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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. 



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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. 



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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. 



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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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(38) 



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OPERATIONS OF THE DIVISIONS. 



DIVISION OF MEDICAL INSPECTION. 



FRBDBRICK C. JOHNBON, M. D., Chief Iiuipector. 



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(40) 



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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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No. 16. COMMISSIONER OP HEAiyTH. 41 

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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48 SECOND ANNUAI- REPORT OP THE Off. Doc. 

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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No. 16. COMMISSIONER OF HEALTH. 49 

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 



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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 



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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 



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<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 



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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 



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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 



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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 



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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 



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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 



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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 



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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. 



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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 



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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 



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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. 



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Ko. 16. 



COMMISSIONER OF HEALTH. 





s 
: 


TIOM. 


RiVAB. 




^ 

M 




1 


MOUPBOU- 
OLOT. 


s 

1 






fr 
1 


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o 


1 




i 


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H. 
Co, 


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8 




Pink 

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+ 
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+ 


50 
SO 
35 
50 
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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. 



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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 



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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» 



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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 



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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. 



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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 



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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. 



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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 



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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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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 



Off. Doc. 



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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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. 



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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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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 



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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 



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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. 



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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 


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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 


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MO' 


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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~' . 





































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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. 





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t 


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f 


10 


n 


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It 




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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, .... 































































































"• 
























^" 
























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mJt ' 








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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 

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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 

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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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J^ 



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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The Bureau of Vital Statistics 



WILMER R. BATT, M. D., State Reeristrar. 



Cl») 



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(166) 



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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 



Digitized by VjOOQIC 



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- 



Digitized by VjOOQIC 



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. 



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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 



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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 



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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 



Digitized by VjOOQIC 



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 



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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 



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WnooPTH© Couon- 
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Diagram showing the comparative mortality from Diphtheria, Whooping 
^^b, Scarlet Fever and Measles hy the number of decedents from each cause 
^ months. 



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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 



Digitized by VjOOQIC 



Off. 


Doc. 


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 



Digitized by VjOOQIC 



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 



Digitized by VjOOQIC 



Digitized by VjOOQIC 



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. 



Digitized by VjOOQIC 



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. 



Digitized by VjOOQIC 



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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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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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 




J«fle»wm .'.1 




j™2?r : : : ; : 






La^avaoML 


1 


1 


uaeas^r:..::::^i^i^^i^;;ii".^^.^.^^.-..^"^.":ii:iii 




Lairraoce 


2 




LebuMo ' '. 




LtSgT ."!i:ii::::::"ii"^i^ii*"'*^.ii"iiiiii'i!!ii!iii 


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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888 



BBGONI> ANNUAL. REPORT OF THE 



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Digitized by VjOOQIC 



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 


g $3g98ia 88§99 2**^^^ sss^^Q sgsats S'^a^s^ S9ti*"§ 


i 


g SI|(SIBSS s^^xd ga^dis K8SS»a 9S§81& §'»9'-S ft99:Sg 



I 



g S|9s;a ss»g88 s'^sas^ Adssig aap«s s^ts'^a ^^^^S 



2 ag!;9a ssagsss 3*aAS s;;i9ax assssss §**a"*s ^^sssg 



S agaaa aagsa §"6«fi ss^saa aatisa s*?:-^- ^'3*2 



g sgsaa gagas S*^^^ agsits ^asjaa 3'«9**s3 aassg 



J, 



I 



S ^gssa* sdgssa g^^^sis^ a{2;::sa a§9sa §**a«-s Mass9 



2 s::g^&a sagas g^xa& »9asa 9gase 8»a^» aaasg 

lA 



§ SS^'" ^agaa Fi^assa ;!:asas a§xaa s^a^s aaa^s 



g s^gtssa ?s!;§a^ s 



8«)ig S9saa sg&»s ^''s^s aaa*^^ 



3 agaaa ad§9s s^;;a9 '^a^'aa aa«;:ja a**s^'*' ^aa**g 



S 3Sg§§ l§333 S»SS§ SSISSS SSSSS S»S&S SSSSi 



;*l 



' is Uf I 



fj ^^ 




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 •« 



S^^sa silvan §»S3^ S-sg* »-fc«« aaaag «a 



5S«53 ^««2aa sngss g^aga 8-oaa SAx^g -a: 



«9asa ssteSifl a»i:p»- g««g* 8-»aa« ss&a^-g •« 



sd^ssg «5;«a^ «-»sas g-^^g* «»-fca* aaa'-g -a 



S9S83 iseasia gsggs g**sg» &38as ^^s^S ^S 



8ssg3g asisas 8-*Fi85; g-'^g- a^a*" «aS''E ^« 



S^egg «Maa g«ga55 g-^-ga a^-as* aaasg 's 



gsisse a*aas a*aaa g-^aa a^aas as^?"? --g 



S8SS9 


8S»^ 


a^aas 


g-^-g* a^5;*a 


8fl5-§ 


«s 


a»«2a 


asaaa 


S-g6- 


2«-g£; B^a'-*- 


asa^g 


sa 


sssss sassg issgs gsssa §&i§s 9ssss ^i 



I 
II 







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 


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896 


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962 


90 


247 


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54.476 

1.949 
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17.681 

5.768 

779 
418 
111 
44 

19 
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169 


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18,288 










170 
600 
988 
1,010 
845 
710 
480 
824 
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119 
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Digitized by VjOOQIC 



The Division of Distribution of Biological 

Products 



HENRT W. PBUR80N. Chief. 



(3SS) 



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(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) 

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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. 



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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. 



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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. 



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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 








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& 


8 


s 


9 




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n 


m 


$^ 


M 


§ 


i 


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Z 


8 


* 


< 


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8 


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s 


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s 


1 
1 


1 










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9 

55 


S 


6 










43 


10 










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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 

: 





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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 









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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 

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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 



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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* 



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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. 



(tK> 
26-16—1907 



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i-.4i-^ V 




i^-ii-.-i 



(sse) 



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J 



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) 



Digitized by VjOOQIC 



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 

Digitized by V C 



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. 



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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 















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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. 



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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 



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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. 



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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 



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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 



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416 



SECOND ANNUAL KB2PORT OP THB 



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No. 16. 



COMMIBBIONBR OF HEALTH. 



417 



CJHAUT NO. 3. 
97-A ANTISBQEIUM WITH DIFB'EiRBNT CU1L.TURE3S. 



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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 



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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. 



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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. 



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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- 



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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 

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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. 

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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 

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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- 

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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- 



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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. 



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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 














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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 



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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. 



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THE) DIVISION OP SANITARY ENGINEERING. 



F. HERBERT SNOW, C. E., Chief Engineer. 



(453) 



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(464) 



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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. 



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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. 



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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. 



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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 



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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 



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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. 

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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 



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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 



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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 

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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. 



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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 



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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. 



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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 



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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. 



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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 



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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 



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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 



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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, and it is herein stipulated that consent to use the 
proposed supply herein approved, including French Creek in emergencies, is 
given on the condition that within one year from the date of this permit the 
said company shall present plans to the State Health Commissioner for a more 
abundant permanent additional supply. It is suggested that it be determined 
whether the maximum amount of water to be drawn from the ground in the 
vicinity of the present pumping station, without depleting the supply in said 
vicinity, has been reached. Possibly this source, if wholly developed, will be 
sufficient to meet all needs for a considerable time. 

"To prevent wastes and at the same time conserve the present supply, meters 
should be generally introduced so far as this may be practicable and consistent 
with the applications of the company as a business corporation." 

On June twenty-seventh, nineteen hundred and seven, the following letter 
was sent by the Commissioner of Health to the president of the Franklin Board 
of Health: 

"The Venango Water Company wishes to conduct some experiments relative 
to the increasing of its ground water supply at the present pumping station, 
during which experiments it appears desirable that said company should utilize 
the intake between the French Creek and the station. We are informed that the 
water company will not use any of this water in its water works system, and, 
therefore, I respectfully request that you permit the valve on the intake main to 
be opened by the water company for the above purpose and under the condition 
and stipulation that none of the water shall be introduced into the public water 
works system. When the tests are completed, kindly see that the valve is 
closed and sealed as usual, and I would suggest that you have inspections made 
to satisfy yourself that by no accident or otherwise any of the water from the 
creek be admitted to the water works system during the experiment. Please 
oblige by writing me when the tests are completed and the seal placed upon 
the valve again." 

Some experiments were conducted and the results were such that the water 
company abandoned the idea of obtaining a never failing supply and satisfactory 
quality of water from the ground. Other projects were considered for an 
additional supply, so it is reported, and abandoned in favor of obtaining the 
source of supply from French Creek and Altering it. 

During the summer of nineteen hundred and seven, from July twentieth to 
October eighth, inclusive, forty-nine cases of typhoid fever occurred in the 
city. Four of them were in July and three of them were in August. The epi- 



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No. 16. COMMISSIONER OP HEALTH. 49d 

demic began about September twelfth. There were twenty-seven cases during 
the remainder of the month and thirteen in October up to the eighth. Of these 
forty cases p thirty-four were in Ward one on the flats where the district is 
supplied with reservoir water. All of these thirty-four cases were in dwellings 
furnished with public water and from information at hand it appears that the 
reservoir water was furnished up to October fifth, when the reservoir was shut 
off, the water drained out and the basin cleaned. Four of the cases were in 
Ward two in dwellings supplied with public water sometimes fed from the 
reservoir, the other two cases were in Oak Hill district. 

Inspections by the Department of the reservoir water shed and that of 
De Woody Run showed ten estates thereon, eight of which are occupied. Four 
of the occupied estates were found to be in an unsatisfactory sanitary condition, 
and notices were served by the Department on the owners. Three abatements 
have been eftected and the water company purposes to attend to the fourth. 

On November twenty-fifth, the water company notified the Commissioner of 
Health that it had become necessary, in order to supply the city of Franklin, 
for the company to resort to the Smith's Run and DeWoody Run water-shed. 
Besides proposing to make a weekly inspection of the water-shed, the letter 
contained the following: 

"The barn-yard will be drained away from any direct drainage. The cows 
will be kept away from the streams and the drain on the Power place will be 
carefully .taken care of, so that the wash water will not enter the run in a 
direct manner.*' 

On Smith's Run is the DeLong residence, where there was found to be an 
overflowinc? privy and a garbage dump within thirty-five feet of the stream. In 
the cellar of the residence is a spring whose sides are walled and from which 
the water flows in an open course out of the cellar and away from the premises 
into Smith's Run. The drainage of the yard is into this natural water course. 
Wash water and slops thrown out on the ground would drain Into the run and 
the reservoir supplying the town. 

At the head of DeWoody Run a sewer from Power's residence was found to 
deliver water from a bath-tub and sink to the surface of the ground at a point 
abount six hundred feet from the run. By means of a small channel the pollu- 
tion of the wati'r in the run was direct and this polluted water was fed into the 
water pipe system of the town. 

Investigations did not reveal the presence of typhoid fever on the water-sheds 
and therefore, there is lack of evidence of the origin of the incipient typhoid 
epidemic. Notwithstanding this, however, (and the milk and food supply were 
investigated) suspicion is attached to the water as the medium of the infec- 
tion, and the citizenn of the town are much wrought up about the supply. 

The foregoing facts are evidence that the terms of the permit of the Com- 
missioner of Health were not lived up to. The Department had been led to 
believe by reports frorn the water company of occasional inspections that the 
conditions were entirely different on the water-shed. 

The plans submitted for approval provided a plant for the treatment and 
puriflcation of French Creek water of a normal capacity of one and a half 
million gallons per day of twenty- four hours, with a maximum capacity of two 
million gallons. 

An addition to the pumping station fifty-eight feet long by forty-three feet 
wide is to be made and in this building the filter units are to be placed, and 
under the filters is to be the clear water storage basin. Outside of the building 
and nearby are to be erected two wooden sedimentation tajiks, each thirty feet 
in diameter and eighteen feet high, holding approximately eighty-five thousand 
gallons. 

The coagulant tanks are to be located on a platform in the building above the 
filters. Each tank, of which there are to be two, is to be three feet in diameter 
and three feet high. The one designed for the use of sulphate alumina will con- 
sist of cedar and the soda ash or lime tank will be made of steel. 

The water from French Creek is to be delivered through the existing pipe to 
a small intake well to be built Just outside of the pumping station. This well 
is to bd fitted with screens and proper arrangement to prevent leaves or other 
floating matter from entering the suction line. 

FYorn the screen well a fourteen inch suction pipe is to extend through and 
below the new station addition to the pump pit in the old pump house, where is 
to be installed a centrifugal pump to be driven by a thirty-five horse power gas 
engine and having a capacity of two million gallons daily, by means of which 
the water is to be raised into the subsidence tanks located Just outside of the 
building and having a flow line in them of thirty-six feet above the pump. It 
is the intention to supplement this pumping apparatus with a duplicate steam 
pumping outflt as an emergency equipment. The tanks are to be covered and, 
at a combined capacity of one hundred and seventy thousand gallons, will 
admit of two hours' subsidence, when the plant is being operated at a two 
million gallon rate. The tanks are to be made of white cedar bound with steel 
hoops. They will be baflled to retard the flow of water and assist in coagulation. 
The coagulant piping is to be of iron and lead. The sedimentation tanks are 
designed to be operated in tandem and the chemicals are to be admitted at the 
point where the water enters the tanks. 



Digitized by VjOOQIC 



SCO SECOND ANNUAL RBPORT OF THB Ott. Doc. 

A twelve inch pipe will conduct the subsided water to the filters. There will 
be four filters, each fifteen feet inside diameter by seven feet high, the tanks 
to be constructed of cedar in the customary manner. On the bottom of each 
filter is to be a heavy cast iron manifold, six inches in diameter, into which is 
to be screwed galvanized iron pipes one and one-quarter inches in diametex, 
which manifold pipes are to be drilled on six inch centres, in staggard section. 
Bach hole is to be seven thirty-seconds of an inch in diameter and the entire 
manifold system is to be anchored to the bottom of the tank. 

An air manifold system is to rest on top of the water manifold and to be 
securely held in position by anchors. There Is to be a two inch air space between 
the two maniofld systems admitting of a uniform distribution of the air and 
allowing space for sand to pass the air pipes without entering the openings. 
The main air manifold is to be three inch wrought iron pipe with brass pipe 
branches three-eights inches in diameter, laid in parallel rows six inches on 
centres. The brass pipes are to be perforated with one-sixteenth inch holes, 
six inches apart. 

The filter manifolds will be connected up to e4mit of through sterilisation of 
the filter beds with steam. 

The filtering materials is to consist of selected sand and gravel. There are to 
be six inches of gravel, from one to one and a half inches in diameter, placed 
on the bottom of the filter and to be covered with a six inch layer of gravel 
ranging in size from three-quarters to one inch in diameter. The third layer 
of gravel, four inches in thickness, will have diameters ranging from three- 
eights to three-quarters of an inch in diameter. The total sixteen inch gravel 
bed is to be covered with a thirty inch layer of moderately fine and well graded 
filter sand. 

Thus it will be seen that there are to be six inches of gravel over the water 
manifold, and four inches of gravel over the air manifold. The designers 
believe this will facilitate the best distribution of both air and water in the 
cleaning process. 

The air blower is to be capable of furnishing two hundred and fifty feet of 
free air per minute against four pounds pressure, and is to be operated by belt 
and friction clutch from the line shaft. One of the engines used to operate the 
centrifugal water pump is to be used for operating the blower. 

The six inch inlet to each filter through which the coagulated water is to be 
admitted terminates in a distributing weir in the filter at the surface. This 
distributing weir is to be of ample capacity to deliver the raw water or carry 
away the waste water. On the six inch pipe is to be placed a gate to shut off 
the supply and to admit of wasting of waph water to the sewer. The gate is to 
be fitted with a butterfly valve and float to maintain a uniform head on the 
filter at all times. 

On the six inch outlet pipe of each filter is to be fitted a conitroUer of the 
"Open Type", consisting of a cedar box twenty-four inches long, twelve inches 
wide and twenty- two inches high, fitted with a removable cover and provided 
with a fioat control, stilling rack and adjustable weir plate of brass construc- 
tion, admitting of a wide range of adjustment and free from parts to become 
corroded. 

The wash water supply is to be taken from the pressure line to the city, and 
a reducing valve is proposed to limit the wash water pressure to twenty pounds 
or less. Provisions will be made whereby each filter may be rewashed and 
this first filtered water be drained to the sewer. 

The drainage of the entire plant, including the water closets, is to pass 
through an existing sewer into French Creek at a point several hundred feet 
below the water works intake. 

There is to be an operating platform constructed between the filters and above 
the main fioor, on which are to be the stands for the manipulation of the gates 
to the filters. The filters may be used simultaneously or independently. The 
clear water basin under the filters is to be forty and sixty-six hundredths feet 
long by thirty-six and sixty-six hundredths feet wide, and thirteen and a half 
feet deep, inside measurements, and will have a capacity of one hundred and 
thirty thousand gallons of water. It is to be constructed of concrete meisonry 
and made water-tight. Facilities for draining to the sewer either by gravity 
or :by steam ejector are to be provided. The fioor over the basin is to be of 
reinforced concrete and is to support the filters above. There are to be two 
baflSe walls with arches in the basin to cause the filtered water to move at all 
times. They will also support the weight of the filters. An electric indicating 
ga,ge is to be placed in the clear water well to show the height of the water 
therein and call the operator's attention whenever the high water mark is 
reached. This will be accomplished by the ringing of an alarm bell. 

The plans show a twelve inch suction pipe from the clear water well to the 
fourteen inch suction pipe in the pumping station. Each of the existing pump- 
ing engines is to be connected up so that either filtered water or ground water 
may be pumped to the city. 

The improvements are to be installed by a contractor who, after the plant 
has been completed and put in successful operation, is to furnish a competent 
chemist to make bacteriological tests of the raw and filtered