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SECOND ANNUAL REPORT
OF THB
COMMISSIONER OF HEALTH
OP THE
COMMONWEALTH OF PENNSYLVANIA.
HARRISBURQ, PA.:
HARRISBURG PUBLISHING CO., STATE PRINTER.
1908.
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OFFICIAIi DOCUMBNT. Mo. IC
TABLE OF CONTENTS.
Lietter of Transniittal,
Second ifuiniial report of the CowarAaaioa&r,
Completion of the organiaaition of the Department,
Medical Inspection,
Supervision of Iiooal Boards,
Vital etatlrtica
Morbidity StatlsUcs,
Marriage StatieticB
Re^iatrars aiMl Sab-ResistrarB,
Proteotion of water supplies
Antitoxin distribution,
Ijaboraitory work,
Appointments,
County Medical Inspectors,
Action of the Advisory Board,
Roster, 10
Sanitary Lesrl0laUo<n of 1907, 16
Control of Tuberculosis IB
Tuberculosis Sanatoria 19
Tuberculosis Dispensaries 90
Sewerage at Hanisburg, 22
Drinking water on railroad trains, 22
Sanitary precautions at Mt. Qreitna, 22
Mortality, »
Frevalenoe of Comanunicable Diseases, 26
SmaltLpox, 26
Tuberculosis, 26
Typhoid fever, 26
Scartet fever, 26
Measles 26
Wboopln«r ooiigh 26
Diphtheria, 26
IjBfproey, 27
Acute infantile pcualysis, 80
Digest of Sanitary Laws of the Commonwealth 81
MairriageB, 81
Births 81
Conferences and conventions, 86
Operations of the Divisions 89
Division of Medical Indn>ection, 41
Sub-DlvlsSon, Tuberculosis Dispensaries, 66
Sub-Division, Stpecftal Medical Inspection, 61
Sub-DiTtoion, School Inspection, 68
Division of Laboratories, . 86
Division of BureeAi of Vital Statistics 166
Sub-Division Morbidity Stajtistics, 885
Sub-D&vision Marriage Statistics M6
Division of Distribution of Biological Products, 868
Division of Accounts 886
Store Room 896
Special Reports, 899
Pennsylvania State South Mountain Sanatorium, 401
(!)
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SECOND ANNUAL. REPORT OF THE Off. Doc.
Pa«e.
The Detection of the Bax^Uiu Typhosus diurinir the ScramUm
Elpideixilc of Typhoid Fever 410
Epidemic of Acute An/tertor PoUomyeUtiB 420
Epidemic of Typhoid F^ver at Ridgrwiay, 441
DiB.xi«:er of fire in Formaldehyde Diainfeotion, 451
Division of Saniitary Englneerinsr 468
Organization and Admdnistration, 466
Office work 461
Corporation Refports, 461
Recorded Flans 461
Petitions and Complaints 461
Nuisances in Streams by industrial wastes, 463
Orders of abatement 466
DrafUniT. 466
Englneerinsr, 467
Applications for Berwnge Disposal Plants 467
AppHceitlons for Water Filtration Plants, 468
Wiater Works, 469
Water Works Permdits and Decrees issued by the Oommis-
sioner, 469
Seweraire, 663
Sewerage and 9erwa«re Disposal Permits and Decrees Issued by
the Commllssioaer 663
Designs and Oonstruction 811
Preliminary Work at Pennsylvania South Mounitain Seuia-
torimn , 811
Sanitary Survey of Mount Oreftna Park 8S9
Rallroiad Waiter Suipply 861
Delaware River Statistics, « 862
Delaware River Basin 863
SchuylklU River Watershed, 868
Field Inspection 876
Epidemics, 882
Scranton, T3rpboid Fever 882
EittanniliDg, Tjrphoid Fever 900
Spansrter, Typhoid Fever, 914
Manhelm, Typhoid Fever, 919
East Conemiaug-h and Fk^ankllni, Typhoid Fever 924
RidfiTway, Typhoid Fever, 927
Bumiiam, Typhoid Fever 967
Oorry, Anthrax 941
References to Special Ooiainsel, 948
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OFFICIAL DOCUMHSNT, No. 16.
LETTER OF TRANSMITTAL.
Commonwealth of Pennsylvania^
Department of Health,
State Capitol, Harrisburg,
December 12, 1908.
To His Excellency, Edwin S. Stuart, Governor of Pennsylvania:
Sir : In compliance with the requirements of Section 13 of the act
^'Creating a Department of Health and defining its powers and
duties" approved the 27th day of April, A. D. 1905, I have the honor
to transmit my Second Annual Report, for the year 1907.
SAMUEL G. DIXON,
Commissioner of Health.
CD
1—16—1907
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OFPICIAT. DOCUMENT, No. 16.
I ■ —
SECOND ANNUAL REPORT
OF THE
COMMISSIONER OF HEALTH
OF THE
COMMONWEALTH OF PENNSYLYANIA
Presented by the Commissioner, SAMUEL G. DIXON, M. D.
December 12, 1908.
The opening of the year 1907 found the Department of Health
fairly well organized in all its divisions, Dr. Benjamin Lee continuing
to hold the position of Assistant to the Commissioner, and Mr. Wil-
bur Morse, that of Secretary to the Commissioner. The Divisions
were, first the Division of Medical Inspection, having subsidiary
general jurisdiction over the whole field of communicable diseases.
All reports of epidemics and the daily reports of physicians in the
rural districts of contagious and infectious diseases occurring in
their practice are referred to this Division either directly or through
the local Health OflScers. Whenever in any locality an increased
number of the ordinary communicable diseases or a single case of
smallpox is reported, an inspection is made by the County Medical
Inspector and appropriate measures are taken to put an end to the
outbreak. A card index of all communicable diseases with places
and dates of occurrence is kept in this division, and also a map
marked with colored pins for ready reference. The Chief Medical
Inspector since the inauguration of the Department, has been Dr.
Fred O. Johnson, of Bradford, McKean county. His assistant is
(3)
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4 SECOND ANNUAL. REPORT OF THE Off. Doc.
Dr. Arthur B. Moulton, of Camp Hill, Cumberland county. The
local working force of the Division consists of some seven hundred
township Health OflScers, appointed by the Commissioner and re-
sponsible only to him. Working in harmony with this force are the
sixty-seven County Medical Inspectors, one in each county, and the
Railroad Medical Inspectors of the three great trunk line railroads,
whole duties are confined to the supervision of the properties, trains
and passengers of their respective companies.
A weak place however in the practical administration of the
health affairs of the State was found to be the absence or inefficiency
of municipal health authorities in many first-class townships and
boroughs as well as in some cities. The former relationship of the
rural to the civic communities as regards sanitary regulations was
beginning to be reversed. Our township health officers constantly
found themselves embarrassed in the enforcement of the rules of the
Department from the fact that the boroughs adjoining their dis-
tricts either had no health boards or that their boards were extremely
lax in the enforcement of the rules, if indeed they had formulated
any regulations. In many instances, townships of the first-class had
not availed themselves of the opportunity afforded by the Legis-
lature for establishing boards of health.
In order to remedy this unfortunate condition, Dr. John A. Bouse,
of Chambersburg, was appointed Special Medical Inspector, with the
duty of visiting all boroughs and townships where the described
defective conditions existed and impressing upon the authorities the
importance of completing their organization in the interest of the
public health and of complying strictly with the requirements of the
law and the regulations of the Department.
Second, the Bureau of Vital Statistics, under the superintendence
of Dr. Wilmer R. Batt, State Registrar, has been through its 972
local registrars and 238 sub-registrars, collecting statistics of births
and deaths, in a manner which won for the Department the admira-
tion of the Chief of the U. S. Census Bureau, and an immediate
place in the list of Registration States.
The machinery of this Bureau had also been utilized for the main-
tenance of a Third Division, that of Morbidity Statistics, through
which the Commissioner was able to keep constantly in touch with
the fluctuations of the public health as affected by communicable
diseases in every corner of the State.
Fourth, the Registration of Marriages has also been maintained
through the same Bureau.
Fifth, the Division of Sanitary Engineering, of which F. Herbert
Snow, C. E., is Chief, employs four Engineers, one Chief of Designs,
one Chief Draftsman, six Draftsmen and twenty-five Sanitary In-
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No. 16. COMMISSIONER OF HEALTH. 5
8I)ectors. All applications for permits to establish or enlarge water
supplies or sewerage systems are referred to this Division for in-
vestigation and report. The reports are then submitted to the Gov-
ernor and the Attorney General, who together with the Conunissioner
of Health, have the duty of final decision. All complaints of pollu-
tion of water supplies come within its jurisdiction and it naturally
acts in co-operation with the Division of Medical Inspection in the
management of epidemics of typhoid fever and other water-borne
diseases.
Sixth, the Division of Distribution of Antitoxins and Vaccines,
under the charge of Henry W. Peirson, of Philadelphia, as Chief
Clerk, was already actively engaged in the distribution of Antitoxin,
through its 515 Distributors, in all the most accessible centers of
population in the State. The depots are at all times kept fully
stocked ready for any emergency, and the system had already justi-
fied its existence by a steady and remarkable reduction in the death
rate from diphtheria.
Seventh, the Division of Laboratories and Experiment Station,
established in the magnificent Pathological Laboratory Building of
the University of Pennsylvania, through the generosity of the Di-
rectors of that Institution, under the management of Dr. Allen J.
Smith, Director of Pathology, and Dr. Herbert Fox, Chief of the
I^aboratories of the Department, had already been for several months
examining pathological specimens presented by physicians, while D.
Rivas had been prosecuting original research work and examining
samples of water. The Bacillus Typhosus in the water-supply of the
city of Scranton, then in the throes of an epidemic of typhoid fever,
had been isolated and the source of the outbreak definitely decided.
In addition to the routine analysis work performed at the Labora-
tory, original research work is being actively prosecuted at the Ex-
periment Station at White Hall, near Bryn Mawr, Montgomery
county.
To carry on the clerical work required by the Commissioner and
the several divisions necessitated a force of one secretary, two book-
keepers, nineteen clerks, and nineteen stenographers, many of them
frequently working until late in the night.
The active force in the field and throughout the State compre-
hended 700 Township Health Officers, 972 Registrars and Sub-Regis-
trars, 515 Distributors of Antitoxin, 67 County Medical Inspectors,
135 Railroad Inspectors and 47 Engineers, Field Officers and In-
spectors, besides nurses, and helpers — and other employes.
The creation of such an organization, each individual of which
needed to be the subject of special investigation, within a compara-
tively brief period, was in itself a task of no small moment, and
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6 SECOND ANNUAL REPORT OF THE Off. Doc.
indicates not only that no time has been lost, but that the Depart-
ment had surveyed the field before it from a broad standpoint and
endeavored to compass all the pressing sanitary needs of the State
as contemplated by the then existing legislation.
Among the duties assigned to the Commissioner are those belong-
ing to members of the Water Supply Commission, the State Quar-
antine Board, the Medical Council of Pennsylvania, and the Dental
Council of Pennsylvania — of all which he is a statutory member and
which taken collectively make a considerable demand upon his time.
One of the duties imposed upon the Commissioner, is that of
"suggesting any further legislative action or precaution deemed nec-
essary for the better protection of life and health."
The report of the Registrar of Vital Statistics placed the Depart-
ment in possession of the startling fact that in the year 1906 the
deaths from Tuberculosis in all its forms in Pennsylvania, reached
the alarming figure of 10,652. If we accept the estimate of those
who have made a special study of this subject, that for every death
from consumption there are seven living consumptives, this would
mean that in addition to those prematurely cut off and lost to the
State, there were between 60,000 and 70,000 individuals whose pro-
ductive capacity was not only either destroyed or greatly impaired,
but many of whom were, also in addition, a burden to their families
and friends and probably to the community.
Over against this was the fact that beyond the amounts contrib-
uted to South Mountain Sanatorium at Mont Alto, and a few private
hospitals and sanatoriums, amounting altogether to |77,500.00, the
State was doing nothing officially to meet this appalling condition.
The Department felt that this knowledge imposed upon it a respon-
sibility for bringing to bear for the diminution of this scourge all
the resources of modem medicine on a scope commensurate with the
wealth and dignity of the Commonwealth, and the magnitude of the
problem.
The Republican party in the State took up the question with
great seriousness, and inserted a plank in its platform pledging the
party to adopt measures at the meeting of the next Legislature, to
begin an efficient movement to remedy this great evil. In conference
with His Excellency, Governor Stuart, the Commissioner suggested
a general scheme of operations, which met the approval of the
former. Bills were, therefore, prepared and presented to the Legis-
lature early in the session of 1907, which provided for the appropria-
tion of the sum of one million dollars for this purpose.
The first of these acts was entitled : An Act "To provide for the
establishing and maintenance of one or more Sanatoria or colonies
in Pennsylvania for the free care and treatment of indigent persons
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No. U.
COMMISSIONER OF HBALTH.
suflFering from Tabercnlosis and making an appropriation therefor."
It pledged the Department to the establishment of a Tuberculosis
Dispensary in every county of the State, not only "for the free treat-
ment of indigent persons suffering from Tuberculosis," but also "for
the dissemination of knowledge relating to the prevention and cure
of Tuberculosis, and for the study of social and occupational con-
ditions that predispose to its development." It then provided that
one or more Sanatoria or colonies should be established in the State
for the treatment of indigent persons suffering from Tuberculosis
and authorized the Department of Health with the approval of the
Governor, to acquire property and erect the necessary buildings for
this purpose. A third purpose contemplated by the Legislature was
continuing research experiments for the establishment of possible
immunity and cure of said disease. This work had already been
b^;un by Dr. Herbert Fox, Chief of the Laboratories.
In accordance with the Legislative program, the care of the Dis-
pensaries has been assigned to the County Medical Inspectors, and
inasmuch as it was essential that these oflScers should be thoroughly
versed in the diagnosis and modem treatment of Tuberculosis, it
became necessary to make some changes in the corps. The following
are the recent appointments, made on this account :
Oonnty.
Pliyilclazui.
Town.
Adamv
J R. DlckBon
Gettysburff.
Emporium.
Ma.pch Chunk.
Cameron
W. 8. Falk
Carlton, '
J. K. Henry,
Chester
Joa. Bcattergood,
West Chester.
Clarion*
J. T. Rimer
Clarion.
Crawford
J. K Roberts
Meadvllle.
l4inoftat/pr ....
J. Ifc Mowery*
Lancaster.
LetiAnon, '
J. K Rleeel ".
Lebanon.
LfOxeme
C. H. Miner
Wilkes- Barre.
McKean
W C Hog'an,
Bradford.
Wrstraoreland
I. M. Portaer
Oreensburv.
York
York .'.
J. T Miller *
The passage of the bills above referred to, at once necessitated
the appointment of responsible physicians to supervise the installa-
tion and equipment of the numerous dispensaries and to assume the
superintendence of the Sanatorium contemplated in the act. To fill
these important positions, Dr. Thomas H. A. Stites, of Scranton, was
appointed Medical Inspector of Dispensaries, and Dr. A. M. Both-
rock, Resident Physician of the Pennsylvania State South Mountain
Sanatorium at Mont Alto, Franklin county.
ACTION OF THE ADVISORY BOARD.
The Advisory Board held one meeting during the year, on July
25tfa, at the office of the Commissioner.
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8 SECOND ANNUAL. REIPORT OF THE) Off. Doc.
The personnel of the Board is unchanged. It consists therefore of
Doctors Samuel T. Davis, of Lancaster; Adolph Koenig, of Pittsbnrg;
Leonard Pearson, of Philadelphia; Charles B. Penrose, of Philadel-
phia; B. H. Warren, of West Chester, and Lee Masterton, C. E., of
Johnstown.
At this meeting the Rules and Regulations of the Department
governing the reporting of communicable diseases were amended as
follows: The provision requiring all physicians practicing in town-
ships to report immediately to the County Medical Inspectors of their
respective counties was amended to require said physicians to report
to the Health Officers of the townships in which the patient may be
located.
It was also provided that in cities or boroughs having no sanitary
authorities and in case of a known vacancy in the office of Health
Officer in township, the report of such cases shall be made directly
to the State Department.
In the case of such diseases occurring in hospitals situated in
cities or boroughs it was ruled that the physicians or other authori-
ties shall make report of such cases, if occurring in cities or bor-
oughs, to the local health authorities, daily, and, if occurring outside
of cities or boroughs, to the Department of Health at Harrisburg,
weekly. In the case of such diseases occurring in hospitals situated
in townships, the reports shall be made to the health authorities of
the city or boroughs from which the cases have been received daily,
but if no such health authorities exist, to the Department of Health
at Harrisburg, and all cases received from the township shall be re-
ported weekly to the State Department.
If no cases of such diseases shall have occurred in a city or bor-
ough during a calendar month, the fact shall be reported by the
sanitary authority of said city or borough to the State Department
at the end of such month on cards supplied for this purpose.
The diseases referred to are as follows: Actinomycosis, Anthrax,
Bubonic Plague, Cerebrospinal Meningitis (Spotted Fever), Chicken-
pox, Cholera, Diphtheria (So-called Membraneous Croup, Diphther-
itic Croup and Putrid Sore Throat should be reported as Diphtheria),
Epidemic Dysentery, Erysipelas, German Measles, Glanders, Hydro-
phobia, Leprosy, Malarial Fever, Measles, Mumps, Pneumonia (true).
Puerperal Fever, Relapsing Fever, Scarlet Fever (So-called Scarla-
tina and Scarlet Rash should be reported as Scarlet Fever), Small-
pox, Tetanus, Trachoma, Trichiniasis, Tuberculosis (specify form).
Typhoid Fever, Typhus Fever, Whoopingcough and Yellow Fever.
In reference to the period of quarantine for Scarlet Fever it was
ruled that it should be 30 days from the date of onset of the disease
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No. 1$, COMMISSIONER OF HEALTH. »
provided that at the end of the period the physician in charge shall
certify in writing that desquamation has entirely and absolutely
ceased.
A resolution was adopted expressing the opinion of the Advisory
Board and the Commissioner that a person who has had the opera-
tion for vaccination faithfully performed three times, at intervals of
two successive weeks without success is for the time being immune
from Smallpox^ and, further, that under the present law persons who
have a written certificate from a reputable physician that two such
attempts to vaccinate were faithfully performed and a second cer-
tificate from a physician of the State Department of Health or of
a Board or Bureau of a City or Borough may be admitted to school
for one year without violating the spirit of the law, the object of
which is simply to prevent the spread of Smallpox.
The following regulations were also adopted:
Absolute quarantine shall be enforced in the case of the follow-
inging diseases, viz: Bubonic Plague, Leprosy, Cholera, Smallpox,
Typhus Fever, and Yellow Fever.
Absolute quarantine was defined to mean — first, absolute prohibi-
tion of entrance to or exit from the building or conveyance except
by officers or attendants authorized by the health authorities and the
placing of guards if necessary to enforce this prohibition; second,
the posting of a warning placard which states the name of the dis-
ease in a conspicuous place, or places, outside of the building or con-
veyance; third, the prohibition of the passing out of any object or
material from the quarantined house or conveyance; fourth, pro-
vision for conveying the necessaries of life, under careful restric-
tionsy to those in quarantine.
(Note. Since these diseases with the exception of Smallpox rarely
occur in this Commonwealth, when reported, special instructions
will be issued by this Department governing the individual cases.)
Modified quarantine shall be enforced in the following diseases,
provided that if in any case modified quarantine is violated, abso-
lute quarantine shall at once be enforced, viz :
Epidemic Cerebrospinal Meningitis (Spotted Fever), Diphtheria,
Measles, Scarlet Fever, and Relapsing Fever.
Modified quarantine was defined to mean, first, prohibition of en-
trance and exit as in absolute quarantine, except in the case of
certain members of the family authorized by the health authorities
to pass in and out under certain definite restrictions; second, the
placing of a placard as before; third, isolation of patient and attend-
ant; fourth, prohibition of the carrying out of any object or material
unless the same shall have been thoroughly disinfected. Under
modified quarantine the wage earner is allowed to continue work,
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10 SECOND ANNUAL. RiaPORT OP THE) Off. Doc.
provided he at no time comes in contact with the patient and that
he has a room entirely separated from the patient and those attend-
ing the same as provided in instructions on isolation. In permitting
householders and wage earners to continue work when cases of
Diphtheria, Scarlet Fever, Epidemic Cerebrospinal Meningitis (Spot-
ted Fever) or Measles appear upon the premises, the greatest care
should be taken to prevent the carrying of the infection, and such
person shall not be employed in an establishment in which is con-
ducted the production, manufacture or sale of fabrics, wearing
apparel, upholstered furniture, bedding, foodstuffs, cigars, cigarettes,
candy, etc. If so employed he should leave the premises after taking
an antiseptic bath, and having his clothing disinfected and thereafter
remain away from the premises up to the time of the recovery of
the last patient and the disinfection of the household.
I desire to express my obligations to the Advisory Board for their
wise counsel and for their readiness to sustain me in every measure
suggested for the maintenance of the public health.
At the end of the year the organization of the Department was as
follows :
Commissioner of Health, Samuel G. Dixon, M. D.
Advisory Board, Samuel T. Davis, M. D.; Adolph Eoenig, M. D.;
Lee Masterton, C. E. ; Leonard Pearson, M. D. ; Charles B. Penrose,
M. D.; B. H. Warren, M. D.
Assistant to the Commissioner, Benjamin Lee, M. D.
Secretary to the Commissioner, Wilbur Morse.
Stenographers, Miss Ivy E. Huber, Miss Mary Stephen Mark.
Messenger, Edward F. Eisely.
Janitor, John B. Sample.
Medical Division, Chief Medical Inspector, Frederick C. Johnson,
M. D.
Assistant to Chief Medical Inspector, Arthur B. Moulton, M. D.
Stenographers, Miss Fannie A. Houseknecht, Miss Dorothy Ster-
line.
Medical Inspector of Tuberculosis Dispensaries, Thomas H. A.
Stites, M. D.
Stenographer, Miss Olive E. Jamison.
Resident Physician of Mont Alto Tuberculosis Sanatorium, A. M.
Eothrock, M. D.
Special Medical Inspector, John A. Bouse, M. D.
The Department also employs seven hundred or more township
health olDScers whose duties are somewhat similar to those of health
officers in cities and boroughs.
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No. 16.
COMMISSIONER OF HBALiTH.
COUNTY MEDICAL INSPECTORS.
11
Ocmnty.
Inspector.
Post Offlotk
Aduns,
Allesbeny
ArmBtronr.
Beaver.
Bedford
Blair.
Bradford,
Berks
Backs
Butler
Cambria.
Ghmeron,
Ou'tion,
Centre
Chester.
Clartoa.
Clearfleld
Clinton.
Columbia
Crawford,
Cumberland,
Dauphin
Delaware.
Elk
Erie
F^rette
Ftaiest,
Franklin and Fulton,
Greene.
Huntingdon,
Indiana.
Jefferson,
Juniata
Lackawanna.
Lancaster
Lawrence
Lehigh
Lebanon.
Luseme
LgrcomlnflT
McKean
Mercer.
MUOm
Monroe.
Montgomery.
Montour
Northampton,
Northumberland
Perry.
Pike
Potter.
Schuylkill
Snyder.
Somerset.
SulUvan.
Susquehanna.
Tioga,
Union
Venango.
Warren
Washington.
Wayne,
Westmoreland
Wyoming,
York.
a. Rice.
S. M. Rlnehart
T. N. McKee
E. & H. McCauley.
W. de La M. Hill. .
Wm. M. Flndley. ...
S. M. Woodbum. ..
Israel Cleaver,
James E. Qroff
H. D. Hockenberry,
Wm. E. Matthews. .
H. S. Falk.
John K. Henry
Oeorge F. Harris, ..
Joseph Scattergood.
J. T. Rimer.
Spencer M. Free. ....
R. B. Watson
S. B. Arment
J. M. Cooper
Harvey B. Bashorc,
Paul A. Hartman. .,
Robert S. Malson
W. L. Williams
J. W. WWght,
T. H. White
F. J. Bovard.
H. X. Bonbrake
John T. lans
A. B. Brumbaugh, .
N. F. Ehrenfeld. ..
W. W. Watson
William H. Banks.
H. V. Logan.
J. L. Mowery,
J. D. Moore
Morris F. Cawley, .
A. J. Riegel.
C. H. Miner
Frank Seely
W. C. Hogan
P. P. Fisher,
A. T. Hamilton, ...
W. B. Oregory
R. H. Whitcomb. ..
Edward A. Curry. ..
Thomas C. ZuUck. .
A. C. Clark,'
A. R. Johnston. ....
Wm. B. Kenworthy.
B. H. Ashcraft. ...
Daniel Dechert
P. J. WagenseUer. .
Charles P. Large, ..
J. L. Christian
H. B. Lathrop.
B. P. Hakes
C. H. Dlmm
J. T. Strayer
W. M. Robertson. ..
C. B. Wood,
H. B. Ely. ,
I. M. Portser
B. B. Bidleman.
L C. Qable
McSherrystown.
Allegheny.
Klttannlng.
Beaver.
Everett.
Altoona.
Towanda.
Reading.
Doyleslown.
West Sunbury.
Johnstown.
Emporium.
Mauch Chunk.
Bellefonte.
West Chester.
Clarion.
DuBols.
Lock Haven.
Bloomsburg.
Meadvllle.
West Falrvlew.
Harrlsburg.
Chester.
RIdgway.
Erie.
ConnellsvlUe.
Tlonesta.
Chambersburg.
Waynesburg.
Huntingdon.
Indiana.
Brookvllle.
Mlinintown.
Scranton.
Lancaster.
New Castle.
Allentown.
Lebanon.
WUkes-Barre.
Jersey Shore.
Bradford.
Sharon.
Lewlstown.
Stroudsburg.
Norristown.
Danville.
Easton.
Sunbury.
New Bloomfleld.
Mllford.
Coudersport.
Schuylkill Haven.
8<>linBgrove.
Meyersdale.
Lopes.
SprlngvlUe.
Tioga.
Mlfflinburg.
on City.
Warren.
Monongahela.
Honesdale.
Greensburg.
Tunkhannock.
York.
RAILROAD MEDICAL INSPECTORS.
(OommiMsioned by the Commissioner of Health but not paid by the State.)
PENNSYLVANIA RAILROAD COMPANT.
Dr. S. W. Latta, Chief Medical Inspector, Philadelphia; Dr. D. W.
Nead, Philadelphia; Dr. I. H. Boyd, Philadelphia; Dr. E. C. Town,
Philadelphia; Dr. J. L. Bower, Reading; Dr. J. L. Wright, Columbia;
)igitized by V \
12 SECOND ANNUAL. REPORT OF THE Off. Doc.
Dr. W. T. Bishop, York; Dr. S. M. Crawford, Harrisburg; Dr. A. T.
Poflfenberger, Sunbury; Dr. C. J. Roberts, Williamsport ; Dr. J. B.
Lincoln, Benovo; Dr. S. A. Bonnafon, Erie; Dr. R. H. Moore, Hunt-
ingdon; Dr. H. W. Pownall, Tyrone; Dr. W. B. Diefenderfer, Al-
toona ; Dr. C. F. Hongh, Cresson ; Dr. C. W. Banks, Derry ; Dr. D. N.
Easter, Yonngwood; Dr. W. K. T. Sanm, Pittsbnrg; Dr. J. B. Hile-
man, Pitcairn; Dr. J. C. Lemmer, Oil City; Dr. W. B. Reynolds,
Clean, and Dr. H. E. Westhaeffer, Monongahela City.
PHILADELPHIA AND READING RAILWAY COMPANY.
Dr. Caspar Morris, Chief Medical Inspector, 227 South Fourth
street, Philadelphia; Dr. Frederick E. Brister, Philadelphia; Dr.
Francis S. Ferris, Philadelphia; Dr. Norris S. McDowell, Philadel-
phia; Dr. Charles F. Detweiler, Reading; Dr. J. Henry Orflf, Reading;
Dr. Thomas F. Heebner, Pottsville; Dr. Albert F. Bronson, Tamaqua,
and Dr. William R. Brothers, Harrisburg.
BALTIMORE AND OHIO RAILROAD COMPANY.
Dr. John L. Burkholder, New Castle Junction ; Dr. I. D. Chaney,
Connellsville; Dr. E. A. Fleetwood, Pittsburg; Dr. W. A. Funk,
Pittsburg; Dr. G. R. Gaver, Pittsburg; Dr. M. H. Koehler, Connells-
ville; Dr. A, L. Porter, Philadelphia; Dr. W. B. Rogers, Pittsburg;
Dr. D. E. Stephen, New Castle Junction; Dr. H. F. Atkinson, Con-
nellsville; Dr. W. J. Bailey, Connellsville; Dr. E. M. Baker, Valencia;
Dr. H. Baker, Connellsville ; Dr. J. A. Batton, Uniontown ; Dr. J. E.
S. Bell, 5221 Second Ave., Pittsburg; Dr. H. J. Bell, Dawson; Dr.
J. B. Black, Cristy Park; Dr. F. C. Blessing, 5442 Second Ave., Pitts-
burg; Dr. Robert W. Brace, 2825 Wharton street, Philadelphia; Dr.
W. J. Bryson, 5424 Second Ave., Pittsburg; Dr. L. N. Burchinal,
Point Marion ; Dr. M. C. Cameron, 190 43d street, Pittsburg ; Dr. W.
H. Cameron, 190 43d street, Pittsburg ; Dr. C. L. Clover, Knox ; Dr.
John B. Critchfield, Ralphton ; Dr. Arthur E. Crow, Uniontown ; Dr.
0. L. Curll, 99 Hazlewood Ave., Hazlewood, Pittsburg; Dr. C. L.
DeWolfe, Chicora; Dr. W. L. DeWolfe, Butler; Dr. E. L. Dickey, St.
Petersburg; Dr. W. F. Donaldson, 1007 Wylie Ave., Pittsburg; Dr.
E. A. Donnon, New Castle; Dr. F. H. Evans, Chester; Dr. John
Foster, New Castle; Dr. W. S. Foster, 252 Shady Ave., Pittsburg;
Dr. J. S. Garman, Berlin; Dr. W. A. Garman, Berlin; Dr. W. D.
Haight, Johnstown ; Dr. H. R. Hardtmayer, 823 Liberty street, Alle-
gheny; Dr. James M. Hess, Marienville; Dr. Hiram Hiller, Chester;
Dr. A. M. Hoover, Parker's Landing; Dr. E. O. Kane, Kane; Dr. T.
L. Kane, Kane ; Dr. A. M. Lichty, Elk Lick ; Dr. Bruce Lichty, Mey;
ersdale; Dr. D. C. Lindley, New Castle; Dr. A. K. Lyon, 413 North
Ave., Millvale Sta., Allegheny ; Dr. H. I. Marsden, Somerset ; Dr. F.
Digitized by VjOOQIC
No, 16. COMMISSIONER OF HEALTH. 18
li. Marsh, Mt, Pleasant; Dr. Q. B. Masters, Bockwood; Dr. B. S.
McKee, New Haven; Dr. W. T. Messmore, Smithfield; Dr. H. A.
Miller, 219 6th street, Pittsburg; Dr. E. S. Montgomery, 219 6th
street, Pittsbui^;Dr. E. J. Morris, 128 South 18th street, Philadelphia ;
Dr. William P. Morrison, 1929 Ritner street, Philadelphia; Dr. W.
8. Mountain, Confluence; Dr. W. D. O'Brien, 99 Hazlewood Ave.,
Hazlewood, Pittsburg; Dr. Benjamin W. Phillips, Tylersburg; Dr.
R H. Pillow, Butler; Dr. R. T. Pollard, Garrett; Dr. J. H. Price,
Allison Park; Dr. S. E. Ralston, Zelienople; Dr. D. T. Rees, Hynd-
man; Dr. P. P. Righter, Markleton; Dr. W. P. Robeson, Westing-
house Building, Pittsburg; Dr. J. Q. Robinson, West Newton; Dr.
C. C Ross, Clarion; Dr. W. T. Rowe, Meyersdale; Dr. J. H. Shan-
non, Washington; Dr. W. A. Shannon, Ellwood City; Dr. J. C. Sheri-
dan, Johnstown; Dr. M. B. Shupe, Connellsville ; Dr. A. R. Shuster,
Pinleyville; Dr. J. N. Sprowls, Claysville; Dr. W. S. Stewart, Brad-
dock; Dr. C. J. Styber, 865 Liberty street, Allegheny; Dr. V. F.
Thomas, Evans City; Dr. B. Thompson. Landenburg; Dr. W. R.
Thompson, Washington; Dr. J. N. Timmons, West Alexander; Dr.
A. W. Urmson, New Castle; Dr. W. E. Walker, McKeesport; Dr.
W. W. Weaver, 6105 Woodland Ave., Philadelphia; Dr. F. H. Weid-
mann, Confluence; Dr. T. H. White, Connellsville; Dr. C. H. Wilson,
5448 Second Ave., Glenwood; Dr. H. R. Wilson, Callery; Dr. W. M.
Woodward, McKeesport; Dr. H. A. Zimmerman, Hollsopple.
CENTRAL. BUREAU OF VITAL, STATISTICS.
State Registrar, Wilmer R. Batt, M. D.
Chief Clerk, Herbert B. Nelson.
Clerks, Elmer W. Ehler, H. E. Fox.
Stenographers, Miss Emma R. Longenecker, Miss Lilla H. Con-
oily, Miss Lillian H. ShaflFer, Miss Anna Magdeburg, Miss Margaret
D. Prescott.
Morbidity Statistics Sub-Division, in charge of Wilmer R. Batt,
M. D.
Clerks, Miss Harriet Morley, Mrs. Edith L. M. Huber, Miss Kath-
arine Irene McCalley, Miss Martha E. McGranagan.
Marriage Statistics Sub-Division, in charge of Wilmer R. Batt,
M.D.
Clerks, Miss Emilie Charters, Miss Teresa Neupert, Miss Josephine
Suavely, Miss Martha Ziegler.
DIVISION OF SANITARY ENQINHERING.
Chief Engineer, F. Herbert Snow, C. E.
Principal Assistant Engineer, in charge of general ofSce work,
Walter 8. Hanna.
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14 SECOND ANNUAL. REPORT OF THE Off. Doc.
Principal Assistant Engineer, in charge of special investigation,
Charles H. Cnmmings.
Principal Assistant Engineer, in charge of design and construc-
tion, Thomas Fleming.
Assistant Engineer, William H. Ennis.
Engineer and Draftsman, John M. Mahon, Jr.
Chief Draftsman, James L. W. Oibbs.
Engineering Inspector, H. A. Otto.
Engineering Inspector, F. L. Gardner.
Transitmen, Chester A. Eckbert, C. R. Forbes.
Bodmen, Edgar B. Barnes, Ivan M. Glace.
Tracers, J. W. German, Jr., Max Matthes, F. M. Sonrbeer, Jr.
Chief Clerk in charge of nuisance complaints, Daniel V. Ness.
Chief Clerk in charge of local health officer work, B. C. Dickinson.
Clerk, Mrs. Ellen Johnston.
Stenographers, Miss M. Irene Cuenot, Miss M. Louise Eckels, Miss
Jane Gilbert, Miss M. Ethel Hurst, Miss Marie Fasey, Miss Mary E.
Bussel, Miss Mary K. Sourbeer.
Chief Sanitary Inspector, M. K. Ely.
Field Officers in charge, James M. Clark, David H. Coleman, John
J. Considine, J. B. Nightingale, John W. Pinkham, William B. Teats.
Special Field Inspectors, Wilson W. Bitter, t>aniel Zellers, Ira F.
Ziegler.
Field Officers, Henry Andrews, W. B. Claypool, John W. Downes,
Bichard F. Einstein, Morris Z. Frederick, Howard M. Haines, Thom-
as Hickey, Warren S. Hood, J. Alfred Judge, H. S. Kauflfman, W. F.
Lerch, Chas. T. Maclay, William P. Miller, Thomas B. Nicholson,
Otto F. Nickel, W. W. Beno, Boy Souder, Charles P. Skelker,. H. B.
Weirick.
LABORATORIES AND EXPERIMENTAL STATION.
Director of Pathology, Allen J. Smith, M. D.
Chief of the Laboratories, Herbert Fox, M. D.
Bacteriologist, Damaso Bivas.
Assistant Bacteriologist, James B. Bucker, M. D.
Assistant, Miss Lucy H. Irwin.
Stenographer, Miss Helen M. O'Donnell.
Laboratory Diener, John B. Taylor.
Animal Diener, Leon J. Harris.
DIVISION OF DISTRIBUTION OF BIOLOGICAL PRODUCTS.
Chief of Division, Henry W. Peirson.
Stenographer, Miss Lucy A. Thompson.
Clerk, Miss Mabel E. Thorn.
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No. 16. COMMISSIONER OF HEAI/TH. 15
DIVISION OP ACCOUNTING AND PURCHASING.
Office 1900 Race Street, Philadelphia.
Accounting and Purchasing Agent, E. I. Simpson.
Bookkeepers, Miss Agnes E. Bean, Miss Mary L. Thompson.
Stenographers, Miss Minnie A. Light, Miss Mary G. Lynch.
STOREROOM.
storekeeper, Charles Hartzell.
SANITARY LEGISLATION OP 1907.
If the Legislature of 1905 distinguished itself by the enactment
of a body of legislation for the protection of the public health far in
advance of any previously enacted not only in Pennsylvania, but in
any State of the Union, that of 1907 maintained the high standard
of intelligent appreciation of the importance of such measures set
by its predecessor. Not only did it support the Department in its
various plans for increasing the efficiency of the sanitary laws, but
it made a wisely generous appropriation to meet the immense ex-
penditures necessarily to be incurred, appreciating that niggardli-
ness in providing means for the preservation of the lives and health
of our people is the falsest kind of economy. In addition to provid-
ing an adequate sum for meeting the rapidly increasing expenses of
the new Department for its routine work, it displayed statesmanship
of a high order in recognizing the necessity for governmental aid in
checking the spread of that greatest of all destroyers in this land.
Tuberculosis. With the reasonable sum of |1,000,000 at its disx>osal
for establishing free sanatoria and dispensaries for the treatment
and instruction of the indigent consumptives of the State, the De-
partment will be able to inaugurate such a system as has never
before been attempted.
The details of the proposed plans will be referred to later. Other
important items of sanitary legislation were:
Act No. 10, approved the 14th day of March, A. D. 1907, amending
the act of the 26th day of March, A. D. 1903, so as to provide for the
acquirement by the several cities of this Commonwealth by pur-
chase or condemnation proceedings of sufficient real estate, within
or without the city limits as may be necessary for present and future
use upon which to erect and construct ♦ ♦ ♦ garbage or incin-
erating furnaces, sewage disposal works or plants with the necessary
filter beds, appliances, drains and sewers, and for extensions thereof.
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16 SEX:OND ANNUAL. REPORT OF THE Off. Doc.
Act No. 81, approved the 23rd day of April, A. D. 1907, amending
the act of the 15th day of May, A. D. 1889 by providing for the con-
struction of sewers without a petition of a majority of property
owners and requiring a permit from the Commissioner of Health.
Act No. 101, approved the 26th day of April, A. D. 1907, provid-
ing for the licensing and regulating of slaughter-houses, shops,
wagons and places where meats, poultry, fish, game and shell-fish
are prepared for use as food, or stored or exposed for sale in cities
of the first class in this Commonwealth, and providing penalties for
any violation of any regulation governing the same.
Act No. 127, approved the 7th day of May, A. D. 1907, regulating
and defining the powers and duties of the Dental Council and State
Board of Dental Examiners, and providing that the Commissioner
of Health shall be a member of the same.
Act No. 129, approved the 7th day of May, A. D. 1907, authorizing
municipal corporations owning their own water systems ♦ ♦ ♦
to acquire land to preserve water supply from contamination.
Act No. 132, approved the 7th day of May, A. D. 1907 amending
the act of the 31st day of March, A. D. 1905, providing for necessary
medical attention to needy persons who may be in danger of suffer-
ing from hydrophobia so as to include all persons who may apply
for aid and providing that the cost of such medical attention shall
be paid by the several poor districts within this Commonwealth.
Act No. 135, approved the 7th day of May, A. D. 1907, to enable
local registrars of vital statistics, and their deputies to administer
the oath or affirmation to undertakers.
Act No. 181, approved the 25th day of May, A. D. 1907, authorizing
boroughs to erect and maintain garbage furnaces, and pass rules and
regulations for the collection, care and removal of garbage and pro-
vide penalties for the violation of the same.
Act No. 186, approved the 25th day of May, A. D. 1907, requiring
the thorough cleansing of the inside of cans and other vessels, used
in the shipment of milk or cream on railroads.
Act No. 187, approved the 25th day of May, A. D. 1907, to protect
the public health by providing for the prevention of the preparation
and sale of meat and food products which are unsound, unhealthful,
unwholesome and otherwise unfit for human food, defining what
shall be regarded as meat and meat food products, authorizing the
appointment and compensation of local meat inspectors ; authorizing
the State Live Stock Sanitary Board to enforce the provisions of this
act, to make rules and regulations for its enforcement and to appoint
agents to assist in its enforcement, and to provide penalties for the
violation or perversion thereof.
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HBALTH. 17
Act No. 216, approved the 28th day of May, A. D. 1907, providing
that whenever any head of a family or a person shall be quarantined
by any authority, because of any infectious or contagious disease,
and by reason of such quarantine such person becomes unable to
pay the expense of maintenance and treatment of his family or him-
self during the period of quarantine, he shall be considered a ''poor
person" or a "needy and indigent poor person'* within the meaning
of the poor laws of this Commonwealth.
Act No. 228, approved the 29th day of May, A. D. 1907, to enable
the township commissioners of townships of the first class in this
Commonwealth to establish boards of health and providing for the
payment of the expenses thereof by the townships.
Act No. 240, Provides for better sanitation of school rooms.
Act No. 273, approved the 1st day of June, A. D. 1907, author-
izing the transfer of the control and management of the Sanatorium
on the State Forestry Reservation near Mont Alto in Franklin
County, from the Commissioner of Forestry to the Department of
Health.
Act No. 282, approved the 1st day of June, A. D. 1907, for the
protection of the public health by prohibiting the manufacture,
sale, offering for sale or having in possession with intent to sell
within the State, of adulterated, misbranded, poisonous or dele-
terious foods and confections; regulating the enforcement of pro-
visions, therefor, providing for the protection of j^ersons buying
and selling adulterated or misbranded foods under a guaranty;
and providing penalties for the violation thereof.
Act No. 292, approved the 6th day of June A. D. 1907, amending
the act of the Ist day of May, A. D. 1905, by extending the territory
in which burial permits shall be valid ; providing for the issuance of
burial permits without fees ; establishing a method for securing the
given names of children; making a uniform date for the returns of
local registrars ; providing for certain fees in cities of the first and
second class to be paid by .the counties and abolishing all other
systems of registration of births and deaths.
THE CONTROL OF PULMONARY TUBERCULOSIS.
No more important acts were passed by the Legislature of 1907,
than Act No. 157, entitled "An Act to provide for the establishing
and maintenance of one or more Sanatoria or colonies, in Pennsyl-
vania for the free care and treatment of indigent persons suffering
from tuberculosis and making appropriation therefor," and Act No.
2— 1ft— 1907
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18 SECOND ANNUALi REPORT OF THE Off. Doc.
273} entitled ''An Act authorizing the transfer of the control and
management of the Sanatorium on the State Forestry Beservation
near Mont Alto, in Franklin county, from the Commissioner of
Forestry to the Department of Health."
The importance of these acts taken collectively consists not so
much in the unprecedently generous appropriation which accom-
panied the first, great as is the opportunity which it confers for con-
ducting a practical campaign against this most widespread and fatal
of all diseases in this country, as in the recognition on the part of
this popular representative body of two great facts: First, that the
most promising if not the only plan of procedure in this campaign is
that which includes the education of all those suffering from the
disease in the methods of precaution necessary to prevent themselves
form acting as centers of infectioooi; and, second, that the only proper
body to take charge of this campaign in behalf of, and in the name
of, the State is the Department of Health. A careful perusal of the
act for establishing the Sanatoria, including its Preamble, will show
that this statement is entirely warranted. It reads as follows:
"Whereas, Tuberculosis by Its widespread distribution throughout this Com-
monwealth Is causing untold suffering and distress. Is affecting the health and
prosperity of our citizens, Is draining the resources of individuals and caus-
ing an appalling waste of human life; and
"Whereas, Modem science has demonstrated the possibility of minimizing
this disease by measures of education, sanitary supervision. Isolation, and
early medical treatment; and
"Whereas, The Department of Health has one physician in each of slzty-slz
counties of the State, and Is about to authorize a sufficient number of health
officers to see that the present health laws, under the rules and regulations
adopted by the Department of Health, are carried out, and thereby care for
those suffering from communicable diseases which are not now cared for by
the hospitals of this Commonwealth; and
"Whereas, The Department, with a sufficient appropriation and Its present
equipment, will establish dispensaries for the free treatment of Indigent i>er-
aons affected with tuberculosis, for the dissemination of knowledge relating to
the prevention and cure of tuberculosis, and for the study of social and occu-
pational conditions that predispose to Its development; and
"Whereas, There are always thousands of Indigent people In this Common-
wealth who have contracted Tuberculosis, whose homes, lodging-places, and
means will not permit them to take advantage of the advice and education
dispensed by the Department of Health, as outlined above; therefore,—
"Section 1. Be It enacted, &c., That one or more sanatoria or colonies be es-
tablished in the State, for the reception and treatment of Indigent persons
affected with Incipient tuberculosis, and those so far advanced with the same
disease, that may be made confortable, and removed from their families and
the people at large to prevent the spread of the contagion.
"For these purposes the Department of Health, with the approval of the
Governor, shall be authorized to acquire property, erect buildings, equip the
same, and do all things necessary to accomplish such work, for the best in-
terest of the people of this Commonwealth, in curing and preventing tuber-
culosis.
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEAIiTH. 1»
"Section 2. Be It further enacted, that flhould the Department of Health
and the Governor select one or two tracts of land, of not over five hundred
acres each, within the boundaries of the State forestry reservations, that said
land be set aside for such purpose. ,
"For the purposes specified in this act, the sum of six hundred thousand dol-
lars, or so much thereof as may be necessary, is hereby specifically appro*
priated, for the two fiscal years beginning June one, one thousand nine hundred
and seven.
"Approved— The 14th day of May, A. D. 1907."
The act anthorizing the transfer of the control and management of
the Sanatorium on the State Forestry reservation at Mont Alto,
Franklin county, from the Commissioner of Forestry to the Depart-
ment of Health should it be found desirable, made imperative the
careful examination of that reservation in order to determine
whether it possessed the essential requirements for the open air
treatment of consumption. A personal cursory inspection produced
90 satisfactory an impression as to justify the ordering of a careful
survey of the entire tract in order to obtain definite data for arriving
at a conclusion. Such a survey was at once made under the immedi-
ate supervision of F. Herbert Snow, C. E., Chief Engineer of the
Department. It included the geography of the area in its relation to
surrounding private properties and their population, its topography
showing the varying altitudes and especially determining the loca-
tion of plateaus available for camps, the character of the forest
growths in different sections, its water supplies, not only as regards
the bacterial content and chemical character of the water and its
sufficiency for drinking and domestic purposes, but also with a view
to the possibility of obtaining power for the development of elec-
tricity for lighting and other purposes, the facilities for natural sur-
face drainage and determining the lines of a thoroughly modern and
adequate sewerage system including provision for purification so
that the bacilli of the disease might not be carried from the Sana-
torium to those at a distance, a possibility which I had recently
demonstrated to be by no means purely theoretical.
Borings were also made in order to discover the character of the
strata underlying the surface mold thus determining where clay ap-
proached the surface, and where it formed basins retaining water for
indefinite periods. Such locations would of course have to be avoided
as unfavorable for the habitations of those suffering from tubercu-
losis, to whom the dampness resulting from ground water has always
been considered especially inimical.
This precaution on the part of the Department must not be con-
sidered as reflecting on the judgment of Dr. J. T. Kothrock, the
former Forestry Commissioner, who, with commendable alacrity
made use of the opportunities which his position offered for utilizing
the advantages of this tract in the interest of the poor consumptives
of the State.
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20 SECOND ANNUAL, REPORT OP THE Off. Doc.
In view of the fact that we were dealing not simply with the
problem of to-day or with a limited number of patients^ but that pro-
vision must be made at the outset for a large and comprehensive
plant, demanding extensive improvements of a permanent character,
the Department owed it both to him and to itself, that it should
verify by actual scientific investigations the conclusions at which
he had arrived without such aids.
The report was so far satisfactory that no hesitation was felt in
adopting the Mont Alto reservation as one in which the first of the
two authorized Sanatoria should be established.
As many applicants for admission were already on the waiting list
arrangements were made with Adjutant General Stewart for fur-
nishing a sufScient number of large tents to accommodate them tem-
porarily. These were placed upon substantial fioors elevated 18
inches from the surface of the ground and were available until the
completion of the cottages. Up to the present time although the
cold has been quite severe during the past month it has been quite
possible to make the patients comfortable and the tents will con-
tinue in use through the present winter.
TUBERCULOSIS DISPENSARIES.
Important as are the provisions for the control of the spread of
tuberculosis by sanatorium methods, their usefulness is necessarily
limited, especially from the educational standpoint. Hence the value
of the Dispensary method as suggested in the preamble to the law.
It is intended that one of these Dispensaries shall be located in
each county at a point easily accessible from all parts of the county.
Each dispensary is under the immediate charge and supervision of
the Medical Inspector of the County. Persons desiring to avail them-
selves of this unusual opportunity are expected to sign an agreement
promising to continue in attendance, at specified intervals, for a
certain period of time, and to faithfully carry out the instructions of
the physician. A careful examination is made of each case which is
recorded in detail on blanks prepared for the purpose. The progress
of the case is carefully noted and placed upon the record for the pur-
pose of comparison, and the treatment is varied in accordance with
the changing requirements.
In a general dispensary where diseases of all kinds are prescribed
for, the physician really has not time to properly examine and follow
up cases of tuberculosis and too often considers his duty accom-
plished if he administers an anodyne to quiet the cough. Here, on
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No 16. COMMISSIONER OF HBAL.TH. 21
the contrary, no time is considered wasted which is spent in obtain-
ing a thorough knowledge of the case. Medication, as emergencies
may require, while not neglected is made entirely subsidiary to a
careful regulation of the diet, the taking of much rest, the avoidance
of all excesses, and the adoption and maintenance of the open air
treatment in the patient's own home for which the most explicit in-
structions are given, and which is insisted on, as a condition of con-
tinued attention. The patient is expected to familiariase himself with
the printed circular of the Department in which are detailed the
precautions necessary to prevent him from re-infecting himself or
infecting other members of his family, or his neighbors or fellow
workmen. Thus a process of education is being carried out all over
the State which cannot but result in a great diminution of the dis.
ease and the saving of many lives. One great advantage accruing
to the pockets as well as the health of these unfortunates consists
in the abandonment of the use of quack medicines advertised as '^sur%
cures for consumption'' with which the market is flooded and tht
only effects of which are to temporarily soothe the cough by reason
of the opium or other anodyne or the alcohol which they contain, to
disorder the digestion and hasten the progress to the grave. Hun-
dreds of thousands of dollars are wasted in this way every year in
this State, which should go to procure nourishing food and home
comforts for the invalid and his family. The appropriation which the
State has given the Department for this item, while liberal, is by no
means extravagant, and will need to be carefully husbanded.
A number of dispensaries for the treatment of this disease having
been already established in this State an inquiry was made into their
history and methods. This resulted in the selection of that at
Wilkes-Barre as, on the whole, presenting the greatest advantages
in the matter of location and methods, and it was decided to adopt
it as State Tuberculosis Dispensary No. 1. As Dr. Chas. H. Miner
had been in charge of this Dispensary since its initiation and pos-
sessed the necessary qualifications for inaugurating such a move-
ment, it wa^ considered wise to name him as County Medical In-
spector for Luzerne county, thus continuing him in charge of the
work.
The Wilkes-Barre Dispensary was opened July 22nd, 1907. The
total number in operation at the end of the year was twenty-two.
Of these one was established in July, two in October, eight in No-
vember, and eleven in December. The time has been too brief there-
fore to enable us to draw any deductions as to results accomplished
It may be said, however, that the total number of applicants has
been 435. Of this number 40 have been reported as improved, 34 as
not improved, 13 as unsuitable for treatment, and 13 as having died
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SECOND ANNUAL REPORT OP THE Off. Doc.
DEFECTIVE SEWERAGE AT THE CAPITAL OF THE STATE.
The attention of the Commissioner having been called to serious
conditions existing at Harrisburg as a result of imperfect sewerage
and drainage, early in September the Chief Engineer was instructed
to investigate Paxton Creek, which runs back of the old city and at
the foot of the hill on which a large portion of the newer city is
built
The report of that official shows that the stream, except in seasons
of flood, consists of a series of pools into which and on the banks
of which garbage, dead animals and rubbish of all kinds are thrown
without the slightest restriction. Many houses and some districts
sewer directly into the bed of the creek. In some places the flow
is almost completely interrupted by the growth of grass and weeds.
In this inspection the State Engineer was accompanied by the City
Engineer and the President of the Common Council of Harrisburg.
A full report of the inspection will be found under the head of
Operations of the Division of Engineering. The conditions existing
in Harrisburg are only the counterpart of those existing in many
towns in the State. This case has been made the subject of special
mention, however, inasmuch as Harrisburg is the capital of the State
and as the capital should be the metropolis, that is to say not the
largest city nor the richest city, but the standard city of the State ;
the city to which all other cities should look for an example in all
matters of civic administration and construction. Her water supply,
her system of sewage disposal, the administration of her Board of
Health, should all be of such superlative excellence that all other
cities of the State, be they large or be they small, should look to her
as a model whenever they desire to improve their own. In one
respect she already realizes this ideal. For cities having a similar
source of water supply she may well point to her own water works
and filtration system, which, when entirely completed in accordance
with the design of the engineer who planned them, will be well
worthy of imitation, having already been the means of greatly reduc-
ing the typhoid death rate of the city.
DRINKING WATER ON RAILROAD TRAINS.
During the summer a large force of inspectors was placed on the
passenger railroads of the State with instructions to carefully in-
vestigate the sources of water supply at stations and yards and the
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No. 16. COMMISSIONER OF HBAL/TH. 23
manner of its collection and storage, in order to determine whether
sufficient care was being taken to ensure the purity of water sup-
plied to passengers.
SANITARY PRECAUTIONS AT MT. GRETNA.
At the request of Adjutant General Stewart, early in the month
of June^ I took up the question of the proper preparation of the
grounds at Mt. Gretna for occupation as a military camp from a
sanitary point of view.
Under the direction of F. Herbert Snow, Chief Engineer of the
Department of Health, a careful sanitary survey of the entire plot
was made. Many sources of pollution of the water supplies were
discovered and abated, certain sources were unqualifiedly condemned
and a detailed report was submitted to the military authorities Indi-
cating further measures necessary in order to make this location
thoroughly safe for permanent occupancy, among which were a
completion of the modem sanitary sewage disposal plants, a filtered
water supply, completion of the drainage system, and proper ar-
rangements for the disposal of garbage.
The anxiety of the military authorities to avail themselves of all
the resources of modem medical science and engineering skill in
order to preserve the health of the troops, indicates that they have
not failed to learn the lesson furnished by the recent success of the
Japanese in their war with Russia, and I feel sure that every possible
effort to prevent the pollution of earth, air, food and water in and
around the encampment will continue to be made.
A complete report of this survey will be found under the Opera-
tions of the Engineering Department.
VITAL STATISTICS.
MORTALITY.
The total number of deaths occurring during the year was 115,969.
The number registered was 125,423, but 9,459 of these were still-
births.
This constituted an increase as compared with 1906 of 1,534. The
death rate however continued the same, 16.5, while the death rate
for the fifteen registration States increased by 4 per cent. The death
rate for males was 17.8 and for females 15.2. That of the native
population was 14.3 and that of the foreign i)opulation 22.6. That
of whites was 16.1 and that of blacks 28.2.
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24 SECOND ANNUAL REPORT OP THE Off. Doc.
An encouragiDg diminution of the death rate in early life is ob-
served which means that more children are living to adult and
therefore productive life
The n'arked falling off in the deaths from cholera infantum and
diarrhoea of childhood is mainly to be attributed to the improvement
in our milk supply and greater care in the feeding of infants. More
than 10,000 deaths from violence occurred, indicating the need for
more stringent laws for the regulation of machinery of all kinds.
SMALJ^POX.
We are fortunate in being able to report but a single death from
sm;allpox.
TUBERCULOSIS.
The mortality from tuberculosis was 10,825, an increase of 45
over the year 1906. The efforts which the State is making to cut
down these terrible figures will be referred to later. The deaths from
tuberculosis of the lungs were 9,317.
It is encouraging to note a decrease in the death rate of pulmonary
tuberculosis of 1.2 as compared with 1906. The number of deaths
of males was 4,896, of females, 4,421, a slight increase for the males
and a decided decrease for the females. Does this indicate a greater
readiness on the part of females to follow the regulations laid down
by health authorities?
TYPHOID FEVER.
Typhoid fever caused the death of 3,538 of our people, principally
at productive ages. This was a reduction as compared with the
year before of 379. The death rate per 100,000 of population was 503.
While our typhoid death rate is still so high as to bring a blush
to the cheek of every thinking Pennsylvanian, it is a matter of
congratulation that the returns show a reduction of 6.5 in 1907 as
compared with 1906, while in contiguous States it has either risen
or remained stationary.
SCARLET FBVBai.
The deaths from Scarlet Fever numbered 657, an increaiie over
1906 of 80. The death rate showed an increase of 1. This was owing
to the fact that the disease was of a more malignant type, as shown
also by the reports of other States.
MEASL.B8.
Measles carried off 714, a decrease of more than one-half as com-
pared with the year previous in which a great epidemic prevailed but
still more thaoi scarlet fever, a disease much more dreaded by the
people.
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No. 16. COMMISSIONER OF HEIAI/TH. 26
WHOOPING COUGH.
Wlioopingeough was reBponsible far 1,287 deaths, a decrease of
2G3, as compared with 1906. It will be noted that these two diseases,
measles and whoopingcoogh, which the public and too often the med-
ical profession are accustomed to trifle with, taken together, de-
stroyed 2,001 lives, or more than three tim«s as many as scarlet
fever which is always and very properly taken seriously.
The number of cases of whoopingcough reported was 3,013, show-
ing the disease to be one of extreme fatality even allowing for defec-
tive returns of cases.
DIPHTHERIA.
Diphtheria claimed 2,136 vi'ctimis. This wad a decreaise from the -
figures of 1906 of 300 and a decline in the death rate of 4.6. The fact
that there is a marked increase in the death rate from Diphtheria
during the school months shows the influence of school life on the
I)revalence of this as of all communicable diseases with the excep-
tion of whoopingcough.
MORBIDITY.
PREVALENCE OP COMMUNICABLE DISEASES.
The number of oases of Communicable Diseases reported during
the year 1907 was 70,864. This was a decrease as compared with the
number reported for the years previous of 17,456. This is partly to
be accounted for by the fact that a wave of measles spread over
the whole country, including Pennsylvania, in 1906. But making
all due allowances for this fact, when we take into consideration on
the other hand the increase of population and the increased efficiency
of our machinery for reporting, this difference still remains suffici-
ently striking to allow of but one interpretation, namely that our
efforts to check the spread of these diseases h<as been attended by
a measure of success scarcely to have been hoped for. It is safe
to say that the diminution in cases of contagious diseases, making
all allowances, amounting to more than 2 per cent, in every 100,000
persons living. The more important of these diseases were reported
as follows:
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26
SECOND ANNTJAL. REPORT OP THE
Off. Doc.
DeatliB.
TnberculoslB,
Smallpox,
Scarlet fever, .
Typhoid fever,
Dlpbtherla, . . . .
Measles,
Whoopineoouerh.
Total,
e,109
62
7, 099
20,060
10,510
11,776
8,118
70.864
10, 8S
1
eS7
S.688
2.188
714
1,887
81.458
While tlie number of deaths from tuberculosis was 10,825; it will
. be noticed that only 6,109 cases were reported. This astonishing
discrepancy can only be accounted for by supposing that the medical
profession is by no means yet fully aroused to the necessity of
promptly reporting this disease. The fight against it is now fairly
on and the first essential to a successful contest is the knowledge
on the part of the Department of every place where the foe is lurk-
ing. Without this, all our demonstrations in the way of Sanatoria,
Dispensaries, Congresses, Lectures and Exhibits will represent to a
great extent time and money thrown away. The campaign will be
like that of Braddock's dress parade against the Indians and will
result as disastrously.
TYPHOID FEVER,
Typhoid Fever we have always with us and will continue to do so
until the State laws for protecting the purity of streams are recog-
nized by the entire population both in town and country, and more
particularly by those in charge of providing drinking water to com-
munities. At the close of the year previous this disease was pre-
vailing to an alarming extent in the city of Scranton, and the bac-
teriologists of this Department had just succeeded in the very un-
usual achievement of actually isolating the bacillus typhosus from a
sample of water obtained from one of the reservoirs of that city.
A full account of this epidemic will appear later in this report.
SuflBce it to say that by the combined efforts of the Department the
local Board of Health and the Water Company, the disease was
rapidly brought under control, but not until the Lackawanna River
had been polluted to such an extent that the infection was carried
to the borough of Berwick, seventy miles farther down the stream —
on the Susquehanna, The Department had already issued a warn-
ing to all cities and boroughs on these rivers to abstain from the
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No. 16. COMMISSIONER OF HEA1.TH. 27
use of water drawn directly from the river, unless after taking the
precaution of boiling it, but Berwick seem» to have trusted to the
long distance separating her from the source of pollution, and the
now exploded doctrine of the self purification of streams. In the
month of August an epidemic of this disease broke out in Ridgway,
Elk county, resulting in 320 cases and 15 deaths. The comparatively
small mortality attending this outbreak must be attributed in part
to the assiduous attentions of the nurses employed by the Emer-
gency Committee. Too much credit cannot be given to these public
servants for their intelligent and devoted services. The local auth-
orities and private citizens co-operated to the fullest extent with
the officers of the Department in stamping out the disease.
The following is one of the typical incidents where an epidemic
can be directly traced to a single individual as in the case of Ply-
mouth :
The latter part of August, 1907, cases of typhoid fever began to be
observed among the children of Dawson, Fayette county. Eight
cases were reported by the Secretary of the Board of Health to the
State Department of Health about September 15th, traced to town
water partly supplied by surface springs upon a hillside which re-
ceives drainage from a collection of families higher up on a plateau.
To one of these houses there came from a distant city about August
15th a case of typhoid. Water used in washing infected clothing
was thrown into a sewer which emptied on the surface of the
ground. As soon as these facts were discovered the Department
ordered the water from these springs cut off from the town supply.
Posters were put up, warning the people that the water must be
boiled. These were also distributed to all houses. No cases oc-
curred in families not using the town water. About fifty caJses
occurred in all in a population of 825.
The number of cases of Typhoid Fever reported in the State dur-
ing the year was 20,080. The mortality in cities and large boroughs
was 15.8 and in the rural districts 33.5. The failure of physicians in
the country to report their cases must be in part responsible for this
great discrepancy. The number of deaths was 3,538.
LEPROSY.
Leprosy is a rare affection in this country. While it is only mildly
infectious, it possesses three characteristics which make it neces-
sary that it should come under the careful supervision of the health
authorities. These are, first, its long period of incubation, the dis-
ease not manifesting itself in many instances for months or even
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28 SECOND ANNUAL. REPORT OP THE Off. Doc
yeoTB after the infection has taken place; second, its painful and
loathesome character and protracted duration, death perhaps not
coming to the sufferer's relief for from ten to twenty years from the
time of its origin, and third, the fact that it is, up to the present
time, incurable.
While, therefore, there is no reason for a panic when a case occa-
sionally makes ite appearance in a community, on the other hand
the authorities who have given the subject the most careful thought
agree that a leper at large is a menace to the health of a community.
Hence, when it was brought to my notice on Friday, July 5, 1907,
that a case suspected of being leprosy had been reported to the
Sanitary Conunittee of Councils of Harrisburg (there being unfor-
tunately no Board of Health in that city) cmd that he had been sum-
marily deported to be set loose in a neighboring city, I made it my
business to communicate at once with the authorities of other cities
and of the State of Maryland in order that he might be arrested
and returned.
He, bowever, returned voluniarily and on Friday, July 9, was
discovered by a Harrisburg police officer in the neighboring borough
of Steelton, acting as a cook in a restaurant.
He was at once taken to the Harrisburg Sanitary Hospital, where
provision had been made for his reception within the grounds,
two tents having been sent out and two gu€Lrds secured. Ttie house
in which he was found was at once disinfected.
Physicians of the Department were immediately detailed to make
an examination and to take specimens for bacteriological investiga-
tion. Following their rei)ort, I visited the patient myself, accom-
panied by Dr. William M. Welsh, consultant to the Municipal Hos-
pital of Philadelphia, and satisfied myself that the patient was a
leper. A portion of the specimens wa« retained in Harrisburg for
microscopic examination by Drs. Ellenberger and Phillips, and an-
other portion sent to Dr. Herbert Fox, Chief of the Department Lab-
oratories at Philadelphia. In both instances the lepra bacilli were
found. The following is the report of Dr. Fox:
"The subject Is a ChlDaman named Mock Sem, twenty-four years of a^e.
He has resided In Harrishurg about four months, and accordinsr to his own
story has been In this country seven years, havinsr landed at Vancouver and
gone from there to San Francisco by water and having lived In that city until
he came here. He claims that the disease had begun to manifest itself before
he left China, and that he has never before been subjected to an examination
:by a Health Officer. The lesions are tubercular, on the forehead, alae of the
nose, and ears, and in so early a stage that I was unwilling to make a definite
diagnosis, until the crucial test of the microscope had been made."
Dr. A. B. Moulton, Assistant Medical Inspector xjontributes the
following somewhat fuller description of the case:
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No. 16. COMMISSIONER OF HEAI/TH. 29
"The lesions present are as follows: Some nodular masses upon the face,
most noticeably on the lower lip and forehead, with some thickening of both
ears, also a small area showins discoloration on the posterior aspect of the lobe
of the left ear. None of these lesions show evidences of anaesthesia. On the
contrary they seem to be hyper-aesthetic. The mouth and throat seem to be
perfectly clear and healthy though a slight mucoid discharge from the left
nostril was apparent. The legs^belpw the knees presented thick, dark, scaly
patches from which large flakes of scales could be readily peeled. No anaes-
thesia of these parts could be determined. The body is free from lesions^the
hands, however, show slight tendency to contraction. The voice is a little
husky and the patient had a cough. The physical examination of the chest
reveals areas of consolidation and small cavity formations in both lungs.
"Stain speciments of discharges from the nose showed the presence of tubercle
bacilli, while serum from the nodules on the ears and face showed the typical
lepra bacillus.
"A diagnosis of combined tuberculosis and leprosy was therefor made.
Under the use of antiseptics on the legs, followed by the use of oils, the
scaley masses were dislodged, a bronze discoloration remaining.
"During November and December, chills in the afternoon combined with a
marked irregularity in temperature evidenced the fact that mixed infection
existed. Some loss in weight was apparent although the patient has not been
weighed since his confinement in the Sanitary Hospital."
A two-roomed house was built especially for him, which was
amply provided with light and fresh air, and in«traction0 have been
given that at least one window must be open at all times. He is
also instructed to spend several hours daily upon the porch of his
shack in the steamer chair which has been provided for him in order
that he m^y obtain as mjnA benefit as possible from fresh air.
While the leprous condition has changed but little, the tubercul-
ous process is making rapid inroads upon his system.
The discovery of the lepra bacilli in due time left no room for
doubt as to the diagnosis. Under the care of the physician of the
Department the general health of the patient has somewhat im-
proved, notwithstanding the fact that it has T>een discovered that
he is also suffering from tuberculosis.
Much interest in the case has been shown by physicians interested
in the study of leprosy and those desiring to improve them«elv«*s in
the diagnosis of diseases ef the skin, and it should also be added that
much kindness has been shown the patient by citizens of Harrisburg.
In this connection the following figures extracted from the Report
of the IT. S. Commission of Leprosy, 1902, are of interest:
Number of cases ezistlnsr in the United States, 278
Males 176
Females, 102
Cases bom in the United States, 145
Cases contracting disease in the United States, 186
Of these cases those segrregrated at the time of the report were, 72
Their nativity was as far as ascertained—
Scandinavian 41
West Indian, 22
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80 SECOND ANNUAL. REPORT OF THE Off. Doc.
German, 12
American (U. S.), 145
EnffUsh, Irish, Mexican and Chinese, 58
The number of states having lepers is 21
California has 24
Florida has 24
Louisiana has 155
Minnesota has 20
North Dakota has 16
Undetermined residence, 39
Leper colony (in Louisiana) 1
Isolation at home enforced in Minnesota and Iowa, 2
Lepers at large, 73 per cent or 203
That there are 203 district centers of infection in the United
States not subject to governmental control affords matter for
thoughtful contemplation.
It will be seen that there is a lamentable laxity with regard to the
control of leprosy in this country. Only one State has suflSiciently
appreciated the eeriousnesB of the condition to establish a lepro-
sarium or leper colony, and in only two are they subjected to State
supervision in their homes. We have only to look at neighboring
states in Central and South America and the West India Islands to
be convinced of the folly of this policy of neglect. And when we
consider that more than one-half of the cases reported were born in
the United States and two-thirds had contracted the disease in this
country, it would seem to require no argument to prove that it is
the bounden duty of health authorities to keep all cases under care-
ful surveillance when discovered in the several States until such
time as the United States Government has accepted the responsi-
bility which naturally devolves upon it, of providing a retreat for
them where they shall cease to be objects of anxiety and menace to
thteir neighbors, and be provided with the comforts of a home at
the same time with all the means that medical science can suggest
for the relief of their sufferings and for their cure if such can be
accomplished.
EPIDEMIC OF ACUTE INFANTILE PARALYSIS.
This disease, so very unusual in epidemic form, made its appear-
ance during the summer of 1907 in Elk, Venango and Butler coun-
ties, coincidently with an outbreak of cerebrospinal meningitis with
which it was confounded by many observers. The chief of the Lab-
oratories, Dr. Fox, was deputed to investigate its history. He
obtained records of 131 cases in and around Oil City, Eidgway and
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No. 16. COMMISSIONER OF HS2AL.TH. SI
DoBoig and information of from 25 to 40 more in one region of Elk
county, showing a considerable distribution of the contagion. The
report which will be found in full later in the volume leads one to
consider whether the time has not arrived to adopt some form of
hygienic control for this disease.
MABBIAOES.
The number of marriages recorded during the year was 60,243, an
increase of 916 as compared with those recorded in 1906. The num-
ber of persons married per 1,000 of i>opulation living was 17.1, which
is the same as that of the previous year.
BIRTHS.
The number of births exclusive of still births was 175,548, while
that reported in 1906 was 167,265, an increase of 8,283. This increase
is partly to be attributed to increased accuracy in reporting.
DIGEST OP SANITARY LAWS OF THE COMMONWEALTH.
One of the duties assigned to the late State Board of Health and
which has been transmitted to the Commissioner is the codification
of the sanitary laws of the Commonwealth. This labor has been
taken up with our legal adviser. Such a mass of legislation looking
to the protection and improvement of the health of the people di-
rectly or indirectly has been found scattered through the pamphlet
laws and digests that it has been thought better to confine our work
of systematizing the statutes to those with the enforcement of which
the Department or local Boards of Health were directly concerned.
We have considered that the laws relative to the health or safety
of the citizens of the Commonwealth might be classified as follows:
I. Laws relating to the regulation of practitioners of the healing
arts and of undertakers, the enforcement of which is entrusted
to the following bodies:
(a) The Medical Council of Pennsylvania and the Board of Med-
ical Examiners.
(b) The Dental Council and the State Board of Dental Ex-
aminers.
(c) The State Pharmaceutical Examining Board.
(d) The State Board of Veterinary Medical Examiners.
(e) The State Board of Undertakers.
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82 SECOND ANNUAL REPORT OP THE Off. Doc
II. lAWfl providing for the health and safety of persons employed in
certain occupations, the enforcement of which is entrusted to the
following authorities:
(a) The Factory Inspectxxr.
(b) The Bureau of Mines.
III. Laws relating to the protection of life and limb from accidents
from illaminating oils, the enforcement of which is entrusted to
Oil Inspectors in the several counties.
IV. Laws relating to the maintenance of quarantine at the Port of
Philadelphia, the enforcement of which is entrusted to the State
Board of Quarantine of Pennsylvania.
V. Laws relating to the construction of buildings and the inspec-
tion of the same, the enforcement of which is entrusted to the
various municipal authorities.
VI. I^aws to prevent the adulteration of food, etc., the enforcement
of which is entrusted mainly to the following authorities:
(a) The Dairy and Pood Ck>minissioner.
(b) The State Live Stock Sanitary Board and State Veterinarian.
VII. Laws making certain acts prejudicial to the public health mis-
demeanors, the enforcement of which is entrusted to the various
prosecuting attorneys.
VIII. Laws relating to the State Department of Health and to
local boards of health in cities, boroughs and townships.
IX. Sanitary Laws of general application, the enforcement of which
is entrusted to the Department of Health and the various local
Boards of Health.
Inasmuch as neither the Department of Health nor the local
boards are authorized to enforce the first seven of these classes of
acts, it has not been thought wise to burden ourselves with their
codification at least for the present. And indeed those relating to
cities of the first and second classes are so voluminous, while at the
same time they are not of general application, that it was considered
allowable to omit them also. Our object has been to present in a
systemized arrangement, for ready reference, such laws as will be
most frequently needed by Health Officers and local boards through-
out the State.
These have been thus codified:
PART I.
Laws Relating to the Department of Health of Pennsylvania-
I. The CJommissioner of Health.
II The Advisory Board*
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Ko. 16. COMMISSIONER OF HEAI/TH. 88
III. The General Pawers of the Oommissioner.
IV. Additional Powers originally conferred upon the State Board
of Health.
V. Powers and Duties of the Oonmitesioner Relative to the Purity
of the Waters of the State.
VI. The Bureau of Vital Statistics.
VII. Miscellaneous Provisions relative to the Department.
PART IL
Laws Relating to Boards of Health in Cities, Boroughs and Town-
ships.
I. Boards of Health in Cities of the First and Second Clasees.
The laws relating to Boards of Health in Cities of these classes are
so numerous and voluminous that the limits of this publication do
not permit of the printing of the same herein.
II. Boards of Health of Cities of the Third Class.
1. Con&^tution of Board.
2. Officers and Fees.
3. Powers and Duties of Board.
III. Boards of Health in Boroughs.
1. Constitution of Board.
2. Powers and Duties of the Board to be the same as those of
Caties of the Third Class.
3. Officers and Fees.
4. Powers and Duties of the Board.
IV. Boards of Health in Townships.
1. School Directors in Townships to act as Boards of Health.
2. To appoint Sanitary Agents.
3. Compensation of Sanitary Agent.
PART III.
Sanitary Laws of General Application.
I. Laws relative to Infectious and Contagious Diseases applicable
to all Municipalities.
1. Physicians in Municipalities to report all contagious diseases
to health authorities.
2. Health authorities to placard houses in which cases of said
diseases may be located. May place guards on such prem-
3. Heads of families to be responsible if placards are removed.
4. Bodies of persons dying of contagious or infectious diseases
to be placed in coffin or casket within certain number of
hours.
5. Such bodies to be buried within certain number of hours.
8—16—1907
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U SECOND ANNUAL. REPORT OF THB Off. Doc
6. Attendance at f nnerals to be fltrictly limited.
7. Snch bodies not to be taken into church or other public build-
ing.
8. (Conveyances for adult relatiyes and pall bearers only to be
furnished by undertakers at funerals of such x>eraonft.
9. Such bodies to be conveyed only in hearse or other vehicle
reserved for the conveyance of corpses.
10. Infected premises, bedding, clothing and other effects to be
disinfected after death or removal of persons suffering from
such diseases.
11. Children or other persons residing in houses with i>ersons suf-
fering from such diseases to be excluded from school for
thirty daye after disinfection of premises.
12. Children not presenting certificates of successful vaccination
or of previous attack of smallpox to be excluded from school.
13. Health authorities must furnish school authorities necessary
certificates and blanks for registration of vaccination.
14. Health authorities to furnish school authorities bulletins of
persons suffering from certain contagious diseases.
15. Persons suffering from such diseases not to enter public con-
veyances without notification.
16. Persons suffering from such disease not to expose themselves
or be exposed in public places.
17. Infected clothing, bedding or rags not to be given away until
disinfected.
18. No house or room in which persons suffering from such dis-
eases have been located to be rented without previous disin-
fection.
19. Health authorities to establish regulations for the isolation
of persons suffering from such diseases and for disinfection
of prenuses and effects.
20. Certain public officers not to be members or officers of boards
of health.
21. Penalties for violation of any of the provisions of this act.
PART in.
Acts Relative to Indigent Sick or Injured Persons.
1. Belief of needy sick or injured persons in counties in which
there is no almshouse.
2. Poor authorities in cities of Third Class to furnish relief to
needy persons.
3. Poor authorities to furnish Medical attendance to persons bit-
ten by mad dogs.
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No. 1«. COMMISSIONBR OF HBAI/TH. 85
PART IV.
Sanitary Laws Relative to Bchool and Schaol Honses.
1. Boards of School Directors and Controllers of School Districts
to provide suitable and convenient water closets.
2. Failure to comply with Act renders directors or controllers
liable to removal from office.
3. BoardlB of school directors and controllers of school districts
to cleanse outhouses periodically. 1
4. Provisions of said act to be carried out before State appro-
priations can be paid.
5. Public school buildings must be so constructed that the health,
sight and comfort of all pupils may be properly protected. Plans
for heating, lighting and ventilation must be submitted.
6. Direction and area of light regulated.
7. Floor space, air space and temperature regulated.
8. School directox8 to adopt a modem method of disinfecting
school houses.
9. School building to be disinfected at least once in two weeks.
10. Where there are local boards of health, method of disinfection
to be approved by such boards.
11. Disinfection to be effected without interfering with regular
sessions.
12. School directors to set aside fund for disinfection.
13. Penalty for failure to comply with provisions of this act.
PART V.
Nuisances.
1. Public Nuisances.
2. Nuisances in cities of the third class.
Petition to Ck)urt to appoint free-holders to report on same.
3. Duties and powers of viewers so appointed.
4. Parties interested may appeal, from viewers award.
5. If owners fail to abate nuisances within sixty days, city authori-
ties to enter and abate.
6. This act applies only to nuisances which are not such per se.
7. Regulations of Bone boiling establishments. Permission of
Health authorities required.
8. Penalty for violation of the Act.
PART vi.
Prevention of Blindnees in Infants.
1. Midwives or others in charge of infants within two weeks of
birth to report inflammation of the eyes of such infants to Health
Officers.
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86 SECOND ANNUAL. REPORT OF THE Off. Doc.
2. Duty of Health Oflftcer on receipt of report.
3. Health OfiQcers to furnish copies of this act to michviyes and
nurses.
4. Penalty for failure to comply.
Provisions of General Application to Prevent the Sale of Adulter-
ated Milk.
1. Penalty for such sales.
2. Penalty for adulteration.
3. Milk wagons to be plainly marked.
4. Penalty for defective marking.
5. Adulteration defined.
6. Councils may provide regulations for milk inspection.
7. Sale of adulterated milk prohibited in cities of the second and
third classes.
8. Sale of skimmed milk as pure milk prohibited.
9. Skimmed milk to be sold and marked as such.
10. Standard for pure milk established.
11. When skimmed milk shall be deemed adulterated.
12. Inspector of milk to take samples.
13. Inspectors to institute proceedings. Fines to go to Board of
Health.
14. Violations of act declared misdemeanors.
CONFERENCES, CONVENTIONS AND ADDRESSES.
On the invitation of the Conunissioner of Health of the State of
New York, I addressed the Health Officers of that State in annual
session at the city of Syracuse, Oct. 24, 1906, on "A Glance at Health
Work in Pennsylvania."
By invitation of the Legislative Club of Harrisburg, on the even-
ing of February 13, 1907, I appeared before that body in the Senate
Caucus Room and made an argument against the repeal of the law
which makes the presentation of a medical certificate of su^ccessf ul
vaccination a prerequisite for attending school in the State.
On March 6, 1907, by command of the Joint Committee on Public
Health and Sanitation, I addressed a public meeting of that Commit-
tee in the Hall of the House of Representatives, laying before that
body my reasons for believing that the repeal of the law above re-
ferred to would work an injury to the State. Many members of the
Legislature and interested citizens were present. I was supported in
this effort by prominent physicians and sanitary officers from the
different i)arts of the State.
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No. 16. COMMISSIONER OF HBAX.TH. 87
Dr. Wilmer R. Batt, State Registrar, was deputia&ed to attend the
conference of the State and Provincial Boards of Health at Wash-
ington, D. C, May 30th and 31st, 1907, in anticipation of a disciiBsion
upon a change in the recognized regulations concerning the inter-
state shipment of dead bodies. After a slight discussion the further
considBration of the matter was postponed until the next annual con-
ference. It was determined at this meeting to petition the Federal
Government for the establishing of a national leprosarium.
On June 5th I delivered the Oration on State Medicine, before the
American Medical Association at Atlantic City, N. J. On this occa-
sion I embraced the opportunity to announce publicly to my fellow
members of the profession the commendable action of our State
Legislature in making a generous provision for the care of the con-
sumptive poor within the limits of the Commonwealth and to out-
line with extreme brevity the general method by which I proposed
to care for this large class of unfortunates, with an especial view to
checking the spread of the disease in our communities and eventually
baniahing it from the State.
In response to a request from the Engineers' Society of Western
Pennsylvania that I should address that body on some subject relat-
ing to their profession, on June 18, 1907, in view of my inability to
be present, I deputized P. Herbert Snow, C. E., Chief EJngineer, to
take my place. Taking for his subject, "The Administration of Penn-
sylvania's Laws Respecting Water Works and Sewerage," Mr. Snow
briefly reviewed the history of oflScial sanitary work in the State
from the Plymouth epidemic which led to the establishment of a
State Board of Health to the Butler epidemic which paved the way
for the establishment of a Department of Health with stringent laws
for the protection of the purity of the waters of the State, and an
adequate appropriation for their enforcement, and invited the co-
operation of the club in the measures proposed, which were re*
hearsed somewhat in detail.
On June 28th, Dr. Wilmer R. Batt, representing the Department,
addressed the Harrisburg Academy of Medicine on "Some statistics
concerning the mortality and morbidity of certain communicable
diseases."
In the month of November I was designated by the Secretary of
the Treasury of the United States as an oflScial delegate to the
Third International Sanitary Convention of the American Republics
to be held in the City of Mexico on the second day of December fol-
lowing. My engagements, especially in view of the approaching
meeting of the Legislature absolutely precluding my attendance, I
contributed a paper describing the organization and work of the
Department.
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OPERATIONS OF THE DIVISIONS.
DIVISION OF MEDICAL INSPECTION.
FRBDBRICK C. JOHNBON, M. D., Chief Iiuipector.
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OFFICIAIj document. No. 16.
THE DIVISION OF MEDICAL INSPECTION.
OOMMUNICABLE DISEASES.
During the past year this Division has been concerned in the sup^
pression of outbreaks of communicable diseases as follows:
SMALLPOX.
ADAMS COUNTY.
Three oases of smallpox occurred in Adams county during the
year 1907, being the result of importation from Torreon, Mexico.
From the report of Dr. George Rice, the County Medical Inspector
for this Department, it appears that one Edward Q. Gulden, aged
26 years, a millwright by occupation, came to his home in Mennallen
township on January 19th from Mexico. He was then in the pus-
tular stage of a severe conflnent variola which terminated fatally
on January 31st. The case was cared for by his father, who later
contracted varioloid of a mild discrete type, evidently modified by
vaccination in early life and again upon the discovery of the nature
of the illness of his son. One other case occurred from this focus,
being that of Mr. Dill Bream, an undertaker who had charge of the
interment of Edward Gulden. It seems noteworthy to state in this
connection that from authentic reports Mr. Bream at no time was
within sixty feet of the corpse. Proper precautionary measures, in-
cluding general vaccination, were observed by the local Board of
Health of Bendersville with the result that no other cases occurred,
ALLEGHENY COUNTY.
During the year there were 16 cases of smallpox reported from
Allegheny County, none of which were in the rural districts.
BRADFORD COUNTY.
A number of cases of smallpox occurred in Wells township during
the year, which from the report of Dr. S. M. Woodburn, County Med-
ical Inspector, it appears were the result of importation. During the
early part of October, 1906, one Eaton arrived! from North)
Dakota, coming by the way of Duluth and the Great Lakes and
evidently contracted the disease en route or just before starting.
(41)
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42 SECOND ANNTJALi REPORT OF THE Off. Doc.
Later his father and brother, neither of whom had been vaccinated,
contracted the disease. The mother was apparently immune by rea-
son of a prior vaccination. Through exposure to this family and sub-
sequent families infected, 22 cases resulted, none of whom had
been previously vaccinated. While there were seven contacts directly
exposed in the infected families, owing to prompt vaccination .none
contraeted the disease. The wisdom of compulsory vaccination of
school children was well demonstrated in the exposure of some 75
pupils to the Bailey case which attended school while in the eruptive
stage of the disease without any resulting cases. In all 175 persons
were vaccinated before the epidemic was stamped out.
CAMBRIA COUNTY.
But one case of smallpox was reported from Cambria Ck)unty.
This occurred at Bamesboro during the month of October.
CHESTER COUNTY.
But one case of smallpox was reported in Chester County during
the year, being that of a resident of Spring City who was later appre-
hended in Pittsburg, found to be suffering from the disease and
placed in quarantine. The premises in which the case resided at
Spring City were taken in charge by the local Board of Health and
no other cases occurred.
CLARION COUNTY.
Three cases of smallpox occurred in Clarion County during the
year.
The first case discovered in the County appeared during the latter
part of June in a resident of Leeper who was employed in Ohio and
came home on account of illness incident to the initial stage of the
disease. Proper precautionary measures were instituted and no
further spread of the disease resulted.
The other two cases were the result of importation from the Indian
Territory during the first week in August. The first case, which
resided at St. Petersburg, had been infected by a relative on a visit
fom Indian Territory. Later this patient visited at Shipville while
in the initial stage of the disease and as a result infected two other
members of the household, one of whom was apprehended in Pitts-
burg. The cases were properly cared for under the direction of the
local Boards of Health. No further extension of the disease oc-
curred, although another member of the household visited by the
patient mentioned above was later apprehended in Pittsburg and
sent to the Municipal Hospital, where he was under treatment for
this disease.
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CUMBERLAND COUNTT.
Four cases were reported in Cumberland county during the year
1907. These cases appeared at Bowmansdale during the first week
of January, which were the result of exposure to an eruptive disease
which was regarded as chicken pox, although no physician had been
consulted. This case, to whom the four cases of smallpox are trace-
able had arrived from Steubenville, Ohio, about two weeks prior to
the outbreak. Precautionary measures were promptly instituted
under the direction of County Medical Inspector, H. B. Bashore and
the infected premises were released from quarantine during the first
week in February without any further spread of the disease.
DAUPHIN COUNTY.
But two cases of smallpox occurred in Dauphin county during the
jear, of which one was reported from Bwatara township and the
other from Harrisburg. Township premises disinfected by Dr. Paul
A.*Hartman, County Medical Inspector.
ERIE COUNTT.
The only cases of smallpox in Erie county during the year oc-
curred in the city of Erie during the month of December, when three
were reported.
FRANKLIN COUNTT.
But one case of smallpox is reported from Franklin county during
the year. The case in question was that of a child eight months old
and presented no direct history of exposure, although it was sus-
pect^ in the community that the contagion was carried to the house
by a woman who went there to help butcher. In the spring of 1905
there were 125 cases of smallpox in the neighborhood in which this
woman resided and from the fact that many cases were secreted and
the premises not disinfected, some importance is lent to the sugges-
tion that the case had its origin in this manner.
LANCASTER COUNTT.
The only case of smallpox occurring in Lancaster county was re-
ported from the Borough of Columbia during the month of January.
The origin of the case is not clear, but it seems to have been con-
tracted during a visit to Maryland during the Christmas holidays.
The local authorities who from experience have learned both the
cost of smallpox epidemics and the efScacy of vaccination in pre-
venting its spread instituted prompt precautionary measures which
prevented results from exposure to this case.
LAWRBNCB COUNTT.
During the year thirteen cases of smallpox were reported from
Lawrence county, four of which were in the city of New Castle and
nine in Neshannock township, adjoining the city limits. The origin
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44 SECOND ANNUAL. REPORT OF THE Off. Doc.
of the first case is indefinite and it is also unfortunate to note that
the nature of the rash which this patient presented was not recog-
nized as smallpox until nearly one month after its origin when other
cases occurred among his associates which were unmistakably small-
pox. With the exception of one case, all were of a mild type of the
disease, although none had ever been vaccinated. The prompt and
thorough enforcement of vaccination by the State and city health
authorities prevented what gave promise of being a serious outbreak.
One of the persons attacked conducted a milk dairy. The delivery
of milk from this place was at once stopped and the house placed
under strict quarantine. The cases occurring in the township were
supervised by the County Medical Inspector.
SUSQUEHANNA COUNTY.
But one case of smallpox appeared in Susquehanna county during
the year and this the result of importation from Deposit, N. Y.,
where the disease prevailed in epidemic form. A number of other
persons were exposed including four unvaccinated members of the
family of the patient, all of whom were promptly vaccinated without
any further extension of the disease.
WAYNE COUNTY.
One case of smallpox occurred in Wayne county during the year,
the result of importation, the patient having contracted the disease
in Deposit, N. Y. The case was seen by the County Medical Inspector
and no further extension of the disease occurred.
TYPHOID FEVER.
AXJ^BGHENY COUNTY.
Aspinwall Boro. Dr. S. M. Binehart, O. M. I. September 12 by
request of the local Board of Health a visit was made to Aspinwall
on account of the prevalence of typhoid fever. Aspinwall is a bor-
ough 7 miles from Allegheny on the Allegheny river, having about
2,000 population. It is built on sanitary principles, having a good
water supply from an artesian well, and a good sewerage system.
Until last month they have had very little typhoid fever, 6 cases oc-
curring in January, 3 in June, and principally traceable to other lo-
calities, that is among those who were occupied during the day
either in Pittsburg or Allegheny. On August 1st a case developed
on Sixth street at the west end of the borough. The house in which
this case occurred is on a terrace above the greater part of the bor-
ough. Twenty or thirty yards below this house and a little west of
it is a spring from which many people procured their drinking water,
coming from all over the neighborhood to secure water as it was
clear and palatable. While no direct connection can be established
between the case mentioned and the infection of the spring, it is
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No. 16. COMMISSIONER OF HEALTH. «
beyond question the sonrce of the infection. Up to the 16th of Sept.
60 cases were reported. The milk supply used by the various fam-
ilies is from many sources. Eighty per cent, of the cases live within
3 or 4 squares of the spring. Samples of water from the spring have
been examined and found to contain Bacillus coli.
ALLEGHENY COUNTY.
West Liberty. On Sept. 22nd visited West Liberty, where 15 cases
of typhoid fever had been reported up to this date. No Board of
Health is acting at this present time. Twelve out of 15 of the cases
can be definitely traced to a certain spring, 3 cases occurring in the
family of the man on whose property the spring is located and 3 in
the home of his brother who lives in the next household. This
spring has an outlet on the public highway from which many pro-
cure drinking water and from which the infection is probably spread.
The examination of water showed the presence of pollution. A warn-
ing notice was posted to prevent the further use of this water.
ARMSTRONG COUNTY.
Worthington. Dr. T. N. McKee, C. M. I., Kittanning. Visited
Worthington on October 31st on account of 5 cases of typhoid
fever reported, no Board of Health being organized. After consult-
ing with the President of the Borough Council and leading citizens
at a special meeting a Board of Health was appointed and will be
duly organized.
ARMSTRONG COUNTY.
Kittanning (See special report).
BEDFORD COUNTY.
Dr. Walter de la M. Hill, C. M. I. At Stonerstown 7 cases of
typhoid fever, of which number four are certainly known to have
drunk water from the same well and other three probably.
BUCKS COUNTY.
Dr. James E. Groflf, C. M. I., Doylestown. On November 1st visited
premises of O. R. H., where typhoid fever existed and ordered the
sale of milk products discontinued.
LJSHIGH COUNTY.
Dr. Morris P. Cawley, C. M. I., Allentown, Salisburg township,
Jan. 29. Last Sunday inspected premises of V. R. and Mr. F., from
whose premises milk was sold in Allentown and on whose milk route
typhoid fever had appeared. At V. R.'s it was discovered that a
child about 11 years old had just recovered from typhoid fever.
Typhoid fever also existed on the premises of J. C, his next door
neighbor. On the P. property it was discovered that 4 cases of
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4« SECOND ANNUAL KBPORT OF THS Off. Doc.
typhoid fever developed simultaneously last week. On Monday I
again visited the places, giving instructions with regard to disinfec-
tion and the disposition of the milk and insisted that the necessary
precautions be taken to prevent infection of the milk supply.
BERKS COUNTY.
Dr. Israel Cleaver, C. M. I. On receipt of instructions from Dr.
Dixon, made inspection of farm near Bhillington, about 4 miles from
Beading. The first case had occurred 4 or 5 weeks from date of
this visit, second case 3 weeks and third case 2 weeks from date of
inspection, all of one family. We have reported 12 cases having
positively originated on this farm. No history of importation can be
obtained.
Water Supply : A well with pump used for culinary and drinking
purposes and watering horses.
A cistern used for washing of clothing and premises only, which
was condemned. Then a spring was used for several days which
was next condemned and water brought by the barrel from an out-
side source.
All cases drank from the well; Everything around the farm is
dirty and filthy.
The house was not occupied at the time of visit of C. M. I., who
ordered it disinfected by the Health OflBcer and he also ordered
a complete renovation of the entire premises. Cows were kept away
from the place for a while and not allowed to use the water on the
premises.
The farm is surrounded on all sides except N. E., with territory
decidedly up grade, and immediately at its borders, becoming hilly,
almost mountainous within a mile. In fact the farm is a fiat or
basin between hills except on the N. E. and here the pitch is upward
towards Shillington. Good judgment therefore and skill are neces-
sary to secure a good water supply on these premises. The family
had the name of being dirty housekeepers and everything around
confirmed the report.
BRADFORD COUNTY.
Dr. S. M. Woodburn C. M, I., Towanda. Athens. In accordance
with instructions from Dr. Dixon, an investigation was made of the
typhoid situation at Athens by Dr. Woodburn, on November 29,
1907. He found 14 cases reported to the local Board of Health from
September 13th to November 26th and also learned of two other
cases not reported. All these cases occurred in different parts of the
town. It has been pretty positively determined that 7 of the 16
cases drank from a public well in front of the town hall, which had
been under suspicion.
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No. 16. COMMISSIONER OF HBAI/TH. 47
As one of the local physicians thought this epidemic originated in
the milk snpply, the Health OfScer for that district was directed to
examine into all sources of milk delivered into the borough of
Athens.
Dr. Woodbum made the second visit to Athens on December 19th.
There were 18 cases of typhoid fever found, the majority of which
admitted drinking from the town pump at Athens, others from
wells at Athens and Sayre, which is one mile north of Athens; in
fact the two places are practically one town. No systems of sewers
exists.
The town pump was thought to be the most suspicious source of
the infection and next the i^ells in general and especially those of
Sayre and of Athens contiguous to Sayre.
Nothing suspicious was found by Health OfScer Hull in connec-
tion with the milk supply. Samples of water from the town pump
and other wells about town were sent to the laboratory for analysis.
CAMBRIA COUNTT.
Dr. W. E. Matthews, C. M. I., Johnstown. On receipt of informa-
tion from Health OflScer J. W. Fouch that a number of typhoid fever
cases Lad developed lately on the Dunlo watershed, Dr. Matthers
miade an. investigation on October 4th of the Beaverdale, Lloydell
and Dunlo watersheds.
Ten days previous to date of inspection a case of typhoid developed
in Lloydell, since which time nine other cases developed. Dr.
Matthews traced the source of the outbreak to a spring located 80
feet from South Fork branch of Conemaugh where, one thousand feet
below, is the intake for water supply for Dunlo, Lloydell and Beaver-
dale. Population of these three districts, five thousand. At this
point a camp was located where 250 men were constructing a new
reservoir, all the filth from which camp reached this stream. Health
OflBcer Fouch was instructed to look after sanitary condition of
camp.
Samples of water were taken and the spring supposed to be pol-
luted was thoroughly disinfected.
CRESSON.
On receipt of information that a number of cases of typhoid ex-
isted in Cresson, investigation were ordered to be made by Dr. W,
E. Matthews, C. M. I., and Health Officer Dr. Lynch, of Cresson.
Two cases of typhoid fever were found on the N. dairy farm in
Munster township, from which milk was supplied to the borough of
Cresson. Samples of milk and water from this farm were sent to
the laboratory for analysis. The sanitary condition of this farm was
very bad, and orders were issued to clean it up.
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CHESTER COUNTY.
Dr. J. C. Mewhinney, C. M. I. Oochranville. In the latter part of
February information was received by the Department that typhoid
fever existed at Oochranville, The County Medical Inspector, Dr.
J. C. Mewhinney, was ordered to make an investigation. Fourteen
cases were found.
The source of infection was supposed to come from two springs
located on private properties — there is evidence of one case, how-
ever, being the result of contagion. The conditions about the house
and pi'emises upon which these springs were located were found to
be in a very filthy condition and a general cleaning up was ordered.
One spring was condemned and a new spring house was built on the
other property.
Samples of water were taken and sent to the laboratories for
examination. All necessary instructions relative to precautions to
be observed were given and no further trouble was reported.
CLEARFIELrD COUNTY.
Dr. S. M. Free, 0. M. I., DuBois. Woodland. Oct. 13. Investi-
gated an outbreak of typhoid fever at Woodland, Bradford town-
ship. Six cases of typhoid fever found in 3 families. The history of
one house shows that for the past 12 years there have been frequent
cases of typhoid fever in it
CLINTON COUNTY.
Dr. R. B. Watson, 0. M. I., Lock Haven. Greenburr, March 8.
Investigated the outbreak of typhoid fever at Greenburr which has
prevailed in that vicinity since last fall. Number of cases have
totalled about 30. As some of these cases had used the spring water
at the camp grounds I examined the same which are about half way
between Boonville and Greenburr. The creek runs by the grounds
and there are 2 springs on the ground which, when the creek is high,
are flooded by water from the creek. The privy used by the campers
is on the bank above the springs. The cases referred to were
below the camp and along the creek as far as Tylersville a distance
of 7 miles. All cases can be traced either to the water of the spring
of the camp or to the water below the camp.
CHESTER COUNTY.
Dr. J. 0. McWhinney, C. M. I., Spring City. Llanerch. On the
16th of September I made an investigation of an outbreak of typhoid
fever in Llanerch, finding that 11 cases had occurred and that all
t»ook their milk from one dairy. It has been determined that
typhoid fever existed on the dairy farm in question.
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COLUMBIA COUNTY.
Dr. S. B. Arment, C. M. I. Berwick. On the 11th of January, 1907,
upon receipt of information that typhoid fever was prevalent to a
considerable extent in the town of Berwick, an investigation was
made by Dr. S. B. Arment, County Medical Inspector. His report
shows the existence of 27 cases of typhoid in Berwick and 22 in West
Berwick up to January 14th.
In going over the situation carefully it was found that the greater
number of cases were located near the pumping station which was
served by water from the Susquehanna river, and although there are
a few apparently secondary cases it is thought that most are
primary, due to infection of the pipes from the river supply that
has been passing through them night and day since last year's
epidemic and which probably became infected at that time. Now,
however, the pipes are filled from the opposite direction as the
water comes from the dams of the Water Company.
DAUPHIN COUNTY.
Dr. Paul A. Hartman, C. M. I. Millersburg. On October 15, 1907,
Dr. Paul A. Hartman, County Medical Inspector of Dauphin county,
was instructed to make an inspection at Millersburg, on account of
the existence of typhoid fever at that place.
He found 4 cases in three houses within 100 yards of each other.
All these cases obtained drinking water from the same well which
had been examined a short time before and found to be polluted.
Another case of typhoid was found, remote from these cases, which
on investigation showed that there was a condemned well on the
premises which was supposed not to be in use. This, however, was
not the case and the party using it accordingly paid the penalty.
Recommendation was made to the local board to abandon both
wells entirely which was accordingly done and ended the trouble.
DELAWARE COUNTY.
Dr. Robert S. Maison, C. M. I. Swarthmore College. The Depart-
ment having received a communication from George B. Cresson,
Secretary of the Board of Health of Swarthmore, relative to an out-
break of typhoid fever at that place. Dr. Robert 8. Miaison, County
Medical Inspector, was ordered to make an investigation. His report
of February 28th shows the existence of five cases in the college.
Samples of the milk and water supplies were sent to the labora-
tory for examination but no positive report was expected, inasmuch
as it was believed the cases all developed as a result of infection of
the college milk supply by the negro who was employed to take care
4—16—1907
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BO SECOND ANNUAL. REPORT OP THE Off. Doc.
of the milk and was believed to have walking typhoid as he con-
tinued working at the milk although gradually getting sicker until
forced to quit.
LEHIGH COUNTY.
Dr. Morris F. Cawley, C. M. I. Franklin. On June 28th an in-
spection was made at Franklin by Dr. Morris F. Cawley, County
Medical Inspector, upon instructions from this Department on ac-
count' of the report of the existence of typhoid fever at that place.
The first case was that of a woman who infected the well on her
premises. Following this, 9 other cases developed who were users
of this same well. It was recommended that this well be condemned
and no further trouble was reported.
MONTGOMERY COUNTY.
Dr. C. H. Mann, Acting C. M. I. Bethesda Home, Chestnut Hill,
Owing to the report of 13 cases of typhoid fever having been re-
moved from the Bethesda Home to the Germantown Hospital, Phila-
delphia, Dr. C. H. Mann, Acting County Medical Inspector for
Montgomery county, in company with our Health Officer, Dr. W. B.
Jameson, made an investigation during the latter part of September,
1907.
A spring on the M premises, near the Bethesda Home, from
which all those afflicted had drunk, was found to be the source of
the infection and a placard signed by the Commissioner of Health,
warning the public not to drink of this water, was placed by the
spring. No further cases were reported.
MONTGOMERY COUNTY.
Dr. H. H. Whitcomb, C. M. I. Evansburg. On October 24th, 1907,
information was received from the County Medical Inspector, Dr.
H. H. Whitcomb, that four cases of typhoid fever existed in one
family at Evansburg. Dr. Whitcomb, in company with Health Offi-
cer Dr. W. Z, Anders, made an investigation.
These cases were traced to a well on the premises and instructions
were given for emptying and cleansing the same. No further spread
of the disease occurred.
NORTHAMTON COUNTY.
Dr. Thomas C. Zulick, C. M. I. Martin's Creek. As reports from
the Easton Hospital showed that four cases of typhoid fever were
received into their wards from Martin's Creek, it was deemed advis-
able to make an inspection.
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No. U. COMMISSIONBR OF HSLAl/TH. 51
Dr. Thomas O. Zultek, County Medical Inspector, visited the place,
according to instructions, on April 4, 1907. The oases reported were
found to exist among the foreign population where the sanitary con-
ditions are bad. A man was stationed to watch these people and
report any new cases.
The source of the infection was found to be in the drinking water,
which upon analysis showed the presence of Bac. coli. This was
ordered disused and no further cases were reported.
WESTMOREL.AND COUNTY.
Dr. T. A. Klingensmith, C. M. I. Export. Eight cases of typhoid
fever haying been reported from Export, Pa., a mining town in West-
moreland county. Dr. T. A. Klingensmith, County Medical Inspector,
was instructed to make an investigation on August 30, 1907.
The conditions about this town are extremely insanitary — ^in fact
filthy. All the cases of typhoid were found to exist among the for-
eign element who worked for the Ooal Company and occupy their
houses. The attention of the Coal Company was called to the con-
dition.
SCARLET FBVBR.
The following are some of the cases in which the aid of the County
Medical Inspectors has been sought in controlling Bcarlet Fever:
ADAMS COUNTY.
Dr. G. Rice, O. M. I., McSherrystown. Tyrone township. May
18, 1907, by order of the Department the dairy farm of T. W. 8.,
Tyrone tovmship, was inspected on account of the existence of scar-
let fever. Five cases were found, one death having occurred. The
patients were isolated and sale of milk from these premises was pro*
hibited. June 6th the premises were again visited and all the regu-
lations of the Department having been carried out, quarantine was
raised and the sale of milk resumed.
BUCKS COUNTY.
James E. Groflf, C. M. I., Doylestown. Dec. 13th investigated
the dairy farm of J. K., where two cases of scarlet fever had made
their appearance. Provisions were made by which Mr. K., who had
not been in the house since the patients had become ill, was to sleep
and board outside of the infected house and was therefore allowed
to continue the sale of milk from his dairy.
Visited Springfield township on account of the prevalence of scar-
let fever and learned from various sources that cases of scarlet fever
had occurred during the past months in this township and very few
of them had been under the care of a physician at all. The school-
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52 SECOND ANNUAL. REPORT OF THE Off. Doc
house had been fumigated as required by the Department. It does
not appear that there had been any considerable outbreak of this
disease.
BLAIR COUNTY.
Dr. Joseph D. Findley, C. M. I. Pleasant Valley. On receipt of
Information from T. C. Herbert, Health Officer, that scarlet fever
existed in Pleasant Valley, an investigation was made by Dr. Jos.
D. Findley, County Medical Inspector, on November 14, 1907.
He found two families in which children had had mild sore throat
with slight rash followed by desquamation. The houses were or-
dered fumigated and he directed that the school which they had
attended should also be thoroughly disinfected.
LAWRENCE COUNTY.
Dr. Jesse D. Moore, 0. M. I., New Castle. New Bedford. Dr.
Moore reports March 15, 1907, as follows, concerning scarlet fever at
New Bedford.
The people of New Bedford and community have been troubled
from time to time with the failure of Ohio doctors to report con-
tagious troubles to the Pennsylvania authorities. This I have told
their Board of Health and instructed them that the Ohio doctors,
while practicing in this State, are under the same supervision as
resident physicians. They have promised that they will see the law
enforced-
The blame, at least partially so, I lay at the door of the present
Board of Health of Pulaski township, in that being composed of the
school directors of said township, they believe they cannot overstep
the authority as given by the Board of Health to the school directors,
as directors only. I have attempted and, I think, succeeded in con-
vincing them that the powers of a Board of Health and the powers
as school directors are distinct and separate, and that they now have
all the power that the Btate of Pennsylvania, under its existing laws,
can confer to control their township in regard to all contagious
diseases.
LrEHIGH COUNTY.
Dr. Morris F. Cawley, C. M. I. Guthsville. An inspection at the
Guthsville school where children were in attendance suffering from
scarlet fever. Ordered such children to be excluded from school
during the proper period of exclusion. Found also a case of scarlet
fever in the house of O. H. Orefleld.
CLEARFIELD COUNTY.
Dr. Spencer M. Free, C. M. I. Hillsdale. August 13, investigated
the scarlet fever situation at Hillsdale, Lawrence township, and
found several cases, but all under good control, modified quarantine
being enforced in each instance.
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No. 16. COMMISSIONER OF HBALiTH. 53
COLUMBIA COUNTT.
Dr. S. B. Arment, C. M. I. Beaver township. On March 30th made
an investigation in Beaver township. Found they had had scarlet
fever at three different houses and as the cases were mild no physi-
cian had been called and no precautions taken.
April 1st again visited Beaver township, discovered a case in
another house where no physician was employed, the cases also being
mild. Stopped the sale of dairy products from these farms for the
present. Instructed the teachers to exclude from school all children
Buffering from communicable diseases.
LUZERNE COUNTY.
Dr. Chas. H. Miner, C. M. I. Glen Lyon. Ox^tober 23, 1908, it was
reported that an epidemic of scarlet fever had broken out at Glen
Lyon and several nearby towns. The County Medical Inspector, Dr.
Charles H. Miner, was at once instructed to make an investigation.
A house to house examination of the town was made in company
with our Health Officer, Dr. Myers, and their report showed that 69
cases had existed in this town since June. There have probably
been 20 other cases not seen by physicians and that have recovered.
The President of the Commissioners of Newport township prom^
ised to call a meeting of the Board at ont^e and appoint a permanent
Board of Health.
The schools were ordered cloeed and no public gatherings allowed.
Schools and dwelling houses to be thoroughly disinfected.
Twenty-eight cases of scarlet fever were found to have existed in
Wanamie since June, with one death.
In Breslau there were eleven cases and two deaths. A public
funeral was prevented by aid of the State Constabulary, who also
assisted in enforcing quarantine.
The school house was fumigated and ordered closed for two weeks.
In Lu Park — a, settlement just below Wilkes-Barre — fifteen cases
were found. The school was ordered closed.
It is evident that the epidemic was caused by the ignorance and
carelessncBS of the people and neglect of the physicians to see that
houses were placarded and later disinfected, early in the epidemic.
The sanitary conditions of these towns is very bad.
DIPHTHERIA.
LEHIGH COUNTY.
Dr. Morris F. Cawley, C. M. I., AUentown. Orefleld. Investigated
outbreak of diphtheria in the family of C. P., living at Orefleld.
Found four cases of diphtheria in the family, one case terminating
in death, no doctor having been called for the first two cases.
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64 SECOND ANNUAL. REPORT OF THE Off. Doc.
Breiningsvllle, May 1. InTeetigated the contagious disease at
Breiningsville as ordered. The man of the house was treated for
tonsilitis. Recovered with partial vocal paralysis. Two children
became ill with the disease^ one dying, presumably from laryngeal
involvement. The other one has recovered with partial paralysis of
the limbs*
Salisbury township. Visited Salisbury township on account of al-
leged cases of diphtheria existing which were not reported. Pound
cases existing in two families. The following day learned that four
families had become infected from the first infected house where
there is a case with no physician in attendance.
Note. — These few cases have been placed on record simply because
they exemplify the constant menace to the public health which lies
in neglected sore throats, failure to summon medical aid and care-
lessness in diagnosis.
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No. 18 COUMISSIONER OF HBAI/TH. 66
SUB-DIVISION— TUBERCULOSIS DISPENSARIES.
THOMAS H. A. STITES, M. D., Medical Inspector of Dispensaries.
TUBERCULOSIS DISPENSARIES.
CHIEFS OF DISPENSARIES.
One in each county. In each case the County Medical Inspector.
ASSISTANT PHYSICIANS.
No assistant physicians were formally appointed previous to De-
cember 31st. In a number of dispensaries, physicians desiring to
assist in the work volunteered their services and in almost every
instance rendered valuable help.
NURSSa
At the larger places nurses have been employed upon salary. At
the smaller places where the number of patients does not justify
such an outlay, it has been found iwssible to secure the attendance
of the nurses upon payment by the hour for services rendered- At
another point will be found a list of the physicians and nurses in
charge of dispensaries, Dec. 31st, 1907.
OFFICE WORK.
The office work may be divided into two sections: (a) The pre-
liminary work; (b) The administrative — that required after estab-
lishment of the dispensaries.
The preliminary work consisted of securing information with re-
gard to such work elsewhere and in the preparation of forms for
use in recording the work of the dispensaries. A large amount of
information was secured by the Commissioner himself and his assist-
ants of the Medical Division. Dr. Charles H. Miner, of Wilkes-
Barre, is entitled to especial credit for valuable aid in organiing
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56 SECOND ANNUAL, REPORT OF THE Off. Doc.
this Division. Thifi information was sought from all parts of this
country and from other countries. A number of the forms for use
in the dispensaries were alsio prepared. The Oommissioner of Health
gave a great deal of his personal attention to this preliminary work.
Included in the preliminary work was the inspection of the work
of a dispensary maintained at Wilkes-Barre by the Wyoming Valley
Society for the Prevention and Treatment of Tuberculosis. After
carefully reviewing the work of this establishment, it seemed expedi-
ent that the Department should acquire the plant and continue its
operation as Dispensary Number 1, and on due consideration and
appraisement of its property, the dispensary passed into the hands
of the Department of Health and opened for work under the auspices
of the Commonwealth July 22nd, 1907.
ADMINISTRATIVE WORK.
The administrative work of the division consists in superintending
the distribution of supplies, reviewing reports and vouchers, and
personal inspection of the various dispensaries. The Medical In-
spector of Dispensaries makes frequent visits to each dispensary, his
coming never being known to thoee in charge of the particular dis-
pensary until his arrival. In this way the Department seeks to
assure itself of the maintenance of the dispensaries in proper physi-
cal condition, and that the physicians are doing their work as re-
quired by the Department.
LOCATION OF DISPENSARIES.
ONE IN EACH COUNTY.
As this Commonwealth was a pioneer in the establishment of such
a system of dispensary treatment, it was felt that progress must be
made slowly and in such a way as to make some provision for the
needs of all sections of the State. The Commissioner of Health
therefore decided that the distribution of dispensaries most likely
to meet the requirements would be to assign one station to each
county, making a total of sixty-seven (67).
LOCATION V7ITHIN COUNTY.
The problem of selecting in each county the particular place best
adapted to serve the needs of the county in question was one which
in a number of instances presented serious difficulties. The points
of greatest importance in each were the population of the place
under consideration and its means of communication with other
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No. le. COMMISSIONER OF HBAIVTH. 67
parts of the county. It was felt that each dispensary must be so
located as to meet the demands of as great a number as x>08sible
of those who might need its assistance. A list of dispensaries given
elsewhere will show the names of the places selected.
NUMBEEING OF DISPENSARIES.
For the sake of convenience it was decided that each dispensary
should receive a number, and that each should be numbered in the
order in which its organization was begun. The dispensary located
at Wilkes-Barre, Luzerne county, having been opened under the
auspices of the State some months prior to any other, is Number 1.
EQUIPMENT OF DISPENSARIES.
The equipment of so large a number of dispensaries is, of course,
an extensive undertaking. In consideration of this fact and in view
of the ease with which articles of furniture may become infected and
serve as media for the transmission of disease from one person to
another, it was felt that the furniture supplies to the dispensaries
must be absolutely plain and as inexpensive as might be consistent
with that durability so necessary in articles in use in public places.
It is needless to say that it was also felt to be desirable to avoid
any articles not absolutely required for conducting the work on
hand. Therefore, the dispensaries will impress the casual observer
as very plain and somewhat bare. This feature has not been carried
to such an extent as to make the aspect of the rooms forbidding, but
is sufficiently marked to serve as an object lesson to all who may
come into them, showing the possibility of conducting a great work
in comfort with but few articles of furniture. The standard equip-
ment, which, of course, is subject to such modifications as may be
necessary to meet the needs of the particular dispensary, is approxi-
mately as follows:
One dozen chalra.
One couch.
One combination filing cabinet and desk.
Two kitchen tables.
One set Fairbanks Physician's scales with measure rod.
Two examining stools— l-Se"^ high and I-IS'' high.
One open work steel door mat.
Two pictures each showing 3 views of State South Mountain Sanatorium.
One-half dosen crash towels.
One portable wash-stand with pitcher, basin and bucket.
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R8 SECOND ANNUAL. RBPORT OF THB Off. Doc
One dinlnfectlng can with supply of dlslnfectantB— Permanganate of Potash
and Formaldehyde.
One linen coat for the physician's use while In attendance at the dispensary.
Pai>er cuspidors.
Paper napkins and bags.
Blank forms for the purpose of keeping records.
In some places the demands of the work call for certain additional
equipment, but the above is the standard and any variations are
simply an adaptation to local needs.
It is expected that each dispensary will be properly disinfected at
such frequent intervals as to insure the safety of those called upon
to work in the rooms. Provision for janitor service is also import-
ant the Department insists that the whole plant shall be kept in
an orderly and clean condition.
METHODS OP DISPENSARY.
Each patient applying for treatment at a dispensary is first called
upon to sign a blank application, declaring himself too poor to pay
for such treatment. After this the personal and family history so
far as relates to health conditions is recorded at considerable length
and the patient is given a searching physical examination. The con-
ditions revealed by the examination are carefully recorded. The pa-
tient is then instru'cted as to the communicable nature of the disease
and the precautions which should be taken to lessen the danger of
infection to those coming in contact with him. The habits of the
particular i>atient are reviewed and the course of life best calculated
to meet the needs of the individual is laid out by the physician
in charge. In certain cases where the symptoms call for imme-
diate relief, drugs are prescribed, but the use of medicine is kept at
the lowest possible limit. Patients who may be unable to supply
themselves with sufficient food of a digestible and nourishing char-
acter are furnished with such quantities of milk and eggs as the
physician in charge may deem advisable. In order to avoid imposi-
tion, a rule of the Department forbids any physician to issue an
order for supplies until after there has been an inspection of the
home surroundings of the patient and a written report made of tbe
inspection. Wherever it is possible to make use of the services of a
Bureau of Information or Associated Charities, the Department
consults the records of such organizations. Every possible precau-
tion is exercised against fraud and imposition. In many instances
it has been found possible to satisfy the demands of patients who
think that unless they are taking medicine nothing is being done for
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No. 16
COMMISSIONER OF HUALTH.
69
them, by dispenaing pure olire oil. In this way the patient can be
indaeed to take an increased quantity of food. Upon their return
Tisits to the dispensary all patients are weighed and the weight is
recorded. Any further particulars concerning the case are also
noted in the history of the patient.
Each dispensary maintains a card catalogue of its patients, also
of the milk and egg supplies distributed. At the end of each month
the physician in charge reports to the Department the names of the
patients who have applied for treatment during that month. He is
also required to submit a detailed report of the work done during
the month.
List of Dispensaries.
1
i
Q
County.
Plaoe.
Date of open-
ing.
Lusenie
WUkes-Barre
7-lt-OT
York. .'. ',, ..,. ..'
York ;
Brte/
Carlisle
U-lB-07
ISe :::::::;:;:::::::::::;:::::::::;::::::::.
U-1IM>7
CmnMrland
10-S5-<ff
Lebanon, ..'.
l^tl-07
Cheater, ' ."
West Chester
S^bSi
Centre
Belief onte . .'
11- h-9t
OEuneron
10- 5-07
Johnstown
ll-Se-07
11
Frfinklln
Chain bersbunr
U-10-07
11
Delaware.
Chester
11-12-07
14
Altoona
U-10-07
n
Butler
Butler
11-16-07
16
Oolambia.
Fulton,
Pike
Bloonsburv
U- 6-07
17
U-1<H>7
It
MllfoM .*
12- 0-07
M
Klttannlnc
11- 6-07
2S
Juniata, T."
MifBlntown'
U-17^
18
Montour,
DanTllle. .'.
U-14-07
ao
Somerset
Meyersdale
12- 4-07
tt
Venango' !',
Forest
Oil City
12-18-07
u
Tlonesta
12-90-07
List of Physicians.
Pbyslctan In Charge.
Nurses.
Days.
Hours.
1 Dr. C. H. Miner.
3 Dr. J. S. Miller
S Dr. J. W. Wrlifht.
4 Dr. H. B. Bashore
5 Dr. A. J. Rlegel
• Dr. Jos. Scatter^ood. ...
7 Dr. Oeo. F. Harris
8 Dr. H. S. Falk
2 Dr. W. B. Matthews, ...
11 Dr. H. X. Bonbrake. ....
12 Dr. R. S. Malson
14 Dr. J, D. FIndley.
15 Dr. H. D. Hockenberry,
16 Dr. 8. B. Arment. ,
17 ' Dr. J. W. Mosser
12 Dr. W. B. Kenworthy. ..
24 Dr. T. N. McKee
22 Dr. W. H. Banks
28 Dr. K. A. Curry
20 Dr. C. P. Large
22 Dr. J. P. Strayer
24 Dr. F. J. Bovard
2 salary
Salary.
Per hour
Per hour
Per hour
Per hour,
Health officer.
Per hour. .....
Per hour
Health officer.
Salary,
Salary
Per hour
Per hour
Health officer,
Health officer,
Health officer,
Per hour,
Health officer.
Health officer,
Per hour
Health officer,
Mon. Wed. Frl..
Mon. Wed. Frl.,
Tues. Wed. Frl.,
Tues. and Frl.. .
Wed. and Sat., .
Wed. and Frl.. .
Wed. and Frl.. .
Tues. and Frl.. .
Tries, and Frl.. .
Tues. and Frl.. .
Tues. and Frl.. .
Tues. and Frl.. .
Tues. and Frl.. .
Tues. and PH.. .
Tuesday
Monday
Mon. and Frl.,
Tues. and Thurs,
Tues. and Frl.,
Wednesday
Tues. and Frl.. .
Saturday.
2-6 P. M.
2-6 P. M.
8-6 P. M.
12-2 P. M.
10-12 M.
2-4 P. M.
1:80-8:30
1-4 P. M.
2-4 P. M.
2-4 P. M.
2-4 P. M.
»-4P. M.
2-4 P. M.
2-4 P. M.
1-4 P. M.
2-4 P. M.
2-4 P. M.
IM P. M.
2-4 P. M.
2-4 P. M.
12:30-2
»-llA. M.
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SECOND ANNUAL. REPORT OF THE
Off. Doc.
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Unsuitable
Deaths.
Return visits
Weight:
Increased,
No Increase,
Loss.
ill
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Na 1€. COMMISSIONER OF HEAI/TH. 61
SUB-DIVISION— SPECIAL MEDICAL INSPECTION.
JOHN A. BOUSE, M. D., Special Medical Inspector.
The following is a condeased statement of special work performed
during the later months of the year 1907, in visiting various counties
of the CJommonwealth, with a view of determining the status and
efficiency of local sanitary administration throughout the State.
This work was begun in the early part of September. In the
county of Cambria nineteen boroughs were visited. A report of the
conditions found to exist is as follows: twelve Boards of Health
were found to be active, that is to say were doing some work on
sanitary lines. One Board found to be inactive, or doing no work
whatever. Number of boroughs visited in which no Boards of
Health existed, six.
Dauphin county, number of boroughs visited, nine: active Boards
five, number of boroughs without Boards of Health, four.
Huntingdon CJounty, number of boroughs visited, ten; active
Boards four, inactive one, number of boroughs without Boards of
Health, five.
Luzerne county, number of boroughs visited twenty-eight, four-
teen having active Boards of Health, two ina^ctive and twelve
without Boards.
Schuylkill county, numiber of borough visited twenty-seven, of
which eighteen were active, one inactive and eight having no
Boards.
Washington county, number of boroughs visited eight. Of these
one had an active Board of Health, one inactive and six were without
sanitary organizations.
York county, thirty-three boroughs visited, fourteen having active
Boards of Health and nineteen with no Boards in existence.
As a result of the visits to the above named counties a small
number of Boards were appointed but failed to organize. This
matter was taken up with the proper authorities and a request made
to proceed at once with the organization. Very little opposition
was met with on the part of Councils regarding the organization of
Boards of Health.
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«2 SECOND ANNUAL, REPORT OF THE Off. Doc.
Ck)mplaints were made by many Secretaries of Boards of Health
visited that the physicians failed to report communicable and con-
tagious diseases promptly. In each of these cases I instructed
the secretary as to his duty to furnish the physicians proper blanks
for making such reports and pointed out the law on this subject.
I further discovered that many of them did not require reports to
be made of all the diseases listed in this Department as reportable
contagious and communicable diseases.
I found that only a few pliaces observed proper quarantine. The
period of such quarantine varied considerably. Disinfection was
improperly and imperfectly performed. I instructed them on this
subject aud acquainted them with the rules and regulations of this
Department.
Appropriations made by Councils for the maintenance of Boards
of Health were found to be small and entirely inadequate to properly
carry forward sanitary work. I believe that if there were a better
understanding on the part of the Councils as to the needs and re-
quirements of Boards of Health, they would receive sufficient finan-
cial assistance.
As far as could be ascertained all the boroughs visited are favor-
able to having active Boards of Health. In some instances great
difficulty is encountered in obtaining proper persons to serve on
such Boards. Many of the villages are small and contain very few
eligible persons. The Secretaries are generally active and well
qualified and under proper regulations should become efficient.
Sufficient importance is not attached to the position of the Health
Officers nor are their duties properly defined. It is suggested that
Boards of Health in boroughs be supplied with Model Rules and
Regulations and with manuals for the guidance of Health Officers,
also with regulations regarding nuisances, as is done in the case of
townships.
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COMMONWEALTH OF PENNSYLVANIA.
REPORT OF THE SANITARY INSPECTION OF SCHOOLS.
FALL 1907.
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<«4)
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OFFICIAIj DOCUMSNT, No. 16.
REPORT OF SCHOOL INSPECTIONS, FALL, 1907.
TOTALS FOB ©TATE.
No. of schools inspected 9,226
No. In which conditions were sanitary* 5,113
No. in which ventilation was poor, 896
No. in which light was poor, 76
No. in which water was poor 323
No. in which privies were dirty 2,217
No. in which privy vaults were full, 1,116
No. in which privy vaults were overflowing, 1,121
No. in which privy vaults were offensive, 1,814
No. in which dividing fences were needing repair 2 , 451
No. in which grounds were uncleanly, 659
No. admitting unvacclnated children, 2,518
No. of unvacclnated children in attendance, 35,150
ADAMS CrOUNTT.
No. of schools inspected, 158
No. in which conditions were sanitary 124
No. in which ventilation was i>oor , 3
No. In which light was poor
No. in which water was poor 1
No. in which privies were dirty 21
No. in which privy vaults were full, 15
No. in which privy vaults were overflowing, 14
No. in which vaults were offensive 16
No. in which dividing fences were needing repair 19
No. in which grounds were uncleanly, 2
No. admitting unvacclnated children, 14
No. of unvacclnated children In attendance, 69
ALLEGHENY COUNTY.
No. of schools inspected, 148
No. in which conditions were sanitary » 95
No. in which ventilation was poor 5
No. in which light was poor, 1
No. in which water was poor, 6
No. in which privies were dirty, 28
No. in which privy vaults were full, 6
(66)
5—16—1907
Digitized by VjOOQIC
66 SECOND ANNUAL REPORT OF THB) Off. Doc.
ALLEGHENY COUNTY— Continued.
No. in which privy vaults were overflowing, 7
No. in which privy vaults were offensive, 24
No. in which dividing fences were needing repair, 25
No. in which grounds were uncleanly, 10
No. admitting unvacclnated children, 37
No. of unvacclnated children in attendance 318
ARMSTRONG COUNTY.
No. of schools inspected 262
No. in which conditions were sanitary, 115
No. in which ventilation was poor 8
No. in which light was poor, 8
No. in which water was poor, 9
No. in which privies were dirty, 116
No. in which privy vaults were full, 39
No. in which privy vaults were overflowing 84
No. in which privy vaults were offensive 102
No. in which dividing fences were needing repair, 81
No. in which grounds were uncleanly 33
No. admitting unvacclnated children, 95
No. of unvacclnated children in attendance 1,176
BBAVEH COUNTY.
No. of schools inspected, 88
No. in which conditions were sanitary 40
No. in which ventilation was poor 7
No. in which light was poor 1
No. in which water was poor 4
No. In which privies were dirty, 40
No. in which privy vaults were full, 36
No. in which privy vaults were overflowing, 33
No. in which privy vaults were offensive, 43
No. in which dividing fences were needing repair 36
No. in which grounds were uncleanly, 7
No. admitting unvacclnated children, 81
No. of unvacclnated children in attendance, 674
BEDFORD COUNTY.
No. of schools Inspected, 201
No. in which conditions were sanitary, 92
No. in which ventilation was poor, ,,.\ 27
No. in which light was poor, 1
No. in which water was poor, 8
No. in which privies were dirty, 29
No. in which privy vaults were full 18
No. in which privy vaults were overflowing 25
No. In which privy vaults were offensive, 18
No. in which dividing fences were needing repair 83
No. in which grounds were uncleanly, 89
No. admitting unvacclnated children 87
No. of unvacclnated children in attendance 2,780
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No. 16. COMMISSIONER OF HEALTH. 67
BERKS COUNTY.
No. of schools inspected, 323
No. in which conditions were sanitary. 221
No. in which ventilation was poor SO
No. in which light was poor, 8
N6. in which water was poor, 8
No. in which privies were dirty 34
No. in which privy vaults were full, 12
No. In which privy vaults were overflowing, 14
No. in which privy vaults were offensive, 27
No. in which dividing fences were needing repair 53
No. in which grounds were uncleanly, 6
No. admitting unvacclnated children, 7
No. of unvacclnated children in attendance, 27
BLAIR COUNTY.
No. of schools inspected, 118
No. in which conditions were sanitary 67
No. in which ventilation was poor, 8
No. in which light was poor, 1
No. in which water was poor 4
No. in which privies were dirty 81
No. in which privy vaults were full, 12
No. in which privy vaults were overflowing 20
No. in which privy vaults were offensive 30
No. in which dividing fences were needing repair, 35
No. in which grounds were uncleaned 17
No. admitting unvacclnated children, 12
No. of unvacclnated children In attendance, 94
BRADFORD COUNTY.
No. of schools inspected, 237
No. in which conditions were sanitary 127
No. in which ventilation was poor 7
No. in which light was poor, 3
No. in which water was poor, 9
No. in which privies were dirty, 63
No. in which privy vaults were full 63
No. in which privy vaults were overflowing, 31
No. in which privy vaults were offensive, 71
No. In which dividing fences were needing repair 78
No. in which grounds were uncleanly, 26
No. admitting unvacclnated children, 38
No. of unvacclnated children in attendance, 284
BUCKS COUNTY.
No. of schools inspected, 170
No. in which conditions were sanitary, 118
No. in which ventilation was poor, 23
No. in which light was poor 1
No. in which water was poor, 5
No. in which privies were dirty, 13
Digitized by VjOOQIC
<8 SECOND ANNTJAL. REPORT OF THE Off. Doc. .
BUCKS COUNTY— Continued.
No. in which privy vaults were full, 4
No. in which privy vaults were overflowing, 7
No. in which privy vaults were offensive 2
No. in which dividing fences were needing repair 23
No. in which grounds were uncleanly
No. admitting unvaccinated children, 34
No. of unvaccinated children in attendance, 124
BUTLER COUNTY.
No. of schools inspected, 167
No. in which conditions were sanitary, • 110
No. in which ventilation was poor, 14
No. in which light was poor
No. in which water was poor 13
No. In which privies were dirty, 28
No. in which privy vaults were full, 14
No. in which privy vaults were overflowing, 17
No. in which privy vauts were offensive, 21
No. in which dividing fences were needing repair, 28
No. in which grounds were uncleanly, 11
No. admitting unvaccinated children, 64
No. of unvaccinated children in attendance 665
CAMBRIA COUNTY.
No. of schools inspected, 204
No. In which conditions were sanitary 88
No. In which ventilation was poor 6
No. in which light was poor
No. in which water was poor, ; 10
No. in which privies were dirty 17
No. in which privy vaults were full, 45
No. in which privy vaults were overflowing 52
No. in which privy vaults were offensive, 66
No. in which dividing fences were needing repair, 70
No. In which grounds were uncleanly, 86
No. admitting unvaccinated children, 84
No. of unvaccinated children in attendance, 1,615
CAMERON COUNTY.
No schools inspections were made in this county.
CARBON COUNTY.
No. of schools insp'^cted 66
No. in which conditions were sanitary, 46
No. in which ventilation was poor, 8
No. in which light was poor 1
No. in which water was poor, 2
No. in which privies were dirty, 12
No. in which privy vaults were full, 7
No. in which privy vaults were overflowing, 5
No. in which privy vaults were offensive H
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No. 16. COMMISSIONER OF HBAI/TH. 69
CARBON COUNTY— Continued.
No. In which dividing fences were needing repair 12
No. in which grounds were uncleanly 3
No. admitting unvaccinated children, 5
No. of unvaccinated children in attendance, 46
CENTRE COUNTY.
No. of schools Inspected 207
No. in which conditions were sanitary, W
No. in which ventilation was poor W
No. in which light was poor
No. in which water was poor, 1
No. in which privies were dirty, 45
No. in which privy vaults were full 82
No. in which privy vaults were overflowing, 27
No. in which privy vaults were offensive, 44
No. in which dividing fences were needing repair, 68
No. in which grounds were uncleanly 30
No. admitting unvaccinated children 94
No. of unvaccinated children in attendance 1»683
CHESTER COUNTY.
No. of schools inspected, 148
No. in which conditions were sanitary 94
No. in which ventilation was poor, 20
No. in which light was poor
No. in which water was poor, 11
No. in which privies were dirty, 36
No. in which privy vaults were full 14
No. in which privies were dirty, 36
No. in which private vaults were offensive, 26
No. in which dividing fences were needing repair, 21
No. in which grounds were uncleanly, 4
No. admitting unvaccinated children, 41
No. of unvaccinated children in attendance, 661
CLARION COUNTY.
No. of schools inspected 78
No. in which conditions were sanitary, 41
No. in which ventilation was iKwr, 11
No. in which light was poor 2
No. In which water was poor 1
No. in which privies were dirty 11
No. in which privy vaults were full 6
No, in which privy vaults were overflowing 6
No. in which privy vaults were offensive, 6
No. in which dividing fences were needing repair 14
No. in which grounds were uncleanly, 11
No. admitting unvaccinated children 18
No. unvaccinated children in attendance, 208
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70 SECOND ANmJAL REPORT OF THE Off. Doc.
CLEARFIELD COUNTY.
No. of schools inspected, 201
No. in which conditions were sanitary, 1^3
No. in which ventilation was poor, 46
No. in which li£:ht was poor, 3
No. in which water was poor 11
No. in which privies were dirty, 67
No. in which privy vaults were full 38
No. in which privy vaults were overflowing, 21
No. in which privy vaults were offensive, 67
No. in which dividing fences were needing repair 67
No. in which grounds were uncleanly 40
No. admitting unvaccinated children, 36
No. of unvaccinated children in attendance, 741
CLINTON COUNTY.
No. of schools inspected, 20
No. in which conditions were sanitary 12
No. in which ventilation was poor,
No. in which light was poor
No. in which privies were dirty, 4
No. in which vaults were full 2
No. in which privy vaults were overflowing, 3
No. in which privy vaults were offensive, 3
No. in which dividing fences were needing repair 6
No. in which grounds were uncleanly, 2
No. admitting unvaccinated children 5
No. of unvaccinated children in attendance 18
COLUMBIA COUNTY.
No. if schools inspected 137
No. in which conditions were sanitary, 85
No. in which ventilation was poor 6
No. in which light was poor
No. in which water was poor, 7
No. in which privies were dirty 28
No. in which privy vaults were full 9
No. in which privy vaults were overflowing, 8
No. in which privy vaults were offensive, 22
No. in which dividing fences were needing repair SR
No. in which grounds were uncleanly, 2
No. admitting unvaccinated children, 42
No. of unvaccinated children in attendance 237
CRAWFORD COUNTY.
No. of schools inspected, 292
No. in which conditions were sanitary, 120
No. in which ventilation was poor 39
No. in which light was poor 1
No. in which water was j?oot 12
No. in which privies were dirty, 98
No. in which privy vaults were full 26
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No. 16. COMMISSIONER OF HSALTH. 71
CRAWFORD COUNTY— Continued.
No. in which privy vaults were overflowing, 34
No. in which privy vaults were offensive, 75
No. in which dividing fences were needing repair 110
No. in which grounds were uncleanly 12
No. admitting unvaccinated children, 223
No. of unvaccinated children in attendance 2,510
CUMBERLAND COUNTY.
No. of schools inspected, 181
No. in which conditions were sanitary, 105
No. in which ventilation was poor 28
No. in which light was poor, 5
No. in which water was poor i
No. in which privies were dirty, 38
No. in which privy vaults were full 27
No. in which privy vaults were overflowing, 22
No. in which privy vaults were offensive 85
No. in which dividing fences were needing repair, 18
No. in which grounds were uncleanly, 12
No. admitting unvaccinated children, 60
No. of unvaccinated children in attendance, 461
DAUPHIN COUNTY.
No. of schools inspected 168
No. in which conditions were sanitary 133
No. in which ventilation was poor, 4
No. in which light was poor, 1
No, in which water was poor, 1
No. in which privies were dirty, 18
No. In which privy vaults were full, 6
No. in which privy vaults were overflowing, 6
No. in which privy vaults were offensive 7
No. in which dividing fences were needing repair 16
No. in which grounds were uncleanly, 1
No. admitted unvaccinated children 9
No. of unvaccinated children in attendance, 84
DELAWARE COUNTY.
No. of schools inspected, 66
No. in which conditions were sanitary 56
No. in which ventilation was poor, 5
No. in which light was poor
No. in which water was poor, 6
No. in which privies were dirty 4
No. in which privy vaults were full, 6
No. in which privy vaults were overflowing, 2
No. in which privy vaults were offensive, 1
No. in which dividing fences were needing repair 8
No. in which grounds were uncleanly 1
No. admitting unvaccinated children, 10
No. of unvaccinated children in attendance, 45
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72 SECOND ANNUAL REPORT OF THE Off. Doc.
ELK COUNTY.
No. of schools inspected 75
No. in which conditions were sanitary, 36
No. in which ventilation was poor 1
No. in which light was poor 1
No. in which water was poor, 1
No. in which privies were dirty, 28
Np. in which privy vaults were full 7
No. in which privy vaults were overflowing 4
No. in which privy vaults were offensive, 26
No. in which dividing fences were needing repair 10
No. in which grounds were uncleanly 2
No. admitting unvaccinated children 7
No. of unvaccinated children in attendance 106
BRIE COUNTY.
No. of schools inspected, » 175
No. in which conditions were sanitary, 93
No. In which ventilation was poor
No. in which light was poor
No. in which privies were dirty 10
No. in which vaults were full, 21
No. in which vaults were overflowing 8
No. in which privy vaults were offensive, 20
No. in which dividing fences were needing repair, 29
No. in which grounds were uncleanly 1
No. admitting unvaccinated children, 51
No. of unvaccinated children in attendance, 816
FAYETTE COUNTY.
No, of schools inspected 219
No. in which conditions were sanitary, 112
No. in which ventilation was poor, 8
No. in which light was poor, 1
No. in which water was poor, 15
No. in which privies were dirty, 57
No. in which privy vaults were full 19
No. in which privy vaults were overflowing, 50
No. in which privy vaults were offensive, 39
No. in which dividing fences were needing repair, 86
No. in which grounds were uncleanly, 14
No. admitting unvaccinated children, 98
No. of unvaccinated children in attendance 1,971
FOREST COUNTY.
No. of schools inspected, 50
No. in which conditions were sanitary, 20
No. in which ventilation was poor, 4
No. in which light was poor,
No. in which water was poor
No. in which privies were dirty, 17
No. in which privy vaults were full, 15
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEAI/TH. 73
FOREST COUNTY— Continued.
No. in which privy vaults were overtiowing. 8
No. in wMch privy vaults were offensive 15
No. in which dividing fences were needing repair 27
No. in which grounds were uncleanly 6
No. admitting unvaccinated children 7
No. of unvaccinated children in attendance 38
FRANKLIN COUNTY.
No. of schools inspected, 119
No. in which conditions were sanitary, 133
No. in which ventilation was poor. 13
No. in which light was poor 2
No. in which water was poor. 5
No. in which privies were dirty 39
No. in which privy vaults were full 6
No. in which privy vaults were overflowing 6
No. In which privy vaults were offensive 16
No. in which dividing fences were needing repair 32
No. in which grounds were uncleanly 3
No. admitting unvaccinated children, 113
No. of unvaccinated children In attendance 1.846
FULTON COUNTY.
No. of schools inspected. 76
No. in which conditions were sanitary 41
No. in which ventilation was poor. 21
No. in which light was poor.
No. in which water was poor, 6
No. in which privies were dirty. 17
No. in which privy vaults were full. 13
No. in which privy vaults were overflowing. ". . 12
No. in which privy vaults were offensive 12
No. in which dividing fences were needing repair. 20
No. in which grounds were uncleanly. 1
No. admitting unvaccinated children, 26
No. of unvaccinated children In attendance. 192
GRBENB COUNTY.
No. of schools inspected. 40
No. in which conditions were sanitary, 16
No. in which ventilation was poor, 6
No. in which light was poor 1
No, in which water was poor. 1
No. in which privies were dirty, 21
No. in which privy vaults were full, 2
No. in which privy vaults were overflowing, 7
No. in which privy vaults were offensive, 11
No. in which dividing fences were needing repair. 20
No. in which grounds were uncleanly. 18
No. admitting unvaccinated children. 89
No. of unvaccinated children in attendance. 597
Digitized by VjOOQIC
74 SECOND ANNUAL REPORT OF THE Off. Doc.
HUNTINODON COUNTY.
No. of schools inspected, 126
No. in which conditions were sanitary 62
No. in which ventilation was poor 23
No. in which lierht was poor, 2
No. in which water was poor, 5
No. in which privies were dirty 15
No. in which privy vaults were full 9
No. in which privy vaults were overflowing, 4
No. in which privy vaults were offensive 7
No. in which dividing fences were needing repair 30
No. in which grounds were uncleanly, 6
No. admitting unvaccinated children, 41
No. of unvaccinated children in attendance, 427
INDIANA COUNTY.
No. of schools inspected, 160
No. in which conditions were sanitary 50
No. in which ventilation was poor 8
No. in which light was poor, 1
No. in which water was poor, 12
NO. in which privies were dirty, 73
No. In which privy vaults were full, 31
No. in which privy vaults were overflowing 46
No. in which privy vaults were offensive 48
No. in which dividing fences were needing repair, 81
No. in which grounds were uncleanly 22
No. admitting unvaccinated children 32
No. of unvaccinated children in attendance 256
JEFFERSON COUNTY.
No. of schools inspected, 36
No. in which conditions were sanitary 10
No. in which ventilation was poor
No. in which light was poor
No. in which water was poor
No. in which privies were dirty 17
No, in which privy vaults were full, 14
No. in which privy vaults were overflowing 14
No. in which privy vaults were offensive 16
No. in which dividing fences were needing repair, 21
No. in which grounds were uncleanly, 6
No. admitting unvaccinated children,
No. of unvaccinated children in attendance
JUNIATA COUNTY.
No. of schools inspected 88
No. in which conditions were sanitary, 46
No. in which ventilation was poor, 2
No. in which light was poor
No. in which water was poor 2
No. in which privies were dirty, 28
No. in which privy vaults were full, 14
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 75
JUNIATA COUNTY— Continued.
No. in which privy vaults were overflowingr 6
No. in which privy vaults were offensive, 2S
No. in which dividln^r fences were needing repair, 16
No: in which grounds were uncleanly, S
No. admitting unvaccinated children, 20
No. of unvaccinated children in attendance, 1,268
LACKAWANNA COUNTY.
No school inspections made in this county.
LANCASTER COUNTY.
No. of schools inspected, 401
No. in which conditions were sanitary 203
No. in which ventilation was poor, 64
No. in which light was poor, 1
No. in which water was poor, 6
No. in which privies were dirty, 64
No. in which privy vaults were full, 68
No. in which privy vaults were overflowing, 60
No. in which privy vaults were offensive, 81
No. in which dividing fences were needing repair, 62
No. in which grounds were uncleanly 10
No. admitting vaccinated children, 75
No. of unvaccinated children in attendance, 372
LAWRENCE COUNTY.
No. of schools inspected, 141
No. in which conditions were sanitary, 68
No. in which ventilation was poor, 6
No. in which light was i>oor,
No. in which water was poor, 11
No. in which privies were dirty 40
No. in which privy vaults were full, 19
No. in which privy vaults were overflowing 15
No. in which privy vaults were offensive, 86
No. in which dividing fences were needing repair, 81
No. in which grrounds were uncleanly, 12
No. admitting unvaccinated children 26
No. of unvaccinated children in attendance, 248
LEBANON COUNTY.
No. of schools inspected, 212
No. in which conditions were sanitary, 168
No. in which ventilation was poor, 4
No. in which light was poor
No. in which water was poor, 2
No. in which privies were dirty 21
No. In which privy vaults were full, 4
No. In which privy vaults were overflowing, 6
No. in which privy vaults were offensive 9
Digitized by VjOOQIC
76 SECOND ANNUAL. REPORT OF THE Off. Doc.
LEBANON COUNTY— Contlued.
No. in which dividing fences were needing repair, 20
No. in wMch grounds were uncleanly 10
No. admitting unvaccinated children 74
No. of unvaccinated children in attendance 1,051
LEHIGH COUNTY.
No. of schools inspected 161
No. in which conditions were sanitary, 118
No. in which ventilation was poor 2
No. in which light was poor,
No. in which water was poor, 4
No. In which privies were dirty, 25
No. in which privy vaults were full, 20
No. in which privy vaults were overflowing 20
No. in which privy vaults were offensive 33
No. in which dividing fences were needing repair 15
No. in which grounds were uncleanly 3
No. admitting unvaccinated children, 8
No. of unvaccinated children in attendance 36
LUZERNE COUNTY.
No. of schools inspected 18f
No. in which conditions were sanitary 101
No. in which ventilation was poor, 14
No. in which light was poor, 1
No. in which water was poor 8
No. in which privies were dirty 46
No. in which privy vaults were full 17
No. in which privy vaults were overflowing, 22
No. in which privy vaults were offensive 22
No. in which dividing fences were needing repair, 68
No. in which grrounds were uncleanly, 16
No. admitting unvaccinated children, 29
No. of unvaccinated children in attendance, 490
LYCOMING COUNTY.
No. of schools inspected 246
No. in which conditions were santltary 166
No. in which ventilation was poor 39
No. in which light was poor, 3
No. in which water was poor 11
No. in which privies were dirty, 63
No. in which privy vaults were full, 63
No. in which privy vaults were overflowing, 43
No. in which privy vaults were offensive, 62
No. in which dividing fences were needing repair, 61
No. in which grounds were uncleanly, 14
No. admitting unvaccinated children 103
No. of unvaccinated children in attendance, 889
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEAIVTH. 77
McKEAN COUNTY.
No. of schools inspected, 108
No. in which conditions were sanitary 36
No. in which ventilation was poor, 15
No. in which light was poor, 3
No. in which water was poor, 1
No. in which prvies were dirty, 24
No. In which privy vaults were ifuU, ^ 24
No. in which privy vaults were overflowing 15
No. in which privy vaults were offensive 32
No. in which dividing fences were needing repair 64
No. in which grounds were uncleanly, 8
No. admitting unvaccinated children, 10
No. of unvaccinated children in attendance, 99
MERCER COUNTY.
No. of schools inspected, 196
No. in which conditions were sanitary, 110
No. in which ventilation was poor, 18
No. in which light was poor
No. in which water was poor 19
No. in which privies were dirty, 67
No. in which privy vaults were full 44
No. in which privy vaults were overflowing, 33
Mo. in which privy vaults were offensive 52
No. In which dividing fences were needing repair, 54
No. in which grounds were uncleanly, 23
No. admitting unvaccinated children 35
No. of unvaccinated children in attendance, 565
MIFFLJN COUNTY.
No. of schools inspected 29
No. in which conditions were sanitary 16
No. in which ventilation was poor,
No. in which light was poor,
No. in which water was poor,
No. in which privies were dirty, 1
No. in which privy vaults were full, 2
No. in which privy vaults were overflowing, 1
No. in which privy vaults were offensive 8
No. in dividing fences were needing repair, 8
No. in which grounds were uncleanly, 1
No. admitting unvaccinated children, 7
No. of unvaccinated children in attendance 24
MONROE COUNTY.
No. of schools Inspected, 80
No. in which conditions were sanitary 28
No. in which ventilation was poor 3
No. in which light was poor 2
No. in which water was poor, 1
No. in which privies were dirty 34
Digitized by VjOOQIC
78 SECOND ANNUAL REPORT OF THE Off. Doc.
MONROE COUNTY— Continued.
No. in which privy vaults were full, 10
No. in which privy vaults were overflowing 10
No. in which privy vaults were offensive. 35
No. in which dividing fences were needing repair 31
No. in which grounds were uncleanly 8
No. admitting unvaccinated children, 14
No. of unvaccinated children In attendance, 61
MONTGOMERY COUNTY.
No. of schools Inspected, 1 Ii2
No. in which conditions were sanitary 78
No. in which ventilation was poor, 7
No. in which light was poor,
No. in which water was poor, 6
No. in which privies were dirty 34
No. In which privy vaults were full 29
No. in which privy vaults were overflowing, 81
No. in which privy vaults were offensive 38
No. in which dividing fences were needing repair 36
No. in which grounds were uncleanly, 3
No. admitting unvaccinated children 6
No. of unvaccinated children in attendance 80
MONTOUR COUNTY.
No. of schools inspected, 46
No. in which conditions were sanitary 19
No. In which ventilation was poor
No. in which light was poor,
No. in which water was poor,
No. in which privies were dirty, 13
No. in which privy vaults were full 11
No. in which privy vaults were overflowing, 13
No. in which privy vaults were offensive, 12
No. in which dividing fences were needing repair 19
No. in which grounds were uncleanly 1
No. admitting unvaccinated children 28
No. of unvaccinated children In attendance, 90
NORTHAMPTON COUNTY.
No. of schools inspected, 122
No. In which conditions were sanitary 71
No. in which ventilation was poor, 2
No. in which light was poor,
No. in which water was poor, 8
No. in which privies were dirty 11
No. in which privy vaults were full 7
No. in which privy vaults were overflowing, 8
No. in which privy vaults were offensive 14
No. in which dividing fences were needing repair 24
No. in which grounds were uncleanly 7
No. admitting unvaccinated children, 22
No. of unvaccinated children in attendance, 74
Digitized by VjOOQIC
No. le. COMMISSIONER OF HSAI/TH. 79
NORTHUMBERLAND COUNTY.
No. of schools inspected, 113
No. in which conditions were sanitary 71
No. in which ventilation was poor, 1
No. in which li£:ht was poor, 1
No. in which water was poor 1
No. in which privies were dirty, 27
Na in which privy vaults were full, 7
No. in which privy vaults were overflowing, 9
No. in which privy vaults were offensive, 30
No. in which dividing fences were needing repair 26
No. in which grounds were uncleanly, 1
No. admitting unvaccinated children, 27
No. of unvaccinated children in attendance 299
PERRY COUNTY.
No. of schools inspected, 98
No. in which conditions were sanitary, 73
No. in which ventilation was poor, 2
No. in which light was poor
No. in which water was poor, 2
No. in which privies were dirty 10
No. in which privy vaults were full 2
No. in which privy vaults were overflowing 1
No. in which privy vaults were offensive, 6
No. in which dividing fences were needing repair, 22
No. in which grounds were uncleanly, 2
No. admitting unvaccinated children 4
No. of unvaccinated children in attendance, 25
PIKE COUNTY.
No. of schools inspected, 80
No. in which conditions were sanitary, 10
No. in which ventilation was poor
No. in which light was poor
No. in which water was poor,
No. in which privies were dirty, 12
No. in which privy vaults were full, 8
No. in which privy vaults were overflowing 2
No. in which privy vaults were offensive, 8
No. in which dividing fences were needing repair, 21
No. in which grounds were uncleanly 7
No. admitting unvaccinated children, 8
No. if unvaccinated children In attendance, 30
POTTER COUNTY.
No. of schools inspected, 125
No. in which conditions were sanitary, 45
No. in which ventilation was poor, 35
No. in which light was poor, 3
No. in which water was poor 1
No. in which privies were dirty, 48
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80 SECOND ANNUAL. REPORT OF THE Off. Doc.
POTTER COUNTY— Continued.
No. in which privy vaults were full 20
No. in which privy vaults were overflowin^r 19
No. In which privy vaults were offensive, 46
No. in which dividing fences were needing repair, €2
No. in which grounds were uncleanly 18
No. admitting unvaccinated children, 21
No. of unvaccinated children in attendance 91
SCHUYLKILL COUNTY.
No. of schools inspected, 172
No. in which conditions were sanitary, 91
No. in which ventilation was poor, 85
No. in which light was poor,
No. in which water was poor 4
No. in which privies were dirty, 63
No. in which privy vaults were full, 32
No. in which privy vaults were overflowing, 25
No. in which privy vaults were offensive, 43
No. in which dividing fences were needing repair 32
No. in which grounds were uncleanly 10
No. admitting unvaccinated children, 43
No. of unvaccinated children in attendance 453
SNYDER COUNTY.
No. of schools Inspected 35
No. in which conditions were sanitary 17
No. in which ventilation was poor 1
No. in which light was poor,
No. in which water was poor %
No. in which privies were dirty, 19
No. in which privy vaults were full 12
No. in which privy vaults were overflowing 12
No. in which privy vaults were offensive, 17
No. in which dividing fences were needing repair g
No. in which grounds were uncleanly
No. admitting unvaccinated children 29
No. of unvaccinated children in attendance, 782
SOMiERSET COUNTY.
No. of schools inspected, 139
No. In which conditions were sanitary, g3
No. in which ventilation was poor 2
No. in which light was poor, 2
No. in which water was poor, 5
No. in which privies were dirty, 27
No. In which privy vaults were full, 2
No. in which privy vaults were overflowing 21
No. in which privy vaults were offensive, 14
No. in which dividing fences were needing repair 45
No. in which grounds were uncleanly, 13
No. admitting unvaccinated children 90
No. of unvaccinated children in attendance 2,119
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No. 16. COMMISSIONER OF HEAI/TH. 81
SULUVAN COUNTY.
No. of schools Inspected, 77
No. in which conditions were sanitary, 51
No. in which ventilation was poor 4
No. in which light was poor
No. in which water was poor, 6
No. in which privy was dirty, 9
No. in which privy vaults were full,
No. in which privy vaults were overflowing,
No. in which privy vaults were offensive, 2
No. in which dividing fences were needing repair, 20
No. in which grounds were uncleanly 8
No. admitting unvaccinated children 15
No. of unvaccinated children in attendance, 93
SUSQUEHANNA COUNTY.
No. of schools inspected 167
No. in which conditions were sanitary, 102
No. in which ventilation was poor 2
No. in which light was poor
No. in which water was poor,
No. in which privies were dirty 38
No. in which privy vaults were full, 12
No. in which privy vaults were overflowing 9
No. in which privy vaults were offensive 19
No. in which dividing fences were needing repair 45
No. in which grounds were uncleanly 3
No. admitting unvaccinated children 73
No. of unvaccinated children in attendance, 767
TIOGA COUNTY.
No. of schools inspected 203
No. in which conditions were sanitary 110
No. in which ventilation was poor, 25
No. in which light was poor, 4
No. in which water was poor, 6
No. in which privies were dirty, 57
No. in which privy vaults were full 36
No. in which privy vaults were overflowing, 33
No. in which privy vaults were offensive, 00
No. in which dividing fences were needing repair, 48
No. in which grounds were uncleanly, 9
No. admitting unvaccinated children 57
No. of unvaccinated children In attendance 448
UNION COUNTY.
No. of schools inspected, 64
No. in which conditions were sanitary, 36
No. in which ventilation was poor 29
No. in which light wsa poor
No. in which water was poor q
No. In which privies were dirty, 16
6—16—1907
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80 SECOND ANNUAL. REPORT OP THE Off. Doc.
POTTER COUNTY— ConUnued.
No. in which privy vaults were full, 20
No. in which privy vaults were overflowing, 19
No. in which privy vaults were offensive 46
No. in which dividing fences were needing repair 62
No. in which grounds were uncleanly, 18
No. admitting unvaccinated children 21
No. of unvaccinated children in attendance, 91
SCHUYLKILL COUNTY.
No. of schools inspected 172
No. in which conditions were sanitary 91
No. in which ventilation was poor, 85
No. in which light was poor,
No. in which water was poor, 4
No. in which privies were dirty, 63
No. in which privy vaults were full 32
No. in which privy vaults were overflowing 25
No. in which privy vaults were offensive, 43
No. In which dividing fences were needing repair, 32
No. in which grounds were uncleanly, 10
No. admitting unvaccinated children, 43
No. of unvaccinated children in attendance 453
SNYDEm COUNTY.
No. of schools inspected 35
No. in which conditions were sanitary, 17
No. in which ventilation was poor, 1
No. in which light was poor,
No. in which water was poor, 1
No. in which privies were dirty 19
No. in which privy vaults were full, 12
No. in which privy vaults were overflowing 12
No. in which privy vaults were offensive, 17
No. in which dividing fences were needing repair 8
No. in which grounds were uncleanly,
No. admitting unvaccinated children 29
No. of unvaccinated children in attendance, 782
SOMiERSET COUNTY.
No. of schools inspected 189
No. in which conditions were sanitary, 83
No. in which ventilation was poor 2
No. in which light was poor, 2
No. in which water was poor 5
No. in which privies were dirty, 27
No. in which privy vaults were full, 2
No. in which privy vaults were overflowing, 21
No. in which privy vaults were offensive, 14
No. in which dividing fences were needing repair, 45
No. in which grounds were uncleanly 13
No. admitting unvaccinated children, 90
No. of unvaccinated children in attendance, 2,119
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No. 16. COMMISSIONBR OF HEAI/TH. 81
SULUVAN COUNTY.
No. of schools Inspected, 77
No. in which conditions were sanitary, SI
No. in which ventilation was poor, 4
No. in which light was poor
No. in which water was poor 6
No. in which privy was dirty, 9
No. in which privy vaults were full
No. in which privy vaults were overflowingr
No. in which privy vaults were offensive, 2
No. in which dividing fences were needing repair, 20
No. in which grounds were uncleanly, S
No. admitting unvaccinated children, 16
No. of unvaccinated children in attendance, 93
SUSQUEHANNA COUNTY.
No. of schools inspected 167
No. in which conditions were sanitary, 102
No. in which ventilation was poor 2
No. in which light was poor
No. in which water was poor,
No. in which privies were dirty 38
No. in which privy vaults were full 12
No. in which privy vaults were overflowing, 9
No. in which privy vaults were offensive, 19
No. in which dividing fences were needing repair 45
No. in which grounds were uncleanly, 8
No. admitting unvaccinated children 78
No. of unvaccinated children in attendance, 767
TIOGA COUNTY.
No. of schools inspected 203
No. in which conditions were sanitary, 110
No. in which ventilation was poor, 25
No. in which light was poor, 4
No. in which water was poor, 6
No. in which privies were dirty, 57
No. in which privy vaults were full 35
No. in which privy vaults were overflowing S3
No. in which privy vaults were offensive 90
No. in which dividing fences were needing repair, 43
No. in which grounds were uncleanly 9
No. admitting unvaccinated children, 57
No. of unvaccinated children in attendance 448
UNION COUNTY.
No. of schools inspected, M
No. in which conditions were sanitary 3g
No. in which ventilation was poor, 29
No. in which light was poor
No. in which water was poor, q
No. in which privies were dirty U
6—16—1907
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82 SECOND ANNUAL ROPORT OF THS Off. Doc.
UNION COUNTT— ConUnued.
No. in which privy vaults were full, 4
No. In which privy vaults were overflowing 2
No. in which privy vaults were offensive, 8
No. in which dividing fences were needing repair, 16
No. in which grounds were uncleanly, 2
No. admitting unvacclnated children, 7
No. of unvacclnated children in attendance, 51
VBNANOO COUNTT.
No. of schools inspected, 164
No. in which conditions were sanitary, 64
No. in which ventilation was poor, 47
No. in which light was poor
No. in which water was poor, 10
No. in which privies were dirty 38
No. in which privy vaults were full, 9
No. in which privy vaults were overflowing, 14
No. in which privy vaults were offensive, 24
No. in which dividing fences were needing repair 81
No. in which grounds were uncleanly, 12
No. admitting unvacclnated children, 72
No. of unvacclnated children in attendance 806
WARREN COUNTT.
No. of schools inspected, 108
Na in which conditions were sanitary 43
No. in which ventilation was poor, 9
No. in which light was poor, 2
No. in which water was poor 6
No. in which privies were dirty, 39
No. in which privy vaults were full, j 16
No. in which privy vaults were overflowing 14
No. in which privy vaults were offensive, 88
No. in which dividing fences were needing repair, 41
No. in which grounds were uncleanly, 12
No. admitting unvacclnated children 19
No. of unvacclnated children in attendance 217
WASHINGTON COUNTT.
No. of schools Inspected, 206
No. in which conditions were sanitary 129
No. in which ventilation was poor,' 2
No. in which light was poor 1
No. in which water was poor 16
No. in which privies were dirty 52
No. in which privy vaults were full, 27
No. in which privy vaults were overflowing, 82
No. in which privy vaults were offensive 26
No. in which dividing fences were needing repair, 44
No. in which grounds were uncleanly, 82
No. admitting unvacclnated children, 55
No. of unvacclnated children in attendance 760
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Xo. 16. COMMISSIONER OF HBAI/TH. 83
WAYNE COUNTY.
No. of schools Inspected, 85
No. in which conditions were sanitaxy, 12
Nb. in which ventilation was poor 11
No. in which light was poor
No. in which water was poor,
No. in which privies were dirty. 9
No. in which privy vaults were full, 5
No. in which privy vaults were overflowing, 8
No. in which privy vaults were offensive 6
No. in which dividing fences were needing repair 19
No. in which grounds were uncleanly, 3
No. admitting unvaccinated children 14
No. of unvaccinated children in attendance, 46
WESTMORELAND COUNTY.
No. of school inspected, 174
No. in which conditions were sanitary 84
No. in which ventilation was poor, 9
No. in which light was poor, 16
No. in which water was poor, 7
No. in which privies were dirty, 48
No. in which privy vaults were full 29
No. in which privy vaults were overflowing 22
No. in which privy vaults were offensive, 35
No. in which dividing fences were needing repair 65
No. in which grounds were uncleanly, 11
No. admitting unvaccinated children 97
No. of unvaccinated children in attendance, 1,563
WYOMING COUNTY.
No. of schools inspected, 67
No. in which conditions were sanitary, 20
No. in which ventilation was poor, 10
No. in which light was poor,
No. in which water was poor 5
No, in which privies were dirty 86
No. in which privy vaults were full 21
No. in which privy vaults were overflowing 23
No. in which privy vaults were offensive, * 33
No. in which dividing fences were needing repair, 26
No. in which grounds were uncleanly, 10
No. admitting unvaccinated children, 26
No. of unvaccinated children In attendance 156
YORK COUNTY.
No. of schools inspected, 813
No. in which conditions were sanitary 200
No. in which ventilation was poor, 13
No. in which light was poor 2
No. in which water was poor 5
No. in which privies were dirty 46
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84 SECOND ANNUAL. REPORT OP THE Off. Doc.
YORK COUNTY— ConUnued.
No. in which privy vaults were full, 10
No. in which privy vaults were overflowing 38
No. in which privy vaults were offensive 29
No. in which dividing: fences were needing repair, 78
No. in which grounds were uncleanly 13
No. admitting unvaccinated children 69
No. of unvaccinated children in attendance €37
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Division of Laboratories and Experimental
Station.
ALXAN J. SMITH, M. D., Director of Pathology.
HERBERT FOX, M. D., Chief of liaboratortes.
(86)
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(86)
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OPFICIALi DOCUMENT, No. 16.
OPERATIONS OF THE LABORATORIES AND EX-
PERIMENTAL STATION FOR THE YEAR 1907.
The opening of the year 1907 began, the real work of the Labora-
tories, for almost in the first week of the year, the supplies, which
had been announced a short time previously by our circular pam-
phlet, were distributed. The work during the last two months of
1906 was but a trifle compcured with that which now came to us
through the use of our containers. The favor with which the Lab-
oratory was received was shown by the great demand for our outfits,
so that in February, those intended for malaria and those for
sputum were doubled in number.
Experience during the year has taught us how we may increase
our eiBciency and it will be our endeavor to improve our service by
this experience. Most physicians realize that pathological work is
merely an adjuvant to clinical diagnosis. Clinical facts may be of
considerable assistance to laboratory workers however, notwith-
standing the fact that tests are based on scientific principles and
should be uniform in their results when exact conditions are given.
Clinical conditions frequently modify pathological tests so as to
render them almost useless. A noteworthy example is the latency of
malaria or the exhibition of quinine before taking a specimen of
blood for examination; again the Widal reaction is occasionally
absent at the height of typhoid fever. With these facts in mind it
is easy to see how exact clinical and accessory data may be helped
to the laboratory workers in making a report.
By furnishing details the physician may help the Department to
collect facts which will eventually be of service to the giver. De-
tails also serve as a safeguard to the physician who eends a speci-
men to us, tor by means of them, identification is more exact.
In order to have these detailB in a serviceable form a definite
system must be adopted and adhered to strictly. There are some
instances which must be judged according to their individual merits
and exception made. The object of the Laboratory is to serve the
people of the State through their physicians, and an exception which
will accrue to the benefit of the patient should be made, even at the
cost of a little time.
For routine work the following is our method; the principle upon
which this system has been operated is to make an examination
directly upon fulfilment of all requirements (by the applicant) and
(87)
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88 SECOND ANNUAL. REPORT OP THE Off. Doc.
to report the result immediately. When a Bpecimen arrives with its
card, it \s immediately given a laboratory and a series number.
These serve as identification and as a direct guide to a file. All
speciments are numbered according to the order in which they arrive.
As soon as the proper record of the arrival of the said specimen is
completed in the office, it is given to the person who is to make the
test and it is his duty to see that the request card and specimen
agree. Upon completion of the analysis, the request card with the
result written in the proper space by the examiner is returned to
the clerk who makes out the report of our special form and submits
the two cards to the Chief of the Laboratories to be reviewed.
Should the examination require more than one day, the request card
is returned to the clerk who places it in the active list in the respec-
tive drawer of the filing cabinet. By this means no card is lost.
With regard to those specimens for which the request card is sent
in a special envelope, special attention must be given. If they
arrive in different mails, as is usually the case, the date of arrival
is marked upon them and they are kept in a separate place. If the
accompanying part, card or outfit as the case may be, does not arrive
in one week, a post card announcement of the same is made to the
name and address on the part at hand, indicating the missing part.
If no complement to our part is received in one months' time, the
can is sterilized and cleaned, or the request card is marked "Not
examined," and kept in a separate file. The cans are not opened to
examine into the state of the specimen until the request card arrives.
It is manifestly unwise to open a package probably containing in-
fective material in an office where there are no facilities for its
proper handling. This explains why we frequently send out a report
stating that the specimen was unfit for examination.
The description will serve to call attention to the need of care in
sending specimens. The packing has very often been careless, the
outer can of our mailing case not infrequently requiring steriliza-
tion because of leakage of urine, sputum, etc., from the inner, its
lid or that of the salve box contained therein having been insecurely
screwed on. Frequent sterilization is hard on the cans. If speci-
mens are properly wrapped in cotton and the lid of the inner can
tightly secured, only the inner can need be sterilized. This is done
after every using. The Postal Department requires the use of two
cans, of which the smaller must be inverted into the larger. Only
one of these is sometimes sent. When cans are sent in an improper
manner, the sender is notified of the irregularity. The Laboratory
regrets to report a greater evil. That is the sending of dried speci-
mens of sputum in cloth or cotton in paper i>ackages, loosely tied
pasteboard boxes or in Widal envelopes. CJomment on the public
danger of such a practice need not be made. The sender is notified
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No. 16. COMMISSIONER OP HEALTH. 89
of the requirementft of the Laboratory and the regulations of the
Postal authorities. A list of such offenders is kept and should the
same thing occur twice by the same individual, due notice will be
given to the Department.
The increase of the work during the year necessitated an augmen-
tation of the staff of the Laboratory. At the time of the investiga-
tion of the epidemic of Poliomyelitis in the northwestern section of
the State, Dr. J. B. Bucker was appointed Assistant Bacteriologist
to carry on the work in the Laboratory. On account of the great
increase of routine work incident to the extensive water analyses
for the Division of Sanitary Engineering, a new Diener, John B.
Taylor was employed September Ist. The price of experimental
animals having risen so much in the Fall, measures were taken to
raise small stock at our Experimental stable. A stableman, Timo-
thy Quinlan, was employed for this purpose and to take care of the
cows. The animals at the Laboratory are in charge of the second
diener. The stock of guinea pigs to date is not large enough to sup-
ply our demands. The breeding is progressing as well as can be
expected in new bins.
During the year the Laboratory has received periodically the
publications of the Hygienic Laboratory of the United States Marine
Hospital and Public Health Service and of the Laboratory of the
Division of Animal Industry. Some few individual contributions
have also been received. Books purchased for the Laboratory during
the year have been Chester's Manual of Bacteriology and Migula's
System der Bakterien. These books are of great service in water
and sewage work.
EXAMINATIONS.
The number of examinations made during the year (4,345) is
tabulated in the accompanying chart. The total was quite expected
although this was the first year of our work. The general tendency
in numbers, as can be seen by consulting the column of totals, was
to rise, but this is not at all regular. Water analyses form the
greater part of the work. This was due to the large number of
examinations made for the Division of Sanitary Engineering during
their investigations on water systems. These are of course greatest
in the open months, having the highest point in September. The
number of other examinations varied but little. They are greater
in the cold months.
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90
SECOND ANNUAL. REPORT OF THE
EXAMINATIONS DURING THE YEAR 1907.
Off. Doc.
-
A
B
C
D
B
F
O
H
J
K
Total
Feb..
March,
Aoril
10
2
7
S6
19
17
»
»
BO
88
86
81
16
86
66
66
80
66
66
78
64
66
64
76
1»
12
4
4
7
8
6
2
6
8
2
4
8
7
10
7
6
10
6
6
6
6
11
10
7
6
8
1
8
4
8
6
6
6
9
96
366
888
217
89
2S1
876
867
440
186
60
64
7
4
2
1
""i"
8
1
1
7
8
6
......
4
5
4
2
9
8
6
n
16
268
896
41S
S48
iSSr .:::::::::::::::::::::;:;::;:
218
June .................. r ......... .
860
July
617
Auffust
6J3
Sept., '
66i
Oct
821
Nov
Dec
206
218
62
80»
869
68
49
8»
68
2,688
80
72
4.843
A—Malaria.
B-Wldal.
O— Sputum.
D-Tirtne.
S>— Pathological fluids.
F— Pathological growths.
O-Mllk and butter.
H—Water.
J— Feces.
K— Miscellaneous.
MALARIA. Of the sixty-two Bearches for malarial organiams
only two, or three per cent, were positive. These two came in July
and August from the same place, Plymouth, Luzerne county. It is
unfortunate for the result of these searches, that quinine is so often
giyen before the blood smear is made.
WIDAL TEST. The records obtained by the Laboratory giw
little upon which to comment. Aside from the vicinity of Scranton,
Ridgway and Franklin, the sources of blood for the Widal test were
well distributed over the State. From the localities mentioned, the
number was considerable. Since there is no checking off of results
and diagnosis at the Laboratory, the i)ercentage of positive Widal
tests to establish cases of enteric fever cannot be given. Seventy-
five (20.4 per cent.) of 367 tests were positive and two were unfit for
examination. Although .many of the specimens were doubtless
sent to exclude typhoid fever, the percentage of positive findings
seems rather small. One passible cause which helped to reduce our
positive findings was our attempt to carry out the test even if the
blood were imperfectly prepared or not in sufficient quantity. The
pieces of paper are frequently folded before the blood is dry, thus
spoiling the blood drop and rendering it diflScult to get sufficient
scrapings to produce the proper color in dilutions. Our test ia rigid,
but strict observance of dilution and time limit prevents false
reactions due to foreign substances which are sometimes mixed
with the blood from the patient's or doctor's hand when taking the
specimen.
SPUTUM. Although this examination was intended to cover all
forms of bacteriological infection, all but two specimens have been
sent to be searched for the tubercle bacillus. Bequests have been
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No. 16. COMMISSIONER OF HEALTH. 91
made to search for other bacteria at the same time. The infection
asnally Buspected is with pnenmococcus, streptococcus, or influenza
bacillus. In reporting this ^examination it has been the custom to
say 'Tneumoooccus, Streptococcus or Influenza forms present or
absent," and the distinctive Gram stain has been used for this
purpose. The cultural determination of these species of bacteria
requires a long and very careful procedure which would delay the
report to an unreasonable time, probably delaying the treatment of
the individual. It is considered safe to speak of the respective
"forms" being present when one sees typical, Oram positive, en-
capsulated diplacocci, or chains of cocci, or typical, small pointed
Gram negative, intracellular rods. When examining for the tubercle
bacillus, our technic has been very rigid. After staining as usual
with Ziehl-Nielson Carbol Puchsin the slides are decolorized with
twenty-flve per cent, sulphuric acid in absolute alcohol and
counterstained with methylen blue. This decolorization is very
complete and excludes any pieces of mould or smegma bacilli which
are occasionally encountered in the sputum. When searching under
the microscope, no slide is admitted which contains any traces of
the red stain and two tubercle bacilli must be seen at different parts
of the field on a perfectly blue ground before a specimen is con-
sidered as containing tubercle bacilli.
No report is made to this Laboratory as to the corroboration of
the clinical by the pathological diagnosis. Among the 869 speci-
mens during the year, 452 were from males, 125 of which were posi-
tive, 297 negative and thirty unfit for examination; 417 were from
females, 114 of which were positive; 275 were negative and twenty-
eight unfit for examination. From 869 examinations it does not
seem justifiable to draw any conclusions. This at least can be said,
that while there were thirty-five more specimens from males than
females, the proportions of positive, negative and unfit for examina-
tion are almost identical. The chief occupation represented by
males was classed as laborers, with farmers and clerks tied for
second place. Among the females, housework was far ahead of all
other occupations.
The number of specimens of sputum maintained about an even
height during the year until I>ecember when it jumped forty-two
higher than it had ever been before. This was due to the opening
of several Tuberculosis Dispensaries in the Btate.
To the sending of the sputum more than any other substances, do
the remarks on the care in the preparation and packing apply. More
than six per cent, of sputum specimens were in a condition in which
it would be extremely dangerous for the laboratory worker to handle
them. Even though the examiner wore rubber gloves and opened
the cans at a special desk covered with carbolized paper, the work
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•2 SBCOND ANNUAL REPORT OF THE Off. Doc.
would be very dangerous and all precautions should be taken in pre-
paring the inner bottle so that fluid sputum does not escape or dry
sputum blow around. Especially to be condemned is a habit some
physicians have of placing the request card between the outer and
inner can where it is not found, (for the reason stated above) and
where it can be contaminated, requiring a new one in the laboratory
and destruction of the original.
At the end of the year the Conunissioner approved alterations and
improvements in our methods of handling sputum by which scores
of specimens can be examined in one day. This was necessary
because of the opening of Dispensaries for Tuberculosis throughout
the State under the appropriation for that purpose in 1907.
UBINK These specimens still come in for general examination.
Perhaps we have had two hundred such applications during the
year, and should these have been done, hundreds of others would
have followed, necessitating a special assistant for that work. The
amount which can be accommodated in our salve boxes is really
insufficient and if it were not, urine which has traveled for a day or
two is not fit for examination. Bacteriological examinations of
urine require a long time and considerable care. We therefore
notify physicians upon the arrival of such specimens that the exami-
nation is being done and will be reported upon its completion.
Bequests for diazo reactions are very few and usually accompany
blood for Widal tests.
PATHOIX)GIC FLUIDS. Bequests for examinations of speci-
mens of this class are few. They have consisted chiefly of pus and
pleural or peritoneal fluid. They have been packed well as a rule,
much more carefully than the more dangerous sputum. To such
specimen's do the remarks about clinical notes in the introduction
apply forcibly. The bacteriologist is at sea in examining pus or
pleural exudate if he know nothing of the case, or if, as frequently
occurs, the physician fail to make any direct request, leaving to
the laboratory to make a pathological diagnosis. Beports on such
samples should be made as rapidly as i>ossible. A few notes may
save several days and keep the examiner from floundering around
in a score of pathogenic species of organisms, many of which require
a special and delicate technic not usual in routine culture work.
PATHOIXKIIC GBOWTHS. These specimens have slowly in-
creased in number. They are almost never sufficiently described.
Very many of them do not give the locations from which the growth
came. This entails correspondence to obtain data which is of the
greatest importance in microscopical investigation. We have rela-
tively less information about these specimens than any other and
we need more. The pieces of tissue frequently come without being
covered with preservative, thereby delaying the examination by
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 93
necessitating two days of fixation here. The microscopical examina-
tion of tissues is made by Dr. Allen J. Smith. Report of the finding
is not made for several days, due to the method of fixing, imbedding,
cutting and staining necessary in histological technic. Upon re-
ceipts of sections of tissues a post card is returned to the sender
announcing its arrival, stating that examination requires several
days and the report will be sent immediately upon its completion.
The reason of undue delay is usually unsatisfactory notes, com-
mented upon above. A sufficient length of time for careful study
must be given especially if there be any suspicion of malignant
growth upon which an operation might depend. The average length
of time which has elapsed between the receipt of a specimen and its
report has been ten days.
WATER. This has formed the greatest part of our work and is
under the care of Dr. Rivas, who personally makes all the analyses.
When samples are received they are recorded by the clerk. The
Laboratory and series numbers are put on each bottle by a gummed
label. A card is then prepared, which contains all possible means
of identification given on the bottles and in a communication from
the sender, which must be received or the water is not analyzed. A
copy of such a card is given further on. This is placed with the
bottle and handed direct to Dr. Rivas whose duty it is to see that
the descriptions on the card and on the bottle agree. The samples
of water are thus handled by only two persons and no confusion can
result. Dr. Rivas' method of analysis is as follows:
The examination of the water depends upon its character; that
is, the source and clearness. As a routine procedure, one cubic
centimeter of the water is plated on plain neutral agar, neutral
gelatin and litmus lactose agar, and incubated at thirty-seven
degrees O. in the case of agar and at twenty degrees O. for the
gelatin plates. After forty-eight hours at thirty-seven degrees O.,
the number of colonies on agar plates is counted. Similar count-
ings are made of the gelatin plates at twenty degrees C. at the
expiration of the same time. After twenty-four hours of incuba-
tion at thirty-seven degrees 0., the litmus lactose agar plates are
examined for the presence of pink colonies resembling B. coli com-
munis, and if any be present, their number is counted and a record
of the same made. A number of these colonies in definite relation
to the whole is transplanted to one per cent, neutral dextrose
bouillon in fermentation tubes and incubated for twenty-four hours
at thirty-seven degrees C. at the end of which time the fermentation
of the dextrose is noted and sub-sultures are made from the tubes
which show gaseous fermentation. These are inoculated on meat
sugar free bouillon, gelatine and milk, and placed in the incubator
at 37 degrees C. for at least forty-eight hours, or longer as the case
Digitized by VjOOQIC
94 SBCOND ANNUAL REPORT OF THE Off. Doc.
may be. After the incubation at thirty-seven degrees C, the co-
agulation of the gelatine is determined by placing the tubes on ice
water until hardening or liqueration is noted; observations are
made on the conditions of the milk. The bouillon cultures are ex-
amined for indol and also for Test No. 2. This is a pink coloration
produced immediately after the addition of about one cubic centi-
meter of a ten per cent, sodium hydroxide solution followed by
one cubic centimeter of a fifty per cent. H"SO solution, to a tube of
the culture.
The fermented tubes are returned to the thirty-seven degrees O.
incubator and, after forty-eight hours, examination is made as to
the percentage of gas and relation of hydrogen to carbon dioxide.
Before this reading is made, the culture is examined for Test No. 1.
This consists of a slight pink coloration after boiling about one-
fourth of a cubic centimeter of the culture in about five cubic centi-
meters of ten per cent, solution of sodium hydroxide. Finally the
motility, coloration by Gram and general morphology of the culture
is considered in making the determination. A typical B. coli culture
besides coagulating the milk, producing indol, failing to liquefying
gelatine, fermenting dextrose, giving a typical relation of hydrogen
to carbon dioxide and a Oram negative bacillus, should also be
positive to Test No. 2 and 3 and negative to Test No. 1. (Refer to
No. 9 of Laboratory publications.)
A typical reaction of B. coli will answer to the characteristics as
stated on the card below.
Lab. Form No. 30.
PENNSYLVANIA DEPARTMEaTO OP HEALTH LABORATORIES.
BACTERIOLOGICAL WATER ANALYSIS.
No. 8431. Source, Ridfirway. Date, (H2245) 9-13.
From Cummlngs. Time of coUectlon
Time rec'd, 3 P. M. Condition, ice. Time plated, 3.16.
Gelatine or agar. Agar. Incubation at 37. deg. C. for 48 hrs.
No. of pink colonies on lit. lact. agar from 1 c. c. , 800; from c. c
No. of bluish purple colonies on lit. lact: agar from 1 c. c ; from c. c
Total No. of aerobic micro-organisms per c. c, 28,000.
Total No. of liquefying micro-organisms per c. c,
No. of B. Coli in 1 c. c, 180; in c. c
other micro-organisms per c. c ; in c. c
Remarks: No. 21, Spring.
Digitized by VjOOQIC
Ko. 16.
COMMISSIONER OF HEALTH.
s
:
TIOM.
RiVAB.
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MOUPBOU-
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The number of B. coll per cubic centimeter is determined by
taking into consideration the number of positive cultures obtained
among those selected in relation to the number of pink colonies in
on cubic centimeter. That is, if three colonies out of six which
were chosen from a litmus lactose agar plate in which there were
twenty colon like colonies, prove to be true B. coli the water from
which the original plate was made is considered to contain ten B.
coli per cubic centimeter or per volume used to make the primary
plate. If the water is known to originate from polluted sources or
to contain a high number of bacteria, dilutions are made which will
enable one to count colonies more accurately. The procedure is the
same as above, and the final result obtained by multiplying by the
dilution used. If the water be thought very good, large measured
quantities are incubated with an equal quantity of bouillon for
twenty-four hours, at the end of which time dilutions of the culture
are made and plated ooi litmus lactose agar. From this point on,
the procedure corresponds to the one outlined above.
When this analysis is complete and the result marked in the
proi)er places on the card, this is returned to the clerk who copies
it in letter form to be sent to the person desiring the analysis.
This letter with the card is checked by the clerk, handed to the Chief
of the Laboratories, for further check, and the report is mailed. Up
to September, a bi-monthly report was made to the Department, but
since that time a carbon copy of every water analysis has been sent
to the Division of Medical Inspection, and tq th^ Division of Sani-
tary Engineering.
Digitized by VjOOQIC
96 SECOND ANNUAL REPORT OF THE Off. Doc.
Rivas' method is rapid and accurate^ enabling us to make
reports always within a week. His work, some of which accom-
panies this report, has enabled him to exclude the colon like organ-
isms and determine only those of the true B. coli group, which we
look upon as an indication of pollution. Beport is made as a routine
upon the number of organisms growing at thirty-seven degrees C.
on neutral agar and the numerical presence of the B. coli is one e. c
We are always ready to make further tests upon requests, to the
extent shown on the card.
Early in the year, samples of water were sent in bottles obtained
by the sender, being collected according to instructions sent by this
Laboratory or by the Department at Harrisburg. In the spring, the
Department prepared express boxes and tin cans for the trans-
mission of water samples. Two hundred of the former and five
hundred of the latter are in use. The boxes with an inner tin tray
having lateral ice compartments are intended for six (6) bottles,
while the can will accommodate only one (1), if surrounded by ice.
The following is a list of places, as to county, from which water
has been shipped. The figures opposite indicate the numiber of
samples from the respective places:
ALLiEGHENY: CAMBRIA:
Ingram, 1 Carrolltown 1
Oakdale 8 Cresson 2
ARMSTRONG: Johnstown, 49
Dayton 12 CARBON:
Ford City, 15 Palmerton, 4
Klttannlng, 388 CENTRE:
Parkers Landing 1 PhiUlpsburg, 1
BEDFORD: CHESTEnR:
Everett 6 Coatesville, 2
Woodbury, 2 Devon, 67
BERKS: Kennett Square 2
Hamburg 1 Oxford 2
Reading. 4 Malvern 8
ShoemakersvlUe 1 CLARION:
BLAIR: New Bethlehem, 1
Altoona 1 CLEARFIELD:
BRADFORD: Clearfield, 10
Athens, 6 Dubois, 6
Canton 1 Mahaffey 6
Wyaluslng 1 Penfleld, 1
BUCKS: Woodland 2
Doylestown 1 CLINTON:
Tardley 17 Bitumen 4
Taylorvllle « COLUMBIA:
BUTLER: Benton, 1
Bau Claire, 6 Berwick, 8
B^rans City 1 Bloomsburg 2
Slippery Rock 6 Catawlssa 8
Digitized by VjOOQIC
No 16.
CUMBERLAND:
Camp HUl, ...
Carlisle
NewTille,
W. Fairview, .
DAUPHIN:
Berrysburgr, ...
Harrlsbur^, . .
Inglenook
MiUersbur^, ...
Prosrefls, ,
Steelton
DELAWABS:
AKbton Mills, .
Boothwyn, ....
Chester
Eddystone,
Media,
Ridley,
Trainer,
Wayne,
BLK:
Johnsonburg, 8
Rldgway 128
ERIB:
Corry,
EJrie
Falrylew,
FAYETT2?:
Dawson,
Dunbar
FRANKI4IN:
Chambersbors,
Fannettsburg,
Greencastle, ..
Marion
Mercersburg, .
Mont Alto. ...
St Thomas, ...
FULTON:
Hustontown S
GREENS:
Mt Morris S
HUNTINGDON:
Huntingdon, f
INDIANA:
Black Lick, 1
Homer City, S
Flmnville, 1
I^CKAWANNA:
Scranton, 682
J-ANC ASTER:
Bath, 1
,t.t.-. ?
COMMISSIONER OF HEALTH. 97
LANCAfiTER-ConUnued.
f Conewago 1
6 Elisabethtown 1
1 Lancaster, 2
1 Mount Joy, 1
LAWRENCE:
1 Ellwood City 4
W New CasUe 11
2 LEBANON:
2 Colebrook 5
2 Lawn 141
9 Mt Gretna (84
LEHIGH:
1
2
10
4
8
1
1
f
16
1
1
19
6
6
1
1
1
8
10
2
Allentown,
Catasaqua
New Tripoli
Slatedale
Slatington
LUZERNE:
Hasleton,
Nanticoke
White Haven
LYCOMING:
Jersey Shore
WiUiamsport
McKEAN:
Custer City
MIFFLIN:
Lewistown,
MONTGOMERY:
Ambler,
Ardmore
Bridgeport,
Bryn Mawr,
Gratersford
Hatboro
Jenklntown,
Limerick Sq
Norrifltown
Above Norristown,
MONTOUR:
Danville
NORTHAMPTON:
Bethlehem,
Siegfried,
NORTHUMBERLAND
Hemdon ,
Shamokin,
flunbury
PERRY:
Marysville
POTTEai:
Giaeton,
6
1
6
1
8
12
18
8
14
8
15
1
8
1
2
8
5
6
8
9
2
12
8
1
8
10
•♦t»» t»f ttf f tftttf !••
C%ristlan»
Digitized by VjOOQIC
98
SEX30ND ANNUAL* REPORT OF THE
Off. Doc.
SCHUYLKILL,:
Ashland
Frackville,
Orwigsburg,
Schuylkill Haven,
SUSQUEHANNA:
Hallstead, ,
Montrose,
TIOGA:
Wellsboro,
Weetfleld,
UNION:
Laurelton,
VENANGO:
Franklin,
on City
WARREN:
Warren,
ToungsvlUe,
WASHINGTON:
Mononsrahela,
Murdocks vllle , . . . .
44
2
8
1
WAYNE:
Hawley ,
Honesdale,
WESTMORELAND :
Delmont,
Grapevine,
Jeannette,
Latrobe,
Mt Pleasant, ...
Scottdale,
Webster,
WYOMING:
LaceyvlUe,
YORK:
Dallastown
Dover,
Hanover
Stewartstown, ..
Wrights vllle, ...
York
1
5
6
1
6
25
1
17
2
12
3
2
2
3
4
MILK AND BUTTER. There have been no butter samples this
year. The analysis of milk is comparable to that of water. No
applications for Tubercle Bacilli, Streptococcus or number of Leu-
cocytes have been made. The following is a list of samples
analyzed:
ARMSTRONG:
Klttanniner» •
Ford City, ..
BEDFORD:
Everett,
BUCKS:
Tardley,
BUTLiER:
Eau Claire, .
CENTRE:
PhllUpsburg,
CHESTER:
Malvern, ....
CLEARFIELD:
Dubois,
DELAWARE, ..
ELK:
JohnBonburg,
9
10
ERIE:
Oorry ,
LAWRENCE:
New Castle, ..
LEHIGH:
Catasaqua, ...
MONTGOMERY:
Hatboro,
Norrlstown, ..
SUSQUEHANNA:
Montrose
VENANGO:
on City
WAYNE:
Hawley, ,
FECES. As will be seen on the tabulated list, these specimetns
were the fewest in number. With reference to these samples, we
always receive too few notes and very indefinite requests. Most of
the requests have been for a bacteriological diagnosis of an obscure
clinical condition, a thing almost impossible to do in the vast
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 99
majority of cases. Once in twelve times, tubercle bacilli have been
found, and once in seven trials typhoid bacilli were discovered.
The specimens are usually packed badly, making an examination
highly offensive, if not dangerous.
MlSCEUiANEOUS. These have been almost altogether swabs
and cultures from throats suspected of diphtheria. No unusual
number has come from any one place. They have been sent in out-
fits (No. 3) or brought from the vicinity of Philadelphia by hand.
A report will be made immediately on any swab sent in one of the
No. 3 outfits with a request card, as described for other specimens
which are sent in this can. Several reports have been made by
telegraph at the physicians' expense.
BESEAROH WORK OP THE LABORATORY.
During the year, the Laboratory has had under investigation the
following subjects.
1. The effect of Normal Serum upon the Tubercle Bacillus.
2. The Pollution of Water by Sewage containing the Tubercle
Bacillus.
3 Reaction of the Opsonins of the Elephant on the Tubercle
Bacillus.
4 Germicidal activity of Liq. Oresolis Compositions, U. S. P.
5. The Predominating Organisms in Feces and Sewage.
6. Improved Rapid Test for Indol.
T. Improved Method of Sterilization of Media.
8. Contributions to Differentiation of B. Coli from allied Species
in Drinking Water.
9. Contributions to the Study of B. l^phosus and B. Ooli in
Drinking Water.
10. Study of Degreased Tubercle Bacilli.
12. The effect of Bile and Pancrease on the Tubercle Bacillus.
13. Study of the Fluid of Dixon.
14. Effect of repeated injections of Tuberculin in healthy oows.
15. Effect of Normal Serum Inoculations on course of inoculated
Tuberculosis.
10. Study of B. Ooli from Intestinal Tract of Fishes.
No discussion of Nos. 1-9 will be made here, because the entire
articles accompany this report. The experimental work in progress
^ill be described up to its present status. In the following work
the experiments are not sufficient to put them in final form:
(10). Study of the Degreased Tubercle Bacilli and their Solutions.
Digitized by VjOOQIC
100 SECOND ANNUAL REPORT OP THE Off. Doc
In all our experiments, virulent orgA^nismfl were used, a fact which
must not be lost sight of in judging the results of experiments,
which in some instances seem favorable to the products used. The
rationale of using the degreased organisms goes back to the original
work of Dr. Dixon, who was able to produce an immunity by a salt
solution extract of avirulent organisms after washing in ether.
In order to rid the organisms of most of the irritant wax, a much
larger exposure to ether was made than originally used by Dr. Dixon.
The method was as follows:
A large quantity of mixed bovine and human tubercle bacilli
from an equal number of cultures, which had been grown for Old
Tuberculin, was filtered off, killed by heat and dried in a vacuum
dessicator. They were then weighed and placed in a soxhlet. The
preliminary removal was made with 95 per cent, alcohol. When
the syphoning fluid began to clear, ether was substituted and allow-
ed to extract until thp cooled ethereal extract gave no precipitate.
The time necessary to achievp this varies with the dryness and size
of the clumps. Even after this indication is reached, a little wax
may be demonstrated in the bacillary bodies by staining. It seems
impossible to remove it all. When grinding in ball mill or mortar,
this may be easily seen. The resulting mass is a dirty grayish
white powder, which crumbles very easily but is still greasy.
Martin and Vaudremer say that after six weeks' extraction with
petroleum ether all the wax may not be removed. This mass was
dehydrated again in a vacuum dessicator, and stored in bulk. Sixty-
five grams of moist T. B. mass lost 52.33 in drying and 6.67 grams in
extraction. I believe that after two days' extraction little weight
is lost. These figures are from two days' extraction. Six days'
extraction at a subsequent time gave as comparable weights 76.5,
with loss of 64.8, and after extraction a loss of 6.58 gnn. The
alcohol used in the preliminary degreasing is always stained a
distinct brown, while the ether extract is not colored.
The degreased bacillary mass is spoken of as our Experimental
Product No. 5. When used, this is weighed out dry and ground up
in salt solution in appropriate doses for injection. In preparing
our syringes, it is ground in a ball mill in a definite decimal pro-
portion on the basis of 10. It is -standardized by evaporating given
quantities to dryness and weighing the residue; from this weight
the amount in one c. c. is computed. Dilutions of this in salt solu-
tion are made and with this syringes are filled. These syringes
being used at present contain .000001 gram.
As a sub-product of this degreased bacillary mass, a salt solution
extract is made and is called No. 6 Porcelain, because it is now
filtered through porcelain, the original solution having been passed
-tJiTpugb paper, This is made by grinding up a definite quantity
Digitized by VjOOQIC
No. 16 COMMISSIONER OF HEALTH. 101
with salt solution (.6 per cent.) in proportion as above of 1-10,
placing this suspension in a shaking machine for eight hours and
allowing it to remain 16 hours at room temperature. It is then
filtered through a porcelain candle, the filtrate being our product.
This filtrate is a faintly yellow tinged fluid. This is likewise put in
syringes in quantities equalling an extraction of .0001 gram. A
half of one per cent, carbolic is added to all solutions to maintain
sterility.
TOXICITY. Repeated large doses, 1 mg. for example, of this
dead degreased bacillary mass given at short intervals will cause a
loss of weight in healthy animals, and they will succumb quite
rapidly to tuberculosis after injections of virulent living bacilli.
We have not had, however, the experience of Vaughan and Wheeler
that hemorrhagic peritonitis follows the injection of tubercle
bacilli in pigs which have been injected once or several times with
the dead degreased bodies. Occasionally, experimental pigs will
die shortly after the second injection, but without signs of anaphy-
laxis or hemorrhage, only a little serous effusion being present. We
are working on the sensitization of No. 5 and tubercle bacilli for
one another, but all we can say now is that they do not appear to
cause anaphylaxis. Single large doses of No. 5 and No. 6 Porcelain
have no toxic effect in healthy animals. Experiments in actively
immunizing guinea pigs and rabbits are now being carried out,
using great care so to time the injections that no great loss of
weight occurs, and that no slight loss occurs continuously. Origin-
ally experiments in active immunity and vaccination were made with
.1 mg., but experience has shown that guinea pigs endure .001 mg.
very frequently repeated better than larger doses less often.
In reference to vaccination of tuberculous animals, one exi)eri-
ment may be given on a chart which will include both No. 5 and No.
6 Porcelain. These pigs all received .1 mg. 8 weeks' bovine organ-
isms one week before beginning these injections. Doses of .1 mg. of
No. 5 will cause a temperature re-action in tuberculosis. The re-
action after No. 6 is uncertain, sometimes quite appreciable, other
times entirely absent.
Digitized by VjOOQIC
102
SECOND ANNUAL. REPORT OP THE
Off. Doc.
Produot.
I
Po«t Mortem.
a?. No. 6,
m. No. 5
«9. No. 6
280, Control.
2S1. No. 6 Pore...
282. No. 6 Pore...
28S, No. • Poro...
.1 mff.,
.1 mff..
.1 rag,,
.1 mv..
Sol. = .1 mff.,
Sol. = .1 mff.,
Sol. = .1 tag..
8
-106 vma....
88 d....
1
T
18 d.,..
2
-20 ffnw....
20 d....
9d.,..
2
2
1
— 60 gmfl....
— 46 giM....
—210 gms....
86 d....
86 d....
47 d.,..
CaMous T.Bo. in liver, spleen
and omentum.
Catarrhal pneumonia,
nodule at eite of inocula-
tion.
Cheesy nodule at site of in-
oculation. Few cheesy T.-
Bc. in liver, omentum infil-
trated.
Cheesy nodule at site of in-
oculation, acute miliary T.-
Bo. of peritoneum.
General Tuberculosis.
General Tuberculosis.
General Tuberculosis.
While this series is not final by any m^eans, it will be seen that
the ayerage length of life in the treated animals is longer than that
of the control. It ie possible, indeed highly probable, that the
dose of No, 5 was too great, because the animals live longer after
treatment with the Salt Solution Extract which is naturally less
irritating than the bodies themselves. All these injections have
been made subcutaneously. We are proceeding with small doses,
iwing great care that continued loss of weight does not ensue.
The pathologic effect of large doses on healthy animals has been
very interesting. The lymphatic organs, especially the spleen,
seem to bear the brunt of all their activity. Quite constantly, after
injections of large doses of the degreased bacillary mass, a tuber-
cular splenitis occurs, as shown by great increase in the endothelium
and a cortical arrangement of the small round cells in the follicles.
Sometimes the process will be quite diffuse, there being only a wide
spread endothelial hyperplasia without nodular arrangement. When
the process is tubercular in type, minute nodules are visible to the
naked eye, but, when the process is diffuse, there is merely a firm
swelling of the organs as a whole; no giant cells are present. No
bacteria can be found in these areas. The longer the death after
the last injection is delayed the more diffuse is the process. The be-
ginning of this process is undoubtedly a focal necrosis which appears
usually in the center of a follicle, but which may be present in the
pulp. This is rapidly surrounded by endothelial cells and the tuber-
cular type assumed. The focal necroses seem to occur more char-
acteristically after injection with the solutions of the degreased or-
ganisms, while the cellular change begins earlier after the use of
No. 5 itself.
These products are being supplied to the Sanatorium of the De-
partment in antitoxin syringes, each containing one dose of the
respective solution. When a lot of syringes are filled, they are
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 103
incabated at 37 deg. C. for 48 hours, and a large dose of the stock
solution Is injected under the skin of a guinea pig, both done to
insure sterility. In no instance has any tube shown any growth,
nor has any pig exhibited symptoms or loss of weight.
(11) The Effect of Bile and Pancreatic Juice on Tubercle Bacilli.
One hundred grams of pancreas were removed from freshly killed
bogs, (which bad been passed by the inspector) and freed as much
as possible from fat. From these animalfi, 80 e. c. of bile was
aspirated from the gall bladder. The pancreas waa cut fine and
ground in a mortar. The juice which exuded was a dirty gray
material containing many oil drops. Many pieces of the gland
remained, and were treated as part of the juice. Fibres were re-
moved.
One part (15 grams) was mixed with human and bovine tubercle
bacilli, and this mixture allowed to remain together three weeks.
They were examined every day for a week, and then every three
days. No considerable change was noted in the form, isize or strain-
ing properties of the bacteria at the end of three weeks; they were
injected into quinea pigs, which animals died, one before, another
after the control animal.
Another portion was mixed with 50 c. c. fresh normal bovine
serum and tubercle bacilli, as above, and allowed to act three
weeks. The result of observation along the same lines of structure
and virulence, as above, were the same; that is, no change occurred
in the organisms.
A large quantity of the ground pancreas (40 grams) was covered
with glycerine and allowed to extract ten days. The extract showed
the presence of all enzymes of the pancreatic juices, except the
milk curdling ferment, the presence of which was questionable.
One third of this extract was mixed with an equal quantity of fresh
hog bile and allowed to act upon tubercle bacilli, while a second
third only received the organism. The last portion was kept at ice
box temperature during the fourteen days that the first two por-
tions were acting at 39 degrees C, which temperature corresponds
to that of the blood in the pancreatic vessels. The two flasks con-
taining the organisms were examined daily for one week and twice
during the second week. No alteration was observed in the bacteria
of either test. The animals injected with the organisms died in
both cases before the controls. The viscidity of the mixture, due
to the glycerine, made it difficult to determine, even approximately,
the quantity of bacilli injected, so that a large loop full of the control
culture and the mixture in the flask was ground up and injected in
similar quantities of the resulting emulsion. It seems that the
effect upon the morphology and toxicity of the organisms by the
pancreatic juice was nil. After two weeks extraction the mixtures
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104 8E2COND ANNUALr REPORT OP THD Off. Doc.
were freed of organismfl (by filtration) and mixed with five times
their bulk of distilled water. The three extracts (pancreatic jnice
which had Ix^en kept on ice^ the pancreatic juice plus bile, and the
plain pancreatic jnice which had alone acted upon the bacilli), were
then precipitated by anunoniujn sulphate and absolute alcohol,
which threw down all the proteids. These were dissolved by a .5
per cent, solution of sodinm chloride in as small a quantity as was
possible to achieve that result. The proteids were principally pep-
tones. The solution which had contained bile was dark, probably
from extractives and bile salts. Equal quantities of this con-
centrated solution of proteids was injected intraperitoneally into
guinea pigs, two being used in each set. One of each set died. The
pig which received plain pancreatic juice proteids died in fifty days
without pathologic lesion to account for death. The one dying after
the injection with the proteids of pancreatic juice plus bile plus
bacteria, and those of plain juice plus bacteria, died in thirty-seven
days and thirty-four days respectively. Neither of these showed any
pathologic lesion to account for death.
Human €Uid bovine tubercle bacilli were introduced into fresh
hog's bile in about the proportions of 1-10. Ten grams of ground up
pancrease was mixed with 50 c. c. fresh normal bovine serum and
20 c. c of hogs' bile.
In order to see if any different results could be obtained with
ground pancreas, bile and organisms than with pancreatic juice,
such a mixture was made. The results of observations on these
three mixtures may be summed up together. Unfortunately, a
shortage of animals prevented their injection, but the tinctorial
reactions were followed carefully. It seemed that the bile has
some slight effect upon the staining properties, because in the pre-
parations from these three tests a wrinkling of the bacteria with
irregularities of their wall and many deeply staining irregularities
in their bodies were observed. They resemble organisms from a
very old culture, which has become concentrated by evaporation.
E^xperiments upon the tinctorial properties of dead tubercle bacilli
of the same treatment gave similar results, however.
In order to see how easily the organisms would give off their wax
to ether or chloroform after treatment by (1) glycerine pancreatic
juice plus hogs bile, (2) glycerine pancreatic juice alone, (3) bile
alone, the following tests were set: a small amount of the organisms
from the various fiasks was placed in tubes and boiled in ether and
chloroform, separately, for two hours. A control tube of untreated
tubercle bacilli was included. At the lapse of ten, thirty, fifty, and
one hundred and twenty minutes, smears were made and stained all
at the same time in the same manner. It was found by this test
that the organisms which had been subjected to a mixture of pan-
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No. 16. COMMISSIONER OF HBALTH. IW
crease and bile^ or pancrease alone^ gave up their wax more readily
than when they had only been acted upon by bile. This was ap-
preciable after ten minutes' boiling and marked at the lapse of
thirty minutes. The chloroform was able to do this with much
greater facility than the ether.
(12) Fluid of Dixon. This product difFers from the last described
(No. 11) chiefly in that it is made from living bacilli. The process
is as follows: An equal weight of human and bovine tubercle
bacilli removed from young cultures, mixed, dried to a paste in a
dessicator, washed 6 hours with ether, the fat removed and weighed
again. They are then suspended in .6 per cent, salt solution on the
basis of 1 grm. of bacilli to 10 c. c. This suspension is shaken in a
machine 8 hours and allowed to remain 16 hours at room tempera-
ture. The bacteria are then thoroughly separated by passing the
fluid through a porcelain filter several times, the filtrate being the
"Fluid of Dixon." (Medical News, Jan. 17, 1891.) It is a clear
limpid pale straw colored liquid. At the end of the year, we had
just begun our work on this product and cannot give any results.
All that we can say at present is that single doses of .1, 1 and 3 c. c.
of the pure fluid cause no fatal issue, nor does the animal seem to
lose weight.
(13) The Effect of Repeated Testing Boses of Tuberculin on Oowi.
The occasional deaths among cows shortly following a tuberculin
test, and the finding of focal necroses in the spleen of experimental
guinea pigs treated with this and other toxins of the tubercle
bacillus, led us to this exx)eriment. The work so far has consisted
in the injection of a healthy oow with 400 milligrams of old Tuber-
culin every two weeks for 6 doses. At post mortem, when the cow
was killed, every organ was found normal. Study of the tissues is
not completed.
(14) Effect of Eresh Normal Bovine Serum on Tuberouloiis in
Guinea Pigs. In order to see the effect upon guinea pigs and the
course of tuberculosis in these animals influenced by repeated in-
jections of fresh normal serum, pigs 233 to 240 were injected Sep-
tember 20 with a minute quantity of living tubercle bacilli. 233
and 234 were inoculated weekly beginning September 26 with .026
gm. bovine serum. 235 and 236 were begun October 10, 237 and 238
were begun October 28, 239 and 240 were allowed as controls. The
evidences of tuberculosis in all these pigs were very inconspicuous,
but in 233 and 234, which lived the longest, it was more marked than
in the controls. 235 and 238 did not live long enough to get the
full effect of the serum.
Pigs 241 to 244 were inoculated weekly with .025 gm. fresh normal
bovine serum, and, after they had received six injections, were in-
oculated with 2 grm. Tubercle Bacilli. 241 died in three weeks of
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106 SECOND ANNUAL REPORT OF THE Off. Doc.
extensive miliary tuberculosis. 242 died before the injection of
organisms. 243 and 244 died three weeks after the injection of
tubercle bacilli with miliary and caseouB tuberculosis, and a few
days before the controls. It would, therefore, seem that the fresh
normal bovine serum did not have any protective affect upon guinea
pigs by the production either of an active or passive immunity.
(15) Presence of B. Coli CominTinis in Intestines of Fish. The
intestinal content of eight carp, seven catfish, four mud suckers,
two trout, one perch, one sunfish, one crayfish, four tadpoles, and
one frog were examined for the presence of B. coli. All these fish
(twenty-nine in number) were caught near the nuouth of the creeks
at the Delaware Bay, a place at which the water is known to be
polluted by sewage. The examination was made as soon as brought
to the Laboratory, the same day or the day after the fish was caught.
The technic consisted in washing the belly of the fish with sterile
water, drying the surface of the skin with a clean towel, making an
incision in the abdominal w^all, and dissecting a portion of the
intestines near the anus. The operation was done with sterile
instruments and all aseptic precautions were taken. By gradually
squeezing the cloaca between two fingers, the feces exuded and
were collected in a sterile pipette and shake plates or stroke plates
were made on litmus lactose agar. After twenty-four hours' in-
cubation at 37 degrees C, the plates were examined and a number
of the suspected pink colonies inoculated on dextrose bouillon in
the fermentation tubes. The further procedure consisted in the re-
inoculation of the cultures which fermented dextrose on gelatine,
milk and bouillon for the study of the biological characteristics of
B. coli. Besides the usual tests, test No. 1, test No. 2 and test No.
3 were applied to all the cultures. The results are as follows: From
the eight carp examined, two showed B. coli in the intestinal con-
tent. One catfish, two mud suckers, one crayfish and the frog gave
similar results, while the rest did not show any B. coli. Beside the
B. coli research, also study was made of the saccharolytic group of
organisms, and this was found to be more abundantly present than
the B. coli. The results show that 31 per cent, of the samples of
feces did not give any suspicious colonies; 24 per cent, contained
true B. coli, and 65 per cent, showed saccharolytic group or organ-
isms.
PRELIMINARY REPORT ON THE EFFECT OF SERUM ON
TUBERCIiE BACILLI.
During my work on Tuberculosis, I have ever been impressed
with the fact that the organisms causing this disease are well pro-
tected from that most potent bodily defense, the blood serum, while
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No. 16. COMMISSIONBR OF HEALrTH. 107
exerting their pathogenic and pathologic influence. It has been
taught that when the tubercle bacillus settles, it produces or calls
forth tissue proliferation. In regard to that most unusual condi-
tion, chorionic tuberculosis, (Warthin, A. S., Journal of Infectious
Diseases, June, 1907), this is most certainly not the case. Here a
necrosis has been shown to occur followed by proliferation and
later degeneration, the effect of these processes being to seclude
the organisms in a mass almost impassible to the full serum. This
same author reports disseminated necroses containing tubercle
bacilli without tubercle formation, (Third Annual Report, Society
for the Study and Prevention of Tuberculosis). This is occasionally
observed in avian tuberculosis. We have seen lately the effect of
resorption of injection of serum obtained by blistering tuberculosis
patients, which according to reports is a beneficent one.
These facts have strengthened an idea which I have long had
that serum would have an influence ux>on the tubercle bacillus in
the animal body, if it but had a fair chance to act upon it for a
sufficiently long period. My exx)erimental idea was to see if normal
serum acting upon the living and growing organisms could extract
something from them which would induce an immunity either active
or passive, more particularly the latter. It was further hoped that
while the serum was acting upon the organisms, it would reduce
'their activity more than could be accounted for by their long life
upon the same culture medium, this naturally reducing their viru-
lence temporarily.
The bacteria used in the Laboratory are cultures which grow with
moderate rapidity and will kill a guinea pig of 500 grams in six to
eight weeks, if a normal dose be inserted or injected either under
the skin or into the peritoneum. In making the serum extract a8
we shall call it, the bacteria were grown on solid media consisting
of coagulated serum and veal glycerine agar and upon veal glycerine
broth. The last is preferable for this work, because of the ease
with which the first two become contaminated during the manipula-
tion incident to applying the serum. To flasks of culture, both
human and bovine four to six weeks of age, a volume of fresh normal
bovine serum was added which was equal to the quantity of fluid
within the flask upon which the organisms had grown. After
thorough shaking, these mixtures were placed in the dark at
37 degrees O. The shaking was to break up the clumps of bacteria
as far as possible, so as to permit a close action of the serum upon
the bacteria. At first the mixture was allowed to extract one, two,
seven and fourteen days, but the resulting fluid when filtered was
found to have little effect on healthy or tuberculous animals, so
that a longer extraction was employed, the time limit being set
arbitrarily at two months. The serum extract used in these experi-
ments was ome of two months' duration.
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108 SECOND ANNUAL REPORT OF THE , Off. Doc
At the expiration of the extraction time, the bacteria were filtered
oflf, first by filter paper and then passing this filtrate through a
porcelain bougie, the resulting filtrate being entirely free of bac-
teria. This effluent was diluted and used in 10 per cent, solution,
doses in the following report being in terms of this dilution unless
specifically mentioned. A preservative was not added, because of
the precipitation caused thereby, and fear that it might vitiate the
results. The bacillary residue was preserved and studied. Clil-
tures made from the extraction flasks at the end of the extraction
period proved them without contamination and the bacteria grew
on transplants with the characters of the original culture. The
serum used for this extraction and in the comparative experiments
was obtained from healthy cows at our stable or from the abattoir.
In studying this serum extract, the following are the lines of work
which received attention and which I will describe in detail.
1. The comparative toxicity of the extract and "a" fresh normal
bovine serum, "b" serum the same age as the extract; "c" glycerine,
"d" old tuberculin.
2. Effect on the temperature of healthy and tuberculous guinea
pigs and cows. Tuberculin in comparison.
3. Ability of this extract to neutralize, devitalize or attenuate the
tubercle bacilli, if allowed to remain in contact with them.
4. Effect of injecting the organisms into the peritoneum and the
extract beneath the skin, and vice versa,
5. The ability of the extract to produce an immunity by repeated
small injections.
6. The effect of the extract on guinea pigs already tuberculous.
7. The pathologic changes present in the experimental pigs.
8. The effect of the extraction on the bacteria themselves.
L COMPARATIVE TOXICITY.
The various stock extracts differed a little in their killing power.
In the first lot, a guinea pig of 300 grams would die within five days
after an injection of 1 c. c. of the pure extract into the peritoneum.
The remainder of the stock solutions would not kill in this time or
dose, but were quite constant in killing in doses of 2 c. c. into the
peritoneum. Injections of the same quantities under the skin, had
the effect of reducing the weight of the animal, but rarely killed.
The effect of fresh normal bovine serum and bovine serum of the
same age as the extract was nil, the guinea pigs resisting it easily
and the temperature of the cow remaining unaffected.
The comparative toxicity of serum extract, glycerine and old
tuberculin is well illustrated by the following table, (I) giving the
results of a single injection of the pure solutions under the skin,
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No. 16.
COMMISSIONER OF HBALTH.
109
where as said above, the effects are mu<:h slower. Indeed animals
will readily withstand doses under the skin which would be rapidly
fatal if given into the peritoneum.
CHART I.
DoM.
Old Tuberculin.
Extract.
Glycerine DUuted.
MO niff ...........
Length of life. ..
Length of life. ..
Length of life. ..
Length of life. ..
Length of life. ..
Living
SO days n
86 days n
88 days n
88 days n.
9A d&vfl
Lived.
SOO ms'.!
600 mg.
1 grm.
Living
16 days.
80 days n..
30 days n..
1 day
10 days.
10 days.
^ )
These results are slightly ambiguous^ for we have all the guinea
pigs dying after the injections of extract, while those injected with
smaller doses of old tuberculin still live; again we have the five
gram dose of the latter killing in one day, and twenty days being
required for the same dose of the extract to kill. The extreme
toxicity of this large dose of tuberculin is, without doubt, due to its
large content of glycerine. The extracts and tuberculin have some
relation pathologically, to be mentioned later. These solutions,
when large in amount, were distributed as evenly as posssible in the
subcutaneous tissue. The serum extract is apparently more toxic
than the same dose of tuberculin, but not so much as similar doses
of glycerine. The extract is, however, much more toxic than plain
serum whether fresh or old.
2. THE EFFECT ON TEMPERATURE.
If healthy guinea pigs were injected with extract beneath the
skin, there was uniformly a rise of temperature averaging .4 degrees
P. When the injection was made into the peritoneum, the tempera-
ture was quite irregular in degree and time of appearance, some-
times there being no effect, at others only a slight fall. Injections
of small doses of tuberculin into healthy pigs, were followed by no
result when the injections were subcutaneous, while the temperature
was very irregular and indefinite when the solution was given into
the peritoneum. The results when the injection was made by the
latter route were practically the same with both solutions.
If the injections were made into the tuberculous guinea pigs, the
reaction was specific with tuberculin within six hours, the rise of
temi)erature averaging 1 degree P. The reaction appeared two hours
after the injection of a similar dose of serum extract, was irregular
and averaged .6 degree. Thefee pigs had been injected five weeks
before with about 1-40 mg. of bovine tubercle baccilli and when
tested received the same dose of extract or tuberculin (.5 mg.) under
the skin. The controls behave as normal guinea pigs, described
above. (Por the effects on cows see the latter part of paper.)
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SECOND ANNUAL REPORT OP THE
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8. TUB EFFECT OP SERUM EXTRACT ON TUBERCLE BACILLI.
Tubercle bacilli used to make this test were five weeks aid bovine
cultures. They were dried at incubator temperature in a weighing
dish, weighed, mashed and 1 c. c of pure extract added for every .5
mg. of organisms. At the end of various periods a stable dose of 1
c c. was removed, washed in salt solution to free it of serum, cen-
trifuged and the bacteria injected into the i)eritoneum of a guinea
pig. The following chart (II) gives the result graphically and shows
the failure of the extract to neutralize or attenuate the bacteria in
any way.
CHLART n.
InJ.
Died. I
8-22
i
8-8
2-22
[2-22
12-22
8- 8
4-29
[2-28
8-11
2-23
2-U
Z-2A
4-8
2-24
8-18
».l
4-10
La-i
8-14
Resalt.
Control for orsanlsmfl. ,
control for Extract. ,
Organisms Serum Bxtraot Immediately,
Organisms after 12 hours
Organisms after 24 hours
Organisms after 1 week.
Early miliary tuberculosis.
Living.
Early miliary.
Caseous mil. T.Bc. of. peritcneal
cavity.
Caseous mil. T.Bc.
Gen. caseous mil. T.Bc.
General caseous T.Bc
caseous mil. T.Bc.
General caseous T.Bc
General miliary T.Bc
4. THE EFFECT OF VARIOUS ROUTES OF INJECTION.
The result of experimentation upon dififerences which might
arise after variously putting the extract into the peritoneum and the
bacteria under the skin and vice versa was rather surprising. It
was rather uniformly the case that when guinea pigs received
extract into the peritoneum and the bacilli under the skin, the
tuberculosis developed very slowly and in one set of experiments was
limited to the site of inoculation and neighboring lymph glands.
On the other hand, when the serum was put under the skin, which
by the way was the rule in our experiments especially during at-
tempts at immunization, the disease developed very quickly and
followed the usual type seen in this experimental work. Although
this experimental influence of the serum wheoi put into the abdomen
occurred twice, once quite pronouncedly, a sound reason for it could
not be found inasmuch as other work with the serum has failed to
show a localizing ability. This experiment is being tried again;
injections of .1 to 1. mg. bovine three to six weeks tubercle bacilli
were made into the peritoneum of guinea pigs and repeated sub-
cutaneous injections of extract, (doses .025 c. c.=.0025 grm.) for the
purpose of immunization did not have the desired effect in most of
the cases, the process seeming to be hastened rather than retarded
by the serum injections.
5. EFFORTS AT ACTIVE IMMUNIZATION.
The effect of repeated small injections of serum extract into
guinea pigs, to produce an active immunity, has been pursued at-
tentively. Several sets of animals have been carried along for
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No. 16
COMMISSIONER OF HEALTH.
Ill
Bome time with monthly injections of .05 and .025 c. c. of the solution.
Two pigs in one set gained seventy-five and one hundred grams
respectively, ^\^l€n these pigs were injected with 1. mg. tubercle
bacilli, however, they died almost as soon as the control, two in one
set dying several days before. The control for the serum still lives
and continues to gain in weight. The result of one set is shown in
the accompanying chart. All these injections were made beneath
the skin, consisting of .05 c. c.
*
CHART in.
With What InJ.
i
i
Lenirth of Life After
Inj. of T. Bo.
Result.
ES
261
Serum Extract
T.Bc.,
+70 Qms.
-16
— ao
+10
Not ini. T. Be
S days,
27 daya«
LivincT control.
Caseous T.Bc. Control.
126
Serum Extract,
Serum Extract
Tuberculin .,
Geneza,! caseous.
127
22 daVH. . . . . r r , r r
General caseous^
e
20 dayw.
General miliary.
10 days
TjOn&llXf^d ^aa^wina
It may be seen from this chart (III) that the repeated injection of
extract into guinea pigs before inoculating them with bacteria, has
no effect in delaying the progress of tuberculosis, nor does it modify
its form to any material extent. Some mention of the microscopic
appearance of the liver and spleen will be made later on.
THE EFFECT ON TUBERCULOUS GUINEA PIGS.
In this experimentation, the effect of introducing the extract after
the tubercle bacillus, is more pronounced than in the former head-
ing. The appended chart (IV) will give examples of this influence.
It will be noted that the average length of life is much longer than
described in the previous heading, and for the controls. The dosage
of tubercle bacilli must be taken into consideration in this experi-
ment, however, for under heading No. 5, represented by the last
chart, 1. mg. was injected. The reason for introducing only half
that quantity in this case, was that after the animals were tuber-
culous^ they would be subjected to repeated handling and wounds
incident to the injection of the extract while they were sick. The
controls received exactly the same quantity of tubercle bacilli and
were handled at the time of injection of the others.
The primary tests with extract alone were done first, the facts
concerning control experimentation with tujberculin afterward and
not being complete, the results are omitted at this time.
Digitized by VjOOQIC
112
SECOND ANNUAL. REPORT OP THE
CHART IV.
Off. Doc.
1
Date T.Bo.
InJ.
No. Bxtract
Injected.
Weight
cbance.
Length of
Ufe.
Reralt.
n
»-16, .6inv.,
8-1, .6 mff.,
8-1. .6 m».,
8-1, .6 mg„
•-1. .6 mg„
4.8&. .6mff.,
4-80 .6mr.,
4-80, .6mff..
4-80, .6mff.,
4-80, .6m«..
4-80. .6m«.,
18. .06 c. c
a. .06 0. 0.
a. .06 e. c.
8. .06 c. 0.
2. .06 c. c.
8. .06 c. c.
2. .06 0. c.
1. .06 0. &
8. .06 & 0.
+180 grs..
14 mos
24 days
7 weeks
7 weeks
*« weeiai,"!!!!
6 weeks. ....
7 weeks
?wl!3S-. ::::
15 weeks
General caseous taberculosls.
XSarly cas. gen.
n
80
78
118
118
U6
118
—10 gm.,
—6 gms.,
—100 gms..
-00 gms..
Slight Infiltration at site of Inocu-
lation.
Slight infiltration at site of Inocu-
lation.
Still living.
General caseous.
General caseous.
Caseous milialy.
Caseous miliary.
Si
—10 gms..
+16 gms..
General cas. mil.
General caseous.
The above chart shaws^ I think a slight effect apon the refiistence
of the animal to the tubercle bacilli called forth by the extract in-
jection^ bat probably not more than would be expected from a
similar treatment with tuberculin. We have two pigs which have
been injected six times during nine months; these will be immunized
for one year and then killed.
7. PATHOLOGICAL. CJHANGBS.
The pathological lesions which are produced by injections of serum
extracts are not peculiar to this substance. In the first charts I
would call attention at this point to a small letter "n" beside the
animals which received 500 mgs. and Igram of tuberculin and 100
mgs.; 200 mgs.y 500 mgs. and 1 gram of extract. This means that in
the spleens of these animals small nodules were found which micro-
scopically proved to be focal necroses. These necroses were oc-
caionlly found also in the liver but in none of the otlier organ-s.
There was no microscopical lymphatic hyperplasia in the bodies of
guinea pigs dying after injection and very little could be found by
miscroscopical preparations. These focal necroses of the spleen find
no counterpart in the regional lymph nodes through, which the in-
jected material must have passed. Occasionally accumulations
of polymorphonuclear and endothelial cells were found around these
focal necroses of the spleen, but not in every instance. The number
of these latter collections in a given spleen seemed directly in pro-
portion to the length of time which had elapsed between the last
injection and death. This would seem to be an early stage of
encapsulation or the evidence of the casting off of the slough formed
by this focal necrosis. General congestion was present in almost
all pigs which died within the first few days following the inocula-
tion, but occasionally a few petechial hemorrhages were observed
in the serous membranes, esi)ecially in the region of the spleen and
kidney. This latter observation could also be made in the bodies
of pigs dying after tuberculin injection.
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No. IS. COMMISSIONER OF HEALTH. 118
The appearance of the liver and spleen of guinea pig& dying after
Beveral injections of extract which either preceded or followed the
inoculation of bacteria, deserves mention. The caseated infiltrate
was of a pale, tawny yellow, contrasted with the red brown of the
liver or spleen. This mass was often no more friable than the
organ tissue itself. It was strictly an infiltrate, no line of demar-
cation existing to show where an exudation began or was limited.
Here and there in the rest of the organ, there would be a large
cheesy nodular tubercle. The miliary forms did not vary from the
usual acute disseminated type.
8. EFFECT UPON BACTERIA.
The effect of the serum extraction upon the bacteria themselves
was of importance and received our attention in the direction of
morphologic change and attenuation. After removal from the
extracted mixture and washing, the organisms were slightly
shrunken and took the stain with a trifle more irregularity than
active growing bacteria. Differences between them and cultures
of their same age, were impossible to detect if the smears were
stained side by side on the same slide. They grew with the usual
charateristics ui>on the same culture. The virulence was somewhat
lower than control cultures of the same age, for when injected in
approximately the same doses (not accurately weighed because of
serum coagulum around them) it required almost twice as long for
the extracted bacteria to kill animals of about the same weight.
This occurred in two out of three experiments; the other test result-
ing in the death of the two sets at about the same time. If these ex-
tracted organisms were killed and other untreated cultures of the
same age were killed, and these two masses injected into separate
sets of guinea pigs, they both produced the same pathologic change,
that is an infiltrated encapsulated cheesy mass at the site of in-
oculation.
EXPERIMENT ON COWS.
Intravenous injections of 10 cubic centimeters of the extract into
healthy cows produced a temperature reaction of about 1 degree P.
during the succeeding twenty-four hours. If the animals were
tuberculous, the temperature change usually consisted in a depres-
sion of .2-.6 degree P. Following injections of tuberculin in the
same dose into the vein of healthy animals, nothing more than an
irregularity of temperature was observed, which in the case of tuber-
culous animals was more marked. No true tuberculin reaction was
ever obtained after such a test. The subcutaneous inoculation of
tuberculin into infected animals was of course specific. Injections
of serum extract under the skin of healthy animals led to no rise in
temi>erature. Subcutaneous injections into infected cows gave rise
8—16—1907
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114 SECOND ANNUAL. REPORT OF THE Off. Doc
to rea€tion8 almost as definite as those following tabercolin, when
used in the same dose. Reactions conld be obtained when using as
low as 100 milligrams, but not lower.
After these facts were determined, one healthy and two tuber-
culous cows received monthly injections of 500 milligrams of serum
extract beneath the skin, from May to December, 1907. They were
again tested, first with tuberculin and then with serum extract.
The reactions were almost exactly the same as upon their first test.
It therefore seems that the serum extract injections did not produce
a complete encapsulation of the foci in the infected animals, but
that antituberculin was still being farmed from some area. Re-
peated injections of this extract produced no temperature suscepti-
bility in healthy animals.
With the hope of employing whatever anti-bacterial substance
might be present in the body fluid after interaction of bacteria,
tissue and toxin, following an injection of tuberculin, a cow was
given double the testing dose of tuberculin. At the time which we
believed to be the highest point of the temperature curve, the animal
was bled, the serum separated and used to extract tubercle as
described in the introduction. The resulting extract was then in-
jected into the vein of healthy and tuberculous cows (10 cubic centi-
meters) the first animal having a rise of temperature of .8 degree P.
within twelve hours, the temperature of the tuberculous animal
remaining unchanged. This is exactly the same as the result of one
previous injection in the same animal,, of extract made from the
serum of a healthy cow.
The preceding experiments on the effect of normal bovine serum
on the tubercle bacillus and on the resulting extracts, seem to justify
the following conclusions:
1. That the resulting extract is toxic, probably due in part to its
serum content.
2. That the serum extract produces a temperature reaction in
healthy animals, when given into the vein or peritoneum.
3. That it seems to produce a temperature reaction in tuberculous
animals specific for itself.
4. That this extract has no power to destroy, neutralize or at-
tenuate tubercle bacilli.
5. That repeated injections do not produce an active immunity.
(Note).— Normal serum extraction of degrreased tubercle bacilli was tried once.
The resulting filtrate had exactly the same effect upon guinea pigs as some of
the same stock of serum used for making it and therefore ten weeks old. This
has not been repeated, because of the first failure and because it seems im-
probable that serum would extract anything from the organisms after they
had been treated with alcohol-ether, in removing the wax and washing with
salt solution.
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No. 1& COMMISSIONER OF HBAL.TH. 115
6. That whatever effect the Berum extract may have in antagoniz-
ing the development of tuberculosis is best shown by injecting it
after the tubercle bacilli and putting it into the abdomen of guinea
pigs.
7. That injections of serum extract produce non-specific focal
necroses in the cppleen and sometimes in the liver.
8. That the bacteria are little if at all injured by exposure to the
eemnt
9. That an anti-toxic body cannot be obtained by extracting the
tubercle bacillua with normal bovine serum in this manner.
MAY DRINKING WATEli, WHEN POLLUTED WITH SEWAGE,
BE ONE MEDIUM OF DISSEMINATION OF TH^. TUBERCLE
BACILLUS?
The tubercle bacillus may be introduced into the animal economy
in various ways. The usual portals of entry are the mouth, nose,
or an abraded surface. In cows it may obtain entrance also through
a milk duct or by way of the vagina. That it sometimes enters the
foetus in utero through the medium of the circulation must be ad-
mitted notwithstanding the opinion of many physicians to the
contrary. Veterinarians tell us that it is not uncommon for cows
to drop infected calves. This of course is entirely apart from the so-
called inherited predisposition to tuberculosis in man which may be
either physiological, consisting of such a condition of the tissues and
more especially of the mucous membranes as will afford a receptive
and favorable environment for the growth of the organism; or
anatomical, depending on a conformation of the thorax such a» the
deformities known as chicken breast, winged chest or hollow chest,
which interfere with the full and healthy development of the lungs.
It may of course be introduced artificially by inoculation as demon-
strated ni>on the lower animals. When it enters by the mouth and
nose, it may as du«t pass directly into the air passages and lungs,
or being detained in the mouth, be swallowed with the saliva and so
reach the digestive tract. Contained in food or drink, it may pass
directly into the stomach and intestines.
It has been definitely proven that it may penetrate the healthy
mucous membrane of the intestinal tube, pass into the lymphatic
circulation without leaving the slightest lesion or trace of its pas-
sage, find its way into the thoracic duct, so into the general circula-
tion and finally into the lungs. So that its presence in the lung,
coincident with its absence in the intestinal wall, does not at all
prove that it was not originally introduced in food or drink.
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U6 SE9C0ND ANNUAL. REPORT OF THE Off. Doc
The early tubercular affections of infancy, meningitlB and tabes
mesenterica, are generally due to the use of infected milk or arti-
ficial feeding.
These considerations prepare us for the question whether in view
of the thousands of human beings who are expectorating tuber-
culous matter and depositing it with their urine and feces, great
numbers of these bacilli must not find their way into our streams
and constitute a source of pollution of our drinking water in many
instances.
Particularly pertinent is this inquiry as regards the opportunity
for dairy cattle if they drink from streams close to the source of
pollution^ becoming infected themselves and conveying the in-
fection to their milk. Any one who has watched cattle drinking
in a stream can readily understand how this might occur. Even
when they do not wade in to a sufficient depth to immerse their
teats and udders, in their efforts to drive away flies they throw the
water dripping from their mouths and from the ends of their tails
over their sides and udders. Prom the stream they usually go direct
to the milking. With the carelessness which prevails on the
average farm, the milker finds no difficulty in mixing the milk which
is distributed over the outside of the teats with any organic filth
which may be clinging to them, as well as to his own hands, and
allowing it, so contaminated, to drop into the milk pail.
In order to remove this hypothesis of the possible contamination
of water supplies from the realms of mere theory and place it upon
a substantial basis, I have been conducting a series of experiments,
with the co-operation of Dr. Herbert Fox, Chief of the Laboratories
to determine whether tubercle bacilli may be found in sewage, and
if so, to what extent. The pollution of water supplies by the organ-
isms of typhoid fever, of dysentery, of cholera and of diarrhoea has
been so evident and of such constant occurrence that it has filled
our field of vision to the exclusion of the possibilities of such i>ollu-
tion by the poisons of other diseases. Tuberculosis is one which has
been thus overlooked. I know of no investigations having been made
or published in order to determine the facts in this matter up to the
present time.
So far my researches have been limited to the examination of the
sewage from the "Rush Hospital for Consumption and Allied Dis-
eases," West Philadelphia, the sewage from the White Haven Sana-
torium for Consumptives, and the mixed sewage from the sewer
outlet at South Street Bridge, West Philadelphia.
The sewage from the main outlet into the sewer from the Bush
Hospital, taken November 24th, 1907, was largely fluid, containing
some solid fecal matter, and what was apx)arently refuse from the
kitchen.
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No. le.
COMMISSIONER OF HBAL.TH.
117
The sample was well shaken, the solid portions broken up with a
rod and i>ortions of 1^ 2.5, 5 and 10 and 20 cubic centimeters pipetted
into centrifuge tubes, the first four being made equal to the bulk
of the last one, with sterile water. These tubes were centrifuged
for eleven hours, with one intermission to remove the supernatant
liquid, and add fresh, sterile water to them. After centrifugatiom,
the solid sediment was spread on glass slides, using the entire 1
cubic centimeter at the bottom of each tube. These slides were
stained with Ziehl-Nielson Carbol Fuchsin for five minutes and one
set was decolorized and oounter-stained with a saturated solution
of methylene blue in absolute alcohol, and another was first de-
colorized with a 25 per cent, solution of sulphuric acid in absolute
alcohol and center stained with LoefBer's, while a third was de-
colorized and counter-stained by Pappenheim's solution. This last
method was used to corroborate the findings of one set of Bush
sewage, and the samples from White Haven. In every instance that
tubercle bacilli were found in smears decolorized by the 25 per
cent, sulphuric acid in absolute alcohol, they were also found on
preparations treated witb the Pappenheim solution. This method
is declared as a final tinctorial test by Pappenheim, (Berliner
Klinlsehe Wochenschrift, 18&8, No. 37), Simon, (Clinical Diagnosis
19M) and Bosenberger (as yet unpublished).
Every side was subjected to the search of an hour under a 1-12
oil immersion Zeiss with No. 6 compensation ocular. The follow-
ing counts are given upon the methods in which the slides are de-
colorized by the sulphuric acid alcohol method, because of the clear-
ness of the field.
One undoubted tubercle bacillus was found on the slide contain-
ing the sediment of 1 cubic centimeter; 2^ cubic centimeters showed
three tubercle bacilli; 5 cubic centimeters showed seven tubercle
bacilli; 10 cubic centimeters showed ten, and tubercle bacilli were
found to be present in the centifuged portion of 20 cubic centi-
meters, but their number was not counted. All these figures repre-
sent the search of one hour each with a mechanical stage.
On December 17th another sample was taken at the same place.
In this sample the result was practically the same at that above
outlined. The number of organisms demonstrable in the slides
made by identical methods was found to decrease appreciably when
the sewage was kept under artificial conditions, i. e. in large dark
bottles in the ice box.
Lenirtli of Time.
Ixnmed.
1 Week.
4 Weeks.
Na orgAntemf, ayen«e of S,
1 0.0. 1
5 o.c. 6
10 CO. 8
10 c.&-f
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118 SECOND ANNUAL REPORT OF THE Off. Doc.
Bamples were taken January 4, 1907, of the sewage from the
bactericidal filter plant of the White Haven Sanatx>riunx for Con-
sumptives. Portions were taken from the mixed sewage, from the
solid sediment after filtration and the effluent. The samples were
treated exactly the same as outlined for the sewage at the Bush
Hospital, and equal volumes taken. The counts by the sulphuric
acid alcohol method and the preparations decolo-rized and counter
stained by the Pappenheim solution, are practically identical. The
counts are given according to the sulphuric acid alcohol method for
the reason above mentioned.
In the stained sediment from 1 cubic centimeter and 5 cubic centi-
meters of the mixed sewage, no tubercle bacilli were found, but they
were found sparsely when the sediment of 10 cubic centimeters waa
stained. This sediment stained so diffusely with methylene blue
that it was practically impossible to see all fields clearly, and some
may have been overlooked. The solid sediment was removed from
one of the chambers 18 inches below the surface, as far down as was
possible to reach. It was a dark, foul smelling mass, about the
consistency of feces, and not dry as far down as could be seen. The
mass was macerated with an equal quantity of sterile water, well
mixed with the rod and portions centrifuged. The sediment of 1
cubic centimeter of this mixture showed two tubercle bacilli after
an hour's search. The effluent from this filter plant was taken
directly into the bottle as it bubbled out of the ground about 200
feet down hill from the separation chamber. It was a turbid fluid
and showed a bacterial count of 370,000. Typical acid fast bacilli
could be demonstrated in quantities of 10 cubic centimeters after
the search of one-haJf hour. They were in clumps and not easily
enumerated. The sediment of smaller quantities failed to show any
such organisms.
The sewage from the Schuylkill river was taken at the mouth
of the sewer below South Street Bridge, West Philadelphia. 150
cubic centimeters were centrifugated for twelve hours, the sediment
thoroughly mixed from the several centrifugation tubes, re-centri-
fuged and dried in the hot air oven, softened with normal salt
solution, again centrifuged, the supernatent liquid jHWired off^ dried
again in the hot air oven, softened with salt solution and spread
on four glass slides for staining purposes. The reason for these
several washings was the presence of a scum or coating over the
sediment when dried after the first centrifugation. No organisms
in any way comparable to the bacillus tuberculosis could be found.
In preparations -decolorized by 5 per cent, hydrochloric acid no
acid fast organisms were found; this was done to see if the smegma
badllus was present in the sewage. There were no masses of
dejecta but the fluid had a distinct fecal odor.
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Na IS. COMMISSIONER OF HEALTH. 11%
The experimental efforts at producing tubercaloeis in guinea pigs
have been omitted up to this point because they can be treated
together; their results being uniformly negative. The sediment in
the several instances directly after centrifugation, was subjected
to temperatures of 60 degrees, 65 degrees, and 70 degrees C. for
fifteen, seven and two minutes respectively with the hopes of killing
off the sewage organisms, particularly the spore formers, without
doing any damage to the tubercle bacilli. Guinea pigs injected with
this heated sediment either succumbed shortly after the inoculation
or when they survived this, failed to show any pathologic lesion
of tuberculosis. In order to have the organisms in their vegative
state, sediment from a large amount of sewage was incubated at
35 degrees O. for twenty hours, centrifuged for a few minutes and
this sediment subjected to heat as above outlined. The second
centrif ngalization was only done long enough (circa twenty minutes)
to throw down a sufficient sediment with which to work, a complete
sedimentation requiring so long as to permit further spore forma-
tion. The results of inoculation into guinea pigs were also negative.
In smears made from some of the injection material, the typical
acid fast organisms were found but they could not be discovered in
smears made from the peritoneum or organs of pigs dying shortly
after injection.
This does not prove that the acid fast bacilli were not tubercle
bacilli. The discovery by stain of tubercle bacilli in sewage does not
prove they were viable. When taken direct from the sewer of the
Bush Hospital and White Haven Sanatorium, it is assumable that
they still live when so recently from the human body. The fact
that no tuberculosis was produced does not militate against our
assumption of the identity of these acid fast organisms, because of
the few that were introduced, inasmuch as we are obliged to use
small quantities of the sediment to lessen the action of the ac-
companying germs which we could not kill or remove. Attempts
at cultivation with pieces of organs and coagulated blood serum
were of course failures.
EXPERIMENTAL WORK UPON THBVTABIUTT OP TUBERCLE BACIUJ
AND fiSWAQE ORGANISMS.
At the outset of this work some hope was placed in the effect of
sunlight upon the sewage organisms. Later eosin with its well
known bactericidal activity was added to our means of removing
the contaminating bacteria. Early in our experimentation the effect
of sunlight upon tubercle bacilli smeared and dried upon filter paper
was determined. Direct sunlight upon these papers was sufficient
to kill the tubercle bacilli in twelve minutes, (Spring of 1907, April).
The bacteria-bearing paper strips were exposed in open Petri dishes,
and then transferred to tubes of glycerine veal agar upon which the
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120
SEX20ND ANNUAL REPORT OP THE
Off. Doc.
stock was growing well at that time. In July and October 1907, ex-
periments upon the e£fect of sunlight and eosin upon the surface
growths in flasks were made. The experiment was set as follows:
one set of flasks was kept as control, one set was used as control
and exposed to the sunlight; to one set of flasks was added, 0.03 per
cent, eosin solution and on the surface of tlie third set a 2 per cent,
eosin in gelatine was smeared in as thin a film as possible. While
I am aware that this procedure is not satisfactory to determine the
lethal sunlight exposure, it was hoped that some assistance might
be given toward determining what would happen tubercle bacilli in
a thin layer of emulsified sewage sediment exposed in these flasks.
The possibility of error in this technic is manifest. It is striking,
however, that the transplants from the sets which were exposed in
flasks smeared on the outside with eosin, did not grow after one
hour exposure although the two tests were made when the sun's
power is quite different, July and October. Chart of this test:
Control.
Hhr.
Ihr.
2 hn. 1 4 hrs.
1
Shrs.
r Control dark,
1
t
'
8-l»
Control without Eoain
Eosin In aolution 0.08 per
cent.
+
+ . +
+ +
+?
EoBin smeared on surface,
[Control dark
-
10-1
Control without Bosin
Eosin in solution O.OS per
cent.,
+
t
+
+
+ 1 +
+ -
—
.Eosin smeared on surface,
—
It api)ears from this that the photodynamic power of eosin is
effective after one-half hour or one hour at least, upon tubercle
bacilli. It restrains growth after transplantation at any rate.
In making a control experiment with sewage, a fresh positive Rush
Hospital sewage was rapidly centrifuged and the sediment allowed
to germinate twenty-hours in 90 per cent, by bulk of bouillon. This
was again rapidly centrifuged and a thick emulsion of the sediment
placed in our usual tubercle bacilli flasks to the depth of about two
millimeters. These were placed in lots like the last experiment, one
set as control, one received O.OG per cent, eosin and the third had a
gelatine coating of eosin. The results of their growth after direct
sun exposure on a very bright day, (although December 14th, 1907),
require no chart. Ti'ansplants made with a loop and with the
extreme point of a straight needle, touching only the surface, gave
marked jwsitive growths of contaminating organisms after four
hours.
The results of exposing dried sewage on filter paper was done
with the tubercle bacilli was likewise disappointing. The germi-
nated sewage was rapidly sedimented, this mass ground up to a state
Digitized by VjOOQIC
No. 16. COMMISSIONSH OF HEALTH. 121
approaching perfect homogeneity. It was then distributed by a
pipette in eqaal quantities on slips of filter jmper which were placed
in a vacuum dessicator without acid for ten minutes, at the lapse of
which they were still a little damp. The exposure to the sun was
made in two minutes after removal from the dessicator. The time
elapsing from removal from the incubator to the sun exposure being
about forty minutes. The slips were then exposed directly to the
sun for one, two, five, ten, thirty and sixty minutes, and transplanted
to neutral bouillon. Every exjwsure grew well.
It is evident from these few sun light and eosin tests that longer
exposure is required to kill the sewage organisms than woula
suffice to restrain growth of the tubercle bacilli, therefore rendering
this technic impracticable.
We are dealing with such a small number of organisms in this
sewage compared to the number usually employed to produce
artificial lesions that some means must be found to render sewage
organisms entirely innocuous, which means must be such as will
not harm the tubercle bacillus itself. We are still working on this
problem but cannot as yet report much progress. The finding of
tubercle bacilli in smears made from sedimented sewage of Tuber-
eulosis Hospitals, by eminently trustworthy methods, is sufficient
proof to us that these organisms are present in such sewage and can
therefore be in the water courses into which the sewage fiows.
THE REACTION OP THE PHAGOCYTES OP ELEPHANT'S BLOOD ON
THE BACILLI OP TUBERCULOSIS.
In casting about for an animal whose blood might be availed of
in conducting exi)eriments on immunity against tuberculosis, it
occurred to me that the elephant possessed two characteristics which
might make it useful for this purpose: First, its remarkable longev-
ity, suggesting a power of resistance to all infections, whether of
human beings or of the lower animals; and second, the fact that no
records could be found of the observation of tuberculosis in this
race.
With the skilful co-operation of Dr. Pox, the following
observations were undertaken. By the courteous permission of
the Zoological Society of Philadelphia, a small quantity of blood
was obtained from an elephant's tail. At the same time experi-
ments were made with the blood of the human being, the cow, and
the guinea pig. The conditions in each case were identical. The
leukocytes were twice washed and the emulsion of tubercle bacilli
was prepared by washing lightly with alcohol and ether and rubbing
up in a mortar in 0.86 per cent, salt solution and then treating with
the centrifuge. The turbidity of the emulsion corresponded to No. 2
of a barium sulphate nephelometer (Table I). A second experi-
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122 SB)COND ANNUAL. REPORT OP THE Off. Doc.
ment was made in which the emulBioa was produced by boiling in
chloroform, the object being to get a saspension which will keep
indefinitely and may always be rendered homogeneous by shaking.
Four salt solutioms of different strengths were used for the puri>ose
of testing spontaneous phagocytosis.
In both experiments the blood of the same individual was used,
the bacteria for different emulsions were obtained from the same
tuberculous strain, and the turbidity was identical. In the second
the whole blood method was employed, using homologous ceUB and
serum. Table II shows the phagocytic capacity of the blood of the
same person on four successive days, the last time on that of the
second elephant test.
Table I. — Comparative Phagocytosis of Human^ Bovine, and Bodent
Blood with Bacillus Tuberculosis.
Phagocytic
Index. Average.
0.1 C.C. elephant's serum plus 0.1 c.c. elephant's leukocytes
plus 2 C.C. bacteria emulsion 1.0 0.40
0.1 C.C. elephant's serum plus 0.1 c.c. guinea-pig's leukocytes
plus 2 C.C. bacteria emulsion, 0.7 0.28
0.1 C.C. elephant's serum plus 0.1 c.c. emulsion human leukocytes
plus 2 c.c. bacteria emulsion, 0.4 0.16
0.1 c.c. elephant's serum plus 0.1 c.c. emulsion cow's leukocytes
plus 2 C.C. bacteria emulsion 0.3 0.12
0.1 c.c. cow's serum plus 0.1 c.c. emulsion cow's leukocytes
plus 2 c.c. bacteria emulsion, 1.0 0.28
0.1 c.c. cow's serum plus 0.1 c.c. emulsion human leukocytes
plus 2 C.C. bacteria emulsion 0.67 0.16
0.1 c.c. cow's serum plus 0.1 c.c. elephant's leukocytes emulsion
plus 2 c.c. bacteria emulsion, 0.43 0.12
0.1 C.C. cow's serum plus 0.1 c.c. emulsion guinea-pig's leukocytes
plus 2 C.C. bacteria emulsion 0.43 0.12
0.1 c.c. human serum plus 0.1 c.c. human leukocytes plus 2 c.c.
bacteria emulsion, 1.0 0.24
0.1 C.C. human serum 0.1 c.c. emulsion cow's leukocytes plua
2 C.C. bacteria emulsion 0.83 0.20
0.1 C.C. human serum plus 0.1 c.c. emulsion elephant's leukocytes
plus 2 C.C. bacteria emulsion, 0.6 0.12
0.1 c.c. human serum plus 0.1 c.c. guinea-pig's leukocytes plus 2
c.c. bacteria emulsion, 0.33 0.08
0.1 c. c. guinea-pig's serum plus 0.1 c.c. guinea-pig's leukocytes
plus 2 C.C. bacteria emulsion, 1.0 0.28
0.1 c.c. ETuinea-pig's serum plus 0.1 c.c, emulsion human leuko-
cytes plus 2 c.c. bacteria emulsion, 0.85 0.24
0.1 c.c. guinea-pig's serum plus 0.1 c.c. emulsion elephant's leu-
kocytes plus 2 c.c. bacteria emulsion 0.67 0.16
0.1 c.c. guinea-pig's serum plus 0.1 c.c. cow's leukocytes emul-
sion, plus 2 c.c. bacteria emulsion 0.4 0.12
One-half hour at 37** C. 100 cells counted.
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No. 16.
COMMISSIONER OF HEALTH.
123
Table II. — ^Average Phagocytosis of Human and EHephant's Blood
with Baclllas Tuberculosis.
I
H
?
A
15
SmulBlon made in Na CI solution of
0.1 per cent.
0.6 per cent
0.86 per cent
1.6 per cent.
0.46
O.tt
0.86
0.88
0.28
0.82
0.82
0.40
0.28
0.80
0.24
0.44
0.80
0.84
0.82
0.88
0.86
0.84
0.48
0.46
The results of these experiments may be summed up as follows:
1. The expectation that the leukocytes of elephants' blood might
possess a high degree of phagocytic energy a» far as the tubercle
bacilli is concerned was not fulfilled to such a degree as to promise
any practical results, being but a trifle higher than that of human
cells.
2. The highest phagocytic average is obtained when the leukocytes
and cells of the same animal or race are employed.
3. When the serum of the various animals is mixed with the
leukocytes of other animals, the results vary very much, in accord-
ance with the order in which the mixture is made. For example,
when elephant serum is added to guinea pig leukocytes, the index
resulting is only 0.7, but if the guinea pig serum is added to
elephant's leukocytes, the index mounts to 0.85. If bovine serum is
added to human leukocytes, we obtain an index of 0.57, but if human
serum is mixed with bovine leukocytes, it reaches 0.83.
4. It seems to make very little difference numerically in the phago-
cytosis of tubercle bacilli whether they are emulsified by rubbing in
a mortar with salt solution or by boiling in chloroform.
COMPARATIVE VALUE OP LJQ. CRESOLIS C?OMPOSITUS, U. S. P. AND
CARBOLIC ACID AS GERMICIDES.
The new germicide Liquor Oresolis Compositus, lately recom-
mended by the United States Pharmacopoeia, has gained consider-
able notice since the publication of an article by C. N. MoBryde (XJ. 6.
Department of Agriculture, Bureau of Animal Industry Bulletin
No. 100) upon its germicidal effect and the parts taken by the
different cresols in the commercial article which have different dis-
tilling points. The following work was undertaken by Dr. Fox, to
determine the efficiency of this new solution and its practical value
for hygenic purposes. As in Dr. McBryde's work, carbolic acid was
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124 SE5COND ANNUAL REPORT OP THE Off. Doc
Qsed as a comparison. The carbolic lime mixture was discovei^d by
the writer about a year ago to have distinctly lower bactericidal
powers than carbolic acid alone.
In preparing Liquor Cresols Ck)mpo8itus the exact formula as
given by the United States Pharmacopoeia was followed most care-
fully. Quoted for reference.
Oresol, 500 gms.
Linseed oil, 350 gms.
Potassium Hydroxid, 80 gms.
Water sufficient to make, 1,000 gms.
Dissolve the jKrtassium hydroxid in fifty gms. of wed&c in a tared
dish, add the linseed oil and mix thoroughly. Then add the cresol
and stir until a clear solution is produced, finally add sufficient water
to make the finished product weigh 1,000 gms.
Two samples of commercial cresols were obtained from different
local chemists, and the two compositions were made by my assistant
and myself side by side, the same kind of clean apparatus being used
in a similar manner by both us. One of the resulting solutions
was darker than the other (Cresol No. 1 was darker than No. 2). The
darker proved to be a trifle less efficient in regard to its germicidal
activity. They had no differing behavior in regard to saponification,
clear solutions being obtained from both in making dilutions for
the experimentation. Separation did not occur in any dilution with
either composition when in dilutions of less than ten i)er cent. No
distillation of the germicide was made as our object was the practi-
cal application rather than the analytical separation of the essential
principals. Strong solutions made clearer mixtures than weaker
onea
In this work, the effects of Phenol and Liquor Oresolis Oompositus
U. S. P. were tried in dilutions of 1-50, 1-100, 1-200 and 1-300 on
Micrococcus pyogenes aureus, (twenty-four hours broth culture)
Bac. coli com., (twenty-four hours broth culture) and Bact. anthracis,
(fourteen day broth culture). The results may be seen on Charts
Nos. 1-4 inclusive.
The following is the outline of the technique used. Inasmuch as
the Cresol solution was weighed in making, dilutions of it were
made by weight and the Phenol was weighed in the chrystal form
before dissolving. The "drop method" was used entirely. It was,
however, not truly the drop method, but instead a quantity of .2
c. c. of the respective culture was allowed to fall directly into the
diluted germicide in the test tube, which was always the same in
quantity, 5 c. c. Larger tubes were used to hold the germicide
during exposure so that the four i>er cent, of culture could be added
and mixed without spreading over the sides of the tube to a great
height, thereby possibly allowing some bacteria to escape by drying,
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No. 18. COMMISSIONER OF HBAL.TH. 126
Two standard loopfuls were transferred from tite germicide^bac-
terial emalsion to a tube of freshly made neutral beef peptone
broth. These tubes of broth average 8 c. c. The time limits may be
Been by inspecting Chart 1. Sub-cultures were kept a week at
thirty-five degrees O. when readings were made. Any suspicious
tube was subjected to microscopical ezamiioation. Chart No. 4
shows the effect of strong dilutions of Phenol and Cresol composi-
tions upon our anthrax culture (Laboratory stock) and the strain
seems unusually resistant.
To determine the comx)arative value of Cresol compound aod
Phenol in destroying the bacteria in a mammalian stool, a small
mass of feces was rubbed up in sterile water, the mixture filtered
and diluted to obtain a thin perfectly even emulsion of bacteria.
The suspension was removed from the flask to three covered dishes,
in which the test was made, by a pipette; this allowed a constant
shaking for mixing and avoided all sedimentation. These dishes
then contained the same quantities of feces solution with similar
bacterial content. Plates were poured from all three before adding
the germicide. It is well to agitate the €K>lutions when adding the
germicide, so that immediate mixture occurs. The results of eight
tests may be seen in Chart No. 5. There is no explanation at hand
for the rapid destruction of the bacteria by Liquor Oresolis Com-
positus, No. 2 in "a" but this is a mean of two tests. The discrepancy
of 'V and "c" is striking and the secret must lie in the food and
intestinal contents of the monkey.
In reviewing these results, it seems that they are more favorable
to Liquor Cresolis Compositus than those of Dr. McBryde. The co-
efficient in terms of carbolic acid is practically two and sometimes
higher in the weaker dilutions. Comparing the effect of the germi-
cide on cultures and feces, it seems that .5 per cent. (1-200) of
Liquor Cresolis will kill B. coli certainly within five minutes, while
it will require fifteen minutes for carbolic acid in the same per-
centage to do the same thing. Five per cent. Cresolis No. 1 disin-
fected a human stool absolutely in four hours and reduced the count
to forty in two hours, while carbolic acid could not do better than
reduce the number to twenty in four hours.
It must not be lost sight of, however, that such experimentation
is carried on under the most favorable condition for the germicide.
Bacteria bidden by masses of feces could not be reached so readily
and rapidly. Deodorization took place no more rapidly by one
germicide than the other.
The germicidal effect of these two solutions aa M. aureus is lower
than on B. coli, but here also the Liquor Cresolis has the advantage.
A .5 i>er cent. (1-200) solution, sueb as could be used for infections
with this coccus, kills it in seven and- one-half minutes, while a
iolvtloii two thirds as strong (l^gQp) )^q[ni^e| Y^r7 little longer
Hgitized by
Google
126 SECOND ANNUAL REPORT OF THE) Off. Doc*
The results of comparison of the two germicides on Bact. anthracis
ai*e less reliable, The strong solutions of carbolic acid, did not, of
course, remain in solution or suspension, so that they had to be
shaken frequently, and even then the bacteria could mot be said to
have had the full effect of the given dilution, but of some indefinitely
weaker ones. A conclusion upon these strong solutions is not
justifiable.
One fact ooncenning the anti-bacterial action of liquor Gresolis
against Bact. anthracis is well illustrated in our work. This germi-
cide will restrain the growth and germination of the spores of this
organism when in very low dilutions. The techmic in Chart IV was
made with the platinum "oese.'' The following experiment was made
by definite percentage method. One per cent, solution of Carbolic
acid and Liquor Cresolis No. 1 and No. 2 were made in sterile water;
to this was added an accurate four per cent, of a twenty day
bouillon anthrax culture. At the expiration of the desired exposure
lime .1 c. c. was removed by a pipette and planted on fresh bouillon.
This addition made the strength of the germicide m the last culture
1-5000. Carbolic acid in such a dilution did not restrain the vegeta-
tion of the anthrax spores, but no growth was obtained in the tubes
maxle from the cresol flasks at the expiration of ten days. Then
twenty c. c. of fresh bouillon was added to the tubes. with the result
that a good culture developed after four days further incubation.
In these experiments the anthrax spores withstood four days longer
exposure to carbolic acid than to Liquor Cresolis of the same
strength. It is therefore evident that these spores cannot develop
in a dilution of Liquor Cresolis which of carbolic acid allows multi-
plication.
Charts Nos. 1, 2 and 3 represent a composite of eight tests. Chart
No. 4 is a composite of four tests. Each of the feces tests, given on
Chart No. 5 was done twice, these figures being an average.
This work seems to warrant the following conclusions:
1. That Liquor Cresolis Compositus, U. S. P. is an efficient germi-
cide against B. coli, Miscrococcus aureus and Bact. anthracis.
2. That its carbolic acid coefficient against M. aureus and B. coli
is about two.
3. That a .5 per cent, solution will kill the colon bacillus in five
minutes and should therefore be a good germicide for dejecta.
4. That is is probably more efficient against spore forming
organisms than carbolic acid is, restraining growth in weaker solu-
tions.
5. That intimate mixing is essential to its success. The cost per
kilo or litre in the Laboratory is about three-fourths of that of pure
carbolic acid.
Digitized by VjOOQIC
No. 16
COMMISSIONER OF HBAL.TH.
127
Chart No. 1. — Germicidal Tests with Liquor Oresolis Ck>mpoflitus
'U. S. P.' Oarbolic Acid used for Ck)mparisoiii.
The heavy lines indicate the average length of time which the
organisms withstood the solutions.
Micrococcus Pyogenes Aureus.
1
%
3
4
6
6
7
s
9
10
1'
w
V
7%'
W
IC
ny
ao"
«y
•O'
r^rhnlln «i*M l-SO
TJn Vf-MAllA 1.£A'' '"]' ' . '.\[[[\[\..^.
€\kThnUf twlA 1-100
T.ia creaolla 1.100
r!ftrhnll<* A/»ld 1.900
Ttia Gi^sollfl 1-200
Carbolic Afiid l.SOfl
Titn rrMinlfa 1 MnI
B. Coll Oom.
CkrboUc acid l-».
zz.
lAa. cnBOllB 1-60
Carbolic acid 1-100
lAa. orMolia 1-100 '
riarholic ai*kl l-MO
Tiln mwnlta LflM
1
C^rfaollA Afild 1-100
Lila ci^M>lla 1-SOO
1
Chart No. 1. — Germicidal Tests with Liquor Oresolis Oompositus
*U. S. P.' Oarbolic Acid used for Comparison.
The heavy lines indicate the average length of time the organisms
withstood the solution. This chart shows the different values of the
solutions of ccMnmercial Oresol from different dealers. Oresols No.
1 and No. 2.
Micrococcus Pyogenes Aureus.
1
S
t
4
6
«
7
8
f
10
U
IS
1'
avfc'
S'
7W
IC
15'
ny
W
40^
«K
IXK
MO'
Cnsol No. L
Cariiolie add l-EO
Lla creaolls 1-tO "....../.'..'.'.
—
Cta-rbollc add ' l-iOO
"LAx criMQliJi 'l lOO"'
r^rbolle add 1-200
T.ln rrfmtiliu l-IMO''
-
OartMllcacld l-SOO, ....«
JAa eiMolla l-MO
Creaol No. S.
Carbolic add 1-60.
—
LlQ. creaolli 1-BO
Carbolic add l-lOO
LJff creaotla 1-100
r^rhoUo fl£id l-iM
C!arfaollB acid 1-200
T.ln. i^wn^ta 1.10A~' .
Digitized by VjOOQIC
128
SBSCOND ANNUAL REPORT OF THE
Off. Doc
Chart No. 1.— Germicidal Testa with Liquor Oresolis CompoeitiM
*U. S. P.' Carbolic Acid used for Comparison.
The heavy lines indicate the average length of time the organisms
withstood the solution. This chart shows the different values of two
solutions of commercial Cresol from different dealers. Cresols No.
1 and No. 2.
Bacilli CoU Compound.
1' ; avfc'
ft' 7%'
S(K
ay
Cresol No. 1.
Carbolic acid 1-60. ...
L*lq. creaolls 1-60
Carbolic acid 1-100, ...
L.iq. cresolla 1-100,
Carbolic acid 1-20O. ..
Uq. cresolis 1-200, ...
Carbolic acid 1-800, ..
LlQ. cresoUs 1-900, ...
Cresol No. 2.
Carbolic acid 1-60, ...
L.iq. cresoUs 1-60
Carbolic acid 1-100, ..
Llq. cresolto 1-100, ...
OarboUc add 1-aoo, ...
Llq. creaolls 1-20O, ....
Carbolic acid l-SOD. ..
I4q. CTMOlIs 1-800, ...
iz_ I
Chart No. 1. — Germicidal Tests with Liquor Cresolis Gompositus
*IT. S. P.' Carbolic Acid used for Comparison.
The heavy lines indicate the average length of time which the
organisms withstood the solution.
Bacteria Anthracis.
1
S
t
4
6
•
7
S
f
10
n
u
It
^
^
00
&
9
»;
M
;(
&
9
Carbolic acid 1-S,
Llq. cresollB 1-6
Carbolic acid 1-10. ....
Llq. cresollB 1-10
Carbolic acid 1-20
Llq. cresollB 1-20, ....
"•
^"
'^.-^■b,
k'.— .**
mJt '
i^
Digitized by VjOOQIC
No. 16.
COMMISSIONEIR OF HBAL.TH.
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180 SDCXDND ANNUAL REPORT OF THE Off. Doc
THE FOIiLOWINa PRELIMINARY REPORT ON THE PREDOMINATING
MICRO-ORGANISMS IN FECES AND SEWAGE AS AN INDEX OF POL-
LUTION IN DRINKING WATER HAS BEEN PRESENTED BY DAMAfiO
RIVAfl. BACTERIOLOGIST TO THE DEPARTMENT.
The fact that Bacillus coli communis is an inhabitant of the in-
testines of man and other mammals has caused this organism to be
regarded as am index of pollution in our water supply; some bac-
teriologists, however, basing their opinions upon the fact that
Bacillus coli is also found in the intestines of other animals, and is
widely distributed in nature, are inclined to regard this micro-
organism as of no importance in water analysis. It is true that in
most cases, if not always, too much reliance is placed upon the
presence of Bacillus coli alone, which has led to an entire neglect of
other and imi>ortant micro-organisms in water; but since a water so
contaminated, regardless of the source of pollution, cannot be con-
sidered as desirable for drinking purposes, and more especially since
Bacillus coli at present is regarded as sufficient indication of pollu-
tion by sewage, it is desirable to make some observations ui>on the
subject.
That Bacillus ooli is a common inhabitant of the intestines is a
well-known fact; that it is also found in sewage needs no further
comment here, but since in the feces as well as in sewage, beside
Bacillus coli, other micro-organisms are found in abundance, it is
desirable to determine the numerical occurrence of Bacillus coli as
well as other micro-organisms in feces and sewage. The purpose of
this research was to determine:
First. — That if Bacillus coli is found to predominate in feces and
sewage, this fact would give to this micro-organisms a more logical
basis as an index of x>ollution.
Second. — If any other micro-organisms was found to predominate,
could it be possible to attach to it more significance than to Bacillus
coli?
Third. — "V^Hiiether in the line of such research it would be jKWsible
to find another practical index of pollution which in some way
would shed a new light on the vital problem of water analysis.
With these points in view the experiments were conducted as
follows: a small amount of feces was dissolved in a test tube con-
taining about six cubic centimeters of sterile salt solution and, after
thoroughly shaking, one cubic centimeter of the mixture was trans-
ferred to another test tube; after shaking one cubic centimeter of
the second tube was transferred to a third tube, and so on, ten to
twelve dilutions being made from the original tube.
In the case of sewage collected at the South street bridge. West
Philadelphia, as it emptied into the Schuylkill river, after
thoroughly shaking the sample a portion of it was transferred to a
tube of sterile salt solution, and, as in the case of the feces, ten to
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No. 16. COMMISSIONER OF HEALTH. IM.
twelve dilutions were made from the original tube. In each case^
one cubic centimeter of each tube was plated on litmus lactose s^ar,
and after an incubation of forty-eight hours at 37" C. the plates were
examined and the colonic further studied.
Assuming that this technic would enable one to separate the
different species of bacteria in the feces and sewage, by the subse-
quent dilution, it would also enable one to show in the corresponding
plate the numerically predominating micro-organisms in the original
tube.
To prove this assumption, experiments were made along the same
lines with a mixture of B. anthracis, B. typhosus, and B. ooli^ by
adding to the original tube a given quantity of these cultures, dil-
uted in sterile salt solution. The number of bacteria per cubic centi-
meter was at the same time determined in each dilution of the above
named three micro<>rganisms, before a given quantity of each was
added to the original tube. Prom the original tube dilutions and
corresponding plates were made, and without any exceptions the
micro-organisms which was added in excess in the original tube was
found to be the last to disappear in the subsequent dilutiona.
Further, in one experiment in which to the original tube were added
60,000 B. coli, 58,000 B. typhosus, and 2,400 B. anthracis, the least in
number (B. anthracis) was found to disappear on the. fifth dilution,
and plate No. 6 (which corresponds to the sixth dilution from the
original mixture) showed three colonies, two of them being B. coli
and one B. typhosus, which showed beyond any douht the axicuracy
of the technic. In the light of such results, I feel certain that such
a procedure would enable one to determine in a precise manner the
predominating micro-organisms, not only of feces and sewage, but
also of coli, pus, in fact of any samples on which such research would
be desirable. The p(rocedure is in itself simple, and so accurate that
such a slight excess as two thousand over a mixture containing in
all about one hundred and twenty thousand of different kinds of
bacteria could be detected.
In the case of feces and sewage, it was found that from the first
to the fourth dilution from the original tube, the plates usually con-
tained too many colonies; these became less after the fifth, and
from the eighth to the twelfth dilution in most cases the plates
remained sterile.
Plates which showed from ten to twelve colonies (which in most
of the oases represented the corresponding sixth to eighth dilution
from the original dilution) were further examined and each colony
studied biologically and morphologically.
In the course of the investigation a great variety of distinct
species were isolated, some of them being only occasionally found,
and for this reason no especial attention was given them, but beside
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131 SEX^OND ANNUAL REPORT OP THE Off. Doc
B. coli, some variety of cocci and the sewage streptococci, there were
four distinct varieties of bacilli encountered in each experiment,
which, by their predominance in feces and sewage, I think deserve
e8i)ecial mention. Ab a matter of convenience I would designate
these "A," "B," "C," and "D" bacillus, which gave the following
characteristics:
"A" bacillus did not ferment dextrose, did not produce indol, did
not liquefy gelatine, coagulated milk and waB Gram positive.
"B" bacillus gave a culture characteristic of B. typhosus, but was
negative to the Widal test.
"O" bacillus gave a culture characteristic of B. typhosus, but wa«
Oram positive.
'^D*' bacillus resembled B. coli, but did not produce indol.
In an average made from the results obtained from feces, the
following represents their order of predominance: 1st, sewage strep-
tococci or other variety of cocci; 2d, B. coli, communis; 3d, "A"
bacillus; 4th, «B" and "C" bacillus; 5th, "D" bacillus.
As shown in the above results, next to the cocci, B. coli was found
to predominate in feces, but I consider it not advisable to deal in
detail with the above results, because it is only in exceptional cases
that tlie direct pollution of water by feces occurs. B^l^ther, because
the pollution by sewage which represents the combined impurity
from a community, I believe to be of greater imi)ortance from a
sanitary i>oint of view, and it suffices to say that beside B. coli and
cocci, "A" bacillus was found to rank third in tlie feces, which is
significant, and in view of the fact that it is second only to the oooci
in numbers in sewage this bacillus may prove to be of importance
as an index of pollution in water.
The average results obtained in the experiments made upon the
predominating microorganism in the sewage is illustrated as fol-
lows:
1st, sewage streptococci or some variety of cocci; 2d, "A" bacillus;
3d, "C" bacillus; 4th, B. coli and "B" bacillus; 5th, "D" bacillus.
As shown in the above results, in both cases (in the feces as well
as in the sewage) the cocci were found to take the first place in their
predominance, but it is worth noting that "A" and "C" bacillus
appear to be more abundant in the sewage by taking the second
and third place, respectively, than B. coli, which occupies the fourth
place; furthermore, the results show "B" bacillus to bear the same
relation as B. coli, while "D" bacillus, as in the feces, so in the
sewage, appears to be least abundant.
In a general consideration of the results so far obtained, it is to
be noted thiat the sewage streptococci, or some variety of oocci due
to their predominance in feces and sewage, would suggest the
advisability of regarding them as the most reliable index of i>ollu-
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Ko. 16. COMMISSIONER OF HBAIjTH. 18S
tkm. It must be remembered, however, that in the process of puri-
fitcatioQ of water either by sedimentation, mechanical filtration, or
by slow sand filtration, as well as by ozonization, in ail the cases
the process can be regarded as a selective one to a certain extent,
but more especially it must be considered as a process of elimination.
Therefore, such being the case, and since by any methods employed
the purification of water is only partial, the cocci will be found in
each Instance to persist regardless of the relaitive purity of the water
after treatment. The correctness of this statement is illustrated in
the results obtained with the water supply of the city of Philadel-
phia, in which the raw water of the Delaware and the Schuylkill
rivers, after sedimentations and slow sand filtration, which process
gave a most desirable removal of bacteria (over 99.5 per cent, in
some cases), the filtered water contained sewage streptococci in
spite of the low number of bacteria (below fifty and as low as eight
bacteria per cubic centimeter) in the effluent water. For this reason
alone, if for no other, I believe I am correct in stating again the
relative unimportance of these non-pathogenic micro-organisnu^ as
an index of pollution in the water.
I am aware of the limited number of experiments here reiM>rted
from which to draw any definite conclusion, but hope they will serve
to stimulate further research upon the subject. Prom the few
results so far obtained, I feel justified in stating that not merely
the presence of B. coli in the intestines (as with it there are a great
many other bacteria associated), but more especially its predomi-
nance over other bacteria in the feces, gives to B. coli a sounder
basis as an index of pollution in water. The ^'B'' bacillus ap-
pears to be as imiM>rtant as bacillus coli, and ^^D" bacillus some-
what less so. And since "A'' and "C bacillus were found to be
more abundant in the sewage than B. coli, undoubtedly they deserve
further study and corroboration by other investigators. A thorough
study of the predominating micro-organisms in sewage, I hope, will
give a better understanding of the bacteriology of our water supply
from a sanitary point of view.
Rivas also contributes following studies.
AN IMPROVED AND RAPID TEST FOR INDOL IN BROTH CULTURES
AND FOR THE PRESENCE OF THIS SUBSTANCE IN MEAT-SUGAR-
FREE BROTH.
B. coli communis presents some constant biological features
peculiar to itself, by means of which the differentiation can be
easily accomplished*. As a matter of convenience, these reactions
were named ^Test 1," "Test 2," and "Test 3," respectively.
Test 1 is a negative test. When about one-fourth c. c. of sterile
dextrose broth is boiled for a few minutes in about 5 c. c. of a
ten per cent, sodium hydroxide solution, a light yellow canary color
)igitized by VjOOQIC
184 SECOND ANNUAL. REPORT OF THE Off. Doc
la produced. Similar treatment of a forty-eight hour old culture of
B. coli produces exactly the same result, whereas with allied species
a pinkish coloration is imparted to the liquid on standing from
five to fifteen minutes.
Test 2 consists in a bright purple or pinkish coloration produced
by B. coli when about one c. c. of a ten per cent, sodium hydroxide
solution and about one c. c. of a fifty per cent, sulphuric acid solution
are added to the culture; cultures of the saccharolytic group pro-
duce no such reaction. A study of the nature of this reaction has
proven it to be very closely connected with indol, or at least with
some derivative of indican.
Test 3 consists in the inability of B. coli to exhaust the sugar in a
cue per cent, dextrose broth, the action on this substance ceasing
after forty-eight hours at 'ST* C, and sometimes as early as eighteen
hours, while allied species, regarded as the Ck)lon group, go on un-
interruptedly until the sugar is completely exhausted. In view of
this x>^culiarity I believe it to be logical to substitute the name of
^'saccharolytic group'' for these colon-like organisms. I deem it
unnecessary to go into details of the teet for determining partial
exhaustion of the sugar by B. coli and complete exhaustion of this
substance by the saccharolytic group. This subject was thoroughly
considered in the previous paper, and it suffices here to say that the
test can be determined by the j>olariscope, or more practically by
Fehling's ^Solution, as in testing diabetic urine.
It is not our purpose to go deeply into the exact chemical nature
of the reaction, but more especially to determine the following
points in regard to them:
1. iJ^lation of Test 2 to B. coli and the saccharolytic group. —
After exhaustive observations upon a number of cultures of true B.
coli and those considered to belong to the saccharolytic group, I
believe that my results demonstrate that Test 2 i^ characteristic of
the former, and that any culture which does not show this reaction
in spite of other biological characters, should be discarded as a
true colon and classified among the saccharolytes.
2. Time required to obtain a positive reaction. — To my satisfac-
tion, it was found that Test 2 does not require the long wait of two
to eight days required by the sulphuric acid and potassium nitrite
test, but only one, or at the most two days of incubation at 37 C.
In fact I have obtained this reaction on B. coli after six hours only,
or in a shorter time, between four and five hours at 37** C, as soon
as the slightest cloudiness of the medium was observed; this was
never the case with the sulphuric acid and potassium nitrite test
applied for comparison.
3. Relation of Test 2 to the sulphuric acid and i>otassium nitrite
test. — ^As a matter of routine in studying a great numiber of cultures
Digitized by VjOOQIC
Ko. 16 COMMISSIONEK OF HBAL.TH. 185
isolated from different Bonrces and comi>ared with a B. ooli culture
as control, both tests were applied sinniltaneouslj to the same
culture, and the result corresponded very closely to the test for
indol. In a few instances, however, Test 2 (sodium hydroxide and
sulphuric acid) was positive, while the test for indol (sulphuric acid
and potassium nitrite) remained negative^ not because such cultures
did not produce indol, as the same thing was observed in the B. coli
cultures, but because the test with sodium hydroxide and suljAuric
acid was found to be more delicate and precise than the test with
sulphuric acid and i>otassium nitrite, as determined by the following
observation:
4. Differences in Test 2 and indol test with different strength solu-
tions of indol. — Experiments with different strength solutions of
indol crystals in distilled water were made and tested simultan-
eously by both tests. The sulphuric acid and potassium nitrite test
gives a salmon-amber color, somewhat resembling the normal color
of broth, while the sodium hydroxide and sulphuric acid gave a
bright purple-pinkish color decidedly more distinct than the sul-
phuric acid and potassium nitrite test.
5. Delicacy of both tests. — The sulphuric acid and potassium
nitrite test was positive to the dilution of 1:1,000,000— that is,
when the test was applied with all precautions and concentrated in
forms of rings; it was almost indistinct in 1:800,000 when tested
otherwise. Test 2 (sodium hydroxide and sulphuric acid) was found
to be positive in 1:1,400,000, regardless of any precaution in making
the test since this does not depend upon any concentration of the
reactions but upon a diffuse general coloration of the medium.
Further to my satisfaction, by making the dilution with broth in-
stead of distilled water, it was observed that the sodium hydroxide
and sulphuric acid produced more or less destruction of the coloring
matter of the medium, leaving an almost colorless broth upon which
the reaction appears more pronouncedly, while the sulphuric acid
and potassium nitrite produced no change in the color of the broth,
which in some ways obscures the salmon-amber color of the reaction.
It was further noted that the color of the broth has an important
bearing ui>on the sulphuric acid and potassium nitrite test, the
darker the medium the less distinct being the reaction. Following
this line of observation we found the test to be positive in some
cases in the concentration of 1:500,000 only, and not beyond that
point. Therefore for this reason, if for no other, Test 2 (sodium
hydroxide and sulphuric acid) is preferable to sulphuric acid and
potassium nitrite. Further it is not necessary to concentrate the
reaction in the form of rings a method requiring a careful technic
by no means always successful, but merely to add the sodium
hydroxide and sulphuric acid without any special precaution. The
Digitized by VjOOQIC
1S6 SDCXDND ANNUAL RBPORT OP THD Off. Doc
coloration is a diffused bright pnrple-pink, of itself distinct and
characteristic.
Ebiving determined by the above experiment that Test 2 (sodiuin.
hydroxide and sulphuric acid) bears a very close relation to the sul-
phuric acid and potassium nitrite test for indol, and having observed,
that this test is not only more delicate and in many ways superior
and more easily performed, attention was next directed to determine
if the meat-sugar-free broth made by the previous fermentation and
exhaustion of the inosite in the meat juice during the incubation of
eighteen to twenty-four hours at 37" C, a method suggested by-
Smith and accepted by all bacteriologists, could be regarded as free
from indol. It is stated that such preliminary fermentation by B.
ooli does not produce any perceptible amount of indol; however, in
an effort to determine the correctness of both assertions, it waa
desirable to make some observations upon the subject. That indol
is never produced in the presence of sugar is a well-known fact, but
is it not possible that the amount of sugar present in the meat juice
would be so small as to be easily exhausted by the B. coli in a few
hours so that in the remaining time this organism would attack all
protdd substances in the meat juice sufficiently to transform them
into indol? Having determined that the sulphuric acid and potas-
sium nitrite test for indol is not very delicate, and being in iMMses-
sion of Test 2 which showed itself to be more delicate and reliable,
some experiments were conducted to determine the presence or
absence of indol in meat-sugar-free broth.
Meat juice was tubed and sterilized in the autoclave at twenty
pounds pressure for twenty minutes and a series of tubes inoculated
with B. coli cultures (the amount inoculated was one drop of a
twenty-four-hour-old broth culture, this small amount being em-
ployed to avoid any possible error from the material transferred)
and placed at 37* C. A number of tubes were tested by Test 2 after
two, four, six, twelve, eighteen, twenty-four and forty-eight hours
respectively. In some cases a positive reaction was obtained as
early as after six hours' incubation. Most of the tubes showed a
positive reaction after twelve hours, and this was more marked
after eighteen hours of incubation at 37** C.
Following the same line of experiments the meat juice was tubed
and without any preliminary sterilization, inoculated with B. ooli
and incubated at 37*" O. The test wa» applied as before, and the
result was much the same. Further, with the idea that perhaps the
subsequent sterilization would produce some changes in the indol
occurring during the preliminary fermentation of the meat juice
both experiments were repeated, but this time the test was applied
after submitting some tubes to 100*" 0., and others to twenty to
thirty pounds for twenty to thirty minutes. In both oases the heat
was found to have had no effect on the reaction, as it was. as typical
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Ko. 1«. COMMISSIONER OF HBAL.TH. 187
and distiiict as when no heat had been applied before performing
the test, proving beyond any doubt that the subsequent sterilization,
that is, the heat, has no effect on the reaction^ This substantiated
my experience in finding a positive reaction of indol in sterile broth
control tubes, as well as in medium stored for laboratory use, and to
this, no doubt, is due our recent literature on indol-positive typhoid
strains.
As a matter of corroboration, and especially in order to determine
in a more precise manner whether this substance was produced
dnring the preliminary fermentation of the meat juice by B. coli,
under exactly the same conditions the sulphuric acid and potassium
nitrite indol test was applied in all the above experiments and the
reactions were found to be negative after six hours. In one case
only a very slight indol ring was obtained; in a few instances the
reaction was concentrated in the form of rings after twelve to
eighteen hours and usually this was positive after twenty-four hours
of incubation at 37* C; this proves beyond a doubt the presence of
indol sometimes in the meat-sugar-free broth. It is not true that
all meat-sugar-free broth contains indol. In some experiments I
was unable to detect this substance, due probably to an excess of
acidity in the meat juice or to unfavorable conditions under which
the preliminary fermentation was carried on, or to some inactivity
of B. coli itself, which inhibited its action on the proteid substance,
and under sucb circumstances it is a question whether even the
sugar has been exhausted from the juice and whether such a broth
can be regarded as free from this substance. It is a question, I
believe, if this preliminary fermentation be desirable in order to
exhaust the sugar in the meat. If so I would recommend the use
of the saccharolytic group which rapidly attacks the sugar and pro-
duces no indol. Such cultures can be easily isolated from water
and be used witb advantage instead of B. coli; I use for the present
some of these cultures isolated from water producing 80 to 100 per
cent, of gas in twenty-four hours, which under the most delicate test
have given negative indol reactions.
Before concluding, it is my desire to state that Test 2, if it be not
a test for indol, can be properly regarded as something very closely
related to it. Inasmuch as it is characteristic of B. coli it seemA
justifiable to use it in determining the identity of this organism,
even though it may not be the same as the indol test.
In conclusion, I think the points to be emphasized from the re-
sults are:
First, the ease with which the test may be applied.
Second, the distinct and characteristic color.
Third, its applicability after an incubation of twenty-four hours,
whereas by the ordinary indol test, a culture of eight days is recoup
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138 SEXJOND ANNUAL. REPORT OF THD Off. Doc
mended. (In this laboratory, forty-eight hours' incubation is given
with the most satisfactory results.)
Fourth, the reaction does not have to be concentrated in the f onn
of a ring.
Fifth, the rapidity with which a culture may be identified ad a
true B. coli.
Sixth, B. coli should be discarded as an agent for exhausting the
sugar in broth, and one of the saccharolytic group used instead.
Some improvements in the sterilization of culture media with
especial reference to the fractional method.
The not infrequent occurrence in the course of bacteriological
research of discrepancies of results, or even of total failure of the
experiment when apparently the technical procedure were faultless,
coupled with apparently inexplicable contaminations in culture or
in a medium after storage for a time, have led the writer to «i»pect
the methods of primary sterilization in vogue as lacking uniform
sufficiency and induced the following study of this subject:
In a medium which had been sterilized in the autoclave at fifteen
to twenty pounds pressure for from fifteen minutes to one-half hour,
and thereafter kept at room temperature and examined daily, it
was sometimes observed that in the course of a few days a growth
had occurred in some of the tubes, and only in exceptional instances
were the tubes all free from contamination after a period of from
three to six months. In case of nutrient gelatin, sterilized at ten
pounds pressure for ten to fifteen minutes, no instance was observed
during the period of this study in which all of the tubes remained
permanently sterile; and in one lot, after maintenance of the tubes
for one to two weeks at 37* C, over one-half were found contami-
nated. Similar results were obtained with culture media sterilized
by the fractional method, as usually recommended (heating on three
successive days at 100" 0. for thirty minutes, with the media left at
room temperature in the intervals). With such faults in mind it
was deemed desirable to make a close study of the causes of these
irregularities and to attempt some modification of procedure promis-
ing greater certainty of complete sterilization.
Satisfied from comparative examinations that the fault is one
entering from incompleteness of primary sterilization, it at once
suggested itself that an important proportion may be due to the
presence of spores resistant to the ordinary measures to which the
medium is subjected. Apparet, a century ago, was the first to dis-
cover the method of conservation of preserves in stoppered bottles
after the bottles had been boiled but in his experience, in spite of
boiling the containers well for several hours, it was not an in-
frequent occurrence that the preserves spoiled. Globbin, in 1888,
observed in case of an organism isolated from potato that the spores
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No. 16. COMMISSIONBR OF HBALTH. 189
were capable of pesisting 100'* C. from five to six and one-half
hours, of withstanding 109° to 113** C. for three hours, and required
for destruction exposed to temperature of US** 0. to 116' 0. for
twenty-fiTC minutes, or of 130** for three minutes. In the same year
Koch found the spores of B. carrotarum to resist 100° O. for eight
hours, and to require four hours' exposure to 130° 0. sterilization.
In 1894 Flfigel obtained similar results with spores of certain
bacteria isolated from milk. Christ, in 1895, found spores of organ-
isms isolated from the soil capable of resisting 130° C. for one
minute. The valuable researches of Heinze, in 1903, are well known
in connection with B. megartherium, B. ellembachensis, and B. sub-
tilis, the spores of the last capable of resisting 100° O. for three
hours. I was able to observe in experiments made along the same
line in the Institut Pasteur the capability of the spores of B. sub-
tilis to resist exposure for two and one-half hours to 100° C. In
case of the bacteria isolated from fresh bread it is familiar know-
ledge that their spores have resisted the heat of the baking oven.
Many similar common examples of such resistive power readily oc-
cur to mind; and literature records numerous observations of facts
of the same import, indicating the possibility of the dependence of
failure to destroy original contamination of material by such heat-
resisting entities.
It must be quite probable, too, that in addition to the above
possible fault the protection afforded to contaminating organisms
against the sterilization exposure may contribute in no unimportant
measure to the same end. While the B. tuberculosis and the other
non-spore-bearing organisms are easily destroyed by a direct ex-
posure to 60° C. for from ten to fifteen minutes they are capable
when protected by albuminoid substances (sputum, feces, etc.), of
resisting for a long time an exposure of 100° C. When in Berlin the
writer had the opportunity of observing in the case of the tubercle
bacillus, the retention of virulence by organisms obtained in scrap-
ings from the walls of one of the tuberculosis wards after the room
had been empty for over four months. Explicable in the same
principle, it is a well-known fact that the sterilization of bouillon or
any liquid medium is more easily accomplished than of agar or
miore especially nutrient gelatin; in fact, the writer has observed
the complete sterilization of bouillon after a single exposure of
thirty minutes to 100° C, but has never obtained similar results with
gelatin.
Although the above factors (special resistance of contaminating
spores and the protection afforded contaminations by the medium)
might well explain imperfections of sterilization by the autoclave,
it suggested itself that in case of fractional sterilization (in which
as is known the spores are permitted to germinate in the intervals of
heating and in their vegetative form become susceptible of jdestruc-j
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140 SEX30ND ANNUAL. REPORT OP THE) Off. Doc
tion by the subseqaent heat exposare) this failure might find an-
other explanation, and with thie in view the following invefitigation
was pnrgned.
Nutrient gelatin was distributed in tubes previously sterilized by
dry heat at 180" to 200" O. for fifteen minutes or longer (until a
browning of the cotton plug appeared, which indicated the decom-
position of the organic matter or complete sterilization) and steri-
lized by fractional or intermittent exposure to 100" C. for fifteen to
thirty minutes on three successive days, being left at room tempera-
ture during the intervals; but in spite of all precaution taken, in a
number of these tubes, after storage at room temperature or in the
incubator at 37" C. in the course of from twenty-four hours to
several days' contamination became apparent, the varying time ap-
parently being related to the temperature of storage locality. This
last at once suggested that in case of contamination by spores resis-
tant to heat the room temperature exposure of the intervals might
very well not be the most favorable temperature for germination of
such spores in the vegetative forms; in other words, the spores
present originally and not destroyed by the exposure to 100". in the
first might at the temi)erature of the interval remain as such (un-
changed) and be equally resistant to the heat of the sterilizing pro-
cess on the second day, and that the same results might follow for
the second interval and on the third heating, and that subsequently
during the prolonged storage of the medium they might germinate.
An experiment made in this line proved such to be the case.
Old cultures of Bacillus subtilis and spore-bearing moulds were
inoculated in different media and left at room temperature, daily
observation showing the medium to remain perfectly clear for from
one to seven days, according to the temperature of the room and
season of the year. These two organisms were preferred because,
in the writer's experience, these have been found the most common
and in many cases the sole agents of medium contamination. This
variation in rapidity of development suggested that in the {Hrocess
the room temperature intervals might prevent the germination of
spores, as this might well be deficient, and that, therefore, it must
be desirable to provide in these intervals of sterilization surround-
ings of a temperature more favorable for the spores to germinate
and cause the vegetative stage of growth. With this in view
gelatin medium, after the first exposure to 100" C. for thirty minutes,
was tubed — the tubes divided into groups. Part were placed in the
incubator at 37" C. for six hours, other series were incubated at the
same temperature for twelve, eighteen, and twenty-four hours,
respectively; after such periods re-sterilizatibn at 100" O. for thirty
minutes was again performed for each group and the tubes stood at
37* C, for observation. As was expected, but few tubes subse-
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No. 16. COMMISSIONER OF HBAI^TH. 141
qaently were found contaminated, the results being much more
favorable than when the room temperature had been employed in
the intervals of heating. Further, it was noted that the short in-
terval of incubation, for but «ix hours, was too short for germination
of the spores even at body temperature; and that on the other hand,
eighteen to twenty hours' incubation was too protracted, sinqp in
these periods the medium became undesirably clouded for growth of
the organisms, while intervals of incubation for from twelve to
eigjiteen hours gave the most favorable results. Following these
determinations another series of observations was made for the
puri>ose of comparisons between the common practice of heating
three times in fractional sterilization and two exi>osures. A series
of tubes were heated for thirty minutes to 100** C, then incubated
at 37*" O. for from twelve to eighteen hours and submitted to a final
sterilization at 100** C. for thirty minutes. A second series of tubes
was exposed on three succeseive days for thirty minutes at 100* O.
and incubated at 37** 0. for twelve hours in the first interval, and
for twenty hours in the second interval. The results in these two
series were practically identical, both being satisfactory.
With a view of determining the possibility of completing a
fractional sterilization in a single day, as in case of need of some
media for which the use of the autoclave is unsuited, as a sugar or
gelatin medium (the high temperature of the autoclave producing
undesirable changes in such media), a medium was prepared early
in the morning and sterilized at 100** C. as usual at about eight
o'clock, then incubated at 37* O. until about five o'clock in the
evening, when it was again sterilized as previously. The results
were quite satisfactory, again proving the efficiency of the method
and establishing the advantage of material saving of time. Such
procedure can, however, be recommended only for use in emergen-
cies, as the writer feels the need of strongly emphasizing the de-
sirability of incubating any medium for at least forty-eight hours
after sterilization is supposed to be complete, in order to detect and
then eliminate any possible contamination.
It is deemed unnecessary to recommend or outline any special
rule for the above procedures. Good results may be obtained by
the usual practice of sterilizing on three successive days, with a first
interval of twelve hours for incubation and a second interval of
twenty-four hours; or by sterilizing but twice, with an interval of
twelve hours for incubation; and as just stated, the sterilization
can be completed in a single day. The routine method followed by
the writer, with most satisfactory results, includes the preparation
of the medium early in the morning and at once exi)osing it to 100*
O. for about ten or fifteen minutes, then incubating at 37* C. for
six to eight hours during the same day, and toward evening again
subjecting It to 100* 0, for fifteen to twenty minutes, followed by a
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142 SBOOND ANNUAL REPORT OF THE Off. Doc
second internal of incubation at 37*" G. over night, and a final heating
the next morning to 100* C. for thirty minutes. This shortens the
general routine by one full day, and, too, the heat exposure is re-
duced by one-third, each a material advantage when at the same
time the final result is not impaired, but, as above indicated, ren-
dered more sure of success. The precise method may vary with the
judgment of each worker, the writer's only desire being to point out
the necessity for providing a temperature during the intervals of
heating which will favor the germination of the spores, so that in
their vegetative form they may be the more certainly destroyed at
the next period of heating, and at the same time to urge the fact that
the ordinary room temperature cannot by any means be regarded as
favorable for this purpose in the intervals commonly allowed
between sterilizations.
There is a further feature bearing upon the above which it is not
inappropriate to bring forward in this relation. In spite of all
precautions ordinarily taken in sterilizing media either in the auto-
clave or by the above outlined fractional method the writer has nvt
found it always possible to avoid contamination of some of his tubes.
It must be recalled that by either method the cotton plugs became
more or less wet from exposure to the steam atmosphere and from
the vapor arising from the heated liquid medium; and it is to be
expected that by mere capillarity a more or less continuous thin
sheet of the condensed moisture will intervene between the plug and
the glass of the container (present in the cotton plug as well, but,
perhaps, not in as perfect continuity). Through such a continuous
liquid it is possible that occasionally organisms coming from the air
of the open room in which the tube is cooling might be afforded a
path of entry from the exterior to the interior of the tube; and it
must be realized that the lower the room temperature when the
tube is first brought from the heated sterilizer the more decided a
current of air is drawn through the plug, as the interior air becomes
cool and contracts, possibly aiding in the introduction of organisms,
as just suggested. To avoid such a possibility the transference of
the medium from the sterilizer to an incubation oven at 37° C. for
at least forty-eight hours most clearly aids drying the surface of the
plug more quickly and at the same time permitting, to a less degree,
the rarefied air in the tube to cool and condense rapidly. Personally
the writer is inclined to believe that lack of this precaution is not
infrequently responsible for the contaminations which enter to spoil
this or that experiment, to cause contradictory results in the work
of the same or different investigators, and which have added much
to the uncertainties and volumes of our bacteriological literature.
Some may be disposed to hold that if the medium has been pro-
perly sterilized, subsequent incubation for forty-eight hours, as
above suggested, at 37** C. is unnecessaiy. This is in ih^iy true.
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No. 16. COMMISSIONER OF HEALTH. 148
bat in practice what means do we possess of knowing snrely
whether the medium is pnre^ save by subjecting it to conditions
known to be most favorable for growth of contamination, if per-
chance contamination exist? The time is past when water analysis
was limited to its physical properties alone; and just as to-day no
one wonld pretend to estimate the number of bacteria in a spark-
ling water or its sanitary condition by its clearness, in the same way,
we are not justified in assuming that because a sample of bouillon
or other medium remains transparent after storage at room tempera-
ture or in the refrigerator, as usually recommended, under condi-
tions unfavorable for the germination of spores possibly present, it
is, therefore, a sterile medium. The procedure recommended is
logically correct and so simple that no objections of inconvenience
or lack of necessity should be held material against it ; and it may be
urged as a definite rule of procedure that in all sterilization by steam,
whether in the interval or after the fractional method, or after the
use of the autoclave, the medium should not be directly exposed to
room temperature or a lower temperature, but should be placed in
the incubator at ST C. because this condition will both aid in early
and certain detection of possible contamination, and will in some
measure favor the exclusion of organisms liable to be drawn into the
container by air suction in undue moisture of the cotton plug. The
writer might add, in conclusion, that it is his opinion that the
fractional method of sterilization, as above recommended, might
often with advantage replace the autoclave not only in efficiency of
sterilization, but more especially as evading the production of un-
desirable changes which the high pressure and temperature of the
autoclave have been found to produce in culture media.
THE DIFFERENTIATION OF BACCILrUB CK>LrI COMMUNIS FROM ALLIED
SPECIES IN WATER.
It is not the purpose of this report to deal with the old and con-
troversal question of the significance of Bacillus coli communis as
an indication of pollution in drinking water, nor to go into detail
upon the typical or atypical biologic characteristics of the organism ;
but especially to determine a constant biologic feature by which it
can be differentiated with certainty from the allied species of the
colon group. It is common knowledge that B. coli communis pre-
sents such extensive variations that often cultures isolated from
water and reported as identical with this mirco-organism will, if
studied more closely, be found to have very little or no relation at
all with it. The hypothesis that the acceptance of such variations
in B. coli communis is responsible for the unsatisfactory results
often obtained in the bacteriologic examination of drinking water
has been the basis for undertaking the following studies.
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144 SSCOND ANNUAL REPORT OF THE) Off. Doc
I believe B. coll commanis, like B. typhns, B. diphtheriad^ B.
anthracis^ etc.^ is a single micro-organism, not a gronp; and if its
biologic and morphologic features are sufficiently studied, is not to
be confused with others. It is true that sometimes an atypical
reaction is seen, but this irregularity if carefully inquired into will
be found to depend, not on the colon bacillus itself, but on the
condition in which it has been placed. The colon bacillus is com-
monly regarded as an acid-producing micro-organism. The reaction,
however, depends entirely on the presence of sugar in the culture
media; and in plain neutral bouillon the reaction of the culture will
be alkaline.
A. Production of Indol.
This depends on the presence of a proteid substance, peptone for
instance. In such a medium, moreover, the presence of sugar in-
hibits the production of indol, which will be manifested only after
the sugar has been exhausted by the colon bacillus. Further, under
anaerobic conditions and by cultivating the organism on special
media containing phenol, nitrates, etc., the production of indol may
be inhibited or completely abolished; and following the ordinary
technic, by using a one per cent peptone bouillon Lembke, Boux,
Widal, Malvoz, Vallet, Dunham, and others, have reported cultures
not producing indol, but otherwise typical of B. coli communis.
Morris, however, by employing a five per cent, peptone bouillon and
making his test after from ten to twenty days, obtained positive
indol reactions from the same cultures : It is probably due to such
variations that our literature on the organism in question is full of
such classifications as ''strong indol-producing colon bacilli," or
marked "distinct," "weak," "faint" and finally "negative" indol-
producing types. Such classifications seem to me the result of too
precipitate conclusions frOm superficial observations. They are pre-
sumed to depend on variations in the organism when in reality they
are the result of variations in the medium of cultivation and the
technic employed.
Much to my surprise, I have often observed a positive indol re-
action in sterile meat sugar-free bouillon, and a close study of the
subject has convinced me that the practice of preparatory fermenta-
tion of the meat- juice with B. coli communis, as recommended by
Smith and followed by leading bacteriologists abroad and in this
country, can not be too strongly condemned. This preliminary
fermentation with the colon bacillus for from eighteen to twentv-
four hours (and by neglect often forty-eight or more hours) is
sufficiently protracted for the production of more or less indol, which
then remains in the medium. The sterilization I found to be with-
out effect in this reaction, as the medium thus fermented gave typical
reactions before and after exposure not only of thirty minutes to
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No. 16. COMMIS8IONBR OF HSAL.TH. Ii6
100^ C, but also after from twenty to thirty pounds steam pressure
exposure for half an hour. To this, doubtless is due our new litera-
ture on "indol-positive typhoid cultures." In this laboratoiy I em-
ploy a strong saccharolydc organism isolated from water^ producing
from 80 to 100 per cent, of gas in from eighteen to twenty-four hours,
rapidly exhausting all sugars, and failing in the most careful test
to produce indol. With the medium thus prepared I have never
obtained the slightest trace of indol in any typhoid cultures which
I have examined; and it is my belief that no typhoid organisms can
produce indol and that no true B. coli communis ever fails to show
the reaction of Salkowsky.
B. Non-Liquefaction of Gelatin.
Almost every bacteriologist is of the opinion that a liquefying
organism does not belong to the colon group, and that of B. coli
communis never liquefies gelatin. It is not the question of liquefac-
tion or no liquefaction which I wish to discuss, but rather the con-
ditions under which such an important reaction is tested. The pro-
cedure recommended by the American Medical Association includes
incubation at from 20** to 22"* C. and the use of medium of from 1 to
U5 per cent, acidity, both of which I have found unsatisfactory, not
because B. coli communis will be affected by the reaction of 1.5 per
cent, acidity, but because the proteolytic fermentation proceeds
better and more quickly in most cases in alkaline or neutral medium
and takes place best at 37** O. As a routine procedure in the labora-
tory, I use neutral gelatin and incubate at 37* 0. for from forty-eight
hours to four days. The tube is placed in ice water to harden the
gelatin and then examined for liquefaction or non-liquefaction of
the medium. The method has given far better results, and what is
of most importance, it is the only way to eliminate gelatin-liquefying
growths which at from 20* to 22' 0. in the acid gelatin do not pro-
duce proteolysis and are often mistaken for B. coli communis.
The classification of cholera spirilla into species, causing rapid,
slow, slight and very slight liquefaction, I believe to be only a
matter of reaction of the medium and temperature of incubation.
In case a number of laboratory cultures as well as six others
isolated from the Schuylkill river, tested after growth in neutral
gelatin at 37' O. for from forty-eight hours to four day«, the
liquefaction was complete; but it was only partial when the organ-
isms were kept in other cultural conditions.
G. Amount of Gas.
It is regarded as characteristic of B. coli communis that there
diould be produced from 50 to 75 per cent, volume of gas in the
closed arm of the fermentation tube in from twenty-four to forty-
1(V—16— 1907 ^ ,
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lit SECOND ANNUAL RE5PORT OF THE Off. Doc.
eight hours (of which the relation of hydrogen to carbon dioxid is
represented by the formula H : C0« : : 2 : 1, also that the fermenta-
tion is usually completed in twenty-four hours at 37** C. I have
observed, however, that cultures of B. coli communis recently
isolated from water producing no gas at all in twenty-four hours and
after forty-eight hours at 37** C. only 15 per cent. The relation of
hydrogen to carbon dioxid just mentioned may be regarded as
correct, but it is by no means constant and reliable, a formula H :
CO^ : : 3 : 2 being even more frequently obtained, and formulas such
as 3 : 1 or 4 : 1 or even higher may be observed according to the time
at which examination is made. If cultures are closely observed it
will be noticed that €ifter twenty-four hours, when the gas formation
is stopped, a gradual reabsorption of the carbon dioxid by the
medium takes place, and the result gives an apparent excess of
hydrogen. Further, when the sodium hydroxid solution is added to
absorb the carbon dioxid a partial vacuum is produced and should
the mouth of the fermentation tube be imperfectly closed by the
thumb or by a rubber stopper, access of air is permitted and the
results may fail to show any carbon dioxid at all. It is possible,
therefore, from conditions in which the culture is placed or from
failure in the technic to obtain a typical colon bacillus gas formation
from an organism which under more careful observation would show
the contrary.
The above features are presented in order to show that the
irregularities obtained in cultures are not due to different types of
the colon bacillus, but to the conditions under which the culture is
grown, or to imperfect technic, and to indicate that the organism
should be regarded as essentially a monotype bacillus and not as a
group.
Differentiation Reaction.
.fWith this view in mind, an attempt was made to find some re-
actions to serve as constant and reliable means of differentiation.
After a series of tests, it was found that if, in each of a number of
tests, about 0.25 c. c. to 0.5 c. c. of a forty-eight hours culture of
various organisms on one per cent, dextrose bouillon was rapidly
boiled in about five c. c. of a ten per cent, solution of sodium hydrate,
there will appear immediately after boiling a clear yellowish-lemon
color in the tubes of B. coli communis (similar reaction is obtained
also with the uninoculated control one per cent, dextrose bouillon) ;
while in others, as an indication of the absence of this micro-
organism, the solution will remain clear and colorless, taking on a
slight pinkish color after five or ten minutes; this reaction I have
arbitrarily called Test 1.
In another and independent observation conducted in other cul-
tures isolated also from water, I found that if about one c. c. of a
ten per cent, solution of sodium hydrate and then about ope c. c. of
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Ko. U. COMMISSIONER OP HEALTH. 147
a fifty per cent, solution of sulphuric acid be added to the cultures^
some tubes will remain colorless^ while others will take on a purple
reddish coloration either at once or within a few minutes. Closer
study of this reaction showed this to be positive as soon as a growth
was apparent in the medium, even as early as four or five hours
incubation at 37 0. in neutral bouillon; and further inyestigation
indicated that this purple coloration with sodium hydrate and sul-
phuric acid was characteristic of the B. coli communis cultures
(Test 2).
This test shows the color reaction on the addition of acid and its
disappearance when alkali is added in excess; this is a direct reverse
of the color reaction of Test 1, in which the color is discharged by
acid and reserved by alkali. The color in Test 2 is not produced in
the presence of sugar. It is apparently related to the presence of
indol or some indigo derivative. Test 1 seems to depend on the
biologic action of the bacteria on the sugar, while Test 2 depends on
the action of the B. coli communis on proteid substance; and the
striking and ready production of these color reactions aid materially
in facilitating the differentiation of bacillus coli. Further study is
in progress to determine the nature of these reactions.
Action of the Colon Bacillus on Sugar.
It was deemed desirable to avoid experimenting in this connec-
tion with the different kinds of sugars, as dextrose, lactose, sac-
charose, fructose or mannite, etc., since, while such study undeniably
is of scientific interest, the multiplication of these sugar-media opens
the chance of to ready and disastrous confusion of results; based
on the fact that any saccharolytic micro-organisms having the power
of splitting other sugars have, in my work, never failed to attack
dextrose, my observations were made on cultures in media containing
this sugar alone. B. coli communis was incubated in a five per cent,
dextrose bouillon, and the culture daily examined polariscopically
for the exhaustion of the sugar in the medium. It was found that
the sugar after forty-eight hours remained the same as after twenty-
four hours; in other words, that the bacillus showed but a weak
sugar-splitting power, the saccharolytic action ceasing after twenty-
four and sometimes after eighteen hours. With this fact in view,
established by identical results in a nunlber of experiments on the
same line, it was thought well to make the same observations with
other cultures which also possessed saccharolytic activity, but which
gave atypical reactions for B. coli communis. Prom a number of
such strains in the laboratory, one was selected and incubated in
five per cent, dextrose bouillon and daily polariscopic examination
pursued as in case of the true colon bacillus above mentioned. In
this instance the sugar was found to be considerably diminished
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148 SECOND ANNUAL REPORT OF THE Otf. Doc.
after from eighteen to twenty-four hours, and to have disappeared
entirely from the medium in from two to three days at 37* C. The
results in tabular form were as follows :
Per cent
Control sterile dextrose bouillon 1.17
Bacillus coll culture after 24 hours at 37 deg. C. , 1.01
Bacillus coll after 48 hours at 37 deg. C, 1.01
Bacillus coll culture after 72 hours at 37 deg. C, 1.01
Allied species culture after 24 hours at 37 deg. C, 0.66
Allied species culture after 48 hours at 37 deg. C, 0.18
Allied species culture after 72 hours at 37 deg. C, 0.00
These results, indicating the more complete saccharolytic ability
of this allied species than that of B. coli communis, gives a constant
feature of the various species in the group of micro-organisms liable
to be confused with the colon bacillus, another reliable differential
test. In order to avoid the necessity for polariscopic examination
of the cultures, a series of investigations, in which Fehling's solu-
tion was employed was pursued. The cultures as above were tested
after twenty-four, forty-eight and seventy-two hours incubation at
37** C, the Fehling's solution was diluted with equal parts of water,
as usually done in qualitive examinations of urine for sugar, and
divided among a number of small test tubes, one c. c. being placed
in each. To these the culture was added in increasing amounts,
beginning with one, two, three, etc., drops up to one c. c. ; and the
mixture then boiled. The result was striking. The controls or
non-incubated medium gave positive sugar reactions with one or two
drops according to the percentage of sugar in the material ; cultures
of the colon bacillus gave positive reactions with about twice the
amount added as in case of the controls — two or three drops ; while
the allied species failed to show reduction of the copper even after
the addition of as much at one c. c. of the culture. Often tests were
conducted with different proportions of dextrose in the medium,
from 0.1 per cent, to five per cent, dextrose bouillon and after forty-
eight hours' incubation at 37** C, the differentiation was the most
typical.
In view of such results, I have tentatively proposed for that group
of organisms which present characteristics similar to that of B. coli
communis, but not corresponding completely to this organism and
which are commonly spoken of collectively as the "colon group,"
the substitution of the name "the saccharolytic group," the name
being based on the splitting action manifested by them for dextrose.
The leading features of this saccharolytic group may be said to
consist of their powerful action on dextrose, their usual failure to
produce indol and their tendency to cause liquefaction of gelatin.
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No. 16 COMMISSIONER OF HSAI^TH. 149
In the group, however, are a few individnal types which fail to
liquefy gelatin and a few which will produce indol. The separation
of such examples may, however, be definitely made by the colorless
to pinkish color reactfon of Test 1, or by the absence of the purple
reddish color reaction of Test 2, as above described, and by the test
of their exhaustion of sugar from a one per cent dextrose bouillon
medium after incubation for forty-eight hours at 37** O. (Test 3).
Being convinced of the importance ,of this strong sugar reaction
of the saccharolytic group and its absence in case of the colon
bacillus, an investigation was made to determine the actual expla-
nation of the difference thus manifested. Two suppositions were
considered: First, that B. coli communis may possess slower actions
on the sugar; or second, that it produces some substance which
inhibits the saccharolysis which would otherwise preceed as in the
saccharolytic group. Both types of organisms begin to form gas at
about the same time, but the colon bacillus produces gas more
slowly than the group of allied species and its gas production ceases
after from twenty-four to forty-eight hours. The saccharolytic
group, on the contrary, after beginning about the same time as the
colon bacillus to produce gas, continue more rapidly and do not
cease until the sugar is entirely exhausted, the duration varying
with the percentage of sugar in the medium. At the same time it
was found that the acidity of the medium was greater with the colon
bacillus, which produced from three to five per cent, in forty-eight
hours; while the saccharolytic group produced only from one to
three per cent, in the same period. This difference suggested that
the greater acidity of the medium in case of the colon bacillus may
exert an inhibltive influence on the further action of the organism
on the sugar. By adding a few grains of sterile calcium carbonate
to the cultures after the fermentation had stopped and absorption
had begun, with the effect of neutralizing the media, it was found
in confirmation of this supposition that more gas is evolved and the
sugar further diminished (even to exhaustion). As suggested by Dr.
Smith, the acidity of the culture was found to be due to the presence
of lactic acid.
Before concluding I would like to point out briefly that, in view
of the apparent variations of B. coli communis, Booker recognizes
seven varieties of organisms of the colon group resembling the colon
bacillus morphologically and biologically (but with no especial men-
tion of the production of indol): that Gilbert describes five types:
(a) non-motile but otherwise typical colon bacillus, (b) non-productive
of indol, but otherwise typical colon bacillus, (c) non-fermenting
lactose, but otherwise typical colon bacillus, (d) non-motile and non-
fermenting lactose, but otherwise typical colon bacillus, (e) non-
motile non-fermenting lactose, non-productive of indol, but other-
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150 SBXJOND ANNUAL REPORT OF THE Off. Doc.
wise typical colon bacillus, that Fremlin regarded fermentation of
dextrose and coagulation of milk as the most reliable indication of B.
coli communis; that others regard the fermentation of dextrose
alone as sufficient evidence of the identity of this bacillus. It is
remarkable to note the elasticity of colon bacillus as disguised at
present under the name of "the colon group." This elasticity is due,
however, to the general conception of the colon group, a term used
to cover all bacteria from the true B. coli communis to the B.
typhosus, and the failure of many observers to realize the individ-
uality of the various members of the chain. Careful controlling of
all colon-like organisms with the two-color and sugar-exhaustion
tests will serve to limit names, and it is with the hope of establish-
ing a clear identity of this important indication of sewage pollution
that these methods are offered.
Conclusions.
From the above I believe the following conclusions to be logical :
1. The saccharolytic group, as its name implies, represents not
only one but different kinds of micro-organisms commonly found in
nature, especially in water, characterized by its predominating
action in splitting dextrose.
2. The constant occurrence of this group in water may prove to be
a factor in itself which may shed a new light on our vital problems
of the bacteriology of water.
3. The B. coli communis must not be confounded with the colon
group, which I name "saccharolytic group," holding that this group
should have no relation to the colon bacillus.
4. Since the saccharolytic group is shown to be more closely
related to what at present is regarded as the colon group, the sub-
stitution of "saccharolytic group" for "colon group" is more com-
prehensible, and I hope will aid considerably, not only in relieving
the confusion which the colon group presents, but especially in
establishing the colon bacillus as a distinct type of micro-organism
and not an indefinite chain of them, as it is considered at present.
5. B. coli communis, in addition to the recognized characteristics,
will be positive to Test 2 and negative to Tests 1 and 3 (that is, it
will fail to exhaust the sugar in one per cent, dextrose bouillon at
37** C. in forty-eight hours), while contrary to this the saccharolytic
group may in many ways present characteristics of the colon
bacillus, but will always be negative to Test 2 and positive to Test
1 and Test 3 (that is, it will exhaust the sugar in forty-eight hours
at 37** C. in one per cent, dextrose bouillon).
6. B. coli should be discarded as an agent for exhausting the
sugar in the meat juice and one of the saccharolytic group should
be used instead.
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No. 16. COMMISSIONER OF HEALTH. 151
CONTRIBUTIONS TO THE STUDY OP B. TYPHOSUS AND B. COLI COM-
MUNIS IN WATER.
The discrepancies in the results so often encountered in the
bacteriological examination of water, and the negative results in the
search for Bacillus coli in samples known by other reasons to
originate from polluted sources, have misled several bacteriologists
to regard this organism of little or no value as an indication of
pollution. One regards with suspicion the few reports in the
literature of the isolation of Bacillus typhosus from water, because
of the small percentage of positive findings compared with the
number of attempts made with such object in view.
As I have demonstrated in a preliminary study on this subject
it is not the mere presence of Bacillus coli in the intestines of man
and mammals that should be considered as sufficient reason for
regarding this organism as an indication of pollution in the water,
but more especially it predominance over other bacteria present in
feces and sewage gives a sounder base to such an index.
There seems to be also sufficient reason to assume that Bacillus
typhosus as well as Bacillus coli exists in polluted water. Epi-
demics of typhoid fever have been traced to the pollution of drink-
ing water by the discharge of typhoid patients. Many methods for
the detection of Bacillus typhosus have been recommended, Hiss,
Copaldi and Proskauer, Von-Drigalski and Conradi, Jaksch and
Ban, Ficker, Hoffman, Wurtz, Rodet, Chatemease and Widal, Vincet
P^re, Eisner, Parietti, etc., etc. The list is too extensive even to
mention the most important procedures. Each investigator advo-
cates his own method, and I deem it unnecessary to describe the
meithods, but only to point out that the mere number of them is
sufficient reason to assume that none at present can be regarded as
certain and reliable. Further, whatever method we employ, we
come to a final and constant technique which consists in the isola
tion of the suspected colony and the differentiation and further
study of the same on special media.
Since at the present time the litmus lactose agar culture medium
is generally used in differentiation, in which Bacillus coli produces
a pink colony and Bacillus typhosus a violet coloration, and further
since the Parietti solution is also generally recommended, and used
in many laboratories, I desire for the present to bring before you
some observations on these two methods, leaving the consideration
of the other methods for further contribution at present in prepara-
tion in our laboratory.
Sometime ago, I had the opportunity to compare the general count-
ing of bacteria per c. c. in the same water on plain neutral agar and
litmus lactose agar, and it was found that the litmus agar exerted
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162 SE>COND ANNUAL REPORT OP THE Off. Doc.
very decided restraining action on the growth of bacteria in the
water in general. Since my first observation as a matter of cor-
roboration, every sample of water examined at the Laboratory has
been planted on both media, (plain agar and litmns lactose agar)
and the number of colonies counted after forty-eight hours' incuba-
tion at 37 degrees C. The experiments have gone over several
hundred, too long for enumeration in detail. The number of
colonies which grew on litmus lactose agar was only 50 per cent,
of the number which grew on plain agar, showing that litmus lactose
agar has the power to restrain the growth of one-half of the
organisms in water.
In some instances, no colonies grew on litmus lactose agar plates,
while from one hundred to twelve hundred were present on plain
agar. In a closer study of these results, it was suspected that such
restraining action was common only to a certain kind of bacteria of
no importance in the bacteriological examination of water from a
sanitary point of view, as stated by the advocates of such medium.
In extensive experiments with twenty-four and forty-eight hour old
bouillon cultures of Bacillus typhosus and Bacillus coli, diluted in
sterile ETO, made simultaneously on plain and lactose litmus agar,
to my surprise I found in general the percentage removal by litmus
agar to be about thirty-four per cent, for Bacillus typhosus and
about thirty per cent, for Bacillus coli. My next thought was
whether the litmus could be more detrimental to a certain form of
Bacillus typhosus and Bacillus coli (that is, would it be possible
that in the life cycle of this organism there exists a certain age,
the very young or the very old form, which was more sensitive to
the litmus), and, with this point in mind, another series of experi-
ments was made with Bacillus typhosus and Bacillus coli after two,
three, four, six, twelve, twenty-four and forty-eight hours, as well as
after five, ten, fifteen, and twenty days, and after one month in-
cubation at 37 degrees C, and also at room temperature of bouillon
cultures exposed to diffuse daylight. It was found that the removal
by the litmus after one to five days was sixty per cent, for Bacillus
coli and sixty-five per cent, for Bacillus typhosus, from ten to
fifteen days it was about eighty per cent, for Bacillus coli and ninety
per cent, for Bacillus typhosus, and from fifteen to twenty days or
one month of incubation it was ninety-five per cent, removal for
Bacillus typhosus. Further, one to five days old cultures will show
from one to eight Bacillus coli and ten to 350 Bacillus typhosus
colonies per c. c. on plain agar, and none on litmus agar; from five
to ten days there were samples which will show from ten to eigh-
teen Bacillus coli and eight to 560 Bacillus typhosus colonies per c.
c. on plain agar and none on litmus agar; from ten to fifteen days
samples will give as many as 6,000 Bacillus typhosus colonies per c.
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No. 1€ COMMISSIONSR OF HBAI^TH. 163
c on plain agar and none on litmns agar; and^ finally, from fifteen
days to one month old cnltnres, there will be samples giving from
fonr to 20,000 Bacillus typhosus colonies on plain agar and none on
litmus agar. The addition of one to two per cent. Parietti's solution
and the amount of litmus tincture added to the medium was in direct
proportion to its germicidal action on both organisms. The room
temperature and exposure to diffuse daylight were more deteri-
mental to Bacillus coli and Bacillus typhosus cultures. Von
Drigalski and Gonradi and Endo methods have been also investi-
gated, and they have shown the same germicidal action as litmus
and Parietti's solution; likewise other methods are under investi-
gation to be considered in a further contribution.
These experiments show in the most positive manner the inac-
curacy of our present technique and methods in the bacteriological
examination of water, also show the gradual degeneration of
BaoilluA typhosus and the deterimental action of litmus and
Parietti's solution upon the culture as it grows older. Such experi-
ments demonstrate in the most logical manner the cause of our
failure in detecting this organism in water. Now, if such de-
generation of Bacillus typhosus has taken place under favorable
conditions for its life, there is good reason to believe that it will be
greater in the water, and the negative results which usually ac-
comi>any a research for the Bacillus typhosus in water supplied to
a comumnity where an epidemic of typhoid fever has just broken
out, may, in the light of my results, be due to the fact that the
organism is present at such a phase of its life cycle that it easily
yields to the detrimental effect of litmus and Parietti's solution.
This degeneration phase may of course be due to the biologic pro-
cesses in water.
From the above results, it is logical to conclude not only that our
present methods are at fault, but also that by using litmus and
Parietti's solution. Von Drigalski or Endo medium, it seems as if we
were working under the most exact technique to arrive at a negative
result. This is especially the case for Bacillus typhosus. No doubt
as a means of differentiation, all the above media are of more or less
importance, but I believe their value as to the isolation of this
micro-organism to be most uncertain.
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(IM) Digitized by Google
The Bureau of Vital Statistics
WILMER R. BATT, M. D., State Reeristrar.
Cl»)
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(166)
Digitized by VjOOQIC
OFFICIAL. DOCUMENT, No. 16.
THE BUREAU OF VITAL STATISTICS.
POPULATION.
The estimated population (TJ. S. Census 0£9ce) of the State for the
year 1907 was 7,032^915. The density of population for square mile
of land area was increased from 155 (1906) to 156.8. The number of
incorporated municipalities was increased by the creation of seven
new boroughs. Five boroughs were absorbed by consolidation with
cities or other boroughs. These changes^ together with extensions
of certain city and borough limits, to include portions of adjacent
townships, have affected to some extent the distribution of urban
and rural population. Based upon the facts of incorporation, the
urban population constituted 66.1 per cent, and the rural population,
33.9 per cent, of the total.
The populations of all incorporated municipalities over 2,500 are
given for the reason that the death rates per 1,000 of population for
these places are mentioned in the mortality statistics. By stating
from year to year the actual basis upon which these rates are com-
puted an opportunity is given to make inquiry concerning the ac-
curacy of the estimated population where abnormally high death
rates exist.
Estimated populations for the minor municipalities, which may
be liable to unusual increase must necessarily be more open to error
than estimates for larger areas with established rates of growth.
Tables relating to the distribution of population by sex, age
periods and nativity, are not repeated in this report for the reason
that the percentage of distribution, for the year 1907, is not
materially different from the rates for 1906.
(157)
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168
SBCOND ANNUAL REPORT OF THB
Off. Doc.
TABLE 1.
Distribution of population according to certain groups with the percentage in
each group to the total population.
UrtMm Popul&Uon.
Numbers.
Per Gent.
to Total
Population.
Oroup 1 In munlclpalltlM of 600,000 and over
1.466.408
662,870
m.667
404.693
494.778
421.974
898.848
641.849
2D.8
Oroup S Tn inunfcli>alltl«a between 100.000 and 600.000
"i
Qroup 8 In municipalities between 60.000 and 100,000
8.9
Oroup 4 In municipalities between 26.000 and 60.000
5.8
Group 6 In municipalities between 10,000 and 26,000
7.0
Oroup 6 In municipalltieB between 6,000 and 10,000.
€.0
Oroup 7 In niunlcipAlltleff between 2,600 and 6,000,
( c
Group 8 In munlclpalltlea less than 2, 600,
7.7
Total urban population
4.M8.787
66.1
Oroup 9 In rural districts.
2.884.148
38.9
POPULATION OF INCORPORATED MUNICIPALITIES EXCEEDING 2,500
INHABITANTS.
Municipality. Population. Municipality.
Allegheny 147.632
Allentown 42 018
Altoona 48,878
Apollo 8.423
Archbald. 0.283
Ashland 6.488
Ashley 4,601
Athens 4.058
AusUn 2,704
Avalon 2.992
Avoca 3.783
Bangor. 6.144
Beaver. 2,865
Beaver Falls 10.277
Bellefonte. 4.392
Bellevue, 4,716
Bellwood 2,668
Berwick, 4,706
Bethlehem. 10.462
BlalrsviUe. 8,556
Blakely 4,793
Bloomsburg, 7,168
Braddock 19,812
Bradford 16,834
Bridgeport 3,387
Bristol 7.462
BuUer. 12.336
California 2,920
Canonsburg. 3,105
Carbondale 16,216
Carlisle 11,032
Carnegie, 7,330
Catasaqua
Chanrbersburg
Charleroi,
Chester
Clearfield,
Clifton Heights ,
Coatesville
Columbia
ConnellsviUe
Conshohocken ,
Coraopolis,
Corry
Coudersport,
Danville
Darby
Derry
Dickson, ,
Dorranceton
Doylestown,
DuBois
Dunmore,
Duquesne.
Duryea
East Conemaugh, ...
East Mauch Chunk,
Easton
East Pittsburg
East Stroudsburg. ...
Ed wardsville .
Elliott
Emporium,
Erte
Population.
4,131
9,769
6,930
38.670
6,922
2.662
7.048
13,594
8,165
6,952
8,611
5,369
4.229
8.071
8.726
2,693
6.143
3,267
3,369
11,635
16.571
12.067
6,000
2,86S
3,906
28,826
2,883
3.187
6,388
3.346
2.668
61,202
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Nal&
COMMISSIONER OF HBALTH.
160
MunldpaUty.
Etna,
Bxeter
Ford City.
£Vu«8t Cit J,
Fradnrille,
Ftvnklln
Freeland,
Galeton,
GalUtilii
GettysbmiK, . —
Gllberton, ,
Girard^iUe
GreeoBburg
Greeocastle, ...
Greenyllle, ....
Hanover,
Harrisburg
Hadeton,
Hollldaysburff,
Homestead, ....
Honeadale
Huntingdon, . . .
Indiana
Jeannette,
Jermyn
Jeney Shore, ..
Johnsonburg, . .
Johnstown, ....
Kane,
Kingston,
Kittannlng
KnoxvUle
Lancaster
Lansdale,
Lansdowne, ....
Tiinitford,
Latrobe, <
Lebanon,
Leecbburg,
Lehlghton
LewiflbuTg •
Lewlstown, ....
Lock Haven, ..
Laxeme ,
Lykens,
McDonald
McKeesport. ...
McKees Rocks,
Mahanoy City,
Marietta
Maach Chunk,
Mayfleld
MeadvlUe
Population.
5,785
2.701
3,940
5,563
2,642
8,029
7,545
2,680
2,998
8,673
4,819
8.719
10.685
4,072
6,498
6,213
66.663
16,008
3.012
16,057
2.898
6.264
6.658
7.636
2.667
3.861
5.598
44.340
6.806
4.798
4.427
4.673
48.073
3.336
3.771
6.463
5.280
19.701
.... 2,809
6.716
3.693
6.216
7,210
4.739
2.966
2.941
44.851
9.384
16.067
2.613
4.029
2.693
U.864
Municipality.
Mechanlcsburg, ..
Media
Middletown.
MiUvale
MUton,
Minersvllle
Monongahela. ....
Mt. Carmel
Mt. Pleasant
Myersdale
Nanticoke,
Nazareth
New Brighton. ...
New Castle
New Kensington.
North Braddock,
Norrlstown
Northumberland .
Oakmont
Oil City
Old Forge
Olyphant
Parnassus
Parsons.
Patton,
Pen Argyl,
Perkasie,
Population.
3,»39
3,295
5,951
8,639
6,733
5,667
5.886
16,628
6,401
3,789
13,563
2.944
7,603
38,464
4.666
6.635
23.995
2.760
2.742
14.896
6.630
7.641
2.666
2.605
2.651
3.233
2,677
Philadelphia 1.466,408
Philllpsburg 3.280
PhoenixviUe. 9,672
Pltcairn 2.601
Pittsburg 883.895
Pittston. 14,132
Plymouth. 16. 664
Pottstown 13,983
Pottsville 16.823
Punzsutawney. 8.405
Quakertown 3.563
Rankin. 3.775
Reading 93.171
Renovo. 4.082
Reynoldsville. 3.855
Rldgway. 4.563
Rochester. 6,363
Royersford 3,116
Sayre, 5,243
Schuylkill Haven. 4.022
Scottdale 6.280
Scranton. 121.343
Sewickley 4.083
Bhamokln 20,861
Sharon. 12.003
Sharpsburg 8,106
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190 SSCOND ANNUAL RBPORT OF THB Off. Doc.
Municipality. Popolatloiv. Municipality. Population.
BharpsylUe S,S86 Tyrone e,689
Shenandoah, 28,386 Union City, 8,662
Sheridan, 2,948 Uniontown, 7.M4
Shippenaburg 8,904 Warren, 11,044
Slatlngton, 4,660 Washington 10,744
South Bethlehem, 16,298 Waynesboro 8.42«
South Fork 8,681 Waynesburg 2,832
South William0port 8,606 Wellsboro, 2,964
Spring City 8,066 West Chester 10,578
St. Clair 6.261 West Hazleton 8.646
St. Marys, 6,963 West Newton 2,685
Steelton, 14,197 West Pittston 7,107
Stroudsburg 4.120 West Washington 2,693
Summit HlU 8,097 Wilkes-Barre 61,621
Sunbury, 11,162 Wilklnsburg. 17,849
Susquehanna. 8,813 WllUamaport 29.896
Tamaqua 8,066 WiUlamstown 8,831
Tarentum, 6,021 Wllmerdlng 6.623
Taylor 4.215 Windber, 6,000
Tltusville. 8,863 Winton 4,483
Towanda 4.984 York 40,077
Turtle Creek 8,262
MORTALITY.
With the completion of the second year of registration it is pos-
sible to present in these statistics certain comparisons which indi-
cate the mortality movement (increase or decrease) from all causes
and for certain important canses of death for the same areas within
the State for two distinct and equal periods of time.
It is obvious that comparisons of this nature are less likely to con-
tain fallacies than are comparisons between localities in which death
rates may be influenced by unequal distribution of population by
sex, age periods, color, nativity or occupation.
As Pennsylvania has taken place among the states admitted to
the registration area of the United States Census Office, it is also
possible to extend these comparisons over a territory including
fifteen states and embracing 39.9 per cent, of the entire population
of the United States which affords a comprehensive view of mor-
tality movements in general and particularly in reference to epi-
demic and preventable diseases.
"Registration States" as designated by the Federal Government
include only those states in which the collection of mortality statis-
tics is considered to be sufficiently accurate to be worthy of con-
sideration in tabulating mortality data. A glance at the states in-
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Ko. It. COMMISSIONER OF HBAL.TH. 1«I
eluded in this gronp will show that ten of them are contigaons,
forming an unbroken area in the north eastern part of the United
States, and that the remaining five form isolated areas with widely
divergent conditions as to constitution and density of population,
occupation and climate. The rates for individual states, rather than
for the entire area, are, therefore, important in studying mortality
movements. Pennsylvania's population comprises 21.3 per cent of
the total population in the registration states.
In the textual portion of the report, reference is made to certain
causes of deaths, important either from sanitary considerations or
by reason of their numerical strength. For this purpose the tables
contained in the text are extracted from the general tables.
A total of 115,969 deaths occurred during the year. The number
of deaths registered was 125,428 of which 9,459 were still births and,
therefore, excluded from consideration in mortality statistics.
As compared with 1906, there was an increase of 1,534 in the total
number of deaths. The death rate per 100,000 of population re-
mained, however, the same, namely 16.5.
'■■ A comparison of the death rates for the states comprising the
registration area is as follows : —
190«. 1907.
Average rate, 16.1 16.4
California 17.4 18.6
Colorado, 15.9 17.6
Oonneotlcut, 16.7 17.1
Indiana 12.5 12.5
Maine, 16.2 16.6
Maryland 15.7 16.1
Maasachtuett 16.6 17.5
lilchlgan, 14.8 18,9
New Hamphlre, 17.8 17.1
New Jersey, 16.2 16.6
New York 17.1 17.5
Pennsylvania, 16.5 16.5
Rhode Island 17.5 18.0
South Dakota, 8.8 9.8
Vermont, 16.8 16.2
From the above table it will be noted that the general death rate
for the entire area increased .8 and that this increased rate extended
to ten states, while bnt three states showed a slight decrease and in
two states (including Pennsylvania) the rate remained stationary.
The nrban rate including all incorporated municipalities was 17.5
and the rural rate 14.5. The greatest number of deaths occurred in
January and the least number in June. The rates during the second
and fourth quarters of the year were nearly identical.
11— le— 1907
Digitized by VjOOQIC
162
SEXX)ND ANNUAL REPORT OF THE
Off. Doc.
Deaths by months and quarters with corresponding annual rates
per 1,000 of population.
'By Montbs.
DeatbB.
Rates.
By Quarters.
Deaths.
Rates.
January,
February,
March, . .
April. ...
May
June
July
AuKust, .
September.
October, . ,
November,
December,
11,024
10.270
10,914
9,754
9.086
8.820
9,496
10.444
9,410
8,797
8.469
10.044
18.8
17.6
18.5
16.6
16.4
14.2
16.2
17.8
16.0
16.0
14.4
17.1
32.206
27.110
29.850
27.800
18.3
15.4
16.7
15.5
Deaths of males numbered 63,891 and of females 52,078, giving a
death rate per 1,000 of each sex living of 17.8 for males and 15.2 for
females.
31.4 per cent, of all deaths occurred to children under five years of
age and 22.6 per cent, to children under one year of age.
The death rate per 1,000 of the native population was 14.3, of
native males 15.2 and of native females 13.3.
The death rate per 1,000 of the foreign population was 22.6 of
foreign males 24.8 and of foreign females 19.9.
The death rate per 1,000 of whites was 16.1 and of blacks 28.2.
A comparison of the deaths at the various age periods between
the years 1906 and 1907, shows a decided decrease in the death rate
under five years of age for the latter year, also a decrease up to the
age of twenty-five and a corresponding increase in subsequent ages.
A diminution of the death rate in the early ages with a stationary
or ascendjng birth rate means that the average age at death is in-
creasing and that more of our population is permitted to reach adult
life. One of the most notable decreases in any particular cause is
found in deaths from diarrhoea and enteritis (cholera infantum) in
children under two years of age. 1,184 fewer deaths occurred from
this affection in 1907 than 1906.
The infective diseases of childhood likewise show a marked
decline. Compared with 1906, deaths from measles decreased 749,
from whooping cough, 263 and from diphtheria 300.
Typhoid fever deaths also declined 379. Deaths from premature
births and congenital affections were 1,486 less than in 1906.
Of the total number of deaths 10,866 occurred as the result of
violence, 5,604 from congenital affections and 99,499 as the result of
disease. Of the latter number 19,226, or 18.3 per cent, were due to
preventable causes, a reduction of 3.0 per cent, as compared with
1906.
Digitized by VjOOQIC
No. U COMMISSIONER OF HEALTH. 16S
DEATH RATES AT CERTAIN AGE PETRIODS.
A«ea:
Death Rates per 1,000
PopulaUon of Cbrres-
pondinff Age.
1900
1907
Under 5
48.6
8.8
8.1
7.0
10.1
14.8
80.8
64.4
138.4
282.9
25.3
44.7
5 to 14,
8.0
15 to 84
8.0
25 to 84,
7.9
85 to 44
10.9
46 to 54
15 6
a to 04
SO 5
66 to 74.
68 6
75 to 84 . .
140 8
sIk !?:..:.!.::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::: "
808 6
Unknown. ........4.
8.0
]
DEATHS BY SEX AND
AGE PERIODS.
Deaths.
Per Cent, of Deaths at Each
Ase to Total at all Ages.
Ases.
,.
,.
1
1
1
1
s
i
1
5§
1^
All ages.
115.960
68.881
52,078
100.0
100.0
100.0
122
Under 1 year
1 to 1 years
8 to 8 years
8 to 4 years
4 to 5 years
88,229
5.687
2,8S0
1.879
1,018
14.670
2,981
1.188
745
621
11.659
2,606
1.002
634
497
22.0
4.7
2.0
1.2
.9
22.9
4.6
1.9
1.1
.8
a.2
6.0
2.1
1.2
.9
126
112
109
U7
107
Total under 5 years.
86,488
20.065
16.878
81.4
81.8
81.4
122
5 to 9 years
10 to 14 years
16 to 19 years
20 to 24 years
25 to 29 years
80 to 84 years
86 to 39 years
40 to 44 years
46 to 49 years,
60 to 54 years
65 to 69 years
00 to 04 years
85 to 09 years.
70 to 74 years
76 to T9 years,
80 to 84 years
86 to 89 years
90 to 94 years
95 years and over ..
Unknown
2,710
i;788
8.429
4.868
4.887
4,717
4,997
4.669
4.751
4.901
5.868
0.150
6.610
0,781
6,98S
4,871
*S
178
107
979
1,828
2,968
2,969
2.769
8.088
2,798
8,808
2.870
8.951
8,420
8.418
8,885
2,899
1.979
908
281
52
04
1,802
804
1.421
1.900
1,988
1.948
1,966
1,871
1.948
2.081
2,812
2,780
8,092
8,846
8,084
2.292
1,281
887
120
48
2.8
1.5
2.8
4.2
4.2
4.0
4.8
4.0
4.1
4.8
4.6
5.4
5.0
6.8
6.2
8.7
1.9
.0
.1
.1
2.2
1.6
2.9
4.0
4.6
4.6
4.8
4.4
4.8
4.6
4.0
5.8
5.3
6.2
4.6
8.1
1.6
.4
.1
.1
2.5
1.5
2.7
8.0
3.6
8.7
8.7
8.6
8.7
3.8
4.4
6.9
6.9
6.4
5.8
4.4
2.4
.7
.2
.1
108
121
128
166
151
142
154
150
144
140
127
125
110
101
96
80
78
72
48
ISO
A comparison of the death rates for the years 1906 and 1907, for
the several population groups shows that the death rates declined
in all municipalities over 100,000 population and also in all under
25,000. The death rates in municipalities between 25,000 and 100,000
show a slight increase. The highest death rate in any particular
group was for boroughs having populations less than 2,500. This
rate is indicative of the municipal neglect of sanitary affairs which
usually exists in the municipalities of this size.
Digitized by VjOOQIC
IM
8BCOND ANNUAL RSPORT OF THB
OfE. Doc.
Vhe increase in the mral rate is to be fonnd in the nnmber of
deatiis of old people^ who form a large proportion of the mral
population.
Death Bates for 1906 and 1907, for Certain Cities and Boroughs
Groups of Cities and Boroughs.
1906.
Group 1. Cities over 600,000, 19.8
Philadelphia, 19.3
Group 2. Cities between 100,000 and 600,000, 18.8
Allegheny 17.9
Pittsburg, 19.9
Scranton, 16.6
Group 8. Cities between 60,000 and 100,000, 14.7
Brie. 14.6
Harrlsburff, 14.8
Reading, 14.6
Wllkes-Barre, 14.9
Group 4. Cities between 26,000 and 60,000, 17.4
Allentown, 16.S
Altoona, 16.0
Chester 16.6
ESaston, 16.7
Johnstown 16.9
Lancaster, 14.7
McKeesport, 19.9
New Castl 13.8
Norrlstown, 26.6
WUUamsport 16,4
Tork, 14.8
Group 6. Cities and borouffhs between 10,000 and 25,000 16.7
Beaver Falls, 14.7
Braddock, 23.0
Bradford, 12.4
Butler 22.2
Carbondale 19. S
Carlisle 12.8
Columbia, 11.6
DuBols, : 13.7
Dunmore, 17.0
Duquesne 23.0
Hazleton, 13.6
Homestead, 19.2
Lebanon 16.7
Mahanoy City 20.2
Meadvllle 18.2
Mt. Carmel, 12.8
Nantlooke, 18.8
Oil City 12.0
Plttston, 20.0
Plymouth, 16.4
Pottstown 16.8
PottsvlUe, 19.0
and
1907.
18.8
18.8
18.1
17.8
19.2
15.9
15.8
16.0
16.3
16.3
17.0
17.6
17.8
14.1
16.2
16.4
16.1
12.7
19.7
14.6
26.1
18.9
16.1
16.4
14.9
23.6
10.9
23.1
17.6
16.5
11.8
13.0
14.0
19.1
12.1
19.0
14.0
16.6
18.2
16.1
16.6
11.6
18.9
15.0
17.8
21.7
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 166
1906. 1907.
Shamokln, 14.1 U.O
Sharon 18.6 24.8
Shenandoah, 24.8 19.7
South Bethlehem 19.1 19.1
Steelton. 18.0 18.6
Snnbiuy, 16.1 18.7
Warren, 11.4 9.9
West Chester, 21.0 23.4
WUklnsburff, 14.8 12.9
Group 6. Cities and boroughs between 6,000 and 10,000 popula-
tion, 17.7 17.2
Archibald 16.4 18.1
Ashland. 14.0 14.6
Bangor, 14.0 11.8
Bethlehem, 19.0 16.6
Bloomsburg, 18.2 14.8
Bristol, 16.8 16.6
Carnegie, 24.0 18.0
Chambersburg 17.6 14.6
Charleroi, ..' 20.6 16.0
Clearfield, 12.0 16.7
CoatesviUe 27.8 24.9
ConneUsville 22.1 19.5
Conshohocken, 18.2 17.6
Corry, 17.8 16.0
DanviUe, 14.2 17.8
Dickson City, 17.7 20.0
BdwardsviUe 20.0 22.0
Etna 16.7. 16.8
Forest City 16.8 17.0
Franklin 16.0 18.2
Freeland, 10.0 10.0
Greenaburg, 29.6 21.6
GreenvlUe, 18.2 16.2
Hanover " 17.9 18.9
Huntingdon, 16.1 14.6
Indiana 14.7 IS.S
Jeannette. 12.5 10.6
Johnsonburg 10.2 9.0
Kane 12.8 18.7
Laneford, 20.8 19.0
Latrobe, 17.0 24.6
Lehighton 11.9 9.8
Lewietown, 25.6 21.8
Lock Haven 18.1 17.0
McKees BockB 29.8 24.0
Middletown 18.6 14.6
Mlllvale 17.2 11.9
Milton 18.0 13.8
Mlnersville. 1*.* 18.0
Monongahela 18.8 18.8
Mt Pleasant 188 24.2
New Brighton 15.9 17.2
Digitized by VjOOQIC
166 SBCOND ANNUAL REPORT OF THE 0«. I>oc
190«. 1907.
North Braddock 8g.2 25.8
Old Forge, 26.0 31.2
Olyphant, W.4 14-3
PhoenlxvlUe 20.0 20.3
PunxButawney 28.8 14.9
Rochester 26.2 2S.3
Sayre 22.8 23.8
Scottdale U.l 13.1
Sharpsburer 18.4 14.1
St, Clair 24.6 18.2
St. Marys, 10.3 11.4
Tamaqua, IS.* 13.8
Tarentum, 16.2 17.6
TltusvlUe 13.« 14.8
Tyrone, U.O 14.1
Unlontown, 29.4 30.4
Wiwhington 27.1 21.2
Waynesboxx), 14.1 16.5
West Pittston 11.2 11.8
Wilmerdlnar 15.2 14-0
Group 7. All cities and boroughs between 2,500 and 5,000, 14.1 11.8
Group 8. Boroughs under 2,600, 20.1 20.0
Group 9. Rural listrlcts 18.2 14.4
COMPARISON OF DEATHS BY AGE PBmiODS.
1906. 1907.
All ages, 114,485 115,969
Under 1 year 27,906 26.229
1 to 2 years 6.126 6,627
2 to 3 years, 2,396 2,280
3 to 4 years, 1,463 1,379
4 to 6 years, 1,060 1,018
Total number under 5 years, 38,961 36,433
6 to 9 years 2,916 2,710
10 to 14 years 1,897 1,783
15 to 19 years 3,402 8.249
20 to 24 years 4,744 4,868
25 to 29 years 4,779 4,887
30 to 34 years, 4.562 4,717
35 to 39 years 4,771 4,997
40 to 44 years, 4,199 4,669
45 to 49 years 4,457 4,761
50 to 54 years 4,559 4.901
55 to 59 years 4,911 5,263
60 to 64 years 5,571 6,160
65 to 69 years 6.026 6,510
70 to 74 years 6,130 6,781
76 to 79 years 5.602 6,933
80 to 84 years 3,861 4,271
Digitized by VjOOQIC
No. 1« COMMISSIONER OF HEALTH. 167
1906. 1907.
86 to 89 years 1,972 2,199
90 to 94 years 639 668
96 years 154 172
Unknown 332 107
TYPHOID FEVER.
Deaths from typhoid fever numbered 3,538. The death pate per
100,000 of population was 50.3. Compared with 1906, the deaths
from this canse decreased 379 and the death rate decreased 6.5 per
100,000. With the single exception of tuberculosis, no other oom-
mnnicable disease presented such a high mortality.
The case rate mortality for the year was 17.6, a slight increase
over 1906, thus further emphasizing the statement made in the
report for that year, that the accredited percentage of mortality as
popularly assigned to typhoid fever is entirely too low when applied
to areas embracing a large rural population such as exists in Penn-
sylvania.
The case rate mortality in urban districts was 15.8 and in rural
districts 33.5.
A comparison of the death rates from typhoid fever for 1906 and
1907 in the states composing the registration area of the U. S.
Census 0£9ce is as follows : —
RATES PER 100,000 OF POPULATION.
Average rate, ...
California,
Colorado
Connecticut,
Indiana,
Maine,
Maryland,
Massachusetts, . .
Mlchlgran,
New Hampshire,
New Jersey, ....
New York,
Pennsylvania, ...
Rhode Island, ...,
South Dakota, ..
Vermont
Prom the foregoing table it appears that while Pennsylvania's
typhoid rate is considerably above the average rate in the registra-
tion area, it, however, decreased 5.2 between 1906 and 1907, although
the average rate for the same period declined but 2.5.
1906.
1907.
31.6
29.1
39.6
32.5
56.0
63.7
22.1
20.5
35.9
34.6
18.5
17.7
40.5
40.3
16.1
12.9
27.8
22.7
21.0
11.9
16.8
18.9
19.3
20.3
56.5
50.3
16.5
11.0
21.0
19.5
19.4
10.8
Digitized by VjOOQIC
168
BE)COND ANNUAL. RBPORT OF THE)
Off. Doc.
In the contiguons states of New York and New Jersey, the rates
increased 1.0 and 2.1 respectively.
The percentage of cases of typhoid fever to total cases and per-
centage of deaths to total deaths by months for the year 1906 and
1907.
JanuAiT,
Fetaruarr.
March. ..
April
May
Jan« ,
July
Auffuat. ..
8«ptemcM^
October
November,
Deoembei',
Peroentace of Oaaea
toTotair
IMS
8.»
9.4
7.7
8.8
7.6
4.9
6.8
8.8
9.8
9.8
7.8
U.8
1907
16.4
10.9
K.8
6.8
4.9
6.8
6.8
9.8
9.7
10.6
8.7
7.8
Peroentactt of Deaths
to Total Deatha.
18.4
10.5
8.8
8.8
8.7
6.0
6.0
7.5
10.6
9.8
8.8
8.8
Deaths from Typhoid Fever by Sex and Age Periods for 1907 Com-
pared with 1906.
190(. 1907.
Total, S,»17 »,6S8
Males %,Z»Z 2.1B2
Females, 1,6M 1,886
Under 1 year 1« 17
1 to 2 years 88 18
2 to 8 years, 88 80
3 to 4 years, 44 42
4 to 6 years 48 84
Total under 6 years 170 142
6 to years 284 155
10 to 14 years. 265 221
16 to 19 years, 645 615
20 to 24 years, 787 663
26 to 29 years, 559 624
30 to 84 years. 877 856
86 to 89 years *.. 294 291
40 to 44 years 210 187
45 to 49 years 137 154
60 to 64 years, 120 118
65 to 69 years 110 80
60 to 64 years, 65 61
65 to 69 years, 88 40
70 to 74 years 29 80
76 to 79 years, IS 18
80 to 84 years, 5 8
85 to 89 years 2
Unknown, 7 i
Digitized by VjOOQIC
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Digitized by VjOOQIC
Diagram showing the com para tWe mortality from Typhoid Fever for the
years 1906 and 1907, by the number of decedents for each year by months The
increase shown for January and February in 1907 was due to the Scranton
epidemic.
Digitized by VjOOQIC
Ho. 16.
COMMISSIONER OF HBAL.TH.
168
I>BATHS FROM TYPHOID FETVKR BY MONTHS FOR THE YEARS 1906
AND 1907.
Total.
1906 1907
Urban.
1906
1907
Rural.
1907
January, ..
Vebruary, .
March
April
May,
June
July
JkUffUBt
September,
October. ...
Movember,
December,
865
827
812
394
842
204
221
806
847
868
340
891
475
874
286
240
237
176
186
268
378
350
290
278
812
286
265
881
289
180
192
255
251
262
256
832
197
147
164
228
271
257
204
827
68
42
47
68
68
84
28
61
96
,106
84
€8
46
68
82
40
29
88
40
107
98
86
61
The increase in the number of deaths in the early months of 1907,
as compared with 1906, was due to the mortality resulting from the
Scranton epidemic.
The cities and boroughs with populations exceeding 5,000 in which
the death rate exceeded the average State rate (50.3) were as fol-
lows : —
Allegheny M.t Meadville,
AUentown, 51.6 MlUvale
Altoona, 67.2 Monongahela, ...
Beaver Falls, 87.6 Mount Pleasant,
Braddock, 146.8
Butler 105.4
68.4
84.1
80.0
Cbarlezx>l, 67.4
Connellsville, 85.8
Danville 99.1
DuBois 77.8
I>i2que8ne, 74.6
Brie, 78.4
Etna 68.5
Huntingdon, 79.7
Indiana, 107.7
Johnsonburg 107.2
Kane, 88.1
Latrobe 118.6
Lewlstown 134.2
LfOCk Haven, 83.2
McKeesport, 95.8
McKees Rocks, 106.6
New Brighton, 144.6
Newcastle, 72.7
PhUadelphia 60.7
PhoenlxvlUe, 134.4
Pittsburg, 180.7
Plttston 64.8
Punxsutawney, 71.8
Rochester, 279.6
Sayre, 114.4
Scranton, 76.8
Sharon, 198.4
Steelton, 68.8
Sunbury, 71.6
Tarentum, 149.4
Uniontown 826.6
West Chester, 128.8
Williamsport 70.0
Digitized by VjOOQIC
170 SBX^OND ANNUAL REPORT OP THE Off. Doc.
DIPHTHERIA.
Deaths from diphtheria numbered 2,138. The death rate per
100,000 of population was 30.4. As compared with 1906, deaths
decreased 300 and the death rate declined 4.8.
A comparison of the death rates from diphtheria for 1906 and 1907,
in the states comprising the registration area is as follows : —
Rates per 100,000
of population.
Average rate,
California,
Colorado,
Connecticut,
Indiana,
Maine,
Maryland,
Massachusetts,
Michigan,
New Hampshire,
New Jersey,
New York,
Pennsylvania,
Rhode Island,
South Dakota,
Vermont,
From the foregoing table it appears that the rate for the entire
area decreased 1.9 and for Pennsylvania 4.8. The rates in the ad-
joining states of New York and New Jersey are respectively 0.1 and
0.8 higher than the Pennsylvania rate.
Death from Diphtheria by Months for 1906. 1907.
Total, 2,438 2.138
January, 266 25!>
February, 213 166
March, 205 146
April, 159 139
May 157 126
June, 86 99
July 89 82
Augrust, 116 118
September 210 167
October 318 267
November, 308 276
December, 312 256
1906.
1907.
26.9
25.0
14.8
22.3
16.1
21.5
27.4
24.9
14.9
12.7
16.2
16.7
25.7
16.3
25.4
24.9
18.1
16.9
21.0
22.2
31.0
30.8
32.7
S0.5
36.2
30.4
25.7
24.8
12.2
16.8
19.7
10.6
The case rate mortality for the year was 20.3, a reduction of 2.1
as compared with the previous year. This rate was maintained with
Digitized by VjOOQIC
WnooPTH© Couon-
McAm rn
Diagram showing the comparative mortality from Diphtheria, Whooping
^^b, Scarlet Fever and Measles hy the number of decedents from each cause
^ months.
Digitized by VjOOQIC
Digitized by VjOOQIC
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Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 171
marked regularity throughout the year. The influence of school life
is illustrated by the diagram showing the marked preponderance of
cases during the school months as well as by reference to the table
showing the ages of the decedents.
DEATH FROM DIPHTHERIA BY SEX AND AGE PERIODS FOR 1906 and
1907.
1906. 1907.
Total, 2.438 2.138
Males, 1.214 1,115
Females 1,224 1,023
Under 1 year, 173 170
1 to 2 years. 373 851
2 to 3 years, 363 337
3 to 4 years, 319 267
4 to 6 years 303 248
Total, under 6 years. 1,531 1,373
6 to 9 years 648 529
10 to 14 years, 144 119
15 to 19 years 44 48
20 to 24 years, 18 22
25 to 29 years 16 11
30 to 84 years, 14 8
35 to 39 years, 8 6
40 to 44 years 3 4
45 to 49 years, 4 2
50 to 54 years, 2 5
55 to 59 years, 2
60 to 64 years. 2
65 to 69 years. 4 3
70 to 74 years 2 2
Unknown 1 2
CASE RATE MORTALITY BY MONTHS 1906-1907.
1906. 1907.
ESntlreState (year), 22.4 20.3
January 25.5 23.6
February, 24.0 20.0
March, 23.9 18.8
April, 22.6 18.8
May, 22.1 21.7
June 15.4 17.9
July, 20.3 17.3
August 27.3 19.8
September. 21.1 20.9
October. 20.0 20.7
November. 21.1 18.7
December, 25.6 19.6
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172 SBCOND ANNUAL REPORT OP THE Off. Doc.
SCARLET FEVER
Scarlet fever caused 657 deaths during the year. This wob an in-
crease of 80 as compared with the previous year. The death rate
per 100,000 of population was 9.3 an increase of 1.0 over 1906. The
Increased number of deaths in 1907, was not due so much to a large
increase in the number of cases (but 29 more cases were reported
than in 1906) but rather to an increased malignancy in the type of
the disease.
A comparison of the death rates from scarlet fever in the states
composing the registration area shows that Pennsylvania was not
alone in this respect, there being an increase of 2.1 in the average
rate for this area. The most notable increases being Colorado 20.3 ;
Massachusetts 6.4; New Jersey 4.4; New York 3.7; Rhode Island 12.1.
These rates are as follows : —
Rates p^ 100. 000
of population.
1906. 1807.
Average rate 7.& 9.6
California 8.2 4.4
Colorado 16.2 86.6
Connecticut, 6.8 6.6
Indiana, 4.1 8.6
Maine 0.7 2.0
Maryland 6.0 2.8
Massachusetts, 4.7 10.1
Michigan, 9.0 6.6
New Hampshire, 8.5 2.1
New Jersey 9.6 18.9
New York 9.2 21.9
Pennsylvania 8.8 9.8
Rhode Island, 16.3 28.4
South Dakota, 4.7 4.2
Vermont, 2.9 2.8
DB^ATHS FROM SCARLET FEVER BY AGE PERIODS FOR 1906 AND 1907.
1906. 1907.
Total 577 657
Males 270 826
Females 807 881
Under 1 year, 43 26
1 to 2 years, 69 60
2 to 3 years 90 100
8 to 4 years, 92 89
4 to 6 years, 62 79
Total under 5 years, 366 894
6 to 9 years 171 192
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No. 16. COMMISSIONER OF HBSAL.TH. 173
10 to 14 years,
J6 to 19 years,
20 to 24 yeani,
26 to 29 years,
80 to 84 years
Over 86 years,
Unknown,
DEATHS FROM SCARLET FEVER BY MONTHS FOR 1906 AND 1907.
Total,
January,
February
March, ^
Aprtl,
May
June,
July,
August,
September,
October
November
December,
The case rate mortality in 1906 was 7.5 and in 1907 it was 8.6.
23
88
11
11
10
LND 1907.
1909.
1907.
577
657
61
66
62
68
59
67
67
40
72
89
82
42
88
29
28
41
84
62
88
68
68
77
48
89
MEASLES.
Deaths from measles numbered 714, a decrease of 749 as compared
with 1906. The death rate per 100,000 of population as 10.2 a
decline of 10.9 from the previous year.
A comi>arlson of the deaths in the registration statee for two
years is as follows : —
Rates per 100,000
of population.
1906. 1907.
Average rate, 13.2 9.9
California, 10.1 10.9
Colorado, 8.4 30.7
Connecticut 16.3 6.8
Indiana, 2.8 8.2
Maine. 16.8 4.6
Maryland 6.6 10.6
Masaachusetts 11.0 8.7
Michigan 9,9 9.4
New Hampshire 8.7 4.6
New Jersey, 10.2 6.6
New York, I5.8 11.6
Pennsylvania, 21.1 10.2
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1906.
1907.
24.9
6.2
6.6
U.3
8.8
2.6
174 SECOND ANNUAL REPORT OF THE
Rhode Island,
South Dakota,
Vermont,
DEATHS PROM MEASLES BT SEX AND AGE PERIODS FROM 1906 ANJy
1907.
1906. 1907.
Total, 1,468 714
Males, 786 S80
Females 678 334
Under 1 year 366 206
1 to 2 years, 478 231
2 to 3 years 210 112
3 to 4 years 116 43
4 to 6 years 70 31
Total under 6 years, 1,240 628
5 to 9 years 129 61
10 to 14 years 28 9
15 to 19 years 19 4
20 to 24 years 16 8
26 to 29 years 6 2
30 to 34 years, 4 2
36 to 39 years 7 3
40 to 44 years 3 2
46 to 49 years, 4 4
60 years and over 6 1
WHOOPING COUGH.
1,287 deaths occurred from whooping cough during the year. This
was a reduction of 263 as compared with 1906. The death rate per
100,000 of population was 18.3 a reduction of 4.1 as compared with
the previous year. The death rates from this disease compared with
similar rates for the registration states are as follows : —
Rates per 100,000
of population.
1908. 1907.
Average rate 16.6 11.7
California 6.9 8.4
Colorado 16.3 7.8
Connecticut, 20.9 12.9
Indiana » 12.0 6.9
Maine 18.6 9.9
Maryland 30.2 11.0
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1906.
1907.
23.1
11.1
17.8
8.2
19.0
15.1
16.7
10.6
9.9
9.1
22.4
18.3
19.0
17.0
19.3
28.7
6.6
14.8
No. 16. COMMISSIONER OF HBAI/TH. 176
Massachusetts,
Michi^ran ,
New Hampshire
New Jersey,
New York,
Pennsylvania,
Rhode Island,
South Dakota,
Vermont
DEATHS PROM WHOOPING C?OUQH BY SEX AND AGE PERIODS FOR
1906. and 1907.
1906. 1907.
Total 1,550 1,287
Males, 679 612
Females, 871 675
Under 1 year 881 731
1 to 2 years 251 338
2 to 3 years, 135 114
3 to 4 years, 83 52
4 to 5 years 58 25
Total under 5 years, 1,491 1,260
5 to 9 years 51 20
Over 10 years, 6 7
Unknown age, 2
56.8 pep cent, of the deaths occurred to children under one year of
age and 97.8 to children under five years of age.
In contradistinction to the other epidemic diseases of childhood
which occur most frequently during the school term of the year, 35.4
per cent, of the deaths from whooping cough occurred during the
summer months and during the interim of school attendance.
DEATHS FROM WHOOPING COUGH BY MONTHS.
January, 73 July 154
February 91 August, 173
March 9S September 145
April 118 October 85
May Ill November 63
June, 112 December, 64
TUBERCULOSIS.
Deaths from tuberculosis in all forms numbered 10,825, an increase
of 45 over the year 1906. Of this number 9,317 were due to tubercu-
losis of the lungs and 1^508 to tuberculosis in other forms. The
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176 SEXX>ND ANNUAL RBPORT OF THB Oft. Doc.
forms of tuberculosis represented with the percentage in each class
to total deaths from this cause are as follows : —
Tuberculosis of lungs 9,817 86.1 per cent
Tuberculosis of larynx 99 0.9 per cent.
Tuberculous meningitis, ttS 4.9 per cent
Abdominal tuberculosis, 451 4.1 per cent
Potts disease, 82 0.7 per cent
Tuberculous abscess, 10 0.1 per cent
White swelling, 41 0.4 per cent
Tuberculosis of other organs, 107 1.0 per cent
General tuberculosis, 193 1.8 per cent
The death rate from tuberculosis in all forms per 100,000 of
population was 153.9 and of tuberculosis of the lungs 132.4.
This was a decrease of 1.2 in the rates of pulmonary tuberculosis
as compared with the preceding year.
The comparison with the states composing the registration area for
the years 1906 and 1907, is as follows: —
DEATHS PER 100.000 OF POPULATION PROM TUBERCULOSIS OP THH
LUNOa
1900. 1907.
Average rate 166.4 166.1
California ." 281.6 »44.1
Colorado, 262.9 267.7
Connecticut, 189.6 149.1
Indiana, 141.2 140.2
Maine 121.8 134.8
Maryland, 180.6 177.7
Massachusett 166.6 167.6
Mlchlgran 90.1 88.7
New Hampshire 129.2 111.2
New Jersey, 171.1 170.6
New York 176.8 171.6
Pennsylvania 183.6 123.6
Rhode Island, 166.2 168.6
South Dakota, 88.9 86.2
Vermont, 113.6 107.0
DEATHS PROM TUBERCULOSIS OP THE LUNGS BY SEX AND AGE
PERIODS.
Total
Males
Females
Under 1 year,
1 to 2 years,
2 to 3 years,
3 to 4 years
4 to 6 years,
Total under 5 years,
5 to 9 years,
:X AND AGS
1906.
1907.
9,268
9,817
4.786
4,896
4.472
4,421
212
289
103
96
66
61
29
86
27
23
427
446
89
92
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Diagram showing the comparative mortality from Tuberculosis of the luDgs
for the yeiirs 1906 and 1907, by the number of decedents for each year by months
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1906.
1907.
186
174
784
679
1,207
1.207
1,249
1,175
1,129
1,112
1,086
1,014
782
791
617
552
473
516
404
406
319
883
248
261
194
213
118
183
83
89
14
16
25
7
No. 16. COMMISSIONER OF HEALTH. 1T7
10 to 14 years,
16 to 19 years
20 to 24 years,
26 to 29 years
80 to 34 years,
35 to 39 years,
40 to 44 years,
45 to 49 years,
50 to 54 years,
55 to 59 years,
60 to 64 years,
65 to 69 years,
70 to 74 years,
75 to 79 years,
80 to 84 years, «
85 years and over
Unknown,
The quinquennial age periods showing an actual decrease in the
number of deaths are 16 to 19 years, 30 to 34, 35 to 39 and 46 to 49.
DEXATHS FROM TUBBRCUL.OSIS OF THE LUNQS BY MONTHS.
Total,
January,
February,
March,
Aprtl
May
June,
July
Augwit
September
October
Koyember
I>eceml)er,
OCCUPATIONAL MORTALITY OF TUBERCULOSIS OF THE LUNGW.
Of the 4,896 deaths from tuberculosis of the lungs among males,
346 were under occupational age and 800 were returned as haying
no occupations. Of the 3,750 deaths in which definite occupations
were assigned, 317 were scattered through a variety of occupations
in such small numbers as to be of slight significance.
The following table shows the death rates in each ten thousand
persons employed in certain occupations and groups of occupations
of similar character : —
Architects, artists and teachers of art 7.6
Bakers and confectioners, 24.4
Bankers and brokers 9.2
Barbers and hairdressers 45.2
12—16—1907
liN)6.
1907.
9,258
9,317
739
804
7W
805
980
976
876
965
886
829
704
727
708
717
740
698
645
594
766
702
673
679
825
821
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178 SECOND ANNUAL REPORT OP THE Off. Doc.
Blacksmiths 12.0
Boatmen and canalmen 6.0
Bookkeepers, clerks and copyists, 33.0
Boot and shoemakers, 22.1
Brewers, distillers and rectifiers, 34.5
Butchers 18.1
Cabinetmakers and upholsterers, 22.2
Carpenters and joiners 19.3
Clgrarmakers and tobacco workers, ' 31 . 5
Clock and watch repairs and Jewelers 87.5
Clergrymen, 6.9
Collectors and agents 39.0
Commercial travelers 2.2
Compositors, printers and pressmen, 28.0
Coopers 27.2
Draymen, hackmen and teamsters, 20.2
Engrineers and surveyors 13.7
Ensrineers and firemen (not railway) 17.3
Farmers and farm laborers, 6.6
Gardeners, florists and nurserymen, 28.2
Glass blowers and glass workers, 18. d
Hat and capmakers 74.4
Hotel and boarding housekeepers, 15.1
Hucksters and peddlers, 21.1
Iron and steelworkers 16.6
Journalists 18.0
Janitors , 16 . 8
Laborers (not agricultural), 33.2
Lawyers, 8.5
Leatherworkers 11.8
Livery, stablekeepers and hostlers, 18.1
Lumbermen , 5.0
Machinists 21.4
Marble and stone cutters 63.4
Masons, 16 . 5
Merchants 11.8
Mill and factory operators (textile) 30.7
Millers, fiour and grist, 12.9
Miners, 10 . 3
Musicians and teachers of music 33.2
Physicians, 17.5
Painters 30 . 1
Plasterers, 30 . 8
Plumbers, gas and steam fitters, 28.1
Policemen and watchmen 18.0
Saloonkeepers and bartenders 29.4
Steam railroad employes 9.3
Sailors 44.1
Servants 37.1
Tailors, 20.6
Teachers (school), 7.0
Tinners and tinwaremakers, 19.3
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No. 16. COMMISSIONER OP HEALTH. 171
Of the 4,421 deaths from tuberculosis of the lungs among females,
365 were under occupational age, 3,591 were returned as without
occupation (the term housewife employed on many of these returns
not being considered) and but 466 were assigned definite occupations.
CANCER,
Deaths from cancer numbered 4,420, an increase of 212 as com-
pared with 1906.
The form of cancer represented in this total are as follows: —
1906. 1907.
Ctocer of the mouth, 160 144
Ctocer of the stomach and liver 1,620 1,666
Cancer of the Intestines 440 488
Cancer of female genital organs, 696 640
Cancer of the breast, 399 368
Cancer of the skin 160 188
Cancer of other and unspecified organs 834 926
The rates per 100,000 of population for the years 1906 and 1907,
were 60.7 and 62.8 respectively. These rates compared with similar
rates in the registration area as follows : —
RATES PER 100.000 OP POPULATION— 1906.
Average rate 70.9
California, 92.0
Colorado 61.3
Connecticut 80.6
Indiana, 53.7
Maine 86.2
Maryland, 60.1
Manachusetts, 90.3
Michigan, 67.6
New Hampshire, 89.2
New Jersey 66.1
New York 76.2
Pennsylvania 60.7
Rhode Island, 78.8
South Dakota 85.4
Vermont 85.8
As cancer is almost nniversally a disease of middle or later adult
life any deficiency in population in the early age periods would very
materially affect the death rates from this disease. In this con-
necfion it is interesting to note that the New England states, with
the exception of California, furnish the highest death rates.
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180 SBXX)ND ANNUAL REPORT OF THE Off. Doc.
It would seem to be evident from statistical records that the
mortality from cancer is steadily increasing, not only in the United
States, bnt throughout the world. It is possible that increasing
accuracy in diagnosis may be responsible for a portion of this in-
crease but an inspection of the returns from our larger cities for a
number of years shows a decided and constant growth in the returns
of deaths from this cause. It is unfortunate that the returns of
cancer of other and unspecified organs continues to be so large (20.9).
Physicians to whom statistics upon the subject should be of the
greatest value, defeat the object of a more detailed classification
by failure in very many cases to definitely specify the locality or
organ effected and what would be of even greater value, the variety
or character of the neoplasm.
DISEASES OF THE NERVOUS SYSTEM.
The total number of deaths due to diseases of the nervous system
waa 12,227, an increase of 347 over 1906. The death rate per 100,000
of population was 173.8. 53.5 per cent, of the deaths occurred to
males and 46.5 to females. The most important individual causes
of death in this group were apoplexy, meningitis and convulsions
in children. As the title of apoplexy includes congestion of the
brain a reference to the table showing the number of deaths from
each specified cause by age periods will indicate the futility of at-
tempting to deduct conclusions as to the individual mortality of
apoplexy. "Meningitis" and "convulsions" as returns are so in-
definite in character as to be of small value except for the evidence
which they present either of carelessness in diagnosis or statement
of the cause of death.
DISEASES OF THE CIRCULATORY SYSTEM.
11,777 deaths occurred from diseases of the circulatory system,
an increase of 1,090 as compared with 1906. The death rate per
100,000 of population increased from 154.2 to 167.4. Heart disease
was responsible for 9,282 of the deaths in this group. Deaths of
males from this latter cause numbered 4,984 and of females 4,388.
By reference to General Table No. 2, it will be found that the
greatest percentage of deaths occurred to persons in thei^advanced
years of life. The death rates from this cause show a tejadency to
increase throughout the United States.
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No. 16. C(»MM1SS10NBR OF HEALTH. 181
DISEASES OF THE EESPIBATOBT SYSTEM.
Diseases of the respiratory system were responsible for 14^384
deaths in 1906, an increase of 544 over the previous year. The rate
per 100^000 of population increased from 199.5 to 204.5.
The most important single cause of death in this group was
pneumonia, which caused 7,849 deaths. The death rate per 100,000
of population was 11.6, an increase of 704 in the total number of
deaths and of 4.7 in the rate. But 36.7 per cent, of the deaths
from pneumonia occurred under 5 years of age as compared with 39.8
per cent, during 1906.
The average death rates from pneumonia in the registration area
show a slight tendency to decrease for a period 1901 to 1906, in-
clusive, but the individual rates for the states composing the area
show wide variations.
RATE PER 100.000 OF POPULATION, TEAR 1906.
Average rate, 109.6
California, 106.9
Colorado 147.7
Connecticut, 118.1
Indiana, 76.8
Maine, 106.4
Maryland, 96.6
M^Msachusetts, 121.6
Michigan 74.4
New Hampshire 104.2
New Jersey, 132.8
New York 123.4
Pennsylvania 106.9
Rhode Island 141.6
South Dakota, 60.9
Yemkont, 126.4
Broncho-pnenmonia was responsible for 2^916 deaths. Of this
number 67.7 per cent, occurred to children under five years of age
as compared with 75.6 during 1906.
DISEASES OF THE DIGESTIVE SYSTEM.
Deathly from diseases of the digestive system numbered 16,037, a
decrease -of 1,226 as compared with 1906. The rate per 100,000 of
population decreased from 249.1 to 228.0.
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182 SECOND ANNUAL REPORT OP THE Off. Doc.
Diarrhoea and enteritis were responsible for 9,973 deaths, or 62.1
per cent, of the total.
Cholera infantum (diarrhoea and enteritis under two years of age)
caused 8,622 deaths, a reduction of 1,174 as compared with the
previous year.
The reduction in this single cause of infantile mortality was
almost wholly responsible for the decrease in the number of deaths
for this group of diseases.
DISEASES OF THE GENITOURINARY SYSTEM.
Deaths from diseases of the genitourinary system numbered 7,659,
an increase of 440 as compared with the previous year. The death
rate per 100,000 of population increased from 104.2 to 108.9.
Bright's disease supplied the greatest number of deaths from any
single cause under this group, 5,761 or 75.2 per cent, being due to
this affection.
The distinction between acute nephritis and Bright's disease is
not as well defined by physicians as it should be on death certifi-
cates; therefore, for practical purposes of comparison, deaths from
these two causes may well be considered together.
The returns from the registration area indicate that deaths from
these causes are increasing slowly from year to year. The annual
average rate for the year 1901 to 1905, inclusive, was 96.0, the rate
for 1906 was 98.2, the rate for Pennsylvania for the latter year
being 86.9.
VIOLENCE.
Deaths from violence numbered 10,866, an increase of 686 over the
previous year. The death rate per 100,000 of population was 154.5
as compared with 146.9 for 1906.
Deaths were distributed among the principal causes of violence
as follows: —
1906. 1907.
Suicide 780 892
Fractures 537 166
. Burns and scalds 847 971
Drowning 655 566
Accidental grunshot wounds 149 139
Mining injuries, 983 1,508
Steam railway injuries 2,159 2,134
Homicide 365 406
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No. 16. COMMISSIONER OF HEALTH. 183
Of the total snicides, 674 were males and 281 were females.
Among the varions agencies employed in suicide were firearms 275,
poison 251, hanging, 160.
Five suicides were less than 15 years of age.
The rate per 100,000 of population was 12.6 as compared with 11.2
for 1906.
Although fatal railway injuries decreased sightly in numbers, they
continued to contribute most extensively to violent deaths.
GENERAL TABLES.
Table 1 gives the deaths by sex and months for the entire State,
for incorporated municipalities having over 5,000 population, for
the group of municipalities having less than 5,000 population and
for the rural sections of each county.
Table 2 gives the deaths in the entire State from each cause and
class of causes by sex and age periods.
Table 3 gives the deaths by age periods for the entire State, for
all municipalities having more than 8,000 population, for certain
municipalities by color, and for each county of the State, including
townships and municipalities having less than 8,000 population.
Table 4 gives the deaths from certain specified causes and classes
of causes for each iq^nicipality in the State having morr than 5,000
population and for the rural section of each county.
Table 5 gives the deaths from each specified cause for the entire
State and for certain cities.
< Table 6 gives the deaths in the entire State by age, sex, color,
general nativity and parent nativity.
Table 7 gives the death by color, general nativity and parent
nativity for each municipality having more than 8,000 population
and for the rural sections of each county, including municipalities
having less than 8,000 population.
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184
SBXX)ND ANNUAL REPORT OP THE
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Kq. is. commissioner of health. 266
BIRTHS.
175,804 births^ exclusive of still births were registered during the
year. This was an increase of 8,470 as compared with the previous
year and an increase of births over deaths of 59,766 for the year 1907.
The birth rate per 1,000 of population increased from 24.1 in 1906,
to 25.0 in 1907. This increase, both in the number of births and the
birth rate, is more apparent than real and indicates am improved
accuracy in the registration of births rather than an actual increase
in the birth rate, for the reason that as noted in the report for 1906,
the birth rate is still less than the rate which must necessarily exist
in order to support the natural growth of our population.
Of the total number of births, 90,938 were males and 84,849 were
females. The birth rate of the native population was 20.4 and of the
foreign population 49.3. There were 1,759 plural births, of which
number 1,786 were twin births and 9 triplet births. Of the twim
births 1,153 occured to native mothers, 627 to foreign mothers, and
in six of the plural births the nativity of mothers was unstated. Of
the triplet births, six occurred to native mothers and three to foreign
mothers.
There were 3,909 illegitimate births, a decrease of 2,190 compared
with the previous year. The illegimate rate per 100,000 population
was 55.5, the native rate being 57.0 and the foreign rate 42.1.
Table 1 shows the births by sex and months for the entire State,
and for all incorporated municipalities over 5,000; also for certain
gronpe of municipalities and for the rural sections of each county.
Table 2 shows the births for the same municipalities, sub-division
by age and nativity of mothers.
Table 3 shows the births for the same municipalities, sub>division
by nativity of mothers and the number of child of each class.
Table 4 shows the illegitimate births by localities and nativity of
mothers.
Table 5 shows plural births (twins) by localities and nativity of
mothers.
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326
SECOND ANNUAL. RBS^ORT OF THIS
Off. Doc
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No.lflL
COMSiaSSIONBR OF HBALTH.
S27
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Digitized by VjOOQIC
828
SECOND ANNUAL REPORT OF THE
Off. Do<i.
TABIiE4.
Illegitimate Births by Locality and Nativity of Mothers.
Total.
NaUve.
Foreign.
Nativity
UnsUted.
Rntlrfl Stfit«x
8,909
98
»
IS
10
IS
u
15
10
17
11
16
50
14
as
19
17
880
»S
10
4
80
8.886
80
16
84
10
18
11
15
10
3
10
15
•'
788
219
61
468
18
6
1
61
ikUeflrheny, ..'
iUlentown,
1
Altoona,
Archbald
Ashland,'
Bangror,
Bwiver Palls,
1
Bethlehem
BIooDifthurir .
Biraddock, ".' ^
8
Bradford
Bristol
Butler
%
Carbondale
Oarllsle '.
Carnegie
2
ChaLmbersburff.
Charleroi, ....'
Chester '
Clearfleid '. !!!.*...
Coateevllle j...
1
Columbia ...
1
Oonnellsville ............. ...... ..................... ...
1
Conshohocken
Oorry
Danville,
Dickson ' City
PuBois
Dunmore
8
1
1
1
1
10
DuQueene
Easton,
Erie ...
Etna,
Franklin
Freeland
*
OreensburflT,
Greenville.
Hanover
1
Harrisburgr
2
Hazleton
Homestead
Hunting'don
Indiana
J
Jeannette,
Johnsonburiff
1
8
1
1
Johnstown,
1
Kane
Tjanoaster
Ijansford,
lA^robf^ '
Lebcuion,
Lehlg'hton
Lewlstown
LiOck Haven,
McKeesport,
7
1
McKees Rocks,
Mahanoy City,
Meadvllle
Mlddletown
MlllvaJe
1
Milton
Mlnenrvllle t
Monon^ahela
Mount Carmel
Mount Pleasant
Nantlcoke '
1
1
2
8
New Brlg'hton,
New Castle
Norristown
1
North Braddock
OH City, '.
Olyphant
8
140
Philadelphia,
M
Phoenixvllle
Pittsburg,
64
1
7
Plttston
Plymouth
Pottatown
Pottsville. ,
1
Punxsutawnev •••...
Reading
' 9
Digitized by VjOOQIC
Nal6.
COMMISSIONER OF HEALTH.
TABLE 4.— Continued.
S29
Total.
Native.
Foreign.
Nativity
UnsUte4.
Saint Clair,
2
%
%
26
IS
6
S
14
10
10
8
t
1
9
la
4
12
6
IB
1
29
2
19
12
68
24
8
^*
»
26
17
U
21
20
28
17
18
8
17
6
12
22
10
6
5
20
22
6
25
21
9
12
47
7
22
42
18
21
5
8
17
12
26
21
29
17
2
4
48
15
19
2
4
8
6
5
8
2
2
2
19
11
4
2
6
9
10
8
2
1
9
11
s^»»«»t Miry**. ... .....' '.'..'...'.'.'.'.'. ..'
Bcottdate, ...'
SkTADtOQ,
7
1
1
1
8
1
Rhiunokin, . ..r...... .....
Sharon '...,. .\ x '
Eteelton, '.
Sunbuiy ^ ^ .. . X ..« . . .
Taniii<iQa a ........ .
Tui^tom, , .
TltnarUle
Tyrone, ,
Unlmtown,
1
4
Wirren
Waihii^ton ... ...
12
6
15
1
22
2
19
1
28
12
47
M
7
16
46
24
24
27
14
27
S
17
22
8
16
6
U
21
10
Vayneiboro' ....
Wwt Cbester
Wtndber
Wflkeff-Bam . .
Wflyj»4hanr, ' V.
. .'!!!!!.! .
Wniiamsport
viiTBM^ifur '....;; -- ;;
TorkT^^.. ::::..;:;;;;:;;;;;:..:::.:. ;:;;!:;;;;:;;::;:;:;:
1
OoontlM.
AdazM .. ..... .
I
AlkglieBy
ii*
-^^nrtroo^ ...
BeATcr ...' -
1
Bedford.
BerkT;.,;::::: ::::::::::;.::::::::: ::::::
1
Sin\::::::::::::: :::::::::::::::::::::::::::::::::::::::::
1
1
Bradfort
Bocks. ..'
Butler.
1
4
CaoBbria,
Ctoboir."'^^**^^J*^^r^i^^i^*ii""^"..""i"iiii**"i..i!
Cbester
Ctarioo:
Cteaiildd
Cltoton.
6
1
fvSSsa; : :::":;"::::-::::::::::::::::::::::::
1
Oawfordl
ClRKhirrii^n4 ,
nannhln ' , ,.,
1
Delaware
Elk '.
6
1
6
Erti. ::::::::::::::::::::::::::::::::::::::::::::::::;::::::::
4
48
6
20
22
28
9
10
47
5
22
36
16
20
5
7
17
12
28
21
87
17
2
4
2S
16
18
8
8
7
6
4
7
PVette
Forest,
Pnnhifn '.
Grwoe. '. '.
BmnJiKdim .
iiwH-nfT^ ";::... .... ! ,!.,.,;;:;:;::;':.:"'
2
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La^avaoML
1
1
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2
LebuMo ' '.
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7
4
1
1
Losene
hycaaiDg
McKeanT.. I.. ..
MenSr .::::::::::::::::::!.::::::::: ::::::::
1
MIfflia,
Monroe i:::::::::::.::. ..:.::: ::.:::::::::.:..::::::
Montgomery
2
Jf "lliainpton,
KorthqinbfTlanA ...... r - , r r ,,.,.. ^ .... ^ ..,. .
2
PerrTv^V^:.. .
rf^ .. :. . .
Potter
Sdhnyiklll
8
saydSr^.,.::::::::::::::::;::::::::::::::::::::::::::::::::
SonerseL
1
Sunivm,
8o«n»ii«"»Mii -
1
1
Tioga. ...."'...;:.:.......
t^ . ". .
Venango ,
1
1
Warrtn
Digitized by VjOOQIC
S82
SECOND ANNUAL RBa>ORT OF THB
TABUS 6.— Continued.
Off. Doc.
Total.
NaUye.
Fbreiffn.
Nativity
Unstated.
SchuylldU. ...
Snyder,
Bomeraet
BulUvan
Susquehanna,
Tlo«a
Union,
Venanffo, . . . .
Warren,
WashlnstoQ, .
Wajme,
Westmoreland,
Wyoming, ....
Toifc
Digitized by VjOOQIC
The Sub-Division of Morbidity Statistics
In charge of WILMSR R. BATT, M. D.» Registrar.
Digitized by VjOOQIC
(SS4)
Digitized by VjOOQIC
OFFICIAL DOCUMENT. No. IS.
THE DIVISION OF MORBIDITY STATISTICS.
COMMUNICABLE DISEASES.
A total of 70,864 cases of coiximanicable diseases were reported
during tbe year. This is a decrease of 17,456 cases as compared with
the preyious year.
The following comparisons will show the increase and decrease for
each of the several diseases.
All communlcyable diseases,
Actinomycosis,
Anthrax,
Cerebro-Splnal Mtenlncritis,
Chicken Pox,
Diphtheria,
Bpidemlc Dysentery,
Erysipelas,
German Measles,
Rabies.
Malarial Fever,
Measles
Mumps
Pneumonia, ,
Puerperal Fever
Scarlet Fever,
Small-Pox
Tetanus
Tracftiomia,
Trlchinlaflis,
Tuberculosis ,
Tsrphoid Fever,
Whooping Oouffh
1906.
1907.
88^320
70,864
1
2
23
26
361
430
2,999
3,442
10,870
10,510
5
3
1,010
972
404
100
8
6
99
81
28,729
11,776
1.337
1.115
6,169
6»282
77
67
7,670
7,699
73
62
66
74
28
26
1
5,284
6,109
24,471
20,080
8,691
3.013
(335)
Digitized by VjOOQIC
336
SECX)NI> ANNUAL REPORT OP THE
Off. Doc.
MORBIDITY TABLE NO. 1.
Number of cases of communicable diseases reported from the en-
tire State and urban and rural districts by months:
Month. Total. Urban. Rural.
Total, 70,864 60,448 10,416
January, 7,660 6,88T 773
February, 5,958 5,291 667
March, 6.242 4.673 569
April, 6.253 4.641 612
May, 6,688 5.096 592
June, 6,528 4,999 629
July, 4,042 3.548 494
August, 4.175 3.740 435
September. 4,429 3,830 599
October, 6.971 4,688 1.283
November, 8.022 6.149 1.873
December 8.896 6.906 1,990
MORBIDITY TABLE NO. 2.
Bates per 100,000 of population of all communicable diseases for
the entire State and urban and rural districts by months:
Month. State Rate. Urban. Rura\.
Janucury, 108.9 195.9 32.4
February 84.7 113.8 27.9
March, 74.5 105.2 23.8
April 74.5 105.0 24.0
May, 80.8 109.6 24.8
June, 78.6 107.5 23.6
July 57.4 78.4 20.7
August, 59.4 80.5 18.2
September, 62.9 82.6 24.9
October, 84.9 105.3 63.4
November 112.6 132.2 78.6
December 126.5 148.5 83.4
Digitized by VjOOQIC
No. 16.
COIUMISSIONEIR OF HEALTH.
837
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Nt). 16.
COlUMISeiONER OF HEALTH.
S89
TYPHOID FEVER.
A total of 20,080 cases of typhoid fever were reported during the
year. Of this number 18,067 were reported from urban districts and
2,013 from rural districts. The greatest number of cases reported in
any single month was 3,099 in January, for which the Scranton epi-
demic was responsible, the beginning influence of which was noted
in the returns of typhoid fever for the month of December, 1906.
Typhoid fever in the rural districts shows the same tendency to in-
crease in the autumnal months as It did in 1906. The increase, how-
ever, extended through the month of December. 54.1 per cent, of
all cases of rural typhoid fever occurred during the months of Sep-
tember, October and November.
MORBIDITY TABL.E NO. 4.
Typhoid Fever by Months, Urban and Rural, Compared with 1906.
Total.
UrtMU).
Rural.
1M7.
1906.
1907.
1906.
1907.
Entire year,
January,
February, .
March, ,....
AS?!'.::::::
June,
July
Auguit, . . . .
September,
October. ...
Noyember,
December, .
24,471
»,177
2.286
1,870
2.122
1,829
1.196
1,404
2.026
2.S42
2,896
1.894
2.9S7
20.060
3,099
2,206
1,178
1.126
999
1.046
1.092
1.849
1.967
2,122
1.880
1.566
22.520
2.009
2,172
1,761
2,081
1.720
1.128
1.294
866 •
1.991
2.068
1.705
2,821
18.067
2,978
2,009
1,107
1.067
961
966
996
1,684
1.671
1.678
1,487
1.258
1,961
158
114
119
91
109
70
110
171
2S1
262
189
96
2.012
121
an
71
69
28
69
96
16S
296
460
248
209
MORBIDITY TABLE NO. B.
Distribution of typhoid fever according to .a^e periods for entire State, urban
and rural districts by i>ercentaere to total cases in each locality.
State.
Urban.
Rural.
Under 6 years,
6 to 9 years, .
10 to 14 years,
16 to 19 years.
20 to 24 years.
26 to 20 years,
80 to 84 years,
26 to 29 years. ,
40 to 44 years,
46 to 49 years.
Over 60 years.
4.6
4.6
12.2
12.8
12.9
12.8
16.0
16.7
18.2
18.2
18.6
18.9
8.1
8.8
6.4
5.4
8.6
8.6
2.8
2.2
2.2
3.0
4.0
11.6
18.4
18.6
17.6
11.2
7.1
6.6
2.6
2.1
4.4
Digitized by VjOOQIC
S40
SECOND ANNUAL BXPOJCT OF THE
Off. Doc
MORBIDITY TABLE NO. 6.
Tsrphoid Fever by Nativity and A^ Periods.
AUacM.
(M.
6-S.
10-U.
20-».
80-18.
«M8.
6040.
60-68.
70.
Un.
NaUye
FtMPeign
Unknown, ..
14,997
4,412
7U
7B9
68
24
m
66
1
4.626, t.906
886' 2 014
146 172
1
770
7»
818
288
86
806
96
7
7
46
U
846
124
186
MORBIDITY NO. 7.
Typboid Fever by Color and Age Periods^
All asee.
0-4.
6-9.
10-19.
20-28.
80-89.
40-49.
60-88.
60-68.
70.
Un.
White
Black
Color unstat-
ed
19.06S
875
140
814
67
*'S
6.876
231
2
6.876
290
7
2.618
U6
1.112
80
408
6
147
64
2
614
U
181
MORBIDITY TABLE NO. 8.
Typhoid Fever by Sex and Color.
All colors.
White.
Black.
Unstated
colors.
Total
20,080
11.641
8.814
126
19.066
11,166
7.909
876
476
899
140
Males'
9
Females
9
Swc unstated
126
DIPHTHERIA.
10,510 cases of diphtheria were reported during the year, a de-
crease of 360 cases as compared with the previoas year.
MORBIDITY TABLE NO. 10.
Diphtheria by Months, Urban and Rural, as Oompared with 1906.
Entire year.
January, ....
February, ...
March
April,
M«y
June,
July
August ,
September.
October
November, .
Deoember, . .
Total.
10,870
l,Ott
885
852
708
688
546
487
4«1
904
1.680
1,468
1,116
1907.
10,610
1,096
828
760
787
676
65S
478
697
796
1,S88
1,601
i.m
Utbaa.
1906.
8,966
824
706
701
670
584
470
866
402
826
1,270
1,190
1,011
1907.
8,666
920
781
668
624
496
480
888
484
666
908
1.196
1.002
Rural.
L,914
US
1T9
161
127
104
76
71
68
168
tlO
268
174
1207.
1,864
176
97
116
112
19
64
86
112
121
Digitized by VjOOSIC
No. 16-
COMMISSIONER OF HEALTH.
S41
MORBIMTT TABLE NO. 11.
I>i9tTl1>iitlon of Diphtheria according to age periods for entire State, urban
&21CI rural districts by percentages to total cases in each locisUlty.
State.
Urbsn.
RuraL
XTiidcT S 3r«ars,
8S.0
87.1
14.4
6.4
S.4
2.6
£.0
0.9
l.t
M.7
f7.t
!!.<
4.8
S.8
16
1.8
1.0
16.4
S to 9 Tears* '.,.
S.I
10 to 14 years
17. S
V to 19 yrAn.
1.4
ao to U arcotTB
4.2
S to n yCSLT*
I.I
m to aM y«iFn
1.7
IS to 39 yoonj
0.1
■10 y fsm and over,
£7
MORBIDITY TABLE NO. 12.
Dipbtheria by Nativity and Age Periods.
AUagw.
0-4.
6-0.
10-10.
80-20.
80-80.
40-49.
60-68.
00-80.
TO.
Un.
Katire
0,218
2.984
8.4tt
1,840
618
280
80
24
8
8
106
PovdSBy • • • •
706
828
2U
116
87
86
17
2
8
16
Unkzkown*
487
100
IM
74
88
18
8
8
2
98
MORBIDITY TABLE NO. 18.
Diphtheria by Color and Age Periods.
Aliases.
0-4.
6-0.
10-19.
80-29.
80-80.
40-40.
60-60.
8040.
70.
Un.
White
COkv isMtat-'
•>«•
84
8
8
1,980
89
1
688
25
208
8
1
08
1
86
1
U
1
I
170
60
MORBIDITY TABLH NO. 14.
Diphtheria by !8ex and Color.
All colore.
White.
Black.
Oolor un-
Totml,
Xaliee,
Femalfla,
10,610
6,016
6,496
10,868
4.896
6,868
188
86
87
84
84
80
SCARLET FEVER
7,699 cases of scarlet fever were reported during the year, an in-
crease of 29 as compared with the previous year.
Digitized by VjOOQIC
342
SECOND ANNUAI^ RBPORT OF THE
Off. Doc.
MORBIDITY TABLE NO. 16.
Scarlet Fever by Montlw, Urban and Rural, compared with 1906.
Entire jmr,
Januanr. •..
SSST:...::
iffiH- ::::::::
June
July
Auffuit.
September, ..
October
November, . .
December, . .
Total.
7,«70
87»
m
758
687
701
617
178
160
426
679
687
764
1907.
7,667
716
676
676
677
476
486
876
414
688
716
1,066
1,066
Urban.
1606.
6,107
668
677
600
686
688
447
888
808
888
646
668
691
1907.
Rural.
1806.
6.188
1.668
679
287
460
196
687
166
426
168
891
119
486
70
888
60
868
48
468
86
677
186
888
129
760
148
1907.
1.667
184
188
149
168
88
60
68
188
258
806
MORBIDITY TABUS NO. 16.
Distribution of scarlet fever according to age periods, State, urban #uid rural
by percentage to total cases In each loccdlty.
Age.
State.
Urban.
Rural.
Under 6 yeam
6 to 9 yeani
10 to 14 yean
28.7
48.9
18.4
6.0
8.4
1.8
0.7
0.8
0.4
89.8
48.4
17.6
4.8
8.6
1.8
0.6
0.8
0.8
86.6
40.7
88.0
16 to 19 yean' .'.'.'.'..'.'....'.'.....'.'.".'.'.'.'.'.'.'.'.'.'.
6.8
80 to 84 yean,
1.7
86 to 89 yean
80 to 86 yean
86 to 89 yean,
1.8
1.0
0.8
40 yean 'and oyer, , x ........... .
0.6
MORBIDITY TABL.E NO. 17.
Scarlet Fever by Nativity and Age Periods.
AUsgee.
0-4.
6-6.
10-19.
80-89.
80-89.
40-49.
60-69.
60-69.
70.
Un.
Native ....
888
68
2.907
840
100
1.628
104
48
887
41
9
66
7
6
17
2
86
Fonlgn
Unknown, ..
6
4
88
'
MORBIDITY TABLE NO. 18.
Scarlet F^ver by Color and Age Periods.
Allagee.
0-4.
6-9.
10-19.
80-29.
80-89.
40-49.
60-69.
60-69.
70.
un.
White
Black
Color unetatec
7,625
68
81
8
2
a.™
1
276
8
87
1
1
85
2
116
15
Digitized by VjOOQIC
No. 16.
GOMMI8BIONER OF HEALTH.
243
MORBIDITT TABLiE NO. 19.
Scarlet Feyer by Sex and Color.
AU colon.
White.
BUck.
Color lu-
Total,
7.0W
7.<S6
t.878
4.0tt
ll
uiStm. *..ll";!!l""!l!l"!!l"";il"!'l''*!!!"!!
14
F«mAJM
7
TUBERCULOSIS.
In comparison with the deaths, reports of tuberculosis continue
to be very incomplete. A total of 6,109 were received during the
year, an increase of 875 as compared with the preceding year.
MORBIDITY TABIiB NO. 20.
TuberculosiB by Months, State, Urban and Rural.
State total.
UrtMui
XSntlre year,
January, ...
February, ..
ICarch
tfiSJ!' .:;::::
June.
July
Auffiut. ....
BeptembeTf
October, ...
November,
December,
6.1O0
610
477
4S0
587
477
«7S
612
482
478
476
818
6,887
626
604
467
428
688
468
468
481
470
487
461
678
242
21
88
SO
21
U
18
8
21
12
U
26
Distribution of tuberculosis according to &ge periods, State, urban and rural
by percentage to total cases in each locality.
State.
Urban.
2.8
2.8
1.4
1.4
1.7
1.8
8.2
8.1
16.1
14.8
15.8
15.7
18.4
18.7
18.7
18.0
8.7
8.1
6.1
8.4
5.2
6.8
2.8
2.8
2.4
2.2
2.7
2.7
Rural.
Under 6 yean
6 to 8 yean,
10 to 14 yean
16 to 18 yean
20 to 24 yean. ....
86 to 28 yean, ...
80 to 84 yean
86 to 88 yean, ....
40 to 44 yean
45 to 48 yean
50 to 54 yean. ...
66 to 68 yean, ....
80 to 84 yean, ....
66 yean and over,
2.8
1.8
1.6
U.2
18.8
18.0
U.O
14.2
4.0
4.0
4.2
0.8
4.0
2.8
Digitized by VjOOQIC
844 SECX>ND ANNUAI^ REPORT OF THE Off. Doc.
Distribution of Tuberculosis by Nativity and A«e Periods.
Aliases.
»-4.
»-».
10-19.
80-29.
80-38.
40-48.
60-69.
60-68.
TO.
Un.
Native
t,no
m
<7
46S
1.818
1.014
628
869
116
88
80
Wonigu,
1.187
<
S
86
408
876
868
ue
68
28
81
Unknown, ...
m
18
<
48
178
168
97
TO
87
8
79
Distribution of Tuberculosis by Color and Age Periods.
AUages.
0-4.
6-9.
30-19.
»-89.
80-89.
40-49.
60-69.
60-89.
TO.
Un.
S2&!' ..::::::
Cblor unstat-
ed
476
66
188
84
8
66
14
1
6U
66
7
1.646
140
11
1.427
114
14
819
64
4
440
89
6
199
U
71
8
1
170
11
8
Tuberculosis by Sex and Color.
All colon.
White.
Black.
Color un-
stated.
Total, T".r t r
6.019
8.464
2.666
6,488
8.164
8.884
476
880
816
66
wmnaJtm **'!!'!**!!!*----'---!*----!*!""--!--!!!!!"
89
86
Digitized by VjOOQIC
The Sub-Division of Marriage Statistics
In Charge of WIIiMBR R. BATT, M. D., Registrar.
(345)
Digitized by VjOOQIC
(M«)
Digitized by VjOOQIC
OFFICIAL DOCUMBNT, No. 16.
MABRIAGES.
60^243 marriages were recorded during the year, an increase of
916 as compared with 1906. The number of persons married per
1,000 of population was 17.1. This rate is identical with the previous
year and the intensity of the marriage movement, as measured by
the number of persons married in proportion to those capable of
contracting marriage, remains practically unchanged.
One male in every 15.8 of unmarried males of marriageable age
contracted marriage, and among females one in every 12.4. The
average age at which marriage was contracted shows a slight in-
orease over the previous year, being for brides 24.7 years and for
grooms 27 years.
Probably no other single factor plays so important a part in the
decline of the birth rate as the increasing age at which marriage
is contracted. This condition prevails to a greater extent among the
native population than it does among the foreign born.
Of the native brides, 63.6 per cent, were less than 25 years of age
while the percentage for the same age of the foreign brides was 74.9.
Of the total, there were among brides 55,488 first marriages, 4,665
i0econd marriage, 86 third marriages and 4 fourth marriages.
Among the grooms there were 54,476 first marriages, 5,597 second
marriages, 159 third marriages, 10 fourth marriages and 1 fifth mar-
riage.
Of the 4,775 second or more marriages among brides, 3,679 had
been previously widowed and 1,076 divorced. Among grooms, 4,856
had been widowered and 911 divorced.
Table 1 shows the number of marriages in each county of the State
by months with totals for the entire State.
Table 2 shows the marriage rate for each county in the State.
Table 3 shows the ages of brides and grooms with nativity.
Table 4 shows the percentage of brides and grooms by age periods.
Table 5 shows the percentage of marriages by months.
Table 6 shows the number of marriages by age periods for brides
and grooms.
(147)
Digitized by VjOOQIC
M
SBCOND ANNUAL RBaPORT OP THfi
Off. DoCl
1
% Sg99SI Ht^^M e^9si9 ttUMS 8S&S9 g^K^H fl«&»S
1
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Digitized by VjOOQIC
ffo. 16.
COMaflSSIONER OF HEALTH.
t4t
a^'SS 5»«^-« sftp«s B'^^gs t-ttrtR 8ag;sa $§
gastts ^aass gsgss g-;33a s^kss wasg •«
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Digitized by VjOOQIC
860
SECOND ANNUAL. REPORT OF THE
Off. Doc.
TABL.B 2.
Number of PersonB Married to Each 1,000 of Population for Bach County.
Adams,
Allegheny, ..
Armatronff, .
Beaver,
Bedford,
Berks,
Blair,
Bradford, . . .
Bucks
Butler,
Cambria, ....
Cameron, ...
Carbon,
Centre,
Chester,
Clarion,
Clearfield, ...
Clinton
Columbia, ...
Crawford, ...
Cumberland,
Dauphin
Delaware, ...
Elk
Erie,
Fayette,
Forest,
Franklin, ...
Fulton,
Greene,
Huntingrdon,
Indiana
JefTerson, ....
Juniiita,
12.2 Lackawanna, 17.3
22.1 Lancaster, 16.9
16.9 Lawrence 16.9
20.1 Lebanon 17.8
18.6 Lehigh, 27.2
18.7 Luzerne, 14.6
21.1 Lycoming 18.8
10.6 McKean, 7.8
11.8 Mercer, 19.6
21.2 Mifflin 20.9
22.6 Monroe 14.4
16.6 Montgomery 14.8
16.2 Montour, 14.0
16.2 Northampton, 19.9
13.8 Northumberland 16.9
12.7 Perry 16.6
16.8 Philadelphia, 17.6
15.9 Pike 6.8
16.7 Potter 6.0
13.6 Schuylkill, 17.9
16.3 Snyder, 17.6
22.7 Somerset 17.8
16.2 SulUv^n 9.1
11.1 Susquehanna 18.0
14.3 Tioga 7.8
18.7 Union 15.7
8.7 Venango, 16.6
18.3 Warren 10.0
10.5 Washington, 18.0
14.1 Wayne 9.0
17.8 Westmoreland, 16.6
22.2 Wyoming 10.6
18.9 York, 16.0
17.7 Entire State 17.0
Digitized by VjOOQIC
No. 16.
COMZMISSIONBR OF HEALTH.
861
TABUD 8.
Marriages by Nativity and Ages of Brides jSJid Grooms.
AVM.
BrldM.
I
I
I
Under IS.
1S-1>
60-34.
70-74
75+
Affe unstated,
Total 00.248
76
48
11,607
7,880
80,260
10,189
10,281
0.610
8,770
2,686
2,024
1,288
090
690
006
884
861
211
108
90
84
47
80
21
U
7
4
8
1
86.846
17
1.760
8.827
2,127
001
424
289
126
66
87
18
7
2
1
1
14,828
15
2,460
4,790
1,548
660
811
165
80
80
85
18
8
2
10.070
2
1,940
26,668
18,288
0,768
8.297
1,648
1.166
088
897
262
148
68
22
8
60.248
1
1,447
14,268
9,418
4.008
2.026
898
708
861
227
148
88
46
U
8
88.798
1
00
6.888
0,020
1,087
780
401
276
140
92
40
28
7
8
418
4,657
2.846
M8
171
U7
78
66
25
t
9
10,064
Brides. Qrooms.
TABLE 4.
The {Percentages of Brides and Grooms In Ejach Age Period <to Total Brides and
Grooms.
Under 15,
16 to 19 years,
20 to 24 years,
26 to 29 years,
30 to 34 years,
86 to 39 years,
40 to 44 years,
46 to 49 years,
Over 60 years,
0.18
0.08
19.2
8.2
60.2
42.6
17.0
80.8
6.8
11.2
3.4
5.6
1.7
2.7
1.0
1.9
1.1
2.6
TABLE 6.
The Percentage of Marriages in Each Month of the Year to Total Marriaflres.
January, .
February,
March, ...
April, ....
May,
June,
7.1
6.8
6.3
8.9
7.2
18.4
July
August, ...
September,
October, . . .
November,
December,
7.1
7.6
8.6
10.1
9.6
7.4
Digitized by VjOOQIC
362
SECOND ANKUAL REPORT OP THE
Off. Doc.
TABLBC
The Number of Marria£re by A^e Periods for Brides and Grooms.
BridM.
aroonw.
i
1
I
i
t
t
i
1
i
t
t
i
AggngtLtB, ..
Under IS
15-M
»-M
>6-»
ao-S4
85.»
40-44
46-49
GO-64,
66-»,
«M4
<6-<9
70-74
75+
Ase UDBtatad,
eo.MS
76
11.6S7
4,666
86
4
U,6«T
39
1
ao.»6
S9.759
496
2
10.291
9.97S
906
8
8.776
X899
900
7
2.0M
1.199
875
10
901
401
679
U
O06
197
896
18
962
90
247
13
2
Itt
SB
127
IS
84
18
61
4
1
96
9
25
a
u
11
8
4
1
1
».»
54.476
1.949
K.488
17.681
5.768
779
418
111
44
19
9
8
8'
5.587
169
10
1
18,288
170
600
988
1,010
845
710
480
824
216
119
50
80
8
18
14
18
84
86
28
15
14
5
1
6.768
8.207
1.648
867
268
148
68
1
8
' "i*
8
1
88
8
t
Digitized by VjOOQIC
The Division of Distribution of Biological
Products
HENRT W. PBUR80N. Chief.
(3SS)
Digitized by VjOOQIC
(854)
-^^ Digitized by VjOOQIC
Digitized by VjOOQIC
Digitized by VjOOQIC
OFFICIAIi DOCUMENT, No. 16.
THU DIVISION OF DISTRIBUTION OF BIOLOG-
ICAL PRODUCTS.
DIPHTHERIA ANTITOXIN.
The total number of cases treated among the indigent throughout
the entire State during the year 1907 was 5^71, of which number
only 376 resulted fatally, showing the remarkably low death rate
of 7.13 per cent., a decrease over the year 1906, of exactly 4 per cent.
A comparison of results obtained for the year 1906 and 1907 will
be found in the ''Summary of Observations upon the Use of Diph-
theria Antitoxin for the year 1907," on page 367 of this report and
much interesting information in detail taken from the clinical re-
ports received from physicians, will be found in the tables beginning
on page 370.
The distribution of Antitoxin to the indigent of the State by
the Department of Health began in October, 1905, but the establish-
ment of distributing stations and the appointment of distributors
did not take place until November 4, 1905, when 473 distributors
were appointed at convenient points in every county in the State,
outside of the cities of Philadelphia and Pittsburg; most of them
being duly registered druggists with the exception of a few physi-
cians appointed at places where no drug stores were located.
The number of stations was increased as the actual need for same,
after careful investigation, became apparent to the Department, and
at the end of December, 1906, numbered 511, an increase of 38 in
a little over fourteen months' time.
The demand for additional distributing stations during the year
1907 became so imperative that the Commissioner of Health felt
it his duty to increase the number already established, and December
31, 1907, found us with a total of 529 distributing stations, an in-
crease of 18 over the year 1906. It must be borne in mind, however,
that all of these 529 distributing stations are not active at any one
time, though such, of course, might be the case.
In this connection it might be well to state that, notwithstanding,
the additional number of distributors appointed during 1907, there
are on file in the Dex>flrtment over one hundred written communica-
tions recommending additional distributing stations at various
(S6S)
Digitized by VjOOQIC
S6€
8BCX>KI> ANNUAL* lUBPORT OF THB
Off. Doc.
points throughout the State, some of which, at least, the Commis-
sioner of Health hopes to see his way clear to grant in the near
future.
A glance at the map to the left will give the reader a fair idea as
to the locations of the distributing stations now existing and the
accompanying list gives the names of the distributors appointed to
December 31, 1907.
DISTRIBUTORS OP DIPHTHERIA ANTITOXIN APPOINTED
BY THE COMMISSIONER OP HEALTH.
Antitoxin either for curative or immunizing purposes and in appro-
priate doses may be secured by physicians practicing in this Com-
monwealth upon their agreeing in writing that no charge of any
kind is to be made for the Antitoxin, and that the person or persons
for whom it is obtained are indigent in the sense that they cannot
procure the necessities of life and at the same time purchase Anti-
toxin, and also that the physician will send to the Department of
Health a full clinical report as specified by the Commissioner of
Health.
ADAM0 COUNTY.
Auker, Bdward T., New Oxford. Stover, Dr. J. G., Benderaville.
Bueliler, Li. "M., Gettysburff. Trout, Dr. N. G., Fairfl^d.
Caahroan, EUmer W., York epringa. Wolf, CliarleB S., Bast Berlin.
Kemi>, Dr. J. S., Llttlestown. Wolff, W. E., ArendtaviUe.
ALl4E)QHB>NY COUNTY.
Bums, H. W., Ooraopolia.
C6vell, a W., WUklnaburff.
Doyle, J. J., Caatle Bhannon.
ForBythe, Geo. W., Natnnia.
GoldBxnltb's Pbarmacy, Tarentum.
Hasrm^er, Mllo M. & Co., Pltcalm.
Hollander, JVw. M., Braddo<^
Kelley & Havekotte, Sharpsburg.
Itel, Albert I., McKees Bocka.
McClaren'a Pharmacy, GUuwport.
Paules, J. X*., HomoBtead.
Bliaffer, P. T. B., Misabetb.
Sprowl's Pharmacy, Turtle Cre^E.
Swearlnfiren, W. H., Bellevue.
Thompoon, Htarry M., Carnegie.
Walker's Prescription I%armacy, Mic-
Keesport.
Whlteley, W. 8., Verona.
ARMSTRONG COUNTY.
HooYer, A. M., Parker's Ltandlng. Sharp & Borland, Dayton.
McClelland Bros., Ford City. Sturgeon, W. J., Kittanning.
Parks, J. H., Leeohburg. Wray, Frank T., ApoUo.
BB3AV(BR COUNTY,
Aber, O. C, Industry. Kaye, Walter D., Monaca.
Bebout, W. I., Darlington. Neubig, Chaa. J., Rochester.
FltBgerald, Thos., Ambridga Pugh, Frank 8., Hookstown.
Hoffman, W. A., Beayer VWls, Beaver. Schweppe, H. Li., New Brighton.
Digitized by VjOOQIC
Mo. 16. COliMIflSIONBR OF HBAL.TH. 867
BESDFORD CX)UNTT.
Alexander, W. A., Sverett. Shaffer A Conrad, Osterburg.
Grubb A Welmer, Cle&rville. Stayer, Irvln C, Woodbury.
Jordan, F. W., Bedford. Tewell, A. U, ChaneysvlUe.
Rhodes, C. R., Hyndman. Zeth, Jno. Im, Hopewell.
Saxton Druff Store, fiaxton.
B&RK8 COUNTT.
Hoffman, Nicholas J., Birdsboro. Sehomo, Chas. C, Hamburg.
Landi», F. T., Womelsdorf. Sellers, K. J., Kutztown.
Mayer, Irene F., Boyertown. Werley, Charles D., Topton.
R,a8er, Wm. H., Reading.
BLAIR COUNTT.
Boecklng, G. C, Tjrrone. Hair, Eld ward. Roaring Spring.
Boecking & Meredith, Bell wood. Heae, I. C, Dttncanaville.
Boecklng & Meredith, AHoona. Ketring, D. T., WiUiainabttrg.
Butler, John P., Altoona. Sanders, J. C, Martinsburg.
Davis, 'H. I., HoUidaysburg.
BRADFORD COUNTY.
Allis, I. IC, Wyaluslng. Lomaz, F. F., Monroeton.
Billings, F. T. & Son, !« Raysville. Paasmore, John £., Gillett.
Carpenter & Pierce, Troy. Porter, Dr. H. C. & Son, Towanda.
Francke, £X O., Athens. Whitman, W. W., Canton.
Jump, H. D., Sfayre. Wilcox, Ray S., Niew Albany.
Laquln Lumber Co., Laquln.
BUOKS COUNTY.
Hellyer, E. F., Newtown. Pryor, William B. T., Langhome.
Hulshiaer, E3st. of Martin, Doylestown. Pursell, Howard, BrlstoL
Johnson, Dr. H. W., Riegelsville. Williams, N. B., Perkasie.
Moyer, Howard R., Quakertown. Willard, S. B., Yardley.
Pryor, Frank C, MorriSTllle.
BUTLiEni COUNTY.
Edmonds, A. J., Bruin. MerBhon, E. B., Saxonburg.
Hall, Amos, Branchton. Redlck & Grobman, Butler.
Hindman, H. C, West Sunbury. Thomas, J. D., Eivans City.
May bury A Pisor, Slippery Rock.
CAMBRIA COUNTY.
Baird, Mrs. Carrie, Dunlo. Morris, H. A., Bamesboro.
Berry, Chas. L., Johnstown. Perley, R. P., Allendale.
Davis, CyruB W., Conemaugh. Reed, K. A., Gallltzin.
Gunn, John A., Patton. Sible, Im A. A Co., Johnstown.
James, IX A Son, Bbensburg. South Fork Pharmacy, South Fork.
Kefler, W. O., Frugality.
CAMERON COUNTY.
Barclay Bros., Slnnemalhoning. Taggert, L. T., Emporium.
Mitehell, Wm. H., Driftwood.
CARBON COUNTY.
Albert, Htoward, Lansford. Latham, Peter H., Weatherly.
Davis, Thomas B., Summit Hill. Mauch Chunk Pharmacy, Ifauch
Gilham, S. R., Lehi^ton. Chunk.
Hess, J. M., BsM Mauoh Chunk. Watklns, William R., Nesqueltfonlng.
Hess A Browell, FaliDsrton.
Digitized by VjOOQIC
S58
BBCONB ANNUAL KESPORT OF THB
Off. Doc.
Green, F. PsottB, BeUefonte.
Meek, H. D., State O^leire.
Melick, W. M., FOillliNiburff.
ODNTRI} CX>UNTT.
Meyer, Thomaa F., Mlllheim.
Murray, Jared D., Goiter Hall.
SIckel, William A., Snow Sboe.
CHB3STESI OOUNTT.
Aiken, James, Berwyn. Seltser, Cb^«. J., Parkesbur^.
Hudson, Thompson, Hopewell borouffh. Taylor, W. C, Sprinir City.
Hutchison, David W., OS. Downington. Thatcher, Jesse, West Chester.
McCuUough, C. B., Oxford. Walton, G«o. R., Maly^m.
Megilliffan, Mrs. H. Y. Avondale. Youncr, W. 8., OoatesvlUe.
Oberholtser, Im, Sons St Co., Fhoeniz-
nue.
CLARION COUNTY.
Corbett, W. W., New Bethlehem.
Coulter, Mrs. N. S., Bligo.
Craig, J. S., St. Petersburg.
Greer, Dr. R. J., Bast Brady.
Hoch, W. H., New MayvUle.
Kuhns, G. W., Leeper.
Mooney, John A., CurUsviUe.
Reid's Drug Store, Clarion.
Whitlinff, W. H., Knox.
CL»B5ARFIB1LI> COUNTY.
Currier, Dr. J., Grampian.
Davidson, T. If., Mahaffey.
Fleffal, Dr. J. 8., Karthaus.
Glen Richey Ttiadingr Co., Glen Rlchey.
McCartney, W. C, Coalport
Miller, Dr. S. J., Madera.
Phoenix Drug Store, Houtsdale.
Quinn, J. S., Du Bois.
Read, F. B. A Co., Osceola Mills.
Shucrert, H. C, Morrifldale Mines.
Spackman, Dr. J. P., Peale.
Tyler Mercantile Co., Tyler.
Wlnbume Pharmacy, Winburne.
Woodward & Brenner, Cleajrfleld.
Wrigley, W. K., CurwensvlUe.
CLINTON COUNTY.
Hillton & Heffner, Lock Haven, Swain Dru^ Co., Renovo.
McGhee, John, Beech Creek. Waits, Frank, Flemlngton.
Mervine, Dr. Graydon D., Bitumen. Valley Drus Store, Mill Hall.
COLUMBIA COUNTY.
Clewell & Currin, Berwick. Goldsworthy, John W., Centralia.
Bly, Chas. S., Millville. McHenry, Dr. M., Benton,
Fisher, J. F., Catawissa^ Rinfl^er, Gko. iP., Bloomsburff.
CRAWFORD COUNTY.
Ea^terwood, F. K., Meadville. Stratton, George, LinesviUe.
Fisher & Fisher, Sprin^boro. Wilkins & Kemble, Titusville.
Lydell, James, Cambridge Springs.
CUMBERLAND COUNTY.
Central Drug Co., Mt. HoUy fliprings. Emrick, B. F., Carlisle.
Claudy, R. B., Newville. Fleming & Fleming, Shippensburg.
Eckels Bros., Mechanicsburg.
DAUPHIN COUNTY.
Coble, A. C, Dauphin.
Davis, T. B., Williamstown.
Felty, WifaEK)n, Linglestown.
Gross, E. Z., Harrisburg.
Hay, John W., Harrisburg.
KiUough, S. M., Hummelstown.
Hunts, John H., West Hanover.
Peters, D. A., Steelton.
Rewalt, J. W., Mididletown.
Smith, A. M. & Co., Halifax.
Steever, Charles C, Millersburg.
Stroup, N. W.. Eliaabethville.
Zimsnerman, H. M., Derry Church,
Digitized by VjOOQIC
No. K. COICMISBIONSR OF HEAX.TH. 86»
DEtAWARE COUNTY.
Cloud, Harlan, DiEurby. Grafstrom, C. J., Llanerch.
CoiK»rdYilte Supi^y Co., Conoordvllleb Hadley, H. C, Wayne.
Dalton, D. A., Upland. Kershaw, Harry, Cheater.
Davis, Harry M., LAnsdowne. Rea, J. H., Chester.
Ellis, Wardle, Media. Shirer, V. C, Swarthmore.
BliK COUNTY.
Amend, John, Wilooz. Qulnn A Smith, Johnsonburir.
Bennett's Bi^anoh Bupply Co., Dent's Ross Dru^ Co., Ridgway.
Run. Sharp, W. N., Hallton.
litthr, F. A., 8t liary*.
ERIE COUNTY.
Ames, N. F. St Co., Corry. Lioop, Q. D., Northeast
Andrews, W. C, Erie. Newman, A. C, Albion.
Frants, G. A., Edinboro. Smith, A. R. & Co., Girard.
Gates, William, Uliion CHy. Wilklns, R. B., Wattsburg.
FAYETTE COUNTY.
Bulffer, H. H. & Co., Brownsville. Rathmell Broa, Cadiwallader.
Dunaway, M. G., Fairchanoe. Springer, R. E., Unlontown.
Feather, G. A., Smithfleld. Steele Pharmacy, Fayette City.
Huston, Frank, ConnellsviUe. Sterling, Jesse A., Ma4K>ntown.
Oglevee, F. E., V^anderbUt. iStoufler, Jas. C, Dawson.
FOREST COUNTY.
Detar, C. Y., Kellettville. May burg Sui>ply Co., Miayburg.
Dunn, J. C, Tionesta* Neill, A. D., Marienville.
Fehlman, Li. A., West Hickory. Ingersoll, J. E., Lynch.
FRANKLJN COUNTY.
Qarl, Chas. B., Greencastle. Montgomery, J. C, Chambersburg.
Krebv, Harry B., Meroersburg. Skinner, H. W., Chambersburg.
Millier, D. "U, Waynesboro.
FULTON COUNTY.
Barton, C. J., Hustontown. Dickson, W. S., McOonnellsburg.
Cunningham, N. G., New Greneda.
GRBENiB COUNTY.
Gibbons, Dr. A. J., Carmicfaaels. Ullom A Bailey, Waynesburg.
Hatfl^d, G. W., Mt Bfiorria
HUNTINGDON COUNTY.
Grove, Hiarry R., Alexandria. Steel, H. E., Huntingdon.
James, G. W. C, Orbisonla. Wolfe, D. R., Birmingham.
Minnlck, J. M., Mount Union. Wright, Geo. W., Mapleton Depot
McClaln, Jesse O., Robertsdale.
INDIANA COUNTY.
Allison, Elmer W., Indiana. Miller, M. G., BlairsviUe.
Conner, Jno. B., Glen Campbell. Park, L. N. & Son, Marion Center.
Fisher, James, Rossiter. Rink, Chas. B., Shelocta.
Qoodlin, Elmer K, Saltsburg. ^ephens, T. D., Penn Run.
McOuUough, H. Li., Cookport Truby, S. H., Brush Valley.
Digitized by VjOOQIC
SeO SECOND ANNUAL. HBPORT OF THB Off. Doo.
JWrFESBSON COUNTY.
Guthrie, H. F., SommervUle. Miller » J. A. & Son, Hamilton.
HjEunllton, Dr. S. 8., PunzButawney. Punxsutawney Dniff Co., Punxsutaw-
Henderson A Cral^. Brookvllle. ney.
Hump4ireyB, G. H., BrockwayviUe. Stoke A Feicbt Druff Co., Reynolda-
Kunselman, M. J., Coblsprins. vllle.
Mahoninff Supply Co., Eleanor.
JUNIATA COUNTT.
Banks, W. H. & Co., Mifflin. Heckerman'e Dru«r Store, Port Royal.
Crawford, M. P., MUIttntown. McMeen, J. B., East Waterford.
Hainefl, W. H., Ttaompsontown.
LACKAWANNIA COUNTY.
Bone, J. G. A Son, DuanHore. Jenkins, Geo. W., Scranton.
Davis, Jos., T^aylor. Koemipel, Carl, Scranton.
Dennis, F. E., Oarbondale. Tiffany, F. M., Dalton.
Foote, M. A., Archbald, Watkins, C. J., Olyphant.
Graves, J. M. & F. M., Jermyn.
UlNCASTER COUNTY.
Buoher, W. U, OoIumbMu Quarry vllle Drucr Co., QuarryviUe.
Dierolf, Chas. B., Elisabethtown. Reeder, Dr. If. T., MillersviUe.
Fry, H. P., Litits. Royer, G. S., Ephrata.
Garber, EUmer W., Mount Joy. Ruhl, H. F., Manbelm.
McCloskey, C. E., Marietta. Weaver, J. G., Strasburg.
Miller, J. A., Lancaster. Wendle, Samuel S., Christiania.
LAWRENCE COUNTY.
Jewell A Martin, New Wilmington. Palace Druff Store, Ell wood City.
McKinley A Frants, New Castle. Shields, F. O., New Bedford.
Mooxliead, Frank B., Volant.
L.EBANON COUNTY.
Bofirer, Chas. E., Lebanon. Light, D. K., Palmyra.
Kline, William C, Myerstown. Soabold, W. S., AnnviUe.
liEHIGH COUNTY.
Backenstoe, M. J., Emaua Horn, Chas. W., Slatinfirton.
Bamdt, Mrs. S. K., Alburtis. Kelper, H. U, Allentown.
Dundore, Harry W., 'Emaus. Lawall Bros., CaAasauqua.
Horn's Drug Store, Coplay. Mohr, John J., Fogelsville.
LUZERNE COUNTY.
Brlffgs, Dr. J. F., Shickshinny. Grover, M. E., Freeland.
Colbom, W. T., Ashley. James, Henry H., Parsons.
Dur bin's Keystone Fhar., Plymouth. Mans, H. W., Hasleton.
Edwfards, EX J., Drifton. Meyer, R. H., NIantiooke.
Evans, Wm. E., ICaltby. Renniman A Co., Avoca.
Farrer A Peck, Plttston. White, W. D. A Co., Wilkes-Barre.
LYCOMING COUNTY.
Harter, C. W., Muncy. Staples. B. E., Jersey Shore.
Miller, John L., Montgomery. SutUff, J^cob, HugtiesviUe.
Mintser, Dr. U H. C, Ralston. Walton, U L. & Co., WilliamspoFt
Digitized by VjOOQIC
No. If.
COMMISSIONER OF HEALTH.
3fl
McKEAN COUNTY.
Hogarth, I^ K.» Smethport Nourse, W. J., Mt. Jewett.
Kane Drug Co., Kane. Thompeon & Wood, Bradford.
MillB, John C, Duke Center. Williams, J. H., Port Allegany.
MERCER COUNTY.
Crawford, C. E. J., Jamestown.
Donaldson, Li. W. & Co., Jackeon Cen-
ter.
Forker, W. J., Grove City.
Good, J. R., Mercer.
Grillln, John Li. Fredonia.
Hines, J. P., Stoneboro.
J/Bu:k0on, T. C. Hadley.
Liewis, A. E., West Middlesex.
Martin, E. K. & Son, SheakleyviUe.
Steele, H. A. G., Sharon.
Wert, Harry D., Greenville.
MIFFLIN COUNTY.
Bishop, D. K., Milroy. Muthenibough, J. A., Liewistown.
FuKs, Allen, Wagner. Roche, William F., McVeytown.
McDonald, J. A., Reedsville. SIhaver, Henry B., Newton Hamilton.
MONROE COUNTY.
Chamberlin, Edgar W., Mt. Pocono. Seguine, J. A., Cresco.
Red CrosB Pharmacy, East StroudB- Trezler, Dr. J. A., BrodheadsviUe.
burg. Trach, Dr. D. C, Kresgeville.
Rhoads, Dr. Geo. H., Tobyhanna. Wertman, Dr. A. A., TannersvlUe.
MONTGOMERY COUNTY.
Beshore Drug Com(pany, Pottstown.
Bunting, E'rank, Souderton.
Craig, Jamea D., Fort Washington.
Cttlbert, Jos. W., Collegeville.
Husisard, Curtis, Norristown.
King, A. J., Ardmore.
King, L. Stanley, Bala.
Kuhns, E. J., Liansdiale.
McLaughlin, Harry A., Jenkintown.
Medico Drug & Chemical Co., Royers-
ford.
Mensch, James G., Pennsburg.
Moore, Christian, Est, Bryn Mawr.
Neville, William, Confl(ho4iocken.
Pennepacker & Bromer, Schwenkvllle.
Roth well, Walter, Hatboro.
Tiefenbach, J. T., North Wales.
MONTOUR COUNTY.
Gosh, J. D., & Co., Danville.
NORTHAMPTON COUNTY.
Burkhiart, H. A., Bethlehem.
Eisenhart, E. K., Bangor.
Heller, H. D., Hellertown.
Jacoby, Cyrus, South Bethlehem.
Miller, S. R., Bath.
Scheffler, J. S., Pen Argyl.
Weaver's Pharmacy, Eiaston.
Yale, Ellsworth W., Siegfried.
Yeakel, Nelson L., & Co., Nazareth.
NORTHUMBERLAND COUNTY.
Armstrong, William K., Sunbury.
Clarkson, T. R., & Co., Shamokin.
Dunn, John B., Watsontown.
Keiser, Ew L., Milton.
Krebs, J. S., Hemdon.
Mengel, J. S., Trevorton.
Samuel, Dr. E. W., Mt. Carmel.
Standard Drug Store, Mt. Oarmel.
Wenck, S. M. G., & Son, Northumber-
land.
POTTER COUNTY.
Chapman, G. F., Genesee.
Cool, W. F., Roulette.
Gilbert, W. E., Harrison Valley.
Lane, H. K., Ulysses.
Lyon, G. W., Shingle House.
McQee & Miller, Costello.
Meine, Dr. Ch^ui., Germanla.
Richardson, L., Cross BV>rk.
Robertson, J. W., Galeton.
Stanford, W. F., Au^in.
Thompson, M. S. ft Co., Coudersport.
Digitized by VjOOQIC
Se2 SECOND ANNUAL. RSPORT OF THB Off. Doo.
PIKB COUNTY.
Armmtrong, C. O., MUford. Shannon, W. R., Lftokawaxen.
FERRY COUNTY.
Rby, B. M., Newport. Liehman, B, W,, Dunoannon.
Jobnflon, A. R., New Bloomfleld. Sliuler, S. M. ft Sons, Liverpool.
Daiir, J. B., Millerstown. Zimmerman, Thaddeue, IckeBburg.
Lakin, Dr. H. A., New Oermantown.
SCHUYL.KIIJL. COUNTY.
Beck, Charles F., Cressona. Holt, William. P., FrackviUe.
Benalnsrer, O. I., Schuylkill Haven. Houck, Paul W., Shenandotali.
Broiwn, Qeo. Ia, Minersville. Krebs, H. J., Mahanoy City.
Coble, Dr. J. W., Tamaqua. People's Pharmacy, TTemont.
Co wen, William S., Pottavllle. Sutton, John, Pine Grove.
Depew, J. A., Deliano. Monafi:han, Dr. W. J., Qii^rdville.
Driebelbis, G. W., Tower City. Williams, R. J., Ashland.
SNYDER COUNTY.
Charles, Jerry, Freeburfir. Wagner, J. O., Beaver Bprings.
Spanffler, W. H., Mlddleburg. Wagenseller, George D., Selinsgrove.
Ulsh, Clavin, Mcdura
SOMERSET COUNTY.
Brallier, J. J., Berlin. Mountain's Pharmacy, Confluence.
Dobson, G. Ia, Stoyestown. Picking, J. 8., Somerset.
Gross, Wm. H., Boswell. Pollard, R. T., Q>arrett.
Home Drug Co., Windber. dembower, A. J., Markleton.
Jacobs, Dr. T. J., Somerfleld. Thomas, F. B., Meyersdala
McCormick, Mrs. D. H., Rockwood.
SULrUVAN COUNTY.
HofCa, Chas. W., Dushore. Liopes Drug Co., Lopes.
Lancaster, H. D., Forksville. Voorhees, C. D., Sonestown.
SUSQUEHANNA COUNTY.
Davis & Allen, Forest City. Sands, F. £2. & Co., Hallstead.
French, A. P., Susquehanna. Taylor, A. J., Hopbottom.
Morris, F. D., Montrose.
TIOGA COUNTY.
Babcock, W. C, Blossburg. Fessler, T. A., Blkland.
Bates, John P., Mansfield. Gilbert, F. L., KnoxviUe.
Blatchley & Campbell, Wellsboro. Holcomb, Frank B., Westfleld.
Darling's Pharmacy, Lawrenceville. Wells, J. Bi, Tioga.
UNION COUNTY.
Baker, Dr. T. D., Lewlsburg. GMver, O. W. H., Laurelton.
Galloway & M«ek, AUenwood. St^ns, J. C, Miflllnburg.
VENANGO COUNTY.
Curtis, L. C, Utica. Straihl, Henry, Petroleum Center.
Gosser Drug Co., Emlenton. Third Ward Pharmacy, Franklin.
Griffith, B. J., Oil City. Zeamer, H. C. PleaSantvllle.
McCllntock Co., The, Kennerdell.
Digitized by VjOOQIC
NalC
COMMI88IONBR OF HEAL.TH.
8<S
WARKESN COUNTY.
Clark* A. A., RueselL Pierce, Wm. S., Warren.
Kemble ft Son, C, Tidiaute. Pryor, G. T.» Bbeffleld.
McDonald, J. G.» Sugar Grove. Simpson Bro6.» North Clarendon.
WASHINGTON COUNTY.
Coulter & Oo., McDoi^ald. McMurmy, H. B., Burgettstown.
Domaldson, J. R, Canonsburg. Piper Bros., Oharlerol.
Hogsett Broe., Monongahela. Piper & Dague, Donora.
Horn, H. M., Washington. Retser, Charles, Hickory.
Jadwin, C. C,
Snyder, M. T.,
WAYNS COUNTY.
Honesdale. Stevens, W. A., Hamllnton.
Hawley. Tiilany, J. B., Pleasant Mount
WBSTMORISLAND COUNTY.
Broadway Drug Co., Soottdcde.
Coldsmith, C. P., Mit Pleasant.
Cook, J. G., New Alexandria.
Pink, George W., Irwin.
Fox, Chas. !}., Vandergrift
Preeman, J. W., Derry.
Pry, P. It., Mianor.
Hunnell, B. S., New Kensington.
Kirk, W. P., Monessen.
Martin, A. B., Greensburg.
Obley, H. A., West Newton.
Smith, Horace L., Jeanette.
Tessell Piiarmacy, Latrobe.
Wilson, J. M., New Florence.
Wilt, R. A., Ldgonier.
Zimmerman, W. J., Delmont.
WYOMING COUNTY.
Besteder, Charles, Center Moreland. Sickler, H., Tunkhannock.
Reynolds, Oscar J., Nicholson. Tibbins, George H., Noxen.
YORK
Britcher, Milton W., Dillsburg.
Emlet ft Jenkins, Hanover.
Cable, John W., Hellam.
Selts, J. E., Glen Rock.
Grove, J. H., New B*reedom«
Hoke, Martin, Spring Forge.
Lafean, A. H. ft Bro., York.
Meyers, G. A., Dallaetown.
Moody, C. W., Red Lion.
OOUNTY.
Mull, Harry, Stefwartstown.
Murphy, J. C, York Haven.
OvermiUer, N. Allen, E3ast Prospect
Stacks, A. Homer, York.
Stable, R. S.. EmigsviUe.
Smith, Samuel S., Windsor.
Stewart, T. D., Delta.
Tinsley, G. S., WrightsviUe.
Wallace, N. G., Dover.
' Digitized by VjOOQIC
864 SECOND ANNUAL REPORT OF THE Off. Doc
0OMMI8SION.
Form A. D. No. SS.
CX)MMONWEALTH OF PENN9YX.VANIA.
DEPARTMENT OF HEALTH.
Diphtheria Antitoxin Division.
Know all Men by these Presents, that
residing at in the county of
State of Pennsylvania, ha this day of 190..
been duly appointed Distributor of Diphtheria Antitoxin, at
County , Pennsylvania, under the rulee of the Department
of Health.
(Seal)
Commissioner of Health.
METHOD OF DISTRIBUTION.
After appointment the Distributor is furnished with an initial
supply of seniniy consisting of Ave packages of Antitoxin of l^OOO
nnits and five packages of 3,000 units, together with blank forms,
stamped envelopes, etc., necessary for its distribution; copies of
which forms appear hereafter.
The physician discovering a case of Diphtheria anywhere in his
locality among the poor, has but to go to the nearest druggist who
is a distributor, sign a receipt and secure all the Antitoxin he needs
for the treatment of the case or cases he has on hand.
Form No. 17-B.
COMMONWEALTH OF PENNSYLVANIA.
DE2PARTMESNT OF HEALTH.
APPLICATION AND RECEIPT FOR DIPHTHERIA ANTITOXIN.
190..
I hereby /acknowledge the receli>t of the following named aonounts ^f Dli^-
therla Antitoxin:
packages containing 1,000 unite. Laboratory Nob.,
packages containing 8,000 units. Laboratory Noa. ,
from Distributor, Addt'ess
in the name of the Department of Hecdtlt. I hereby certify that the persons
mentioned for whose treatment this Antitoxin is furnished are indigent and
unable to otherwise procure the same. I agree to make no charge for it directly
or indirectly, and if unused to return to the Distributor within ten days; also
to mail to the Department of Health, immediately upon termination, a clinical
report for each case, on the blanks furnished for this purpose.
We have in stock at this time:—
packages of 1,000 units.
packages of S,000 units. (Physician's signature.)
(AddreM.)
(Distributor's Signature.)
(FuU Addresa)
Digitized by VjOOQIC
No. IC COMIMI8BIONER OF HEALTH. 315
with blae stub for Distributor's record; being application and receipt
to be signed by tlie physician upon making application to the Dis-
tributor for Antitoxin for use on indigent patients in his locality
found stricken with the disease, which gives the exact number of
packages of Antitoxin, both 1,000 units, (immunizing) and 3,000
units (curative) taken by him, and which is forwarded to the De-
partment with Form No. 19, mentioned below. The blue stub is for
the Distributor's record of Antitoxin issued.
Form No. 17*B.
Blue Stub.
OOMMONWEAL.TH OF PE^NNBYXiVANIA.
DBPARTMSSNT OF HEALTH.
APBLIOATION AND RBOBIPT FOR DIPHTHERIA ANTITOXIN.
190...
I hereby acknkywle^e the receipt of the foUowlnfir n^uned amounts of Dlph-
tfherla Antltozin:
paxikagee oontaininff 1,000 units. Laboratory Nob.,
packages oootaininflT 8,000 units. Laboratory Nos
from Distributor, Adress,
in the name of the Department of Health. I hereby certify that the persons
mentioned for whose treatment this Antitoxin is furnished are indigent and
unable to otherwise procure the same. I agree to make no charge for it di-
rectly or indirectly, and if unusedl to return to the Distributor within ten
days; also to mail to the Dei>artment of Health, immediately upon termination,
a clinical report for each c^mc, on the blanks furnished for this purpose.
We have in stock at this time:—
packages of 1,000 units.
packages of 8,000 units. (Physician's Signature.)
(Address.)
(Distributor's signature.)
(Full Address.)
Dipiitheria AnUtoxin.
UniU,
tICanuftusturer.
Form A. D. No. 19.
COMMONWEALJTH OF PENN'A.
DSSPARTMENT OF HEALTH.
LahoraAory No.
Date within which the unopened vial
or attached irtip must be returned to
Distributor,
Diphtheria Antoxin, Units..
Manufacturer, Laboratory No...
Pteutient, Address
Date of use,
Physician's signature
Address
Distributor's signature,
Address,
This slip w^hen returned to Distributor
must be forwarded to the Depart-
ment of Health, together with the
application for the same.
SAMUEL G. DIXON, CV>mmissioner.
Digitized by V v^
866 BECX>ND ANNUAL REPORT OF THB Off. Doc.
This slip is found placed around the outside of the packages of
Antitoxin and is to be filled out by the physician using same; giving
name of patient and address, date of use, physician's name and ad-
dress^ distributor's signature and address, and to be forwarded to the
Department with Form No. 17-B above mentioned.
These slips, Forms A. D. No. 19, are filled out for 1,000 units im-
munizing and 3,000 units curative treatment, respectively; each slip
or Form A. D. No. 19 representing one package of either 1,000 or
3,000 units strength; having also printed thereon the Laboratory
number of the package of Antitoxin produced by the manufacturer.
Form A. D. No. 18b.
. . COMMONWBALiTH OF PSSNN8YX.VANIA.
DEPARTMiBNT OF BBAI/FH.
ClilNICAL. REPORT OF DIPHTHERIA TREATBa> WITH ANTITOXIN.
Use a separate blank for each case and forward immediately upon termination
of the same to the Department of Health, Harrisburg, Pa.
Patient's name, Address, County Pa.
Age, 8ez, Color, Date of first visit,
Was treatment inununising or cura;tiye7
If the treatment was immunising, answer only the following questions:
Date of treatment, No. of units used
How long had patient been ezix>sed to the disease?
Did Patient subsequently contract the disease (Yes or No.) ?
If the treatment was curative, answer the following questions:
Date of onset of the disease
SPECIFY EACH TREATMENT.
units used within hours of onset.
units used within hours after first treatment.
units used within hours after second treatment.
tmits used within hours after third treatment.
units used within hours after fourth treatment.
imits used within hours after fifth treatment.
State whether disease was Post-nasal, Tonsillar, Phanmgeal, Laryngeal.
(Specify by crossing out names of regions unafTected.)
State complications if any
State termination (Recovery or Death)
Number of persons in household Nunvber affected. . . .Number immunised. . . .
What was the probable source of infection?
Remarks
Distributor's Name Signature M. D.
Address
The above is the Clinical Report which gives the complete history
of the case from the beginning of treatment to either recovery or
death and which is to be signed by the physician and forwarded to
the Department.
Digitized by
Google
No. 18. COMMISeiONER OF HEALTH. 367
The three forms aboTe mentioned when properly filled out make
a complete record of each case of the distribution and use of Diph-
theria Antitoxin issned by the Department of Health to the indigent
throughout the entire State of Pennsylvania.
SUMMARY OP OBSERVATIONS UPON THE USE OF DIPH-
THERIA ANTITOXIN BY THE DEPARTMENT FOR THE
YEAR 1807.
CURATIVB TRffiATMBNT.
The statistics compiled as taken from the clinical reports received
from physicians covering the curative treatment of diphtheria among
the indigent for the year 1907, shovir a marked decrease in the death
rate over the year 1906, proving, conclusively, that the physicians
throughout the entire State have, during the year, taken heed to
the urgent requests of the Commissioner of Health, given from time
to time, to use Antitoxin as early as possible after onset of the dis-
ease and in larger doses.
It will be shown by a comparison of Table No. 1 for the year 1907,
with the same table for 1906, that 5,271 persons were treated for
diphtheria with only 376 deaths (an increase in number treated, of
1,742 over the year 1906); that the death rate has been decreased
from 11.13 per cent, in 1906 to that of 7.13 per cent, for the year
1907, (a reduction of 4 per cent.) Likewise it will also be noticed in
Table No. 1, for 1907, compared with 1906, in the treatment of cases
of diphtheria within the first twenty-four hours of onset, that the
death rate has been reduced from 8.78 per cent, in 1906 to 4.59 per
cent, in 1907; a decrease of a fraction over 4 per cent.; truly a most
gratifying result to the Department. In each succeeding day of
treatment after onset, comparing this same table for 1907 with 1906,
a reduction in the death rate will be observed until the fourth day
is reached, when a very slight fraction of an increase of the per-
centage of 1907 is shown over 1906; the fifth day treatment also
being lower than in 1906, while in the sixth day treatment a marked
increase is shown in 1907 over 1906, the seventh and eighth day treat-
ments for 1907 being much lower than 1906.
In Table No. 2, showing "Results of treatment of Diphtheria with
Antitoxin with relation to Sex and Age," it will be seen that 2,493
males and 2,778 females were treated for diphtheria in 1907, as com-
pared with 1,634 males and 1,895 females in the year 1906. It also
reveals the fact that in both years the greatest number of cases of
diphtheria occurred in children of both sexes between the ages of
5 and 9 years; the females predominating in 1906, with 642 females
to 696 males, and the males predominating in 1907, with 1,002 males
to 979 females.
Digitized by VjOOQIC
868 BECOND ANNUAL RBPORT OF THE Off. Doc.
In Table No. 3, showing result of treatment of diphtheria with
Antitoxin according to period of initial treatment after onset and
age, it will be found that, in addition to the increased number of
cases treated in 1907 over 1906, the number of recoveries amounting
to 1,278, treated within the first twenty-four hours, also occurred in
children between the ages of five to nine years; that the percentage
of deaths in cases treated in the first twenty-four hours of onset has
been reduced from 8.78 per cent, in 1906, to 4.57 per cent, in 1907,
which would seem to bear out the statement made in the first para-
graph, that physicians were using Antitoxin much earlier than in
1906.
In Table No. 4 showing treatment of diphtheria with Antitoxin
according to areas affected and period of initial treatment after
onset of disease, it will be seen that the largest number of cases
treated were of the type known as tonsillar diphtheria and number
1,696, with but 19 deaths; showing the lowest death rate of this
table, or 1.12 per cent. The highest rate of deaths in this table for
1906 was a combination of three types of diphtheria, ^'pharyngeal,
tonsillar and laryngeal," which produced a death rate of 32.05 per
cent. The highest death rate shown by this table for 1907 is 18.26
per cent., where the laryngeal type of diphtheria caused this per-
centage in a total of 482 cases treated, with 88 deaths. A compari-
son of the percentages of deaths of 1906 with 1907, for all cases of
the tonsillar type of diphtheria, shows 1.90 per cent, in 1906 as
against 1.12 per cent, in 1907.
In Table No. 5 showing result of treatment of diphtheria with
Antitoxin in the several counties by the months, for 1907, it will be
seen that diphtheria was prevalent in all of the sixty-six counties in
the State where Antitoxin was distributed to the poor, except Forest
and Fulton counties; that Lackawanna county heads the list with
the largest number of cases treated, or 649, with 33 deaths, and the
remarkably low death rate of 5.08 per cent. Allegheny county comes
second with 385 cases treated with 19 deaths, or a still lower death
rate of 4.93 per cent. Luzerne county is third with 322 cases treated
with 24 deaths, and a death rate of 7.45 per cent. The lowest death
rate is found in Armstrong county; where forty-eight cases were
treated with but one death, or a mortality of 2.08 per cent. Another
interesting feature shown by this table is that the treatment of diph-
theria in Butler county with 7 cases; Centre county with 16 cases;
Chester county with 46 cases; Crawford county with 20 cases; Erie
county with 27 cases; Juniata county with 4 cases; Lawrence county
with 87 cases; Pike county with 4 cases; Potter county with 6 cases;
Sullivan county with 16 cases and Union county with 7 cases, re-
sulted in each county in 100 per cent, of recoveries.
Digitized by VjOOQIC
Diagram showin;^ percentage of deaths in cases treated according to dura-
t'on of disease for r. oi) as compared with 190T.
Digitized by VjOOQIC
Digitized by VjOOQIC
No. 19. COMMISSIONER OF HBAL.TH. 869
Table No. 6 showing result of treatment of diphtheria with Anti-
toxin according to number of units used and period of treatment
after onset, reveals the fact that the initial curative dose, or 3,000
units of Antitoxin, was administered within the first twenty-four
hours of onset, in 1802 eases, with but 42 deaths, or a death rat<» of
2JS2 per cent., as against 1,615 cases, with 110 deaths, or a death rate
of 6.81 per cent, in the year 1906. It also reveals the fact, compar-
ing it with the same table for 1906, that much more Antitoxin has
been used in each day's treatment; the greatest amount of Anti-
toxin used in the entire treatment of any one case having been 65,000
nnits, showing that physicians have attended to the advice of the
Commissioner of Health to use larger doses of Antitoxin. A careful
inspectioD of this table also shows that the number of units used for
the entire treatment of any single one of these cases will range all
the way from 1,000 units up to 65,000 units, with a gradual increase
of about 500 units' difference, until the maximum number of units is
reached.
By Table No. 7 showing the number of cases where subsequent
treatments of Antitoxin were administered after the first twenty-
four hours, it will be seen that the number of units used, in
the subsequent treatment of these cases, ranges all the way from
300 units to 62,000 units; until the maximum number is reached,
showing again that the physicians have used much larger doses in
cases where subsequent treatments were necessary than in 1906.
The total number of cases treated has been arranged into one set
of tables numbered from 1 to 8 (number 1 to 7, inclusive, covering
curative treatment, and number 8, immunization treatment) which
give in detail the number of cases treated from January 1, 1907 to
December 31, 1907, and show results tabulated under the following
headings:
1. Period of initial treatment after onset of disease.
2. Showing results of treatment according to sex and age.
3. Period of initial treatment after onset and age.
L Areas affected and period of initial treatment after onset of
disease.
5. Number of cases treated in the several counties of the State by
months with result.
6. Besult of treatment of Diphtheria with Antitoxin according to
number of units used and period of treatment after onset of disease.
7. Statement showing cases where subsequent treatments of An-
titoxin were used after first twenty-four hours.
8. Number immunized, with result.
24-^16—1907 ,
Digitized by VjOOQIC
S70
SECOND ANKUAl. REPORT OF THE
Off. Doc
,
&
8
s
9
1
lO
V
n
m
$^
M
§
i
n
i
Z
8
*
<
I
i
tL
8
s
»
s
1
1
s
1
1
1
i
e
s
S
9
55
S
6
43
10
t
1
§
S
a
s
S
1
;
3
IS
s
S
1
s
i
§
00
a
i
i
••
a
s
Hi
ti K Q
Diqitized by
Google
l<o. 16.
COMMISSIONER OF HEALTH.
371
TABUS II.
Antitoxin Treatment of Dlpbtheria, 1M7.
Initial Dose, 8.000 UnitB.
Result of lYeaUnent of Diphtiherla witii Antitoxin with Relation to Sex and Age.
Ag% Fttrtoda.
Remits.
SOL
0-1
1-2
14
8-4
4-6
6-9
10-14
15-19
»+
Totol.
Totals ....» r--^---,,
a
i»
lit
83
176
179
196
196
181
m
1.002
979
896
496
116
111
106
394
2.498
2.778
6.171
F..
M
16
80
66
149
160
176
170
196
N7
916
880
479
117
107
197
889
2.188
1.607
4.896
X>cftt1iii
?::
7
t
41
17
16
11
17
u
15
56
68
IS
17
9
6
8
5
106
171
876
TABI.B UI.
Antitoxin Treatment of Diphtheria, 1907.
Initial Dose, 8.000 Units.
Result of Treatment of Diphtheria with Antitoxin According to Period of
Initial Treatment After Onaet and Age.
RMttlta.
Ave Pertods.
Period of Treatnient
0-1
1-1
M
3-4
4-5
5-9
10-14
16-11
20f
Total
1
t.f dKT ..-■,T T
Total
Rec
Deaths...
46
89
6
121
94
27
64
86
18
tn
216
10
247
232
16
n
81
10
a
14
7
11
10
1
296
274
n
1.834
1,278
66
682
670
U
206
202
4
894
894
2
8.467
8,296
169
4.57
2j llay
Totol.....
Rec
Deaths...
18
10
8
67
59
8
106
90
16
407
878
28
199
189
10
74
78
1
128
128
6
1.140
1.089
101
8.86
M dBT>
Total
Rec
Deaths,..
U
9
4
80
18
U
80
26
4
146
180
16
65
62
8
87
83
4
46
42
8
401
848
54
11.48
4t1l dlB,Y
ToUl
Rec.
Deaths...
U
5
7
16
11
8
9
4
6
88
80
8
24
U
8
18
10
8
18
U
1
186
104
81 ! 18.62
Rftti Am.-w
Total,....
Rec
Deaths...
1
1
2
8
7
1
12
19
8
9
9
1
8
7
7
66
64
U
16.91
fUl day
TWal.....
Rec
Deaths...
1
1
1
1
1
14
9
5
1
1
4
8
1
6
6
1
84 1
U
86.19
Tth day ,.,,,-,-^.^^-.
Total
Rec
Deaths...
9
8
1
6
6
1
1
2
14
10
4
16.66
8th dear and ov«r...
Total
Rec
Deaths...
2
2
6
5
4
8
1
6
1
1
18
10
8
21.07
Total KC. ....
4.895
Total dwithff
876
7.18
■> i 'mr
87S
SBCX>ND ANNUAL REPORT OP THE
Off. Dot
TABLE rV.
Antitoxin Treatment of Dlpbtheria, 1907.
Initial Dose. 3,000 Units.
Result of Treatment of Diphtheria with Antitoxin Accordinsr to Areas Affected
and Period of Initial Treatment After Onset of Disease.
Results.
Period Within Which Initial Treatment was ICade.
1
§
i
1
i
1
i
H
^
a
s
§
i
«0
i
5"
^
Post-nasal.
Pharynseal, ....
Tonsillar,
lArynceal,
All combined, ..
Pn. and phar., .
Pn.. phar., ton..
Pn., ton., lar., .
Pn. and lar
Ton. and lar., .>
Ph.. ton., lar., .
Ph. and ton., ..
Pn. and ton
Ph. and lar., ...
Pn., ph., lar., .
Total,
No area stated, .
Orand total
Total
Rec,
Deaths,..
4S
42
6
18
14
2
6
4
2
1
1
1
1
76
61
10
18.33
Total
Rec
Deaths,..
146
142
4
41
88
8
7
6
1
8
5
8
1
1
208
191
12
5.10
Total,....
Rec
Deaths...
1.158
1,247
11
808
304
4
88
86
2
25
24
1
3
8
1
1
1.686
i.6n
19
1.12
Total
Rec
Deaths...
28S
244
80
118
91
27
46
86
10
20
14
6
6
2
8
1
1
482
894
88 18.2S
Total,....
Rec
Deaths...
680
551
29
188
161
22
76
63
12
20
18
7
18
13
5
4
1
3
8
sa ;
810 1
72 8.11
Total
Rec.,
Deaths...
11
9
2
16
14
2
2
2
2
2
2
2
6 18.1S
Total,....
Rec,
Deaths...
186
174
12
20
1»
1
18
42
30
12
8
8
6
8
5
2
3
2
2
3S0 '
297
B8 15.14
Total
Rec,
Deaths...
4
4
8
8
2
2
29
28
1
3.44
4.8
Total
Rec
Deaths,..
80
19
1
12
88
30
2
Total,....
Rec
Deaths, . .
54
47
7
29
26
8
12
9
8
a
2
1
4
1
8
2
2
1
1
107
90
17 15.9
Total
Rec
Deaths...
5«
60
6
40
86
6
18
14
4
8
3
3
2
1
1
1
2
2
127 i
^ 17.»
Total
Rec
Deaths...
610 200
489 198
21 7
67
68
4
18
17
1
8
8
5
}
1
1
812 {
Total
Rec
Deaths,..
179
187
12
60
68
7
89
25
4
8
8
4
8
1
1
1
281 j
256
26 8 »
Total
Rec
Deaths...
47
41
8
22
19
t
5
4
1
5
8
2
80 1
68
12 |1S.
Total
Rec
Deaths...
67
65
2
12
U
1
2
2
1
1
1
1
73 ;
70
8 j 4.10
Rec, ....
4,886 1
371 1
Deaths,..
Rec,
1 1
Deaths. . .
Rec
4.896
376
Deaths...
T.B
Digitized by VjOOQIC
{^0.16.
COICMISSIONBR OF HEALTH.
S7S
TABUS V.
Antitozin Treatment of Diphtheria, 1907.
Initial Doae, 3,000 Unita.
Remit of lYeatment of Diphtheria with Antitoxin In the several Counties by
the Months.
Ooanty.
i
1
i
1
i
<
i
1
i
5
1
ll
1
1
^
i
i4«in» ...
ToUl.....
Rec
D.,
IT
It
2
~T
1
16
U
2
~
2
"sT
24
1
"7
6
T
1
"o"
lo
20
1»
10
~
7
"7
1
~
1
IT
14
2
T
1
~
t
"o"
2
2
"T
S
~7
4
2
2
IT
21
"T
1
~r
1
~
1
"3"
12
"5"
IS
1
s
2
1
"T
4
"T
6
1
T
~
6
~r
2
"o"
T
"T
5
~
4
~
1
10
10
2
"5"
16
I
B
8
2
"S"
so
2
~r
1
1
1
Ti"
24
2
~o"
%
4
"n
71
1
"iT
n
UT
8
2
"T
4
"5"
68
4
IT
IB
"T
2
"T
1
_±
24
21
2
"5"
17
2
IT
16
2
"7
2
T
2
~»
24
2
IT
61
8
"7
7
1
t
2
886
868
IS
"77
47
1
20.00
Alh|1«iT
Total
Rec.
D.,
4.88
Anaitrtmg
Total, ....
Rec.,
D
S.06
BttTtr
Total
Rec.,
D
t
t
2 tt
t
2
t
2
2
U
4
14.28
Bdttort
Total
Rec
D
6 1
6 1
1
1
SI 27
IS S2
2 6
28 ! lao
22 168
0, 7
01 07
7 1 80
2 1 7
U 1 77
8 86
2 12
8 1 88
! 86
1 1
Bklr
18.61
Total
Rec
D..
IS
12
s
s
u •
10 , B
1 1
20
m
1
4.87
Bradford,
Total
Rec
D
^ 1 <
Ol
12 >
—
7 1 6 10
I 6
1
T T
2 , S
2
T'T
2 2
1 1
1 1
12
7.81
Boil
Total
BBda
Rec
D.
11
1
2
•
"7
li"
14
"T
T
8
16.68
Total
Rec
D
S
t
~r
1
Butte.
2.77
Tbtal,....
Rec
D
1
1
7
7
too
"iT
17
1
46 , 200
42 184
4 16
CunMa.
Total
Rec
D
10 IS < *^
1
1
4 B
4 > S
0, 2
ss
1
"T
"T
6
1
8.
Ottnatn,
Total
Rec
D.,
2
1
1
~T
6
' *•
"7
2
T
4
~7
1
1
80
W
8
"T
4
"«"
47
1
"T
7
2
1
68
48
8
SK.
Carbon
Totfi
Rec
D
8.48
C«it»
S 16
8 16
7 i le
Total
Rec,
D
' "*
—
—
1 A 1 1
»
9
1
~r
8
"5"
IS
"S*
IS
"T
4
"T
15
2
"T
a"
20
2
4
Iz
18
T
1
1
"S"
22
2
2
"»"
20
100
Cherter
Total
Rec
D
7
"T
1
1
"aT
26
8
6
6
"tt"
80
2
46
U
10
2
171
IBS
18
68
66
8
157
IBS
6
100
Clarfcm
Total
Rec
D.
16.66
Chartdd
Total
Rec
D
7.60
ataton
Total
Rec
D
6.17
Columbia
Total
Rec
D
8.18
Digitized by VjOOQIC '
374
SECOND ANNUAL REPORT OP THE
TABLE v.— Continued.
Off. Doc.
County.
i
1
i
1
J
1
1
t
1
1
i
1
^
1
Cntwford .• •
ToUl,....
Rec
D
46
2
T
2
14
14
11
9
2
a"
21
4
IT
14
2
«"
S6
12
12
"o"
3
3
16
12
8
U
11
T
1
T
~r
s
~
I
~T
1
1
T
IT
89
8
4
4
~
2
8
2S
4
u
13
f
IT
81
3
4
3
1
T
8
"iT
U
8
21
12
2
IT
17
2
2
~
4
T
3
8
8
~
1
"T
9
"T
2
T
T
1
T
8
1
1
SI
27
4
1
1
"T
3
14
11
8
12
11
1
k"
22
2
T
2
14
12
1
6
6
"7
2
"T
1
"o"
T
T
4
4
~T
5
~
2
T
JL
35
34
1
1
1
T
8
T
7
26
26
9
7
2
IT
28
1
T
1
2
"T
6
~r
6
~
1
"T
~
8
~T
1
T
"T
2
T
1
T
48
45
1
T
"T
6
IT
11
1b"
21
1
2
2
~
4
"o"
8
14
14
6
6
2
2
4
4
7
7
~
8
1
T
8
IT
18
8
IT
14
T
6
"iT
7
9
18
17
1
T
8
8
8
"T
2
IT
14
22
22
18
16
8
20
20
81
80
1
100
CamberlAnd
Total
Rec,
D
Dauphin,
Delaware,
8.22
Total
Rec,
D
56
49
8
10.90
Total
Rec
D
144
126
9
6.26
Blk
Total,....
Rec
D
76
78
8
8.94
Brie
Total
Rec
D.,
6
5
8
8
1
1
27
27
100
Fayette,
Total
Rec
D
21
19
2
"o
A
8
8
1
88
86
2
6.26
S\>reBt
Total
Rec,
D.,
6
Franklin
7 1 ifi
Total,. ..
14
12
1
"o"
IT
11
1
u
10
1
8
8
"T
2
IT
9
1
68
68
4
Rec
D.,
6
1
T
"o*
4
4
c
17
1
T
T
1
$.24
I*u]ton
Total
Rec
D.
Greene,
Total
Reo
D.
28
XL
2
8.69
Huntingdon ........ r ..... ,
Total
Rec
D.
10 : 4
86
81
4
11.42
_ __
117
2
Indiana
Total
Rec
D
a
88
8
967
Jeffenon
Total
Rec
D
8
8
"T
63
60
8
T
1
T
6
8
7
1
21
21
2 6
2 6
TT
1
1
1
"ST
97
2
_
9
IT
18
21
21
"«"
88
2
22
20
8
12.04
Juniata
Total,....
Rec
D
4
4
100
Lackawanna,
Total,....
Rec
D.,
81
76
6
~
6
T
6
lo"
8
2
«r
29
2
112
109
8
"T
7
"iT
19
"T
7
IT
47
6
649
616
88
6.06
TiAncast^r^ x .
Total
Reo
D.
86
24
1
2.86
LAwrvnce, .... r ........... .
ToUl
Rec
D
87
87
100
Lebanon
Total
Rec
D
ito
117
12
10.
I^ehlgh
Total
Rec
D
808
286
22
7.14
Luserne
ToUl
Rec
D.,
16
14
1
81
28
8
24
82
2
28
22
4
TO
88
4
68
64
4
222
286
M
7.4B
Digitized by VjOOQIC
No. 16L
COMMIdBION'BR OF HBAL.TH.
TABLE v.— CoDtlniied.
t7i
OOOBftj.
i
1
i
1
1
i
»n
i
i
1
i
i
i
i
i
I^rmmliif, .................
Total
Rec
D.,
«
$
T
4
S
8
T
4
u"
10
1
T
1
1
6
1
T
4
1
H
U
~
4
~
T
s
1
1
—
1
11
10
1
T
11
1b
18
U
11
17
15
2
"T
8
1
T
8
T
T
«"
88
%
T
1
28
28
T
T
7
"5"
14
1
~7
6
1
IT
14
T
s
IT
u
s
u"
u
"o"
ao
2
~r
4
TT
u
1
"T
4
1
~r
2
"JT
10
4
~T
8
1
IT
28
1
m
118
•
18
»
8
74
n
B
11
»
8
tt
20
2
8.04
MoKflUB,
Total
Roc
D.,
U.IB
Mecctr
Total
R«c.
D
U
10
1
~
1
6.7B
Xlfllhi.
Total
Roc
D
1 1 1
:
TiT
,
1.11
Monro*,
Total.....!
1
1
uT
u
Rec
D.,
t
7.14
MoDtgoDerx
Total,....
R«s
D
9
a
1
"iT
11
1
154
140
14
8.06
Hontonr
Total
Reo.,
D.
4
4
1 ' A
»
1
1
"S"
12
A
u"
u
T
1
T
%
8.17
Nmbampton.
Total
Rec..
D.,
9
6
8
17 17
17 17
8 5
8
TiT
1
\
168
144
12
7.66
N^rttnmbfrlaiiA
Total
Rec.,
D
11
U
T
T
~0
~
7 08
7 n
4
6.16
Ptny
Total
Rm
D
1
1
A
0.
28.
Plln,
ToUl,....
Rec
D
1
—
T
1»
80
8
A
IT
u
iT
IS
1
~
1
"T
1
"7
J_
1
1
"o"
"T
"T
28
"iT
18
T
4
T
100
Pettw
Total
Rec
D
160
BdmylMt
ToUl
Rec
D
99
84
n
80 ; M 1 800
20 1 41 j 278
1 1 6 1 80
18 IT
11.65
Ti"o"
1
,
Bnjdv.
Total
Rec
D
6
6
8 i 1
8 1
T IT
4 14
8
1 1
1 1
18
1
6.88
Bamenet.
Total
Rec,
D.,
9
7
2
8
5
6
~r
1
"o"
*r
1
T
T
1
11
10
1
10
10
70
74
5
6.82
Salttraa,
Total,....
Rec
D
—
1
"^
lo"
8
1
16
16
11
12
1
T
1
1
1
"o"
~T
2
T
1
"T
4
A
T
8
"T
1
100
Total
Rec
D.
7.09
Tloia.
Total
Rec,
D.,
18
14
1
7
7
21
n
1
8
8
1
6.66
tJnkin.
Ttotal
Rec
D
100
Vcuago,
Total,....
Rec
D
s
s
4.84
Vfunn,
Total
Rec
D.
U.U
Digitized by VjOOQIC
S7e
SBC50ND ANNUAL, REPORT OP THE
TABLE v.— Continued.
Off. Doc.
Coanty.
1
1
i
1
^
S
i
i
9
<
t
i
i
^
1
1
Wuihlngton
Total
Bee
D
—
—
t
%
~r
1
11
u
"o"
—
—
f
4
2
2
9
a
1
8
e
2
46
25
10
22.22
Wftjrn4, ..., t
ToUl,....
Rec
D
6
12
11
1
15
14
67
62
4
7.01
Total
Rec
D
—
—
**
22
19
2
19
17
2
22
19
S
IS
14
140
U4
16
11.42
Wyomlair
Total
Rec
D.
6
4
1
12
12
1
7.69
York,
Total
Rec
D.,
10
10
7
5
2
IS
10
2
12
11
1
15
14
1
29
12
2
17
12
1
UO
100
10
9.09
Total pec
1....
4.296
276
Total D..
..1
7.12
TABLE VI.
Antitoxin Treatment of Diphtheria, 1907.
Initial Dose, 8,000 Units.
Result of Treatment of Diphtheria with Antitoxin According to Number of
Units Used and Period of Treatment After Onset of Disease.
Namber of Units Used.
5
1
8
1
S
1
1
1
i
i
i
1
1
1,000
ToUl
Rao.
Deaths
78
77
1
18
17
1
178
162
16
U
10
1
2
1
1
62
41
11
1.600
Total
Rec
Deaths
4
4
2,000»
Total
Rec
Deaths
60
66
4
15
14
1
t 600,
Total
Reo
Deaths
1
1
• TOO
Total
Rec
Deaths
22
12
4
2
S
1
1
S 000
Total
Rec
Deaths
1,802
620
600
21
S,800
Total
Rec
Deaths
1
1
167
44
40
4
4,000,
Total
Rec
Deaths
4.600
Total
Rec
Deaths
6
6
\
Digitized by VjOOQIC
No. K.
COMMISSIONER OF HEALTH.
TABLE VI.— OontinuecL
877
Number of Units Used.
i
1
i
s
1
1
1
1
1
i
1
1
6,n$,
Total
Rec.
Deaths
42
88
4
1
1
7M
686
41
44
S8
6
S
8
18
14
4
244
227
17
88
21
2
1
1
11
10
1
106
M
18
12
12
6
6
84
SO
4
4
8
1
4
8
1
84
80
4
7
6
1
S
8
21
18
8
5
8
2
86
72
18
*
20
16
2
2
88
26
12
1
1
10
7
8
2
8
2
•
u
Q
5,600
Total
Rec
Deaths
«,000,
Ttotal
Rec.
Deaths. ....
279
261
28
19
17
79
60
10
9
6
8
8
2
41
88
8
8
8
28
ai
2
6
S
8
2
1
1
18
16
2
1
1
2
2
o.eoo,
Ttotal
Rec
Deaths
7,000.
ToUI
Rec
Deaths
7,B0O
ToUI
Rec
Deaths
8,000,
Total
Rec
Death
1
6 10
1
IS 1 «
f,000
Total
Rec
Deaths
1 1
1
10,000
Total
Rec
Deaths
10,600
Tbtal
Rec
Deaths
1
'
11.000
TbUl
Rec.
Deaths
!
1
'
12,000,
Ttttal
Reo
Deaths
2
1
1
10
1
I
lt,000,
Total
Rec
Deaths, ....
1 ' A
2 ' *^
14,000
Total
Rec
Deaths
t
16,000,
Total
Rec
Deaths
r
16,000,
Total
Rec
Deaths
1
17,000,
Total
Rec
Deaths
W.OOO
Total
Rec,
Deaths
'
If.OOO,
Total
Rec
Deaths. ....
*
»,000
ToUI
Rec
Deaths
Digitized by VjOOQIC
878
SECOND ANNUAL. REPORT OF THE
TABL.E VI.-<:o]iUniMd.
Off. Doo.
Number of UnlU Used.
i
1
S
i
8
i
1
1
i
i
1
a,ooo,
Total
Rao.,
Doatlis
11
Q
J
tt,00O,
Total
Roc.
Death!
2
;
2S,000,
Total
Rec
Deathe
I
•
M.OOO
TVrtal
Reo
Deaths
I
2S,000,
Total
Rec
Deathe
»,000 ,
Total
Rec
Deathe
*
28.000
Total
Rec.
Deaths
J
10,000.
Total
Rec
Deatbfl
®
1 1
a.ooo.
Total
Rec
Death!
89.000
Total
Rec
Deathe
1
1
88.000
T6tal
Rec
Deaths. ....
g
88,000
Total
Rec
Deaths. ....
t
1
'^
88.000
Total
Rec
Deaths,
1 '^
40.000.
Total
Rec
Deaths
48.000
TOUl
Rec
Deaths
A ' A 1 A 1 «
1
1
1
48.000.
Total.
Rec
Deaths
Q A ,V 1 i. ..
1
48,000,
Total
Rec
Deaths
1 1 A 1 A
49.000,
Total
Rec
Deaths. ....
60.000,
TOUl
Rec
Deaths
60,000
Total
Rec
Deaths
08,000
Total
Rec
Death
8
:
Digitized by VjOOQIC
No. IC
COMMISSIONER OF HEALTH.
S79
TABIiB VII.
Antitoxin Treatment of Diphtheria for 1907.
Initial Doee, 8,000 Units.
Statement Showing CTasea TVhere Subsequent Treatments With Antitoxin Were
Used After First Twenty-four Hours.
BMulU.
Number
of Oases.
Units
Used.
ResulU.
Number
of cases.
UniU
Used.
Tf^tal
1
1
200
TMal ......................
Itoc.
Rec,
16,000
EkeathR
Doaths
Total,
2
2
600
Total
\
Reo./
Rec
Deaths
17,000
Deaths. ....................
Total,
86
81
6
1,000
Total,
Rac.
Rec
Deaths
18,000
Poathi
Total
1
1
0,
1,600
Total,
Rao.,'
Rec
1 1 12,000
Death!
Deaths,
1
Total,
46
41
S
2,000
Total,
10 1
Reo.,
Rec.
9 21,000
ijfttit'hn
Deaths
912
2.000
TfttllJ r
1 1
Reo^' .:::::::::;::::::::::::
•»
Rec,
1 22,000
Deaths
1
Total,
62
1
4.000
Total
Rec.,'
Rec
Deaths
6 i 24,000
Deathn,
•IV>tal
2
Total
* 1
Rec. .... X .................. ..
2
4.600
Rec
Deaths
1 25,090
Deaths
Total
21
17 6,000
Total
7 '
Rec.,'
Rec
4 27,000
Deaths ,
Deaths,
TotiU.
272 1
aSA 1 ft flOA
Total
*
Rec
Rec
1 1 29,000
Deaths 1 48 |
Deaths
Total
M i
Total
4 1
Rec
Rec
4 i 20,000
Deaths, r,,..r,,r..... • 2 1
Deaths
1
Total
2 1
2 , 7,500
A
Total
6 !
Rec,
Deaths* '*!!!!.'!!'.*.!!!.'.'.'.*!!!!
4 1 38,000
Deaths
TotaL
12
Total
1 •
Rec.,'
U 8,000
Rec . ... ............
1 i 24,000
I>eaths
Deaths
Total
108
76
27
fl.OOO
Total,
Ree.,
Rec..
Deaths
1 I 26,000
Deaths
Total
10
10.000
Total
Rec.
8
2
Rec
Deaths
1 : 40,000
Deaths,
Total
1
1
U.OOO
Total
1 1
Rea
Rec
1 1 41,000
Deatki
I>eaths
1
1
Total
67
62
5
12,000
Rec
Rec
Deaths
1 1 42,000
TVM,th8
,
Ttotal.
6
2
2
13.000
Total
Rea
Rec,
46,000
Deaths . .x
Deaths
Total
4
2
2
14.000
iy>tal
Rec
Rec
f
*
17,000
Deaths
Deaths . ^
Total,
80
24
5
16,000
Total
Rec.,'
j{ec *
62,000
Deaths .t
Deaths " r tT
Digitized by VjOOQIC
380 SKCX>ND ANNUAL, RBS^ORT OP THE Off. Doc.
In the diagram Bbowing the percentage of deaths of caBes treated
a-ecording to duration of disease for 1906 as compared with IQOT, it
will be seen that the best results in the treatment of diphtheria with
Antitoxin were obtained in the first twenty-fonr hours after onset
of the disease and that the i>ercentage of deaths increases in each
twenty-f onr hours thereafter.
The results obtained as shown in this diagram would seem to
indicate that physicians, generally, throughout the State were treat-
ing diphtheria among the poor at an earlier period after onset in
1907 than in 1906.
In this diagram it will also be noticed that in the fourth day treat-
ments the percentage of deaths in 1907 was slightly increased over
the year 1906.
A careful inspection of the clinical reports covering the 32 cases
which resulted fatally (and in which treatment was not begun until
four days after the onset of the disease) reveals the fact that 19 or
nearly 60 per cent, of said cases showed laryngeal type of diphtheria
together with one and in some cases two other types well defined,
and that in 12 of the 19 cases above mentioned, only one package
of three thousand units of Antitoxin was used in each case as the
initial dose.
It is a well established fact that after the disease has been allowed
to run for a period of three or four days before treatment with Anti-
toxin is begun, it is almost unreasonable to expect successful results.
It seems remarkable, indeed, that physicians did secure such suc-
cessful results in many cases where they did not treat the patients
until after the third, fourth, fifth, and even the sixth day after onset
of the disease.
IMMUNIZATION TREATMENT FOR THE YEAR 1907.
In addition to the curative treatment for which Antitoxin is fur-
nished free by the State to the indigent, the Department of Health
also furnishes free, for use in preventing the spread of diphtheria,
what is known as an immunizing dose of Antitoxin, 1,000 units
strength, with which physicians are instructed to immunize all
those in the household where the case of diphtheria is found, as well
as all those outside of the house who may have come in contact
with the patient.
Clinical reports received, in which Antitoxin had been used for
the purpose of the immunization of persons who had been exposed
to diphtheria, from January 1st to December 31st, 1907, show that
Digitized by VjOOQIC
No. 16.
COM31ISSIONER OF HEALTH.
881
three thonsand seven hundred and ninety-nine (3,799) persons had
been immanized, of which number but thirty-four (34) were reported
as having contracted diphtheria at some time within twenty-one
days after immunization. Of these thirty-four cases but two cases
resulted fatally.
Comparing the number immunized in 1907 with those immunized
in 1906, it shows an increase of 1,465 in 1907 over the year 1906,
and by comparing the Immunization Tables of 1906 with 1907 it will
be seen that in 1906, seventy-seven x>erso(nfl out of a total of 2,334
immunized in that year contracted the disease, while in the year
1907, when 3,799 persons were immunized an increase as above
stated of 1,465 — only thirty-four persons contracted the disease.
For results in detail of the treatment for immunization during the
year 1907, the following table is presented.
TABLE VIII.
Ghtofwing the Results of Treatment for Immunization, 1907.
Number Treated for Immunisation.
t
2
H
ll
Number developinar
dii>htberla.
1
1
1
•
260
no
m%
400
500
TOO
760
1.000
1.500
2.000
2,600
2.000
4.000
e.000
<
1
20
1
128
2
9
40
1
182
1
7
24
22
1
ao :;;"".jj":""!»;;!;:::!";;.;!;!!!!:";:!.
1.
&;
iT..
I: : .. ,
«3» »!.......
w^. ::::::::::::::::::::::::::::;:::::::::;:;:::
40|
1
188 .... I ... ..
ir\. .
M :::::::::::::::::::::::::::::;::::::::::::::::!:
8 T99 Total . . .............. ^ . - -
2.765
24
82
2
The following statement giving the number of syringes of Diph-
theria Antitoxin supplied to Distributors during the three months
of 1905 and during each month for the years 1906 and 1907, shows a
steadily increasing demand for the use of this life saving agent in
the treatment of Diphtheria and also reveals the fact that from
October, 1905, to December 31, 1907, there was supplied to five hun-
dred and twenty-nine di^trlbfltor^ pf Antitoxin, located in every
Digitized by VjOOQIC
S82
SSCOND ANNUAL. REPORT OF THB
Olt Doe.
county of the State, 12J69 packages of one thousand units, or im-
munizing doses of Antitoxin, and 19,460 packages of three thousand
units, or curative doses of Antitoxin:
NTJMBEJR OF STRINK3-BS OF ANTITOXIN SUPPLIED TO DISTRIBUTORS
BY MONTHS FROM OCTOBER. 1905. TO DECEMBER 81, 1907.
IMS.
1901
1897.
1.900
imiu.
9.000
ontta.
1.090
units.
9,000
units.
1.000
units.
9.909
units.
October
64
2.n7
877
69
9.498
498
January
February,
Marvb ...... ..
914
169
989
986
149
118
199
Itt
694
686
109
984
469
479
986
919
914
988
789
1.408
i.fn
1.007
40O
988
997
919
988
891
989
699
947
919
870
804
no
M
D6C6inber
848
Anrll *
941
469
Total
t,W
9.000
kSSr • .:::::::::::
June
489
Julv
686
884
199
784
1.997
GRAND TOTAIi.
September.
October
November.
December.
Tbtal
1.001
units.
8.000
units.
1.889
4.889
7.4W
9.119
8.891
1906
2,969
i.6S8
6.179
9.009
7.470
9.891
190e*
1907*
19,799
19.400
SUMMARY.
1906.
Number of cases treated during October. November and December.
1905, 293
Number of de^^ths 88
Peroentaflre of deaths 12.98
Number immunized. 156
Number immunized and later contractlner the disease 5
Number of eyrlnges, 1.000 units, dispensed by distributors 327
Number of syringres. 3.000 units, dispensed by divtributors 619
Total cost (including "Initial Supply," which cost $6,199.73) $7,261.80
1906.
Number of cases treputed from January let to December 31st. 1906,.... 3,629
Number of deaths 398
Percentage of deaths, 11.13
Ntunber Inununlzed 2,334
Number immunized and later contracting the dlseaire (three deaths),. 77
Number of syringes, 1.000 units, dispensed by distributors. 3,726
Number of syringes. 3,000 units, dispensed by distributors 6.664
Total cost $16,192.82
1907.
Number of cases treated from January 1st to December 31st, 1907,... 6,271
Number of deaths 876
Percentage of deaths, 7.18
Number Immunized 3,799
Number immunized and later contracting the disease (two deaths),.. 84
Number of syringes, 1.000 units, dispensed by distributors 8,481
Number of syringes. 3,000 units, dispensed by distributors 6,981
Total coat, ,,,,,,.,.......•.....,.,,, $17,887.M
Digitized by VjOOQIC
No. K. COMMISBIONER OF HEALTH. 883
OBNOSSiAL. SUMMARY.
1905-1906-1807.
NHuDiber of caaes treated from October, 1905, to December Slst, 1907,.. 9,098
Nhimber of deaths, 807
JPeroentage of deaths, 8.87
Number Immunized, 6,288
Number immunised and later contracting the disease (five deaths) , . . . 116
Number of syringes, 1,000 units, dispensed by distributors 7,488
Number of syringes, 8,000 units, dl8(pensed by distributors, 14,114
Total oo«t $40,881.25
THE DISTRIBUTION OP VACCINE AND VACCINE SUPPLIES.
The free distribution of Vaccine and Vaccine supplies is made by
the Department of Health only to second-class townships and only
to those people therein who are too poor to purchase the same, where
no Boards of Health exist, also to boroughs just organized and to
charitable institutions in Pennsylvania not receiving appropriations
from the State, at the request of physicians located in any county in
the State, (except Philadelphia county) upon the recommendation
of the County Medical Inspector.
Under the urgency of a serious epidemic, however, the stringency
of this rule may be relaxed, the safety of the people being of vastly
more importance than economy in administration.
During the year 1906, Glycerinized Vaccine Points and Vaccine
Lymph for use in the vaccination of persons exposed to smallpox,
were supplied through the duly organized channels to seventeen
different localities throughout the entire State, namely: Anson-
ville, Kylertown, Du Bois, New Millport, Clearfield county; Chadds
Pord, Chester, Delaware county; Webster Mills, Warfordsburg, Ful-
ton county; Ernest, Indiana, Indiana county; Port Kennedy, Mon-
tour county; Honesdale, Wayne county; Warren, Warren county
Force, Elk county; linglestown, Dauphin county; Brookville, Jeffer
son county; Elmora, Cambria county, which shows how little, com
paratively speaking, the inhabitants of the State had been exposed
to this disease, since only 1,610 Glycerinized Vaccine Points and
only 110 tubes of Vaccine Lymph were furnished physicians through-
out the entire year, the entire cost of these supplies having been
only 168.47.
During the year 1907, the free distribution of Vaccine matter was
confined to ten different localities in the State, namely: Wells, Brad-
ford county; Tioga, Tioga county; Chester, Delaware county; Equln-
unk, Wayne county; McGonnellsbTP^i F^ltoi^ county; AnsonviUe*
Digitized by VjOOQIC
884
SECOND ANNUAL REPORT OF THB
Off. Doc
Elmora^ Clearfield county; Castle Shannon, Allegheny county; Lud-
low, McKean county; Bloomsburg^ Columbia county. Only 1,070
Glycerinized Vaccine Points and 390 tubes of Vaccine Lymph were
furnished physicians during the entire year, the entire cost of fur-
nishing these supplies being only |42.83, a decrease of f26.46, in the
cost of said supplies for 1907 as compared with 1906.
The following statement shows the number of cases of smallpox
occurring in the years 1906 and 1907, by the months:
190«.
January, ..
February.
Mexch, ....
April
May
June,
July,
Ausujit, . . .
September,
October, . .
November,
December,
1907.
10 January, ..
9 February, .
4 March, . . . .
12 April,
19 May,
7 June,
7 July
3 AufiTUSt, ...
September,
October, ..
2 NovemJt>er,
December,
Total,
78
Total, 62
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THE} DIVISION OF ACCOUNTING AND
PURCHASING.
ACCOTTNTINO A<N1> PURCHABINa AOBNT. Bl I. SIMF0ON.
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26-16—1907
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OFFICIAL DOCX7MSNT, No. 1«.
THE DIVISION OF ACCOUNTS.
FINANCIAL REPORT.
The Commissioner begs leave to respectfully report that under
the three Appropriations of the Legislature of 1906^ for the use of
the several divisions of the Department, the following sums were
received and expenditures made during the year of 1906-6, as per
First Annual Report of the Department:
APFROPRIATIONB.
Act Nk>. 506 for general Balarles and expenditures of the
Department for two years ending May 31st, 1907 $800,000 00
Expended as per Report, year ending I>ecember 81st,
1906 117,695 48
Unexpended bcdance of Appropriation, January 1st,
1907 1182,304 57
Act No. 221 for salaries and expenditures of the Bureau
of VHal Statistics for two years ending May 31st,
1907 18.000 00
Expended cub per Report year ending December 81st,
1906, 18.745 51
Unexpended balance of Appropriation January 1st, 1907, |4,254 49
Act No. 219 for emergencies for two ye^rs ending May
81st 1907. 60.000 00
Expended as per Report year ending December 81st.
1906 20,191 09
Unexpended balance of Appropriation January 1st, 1907 29,808 91
and that the Receipts and Expenditures from January 1st, 1907 to
May 31st, 1907, on account of the three foregoing ApiH*opriations
have been as follows:
QENBRAL FUND ACT NO. 606.
Cash on hand as per Report year ending December 81st, 1906, $69,804 67
Received from the Auditor General, warrant on account as fol-
lows: Maroh 8, 1907, 87.600 00
M^Jdng total receipts. May 81st, 1907 $107,804 67
(887)
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888 SBOOND ANNUAL. RBIPORT OF THE Off. Doc
Tluut the expenditures from December 8l8t, 1906, to May 8lBt» 1907, bave
been aa follows:
Advertising rules and regulations, $7 70
Advisory Board, traveling expenses, attending meetings, 82 82
Commissioner's traveling expenses, 169 26
Distribution of diphtheria antitoxin 16,614 16
Sialaries, antitoxin division 1,122 25
Inspecting, disinfecting, quarantining, etc, account
diphtheria, 2.366 18
Inspecting, disinfecting, quaiantining, etc, account
scarlet fever, 2,706 96
Inspecting, disinfecting, quarantining, etc, account
smsUpox 1,104 92
Vaccinations, 860 67
Inspecting, disinfecting, quarantining, etc., account
tjrphoid fever 1,698 60
Inspecting, disinfecting, quarantining, etc., account
cerebro-spin^i meningitis 6 00
Inspecting, disinfecting, quarantining, etc, account
tuberculosis 100 00
Inspecting, disinfecting, quarantining, etc, account
measles and mumps, 25 10
Inspecting, disinfecting, quarantining, etc, account
rabies, 62 50
Establishment and maintenance of laboratory, 4,999 28
Collecting, tabulating and filing morbidity statistics,.. 3,926 97
Mosquito investigeutions 17 91
Inspecting and abating nuisances, 9,460 46
General office expenses, 4,712 79
Disinfectants 7,48161
General salaries, 14,428 29
Sanitary Engineering Division, salaries, travelling ex-
penses, etc 9,638 74
Legal services 2.483 79
Collecting and recording marriage statistics, 614 28
Total expenditures 183,068 21
Cash balance on hand May Slst, 1907, 24,236 86
1107,304 67
Note: That the following amounts were paid to the Department:
April 16, 1907, being for certified copies of births and
dea/ths HOO 00
May 18, 1907, being refund of expenses incurred in
abating nuisances 263 48
June 26, 1907, being interest on deposit bal^Jice, 628 92
Aug. 28, 1907, being refund of deposit on mileage books, 70 00
$1,062 36
That the same were returned to the State Treasurer aa follows:
April 16, 1907 |100 00
May 18, 190?, 263 48
June 26. 1907, 628 92
Aug. 28, 1907, 7000
11,062 36
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Nt>. 16. COMMJBQlOtmR OF HSAL.TH. 889
That the cash balance on hand May Slst, 1907, was returned to ithe
State Treasurer: August 28» IWt, $24,286 86
SUMMARY.
Ai>proprl,ation, $300,000 00
Expenditures to Dec. 81, 1906, $117,695 48
Expenditures from December 8l8t, 1906, to May 81st, 1907, 88.068 21 200,768 64
Unexpended balance of appropriation reverting to State Treasury, $99,286 86
BUREAU OP VITASL STATISTICS FUND. ACT NO. 221.
Cash on Oiond as per Report year endlncr December 31st. 1906, $2,004 49
Received from the Auditor General, warrant on account as follows,
March 18, 1907, 2.260 00
Making: tot^ receipts, May 31, 1907 $4,254 49
That the expenditures from December 31, 1906, to May 31, 1907, have been
as follows:
General office expenses, $170 87
Postage, expressage, etc., 809 00
Salaries, 8,101 65
Travelling expenses 89 16
Legal expenses, 20 00
Total expenditures $4,140 68
Cash balance on hand May 81st, 1907, U3 81 $4,254 49
N^e:— Tlb|at the fallowing amounts were paid to the De-
partment:
May 29, 1907, being interest on deposit balance, $16 10
June 25, 1907, being interest on deposit balance, 4 80 $20 90
That the same were returned to the State Treasurer as
follows:
May 29, 1907, $16 10
June 25, 1907, 4 80 $20 90
That the cash balance on hand May 31, 1907, was returned to the
State Treasurer, June 25, 1907 $118 81
SUMMARY.
Appropriation. $18,000 00
Expenditures to December 31, 1906. $18,745 61
Expenditures from December 31st. 1906, to May 31st.
1907 4,140 86 17.886 19
Unexpended balance of appropriation reverting to State Treasury, $118 81
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S90 SECOND ANNUAL RBPORT OF THE Off. Doc.
BnCEROENCY FUND, ACT 219.
Ca4lh on band as per Report, year ending December 31, 1906 $e,679 12
Received from the Auditor Geneiml, warrant on account (none.)
Mlaklnflr total receipts, Hflay 81, 1907, 16,679 12
That the expenditures from December 81, 1906, to May SI, 1907,
(have been as follows:
Disinfecting and duarantlninff account of typhoid fever, $2,841 47
Dtalnfectln^r and quarantining account of smallpox, 2,708 61
Total expenditures $6,649 98
Cash balance on hand May 81, 1907, 1,129 14 $6,679 12
Note: That the following amounts were paid to the Department:
June 26, 1907, being Interest on deposK balance, $51 74
October 21, 1907, beincr Interest on de^posH balance, 14 08
$66 82
That the qame were returned to the State Treasurer as follows:
June 26, 1907 $51 74
October 21, 1907, 14 08
$65 82
Ths/t the cash balance on hand May 31st, 1907, was returned to
the State Treasurer, dept 8, 1907, $1,128 14
SUMMARY.
Appropriation $50,000 00
Expenditures to December 31, 1906, $20,19109
Expenditures from December 81, 1906, to May 8l8t, 1907, 5,649 98 26,741 07
Unexpended balance of appropriation reverting to State Treasury,. $24,258 93
The Commissioner further begs leave to respectfully report that
the Legislature of 1907 made three appropriations for the use of
the tseyeral Divisions of the Department as follows:
Ajct No. 678 for generfEa salaries and expenditures of the Depart-
ment for two years endlnfir May 31st, 1909 $1»100,600 00
Act No. 678 for the establishing and maintenance of Tuberculosis
Dispensaries for two years ending May Slst, 1909, 400,000 00
Aot No. 167 for the establlshinfir and maintenance of one or more
Tuberculosis Sanatoria for two years ending May Slst, 1909, 600,000 00
and that the receipts and expenditures fixnn June 1st, 1907 to December 31st,
1907, on account of the three foregoing appropriations have been as follows:
OBNIBJRAL. FUND ACT NO. 678.
That there have been received from the Auditor General warrants
on account as follows:
June 26, 1907 $44,138 00
August 28, 1907 44,188 00
November 22, 1907, 44,188 00
Becemher 12, 1907 44,138 00
^ $176,568 M
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Nt>. 16. COMMIBBIONBR OF HBAL.TH. S91
That the Auditor Oeneral has iMued (warrantB on account, general
iHaaries to December 31, 1907, 11,208 06
Making total receipts, Dec. 31, 1907, $187,760 96
Thttt tihe expenditures flrom June Ist, 1907, to December 31, 1907,
hAve been as follows:
Inspecting, disinfecting, quarantining, etc., on account
of following:
Cerebro-spinal meningitis, $57 21
Chicken pox, 12190
Dipihtlieria, 9,962 46
Dysentery, 4 80
E<ryBlpe^s, 6 01
Hydpoptoobia 25 26
Measles 1,462 69
Membranous croup, 12 86
Scarlet fever 2,994 01
Smallpox 952 67
Bcabies 17 67
9pinal paralysis 28 78
aoarlatina 12 50
Tubercutosis, 37 76
Typhoid fever 3,960 61
Vermin, 16 64
Whooping cough 814 78
Guarding and keeping leper, 172 71
Disinfectant 1,139 98
VaccinaUons. 146 40
Oollectinsr, tabulMing and filing tnarriage statistics 1,236 82
OoUeotlng, tabulating and filing morbidity statistics, 5,728 32
Collecting, tabulating and filing vital statistics 1,966 03
Inspecting and abating nuisances 25,085 89
Instructions to and supervision of health ofUcen and or-
ganising loqal Boards of HeaHh 2,230 42
Sanitary engineering Division, salaries, traveling ex-
penses, etc., 28,712 18
Sanitary inspection of schools, 7,208 43
Advertising rules and regulations, 1,593 63
Commissioners traveling expenses, 170 19
Oeneral salaries, » 29,045 66
Oeneral ofllce expenses, 4,400 62
ESBtablishment and maintenance of laboratory 4,894 06
Liegal services 96125
Advisory board, traveling ex^penses attending meetings, 6 24
Attending scientific and educational meetings, etc., .... 166 48
Mosquito inspection, 2 62
Total expenditures $184,92172
Cash balance on hand, December 31, 1907 62,839 24
$187,760 96
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892 SBXX>ND ANTOJAIi RBPORT OF THB Off. Doc.
Nk>te: That tbe following lunounts were paid to the Dei»artment:
July 28, 1907, helns refund of frelffht oharses, $19 80
December 81, 1907, beinff interest on bejik deposit, 878 89
December 81, 1907, beincr for certified oopies of biiitlhs
and deaths, 688 00 $98169
That the same were returned to the State Treasurer as follows:
July 26, 1907, $19 80
December 81, 1907, 878 89
December 81, 1907, 688 00 $98169
SUMMARY.
Appropriation, $1,100,600 00
Expenditures to December 81, 1907 134,921 72
Unexpended balance of aptpropriatiOQ, $966,678 28
DISPBNBARIBS FUND ACT NO. 678.
That there have been received from the Auditor Qeneral warrants
on account, as follows:
July 26, 1907, $16,666 67
Nov. 24, 1907 16,666 67
Making total receipts Dec. 81, 1907, $88,383 84
That tlhe expenditures from June 1, 1907, to December 31, 1907,
have been as follows:
Furnishing and equipping dispensaries, $1,498 05
Rental of dispensaries, 83134
Maintenance of laboratory, 860 25
Traveling expenses, nurses and doctors, 430 41
General oflice expenses, 813 52
Salaries, oflice, doctors and nurses, 1,378 14
Distribution of sputum cups, napkins, etc. , 2, 614 18
Distribution of milk and effgs 650 76
Drugs and disinfectants 102 20
Examination for admission to Mont Alto, 216 98
Disinfecting houses 81 00
Legal services, 4 00
Total expenditures $8,810 82
Cadh balance on hand, Dec. 81. 1907, 24,522 52
$83,333 34
Note: That the following amount was paid to the Department:
Nov. 80, 1907, being interest on bcmk deposits, $61 01 $61 01
Tliat the same was returned to the State Treasurer December
7. 1907 $6101 $6101
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No. 16. COMMISSIONini OF HEALTH. 89S
SUMMARY.
Appropriation, HOO.OOO 00
Expenditures to December 31, 1907, 8,810 82
Unexpended balance of appropriation, $301,189 18
SANATORIA FUND, ACT NO. 167.
Tbf&t there bave been received from the Auditor G(eneral iwar-
rants on account as foUowv:
June 17, 1907, , $25,000 00
AufiT. 31, 1907 60,000 00
Nov. 30, 1907, 26,00000
Making total receipts Dec. 81, 1907, $100,000 00
That the expenditures from June Ist, 1907, to December 31, 1907,
have been as follows:
Buildings and real estate of Mountain Side Sanltorium,
purchased trom J. T. Rothrock $27,660 00
Building materijals for additions and improvements, ... 6,948 82
Sewage disposal plant on account construction, 4,662 61
Slalaries, engineers, etc., on account construction, 6,619 88
Traveling expenses, engineers, etc, on account constmo-
tion 164 47
Furnishings for buildings, 18,264 46
Nurses' salaries 267 66
Doctors' salaries, 626 02
Miscellaneous salaries, 1,946 67
Milk and eggs, 8,768 62
Food stufCs, other tihan mllkiand eggs 2,721 32
Operating supplies, 1,088 67
Drugs 784 80
Traveling expenses, doctors, nurses, etc, 194 69
Sundry operating expenses, 946 06
Total expenditures, $69,366 93
Cash balance on hand Dec 81, 1907, 30,638 07 $100,000 00
Note: That the following amount was paid the Department:
December 31, 1907, being interest on bank deposit, $282 62
That the same w|^ returned to the State Treasurer as follows:
Dec. 81, 1907, $282 62
SUMMARY.
Appropriation $600,000 00
Expenditures to Dec 81, 1907, 69,366 93
Unexpended balance of appropriation, $680,638 07
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STORE ROOM.
CHARIiS]S HARTZELL, Storekeeper.
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OFFICIAIi DOCUMENT, No. 16.
REPORT OF STORE KEEPER FOR NOVEMBER
AND DECEMBER, 1907.
The work of the Department of Health increased so rapidly and
the demands of the several Divisions for stationery and supplies
were such that the absolute necessity for a Storekeeper or supervis-
ing official^ who should devote his attention entirely to this work,
soon became apparent.
Charles Hartzell, of Philadelphia, was therefore appointed and
assumed the duties of Storekeeper on October 28th, 1907, in room
48 in the north end of the Capitol.
There having been no recognized head for this particular work,
prior to Mr. Hartzell's appointment, there was a necessity for entire
reorganization.
It was at once found that more room was needed and on applica-
tion an additional room was promised in the coming year.
The duties of the Storekeeper are to receive, receipt for, arrange
and care for all stationery, desk furniture^ printed €irculars, forms,
reports and miscellaneous supplies; to furnish all such supplies to
the seven hundred and fifty (750) Health Officers throughout the
State; also to the sixty-seven (67) County Medical Inspectors, and
the sixty-seven (67) or more Tuberculosis Dispensaries to be estab-
lished and operated in each county of the State in the ensuing year,
as well as to the different Divisions of the Department; to draw up
requisitions for and keep accounts of all supplies needed from time
to time, and to make up the schedules, outfits, files, lists, etc., neces-
sary for the work of the Department in its several Divisions, and
to keep account of the stock on hand.
One of the most important of his duties will be to have certain
outfits and special supplies selected, counted and arranged sys-
tematically so that they may be mailed or shipped at a moment's
notice, correct and prompt shipping of important supplies being
absolutely necessary in order to obtain the results desired by the
Department.
In addition to the routine work much time has been devoted dur-
ing the past two (2) months to cleaning up, and re-arranging the
stock on hand; but it will take much persistent labor with additional
assistance to get this branch of the Department on the high plane
of efficiency that is desired.
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SPECIAL REPORTS.
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OB-B-ICIAL. BOCUMBNT, No. 16.
PENNSYLVANIA STATE SOUTH MOUNTAIN
SANATORIUM,
I>B. ADDISON MAY ROTHROCK, RMtdeot Phyeldan.
The Sanatorium at Mt. Alto had its beginning in the summer of
1902, when a party camped for a few weeks back four miles from'
the station in the mountain. One of the campers was an asthmatio
and a little eight by eight foot cabin was built of second hand lum-
ber for his accommodation. From this cabin, which is still in use,
sprsiig the present camp.
The first buildings erected after this were plain little square cabins
ten feet each way, and for the first year this was all th/^t could be
offered — simply the shelter. Those who came cared for themselves
in every particular.
In 1903 the Legislature appropriated eight thousand dollars for
the erection and maintenance for two years of a camp at Mt. Alto.
Six small eottages and an Assembly Building were then constructed
and the original cabins were moyed to a newer and drier site.
Through the generosity of the ladies of the Phoenixrille and Een-
nett Square Club another cottage large enough for four more pa-
tients was constructed, bringing the capacity of the camp up to
twenty-six.
It iBiraa still impossible to furnish the meals to the patients, but
they i^ere given shelter, fuel^ medicine and medicinal attention free,
and a matron and resident physician were appointed to care for
them.
In 1906 the Legislature appropriated fifteen thousand dollars to
maintain the camp for the next two years. A kitchen and dining
room were then installed and everything was furnished but the laun-
dry at the charge of one dollar a week.
In 1907 Governor fituart in his inaugural pledged himself to this
work and brought it earnestly to the attention of the Legislature
early in the session and the sum of six hundred thousand dollars was
appropriated to the Department of Health for the erection and main-
tenance of one or more Sanatoria for the care of tuberculosis. The
Camp at Mont Alto was then transferred from the Department of
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402 SECOND ANNUAL RBPORT OF THB Off. Doc.
PoreBtry to the Department of Health at the request of the Forestry
Department and at once the work of planning and constructing a
large institution was commenced.
The camp is located in the heart of the South Mountain range in
Franklin county and includes within its limits between fiye and six
hundred acres of land surrounded by a State forest reservation of
flf ty-flve thousand acres.
The site is a little over sixteen hundred feet above sea level with
the ground rising three or four hundred feet higher on all sides, thus
forming a small basin of four or five miles in area. Passes open in
through the mountain from the southwest and northeast and east.
The land is well wooded and watered and the forests are stocked
with game and the streams with trout.
In summer the weather is rarely oppressive and no matter how
hot the day may be at the foot of the mountain one is always greeted
with a cool refreshing breeze as the summit is reached on the climb
up to camp. At night it is safe to say that it is always cool enough
to sleep comfortably.
During the winter months, as might be ^expected, the temperature
is somewhat lower than in the neighboring Cumberland Valley, but
even so it seldom in the course of an entire winter falls to the zero
mark.
There is a large number of excellent springs on every hand, and
careful analysis shows the water to be very free from mineral sub-
stance, while the engineering work done for its protection makes it
next to impossible for the water supply to become infected.
Two different lines of springs are piped into the two extreme ends
of our Camp into two cement collecting basins capable of holding
7,500 and 42,000 gallons. From these basins the water ifi then
pumped to a much larger cement reservoir of a capacity of 300,000
gallons, above the level of the Camp, and from here water mains
conduct it down the streets and into the various buildings where it
is in use.
Our sewage is all collected into a regular sewer system running
down the main streets and is then conducted about a mile below the
Camp. Here it passes through a septic tank from whence it is piped
to a sprinkling plant where the fluid is sprinkled out over crushed
stone. In this manner the air and sunlight do their work of destroy-
ing the anaerobic micro-organisms in the mass. Next the material
goes into a sand filter and from here passes on to another tank where
it is treated with chlorinated lime. It is then turned out to percolate
away, and this last fiuid as it leaves the plant is as safe as sewage
can be made.
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No. 16. COMMISBIONBIR OF HEALTH. 408
The grounds around this dispoeal plant haye been moBt carefully
cleaned up and from the generally attractive appearance a yisitor
would scarcely beliere, unless he were so informed, that this was the
outlet for the sewage from the Camp. In fact visitors h^ve inquired
whether it was not the water works.
As soon as the large appropriation became available twenty-five
army hospital tents were erected on the grounds of the old Camp.
These tents had each a large fly covering them and extending an
equal distance beyond their front end. The body of each tent is
double floored with a layer of paper between the two sets of boards
and the fly is likewise floored at a level somewhat lower than that
of the interior of the tent. This provides not only a good shelter to
the inmates but likewise makes a convenient porch and gives a shel-
tered spot for a rank of fire wood and the buckets and cleaning
apparatus of the inmates.
There is a wood stove for every tent and one is surprised to find
how comfortable these little shelters have been made all winter
long. Four persons occupy a tent and this provides comfortable room
with no undue crowding.
We did not have a single case of pneumonia or any other untoward
result during the entire period of cold weather during which they
were in use.
Forty-one new cottages have just been completed each one of
which will care for eight patients. These cottages are laid out on
little blocks^ each block having a double row of five houses with the
comers of the houses directed to the four cardinal points of the com-
pass — ^northy south, east and west.
All of the cottages are twenty-seven feet square with four bed
rooms, each for two patients, and a hall running through the middle
of the building, heated with a coal stove, affording a comfortable
dressing room. The eaves are not allowed to project far over the
edges, as a maximum amount of sunlight within is to be desired. It
is for this same reason that the corners and not the sides are faced
towards the cardinal compass points, for such an arrangement of
the buildings permits the maximum amount of sunlight to enter the
rooms fronting towards the north, a point much to be desired espe-
cially during the colder portion of the year.
All of the new buildings are roofed with asbestos shingles, giving
us the most durable as well as the most fire proof material, a great
advantage in a well wooded mountainous region.
Our dining room building lies in almost the middle of our present
camp and exactly in the center of the new group of cottages. It is
a large T shaped structure and there is comfortable room for five
hundred patients in the long wing of the T while the rear portion
will provide for kitchen, bakery, cold storage, servants' dining room
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404 0BOON1> iLNNUAIi KB2PORT OF THB Off. Doo.
and the other dining building necessities. The second floor aocom-
modates the help, and the splendid high third story gives as an ideal
storage place.
Sixteen large open pavilions with their floors sloping from the
center to the sides, give us ample room for oar patients to take the
cure.
These pavilions are forty feet by twenty-two, and will be provided
with drop curtains of canvas to protect the inmates from rain or
snow if need be.
Three bath houses, every one equipped with shower bath and toilet
facilities, provide ample opportunity for bathing. Each one of the
bath houses is steam heated and has at one end the sitting room; in
the middle is the room where the bath compartments are situated,
while the far end is devoted to a furnace and coal room.
A short distance below the camp, the laundry is located with not
only a complete line of laundry machinery adequately housed but
also with comfortable quarters for the employes of the plant.
About half a mile distant from the portion of the camp so far con-
sidered, a large two and a half story Infirmary is approaching com-
pletion. It is a T shaped building three hundred and twenty-flve
feet in length and lies protected by the crest of an abruptly rising
hill from the northwest and north winds.
The Infirmary we expect to be able to occupy in January, 1909,
by which time it has been contracted to be turned over to us.
A beautiful grove of white pine well trimmed and cleared from
underbrush, lies just along the northern edge of the building and
under its shelter is to be found an ideal resting place for the patients.
Some years ago it was named by a visitor the Oathedral Pines, a
name which most fittingly describes the beauties of the grove where
the flickering sunbeams filter through the boughs as through the
time hallowed windows of an old Cathedral. Thus we have now
what has been appropriately called 'The Hillside City of Hope."
There is a large Administration building at one end of the camp
used as a nurses' home and down stairs provided with the offices foi*
the work of the Institution. A residence is also provided for the
physicians and another double building in the Colonial style is to
be begun at once for the superintendent and his family and the re-
mainder of the medical staff. There are also seven small cottages
formerly part of a private Sanatorium — ^the Mountain Side — which
was added on last summer by the State to the present institution.
The water plant and the sewage disposal system have been built
with the idea of the expansion of the institution and both are cap-
able of caring for a camp of three thousand people.
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No. 16. COlOilBBIONBR OF HBAL.TH. 405
When the infirmary is completed we shall be enabled to care for
six hnndred patients, though even these accommodation are far from
being adequate to the demand upon ns for help.
With the completion of our infirmary we will be able to classify
our patients under the headings of incipient or hopeful cases, and
those too ill to be helped and who have been in many instances cared
for in our present camp with its primitive conditions of the last
winter.
Our patients are not sent to us until after having passed the ex-
amination of the County Medical Inspectors; a great help to us
for in this way many a case too ill for the condition of camp life
is spared the hardship of a useless trip. It is for these cases that
our Infirmary is designed; to give them a chance to spend their re-
maining days in comfort and to prevent them from being a source
of infection to others.
The general line of work and treatment here is much the same
as at any other Sanatoria for the outdoor treatment of tuber-
culosis. During the past winter and spring we have been treat-
ing a large number of cases with two lines of serum the result of
years of experimental work on the part of Dr. Samuel G. Dixon, now
the Commissio(ner of Health of Peniu^ylvania. Our results have
been most gratifying and while over eighty cases have been thus
treated, we have yet to see the first evil result therefrom. In
no instance have we asked the patients to allow us to use it upon
them; such requests must come voluntarily from the patients them-
selves and no one feels that she or he is being brought here and
experimented upon. In fact so popular is the treatment that it is
found difficult to keep the supply of serum up to the demand for
its use.
One fact should have been mentioned earlier in the historical part
of this article, namely — ^that during the first winter of the campus
existence it was only kept alive through the generous contributions
of the Federation of Woman's Clubs of Pennsylvania. There was no
money whatever to draw upon, and fuel and other necessities for
the actual life of the camp came through this generous aid.
Digitized by VjOOQIC
4oe
SECOND ANNUAL RBPORT OF THE
Off. Doc.
DEPARTMENT OP HEAI/TH SANATORIUM FOR TUBERCULiOBIS AT
MONT AJl/rO, PA.
Incipient and moderately advanced CaseB. Report for the yeair ending: May
31, 1908.
Color.
Beoc
avu
CondltloB.
Total.
W.
B.
M.
F.
Iff.
&
Number patients on the first of year
Number xMttients dlscharffed during the year.
Number patients discharged as disease ar-
rested,
14
81
86
86
10
17«
109
1
1
1
9
W
U
80
6
114
m
12
6
28
18
6
6
66
46
88
6
4
6
80
18
16
8
68
46
9
82
24
20
8
111
«r
U
82
87
Number patients discharged as improved, ..
Number patients discharged as unimproved.
86
10
Number patients admitted during the year.
Number patients reroalnin«r to date
Number patients showing increase in
weight,
8
8
179
132
188
Number patients showing no change in
weight,
IT
Number patients showing loss in weight, ..
••
9
DEPARTMENT OP HEALTH SANATORIUM FOR TUBE3RCULOSIS AT
MONT Al/rO, PA.
Incipient and moderately advanced, Remaining Three Months or Less. Report
for the year endin^r May Slst, 1908.
1
Color. 1 Seoc
1
avu
CoodlUon.
Total.
W.
Bw M.
P.
H
8.
Number patients admitted during year, ....
Number patients discharged during the year.
Number paUents discharged as disease
arrested,
40
40
10
1
82
88
7
20
4
27
1
2
8
8
8
4
2
7
2
1
17
17
8
12
1
28
22
7
12
S
40
40
10
Number patients discharged as improved,..
Number patients discharged as unimproved,
Number patients showing increase in
weight
24
6
14
Number' patients showing no change in
weight,
s
Number natlents showlnjr loss In welsrht
1
Digitized by VjOOQIC
No. le.
COMMIfiSIONETR OF HE2AL.TH.
407
DEPAJEtTMENT OF HWAT/TH 8AKA1X>RIUM FOR TUBBatCUIiOSIS AT
MONT Al/rO, PA.
Far adyanced or Infirmary Caaes. Report for the year ending May 81, 1908.
Color.
Gteoc
Civil
Condition.
Total.
W.
B.
M.
T,
M.
B.
Nmnber patients on the flnt of yeftr. UOT,
Nunter paUenU diacharsod duriii« the year.
Nninber paUenU diaeharsed aa Improved. ..
Number patlanta dlacharved aa unimproved.
Number patlenta admitted dnrinff the year,
Number patlenta remaining to date
Kamber patients ahowlnff Increase in
welfbt,
12
68
18
80
8
78
87
i'
i'
i*
4
40
17
17
•
60
14
81
86
8
18
t
14
8
M
18
8
16
1
88
6
18
8
84
9
U
88
14
12
7
40
18
18
68
18
81
8
74
n
14
Number patlanta ahowln^ loaa in welrht. .
40
DEPARTM^BNT OF HEALTH SANATORIUM FOR TUBERCULOSIS AT
MONT ALTO, PA.
Far advanced or Infirmary Caaes, Remaining Three Months or Less. Report
for the Year Ending May Zl, 1908.
Odor.
Bex.
avu
Condition.
I
Total.
W.
B.
Iff.
F.
Iff.
B.
XanAer patfenta adnUtted during year. ....
Number paUenta dlacbargcd during the year,
Vumber patlenta dlacharsed aa improved. ..
Number patlenta diacharved aa anlmproved.
Number paUcnU discharged by death
Number paUants ahowlnc increase in
r
87
6
88
8
':::::::
88
88
6
16
8
8
8
16
U
11
1
7
8
1
8
8
18
18
8
14
8
18
18
8
8
7
5
8
88
8
7
Number patlenta abowln^ no change in
vei^t, 1
%
Nvaibcr patlenta ahowlna loaa in weight, .. ■
u
i
COUNTIBB FROM WHICH PATIEINTS WERE RECEIVED.
Male. Female.
Adama
Allegheny,
Armatroog,
Berka
Blair
Bocks,
Butler
Cambria.
Oarbon.
Centre,
Chester,
Oarton
Ctearteld
Ctawford
Cnmberland,
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408
SECOND ANNUAL. KB2PORT OF THB
Off. Doc
COUNTISS FROM WHICH PATISNTS WBRB REX:;E2IVSI>--Contlniied.
Male. Female.
Dauphin
Delaware
Erie,
Franklin,
Huntin^on
Jefferson,
Lancaster,
Lawrence,
Lebanon,
Luzerne
Lycoming,
McKean,
Mifflin,
Montgromery, . . .
Northampton, . .
Northumberland ,
Perry,
Philadelplhia
Sohuylkill,
Somerset,
Tioga
York,
24
1
S
4
1
6
1
2
1
2
9
2
1
7
45
1
1
6
9
19
7
8
6
1
2
1
18
2
2
6
OCCUPATIONS OF PATIENTS.
Men. Women.
Seamstress, .. 6
Florist 1
Housewife, .. (k2
Housewife (domestic), .. 2
Teamster, 6
Bartender 8
Textile worker, 8
Kennelman, 1
Miner, 6
Nurse, .. 4
Telegraph operator, 1
Laundryman, 1
Designer, 1
' Electrician, 3
Boxmaker, .. 2
No occupation, .. 1
Painter, 4
Bookkeeper, 4 3
La1±Ler, 1
Cooper, 2
Walter, 1
Silk weaver, .. 2
Draftsmen, 2
Bricklayer, 2
Iron worker, 8
Laborer, 14
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No. IC.
COlfiB£I0SIONBR OF HBAL.TH.
409
(KXJUPATION8 OF PATIBNTS-Contlnued.
SUmecatter,
Clerk
Mill worker,
Machinist
Baleoman,
Printer
Motonnan, , ,
Railroad hoBtler
Student,
Tanner, .'
School chUd.
Shoe cotter,
Prlert
Tardmaster, ,....
linotype operator,
Barber,
Merchant,
Farmer
Dmggtet,
Plasterer ,
Newsboy,
Chemist
School teacher,
Broonunaker .., ,
Undertaker,
Accountant,
Cigar maker,
Musician,
^'Iwanan (dty Are •ervlce),
Hectrtdan,
Railroader,
Hold keeper
Blacksmith,
Child's none, ,
Sngar refiner,
Retired,
Patternmaker
Decorator.
Panter,
8*enograpiier,
Cartoonist,
Miller. !....!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Miuiner, !..!!!.!..!.!.!.!...!!..!!
Salvation Army <«cer,
*rrain conductor,
foundry boss ,,,
Carpenter,
Jeweler,
Showman,
^▼ate lecretary,
Wiysldaa,
Pyer, !]!.!'/.!.!!!.!!'.
Men.
2
11
3
U
2
8
2
2
Women.
1
6
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410 SECOND ANNUAL REXPORT OF THE Off. Doc
OCCUPATIONS OF PATIEJNTS— Continued.
Weaver
Boiler maker,
Railway mall clerk
GUusB worker,
Tailor,
Elevator boy,
Rigger,
Sailor's apprentice, U. S. N.,
Chambermaid ,
Newspaper carrier
Livery stable manager ,
Lineman,
Encrlneer
GHass blower,
Men. Women.
1
THE DETECTION OF BACILLUS TYPHOSUS IN THE WATER
SUPPLIED TO THE CITY OF SCRANTON.
Scranton's typhoid record for the earlier half of the year 1906
was a remarkably clean one and the few cases of the disease which
occurred could easily be attributed to importation. In the month
of August, however, a trifling increase was noticed by the Depart-
ment of Health in the typhoid returns from the city, and for the
next two months there was a constant, though comparatively slight,
unusual prevalence of the affection, indicating the presence of some
disturbing condition. No alarm was felt, however, by the citizens
or the local authorities until December 7, when there was a sudden
and startling rise in the number of cases. By the middle of the
month it was evident that a serious epidemic was under way. On
the 13th, thirty-three cases were reported as having occurred in the
last twenty-four hours. There could be no doubt as to the true
nature of the disease as a large percentage gave a positive Widal
reaction. A medical and an engineer inspector of the Department
were at once commissioned to visit Scranton, put themselves in
communication with the local board of health and other city authori-
ties and endeavor to discover the origin of the outbreak. Our
representatives reported that one hundred and thirty cases had oc-
curred in six days and that the fact had developed that all of the
cases had been found in a section supplied from one only of the three
reservoirs which furnish the city with its drinking water.
Digitized by VjOOQIC
Nt). 16. COBISMISSIONilR OF HEALTH. 411
The local authorities had accordingly taken the precaution to shut
off this Bource, known as the Elmhurst Reservoir. The increase in
the number of cases was now very rapid, so that by January 5,
1907, it had reached 1010 in the city and 18 in the adjoining borough
of Dunmore, evidently due to the same source.
No antecedent case of fever could be discovered on the watershed.
An examination of the water itself, therefore, became of pressing
importance and arrangements were made at the Department of
Health laboratories by Dr. Herbert Fox, chief of the laboratories,
and First Assistant Rivas, for the immediate bacteriological in-
vestigation of a large number of samples. The following is in
part the report of their work submitted February 1, 1907.
On December 12, there were received from Dr. F. F. Arndt, bac-
teriologist of the Scranton Board of Health, two samples of water
from the reservoir and one sample of sewage.
The sewage was collected on its escape from a hotel in the village
of Moscow where it flowed into Roaring Brook, and from the stream
into Elmhurst Reservoir. No colon was found in the water samples.
That in the sewage of course was of interest simply as showing a
possible source of pollution of the reservoir.
From our own inspectors were received December 19, four
samples; December 21, fifteen samples; December 29, four samples;
January 7, six samples; January 16, twenty-four samples; January
28, three samples; January 31, eight samples; February 1, nine
samples; February 4, eight samples; February 7, six samples; Feb-
ruary 8, six samples; ninety-three samples in all. These samples
were collected from ten reservoirs, one creek, seven brooks, one
watering trough, two taps at hotel, two at restaurants and one at
the city hall. Those from the reservoirs were taken in different
situations and at different depths, and at gate houses, screen cham-
bers and spill ways.
All of them were received from the Department's inspectors in
glass stoppered bottles, which varied in content from one to five
ounces. They were all received in containers and packed well with
ice.
The methods of examination used in the determination of bacteria
In these samples consisted in planting quantities of one cubic centi-
meter of the raw water, or in making dilutions when it appeared
that the water contained many bacteria. Agar-agar was used en-
tirely, and the plates were incubated at 37 degrees C. for forty-eight
hours for the determination of the number of baijteria per cubic
centimeter. One cubic centimeter of the raw water was also plated
in litmus lactose agar with about one per cent. Parietti's solution
and incubated at 37 degrees C. for twenty-four hours, to discover
Digitized by VjOOQIC
412 SSCOND ANNUAL RBSPORT OF THE Off. Doc
contamination of the bacillus coli. These plates were fished at the
end of twenty-fonp hours and grown in dextrose broth, and those
showing fermentation were studied further for the determination
of the bacillus coli. After these quantities were removed from the
original bottle of raw water, the remainder of the water in each
bottle was poured into flasks containing double strength bouillon
in about equal quantities, and to this mixture about one per cent.
Parietti's solution was added. Unfortunately the water in these
bottles was not measured, so we can not report on the exact quan-
tity of water, but as the bottles averaged about three ounces (about
equal to 100 cubic centimeters), we have spoken of the bacillus coli
content of that quantity. These plates were fished at the end of
twenty-four hours, and the routine examination of the bacillus coli
made.
Being mindful of the epidemic of typhoid fever in Scranton, we
were on the lookout for the bacillus typhosus, and from the plates
made of the large bulk of water grown in double strength bouillon,
we fished about one hundred colonies which were suggestive of that
organism, being small and blue or violet. Of this hundred, four grew
diffusely upon dextrose broth without the production of gasp and
were accepted as suspicious. These cultures came from (1) number
7 reservoir surface at Spillway, laboratory number, 97-a, (2) brook
just below hotel sewer at Moscow, laboratory number, 100, (3) Soar-
ing Brook just below bridge, Mill St., Moscow, laboratory number,
103, (4) Van Brunt Brook just below run leading from Moscow cess-
pool, 108. (These cultures will hereinafter be mentioned by their
laboratory numbers.)
The culture, Lab. No. 97-a, was proven to be identical with the
bacillus typhosus, biologically, morphologically and in its serum
reactions. This culture will be described later on.
The culture. Lab. No. 100, reacted with blood of one patient on
two occasions, and was biologically strongly suggestive of bacillus
typhosus, except in milk, where the alkalinity ruled out such a deter-
mination. Since this time, the organism has not reacted to any-
thing, and has unfortunately been lost by contamination.
The culture from Lab. No. 108 was biologically like the bacillus
typhosus, is nonmotile and does not react to any blood.
The culture 103, in many ways suggestive of bacillus typhosus,
reacted to three samples of blood from typhoid patients, but does
not produce a serum after injection into rabbits which will agglutin-
ate either the bacillus typhosus or culture from Lab. No. 97-a, now
to be described.
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HIIAX.TH. 418
REPORT OP THE CULTURE FROM LABORATORY, NUMBER 9T-A.
The foUowlnsr is a report of ithe baoteriologlcal examination of the culture ob-
tained Arom tlie water eent to us labeled "No. 2', Spillway of dam No. 7," in
a series of samples sent on December 21, 1906. This sample was subjected to
the same routine examination as the other samples, accordincr to the metliod
outlined- above. On the plates made fkom the bulls of the water which was in-
cubated with double strength bouillon, about 200 blue colonies were found. Fif-
teen of tbe most suspicious of these colonies were transferred to dextrose broth
and fermentation tubes. One of these fifteen showed a diffuse, even turbidity
with no gas, no excessive growth on the bottom, of the bulb, and proved to be
a motile organism, negative to the Gram stain. The other fourteen tubes were
easily excluded from consideration. This one very suspicious tube was trans-
ferred to the various culture media, and the following is a detailed account
of its growth.
The organism was negative to Gram stain, stained rather diffusely with
Loefiler's, and all stains showed a short, rather plump rod, with rounded ends,
sometimes present in filcmientous forms. They were acUvely motile, with a
typical wiggle.
On agar slants, there grew a pale, even, smooth, regular veil-like grayish blue
streak on the surface.
Agar plates presented small, smooth, even regular, round entirely superficial
colonies, having bluish gray color by reflected light; in the depth round or
whetstone shape, finely granular, yellow brown coloniea GE^acticaJly the same
colonies were present on gelatin, except that they were more finely granular,
the radial lines were not clear, and the nuclei were central or slightly eccentric.
No liquefaction.
Gelatin tube: after forty-eight hours, there was a pale, whitish growth along
the stab, with flat smooth surface growth, showing a little tendency to spread.
No liquefaotlon.
Lactose litmus agar tubes: the medium has a violet color after twenty-four
hours, with a slight, smooth, bluish growth on the surface, but no gas and no
red color. No gas in lactose litmus bouillon.
Lactose neutral red tube: there is a growth along the stab and along the sur-
face as above. Medium has slightly deeper red color.
Milk: At the end of twenty-fbur hours, the first change was seen, the medium
being sUgbtly violet or lilac, wthicli is more marked at the end of forty-eight
hours, but does not increase thereafter. There is at no time any viscidity of
the milk.
Pc/tato (acid) : There is a very faint moist colorless growth on this medium.
Bouillon and peptone water: Even turbidity, more marked in the former; no
pellicle and no indol after a growth of eight days.
Conradi-Drigalski plates: Stroke plates showed small, bluish, round, regular,
even end entire colonies, the largest being three millimeters in diameter at the
end of forty-eiglit hours.
HIS tube: Growth alone: the stab quite clear, extension into the medium very
faint. No gas by stirrlngr with the rod.
HIS plates: The colonies on the surface showed typical granular center, with
thready outgrowths.
Serum Tests. On January 2, this culture reacted positively in dilutions of 1-50
and 1-100 with three samples of blood collected from, typical typhoid fever pa-
tients in the Hospital of the University of Pennsylvania; controls made with
the bacillus typhosus made at the same time were foimd to be positive.
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414 SECOND ANNUAL REPORT OP THE Off. Doc
On January 6, we obtained three samples of blood from- Dr. F. F. Amdt, bac-
teriologlflt of the city of Scranton, and five epecimens from new cases from the
Hospital of the University of Pennsylvania. From, the^ bloods were obtained
five positive reactions with tihe ba^lUucr typhosus, and with the culture from
JjBLh. No. 97-a. The bloods which were negative to the bacillus typhosus were
llewlse negative to this culture.
On January 8, these bloods were retried with exactly the same results. This
culture was then tried with normal blood, and both it and the bacillus typhosus
were negative in dilution of 1-10 and 1-60, even after the lapse of one hour.'
Rabbits were immunized with the bacillus typhosus, culture from Lab. Nb.
•7-a and with culture from Lab. No. 103. They were injected with dead cultures
and then with minute quantities of live cultures, ten days apart. They received
in all three inoculations. Our preliminary agglutination test, set ten days after
the second injection, showed that the serum from the rabbit injected with
bacillus typhosus agglutinated the homologous organism in dilutions of 1-10
and 1-100, the latter reaction occurring promptly and clearly at the end of
twenty minutes. This same serum clumped the culture from Lab. N0.97-& in
dilutions of 1-10 and 1-100, the latter reaction being complete and typical aA
the end of twenty minutes. This antityphoid serum did not react in dilutions of
1-10 and 1-100 with culture from Lab. No. 103.
The animal which had been injected with. 97-a was bled at the same time, and
the serum agglutinated this culture, that is, 97-a, in dilutions of 1-10 and 1-100,
the latter being prompt and positive wthen observed after twenty minutes. This
same serum agglutinated the bacillus typhosus in dilutions of 1-10 and 1-100,
the Latter reactions being typically positive when observed after twenty minutes.
This serum from the rabbit injected with the culture from Lab. 97-a did not
chimp the culture 103.
The serum from the rabbit injected with culture Lab. No. 103 agglutinated the
homologous bacterium in dilutions of 1-10 and 1-100, but had no effect in dilu-
tions above 1-10 upon the culture Lab. No. 97-a, or bacillus typhosus.
The microscopical method of agglutination test was used, and the controls in
all cases were free of clumps and actively motile. Th/& time limit of ten min-
utes was set for dilutions of 1-10 and wlien dilutions were 1-100, no reaction was
considered positive that did not appear within ninety minutes.
Ten days after the third injection, the rabbits were again bled, and on this
occasion we determined the limit of agglutination value of each serum for Its
own culture, and the heterologous bacillus. We determined primarily by the
microscopic method, that each serum would react with its own, and with the
other organism rp^pidly in dilutions of 1-400. (See Chart No. 1.) The teat for the
limit of dilution which would give a positive reaction was set by the macros>-
copic method, and it was found that the serum from the rabbit injected with
the bacillus typhosus would agglutinate . that organism in dilutions of 1-6000,
while the serum from the rabbit injected with culture 97-a would agglutinate
its native bacterium in dilutions of 1-4000, and questionably in dilutions of 1-5000.
The limit of agglutination of each serum with the heterologous bacterium was
then tried, and it was found that the antityphoid serum would react with the
culture from Lab. No. 97-a in the dilution of 1-4000, and that the serum from the
rabbit injected with culture Lab. No. 97-a would react with the bacillus typhosus
in dilutions of 1-3000.
After having discovered that each serum would agglutinate the homologous
and heterologous organisms in high dilutions, it was natural to suppose that the
heterologous organism would absorb all or nearly all the agglutinin produced by ,
the homologous organism, and therefore reduce the limit of the dilution value
for the latter. The dilutions of the ^-a and bo^llus typhosus antlsera to
Digitized by VjOOQIC
No. 16. COMMISeiONETR OF HRALTH. 415
which the beterologous organism had been added , to determine the heterologous
agghitinatlon limit, were centrifuged to free them of all bacteria. These, then,
were reispectively the proper dilutions of the typhoid antiserum in which the
agglutinin had been absorbed by the culture from. liab. 97-a, and of the 97-a an-
tiserum, the agglutinin of which had been absorbed by the bacillus typhosus.
Having removed the heterologous bacilli from the absorbed dilutions, very
small quantities (1 drop in 2 c.c. dilution) of a thick emulsion made in salt
solution from twenty-four hour old agar slants of the respective bacteria, were
added to their native sera. (See Chart No. 2.)
It was found by this that the culture 97-a had absorbed sufficient agglutinin
f^m the antityphoid serum to reduce the agglutinin limit of that serum for the
bacillus typhosus from 6,000 to 100. Controls of the anti- typhoid serum which
had been preserved in dilution (therefore about twenty-four hours old) reacted
with the bacillus typhosus positively in dilutions of 1-400, and questionably in
dilutions of 1-6000. It seems, therefore, from this experiment that -the culture
from Liab. No. 97-a is capable of absorbing nearly all the agglutinin produced
in rabbit serum by the beu:illus typhosus.
In order to determine whether the bacillus typhosus could absorb the ag-
glutinin produced in rabbit serum by injection of 97-a culture, complimentary
tests were set. It was discovered that the 97-a antiserum would clump the
bacillus typhosus to the dilution of 1-3000, but when this serum, was centrifuged
and mixed with its homologous culture, the agglutinin limit for this culture,
that this culture, that is, 97-a, had been reduced to 1-200. Controls, as before,
made from the twenty-four hour old dilutions of 97-a antiserum showed that
these dilutions still recucted to the limit of 1-3000, with 97-a culture. It therefore
seems that the bacillus typhosus can absorb most of the agglutinin produced in
the serum of rabbits by the culture of 97-a.
Time limit of sixteen hours was established for ail these macroscopic experi-
menta.
There are in the laboratory, four cultures determined to be the bacillus ty-
phosus, and four cultures suspected of being the same. The serum produced
by the injection of culture from Lab. No. 97-a was tried wtih these eight, and
the 97-a culture, with the bacillus paracolon, bacillus paratyphosus, and with
the culture Lab. No. 103. The results obtained are presented in Chart No. 3. 1,
8, 4 and 6 are determined strains of bacillus typhosus, while 6, 7, 8 and 9 are
at present under examination as belonging to the bacillus typhosus group. It
will be noted that this antiserum of 97-a agglutinated also the paracolon organ-
ism (bacillus enteritidls Gartner) but not the bacillus paratyphosus. Upon the
culture from Lab. No. 103, this serum has no effect.
From the results of the biological €uid morphological ch«uracters, the agglu-
tination experiments, and the absorbing ability of this culture from Lab. No.
97-a for the anti-typhoid ejgglutinln, it seems Justifiable to call this orgranism
the bacillus typhosus.
Respectfully submitted,
H£niB£niT FOX,
Chief of the Laboratories.
D. RIVAS,
First Assistant in the Laboratories.
The conclusion reached by Drs. Fox and Rivas must be that of
every experienced bacteriologist. The fact that they met with suc-
cess in a quest where so many have failed^ is due possibly not so
much to superior skill as to the fact that they happened to receive
Digitized by VjOOQIC
416
SECOND ANNUAL KB2PORT OP THB
Off. Doc
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Digitized by VjOOQIC
No. 16.
COMMIBBIONBR OF HEALTH.
417
CJHAUT NO. 3.
97-A ANTISBQEIUM WITH DIFB'EiRBNT CU1L.TURE3S.
Now
Namei
Dilutloii.
RMUlt.
1-600
+
1-600
1-600
1-600
1-600
1-600
1-600
1-eoo
1-600
1-600
_
1-600
+
1-600
Tlmd Umlt.
Control.
Tjrpliold
S"*.
Flezner,
F-1.
F-»,
Hunt
WalnwrUrht, ..
«M-1.
S84.2,
Bw iMtratyphold,
B. panoolon, .,
10^
20 mln.
to min.
to mln.
40 mln.
SO mln.
65 mln.
aomln.
S6 min.
86 mln.
Sbn.
Ihr.
S 1-2 hn.
Good.
Fair, few cIumiNi.
Good.
Good.
Good.
Good.
Good.
Good.
Good.
Good.
Good.
Good.
BampIeB containing an unnsual number of typhoid organigms, to the
large number of samples f umighed, and to the industry and pertina-
city of their search. The practical value of their discovery can not
be overestimated, as it enabled the Department of Health to declare
with absolute authority that which it had before asserted inferen-
tially, that the water shed was polluted, and, further, to point out
the precise place in the particular reservoir where the pollution
was detected. From this resulted the complete co-operation of the
city authorities and the water company with the department in its
efForts to remove every source of pollution from this large water
shed of fifty-nine square miles, and to thoroughly cleanse the entire
system from dangerous organisms.
I may state that not less than five hundred separate sources of
pollution, ranging from a hotel sewer to a piggery, were discovered
and removed, and this in a mountainous country, in zero weather,
with the gi^ound frozen to the depth of eighteen inches and often
covered with a foot of snow.
AN OBDEB ISSUED BY THE GOMMISSIONEB OP HEALTH OF
THE STATE OP PENNSYLVANIA FOB THE SANITABY PBO-
TEOTION OP THE WATEBS USED BY THE SCBANTON GAS
AND WATEB COMPANY FOB THE SUPPLY OF WATEB TO
THE PUBLIC IN THE CITY OP SCBANTON AND ITS IMME-
DIATE VICINITY.
Section 1. — No cesspool, privy, or other place for the reception,
deposit, or storage of human excrement, and no urinal or water
closet shall be located, constructed or maintained within 50 feet of
the high water mark of any lake, pond, reservoir, stream, ditch,
water course, or other open waters used by the Scranton Gas and
Water Company, as a source, or for the conveyance, storage or dis-
27—16—1907
Digitized by VjOOQIC
418 SECOND ANNUAL RBZPORT OF THB Off. Doc.
tribution of the water supply of the city of Seranton or its imme-
diate vicinity, or withia 50 feet of the high water mark of any lake,
pond, reservoir, stream, ditch, water course, or other open waters,
the water of which flows directly or ultimately into any waters so
used by the Seranton Gkis and Water Company.
Section 2. — ^No human excrement shall be deposited or discharged
in or into any lake, pond, reservoir, stream, ditch, water course, or
other open waters, used either directly or indirectly by the Seranton
Gas and Water Company, for the supply of water to the public in
the city of Seranton or its vicinity; and no human excrement shall
be kept in, deposited or discharged in or into any cesspool, privy,
or other receptacle situated within 250 feet of the high water mark
of any open waters so used directly or indirectly by the Seranton
Gas and Water Company, unless such cesspool, privy, or receptacle
is so constructed that no portion of its contents can escape or be
washed into any such waters.
Section 3. — ^No human excrement, or compost containing human
excrement, or contents of any privy, or cesspool or sewer or other
receptacle for the reception or storage of human excrement, shall be
deposited or discharged upon or into the ground at any place from
which any «uch excrement, compost or contents, or particles thereof,
may flow or be washed or carried into any lake, pond, reservoir,
stream, ditch, water course, or other open waters used by the Seran-
ton Gas and Water Company, as a source, or for the conveyance,
storage or distribution of the water supply of the city of Seranton,
or its immediate vicinity, or into any of such waters of the State, the
water of which flows directly or ultimately into any waters so used
by the Seranton Gas and Water Company.
Section 4. — ^No house slops, sink wastes, water which has been
used for washing or cooking, or other polluted water, shall be dis-
charged directly or indirectly into any lake, pond, reservoir, stream,
ditch, water course, or other open waters used by the Seranton Gas
and Water Company as a source, or for the conveyance, storage or
distribution of the water supply of the city of Seranton, or its imme-
diate vicinity, or into any such waters of the State, the water of
which flows directly or ultimately into any waters so used by the
said Water Company; no house slops, sink water, water which has
been used for washing or cooking, or other polluted water, shall be
discharged into the ground within 50 feet of the high water mark
of any open waters so used by the said Company, or of any open
waters flowing as aforesaid into the waters so used by the said Com-
pany, and not then, unless such discharge into the ground be so ar-
ranged that no portion of it can cfscape to the surface of the ground
and be washed into any such waters.
Digitized by VjOOQIC
No. 16. COMMI8SIONBR OF HBLA.L.TH. 419
Section 5. — "So garbage^ manure or putrescible matter^ whatso-
eyep, shall be put into any lake, pond, reservoip, stream, ditch, water
course, or other open waters used by the Scranton Gas and Water
Company, as a source or for the conveyance, storage, or distribution
of the water supply of the City of Scranton and its immediate vicin-
ity, or into any such waters of the State, the water of which flows
directly or ultimately into any waters so used by the said Water
Company; and no garbage, manure, or putrescible matter, whatso-
ever, shall, except in the cultivation and use of the soil in the or-
dinary method of agriculture, be put upon the ground within 250
feet of the high water mark of any open waters so used by the said
Water Company, or of any open waters indirectly so used by the
said Company, nor on said ground beyond said limits, unless precau-
tions are taken that prevent any portion of such matter to escape
or be washed into any such waters.
Section 6. — No stable, pig sty, hen house, barn yard, hog yard,
hitching or standing place for horses, cattle or other animals, or
other places where animal manure is deposited or accumulates, shall
be located, constructed or maintained, any part of which is within
50 feet of the high water mark of any lake, pond, reservoir, stream,
ditch, water course or other open waters used by the Scranton Gas
and Water Company, as a source, or for the conveyance, storage or
distribution of the water supply for the city of Scranton or its vicin-
ity, or the waters of the State, the waters of which flow directly or
ultimately into any waters so used by the said Water Company, and
no stable, or other place as above enumerated, shall be located, con-
structed or maintained on any ground, the surface drainage of which
is either directly or indirectly into the aforesaid waters so used by
the said Water Company, unless suitable and adequate provisions
are made to prevent any manure or other polluted matter from flow-
ing or washing into such open waters.
Section 7. — No manufacturing refuse, or waste product, or pol-
luting liquid or other substance of a nature poisonous either to
human beings or animals, or other putrescible organic matter, what-
soever, shall be discharged, directly or indirectly into or at any place
from which it may flow or be washed or carried into any of the open
waters of the State used by the Scranton Gas and Water Company,
as a source of supply to the public, or for conveyance, storage or dis-
tribution of the water supply of the city of Scranton and its vicinity.
Issued January 1st, 1907, and to remain in force until further order.
SAMUEL Q. DIXON,
Commissioner of Health.
Digitized by VjOOQIC
420 SECOND ANNUAL REPORT OF THE Off. Doc.
REPORT ON THE EPIDEMIC OP ACUTE POLIOMYELITIS IN
NORTHWESTERN PENNSYLVANIA DURING THE AUTUMN
OF 1907.
By HERBERT FOX, M. D., Chief of Xj&boratoriee, Under the Direction of the
Department.
The first knowledge that poliomyelitis really existed in epidemic
form in Pennsylvania came to the Department of Health when report
was made of the appearance of twelve cases in the town of Eau
Claire, north Butler county, during the last two weeks in September,
1907. Rumors of cases had come sometime previously from Ridgway,
Elk county, but these tales were so confused with reports of existing
cerebrospinal meningitis that little attention was paid to them.
Acute anterior poliomyelitis is not included among those diseases
which are to be reported as communicable, but from the experience
gained in this epidemic, from a review of literature and because the
disease is known to exist in an epidemic form in New York, it seems
to the writer that there is as much justification for adopting some
kind of hygienic control in this condition when epidemic as in spotted
fever. While we now recognize a specific etiologic agent in cerebro-
spinal fever and other communicable diseases, they were guarded
against before this was isolated, and we guard against some diseases
whose causation is not yet known. This investigation was instituted
by the Commissioner with the hope of establishing some fact or facts
indicating the means of transmission, degree of communicability,
and causation of this actue infantile palsy. Bacteriological and path-
ological materials were taken. The epidemic was on its ebb tide
when I arrived, so that experimental work was possible in less than
a score of children, although I could not gain family consent in a
few other serviceable cases. The hearty support of the physicians
deserves the thanks of the Department.
The first cases of which I could obtain reliable information oc-
curred in Elk county, about the last of July or the first of August.
A few cases occurred in Venango county a short time later. It might
be added that efforts to connect these two counties and the indi-
vidual cases yielded nothing of value. The disease then made its
appearance in the center of Elk county at Ridgway. Thence it may
be said to have jumped to Oil City, after which DuBois was visited,
and, lastly, in Eau Claire twelve cases developed in two weeks. It
must not be understood that these were the only places visited, for
small villages and single outlying houses were attacked during this
time, the number of these so-called sporadic cases probably equalling
or exceeding that in the larger centers. I have records of one hun-
dred and thirty-one cases in and around Eau Claire, Oil City, Ridg-
Digitized by VjOOQIC
No. le. COMMISSIONER OF HEALTH. 421
way and DuBois, and slight information of twenty-five to forty more
in one region of Elk county, so that the epidemic was general. The
territory through which the disease prevailed might be roughly
bounded as follows: On the north by a line between Ridgway and
Oil City; on the east by DuBois; on the south by a line east and west
just north of Butler City, and on the west by New Castle near the
Ohio line. The question bearing on the relation of these towns will
be discussed under general hygiene, but the reader could easily
satisfy himself of the relative position by a glance at a map of the
State of Pennsylvania. This area is from 78° 45' to SO** 15' W. Long,
and from 41** to 41° 30' N. Lat.
If the epidemic be taken as a whole, it can be said that it had
a gradual rise and a much more rapid fall. The earliest cases ap-
peared in the midsummer; they then increased slowly and steadily in
number until the last half of September when the greatest average
was reached, after which a rapid subsidence occurred, so that at the
first of November only a few scattered cases were reported. The in-
dividual centers in which the disease broke out had a somewhat
different experience. The first place studied, Eau Claire, for instance,
was stricken suddenly and nine persons were taken sick within eight
days, after which a slow decline was observed. In Oil City the rise
was quite slow, with its high point about the first week in October,
and then a slow decline. In Ridgway a slow onset, slow progress
with no definite high point and a rapid cessation, outlines the course
of the epidemic. In DuBois there may be said to have been two out-
breaks; the first in September, the second late in October, the latter
being succeeded by a rapid disappearance of the disease. Such a
course as outlined for the epidemic as a whole seems to indicate a
dependence upon some condition consequent upon the advancing
summer and approaching autumn. Moreover, the different behavior,
and indeed the different times of the individual outbreaks, whose
locations are geographically comparable, do not jJoint in the same
direction. The fulminating outbreak at Eau Claire, and the slow
progress at Ridgway, would not seem an expression of the same de-
termining factor. Some reference will be made to this under another
heading.
CI4INICAL. CONSIDERATiaNS.
The primary desideratum was of course to establish the diagnosis.
This appeared difficult from reports and the first few examinations.
It was a current belief with the laymen and some of the physicians
that we were dealing with a form of spotted fever. This idea was
not unfounded because of the frequency of meningeal symptom?* to
a greater degree than observed in the usual sporadic case of acute
infantile palsy. The incubation symptoms and period strengthened
Digitized by VjOOQIC
422 SECOND ANNUAL. RIZPORT OF THB Oft. Doo.
the belief. The absence of reflexes in the affected area, the presence
of palsji absence of eye signs and infreqnency of delirium soon
directed the decision against cerebro-spinal meningitis.
I will briefly outline the average clinical course and variatioiiSy
the latter appearing to have great importance in hygiene. The child
will go to bed in its usual health, but during the night may be
noted as somewhat restless. In the morning, nothing abnormal may
be observed, but during the day the child will complain of being
tired; it is quiet, perhaps somnolent when undisturbed, but ner-
vous and peevish upon the slightest molestation; the pupils may be
dilated and the conjunctiva glassy and sensitive to light at this time.
The tongue is probably not yet coated, but soon becomes so, and
the papillae of the anterior half are red and prominent. This tongue
I have called an atypical strawberry tongue. At night the child will
have fever, sleep fitfully and awaken several times peevish or cry-
ing. Vomiting or convulsions are occasionally encountered at the
onset. During this time constipation exists, and often forty-eight
hours elai>se without a bowel movement; this consrtipation may be
unaffected until an enema is employed to assist after the exhibition
of a reliable cathartic. This speaks for a paresis of the bowel. In
a few instances, diarrhea is reported, but whether this were true
looseness or due to the constipation, I was unable to decide from the
histories. Urine not infrequently is retained, and voided perhaps
not oftener than twice daily, or even less. The bladder is usually
full, however, and later urine is free; therefore, the paresis or atony
of the bladder appears early and is transient. The reflexes of the
foot, knee, abdomen and eye are not disturbed at this time. On the
third day, there may be an improvement and the fever, which has
been moderate, averaging 102 deg. F., will begin to subside. During
the day before the fever subsides, or when it is at its height, general
aches and pains are noted, especially referable to the head, neck,
shoulders and legs, not often the thighs. With the decline of fever,
this symptom improves only to reappear a day or so later. When the
patient cannot express pain, it will cry on passive movement, and
must also be turned frequently to be comfortable. The child lies
by preference, partly on the back and partly on the side, with the
legs and thighs flexed and the head thrown slightly backward. The
posterior cervical muscles are frequently stiff, which sign appears
just before the palsy in the average case. Pressure over them and
along the vertebrae may sometimes elicit tenderness at this stage,
and almost always a day or so later. As the temperature subsides,
a paresis of the parts to be affected appears, which is rapidly suc-
ceeded by paralysis. When the paralysis is well established, the
constitutional signs and symptoms rapidly clear up and the child's
appetite returns. The soreness and pain may persist for some days.
Digitized by VjOOQIC
No. 16. COMMI8SIONER OF HEIAX.TH. 42S
Physical examination of the trunk during the acute stage discovers
an enlarged spleen in fifty per cent, of the cases, which persists for
a week. Otherwise, physical examination is usually negative. Occa-
sionally tymjmnites may be present. The paralysis of course is ac-
companied by complete loss of reflexes in the respective members.
Tache Gerebrale was present in a small i>ercentage of the acute
cases which I saw. Kernig's sign is rarely present, except in the
fulminating cases next to be described. It is always noted when the
symptoms of meningeal irritations are greatest. The general course
differs from the sporadic case in its slowness of development, early
evidences of pain and other meningeal symptoms. The average
duration of the constitutional conditions was four days.
Another type of case suggests Landry's ParaJysis, and was ful-
minating in its progress, the initial symptoms perhaps developing
in twenty-four to thirty-six hours accompanied by complete paralysis
and ending in death within seventy-two hours from the onset. Two
cases may be cited in detail in illustrate this type.
Case 12, H. K., eleven years. Five brothers and three sisters.
Family and personal history negative. This boy lived in the town
of Eau Claire during the school week and spent Sunday with his
family, about a quarter mile out of town in a valley. During the
week of 9-20, he had complained frequently of headache and abdom-
inal distress, which was ascribed to dietetic indiscretions and relieved
by cathartics. This is the only case among the fatal ones in which
I can obtain a clear history of dietetic indiscretions. October 8th he
complained of severe headache and backache and had fever, but this
was better on the following morning. That day he was put to bed and
the general condition was worse at night. There were no catarrhal
symptoms at any time. There was almost absolute retention of the
bowels. The pupils were dilated, but the conjunctive was not in-
jected. On October 10th, paresis of the legs, followed closely by that
of the arms, was observed, which proceeded into paralysis in the
afternoon of the same day. During the night of 10-10, respiratory
paralysis occurred, and from then until death respiration was car-
ried on by the cervical muscles. The eyes at this time were widely
open, dry, perfectly straight, the pupils were dilated and reacted to
light and distance. The child was uncomfortable by reason of gen-
eral pains and aches, which appeared very shortly after the onset.
There was no pain on pressure over the spine, but the dorsal and
lower cervical vertebrae were tender when struck by the finger.
The liver and spleen and thorax were negative. Retraction of the
head was first observed on the morning of the 10th, but this retrac-
tion was more a matter of comfort than spasticity. Kernig's sign
present. After midday on the 11th, dyspnoea became worse, respir-
ation assumed the Gheyne-Stokes type; mild active delirium set in
Digitized by VjOOQIC
424 SECOND ANNUALi REPORT OF THE Off. Doc.
and death occurred that same afternoon. Post mortem limited to
the brain and cord, done 18 hours after death. Fluid had been in-
jected into the cavities by the undertaker. Lumbar puncture re-
sulted in a dry tap. Blood stains were noted beneath the skin aU
over the body, giving rise to the suspicion of spotted fever. No such
condition could be discovered. The cord in the meninges seemed
entirely normal, while the membrane was smooth and pale. The
spinal fluid could not have amounted to more than 1 c.c. Cultures
were taken from beneath the dura, just below the fourth vertrical
and smears were also made from this fluid. The dura of the brain
was closely adherent to the skull and to the pia of the central sur-
face of the left hemisphere. The longitudinal sinus was very full of
dark fluid blood, and its walls were closely attached to the pia of the
internal surface of the hemispheres. The pia of the left hemisphere
along the longitudinal fissure was cloudy and congested. At no
other point, including the base, was the pia affected. No opacities
along the vessels. Cultures and smears were taken from the cloudy
pia and the subjacent brain. Cultures taken from the lateral ven-
trical, nose and throat; the eyes and ears had been handled too
much.
Pathological sections of this brain and cord showed typical lesions
of poliomyelitis. The spaces around the cells of the anterior horn
contained thrombi, around the edges of which was an excess of
mononuclear cells, apparently of the lyphoid type. The pia and sub-
pail layer of the cord, medulla and pons were the seat of infiltra-
tion of lymphoid cells of the same type seen around the motor cells.
The process involved the cord, bulb and pons, while the gray matter
of the cerebrum and cerebral pia was markedly congested. This
brain, with some other work on the pathology of this condition, will
form the basis of a later paper. The cytologlcal studies upon smears
made from various parts of the brain surface were quite unsatis-
factory. The slides showed only a very few cells, perhaps two doeen,
on a large smear, and these were almost entirely large regular
mononuclear cells with a large nucleus and narrow protoplasm. A
few polymorphonuclears were also encountered. Preparations fixed
and stained in many different ways failed to show any trace of pro-
tozoa, cellular inclusion or intracellular bacteria. A gram positive
diplococcus was found in cultures from the fourth ventricle and
longitudinal fissure. This will be discussed later.
Case 19, R. H., four years. Personal and medical history negative.
House and family hygiene, good. First taken sick October 16th A.
M., by sleepiness and vomiting after taking a glass of milk. Tem-
perature in the middle of the afternoon IQl deg. F. Bowels abso-
lutely constipated after 10.16 a. m. until death. Tongue was dry,
covered with a whitish coating and there were a few small promin-
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 426
ent papillae. The afternoon of October 16, stiffness of the neck with
i^etractlOQ was noticed. There were no convulsions at any time. Ten-
derness in extremities and back was noted in the evening, and the
child was very peevish and restless during the afternoon and night.
The pupils were moderately dilated, conjunctiva normal. When first
seen, there appeared to be some weakness of the legs, but thi« could
not be determined definitely because of the child's irritability. Oc-
tober 17, considerable depression, greater prominence of the above
described symptoms, distinct palsy of the legs. Oct. 18, absolute
paralysis of all extremities and thorax with marked dyspnoea was
noticed. Kespiration became Cheyne-Stokes at 4 p. m., ajid the child
died about 8 p. m. There was Kernig sign but no tache. Pain was an
inconspicuous symptom probably because of the great depression of
the child on the second day. Three hours before death, 10 c.c. of a
clear fluid was removed at the second lumbar space, and after its
withdrawal the general condition improved for about half an hour.
The family would not consent to a repetition of the procedure. The
pulse was strong until death, averaging about 120. Post mortem
was refused.
The first case fails to show the excess of fluid causing pressure
with its accompanying symptoms, which the second case demon-
strates quite clearly. In one three-year old child, which died in
sixty hours after the onset, 20 c.c. of clear fluid was obtained at Ihe
second space, directly after death. Autopsy refused. These are
practically the same as Landry's Palsy, with evidences of excess of
cerebro-spinal fluid and meningeal irritation. In one case which I
saw during its entire course (72 hours), the knee reflexes were not
increased during the first day, while there was no palsy, which fact
seems to me to indicate that meningeal irritation was not great at
that time, especially in the absence of pressure symptoms and cer-
tainly the membranes were not sufficiently affected to determine a
meningitis. This particular case supplied eighteen cubic centimeters
of a clear limpid fluid on lumbar puncture.
The palsy of these cases occurred rapidly, affecting perhaps the
entire body within twenty-four, apparently in an ascending direc-
tion. Among thirty-five cases in all, which were examined per-
sonally, five were fatal, four of this number presenting the picture
illustrated above. One case, which improved, exhibited general
paralysis with paresis of the respiratory muscles, the latter rapidly
improving after becoming well marked. In the typical case, the
pain appeared before the palsy; this might be interpreted by the
description of Harbitz and Seheel (J. A. M. A., October 26th, 1907)
that the pia is the seat of injection and infiltration quite early. They
maintain that the process progresses inward, beginning in the mem-
brane and affecting the entire cord, with the greatest evidences, how-
Digitized by VjOOQIC
4M SBCOKD ANNUAL REPORT OF THE Off. Doc.
ever, in the gray matter. In coneidering these f alminating caBes, it
would seem probable that the membrane and cord are affected al-
most Bimultaneonsly for the pressure symptoms and palsy appear
almost at the same time.
If we consider the typical and fulminating types, it is evident that
the infection may attack any part of the nervous system. Accord-
ing to the pathological studies of Harbitz and Scheel^ this actually
occurs. They find initial changes in the pia mater, and, because they
found these changes in parts of the pia with no lesions in the gray
matter at the corresponding level, they deduce that the infection
spreads inward from the pia. There were no cases in this epidemic
showing exclusively affections of the meninges, so as to constitute
a true meningitis, but in all, at some time or other, and usually early,
there were symptoms of meningeal irritation and excess of fluid.
Never was there spasticity of the extremities. Frequently rigidity
of the neck was noted, enough to indicate gradations from a pial
irritation to a meningomyelo-encephalitis. There were never any
cocci or polynuclears found in the fluids, so that cerebrospinal men-
ingitis cannot be considered. Among twenty-six average typical
cases, there were seven instances of early pronounced meningeal
symptoms.
Great variation existed in the distribution of the paralysis: this
is more marked of course in the typical cases which improved than
in the fulminating cases. The legs as usual were affected most fre-
quently, twenty-seven times in forty-five cases, seventeen times alone
one or both, five times participating in a mixed palsy, and five times
in a crossed paralysis. The arms were affected five times singly,
twenty- two times as a double arm or crossed paralysis; once there
was a simple crossed paralysis. Once the respiratory muscles were
the only seat of paralysis, which seems to be the only case in which
the bulb alone was effected.
Another class of cases deserves particular mention and special
attention, because of their hygienic importance. I refer to the abor-
tive or. atypical cases. This nomenclature has been used before, and,
while it may be open to objections, there are mo other apposite
single words. Such cases show the constitutional symptoms and
physical signs but no iwJsy, or at most only a transient weakness.
The symptoms consist of nervousness, irritability, slight fever, con-
stipation, transient suppression of i:rine, headache, occasional pains
in the shoulders or lower extremities, the atypical strawberry
tongue, dilated pupils, photophobia and injected conjunctiva, but no
alteration of the reflexes. In three of thirteen cases which I saw,
more or less acutely ill, there were symptoms of stiffness of the
neck and indefhiite soreness on pressure over the cervical vertebrae.
These all recovered without sequelae.
Digitized by VjOOQIC
Nik 16. COA£MIS8ION£R OF HSAL.TH. 427
The prognosis of the typical cases is good for life and unfavorable
SB to the use of the affected muscles, it is moreover noteworthy that
a few of the cases which are typical in course, and pronounced in the
paralytio signs, clear up so well that no trace of the cord lesion
remains. I do not have later reports from all the cases of which I
have notes, but these attacks which clear up x>erfectly form but a
very small percentage of the completely reported cases. These can-
not be classified among the abortive cases because of the pronounced
paralysis, in one case even accompanied by appreciable wasting.
The outlook for the rapid fulminating type is very grave, four out of
five cases seen by the writer proving fatal. The abortive cases, of
course, rapidly clear up and leave no sequelae. Among 114 cases of
all types, eighty of which were typical or fulminating, there were
ten deaths or 9 jper cent. Nine of these fatal cases were of the ful-
minating type or acute ascending paralysis affecting the respiratory
center.
These clinical considerations contain little if anything new of the
epidemic picture of acute anterior poliomyelitis; they do, however,
characterize the form assumed by the disease and indicate the differ-
ence from the sporadic cases. 13ie evidences of the disease varied
considerably, and there were many combinations of the palsied parts.
The disease carries with it the expression of an acute infection. In
this outline, I have not attempted to be exhaustive in clinical study
since this has been so well done by neurological observers. I have
merely intended to draw the clinical picture and emphasize the
prominent features, especially those to which I must refer further on.
Before taking up the next heading, a word might be said as to the
infection atrium. It has been suggested that the intestinal tract is
the infection atrium of this disease. So far as the probability of
Intestine toxemia or of auto-intoxication is concerned, I think it can
readily be excluded if the extent of this epidemic be considered. In-
testinal conditions in a child of four months and of fifteen years are
essentially different. These, it might be mentioned in passing, are
age limits of the typical cases encountered in my work. The in-
testinal tract, as the place of entrance for a specific organism, is
naturally difficult to establish, especially because of the difference
In age, such a difference carrying with it a priori, a difference in the
possibility of exposure because of the difference in food. The absence
of history of dietetic errors, except in five of thirty-five cases, makes
the probability of dyspeptic disturbance having anything to do with
the disease rather remote.
Attention was given to nose and throat conditions and the pres-
ence or history of eye and ear diseases. With reference to the latter
it might be said that the eye was never acutely affected, In one
case only was there ear disease, which had existed for a long while
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428 SECOND ANNUAL REPORT OF THE Off. Doc.
before the onset of the paralysis. In twelve cases out of forty-five
there were hypertrophic tonsils; in two others, acute pharyngitis and
tonsilitis were present; in one, an acute coryza. In no case (of which
I have complete notes) is there a history of pre-existing infectious
disease within six months. I cannot substantiate the observation
made several times that this disease is connected with the acute in-
fections of childhood. In DuBois, there were no cases of infantile
paralysis, but over a hundred cases of measles.
The infection atrium is, according to these observations, abso-
lutely hidden. By exclusion only, the indication is toward the diges-
tive tract. Personal experience in this epidemic leads me to believe
that an acute general infection is present which later attacks the
spinal and cerebral systems, because they are the seats of predilec-
tion of the virus. The pronounced acute constitutional symptoms,
with their very uniform character, point directly to such an assump-
tion. Harbitz and Scheel believe in the origin in the alimentary
tract.
HYGIENIC CONSIDBRATIONe.
This heading can well be divided into General (including distribu-
tion of cases in centers, municipal, sanitation, etc.) and Personal
(comprising the factors surrounding the individual cases).
In considering the subject of General hygiene, the first thing to
claim our attention is the distribution of the cases within the town.
No better example for our use could be found than that of Oil City.
This city of 16,000 population is divided into three parts by the Alle-
gheny River and Oil Creek. The eastern and southern portions of
the city are situated on the sides of hills where the natural drainage
is perfect. The northwestern section is on the lowland by the river
and creek beneath a hill, but not running up on it. This portion
and the section bordering the Oil Creek on the west side of the
stream and a portion of the east hill, north side, form the poorest
section of the town. Here foreigners live under the most insani-
tary conditions. The southern and central portions of the east hill,
the eastern portion of the south side of the town, represent the
middle and upper middle classes whose sanitary conditions are good.
The western section of the south hill is the best part of the town,
both as to class of residents and sanitary condition. In the sec-
tions first described, fifteen cases of poliomyelitis, typical and atypi-
cal and cerebrospinal meningitis (fulminating attacks (?) ) occurred
during the late Summer and early Fall. In the middle clase section
of the town, thirty-six cases represent these diseases. The remain-
ing six cases were among the very best families. These figures rep-
resent approximately the relation between the classes, numerically
speaking, represented in Oil City. On the top of the south hill, the
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No. 16. COMMISSIONER OF HBAL.TH. 429
climatic conditions are exceptionally good, and within a short radius
six cases developed. The whole town receives the same water. There
is no connection between the waterways, railroads or manufacturing
plants to the houses chiefly affected. In considering the platted
cases, as shown on the chart, it can be said that there is practically
no relation so far as the dwelling is concerned. In one instance,
there was a rapidly fatal case of so called cerebro-spinal meningitis
and typical poliomyelitis in adjoining houses, but no trace of inti-
mate relation between the families could be discovered aside from
the ordinary intercourse of neighbors. They developed within a few
days of one another, the poliomyelitis case first. Attention is par-
ticularly attracted to this town because of the ease with which the
classes of people can be separated. The poor live in the most un-
healthy section on the lowlands, but show relatively no more cases
than the affluent class on the opposite side of the river. It is inter-
esting to note six cases in the southern part of the south side; this
is at the top of a long hill, perhaps three-fourths of a mile from the
river, the very best topographical locality.
The town of Eau Claire is at the highest point in Butler county
(1,400 feet), and is situated on the crest of a hill, the main street
running along its ridge, a gentle slope on either side. The situation
and surrounding country are nearly ideal. The cases were located
irregularly through the borough, seven of them being in the south-
east quadrant. If any comparison can be made between the divisions
of this borough, this particular section is the second best.
The town of DuBois lies in rolling plateau land, and the eastern
section of the town is divided from the business part by a marsh to
the north of Sandy Lick Creek, perhaps three-fourths of a mile wide.
The eastern section of the town, the best residential part, is located
on a low hill with natural drainage into the swamp. There is a
slowly running lake behind this hill. There were nineteen typical
and two atypical cases in the borough and seven outside reported
by the physicians. The main town is not divisible into sections
representing classes, but these classes are about evenly represented
in the eases developing in this section. There were three cases on
the east side.
It has been suggested that dwellings on the lowlands are more
often visited than those on higher localities. The foregoing facts
actually controvert this suggestion. The writer does not mean that
there seemed to be anything in the high tocalities which predisposes
to the development of the disease, but merely that the cases could
be so platted. One collection of cases, few in number, of which. I
have no accurate notes, occurred in a low lying village. It would
seem from these facts that altitude, ground drainage and municipal
locations have no relation to the development of this disease.
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4S0 SECOND ANNUAIi RIZPORT OF THB Off. Doe.
Water and milk can, I think, be easily excluded from the list of
probable contagion carriers. Ean Claire was a favorable field in
which to study these subjects. The water supply of this town Is
from drilled wells, fifty to eighty feet deep, cased through to the
rock, some by iron and a few by cement. These wells are used only
by the families owning them with the exception of a few. It happens
that three of the families affected in this epidemic used wells owned
by other people, among whom there were no cases. Moreover, these
wells are used by other families having children who were not at-
tacked. This water was drawn by bailers. The milk supply of Eau
Claire came from individual cows belonging to families and from a
dairyman who had three customers in town. Two of the five famil-
ies affected took their milk from this farm. On examination of the
milk after delivery, 140,000 bacteria were found, but no Bac. coll,
no excess of leucocytes, and only a few streptococci. Inspection of
this dairy and of private cows revealed them both to be good. One
child of four years in this borough never used milk, and another four
months old baby took only the mother's nursing. This water is
ground water, that of Oil City is from artesian wells, while that of
Dubois is surface water. There is, therefore, no relation between
the source or kind of water and this disease. The sewerage systems
of Oil City, Ridgway and Dubois have been inspected by this De-
partment. They are not different from many other systems in the
State, for which permission has been granted to make extensions.
The sanitary conditions of the towns could be described as good.
The houses in the city are supplied with modem bathrooms in the
majority of instances. In Eau Claire outhouses are used almost ex-
clusively.
This entire region is drained by the Ohio Biver and its branches,
so that the natural conditions are nearly the same as on any other
extensive watershed, with one exception. Perhaps no other stream
in this part of the country has been so polluted as the Allegheny
river. The towns visited by this epidemic are near one of its tribu-
taries, except Oil City, which is on the river.
Some one has observed that this disease spreads along lines of
travel. New Castle on the west is a long distance from Oil City,
Polk and Franklin counties intervening, the former with its institu-
tion for the feeble-minded having no cases, the latter only three.
Ridgway and DuBois are but thirty miles apart and might be con-
nected, but to connect Oil City with Ridgway, or even Eau Claire, is
difHcult. There is no railroad into Eau Claire, and the journey from
Oil City to Ridgway takes one through Erie and Warren counties
where there have been practically no cases: It is, therefore, probable
that transmission did not spread along the railway. This means that
the origin and course of the epidemic could not be followed along any
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No. 16. COMMIBSIONER OF HBAL.TH. 481
definite line of communication. The disease must still be classified
in that group which we call ^^contagions'' or requiring contact, and
is, therefore, only transmitted any distance by traveling of people
carrying the infective agent. I think it reasonable to assume that,
if the disease were carried by travelers, it would not be limited to
the section in which it prevailed. If the disease were carried by
lines of travel, why should it have appeared in Oil City before it
api>eared in DuBois, which is very much nearer the original focus in
the center of Elk county? We could of course suppose two foci.
Much less did the water courses have to do with it because no in-
fected town is down stream from another, nor is there any exten-
sive water commerce in this region.
The transmission of this disease by the schools can, I think, be
excluded. One fourth of the families which were studied closely had
no children of school age, while among 114 cases only 11 occurred in
children attending school. In Eau Claire this could be followed
well; one child who had a typical attack sat in close proximity to
five other children up to 24 hours before being taken sick; none of
these five developed a single symptom.
Meteorology. By study of the reports of the Weather Bureau
of the State of Pennsylvania, obtained by the courtesy of the office
at Philadelphia, no unusual meteorological conditions could be dis-
covered in the section affected by this epidemic during the months
of June, July, August, September and October. The Spring had been
•luite rainy, the ground being damp most of the time.
Personal and Case Hygiene. This naturally falls into divisions
which concern the environment of the case and the case itself. In
investigating these cases, a set of questions was formuilated to which
rigid adherence was observed.
The personal and medical history of the case can be dismissed
with the word negative. The manner of life has little, if any, in-
fiuence upon the development of the disease; it has been thought
that the disease is more common among the people who are careless
of the children's food. The majority of parents are careless of the
feeding of children. There was only one instance in twenty-eight
families where unusual carelessness existed. I have no reports of
cases among colored people, in the families of whom the hygienic
surroundings are bad in the vast majority of instances. The manner
of Ufe could be described as good, in a few as excellent; naturally
some very slovenly houses were seen. The number of children aver-
ages three in twenty-eight families studied. The observation was
made by Dana of New York that animals were sometimes affected
during epidemics. In the regions visited, any manner of animals was
to be found, but in only two instances chiclcens were reported sick.
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482 SECX>ND ANNUAL. RBTPORT OF THBJ Off. Doc
This was in DuBois. On one occasion I was able to get two of the
sick chickens which I killed with ether. Observation of these birds
revealed that they squatted and rose with difBculty, but there was
no paralysis. The neck was not stiff and the bird could move it, but
in lowering the head it seemed to use the wing and thorax muscles
to force the neck down. Another family had sick chickens all the
Summer and gave the following history: The chickens were noticed
to be unable to run around as fast as the others, and later on became
unable to run at all; when sitting, they would rise with difBculty
and often topple to one side, which was always the same side in
each case (?). They would hold their head and neck very erect and
seemed unable to flex it to pick up food. They became quite weak
and the householder, being unable to do anything for them, killed
the sick birds as soon as found in order to protect the others. None
of these were secured.
In beginning case hygiene, the incidence in the family will claim
our attention first. Of the hundred and thirty-one cases of which
I have reports, including typical and abortive attacks, one hundred
and ten occured singly in the family. There were two cases in a
family seven times, three in a family once and four cases in a family
once. Of the seven instances of two cases in a family, three had two
typical cases, three had one typical and one atypical, and one had two
abortive cases. The instance of three cases in one family concerned
two atypical and one typical; where the four cases occurred, typical
and atypical were each represented by two. Of fatalities among
these multiple cases, there were two, one where there were three
cases in a house, and one where there were but two. The average
number of children as mentioned above was three. The relation of
boys affected to girls is about as five is to four. The average age
was 3.3 years. Of twenty-eight families closely studied, seven had
one child, three had two children and eighteen had three or more.
When cases developed in the same family, they usually appeared
at the same time, or within two days of one another. When any
interval elapsed between the cases, the secondary was usually abor-
tive in type. This does not mean that cases which develoi>ed at or
near the same time in one family were alwlays typical for as in family
"A" (cases 6-9 inclusive) a three year old boy developed a typical
case 9-22, a sixteen months old boy developed an atypical attack
9-24, and the mother (thirty-one years) was taken 9-27 with an
atypical -case; to follow this, I might add the cases of two sisters, the
first being a five year old girl who died on the fifth day of an ascen9-
ing paralysis, while the seventeen months old child developed a mild
typical attack seven days after the sister was taken sick and two
days after her death. When last seen, the paresis, which had been
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Ko. 16. COMMISSIONER OF HEALTH. 488
present three weeks altogether, was completely gone and a slight
knee jerk could be obtained. The younger child had been allowed
to play unrestrainedly with the sister until two days before the lat-
ter's death. There is no reason to believe that this child had been
otherwise exposed to a case. The diet of both had been careful and'
identical in character.
Another case may be cited which was severe and fatal, followed
in four or five days by two abortive attacks in brothers. There had
been no restraint in communication with the other children or play-
mates. Among these latter no cases occurrred, for I was able to
follow every visitor whom the child had seen. Prom the fact that
the majority of multiple cases break out simultaneously in a family,
it would seem that the infective material is contagious only at one
time^ acts suddenly and is gone, perhaps being transmissible at only
one stage.
Another interpretation might be put on this secondary develop-
ment of atypical attacks. It may be that the children were ex-
posed or infected at the same time, but for some unknown reason
one child reacted in a typical manner, while the other had resistance
enough to attenuate the virus and react in an atypical manner.
Although I have no proof for maintaining either of the hypotheses,
one basis for this latter is found in the two sisters (one of whom
died) who were kept under identical conditions, the family life
being so arranged. It is very difQcult to compute the effect of
the typical cases, but it is almost impossible to measure the effect
of the atypical cases because many of them are ambulatory.
The beginning of the outbreaks is absolutely obscure. Only four
instances are at hand which may indicate an incubation period, two
of which I have by the physicians' report. The first is the instance
of the two sisters described above, in which seven days elapsed
between the time the two children were noted to be sick and four
days elapsed between the last time the second child played with
her sister and the development of her illness. From what follows,
the first stated period seems more like the incubation time, indicat-
ing in this case that the second child caught it from the fatal case
during the beginning of the attack. Another instance, suggesting
an incubation time, is one of which I have imperfect notes, but con-
cerns a child who met a relative, when returning from a house
where a case existed, at a railway station, the child being taken
sick a week later with a typical attack. A third instance cofild be
closely folUowed. A woman visited daily from 9-26 to 9-30 two
families where cases existed, and on 10-10 her boy, fifteen months
old, developed a very pronounced abortive attack. These facts sug-
gest an incubation period of seven or ten days.
28—16—1907
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484 SECOND ANNUAL* RBPORT OF THB OS. Doa
A case reported by a physician from a town distant from the
section which we are now considering, where there were a few
eases, concerns a girl who had a typical attack, this being followed
in ten days by abortive attacks in twin brothers (nine months old).
These are only instances in my work where any sort of trace to
a previoas case coald be found.
In reviewing the foregoing facts, it is far from an easy matter
to draw conclusions, or to generalize. Although it has been
claimed that the alimentary tract is the infection atrium of this
disease, careful case recording of thirty-five instances of illnesses,
less than three weeks' duration, when the history giver's memory
was freshest, fails to elicit history or symptoms definitely pointing
to a condition which would lend support to this view. I have heard
of six cases following the ingestion of bananas in moderate num-
bers, by two to four days, but in only one instance did the child
show any dyspeptic symptoms after eating the fruit.
Insects deserve a word. Mosquitoes are not very plentiful in that
section of the State. If one child of a family were bitten by an
infected mosquito or other insect, why were there so many instances
of single cases in a family, all of the children presumably exposed
in the same degree? In these rural districts, many of the children
are covered during sleep. Domestic flies are numerous this year,
but not more so than at some previous seasons. Inspection of the
swamp and lake at DuBois failed to discover any larvae of mos-
quitoes at the time I was there. No unusual insects were seen this
year.
PATHOLOGICAIi WORK.
In considering the best means of investigating the etiology of
acute anterior poliomyelitis from a bacteriological standpoint, it
was decided that the nose, throat, eyes and ear and spinal fluid
should receive the most attention. Blood was not investigated be-
cause it has been done thoroughly before and the difficulty of work-
ing 80 far from the laboratory. The material was difficult to ob-
tain, family objection being presented very often. Of six deaths,
I was able to get but one post mortem. Of a score of cases under
a week, older than this but showing signs of pressure, or slowness
to recover from the constitutional symptoms and signs, only flve
lumbar punctures were permitted. These punctures were made at
the usual interspace. The fluid was in all instances perfectly clear
and limpid, and did not produce a coagulum on standing. The
smears made at the bedside showed very few cells. They were
almost altogether lymphocytic, there being practically no polymor-
phonuclears. The cells found in a single fluid were too few to count.
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No. 16. COMIMISSIONER OF HEALTH. 485
but by taking the several fluids together the mononuclear per cent-
age seemed to be 60-70 per cent. These fluids were inoculated on
blood agar^ Loefflers blood serum and plain agar. Smears were
also made from the nose and throat. Other points of pathologic
change were examined when present.
Bacteriological work on the spinal fluid and other cultures is pre-
sented in detail below. It will be observed that in four spinal
fluids a Oram positive diplo-or-tetracoccus was recovered when the
fluid was poured into glucose bouillon and incubated. This Gram
positive diplo-or-tetracoccus was found in all the cultures from the
nose and throat. In 70 per cent, of these nose and throat cultures,
a pneudo-diphtheria bacillus was found and in two cultures an or-
ganism, morphologically and biologically the true diphtheria bacillus
was found, but which did not have virulence in guinea pigs. None
of these cultures produced any pathologic manifestation in experi-
mental animals which could be compared to poliomyelitis; indeed
they seemed devoid of pathogenicity.
The spinal fluid of two of the cases was injected into the spinal
canal of a monkey without result. The monkey's nose and throat
were inoculated with the Gram positive coccus, likewise without re-
sult. Despite the constant occurrence of these pneudo-diphtheria
organisms and diplococci, their lack of virulence seems to relieve
them of responsibility. Perhaps we do not yet know how to handle
them, or^ as suggested above, they are attenuated. It is only advis-
able to mention their existence.
Because of the presence of diphtheria-like organisms, Dr. Dixon
suggested the use of diphtheria antitoxin. It was injected into one
case during the early acute constitutional manifestation, except the
paralysis which did not develop after the injection. Naturally the
effect of the antitoxin is problematic. To add to the probability that
this case was truly a poliomyelitic infection, it may be mentioned
that the boy played with some children ten days before, among whom
one child died five days later of poliomyelitis.
The following is the detailed report of Dr. J. B. Bucker, Assist-
ant Bacteriologist in the Laboratories, upon the cultures which I
forwarded from the field:
Case U. Mild atypical, male (fifteen monthe). Smears— noae and throat. Mono-
nuclear and polymorphonuclear leucocytes, desquamated epithelium,
gram positive diplooocd, a few gram, positive rods.
Cultures: £>ye — Micrococcus aureus.
Nose—Gram positive diplococci and bacterium pseudo-
diphtheriticum.
Throat— Micrococcus pyogenes and bacterium pseudo-
diphtiheriticunu
Case 12. Fulminating fatal, male (eleven years). Smears— fourth ventricle.
A few nerve cells and lymphocytes. No bacteria or protozoa. Lon-
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486 SBCJOND ANNUAL. REPORT OP THE Off. Doc.
ffitudinal fissure— lymphocytes and polymorphonoclear leucocytes.
No bacteria or protozoa.
Cultures: Fourth ventricle— Gram positive diplococcus.
LfOngitudinal fissue— Gram positive diplococcus.
Nose and posterior pharynx-micrococcuB aureus and
bacterium of bacillus subtilis type.
Case 18. Severe atypical, female (seven years). Smears— nose,— Lymphocytes,
epithelium. Gram positive diplocoocl, rods resembling Bacterium
pseuido-diphtlheriticum.
Throa.t— Lymphocytes, polymorphonuclear leucocytes and epithelial
cells. Many diplocooci and staphylococci.
Eye— Polymorphonuclear leucocytes.
Cultures: Nose, tonsil and naso-pharynx— Gram positive, diploco-
cus and Bacterium pseudo-diphtheriticum.
Eye— micrococcus pyogenes.
Case 14. Severe atypical, male (four years). Smears— nose, tonsil.
Nose— mononuclear and polymorphonuclear leucocytes; Gram positive
diplococci, medium length thick rods and diphtheroid forms.
Tonsil— mononuclear and polymorphonuclear leucocytes; Gram posi-
tive diplicocci, streptococci and diphtheroid forms. Bacillus maxinuk
Cultures: Naso pharynx and nose— Gram positive diplococcus.
Bacterium pseudo-dij^theriticum, micrococcus aureus
and a baccillus of the subtilis type.
Case 15. Severe typical, femaie (two years) (8 c.c, fluid). No nose or tlhroat
smears made. Smears from epinal fluid — a few erythrocytes, mono-
nuclear and polymorphonuclear leucocytes, with the mononuclears
greatly in the majority. No bcu:teria or protozoa were found.
Cultures: Nose — Gram positive diplococcus, bacterium pseudo-
diphtheriticum and bacillus mesentericus.
^inal fluid— Gram positive diplococcus.
C&ae 19. Fulminating fatal, male (four years). (10+c.c. fluid).
Smears: Nose sjid spinal fluid.
Nose— Mononuclear and polymorphonuclear leucocytes; many Gram
positive diplococci and dlpththeroid forms.
Spinal fluid— mononuclear leucocytes in small numbers; a few erythro-
cytes and Gram, positive diplococcL
Cultures: Spinal fluid— no growth.
Case 21. Severe typical, male (four yeaxs). (3 c.c. fluid) Smearsr— Nose, throat,
spinal fluid.
Nose— epithelium, monio- and polymorphonuclear leucocytes. Gram
positive diplocooci and Gram negative rods.
Throat— epithelial cells, mono- and polymorphonuclear leucocytes.
Gram positive diplococci, a few long rods, probably Bacillus maxi-
mus.
Spinal fluid— mononuclears, no organisms found.
Cultures: Nose and throiat— Micrococcus aureus. Micrococcus pyo-
genes, a Gram positive diplococcus.
Case 26. Mild typical, male (two and a half years). Smears— nose.
Nose— large and small mononuclear and polymorphonuclear leucocytes.
Gram positive diplococci and streptococci.
Cultures: Gram positive diplococcus, Bacterium pseudo-diphtheri-
ticum, Micrococcus aureus and Cladothrix fungi-
formis.
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No. 16. COMMISSIONER OF HEALTH. 4S7
Case 30. Severe typical, male (thirteen montlis). 3mears— nose and throat.
Nose— diplocooci and tetraciocci, short pointed rode, epithelium and
polyvnorphonuclear leu<X)cytes.
Throat— epithelial cells, diplococci ^ind streptococci.
Cultures: Nose, throat, eye.
Nose— Micrococcus pyogenes, Bax^terium pseudo-diphthe-
riticum, Leptxythrix glgantia, Cladothrix fungiformls.
Throat— Bacterium i>seud)o-dlphtheriticum, Cladothrix
funglformis.
Eye— A grram positive diplococcus. Micrococcus pyogenes,
Cladothrix fungiformis.
Case 3L Mild typical, female (three years). No smears from this case.
Nose— Bac. cereus and Bacillus mesentericus.
Ear— Bacterium pseudo-diphtheriticum, B. cltreue, B. cereus.
Case 38. Mild atypical, female (nineteen months). Smears— nose,
Nose-^epithelial cells, leuciocytes, many diplococci, a few short thick
rods.
(Cultures: GOiIld's nose, mother's nose, mother's throat
Child's nose— Micrococcus pyogenes. Micrococcus aureus.
Mother's nose — Micrococcus aureus. Micrococcus pyo-
genes, bacterium pseudo-diphtheriticum. Gram positive
diplococci.
Mother's throat— Micrococcus aureus, bacterium pseudlo-
diphtheriticum.
C^ase 34. Severe typical, fatal, male (fifteen months) (26 c.c. fluid). Smears:
Spinal fluid— no bacteria mononuclears.
(Tase 36. Severe atypical, male (six years). Smears— nose, throat.
Nose — epithelium and Gram, positive diplooocd.
Throat— epithelium, polymorphonuclear leucocytes. Gram positive di-
plococci.
Chiltures: Nose and throat.
Nose— Gram positive diplococci. Micrococcus pyogenes,
Bacterium pseudo-diphtheriticum.
Throat— Baoterium pseudo-diphtheriticum. Micrococcus
citreus.
These are the results from smears and cultures made at the bed-
side. When the tubes containing cultures and fluid were received in
the Laboratory, same of the latter was immediately planted in 1 per
cent, glucose neutral broth aerobically and anaerobically. Of the
four spinal fluids examined, all showed the presence of a Gram posi-
tive diplococcus. The same organism was found in nine of the above
thirteen cases upon the cultures sent to the Laboratory from the
patients' bedside, and twice it was found only in the smears made
at the same time. A description of this coccus follows, and pertains
to the organisms isolated from the nose and throat, on cultures from
the patient, and from the spinal fluid in the Laboratory. From the
cultures of the spinal fluid made at the bedside, only one (case 15)
showed Ihe presence of this Gram positive diplococcus. The culture
from the fourth ventricle of case 12 also contained this coccus.
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i88 SIXX>NI> ANNUAL. REPORT OF THB Off. Doc
Tfie Oram positive diplococcns found in all but one of the cases
may be described as follows:
Morphology; biscuit shape diplococci and tetracoccii some times
in chains of three or four pairs, with flat sides apposed, non-motile,
Oram positive.
Oelatin plates.
Macroscopically: convex, circular, homogeneous, mucilaginous, en-
tire, translucent, iridescent, gray; center, yellowish gray.
Miscroscopically: circular, granular, entire, translucent, brown.
Agar slant: luxuriant moist, mucilaginous, homogeneous, entire,
gray.
Olycerine agar: same as agar.
Blood agar: same as agar except as to color, which is yellowish
brown.
Blood serum: confluent white to cream in color, no liquefaction.
Oelatin: white granular growth along stab, no liquefaction.
Potato: moist, white growth, no change in color of potato.
Bouillon: turbid, white stringy sediment, no surface growth.
Milk: acidifled. No coagulation; acid but no gas in gluoose bouil-
lon, no indol produced, nitrates reduced to nitrites.
Pathogenicity: 3 c.c. of the spinal fluid from cases 16, 19, 21 and
34 were injected into the peritoneal cavity of guinea pigs with no
effect whatever, and even 3 c.c. of the glucose bouillon cultures,
twenty-four hours old, of the Gram positive diplococcus from the
spinal fluid of these cases, when injected into the peritoneal cavity,
yielded no results.
A white mouse was inoculated subcutaneously at the root of the
tail with 1 c.c. of a twenty-four hour bouillon culture of the Oram
positive diplococcus. There was no reason for believing that this
diplococcus was pathogenic even to mice.
Two loopfuls of what appeared morphologically and culturally
to be the true diphtheria Bacillus, when Introduced into a pocket of
skin of a guinea pig, failed to show any pathogenicity.
The post mortem examination on the two hens sent to the Labora-
tory showed two very thin bony chickens; gills ears, nostrils, and
whole head under feathers were yellow, as is found in chicken chol-
era. An organism practically identical with cholera Bacillus in
chickens was found in the blood and throats of these birds. Hen
cholera was evidently the cause of death. No lesions similar to those
of poliomyelitis were found in their cords.
Upon returning to the Laboratory, the experiments and tests just
described in Dr. Bucker's outline were repeated and found uniform.
The discovery of the Gram negative diplococcus in four spinal
NOTE.— So far as we are able to discover, this corresponds with the coccus
found by Oelrsvold and by flarbltz and Sciheel durln^r the epidemics In Norway
and Sweden.
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No. 16. COMMISSIONER OF HEALTH. 489
fluids, and its frequent recovery from the nose, led us to hope that
we had an organism of some importance. As was mentioned in the
outline, the meagre description given by the Scandanavian workers
seems to fit our coccus exactly. As has been shown, we were disap-
pointed in its toxicity toward small laboratory animals. We, there-
fore, decided to try its virulence upon a monkey, of which the fol-
lowing is the history:
On October 29th, 2.5 c.c. of spinal fluid from case 34 was injected
into the spinal canal of a cebus monkey. No result came of this, so
that on November 4th 3.5 c.c. of the same fluid was again injected
into his spinal canal; this time with no result, not even a rise in
temperature. On November 25th, two loopfuls of the culture of the
Gram positive diplococcns were introduced into each naris of the
monkey with no effect. On December 6th, at 4 p. m., the monkey was
Inoculated with two thirds of the surface growth of a twenty-four
hour agar culture, from the spinal fluid from case 34, into the spinal
canal. On the morning of December 7th he was unable to use his
hind legs in walking; when sitting up, he tended to fall backward
unless he very carefully balanced himself. When lying down, he
seemed to lie by preference on his right side. He showed on exam-
ination a spastic palsy of the legs and tail. The knee jerk was very
greatly accentuated. No affection of the upper extremities could be
observed. The monkey took a banana which was handed him and
ate it greedily. His temperature rose to 102 deg. F. on the night of
the injection, was the same on the following morning; it was 102 4-5
deg. F. that evening, which was its highest point, and after this it
rapidly declined, reaching normal at midnight, after which it ran the
average daily course seen before the injection. The palsy disap-
peared two days later, after which the animal regained perfect
health. On the third day the spinal canal was tapped. One c.c. was
obtained. This fluid contained a very high percentage of polynu-
clears, with few mononuclears. None of the former contained the
cocci. Cocci were seen in the stain and obtained in pure culture by
incubation on bouillon. The animal showed no symptoms of polio-
myelitis during his illness, which was like a meningitis. Meningitis
was found at the animal's death on December 20th, 1907. It is not
necessary to include all the autopsy notes, but it will suffice to state
a violent hemorrhagic meningitis, bearing no resemblance to polio-
myelitis, was present. Microscopical sections show a violent polynu-
clear infiltration with congestion involving the meninges of cord and
brain and the superficial layers of the cortex. There was no excess
of fiuid, but that present was turbid. The same Gram positive
diplococci were recovered.
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440 SECOND ANNUAL REPORT OP THD Off. Doc
Patholagical sections of the cords of guinea pigs also failed to
show any analogy to this disease. Because of the nervous manifes-
tations of the chickens, their cords were also sectioned. They were
found quite normal. The birds had nothing to do with the disease
now being considered, that is evident.
The result of the pathological work has been disappointing. Our
hopes lay in a careful examination of the spinal fluid, its character
and its sediment, but they were completely blasted. The paucity of
cells has, of course, no diagnostic significance, but it does not seem
too much to say that an excess of fluid with very few cells would
be helpful in difFerentiating a case of epidemic poliomyelitis with
meningeal irritation from cerebro spinal meningitis.
If this work dk)es nothing more than present clearly the type as-
sumed by infantile palsy in the epidemic form as contrasted with the
sporadic, it will help perhaps some subsequent work; first, i)erhaps
in classification, and later in etiology. Perhaps the disease is con-
tagious, but the simple rule of contact will not explain its commun-
ication.
Prom this report the following conclusions seem justifia1)le:
1st. That acute anterior poliomyelitis was epidemic in the north-
western x>art of Pennsylvania during the late summer and
fall of 1907.
2nd. That the epidemic form of acute anterior poliomyelitis differs
from the sporadic form.
3rd. That there are many stages of severity in epidemic poliomyel-
itis, varying from the abortive type to a rapid form like Lan-
dry's paralysis, combined with symptoms and signs of men-
ingeal irritation.
4th. That in most cases, at least of typical poliomyelitis, there is
some evidence of meningeal irritation and excess of fiuid.
5th. That the disease seems to be an infectious one, because of the
widespread appearance in localities certainly not exposed to
conditions which we have reason to think would bring about
the same form of intoxication.
6th. That personal and medical history have no bearing on the oc-
currence of the disease.
7th. That simple contact will not as yet explain the transmission
and failure of transmission.
8th. That fomites and insects do not seem to transmit the disease.
9th. That water, milk, etc., do not transmit the disease.
10th. That municipal and personal hygiene have little or nothing to
do with the causation of the disease.
11th. That geographical conditions seem to have no influence either
in the origin or the spreading of the disease.
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No. 16. COlffiMIfiSIONER OF HEAI/TH. 441
12th. That the contagion seems to strike a house, exert its influence
at once and then leave or lose virolence; probably also a
caBe is infective only at a certain stage.
13th. That the incubation period is probably seven to ten days.
14th. That the bacterial infection may find its infection atrium in
the alimentary tract, this being arrived at by exclusion. Al-
though a bacterium has been found in the nose and in the
spinal fluid of these cases, there is no justification at present
to connect it with the etiology of the disease.
15th. That non-virulent diphtheria organisms and Gram positive
diplo-ortetracocci are present in a very large i)ercentage of
noses and throats of acute cases.
16th. Prom the reasons already given the hygiene of anterior polio-
myelitis in the epidemic form deserves serious consideration
from health authorities.
EPIDBMIC OP TYPHOID FEVER AT RIDQWAY, ELK C?OUNTT.
Typhoid fever having become unusually prevalent in the town of
Bidgway, Elk county, early in the month of August, Dr. A. B. Moul-
ton, first assistant in the Division of Medical Inspection, was deputed
to investigate the causes of the outbreak and aid the local authori-
ties in its suppression. He was shortly followed by Chief Engineer
Snow and one of his assistants who made a careful inspection of the
various sources of water supply.
Bidgway, the county seat of Elk county, located in the valley of
the Clarion River, at the point where it is joined by Elk Creek, is a
prosperous business centre of about 6,700 population, on the main
line of the Philadelphia & Erie Division of the Pennsylvania Bail-
road, as well as the Buffalo, Rochester & Pittsburg Bailroad.
The town is situated on both sides of the river and creek and is
divided by these streams in three wards. Ward One comprises that
portion of the Borough south of the creek and east of the river.
Ward Two comprises that portion of the town west of the river,
while in Ward Three is included all that portion of the town east
of tlie river and north of the creek. The larger portion of the manu-
facturing district is included in Ward Three, as well as that resi-
dential portion of the city called Hyde's Hill. The First Ward in-
cludes by far the greater part of the residential portion of the town.
The water for domestic purposes is secured from three different
sources — ^the general municipal supply, a quasi-public supply from a
county spring, so called, and from numerous springs and wells
throughout the town. The municipal supply proper comprises that
secured from Gallagher Bun, which has a water-shed of about 1}
square miles, almost uninhabited. This supply is sufficient for do-
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442 SECOND ANNUAL. RSPORT OF THB Off. Doc.
mestic purposes only during about six month of the year, and is
sapplemented by water secured from two drilled wells, cased with
8 inch pipes, whose depths are variously stated to be from 62 feet to
93 feet. The general report being that the last 25 feet of these wells
was bored in the solid rock.
Since, as we have previously stated, Gallagher Bun is frequently
dry, as was the case at the time of our visit, water was pumped
from these wells direct into the mains — ^any surplus overflow being
stored in a circular concrete reservoir 70 feet in diameter by 12 feet
in depth, located just below the dam in Gallagher Bun. From this
Beservoir the water is delivered by gravity into the town.
The county or Early's spring, so called, is an out-cropping on the
hillside in the southwestern part of town, and furnishes an abundant
amount of water, and owing to the fact that the city water is hard
and contains iron, and furthermore, because of the fact that this
spring was dedicated to the county and a provision was made where-
by those who desired to have pipes connected with it were freed from
a water-tax, it has been piped into many homes. This spring also
furnishes water to the jail, court-house, and a public fountain in the
Square.
The springs and wells which constitute the third source of supply
are numerous and scattered very generally about town, some of them
being located high up on the hillside above any house, while oihers
are situated in the lowlands. Among the springs in general use
may be mentioned the Hyde Spring, Powell Spring, Hospital, Shee-
han Spring and Bailroad Spring. Some few of the springs are so
located that pollution would be improbable, but the city wells are
located on the flat, as well as the Oounty Spring, and many other
wells and small springs about town, which are in constant use, are
very liable to contamination. Table No. 8 shows the result of the
bacteriological examination of both the public and private water
supplies.
The milk used in Bidgway is secured from dealers, who obtain
their supply from dairy farms in the vicinity of Bidgway, as well as
from numerous dairies at widely scattered points throughout the
northwestern portion of Pennsylvania and even through the south-
western portion of New York State. This supply is supplemented
by a large number of private sources. A common pasture is pro-
vided where those having a single cow may flnd pasturage, and the
people are encouraged to produce their own milk, those having a
cow often selling the milk to their relatives or friends.
The method of sewage disposal in this town is not what one might
expect in a town in which is represented so much wealth as there is
Lq Bidgway. Human waste is disposed of through privies and public
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No. 16. COlflMISSIONER OF HEAL.TEL 443
sewerSy as well as oatside cloBets with dirt vaults. It is said that
about half the streets are piped with private sewers, some of which
empty into the rural runways, which finally empty into the river,
and since many of the private sewers existed prior to a limited
municipal sewerage system, the people have been very loath to make
connections therewith. In many sections of the town, even in locali-
ties where one would least expect them, the outside closet with dirt
vault exists.
The soil is porous and a few feet below the surface broken rock
and hard pan are encountered, and since the town is built on rising
ground with steep slopes, many of the houses are above the springs.
Under these conditions the contents of earth vaults or open surface
sewers could quickly saturate the ground with pollution, which
would naturally be carried by the first heavy rainfall, either on the
surface or by underground channels to the springs.
At the time of our arrival an open sewer emptied into a basin
within twenty yards of the city wells above mentioned, and from
this basin it drained by an open ditch to the river.
In 1904 this town was visited by Typhoid Fever and as a result of
the investigation made by an inspector from the State Board of
Health the following recommendations were made:
1. That the city wells be abandoned. The location is such that I
would not recommend drilllngr the wells deeper. The spot on which
the pumping station is located has been the dumping ground of the
city for years. A better location would be higher up. (Perhaps near
the city reservoir. A person understanding sanitary conditions
should locate the well.
2. That the county spring be abcmdoned as far as being used for
drinking purposes.
8. That (the ZIon Hill Spring, under Ruse Street, be filled up at
once.
4. The sewer from the hospital and the one emptying near it be
extended to the river.
On these recommendations the County Spring and City Wells
were condemned and recommendations relative to a safe supply were
made.
Prom the time of the former epidemic to the present. Typhoid
has been endemic. In spite of the lesson so forcibly illustrated and
the advice of the State Board of Health, no actioin seems to have
been taken and when the present epidemic made its appearance the
wells and County Spring were the main sources from which water
for drinking purposes was secured, a large public fountain in the
Square being supplied from the County Spring. This was largely
patronized owing to the good taste of the water and its clear spark-
ling appearance.
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444 SECOND ANNUAL. REPORT OP THE Off. Doc.
At the time of our arrival in Bidgway some 80 people were said
to be suffering from Typhoid Fever. These cases were very widely
distributed among the various classes of people so that a water-
borne infection was suspected. A careful census of the cases showed
that this suspicion was well founded, and moreover it i)ointed very
conclusively to the source from which the infected supply was ob-
tained, as is very clearly shown In Table No. 1. Reference to this
table will «how that in over 90 per cent, of the cases developed it
can be conclusively proven that water from the County Spring was
either habitually or occasionally used for drinking, either in the
home, at the place of work or at the public fountain, and in this
connection we disregard the possibility of the individual milk supply
being contaminated by the use of this water for the washing of pri-
vate milk utensils. A careful investigation of the Ck)unty Spring and
its surroundings was consequently made. This spring, as we have
previously stated, is situated on the hillside in the southeastern por-
tion of the town, the bank having been dug away, the spring has
been walled up and a house built over it. The pool is approximately
some 20 feet wide and 25 feet long.
Above this spring are a number of houses with outside dirt
closets, and with hoppers at the back-door into which they throw all
forms of household slop and chamber-lye. This is carried by a 4
inch sewer pipe down the hill past the spring. The joint of this
pipe was dug up and it was found that the sections of pipe were not
cemented together, and the earth about was discolored from the
oozing of the waste material.
Immediately above the spring, some 300 feet is a double house
with an earth closet some 40 or 50 feet back, and in the upper side
of this house a case of Typhoid Fever occurred during June. This
patient was in Pittsburg during the month of May and returned on
the last day of the month. He worked until the 6th of June although
he felt unwell and on the 6th he called upon a local physician who
sent him home. At this time he had a diarrhoea and was in the
habit of visiting the closet in the rear of the house, up to June 10th,
at which time another physician was called and the diagnosis of
Typhoid Fever was made. The positive diagnosis was made on the
12th. This patient was ill in bed for six weeks. An examination of
a specimen of blood taken from this patient gave a positive Widal
reaction.
When this closet was cleaned out by order of the Department of
Health, a small spring was found to be present in the vault, although
there was no evidence of overflow. As we have previously stated the
soil is very porous and underlain by broken or loose stone, and it is
reported by reliable parties that when wells were drilled on this
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No. 16. COMMISSIONER OF HEALTH. 445
hillside the water in the County Spring became roily, and it is fur-
ther stated that when a certain garden some ways from the Spring
was plowed the water became roily.
The character of the soil, the testimony relative to the Spring
being influenced by local conditions of the soil, together with the
existence of the improperly laid sewer pipe, and a privy vault with
a spring in it, which must have discharged somewhere, and the pres-
ence of a Typhoid Fever patient on the hillside, which used the
priTy prior to the outbreak of this disease, forms a very conclusive
chain of incriminating evidence against this water supply.
Id addition to this circumstantial evidence, samples of water from
the Spring submitted to the Laboratory, showed the presence of
Bacillus coli, as is shown in Table No. 8.
This spring was promptly condemned as a source of water -supply
for domestic purposes, and a large quantity of freshly burned, un-
slaked lime was dei>osited in the Spring.
Placards warning the people to boil all water intended for domes-
tic purposes were posted about town, and the Department circular
setting forth the precautions to be observed by nurses and others
having the care of cases of Typhoid Fever were published in the
local papers.
The department stores, hotels and restaurants were instructed to
serve to their patrons only such water as had been boiled for at least
30 minutes. Lime was provided in generous quantities, both for use
in disinfecting discharges and to be deposited in privies and in open
sewers.
A system of district nursing was instituted, not because of the
poverty of those afflicted with the disease but because of the fact
that nurses could not be secured for private work and there were loo
many cases for the families to care for their own sick.
Emergency hospitals were established — one in a private dwelling,
the other in the Elk lodge rooms. These were for the care of those
who could not receive proper care at home or could not be received
in the County Hospital. The Doctors were requested to report not
only such cases as had been conclusively diagnosed as Typhoid Fever
but also those who were thought to have the disease. A copy of this
list was given to the Health Officer who made a house-to-house can-
vass of the place, placarding the premises and determining the needs
of the household, as well as learning whether it was necessary, or
desirable that a district nurse should call. In nearly all instances
where private nurses had not already been installed the people
seemed anxious that the district nurse should pay them a visit and
instruct them in the proper precautions to be observed, in order to
prevent other members of the family from becoming infected. When-
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446 SECOND ANNUAL RBEPORT OF THS Off. Doc
eyer during sach visits the nurse found that a case could not be
given the attention needed at home, the physician i)n attendance
was consulted as to the advisability of moving the patient to one
of the emergency hospitals.
Since not all of those sent to the emergency hospitals were in
indigent circumstances a committee of two prominent citizens was
appointed to determine whether those admitted should be treated
free of charge or should make some payment, according to their
means, for the attention given them, but none of those needing help
were turned away. Distilled water for the use of the hospital was
supplied by the Laboratory of the Elk Tanning Company.
When a patient recovered, was removed or died in any house, the
physician in attendance notified the Board of Health on a card and
the room occupied by the patient was disinfected by the Formal-
dehyde-Potassium Permanganate method.
The nurse in charge of the district work has reported that the
people were, in all instances, very anxious to carry out the instruc-
tions given, and in so far as it was possible did everything in their
power to prevent other members of the family from becoming in-
fected.
The money for meeting the expenses incident to the epidemic was
rasied by appropriation of Council and gifts through the Emergency
Committee, and I must say that the donations were liberal and were
confined to no one class of individuals. The Ladies' Aid and Auxil-
iary provided the bed and body clothing which were needed, both at
the hospital and in the private homes. The citizens of the town re-
sponded quickly and generously to all requests for supplies, money
or time.
The nurses employed by the Emergency Committee were untiring
in their efforts and rendered most valuable aid to the physicians in
their efforts to stamp out the disease. These faithful public servants
are certainly entitled to a large share of the credit for the small
mortality accompanying this outbreak. Out of .320 cases there were
only 15 deaths. This is less than half the usual mortality and is a
fresh testimonial to the value of the system of district nursing
during an epidemic of Typhoid Fever.
TABUB NO. 1.
SOURCE OP WATER USED BY PATIENTS.
Of the 270 cases of wliich » census was taken—
130 drank from the County Springr constantly.
63 drank from the County Springr occasionally.
77 were uncertain.
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No. 16. COMMISSIOKBR OF H1IAL.TH. 447
TABLES NO. 2.
DISTRIBUTION OF CASES AS TO FAMILIES.
Number of Families Afflicted 200.
No. of families In wtblch were 1 caae 166
No. of families In which were 2 cases, 29
No. of families In which were 8 cases, 8
No. of families In which were 4 cases, 5
No. of families In which were 6 cases, 1
No. of families In which were 7 cases, 1
TABLE NO. 3.
DISTRIBUTION OF CASES AS TO SEX, AGE AND CIVIL CONDITIONS.
SEX:
Male, 156
Female 109
Not given, 5
Total, 270
AGES:
1-10, 16
10-20 98
20-30, 82
30-40, 2T
40-60 21
60-60 8
60-70, 6
Not given, 12
Total 270
CIVIL CONDITIONS:
Widower, 8
B£arrled, 62
Single, 60
Total '. 270
TABLE NO. 4.
OCCUPATIONS OF PATIENTS.
Blacksmiths , 2
Book-keepers , 4
Carpenters, 8
Civil engineer, 8
Clerks, 19
Domestics, 16
Draughtsman, 2
Housewife , 80
Laborers , 18
Masons, 6
Molders, '• 7
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448 SECOND AimUAL RBPORT OF THB Off. Doe.
TABUS NO. 4-OonUnued.
OCCUPATIONS OF PATIENTS.
Mail oarrleFB,
Maohlni8t0,
MUllner,
Painters
Plumbers,
Printers
Photoerraphers ,
Pupil-nurse,
Railroaders
Sctaool children, 63
Teacher
Telephone operators,
Undertakers
TABI4E NO. 6.
DISTRIBUTION OF CAS(ES AS TO DATE OF ONSET.
Aucrust.
September.
3rd,
6th,
7th, .
nth,
12th,
13th,
14th,
15th,
16th,
17th,
18th,
19th,
20th,
21st,
22nd,
23rd,
24th,
25th,
26th,
27th,
28th,
29th,
30th,
3l9t,
1st,
2nd,
3rd,
4th,
5th,
6th,
7th,
8th,
10th,
nth.
12th,
21
13th.
10
14th,
46
16th,
2
17th,
3
23rd,
6
24th,
6
27th,
4
28th,
7
30th,
8
17
l«t.
8
2nd,
10
4th,
3
7th,
8th,
October.
TABIiB NO. 6.
EXPENSES CAUSBID BY THE EPIDESMIC.
Ntirses' fees,
Board,
$2,378 00
1,004 75
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No. 16. COMMISSIONER OF HEALTH. 449
TABLE NO. 7.
Total Nio. of Cases, 320. Deaths, 15.
CASES TREATED AT EMERGEINCy HOSPITAL*.
Total No. Oomplicatlons. Deaths.
61 9 4
C6m<plications Classified.
Hemorrhagres, 5
Typhoid pheumonia, 2
Phlebitis 2
CASES TREATED AT JBLK COUNTY HOSPITAL
Total No. Complications. Deaths,
68 9 6
Complications Classified.
Hemorrhages, 3
Hypostatic conjestlon of lung, , 1
Perforation 2
Pneumonia, 2
PWebiUs 1
TABLE NO. 8.
Reports of samples of water from Ridgway examined at Department of
Health Laboratories: —
Bact. B. Coll
8-20. per c.c. per c.c.
No. 1. County Spring 12
No. 2. City water from well, 7
No. 8. Hospital spring 2
No. 4. County Spring, (?) 10
No. 6. Mill Creek water 700
No. 6. Caught from pipe running from tank 15 C
8-21.
No. 1. City well pump, 12
No. 2. Snow plow works, 60
No. 3. R. R. Spring 200
No. 4. Hyde Spring, 350
No. 5. County Spring, 280
No. 6. General Supply, 40
9-3.
No. 1. C>>unty Spring 5,000 66
No. 2. Sheihan Spring 6
Na 3 500
No. 4. City ptmips, 180 4
No. 5. Snow plow, 3,000 32
No. 6. Dynamo works, 560
9-3.
No. 1 70
No. 2. 600 10
No. 8. 5.400 26
No. 4 5,500 32
No. 5 840 32
29—16—1907
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4S0
SKOOND ANNVAl^ RSPORT OF THS
Off. Doa
9-10.
No.
1.
No.
2.
No.
8.
No.
4.
No.
5.
No.
6.
No.
7.
No.
8.
No.
9.
No.
10.
No. 11.
No.
12.
9-12
No.
13.
No.
14.
No.
16.
No.
16.
No.
17.
No.
18.
No.
19.
9-18.
No.
20.
No.
21.
Na 22.
No.
23.
No.
24.
No.
25.
No.
26.
No.
27.
No.
28.
9-14.
No.
29.
No.
30.
No.
31.
No.
32.
No. 33.
No.
34.
No.
35.
No.
36.
No.
37.
No.
38.
No.
39.
No.
40.
Nb.
41.
No.
42.
No.
43.
No.
44.
No.
45.
No.
46.
TABLE 8.— Continued.
Bact
per c.c.
Drilled well, No. 329 South St 46
Vug well, N. W. Corner South & East Sts 700
Dug well, S. W. Comer Centre & East Sts 130
Powell spring, No. 324 South St. 46
Johnson spring, S. W. Cor. Metoxet & Stockholm 410
Spring (Shultz), from faucet on N. side of Metoxet, K
of Jackson 600
Drilled well. No. 40 South St 23
Drilled well. No. 122 Elk St 14
Drilled well. No. 237 Hlgli St 65
Dug well. No. 231 High St 10,000
Drilled well, Nb. 409 2nd Ave 62
Drilled well. No. 101 Cardott St 280
S. Borough well, 3
Early spring (near bottom 1% water m. sp.) 6,000
Dug well (or spring) reftr of No. 610 Race St 220
Spring, No. 610 Race St 11,000
Spring, B. end of Race St 110
Dug well, E. 12 Main opposite Hyde barn 360
Dug well. No. 122 Grant St., 4,200
Drilled well, No. 122 Sherman St., 10
Spring, No. 142 Sherman St 28,000
Spring, E. end Allenhurst Ave., 3,000
Driven well, S. E. Cor. 2nd & Chestnut Sts., 350
Dug well. No. 416 W. 2nd St 430
Drilled well. No. 606 W. 3rd St 210
Driven well. No. 423 W. Ist St 6
Dug well. No. 418 W. 1st St., 10
Dug well, No. 402 l«t St. (N. W. Cor. Cherry) , 210
Garretts spring, N. side of Ist, B^ of Maple 16
Grant's spring, near W. Boro. line, N. of W. Ridgway, 48
Drilled well. No. 502 W. 3rd St 3
Drilled well. No. 314 W. 3rd St., 160
Drilled well. No. 519 Chestnut St 52
Drilled well, No. 414 CThestnut St 13
Driven well. No. 315 2nd St 120
Driven well. No. 313 Cherry St 28
Driven well, S. W. Cor. 1st & Cherry 290
Driven well. No. 432 W. Main St 140
Driven well. No. 318 W. Main 98
Driven well. No. 310 W. Main, 85
Drilled well. No. 239 W. Main 260
Drilled well. No. 253 W. Main 4.200
Driven well, No. 269 W. Main 8
Driven well. No. 263 W. Main 10
Driven well. No. 144 W. Main 200
Driven well. No. 120 W. Main St 290
B. Ck)li
per c.c.
6
260
40
180
36
1
Digitized by VjOOQIC
No. 16. COM^ISSIONSR OF HBALTH. 461
9-17.
Nk>. 47. J>ug well, No. 122 Montmorency Ave. ,'
No. 48. Drilled well, No. 206 Montmorency Ave.,
No. 49. Drilled well, No. 214 Montmorency Ave. ,
No. 60. Driven well, No. 314 8rd St.,
No. 51. Driven well, No. 814 lat
No. 62. Driven well, N. W. Cor. Ist & Chest. Sta
No. 53. Driven well, Standard Axe & Tool Works
No. 64, Spring, No. 638 W. Main St
No. 66. Driven well, No. 308 Chestnut St.,
No. 66. Driven well. Chestnut, opp. 1st
No. 67. Driven well. No. 206 Chestnut St
No. 68. Spring, above N. end of Cherry St
No. 69. Drilled well. No. 229 2nd St
No. 60. Driyen well, No. 229 2nd St.,
No. 61. Dug well. No. 132 W. Main St
No. 62. 9. Boro drilled well
2,400
210
16,000
68
22,000
60
46
230
2
38
40
22,000
1
780
800
2
110
220
96
1
REPORT ON THE DANGER OF FIRE IN FORMALDEHYDE
DISINFECTION.
By CHARIjESS H. LaWALL, Ph. O., Consultinsr Chemist to the Commissioner.
The increased efficiency of formaldehyde disinfection as applied
at the present time by means of the formalin-permanganate method
of evolving the gas has brought with it a new danger^ uncertain, yet
none the less real, in consequence of the fact that upon several occa-
sions at least the mixture has been known to take fire spontaneously.
During the winter of 19061907, Dr. Courtland Y. White, of Phil-
adelphia, in connection with some disinfection work which he was
doing for the Department of Health of the State of Pennsylvania,
observed upon three occasions that the mixture caught fire after the
combination of the constituents had begun and the room had been
closed. It was fortunate that the fact was discovered on one of
these occasions, as the flame was so high as to endanger neighboring
articles in the room. Suspecting the possibility of impure ingredi-
ents, he wrote to Health Commissioner Dixon concerning the matter,
who referred it to the writer for consideration and investigation.
It is well known that there is consideriable uncertainty connected
with reactions in which potassium permanganate plays a part, and
that even with inorganic substance, as in the Kjeldahl method for
the estimation of nitrogen, there is sometimes a spark or flash of flre
when the permanganate is added to the other constituents. In the
Digitized by VjOOQIC
462 SBCOND AN<NUALr RESPORT OF THB Off. Doc
formalin-permanganate method it has been customary to use two
parts of formalin to one part of permanganate, adding the latter to
the former and quickly leaving the room before the violent evolu-
tion of gas which shortly takes place has time to aflfect the operator.
Working with quantities in some cases as high as one pound of per-
manganate, the amount of heat developed must be very great, and
if there are any uncertain factors present, such as organic matter
in the container which has been imperfectly cleaned, the danger of
possible ignition is that much greater.
The flame which appeared upon the occasion described by Dr.
White was a pale blue flame, reaching several ftn^t into the air from
the generating container. This agrees with the appearance of the
fl'ame of formaldehyde gas, which burns freely when ignited, even if
mixed with a fair proportion of steam, as is usually the case.
The gas may be ignited from a 40 per cent, solution of formalde-
hyde by simply heating it and applying a match to the surface after
ebullition has begun, and when the formalin-permanganate disin-
fection proportions are used in as small a quantity as one ounce of
formalin and one half ounce of permanganate, using a beaker for a
generator, the flame of the ignited gas has been observed to have a
length of more than one foot.
In view, thei-efore of the uncertainty regarding the cause of the
ignition of the vapor in these observed cases and in recognition of
the hitherto overlooked fact that formeldeliyde vapor is very inflam-
mable, it would be well to practise this method of disinfection with
the precautionary measures of using small quantities of the ingre-
dients (not over one quarter or one half pound of permanganate to
a charge) in several containers, surrounding these containers with
larger ones containing water, being careful to extinguish all gas
jets, pilot lights, flre, and other possible causes of ignition, and keep
the generators away from the sides of the room where a flame might
be communicated to inflammable material. It is not believed by the
writer that this method of disinfection need necessarily be aban-
doned, but it is essential that its limitations and dangers be not
overlooked in its future use.
Digitized by VjOOQIC
THE) DIVISION OP SANITARY ENGINEERING.
F. HERBERT SNOW, C. E., Chief Engineer.
(453)
Digitized by VjOOQIC
(464)
Digitized by VjOOQIC
OFFICIAL DOCUMENT, No. 11
THE DIVISION OP SANITARY ENGINEERING.
CONTENTS.
I. ORGANIZATION AND ADMINISTRATION.
Office and and Office Force.
Assistant Engineers.
Field Officers.
Local Health Officers.
II. OFFICE WORK.
Corporation Reports.
Recorded Plans.
Petitions and Complaints.
Orders of Abatement.
Drafting.
III. ENGINEERING.
Water Works.
Seweras:e.
Designs and Construction.
Special Work.
(a) Mt. Gretna.
(b) Railroad Water Supply.
(c) Miscellaneous.
IV. FIELD INSPECTION.
Improvement of Water Sheds.
General Sanitation.
Water Sample Collection.
V. EPIDEMICS.
Typhoid Fever Outbreaks.
Scranton.
Huntingdon.
Klttannln^.
Spangler.
Manhelm.
East Conemaugh and Franklin.
Rldgway.
Bumham.
Anthrax Outbreaks.
Oorry and Spring Creek.
VI. RBFERENCE>S TO SPECIAL COUNSEL.
VII. CONCLUSIONS.
(456)
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456 SECOND ANNUAL llfiPORT OP Tttfi Oft. Doc
DIVISION OF ENGINEERING.
The following is a detailed statement of the operations of the
Engineering Division of the State Department of Health to the end
of the year 1907, being the second annual report made since the
creation of the new Department of Health under Act No. 281, ap-
proved April 27th, 1905.
I. ORGANIZATION AND ADMINISTRATION.
Office and Office Force.
F. Herbert Snow, C. E., has continued throughout the year to dis-
charge the duties of his position as Chief of the Engineering Divi-
sion of the Department.
The offices of the Division are on the ground floor front, north
corridor of the Capitol, and are those occupied by the Division dur-
ing the latter half of the preceding year. Besides these rooms addi-
tional space has been assigned to the Division and used, comprising
four rooms on the fifth floor of the building:
Six sub-divisions of the organization have been created in the
administration of the work put upon the office, namely: That of
general office work, that pertaining to water works and sewerage
applications, that relating to sx)ecial investigations, that relating to
designs and construction, that of map-making and flnally that of san-
itary regulation.
There have been employed in the office eight stenographers and
three clerks.
Assistant Engineers.
Walters. Hanna, C. E., has been the principal assistant engineer in
direct charge of the general office work. He received his appoint-
ment in March.
Mr. Frederick W. Witherell, principal assistant engineer in charge
of investigations of water works and sewerage applications, re-
signed in March to accept a position with the American Water
Works and Guarantee Company of Pittsburg.
Mr. F. H. Shaw was appointed and assumed Mr. Witherell's
duties in May. In November Mr. Shaw resigned in order to devote
his time to private practice, more particularly as engineer to the
Sewerage Commission of the city of Lancaster.
Mr. William H. Ennis, who was appointed in August, served a
short time as assistant engineer on water works and sewerage in-
vestigations. He was then transferred to construction work at
Mont Alto.
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No. 16. OOMMIS6IONBR OF H.KAT«TH. 457
Mr. Charles H. CummingB has been the principal assistant in
charge of special investigations. Mr. Balph E. Irwin, a graduate
bacteriologist, was employed in this kind of work during the sum-
mer months and so also waB Mr. John A. Behaeffer, a graduate
chemist.
Thomas Fleming, Jr., C. E., assumed the duties of his position as
principal assistant engineer in charge of designs and construction in
September. The preliminary surveys and topography for the State
Sanatorium lay-out at Mont Alto had been made previously by a
special field corps, under the direction of Mr. Harvey Linton, an
expert topographer. Mr. Linton began the surveys in May and con-
cluded in September. In the party were assistant engineers C A.
Phillippi, George H. Strode and Reynold P. Si>aeth. Professor J. P.
Wentling, of the State Forestry Academy, iind twelve students as-
sisted Mr. Linton in the topographical work. Of this force, Mr.
Phillippi only remained when Mr. Fleming took charge.
The office force under Mr. Fleming has consisted of three en-
gineering draftsmen^ namely, John M. Mahon, Jr., H. A. Otto and
P. L. Gardner. Mr. Otto and Mr. Gardner were transferred to en-
gineering insx>ection work on sewage disposal construction at Mont
Alto. Mr. Fleming's field force has comprised Mr. Ennis, resident
engineer at Mont Alto in place of Mr. Phillippi, resigned; Chester
A. Eckbert and C. R. Forbes transitmen; and Edgar R. Barnes, Ivan
M. Glace and George H. Fox, rodmen.
Mr. J. L, W. Gibbs has continued as chief draftsman in charge of
map-making. The following men were employed under him to make
tracings: J. W. German, Jr., Max Matthes, F. Marion Sourbeer, Jr.,
Wilberforce Eckels, Jay Gilbert, Robert Hunter, Chester Hogen-
togler and C. K. Weigle. The last five named men worked during
the summer months only. Messrs. Otto, Gardner, Mahon, Forbes
and Barnes were engaged part of the time in map-making.
Mr. Moses K. Ely, the chief sanitary field inspector, has been in
charge of the office work incident to the supervision of all field
officers' reports.
These assistants have comprised the permanent force, but at in-
tervals during the year eight other engineers, residents of the
State, were called upon to render assistance of a specific character.
Their names are presented in alphabetical order.
L. E. Chapin, Pittsburg; C. F. Drake, Pittsburg; Harvey Linton,
Altoona; Charles F. Mebus, Philadelphia; F. H. Shaw, Lancasterj
Elton D. Walker, State College; Nathan F. Walker, Athens; D. F.
A. Whellock, Warren; F. W. Witherell, Pittsburg.
Mr. Chapin made an examination and report relative to sewerage
in the thirty-ninth ward of the city of Pittsburg; on sewerage con-
ditions of Mt. Lebanon School plan of lots and in the Clearfield Ad-
dition, Scott township, Allegheny county; and on the plan of the
existing sewer in Stowe township and Mckee's Rocks.
Mr. Drake investigated and reported on the sewerage of Arnold,
of Canonsburg and South Canonsburg and of Brackenridge borough.
Mr. Linton reported investigations of the Westmoreland Water
Company system, sewerage at Bellofonte, the water works at Creek-
side, the system of the Reedsville Water Company, and certain facts
relative to the typhoid fever outbreak in Burnham,
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468 SECM3ND ANNUAL. REPORT OF THE OBt. Doc
Mr. Mebufl investigated the pollution of the source of the West
Conshohocken Water Works; the sewerage system of Bryn Mawr
College; the sewers and sewage disposal fields of the State Hospital
at Norristown; and the pollution of Ck)bbs Creek by the sewers of
the city of Philadelphia and other places.
Mr. Shaw examined and reported on the sewers in the following
boroughs of Berks county; Bechtelville, Bernville, Birdsboro, Boy-
ertown, Oenterport, Fleetwood, Hamburg, Kutztown, Lenhartsville,
Mt. Penn, West Leesport, West Beading, Womelsdorf and Wyomis-
sing. He also examined the sewerage system and water works of
the State Hospital at Danville.
Prof. Walker examined and reported on the applications for sew-
erage of Middleburg, Verona, Oakmont, Middletown Drainage Com-
pany, East McKeesjKxrt, Coraopolis, Ben Avon, Jeannette^ Wall,
Chartiers township, Watsontown and Hughesville. Also on the
Hummelstown Consolidated Water GoTapanj and East McKeesport
Water Company applications.
Mr. Nathan Walker made a special investigation of the sources
of supply of water to Towanda borough.
Major Wheelock made water works investigation at Franklin,
Bradford, St. Marys, Reynoldsville, Clarion, South Bradford, Ell-
wood City, Farewell village, Foxburg, Austin and Sharon. He also
made sewerage investigations at Edinboro, Natrona, Franklin, Rey-
noldsville, East Mauch Chunk, Canton, Kane, White Rock Land
Company of Kane, Ellwood City, Corry Tannery, Tarentum, DuBois,
Bradford, Clearfield, Sharon and South Sharon. Special investiga-
tions and report were made by Mr. Wheelock at the State Hospitals
at Warren and Polk relative to improved sewerage and sewage dis-
posal works.
Mr. Witherell looked over and made certain suggestions relative
to the filter plans submitted for approval by the Hummelstown Con-
solidated Water Company, the Dauphin Consolidated Water Supply
Company, the Venango Water Company and Cambridge Springs
borough.
Field Officers.
Besides the sanitary inspectors in the employment of the Dei)art-
ment at the beginning of the year, 24 additional sanitary inspectors
have been appointed by the Commissioner of Health. The name,
place of residence and date of appointment of each is given below:
Wilson W. Ritter, Harrlsburg, January* 1807.
William R. Teats, Bumham, January, 1907.
H. S. Kauffman, Lltltz, February, 1907.
J. B. Nlghtlngrale, Doylestown, February, 1907.
A. L. Avery, Tunkhannock, February, 1907.
Daniel Zellers, Lebanon, February, 1907.
Thomas Hlckey, Pittsburgrh, March, 1907.
William P. Miller, Pittsburgh, March, 1907.
J. W. Plnkham, Philadelphia, March, 1907.
Charles T. Maclay, Chambersburg, April, 1907.
Ira F. Zeigler, Carlisle, June, 1907.
W. R. Claypool, Philadelphia, June, 1907.
Warren S. Hood, Philadelphia, June, 1907.
J. Alfred Judge, Philadelphia, June, 1907.
Otto F. Nickel, Johnstown, June, 1907.
Richard F. Sinstein, Harrisburg, July, 1907.
Morris Z. Frederick, Telford, July, 1907.
Digitized by VjOOQIC
Nt>. 18. OOHMISeiONBR OF HSALTH. 450
Howard M. Haines, Harrisburg, July, 1907.
Thofl. R. Nicholson, North Wales, July, 1907.
Roy Souder, Lancaster, July, 1907.
Charles H. Spelker, Pittsburg, July, 1907.
H. C. Welrick, Enola. July, 1907.
W. W. Reno, Rochester, Ausrust, 1907.
W. F. Lerch, Easton, August, 1907.
Twenty temporary field officers were appointed for the summer
months. The names of these men are given in alphabetical order.
They concluded their work before the end of the year. Most of them
were students who returned to college in September.
J. Simpson Africa, Harrlsburg.
Richard Bayard, Dauphin.
W. B. L. Drawbaus:h, Carlisle.
J. M. Fair, Saltsburg*.
M. W. Fleming, Bellefonte.
Clarence Funk, Harrlsbur^.
James K. Jackson, Hanisbur^.
George Karmany, Hummelstown.
Carl C. Koenls, Pittsburgh.
R. W. Lenker, Schuylkill Haven.
Horace S. MlUer, Harrlsburg.
Thomas R. Mofflt, Harrlsburg.
James Morse, Philadelphia.
Harry T. Neal, Harrlsburg.
Paul Rupp, Lancaster.
F. P. Stock, Shamokln.
R. A. fiawyer, Harrlsburgr.
James A. Walker, Philadelphia.
H. B. Whltmoyer, Harrisburg.
B. D. Workman, Harrisburg.
Deputy Field Officers, so called, because while being in the em-
ployment of a private corporation, they are deputized to represent
the Oommissioner of Health in inspecting the sanitary condition of
property and to report results to him, were apx>ointed in four in-
stances prior to 1907. During the current year no additional deputy
field officers were appointed.
On December 31st, 1907, the regularly employed force under my
direction was as follows:
Walter S. Hanna, Principal Assistant Engineer, in charge of general office
work.
Charles H. Cummlngs, Principal Assistant Engineer, in charge of special in-
vestigations. ,
Thomas Fleming, Jr., Principal Assistant Engineer, in charge of design and
construction.
William H. Bnnis, Assistant Engineer.
John M. Mahon, Jr., Engineer and Draftsman.
James Ih W. Oibbs, Chief Draftsman.
H. A. Otto, Engineering Inspector.
F. Ifc Qardner, Engineering Inspector.
Chester A. Eckbert, Transltman.
C. R. Forbes, Transltman.
Edgar R. Barnes, Rodman.
Ivan M. Olace, Rodman.
J. W. German, Jr., Tracer.
Kax Matthes, Tracer.
F. H. Sour beer, Jr., Tracer.
Daniel V. Ness, Chief Clerk, in charge of nuisance complaints.
B. C. Dickinson, Chief Clerk, in charge of local health officer work.
Ellen Johnston, Clerk.
M. Irene Cuenot, Stenographer.
Hi. Louise E2cke]8, Stenographer.
Jane Gilbert, Stenographer.
M. Ethel Hurst, Stenographer.
Marie Fasy, Stenographer.
Mary E. Russell, Stenographer. '
Mary K. Sourbeer, Stenographer.
M. K. Ely, Chief Sanitary Inspector.
James M. Clark, Field Officer in charge.
Digitized by VjOOQIC
460 SECXDND ANNUAL REPORT OF THB Oft, Doo.
David M. Coleman, Field Officer in charge.
John J. Consldine, Field Officer in charge.
J. B. Nightingale, Field Officer in charge.
John W. Pinkham, Field Officer in charge.
William R. Teats, Field Officer in charge.
Wilson W. Ritter, Special Field Inspector.
Daniel Zellers, Special Field Inspector.
Ira F. Zeigler, Special Field Inspector.
Henry Andrews, Field Officer.
W. R. Clay pool. Field Officer.
John W. Downes, Field Officer.
Richard F. EMnstein, Field Officer.
Morris Z. Frederick, Field Officer.
Howard M. Haines, Field Officer.
Thomas Hickey, Field Officer.
Warren S. Hood, Field Officer.
J. Alfred Judge, Field Officer.
H. S. Kauffman, B^eld Officer.
W. F. Lerch, Field Officer.
Chas. T. Maclay, Field Officer.
William P. Miller, Field Officer.
Thomas R Nicholson, Field Officer.
Otto F. Nickel, Field Officer.
W. W. Reno, Field Officer.
Roy Souder, Field Officer.
Chas. H. Spelker, Field Officer.
H. C. Weirick, Field Officer.
Mr. E. T. Edwards, City Health Officer for Johnstown, has con-
tinued to represent the Department as a special sanitary inspector
in the immediate territory beyond the jurisdiction of that city au-
thority.
Local Health Officers.
To 'better administer the work of the Department throughout the
1,519 second class townshix)s of the Commonwealth, wherein reside
over two and a third millions of x>eople entirely without sanitary
protection such is afforded by the boards of health of 34 first class
townships and the 868 boroughs of Pennsylvania, the Commissioner
of Health had the State — 66 counties excluding Philadelphia — di-
vided into sanitary districts totalling 733, for each of which he ap-
pointed a resident agent.
In so far as possible and practicable, township boundaries were
followed. Usually a district comprises two or more townships in-
cluding the boroughs and cities therein. For instance, Logan town-
ship, Blair county, including within it Altoona city and Juniata bor-
ough, comprises a district. The city of Pittsburg proper is a dis-
trict by itself and so is Allegheny city.
The resident sanitary agent of the Commissioner of Health, in bo
far as his duties relate to the Medical Division of the Department, is
confined to the territory wholly without the borough, city- and first
class township because these municipalities are required by law to
have their own organized boards of health; but everywhere within
his district regardless of the municipal boundaries the resident sani-
tary agent is expected to investigate stream x>ollutions, water works
and sewers, to render assistance to field officers and to report to the
chief of the Engineering Division.
Many of the agents were not appointed until late in the year and
in consequence the system was not fairly under way at the close of
the period covered by this report. The work performed for the En-
gineering Division of the Department by the local health officers
appears elsewhere herein.
Digitized by VjOOQIC
No. 16. COMMISSIONER OF HEALTH. 461
II. OFFICE WORK.
The general office work necessary to administer the operations of
the Division, including general correspondence, recording corpora-
tion reports and plans required by law to be filed in the office of
the Department or in compliance with the decrees of the Commis-
sioner, attention to petitions and complaints, the issuing of orders
for the abatement of nuisances and menaces and the preparation of
plans of water sheds for the use of sanitary inspectors in the field,
comprises the subjects treated of in this part of the report under
the head of Office Work. More or less office work is performed in
connection with the other sub-divisions of the organization and it is
mentioned elsewhere.
Corporation Reports.
Under provisions of Law No. 182 of the Acts of Assembly of Penn-
sylvania, approved April 22nd, 1905, entitled "An Act to preserve
the purity of the waters of the Btate, for the protection of the pub-
lic health," it is the duty of every municipal corporation, private
corporation, company and individual supplying or authorized to
supply water to the public within the State to file with the Com-
missioner of Health a certified copy of the plans and surveys of the
water works, with a description of the source from which the supply
of water is derived.
Under the provisions of the same law, it is the duty of the public
authorities having by law charge of the sewer system of every mu-
nicipality of the State to file with the Commissioner of Health a
report of such sewer systems, which shall comprise such facts and
information as the Commissioner of Health may require.
Three hundred and eighty-two rei>ort» were received. Two hun-
dred and ninety-six of them were from municipal corporations and
86 were from private corporations.
The municipal returns comprised 144 water supply reports and
152 sewerage reports.
The private corporation reports related to water works.
The Department now has on file information obtained in this
formal way relative to water supply in 658 places. And relative to
sewerage in 396 places.
Recorded Plans.
On December 31st, 1907, there were 3,599 official plans registered
in the Department, 2,072 having been added during the year and of
the grand total 1,797 accompanied water works and sewerage reports
of which 905 were added during the year, 1,592 accompanied water
works and sewerage applications of which 885 were added during
the year, and 310 were of a miscellaneous character including some
of the office working maps and those used in field engineering and
inspection work.
Petitions and Complaints.
The Commissioner of Health, in addition to the powers conferred
by the new law, has all the powers conferred and must perform all
tbe duties heretofore imposed by law upon the former State Board
Digitized by VjOOQIC
462 SECOND ANNUAL REPORT OF THB Off. Doc
of Healthy or any member, committee^ or officer thereof, including
the Becretaiy. The work of fluperyising the general interests of the
health and lives of the citizens of the Commonwealth has been done
in i>art in answer to petitions and complaints and requests for ad-
vice. The Commissioner's instructions to give prompt attention to
petitions, complaints and requests have been complied with in so
far as the Department force made possible.
Hundreds of communications relative to stream pollution by sew-
age, or by industrial waste, or with respect to insanitary conditions,
inferior water supply or ice supply and respecting sewers, sewage
dsposal, water supply and general sanitation have received attention.
Three hundred and forty-three complaints and petitions have been
acted upon during the year. Two hundred and seventy-five of these
cases have been satisfactorily settled.
Fourteen requests for advice relative to water supply, sewerage,
garbage disposal, drainage of stagnant water, disposal of creamery
wastes and location of cess-pools have been answered.
Common nuisances located within the territory of a municii>ality
having an organized board of health and made the subject of com-
plaint to the Commissioner of Health have been referred by the
Department to such local boards. There have been 94 references of
this kind during the year as follows:
Stream Pollution. Waynesburg, Lebanon (2 cases). East Berlin,
Freemansburg, Brockwayville, Thompson, Derry, Sunbury, Middle-
burg, Linesville, Lewistown, Troy, Wilkins township, Carbondale.
Well Pollution. Williamsburg and Montgomery.
Bewage in street gutters. Phoenixville, North Braddock, Whit-
aker, Telford, Blairsville, Chest Springs, York, Delta, Hatfield, Dun-
cannon, New Holland, New Berlin and Jamestown.
Open sewer. Bockwood, Oakmont, Sunbury and New Kensington.
Defective sewer. Monongahela (2 cases), Washington, Juniata,
North Braddock and Atglen.
Sewer outlet. CoUegeville and Donora.
Insanitary premises. Blairsville, Norwood, Mt. Pleasant, Turtle
Creek, New Haven, Grove City, Latrobe, Williamsport (2 cases),
Huntingdon, Sheridanville, Wyalusing, Lock Haven, Qirardville,
Cambridge Springs, Stillwater, South Fork, Berwick, Ambler, Punx-
sutawney, Ridgway, Siverly, Lehighton, Avoca, Flemington, Pitts-
ton, Narberth, Millville, Shamokin, Tamaqua, Old Forge, Leechburg,
York Haven.
Dumping grounds. Turtle Creek, Stroudsburg and Carbondale.
Dead Animals. Verona, Eldred and Spangler.
Slaughter Houses. Jersey Shore, Spartansburg, Dushore, Nazar-
eth Roaring Springs and Carrollstown.
Swamp land and stagnant water. Watsontown, Edgewood, Weiss-
port, Wellsboro, Lewistown, Irwin and Lehighton.
At the close of the year of the 94 cases referred to local boards
of health all but 26 have been adjusted to the satisfaction of the
complainants. The Department will follow the remaining cases to
a conclusion.
Two hundred and thirty-five complaints and petitions were made
the subject of special investigations and report by the Engineering
Division. The localities were usually outside of boroughs and cities
Digitized by VjOOQIC
No. 16. COMMISSIONER OF IIBALTH. 463
and in territory where only the State Department of Health has
adequate jurisdiction. One hundred and fifteen of these commanded
the services of engineers, field inspectors, and county medical oflS-
cers and one hundred and twenty commanded the services of the
local health officers. Classified, these subjects were as follows:
Nuisance in streams by sewage and industrial wastes 67
Impure water and ice supply 28
Sewerage systems 6
Defective drainage 7
Garbage and night soil dumps 14
Unsanitary premises 60
Nuisances in street gutters by sewage, 21
Slaughter houses 18
Reduction, fertilizer and glue works 5
Dead animals, 7
Mine drainage 1
Swamp land and stagnant water, 10
Stench from sewage works, 1
235
The localities of the cases investigated are shown in the following
statement:
Nuisances in streams by sewage and industrial wastes.
In Adams county, Tillie village; in Allegheny county, Coraopolis,
Wilkinsburg and White Ash; in Beaver county, New Sheffield and
Aliquippa; in Bedford county, Sulphur Springs; in Berks coun-
ty, Ryeland, Womelsdorf, Lyons Station, Boyertown; in Brad-
ford county, Bradford; in Bucks county, Solebury, Langhorne;
in Butler county, Mars; in Carbon county, Lehighton (2 cases); in
Centre county, Aaronsburg; in Chester county, Whitford, Valley
township and Paoli; in Crawford county, Conneaut Lake; in Cum-
berland county, Mt. Holly, Hunters Run and New Cumberland; in
Dauphin county, Dauphin (2 cases) and Beaver Creek Station; in
Fayette county, Brownfleld, Broad Ford and Connellsville; in Lack-
awanna county, Scranton suburbs and Carbondale township; in Lan-
caster county, Lititz suburbs; in Mercer county, Sandy ikke and
South Sharon suburbs; in Montgomery county. Centre Square, Nar-
cissa, Gilbertville, Bryn Mawr and Lower Merion township (2 cases);
in Montour county, Danville suburbs; in Potter county, Ulysses; in
Schuylkill county, Ashland suburbs; in Sullivan county, Muncy Val-
ley and Eagles Mere; in Tioga county, Elkland and Wellsboro; in
Union county, Mifflinburg; in Warren county, Sheffield; in Washing-
ton county, California; in Wayne county, Orson and Bethany; in
Westmoreland county, Penn township and Pennboro suburbs and in
Wyoming county. Lake Corey.
Where the above places are not designated as townships, the places
named are villages or suburbs of boroughs. Sometimes in the latter
instances the inspections involved examinations within the corpor-
ate territory of the municipality.
Impure water and ice supply. In Beaver county, Beaver suburbs;
in Bradford county, Towanda suburbs (2 cases); in Berks county,
Oumru township, Kutztown and Fleetwood boroughs; in Cambria
county, Gallitzin borough; in Carbon county, Mauch Chunk; in Ches-
ter county, Coatesville; in Cumberland county, Carlisle; in Dauphin
county, Middletown and Pillow; in Lackawanna county^ Moscow (2
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464 SECOND ANNUAL REPORT OP THE Oft. Doc.
caaeB); in Lehigh county, Fullerton and Salisbury township; in Leba-
non county, Bouth Londonderry township; in Montgomery county,
North Wales, Souderton, West Oonshohocken and Boyersford; in
Northumberland county, Sunbury; in Schuylkill county, Tremont; in
Susquehanna county, Dimmock; in Warren county, Oonewango
township and Sheffield; in Wayne county, Honesdale, and in York
county, Dallastown.
Sewerage systems. In Cambria county, Hastings; in Oarbon
county. East Mauch Chunk; in Delaware county, St. Davids; in Mont-
gomery county, Bryn Mawr and Lansdale, and in Perry county,
Blain.
Defective drainage. In Columbia county. Espy; in Greene county,
Franklin township; in Indiana county, Saltsburg; in Lackawanna
county, Moscow; in Lehigh county, Salisbury township; in Montgom-
ery county, Ambler, and in Washington county, Washington.
Garbage and night soil dumps. In Allegheny county, Goraopolis,
Homestead and Braddock; in Berks county, Bernyille; in Bucks
county, 'Sellersville; in Cambria county, Johnstown; in Ctentre coun-
ty, Penn Hall (2 cases); in Elk county, Ridgway; in Payette county,
Uniontown; in Lebanon county, Cleona; in Luzerne county, Harvey's
Lake; in Montgomery county, Ardmore, and in York county, West
Manchester township.
Unsanitary premises. In Allegheny county, Hoboken, Wilkins-
burg, Goraopolis, Craftoin, Oak Station, Homestead and East Pitts-
burg; in Berks county, Robisonia and Leesport; in Blair county,
Prankstown; in Centre county, Spring Mills; in Chester county,
Eirklynn, Devon and Berwyn (2 cases); in Clearfield county, Wind-
burn; in Clarion county. New Bethlehem; in Dauphin county, Eliza-
beth ville and Linglestown; in Delaware county, Llanerch, Trainor,
Lester, Oollingdale, Darby township and Chadds Ford; in Fayette
county, Georges and Connellsville; in Franklin county, Lehma^ters;
in Greene county, Waynesburg; in Huntingdon county, Broadtop; in
Lancaster county, Upper Leacock, Eden, Falmouth and West Done-
gal township; in Lehigh county, Laurays; in Mifflin county, Yeager-
town and Newton Hamilton; in Monroe county, Pocono Pines; in
Montgomery county, Narcisisa, Haverford, Glenside (2 cases), Ard-
more (2 cases), Merion (3 eases). Edge Hill, Abington township, Bryn
Mawr and East Greenville; in Northampton county, Rosetto and
Pottsgrove; in Pike county, Greentown; in Snyder county, Paxton-
ville and Kantz; in Susquehanna county, Liberty township and Mont-
rose; in Union county. White Deer Water Company; in Wayne
county, Gallilee.
Nuisances in street gutters by sewage. In Allegheny county, Penn
township and Idlewood; in Bucks county, Perkasie; in Cambria
county, Salix; in Chester county, Devon; in Clearfield county, Deca-
tur township; in Dauphin county, Fort Hunter and Highspire; in
Delaware county, Haverford township, Fairview and Femwood (2
cases); in Fayette county, Ohiopyle; in Forest county, Marionville;
in Lebanon county, Hebron; in McKean county, Hazlehurst; in Mont-
gomery county, Bryn Mawr and Plourtown; in Schuylkill county,
Shenandoah; in Washington county, California, and in Westmore-
land county, Derry township.
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No. 16. COMMI3SI0NBR OF HSALTH. 465
Slaughter bouses. In Adams county, Cash town; in Bedford coun-
ty, Gapsville; in Butler county. Harmony; in Cambria county, Vin-
tondale; in Centre county, Phillipsburg; in Huntingdon county, Lo-
gan township; in Indiana county, White township; in Lackawanna
county, Waverly; in Lancaster county, Lancaster; in Lebanon coun-
ty, Oampbellstown; in Mifflin county, McVeytown; in Northumber-
land county, Bhamokin and Mahanoy; in Somerset county, Stoys-
town; in Susquehanna county, Liberty township; in Union county,
West Milton; in Washington county, Hackett, and in Westmoreland
county. Unity township.
Reduction, fertilizer and glue works. In Northumberland county,
Shamokin; in Somerset county, Glade; in Tioga county, Westfield;
in Westmoreland county. West Newton, and in York county, York.
Dead Animals. In Bedford county, West Providence; in Cambria
county, Jackson; in Chester county, Kennett township; in Lehigh
county, Washington township; in Luzerne county. Sugar Loaf town-
ship; in Mercer county, Greenville, and in Montgomery county, Hoyt.
Mine drainage. In Cambria county. Salt Lick Creek.
Swamp land and stagnant water. In Allegheny county, Boston;
in Centre county. Port Matilda, Aaronsburg; in Lackawanna county,
Clarks Summit; in Potter county, Galeton; in Montgomery county.
South Hatfield and Lower Merion township; in Northumberland
county, Dewart, and in Westmoreland county, Bolivar and Bairds-
town.
Stench from sewage works. In Delaware county, Ithan.
Some of the petitions came from local Boards of Health and bor-
ough authorities and in these cases the investigations were in the
towns.
Orders of Abatement.
To prevent causes of disease and mortality, so far as the same
may be caused by public menaces and nuisances, more especially out-
side of municipalities on the water sheds of the State, the Commis-
sioner of Health has the power and authority to order such nuisances
and menaces to be abated and removed. Upon examination made by
any i>eTSon8 duly authorized by the Commissioner of Health so to
do, information as to the facts is submitted to this office and subse-
quently an order to abate or remove may be issued. These orders
are signed by the Commissioner and served by the field or local
health officers. The abatements listed below were had by formal
notification. Many hundreds of properties have been put in sani-
tary condition on inspection and verbal request by the field or local
health officer.
Three thousand and three hundred and eighty-nine written orders
have been prepared and issued during the year. Two thousand eight
hundred and fifty of them were issued as the direct result of inves-
tigations on water-sheds by the division field officers, and all but one
hundred and sixty-seven of the menaces were found existing on
drainage areas feeding public water supplies. They are more fully
reported elsewhere herein. The remaining five hundred and thirty-
nine written orders were of a miscellaneous character reported, in a
large majority of the cases, by the local health officers who served
30_16— 1907
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4M 8EO0ND ANN.UAL. REPORT OF THE Off. I>oc.
the notices. Many of the other notices were also served by the local
health officers under the supervision of the Department's field offi-
cers.
Drafting.
The mai>-making force was limited to one man up to the latter
part of May, except when assistant engineers and field officers may
have temporarily engaged in the preparation of plans in connection
with work to which they were specifically assigned. After June first,
the force varied from three to eight men. In the latter part of June
four rooms on the fifth fioor of the Capitol were secured and they
have since been used by draftsmen of the Department engaged in
map making.
During the year maps of forty different counties, each showing
townships, boroughs, cities, postoffices, villages, railroads, street car
lines and streams, have been prepared with care. They are to serve
as a basis for general reference and more particularly as a founda-
tion for future map making of districts within the county. The uni-
form scale of these maps is three miles to one inch.
An atlas of health officer districts was compiled. The atlas com-
prises sixty-six sheets, a county to each sheet. On each map is
shown the county and township lines, the location of boroughs and
cities and the boundaries of the sanitary districts, there being in all
seven hundred and thirty-three such districts. Each district is desig-
nated by a number on the sheet. There are three copies of this
atlas in daily use in the Department.
In this connection a book was prepared and is kept up to date
by counties, showing the number of each sanitary district in the
county, the area thereof, the cities, boroughs, first and second class
townships, and the x>opulation of each included in this district.
These max>s are drawn to a scale of three miles to one inch.
Special inspection of the sources of water supply to the railroads,
the stations, yards, shops and water in places thereof throughout the
Commonwealth has necessitated the drawing of special maps of
these places and the source. One hundred and fifty maps, each sheet
forty-five inches long by twenty-five inches wide, have been com-
piled from the United States Topographical sheets and from various
other sources and arranged into three folios. On a scale of one inch
equal one mile, these maps show boroughs, township and county
lines, villages, post-offices, streams and the railroads. On each map
will be put the location of springs, wells, streams, which are the
sources of water supply to the railroads, and the location of the
water pipes, reservoirs and tanks, pump houses and standpipes.
In connection with and to facilitate the work of a sanitary survey
of the sources of major pollutions on the watersheds of the Alle-
gheny river and the Monongahela river in Pennsylvania, a map of
each basin has been prepared and copies thereof have been sup-
plied to the officers in charge of field work in these districts. This
is also true with respect to the watersheds of the Beaver River,
Perkiomen Greek, Tacony Creek and Gulf Creek and also with re-
spect to the watershed of Conodoguinet Creek, above the intake of
the Carlisle water works, Conocheague Creek above Chambersburg
water works intake, and Crum Creek above the Springfield Water
Coijipany's intake.
Digitized by VjOOQIC
No. 16. C0MMIS6I0NSR OP KBALTH. 4<7
Special inspection of the water sheds furnishing the supply to
Lebanon, Beading and Huntingdon have necessitated the making of
maps in the upper Gonestoga basin in Lebanon and Berks county,
and plans of the water sheds of Burnhart and Egelman near Bead-
ing, and Sandstone Creek near Huntingdon.
To facilitate the work of a stream pollution in£x>ection for the
abatement of every nuisance and menace, detailed township maps
have been prepared in folio form covering all the territory of the
watersheds yielding a supply of water to the public in the following
places, namely the cities of Lancaster, New Oastle, Beading and York
and the borough of Selins Orove; and the streams named in their
respective order are Gonestoga Creek, comprised in a 16 sheet folio;
Shenango Biver, comprised in a 38 sheet folio; Maiden Creek, com-
prised in a 14 sheet folio; Penns Creek, comprised in a 17 sheet folio;
and Codorus Creek comprised in an 18 sheet folio.
■Some miscellaneous map making in connection with pollutions
along Harveys Lake, in connection with typhoid outbreaks at Frank-
lin^ Lititz and Manheim, and in connection with the consideration of
sanitary problems of the central poor district in Luzerne county, the
pollution of Quittapahilla Creek near the city of Lebanon has all
told required the expenditure of not a little time.
For maps made in connection with Mt. Alto work and the sanitary
survey at Mt. Gretna reference may be had to the special reports.
III. ENGINEEBING.
The review of plans of projMXsed sewerage and water works sys-
tems, and of extensions to existing systems, and the making of in-
vetigations and reports in relation thereto has been an important
part of the work performed by the Engineering Division.
There were two hundred and thirty-six sewerage and water works
applications received during the year, of which one hundred and
sixty-five i)ertained to sewers and seventy-one to water works. Of
the sewerage applications seventeen were received from private
sources and the remaining one hundred and forty-eight were sent
in by municipalities. Of the water works applications, fifty-five
were submitted by private corporations and sixteen by municipali-
ties.
The sewerage applications may be classified as follows: Sixty-
eight for separate systems for sewage only, 71 for combined systems
to receive both sewage and storm water and 26 for sewage disposal
works.
The applications for sewage disposal plants arranged in order by
dates are given below:
1. Warren State Hospital, Warren county.
2. GreenvlUe, Mercer county.
3. State Hospital for Insane, Danville, Montour county.
4. Mt. Carmel, Northumberland county.
5. State Hospital for Insane, Polk, Venango county.
6. Oxford Drainage Company, New Oxford, Adams county.
7. New Oastle, Beaver county.
8. Bureau of Filtration, Pittsburgh, Allegheny county.
9. Bristol, Bucks county.
10. Bast Mauch Chunk, Carbon county.
11. Saint Maxys, Elk county.
12. Chambersburg, Franklin county.
18. York, Tork county.
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4W SECOND ANNUAL, REPORT OF THE Off. Doc.
U. Village of Palmertonp (N. J. Zinc Company), Carbon county.
16. Northumberland, Northumberland county.
16. New Wilmington, Lawrence county.
17. Chambersburg, Franklin county.
18. Carlisle, Cumberland county.
19. New Wilmington, (Revised Plans,) Lawrence county.
20. Indiana, Indiana county.
21. Allegheny City Home, Allegheny county.
22. Derry, Westmoreland county.
23. Presbyterian Home, Devon, Chester county.
24. Osborne, Allegheny county.
26. Aliquippa, Beaver county.
26. Indiana, Indiana county.
The water works applications may be classified as follows:
Twenty-four for ground water sources, and 47 for surface sources
in 11 cases of which the plans provided for purification by filtra-
tion of the surface source and in six additional instances the surface
water was being filtered at the time application for extensions were
made namely in the case of the Home Water Company of Spring
City and Royersford, the Bethlehem City Water Company of South
Bethlehem, the Sunbury Water Company of Sunbury, the New Ches-
ter Water Company to supply Eddystone borough via the Ridley
Water Company, the New Chester Water Company for the supply
to Marcus Hook, and the Armstrong Water Company at Wickboro.
The applications for water filtration plants arranged in order of
date of receipt are given below :
1. McKeesport, Allegheny county.
2. Hummelstown Consolidated Water Company, Dauphin county.
3. Cambridge Springs, Crawford county.
4. Tarentum Water Company, Allegheny county.
6. Lancaster, Lancaster county.
6. Steel ton, Dauphin county.
7. Dauphin Consolidated Water Supply Company, (E^nola,) Cumberland
county.
8. Venango Water Company, Franklin, Venango county.
9. Ridgway, Elk county.
10. York Water Company, York county.
U. Hummelstown Consolidated Water Company, second application.
Of 236 applications received daring the year, 155 have been ex-
amined and reported upon besides 31 applications left over from
1906, making a total of 186 applications investigated and reported
upon during the year. In 111 cases conclusions have been reached
and a permit or decree duly issued by the Commissioner of Health.
Of the 111 cases, 25 related to water works and 86 to sewerage
and disposal works.
With respect to water works decrees, 17 embraced surface sources
of which in 11 cases adequate purification by filtration was required
and 8 embraced ground sources. The 11 caaes where filtration was
required are stated below in order of issuance.
1. Lebanon City on 1906 application.
2. Warren Water Company of Warren borough.
8. BUwood Water Company of Sllwood City boroufirh.
4. Clymer Water Company of Indiana borough.
6. Ridgway borough, Elk county.
The remaining cases were those of McKeesport, Cambridge
Springs, Hummelstown, Tarentum, Steelton and Franklin, men-
tioned in the above list of 1907 applications.
With respect to the sewerage decrees, 19 involved sewage dis-
posal works and the other 67 related to sewers and ultimate treat-
ment plants as more fully hereinafter appears. The Presbyterian
Digitized by VjOOQIC
Nt>. 16. COMMISSIONER OF HEALTH. 469
Home application for sewage disposal was dismissed. Sewage dis-
posal applications in nine instances are pending, namely, Nos. 1, 3,
4, 7, 15. 16, 19, 22 and 26 in the above table.
A brief summary of the applications! received and acted upon
relative to water works and sewerage since the inauguration of the
Dei)artment is given below:
Applications received in 1905 and 1906 156
Applications received In 1907, 2S6
Total 391
Applications acted upon in 1905 and 1906 74
Applications acted upon in 1907 159
Total, 233
There were 154 applications x>ending at the close of 1907, 4 having
been dismissed. Fifty-six of them were water and ninety-eight sew-
erage and disposal applications. Twenty-seven of the water works
and forty of the sewerage applications were investigated, leaving 87
to be investigated.
The 391 applications comprise 105 water works and 286 sewerage
systems. Two hundred and fifty-three of the latter were municipal
plants and 33 private works, and of the former 82 were owned by
private and 23 by municipal corporations. It may be interesting to
note that 35 of the water applications concerned ground sources and
70 concerned surface sources, in 7 instances of which the water was
being filtered and in 13 cases new filters were contemplated. Also
with respect to the sewerage applications, 107 related to separate
sewers, 130 to combined sewers, 9 to separate and combined and 40
to disposal works.
So it appears that plans for 20 water filters and 40 sewage treat-
ment plants have been considered and passed upon, or will engage
the attention of the Department at an early date.
WATER WORKS.
Water Works Permits and Decrees Issued by the Commissioner of
Health up to January 1st, 1907.
This work has been done under Act 182 approved April 22nd,
1905. The law is entitled "An act to preserve the purity of the
waters of the State for the protection of the public health." The
term "waters of the State" is defined to include all streams and
springs, and all bodies of surface and of gro md water, whether nat-
ural or artificial within the boundaries of the State.
Acting under this law which prescribed that no water works for
the supply of water to the public shall be constructed or extended
or an additional surce of supply be secured, without a written per-
mit to be obtained from the Oommissioner of Health, the scope of
inquiry in each case has been strictly confined to whether the supply
be prejudicial to public health.
The virgin waters of the State are pure. They gather in their
devious courses on or below the surface of the ground foreign mat-
ter, oft times of a poisonous character, To preserve the purity abso-
470 SECOND AKNUAX. RBPORT OF THB Off. Doc
lutely is impossible, but approximations may be acbieyed. The
results frequently concern the removal of impurities injurious to
public health under conditions demanding continual superrision by
the State.
Precedent to judgment in any particular case, the full informa-
tion as to the source of supply and capacity the manner of collection
and the means of distribution, is indispensable; with respect to the
source, principally as to danger to be guarded against and means
necessary for protection; with respect to capacity, because, besides
other reasons, where a supply be altogether good and limited, con-
sumers may be compelled by shortage to have frequent recourse to
private wells and neighborhood springs in close proximity to and
polluted by cesspool or privy drainage or other sewage contamina-
tion, or because recourse may be frequently had to a x>olluted stream
as the supplementary supply and thus spread disease in the town —
conditions which the law does not contemplate the State authorities
should overlook or sanction; with resx)ect to details, because, besides
other reasons, the interests of the public health require that ample
facilities for quick drainage or shutting off of any infection in any
part of the system shall be provided, or where a filter may amply
purify a water in ordinary times, during a Are the speeding up may
be at a rate entirely beyond the purifying capacity and thus sewage
water may be introduced into town, or direct recourse may be had
to raw creek water for emergencies.
In connection with the subject, it may be imi>ortant to know
about the private wells and springs in the town.
For the dissemination of information, the i>ermits set forth quite
fully the local situation leading up to the conditions under which
an additional source of supply or an extension to existing water
works will not be prejudicial to public health.
The stipulations refer to provision for removal of sources of pollu-
tion, protective measures such as sanitary i>atrol of water sheds and
reports thereof, efficient operation of purification works, remedial
measures to be adopted by approval or advice of the Commissioner
of Health in case the supply or any part of the water works system
becomes prejudicial to the public health and other matters, all ap-
pearing in the various cases herein set forth in full and arranged
alphabetically.
BADEN, BEAVBR COUNTY.
This application was made by the borough of Baden, Beaver county, and is
for permlBBion to install a municipal water works plant for the supply of water
to the public in said borou£rh.
It appears that Baden borough is a residential community of about five hun-
dred citizens, located on the east bank of the Ohio River, in the southeast
part of Beaver county, twenty miles below Pittsburg and about five miles above
Rochester, where the Beaver River enters the Ohio River.
While the municipal boundaries are one and twenty-flve hundredths square
miles, only a small part of the incorporated territory is built up. Most of the
area is under cultivation. Paralleling the river and east of it about two thou-
sand feet is a ridge elevated about two hundred and sixty feet above the valley
and extending throughout the borough, and on the slope from the summit to
the banks of the Ohio and immediately south of a stream called Tevebaugh Run
is the village. The main line of the Pittsburg, Fort Wayne and Chicago division
of the Pennsylvania Railroad system passes along the railroad bank through
the town. The bank is forty feet in height and twice in twenty years, once
in eighteen hundred and eighty-four and the last time in March nineteen hun-
dred and seven, the freshet flow reached the railroad tracks and submerged
them.
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Nx>. 16. COMMISeiONBR OF HEALTH. 471
Ju8t east of the railroad is the Ohio valley thoroughfare known as State Road.
It was orifflnally laid out by the Qovernment from Pittsburg westerly. In this
highway the Pittsburg Railways Company is now laying its trolley line from
the Beaver Valley through Baden to connect with the Pittsburg lines. The
purchase price of the Baden borough franchise for this trolley right of way
was twenty- five thousand dollars cash and other considerations. The cash has
been set aside to defray the cost of the municipal water works plant.
Tevebaugh Run rises in the uplands east of the ridge and flows down for a
distance of about three miles » draining a farming district and natural gas and
oil fields and passing through the ridge In a deep valley to the river. The other
runs in the borough do not have channels through the ridge but rise at the
summit thereof.
There are outcroppings of the Kittanning vein of coal in the borough and
there are also strata of fire clay. The dip is toward the Ohio and above the
impervious layers numerous springs appear. This source of drinking water is
availed of by some of Baden's citizens.
At the present time the inhabitants derive their drinking water from dug
wells » cisterns and springs located on individual properties.
The top soil is not well adapted to percolation. This accounts for the few
cesspools there. Kitchen water is usually disposed of onto the surface of the
ground » or drained to street gutters. Excrement is placed in privy vaults which
are holes dug in the ground. As soon as one vault becomes filled, the super-
structure may be moved therefrom and located over a hole. The dug well
supply and some of the springs are suspicious on this account. Any perco-
lation from soil pollution sources is liable to reach the shallow dug wells and
the springs If the latter be at the lower elevation. There are a few private
sewers, but a privy vault exists on most every property. It Is evident that both
public water works and sewerage are desired as public health precautions.
The desire on the part of the residents for modern plumbing facilities in
their dwellings, and the necessity of these things to promote the development
of the borough and its best sanitary welfare, is set forth by the petitioners as
suflBicient reason why the application should receive favorable consideration.
It appears that a rapid development is reasonably anticipated. Across the
river, for several miles along the banks, are being erected enormous steel plants
which afford employment to thousands of men. A charter for a river bridge
connecting Baden with the opposite shore has recently been granted by the
Commonwealth, and this increased facility for public highway travel, together
with the Industrial boom in the district, seems to assure a rapid growth for
Baden. This argues in favor of the installation of some other water supply
than the private dug wells and springs above referred to.
A public sewerage system is also contemplated and plans therefor are now
before the Commissioner of Health for approval.
The source of supply of the proposed municipal water works plant is a series
of driven wells located in the gravel shore of the river in the lower part of the
borough at the mouth of Tevebaugh Run.
The water is to be drawn from the wells and forced through the street pipe
system into a standplpe to be located on the ridge in the borough from whence
it is to flow by gravity to the town.
The plans provide for a pipe in every street in the borough. The pipes are to
range in size from four inches to eight inches in diameter, and there is to bA
about one mile of four inch, six inch and eight inch pipe respectively. The
eight inch pipe leads from the pump house to the stand pipe on the hill. The
water is to be pumped into the street system, the overflow being into the tank.
Fire hydrants are to be placed at convenient points about the town. A blow-
off is provided at the pump house. All but a small part of the pipe system will
be drained thereby.
The stand pipe is to be constructed of steel and is to be twenty-three feet in
diameter and twenty feet high. The thickness of the shell will admit of in-
creased height if this should prove desirable in the future.
The pump house is to be located on the river bank west of the railroad at the
foot of Liessing Street. As hereinbefore stated, twice in twenty years high
water has reached this point. The station is to be of brick forty feet long by
thirty feet wide, resting on a concrete foundation and a brick pump chamber,
the latter being flfteen feet in diameter and twenty-eight feet deep.
This chamber is to rest on a concrete foundation, three feet in thickness and
is to be made water tight; but at its bottom, which the plans provide shall be
elevated three feet above the nine foot stage of the river, is to be a drain for
the removal of any water in the chamber at times when the stage of the river
may be below said chamber. There is a check valve provided on the drain
and also a small centrifugal pump for the purpose of freeing the chamber of
any water which may enter it when the river is high.
In the engine house is to be Installed a thirty- five horse power gas engine,
and in the pump chamber one single acting triplex deep well pumping engine,
having a daily capacity of four hundred and fifty thousand gallons. There is
room for duplicate installation.
A twelve inch suction pipe extends from the pump well to the driven wells
nearby. Six eight inch wells have been driven on the river bar to a depth of
twenty feet and have been connected up to the main suction. The casing of
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472 SECOND ANNUAL. REPORT OP THE Off. Doc
each well is eight inches In diameter, the lower five feet are perforated with
three- fourth Inch holes and the pipe has been driven through fifteen feet of
gravel and sand, two feet of river hardpan and into two feet of water bearing
gravel below. On top of each casing is screwed a cap through which a four
inch suction pipe is inserted to within one foot of the bottom of the casing pipe.
This vertical suction is connected to the horizontal suction main in the usual
manner. The space between the four inch pipe and. the rim of the opening in
the casing cap is made securely tight by soft leading packing.
The wells have been tested to a capacity of about one hundred gallons per
minute each and during this pumping test the water level in the well nearest
the pump was lowered about one foot only. Ordinarily, when the river is in a
low stage, the water stands in each well at a hight slightly above the river.
The top of the main suction and hence all of the piping is buried at least three
feet below the bed of the river channel in compliance with the regulation of the
Federal Government of whom a permit was first obtained. At the present
time the main is froto one to two feet below the river level during the low
BtAge season, but when dam Number Five which is being constructed by the
Federal Government in the river at Freedom four miles below, and is a col-
lapsible dam, is put in commission, which will be during the latter part of
the current year, all of the piping will be permanently submerged about eight
feet beiow the river level. Dam Number Six which is five miles below dam
Number Five, and below the Beaver River, has been in operation for a number
of years and it is reported that the river stage has been such during this time
that the dam which is also collapsible has been down approximately fifty per
cent, of the time.
Detail plans of the pumping station, wells and appurtenances and of the
stand pipe have not been submitted to or filed in the State Department of
Health.
It is reported by the local authorities that the well water proves to be soft
and always clear, regardless of the sediment in the river water, and that it is
desirable for drinking purposes. The supply is abundant and there seems to be
no local reason why the quality thereof should not be equal to that of other
municipal supplies obtained in a similar manner along the Ohio River. Never-
theless, the fact should not be overlooked that so long as the Ohio River receives
the sewage of the cities and towns above Baden, there will always be a
possibility of serious pollution of the subterranean stream from which the
borough's supply is to be drawn. A natural impervious roof separates the sur-
face from the subsurface stream and if this roof remain impervious or its
integrity be not disturbed, the subterranean waters may be reasonably safe.
Even in this case the manner of drawing this underground supply which un-
doubtedly is fed frofm the river itself to a greater or less extent, and the
apparatus used therefor must receive constcmt and vigilent supervision, but
who shall say that a break or fault does not exist or may not occur by means
of which the public water supply may be poisoned.
It is the bounden duty of the public authorities to safeguard the proposed
supply in so far as they may have Jurisdiction to do so. The State Department
of Health is undertaking to bring about the final discontinance of the discharge
of sewage into the Ohio River or its tributaries above Baden. There is one
public sewer in the borough and several private ones now emptying their con-
tents into the river at points ranging from one thousand to four thousand feet
above the driven wells. After the pool formed by dam Number B^ve is created,
the danger of percolation of surface water befouled by this sewage through
leaky Joints into the town's supply will be increased. If the borough's sewer
plans are carried out the nearest sources of danger will be removed, and it
will be many years before the gross pollution of the Ohio by up stream munici-
pal sewage will have been materially reduced.
It appears that every precaution has been taken In the design and construc-
tion of the wells to safeguard the public health. Ehccepting a filtration plant,
nothing remains to be suggested other than careful and regular inspections of
the driven well system of piping. These inspections should be a matter of
official record and should be reported to the State Department of Health.
Tevebaugh Run is not a suitable source of supply, and the Department is not
informed of any other source available within the borough's financial resources.
Neither can the borough aftord to install a filter plant. This, however, should
be done as soon in the future as the municipal finances will permit, more as a
cheap and desirable insurance against infection, than of necessity so far as the
quality of the supply may be revealed by bacteriological tests.
Regular samplings of the well water should be made by the borough authori-
ties and sent to the laboratories of the State Department of Health. At least
ozM sample should be collected weekly.
It has been determined that the proposed source of supply and the water
works system will not be prejudicial to the public health, and a permit is
hereby and herein granted therefor, under the following conditions and stipula-
tions:
FIRST: That complete plans of the wells, pumping station, stand-pipe and
showing all valves, piping, machinery, etc., shall be prepared and filed by
the borough In the State Department of Health within sixty days of the date
of this permit.
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No. 16. C0MMIS8I0NBR OF HEALTH. 473
SECOND: That at the close of the seaaon'a work, the borough shall file
a plan of the water pipes laid durln^r the season, together with any other
information in relation thereto that may be required by the State Department
of Health.
THIRD: Regular reports of the operation of the plant, including inspection
of aU piping and apputenances of the driven well system shall be made on
blank forms to be provided by the State Department of Health.
FOURTH: The borough shall regularly and at such times as requested by
the State Department of Health, collect samples of the well water and express
them to the State laboratories for tests, but these tests shall not relieve the
borough authorities from the responsibility of supplying a pure and wholesome
water to the public within the borough. Dally examinations shall be made by
the local authorities of the well water and if at any time such water c^ppears
to be even slightly cloudy or discolored, thereupon, forthwith, notice shall be
served upon the water consumers to boil the water.
FIFTH: If at any time in the opinion of the Commissioner of Health the
source of supply shall have become prejudicial to the public health, then the
borough shall adopt such remedial measures as the Commissioner of Health
may suggest, advise or approve.
Harrisburg, Pa., July 23, 1907.
BETHLEHEM, NORTHAMPTON COUNTY.
This application was made by the Board of Water Commissioners of the
borough of Bethlehem, Northampton county, and is for advice relative to
obtaining a new source of supply from the Delaware River and on three
specific matters as follows:
"First, is it iwssible for a water company to be formed and chartered by
the State in which the charter stock-holders are various contiguous munici-
palities? In other words, can municipalities combine to form a water com-
pany, thus retaining the municipal ownership, increasing consumption, and
decreasing cost?"
"Second, does the seven per cent, limit of bonded indebtedness apply to
water bonds? That Is, since water bonds represent productive property, in
the case of Bethlehem, a large profit— are they not separate from the bonded
indebtedness of the borough, and should not the borough, therefore, have the
right to its indebtedness for water purposes under different debt regulations
from those applying to bonds that are laid against non-productive property like
streets and borough houses?"
"Third, what do you think of the Delaware scheme as outlined? Have you
any suggestion to offer that may assist us in tackling the problem?"
It appears that the borough of Bethlehem is located on the north bank of
the Lehigh River opposite South Bethlehem and about five miles below Allen-
town and about twelve miles above where the Lehigh empties into the DelaY^are
River.
The municipality includes what was formerly the borough of West Bethle-
hem, Lehigh county. In the year one thousand nine hundred, Bethlehem
proper had a population of seven thousand two hundred and ninety-three and
West Bethlehem three thousand four hundred and sixty-five. Now the com-
bined population is estimated to be sixteen thousand, an increase of about five
thousand or nearly fifty per cent, in seven years. This increase is attributable
to the growth of iron, steel and cement manufactories and allied industrial
activity in the vicinity of the Bethlehems.
West Bethlehem is mostly a residential section of the town located on a
bluff with the Lehigh River at its south base and the Monocacy Creek at its
east base forming the boundary line between Lehigh and Northampton counties
and the physical division between Bethlehem and West Bethlehem. Bethlehem
proper is on a hillside, the principal part being an elevated plateau, the drain-
age principally into the creek.
There are no sewers in the borough, but there are reported to be storm drains.
The custom prevails of drilling a hole into the underlying limestone rock on
each individual estate and despositing sewage therein. The liquid fiows away
through crevices.
The old town is historical and aristocratic in appearance. Street improve-
ments have been extensive. In the year one thousand nine hundred and six,
the assessed valuation of Bethlehem proper was four and a quarter million
dollars and for the entire borough six million dollars. The bonded indebtedness
is reported to be two hundred and thirty- six thousand three hundred dollars.
If this be true, the borrowing capacity of the municipality does not exceed
one hundred and eighty- four thousand dollars on this basis.
The surface of the public water supply in Bethlehem proper is a spring in
the Monocacy Creek valley. West Bethlehem is supplied by a private water
company. The Bethlehem plant is owned by the town. The spring is within
the borough limits, water is pumped therefrom against a head of about two
hundred feet to two stand-pipes located on the same lot side by side, frota
wbic^ the water fiows by gravity through the street mains. The plaut was
Digitized by VjOOQIC
474 SECOND ANNUAL RBPORT QP THE Off. Doc
purchased by the town in the year one thousand el^ht hundred and seventy-
two. Originally established in the year one thousand seven hundred and sixty-
one, the system is said to be the second oldest public water works in the
United States. Since the year one thousand eight hundred and seventy-two,
the borough has installed improved machinery , stand-pipes and cast Iron street
Tlie daily consumption is about one million two hundred thousand gallons
and is delivered to the stand-pipes by a Deane compound single-acting pump-
ing engine which was installed in the year one thousand eight hundred and
eighty-nine. The old Worthington pump installed in the year one thousand
eight hundred and seventy-three is kept for emergencies. Both pumps are
much worn and liable to a breakdown at any time. The stand-pipes are
circular, built of iron, one being twenty-four feet in diameter by forty feet
high and the other fifty feet In diameter by fifty feet high. They are located
at the highest point in the municipality. There are dwellings in the immediate
vicinity. TTie pressure when the tanks are full varies from eighty pounds in
the lower to about twenty pounds in the higher districts. Plans of the system
have not been filed with the Department and, therefore, details with respect
to the service are not known to the State at the present time, but it appears
that the pressure is not satisfactory for fire service nor for domestic service in
the higher parts of the town. The mills are located along the river at the foot
of the bluff between the canal and the river. They are operated by water
power supplied by the canal which is owned by the Lehigh Coal and Navigation
Colmpany. The silk mills are in the valley of the Monocacy Creek above the
water works plant. These industries are all west of the creek and hence do
not make demands upon the town's supply. The daily consumption, therefore,
of one million two hundred thousand gallons is for domestic use only. Service
taps are metered.
The spring from which the supply is taken is located at the foot of the bluff
on which the business part of the town is built, about twenty-five feet back
from Mill Race and one hundred feet from the creek. The spring is a fiowing
one, is walled up, housed over and delivers water by gravity to the pumping
station, located about two hundred feet down stream. The supply is nearly
exhausted daily. An emergency intake pipe is provided whereby raw creek
water may be pumped into the system.
The pumping engines are operated on an average of twelve hours daily.
The limestone deposit from which the spring issues is said to have Its strike
north and south and pitches in such a way as to premit house drainage from
West Bethlehem to find its way towards the spring. In fact, subterranean con-
nections may be so extensive that an opening up of direct communicatiofci
between the fissures which receive the town sewage and those supplying the
spring might happen at any time. At one time the Water Board made an
attempt to obtain more water by sinking a well between the spring and the
pump house. This well was drilled three hundred feet deep and water was
obtained in abundance, but the quality was so inferior that it could not be
used for drinking purposes.
Out of twenty-nine samples oC water taken from the existing spring and
tested during the year one thousand nine hundred and six and up to date in
the year one thousand nine hundred and seven, coll communis were present in
twelve samples or forty-one per cent, of the time and in sufficient numbers to
indicate sewage contamination calling for remedial measures.
Such records as the Department has for ready reference do not show the
prevalence of typhoid fever In Bethlehem in excess of that of surrounding
municipalities. In the year one thousand nine hundred and three, the disease
was epidemic in all of the Bethlehems. Because an epidemic has not occurred
among the users of the spring water is no reason why the Bethlehem spring
should be considered a safe source. The risk run by the borough's consumers
involves such grrave consequences, that there is but one position which the
State can assume relative to the supply, namely, that it is dangerous and
should be abandoned unless the water be filtered.
West Bethlehem's supply is wholly furnished by the Bethlehem City Water
Company of South Bethlehem. The water is taken from the Lehigh River and
filtered. The filter plant was installed and put in operation during the year
one thousand nine hundred and five to prevent occurrences of typhoid fever
epidemic which in times past have been attributed to the sewage pollution of
the river.
The pump house and filters are in Fountain Hill borough. The company sup-
plies this borough of fifteen hundred population, which is a suburb of South
Bethlehem; South Bethlehem, population fifteen thousand, Northampton
Heights borough, fifteen hundred population, the suburb to the east, and on
the opposite side of the river West Bethlehem, five thousand population, and
the villages of Rittersville and "Bast Allen town, combined population two thou-
sand, making in all, twenty-five thousand people, supplied by this system.
It is reported that further increase of valuations in taxable property have
been made this spring and that Bethlehem borough may find that its borrow-
ing capacity is in the neighborhood dt two hundred thousand dollars. The
receipts from the water works are about sixteen thousand dollars per annum
and the expenditures nine thousand dollars, leaving a net income of seven
Digitized by VjOOQIC
Kt>. 16. COMMISSIOKB^R OP HEALTH. 475
thouBand dollars which is turned into the borough treasury for current ex-
penditures. Since there is no law in Pennsylvania which exempts productive
municipal water works froim the action of the constitutional debt limit, it is
plainly evident that even if the borough of Bethlehem should so improve its
water works property as to make it capable of earning interest and sinking
fund charges, upon a capital investment of half a million dollars, yet the
municipality could not legally guarantee investment bonds for more than two
hundred thonisand dollars, if this amount were the constitutional limit of its
indebtedness. However, such earning capacity if pledged by the municipal
authorities as security for payment of the purchase of water by wholesale from
a private corporation making the capital investment of half a million dollars
for water supply purposes might be legally a.ccomplished and in this way enable
the borough to secure an adequate supply of pure water.
If the borough purposes to construct its own works, then it is limited to an
expenditure of not over two htmdred thousand dollars and probably less.
There is legislation, which if approved will enable municipalities to purchase
private water works systems and for the payment thereof to issue bonds
guaranteed wholly and solely on the water works plant as security. TTie pay-
ment of such a debt can in no way become an obligation upon the general tax
levy, thus operation to exempt such municipal water works bonds from the
constitutional indebtedness.
With respect to the Delaware River, it may be said that It is a superior
source of surface water supply. The waters are soft, clear and subject to
little pollution especially above Martin's Creek which is about seven miles above
Baston. The project submitted for consideration comprises a plain sand filter
plant, pumping station and ten and five-tenths miles of rising main to a
storage reservoir on Quaker Hill three hundred and forty feet above the river,
and a gravity supply main from this reservoir to the town distant three and
twenty-five hundreths miles. The estimated cost of the project is five hundred
and thirty-five thousand dollars, itemized as follows: Intake, pumps and filter
plant, one hundred and sixteen thousand dollars, main station and rising main,
two hundred and thirty thousand dollars; reservoir and supply main, one
hundred and nineteen thousand dollars; engineering and contingencies seventy
thousand dollars, a total of five hundred and thirty-five thousand dollars.
The rates at present produce an annual income of about sixteen thousand
dollars. There are said to be nine thousand water takers, which is equivalent
to a per capita revenue of about one dollar and eight cents. As stated in the
borough's report, the average per capita income from American municipally
owned systems is about two dollars and fifty cents, and in many cities between
three and four dollars, so it is argued that if greater revenues are necessary
to secure a larger and better water supply, the rates could be properly raised
to at least three dollars per capita. If this were done this would increase the
use of water and hence substantially increase the revenues. Ample fire service
would Justify higher rates, and it is possible if the municipal system were
extended into that pait of the borough called West Bethlehem now supplied by
the private water company, that further increase in revenues would obtain.
It is quite safe to assume, however, that for the first few years the total
receipts would be insufiScient to make the investment in the Delaware river
scheme a profitable one were the enterprise promoted by the municipality.
It has been represented that the city of AUentown stands in need of an
abundant supply of soft and unqualifiedly pure water, and since this city owns
its own water works, provided the municipalities of AUentown and Bethlehem
were to build Joint works with the Delaware river as the source, the per
capita cost would be so reduced as to bring the project within the means of
each place. As a municipal undertaking however, it is not possible under the
laws of Pennsylvania, for a water company to be formed in which the stock-
holders are various contiguous municipalities. An act authorizing municipali-
ties to issue bonds secured by municipal water systems failed of passage at the
present legislative session of the General Assembly.
The field, however, it wortb looking over by capitalists who might care to
supply filtered Delaware water wholesale under conditions mutually satisfac-
tory to all concerned.
At one time, Bethlehem led the country in public water works. Conditions
have changed, the present source is dangerous and Insufllcient and a remedy
is derianded. The solution of the problem is limited, as above described, to
private enterprise or to the consideration of municipal projects whose cost shall
not exceed the borough's borrowing capacity.
It is possible for Bethlehem to buy water of the Bethlehem City Water
Company. It is also possible for the borough to filter Lehigh river water, its
present supply, Monocacy Creek water or other surface sources. It is also
possible that an additional ground water supply might be obtained. These are
lubjects which should receive the special study of the borough authorities and
the Department of Health will be glad to review the conclusions when the
borough shall have formed some definite idea of what it purposes to do. The
State cannot take the initiative in working out local problems. Its province is
to advise and approve plans worked out in detail by the municipality.
Digitized by VjOOQIC
476 SEC50ND ANNUAL REPORT OP THB Off. Dpo.
It has been determined that the present source of supply of water to the
public In Bethlehem Is prejudicial to the public health, and, therefore, the
Board of Water Commissioners Is apprised of the danger to the public accom-
panying the use of the existing source of supply, and said Water Commission-
ers are hereby advised and requested to prepare and submit to the State Health
Department for consideration a plan or plans for the supplying of pure water
to the public, which plans should be submitted on or before September first, one
thousand nine hundred and seven. Also that on or before September first, one
thousand nine hundred and seven, the borough shall comply with the law requir-
ing the filing with the Department of plans and a report relative to Its existing
system of water works.
H&rrlsburg, Pa., May 27th, 1907.
BRADFORD, McKBAN COUNTY.
This application was made by the city of Bradford, McKean county, and is
for permission to extend and improve Its water works system by the construc-
tion of a distributing reservoir with necessary connections.
It appears that plans for the proposed reservoir were submitted to and
approved by the Conunissloner of Health on April twenty- ninth, nineteen hun-
dred and seven under the following conditions:
"The Department understands that the source of supply is unpolluted and
that no precautionary measures are necessary to protect the supply from pollu-
tion. Approval of the plans, therefore, is given conditionally that If upon an
examination by the State Department It subsequently appears that precaution-
ary measures should be taken with respect to the sjrstem and the facilities by
which the water is delivered to the consumers, then such remedial measures
shall be adopted as the State Department of Health may approve. After an
examination by the State a formal approval will be issued relative to the entire
system."
Investigations were made and it appears that Bradford is a city of the third
class, having a population of fifteen thousand and twenty-nine in nineteen
hundred and now estimated to be over seventeen thousand, located In the
northern central part of McKean county about three miles from the State line
in the valley of Tunungawant Creek. The east branch of this stream which is
the larger rises in Lafayette township, and fiows down in a northerly direction
a distance of twelve miles adjoining the west branch in the central part of
Bradford city; whence the main stream continues in a northerly direction and
empties Into the Allegheny River in the State of New York at a point about
six miles north of the Pennsylvania line. The west branch rises in the edge
of Lafayette township and takes a northeasterly course through Bradford town-
ship to the city, traversing a distance of about seven miles.
In the forks on the flats is built the business section of Bradford. On the
lowlands abutting the main stream the Industries are located comprising among
others wooden ware manufacture, terra-cotta and brick works, a silk mill,
foundries and machine shops. The EJrie Railroad and the main line of the
Buffalo, Rochester and Pittsburg Railroad passes up the valley of the east
branch and local railroad lines exist in the valley of the west branch and its
tributaries.
In the city and country round about oil wells are in operation and the field
is a productive one though old.
A combined sewer system has its outlet into the main stream in the lower
part of the city.
It is reported that the city water works system is self supporting and that
the city Indebtedness does not exceed fifty-five thousand dollars. Also that the
assessed valuation of property is upwards of five million dollars which, If so,
leaves the city well off financially since its Sorrowing capacity inside of the
constitutional limit is in the neighborhood of three hundred thousand dollars.
According to information at hand, with the exception of possibly six hun-
dred and fifty people who obtain drinking water from wells and springs, the
entire population of Bradford city obtain their supply of water from the public
system. The plant comprises at present about twenty-two miles of street mains,
two Impounding reservoirs, one distributing reservoir, drilled wells, pumping
station and two lines of gravity supply mains to the town.
The surface supplies are derived from Gilbert and Marllla Brooks. The
reservoirs on them being located about five miles west of Bradford city. Gilbert
Brook fiows Into Marllla Brook and the latter Is a tributary of the west brancn
of Tunungawant Creek.
The ground supply is derived from six drilled wells located in the valley of
Marllla Brook Immediately below reservoir No. 3 on said brook. The
average depth of these wells is one hundred and fifty feet, the customary pre-
cautions were taken to prevent surface contamination, and the water drawn
from the water bearing strata of red sand rock while harder than the surface
supply, is reported to be satisfactory. It is pumped Into a small Intake reser-
voir constructed by means of a dam across Marllla Brook to serve the purpose
Digitized by VjOOQIC
Nt). 16. COMMISSIONER OP HEIALTH. 477
of a point of distribution of the water to the town. A fourteen Inch gravity
main be^ns here and extends to the city. The ground water supply has not
been used, so It Is reported, except during dry times.
The surface supply comes from a well timbered rolling uninhabited water
Bhed, and the city owns and controls about all of it. including the territory
from which the ground supplies appear to be derived. The city's possessions
aggregate about eight thousand acres.
Reservoir No. one is a small earth structure, capacity four and a half million
gallons, is two hundred and thirty-six feet above the elevation of the city and
is located to the side of Marilla Brook and serves the purpose of a distributing
basin.
Reservoir No. three is located on the brook about one-half mile above reser-
voir No. one and Is formed by the erection of a dam across the stream which
impounds one hundred and twenty million gallons. The high water mark is
three hundred and six feet above the city of Bradford. The ground supply
distributing basin is between reservoir No. one and No. three, and the four-
teen-inch gravity main from it also delivers water from reservoirs No. one and
three to the city, the connecting pipe to No. three being sixteen inches in
diameter.
Gilbert Brook comes down from the north and Joins Marilla Brook about
half a mile below reservoir No. one. Across Gilbert Brook, three thousand feet
above its mouth there is a dam constructed which forms reservoir number two,
and Impounds thirty-five million gallons. The high water mark of this basin
is two hundred and thirty-six feet above the city. An independent supply main
twelve inches in diameter extends down the valley to the fourteen-inch pipe
from the other supplies where It is connected by a valve and from whence the
two lines of pipe parallel each other in same trench to the city.
The sites of both impounding reservoirs were stripped of soil and organic
matter, have reasonably steep side slopes ajid small percentage of shallow
fiowage. The earthen dams seem to have been substantially constructed and are
efficiently maintained.
There are six and two- thirds square miles of water shed above dam number
two and five and one-quarter square miles above dam number three. The rail-
roads in each water shed are abandoned so that there is no source of pollution
of a permanent character to menace the supply. The city maintains a patrol-
man who devotes his entire time to care of the reservoirs and the water shed.
Notices against trespassing have been posted and a vigilent water is main-
tained to prevent accidental contamination.
During night times tlie normal pressure in Bradford is about eighty-eight
pounds, but this fluctuates during periods of greatest constmiption to as low as
forty pounds, so it is reported. The average daily consimiption is about one
million eight thousand gallons dally, which increases to a maximum of three
and eight- tenth millions. So it appears that the rate is about ninety-six gal-
lons per capita. The domestic consumption is unmetered but meters are put
on the industrial connections.
During August, September and October of nineteen hundred and six the
surface supplies augmented by the ground supply was Insufficient to meet the
demands on the systems so that the reserve stored in the reservoirs had to be
drawn upon and was nearly exhausted. It was only by restricted use of water
in tho city that a water famine was averted.
The proposed distributing reservoir is to be an open concrete structure,
capacity three and a half million gallons located on a side hill in the north-
western corner of the city at an elevation of two hundred and five feet above
the city and hence thirty-two feet below the elevation of reservoir number two
and one hundred and one feet below the elevation of reservoir number three.
The object of the improvement is to secure a better pressure in the city mains
and to furnish a steady water supply to those portions of the city which some-
times at present are without water. If the reservoir therefore, does not Improve
the domestic supply and afford better Are protection there will be dissatisfaction.
The State's advice was not asked with respect to the advisability of con-
structing the rtsen-oir at its present site.
Th*? basin is to have vertical concrete sides and be three hundred and four-
teen feet long by one hundred feet wide and have a depth of seventeen feet
to the top of the wall. The depth of water at the overflow line will be fifteen
feet. A division wall carried up to within a foot and a half of the flow line,
extends across the basin half way from the end walls, dividing it into two
equal compartments. The gate house is placed outside of the basin opposite
one end of the division wall. It too is divided into two compartments, one con-
taining the piping and valves for the admittance of water to the reservoir,
together with the main drain and overflow and the other compartment con-
taining pipes and valves for the distribution of the water to the town.
The water is to be delivered to the Inlet chamber through a fourteen-lnch
cast Iron main from reservoir number three about Ave miles distant Prom this
inlet compartment the water will then flow through a twelve-inch cast iron
pipe into either one of the two divisions of the distributing reservoir and l?^
delivered at the bottom near X^e genter.
Digitized by VjOOQIC
478 BB200ND ANNUAL RBPORT OF THB Oft. Doo.
The water will leave the reservoir at the bottom through eighteen-inch pipe*
having acreenf. on them and located at the gate house. These pipes are con-
nected up with a twenty-rour-mch cast iron main leading to the city.
The drainage of either compartment of the reservoir will be effected through
the twelve-inch cast iron pipes which are otherwise used for the Inlets. There
is a twelve-inch drain extending from the inlet chamber of the gate house to
Winter street and connected with this drain is a vertical twelve-inch overflow
pipe which will automatically prevent water from reaching a higher elevation
in the reservoir than that intended.
As above stated, the water is to flow from the outlet chamber through a
twenty-four inch gravity main to the city. There will be about one-half mile
of pipe of this diameter added to the street system and about an equal amount
of fourteen-inch supply main to the reservoir from the existing fourteen-inch
main at Barbour street
It is proposed to deliver water through the city mains to the consumers
simultaneously from the new distributing reservoir and from the twelve-Inch
and fourteen-inch gravity mains from the original source of supply, all being
connected to the city mains at the same time and constantly, in which event
the advantage of the new distributing reservoir will be that chiefly of storage
in the town. This will help equalize the pressure as anticipated and supply
water in those districts which now go dry in times of greatest consumption.
However, the degree of relief afforded will depend upon the abundance of the
supply at the source.
The quantity of water from the impounding reservoir and the driven wells
is not now sufficient to meet all demands in extreme dry periods, and the
distance of these sources from the town, together with the small diameters of
the two supply mains offers frictional resistance which reduces the quantity
of water which can be delivered to the high districts in the town to an in^
sufficient amount for short intervals even when there is an abundance of water
at the source.
While the new distributing reservoir will partly counteract the latter trouble,
yet because the reservoir is but little lower than the impounding basins of the
source, under the most favorable conditions where the town is to be cut off
and were the two supply mains to deliver their full capacity into the new
distributing reservoir, such delivery would be a quantity less than the maxi-
mum daily consumption of water in the city and very much less when the
conditions at the source were unfavoraUe.
Therefore, it is apparent with the sources inadequate to supply the town
always and gravity mains inadequate to deliver water fast enough to
furnish all portions of the city constantly that the distributing reservoir is not
the only immediate improvement demanded to the water works system. A
larger gravity main from the source to the new reservoir and the town is
needed provided enough water can be gathered from the existing sources to
warrant the expenditure. Otherwise a new source of supply should be sought,
and obtained to be used in conjunction with the distributing reservoir under con-
sideration.
It Is reported that the Water Commission has given some thought to the ad-
visabilty of seeking an additional source of supply on Lewis Run, a tributary
of the east branch of the Tunungawant Creek. This stream is about ten miles
south of Bradford City and were its waters impoimded, they could be delivered
by gravity probably to the new distributing reservoir in town so that this
structure which is estimated to cost sixty thousand dollars should be a valu-
able adjunct to the system of water works whatever tthe city may determine to
do about an additional supply.
Since an abundant supply of pure wholesome water is one of the prime requi-
sites of public health, and the city of Bradford is financially able to assume the
expense of securing such abundant supply, it would seem desirable that the lo-
cal authorities should take Immediate steps to safeguard the Interests of all
concerned by establishing adequate works for the supply of water to the publlo
to meet existing demands and future requirements,
In view of the foregoing considerations It has been determined that the pro-
posed Improvements to the water works system will not be prejudlclej to the
public health and permission is herein granted for the construction of the pro-
posed distributing reservoir under the following conditions and stipulations:
FIRST: That upon completion of the construction of the proposed distribu-
ting reservoir a full description of the same, its dimensions, valves, piping, in-
lets and outlets and proposed method of operation shall be prepared by the city
and filed with the Commissioner of Health together with plans of any changes
or alterations at variance with the plans already filed in the State Department
of Health by the city.
SEX:;OND: On or before January first, nineteen hundred and eight, the city
shall prepare and file with the State Department of Health plans and profiles of
the gravity supply mains to the town, showing, among other things, the blow-
offs and facilities for draining these pipes and the location of all gates and
valves on them, together with a plan of the street mains, showing the precise
location and dimensions of all facilities for the blowing off or drainage of the
system of street mains.
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Nt). 16. COMiaSSIONSR OF HBALTH. 479
THIRD: The city may extend the street mains from time to time as necessity
may require, but at the close of each season's work a plan shall be prepared
and filed with the Btate Department of Health showing such extensions made
durlner the year, together with any other information in connection therewith
which may be required by the Commissioner of Health,
FOURTH: If at any time in the opinion of the Commissioner of Health, the
source of public water supply has become unsuitable for such purposes, then
such remedial measures shall be adopted as the State Department of Health
may suggest or approve, and the city shall make out such reports of the in-
spections of its sources of supply and the operation of the water works system
as may be required by the Commissioner of Health on blank forms to be fur-
nished by the Department,
FIFTH: That before adopting any additional source of supply the local au-
thorities shall consult with the State Department of Health and submit plans
and a report for approval,
Harrisburg, Pa., June 19, 1907.
CAMBRIDGE SPRINGS, CRAWFORD COUNTY.
This application was made by the i5orougn of Cambridge Springs, Crawford
County, and is for permission to construct a filtration plant in connection with
its water works for the supply of water to the public within said borough.
The borough of Cambridge Springs, Crawford County, Pennsylvania, is lo-
cated on the banks of FYench Creek about ten miles north of Meadvllle, the
county seat. It has a winter population of about eighteen hundred, but the
summer population increases to possibly five thousand. Mineral springs In the
borough and vicinity having become extensively advertised, attract summer
guests who come to the resort to be rejuvlnated, and to enjoy the pleasures af-
forded by the popularity of the place and the accomodations of the variotis
first class hotels there.
The borough has a municipal water supply system and public sewerage. The
sewers empty into French Creek both above and below the point out of which
water is drawn from said creek to supply the borough. Because the creek is
polluted by the town's sewage the creek water is a dangerous source of public
supply. Since typhoid fever has been normal in the community, it is necessary
to observe that while possibly seventy per cent, of the citizens of the town are
supplied by the public water there are numerous driven wells in the borough on
private properties scattered all over the town from which most of the drinking
water is derived. It is reported that the citizens apprehend danger in drinking
the public supply, and it is safe to assume that very little of it is used except
for meaner domestic purposes.
The borough applied for State approval of extensions of its sewer system and
the question was carefully considered as to whether public health demanded
that the sewage pollution of the borough's water supply should be increased.
The Governor, Attorney General and Commissioner of Health reached a unani-
mous opinion that in justice to the water takers, the community at large and
the interests of the public health in general, three things were demanded; first,
that the water supply be filtered, second that pollution of this supply by sewage
should be stopped, and third, that the sewage of the borough should be inter-
cepted and conveyed to some point below the water worka intake and there
should be purified before the liquid be discharged into French Creek.
French Creek drains an area of five hundred and seventy square miles above
Ccunbridge Springs. Its fiow fluctuates widely and so does the quality of the
water. The population in boroughs and villages on B*rench Creek above Cam-
bridge Springs within a radius of thirty miles, was in nineteen hundred, forty-
eight thousand and fifty-eight. The possibility of pathogenic pollution arriving
in the creek at Cambridge Springs is always present and the repetition of the
Butler epidemic of Nineteen hundred and three and four is easily possible at
Cambridge Springs, provided the people drink the town water. So even if the
borough were to remove Its own sewage to below the water works intake,
there would still be danger, making necessary the filtration of the supply.
In response to the advice of the Commissioner of Health, the petitioners de-
sire to install a mechanical filtration plant.
The public supply is taken from French Creek in the central part of the
borough and pumped without any attempt at purification directly to a wooden
stand pipe, holding about one himdred and twenty-five thousand gallons,
located on a hill from which the water flows back through the borough.
The pumping station is situated on low ground north of French Creek in the
borough and is sometimes flooded during freshets. Five wells were drilled in
the vicinity of the pump house several years ago and the water therefrom was
supplied to the stand pipe and village; but it became unpalatable and in con-
sequence the borough authorities decided to abandon the well water and did so.
At the present time the water supply Is taken wholly from French Creek.
The pumping station contains an intake well, two triplex pumps, a steam
engine, one gas engine and a boiler plant. Each pumping engine has a capa-
city of about four hundred thousand gallons dally. The average water con-
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480 SECOND ANNUAL, REPORT OF THE Off. Doc,
sumption is from sixty thousand to one hundred thousand gallons dally » a very
small amount for a borough the size of Cambridge Springs. Were the water
supply to the public satisfactory to the people, undoubtedly the consumption
would Increase to ultimately about four hundred thousand gallons dally during
the summer time. It is becoming the universal experience of water companies
that the way to rehabilitate a non-paying proposition is often by purifying
the water whereby the consumption is largely increased and the revenues pro-
portionately. Undoubtedly the Improvement of the water supply of Cam-
bridge Springs will materially increase the consumption and hence the revenues.
The proposed improvements comprise a concrete coagulating basin, ap-
proximately forty-eight feet long by eight feet wide and eight feet deep, two
reinforced concrete filter units, each ten by twelve feet wide, located side by
side, each with a capacity of three hundred and thirty thousand gallons per
twenty-four hours, allowing the customary rate of three hundred and sixty
square feet per one million gallons of water filtered, together with all neces-
sary pipe, valves, controllers and appurtenances for operating and regulating
the fiow of water through the coagulating basin, filters and clear water well.
However, it Is not intended to equip but one filter unit at the present time.
Also a clear water well to be constructed out of the existing pump well and
all to be housed within a brick or concrete block superstructure with roof
covered with elate and joined to and made a part of the present pumping
station.
The plant is to be Installed by a contractor, who upon completion of Ihe work
shall place the plant in charge of an expert for a ten days* operation test,
during which the borough may have the water analy<<ed to determine the
degrees of purity obtained by the plant, which purification shall be such that
in no case shall the average number of bsu^teria In the filtrate exceed one hun-
dred per cubic centimeter, except when the number of bacteria in the applied
water shall exceed three thousand per cubic centimeter, in which event the
average reduction of bacteria in the filtrate shall be at least ninety-seven per
cent.
The specifications required that not more thaji five per cent, of the individual
samples of the filtrate shall show more than one hundred and fifty bacteria per
cubic centimeter, or as efficiency as low as ninety-seven per cent. No trace of
undecomposed coagulent shall be left In the filtrate, nor shall the filtrate show
an Increase in iron or alumina. But the water shall be clear, bright and
practically free from color, turbidity and matter in suspension and shall be sup-
plied at the rate of two hundred and forty thousand gallons per twenty-four
hours when the filters are operated at the normal capacity.
It is the intention and purpose of the borough to have placed in one filter
only, the apparatus necessary for operation. It consists of a wash and col-
lecting system of heavy cast Iron manifold sections into eax;h side of which and
extending to the side walls of the filters, shall be tributary pipes. These
laterals are to have screwed into them the latest improved bronze metal
screens. On this collecting and wash system Is to be placed eight inches of
gravel whose diameter shall range between three-sixteenths and ten-sixteenths
inches and on top about thirty Inches of specially selected and screened filter
sand to have an effective size of not less than thirty-five hundredths millmeters
nor more than fifty-six hundredths millmeters with a uniformity coefficient of
one and seventy hundredths.
The filter Is to be equipped with two overfiow troughs for distributing the
Incoming raw water and remove evenly from all parts of the bed the soiled
wash water. As near as can be ascertained the top of the troughs will be at
least one foot above the surface of the sand bed.
Raw water is to be delivered from the creek through one of the existing
pumps which is to be disconnected from the other pump which It to be tised
for raising the filtered water into the town. This second pump, according to
the plan is to be given connection with the suction pipe to the creek, to be
used only In emergencies, probably In case of fire.
A tank for dissolving the chemicals to be used In coagulation and for Intro-
ducing the solutions in proper amounts In the raw water Is to be provided and
a constant head office box and a finely graduated adjusted orifice for feeding
the solution at the proper rate to the raw water. Is also called for.
The coagulating basin Is to hold about twenty-three thousand gallons and is
to be built of re-lnforced concrete and covered over, except near its outlet
end. There are to be two baffle walls, so as to insure complete mixing and
there aref two sumps In it connecting with a drain which will lead to French
Creek. The location of the point of drainage into the creek is not shown.
Presumably this drain will also take the wash water.
The outlet from the coagulant basin is to be at the surface over a wier plate
from whence the chemically treated water will pass Into the troughs at the
filter. The filtrate from the filter is to go to the present Intake well which is
fifteen feet in diameter and about thirty feet deep. This well Is to be filled up
with concrete and may be twenty-five feet deep, thoroughly repaired and to
receive a water tight coating on the interior. The outside of the well is to
be plastered up and made tight and the whole will be covered over with a
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No. 16. COMMI88IONSR OF HEALTH. 4S1
cement floor. The capacity will be twenty-six thousand gallons after the re-
construction. The second pump will take the water from this well and raise
It to the stand pipe on the hill from whence it will be distributed to the town.
It is intended that the washing of the filters shall be accomplished by water
directly from the standpipe main. Also a blower la to be installed and the
filter agitated with air at the time of cleaning for the purpose of loosening and
scouring the sand free from adherent impurities.
If it be true that the water consumption is never over one hundred and
twenty-five thousand gallons, the proposed filter plant will be amply adequate
for all domestic uses except during the time of fire when it is altogether pro-
bable that raw creek water would have to be used. Such use after the people
were resting in the sense of security afforded by the filtration plant might be
attendant with a serious epidemic. Such was the case at Butler. If the iK>pular
fluapicion of the public supply be removed, by plans approved by the State,
these plans must be comprehensive enough to prevent the i>ollution of such
supply at any time, hence the capacity of the improvements must be equal
to greatest demand on the system. Two filter units are necessary for this
purpose. The storage of filtered water is to be effected practically wholly in
the standpipe on the hill which holds about one hundred and twenty-five
(thousand gallons. It is only Intended to run the plant a few hours daily, so
a fire may occur when the water is low in the tank on the hill and the demand
on the system come wholly upin the speeding up of the the filters. The maxi-
mum rate of these two filter units is in the vicinity of six hundred and sixty
thousand gatOons, and if at this rate the creek water happened to be very
turbid, unless ample preliminary treatmenC by the chemicals were accom-
plished, the filters might clog up in a short time before the fire ceased and then
necessitate the introduction of raw creek water into the system, it is thought
advisable that the coagulating basin should have a capacity of at least double
that now provided. Such capacity can be economically provided by duplicating
the basin now proposed.
As an added security the local authorities should not permit the water In the
tank on the hill to fiuctuate more than a normal amount.
Facilities should be afforded for at least four fire streams whose maintenance
would call for a rate of not less than sixty thousand gallons per hour.
Economy dictates that this rate be met by stored filtered water rather than
by additional filter units. Furthermore, the present pumping capacity is
needed for the supply of filtered water to the town. The arrangement as pro-
I>osed is unsatisfactory. If either pump broke down, crude creek water would
have to be supplied to the consumers probably. The plant needs to be im-
proved by the installation of duplicate centrifugal pumps of low lift, by means
of which the creek water shall be raised into the purification plant. Preferably
the present pump well should be continued In use for this existing purpose.
Then existing pumps should be maintained for raising the filtered water to the
standpipe on the hill or to meet fire emergencies.
A new filtered water basin of about 250,000 gallons capacity should be con-
structed outside of the station and approved means of controlling the rate of
filtration should be provided.
To do these things means iK>8sibly an expenditure of fifteen thousand dollars.
The Department is Informed that the borough cannot legally raise this amount
of money by a bond Issue but it can raise money enough to equip both filter
units.
It is reported that the valuation placed on property in Cambridge Springs la
exceptionally low and that without injustice to anybody and in the Interests
of the public welfare the valuation should be increased. If this were done, the
borrowing capacity of the borough would be extended sufiSciently to admit of
proper improvements to the existing water works plant.
Because crude creek water is supplied all of the time now to the public, there
is less danger than would be the case after a filter were installed to purify the
creek water mo^t of the time but not all of the time, for reasons previously
stated. But, of course, the plant proposed will render the public supply more
desirable during a considerable portion of the time and if approval be given to
the plans under conditions that will assure its enlargement as fast as the
borough shall obtain funds to meet the expenditures, and, meantime, the
public be given to understand that in case of fire or other abnormal use of
the town supply only boiled water shall be used for domestic purposes, a step
in the right direction may have been taken.
The borough may be permitted to install one filter and to operate as now
intended in conjunction with a covered clear filtered water basin to be built
independent of the pump well and In such a manner that it may be increased
in capacity when the other parts of the filter plant are added to the layout, as
a temporary expedient if this be done in line with a plan to equip the water
works S3rstem thoroughly and efllciently as generally suggested hereinbefore.
So the comprehensive plan should be prepared now and submitted for approval,
but this need not deter the local authorities making a contract for the construc-
tion of the proposed filters.
31—16—1907
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482 GMBOOND ANKUAJL RBPORT OF THB Off. Doo.
In view of these considerations, I have determined that the proposed ad-
ditional source of supply, and the construction of a filtration plant as proposed
for the purification of the water will not be prejudicial to the public health
under certain conditions, and I do hereby and herein srrant a permit therefor
under the following: conditions and stipulations:
FIRST: That on or before the date of operation of the filter unit herein
approved, the borough shall prepare comprehensive plans for a water purifica-
tion plant, comprising independent duplicate pumps for raising the raw river
water to the plant, .a coagulating basin or basins at least double the capacity
now proposed, two filter units, a clear water basin Independent of the pump
well and duplicate supply pumps to the town, together with all appliances and
appurtenances and submit the same to the State Department of Health for
approval. And with the exception of the converting of the present pump well
into a filtered water basin, which Is disapproved, the proposed plans are ap-
proved and the further additions to the plant called for may be made additions
to said proposed plans.
SECOND: The borough authorities shall notify the water consumers that
raw creek water may be introduced into the water works system and that
during fires and for sometime thereafter, until the street pipe system be
thoroughly flushed and drained, the danger of infection may be greatest.
Hence absolute safety only is assured when the consumer bolls the water.
THIRD: After each fire the borough shall thoroughly drain the entire water
works system of all raw creek water if any has been Introduced into the
system. And weekly reports of the operation of the plant shall be filed with
the Commissioner of Health on blank forms furnished by the Department.
FOURTH: If at any time, in the opinion of the Commissioner of Health, the
water works system or any part thereof, or the quality of water, has become
prejudicial to the public health, then such remedial measures shall be adopted
by the borough as the Conunissioner of Health may advise or approve.
FIFTH: Approval of the proposed plans, excepting the clear water basin, is
given as a means to an end and it is expressly stipulated that in acceptlnfer
this permit the borough obligates itself to complete the construction of the com-
prehensive plans to be prepared by the borough and modified, amended or
approved by the Commissioner of Health at as early a date as shall be found
practicable, or when ordered by the Commissioner of Health.
SIXTH: The emergency connection from the filtered water pump suction to
the raw creek water shall not be used and raw creek water be Introduced into
the system except during a fire or some equally important emergency. The
borough shall promptly notify the Commissioner of Health whenever this con-
nection is used or raw creek water Is supplied to the consumer. This relates
to the proposed plan, but when the comprehensive plant shall have been built,
no connection whatever between the filtered water pumps and the creek pumps
will be permitted.
SETVBNTH: A complete set of plans of the purification plant and the pump-
ing station layout proposed to be constructed shall be prepared by the borough
and filed with the Commissioner of Health upon completion of the work. And
•a domplete report of the test of the filter plant before it Is accepted by the
borough shall be made to the Commissioner of Health.
EIGHTH: An approved rate controller shall be fitted to the proposed filter
whereby the rate of filtration may be regulated as desired. From time to time
the State Department of Health will make tests of the water and borough
Qhall assist. If found desirable or necessaryt the Commissioner of Health may
prescribe standards of efficiency and make regulations for the operation and
maintenance of the plant.
Harrisburg, Pa., August 16th, 1907.
CAMBRIDGE SPRINGS, CRAWFORD COUNTY.
This application was made by the borough of Cambridge Springs, Crawford
county, and is for a modification of a permit dated August fifteenth, one thou-
sand nine hundred and seven, and issued to said borough for the construction
of a filtration plant in connection with its water works for the supply of water
to the public within said borough. It appears that in clauses one and five of
said permit of August fifteenth, one thousand nine hundred and seven, reference
was made to the existing pump well. Said clauses are as follows:
"FIRST: That on or before the date of operation of the filter unit herein
approved, the borough shall prepare comprehensive plans for a water purifica-
tion plant, comprising independent duplicate pumps for raising the raw river
water to the plant, a coagulating basin or basins at least double the capacity
now proposed, two filter units, a clear water basin Independent of the pump
well and duplicate supply pumps to the town, together with all appliances and
appurtenances and submit the same to the State Department of Health for ap-
proval. And with the exception of the converting of the present pump well into
a filtered water basin, which is disapproved, the proposed plans are approved
and the further additions to the plant called for may be made additions to said
proposed plans.
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No. 16. COMMIS6IONBR OF HEALTH. 488
"FIFTH: Approval of the proposed plans, ezceptlnff the clear water baaln^
is given as a means to an end and it is expressly stipulated that in accepting
this permit the borough obligates itself to complete the construction of the
comprehensive plans to be prepared by the borough and modified, amended or
approved by the Commissioner of Health at as early a date as shall be found
practicable, or when ordered by the Commissioner of Health."
On behalf of the borough authorities, the Pittsburgh Filter Manufacturing
Company, whose plans for the erection of the water filtration plant were
adopted by the said borough and approved under certain conditions and stipula-
tions by the Commissioner of Health in said permit, now represents that the
finances of the borough will not permit the construction at this time of a
clear water basin outside of the station and independent of the old pump well
within the station. Further, it is represented that if the borough be permitted
to use the old pump well temporarily as a filtered water basin, as soon as
moneys can be obtained therefor the borough will construct the outside and
larger clear water basin in compliance with the terms of said permit of
August fifteenth, one thousand nine hundred and seven; but if approval be
withheld to such temporary use of the. old pump well with proposed im-
provements, then the borough will be unable at this time to install any filtration
plant and the safeguarding of the public health will, therefore, be postponed.
It has been determined that the temporary use of the pump well as intended
will not be prejudicial to the public health, and a permit therefor is hereby
and herein granted, under the condition and stipulation that this permit shall
operate as a modification of the permit of August fifteenth, one thousand nine
hundred and seven, only as far as relates to said pump well, and that all
other terms and conditions of said permit of August fifteenth, one thousand
nine hundred and seven, shall stand and remain in full force.
Harrisburg, Pa., October 2, 1907.
CHAMBERSBURG, FRANKLIN COUNTY.
This application was made by the borough of Chambersburg, Franklin county
and is for permission to increase its source of supply to the public and to ex-
tend and improve its water works system.
It appears that the borough of Chambersburg, county seat of Franklin county,
is situated in the central part of said county in the Cumberland Valley, on the
east branch of the Conococheague Creek near its head waters and the divide
between the Susquehanna and Potomac River basins. The town has a popula-
tion of about ten thousand, is the trading point for the surrounding farming
country and also possesses important manufactories.
The geological formation of the borough site is limestone. The rock is so
near the surface that some of the trenches for water pipe were excavated in
the limestone. It Is the common custom to dispose of household drainage and
sewage into crevices in the rock. This pollutes the soil and renders well water
absolutely dangerous. So far as the Department is informed, the custom of
obtaining drinking water from private wells in the borough has been
abandoned. About everybody takes water from the public system which is
owned and operated by the municipality. There are no public sewers in
Chambersburg. A few private sewers exist with outlets into the Conococheague
Creek, or its tributaries, within the borough limits.
The water works system was installed in the year eighteen hundred and
seventy-six. It now comprises an intake dam and pumping plant, force main,
two distributing reservoirs, gravity supply mains and street pipe ssrstem.
The source of supply is the east branch of the Conococheague Creek, from
which water is taken at a point two miles above Chambersburg. Above the
pumping station there is a drainage area of one hundred and six square miles,
the lower half of which is farm land of limestone formation, the upper or
eastern half being wooded, mountainous country of rock porphyry formation,
in which is located a part of the State Forestry Reservation. The Cumberland
Valley Railroad and Its branches, and the Western Maryland Railroad traverse
the water-shed, along their lines are numerous stations, and all told, the
water-shed contains a population of about five thousand people. At Conoco-
cheague Island, about six miles above the pumping station and intake, there
is a colored camp-meeting ground, used for about two weeks each summer,
whereon the largest day possibly two thousand people congregate. Scotland
Village, in Greene township, population two hundred and fifty, is on the creek
four and a half miles above the water works intake. The stream has a rapid
descent and the run-off is correspondingly sudden, so that pathogenic pollu-
tion from any one of the numerous permanent sources could be transported to
the water works intake in a short time and gain admittance to the system in
a condition capable of producing disease in Chambersburg.
Across the creek at the old pump house, a dam about six feet high has been
constructed to serve Intake purposes. The stream here taken a half -circle
course to the westward, the dam being at the up-stream end of the turn and
the pump house at the down-stream end of the semi-circle, the two points
being connected by a race forming an island. In the pump house there is
located two pumping engines, one being operf^t^a by eteam and the otber by
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484 SECOND ANNUAL REPORT OF THE Off. Doe.
water power. The steam engine has a capacity of one million five hundred
thousand flrallons dally and the other engine a capacity of about two million
gallons dally. Up to the present time, water has been taJcen from a small
intake cham^ber fitted with a screen on the bcuiks of the race through a twelve
Inch suction pipe to the steam pump, and directly from the race through a ten
Inch suction to the power pump and thence through a force main twelve Inches
In diameter, length about one-half mile, to a two million gallon distributing
reservoir elevated about one hundred and sixteen feet above the pumps, and
located on a hill north of the borough partly in Greene and partly in Hamilton
townships, from whence water is supplied by gravity through a twelve Inch
main to the town and to a smaller distributing reservoir located in the western
part of Chambersburg and about seven feet lower than the main reservoir. Its
capacity Is reported to be one million gallons.
The larger reservoir is paved with brick on the sides and bottom and it Is
enclosed by a board fence four feet high. There is nothing to prevent anyone
maliciously inclined from casting pollution into the water in the basin. The
inlet pipe is at one corner, enters at an upward incline and throws the water
some distance above the surface of the high water mark, effecting aeration to a
small degree. The outlet pipe is at the further side about five feet from the
bottom of the basin and about ten feet below the surface of the water and Is
covered by a strainer. Facilities for drainage are afforded. All valves are out-
side of the reservoir. Detail plans have not been submitted. The conditions at
the smaller reservoir are similar.
There are reported to be fifteen miles of distributing mains, of which one
and three-tenths miles are ten inches in diameter, three-tenths of a mile Is
eight inches, two and a half miles are six inches, ten and six- tenths miles are
liouo' inches, one-tenth of a mile Is three inches and two-tenths of a mile is
two inches in diameter. The iarge percentage of four inch pipe would indicate
that the fire pressure service in the town is unsatisfactory. There are many
dead ends in the system.
A plan of the distributing system showing sizes of water pipe, locations of
hydrants and valves, has been filed in the Department of Health, but informa-
tion has not been submitted showing clearly the facilities for draining every
part of the street pipe system.
It Is reported that the average daily consumption for all purposes is one and
a half million gallons, and that the maximum is less than two million gallons.
The petitoners represent that the present pumps are in need of repairs and
a thorough over- hauling, and that since the combined storage capacity of the
reservoirs is only sufilcient for a two days' supply under average conditions,
that the town is compelled to install a new pumping engine of two million
gallons dally capacity to Insure a satisfactory service.
It is proposed to erect the new pumping engine in a n«^w pump house on the
Island and not far distant from the old pump house and to use the main source
of supply. On this island there is a settling basin formed by excavation, into
which the race water is to be conducted by percolation through an earth
channel filled with gravel, or at choice, through a pipe connecting the race
with the said settling basin. The suction pipe of the new engine is to extend
out Into this open pump well, and the discharge pipe is to be connected up
with the existing force main.
At Scotland Village one of the State Orphan Schools is located. The buildings
are of modem construction, are supplied with water from springs located on the
banks of the creek, and are drained by a separate system of sewerage, thf
sewage being disposed of by the Waring system of surface irrigation. There
is a receiving tank, thirty thousand gallons capacity, which discharges, when
full, by syphon through broken stone strainers into a ten inch pipe to the dis-
posal field containing about two acres, over the surface of which the sewage
is distributed by gravity. The field is located about two hundred feet from the
creek and is said to receive about two tanks discharges every twenty-four hours.
There is an over-flow from the sjrphon tank, which may also be used as a by-
pass, by means of which the institution's sewage may be conducted directly
Unto a storm drain on the property and through it to the creek. In cold
weather when the field becomes frozen, it would be strange indeed if some sew-
age did not reach the stream almost as soon as discharged onto the field.
Ordinarily, especially in dry weather, it appears to soak away in the ground
or pass off by subterranean channels. The disposal area is level and thirty
feet above the creek, and Judging from numerous outcrops in the vicinity, Is
entirely underlaid with limestone formation. The topographical evidence is
entirely favorable to the conclusion that the sewage to a greater or less extent
from the institution must reach the Conococheague Creek in a condition to
menace Chambersburgr's source of supply.
In case of a typhoid outbreak in the school, its own water supply might
thereby become infected because the springs from which the water I9 pumped
are about six hundred feet farther down stream below the disposal area and
the storm drain and sewer pass in close proximity to one of the springs.
Whether there is any underground indirect connection between the crevices in
the limestone rock under the disposal field and the stratum supplying the water
to the spring, is not known. However, should vast quantities of water be
pumped out of these springs, it would pull on the underground storage for long
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Ko. 16. COMMIfiBlONBR OF H&ALTH. 485
distances and then direct connection would undoubtedly be developed between
the disposal area and the springa It is reported that not a sinffle case of
typhoid fever has occurred since the buildings were erected about the year
eighteen hundred and ninety-three. It is evident, however, that the springs
are a suspicious source of supply of drinking water to the institution, so long
as the present method of sewage disposal there prevails. Furthermore, this
disposal should be condemned in the interests of the public health generally.
A water-shed occupied by railroads, whose coaches are fitted with toilet
facilities, from which infection may at any time be discharged into the
streams supplying Chambersburg with water, and also having upon it villages,
camp grounds and sewage disposal plants, from whose remotest part waters
pan i^ach the intake of a pumping station in a few hours, Is not a safe or
suUable source for a public supply, unless the waters be first adequately
filtered. While the State can minimize the menaces and will do so, these pre-
cautions lyill not be sufficient to wholly safe-guard the interests of the public
health and it is clearly thn duty of the local authorities to instal a water
filtration plant at once.
The borough has given some consideration to the obtaining of a gravity
supply of pure mountain water. Such a supply is desirable, but it also appears
that the Interest of all concerned demand the immediate installation of a public
sewerage system in the borough. If it be true that Chambersburg's borrowing
capacity at present is not in excess of one hundred thousand dollars, or there-
abouts, then it would appear to be impossible for the municipality to secure
both Improvements, namely, the mountain supply of pure water and the pub-
lic sewerage system. While much of the cost of the latter can be assessed on
the abutting estates, according to a uniform rate of assessment that shall
obtain over the whole borough, yet the trunk sewers and the sewage disposal
works, and some other general expenses must of necessity by defrayed by
general taxation. It is believed that this sum deducted from the borough's
borrowing capacity leaves an amount barely sufficient to pay for the cost of
the installation of a modern water filtration plant capable of treating two
million gallons of water daily, and totally insufficient to carry out the project
of the gravity mountain supply.
It has been determined that the proposed increase of the water supply to the
public in Chambersburg, by means of the installation of additional pumping
machinery according to the plans submitted, will not be prejudicial to the
pubQic health under certain conditions, and a permit is hereby and herein
granted therefor, under the following conditions and stipulations:
FIHST: That detail plans of the layout of the new and old pump house,
pumping engine, piping valves. Intakes, settling basin, etc., together with a
plan and profile of the force main, shall be prepared and filed by the borough
with the State Department of Health on or before September first, one
thousand nine hundred and seven.
SE2CONI>: Detail plans and sections of the distributing reservoirs, showing
all piping, valves, etc., together with a satisfactory report as to the facilities
afforded in the street pipe system for adequate drainage thereof, shall be
prepared and filed by the borough with the State Department of Health on or
before September first, one thousand nine hundred and seven.
THIRD: The borough may extend its street mains and enlarge existing ones
from time to time as necessity may require. At the close of each season's work,
plans of the improvements made to the system during the year shall be pre-
pared and filed by the borough with the State Department of Health.
Fourth: On or before September first, one thousand nine himdred and seven,
Che l>orough shall submit plans and specifications for a plant to treat the
Coinococheague Creek water to render it safe for drinking purposes, or plans
and specifications for the obtaining at once of a source of supply not prejudicial
to the public health, and meantime, the proper local authorities shall notify
the public to boil all water used for drinking or culinary purposes. People
should be warned of the danger respecting the use of the Conococheague water
In Us raw condition. If the warning be not heeded, then in the event of an
epidemic of a water-borne disease, the responsibility will rest on other shoulders
than those of the public officials.
FIFTH: If at any time the water works system herein approved, or any
part thereof, shall have become prejudicial to the public health, in the opinion
of the Commissioner of Health, then such remr^dial measures shall be adopted,
not herein otherwise provided for, as the Commissioner of Health may approve
or suggest.
The attention of the borooigh authorities is called to the responsibility resting
upon the municipal corporation to furnish a pure and wholesome water to the
public. Also to the fact that because of advancement in the art of sanitary
engineering, it is now practicable at reasonable cost to filter water and furnish
it to consumers in a purer state than it may be possible to obtain it from its
source and that the courts of Pennsylvania are beginning to take cognisance
of this fact as evidenced In a recent decision. Again, because Chambersburg
has not been stricken with an epidemic, is no proof that an explosion may not
occur to-morrow. The Scranton epidemic of the winter of one thousand nine
hundred and six, and seven, well illustrates this fact. The conditions are more
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48e SECOND ANNUAL. REPORT OP THE Off. Doc.
favorable for an outbreak In Chambersburgr or in any event as favorable ae
they were at Scranton. The necessity for a proper safeguard cannot be too
Btrongrly urged by those In authority at Chambersburg.
Harrisburg, Pa., June 24, 1907.
CLARION, CLiARION COUNTY.
Clarion Water Company.
This application was made by the Claxlon Water Company of Clarion, Clarion
county, and is for permission to extend its water works for the supply of water
to the public within the limits of the borough.
It appears that Clarion borough is the county seat and a trading point for
the surroimding farming country. It has a glass bottle and a cigar manufac-
tury, the former employing about one hundred and ten hands, and the latter
about eighty hands. A State Normal School, having a maximum enrollment
of five hundred students, is located in the town. The municipal population
is estimated to be two thousand two hundred. In the year nineteen hundred,
it was two thousand and four. In the year one thousand eight hundred and
ninety it was two thousand one hundred and sixty-four, and in one thousand
eight hundred and eighty. It was one thousand one hundred and sixty-nine.
Thus it is seen that the town's growth has been moderate, and Judging from
this fact and present Indications, there is no occasion to estimate a greater
proportional growth for the future.
Clarion county is in the lower productive coal measures and the surface of
the ground is generally of a rolling aspect. Interspersed throughout are deep
channels which the water courses have made for themselves and these chan-
nels are usually in the underlying conglomerate measures. Clarion borough
is located on the south bank of the Clarion River and about five hundred feet
above it. The river here is in a narrow gorge In some places the banks being
almost vertical. The streams tributary to it are short and precipitous. The
Bite of the borough is on a bench somewhat conical in shape, the summit being
dine hundred and thirty feet above the main street of the town and five hun-
dred and sixty feet above the river. On this hill the water company's dis-
tributing tank is located and also the State Normal school buildings.
The river at this point is a very considerable stream. Its drainage area
comprises about nine hundred square miles in which are portions of McKean,
Elk, Jefferson, Forest and Clarion counties. The waters are polluted by
sewage and industrial wastes from coal mines, tanneries, chemical works and
paper mills, which render the stream unsuitable as a source of public water
supply.
The local authorities report that there are both public and private sewers in
the town and that about three-quarters of the population use the sewers.
Some of the sewers empty into the Clarion River and others on the hillsides.
About one-half of the present population obtain drinking water from wells
and springs in the borough and the others purchase water from the Clarion
Water Company. There is a contract between the borough and the company
whereby the latter maintains a fire service. The total daily consumption
averages two hundred thousand gallons, with a maximum of two hundred and
fifty thousand gallons.
The Clarion Water Company. was originally founded in the year one thou-
sand eight hundred and seventy-four. It was reorganized and duly incor-
porated under the laws of the State in one thousand eight hundred and eighty-
seven for the purpose of supplying water to Clarion borough and vicinity. It
is a home corporation.
The works were first built in one thousand eight hundred and seventy-five
and the source was the river. The water was pumped through a six inch main
into an iron tank thirty feet In diameter and forty-five feet in height, resting
on a stone and concrete foundation, located on the hill in the borough. This
source was used until one thousand eight hundred and ninety-six when it
became so polluted with trade wastes, principally produced in Elk county as to
be unsafe for domestic purposes. The company was then compelled to seek
other water, which it did by resorting to a small stream on the opposite side of
the Clarion River from the borough, known as McLain Run. As early as one
thousand eight hundred and ninety-three the water company petitioned the
local and state board of health for an abatement of the paper mill and tannery
pollutions at Ridgway, Johnsonburg and other places in Elk county.
At the present time the system comprises an impounding reservoir on McLialn
Run, a mechanical filter plant, pumping station, drilled wells, distributing
tank and nearly six miles of street mains, ranging in sizes from two Inches to
ten inches in diameter, of which the four Inch pipe comprise about thirty-four
per cent., the six Inch twenty-five per cent., the eight inch ten per cent, and
the ten inch about thirteen per cent.
Tlie reservoir is near the mouth of McLain Run, has a storage capacity of
about five million gallons, and a water shed of about seven hundred and fifty
acres. The stream Is fed by numerous springs, outcropping on the hillsides
and at its source a mile and a half north of the river. The water company owns
Digitized by VjOOSIC
No. 16. COMMISSIONER OF HEALTH. 487
the land immediately surrounding the reservoir, but the balance of the water
shed belongs to farmers, approximately fifty per cent, of it being cleared and
under cultivation. There are seven dwellings and between thlrty-flve and fifty
people on the area above the dam which constitute the permanent menace to
the purity of the water.
The S. B. McClain's property, which is about half a mile above the reservoir,
the barnyard drainage is to a tributary of the run.
A few hundred feet further up stream, at the property of Jacob McLaln,
thene is a privy on the steep slope to the run, from which privy which is
overflowing all rain water flows directly into the water supply.
Nearly a mile above the reservoir there is a public highway and hereon the
i0aiBt side of the run is the residence of George W. McLain, and on the west
side, Frank P. McLain. At the former a pigsty e extends across a tributary of
the run. At the latter a pigstye, privy and kitchen slops drain towards the
run and pollute the water supply.
There is a pigstye on the Fred Williams estate which also drains into a
tributary of the run.
At the head of the run on the property of Isaac I. ImhofC, there is a privy on
the banks of the run and a pigstye across it, and also a tenement house over a
^rtng leading to the run, drainage from all three going to the public water
supply. The privy is in specially foul condition and overflowing. This property
is elevated in the neighborhood of four hundred feet above the impounding
reservoir. The water shed being steep assures a rapid run-off of rain-fall and
hence any pollutions thereon could be introduced in a short time into the water
pipe system of Clarion.
However, it is reported that McLaln's Hun was a comparatively pure trout
stream until about two years ago. Early in the year one thousand nine hun-
dred and flve, oil prospectors discovered valuable oil deposits and natural gas
on the water-shed and since that time, the fleld has been developed and is
now a very productive one. There are about thlrty-flve wells on the area
draining to the Impounding reservoir. Others will be added in the future.
This pre-emption of the water-shed by oil and gas interests has seriously
polluted the run and temporarily crippled the water company's facilities.
The waste material produced in the operation of drilling the wells, in shoot-
ing them, and in cleaning them out, is deposited on the surface of the ground
rbund about and eventually gets Into the main stream of the water supply.
Sometimes the waste will impart a light milky color to vue wa^er, resulting
from sand pumpings, and again the material may be an oily and greasy waste
or a black substance called burnt glycerine. The drippings from oil tanks and
leaky pipes inevitably occur, so that the water of a stream passing through a
highly developed oil fleld is bound to be polluted.
The dam is constructed partly of timber but mostly of earth and stone. It
is in poor repair. An eight Inch supply main, the end of which is covered by
a screened box, conveys the water across the river and down stream about
half a mile to the pumping station, located on a bench excavated in the hillside.
The water is delivered here under a head of about one hundred and twenty-
flve feet. In the station are installed two gas pumping engines, each being
compound duplex and having a combined capacity of a little less than two
million gallons. The pump well is about eii^ht feet square and eight feet deep
and the water from the reservoir may be dellverd to it or to the filter or both
at the same time. The bottom of the well is reported to be about twelve feet
above the river and a twelve inch cast iron pipe extends from the bottom of
the well Into the river. It has a valve on it and formerly was used as the
suction pipe when the river was resorted to as a temporary source. This pipe
is now maintained for emergency purposes. Connection with the suction pipes
of each pump can be made in a short time and it is reported that the specials
are kept on hand. So raw water can be pumped to the town in an emergency
or at any time if the said connection be made.
The force main is six inches in diameter and extends up the ravine of Woods
Run, a distance of thirty-six hundred feet to the iron tank on the hill. The
plant is operated intermittently from nine to twenty hours, depending upon the
season of the year.
The filter is of the Jewell mechanical type sixteen feet in diameter, located in
tShe station near the pump well and is used to purify |the reservoir and the
river water. However, no subsidence or coagulating tank is provided in con-
iiection with the filter, the alum solution, when it Is used, is applied to the
water on the surface of the filter, and the rates at which it must be operated
if all of the water raised into the town during any particular day be filtered,
are so excessively high that efllcient purification should not be expected.
The reservoir water is delivered on surface by gravity. The river water is
raised on to the filter by a centrifugal pump specially provided for the purpose
and having independent connections with the river and the filter.
The drilled wells are nine in number. Thf^y extend along the bank of the
lAvier and ar<^ sunk in the rock and shale to a depth of . seventy feet ap-
proximately and to a black gritty slate in which an abundance of water is
found. Evidently the water must come from a distance laterally for it is
under pressure and rises within seventeen feet of the surface of the ground.
Digitized by VjOOQIC
488 SECOND ANNUAL, REPORT OP TKHS Off. Doc.
l£|o the height 1b slightly above that In the river. Six of the wells are up
stream ftom the pumi^zifir station and three of them Immediately below it.
Only seven of these wells, however, have been in use. The water is raised
from them by compressed air into a gravity cast iron pipe leading to the pump
well at the station. The collecting main and the tops of the casing pipes and
the caps are above the surface of the ground and exposed to view.
It was discovered after the river was abandoned for the McLaln reservoir
supply that this source was insufficient in dry weather to supply the town, so
recourse had to be had to the river. The filter plant was installed about the
year one thousand nine hundred and two. It is reported that prior to this date
the water company had drilled one well near the pump house and that it pro-
duced salt water. About this time an oil well had ben drilled by Woods Run
less than seven hundred feet distant. It has since been discovered that salt
water from the oil well, which well was unproductive and never operated, was
the cause of the contamination of the water well at the pumping station
because after the casing of the oil well was removed and the well plugged at
required by law, thereby shutting off any further flow of salt water, the water
in the well at the pump house began to freshen and finally was soft and suitable
for drinking purposes.
Upon this discovery or later, the other wells were drilled at the pumping
station in an effort to develop a ground water supply of sufficient quantity to
supply the town.
The driven well supply and McLain reservoir supply proved together to be
ample. The cost of operating the wells made the reservoir supply the more
profitable one for the company. Hence this water was supplied to the town
as long as it lasted. The oil development of one thousand nine hundred and
five on the reservoir water shed, herein before described, contaminated the
run waters with a class of pollution which the filter could not remove and in
consequence, there being no adequate remedy at law in this case as appeared
after a preliminary injunction restraining the oil operations had been granted,
that the water company was forced either to use the river or further develop
the driven well supply. It is for approval of the new wells that application has
been made.
Eight wells have been drilled recently along the southern bank of the river
in proximity to the other wells, and abundant supply of water of the same
quality as that obtained from the old wells has been produced by the new wells,
and the water company desires to connect the new with the old well system
and operate them all together.
Detailed plans of the McLain reservoir supply main, pumping station, filter,
piping and valves and force main, and details of the driven well system, both
old and new, have not been filed by the water company in the State Department
of Health.
Such tests, chemical and bacteriological of the waters as have been made,
show them to be suitable for drinking and manufacturing purposes.
The proposed well supply is excellent and abundant. There Is ample op-
portunity for future extension. The danger from sewage pollution seems to
be very remote If not wholly eliminated. The geological structure in the valley
of the river being in the conglomerate measures, the water bearing rock, being
far below the river bed and roofed over by impervious rock, in all probability
collects its waters from remote points and it Is altogether probable that the
numerous oil and gas wells on McLaln Run may penetrate the stream supplying
water to the water company's driven well system. If this be the fact, it ap-
pears evident that by neglect In properly closing abandoned oil or gas wells,
salt water may impregnate the town's drinking supply as it did at the one well
previously described.
In the construction of an oil or gas well, the iron pipe casting is driven down
through the different strata to bed rock and firmly imbedded therein. Below
this it is unusual to encounter water until the oil bearing strata Is reached
where sometimes salt water abounds. When a well ceases to be productive of
oil or gas it is the custqfm for the owner to draw the casing and use it else-
where. If the well be not plugged, surface and sub-surface water will flow in
and being heavier than oil, will fill up the natural oil reservoirs and force the
oil back perhaps long distances. It is known to be a fact that In this manner
a property in which oil abounded has been entirely robbed of this resource and
the owner thereof forced to sustain a loss of thousands of dollars.
Act number one hundred and twenty-three of the year one thousand eight
hundred and eighty-one. regulating the mode of plugging abandoned oil wells,
related only to oil wells and was passed for the purpose of protecting oil by
excluding all fresh water from the oil bearing rock.
Act number one hundred and fourteen of the year one thousand eight hundred
and eighty-five, was passed to protect gas wells also. Its provisions are
similar to the law of one thousand eight hundred and eighty-one. Both stipu-
late that upon abandonment or ceasing to operate the wells, the owner shall,
before drawing the casing, fill up the well with sand or rock sediment to the
depth of at least twenty feet above the gas or oil bearing rock, and drive a
round, seasoned wood plug, at least two feet in length, equal in diameter to
the diameter of the well below the casing, to a point at least five feet below
X
Digitized by VjOOQIC
No. 16. COMMISSIONBR OF I£BAL.TH. 489
the bottom of the casing; and Immediately after the drawing of the casing
shall drive a second round, tapering wooden plug into the well. The second
plug is provided as a double Insurance against inflow of water. It is to be
placed Just below where the lower end of the casing »hall have rested* and
after being properly driven, sand and rock sediment to a depth of at least five
feet is to be flUed in on top of the plug.
Any owner of land adjacent to, or in the neighborhood of, an abandoned well,
on neglect of the owner may enter and plug the well at the expense of the
owner of said well.
Act number one hundred and fourteen, of the year one thousand eight hun-
dred and ninety-one, was passed to prevent the pollution of springs, water
wells and streams, by water escaping from abandoned oil wells and gas wells.
The plugging provided for by law is to completely shut off and prevent the
escape of all water impregnated with salts, or other substances which will
render springs, water wells or streams unfit for use for domestic, steam making
or manufacturing purposes.
Any person injured may plug such abandoned well and recover the expense
for the same. As a protective measure, the water company should maintain a
patrol of the territory liable to contribute to its driven well system whereon
may be located oil or gas wells to prevent through carelessness or neglect the
contamination by salt water of its ground supply.
The water company has purchased a tract of about seventy acres on which
is located Its pumping station and driven wells, which purchase is said to have
been made to keep oil prospectors from menacing the town supply. This
restriction should be rigidly maintained.
The McLain reservoir supply should be abandoned. It is unnecessary and
dangerous. If used, it should be only in connection with an adequate puriflca.
tion plant.
In case of an accident to the driven well system, temporarily putting it out
of commission, in lieu of adequate storage, either the water company would
be obliged to draw from the McLain reservoir or take water from the river. It
would not be expedient to entirely shut ofC water from the town. Therefore,
since the river water is polluted and dangerous, if it be used it should be first
adequately purified. Hence, the necessity appears for the maintenance, by the
company, of a filter capable of rendering either the run or the river water safe
to supply to the public. The existing filter is Inadequate in capacity, the ar-
rangements for the preliminary treatment of the water with chemicals are
deficient, and an improvement to the plant in this respect is demanded for
public protection if either of the two waters are to be used in emergencies or
at any time.
It has been determined that the proposed source of supply will not be pre-
judicial to the public health and a permit is hereby and herein granted there-
for, and for the extension of the street mains in the borough, under the follow-
ing conditions and stipulations:
FIB0T: That at the close of each season's work plans of all water mains
laid during the year, with any other information in connection therewith which
may be required, shall be filed in the State Department of Health. And, no
new reservoir or additional force main, or other extensions or alterations to
the existing water works system, as herein otherwise approved, shall be made
by the water company unless the plans thereof shall have been submitted to
and approved by the Commissioner of Health.
SEX70ND: That on or before January first, one thousand nine hundred and
eight, the water company shall file with the State Department of Health
detailed plans of its pumping station and plant, driven well system, filters,
supply and force mains, distributing tank, all pipes, valves and appurte-
nances.
THIRD: The McLain reservoir supply is condemned as prejudicial to the
public health, as also is the Clarion River supply and these sources shall not
be used by the Clarion Water Company unless the waters thereof be adequately
filtered and purified by a plant to be specially provided therefor according to
plans which shall be submitted to and approved by the Commissioner of Health.
In the event of the Clarion Water Company electing to abandon the said
sources, then said company shall forthwith absolutely sever all connecting
pipes between its water works system and the said sources and file a certified
description of the date and manner of such severance, with the State Depart-
ment of Health.
FOURTH: The Clarion Water Company shall not drill, or permit to be
drilled, any gas or oil well on its property within the now existing boundaries,
unle ss pe rmission to do so be obtained from the Commissioner of Health.
FIFTH: The Clarion Water Company shall make frequent inspections of all
gas and oil wells anywhere in the vicinity of Clarion borough, and take prompt
action, is necessary, to prevent salt water pollution of any springs, well waters
or streams in such vicinity and reports of such inspections and of the operation
of the water works system shall b'^ kept on blanks to be provided by the Com-
missioner of Health aipd returned to the State Department of Health when
called for.
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490 SBCXDND ANNUAL, REPORT OF THE Off. Doc.
SIXTH: If at any time It shall appear to the CommlBsioner of Health that
the source of supply, or any part of the water works system, has become pre-
judicial to the public health, then such remedial measures shall be adopted as
the Commissioner of Health may advise or approve.
The Clarion Water Company Is therefore advised to give favorable considera-
tion to the providing of an adequate storage tank on North Hill in the borough.
Such storage would be an insurance against any break in the force main,
pumping machinery, or driven well system, and might entirely obviate the
necessity of ever having recourse to the river or McLaln reservoir source.
Harrisburg, Pa., July 28d, 1907.
EAST McKEESPORT, ALLEGHENY COUNTY.
This applicaUon was made by the East McKeesport Water Company of East
McKeesport, Allegheny county, Pennsylvania, and is for permission to extend
water-works for the supply of water to the public within the borough of East
McKeesport, and to obtain a new source of supply therefor.
It appears that the said application of May seventeenth, one thousand nine
hundred and seven was for permission to extend water works for the supply of
water to the public within the borough of East McKeesport, Wilmerdlng and
Wall and the township of North VersaiUes, all in Allegheny county.
It appears that the East McKeesport Water Company was chartered August
thirtieth, one thousand eight hundred and ninety-six, to supply water to the
borough of Baat McKeesport, which it has since done. On December thlrty-
flrst, nineteen hundred and two, it bought out the South Versailles Water Com-
pany, which was chartered November twenty-sixth, nineteen hundred and one,
to supply water in North Versailles township. On February twenty-eighth,
nineteen hundred and seven, it also acquired all, or a majority of the stock of
the Melrose Water Company, which was chartered August twenty-eighth,
nineteen hundred and six, to supply water to the borough of Wilmerdlng. The
borough of Wall, having been recently incorporated from North Versailles
township, it is seen that the territorial rights of the said East McKeesport
Water Company and the two other said companies which it owns and operates
cover the district for which permission is asked to obtain a new source of sup-
ply.
The three boroughs mentioned and the township are situated in Turtle Creek
valley and on the hills to the south, the district ranging from two to five miles
from the mouth of Turtle Creek. On each side of the valley, which is from a
quarter to a half a mile in width, the slopes are abrupt and often nearly verti-
cal. The elevations reach five hundred feet above the valley. The hills are
cut by numerous ravines. Most of the land is cleared and used for farming.
Bordering both banks of the creek and on the main line of the Pennsylvania
Railroad, fourteen miles east of Pittsburg, is the borough of Wilmerdlng and
the passenger station. South of it on the summit of the hills lies East McKees-
port borough whose citizens have their nearest railroad station in Wilmerdlng.
The borough of Wall lies along the south bank of the creek east of Wilmerdlng.
The Westlnghouse Air Brake Company, employing about four thousand hands,
is the only manufacturing plant in the district. It is located at Wilmerdlng.
The valley, however, has numerous extensive industries and the region on and
about the hills is desirable for residences and will, undoubtedly be developed.
The present population of the three boroughs and township adjacent thereto, is
estimated to be between eleven thousand and twelve thousand. Houses are
said to be in demand with none available for rent New districts are being
developed and they stand in need of water works and sewerage systems. The
public sewers in Wilmerdlng cover nearly all of the town, there are but a few
in East McKeesport and less than half a mile of pipe in wall. In the latter two
places the customary method prevails of household waste disposal on to or
near the surface of the ground in proximity to wells in some cases. Such
wells in East McKeesport borough are largely driven or bored and cased with
pipe for protection from sewage pollution.
Typhoid fever has been attributed to the use of water from at least one of
the springs in the borough, of which there are several, the water of which flows
from the end of pipes driven into the side of the hill. Since August first, the
current year, sixteen cases of typhoid fever have been reported. The source
thereof Is undiscovered. The evidence does not point to the public water supply.
East McKeesport and adjacent parts of North Versailles township are sup-
plied by the East McKeesport Water Company which, up to September tenth,
nineteen hundred and seven, purchased the water from the Pennsylvania Water
Company. It was pumped by the latter at a station maintained in Wilmerdlng
and forced Into a standpipe twenty-six feet in diameter and fifty feet high
located on a hill near the centre of East McKeesport borough and owned by the
E>ast McKeesport Water Company. From this point the water from whatever
source will continue to be distributed by gravity. The ground at the standpipe
is elevated twelve hundred and thirty feet above sea level and in the southern
part of the borough the elevation is about ten hundred and seventy. It is
reported that two thousand people use the water which is two-thirds of the
entire population. The average consumption is stated to be thirty thousand
Digitized by VjOOQIC
No. 16. COMMISSIONBR OF HISALTH. 491
sallons daily, which if true, is a remarkable low per capita rate. This would
indicate that the use of spring water and that from wells is larger than esti-
mated.
On a canvass made by agents of the Department and from records, it appears
that there were thirteen cases of typhoid fever in East McKeesport in nineteen
hundred and five, fourteen cases In nineteen hundred and six and two cases to
August first, in nineteen hundred and seven.
The Pennsylvania Water Company supplies water to a large number of
municipalities adjacent to Pittsburg. Its main source is obtained from filter
cribs located in the Allegheny River, but it has an emergency intake into the
Monongahela River at Port Perry. Both sources are polluted with sewage.
The water is pumped into reservoirs located in the several boroughs within its
territory. Wilmerdlng is supplied by the same company. There has been con-
siderable typhoid fever in this company's district. The resident physicians of
Turtle Creek valley appear to think that the water which the Pennsylvania
Water Company furnishes is not responsible for the fever. In a few instances
contaminated wells and springs were thought to be responsible.
In the borough of Wilmerdlng in nineteen hundred and five, there were
seventeen cases of typhoid fever. In nineteen hundred and six, fifty- nine cases,
but up to August first, nineteen hundred and seven, one only. In the neighbor-
ing borough of Wall, which at present does not have a water works system
but relies upon springs and wells, there was in nineteen hundred and five, one
case of typhoid fever, in nineteen hundred and six eleven cases and in nineteen
hundred and seven, three up to August first.
So far as the Department is Informed, the only, wells in use in the borough
of Wilmerdlng are those at the plant of the Westinghouse Air Brake Company
and the two public wells which are drilled, cased and cemented to cut off
sources of pollution. One of these wells is located on Commerce street near
Westinghouse avenue and is said upon analysis, to have been pronounced free
from contamination by a reputable chemist. The other well is located near the
end of the viaduct which crosses the creek and the yards of the Westinghouse
Air Brake Company and is not of as good quality, although reported to contain
nothing which indicates any contamination. The water is said to be derived in
part from strata of soapstone, which impart an unpleasant fiavor to the water
and on this account is but little used.
The wells at the plant of the Westinghouse Air Brake Company are bored
two hundred feet deep and encased, so as to cut off possible pollution and are
used for drinking purposes. The water is reported to be piped to all depart-
ments and make generally available for drinking purposes at the plant. This
company uses, for general purposes other than drinking water obtained from
the Pennsylvania Water Company.
Other manufacturing establishments in Turtle Creek valley also have private
supplies for drinking purposes.
When the Pennsylvania Water Company began to supply water, it delivered
raw water from the Allegheny l^iver and there was a considerable amount of
typhoid fever and other intestinal diseases attributed to the supply. Later the
company installed filter cribs at the intake, which installation was followed by
a reduction in the number of cases of such diseases. When the capacity of the
cribs became taxed to meet the increased consumption of water, the company
resorted to raking and flushing the bed of the river above the cribs to remove
the accumulation of silt so as to increase the rate at which water could be
obtained from the cribs. As the consumption increased and the rate of filtration
in the cribs increased, typhoid fever also increased among the consumers
taking water from this company, but It is reported to be a fact that in the
districts supplied by this company within the city of Pittsburg's territory,
there was less typhoid fever generally, than in the other districts of said city
supplied with water by the City Water Works, deriving its source from the
same river. In the spring of nineteen hundred and six the water company is
reported to have notified all of its consumers by mail and by posted notices in
the street cars and throughout the boroughs, that in the interests of safety all
water used for drinking and culinary purposes should be boiled. It appears
that since that time fewer cases of typhoid fever originated in those boroughs
where the injunction to boil the water was generally observed than where little
attention was paid to the notification.
When the Melrose Water Company petitioned for the granting of a charter,
said company represented that its source of supply would be obtained from five
springs at the head of a small stream tributary to Turtle Creek on the south,
at the east end of Wilmerdlng. These springs were located on either side of
the ravine at the head of this run and Joined a short distance below to form
the stream. A contract had been let for the construction of a dam to impound
the water. The East McKeesport Water Company, by virtue of its holdings
in the Melrose Water Company, has acquired the right to take water from
these springs located on the farm of Philip Maser in North Versailles township
and the borough of Wall and has constructed masonry enclosures at each spring
to prevent the pollution thereof. The company has also laid mains to convey
this supply to the borough of EaFt McKeesport, the borough of Wilmerdlng and
Wall. The combined fiow of these springs Is reported to be between four bun-
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402 SECOND ANNUAL REPORT OF THE Off. Doc
dred thousand and five hundred thousand grallons per day, an amount insufficient
to ultimately supply the population that may be reasonably expected in the dis-
trict within a short term of years.
The springs occur at outcrops of rock in the hills south of the borough of
WaU. One of them is within said borough limits. The rock is generally shaly.
The surface soil, is a sandy or gravelly loam, underlaid by some clay.
Each spring is enclosed in a brick arched masonry vault about three feet
square, provided with tight doors locked.
The fields about the springs are used either for the growing of grass or for
pasturage.
At the "Redhouse Spring" a drain has been built to intercept water from
smaller springs in the vicinity, but it extends to the surface and is liable to
rv ceive surface drainage. The tract has not been fenced ofC to exclude animals.
At the "Uvingstone Spring" there is danger of pollution from an open privy in
the rear of the farm house located about two hundred feet up the hill. This
privy should be provided with a water tight vault and receive proper attention.
The vault which encloses the spring is inside of a masonry building which is
to be used for the storage of milk, etc.
The storage reservoir into which the spring water is piped is located in a
narrow gorge. All surface soil and loose rock was removed from the site. The
dam is a concrete structure about forty feet high, eighteen feet thick at the
base and three feet thick at the top. Loose rock and other material excavated
was placed on the lower side of the concrete wall to form an earth embankment.
No detail plans of this structure have been submitted.
At the upper end of the reservoir, there are two gullies draining the hillsides.
Concrete walls across them are to cut off the surface drainage and divert It into
drains, one on either side of the reservoir to below the dam. The wash from
the steep hillsides if too rapid might sweep across the drains into the reservoir.
A low barrier of earth should be constructed on the reservoir side of the drains
to prevent this wash.
If a tight board fence enclosure around the reservoir to prevent the pollution
of the water by animal excrement has not been provided, it should be con-
structed.
As the reservoir is intended to receive the flow from the springs only, the
spillway will not be called upon to carry away any sudden Increase in the
amount of water entering the reservoir. No plans have been prepared for the
spillway. Such should be submitted for approval to ensure the stability of the
dam and earth embankment outside of It. The Department Is not informed as
to the extent engineering advice was sought by the water company in the
design and construction of this reservoir.
The East McKeesport Water Company's contract with the Pennsylveula
Water Company for supply of water expired on May first, nineteen hundred
and seven, and thereafter the Pennsylvania Water Company continued to
supply water to the said East McKeesport Water Company under special agree-
ment between the two companies. Said agreement was terminated on Septem-
ber tenth, on and after which time, there being no other alternative, water has
been furnished from the proposed new source.
The general plan filed contains but little explicit information. It would ap-
pear from it that the water is to be furnished by gravity to the boroughs of
Wall and Wllmerding, but that the supply has to be pumped into the East
McKeesport standpipe from a station located in Wllmerding on Welsh avenue
near Florence street.
The hills above the springs €md reservoir are sparsely populated and at present
may be adequately protected so far as to conserve the purity of the ground
water supply. The quality of the water now being furnished by the company
to the district should be equal to the quality of the water furnished in the past
by said company, but the extent of the water-shed, or the streets in which
water pipes have been laid and the details of the system are not known to the
Department. It would be Impossible without much undue labor for the De-
partment to tell in the event of an outbreak of a water borne disease whether
it were attributable to the said ground water supply or the Pennsylvania Water
Company supply of springs or private wells. The law requiring full plans and
descriptions of water works systems to be filed in the State Department of
Health has not been complied with, probably through lack of knowledge of
what is required.
While the Commissioner of Health does not determine the charter rights of a
private water company, yet an application for approval of plans for the supply
of water to the public at wide variance with statutory laws governing such
companies would not be considered. The statement of purpose in a charter is
presumably to identify the class under which a corporation is desired and as
so identified, the corporation takes the power conferred upon that class by
statute. The law conferring the powers makes no stipulation as to where the
publii? supplied shall reside. It is a well settled principle that a coroporation
cannot supply water beyond the territorial limits for which it was created, and
in which it is located, with the exception, that upon the written request of a
majority of the land owners in a district adjacent to such territory the com-
pany may thus enlarge its territory specifically described.
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No. 16. COMMISSIOKBII OF KfilALTB. 49S
Tho supply, however, may come from within or without the district and while
rivers and creeks are the most natural source, the company may procure a
supply from any other source such as the purchasing of it from another water
company, provided, however, that the latter company be allowed to sell it.
It appears In the case in question that the East McKeesport Water Company
purposes to procure its supply from springs ajid a reservoir in North Versailles
township and Wall borough and by pipes leading through North Versailles
township and Wilmerding borough and a pumping station necessary to raise
the water into East McKeesport borough, to supply the public with water in
the territory stipulated in its charter, namely East McKeesport borough; and
further it purposes to supply the public outside of these limits; but the peti-
tioners have not shown by what right and authority of law the E^ast McKees-
port Water Company can sell water in the territory of Wilmerding, Wall or
North Versailles. Clearly the Melrose Water Company may sell water to the
public in Wilmerding borough, and the South Versailles Water Company to
the public in North Versailles township and the borough of Wall, but these
companies have not applied for permission to construct or extend water works
in their respective territories. The mere ownership of stock in these companies
by the East McKeesport Water Company, does not give the latter the right,
and in absence of a legal merger of all three companies, the approval by the
Commissioner of Health of the proposed water works must be limited to the
portion thereof necessary to supply water to the public within the territory
stipulated in said East McKeesport Water Company's charter.
It has been determined that the proposed source of supply, pipe lines and
pumping station necessary to deliver the water from said source of supply to
Bkist McKeesport borough, and the water works extensions within said borough
will not bo prejudicial to the public health and a permit is hereby and herein
granted therefor under the following conditions and stipulations:
FIRST: That each spring be enclosed and covered with a suitable masonry
cor.struction provided with a tight fitting door which shall be kept locked so
as to prevent pollution by surface drainage or otherwise. And all of the springs
except the Livingstone Spring shall be fenced about so as to exclude animals
from the immediate vicinity.
SECOND: In the case of the Redhouse Spring, the drain which connects
smaller springs in the immediate vicinity with it, shall be covered to prevent
surface washings entering the drain and a ditch shall be constructed on the
uphill side of tbe spring to intercept surface drainage and conduct it to points
below the spring.
THIRD: The water company shall provide or cause the privy on the hillside
above tho IJvlngstone Spring to be provided with a water tight vault, and the
contents to be removed, when necessary, to some point from whence the sew-
age cannot directly or indirectly contaminate the waters to be supplied by said
company to the public.
FOURTH: The company shall maintain a sanitary patrol of the water-shed
and report monthly to the State Department of Health thereof. The existence
of any infectious disease thereon shall be immediately communicated by said
company to the Commissioner of Health. Such efforts and precautions shall be
taken by said company as are customary and essential to preserve the purity of
the water to be supplied. If at any time in the opinion of the Commissioner of
Health the source of supply, or the water works, or any part thereof, has,
become prejudicial to the public health, then the said water company shall
adopt such remedial measures as the Commissioner of Health may advise or
app rove.
FIFTH: The Company shall cut off surface drainage from the gullies at the
upper end of the reservoir by suitable concrete walls extending to solid rock
and adequate drains extending from these concrete walls down either side of
the reservoir to carry off surface water from the hillside slopes to below the
dam, shall be provided. These drains shall be substantially built to avoid
erosion. An embankment shall be built between the drains and the reservoir
as an added precaution to prevent surface wash into the reservoir. Said
reservoir shall be enclosed in a tight board fence to prevent accidental or
malicious contamination of the waters in the reservoir. These things shall be
done and a certificate thereof rendered by the water company on or before the
first day of May nineteen hundred and eight.
SIXTH: Detail plans of the water-shed above the springs and the reservoir
showing roads and buildings and the limits of the water-shed and land lines
and the location of the springs and the reservoir and the land owned by the
water company; and detail plans of the dam and the reservoir, pipes and loca-
tion of valves and the topography of the reservoir; and detail plans and profile of
the supply mains and of the water pipes in the streets of the water district
showing sizes, location of gates and hydrants and facilities for draining the
system; and detail plans of the pumping station, force main and standpipe
and a plan showing clearly the line dividing the pumping district from the
gravity district shall be prepared and placed on file in the State Department of
Health on or before May first, nineteen hundred and eight These plans shall
be made on a scale not less than two hundred feet to an inch so as to be
readily intelligible.
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494 SE(X)ND ANNUAL REPORT OF THE Off. Doc.
SEVENTH: At the end of each year, plans and profHes of the water mains
laid duriDff the season shall be made and filed with the State Department of
Health, together with any other information that may be .required in relation
thereto or the operation of the water works system.
BJCIHTE: A complete plan and profile of the dam and the construction of
the overfiow channel there shall be submitted to and filed with the Commis-
Bione.* of Health.
NINTH: So niucli of the East McKeesport Water Company's application,
herein considered, as relates to the supplying of water to the public in Wall,
Wilmerdlng and North Versailles township is rejected, being thrown out for
the reasons hereinbefore stated. Since there appears to be no law prohibiting
the approval of a plan for the supply of pure water to the public in Wilmerding
by the Melrose Water Company, and to the public in North Versailles township
and Wall borough by the South Versailles Water Company, the source in each
case being water furnished by the East McKeesport Water Company at a point
in the territory where such a sale of water might be legal, the Commissioner
of Health will entertain such applications from said Melrose and South Ver-
sailles Water Companies, owing to the fact that there seems to be a demand for
and there Is need of a pure public water supply for these places.
This permit is issued under the express stipulation that the East McKeesport
Water Company's charter rights shall not be exceeded and that all laws regulat-
ing and controlling the business in which it purposes to engage shall have been
complied with so far as the same may be applicable.
Harrlsbbrg, Pa., November 2nd, 1907.
ELLrWOOD CITY, LAWRENCE COUNTY,
Ellwood Water Company.
This application was made by the Ellwood Water Company of Ellwood City,
Lawrence county, ^ nd Is for permission to extend and improve its system of
wat3r works in said borough by the enlargement of the reservoir or storage
basin of the said water work^t system.
It appears that Ellwood City borough is a manufacturing town of about
thirty- two hundred population and including its environs, four thousand people,
located in the extreme southern part of Lawrence county on the south bank of
the ColinoquenesBing Creek one mile above and west of the point where the
creek enters the Beaver River.
The people very generally use the public supply, there being reported to be
only about fifty driven wells scattered over the borough supplying possibly two
hundred inhabitants. The industries use considerable quantities of water, the
total consumption being about one million gallons for all purposes in the distncc.
The Ellwood Water Company was Incorporated under the laws of the State
in eighteen hundred and ninety-two to supply water to the public in the town-
ship of Wayne, Lawrence county and adjacent thereto. This was before Ell-
wood City became a borough and while the place was not much more than a
summer resort located on the sandstone bluff or table land abutting the creek.
Now the town extends southerly up the rising ground to the hill in North
Sewickley township, Beaver county. Its thriving industries point to a robust
growth.
The source from which the supply of water is taken is the Connoquenessing
Creek at a point in the north-eastern comer of the borough, and also from a
point on Slippery Rock Creek in Perry township, Lawrence county, immediately
above the confiuence of said creek and the Connoquenessing.
The main supply Is taken from Slippery Rock and is pumped through the
borough mains to a storage reservoir on the hill In North Sewickley township.
This reservoir holds less than one million gallons. The machinery at the
pumping station is operated by electricity, generated at the pumping station
on the Connoquenessing where there is a dam across the creek built for power
purposes. When the Slippery Rock pumping station machinery is not in use,
the entire supply of the borough is pumped from the Connoquenessing Creek.
The pool formed by the dam extends up stream about three-quarters of a mile.
No attempt at purification is made of either source. How much water from each
creek is taken is not a matter of record in the State Department. The company
has not furnished the Department with plans of its intakes, pumping stations
and distributing mains. The system furnishes fire protection to the borough,
and at present, there are all told about thirty-four hydrants located at im-
portant street corners, and in the yards of the various industrial plants. The
pressure is reasonably satisfactory averaging from twenty-eight pounds at
high points in the town to nearly one hundred pounds in the lower parts.
The Company purposes to enlarge the storage reservoir to a capacity of four
million gallons by constructing new earth embankments with masonry core
walls carried up above the height of the fiow line of the water. The means by
which the water Is to be forced into the reservoir and drawn from it, and the
facilities for drainage are not clearly shown or described in the plan and report
submitted with the application.
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No. 16. COMMI86IONBR OF HEALTH. id6
The Connoquenessingr Creek receives sewasre from the boroughs of Zelienople,
Harmony, Butler and from other sources. Zelienople is twelve miles above EUl-
wood City and Butler is twenty-seven miles. The population on the water-shed
of the creek above Butler is rural, and the discharge of sewage into the streams
on this area caused the epidemic of typhoid fever in Butler in the fall of nine-
teen hundred and three. The danger of a similar scourge at Bllwood City so
long as the water supply is taken from the streams and used unflltered, is
greater and because of the pollution of the Connoquenessing Creek by the
sewage of Butler, Harmony and Zelienople, the risk of using this creek water
at Ellwood City for drinking purposes is materially increased.
The population on Slippery Rock Creek comprises two boroughs. Slippery
Rock borough is the first and is twenty-four miles above Ellwood City. Its
population is about one thousand. Grove City is five miles further up stream
and has a population of sixteen hundred people. However, it is evident that a
less population does not afford security from dangerous pollution and while
Slippery Rock Creek is less polluted than Connoquenessing Creek, neither of
them are safe sources of supply to the public unless the water taken from these
streams b» filtered.
In view of the circumstances, approval of the plans of the proposed extension
of the water works system is withheld until plans for the purification of the
sources of supply, or some other project for the furnishing of a pure and whole- •
some su])ply to the public in Ellwood City borough and vicinity be submitted
to the Commissioner of Health for approvaL
Hairioburg, Pa., April 2»th, 1907.
FRANKUN, VENANGO COUNTY.
Venango Water Company.
This application was made by the Venango Water Company of Franklin,
Venango county. Pennsylvania, and is for permission to secure an additional
souice of supply.
It appears that the Venango Water Company now supplies the city of
Franklin and suburbs with water. The city is located at the Junction of French
Creek and the Allegheny River and lies on both sides of the creek and the west
bank of the river. Along the streams are the fiats upon which the community
resides. These fiats are hemmed in between high hills which are precipitous.
A few of the citizens only have erected dwellings on the steep slopes.
The principal source of supply of water is from the ground in the valley of
French Creek, but copious springs on the hillside are also resorted to. Owing
to the difference in elevations the higher occupied portions of the built-up terri-
tory are supplied by high service systems while the flats are put on Uie low
service system. Two of the high service districts are furnished with water
frotv't springs on Gurney Hill. This hill is south of French Creek and down it
in a ravine northward to the creek is Gumey's Run, separating Gurney Hill
from Plummer Hill.
Gurney Spring is tlie most important one and water therefrom is delivered
into an iron tank located on Plummer's Hill, supplying the immediate district
known as Miller's Addition, all surplus water from the tank flowing into the
Liberty street high district system. This latter district is also supplied from
Collin Spii ng located on Gurney Hill from whence the water is piped to an iron
tank on Plummer Hill near the other tank.
Thnse springs were approved, together with the other sources of the Venango
Water Company, in a permit iESued by the Commissioner of Health and dated
Harrisburg, August second, one thousand nine hundred and six.
The petitioners represent that the system known as the Liberty street system
of the Venango Water Company is inadequately supplied, and as an additional
supply can be procured from a spring located along the Pittsburg road in
Gurney Run Ravine, on the up-hill side of the road and distant from any dwell-
ings or source of contamination, that a permit be granted for this additional
supply. Th'^ amount of water prc-duced by the present springs of the Liberty
street system is insufllcient for domestic use. By attaching the proposed new
spring to the system, the supply will be augmented about forty thousand gal-
lons daily, which will be ample, it is estimated, for the district.
It is proi«osed to convey the water from the spring through a two inch line
of pipe to the main line in the ravine leading from the Collin Spring.
The new source is a natural spring cropping out at the foot of a high bank
above which the sui*face of the ground ascends rapidly through a wooded un-
occupied territory to the top of the ridge which is elevated about seventy-flve
feet above the spring.
An excavation has been made in the bank and a masonry basin about six feet
square constructei and covered over and made tight for protection. There are
three outlet pipes from the tank. One is an overflow and terminates Just out-
side of the wall, the waste water going to the gutter; the second is the supply
main, and the third is a pipe leading to a watering trough at the highway. All
three pipes terminated horizontally in the inside of the tank.
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4M SECOND ANNUAL REPORT OF THE Off. Doc
It haa been determined that the proposed source of additional supply appears
to be not prejudicial to the public health, and said supply is hereby approved
and permission granted therefor, under the following conditions and stipula-
tions:
FIRST: That the conditions and stipulations set forth in the said permit
Issued to the Venango Water Company by the Commissioner of Health, dated
August second, one thousand nine hundred and six, shall be extended to and
include the additional source of supply herein approved in so far as said con-
ditions and stipulations may apply.
SEICONDr That the overflow pipe from the new well herein approved shall be
fitted on the Inside of the tank with an albow. Also that the supply main troia
the tank shall be fitted with a valve in order that the spring may be cut off as
A source of supply if necessity should require it.
Harrisburg, Pa., July 12th, 1907.
FRAN'KUN, VENANGO COUNTY.
This application was made by the Venango Water Company of the City of
Franklin, Venango county and is for permission to obtain an additional source
of supply from French Creek, and to approve plans for the filtration of said
source of supply.
Franklin is a city of about nine thousand population and its suburbs contain
abount one thousand more. It is located on the west bcuik of the Allegheny
River at the confluence of this river and French Creek.
The built up part of the town is largely on the flats which are surrounded by
hills. French Creek comes down from the west and south of it in the city is
Gumeys Hill and Plummers Hill, the two being divided by Gurneys Run, which
flows northerly into the creek.
Smith's Run is the southerly boundary of the city and Gurneys Hills and it
empties into the Allegheny River.
North of French Creek there is Gardners Hill at the fork of the river and the
creek, and Oak Hill westerly of Garners Hill, the two being separated by
Monkey Run, which flows southerly into FYench Creek within the city.
A small percentage of the city's population live on the hillsides. The indus-
tries are mostly on the flats north of French Creek. These flats are about
twenty-five feet or more above the creek and are never flooded, but the lower
portion of the city, on the Alleghney River is subject to flood.
The Venango Water Company, which supplies the city with water, was
cretaed by special act of Assembly, dated April fourteen, eighteen hundred and
sixty-three. At present the principal source of supply is obtained from the
ground in the vicinity of the pumping station In FYench Creek township.
Copious springs on the hillsides and surface waters therefrom furnish the next,
but smaller, volume of the total supply. When all other sources are insufficient,
French Creek water is used.
The larger part of the town is on the low service system, and, under ordinary
conditions, is supplied with water by gravity from Smith's Run and De Woody
Run and from springs tapped into the supply main below the reservoir on
Smith's Run. Also by ground water pumped directly into the system from the
French Creek township pumping station.
On account of the fact that Smith's Run reservoir is of insufilclent elevation
to maintain the desirable pressure on the low service system, it is but little
used. During times when the surface water from the two runs is turbid, it
is not admitted to the pipes. At such times a greater demand is made upon the
supply by the pumps.
When fires occur, the high service district tank Is connected with the low
service system and the entire town put under high pressure, the water in the
high pressure tank and the pumping supply furnishing the water at such times.
There are three independent high service districts. Two of them obtain their
supply from springs on Gurneys Hill. They are the Miller's Addition and the
Liberty street district.
The third high service district is the Oak Hill system and it is supplied with
water from the pumping station. The water is pumped into an iron tank forty
feet in diameter and forty feet high, located on Oak Hill about five hundred
feet above the pumping station. From here about sixty families are supplied
in Franklin and about one hundred and forty families outside of FYanklin in
Sugar Creek township.
When a fire occurs in the city it is the Oak Hill tank pressure which is put
on the whole system.
On the east side of the Allegheny River, opposite Franklin, in Cranberry
township, there are a few dwellings supplied with water from a spring.
In the Oak Hill district there is a spring known as Stony Spring, which sup-
plies drinking water to twenty families in the city. Springs in the valley of
Emory Run also supply water. This run empties into French Creek at the
pumping station. It has its rise in the table land about a mile and a half back
from French Creek and about five hundred feet above it. The water shed may
comprise about one square mile, and its tributary possibly one- third of a
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No. 16. COMMISSIONER OP HEALTH. 4M
square mile. At the head of the main stream there are in the nelgrhhorhood of
a score of dwellings. On the drainagre area of the tributary, near the summit
thereof, there are four or five habitations. The water company conducts the
water of some of the sprinsrs in this valley to a dug well at the pumping station.
The surface water from the main run is not used. The distance up the run
from the pumping station to the spring is about one-half mile.
The pumping station is located near the banks of French Creek above the
city, in the center of a little basin bounded by hills, French Creek and Emory
Run. West of the pumping station and about one hundred and twenty feet
distant therefrom, there is a well eight feet in dameter and thirty-six feet deep,
excavated in gravel and walled up in cement masonry through which there are
holes to admit of the entrance of ground water. This well extends to bed rock
which is sandstone. A suction pipe extends from this pump well to the station.
This supply is spoken of as the dug well supply.
East of the station, and within a distance of two hundred and twenty feet,
there are eight driven wells sunk through thirty-six feet of gravel and forty
feet of sandstone to shale rock. These driven wells are connected with a four-
teen inch suction pipe to the pumps. North of the station on the banks of
French Creek and about two hundred and fifty feet from the station, there is a
settling basin about eighteen feet square and quite deep, the bottom being
excavated in shale rock and the sides close sheeted and braced. French Creek
water is Introduced into this tank, from whence it is pumped through a twelve
inch suction pipe. The creek water is strained in a small chamber before enter-
ing the tank.
In the pumping station there are two pumping engines. The larger has a
capacity of two million gallons per twenty-four hours and is called the low ser-
vice pump. It is connected up with the dug and driven wells. It is into the dug
well that the water from a small spring from the adjoining hill and from the two
springs in Emory Run valley is piped. While this pump is termed the low pres-
sure pump, in cases of fire it is connected with the Oak Hill high service tank.
The smaller pump has a capacity of one million gallons daily. It is used for
the high pressure service during ordinary times. It is also used to pump French
Creek water. By an arrangement of gates, it is possible to use both pumps
simultaneously on the low service or the high service. Thus depending upon
the manipulation of the gates, French Creek water may be pumped into the
Oak Hill district, the low service district, or the Liberty street high service dis-
trict, or all three of them. A check valve prevents water from the low pres-
sure district backing up into the Smith Run reservoir, but there is a by-pass
by means of which the reservoir may be filled by pumping.
On June twenty-seventh, nineteen hundred and six, the water company gave
notice to its consumers to boil all water. This was done because the ground
water supply had become exhausted, or rather was insufficient to meet the
increasing demand of the pumping service. On June twenty-seventh, Uie total
water pumped was in the neighborhood of one million one hundred and twenty-
five thousand gallons. The next day it increased to one million one hundred and
eighty thousand gallons, of which one hundred and ninety-five thousand gallons
were French Creek water. On subsequent days, up to and including July
thirteenth. French Creek was Introduced into the system, being always pumped
into the low pressure service. The largest day's pumping record for the period
showp that over three hundred thousand gallons of French Creek water were
used. The largest day's pumping record was one million six hundred thousand
gallons. The manufacturers are all in the low district. On the high districts
reached by pumping there are about one thousand people served. The records
show that for a period of twenty-nine days at that time the people in the high
districts used on an average of about sixty-four gallons per capita daily and
this water was used only for domestic purposes. In the low pressure district
the records show that for the same time one hundred and twenty-five gallons
of pump water were used per capita. This does not include the gravity supply
from Smith and De Woody Runs, et cetera. This water was used for domestic
purposes also, very largely because the city is in the natural gas field and the
industrial plants are operated by gas driven engines.
The domestic consumption in the city during the last week in June and the
first two weeks in July fluctuated between one hundred and twenty-five and
one hundred and fifty gallons per capita daily.
Subsequent to June twenty- sixth of that year, the water company Introduced
meters on those taps where it was thought the consumers were extravagant in
the use of water. Prior to this time there had been no attempt to check water
consumption. The meter results conclusively prove that there was a very
great waste of water on the connections where the meters were Installed.
French Creek, at its Junction with the Allegheny River, drains an area of
fourteen hundred and fifty square miles. Twenty-eight miles above it, the city
of Meadville discharges its sewage into the creek. Between these two cities
there are several smaller places on the banks of the creek.
The stream is not a rapid one. There are few mill privileges along its course.
The valley is generally broad and the bottom lands are under cultivation to a
considerable extent. Shoal waters and a rocky bed afford frequent opportunity
for fords. Bridges across the creek are not numerous. The stream below Mead-
32—16—1907
Digitized by VjOOQIC
498 SECOND ANNUAL, REPORT OF THE Off. Doc.
viUe during the dry season is a succession of pools and shoals. Thus sewage is
afforded an opportunity for sedimentation and aeration. This accounts for lack
of much evidence of sewage pollution in samples of water taken from the creek
at Franklin and analyzed. But sewage is present. In nineteen hundred and
five, there were twenty- three cases of typhoid fever recorded in Franklin City,
between June tenth and September sixth, nineteen of which used city water,
and while upon investigation no evidence was found connecting the epidemic
with the city water supply, the general impression prevailed that the use of
French Creek water was a public menace.
On August second, nineteen hundred and six, the Commissioner of Health
issued a decree to the Venango Water Company, prescribing among other
things the following:
"All of the springs and surface waters now belonging to and used by the
Venango Water Company shall be properly protected from contamination.
When said waters are taken from springs, said springs shall be walled up and
covered over and otherwise protected satisfactory to the Commissioner of
Health; and where they are taken from natural water courses, the water com-
pany shall patrol the watershed and report to the Commissioner of Health
monthly regarding the sanitary condition of all properties, dwellings, barns,
outhouses, cess-pools and other occupations thereon, to the end that no sewage
or deleterious matter shall directly or indirectly contaminate said waters.
"An emergency intake to FYench Creek is hereby approved, but its use is
absolutely prohibitive during all ordinary times, or even in emergencies,
except an extraordinary emergency. To regulate this use to the satisfaction of
all concerned, it is prescribed and expressly stipulated that the gate or valve
on the intake pipe to French Creek shall be closed and sealed to the satisfaction
of the Commissioner of Health by a seal to be made by the water company and
kept in the custody of the local board of health, who shall have permission to
inspect the premises. This seal shall not be broken by anybody but the water
company, and it shall not be broken and the valve opended and the creek
water used except in an extraordinary emergency as above provided, in the
event or which use the State Health Commissioner shall be notified and the
local board of health. The water consumers shall be forwamed to boil the
water, and thereafter such measures shall be taken as the Commissioner of
Health shall prescribe or approve for draining the entire water works system of
French Creek water. When the emergency shall have passed the valve shall be
closed by the company and the seal afllxed by the board of health.
"To the end that the water company may meet the demands of a growing
municipality and obviate the necessity of using French Creek water, it is
necessary that the water company should look about for some permanent and
abundant additional supply 
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