dr. Clapp was retained

under the new title which has continued in use

down to the present time. The office was not

made a full time position until 1926. Physicians

who have filled the place of health commissioner

in Evanston are :

Dr. E. P. Clapp 1892-1896

Dr. W. A. Phillips 1896

Dr. Josiah Jones 1897

Dr. E. E. Shutterly 1898

Dr. A. B. Clayton 1899-1901

Dr. William R. Parkes 1901-1909

Dr. S. V. Balderston 1909-1914

Dr. C. T. Roonie 1914-192.5

Dr. John W. H. Pollard 1926 to date

Manifestl}' the medical profession has al- William G. Alexander, M.D.

ways exercised a predotninating influence over Dairy inspector, Board of

^ ^ . ^ , , • Health. 1901; Mayor,

the public health mterests in Lvanston and this igoc to date

w;.'. doubtless a factor in establ'shing the health
reputation enjoyed by the city.

146

DOWN-STATE Ml'.N ICIPAI.ITIES

The breadth of vision, the foresight and withal the broad understanding
of heahh service requirements displa\cd in the code of ordinances adopted
in 1892 were sncli ihal no materird changes have since been necessary. That
code vested a(hiiini>trati\r authority in the commissioner of health and gave
iiini power to cnfurtx- all rules, regulations, ordinances, etc., relating to
health. It rcciuired the reporting of contagious diseases by any person having
knowledge of a case; it provided for quarantine; it placed the commissioner
of health in charge of the city hospital; it gave the commissioner of health
supervision over health in the schools ; it required the vaccination of school
children; the keeping nf \ital statistics; the abatement of nuisances; the
abandonment of privies where sewer facilities were available; the adequate
ventilation of public buildings ; the sanitary supervision over milk supplies.
In short it provided the legal machinery necessary for the operation of an
efficient and adequate department of public health.

Since the adoption of the code in 1892 no significant changes have taken
place in the health organization of the city. It has simply grown and de-
veloped, increasing its staff and expanding its services as the multiplying
complexity of the community on the one hand and the knowledge of medi-
cine on the other demanded.

Of course, the official health department diil not grow in size and
ability fast enough to meet all the demands of the city for public health
service. No health department ever did. Voluntary agencies sprang up and
did an enormous volume of work. The two
school boards employ physicians, dentists and
nurses to work among the children. But with it
all a splendid policy of co-ordination h.as pre-
vailed so that the commissioner of heaUh exer-
cises the leadership and really directs the public
health service of the municipality.

The State Department of Public Ilcalcli con-
ducted a survey of the public health facilities of
I'.vanston in 1926 and compared the results of
the study with those found in 14 other communi-
ties of the State. The report gives a clear picture
of the situation as it was at the close of 1925.
Pertinent quotations read as follows :

"Reckoned on the basis of the appraised value. Evanston, with a
score of 812 points, enjoys the most satisfactory public health service
maintained in any of the fifteen cities embraced in the study.

"The best health organization was found here. Practically all work
is centralized in the city health department which engages in compre-
hensive activities relating to vital statistics; communicable disease con-
trol: ]irenntal, infant and preschool and school hygiene; safety of food

S. V. Balderston, M. D.

Commissioner of Health,

1909-1914

EVANSTOX 147

and milk supplies: sanitation; i)iirity of water supply; diagnostic lab-
oratory service. All employes are appointed by the liealth officer, sub-
ject to civil service regulations.

"The Chicago Tuberculosis Institute conducts tuberculosis clinics
and field nursing work, the nurse having her office in the health depart-
ment. The Visiting Nurse Association, in addition to bedside care,
does some prenatal and infant field work. The nurse so engaged also
has her office with the health department. A very satisfactory coordi-
nation of all social service agencies is in effect.

"This city furnishes a good example of the efficiency in health serv-
ice which can be secured through a part-time liealth officer, who has a
grasp of public health ]3roblems and who devotes his energies to develop-
ing an efficient organization. He, however, has realized that the de-
mands on the time of a health officer have become such that full-time
service Is needed, and has convinced the city government of this need.
A full-time health officer will have been appointed before this report
appears in print.

"Based on the U. S. Census Bureau estimated population of 4:3, SS3.
exactly one dollar per capita is being spent for health service in Evans-
ton. Of this, the city spends $26,SO0, or sixty-one cents per capita. If

EVAN5T0M

[^ T " T — T —

VITAL 5TATI5TICa9l
conn. DI5. COHTROL^

vEh. DI5, cohTROL :m

TUB. COMTROL i^M
HEALTH CHILD ^"-^ ^
HEALTH 5CH. CHILD [i^M
5AmTATI0riT^^J.T^5H
niLK COfSTROL []«■
LABORATORY SB
POP. HEALTH milM

PERCE MT OF STAhDARD SCORE
FOR EACH OF TEM MAJOR HEALTH ACTIVITIES

I9Z5

This graph illustrates the strong and weak points in Evanston's public
health service, official and voluntary, as it existed in 1925. It is based upon
a personal survey and rated uijon the standards evolved by the American
Public Health Association. The total efficiency rating in Evanston was 81
per cent of the standard perfection requirement.

148 DOWX-STATi; Mr.MCII'AIJTlES

local estimates of population are used the expenditures are forty-nine
and seventy cents respectively.

"Very efficient measures are carried out for the control of contagion.
A high percentage of cases are hospitalized and the communicable
disease control score equals the standard except that a communicable
disease nurse does not visit all cases: only about fifty per cent of
grade schools show a vaccination against smallpox; and immunization
of preschool children against diphtheria is not quite up to minimum
requirements for full credit on that item. It should be noted, how-
ever, that Evanston's score for the immunization of children against
diphtheria is by far the highest of any of the fifteen cities of this
group.

"Measures for the control of venereal disease constitute the most
neglected phase of health service in Evanston and stand out in striking
contrast to the efficiency of other activities. It is true that owing to the
presence of clinics in Chicago, the need here is not so great as in some
other towns. However, the few cases of venereal disease recorded indi-
cate that physicians rarely report these diseases.

"Evanston is unique among the fifteen cities surveyed in accepting
! as a health department function all activities for the promotion of

prenatal, infant and preschool hygiene. Evanston stands first in the
service rendered in prenatal, infant and preschool clinics and in field
nursing service. This is in addition to a considerable amount of work
done at similar clinics in the Evanston Hospital, a definite record of
which was not secured. Evanston has the honor of being the only city
in this group to score 100 per cent on the care given to its children
under school age.

"The administration of school health activities in Evanston is com-
plicated by the existence of two school boards, each representing approx-
imately one-half of the city. This work is carried out by two school
physicians (one in each district), who are assisted by three nurses.
The nurses perform the work of truant officers in addition to their school
work. A school dentist also is employed by the board of education. The
school work is not so well organized as most other health activities.
The two physicians do not employ uniform methods in their work or
in their record reports. Children are weighed but parents are not
notified. A total of more than five thousand out of a total grade school
population of seven thousand are examined each year, but the examina-
tion is not so thorough as is desirable. In some cases a nurse and a
school physician each inspect a child rather than have the nurse conduct
the vision, hearing, height and weight inspection, leaving the medical
examination to the physician.

"More than 95 per cent of the Evanston milk supply is pasteurized
and practically all of the remainder is certified. Since the same milk
plants supply both Chicago and Evanston, an intimate supervision of
the ijlants is not possible. A higher percentage of samples of pasteurized
milk than would be expected was shown to have a count in excess of
fifty Ihousmd bacteria per c. c.

"In addition to the health services recorded on the standard ap-
praisal form and which have been discussed above, a number of addi-

EVANSTOX

149

tional activities have been carried out. Prominent among these has
been the demonstration in active immunizations against scarlet fever
in one school. The health department secured the services ot the Doc-
tors Dick, who tested the children and immunized 155 who were found
to be susceptible. Since scarlet fever has been prevalent in Evanston,
it will he interesting to observe the case incidence among this group
of children as compared with children of same ages in other schools.

"A mental hygiene clinic is maintained at the Northwestern Uni-
versity, cases being referred to the clinic by the health department,
schools and social agencies. Group and individual mental tests have
been made in a number of the schools. In 1925, a heart clinic was
started at the Evanston Hospital, one evening clinic every week being
held. The city health officer was instrumental in bringing about its
organizations. Fort.v-nine cases attended in the month of December.
Through the social service department of the hospital, vocational read-
justments are made for the cases whose condition makes a change of
occupation advisable. The Evanston Hospital conducted a numlier of
other clinics, including dental and prenatal,

"The interest of the local medical profession, as evidenced by the
hospital clinics, has been a considerable factor In the progress of health
services in this city."

."^ince the time when the report quoted above was written Evanston has
emplo3'ed a full time commissioner of health, Dr, John W. H. Pollard, estab-
lished a venereal disease clinic and increased the efficiency of the public
health service at a number of points by co-ordination and co-operation be-
tween the various official and voluntary agencies at work there. The budget
for 1*^27 amounted to $38,6v^3.75, a respectable sum for a city of that size.

\ Oluntary and c|uasi-public organizations have played a particularly
active part in the health history of Evanston. The milk borne scarlet fever
epidemic of 1907, which spread into Chicago when the contaminated milk
sup;)ly was diverted to that market, led to the
birth of what is known as the Chicago and Sub-
urban Health League. The function of this non-
official agency is to keep health officers in the
whole metropolitan area informed about local
conditions that may prove to be inimical to the
health of any section or district in the absence of
precautionar_\- activity.

Prior to this, however, in 1906, the medical
inspection of school children was undertaken as a
privately supported enterprise although the school

Clarence T. Roome, M. D authorities heartily co-operated in the project.

Commissioner of Health. Later this work was taken over and enlarged by

1914-1925 „, III ,

the school Ijoards.

J^o

IXiVVN-HTATI. MCNK fl'Af.l'f (IS

111 I'MO the cxlicii'liliiics ()( the liciillli il(|»;iitiiiiiit aiiii)Uiil(.<l to
$.3,141 ,62, of wliich .$7fK),(K) vvr'iil to the. I'.vaDHKin :\ni\ .St, I'l-incis llospil.-il
AtiHoci.'ilidtm, $l,SO.(XJ to llic ViHitinj; Nurse A.SHOciation and ^l.SH,^) lo ilic
linanl of phiiiiliinj.; cxamincis, These ileiTis betray iidt only a close s|)itit oi
eo-opeialion lietvveeii the city oCCicials an<l the axeneies iiJmied, hut indicate
(hat the oi>{atiizatioii» were enj{a((ed in health work jiopnlarly remarried r.s
definitely jfuhlie in eharaeter. They show, fnrtherinore, that these agencies
were of lon){ st.'itiditiK in the ( iMiininnily at th,'il time and enjoyed implicit
piihlic conCideiicc.

,'\),'ain, in 1''I2 a public spirited citizen donated limds for the constriic-
lioii of a contajjion*! di.nease hoHpil;il. An endovvnicni fnnd of $l(X),fXX) was
promptly siihscrihed hy citizens in the whole stihnrli.in territory of northern
Illinois .'ind the institntion was tiM'iied over for niaii,'if,'emenl to the Isvanston
liospil.'d Assoriation, The conditions of the ori).,'in;il donation as well as
the source fi'oni which the endowment fimd vs-av dr;ivvii ni,'i<le the hospital a
distinctly pnhlic insliliiiion ami Ji ha, fiim lioncd in lh,'il way.

It was in l'M2 also tli;it the h.vanslon Woman's (Iiih nndcilook a
speciCic piece of pnhlic health service in ihi- ii;iIhic of fo.nl .aiiii,itioii.
Tmr lo (ill- hij,di (le^ree of inlellijjence that has niarkcl so iii.un of ilif
lieallh projects there the clnh first ohl.iinrd ilic
{■■^^■■^■■■■■^■l advice , and assistance of Professor lulin II
\^^^^f^ ^^^1 "'' Northwestern I'nivrsily who idcniilicd

^^^Hf ^^H self will) many irnport.ml health projects in the

V^^f- ^^M tominiinily and State, tniiicnl.'irly those involving;

^^^K' ^^^B l.il.nratory service, and . f I )i ' i Koildcr, assis-

^^^^^ ^^^M ( oiiimissionei- of ||, .ilih ( liii ajMi, in draw-

^^^VV^k^ ^^^M lip their pl-iiiH for :\u- A s.'ilisf.'icioi'y

^^^^^^^Ma^^^^^H adopted, the clnh

^^^^^^ ^^^^^^M it wa» to inspi'i I ^roi cry

'^^m^ ^B^I^H nwirkels, oilin fcvul est,'d)lish-

.lotiii W II. I'lilliiril. .VI. 1», iiicllls. 'I'o provide him with .mllMJiih an onli

('olMllllnMldllcr of llollltll, I 1 ,1 ', 1 1,1.,

Ili;!(i Id (liiie nance was passeil hy trie cily rmiiH il .iml iIlii upr

of woiiv liciamc pi'lln.'iliclit in llir coinmiimly,
■fill- iiii.ihci -■ chill-, ill iM'ial •( honis iiiiilcilooU ihc u cij^iiiiiii; and
meaMiiiii)/ of scjiool .Inlilim III I'd'' .11 the iiislinice of lln- 1 nilcd .Slates
Children's I'.nreaii and m I'' 'I iln I h/.ilirili McCoiiniiL .\l( inoii;il ImiikI
!■ l.iMi licij a nnliilioii . I.i ■ . m nnc ni ilic- pnhlic schools (Dewey). Then in
I'l.'l ilir l.vanslon I'.i.iinli of du- Inl.nil Welfare .Society .started picnal.ii
woi'l\ in the cil\, Their was alsn in I'.vanslon the (onncil ('ommillee un
.Similalion, Charities and Health, an orj;ani/.alioii repres(•nlin^,' m,niy com-
ponenl parts, which for a lon^; lime pailiripaied in a lar^e \\a\ in llie hcdili
and sanilary pi'o^M'inn of the miniicipaliu

EVANSTON 151

These references, although not exhaustive, indicate how strong the pub-
lic sentiment favors preventive medicine and they explain why Evanston has
always enjoyed the reputation of being the healthiest city in Illinois. A bona
fide reputation of that kind comes only as the result of steadfast determina-
tion that inspires intelligent and persistent activitw

Watkr Supply.

Water supply was one of the first matters discussed after Evanston was
incorporated as a village in 1872. An ordinance providing for a waterworks
was passed in 1873 and in 1875 the water supply was put in service. North-
western L'niversity donated the site for the pumping station at Lincoln Ave-
nue and the lake. The installation consisted of an intake pipe, extending
about one-half mile into Lake Michigan, wooden crib, and pumps which
delivered the water direct to the distribution system. A sewer outlet was
within one mile of the intake, but the supply was used by .some for drinking
purposes.

In 1884 the village of South Evanston installed a waterworks, securing its
supply from an artesian well. When this \illage was annexed to I'.xanston
this waterworks was abandoned.

As the population of Evanston increased, more pumps were added and
the intake was enlarged and extended.

Analyses made between 1897 and 1''12 indicated that the water was
safe for drinking purposes only a part of the time. Typhoid fever was
prevalent. At times 10 per cent of the cases in ho.spitals were typhoid
patients. The water was also turbid dining lake storms or dredging opera-
tions along the lake front.

In 1012 treatment of the water with hypochlorite of lime was started.
The sanitary quality of the water was improved but the method of applying
the hypochlorite was rallier crude and the supply was not considered safe
at all times.

Financed by a bond issue, a motlern, adequate, purification plant was
placed in service in 1914. In 1922 the purification plant was doubled so as
to have a capacity of 24-million gallons a day in order to meet the increased
consumption demands. Liquid chlorine replaced "hypo" as a sterilizing
agent in 1921.

Since the installation of the pinification plant the supply has been con-
sidered safe for drinking puri)oses at all times, and by 1922 the typhoid rate
had dropped to a small percentage of the rate before purification.

The original limited distribution system has been enlarged and extended
so that it serves practically the entire built-up area.

152 DOVVN-STATl-: MUNICIPALITIES

Sewerage.

Evansloii, like all (iIIut cities alon.y; Lake jMiclii.i;aii, originally disposed
of its sewaije 1)\ dischari^ini;- it into the lake. By 1912 there were five separ-
ate outlets to the lake, .\llhough in the Chicago Sanitary District, it was not
until 1920 that an interceptor was constructed to divert the Evanston sewage
from the lake into the north shore channel of the Sanitary District.

-\t the close of this history period the north side sewage-treatment plant
of the Chicago Sanitary District was nearing completion and it will treat all
the sewage from Evanston before it is discharged into the drainage canal.
E.xtensions of submain and lateral sewers have been made from time to time
and good sanitary conditions maintained.

HicALTn Conditions.

While vital statistics are not available for the first fift\' \ears of com-
munit\' life there, it is probable that Evanston never experienced an exces-
sively high mortality rate. Epidemics did not spare the place, to be sure,
but the general tone of health was good and the intelligent management of
home and communit\ kept it so. The general mortality rate since 1900 has
rarely amounted to as much as 12 per 1.000 population per year and was
onh' 14 in 1918, the great influenza year. More recently, the rate has tended
a little higher but that does not necessarily imply a decline in the general
health. Hospital facilities there attract people from outside the city and this
i>> liable to affect adversely the crude death rate. I'nrthermore, the city is
gettting to l:)e of respectable age, as cities go in the Middle West, and that
indicates an increasingly large number of people in the upper age strata.
Over 23 per cent of the inhabitants in 1020 were 45 or more years old.

Apparently Evanston escaped the unhappy experiences A\ith smallpox
that colored so vividly the "pest house" period in the history of so many
communities. They didn't even have a "pest house" in Evanston so far as
available evidence shows. Physicians were always at the helm in health mat-
ters and they knew a lietter way of controlling that loathsome disease than
by casting into the exile of a barren shanty the unfortunate victims of the
disorder. The people who lived there w-ere the sort who resort to calm
judgment and sound advice rather than to public alarm and mob psychology
in dealing with public problems whether of health, economy or what not.
Thus smallpox has been a minor problem there because the inhabitants so
willed it. Trior to I'.'UO the disease was so rare that a case discovered on
the last day of that _\ear provoked no little comment and brought out the
interesting fact that no other case had been observed in the city for eight
\ears.

EVANSTON

153

Siib.sequeiitly the smallpnx record has been a httle less favorable due to
the supreme court decision that compulsory vaccination is not constitutional
in Illinois. There was an outbreak involving 81 cases in 1902 and another
of 3 cases in 1908. In 1920 another little flare-up took place when 17 cases
were reported and again rarly in 1927 another epidemic was vaccinated out
of existence when half a dozen cases endangered the community. Perhaps
smallpox appeared within the city on other occasions but the story is the
same. That disease nevers gains any considerable headway in a community
where public health affairs are managed as they have been in Evanston.

Typhoid fever was not so easily managed. Ways by which this infec-
tion was communicated from one to another were mysterious even to the
medical profession and specific preventive measures were unknown until
about 1900. Consequently, outbreaks of considerable severity though not
of the serious character frequently observed in the history of many other
places have marred the happiness of the inhabitants from time to time.
Furthermore, Chicago suffered from disastrous outbreaks of typhoid fever
time and again while the infection was endemic there during the last half of
the nineteenth century and the proximit}' of that comnumity to Evanston and

Table 1.
Mortality From Certain Causes.

YE.\R

.2 ^
So

■g

a.
1

H ^

1897

200

1898

191

1899

1900

206

1901

173

1902

233

1903

212

1904

201

190.1

209

1906

216

1907

268

1908

258

' '4

1909

24.5

1910

273

1911

281

191-2

302

1913

276

.■-.

1914

304

191 r>

340

' '4

1910

369

'16

1917

38r,

1918

496

1919

385

1920

493

I 7

1921

410

! 17

1922

495

1 4

' '4

.39

1923

478

1 5

1924

476

192.-,

570

' i

' 'i

1926

623

? 1

154

DOWX-STATI-; .ML'MlIPAI.ITIKS

Table 2.
Mortality Rates From Certain Causes.

VE.vi;

1
1

as
1=

H.2

1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
IHll
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926

11.0
10.2

10.6
8.7
11.4
10.1
9.3
9.4
9.5
11.5
10.8
10.0
10.9
10.6
10.9
9.4
10.0
10.8
11.2
11.3
14.0
10.5
13.0
10.5
12.3
11.5
11.2
13.0
13.8

21.4
10.7

25.9
55.4
34.3
33.3
23.2
13.5

2i;4

33.5
28.5
24.1
27.3
22.9
14.7
10.8
3.6
3.5
3.4
3.3

7.'8

2.4

6.9
4.6

3'..^

2.3

12!5

4!6

23.4
3.8
7.4

ib'.i

3.5
6.8

2.':i

2.2

h'.h

10.0
9.5

i.'i
17.1
8.4
8.0
4.0
7.8
19.0
18.4
7.2

34!8
34.1

2 .'7

18.4
2.0
7.5
2.4
9.3
2.3
4.4

4^2
4.1
15.9
3.9
3.8
3.7

3.6

S.i
13.3

16 .".5
5.1
2.3
4.8
4.6
4.6
6.6

26.7
26.7

20! 7

24 is
14.3

9.2
22.6

8.8

leis
4.0

8.0

31.2
26.7
14.7
14.4
14.3
24.4
20.5
6.0
8.1
18.4
43.5
9.9
12.0
6.9
4.6
2.2

ih'.s

24.5

14. '3
3.5
3.4
310.0
51.3
65.7

9^9
19.2
6.9
9.1
4.4

4. '5

9.5! 4

63.7
104.8
129.9
85.9
96.8
77.4
117.4
80.1
88.0
70.1
53.3
44.3
72.1
67.8
62.7
71.7
66.6
35.1
81.5
56.4
47.2
43.4
18.6
43.2
37.7

ib'.lt
101.7

138.2
46.4
90.4
132.2
210.6
88.1
73.7
180.9
120.7
76.2
88.4
104.6
124.9
135.8
150.2
290.0
113.5
107.8
69.1
90.9
70.0
16.2
72.8
100.0

Note: The rate from .\ll Cau.se- is per 1.000 pcijulatioi

per 100,000 populati

the close social and commercial intercommunication between the two munici-
palities exposed the citizens of Evanston constantly. There was local danger
too because of inadequate sanitary sewer facilities, because the lake from
which the pulilic supply was drawn was contaminated from a sewer outlet
relatively near the water intake, because effective water sterilizing processes
were not started until 1912, because the factors involved in the sanitation of
milk were not full\' appreciated, because the public supply after it became
safe was not available to all citizens and because, withal, the public had not
learned the very close and subtle relation between sewa.sje disposal, safe water
supplies and typhoid fever.

Increasing knowledge on these points was reatlily appreciated and re-
duced to practical application, however, so that typhoid began to dwindle as
soon as preventive measures could be made operative. The year 1901 seems
to have been the worst typhoid year in the whole history of the municipality.
Eleven deaths occurred, giving a mortality rate of about 55 per 1(X),000
inhabitants. This was about twice the rate for Chicago in that year but there
is no data available to show^ the source of the outbreak. It might have been

EVANSTON ■ 155

from the public water supply. The population at the time was a bit short
of 20,000 and 11 deaths from t\phoid fever suggest an epidemic of more
than 100 cases, a rather severe experience.

Subsequently, energetic measures toward vv'ater purification, sanitary
sewage disposal and sanitary supervision over milk supplies began to result
in perceptible declines in the annual typhoid fever rates but no marked de-
creases occurred until 1912 when the practice of treating the public water
supply with hypochlorite of lime was .started. After the modern purification
plant was put into commission in 1914 typhoid became a negligible factor
in the health problems of the community. The city profited also, in regard
to danger from tvphoid, from the general practice of pasteurization of milk
which became generally effective in Chicago in 1914 and by its own vigorous
efforts to safeguard milk sold in the city (much of Evanston's milk is handled
by Chicago dealers). Evanston had prexifuisly suffered from a few milk
borne outbreaks, particularly in 1912 when twenty cases were traced to a
single dairy.

Another flare-up of typhoid started in 1923 and stretched out over three
years, confining itself however to the late autumn or winter months. This
caused no little public concern because most cases were among the best
families and because the source of infection appeared at first to be quite
bafifling. Careful epidemiological studies finally incriminated raw oysters
as the offending agent, however, and after considerable agitation which
ultimately involved the whole oyster industry of the United States and the
local. State and federal health agencies — because outbreaks traced to the
same source occurred elsewhere — the disease abated in Evanston and has
continued to be a health problem of minimum >ignificance in the city.

Diphtheria was another of the gra\e problems that presented itself for
perennial solution and its savage assaults on the child life made it a subject
of very active consideration from time to time. Epidemic waves carrying
off from one to five children came and went with the seasons, sometimes
confined to a handful of cases and again reaching alarming proportions.
Experiences prior to 1900 were much the same as those elsewhere. Until
the last few years before that date antitoxin was unknown so that quaran-
tine was the only control measure applicable in a public way and this all
too frequently was not utilized with the promptness antl uncompromising
rigidness necessary for maximum benefits.

After 1900 the increasingly general use of antitoxin caused a marked
decline in the ratio of deaths to cases but that had little effect upon the
number of cases, which sometimes grew to alarming proportions. They
varied, of course, from year to year but 1921 seems to have been the worst
in the history of the city. In that year 178 cases and 17 deaths were re-
ported. That gave a mortality rate of about 43 per lOO.OOO population.

156 I)0\V\-STATE MCNICIPAI.ITIKS

OlluT years since I'HKl wlieii the rale has soared alxne 20 per 1(K).000 are
1902. l''»05, l'»ll, 1012, 1016 an.l l'il7.

Since r'21 llie possihilit} nf prexentini; diphlheria b_\- the immunization
of children with toxin-antitoxin has come into popular favor and Evanston
demonstrated her historic attitude of a will to be well by taking advantage
of this opportunit\- on a large scale. Although there is in Evanston a con-
siderable element who are opposed to the specific methods of prevention ad-
vocated by the orthodox medical and public health professions, still the gen-
eral ])ublic follows the lead of these scientific proponents and the result seems
to justifx' their faith. The total number of cases of diphtheria reported in
Evanston during the five years ended with 1927 is less than tliat for the one
year of 1021.

The history of scarlet fever in Plvanston has been consiilerably different
from that of diphtheria because the milk supply has been involved in the
spread of the former. On at least three occasions, in 1906, 1907 and 1908,
rather conclusive evidence was secured pointing toward specific milk sup-
plies as the source of outbreaks. The epidemic of 1907 was the worst of
the three and the wor.st that the city ever experienced. There were 279
cases reported and the city had less than 25,000 people at that time. Dr.
H. B. Hemenway made a careful epidemiological study of the outbreak and
concluded that the source was a contaminated milk supply. The fact that
the epidemic promptly subsided when the sale of milk from that supply was
cut off and the further fact that a severe outbreak occurred shortly after
in Chicago among families who l)ought the milk that had been diverted from
the l-lxanston market, \erihed the conclusions of Dr. Hemenwax' in the
matter.

In 1''25 there was another wave of scarlet fever that caused 260 cases
of illness but at that time the population of the city was estimated at 43,833 .
so that the ratio of prevalence was far less than in 1907. True to the spirit
of keeping abreast of the times arrangements were made to promote the
use of scarlet fever toxin as an immunizing agent against the disease. This
procedure is very new, having been announced by the discoverers. Doctors
George F. and Gladys H. Dick, in 1923. The Dicks themselves were secured
to test the children in an Evanston school and to immunize the susceptibles,
a task which was completed in 1925. Results of the demonstration are not
a\ail;ible for use here.

Other than the points mentioned there has been nothing unusual about
the scarlet lexer history of Evanston. The disease appears to have grown
milder there as it has elsewhere in the country although the incidence has
declined but little.

Tuberculosis is a disease particul.niy sensitive to errors in the habits of
living and accordinglv we should exi)ect to find relativelv little of it in

EVAXSTON 157

Evaiiston where the public has manifested such a keen and intelligent in-
terest in health matters. That is exactly the case. Since 1908 the annual
mortalit}- rate from that disease has always been less than 100 per 100,000
population, with a persistent downward trend that reached the point of i7 7
in 1926. That is an unusually low rate, less than one-half of that which
prevails in Chicago and scarcely more than one-half the rate for the State
at large.

Before 1909 the mortalitx' rate sometimes grew to a figure in the neigh-
borhood of 150 but those were the days before the anti-tuberculosis move-
ment with its modern effectiveness was well under w'ay. Even so the people
in Evanston were alive to the importance of tuberculosis and were busy at
whatever measures gave reasonable hope of prevention and control. Were
not three herds of cattle in the vicinity tuberculin tested in 1900?

The bulk of the anti-tuberculosis work has been done by vokmtary
agencies, principally the Chicago Tuberculosis Institute. Splendid response
from individuals and the public to control and preventive measures made
possible the enviable progress that has marked the trend of the local cam-
paign against tuberculosis.

Influenza struck Evanston a rather severe blow in 1918 although the
mortality rate from that infection and pneumonia was not so great as in
many other places. Ninety-three deaths were attributed to influenza that
year and 87 to pneumonia, giving mortality rates of 310 and 290 per 100,000
respectively. This was disastrous enough but 12 other cities embraced in
this volume suffered worse from influenza. The combined rate from influ-
enza and pneumonia was greater in 11 other cities. Rut even with this un-
happy experience the general mortality rate was only 14 per 1,000 population
compared with 18 and 20 in man}" of the other municipalities.

It W'ould hardly do justice to the health histor}- of Evanston to close
the account without reference to the infant mortality rate. This, like the
tuberculosis mortality rate is a sensitive index to the efficienc\' of public
health service. Evanston has for a long time enjoved one of the lowest bona
fide infant mortality rates in the State. The average number of deaths
among children less than one year of age was 50.4 per 1,000 live births
reported during the seven years ended with 1926. During the same period
the average annual rate in the State at large was more than 75. The favor-
able showing in Evanston is doubtless the result of the splendid infant and
child hygiene and the prenatal service that has so admirably supplemented
the general sanitary and health program of the ctiy.

No community in the State has gone at its health problems more earn-
estly nor more intelligently than has Evanston and none has reaped more
enviable rewards of efforts in the shape of favorable health conditions and
low mortality rates.

158

DOW X-ST ATE il U N ICIPALITIES

Table 3.
Cases of Certain Diseases Reported.

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

318

228

1206

141

1169

108

410

329

17S

150

174

111

181

260

142

110

Whoop. Cough

120

487

250

204

425

162

217

137

178

Influenza

2878

124

574

Polionivelitis

Meningitis

•t

104

119

Sypliilis

125

Gonorrhea

•All forms.
Note: Case reports are never complete, but they have been much more so since 1920 than before
Illinois. Notification in Evanston now is as nearly complete as in any city of the country.

Table 4.
Births and Infant Deaths.

Ml A It

Number

Rate**

Number

Rate*

1910

1911

1912

1913

1914

1915

1910

1917

1918

1919

1920

960

25.4

63.5

1136

29.0

1922

1203

29.5

51.5

1923

1313

31.7

45.7

14S1

34.7

43.2

1925

1528

34.8

43.2

1920

1724

38.2

51.6

"Deatlis of infants under 1
•Per 1000 population.

of age per 1000 births reported.

References.

Data supplied by Dr. John W. H. Pollard, Health Commissioner of Evanston.

Data by Oity Clerk's oflBee, City of Evanston.

Annual Reports of the City of Evanston.

Laws and ordinances of the City of Evanston, 1902 and 1904, Evanston, Illinois.

History of Cook County, Andrews, J. I., Chicago, 1884.

Health Survey of Fifteen Illinois Cities in 1925. Rawlings, Isaac D., Director of Public Health,
State of Illinois. Health News, May-.Iune, 1926. , , , „ , , „ , .

Annual Reports of State Board of Health, vols. 1-9, Ranch, John H.. Secretary state Board of
Uealth.

,\nnals of Health and Sanitation in Chicago, Koehler, G., Chicago, 1919.

V. S. Census Reports, varioiis dates.

Freeport

The cit\ of Freeport is located in Stephenson Count}-, about 15 miles
from the northern boundary of the State and is about 113 miles west from
Chicago. It is served by three railway trunk lines and one interurban sys-
tem, namely, the Illinois Central, Chicago, Milwaukee and St. Paul and
Chicago and Northwestern railways and the Rockford and Interurban elec-
tric line.

The cit\' is located on the Pecatonica River, which forms a part of the
north and east boundaries. The greater part of the city is so located that
good natural drainage is afforded. There are certain sections, however, espe-
cially the northeast, which become flooded during high water. The greatest
known flood in the history of the Pecatonica River occurred in March, 1916.
The river frequently spreads out over a whole valley north and east of the
city limits during flood period, and there is considerable property damage
in that part of the city located on the east side of the river due to a silting
up of the channel.

The rich alknial soil of the bottom lands and the good rail facilities
encourage extensive farming and grazing, devoted largely to the raising of
cattle and the production of dairy products.

The city occupies an area of 4.2 square miles, the highest elevation
being 873.5 feet above sea level and the lowest 743.5. It has a total of 10.7
miles of alleys and 70 miles of street. There are six parks, four of medium
size, comprising an area of about two acres each, and two large parks, one
covering an area of 90 acres and the other 75 acres. Aside from these there
are six small flower parks of about one-quarter acre each. The city has a
park board operating under special State law, which has control over all
the "breathing spaces."

Freeport is an industrial community. Here one of the large shops of
the Illinois Central Railway is located while thirty-odd manufacturing con-
cerns maintain plants in the city. Hardware, engines, toys, furniture and
medicinal products are the chief items made in the factories.

In 1920 the population of Freeport was 19,669, a figure to which the
number of inhabitants had grown from 17,567 in 1910 and 13,258 in 1900.
The 1890 census returns showed a population of 10,189. Of the 1920 popu-
lation 5,410, or nearly 28 per cent, were listed as being 45 years or more of
age. Native whites predoniinatcnl with a jiercentage of 87.7, the remainder

(159)

160

DOWN-STATE .MUNITIPALITIES

being divided between foreign born whites and
negroes with percentages of 10.6 and 1.7 respec-
tivel\. Tile character of the population had
changed hut httle during the decade that pre-
ceded.

Health jMacuinery.

The orilinance creating the first otlicial

health organization in Freeport was adopted in

1893. It provided for a board of health under

which a health officer performed the executive

duties ascribed to him. From the very outset a

physician has always filled the position of health

officer. Under the first board of health ordinance

the health officers who served Freeport included the following, the dates

indicating \ear of original appointment from which time each continued in

office until the next one Hsted :

E. H. Best, M. D. 1S93-1S95

J. A. Poling, M. D. 1S95-1899

E. E. Burwell, M. D. 1899-1901
T. .T. Holke. M. D. 1901-1903

R. ,J. Burns, M. D. 1903-1909

Robert J. Burns, M. D.

Commissioner of Healtli,

1903-1909; 1923 to date

E. H. Best, M. D.
J. A. Poling, M. D.
E. E. Burwell. M. D.
E. J. Torey, M. D.

1909-1911
1911-1913
1913-1915
1915-1917

In 1917 the original board of health system was abandoned when a
new orcHnance, creating a department of public health with a commissioner
at its head and administered through a committee of the cit}- council, was
adopted. Under this plan the mayor appoints, every two \ears, a commit-
tee of three aldermen and a health officer or commissioner of health who,
with himself, make up the official health organization of the city. The com-
missioner of health is the executive officer.

The ordinance of 1917 requires that the cit\ health commissioner shall
be a legally qualified physician possessed of the requisite knowledge of sani-
tary science. It specifies as a duty of the health commissioner that he shall
assist and advise the health committee in all matters pertaining to public
health and clothes him with the power and responsibilit\' of general super-
vision over the health conditions of the community. The ordinance is suffi-
ciently broad in its terms to provide ample legal authorit}' for initiating and
carrying out every reasonable activity calculated to benefit the public health.

I'nder the ordinance of 1917, which still constitutes the legal basis for
the official health activities in Freeport, three physicians have served as health
commissioner. With the date of appointment they are :
E. H. Best, M. D. 1917-1919

.1. A. Poling, M. D. 1919-1923

U. .1. Burns, M. D. 1923 to date

FREEPORT

161

Besides the commissioner of health the city hcahh department emplo_\s
a sanitary inspector.

\'oluntary agencies and such public organizations as the local school
and count}- tuberculosis boards have done more active public health work
in Freeport than the city government. This is not uncommon aniung muni-
cipalities.

In 1915 the board of education employed a nurse to do health work
among the school children of the city and that service has continued. At
about the same time, through the cooperation of the Stephenson County
Dental Societ\', tlie board of education established a dental clinic in the
schools where necessary dental work is done gratuitously fur indigent
children.

The Stephenson County Tuberculosis Board employs two nurses who
spend a part of their time in Freeport. Their attention is devoted entirely
to problems relating to tuberculosis and their efforts are directed i)riniarily
toward preventing that disease.

The Amity Society, oldest of Freeport's charitalile organizations, dating
back to the seventies, is responsible for the largest volume of active public
health work accomplished in the city. With an annual budget of about
$4,000 this society has carried on practically all of the infant and child
welfare work, other than that in the schools, which has been undertaken.
It first became active in this field in 1917 when the Children's Bureau of
the U. S. Department of Labor stimulated interest in a child health program.
Later the Amity Society became affiliated with the American Child Health
Association and has operated a child welfare station for many years. It
has sponsored a crippled children's clinic, provided by the Rotarians, and
has been responsible for much of the success of this clinic to which crippled
children have come from a large surrounding area.

\V..\TER .Supply.

A waterworks was first installed in 1882 when a thirty-year franchise
was granted the Freeport Water Company. In 1912 the franchise was re-
newed but with some important alterations in the terms of the ordinance.

In supplying the city with water the founders of the company first
planned to develop a spring which issued from a bluff near the river on the
north edge of town. A large pit was excavated and the flow from this
spring was conveyed to this pit through a drain tile. Beside the pit was
buill ;i pumping station which still forms a part of the present waterworks
plant.

It soon fjecame ap]5arent, however, that the spring suppl_\- was altogether
inadequate to meet the demands and for a period of three or four years it
was supplemented by water drawn direct from Pecatonica Ri\er.

162 DOWN-STATE MUXICIl'AI.ITIES

Next a small well was bored at the plant and it was found that the
water rose and overflowed at the ground surface. This encouraged the
sinking of several more wells. The static head receded, however, in a short
time and it became necessary to pump the wells. These wells then became
the main source of su|>])ly. In 1890 the old river intake was discontinued
and the old pit filled up.

In 1893 there were 14 wells in service, all confined to an area of one-
fourth of an acre lying just north of the pumping station.

Between 1893 and 1915, 11 drift wells and 2 wells entering St. Peter
sandstone were added to the system. These additions extended westward a
distance of about 300 feet.

For a number of years the drift water was satisfactory and then diffi-
culties began to arise due to iron and growths of crenothrix in the wells
and pipe lines. In 1900 an effort was made to eliminate this trouble by
seeking a new supply from St. Peter sandstone. One well was drilled and
is said to have furnished good water until it also began to contribute iron.

Experiments were then begun to discover a means of overcoming the
difficulty by treating the water. Aeration alone proved inadequate while
treatment with lime resulted in the precipitation of the iron.

In 1903 the company added to its equipment a purification plant of
2,000,000 gallons per day capacity, consisting of a means for treating with
lime, two sedimentation tanks, four gravity filters, clear-water well, and
low-lift pumping machinery. In the same year new high-service equipment
was installed.

In 1910 an appraisal of the company properties was made and nego-
tiations undertaken looking toward renewal of the franchi.se in 1912. The
city and company could not agree on the original appraisal and a commis-
sion was appointed which made a new appraisal and submitted a report
including recommendations for extensive improvements.

B\- 1915 most of the recommendations of the committee had been carried
out. In 1915 a second well was drilled to St. Peter sandstone but was not
equipped for the reason that the metering of the city so reduced the water
consumption that additional water was unnecessarw The capacity of the
filter plant was doubled, an additional clear-water basin was built and new
low-lift equipment, coal bunkers and new service mains were installed. The
cost of these improvements was approximately $215,000.

In 1915 the water consumption was about 1.6 million gallons per day.
The distribution system comprised about 54 miles of service mains.

In 1917, 25 drift wells and 2 wells into St. Peter sandstone were in use.

In 1920 there was a threatened shortage of water and in changing pump
connections so as to connect with the deep wells, a mistake was made which
permitted raw river water to enter the system for several hours.

FREEPORT 163

In 1921 a new well entering St. Peter sandstone was constructed. Dur-
ing this year also, attention of local officials was directed to numerous indus-
trial cross connections between polluted river and the cit\- well-water supply.

In 1922 to safeguard the water supply a chlorinator was installed. To
date, however, it has been impossible to secure the removal of dangerous
cross connections which are in existence.

The pi'esent suppi}- comprises 25 shallow drift wells and 3 deep wells.
The waterworks comprises a purification works and pumping equipment.
The present water consumption is about 1.85 million gallons per day.

Due to dangerous cross connections, the water is regarded as of doubt-
ful sanitary quality.

Sewerage.

The city is served by a system of separate sewers with 8 sanitary and
storm outlets to the river ranging from 12 to 144 inches in diameter.

Health Conditions.

Only present day health conditions in I'reeport can be appraised on the
basis of statistical evidence. Reliable records date back to 1907 only. Since
that time the general mortality rate has fluctuated between 14 and 20 per
1,000 inhabitants. These figures are higher than the rates for the State
generally and for some of the other municipalities. This results partly, at
least, from the character of the age distribution in Freeport. Nearly 28 per
cent of the population in 1920 were above 45 years of age. That suggests
a considerable number of individuals in the upper age strata. At any rate
the group constitutes a much larger share of the whole population than in
the State at large and in a number of other places.

Infant mortality and the death rate from tuberculosis are usually re-
garded as sensitive indices to general health conditions. Since 1920 the
infant mortality in Freeport has fluctuated between 50 and 80 per 1,000 live
births reported with an average of 65.2. This is what may be termed a
moderately low rate. In a few cities the infant mortality is much higher, in
a few it is much lower. The average for the State during the same year
was 73.0.

Mortality from tuberculosis has consistently declined in recent \ears,
reaching the unusually low point of 28.8 per 100,000 population in 1926.
Most of the decline has taken place since 1918 when 24 deaths gave a rate of
120. Prior to that time the number of deaths seldom fell below 18 per year,
yielding rates above 100.

In Dixon and Freeport rather aggravating situations developed in 1922
when activity on the part of anti-vaccinationists delayed the establishment
and carrying out of control measures in the face of a threatened epidemic

164

DOWX-STATl-: MUXICIPALTTIES

Table 1.

IMOKTALITY I'KOM CeKTAIN CaUSES.

«:

YEAR

■£

■5 1

£.

a 1 CO

™

—

E-w

1907

248

...

1908

228

1909

234

. . .

1910

246

1911

260

.'.'

•i

1912

285

1913

274

' -i

1914

1915

1916

296

'23

1917

1918

366

' i

'24

'36

1919

296

1920

399

1921

308

1922

302

... 1

1 1 ...

1923

330

1 1 1

1924

311

... ...

192:>

308

... f ...

192fi

359

...

4 j ...

Table 2.
Mortality Rates From Certain Causes.

<«

YEAR

fa
3

•j^

j::

U.S

H -

1907

15.2

49.1

12.2

24.5

141.3

116.7

1908

14.5

1909

13.8

. . '.

1910

14.0

1911

14.0

4.5! 6

5.6

ii.2

123 .'7

1912

15.8

17.0

100.0

1913

15.0

10.9

16.' 9

16.9

27! 4

120.8

1914

10.8

■ \

103.2

1915

10.7

2i!4

85,9

1916

15.' 7

10.6

.5.3

26'5

95.6

122.' 1

1917

'.'.'.

1918

is'. 9

il.i)

5.0

9.9

260.6

126!6

150.6

1919

15.1

16.2

15.3

91. S

107.1

45.9

1920

20.2

25.0

200.0

79.9

129.9

1921

15.4

soli

,'.b

10.0

s'.o

15.0

70.1

95.3

1922

IS.O

h'.i)

14.9

9.9

84.4

89.4

1923

16.2

4.9

39.4

54.1

123.1

1924

15.2

4.'8

4.8

58 . 5

63.4

1925

14.9

24.1

19.3

iis

72.5

72.4

1926

17.2

...

19!]

19.' i

28.8

110.0

The rate fio

1.000 pipuliition ; all others per 100,000 populatic

(if sniallpiix. .\t Di.xdii the differriicc Ix'twet-n local adherents to the con-
stituted authorities and tn the Medical Lihert\- League terminated in court
action, and the same thin.sj; was threatened in I'reeport, althoutjjh the final
outcome at each point resulted in the ,s,reneral \accination or quarantine of

FRF.KPORT

165

all umacciiiateil contacts with active cases and the outlireaks were stamped
out with less than 100 cases at each point.

The influenza epidemic of 1918 was not severe in Freeport, relatively
speakin.t;-. The death rate of 2()() per 100,000 was moderate. Pneumonia
was also relatively light that year, the rate of 150 being much lower than
for many municipalities.

Table 3.
Casf..s of Cfrtain Diseases Reported.

1!119

1020

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

•2

Smallpox

103

4!1

4(i

Me.isle.s

207

572

f)7

112

573

Scarlet Fever

4."i

119

Whoop. Cough

IfiO

Diphtheria

1.")

12.-.

123

Intlueriza

124

34S

Poliomyelitis

Meningitis

Tuberculosis*

2.}

.56

3.5

Svphilis

Gonorrhea

(iO

*A11 forms.
Note: Case reports are never complete, but they have been nuicli i
Illinois. This table indicates that notification of more diseases
there is still room for improvement in the completeness of returns

Table 4.
Births and Infant Deaths.

YE.Ul

Number

Rate**

Niunber

Rate*

1916

407

81.0

1917

1918

1919

1920

427

21.5

77.3

1921

483

24.0

.51.8

1922

423

20.7

78.0

1923

453

22 ..^

66 . 2

1924

506

24.7

49.4

1925

487

23.5

53 . 4

1926

485

23.2

80.4

per 1000 births reported.

References.

Dr. Robert .1. Burns, Conunissioner of Health, personal coinnmnicatii

niinois Health News, Ma.v 1918, Paul L. Skoog.

Freeport Municipal Records, various dates.

Freeport Chamber of Commerce. A Survey of Freeport, Illinois, 1925.

U. S. Census Reports, Washington, D. C. various dates.

Qalesburg

Galesburg, the county seat of Knox County, is located near the divide
between the basin of Henderson River, a tributary of the Mississippi, and
that of the Spoon River, a tributary of the Illinois, in the west central portion
of the county. The city occupies high level ground on the divide between
the two drainage basins.

Cedar Creek, a branch of Henderson River, flows westerly through the
city, receiving practically all of the drainage with the exception of a portion
from the southwestern part, which enters Court Creek, a tributary of the
Spoon River.

The soil consists of a glacial drift, varying in depth from 30 feet in
the uplands, to as much as 120 feet in the valley of Cedar Creek. This
drift contains water-bearing strata, which }-ield large quantities of water.
The underlying rocks lie deep and are generally limestone with some soft
sandstone. Bituminous coal is mined in the vicinity. There are no ponds,
lakes or marshes in the city or within a radius of five miles.

Settlement of Galesburg began in 1837 and the communit\' was incor-
porated as a city in 1S41. It was reorganized under the general law of 1872
in 1876.

The population was 882 in 1850. In the following decade there was a
marked growth of the city, the population reaching 4,953 in 1860. In the
next ten years the population doubled, the inhabitants numbering 10,158 in
1870. The end of another decade found 11,437 people there and this number
had grown to 23,834 by 1920. Of this number 20,054 or 84.1 per cent were
native born whites, 2,925 or 12.3 per cent were foreign born whites and 843
or 3.6 per cent were negroes. There were 6.749 or 28.3 per cent over 45
years of age.

H i: A LT H M A C H I N ER Y.

Health service in Galesburg is now provided
vuider an ordinance, adopted in 1915, that divides
responsibility between a commissioner of health
and a board of health. Conflict of purpose and
action between the two is avoided by making the
commissioner of health a member of the board
and by limiting to $25.00 any item of expenditure
incurred by the health commissioner without the
approval of the board.

E. D. Wing. M. D.
Health Commissioner,

191S to date

(166)

GALESBURG 167

Lnck-r the lioarcl there is an executive officer, a layman, known as the
health officer. In matters not medical, he has authority equivalent to that
vested in the health commissioner, who is a physician. The ordinance speci-
fies that the city council may from time to time prescribe the duties of the
board of health but the duties of the health commissioner are set forth in
the ordinance. There is, furthermore, another city officer known as the city
physician. His duties are not public in character but relate to the medical
care of indigent sick who find themselves as city charges. The first four
sections of the ordinance read :

"Settion 1. The board of health shall consist of the nuiyor. commissioner
of health, chief of police, poormaster and city physician. The city clerk shall
be clerk of the board.

"Section 2, The mayor shall he ex-officio the president of the board of
health.

"Section .''.. The city council may from time to time prescribe the duties
of said board of health.

"Section 4. Said commissioner of health shall have and exercise a general
supervision over the sanitary condition of the city, shall give to the mayor
and other city authorities all such professional advice and information as they
may require concerning the health of the city and the preservation thereof,
enforce all the laws of this state and ordinances of the city relating to health,
and promptly abate all nuisances which may in any manner endanger the
health of the city."

The other fifteen sections enumerate various duties, responsibihties and
powers of the health commissioner and the board of health.

This system is the cuhnination of a long experience in official health
activities that began when the city was \oung. The Cities and Villages Act
under which Galesburg was reorganized in 1876, provided for a board of
health and the city took advantage of that provision. Prior to that lime a
board or committee of health met the emergencies that faced the nnmici-
pality from time tn time.

During the earlier years there was no regularity' in activities directed
toward the control and prevention of disease and consequently there was no
permanenc}- in the executive office of the board or committee of health.
After 1876, it was the practice to appoint a physician as health officer. Dr.
George W. Foote filled the office in 1881 and was succeeded by Dr. James
E. Cowan, in 1884. Then Dr. D. W. Aldrich was appointed health olficer
in 1885.

Later it became the practice to let a non-medical person fill the office of
health oflicer and Uiis has continued. Medical direction of health service
was maintained, however, through the creation of a new office known as
health commissioner.

Recent incumbents have been _b>hn 1). Bartlett, M. D., 1914; F. G. Hall,
Al. 1),, l'H5-1018; F. D. Wing. M." D. 1918, to date.

168 nOWX-STATK MUNICII'ALITIES

Voluntary agencies have done and are still doing a great deal of work in
Galesburg. There are six public health nurses, supported by various organi-
zations at work in the city and county. Among other things, the agencies
which support the nurses participate in infant and maternity hygiene service,
do work among the school children and maintain, through the co-operation of
the Illinois Crippled Children's Societ\. a clinic for crippled children.

W'.ATKR .Sltply.

In the seventies a public water supply was provided. This was derived
f re nil wells and cisterns. One well was located in George W. Rrown's works
and the cither at the Frost factory. These were drift wells about 12 feet in
diameter.

Two reservoirs were maintained for storage purposes, one on Seminary
Street witJi a capacity of 1,100 barrels, the other on West Street, holding
1,500 barrels.

Besides these reservoirs for well water, there were twenty large cisterns
for the storage of rain water.

In 1878 water pipes were laid only in the central part of the cit\'.

A water supply obtained from artesian wells was established in 1887,
supplemented hv drift wells.

In 1890, after a private company, which received a franchise to supply
water, had its contract revoked on account of failure to meet its obligations,
the city took over the waterworks. The supply was derived from a series of
driven wells about 80 feet deep, in a line parallel to Cedar Fork at the present
site of the waterworks. These wells were connected to a common suction
pipe from steam pumps. The methnd of pumping was unsatisfactory and
two wells, 1,226 feet deep pumped with air, were installed. Later several
wells about 70 feet deep were addeil.

In 1''12 two deep wells and six shallow wells were in service. Water
was deliveretl from the wells into a collecting cistern from whence it was
pumped into a storage reservoir. Just prior to l')12 a large service pump to
pump water from the storage reserxoir directly into the mains, was installed.

In 1914 a \'enturi meter on the discharge of the high-service pump was
installed. .\t this time three deep wells penetrating St. Peter sandstone and
four drift wells were in service. During this year, a shallow drift well of
large diameter with a special straining device to eliminate troubles due to
fine sand was sunk to replace three of the old drift wells. The consumption
in 1914 was about 30 gallons per capita daily.

The (juestion of an adequate supply had at times been the cause of
anxiet}' and prior to 1915 studies had been made relative to increasing the
supply by developing of either a surface-water supply or de\elopment of an
isolated deep-well system.

GALESBURG 169

Due to the continued inadequacy of the supply, private shallow dug
wells and cisterns, open to contamination, were maintained for many years.
In l'U5. following an epidemic of typhoid fever, investigations cast suspicion
upon the pulilic water su])pl\' and the supph" was given hxpochlorite treat-
ment fur a time.

In V>1? a new deep well was started at the pumping station, but due to
dela\s and breakdowns the well was not yet completed in 1919. In 1916 and
I'll/ four more shallow wells were added to those already in existence. In
l'*17 a new deep well {\.IS2 feet' deep) was constructed just back of the
city hall. In l''l'i another deep well in the southeastern part of the city was
Constructed, and placed in service.

In 1''22 the supply comprised three wells entering St. Peter sandstone
and one well entering Potsdam sandstone located near the waterworks station
and two wells entering .^t. Peter sandstone located near the city hall and in
the southeast part of the city, respectively. The Potsdam well, which was
started in 1''1,t and not completed until late in l'U9, was the only well nor-
mally pumped in 1922.

The present supply comprises the four wells in service in 1922. The
supjily is still subject to contamination at the open reservoir and its sanitary
c|ualily is regarded as doulitful.

In l'*19 there were 41 miles of service mains and .\.^(_K) services. The
present water consumption is 65.7 gallons per capita.

Seweragk.

The major portion of the city has natural drainage toward Cedar Creek,
which flows in a .southwesterly direction through the central portion of the
city. The southeast part of the cit\- drains to Court Creek, which flows
easterly and discharges into Spoon River.

The first public sewer system was installed in 1870. This was on the
combined plan and served part of the area on the south side of Cedar Fork.

Between 1870 and 1880 four other limited systems were constructed.
Porous tile drains laid beneath street gutters facilitated somewhat the re-
moval of surface drainage. These early sewer projects were financed by an
arrangement whereby two-thirds of the cost was defrayed by abutting prop-
ert_\' owners and one-third l)y the city.

In 1880, nearly all the private dwellings depended upon privies for
sewerage facilities. Onl_\- hotels and other public buildings were connected.
About this time the board of health prohibited the digging of more privy
vaults and endeavored to bring into use the dry-earth system. This was
done because the board had had anal\zed the water from wells on premises
where diphtheria cases had occurred and had found it contaminated. At
this time the board was of the opinion that \ault privies were the cause of

170 nowN-STATi-: municip.m.ities

diphtheria epidemics which previously had occurred. There was violent
opposition at first, to the installation of dry-earth closets, hut the board, in
1880, reported that the number was gradually increasing.

Night soil was used as manure by farmers a few miles distant from the
city, but such use was prohibited on the gathering ground of the public
water supply.

The sewer system, built mostl\- on the combined plan, was extended
from time to time as local re(|uirements demanded. Many sewers, especially
in the extreme northern and southern parts of the city were laid at such
shallow depths that basement drainage was not afforded.

The numerous outlets discharged into Cedar Creek, which soon became
an open sewer ffowing through the city. In 1914 gross pollution extending
seven miles below the city was observed in Cedar Fork. Some sewage was
discharged into Court Creek in the southeast portion of the city, and pro-
duced conditions concerning which many complaints arose. In 1916 the
matter of the pollution of Cedar Creek came to a hearing before the Rivers
and Lakes Commission, and an order was issued requiring the city to abate
the nuisance before July, 1918, which order was never enforced.

At the present time there are 36 combined sewer outlets discharging
into Cedar Fork. The tributary sewers are divided into 34 sewer districts.
Practically all streets are served and 90 per cent of the population are con-
nected. About 50 miles of sewers are in existence. In addition there are
some sewers discharging into Court Creek, but further development of this
system as an outlet watercourse has been curtailed through an injunction
granted by the court.

Two comprehensi\e preliminary studies of the sewerage needs of Gales-
burg have recently been made, the second study being made in 1924. The
consulting engineers have recommended the construction of a trunk sewer
following along Cedar Fork, channel improvement along certain portions of
Cedar Fork, force main and pumping station to serve the Court Creek area,
intercepting sewer for the purpose of conducting the dry-weather flow to a
point west of the cit\', and a modern sewa.ge-treatnient plant comprising grit
chambers, Imhoff tanks and slud,gc beds.

Hi:ai,tii Conditions.

The stor_\- of a "pest house" located on the outskirts of town and shunned
like a leper by all health loving citizens, is somber evidence that Galesburg
felt the sting of smallpox and experienced the alarm that was want to follow
fast upon the heels of an outbreak in years gone by. Cholera doubtless paid
its gruesome respects to the inhabitants of that college communit}-, too, but
historians seem to have left the recording of such e\ents t(3 others and the
others found more congenial ways to pass the time. At all events we find

GALESBURG

171

very little about the coming and going of epidemic diseases even in later
years. It is reported that the city escaped with but four cases of smallpox
during the State-wide epidemic of the early eighties. A typhoid fever out-
break of 20 cases occurred in 1902. With these meagre references we are
left to surmise what other ailments may have plagued the citizens until 1918.
What has transpired since that time is suggested in the mortality and mor-
bidity tables hei"ewith presented.

Table 1.
AIoRTALiTY From Certain Causes.

YE.\R

3
H'

ft.

1907
1008
1909
1910
1911
1912
1913

1918
1919
1920
1921
1922
1923
1924
1925
1926

275
283
263
292
311
304
297

459
317
376
324
372
414
344
340
401

8
2
4
1

1
4
1

]

"i
1

3
3

65
17
16

9
10

8
16

15
23
14
15
28
11
13

49
29
49
23
27
25
16
17
ol

Table 2.

Mortality Rates From Certain Causes.

YE.^R

i
s

.5'«

1907

13.0

38.0

19.0

14.2

4.7

14.2

99.7

1908

13.2

...

1909

12.0

1910

13.2

...

1911

13.9

1912

13.0

26.5

4.4

13.2

110.5

....

1918

19.5

32.0

4.0

12.0

16.0

260.0

116.0

196.0

1919

13.4

6.3

S.8

70.8

104.1

120.8

1920

15.7

16.0

4.1

8.2

4.1

66.6

02.0

204.1

1921

13.4

4.1

S.3

8.3

4.1

8.3

95.3

95.4

1922

15.3

...

4.1

20.6

37.1

57.6

111.2

1923

16.9

12.2

4.0

24.5

8.1

40.9

61.0

102.4

1924

14.0

4.0

24.0

4.0

8.0

112.0

64.0

1925

13.7

16.1

4.0

32.2

4.0

44.3

68.5

1926

16.2

4.0

12.0

64.0

52.0

124.0

Note; The rate from XU Causes is per 1.000 pop\ilation ; all others per 100,000 populatii

172

DOWN-STATI-; Mr.XICIPAr.ITIES

Tal)le 3.
Cases of Certain Diseases Reported.

1 1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

T.vphoirl Fever

tr,

Ifi

,.,

Siimllpox

174

Meusles

2(17

ISO

021

1(10

376

260

Scarlet Fever

1.')

\V hoop. Cough

l.iC

1S7

147

Diphtheria

«->

.14

Influenza

3Cr,8

50.^1

248

I'oliomvelitis

Meningitis

i'ul)erculosi.s*

2;")

.19

Pneuninniii*

.11

.12

Sypliilis

.19

4.1

(iononliea

:)4

4.-1

Chanrroirl

*AU forms.
NoTi:: Case reports are never complete, but they have been
Illinois. This table indicates improve-ment iniiotifitation i

Table 4.
Births and Infant Deaths.

YEAR

Number

Rate'*

Xuniber

Rate*

WIS

1919

1920

503

21.0

91.5

1921

547

22.7

43.9

1922

463

19.1

101.5

1923

585

23.9

82.1

1924

592

24.0

64.2

1925

572

23.1

64.9

1926

545

21.8

78.9

^Deaths of infants under 1 vear of age per 1000 births reported.
*l*er 1000 population.

References.

Annual Reports, State Board of Health, Spring-field, Illinois, various dates.
Bulletins. Illinois State Water Survey, Urbana, Illinois, various dates.
U. S. Census Reports, Washingrton, D. C, various dates.

Jacksonville

The site of Jacksonville, the county seat of Morgan County, was one of
the most beautiful locations on the native prairies of that county. For about
a mile to the east and north of the center of the town, a line of heavy timber
marked the changing course of Mauvaisterre Creek on its way to the Illinois
River about twenty miles to the west.

About four miles to the south a line of timber marked the western
course of Big Sandy Creek. A mile west was a magnificent grove of large
timber, through which the land gradually rose to culminate in what was
called the Mound three miles away. To the south, on another ridge al)out n
mile away, was another grove, later known as Diamond Grove.

The town was laid out in 1825 and was located on a well-drained prairie
ridge. According to Peck's Gazetter, twenty families resided there at that
time. Dr. Ero Chandler, the first physician, arrived in 1821.

Located in a spot so favored by nature and lying almost in the very
middle of Illinois, it was but natural that Jacksonville should become a seat
of learning. That is exactly what happened, and more, for it not only be-
came a college town, Illinois College and Jacksonville Female Academy, now
called the Illinois Woman's College, being located there but one that accom-
modates three great State institutions, one for the blind, another for the deaf
and one for the insane.

Jacksonville was incorporated as a city in 1840 under a special charter
granted by the legislature. The charter provided for a board of trustees and
among those elected the next \'ear was Isaac D. Rawlings, grandfather of
the present director of the State Department of Public Health who bears
the same name. Subsequently, the city was reorganized two or three times
under new charters and laws, changing in 1911 to the commission form of
government and back again to the aklermanic in 1918.

The population in Jacksonville grew from 1,900 in 1840 to 15,713 in
1920. Of late years the increase has been small. Of the 1920 population
86 per cent were native born whites and 7^^ per cent were negroes, a rela-
tively heavy black element. Nearly 35 per cent were 45 years old or over,
suggesting the pronounced influence of the State institutions, particularly
that for the insane, over the age characteristics of the population. This same
factor is important in the general death rate.

H i: A LT 1 1 M A cm x ii r v .

Alarm over the possibility of a smallpox epidemic in 1880 frightened
local officials into action and the result was an ordinance creating the office

(173)

174 DOWN-STATE MUNICIPALITIES

of hualtli warden. This appears to be a unique title for the office which was
fillcil by the following physicians :

C, G. Brown, M. D. 1880-1882

W. H. King. JI. D. 1882-1883

Morris H. Goodrick. M. D. 1883-1884

T. M. Cullimore, M. D. 1884-1885

For some reason, possibly the passing of apparent danger and the waning
of popular interest in such matters, the practice of appointing a health war-
den to keep watch over the health destinies of the inhabitants apparently fell
by the wayside for a period, only to be revived again at the turn of the
century. Then came the following:

L. H. Clamplt, M. D. 1S9S-1901

George E. Baxter, M. D. 1901-1908

George F. Dinsmore, M. D. 1908-1909

A. M. King, M. D. 1909-1922

These health wardens or officers were employed on a part time basis
and were expected to function only in emergencies or when some legal
authority was necessary to abate nuisances or for another cause. Up to
1922 the health warden was the only person employed by the city to perform
public health functions of any sort and he was responsible to a committee of
the city council.

Voluntary and quasi-public organizations were more active than city
officials in providing public health service during the first quarter of the
twentieth century. The Morgan County Anti-Tuberculosis League, for ex-
ample, began to function early in that period and was responsible for the
adoption of the county sanitarium law in Morgan County in 1916 and for
readopting the law in 1924 after it had been abandoned, in the meantime by
vote. The first open-air schoolroom in the State outside Chicago was opened
in Jacksonville in 1913 by the tuberculosis league. The next year the school
board employed a teacher for the open-air school and two years later ( 1916)
it began the regular employment of a teacher with nursing training to teach
health and do public health nursing duty in the public schools.

In 1920 there were four full-time and two part-time public health
nurses working in the city and county. These were supported by various
organizations such as the tuberculosis association, Red Cross, school board,
etc. Furthermore, a series of clinics for crippled children had been held by
die State Department of Public Health under local auspices and an infant
welfare station was functioning at a local hospital.

This was the state of affairs in 1920 when the local chapter of the
American Red Cross undertook and carried out a community study that
embraced an account of the public health facilities. In the report it was

176

DdW.N-STATI. M IMCII'Al.ITIIv

Stated that the mayor of JacksonviUe, E. E. Crabtree, had under considera-
tion the subject of provicHng the city with a more adequate health service
and that similar ideas were agitating the minds of county otTicials.

During the next sear Dr. Isaac D. Rawlings was appointed State direc-
tor of public health in Illinois and he cherished the idea of promoting the
establishment of countx' health departments throughout the State. Enjoying a
wide acquaintance in Jacksonville, where he had
formerly resided, he laid before the local officials
a plan for creating there a health department that
would serve both the city and the county and they
accepted the proposal which gave to them the
first full-time county health department ever
established in Illinois. It began to function in
Ma>-. 1922, with Doctor R. \'. Brokaw at its
head. He filled the office for two years and was
succeeded by Dr. Thomas A. Mann who in turn
was succeeded by Dr. W. H. Newcomb the
present incumbent.

How the new organization began to function
and what it was like is described in the first
lirector. He sa\ s :

. Brokaw. M. D.
Health Director,
1922-1924.

quarterly report of it^

"Previous to the inauguration of the present program, considerable
health activity was carried on by public and jirivate enterprise in the
city and county. All of which, however, lacked coordination.

"The staff has to date included a field director, a nurse, and an
office secretary.

"The field director functions as the Morgan County health officer,
the city health officer of Jacksonville, and the registrar of vital statistics
for three contiguous registration areas including Jacksonville and ad-
jacent territory.

"The budget of $10,000 is provided .iointly by the Rockefeller
Foundation, State ot Illinois, County of Morgan and City of Jacksonville.

"The primary object of the present enterprise is a demonstration ot
the fact that the county is the logical administrative unit for the pro-
vision of adequate health service to smaller towns and rural areas.

"The program is designed to meet the problems of individual and
community health throughout the entire county, featuring public health
education, communicable disease control, child hygiene, and sanitation.

"The work was introduced by the ordinary methods of publicity.
The reaction was immediate and favorable. County and city officials,
the medical profession, clubs, and influential citizens have lent a hearty
and continued support.

"A census and sanitary survey of the city of Jacksonville was begun
at an early date. Facts regarding race, age groups, water supply, sew-
age disposal, and other sanitary features, were obtained as a basis for
the development of a future improvement program.

JACKSONVILLE

177

Enrol

Med'C4l Inspection of School Children
Morgan County

wanaarm

Ext MINED
HoRMiL 159?

WACCINiTEDjy ,87

V////^y^^^^Ijf.

2721
262S

Corrections of Physical Defects

Morgan County School Children

1926 - 1927

477

V////)\

429 - 28*

'//i, 193

6IS Legend

- 31* ^__

HH defects

J//y^ CASES corrected

^ 66 "1

31.5%

178 DOWN-STATE MUNICIPALITIES

"Communirnble disease control is a major featvire of the work of
the department. Cases in the most remote areas of the county are com-
ing under surveillance. In general, there has been a very .gratifying
lack of resentment toward quarantine regulations. County and city
officials have commented upon the obvious reduction in the expense of
quarantining under the new regime.

"A twelve bed isolation hospital project is well under way in Jack-
sonville: and the building will no doubt soon be in course of construc-
tion. At present there are no hospital beds in the city for the care of
communicable disease. As a committee member, the health officer has
been able to render material aid in this enterprise.

"In June. 1922, there was no pasteurized milk .sold in the city
of Jacksonville. As a result of the efforts of the health officer, a com-
pany was formed, an abandoned plant was leased, modern equipment
was installed, operation was begun, and at present the company is dis-
tributing 150 gallons of pasteurized milk daily. A specially designed
building is already being considered to provide for the increasing busi-
ness.

"Upon the recommendation of the health officer, the city school
board voted to use nothing but pasteurized milk in the cafeterias and
grades of the school system.

"There is every reason to believe that the city of Jacksonville will
in the near future adopt the model milk ordinance recently suggested
by the State Department of Health.

Later the staff of the Morgan Count)- health department was increased
so that at the close of 1927 it consisted of the director, 2 nurses, 1 inspector
and a secretary-clerk.

Water Supply.

The first ordinance relating to waterworks in the ordinance book of
Jacksonville, was drawn up in 1869. In 1871 work was begun on a reservoir
one and one-half miles southeast of the town located on Pullman's Ravine,
tributary to Mauvaisterre Creek, in what is now known as Nichol's Park.
The supply was developed in accordance vi-ith plans prepared by E. S. Ches-
brough of Chicago, $150,000 being appropriated for the purpose. Nichol's
Park was donated to the city for recreation purposes. At the time the reser-
voir was constructed, cultivated fields occupied the park area. Strong springs
used to bubble forth from the ground just south and east of the present
pavilion and these springs are reported to have been the main source of
supply for a small pond which formed there. A dam was built across the
northern outlet of the pond and Morgan Lake thus formed, with a storage
capacity of 60,000,000 gallons. A vitrified-tile pipe line was laid to the
pumping station located on the bank of Mauvaisterre Creek, about one mile
north of the reservoir. Water was pumped to a distributing reservoir of
2,500,000 gallons, built on Colle,ge Hill about a mile west of the city.

A School Well OK'd by
the Health Department.

Morgan County Nurses
at Work in a Rural School.

Lake Mauvaisterre, Source of Jacksonville's Water Supply

180 DOWX-STATE MUNICIPALITIES

In 1883 the Gas and Oil Syndicate put down a 1,600-foot well near the
Wabash Railroad. The city purchased the well and deepened it to 2,200 feet.
The yield proved inadequate and the well was sold. The well was abandoned
as a source of thi' city water supply about 18''3.

In 1888 the Decker well, located just southeast of the pumping station,
was sunk to a depth of 3,110 feet, being 10 inches in diameter at the top
and 4->s inches at the bottom.

In 1890 another well was sunk 200 feet west of the Decker well. In
1895 the American well, similar to the Decker well, was sunk to a depth of
3,118 feet, just northeast of the pumping station.

All three wells flowed into a cistern at the pumping station, from which
the service pumps drew their supply. The water contained considerable
hydrogen, sulphide and iron, making it rather objectionable for domestic
uses. In 1914 only one of these wells was flowing, and the yield from this
w-as very small.

The flow of the wells gradually diminished sf) that the supply had to be
supplemented from other sources. In 1899, a small dam w^as constructed
across Mauvaisterre Creek opposite the pumping station and creek water
was allowed to run into the pump cistern when the )ield of the wells became
inadequate. This arrangement was still in use in 1914.

In 1898 the project of deriving a suppl\' from Rig ."^andy River, tive
miles southwest of Jacksonville, was considered, but eventually dropped.

In 1904 the Jacksonxille \\'ater Company obtained a franchise to supply
the city with a suitable water supply, derived from wells sunk in the alluvial
deposits of Illinois River near Blviffs, about twenty miles west of Jackson-
ville.

yV pumping station was erected with a combined capacit}' of 6,000,000
gallons daily and a 20-inch spiral riveted steel pipe line constructed, leading
to the city. The pumps drew water directly from the wells and discharged
into the pipe line. Fourteen wells, 10 inches in diameter, sunk to bedrock at
depths of about 70 feet, were developed.

From October, 1907, to April, 1908, the company delivered water into
the city reservoir at Jacksonville. The company was required to make a test
of suppl\ing 6,000,000 gallons of water in 24 hours every fifteen days, and
at each of these tests only 2,500,000 gallons of water were delivered to the
city within the specified time. Following the test in April, 1908, after more
than 3,000,000 gallons had been delivered within the 24-hour test period, the
city refused to allow the company to pump into the reservoir for a longer
period. The waterworks company pulled the strainers from the wells and
had them recut and replaced. A test which followed resulted in only
5;000,000 gallons per 24 hours although tiie rate of supply exceeded at times

JACKSOXVILLE 181

the required rate. Litigation followed between the city and the water coni-
pan}-, which lasted for several }-ears.

In 1912 the water company was incorporated and an agreement reached
with the city relative to the supply of water. A part of the pipe line was
repaired, but no water was delivered to the cit_\'.

The next source of supply adopted was the Widenham-Daub group of
wells located about one mile southeast of the public square and near the
Chicago, Peoria & St. Louis Railroad crossing over INIauvaisterre Creek.
Three drift wells were put down by Widenham-Daub about 1910 and soon
after two more wells were added by the city, which had purchased the supply
and the surrounding land. Water was discharged into a collecting reservoir
from which it was pumped directly into the distributing system. These wells
were from 58 to 74 feet deep and penetrated alluvial deposits of clay and
beds of sand and gravel. These wells were used only intermittently until
1914 when, due to low water in the creek and in Morgan Lake, they had to
be operated continuously for 22 to 24 hours per da\-.

In 1914 the supply comprised Morgan Lake, Alauvaisterre Creek and
the Widenham-Daub wells. The wells were subject to contamination due to
overflow of the polluted waters of Mauvaisterre Creek. During this year a
levee was built along the banks of the creek and the height of the projecting
well casings was increased. The lake and creek water was, of course, at all
times subject to contamination.

In 1917, a pump of 150-gallon-per-minute capacity was installed to pump
water into the service reservoir from Ashelby pond and a drainage ditch
located in the southwest part of the city. During the same year six test
wells were sunk in the valley of Mauvaisterre Creek near the north city
limits, with the view of increasing the supply.

The serious water problem at Jacksonville had much to do with the
development of a bottled-water company in the city. This company was
incorporated in 1902. Water from a spring near Markham was pumped to
the bottling plant of the company in Jacksonville, and from there distributed.
At the close of the period covered by this history this company owned more
than 5,000 glass carboys and water is distributed to many points in Illinois
through branch distributing stations. The supply has never been under the
close surveillance of the State Department of Public Health, exercised for
many years over the public water suppl\-.

The water problem of the city was studied in detail in 1917 through
co-operation of the State Board of Health, Geological Survey and State
Water Survey. Recommendations were made for a thorough investigation
of the ground-water supply and development of a surface supply in case
such investigations showed the extension of the ground-water supplv would
be impracticable. In 1918 the preliminary stuilies were continued b\- the

182 DOWN-STATK M I' XICIPALITIKS

co-opcratinti' State agencies, various wells tested and conclusions reached
that a siippl)^ from wells was impracticable.

In 1919 work on a surface-water-supply project was begun. An im-
pounding reservoir was constructed on Mauvaisterrc Creek, with a surface
area of 234 acres and a capacity of 418,000,000 gallons. A water-purifica-
tion plant was constructed cc mprising aeration, coagulation, sedimentation,
filtration and chlorination.

After the water shortage in 1922-23 the spillway elevation of the reser-
voir was raised two feet and the reservoir capacity increased to 200,000,000
gallons. Three of the W'idenhani-Dauh wells constitute an emergency source
of su[)ply.

.^ince the construction of the pvunfication plant, minor changes have
been made in the mixing basin and aeration has practically been abandoned.
An additional sedimentation basin has been constructed and one filter has
been added to the original installation. As now constituted the water-supply
system of Jacksonville comprises the Mauvaisterrc Creek impounding reser-
voir and the three Widenham-Daub wells as an emergency source, the water-
purification plant, and pumping station and two distribution and equalizing
reservoirs.

In September 1926, due to unprecedented rainfall over the Mauvaisterrc
Creek drainage area, a serious flood occurred resulting in the inundation of
about one-tenth of the area of the city. Due to inadequate spillway provision
the reservoir dam broke and the water-purification plant was flooded. After
the flood waters receded, the dam was re-built. Due to careful protective
measures taken no outbreak of water-borne disease resulted.

There are about 32 miles of service mains and the present water con-
sumption is about 114 gallons per capita daily. Routine analyses of water
samples for the city have been made by the State Department of Public
Health .since May, 1921.

The water supply is regarded as being of a safe sanitary quality.

Sewerage.

A portion of the present sewer system was built in 1895 and additions
were made in 1901, 1903, 1904, 1906, 1908, 1909, 1910, 1913, and 1916.
These sewers were built on the combined plan and were paid for by special
assessment. The development of sew-erage in the city has been in a hap-
hazard fashion and without regard to a comprehensive plan or the future
needs of the cit\-.

At present three distinct systems are in existence with outlets discharg-
ing into Mauvaisterrc Creek and its tributaries. Practically all of the sewers
are overloaded.

JACKSONVILLE

183

In 1''21 detailed preliminary studies of the sewerage needs of the city
were made and recommendations made for the organization of a sanitary
district.

In 1927 an attempt was made to sewer some additional areas of the
city. A group of riparian owners along Mauvaisterre Creek sued for an
injunction and the same was granted. The present status of sewerage im-
provements in the city is that no more sewers may be installed until proper
provision is made for treating the sewage now tributary to the creek. The
effect of this injunction will undoubtedly be the construction of a modern
sewage-purification plant in the near future.

He.ALTH COXDITION.S.

Judge \\ illiani Thomas came to Morgan County in the autumn of 1826.
He seems to have been particularly observant of health conditions for his
letters carry numerous references thereto. In a letter written shortly after
his arrival he says :

"From the crossing of the Wabash River all the way to Jacksonville
there seemed to be prevailing an epidemic of sore eyes. Several families
in Jacksonville * * * * were severely afflicted".

Table 1.
Mortality From Certain Causes.

■~

YEAR

■u

.So

S<H

*&
&

5 "

1900

268

1901

350

' ' k

3.5

1902

364

1903

372

', ',

1904

S39

1905

301

1906

290

1907

321

1908

329

" i

1909

319

1910

364

...

1911

388

' 2

1912

367

1913

393

1914

441

191.-)

454

1916

.545

1917

545

1918

617

' 4

1819

475

1920

540

' i

1921

448

1922

509

2 i

1923

304

1924

518

192.5

510

...

1926

635

6 1 ...

...

184

down-stat:-: municipalities

Table 2.
Mortality Rates From Certain Causes.

„

"fci

.2 "

'S'S

a-^

YEAU

1
^

■5

^■o

*_;

g —

.2* =

£C

1900

17.8

26.5

6.6

46.4

212.3

92.9

1901

22.9

32.7

6.5

19!6

i3!i

32.7

228.9

124.2

1902

23.5

96.7

12 . 9

6.5

12! 9

6.5

303.1

161.2

1903

23.7

101.8

12.7

44.5

19.1

25 !4

63.6

299.0

108.1

1904

21.3

56.5

6.3

18.8

269.9

194.6

190S

19.5

32.9

e'.e

19.7

289.4

151.3

1906

17.7

18.3

C.l

24! 4

!!!

293.3

91.7

190T

21.0

32.8

!!!

6.6

6!6

301.5

124.5

1908

19.6

17.9

6!6

11.9

214.4

113.2

1909

20.8

26.1

ISKli

6!5

26.1

6.5

196.0

156.8

1910

22.6

32.6

6.5

280.5

221.8

1911

24.7

26.0

13 '6

13.0

6.5

32.6

253.9

149.8

1912

23.8

45.5

6.5

19.5

6.5

227.5

130.0

1913

2.5.4

6.5

is! 6

13.0

220.7

175.3

1914

28.5

45.4

278.7

200.9

191.-)

29.2

6.6

6.5

12! 9

271.7

226.4

I9ir,

35.0

38.8

G.h

19.4

25.8

239.0

303.6

1917

34.9

32.2

12!9

12.9

19.3

496.6

464.3

1918

39.4

51.6

2.5 .8

6.4

303.2

470.9

529.0

1919

30.3

25.3

94.9

272.1

316.4

1920

34.3

12.4

6!2

112. S

262.5

450.0

1921

28.4

12.7

6.3

228.2

221.9

1922

32.2

56! 9

6!3

12.6

284.6

297.3

1923

31.8

18.9

'. .'.

'.'.'.

82.2

278.4

360.7

1924

32.6

12.5

...

12! 5

h'.i

12.5

287.5

200.0

1925

32.0

0.3

6.3

207.1

169.8

1926

39.7

37.5

6!3

'.::

37.8

212.5

331.2

Note: The rate from .\11 Causes is per 1,000 populatic

11 others per 100,000 population.

!H!e continues, saying:

"The fever and ague had prevailed during the fall in every neigh-
borhood in the county and especially on the river and margins of small
streams."

A few years later the town received a se\Tre check by the ravages of a
cholera epidemic which carried off a great many inhabitants in 1833. Mr.
James S. Anderson, a local undertaker at the time, describes ihi.- outbreak
from start to finish. He says :

"The first case made its appearance in .May or .lune of the year
1S33. A mover traveling by wagon through the county stopped here
and his wife was taken sick. The citizens went to his assistance and
the case was pronounced a case of genuine Asiatic cholera. The citizens
conveyed the sick woman and the others to a log caljin outside of town
so as not to spread the infection. * * * *

"The woman died and the people burned the clothing, etc., supplied
the man with money and sent him on. I saw this woman just before
she died. Myself and several companions went there out of curiosity.
Two weeks later the second case appeared, being that ct a young man
from Exeter, who was visiting relatives who kept a boarding house,
where Marble Block now stands. He died, and the disease began to
spread rai)idly.

JACKSONVILLE 185

"The town at that time contained about 500 inhabitants, fully half
of which tied to the country. Of those who remained about 75 were
attacked with the epidemic of whom about 55 died. It was very ma-
lignant. Besides these quite a number who fled to the country died,
some of them I believe were scared to death. *** Ross (his partner)
and I concluded to take our chances and stay in town. We were both
young, unmarried men. and we left our shop and commenced to nurse
the sick and we were almost the only ones who devoted our time to it.
We went from house to house, sitting up night after night, waiting on
the sick, i)reparing the dead for burial and doing what we could. The
whole community seemed paralyzed and little business was done. * * * *
The scourge lasted six weeks and was the most terrible that ever visited
Jacksonville."

It i.s recorded that Ductors Samuel L. Prosser and Bezalleel Gillet
wo.'ked valianth' with the afflicted, serving rich and poor ahkc ur.til the
epidemic subside) L

In the fall of 1844, Jacksonville was visited by Dr. Daniel Drake. From
the local physicians, Doctors Henry Jones, Sainuel L. Prosser and Nathaniel
English he learned that all forms of autumnal fever occurred there, also
that they were less prevalent than formerly. Ma-
lignant intermittents were rare, remittents tend-
ing to a continued type, rather frequent. On the
whole, he found that these fevers prevailed there
in a mitigated degree, compared with the sur-
rounding region generally.

These constitute the principal historical ref-
erences to health conditions in Jacksonville and
vicinity during the early years of community life
there but they are sufficient to show that people
there did not escape the severe hardships of
Nathaniel English. M. D. pioneer existence on the prairies. Later, how-
ever, it seems that the cominunity developed a
reputation for unusually favorable health. Only one case of small-pox was
reported from that vicinity during the great epidemic wave of the early
eighties and Eames, the local historian, declared in 1884 that:

"The health of the city has always been remarkable, the average
death rate being much lower than that of the average cities of the West."

\\'hether this reputation was altogether justified on the basis of fact is
questionable although the community doubtless enjoyed a noticeable free-
dom from those contagious diseases which ordinarily attract particular pub-
lic notice and stimulate fear and alarm. At any rate typhoid fever has been
a problem of long standing and it has entailed a heavy burden upon the peo-
ple there for many years. Fairly reliable statistics since 1900 show that the

186

DOWN-STATE MUNICIPALITIES

nioi"talit\" rate from Ixplioid has been [jfrsistently higher than modern cities
like to recognize or talk about when the booster club is active. The source
of their trouble appears to be in a considerable area of unsewered residential
district.

Tuberculosis likewise has been a problem of signilicant magnitude.
It is complicated by the presence there of the hospital for the insane so that
statistics are somewhat misleading. Undoubtedly the loss of life among
citizens has been heavy enough, however.

The unrefined general mortality rates appearing in iiie accompanying
tables are not satisfactory evidence of underlying health conditions because
of the influence of the institutions. People confined in the asylums remain
there for periods long enough to make of them, technically at least, local
citizens. This adds intricacy to an already complex problem of analyzing
mortality returns.

On the other hand the extraordinary freedom from diphtheria and scar-
let fever which the city has enjoyed in recent years suggests the successful
prosecution of a sound public health program and the annual reports of the
health department carry incontrovertible evidence of satisfactory sanitary
and h\genic improvements. A reasonable conclusion is that Jacksonville is
a healthful city which is prepared to meet all ordinary hazards that may
arise to endanger public health ami that both the city and the county are
profiting by the services of a modern pulVic health department devoted to
preventive medicine and heahh ])rim()ti<in.

Table 3.
Cases of Certain Diseases Reported.

1916

1917

1918

1919

1920

lil21

1922

1923

1924

1925

1926

1927

Typhoid Fever

l.i

Smallpox

.■iS

107

Measles

•25o

134

.">5

Sll

•2

'24

037

306

Scarlet Fever

4.5

114

Whoop. Cough

146

166

Diphtheria

Influenza

2025

00;-)

Poliomyelitis

Meningitis

' i

Tuberculosis*

'88

'49

Pneumonia*

107

100

Syphilis

218

192

Gonorrhea

*A1I forms.

S'OTK : Ca.se reports are

lever complete

but thev hav

beei

Tnnrh m

ire SI

Illinois. This table i

Klicates that

intificatioTi ill

lackM

nviUe lias

reac

riefcree of cornpleteiies

JACKSONVILLE

187

Table 4.
Births and Infant Deaths.

Births

Infant Deaths*

YEAR

\uniber

Rnte**

Nu.nber

liate

lilOO

114

7.5

272.

1901

130

8.6

292! 3

1902

213

14.0

112.

1903

210

13.8

95.2

1904

234

1.^>.4

141.

1905

238

15.6

134.4

1906

210

13.7

128.5

1907

250

16.3

112.

1908

196

12.8

107.1

1909

183

11.9

2.1

136.6

1910

165

10.7

115.1

1911

172

11.1

75.6

1912

230

14.9

73.8

1913

235

l."i.2

85.1

1914

242

l.-| . 4

70.2

1915

298

19.2

80.5

1916

263

10.9

3.".

133.1

1917

260

16.6

92.3

1918

286

IS. 2

52.4

1919

272

17.3

143.4

1920

286

18.2

83.9

1921

296

18.7

74.3

1922

308

19.4

84.4

1923

307

19.3

78.2

1924

320

20.1

71.9

1925

337

21.1

68.2

1926

353

22.

65.2

•Deaths of infants under 1
** Per 1000 population.

of age per 1000 births reporteJ.

References.

Annual Reports, Department of Health, J.ackson'
Annual Reports, State Department of Public H^
Illinois Health News, State Department of PiiM
American Red Cross, Survey of the City of .l;n
Letters and correspondence, prominent citizeii>
U. S. Census Reports, Washington, D. C. various

s, various dates,
irtield, Illinois, various dates.
Springfield Illinois, various date;
linois, 1920

JoUet

Joliel has the unique distinction of being tlie locahty where the first
doctor in IlHnois was located. This was tlie surgeon who was in the iUinois
country when Father Marquette sojourned at the Chicago portage during
the winter of 1674-5 and who came to him on January 16, 1675, with Pierre
AForeau ("La Toupine") when they heard from Indian messengers of the
holy Father's plight.

-Vfarquette was suti'ering from an intestinal disorder probably dysentery.
In his journal he recorded that the surgeon gave him whortle berries and
"did and said everything that could be expected." The surgeon's name is not
found recorded in Marquette's journal but recent historical research shows
that he probably was Louis Moreau, of Quebec.

Soon after this, Chicago and the mound at Joliet, called Monjolly on
the old maps, where the surgeon who attended Marquette may have resided,
were lost track of and closed to the white men for nearly a century because
hostile Indians occupied the Chicago portagt .

Toliet again gained prominence when the work on the Illinois and Michi-
gan Canal was started in 1836. Dr. John H. Ranch reported that in 1838,
laborers employed on the canal were afflicted with ;i disease resembling
cholera which struck them down suddenly. Also that nearly all who resided
along the line of excavation and almost all the laborers on the canal suffered
with autumnal fever.

Dr. Daniel Drake on his vo\age up the Illinois River in ibe Fall of 1S44
visited Joliet. Doctors Schoolfield and N. W. Bowen reported to him that
the locality was annually invaded by autumnal fever, though it seldom as-
sumed either a wide-spreading or fatal character. The Irish laborers on ihe
canal in 1838 and 1839 were the greatest sufferers.

The canal was completed in 1848 and opened communications with Chi-
cago. The Rock Island railroad was under construction at the same time.
The canal and the railroad both passed through Joliet and it was naiural
that the cholera, which was Ijrought to Chicago on April 29, 1849, sliould be
introduced in Joliet, within a short time. This occurred and the disease
raged there until 1854. It is reported that the mortalii;- was 13.8 per 1.000
population, .\mong the victims was Dr. Alexander M. Com.stock. who came
to Joliet in IS.v and took an active part in treating the sick, during ihe
epidemic.

The village of Joliet was incorporated in 1837 by an act of the legisla-
ture In 1853 it was incorporated as a city. The population in 1850 was

(188)

JULIET 189

2,659; in 18()0,, 7.104 and in 1870, 7,263. In 1880 it rcacliftl 11, 657, of .vhich
number 3,148 were foreign born. There were 98 negroes counted in the
cit}' at that time. During the next decade the population more than doubled
reaching 29.353 in 1900 and rising t(j 34,670 and 38,442 in 1910 and 1920
respective!} .

The city lies on both sides of the Des F'laines River, and the IlHiiois and
Michigan Canal passes through it. The city is situated mainly in the river
valley and extends to the bluffs on either side, rising to a height of iifty feet
above the river level. The soil is underlaid b\' a laver of fine!\ stratified
li.mestone, 2(J0 feet deep.

Public Health Service Equipment.

A board of health, composed of one citizen from each ward, appointed
by the mayor and confirmed by the city counc'l. constituted the sanitary or-
ganization of Joliet in 1880. One mejmber of the board was a phwsician.

Tlic heahh officer was appointed by the mayor, at a salary of $100 per
annum. His principle duty was the inspectiori of nuisances.

Smallpox cases were taken to the "pest house" situated outside of the
city limits. Scarlet fever cases were quarantine.! in t)ie home. \'accinaiion
•■'•IS not compulsory.

By law all births were recjuired to \>e reported, to tht county clerk.

Health Officers.

One of the first medical health officers of Joliet was Dr. Alfred Nash
who held that position in 1886. He deserves mention particular!}- because
of his interest in sanitation. Among other things he invited Dr. John H.
Rauch, secretary of the State Board of Health to visit Joliet in the interest
of sanitary improvement. Together they made a brief survey of conditions
and concluded that the extension of the sewer system was the greater sani-
tary need of the city. The same recommendation was made forty years
later after a thorough survey of the city's healtli facilities by Dr. Thomas
Parran, Jr., of tlie U. S. Public Health Service who at the time was attached
to the Illinois State Department of Public Health.

Dr. Chas. Kolm, liealth commissioner in 190! and 1902, started tlie
laboratory service in the healtli department. For that purpose he secured
an appropriation of $200. Although laboratorx- facilities have not developed
commensurate with the needs of the city it was, nevertheless, an import-
ant advance to make a beginning in that respect. The immediate purpose for
opening a laborator}- was to provide equipment for making examination of
water and milk supplies.

190 DOWN-STATE MUNICIPALITIES

In 1''04 Dr. Martin Gushing, the commissioner of health at that time,
succeeded in adding a plumbing inspector to the health service personne'.
He was followed the next )ear by Dr. W. A. McRoberts who helrl the office
but a short time, being succeeded by Dr. W. B. Stewart. During this period
a survey of school drinking water supplies was made and the source in prac-
tically every instance was condemned. It appears that the supplies v.eie
drawn largely from local wells.

The present health commissioner is Dr. Ed. J. Higgins.

City Hi-.altu Servicic Appraisal in 1926.

Juliet was one of fifteen Illinois cities in which a careful study and an
appraisal of local public health services was conducted by the State Depart-
ment of Public Health in 1926. For this study a survey and appraisal form
prepared and recommended by the American Public Health Association v.as
used. The results of this study give a clear conception of present facilities
for doing public health work. Pertinent quotations from the report read as
follows :

"With a total score of only 44G health service in Joliet falls short
of the standard in many respects. The city officials state that owing
to low taxable valuation, due to the inability of the city to extend its
boundaries, all city functions are seriously handicapped for lack of
funds. The health department consists of a part-time physician and one
sanitary inspector. In addition the city pays $1,S00 per year to the
Joliet Public Health Council for the employment of a nurse. Some
laboratory work is done for the city by local laboratories. The board
of education employs three public health nurses and the Public Health
Council, a volunteer organization, employs a supervising nurse and
five field nurses who conduct in and around .Toliet the prenantal and in-
fant welfare, tuberculosis and bedside nursing services.

"Expenditures on the part of the city are $7,715 per annum ;ind
the total expenditures by all agencies $24,714. giving an annual per
capita expenditure of 19 cents and 61 cents, respectively.

"Communicable diseases are handled by the health officer and san-
itary inspector, no contagious disease nurse being employed. About one-
halt of the cases of smallpox and most of the cases of typhoid fever
were hospitalized, but other contagions were not treated in hosiiitals.
As a result of the smallpox epidemic early in 1925 a large number of
people were vaccinated against this disease. Xo immunizations were
done against diphtheria with toxin-antitoxin.

"Venereal disease cases are incompletely reported and there is no
clinic service for indigent sufferers of these infections.

"The number of field nursing visits to tuberculosis patients last
year was only about one-half the requirement for full credit in the
appraisal scheme. Two clinics during 1925, with a total attendance of
32 and a like registration, fall far short of the required attendance of
660 with an average of 3 visits per patient. Advantage was taken of the
splendid county tuberculosis sanitarium where beds are free to Will

JOLIET

191

County citizens. It appeared, however, that practically all patients
hospitalized were well advanced in the disease. One open-air classroom
is maintained in the public school system.

"An infant welfare clinic is maintained, 1,700 visits being made to
it last year. There is no prenatal or preschool clinic, and relatively
few field nursing visits are made in behalf of these age groups. The
Public Health Council also supports a crippled children's clinic. This
organization is covering a broad field of activity with limited personnel.

"There is no medical inspection of school children; the nurses
weigh and measure the children, inspect for obvious defects and do home
visits. Five school buildings in the city (two public and three paro-
chial) have outside toilets.

"The Elizabeth McCormick Memorial Fund has been conducting in
Joliet for a numljer of years a demonstration in health education and
an intensive study of the group of about four hundred school children.

"The one inspector employed by the health department does some
sanitary and food inspection work. The city water supply does not com-
pletely meet the United States Treasury Department Standards because

JOLIET

1%^ — 'i° 'i° T T T T Y r T -T

VEM. DIS. COtSTROL >»■

HEALTH CHILD i^lHH^^

SAhlTATIOn [^^m^^^KM

niLK cohTROL 'ym^K^m

LABORATORY iS^^HH

POP. HEALTH IMST^M^

PERCEMT OF STAMDARD SCORE

rod EACH OF TEM MAJOR HEALTH ACTIVITIES

1925

This graph illustrates the strong and weak points in Joliet's public
health service, official and voluntary, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in .Toliet was 45 per
cent of the standard perfection requirement.

192 DOWN-STATE M UNICirALITIES

of ;i possibility of contamination between tlie sujiply wells and the dis-
tribution system. It has been given a provisional certification only by
the State division of sanitary engineering. It is distributed to approxi-
mately 95 per cent of the homes. The sewer system, it was estimated,
serves less than GO per cent of the dwellings, giving the city a very low
score for this section.

"The city has an excellent milk ordinance which requires that all
milk sold in the city be pasteurized. However, no machinery is pro-
vided by the city for the proper enforcement of this ordinance, and a
recent investigation of the pasteurization plants shows much to be
desired in some of them. There are eighteen such plants in the city.
A local laboratory made for the health department weekly examinations
of milk from two plants during November and December 192.5. These
examinations show a constantly low bacterial count, but no information
was available concerning the bacterial quality of the remaining milk
supplies."

Water Supply.

The original waterwork.s, installed in 1884 by private interests a'.'d
purchased bv the city in 1888, comprised a group of drift wells about 40 feet
deep, in the eastern part of the city in the valley of Hickory Creek. From
time to time additional wells were sunk until finally there were 20 such
wells serving the city. Later, due to increased demands, it became riecessary
to drill six rock wells (1,200 to 1,700 feet deep) on the same site. These
wells entered St. Peter sandstone and secured a large additional suppl_\-.
After a few more years the supply again became inadequate and an open a- id
unprotected storage reservoir, deriving its water from Hickory Creek, was
constructed to tide the city over dry periods.

In 10(X) the water supply problem was thoroughly studied by Daniel
W. Mead, who made recommendations for extension of the deep-well sys-
tem and development of a .shaft and tunnel system, but construction was
never carried out.

Until 1907 the city got along as l)est it could by using the existing wells
supplemented by polluted water from Hickory Creek whenever the v.ells
alone failed to meet the demand.

In 1007 construction of a system of isolated deep wells, located in the
central [xirtion of the city, was begun, one well being installed in 1907, one
in 1911, one in 1912, two in 1913, one in 1914, and two in 1925. These wells
are about 1 ,600 feet deep and enter Potsdam sandstone. As these wells were
developed the original drift wells were gradually abandoned.

In 1911 the city increased its supply somewhat by pumping into the
open reservoir at the pumping station, spring water from two stone quarries
situated one-half mile south of the waterworks.

.lOLIET 193

Until 101, \ water from Hickory Creek and the stone quarries was used
as an auxiliary source of supply, although in 1910. following a typhoid fever
epidemic, a hypochlorite treatment plant was installed. This plant was rather
a crude affair and was never regarded as an adequate safeguard. In 1913
the practice of ulnaining additional water from the creek and quarries was
discontinued.

In I'M 5 a second open and unprotected concrete collecting reservoir
was constructed, adjacent to the old storage reservoir.

At the present time only four of the first six deep wells constructed on
the original site arc in service, two wells having been completely abandoned.
In addition to these four wells, the present suppl}' is obtained from the eight
deep wells which were progressively sunk between 1907 and 1925. Water
from the wells is delivered to one of two open concrete collecting reservoirs
situated at the site of tlu' main pumping station. A fence constructed around
the collecting reservoirs in 1925 gives some protection a.gainst wilful con-
tamination. The supply, however, is subject to possible contamination at two
of the wells in case the cit\' sewers are surcharged and at the open collect-
ing reservoirs, and th,- sanitary tjuality of the supi)l\' is regarded as duublfu].

The consum])tiiin of water has been rather high, a\craging 117 gallons
per capita in 1921.

Skwkragk.

In 1880, about one-third of the household wastes were dischargeil into
sewers. A large proportion of the houses depended upon privy vaults.
These were cleaned during the night, under permits issued liy the board of
health. The night soil was disposed of outside the cit\ limits.

DesPlaines River at Joliet has a very large flow as the result of the
discharge into it of Chicago's sewage. \\'ater power is developed at Lockport
and near the center of Joliet. by means of dams across the river. Des
Plaines River is decidedl_\- polluted. It is extremely turbid, carries consid-
erable oil and floating material anil emits a characteristic sewage odor.

The old Illinois-Michigan Canal crosses DesPlaines River at Joliet b)'
using a portion of the river above the Public Service Company dam.

Hickory Creelc and Spring Creek are small watercourses which enter
the city from the east and then flow southerly through the east part of town,
having confluence near the center of the east corporate limits. Hickory
Creek circles to the south and west around the southeast corner of the city
and joins DesPlaines River.

The city proper at the present time is extensively sewered on the com-
bined plan. These sewers, carrying both sanitary sewage and storm water,
discharge at numerous points along the various watercourses. The sewers
have been in>talled largeh" in a "piecemeal" fashion as immediate develo])-

104 DOWN-STATE MUNICIPALITIES

ments demanded and without regard to a comprehensive plan or the ultimate
future needs of the city. As a result there are portions of the city not ade-
quately served and several heavily populated outlying districts where sani-
tary conditions are deplorable and the need for adequate sewerage facilities
is acute.

Health Conditions.

In common with every other community of the Middle West, smallpox
and cholera were the barometer of health conditions in Joliet during the last
quarter of the nineteenth century. Scarlet fever attracted some attention
but such diseases as typhoid fever, diarrhea, malaria, measles, diphtheria and
tuberculosis were so common and so thoroughly endemic that both public
and medical profession seem to have taken them as a sort of matter of course.
Consequently, we can arrive at no definite idea about the prevalence of these
infections and can establish reasonable conjecture only on the basis of vague
references and indefinite statements.

Smallpox and cholera were different. They came in violent epidemic
waves. Folks knew that they were contagious. Many had seen their deadly
havoc and not a few carried the scars of smallpox as a living evidence of
what might be expected from that disease. Consequently, an outbreak
caused public concern. The "pest house" crowned a desolate bluff on the
outskirts of the city. No mischievous boy was ever bold ent)ugh to crash
out the windows or play ghost there.

For these reasons the story of smallpox gives a tangible basis upon
which to build an idea about what kind of health conditions prevailed in a
community in those days. Even then vaccination was a generally accepted
method of preventing the disease. If people neglected that precaution and
permitted their health officer to trail around behind an epidemic like a dog
behind his master, that fact implies that other and less definite preventive
methods against other diseases were probably less actively pursued and less
effectively utilized.

Accordingly, the experience of Joliet with the smallpox epidemic of 1882
is illuminating. The story shows how obviously this disease always comes
to town and illustrates how stubbornly people resist the one clear-cut way
of controlling its course. The story is by no means peculiar to Joliet but
rather it is typical of what took place in nearly every town that enjoyed a
sturdy growth and thriving commerce in those days. This is the way things
transpired in Joliet.

In the winter of 1882. tramps in different stages of sniallixix were on
three different occasions picked up on the streets of Joliet .•uid taken to the
"pest house".

JOLIET

Mortality From Certain Causes.

195

YEAR

1 =

i^-^

1907

505

1908

611

1909

594

1910

680

...

1911

593

1912

499

1913

659

1918

1062

236

212

1919

503

1920

447

1921

515

1922

449

1923

503

1924

477

1925

527

1926

593

...

""'

Mortality R,\tes From Certain Causes.

YEAR

1
1

1907

14.9

51.4

...

3.02

9.0

196.5

193.5

1908

18.1

1909

17.3

1910

19.6

1911

16.9

1912

14.0

1913

18.3

58.6

27.9

li.i

2.7

8.3

139.6

1918

28.1

17.8

2.5

25.4

38.1

000.5

129.7

539.4

1919

13.2

21.0

2.6

18.4

123.6

81.5

121.0

1920

11.6

12.8

2.5

10.2

20.5

61.5

69.2

125.6

1921

13.2

28.2

23.1

5.1

17.9

28.2

12.8

74.3

1922

11.3

17.8

15.2

78.6

99.0

1923

12.6

5.0

7.5

60.3

62.8

90.4

1924

11.9

15.0

2.5

7.5

35.0

80.0

92.5

1925

13.0

19.7

7.4

2.4

27.1

54.2

86.2

1926

14.5

9.6

2.4

9.6

7.3

52.8

60.9

97.5

Notk: The rate from All Causes is per 1,000 population; all others per 100,000 population.

Early in March of the same _\ear, the son of a gunsmith returned from
Chicago to his father's house in Joliet. On the 18th his mother and sister
were taken ill with hemorrhagic, confluent smallpox and both died. During
their illness they were visited by a neighbor who caught the disease and died
shortly thereafter.

Very little precaution was taken with these cases. The sheets and
blankets used by the two confluent patients were hung in the yard next to
a public street to dry.

196 nOWN-STATE MUNICIPAMTIES

I'lMiH March IStli tn June 30th, there were a total of 57 cases of small-
pox rcidiricd in the cil\ with 18 deaths. It cost the city $26,402.07 to quell
the epidemic.

In the nieanlime, neii^hhorin.y towns (|uarantined against Juliet, the city
council ordered schools, churches and all public gatherings suspended, special
policemen were detailed to guard the infected houses and excitement ran
high. JMnally the State Board of Health was appealed to and Dr. John H.
Raucli, the secretary, made a personal visit to the city and urged vaccination
and the enforcement of quarantine.

This epidemic of smallpox merely stands out above the many outbreaks
of that disease, like a given flood or snowstorm above others, because of its
fierce deadliness and the general public alarm which it provoked. Even as
late as 192,i the city was visited by an outbreak that yielded 64 cases and
in 1925 b\' one that produced 23 cases and 3 deaths.

Typhoid fever began to attract particular public notice about l''0O. I'rom
that time on there appear references from time to lime of e])ideniics in Joliet.
Twelve cases in 1902, for example, were attributed to drinking water drawn
from shallow wells. In 1918 a series of 43 cases were likewise said to have
resulted from contaminated well water.

The onl\- reason for pointing out these two epidemics is that the\' re-
ceived particular epidemiological studies by health officials. Neither was
unusual and very likel\' the number of cases reported fell considerably short
of all the cases of the year in the cit\ and its outlying populated district. Joliet
has alwavs had a high t\']ihoid fever rate. Mortalit}' from this disease is
ordinarily from two to h\e times the prevailing rate in the .^tate at large.
The reason probabl} is fmnid in the large unsewered areas that still exist
there.

From the morlalily returns in recent \ears it appears that tuberculosis
was less extensi\'e there than in some of the other cities of comparable size.
It is significant, however, that the tuberculosis death rate among prisoners
at the State penitentiary was so excessively high that it attracted especial
attention as earh as 1870. Reports concerning the condition apparently
h.-istencd the anti-tuberculosis program in Illinois, a matter that is treatetl
at some length on page 364 of \'olume 1 of this book'.

\\'itli the discovery of diphtheria anti-toxin in the nineties and the pro-
gress made subse(|uent to 1890 against typhoid fever, cholera and malaria,
people began to regard contagious diseases generally as an unnecessary
burden rather than one of the necessary evils that complicate the vicissitudes
of life. C'onsequentlw the more deadl}' infections, such as scarlet fever and
diphtheria liet;.in tn receive public notice enough to stimulate some recording
of prevalence by health officers.

197

Thus we find thai 7'1 cases of scarlet fever and 38 of diphtheria were
registered in Joiiet during 1905. There is no evidence to show that these
figures represent the total incidence of that year while the fragmentary re-
corded notification from }ear to year implies that case reports picked up
during the periods when outbreaks reached proportions sufficient to provoke
public concern and that notification fell off' in comjileteness between these
epidemic cycles.

Cases ok Certain Diseases Reported.

1 1919
1

1920

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

Smallpox

1.-)

Ifi

Measles

r.3

304

•'9

137

310

235

Scarlet Fever

110

10.5

Whoop. Couffh

Diphtheria

l.-)2

.52

2.5

Influenza

Poliomyelitis

Meningitis

■2

Tuberculosis*

.58

195

146

Pneumonia*

.54

107

102

S\'philis

277

Gonorrhea

Chancroid

*A11 forms.
Notk: Case reports are never complete, but the
Hlinois, This table indirntes improvement in

Births and Infant Deaths.

Infant Deaths

1918

1919

1920

568

1921

707

1922

713

1923

802

1924

800

1925

747

1926

810

159

14.7

142.6

18.1

114.6

18.2

94.0

20.2

102.2

19.9

91.2

18.4

95 .

19.8

92.6

■ of age per 1000 births reported.

An epidemic of scarlet fever that took place in the spring of I'M.i is
worthy of mention because it reached such alarming proportions that the
State Board of Health assumed charge of the situation and because the local
newspapers, presumably expressing public sentiment, suggested the creation
of a first rate local health department at an annual cost of from $25,000 to
$50,000. The outbi'eak involved several hundred cases, accurate figures be-
ing unavailable. There were 140 active cases at the time the State Board

198 DOWN-STATE MUNICIl'AMTIES

took charge in May and there were 53 under quaranlnie on June 30th. The
city spent about $1,500 in emergency work during the epidemic hut the
newspapers estimated that commercial and other economic losses due to the
disease amounted to fully $100,000.

The influenza wave of 1918 struck Joliet with a deadly vehemence that
has few, if any, parallels in the State. Mortality from the infection reached
the extraordinary high peak of 600 per 100,000 people while deaths attri-
buted to pneumonia soared to 539 per 100,000 people. The influenza mor-
tality rate was higher in Joliet than in any other city embraced in this volume
and the rate in Joliet from penumonia was exceeded only by that in
Kankakee.

These illustrations are sufticient to show that health conditions in Joliet
have been about average in most respects. The prevalence of typhoid fever
has been more unfavorable than in many other places and the influenza pan-
demic spent itself with greater fury in that place than in most other cities.
For the most part, however, epidemics have come and gone creating senti-
ment favorable to a strong public health department during the heat of the
outbreak but invariably leaving behind the chronic problems involved in
endemic health conditions which probably influence more profoundly than
is ordinarily realized the severity of epidemics.

References.

Annual Reports of the City of Joliet. Joliet, 111. — various dates.

Annual Reports of the State Board of Health, John H. Rauch, Secy., Springfield, 111. — various dates.

llistoiy ..f Medical Practice in Illinois — Vol. 1, Lucius H. Zeuch, Chicago, 1927.

■^^ '''11 It II I'.iitise on the Principal Diseases of the Interior of North America — Drake, Daniel —
Cinciiii li • I - «'i.

i: I' 11 Apprai-sal of Health Service for the vear 1923 in Fifteen Illinois Cities — Illinois

Healll. \. - Mil hine, 1926, Rawlings, Isaac D.

Hulletin of the State Water Survey, Urbana, 111., — various dates.

U. S. Census Reports — Washington, D. C. — various dates.

Kankakee

In the days of the early explorers the Kankakee-St.Joseph Rivers route

was used alternately with the DesPlaines-Chicago Rivers route in traveling

between Lake ^Michigan and the Illinois River. Father Louis Hennepin

traveled by way of the Kankakee River in 1679 and was impressed by the

vast marshes in the territory through which the river flowed. He said,

"The country is nothing but marslies, full of elder trees and rushes;

and \ve could have hardl.v found for forty leagues together, any place

to plant our cabins, had it not been for the frost which made the earth

more firm and solid. * * * * We suffered very much in this passage and

* * * * most of them (the men) were so weary of this laborious life,

that they would have run away, if possible, and gone to the savages."

After Father Charlevoi.x made the descent to Louisiana via the Kanka-
kee River, then called the Theakiki in 1721, the route was closed because the
territory was held by the unfriendly Foxes and their allies and later by the
Pottawottomies, Ottowas, and Chippewas, which were not dispossessed of
their holdings until the treaty of 1833.

The settlers who then poured into the territory suffered much from
malarial fever. Dr. Hiram Todd was one of the first doctors to settle in
the Kankakee \'alley. He arrived there in 1836 and made his headquarters
at the village of Waldron on the banks of the Kankakee, opposite the mouth
of the Iroquois River. His intention was to look after his land interests
which consisted of 8.000 acres along the banks of these two rivers, but he
was soon drafte<l t(j look after the sick.

During an outbreak of smallpox among the Indians in the vicinity,
Dr. Todd's services were procured and he stopped the spread of the epidemic
by vaccination of the redskins. They in conse-
quence held him in high esteem as a medicine
nian.

In 1836 Dr. Todd was commissioned post-
master of Kankakee post office located about two
and a half miles up the river. This was the
first use of the modern spelling of the name and
was derived from the various appellations such
as Theakiki, Kiakiki, Kankiki. etc., given to the
river in the early reports and maps of the ex-
I)lorers. all said to have been derived from the

Abraham Lennington Small. Indian word Theak, meaning "wolf".
M. D.

(199)

200 DOWN-STATE MUNICIPALITIKS

One of the early physicians in Kankakee County was Dr. Abraham
Lennington Small, fatliir nl ilic jjresent Governor, the Honorable Len Small.

Dr. .Small en,i;at;eil in the practice of medicine at \\'ilmin.g'ton, Illinois
in IS.tO, and later nio\ed to Ivockville, Kankakee County. He was burn
September .^th. IS.^O. in Wayne County, Indiana, and was the second of
eleven children of John and Mary Lennington Small. j(]hn"s father was
opposed to slavery anil emi,grated west from \'irginia for that reason. The
family was of Scotch origin.

Htber early physicians were Doctors Henrv Russell, who came to
I'liiurbdiinais in bS.^d, C. W. Knott, who was the chief physician during the
cholera e])idemic of IS.^l. James F. Alazuzan. who arrived in Momence in
IS.v and settled in Kankakee township in 184i).

Settlement and Larlv Diseases

The first house in Kankakee was built in 1834 on ground that is now
the northeast part of the court yard. The original town was platted June
8th, 1853, and was called Bourbonnais. The nearb\- station on the Illinois
Central Railroad was known as Kankakee Depot.

In 1853 when the Illinois Central Railroad scouts came to Bourbonnais
and asked for a right of way for the new railroad, the French-Canadians
and early settlers told them that they were not anxious to have the railroad
come through the town, giving as their reason that the railroad would scare
the horses, frighten the children and that the smoke and soot would damage
the white clothes that the wives would have on the line. For this reason
the Illinois Central officials decided to buy a right of way two and one-half
miles southeast. The first town site was called Bourbonnais City, but when
the people of the county decided to vote on the location of the county seat.
a contest arose between this new Illinois Central town site and the town of
Momence. Immediateh the Illinois Central officials feared that the voters
might suspect Bourbonnais was contesting with Momence and they changed
the name to Kankakee Depot.

The election was held on June 21, 1853. The town site projectors of-
fered as an intlucement the magnificient square as the seat for the court
house, also the sum of $5000 for the construction of the building. With
the aid of the voters from the vicinity of Limestone and Illinois Central
employees, the election was carried by Kankakee Depot.

The first term of court was held in the upper floor of the Illinois Cen-
tral freight depot and the second term of court was held at the \'an Meter
Hotel. In 1865. duriuL; the liuildin;; (d" the court house, the cit\' of Kan-
kakee was granted a ch.irter by the .^tate legislature which was signed by
Richard J. Oglesby, (io\ernor. .Section 18 of this charter provides that the
common council ma\' make regulations to prevent the introduction and spread

KANKAKEE 201

of contagious disease in the city. The office of heakh officer was not men-
tioned in the charter, luit the charter granted the mayor and council permis-
sion t(i appiiinl (ilher officers than those which were mentioned. Conse-
quent 1\ the auth(]rity for employing a health officer was there.

I'.y an act nl the legislature February ISth, 1855, the name of the muni-
cijiality was changed to Kankakee City.

In later \ears the city became incorporated under the general law nf

is;2.

The natural la\ of Kankakee is high, with a perfect natural surface
drainage. It is underlaid with a layer of limestone, deep enough under the
surface of a loose alluvial soil tn afford an e.\ce!lent drainage.

The city extends back and east of the river a distance of nearly three
miles sloping gradually to the river frtjni the cast, south and west. The
north side is drained by Soldier A'alley Creek, running to the west, and empty-
ing into the river below. Practically all the wells in the city are drilled into
the limestone which lies only a few feet below the surface.

Kankakee is one of the smaller of the jjrincipal cities of Illinois. In
1920 the population was Id, 753. This represented an increase of about 60
per cent in twenty years. Of the 1020 population 14,363 or 85.7 per cent
were nati\e l)orn white, 2121 or 12.7 per cent were foreign liorn whites and
265 or 1.0 per cent were negroes. Nearly 25 per cent were 45 years old or
over.

Hi:ai.tit Maciiin'kkv

.\ fire in the police station destroyeil all the official records made by
the cit\' council during its early years so that evidence from that source is
completely wanting, for the period prior to 1S')8. In that year the ordinances
were revised and among them was one granting the local government power
to establish a health department with broad authority relating to sanitary
and hygienic matters. The inclusion of this ordinance in the revised code
of the city implies the previous existence of a similar instrument that no
doubt was a part of the city's legal equipment from an early date. It ap-
pears that a health officer was functioning in 1868 and \'ery likel\- there was
either a committee or a board of health whose chairman exercised the author-
ity of a health officer even earlier.

Since 1898 the legal provision for authorizing the city gcnernment lo
participate in health work has changed but little. It provides for a hoard
of health which is \ested with power to emplo\' a health officer and other
personnel and t(j ilo all of the ordinary functions usual to such an agency.
A few new ordinances ha\e l)een added to the health and sanit,ir\ code, regu-
lating milk and food >u|i[)lies. plumbing, theatre \entilation .nnd the- like but
the basic ailni!nistrati\e scheme remain> unaltered. The capacit\- and :ide-

202 DOWN-STATE MUNICIPALITIES

quacv of tlu- health department nia_\- be sunnise'l from the size of the annual
appropriation which was $2200 in 1927.

It seems that the first heahh officer in Kankakee was a doctor. Later
it became the practice to fill the position with laymen and then in 1917 an-
other change back to the medical profession came. Since 1917 the office
has been held by a physician. So far as available records disclose, the
following persons have acted as health officers of Kankakee.

Miron H. Van Riper, M. D. 1SC7 Charles K. Smith, M. D. 1917

John H. Van VonVert 189.5 William Yates, M. D. 1923

John H. Bell 1900 Charles K. Smith, M. D. 192.5

John Metzgsr 1915

Besides the work done by the city health department, voluntary agencies
have been active. The Kankakee Tuberculosis League inaugurated a public
health nursing service in 1919 and since then that type of service has been
continued. There has also been a clinic service for crippled children estab-
lished subsequcntl}- to the infantile paral\sis epidemic of 1917 and continued.

Water Supply

The waterworks system was first installed in 1886 by the Kankakee
Water Works Company and was later purchased by the Kankakee Water
Supply Company. In 1890 this company was bought by the American
Water Supply Company and in 1912 it was taken over b\- the Northern Illi-
nois Water Co., a subsidiary of the above corporation.

The present franchise which expires in l'>32, requires that the water
shall l)e suitable for domestic consumption and specifies the amount neces-
sary for fire protection.

Lentil 1901 the supply consisted of raw water from Kankakee River, but
in that year a new 3,000. 000-gallon rapid sand filter plant was constructed.
In 1910 two more one-half million-gallon filter units were added and the
settling capacity was increased. Equipment for the use of calcium hypo-
chlorite was replaced by a modern chlorinator in 1917. Since that time only
minor ch;inges have been maile in the treatment plant.

Sewerage

The first sewers were installed in 1886 and at present there are five
outlets discharging into Kankakee River below the waterw^orks intake and
the dam.

Due to a number of complaints abnut the condition of the river in the
city it is proposed to construct an interceptor to carry the sewage well below
the city before discharging it into the river.

KANKAKEE

203

Health Conditions

Speaking of the sufferings of the pioneers in the Kankakee region in
1844 Borroughs

"There was one, two and three day ague * * * * Mostly, however, it
was just plain 'ague' that a fellow had almost daily and with no let
up from aching bones, creeping chills, and "shakes' followed by fever.

"Whole families were thus afflicted, and the misery endured has
never been adequately set forth by those attempting to describe it. * * * *
Nine members of the Nichols family were afflicted with the malady at
the same time, and a favorite practice when the premonitory symptoms
of chills were felt was to line up in some bright, sunshiny nook where
the sun shone hot against the cabin and sit and quake and bake until
the fever came on."

At an old settlers meeting in 1841, Mr. George Legg said that the physi-
cal hardships of the early settlers were overshadowed by the almost continued
fever and ague which sapped the vitality of the pioneers and, coupled with
prairie itch, menaced the advancement of agriculture. Smallpox was suc-
ceeded by fever, ague and itch. Quinine proved a boon in the hands of the
early doctors in this communit}'.

Dr. Benjamin Franklin Uran, now president
of the Kankakee County Historical Society, who
0y has practiced medicine in Kankakee since 1872,

'^^ states that a cholera epidemic came into the ter-

^ ritory in August 1838, starting at first in a fam-

il\ named Magill, who resided on a tract of land
.1 few miles down the river from Kankakee, which
i> now part of Governor Small's farm. Strang-
ers from Indiana, traveling by covered wagon,
came to the ]\Iagill home to do some trading and
to acquire food to take on their trip. After the
strangers departed the two sons of the Magill
family took sick suddenly and died with a dis-
ease that was first thought to be "milk sick".
Then the father and mother followed the same course. It was Dr. Uran's
opinion that this was a cholera epidemic. He based this conclusion upon
the description given by a Dr. P. ^V. Knott who had lived through the out-
break.

Another cholera epidemic attacked the community in 1851. It is des-
cribed by Burroughs, who says that it appeared suddenly in June of that
year in the little community of Bourbonnais. He continues :

"A party of twenty or thirty French emigrants from Canada came
to Bourbonnais in June bringing with them the body of a child that
died on the way the day before a( Joliet. The next morning one of

Benjamin Franklin Uran,
M. D.

204

now \ -STATE Ml'NMrirAI.ITIES

them was Ktriekeii down with the terrible scours^e. Tlie weather bein.a;
very warm these emigrants were lodged in Noel Vasseur's barn. By 11
o'clock the sfime day, eight or ten more were taken ill and by 10 o'clock
that night 15 of the men were seized with the disease and all who be-
came sick, died."

Table 1.
^Mortality From Certain Causes.

w'?

.ii'?

\K \\l

S r

§,

5! =
It

WIS

n:>

112

8.1

1919

2S.S

111-20

224

1921

2 2. J

1.-.

1922

251

;■)

1923
1924

241

' 4

8
12

1.3

192.-,

248

1921!

294

8 1

Table 2.
Mortality Rates From Certain Causes.

■So

."ti

'I'J

.g"

YEAU

—

-— C

c ^

1 =

i25

= <

1918

47.:-.

20.9

13.9

6.9

510.4

783.2

594.4

1919

14.0

5 . 5

161.1

66.6

88.8

1920

13.1

ii.7

11.7

5.8

11.7

5.8

29.4

70.5

117.6

1921

12.9

...

17.3

86.5

69.2

1922

14.2

28. 4

22.7

56.8

79.5

1923

13..-)

5.5

22.3

44.6

83.7

1924

14.0

5 5

22.2

38.8

60.6

66.6

192.5

13.4

10.8

...

21.6

10.8

37.8

48.7

59.4

192fi

15.6

2.1

...

8.4

21.2

5.3

53.0

42.5

122.3

ilte fidin All Cj

per 1.000 population; ;ill others per 100.000 populati.

The outbreak ran a swift, acute, deadly course, accordint;- to Dr. L'ran's
memory of Dr. Knott's description, causing about 30 deaths within ten days
and sparing neither Indian, halfbreed nor white.

Smallpox, likewise, did not overlook the quiet villat;e of Kankakee in
the early days. Here again we have a verbal report from Dr. Iran who
was practicing medicine there when an outbreak fell upon the community in
1877. History is that 40 or 50 French and German families who occuppied
a group of small houses in a segregated district south of the Illinois Central
tracks, suffered the brunt of the epidemic. Tlie\' chose smallpox rather
than vaccination and the result was lieav\- loss of life. Their dead were

KANKAKEE 205

buric-d near the liomes and later, w lien the site was utihzed for cominercial
liuililing, the excavators were frightened away from their work when the
news went around that tlie bones were those of smallpox victims rather than
of aborigines.

Even earlier smallpcix left its indelible impression upun the place.

A severe epidemic liovered over this little C(jmmunity during the winter
of 1837-1838. That outbreak was attributed to French emigrants who came
in from Canada.

No deaths from smallpox have occurreil in the city during recent \ears
but occasional outbreaks have come from time to time to disturb the tran-
c|uility of the public mind and to stimulate the application of control mea-
sures which ha\e alw a\ s pnjved effective.

Tvphoid fever in Kankakee has run a unique course. Elsewhere it
was a chronic problem, recurring with the autumnal season with the regu-
larity of harvest and weather phenomena. Here it was sporadic. Some-
times the community escaped entirely with no cases and no fatality during a
whole year. Again a violent outbreak would darken the prospects of health-
ful prosperity. Thus in 1900 and 1901, typhoid occurred with great severity
bringing to the city in November 1901 Jacob A. Harmon sanitary engineer
of the State Board of Health who was sent in answer to an urgent request
to make an investigation. He found that 60 per cent of the families in which
the disease occurred derived their water supply fr((m the Kankakee l\i\er
which was contaminated with sewage above the cit_\'. The remaining 40 per
cent obtained their water supply from shallow wells sunk in the stone forma-
tion at the surface of which were located many privy vaults. Mr. Harmon
advised the boiling of all water used for domestic purposes whether from the
river or shallow wells, the closing of all privy vaults and the construction
of suitable sewage-treatment and water-filtration plants. The latter recom-
mendation was subsequentl}' carried out by the water-works company.

The venerable Dr. Uran recalls a significantly severe epidemic that
occurred in the nineties. More recently- statistical evidence shows that from
one to four deaths are apt to occur in a \ear or that the city may escape
without any mortality. Since 1918, for instance, there have been four dif-
ferent years in which no death from typhoid was reported. On the other
hand 1927 brought the worst record in ten years, the four deaths \ielding
a rate of 20.9.

Influenza was very severe in 1918. There were Th deaths attributed to
intluenza and 85 to pneumonia, giving a mortality rate of 510 and 594 per
100,000 respective!}'. Only one or two other nuuficipalities in Illinois under-
went such a heavy loss to those diseases that _\'ear.

Alortality from tuberculosis was also extraordinarily heavy in 1918.
The 112 deaths gave a rate of 783. Since that time, however, the mortality

206

DOWN-STATE MUNICIPALITIES

Table 3.
Cases of Certain Diseases Reported.

19-21

1922

1923

1924

1925

1920

1927

Typhoid Fever

Smallpox

Scarlet Fever

.53

Whoop. Cough

Diphtheria

Influenza

Poliomyelitis

Pneumonia*

Syphilis

Gonorrhea

*AU forms.
Notk: Case reports are never complete, but they have been much more so since 1920 than before
Illinois. A comparison between the figures in this table and those showing mortality in table
makes obvious the fact that notification is still far from complete in Kankakee.

Table 4.
Births and Infant Deaths.

Infant Deaths

YEAR

Number

I?ate»»

Number

Rate*

1918

1919

1920

347

20.5

72.

1921

326

19.

104.3

1922

366

21.4

76.5

1923

444

24.8

76.6

1924

469

2.i.8

74.6

1925

465

25.2

83.9

1926

447

23.8

82.8

■ Deaths of infants unde
• Per 1,000 population.

1 year of age per 1.000 births reported..

from tuberculosis has been more favorable than that found in most of the
other cities of the State. The rate in 1926 was 42.5, a very low figure.

Other communicable diseases have run courses that appear to have
manifested nothing particularly unusual. Diphtheria and scarlet fever have
risen and fallen with the seasons and with the epidemic cycles characteristic
of both. Neither is so fatal now as it was prior to 1900. Diphtheria is far
less prevalent.

The general death rate is rather high but this is unfavorably influenced
by the location there of a State hospital for the insane. The percentage of
people in the older age group is also larger than usual.

References.

Reports of State Board of Health, various dates.
Local official records.

A New Discovery of a Large Country in America, Father Louis Hennepin, Chioaffo. 1903.
Legends and Tales of the Homeland, Burt E. Burroughs, Chicago, 1023.

Dr. Thomas H. Leonard's personal interviews with various officials, physicians and citizens of
Kankakee.

Ketvanee

Edward C. Kent

First Health Officer. Village

of Kewanee, 1S88-1890

Soon after Kewanee was incorporated as a village in 1855 certain mem-
bers of the village board were organized into a nuisance committee. This
was the beginning of what later developed into the municipality's public
health service but the functions of that committee, as the name implies, were

confined to the abatement of nuisances except

that it was expected to initiate and carry out
measures calculated to prevent and control chol-
era and smallpox whenever epidemics of these
diseases developed or threatened. So far as
available, records disclose that no occasion ever
arose which prompted this committee to attempt
any significant epidemiological work during the
forty-two years of its existence.

In 1890 the village board appointed sort of
a health board whose duties were entirely advis-
ory. This board consisted of Doctors W. H.
Cole. J. H. Mannon and J. C. Nichols ; from 1891
to 1892 Doctors J. H. Mannon. W. H. Cole and
E. C. Stilson. During the )ears 1892 and 1893 the health advisory board
was also suspended, but in 1894 the board consisted of Doctors J- H.
Mannon, J. C. Smiley and E. C. Stilson, who served up to the time that the
city was incorporated in 1897.

When the village was transformed into a city in April 1897. the village
nuisance committee metamorphosed into the committee on fire and nuis-
ances and George Tunnicliffe was at once employed at $20,00 per month
as its executive officer. In July of the same year
the responsibility for health work was shifted by
ordinance to the finance committee which ap-
pointed Tunnicliffe as health officer at $30.00 per
month.

In 18'^S another change came when the
duties and functions of city collector were fused
with those of health officer and Tunnicliffe, fall-
ing heir to the double job, was the recipient of
another advance in salary which now netted him
$40.00 per month. Except for changes in person-
nel and some modification in pay this continued
to be the health arrangement until 1907.

George Tunnicliffe

First Health Officer, City of

Kewanee, 1894-1S99

(207)

208

IIOWX-STATK .M UNICIPAI.ITIES

John Chisnall succeeded Tunniclift'e in 1899 and was, in turn, replaced
In- Charles Collins on October 6, 1902. Then fallowed \\'. H. Barrett who
took (ifhci,' with a new city administration in the sprini,' of 1'1)5. He resis^ncd
sh<.)rtl\ and was succeeded by B. j\l. Cavanaugh who (juit in the fall ni 1906
and \\a^ followed by I{. P. Reeser.

ll i,- interesting to observe that when the monthly rfmuneratiini of the
oflice was $40.00 only $10.00 were specified for health service and that from

1902 on to 1907 when the pay was
$50.00 per month, $20.00 were speci-
fied as pay for the health officer part
of the job.

Bo.-\RD OF He.m.tti Brings Medical
Ixi-lim;xci:.
I'roljably the UKJst important single
change in the public health service
histiir}- of Kewanee took place in 1907
when an ordinance creating a board
of health became effective. Its most
significant feature was the stipulation
that the membership should consist of
a physician and a layman, the physi-
cian to act in the capacity of city
health commissioner. For the first
time we find here an official expression
of the influence of the medical profes-
sion in directing the policies and ac-
tivities of local public health work.
Dr. \\'. D. Hohmann and .\. 1!.
Spickler, iluly appointed, constituted
Thus Dr. Hohmann

W. D. Hohmann. M. D

First Medical Health

Officer. 19117

the first board of health

became Kewanee's first medical health ofiicer.

During the same }ear the medical profes-
sion manifested its interest and exerted its influ-
ence in another and probably no less important
wav when a committee of ])hysicians headed by
Dr. 11. N. Heflin succeeded in getting the cit_\-
council to pass a milk ordinance. This legislation
created a milk commission which was vested with
authority to regulate the production, handling
and sale of milk in the municipality. Dr. Heflin
was made chairman of this commission which
soon nu'VLied with the liojird of health when Dr.

A. B. Spickler
Member First Board of

Health. 1907

KEWANEE

209

Heflin becanic health commissioner, a positi(in which lie has held continu-
ously up to the time of this writing.

The list of lay health officers who have served Kewanee as a village and
city include :

E. C. Kent lSSS-1890 W. H. Barrett ISU-J

W. M. Elliott 1S90-1S92 B. M. Cavanaugh 1905-1 90(i

George Tunnicliffe 1894-1899 E. P. Reeser 1906-1907

John Chisnall 1899-1902 Floyd Johnson 1907-1911
Charles Collins 1902-1905

The two medical men who have served Kewanee as health commis-
sioners are:

W. D. Hohmann, M. D. 1907

H. N. Heflin. M. D. 1907 to dale

Commission Form of (^Iovernment Adopted.

In January 1911 the city of Kewanee adopted the commission form of
government and the powers and responsibilities of the board of health auto-
matically fell upon the commissioner of public health and safety. Under
the new form of government. Dr. Heflin was re-
tained as health commissioner and a sanitary in-
spector in the person of James L. Torticil was
employed. The appropriation to the health de-
partment for 1911 amounted to $737.00 and of
that sum the sanitary inspector drew $240.00.

Another and final change in the legal status
of the ]iul)lic health service caine to pass in 1920
when a new ordinance creating again a board of
health was adopted. Under this arrangement.
Dr. Heflin was appointed chairman of the board
and health commissioner.

The expenditures of the city for public health
work totaled approximately $3000 in 1926 and
d the commissioner — on a part-time basis — and

H. N. Hetlin. M, U.

City Health Commissioner

1907 to date

the paid personnel inclu
two sanitar\' inspectors.

Otiikr Oeficial and Voluntary Health Agencies

Like man}- other places, Kewanee gets a larger volume of health work
done through quasi official and voluntary agencies than directly through
the city health organization. In 1926, for example, there were three school
nurses at work in the community, one nurse employed by the Wolworths
Manufacturing Company and one nurse employed by the Civic Nurse Asso-
ciation. All of these four were actively engaged in public health work".

210 DOWN-STATE MUNICIPALITIES

Kewanee also supports a clinic for the benefit of crippled children in
that vicinity. The orthopedic medical and the specialized nursing service
for the clinic proper is provided b\ the IlHnois Crippled Children's Society
but local organizations manage the many details which keep this piece of
work going in that community. Kewanee is, futhermore, the home of Mr.
E. E. Baker, president of the Illinois Crippled Children's Association, who
has exercised a very large influence in vitalizing the activities of that organ-
ization throughout the State.

Water Supply

The original waterworks was installed in 1883-1884 comprising a single
well drawing its supply from glacial gravel deposits in the vicinity of Crystal
Lake at the northern edge of the city, a pumping station, collecting basin,
and limited distribution system. The single well proved inadequate and
the supply was subjected to some surface and shallow-ground-water pollution
because the water-bearing gravel was not covered with a protecting imper-
vious clay layer and the area in the vicinity was building up.

In 1887-1888 three drilled wells, a litde less than 1,500 feet deep and
drawing their supplies from St. Peter sandstone were drilled near the original
pumping station and the original well was abandoned except for supplying
water for road sprinkling purposes. Later, while working on one of these
wells, it was so damaged that it could not be used, and in 1905 a fourth well
was drilled in the same locality which well was extended into St. Peter sand-
stone. Trouljle was experienced in pumping from these wells, possibly be-
cause the holes may have been crooked, and in 1903-1904 air-lift equipment
replaced the deep-well pumps.

The water from the St. Peter sandstone wells was of good sanitary
quality as drawn from the wells, but it was subjected to some possible con-
tamination in open basins after withdrawal. It was quite hard and the sup-
ply did not continue tu meet tiie demands of the growing cit\ .

In 1908 a new pumping station and two new wells ending in St. Peter
sandstone were installed near the C. B. & Q. railroad tracks near the center
of the chy, but these wells and station were not placed in service until about
1912. In 1911 and possibly other years the city had to purchase water from
one of the industries that had a separate well supph'. Following a report
made by a consulting engineer, the new station was placed into service in
1912 and another well recommended at that time was finally drilled in 1919.
This last well was 2,497 feet deep and ended in Potsdam sandstone. The
old pumping station and wells at the northern edge of the city were aban-
doned and a new half-million gallon storage reservoir built near the new
pumping station in the central portion of the city. The old one and one-

KEWANEE 211

lialf million gallon reservoir near the old pumping station had leaked badly
for some time so that it was not possible to maintain it full.

Since 1919 the Potsdam well drilled in that year has served as the main
source of supply, but the two other wells at the same pumping station have
been available for emergency or supplemental use. All wells are pumped
by air-lift.

The water as drawn from the wells is safe and its sanitary quality as
delivered to the consumers depends on whether or not it is exposed to con-
tamination in the receiving basin into which the well water is discharged be-
fore it flows to the storage reservoir. Cross connections between the city
mains and the private supplies of several industries might serve to contamin-
ate the public water supply if the private supplies are not always maintained
in excellent condition and free from contamination. The water from the
Potsdam well is even harder than that from the St. Peter wells and there
has been some local agitation in favor of a supplx- of better mineral quality,
but no definite plans or possibilities for such improvement have been de-
veloped.

Sewerage

Most of the area in the city drains to the east to .Spoon River, a tributary
of Illinois River, and the smaller northwest and northern portion drain to
the north into tributaries of Green River, a tributary of Mississippi River.

Private drains may have been installed previous to 1890 but in that year
the first public sewer system was installed by the city and comprised the
existing 18-inch main outlet sewer to the east and some of the larger sub-
mains. Since that time several additional districts have been sewered and
connected to the original sewer district and outlet sewer.

Extensions and improvements to the sewer system have been very slow
and inadequate to satisfactorily serve the growing city and maintain sani-
tary conditions. Up to the close of the period covered by this history sewers
were serving only about 8,000 population out of the total estimated popu-
lation of 20,000. Also many of the sewers are overloaded, causing water
from them to overflow from manholes and back up into basements. Of
the total estimated population of 20,000, 18,000 are in that portion of the
city which drains to the east and 2,000 are in the northwestern and northern
part of the city that drains to the north, in which no sewers at all have been
installed.

The original sewer system comprised a septic tank for partially purify-
ing the sewage. The tank is entirely inadequate to effect any material puri-
fication of the sewage, and the stream below the outlet has been grossly pol-
luted for years.

212

DdWN-STATI-; .MUMCn'AI.ITIKS

At the close of thi.s historical period the city was ijlanning to enjiage
competent consulting engineers to make an inventory of the existing sewer
s\stem and prepare a report, plans and specifications for an adequate s_\stem
of sanitary sewers, treatment plant, and also storm-water sewers so that it
is quite probable that in the near future the existing insanitary conditions
at Kewanee cauM-il b\ inadequate and defective sewerage facilities will be
entirelv remedied and the entire built-up area will be provided with adequate
sewerage and drainage facilities and existing objectionable stream pollution
abated.

H HALT II Con nrr IONS

Kewanee went through the "pest house" and "shotgun quarantine"
periods like most other cities and villages that existed prior to the twentieth
century and like most others the records of severe epidemics promptly fell
into obscurity when the "passover" was done, leaving nothing but tradition
upon which to depend for history.

It is related that the water committee of the city council was authorized
in July 1897 to dispose of the "detention hospital", a dignified name given
to what in other communities was ordinarily bluntly called "pest house".
This transaction implies that smallpox and perhaps cholera had not over-
looked the tranquil village of Kewanee. Doubtless, the "pest house" was a
monument to the havoc wrought and the alarm inspired by these loathsome

Table 1.
AIoKTALiTV From Certain Causes.

■-

•X,

i"?

rf «■

Y !■: \ 1!

>-.

■5 £

c £

£.£

J =

'~.

£2.

1907

203

1908

1.54

1909

167

'.'.'.

1910

148

1911

154

' 1

' 6

1912

138

•2,

2.'»

1913

209

1914

' i

1915

1916

' 1

' i

1917

•2

1918

' '3

■36

1919

1920

270

1921

221

1922

216

1923

246

1924

195

192.5

199

1926

237

" '4

KEWANEE

213

Table 2.
]\IoRTALiTY Rates Froji Certain Causes.

„

[£

'gift

gl?

YEAR

._,

fc,

§1

ci.

j:'

.-•

5!!l!

■r.

■S

(£

•
1907

22.4

88. 6

11.0

44.3

11.0

...

1908

16.8

1909

IS.l

1910

1.1.8

1911

1.0.4

i6!6

16.

o6!i

eoii

1912

12.9

IS .'7

9. ->

9.3

65.7

234.7

1913

18.4

26.4

oi!s

44.1

132.4

291.4

1914

16.6

8.3

16.6

"%.'%

41.0

116.7

1915

7.8

78.9

134.2

1916

14.9

7.4

44.9

202.4

1917

14.2

14!2

71.3

242.7

191S

13.6

0.7

1S).\

264!3

34.0

531.3

1919

26.0

6 . 5

6.5

05 . 1

97.7

267.1

1920

16. '7

50.0

g'2

6.2

18.6

237.5

93.7

250.2

1921

13.4

24.3

12^2

12! 2

6.1

79.0

18.2

9] .2

127.7

1922

11.5

10.7

.'.■;

10.7

53.2

149.1

1923

12.9

21.0

5.2

2i!6

5.2

84.2

57 . S

163.1

1924

10.0

sois

5.1

36.0

51 . 5

51.5

192')

10.0

5.1

]6!i

35.4

40.5

111.6

1920

11.8

19.8

23.7

47.4

24.8

149.2

per 1000 pninil;itii

.lU others per 100,000 popiilatic

Table 3.
Cases of Certain Diseases Reported.

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

Tv-phoid Fever

Smallpo.x

;)

Measles

580

258

346

118

Sf.irlet Fever

139

143

190

Wlinop. ColIRh

109

122

134

112

Diphtheria

106

IiifliiPiizri

2765

399

2500

Piiliomvelitis

Meniiitfilis

Tuherrulosis*

;-,

14S

116

Snihilis

Gonorrhea

•T

•All forms.
Note: Case reports are never complete, but they have been nuicli more f
Illinois. Kewanee is among the cities where notification now is complet
rate index to epidemic conditions.

diseases. Mow frequently smallpox visitesl the community is largely a mat-
ter of conjecture. That the disease left its mark upon the hearts, and pro-
bably the faces too, of the local people, the story of the "detention hospital"
declares.

P.ut the passing of the "pe.st house" with all of its implications did not
prohibit the disease nor protect the people against smallpox. In 1911 an
epidemic involving 79 cases spent itself upon the communit\- and a milder
outbreak, involving 19 cases, occurred in 1913.

214

DOWN-STATE MUNICIPALITIES

Table 4.
Births and Infant Deaths.

Births

Infant Deaths

YEAR

Number

Rate**

Number

Rate"

1911

1912

1913

1914

1915

1916

337

25.2

118.6

1917

308

21.9

139.6

1918

385

2G.2

127.2

1919

355

23.1

70.4

1920

372

23.2

94.1

1921

376

22 .

103.7

1922

350

111! 7

85.7

1923

364

1!1.1

85.2

1924

359

IS. 5

91.9

1925

379

19.2

71.2

1920

381

IS. 9

94.4

Some of the data not obtainable.

* Deaths of infants under 1 year of age per 1000 births reported.

*» Per 1000 population.

A return wave of influenza overwhelmed the city in the winter of
1919-1920 when some 8,000 or 9.000 cases developed, leaving a considerable
fatality rate behind.

Other recent epidt-iiiics include 280 cases of scarlet fever in Kewanee
and vicinity in 1''20 and an unusual prevalence of wliouping- cough during
the same season.

In l'^22 an mithreak of typhoid fe\'er caused 3.^ cases of sickness and
resulted in a careful epitlemiological study by the State Department of Public
Health. It appeared that the source of the epidemic was a carrier on a
dairy farm and that the disease had been spread through a local dealer who
did not pasteurize hi> milk. ( )ne of the two lirothers who operated the
plant succumbed to an attack of typhoid and the tracing of the epidemic to
this concern wrecked the entire business.

During the following winter season a mild epidemic of scarlet fever
was attributed to a local milk supply. This, together with the typhoid ex-
perience, led to the adoption of an ordinance in 1''23 which practicalh' re-
quired the pasteurizatii)!! of the city"s milk supply.

In the spring of 102() an epidemic of German measles yielded 663 cases
and was accompanied by a considerable wave of pneumonia.

These illustrations indicate that the city has experienced what might be
termed an ordinary health history. Within the course of seventy odd years,
the public efforts to protect community health and prevent disease have run
about the average course, beginning with a vague conception that somehow
there existed a relation between miisances and contagion and culminating

KEWANEE 215

with a service directed by a physician who is able to place at the puhhc dis-
posal as much of modern epidemiology as it is willing to accept and utilize.
In the meantime, ordinances relating to milk, water, sewage disposal, plumb-
ing and similar matters have marked the advance of popular knowledge
about the prevention of disease and the preservation of health.

References,

Data supplied by Dr. H. X. Heflin, Commissioner of Health of Kewanee.
Annual reports of the City of Kewanee, Kewanee, 111., various dates.

Bulletins of the Illinois State Water Sun-ey, Dr. Edward Bartow, Director. Urbana, lllimiis. various
dates.

U. S. Census Reports, Washington, D. C, various dates.

La Salle, Oglesby and Peru

These lliree munici])alilies are talvcn toijetlicr because all three now en-
jo\ the services of a single health department known as the H\gienic Insti-
tute. LaSalle and Peru are contiguous, constituting a single community
with twii municipal governments. Oglesb}' is across the ri\er and a little
south. All three grace the banks of the Illinois River.

The three cities have this in common. They are strictly industrial.
In the tri-cities and vicinity are three cement plants, two zinc plants, a clock,
a wheel and a [dow factorx', a number of coal mines and numerous smaller
industries.

The piipulation is strictly industrial in character with a heavy foreign
element. In l'^20 there were 13,050 people in LaSalle, 4.1o5 in ( )glesby and
3,860 in Peru.

Peru W'as incorporated in 1851, LaSalle in 1852 and Oglesby in 1902.
Each maintained separate and di-stinct governments throughout until 1914
when a plan, which will be discussed at some length hereafter, for providing
a health service for all three through one organization was devised and car-
ried out.

Hkaltii Macitinicry

The first board of health in Lai-^alle was appointed in 1852 with John
Gillett, James Strain and David L. Hcnigh as members. .\ year later Peru
felt the need of such an agency and the city cnuncil elected J. \'. H. Judd
and R. P. Wright to constitute the first board ')f health there. After their
creation, however, the boards of health succeeded in doing very little worthy
of record. At least no record of an_\- significant activities has survived.

Some thirty years later, in 1886, a physician by the name of P. AI. I'.urke
became a member of the board in LaSalle and it seems that from that date
the medical profession began to exercise an intimate influence over the
public health affairs in all three communities. At any rate it became the
customary practice to make some doctor the health officer in each com-
munity and to remunerate him at the rate of about $300 annually, expecting
of him no arduous duties except, perhaps, in the face of some emergency
which everyone, including the health officers, hoped would not arise. But
emergencies did arise periodically and at such times the boards of health
and the health officers became active, doing e\erything that their know-
ledge and resources permitted to bring relief. It was during such an oc-
casion in the nineties that Dr. A. W. Ilatton did constructive work enough
in LaSalle to attract |)ublic attention. Sometimes sanitary policemen or in-

(216)

LA SALLE, OGLESDV AND PERU

217

spectors were emploxed ami again no one was active in health work so that
expenditures varied from a few hundred to a thousand or more dollars per
year.

Ordinances, too, were placed upon the hooks from time to time as
occasion and public sentiment required liut these, like the activities of the
health departments, meant much or little according to some momentary emer-
gency or condition that provoked favor or disdain. It \\as hard enough to
enforce regulations that seemed to curtail the liberties or desires of any con-
siderable number of people. In 1''12, for example, when smallpox became
epidemic. man\' infected or exposed persons were concealed while others
Ixildly walked the streets in open defiance of the quarantine rei^ulations.

It was conditions like these coupled with the obvious need for efficient
liealth service, that led I'rederick \\'. Matthiessen, a wealthy local citizen,
to inaugurate a plan for giving to the people in
the three communities a first class, efficient
pul)lic health service. ( )ne thing he saw clearly
— that the hoards of health could not pro\'ide the
sort of service recjuired with the resources at their
command and the task of increasing their re-
sources would be difficult. He saw, too, that
it would be uneconomical to maintain a separate
health >er\ice of the type desired for each com-
munit\'. Thus in 1910, he began to manifest
an interest in the health of these communities
when he donated $10,000 as an endowment fund
for the maintenance of a medical librarw The
next year he pro\ ided the funds for opening and operating a milk laboratory,
designed tn >upply at ;i reasonalile cost the proper kinds of milk for infants
and children in the vicinity.

This laboratory was placed under the di-
rection of a board of directors, made up of Doc-
tors W. W. Greaves, R. C. Fullenweider, P. M.
I'.urke, H. AI. Orr, W. O. Storey, Anna Hen-
nesy and O. B. Stafford. An expert nurse,
.Minnie Farrar, was placed in charge and food
mixtures were made and dispensed upon pre-
scriptions from physicians. This practice soon
fell into disfaxor among the doctors, however,
antl die laboratory became a milk dispensary for
poor people. Still later the laboratory was fused
with the Hygienic Institute and was transformed
into the F-mma Alatthiessen Chancellor ]\Iemor-
i.al Infant Welfare .Ntalion.

Frederick W. Matthiessen

W. \\^ Greaves, M. D.

218

nnwX-STATE MUNICIPALITIES

Thesf experiences
takiiiL'. He decided t<i

li'd Mr. Matthiessen into a more ambitious under-
|)r<i\ide the tliree cities of LaSalle, Oglesby and Peru
with an adequate pubHc health service if a prac-
ticable plan could be devised. He took counsel
with his son-in-law. Dr. Phillip S. Chancellor
;inil with Dr. ( iiistiu F. Kuediger. As a result
.\lr. .Matthiessen proposed to endow an organiza-
tiiin to be known as the Hygienic Institute, with
headquarters in LaSalle, fully ef|uipped and
manned for rendering adequate health service in
the three cities provided each community wi)uld
accept the director of the Institute as its chief
health officer and take care of such legal techni-
calities as were necessary to clothe the organiza-
tion with whatever authority was re(|uire<l to ful-
fill its purpi i^es.
The |)roposition was accepted and the Hygi-
enic Institute came into existence in 1914 and
developed into one of the best equipped and most
complete health departments in Illinois. To
legalize its functions in the three cities, the
ma_\ors appoint health officers who are nominat-
ed by the director of the Hygienic Institute, whose
assistants they become, and who are paid by the
Hygienic Institute. This scheme eliminates pol-
itical influence, insures cooperation and provides
all necessary authority.

Futherniore. the parlicii^ating communities Gustav F. Ruediger, M. D.

Director, Hvgienic Institute,
1914-1917

FuIIenweider, M. D.

parlicipatmg communities
were recpiired to employ each a sanitary police-
man, to adopt uniform sanitary codes, to report
all contagious disease:

Anna Hennesy-Kinder
M.D.

to the main headquarters
and to manifest good faith in otherw-ise provid-
ing for complete harmony of service from the
principal organization.

Thus the Hygienic In.stitute came into being
and its continuity is assured by reason of a liberal
endowment made for the ]iui'pose by its creator.
It is governed b\' a board of trustees made up
of five members who elect new members to fill
vacancies, subject (inly to the disappro\al of the
-Matthiessen heirs. They constitute the actual
board of health of the three municipalities

LA SALLE, OGLESBY AND PERU

219

althougli each has a paj)er board of health in order to lawfully settle any
legal questions that may arise at any time. The first board of trustees was
made up of Ernst Roth, president, George A. Wilson, treasurer, J. Henry
Cox, Charles Nodler and Harry A. Bent. Dr. Gustav F. Ruediger was the
first director of the Institute. Subsequently, Dr. Carl F. Raver, Dr. Edmund
W. Weis and Dr. Arlington Ailes have occupied the position of director, the
latter being the present incumbent.

The Hygienic Institute is housed in a remodeled building adjacent to the
LaSalle-Peru Township High School. Here are maintained properly fur-
nished offices with filing cabinets and printed
blanks for keeping records, and a completely
equipped laboratory for making bacteriological
diagnoses and sanitary chemical analyses of
water and foods. It was thought desirable tn
have the Institute in close cooperation with the
hiyh schnol so as to liring the pupils in touch
with the pulilic health work. This has been
amply justified as high school classes have fre-
quentl}- visited the offices and laboratory and
have had the work explained to them. JNIembers
of the Institute have frequently been invited by
the high school principal to give health talks be-
fore classes or at the general assembly.

In formulating the plan of organization of the H\ gienic Institute and the
cooperative health department, economy of operation was not the paramount
consideration. The first thing sought after was
efficiency in public health administration, but
those who advanced the project were desirous
that original research should also be provided for.
They therefore, aimed to have assistants enough
to allow the director and the bacteriologist to de-
vote considerable time to this important side of
the work.

The H\gienic Institute now provides every
t\pe of service ordinaril}' expected of or perform-
ed by a health department, delves into the field
of research and makes itself a general public
health, medical and welfare center for the com-
munities it serves, it seems to be meeting fully the purposes for which it
came into being. A clear picture of the organization is given in the June
1927 edition of Nation's Health. Its present director. Dr. Arlington .\iles. is
speaking.

.J. Henrv Fox

Harry A. Bent

220

DOWX-STATE M U N 1 CI PAI.ITIES

Carl P. Raver, M. D.

Director, Hygienic Institute

1917-191S

"Despite tlie fart that this is an endowed institution and could
better afford to be independent than most health departments, every
effort is made by the director and staff to promote harmony and a spirit
of cooperation lietween itself and the practicing physician. The dinners
spoken of above is one method used to ai>
jiei'se the primitive instincts of the human
animni, and are enjoyed by the doctors and
staff as well. These dinners are prepared
and served by the nurses at cost to the so-
ciety, after which the physicians enjoy
tlieir regular monthly piogram in the li-
lii-ai-y of the Institute. The library is
l<eiit up-to-date with a rensouable selection
(if late books and current journals. This,
together with the laboratory service ren-
dered the physicians, is of great value in
piomoting and preserving mutual good
will. The Institute also recognizes the in-
aliennbie rights of the physician to trent
the sick, and the broad principle thnt
health should be bought and paid for
the same as any other valuable and purchasable commodity.

•'The physicians, on their part, are showing confidence in the health
dejiartnient and their program by endorsing the various diagnostic,
educational and demonstrational clinics, and by meeting the Institute
half way in the field of preventive medi-
cine, especially when epidemics threaten.
The danger of mentally impoverishing cer-
tain classes by carelessly e.xtending free
service is guarded against. The details of
this cooperative service in the field of pre-
ventive medicine have not been fully
solved, but it is being approached with the
hope of solution along the lines stated
above.

"In the matter of community coopera-
tion, with other agencies, in the field of
public health, there seems to be entire
harmony. The three boards of education
are cooperating with the health program
in their schools and are assisting finan-
cially. The tuberculosis society employs

a nurse, who is. in fact, a member of the Institute staff of nurses, and
who is under the supervision of the chief of this division. Their other
expenditures for health have been made in harmony with the wishes
and with the guidance of the health officials. There are many large in-
dustries in the community, three of which maintain medical or nursing
service, and with which the Institute cooperates. The Tri-City Family
Welfare Society is also well organized and officered, and the chances of
cooperation and mutual usefulness between the Hygienic Institute and
this society are many.

Edmund W. Weis. M. D.

Director. Hvgienic Institute,

191S-192.5

r.A SALLE, OGLESBY A\D I'F.KL'

221

"A unique and valuable service of this society is the sponsoring of
mental clinics, which are held at the Hygienic Institute. The clinicians
are furnished by the Illinois Institute for Juvenile Research, and the ser-
vice is taken advantage of by the society,
the Institute, and the schools. The La-
Salle-Peru Township High School also
maintains an unusual service, known as a
Bureau of Educational Counsel, which gives
individual study, advice, and guidance to
students, especially in their mental and
emotional complexes and their fitness and
choice of vocations. The psychiatric and
psychological service for this bureau is
also rendered by the Illinois Institute for
Juvenile Research located at Chicago, and
the physical examinations are made by the
Institute staff. The Metropolitan Life In-
surance Company also maintains a full
time nursing service, but as yet this is not
under the service of the Institute. There
is, however, entire harmony and cooperation, which is exceedingly
important since the Hygienic Institute also maintains a visiting nurse
service.

"The organization and activities of the Hygienic Institute have
grown and changed and kept pace with the ideas of the best public
health practices, ranging from almost purely sanitary, through pre-
vention, to the modern idea of health promotion."

Arlington Ailes, M. D.

Director, Hygienic Institute

1925 to date

La Salle Water Supply

The fir.'^t waterworks was constructed in 1888 with a spring about two
miles east of the pumping' station as a source of supply. During 1894 a
second high-lift pvnnp was added and in 1903 and 1904 extensive changes
were made. The spring supply was abandoned and a well developed, lo-
cated in the Ilinois River bottom land at the southeast corner of the city
just south of the Illinois-Michigan Canal, between Little Vermilion River
and the Illinois Central Railroad. The well was pumped by a centrifugal
pump. A larger collecting reservoir was constructed and the present boiler
room, equipped with new boilers, was built. In 1907 a feed-water heater
was added and in I'Jll a second well was sunk.

The two wells in use in 1913 were 39 feet deep and /i-; feet in diameter
and penetrated a gravel water-bearing stratum. The collecting reservoir
had a capacity of 35,000 gallons. \\'ater was ]3umped directly into the ser-
vice main.

In 1913 a third well was sunk and two elevated equalizing reservoirs
constructed.

The waterworks remained unchanged until 1921 at which lime the old
plant was abandoned and a new plant built.

222 DOWN-STATE MUNICIPALITIES

The present waterworks comprises the three drift wells, pumping station,
and two equalizing resei'voirs. There are about 25 miles of service mains
and the average water consumption is about 153 gallons per capita daily.

I'r(im time to time cross connections have been in existence between
]j()lluted river water and the citv well supply at certain industries. The last
of these cross connections was broken in 1926.

Routine analyses of samples from the public water supply have been
made 1).\ the State Department of Public Health since September 1921.

At the present time the water at I.aSalle is classified as being of a safe
sanitary quality.

La Salle Sewerage

.\ combined system of sewers, with three 36-inch outlets discharging
into the Illinois-Michigan Canal, and serving that portion of the city south
of Eleventh Street has been in existence for several years. There are sev-
eral areas in the city not adequately served, and no immediate improvements
are contemplated.

Poor drainage facilities couiiled with the extensive overflow lands in
Illinois River bottoms have from time to time produced severe mosquito-
breeding nuisances.

Perl' Water Supply

The first waterworks was installed in 1891. At that time the city was
too much in debt to issue bonds and build the works, so the Peru Water
Company was formed and bonds issued for $43,000. Besides this sum the
city paid $25,000 for mains and hydrants, making the cost of the system
$68,000. It was the intention of the city to purchase sufficient bonds an-
nually to acquire complete ownership of the works in nine years, but owing
to paving expenditures, this was not done and a re-issue was necessary. In
1914 all but $2,000 in bonds had been taken up b}- the city. .Mthough the
water company owned the plant, the city alwa^-s operated it.

The original supply consisted of one well constructed in 1889, 1,365 feet
deep into St. Peter sandstone, located in the south part of the city. A col-
lecting reservoir of 250,000 gallons capacity was constructed in 1891, when
the water plant was built.

In 1893 another well was sunk 1,254 feet deep near the Chicago, Bur-
lington & Quincy railroad depot. In 1905 a third well was put down at the
pumping station site. In 1913 a fourth was constructed. The collecting
reservoir was not used after construction of the fourth well in 1913.

At the present time only three wells are in service, the first well having
been abandoned. Water from the wells flows into a concrete collecting
reservoir of 360.000 gallons capacity located at the pumping station from

LA SALLK, OCLESBY AND PERU 223

whence it is pumped to the (hstribution standpipe. The pumping station
was being rebuilt in 1926, at which time four cross connections between the
city supply and that of the Western Clock Company were in existence.

The present water consumption is about 56 gallons per capita daily and
the water is regarded as being of a safe sanitary quality. Analyses of
samples from the public water supply have been made b\- the State Depart-
ment of Public Health since September 1923.

Peru Sewerage

In 1914 the city was said to be quite thoroughly sewered by a system
of combined sewers, with ten outlets discharging into Illinois River, ranging
from 15 to 24 inches in diameter.

In 1925 several portions of the city were affected by the backing up
of sewage in basements and improvements to the sewer system were contem-
plated. Recommendations were made for systematic and comprehensive
study of the sewerage needs of the city, but to date little progress has been
made.

Oglesbv Water Supply

The waterworks was installed during 1915 and 1916. A well 14 inches
in diameter and 1,645 feet deep was constructed near the center of the town.
Prior to 1915 a local coal company supplied a number of residences with
water which previously had been passed through a softening plant.

At the present time the waterworks comprises the original well which
enters St. Peter sandstone, the air-lift equipment which was installed in
1916, an open surge tank above the well, a 15,000-gallon collecting tank, and
the pumping station. \\'ater is pumped direct into the distribution system.

The present consumpticm is about 40 gallons per capita. The water is
regarded as being of a safe sanitary quality. Analyses of samples from the
public water supply have been made by the State Department of Public
Health since October 1926.

Oglescy Sewerage

A system of sanitarv sewers, which serves the central portion of the
city, was installed prior to the development of the public water suppK'.

Health Conditions

A. D. Jones, who visited the town of Peru on his trip up the Illinois
River in the late fall of 1838, wrote :

"Peru is said by many to be unhealthy which the residents on the
spot stoutly affirm to be highly libelous. Still I need further proof
that it is not generally unhealthy on that river — not sickly, however,

224

now X -STATIC M UNICTPALITIIC:

that it need be shmined by those who are disposed and determined to
take care of their health * * * * in these bottoms, swarm such hosts ot
mosquitoes as New England men never dreamed ot. They fairly malje
it difficult to breathe and silence was imposed from very fear of inhaling
tliem with our breath. They were not to be endured and hot as it ^vas,
we closed the curtains and smolu'd them out with our cigars."

During the early \ear.s, however, there seems to have been but one epi-
demic of sufficient importance to impress the minds of the la}- historians.
It was the cholera outbreak.

In LaSalle, this epidemic is reported to h.ave killed the inhabitants by
the hundreds. The burial of the dead of all ages and sexes is likened to
scenes after a l>attle.

Table 1.
Mortality From Certain Causes in LaSalle.

cS-S-

YEAlt

-h

-"5

1918

320

1919

149

1920

196

1921

151

...

1622

1«4

1923

174

1924

161

1925

161

...

;)

1926

184

Table 2.
AIort.nlitv Rates From Certain Causes in LaSalle.

nl?

YEAR

3
C

1 =

1918

25.4

32.4

40.3

8.0

24.1

548.3

64.5

510.1

1919

11.5

7.6

30.7

123.0

115.3

1920

14,9

30.6

15,3

15.3

130.7

53.8

192.3

1921

11.4

22.6

60.2

67.8

1922

12.2

...

29.8

14.9

29.7

104.2

1923

12.8

7.3

22.2

44.4

111.1

1924

11.7

14.2

28.4

42. S

64.2

1925

11.6

21.5

7.1

35.9

79.1

93.5

1926

12.6

13.7

...

13.7

41.4

62.1

89.

109.5

per 1,000 pii|nil;iti.

per 100.000 populati.

LA SALLE, OGLESBY AND PERU

225

Beebe says that :

"During the summer of 1853 cholera again made its appearance, and
with increased violence. From the first settlement of the town to 184S,
with the exception of the years 1838 and 1839, when bilious fever pre-
vailed to some extent, the inhabitants had enjoyed immunity from
disease, seldom experienced in new western settlements, or indeed, in
any other. For the space of one year, no death occurred except from
casualty. Even the ague found few. if any subjects. Throughout the
summers of 1S50 and 1851. cholera continued its ravages in the surround-
ing towns and country, and visited Peru but slightly. In the early part
of the summer of 1S52, when LaSalle and other contiguous places were
scourged, Peru remained healthy. At length it appeared tc have spent
its material and departed the entire country. Suddenly it reappeared;
and while the places i)reviously afflicted remained healthy, Peru was
devastated to an extent not surpassed, if equaled, by any place in the
United States. The estimated number of victims was from five to six
hundred, being about one-sixth of the entire population. It was observed
that less panic and excitnient were produced than upon its visitation in
1839. But few cases occurred in the two following years, and from
that time to the present — 1S5S — the same freedom from disease has pre-
vailed which distinguished its early settlement."

This hamnving experience with cholera was evidently the thing that
first brought a demand for an official public health organization in any of
the three municipalities. The boards of health that this emergency sum-
moned into being probably had little to do with it but cholera never again
spent its fury upon these communities with sufficient force to awaken alarm.
If it ever appeared there again the fact escaped significant notice.

One bad epidemic of smallpox in the communities is recorded. It oc-
curred in lyl2. Due to the character of the population, a good deal of
prejudice and the lack (jf a strong health department it was hard to manage

Table 3.
Cases of Certain Diseases Reported in La.Salle.

1916

1917

1918

1919

1921

1022

1923

1924

1925

1926

1927

Typhoid Fever

Smallpox

Measles

112

247

212

r,n

42.3

411

'32

Scarlet Fever

161

Whooping Cough

...

116

190

Diphtheria

'30

'76

'2s

.'i'l

Influenza

1781

1«

1.)

Poliomyelitis

' h

•2

Meningitis

Tuberculosis*

' '3

■24

'i7

'24

Pneumonia*

102

Syphilis

Gonorrhea

•All forms.

No figures avaihible for 1920.

226

DOWN-STATE ilU X 1 CI I'ALITIES

0. C. Yoder. M. D.
Health Officer, Peru

and involved over 200 cases before it subsided. Since the orj^anization of
the Hygienic Institute, smallpox has never stained an appreciable foothold
in tile territory that it serves.

1 )i])litheria also visited these communities with particular severity on
one occasion that made the epidemic stand out in
bold relief above ordinary outbreaks of that dis-
ease. This happened in 1888. Scarcely a home
in which there were children escaped and few
families withstood an attack without the loss of
one or more members. Diphtheria was com-
mon before and after that dreadful experience
but no other single epidemic of this disease is
recalled with such grievous vividness. More
recently a determined campaign by the health
department against diphtheria seems to have been
attended with satisfactory results. Only one
death was registered in LaSalle and Peru in 1925
and none in 1926. No cases were reported in LaSalle in 1927. although
the prevalence of the disease in the State at large that \ear advancetl thirty
per cent above the 1926 figure.

Problems of typhoid and scarlet fever presented themselves to plague
the inhabitants of the district on numerous occasions. There were 25 cases
of typhoid in LaSalle in 1916 but that disease has been practically eliminated
from the district through successful efforts to cause the abandonment of
privies and through intelligent sanitary supervision over water and milk
supplies. Scarlet fever is still an unsolved problem, a rather widespread
epidemic having occurred in 1927, but it seems to be less malignant than
in years gone by and there is hope upon the horizon that specific means of
prevention may shortly be at hand.

Infantile paralysis did not overlook the district during the epidemic
wave of that disease in 1916 nor in 1927. In the former year nine cases
were reported from LaSalle and Peru and some half dozen in the latter.

Influenza was deadly there in 1918. It caused 68 deaths in LaSalle
and Peru, yielding a mortality rate of 548 per 100,000 population. Pneu-
monia was charged with 64 deaths in the same year, giving a rate of 516 per
100,000.

Statistics for }ears prior to the opening of the Hygienic Institute are
incomplete and unreliable but the illustrations cited are sufficient to indicate
tliat the communities now embraced in the health district suffered from their
full share of communicable diseases and that the operation of the Institute
has resulted in a pronounced improvement in health conditions.

LA SALLE, OGLESBV AND PERU

227

Table 4.
Births and Infant Deaths in LaSalle.

Births

Infant Deaths

YEAR

Number

Rate**

Number

Rate*

1918

1919

1920

3.-il

26.7

99.7

1921

344

25.!.

72.7

1922

301

22.0

69.8

1923

320

23.3

81.3

1924

347

25.2

77.8

1925

310

22.3

96.8

1926

301

20.6

89.7

'Deaths of infants under 1 ye
** Per 1000 population.

of age per 1,000 birtlis repurted.

References

Data supplied by Dr Arlington Ailes, Director of the H^vgienic Institute, LaSalle, Illinois.

Text supplied by Dr. Arlington Ailes. especially in reference to the early boards of health, cholera

and other epidemics of thi
Annual Report of the
Annual reports of the
Illinois and the West,
History of Peru, H. S.
State Water Survey Bulletin, Bartow

1 the organization of the Hygienic Institute.

Ik', fiscal year ending March, 1902, LaSalle, Illinois.

iiMte, LaSalle, various dates.

l-.nston, 1838.

U, S. Census Reports, Washington, D. C,

"Moline

Located on the banks of the Mississippi River a few miles above the
mouth of the Rock River, Moline spreads across most of the intervening
territory which is only one and a half miles in breadth, with a population
largely of Scandinavian ancestry, estimated at 34,500 in 1926. F'rincipally
industrial, the business of the community centers around the manufacture of
farm implements and tractors.

Moline is not a communit)' apart but lies contiguous to the cit\' of Rock
Island on the one side and practically so to East Moline and Silvis on the
other, while Davenport stretches along the opposite shore of the Mississippi.
Intimate intercommunications are always maintained between these several
municipalities and this fact complicates the health problems of the one great
community.

-Moline was incorporated as a town in 1848 and under a special charter
in 1855. It was reorganized as a city under the Cities and Villages Act in
1872. Another change in the city administration took place in 1911 when
the commission form of government was adopted and then in 1919 it reverted
back to the aldernianic form.

Growth and development in Moline have lieen gradual and substantial.
The place first appeared as a separate unit in the United States Census re-
turns in 1860 when 2.028 people lived there although the first white settlers
arrived about 1828. This number grew to 4,166 by 1870 and to 7,800 in
1880. In IS'HI there were an even 12,000 inhabitants and in 1900 there were
17,248. At the end of the next decade the population was 24.199 and 30.-
734 in 1''20. About 24 per cent of the 1920 population were foreign liorn
whites and a trifle more than one per cent were negroes. About 21li> per
cent were 45 \ears old or over.

Health Maciiinkry

The Cities and \'illages Act provides for the establishment of local
boards of health and it is ])robable that Moline adopted an ordinance taking
advantage of that feature in 1872 when the city was incorporated under the
Act.

At any rate we find the cit\' council ado])ting a compulsor\- vaccination
ordinance in 1881. when .smallpox threatened the community, and the health
officials busied themselves with its enforcement. Both the passage of the
ordinance and the activities concerning its enforcement imply the previous
existence of some sort of official machinery. Not only so but reference

(228)

MOLINE

229

is made of the fact that Dr. C. Piper was president and Dr. L. G. Dunn,
secretary, (if the lioard of health in 1882.

About this time the cit\" spent $6,000 in cnnstructinsjf an iscilation hos-
I'ital. tor the detention of smallpcix jiaticnts. There seems to have been
Httle if any change in the legal arrangements for providing a healtli organ-
ization between 1872 and 1905. During all that period there was probably
technically in existence a board of health and for the greater part of the
time it functioned through a lay health officer, usually the chief of police.
Edward Kittleson, still a member of the police department, filled this dual
office over a long period. The board of health had on it one (ir more physi-
cians and apparently the chairman of the board, usually a doctor, was re-
garded as the administrative head of the city"s health service.

In 1905 a new practice was inaugurated when an ordinance revising
the status of the board of health and creating the
office of city physician was adopted. This
lilaced the responsibility for administration
s(|uarely in the hands of the meiiical profession,
the cit\' physician being paid for his services on
a part time basis.

The list of city physicians include:

R. C. .J. Meyer, M. D. 1!H).5

A. H. Arp, M. D. 1907

Perry H. Wessel. Jr.. M. U. 1911

H. S. Bennett. M. D. 191.5

W. T. Hinmiui, M. D. 1917

A. H. Kohler, M. D. 1919

E. A. Edlen, M.D. 192:1 to date

R. C. J. Meyer, M.D.
City Physician, 1905-1907

With the a(lii]ilii>n of the commission form
of government in 1911, no material change was
made in the method of administering the health
department. The office of city physician was
continued and the commissioner of public health
and safety chose to deleg"ate to him the responsi-
liilities of carrying out the public health duties.

.\fter a few }'ears of commission government
the city revertel back to the aldermanic form in
1919 when an ordinrmce was passed making the
mayor the citv ph\sician and the health inspector
a board of health. This was later expanded to
include other members of the health department,
which in 1027 included an inspector and a
chemist, and an alderman.

E. Z. Eastman

First Commissioner of

Healtii and Safety,

1911-1919

230 DOWN-STATE MUNICIPALITIES

\'oluntary and other public or quasi-public agencies have added a very
considerable strength to the public health machinery of the city so that the
volume of work done is much greater than the limited capacity of the health
department staff would suggest. The county participates in tuberculosis
work through funds collected by tax levy under authority of the tuberculosis
sanitarium law, the school board employs a nurse and operates a dental
service while voluntary agencies maintain a clinic for crippled children, a
system of infant welfare stations, a visiting and
public health nursing service and allied types of
work. One of the most complete and active
health centers found anywhere in the State is in
Moline under the management of voluntary
agencies with Miss Mabel Dunlap, a nurse and a
splendid executive, in charge.

A good conception of what public health ser-
vice is maintained may be gathered from the re-
port of a survey made by the State Department

of Public Health in 1926. It reads, in part, as „

^ E. A. Edlen, M. D.

follows : City Physician, 1923 to date

"Scoring 571, or .57.1 per cent, Moline ranks seventh from the top
among the fifteen cities embraced in the appraisal of public health
activities.

"The health department, functioning under the authority of a
hoard of health, consists of a part time health officer and an inspector.
The former acts as registrar of vital statistics and is personally active
in communicable disease control while the latter, who is appointed by
the mayor, placards premises for quarantine, makes sanitary inspec-
tions, collects samples of milk and supervises garbage collection. One
full time school nurse and a part time dentist are supported by the
board of education, while the King's Daughters and the Red Cross com-
bine resources in maintaining a public health and bedside nursing serv-
ice, devoting considerable energy to prenatal and preschool hygiene.
Voluntary and other agencies are responsible lor far more of the health
work in Moline than is the city government, efforts of the latter b?ing
credited with only 149 of the 571 points earned.

"The tuberculosis clinic is a county project in which Moline shares.
A venereal disease clinic was discontinued in 1925 after several years
of operation. Clinics for infants and children appear to be functioning
less vigorously than in years gone by.

"Out of the city treasury is expended slightly more than eight cents
per capita annually for public health service, funds appropriated to the
health department for garbage collection being excluded. Other agencies
contributed enough to make the gross per capita expenditures about 39
cents in 1925. Apparently Moline gets maximum returns on the money
invested in health projects, ranking relatively high on the score sheet
and very low in the appropriation column.

.MOLINE 231

"Reporting of cases of comniunicable diseases and record keeping
was reasonably complete. The health officer states that he personally
visits about one-half of all cases of contagion reported, giving educa-
tional advice to the household. A sanitary inspector placards premises
and releases from quarantine. No communicable disease nursing service
is maintained. Two isolation hospitals, one for smallpox and another
for other communicable disease patients, are provided in the city. Out
of 14 cases of diphtheria last year only one was cared for by the isola-
tion hospital, while but 5 out of 72 scarlet fever patients received hos-
pitalization.

"A very commendable practice is that of notification between the
school and health authorities of all cases of communicable diseases that
may be of concern to eitlier.

'"Tuberculosis field nursing service and the follow-up work of post-
sanitarium cases is done with great thoroughness. A total of 1,020
visits were recorded as having been made in 1925, whereas the aiipraisil
quota tor the city on the basis of 13 deaths from tuberculosis during the
year was only 650. Under the supervision of the county sani'arium
board a clinical service is maintained for the entire county in wliich
Moline participates.

"While local sanitarium facilities are inadequate to take care of the
community needs, still the county allows $25.00 per week per patient
for this service to tuberculous citizens. Under these circumstances only
1,646 patient days were spent in sanatoria by Moline citizens. Further-
more, the patients who received sanitarium care at public expense were
mostly moderately advanced in the disease, practically none being in an
incipient stage.

"Voluntary agencies provided 210 field nursing visits to prospective
mothers. There is no prenatal clinic, although an educatioral center
for prospective mothers is maintained and had 550 visits recorded for
last year.

"A rather large percentage of the l)irths of the city take place in
hospitals. Field nursing visits in behalf of infants are about one-half
of the required number for a maximum score on that item, while the
number of infants in attendance on the clinic uumljered l,:;4ii against
a requirement of 1,642.

"Field nursing and clinical service for the preschool child were at a
higher ratio, the score for these items approaching very nearly the
maximum. It appears that the work done in behalf of the preschool
child (age 2-6 years) is much more nearly equivalent to the appraisal
requirement than any other jjhase of public health service in the city.

"The board of education furnished a visiting nurse and a part-time
dental surgeon, but no school physician to look after the health of its
grade school children. In the private schools these activities are under
the supervision of the King's Daughters. Frequency and completeness
of the weighing, notification of parents, and the follow-up of under-
weights meet all reasonable requirements for such activities.

"Out of 3,474 public school children examined by the dental sur-
geons, 1.739 were found who needed attention, and 1,311 received treat-
ments consisting of fillings, extractions and oral prophylaxis. In the

232

DOWN -STATE MU XICIPALITIES

private schools 104 of the 519 ohilrlren found with dental defects were
given treatment.

"While the public water supply is ordinarily sate and the super-
vision good, still the purification plant is heavily overloaded. To this
condition has been attributed one or more epidemics in the past. A
house-to-house sanitary survey made by the State Department of Public
Health in 1920 stowed the existence of 1.635 privies with only 77 per
cent of the dwellings connected to sewers. While many of the privies
have doubtless been abandoned during the intervening years, it is reason-
able to conclude, in view of experience
elsewhere, that hundreds of these primitive
accommodations still exist.

"The city maintains no public health
laboratory, although a municipal chemist
is employed who tests the public water
suiiply daily and examines samples of milk
and food supplies at the request of the
board of health. A branch laboratory of
the State Department of Public Health pro-
vides facilities for examination of diph-
theria cultures locally.

"In summing up the situation in Mo-
line, it can be fairly stated that the local
health department is doing all that is
humanly possible with the limited person-
nel at its command. The president of the board of health, the city phy-
sician, the registrar of vital statistics and the health officer are one and
the same man; and he is on a part-time basis with a salary of $600 per
year. The health inspector, in addition to his multiplicity of re-
sponsibilities in the health department, assumes supervision of the
collection and disposal of garbage."

\. E. Anderson
City Chemist

Water Supply.

The first waterworks at Moline vi'as constructed by a private company
in 1883 and pin-chased by the cit\- in 1S87. The supply was obtained from
Mississippi River.

The city installed a mechanical filtration plant in 1902, consisting of
three filters. In l''ll, two more filters were added. Hypochlorite was used
in that year and was replaced by liquid chlorine in 101, t.

It was estimated that the typhoid rate was about four times as hijjh
previous to the installation of the purification plant, as it was later. How-
ever, in the winter of l''17-18, typhoid became more prevalent and an investi-
gation indicated that cit\ water was the cause due to the use of insufficient
chlorine.

I'ntil recently cross connections lietween the raw and filtered water
made it necessary to classify the suppl\- as doubtful. At present, the plant
is old ;uid liadh in need of reconstructing; and enlarCTinaf.

233

MOLIME

VITAL 5TATI5TICS«1

conn. Dis, coriTROLsi

VEh. DIS. COriTROL
TUB. COMTROL
HEALTH CHILDs<--n5
HEALTH 5CH. CHILD ^
SAMITATIOri^ss."-^
niLK COMTROL
LABORATORY
POP HEALTH m5m

PCRCEMT OF STAMDARD SCORE
FOR EACH OF TEM MAJOR HEALTH ACTIVITIES
1925

Tliis i;raijh illustrates the stioiis and weak iioints in .Moline's pulilic
health service, official and voluntary, as it existed in 192.5. It is based uiion
a personal survey and rated ui:on the standards evolved by the American
Puljlic Health Association. The total efficiency rating in Moline was 57
per cent of the standard perfection reriuirenient.

Reports on tlic pollution of the river and the purification plant prepared
by Alvord & Burdick, sanitary engineers, and Dabney H. Maury, consulting
engineer, recommend reconstructing the filters and increasing the storage
capacit}'.

Si:\vi;ra(;k.

The first sewers were installed about \'Hr> and since that time the sys-
tem has been extended luitil, at present, the most of the city is adeqitately
sewered. The system is built on the separate plan. There are t\\d sanitary
sewers discharging i^aw sewage below the waterworks intake and one sanitary
sewer discharging treated sewage above the intake. The treatment includes
Imhoff tanks and chlorination.

The ri\er is badly polluted b\ other cities as well as Aloline. and many
complaints ha\e been made.

234 DOWX-STATK MUNICIPALITIES

IIl'.Al.TH COXDITIOXS.

\\ liilc tuberculosis, typhoid fever, diphtheria and pcrhajis other infec-
tions were undoubtedly causing far more damage to health and life smallpox
is the deadly disease about which centers practicall\ the whole story of com-
nnniit\- health during the early days. Tradition of earlier suffering very
likcl\ grew dim in the glare of subsequent epidemics so that the first im-
l)oriani outbreak of which record is available took place in 1881. During
that \ear smallpox, carefully concealed in a bale of rags, arrived in Moline.

A great epidemic wave of smallpox was just starting in the .'^tate. f-)ne
of the most deep seated foci was in Chicago, the great immigration terminal.
I'rom that point a bale of rags was consigned to a factor) in Ahiline and
eight of the employes who handled it promptly came down with smallpox.
Exposure of citizens had been general so the disease started to spread.
Alarmed at the prospects of a general epidemic compulsory vaccination was
ordered by the city council so that the outbreak was limited to 21 cases and
some half dozen deaths. During the next few years smallpox could not get
a foothold in the city although introduced on several occasions and in spite
of the fact that a general epidemic prevailed in the State during the early
eighties. The wholesale vaccinations iluring the autumn of 1881 rendered the
communitx' immune.

Like every other good thing the immunity against smallpox wore oflf
with the passing of time and the neglect of vaccinatitin. Xew immigrants
came in, new babies were born and even the immunil\ in those who had been
vaccinated grew less complete as time went on. Consequentlv, the city was
again open to danger and danger usually seeks out favorable places. So
from about 1900 on Moline has been a rather chronic focus of smallpox.
Records are incomplete for the first fifteen years after that date but begin-
ning with 1916 up through 1927 the city has not entirely escaped the disease
in an\ \ear. Case reports have varied from 1 to 102 per year while
the character, of the disease has manifested itself in every degree from ex-
treme mildness to extraordinary malignancy. In 1''24, for example, nine
out of 52 cases that occurred in Aloline. R(.)ck Island and ."sterling, termin-
ated fatally.

Tvphoid fever has been a chronic problem in Moline for years. The
citv escaped during a whole \ear without a single case for the first and only
time, so far as records disclose, in 1927. The worst experience occurred
in 1917 and 1918. Toward the end of December 1917, a serious outbreak
of typhoid fever developed. The first cases appeared late in July and in-
creased numbers were reported during the following months. In the middle
of January 1918, the disease reached epidemic proportions approximately .SO
cases being reported during the first half of the month.

Table 1.

IMoRTALiTY From Certain Causes.

235

YEAU

•3

1906
15107
1S08
1!)0»
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
192G

276
286
309
352
276
443
358
502
436
383
386
373
614
389
371
300
281
344
311
347
359

7
5
18
15
12
13
(i
12
7
24
11
3
1
1
4
1
1
1

' i

"7
"i

4
2

3
1

6
1

' 1

' i

' "5
"3

8
10

7
3

1
4
7
(>
3
3
1
1
3
4
1

" '2
8

1
134
19
15
1
(i
7
6
7
8

26
44
26
32
33
38

27
41
33
10
40

2(1
17
23
20
20

36
2S
35
32
30
46
30

■33
47
48
41
89
31
46
12
12
31
13
15
29

Table 2.
AIoRTALiTY Rates From Certain Causes.

YEAil

•X

■c

c'^.

1906

12.8

14.0

23.3

37.3

121.3

IflS.O

1907

12.9

22.6

(»

104.0

45.2

198.9

126.6

1908

13.5

21.9

4.3

8.7

113.9

153.4

1909

14.9

29.7

21.3

4.2

136.1

1910

11.4

20.6

12.3

20.6

136.3

123.9

1911

17.8

72.8

4.0

28.1

4.0

152.8

183.1

1912

14.0

58.8

11.7

125.4

117.6

1913

14.1

45.8

3.8

7.6

103.2

1914

16.2

48.4

7.4

152.8

123.1

1915

14.0

21.8

7.2

10.9

120.1

171.1

1916

13.7

42.6

3.5

17.7

56.8

170.6

1917

12.6

24.3

13.8

3.4

138.9

142.4

1918

20.4

85.7

21.4

1(1

25.0

478.5

114.2

317.8

1919

13.2

35.8

3.2

19.5

61.8

84.6

100.9

1920

12.0

9.6

48.3

54.8

148.3

1921

9.7

3.2

9.5

32.0

72.9

38.0

1922

8.7

3.1

18.6

62.1

37.3

1923

10.5

12.2

3.0

21.7

61.1

94.8

1924

9.3

3.0

9.0

18.0

66.0

49.0

1925

10.2

2.9

11.7

20.6

38.3

44.2

1926

10.4

2.9

3.8

2.9

23.2

52.1

84.0

XOTE :

"he rat

=• from

\ll (

3a u

is r

sr 1

300

popula

tion

1 olhcr

Iior 100.00

lir

pulatio,,

DOVVX-STATF. MUXirirALITIES

The State Department of Public Health was called upim td make an
investigatinn. The findings pointed strongly to the water supply as the
soiux'e nf infection and after remedial steps were taken the epiilemic abated
ill llu' latliT ]>art of Januar\. and the situation seemed practically cleared up
during l-"cl>ruary and .March.

Table .1.
Casus oi- Ci;rtain Diseases Reported.

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

•I'viilioid Fever

!)7

334

Sinuilp.i.t

102

Measles

110

4.59

452

159

1042

357

247

1026

Srarlet Fever

r.3

Wli. ,.!,,. C.u^'li

164

219

373

179

liiplilli.Ti.,

Irillnt'iizj

2008

247

I'l.li.iiinelitis

' 4

Meiiiiisitis

' "i

Tuberculosis*

114

143

Pueunioniii*

...

129

Svphilis

' 6

(i.uuu-rhe:i

(13

127

244

294

142

137

111

CluiTicroid

...

♦.Ml forms.
NOTIC : Case reports
Illinois.

never complete, but they lune b
table indicates signific^int iinpri

In .\pril 1018, the disease reappeared, with an increased number of
cases during May and again assumed epidemic proportions in June and in-
creased in seriousness during the first half of Julw In the first fifteen da}S
of this month, 125 cases were reported.

A more painstaking and exhaustive study of the situation was made
which linall\ determined that the epidemic was due to the faulty operation
of the water plant, whereby raw and untreated water from the Mississippi
l\i\er had been permitted to enter the local supply.

The epidemic carried over into January of l''!'.* liut since that time
the typhoifl rate has not lieen unusually high although the city had but one
free \ear, \'>27, from the disease.

Tuberculosis was at one time of major importance as a cause of death
in .Moline but the careful and persistent work a,gainst that malad}' has re-
sulted in a \ei'y satisfactory improvement in that respect. The mortality
rale of .s2.1 ])er llH),(K)(l population in I'lid was one of the most favorable
among the cities of the .State. None of the other communicable diseases
have manifested themselves in any extraordinary fashion in IMoline, with
the possible e.xception of influenza and ])neunionia. The mortalitv rate in
.Moline from these two inlcctioiis together was the sixth highest among
municipalities of the State in I'MS. With l,i4 deaths attributed to inlluenza
and S'» to |ineinnonia in that \ear, the niorl.'dity per 100,000 mounted to
478. .S and 317.8 resi)eclivel\ .

237

Table 4.
Births and Infant Deaths.

1 Births
1

Infant Deaths

YE Alt

Number

Hate**

Number

IHate*

1!IOO

1901

1902

1903

1904

190r,

ISOfi

434

20.3

117.5

1907

490

22.2

130.6

1908

473

20.8

114.1

1909

385

10.4

132.4

1910

480

20.0

89.4

1911

563

22. 8

85.2

1912

508

20 ^0

120.0

1913

5f,5

22.0

128.0

1914

626

24.0

86.0

1915

512

18.2

96.0

191(i

597

22.0

92.6

1917

547

IP. 7

61.1

1918

554

19.fi

92 . 6

1919

579

19.7

75.0

1920

834

26.8

44.4

1921

739

23.3

43.3

1922

658

20.4

48.6

1923

626

19.1

65.5

1924

630

18.9

61.9

1925

643

19.0

42.0

192(5

662

19.2

60.4

1927

732

20.08

42.3

* Deaths of infants under 1
*• Per 1000 population.

of age per lOOil births reported.

Altogether, however, Mohne enjoys splendid cominunit\ health in spite
of her unhappy experiences with some of the epidemic disorders. The gen-
eral death rate is lower than that for the State and lower than that for most
of the comparable municipalities in Illinois or any other state for that matter.
Deaths among infants less than a year old are likewise few in number com-
pared with other places. The rate in 1926 was 60.4 per 1,000 live births,
a figure just one-half of that for 1912. Since infant mortalit}' is regarded
as a sensitive index to health conditions and to the effectiveness of public
health service, the prevailing low rate during recent years may be accepted
as a manifestation of effective infant and prenatal hygiene service in Moline
and of a relatively good condition of public health.

References.

Revised Ordinances, Citv of lloline, niinois, 1920.

Annual Deports of the State Board of Health, Springfield, Illinois, various dates.
Report of an Apprni-;il r.f Hoalth Service for the Year 1925, in Fifteen Illinois Cities, Isaac D.
vlings, M. D., Direrl". "1 I'ulilir. Health, Illinois Health News, Ma.v-.Iunc, 1920.
Bulletins of the IIIu.mi- ^i m. Water Survev, Urbana, various dates.
U. S. Census RepniK. n .i.lji.i^i.jn D. C, various dates.

Oak Park

B\ Dr. 1-raitk S. Nccdhain. Health Coiiiiiiissio)icr.

Joseph Kettlestrings, an Englishman from Yorkshire, was the first white
settler within the boundaries of what is now known as Oak Park. With
his wife and three children he came here in 1833, making the journey from
Cincinnati in a covered wagon. At that time, according to William Halley
in his Pictorial Oak Park, "Not a vestige of civilization was visible. Chicago
itself was only an outpost village of a few inhabitants. There were no rail-
roads and no country roads. There were, however, few Indians to fight,
no trees to blaze for pathways through dense forests, but still the pioneers
had hardships to endure. The land itself was not yet pre-empted nor open
for settlement and those who had settled were simply squatters."

Two years later, when this land was put up for sale, Kettlestrings
purchased the quarter section known as Oak Ridge because, as he said, "It
was the only dry land between Chicago and the Aux Plaines", — as the Des
Plaines River was called. The home of oak boards which he erected on
this land was the first house of any kind ever built in Oak Park. Later,
when suitable additions had been made tu this building, he started a tavern
known as "Oak Ridge House". He had been working, meanwhile, for
George Bickerdike, who owned a saw mill on the banks of the Aux Plaines,
and eventually Kettlestrings became his partner in the business.

The sale of public lands, of course, brought more settlers and the busi-
ness man, and in 1848 the first train ran from Halsted Street to the Des
Plaines River. Later this road became the Chicago & Northwestern railway
and transported grain brought by the farmers from west of the Des Plaines
River to Halsted Street.

In 1858 the town could not boast more than half a dozen houses, all
situated on Lake Street. The school house had been erected in 1855. The
first drug store and doctor's office were opened in 1866, just after the Civil
War, by Dr. Orin Peak.

The name "Oak Park" dates only from 1871, when the Noyesville post-
office and the Harlem railroad station were changed to conform to the new
name. At that time and until 1902, Oak Park had no local governing body,
being part of the town of Cicero. However, when Cicero was organized in
1857, the residents of Oak Park had a large part in determining Cicero
policies through a controlling power in elections, and this condition existed
until 1867. From this time on there were fewer Oak Park men on the
board and finally, in 1809, the misuse of privileges by officers of the board
caused Oak Park to secede.

(238)

OAK PARK

239

Election of officers followed in ( )ak Park on December 17, 1901, and
village government was inaugurated January 2. 1902, witli Allan S. Ray as
the first president.

Since then its po|)ulatiiin has increased rapidly and many changes and
improvements have taken place. All of the streets and many of the alleys
are novi^ paved. The sewerage system, wliicli was installed in 1891, has been
enlarged to meet the increased demand, and an adequate supply of good
water has also been provided for the village needs.

The village of Oak Park is located directly west of Chicago and con-
stitutes a rectangular area, three miles long and a mile and a half wide. On
the north and east it is bounded by the city of Chicago, on the south by
Berwyn and Cicero, and on the west by Forest Park and River Forest.

The population of Oak Park has experienced its greatest period of
growth since 1900 and particularly since 1910. There were 500 inhabitants
in the village in 1871 and 10,000 in 1902. The census returns showed
1').444 in 1910 and 39.900 in 1920. Of the 39,900 there were 9,877 or 24.7
per cent in the 45 years or c>ver age group and 85.4 per cent were native
born whites. Only 169 negroes, a matter of four-tenths of one per cent,
were residents of the village.

Health Department.
On January 5, 1905, an ordinance was adopted by the village of Oak
Park, creating a department of health. The first board of health was ap-
pointed at that time, comprising Drs. W. E. Potter, H. G. Vaughn and
A. F. Storke. Another ordinance providing health regulations was passed
on January 14th.

The health of the community was cared for l)y boards similarly a])-
pointed until April 20, 1916, when Mr. C. E. Buck was appointeil as the first
commissioner of health. Three months later, on July 20th, an ordinance
was passed creating the first advisory medical
board, consisting of the following: Drs. W. E.
Potter, W. A. Ribbeck, G. W. Beebe, H. C.
Vaughn, C. W. Poorman and J. W. Tope.

About a year and a half later Mr. lUick re-
signed and Dr. Frank S. Needham was appointed
commissioner of health on Januar)' 17, l'M8 and
has continued in office to date.

As the result of a court decision in connec-
tion with the quarantining of contacts, during a
smallpox epidemic in another city in Illinois, the
villa.ge of Oak Park amended the above ordi-
Frank S. Neefiham, M. D. „ance on Mav 17, 1922, creating a board of
Commissioner of Health, , , , '. . , . . ■" r i i i

1918 to date health to consist of the commissioner of health

240 DOWN-STATE MUNICIPALITIES

and six otlier members selected from among the physicians of the village, to
be appointed by the president, with the advice and consent of the village
board, the commissioner of health to act as executive ofificer. The mem-
bers of the first board of health so ap])ointed were as follows:

Frank S. Xeedham. M. D.. Commissioner and ex-officio Chairman.
L. W. Beebe, .M. D. W. L. Ruggles. M. D.

C. E. Hemingway. M. U. W. T. Hughes. M. D.

A. H. Parmalee. M. D. M. D. Jones. M. D.

OAK PARK

l% y ? ' : ° ^f ^

VITAL STATISTICS^
conn. DI5. COTiTROLwl
VEh. DI5. COMTROL ^
TUB. COMTROL
HEALTH CHILD^-i-il
HEALTH 5CH CHILD '^
SAMITATIOh'^-"'-^"Il
lilLK COMTROL
LABORATORY
POP HEALTH mt

I PERCEMT OF STATIDARD SCORE

FOR EACH OF TEM MAJOR HEALTH ACTIVITIES
[ 1925 I

This graph illustrates the strong and weak points in Oak Park's public
health service, official and voluntary, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in Oak Park was 60
per cent of the standard perfection requirement.

The system of public health administration created by the ordinance of
1922 continues to prevail. Under this ordinance the health department
meets all legal requirements necessary for performing satisfactory service
and for dealing adequately with all problems which the health authorities
are likely to face. It ranked well up toward the top among fifteen leading
cities of the State in a health service appraisal made by the State Department

OAK PARK 241

of Public Health in 1926, based upon the 1''23 activities. In the appraisal

report we read :

"The score of 599 gives Oak Park fifth place among the fifteen cities
studied for efficiency and adequacy of public health service. This city
is unique in being the only one of the group in which there is a board
of health, all members of which are physicians, and this board has been
of much assistance to the health officer in promoting a spirit of harmony
between the health department and the local medical profession. Those
activities which have been undertaken by the health department have
been well carried out. A number of important services, however, are
not under the direction of the health department. The health depart-
ment employs one nurse for work in the parochial schools, but other
school hygiene activities are under the direction of the board of educa-
tion.

"Infant welfare work is conducted by the Infant Welfare Society, and
tuberculosis service by the Chicago Tuberculosis Institute. The health
department handles vital statistics, contagious disease control, food and
milk control, sanitary inspection and laboratory services.

"The city health budget is $16,000 per annum, funds from other
sources bringin.H' the total yearly expenditures up to $43,532, a matter of
31 cents and S5 cents per capita, respectively."

ViT.vL Statistics.

The commissioner of health is the registrar of vital statistics and the
records are maintained at the department of healtli. From the year 1917 to
date, such records are intact and available for use.

Published statistics usually are made up of all the births and deaths
which occur in the village. This circumstance, coupled with the fact that
a large maternity hospital to which many obstetric patients from other com-
munities come, is located in Oak Park, makes it appear that the people of
this village are unusually fecund. According to these gross vital statistics
annual birth rates of from 30 to 50 per 1,000 population are common. As a
matter of fact these rates shrink to a range of 12 to 20 when the data are
analyzed to show the births in families who reside in Oak Park.

Epidemics.

During the year 1915 an epidemic of typhoid fever appeared in this
C(jmmunity, caused by a typhoid carrier who was employed in the kitchen
of the high school lunch rooms. About thirty cases of the disease developed
among the pupils and teachers of that school.

The year 1918 brought the influenza epidemic from September 23rd to
December 31st. There was a total of 1,368 cases of influenza reported, with
47 deaths from that disease. Seventy-six deaths from pneunu)nia also oc-
curred during the same period.

242

DOWN-STATE MUNICIPALITIES

Table 1.
Mortality From Certain Causes.

YEAR

5
1

Diphtlieria
Influenza

1917
1918
1919
1920
1921
1922
1923
1924
192r.
1926

■l.-,6
519
448
ri39
527
566
651
708
759
824

...
1

' i

'.'.'.

1
4

' i
2

12 47

2 29

3 11)
5 8

4 5
2 7

1 4

2 8
4 13

16
16
16
13
8
17
31
22
15

'76
50
68
37
29
39
29

■53

Tal)le 2.
Mortality Rates Fro.m Certain Causes.

»•

fc.

■2

.2?

YEAR

•v

■i

"3 ^

1917

13.5

1918

14.4

11.1

33.5

131.2

44.6

212 . 2

1919

11.8

2.6

5.2

76.6

42.2

132.1

1920

13.5

10.0

5.0

20.0

32 . 5

170.4

1921

12.3

2.3

4.6

11.6

18.6

30.2

86.0

1922

12.5

2.2

4.4

8.9

11.1

17.7

64.3

1923

13.7

4.2

14.8

30.0

82.5

1924

14.3

2.0

6.0

2.0

8.1

62.8

.58.7

1925

14.8

1.9

3.8

15.5

42.7

1926

15.4

3.6

7.4

23.4

28.0

99.0

Note: The rate from All C:u

per 1000 pnpnlnti.

nil others per 100,0110 populatii

Smallpox appeared in Oak Park at the close of the _\ear 1920, 36 cases
being reported. The State regulations for the prevention and control of this
disease were established and unvaccinnated children were excluded from
school, which involved legal entanglements. The case was finally disposed
of in the courts in favor of the defendants.

School Nurses.

The first school nurse in Oak Park was appointed in January, l'U6, to
take care of all schools in the village and to receive a salary paid jointly by
the board of education and the village.

Following the influenza epidemic in 1918, school inspection was
arranged for and the number of nurses increased to four in the grade
schools. Two other nurses were provided by the high school.

OAK PARK

243

Tabel 3.
Cases of Certain Diseases Reported.

1921

ly22

1923

1924

192.-.

192(1

1927

Typhoid Fever

Malaria

Smallpox

Measles

1244

2S6

.i34

314

1088

108

1044

Scarlet Fever

17S

142

168

110

133

Whoop. Cnnsli

22 I

53S

37S

2fi7

404

173

264

Diplnheria

107

:'.8

Influenza

Poliomvelitis

Meningitis

■■'■

Tuberculcsis*

41)

3.-)

f>7

.'>.')

Pneumonia*

111

119

140

1.57

213

l.-)3

Syphilis

Gonorrhea

*AI1 forms.
Note : Case reports are never complete, but they have been much i
Illinois. This table indicates improvement in notification more tl

About three years later the nursing force was increased to its present
size, that is, five nurses for the grade schools, whose salaries are paid by
the board of education, one nurse provided by the high school, and one nurse
for parochial schools and health department work, whose salar\- is paid by
the village.

Laboratory.

The laboratory in the health department was first established in a meagre
way in 1905 and continued until l')14, when a full time bacteriologist was
employed.

At present a well-equipped laboratoi"}- is maintained as a part of the
health department. Regular examination is made of the drinking water and
all milk and cream sold in the village, in addition to the usual routine work,
including examination of cultures, smears, etc.

Talile 4.
Births and Infant Deaths.

ths

Infant Deaths

YEAR

Nuniher

Rate"

Number

Rate*

191Y

777

23. C

1918

941

23.6

43 . 5

1919

913

24.1

47.0

1920

1207

30.2

65.5

1921

1224

28. 4

53.9

1922

1.503

33.3

54.5

1923

17S1

37. 7

37.0

1924

2152

43.6

29.2

192.'>

2283

44.4

35.0

1926

2531

47.3

35.1

Kier 1 year of age per 1000 births reported.

244 DOVVX-STATK MUNICIPALITIES

Watkk Sri'j'LV.

Oak I'ark oljlaincd its water sii])ply from in(li\i(kial wells until the
year 1885, when deep wells were drilled, a reservoir constructed and mains
laid. This remained the source of suppl\ until 1909, when Oak Park first
connected with the water system of Chicago and a portion of the village
enjoved this service. During the }ear 1912 the connection was completed
and ( )ak Park received Lake Michigan water in all of its mains, pressure
heing maintained by its own pumping station.

The supply thus olHained proved to be inadecjuate at certain times of
the day, especially during the summer montlis, so in 1912 a reservoir was
constructed and installed, with a capacity of 5,000,000 gallons, enabling the
village to maintain a reserve amount for use when the Chicago supply be-
came low.

Adjoining the reservoir is the ])umping station, which has six pumps.
These may be used, in combinatiini, to raise the pressure to 45 pounds for
domestic use and 60 pounds for lire protection, throughout the 101.38 miles
of water pipes in the entire village system.

Seweracf-:.

The sewer system in Oak Park was laid about 1S'>1. draining south and
empt_\ing into the Drainage Canal. Since that time two additional sewers
have been laid in Chicago Avenue and North Avenue, flowing westward
through the sanitar}- district sewage plant located in Maywood, Illinois.

Oak Park now has 88 miles of sewers, ranging in size from b" to 84"
in diameter.

Privies are not allowed to be maintained within the village limits, as all
streets have access to sewers.

Garbage Collection and Dlsposal.

The present incinerator was built in 1907, at an approximate cost of
$12,000, with an estimated capacity of burning 30 tons a day. At the present
time apprnximateh' 60 tons of garbage alone are burned dail\'.

An ordinance [)n)vides for careful wrapping of all garbage, covered
metal containers and other s;mitary precautions.

S.\NITARV IxSPECTrOX.

In addition to the nurse, bacteriologist and quarantine officer, the depart-
ment employs a sanitary inspector, whose dvity is to examine all stores where
food products are dispensed and to investigate insanitary conditions.

OAK PARI-: 245

Oak Park has a milk ordinance similar to that in effect in Chicago,
which rec^uires all herds furnishing milk sold within the limits of the village
to be tuberculin tested, as well as regular re(|uirements pertaining U> butter
fat, bacteria and adulterants.

Hospitals.

There are two general hospitals in Oak Park, with a total capacity of
about 500 beds. There is no cmitagious disease hospital but, when neces-
sar\', patients with contagious infections ma\' be removed to the Cook County
Hospital, or arrangements made for care at the Municipal Contagious Hos-
pital or the Isolation Hospital in Chicago.

During the year 1926 the health department purchased a new modern
ambulance for the removal of such patients.

Oak Park Hkaltii Center.

The Chicago Tuberculosis Institute was responsible for the tuberculosis
work begun in Oak Park. The first nurse employed by the Institute opened
the first health center here on JNIarch 19, 1917, which was located in a store
on Roosevelt Road and Harvey Avenue. Larger quarters were necessary
in two 3'ears' time, when the health center was moved to Maple Avenue and
Madison Street, where the Child Welfare Association was quartered. Regu-
lar weekly clinics were held, with a local doctor specializing in tuberculosis,
in attenflancc.

In December of 1922, Dr. H. H. ]5ay came to the staff of the Chicago
Tuberculosis Institute and has since been the attending clinician, having two
clinics a month in Oak Park.

Two years later, in 1924, the Institute severed its connection with the
Child Welfare Association and moved into quarters of its own. The present
health center is at 1145 Washington Poulevard, (Jak Park.

The health center work is hnancetl entirely by the sale of Christmas
seals through the Chicago Tuberculosis Institute, of which Mrs. Theodore
B. Sachs is superintendent.

Child Welfare Work.

In the wSpring of 1919, the Oak Park Center of the Chicago Infant
Welfare Society, which had been supporting a station in Chicago for three
years, was asked by the Associated Charities of Oak Park to take over an
infant welfare station which they had been trying to maintain for three or
four years under great difficulties.

This was done and from a registration of 52 babies, with one confer-
ence each week, the attendance increased so rapidly that by 1924 the station

246 DOWX-STATE Ml.XICIPALITIKS

was holding three clinics for infants and one-pre-school clinic each week.
Many mothers, who learned the value of the education received at these con-
ferences, continued to attend and bring others with them, even after moving
to other suburbs, until it became necessary to open three additional stations in
nei.^hborins' towns.

At the present time. Oak Park station has a registration of about 750,
with ,111 average attendance at clinics of 40 babies and 15 children of pre-
school age. The discharges for non-attendance, removals and age limit are
offset by new registration of infants, thus maintaining the above average.

The two nurses at this station visit the homes to demonstrate preparation
of food formulas and render aid and instruction to the mother concerning
general care of the baby. These nurses, together with a iihysician, are in at-
tendance at each conference.

The slogan of thte organization is "keep the well baby well", and their
aim to instruct mothers to give their babies proper food, fresh air and rest,
— above all, to consult a physician when the baby is ill.

Heat.

In January. 192,\ an orilinance was passed relating to heated apartment
buildings, stores and factories, requiring that owners or agents must main-
tain a minimum temperature of 60 degrees Fahrenheit at 6:30 A. M., and not
less than 68 degrees Fahrenheit from 8:30 .\. AI. to 10:30 P. M.

Plumbers.

The board of examiners of plumbers was created in the year 1917. for
the purpose of conducting examinations for the licensing of journeyman
and master plumbers.

Mr. W. A. Bunge, master plumber, and Mr, .Vlliert Lajeunesse, jour-
neyman plumber, comprised this first board, with Dr. Frank S. Needham,
health commissioner, as ex-officio chairman.

Referen'ces.

Xei'ilhaiii, Oak Park.

Peoria

Several starts were made under three or four names and the exact site
of settlement was changed at least once before a permanent community got
under way to make the present cit\' of Peoria. In 1680 the indomitable
LaSalle gave it the name of Creve-Coeur when he felt heart-broken at the
news of the loss of his boat the "Griffen". For a hundred years thereafter
the place was a trading post where Indians, trappers and voyagers met to
exchange their wares.

In 17'il Robert Maillet built his house a mile and a half below where
the cumniunity was located at that time because he thought it more healthful.
The land was higher and drier and the drainage better. He was followed
by all of the inhab.'tants and the new place was called LaVille de Maillet.

Then came in 1797 a band of 126 Virginians who arrived after a gruel-
ling journey thrdugh the woods, prairie and swamp only to be virtually ani-
hilated by a putrid and malignant fever (probably diphtheria) that fell upon
them in the overcrowded cabins that had been opened hospitably for their
reception and comfort. It appears that none but French were occupying
the place in 1812 when Captain Thomas E. Craig, under orders from Gover-
nor Ninian Edwards, razed the place by fire after a brief bombardment and
took captive the 75 white people who were there. All had French names
but one and he was a Frenchman wlio had adopted an English name.

A little later a military furt was established there b_\' the Amer.cans
who called it I'ort Claris. This seems to have been the last change before
the permanent civil communit}' that developed into Peoria began in 1819.
Tlie fort was burned in 1818 by the Indians. Thus the present city of Pecjria
began the next year after Illinois was admitted into the L'nion as a full
fledged State.

For fifteen years the struggling colony was
scarcely more than a prcjspective community, too
small to suggest organization. Then in 1835 a
village government was created with Dr. Rudol-
phus Rouse as president of the first board of
trustees. The next decade was marked liy a
gradual growth so that the community with some-
thing less than 1.000 souls was incorporated
as a city in 18.VJ. .\ few- years later, 1845, the
first distillery, which proved to be the beginning
of a tremendous industry that won for Peoria a
naticin wide rc|)Utati(jn. was eslablished.

HiKlolphiis RoM.se. .\1. D.

(247)

248 DOWX-STATIi MUXICIPAI.ITIKS

Peoria lies on the west bank of Peoria Lake, a widening of the Illinois
River, about 160 miles southwest of Chicago. The city is located on a
plateau which rises from the lake to an average elevation of 85 feet abo\e the
water level and varies in width from one-half to one and a half miles. IJack
of this plateau are the bluiifs which rise from ItX) to 125 feet higher. Lake
Peoria is about a mile wide and 20 miles long. .Many residences on the blufifs
overlook the river, lake and surrounding country.

The development of the city began with the opening of the Illinois and
Michi.gan Canal in 1848. This prcjved of two-fold significance for it not
only brought ccimmerce and industry. Init also a danger of invasion by
disease, especially the dreaded cholera which broke out in Chicago in the
following year and remained epidemic there fi)r aljuut f<iur years.

In 1840 the population of Peoria was L467. P>y 1850 it has grown to
5,095 and to 14.045 in 1860. The next six decennial census years found the
city with 22,849, 29.259, 41,024, 56,100, 66,950 and 76,121 inhabitants re-
spectively, the last figure being that for 1920. Of these 76,121. eighty-six
and nine-tenlhs per cent or 66,177. were natise burn whites while 10.2 per
cent or 7.7''0 were foreign born whites and Z.S per cent or 1,170 were
negroes. There were 19.213 or slightly more than 25 per cent who .gave
their age as 45 or more \-ears.

HkAI.TI I MaCI 1 INHKY.

The first profession;d health service of any permanent character in
Peoria started with the arrival of Dr. Augustus Langworthy in 1824. He
found less than 1,500 settlers in an area embraced in a radius of more than
one hundred miles. Other phxsicians who located there during the early
days inchiiled Rudolphus Rouse, Alfred Castle, I'.dward Dickinson and
Joseph C. I'l'ye. l!y 1848 there were at least seven resident physicians in
Peoria for in that \ear tlie Peoria City Medical Society, the first city medical
society in Illinois, was organized with seven charter members. That was
an important event in the health history of the community.

This society began at once to exercise an active interest in public health.
No later than January 10, 1849, it passed a resolution praying the city gov-
ernment to create a board of health composed of four phxsicians and four
non-medical members. This movement was precipitated b_\' fear of cliolera
which was raging at the time in the L^nited States and while official records
are l.'icking concerning the consequent response of the city council. Dr.
O. B. Will of Peoria, who furnished the minutes of the medical society
relating to the resolution, presumes that a board was appointed and began
to function. He says:

•■.•\11 of which means, as I talie it. tliat while nothing fan be found
ro.si)ectin.i; the action of the "Town Council', it is fair to |)re=unie tint

PEORIA 249

the medical represeiitfitives consisted of Doctors Francis A. McNeil,
Rudolphus Rouse, Edward Dickensen and Blias Cooper, particularly
since Dr. Rouse was head of the Council."

It is verv probahlc that a hoard came intn existence then and doubtless
was very active during tlie summer of 1840 when the cholera which the doc-
tors feared played deadly haxoc in the community. It is probable also that
this or some similar bcjard continued to exist. technicall\' at least, until a
reorganization (_)f the city goxernment in \S78.

In that \ear the revised ordinance provided for a board of health C( m-
posed of three members. One member, at the time, was a physician. It
was vested with the broad powers and responsibilities common to such boards
in municipal and state experience with the usual limitation of activities guar-
anteed by short appropriations. Annual expenditures amounted to about
$5CX).00 of which $200.00 went to the president of the board for executive
duties which were a function of the office. Apparently the practice frotn
date of reorganization was to appoint a physician chairman of the board and
in his capacity as its executive officer he was actually the health officer of the
community. Doctors who filled the position include :

.John H. Niglas. M. D, 1880 Marcus Whiting. M. D. 1888

J. L. Hamilton. M. D. 1882 B. M. Ross, M. D. 1891

L. H. Si)aulding. M. D. 1S84

In 1898 it became the practice to appoint a physician as health officer
and to designate him as the commissioner of health. Physicians who held
that position include :

Alliert Weil, M, D. 19""

.1. Rix SchoU. M. D. 1909

Edward Hassom, M. D. 1913

E. A. Garrett, M. D. 1916

George Parker. M. D. 1917

E. A. Garrett, M. D. 1919

Sandor Horwitz. M. D. 1923
192.'5 to date

Thus it appears that Peoria is one of the very few places in Illinois
where the practice of employing laymen as health officers never prevailed.
At first the president of the board of health always a physician, exercised
whatever executive powers were necessary to accomplish the health projects
undertaken. Later the commissioners of health, always physicians, exercised
those functions.

No radical change in the scheme for providing public health work in
Peoria has marked the development of that service except the one in 1898
when the board of health was abandoned and in its place a department of

J. W. Hensle.v. M. D.

1898

F. C. Bourscheidt. M. D.

1899

J. T. Sloan, M. D.

1901

W. R. Allison, M. D.

1901

Lewis A. McFadden, M. D.

1901

H. M. Hayes, M. D.

1903

Elmer M. Eckard, M. D.

1905

.Toel A. Eastman, M. D.

250 Dowx-STAxr. mi'Mcii-alitiks

licaltli created with a commissioner and emi)lo_\cs appointed by the mayor
Id man it. liefore tliat time the board of health was the responsil)lc agency.
Since that time resjxinsibihty has been transferred by the mayor upon the
commissioner of hcallli.

The first nicihcal health oflicer, Dr. Jnhn X. Xigias was a man of
unique liistory. He tied frcjui ( lerniany to a\ui(l incarceration because of
his revolutionary activities in that country. He left a practice he !iad built
up in Peoria to win distinction as a medical officer in the Union Arni\ of the
("i\il War and later in the capacity of health officer of Peoria he earned a
reputation a> an epidemiologist. He introduced in his C(jnmiunil\ the use
of antiseptics and he promoted the practice of isolation of jjatients suft'ering
from contagious diseases.

Too little was known however, in those early da_\s to steer the city di-
rectly into the practices of modern preventive medicine. It therefore went
through the "pest house" period, maintaining on the outskirts of the com-
munity a building in which smallpox patients were housed with all of the
vigor and fear that might have surrounded a leper. Comforts and conveni-
ences were doubtless scarce enough in the "pest house."

However the development of hospitals, the first of which was opened
in 1876 by the Franciscans, and the growing public confidence in the efficac}'
and safety of vaccination led away from the "pest house" which fell into
disuse about the turn of the century.

Beginning about 1900 the health department began to grow in resources
and functions taking on new employes and new activities as occasion arose
and the increasing demands for preventive medicine manifested themselves.
.\ milk ordinance, for instance was adopted in 1898 and the health depart-
ment began to enforce it about in 1899. About the same time considerable
attention began to be paid to sanitary matters such as privies, garbage, etc.
These activities required additional personnel in the shape of inspectors.

Then in 1907 a laboratory was established with Dr. John F. Sloan in
charge as bacteriologist. In 1921 a venereal disease clinic for treating indi-
gent persons w-as opened. Along with these new projects more rigid sani-
tary supervision iner milk supplies was required by revised ordinances
adopted from time to time w hile the ([uarantine and isolation of patients with
communicable diseases became more and more technical. These increasing
demands entailed larger and larger exjienditures and rei|uired more and more
personnel imlil the close of \'>2? fouml the health department with a staff
of ten members made u[> of a part time commissioner of health, a ])art time
laboratory director, one nurse, one clerk. f(jin- full time and one ])art time
inspectors.

\'<jluntar\ and quasi-public agencies also sprang up or began to assume
pul)lic health actixities in the city soon after the turn of the century. The

TEORIA 251

Associated Charities, for example, made a study of tuberculosis in the city
in 1903 and recommended as a result that the disease be made reportable.
The Peoria Society for the Prevention of Tuberculosis came into existence
shortly thereafter and in 1905 joined with the Associated Charities in em-
ploying a nurse to work under the commissioner of health.

Ily l''l? popular sentiment toward the tuberculosis problem was such
that an election providing for the erection of a municipal tuberculosis sani-
tarium resuhed in favorable action. Buildings for this purpose were con-
structed and patients began to l)e received in 1919.

Infant and child hygiene work began under tlie auspices of xoUmtary
agencies while the school board undertook to provide a health service for
the children by the emploxment of nurses, dentists and a physician. These
developments fountl the city at the close of this historical pt'i-iod with a
corps of six part time physicians, one full time phy.sician. cme full time
dentist, four full time and one part time inspectors, seven full time nurses
and several clerks engaged in public health service in one capacity or another
in the city.

A good description <.)f just wh;it was being done is found in the report
of a surve}' and appraisal made early in 1926 by the State Department of
Public Health. It was based on the 1925 record and was one of fifteen made
in the State at the time. From the report we read :

"The largest of the fifteen cities studied, Peoria stands sixtli from
the top for adequacy of public health service. The score earned by
Peoria is 580 or 58 per cent of a possible ma.ximum.

"With an almost complete change in personnel last year (l!t25), the
city health department gives promise of marked improvement in organ-
ization which will increase efficiency in communicable disease control,
vital statistic record keeping, sanitary and laboratory work and venereal
disease supervision — the activities in which it is engaged. Tuberculosis
clinics, field nursing and sanitarium services are provided from the
resources of the municipal tuberculosis sanitarium board, while the
board of education is responsible for an excellent school hygiene pro-
gram. Public health and bedside nursing and prenatal and infant
hygiene clinics are conducted by the public health nursing association.
This association also maintains a Neighborhood House where all public
clinics except those for venereal and school dental patients are held.

"With the city government contributing 16 cents per capita the
total expenditures for public health woik in 1925 amounted to (it cents
per capita. Eleven out of the fifteen cities appropriated more, propor-
tionately, for health service than did Peoria.

"Computing no mortality rates. attemiitiiiL; no lorrclafiou lietween
death certificates and contagious disease or birth leports, making no
graphs or charts. Peoria not only ranks lowest for vital statistic record
keeping but losss the splendid advantages which a careful study and use
of these important data provide.

IX)\VN'-STATE MUNICIPALITIES

PEORIA

VITAL STATISTICS \k
COMM. DI5. COMTROLl^zl
VEM. DI5. COMTROL^
TUB. CONTROL [z3
HEALTH CHILD -»!'

HEALTH 5CH. CHILD m
SAHITATIOM "=°^-/&°- ^
niLK CONTROL !«f^
LABORATORY
POP. HEALTH IhST.^

PERCEMT OF STATiDARD SCORE
FOR EACH OF TEM MAJOR HEALTH ACTIVITIES

Thisi graph illustrates the strong and weak points in Peoria's public
health service, official r.nd voluntaiy, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in Peoria was 58 per
cent of the standard perfection requiienient.

"Reporting of cases of contagious diseases seems reasonably com-
plete, the activity of the director of school hygiene in locating and re-
porting cases being especially commendable. There is no communicable
disease nursin.g' service e.xcept occasional visits made by the public health
nursing association. A communicable disease hospital is maintained by
the city health department. In 1925. 86 out of 350 eases of scarlet fever
and 19 out of 28 cases of smallpo.x were hospitalized. The hospital, ap-
parently, is not used for diphtheria, whooinng cough or measles. Im-
munizations against diphtheria by toxin-antitoxin have not been per-
formed or promoted by the health department and only 58 per cent of
the grade school population are protected against smallpox.

"Case reports of venereal disease are above the average but attend-
ance on the local clinic, which is efficiently managed, falls a little short
of the requirements for full credit. There is a lack of follow--up service
designed to prevent patients from quitting treatment too early for public
safety.

"Peoria has made more progress than any of the other fifteen cities
surveyed in organizing open-air classrooms in the schools. Four such
rooms were in operation last year, the average attendance being about
1 :'.."> iiupils. and an additional room is being opened this year.

253

"The public health nursing "ssoci;Uioii condurts the field nuisins
service for prenatal, infant and preschool cases. Prenatal, infant and
preschool clinics are held at the Neighborhood House, but these clinics
are not well attended, only 273 new children being registered last year.
A large proportion of the patients, too. are sick babies. The Peoria
medical society recently has endorsed and is to sponsor a prenatal and
infant welfare center which should meet the need in this field of health
work more fully.

"The board of education employs a full-time physician with two
nurses and a clerk, and a full-time dentist with one assistant, these ac-
tivities being carried out by two separate departments. The school
hygiene in Peoria takes first place among the fifteen cities surveyed.

"The first concern of the school hygiene department is the control of
contagion. Last year (1925) a total of 197 cases of contagion were dis-
covered and reported, in addition to 3S5 cases of pediculosis, impetigo
and pink eye. Nearly l.GOO children were excluded from school because
of suspected contagion and more than 50,000 were inspected for evidence
of contagious disease. Routine weighing and measuring of children
is not practiced. Routine physical examinations are made each
year of the first, third, fifth and seventh grades, nearly 4,000 such ex-
aminations being made last year. T\vo thousand special examinations
were made, in addition, on recommendation of the teachers and to
select children for open-window rooms. All children who fail in their
grades are given a careful examination which is repeated each month
until correction of defects has been secured. The school health program
is unique in the intensive w'ork which is done on this group of children,
the results of which have been most encouraging. The demonstration
thus made is increased scholastic efficiency when physical conditions are
improved, and the successful control of contagion have been the im-
portant factors in convincing the education authorities of the value of
its school hygiene program.

"In addition to measures for the control ot contagion and for the
detection and correction of physical delects, considerable effort has been
directed towards health education both by lectures to the pupils and by
interesting teachers in this problem.

"The percentage of physical defects corrected, as shown on the
records, is almost up to the appraisal renuirements for full credit and
doubtless would exceed this quota if a follow-up nursing service checked
up on all corrective measures. Visits of nurses to the homes of school
children were about two-thirds of the required number.

"The dental work in the Peoria schools is one of the pioneer pro-
jects of its kind in the country and easily stands first among the group
of cities.

"The development of this s|)lendid undeitaking was due primarily
to the efforts of two or three local dentists, wlio a decade or more ago,
induced the school board to permit the dental society to introduce this
work. The growth of the dental department has been gradual and has
reached its present efficiency as a result of the ability and enthusiasm
of the present director who has been emidoyed since 1917. The dental
hygiene program embraces: (1) education: (2) dental inspection: (3)
clinical service. Dental education is carried out through lectures by the

254 DOWN -STATIC MUNICIPALITIES

dentist in every grade schcol room every year. The lectures given vary
for each grade. The children's interest in dental hygiene is aroused and
each room carries out a dental project; in some cases this is combined
with the art work and many interesting posters have been prepared; in
other instances, it has been combined with the English work and the
children write compositions concerning some aspect of dental health.
Wednesday of each week is devoted to lectures. Each lesson is con-
cluded with a thorough drill in toothbrush technique. Lectures are also
given before mothers' clubs, parent-teacher's association, teachers' train-
ing classes and teachers' assemblies. Each year, examinations are
made of the second and fourth grades.

"The striking fact should be noted that l.OTK children in a total of
4,307 examined had good teeth; and that of tlie remainder l.lStJ were
receiving dental care at the time of the survey. In other words, more
than one-half of the children at the time of the examination had good
teeth or were then receiving dental care. When the thoroughness of
the examinations is considered, this record falls little short of remark-
able.

"Two schools are provided with dental equipment. At these clinics
only children unable to pay for private dental work are admitted. In-
come in relation to the size of the family, determines eligibility for
treatment. Four days per week are given to the clinic work during the
second semester. During the first semester four afternoons per week
are given, the remainder of the time being used for the dental examina-
tions. Orthodontic treatments are not given nor are permanent teeth
extracted. For needy cases these services are given gratis by local
dentists. The service thus given by one dentist figured at current rates
amounted to more than $1,000 last year. Five hundred fifty patients
made a total of 2,210 visits to the dental dispensaries last year.

"The public water supply in Peoria is of good quality and is dis-
tributed, it is estimated, to 95 per cent of the homes. Only 66 to 70
per cent of the homes are connected with the sewer system. There is
no record of the actual number of open privies. Sanitary inspection
service is handled by two untrained inspectors. Last year many notices
were given for sewer connections but relatively few were complied with.
Food establishments are inspected and are licensed by the city for
revenue.

"Ninety-two per cent of the Peoria milk supply is pasteurized and
a small amount (150 gallons per day) is certified. Milk supply control
has been under the direction of one part-time inspector who has had
experience in pasteurization plant operation. Plants have been fre-
quently inspected and during the year 116 samples of pasteurized milk
were analyzed. The bacteriological counts were in excess of the stand-
ard and no examinations were made of milk before pasteurization. No
inspections were made of producing farms. The inspector recently has
been placed on a full-time basis.

"The city health department maintains a small laboratory and em-
ployes a local physician who is part-time bacteriologist. Apparently
milk analyses and diphtheria examinations constitute the major part of
the work. Water analyses are not made regularly."

PEORIA 255

WaTF.R SlTPLY.

TIiL- water supply was installed 1)_\- the city in IB'iS. Since 1889 the
waterworks system has been owned and operated by the Peoria Water Works
Compan}-, a private corporation. The ordinance conveying the municipal
plant to the private company in 1889 provided for a repurchase b\- the city
or a renewal of the contract in 30 years. It allowed the free use nf water
for practically all public purposes and for public and charitable in>titutions.

The original works comprised a group of wells located in the northeast
](iiiti(in of Averyville between the tracks of the Peoria branch of the Rock
Island railroad and Illinois River. A large main well, now used as a col-
lecting well, 34 feet in diameter and ()0 feet deep and extending into gravel,
was in ser\ice in 1892.

I'efore the opening of the Chicago Drainage Canal, during summer
seasons when the water level in the ground was low, it was impossible under
the existing arrangements to prevent the pumps from sucking air. Conse-
quently the main well was pumped dry and a circular steel tank 20 feet in
diameter and 12 feet in depth was installed in the bottom of the well. Foot
valves placed in the bottom of the tank made it possible for water to flow into
the well without flowing back. The pump suction terminated in this tank
about one foot from the bottom.

In 191'> the water suj^iily comi)rised the main collecting well and seven
auxiliary and reserve wells at the original waterworks site and two wells
located about 2)/^ miles north of the main pumping station. All of these
wells discharged into the main collecting well. There were also two jjinnp-
ing stations, one being held in reserve.

One of the reserve wells was sunk in 1908 ami the two somewhat iso-
lated wells were constructed in 1910 and 1911. Water was pumped from
the main collecting well directly into two 30-inch cast-iron supply mains,
one of which lead to an equalizing reservoir of 19,000,000 gallons capacity
on Peoria Heights constructed in 1892, and the other through the village of
Averyville direct to the city.

The present supply comprises a system of wells from which water is
pumped direct into a distribution system in one service with an equalizing
storage reservoir. The supply works comprise one main well completed in
1892, four auxiliary wells constructed in 1899, one reserve well constructed
in 1909 and eight supplementary wells constructed between 1895 and 1913.
Total available yield is estimated at 17,700,000 gallons daily. The wells vary
from 40 to 90 feet deep and penetrate gravel formations. Two pumping
stations are maintained, one always acting as a reserve. One station was
built in 1890 and the other in 1913. The open equalizing reservoir is still
in service. The pumping equipment comprises four pumps with a combined

256 DOWX-STATE MUNICIPALITIF.S

capacity of 17,200,000 gallons per da)-. There are approximate!}- 150 miles
of distributing mains and the static pressure maintained varies from an aver-
age of 48 to 99 pounds per square inch. The average dailv water consump-
tion is about 97 gallons per capita.

In 1918, an epidemic of intestinal disturbances in which approximately
30,000 cases developed was attributed to contamination of the water supply.
The source of contamination was calculated to be polluted river water which
entered the supply wells through an underground route. The epidemic oc-
curred during high-water stages in Illinois River. In 1919 a mild outbreak
of d}-senterv occurred in which 3,000 cases developed. The cause was
thouglit to be identical with the cause of the 1918 epidemic.

In 1920 a considerable number of cases of enteritis developed, but in-
vestigation established that the water supply probabl_\- was not involved,
although conditions were similar to those in 1918 and contamination of the
supply was possible.

In 1922 minor changes were made to eliminate the danger of contami-
nation during- high-water conditions and provision made for the installation
of chlorinators for emergency purposes. The water supply at the present
time is regarded as of a safe sanitary Cjuality.

Sewerage.

In 1880 most of the liquid wastes of the city were discharged into cess-
pools. About ten per cent of the houses were provided with indoor toilet
facilities, the remainder being dependent upon privies. Priv}- vaults, by
regulation, had to be 10 feet in depth. Night soil was reuKned liy scavengers
to points outside the city limits.

Sewers have been built im tlie combined plan with se\-eral outlets into
Illinois River. In addition there are many industrial sewers and the prob-
lem of disposing of industrial wastes is an acute one. In 1926 preliminary
studies of the sewerage needs of the cit}' were carried on and recommenda-
tions made for the organization of a sanitary district, the construction of an
intercepting sewer along the river front, a sewage-treating works, and mis-
cellaneous internal improvements. The Peoria Sanitary District was organ-
ized during 1927.

At the present time it is estimated that only aliout 70 per cent of the
population are connected to the sewers.

Health Conditions.

The first account we have of health conditions in Peoria is that of
Robert Maillet who caused the communit\ to move a mile and a half down
the river to a more healthful location. lust what the unhealthful conditions

PEORIA 257

at the original site were is not disclosed but more than likely the\- were ills
attributed to poor drainage.

Next came the disaster to the colonists from Virginia referred to at the
opening of this article. To their sad experience more, perhaps, than to any
other one factor was due the reputation for unheahhfulness which spread
abroad throughout the civilized world concerning the Illiudis territory.
Physicians think that their trouble was diphtheria.

^^ hat health conditions were like during the cholera wave that followed
the Black Hawk War may be surmised from a descriptive paragraph taken
from James Haines. Quoting from his "Early Settlement of Illinois", we
read :

"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 w-as 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 fol-
lowed 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 grave-
yards, being then set apart for liurial of our first dead."

Another reference to this same period, a little later perhaps, is found in
Drown's "Record and Historical View of Peoria". Here we find :

"During the autumn of 1S?,i considerable sickness prevailed and
many deaths occurred among the inhabitants. Those who kept their
health and those who recovered from their sickness put their shoulders
to the wheel with renewed vigor, and the town for several years grew
rapidly."

Zeuch finds evidence of a severe epidemic of yellow fever that occurred
in 1836 in Peoria. Dr. and Mrs, Alfred Castle are said to have greatly
endeared themselves to the community through their untiring and self-sacri-
ficing services to the sick during that dreadful experience.

A. D. Jones, in his "Illinois and the West," states that the ferryman who
took him across the river at Peoria in 1838 said "that it was mighty sickly
there ; everybody had the chills and fevers".

258

DOWN-STATE M UXICIPAI.ITIES

Doctor Daniel Drake visited Peoria in 184-1 while un one of his obser-
vation excursions and learned from Doctors Dickenson, Rouse and Fr\ e that
both remittent and intermittent fever was prevalent in the vicinity. Dr.
Frye reported that the intermittent was more prevalent in the low, wet
timbered spots.

Again in 1849 the dreaded cholera returned. Local physicians had
given warning of its probable coming and efforts to ward it off had been
made with no avail. Its violent deadliness is described by Alunsell in his
History of Peoria Count}'. A paragraph taken from that volume reads :

"A terrible e|)ideniic of cholera having broken out in the summer
of 1S49 the commissioner, on Jub' 11th. granted the use of the three
upper rooms in the Court House for cholera patients of the city and
county; also such beds and bedding as might be needed at the poor
house, the county to stand the expense of furnishing the sick with all
medical and hospital stores and provisions as well as nurse. These
rooms were used as long as needed for this purpose."

Among the prominent citizens who succumbed to attacks of cholera
during the epidemic were listed Samuel H. Davis, publisher and William
Mitchell, postmaster.

Table 1.
Mortality From Certain Causes.

. ■-

YEAR

■Si

i'S

i ^

1900

279

...

1901

774

:;: I

1902

745

.:;

'7.5

1903

772

'27

1904

8S4

190.^>

1081

'84

1906

732

1907

SOI

■■.5

'is

130

'78

190S

S37

...

1909

898

'is

'7i

1910

990

1911

994

1912

905

1913

952

'56

1914

973

191."i

19lri

lilG

1917

1247

\ .' \

'so

14.5

191S

1397

'io

■■7

232

193

1919

ino.-i

1920

1174

115

1921

1014

1922

1 OIlCi

1923

1218

113

1924

1102

1925

1125

1926

1108

...

' 's

259

Table 2.
Mortality Rates From Certain Causes.

YEAR

>
3

i
s

c
si

1
Q

•2--,

1900
1901
1902
1903
1904
190.5
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926

4.9

13..-;

12.8
13.0
12.9
17.5
11. G
12.5
12.9
13.6
14.8
14.6
14.0
11.9
13.7

15.4
17.0
18.7
14.1
15.3
13.0
13.5
15.3
13.7
13.8
13.4

10.6
is.k

5.2
3.8
6.4
2.5
13.8

s.'e

'.k

L.2
-.4

)'.6

10
9

10
3
7
1
1
4

2
2

'. ..

i'.s
s'.s

2.6
9.0
1.3
3.8
6.0

3.6
1.2

45!4

2.9

9.'7
IS. 4
24.6
27.0
8.9
5.0

i!2
7.2

322!
119.

80.
9.

39.

51.

14.

41.

40.

3
7

'. '. .

i!2
1.2

128!9
130 !.5

204! 6

107^9

S6!4
99.2

109! 6
111.1

97.3
77 9
51.4
77..')
60.3
77.7
46.6
47.2

106^7

i9i'.e

268.0
121.0
149.3
74.6
95.3
14.1
108.6
104.1
87.2

All Causes is per 1000 populatit

all others per 100,000 populati.

This appears to liave been the last outbreak of cholera of any significant
magnitude and it was indeed enough. Peoria had certainly suffered enough
from that harrowing plague.

Smallpox likewise had a long and ugly history in Peoria but it never
reached the fatal proportions characteristic of cholera. The "pest house"
that defied small boys and tramps alike was a monument to the fear and
alarm which the disease had inspired even before 1880. Records are unreli-
able and nothing more than vague references to smallpox in those early
years are available but it must have required a considerable outbreak at one
time or another to bring into operation the pest house.

Throughout the years since the time when records became more reliable
smallpox has occurred sporadically. Epidemics involving from 100 to 500
cases were reported in 1885, 1901, 1907, 1909, 1916, 1917, 1918, 1919 and
1922.

While both cholera and smallpox provoked greater alarm and concern
because of the suddenness and dramatic character with which these diseases
descend upon a community, tuberculosis doubtless was a more destructive
ailment in the life of Peoria than either of the other two. Indeed it prob-
ably was Peoria's major health problem for many ^ears although few people

260

DOWN-STATE M UNICIPALITIES

Table 3.
Casks ov Curtain Diseases Reported.

1 1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

1927

Typhoid Fever

Smallpox

146

125

264

207

251

Measles

1404

170

492

904

142

1101

707

Scarlet Fever

143

170

203

399

599

237

184

243

128

Whoop. Cough

142

108

227

Diphtheria

232

2.-) 3

l.iS

289

Influenza

7260

12.>2

7.')0

Poliomyelitis

Meninf^itis

Tuberculosis*

142

101

288

138

Pneumonia*

157

Syphilis

289

228

119

150

477

Gonorrhea

286

422

492

246

347

303

004

Chancroid

•All forms.
Note: Case reports are never complete, but they have been much more so since 1920 than before in
Illinois. This table indicates considerable improvement in notification, although reports of pneu-
monia, tuberculosis, influenza and some of the others are manifestly far below the actual incidence.

Table 4.
BiRTiis AND Infant Deaths.

Infant Deaths

YE-\U

Number

R;ite"

Number

Rate*

1918

137

1919

1920

1209

15.S

134

110.8

1921

1322

17.0

115

87.

1922

1335

17.2

121

90.6

1923

1417

17.8

126

89.0

1924

1311

16.3

111

84.7

1925

1517

18.fi

110

72.6

1926

1503

18.2

61.2

age per 1000 births reported.

recognized it as such until after the turn of the centurx'. During the nine-
ties, for instance, when the registration nf deaths was far from complete,
more than fifty fatalities per year were charged against tuberculosis. In
1884 when the population of the city was about 35.000. there were 82 deaths
attributed to tuberculosis. In l'^02 there were 73 and in 1905, 84 deaths
attributed to that cause. 1m ir the three years ended with 1927 the average
annual number of deaths from tuberculo.sis was 41 although the population
was liver 20,000 greater than in 1900. These data show what a scourge
tuberculosis really was in Peoria for a long period. Cholera kills quickly
and the fatalit}' ratio is high. .Sometimes smallpox is extremely mortal and
sometimes not but rarely is the prevalence rate very high. Tuberculosis is
a slow devitalizing disease that leaves ten people sick for each one it kills.
.\ bit of arithmetic baseil upon the deaths reported will give one an idea of

PEORIA 261

the heavy burden which that disease has phiced upon Peoria. Apparently
the measures employed against it have proved splendidly effective. Deaths
per year are now but little more than one-half what they were in 1900 while
the rate per 100,000 people is one of the most favorable among Illinois
municipalities.

T\phoid fever appears to have been a problem of less magnitude in
Peoria than in many other places. From the meagre records available it
seems that after 1910 the disease has not lieen widespread although an out-
break in 1923 resulted in 11 deaths. Before 1910 it was common to tind
fr(.im 13 to 20 deaths per year attributed to t\i)hoi(l. That suggests from
100 to 200 cases in a population under 60,000.

Diphtheria and scarlet fever ha\e run cnurscs similar to those observed
in municipalities generally. Up to 1900 diphtheria was particularly deadly
and even as late as 1903 an outbreak carried off 27 souls. More recently the
number of deaths has been quite small. Scarlet fever has declined in malig-
nancy but not so much in prevalence. Both these diseases have appeared in
epidemic waves from time to time, the one growing less and less extensive
even in epidemic \'ears and the other changing but little in magnitude of
prevalence but becoming milder in form.

The influenza epidemic of 1918 was moderate in Peoria, comparatively
speaking. Mortality amounted to 322 per 100,000 population from influenza
and 268 from pneumonia. The combined figure of 590 was exceeded in a
dozen other Illinois cities. About that many had lower rates.

(iencral health conditions are subject to some improvement in-so-far
as the mortality rate may be accepted as a barometer. The rate has ranged
above 13 per 1000 steadil)- and that is a good deal higher than for the State.
In small places homes fur the aged and hospitals are apt to affect death rates
rather decidedly in an unfavorable way but Peoria is approaching, if not
already there, a size that should have al)sorbed a good deal of the unfavor-
able influence of those factors without any marked effect on the general
death rate.

References.

Data furnished by Dr. Joel Eastman, health commissioner of Peoria.
Data furnished b.v Dr. George Parker, former health commissioner of Peoria.
.\nnual reports of the Citv of Peoria, various dates.

.\nnual reports of the State Board of Health, Dr. John H. Rauch, Secretary, Sprin!ffieI<I, Illimiis,
various dates.

Ifivton ..f Mcdi.al PiM.ticp ill Tlliiini-. Vol. l.Dr. Lucius II. Zeuch, Chicago, 1927.

I,'. ■..II ..; -I . .1 !iM..i, ir ., ( ' . ~r I'r'., Illinois "Health News," Mav-.Iune, 11120. Dr.

Is:i;ir h I: I;. , hn. i. , .i n. ,. ,i .i r .i.:i. l|...,hli.

I, III' -.!( I .. Mil , .litiii. llHi.- I'uiilh ;(ii,,n No. 10, lUO.-i, Illinois Historical Library.

II - ih.l IlM \\. I, X, II. .Iniies, Uostnn, ls:)S.

I.'r-t.l .ii.l III I. -II. il \ie\v of Peoria, S. DeVVitt Drown, 1830.

llliN.i- Niii- Willi Survey Bulletins, Edward Barton, Urbaua, vurious dates.

I ^ i.n-iK i:.ii'iiis. Washington, D. C, various dates.

Qtiincy

Ouincy is located on the east bank of the Mississippi River, 150 miles
above St. Louis. The city and surrounding country is hilly, except along
the ri\er. A short distance to the north there are several bluffs and mounds,
which rise from 150 to 250 feet above the river level. Beyond these, to the
north and south of the cit}- the land is low and moist, or so-called "Bottoms."
These have been drained.

The site and vicinity belong to the carboniferous limestone period, with
coal seams in the vicinity. The surface rocks are limestone, and the under-
lying strata, from above downward, are clay, loam, gravel and limestone.
The strata are horizontal with no dip nor slope. Soil-water flows in continu-
ous fissures in the rocks, and through the gravel strata.

Quincy is an old cit\', as Illinois cities go. It was founded in 1822, and
incorporated in 1825. It was once "The Crossing" and "The Track's End."
Here in the early days of the settlement of the Great West the flood tide of
immigration stopped for a time before it crossed the Mississippi by ferry.

The river with only a ferry for crossing was like a dam holding back
waters. The flood was a tide of humanity. Ouincy was then a stormy,
seething mob. It was the frontier, the jumping off place. Gunmen and
gamblers, rough people of every sort, men without money and men with
much mone\' congregated here.

I'inally came the railroad bridge, tracks on through to the Great West
beyond. Building the bridge was like breaking a dike. The reservoir of
humanity rushed out. Streams of men who came after flowed through
without stopping. This was followed b}- a different day for Ouincy. Busi-
ness fell off. Then came \ears of quiet, almost stagnation. Finally
Ouincy built in a newer and sounder wa}', gradually the Ouincy of today.

Returns from the I'nited States census bureau show population figures
for Ouinc\' for each decade beginning with 1840. In that year it had 2,319
inhabitants. This number almost tripled by 1850 when the population reach-
ed 6,902. For the next fifty )ears the city settled down to a substantial de-
cennial growth, finding itself the home of 36.252 people in 1900. Since then
it has experienced no growth, the 1920 census revealing an actual loss of 609
below the 1910 returns. Of the 35,978 people there in 1920. 32,349 or
89.9 per cent were native born whites, 2,411 or 6.7 per cent were foreign
born whites and 1,210 (ir 3.4 jier cent were negroes. Something over 29
per cent were above 45 }-ears of age, a percentage larger than that for an\
of the other cities in the State.

(262)

263

Health Machinery

The hard campaign waged by the physicians of the county against chol-
era and other diseases which swept the country in 1849, called very forceful
attention t<i the necessity of organization and cooperation, both to meet emerg-
encies and for purposes of consultation and
progress in ordinary times. Accordingly
Adams County Medical Society was organized
in Ouincy, March 28, 1850, at a meeting pre-
sided over by Dr. Samuel W. Rogers. It is
the third oldest medical society in Illinois, its
on]}' seniors being the Aesculapian Society of
the Wabash Valley, and the Rock River Medi-
cal Society, both founded in 1846. The Adams
County society antedates the State Medical
and the Chicago Medical society by about two
months.

The officers selected were : Joseph N.
Ralston, president, Samuel W. Rogers and M.
Shepherd, vice-presidents; J. R. Hollowbush,
recording secretary ; Louis Watson, corres-
ponding secretary.

This society gave much attention to sani-
tary matters and l>y its persistent efforts
secured the creation of a board (.)f health by
the city and the adoption of a system i-f mortu-
ary registrations, several years previous to the
passage of the present State laws relating to
these matters.

Naturally general sanitation early en-
gaged the attention of the medical society.
Thus in November, 1865, Doctors Edward G.
Castle and Joseph Robbins appeared before the
citv council and asked that, in view of a prob-
able visitation of epidemic cholera, steps be
taken to put the city in a proper sanitary condi-
tion. The authorities acted promptly, created a
board of health of which Dr. Castle was made
president, and under his direction the city A\as
placed in such hygienic condition that when,
in the following summer, disease came up the
Mississippi River. Ouinc_\- escaped with less
than a dozen cases, and only two or three of
these were fatal.

.lo.seiili .\. l;:il.-,iuu. .\1. D.
First President Adams County

Medical Society. 1850.
(President 1S64. 1865 and 1866. 1

•Joseph Robbins, M. D.

264

DOWN-STATI', M UNICI I'Ar.ITI I'.S

Dr. I'rancis Dnulc, representing the county society, organized in I860,
a more eflicicMU lioard of health, replacing the old body which after the
cholera failed to ;ippear had \'irtually dro[)])ed out of existence.

The I'corganized i)(iard comprised hve members, three of whom were
regular ]ihy>ician.s. .Ml were appointed by the mayor, himself a member ex-
ofificii'. I 'r. I )ru(K' str\ ed as its chief officer and registrar, with only nominal
compensation for twenty years or more.

It became the practice, probably much
earlier than the time when the board of health
was organized, to appoint a ddctnr. at a small
or nominal .salary, known as the cit\ physician
to look after indigent sick which the commun-
ity found upon its hands. He became subject
to the board of health which ordered him to
put on a general vaccination campaign in 1871.
.\t that time Dr. Piatt was city physician and
he reported ')()4 vaccinations. During the pre-
cefling _\ear Dr. Piatt established the city
dispensaries.

It afforded ready means of relief to the
Francis Driuie. M. D. indigent sick and also saved $100 to $150 per

First Adams Count.v Pliysician nionth to the cit\- in the difference between
to Celebrate 50 Years o£ , ' . .

Continuous Practice. medicmes and prescription prices and whole-

sale rates. Previous to this time prescriptions
had been given out, but no drugs were procured at wholesale prices and
dispensed from the dispensary, which was open from 9:00 A. Al. to 4:00
P. M. daily.

.-Viiothcr city |.)hysician found to his dismay that public office is not
alwaxs the easy jiath to financial comfort and mental tranquility which it
sometimes appear^ and he was not one who minced his words in expressing
his opinion of the matter. Herewith is ipioted from his report of 1873 a
statement of his activities fur the \ear and of his determined attitude toward
the job which lie expressed with vigor:

"Visit.s made in the city 1592

Patients visited in the city 450

Office consultations 515

Patients treated at city hospital 54

Average number per day 5.5

Visits paid to hospital 119

"To this I add iitlendance on ten acrouphmeiits and the coniiiouud-
ins of 2.'i(;ii i)rescrii)tians.

"This report closes my career as city physician and llrinl; C^d for
it.

QUINCY 265

"I congratulate myself upon my release from such a public burden
at such an insignificant salary, six hundred dollars per annum; and I
thank the Honorable Council for their practical appreciation of my serv-
ices by refusing me additional pay for services made additional by the
severest and most protracted winter we have ever seen and also by the
outbreaking of two epidemics (smallpox and cerebrosiiinal meningitis) —
causes which human wisdom could neither anticipate nor prevent.

"Before closing this report, I cannot forbear expressing my ad-
miration for the consistency of your Honorable Body in allowing the
Overseer of the Poor extra compensation for his services rendered
paupers and yet disallow the City Physician extra compensation for
extra services rendered the same paupers nor can I forbear expressing
my appreciation of that consistency of your Honorable Body which
would and did allow the City Sexton double pay for the interment of
smallpox cases and yet disallow the City Physician extra compensation
for medical attendance on them. 'Consistency, thou are a jewel!' is the
jiioud ejaculation of your retiring City Physician.

"Respectfully submitted.

Samuel A. Amery, M. D.

City Physician."

Tlie same _\etir the board uf health declared in it.s report that ".Modern
science has demonstrated beyond all controversy that a very large percentage
of disease is preventable by proper sanitary regulation."

Cut off from the stimulation of deadly epidemics, however, the board
of health soon fell into a dormant paper organization with the result that
the medical profession dropped almost completely out of the picture.
Indeed in 1885 the mayor and three alderman constituted the board which
had power to nominate and elect to membership three physicians in case of
emerge!ic\'. From this time on for a long period the executive officer of
the board was a layman who drew pay varying from about $100 to $600
annually. Garbage collection and scavenger service were under the
jurisdiction of the board so that it handled a considerable sum of money and
employed a number of people. It also had charge of quarantine, fumigation
and the other functions common to health departments or boards.

Boards of health came and went for a long time. Some were large,
some small. Some had on them physicians. Others did not. The
executive or health officer continued to be non-medical Init the staff increased
and the rate of pay.

This was the state of affairs in 1020 when the periodic ascendency of
public interest in health problems, probably intensified by national activities
in that field during the war, resulted in the erection of a public health dis-
trict in Ouincy. This was done by popular vote in conformity with a law
passed by the legislature in 1917. It provided among other things:

"1. That any town, or two or more adjacent towns in counties
imder township organization, or any road district, or two or more road

266 nOWN-STATF. MUNiriPAI.ITIES

cUstrifls in counties not unilei' township orsiini/.ation. or any town or
towns in a connty nnder township oriranization. may l)e organized into
a public health district.

"2. That, upon presentation of a petition signed by not less than
5 per cent of the total vote cast In any town or road district, and filed
with the town or road district clerk at least 30 days before the regular
election, the proposition shall be submitted to a vote of the people at

the next town or road district election.

"3. That the supervisor at large, the townshi]} clerk and the
assessor shall constitute the board of health and shall select a health
officer from a list of eligibles submitted by the State Board of Health.

"4. That an annual tax levy, in addition to all other taxes which
now or hereafter may be authorized to be levied on the aggregate valu-
ation of all property within the public health district, not to exceed
2-i'i mills on the dollar on all taxable property embraced within such
public health district according to the valuation of the same as made
for the purpose of the State and county taxation, may be made — this
tax to form, when collected, a fund to be known as the 'public health
fund'."

Quincv was the first cit_\- in the State to take advantage of this law and
since that time she has had one of the best equipped health departments in
the State. Its organization is outlined as follows ;

"1. Registration division where all deaths and birth certificates
for the townships of Quincy, Melrose, Riverside and Ellington are re-
ceived and recorded, and from which all burial and transit permits are
issued to undertakers.

"2. Communicable disease division in which all contagious and in-
fectious diseases are registered, and from which history cards of each
case are forwarded to the State Department of Ht-alth at Springfield.

"3. Clinical laboratory division in wiiich specimens of blcod,
sputum, throat swabs, smears, feces, water, milk, etc., are examined
by an expert bacteriologist and serologist. This work is done free upon
request of local physicians. During the first eight months of its ac-
tivities upwards of 1200 free examinations were made.

"4. A sanitation division, where all complaints in regard to in-
sanitary conditions are registered and investi.gated. In addition the
sanitary officer inspects restaurants, dairies, meat and fish markets,
grocery stores, soft drink stands, etc. Also all complaints for non-
collection of garbage are received by him. the garbage collector is noti-
fied, and a weekly report forwarded to the mayor.

"."i. A quarantine division, the responsibilities of which are to
establish and enforce quarantine for all contagious diseases, and to
report all such quarantines to the public library and to the proper au-
thorities, either school or business, as the case may be. Release from
all quarantines is likewise reported.

267

"6. A social hygiene division, presided over by a registered pliy-
sician and a social worlier, in wliich all indigent, cases of venereal
diseases are treated free. During the first six weeks after its establish-
ment this clinic received o40 visits for consultation, examination, and
treatment. Thirty-nine patients were under treatment at the end of
that period.

"7. Dental clinic division, for the treatment of children of school
age. This clinic was opened on February 28, and bids fair to have more
worlv tlian it can handle."

John W. H. Pollard, M. D.
Health Officer, 1921-1924

Under .this new organization. Dr. John \\'. H. Pollard of Lexington,
\'irginia, was chosen as the first health officer
an'd he served the community in that capacity
from July 1921 until 1924 when William D.
Wrightson, a sanitary engineer, was elected to
succeed him. Wrightson was succeeded in 1925
!)}• Dr. Thomas W. Rhodes who is still in office.

From 1900 to 1920, Quincy saw much public
health activity. During that period an infant
mortality surve.\- was made by Miss Nannie Lack-
land, R. N., of the Children's Bureau, Washing-
ton, D. C. This was sponsored by the Quincy
Council of National Defense. It was found that
too man\' babies were dying under one _\ear of
age; that there were too many deaths of infants due to prematurity and con-
genital debility; also that stomach and intestinal conditions were responsible
for a great nunil)er of infant deaths.

Better birth registration and education of
mothers in prenatal and infant care, and especially
in the feeding of children were recommended as
remedies for these conditions.

Two better babies conferences were held at
Cheerful Home Settlement. Members of the
Adams County medical and dental societies and
nurses from Blessing Hospital cooperated in this
movement. The attendance at the first confer-
ence was 112, and 432 at the second.

In 1918, following these conferences, in order
to emphasize "Children's Year" and to afford an
opportunity for giving advice to post-infantile-
paralysis cases left after the epidemic of this disease in 1916 and 1917, Dr.
Elizabeth B. Ball, who at that time was secretary of the Adams County ■Med-
ical Society, proposed to the society that it go on record as favoring the

Thomas W. Rhodes, M. D.
Health Officer. 192.5 to date

268

DOWN-STATIC M UNICIPALITIES

Eli^iilieth B. Ball, M. D.

Long-time Secretary of the

Adams County Medical

Society

establisliment of a crippled cbililrcn's clinic in
Ouincy. She also sus^tjesled that the clinic be
similar to the ones alread}' in o])eration in various
pan- (if the State, and that it be conducted by an
(irihiipeihst from the .State Department of Public
Health. A mcilion was duly made, seconded,
and carried that this be done. The clinic was
established and held at I'lessing Hospital for
several \ears, and many unfortunate crippled
children were helped to such an extent, that
instead of being handicapped wards of the State,
they are or will become self-sustaining useful
citizens.

In the same manner an infant-welfare station was opened at Cheerful
Home, to which mothers could bring their babies every ^\'ednesday after-
noon. A physician and a nurse were in attendance at this time.

A conference for mental defectives was also established in Ouincy in
1918. Once a month a physician from the State Hos|)ital for Mental Dis-

Cheerful Honx

1. A Unit in a Mammotli Parade Manifesting Public Interest in Health.

2. Two Views of "Hillcrest", Adams County Tuberculosis Sanitarium.

3. An Inside View of "Cheerful Home".

270

DOWN-STATE M UNICIPALITIES

eases at Jacksonville gave mental tests, and made recommendations as to
the handling of the cases. The probation officer furnished most of the
cases for this work. The \'isiting Nurse Association cooperated in the
undertaking.

During the influenza epidemic in 1918, daily medical inspection of the
school children was carried on.

In 1919 classes in nutrition were established in some of the public
schools. Miss Martha D. Fitzgerald, R. N., supervisor of visiting nurses and
at present head resident of Cheerful Home, was in the main responsible for
this work.

The Cheerful Home Association has played an important role in the
improvement of health conditions and in rendering social service in Quincy.
In the spring of 1901, Mr. Lorenzo Bull announced his intention of present-
ing the property formerly known as Wells residence. No. 421 Jersey Street
for use by this Association. The gift was accepted. Following this the
Association reorganized and incorporated.

QUIMCY

VITAL STATISTICS E°

conn DI5 coriTROLs^

VEh DI5 COnTROL
TUB COHTROL
HEALTH CHILDs."-
HEALTH 5CH CHILD ^
SAMITATIOh'^i^? »
niLK COMTROL '^^
LABORATORY
POP HEALTH IhSTI

PERCENT OF STANDARD SCORE
FOR EIACH Of TEM MAJOR HEALTH ACTIVITIES

_IS25_

This graph illustrates the strong and weak points in Quincy's public
health service, official and voluntary, as it existed in 1925. It is based
upon a personal survey and rated upon the standards evolved by the Amer-
ican Public Health Association. The total efficiency rating in Quincy was
47 ijer cent of the standard perfection requirement.

271

The object of the Cheerful Home Association as stated in its by-laws
is "to promote right living, thrift and happiness by means of instruction in
useful knowledge, industrial training, wholesome recreation, and friendly
visits."

Among all the educational and philanthropic organizations in Ouincy,
there is none that is doing a more necessary or hopeful work than the
Cheerful Home Association.

In 1907 the Association started a day nursery, which in the last few _\-ears
has taken over a large part of the first floor of the settlement. The daily
attendance ranges from 25 to 50. Two nursery mothers are in charge.
The children cared for during this period were nearly all immunized against
diphtheria.

A social service is conducted in connection with the institution. A
visiting nurse service was undertaken in 1914, doing bedside nursing and
corrective work, teaching home nursing and making infant-welfare calls in
the home. In 1926 a nursery school for cultural training was established
in connection with the institution.

Cheerful Home Association has been working for the establishment
of an isolation hospital by the citw and for better housing conditions.

In February, 1903, Miss Clara L. iVdams entered the settlement, as the
first resident worker. Miss Martha D. Fitzgerald, R. N., is head resident now
and through her popularity and untiring efforts, the work of Cheerful Home
has been crowned wdth great success.

The Adams County Anti-Tuberculosis League has been a tremendous
factor in the public health activities of the city.
Through its initiative a splendid tuberculosis sani-
tarium is located a short distance outside of
Ouinc\- and a good field nursing service is main-
tained.

The Red Cross and other voluntary organiza-
tions have likewise been active.

The State Department of Public Health made
two surveys in the city. One was an exhaustive
sanitary study, made in 1920, involving a house
111 house canvass and was undertaken for the pur-
pose of providing accurate information upon
which to base the program of the newly adopted
health district. The other was made in 1926
as a basis for appraising the health facilities of
the cit\- and the result is shown in an accompanying illustration. The report
of the survey reads, in part, as follows :

T. B. Knox. M. D.
First President, Adams
County Anti-Tubercu-
losis League, 1913

272

now X -STATE M T XICIPALITIES

"For iuleqiKicy oT puljlic health service Quincy, with a score of 472,
or 47.2 per cent, ranks tenth among the fifteen municipalities studied.

"The health department is distinctly unique in that it operates
under a State health district law, adopted by popular vote in 1920, where-
by ample funds for a completely satisfactory program can be collected
through taxation. A board of health consisting, a.s required by law, of
the township clerk, assessor and supervisor-at-large, administer the
public health affairs of the city through a full-time health officer whosa
staff includes a part-time dentist, a sanitary inspector, a practical nurse
and a clerk. Laboratory service is secured by contract with a local
concern. The county tuberculosis sanitarium board and the county
anti-tuberculosis league each employ a nurse for field duty while the
Cheerful Home Association maintains four nuises who engage in bedside
nursing and promote infant and prenatal hygiene.

"The work of the health department is confined largely to vital
statistics, communicable disease control, dental hygiene, sanitation
including supervision over milk supplies, diagnostic laboratory service
and limited popular education. Other agencies named above do tuber-
culosis field nursing and promote prenatal, infant and child hygiene.
Clinics are maintained for the diagnosis of tuberculosis and for dentistry
among children, the one for venereal disease patients having been
abandoned early in 1925.

"Oddly enough, Quincy is in a position to provide, through taxation,
funds sufficient for a well rounded, adequately extensive public health
program and yet neither the amount invested in this basic governraenfil
function nor the breadth of the service undertaken measures up to what
is regarded as a reasonably satisfactory degree. Total expenditures
from all sources for health work amount to about .54 cents per capita
per year. Over 45 cents of this is contrilnited by the l)oard of health,
making a much larger percentage from the niuniciral government than
in any other of the fifteen cities."

Water Supply
The legislature in 1868-1869 passed a law b\ which the cit\ of Ouinc\
could issue bonds, build waterworks, and create
a board of water commissioners. In that year a
])ump house was constructed near ]\Iississippi
River at the end of Main Street. Six-inch mains
were laid on IMain Street and three fire hydrants
were provided.

In August 1S7,^, the city council passed an ordi-
n.nicc under w hich a 3U-year franchise was given
to the Ouinc\^ Water Works Compan\- to main-
tain and operate the water supply. When this
franchise expired in 1904 the Citizen's Water
Works Company, acting as a holding company Colonel Edward Prince,

f(ir the cilv. took over the waterworks and sold Hydraulic Engineer Project-
ed and Constructed Water
U to the citv m 1916. Works in 1S73

273

A survey made tor the State Board of Health in 1885 indicated that
three-fourths of the pojjulation used cistern water for all domestic purposes.
At that time the v'wl-v water was allowed to settle and was pumped to a
reservoir, from w iiicii it was fed to the mains by gravity.

The city of Ouincy possesses a distinction, in
that it was one of the first cities in this country
to adopt the use of filtration as a means of puri-
f_\ing its water supph'. The hiter plant was
constructed in 1891 and was in service until 1914.
This city was also one of the first to adopt hypo-
chlorite as a sterilizing agent, which was done
soon after the first experiments in 1908.

On .September 1. 1914. the city put in service
a new mechanical filtration plant. The plant at
that time was modern and adequate for the city's

„ ,, needs. Liquid chlorine replaced hypochlorite in

Lorenzo Bull ' i . i

Joint-owner Water Works the new plant.

up to lfl04 Several changes and atlditions have been made,

hut the plant still is essentially as constructed in
1914 and is still delivering an adequate supply of
safe water.

Sewerage

In 188.^ there were two city sewers, three feet

in diameter, emptying into a creek tributary li >

Mississippi River.

Since that time the system has been extended

to include several outlets but it is still inadequate.

Several nuisances have been reported.

In a report on the sewerage facilities by Black

& Veatch, consulting engineers, prepared in 1926,

it was recommended that intercepting sewers be ,,,•„• td o n

'^ " William B. Bull

constructed to carry most of the sewerage direct Joint-owner Water Works
to Mississippi River. ' "P t° ^^^'^

Health Conditions

On Jul\- 4, 1833, Asiatic cholera first made its advent into Ouincy. The
expense of fighting the epidemic was borne by pulilic subscription. The
record shows that $26.81 were contributed.

.\t the time of this outbreak a citizens' committee with William (1.
Flood, as chairman, was formed, to take the actions deemed necessary in
the emergency. That the committee acted with vigor is shown by an

274 DOWN-STATE MUNICIPALITIES

excerpt from tlie minutes of the first meeting, preserveil in tlie handwriting
of Honorable Orville H. Browning, who acted as secretary, which reads:

"At a meeting of the citizens of Quincy, July 6, 1S32, to consult upon
the means of preventing the further spread of cholera, it was

"Resolved, that the town of Quincy be divided into three districts
and a committee of Vigilance be appointed in each district.

"Resolved, that J. T. Holmes, O. H. Browning and R. S. Green,
Chairmen of the Committees of Vigilance shall constitute a Board of
Health for the Town of Quincy; that they shall meet at the Court House
each morning at eight o'clock and oftener if necessary and shall have
power to make all necessary arrangements to procure attendance and
nourishment for the sick and burial for the dead."

This epidemic cost the village 33 lives within five days out of a popu-
lation of 400. It ran the true course of cholera, short, acute, deadly.

Tn March 1849, the same type of cholera broke out again. This time
the number of deaths was placed at 400 out of a population of about 6000,
a ratio about the same as that of 1833. After the first fatal burst of the
epidemic, the disease subsided but smouldered in the conmiuiiity until 1851.
Dr. Joseph N. Ralston, one of the physicians who did much to stem the
tide of the epidemic, denied belief in the infectious and contagious nature of
the disease. The "sulphur remedy" seemed to be the favorite treatment
among the local physicians.

Among other remedies, one used on two }oung ladies by a religious sect
deserves mention. It reads ;

"The process consisted of anointing with oil, prayer, brandy, i)salm
singing, flannels, e.'chortation and hot water. The prescription was
carried into effect with great vigor and perseverance throughout the
entire night and in the morning the patients were quiet and without
pain. — both being dead."

Dr. Francis Drude was a new arrival in Quincy at the time of the epi-
demic. He came from Germany in 1848. In his reminiscenses he relates
his experiences during the cholera season of 1849-51, in part as follows:

"Cholera made its first appearance in Quincy in June, 1849. It
was imported by immigrants coming on a sailing vessel from Europe
by way of New Orleans. It was a family by the name of Jost. They
had lost the head of the family and two children or the way from Xew
Orleans here. They found shelter with their relative. Leonhard Schraitt,
living in Hampshire Street, between 8th and 9th Streets.

"During the first months of its appearance, the disease proved to
be the most, malignant in its character. Then it lost much of its
virulence, appearing in a much milder form in 1850-51.

"The worst cases of cholera occurred 1 to 3 o'clock at night, the
attacks were often so severe, that when called an hour later, we would
find the patient in a state of collapse.

QUINCY

275

"In regard to mortuary records, Qiiincy was at this time in a
rather primitive, unorganizert. yes, chaotic condition. No certificate of
deatli was required, tlie two sextons, one American, one German, buried
a corpse placed in a coffin box, at once when notified.

"Quincy had at this time scarcely a papulation of GOOO inhal)itants.
Without records, it is. therefore, quite impossible to make an estimate
of the percentage of the dead.

"I cannot close the reminiscenses without mentioning an episode
that occurred to myself. It was at the end of the most busy season of
1859. Daily from early in the morning until late in the evening I had
worked. For many a week, every night, someone would disturb my
short slumbers.

"Once at midnight 1 woke up dreaming that I was taken sick with
the disease, and would be a corpse at daylight. This horrid dream had
prwluced a cold sweat all over my body, the rolling of my intestines
could be heard by an outsider. Being wiped dry and re-dressed, I took
a dose of calomel and quinine, each 5 grains, and lay down again. I
Boon fell asleep and rested till late in the morning when I awoke
^eak, but restored to my usual business.

"Dr. Woebken. a young German physician, having a great run of
custom, presented a similar example, which, unfortunately ended his
brilliant career. I recollect his case quite
distinctly. He came to his office about 11
A. M., felt quite exhausted and had to lie
down. He told his friends at his bedside
that he would be a corpse in about three
or four hours. He had no confidence in
any medicine, refused every advice and
medication, and made his prophetic words
true. He died at 3 P. M.

"Dr. Stahl. another German physician,
who had lived in Quincy about 6 years be-
fore the cholera season, after treating a
good many patients with cholera, and los-
ing an alarming big percentage, felt so
disgusted with the practice of medicine,
that he quit it entirely, having lost his wife and two children within
one week.

"Almost had I forgotten to mention my old friend. Dr. Louis Wat-
son, who lived here during the whole season. At 10 o'clock he would
regularly frequent the then old, fashionable Hall of John Nelscbs , take
a big glass of Dayton ale, into which he would invariably put five grains
of quinine, believing that it was a sure preventive of the disease."

In reference to health conditions in the fifties, Dr. Daniel Stahl wrote
as follows :

"We have here in autumn bilious diseases, more or less, for instance
the ague, the intermitting, and the properly called bilious fever. In
very rare cases however do these diseases prove dangerous; every new
resident in the West acquiring in a short time the knowledge of the
very simple remedies by which their care is effected.

Daniel Stahl. M. D.

276

DOW N -STATE M U N ICI PALITIES

"Fifteen or twenty years aso those diseases, together with those
sure always to accompany them, the hepatical diseases, hypochondriasis
and jaundice, held such a formidable sway, that they spared but very
few especially of the immigrants. * * * *

"Diarrhea prevails to some extent liut always in a mild form, being
very rarely, if ever, dangerous. '

The statistical tables show that (Jiiincy has had Irdtihlu en(niL;h fi'din
communicable diseases cif all kinds but that a vast amount of her suffering
is now ancient histmy if present conditions may be regarded as a basis for
forecasting. Typhoid fever was a bad problem until 1917. Smallpox
periodically alarmed the community. Diphtheria has exacted a heavy loss
of life. Tuberculosis was once a common plague. Influenza caused a
sharp ;i(Kance in the death rate of 1918.

Table 1.
MoiJTALiTY From Certain Causes.

YEAR

ElH

•2^

'c E

.£=0

.£

■7;

JS-C

_ S

1875

114

■2

1S70

1.5

'20

122

1877

104

1878

1S7!)

117

1880

' '7

101

1881

1882

1883

1884

311

1885

103

1895

548

1896

521

1897

545

'. '.'.

1898

522

' i

1899

528

".3

■57

1900

568

1901

542

" '4

1902

561

190,'i

552

1904

580

...

1905

472

""2

1900

505

1907

602

;",

' (i

1908

577

1909

496

1910

620

"•2

' 's

1911

673

' '9

1912

535

1913

S75

1914

543

1915

504

191(5

010

' 's

'.'.'.

1917

5K9

1918

859

' 2

126

1919

473

1920

554

1921

511

1922

557

1923

600

1924

536

1925

585

1926

605

" i

' '3

'i(i

;;:

277

Table 2.
Mortality Ratf.s From Certain Causes.

ca 3

'%'s

.2 2'

YEAR

fc-

S£

■3s

u °

J=-a

-I

187-1

438.8

7.6

' 19.2

80.7

330.7

184.6

1S7B

150.0

57.6

30.0

50.0

76 .'9

65.3

469.2

188.4

1S77

92.3

34.6

61.5

73.0

211.5

400.0

14B.1

1878

77.7

22.2

129.6

337.0

137.0

1879

137.0

59.2

59 .2

48.1

433.3

155.5

1880

148.1

37.0

2.5 .'9

3.5

51.8

151.8

374.0

251.8

1881

160.0

60.0

10.0

21.4

3.5

196.4

289.2

110.7

1882

75.0

46.4

3.2

96.4

3.5

71.4

267.8

110.7

1883

89.2

17.8

75.0

242.8

196.4

71.4

1884

'. '.'.

106.8

41.3

24 .'i

165.5

293 . 1

148.2

1885

82.7

24.1

3.4

10.0

51.7

355.1

110.3

1895

16.1

70.8

14.7

2.9

5.9

56.0

156.4

1896

15.1

49.4

8.7

2.9

93.1

119.3

1S97

15.fi

25. S

'. '. '.

2.8

43.0

134.9

1898

14.7

22.6

2.8

14.1

h'.e

8.4

144.4

1899

14.7

19.5

5 . 5

5.5

2.7

.5 . 5

8!3

81.0

159^3

1900

30.3

8.'3

2^8

2.'8

2.8

27.6

2.8

187.6

124.1

1901

14 is

40.8

ii!6

2.7

27.2

201.5

79.0

1902

15.0

56.4

k'.l

5!4

'^'a

16.1

22.0

11.0

196.2

110.2

1903

14.7

39.8

8.0

2.6

5.3

2.6

13.3

21.3

161.9

98.2

1904

15.4

52.4

7.9

13.1

207.1

159 . 9

1905

15.6

27.5

2^7

5.5

8.2

liio

13.7

19.2

205.9

107.1

190(5

12.9

33.2

7.7

2.6

...

7.7

20.5

130.4

48.6

1907

16.5

21.9

7.7

u.h

16.4

00.3

30.1

211.0

76.7

1908

14.4

22.5

2.5

12.5

17.5

30.0

187.3

79.9

1909

13.6

38.3

2.7

'.'.'.

...

24.6

10.9

169.6

101.2

1910

16.6

27.3

8.2

21.9

27.3

8.2

169.4

136.6

1911

18.1

30.0

24.6

2.7

38.2

19.1

180.2

163.8

1912

14.7

32.7

13.6

8.2

174.fi

84.6

1913

15.8

65^4

2.'7

2.7

IB. 4

24.5

147.1

100.8

1914

14.9

33.4

.5.4

2.7

10.9

171.5

100.7

1915

15.6

27.2

2. 7

!:.'

24.5

8.2

.59.8

165 . 9

130.6

1916

16.9

8.2

29.9

2.7

16.3

35.3

201.1

149.5

1917

16.3

21.7

2.7

21.7

38.0

116.7

146.6

1918

23.8

10.8

5.4

2.7

13 . 5

340.5

181.0

229.7

1919

13.1

11.1

s.'s

2.7

8.3

72.2

122.2

102.2

1920

15.4

11.1

8.3

5.5

11.1

69. 4

100.0

111.1

1921

14.2

13.9

16.'7

33.4

11.1

75.1

41.7

1922

14.9

8.0

18. '7

8.0

72.0

66.7

1923

16.0

5.2

2.6

5!2

2.6

5^2

7.8

29.4

48.1

122.9

1924

14.3

16.0

2.6

5.2

7.8

50.6

77.3

1925

15.6

13.3

11.0

61.3

69.2

192(1

15.4

10. '6

12.0

4.0

7.6

22.5 1 ...

76.5

91.8

The rate from .\II Ca

per 1000 population ; all others per 100,000 pnpiil.ition.

But it appears that a new day has come for communit} health in (Juinc)'.
The 1926 mortahty record was exceptionally favorable viewed from the
standpoint of communicable diseases, compared with that of 1900 and most
of the intervening years. Epidemics will continue to come and go but it
is probable that the health department will be able to keep them under suf-
ficient control to prevent the terrible havoc that has often followed their
advent into the community during years gone by.

A fair conception of what (Juincy has experienced in her long journey
toward a healthful city would scarcely be complete without mention of Slab
Hollow and the "pest house." These two institutions held sway in the com-

278

DOWN-STATK iMUNICIPALITIES

Table 3.
Cases of Certain Diseases Reported.

1 1916

1917

1918

1919

1920

1921

1922

1923

1924

1923

1926

1927

Typhoid Fever

Smallpox

.58

Measles

SO.-.

191

194

478

253

613

207

649

217

Scarlet Fever

.50

126

Whoop. Cough

177

116

232

Diphtheria

fi2

Influenza

2909

402

176

Poliomyelitis

Meningitis

Tuijerculosis*

r.i

103

Pneumonia*

192

Syphilis

(Junorrhea

*.\11 forms.
N0TK8 Case reports are never complete
Illinois. This table indicates

Table 4.
Births and Infant Deaths.

Inf.int Deaths

1875
1876
1877

1900
1901
1902
1903
1904
1905
1906
1907
190,S
1909

1923
1924
1925
1926

Number

Rate-

Number

Rate*

469.2

149

573

142

546.1

157

146

lis

100

590

is. 4

51
56

98.7

573

14.4

87.2

644

16.6

92.2

.536

13.7

69.0

701

19.5

69.9

67!)

18.9

61.9

697

19.4

.\ri

77.5

773

20.6

60.8

766

20.4

64.0

798

21.3

91.4

,.,

19.3

■'■'

72.6

" Deaths of infants
Per 1000 populatic

nf age per 1000 births reported.

QUINCY

279

inuiiit\ over a period of years and were responsible for many a shudder to
tliinkint; citizens of unfortunate victims of their influence or function.

The story of Slab Hollow in Ouincy holds something to put towns and
cities to analyzing. Slab Hollow was a gulch. Poverty-stricken people
lived there. They huddled in shacks crudely fashioned out of discarded
slabs which men and women and children dragged from a nearliy sawmill
to patch together into inhuman abodes.

Here in Slab Hollow the grass was worn away, here was sickness and
death. People from the outside shunned it. Just over the ridge was
another place that was shunned — the pest house.

Gone now is Slab Hollow. Gone the pest
house. They went in the main because one man,
in the beginning, rebelled against them. He was
IL J. Parker, banker. His widow, now gray
haired, carries on for him. Air. Parker felt
that Slab Hollow and the gloomy pest house
should go. First Slab Hollow and then the pest
house were rooted out. In their place stands
all the beauty of the public parks system of the
city.

And the point of it is that when the slab shacks
of .^lal) Hollow vanished the poverty that was
there vanished, too. The people were forced
into better living!

The property which was called Slab Hollow consisted of ten acres of
ground bounded by Cedar. Spruce, Third and Front Streets, and belongs to
the Wabash Railway Company. About I9I0, Air. F. J. Parker, president
of the Ouincy Park and Boulevard Association, took up with President
Delano of the \\'abash Railway Company the matter of leasing this pro-
perty to the Park and Boulevard Association for an addition to the park
system. Mr. Delano was agreeable to the proposition and the lease was
made at a nominal amount per year. Up to the time the lease was made the
property was occupied by a very undesirable lot of squatters, poor white
trash, negroes, and all sorts of combinations of these races.

Edward J. Parker

President Park and Boulevard

Association, 1SS7-1912

References.

th B. Ball. Pediatrician, Division Child Hygiene. Departn
.\dams Count.v Medical Societ.v.

DM:i Mii.|.li..l la \h.
lle.llth. f.irir. 1 U -. , i.iiM

Annn.il ,r|,M,i- Ml 111,

.\nniuil i.-i.Mii. ,.f III, li,i:,i,l ,,f health lif the Quinev Public Health Distrir

Uep<jits of the Cheerful Home Settlement. Miss Martha D. Fitzgerald, I!

Heport of l>r. Isaac D. Rawlings, Director of the State Department Publi
of Health .Service of Fifteen Illinois Cities in 192.5, Illinois Health News, Mav-

Aimual Reports of the State Board of Health.

Ilistnrv of Medical Practice in Illinois, Vol. 1. Zeuch. L. H., Chicago, 192

Illilll.i^ A- It Is, Fred Cerhard, Chi<aKo. IS.".-,

X., Head Res
Health on an
mie, 1926.

ident.
Appraisal

Rockford

Rockfurd has established a well earned name and reputatiun in the
health history of the State. In this connection it may be tittin.s^ to recall
lohn 11. 'riuirstun's story in regard to the origin of the city's name. To
the earh tra\elers from Chicago to Galena, the locality of the rock ford in
the Rock River was called "Midwa_\" because it marked the beginning of
the second half of the journey between the two towns.

Thurston says when the original claimants of the mill privilege met in
Dr. |. C. Goodhue's office on Lake Street in Chicago to name their claim,
which the\ hoped at some time would become a
town, the name "Midway" was not in favor.
\'arious other names were suggested and reject-
ed until Dr. Goodhue said : "Why not name it
'Rockford' from the splendid rock bottom ford
on the river there?" The name seemed approp-
riate and was at once unanimously accepted.
This happened in 1835. but the legislature, meet-
ing in Vandalia in 1836, in its proceedings still
referred to the site as "Midwa}'." But news
traveled slower to the capital in those days than
reports of contagious disease do now.

This same Dr. Goodhue, who was not satisfied
<nown only as a midway halting place between
Chicago and Galena, put into effect his convictions, and went to Rockford
in 1838 and settled there.

.Io.siali C. Goodhue, M. D.
that Rockford should be

In Chicago he had been an alderman from the first ward, in which office
he was succeeded fifty years later by "Hinky Dink" Kenna. As a council-
man, he took a leading part in the establishment of the public school system,
in fact is known as the father of Chicago's public schools. In 1834 he
served with Dr. W. B. Egan as a sanitary ofiicer of the Town of Chicago
under the \"igilance Committee which was acting then to protect the city
from an\ fiu'tlier invasion of the cholera.

In this capacity it was a part of hi^ dut\ to enforce the first .sanitary
ordinance of Chicago, which was passed i)y the town council in 1833. This
prohibited the throwing of refuse into the Chicago River, a simple provision
yet very significant, in that it was the forerunner of the great efforts made
in the next 75 years to solve the great sanitar}- problem of the citw namel.\-,
the pollution of the river and the contamination of the water suppl\ .

(280)

ROCKFORD 281

Dr. Goodhue was a close friend and associate of Dr. Daniel Brainarci
and with him was one of the founders of Rush Medical College, and is
named as one of the original trustees in the charter granted to that institu-
tion in 1837.

When Dr. Goodhue became a resident of Rockford, he continued to tlis-
pku' the same interest in |)ul.ilic affairs as he had in Chicago. In 1846 ,
he organized the Rock River Medical Socict\-, one of the earliest in the
State, and became its first ])resident.

If the early proceedings of that society were available, they would
pnjhablx show that the health of the community was given much consider-
ation and the first efforts to check the ravages of contagious diseases were
made by public spirited members of this society.

Rockford appeared first in the U. S. census returns in 1860. At that
time 6.979 people inhabited the place. By 1870 the population figure had
grown to 11,049 and to 13,129 in 1880. The next decennial census year
found 23,584 souls in Rockford and this nuniljcr had increased to 31,051
when the new century began. In 1910 the population was 45,401 and in
1920 it was 65,651. Of the 1920 population 47,782 or 72.8 per cent were
native born whites, 17,343 or 26.4 per cent foreign born whites and 490 or
0.7 per cent negroes. There were 14,584 or 22.2 per cent in the 45 or over
age group.

PuuLic Hkalth Skrvuk Maciiinkry

The stor_\' of public attempts in Rockford to protect itself against the
ravages of disease divides itself into periods that correspond very closel\-
to the advancements in sanitary science. At the outset attention was con-
cerned almost wholly with environmental conditions that dealt principally with
physical cleanliness of streets and premises and with the abatement of
nuisances. As time went on bacteriology came into practical use and the
citizens of Rockford through their local officials took advantage of the new
methods prescribed by it more promptly and on a larger scale than most
other communities of like magnitude in Illinois.

To begin with the sanitary efforts were handled bv laymen independent
of the medical profession. This arose, as it did in other places, not from
;i lack of confidence in physicians of the day but because doctors were regard-
ed as a profession dealing only with the cure of disease and the alleviation
of the sick and not as men whose training fitted them to cope with external
conditions that were regarded as the source of contagious infections. An-
other reason was that doctors were busy people and could ill afford to devote
their time and talent to the current sanitar\- procedures, the benefits of which
were doubtful enough. Futhermore, the remunerations provided for per-

282 DOWN-STATE MUNICIPALITIES

sonal service and the resources for carrxing out constructive programs were
onlv too meagre.

Thus the first public health efforts in Rockford were an expression of
this prevailing attitude. An epidemic of cholera that reached the cit\- in
1853 led to the adoption of an ordinance requiring the abatement of nuisances.
In June of 1854, therefore, a board of health was organized and Newton
Crawford was employed as its executive officer. This was the beginning
of what may be termed the lay or non-medical period of public health service
in the city. It continued for almost exactly thirty years during which time
only one physician was named among the long list of health officers who
included the following:

Newton Crawford 1S54 J. Fisher ISfiS

T. B. Potter 1S55 R. H. Paddock 18(i4

E. H. Potter 1S56 T. Sully lsG.5

Dr. R. P. Lane 1857 G. H. Platter (.3 months) ISiJG

E. C. Roberts 1858 T. Sully 18G7-1S79

M. T. Upright 1859 P. A. Coonradt 1880-1881

A. J. Pennock 1860 T. Sully 18S2-1S84

A. Halstead 1861-1862

During this lay period numerous ordinances of a sanitary nature, relat-
ing for the most part to nuisances, were adopted and placed under the juris-
diction of the health officer for enforcement. In 1860, for example, a code
of sanitar\' regulations was adopted and the next year an ordinance concern-
ing barber shops was added. Then folh.iwed from time to time new regu-
lations, prescribed by the city council, relating to plumbing (1875), weeds
and grass in streets and alleys (1877), scavenger service (1878), inspection
of slaughter houses (1878), sewage disposal (1880) and the reporting of
cases of contagious diseases. Apparently the continuity of the original
board of health was not maintained for in 1879 the ma\or apjiointed a com-
mittee from the city council tn form a board of health.

I'"rom this account it is clear that ]nililic health work in Rockford up to
1885 was chiefly a matter of abating nuisances and promoting general com-
munity cleanliness. Responsibilit\' for providing this service was vested in
a sanitary policeman, the health officer, who had authority to employ medical
service when circumstances required it. The city paid from $200 to $450
a \ear to the health officer.

I'eginning with 1881, three years before the medical profession took
over the direction of public health affairs, a series of ejiidemic events brought
health protective measures to pass in a hurr\- for two years. Scarlet fever
and smallpox were the chief offending infections during this period, the first
causing 53 cases of illness in 1881, with a recurrence the next year and the
second bringing 23 individuals to bed and 3 to their graves.

ROCK FORD 283

Public concern over this situation led to the expenditures of $593.75 in
health work during 1881. an unheard of sum up to that time; the building
(1882) of a pest house on the outskirts of the city at a cost of $2,000 with
an additional $175 per annum for its operation; the construction of a gen-
eral hospital (1882) now known as the Rockford General Hospital; and the
placarding (1882) of houses in which scarlet fever existed.

These developments manifested a distinct tenderness of the public con-,
science toward health service and demonstrated the important fact that the
people were willing to pay for any reasonable activity that promised pro-
tection from epidemic attacks. According!)- we are not surprisetl to observe
signs of substantial advancement in the years that follow.

Period of Medical Influence

The years of 1884 and 1885 mark two important changes in public health
administration of the city. Both involved a reorganization of the board of
health. The first provided a board of four members, made up of the mayor,
the health officer, the city marshal and an alderman. At the same time the
city council inaugurated the practice of maintaining a standing committee
on health.

The second change provided for the organization of a board of health
"consisting of the mayor, city marshal, the chairman of the committee on
health of the cit\' council, and a health officer who shall be a resident prac-
ticing ph\sician possessing the requisite knowledge of sanitary science and
preventive medicine, and shall be appointed by the mayor with the consent of
the city council."

Here we find the influence of the medical profession manifesting itself
and from this date forward that influence plays an increasingly important
part in the public health service of the city. This is significant because it
probably became a big factor in giving to Rockford what is today one of the
finest health departments for cities of its size in the country.

But the administrative reorganization of 1885 did not stop with provid-
ing a more satisfactory and serviceable board of health. The board was
clothed with vigorous authority. For one thing the health officer could
forcibly hospitalize persons found sick in the city of "any pestilential or
infectious disease." Strict reporting of all cases of communicable dis-
eases was required. Compulsory vaccination of school children, as required
by the State Board of Health, was made mandatory. The keeping of vital
statistics was ordered by ordinance.

These requirements together with numerous others expressing the
most advanced sanitary and hygienic ideas of the day indicate a lively public
interest in health problems and suggest a well advised and deliberate policy
on the part of those in charge. While not largely compared with present

284

)W \ -STATE M f X UI I'ALITIES

(lay r.\|)cn(lilurc> for tirst class health service, the appropriation of 91,425
to the liL-allh department in 1885 was generous for that time when the State
appropriated only $9,000 for such purposes. Moreover, the same generous
attitude added dignitx- to the health department by providing it with furnished
quarters uf its own in the city hall. The property schetlule showed a desk,
a stove, a bill tile, a pick and an uthcer's badge. Just what the function of
the pick was is left to the imagination.

Beginning with 1885 none but medical men have served Rock ford in
the capacity of health officer. The position was on a part-time basis until
1923 when the present health commissioner, Dr. N. O. Gunderson, found it
advantageous to the service and the public to convert the office into what is
practically a whole-time proposition.

The list of physicians who have acted as health oflicer or commissioner
of health, as the officer was officially known after 1892. includes the
following :

Health Officers of Rockford
1885—1927

Dr. E. E. Oder
Dr. W. B. Helm
Dr. W. A. Boyd
Dr. G. W. Rohr
Dr. C. E. Crawford
Dr. E. Lotgren

1885-1SS7 Dr. C. E. Crawford 1907-1910

1888-1890 Dr. W. E. Park 1911-1916

1S91-1894 Dr. G. S. Lundliolm 1917

1895-1900 Dr. W. H. Cunningham 1918

1901-1902 Dr. J. S. Lundholm 1919-1920

1903-1906 Dr. X. O. Gunderson 1921 to date

.Mong about 1890 the responsibility for garbage removal was place
the health department, a common practice of
municipalities, and appropriations were made to
include that item. The strength of the depart-
ment may be surmised from the fact that its
total appropriation for 1892 amounted to $2,tX)0
with $157.50 specified for garbage removal.
Most of the money was spent during that and
immediately subsequent years in making house
to house sanitary inspections, a practice that was
believed to be of the greatest importance in dis-
ease prevention and one that was probably stim-
ulated by the policy and emphasis of the State
Board of Health. Fumigation of premises,
especially where contagious diseases had existed and public buildings includ-
ing schools was also an important function so far as time and expense was
concerned.

.\biiut 19()(J it became the custom to retain on the staff of the health
department a regularly eni])li)yed sanitary insjiector. Work of this char-

Charles E. Crawford, M. D.

Commissionei of Health,

1901-1902; 1907-1910

286

DOWN-STATE JI UN' K'l I'AI.ITI ICS

actcr frL-(|ueiitl\- retiuircil a larger staff but ailditimial help was put on tem-
porary ilut> fruiii time In time as occasion arose.

The heallli (lei)arlment continued to grow _\ear hy year in size, function
and influence until 1917 found it with an annual appropriation of $8,250.00
and consisting of the commissioner of health, one clerk, two sanitary in-
spectors and a chemist (part-time). It had a small laboratory for testing
samples of water, milk and food and for doing some bacteriological work.
The functions of the department embraced vital statistics, communicable dis-
ease control, food and dairy inspection, abatement of nuisances, laboratory
service and supervision over garbage removrd.

Then came the World War that brought with it to Rockford a sudden
and tremendous influx of population, due to the proximity of Camp Grant.
This created complex health problems of greater magnitude than the city
had before experienced. Not only so but the activities of the Federal and
State authorities emphasized health more vigorously than that subject had
ever before been emphasized. The influence of this general movement fell
with particular force upon Rockford not only because of the acute problems
that suddenly faced it but because the public conscience had for more than
fifty years been growing in its respective attitude toward sanitary and hygi-
enic service.

During the war, therefore, Rockford welcomed the widening scale of
puiilic health work made possible by the establishment there of a sanitary
district, including the camp, with a State district health superintendent in
charge and on its own initiative the city carried out an exhaustive sanitary
study, including a house to house canvass, supervised by a staff member of
the State Department of Public Health. This project was undertaken with
the view of bringing to Rockford a health service organization commensurate
with the needs of that rapidly growing munici-
pality.

As an outcome of all these influences, we find
the health department taking on a nursing service
in 1918 and by 1920 the personnel included a
nurse, a cjuarantine officer, two sanitary inspect-
ors, a chemist and a bacteriologist. The next
year Dr. N. O. Gunderson was appointed health
commissioner and this event marked the beginning
of a period during which Rockford has enjoyed a
public health service of the first rank.

One of the first things Dr. Gunderson did was
to complete the organization of the department
intd bureaus. He charged each with specific

N. O. Gunderson, M. D.

Commissioner of Healtli,

1921 to date

Two views of the Rockford and Winnebago County Tuberculosis Sanitai-iuni.

288 DOWN-STATE MUNICIPALITIES

responsibilities and required from each periodical reports that not onl\- stim-
ulated the best efforts of the staff but provided the commissioner with valu-
able data serviceable in measuring the capacity of his department, in fdrm-
in.ij; policies and in dealing with appropriating bodies.

L'nder Dr. Chmderson. who continues as health commissioner at the
present time, the health department has developed into a strictly modern
public health service organization.

While still falling short of what might be regarded as the ideal, it par-
ticipates in nearly every phase of work embraced in the modern conception
of what official preventive medicine implies and gives to the city a thoroughly
sound and well rounded program.

Other Official and Voluntary Agencies

Like most other communities the public demand for health service in
Rockford exceeds that which officials of the municipality have arranged to
supply and consequently we find that voluntary organizations and the board
of education engage in hygienic and sanitary activities on a considerable
scale. Indeed the other agencies combined spend more money than does
the health department proper for purely public health work.

In addition to these organizations the city voted to establish a municipal
tuberculosis sanitarium in 1914 and opened the institution two years later.
Winnebago county, in which Rockford is located, voted a tuberculosis tax
in 1922 and arrangements were made by officials for the city and county to
operate the sanitarium jciintly for the lieneht of all citizens both urban and
rural.

In 1926 a stud\- of the health activities in Rockford. including both
official and voluntar_\ , was made by the State Department of Public Health.
The data collected were compared with similar information gathered in four-
teen other cities in the State of comparable rank and were also reduced to a
numerical expression in the form of a score, based upon a possible perfection
rating of 1000 points. The fact that Rockford earned 770 points, standing
next to Evanston with 812 as the highest scoring of the fifteen cities, indicates
the character and extent of present day service there.

The following (|uotation from the report of that stud\ indicates the
character and comprehensive nature of Rockford's public health program
and organizations :

"Enjoying a public health service far above the average of the
fifteen cities studied, Rockford scoring 770, or 77 per cent perfect, ranks
second to Evanston only in the appraisal results. All health activities
are on a much higher plane than the average. Especially is this true
of vital statistics, tuberculosis, milk control, laboratory and health edu-
cational services. The health officer gives practically full-time services
and administers a very efficient department, although many activities

ROCKFORD 289

are not under his direction. The board of education conducts all school
hygiene work, employing a part-time physician, dentist and five nurses.
The tuberculosis, prenatal. Infant and preschool work is conducted by
the Rockford Visiting Nurse Association. For the tuberculosis ac-
tivities the Municipal Sanitarium Board pays $2,000 per annum to this
Association for field nursing service. The city health department
conducts all of the other phases of health service and in addition
handles garbage collection. The expense of garbage collection has been
eliminated in estimating costs. Expenditures for health service by the
city health department for 1925 amounted to $28,500 or 37 cents per
capita. Other agencies spent money suflScient to bring this figure up
to $61,267 or a grand total of about 65 cents per capita."

ROCKFORD

ra 'p 'p y "p — I-

VITAL 5TATI5TIC5§1
conn. DI5. CONTROUEI
VEh. DI5. COMTROL :^^1
TUB. CONTROL Si
HEALTH CHILD=<:^"-^
HEALTH 5CH. CHILD ^J
5AhlTATI0h's?icX^^
MILK COhTROL ^1
LABORATORY >^M
POP.MLALTH IMSTkI

PERCENT OP STAMDARD SCORE
FOR EACH OF TEM MAJOR HEALTH ACTIVITIES
1923

This graph illustrates the strong and weak points in Rockford's public
health service, oflScial and voluntary, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in Rockford was 77
per cent of the standard perfection requirement.

The significant developments in the pubhc health machinery of the city
may be briefly summarized chronologically as follows :
185^1 — First board of health organized.
1854 — First health officer employed.
1882 — Began quarantining for smallpox and scarlet fever.

290 DOWN-STATE MUNICIPALITIES

18S-1 — Reorganized board of health and created stanchng committee on

health in city council.
1885 — Mandatory requirement that health officer must be physician.
1891 — Plumbing in.spector employeil.
1902 — Milk inspections started.
1904 — Dairy inspection inaugurated.
1910 — Medical inspection of school children started.
1911 — Visiting Nurse Association organized.
1912 — City laboratory opened.

1913 — Fresh air rooms in schools started operation.
1915 — Fresh air camp opened.

1915 — Bureau of communicable diseases established.
1916 — Municipal Tuberculosis Sanitarium opened.
1916 — Bureau of food control created.
1917 — Bureau of vital statistics organized.
1918 — Tuberculosis clinics started.

1922 — County adopts Glackin tuberculosis sanitarium tax.
1923 — Health commissioner began devoting full time to duties.
192-:1 — Bureau of ventilation and heating, bureau of publicity and bureau

of water safety and typhoid control established.
1925 — Pre-natal clinics started.

Water Supply.

The original waterworks were installed in 1874-75 when Rockford had
a population of about 12,000. It comprised a pumping station on the west
side of Rock River, an infiltration well beneath the station, some tile drains
connecting springs to the infiltration well, a pipe line from the river to the
infiltration well, and a limited distribution system. Since the original instal-
lation, numerous changes and additions have been made from time to time
to make available an adequate supply of safe water to meet the growing
needs of the city. The city has faced threatened water shortages several
times.

By 1881 the first installation had become so inadequate that a dug well
about 50 feet in diameter and 38 feet deep with a 12-foot shaft going 10 feet
deeper was sunk south of the station. In 1883 the infiltration system was
cleaned, possibly with the hope of increasing the yield, but river water had
to be admitted from time to time and by 1885 the main part of the supply
was being obtained from the river.

In 1885 after consulting Professor T. C. Chamberlain, then of the
Geology Department of Beloit College, the first artesian well was sunk at
Rockford. The well was about 1,530 feet deep and water rose about 136
feet above the citv datum-line or 35 feet above the average Rock River water

ROCKFORD 291

level. In each of the four succeeding years another artesian well was drilled.
In 18'Jl the combined flow from the five wells reported as 1,100,000 gallons
daily, was not adequate, and an engineering committee was appointed to
report on the water question. The static water level of the wells was then
about 20 feet above the ground surface, and the water flowed to the old
infiltration well below the pumping station, which was used as a suction well
for high-service pumps. The engineers recommended the installation of
three more wells to be equipped with pvuups for discharging the water into
a new storage reservoir. In 1892 a 1 ,000.000-gallon concrete storage reser-
voir was built, and during that year and the following year four or five new
wells ending in St. Peter sandstone were drilled.

In a further effort to increase the supply, all wells were equipped with
air-lift in 1895.

In 1896 the so-called shaft-and-tunnel system was installed which con-
sisted of a central shaft about 80 feet deep from which tunnels connected
to the tops of the several wells. Pumps located at the bottom of the shaft
drew water from the wells and discharged into the reservoir and suction
well at the ground surface. This development yielded about 6,800,000 gal-
lons of water a day and proved more or less adequate for about a dozen
years. River water had been used more or less frequently since the original
waterworks were installed.

In 1897 the sixth artesian well was drilled. By 1900 the water con-
sumption for the population of about 31,000 was about 84 gallons per capita.

In 1910 a second engineering commission consisting of J. W. Alvord,
D. H. Maury, and D. W. Mead, leading consulting engineers then practicing
in the Middle West, were engaged to make a thorough investigation of water
resources and the waterworks system because the supply was again proving
inadequate. These engineers recommended the establishment of a new cen-
tral station on the west side of the city with some wells in that vicinity ex-
tending into Potsdam sandstone and other wells at scattered points in the
city, from which water could be pumped directly into the distribution system.
The first result of this report was the installation of two separate well sta-
tions, one in the northwest and one in the southwest part of the citw and a
second 1,000,000-gallon storage reservoir near the main station on the river
bank. Before these wells were available in 1911 river water was again used.
In 1913 three of the wells locally known as the Peach Street wells because
of their location in that street near the main pumping station, were tempor-
arily abandoned because they were suspected as one possible source of con-
tamination of the public water supply that had caused a water epidemic the
preceding year, and these wells were not again used except for short periods
in 1916 and 1920 but are still maintained as a second reserve supply. In 1913
the use of the old infiltration well as a suction well was also abandoned and

292 DOWN-STATE MUNICIPALITIES

re|)aii"s made to the (irii,'inal sttirage reservoir, as result of the water-borne
typhoid- fever investigation.

In 1921 the new west side pumping station recommended by the con-
sulting engineers in 1910 was started, together with four drilled artesian wells
and a 5.000,(X)0-gallon storage reservoir. At the close of the period covered
by this history the water supply was being obtained from the drilled wells
near the west side station, the two isolated wells installed immediately after
the engineer's report in 1910, and the Peach Street wells and the others near
the old station along the river bank are held as a reserve source of supply.

The sanitary quality of the original water sup]:ly obtained by tile lines,
tapping springs and an infiltration system was of questionable character.
Also the river connection subjected the supply to contamination even though
there was no city sewer outlet that entered the river above the dam, which
dam is below the waterworks station, until 1883 or about nine years after
the original waterworks installation. Although there is no record of a water-
borne epidemic being caused by the public water supply previous to 1912,
it probably was at all times of doubltful sanitary quality and may have been
responsible for some scattered cases of typhoid and other intestinal diseases,
especially when river water was definitely being admitted into the system.

The typhoid-fever epidemic in 1912 was undoubtedly caused by the
public water supply. The investigation made at the time of the epidemic
showed that the supply may have been contaminated in any of three ways
or a combination of them, namely : — pollution of the Peach Street wells near
which a city sewer was located, pollution of the water in the original
1 ,000,000-gallon reservoir when the water in that reservoir was drawn down
in order to fight a fire, and pollution through cross connections with polluted
river and creek supplies at factories. Later data showed that although the
Peach Street wells and reservoir leakage may have added to the contamina-
tion, that the main pollution and cause of the epidemic was the pumpage
into the city mains of polluted river water by operation of fire pumps at
one factory in order to help supply water for fighting a big fire at another
factory.

The city passed an ordinance in l'*12 prohibiting the further mainte-
nance of dangerous cross connections, but no special efifort was made to
enforce this ordinance until 1922 when the danger of the cross connections
was brought by the State sanitary engineer to the attention of Dr. N. O.
Gunderson, who had recently become commissioner of health. A chlorina-
tor was obtained for emergency use at the main station in 1922 and through
the efforts of Doctor Gunderson the cross connection ordinance was
enforced, and since that time the water as pumped into the distribution
system has been of safe sanitary quality. .\t times the chlorinator has been
operated to take care of any contamination introduced when working on the

ROCK FORD 293

wells or when analyses have indicated slight contamination. Some improve-
ments at the waterworks, including drainage of well pits and repairs to the
reservoir top in accordance with recommendations made by Health Commis-
sioner Gunderson and endorsed by the State sanitary engineer, remained to
be carried out at the close of the period covered by this history.

Since Doctor Gunderson became commissioner, very careful local ana-
lytical control supplemented by occasional analyses in the State sanitary
engineering laboratories have been maintained. With similar continued
control and the carrying out of the recommended improvements mentioned
ab()\e, the supply should continue to be of safe sanitary quality.

The first record of an analysis is in 1878 when the sample was sent to
some laboratory at Bridgeport, Conn., and was reported back as "good". In
1912, 515 samples of water, including many from the public water supply,
were analyzed at the city laboratory, and the laboratory control as noted
above has been further extended since 1922.

The original distribution system of about ten miles of mains was
planned by Engineer Birdsall Holly. For several years the next additions
included extensions of laterals so that eventually the larger mains became
inadequate. Since then larger feeders have been installed and the distribu-
tion sxstem now serves practically all of the built-up territory in the city and
the ])ublic water supply is in general use throughout the city.

Sewerage.

In 1875 an ordinance relating to plumbers was passed, and in 1880 an
ordinance relating to sewerage and drainage. In 1880 the drainage system
consisted of surface gutters leading to the river.

In 1886 there began the development of a system of sewers b\ the
installation of two sewers, each about one mile long, with an outlet to the
river. There were then about 3,500 dwellings in the cit\' and nearh- 1,000
cesspools. These original sewers were recorded as being for sanitar\- sewage
only, surface drains and gutters being relied upon to carry storm water to
Rock River, on the banks of which the city was developing, or to Kent and
Keith Creeks, tributaries of Rock River, which furnished natural outlets for
storm waters as the city expanded away from the main stream.

It was reported that by 1887 only about 235 houses were equipped w ith
water-flush toilets, and that one-half of these drained to cess-pools. About
24 out of every 25 houses still had privies.

As the city continued to grow, additional sewers were installed with out-
lets to the river or the two creeks that are tributary to the river at Rockford.
It was reported that shortly before 1900 a rather comprehensive plan for
sewerage for the city was prepared, but this plan was not followed.

294 DOWN-STATE MUNICIPALITIES

By l'J18 there were 2,142 privies in the city, whicli indicates that the
installation of sewers and plumbing had not kept up with the growth of the
citv. By 1921 the number of privies had been reduced to 1,345 and there has
been a further reduction every year since that time.

At llie close of the period covered by this history there were a total of
50 or more public sewer outlets, one-half of which discharge into Rock River
above the dam in the southern portion of the city, another one-fourth into
the river below the dam, and the remaining one-fourth into Kent Creek.
The city has developed so that there were about equal areas on the east and
west sides of Rock River, which flows southerly through the city. Near the
close of this period additional sewerage facilities were urgently needed to
take care of subdivisions that had developed fairly rapidly and also to abate
and prevent stream pollution. Consequently, in 1926 Rock ford took advantage
of the sanitary district law enacted by the legislature in 1917 and organ-
ized a sanitary district which included the entire city and some surrounding
territory. Just before the close of the period covered by this report Pearse,
Greeley & Hansen, consulting engineers for the district, had submitted a
report on a sewerage project which included main intercepting sewers on
both sides of Rock River to pick up the sewage from the main existing out-
lets and to carry this sewage to a suitable treatment-plant site south of the
city where the sewage will be treated by progressive steps to abate any exist-
ing pollution and prevent any objectionable stream pollution in the future.
This report has been approved by the State Department of Public Health
and also by the board of trustees of the sanitary district, and plans for carry-
ing out the project are under way.

With the carrying out of the Rockford Sanitary District project and
some additional lateral sewerage work which is also planned, all built-up
territory within the city and district will be provided with sewerage facilities
and the collection and disposal will conform to modern sanitary standards.

Milk Control.

For forty _\ears milk control has been a subject of jealous public con-
cern in Rockford and the efforts to provide the cit\- with an adequate, safe
and otherwise satisfactory supply have culminated in giving to the munici-
pality a system of sanitary milk supervision that is far superior to that pre-
vailing in most other ci immunities of Illinois.

The first official step toward municipal control of the milk supply took
place in 1888 when an ordinance was adopted requiring all dealers to procure
a license. The main reason for this step was probably for revenue but it
enabled the city to dictate conditions upon which a license would be issued,
providing a splendid means of enforcing sanitary or other standards that
mieht be deemed wise.

ROCKFORD 295

At first the chief concern was for chemically satisfactory milk. The
public wanted a product free from water and with a butter fat content no
less than the cow prescribed. It wanted milk without manure and other
barnyard filth that frequently finds its way into the milk pail of careless
producers. Still it was recognized that milk has some close relation to health
because the jurisdiction over milk supplies was placed under the health
ofticer.

Thus in 1902 a special milk inspection service was undertaken by the
health department and in 1904 this was extended to include dairy farms.
Chief emphasis was placed upon chemical standards and ordinary cleanli-
ness for its own sake. This attitude was disclosed by the number of samples
analyzed for chemical contents. In 1907 more than 1200 samples were
collected and chemically analyzed.

In 1912 came the first movement toward controlling the bacterial qual-
ity of the city's milk supply when an ordinance requiring the cooling of milk
and the routine inspection of dairies was adopted. This ordinance vv'as re-
vised a year later and amended in 1914, each time prescribing more stringent
sanitary requirements and giving the health authorities more extensive
control powers. In 1924 a complete new ordinance which practically re-
quires the pasteurization of all milk except that produced and handled under
very high sanitary standards was adopted. The ordinance gave the health
officer power enough to carry into effect a thoroughly modern control
SNstem,

A rather unique feature of the system so far as the producing farms
are concerned, is what Dr. Gunderson calls remote control practice. Daily
bacterial and reductase tests are made at the milk-receiving stations of city
dealers. When the results suggest insanitary or other undesirable conditions
at the farm an inspector is dispatched promptly to the point in question.
This method appears to have worked out very sastifactorily in Rockford.
Certainly few cities enjoy a more satisfactory supervision over this most
important and easily contaminated food supply.

Health Conditions.

What appears to be the earliest historical reference to prevailing health
conditions in Rockford is found in a history of that citv, covering the period
of 1834 to 1861, by Charles A. Church. He says:

"The year 1S4G was sigualleil by much sickness. Nearly every
family living on low land had malarial fever, and the doctors were busy
people. At one time Dr. Catlin, who settled in Rockford in 1839 could
get but four or five hours sleep out of the 24, and he would become so
exhausted that he frequently slept while riding from house to house.
One day in 1S46 he made "0 calls, and prescribed for GO patients.

296 1X)\V.\'-STATK MUNICIPALITIES

'■Durins this season, Dr. Goodhue was asked what to do tor the
sick. To this grave question the doctor made this characteristic reply:
i (ion't know, unless we buy a big smoke house and cure them.'"

No otiicial iiKirtaliiy records were kept in those earl_\- (la_\s but statis-
tics taken from sexton and cemetery registers indicate an annual death rate
of something more than 12 per 1.000 population. The rate fluctuated from
year to year with the rise and fall of epidemics but no statistics are available
to show how wide the margin of variation was. An annual mortality rate
of 12 per 1,000 people suggests favorable health conditions, but it must be
remembered that settlers in a new country ordinarily constitute a sturdy
groui), free from any considerable number of those in the very early and
very late age periods of life. Since the highest mortality prevails among

TEN PRINCIPAL CAUSES OF DEATH

ROCKFORD ILLINOIS

1 —

IZ
10

6
i
2

1 HEART DISEASE 6 TUBERCULOSIS

2 CANCEO 7 PNEUMONIA

3 BBIGMTS DISEASE 9 PREMATURITY

4 STROKE 9 CONTAGION

5 ACCIDENTS 111 DIABETES

CAUS[

]

PAT[

].l

6.0

5.4

4.8

For Year 1926.

persons under one and over fift_\- it is clear that a rate (.if 12 or more in a
population without many of these is not indicative of so healthful a condition
as might be surmised at first impression. The annual death rate in the
United States Army in times of peace, for example, is ordinarily less than
5 i^er 1.000 men.

An epidemic wave of cholera appeared in the United .States in 1849 and
it appears rather certain that this outbreak reached Rockford in 1853. No
authentic records about it have been preserved but tradition informs us that
public alarm reached ;in altitude sufficient to lead officials to procure the
use of a new barn i>n ihc outskirts of town for housing and caring for
patients. It is probable that this unhappy experience led directlx to the
first efforts in the cit}' toward organizing a public health service.

297

The next epidemic disturbance of sufficient magnitude to inspire notice
on the permanent records of the city took place in 1877 when 399 cases of
scarlet fever occurred. That was a terrible experience for a community of
less than 14,000 souls. Such wide-spread prevalence of so dangerous an
infection is enough to justify a pronounced public demand for every official
service that might reasonably be expected to prevent or favorably modify
recurrences of that character. It followed very naturally therefore that
public sentiment in Rockford resulted in the adoption of various ordinances
requiring general cleanliness in the city, sewage disposal and the naming
of a committee to form a new and active board of health. No less could be
expected frum an intelligent people.

Table 1.
AIoKTALiTV From Certain Causes,

YE.\R

i
6

3
P

6
5

5<S

'c 5
5_

1886

158

1887

228

' i

' 8

1888

1889

1890

340

',54

'46

1891

355

'ii

1892

389

' i

■38

1893

409

1894

298

189.3

350

' 6

' 8

1896

283

.")

1897

335

...

1898

272

1899

272

" -2

4 1

1900

300

' (i

...

1901

429

1902

403

1903

433

1904

460

...

190.-)

739

1906

416

1907

498

' 's

' a

1908

450

1909

503

'.'.'.

1910

610

1911

720

1912

582

1913

593

' i

1914

562

1915

603

1916

061

1917

723

' 6

101

1918

1087

323

'.'.'.

1919

702

1920

835

1921

697

1922

708

1923

755

' '9

1924

672

1925

681

1928

836

* For Enteric fever for years 1886-99.
Note: Slight disi.*repancie.s exist between
different nietliotls employed and areas iiicliided

table and th(
:he conipilatio

298

DOWN-STATK MUNICIPALITIES

Table 2.
Mortality Rates From Certain Causes.

YEAR

s
s

%s.

Jo
3 "

1886
1887
1888
1889
1890
1891
lS»-i
1803
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926

8.1
11.1

liii

H.6
1.").5
15.8
11.2
12.8
10.0
11.6
9.2
8.9
9.6
13.2
11.8
12.3
12.5
19.3
10.4
12.1
10.5
11.4
13.4
14.5
11.2
11.1
10.1
10.5
11.1
11.7
17.1
10.7
12.3
10.0
9.9
10.3
8.9
8.8
10.5

10.3
107.6

3219
91.7
(2.3
15.0
21.9
17.7
34.7
3.4
9.9
3.2
9.2
6.3
2.8
29.7
15.6
10.0
14.4
9.2
4.5
24.2
22.1
79.8
27.9
7.2
6.8

h'.e

3.1
1.5
4.4
1.4
1.4
1.4
2.6
2.6
3.9

'.'.'.

'.'.'.
'..'.

1.5.9
2i!9

8'.4
4.4

i!8

1.7
8.5
6.4
3.1
9.0
4.4
1.4

12!2
5.2
3.4
3.9

16.9
10.5
19.9
45.6
37.6
3.6
3.5

19!2
3.1

52 . 2
5.6
8.1
2.6

19!2
4.6
4.5
4.4
2.0

i.'g

3.6
6.8
13.6
12.8
1.6

5.6
1.8
1.3

2.6
1.3

4.2

V.e

11.4
29.6
7.1
3.5

3.3
3.2
9.2

16.8

2!6

7!2

:::

5.6
3.6
8.5
1.7

11.2
1.6
1.6
5.9
4.2
1.4

10.9
2.6
1.3
1.3

15.4
14.5

229!o
49.4
31.8
3.8
3.8
21.9
53.1
179.9
88.4
32.9
16.0
3.1
31.9
11.2
5.4
13.0
10.0
24.3
6.9
4.6
17.6
20.1
9.5
18.6
10.8
10.2
3.4
4.8
20.4
10.5
13.3
10.8
4.2
12.2
2.6
1.3
1.3

45. '2
59.5
22.8
15.0
29.6
10.5
10.4
13.8
13.2

6.<k
12.3

6.3
16.8
13.5

"s'.b

2.4
16.1
2.3
4.4
4.0

'3. '7
3.6
10.2
1.7
1.6

507.1
6.0

143.6
1.4
2.8

35 . 4
9.1
2.6

31. 5

77.0
141.8

loo.'o

135.6
171.4
152.0
169.3
109.8
80.5
159.2
102.0
138.2
115.2
171.9
139.2
103.6
148.5
161.2
97.5
68.0
126,5
124.9
110.0
92.5
85.5
76.3
108.0
83.3
73.1
96.0
106. S
78.0
90.3
70.0
66.7
32.6
42.9
29.7
48.3

38^4

loiis

...

151.5
83.6
.52.3
76.1
87.6
51.9
81.6
65.8
64.0
144.3
95.7
84.0
89.1
111.8
07.5
182.3
89.7
81.7
85.8
134.7
110.2
100.4
79.2
98.6
141.1
161.0
138.2
133.5
130.2
68.6
109.8
110.2
48.1

54^6

NoTK : 1

•For Enti

Slif^ht discrepancies

methoils emplu\"etl .iiid .i

rate from All d

per 1,000 population; all others per 100,000 population.

in Rockford due to different

For the next four years nothing of extraorchnary significance in the
health of the city transpired hut in May of 1881 smallpox was introduced
from Milwaukee and smouldered in the community for fifteen months. Some
23 cases and 3 deaths therefrom are recorded. This experience in itself is
not particularly noteworthy except for the fact that Rockford appears to
have escaped smallpox prior to that time and the further fact that the out-
break led to the construction of a "pest house" without the walls of the city.
Added to the public anxiety created by another visitation of scarlet fever the
experience with smallpox stimulated another reorganization of the health
department and very likely had to do with the passage of the ordinance in
1884 that required the health officer to be a qualified resident physician.

299

Another experience that instilled into many hearts an earnest desire for
protection against the ills which best humanity was that involving 135 cases
of diphtheria in 1890. Those were the days before antitoxin had been dis-
covered when diphtheria ran its dreadful course without stop or hindrance.
This particular outbreak resulted, therefore, in 54 deaths, giving a fatality
rate of 30 per cent. The number of deaths amounted to about 180 per
100,000 people, a rate nearly two hundred times greater than that which

usually prevails now. In 1926 Rockford
lost but one life to diphtheria and that
gave a rate of slightly more than one per
100,000 population.

About 1900 typhoid fever and tuber-
culosis began to attract attention in Rock-
ford because of general agitation on these
bjubjects which had found birth in the
minds of sanitarians familiar with the
new born science of bacteriology. Both
diseases had preyed upon the local citi-
zens for years. Indeed they were looked
upon rather as an evil habit or pernicious
consuming sin that could neither be
avoided nor compensated for because
they were endemic or chronic in the com-
niunit} .

The general agitation concerning the

preventable character of tuberculosis and

typhoid fever provoked an examination

of the mortality statistics in Rockford.

This study revealed that the mortality

from tuberculosis was 169 per 10(J,000

population in 1901 and that this disease

was the most frequent cause of all deaths.

Typhoid fever had created no little

ciiiicern in 1892 when a severe outbreak

had resulted in 23 deaths. Another epidemic involving upwards of 100 cases

occurred in 1904 and then came a frightful experience in 1912 and 1913

when 512 cases carried 57 persons to their graves.

Repeated epidemiological studies by local health officers. State health
officials and an epidemiologist from the University of Chicago incriminated
both water and milk supplies at various times. The outcome of these investi-
gations together with the propaganda for tuberculosis eradication resulted
in the establishment of services that gave to Rockford milk and water supplies

300

DOWN-STATE MUNICIPALITIES

of the highest sanitary quality and a s])li.-iuli(l program against the great white
plague. The phenomenal reduction in t_\ pht)id fever, scarlet fe\er and tuber-
culosis all point to the splendid improvements in milk and water Mipplies and
to the effectiveness of the anti-tul)erculosis work.

Table 3.
Cases of Cicktain Diseases Reported.

1916

1917

1918

1919

1020

1921

1922

1923

1924

1925

1926

1927

Tvphoid Fever

Smallpox

149

391

Measles

863

394

420

452

120

212

931

833

397

Scarlet Fever

216

127

lis

208

413

237

179

247

Wlioiip. CouRh

206

261

223

146

364

Diphtheria

131

279

124

iTiflueiiza

P..li.imvelitis

MeliiriKitis

Tul.en-iilosis*

118

2.56

178

135

185

285

180

Pneumonia*

•^0

115

163

121

129

130

Svphilis

17r>

106

Chancr„i,l

*A1I forms.
NoTF. : Case reports are never complete, but tliey h:ive been much more so since 1920 than before in

Illinois. Rockford is one of the cities where notification has reached a reasonably satisfactory status.

Slight discrepancies exist between this table and the illustration made in Rockford due to different
methods employed and areas included in the compilation of data.

Table 4.
jIRTIis and Infant Deaths.

YK.\R

Number

Rate**

Nuniber

Rate*

1906

757

IS. 4

1907

830

19.5

was

la-i

17.9

1909

706

15.6

1910

850

18.1

1911

924

18.6

105

113.6

1912

932

18.0

83.7

1913

1069

20.0

87.9

1914

1189

21.0

70.6

1915

1084

18.9

83.0

1916

1276

21.0

127

100.0

1917

1273

20.(1

127

09.8

191S

1329

20.9

164

123.4

1919

1420

21.0

127

S9.0

1920

1539

22.8

124

80.6

1921

1588

23.2

51.4

1922

1477

20.8

io.->

72.6

1923

1501

19.9

126

83.9

1924

1595

21.3

55.8

1925

1600

21.0

52 .

1926

1664

21.1

101

60.7

*I)eaths of infants under 1

**Per 1,000 population.

Notb: Slight discrepancies exist between

different methods emploi'ed and areas included

f age per 1000 births reported.

is table and the ilhi.stri.ti
the compilation of data.

Rockford due to

ROCKFORD

301

A! INUAI - CpNTA MIO US DISEASt ^ R ATE

1913 1914 1915 1916 1817 1918 1919 1920 1921 Mi 1023 1924 I9?5"

place:

ISS\\\S\\\V^

O F"

BIRTH

YEflR|Nyi>IBM|PCBC[h%

REIRCEIMTA&E

10 ?0 30 40 50 60 70

1911

I9I9F

i920F

1921

.\\\!\\\k\\\\\^

Sfi

\\\\\\\i

\\\\\\\\\\\\\\v^ I

\\\k\\\\V\\\\'\\'d^^

\\\'\\\T\\^ V\\'\\\\\ M

302 DOWN-STATE MUNICIPALITIES

l\()ckford fared far better than many other communities in the State
diirins,' the 1918 pandemic of influenza. Deaths charged against that infec-
tion amounted to 265 per lOO.CXX) population while most of the other com-
munities suffered rates above 300 and n(jt a few above 500. The combined in-
fluenza-pneumonia rate in Rockford in 1918 was 640 per 100,000 people
whereas eight or ten other municipalities experienced losses that amounted
to from 650 to 1.139 per 100.000 population.

Reference to the statistical tables and the illustrations will show that
Rockford is now enjoying a freedom from communicable diseases that results
in mortality rates both specific and general which compare favorably with
those of any comparable cit\' an_\ where.

References.

\hnii,l I:. Ill, ,jf the City of Uockford, 1S97 to date.

I i ill II iM furnished bv Dr. N. O. Gunderson, Health Commission of Rockford, Illinois.
1' , I I, 1 l.y Miss Pearl Hixson, Public Health Nurse of Rockford, Illinois.

ell It ihl liaiirams drawn by Mr. E. L. Johnson, quarantine officer. Department of Health, Rockford.
Itepoit nf engineers to make a survey and recommendations for an adequate water supply, Rockford,
1910.

Reports of the State Board of Health, John H. Rauch, Secretary, 1883-1888.

History of Rockford, Charles H. Church, Rockford, 1900,

History of Medical Practice in Illinois, Vol. 1, Lucius H. Zeuch, Chicago, 1927.

Appraisal of Health Service in Fifteen Illinois Cities in 1925, Illinois Health News, Ma\-June. 1926.

Social statistics of Cities, U. S. Census, Report 1880, Vol. XIS, 1888.

Rock Island

The island in tlie jNIississippi River from which Roclc Island takes its
name was first occupied in 1816 when Fort Armstrong was erected on its
lower end.

In 1835, the commissioners of Rock Island County entered at the Galena
land office a fractional quarter section of land, in what is now the central
part of the city and laid out a town called Stephenson. By an act of the
legislature passed in March 1841, the name was changed to Rock Island, and
it was incorporated as a town. In 1849 it was incorporated as a city. The
population according to the U. S. Census of 1850 was 1,711.

The city stands on a level plateau which is for the most part 10 to 25
feet above the high water mark of the Mississippi River. From one-half
to a mile back from the river, rise bluffs generally about 200 feet above high
water.

The soil is rich loam, with some deposits of clay, sand and gravel with
an underlying bed of magnesium limestone from 3 to 10 feet below the sur-
face of the ground.

A strip of low, marsh}- land about 500 feet wide extends from the center
southwest through the city, and one mile beyond to Rock River. In times
of high water, this land in the early eighties was covered to a depth of from
6 to 14 feet of water.

This marsh was formerly a prolific breeiling place of malaria carrying
mosquitoes, but after the sewer was built draining this slough, malaria prac-
tically disappeared from the city.

Rock Island is now a city of 35,177 people (1920 census) being separat-
ed from Moline by nothing more obvious than the middle of a street and
from Davenport, Iowa, by the Mississippi River across which a bridge facil-
itates close communication. Settlement began during the first half of the
nineteenth century. 1850 finding the community with a population of 1,711.
In 1920 the 35,177 inhabitants included 29,064 or 82.6 per cent, native born
whites, 5,352, or 15.2 per cent foreign born whites and 754 or 2.1 per cent
negroes. The age distribution showed 4,258, or 23.3 per cent, to be 45 or
more years of age.

Health Machinery

The first ordinance of public health significance was adopted in 1857.
It provided for a board of health and stipulated a sanitary code of sufficient
breadth to give the board plenty of room to perform any justifiable program
which it might have deemed wise to undertake.

(303)

304

DOWX-STATE MUNICIPALITIES

G. G. Craig, Sr., M. D.

First Health Commissioner,

1S80-18S7

But the board did little or nothing and per-
hap.s one paper organization succeeded another
until 1880, when the city was organized under the
general law. At that time a new board of health
iiiilinance was adopted which provided for six
members, the mayor and cit\- clerk being ex-
oflicio. The first board appointed under this
new ordinance included three physicians on its
membership.

Under this ordinance it at once became the
practice to designate some local physician as
health commissioner who acted as the executive
officer of the board. He received a small salary
while board members got two dollars each for attending meetings. At first
the board manifested considerable interest in its duties and functions, making
periodic tours of inspections and scrutinizing alleged nuisances, etc. This
ardor soon weaned, however, as had been usual and matters were left more
and more in the hands of the health commissioner.
This practice continued until 1911 when Rock
Island adopted the commission form of govern-
ment. The most significant change that the
transition brought to the health department was
that the health commissioner now had to serve
one master instead of half a dozen. At any rate
there appears to have been no pronounced differ-
ence in the character or volume of the work
imdertaken.

In \'>24 the commission form of government
was given up and another board of health made
up of the mayor, the city ph3'sician, as the health
commissioner now came to be called, and the
health officer (sanitary inspector) came into
being. This system still prevails.

George L. Eyster. M. D.
Health Commissioner,
1SS9-1S91; 1893-1895

Health commissioners who have served Rock Island inclu(

Dr. G. G. Craig, Sr. 1880-1SS7

Dr. Sanuiel Plummer 1887-1889

Dr. G, L. Eyster 1889-1891

Dr. C. B. Kinyon 1891-1893

Dr. G. L. Eyster 1893-1895

Dr. E. M. Sala 1895-1897

Dr. Joseph P. Comegys 1897-1899

Dr. Joseph de Silva 1901-1903

Dr. George G. Craig, Jr. 1903-1905

Dr. James F. Meyers 190,5-1907

Dr. Ralph Dart

Dr. Albert N. Mueller

It. George G. Craig, Jr.

Dr. Albert N. Mueller

Dr. C. T. Poster

Dr. Albert N. Mueller

Dr. Harry Prey

Dr. J. R. Hollowbush

Dr. Albert N. Mueller

le:
1907-1909
1909-1911
1911-1914
1914-1915
1915-1919
1919-1923
1923-1927
May-Oet. 1927
1927 to date

First Infant Welfare Clinic, opened in Rock Island, September 5, 1914.

■'irsi (iiMii Air Si licKil for Tnlierculous Children, opened in Rock Island, 1925.

306

DOWN-STATE MUNICIPALITIES

George G. Craig, Jr.. M. D.
Health Commissioner,
1903-1905: 1911-1914

Money appropriated to and spent Ijv the health department increased
as the demands of the city grew. New functions have been added from
time to time while voluntary agencies have arisen to supply services not pro-
vided by the city.

Rock Island was the second city in the State
to establish a municipal tuberculosis sanitarium.
It was voted in April, 1910. The institution
was opened in 1916 and continued to function
as a city project until April 1927, when its oper-
ation was taken over by the county as a result
of an election in 1920.

\'oluntary agencies began infant welfare work
in 1914 when the West-end Settlement House
and the Visiting Nurse Association opened a
station. Mrs. John Hanberg, Mrs. W. B.
Barker, Dr. Albert N. Mueller, Edna Flannagan,
R. N., and Sophia Rosene, R. N., were the mov-
ing spirits in bringing this service into action.
The school board l)egan to participate in health work in 1918 when a full
time nurse and a part time physician and dentist were employed.

A social hygiene clinic was operated in the city
by the county f<;)r a number of vears following
the World War.

Developments and growth in health work were
accompanied by ordinances of various character
providing ample authority for the health officials
to exercise their full resources in giving the com-
munity sanitary and hygienic supervision.

An appraisal of the public health facilities in
the city in 1925, made by the State Department of
Public Health, gives a rather accurate notion
of conditions at that time and they remain much
the same. Excerpts from the report of that
study read :

"With a score of 469, Ronk Island stands eleventli from the top
among the fifteen cities in which the public health activities were
appraised for adequacy in extent and character.

"The city health department, consisting of a part-time health officer,
a full-time inspector (another inspector was added in 1926). and a part-
time clerk, undertakes vital statistics work, communicable disease
control and supervision over milk supplies and sanitary conditions.
The board of education employs a part-time dentist, a part-time phy-
sician and a nurse for school hygiene service. Nurses on the Visiting
Nurse Association staff do bedside and public health work. In the

Cyrus T. Foster, M. D.

Health Commissioner,

1913-1919

ROCK ISLAND

307

field of tuberculosis a special tax levy by the county provides sanitarium,
clinical and nursing facilities.

"Excluding funds appropriated for tuberculosis sanitarium service,
in order to eonforni with the policy followed in eomputiug costs else-
where, the city spent about 13.5 cents per capita for public health pro-
tection last year. Other agencies contributed about 22.5 cents per capita,
making the grand total about SB cents. Expenditures in Danville were
the same per capita, no other of the fifteen cities spending so little for
this most basic governmental function.

"Practically no tabulations or analyses of vital statistics are at-
tempted. This permits the city to lose all of the benefits that, might
accrue from these valuable records.

"No communicable disease nurse is employed nor is there provided
a physician to visit all cases of contagion. The sanitary inspector pla-
cards premises and releases from quarantine.

"Sanitarium care of tuberculous patients is up to standard with the
disease incipient only on a goodly percentage of admissions. No open-
air classrooms or preventoria for children predisposed to tuberculosis
are provided.

"The prenatal, infant and preschool child hygiene program is
limited largely to a field nursing service provided by the Visiting Nurse
Association. While excellent in character the volume of this work is
not commensurate with the needs of the city. A total of 7'OS visits
were made to the preschool age clinic last year.

"The health of the public school children is receiving careful con-
sideration. Under the supervision of school physician and dental sur-
geon, assisted by the school visiting nurse, the children of the grade
schools are given periodic physicial ex-
aminations, defects listed and parents noti-
fied. Contagious diseases are promptly de-
tected and the patients removed from
school. Twelve hundred and sixty-five
(1265) dental defects were corrected by
the school dental surgeon during the past
year. Records of the findings of the school
l)hysician are tabulated but similar records
of corrections of physical defects are not
availalile.

"The curriculum of the public schools
|)rovides for health instruction in all
grades from the first to the sixth inclu-
sive.

"The public water supply is adequate
and meets fully all sanitary requirements
but only 80 per cent of the dwelling houses
utilize it. Likewise 20 per cent of the
homes have no toilet facilities other than outside privies.

"An inspector spends part of his time making sanitary investiga-
tions. Some of the food handling establishments are required to hold
license and are inspected from time to time.

Albert N. Mueller, M. D.

Health Commissioner, 1909

1911; 1914-1915; 1919-

1923; 1927 to date

308

DOW N -STATK M U N IC 1 PA I.ITI ES

"About GO per cent of the milk supply is pasteurized. Laboratory
examination of samples is not systematically practiced, no inspection of
produciuK farms is attempted and the insiiection of pasteurizing plants
is inadequate."

Watmr Supply

W'aterwork,'^ were first in.-^talled in Rock Island in 1870. Water was
drawn from the Mississippi River below the sewer outlets and pumped to
the mains without treatment.

In 1878 Mr. I'. 1.. Cable donated the lands and funds for a new plant
to be located about two miles upstream. The
intake was to be above the sewer outlets and ex-
tend into the main channel of the river. This
plant delivered a somewhat better water, but
it was still contaminated b}' sewage from cities
further upstream. Sedimentation was the only
form (jf treatment until the early 90's when j\Ir.
Cable donated funds for a filtration plant.
\\ooden tub filters of the Jewell gravity type
were installed. These filters did not prove satis-
factory, but were used for about ten years.

In 1899 a new filtration plant was built by the

city. The new plant included sedimentation and

three slow-sand filters of one-half acre each.

This plant was built up on the bluff in the highest part of the city. The

slow-sand filters were not very satisfactory treating such a turbid water

and soon became inadequate.

A new rapid-sand filter plant replaced the slow-sand plant in 1911.
This plant was modern and adequate, and is still in use.

P. L. Cable

Sewerage

A s_\-stem of sewerage had been started in 1885. About one-tenth of
the city was served and there were four outlets discharging into the ^lissis'
sippi River below the city.

The system has been extended and outlets have been added, until at
present the cit\ is well sewered and there are many outlets scattered along
the river. Tlu-re are three small treatment plants on sewers emptying into
a small creek tributary t(i the rixer.

^lississippi River is \i;\(\\\ pcillutcd at this point b\- sewage, part of which
comes from Rock Island.

The city is in nee<l of ade(|uate interceptors and treatment plants.

ROCK ISLAND

309

ROCK I3LAMD

l%1 '1° 'f 'f 'T -

"P 'f

-¥ 1

VITAL 3TATI5TIC50
conn. DIS. COMTROLS
Vm DIS. COnTROL««l
TUB. COMTROL
HEALTH CHILD
HEALTH 5CH.CHILD^
SANITATION
MILK COMTROL
LABORATORY
POP. HEALTH INSTH

PERCCMT OF STANDARD SCORE
FOR EACH OF TEM riAJOR HEALTH ACTIVITIES

I92g

This graph ilhi-strates the strong and weak points in Roclv Island's
public health service, oflficial and voluntary, as it existed in 1925. It is
based upon a personal survey and rated upon the standards evolved by the
American Public Health Association. The total efficiency rating in Rock
Island was 47 per cent of the standard perfection requirement.

Health Conditions

The first statistics regarding diseases and deaths are those for the gar-
rison located at Fort Armstrong dm'ing the seven years that followed its
establishment in 1816.

During this period the ratio of intermittent fevers was 17 per cent and
remittents 10 per cent. The relation of diseases of the respiratory organs
to all other diseases, exclusive of accidents and venereal infections was 1 to
3.8. The ratio in all military posts at the time was 1 to 7 or less than half
as great as at Fort Armstrong.

During the Black Hawk war in 1832, the fort was a special place of
interest and seciu-ity. Here the early pioneers used to rendezvous when
Indian attacks threatened.

It was here that General W'infield Scott met with Governor Reynolds
to conclude the treaty of peace with Black Hawk and his warriors.

310

DOW N-STATK M U X I C 1 PA LITI ES

Governor Reynolds in "i\Iy Own Times" says:

"While arrangements were being made to hold the treaty at Roclv
Island, the cholera appeared in its worst form in that section of the
State and amongst the Indians. This disease was a stranger in the
country at that day and spread terror and panic wherever it went.

"We were compelled to disperse the Indians while the disease
raged at Fort Armstrong on Rock Island some distance from the fort
so as to be more healthy.

"After waiting a month or more for the cholera to subside, we con-
cluded the treaty on the loth of September, 1831.'."

It is probable that cholera was again prevalent in Rock Island during
the general epidemic that swept the country during the middle of the nine-
teenth century although there are no records to substantiate this conjecture.
On the other hand the health commissioner declared in 1885 that cholera,
and a few other diseases, had not been epidemic since the organization of
the health department in 1882, This implies that the memory of an epidemic
still lingered in the minds of public officials.

Such mortality records as are a\ailable suggest that smallpox nevef
appeared in epidemics of large magnitude in Rock Island. An outbreak
of 15 cases is recorded in 1882 and a few cases at a time have been registered
periodically since that date. Posting a police guard at the entrance of pre-
mises to insure the rigid quarantine of patients seems to have been the method
of controlling smallpox prior to 1900. This, of course, was in addition to
vaccination which was nrade compulsory, so far as school children were con-
cerned, bv ordinance.

Fort Armstrong, the nucleus around wbirh tlie Tri-eities have been built.

ROCK ISLAND

311

Table 1.
Mortality From Certain Causes.

YEAR

fc!

.2 3

.2 "

ic-c

fe^

iS "

1881

288

18S2

225

1883

134

! !!

1884

161

' '4

1S85

...

1895

148

...

1907

211

1908

188

...

1909

298

' ii

' i

'26

1910

350

1911

356

'io

1912

312

1913

366

'24

1917

482

...

1918

561

' '4

•84

1919

347

1920

407

1921

356

1922

335

1923

315

' i

1924

343

2 1 1

1925

325

... 1 1

1928

404

. . . f 1

Table 2.
^loRTALiTY Rates Fro.m Certain Causes.

YE.VE

.So

5 "^

c
%

■3 ^

£2.

1881

24.7

125.0

50.0

42.7

116.6

16.6

83.3

325.0

66.6

1882

19.2

125.0

16.6

33.3

8.3

116.6

275.0

83.3

1883

13.2

41.0

33!3

75.0

208.3

75.0

1884

12.9

75.0

leie

33]3

leie

175.0

200.0

66.6

1885

1895

8.9

17.6

11.7

35.2

58.8

1907

9.2

17.4

13.1

43.7

30.5

74.2

91.7

1908

9.7

...

1909

12.4

37.7

4'i

i.\

117.4

83 . .8

1910

14.3

1911

14.0

39.. 3

1912

11.7

1913

13.2

36!2

a'.e

S.6

■ih'.i

i-i'.i

...

86.9

1917

15.09

6.2

169.1

1918

16 9

15. i

3.'6

21.5

12^3

24 '. 6

258.4

141 is

227.6

1919

10.2

2.8

ii'.S

2.8

5 7

54.2

111.4

60.0

1920

11.4

5.5

s'o

5 5

19.4

2.7

50.0

113.8

88.8

1921

9.8

5.5

2!7

2.7

8.2

2.7

5.5

82.1

52.0

1922

8.9

10.7

16.0

82.8

48.1

1923

8.2

2.'6

7.'8

13.1

21.0

65.7

36.8

1924

8.8

5.1

2 .;")

10.2

2.5

76.9

25.6

1925

8.1

7.4

2.5

5.0

32.4

2.5

57.3

34.9

1926

9.9

2.6

2!6

12.1

26.0

2.4

53.6

48.9

The rate from .\11 Cau.ies

lOn.OOO popuhiti.

312

I)()\V.\ -STATE MUiXICirAI.ITlES

Table 3.
Cases of Certain Diseases Reported.

1 1916

1917

191S

1919

1920

1921

1922

1923

1924

1925

1920

1927

Typhoid Fever

Smallpox

7.5

142

173

Meiisles

436

580

881

456

368

687

Scarlet Fever

7.>

1)4

Whoop. Cough

118

405

224

243

108

313

Diphtheria

109

Influenza

298.5

•?

497

Poliomveliti-s

Meninpritis

Tuberculosis*

Pneumonia*

...

2(9

9.5

129

S.vphilis

...

124

Gonorrhea

...

166

•.Ml forms.
Note: Case reports are ne\er complete, but thev ha\
Illinois. This table indicates improvenient i

Table 4.
Births axd Infaxt Deaths.

YK.\R

1 Number

Rate*'

Nutnber |

Rate*

1881

- 1

616.6

1882

02 1

516.6

1883

43 1

358.3

1884

41 1

341.6

1916

490

10. 1

56 1

112.9

1917

432

13.5

120.3

1918

460

13.9

126.1

1919

475

13.9

82. 1

1920

481

13.5

128.5

1921

494

13.4

83.0

1922

466

12.3

1923

420

11.0

78.6

1924

450

11.5

53.3

1925

399

10. n

30 1

75.2

1926

410

10.0

20 i

48.8

per 1000 births reported.

It was different with typhoid fever. That disease lia.^ cost the city
dearl}' in both life, suffering and money. Statistics for the early eighties
indicate that 44 deaths resulted from typhoid fexer in the four years ended
with 18S4. Tliat number of fatalities suggests the occurrence of some four
or five humlred cases, a severe experience for a community of about 12,000
souls.

It is probable that the disease had fallen upon the inhabitants during
earlier years witii no less disastrous results. .'subsequently to that period
epidemics varying from a dozen to 5tX) cases have occurred. In l')0o there

ROCK ISLAND 313

were about 500 cases and there were about 1150 in 1911. An outbreak of
12 cases in 1890 was confined to the pupils in Augustana College. As late
as 1922 there were 20 cases reported from Rock Island. These statistics
show what remarkable progress has been made against typhoid fever. In
the whole state of Illinois there were but 1,286 cases reported in 1927. l-i-ock
Island had two in that }ear.

Diphtheria, Hkewise, has si)illed its wrath upon Rock Island from time
to time. In 1889, for instance, this infection began to spread and continued
until 222 cases had been reported, resulting in 45 deaths. Again in 1923
there was a rather peculiar epidemic that seemed to follow and complicate
an outbreak of measles. Case reports ran up to 109. Between these two
there has been the constant seasonal incidence that hasn't ceased to arrive
with the autumn of each succeeding year.

Tulierculdsis was once the chief cause of tleath in Rock Island as it was
elsewhere in Illinois and the country. In 1881 the number of deaths attrib-
uted to tuberculosis in Rock Island gave a mortalit}' rate of 325 per 100,000
population. In 1926 the rate was 53.6. The most pronounced period of
improvement began in 1918 when the rate was 141.5.

Influenza and pneumonia struck Rock Island but lightly in 1918. The
combined mortality rate was only 486 per 100,000, a figure lower than from
influenza alone in many municipalities. Only four or five other places in
the State escaped with such small losses.

The general death rate in Rock Island suggests good health conditions.
It is unusuall\- low. It may be that hospital facilities across the river in
Davenport attract enough of the sick to be no small factor in the low death
rate.

References.

Am III] 1.1, iN ,if the City of Rock Island, Itock Island, Illinois, various dates.

(h.ii . I ilia furnished b.v Dr. Albert N. Mueller, Health Commissioner.

Ainu ! MI !i, ,,f the StateBoard of Health, .lohn H. Raueh, Secretary. .Springfield, variovis dates.

Ml iiAii I I ., Governor John Reynolds, lSo.5.

Report ot iin Appraisal of Health Service for 192.5 of Fifteen Illinois Cities, Dr. Isaac I). Rawlings,
Director of Public Health, Illinois Health News, May-June, 192G.
U. S. Census Reports, Washington, D. C, various dates.

Springfield

The first settlement on the present site of Springfield was made in 1818,
the _\ear Illinois entered the Union. At first it was called "Calhoun," in
honor of the threat nullifier of South Carolina, hut the name proved to be
un])opular and few peo])le used it. They preferred Springfield, the name
given to the postoffice in the embryo city of Calhoun.

Early in the career of Springfield, the municipality began acquiring
political honors, a habit which it showed no tendency to forsake. In 1821,
two years before it was officially laid out, it accjuired the title of county seat
of Sangamon County.

In 1837, as the result of a rather strenuous political contest, it became
the State capital and the first session of the legislature to meet there assembled
in 1839. Abraham Lincoln, as a member of the long-nine, had much to do
with the removal of the State capital from Vandalia to Springfield. Among
the many rumors of reasons for removing the capital from \'andalia to
Springfield are two that relate to health.

One is that the legislature had gmwn tiretl of the preponderance of
venison, wild turkey, wild duck, and other game meats supplied them at
Vandalia, and they moved the capital to Springfield where they could get
more pork and beef.

Another is that the Kaskaskia bottoms around \'antlalia made the
location so highh malarial that the legislature wanted a healthier site for the
State House.

The village government in .^pringlield consisted of a president and a
board of trustees of five members. In 1839, Abraham Lincoln was elected
a member of the board to fill a vacancy, and was re-elected in the following
year.

-Springfield is located near the .Sangamon l\i\'er in the ver_\- heart of a
rich coal mining and agricultural region where the terrane is so flat that
adequate drainage of residential districts depends upon unusual engineering
skill in the construction of sewer mains. In 1920 it had a population of
59,183, the fifth largest city in Illinois. The number of inhabitants in 1840,
the earliest year listed in the United States census returns, was 2,579. Sub-
sequent to that time two decades, 1850-1870, witnessed ver\- rapid growth,
the increase amounting to 96 per cent during the twenty \ears, but later the
population has grown more gradually. ( U' tin- 1920 population 84.7 per
cent were native liorn whites. 10. (i foreign born whites and 4.7 negroes.
Nearly 24 per cent were in the 43 and o\'er age grouj).

(314)

SPRINGFIELD

315

Health Machinery

Among the books and papers of the late Dr. A. \V. French, a dentist
of Springfield, was found an old note book, the binder's title on the back
of which reads "Minutes of Springfield, Illinois 1832-1840." On the fly
leaf of the book is written: "jXIinutes of Board of Trustees of the Village
of Springfield, Illinois, of its meetings from April 1832 (first meeting) to
the org-anizing of a city in 1839.'"^

These minutes show that on Jul\- 19, 1832, at an extra meeting of the
board, the following preamble and resolutions were read and passed :

"Whereas, we have information that the Asiatic cholera is now pre-
vailing in Chicago, and whereas, it becomes the duty of the trustees
to guard the town from infection from tliat source." etc.

The usual orders were then made as to cleaning up the town. On Novem-
ber 14, orders were given out that the court house be fitted up as a hospital
in case it was needed for the cholera patients.

The next event of importance to the health machinery of the city took
place in 1840 when the community was incorporated as a city under a special
charter granted by the legislature. This charter provided for the annual
appointment of a board of health consisting of three or more commissioners,
over whom the mayor was designated as the presiding officer and the city
clerk as clerk. Broad powers relating to public
health were vested in the board. The charter
required, among other things, that physicians
should report all cases of communicable diseases
and that the health officer visit patients suffering
from such diseases and report his opinions rela-
tive thereto to the city clerk. There is no evi-
dence that any of these provisions were carried
out with any degree of regularity or completeness.
Doubtless the board of health became active
during epidemic emergencies but for the most
part it sank into a dormant or inactive status over
long periods of }ears. In 1877, when public
health ideas filled the air about the capital build-
ing, due to the legislative act creating the State Board of Health, the council
in Springfield adopted an ordinance requiring the isolation of persons
sick with contagious diseases and giving the board of health power to
quarantine premises upon which communicable diseases existed. It also
prohibited slaughtering in the city and regulated food and milk supplies.
Moreover there was an ordinance making vaccination against smallpox
compulsory.

George Thomas Palmer, M.D

Superintendent of Health

1909-1913

1 Journal Illinois Historic-al Society, Vol. 2.

DOWN-STATE MUiNlClPALITIES

In 1S80 the board of health was made up of six members, one from each
waiil, besides the mayor and city clerk. It appears that annual expenditures
amounted to about $300 during ordinary times and that this went largely to
inspectors, employed during jileasant weather in order to stimulate general
civic cleanliness.

In 1SS2 a new ordinance introduced the police department into the board
of health. It pri)\iileil that the board should consist of seven members
.'ippointed l)y the mayor, and the mayor, superintendent of police and
city clerk as ex-offlcio members. From this time forward over a number
of years the mayor appointed a member of the police force to act as health
officer. It seems to have been the practice from the start to select physicians
for members of the board and not infrequently all members except the ex-
officio were doctors.

Subsequently to 1882 the growing demands of a growing city caused
a gradual increase in the appropriations made
til the health department and these were expended
for the employment of persons who varied in
number with epidemic emergencies, for the
operation of a "pest house", the removal of dead
;inimals, etc. It soon became customary to em-
pldv a full time inspector working directly under
the board of health and by 1903 there were two
or three inspectors, one acting as health officer.

A distinct change came in 1909 when Dr.
George Thomas Palmer was appointed superin-
tendent of health in Springfield. He was the
fn^t physician to fill the chief executive position
of the board of health in Springfield. Since that
date a doctor has always filled the office, sometimes on a full time basis,
sometimes on part time duty. The health department staff in 1909 consisted
of the superintendent, an assistant, a meat inspector, two health officers, a
plumbing inspector and the matron of the "pest house."

The next important change came in 1911 when the city adopted the
commission form of government. This disposed of the board of health,
placing its duties and responsibilities upon the shoulders of the commissioner
of public health and safety and bringing closer to political power the office
of superintendent of health. The staff of the health department was changed
but little, a secretary-clerk replacing the assistant superintendent.

.\liout this time there occurred a pronounced wave of public interest in
health and social welfare matters that resulted in an exhaustive sanitary,
social and educational study of the city, put on by the Russell Sage Found-
j^lion in 1''14. This stiuh- reduced information concerning the health and

B. B. Griffith, M. D.

Superintendent of Healtli

1914-1918

SPRINGFIELD

317

Albert E. Campbell. M. D.

Superintendent of Health

191S-1924

sanitary conditions of the community to a report which detaileil all possible
shortcomings, featuring infant mortality and other statistics, and offered
some very definite recommendations for improvement.

Sh(.)rtly after the survey the voluntary agencies became active. The
study had indicated an unnecessarily high infant mortality rate so in Feb-
ruary 1916, the first infant welfare clinic was opened through the initiative
of the Springfield Improvement League. This was the beginning of what
proved to be a very important factor in the health
machinery of the cit_\-, growing in size from one
to seven infant welfare stations with a nursing
staff of four.

In 1918 a full time ph\sician in the person of
Dr. A. E. Campbell, was employed as superin-
tendent of health and since then the office has
iieen rated as a whole time position.

One improvement followed another until at
the close of 1925 the health department together
with the quasi-public and voluntary agencies, were
doing a very creditable volume of work. A good
summary of the nature and adequacy of the mach-
inery at that time, which continues to be the case,
is found in a report of a survey made early in 1926 by the State Department
of Public Health. From it we read :

"With a total score of 667, Springfield stand.s fourth among the
fifteen cities in which the public health activities were appraised. This
is in itself a very creditable record ; but the striking fact is the recent
development of improvements in health service, some of which were
inaugurated too late in the year to be credited in this survey, which is
based on the 192.5 record. These improvements, set forth in another
section of this report, have been due to (1) the hearty cooperation of
the local medical profession, (2) the active interest of the citizens, and
(3) the initiative of the full-time health officer.

"Springfield takes first! place in its venereal disease control pro-
gram, an important feature of which is the clinical service conducted
at St. John's Hospital and financed jointly by the State and county. In
vital statistics and health measures for children under school age,
Springfield ranks second and third in communicable disease control.

"This city expends $21,110 or 3:! cents per capita through its health
department. Expenditures by other agencies bring the grand total to
$16,991 or 7.3 cents per capita.

"The school hygiene work Is under the direction of the board of
education, which employs a part-time dentist and four nurses. Last
year, upon request of the local medical society, the city health offlcer
was appointed director of hygiene for the public schools. The parochial
schools employed a nurse early in 1925. There is no medical examina-
tion of school children, although the nurses make physical inspections

318

DOWN-STATU MUNICIPALITIES

and home visits. Healtli education in tlio scliools is not as thorougiily
carried out as is desiralile. Springfield is one of tlie seven cities in this
group, all of them much smaller than Springfield, which does not have
medical supervision for its school children. Playgrounds are conducted
in connection with many schools and in the several parks throughout
the city under a well organized recreation commission.

"The most striking fact in connection with Springfield's public
health status is the marked improvement which began with the reor-
ganization of the health department in 1924. This improvement has
been manifested (1) by the hearty co-
operation of the county medical society
with the health department, (2) by the
substantial support of the council of social
agencies In promoting the health depart-
ment program, (3) by the coordination of
the infant welfare and school hygiene pro-
grams with the health department, and
(4) by the confidence of the dairy interests
expressed in their petition to the city com-
mission requesting supervision of their in-
dustry by the health department.

Raymond V. Brokaw, M. D.

Superintendent of Health

1924-1927

"The county medical society endorsed
the new isolation hospital project soon to
be opened as an integral unit of St. John's
Hospital; and also the child guidance
clinics which are now conducted in this
city by the Institute for Juvenile Research. The society formerly re-
quested the board of education to appoint the city health officer as
supervisor of hygiene in the public school system, to establish an open-
air school, and to provide facilities for mentally defective children, all
of which requests met with favorable action.

"The Council of Social Agencies, representing a large group of in-
fluential and interested citizens, has materially advanced Springfield's
public health program by raising the standards of social service; by
financing the new $100,000 isolation hospital project; by contributing in
part the salary of the health officer, and in full the salary of a director
of nurses: by sponsoring the child guidance clinics, and financing a
social service worker in this connection; and more recently by promot-
ing a mental hygiene educational program, which is being conducted by
the Illinois Society for Mental Hygiene.

"The coordination of the public health nursing activities has pro-
vided for direct supervision by the city health department of the com-
municable disease nurses, the infant welfare nurses, the public school
nurses and the county school nurses. A new director of nurses has
been added to the staff of the city health department to develop this
program."

SPRINGFIELD

319

SPRIMGHELD

VITAL 5TATI5TICSi^
conn. DIS. CONTROL}^
VEh. DI5. CONTROLS
TUB. COMTROL ^
HEALTH CHILD
HEALTH 5CH. CHILD 3§
S^MITATJOh
MILK COMTR0L[S
LABORATORY @
POP. HEALTH IN5T^

PERCEMT OF STANDARD SCORE
FOR EACH OF TEN MAJOR HEALTH ACTIVITIES

1923

This graph illustrates the strong and weak points In Springfield's public
health service, official and voluntary, as it existed in 1925. It is based upon
a personal survey and rated upon the standards evolved by the American
Public Health Association. The total efficiency rating in Springfield was
67 per cent of the standard perfection requirement.

The physicians who have served Springfield as superintendents of health

George Thomas Palmer. M. D. 1909-1913

0. H. Deichmann, M. D. 1913-1914

B. B. Griffith, M. D. 1914-191S

A. E. Campbell, M. D. 1918-1924

R. V. Brokaw. M. D. 1924-1927

H. H. Tuttle, M. D. 1927 to date

Water Supply

The public water supply was installed about 1868. The water was
pumped direct from Sangamon River and consequently was at times turbid
and not safe for drinking purposes. At that time a majority of the inhabit-
ants depended on wells and cisterns for their drinking water.

In order to secure a cleaner and safer water a large well was constructed,
in 1884, on the bank of the river. The well soon proved inadequate and in
1888 an infiltration gallery was constructed near the well.

320

DOWX-STATE MUNICIPALITIES

In IS'K) tlic su[)i)l\- asjain became inadequate and a connection was made
between the ri\er and the inliltration gallery to supplement the well water
with riser water.

The use of river water created much dissatisfaction and several wells
were drilled to make the continuous use of river water unnecessary.

In 1918 a chlorinator was installed to make the water safe, Init it was
still turbid at times.

From time to time additional wells were drilled and the infiltration
gallerv was enlarged, but in general the water was rather unsatisfactory.

In 1926 a modern water-purification, iron-removal and water-softening
plant was completed. A combination of well and river water is still used
but the treatment plant makes the water desirable for all household uses.

The construction of a dam to form Lake Springfield is being considered.
When the lake is formed it will be used as a source of suppl\- and will furnish
a better supply than the river water.

Table 1.
Mortality From Certain Causes.

1S73
1876
1877
1878
1879
1880
1881
1882
1883
1884

1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1018
1919
1920
1921
1922
1923
1924
1925
1920

605

674

040

598

801

750

831

764

851

866

867

866

994

902

995

976

979

1223

965

1002

903

976

1049

969

1121

1094

...

103

111

105

145

•Prior to 191)0 for Enteric Feve

SPRINGFIELD

321

Table 2.
Mortality Rates From Certain Causes.

YEAR

o'l

E>2

1875

26.5

-^.7

5.3

164.3

. .

275 . 6

118.5

1876

26.6

37^2

74 ".2

26.6

85.1

190.8

69.1

1877

78.0

10.4

5. 2

88.4

36.4

26.0

239.2

94.3

1878

56.1

15.3

30.6

10.3

102.0

265.2

56.8

1879

30.0

5.0

.5! 6

230.0

65.0

195.0

101.8

1880

56.1

10.1

20.2

153.0

16. i

45.9

244.8

116.4

1881

171.5

29.4

19.7

9.8

24 . 5

303.8

78.9

1882

139.2

9.0

9.6

...

67.2

27S.6

62,5

1883

56.4

4.7

9.4

32.9

211.5

99.0

1884

39.6

4.4

13.2

61 . 6

250.8

58.1

IHOO

17.7

35.1

11.7

17.6

58 . 5

26.3

234.2

99.5

1!)01

19.3

25. S

17.2

8.6

28.7

74.6

31.6

307.1

117.7

1902

18.0

31.0

22 is

2.8

8.4

53 . 5

16.9

270.3

11)4.1

1903

16.5

49.7

2.8

11.0

19.3

60.8

5.5

228.1

127.0

1904

21.4

40.0

2.7

10.7

18.7

16.0

29.3

21.3

266.7

208.0

1905

15.5

33.7

2.4

4.8

26.5

12.0

204.6

103.5

1906

19.3

41.1

12.8

2.6

15.4

53 , 9

7.7

'.'.'. 161.8

125.9

1907

18.1

73.9

28.3

10.9

6.5

45.6

19.6

... 221.7

121.7

1908

17.3

38.6

6.3

25.0

9.1

13.6

15.9

186.0

102.1

1909

16.8

33.6

25.7

2.0

5.9

7.9

179.8

134.5

1910

16.6

52.0

5.8

11.5

3.8

25.0

9.6

225.2

127.0

1911

16.7

28.2

11.3

22.5

7.5

185.8

142.6

1912

16.2

41.8

.5.5

14.6

41. S

3.6

136.4

121.9

1913

18.4

30.1

31.9

i.'s

24.8

5.3

161.2

157.6

1914

16.4

29.3

8.6

6.9

17.2

1.7

177.6

138.7

1915

17.8

28.5

36.9

10.1

1.7

21.8

10.1

157.0

157.7

1916

17.3

13.1

9.8

6.5

16.4

29.5

14.7

124 . 1

119.4

1917

17.1

27.1

1.6

9.6

12.8

113.4

107.7

1918

21.1

18.5

IS. 5

1.5

(i.'i

13.9

370.3

143 . 5

223.7

1919

16.4

8.5

1.7

18,7

115.2

142. S

147.4

1920

16.8

13.4

10.2

76.6

100.7

169.5

1921

14.9

8.3

sio

11.6

sis

11.6

11.8

74.6

102.8

1922

15.9

3.3

1.6

0.5

11.5

3.3

62.4

95.0

104.8

1923

17.0

4.8

16.1

6.4

12.8

63.1

92.1

92.2

1924

15.5

6.3

i!.5

4.7

14.2

49.2

55 . 5

90.4

192fl

17.5

0.3

i.s

4.6

3.1

4.6

86.0

i.'.i

87.5

76.6

1926

16.9

6.0

" 1

3.0

1.5

16.5

4.6

67.5

1.5

80.3

98.9

Note: The rate from .\1I Causes is per 1000 population; all otiiers per 100,000 population.

Sewerage

In 1885 there was a sewerage system with about ten miles of sewers and
three outlets discharging into Spring Creek. The system had been enlarged
until by 1913 there were twelve outlets.

In 1924 a report on sewage disposal was prepared by Pearse. Greeley &
Hansen and Dawson & Walraven. It was recoiiiniended that interceptors
and a treatment plant be constructed.

\X present the interceptors are completed, and crinstiuction of the treat-
ment has been started.

322

DOWN-STATE MUN ICII'ALITIES

lir.ALTii Conditions

I. ale in 1832 cholera was responsible for the Hrst grave public health
l>ni])lcin that the officials of Springfield were ever called upon to meet. The
disease liad been introduced into the mid-western territory by troops under
the command of General Winfield Scott, moving westward to participate in
the Black Hawk War, and spread quickly to Springfield because of close
communications maintained between the military forces and the State officials
at the Capitol. Lack of statistical records leaves to conjcclure an idea of
how severe the epidemic prtjved to be in Springfield.

Again in 1844 the redoubtable Daniel Drake, M. D., while enrcniU- up'>n
one (jf his many observati(jn tours of the mid-western territory, fuund in
Springfield some cases of intermittent fever declared by him to be as malig-
nant as those ordinarily found upon the banks of the Tuscaloosa or Pearl
Rivers, seven degrees latitude further south. He was informed moreover
by John Todd, A. < 1. lliiu\v. William .Merriman and Gershom Jayne, four
local physicians, that auiuiiuial fevers, probably typhoid and malaria, pre-
vailed in the .Sangamon \ allc\-. Later history suggests that both typhoid
and malaria were in; Iced prcwilcnt .and caused losses that today would be
regarded with the greatest public .alarm.

In 1849 another epidemic of cholera occunnl in (lie cit\ . 1 )r. ( iershoni
Jayne, who came to Springfield in 1821 and wlm \\,as one ni the tn>l com-
missioners of the lllin(jis and Michigan can.al. was in tlic thick (if tln' battle
against this choler.a outbreak .and mnnindful of
(l;in,i;<T.

Cholera morbus w,as also very ])revalenl during
this period. Accoi'ding to ] )r. ( icorge Noble
Krcider. it w.as (hie to spoiled focjds. The means
of preserving food in the summer time were very
pool", .and the lue.at w.as often spoiled and un-
doiililedl\ the milk too. Dr. George I'aslield re-
poiled lli.al ii was nothing unusual to iind on a
lioi Slimmer tli.il three or four citizens had died
ol' cholera morbus during the night after only a
few hours' illness.

A pandemic of inlluenza occiined in 1849-1850.
Not niiub reference was made to it in Illinois, possibly on .account of the
cholera e|)idemics in the same ye.ais. which overshadowed it. The outbreak
was widely diffused in the |i(jpiil,atioii of the Ciiited States, .and prob.ably
more fatal than the statistical records wanild indicate.

During a long i)eriod of its early history Springfield appears to have
escaped the uncontrolled outbreaks of sniall])ox tb.at were attended with so
mucli public .al.anu .and furor in other places. .\t le.isl there is scant record

George N. Kreider, M. D.

srRixciFiKi.n

323

George Pasfield, M D.

of ail}' such experiences except fur a inilil rofrrcnce nf an epidemic in tlie
early eighties. It must be renicnilicrcil in thi> i-dniu-otinn that vaccination
was compulsory in the citv and that Si)rini;tield \\a^ tin- capital of the State
dnrini;- thnsr early \ears iif ihe State Board of llcallh wln'u the or^aniza-
tiiin ]iro)noted vaccinalinn with an overw hclniinc;'
/(■al and rni])hasis.

Kut C()m|)ulsory vaccinalinn was declared
unconstilutional during the ninrlies and in 1901
Springfield fell \ic(im lo an otiihreak of smallpox
whicli seenicil lirnl npnn avenging itself against
])enple who had enjoN'ed such a long-time inimun-
itw Al any rate 527 cases were rec()rde<l in l''l)l
and ,i.>5 in l'X)2. A "pest house" was constrncird
in a desolate localit\ near the cemeler\ and con-
siderahle ex[)enses were incurred in olhei' ways
in efforts to conlrol the disease. I Ins epidemic
aetuallv smouldeied in the cil\- for three or four
years hut since that time smallpox has ne\ er ai;,ain appeared in a seriously
embarrassing character. While vaccination is not and cannot he compulsory
an alert health departnu-nt has managed to slimnlale a considerable degree
of \accination on the one hand and on the other ha^ ]ndni]itly applied C(introl
and i>reventive measures when smalljioN broke om in the cdniinnnity.

Typhoid fever has had a long and ugly history in Springlield. Up to
1918 the annual mortality from that disease rare-
ly fell below 20 per 100,000 population and not
infrecjuently the rate ascendeil to i)oints above
40. The actual number or deaths ranged from
5 to 35 indicating a very heavy prevalence. ll
was ascertained through a house to house can-
vass in 1910 that 7,000 shallow wells and 6,000
privy vaults w ere in use in the city and very likely
this condition h.id a close relation to the perpetual
typhoid problem that cost the community so dear-
ly. I!\ 1918 a big percentage of both privies and
wells had been abandoned and subsequentlx to
that date typhoid fever steadily declined.

Springfield has suffered from its full share of dii)hlheria and scarlet
fever although both diseases are at present insignificant causes of death com-
pared with what they were up to 1916. Prior to that date both infections
paid unwelcomed epidemic visits to the city at periodic intervals, while a
kind of nonnal or residual prevalence prevailed constantly to plague a limited
mnnlier of unfortunate victims. Diphtheria usually was the more fatal of

Willinni .laviU'. M. 11.

324

IIOWN-STATK M L'NUII'AI.ITIKS

the two and was rcsi)()iisil)k' for the hca\icr mortality. A particularly severe
outbreak of scarlet fever occurred in 1879 when 46 deaths were attributed
to it. The epitleniic stretched out over the next year carrying 30 more
victims to their graves. Another widespread outbreak occurred in 1920
and 1921 but it was milder and resulted in but 8 and 7 deaths, respectively.
Diphtheria has been more strictlx seasonal, the average annual mortality
being greater than that from scarlet fever with 31 deaths in 1875 being the
greatest number ever registered for a single year. Other bad diphtheria years
were 1878 with 20 deaths, 1901 with 26, 1903 with 22, 1906 and 1907 with 21
each and 1912 with 23. The mortality is not always an accurate index to
the prevalence, however, because the malignancy of the disease varies con-
siderably from time to time.

Table 3.
Cases oi" Certain Diseases Reported.

1 liil9

1920

1921

1022

1923

1924

1925

1926

1927

Typhoid Fever

Malaria

Smallpox

Measles

2(10

170

1203

300

432

1589

Scarlet Fever

507

638

130

100

187

Whooping Cough

120

309

207

422

Diphtheria

7.5

100

134

Influenza

573

256

Poliomyelitis

Meningritis

Tviberculosis*

230

273

102

108

145

Pneumonia*

205

223

191

146

169

Syphilis

270

325

257

387

280

Gonorrhea

337

379

285

453

335

Chancroid

*.\11 forms.

NOTK : Case reports are

never complete,

Im-

thp\

lllin..is. This table

in.licates that n.

tih.

Itinli

The trend of tuberculosis has been distinctly downward since about 1900.
Prior to that date the disease was very common in Springfield, as it was else-
where, causing a very noticeably heavy mortality and incapacitating no small
number of citizens. Happily this infection now causes less than a third
of the mortality that it did in lOQO and .'Springfield has a death rate from it
which is but slightly higher than that for the State. Mortality from tuber-
culosis in Sangamon County remains high, however, due to the location
of two large sanitariums to which patients come from many other counties.

Influenza was moderate in Springfield in 1918 compared with the havoc
it wrought in many other places. The deaths attributed to it numbered 240,
giving a mortality rate of 370 per 100,000. compared with figures using above
400 in a number of other municipalities. Even when combined with the
mortality from pneumonia the deatli rate fell a bit short of 600 which was
lower than tliat of a dozen other Illinois cities.

SPRIXCFIELD

325

Table 4.
Births and Infant Deaths.

Birtlis

Infant Deiiths

YEAR

Number

Riite**

Xuiiiber

1 Riite*

1871!

1S77

1S7S

187!)

1880

1881

400

19.7

217.5

1882

386

18.5

199.4

1883

410

19.2

148.7

1884

239

10.9

305.4

188.-,

2117

9.3

I'lnn

135

1!H)7

113

l»in

152

11)11

118

1913

171

IHIJ

132

191.-.

118

101(1

119

1!)17

104

107.3

1918

136

105.8

1919

117

1920

116.5

19.6

109

92.7

1921

1350

22.4

120

88.8

1922

1212

19.8

111

91.fi

192S

1352

21.9

108

79.9

1924

1412

22.5

69.4

1925

1394

21.8

119

85 . 4

1928

1317

20.4

75.2

* l)eath>( of infants iinde
•* Per 1000 population.

per 1000 births reported.

The general mortality rate in Springfield appears to be a little high but
an unfavorable influence comes from many factors that do not indicate a
low level of general health. For one thing the city has hospital and medical
facilities superior to those in many communities of much larger size. This
attracts patients from a considerable outlying territorw Another is that
the age distribution cif the population is unusual. Nearly 24 per cent are
45 or more \ears old. .\ home for the aged is located there. Futhermore
the fact that it is the capital city brings to it a considerable number of non-
residents. Allowing for all of these factors, it is probable that the general
mortality rate in Springfield would be no higher than that which obtains in
any other Cdninnmity of gudd prevailing health conditions.

Rl£FERENCI-:S.

Data supplied by Dr. H. H. Tuttle, Superintendent of the Healtli liepartnient Sririnn-fleld

Annual Reports of the City nf Sprinsrfleld.

Frill? SrhnrMrr, ,lr . I'lil.iir II. .iltli in Springtiekl, Pepartment of Surveys and Exhibits

Hisloi,\ ,,i Mfihral 1
Report on an -Appra
re. May-June, 1926.
United States Census Reports,

Mini..! ^1 H.. Unard of Health, various dates.
i|ii \,ill. 1 . I'.niiel Drake, M. D.

ttice m lliniois. Vol. 1, Lucius II. Zeuth. M. D.. Chiiago. 1927.
1 of Health Service during 1925, in Fifteen Illinois Cities; Illinois Health

Edmund S. Kimberly, M. D.

Member of First Board of Health of Chicago, 1934.

Other Member, Dr. William S. Clark.

Daniel Brainard. M. D.

First Health Officer and Member First Organized Board of Health of Chicago

composed of Ma.vor Benjamin W. Raymond and

Doctors Stephen B. Gay and Josiah

T. Belts, 1S37.

HISTORY OF THE DEPARTMENT OF HEALTH
CITY OF CHICAGO*

Organization

The health department of the city of Chicago was established by an
ordinance passed by the city council on July 19, 1876.

This action was taken in jjursuance to an act of the legislature known
as the Cities and \ illnges Act, passed in 1872, and adopted by the city in
1875, in lien of the charter previously in force. This act provided for the
appointment of a lioard of health and also gave the city council the power,
by a two-thirds v(.ite, to create offices, and the mayor the authority to fill
these offices, such aiipointnients to be made with the advice and consent of the
city council.

The ordinance creating the health department provided for the appoint-
ment of a commis-iioner of health at a salary of $1500; an assistant commis-
sioner of health at $1200; a secretary at $1200; an assistant secretary at
$1000 per annum ; two meat inspectors and 13 sanitary policeman at a salary
of $60 per month. The following year the salary of the commissioner was
raised to $3000 per year.

The newly established department of health was vested with all the
powers and charged with the duties of the board of health, which had been
in existence since 1867.

Dr. llrockhurst L. .Mc\'ickar was appointed as the first commissioner
of health, but resigneil the position before the end of the \car. < )n January
29, 1S77. Dr. t iscar DeW'olf was appointed commissioner and held the office
continuou.sly for a ]jeriod of 12 years.

The population of the city at this time was approximately 407,660 in-
habitants. The annual appropriation for the health department, excluding
the amounts designated for scavenger service and dead animal removal, was
$36,640, which represented an expenditure of a little less than nine cents i)er
capita for general health work.

The annual death rate from all causes was 21 per 1(X)0 inhabitants. The
deaths under one year of age constituted 31.4 per cent of all deaths. The
annual death rate from typhoid fever was 41.2 per 100,000 population, and
the death rates from diphtheria and scarlet fever were 184.5 and 198.9 per
100,000 population, respectively. The death rate from scarlet fever in 1876
was the highest in the history of the city, and constituted the first big prob-
lem confronting the newly established department of health.

history prior to It^TC see Vol. I, p. 101, thi:

(327)

Pre'Bacteriologic Period

: I'rc-W Grid's fair Period)

The years 1876 lo 1892 may properly be called the pre-bacteriologic
[K-riod of the health (le])artment. During' this time the office of commis-
sioner of health was filled by Doctors lirockhurst L. Mc\'ickar for five
months : Oscar C. DeWolf for 12 years ; Swayne Wickersham for two years
and John D. Ware for two years, in the order as enumerated.

Tlie reason for designating this period of activities of the liealth depart-
ment as the pre-bacteriologic period is because it fell in the time before the
germ theory of disease had been generally accepted. Tlie lilth origin of
disease, as pronounced by Pettenkofer in Germany, and Chadwick, Simon
and ]\Iurcheson in England, was still the basis of sanitation and disease con-
trol when the department of health was established.

In Chicago, Dr. John H. Kauch had given impetus to this theory with
practicing physicians and the general public, during his work as superintend-
ent under the board of health, and was continuously following its tenents
as secretar}- of the State Board of Health, which position he then occupied.
Consequently, there was every reason for the commissioners of health, upon
whom now fell the responsibility for directing the public health work, to con-
tinue along the lines, the effectiveness of which had apparently been so well
established.

During these early years of the department the practice of medicine
was not yet subject to .State control, and the standard of medical education
as a whole was very low. In addition to the physicians who had taken ad-
vantage of medical education as offered at that time, there were a host of
practitioners who lielil iheiiisclves out as doctors. These were followers
of .some cull such as the i'lnnvnian. or Ilotanic School, or were quacks prey-
ing upon a gullible public.

Contagious Diseask Control

During the pre-bacteriologic period disease ran rampant. The city
was growing by leaps and bounds, and the older parts were becoming more
and more congested. Chicago had become the metropolis of the West, and
a great center of travel and immigration.

It was. therefore, natural that communicable diseases should spread
rai)idl\- with the efforts of control then in vogue. How futile it was to
stop the >priad nf scarlet fever, diphtheria and other contagious diseases
by overhauling plumbing and relaying drains, or by making efforts to con-

( 328 )

330 CHICAGO

trul the Stock Yards nuisance, is shown by the bills of mortality during this
epoch. As a rule the records show that the death rates from these diseases
were the highest in the history of the city.

Scarlet fever was of epidemic proportion when the department of
health was first established. The years 1876 and 1877 show the highest
death rates from scarlet fever in the history of the city since 1869, as
illustrated by the chart in Figure 2.

The chart shows that the death rates from scarlet fever were 198.8 and
190.5 per 100,000 population, respectively, in these two years.

Diphtheria was also very prevalent between 1876 and 1881. It reached
its height in 1880, when there occurred 290.7 deaths from the disease for
every 100.000 jjopulation. This represents the highest annual death rate
from diphtheria in the history of the city, as shown by the chart reproduced
in Figure 3.

From 1880 to 1891, the death rates from measles were very high. The
years 1882, 1884 and 1887 were especially bad in this respect. In 1885,
the death rate for measles was 50.6 per 100,000 population, the highest in the
history of the city.

In 1876 whooping cough assumed ejMdemic proportir)ns and the deaths
reached 53.8 per 100,00(J. This is by far the highest death rate from this
disease on record.

The great prevalence of these diseases caused the commissioner of
health to require the reporting of contagious diseases by physicians. This
v>'as first made effective in 1877. At the same time it was also required
that cases of scarlet fever should be placarded.

These new requirements, as was to be expected, brought on a protest.
The views of the protesting physicians were reflected in an address, delivered
by Dr. Henry M. Lyman, at the fifth annual meeting of the American Public
Health Association, which was held in Chicago in 1877, in which he protested
strongly against the placarding of scarlet fever cases, and deplored the waste
of cards and tacks. He stated that the people revolted against the "yellow
card nuisance."

In 1888 the foundations were laid for the isolation of persons suffering
from diphtheria, by a declaration issued by the conimissioiier of health to
the effect that diphtheria is not a filth disease. Init a contagious disease, like
smallpox.

In 1881 and 1882. when scarlet fever and diphtheria had "burnt out"
and again reached what in those days was considered normal portions,
a severe out-break of smallpox occurred. It started among the immigrants
that flocked to the city in great numbers in 1881. Altogether there occurred
about 6,000 cases during the two vears. of which nunilier 2,472 died. The

Scarlet Fever.

Deaths Per 100,000 Population.

Average Death Rates for Stated Decades.

1667-76 1
1877-86 I
1887-96 1
I697-06 i
I907-I6 1

" 21 I

14 2
• 19 6

DEATH RATES BY YEARS

YEARS

50 lOO ISO 200

1867
1868
1869
1 I670
1871
1872

1 6 73

IS7.<)-
1675
1676

1877
1 678
1679

laeo

1861
1 682
1663
1664-
1665
1886
1S67

1666

1 889

1690
IS9I

1692
1693

1 694

•m^

189 5

1 896

■

1697

1696

1899

I900

I90I

I902

1903

^^^

I904

190S

■

1906
I907
I908

1909

^^^

I9IO

^^mm

19 11

1 912
1 913
1 914

1915

■

I9IG

•m

1917

1918

19 19

1 920

1921

1922

■

1 923

1924

■

1925

■

332 CHICAGO

death rate from smallpox was 218.3 per 100,000 population in ISSl. and
230.2 in 1882. These were the highest death rates from this disease in the
city to date.

The reason that smallpox gained such headway seems to be that the two
measures, always found effective in the control of this disease, were not
carried out vigorously. In 1881, the cit\' council revoked the ordinance per-
mitting the forcible removal of cases to the hospital. The smallpox hospital
must have been quite unpopular even at that time. To improve this con-
dition it was placed in charge of Catholic Sisters in 1882.

\'accination was not carried on so vigorously at first as the situation
demanded, the reports of the department of health showing that only 48,900
vaccinations were performed in 1881, and 110,504 in 1882. The population
of the city in 1880 was 501,185, according to the United States census.

I'ollowing this there were no unusual outbreaks of disease, and the gen-
eral death rate continued irregularly downward until 1891, when it suddenly
increased to 24.16 per 1,000 population. This increase was principally due
to an outbreak of influenza which started in January 1890, and which was
followed by a high acute respiratory disease death rate during the three
succeeding years. This reached its height in 1891.

T_\phoi<l fever also became prevalent in 18'X). and continued so for three
years. It reached its height in 1891, during which year the death rate from
this disease was 173.8. per 100,0(i0, which is the highest mortality rate from
typhoid fever in the history of the city. The rate remained high during
the following year, nearl_\- 124.1 per 1(X).000 population.

It is interesting to note the attitude of the health department in regard
to the origin of this typhoid epidemic. In his annual report to the mayor
for 1892, Commissioner \\'are commented on the origin of the txphoid out-
break as follows :

"The examination showed that in almost ever.v case where death
had occurred, the plumbing was notoriously bad, the drainage worse
and in many instances not the slighest effort had been made to keep
the house and surroundings in sanitary condition; drains under houses
had been broken into, the drain overflowed cellars, and the openings
left for months until discovered by our inspectors; dwellings by the
hundreds built on undrained ground and where it is impossible to dig
twelve inches into the ground without finding water. Is it any wonder
that typhoid should exist under such circumstances? * * * * We have
tyi)hoid and always will have so long as there remains so much un-
drained property. There are 40,000 old-fashioned privy vaults in the
city. * * * * Never, in the history of Chicago, has the water supply
been better. * • * * Chemists of reputation have made tests during the
past year and the finding in every case demonstrated that Chicago has
every reason to be proud of the results obtained."

DlI'HTHKRIA AND CrOUP.

Deaths Per 100,000 Population.
AvKK AGK Death Rates for Stated Decades.

1667-76 1
1677-86 1
1687-96 1
I697-06 '
I907-I6 I

YEARS

DEATH RATES BY YEARS

50 ICO ISO 200 250 300

1667
1666
1869
1670
1671
1872
1 673

ia7.+

1675
1676
1677
1676
1679
1880
1861
1 682
1663
1664
1665
1666
1667
IS66
1669

laeo

1891
1692
1693
1 694
1895
1696
1697
1896
189 9
I90O
I901
I902
1903
I904
I90S
1906
I907
1906
I909
19IO
19 11
1912
1 913
1 914
1915

i9ie

1917
1918

19 19
1920
1921
I9Z2
1923
1924
1925

^^^^^"^

]

^^^^^^

1 ^^1 ""

1 ^^^^

"■^^^^^^n

1 1

1 ^^^^1

1 "^^^"^^^^^

^T"^^^^^

1 1

^^^^"^^^

^^^

334 CHICAGO

The t\pli()i(l outbreak was of particular sif^nificance, not only on
account of its severity, but also on account of the appruachini,'^ World's Fair,
which was scheduled to open in the following ^ear.

The State Board of Health took cognizance of the typhoid epidemic in
Chicago, and made an investigation and report of the extent and apparent
causes of the outbreak. This, together with the report previously made by
Sedgewick and Hazen, and the observations of the Chicago department of
health, hastened the improvement of the water supply, the bad condition of
which appeared to be the cause of the epidemic.

An ordinance was passed in 1892 adding diphtheria, typhoid fever and
typhus fever to the list of reportable diseases, and the method of reporting
contagious diseases by postal cards was inaugurated.

General Sanitation

Aluch attention was given to general sanitation during this period. This
was to be expected in view of the fact that the diseases coming under the
attention of the health department, on account of their epidemic or local
appearance, were thought to be due to filth.

Even in diphtheria, scarlet fever and erysipelas, there was a strong sus-
picion that filth pla\ed a major rule in their development and spread.
Where no visible filth could be found sewer gas and other effluvia were sus-
pected as the causative agents. Plumbing and drainage of buildings con-
sequently received a great deal of attention.

In 1879 a survey of tenement houses was made by a volunteer corps of
thirty-three physicians. An ordinance was passed, providing for the in-
spection of all places of employment, and six inspectors were provided for
its enforcement.

On account of the threatened invasion of cholera from Europe in 1885,
an appropriation of $100,000 was made for a general sanitary inspection and
cleaning of the city. This was a part of the comprehensive general survey
and cleanup campaign conducted by Dr. John H. Rauch, secretary of the
State Board of Health, to ward off the invasion and spread of cholera.

In 1881 a State law was passed which gave the health department full
control over the plumbing, drainage, Hght and ventilation of tenements, work-
shops and lodging houses, and required that plans must be submitted to the
health commissioner for approval of any such buildings to be erected.

Following the passage of this act, considerable attention was given to
tenement house and workshop inspection. A total of 2,444 plans for tene-
ments were approved in 1883, of which number 1.142 were for so-called
"flat buildings."

.\ moderate degree of phunbing control was exercised by the health
department in the }ears ininiL'(liritely following the passage of this act.

CHICAGO 335

In 1889 following the failure of the legislature to pass the compulsory
plumbing law, drafted in cooperation with the Illinois Association of Archi-
tects and the Chicago Plumbers' Association, the health department promul-
gated a set of rules governing the drainage and plumbing of new buildings.

In 1890 an ordinance was passed prohibiting privy vaults on sewered
premises, and in 1891 the council passed a comprehensive plumbing ordi-
nance.

The general housing conditions were bad. largely because no control
had been exercised over building construction, plumbing, drainage, light and
ventilation until the early eighties. The city passed the 500,000 mark in
1880. and it was only in the \ear following that the building department was
established and the health commissioner was given jurisdiction over the
sanitation of tenements, workshops and lodging houses.

The bad tenement house and workshop conditions, although primaril}-
due to a lack of building control in earlier years, in the course of time became
associated with the problems of poverty and the living conditions of the
working classes.

In the early eighties the conditions of the laboring people became acute
and caused a class consciousness which was reflected in the efforts to
organize labor and to improve the conditions of the laboring classes.

It was, therefore, natural that the health department, in connection with
the intensive efiforts that were being made to investigate and improve tene-
ment house conditions, should also collect statistics in regard to conditions
of employment, wages and cost of living.

In 1883 the city council passed an ordinance requiring the commissioner
of health to make such investigations and to report the findings annually.
This work was at once undertaken by the department and continued for a
period of 12 years. Even at this time the reports are valuable because they
show the wages received and the working conditions of the laboring classes
at a time when they were making vigorous efforts to improve their condi-
tions through collective bargaining.

The Citizens' Association, in a report issued in 1884, called attention to
the wretched condition of tenements, and in 1889 this same condition was
again pointed out in a report made by the City Homes Association.

Although the health department paid more or less attention to these
conditions, and at times paid especial attention to the inspection of work-
shops, and made a study of employment conditions, not much improvement
was accomplished except in the better construction and sanitation of new
buildings.

In 1891 and 1892, which was a period of great municipal development
and growth, brought on by the oncoming World's Fair, the great increase in
population resulted in overcrowding and congestion of existing tenements

336 ciiuAGo

and till- huildiii!,' nf luaiiy cluM]) structures, which afterwards proved to he
nut only a tire hazard, but also a menace to heaUh and sanitation.

( In account of the possibility (if tlie invasion of cholera from Hamburg
and other European cities in l''n2. the .^uni of $30,000 was appropriated to
clean the city. The cleanup order included even the woodsheds among the
structures to be cleaned, "(ireat care was exercised to thoroughly clean
the paved alleys ; nothing was left that could possibly become a breeding
place for cholera germs, and each load of refuse removed was sprinkle<l
with lysol after being dumped."

The two outstanding sanitary problems for which Chicago had become
famous, or rather infamous, namely, the Chicago River and the Stock Yards,
loomed as large as ever when the department of health was organized.

The board of health, which had been created ten }ears previously, was
established largely with a view to dealing with these problems and, primarily,
because the great fatality fnjm cholera in the previous year had stimulated
the citizens, interested in sanitarx- reform, to action. The newly established
board set out vigorously to study and to improve these conditions, but in
1874, the year after Dr. Ranch resigned as sanitary superintendent, the
annual report of the board of health states that "there is much nuisance
from slaughter houses." Those in the neighborhood of Eighteenth Street
and the Chicago River are particularly mentioned in this connection, on
account of their location near the residential section. It was also reported
that the South Branch of the Chicago River is a stagnant pool of abom-
ination.

In 1877 the Stock Yards nuisance became \ery acute. Prosecutions
in the police court pro\ed unsuccessful. Tlie city then attacked the problem
from a new angle. Attorney R. .^. Tuthill, later Judge Tuthill, prepared
an ordinance providing for the licensing of slaughtering and rendering
plants. X'igorous proceilures were now vmdertaken to rid the cit}' of the
Stock Yards nuisance. In 1878, twenty-seven indictments were \oted by
the grand jury against operators of slaughtering and rendering plants for
maintaining public nuisances.

The licensing ordinance was sustained in the supreme court, and it was
this carefully drawn ordinance that brought the Stock Yards plants under
control and laid the foundation for future licensing ordinances passed as
sanitar}- control measures.

The result of this movement was that all the slaughter houses were
moved outside the city limits, but soon the cit\- grew and embraced their new
location.

The Chicago River also recei\e(l much attention by the department of
health during this ])eriod. In 1879 the State Board of Health, after an
investigaliiin of the canal in the DesI'laines \'alle\, recommended that the

CHICAGO 337

pumping works at Bridgeport be rebuilt and operated to cleanse the channel.
These were completed and put in operation in 1884.

In 1880 the Fullerton Avenue conduit was completed. This was twelve
feet in diameter and served to supply fresh lake water to the North Branch.
The water was forced through the conduit by two screw pumps. At times
when the river was very bad, water was pumped from the river to the lake
through this conduit.

This ailditiunal supply of water, flowing down from the North Branch,
and the increased velocity, caused by the operation of the pumps at Bridge-
port, improved the condition of the river for a time ; but the rapid increase
in population and in industrial development resulted in the discharge of in-
creased amounts of waste material to offset the good effects of these mea-
sures and the result was that the river was as bad as ever.

The sewage-laden river was a constant menace to the water supply.
The water pollution, resulting from the flow of the river into the lake, varied
with the rainfall and the height of lake levels, but was always sufficient to
contaminate the water near the short intakes of the water supply system.
The typhoid fever death rates were high and rarely fell below 50 per 100,000.

In 1885 a final and definite solution of this problem was suggested and
taken up with avidity. A subcommittee of the Citizens' Association on drain-
age and water supply, of which Messrs. Lyman E. Cooley, Ossian Guthrie
and Dr. Frank W. Reilly were members, after a comprehensive survey, sug-
gested that a new drainage canal be dug, so as to reverse the flow of the
river. Dr. Rauch, the secretary of the State Board of Health in 1886. in
a report based upon examinations made by Professor J. H. Long, recom-
mended the diversion of the sewage from the lake into the river and canal,
and the dilution of the same with an average of 24,000 cubic feet of water
per minute for every 100,000 inhabitants. The board urged that a proper
waterway to carry out this plan be constructed.

In the following year the drainage and waterway committee. a|)pointed
by the mayor, in accordance with a resolution of the city council, with
Rudolph Hering as chief engineer, made a report recommending the con-
struction of a new drainage channel. In the meantime, comprehensive exam-
inations of the water in the Illinois and Michigan Canal and Illinois River
were continued by Professor J. H. Long, and reported in 1888.

In the following year the establishment of the Chicago Sanitary District
was authorized by the legislature, following which the district was organized
and the plans formulated for the digging of the canal. Actual work on the
canal was begun on September 3, 1892. and thus the problem of sewage dis-
]50sal and river and lake pollution was brought to what at that time seemed a
favorable solution.

338 ciiu'AGo

( larbajic rcniowil and tither scaven^^cr work, such as the removal of
(lead animals, was one of the principal activities of the health department
durini,' this period. Approximately one-half of the already meagre appro-
priations of the department were for this work. In 1885 the contract system
of garbage removal was adopted. This cost the city $75,000, which was
about one-third of the cost of the old system. In 1886 the sum of $176,196.34
was set aside for scavenger service, out of a total appropriation of
$258,356.34 made for the health department for this year. In 1887 a garbage
furnace, capable of consuming 150 tons daily, was built at Seymour Street
and C irand Avenue at a cost of $7.0(X). The cost of maintaining this crema-
tory in 1888 was $11,643. Garbage receptacles of standard style were de-
signed this year, but in spite of these improvements the garbage cjuestion
was pressing, demanded much attention and was subject to considerable
criticism.

In 1890 garbage disposal was placeil un<ler the direction of a general
sanitary officer in the department. A study was made of garbage removal
in other cities. A survey showed that there was much nuisance from
manure. It was found that there were about 100.000 horses in the city at
that time.

An odor division was also organized this year. Necessity being the
mother of invention, it is to be presumed that there was an urgent necessity
for such a division.

In 1881 a smoke-control ordinance was passed by the city council, and
its enforcement was assigned to the laboratory of the department. In 1884
a smoke inspector, under the jurisdiction of the health department, was ap-
pointed to handle this work.

\V.\TKR, Food and Mii.k.

The work of the health department in the control of water and milk
during the years 1876 to 1892, inclusive, the so-called pre-bacteriologic
period, was almost entirely based on chemical examinations and attention to
chemical standards of purity.

In reference to the condition of the water suppl\- the records show that
a study was made of lake pollution in 1877, and that it was found to be
due to two sources, namely, the Chicago River and the dumping of refuse.

In 1881 typhoid and diarrheal diseases were very prevalent. There was
also a high mortality of children under one year of age. Whether the in-
creased prevalence of these diseases was due to polluted water, or infected
milk, was not determined.

In 1886 a report on the water supply of Chicago was made by Dr.
Ranch of the State Board of Health. This showed that it was polluted, by
sewage entering the lake throinjli numerous sewer outfalls, and the Chicago
River.

339

SANITARY MAP OF CHICAGO : SHOWING TYPHOID-FEVER REDUCTION

Between 1891 and 1894.

above the horizontal lines show the
proportion of deaths from Typhoid Fever
per 1000 of population in 1891.

Figures below the lines show the proportion

PER 1000 OF Population ik the Ten

Largest Cities of the

United States.

Per cent, of
Cities. 1891 " "• " '■

Chicago 1-59

Cincinnati .
Cleveland .
Philadelphia
San Francisco .
Baltimore

Boston

St. Louis
Brooklyn
New York

Average redact

36.1 per cent. Redaction for Chicago: 80.3 per cent.
Figure 4.

340 CHICAGO

The Hyde Park water tunnel, one mile long, was completed this year.
Before this the Hyde Park pumping station was supplied thr(]ugh an iron
pipe extending 1,400 to 1,800 feet into the lake.

A tunnel, 3,000 feet long, was completed in 1887 at the Chicago Avenue
pumping station for emergency use in case of fire. This was used for the
regular water supply at times, and especially in 1892. There was a similar
shore intake for the Lake \'iew pumping station.

The location of the water intakes to the sewer outfalls along the Lake
Shore is shown in Figure 4.

This map also shows the death rate from typhoid in the various sections
of the city during 1891 and 1894. The typhoid rates in 1891 were highest
in the territory supplied by the Chicago Avenue and the Fourteenth Street
intakes. This was before the latter intake was extended four miles out into
the lake in December 1892, after which there occurred a marked reduction
in the territory supplied by the new Four Mile Crib and tunnel system.

The Chicago health department reports for this period do not make any
reference to any examination of water made by the department. The re-
ports on the W'-ork of the laboratory, which was established in 1894, relate
only to smoke inspection and later to examination of milk samples.

Light on the condition of the milk supply which existed at the time
the department was organized, is shown by investigations made in 1874 and
1875. These showed 4,372 cows fed on distillery slops from the seven dis-
tilleries in the city. A large amount of the milk supply, especially on the
West Side, was obtained from cows fed on brewery slops. This milk sold
for half the price of country milk.

In 1877 an ordinance was passed regulating the sale of milk and pro-
viding for the appointment of a milk inspector. Twenty-nine convictions
of milk dealers for violations of the milk ortlinance were obtained during the
year.

Approximately one-half of the sixty-seven milk samples examined in
1879 contained less than two and one-half per cent butter fat. The follow-
ing year thirty-four per cent of 101 samples collected contained less than
this amount of fat.

In 187') a ."-^tate law was passed prohibiting the sale of adulterated milk
and milk obtained from cows which were diseased or fed on distillerx- slops.
In 1885 another hill was passed b\' the legislature regulating the productit)n
and sale of dairy products.

This year Professor J. H. Long made chemical examinations of the
city's milk supply for the Chicago health department, and found half of the
samples below grade. This work was started in a drug store on Cottage

CHICAGO 341

Grove Avenue near 39th Street, and was continued for a period of three
)-ears. In 1886 efforts were made to stop the coloring,'- (jf milk, which was
extensively practiced at that time.

In 1892 a division of milk inspection was created b\- cil\- ordinance inde-
pendent of the health department, and a comprehensive milk ordinance was
passed requiring the licensing of milk dealers and the maintenance of sani-
tary conditions in establishments handling milk. This ordinance also estab-
lished chemical standards of purity for milk sold within the citv limits.

It was found that, of the 500 samples of milk first examined, 75 per
cent were below the standards set by the ordinance, while only 8 per cent
of a similar lot taken from trains on arrival were below grade.

Milk inspection was carried on only spasmo<lically during this period,
and the results of analyses of samples reported in 1892, showed that no
marked improvement of the milk supply resulted therefrom.

The attitude of the department, as set forth in the report of the general
;-anitary officer to Commissioner John D. Ware, in the 1891 annual report of
the department, shows an attitude that was not provocative of remedying
the bad conditions of the milk supply that had been previously pointed out
by Professor John H. Long, when he served as city chemist.

The report of the general sanitary officer of that \ear on milk and food
inspection, read in part as follows :

"The price per quart of niillv paid l).v tlie consumer is generally
the best test as to quality; milk sold at three cents per quart is
skimmed. Look at the can from which the milk is taken, and you will
find it plainly marked 'skimmed'. The State says it must be so marked
and it is. The city milk supply is all drawn within a radius of fifty
miles. The railroads handling the milk take an interest in it. They
have their own milk agent and he is alive to their interests. The milk
leaves the farmer all right and gets into the hands of the dealer all
right.

"Ccnsuniers. it you pay a rood price for your milk and it is not
satisfactory, change milkmen until you get value received. The poor
man who purchases his milk at the corner grocery will say he receives
no assurance that his milk is not adulterated. To him the department
of health will say 'Bring your sample, and if it is supicious from the
crude means of test at our command, the taste and microscope, the
department will take the risk of error and dump the milk in the
sewer.' "

Other food inspection was almost entirclx limited to inspectinn of meat
at slaughtering houses. Two meat inspectors were pro\i(led for this work
when the department was first organized in 1876. In 1892 this number had
been increased to nine. Three of these were assigned to inspection outside
of the Stock Yards.

342 CHICAGO

The first comprehensive federal meat inspection hiw, applying to inter-
state shipment of meat, was enacted by Congress in 1891. The institution
of federal inspection had a salutary effect upon the meat inspection main-
tained at the abattoirs located within the city. The city continued its service,
and at times there were misunderstandings between the two corps of
inspectors.

In 1890 a dispute developed with the State Live Stock Commission
in regard to bringing of diseased or condemned animals into the city and
slaughtering them in establishments under city inspection. This controversy
was adjusted by both parties agreeing that a special place should be provided
for the slaughter of such animals.

Period of Developvxent

The years 1892 and 1906, inclusive, may well be designated as the time
of development of health conservation and sanitation in Chicago.

During this period the office of commissoner of health was occupied by
Dr. Arthur R. Reynolds for two years, William R. Kerr for two years, Dr.
Arthur R. Reynolds a second time for eight years, and Dr. Charles J. Whalen
for two years. Dr. Frank W. Reilly who became associated with the depart-
ment in 1894, was appointed assistant commissioner in January of the fol-
lowing year, and served in this capacity through this entire period.

Although the great discoveries in bacteriology were announced around
the early eighties, such as the discovery and description of the anthrax
bacillus by Pasteur and Koch in 1877, staphilococci by Pasteur, Billroth and
others in 1880, typhoid bacillus by Eberth in 1880, tubercle bacillus by Koch
in 1882, diphtheria bacillus by Klebs in 1883, cholera vibrio by Koch in 1883,
they did not become generally applicable, either in the practice of curative
or preventive medicine until the early nineties.

In 1881, Koch made his epoch-making report, in which the method of
using solid culture media for obtaining pure cultures of bacteria and the
fundamental postulates for determining the specific pathogenicity of bac-
teria, were first announced.

The first course of lectures on the germ theory of disease was given by
Dr. Henry Gradle in 1883, at the Chicago Medical College. Dr. Wm. T.
Belfied also gave a course of lectures on this subject in the early eighties.
Twelve j'ears later, Dr. Isaac D. Rawlings gave the first laboratory course
in bacteriology at this college.

Dr. Christian Fenger came to Chicago in 1878, thoroughly imbued with
the European views in regard to the role of bacteria in surgical infections
and began to teach and demonstrate these principles at his clinics at Cook

OMMISSIONERS OF HEALTH
CITY OF CHICAGO
Afxd D^vfe of Appoirvtmcnf

Commissioners of Health— City of Cliieago
187G to 192S

344 CHICAGO

C'uunt\' Ilospital. Aiudiil; the students who clustereil around him were
Ludvig Hektoen and others who hiler jilayed a prominent role in teaching
the bacterial origin of disease to medical students and in popularizing these
facts with the practicing physicians.

It was natural that the older practitioners and the followers of other
schools of practice, should he reluctant to accept the new theories and find-
ings in regard to the origin of infectious diseases. Dr. N. S. Davis, who
had taken such an acli\e part in imprtjving the health of the city and State,
was one of the outstanding figures in the medical profession who refused
to accept the germ theory of disease at this tin:e.

In the 1884 edition of his lectures on the Principles and Practice of
Medicine, he said :

"If we adhere impartially to well ascertained facts, we must adtiiit
that diphtheria often makes its appearance in families, asylums and
schools, as well as at the beginning of epidemics, under such circum-
stances that it is imjiossible to trace it to any form of communication
with previous cases, either in the same localities or elsewhere. In other
words, it is capable of spontaneous development, and consequently does
not depend for production and spread upon any specific contagious germs
or virus generated in the bodies of the sick."

Such views were hard to dispel in the minds of the older practitioners.
With but few exceptions, the germ theory of disease was, however, quite
generally accepted in the early nineties. The same change in views were
gradually being applied in preventive medicine.

In 1888, Health Commissioner De Wolf had declared that diphtheria
was not a filth disease, but an infectious disease, like smallpox. In 1885, Dr.
Frank W. Reilly first called attention to flies as carriers of disease. The
report of Sedgewick and Hazen had definitely called attention to the relation
of the ])olluted water suppl\- to the prevalence of typhoid fever in the city.

In 189v3, F. L. Dibble, in his book entitled The Vagaries of Sanitary
Science, presented a scathing denunciation of the filth theory of disease and
the methods previously in vogue for controlling diseases, and showed more
or less accurately the futility of proceeding along these lines.

This status of sanitary science, and the development and quite general
acceptance of bacteriology, made it possible for Dr. Arthur R. Reynolds,
when he was appointed commissioner of health in 1893, to direct the work
of the health department along scientific lines.

One of the first steps taken by him in this direction was the establish-
ment of a laboratory. Tn 1804 Dr. .\dol])h (lehrman was a]jpointed
director of the laboratory, which was e(|uipped to make analysis of
milk and water. This avoided the necessity of sending such samples to
private laboratories, as had been the custom. In September, examinations of
diphtheria cultures were begun. The first W'idal tests were made in 1896.

CHICAGO 345

A total of 12,580 analyses of all kinds were made in the laboratories
during 1894, 12,093 of these were of milk and cream, 239 were of the city
water supply, 95 diagnoses of diphtheria were made, 26 of bread, 8 of air
and various food products. In all 21 different things having a bearing on
health were analyzed.

The department's crusade to BOIL THE WATER during 1893 and
1894 was very effective in reducing typhoid fever. Some of the daily papers
carried the phrase — BOIL THE WATER — in large type on the front page.

The first diphtheria antitoxin was issued by the health department on
October 5, 1895. At the same time a corps of antitoxin administrators was
appointed. The results obtained, when tabulated, showed a great lower-
ing of the mortalit\- in the cases where this remedy was used. A circular
of Informatiiin on the Antitoxin Treatment of Diphtheria was issued b\' the
department, with a \ie\v t" pdiiularizing this form of treatment.

IxFi-xTious Diseases.

During the World's Eair which was held in Chicago in 1893, and visited
by millions of people, there was much overcrowding in the city. The lodging
houses were crowded, and the outbreak of smallpox among the lodgers led
the department to inaugurate a vigorous campaign of vaccination, but in
spite of this 140 cases of smallpox occurred, of which number 23 ended
fatally.

The next \'ear, during which there was much unemplo_\'ment, man\ labor
disputes and strikes, smallpox assumed epidemic proportion. A total of
2,332 cases and 1,033 deaths from the disease occurred during the year.
A vigorous vaccination campaign, in fact, the most extensive of its kind in
the history of the city, was carried on by the department, with a result that
1,084,500 vaccinations were performed in the city during the year. The
"vaccination creed" of the department, first issued at this time, was distri-
buted in large numbers.

Additional hospital accommodations had to be provideil for persons
suffering from smallpox. The Msiting Xurse Association furnished the
nursing service for these hospitals.

Plans were made for the construction of a large municipal smallpox
hospital, and the foundations laid for it, but in the following )ear, when
smallpox had subsided, the plans were modified and the size reduced to
about 125-bed capacity. The new hospital, located at 34th Street and
Lawndale Avenue, was completed in 1896.

The next increase in the smallpox incidence was in the years 1903 and
1905. In 1905 there were 546 cases of the disease reported, with 61 deaths.

346 CHICAGO

A marked reduction in the incidence of typhoid was speet.lily accom-
plished. The death rates from ty]ihoid fe\er in the \arious wards of the
city during 1894, as compared with IS'M. are shown in tlie map, Figure 4,
pajje 339, repro(hiced from annual rejjort of the department for 1894.

This also shows the four water intakes and the sewer outlets ahjng the
shore line.

All of tlie other infectious diseases, with the exception of tuberculosis
and pneumonia, were brought gradually under control during this period,
and the only outstanding epidemics that occurred from these diseases, were
a moderate outbreak of epidemic cerebrospinal meningitis in 1898. and an
outbreak of typhoid on the West Side river wards, due to a pollution of the
water supply in this district. A typhoid rate of 44.5 per lOO.OOO for the city
was recorded that year.

An extensive outbreak of scarlet fever occurred at the end of this period,
affecting especially the North and West sides of the city, due to the infec-
tion in the country of the milk supplied by a large dealer. This outbreak
reached its height in January 1907, during which month 3,058 cases were
reported.

The disease, although widespread, was mild in character, and. therefore,
many cases were not reported. These served as new sources of infection,
and helped to augment and prolong the epidemic.

During the }ear, a total of 718 deaths from scarlet fever were recorded,
representing a death rate of 35.1 per 100,000 population.

In 1903 the death rate from the acute respiratory diseases, was 313.4
per 100.000 population, which was the high mark from this class of diseases
during this period.

A marvelous reduction was accomplished in the death rate from diph-
theria and croup. This was reduced from 129 per 100,000 population in
1892, to 27.1 in 1907. The reduction was especially marked after 1895, and
followed the introduction of the use of antitoxin in the treatment of this
disease.

Diphtheria, for which the new science of bacteriology had found not
only the causative genu and an accurate method of diagnosis, but also a
curative and preventive agent in the form of an antitoxin, was especially
amenable to preventive measures. It was the application of these that
brought the death rate down as indicated.

In 1896 the laboratory was equipped with an incubator to facilitate diag-
nosis work. The following year four antitoxin and incubator stations for
diphtheria cultures w-ere established in different sections of the cit\'.

Better methods of disinfection were employed. In 1898 the use of
formaldehyde for this purpose was introduced, first by the use of generators,
and later in the \car, bv the sheet method.

347

In 1905 antituxin beciime very high priced, and in order to make it
generally available, the department took a hand in lowering the price and
also resumed the free distribution of this product. The next year these
efforts culminated in an arrangement with the McCormick Memorial Insti-
tute for Infectious Diseases whereby the Institute supplied antitoxin to
physicians and the health department at cost. By this means the combine
of manufacturers to hold up the price was broken.

To overcome the objections to the placarding of premises on which a
person suffering from a contagious disease was isolated, the department in
1896 began to allow physicians to assume the responsibiHty of quarantining
cases of contagious disease under their care. This procedure remained in
effect until 1909, when it was rescinded because it was found that it retarded
the reporting of cases and was a hardship on physicians who could not con-
scientiously assume this responsibility.

Following the death of Chief Medical Inspector Garrot, Dr. Heman
Spalding was appointed to that position on May 1, 1899. He held the office
continously until his death in 1926. Dr. Isaac D. Rawlings entered the

department in March 1899, as a
medical inspector and was appointed
assistant chief medical inspector five
vears later. These two officials
played an important role in the
development of communicable
disease control and school inspec-
tion in Chicago.

Dr. .Spalding, ever reminiscent of
his early experience in the smallpox
epidemic of 1893 and 1894, special-
ized in the diagnosis and control of
this disease, and was an ardent
advocate of vaccination at all times.
Cpon Dr. Rawlings fell the re-
sponsibility of attending to the end-
less details necessary to carry on the
measures required, to guard the in-
habitants of a large and growing
city against the inroads of contagi-
ous disease. His careful planning
and systematizing of the work' laid
the foundations for the methods of communicable disease control now in
effect in the City of Chicago and the State of Illinois. On February 3, 1921,
he was appointed Director of the Department of Public Health of the State.

Jleniun SiJiihliii,^, M I)

348 CHICAGO

An ordinance was passed in 1895 licensing and regulating undertakers.
Dr. O. M. llcckar<l was appointed registrar of vital statistics this year. The
same year funeral in>pecticin was inaugurated li\' the department.

Efforts were also made to lower the high infant mortality that prevailed
in the early nineties. The deaths of infants under one year of age then con-
stituted about 30 per cent of all deaths.

In 1894 the department started to distribute its circular on the hot
weather care of babies. Tn 1896 rules were promulgated regulating the prac-
tice of midwifer\'. In 1898 a system of reporting births by postal cards was
inaugurated and remained in effect for three years.

The first comprehensive step taken to combat the annual hot weather toll
of infants was in the summer of 1899, when a volunteer corps of 73 physi-
cians was detailed in the congested districts of the city to give instructions to
the mothers on the care of babies.

Medical inspection of schools was started b}- the department of health at
the beginning of the school year, September 3, 1896, when eight of the ten
medical inspectors in the service were detailed to this work. This w'ork was
continued until January 8, 1900, when through the efforts of Dr. W. S.
Christopher, SO medical inspectors were detailed by the board of education
for this work, with the understanding that they would work under the direc-
tion of the commissioner of health. They remained on duty until nearly the
end (if the school term. ( )nly ten were reassigned to this work with the open-
ing of schools in Septeml)er, and continued to visit the schools on emergency
calls, and made inspection for contagious diseases. In the fall of 1900. the
Compulsory Education Department assumed control over this corps of in-
spectors. This led to duplication of work and misunderstandings, so that the
commissioner of health in 1902 found it necessary to protest against this
arrangement but not nnicli iniproxenient resulted therefrom.

During the extensive outbreak of scarlet fever in the early part of 1907,
250 school in.spectors were provided during the emergencx'. of which num-
ber 100 remained after the epidemic was over until the end of that school
year.

The reductions in the death rates from contagious diseases, and efforts
made to conserve the health of infants and children, reflected themselves in
the decline of the general mortality rate during this period. During the first
17 years following the establishment of the health department, the so-called
pre-bacteriology period, the average annual death rate was 20.3 per 1,000
population. During the last three years of this same period the average
annual death rate was 21.9. showing that practically no inroad had been made
on the ravages of disease, with the arniamcnturium u>ed during the pre-
bacteriologic period.

CHICAGO 349

With more scientific methods, and a more accurate knowledge of the
causes of disease, the death rate was reduced nearly 25 per cent in the first
14 years of the bacteriologic era. In 1901 the annual death rate for the first
time reached the low minimum of 13.9 per 1,000 and from there on averaged
about 14.7 per 1.000 annually during the last six }-ears of this period.

The average age at death in 1905 was 31 _\ears, 9 months and 18 days.
as compared with 16 years, 2 months and 12 days in 1875, the \ear preced-
ing the establishment of the health department.

Sanitary Engineering.

The completion and opening of the new drainage channel on January 17,
1900, was a great accomplishment from a sanitary engineering standpoint.
The object of the new canal, with the tributary branches which were to be
dug subesequently, was to divert all of the sewage of Chicago and adjoining
territory in Illinois from the lake. To do this for Chicago, north of the Calu-
met district, it was necessary to intercept all of the sewers emptying into the
lake, and then to divert the sewage from the interceptors, by great cross-
town sewers, to the Chicago River and drainage channel. x\lthough a com-
mission had been appointed in 1896 to prepare plans for diverting the city
sewers to the river, the major portion of the intercepting sewer system was
not ready when the drainage channel was completed in 1900.

In 1898 the main sewers in Twelfth and Twenty-second streets had
been changed in grade, so as to discharge into the river instead of into the
lake. The Thirty-Ninth street intercepting sewer, diverting all sewage
between Thirty-first and Seventy-fifth streets, was opened in December,
1905, but the Lawrence avenue sewer, receiving the intercepted sewage from
along the North Shore, was not completed until 1908.

On the same day that the drainage channel was opened the State of Mis-
souri started an injunction proceeding against the State of Illinois, seeking
to restrain the sanitary district from discharging its drainage into the Mis-
sissippi River, via the Illinois and Des Plaines Rivers. In anticipation of
these proceedings. Doctor Reynolds, commissioner of health of Chicago in
1898, inaugurated the work of stream examination for the Sanitary District
of Chicago.

No plan of water analysis of such broad extent and great magnitude had
heretofore been undertaken. It covered the waters between Chicago and St.
Louis and was national in its influence and significance.

The reason for the work was a persistent rumor that the State of Mis-
souri would take steps to enjoin the State of Illinois from opening the drain-
age channel that was built to carry the sewage of Chicago, together with
the waters of dilution, from Lake Michigan in its course to the Mississippi
River.

350 CHICAGO

ThvL'L' laljoratories, making iiuli\iilual examinations, wx-re hrnutjht into
the service. Dr. A. S. Draper, licad of the L'niversity of Illinois, appointed
Professor Arthur W. Palmer and Dr. T. P. lUirrill for the work. Dr. W. R.
Harper of the University of Chicago appointed Dr l-ldwin O. Jordan and
Dr. Adolph Gehrman was appointed for the laboratory of the department of
health of Chicago.

These men organized the work, agreed u|)on niethoil.s. went o\er the
streams from Bridgeport, where the drainage channel began in Chicago, to
St. Louis, in Missouri. They selected the different points at which samples
of water were to be taken, selected and instructed those who would collect
the samples and ship the containers. The samples were collected in triplicate
at stated periods and shipped one to each of the laboratories.

A small laboratory was set up by Dr. Jordan at Grafton, Illinois, where
determinations were made at once. It was presided over by Dr. E. E. Irons
of Chicago, who was then an under-graduate in medicine.

Dr. Reynolds alone held the conference with the trustees of the sani-
tary district that secured their consent to undertake the work, and he is
authority for the statement that the letter of the department of November 28,
1898, urging the policy of making the examinations, and the letter of trans-
mittal of the results in their literary excellence and final form, are the work
of Dr. Frank W. Reilly. These two letters were considered by the depart-
ment of health as its masterpieces as state papers. The full report was
printed by the trustees of the sanitary district in 1902.

This work was started in May, 1899, and continued until Jul\-, 1900,
and showed that all of the pollution in the Illinois River from Chicago sew-
age had disappeared before reaching Peoria, also that the water at the mouth
of the Illinois River was purer on an average than that of the Alississippi
above this junction.

These findings were used, together with those obtaineil by Professors
]. H. Long and F. R. Zeit. in another somewhat later comprehensive chem-
ical and bacteriological examination of the Illinois, Missouri and Mississippi
Rivers made in 1902, in the mjunction proceedings which were heard in
St. Louis before a commissioner of the United States Supreme Court and
finally decided by the United States Supreme Court against the State of
Missouri in May, 1906.

Following the extensive prevalence of t\phoid fever in the years just
preceding the World's Fair, greater attention was given to the purity of the
water supply. Owing to an unavoidable delay in extending the Hyde Park
Crib, it was found necessary to purify all the water used on the World's Fair
grounds by Pasteur filtration. An attempt was also made to la\- a pipe line
from Waukesha, Wisconsin, to supply the Fair with spring water from that
localitv.

CHICAGO 351

The Four-lNIile Crib off Fourteenth Street was put into operation in
1893, and the use of the shore intakes at the Chicago Avenue and Lake
View pumping stations was permanently discontinued. Doubtless the water
from these sources played an important role in the high typhoid incidence in
the city during the years 1890 to 1892.

Extensive examinations of the city's water supply were inaugurated in
the cit\- laboratory in 1894. The following year daily examinations were
started, and after that the department published the results in the daily
papers and inserted a warning notice and advice to BOIL THE WATER
whenever the findings were especially bad.

The H_\de Park intake was extended two miles in 1894. The North-
western Lake and Land Tunnel System, supplying the Central Park and
Springfield Avenue pumping stations, was completed in 1900.The use of the
Rogers Park pumping station, which received its water through a short
shore intake, was discontinued in 1906 and the territory was supplied from
the Lake View Pumping station.

A State law was passed in 1897 providing for the licensing of plumbers
and inspection of plumbing by municipalities. Acting in accordance with the
provisions of this statute, a city ordinance was passed providing for the
licensing of plumbers by a board of examiners and also setting forth stand-
ards for plumbing installations.

The first free public bath house, the Carter H. Harrison at 759 ]\Iather,
was established in 1893. From then up to 1907 the number was gradually
increased to fourteen.

General Sanitation.

The scavenger service, the operation of which had given the health
department so much vexation, was transferred to the department of public
works in ^larch, 1893, but this did not settle the garbage problem. Com-
plaints in regard to garbage accumulations on premises and in alleys con-
tinued to come to the health department daily in large numbers, and the
public had the same reasons for being dissatisfied with the service as before.
In 1900 an ordinance was passed requiring the separation of garbage and
rubbish.

The wooden refuse receptacles, one side for ashes the other side for
garbage, maintained in the alleys in the rear of every building, were usually
in bad repair or, as often happened, wrecked by a passing vehicle. These
receptacles were neither rat nor fly-proof and offered, especially when filled
to overflowing, as was often the case, the best sort of habitation and food
supply for such vermin. The garbage, after collection, was dumped in low
places or in available holes or excavations. These "dumps" were the source
of much nuisance in the summertime, and the odors from them often per-

352 CHICAGO

meatwl the surrouiulins,' neighborhood. Strange to say, they attracted liordes
of women and chil(h"en from the poorer sections who picked over the refuse
and garbage and carried or carted home anything that they thought was
worth salvaging.

This condition prevailed until I'Wi, when the first contract was made
for the disposal of the city's garbage at a reduction ])lant. The storage
and disposal of manure remained under the jurisdiction of the health depart-
ment. The quantit}' of manure produced increased from year to year, and
the nuisance created thereby presented a problem which became greater as
the population of the city increased and its area was extended.

The stud}- of typhoid fever, which was so prevalent among the troops
during the Spanish-American War in 1898-1899, had demonstrated the role
of flies in the transmission of this disease. In 1902 the relation of flies to the
spread of typhoid was studied by Alice Hamilton in the epidemic of the dis-
ease which occurred on the West Side.

These and numerous other observations had established the danger of
flies, so that in the early nineties cognizance began to be taken of their sani-
tary significance, but it took nearly another decade to educate the general
public sufficiently in regard to their danger so as to demand the enforcement
of laws intended to prevent the breeding of flies in the city.

The numerous privy vaults in the city were another matter that received
closer attention when the role of flies as carriers of disease had been demon-
strated.

.\ census and canvass in 1907 showed that there were 66,(K)0 horses
and 14,047 privy vaults in the city.

In 1902 a comprehensive tenement house ordinance was passed, modeled
after the New York law. At the beginning of this period women were added
to the corps of sanitary inspectors, with the idea that they might be more
alert in detecting and remedying insanitary conditions found in the inspec-
tions of homes and premises.

An ordinance prohibiting spitting in public places was passed in I'Wl.
Smoke inspection, which had been under the jurisdiction of the health
department since 1881, was transferred to the newly created department of
boiler inspection in 1903.

Food .\nd Milk Instection.

The division of milk inspection, which had been organized as a separate
department, was brought under the jurisdiction of the health department in
1893, and operated in connection with the laboratory, which was established
at the same time. Milk samples were now taken more or less regularly.

A study of the milk supply of the city, made by the I'niversity of Illinois
Agricultural Experiment Station in 1899, showed that much of the supply
was of inferior grade.

ciiuAco 353

111 I'-'OO the health ileiiartmeiit lalioratory detected formaldehyde in
293 samples, and a campaign was started to stop its use as a milk pre-
servative.

Dairv inspection was inaugurated in 1902. At first the Chicago Civic
Federation paid the salaries and exi'enses of two dairy inspectors. More
attention was alsn paid to city milk inspection. In 1904 the country dairy
inspection was taken o\er 1)\ the health department. This work as first
was large!)- educational and was princii)all\- CDUcerned with the feeding of
wet malt, which was f(jund in about 20 jier cent of the farms inspected.
An ordinance was passed re(|uiring milk cans to he sealed in transit.

An independent examination of the milk supply, made by P. G. Heine-
mann in 1904 for the Civic Federation, showed that 26.8 per cent of the
samples were below grade in butter fat, 30.9 per cent in solids not fat, also
that 15 per cent of the restaurant samples contained formalin. The average
bacterial count of samples taken on May IS of that year was 942,000 per
cubic centimeter.

In 1905 the making of sanitary inspections of milk depots in the cit\'
was inaugurated, also bacteriologic examination of samples. A total of
5,838 samples were thus examined and most of the samples showed over
500,000 bacteria per cubic centimeter, and some ran as high as 10,000,000.
In the following year bacteriologic examinations were first made of milk
samples collected on dairy farms, but only thirty samples were examined.

The bureau of food inspection was established by an ordinance in
1905, but the work of the bureau was performed at first under the super-
vision of the director of the laboratory. The same year Commissioner
Whalen concentrated on meat inspection at the Stock Yards, and gave
much attention to the inspection of canned goods and of foods in cold storage.

The Jungle, by Upton Sinclair, published in February, 1906, portraying
the picture of a workman emplnxed at the Stock Yards, was embellished
with incidents relative to insanitar\ cimditions of the slaughter houses and
the laxity nf meat inspectinn which were so revolting that they received
!.;eneral public consideration and ullimatelx lirnught about a federal inves-
tigatinn.

The report of this investigation, the so-called McNeil-Reynolds report,
showed that the conditions depicted in The Jungle, although written as
fiction, were indicative of the insanitary conditions and inadequacy of the
meat inspection service of many of the slaughter houses investigated. The
revelation of these facts and the iniblic attention they received caused Con-
gress to pass a comprehensive meat inspection law, eiifective in 1906, regu-
lating the .sanitary condition of plants and requiring the inspection and ap-
proval of all meats and meat products pre|)arc(l in establishments shipping
products via interstate commerce.

354 CHICAGO

In 19CKj the city council passed ;ui (in.linance proxiding for the licensing
and control of restaurants.

The ice suppl\' received attention in 18%. It was found that ice
obtained from clayholes, the Chicago and Calumet Rivers, was unfit for
domestic use. To prevent the sale of this ice for such purposes an ordinance
was passed licensing ice dealers and regulating the production and sale of
ice. Following this the department carried on a systematic inspection of the
ice supply, sending inspectors to the sources of production each winter to
make inspections and take samples.

Publicity and Education.

Publicity and education in public health work was given an impetus
by the acceptance of the bacteriologic origin of disease. It was soon evident
that in order to prevent effectively the spread of infection it was necessary
that the public should be familiar with the simple facts in regard to the origin
and spread of contagious diseases. Consequently, much attention was given
to educational propaganda during this period.

In 1894 the Monthly Statement of Mortality, published b\- the depart-
ment, first contained notes by Commissioner Reynolds on health conditions in
the city. Following the appointment in 1894 of Dr. Frank W. Reilly, a
trained sanitarian with newspaper experience, there came from the depart-
ment a series of circulars and bulletins, which were dignified by literary style
and a conservative and accurate statement of the facts in simple language.
The first of these publications was The Vaccination Creed and the cir-
cular on the Hot Weather Care of Babies, issued in 1894, already referred
to. These were followed the next year by circulars on the Prevention of
Smallpox, The Anti-to.vin Treatment of Diphtheria and Advice to the Family
in the Care of Contagious Disease.

In the appointment of E. R. Pritchard as secretary in 1899, another
newspaper man was added to the staff of the department. In 1901 the
department started publishing the State of the
City's Health every week in the newspapers, and
discontinued the publication of the Monthly
Statement of Mortality.

The following year the State of Chicago's
Health was published as a weekly bulletin. For
the first time Fourth of .Inly Dont's were pro-
mulgated by the department.

In 1906 the Bulletin of the Department of
Health was first issued as a weekly publication,
and mailed to physicians and others interested in
E. R. Pritchard public health work in the city.

CHICAGO 355

The Chicago health department was awarded a gold medal at the Paris
Exposition in 1900 for an exhibit showing methods of work and results
accomplished. The following year it received a medal at the Pan-American
Exposition in Buffalo. At the Louisiana Purchase Exposition in St. Louis in

1904 the department was given the highest award for the best and most com-
prehensive display of public health methods.

Quasi-Public Agencies.

During this period the advances in preventive medicine came so fast, one
after another, and the opportunities of the application became so numerous
that it was impossible for the constituted authorities, with the funds avail-
able, to do all the things that should be done to improve the public health.

Although the population of the city increased from 1,253,022 in 1893 to
2,047,690 in 1907, or in other words, nearly doubled in numbers and the
area was increased nearly four-fold, the 1889 annexation alone adding 133
square miles of territory to the 43.9 square miles which constituted the city's
area prior to this annexation, the appropriation and personnel of the health
department were not increased proportionate!}'.

At the end of 1892 tlie health department report listed 101 emploves; bv

1905 this number had been increased to only 160. Correspondingly, the
expenditures, exclusive of scavenger service, increased from only $120,-
596.87 in 1893 to $243,209.76 in 1905.

It is for these reasons that this period is characterized by the organiza-
tion of many societies interested in promoting certain fields of public health
or social welfare endeavor, and in numerous instances, actuallv engaging in
this line of work at the expense of private philanthropy.

Among these institutions was Hull House, established in 1889. This
was followed by the Chicago Lying-in Hospital and Dispensary in 1895, the
Chicago Association of Day Nurseries, in 1897, the City Club in 1903, and
the Juvenile Protective League, in 1904. The Chicago Visiting Nurse
Association, founded in 1888, rendered valuable service during this period,
especially during the smallpox epidemic in 1893 to 1895.

In 1903 the city milk committee was organized for the distribution of
modified and pasteurized milk, also the tuberculosis committee of the Visiting
Nurse Association. In 1906 this was organized as the Tuberculosis Insti-
tute. This group held a tuberculosis exhibit at the public library in 1905,
which gave a great impetus to anti-tuberculosis work in the city.

In 1904 Dr. T. B. Sachs published a report on the pervalence of tuber-
culosis in the West Side Jewish district, which attracted considerable atten-
tion. The next year the City Homes Association presented the results of its
studv of tuberculosis in the citv.

356 CHICAGO

The Cliica,i;i;) Sucicty of Social Hygiene was organized in 1906. The
Chicago Pediatric Society assisted in carrying on infant welfare work in
the siunmers of 1905 and 1906. One feature of this work was the con-
duct of improvised infant welfare stations in tents, erected in the poorer
sections of the city, where pediatricians selected by the society gave advice
to mothers on the care of babies during the hot weather.

Period of Systematic Control

Starting with the year 1907, the efforts of the health department have
been directed towards the systematic control of the various preventable
diseases. Likewise, the other activities of the department, such as the
control of the milk supply, meat and food inspection, ventilation inspec-
tion, and control of the purity of the water supply, have been undertaken
on a comprehensive scale, in accordance with well understood principles
intended to accom[)lisli the object in view, namely, the conservation of the
I)ublic health.

It is on account of these facts that this has been designated as the
Period of Systematic Control.

The commissioners of health who served successively during this time
were Doctors William A Evans, four years ; George B. Young, four )ears ;
John Dill Robertson, seven years ; Herman N. Bundesen, five years and
from December, 1927, to date, Arnold H. Kegel. The term of the com-
missioner was lengthened to four years in 1907, which gave the incum-
bents a more nearly sufficient time to put into effect their policies. The
salary of the commissioner was raised to ?8.00(» in 1907 and to $10,000
in 1914.

CoMMl'NirABLE DISEASE CoNTRGL.

In 1907 the department for the first time had an adequate appropria-
tion to carry on its activities. This amounted to $848,966 and represented
an increase of nearly 200 per cent over the $288,733 available in 1905. This
appropriation had been obtained by Commissioner Whalen, in part for
increased activities in meat, milk and miscellaneous food inspection, and
at the end of his term, for medical inspection of schools, quarantine service,
and other activities in connection with the outbreak of scarlet fever, which
occurred at that time.

The communicable disease situ;ition th;it presented itself to Commis-
sioner Evans at the beginning of his term in 1''07 was approximately
as follows: There had been no substantial reduction in the death rates
from tuberculosis and the acute respirator}- diseases. In fact, in recent
\cars these diseases had shown a tendency to increase. The tuberculosis

CHICAGO 357

(all forms) death rate had reached 197.2 per 100,000 in 1907, which rep-
resented the highest annual death rate from this disease since 1893. The
deaths from the acute respiratory diseases stood at 282.1 per ltX),000,
which was higher than the average annual death rate for the preceding
three decades.

All the other infectious diseases had been reduced in the preceding
14 years, lint all were still far too prexalent. The typhoid death rate
had (h'opped to 18.2 per 100.000 and even diphtheria, in the reduction of
which such marvelous results had been obtained in the preceding decade,
showed a death rate of 27.1 per 100,000 at the beginning of this period.

The infant mortality, greatly decreased in the '90's, had shown a tend-
enc\' to increase since 1901. It reached the figure of 3.2 per 1000 popu-
lation in 1907. Births were only partially registered and consequently the
onl\- fair wav of calculating the death rates of infants was in relation
to the whole population.

From the foregoing data, it is plain that the great problems confront-
ing the health department at the beginning of this period were the con-
trol of tuberculosis and the acute respiratory diseases and the reduction
of infant mortality.

Tuberculosis.

Conditions were favorable from the outset for active measure to lower
the tuberculosis mortality. The pulilic had been awakened to the gravity
of the situation. A tuberculosis exhibit had been held at the public library
in 1905. The Chicago Tuberculosis Institute had been organized in 1906,
and in the following year opened seven dispensaries for the diagnosis and
treatment of cases.

The health department took immediate steps to enforce the reporting
of cases. A definite pronouncement was made in 1908, adding tuberculosis
and pneumonia to the list of reportable diseases. All cases of tuberculosis
reported were entered on the records of a house hie. which was started
in 1909 and continued by the health department until about 1920.

Active anti-spitting crusades were conducted in the campaign against
tuberculosis. After a trial at arresting and fining violators. Commissioner
Evans in 1909 resorted to the use of a warning card as illustrated on page
369 of Volume I. These cards, bearing a picture of a crusader with a
red cross on the shield, were carried by all employes of the department,
and politely handed to anyone seen spitting on the sidewalk or in public
places or conveyances.

After repeated efforts of the State Board of Health to pass a law
providing for the establishment of a State tuberculosis sanitarium had
resulted in failure the Glackin law. providing for the establishment of

358 CHICAGO

tiilicrculosis sanitariums by immicipalilies, passed the Legislature in 1908.
The following year the city, by a referendum vote, decided to establish
,'i sanitarium under the provisions of this act. The vote taken was 167,-
230 for and only 39,410 against the proposition. Thereupon Mayor Busse
appointed Harlow N. Higginbotham, Dr. Theodore B. Sachs and Dr. Wil-
liam A. Evans as the first board of directors under the provisions of this
act. This board elected Mr. Higginbotham president, and Dr. Sachs secre-
tary, and proceeded at once to secure grounds, and to build a sanitarium,
all to be paid for out of the succeeding annual tax levies of one mill on a
dollar of the assessed valuation. This gave the board approximately a
million dollars annually.

In 1910 the board took over the operation of the seven tuberculosis dis-
pensaries maintained by the Chicago Tuberculosis Institute. A nursing
service was conducted in connection with the dispensaries, which served
to supervise and care for persons infected with the disease. As far as
possible restrictive measures were enforced in open cases in the home
or industry.

The sanitarium, located at Bryn Alawr and Crawford avenues, was
completed and opened on March 9, 1915. This provided 380 beds for the
isolation and treatment of early cases of tuberculosis, which were increased
to 1,000 the following year. Thereafter only late cases were cared for at
Cook County Hospital, and after December 1, 1910, also at the County
Tuberculosis Sanitarium at Oak Forest. In this connection it should be
noted that after the passage of the registration law in 1915, tuberculosis
deaths at the Oak Forest institution were no longer included in the Chi-
cago count.

In 1916 a house-to-house survey was made by the Municipal Tubercu-
losis Sanitarium in the district between Twenty-second Street and North
Avenue, extending from the Lake to Ashland Avenue, comprising a total
of approximately eight square miles. In 1917 this sui'vey was extended
to embrace the territory south to Fifty-Fifth Street between Wentworth
Avenue and the Lake. This territory had a total population of 371,259.

A total of 165,700 persons in this area were examined and 8.6 per cent
were found afflicted with tuberculosis. One result of this entire survey
was that 14,282 unregistered cases of tuberculosis were found and brought
under observation.

In 1917 all physicians in the Municipal Tuberculosis Sanitarium dis-
pensaries were placed on a full-time basis. A quarantine system was
instituted and no open cases of tuberculosis were allowed to remain in
contact with children in the home. Where cooperation on the part of such
patients could not be obtained the premises were quarantined or the cases
were hospitalized.

CHICAGO 359

As a result of the systematized efforts and others, to be referred to
later, such as the pasteurization of the milk suppl.v and the attention to the
health of children in the schools, the tuberculosis death rate was lowered
from \ ear to \ear and reached a minimum of 78.3 per 100,000 in 1922,
since which time it has sliown a sli,<,'ht tendency to increase.

Acute Respiratory Diseases.

The fight against the acute respiratory diseases, although also actively
started in 1507. has not shown such good results as the campaign for the
suppression of tuberculosis, largely owing to the fact that many of the
factors in the transmission and the snsceptibilit\- to these diseases are still
wrapped in obscurity.

After pneumonia was added to the list of reportable diseases in 1907,
the reporting of cases was by no means complete at once, and it was not
until 1914 that the number of cases of pneumonia reported exceeded the
number of deaths recorded from this disease.

Much effort was expended in directing public attention to the neces-
sit}' for adequate ventilation and ordinances were passed in 1910 requir-
ing proper ventilation for places of public assembly, public conveyances,
factories and workshops. Much attention was also given to the ventila-
tion of theatres and street cars, with the result that the ventilation of these,
even as early at 1917. was better in Chicago than in any other cit\' in the
countrv. It was in this )ear that all street cars were equipped with proper
ventilation appliances.

During this time the acute respiratory disease rate began to drop, but
in the spring of 1917 a sharp rise occurred and the death rate frc:m these
diseases reached a total of 214.6 per 100,000 during the \ear.

In November, 1917, the laboratory started typing pneumococci. In
December the same \ear it was first required that cases of pneumonia be
placarded. This action was taken none too soon, for in the following
year, when Chicago was reached by the pandemic of influenza which encir-
cled the globe, the death rate from the acute resjiiratory diseases jumped
to 552.1 per 100,000.

This pandemic of influenza reached Chicago .September 21, 1918,
attained its maximum on the following October 17, on which day 381
deaths from pneumonia and influenza occurred in the city. Following this
it declined until the death rate frcmi ,ill causes fell to normal again during
the week ending November 23. The t"tal number of deaths from influenza
and pneumonia during the outbreak was 8,510. The total excess death
rate during the 25 weeks following September 8, l')17. was 3.8 per 100.000,
which was the second lowest increase in mortality recorded for any city
in the United States with a population of 500,000 and over.

360 CHICAGO

\'if,r(ir()us measures were taken to combat this e])i(lemic. Inliuenza
was made reportable on September U). I'ulilic funerals were prohibited
on October 12. Smoking on street and elcvaicd railroad cars was pro-
bibitcd un October 13. This order was not rescinded after the epidemic,
with the result that smoking, together with the accompanying spitting nuis-
ance on these cars, has been abolished in Chicago since that date.

Theatres, skating rinks, night schools, and lodge halls were closed on
Octol)er 15 and kept closed for 1.5 days.

.\ nii.xed vaccine was prepared under the auspices of a laboratory com-
mittee appointed to handle this phase of preventi\e work, and a total of
313,028 do.ses were issued up to January 1, I'MO.

.\ distinct recurrence of the influenza occurred from January- to March
the following year, but Chicago was not as hard hit during this epidemic
as some of the other communities. The death rate from the acute respira-
tory diseases in 1910 reached 2(X).() per 100,000 population and 231.5 in the
following }ear.

-\. i^neumonia commission was appointed in the fall of 1''24, to study
the prevalence of the acute respiratory diseases and recommend measures for
their control. After a survey and detailed investigation of all the cases
resported during a season and a review, reclassification and stud\' by Dr.
William H. h'vans. of the reports of deaths from pneumonia during the
same period, the commission made its recommendations which were em-
bodied in a set of rules and regulations governing the handling of pneu-
monia cases, issued b\' the .State Department of Public Health in Decem-
ber, 1925.

Ty/^lwid.

\ mar!;ed reduction in the typhoid death rate was accomiilished during
this periotl. The steps taken to bring this about were the pasteurization
of the milk supply, which was first required by an ordinance passed July
13, 1908, on the recommendation of Dr. William A. Evans, and the chlorina-
tion of the water sui)i)l\-, started March 15, 1912, by Dr. George B. Young,
and applied to the entire water supply of the city by Dr. John Dill Robert-
son on October 6, 1916. On July 22 of the same year, during an outbreak
of infantile paralysis, it was definitel}' required by Dr. John Dill Robertson
that all milk and cream, except certified, be pasteurized at a temperature of
145 degrees I'ahrenheit for 30 minutes. This executive order has not been
rescinded to date, and as a result, no niilk-borne outbreak of txphoid fever
has occurred in the city since that time.

Previous to the a|)plication of these measures, local milk-borne epidemics
of t\phoid h.ad been noted almost annually since the systematic inspection of
t\i)hoid cases had been inaugin'ated in l'H).S.

Typhoid Fever.

Deaths Per 100,000 Population

AviRACE Di-ATii Rates For Stated Decades.

1667-76 I
1877-86 I
1887-96 I
1697-06 I

1907-16

^ 10 7

YEARS

DEATH RATES BY YEARS

50 lOO I50

1667
1666
1869
I670
1671
1672
1873
IS7-4
1 875
1676
1677
1878
1679
I860
1881

—

1 882
1683
1864
1665
1886
IS87
I6S8
1869
1690
169 1
1692
1693
1694
189 5
1896
1697
IS96
1699

I900

I90I
I902

1903
I904

I905

1 906

I907

I908

^^B

I909

^^m

I9IO

^BB

1911

■MB

1 912

1 913

1 914

■M

1915

1916

1917

1 1 <b

1918

1 14

19 13

1 1 2

1920

1921

1.1

1922

1.1

1923

I 1 9

1924

1 IS

1925

1 1 5

362 CHICAGO

In this cniinecticin it is interestinsj' to note that the Annual Reports of
the Health Department, prior to 1''07. record but one local outbreak of
t_\phoid due to milk and that is the one reported by Commissioner Whalen
in 1906. I'rom the history of typhoid as it is now known, it is safe to pre-
sume that such outbreaks occurred frequentlx' but were ntjt recognized,
because they occurred in the midst of a heavy tvphoid incidence due to
polluted water or infected shell-fish, and were not separated from the sum
total of cases that occurred.

On January 26, 1916, an outbreak of typhoid fever occurred in the
district supplied by the Sixty-eighth Street water pumping station. The water
at this station became polluted by sewage getting into the pumping wells
as a result of flooding of the basement of the pumping station during a
general flooding of the territory drained by the South Side intercepting
sewer system. A total of 105 cases developed, of which number eight died.

More and more attention was paid to carriers to avoid contact infection.
Persons afflicted with typhoid were ho-spitalized as far as practicable. Nurses
were detailed to make periodic visits to cases isolated in the home.

The effect of all these efforts was reflected in the lowering of the typhoid
death rate from year to year. In 1917 it dropped to 1.7 per 100,000. This
established a record for Chicago of a typhoid death rate lower than that of
any city in the United States with a population of 100.000 or over. The fol-
lowing year the rate was reduced to 1.4 and again Chicago held the record
of the lowest rate in cities of the 100,000 population class and over.

In 1922 the record was established for Chicago of having had the lowest
typhoid death rate of any city in the country with a population of 500,000
or over for six consecutive years. The rate this year and the preceding
three years was 1.1 per 100,000.

From October 13, 1923, to January 25, 1924, an outbreak of t\phoid
occurred in the territory supplied from the Hyde Park Crib. A total of
288 cases were reported, with 23 deaths.

The waters along the South Shore had been, and at the time of the
outbreak were, found contaminated with sewage from the Calumet River
and the Thirty-ninth Street sewage pumping station, wdiich followed heavy
rainfalls on October 17 and 18.

The State Department of Public Health detailed Chief Sanitary Engi-
neer Harry F. Ferguson to make an investigation. Based upon the results
of his findings, it was concluded that the lake water carried more than
average pollution at the critical period of reversal of flow of the Calumet
River and the outflow of some sewage from the Thirty-ninth Street pump-
ing station, and that the chlorine and analytical control was not adequate
and sufficientl\' responsive to changing conditions in the lake water to
assure<lly provide for a safe water as punipeil into the distribution system.

CHICAGO 363

The State Department thereupon made recommendations for the better sani-
tary control of the public water supply of the city and urged the emplo\-
ment of a sanitary engineer to supervise this work.

On November 30, 1924, another outbreak of typhoid occurred and lasted
until the following January 21. A total of 129 cases with 16 deaths occurred.
The cases were reported mostly in the better residential districts of the city.
A careful study of the cases, made by the health department, and later
reviewed by Dr. L. L. Lumsden of the United States Public Health Service,
showed the infection to be due to shell oxsters shipped from the Great
South Bay region in Long Island, New York.

After these outbreaks, the usual low t_\phoid record was again main-
tained.

Diphtheria.

It was in the suppression of diphtheria, even more than in the control
of typhoid and tuberculosis, that a full understanding of the disease made
it possible to institute an almost perfect system of control. With the dis-
covery by Von Behring of a method of active immunization against this dis-
ease, and the perfection of a method by Schick for determining immunity
against the infection, health officers were supplied with all the weapons
necessary to control diphtheria effectively.

How successfully these measures were used is shown by the course o'f
the death rate from this disease during this period. From 1907 until 1917
the rate remained practically stationary and averaged 33.3 per 100,000
population.

Early in this period it was first required that cases should be terminated
only if these showed two negative cultures, and after 1908, that cultures
from persons in contact with cases should be similarly negative. After
1909 it was also required that such person should receive an immunizing
dose of antitoxin.

Police stations were made distributing depots for culture media and
antitoxin in 1908, and were also designated as receiving stations for cultures
for transmission to the health department laboratory. In order to make
antitoxin generally available in the handling of diphtheria, the State Board
of Health in 1909 established 28 free distributing stations in Chicago.

At the same time the old smallpox hospital was converted into a munici-
pal hospital for the reception and care of diphtheria cases.

In 1917 diphtheria became very prevalent, especially in October and
November. A total of 10,290 cases and 1,216 deaths from the disease
occurred during the year, representing a mortality rate of 47.8 per 100.000
population.

364 CHICAGO

Acli\f imnmnization a.yainst (li]>htlici'ia with toxin-anliloxin mixture
was inaugurated in the |)uhhc schuuls, and in institutions carint; for infants
and children.

Since that time greater efforts were made from year to year to apply
this method of immunization to all susceptible infants and children. In 1921
such immunizations were offered at infant welfare stations in addition to
ihe work carried on in the schools, with the result that within recent years
an average of 40,000 injections of toxin-antitoxin have been given annually.

In immunization with tuxin-antitoxin, an effective weapon has been
found to wipe out this disease liut its apjilication is as yet far I'mm uni-
versal.

The death rate from diphtheria dropped from an average annual rate
of 33.5 per 100,000 population to 7.3 per 100,000 in 1926, the lowest in the
histtiry of the city.

In 1927, diphtheria again became much more prevalent and more fatal.
The death rate rose to 14.1 per 100,000, and the fatality rate among reported
cases was 10.6 per cent, as compared with an average of 7.4 per cent in the
preceding three years.

Scarlet Fcirr.

Scarlet fever remained fairly prevalent after the milk-borne outbreak
in 1907 up to 1913. During that year a death rate of 38.5 per 100,000
population was recorded. ( )nly once since then has mortality from this
disease approached such a rate. That was during 1917, when a total of
13,444 cases were reported with an annual death rate of 24.4 per 100,000
population w'as recorded.

Since that time the disease has not been very prevalent and the death
rate from it has been \'ery low, especially in the years 1923 to 1927, inclu-
si\e, during which the death rate reached the phenomenally low average
figure of 2.8 per 100,(KX) population.

SiiHiHpn.v.

Xo epidemic of smallpox occurred during this period. -\ new sniallixix
hospital was finished in 1908, -with a bed capacity of 40 but only on a few
occasions has the hospital been filled with patients.

The law requiring the compulsory vaccination of school children was
held unconstitutional bv the Illinois supreme court in I'KJS, and following
that the department was able to enf<.)rce vaccination only in the ])resence
of an epidemic.

The ruling of the court was gi\en rather broafl interpretation by the
department until 1922, when in a case against the school Ixiard, which was
appealed to the supreme coin't, the court held against the board.

CHICAGO 365

No deaths occurred from smallpox in the years 1908, 1909, 1915,
1910 and 191').

The highest incidence of smallpox was in 1917 and 1918 when 296
and 266 cases occurred annuallw

Misccllaiicuiis Infectious Diseases.

An extensive milk-borne outbreak of streptococcus sore throat occurred
in December, 1911. and lasted until the following February, An investiga-
tion showed that the milk responsible for the epidemic was improperly pas-
teurized on a number of days. It was estimated that approximately 10,000
cases, due to milk infection, occurred in the cit\' during the two months.

An outbreak of infantile paralysis started on July 14, 1916. six weeks
after an extensive epidemic in New York City. It lasted until November
10, and resulted in a total of 254 cases with 34 deaths from the disease. A
system of train inspection was inaugurated immediately after the disease
occurred in New York. All cases were hospitalized, and children that had
been in contact with cases were kept under observation.

.\nother outbreak of infantile paralysis occurred in 1917, beginning
Jul\- 1 and lasting until December 1 of that year. A total of 527 cases
with 177 deaths were reported during this outbreak.

Moderate outbreaks of infantile paralysis and meningitis occurred in
1927, when a total of 148 cases and 29 deaths from the former, and 193
cases with 92 deaths from the latter disease, were reported.

Tetanus, which had occurred rather extensively after each old-fash-
ioned Fourth-of-July celebration, was greatly eliminated as a cause of death
in the annual bills of mortality by the passage of the "Sane Fourth Ordi-
nance" in 1911, prohibiting the sale of fireworks.

Beginning in March, 1919, cases of encephalitis lethargica began to
occur as is usual after an epidemic of influenza. A total of h9 such cases
with 25 deaths were reported during that year.

Malaria contracted locally disappeared entirely from the mortality
tables during the latter part of this period.

General Measures.

In addition to the s|iecific procedures instituted to control the various
communicable diseases, certain general measures were inaugurated during
this period which are worthy of mention.

The first of these was taken in 1907, when the rules allowing physi-
cians to assume responsibility for cjuarantining cases of contagious dis-
eases were rescinded and the corps of disinfectors were detailed as cjuaran-
tine officers to watch cases isolated in the homes.

366 CHICAGO

At the same time the policy of hospitalizing cases as far as practicable
was adopted. At first, in addition to the old smallpox hospital made avail-
alilc f(ir diphtheria cases, already referred to, the Count_v Hospital and the
Durand Hospital, established in 1909, were used for the hospitalization of
scarlet fever and other contagious cases. Typhoid cases were cared for
in private hospitals or in Cook Count\' Hospital.

On Januar\- 8, l''I7. the new Municipal Contagious Disease Hospital
was opened at California lioulevard and Thirty-first street. The adminis-
tration building and one ward building were completed at that time. Sep-
arate cubicles enclosed with glass, and so arranged that visitors can see
the patients from the visitors' aisle, were provided for all the patients in this
hospital, and proved successful in popularizing the hospitalization of children,
to which parents were so prone to object, especially when they were not
allowed to visit their children while in the hospital.

In 1921 another wing was added to this hospital, which gave a total
bed capacity of 400. One ward, or approximately 60 beds, was set aside
for the isolation of women infected with venereal disease, and the rest of
the hospital was used principally for diphtheria and scarlet fever cases.

In I'H.i a classified system of tjuarantine worked out b_\' Dr. Isaac D.
Rawlings, head of the division of contagious diseases, was adopted for cases
of diphtheria, scarlet fever and whooping cough, which modified the quaran-
tine of the cases with a trained attendant, so as to place fewer restrictions
on the other members of the family. This was kept in effect until 1915,
when the health department rules on quarantine were superseded by those
issued by the State Board of Health. These have been followed ever since
and in a way have served to absolve the health commissioner from making
any changes and concessions in the isolation of cases or maintenance of
quarantine.

In July, 1924, terminal gaseous disinfection was abolished and rules
were promulgated requiring concurrent disinfection during isolation, and
cleansing of the rooms after the termination of a case of communicable
disease.

In August, 1924, the department adopted a series of normals or expect-
ancies for comparison with the number of cases of a given communicable
disease reported each week in order to watch and pre-judge the trend of
the disease. These were adopted after a thorough study by A. W. Hedrick
of the long-time trends, seasonal cycles, epidemic occurrences and irregular
movements of the principal communicable diseases occurring in Chicago.

By this comparison, the ratio of reported cases to the normal or expected
number, termed the epidemic index, is used as the basis of indicating the
trend of any disease during a given period and serves as a standard in fore-
casting epidemics.

367

Venereal Disease Control.

The control of venereal diseases was a new activity, imdertaken by the
health department during this period. The vice commission appointed by
Mayor Busse in 1910 made certain recommendations in regard to it.

Commissioner Evans was a member of this commission and helped to
draft these recommendations, and this doubtless prompted him to start
certain measures of venereal disease control by the health department at
that time.

In the same year advice in regard to the prevention of venereal disease
was first published in the bulletin of the health department and pamphlets
on the subject, published by the Chicago Society of Social Hygiene, were
distributed in the lodging houses. An ordinance was passed requiring dis-
pensaries to report cases of venereal disease.

A few premises were placarded and quarantined in 1910 where cases
were reported in houses of prostitution. Infected prostitutes convicted and
sentenced to the Bridewell were held until cured.

A municipal venereal disease clinic conducted by a volunteer staff was
opened and maintained for about six months at the Iroquois Memorial
Hospital.

In 1911 the segregated vice district was abolished by State's Attorney
John E. Wayman, following which efforts to control venereal disease lagged.
Attempts made by Commissioner Young to have an ordinance passed by
the city coimcil requiring the reporting of venereal disease remained unsuc-
cessful. The laboratory began making Wassermann tests in 1911.

In the meantime nothing further was accomplished until Commissioner
Robertson, on June 29, 1917, had an ordinance passed much more compre-
hensive in its scope than was formerly attempted. This ordinance was
modeled after the South Australian law and required the reporting of cases
without giving the name of the patient, required the patient to remain under
treatment and provided that in cases where the patient failed to continue
the treatment until cured his name and address should be reported to the
health department.

This ordinance served as a basis for man\- of the laws that were
adopted subsequently during the ^^''orld ^^'ar by numerous states and cities
of the country.

A municipal venereal disease clinic was opened at the Iroquois Mem-
orial Hospital in 1918. Prostitutes arrested by the police were examined
for venereal disease, and if found infected, were hospitalized until free
from infection. At first the old smallpox hospital, which had been used for
diphtheria cases and had been vacated upon the opening of the new Con-
tagious Disease Hospital, was used for this purpose and renamed the Lawn-

368 CHICAGO

dale Hospital. This hospital remained in use until 1920, when the patients
were transferred to a ward of the new Contagious Disease Hospital.

A tutal of 7,2.^r< cases of venereal disease were reported durint; the
first _\ear that the ordinance was in effect. Within recent xears this num-
ber reached approximately 25,000 annually, and is interpreted by the health
department as indicating not that venereal disease is on the increase but that
better reporting of cases has been attained.

The control of venereal disease was systematized in 1922 when the
State Department of Public Health promulgated rules and regulations apply-
ing to this work. These were drafted in cooperation with an advisory com-
mittee of the Chicago department of health. At the same time the State
Department adopted standards of infectivity and approved methods of diag-
nosis for the handling of venereal disease cases.

In 1923 the four neighborhood venereal disease clinics were consoli-
dated into a central clinic located at the Iroquois Memorial Hospital. Clinics
for the diagnosis and treatment of venereal diseases were also established
at the Cook County Jail and the House of Correction.

A special edition of the bulletin prepared by Commissioner Bundesen
dealing with prevention of venereal disease was distributed to 500,000 homes
in the city during Decemlier. 1924.

Child Hygiene.

iluch consideration was given to conserving the lives of infants and
children during this period.

One hundred physicians were assigned to the congested districts in
July and August, 1908, to instruct mothers in the care of babies. The
following two summers the work was carried on by a corps of nurses mak-
ing house-to-house visits under the direction of ]")r. Caroline Hedger. The
campaign was conducted in cooperation with the United Charities and
\'isiting Nurse Association.

The Infant Welfare Society was organized in 1910 as a successor to
the Chicago Alilk Commission and opened its first infant welfare station in
December of this year. In May, 1911, a child welfare exhibit and confer-
ence was held at the Coliseum under the auspices of the Infant Welfare
Society, United Charities and Msiting Xurse Association. This helped a
great deal to stimulate interest in infant welfare work.

In 1913 foiu- infant welfare stations were established In the health
department and in the following year a division of child h_\giene was created.

Tlie lack of complete birth records was a great obstacle in carrying on
infant welfare work during the early part of this period. In 1908 the health
department ceased entirely to enforce liirth registration on account of inade-

CHICAGO 369

quate laws and the divided authority between the city and county. Follow-
ing this the county clerk received the small number of birth reports pre-
sented for registration.

Dr. C. St. Clair Drake of the Chicago department of health was ap-
pointed secretary of the State Board of Health in April, 1914, and proceeded
at once to secinx a State registration law for births and deaths. At the fol-
lowing session of the legislature the passage of such a law was secured and
on January 1, 1916, when it went into effect, the health department again
resumed the function of registering births.

Efforts were made at once to enforce this law, with the result that
47,760 births were registered during the year, which constituted appro.xi-
matel}' 85 per cent of the number estimated as occurring in the city.

A hearing board was appointed in July, 1920, to hear the cases of
physicians and midvvives who had failed to report births. Since then much
attention has been given to compelling the reporting of births with the
result that during the last few years over 99 per cent of all births were
reported.

A fund of $50,000 was appropriated l)y the city council in 1922 for addi-
tional infant welfare work. This was used in part for the establishment
and maintenance of 18 infant welfare and five prenatal care stations. In
1923 the total number of stations in the city was increased to 48, of which
number 27 are operated by the Infant Welfare Society.

Conferences for the attention to children of pre-school age were estab-
lished at nine infant welfare stations during 1925. The practice of mailing
a handsome certificate of registration to the parents of all children whose
births were reported was begun in ]\larch, 1924.

.V profusely illustrated baby booklet was prepared and subset|uent to
October, 1925, a copy was delivered by the health department nurses to all
mothers upon the report of a birth. This was followed by circulars of
instruction mailed to the mother every month until the baby reached the
age of one year.

In November, 1925, the department began to enforce vigorously the
provisions of the State registration law requiring births to be reported within
10 days. This was found essential in carrying out the program of breast
feeding, which had been started during the year. An illustrated booklet
on the prenatal care of mothers has been distributed since 1926.

The efforts to prevent infant mortality have proved highly successful.
The rate declined steadily during this period reaching 62.7 in 1926 per 1,000
births reported. The reduction of the diarrheal diseases in children under
two years of age was even more pronounced. The death rate from these
diseases was approximately only 20 per 100.000 population during the last
three years as compared with 119.7 at the Ijeginning of this period.

370 CHICAGO

Since l'H6 the acute respiratory (lise.ises of infants showed a tendency
to increase and since 1921 have caused more deatlis at this age period than
the diarrheal diseases.

School Inspection.

School inspection was also systematized and greatly extended. The lOU
school medical inspectors, left on the payroll after the scarlet fever outbreak
in the early part of 1907 had subsided, were the first adequate force avail-
able by the health department for this purpose. It was soon discovered that
correction of the physical defects found in school children would not be cor-
rected to any great e.xtent, unless a force of nurses were available to follow
up such cases.

Consequently a school nursing service was organized in 1908, under the
supervision of the Visiting Nurse Association, for which this organization
and the city each furnished part of the 100 nurses employed. In I'^IO this
work was taken over by the city health department.

In order to attack the tuberculosis problem as it affected children of
school age, fresh air schools were established. In 1908 the health depart-
ment established an open window room at the Graham School. This experi-
ment proved so successful that it led to the establishment of the Elizabeth
McCorniick Open Air School on the roof of the Mary Crane Nursery. The
board of education was also persuaded to follow the example and established
its first open air school, the .same year at the Harvard School.

The school dental service was inaugurated by the Chicago Dental Society
in 1910 and was taken over by tlie health department three years later. In
1921 the Municipal Tuberculosis Sanitarium established dental clinics at
eight of its dispensaries.

In 1915 the Municipal Tuberculosis Sanitarium provided 50 school
health officers and 50 field nurses for the school inspection and follow-up
work, with the understanding that a certain portion of the time of the entire
force would be devoted to the early diagnosis of tuberculosis and preventive
treatment of school children found suffering from malnutrition and
tuberculosis.

At the beginning of the fall term of school in 1916 a doctor's certificate
of health was required of all children for readmission to school. This was
tried for a few- years, and discontinued because the parents seemed unwilling
to pay private physicians the proper fee for making the necessary exam-
inations.

In September l'^22 the medical inspection of school chilch-en for con-
tagious and parasitic diseases was transferred from the division of child
hygiene to the division of contagious diseases, and combined with the work

CHICAGO 371

of the 150 field health officers. A corps of 10 school health officers was
assigned to make physical examinations, Schick tests and immunize against
diphtheria in the schools.

lieginning with the opening of schools in 1924 the corps of ph) sical
examiners assigned to the schools began making a thorough physical exam-
ination of pupils in the kindergarten and primary grades. The records show
that a total of 101,376 phj-sical defects were corrected during tlie year and
an equally large number in the succeeding years.

Air, W'ater, Milk and Other Foods.

The reductions in mortality accomplished during this period were to a
large extent due to efforts made to conserve the purity of the air, water, milk
and other foods. Of these milk received the first and the most consideration.

Milk.

The condition of the milk supply of Chicago in 1907 may be visualized
by the findings of John M. Trueman of the Illinois Agricultural Experiment
Station. His examination of 325 samples showed 19 per cent below grade
in total solids, and 88 per cent containing a visible dirt sediment. A bac-
teriological examination of 1,271 raw milk samples made by the health de-
;iartment in 1909, showed an average bacterial count of 5,547,502 per cubic
centimeter.

That the milk was bad was further indicated b_\- the high mortahty
among infants from diarrheal diseases, and the frequent outbreaks of infec-
tious diseases traced to the milk supply.

The Hygienic Laboraton,- Bulletin No. 41 on Milk in its Relation to
Public Health was issued by the United States Public Health Service in
1908. In this comprehensive review of the subject, Trask listed 260 out-
breaks of typhoid, scarlet fever, diphtheria, and streptococcus sore throat,
traced to milk infection. The clinical and experimental evidence in regard
to the frequency and dangers of tubercle bacilli of bovine origin in milk
was presented by Mohler and Schroeder, and showed emphatically the
necessity of dealing with this problem. Rosenau presented a review of the
literature, and the results of some personal experiments on the thermal death
point of bacteria, with special reference to the tubercle bacillus. The con-
clusion arrived at from the facts presented was that it was relatively simple
to kill the bacteria in milk by heating it to a temperature short of the boiling
point, or so-called "pasteurization".

Dr. Evans, soon after assuming the office of commissioner of health,
became convinced that radical measures were necessary to improve the milk
supply of the city. That tuberculin testing of the cattle would not solve the

372 rnu'AGo

l)r<)l)lt'in was sult-cviilcnl, and fuillif rninrc tliLTc was tlic Dppn.sition of the
farmers to this procedure to contend with. When tlie State a few years
previously had attempted to test some of the cows in McHenry County, the
fanners drove the veterinarians from the farms with shot guns.

In the meantime a milk commission was appointed by the commissioner
to help solve the problem. Dr. G. Koehler was appointed chief of the bureau
of food inspection in August, 1907. Efforts were made to improve the
conditions b\' concentrating on inspection of milk plants and dairies. The
score card s\stem of grading these establishments was adopted.

i\n ordinance was also passed this year prohibiting the sale of bulk milk
in stores. This helped materially to uphold the butter fat standards for
such milk and eliminated the likelihood of contamination.

A sediment test, showing the amount of dirt in the milk was developed
by the chief of the bureau of food inspection, and extensively employed for
the detection and exclusion of dirty milk.

After a _\ear's study and investigation of the local situation, as well as
of the milk supply and inspection methods of other cities. Commissioner
Evans had an (ordinance passed on July 13, V)()S. recjuiring all milk to be
pasteurized unless obtained from tulierculin tested cows. About 45.000 cows
were tested in the following three years, and the milk supply from the
remaining 75,000 cows had to be pasteiu"ized.

Systematic bacteriological examinations of the milk supply and testing
of pasteurizers were inaugurated in 1909. Rules were promulgated regulat-
ing the pasteurization of milk. These were made the basis of the require-
ments for pasteurized milk embodied in the milk ordinance passed in 1912.

The small milk dealers, numbering about 1,800 at that time, were not
prepared or, as in the case of the majority, unwilling to comply with these
requirements. Consequently there developed considerable opposition to the
ordinance. Numerous unsuccessful efforts were made to get it repealed.
In 1910 a commission was appointed by the legislature upon the instigation
of Speaker Shurtleff from Marengo to investigate the milk question. This
commission, after lengthy hearings, made a report which advised against the
tuberculin testing of cows but did not particularly condemn pasteurization.

In the following year the legislature passed a law prohibiting munici-
palities to require a tuberculin test for dairy cattle.

It was held that this law invalidated the Chicago milk ortlinance, and
after a year's investigation it was decided by Commissioner Young to draft
an ordinance eliminating the tuberculin test requirement and embodying spe-
cific requirements for two grades of milk, namely, pasteurized and inspected.
The task of preparing this ordinance \vas assigned to Dr. Koehler, who after
careful consideration of all the details to be covered, drafted an ordinance
which was presented to the city council and passed August 14, 1912.

This ordinance required all milk to be pasteurized by prescribed meth-
ods, unless produced on approved, inspected farms and as an original feature
contained a requirement for thermostatic control and recording of pasteuri-
zation temperatures. It also required the refrigeration of milk in transit,
established a standard of purity for each grade, including a requirement in
regard to the maximum amount of visible sediment permissible, and pro-
vided that all milk sold to the consumer must be contained in tightly closed
receptacles, properly labelled and dated.

The enforcement of this ordinance at first presented numerous difiicul-
ties. The small milk dealers continued their opposition and sought to re-
strain the cit_\' from enforcing it by an injunction, l:)ut on appeal to the
Supreme Court in 1914 the health department was sustained and the ordi-
nance was upheld.

This occurred none too soon, because in the fall of this }ear a wide-
spread outbreak of foot and mouth disease occurred among cattle. This
epizootic started on October 15 at Niles, Michigan. In November cattle
of the dairy show held in the Union Stock Yards became infected. It also
spread to the dairy district in and around Chicago and during the following
two years recurred in various localities.

Additional safeguards to protect the milk supply were taken during this
outbreak, but the pasteurization of the entire milk supply was not consum-
mated until Commissioner Robertson issued the order on Jul\' 16, 1916,
during an epidemic of infantile paralysis, that all milk and cream sold in the
city unless certified must be pasteurized. This was directlv in line with the
doctrine that Dr. Robertson practiced and preached during his term as com-
missioner of health of the city for seven years, namely that the purity of
the milk, water, and air must be insisted upon without fear or favor. This
policy carried on in earnest meant difficulty for the non-progressive milk
dealers and the consequence was that many had to go out of business. During
his term of office their number was reduced from 1,260 to 545 and pasteuri-
zation was universally adopted by those remaining in business.

The chemical sterilization of milk bottles was permitted by the depart-
ment in 1922, after an inquiry into this method had been made by a commit-
tee of experts.

Beginning in Alarch 1924 all restaurants were required to furnish milk
in bottles or from approved urns. Following this the percent of low grade
samples collected from restaurants dropped to 5.9 during the \ear, as com-
pared with 24.8 percent in the previous year. The hand capping of milk
bottles was also prohibited at that time.

A rule requiring that the ice cream "mix" must be pasteurized before
being frozen was promulgated in 1925. This was followed by a great im-
provement of the ice cream sold in the city, as shown by the liacterial con-
tent of the samples examined.

374 CHICAGO

That the cainpaij;!! to inijirnvc the pastcuri/.aticju of the milk supply was
Miccessful is shown by the haderiological examiiiatinn of milk samples col-
lected during recent years.

Only 33.6 per cent of the pasteurized milk samples examined in 1925
showed bacterial counts above the legal number. The 4,360 samples of
pasteurized milk collected during the year showed an average count of
194,000 bacteria per cubic centimeter. The significance of this is most
striking when these counts are compared with the count of 2,350 samples
of raw milk examined in 1910, which showed an average count of 11,574,000
per cubic centimeter. In 1910 only SO per cent of the entire milk supply
was pasteurized. The raw milk was largely sold in the poorer sections of
the city.

The legislature in 1''25 enacted a comprehensive law, providing for the
tuberculin testing of cattle, the establishment of accredited herds and the
enrollment of counties under the accredited plan. An appropriation of two
million dollars was also made by the State for the eradication of bovine
tuberculosis.

Other states, notably Wisconsin, had made great progress in the eradi-
cation of bovine tuberculosis. In Illinois not much had been accomplished
in the dairy district in the northern section of the State from which Chicago
received its milk supply, although certain breeders and cattle raisers' associ-
ations were strongly advocating the eradication of bovine tuberculosis in the
State.

The tuberculin testing of cattle was given a great impetus in the latter
part of 1925 when Commissioner Bundesen announced that after April 1,
1926 all milk and cream sold in Chicago must be derived from herds free
from disease and under federal and State supervision. On December 23,
1925 the city council passed an amendment to the milk ordinance embodying
such a requirement.

This order met with much opposition from the dair^inen with untested
herds who tried to stop its enforcement In' a temporary injunction obtained
in the circuit court of Kane County but which was later dismissed. On
April 1, 1926, when the order went into effect and was strictly enforced by
the department, the milk supply from a large number of farms m northern
Illinois was excluded from the Chicago market and the city reached out
into new territory and especially into Wisconsin for milk from accredited
farms, the supply of which was found ample to meet all needs and which
could readily be brought into the city with refrigerated t.ank cars that had
come extensivel}' into use within recent times.

In order to insure the safety of the milk suppl\- and especially of that
derived from the territory which had not licen subject to periodic dair\'
inspection by the department, as had been done in the old dairy district for

CHICAGO 375

over 20 years, special attention was given to the efficiencs' of pasteurization.
A sanitary engineer was put in charge of milk and dairy inspection, who at
once undertook a survey of pasteurizing plants, with a view to eliminating
the by-passing or imperfect pasteurization of the whole or part of the milk,
as had been found in the experiments made at Endicott, New York, and
reported in Public Health Bulletin No. 147.

The conditions found such as leaky valves, dead ends in pipes, forma-
tion of foam, spashing and short circuiting, were largely corrected by the
end of the year and the equality of the milk as shown by the bacterial count
was improved.

iratcr.

The qucbtiun of the purity and safet}- of the water supply was also taken
up systematically during this period. By 1909 it was found after investiga-
tion of the reported cases of typhoid fever that aside from infected milk
there remained a large percentage of cases apparently due to other causes.
At the request of Commissioner Evans, Dr. L. L. Lumsden of the United
States Public Health Service, in 1909 made an intensive study of the typhoid
situation in Chicago and found that aside from carrier and contact infec-
tion the water supply was responsible for a large per cent of the cases. This
directed attention, first of all. to lake dumping, which was carried on rather
extensively at that time.

In 1910 a federal law was passed prohibiting the dumping of refuse in
the lake within eight miles of the shore. In 1912 the city council passed an
ordinance prohibiting such dumping within four miles of any water intake.

In the following year an ordinance was passed pi-ohibiting the discharge
of any refuse or sewage from boats within four miles of any water intake.

Finally in 1914 an ordinance was passed prohibiting dumping in the
lake within 10 miles of the corporate limits of the cit)- which meant 13 miles
from shore.

The enforcement of these provisions unfortunately did not eliminate the
"water typhoid." The Calumet River remained as a source of infection, as
was shown by the preponderance of typhoid from year to year in the south-
ern section of the city. In addition there occurred periodic reversals of the
Chicago River and much shore pollution, beside the wash-off from dump
scows or the (luni[:iing in violation of the ordinances, as constant sources of
water pollution.

In the meantime, work had hc-en dune by C. -\. Jennings in 1908, that
later served as a temporary remed_\- for these ills. Jennings, in attempting
to purify and render potable the effluent from an experimental sewage treat-
ment station, used for the treatment of Bubbl}- Creek sewage, had found
that the application of a solution of calcium li\ pochlorite (chloride of lime)

376 CHICAGO

was most efficient in sterilizing the effluent, and at the same time was entii"el_v
harmless. Subsec|uently, this i)rocedurc was applied to water supplies by
sanitary engineers.

On March 15. VJlZ Commissioner Young applied this treatment to a
portion of the Chicago water supply, mainly in an experimental way at the
E. F. Dunne water intake. On July 16 in the same year, this treatment was
extended to the Hyde Park Crib, on August 15, 1913 to the Lake View Crib
supply and used when the wind was offshore. The treatments were dis-
continued during the winter months on account of the sohui(jns freezing in
the temporar\- installations.

On September 16, 1916 the use of licpiid chlorine was started at the
Chicago Avenue pumping station, and next at the 22nd Street pumping sta-
tion on December 15 during the same year. Dr. Herman N. Bundesen was
assigned to supervise the application of chlorine at these stations and kept a
close watch over the effects of the treatment on the incidence of typhoid in
the districts supplied b\' the treated water. The results obtained were so
striking that they led Commissioner Robertson to recommend that liquid
chlorine be applied to the entire water supply of the city. This was accom-
plished on October 6, 1916, with the completion of the installation at the
Springfield Avenue station.

This chlorination of the entire water supply was an important factor in
reducing the typhoid death rate in Chicago to the low minimums that have
been recorded annually since 1916. Only one outbreak of typhoid due to
infected city water occurred since October 6. lOld, and that was the one
that developed in the winter of 1923-24 in the territory supplied from the
Hyde Park Crib, already referred to.

Following this additional precautions were taken. In January l')24 a
sanitary engineer was placed in charge of the application of chlorine and the
control of the safety of the water supply. Since then hourly tests were made
for residual chlorine in samples taken from the discharge mains at each
pumping station and the total amount of chlorine applied was practically
doubled. A total of 23,000 samples of water were examined in 1924; only
0.3 per cent of 9,638 samples of chlorinated water examined showed colon
bacilli in 10 cubic centimeters and none showed them in 1.0 of 0.1 cubic
centimeter portions.

In 1921 the supervision of lake dumping and dredging was placed under
the jurisdiction of the department of health, and thus the approval of the
department was required for all such undertakings.

The constantly increasing magnitude of lake shore improvements which
have been going on during recent years has demanded a continual vigilance
on the part of the health department to prevent gross pollution of the water

CHICAGO 377

In Fehruary, 1924 the policy was adopted by Commissioner Bundesen
of having all dredged material deposited behind tight bulkheads. During
this year a total of 3,479.700 cubic yards of lake bottom material and
1,273,800 of dredged and excavated materia! were deposited behind bulk-
heads in connection with the lake shore improvement projects.

A sanitary survey of Lake Michigan was begun in July, 1924, in con-
junction with the United States Public Health Service and the Sanitary
District. Thirty-six modern water chlorinators were purchased this year at
a cost of $250,000 and their installations at the pumping stations were com-
pleted in 1925.

This same year a survey was started to tind and break all cross connec-
tions between the city and other water supplies, which resulted in the finding
and abolishing of approximately 500 such connections.

In Februar}-, 1926 the supervision over the application of chlorine and
the control of the safety of the water supply system was transferred to the
departments of public works.

The excessive quantities of chlorine required whenever the water was
badly polluted has, during the last three years, given rise to much complaint
about the bad taste of the water. This was especially notable when the pollu-
tion consisted of industrial wastes, containing phenol and other soluble coke-
oven products. To abate this condition Mayor William Hale Thompson, on
January 3, 1928, upon the recommendation of Health Commissioner Arnold
H. Kegel, appointed a commission consisting of five city officials with the
health commissioner as chairman, to take steps to prevent the pollution of
the lake with such industrial wastes. The matter was taken up at once with
the officials of the Indiana cities and the industrial plants concerned and it
was agreed that all would work together to correct the condition as soon as
possible.

Air.

Inasmuch as serious efforts were made during this period to reduce the
prevalence of tuberculosis and the acute respiratory diseases it was natural
that much attention should be given to the purity of the air.

A comprehensive smoke abatement ordinance was passed in 1907 and its
enforcement was placed under the newly created department of smoke inspec-
tion with Paul Bird, a competent combustion engineer, in charge.

In the same year an ordinance was passed providing for the ventilation
and heating of street cars.

Conynissioner Evans in 1910 appointed a commission on ventilation
which made an intensive investigation of the ventilation of school buildings
and assisted in drafting a ventilation ordinance embodying for the first time
definite standards of ventilation for public buildings, conveyances, factories.

378 CHICAGO

and workshops. This ordinance was passed by the city council this same
year and has been a big factor in bringing about better ventilation. Its
application to theatres and similar places of assembly was especially timely,
in that it was applied to the construction of the numerous moving picture
theatres, which began to be built at that time, and which have since become
such a big factor in the cit\ 's amusements.

In 1912 a ventilation division was created in the bureau of sanitation
fur the enforcement of the ventilation ordinances. Dr. \'. li. Hill was
appointed as head of this division. The division proceeded to make an
exhaustive .study of street car ventilation on the basis of which a new ordi-
nance was formulated and enacted, following which its enforcement was
gradually accomplished. By 1917 all street and elevated railroad cars were
equipped with proper ventilation and thus another source of danger from
bad ventilation was largely eliminated.

Continued progress was made in the installation of ventilation equip-
ment in existing theatres and places of assembly. A survey- in 1915 showed
that nearly all were thus equipped. When the wave of acute respiratory
diseases and influenza struck the city in 1917. 1918 and 1919 the places of
public assembly were found well ventilated, and this condition doubtless
helped to save many lives.

In October, l'M9, smoke inspection was again transferred to the health
department, following which a railroad smoke abatement board was appointed
b\- the commissioner with the object of obtaining the cooperation of the rail-
roads in abating the smoke nuisance.

The smoke inspection was carried on by the health department until
July. 1927, when it was transferred to the department of boiler inspection.

Foods.

The inspection of foods was directed into channels tending to conserve
the public health. Early in 1907, an agreement was made with the State
Food Commission whereby the cit\- was to direct its efforts to food inspec-
tion as related to liealth and the State to control measures relating to
fair trade.

After the L'nited States Bureau of .\ninial Industry had assumed con-
trol of meat inspection, in accordance with the iirovisions of the Federal
Meat Inspection law of 1906, the city passed an ortlinance requiring all meat
sold in the city to be inspected and passed b\' some governmental authority.

The city's power to seize and condemn foods was cjuestioned by the
operators of cold storage warehouses and the case was taken to the United
States Supreme Coint. In 1907 this court rendered a decision completely
upholding the city in its contention. This established the city's power to

CHICAGO 379

control food supplies veiy decisively, and it was not again questioned there-
after until 1911.

The health department had in the previous year attempted to prohibit
the sale of ice cream containing an excessive number of bacteria. Because
the State standard did not contain any reference to the number of bacteria
permissible the city's right was questioned, but the State supreme court in
passing upon the case in 1911 ruled that the city's food regulations may
be more stringent than those of the State, provided that they are not other-
wise in conflict therewith. This established another principle which tended
to aid the health department in its efforts to prevent the sale of unwhole-
some food.

The only food establishments or purveyors of foods that were subject to
control by licensing at the beginning of this period, were slaughter houses,
milk dealers, ice dealers, restaurants, butcher shops, fishmongers and poul-
terers. This list has been gradually extended until now all classes of food
establishments or purveyors of food or food products are subject to licensing
and regulation.

In 1910 the manufacturers of carbonated beverages were added to this
list. Following this a survey of the industry showed that quite a per cent
of samples of carbonated beverages examined contained lead derived from
lead stoppers or from piping in the plants. The correction of this condition
was required immediately.

All other meat food products establishments were required to be licensed
and were subjected to control b_\- an ordinance passed in 1914. By an ordi-
nance passed in 1919 all groceries, delicatessen stores, butcher shops and
meat food products establishments were reclassified for licensing purposes
into two classes of food establishments, namely, wholesale and retail, and
uniform sanitary requirements were adopted for the same.

A comprehensive and definite food covering ordinance was passed in
1915 after repeated unsuccessful efforts had been made to secure this desir-
able legislation.

Egg breaking establishments, which had been the source of consideralile
complaint, were in 1917 brought under State control by an act requiring
the licensing of this class of establishments.

The cold storage warehouse problem was finally settled in ihe same way
when the State in 1917 assumed control of this industry.

Retail beverage dealers were required to be licensed by an ordinance
passed in December 1920.

The proper disinfection with heat or chemicals was required of utensils
in public eating places by an order issued in November, 1926.

3<S0

H0U.S1X(; AND Gl-'.NiCRAI. SANITATION'.

I'lxiii the appointment of Charles B. I'.all as chief of the bureau of
sanitation in 1907 the work of this bureau was to a large extent directed
toward improving housing ccjnditions and to securing better light and air in
places of employment.

In this connection the underground bakeries, of which there were 581
in the cil\ in 1907, rccei\ed first attention. An ordinance requiring their
abolishment and maintenance of so-called "daylight bakeries" was passed
in 1907. Its enforcement met with bitter opposition, but after eight years
of concerted effort practically all of the underground bakeries were moved
into approved quarters.

.V policy of strict enforcement of the provisions relating to light and
air in the new building and tenement house code was adopted and carried
out against considerable opposition on the part of speculative builders for a
period of approximately ten years, after which time they were more or less
educated to the new requirements.

In VJll a revised and comprehensive building code was passed. Ad-
vanced housing and ventilation standards were embodied in this code upon
the solicitation of the department of health.

Early in 1907 the drastic requirements in regard to the disposal of night
soil were revised so as to allow its deposit properly diluted with water in
the cit\' sewers.

Common drinking cups were abolished by an ordinance passed in 1911.
The same year common roller towels were also prohibited.

.Screening against flies in tenement houses and the screening of stables
were required by ordinances enacted in 1917.

Adequate heat in dwelling apartments and places of employment was
required by an ordinance passed June 10, 1922. Since then the department
has devoted considerable time each winter to the enforcement of this
provision.

A comprehensive ordinance licensing and regulating laundries was
passed in 1920. This prohibited the establishment of laundries in tenement
houses and sleeping in laundries.

r)n June 28, 1921, an act was passed by the legislature authorizing cities
to adopt a comprehensive zoning plan, following which Mayor William Hale
Thompson on July 22 appointed a commission to study the problem and
prepare a zoning ordinance for the city of Chicago. A comprehensive zon-
ing ordinance was drafted and was adopted b\- the city council on April
5, 1923

Building operations in the city dropped off considerably during the
war but were actively resinned in 1021 when 10,309 building permits were
issued. This ;ictivit\- has continued and reached a climax in 1''25 and 1926.

CHICAGO 381

In the summer of 1923 the department began the inspection and sanitary
supervision of summer outing camps for children.

The various general sanitary activities of the department were reorgan-
ized and placed in a bureau of sanitary engineering which was established
in January, 1923.

After this the policy was adopted of giving more attention to matters
of public health significance in carrying out the sanitary inspection and food
stores inspection work of the department. All public toilets were subjected
to periodic inspection since 1924.

Sanitary Engineering.
Water Siipl^ly.

The extensions of the water works system during this period were
made for the purpose of keeping up with the rapid growth in population. A
new intake, known as the E. F. Dunne Crib, was completed in 1912, oppo-
site the Hyde Park Crib. The Southwest Land and Lake tunnel supplying
the Roseland pumping station was completed in 1911. By these works the
far southwest side was for the first time adequately supplied with water.

A large intake, known as the Wilson Avenue Crib, on account of its
location four miles out in the lake opposite Wilson Avenue, was completed
in 1918 with a tunnel to the Mayfair pumping station in the northwestern
section of the city. Following this the use of the Lake View intake was
abolished and the Montrose .\venue pumping station supplied from the
new crib.

In August, 1927, the W'illiam Hale Thompson pumping station on
Western Avenue and 57th Street was opened. This is supplied by the Hyde
Park and the E. F. Dunne intakes and serves to supply a section of the near
southwest side of the city, which was badly in need of additional water.

Since the two w-ater-borne typhoid epidemics in 1916 and 1923 sur-
veys have been made of all the old tunnel s\stems and changes made to pre-
vent the contamination of the water enroute to the pumping stations.

Garbage.

In 1913, when the cit}' refused to renew the contract with the Chicago
Reduction Company, the health department was once more charged with the
disposal of the city's garbage. Pending the rehabilitation of the old reduction
plant which the city purchased a temporary garbage disposal station was
maintained at Grace Street and the Chicago River until August, 1914, when
the municipal plant was completed.

A waste commission was appointed by the city which employed Engi-
neers J. T. Featherstone and J. S. Osbom to make a technical sun^ey and
recommendations for handling and disposing of the city's wastes.

382 CHICAGO

I'roni January 15, 1''14, the health dupartnient npcratcd the reduction
plant located at 39th and Iron streets, after which time it was transferred
to the department of public works.

A garbage incinerator with a daily capacity of 30 tons was completed
on the House of Correction grounds in 1915.

Comfort Stations.

Two i)uhlic comfort stations were opened by the health department in
1916, another in 191'), and since 1925 the West Park Board has established
a number in convenient locations in the park and boulevard system under
its control.

Publicity and Education.

Publicity and education of the public in matters relating to health and
sanitation were relied upon extensively to accomplish the prevention of sick-
ness and deaths that was attained in the last two decades.

Three of the commissioners who held office during this period were
masters in the art of publicity and the other. Commissioner Young, carried
on the educational work of the department in a reserved yet persistent man-
ner, so that substantial results were deri\ed therefrom.

Under Commissioner Evans the publicity work of the department was
greatly extended, especially along the lines of infant mortality and respira-
tory disease prevention. Much attention was given to pure milk and fresh
air. A weekly foreign language and neighborhood press service was estab-
lished. A lecture bureau was established and some lecturers were made
available to give talks in foreign languages.

In 1907 the health department bulletin was issued as the "Bulletin of
the Chicago School of Sanitary Instruction," which had been organized in
the department. This made it possible to enter the bulletin as second class
matter and to greatly extend its circulation.

E. R. Pritchard succeeded Dr. C. St. Clair Drake as editor of the bulle-
tin in April, 1914, and continued as editor until 1924.

The use of mo\ing [)ictures was first introduced for health educational
work in 1910.

Little ]Mothers' Clubs, for the practical education of girl pupils in the
care of babies, were first organized in the public schools in 1912.

Commissioner Robertson during his term of olfice relied largely on
the newspapers to transmit a health story, knowing that in that way millions
could be reached instead of thousands by a pamphlet or bulletin.

By giving wide newspaper publicity to such health demonstrations as
the diet squad, which was conducted in 1916, for the twofold purpose of

383

showing how to reduce in weight and also how to live on a daily bill of fare
costing not over 30 cents, millions were reached where a pamphlet or report
on the experiment could have reached only thousands.

He conceived the idea of holding a large health show and succeeded in
holding such a show at the Coliseum in November, 1920. which was attended
by thousands of people. In the succeeding two years this health show was
merged with the Pageant of Progress held on the Municipal Pier.

He also established a school of home nursing in August, 1919, which
was largely an educational feature. An eight weeks' course was given on
the home care of the sick and hygiene to approximately 10,000 women dur-
ing the first two years of its existence.

Beginning with the issues in August, 1923, a change was made by Com-
missioner Bundesen in the bulletin published by the department. The num-
bers were made more attractive by the use of cartoons and neat illustrations.
Larger type was used and only one subject was treated in each issue. Posi-
tive health has been stressed. The circulation of the bulletin was also greatly
increased. A number of special editions of the bulletin have been issued
and widely distributed. In addition to the one on venereal disease preven-
tion already referred to, one was issued on diphtheria prevention in Decem-
ber, 1923. in an edition of 400,000 copies.

Another special number was issued in April, 1924, featuring milk, and
sent to every home in the city. At the end of the school term in 1924 a
special bulletin relating to physical defects was distributed to 500,000 school
children. In June. 1925, one featuring ice cream was distributed to every
household in the city.

A series of very complete annual reports were issued by the department
during this period. Beginning with the octennial report for the years 1911-18,
which is in fact a 1,540-page handbook, the reports have been compiled and
edited by Dr. G. Koehler, who following the death
of Dr. Frank W. Reilly on December 16, 1909,
was appointed assistant commissioner of health
February 25, 1910.

Functions and Appropriations.

In the 20 years since 1907, the department
of health showed a tremendous growth and was
almost completely transformed. From a depart-
ment occupying d few rooms on the first floor
of the old city hall it had developed into one of
the major branches of the city government oc-

G. Koehler, M. D. cun\ing nearlv the entire seventh floor of the

Assistant Commissioner of i . ^

Health. 1910 to date new city hail.

384 CHICAGO

Thf total appropriations for tlic department increased from $848,966 in
lyU7 to $1,560,157 in 1922, and reached the grand total of $2,291,240 in
1927. The expenditure for health department activities in 1907 was 22.6
cents per capita, from which time tliey have gradually increased and in
1926 amounted to $1.22 per capita, including the expense of maintaining
the Municipal Tuberculosis Sanitarium. The number of emploxes has
also increased annually, reaching 976 in the 1927 Inidget, as compared
with 403 at the lieginning of this period in 1907.

The work of the department has been s\stematized and routine pro-
cedures have been adopted for all the major activities. Following the
administration of Commissioner Evans, during which the work of the
department was greatly expanded and inspection and other services were
rendered more efficient by the introduction of report forms and office pro-
cedures for the keeping of records, the time arrived under Commissioner
Young when it was advisable to outline definitely all of these methods of
procedure in department and bureau orders. Such orders were issued dur-
ing a period of three years. In 1914 and 1915 they were codified and
issued as department and bureau handbooks of rules and regulations.

A control system of handling and filing correspondence was estab-
lished during this period.

In the meantime a comprehensive efficiency survey of the department
was made. The findings of this and other studies of department pro-
cedure served as a basis for Dr. Koehler, the assistant commissioner of
health, to make the following recommendations in 1014 for the improve-
ment of the service :

1. The establishment of a central stenographic division.

2. The liolding of hearings by a board preliminary to starting suits, for

violation of sanitary regulations.

3. The re-arrangement of the department office space and the establish-

ment of a central stock room.

4. The establishment of a statistical division to handle the statistical

work of the entire department, and the use of machines for compil-
ing all statistics.

5. The unification of the insi>ection service so as to combine the food.

sanitary and quarantine inspection work, to be handled by one in-
spector in a district.

The first two recommendations were made effective by Commissioner
Robertson and the others by Commissioner Bundesen, during their respec-
tive terms of office.

Their adoption and further perfection has helped materiall_\- to improve
the admitiistration of the department and served to make it function more
efficienth".

CHICAGO 385

Numerous changes in the organization and personnel occurred during
this period, especially in the last five years.

The bureau of food inspection was split off from the laboratories in
1908, and handled all food inspection until 1926, when it was divided into
the bureau of dairy products and the bureau of food inspection.

The Iroquois Memorial Hospital, donated to the city by the Irocjuois
Memorial Association, was opened as an emergency hospital and first aid
station in 1910. The bureau of ambulance service was transferred to the
health department in 1907 and transferred back to the police department
in 1910.

A bureau of hospitals was established in the health department in
1912 which lasted until 1922, when it was abolished.

The Municipal Lodging House, which the health department had oper-
ated since 1908, was transferred to the department of public welfare
in 1917.

From 1913 to 1918. the department of health was charged with the
disposal of the city's wastes and the building and operation of the garbage
reduction plant.

The operation of the public bath houses and comfort stations was
transferred to the bureau of small parks of the department of public works.
An advisory staff of 100 members was appointed in 1922.

In January, 1921, a bureau of water safety and typhoid control was
established, the functions of which were transferred to the division of
sanitary engineering and bureau of medical inspection in 1924. The water
safety control and direction of the chlorine applications was exercised by
the division of sanitary engineering until January 1, 1926, when this
activity was transferred to the bureau of engineering of the department
of public works. The bureati of medical inspection was divided into the
bureaus of communicable diseases and child welfare in January, 1923.

In May, 1924, the health department was divided for administrative
purposes into medical and technical sections, with an assistant commis-
sioner in charge of each section. In 1927 an assistant commissioner and
executive officer was appointed and the secretaryship was abolished.

A bureau of inspection was organized in July, 1924, under the juris-
diction of which were consolidated all the quarantine and non-technical
inspection work of the department. In 1925 the bureau of sanitation was
reorganized as a bureau of sanitar)- engineering.

In October, 1919, the health department was again charged with the
smoke inspection and handled this work until 1927, when it was merged
with the department of boiler inspection. The same year an ordinance was
passed transferring the inspection of plumbing and ventilation installation
in new buildings to the department of buildings.

386 CHICAGO

'IIk- IlliiKiis suprcnu- cmirt. in tlie case of People ex rel. Jennie lUv-
morc vs. Jolui Dill Robertson, et al, rendered a decision in 1922 which had
a far-reaching effect on the department of hcahh. Although the case was
taken up primarily on the right of the commissioner of health to quaran-
tine carriers of typhoid, the question of the legal powers of the commis-
sioner was raised and the cnurt held that the cities and villages act, under
which the department nf lu-alih was organized, provided for a board of
health and that therefore the commissioner of health had no power to
make rules and regulations.

In the crisis which resulted when the commissioner issued the order
in 1925 that all milk must be derived after April 1, 1926, from healthy
cows under governmental supervision, an ordinance was passed January
13, 1926, providing for the appointment of a board of health consisting of
five members. Mayor Dever appointed five members of his cabinet as
members of the board.

In ilay, 1926, the legality of the health commissioner's appointment on
the board nf directors of the Municipal Tuberculosis Sanitarium was ques-
tioned and F. X. Rusch. corporation counsel, and member of the board of
health, was appointed to take the place of the health commissioner on the
board of directors of the sanitarium, because it was held that the health
commissioner was ineligible to the appointment because he was not a mem-
ber of the board of health.

( )n November 30, 1927 Dr. Arnold H. Kegel was appointed commis-
sioner of health and on January 3, 1928. he was appointed a member of the
board of health and also a member of the board of directors of the Munici-
pal Tuberculosis Sanitarium.

Rmduction of Death Rate.

A review of the mortality records for the city shows that the syste-
matic repressive measures against the various preventable diseases, during
this period resulted in the lowering of the death rates from all the diseases
towards which they w-ere especially directed.

Principally on account of the control and prevention of the communi-
cable and diarrheal diseases that was accomplished during this epoch, as
chronicled in this article, the death rate from all causes was lowered 24
per cent, or 3.5 per 1000 population.

During 1''06 and the three following years the average annual death
rate from all causes was 14.8 per 1000 population. This was gradually
reduced, e.xcept during the influenza years, to an annual average of 11.4
for the seven years ending in 1925. This represents a saving of approxi-
mately 10,500 lives in each of these years over the number that would
have occurred if the death rate prevailing at the beginning of this period
had continued.

CHICAGO 387

The records also show that heart disease and cancer for the preven-
tion of which no special efforts were made showed a marked increase as
a cause of death. For example, the annual death rate from heart disease
in 1906 was 109.8 per 100,000 population, from which it steadily rose, reach-
ing 210.6 in 1925. Similarly the cancer death rate climbed from 66.5 in
1906 to 107.5 in 1925. In other words, the annual number of deaths from
these two diseases nearly doubled in the twent}' years.

Inasmuch as heart disease and cancer are a frequent cause of death
this increase in the rates alone represented 3,250 more deaths in 1925
over the number that would have occurred if the death rates from these
two diseases had remained as low as it was in 1906.

This increase and others such as apoplexy, nephritis and violence have
counteracted the lowering of the total death rate, brought about by the
prevention of the communicable and diarrheal diseases, and must there-
fore be taken into consideration in estimating tlie total saving of lives
accomplished in this period. If this is done then it is found that the
actual saving of lives within recent years amounts to nearly 14,000 annually,
as a result of the systematic application of disease preventive measures
instituted and carried on during the last two decades.

Water Supply.

The original water supply was installed in 1840 and was taken over
by the city in 1854. The supply was obtained from Lake Michigan and
pumped to the mains without treatment.

As the demand increased pumps and intakes were added and the mains
were extended.

Before the direction of flow of Chicago River was changed, in 1900,
the lake not only supplied water for Chicago, but received all of its sewage.

During 1893-94 everyone was advised to boil the water and the result
was a reduction in typhoid fever.

Exten.sive examinations of the city's water supply were inaugurated
in the city laboratory in 1894. The following year dail\- examinations
were started and the results were published with a warning to boil the
water whenever it was especially bad.

In the past, many outbreaks of typhoid fever have been traced to the
cit\ water supply, the most recent of which was in the winter of 1922-23.

Chlorine has been in use as a sterilizing agent since 1912, and since
that time there has been a marked reduction in typhoid.

Investigations and experiments are now being made on the possiliility
of filtering the lake water.

Table 1.
Mortality Statistics — City of Chicago 1850 — 1926

YEAR

■S

.b.

■<

1850

29,963

1,467

48.9

1831

34,000

927

27.2

29.4

6.0

1852

38, 734

1,809

46.7

123.7

23!3

40.5

1853

59, 130

1,325

22.4

59.2

32.1

52.5

1854

65, 872

4,217

64.0

130.5

18.2

70.0

1855

80, 023

2,181

27.3

53.7

37.5

11.2

1856

84, 113

2,086

24.8

78.5

19.0

1857

87, 600

2,414

27.6

93.6

11.4

44.5

1858

90, 000

2, •.!55

25.1

54.4

5.5

24.4

1859

93. 000

2.008

21.6

44.0

10.8

1860

109, 200

2, 204

20.7

42.2

2^7

13.7

1861

120, 000

2.279

19.0

61.6

4.1

21.7

1802

138, 180

2. 835

20.5

62.0

3.6

27.7

1863

150, 000

3.875

25.8

149

99.3

115

76.6

18.7

1864

169, :).o3

4.448

26.3

192

113.3

283

167.4

135

79.9

1865

178, 492

4.029

22 . 6

190

100.7

32.0

11.2

1866

200,418

0. 524

32.6

203

102.5

4.4

160

83.0

1867

225,000

4,773

21.2

165

73.3

123

54.7

39.1

1868

252, 054

5,984

23.7

200

79.3

140

57.9

107

42.5

1869

280, 000

6,488

23.2

183

65.3

6.1

109

38.9

1870

306, 005

7, 323

23.9

268

87.4

4.9

31.0

1871

334,270

6, 976

20.9

204

61.0

21.8

1.56

46.7

1872

367, 396

10,156

27.6

524

142.6

055

178.3

10.1

1873

380,000

9.657

25.2

272

71.0

517

136.1

105

27.6

1874

395,408

8. 025

20.3

211

53.4

22.8

3.8

1875

400, 500

7.899

19.7

207

51.7

2.5

117

29.2

1876

407,061

8, 573

21.0

168

41.2

7.1

3.7

1877

430,000

8, 026

18.7

159

37.0

10.0

13.7

1878

436.731

7, 422

17.0

146

33.4

4.8

8.2

1879

491,516

8.614

17.5

208

42 . 3

10.4

1880

503, 185

10,402

20.8

171

34.0

8.5

129

25.6

1881

540, 000

14,101

26.1

568

105.2

1180

218.5

110

20.4

1882

560. 693

13,234

23.6

402

82.4

1292

230.2

244

43.5

1S83

580, 000

11,555

19.9

301

62.2

7.9

7.6

1884

629, 885

12,471

19.8

354

56.2

319

50.6

1885

605, 000

12,474

18.8

496

74.6

1.2

11.4

1S80

703,715

13, 699

19.5

483

08.0

126

17.9

1887

760, 000

15. 409

20.3

382

50.3

341

44.9

1888

802, 051

15. 772

19.7

375

46.7

151

18.8

1889

935, 000

16.946

18.1

453

48.4

204

21.8

1890

1, 099. 850

21.869

19.9

1008

91.6

6.1

1891

1, 148, 795

27. 754

24.2

1997

173.8

'■'■

265

23.1

1892

1, 199,730

26.219

21.9

1489

124.1

':2

185

15.4

1893

1, 253, 022

27.083

21.6

670

53.5

1.8

234

18.7

1894

1,308.082

23,892

IS. 3

491

37.5

1033

78.9

182

13.9

1895

1.306,813

24, 219

17.7

518

37.9

160

11.5

156

11.4

1896

1, 427, 527

23, 257

10.3

751

52 . 6

5.1

1897

1.490.937

21, 809

14.0

437

29.3

139

9.3

1898

1, 557. 164

22,793

14.0

636

48.0

3.0

1899

1.020.333

25, 503

15.7

442

27.2

.'i

168

10.3

1900

1. 698. 575

24,941

14.7

337

19.8

194

11.4

1901

1.751,968

24,406

13.9

509

29.x

158

9.0

1902

1,801,255

20, 455

14.7

801

44.0

123

6.8

1903

1, 850. 542

28. 914

15.6

588

31.8

2.5

276

14.9

1904

1,899,829

20.311

13.9

373

19.0

1.5

2.5

1905

1,949,116

27. 212

14.0

329

16.9

3.1

231

11.9

1906

1,998,403

29. 048

14.5

370

18.5

128

6.4

1907

2,047,090

32,198

15.7

372

18.2

' '. 05

262

12.8

1908

2,096,977

30, S88

14.5

3S2

15.8

169

8.1

1909

2,140,264

31,296

14.6

271

12.6

165

7.7

1910

2, 196,238

33. 241

15.1

300

13.7

'.'6 5

191

8.7

1911

2,249,303

32. 571

14.5

241

10.7

129

5.7

1912

2,301,946

34.034

14.8

175

7.6

128

5.6

1913

2, 354, 529

35. 298

15.0

249

10.0

.04

292

12.5

1914

2.410.800

S3, 952

13.9

107

0.9

.04

3.1

1915

2,464. 189

34, 894

14.2

132

...

240

9.8

1916

2.517,172

30.304

14.4

128

...

131

5.2

1917

2, 569, 755

38. 027

14.8

i'.e

.07

243

9.5

191S

2, 022, 338

44. 005

17.0

1.4

.15

2.4

1919

2,674,921

33.494

12.5

1 .2

197

7.4

1920

2,728,022

34.841

12.8

1.1

';64

3.3

1921

2, 780, 055

30. 819

11.1

l.l

.14

127

4.6

1922

2,833,288

31,700

11.2

1.1

.53

152

5.4

1923

2,886.971

33, 771

11.7

1.9

.03

206

7.1

1924

2. 939. 005

32, ,918

11.2

1 .5

.03

2.5

1925

2. 995, 239

34, 318

n.5

1.5

116

3.9

1926

3, 048, 000

35, 623

11.7

.06

1.7

The r.ite from All Ca

per 1000 poimlatii

all others per 100,000 populatic

Table 2.

JMoRTALiTY Statistics — City of Ciiicaco.

•2^

YEAR

d i2

■5 C

-" 0)

H<2

S i

n-<

a a

a S

18")!

123.5

23.5

3.0

...

8.8

1852

116

300.0

77.5

5.1

7.7

18r,3

176

298.3

47.5

6.8

-y

8.5

1854

216

327.3

53.1

;",

7.6

22.7

1855

162

202.5

68.7

3.8

23.7

1856

288

342 . 9

54.8

2.4

8.3

1857

255

291.1

57.0

13.7

1858

334

371.1

85.5

'4.4

19.0

1859

256

275.3

57.0

5.4

18.3

18G0

276

252,8

44.0

.")

4.6

20.2

18B1

320

266.6

45.8

5.8

26.7

18B2

348

252.2

64.2

2.2

19.0

1803

283

188.7

126

84.0

6.0

lis

21.3

18G4

410

242.6

163

96.2

6.4

2.3

30.8

1865

340

190.5

150

84.0

S . 9

3.9

21.8

1866

406

203.0

1S7

93.3

18.0

1.4

30.5

18G7

541

240.4

171

76.0

20.0

3.6

28.9

1868

026

248.4

341

135.3

32.5

10.7

121

48.3

1869

754

269.3

313

111.8

22.5

13.2

130

46.4

1870

863

281.5

314

102.4

28.4

9.8

140

45.6

1871

829

248.0

. 386

115.5

20.3

8.4

133

39.8

1872

1009

274.6

462

125.7

20.4

14.7

169

46.0

1873

930

244.7

435

114.5

107

28.2

13.7

179

47.1

1874

804

218.5

377

95.4

109

27.6

12.0

189

47.8

1875

880

219.7

493

123.1

122

30.5

14.0

213

53.2

1S76

886

217.3

364

89.3

122

29.9

20.0

189

46.4

1877

913

212.3

345

80.2

130

30.2

18.8

183

42.6

1878

856

196.0

377

86.3

177

40.5

22 2

302

69.2

1879

854

173.7

460

93 . 6

177

30.0

131

26.7

354

72.0

1880

981

195.0

633

125.8

163

32.4

179

35.6

303

60.2

1881

1191

220.0

707

130.9

217

40.2

161

29.8

335

62.0

1882

1183

211.0

829

148.0

220

39.2

184

32. S

374

66.7

1883

1150

198.3

094

119.7

232

40.0

223

38.4

421

72.6

1884

1185

188.1

713

113.2

265

42.1

233

37.0

388

61.0

1885

1289

193.8

736

110.7

249

37.4

235

35.3

400

69.2

1886

1377

195.7

880

125.1

230

32.7

300

42.6

453

64.4

1887

1540

202.6

1008

132.6

301

39.6

320

42.1

549

72.2

1888

1610

201.3

1105

137.7

361

45.0

330

41.1

619

77.1

1889

1692

181.0

1170

125.0

379

40.5

373

39.9

664

71.0

1890

2221

201.9

2073

188.5

461

41.9

509

46.3

816

74.2

1891

2400

208.9

2898

251.8

545

47.4

594

51 . 7

927

80.9

1892

2383

198.6

2397

199.8

539

44.9

610

50.8

1058

88.2

1893

2647

211.2

2457

196.1

609

48.6

753

60.1

1100

88.3

1894

2499

191.0

1520

116.1

639

4S.8

680

52 .

1038

79.3

1895

2463

180.2

2359

172.6

682

49.9

701

51.3

1304

99.8

1890

2667

186.8

2149

150.0

734

51.4

818

57.3

1289

90.3

1897

2574

172.6

2152

144.3

742

49.8

937

02.8

1365

91.0

1898

2829

181.7

2477

159.1

791

50.8

1051

o7.5

1399

89.8

1899

2910

178.9

3438

211.4

890

54.7

1180

72.6

1492

91.7

1900

2953

173.9

3389

199.5

986

58 .

1117

65.7

1893

111.4

1901

2874

164.0

3127

178.5

1003

57.2

1016

57.9

1947

111.1

1902

2979

165.4

3433

190.6

1074

59.6

1258

69.8

2098

116.5

1903

3377

182.5

4629

250.1

1063

57 . 4

1510

81.9

2092

113.0

1904

3543

186.5

4138

217.8

1124

59.2

1848

97.3

2043

107.5

1905

3674

188.8

3582

184.1

1191

61.1

2017

103.5

2110

108.3

1906

3837

192.0

4047

202.5

1328

66.5

2128

106.5

2195

109.8

1907

4039

197.2

4753

232.1

1538

75.1

2496

121.9

2338

114.1

1908

3915

186.7

3511

167.4

1571

74.9

2138

102.0

2086

128.1

1909

3885

181.0

4713

219.6

1646

76.7

2273

105.9

3163

147.4

1910

3908

177.9

5286

240.7

1804

82.1

2500

113.8

3323

151.3

1911

3726

105.6

4929

219.1

1799

80.0

2460

109.4

3546

157.6

1912

3763

103.5

4892

212.5

1778

77.2

2377

103.3

3488

151.5

1913

3866

164.2

4871

206.9

2004

85.1

2325

98.7

3460

147.2

1914

3908

162.1

4077

169.1

2115

87.7

2006

83.3

3900

161.8

1915

4204

170.6

3800

156.6

2081

84.4

2168

88.0

4195

170.2

1916

3734

148.3

3862

153.5

2267

90.1

2069

82.2

4524

179.7

1917

3800

147.9

5018

195.3

2256

87.8

2293

89.2

4767

185.5

1918

3827

145.9

7000

266 . 9

2407

91.8

2340

89.2

4936

188.2

1919

3244

121.3

3353

125.3

2534

94.7

2125

79.4

4140

154.8

1920

1 2652

1 97.2

3815

139.8

2573

94.3

2218

81.3

4909

179.9

1921

2325

83.6

2216

79.6

2663

95.8

2122

76.3

4730

170.1

1922

2220

78.3

2779

98.1

2S00

98.8

2313

81.0

5498

194.1

1923

2335

80.8

3745

129.7

2949

102.1

2737

94.8

5547

192.1

1924

2434

82.8

2892

98.4

3177

108.1

3232

109.9

r.en

191.1

1925

2489

83.1

3075

102.7

3219

107.5

3092

103.2

6309

210.6

1926

2530

83.0

3238

106.2

3283

107.7

3691

121.1

0547

214.8

liales per 100,000 populatic

Table 3.
Mortality Statistics — City of Chicago.

1851
1852
1853

1854
1855
1856
1857
1858
1859
1860
1861
1802
1863
1864
1865
1866
1867
1868
1869
1870
1871
1872
1873
1874
1875
1876
1877
1878
187!)
1880
1881
1882
1883
1884
1885
1886
1887

1890
1891
1892
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1012
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926

206

811

819

133

389

339

187

200

400

354

279

220

190 I

184

185

143

79
493
718
410
369
404
474
620 I
906
228

61.0
36.4
6.2
17.9
85.6
259.0
272.0
114.7
37.5
244.5
270.0
41.4
49.9
63.5
44.9
72,. 2
204.6

20.6
51.4
198.9
190.5
30.5
79.1
67.4
34.6
35.7
69.0
56.2
41.1
31.3

43.4
31.8
26.3

4.3
32.8
13.3

53 . 3
23.7
10.7
22. S
21.1
12.9
22.0
20.0
19.7
60.7
11.2

8.4
91.8
27.6
25.0
46.8
29.7
18.8
33.8
40.8
27.1
20 . 5
32.6
12.1
53.8

6.7
13.0
29.1
18.0
15.9
17.8
14.1
15.9
13.9
22.8
10.3
18.3
16.9
13.7
16.8
10.0

8.9
13.1
10.7
13.4

4.7
10.8
11.8
14.8
14.6

5.9
18.4

8.4
12.0

0.4

6.5

7.9

2.5

164
190

169 I

279

236

175

314

1463

1009

753

817

905
1012
1303
1405
1297
1509
1261
1358
1548 I
1467
1406
1642
1098

774

680

917

840

515

627

637

409

433

554

555

680

822

877

940

952

764

679

787
1228

720

592

030

676

561

18
25.
196
119.4
209.3
178.3
231.3
144.0
79.1
77.4
91. S
139.3
73.6
97.2
62.1

135.8
120.2
196.9
290.7
186.9
134.3
140.9
143.7
1.52.2
135.2
184.9
161.6
161.4
114.7
118.2
129.0
117.1
107.4
120.1
76.2
1.1.9
43.7
56.4
49.5

40.8
40.4
31.9
27.7
31.3
47.8
27.4
22.1

72
85
117
287
404
202
6971
1757
2037
114
317
428

1.2

1.0

18.0

19.1

9.4

403.4

416.8

495.9

454.3

424.3

436.8

479.4

407.6

416.1

433 . 1

400.6

351.4
330.8

362.8 I
098.2

327.9 I

328.8 I

179.9 1
200.2 I
237.8 I
190.4
203.8 I

12.1 I

465
224
110
101

122
137
143

64 I
121 I
103 I
133 I
136 I
100 I
54 I
07 I

39 I
01 I
47 I
51 I

Rales per 100,000 iiopuKitii

Table 4.
Mortality Statistics — City of Chicago.

■^

VEAK

i. ^

g±

111'

^ '- —

O T^

—

£S

— H

i-K

—

1S.31

...

53.0

1S.".2

'.'.'.

131.8

.05

18.",3

...

; ; ; :

52.5

.08

18r,4

...

210

319.7

1855

115.0

" ! 05

1836

79.9

.29

1857

'i!i

71.9

1.37

1858

3.3

18.9

2.11

185!)

2.2

39.8

1.04

1800

33.9

.44

1861

25.8

.13

1802

32.1

.35

1803

32.7

.26

1864

1^2

45.6

.58

1805

11.1

47.6

.27

1860

0.0

12o

62.3

.30

1867

9.8

147

65.3

.02

1868

17. o

184

73.0

.05

1869

13.9

229

81.8

.92

1870

10.1

260

84.7

.75

1871

12.6

109

50.0

.97

1872

300

81.7

202

71.3

131

1.29

1873

129

34.0

288

75.8

133

1.38

1874

22.5

223

56.4

.79

1875

21.2

252

63.0

.72

1870

115

28.2

160

39.2

.57

1877

102

23.7

227

52 . 8

..54

1878

111

25.4

153

35.0

.78

1S79

104

21.2

215

43.8

.08

1880

15.1

147

29.2

.66

1881

320

59.3

317

56.9

144

1.03

1882

120

21.4

242

43.2

107

.81

1883

108

18.6

219

37.8

152

1.32

1884

14.1

244

38.7

108

.86

1885

142

21.4

171

25.7

107

.80

1886

103

14.0

130

18^5

126

.92

1887

10.7

102

21.3

149

.91

1888

138

17.2

148

18.4

186

1.18

1889

110

11.8

167

17.9

137

.81

1890

142

12.9

245

20.4

160

.76

1891

301

26.2

375

30.0

176

.63

1892

223

18.6

223

15.5

174

.66

1893

388

30.9

145

9.1

181

.67

1894

249

19.0

136

8.7

214

.89

1895

.58

110

0.9

140

.58

1890

.14

150

9.3

IJO

.63

1897

2.3

143

.66

1898

1.6

701

40.8

114

.50

1899

1.1

788

48.4

143

.56

1900

.35

804

50.8

101

.40

1901

832

47.5

113

6.4

1902

!22

713

39.5

108

5.9

1903

.05

720

38.9

105

5.6

1904

.15

1702

89.0

131

6.9

1905

2180

111.8

142

7.3

1900

2236

in. 9

133

6.7

1907

*15

2451

119.7

197

9.6

1908

♦12

.57

3070

140.7

179

8.3

1909

* 3

.14

3116

145.2

189

8.8

1910

2.0

3511

159.9

178

8.1

1911

1.8

2983

132.6

204

9.1

1912

1.7

.95

3050

132.4

124

5.3

1913

2 . 5

.17

3214

136.4

4.0

1914

2.0

.41

3029

125.6

119

4.9

1915

2.1

.40

2023

107.1

2.9

1916

2.1

1.9

3429

137.9

3.9

1917

198

7.7

187

7.2

2845

111.7

2.6

1918

3.5

.95

2960

114.0

2.8

1919

1.7

.63

2536

94.8

2.0

1920

1.4

.29

2203

80.7

2.8

1921

1.1

.50

1755

63.1

2 3

1922

.73

1245

43.9

2.0

1923

1.1

.13

1095

37.9

3.2

1924

.« 1 2

.00

876

29.8

131

4.5

1925

1.01 7

s.s

887

29.6

2.7

1920

.9 3

1.0

600

16.4

102

3.4

* Encephalitis.

*R:ites for puerperal septicemia percentage^ of total
Other rates per 100,000 population.

Table 5.
Mortality Statistics — City of Chicago.

YEAR

Reported
Uirths

Infant
Deaths
Under 1 yr.

o
o

S.S

1851

50.0

1852

98.1

1863

57.5

1854

100.3

1855

37.5

1858

20.1

1857

53.0

1858

17.7

1859

10.7

1860

22.0

1801

12.5

1862

13.8

1803

18.0

'.'.'.'.

1864

18.8

1865

24.1

1860

30.9

1867

17.3

1868

11.5

2.330

lit'.b

180!)

11.4

2251

8.0

1870

15.9

2709

8.8

1871

10.4

2475

7.4

1872

15 . 5

3431

9.4

1873

10.5

S570

9.4

1874

7.8

3308

8.4

1875

11.0

3024

7.0

1876

15.2

2094

0.0

1877

4.8

2432

5.7

1878

13.5

2465

r> (i

1879

9.9

2549

5.2

1880

14.1

3147

0.3

1881

124

22.9

4374

8.1

1882

15 . 8

4059

7.2

1883

10.3

3850

0.0

1884

!)S

15.5

4179

6.6

1885

111

16.6

4000

0.02

1880

118

16.7

4081

5.8

1887

11.4

44S3

5.9

1888

11.9

4718

5.9

1889

105

11.2

5008

5.4

1890

121

10.0

'.'.'.'.

0630

0.0

1891

143

11.4

800S

7.0

1893

139

9.0

7.574

0.3

1893

5.1

8125

0.5

1894

2.1

7336

5.6

1895

3.5

6817

5.0

1890

2.0

6512

4.6

1897

1.5

5735

3.9

1898

1.7

2S, 009

ik'.s

5415

189.2

189!)

29, 065

17.8

5620

189.9

1900

'i!9

29, .568

17.4

5341

180.6

1901

1.2

26.048

15.2

5044

189.2

1902

27.343

15.1

5144

188.1

1903

1.0

29. 033

15.0

5316

183.1

1904

27, 803

14. G

5025

180.7

1905

20,092

13.3

5831

223.4

1906

25,171

6114

242.8

1907

25, 702

0699

260.6

1908

27, 533

13^1

6888

250.1

1909

t54,729

25.5

0334

116.6

1910

155, PI 4

25^4

6841

122.3

1911

t56. Ill

24.9

0293

112.1

1912

156,379

24.4

6089

118.0

1913

t56, 626

24.0

6928

122.3

1914

t36, 895

23.5

6880

120.9

1915

t57, 045

23.1

6205

108.7

1916

47, 760

18.9

6007

144.6

1917

49, 5.56

19.2

0057

134.3

1918

51, 255

19.5

0036

129.4

1919

47, 853

17.9

5739

119.9

1920

55, 720

20.1

5674

112.8

1921

'.I

00, 902

21.9

5051

89.3

1922

50, 724

20.0

4850

85.5

1923

55.935

19.4

4883

87.3

1924

. 2

5S; 900

20.0

4528

76.9

1925

60, 155

20.0

4457

74.7

1926

.03

60,200

19. S

4007

00.6

• Per 1000 population.

t E.-tiiiintcd.

Hirtli r.ile.s per 1000 population.

iTif.nit deaths under 1 year, period 1808 to 1S97

Infant deaths wider 1 .year, period 1.S98-1920, r;i

Other rates per 100.000 population.

393

Sewerage.

The first sewers were designed with outlets (hrect to Lake Michigan
and into Chicago River, then a tributar\' of the lake. It was obvious that
the lake could not be used both for a water supply and as a means of
sewage disposal. As no other source of supply was available it necessitated
the disposal of sewage in some other manner.

The Chicago Sanitary District was organized in 1889 under a special
law enacted b\- the legislature in that year. When the district was organ-
ized it included 18.^ square miles and served 1,150,000 people. Now the
district co\ers j7 square miles, serves 3,465,000 people and includes part
or all of 57 suburbs.

Construction of the main channel of the drainage canal was started
in 1892 and completed in 1900, reversing the flow in Chicago River. Dur-
ing that period and the following few years interceptors were constructed
to carry the sewage to the river.

Due to the amount of sewage and restrictions on the amount of
diluting water that could be taken from the lake it became necessary to
consider treating the sewage.

In order to treat the sewage the district was divided into various
treatment projects. At present the Calumet and DesPlaines River projects
are in operation, the North Side project is nearly finished, the West Side
project is started and small treatment plants are being operated at JMorton
Grove, Glenview and Northbrook.

References.

Annual Reports of the Chicago Health Department, various dates.
Monthly Statement of Mortality, Chicago Health Department, 1894.
Principles and Practice of Medicine, N. S. Davis, M. D., 18S4.
Vagaries of .Sanitarv Science, The, F. L. Dibble, 1893.
Jungle, The, Upton Sinclair, 1906.
Hygienic Laboratory Bulletin, No. 41, 1908.
Public Health Bulletin, No. 147.

THE SANITARY DISTRICT MOVEMENT

Drainage for sanitary as well as agricultural purposes is a subject that
has bewildered the inhaliitants df Illinois from the time when a desire to
till the soil and esca])e frum malaria first burned in the hearts of early
settlers. For more than a hundred years the thought of satisfactorily
solving this problem has agitated the minds of pulilic officials and private
citizens.

I'lefore a State government was organized a number of comnumities
were either moved or abandoned outright because of difficulties in draining
the original sites. The settlers at Cahokia abandoned the place in favor
of Belleville in 1813 and the original community that ultimately grew into
Peoria was moved a mile and half further up the river at an e\en earlier
date.

In 1810 the first legislature to meet after Congress had fomially admit-
ted Illinois to the Union passed a law legalizing lottery for the purpose
of raising funds with which to drain the American Bottoms. About the
same time a voluntary organization, the Illinois Agricultural i\ssociation,
specified as one of its functions the promotion of drainage for sanitary
and agricultural purposes.

Then followed a long period when local governments managed in
one way or another to get rid of communit}' sewage and drain the com-
munit\ grounds in a manner that made the places habitable, if not sanitary.

At length the lack of drainage facilities in Chicago, coupled with the
rapid growth of that municipality, created sanitary problems that demanded
solution by some extraordinary means. This led to the beginning of what
ma\- be called the sanitary district movement in the State, which bids fair
to give to the drainage problem the most satisfactory solution of any
method yet devised.

This movement began when Chicago, in 1889, persuaded the legislature
to pass a law authorizing that city to create a sanitary district with power
to levy taxes, build sewers and drainage channels and participate otherwise
in relieving the community of its problem of sewage disposal.

The next step in the movement took place in 1911, when the legislature
authorized the creation of the North Shore Sanitary District. Then in 1917
a law was passed which authorized the creation of sanitary districts gen-
erally in the State wherever citizens manifested an interest sufficient to get
the names of 100 voters attached to a petition. ]\Iore detailed account of
the development of the sanitary district movement is presented hereafter
in this chapter.

(394)

THE SANITARY DISTRICT MOVEMENT 395

Even more recently, in 1925, the general sanitary district movement
idea was enlarged when a law granted local communities the privilege of
creating by popular vote what are known as river conservancy districts.
These districts or organizations have many powers and functions similar to
those of the sanitary districts.

Sanitary District of Chicago

The Sanitary District of Chicago was formed primarily to cope with
the sewage disposal of the city of Chicago. Before the opening of the
sanitary channel the sewers of Chicago emptied direct into Lake Michigan,
the Chicago River and into its north and south branches. The pumpage
into the old canal from the river was never sulTicient to prevent the periodic
flow (if its sewer-laden contents into the lake.

The fouling of the river became greater from \ear to \ear, as the
population of the city increased and the industries on its banks and tribu-
tary sewers developed. The nuisance from the river became the subject
of continual public complaint, with increased emphasis during each succeed-
ing summer season. This condition and the nuisance from the stock yards
were outstanding features associated in that day with the name of Chicago,
and were commented on disparagingly b}- the press of the country and
travelers from other lands.

\\'hile the greasy, bubbling scum and the nauseating odor from the
river were the ponderable evidence of pollution and the subject of comment,
the real danger lay in the discharge of t\phoid-laden sewage into the lake
from the numerous sewer outlets along the lake shore. In time of freshets
from heavy rainfalls, the contents of the river were also swept into the
lake and materially added to the pollution of the water supply.

ILvRLY Efforts to Purify the River.

When the Illinois and Michigan Canal was completed in 1848, the
Summit level was eight feet above the low level of the lake. Pumps were
installed at Bridgeport which fed the canal from the South Branch of the
Chicago River to furnish the needed water to make the canal navigable
during the dry season.

In 1849 a crude system of drainage with heavy box sewers, discharg-
ing into the river was installed in the territory between State Street and
Fifth Avenue, frcim Randolph .Street to the river. The project proved
unsuccessful because, when most needed, the drains were below the level
of the water in the river.

396 Tin-; samtakv distkict .mdviimknt

In 1855 a board of sewerage commissioners was created by an act of
the legislature, and Mr. E. S. Chesbrough was appointed cliief engineer.
A system of sewers was designed to discharge intd the ri\er l)y gravity.
This necessitated the raising of the grade in the central business district.

Mr. Chesbrough also presented a plan fur purifying the river <le|)endent
uiKjn the introduction of water pumped from the lake through a covered
canal in Sixteenth Street.

In 1X65, the condition of the Chicago River and the measures necessary
to reduce the pollution, were studied by a commission of engineers with the
result that a recommendation was made that the Summit level of the canal
be lowered so as to create a continuous flow of water from the lake. An
amendment to the city charter gave the board of public works power to exe-
cute this project for the cleansing of the Chicago River.

Between 1866 and 1871, the city deepened the canal at a cost of
$3.300,88,1. The pumps at Bridgeport were considered of no further use
niiw. After two years of idleness, they were sold for $2,500 and the site of
llie piniiping station was leased to private parties.

.\fter a few \ears, the city deplored the sale of the pumps because, due
to fluctu.-itic.ins in lake levels, it was soon found that the flow in the river was
insutVicient to prevent its fouling.

The Sag feeder, which had been constructed to feed the canal below the
Summit level by water drawn from Stony Creek, a branch of the Little
Calumet at Blue Island, and from the swamiis, known as the "Sag Slough",
was dammed four miles west of Blue Island in order to increase the flow
of water through the C'hicago River.

The Ogden-W'entworth Canal was completed in 1872 as a private under-
taking for the purpose of draining ]\lud Lake. This established a communi-
cation between the West Fork of the Chicago River and the Des Plaines
River. The additional water thus supplied through the West Fork had the
effect of lessening" the flow in tlie main channel of the river.

In 1877, a dam w'as built in the branch of the DesPlaines River, com-
municating with the Ogden-Wentworth Canal, after the city had filed a com-
plaint that the flow of water through this channel had the effect of lessening
the current in the South Branch of the Chicago River.

The foul condition of the canal and tlie DesPlaines River at Joliet, were
brought to the attention of the State Board of Health in 1878. Investiga-
tions made under the direction of Dr. John H. Ranch, secretary of the board,
showed that a low stage of water was already accompanied b_v increased
offensiveness of the canal and river. It was estimated that from 60,000 to
100,000 cubic feet of watei" per minute would be required to cleanse the
canal.

THE SANITARY DISTRICT MOVEMENT 397

As a result of these investigations, and in view of the serious complaint
of the citizens of JoHet, the secretary of the State Board of Health made a
recommendation to the city of Chicago in 1879 that the pumping works at
Bridgeport be rebuilt.

After some dela} , during which time the Chicago River became worse
from year to year, new and more powerful pumps were installed by the city
of Chicago at a cost of $250,177 and put into operation in 1884.

In order to supply the North Branch with a flow of fresh water, the
l'"ullerton Avenue conduit, 12 feet in diameter, was completed in 1880. By
means of two screw pumps, water was forced through it from the lake, and
at times the water from the north branch was pumped lakeward, with a
view to cleansing this part of the river. The net result of all these efforts
was that the river and shore of the lake remained foul. Professor John H.
Long made a series of chemical examinations for the State Board of Health
from September 5, 1885 to August 28, 1886, of the water supply of Chicago,
H\-de Park, Lake View and Evanston. The sewage of the river had been
flowing into the lake for nearly a month when the examinations were begun.
The analysis of the Chicago supply taken from a hydrant showed .0105 parts
per million of free ammonia, and .085 parts of albuminoid ammonia. The
greatest contamination was found during the week ending Februar}^ 27 when
thawing weather had set in, with light rainfalls and the pumps at Bridgeport
were not operated. The best results were obtained between May and August
when the operation of the pumps promoted the outward flow of the river.

The city was increasing in population beyond all expectations, and the
rather desperate situation was a constant source of discussion and even dis-
may until the celebrated downpour of August 2, 1885 when it rained with
violence for nearly two days. The Chicago River, augmented by a large
overflow from the DesPlaines through the Ogden-Wentworth Canal, rushed
in a torrent into the lake, and its foul contents were swept out as far as the
Two Mile Crib off Chicago Avenue, which was the sole source of the city's
water supply at that time.

The people were aroused and the Citizens' Association appointed a com-
mittee consisting of Mr. Ossian Guthrie, Mr. Lyman E. Cooley, and Dr.
Frank W. Reilly, then assistant secretary of the State Board of Health, to
inquire into the situation and report. Evidently no time was wasted for the
committee reported on August 27 and recommended the construction of a
ship canal substantially as the drainage channel exists today. The report
was promptly adopted, was given wide publicity by the press and the agita-
tion for the construction of the canal was continued until results were ulti-
matel\' obtained.

In January 1886, the city council provided for the appointment of a
watcr-.^upply commission. ]\lr. kudolf Hering of New York, a celebrated

398

TH1-: SANITARY DISTKICT .M( >Vi:.MF.XT

en,<,'iiH'iT. Mr. Samuel d. Artingstall, city engineer, and j\Ir. Renezette
Williams, also an engineer, were appointed as members of this commission.
They made a preliminary report in January 1887. No final report was ever
made, hut all three, in their individual capacity, rendererl valuable aid in
linally securing the passage of the Drainage District ]>ill.

Sanitary District Ckkated.

The efforts to improve the drainage system of Chicago finally culminated
in an effort to secure the necessary enabling legislation during the legislative
session of 1886-1887. Two bills were introduced to provide for an adequate
drainage system for the city. The one, known as
the Winston Bill, proposed to raise money, by
special assessment, to construct an outlet through
the DesPlaines Valley . The other, the Hurd Bill,
proposed the creation of a metropolitan district
with power to issue bonds and levy taxes.

Murry Nelson
I-'irst President, 1890

The Hurd liill. as amended, was reported
favoralily but the questiijn developed such broad
relations that a general conviction prevailed that
the problem should be fully considered before
legislative action was taken. Consequently, a
joint resolution was passed which provided for a
committee of five to consider "the subject of the
drainage of Chicago and its suburbs" and to report to the next legislature.
The committee consisted of Mayor John A. Roach of Chicago, two senators,
B. A. Eckhart of Chicago and Andrew J. Bell of Peoria, and two repre-
senatives, Thomas C. McMillan of Chicago and Thomas H. Riley of Joliet.
Mr. John P. \\'ilson of Chicago was employed as counsel and Mr. L)man
E. Cooley as engineer. The report of this committee was submitted to the
General Assembly on February 1, 1889, in the form of a bill which pro-
vided for the creation of the Chicago Sanitary District.

After many hearings and amendments, the bill was tinall}- passed and
received the signature of the Governor on May 29, 1889. It became a law
in force and effect on the following July 1st.

In accordance with the provisions of the act a petition was made to the
county judge of Cook County in which it was requested that he appoint two
judges of the circuit court to act as commissioners with him for the purpose
of fixing the boundaries of the district. The commissioners fixed the orig-
inal boundaries of the district as shown in Figure 1. It comprised about
IS.S s(|uare miles.

400 Till-: SANITAKV DISTRICT MOVE.M iIXT

The matter of organizing the district was then submitted to the voters
at the general election held November 5, 1889, with a resulting vote of
70,958 for, and only 242 against the proposition. This vote showed the
sentiment that prevailed in favor of the project in the city of Chicago.

The press had played an important part in crystalizing this sentiment.
Dr. h'rank W. Reill\'. who spoke as a represcntati\e of the press, at the cere-
monies inaugurating the tligging of the channel said :

"The Sanitary District is essentially and distinctively the creation
of the public press of the city of Chicago and of the Illinois Valley. The
egg from which it was hatched was laid in a newspaper office, a little
over seven years ago. It was incubated by the newspapers and the
newspapers did the proper and necessary cackling at the various stages
of its evolution. * * * * Xo one subject has been given so much space
in the columns of the daily press as this enterprise."

Dr. Reilly was in a position to speak knowingl}- on this subject for it
was he who had inaugurated this publicity campaign and as a newspaper
man and a sanitarian, had inspired its continuation until the object sought
was obtained.

On December 12, 1889, at a special election, the first board of trustees
of the Sanitary District was elected. Dr. Arnold P. Gillmore was a member
of this board. Soon afterwards the validity of the act was tested in two
suits and sustained by the Illinois su])reme court.

Surveys and estimates of the cost of the channel were ordered made.
After several changes of engineers, and the consideration of various courses,
a plan was finally agreed upon by the new and reorganized board of trustees
elected November 3, 1891.

Frank Wenter was chosen president of this board and trustee Lyman E.
Cooley, former chief engineer, was made chairman of the committee of engi-
neering. Benezette Williams was appointed chief engineer.

The route of the ch.innel, between \\ illow Springs and Lockport, was
agreed upon and contracts for its construction were awarded on July 13,
1892. The route from Bridgeport to Willow Springs was reported by the
engineers on June 7, 1892.

The work on the main drainage channel was begun on September 3,
1892. No sanitary undertaking of such magnitude had been undertaken
previously in the State or Nation. It provided for the digging of a canal
thirty miles long, 202 feet wide in the earth section, 161 feet wide in the
rock section, and 24 feet deep. It cut across the divide that separated the
St. Lawrence watershed from the Mississippi Valley and renewed the flow
of water from Lake Michigan to the Mississippi, as it had flowed in pre-
historic times.

MEMBERS HRSTBOAI^D OF TRUSTEES '
The Sajvfoj'y Dic/'fv^cfof Clyic^qo ^

Twu other Mienilieis of the tirst boaril were Arnol.l 1'. (aihuorc. M. I)., ami \V. II. liussell.

402 THE SANITARV DISTRICT MOVEMIIXT

riie purpose of the canal was to furnish an outlet for tlie drainage of
the cit} of Chicago and aid toward a waterwav or shi]) canal from Lake
Michigan to the Mississippi.

Isham Randolph was appointed chief engineer on July 7, 1893, and
served until 1907.

Sanitary Channel Completed.

During the World's Fair of 1893 in Chicago, a trip to witness the blast-
ing and the new and successful cantilever cranes removing the rock and earth
from the channel to the spoils banks was one of the sights shown to visitors.
The work- was finally finished and the waters of Lake Michigan turned into
the channel to flow by gravity in its course toward the Gulf of Mexico at
11 :15 A. M. on January 17, 1900. The cost of the project was $45,220,588.

Continued expansion of the drainage channel system was marked by the
completion of the North channel in 1910, and the Sag channel in 1922.

When the work on the Sag channel was first started in 1906, the Sani-
tary District made application to the War Department for the necessary
diversion of water from the lake, to reverse the flow of the Calumet River.
This was refused and litigation was started, which was finall}' adjudicated
in an injunction proceeding in the L^nited States District Court, seeking to
restrain the Sanitary District from withdrawing more than 4,167 feet per
second of water. After a lengthy hearing, in a decree issued on June 18,
1923, the Court rendered a decision against the Sanitary District and required
it to hold to the provisions of the 1901 permit, allowing the diversion only
of the aforesaid quantities of water.

The district appealed from the decision to the United States Supreme
Court. This Court affirmed the injunction of the district court on January 5,
1925, and ordered the decree to go into effect in sixty days, without preju-
dice to any permit that might be issued by the Secretary of War, according
to law.

In the meantime, the district had gone ahead with a program of sewage
treatment. The first of the proposed sewage treatment plants was the one
in the Calumet district, designed to treat the sewage from 42j4 square miles
in that territory, with an estimated cost of $17,360,000, including the con-
tributory sewers. This was started in 1920, began treating sewage in 1922,
and was completed recently.

The construction of the Howard Avenue sewage treatment plant was
started in 1923. This will serve an area of 62 square miles and will be the
largest activated sludge plant ever built. The estimated cost is $27,433,000,
of which $11,(X)0,000 is for the contributing and intercepting sewer system.

The 95th Street sewage pumping plant was completed in 1925. The
total estimated volume of sewage and industrial wastes of the Sanitary

THE SANITARY DISTRICT MOVEMENT

403

District was 835,000,000 gallons daily in 1925, with an average of 147 parts
per million of suspended matter and .176 parts per million of bio-chemic
oxygen demanded.

A bill was introduced in Congress permitting the district to withdraw
10,000 cubic feet of water per second, on which hearings have been held, but
which has not been passed.

Upon making application to the Secretary of War. after the United
States Supreme Court decision, it was agreed on March 3, 1925, that a
permit would be issued to the district to withdraw an annual average of
8,500 second feet, and an instantaneous maximum of 111,000 second feet for
a period of five years, provided that the district would construct sewage
treatment plants to provide for the complete treatment of wastes from
1,200,000 persons within that time, and that the universal metering of the
water supply of the city of Chicago would be undertaken at the rate of
10 per cent annually.

The Sanitary District's definite construction program for sewage treat-
ment works, which was approved by the War Department, conditioned on
issuing the permit, contemplates the expenditures of $73,419,000 for such
plants and allied works during the }ears 1925-29 inclusive.

Extensions and Sewage Interception.

The Sanitary District act was amended in 1903 by providing for the
annexation of the North Shore and Calumet regions and authorizing the
development of water power.

The 39th Street sewage pumping station was completed by the city of
Chicago in December 1904 and a part of the sewage from the south side
was diverted from the lake. In the following year, the south side inter-
cepting sewer system was completed as far south
as 75th Street.

The main channel extension was completed
in 1907 at a cost of $4,489,913. It was con-
structed in order to preserve navigation after the
Illinois and Michigan Canal was cut by the Sag
channel. The project is 4.25 miles long, extend-
ing from the Lockport controlling works to the
upper basin in Joliet.

The north-side intercepting-sewer system,
and the Lawrence Avenue pumping station were
completed by the city in 1908. The pumping of
flushing water from the lake was started on
November 28, this year.

T. J. Crowe
Present President

404 'IIII-; swiTAin' distkut m(i\'k.m::n't

Tlif upcration of llic 3''tli Strcut ami 1-awrencf Awniie sewage and
lliisli-vvater ijuniping stations was tiiincil nver to tlie Sanitary District in 1910.

This \'ear the North Shore cliaiiiiel \\a^ completed, and a conduit was
constructed in Western \\eniie to lhi--h the wcNt arm of Bubbl}' Creek.

On .September Id. I'Ml, ihc eoiislriRtion of tin- Cahimet-Sag channel
was begun with ,i view to diverting llie flow of the Calumet River, through
a channel f)i>ni the Little Calumet in the neighborhood of Blue Island to
the main (lr,iin;ige channel at the Sag. In the meantime, dredging was begun
in tlu' main channel, between Robey Street and i-^ummit. to enlarge this
section.

The diversion of the I-lvanston sewage by the completion of the inter-
cepting sewer system in that city in 1921, and the completion of the Calumet-
Sag supplementary channel in 1922. completed the main dilution and diver-
sion projects of the district.

Si;wAi;i-: Tkk.\tment.

The refusal 1)\ the federal government of a permit to divert additional
water from the lake, for the creation of a flow in the Calumet-Sag channel,
emphasized the importance of sewage-treatment jirojects in the disposal of
the sewage handled b_\' the district.

Study of the sew'age-treatment problem was first inaugurated in 1909,
when an experimental sewage-testing station was established at the .VJth-
.Street pumping station. In 1912 the studies were extended to the stock
yards sewage. .\ sewage-treatment plant, handling the sewage of Morton
Grove, was completed in U'Lv I'.xperimental testing and treatment stations
were maintained in l'*2ll for the purpose of studying the disposal of tannery
wastes, and the wastes from the corn products ])lant at .\rgo in the follow-
ing year.

In the meantime. Mr. Langdon Pearse, the sanitary engineer of the
district, made studies and ol)servation of sewage-treatment plants in all parts
of the country, ami the trustees accompanied by the sanitary engineer, made
numerous annual inspection tours with a view to keeping in touch with the
results of the \arious treatment projects in all parts of the United States.

The first large sewage-treatment project undertaken by the Sanitary
District for the treatment of Chica.go sewage was the Calumet .sewage treat-
ment ])lant. This was started in 1^20. It is located at 125th Street and
Cottage Grove Avenue and is designed to treat the sewage of the territory
of approximately 52 sc]uare miles in the city south of 87th .Street.

The initial installation was designed for a population of 225,CXX), and
an a\erage sew.'ige flow of 36 million gallons per day. The treatment is by
Imhoff tanks. Experimental activated sludge units and trickling filters were
installed in connection with the plants.

CHIEF ENGINEERS
.The S 8VT\if 2v.ry Dr^^ricJ^ of Chic^lgo I

406 TIIK SANITARY DISTK:lT .MArMKiVV

Underdrained sand beds are provided for drying the sludge, covering
an area of 3.5 acres. A part of the bed is covered with a green-house type
of construction.

The plant cost $6,601,120, and was put into operation in .September 1922.

A large intercepting sewer, with pumping stations at 95th and 125th
Streets, delivers the sewage to this plant from the Calumet district and from
the territory as far west as Halsted Street.

The DesPlaines River sewage-treatment works was also completed in
1922. This is an activated sludge plant and serves for the treatment of the
sewage of Elmwood Park, River Foi-est, Melrose Park, Maywood, Forest
Park, Bellwood, the Speedway Hospital and a portion of Oak Park. The
plant, which is located in Broadview, is designed for a population of 45,000,
and an average sewage flow of 4.5 million gallons per day. The total con-
struction cost was $1,136,044.

LlTICATION OVKR WITHDRAWAL OF WaTER.

The hearing on the litigation, which started in 1906, when the Sanitary
District w-as refused a permit by the Secretary of War for the necessary
diversion of water from the lake to reverse the flow of the Calumet River,
was finally adjudicated in an injunction proceeding in the United States
District Court, seeking to restrain the district from withdrawing more than
4,167 cubic feet of water per second. On June 18, 1923, the Court rendered
a decision against the Sanitary District, requiring it to hold to the provisions
of the 1901 permit, which allowed only for the diversion of the aforesaid
quantities of water.

The district appealed from this decision to the United States Supreme
Court. In 1922, the state of Wisconsin filed a suit in the United States
Supreme Court, also seeking to restrain the district from diverting more
water from the lake than that allowed by the aforesaid permit.

The average diversion of water by the Sanitary District in 1924 was
9,465 cubic feet per second. The Sag channel carried normally about 700
cubic feet per second of this amount.

In a decision, handed down by the United States Supreme Court on
January 5, 1925, the injunction of the district court was affirmed, the decree
to go into effect in sixty days, without prejudice to any permit that might
be issued by the Secretary of War, according to law.

In the meantime, a bill had been introduced in Congress, permitting
the district to withdraw 10,000 cubic feet of water per second. Hearings
were held on this bill, but to date it has not been passed.

Upon making application to the Secretary of War, after the United
States Supreme Court decision holding the district to the terms of the orig-
inal permit, it was agreed (jn March 3. 1925, that a permit would be issued.

THE SANITARY DISTRICT MOVEMENT 407

allowing the district to withdraw for a period of five years, an annual average
of 8,5fX) second feet, and an instantaneous maximum of 11,000 second feet,
provided that the district would construct sewage-treatment plants, to pro-
vide for the complete treatment of wastes of 1,200,000 persons within that
time, and that the universal metering of the water supply of the city of
Chicago could lie undertaken at the rate of ten per cent annually.

The Sanitary District was required to submit a definite construction
program before the permit was issued. The program that was submitted
and accepted contemplates the expenditure of $73,419,000 for sewage treat-
ment plants and allied projects during the years 1925-29.

.\n ordinance providing for the metering of the water supply in accord-
ance with the term^ of this agreement was passed liy the cit_\- council on
September 1. 1925.

The same vear the states of Ohio, Pennsylvania, Minnesota, and later.
New York, were permitted by the United States Supreme Court to join with
the State of Wisconsin in its suit seeking to restrain the Sanitary District
from withdrawing an excess of 4.167 second feet of water from Lake
Michigan. Subsequently, this case was referred to Justice Charles E.
Hughes, as master, to hear the evidence for the court and submit his findings.

After a lengthy hearing, he found against the states praying for the in-
junction. On account of this litigation, the district appropriated $419,540
for legal expenses in 1926, and $499,940 in 1927.

In 1928. an appropriation of $294,270 was made for a health depart-
ment, with a director at a salary of $15,000 per annum.

Work O.n Sewage Treatment Projects Continued.

The trend of the litigation over the withdrawal of water made it more
apparent that the treatment of the sewage discharged into the channel was
imperative.

In 1925, the legislature increased the bonding power of the district to
four per cent of the assessed valuation of the property in the district. This
helped to provide the funds necessary to carry out the construction program'
agreed to with the Secretary of War.

A new and larger sewage laboratory was established at the main offices
of the district in 1924, after which the one at 39th Street pumping station
was discontinued.

The Glenview sewage treatment plant was completed in 1924. This is
an Imhoff tank trickling filter plant, costing $70,783. and designed to serve
a population of 1,200. A similar plant was completed in 1925 to handle the
sewage of Northbrook. designed for a population of 1.500. Its cost was
$71,065.

408 Tlir. SAMT.'.KV DISTRICT M'lVK.M I'.NT

Wdrk was started mi the North Side trcatnu-iit works and its suppk--
meiital-intcrccpting-sewer s_\stcm in 1923. This plant is being built to treat
the sewage from Chicago, north of F"ullerton Avenue, and from Evanston,
Wilmette, Kcnilwurth. (Ilcncoe, Xik's Center and Xiles. an area of about 87
square miles.

Tile pkaiit iv loeated at Howard Street west of the North Shore channel.
It i> of the actixaled-skidge t\pe and designed to handle the sewage of a
population of SOO.OOO, with an average sewage flow of 175 million gallons
per day.

The total cost of the project is estimated at $17,500,000.

In 1926 the first contract was let for the construction of the \\'est Side
treatment works. This is located in the village of Stickney at the intersec-
tion of West Pershing Road and 52d Avenue. It is being built to treat the
sewage from the part of Chicago between Fullerton Avenue and the Chicago
River, the Loop district, limited areas south of the river, and communities
along the lower DesPlaines River and Salt Creek.

The plant W'ill be essentially of the Imhoff tank t\pe and is designed to
digest the waste sludge from the north side plant and will be provided with
extensive sludge-clr\ing beds.

The plant, when completed, will serve a population of 1,850,000 and an
average flow of 400 million gallons of sewage a da\-. The estimated cost
is $19,500,000.

The total volume of sewage and industrial wastes of the sanitary district
in 1925 was estimated at 835,000,000 gallons dailv. The estimated concen-
tration, including industrial wastes, was 147 parts per million of suspended
solids, and 176 parts per million of hio-cheniical oxygen demanded. The
industrial wastes were estimated at ec|ui\alent to a population of 1,500,000.

The figures show the magnitude of the problem that confronts the Sani-
tary District in attempting to treat and render innocuous and nonputrescible
the wastes in llie territory where it assumes jurisdiction over this disposal.
The area of the district is now 437.4 s(|uare miles, 207 square miles of which
are i:i the city of Chicago. The |iopulation of the district is estimated at
3.465,000.

In 1926 there were 314 sewer outlets into various streams in the district,
as follows: Into the Chicago River and its branches, 221 ; into the Calumet
River and Sag channel. 34; and into the DesPlaines River and Salt Creek,
59. NearU- all the sewers in the ?7 municipalities, wholly or partly within
the territor\ of the <listricts, are constructed on the conihined plan, that is,
they are designed to carry both the storm water and the domestic and indus-
trial sewage and wastes. The- per capita consuni;ition of water in the city of
Chica.go is about 280 gallons daily.

The averasre annn.al rainfall in the C/hicago area is 33.11 inches.

THE SAXITAKY DISTRICT MOVEMENT 409

These factors render the problem of treating the sewage more difficult
and exceedingly expensive, it being estimated that the total cost of the sew-
age-treatment plants and intercepting sewer systems necessary to handle all
the sewage and storm water of the district, will excel the amount of
$150,0(X),00(). the largest sum ever expended for any sanitary project and in
comparison with which the amount originally expended for digging the sani-
tary channel seems small.

North Shore Sanitary District.

The North Shore Sanitary District in Lake County was organized in
pursuance to an Act of the legislature passed in 1911. This Act provides
that "whenever any area of continuous territory within the limits of a single
countv shall contain two or more incorporated cities, towns or villages own-
ing and operating * * * and procuring a supply of water from Lake
Michigan, the same may be incorporated as a sanitary district." In accord-
ance Vi'ith this law, a part of the territory along the lake shore in Lake County
was organized as a sanitary district in I'M 4. It has since been expanded
to include all the territory from the Cook County line which is contiguous
with the Chicago Sanitary District line, northward to the Illinois-Wisconsin
state line, which is the northern boundary of Lake County.

The district embraces the cities and village of Deerfield, Highland I'ark,
High wood. Lake Forest, Lake Bluff, North Chicago, Waukegan and Zion
City. The population of the district was 36,000 in 1920 and estimated at
38,000 in 1927. Sewage-treatment plants have been built at Highland Park,
Highwood. Deerfield, Lake Rluff and Waukegan. The plant at Lake Forest
was remodeled. Some of the plant sites are in high-class residential districts
and. therefore, the plants represent especially good design and also archi-
tectural appearance.

The management of the district is vested in a board of five trustees ap-
pointed by the county judge and two circuit court judges. The district is
divided into five wards and one trustee is appointetl for each, they elect a
president from among their number.

With popular approval the board of trustees is authorized to issue bonds
not to exceed five per cent of the valuation of the taxable property in the
district. This power has not been exercised. All the treatment works thus
far constructed, costing $350,000. have been paid out of current and accumu-
lated taxes. The Board is not vested with authority to construct sewers or
otlici" works by special assessment.

Sanitary Districts Organized L'nder Act of 1917.
In 1917 an Act was passed by the legislature providing for the estab-
lishment of sanitary districts, generally throughout the State, upon petition
of 100 legal voters, to the county judge of the county in wliich the major

^10 THE SANITARY DTSTKKT M I iVK.M I'.NT

portion of the proposed district is located. Upon such petition the county
judge and two judges of the circuit court fix the boundaries of the district
and the proposition is submitted to the legal voters for approval. Xo terri-
tory located more than three miles from the corporate limits of any city,
town or village can be included in such a district but it max include con-
tiguous territory of one or more incorporated communities.

The management nf such districts is vested in a board of three trustees
appointed by the county judge. The trustees elect one of their members to
act as president. The salary of the truslc-cs was originally fixed at not to
exceed $100 ]ier annum and by legislature in \'>27 was increased to $300 per
annum. In addition to providing for the treatment and disposal of sewage
of the district, the trustees are empowered to preserve the purity of the water
supplied to the inhabitants and to this end are given power to prevent the
pollution of any waters from which a water supply is obtained 13\ an\ com-
munity within the district within a radius of fifteen miles from the intake or
source of such water supply.

The districts are authorized to levy and collect taxes not to exceed one-
third of one per cent of the assessed valuation of the taxable property and
upon vote of the people to levy an additional one-third of one per cent tax and
to issue bonds not to exceed five per cent of the assessed valuation.

In 1923 the law was amended so as U> give the trustees power to con-
struct and pay for sewers, drains, laterals and appurtenances b\- special
assessments, in accordance with the Local Improvement Act of 1897.

The first sanitary district established under the Act of 1917 was organ-
ized at Decatur in August, 1917. The districts that have been established
under this Act are given in the accompanying table :

Sanitary Districts Established Under Act of 1917.

Location

Date established

Arm 8q. Miles

Decatur

1917

Bloomington-Normal

1919

8.3

El Paso

1919

2.3

Champaign-llrbana

1921

8.5

Downers Grove

1921

5.6

Elgin

1922

8.3

Taylorville

1923

3.5

Springfield

1924

36.2

Galesburg

1924

17.2

Wheaton

1925

15.5

Clinton

1925

l.G

Aurora

1925

Lincoln Highway

1925

10..-)

Hinsdale

1926

Rockford

1927

44.5

Beardstown

1927

11.6

Peoria

1927

28.0

THE SANITARY DISTRICT MOVEMENT 411

The establishment of the sanitary districts has and is making possible
the abatement of nuisances and protection of water supplies and fish life.
The remedy applied is the interception of the sewage, and delivery to a
treatment plant for purification.

In the communities with combined storm and sanitary sewers, intercept-
ing sewers are built with a capacity of 400 gallons per capita in 24 hours,
with overflows into the nearby streams. In Springfield, where four com-
bined sewers discharged ten miles above a proposed waterworks impounding
dam, the intercepting sewer system was constructed so as to carry up to
325 gallons per capita per 24 hours to the treatment works at a point below
the proposed dam and to chlorinate any overflow at the pumping station
before allowing it to discharge into the stream higher up. This was found
necessary because the cost of diverting the entire flow during storms to below
the dam was estimated at $2,250,000, which was a prohibitive expense under
the limited taxing and bonding powers granted to the district under the
general statute.

Other districts were also compelled to retrench, on the expenditures for
treatment or intercepting works on account of lack of available funds. At
Decatur, where the cost was increased by the large volume of industrial
wastes, that from the starch works amounting to about 4,500,000 gallons per
day, the first funds available covered but little more than half the necessary
total expenditures. The total flow of sewage is over 10.000.000 gallons per
day, which is over 25 per cent of the voted capacit\- of the plant. At this
rate of flow the displacement period in the Imhoff tanks is about 1.15 hours,
but the tanks have reduced the suspended matter about 75 per cent by weight.
This, however, leaves a heavy burden on the sprinkling filters. Pre-aeratioii
units have been added in order to make possible increased filtration rates.

Sewage-treatment plants operated by sanitary districts formed under
the Act of 1917 are:

Date first iniils
District comiJlrted

Downers Grove 1921

Decatur 1922-1924

Champaign-Urbana 1923-1924

Elgin 192o-192fi

W'heaton 1925

All of these plants include tanks and sprinkling filters except W'heatfjn,
which has intermittent sand filters. Decatur also has pre-aeration units.

In three other districts, namely, Bloomington-Normal, Taylorville and
Springfield, major construction work on sewage treatment plants is under
way. Up to 1926, the total bonds authorized to cover the cost of sewage-
treatment pumping and intercepting works in the various districts of the

412 THE SANITARY DISTRICT .MGVE.MICNT

State, organized under the law of 1917, amounted to $4,504,000. In addi-
tion the C(jst of part of some works was defrayed out of accumulated taxes.
The ]HT c;ii)it;i cnsl of the sewage-treatment plants constructed thus far
\arii(l from ^'».4() in Decatur to $12.17 in Elgin for the basis capacity
of ihf plants.

I\i\i:k C'onsi'.kvamv Distrkts.

The establishniL-nt of River Conservancy Districts was provided for
ii\ an .\ct of the legislature passed in 1925. Such districts are authorizetl
to provide for sewage-disposal, development of water supplies, roads and
sanitary policing. Provisions are contained in the law providing for the
transfer of sewage works from existing municipalities or sanitary districts
upon a favorable referendum \(ite and the compensation of such communi-
ties for works constructed and transferred.

The Fox River Conservancy District is the only one organized under
this law. The Fox River confederation was organized in 1923, with the
object of preventing the pollution of the Fo.x River, regulating the flow, and
restoring it for recreation purposes. .\lso with a view to securing a pure
water supply for the communities located on the river. To carry out this
program, the confederation secured the passage of the River Conservancy
Act. under which a district was approved by the voters in 1926, and organized
to C'lrry dut the general provisions of the law.

]\i:it:ri:nci:s.

Some projects for Se\va^'e-Tle:itment Works under the niinois Sanitiiry District .\ct of 1M17. Snmuel
A. (ireele.\'.

Transactions of American Societj of Civil Engineers, Vol. 51, p, 441. Dec. 1027.

THE PUBLIC TUBERCULOSIS SANITARIUM
MOVEMENT

Strike a match, lisht the fuse of a t^iaiit firecracker, watch the nervous
spark that hastens along the full length of the fuse cord, listen to the ear-
splitting explosion and you have the story of the public tuberctilosis sani-
tarium movement in Illinois. Back in the nineties somebody struck the
match w hen an agitation about tuberculosis control was started. That agita-
tion sputtered along, like the nervous spark in the fuse cord, mostly in the
form of legislative bills providing for a State sanitarium or system of sani-
tariums, for about ten years.

Then in 1908 the movement took on new life when the General Assembly
enacted a law that authorized cities to construct and maintain tuberculosis
sanitariums where popular favor expressed itself through the ballot box.
Four cities, Chicago, Rock Island, Peoria and Rockford, in the order named,
took advantage of this law and actually acquired sanitariums which were
placed in operation. Two of these, Rockford and Rock Island, were later
transferred to the county tuberculosis sanitarium board when the counties in
which these cities arc located undertook to maintain sanitariums.

This municipal sanitarium law of 1908 was a sort of preliminary burst
that kept the fuse cord spark alive and gave it a fresh start sufficiently strong
to carry it over seven more years of agitation. During this period the idea
of a State sanitarium was definitely abandoned and in its place grew u]) the
county sanitarium idea.

This new notion found favor with the legislature so that in 1915 a
law was enacted which reposed in counties the same privileges extended to
cities under the 1908 sanitarium law. The next year eight counties took
advantage of the law and then the major explosive outburst occurred in 1918
when 33 counties decided by popular vote to levy upon themselves the tax
provided for under the sanitarium law. Since that time only six additional
counties have adopted the tuberculosis sanitarium proposition.

Observation of the table reveals the fact that sentiment in favor of the
sanitarium project prevailed in eight counties. Rock Island County later
(1920) voted favorably on the question but Greene has steadfastly refrained
from adopting the measure. The vote cast on the sanitarium proposition in
these ten counties trailed a trifle behind that cast for United States President
in the same election.

(413)

Against

Total

7,263

21,357

5,576

17,231

2,907

5,089

9,192

29,422

5,893

21,287

4,337

12,212

2,335

9,706

7,714

17,375

4,284

9,382

18,370

24,701

414 THI-: TUIil'.KCULOSIS SANITARIU^t MOVEMENT

111 \'H(i the tulxTciilosis [jrojcct was vol(,-<l (in in ten eounties. These
inchideil ;

Votes Cast.

For

Adams 14,094

Champaign 11,655

Greene 2,182

Kane 20,230

LaSalle 15,394

Livingston 7,875

Morgan 7,371

McLean 9,661

Ogle 5,098

Rock Island 6,331

For tlie big-, popnlar explosive outburst of favor that occurred in 1918
sentiment had broadened considerably in volume. This was manifested by
the size of the vote and the favorable majority. The election was cleverly
timed and the campaign ingeniotisly conducted. Under the strain of war
activities health was a subject greatly stressed by the Government. People
had reached the point where they fell whole-heartedly in line with anything
the Government favored. Not only so but markets were good, wages were
high and the people were getting accustomed to the sound of big figures
when public appropriations were talked of. Forty or fifty thousand dollars
sounded like a family budget schedule compared with the gigantic sums
that Congress prodigiously appropriated daily for war activities and yet the
tuberculosis people asked for amounts of that character for sanitariums.

Furthermore, people had come to respond quickly and generously to the
"drive" method introduced by the Government in connection with the sale of
loan securities. The tuberculosis people were not slow to recognize the im-
portance of the drive and they utihzed this campaign methotl effectively in the
thirty-three counties.

Thus we find a jiroponent of the measure enthusiastically observing:

*"The table shows the result of the election in thirty-three Illinois
counties where the county tuberculosis sanitarium measure was sub-
mitted to a popular referendum.

"It was a landslide.

"The sanitarium proposition carried by an overwhelming majority
in every county. In nine counties more votes were polled on the sani-
tarium measure than were cast for United States Senator. There were
four issues, including the sanitarium proposition, on the little ballot,
and in twenty-one counties the sanitarium project led the entire ticket.

•niinois .\irow, December 1918.

THE TUBERCULOSIS SANITARIUM MOVEMENT

415

"There are 102 counties in Illinois. The majority of votes on the
sanitarium proposition in the thirty-three counties where the measure
was submitted to the people was 101,209, or nearly twice the majority
given the successful candidate for United States Senator in the entire
State. The sanitarium measure polled a larger majority in these thirty-
three counties than any other issue on the little ballot polled in the
entire State.

"This result astounded even the most sanguine of our enthusiastic
sanitarium boosters— and it was accomplished in the face of a series
of handicaps, the like of which is seldom encountered in any campaign."

Counties included in this "landslide" were:

Boone

Grundy

Marion

Bureau

Henry

Piatt

Christian

Jackson

Pike

Clark

Jefferson

Randolph

Clay

Kane

Scott

Coles

Lee

Stephenson

Crawford

Livingston

Tazewell

DeKalb

Logan

Vermilion

DeWitt

McDonough

Whiteside

Douglas

Macon

Will

Fulton

Madison

Woodford

Winnebago

Subsequently the project was voted on in six other counties. It was
carried in each. The counties and vears of election were :

Alexander*

1921

Knox

1920

Menard

1922

Montgomery

1920

Sangamon

1922

Shelby

1920

Sanitariums have not been constructed in all of the counties which levy
taxes for sanitarium purposes. The law does not make the acc[uisition of
a sanitarium mandatory but it does specify that the funds collected shall be
used for no purpose except to combat tuberculosis. Accordingly most of the
counties have seen fit to hire sanitarium care for their tuberculous citizens
rather than to construct and operate sanitariums of their own.

Thus at the close of 1927 there were 46 counties collecting taxes under
the provisions of the tuberculosis sanitarium law, commonly known as the
Glackin law, but only 15 of these counties owned sanitariums. Not only so
but sentiment favoring the construction of sanitariums is much milder now
than it was at the close of the World War. Depreciation of farm land values,
decline in the price of farm products and the rather chaotic condition of agri-
cultural economics in general have been very important factors at work on
the public mind in Illinois. These have influenced the trend away from addi-

•Subsequently .abandoned througli litigation initiated by certain ta-xpayers.

416 THE TL'BKKCUI-OSIS SAN ITAKIU.M MdVllMENT

tional tax Icsics and c^pcciallx for imrposcs like tuberculosis sanitariums.
It would prol)abl\ be ver\ difhcult tij carr\ an election now in any county of
the State where the sanitarium law is not already functioning. The project
mitjht even be defeated in some coimties that have already adopted it, were
the proposition iirou.nht to a vote.

Table 1.
County Tuiserculosis Sanit.\riu,ms in Illinois.

County Location Voted Opened Capacity

Adams Quincy, 111 1916 May 1,1920 60

DeKalb DeKalb, III 1918 1920 IS

Champaign Urbana, 111 1916 Feb. 16,1922 48

Cook Oak Forest, 111 1912 Jan. 22, 1912 634

Kane Aurora, III 1916 Sept. 1920 85

LaSalle Ottawa, 111 1916 Mar. 3,1919 60

Livingston Pontiac, 111 1916 Sept. 22, 1922 30

Macon Decatur, III 1918 July 14,1923 45

Madison Edwardsville. Ill 1918 May 6,1926 100

McDonough Bushnell, 111 1918 Jan. 14,1926 36

McLean Normal, 111 1916 Aug. 17,1919 56

Morgan Jacksonville, 111 1916 Feb. 1,1922 35

Tazewell Mackinaw, 111 1918 Sept. 11, 1921 41

Will Joliet, 111 1918 Apr. 1925 61

♦Winnebago Rocktord. Ill 1918 Jan. 1916 105

W^oodford Minonk, 111 1918 Mar. 1,1921 14

The Chicago Municipal Tuberculosis Sanitarium was the hrst public
institution of the kind to open in Illinois. It was authorized by jiopular vote
in 1909 and was opened to patients in 1913. It was not, of course, the first
tuberculosis sanitarium in the State. More than a dozen sanitariums and
preventoriums, promoted and operated by private individuals for profit and
by voluntary organizations for public benefit, were functioning prior to 1910
and had already demonstrated the important fact that tuberculous patients
could be successfullv treated under the climatic conditions found in Illinois.
This demonstration anil the momentum given to the movement through the
initiative of the voluntary organizations were very important factors in the
ultimate magnitude of the sanitarium program.

The first public count\ tuberculosis sanitarium to open in Illinois was
the one at Ottawa, La Salle County. This institution authorized at the ballot
box in 1916, was dedicated on Sunday, February 2, 1919, amid ceremonies
almost sacred in character. Dr. David R. Lyman of Wallingford, Connect-
icut, president of the Xational Tuberculosis .\ssociation and Dr. C. St. Clair

•First opened as a m\iiiicip.-il saiiit.aiium .I:in. I, 1!>1(1, taken nver and maintained bv i-.nnitv after

THE TUBERCULOSIS SAXUfAKIUM MOVEMENT 417

Drake, director of public health in Illinois at the time, participated in the
progi'am.

Table 2.
AIuNiciPAL Sanitariums in Illinois.

City Voted Opened Capacity

Chicago 1909 1915 1,101

Peoria 1913 or 1914 Feb., 1919 80

Rock Island 1910 Oct., 1916 *

Rockford 1914 1916 *

Table 3.
Tuberculosis Institutions in Illinois Prior to 1915.

Institution Location

Edwards Sanitarium Napervllle ....

Ottawa Tent Colony Ottawa

Illinois Homoepathic Open Air Sanitarium Buffalo Rock. .

Lake County Sanitarium Waukegan ....

Cook County Infirmary Tuberculosis Department.Oak Forest. . . .

Chicago Winfield Sanitarium Winfield

Springfield Open Air Colony Springfield ....

Harrison Tuberculosis Colony CloUinsville ....

Olney Sanitarium Olney

Ridge Farm Preventorium Deerfield

Lake Breeze Sanitarium Waukegan ....

Chicago Fresh Air Hospital Clhicago

Otto Young Pavilion — Home for Incurables Chicago

Cook County Hospital, Tuberculosi.s Department. I^hicago

It seems fittingly coincidental that the first public cuunty sanitarium in
the State opened at Ottawa. There Dr. J. W. Pettit, moving spirit in the
initiative efforts that started the anti-tuberculosis movement in Illinois, made
his home. There Dr. Pettit had opened in 1904 a tent colony for tuberculous
patients, the very first institution of a sanitarium character in Illinois. There
Dr. Pettit had demonstrated to his own satisfaction the possibilities of suc-
cessfiJly managing tuberculous patients i:i this latitude, a knowledge in
which he found an inspiration that led to the organization of the Illinois
Tuberculosis Association.

Similarly there are stories filled with human interest features, manifest-
ing hope, confidence and faith in the possibilities of medical science and be-
traying a deep sympathy for the unfortunate victims of a wasting disease,
that associate themselves with the construction and final opening of many

^Converted into county sanitar

PUBLIC 5AniTARlUM5

COUMTY TUBERCUL05/5 ^
MUNICIPAL TUBEROJLOSIS "ff

SAMITARIUM TAX LEVY C^
Alexander County Collected Tax under the Glatkiu Law tor One Year Only.

THE TUBERCULOSIS SANITARIUM MOVEMENT

419

of the county sanitariums. Thus "Hillcrest", the Adams County sanitarium,
located at Quincy, was started hy the D. A. R. as a memorial to Mrs. T.
Woodruff. A public tax for carrying out the project to a successful culmina-
tion was voted in 1916 and subsequently the institution became the beneficiary
of gifts left by Mrs. Rose Neal of Mention and others.

Table 4.
Functional Cii.\racteristics of County Sanitariums.

County

Appropriations

No.
Patients
Present
May 1928

Field
Workers
1927-28

Outside

Clinics

1927

Number
employees

1927

1928

Adams

$40,000

$48,000

DeKalb

25,000

20,000

Champaign

45,000

Cook

150,480*

150,000

531

Kane

48,000

LaSalle

37,500

30,000

Livingston

20,000

"62

Madison

82,000

Macon

80,000

McDonougli

35,000