/ L 1 B RA R,Y OF THE UNIVERSITY or ILLINOIS ?. llUMfllS IWSTORJCAl'SURm \' S "-i!;. ILLINOIS HISTORICAL SURVEY The Rise and Fall of Disease in Illinois IN TWO PARTS Printed b) authorily of the Slate of lllinoii LIBRARY UWIVERSiiy OF ILLINOIS UREANA The Rise and Fall of Disease in Illinois by ISAAC D. KAWLINGS, M. S., M. D. in collaboration with WILLIAM A. EVANS. M. D., D. P. H.. GOTTFRIED KOEHLER. M. D.. and BAXTER K. RICHARDSON. A. B. PUBLISHED BY THE STATE DEPARTMENT OF PUBLIC HEALTH IN COMMEMORATION OF ITS FIFTIETH ANNIVERSARY 1927 ILLISTRATEU WITH GRAPHS DEVELOPED AND DRAWN BY A. F. DAPPERT. AND WITH PICTURE REPRODUCTIONS OF MANY PERSONS ASSOCIATED IN ONE WAY OR ANOTHER WITH THE STORY. INDEXED Br CLARA BREEN IN TWO PARTS ^isJS g ipaa- ScHNEPP & Barnes, Printers Springfield, III. PREFACE. rrcifound changes have taken place during the last one hundred years in all departments of civilization but in none has the transformation been mure fundamental nor more nobly crowned with advantage than in the field of health. At the beginning of this period man was little short of a helpless victim to infectious diseases that frequently swept over whole cities and nations in great lethal waves. Today he is able to exercise a marvelous con- trol liver the factors involved in health, adding strength to his years and years to his life. The need for genuine jirogress in the conquest against disease was essential to the healthy contiiuiity of human life amid the growing complexity of modern existence. Swifter means of communication have brought all men closer together for good or for evil. Disease respects neither wealth nor social rank, becoming a universal hazard when the human carrier of infection mav he thrust across a continent between the rising and setting of the sun. When automotive ])ower unites a nation into one great social and commercial commingling, obliterating political boundary lines and increas- ing enormously the range of individual contact between fellow beings, there can be no compromise with comnumicable disease. When days have been reduced to hours and hours to minutes in measuring the travel distance be- tween points man has no choice but to conquer or succumb to the agents of epidemic infections. That he has subdued one after another of these ancient enemies is a signal manifestation of man's superiority over all living things and a splendid evidence that humanity is sweeping onward toward that great millenium which has lived in the aspirations of men since the beginning of time. The story of how man has triumphed over disease in Illinois ought there- ~~'" fore to be of common interest to every person in the State. Life is as dear ..to the beggar on the street as il is to the lord in the mansion, b'actors that ?"; tend to preserve or destroy- health in the one operate toward like ends in the ' other. Both may rejoice in the advancements of medical and sanitary science J^^ which have made possible the remarkable improvement in health conditions that are described in this volume. Both have inherited a score of \ears from 1 the wisdom that led sanitarians and doctors to apply their knowledge for .^-tke public good. 1 hat the State created, dexelujied and maintains an official agency charged with the duty and responsibility of participating in a moxeiuent so pregnant with jiossibilities for individual and public benefit ought to stim- ulate jjride and confidence in the character ol our government. •■^:) It is the dut\' nf Stale officers in rt-cord the ini]Hii-tant features of the public health inovenieiit as has been (Imie in tliis vdiunie. It is the ])rivilege of inchviduals to read and study these records, iioth processes will prove helpful in guiding future activities to even greater triumphs than the ])ast has witnessed over the enemies of human health. Lex Sm.\ll. FOREWORD. The title of this vohiiiie expresses a very gratifying actuaHty with greater approximation to the whole truth than might he surmised at first tihish. It may not be universally known that since the coming of white men into Illinois a considerable number of diseases have been kindled, flamed into constiming plagues and were then extinguished altogether or have left only the dying embers of what may soon be transformed into the ashes of history. Cholera, malaria, smallpox, yellow fever, typhoid fever, dysentery and per- haps diphtheria may be included in that group. Tuberculosis, the diarrheal infections and scarlet fever were once far more deadly and widespread than they are now. These and other diseases were not introdticed into Illinois in keeping with some predestined program prescribed by fate to pursue the particular group of people who elected to make the prairies their home. On the con- trary they came when conditions created by man himself invited, and they began to disappear when conditions created by man began to be intolerable for them. Most of the conditions which invited disease were in that respect created unconsciouslv. Xearl\- all of the factors which have influenced the waning strength of infections were consciously and deliberately employed to improve health conditions. Thus we have two very definite periods in the health history of Illinois. One embraces the time when communicable diseases played havoc with the public, finding nothing to check them in their gruesome business but the natural limitations of time, space and susceptible material. The other in- cludes the years since the public first began to employ scientific metlmds of prevention which h;ive played havoc with disease. .Accordingly \.h\> volume is divided into two parts. The first relates ihe story of health conditions from the very earliest times, so far as records per- mit, down to 187 T when the State began its attack ujion disease with the organization of the State Board of Health. The second relates to the fifty year period between 18TT and 1927, during which time a strong pulilic health service developed with telling results. There was no purpose to make this an exhaustive accoimt of all the factors involved in the field of health improvement. Such an ambitious un- dertaking would lead into the paths of medicine, bacteriology, chemistry, agriculture, economics, engineering, etc. .\n effort has been made to trace the history of communicable diseases in broad outline and to describe the origin and develo])nient of organizations devoted entirely or in some sig- nificant and direct way to the promotion of ])ublic health. Il is believed CM 10 KOKI!\VORI) that some reference may be found in this vcjUiiiu- to all important events bear- inji upon the subject t)f ])ublic liealth in ihc State, thus bringing together in one ])lacL' many valuabU- recnrds that were widely scattered before. It was the original plan tn include cha|)tcrs relating to the organization and develo])ment of municipal lioards and departments of hc'alth in the State. This scheme was abandoned at the last moment, after account had been written (if e\ents in sexeral cities and muiu' had been put into t\pr. hicause cif limited time and s|iace. The hojie tmw is that another vohnne will fol- low thi> one. pro\iding s]iace {(U' a fuller story about local public health work than this \dhtme could ever have accommodated. Aside from the collaborating authors much credit for liringing this ma- terial together is due to Miss Clara Breen, wdiose untiring efforts in searching records, collecting photographs and cross checking source liiaterial and to Miss Elin Berg whose services in classifying the source material and man- aging the stenographic work have made the task easier. Credit is also due to the chiefs of the various divisions of the State Department of Public llcalth who furnished the records embraced in the account of the divisions and to 1 )r. Carl lUack of Jacksonville who very generously supjjlied the jjlates of several photographs that would otherwise have been difficult to secure. The Editor. CONTENTS. Pakt One. PAGE Preface by Governor Small 7 Foreword U Introduction 13 General 1 lealth History Prior to 18" 15 The Indian 15 The French Regime '■^2 The British Regime 2G The Spanish Influence 27 The American Regime 27 History of Certain Diseases Prior to 187^ 35 Cholera. 43 ; Consum|.)tion, (iO ; Cynanche, 55 ; Diarrhoea and Dy- sentery, 83 ; Diphtheria. 55 ; Erysipelas, 50 ; Gonorrhea, (in ; Malaria. 35; Measles, 54; Meningitis, 5() ; Milk Sickness, >U'< ; Nursing Sore Mouth, (iiJ ; Ophthalmia-Epidemic, 57 ; Pneumonia and Influenza, 62 ; Puerperal Fever, 65 ; Scarlet Fever, 53 ; SmalljKix. 49 ; Snake P)ite, 47 ; Syphilis, 58 ; Tuberculosis. 60 ; Tyjihoid I'^ever, (ill ; Typhus Fever, 47 ; Yellow Fever, 46. Infant Mortality SG Deaths of L'hildren Lender Five 88 Seasonal Distriliuti(in nf Disease 8i) \"ital Statistics and Mortality from All Causes !)(i Health in ."some Cities Prior to 1877 101 Chicago 101 Springfield 115 Kaskaskia 1 1 (; Shawneetown 11 S X'andalia 118 (11) 12 con'thnts Part Two. i'ac;e Public llt-alth Admiiiistraiidii 127 Genesis (if Public 1 U'alili 1 .:i\v 127 l^evel(i])iuciit cif Stale 1 IcaUli Service i;i;? Stall' Health Machinerv l;ii; Rauch Regime 1 'Mi Mgau Regime 1 .")!) 1 )rake Keniiue 1 ; 4 Rawlini;^ Regime I'.ii lutra-De|)artnieutal < )r,i,fauizati(in 208 luifnrcenient of Medical Practice Act 2T3 Auxiliary 1 lealth At^encies 2S7 Mealth C'onditious After is:: 304 Cerebrospinal Fever. ;5:(); Cholera. 3'2() : Diarrhoea! Diseases, 3TT ; Pneumonia. 3S: ; Polionivelitis, 380 ;' Scarlet Fever, 348; Small- ])ox, 3o: ; Tuberculosis. 3(il; Typhoid Fever, 338; Whooping (.out^h. 3!M); \'ello\v Fever. 3-^: ; Infant Mortality. 393. Sitniniar\ and Conclusion 39G INTRODUCTION. Acccirding to traditimi the first dcciqiants of the llliiKiis terrii(ii\- were the mound builders. They were followed by the Indians. W hence they came to the Illinois territor)- is a matter of surmise. The rather acccjited opinion is that the first Indian occupants of the territory came from tiie west. Tribes generally accepted as being of west- ern origin occu])ie(l tjie region at the time when the jiressure of white men in the countr\- to the westward caused a migration liringing some more east- erly trilies of Indians into conflict with the tribes of western origin. At the time white men began coming into the territory the conflict be- tween the eastern and western tribes had not ended. To the south of Illi- nois there lay a great lumting grovnid which served as a barrier against the southern Indians. From Pickett's History of .Alabama we learn that one tribe migrated from Mexico north-eastward to the Illinois territory but they did not remain long. Thev soon moved southward across Kentucky and Tennessee, to come to rest in .\labama, and tiie\' never ventured north again. If the Indians of the south had malaria and (jther fevers the\' had little oii])ortunit\- to spread them in Illinois. If there was anv transmission of disease from one Indian tril)e to another such transfer was from east to west or west to east. The first French and French-Canadians came into the territory in llwO. From KiTO to ITCi^l. practicalK- one hundred vears, the so-called French period, the territory was occupied liy Indians and French and lialf breeds in varying proportions. The first French invaders were trapjiers. These were soon followed by missionaries. Next came the traders and tinally the settlers. There was a moderate amount of inter-inarriage between the French and the Indians. Abj..i of tlic half ])reeds, many of whom remained in the territory after the Indian> left, were thi' results of French and Indian unions. Tlu- sources of information as to heaUh concHtions in tlie French period ;ire few. I'he missionaries wrote voluminous reports, but thev dealt with such subjects as religion, the geography of the countries, the routes of travel, the .'iltitudc of the Indians with almost no reference to healtli. 'Ihe trap- pers did not write at all. .V few of the traders wrote but they gave scant space to health. In ITG:! the l-'rench ceded the territory' to the ilritish who relaiued sonic control until Claik wrested it from them just prior to \]S{). in the British period of less than seventeen years, the governing nation (bd lillle more than occupy the garrisoned forls with a few troops and piomote intrigue wilh (13) 14 IXTKODI'CTIOX tlu- liiiliaiis. Tlu' |)(i|iulali(Jii (luring- tlic l-lrilish in-iiiid were Indians, I'Voncli and niixfd hrcrds, a few American settlers and a few British settlers and a few inMi|i,-.. 'rin- I'.ritish did not mate with tlu- Indians as the French fre- eriods. I^^IS to ISTT. hfty nine years, the perio:in. History would indicate that wars and famines furnished the expla- nalion. The historv of Indian medicine contributes little to the answer. To l)e.i,'in with the Indians had ne\ond a slight knowdedge of medical plants and medicinal waters the Indian medicine men had no medical knnwledge. They knew almost no ianitarv science. The tribe knew enougli to move a camp when the soil became badly fouled but there is nothing to show that the medicine men knew any more about this than the others did. As to sanilarv science in general the Indians never knew a tithe of what th;' Jews did in the lime iif Moses. Though the\- had ikj books and no written history, they did have legends of outstanding occurrences. Had there been great epidemic disease waves among ibem some tradition of these nnist have survived. It is altogether possible that the scanty ])opulation, the short life and the small family were qualities for which war, and famines were ])rinci|ially responsible. This e.\j)lanation does not undermine our regard for the Indian consti- tulion. but the matter is of small consequence since the Indians removed GENERAL HEALTH HISTORY ruinu 1S7' l: from the State leaving behind as progenitors of future citizens not very nianv mixed breeds and still fewer straight bloods. Hrdlicka- says. "The traditions of the In- dians, the existence among them of elaborate liealing rites of undoubtedly ancient origin, their plant lore in which curative agent's prop- erties are attributed to many vegetaljle suli- stances and the presence among them of a innnerous class (if professed healers, honored, feared, and usually well paid would seem to indicate that diseases were not rare, but actual knowledge and even tradition as to their na- ture are wanting. The condition of the skele- tal remains, the testimony of early observers ,ind the present state of some of the tribes in this regard warrant the conclusion t'nat on the whole the Indian race was a comparatively healthy one. It was probably spared at least Some of the epidemics and diseases of the old world such as smallpox, rachitis, while other scotu-ges such as tulierculosis, syjihilis (pre-Columbian) tvphus, cholera, scarlet fever, cancer etc.. were rare if occurring at all." It would be difficult to ini|jrove on this statement. It was written Ijy a man who know, well the literature on Indian health written prior to his day and wild has had years of opportunity to study the jiroblem at first hand. It is in general accord with all references found in the literature. The state- ments he make■^ are a skeleton on which some further comment can be hung. While the majoritv of Indians lived in villages, these villages were changed at rather short intervals. Black Hawk spoke of ;i village on the Rock Ri\er which his tribe was occupying in 1816, saying (.)f it that it was in a good location and had an abundant pure water sup])ly. "Our village was healthy", he said. The point he was making was that they had a village there for fourteen years ; there- fore, they wanted to be regarded as having ownershi]) and being fixtures in the Rock River X'alley. But even at that the population periodically moved in and out of the village returning to it for some part of the time in each year of the fourteeiL The Illinois Indians did not have organized commun- ity government and town stability as it was known among such southern Indians as the (hickasaws and Mobilians. This type of Indian village or cani]i had no organized excreta dis])osal, the nearliy cover speedily became befouled, whereupon the Indians moved their camp to a clean terrain. ■ HrcUicka (Bur !>luB> It 1. p. Ales HriUicka). li-i (;i-:nki;ai. iii-.ai.tii iiistokv tkiiik tcj |sT7 .Mcxaiukr Ros.s-' has a diffeicnt explanation, lie .say.s, "But anolhcr cause and perhaps the best that can be assigned for their abandoning their winlcr doiniciles as soon as the warm weather sets in is the immense swarms of rit'as thai bri'rd in them during that season.'' If there was such a disease as typhoid fever in that day. there is no evi- dence thai the Indians had ii. The sparseness of tine population (and there were hut fi'w Indians) the ci'stom of frequent renioval of their villages to new and clean locations wimld have been sonn- protection against typhoid fever had theri' been such a disease. llnllick,-i writer that even toda\' t\i)hoid is ver\' rare among Indians. The Indians had [ilenly of diarrhocal troubles. .M(.)st of the writers sjieak of digestive difficulties probal]l\ including in the term indigestion due to poor food, constipation and diarrhoea and dysenter}-. Some go into more details. Koss wrote in ISKi as follows: "The diseases most fre(juent among these Indians are indigestion, fluxes, asthma, and consumption. In- stances of longevity are found, liut not often. Babies suckle their mothers until they are old enough to feed themselves (on the Indian diet). The in- fant is generally robust and healthy but the mother soon becomes an old woman." .Mexander Henry ( KiKt-Kii-l) said "The Indians were in general free from disorders and an instance of their being subject to dropsy, gout or stciie never came within ni\ knowdedge. Inilanniiations of the lungs are among the most prevalent disorders." Father i\lar(|uette died from a chronic d\senterv which had manv of the earmarks of amoebic dysentery. It is difficult to see how his disorder could have been other th,-m th.it. In Parkman's account of .Marcpiette's illness and death it is stated that on one nn'ssion he went far down the Mississippi (as far as the Arkansas) anatas and Tarahumares have much malaria. A. B. Hol- der wrote in is'.i".": "In the Indian territory and among a few trilies else- where malaria l)ecomes of greater importance than consumiition." I'lUt such reports were not made until the Indian had been long in con- tact with the white man. How much disease did the Indians contriliute to the early history of the State? To what diseases were they suliject? What did they pass on to the whites? let us answer the question as to a few diseases. Consitmpfioii. Hrdlicka says if consumption existed at all among prehistoric Indians it was extremely rare. It was seldom seen up to a ci'iUury ago. It is grad- ually becoming more common. \Mien he wrote this he was reporting on the Indians of the southwest ( l!H),s), but he knows the Indians elsewhere and their history as well as any man. He also wrote, ".\mong the uncivi- lized tribes pneumonia is the worst hu''g infection, but among the civilized tribes consumi)tion begins to rival it." However, Drake wrote in ISI:!, "The mosi prevalent disease of the In- dians is scrofula. It almost annihilated the I'eorias." V,\ scrofula he meant 'New York Mi-dii-al Record, Any. !.■!, is;i2 20 GKXKUAL HEALTH IlISTOUY PRIOK TO 1S7? liiherculosis of the glands, hmu-s and lnn,<;s. At the time he referred to, the I'eorias were at least ai)])r(iaehinL; the cla>s whicli ITrdlicka calls the civilized trilies. It is also to he rcineinliereil that the Indians had heen in con- tact with whites since soon after the year UidI). Dr. Esmond R. Long is my authoiit\- fur the statement that the J 'nritan fathers sufl'ered heavily from coii>tiniiiiiiin the lirsi year> ihe_\- >])ent in America. They niay have infected >ome Indian^ wlm later carried infection westward. It i^ not proh- ahle that the Indians ni the early days in Illinois gave the white man much consnniptioii. Piiriinniiild. ^\w\\ lecnrds as are availahle. indicate that the Indians had a great deal of inieunKiiia and pleurisy, llrdlicka referring to the Indians of the south- west twentv years ago says: "I'neumonia has appeared in epidemic form." 'Hiis disease was epidemic rather freiitu-ntly among the white settlers in Illinois. If anything saved the Indians from similar epidemics it was the s[iarseness of the population, the >mall size uf the villages and the open air living. Ditinliixd (iinl Di/si'iifrni. That digestive disorders including diarrhdcas and dysenteries were ])rev- alent among the Illinois Indiana i?. certain from the records. Ne.xt to the rheumatic di.-orders the diarrhoeas and dysenteries are mo>t frei|ueinly al- ]ud.-,l to. A iHdihic Difsi iiti 1)1. l''ather .\lan|uette contracted what ajipears to have been amoebic dysen- tery while goiug down the Mississippi associating all the time with the In- dians. Ill' then returned to the Illinois territory where he remained an in- fectious i-ase or infective carrier all of the time until his death. Tllllhni,!. llrdlicka savs. "Contrary t(j all expectations typhoid is rare." The essav bv Louis which established ty])hiiid as a separate disease was not writ- ten until eight \ears before the Indian-, were moved from Illinois. It was not generallv known in Illinois until after the Indians had gone, but the prob- abilitv is that typhoid \va> not prevalent among the Illinois Indians. They did not seem verv --u-^ceptible to fevers of any sort. MdldiKl. .Malaria i^ thdUgbt U< li.ive pretty will wi|)ed tint the Nez Perces. It is \er\- prevalent among some trd)e> in the southwest, but the writings do not show that Illinois Indians suH'ered heavily from it if at all. GENERAL HEALTH HISTORY TRIOR TO 1877 21 VoiiTcal Disca,sc. ^o far as cuiicenis venereal disease in general the Indians seem lo have snlYered far more from the white man than the white man did from the In- dians. X'enereal disease was said lo j)revail anmng the drinking, degraded [ncHans who camped near while men's towns, hut not among Indians who kepi away therefrom. Tile Irihal reguhitions were aimed at protection of the Indians against venereal disease among the whites. Their attitude in- dicated their fixed conviction that the white man was the source of the vener- eal infections of every kind that the Indian found among his people. Jiecause of the interest in the discussion of pre-Columbian s_\phili- a separate heading is given to the history of svphilis of the Indians. Blicillliilfisill. It is certain that rheumatism troubled the Indians greatly. It is im- possible to say where they got it, who brought it to them, if anybody, where it originated or came from. The Indians seem to have recognized that ex])(isure played a part in causing it. They also seem to have recognized the \alue of hot baths in curing it. Most of the hot s])rings enjoying wide vogue today were handed (jver to the white man from the Indians as health resorts particular! \ in rheumatic disorders. Wandering a little afield, the fact that the Indians ai)preciated the value of .Sulphur Springs in skin dis- orders is some ]jroof that they suiTered from parasitic skin disorders. Rheumatism is known to have existed among the l\gvptians as proven by the lesions in mummies. .\lso among the cave dwellers of France and .Sp.nin king liefore the Egyptian period. In fact the skeletons of wild ani- als found in caves in Europe jjrove the j)re\alence of rheumatism among animals in prehistoric times. This is scarria,L;cs wdiild >cciii lu indicate that ihc Indians did not sutTer nuu-li I'mni xcntTcal (li>casr, cither gonorrhea or sy])hiHs. 'Idle siatenieiit liiat "the liuHan witliers at the tcuich of civilization" sug- gests so far as Illinois is concerned thai the while intruders into this territory gave nuich disease to the Indians ihere and recei\ed lnu little from them. Schoolcraft (History of the Indian Trihe^ (jf the United States 185T) agrees witli the opinion that tin- Kjw liinh rate nf ilu- Indians was the reason tor ilu'ir lewne^s, savins^-, "It i> a wfll known fact thai the Indian tribes do not increase in the ratio of other nations. The average number of children to each family does not exceed two." Other contributing causes given by Schoolcraft were laziness, lack of thrift and ])rudence, lack of will or even desire to ])o]iulate, occupy and u.se the laml. ,iiid their addiction to alcohol. In his \-i-ry extensive writings on the subject he refers to no disease as being very hannfnl to the Indians in a racial way. except smallpox. This disease did at tiin^s almost wipe out villages and even tribes. He specifically states thai pe--iilence was of minor importance as compared with low birth rate and alcohol in wiping out the Indian poinilations. Slim iiinrji. Summing it all up it appears that the Indian during his residence in contact with white men in the Illinois territory from the incoming of the wliitc man about IGIO until the de]iarture of the Indian in l!-i37, contributed but little to the white man's diseases — scarcelv more than he contributed to the constitution of the racial stock, composed of several white bloods and a \ery small infusion of Indian blood. The French or French-Canadian Regime. TiiK Fiii:.\(ii-( '.\x.\iii.\.\ TitAPrKiis, ^Lis.^^ioxakies .\xd Tk.uiers. Soon after the whites came to America they began to find their way among the Indians. Some of these were captives, some were squaw men and some lived among the Indians because they loved the life. llowcNcr, these were of little significance from the social stand]>:>int. They had little intfuence in the methods of living of the Indians, nor is there any evidence that they altered the lieallli problems of the Indians materially for either the ln-tter or worse. On the otlier hand, the fairly definite French-Canadian- trapper- trader- missionary iiioNcmcnt in Illinois was of social significance. It altered the religious life of the Indians and .also their habits and customs in some degree. The bio,grapliy of ( iurdon .s. Hubbard contains nianv allusions to the heavv drinking of the ln more white than Indian. In time these towns were abandoned or lost their iM-encb flavor. The I'rencb system (jf laying out towns and even farms, the French law, customs and language did not persist. lUit in some of the rural dis- tricts in v.allevs like the Kank.akee .and its ii-iliui;iries there is cunsiderable '^4 (;i:.\i;iv.\i. iii;.\i.tii iiisToin' I'uiou to IS" French Havor ami iradilidii cvtMi today. I lie h't'cnch-Canadian infliU'iice was more eiiduriiiy in the conntry than ii \va> in the tdwii. But there is no evidence that t'itlier ut' these French niovenients, if the last one can he termed as >ncli. added significantly to the health prohlem of the Illinois territory. There was some disease; principally venereal disease and I'onsiiniption in the \icinity of the posts as has elsewhere been indicated. It is more possible that smalljHi.x was introduced to the Indians here and tliere bltt there is no record of ijreat pestilential outlireaks of any sort or of detinite change in disease t\|ie i r of an\- dift'erence in the health and \i,ijor of the [K'ople in the wake of this series of intrusions. 1 lowever, there is not much health history of the period on whtch to go. riie Indians were not waiters — neither were the trappers. The earlv trad- ers of the period wrote nothing, though later traders were more prolific. The explorers and the mis-;ionaries were prolific writers, considering the times, but they wrote about adventures, conflicts, battles, attitude of the natives toward foreigners, geogra])hy. tojiography and religion. In none of the reports of the period i> there any reference to the prevalence of ma- laria or any other disease that is comjiarable with conditions as they were described b_\' writers who observi'd from about 1800 onward. Some of the dilTerence nia\' be ascribed to the different interests and viewpoints of the writers, but not all of it can l)e mi interjjreted. It is not believable that conditions such as were described by these later writer^ could have existed and lieen overlooked or have gone unrecorded by the Jesuits. The conclusion mu-^t be that the health and vigor of the In- dians ;in dthe traders and trappers, and the French-Canadian settlers be- tween l(;S(i ;ind 17S0 was about the same as that of French-Canadians and lndi;in> in .MoiUreal and along the St. Lawrence in about the same period. Just how dilTereiil was the pictin-e soon after llsi) will appear in the next chapter. In the records of the earlier \ears of the I'rencb regime there are few alhtsions to ,an\- disease which can be recognized ;is m.'ilaria. There are some references lo endemics and ejiidemics but these cannot be interpreted as being ni,al.iri;i. In f.ict. it is difiicult to guess what the\' were. /euch ' says, "In the year KiiO. the settlements in the American P>ottoms bad, in spile of the stigma that had lieen placed upon them by sickness, reached the size of .a consider.ible colon)'." .Most of the colony were I'^rench. .Most of the sickness was ni.alaria. A I'"rencli religious order was forced to .abandon their hte(l (elsewhere) as saying the French were immune. This was not true ; that the l'"rench have no immunitv to malaria was shown in Panama. LaKlanc said to de Lesseps in ISSl, "If you try to build this canal (Panama) there will not he trees enough on the Isthmus to make crosses for the graves of your laborers." In lS,s,s, a jnurnalist wrote "Death is con- stantly gathering- its h.arvest about me. Since the ad\-ent "f de Lesseps on Fdiruary v'S, Issl, thousands upon thousands have been buried here." Gorgas estimated thai the I'"rench lost a tntal (if one third (if all their white employees. "We estimate ended, 'rhert'forc. they can he held responsible for only seventei-n years of the history of the Illinois rej^ion. During that time they diritish left the jieople and the country about as they found them, just sucli a gradual increase in disease as is to he expected when nothing is done to prevent it. Since the British of the period did not settle and did not intermarry with the Indians they made no conirihution tn the character of the racial stock. The Spanish Influence. The Spanish made a moderately efteclive effort to cajjlure and hoUl the west bank of the Mississippi in the region of St. Louis. In 1780 they sent a company of sixty men to St. Joseph. ^Michigan, across the southern end of what is now Illinois. lUit neither they nor any other Spaniards remained long enough in the territory to alter health conditions for better or worse. Zeuch", rjuotes the following from the minutes of the Court of Quarter Sessions held at Cahokia in r;!)'.i. "In order to keep off the plague of the smallpox that now rages on the S])anish side no one was allowed to cross the river and goods brought from the Spanish side were to be confiscated." The American Regime. Pkiikji) 1780 TO 1S77. There had been some immigration into Illinois territory from the other states prior to 1780, but it was not until Clark occupied southern Illinois in that year that the American colonists began to dominate the picture. By 1800 the po])ulation. which had immigrated from other states, though few in number and widely scattered, were numerous enough to control the social life, the customs, habits and religion and to shape such political jioiicy as there was. 'J'hey shaped the disease history even more markedly. ISetween 1800 and ISKi, the ])opulation increased in numbers but the increase was gradual. After ISK; it was more rajiid. There were two great gateways through wdiich the poinilation entered. The north end of the State was settled by people, the great majority of whom came through Chicago. Many of these settled in the immediate Chicago area; manv others radiated northward, northwestward and westward. \"ery few went south of the Kankakee and the fllincis rivers and a line running westward from where the latter river tin-ncd southward. In the earlier years, the great majority of those who entered the State through the Chicago gatewav came from New b'.ngland. New ^'ork and the states west thereof. Few came from those states that bordered the Mason-Dixon line on the north tltereoi and fewer .still from south of that line. There was little European immigra- tion. "Zeuch, Ibid. 28 (;i-:.\i:rai. uiiai.iii insidin rkiou td is;; 1 lie Miuiln'in <;atc\\ay was less a porlal in a physical way. It included tlic W aliash basin sciulh froni \'incenncs and the Ohio valley. Those who i'i-i>sM(l these borders ]iiisheil across the State, l^oing westward, to the brink (if llie l''rench settlements alnnt; the .Mississippi and north and northwestward until they reached the threat prairies. I'lClwecn the iriet;ular frinyedikc north li(nnidar\- of this immigration wave and the simil.ar xayut' sonth lMiinidar\- of the Chicago immigration, there \\,is ,i bidad neutral belt a no nian'> lami. The wel. stiff-soil prairies made liei-e a natural geiigra]ihic barrit'r. The waterways were the great .arti'ries of trans])ortation and the lode- stones of settlements. It wa> along the vtdleys that the people settled al- most altogether in the --oulh. and to a large extent in the north. In the prairie si-ction there were no large rivers and no great valleys. Besides the immigrants were a [leojjle who knt'w the soil of valleys and who did not know how to judge nor how' to break or to cultivate prairie land. The bear- ing of .all lhi> on heallh will appear shortly. There were few finx-ign boin .among thii~e wlvi came in through this galewaw The Poles who pariicipateil in the kt'\ci]ntionary war were given large laud grants in Indiana tow.ird the north end of this sweep of invasion, but tlie\ did not come into Illinois, .\niong the colonists wdio crossed the \\':di.c.h were some luiglish groups who formed settlements concerning which some rt fcrences will be made. Willi few exceptions there were no social or religious or communistic colonies from foreign lands in this southern liiinois territory. The majoritx' of those wdio came through this portal were from the Ohio v.ille\ stales lo the east: 1 'eiinsyl vania and \irginia beyond the Ohio valley and l\(utuck\- on its -nuth. Hut not all were from these states. They liruugbl with them malaria ;ind some other diseases of the states from whicli they came to add to the slock of malai-i.i ;nid dysentery with which the coun- try was alri'ady provided. The (.'oloni.d period had a heallh history that is even more distressing than tliat of the latter end of the b'rench regime anil of the British regime. In the writings of llio.se who knew Illinois .liter i;si) and ])articularly after ISOO. the allusions to beallh oi' r.ilber ill heallh are fre(|uent and illuminating. Ilc.dtli or kick of it was pidmineiu in the ])ublic and private mind. The tirriloix liecauie a Stale in ISIS, but the newly organized State ilid nothing for the heallh of the peopU'. The political change in 1S18 made no cli.ange in hi;ilth coiidilioiis. Tlierefort'. the health story will be told 'v\itlionl p.irlicukir notice of the |Hililic;il idi.angi- which occurred in ISIS. It will be co\(.red in the main by sep.arate treatment of several of the more im- portant diseases. GENERAL HEALTH HISTORY PRIOR TO 18TT 29 With the exception of a few Germans along the Ohio and Mississippi rivers, some Freneh who were ah"ea(ly here and some IndiaiLs who had re- mained, the population of the State jiridr to the latter part of tlie thirties decade were almost exclusively English. \\ elsh. Scotch and North Irish stock. Almost all were born in the states to the east and southeast. l"(.)ward the latter part of the decade, the first great South of Ireland wave began to roll in. In the forties decade the first great German wave was in evidence. The Swedes and Norwegians began with settlements in Cook. Henry and Vermilion Counties. Their first great wave began to arrive in the middle of the seventies decade. The Poles first tried some settlements in Cook County and along the Illinois Central road well to the south and in Ogle County, but their great w'aves of immigration did not start umil well after the close of this so-called pre-health department pi-riod |)ri(ir tn IST^. These incoming people may have bniught with them some of the dis- eases of the countries from which they came but there is no evidence that they brought anything new in that line. The peculiarities of |ihvsical vigor and weakness, of strength and (if what is termed cunstitutiDU. were much the same as those of the people df the liritish Islands and of the mirthwesi fringe of Europe, the soiux-es frnm which the Illiiidis of that dav was in- directly populated. GeNER.\L ITNHE.\LTHKt:LNES.S. During the French-Canadian regime, the Illinois terrilor\- did not have a reputation for unheallhfuhiess. Prospective settlers were deterred from settling b\- the reputation of the country for danger from Indians and for hardships due to extreme ciild and lack of conveniences but ihix were not held back by the rumors of disease in the land. By the year ISDO the story was different. Disease had come to be re- garded as more of a menace than tlu- Indi.an--. and ihc reputation of the coun- try for unhealthfulness was both widesjiread and juslihed. The settlers of this jieriod includelic(l b\ the Illinois .Medical Society, has. as ils major (]l)iecli\ e. the bi(i.i;ra|)hics i)f medical men and the history oi ihv ])ractice of nie History, as follows: Tlii^altc's Jcsiiil I\i-hifi()iis: "\ plague bmke ciut amonsj the Indians near Cairo. ll.alf the tribe dieil and ibe survixiir^ fled in every direction." In Aiin-rictui Xolrs ( 1 S p.' ) Dickens describes Cairo as a detestable morass. The followinL,r is cpioled from .Martin Chuzzlewitt (Dickens), "A native of Cairo (or I'^den) when asked to help Mark Tapley and Martin Cbux/.lew itl with their luggage replied, 'My eldest son would do it if he could but tiKla\ he has his chill tipon him and is lying wrapped up in blankets. .M\ \nungest son died last week. * * * We buried most of 'em here. the rest have gone away. * * * Tlu' night air aim c|uite wholesome. Its deadly ])oison.' " Zeuch'' sa\s, "There were two reasims why colonization took place in the Kaska^kia and C'ali(ilection, "Several towns ha\e been ver\ sickl)' this season especially those situated contigumis to rivers nr mill ponds." On the otlier hand bordham wrote about the same time and from the same section that the cou)itry was about as healthy as England. "Consump- tives are almost unknown, liilious fevers are rather ])revalent but not dang- erous when attended to early." The fdUowing references to disease in Illinois are taken from Zeuch's History. '"Reynolds (Mv own 'rinu-s. fiiilir:u-iiiK al.'ii) tin- history of my life, .lolin Rey- nolds, 17Sfl-lS65, Brll.ville, Illinois. 11. H. I'eirynien and 11. I... Davison, printers, ISoo). '■ Zeueh, Ibid. GENERAL HEALTH HISTORY PRIOR TO 18TT 33 "The stigma of unhealthfulness was fastened upun this region." f77;c reference is to English Prairie, i8ig.) "The unhealthy state of the region taxed these vaHant Knights of Aesculapius to the utmost." (The reference was to Bond County in 1844.) 'Tn 1820 a sickness prevailed in Pike and Calhoun Counties, the nature of which was not determined." Writing of Ouincy in 1848, Dr. Frances Drude said. "There was an alarming mortality among the physicians due to their exposure to contagious and infectious disease." "The bad reports contiimalh' made concerning the state of health in the west created a fear that resulted in great economic loss in immigration and business." "A good settler must have withstood the ravages of malaria." (The references are to Will Cminly.) "No other town in the county suffered as much from sickness as did St. Charles." (The reference is to Kane County.) "The year 1839 was known as the sick year for so nuich illness was prev- alent along the Mississippi River that few coulil lie induced to locate any- where near it." (The reference is to Tiiltuii County.) "On the other han) characler for healthfulness and salubrity." '"Hihli-eth (Amfrir:ni .Ii.in-nal Mfdiual Science, l.S2tl, Hr. .S. F. Hildreth). 34 GENERAL IIICALTII 1II.ST0K\- I'KIOK TO 1 S^ T In 1S19 the 1 Hindis legislature passed an act authorizing a lottery to raise funds for the ])urposc of "draining ponds and lakes in the American Bottoms and of improving the health thereof." In its introduction, this law- says, "these ponds and lakes stagnate and annoy the health of the inhabitant of said bottom by producing autumnal fever." It appears that no drawings were held under this law until 1838. Tt was planned to hold the first draw- ing on July 1 of that year, "hut ihc sickness of the contractor and the gen- eral ill hcahh (if the whole country, etc., h:ive caused this unlocked for de- tention and dcl.iy." Tlic first dr.iwing took place November 17. 1839 at ITarrisonvillc. There was a weekly drawing thereafter for some time. The eighth took place at .\.llon, January ."), 1839, and the tenth at Harrisonville, January 19, 1839. 'The lottery did not prosper. Professor George W. Smith''', wrote "Little was accomplished by the lottery system." In (Jctober \S'M, J. .\. Townsend, Manager of the .\merican Bottoms Improvement .Association asked the owners of land to ])av a voluntary tax of $1.0(1 an acre to ])ay for drainage. In .\pril •21, 1S3S \V. C. Greenup, President, l-ioarcl of Managers, sent a cummunication to Congress ask- ing that the Board be given the v;icant land in the .\merican Bottoms to be used to raise money to pay for the ci)nteni|jlatehn AlacCulloch wrote a book cm malriria. There is no proof that he had Illinois in mind, but what he wrote of the region along the Missis- sippi river in the south and possibly north would apply to this State. He said : "In many place.s in the southern States malaria has been rapidly increasing as almost to threaten the abandonment ot the land. And in the newly settled or uncleared lands along the Mississippi and its endless tributary streams the same plague is found to prevail very widely to the surprise and serious grievance of the settlers. What the fate of this new country may be ultimately in this respect is difficult to foresee. It is to be suspected that no changes and no culti- vation will ever bring it into a state ot salubrity." Mrs. Tillson, writing of Pike County in Illinois in 1821, said: "Your father had a shake of the ague. * * * Feeling that he was in fer a smart grip of agy he rode seven miles toward Edwardsville where he stayed to have another shake. The next day being intermediate day he rode twenty- five miles to Mr. Hoxie's where he waited over there fer another shake which Mrs. Hoxie said "beat all the shakes she ever see. He shuk the hull cabin.' " (35) 3G IIISTOUV OF CICRTAIN DISEASES PRIOR TO ISTT In Pioncrr Health Conditions by the- Norwegian-, Vimricaii History So- ciety is t\)Uii(l tlu' fcilldwing statement: "Evorywhero in the West the ague attacked the settlers more or less severely during the first development of the country. * * * Wherever new land was broken in swampy regions the ague harried the people with the most disastrous results. * * * Malarial fever prevailed in the Rock River valley to the Mis- sissippi River in Illinois. At this time (IS.SD) malaria ravaged Chicago very severely and especially many of the poor hard working immigrants who were poorly fed and lived in miserable huts, fell victims to the disease. When fall came only a few were alive. Most of them had succumbed to the unhealthy climate. * * * " Sandburg-" says : "Fall came with miasma rising from the prairie, and chills, fever, ague, for Tom Lincoln and Sally Bush; and many doses of 'Barks,' a Peruvian bark and whiskey tonic mixture, bought at Renshaw's general store in Decatur, was administered." By long odds the best informed man of hi^ day in the liealth nf the people of the Mississippi \'alley was Dr. Daniel Drake of Cincinnati. In 183T he wrote that in \><'io, IS'^7, l,s28 and 1830 malignant fevers were un- usually prevalent in the \N'estern territory. Dr. Drake gathered his informa- tion through travel, through correspondence and through articles sent his j(iurn;il. There is no proof that he had visited Illinois so early as IS'lo to is;i0. He had one regular correspondent in the State, Dr. J. F. Henry of Blooniington. Through Drake's travels and his correspondence he gathered the fol- lowing re])orts on m.ilaria in different sections of Illinois, particularlv how- ever, in the basin of the Illinois River. In 183o-3(; Drake made a trip to St. I.ouis, writing of the American Bottoms opposite St. Louis, he said ; "It is among the most fertile spots in the whole earth, but at present it is infested with mosquitoes and intermittent fevers, the latter followed by enlarged viscera and dropsical infiltrations." "Bloomington — Autumnal fever prevails annually. One of the citizens in- formed me that he had resided where I found him three years before a member of his family was seized with that fever. Such instances are not uncommon though difficult to explain. Drs. Colburn and Henry were convinced that an extensive plowing up of the soil of the prairies for the first time had been followed by fever especially in those who resided on the northern or leeward side of such tracts. They had rarely seen malignant cases. "Adams County — We have here in aiUumn bilious diseases more or less for instance the ague, the intermitting and bilious fever. In very rare cases do these diseases prove dangerous. Fifteen or twenty years ago the hepatical diseases, hypohondriasis and jaundice held such a formidable sway that they spared but very few, especially of the immigrants. "Woodford County — In summer miasniatical fevers prevail. In moist springs the inhabitants of the prairie suffer from them. In fall and winter the abdominal typhus fever sometimes occurs, but never real typhus. "Pckin — Intermitting fevers reappear after the lapse of some two, three or four weeks. The best remedy is acid sulphuric Peruvian bark in doses of from 2 to 4 grains at intervals until 10, l.'i or 20 grains are taken. Tuberculosis (con- sumption) is very rare. Acute inflammations of lungs occur in winter. * * « ' SandbuiK, (Life of Lincoln, Carl Saiullmrgr. Vol. 1, p. 106). ^^J^^^es^^T'te^-^, ^^^^^ 38 HISTORY OF CICRTAIN DISEASES TRIOR TO 1ST7 "Peru — In some casps of fliills :uul fever *■■:■* ^ few outward applica- tions of soap and water no ilouhl would have relieved the patient. * * » People drink surface water. "Tazewell Count y — They plowed up the prairie near their residences and in the following autumn experienced a decided invasion of remittent fever, while the surroundins population remained healthy. At lengtli a colony arrived and establishins themselves near each other enjoyed excellent health the first year; but the next spring they broke up a large extent of prairie near their dwellings and suffered severely in autumn from fever, while the country around remained comparatively healthy. Dr. Prye lias remarked what has been noticed elsewhere that in low and wet timbered spots tlie intermittent form of fever is more prev- alent than the remittent — also that in some autumns every kind of locality is affected, while in others some places suffer and escape." Speaking of the especial iirevalence of the disease in the \aUeys of ihe Wabash Dr. Drake said : "Between these wet, marsliy prairies which will be made dry by cultivation and the bottoms the whole of this extensive and fertile portion of the Wabasli basin is infested with autumnal fever, of which many cases assume a malignant and fatal character. The people who live in the hills are healthier and live longer. "From what can be collected of the travels of Lewis and Clark, Pike Long, Catlin Preemont an dGregg not less than from fur traders and Santa Pe mer- chants malaria is almost unknown at a distance of more than 300 miles from the west boundary of Missouri and Iowa and above the 37tli parallel. To the north it does not prevail as an epidemic beyond the 44th parallel and it ceases to occur even sporadically at the 47th parallel. It came in from the south and it pushed up the valleys to the north." Daniel Drake-' writing of his observatii.ms on the distri1)iition of ma- laria along the Illinois river and points not far tiierefroin in ihe period Ije- tween 18-10 and 1845 made the following statements: Kuskaskia — "Such a surface must of necessity give rise to severe autumnal fevers whicli are known to prevail throughout the whole Ivaskaskia basin." Lower Illinois Valley around Mereclosia — "It seems almost superfluous to say that the population along such a valley are subject to grave autumnal fevers." Jacksonville and Moryan County — "Prom Doctor Jones I learned that all the forms of autumnal fevers occur at this place. Dr. Prosser informed me the prevalence of these fevers is much less than formerly. Dr. Smith thought them not more frequent or more fatal than ho had seen them in the basin of the Ohio River in Kentucky. Dr. English had found them more malignant than in the lower valley of the Great Kanawha in Virginia." Sprinyfield and Hanyamon County — "Doctors Todd. Henry, Merriman and Jayne all of Springfield assured me of the presence of malaria and they afforded me an opportunity of seeing intermittents as malignant as those on the banks of the Tuscaloosa and Pearl Rivers (Alabama and Mississippi!." ilaekinaw — "Dr. Burns told me that there was autumnal fever here and there." 7'cor/a— "In 1833 the Anglo-American town of Peoria contained not more than twenty-five families. But it was the site of an old French mission and in 1779 it began to be a village of Indian traders, voyagers and hunters. "Although so old a settlement its autumnal diseases are substantially the same as those of the more recently settled territory. From Doctors Dickinson, Rouse and Frye, I learned that in and around the town intermittent and remit- tents prevail every year." " Drake (A Systematic Treatise, Historical, Ktiological and Practical on the Prin- cipal Di.seases of the Interior Valley of North America as they appear in the Caucasian, African, Indian and lisciiiimaux Varieties of its Population. Cincinnati, 1S50. Daniel Drake, M. D. Winthrop B. Smith & Co., pub.). HISTORY OF CERTAIN UISEASES PRIOR TO 1877 39 Peru and LnSaHr—'-DT. Whitehead said in a residence of eight years he had seen epidemics of autumnal fever in only two years and then chiefly in immi- grants from the north and in Irish laborers on the Canal." Ottawa — "From Doctors How.land, Schermerhorn and Hurlbert I learned that autumnal fever is common in this locality. The Irish laborers on the Canal had suffered greatly." Ottawa to .Jolirt— "From the best information I could obtain malarial fever is both rare and mild." JoJie/— "Doctors Schoolfleld and Bowen told me that Joliet is annually in- vaded by autumnal fever but it is neither widespread nor of a fatal character." In 1883 Dr. J. Murph}' of Peoria wrote: "When I first settled in Peoria some thirty-five years a.ao (about 1S4S) the entire prairie was saturated with malaria. In fact, the entire area of central Illinois was a gigantic emporium of malaria." In 1842 Dr. Snuck-- of Darwin, Illinois, Clark Connty, wrote: "We have more or less of every grade of fever from the simplest intermit- tent to the most remittent every year." In ISIo Dr. R. Robson-^, New Harmony, Imliana, wrote of the fevers of White County, Illinois, and Posey County, Indiana: "When I commenced practising in 1830-31 the country (except the town of New Harmony) was Infested with fevers of almost every grade. During the summer of 1834 very few families escaped a visitation of fever and many of the most respected citizens were carried off." in 1843 and 18-1:'± Dr. Drake visited Illinois, including Chicago and the north part of the State, a considerable part of Wisconsin and the lower Missouri in his itinerary. After he had left St. Louis and gone up the Mississippi to Alton, Illinois, and some distance uj) the Missouri, he wrote of the autumn fevers, "which prevail not only on its banks (Alissouri) but far and wide in all directions from them." "I can hear of no spot high or low, wet or dry. wood or prairie, village, town or city socalled that Is not invaded. To find a sin.s;le family some member of which has not had a chill or two. would be a curiosity. In one village every inhabitant except one negro boy had had the disease." Of Galena and vicinity he saiil : "The people on the Fever River are as free from fever as their neighbors; meaning that they had as much malaria, but no more. He discusses three possible origins of the name of this river; one was that it got its name from a Sac word meaning smallpox; another that it came from the name of a local French trader LaFevre and the third was that it was derived from the French word "feve" meaning bean. He did not state his opinion, InU he did say 'the name is not undeserved.' " In l\ report are found eight references to the several tvpes of malaria. In the 1852 report written l>y X. .S. Davis and 1.. Hall, there are four leferences to forms of malaria, and one "Isth- mian I'^ever." In 18.'")4 Dr. X. S. Davis reported to Chi- cago Medical Society on conditions in Cook (, ounty : "The attacks of ordinary intermit- tent and remittent fevers were more frequent during September than for several years past." lie also wrote that around Ottawa malaria out- ranked other diseases in importance. In 1835 Dr. Thompson's report on practical medicine had eight references to the prevalence of malaria. The report from Van- dalia furnished by Dr. Haller read: "The Okaw river l)ottom is two miles wide and it is subject to inundation. In conse- quence bilious, remittent, intermittent and con- gestive fevers prevail." Dr. H. R. I'a\ne nf Marshall reporting for Clarke County said: "1-lvery family was attacked l:ist year." The ls.")S repurt said ".Since the conipleticm of the Illinois and Michigan canal in ISi; the health of the Des Plaines valle\- has been an- nually imjjroving, by reason of the better drainage. This is es].eciall\' true in loliel." The l.s(i() report by Dr. (iuddbrake con- tains four references to ni:ilaria. In 1S(m ma'aria is referred to b\ ihrie ])liv>icians in the Re hart on Practical Medicine. In the ISd!) ' . Dr. Cooilbrake. rei)ort there are seven reports (jf malaria. .-\fter that year the subject was not often referred to. -Such discussion of malaria as persisted shifted to new l);ittlefields — to wit : Is there a typho- malarial fever, and. the relation of t\phoid to malaria? HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 41 In the 1864 report appear the following stateineiits for which Doctors J. S. Jewell and N. S. Davis appear to divide responsibility: "From 1855 to 185' there was little of disease except malaria. After 1S5T a transition from the periodic to the continued type of fever occurred. In two or three years continued fever almost entirely su])planted the autunmal type." Just how much of the continued fevers referred U> was typhoid it is not easy to guess. In 185G Dr. Gerhard wrote an immigrant's compendium of information entitled "Illinois as It Is." One chapter was devoted to health. He did his best to answer adverse criticism of Illinois such as "When people speak of Illinois in the eastern states they will often express their fears in regard to the fever and ague said to prevail there." He said : "Everybody knows that of all diseases the ague occurs most frequently in Illinois * * * that it depends very much upon the particular plan of abode or manner of living whether the fever is to visit a family or not. Whosoever resides in the Bottoms or close by swamps or in districts where the water cannot rapidly flow off. will be more e.xposed to the fever. * * * One-half of those who are down with fever have to ascribe this to nothing but their own imprudence and the use of improper food. Causes — drinking stagnant water ; too immoderate use of fruits, lard, eggs or fish. Nobody should expose himself needlessly to night air." He had some ground to talk since unciuestionably there was less malaria in 1856 than there had been thirty years before that date. He quoted from laymen who were very enthusiastic as to the healthfulness of the State. The six physicians quoted were more reserved. Dr. Daniel Slahl of .\dams County said, "There is some malaria but not as iinich as formerh'. Diarrhoea in adults prevailed somewhat." Dr. j. (i. l.iller of Woodford C'ounty said the people of that county had some malaria in the summer and some typhoid in the autunni. Dr. T. .\. Hoffman of I'eardstown. Cass County, said they had some malaria but not as nuich as formerly. Dr. l\ Borendel of Peoria County said that countv had some malaria and typhoid and the last epidemic of cholera affected them. They had very little consumption. Dr. V. Wenzel of Belleville, St. Clair County, said, "The time in which southern Illinois was deni)unce. Johnson'-'' writing of Bond C'iiunt\ and other regions in cen- tr;il Illinois >ai(l : "lS(i6 yielded abundant crops of all kinds including malaria in all its forms." Of the last great endemic wave of malaria in Illinois he wrote: "To- ward the close of the summer of 1872 came the last general extensive epidemic of malarial fever in central Illinois. The epidemic lasted from the last days of July till the coming of a killing frost and within the bounds of my practice I think almost no one escaped an attack. All suffered sooner or later from the infant at the breast to the ohl man tottering to his grave." =«Zeucli, Ibid. ^■■'Vaughan (A Docloi-'s .MpiiiDiie.s). ^John.son (Sixty Year.s in Medical Harness; or, Ttir Stuiy of a r.diis Mftlical Life 1S65-1925. Charles Beneulyn Jolinson). HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 43 Clark Carr,-" writing of northern Illinois in 1850 and thereabouts gives- at least one reason why the fevers of southern Illinois were spread to north- ern Illinois. "Large numbers of inhabitants ot southern Illinois went to the Galena district to work in the mines after they had made their crops and then returned home for the next crop. The roads in Henry and Knox County were filled with people emigrating, every day movers passed our house." This was a jK-riod uf active building of railroads and canals and duubt- less a great deal of malaria, dysentery and typhoid was spread through labdr cani]>s. Before leaving this subject the following two references from Bartlett's "Classical Work on Fevers" as to the malarial fevers and particularly the element of periodicity therein are referred to. lie writes: "What reason is there to believe or hope that the thick darkness which has ever wrapped and which still wraps this fever so full of mystery and wonder will ever be dis- pelled." In less than fcirt)' years thereafter all of the nivstery had lieen cleared up; in eighty years after Bartlett wrote, malaria had been banished from all but twelve counties in Illinois and it should be easy to banish it from those. He also reports that Dr. Oliver Wendell Holmes once wrote a prize essay on the disa|)pearance of malaria from Xew England. Cholera. Hirsch-* gives the dates of the pandemics of cholera as fi^illows : first, 1817 to 1823; second. 1826 to 1837; third, 1846 to 1863; fourth. 186.-, to 187--). The first pandemic is not sujiposed to have reached America. The second pandemic reached Illinnis. In 1832 there were no vital statistics, but a Chicago Health Department Report says that forty-eight soldiers and several citizens died of clmlera. In is:il Daniel Drake wrote of the cholera epidemic: "Illinois has suf- fered but little. The Eastern portion of the State has suffered most. Some villages have been scourged." The following in regard to Central Illinois, folldwing tb.e Black Hawk War, is qunted froni the Social Life — Early Settlement of Illinois, Haines: "Time had but little softened grief for those slain by Indians when the cholera spread a funereal pall over the same territory lately stricken by war. The swift flying messengers on horseback in pursuit wherever to be found dotted the prairies with omens of dread, for when the dread disease struck its victims no time could be lost before active remedies were applied. Death was the quick result if potent relief was not found within the early hours of attack. In my family four were fatally stricken in as many days. Many who were not at once attacked fled their homes, only to meet death a little later in the lonely prairie =' Carr (The lUini, a Story of the Praii-ies. Clark E. c:arr. Chiiago, A. C. iri:ClurK & Co. 1904). =*Hirsch (Handbook of Geographic and nistorkal Patholog.v). 44 niSTOKV OK CKKTAIN DISILASES PRIOR TO 18TT or unsettled forest. Bereavement and sorrow were widespread, almost universal over a great part of tlie West. Typlioid and other fevers followed this dreadful visitation, swelling the death list generally from those who escaped the cholera. Indeed, the 'cholera year' as it was long referred to. was a period of gloom from which memory turns in horror. From this period may be dated most of our country graveyards, being then set apart tor burial of our first dead." r^arrish''", wriliny; of the Black Hawk War, l8;iS, said: "Cholera which had appeared among General Winfield Scott's troops had detained them at Detroit, Chicago and Rock Island. * * * Nearly one-fourth of his entire detachment of one thousand men having died of the pestilence. * * * Beyond this the entire American loss in the war was probably not in excess of two hundred and fifty." I'arrish. writing of the Swedish Cniony at Bishop Hill, Henry Cnuiity, ill llliniiis s;iid : "During the cholera scourge of 1S49-52 men would go to work in the morning in good health and be dead before sundown." Imoiii is;!; (or 1838) until IS 1(1 liirsch says: "Europe. Africa and America were ccnnpletely free frcmi chcilera." In the third pandemic the disease was widely prevalent and highly fatal in Illinciis. It is mentioned in the A'c/ioc/.s- on Practical Medicine in 18."51, 1852, 1853, 1854, and 1855. In sduie nne of these reijorts Jerseyville is quoted as congratulating itself in escapint;- the epidemic, attrihutintj it to having appointed a local hoard of health and to the excellent woik done hy the board. Chicago also appointed a new l)oar(l of health whenever cholera was seen coming down the road (or down the lake or up the river), Imt it was not so fortunate as Jerseyville. The Transactions of tlic Illinois Medical Society reported cholera in lS(;ii-lSiM and IStiS. It was also present in 1S';3. By somewhere toward the end of ISC.'. the fourth pandemic was at hand and cholera was again in Illinois. The Committee on Practical Medicine reported its wide prevalence in l.s()G and 18GT. Dr. P. AI. Cook, reporting in 1868 said, there were 1582 cases, 970 deaths in Chicago in Isii; : 1082 ca.ses were reported in October. October 10th, 175 cases were re|)orted. The population of that city in that year was given as 200,330. In 1868 the disease still prevailed. Zeuch^' gives the following instances of epidemics in several counties: White County, in 1832, 1S4S, 1856, 1866 and 1873. St. Clair County, 1832. Governor Edwards died of the disease in this epi- demic in Belleville. Sangamon County, 1849. Morgan County, lS:i3. "Thi' little village of .Jacksonville received a set back when cholera took a toll of fifty-three deaths." Greene Couuty. 1S44. "An epidemic of cholera destroyed fifty of the stru.ggling colony (Carrollton)." » Parrish ( ilisloiic iniiiois. tlie i-(imance of the earlier days. Randall Pni-rish. HISTORY OF CERTAIN DISEASES PRIOR TO 1877 45 Adams County. 1S49. 1S50-1S51. Vermilion County. 1S34. Fulton County, 1S49. Henderson County. 1S49. Tazewell County, 1834. 1S44. 1849. Will County. 1844 to 1854. "The epidemic left in its wake a case mortality of 60 per cent. Kane County. 1849, "The Colony of Swedes at St. Charles was almost deci- mated by it." Putnam and Marshall Counties in 1849. "Cholera killed 143 in the Swedish colony at Bishop's Hill." "In 1832 cholera was mostly in the cities, but by 1834 it had reached the rural populations." Short's History of Morgan Caitiily rciiurted an epidemic of cholera last- ing six weeks in Jacksonville in the summer of 18o3. "In ISol cholera visited Morgan County; the path of the scourge was a narrow strip south- ward as far as Belleville." The Springfield Journal published a letter Alay 26. 1852. from Cairo which said "Cholera has been prevailing here for the past two weeks prin- cipally among recent German immigrants. Ten or twelve have died.'' June ]4:th the same paper printed a letter from Walnut Crove which said. "There had been some fatal cases of cholera in Woodford County." The Bloomiugton Intelligencer corroborated this report of the death from cholera in that city of a man who had recently returned from a visit east and on the river. June T.)th chcilera was reported in LaSalle, Illinois, but reputed as under control. June 22nd the Monmouth Atlas re]iorted that cholera which had lieen under control in Warren County had reappeared. Dr. Wright who had been attending the cholera cases was one of those who died of the disease. The Springfield Journal on May ISth reported cholera at Cairo and at Peoria. The ligyplian Republican {]\mii i;i, l'J27) writing of Williamson County said : "Cholera made its first appearance in July. 1849, but caused only a lew deaths. It reappeared in 1866 and lasted for six weeks during which over twenty- five persons were taken away and the city of Marion vacated. Among the de- ceased were the three beautiful Ferguson girls, ladies without parallel in all the area for beauty and refinement." In 1867 the Illinois Medical Society had a red hot debate on the eating of fruit during an epidemic of cholera. Those who participated in the debate were Doctors J. Adams Allen, who introduced the motion, David Prince, W. S. Edgar, E. Ingals, T. F. Worrell, 1). W. ^■.lung, 11. A. Johnson and N. S. Davis. The resolution was aimed at the authorities of St. Louis who had tried to .stop the eating of fruit during the prevalence of cholera. The resolution which tinally carried, re.id ;is follows: "The moderate use of ripe but not stale or decayed fruit, taken at the ordinar_\- meals, is not ob- 4G IIISTOKV OK CKUTAIN DISEASES PRIOR TO 1877 jectionable as tending to produce cholera, hut ratlier is conducive to the pres- ervation of health during the hot season." L. T. Ilcwins of Loda (Committee of Practical ^Medicine) reported cholera jircsent in IS(ir) in Alexander, Coles, Champaign, Cook, Iroquois, and ])r()lial)lv other ciiuiilies. Yellow Fever. The mos(iuitoes which act as vectors of yellow fever are found in the southern end of the State, yet there are only two records of epidemic of yellow fever in the State. In August, September and October 1878 yellow fever prevailed in Cairo, Illinois. In all there were eighty cases of the dis- ease with sixty-two fatalities. In that year an extensive and highly fatal epi- demic prevailed in the lower Mississippi River Valley. The nearest point to Cairo reached by the disease prior to its appearance in Cairo was Hickman, Kentucky. By a strange irony it appeared first in the household of the Cairo Bulletin whose editor had been active in stimulating the authorities to clean up Cairo and simultaneously in trying to caln; their fears. So far as the record shows the disease prevailed solely among residents of the city of Cairo and it did not spread to any nearby city nor to the sur- rounding country. Just who brought it into the city was never known. The first case w"is the father of the publisher of the Bulletin and he died in the Bulletin office. Later the editor and two printers of the Bulletin died with it. The disease abated in September and the schools opened, but it reap- peared in October and lasted until the frost came in the latter part of the month. r)n October (ith there were six deaths from it. Perhaps this epidemic was sent as a baptism of fire for the infant State Board of Health. On several occasions cases of yellow fever have developed among ref- ugees in Chicago. There have never been any secondary cases. An accnunt of a small outlireak at Centralia is found elsewhere in lhi> volume. Dengue. Jn 18'2.S there was almost a iiandemic of dengue called by some the Spanish fever. It travelled a long distance u]) the Mississippi River but there is no evidence that it w-ent north of the 3-lth parallel, and Illinois prob- ablv escajied. There is no record that the people of Illinois ever suffered I'n.ni dengue. Since the mosquito which spreads this disease is closely re- lated to the varietv which sjireads yellow fever and since this type of mos- quito is onlv found in the southernmost part of the Slate, dengue should never menace Illinois. history of certain diseases prior to 18 i 7 47 Snake Bite. In the early Illinois days snake bite was frequent. [Many fatalities re- sulted. In the Reports of the Committee on Practical Medicine snake bite was reported on in 1852. In 1854 Dr. Daniel Brainard made snake bite the subject of his presidential address before the State Medical Society. He did a great deal of scientific research work on the subject. He said Indians used rattle snake venom on their poisoned arrows. He showed that the whiskey cure was worse than useless. He advocated local treatment with iodine. Snake bite figured in other discussions before the medical societies. As the country became more densely settled and the land better cleared snake bite as a menace to health and life disappeared. The favorite remedy for it, whiskey, remained as a menace for a long time afterward though its use (as a remedy for snake bite) is about to become legendary. TvPHus Fever. llirsch"- makes the statement that he never found a single reference to typhus fever in the Mississippi Valley. It is probably true that European typhus never invaded Illinois. In about 1916 there were a few cases among Mexican laborers along the Santa Fe railroad within the State but the au- thorities prevented it from spreading. It is also true that cases of Brill's disease or modified typhus have been reported from Illinois but it is a state- ment of essential fact to say that in the period of Illinois history, now under consideration, typhus was never present. Drake''^ says that Indians were infected with typhus from a ship at Nantucket in 1763, but no evidence is found showing that typhus ever reached the Indians of the Illinois regimi. Drake writes abinit Irish immi- grant fever, but mentions no cases in Illinois and Indiana. -Vnd yet the disease is rather frequently referred to in the writings of physicians and even in the reports from the Chicago Health Department. It must be re- membered that Louis did not difTerentiate typhoid fever from typhus until 1s-.':i, and his views were not generally known in Illinois until at least ten years later. Som.e of the references to typhus in these earlier reports re- ferred to typhoid and some of the low delirium .stages of malarial fevers and other diseases. ' Hirsch, Ibid. I Drake, Ibid. First health officer of Chicago, appointed in 1S37. He was probably the first municipal health officer reg- ularly appointed by a board of health in Illinois. HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 49 When the controversy over t}-phoid was warm. Dr. E. P. Cook of Men- dota said he had seen typhus in Ireland and what he saw in this country that was called t^■phus was not the disease he saw under that name in Ireland. Mirsch probably overlooked the definite re- ports of tv])hiis "jiven in some instances by street location found in the Rrports of the Chicago Health Dcpartninit in 18(3T, 1868 and isd!). The diagnosis in these cases was prob- dblv erroneous but Mirsch had no way of kn(}win<;- that. ( )ne sometimes wonders how llirsch tailed to read the so-called Ranch Report of thi Chicaf/o Health Department made in IS'io or IS'Il. Hirsch's Handbook is encyclopedic. He seems to have had access to nearly all the literature of the world, yet somehow he seems to have missed this Ranch report and in spite of some of the mistakes found in it we know of no American re]iort of the {:)eri(.i(l which compares with it. Smallpox. Smallpox was a disease of the Indians. It was brought to them by white men, but just when is not known. It may have been among the Illi- nois Indians at the time of the French-Canjidian occupation, but there is no proof of the fact. It was elsewhere and it is not easy to understand why the Illinois Indians escaped if they did. Drake ■' wrote : "Smallpox has penetrated far into the wilderness and proved extremely mortal among the Indian tribes. Ross tells us the chief remedy used by the Indians for smallpox was to pour cold water over the patient. It was a period in which smallpox was very prevalent and highly fatal among the Illinois popula- tion. It came in periodic epidemics and most of these were due to a violent virus. Vaccination was not general." Catlin-'"' says ; "Trade and Smallpox were the prin<-ipal destroyers of the Indian tribes." Hrdlicka, writes of the Southwest Indians of our times what has been true of Indians for a hundred years or more. "Smallpox is the most dan- gerous contagious disease." This disease has plagued the white man ever since he landed in America and for that matter long before. "Drake, Ibid. 3'Catlin (North American Indian.s nin:!). I'lil). 50 HISTORY OF CERTAIN DISEASKS PKIOK TO 1877 1 iirsch'-'', spcaUinsj of smallpox in America says to whatever places the Euro])ean inimisjrant camr ami scttU-cl. everywhere thev carried the disease willi llieni and i^axe it to the natives. i5ut a still mure lerrihle sdurce for .America \\a> tin- ini])iirlatii>n ot' nciiin sla\es. livery fresh outbreak of smallpox could he traced tn importalinn fmm Africa. Table I. Deaths fko.m Smai.li'ox — City of Chicago. Rates Per 100,000 Population. 1S6T-19-26. 1867 1868 1869 IS70 1S71 1872 1S73 1S74 1876 1877 1878 1881 1882 1883 1884 1883 1887 ISSS 1889 1.S90 1891 1892 1893 1894 1895 1898 1899 1900 1901 1902 1903 1904 1905 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 0.04 0.14 Wherever it came from and whatever the source of reinforcement small- pox was present somewhere in the State practically all the time after 1S40 and it was epidemic somewhere in many of the years. The Reports of the Cominittee on Practical Medicine refer to the dis- ease in 1S,')2, 1855-1857, 1858, 1869, lS7v. and 1875, as being epidemic in one or more counties in the State. 'Hirsi'h, Ibid. HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 51 The Annual Reports of the Chicago Healtli Dcparlincnt shows that the disease was prevalent in that city in every year lictwecn ISG? and ISSS (See Table No. 1.) It was present in epidemic prujiortions in many years jjrior to 1867. Among the reports of smallpox epidemics in lllinnis found in Zeuch's History of the Practice of Medicine are: Henderson County in 1854 and 1855 and Kankakee County in ]8.'!7-;iS. The account says: "Smallpox ravished the settlements during the winter of 1837-38." A history of Williamson County (Egyptian Republican June JJ, ig^y) says, "The smallpox has visited the county on several occasions but never resulting in nu'un- deaths until 1S7 3 when a good many died in the south side of the cuunty." Erysipel.\s. The student who considers the prevalence of the different diseases in Illinois in the first seventy-five years of the nineteenth century is struck by an apparent relationship of a group of diseases now known to be due nr in some instances suspected of being due to members of the streptococcus group. The diseases referred to are erysipelas, scarlet fever, puerperal fever. se])ti- cemia and rheumatism. In the early days these diseases were very prev- alent. In many cases they swept over communities in epidemic proportions. Furthermore, their case fatality rates were higher than in the present day. One of the significant improvements in the last half century is the lessened prevalence and the lowered virulence of most members of this group. In Ma\-, l'.i".'7, R. M. Atwater-'", writing of the relatii)nship of this group of infective disorders, said: "When rheumatic fever is compared with scarlet fever, chorea, erysipelas. septicemia and puerperal fever, it is seen that the trends, as well as the yearl.v oscillations of these diseases, are alike. Acute rheumatic fever appears to be related to the family of streptococcal infections. There is a community of rela- tionship between these diseases. This correspondence appears in the United States, as well as in the English records where it may be traced back as tar as seventy-five years." In the early history of the State erysipelas was l)oth freipient and fatal. At times it swept over the country in well marked epidemics. In spite of the fact that the sick were generally cared for in their homes and hospitalization was rare, the disease was regarded as contagious at least in certain epidemic outbreaks. Some relations to puerperal fever and hospital gangrene and perhaps other infections were guessed at here and there and at intervals. A study of ei)idrmic erysipelas made by Dr. l'',ihnund Andrews in Chi- cago in 1808 will be fnund in the section dealing with Chicago. He made ^'Atwaler (American Journal of Hygiene). 52 1IIST0R\' OK CERTAIN DISEASES PKIOK TO 1877 spot maps of the disease and tried to show its relation to the very foul stretches of the Chicago River and to badly sewered sections of the city. in ls|;; and ISII their \\a> a ^real epidemic of erysipelas which was rc])oited by Doctors J. 1*". IKnry, and Lnlliurn'^ of i!loomin<;;ttjn. 'i"he\' re- ported that the disease came from the Mast and that the ejiidemic extended far beyond the boundaries of the Slate. One of the names by which erysipelas went in that early day was "Ijlack tongue". Dr. Meeker-'" of Rush Medical College wrote a paper in May, ISKi, on black tongue or eijidemic erysipelas, as it appeared in LaPorte County. Indiana. He said the epidemic first appeared in Canada. During the \\ inter of 1842 notice appeared in the public papers of an epidemic pre- vailing along the Illinois River called the black tongue. It was extensive and highly fatal in Lal'orte County in isi.'). In 18 Ui Ur. l-'itch''", reported the ])revalence of the same epidemic in Logansport, Indiana. In Drake's" writings erysipelas is fre(|ueiitly rejjorted under the name "Black tongue". In 18(11 Dr. N. S. Davis, in reporting for the committee on practical medicine said: "Those epidemic diseases chiefly worthy of mention are erysipelas and cerebrospinal meningitis. Coincidently with the presence of erysipelas, typhoid and typhoid-pneumonia were unusually prevalent. There was a wide-spread epidemic influence of a tophus ty])C." At that date Dr. Davis could not get awav from the use of the word typhoid in describing ciinditions of low vitalit\- regru'dless of llie disease which caused them. He more or less connected together all diseases in which lbiirn (W.stirii .M,di,-.il ami I •|i.\ sii:i I .Iciirual ). :»Dr. Mi-ckir (III. :in linding he t'xpressed the opinion that syphilis was one of the MHrdlifk.T (.Icuirnal, Am. Jledical Assn., Mar. Id, run;). M Joseph .tonus (X. (). Ih-d. & Sni-Rical .loiirnal, .June, 1S7S). HISTORY OF CERTAIN DISEASES PRIOR TO 1877 59 pestilences which destroyed vast numbers of the aborigines. It is not cer- tain from the reading of the text whether he meant to say that syi^hilis among Indians was a pestilence pri(jr to the Cdming of the white man. liut it is cer- tain that he was sure that the bones he examined showed that the mnund builders had syphilis of the bones prior to the discovery of America. His report supported the Columbian theory of the origin of syphilis. Jose])h Jones was an able scientist and a learned jiathologist for hi^ day but he could easily have been in error. It will be recalled that at one time the lione lesions found in the l^gyjitian mummies were thought to be syphi- litic and this was given as proof that the Columbian theory was wrong. It was not until a very capable modern British pathologist, Ruffier examined these Egyptian mummies that it was proven and accepted that the lesions were not syhilitic. Probably a review of the evidence in the case of the mound builder's bones might lead to a reversal of Joseph Jones' opinion as it did in the case of the Egyptian speciinens. Dr. Michel Gandolphe''" says the origin of sy])hilis is one of the most controverted points in medical history. The epidemic of the disease which prevailed so widely in Europe about 1900 acts like a curtain in shutting out all the history of syphilis which preceded that conflagration. He says the research in the literature made by Notthaft of Munich exhausted all the pos- sible ties of solution on the literary side and came to no conclusion. There- fore, he advocated trying tn solve it b}' study of the bones of ancients. Lortel found what he thought was evidence of syphilis in the skull of an Egyptian nnmimy. (iandolphe examined this specimen and disagreed with Lortel. But in 1111 1 Raymond sent Gandolphe two bones from a skeleton found in a cave in the .Marne region in France. These bones were from ]ieiiple who lived before the days of Christopher Columbus, (iandolphe and also Raymond thought these bones were syphilitic. Whether or not the Indians infected the whites with syphilis originally, or vice versa, it is nevertheless true that this disease was moderately prev- alent among the whites during the period covered by this history. They doubtless brought some of the infection into the State with them. The several army posts located in the area nnist have contributed to its spread. However, the great majority nf the people were males. They lived isolated lives. Syphilis was not a major health problem. Kramer holds that the Indians had syphilis in the pre-Columbian period. He bases his opinion on the relative freedom of the Indian from general paresis. This he thinks is because they went through that jihase in the evo- lution of the disease prior to 1.')(|(). The while European became suliject "Gandolphe (Lyon Medicul, Aug. i, 1U1L>. In-. .Miclu-l i laminlplic ). 60 HISTdin' OF Cr.KTAIN DISEASES PRIOR TO 1877 to it aluiut loDii. Al)()ui i;i)() lu- lie,<,'an tn (k'velop nerve syi)liilis. Since 1IU)0 he has Ijeen passinsj mil uf tlir .stai;x- of nerve syphilis. 'The black man is following in his footsteps about two huniired years bchinil the white man just as the red man preceded him. There are many accounts of the presence of syphilis and other venereal diseases ainong the Indians at later periods. Ross names the venereal dis- eases as being among the more common com])laints of the Indians in the eighteenth and nineteenth century. Hrdlicka", speaking of modern Indians says "V'enereal diseases, while predominant among the more degraded Indians, are more or less effectually guarded against by others. The Indians tried hard to prevent the whites from infecting their people with venereal diseases. I. W. Hunter''" who lived a captive among the Indians from 1796 to 181(1 re])orts "They had no syphilis until they contracted it from the whites." So far as it is possible to conclude from so little evidence the conclusion is that syjjhilis was in France long before Columbus sailed from America. GoXORPtHEA. Gonococcal infections are supposed to be far older than syphilis. They are mentioned in the Bible in several places. For all that is known they were present in Egypt before the Hebrews were there. \\'hen these infections came into Illinois is not known, nor where. Armies of some sort and army posts were always in evidence in the State. There were French. Spaniards and British to iic fought and the Indians were a constant menace. All in all there were enough sources of infection. Fortunately the peojjle were hard-working and they lived in rural com- nnmities in the main. Gonococcal infections never constituted a major health prolilcm. ("OXSI'MFTIOX AND ( )THEI{ FoKMS Ob' TuiiERCl'LOSIS. In 18 13 Daniel Drake''" wrote "The most ]M'evalent disease of the In- dians is scrofula. It almost annihilated the Peorias." His description of scrofula shows that he includes tuberculosis of the lungs and bones with tuberculosis of the glands and lungs. lUit this oi)inion was not the general piilali(iii : 18,-)0 J SCO 18T0 isso is'.iO 114.5 145.0 i:i|.-l 14s.!( Tile death rates in Chicago as shown hy the Cliicatjo Health }1cpar;incni Krf'ovt were : IS51 l,S(iO 1870 1880 IWiU 123.5 25,2.8 i:(j.s 1G9.5 16:5.2 The figures do not suhstantiate the opinions of the pliysicians of the time. It is not necessary to discuss the reason for their error. It is enough to say tlie error is a common one. I-'.veryw-here in the [leriod when the general opinion is that consumption is a rare disease it is fnund that the deatli rate from it is around 280 jier 100.000. .Vs attentinn is directed to it. the consumption deatli rate conimimly declines. The limits uf this de- chne is ahout 1 10 per KJO.OOO. During this period the causes indirectly respimsilile lor the decline are certain changes in customs and attitudes. The cases are recognized and some effort is made to prevent them from sjireading infection. Careless- ness in spitting gives way to some degree of care. Sleeping with consump- tives becomes less general. Ventilation is im])roved. Wages go U]). Stand- ards of living are raised, food is more abundant and of lietter quality. Pro- found fatigue is less general. These are illustrations of the kind (if change in custom, habit and attitude which reduces the consumptioit death rate from about 280, the level of no information of facts nor interest in them, to about 140, the level at which specific work against the disease is generally added to the program. These added features called specific work against the disease, consist in such procedures as reporting cases of the disease, build- ing and operating tuberculosis hospitals, sanitaria and dispensaries, main- taining centers and nin^ses. enforcing sjiitting regulations and other nrdi- nances and laws. The decline in this period of systematic control is from about 1 10 to abnnt ^0. This epuch was entered in Chicago in 190^ and in the remainder of the State about five to ten years later. PxKfMOXI.V AND Txi''H'EXZA. In the hisi(ir\ of disease in llliniiis. it is im])ossible to separate the pneu- monias from intlueiiza at all times and with certainty. The former were always ])resenl aii, a \ery severe and fatal epidemic of pneumonia appeared in both the arni\' and the civilian popnlatidn." lie refers to the e]iideniic at French Mills in which 1 7 ])er cent nf the command were sick. Of the sick 52 per cent had dysenterj', 24 per cent pneumonia, 8 per cent typhoid, while IR per cent had ergot paralysis attributed to bread made from flour which contained fundus material. "An epidemic of influenza prev:iiled in Shawneelown in the very early days." Hirsch says influenza was again in pandemic proportions in 1824-26. It was generally present in N'orth .\nierica and was reported from the west. An account of a limited eiiidemic in the Wabash \'alley found in Drake's magazine""' refers to a part of this epidemic. In 1843 he reported another pandemic in North .\merica. In this ejiidemic influenza was reported from Illinois. Drake wmte, "Influenza prevailed in 1.S43 in Xew Orleans and St. l.ouis and in all the intervening towns." In IS I!) a report on pneumonia in Illinois credited the gaseous emana- tions from the school stove as a cause of the prevailing disorder. The the- ory that carbon monoxide from stoves is a contributing cause of pneumonia is being revived today. In 18."),") Dr. Crothers of Bloomington reported an epidemic of pneumonia in McLean County. Dr. Spalding reported a simi- lar epidemic in the same year from Galesburg. In is."")? Dr. Thomas Hall of Stark County wrote: "Last winter Dr. Chamberlain and I treated 7(i cases of jineumonia." Dr. C. P>. Johnson of Cham]iaign writing of his practice in Chatham, Sangamon Coiint\- about ISCS to 1S7(1, s.aid "During the two and a half years that I ])racticed in this loeality 1 .saw more cases of pneumoni.a (lung fever) than I have seen in many 3'ears of practice since." Dr. Forry, the Surgeon General of the Army, and Dr. Cuolidge gave very good accounts of epidemics of pneumonia particularly in the army, in the Nc7i- York Journal of Medicine and in the Army Statistical Reports. The p.andemic of Is7-") was said to have been "univers.al in America." It was highly fatal in Illinois. It was peculiar in that it was shortly followed if not accompanied by a jiandemic of epizootic among horses. The great ])an(lemics of 18S!l-'.il and r.tl8-2() are matters of more recent history. "'Edgar (Jlilitary SurRi-on, Ifarc'li. Itt27). "■'■Draltc (WL-Ktcni .M<;in Jonrn.-il Medical Sciences, 1830). c,r, HISTORY OF CEUTAIX DISEASES PKIOR TO IS" ties anil tnwns i:f llic Stale. Haull tlir cluiinnaii, w i-nU', variabl\- fatal." In the Practical Mcdiiinc Rcf^ml for IsTi:;. Dr. I'm-rjieral fever was rife and 1 tliinl< it was in- In Dr. R. I. 1 lannll's Report on Prac- tical Medicine made to the Aniericati MecUcal .Associatirm there is an account of an e]M(leniic (if j)uer])eral fever in County Hospital which beijan in June. Isds, reported by Doctors H. W. j'ines and \\'. E. Ouine, the latter an in- terne was later President of the State Hoard of Health. Doctors Jones and Ouine clearly connected the prevalence of the disease with two sources of infection. The obstetrician of the hospital doubled as pathologist there. He alternated jobs be- tween the obstetric wards and the autopsy table. The internes, students and physicians iM K.ii.iTt c. Haniin. were allowed to exaiuine jjarturient women al- most withnut limitation. In 18 K). Dr. Oliver Wendell Holmes wrote, "The disease known as puerperal fever is so far contagious as to be frequentlv carried from patient to patient by physicians and nurses." He had in mind childbed fever as it was ill hospitals, Ijut there is proof that the disease was sometimes conveyed bv persons who have no hospital contacts. It is the custom now to say that there is no decrease in the mortality rate from puerperal fever. The statement may be true when the present day is compared with say twenty to tvventy-tive years ago. But it is not true W'hen the present day is comjiared with the period between fifty to one hundred years ago. In s]iite of the distance between homes and the almost total absence of hospitals for maternity cases in that earlier period puerperal fever prevailed. Milk Sioknes.'^. In the Report an Practical Medicine made to the Illinois Medical Society in 1S.")1, this statement is found "ll seems singular that a disease s])ceially lielonging to one soil, the fear of which has turned back man\- an immigrant from settling in our State should ha\e found so few historians." .Milk sickness, while not spccialh' belonging to the soil of Illinois was very prevalent in the State in the early days and may have prevented many prospective settlers from entering or remaining in the State. HISTORY OF CERTAIN DISEASES PRIOR TO liSTT 07 Drake w rote of milk sickness un(k'r the name "Indian trembles". He says "Hennei>in first wrote of the trenililes according to this version. The Indians kiKiw of it and snlTered from il. It is difficnlt to understand how llie\- could have esca|)e. dugs and liuzzards cijuld contract it and that carnivemus animals such as men. dogs and buzzards got it from drinking milk or eating meat from poisoned animals. It was not until very recent times that milk sickness in Illinois was proven to be caused by animals eating white snake root. Vnr this discovery Dr. Clay of Hoopeston was largely responsible. Other plants can cause it and in other sections of the country they are the principal cause of it. Rowe and other farmers, Barbee. Drake, McGarragh and other physicians were not far wrong in their speculations and experiments made between 183S and ]s.'i,s. Had they and their successors stuck to their lead the cause of the tniuble shdiilfl have been discovered at least a ([uarter of a century earlier than it was. The fiilliiwing quntations are from Zeuch's History of tin- Practice of .Medicine: "Even as late as 1855 mucli distress was created by tlie appearance of milk sickness near Albion." "Dr. Joseph Gates of Marine was called all over the State to treat milk sick- ness which had an extensive prevalence. This was in 1830 and for several years thereafter." "Many people died from this worse than the plague." (The reference was to milk sickness in Crawford and Clark Counties.) HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 G9 "The milk sickness lay in wait for man and beast along nearly all streams throughout the county and often proved as fatal as the horrible malarial." ( This is quoted from some pioneer as being descriptive of conditions that were rather wide-spread in the State.) "Milk sickness was frequently reported from Edgar County." The disease, if it can be properly called such, began to diminish in im- portance early in the history of the State. In 1851 the Report an Practical Medicine contains one reference to milk sickness. That of 1855, devoted considerable space to the subject and quoted a fair amount of literature deal- ing with it. That of 1858 discussed milk sickness extensively. After 1858 it was seldom alluded to at meetings of the State Society. Of all the promi- nent diseases of the early days of Illinois history milk sickness was one of the first to diminish in importance. Nursing Sore ^Iouth — (Possibly Sltuvy). Somewhere about 1856 a peculiar malady prevailed. It was called nursing sore mouth. It affected mothers who were nursing babies and some of the reports refer to nursing babies having the same malady. Nursing sore mouth is found covered in the Practical Medicine Reports for 1857. It may have been that this sore mouth was scurvy. In 1858 Eaily devoted much of the Report on Practical Medicine to a discussion of scurvy as a source of illness in Illinois. Among other things he held that it was a factor in the prevailing sore mouth of nursing mothers. The literature does not record the acceptance of Dr. Baily's opinion that scur^'y underlay many of the ills of the people of the State. Dr. E. P. Cook of Mendota, in an earlier Report of the Committee on Practical Medicine, had referred to scurvv as being in part respon>il:jle for the continued fevers of the period. Dr. J. H. Hollister reported on the prevalence of nursing sore mouth in Illinois in 1859. Typhoid Fever. The travellers, historians and other lay writers who wmte incidentally or otherwise of health in Illinois in the first half of the nineteenth century or prior thereto, made no mention of typhoid fever. The medical men who wrote in the same period wrote rather frequently of continued fevers of one sort and another calling them by different names. When they began to refer specifically to typhoid fever by that name, about 1S50 and for several years thereafter, they spoke of the disease as having rather definitely in\aded the State though they do not state 1)y what means nor from where. 70 HISTORY OF CERTAIN DISEASES PRIOK TO IST? In IS.jl, Dr. N. S. Davis told the Chicago Medical Society: "Typhoid fever tirst became e])i(lemic in 1848, and was highly fatal. Since then it has been milder." In ]S.")I), Dr. Roe of Hloomington wrote: "Typhoid fever is now first in inipiirtance. I'erhaps not even cholera exceeds in the number of its vic- tims this fell disease. It is almost as yesterday this disease made its first appearance among us." In 1851 the Report of I he L'oiiuiiittrc uii Practical Medicine of the Illi- nois ]\Iedical Society, contained this statement: "Much has lieen written on the extension westward of typhoid fever." In 186:3, Dr. Noble told the State Medical Society: "Typhoid first came to McLean County in 1846 and 1841." In 1864, Dr. J. S. Jewell wrote: "In two or three years after 18.57 the continued fevers almo.st entirel}' supplanted the autiuunal fevers." Dr. J. K. Reeves"-' gives an account of the first appearance of typhoid fever in \'irginia in 184;3. "It seemed to have suddenly appeared in that year. By 1X45 it was one of the major epidemic diseases." I think it is a f;iir assumption that the general opinion about 1S60 was that Ivphoid came into Illinois .-ibout 1815. Htstorji of Steps In llic Estdlilislinniil of Ti)i>Jiiiit! Fcrer as a Specific Disease. Physicians everywhere li:id such great difficulty in recognizing t)'phoid as an entity that it is interesting td trace the ste])s by which this disease emerged from the fug which (il)scured the entire field in the first quarter of the nineteenth century. To travel this path properlv it will be necessary to begin far away from Illinois and j)ri(ir to the date of Illinois statehood. However, the place of Illinois physicians in the world wide controversy will be established before the story has been cdmpleted. It seems pirdbable that typhoid fever has always existed, though the dis- ease was not clearK established as an entity until the study by Louis ap- peared in I S3!). Dawson"" s;i_\-s : "The low fevers of Hippocrates and (/ialen may have been ty|)hoid." Dr. C. (i. Cumston'' thinks typhoid fever a very old disease. He (juotes Thucydides' description of a fever which prevailed in the Greek army in the Peloponnesian wars and gives his opinion that the disease was typhoid. He says: "Petechial fever — what we now suppose was typhoid — ravished the ^^ Reeves (Practical Treatise on Enteric Fever, lS5it). '"Dawson (Western Medical Medical and Physical Journal, 1S44). •'Gumston (N. Y. Medical Journal and Record, Feb. 16, 1927). HISTORY OF CERTAIN" DISEASES PRIOR TO 1877 71 island of Cyprus at the end of the fifteenth century, and Italy in l.Vll during the expedition of Louis XII against Naples. Hence it appears to nie that typhoid fever was not a new disease ajipearing at the end of the 15th cen- tury." Murchison'- says: "Some of the descriptions of the Greek writers I^robahly referred to enteric fever." He quotes from the writings of Hip- pocrates and ( ialen. Spigelius speaks of this fever as comiuon in various jiarts of Italy. With this statement, however, Hirsch'^ disagrees, saying: "I do not agree with Murchison that Spigelius wrote of typhoid fever in the 17th Century." However, Hirsch says: "In the writings of the Hith and 17th centuries there are accounts of certain forms of sickness which can hardly be interpreted than as referring to typhoid." Among those who wrote of what Hirsch said was typhoid were : Syden- ham ( IGGl) ; Welles (1682) which description Hirsch pronounces "the first clear description of typhoid": Lancise (1718) ; Hoffman (1728) ; Strothers (172!)): Gilchrist (1735); Chirac (1742); Morgaginni (1761) and Hux- ham (1781). He also gives a large numljcr of citations from the French, Genuan and Italian, all of which show that a considerable amount of accurate knowl- edge of typhoid fever was known to Europeans prior to 1800. In most instances the literature cited by Murchison is the same as that cited by Hirsch. Bardett says that the first good description of the pathology of typhoid fever was that of Prost (1804). Ahirchi>on quotes Prost as having made ])Ost mortems on 200 cases of typhoid. In thi> connection the year 1804 should be kejn in mind. It will be referred to in discussing the American doctrine of the unity of fevers as put forth by Benjamin Rush. Hirsch savs : "Petit and Serres (l.Ml) gave an accurate account of typhoid fever." .Murchison says of Petit and Serres (1813) : "They were the first to regard typhoid as specific." These are a few citations of tlic literature prior to that of 182U. In that year Louis wrote the treatise which fixed the name "typhoid" and secured general recognition of the disease as an entity. In the period prior to 182'J tv])hoid was frecjuently confused, es])ecially with tyi)hus. Lois' pupils, drawn from all over the world, returned ti^ their homes carrying the teachings of the master. It was Gerhard of Philadi-lphia, an almost yearly visitor to European hospitals during this period, who liroiiglu b;ick to .\merica definite ideas as to typhoid and spread them over the country, hut particularly along the At- lantic seaboard. ■MClontinued Fevers, 1.SG2). "Hirsch (Handbook of Hist. & Geog. P.ith.. ISSl). 72 iiisTiiin Hi- I i:rtai.\ diseases pkiok to 1ST? Subsf(|ia'iU ti] the yt-ar IS'ili mcisi of ihc coiilincntal writers of ])romi- nence raii.i,R'(l iheniselves lirhind I.Duis. ( )!i the (ither hand the I'.ritish were verv iinieh (Hs])i)se(l to huhl that ly]>lui> ami tyi)h(ii(l, and other forms of continued fever, were due to the same yroup of causes. 'I'heir scientists, Sydenham, lluxjiam. \\'elles, Strothers and Erasmus had contrihuted valu- able information sustaining the position ultimately taken by I.ouis. but this they seem to have disregarded. In adopting what might have been called the British doctrine of the unity of fevers, they may have been under the influence of |)atriotism growing out of the Xajioleonic wars. Who knows? It was not until Sir W. jenner wrote in ISH) to ls.")l that the British tinallv abandoned this position — the doctrine of the unity of fevers. In 1804 Benjamin Rush was an outstanding figure politically and in American medicine. He had signed the Declaration of Independence, mean- ing American independence of Great Britain, but in his views on the con- tinued fevers he was anything but independent of British contemporary opinion. It was in that }ear. or ISO."), that he wrote his views on fevers as follows : "The usurd forms of the disease produced by the miasmata from the sources of them which have lieen enumerated are: 1. Malignant, or bilious yellow fever. 2. Inflammatory bilious fever. 3. Mild remittent. 4. Mild intermittent. 5. Chronic, or what is called nervous fever. 6. Febriculi. 7. Dysentery. S. Colic. 9. Cholera morbus. 10. Diarrhoea (morbus)." Dr. Ix-njaniin Bush had just passed througli a great epidemic of yellow fever in Philadelphia, aiul some jian of this opinion was founded on his experience there and then. P>ut much of it was due to his reading of British medical literature. Thereafter, as will be seen, this doctrine became known as the .American doctrine of the unity of fevers. I'erhaps one statement by Rush in the pajier quoted is enough to absolve him for the hann he did by advocating this theory. It is: 'T look fin- the time when our courts of law shall punish cities and \-illages for iiermitting any of the sources of bilious and malignant fevers to exist within their jurisdiction." About this time (1T0!I) Xoali XW'bster contriljuted to the same grave error of a common meteorologic and miasmatic origin of contagion in his otherwise great work. "A Brief History of Epidemic and Pestilential Dis- eases." HISTORY OF CERTAIN DISEASES PRIOR TO 1877 73 But not even the name of Webster could dis[)lace that i_if Rush. The (liictrine of the unity of fevers travelled under the mantle uf fame nf Rush until it reached the Northwest Territory embracing Illinois and the contig- uous states. In the East, Nathan Smith, Jackson, Gerhard and Hale, and probably Oliver Wendell Holmes were doing their best to spread the facts about typhoid, but they were not wholly equal to the task of overcoming the influence of the \iews of the signer of the ncclaratiim of Independence. J. W. Monette uf .Mississippi attacked the ihenry that yellow fever was caused Ijy the cause uf malaria in a series of articles, most of which appeared in the jrrstcni Mfilicul and Physical Journal, and the Aiiwricaii Journal of the Medical Sciences. Dr. Munette's jiapers were masterpieces and left Rush with nnthing to stand cm. In these earl\- days the princijial tliscussion was over the separateness of typhus and typhnid. In 1842 Bartlett published his magnificent, clear- cut study entitled ".-/ llislory of Continued Fevers". After that the opinion of Rush as regards the oneness of typhus and typhoid was without founda- tion. The same may be said of the oneness of typhoid and malaria though il was more than two decades before the notion that these two diseases or groujis of diseases were related some way or other came to an end. .\nd now. let us move from the Atlantic seaboard to Ohio, Indiana and Illinois. The (jutstanding medical man of influence in this region from aliout ISl.') to about IS.'id. was Daniel Drake of Ohio. lie lectured in Cincinnati and Lexington, he wrote a textbook, he conducted the first medical journal in the region, and he carried on an extensive corresijondence with physicians in all parts of the Mississippi X'alley. There was scarcely a section that he did not visit. His ac(|uainlance was wide and his influence was great. Drake was very much under the influence of Rush. Roth he and his correspondents believed in miasmata and telluric influences as heaig able to cause malaria and other fevers, perhaps typhus. He showed a marked ten- dency to hold that the typhoid state, or a fever of the type of t\iihoid could be the outcome of these miasms. If Drake had read any of the contributions which paved the way for Louis in that year, there is no evidence that they changed his views: nor is it certain that be read Louis or Gerhard anywhere soon after ls2!i. luniy in the IlHh century the ]ihysicians of the U])i)er Alississipjii \alley seemed to have accepted the opinion that the slow fever in that region was not typhus. After about 1830 the difficulty in this region on this question 74 HISTORY OF CERTAIN DISEASES PRIOR TO 18T7 seemed to lie liniilL-() for about fortv vears the nidst intlueiuial member of the Illinois profession was Dr. N. S. Davis. In 18,")5 Dr. C. X. Andrews of Rockford spoke to the Illinois Medical Society as follows: "Several articles on fever w-ritten by Prof. N. S. Davis have appeared in the North- zvcstcni Medical and Surgieal JournaL He advocated the American doctrine of the unity of fexers. which doctrine I regard as truthful as nature itself. It has been advanced and supjiorted by the most able and distinguished of American ]ihysiciaiis and. above all. Dr. Benjamin Rush." Flere comes this doctrine of the unity of fevers again. It was of British ancestry. Then the signer of the Declaration of Independence made it American. His name almost became a part of its name. And. at last, we find it here in the Northwestern Territor\- aliuost become tlie Illinois doc- trine of the unity of fevers, and even the Davis of Illinois doctrine of the unity <;)f fevers. Dr. N. .S. Davis said: "I do not think that all tyjihoid is caused l:)y a specific cause. The disease can lie caused bv an\' one of man\- causes." In a discussion of fever before the Illinois Medical .^ociet\- in is; I, Dr. Crawford said: "The whole famil\ of the coiuinued fevers are from the same cause. The cause is miasmatic.'' HISTORY OF CERTAIN DISEASES PRIOR TO ISTI But Dr. Cook of Mendota said he differed from Dr. Crawford: "We are all in error in considering these fevers as a unity. 1 have seen typhus fever in Ireland. I never saw a case here." In IS-I-l one of the ablest physi- cians in llliniiis moved tn Jacksonville, .Mnvi^an Cdunty. This was Dr. David I'rince. In Xovember, 1846, Dr. F'rince read a jiaper on the fevers of .Morgan Liiunty''. He named four kinds uf malarial fever as prevailing in that riJiintv. The third of the series of four was called typhi lid fever. He said the icvers of one tyjie tend to run into annther type. There had been some change in the fevers of Morgan County since is:5:. Those of 1837 to 1.S40 were more sthenic and stood bleeding better. Those of 1S41 to 1846 inclusive, and especially 1S44 to 1846, tended to be of a lower type with more tendency to typhoid, stood bleeding and active treat- Dr i>ivins concerniniL; the similarity of tv]>hoid and lyi)hus." In ISlv! I''.lisha iiartlett's wonderfully clear cut text on fevers a]3peared. While an eastern \\(irk. it had some western circulation, and it made the picture clear. After it appt'ared, the onlv job that remained was to get the ])hysicians to read, observe and think. In 1843 Carroll"" reported what seemed clearl\' to have been a detinite outbreak of ejiidemic tx'phoid fe\er in I .ane Theological Seminary. Cin- cinnati. However, the old Rush influence, i)articularly as regards malaria and tvphoid, was not entirely ready to die, jiarticularly in Illinois and Indiana. The great leader of medical opinion in Illinois was Dr. N. S. Davis. The yearly transactions of the Illinois Medical Society show that he was a be- liever in the theory that the same basic cause, moditied one way. caused ma- laria : modified another, caused typhoid. Cp to the middle of the decade of 18.")()-]8(i0 this was the prevailing opin- ion of the physicians of the State, though the minority who thought other- wise was increasing year after year. By I860 the majority seems to have swung the other way. Dr. Davis himself changed his views gradually, though still holding to some part of his basic belief. We find him stating his adherence to ^ome part of tliis basic belief as late as the year 1S';4. Dr. Davis said: "1 do not think that all tyjihoid is caused by a sjiecitic cause. The disease could be caused liy any one of many causes." In the 'ryaiisaclioiis we find him reporting cases of typhoid in the fifties. In ISCil he rep the country was cleared up the trees were cut away and the air could circulate, malaria less- ened and typhoid appeared." 1. .\. I'.gair", Secretary. State Board of Health, Illinois, said: "The ]ieople of the early day were compelled to meet chills and fever, cholera, smallpox and other scourges as best they could. .\t first there were the diseases of the wilderness, plasmodial diseases, cholera, dysentery and other ailments which gradually disappeared with the cultivation of the jirairies and the destruction of the forests. Rut in the jjlace of these came the sani- tarv prolilems of denser population." Hirsch wrote: "That the prominence of typhoid as malaria wanes is because the ]:)opulation grows crowded in proportion as the sources of ma- laria disappeared from the soil by drainage and cultivation." There is no statement that better expresses the relation of environment to the two dis- eases. The theorv that t\i)hoi(l grew out of malaria was also jiopular toward the middle of the nineteenth ceiuury. 1 )r. W. L. I'elder", descriljed a fever which he said was originally iiUer- miltent and lapsed into tv|ihoid. Mettaurer"-, writing of the fevers of \ ir- ginia, lM(i to ISv!'.). described a continued fever which was of malarial origin. Of this fever there were three varieties: synochia, or ordinary malaria, tyi)hoid and typhus. •"Flint (HiilTalfi .Medical .Tcuiriial. 1S47.) »" Eg-an (Jlilitary Tract Medical Society, 1906). »' Felder (Trans. A. M. A., 1852). s^Mettauer (Amer. Jour. Med. Sc, 1S43). HISTORY OF CERTAIN DISEASES PRIOR TO 187' 79 S. H. Dicksoir' says: "In the long protracted cases of ordinary re- mittent fever of the mahirious region, there is a tendency of the fever to continuousness, the whole ap])earance is I hat met with in continued fever — simple, nervous or typhoid. In cnniniiin ]ir(ifessii)nal parlance, such cases take nn the 'typhoid character.' " W. \\ Veatch**"* wrote: "In Sangamon County, Illinois, there are three classes of tviiho-malarial fever, tw" nf wliich .are i)rc:)lial)ly malarial and one, tj'phoid." T jijilni-Malarial Fever. It was in \s',i\ that Dr. Woodward of the I'nited States .\rmy read a paper before the Intern.-itional Medical Congress on the subject of iypho-malarial fever. This paper served to fix "t\']!ho-malarial fever" in the literature. It also served to precipitate a great volume of discussion on several phases of both the ma- larial (juestion and the typhoid question. The view of Dr. Wdodward met with a mixed re- ception from the .\rmy Medical Corps. Ur. Charles Smarl^' says: "Ilefi.re the introduc- tion of the term the .association of typhoid svmi)toms with malari.al fever and of malarial sym])toms with tvphoid fever was well recog- nized." If it he contended that \\"oodward's p;i])er was a piece of s]iecial ])leading for typho- nialarial fever, it can lie .answered that Smart's discussion in the Medical and Siiri/ical History of the War of the RcbcUioii is special pleading against it. \'aughan^'' says: "Early in our Ci\il War medical officers re|iorted fevers which, in their opini(jn. diffcreil from typhoid fever as seen in the north. The first board appointed I ISdl i to investigate the matter reported the lever prevalent among the soldiers was bilioiis remittent fever (malaria), which not having been controlled in its primary stage, has assumed that adynamic type which is present in enteric fever. The second board was convened ( \S{;2 } for the purpose of revising the sick report. Major Wood- ward, the chief of this staff insisted that the prevailing fevers of the Armv of the Potomac were hvbricl forms resulting from the combined influences of » Dickson (Trans. A. 11. A., 1S52). "Veatch (Chicago Medical Examiner, 1866). *» Smart (Medical and Surgical History of tlie W.ir of tlie ""Vaughan (Epidemiology and Public Health, V^r in. 80 HISTORY OK CKKTAIN DISEASES PRIOR TO 187 T iiKiIarial puisoniiii; ami the causes of lyplmid fever; and he insisted they should be reported as typlm-nialarial fever. This designation became official July 1. isr,-..', and fmni that lime until June "-'It. ISCG. ."):,40() cases with ."),;!60 deaths were re]i(irled under this name." Tin- aclion taken by the Army Hoard in ISli'^ under the influence of \\" Iwanl. ]ir(i(luced a great amount of discussion, scime of which was acrimonious. It was asserted that the adoption of the term "typho-nialarial fever"' was a recurrence to the badly discredited and well nigh abandoned doctrine of the unity of fevers. Some said it provided a way down for some men of eminence who had allowed themselves to become stranded on that dead limb, the unity of fevers. It is said that there is a way out for those who had denied the existence of typhoid fever. Also that it furnished a new wav for men who wanted to co\-er uj) antl hide the ])revalence of typhoid fever in their regions and connnunities. The same statement was made in the reverse, nanielw that the term was used as a camouflage for malaria. It was said that its use led to sloppy diagnoses, lack of care in sanita- tion and hygiene, and to wrong treatment of the patient. It was said to be unscientific, as well as incorrect. The hre and heat was so intense that the term fell into disuse. To this doubtless the decrease in malaria contributed. In time the theory that there may be simultaneous infection with a bacillus and a plasmodium will be re- vived, though there may never be a great, impelling reason for reintroducing the term tvpho-malarial fever into the popular vocabulary. There is no reason win' an individual may not be simultaneously in- fected with the ])rotozo,an of malaria and the bacillus of typhoid. The two organisms can exist side l)y side in the same individual either with active sym])toms of each, or with one or both latent, or in the latent or passive carrier state. Dr. C. B. lohnson"' who liegan practice in Illinois soon after isii."), and who has practiced widely since in central Illinois, ex])resses the opinion which was aluKjst universal among the rank and file of practitioners of the period. It was that there is a fever which should he called (and was so- called) typho-malarial fever — "the result of a double infection." Dr. Breed of Princeton held that t}])ho-malarial fever was due to three causes o])erating simultaneously in the same ])atient. These were the cause of malaria, the cause of ty]ihoid and the cause of scurvy — typho-malarial fever was a combination of typhoid fe\er, malarial fever and scurvy — all three of these diseases abounded in Illinois in the same general ])eriod in the early day. <■■ Johii.son. Ibid. HISTORY OF CERTAIN DISEASES PRIOR TO 18TT SI The Transactions of tlic Illinois Medical Society for 18T.5 show that in that year typho-malarial fever was both attacked and defended. Dr. E. P. Look of Mendota said : "1 think there is no donbt Init what the malarial poison and the typhoid fever poison can and do affect the system at the same time, giving typho-malarial fever." Fs bacilli right now and every day, and here. If somewhere between one and three per cent of all convalescents from typhoid become chronic carriers, or intermittent carriers, and remain so for life, what becomes of all the carriers? Why are thev spreading so little typhoid? If ]iractically the entire mature population of thirty years ago h.id had typlKiid, if ninety-two per cent of those who had the disease re- co\-ered. and 'i per cent of those became chronic carriers, the carrier popu- lation of the country must have nKJunted to more than a milli(jn. Why is it they infected so few people? Could their typhoid l)acilli have lost the spec- i;i] (|ualities of the bacillus tyiihosus? These are cjuestions t(.) which there can be no answer now. In the inyestigalion of ty[)hoid among troops in the Spanish-American \\'ar, the tyi)lioid commission found, among other conclusions, two that have a bearing on this discussion. ( )ne was that typhoid was often inaugurated by a diarrhoea which de- viloped during the incubation period of the disease. The other was that of the troops who had diarrhoea some weeks prior to the onset of the e|)ideniic of typhoid, very few subsequently developed typhoid and. converseh', ninety jier cent of the men who developed typhoid had no preceding intestinal disorder. ' SavaKe and White (Briti.sli Research Council l!i2i; Spec-ial Report.s ill, ;i2, lO.'?). 88 iiisrom- oi-- ckktain ihskases prior to 18T? '1 he bru-lfrial causu df ihcsc diarrhoeas was not (k-tL-nnincd. Tlierefcire, what they .'-hiiw either fur or against the Savage and White theory is purely sjjec- iihiti\e. Coiiclii>;iaiis as hi Tjiithanl in lUiiHiis prior lo 1S77. A reasonable interpretation of the evidence with due regard to what is known of the hahits and customs (if the peciple and making use of what is nciw known ahunt malaria and lyplmid leads t" the fcillowing conclusions as to typhdid fe\er in Illinois jirior to liS^i : 1. Txphiiid was hrouglu to Illinois by [leojile who were carriers, and at times. l)y a ty])ical and incubatory case. •i. In the earlv days the sparsity of the population operated against great prevalence of the disease. .'i. Its presence was obscured liy the overwhelming prevalence of ma- laria. 4. ?\luch of it was unrecognized because of the meagre facilities for diagnosis. ■). \\\t\\ the increase in density df ])opulation the disease became more prevalent. (!. With the decline of malaria and the inipro\ement in the methods of diagnosis recognition became easier and more certain. T. It is possible that some typhoid evolved out of the diarrhoeas and food poisonings which were so much in evidence amimg the early settlers. It is possible that such evolutiun, backwards and forwards, is going on all the time but that fact is not proven. It is purely speculative. Increase ill T fijilidid . In the earlv da\s. according to all autbcirities, the conditions were right for the increase of typhoid once it found entrance. Flies abounded; water was poor and frequently polluted; tuilet facilities were meagre. The salva- tion of the people was then isolation. By the decade lS10-lS."iO there was a tendency towards the building of cities. Railroads were being built and canals dug. There was travel. Some congestion was in evidence and isolation no longer ilominated the [)icture. Tyiihoid fever began to be recognized as a menace. Dr. C. B. Johnson*" said: "In most instances when a case of typhoid occurred in a family where there were young people, all would be apt to be- come infected before the disease had spent its force." I'reraleiiee iif I'l/plioid Fever After 1S-'>0. The earlier decennial reports of the V. S. lUireau of Census did not in- clude inortality reports. The lir>i u> inclut(iiid. Diarrhoea and dysentery were very common disorders. In most cases they were treated by domestic medicines and by refraining from eating. When a physician was called he generally treated the disorder symptomat- ically. Not much was known about either diarrhoea or dysentery. Most cases got well with simple treatment. In order to account for the serious cases the doctor fre([ucntly attributed the disorder to some other malady. Malaria was the generally ascribed cause. In IS.'i-^ Dr. Thomas Hall of Toulon. Stark County in the Report of the Committee on Practical Medicine said physicians all acce]ited the view that : "The dvsenter\- is the very fever itself, with the particularity that it is turned inwards up(in the intestines and discharges itself that way." Dr. Hall was correct. Physicians either accejited diarrhoea and dysenteries as incidents of the day's work and gave them no special thought or else they ascribed them to malaria and wrote of what they regarded as the basic dis- ease. In 1S.")1 Dr. Samuel Thompson, Chairman of the Committee on Prac- tical Medicine, Illinois Medical Society exj^-esses it as his opinion that diar- rhoea, dysentery, typhus fever, cholera and milk sickness were modifications of the same disease. lUit whatever ma_\- have been their opinions of the IIISTOR'l' OF CFRTAIX DISEASES PRIOR TO 187T 85 cause, from time to time the malady would be so widespread and so fatal that the physicians writing papers would mention it one way or another. Dr. S. H. Shoemaker of Columbia, Monroe County, wrote in the Si. Louis Medical Journal, March. iSfjo: "Almost every physician in the course of his practice in 1848 and 18-1:!) must have remarked a great proclivit\- in almost every disease to diarrhoea." In 185"i Dr. N. S. IJavis in the Report on Practical Medicine. Illinois Medical Society, says Dr. S. H. Shoemaker of Columbia reports an ei)idemic of dysentery of a very severe type in southern Illinois. Dr. J. T. Stewart of Peoria wrote Dr. Davis. "The most prevalent disease in this locality was diarrhoea. It showed a tendency tci run into cholera." Dr. Thomas Hall of Stark County wrote. "Early in August diarrhdea was jirevalent in some lo- calities. C)n September !)th dysentery broke out." In IS."):; Dr. Thomas Mall of Toulon rc]iorted to the State Medical So- ciety an epidemic of d\senler\' which followed one of diarrhoea and which was followed l.iy an ei)idemic of typhoid. In 185?. Dr. L'. X. Andrews of Rockford reporting for the Committee on Practical Medicine told of an epidemic of "spasmodic cholera" near Rock- ford in September and October. In 1S5S Dr. V. K. Baily of Joliet reporting for this Committee wrote of an eiiidemic of dysentery in his practice. He described one case — a ladv who came from "a place where a severe and fatal form of dysentery ap- peared about the time she was taken sick." In 1S()() Dr. C. ( loodbrake of Clinton, Chairman of ihe L'ommittee quoted Dr. R. G. McLaughlin of lleyworth as saying (h'-enter\- was one of the most ])revalcnt diseases. Dysenierv ^vas (|uite prevalent during August and September. Dr. J. W. Coleman of LeRoy, McLean County, reiiorteil an epidemic of dysentery which ap]}eared in August. "No class, age or sex were exempt. About one patient died out of each fifteen sick but five miles from LeRoy on the Bioomington road twenty cases developed of whom six died." In ]SU) Dr. W". II. \'eatch reported an epidemic of dysentery at Rood- house, Greene County. It appeared suddenly July 1. 1S7 5, and lasted sixty days. There were 300 cases and man}' deaths. b\'w families escaped. In ISS'.l I^r. 11. \\. Chapmrm re|iorled an epidemic of dysentery at White Llall. "It started in June. Iss'.i. lly the middle of the month the epidemic was on. It lasted until llie last of ( )ctobcr. There were 5'.1 deaths from dysentery. My dealli rate was 1 in 11." in discussing Dr. Ch.apman's paper Dr. J. 1'. .Matthews of C;irlinville said he had seen Xwo such ei)i(lemics. One was near Corinth. Mississi]3pi, 8G HISTORY OF CERTAIN DISEASES PKIOR TO 18?7 ill tliL' army in lsi;:i. The other was in Bird eight miles west of Carhnville in 1 M.i I. In that epidemic 25 died in a radius of five miles. Dr. \V. J. Chenoweth reported that in an earlier day he had heen in a similar epidemic in Decatur in which one tenth of the ca.ses died. Dr. ^V. L. (ioodell of Effingham reported an epidemic between 1850 and 18G() in which he saw 27 cases. Dr. Stahl of Grandville said fluxes were very prevalent in his section. Dr. E. P. Cook of Mendota reported an epi- demic in which he had served in 1864. In 18(;; Dr. L. T. Hewins of Loda (Coiiiiiiillrc an Practical Medicine) reported "Dysentery in an epidemic form has not prevailed in the eastern and southern parts of the State except in Edgar County and some parts of Coles County." However, Dr. George Ringland reported an epidemic that year in a town of 600 inhabitants. The first case appeared June 2S and the last in September. There were abovit 100 cases and 13 deaths. Silas Reed'"' wrote that typhoid dysenteries were especially prevalent in the Western Reserve in 1824, 1826 and 1828. In those years Illinois was drawing heavily on the Western Reserve for accessions to its population. The annual reports of the Committee on Practical Medicine of the Illinois Medical Societ\' (there were years in which no reports were made) contained reports on the prevalence of diarrhoeas and dysenteries in 1852, 1853, 1855, 1857, 1858, 1860, 1867, 1869, 1872 and 1876. Some of these referred to diarrhoea in children, some to the disease in adults. Some referred to epi- deiuics of diarrhoea and dysentery tlmugh in most of them the disease is re- ported as endemic. Infant Mortality. ( Especiallv that due tn diarrhoeal diseases.) Every jierson who wrote of health conditions during this period placed especial stress on the sickness rate and esiiecially on the diarrhcieal disease rate among babies. If there was confusion as to the causes of the different kinds of di- arrhoea among adults there was more of it as to the same symptom or disease among babies. Diarrhoea, sumiuer coni]ilaint, cholera morbus, cholera infantum and dysentery were terms used more or less interchangeal)ly. In 1858 Dr. F. K. P)aily of Joliet ]iroposed that the term cholera in- faiuum aiuericana be used since the disease was so prevalent in America. He said that it was often confounded with ordinary diarrhoea. He said one of the i|uestioiis which he had asked related to cholera infantum. Nobody replied to that (|Uestioii \m{ he knew the disease was prevalent liccause he had seen much of it in his praciice in joliet for four or five years. "' Heed, Uiiil. HISTORY OF CERTAIN DISEASES PRIOR TO ll^TT 87 III 1S71 Dr. D. W. Young of Aurura quoted Dr. A. Jacobi as saying that chiilt-ra infantum was the rcsuh of paralysis of the nervous system caused by heat. In 1.SS3 Dr. L. H. Corr of Carlinville said cholera infantum was a neurosis. Many writers thought it a manifestation of malaria. Dr. I. Alurphy uf Peoria told of his success in pre\-enting it by giving prophylactic doses of i|uinine in the summer time. In IS.M Dr. C. X. .\ndrews of Rock ford ( Cdiiuiiittcc (III Practical Medicine) reported diarrhoea and cholera mcirbus were also s(.ime- what prevalent ])articularly among the children. In l.sriS Dr. Hiram Mance of Lafayette wrote "Cholera infantum prevails every sum- mer in this vicinity." In 1859 Dr. J. O. Harris of Ottawa wrote "During the summer months i,,. |_ I, ,.,,,. J. diarrhoea among children was extremely prev- alent." In 1S7 1 Dr. O. W. Young gave this oi)inion : "It is generally conceded that mi)re children die annually from cholera infantum than from any other disease." In is:'.) Dr. L. H. Corr of Carlinville said "Nearly one half the children born die before reaching 5 years of age and nearly one half of these deaths are from bow^el troubles commonly called cholera infantum or summer com- plaint." In the Transactions of the State Medical Society either through papers or through references in the report of the Committee on Practical Medicine, cholera infantum was covered in 1858, 1860, 1869, 1871. 1876 and 1878. Diarrhoea and dysentery usually referring to these diseases in children were covered in 1852, 1853, 1855, 1857, 1858, 1860, 1867, 1869, l.s;v' and is: 6. For twenty-seven years 1813 to isii!) inclusive the Cliicac/o Health De- partment Annual Reports carried a table in whicli was shown the total num- ber of deaths at all ages and the total number occurring in children five years of age and younger. Table 2 shows the percentages of the total deaths in each vear which were in children as aforesaid. Twice in the period the number of deaths of children was less than :ln per cent of the whole. Six times it was between 30 and 40 per cent of the whole. Six times between 40 and 50 per cent. Eleven times it was between 50 and 00 per cent. Twice it was over 60 per cent. It seems almost inconceivable that in any vear the deaths of young children should nmre th:in eipial, should even a]j]3roximate two thirds the total deaths at all ages. .\nd yet thai h.-ij)- H,S IIISTOUV OF CERTAIN- DISEASES PRIOR TO 1877 jK'iK'd in ("hicaj,'ii and ])rohalily also in those other pcn'tions of the State in wliich n(] fecord was ke])t. in those years llie total the relation hetween deaths under •"> and all deaths Dr. N. S. Uavis was interested in that suhject. In ls;:i he told the Illinois Medical Societx' that in Xorwa\- the deaths of children under live years of age were onlv 1 •'> i)er cent of the total deaths ; in Alassachusetts 'ill per cent : in Bavaria ."iD per cent. It would he interesting to know whether Illinois was in the class with Norwa\- or with that of kJavaria — or was somewhere in between, hi all prohabililv it was nearer liavaria than Norwa} hut there is no way of knowing for certain since Illinois was not keeping hooks in terms of vital statistics at that time. But Chicago was and the figures are available for coiuparison. While the death rate of children imder -"i years of age down-state was not quite equal to that of Chicago the difference was not great. Table "2 shows the [M-o])ortion of deaths of children imder five years of age to total deaths in Chicago from lsi:i to isll inclusive and for purposes of comparison the ]jroportion for lii^o, a typical \ear in the present period is also shown. This table shows that Is; I had the worst record with a ]3ercentage of 70.7. In 1873, the year in which Dr. Davis made the slighting reference to Bavaria, the proportion in Chicago was •")!•. •'!. in Ba\-;iria .")(). The average for all the years l.sbl to 1S7; was I'.i.l, the average for the ten \ears 1S(!-1: to 187:! in- clusive was 'il."!. Compare this with Chicago's iiresenl day |iroiiortion \' A and Norway's l-'i. In I8;!i Dr. L. II. Corr of Carlinville said one half the children born ill Illinois died bt'fore reaching five )'ears of age. In the C. S. Registration .\rea in r.iv'."i, the intmber hall not be \ery misleading it is necessary to combine lobar and broncho pneumonia, bronchitis and endemic influenza (either actual or so-called). It m;iy be possible to separate in- fluenza in great epidemic years without radical statistical error but not at other times. This has been referred to in the section dealing with pneumonia and influenza. Sc«leof Noiitlily Morlalitv rar^irrjis^.iiraficryov. v^::3o: j^ ,:i::x::mt^\ Tzr^ax 25?; 9 « TTTTTill? RAIN B.WI-ND W.WINE. ClUR DAYS CLOUDY DAYS nduAo FOLDOUT BLANK THE COURSE OF THE TOTAL MORTAIITYAND THE CHIEF FATAL DISEASES IX CHICAGO FOR 18G«. (with Mcl(H)rological Observations for the same period made by J.G. LANGGUTH JR at 117 Randolph St.) Prepared by M.MAXXHEIMER.M. I), under the direction of the Registrar of Vital Statistics. -lIumidity.Moisliireof Atmosphrrc,(Foint uf Saluraliuii 100) ' liaroiiicter.WVi^t or Alniositiiere. ■ " -ofr -• Uiicheat and Luweitt Raniic oi Barometer. Thermometer. Temperature of Atmosphere. Highe.st and Lowest Rai^e of Thermometer. Fig. 2. Second Mannhelmer chart. THE C^OURSE OF THE TOTAL MORTALITY AND THE CHIEF FATAL DISEASES IN CHICAGO FOR 1867. (with Mctooiological Observations for tlie same period made by J. G. LAXGGUTH JR at 117 Randolph St.) rrepared by M.:^L\XXHEI^^^:R.^^.D. under- the direction of the Resistrar of Vital Statistics. Fio. 1. First Mannheimer chart. HISTORY OF CERTAIN DISEASES PRIOR TO ISTT 91 '-J_JI 1 . . ""^ 3 ^^ it'' £. **s L ^-^ cT - ^^0-" <' — ^^ hE -^^ Et *> - It ^ — !- r ■ ■ ■ 1 Qj 1 ■ N^ c: 1 * ' 1 oi ' " It ^^'' "- * m I '5^ ' int i ^»«^ =--*■ '^ ^<«* *t di ^^ ^s V T X ^ m 1 1 "*.^ -^ Z^ f ^---' "" ■ " ^ ^^"^ I ^^-^ 1 ^""s = " ^*" 4^ ^s^ 7 O '^ _l 1 ^^ ^a" ^t I "■*»-• = ± i *■» T ^ J. I __ It A z 4^ )► - I " " "" '"^ i i _i 1 a 1 _^ z 1 ^ O I 1 _l_ ^' " *\^ < ' ^^ >•! f _f*"-i» ■° —L " "'*t^V ^ 1? < t\ gl 1 _J 1 11 u 1 1 1 ' ^ 1 J_ ■> 1 1 11 1 111 o d 92 HISTORY OF CERTAIN DISEASES PRIOR TO 1877 Jan. Feb. Mar. Apr. Hay June July Au^. Sept. Oct. Nov. Dec. Fui. 4. Moiitlily mortality rates in Chicago showing the change fifty years have wrought in seasonal distribution. HISTORY OF CERTAIN DISEASES PRIOR TO 187 93 Chicago (lortality Rate for Acute Respiratory Diseases by Decades 27 26 25 24 23 22 21 20 19 18 17 16 15 ' \ 1 J 1870 1880 1690 1900 1910 Fig. 5. 94: IIISTOUV OF CEUTAIX DISEASES PRIOR TO 1ST7 30 19 Z8 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 \ \ \ ^"" \ 1 < \ \ \ \ \ \ \ « \ \ \ /^ o, / / \ / \ V 1 \_ s N s 1870 1860 1890 1900 1910 Pig. 6. Sliowing tleceniiial ninrtality rates frmii all causes in Chicago for .Tamiary, February and March cuntrasted with that for July. August and September. IIISTORV OF CliKTAIN DISEASES PRIOR TO 1877 95 Jan. Feb. Mar. Apr. May June July Aug. 5epl. Oct. Nov. Dec. Fig. 7. Note the difference in seasonal peaks. The autumnal rise in the 1916-1925 decade was due to the influenza pandemic of 1918. 96 HISTORY OF CEKTAIX DISEASES I'KIOK TO 187? Bat in ackliliun to intiueiiza and tlie pneumonias the winter ])eak is made up of contributions of other diseases less easily related to respiratory infec- tions. The death rates from smallpox, measles, scarlet fever and diphtheria — all important diseases of the winter peak period — h;ive declined without any decided or certainly without a pari passu decline of the winter peak. Some of the few health students who have studied the development of this winter peak ha\-e attributed it to the great influenza wave which prevailed in Illinois during a peridd which began about December, bS'.ill. Iklt the tables and the charts show that whatever was operating to change bacteria or people or en- vironment or several of these combined was in operation prior to 1890. The solution of this problem is bequeathed to the Illinois Department of Public Health during the next few years. The solution will require their best thought. It will require research, planning and strategy because it is possible that the people may need to change many of their social methods and customs before they can enjoy good health and low death rates during the winter and early spring. Vital Statistics atid Mortality Rates From All Causes. The Seventh Census, that of lS."iO was the first to give anv vital sta- tistics and what it gave was limited to ]>opulation .gain, tn ])opulation figures and gross death and liirth rates. The introduction to the report of this census contains the following statements ; "The tables ot the census which undertake to give the total number of births, marriages and deatlis in the year preceding the first of June, 1S50, can be said to have very little value" — "Upon the subject of deaths no one can be deceived by the figures of the census since any attempt to reason from them would demon- strate a degree of vitality and healthfulness of the United States unparallelled in the annals of mankind and would overthrow the best established principles of statisticians and contradict all science and experience. The truth is but a part ot the deaths have been recorded varying for sections from a very small to a very large part of the whole" — "In the form in which these deaths are published they are of no value, yet in the opinion ot medical gentlemen in different parts of the Union of high reputation who have been consulted and whose testimony is now on file in the census office and in the opinion of the National Medical Conven- tion (American Medical Association) who are equally aware of the precise char- acter of the data, the publication of the names of the diseases for each of the counties of the United States, the period ot sickness, the age, birth-place and occupation of the deceased, the exact time of death, defective in many respects though the returns maybe, would essentially subserve the interests of the medical profession of the country and tend to the promotion of public health." 'fhe death rate as given l)y this census for Illinois was 13. G — this is the death rate that was esteemed impossible because it "would demonstrate a degree of vitality and healthfulness unparallelled in the annals of mankind and would o\ertlirow the best established |)rinciples of statisticians and contradict all science and experience." 'fhe statement was true in I80O but HISTORY OF CERTAIN DISEASES PRIOR TO ]ST7 97 by i;ilu the death rate had fallen below 13. G and it has been below that tigure every year since except in the influenza epidemic period. What was thought to be impossible in 1850 is now more than achieved and being achieved is accepted as a matter of fact and alnmst without cumnu-nt to say nothing of praise. By 1860 most of the standards referred to in the introduction t(3 the rejiort in the Seventh Census had Iteen adopted. Nevertheless, the actual returns nf death were far from satisfying as the Sui)erintendent of the Seventh Census had warned. In the introduction to the report of the Eighth Census are found the following statements : "It is manifest that neither in 1S50 nor in ISSO was tlie entire mortality of any state ascertained and reported nor was even such an approximation obtained as will permit any reliable calculation to be made of the rate of mortality. The same holds true of the deaths reported as due to the several causes of death such as consumption." In Tables 4 to 10 are presented some excerpts from the V. S. Census reports of 1S,-)0-1,S80 relating to mortality in Illinois and the population of the State. Table 4. Deaths from all Causes and Certain Diseases in Illinois — Decennial Years 1850-1880 — From U. S. Census Reports. Illinois. 1850. 1860. 1870. 1880. n,619 13.6 19.300 11.2 33,672 13.2 45.017 14.6 Doath rates under 1 yr. per I.OOO births 51.4 87. 4.1 113.7 128.8 70. 66.9 6.3 65.7 41.2 98.7 .4 22.3 10.6 I. 50.3 123.8 1.2 145.6 188.3 59. 35.5 43.4 Bronchitis 1 Pneumonia .•.. 1 168.2 Influenza 1 Pleiirisv J 150.9 148. Teething: Bowels, disease of 122.9 Mahiria 1 36.1 Remittent Tvphoid anrl Tvnhus Meninnifi'* 70.3 53.6 CephiilitK 77.8 85.1 6.7 Cerel.n. -^imMl 28.3 Meiiir«in- Enceilnllu.- Scarlet Fever 44.4 Smallpox i-'u 10.5 10.7 Yellow Fever Tvphus Fever 98 IIISTOKV OF CEUTArX DISEASES PRIOR TO 18T' Tabic 5. PorULATlON AND NuMBICR OF DeATHS ILLINOIS U. S. Census Report 1850. Total Population 851.470 White 846,034 Free Colored 5.438 Number died during year 11.619 Table 6. Number of Deaths from Certain Diseases — Illinois U. S. Census Report 1860. Population 1,711.951. Deaths 19,300 Bowels, disease of 26 Bronchitis 75 Cephalitis 701 Cholera 70 Cholera infantum 315 Consumption 1,948 Croup 1,158 Diarrhoea 607 Diphtheria 41 Dysentery 845 Enteritis 329 Fever intermittent 464 Fever remittent tJS2 Fever typhoid 1,1 S3 Infantile 373 Influenza 14 Measles 109 Pleurisy 46 Pneumonia 1,357 Scarlet fever 1,698 Smallpox S Teething 198 Deaths under 1 year 4.407 Deaths under 5 years •. . 9.928 Whooping cough 3S2 Yellow fever 1 Table 7. Number of Deaths from Certain Causes — Illinois U. S. Census Report 1870. Population -i.S.-iO.SOI. Deaths all causes 33,672 Cholera infantum 1,869 Croup 886 Whooping cough 640 Measles 702 Pneumonia 2. 882 Smallpox 170 Diphtheria 603 Scarlet fever 2,162 Malaria 888 Meningitis 43 Typhoid 1,758 Typhomalaria 17 Typhus 131 Meningitis 1.932 Diarrhoea 1,284 Dysentery 664 Enteritis 603 Bronchitis 219 Under 1 year, Total 9,215 Under 1 year. Females — 4,149 Under 1 year. Males — 5,066 Under 5 years. Total 16.953 Under 5 years, Females — 7,836 Under 5 years. Males — 9,117 IIISTORV OF CERTAIN DISEASES PRIOR TO ISTT 99 Table T — Continued. Illinois — 1S70 — Deaths. Disease. Male. Female. Total. 2 19 12 2 139 688 472 28 131 13 5 3 125 522 414 12 157 2 32 Tvphonialarial 17 5 264 1210 886 40 288 Table 8. Number of Deaths fro.m Certain Causes — Illinois .\xd Chicago U. S. Census Report 1880. r'o])ulation :!.07 ;,871. Number deaths 45,017 Bronchitis 709 Cholera infantum 1,884 Cholera morbus 169 Consumption 4,645 Diarrhoea 770 Diphtheria 2,403 Dysentery 698 Enteritis 988 Fever 77 Meningitis 278 Enteric fever 1,652 Malarial fever 1.114 Scarlet fever 1,.369 Typhus fever 23 Yellow fever 5 Whooping cough 488 Measles 603 Meningitis 594 Pneumonia 4,378 Smallpox 45 Erysipelas 334 Yellow fever, group 2 2 Yellow fever, group 3 3 Bowels Ill Croup 1.370 Pleurisy 91 Table 8 — Continued. Census — 1880 — Illinois. Living 1 yr. of age 87,859 Death per 1000 births (males) . . 94.1 Death per 1000 births (females) 75.8 Total deaths under 1 yr 10,96S Deaths under 5 19,667 Percent of total deaths (males) . . 44.8 Percent of total deaths (females) 41.9 Deaths — Ciiic.\(;o — Certain Causes — Under 1 Ye." Per 1,000 births (males) 166.7 Per 1.000 births (females) 122.4 Total under 1 year 3,533 Under 5 years 5,871 Percent of total deaths (males) . . 57.3 Percent of total deaths (females) 54.8 100 IIISTORV OF CERTAIN DISEASES I'UIOR TO l.ST Table 9. Population' ok Illinois — Census Years Frdm U. S. Census Reports 1810-1888. Population. ],K,ease. Year. Per cent. Numeriial. U,282 85.211 155,455 476.183 851,470 1,711,951 2,539,891 3,077.871 349,52 185.16 202.44 78.81 112.8 48.36 21.18 32,929 1830 100,244 1840 1850 1860 320.72S 375.287 860.481 827,940 537,980 Table 10. Increase of I'oI'ulation by Census Years From U. S. Census Reports 1810-18.511. Year. Whites. Increase. Free Colored. Int-rease. Slaves. Increase. Total. Percent. 613 457 1,637 3,598 5,436 12,282 55,211 155.445 476,183 851,470 1820 53,788 1830 155,061 1840 472,254 1850 846.034 367.68 188.28 204.56 79.14 20.44 1 917 258.2 i 747 119.79 331 57.08 445.83 18.53* 55.68* 349.52 185.16 202.44 78. SI HEALTH HISTORY PRIOR TO 1877 OF SOME OF THE CITIES, IN ILLINOIS. Chicago. In a health history of Illinois, Chicago anil the Chicago area deserves especial consideration. It was the portal of entry for that great part of the population which now dominates the State ancl which has been prominent in the State since 1840 at least. They or their parents or grandparents en- tered Illinois at Chicago and remained there or somewhere else north of the center of the State. This population has been a health factor differing some- what from that of other parts of the State. Chicago is the largest center of population in the State. It had a health department many years before the State organized one and this example helped the medical profession to get a state health department. At times it has contributed diseases to other parts of the State and at times other parts of the State have contributed disease to Chicago. The great Irish wave of immigration of the thirties and forties, the great German wave of a little later period, the great Scandinavian wave of the seventies and the lesser immigration waves from other lands, all these great masses of people influenced the health of the population among whom they settled. The immigration into the State from other states which came through this portal, speaking in a general way. came from diiYerent states than that which settled in the prairies and to the south thereof. The great aggregation of people, several millions in number near the Chicago River, by their very congestion, created health problems that difl:'ered in quantity and to a degree in quality from those of the other parts of the State. The location of Chicago did not jjresage good health. There were no currents in Lake Michigan by which sewerage and soil pollution could be kept awav from the water supply and the city was near the lake head where these forces are most potent for harm. The country was flat and drainage was not possible. Mosquitoes abounded. Long John Wentworth makes the statement that there were no mosquitoes in the Chicago area prior to the opening of the Illinois-Michigan Canal but in this he was mistaken. This statement is found in his address on the early days in Chicago made in his later life long after the opening of the canal. Doubtless his recollection of things political and economic was correct but lie forgot the mosquitoes. He is contradicted by a number of witnesses who wrote when the matter was fresh in their minds. 102 HEALTH IX SOME CITIES rUIOK TO 1877 (j'ordDii Salstciistill liuljl)ard writinL; nf his first ])(irtage through Mud l.akc. C'liicagii. in < )ctridgeport sewerage pumps started. ]S(i;5. Death rate increased. There were 94? cases of smallpox. Epi- demic of erysipelas present. This outbreak was studied by Dr. Edmund Andrews who showed how the disease prevailed along the filthy Chicago River and in the unsewered parts of the city. 1864. The result of the almost total neglect of sanitary laws during the past five years in addition to the fact that the construction of sewers did not keep pace with the increase of population is apparent from the great mortality of this vear. Compared with 18()3 there was a great increase of cholera infantum and cholera morbus. Erysipelas and the low grades of fevers almost doubled and smallpox trebled. There was a great increase in diar- rhoea and dysentery. There were nearly five times as many deaths from measles and a great many more from pneumonia. .\nother remarkable fact is that only 164 more died in the last si.x nioiilhs than in the first. Erysipelas continued to be epidemic until July. This vear witnessed the first great increase in pneumonia and the first tendency to a change in the seasonal distribution of fatal disease from a summer to a winter peak. The tendency was scarcely perceptible for sev- eral years. ]8t).-). The high pneumonia rate continued. The efi:'ect of the heat and sudden change increased the mortality particularly among the children. Fear of cholera stimulated owners of property to make sewer connections. Cholera was reported on its way and Dr. T. B. Bridges was appointed health officer. 1866. A total of 1,581 cases of cholera occurred. Health officer was given ;52 assistants. The death rate was 32.55 per 100.000. The death rate of chilclren under 5 was high. '"The heavy rainfall from July to October in IlKALTII IN SOME CITIES PRIOR TO IS'!'; 105 connection with the localities in which cholera occnrred goes far toward cor- roborating- the ground water theory of I'ettenkofer", says Dr. Ranch. 186T. Chicago organized a board of health which followed the lines of the Metropolitan Board of Health of New York of which Dr. Stephen Smith was the moving spirit. The Chicago board made Dr. Hosmer A. John- son president and Dr. J. H. Ranch, a former surgeon in the Civil War, as its executive officer with the title sanitary superintendent. Dr. Ranch was an unusual health officer for his day. Dr. Arthur R. Reynolds, formerly commissioner of health of Chicago, has written a good short sketch of the life of Dr. Ranch. (Three Chicago and Illinois Public Health i fficers. J. 11. Ranch, Oscar C. Dewolf, F. W. Reilly, lUdletin Societ\- ^Medical History of Chicago, August 1912.) The only diseases which prompted municipal action were sniallpo.x and cholera. Little attention was jiaid to health ordinances until ISp.i, when the city was threatened with cholera. Drainage was inaugurated after the great cholera epidemic nf 1854. Sewer building lagged from 1856 to 18GG wdien cholera again started sewer building. The agitation against privy vaults began. .\n epidemic map by Dr. Mannheinier in the report of the dejmrtment for this vear shows the distribution of an epidemic of erysipelas in 18fi3 and one nf cholera in 186G. Erysipelas followed the river and lia years of age. ls;i. This is the year of the fire. Records of the health department burned. Smallpox present. Death rate high. In this year appeared an extraordinarily good report from the (^'hicago health dejjartment. most of the copies of which were burnt in the fire. \X',2. 15eath rate "JI.Cil. ".'.-'is^ cases of smallpo.x. (/leneral death rate 27. (34. Death rate of children under 5 high. 1,150 horses died of e]>izootic. 1873. Cholera appeared. 48 deaths, 1.7<>(i cases of smallpo.x. Dr. Ranch resigned as sanitary superintendent on .\ugust 5, and was succeeded by Dr. Ben S. Miller. 1874. Smallpox present. 1875. City chartered under Cities and Villages Act. This provided for a board of health. 187li. De])artment of health with a commissioner su])erseded the board of health. Greatest scarlet fever epidemic in the history of the cit\' occurred this year. The health history of Chicago as set forth in the annual reports of the health department show the rather rapid development of great health prob- lems. The seriousness of the situation was appreciated rather early. The raising of the datum to make drainage possible was begun. This work was undertaken because it was thought to be necessarv for health. .\ desire for health was one urge though not the jirincipal one behind the digging of the Illinois and .Michigan Canal, .-\lniost from the beginning Chicago had some sort of a board of health. In times of great fear of cholera or smallpox the board was supported: at other times it was neglected. This board was not of great imjiortance so far as prevention or even sustained study of health problems was concerned until the organizatitm of a real health department in 18fi7. The iei)ort of the lioard of health ISC;, Isds and ISdl) is a very v:du- alile (locnment. It indicated that during those years sustained studv of health prolilenis w;is made. HEALTH IN SOME CITIES PRIOR TO ISTT lOT This report gives the total number of deaths all ages and ages under 5 and 5 to 10 years, each year from 1843 to 1851. These statistics were gath- ered from undertakers' and sextons' reports and from clippings from news- papers and medical journals. Dr. Ranch supplied correctixe factors which when applied made these figures approximatelv accurate. Aiiiiuid Diath luiti's. From July, 18ol t(j LSiill the vital statistics are given with increasing detail and are probably increasingly accurate. A study of these figures sup- plies the following data : Table 11. Annual IJeatii Rates per l.OOO Population — Chicago, 1S1::3-18T7. Year. CJeneral death rate. \esir. General death rate. Year. General death rate. 1843 18.60 1855 27.26 1867 21.21 1844 33.04 1 856 24.8 1868 23.74 1845 28.46 1857 27.56 1869 23.17 1846 27.81 1858 25.06 1870 23,88 1847 33.93 1859 21.59 1871 20.87 1848 31.86 1860 20.73 1872 27.64 1849 73. SO 1861 18.99 1873 25.15 1850 48.96 1862 20.52 1874 20.30 1851 27.26 1863 25.83 1875 19.72 1852 46.70 1864 26.26 1876 21.03 1853 22.41 1865 22.57 1877 18.67 1854 64.02 1866 32.55 While recognizing the inaccuracy of the figures they are sufficiently complete to show a general picture of the health conditions at the time. Tak- ing out certain years for reasons presently to be stated, the average death rate for what is left of 1S43-41I inclusive, is found to be :il.(i'.' per l,(i()() population. For lS."iO-.3!» inclusive, it is •-' l.o:! : LsGO-Cl) inclusive it is •.'•J..")(i; for ls7()-7!) inclusi\e it is 1!).^* ; 1S|:; is withheld because it is obviously inaccurate; Is I!) is reported as having a death rate of 73. NO, more than twice that of any jireceding year. It is withheld because it is freakish. One of the outstanding causes of the great death rate of that year was the prevalence of cholera. In the next decade, 1S.")(l with a rate of 4S.!Hi and IS.")-..; with one of 4U.7U are withheld. IS.")!) was a cholera year. Is.ji was a cholera year. 1866 is held out as being abnormal. It will be noted however that ISIil! had a death rate that was only a fraction higher than the prevailing rate in 1843 to 1849. ]S()6 was a cholera year. In the decade 187(l-:!>, 1S7-.' and 1873 with rates of '.^7.64 and ■,'5.1.") are held as being abnormal. The great influenza pandemic was the princi])al cause of the abnormalit\- though both cholera and smallpox prevailed. 108 HEALTH IX SOMK CITIKS PRIOR TO 1S7 This study shows a I airly satisfactory decrease in the a\"erage death rate hetween 18-13 and l.'-^so but the decrease was occasionally interrupted 1)V great epidemic \va\es. I'he increase in efforts to promote health more than equalled the increasing tendency toward bad health due to poor drain- age, water polhuidn. sewerage, contamination, crowding, \totn- liousing and ra|ii(l immigration. 'I'l/jjlinid Mortaliit/. An interesting item of the general health picture is the yearly death rale from tv[ilioiulati(in was ItS.-j. However, in this period there were at least two years 1852 and 1854 that were much aliove the average. They were abnormal for some reason. I)il,llfln I Id MniUllitll. During the years 1.S52-59 the average diphtheria death rate was lOG.l ])er 100,000 population. During the decade ISGU-GD it was 15G..S. During 18:0-:9 it was 112. OS. In this ])eri(id of 28 years for much more than half the time dii)htheria outranked typhoid as a cause nf death. The great wave which >tarted in l,s5:, while it tluctuated, di is shdwn in Table lii. In spite of I lie repeated statement that there was no consum])tion in Illinois, (ir but little, the rate the first year the record was begun in Chicago was 299 per 100, OOO pojiulatinn. It is ikiw in the vicinity of 75. The worst record in Chicago's bisliir\' was :;70 m l.s;5S. The average for the decade was 298. The worst year in tlie next decade was 18(;9, 2(19. the best 1865, 187. The average was 2:11.5. Ccinsumptidu apjieared to be mi the decline. In the next decade the ^yorst year was \s]0 with 281 ; the best 1879, 173; the average was 22S. a fuitbur decliiu- thciugh a small one. This de- cline showed a disposition lo slop in the early part of the twentieth century. I'nder ilie impetus of a new type of activity in control it began again. .\t tlie time of writing (in l!i2;) it has again come to a stop. There has bei n no decline for several years. HEALTH IX SOME CITIES PRIOR TO 187' 111 Table 16. Annual Death Rates from Consumption per 100.000 Population- Chicago. 1853-1880. Year. Death rate. Year. Death rate. Year. Death rate. 1853 299 1863 188 1873 244 1854 324 1864 242 1874 218 1855 201 1865 187 1875 219 1856 341 1866 203 1876 217 1857 288 1867 240 1877 1858 370 1868 24S 1878 196 1859 274 1869 269 1879 173 1860 251 1870 281 1880 195 1861 265 1871 248 1862 247 1872 274 Siiiifil po.r Miiitalifij. The years 18-52-n had an average smallpox death rate of 3(i.l ; ]8(jO-(59 an average of -j^.HG ; 1870-7!) an average of i:).17. In 1857 there was a bad small])! IX (intljreak and it extended into 1S5!». But ls5l) was the only \"ear in the earh history of Chicago ^ter 1S5-.' that did not record a death fmni the disease. lS(i:; and 1804 were years of l)ad epidemic conditions but there was a low rate (i.l in 18(il); 187"2 and bS'o were bad epidemic years, is;;) had a rate of onlv .5. The disease wa> more than holding its own against society until ISiili. Frdin that time on it lost ground though, in ls;-J and is;:! it again more than held its own. The epidemic waves were farther apart and in the low years the disease was near the vanishing point. Table 17. Axxu.\L Death Rates from Smallpox per lOO.doO Population — Chicago. 1853-1879. Year. Death rate. Year. Deatli rate. Year. Death rate. 1852 23 1862 36 1872 178.3 1853 32.1 1863 76.6 1873 136.1 1854 18.2 1864 166.6 1874 22.8 1855 37.5 1865 317. 1875 2.5 1856 19. 1866 45. 1876 7.1 1857 114. 1867 54.7 1877 10. 1858 55. 1868 57.9 1878 4.8 1859 0. 1S69 6.1 1879 .2 1860 27. 1870 4.9 1861 25. 1871 21.8 Measles Mortality. Between 1852 and 1851) the yearly average death rate from measles was 33 per 100,000 population. 18C0-G9 it was 37.5 ; 1870-79 it was 18.44. 1S53- 1854 and 1857 were bad measles years whereas 1859 had a low death rate 112 HEALTH IX SOME CITIES I'KIOK TO 1 S ^ 1 of 1(1.';. Ill tin- iifxt decade iSG-t and ISCti were bad measles years. 1865 was low with II. 'J'he rate in 18C6 was the highest Chicago ever knew. 18T1 had an epidemic but scarcely comparable with that of 1866, 1874, 18T6 and 1878 had rates well under 10. The records show that untiljl876 measles was winning its fight against society. Since then society has been gaining the upi)cr hand but backslides occur occasionally. Table 18. Annu.al Death Rate from Measles per 100,000 Population — Chicago, 1852-1879. Year. Death rate. Year. Death rate. Year. Death rate. 1852 34.6 1862 28.5 1872 10. 1 1853 52.1 1863 18.6 1873 27.6 1854 69. 1864 78.3 1874 3.8 1855 11.5 1865 11. 1875 29.2 1856 19. 1866 83 1876 3.7 1857 43. 1867 39.1 1877 13.7 1858 24.2 1868 42.5 1878 8.2 1859 10.7 1869 38.9 1879 10.4 1860 13.6 1870 31. 1861 21.6 1871 46.7 Wltnnji'nui (.'i)ii leased on liie germ theorj- of disease. HEALTH IX SO^[E CITIES PRIOR TO ISTT 115 Springfield. The lirst settlement on tlie present site of Springtield was made in 1818, the year IlHnois entered in Union. The town was not regularly surveyed and laid out until 1833. in which year Elijah lies and Pascal P. Enos j)er- formed the necessary service. At first it was called "Calhoun," in honor of the great nullifier of South Carolina, but the name proved to be unpopular and few people used it. They preferred the name Springfield, which was the name given the postuffice in the embryo city of Calhoun. Earlv in the career of Springfield, burn Calhoun, the nnniicipality began acquiring ])iilitical lumors, a haiiit wliich it shows no tendency to forsake. In 18-,'l, two years before it was officially laid out, it acquired the title of CDUntv seat of .Sangamon County. This was in spite of the fact that it was not incori)or,-ited until 183"^ In 1^3^, as the result of a rather strenuous political contest, it became the State cai)ital. and the first session of the legislature to meet there as- sembled in ls:!lt. Abraham Lincoln, as a niember of the long-nine, had much to do with the removal of the State capital from X'andalia to Springfield. .\mong the manv rumors of reasons for removing the capitol from \'an- dalia to Springfield were two that relate to health. One was thai the legislature had grown tired of the preponderance of venison, wild turkey, wild duck and other game meats supplied them at \'andalia, and thev moved the cai)ital to Springfield where they could get more pork ami beef. Another is that the Kaskaskia l)oltoms around N'andalia made the lo- cation so highly malarial that the legislature wanted a healthier site for the State capital. Sangamon County was so near the geographical and population center of the State that it was a popular prospective location for the Capitol as soon as the people began thinking in terms of the State as a whole. There is a story that the plan was to place the Capitol at Illiopolis, a town in Sanga- mon Comity, about ten miles to the east of Springfield. The name was cut to fit. So were the i)lans, but dame rumor, or is it scandal, says, some parties high in power bought up the land around Uliojiolis, whereupon the indignant many not in on the deal "kicked the fat into the fire'' and threw the Capitol into the willing lap of Springfield. Among the books and papers of the late Dr. A. \\ . I'rench, DDS. ,''■'' of Springfield, was found an old blank book, the binder's title on the back of which is "Minutes of Springfield, Illinois, 1832-1840." On the fly leaf of the book is written: "Minutes of Board of Trustees of the \'illage of il lUinois HLsturiial Society, Vol. 2). 116 HEALTH IN SOME CITIES PRIOR TO 18T7 Springfield, Illinois, of ils meetings from A]iril is:',-.' ( lirst meeting) to the organizing of a city in ls:!!i.'' On July 19, 1832, at an extra meeting of the lioarcl, the following pre- amhle and some resolutions were read and passed : "Whereas, we have information that the Asiatic cholera is now prevailing in Chicago, and where- as, it becomes the duty of the trustees to guard the town from infection from that source,", etc. The usual orders were then made as to the clean- ing of the town. On November 14, orders were given out that the court house be fitted up as a hospital in case it was needed for the cholera pa- tients. Some indication of the improvement in the health of Springfield is indicated by Table 22. Table 22. Annual Death R.-\tes fro.m all Causes and Certain other Diseases — Springfield, III., 1875-78 and 1923-1926. Per 100,000 Population. 1875 1876 1877 1S78 1923 1924 1925 1926 18.553 18.791 19.074 19.357 61.833 62,715 63.923 17.5 64.700 Death rate all causes, per 1.000 popula- tion 15.3 14.5 Death rate per ICO.OOO poinilation— Typhoid Fever Starlet Fever 26.5 26.6 74.2 26.6 85.1 190.8 127.2 26.6 339.2 78. 88.4 36.4 26. 239.2 72.8 10.4 332.6 56.1 30.6 10.3 102. 265.2 56.1 15.3 285.6 4.8 6.3 1.5 4.7 14.2 57.4 6.2 4.8 3.1 4.8 89.6 6. "WTioopiii!; f.iiiMli Diphtheria- 5.3 164.3 275.6 153.7 15.9 6.4 12.8 92.1 41.6 16.5 4.6 .Malaria.- Infant Deaths Under 1 Year .Age 174.6' 156.2 156.1 75.2 Springfield's bad year for typhoid since the keeping of records began was 1881, with a rate of 171.5 per 100,000 population; for scarlet fever, 1879; with a rate of 230; whooping cough, 1877 with a rate of 36.4; diph- theria, 1875, rate 164.3; tuberculosis, 1881, rate 303.8; infantile diarrhoeas 1875, rate 153.7; baby death rate, all causes, 1880, rate 433.5; malaria, 1881, rate 29.4. Kaskaskia. This town located at the jjoint of junction of the Kaskaskia or Okaw Ri\er with the Mississippi, was founded by Marquette in 1672. The earlier French settlers married Indians or girls brought to Kaskaskia for wives from Canada and Louisiana. These earlier French half-lireeds and Indians enjoyed good health in spite of the location of their town. The Knglish took possession in 17(5."). ."-'ettlers began to come in from the South in 1770; Clark was there in Ills and 17^9 to about 1783. A military garrison there lIEAr.TlI IX SOME CITIES PklOU TO sut'lcred severely from disease iluring some of this time. There was a United States land office there in I sol. In ISO'.i the Territorial Capitol was located in Kaskaskia and there it remained until the State was organized in 1818, wheren])on Vandalia became the capital city. Although in the later years of its existence the health of the people of Kaskaskia was ])ii(ir that was not the reason fur the removal of the capital. Overflows and the caving banks of the adjoining rivers brought that about. However, had Kaskaskia retained a large population between 1818 and 1877, it would inevitablv have become a liotbed of malaria, typhoid, dysentery and pestilence general!}'. Shawneetown. The principal reason for writing especially of Shawneetowm is the fact that it was the seat of (ine of the land offices through which the colonists of other states who located in the south end of the State secured their lands. In his article on a Pioneer Medical School Dr. C E. Ijlack'"' of Jacksonville, says: "When Illinois became a state in ISIS most of its inhabitants were south ot the mouth of the Illinois River." .Ml of those who owned land in this sec- tion had entered their land through the Shaw- neetown office. Many of them had been there in person taking their diseases with them and '"■ ''■ !'"■ Biaik. swapping diseases while there. In "rictures of Illinois, One Hundred Years ago"' — (Lakeside Classics, 1!)1S) we read: "Shawneetown enjoyed something of a real estate boom in 1S14. but due to the annual inundation of the Ohio River and to the general unhealthfulness of the place the boom speedily collapsed." Vandalia. \'andalia became the State capital in 1818 and retained this honor until some date between 1837 and 1839. It is located on the banks of the Kas- kaskia River, which river was sometimes called the Okah. Elsewhere iti this narrative are accounts of malaria and other forms of disease at \'andalia. Most of the reports were taken from communications from Dr. F. Haller. While the low ground of the Kaskaskia bottoms made Vandalia a malarial 'Black (III. Histc HEALTH IN SOME CITIES PRIOR TO 1877 119 location in the early days that disease does not appear to have influenced the legislature to remove the capital. One account says the change was made because the only meat available in Vandalia was turkey and venison, of which the members of the legislature had grown tired. They ])ref erred hug meat and they moved the cajjital t m iml.lh ,iimI i.iivate schools lllllll IN.^N. wllell lu- «;is .1, . l,',l lo III. oil!,.' ol .S|:il,. .SM|i.in iMil o| I ■ublio Instruellun, a posillull lie lieUI lor loin leell .Vcal.s. I'le.sulent ol Kno.^. Collii;,, CaleS- burg-, 1875-1S93. Member State Board of Health, ISTT-lSai. Author ot numerous historical books and publications. Died in Galesburg, October 21, ISII". Reuben l.udhim. M. D. mo, lioin ii.-tober 7, 1.S31, Camden, New Jersey, Orad- , ol 111, Iniversity ot Pennsylyania, lsr,L> ;mm1 went to Cbirasi., l,s.5:i. .M.inli.i :iiel .1. in r,oiilty Hahnemann Medical (•oll.■l;.^ ImiI-1S99. President of uunnioiis iii..lio,il oi t;,i n i7,:i I ions. Author of several me(li,:il 1 ks and editor of professional journals. Member of State Board of Health. 1S77-1S!I2. An.son L. Clark, M. D. AX.S( IX 1 :.. ci Wa; s take] 11 1 ly IKU-f at 1 \:i\, si, or ■^ III r assi 1 S 1 : 1 1 1 1 1 L o'. in Ben U. 1 1 .\ I.I ll. .ll 1- 1911 1. .\1 e jii he I 271 1S7' :-isi)3. A I ithor 1S36, Clarksburg-, Massachusetts. Craduated from Lombard College .\l..li.;il liisiitute in 1S61. First \il W.ii .111. ..r the founders of [ ii.>ni lis ..i i;.i nization in 1S70 to .M.inl.ii St, lie Board of Health, ' Died April 11, 1910. William M. Chambers, M. D. WILLIAM M. CHAilBEPLS. Charleston; born April 11, ISH, Cynthiana, Kentucky. Gradn.itiil fr.mi McdirnI (^.ll.qe of Transylvania University, Lexington, 1S43. Went to Col. s i'..iiiii\. llliimis ill \s:,:. Ih-igade surgeon, U. S. Army, 1861 to close of Civil War w h. II In u.is i.i.\.ti..l I'oi.ni.l for meritorious service. President of numerous merii.nl ..rL:niiiz,iii..iis, .M.niil.. r .■^inle Board of Health, 1S77-1SS1. Died in Charleston, November 12, 1.MI2. John Milton Gregory, LL. D. JOHN MILTON GREGORY, Champaign; born July 6, 1S22, Sand Lake, New York. Graduated ITnion College, 1S4B, A. P.. Studied law, Schenectady, New York, 1S4B-47. Pastor Hnptist I'hvir.h H..osi,k Falls, New York. lS47-l.'iSO and Akron. Ohio. 1X50-1852. Prill, innl I ■l,-.-sn;il Si 1 1, |..-lri.il. 1 s,".2-l s,".:i : .-.11 1 . .r n ii.l piil.l isli. i , .Mi.lii^nii ,l..nrnal of |.:.lin,iii..n l-,-,Ms,-.;. S r 1 1. 1 . in l.ni I ..I I'lil.li.' InsliM.I , .MlIiil:.!!, I--,..-1S64. Presi.i. ni Is.il I tii.iz ■i.ll.^.-. K.ilniiinz...., .\l I. li I ij , i ii , 1m;,'.-1s.;t I;. -. ni il-i.sident) lUin..ls lli.lnsliinl riilMlslU-. ISDT'ISMI r S .■i.innilssi I, \nMn,i i; \ | .. .si t l,,n, 1S73. lllin..is Si,iii- c- ,iissi..ii.-i' to l',iiis i;m...^ii loll, 1^T^ .\l.ni.l..-i hhI |.i.sident (ISSl- lSs:ii ..r si,ii., r,..,.i.l ..t Health. IsTT i ' : m. mi., r I' S i'i\il S. I X n . c'ommission, lSS:i-l,^,^,'., I'l ..i.-ss..r Emiretus of I'l.liii.,.! i: ..ni.x. riu\.nsii,\ ..I lllin..is. Author of numerous peiiafiogl.al works. l>ie.l In W ash i n^ I. .1 1, 1 1. C, Lletohel 211, 1S9S. John Henry Ranch, M. 1). JOHX HENRY RAUCH, Chicago; born September 4, 1S2S, Lebanon, Pennsylvania. Graduated University of Pennsvlvania, lS4i). Meniher faculty Rush Medical College, Chicago, 1S57-1S60. "Sanitnrx' snl .. i i nl .ni.l. n l oT i 'li i. ,i i;. ., 1SI;7-1S73. Chief medical officer under General Gimiii m l.n- T.nin ,.ii.l \iiliiiii i n mpnigns. At close of Civil War he was brev.ii..! I.nni.n, '..[.in. I i..i nniii is services. Member, president and secretary of Sini.- I;..,.i.i ..i ll.ilih, 1,^7.-In!i1 i>i.-.l in Lebanon, Penn- -sylvania, March 24, 1S!I4. Horace Wardner, M. D. IKiIlAi'E WARDNER, Cairo; horn August 2.t, 1829, Wyoming County, New Ymk, Studied at CavuKn A.ademv ami .Mfred University and graduated in medicine fnun Rusli .Medical' «'.. 11. i;., ilinn;;.. in l^,.r. r..i;nii practicing medicine at Libertyville. Illinois in 1S5S. i;. itiin..! i.. ihn.u.. I.. i..i. ihe year was up and opened a private anattunieal room wini. In i,in:;lii nn.ln,.! ,-iii.liiits. Elected member faculty Chicago Medical College, l.s.j;i. .Suiyeon 12tli Illinois Volunteer Infantry and staff-surgeon in Grant's Tennessee Army during Civil War. Brevetted Lieutenant Colonel for meritmious services. Located in Cairo, Illinois in 1SC7. Appointed superintendent Anna State Hospital, 1878. Member State Board of Health, 1877-1881. Dr. Cadwell was a prominent citizen during tlie early period of Illinois history and participated in the first efforts to secure laws relating to the prac- tice of medicine and to public health. PUBLIC HEALTH ADMINISTRATION IN ILLINOIS. 'J'hc uiganizatioii of the Stale Jloanl uf llealth in isT^, niarkb the lime when the conservation of the pnhhc liealth was first nndertaken by the State oi Illinciis, and when a department of the State government was first charged with liiis fnnction. Prior to that time, the local lownsliip and numicipal governments in the State had been given the power, either by special charters, or general legislation such as the Cities and \ illages Act of 1S7:.! to protect the public health, in their respective local communities, in some of the larger cities of the State, this authority had been exercised, and local lioards of health or cit\- physicians appointed to attend to this duty. Such action was usually taken during some epidemic of cholera or smallpox and after the danger from the epidemic had passed, the sanitary measures instituted lagged, the enthusiasm of the officials waned, appropriations for the work lapsed and were not renewed, with the result Ihal it was discontinued, only to be re- newed again with the next a])pearance of an epidemic. This was the general history of the local health organizations in ihe State. Even Chicago was not an exception; there the board of health was aliolished as late as 1860, "on account of the absence of any alarming con- ditions", but was reestablished in ISii; when cholera had visited the city and smallpox was reaching epidemic jiroporlions. The local medical societies took an active interest in instituting measures for ihe protection of their communities against pestilential diseases and in some localities attended to this work, without any form of health organiza- tion. Active members of these societies often served as members of the local boards of health. In this work as well as in their jiractice they came across the numerous unc|ualified jiersous who were jiracticing medicine, be- cause as yet. there were no laws t(] prohibit this. It was this state of affairs that brought on the movement which resulted in the organization of the State Hoard of liealth. Genesis of the Public Health Law. Public health work as a permanent function of the .^tate go\ernment was first established iij, Illinois in ItSTT. < hi |nl\- 1 of that year two laws, one known as the State Board of Health Act and the other as the Medical Practice Act, became effective. The former was aiij>roved by the Ciovernor on May 25 and the latter on May 2'J, is: ;. Both laws had the same ultimate purpose in view and the State Board of Health, which was organized on July 12 of the same year, was charged with the responsibilities and duties in- (12:) Shelby Moore Cullom. Governor of Illinois 1S77-1SS3, who signed the first public health law enacted in the State and the first perma- nent law regulating the practice of medicine. PUBLIC HEALTH ADM I MSTRATIOX 139 volvfd ill the enforcement of both. This dual responsibility of regulating the practice of medicine and promoting sanitary and hygienic activities ordin- arily referred to as public health service was a new thing for a state board of health in the United States, and it provoked considerable interest among sanitarians and the medical profession throughout the country. The passage of these two public health laws was not an expression of a sudden burst of enthusiasm for more healthful conditions but rather the belated fruition of an idea that took root and provoked agitation among the people, especially the medical profession of Illinois in territorial days sixty years and more before. Proof of this is the fact that an ordinance or law regulating the practice of medicine was enacted by the territorial Genera! Assembly in 1817 and duly signed by Ninian Edwards who was the terri- torial governor at the time. Furthermore the first State General Assembly passed a medical practice act in 1819 and another was passed by the General Assembly in 1825. Both were promptly repealed, however, by the next legis- lature succeeding the enactment. Bills introduced in later sessions of the General Assembly failed to become law until 1877. Dual Co)U-('pfioii of FiihUc HeaJtIi Worli. The idea of public health service as it was finally expressed in the first permanent statutes grew out of two very definite conceptions which have not always promoted harmony of action in this field of endeavor. One conception was and still is that good doctors are the dominant factor neces- sary to good public health and to secure the latter the state can best function by bringing about the former. This idea was expressed very well by Dr. Horace Wardner. as president of the State Board of Health in isso, when he said, ■•Through the work of the Board the profession has deliberately said to the people: 'Your greatest danger is from ignorance and the iniquity of pretending physicians, and we have sought, and are seeking, to protect the people at this point, by subjecting the tjualiflcations of all persons desiring to practice medicine to reasonable and satisfactory tests;' " and again by a committee of the State Board of Health appninted in 1880 to inquire into requirements for "good standing" of medical colleges which concluded that. "We shall only fulfill our duty as a State Board of Health by promoting to the utmost that largest and most potential force in sanitary science and in public hygiene — a well trained and thoroughl.v educated medical profession." The other conception was and is that sanitation, quarantine and hygiene are things the application of which will produce significant results in pre- serving and improving public health hexdiul the capacity of private medical practitioners, be the profession ever so efficient and well trained. Advocates of this conception believed that regulating the practice of medicine was in- 130 I'UliLIC IIKAI.TII ADMINISTKATIOX cidental or subordinalc to other j)ul)lic' lii'alth futictit)iis of the Siatu. A yno.l expression of this conception is found in a paper read Ijy Dr. I'".. W". ( .ray of Bloomington, hefore the Ilhnois State Medical Society in May. ls:(), which reads : "The people need to be enlightened; they need to be directed: in many cases they need to be restrained. A board of health organized, and provided with means to collect information, and diffuse among the people a better knowledge of the laws of health, and to discover to them the dangers to which they are exposed, would save thousands of poor victims from untimely death." ' The "good doctors" conception is much the older. It was the only one expressed in the territorial law of ISH. In the law of ISli) a section re- quired the reporting- of hirths, deaths and diseases Imt otherwise it was concerned only with providing "good doctors." The \><2'i law was con- cerned with nothini:; but the regulation of the practice of medicine. Dr. George t/aduell, a ])rominent and useful citizen who came into Illinois he- cause of his bitter animosity toward slavery, championed the law of LSI!) while Dr. Conrad Will was the moving spirit behind the act of \x2o. Dr. George Fisher was Speaker of the House of the territorial .\sseml)ly in IS 17 and presumably had considerable tth attem])ts failed to produce the desired results. Very likely the matter was agitated and brought before the General Assembly at other times during the fifty year period between 1827 and 1877. The "good doctors" conception was revived by the Jersey County Med- ical Society in a communication addressed to the Illinois State Medical Society and read before that organization at its annual meeting in May, 187G. It advocated the organization of a State Board of Health for the purpose of regulating the practice of medicine and of collecting statistics of births and deaths. This communication was an important factor in crystalizing sentiment which resulted a year later in the Medical Practice Act of 187;. It was not until after the Civil \\'ar that the sanitary and hygienic con- ception began to take root in this country. There is record of four meet- ings known as Xatioiial Sanitary Conventions which were held in 1S.")7, 1S.")8. 185'J and iscd in Philadelphia, Baltimore, New York and Baltimore but these were abandoned with the outbreak of hostilities and nothing f mi her was done on a nation.al scale mitil is;-.' when the .\merican Pn'nlic Health Association was onj.ani/.ed. Sl;ite Mertii-al Snrioty, 1S7G. PUBLIC HEALTH ADM I MSTKATION 131 The very first public utterances on sanitation as an important factor in healthfulness took place in this country about ISoO when Lemuel Shattuck published lii> report on sanitary conditions in Massachusetts. It was 1S57 before I'asteur. wcjrking in France, published his first report which opened up the field of bacteriology and it was ten years later before Lister, the cele- brated English physician and pupil of I'asteur, began to attract public notice by his great success in the [jractice of antiseptic surgery. Prior to Pasteur and Lister, whose work related to bacteriology, was the German, Max von Pettenkoft'cr, founder of modern hygiene, lie it was who recognized more fully than had ever before been recognized that health is impaired by factors not in ourselves lint in our environment. This a])ostle of cleanliness was prominent enough in ISCi.") to be appointed head of ihe first institute for the study of hyL;iene which in that year was inaugurated at the L'niversity of .Munich. It was doubtless the works of this man that stinuilated the first agitation in .\merica for sanitation as a public health activity. Bacteriology developed later and began to be apjireciated on a significant scale in this countiy toward the closing \Tars of the nineteenth century. I'lorn in luiro|)e and finding ready disciiiles along the Atlantic seaboard in this country the new ideas of samtar_\' control over diseases began rapidly t(] lilter into Illinois. Dr. John W. Ranch of Chicago manifested interest enough in the new movement to attend the organization meeting of the American Public i lealth .\ssociation which took place in New York on April IS. l,s;->. By ISTti Dr. E. W. (iray of Bloomington had become enthusiastic enough to prepare a paper on the sul.)ject addressed to the people of the State, which he read before the annual meeting of the Illinois State Medical Society in May. In thi> |japer Dr. (iray advocated the establish- ment of a State Board of 1 lealth. .\s .a result of this pajier he was ajipointed chairman of a comnn'ttie to memorialize the legislature on the Miljject of a state bo.ird oi health. That the work of this committee was crowned with success shows that Dr. (iray and his colleagues carried their enthusiasm for sanitation to pr;ictical account. While both the "go(jd doctors" and "sanitation" conceiitions of public health ser\ice pie\aileoar(rs procedures. a]ipropria- tit}ns. etc. The sweeping authority — "i^enera! ■-uiierxi^ion of the interests of heaUh and life of citizens" and "authority to make ■'Ucli ru'e> and regulations and such sanitarv investigations a> they from time to time may deem necessary for the preser\;uioii and improvement of jutblic health" — granted to the State Hoard of I K-;dth in the original law was a recognition liy the legislature that public lualtb work is highly technical in cb.aracter and requires specially trained personnel. I-'rom this position the lawmakers have never retracted ri'BLlC HEALTH ADMINISTRATION 133 SO that ihe laws are still bniad, niakini; the rules nf the present State health organization tantanmunt to law. Time and ai;ain from the very outset the State health offieials ha\'e found it eiin\enient and necessary to initiate activ- ities oi an arbitrar\- character under the authority granted in this generalized section and the courts have generally ui)liekl these measures. It will be seen that the compromise of the General ;\.ssembly, which vested in one board the powers and duties representing two distinct scIkkiIs of thought was not destined to unite and harmonize the two and that even a State Board of Health cannot serve two masters. Ultimately the State Board of Health lost its identity as an integral part of the State government and in its place were created two departments, the one to devote its full energy and resources to sanitary and hygienic activities and the other to regulate, among other things, the practice of medicine. Development of State Health Service. Three Periods. State public health service in Illinois falls conveniently into three r.'ither well defined periods. The first ended with the century in IDOO, It may be described as a sort of probationary exjjerience for the State ooard of 1 lealth. During that time the State health organization was on trial, so to speak. It faced the problem of justifying its existence. Governors and lawmakers suffered it to continue through a sort of kindly tolerance. They were never warmed with sufficient enthusiasm for this new venture to unlock the treas- urv vaults for its benefit. The first appropriation was $.'J()()U for the bien- nium. For the last fiscal year of the century, ended Jtuie 30, 1899, the appro- priation to the State Board of Health for ordinary expenses was $9250. A contingency fund of $10,000 was available to draw on under specified condi- tions during a number of years in this period but those conditions rarely arose — at least not in the opinion of the Governor whose judgment in the matter was a lock on the purse strings. The second period started out with the new century and terminated in mil. For the State Board of Health these years may very properly be called the period of expansion and recognition. In 1901 the legislature approjjri- ated a sum of S-1.J,300 per annum for expenditure through the State Board of Health. For the fiscal year ended June 30, liMl, the available apjiropria- tion amounted to $l(iri.."iS9. Alanifestly the people of the State and the legislature found in ihe State P.oard of Health something for which they were willing to ]jay considerably more than had been the case twenty-five years before. The 1901 appropriation amounted to ^t^'.t ])er 1000 persons per year while that drawn upon for the fiscal year ending June Mi), lull, amount- ed to nearly $2.'). The changes that took place in the amount of mone\ made 134 I'l^BLIC HEALTH ADMINISTRATION available lor health service make a good measure for the amount of ])ublic interest in that work during those years. The third and last period to date began with the adoption of the Civil Administrative Code by the Illinois state government and continues to this writing in 1!)2T. It is called the period of maturity not in the sense that the State public health organization represents what might be considered a ma- ture or adecjuate agency for combating disease and promoting health to the fullest practicable extent under present condition^ but rather in the sense that it now is regarded as an essential factor in the State government and functions on a jjlane commensurate with that of any other department. The dominant characteristic of this period is the divorcement in practice of the "gooil (ioclor>" from the "sanitation and hygiene'' conception of public health service, r.oth contiiuie to be important activities of the State administra- tion but all matters relating to the registration of physicians and regulation of medical ])ractice repose in the State Department of Registration and Edu- cation, while those concerned with sanitation, hygiene and vital statistics are in the hands of tiie Slate I )e]);irtnient of Public Health. Four PcrsdiKilifics. The three ]x-riods of development of the public health machinery in the State are dominated by four personalities. About each of these revolve the policies, the character and the color of the State's participation in public health service during the period in which each was active. Each made sig- nificant contributions to the [lublic health movement in Illinois. The first of the four was Dr. John H. Ranch, moving s])irit in the period of "probation." As his contribution he coni])leteIy justified the exist- ence of a State public health service. l-"ew men have even accomplished so much with such meagre resources. Blessed with a rare faculty for organiz- ing, driven by an overwhelming enthusiasm for getting things done, guided by a wealth of meilical and sanitary information which a passionate curi- ositv led him to sei'k. balanced by a ca])acity for sound judgment and endowed with tact 'and diplomacv Dr. Ranch literallx' ni;ide the public heilth service of his time. A disci])le of sanitation ami hygiene he also had a ])rofound belief in the importance of good doctors so that under his influence the dual functions of the State P.oard of Health jmigressed harmoniously during the fourteen years of his service and carried over for several years afterward. The "probationar\" period might very properly be called the "Ranch" period. Dr. Ranch's name will appear frequently on pages to follow that relate to the early health machinery of the State. The second in chronological order of the four jiersonalities was Dr. lames A. Egan. lie became the executive secretary of the State Hoard of Health in 189" and belongs to and was largely responsible for the "period PUBLIC HEALTH AUM INISTRATIOX 1-^5 of recognition." Money getting was his unique contribution to the jiuhlic health machinery of the State government. Before Egan's time, $l-4 .()()() per year, besides a contingency fund, was the largest appropriation that the leg- islature ever granted to the State Board of Health. The last General Assem- bl\- to meet during Egan's tenure appropriated $120, G25, besides a conting- ency fund, for annual expenditure by the State Board of Health. As an opportunist. Dr. Egan took advantage of the phenomenal developments in sanitary and medical sciences that were taking place immediately before and during his time and turned them to good account for public health service in the State. Based upon highly scientific knowledge, successful ptiblic health services requires highly trained technical personnel and this requires money. Dr. Egan made a splendid contribution to public health service in Illinois, when he got the legislature in the habit of granting significant apjjropriations to the State Board of Health. The third of the four personalities was Dr. C. St. Clair Drake. He became the executive officer of the State public health organization in l'-)H and continued until 1921. His tenure was therefore partly in two of the major periods. By nature a propagandist, in the best meaning of that term, Dr. Drake poptilarized public health work in the State. He was a man who radiated enthusiasm. Endowed with a resourceful imagination, he managed to create ingenious mechanical models that carried fundamental public health messages into every part of the State. This exhibit material which was suf- ficient to fill one thousand square feet of display space was in demand at local fairs everywhere and it never failed to command attention and it left indelible impressions upon those who saw it. Furthermore, Dr. Drake in- itiated the Better Baby Conference movement in Illinois. He developed a motion picture library from which health films are circulated in the State. He inaugurated the "Health Promotion Week" idea that has come to be an annual event and one that has always attracted wide attention and a fine response. Under Dr. Drake the State Board of Health was reorganized into the State Department of Public Health and it was Dr. Drake who drew up the plans of organization which still characterize the Department. This movement, however, was initiated by Governor Lowden in his Civil Ad- ministrative Code scheme and was only incidentally a part of Dr. Drrike's achievements. Dr. Drake was primarily a publicity expert. His donation was an educative method. He popularized public health activity. Dr. Isaac D. Rawlings, appointed in 1921 as Director of the State De- partment of Public Health and the last of the four personalities brought system into the service. Vital statistics were far from satisfactory, and had been a bane to State health officers since the days of Ranch. .Mor- tality returns were complete enough to be acceptable to the United States 136 ITin.lC JIEALTII ADMINISTRATION bureau of the census but no compilations or analyses of consequence were made by the State registrar before his coming. Birth reports were too in- complete to meet the federal requirements for recognition. Dr. Rawlings went methodically about the task of improving vital statistics, arranging for every division of the Department to cooperate to that end so that within eighteen months Illinois had been admitted to the United States birth regis- tration area and fairly satisfactory annual compilations were forthcoming from the State registrar. Under Dr. Rawlings, regular staft meetings of division heads were started, the first board of public health advisors was appointed and met regularly, a central filing system of Department cimi- munications was installed, the official bulletin was established on a monthly basis in fact as well as in name, newspaper publicity w^as supplied regularly each week to the press of the State, a scheme of supplying local health offi- cers w-ith weekly morbidity reports was established, the method of record- ing morbidity reports was simplified and made much more serviceable, the routine investigation of every reported case of typhoid fever and smallpox was started — in short the work of the Department was systematized. Each of these four sanitarians did other important public health serv- ices. Other executives of the State public health organization accomplished many things of importance and value. Justifying the existence of a board of health, wringing money from a skeptical legislature, popularizing health on a large scale and systematizing the public health service are the larger achievements that have marked the progress of officially organized pre- ventive medical activities in Illinois and for these significant contributions Ranch. Kgan. Drake and Rawlings were respectively responsible. State Health Machinery. Rarely may one find in history circumstances more favorable to the launching of a great public health movement than those w'hich prevailed in Illinois in the "seventies". The severe losses of the Civil War in which disease caused far greater mortality than shot and shell was still fresh in the minds of men and especially in the memory of the medical pro- fession. Disastrous waves of cholera had swept the country in lS.j-3 and 1867. Highly fatal and widespread epidemics of diphtheria and scarlet fever came and went with the seasons while helpless communities sat grimly by until the infections burned themselves out by natural limitations. Ty- phoid fever was frightful, frequently striking whole families simuitaneously. Yellow fever broke out periodically in the lower Mississippi Valley and was a perennial source of paralyzing fear to the citizens of Illinois. Immigration into the State from abroad was very heavy, establishing dangerous contact with European foci of smallpox, cholera and other infections that often in PUBLIC HEALTH ADM I MSTKATION ] li? that day cleijopulated great areas of land, especially in foreign Cduntries. Quackery was rampant in the State because the field was fruitful. On the other hand an awakening to the possibilities of preventing and controlling communicable diseases through sanitation and hygiene was be- ginning to manifest itself here and there among research workers. P"or- ward looking members of the medical profession and others in Illinois were already beginning to appreciate the significance of what Pettenkoffer. Pas- teur and Lister were doing aliroad. \'accination as a preventive against small])Ox was an estaljlished medical procedure. BdunJ of Ifcdill/ Orfiaii'iK (1. If the time was oppiirtuiu' the members of the first State Board of Health, ajtjjointed liy Governor Culldm were e(iual to the occasion and fully worthv of the confidence and trust rejiosed in them. Thev were Newton Bateman, LL. D., of Galesburg. intimate friend of Abraham Lincnln and an eminent educator and author, president of Knox College at the time of appointment; Reuben Ludlam, M. D., of Chicago, dean of the faculty of Hahnemann College and author of numerous medical treatises; Anson L. Clark, M. D., of Elgin, assistant surgeon in the Cnion Army, moving spirit in the organization of Bennett Medical College of which he was president for many years, president of a number of medical organizations and member of the Elgin Board of Education ; William Al. Chambers. Al. D., of Charleston, brigade surgeon in the Union Army where he was brevetted Lieutenant Colonel and Colonel successively for meritorious services, jiresi- dent of a number of medical organizations and member of the American Public Health Association ; John Milton Gregory, I^I^. D., of Champaign, ordained minister of the Baptist faith, eminent educator and author and many times commissioned by state and federal governments to fill important posts at home and abroad and president of Illinois Industrial University at time of appointment; John H. Ranch, M. D., of Chicago, highest rank- ing medical director on General Grant's staff in the Army of Tennessee, chief of the medical staff under U. S. Grant in his Virginia campaigns, sanitary superintendent for the board of health in Chicago ; Horace Wardner, M. D., of Cairo, assistant medical director on General Grant's staff in the Army of Tennessee, member of faculty of Chicago Medical College, While not a member of the Board, Dr. Elias W, Gray of Bloomington, who had partici- pated in the Civil War as an assistant surgeon, was elected the first executive secretary of the Board. First Jpjiiojiriafiniis. With an .-qiprojiriation of $.j,()OO.U0 for the first liiennium and author- ized to spend moneys collected for license fees al the rate of -tl.Dd each KiS ITlil.lC IIKALTIl ADMINISTRATION from practilidiKTs lidliliiis^ hoiia lidc (liplonias and •$."). 00 each from those wild had to In- L-.\amiiK-d, the State lioanl of Hcahh, duly organized on luly \'i. l^^i wiih Dr. Ranch as president, set itself energetically to regu- lating the practice of medicine — the most olnious t;isk at hand. ORGAniZATlOn OF STATE BOARD OF HEALTH 1677 STATE BOARD OF HEALTH 7 Members Members participatinq in the enforcement ot riedicaK Practice Act with aid ot extra 1 1 Clerical Service 2 Clerks 1 Executive Secretary Vw.. N. Woi'kint; strength (if tlie lirst SUite health organization. /''//■,s7 Jrlirillrs. During the lirsi six months of its existence the memhers of the Board of Health and it^ executi\e secretary, with very limited clerical assistance, made u].} the entire strength of the State's puhlic health organization. The PUBLIC HEALTH ADMIXISTUATIOX 131) iiiagnituile of the job of certifying doctors and the extreme meagerness of resources practically prohibited any signilicant attention to sanitary and hygienic matters. Presumably chafing under what he regarded as a neg- lect of its sanitary duties by the Board, Dr. Gray resigned as secretary on December 20, 1S7 7. In accepting his resignation the Board emi)hasized its appreciation of Dr. Gray's interest in sanitation. Dr. Ranch acted as secre- tary from December, 187; until May, IS^S. Then Dr. Clark was secre- tary for about a year. Dr. Ranch then became secretary again in .\pril 1S7U and served continuously in that cajiacity until Is;)]. At the beginning the resources of the State Board of Health were its own membership; such help as it could afford to enii)l(iy with the sums appropriated by the legislature plus suius collected from aiiplicants fur li- cense ; all police officers, sheriff's and constables who were required b\' law to enforce the rules and regulations of the State Board of Health in so far as success depended thereon; vnUmtary assistance from interested citizens; the National Board of Health; such assistance as might be derived from in- terstate voluntary agencies; such active support as it was alile to secure from comiuercial and industrial interests indirectly through legal authority to (juarantine. etc. The Rai^cii Rkgime. Dr. Ranch's amazing ability to utilize these resources to a remarkable degree constitutes the story of public health service in Illinois for the first fifteen years after its foundation. The legislature was never generous in providing funds. That body deemed it wise to clothe the Board of Health W'ith extensive power and a small purse, h'or the first two years it allowed $5000 plus fees collected by the Board which amounted to less than $15000. For the next four years the appropriations amounted to $5500 per year ex- clusive of a standing contingency fuml nf $5()()() that cfiuUl be used imly in the face of .serious epidemic outlireaks. In I.SS5 the legislature granted the Board $9000 ])er year for the ordinary expenses and the usual $5000 con- tingency. For the next two years the apjjropriation soared to $2-1,000 for the biennium and a $40,000 contingency fund. This liberality was actuated by fear of a cholera epidemic. When the outbreak failed to materialize the annual grant fell again to $9000 but with the annual $20,000 contingency remaining. In 1889 the appropriations made for the ensuing biennium were $9000 per year for ordinary expenses and $5000 per year for emergency use. The money appropriated during this period was scarcely enough to pay the necessary expenses involved in collecting and compiling vital statistics and in meeting the expenses of the P)oard which met as often as thirteen times in one year for the convenience of those who wished to be examined. SECRETARIES lliaoLS State Boacd of Hcaltli Ellas ^ Gray. m.D. JohixH.UaucK/m.D. AnsoaLClack.m.D. ji/jTS' 1S7S --.^PK-mp \Viiv.R.7ll^Keii3UL,m.D. ^U(S. 4.1391 - iSPTa-f. ISi>l No photosraph of Dr. Cray was available. PUBLIC HEALTH ADM IXISTRATIOX 141 Dr. Rauch was ambitious to raise the standard of medical practice to the highest possible level. He was no less an.xious to put into operation every possible sanitary and hygienic measure calculated to prevent and control dis- ease. Too energetic and resourceful to allow the lack of funds to thwart him in his purpose he set about \\-ringing from the other resources at his c(jm- mand every ounce of activity and ciKipL'ratinn which was available. General J'ieic of P roll (in. It will be well to bear in mind that Dr. Rauch looked at sanitary prob- lons from a national and even a world ])oint of view. He would have gloried in the League of Nations because of its possibilities as an interna- tional health agency. He recognized, from a sanitary standpoint, no political lines of demarkation but only the great boundaries established by nature herself — the great oceans that .separate whole races of people. He had a passion for inaugurating such things as immigrant inspection service at the ports of entry and for the requirement of a clean bill of health as an essential factor in a "passport" from abroad. "Concert of action" was a phrase dear to his heart and furnished the basis for most of his achieve- ments. Perhaps his national point of view was too far reaching to be appre- ciated by the average State legislator and maybe that explains to some de- gree his inability to secure adequate appropriations for the execution of his plans. Even when he succeeded in alarming the lawmakers about the dangers from Asiatic cholera in 18ST the stupendous grant of $40. (KH) was so guarded with contingent clauses that it was not available for any practic- able purpose. Collecting vital statistics was the problem that led the State Board of Health first to connect itp with the State's health machinery resources out- side of its own immediate organization. In the law county clerks were re- quired to collect certificates of births and deaths and to make returns to the State Board of Health. The Board put the cotmty clerks to work on this job in the first year of its existence so that at the end of twelve months the functioning State health machinery consisted nl the .State 15oard of Health, which had met 13 times, and the comity clerks, .Small sums had been spent fur the laboratory examination of drinking water su])]>lies. In a few places local boards of health had been organized under the Cities anj X'illages Act of is;2. (Jiithr((ik (if YeUdiv Fcicf Siails Macliincri/ far ('(nilidl of E iii(l( lines. I)arl< clouds of epidemics and rumors of epidemics of yellow fever, .Asiatic cholera and smallpox began to hover above the health horizon in the ^nmmer of 1ST8 and the yellow fever thre.it actually materialized into 142 mii.ic iii:.\i.Tn ad.m inistkatiox :i disastnnis cuitlircak that worki-il its way ii]) the Mississippi Valley as far north as llhinii-.. invading C'aini. 'IIk'sc' amditions concentrated the thought ol hralth ciflicials everywhere upon sanitary matters. In Illinois the State r.uard (if I iealth wanted U> make the ])remises of every household clean and drv. It wanted tii make every puhlie and private water supply safe for diinkin';. Ii wanted everv iiersnn in the State vaccinated against smallpox. Il wanted ever\liiid\' to l)e1ie\'e in the cleanliness of environment as a pre- ventive of disease and to practice it. It wanted immigrants inspected and vaccinated. Iliiw to hring these things to pass was the question. The State Board of 1 Iealth h.-iil no funds availahle to undertake such stupendous tasks with its own emjikives. A way out was found hy the diligent and resourceful Ranch. The vellow fever crisis ol IS'iS, as it was regarded at the time, led the Slate I'loard of Health to test its power granted under that clause in the law w hich read : •• and sliall liave authority to nialce such rules and regulations, and such sanitary investigations as tliey may from time to time deem necessary for tlie preservation or improvement of public healtli " The Pioard made some rigid ([uarantine and sanitary regulations con- cerning the rail and steamlmat iraflic coming into the State from the lower Alississippi and it put the transpniialinn mteresls to work at complying with these rtgulations. A few inspectois, lempor iry at first, were employed by the Txiard lo >ee that the rules were carried nul. Thus il was discovered lli.it in making a rule, which had the weight of law, the State Hoard of lle.ilth could increase enormously the health machinery without any material increase in expenditure. This was ihe beginning (if "rules and regulations" and we shall see how Dr. Ranch, with the su])])ort of the Board, turned this earlv e\]urience to good account in carrying out his sanitary and vaccina- tion plans. ('nilf( rl nf Actinll. W hen Dr. I\auch was elected secretary in the spring of 18T!) the ambi- tions of the .State ISoard of Health to "sanitate" and vaccinate the State began lo resolve into plans and ]iraclical application. Cherishing his national ])oinl of viiw he took aihantage of e\ery opportunity and created oppor- innilit'- li> m.ake Cdni.acl with (Uilside .igencics. Thus in April, 18T9, almost iinnudi.aleK .after be became seeielary of ihe State Board of Health, he went 1(1 .\bniphis .and gdl himself elected secretary of the Sanitary Council I if the Mississi]ipi \alley, an iiUerstale \dluntary organization created at lli.il lime. Its function wa^ tn keeji member health officers informed of all epidemic oiubreaks. t-speckill}- of yellow fever, and to draw u]) uniform sani- PUBLIC IIICALTIl ADMINISTUATION 143 tary rules and regulations which all nieniliers agreed to adopt and enforce in their several states. This strengthened the i)u1)lic health, machinery in Illi- n(.iis bv adding the weight of group opinion to propcjsed plans and by pro- viding timely information serviceable in promoting pr(]mpt action on local plans. How an effective working contact was made with the National ISoard of Health, a federal agency created by Congress in ISIS with a $.")()0,()00 appropriation, in May and with transportation interests in July of 1879 is best described by Dr. Rauch himself who gives this acc(]unt in the second annual report of the State Board of Health: "While the Illinois State Board, through its executive officer, was thus exerting its influence, beyond its own boundaries, to secure such a general sani- tary reform throughout the entire valley as would prove the best safeguard against the Introduction of epidemic disease from without, the National Board of Health, in anticipation of the act of Congress increasing its powers and resources, was seeking trustworthy information upon which to base such actions as the law might empower it to take in the discharge of its duties.* "In response to a telegraphed invitation, received May 2S. the Secretary re- paired to Washington, for conference with the National Board, and on June 1 pro- ceeded to New Orleans, under confidential instructions from the executive com- mittee of that body. These instructions involved, among other matters, a report upon the general sanitary condition of New Orleans, and an inspection of the Mississippi quarantine station, seventy-five miles below the city. Returning to Washington, on June S. two da.vs were spent in consultation with the executive committee: and during this conference the situation in the Valley, from St. Louis to New Orleans, was thoroughly discussed, the various available sanitary agencies were duly canvassed, and divers plans were suggested for most efficiently extend- ing the cooperation and aid of the National Government, through this organization, to 'State and municipal boards of health, in the execution and enforcement of the rules and regulations of such boards to prevent the introduction of contagious and infectious diseases into the United States from foreign countries, and into one State from another.' "A code of rules and regulations was also prepared, and recommended for adoption, for ports designated as quarantine stations: for securing the best sani- tary condition of steamboats and other vessels: also, the best sanitary condition of railroads, including station houses, road-beds, and cars of all descriptions: and the precautions to be enforced in a place free from inspection, having communica- tion with a place dangerously infected with yellow fever; and when .yellow fever is reported or suspected to exist in any town or place in the United States. As the general adoption of this code would tend to secure uniformity of practice throughout the Valley, and thus promote efficiency in preventive measures, the agency of the Sanitary Council, through its secretary, was invoked to attain this desirable result. The Sections relating to island quarantine were subsequently referred to a committee composed of Drs. H. A. Johnson, of Chicago, R. W, Mitchell, of Memphis, and S, M, Bemiss, of New Orleans, members National Board of Health. Representatives of other sanitary organizations, among them the Sec- retary of the Illinois State Board of Health, were invited to confer with this com- mittee. The report is as follows: "By invitation of the committee appointed to confer with the representatives of the railroad and steamboat interests of the Mississippi Valley, representatives of these interests met in the city of Memphis, July 2, lS7fl, and organized by elect- ing Dr. R. W. Mitchell, Chairman, and Dr. John H. Rauch, of Chicago, Secretary. The following lines and companies were represented: Mr. James Montgomery, Louisville and Nashville Railroad; Mr. J. D. Randall, Memphis and St. Francis * The act referred to was not approved until .June 2. but the iiiemher.s of the Board, realizing the gravity of the .sitiiati m, louli sueli iireliniinary steps as were possible at this time. 141 ITI'.I.IL lll;AI.rll ADM IMSTKATIDX River Packot Company; Mr. W. E. Smith, Memphis anil Little Rock Railroad Company; Mr. M. S. Jay. Memphis and Little Rock Railroad Company; Mr. M. Burke, Mississippi and Tennessee Railroad Company; Dr. J. I!. Lindsley, Chatta- nooga, Nashville and St. Louis Railroad Company: Mr. T. S. Davant, Memphis and Charleston Railroad Company: Capt. Ad. Storm, St. Louis Anchor Line Packet Company: Mr. R. A. Speed, Memphis and Arkansas River Packet Company; Captain Lee, Memphis and Friar's Point Packet Company: Capt. R. W. Lightbarne, Memphis and Cincinnati Packet Company. The 'rules and regulations for secur- ing the best sanitary condition of steamboats and other vessels, also the best sani- tary condition of railroads, including station-houses, road-beds and cars of all descriptions,'* were read separately, discussed, and unanimously approved. Assur- ance was given of the cordial cooperation of the railroad and steamboat interests in all measures adopted by the National Board of Health in their efforts to pre- vent the spread of contagious and infectious diseases. All that was asked was that all rules and regulations adopted by the National Board of Health be made uniform at all places and ports. The representatives also approved the recom- mendations made by the Mississippi Valley Sanitary Council as a special measure of protection to the Mississippi Valley, that stations of insiirction be established at Vicksburg. Memphis and Cairo." Thus by iniilsuinnier of ISID ;l fmir cuniered tirgaiiizatidii fur lighting disease in Illinoi.s had been jjerfected. It incktded the State Board of Heahh and such voluntary assistance as it was able to stimulate within the State, the Sanitary Council of the Mississippi \'alley which furnished morbidity intelligence, the Xatinnal Board of Health which formtilated interstate sani- tary requirenit-nts ;ui(l the conference of Sanitarians and Transportation Inlerests which ]iut into cM'ect, through the resources of the common car- riers, the sanitary measures agreed upon. By titilizing every ounce of ])o\ver that could l)e S(|ueezed from these sources by means of persuasion and threats. Dr. Ranch was able to e.xtcnd the influence of his sanitary ideas throughout the length .'ind 1)readth of the Mississippi Valley. \\ ithin a few months from the time when the Sanitary Council was organized he was able to report : "At the beginning of this section, 'Yellow Fever in 1S79' there is given a comparative statement of freight movements over the Illinois Central railroad in 187S and 1879, showing an increase of plus 37 per cent in the latter as compared with the former years. In this statement will be foinid an illustration of the effect upon commerce by the different systems in vogue in the management of yellow fever in the respective years. In 1S7S there was a quarantine practically excluding ever.vthitig that came from the south, while in 1S79 it was one of sani- tary inspection, including only dangerous articles. This result could not have been brought about without the cooperation of the National Board of Health, since neither the Illinois State Board nor the Cairo Local Board, without this cooperation, could have permitted the immense amount of material to be brought into the State from the south during the months of July, August, September and October. It required the constant presence of the Secretary at Cairo (especially in July I, and repeated assurances to the local authorities that every precaution was being e.xercised by the National Board and the Louisiana State Board of Health at New Orleans, and other organizations along the entire route, to prevent the introduction and spread of the fever northward, to allay their fears, as this year a majoi-ity of the citizens of Cairo were favorable to a quarantine of exclu- sion. Such was the feeling of apprehension that fully one-third of the population of Cairo, from July 15 to September 1, was ready to leave the moment the first case appeared, no matter whether it was of foreign or local origin." uloptprl by the S;init,iry Cciincil at Atlanta, witli PUBLIC HEALTH ADM I .\ ISTKATIOX 143 How he played one force against another is suggested in a telegram sent by Dr. Ranch on October 3. ISIK, to the secretary of the National Hoard of Health. It read: "I am almost constantly advised by telegraph, no matter where I am. of the condition ot affairs throughout the whole Valley and 1 am. therefore, in posi- tion to judge intelligently of the situation." The intelligence set forth in this coninnmicatiun was obtained ihroiigh the operation of the Sanitary Council of the Mississippi Valley and the pur- pose of the message was to bring the National Board of Health to support Dr. Ranch's plan for combating yellow fe\er at the moment. Everywhere in the records of his work it is patent that Dr. Ranch kept well informed of epidemic outbreaks all over the world, so far as that was possible. Time and again he went before the national congress, the State legislature and other organizations with his jilans and invariably he would recite stories of epidemics abroad, naming foreign cities with the familiarity of a native and quoting figures and relating circumstances like a local observer. Small- jiox, cholera and yellow fever — these were the diseases he was fighting. When sanitarv interest and activity in the State tlireatened to grow sluggish. Dr. Ranch would begin to search the skies for ei)idemic clouds. Invariably he found them, usually an Asiatic cholera thundercloud that flashed and rumbled with deadly threats. Still catering to his national viewiioint Dr. Ranch resorted again to his "concert of action" idea in 1881 when smallpox outbreaks in the State be- gan to take on serious aspects. Tlds time he took it uijon himself to call a conference which again is best described in his own words, taken from the fourth annii.'d report of the State Board of Health, which reads as follows; "Early in the following June. (ISSl), the Secretary — convinced by past experience of the futility of independent preventive measures, confined to States and municipalities, while the disease was increasing in the chief European ports, and thousands of unprotected immigrants were pouring into the interior, and after consultation with leading sanitarians — issued a call for a conference of health authorities. National, State, and local, with a view to co-operative action by all interested, and especially with reference to the arrest of further introduc- tion of the contagion from abroad. This Conference, which was held in Chicago. June 29-30, was attended by representatives of the National Board of Health, and of eighteen other health organizations in fourteen different States. After full deliberation the Conference recommended that Congress incorporate into the laws regulating immigration, a provision requiring protection from smallpox by successful vaccination ot all immigrants: that the National Board of Health con- sider the propriety of requiring the inspection of immigrants -at the port of de- parture, the vaccination of the unprotected, and the detention of the unprotected exposed until it was certain that they were not carrying the germs of the disease on shipboard for the infection ot the vessel and the transportation of the disease into the United States: that measures be taken tor the quarantine detention of steamships bringing immigrants not provided with proper evidence of vaccinal protection; that local health authorities inspect all immigrants arriving in their respective jurisdictions, and enforce proper protective and preventive measures when necessary; and that, 'to meet present emergencies,' the National Board of Health secure the inspection of all immigrants, and the vaccination of the unpro- tected, before landing at any port of the United States." PRESIDENTS llUaols Stala £)oard. of Health, isrr - • W79 mJtm M'^>§/f?.s^-^L.D. Hocace ^acdnct,9Tl.D. ISZ9-/SSI 9Uvi'toa BaUiiiau.lL.D. PUBLIC HEALTH ADXr INISTRATION 147 As an outcome of the Chicago Snialljiox Conference the National Board of Health inaugurated an Inmiigrant Inspection Service in June of 18iS2. It iivovided physicians, stationed at railway terminals throughout the coun- try, will' examined immigrants and vaccinated all of those susceptible to sniallpnx who were enroute to territory over which the inspector had charge. 1 )r. Ranch was appointed chief inspector for the western district. The in- spection service continued oidv seven moinhs liut during that brief period ll.j.O.'iT iinniigrant> liound fdr Illinois werr examined and ".M.illS vaccinated against smallpox. \\'hile this service lasted the tive inspectors located at Chicago and the two located at St. I.cmis and Indianapolis respectively, added great strength to the health machinery in Illinois and doubtless led to the coast cjuarantine service which subsecjuently relieved states from work and apprehension covering the health of immigrants to this country. ('(1)11 prcli cits') vc State S)i )')'(' t/. While working with interstate ami national agencies for the sake of pre- \enting the introduction of disease from the outside, the State Board of Health, through its secretary, was not idle in promoting sanitary activities widiin its own state boundary lines. In December of 18T8 the Board adopted a form for use in making sanitary surveys. Plans for the use of these forms and what was expected to be gained therefrom are expressed in the first annual report of the Board as follows : "This schedule of ciuesticns embraces everything appertaining to the sanitary interests of any city or town, and it can be carried out without a great deal ot expense, as the local medical men or societies will no doubt cheerfully answ'er all the queries contained therein. The information asked for is necessary to a cor- rect understanding of what is needful to be done to improve the sanitary condi- tion of any city or town in this state. While this information is being obtained, it at the same time stimuJntes the siudij of sanita)-y scirnrc all over the State. It is therefore very important that this survey should be made." The first survey forms were sent out to 8 communities in southern Illinois during the spring of ISV-K After yellow fever brc.ike out in the lower Mississippi Valley during that summer the forms were sent tt-s and much information concerning local epidemics .■uid famiU lu-:dih histories. The achievement of this stupendous task is signilicanl here llecau^c it shows hiiw the Board was al)lc to bring into action hundreds of l(ic;d peii|ile lh;U ])Ut the State's ln'alth machinery int(i im- mediate li.uch with praclicalU" e\er\ household in lllin(iis. Vaccinal Kill (if School ('hihlnii llc([iiiri'(l. Another illustration of the same means for expanding the health ma- chinery of the State was based upon a resolution passed by the State Board of Health on Xovember 'i'i. is.si. which reads; '•RRSOU'llD. That by the authority rested in this Board, it is hereby ordered. Ihiif on and after January I. iSSj. no f^upil shall be admitted to any pnblie sehotd in this State 7vithouf pi-esentin;/ satisfaetorv e^'idenee of f^roper and siieeessfnl I'aeeination." Acting upon this authority Dr. Kauch. as secretary of the Board, made ready such fonus as were necessary for i)roviding children with vaccina- tion certiricates and for collecting the desired reports for office records ami study. Then he plunged into the task of communicating the order to all school officials and teachers in the State. So energetically was the iob prosecuted that by January 2-i, 1882, he was able to say: "1 doubt if the people of any other state of equal age are as well protected against smallpox as those of Illinois at the present time." In a comiilete report that was jniblished later ap])ears the assertion that ; "Nearly 500 Individuals, embracing attending physicians, and municipal, town and county officers, have contributed, each in his proper capacity, to the Information furnished as to the introduction of the contagion, its mode and ex- tent of propagation, the measures resorted to for its suppression and their result, the cost, actual and constructive, and other noteworthy features. In like manner, the vaccinal history of 304.586 public-school children — based upon physicians' certificates of vaccination — has been furnished by over 8.000 teachers; 49.3 physicians have reported the results in 187.22:5 vaccinations at all ages; and the vaccinal status of 1ion of labor brought whole groups of persons to depend more and more ujjon other individuals and groups for supplies, the utilization of which had a direct influence over health and as sanitary and hygienic knowledge increased. By 1885 there were laws authorizing cities and villages to establish boards of health and making the supervisor, assessor and town clerk of every town a board of health to function outside of incorporated cities ;ind villages. There were also numerous laws relating to food, milk, nuisances, etc. To promote desirable sanilar\- practice and uniformilv of procedure throughout the State the State Board of Health drew up what wa> termetl a Model Sanitary Ordinance and recommended its adoption. In this ordinance an attempt was made to codify all existing laws relating directly to lu-ilth as well as the rules of the State Board of Health that had to do with ipiarantine, report- ing of contagious disease, and sanitary conditions. It also embraced articles on vital statistics, burial permits, etc. Jiti'iifinii fn U'dfcr Siipiilii's. Water supplies attracted the attention of Dr. Ranch throughout the whole period of his association with State health service. Never was he too busy to think and talk about the importance of safeguarding drinking water from pollution. l-'re(|uentlv he found time to make extensive held studies himself. (Jften he arranged for others to do it. Scarcely a rejiort came from his office that dii^l!).2o for costs involved in '.he collection and analysis of samples of water taken from the Chicago River. During the \'ears that followed samjdes were fre(pientlv taken from many other streams as well as from jntblic and private supplies. Studies and observations. frei|uently carried cnit by Dr. Ranch himself, were often con- ducted for months at a tinie. Even after leaving the State Board of TIealtli as its secretary. Dr. Ranch was employed by the Board to study the water supply question. Tie had nuich to do with proxiding a jiotable water in Chicago just i)rior to tin- (ireal World's hair in that city. lo2 ri'iii.ic iii:ai.tii admixistkation Ediiratioiial ^Ictiril ics. I'^ducaliiin >>i llu- juililic thruugh the inililiLaiidii aii.l (listri1)Ulii)n of special iiampliU-lh and through the newspapers was recognized from the outset as a \alualilc means for extending the pubhc health machinery of the State. The early annual reports of the State Board of Health are rejjlete with lengthy dissertations, reports and quotations on sanitation. Education was one of the chief purposes of the great sanitary survey which really began in Is'IS. In 1881 a circular entitled "Concerning the Pre\;entinn of ."-Smallpox" was published and distributed widely throughout the State. I'.v lss."i circulars on smallpox, diphtheri.i, scarlet fever and t\])hoid fever had lieen published ami hundreds of thousand'- of co])ies distributed. Correspondence on these and other sanitary m.'Uters was \oluminous. The sanitary ideals toward which the first State health officials strove, and ]iarticularlv Dr. Ixauch whose ideas dominated the activitv of the Hoard e\'en before he became its executive secretary. wei"e two-fold. On the one hand, the desire was to so educate the people that they could and would vo'untarily, through personal action and local health officers, put into prac- tice the sanitary and hygienic measures calculated to preserve and promote health and thereby make imneccssar\- a large corps of State health workers. ( )n the other hand the desiie w;is to bring into existmce interstate, national and international m.achinerv which woidd function so as to ])revent the introduction of diseases from without and to keej) the State health officials informed of world health conditions. To the end of realizing these ideals the contacts heretofore referred to were made and the activities mentioned were undertaken ])rior to the close of ISS."). This general scheme continued wi'di but few- and not \-ery important exce]itions, to govern the plans, policies, organization and ])erform,-inces of the State ])ublic heallh machinery in Illinois until the close of the nineteenth century. Dr. Ranch continued as executive .secretary of the Stale Boanl of Health until June :il). ls!il, when he resigned and was succeeded ])\ Dr. Frank W. Reilly of Chicago on ."^ejitember 21, If^iH, Dr. \\\ R. AlacKenzie of Chester, a member of the Board, lilling in ihe iiUerim. Arc()i)ij)lislniiiiif.s. Throughoru the 1 1 ye.ars of his connection willi the State Board of Health, mi'd of uni|ualilicd practitioners of nu-di- cine. I'hysicians who ■were allowed to piactice held bi>n,-i tide credennals. 154 rUHI.K' HEALTH ADMIXISTKATION and medical education had been raised to a considerably higher levi-l. This work was achieved largely by the State Board of Health itself whdse mem- bers served without pay and met frequently in all parts of the State. 2. Practically every household in the State had been inspected from a sanitary point of view. This was accomplished through tlie voluiilary serv- ices of local people. .■>. Nearly every school child in the State had been vaccinated against smallpox. The law making it the dulv of local officials to carry out the orders of the State Board of Health and that empowering the Board to make rules and regulations were invoked to bring success in this case. I. \'ital statistics such as reports of births and deaths were collected, comiiiled and published in great detail for the years of 1880 to 1886 in- clusive. While estimated to be about 48 \k-v cent incnniiilete for births and 31 per cent for deaths, the machinery for collecting them was set in motion and even in so incomplete a condition Ihev furnish valuable data for comparison with present day conditions. This task was accomplished li\' putting county clerks to work, at this task as the law required, and b\- utilizing the limited clerical resources availaljle to the Board. "i. Rules and regulations concerning (|iiarantine and sanitation had been adopted, their enforcement wa^ i)riini(ile(l through ;i law creating local boards of health throughout the Stale. (i. Exhaustive studies of stream ijolluiinu in the State and of water supplies and sewer facilities, e^pecialh' in L hicago had been luade. 'Ibis had been accomplished largely ])y the jjcrsonal etTori of Dr. Ranch himself and the analytical laboratory service which was ]iaid for out of the general office exjiense fund. 7. The phvsical exaiuinalion of immigiants for the specril purpose of ])reventing smallpox, cholera and yellow fever was in general ]iractice along the .Vtlantic seaboard and sjioradicalh' inl.ind. This had coiue about, to ^ome exteiU at least, because of contact with outside agencies. S. 'J'he influence of the foremost s.anilarian^ all oxer the country had made itself felt in Illinois. This had resulted from the prominent |)art taken bv Hr. Ranch in organizing and parlicii)ating in .-i dozen national sanitary movements. r.ven after his resignation as secretary. Dr. Ranch contiiuied to ex- ercise a direct influence over the sanitary thought of the State and the policies of its health machinery. Indeed he was time and again called back to duty b\- the ISoard of Health in the cajiacitx- of Sanitarv Counsel. ( )nly death, which clo-ed the career of thi^, uni([ue ligure in the public health history of the countr\- in March of ISKI, could eliminate him as a luaster figure in the sanitar\- thought and activities of his Slate. PRESIDENTS llliaois State Jboatd. of Hcaltk W.A.HaskdX.m.D. /ssr ' IS 93 JoKaA.Vlnar\t,9U.D. /S93 " 1894 V^.E.QuuuL, m.D. l&9-^ - /S9ay of a chii-f clerk rfiluced the tutal by .$l.,S()U more. 'I'wo clerks were entitled by law U< gvl -l^-.M .".0 tiiyether. 'i'his left $2,350 for travel and other expenses of the Board members antl secretary, printing, general office expense, other ])ersc:nal services not regularly employed, etc. There was a five thonsand dollar contingency appropriation \yhich the vari- ous secretaries tried to utilize froni time to time. Ilow successful they were dr|.eu(k'd upon the whim of the particular governor in oflice at the time and upon the ability of tlu' seeietar\- to jiicture imminent danger from any of a group of diseases listed in the appropriation law. Thus on July 12, IIKK), the State's official ])ubHc health organization was 2-i years t)ld. During that time this infant governmental function had survived apjiarently by reason of its stubborn refusal to die and a tenacious gri]) on life. From then on its growth was considerably acceler- ated. Ecu II inc. .\t the beginning of this short cjuarter of a centurv there was a State Board of Ilealih with an executive secretary and a small clerical staff. .\t the end of it there was a Board, an executive secretary and a clerical .^taff a trifle larger. .At the beginning the Board members met frequently — thirteen times the first }ear — but they received no remunera- tion except travel exi)enses. .\t the end of this period the Board members received a ])er diem pay, their tra\-el expense and met less frec|uently, rarely more often than quarterly. Thus it is clear that the health work of the State devolved more and more upon the executive officer of the Board. An annual contingency fund made possible a medical and sanitary field service under epidemic conditions while sporadic work of this kind could be accomplished out of the routine funds. During the ''■'' years the Board of Health had indulged the authority vested in it by law to make "rules and regulations" and a number of these efforts had been tested in the courts. Thus the limitations of the health machinery had been pretty well estal)lished, the courts leaning to the view- that dangerous disease must be present in a community before drastic quarantine or sanitary rules ma\' become operative. Nearly everybody in the .State had come into eon'.act with the .State health organization thi-ougb the vaccination and sanitary survey projects so that the idea of doing i)ublic health work had l.aken root. Local boards of beihh had more than doul]k- the Governor in Januai-y of that year which set forth seven specific requests. They were: "First: The creation of a State Board of Medical Examiners to examine and license physician.s and midwives. Second: The creation of a local board of health in every city, village and town, and in every connty not under township organization, certain duties to he imposed upon such Boards. Third: The forbidding of the interment or cremation of a body dead from any cause, in any portion of the State, except upon a legal permit, the burial or cremation permit to be issued by the nearest health officer who shall be required to report monthly to the State Board of Health. Fourth: Granting to the State Board of Health supervision over the sources of public water supplies and of sewage disposal throughout the State. Fifth: Granting to the State Board of Health an appropriation commensurate in a degree with the sanitary duties the Board is expected to perform. Si.rtti: Requiring that owners of cattle condemned tor tuberculosis, should be adequately compensated by the State tor the loss of the same when it can be shown that the owners were ignorant of the fact that the cattle were diseased when the purchase was made. Requiring also severe penalty against owners who fail to promptly report sick animals to the inspectors, or who oppose any attempt to the inspection of their herds. Seventh: Amending 'An Act to Create and Establish a State Board of Health in the State of Illinois, approved May 25, 1877, in force July 1, 1S77.' As under the recommendations outlined above, the majority of the sections of this Act will be amended, I would recommend that the entire act be amended. Section 2. (The Power and Authority of the Board), especially needs careful revision. In the opinion of the Attorney General, this section is weak and may often be found inoperative for a time at least." Out of this ambitious program. Dr. Egan succeeded in getting an in- crease of $'250 per vear in appropriations and that went to the salary of two cleiks. He had asked for an increase of >(;2."i.(i()o. That was the be- ginning but Dr. I-!gan was de>tine(l to learn how to gel the ear of the law- makers and how to mani])ulate their purse string pulse. But there were (Jther resources. There was tlie contingency fund of $5,000 i)er year. It could be spent with the consent of the Governor "in case of an outbreak, or threatened outbreak of any epidemic or lualignant diseases". To get it the task was onlv to convince the Governor that a malignant disease had appeared or threatened to appear in the St.ate. This Dr. Egan could do. Prior to his time the contingency fund usually went back into the treasury untouched. Im-oiii now on a year r.arely passe. 1 when it was not drawn ujum. It was usvd to ji.ay ]ihysicians and quarantine officers appointed for s])ecial duty in connection with yellow fever alarius, smallpox outbreaks, ty])hoid fever and other disea^i-s and for sanitary service in flooded areas along the Oliio, Illinois and Mississi]i])i river bot- toms. PUBLIC HEALTH ADII IXISTRATIOX Ibi Pdi/iiK-iif for Field ^Yorl^ Still Undecided. But the State's machinery for getting sanitary work clone was liap- hazanl at best. jNIembers of the Board of Health as well as the executive and clerical staff were heavily burdened with licensing doctors, midwives, pharmacists, etc. Then there were vital statistics to be collected and com- piled. Epidemics more often invaded than threatened the State. Everyl>ody agreed to the need of expert medical and sanitary services wherever infec- tious diseases became epidemic but nobody agreed upon who should pay for such services. A law required counties to pay for medical services in in- stances where the patients were unable to do so even though not classed as paupers. Another law appropriated money to the Board of Health for use in such emergencies. Who finally paid seemed to be a decision arrived at largely by skill in "buck passing". In December of 1898, for instance, a smallpox panic at Griggsville caused the secretary of the State Board of Health to employ Dr. Isaac D. Rawlings for duty in that area and Doctor Rawlings reported great difficulty in collecting his compensation and that of nurses employed in the emergency from the county commissioners. At another time a group of nurses employed a lawyer who appeared before the State Board of Health in October 189!) and jiresented a claim for pay for services rendered to smallpox patients in St. Clair County. In this case the Board paid the bill. Again the minutes of the Board at its January, 1!HI0 meeting show that it paid claims aggregating $210 for work done in con- nection with smallpox quarantine in East St. Louis but refused to pay a supplemental claim of $159.50 for expenses incurred in the same procedure. This indicates that the public health machinery of the State was still so chaotic that nobody had a clear conception of whose duty it was to per- form the sanitary work necessary to suppress disease and a still more con- fused notion about who should pay for it once the work had been done. Miscellajt eons A cfi vities. This confusion expressed itself in other ways. The State Board of Health had power to make rules and regulations. So did cities and villages. The one should not conflict with the other but in the face of alarming outbreaks when State help was not forthcoming the local people took mat- ters in their own hand. Thus "pest houses" and "shot gun" quarantine came into vogue, especially where smallpox appeared and that disease seemed to pursue health officers in those days like an evil spirit. An insatiable reader, Dr. Egan knew what was going on in the held of sanitation and he began to transform his information into plans as soon as he found himself in a position to be heard. SECRETARIES lllnois State Board a^ Health. Amos Sawyer acted as secretary for fourteen months piior to the appointment of Dr. Drake. PUBLIC iii:ai.ti[ aomixistkation lfi3 At the quarterly meeting ^)i the State Board of Health in October, 1S98, Dr. Egan presented a report concerning a recently established state tuberculosis sanitarium in Massachusetts. It was so favorably received that the Board instructed Dr. Egan to take n]) with the next legislature the mat- ter of constructing such an institution in Illinois. The 1S!)!I (ieneral .\s- semlily declineil to provide for the construction of a sanitarium but it did l)ass a jnint resolution directing the State Board of Ilealth to inxestigate the matter and report back to the Governor for that body. This indicated an awakening interest in sanitary matters. The leaven was at work. In June, 1899 Dr. Egan arranged to spend $4,000 for making stream pollution investigations. His ]ilan was to establish ■,'() observation stations along the Illinois River, hire an engineer to kri']i tluni functioning and pay for laboratory tests on the volume plan. This scheme was carried out, add- ing considerable volume to the State's health niacbiner)-. This piece of work, it may be observed, ultimately had an imj)ortant bi'aring on the outcome of litigation between Illinois and .Missouri over the (piestinn of stream pollu- tion and very probably was undertaken with that end in view. Tuberculous cattle offered a lield for expansion and Dr. Egan consid- ered taking upon the State ISoard of Ilealth the tuberculin testing of herds. He asked the opinion of the .\ltorney (ieneral in IS!)'.), whether the Board had power to so do and received a favorable leplw rmbablv the reasnii he did not go into that work was lack of funds so he cnntented himself with agitating legislation on the suliject. The work of tuberculin testing herds started in .Ma\-. 1S!I9 by the State Board of Live Stcick Commissioni'rs and has since been continued under that agency which later lost its identity, becoiuing a part of the State De- partment of .\grieulture created under the Civil Administrative Code in 1917. The operation of the State's health machinery was simplified some and the power centering in the secretary of the Huard considerably iticreased on January 17. IS'.)!) when tin- State Board nf Ilealth passed a resolution which reads : '■Ri'nohwd, That the Secretary of the Board, Dr. James A. Egan, is liereny appointed executive officer of the Board and is empowered to act for and in the name of the Board when the same is not in session." A similar resolution was ])assed the next year but was made unneces- sary later by an amendment to the law in 11(01 ])ermanentl\- jmixiding the same thing. This largely oln-iated the necessity of called n)eeliiig> and .it the same time gave the secretary a free hand to exercise his faculties. Health machin- ery in the .^tate is drifting toward ( ne man control. IG-t PUBLIC HEALTH A1)M*I N LSTKATION L']) to this time, about ]!)00. nearly all requests and complaints reach- ing the State Board of Health had concerned the practice of medicine. Such expressions as : "Three petitions, signed by fifty pliysiciaus, asking for an investigation of tlie unprofessional conduct, etc." and "Charges of unprofessional conduct have been received by the Board against nearly 100, etc." appi-ar in the early annual reports but lew references are made to petition-' begging for investigations of outbreaks and endemic iirevalence of diseases and of insanitary conditions. beginning in the nineties the Board is called upon more and more fre- quently tur help in sanitary matters. By 1899 every meeting of the State I'nard iif lleallli brings questions about water supplies, milk, stream pollu- tion, nuisances, infectious diseases. The deplorable sanitary conditions in penal and charitable institutions of the State are aired in the press. A com- mittee of the Board investigates and reports. Floods at various places in the Stale at jieriodic intervals bring requests for sanitary investigations espe- ci;dly of water supplies. The public conscience is beginning to awaken. I'dsiibilities of preventive medicine are j)laving upon the popular imagina- tion. I'he time for exiianding is opportune. Ltiihlhifi lliiii.sr Iiispcclioii. A law making certain sanitary regulations concerning lodging houses in cities of 11(0,000 or more, which confined it to Chicago, was passed by the legisl.itnre in 1S99 and placed under the State Board of Health for en- forcement. The liill carried an emergency clause so that it became operative upon a])]ircival on April '^1, IcSliH. No funds were appropriated for carry- ing out the provi>iuns which enumerated minimum air space, maximum ca- paiily, elc, for sleeping rooms. The enforcement of this would necessarily require ihe constant ser\-ices of a considerable staff" of inspectors. Work was started in a small waw hdwexer. when Homer C. Fancher and Al. M. Jonas Wert' appointed as chief inspecldr and a^sistanl, respectively, on July I"). IS'.l!!. their ]ia\- tu lie dr;i\\n \vn\\\ ihr conlingenc\- fund. It was stipu- lated ibal iheir services sh(inlv llie Stale Board of llealth. lie was. iberefore, brought inlii iiilim;ite conlacl wilh the njieratidn nf the llu.iril. .\s chief lodging hnn>e inspi'ctoi- be experienced the ini;i\iiidab]e dilVicultx' of getting pay prom])tly fur lii-^ own servici'> .ind \\ui^v ni hi; slaff. This was because no funds had been speciliealh pvuxided fur that pmjiose and each claim PUBLIC HEALTH ADMINISTRATION 165 for pay had to be passed on by the Board and sometimes by the Governor when contingent money was used. Delays of from three to six months were common. By C)clol)er of lUiiO a staff of 10 inspectors were emi:iio_\ed in Icnlging house work and this increased the ]kiv difficuhies. Under these circum- stances Smejkal managed to lend material aid in securing for lodging house ORGAFilZATIOn OF STATE BOARD OF MEALTM !90l STATE BOARD OF HEALTH 7 Nembera Members porticipolina in the enforcement of riedical Pracfice Act with oid of extra V help 1 Chief clerk Z clerks 1 executive Secretary todqinq House Inspection Service 1 Chief Inspector 3 Reqular Inspectors 1-20 Temporary Inspectors Fig. fi. Effective streiiKtli at tlie end of twenty-five years of existence. inspection an appropriation of $J"^,.")00 per year from the tieneral Assembly in 1901. The next year Smejkal was elected to the General Assembly and .soon became an influencial member of that body. This established an important connection between the State Board of Health and the appro]iriating body which doulitless had considerable significance over subse(juent events. KKl ITr.I.ll- III'.AI/Ill ADM INISIKATION Colli III uiiicdhli' Disidsi' (' II rail re Measures. In his annual rcpurt lo the (lovcnior for the year of I'.IOO Dr. h's^aii reconnuended virlnallv ihv same lei^ishitive pri)L;rani that was outlined two years hefore, addinj; the item of a state luliercul(]si> sanilariuni. This time the outeome was more favorable. The a]]i)i'oprialiiin junijied ficim -^H.'-^Ml to $•.'",'. "il 10 per annum for routine ex|iendilures while the con- tingencN tyrant increased fmm ^ri.iilio to .$1().(I0|) per year. These funds l)e- canie availahle on lul\- 1. I'.Kll, shortly after the adji urnment of the (ieneral Asseml)ly. Of the $■.'■.'. :>tMI a sum of $l-.',:)iiO had l)een set aside in the law for lodging hoii.'r'e inspection. This left hut ^lO.dOii f(ir genei'al work. ( )n the other hand there was the $10,000 conlin.gency. This justified a plan, at least. for liuildiniL; u]i the health machinery. In July 1!M)1, Dr. I{gan reported to I'ae Board at its regular (piarterly meeting that ; "Despite the faet tliat there is no available appropriation availaljle for laboratory purposes, the necessity for a bacteriolosic laboratory for the prompt diagnosis of tuberculosis, diphtheria and typhoid fever has become so ui-gent that the Secretary has diverted sufficient funds from the appropriations for investiga- tion of contagious diseases, to equip a laboratory which is now in operation. Suit- able quarters could not be obtained in the Capitol Building and offices were con- sequently taken in the Odd Fellows Building, in Springfield, the best equipped building in the city and convenient to the offices of the Springfield physicians. A limited but adequate equipment has been installed and the Board is now mak- ing diagnostic examinations of specimens for the physicians of the state witliout cost to them." This is e\idence that plans were maii-rializing. .\lioul this time a plan for s\stcniatic ^ervice in connection with epidemic outl)i-eaks was also evolved. A corps of physicians, located in \arioUs convenient jila.ces through- out the .State, was selected. Arrangements were made to call ui)on anyone of them at anv time when necessity ref[uired. Remuneration was on a per diem hasis. .Money cotild legally he drawn fi'om the contingency fund to defray such expjn.cs. The annu.il financial statements of the Board indi- cate thru this was done. The system \yas sonn \\ h;it like the reserve scheme in the national military organization. No workahle system for securing jirom])! and complete rejiorts of com- nuinicahle disease incidence had been evolved hy the State Board of Health in UK)-.'. During .\ti,gnst of that year when ( hicago found itself in the ihri es of a >e\ere txphoid fever (Uithreak, the cil\' health comnussioner. Dr. .Arthur R. RcAUoUls, re(ittested from the secretar\- of the Stale P>oard of Jleallh, Dr. JCgan. information concerning tlu' down stale prevalence of the disease. Dr. ICgan dispatched telegrams to health otTicers in :!."i towns to get the desired information. The rules of the I'.oard still rei|uired nofih- cation of diseases luu the ni;ichiner\- w ;is loo feeble to enforce it. PUBLIC HEALTH ADMINISTRATIOX 167 Progress Made But with all of its inadequacy the health niacliinery was Ijeginning to impress itself upon puhlic men who were ni a ])usition to help it grow. The plan which worked best seemed to lie that (if starting something and then initting the matter uii lu the legislature for support. Thus the lodging house in^])ection work began. Now a diagnostic laboratory had begun. A chemist and a sanitary engineer had been employed sporadically and their investigations in stream pollution promised to be valuable in pending litigation between Illmois and Missouri. .\ enr[)s of physicians known as sanitary inspectors were organized ready fur duty when called upon. The machmery was there and it was too valuable to be without. How the po- litical leaders felt about the situation in \SWi is expressed in a speech by Governor Yates, delivered at Anna on ( )ctober Mth. Amung other things he said : "The sanitary work done by the Board must interest every citizen ot the state. The Board now has, as tor two years past, a corps of competent medical inspectors distributed throughout the state, prepared to investigate promptly all epidemics and all reports of any undue prevalence of disease. During the pas't four years the Board has had to contend with three epidemics of smallpox. Although, until the last year, handicapped by an inadequate appropriation — only $5,000 annually having been appropriated tor this purpose, against $25,000 annually in the neighboring states of Indiana and Wisconsin — the Board has accomplished results of the greatest benefit and importance. Through its efforts, acting with the local authorities, the epidemic of smallpox has been kept well under control during the past year, notwithstanding the fact that the disease had reached an epidemic form in adjoining states. Smallpox is now widely prevalent through- out the Union, but there are comparatively few cases in the State of Illinois. "Particular attention must be called to the sanitary investigations made by this board during the past three years, ot the waters of the Illinois River and its tributaries, with special reference to the effect of the sewage of Chicago. Most exhaustive and elaborate tests and analyses of the waters have been made and the results, up to the summer of 1901. published in two comprehensive and com- plete reports. A report of the investigations made during the past year will be published within a month. Those disinterested and independent reports of a thorough chemic and bacteriologic analysis of water, the condition of which has excited so much controversy, have received unusual attention at home and abroad owing to the fact that they contain testimony ot an unimpeachable character, given by a body which has but one object in view, namely, the truth. This testi- mony is of inestimable value, not only to the people of Chicago, but also to the people of the entire state. It demonstrates that the Illinois River, into which four-fifths of the sewage of Chicago is now turned, purifies Itself through natural causes; that the influence of Chicago's sewage ceases long before the Mississippi is reached and that, notwithstanding the enormous pollution 800 miles above, the Illinois River at its junction with the Mississippi is in better sanitary condition than the Mississippi at that point. "This is the most important work ever accomplished by the State Board of Health. Not only has the Board demonstrated to scientists the self-purification of running streams and thus vindicated the wisdom of the people of Chicago in undertaking one of the greatest engineering projects of the century, but also, to use the language ot a leading Chicago daily newspaper, 'has furnished the most conclusive testimony in favor of the contention of Illinois in the suit brought by the State of Missouri in the Supreme Court of the United States, that has ever been presented.' Through the expenditure of a few thousand dollars in scientific research, the State Board of Health has saved the tax-payers of Illinois very KiS l'i;i!l,lr IN'.ALTII ADM IXISTkATlOX many thousands of dollars and lias prevented years of litlKation. Tlii" r(>ports made by the State Board of Health on the effect of the drainage canal, the only published reports on the subject extant, will undoubtedly be accepted by the Supreme Court of the United States as trustworthy and conclusive testimony that there is little or no contamination in the water supply of St. Louis which can be attributed to the sewage which passes through the Chicago Drainage Canal." This show.s that the liailrrs were hci^iniiiiiij tu apjirccirilc sanitary de- velopments hut science iiad lra\ele(l too fast for the puhhc at large. Bac- teriology had been horn during the preceding fifty years but it had grown tremendously and es[iev-ially toward the close of the nineteenth century. The causative, organisms of tuberculosis, typhoid fever, diphtheria, malaria, dy- sentery, tetanus and other diseases had been isolated and described ])rior to 1900. Diphtheria antitoxin had been made available. Typhoid vaccine could he purchased. The means by which yellow fever, malaria, typhoid fever, diphtheria and a luimber of other infectious diseases sj)iead had Ijeen clarified. Laboratory diagnosis of diphtheria, typhoid fever, tul)erculosis and other diseases had been perfected. Great things in the control and pre- vention of diseases were possible. The practical application of knowdedge at hand was the only necessar\' rei|uirenient. This depended upon jiublic appreci.-.tion and su])])ort. The pul)lic still clung to its traditional idea about disease, however, and indulged its consummate fear about some, such as smallpox, but calmly tnjer- ated others as a necessary evil. Those who heard about the new scientific procedures were still skeptical. Otherwise funds for interpreting the scien- tific discoveries into practical terms and for a])plying ])reventive measures would have flown more ([uicklv and more freel\- from the aijpropriating agencies. The (ieneral Asseiubly in ]'.)():] raised the appropriation for State health work ■''I,:; 10 above lliat of 1!H11 but the items specified were still general exce])l for lodging bouse inspection and clerical work. It is probable that the health officials had no very definite ])lan of organization and the mem- bers of the General Assembly had still less, fn the year of I'.HK) uvw items find their wav into the ajiprojiriations law. Assistant secretary, laboratory, registrar of vital statistics, bacteriologist were terms that appeared then fill' the lirst time. The total vearly sums granted, exclusive of contingency which remains at $1(1,0(1(1 have risen from Sp26,8f)0 to $:i2,860. The plan of giving birth to an idea, mu"sing it a'ong as an infant function and then turning it over to tlu' ( ieneral .\sstm1)ly who had to accejit the respoiasibility of feeding it or allowing it to ]>t'rish is working well. An assistant director had been employed in 10(1 1. During the same \ear the registrar of vital statistics had been jilaced in eh.irge of the bacteriological laboratory. The expansion program is picking up moiueiUuni. PUBLIC HEALTH ADMINISTRATION 169 Aiititoxiii Distributed and Pasteur Treatiuents. Beside the enlargement of ai)])ropriation tn the State Bciard of Heakh for sanitary purposes the VMKi ( ieneral .Vssembly passed two other ini]wjrtant laws which enlarged the health machinery considerably. One made it the duty nard could call upon the Water Survey Bureau of the L'niversity, to make investigations of water supply and sewerage systems as reque^teoard of Health specific anlboriiy to e-tablisb and maintain a cluniical :iuil ])acteriological lalioratory. 'flii'- l.iw' clarilied matters cnn>ider;dil\ .ami establis'ied the State Hoard iif llealtb \ery definitely as the supreme lieallli organization in tin- State, kroni this time forth no rule, rculatiun or acti\it\- of local PUBLIC HEALTH An^^ I N ISTRATION 171 health nfficials relating' to sanitation and quarantine couKl legalh' he in eontliet with those of the State lioard of I k-allh. To lieconie a powerful anil adequate at;ency for comhating- diseases in the State the Boar of the salaries of tlu' secretar}- and assistant. This same condition |ire\ailed in \'J\:) when Dr. Egan died while still the executive secretary of the State Hoard of Health. The biennial appropriation to the l.ioard in that year anKunited to $5 t;).;M9."^"). Hut this enormous sum. compared with the $"28,(iOO for the bienninm when Dr. Egan came into office, did not change the complexion of the State's machinerx' inr doing sanitary and hygienic work as much as might be expected. Potential resources were axailablc but tlie organization of these resources was poor. A diagnostic ]al)orali ir\-, the lodging house ins])ection ser\ice in Chicago, the distribution nf antituxin and the \ital statistics service were the only units in the State's public health inachin- erv, except that in\-ol\-ed in the regulation of the practice of medicine, which functioned systematically as a routine business in lilb!. .V cor])s (if plnsicians located at convenient ])oints in the State who accepted temporary dut\- when called u]ion were depended upon for field ser\ice in connecti(in with epidemic outbreaks. There was no machinerv opera- ti\e for c(illecting reports of communicable diseases. The Water Sur- \ey at the l/niversity of Illin.ois was on the Surgeon ( iencral for ad\ice and assistance, especially in regard to \ello\v fe\'er outbreaks. Lucal Boards in liural Disfricfs. Largel\' tlirough Dr. F,gan's efirorts there came into existence a law in 191)1, which was amended in 1i)0.'!, that created local boards of health in the rural districts throughout the State. In township organization the superx isor, assessor and tnwn clerk of e\er\- town was made a local lioard (if health to functiim outside incoriiorated \illages and cities. The County connnissioners in other counties constituted the board of health. This provided a definite local authority through which tlie State Board of Health could function. It remains to this day the macliinery through wdiicli the State healtli officials work in rural areas. Dr. Egan tried hard to get a law making it compulsorv on cities and villages to appoint boards of health and also to get a state tuberculosis sanitarium but failed in both. A large number of sanitary and hvgienic regulations in which Dr. Egan was interested and for which he worked was written into law. These related to stream pollution, free distribu- tion of biologies, \ital statistics, pure food, dair_\ ].iroducts, common drinking cups, etc. There was a law passed in UJOS which enaliled cities to establish public tuberculosis sanitaria. h'rsionc. Dr. l\gan found the State Board of Health jtretty well organized to enforce the ^ledicil Practice Act and he left it so. This work increased PUBLIC HEALTH ADMINISTRATION 173 enormously during his time but so did the resources. Fees collected for licenses could be used by the Board for expenses involved in re!:;'u- lating medical practice. These fees amotnited to $10,000 or more per year. The work was performed largely by the Board members themselves with the necessary clerical and legal assistance. When Dr. Egan began, an attor- ney was chosen and paid for in accordance with the amount of work done. When he left there was provision in the appropriation law for hiring an attorney and a law clerk. W'hen Dr. Egan first took office there was no trained corps of sani- tarians steadily employed to promote preventive measures against dis- ease. At the end of his incumbency the same condition prevailed. There was this difference — Dr. Egan had a little larger ajjpropriation for that sort of work and he had learned how to get hold of the contingency fund on the one hand. (_)n the other hand he had designated a certain number of physicians throughout the State and upon whom he could call at will for temporary duty. When Dr. Egan came into State health service there was practicall}- no work being done on vital statistics. .At the end of his time there was a state registrar of \-ital statistics and clerical assistants. The law had been changed several times, apparently from bad to worse, and was still unsatisfactory. But a considerable volume of records were secured and they were compiled and preserved in good shape for each }ear after 1902 until 191 ;;. At tlie beginning of Dr. Egan's term the practice was to emiiloy sanitar}' engineers antl chemists when studies of water supplies, sewer systems, etc., were desired. At the end of his time the University of Illinois had established a sort of bureau called the State Water Survey and arrangements were made for that agency to do the santiarv engin- eering work of the Board. No quarantine officers were steadily employed when Dr. h^gan began and none were so employed when he quit. During his time a lodging house inspection service, confined to Chicago, began to function and an embryonic diagnostic laboratory was established. A .system of agents through whi}m diphtheri.i antitoxin \\a^ dis- tributed free throughout the State was estalilished. .\ nioulhh bulletin devoted to sanitation, hygiene and the practice of medicine was pub- lished with consiclerable regularity. This was the machinery which the ."^tate h.'.d built up b\- 1!)!.'! for the |.)rimar_\- purpose of combating disease. It had exp.anded enormous- 1\- since 19. m. It was busv all of the time. Its mone\ resoiu'ces had in- 174 rULil.U' illCALTIl ADMINISTRATION' creased over 700 jjct cent Init it was ])i)(iiiy urtiani/cfl. It was withmit form ])ut certainlN' imt \iiiil. 'I'lic iimst iiii]i()itaiit cniuiihutinn nf the F.gan reijiinc to |)iil)lic lu-altli st-rvice in the State was tlie enlti\ ation (if tlu- lialiit aninnt; k\i;"islat(irs to i^ranl nKJuey fur tliat ])nr|Mise. TtiE Drakk Rkciimk. After a lapse of a little nmre than a year fnmi the time when Dr. l'".gan (lied in March, lUl;!, dniinL; which period -Mr. AnidS Saw'_\er, chief clerk of the Board for many years, acted as secretary, Dr. C. St. Clair Drake of ChicaLji) was appointed hy (loxernor Dunne to take <.)\er the executive w ( irk nf the Stale Fxiard of llealth. Dr. I3rake was appointed in Alay of lUl I aii(.l to(jk active charge mi the first of June. Several visits prior to that time had familiari/ed him with the situa- tion, h'evv sij^nihcant ch.anges liad taken place since Dr. h'-gan's death. The llnancing (if the l>(iard at that time was con the ]iress contributed sjjace g^enerously. Traveling re]ire- sentatives visited practicallv all comnumiiies in the State effecting local organizations. The project was a tremendous success. Few if any other deliberate attempts to create juiblic thought on health matters at a given time ever achieved its jiurpose so completely. It led to a permanent annual e\'ent b)- the same name l)Ut somewhat difl'erent in character. Health Promotion Week has come to be a sort of instiiutidn in Illinois. It is an occasion looked forward to by health workers all o\er the .State as a time for starting new cam])aigns or for reporting to the public. It is a sort of revival project for liic d health workers. I III poi'taiit Il( (ilfli Lans Kiuutid. .\ number of iiuportant health laws were i>assed during the Drake regime. In PH.") a satisfactory vital statistics statute came into being, pro- viding for the first time the legal machinery necessary to the collection of reasonably complete returns id" birtli and death records. .\t the same meeting of the legislature a bill known as the ( .lackin Law, which author- ized counties to levy a tax and spend the re\emie therefrom for constructing and maintaining tuberculosis sanitaria was passed and signed bv the Gov- ernor. Still am ther law of 1!)].") provided for the establishment of health districts in one or more adjacent towns or road districts, making it possible to lev\- taxes and maintain modern local health organizations. Advantage of this law has lieen taken in (Juincv and Berwvn while a privately endowed health department serving PaSalle, r)ulesb\' and Peru exercises legal authority under it. ISO PUBLIC HEALTH ADM 1 X ISTUATION These three laws had a tremendous influence over the puhHc heaUh machinery of the State. This is especially true of the san-tarium law. It and the vital statistic statute are discussed in detail in another chapter. The district health law appeared to have come int(.) existence more as a nieaiLs of legalizing the LaSalle, Oglesby and Peru organization than any- thing else. It has never been regarded by State health officers as the best plan upon which to promote local health units. To make it apjily in more than one town or road district the proposition nuist carry by poj)ular vole in each. This makes it very difficult to work on a county basis and hence the county has I)een regarded by the Department as the most practical po- litical unit in which to develop full time modern health dejiartments for rural ^-ervice. The larger cities are legally able to take care of themselves in health matters. Neic Rules for Ilaudlhifi Coufagious Diseases. One of the very important things that Dr. Drake did early in I'.M") was to revise the rules and regulatior.s of the State Board of Health concerning communicable disea.se. Since the very early days of the Board's existence there had been rules re(|uiring the notification of certain epidemic diseases but these had been general on the one hand and there had existed no local machinery through which they could be enforced on the other. Dr. Drake codified the rules and made a s])eciric list (if re]iortal)le diseases. He speci- fied a time limit within which the diseases should be reported. He specified to whom they should be rejjorted locally — health officer, health commissioner, chairman of the board of health, mayor, village president, supervisor, county commissioner, etc., co^-ering every case. These officials. in turn, were required to forward the reports to the State F>oard of Health within specified time limits. The rules also covered matters of quarantine, specifying time limits for isolation of jiatients and thev sjiecilied sanitary and h\gienic ])recautions that were recjuired on (piarantined ]iremises. (iciiciiil I'liiii (iii'l I'crsdinii'l. it will In- ^een, then, that Dr. Drake |)r()])ose(l to bring sanitation and hygiene into ]iopulai fa\iir through educational channels and to appl_\' moilt-rn disease control methods as rigidly as public sentiment would ]iermit through an adecpiate organization. Prompt notification of comnnuiicable diseases was essential to the functioning' of the State organizatiiin >o lar as e]iidemic outbreaks was concerned, so he ])ro- vided for this continL;('ncy with bis new rules. He was andiitions to concentrate all State health work mider the Hoard of Health. This would include food, drnL;s, (lair\- inspectinn, tuberculin testing of cattle PUBLIC HEALTH ADM I XISTRATIO.V 1X1 and stream pnllutinn Avhich were under \'ariiius boards and cunimis- sions. He was e\'en willing- that the retjuhitiiin of medical practice remain under the State ISoard ol" Health l)nt this he would have sep- arated intn a (lejiartment of its own, distinct from another department that would function only in the field nf what mi^ht be called iH-eventi\e medicine. As soon as the lUl.j approiiriation law became effective Dr. Drake set to work organizing the health service in com]iliance therewith. This was slow for several reasons. In the first place the personnel had to be employed under civil service regulations and that took time. Sec- ondly , it was difficult to locate suitablv trained persons to fill the tech- nical ])ositions at the salaries proxided. Furthermore there was lack of space in the capitol Ijuilding to house the new machinery. By early spring of litjii, however, tlie difficulties had l:)een largely o\erc(inie and there was in existence the lic.^t organized force that the State liad e\'er employed for dning straight ])ublic health wcirk. There were fi\e full time physicians in the bureau of sanitary and me(lical inspection each assigned to one nf h\t^ districts into wliich tlie State had been dixided for that ])iu'i)ose. In the same l)ureau there were milk inspectors and a clerical staff. There was a bureau of sanitar\- engineer- ing made up of a chief and two assistant engineers and a stenograjiher. A bureau of \ital statistics, headed by a registrar under wIkjui was a corj)s of clerks, was functioning and had already ])ut into operation the new law which required many new procedures. There was a central diagnostic lal)oratory. manned by a small staff, located in Springfield and two l)ranch laboratories, the latter being ojierated on a contract liasis with [irixate laboratories already in existence. The agency sys- tem for the distribution of biologies now made easily available to every (hictor in the .State diphtheria antitoxin, typhoid ^■accine, smallpox vac- cine, silver nitrate for the ])revention of blindness, mailing containers for laboratory specimens and circulars of information. In tlie central office there was a considerable clerical staff that (H\ided its time between duties relating to health service and to licensure. There was the educa- tional work of publishing a monthly bulletin and supplying copv to the press. .Ml this was a splendid organization compared with what had g'one before. In the meantime national diplomatic difficulties with Alexico had led to a military complication which resulted in the mobilization c;if the National tluard. This incident in\ol\ed the State Board of Health in camp sanitation activities and it is worthy of note that Governor Dunne twice dela}'ed mol)ilization orders upon the recommendation of Dr. 182 PUBLIC IlKAI.TIl ADM I XISI RATION' Drake- because sanitary facilities were iiici unplete. I'liis was an expres- siiin nf ciinlidence in the State healtli autln irities. ['"urthernKire, the State I'xiard dl' lU'alth furnished sniaili)ox and tyi)hoid fc\er \-accine with which the trciups were iniuninized against those diseases. With the new \t-ar nf I'.ti; cauie the I.owden administration with its reorijauizaliiin plan that prn]Hised tn substitute a few departments, each headed b\ a (hrecinr, fur the manifnid hoards and commissions that con- stituted the Stale l;i ivernnieut and to put all governmental activities upon a budget system. Xuthing could have pleased Dr. Drake better, lie had an organization scheme already started. This (ippdrtunity allowed him tn elab- orate on it. Me presented to the administration a plan that would have retained the State Board of Health to reign over two great departments — the one tn dn ])ublic health service and the other to regulate the j^ractice of medicine. The administration clmse to drop the Bcjard, make two dejjart- ments to carry cm the wurk- and incnrpnrated the Drake ]ilan for health service into the C'i\il .\dniinistrati\e Lode as the l)e])artment nf I'ublic Health and which still gn\erns the nrganizatinn as it functitress of the W ar the federal gov- ernment launched against venereal dise;ises a tremendous program which reached every soldier in the army and spread over into the civilian population through the state governments. .Since drying up the source of infections is a basic activity in this field the federal government appnipriated large sums for the establishment of clinics. The iilan of the federal government antici- 188 I'ur.i.u' iii;ai.tii admixistkatiox ])aicil hdili cilucaliiiiial and curativt- activity. It ])r(i])(ise(l to funii>h iiuiney witii which ti) start ihc wurl-: as a ilcnumstratinn and then U> witinh'aw as state and local agencies took owr the matter. Illinois joined in the plan and added a division of social hyt;iene to the organization of the .State 1 )e|)arlnient of I'nhlic Health on July 1, 11)18. Funds which were ])rovided 1)\' the federal government, became available November 1 of that year and the new division started to function at that time. Within a year five clinics had been established at as many different ])oints in the State. These were of a jiermanent character, the equipment and the pay of the director, who was always a local physician, were furnished out of funds allotted to the State by the federal g(ivernment. l'ltimatel\' the number of clinics grew to more than a score and the State's go\ernnient pr also a i)lan to conduct schools ol various >orts — one s\stem for local health oftict'rs at regional points and another for ])tiblic health nurses. The ])lan for the latter was to hold the school at S]>ringlield during the summer when field work, ])articularly in the schools, w.as light. Xeilher jiroject ever grew into anything of magnitude or permanence. 19'^ ITIiMC 111;. \1. Ill ADM I NISI NATIIIX With all (if llic s]ilriuli(l ]inii;iH->s in (ir^anizaliini and magnitude nf service since ll'l 1 llieri- was. at the end ol" the Drake it-mux' in l-'el)ruarv 1!)31, a distinct lack of ccxjrdinatiim hetween the varinus divi>i()ns in tjie State Department uf I'nhlic 1 lealth. It was iidt innisiial, tdr instance, for a new staff nienilier in he with the l.)t-i)artnienl for niontiis hefore he knew the other divi>ion chiefs with whom he was supposed to work. A district liealth sujierintendent minlit \isit a town lime and again where some recal- citrant local registrar olistiucted jirompt and complete returns of vital statis- tics without knowing of the dilVicnlty. The field staff did not always know that the l)e|iartment operated a free motion ])icture library or that Health News was availaljle free to any citizens of the State who wantetl it. The niachinerv for collecting and compiling vital statistics was all set up and functioning" more or less satisfactorily hut no comprehensive mortality sta- tistics were forthcoming nor had the ."-^tate been admitted to the L'. S. hirtli registration area. hurthennore. Dr. Drake never felt the need (.)f official advisory council in determining policies and pro.grams. The Civil Administrative Code jiro- vided for an Advisory Board of five members. Xone was ever a])])ninted during Dr. Drake's time as State Director of Health. .\ staff meeting of division heads was never held. Husiness with each was transacted indixidually. The divisions were located in half a dozen different places. C)ne was in the arsenal, another occupied rented quarters down-town in .Springfield, some were on one floor and some on another in the State House. Division chiefs made no reports of their activities except for copies of correspondence and the annual re])ort. Discipline concerning work hours, time off, etc., for enijjloyes was a matter for the chief clerk to keep u]> with if he could. Even Health Nezvs fell into the most irregular publication although the newly created Division of Public Health Instruction had the prei)aration of this bulletin as a princi])al function. In early December of I'.IPI ;i Chicago nevvs]japer columnist humorously observed: "Xow come to b.-md the ( )c- tober and Novembt'r numbers of Doc Drake's 'Illinois Health .\'e\vs.' There is a chance for the printer to catch u|) this year, so here's ho|iing for the Dect-mber number before Jan. 1." When Dr. Drake left the Department in h'ebruarv r.i".M. Hcallli A'iTi'.v was fully six months behind, according to records in the oHice. SminiKini. When Dr. Drake cann' to the Capil.al as the State's chief health oflicer he found a r.oar t'lianlic \va\> of |ir(jni(itinL; public health and in its place had imt a llcalth I )cpai tnum, ranking with aii\' mhrr di-partmiMit of the Stale i;(i\eninient. wilh a splendid organization plan for systematic, co- ordinated, well balanced and up-to-date service. The main trouble was that the "system" and "coordination" were lacking. The Kawi.incs' Reoime, A political change in the administration of the State government took ])lace in J.anuary, l'.)21. It l)rought to the Department of Public Health its second Director, Dr. Isaac D. Rawlings, who took office on February 1. Like most of the executive officers of the State health service who had pre- ceded him. Hr. K.awlings hafl been with the city health department in Chi- cago. Indeed he had s])ent over twenty years in the public health service of tha.t city and had been closely associated with all of the great sanitarians since l!i(i() who had built up in Chicago one of the finest municipal health depart- ments in the country and given to the city an envialile record for good health conditions. In education and experience. Dr. Rawlings was better trained than any man who had precedeil him with the possible exception of Dr. Rauch, who lived, of course, before the day when preventive medicine came into its own. Dr. Rawlings was a graduate of Northwestern University Medical School, one of the best in the country. Later he spent considerable time at the great medical educational centers in Germany, Austria and England. Then he taught for a number of years in Northwestern University Ale.lical School and subsequent 1_\- ])ul in twentv years at pulilic health work. He was, there- fore, thoroughly familiar with the problems both medical and sociological, the It-chnical procedures and the difficulties to be encountered in the field of p)ulilic health service. .\s native e(|uipment. Dr. Rawlings had a love for routitie system, a thirst for details, a passion for work and a tenacity of purpose that led him to carry ovu jilans and policies in letter and sp.irit alike. If the law provided for a board of public health advis ])articulaiiy heliiful In those employees wdio travel about the State and are frei|nentl\ iniestinned about health matters. B\- May K, P.)21. Dr. Rawlings had arranged for a meeting of all the field staff, consisting of 7 or S physicians with the division chiefs in Spring- field. That was another step toward unification. Questions of policy were discussed, luich divi.sion chief outlined the services which he was prepared to undertake. .\ci|uaintances were made for the first time between many of those ])resent. This general conference of Dejiartment members became IDG I'lnii.ic iiicAi/rii admimstkatiox an annual alTair and constitutes an ini|"irtani factor in tlic systematic oper- ation of the Stale's health machinery- A/lrisiiri/ BiKiiil. Then there was the matter of an advisor)- hoard. The Ci\il Adinin- istrati\e I'ode provided for one, luade up of live meinhers. that should meet ;is fre<|uently as deemed necessary hut not less often than quarterly. The matter \\a^ laid hefore the Governor who appointed to the board on Septem- ber •.;■;;, II''.' I, the full complement of members. It consisted of Dr. W. A. I'^vans and Dr. John Hill Robertson of Chicago. Dr. E. P. Sloan of Bloom- inSton. Dr. C. W. l.illie of ICasl St. Louis and Mrs. l'.. N. ^Monroe of Quincy. h'rom the outset the board has met rcLjularly and has participated energetic- ally in the business of reiiderini,' advice about tlie health policies and prob- lems of the State. Its contact with the jirofessional and public life of the State enaliled it to not onl\' interpret public sentiment but to exercise con- siderable influence o\er the trend of sentiment concerning; health matters. It has, therefore, proved to be an important factor in welding together the lualih niat-biner}' and of guiding the activities of the State Department of I'nlilic 1 le.ilth along a course that was both sound scienlihcalh' and wise sociologicall) . Alh ii///fs to Inipnirc Locul Ih alfli MiuIi'iik iij. Local health machiner\- was another iniporlant tactor in the program of unihcation. The lars^er municipalities had fairly well organizel\'. It h.as pleased Morg;m C'ounl\ well enough to be continued on ,i |)ermanent basis. MEMBERS First Boaud of Public Health Advisors cpj^oinied S'epicml'cr 'ZQ. /P2/. E. P. Sloaii,m.D. -T^t V">A.EvaJis.9IL.D. Chaio/Ut/i ;^f^ ^^^.. \amV.miiM.D.* \ Sccce.ta.ry *"•" ! *Dt'.EAS'-D I ' JoHiiDilltolwtson.lIl.D. 198 I'UP.LIC IIICAI.Tli ADMIXlSTRATinx An enabling bill authorizing counties to establish health ociation in their time. .\s a means of creating interest in local health .'idministration. the Kawlings' surxey wa^ the most successful single acti\it\- the State Depart- ment of Pitblic Health t-ver undertook. Pach city was rated on a percentage iiasis as ;i result of the fnidings and the newspapers devoured the reports. National magazines interested in the pnl)lic health lield coiumented exten- PUBLIC HEALTH ADM I XISTRATIOX lOil sively on it. More important still, the cities concerned took steps to make the improvements recommended. Evanston, for example, replaced a part time with a fnll time health officer. Other of the cities built isolation hos- pitals. ])ut on public nursing services, started infant welfare projects and added such other improvements as seemed practicable imder local circum- stances. In January. TJ"24 a system of clinics which the State Department of Public Health had been conducting for a number of years for the benefit of crijipled children was discontinued. These clinics involved a consider- OR&AniZATIOn OF 5TATE DEPARTHEnT OF PUBLIC HEALTH 1927 GBIERAL OmCE 57ATI OF ILLinOIS DEWRTrtm" OF PUBLIC HEALTh Director of Public Mealth A55i5tant Director mxns Of LABoiiAiaxs iL- .|f=°^^ Ilk. L. Fig. 11. Showing the available strensth of the State Department of Public Health on July 1. 1!I27. able amount of curative or correctixe practice and this had caused some unfavorable feeling in the ranks of the medical profession. The work was continued under the atispices of vdlnut.nry agencies but its divorcement from the State service left the lleallh Dcparuiicnt free to engage in purely pre- ventive activities. MdtcniH 1/ and Cluhl lli/fiiciic. To stimulate activitv in the field of niatcrnit\- and chikl hygiene. Dr. Rawlings took advantage of the fmancial ^upiiurt offered by the federal 200 ri'iii.n 111-;. \i. Til ahm ixisi ration- government thi(iiiL;li llu- children's hurcau under what is ordinarily called the Sheppard- I uwiKT Act. A (h-;ift (ni the federal treasury in favor of the State of Illinois to the amount of over $1!),000 was forwarded to Dr. Rawlings during the summer of 1922 but the State auditor had no legal authority to accept the funds and the legislature declined to ever grant that authority. Thus the State's child hygiene program had to he worked out with no outside tuianctal snp|i(irt. This was undertaken by the furniation in li)25 of a State advisory com- mittee on child hyt;iene. ( )n it are represented the Illinois State Medical Society, tile Illinois State Dental Society, the Illinois Federation of Women's Clubs, the Illinois Council of I ';irent-Teacher Associations and the State Department of Public Health. Through this committee, which has before it plans and programs concerning maternity and child health, a considerable amount of strengfth has been added to the State health machinery. It func- tions by informing the several ori;anizations concerned about the programs and special campaigns undertaken by the State health officials and exercises no small inlluence in putting oxer definite projects. Thrc'ugh it, for instance, direct contact was made with club women and parent-teacher associations in every countv of the State in connection with a diphtheria eradication cam- ])aigii in llt2(i. Another link in the chain that systematized health work in the ."-^tate was welded wlu'ii Dr. Rawlings succeeded in interesting the Uliiniis State Dental Society in a mouth hygiene program. The Illinois Stale and Chicago Dental Societies agreed to pay the salary of a dentist to work uiuler the State Department of Public Health as a temporarv demonstration of what could be dene. The Illinois Tuberculosis .\ssociation contributed some funds to this ])roject. The plan was carried out beginning in August. 192(i. It culminated on Julv 1. lli"3; when appropriations made by the li)2T General .Assembly became available for continuing the |irogram. Ollirr Activities. In l!)2.j arrangements were made to open a branch diagnostic lalxn'atory in C arbdiidale and in \'J'>', amither was opened in Chicago. Prior to these dates branch l.al.oraldries had been establislied and maintained at various points but their wcnk was conlined to diplitheri;i. These two new branches were e(|uip|)ed ti> handle pr;iclically exery l^in(l of procedure common in pub- lic health L-ilmratiiries. This step provided dia,i;ni'stic laboratory facilities in easy reach nI every part of the .^tate so tli.it physicians and the public could profit by prom])t service whenever neelion 1j\' munici]jalities. In .\ugust \'.)2'2 the ordinance was brimght before and thoroughlv discussed by a group of the most repre- sentative .sanitarians and milk dealers of the State, gathered in Chicago at the Pageant of I'rdgress In ccmsider imjiortant public health problems, and received a vote of ajiprcxal by thai body. The ordinance was evidently about right. MEMBERS Present Board of Public Healtli Advisors {i ■'^■ € W? A.Evaivs/l.D. Via - C/iMr/rutK Tlws.D.I'oaa.t.D. Chairman E. P. Sloaa.l.P. Hecniii]i''Lliatuksf,ti,t,l). Seccettif^ 204 iTiiijc iii:.\i/rii adm ixisiratiox 'J'he next step was to get the ordinance adopted by local immicii)alities. 'iliis task was approached in the same way that proved successful in birth registration. Communications went out to mayors. Traveling representa- tives of the Department from whatever division who had opportunity to promote the idea were given assignments to meet with local officials, leaders, civic organizations etc. By 1927 a total of (iO cities with a combined popula- tion (if cSJJO.OoO had adopted the ordinance. P>ut adopting an ordinance wotild not in itself provide safe milk. It had provoked thought, however, and soon the Department began to get requests for information abtiut various municipal supplies. This led to a survey of all milk pasteurizing ])lants in the State by the division of sanitary engineering. The First survey was made in 1921 before much agi- tation for improvement had begun. Then in 1924 a sanitary engineer was assigned to do nothing but milk work. In 1925 a law that required the cer- tification li\- ihc ."^tate I'eiiariment of Public Health of all plants pasteuriz- ing milk was passed. .\t the same time pro\'ision was made for em])loying a milk sanitarian and a milk bacteriologist and the pmxhase of a mobile laboratoi\- to be used in that work. Thus bv I!i2; the De])artment of Health had ciinsiderabh' broadened its safe milk program and was m a position to jirosecute the undertaking in earnest. This milk project brought the State health machinery to ojierate syste- maticalh" in a lield thai had lieen entered before onlv spi radicallv and in a haphazard kind of way. It lirnught milk deak-rs and producers into contact with health work more delinitely than they had before experienced. Under Dr. Rawlings milk dealers became acti\e agents of the State Department of Public Health because it would In- an unwise business man indeed who could ignore a bad report on his milk pasteurizing plant and especially so when he was informed that responsiliilit\' fur e|ii(lemic outbreaks that might be traced to his products would be put >(|uarel\ up to him. jlpitrccidtiiiii (if Di'jiinl nil lit (il Jin/iilat miis. In 192"i, following the development of a rather unusual incidence of tvphoid fewr attributed to contaminated oysters, an order was issued by ])r. Rawlings jirohibiting the sale of oysters in the State for raw consump- tion. The effect of the order was nation-wnde in magnitude and disastrous for the ovster industry ( )nc conference between representatixes of the oyster innlilic health officials followed fast upon the heels of another. With the Illinois Director of k'nlilic Health as the central figure the affair soon eame to the attention of the United States Public Health Service and nearly e\ery state health olVicer in the country. The result was a general sanitary iniiiros enienl in the production and distribution PUBLIC HEALTH ADM I X LSTRATION 205 of shell fish, made necessar)- to meet requirements laid down by Dr. Raw- lings and the Illinois Oyster Committee for any oysters allowed on the markets of Illinois. Indeed a couperative slate and national system of certifying oyster jjroducing concerns was created and continues to operate under the general supervision of the United States Public Health Service. This oyster business represented a new use of the authority granted to the State Department of Public 1 lealth t(i make rules and regulations con- cerning health matters. Bv such action the .^tatc health machinery extended its influence from coast to coast, causing a general sanitary adsancement in a great industrial field. Again in 19"36 use was made of the same type of authority. This time the action related to stearate of zinc toilet powder. A few deaths of infants had been attributed to the accidental inhaling nf this kind of pow tier. All cases, it appeared, could have been prevented had the powder containers been e(|uipped with automatic safety caps. Accordingly it seemed wise to prohibit in Illinois the sale of stearate of zinc toilet j)Owder except in safety containers. This was done and again the effect was nation-wide because the large manufacturers, engaged as thev were in inter-state commerce, [preferred to turn out a uniform product to ,ill of their trade, including Illinois. Thus again was demonstrated the f.ir reaching influence i.if the power of the ."-^tate l)ei)artment of Public Hcaltb to make rules and regula- tions. Ediicdlioiial and Mu^cclluiicoiis Aitu'ltics. Another activity that strengthened and extended the influence of the State's health machinery related to health education. In l!)2.j arrangements were made between the State Department of Public Health, the .^tate De- partment of Registration and Education .and the five State Normal schools to introduce courses of health instruction in the curricula of the institutions. The object of these courses, which ha\e been introduced and expanded as rapidly as facilities permit, is to provide prospective teachers with the sort of sanitary and hygienic knowledge necessary for their personal health bene- fit and to ecjuip them to not only impart knowledge to children but to exer- cise intelligent supervision over their health in the school room. This links up a great educational system with the State's health machinery and plants the seed of sanitary knowledge where \\u-\ ai'e apt to \ield the greatest returns. The foregoing references to projects imdertaken by the State Depart- ment of Public Health under Dr. Rawlings by no means exhaust the field of activities which might be drawn upon but they are sufficient to illustrate very well the process of welding together the resources of the State for doing 200 PUHLIC IIICAI.TH ADMINISTRATION public health wdik uhii-h has characterized his entire administration. In every divisiim the vdhimc of work done has expanded very noticeably. On all sides a greater degree of codrdination than had hithertu existed has prevailed. \'ery few ciianrjes in the organization plan were made by Dr. Rawlings. During his lirst year he eliminated the division of surveys and rural sani- tation, transferring the work and personnel to the division of sanitary engineering. Otherwise the divisional arrangement was unmolested. Each division grew in size and enlarged its volume of work but '■emained in the organization scheme as thev were under the organization plan which ])re- vailed when Dr. Rawlings liecanie State Director of Public Health. \ ^StaTEDept'^vPublicHealth' .. ..'.I r.':NTflL ADVICE ■ !-•■ A line o( 25 to 100 deep constantly flanked the entrance to the adult examination booths at the 1925 State Fair. ^l /ijiid/iruit ion. 'I'lie last ap|)rnpriati(in made to the State Department of Public Health prior to tin- ap|iiiiitnu lU (if Di'. Rawlings, that made b\- the (ieneral Assem- bly in I'.tP). amiiuntt'd to $120,810 for the bicimiuni. In I'.tvll the biennial appropriaiiiin jumped to -$1, 119, 7 12. After that it changed but little up to the pre-ent lime .\ugust 1!12:. it fell liack to $!)85,o8? in 1!)23, due to ;iiui-adminisiratiiin pdliiical nianiu\ers but 1II2.J found the grant back u]) to $1,138,88;. In 1!)2; ihe ( ieneral Assembly voted $1,187, 684 for the gen- eral expenses of tlie .^tate De])artment of Public Health during the ensuing twd fiscal vcars. This is a substantial incri-ase of money compared w-ith the modest sum of -t.'i.ooo approjiriated fifty years before to carry the infant rUBLIC HEALTH ADM I X ISTKATION 20? State Board of Health* along through its first two years of life. Com])ared with funds provided by many other states, including Xew ^'ork, Pennsyl- vania and Massachusetts, for public health purposes the amount appro- priated by Illinois in 1!)2T is relativel\' small as she ranks twentieth among the States in her jier ca])ita expenditure for health although she is tliird in wealth and population. The organization of the State Department of Public Health in 1!)2T is graphically shown bv the illustration in Fig. 11. How this differs from the organization in 1i)lT. the first year under the Civil Administrative Code, in AnnUAL APPROPRIATIONS 1879-1927 fAPPROPRiATIOnS MADE BIEnniALLY) F:g. 12. IIM."). the last year under the State Board of Health and in is;:, the first year under the State Board of Health mav l.)e observed bv reference to Figs. 8, 9, and 10. H iiuniKini. When Dr. Rawlings became State Director of Pub'ic Health in 1!I2 1 he found the Department functioning under a well devised organization plan with facilities for ])articipating in practically every phase of public health 208 ruiu.ic iii:ai.tii ahm i n isi i.:Ari().\ stTvict liUt it was Idciscly linuiid together. At the time this is written in V.)27 , wiiii Dr. i\,i\\ lings still in oi^ce, the variuns divisions are coordinated intu a nnilicd Department which is capable of moving swiftly and efficiently to- ward the at liievenKiit nl' any general purpose and at the same time each di- vision takes care of the routine ]irohlems within its own i)articular field with all other divisions fully informed of the work being done. When Dr. Kawlings assumed office most of the divisions in the De- [lartnieni w ere \eiy small and several of them were scarcely more than skele- ton units. By !!:»•<;? all of them had been materially strengthened, giving the Department the capacity td perform jiromptly and elYectively all of the activities in which it professes to engage. The foregoing statements concerning the health machinerv in the State suggest the way emjiloyed by Dr. Rawlings in binding it together into a systematic whole so that every unit of the State Department of Public Health and every other agency engaged on a significant scale in public health work meshed together in their programs and eft'orts like gear wheels that drive mechanical machines, b'vidence that the job was well done is found in the accuracy, magnitude and [iromptness of returns of statistical data dealing with births, deaths and disease. Another evidence is found in reports of local participation in various campaigns inaugurated by the Department. A still more important evidence is the freedom which the State has enjoyed from epidemic diseases and the steady decline in infant mortality and the prevalence of such diseases as smallpox, typhoid fever and diphtheria. Much detailed information concerning the organization, functions and activities of the various divisions may be found in the chapter on each di- vision's history. Intra-Departmental Organization of State Health Machinery b'roni the time when the State Board of Health was cre.'ited until IS'.M) there was no distinct division of labor among the regularly employed per- sonnel. In julv of that year two men were appointed to devote their full time to the inspection of lodging houses. While these appointments were originally made on a temporary basis they proved to be permanent in char- acter and became established as a distinct unit of the State health machinery when the General Assembly made a specific appropriation for lodging house inspection in 1:m)1. This then was the first step toward a .State health ser- vice organized into specialized units. .Along about 1902 or 1903 one member of the office staff of the State Board of Health was designated as State registrar of vital statistics but in 1904 the same man. W. !I. Hoyt, was also designated as State bacteriologist and given charge of the small diagnostic laboratory which started then. Then rUBLIC HEALTH All-MIXISTKATION 209 ill VJO'j the General Assembly included "registrar of vital statistics", "bac- teriologist" and "laboratory" as items for whicb specific appropriations were made. Yet it appears that no marked division of labor took place but that the technical and clerical employes were subject to routine duties of what- ever character might be most pressing at the moment. Subsequent to 1905 there appears to have been little or no attempt at organizing the resources of the State Board of Health into specialized units until 1915 when a definite plan of organization was adopted and five bureaus were created. These included "medical and sanitary inspection", "vital sta- tistics", "laboratory", "sanitary engineering" and "lodging house insjjection". Each of these was the forerunner of what became a division of the State Department of I'ublic Health under the Civil Administrative Code adopted in 191 T. The first appropriation under the Civil Administrative Code, made in 1917, specifically, provided for seven divisions. These included "general office", "communicable diseases", "tuberculosis", "sanitation", "diagnostic laboratory", "\ital statistics" and "lodging house inspections". As a matter of fact 1(1 divisions were created in \'M]. including besides those listed above "child hygiene and public health nursing", "surveys and rural hygiene" and "public health instruction". To these was added the division of "social hygiene" in 1918. In 1927 the divisional designation was the same except that the division of "surveys and rural hygiene" had lost its identity in 1921 and the division of sanitation changed its name to "sanitary engineering". Details concerning each division are enumerated under its own title on the following pages : Gener.\l Office. The general office is made up of the Director, assistant director, chief clerk and corps of clerks. Up until 19i; the general office was about synon- ymous with the State Board of Health so far as sanitary and hygienic work was concerned. Sanitary engineering, diagnostic laboratory services and field medical activities were centralized under different heads and the first two occupied independent quarters. There was also a registrar of vital sta- tistics but this work was done in the main office and came under the imme- diate supervision of the chief clerk of the State Board of Health. Since 1895 the general office has been presided over by a chief clerk Prior to the introduction of the division plan the chief clerk actually directed the office personnel employed in the State health service with the exceptions mentioned, .\fter the introduction of the division .system in 1917 the gen- eral office has been a headquarters unit through which divisional contact is maintained. Technical matters are left entirely to the division chiefs who are responsible to the director for matters of a scientific and technical nature. 211) 'UBLIC IM'.AI.TII ADM IMS'IUATION Mr. Chas. Ry All department records and correspondence are hanilled by the general office. Through it all accounts are settled including payrolls. In it is lo- cated the central filing system which was introduced by Dr. Rawlings in 192G. All personnel records are also ke])t there. Although it was customary to have one person in charge of the clerical force prior to that time, specific provision for a chief clerk was first made by the legis- lature in 18!)."). Mr. F. A. Treacy was the first man a])pointed to hold that position, he being already in the employ of the State Board of Health, at the time the jsition was first recognized by the legislature in the appropriation law. He was succeeded in May, ISDT, Mr. Charles Ryan who in turn was succeeded on Mav I, 1 !)()!, bv Mr. Amos Sawyer. Mr. Sawyer has filled the office of chief clerk cimtinunu^ly from the time of his appointment to date. Divi.sioN OF Communicable Diseases. The work of this division, as the name implies, is concerned directly with the control of contagious and infectious diseases. It has charge of morbidity reports, quarantine, rules and regulations relating to reporting and quarantine, epidemiological investigations, promotion of local health machinery and the distribution of biologies such as antitoxin, vac- cine, silx-er nitrate, etc. While activities of the character of those performed by llu- '- ■'■ ■'■ iiiSiiMne. the State Board of Health. More often they were not. Beginning about 1!)00 a scheiue was devised whereby a number of ])hv>icians. located at convenient jwints in the State, agreed to accept appoint- ment for temi>orar\- dutv whenever called upon and receive therefore remun- eration at a sti])ulatt(l per diem rate. This method of handling communic- PUBLIC HEALTH ADMINISTRATION 211 able diseases continued until July, HH."). when it was converted into the bureau of medical and sanitary insi)ection with a definite amount of money appropriated sufficient for eniplo}ing- a medical staff of five and specific duties assigned to it. By early spring of 1916 the necessary civil service examinations had been held and the five appointments made. They included Dr. E. S. God- frey, who was designated as State epidemiologist. Dr. C. E. Crawford, Dr. C. S. Nelson, Dr. Clarence W. East and Dr. I. N. Foster. These physicians were assigned to field duty, each covering one of five districts into which the State was divided for that purpose and all were placed under the general supervision of Dr. Godfrey. Besides these district health officers, as they were called, there were attached to the bureau three dairy inspectors, one on a full and two on a part time basis and a small clerical staff. In r.iK, with the adoption of the Civil Administrative Code by the State government and the consequent reorganization of the health service, the bureau of medical and sanitary inspection became the division of communi- cable diseases which title it has retained. Funds sufficient to employ one chief, one superintendent of field service, six district health officers, two nurses, two (|uarantin_e officers and a clerical staff" of five were appointed to the division. All of these positions were filled although the two nurses and one physician were utilized in another type of service and formed what de- veloped into the division of child hygiene and public health nursing. Dr. J. J. AlcShane became the first chief of the division, on August 1. T.>1 i. as a result of a civil service examination. Dr. McShane has continued in that capacity to date. During the ten years ended with June -W. \'.^'i]. the field personnel of the division varied considerably, dtie to small salaries provided in the early part of that period and fluctuations in the appropriations made from time to time. In I'JIO a total of $16,000 per year was granted for the employment of district health officers, with maximum salaries specified at $2500. The next General Assembly, that of 11)21. raised the appropriation for medical field personnel to $100,000 per year, set $1,800 as the maximum salary and changed the title of the positions to district health superintendents. Tlie difficulty of securing trained men delayed the filling of these places, how- ever, so that the field strength never exceeded abotit 20 men. Then in 11>2;) the sum apjiropriated for district health superintendents was set back to $30,000 per year and raised ag.iin \n ^:,{).()\ut in 1'.I2.''). In l!t2; it remained at $50,000 with the maximum salary placed at $l,al health departments it appeared wise to permit a wider use of local di.scretioii in connection with quarantine than the strict letter of the rules would permit in all cases. Thus in 1923 a system of wdiat is known as modified cjuarantine regulations was inaugurated. By means of this arrangement local health officers wdio are able to satisfy the State Director of Health that they have the facilities 214 PUBLIC HEALTH AIIM I X ISTUATIOX for adequately handling; the local situation may receive permission to prac- tice moditied quarantine. This system permits the isolation of a ])atient in a room to himself with attendant and the free use of the remainder of the house by other members of the ([uarantined premises. Another instance of the changing character of the rules was the in- clusion of carriers of disease within their scope. Thus persons found to lie chronic carriers of typhoid fever are required to stay out of occu])ations that bring them into direct contact with food supplies of other people. ('lioid vaccine was added to the free list and silver nitrate in 191.'). Later the law on this subject became general so that the Department is in a position to pur- chase and distribute whatever biologies may be deemed necessarv for the preservation and improvement of the public health. 216 ri'iii.u; health admi.nistkatiox In i;i|5 what is known as the Ojjhlhahnia Nennaturuni Law was en- acted. This law defines ophthalmia neonatorum and makes it the duty of physicians and niidwives to report all cases immediately upon discovery. Dist rihiiUdii (if Biologies. The (li>Iriliution nf free state biologies began in IDOl, when the legis- lature aijpropriated $15,000 to the State Board of Health for that purpose. Diphtheria antitoxin was the only product included at that time. l)istrihutii)n was accomplished through a system of agents, usurdly a local druggist. This agency system began in 1905 when a law was passed requiring their appointment and providing that they shall handle antitoxin approved by the State Board of Health. Then after the 1907 act they be- came the agents for distributing diphtheria antitoxin supplied free by the State. By 1927 these agents, who number 477, were handling antitoxin, toxin-antitoxin, silver nitrate and typhoid vaccine. The biologies provided by the State in 1922 included the following: Diphtheria Antitoxin, in both immunizing and curative doses. Diphtheria Toxin-Antitoxin, for active immunization against diphtheria. Schick test material to determine susceptibility to diphtheria. Silver Nitrate Solution to be used in new born babies' eyes, as a preventive of Ophthalmia Neonatorum. Typhoid Vaccine tor immunization against Typhoid Fever. Smallpox Vaccine as a preventive o£ Smallpox. Antirabic Vaccine for prevention of rabies In humans. The antirabic treatments are available free to poor people only but the other products are free to every citizen who needs any of them for therapeu- tic use. Table 23 shows the amounts of biologies distributed during recent years. PUBLIC HEALTH AD.M I XISTRATIOX 217 1 38.416 39,306 60,409 75,811 79.500 41.907 29.047 30.565 16.630 s til 450 730 1,078 1,717 3,289 295 412 870 93 s 1,550 839 1.197 1,886 2,483 407 437 805 365 ! o S( 1 i 5 7.474 8,995 16,586 21,863 24.590 13,589 10.109 10.069 5,340 1 z o H it 10,528 9,717 16,564 20,504 20,437 10,774 5,752 6,342 3,640 'A < il llli S °-3 13,501 14,166 22,539 29,844 28,701 16,842 12,337 12,479 6,740 S s July 1, 1918-June 30 July 1, 1919-Junc 30 July 1, 1920 June 30 July 1, 1921-Jiuie 30 July 1, 1922-Juuc 30 1 2I« I'UliLIC lllCALTH AD.MIXISTKATION PUBLIC HEALTH ADM IXISTRATION Table 2'■^ — Continued. Toxin- Antitoxin. 219 St.vle A sinsle tr. Style B three tr. St.vle C ten tr. Total. 4,106 588 793 1,089 212 2,433 1.147 2.513 2.679 2,053 6,539 1,735 3.306 3,748 5,929 8,194 6,768 5,929 10,825 23,522 Schick Test Material. No. pkgs. Total tests. July 1 1923 .lune 30, 1924 . 181— 50-tests ea. 128— 50-tests ea. 285— 50-tests ea. 295— 50-tests ea. 9,050 6.400 14.250 14.750 889 pkgs.— 50-tests ea. 44,450 Smallpox Vaccine. No. pkgs. Total points. 1,443— 10-points ea. 1,464— 10-points ea. 202— 10-points ea. 14.430 points 14,640 points 2.020 points 3,109 31.090 points A \TIRAIilIC Treatment. No. pk'.s. Total. lulv 1, 1924-June 30, 1925 56 90 paiil 77 pai.l for In- .statu, 31 jiaiil for personall.v for b.v state, 19 paid for personally 56 Inlv 1, 1925 .Jime 30, 1926 121 Jul.v 1, 1926-l)ec, 31. 1926 96 Total distribution 223 paid for by state, 50 paid for personally 273 I'Uin.lC lllCAI.lll ADMINISTRATION DniSIO.N ()!■' TrBERCULDSIS. 'I'lu' division of tulnTculosis has never been more llian a skeleUm unit of the State Uepartmenl of Public Jlealth, Lii and polluted streams in the State. In 18SS an analytical study was made of the quality of the larger rivers in Illinois that were more or less ]3olluted, the samples being collected over a [)eriod of si.x months. In 19i)U engi- neers, not regular employees of the Board, were engaged to investigate the contamination of Mississippi I\i\-er at Chester by sewage from the Southern Illinois Penitentiary. The need for sanitary water, sewage, and stream-pollution surveys apparently becoming more and more realized and the procedure of engag- ing part-time occasional outside assistance proving not sufficient, the Board adopted a resolution in 1894 favoring an apisropriation by the legislature of money to the University of Illinois for making analyses of sam])les of water and polluted streams at the laboratories of the Universitv. As a result such analytical studies were undertaken at the L'niversitv in KS!).") tmder the supervision of Prof. Arthur William Palmer. The approi)ria- tion to the Universitv at that time for additions and imijrovements to the 'i'i'i VVV.LH' UI'.AI.ril ADMINISTRATION clu-mical lahnratory was -^ojioii. 'Hic chemical studies of the waters of llliiidis at the L'liivcrsily ])ossil)ly ikjI fully meeting the needs of the State Board of Health, the Board in IS'.il) adojited a resolution ])reliminary to the en^^^as^enicnt of the services of I'rof. John II. I.onL,f. of .Vorthwest- crn I'niversity .Medical School and lac(]h A. llarnion. a ci\il cnt^ineer of I'coria. to investigate the (|uality of the w.atcrs of lllimiis River. l're\ious to this time the Board had some stream-jwllution studies made by Professor Long and the results of these investigations of the Illinois River are included in a report of the Board issued in 1901 en- titled "Saiiftiirv IiiZ'cstifiatioiis of the Illinois River (iiiil I'rihiilarics". The decision of the United States Supreme Court in favor of the State of Illinois and the .Sanitary District of Chicago in the action brought li\ the state of Missouri because of the discharge of sewage from Chicago into a tributary of Mis- sissippi River was handed down on February 19. studies made by Professor Long and his associates at the reipiest of and by arrangement with the State Board of Health were major items of evidence in this litigation and the favorable outcome of the State of Illinois, was based to (|uite an extent uiion these investiga- tions. In a further eft'ort to increase the extent and value of chemical studies of waters and streams of Illinois, the Board in 19U(.! entered into a co- ojjcrative agreement with the State Water Siu'vey located at the Uni- versitA-. and which had developed into a separate unit although administered bv the L'niversitv trustees since the chemical studies (jf the v\ aters of Illi- nois were started in 1S!L3. Harry F. Ferguson. T.IOC. The report and Siniitdii/ EiiijiiK I riini Iiiir(ulation m the St.ate, bv the engagement of outside occasional services and cooperative agreements with otiier agencies located miles away from the l!o,u-d headquarters. PUBLIC HEALTH ADM I XISTRATIOX 2 2;? The first appropriations for the sanitary engineering biu-eau provided for a chief engineer, an assistant engineer for field studies, an assistant engineer for a water and sewage laboratory, and a stenographer. Paul Han- sen was a])pointe(l by tlie Board of Health upon the reconimenchition 160 - 140 - / 120 - / 100 5cweraqe and stream poUvilon / / 6t> 60 — — " " Scwerat^e \\ / , / /' 40 V^' / 20 . Strcom pollution ■" 1 1 1 J 1 1 151819 \9l9-aO 192021 I92RZ 1922-23 1923-2'^ 1924-25 1925-26 1916-27 FISCAL VEAR5 Fig. 13. Number investigations made b.v sanitary en,aineer relative to existing and proposed sewerage installations and stream pollution. 400 r J50 \ ^^ 300 r /""^ tSO : y 100 \ ^~~~~~~^ 150 - ^^^ 100 ^^^"^^ 50 '- ; Fig. It. Xumber of investigations made by sanitary engineers ot existing and proposed public water supplies by fiscal years. 224 PUBLIC HEALTH ADMINISTRATION I9?l-2i mZ-23 1923-24 19Z4Z5 nSCAL YEARS Fig. 15. Niiml)er of inspections made by sanitary engineer.s for all pur poses by fiscal years since July 1, 1918. Fig. Ifi. Number of water analyses. PUBLIC HEALTH ADM IXISTRATION T40 of Dr. C. St. Clair Drake to serve as chief engineer to organize the new bureau, and later Mr. Jrlansen agreed to continue in that position and the aiijiointmeni was conhrnied by the civil service commission after hold- mg an examination. He resigned in 1 !»";;() and was succeeded on Alay !•") of that year by Harry F. Ferguson, then principal assistant engineer, who has continued as chief sanitary engineer to date. That the establishment of a sanitary engineering bureau by the 1!»15 legislature was a sound step and the sanitary engineering activities inet a need throughout the State is perhaps best evidenced by the fact that the following legislatures have from time to time increased the appropriations for that division so that on July 1. 192T the positions in the division had increased from three engineers and one stenographer to seven engi- neers, three bacteriologists and chemists, one supervisor of rural sanita- tion, two milk sanitarians, six clerks and stenographers, and f(.iur other assistants. Previous to the adoption of the Civil Administrative Code in IHIT. the actixities of the bureau of engineering were regulated by the law cre- ating the State Board of Health as amended and especially that portion of the law' which provided that the State Board of Health shall have ■'general .supervision of the interests of the health and lives of the citizens of the State" and "authority tu make such rules and regulations and such sanitary investigations as ihev may from time to time deem necessary for the preservation and improvement of the pulilic health". In accordance with this law the Board in IDIO adopted the following rides and regulations relative to water and sewerage installatioits : "(1.) No municipality, district, corporation, company, institution, person or persons, shall install or enter into contract for installing, waterworks oi sewers to serve more than 25 persons until complete plans and specifications fully describ- ing such waterworks or sewers have been submitted to and received the written ap- proval of the State Board of Health and thereafter such plans and specifications must be substantially adhered to unless deviations are submitted to and receive the written approval of the State Board of Health. '■(2.) No municipality, district, corporation, company, institution, person or persons, shall make or enter into contract for making, any additions to, or changes or alterations, in any existing waterworks serving more than 25 persons, when such additions, changes, or alterations involve the source of supply or means for collecting, storing or treating the water, until complete plans and specifica- tions fully describing proposed additions, changes or alterations have been sub- mitted to and received the written approval of the State Board of Health and thereafter such plans and specifications nnist be substantially adhered to unless deviations are submitted to and receive the written approval of the State Board of Health. "(3.) No municipality, district, corporation, company, institution, persons or person, shall make or enter into contract for making, alterations or changes in or additions to any existing sewers or existing sewage treatment works, serv- ing more than 25 persons, until complete plans and specifications fully describing such alterations, changes or additions have been submitted to and received the written approval of tlie State Board of Health and thereafter such plans and 2'H> iTiu.ic iii;ai.tii admimstkation specifications luiist be substantially adhered to unless deviations are submitted to and receive the written approval of the State Board of Health. "(■1) Any municipality, district, corporation, company, institution, persons or person, owning or operating a water purification works or sewage treatment works shall submit to the State Hoard of Health monthly records showing clearly the character of effluents produced. "(T).) No municipality, district, corporation, company, institution, person or persons, shall offer lots tor sale in any subdivision, unless within the boundaries of an area incorporated as a municipality or sanitary district, until complete plans and specifications for sewerage, drainage and water supply, have been submitted to and received the written approval of the State Board of Health and thereafter such plans and specifications shall be substantially adhered to unless deviations are submitted to and receive the written approval of the State Board of Health. "(6.) No natural Ice shall be furnished or vended to the public for domestic purposes until the source of the ice supply has received the written approval of the State Board of Health, which approval is revocable upon evidence being pre- sented or discovered of undue contamination entering the source." The Civil Administralive Code placed upon the Department of Public Health all of tlie dtttie.s and powers of foniier Iniards of health in^-ofar as the sanitary engineering- activities were concerned, and in addition provided more delinile duties relruive to \vater-su])])lv and sewerage installations by providing that the ])epannient of Public Health shall have authority as follows: "To act in an advisory cajiacity relative to pulilic water sttpjilies, water- ])urillcation works, sewerage systems, and sewage-treatment works, ;uid to exercise supervision over ntiisances growing out of the operatimi of such water and sewage works, and to make, pronudgate. and enforce rules and regulations relating t(j such iniisances : "To m.iini.ain chemical and biological laboratories, to make examinations of mills, water, sewage, w.iles. ,ind other substances as may be deemed neces- sary for llie prolcclion of the people of the State". The w.ater supply and sewiTage rules adopted in 111 1(1 h.ave never formal- ly been rein-aled, but ihey are jiracticall)- \e \ears. One was an in- adequate law and the other was lack of clerical machinery. 2-3-> I'l'BI.ir lll.AI.III ADM IMSTKATinX H'o/Vr Lnffft. Tlui^ ihc opc-ninj,^ o\ i\\v ninct(,-cntli century fiiunil lioth the system and the registration of vital statistics in a rather chaotic condition. About that time matters began to take on a brighter aspect. Dr. Egan, secretary III ilic St;ite lioard of iieahh, managed to get a new law enacted in 1901. It re(|uired burial permits friim county or town clerks, according to the type of governiueni organization in the counties. It also provided a fee of So cents each to go to the person making the report to the local registrar. The burial jiermit feature was the backbone of the system and its enforce- ment would ha\e the desired results. About this time Dr. I'.gan also employed W. 11. Hoyt to have charge of the \ital statistic work of the Board. In r.Hi.'i an item for "registrar of \ital statistics" appeared in the aiipropriation law and from that time forward jirovision was regularly made for a regis- trar. l)r. I'lgan went further. He sent Mr. Hoyt to study the vital statistics system employed by the State Board of Health in Michigan, which was con- sidered verv good. .\s a result of this study a satis- factory method of handling the statistics was intro- duced in Illinois. The 1!HI1 law oi)erated with a fair degree of satisfaction to the State bioard of Health but it provoked formidable ojjposition in the counties not under township organization where burial permits could be issued only by county clerks. That often entailed considerable hardship and delay in coimection with funerals so that a general jiolitical movement to repeal the law entirel_\- was set in motion. This movement was strong enough to force a revision so a new law was enacted, one drafted by the secretar\- of the State Board of Health. This law pro\ided for birth reports to Lie made direct to count\- clerks, except in cities of .Mi.ooo cr more where the\- should go to the health comnussioner, and for deaths to lie reported direct to the State bSoard of Health exce]it in municipalilies enforcing a burial permit ordinance. A fee of ■^") ceiUs each was paid to the one making the report. Under this law statistics were complete enrugh to justif)' comiiilations and rejiorts for the years IIH)',' to I'.ii:; iticlnsi\'e. The last law afTecting vital statistics, the one now operating and known as the model vit.al statistics law. was enacted in l!M-i after having failed in two |ireceding attemjits. It provick s for a system of local re,gistrars located at convenient places in all parts ( f the .State. b'ees of 25 cents Slieldon L. Howard. PUBLIC HEALTH AD.M 1 \ ISTRATIOX 'i'.V^ each are paid to the local registrars while physicians and others are re- cjuircd to make reports as a luirt of their professional duty to society. Up until julv. !'.)()•.' \ital statistics received hy the State Board of Health were summaries compiled liy county clerks on forms sent out by the Board. Such analysis, recordint;' and fdinj; as was possible from these records was a relatively simple matter and reiiuired a relatively small amount uf clerical work. ( )n August "2S, 190"2, a communication was directed to the count\ clerks making a change. It requested the county clerks to send the original certificates to the State Board of Health specifying that this would be con- strued as fulfilling the re(|uircments of the law. This change was effective July 1, 19U2. Manifestly the new method made necessary a much larger amount of clerical work on the part of the State Board of Health and required some one to supervise the classification, compiling and recording of the cer- tificates. Thus a registrar of \ital statistics was employed. He began to function in the spring of ]!)():!. The man chosen for this work was \V. II. Iloyt who was given charge of the bacteriologic laboratory started in VM)\ and was referred to in the dual capacity of registrar and bacteriologist in the minutes of the Board for July liHiJ. Air. Hoyt continued as registrar of \ital statistics imtil Alav 1."), I'.iln when he was succeeded by Dr. C. C. Ellis who was followed in turn on March I, I'.Hl. by Dr. T. H. D. Gritfitts. He occupied the position until llil."i when ( )rrin Dillv took' over the work. Mr. Dillv was suc- ceeded in IIMI by .^beldon L. Howard who has continued to date as regis- trar of \ ital statistics. Thus it is seen that the work of the dixisinn of vital statistics is as old as the State public health service itself. -Vbimt I'.Ki:! it Ijecame suffi- ciently systematized and \r)luminiins enough to re(|mre a special corps of workers under the supervisicm i-f a regislr.ir. Tlicn in li'l.") it liecame an important unit (if the original organization pl.ni uf the sl.Ue heilth service and received a special appropriation of •t.'j.~)l)t) per \ear a> the bureau nf \ital statistics. That amount provided for a registrar and four clerks. hiijirdnnifiii Afti'r Xcir Lair ]]'(is I'fissrd. The bureau of \ital statistics became the ]: with the creation of the State Department of I'ubHc I le.dtli and fared well in the ap])riipriations. A registrar, and assistant registrar and nine clerks were proxided with $12,800 per year as total salaries. This cdutinned to grow until Jii-i7 found the division with a stat'f of 2fl. including the registrar, assistant registrar, medical assist.ant. twn fulil agents and clerical staff. 234 I'UIil.lC IIICAI.ril ADMINISTRATION Stalislics thai wcro mt conipklL' aiul never so reijarded luu which were euiuplete enough in show llie s^eiieral trend of lieahh ccin(Hliiin> were eul- lecled. compiled and jjuhlislied for the _\ears ni UK)-.' tn I'.Mo inckisive. After thai a perind (if cnnfnsinn and inicerlainty set in. due tn the death of the secrelar\ of the State lliiard nf 1 li'ahli in Ahirch. IIMM. and the change in the vital statistics law in l!)lo. .\cc(n(lin>;l\- im cnnipilations were made f(ir the intervenins; years hetween IIM;; and I'TlCi. Summary statistics for liirth> and deaths were made nj) f(ir IDlii and I'Ji; Iml nu analyses were made. Illinois Adnnlliil liila Itcf/islratioii Ana. Hv I'.M.S the registration system was working satisfactorily enough to justifv the federal bureau of the census to accept Illinois into the U. S. registration area for deaths, a minimum nf IMi per cent completeness being required for that purpose. It was slower for hirths liiu tifter a long drawn out camjiaign the State w-as admitted to the L'. .'-^. hirth registration area in IM'.'-.'. Detailed statistics are available from the mortality reports of the bureau of the census for I'.M.s and subsequent years. The division has published detailed statistics of its own sinct- \'Xl\. Infant mortality rates have been published by the division aiuuially >ince IH'^'I and the tables include tigures for l!l'.'(l. The federal reports include these figures for \'Xl'l and suljse(|uent years. Division oI'' ('iiii.u IIygiexe and Public Health Xursixg. This division was officially created by the legislature in 1!M!) but like several of the others it had come into existence prior to that time. An effort had been made to secure an appropriation for work of that type in l!il."i, hut it failed in the General .\ssembly In 1!IK an item providing for a chief of a divi- sion of child h_\-giene and ]iublic health nurs- ing |)assed the legislature hut was vetoed l)\- the (lovernor. Xecessit\'. however, was the governing factor in bringing together a staff that real!)' betian child hygiene and nursing work as early as i;il(i. In the late summer of that year at) epidemic of infaiuile paralysis appeared in the State and caused the State Board of Health nr. 1. . w. Ka.-t. ^^^ begin work that was calculated to relieve the children alTected. .A recurrence of the ejiidemic in liiK led to the definite PUBLIC HEALTH ADNr IXISTRATIOX 235 creation of a division of child hygiene and ])ubHc heahh nursing with Dr. C. W. East as chief and two nurses on the staff, all df whom were Ixirmwed from the division of communicable diseases. This arrangement continued until July I. liMH, when an approiiriation of $22,480 for salaries and wages for two yearN hccnm- available for the division. In 1921 an equal sum was appropriated tn meet the salaries and wages of the division during the ensuing two years, in lic^'i there was granted $45,600 and in 1925, the sum of ii^lT.dlo. The appropriation in J'.f>: for salaries and wages in the divisiim for the ensuing biennium was $12:'),S-30 and provided for a staff' of four iihysicians. sixteen nurses, ime dentist, one dietist and three clerks. The infantile paralysis wdik which ])recipitated the creation of the di- vision involved the establishment of clinics at more than a score of points in the State. The staff' traveled from one jilace to another, holding clinics weeklv or less often as circumstances permitted, and giving such aid as could be provided for cripples of all kinds and particularly the victims of poliomyelitis. This work soon began to necessitate considerable curative or corrective service. Demands for crippled children's work increased instead of diminishing after the epidemic subsided and formed a major part of the work of the di- vision until February 1. l!i-M, when it was taken over by the [Hindis Crippled Children's Society, a voluntary organization. The ])urposes of the division of child hygiene as set forth in the organ- ization scheme of the Department are td combat tht- high mortality among children by promoting child health service in the various communities throughout the State, establishing infant welfare stations and visiting nurse service; to promote medical inspection of school children; to disseminate information and advice on the care of children and investigate local condi- tions aft'ecting child life. .\lso. to have general supervision of the nursing service maintained l)y communities and by extra-governmental agencies ; to investigate orphanages, homes and hospitals for children ; to assist in the management of baby health conferences, b.-iby week programs, etc., and to supervise the practice of midwivcs with special reference to the prevention of blindness from infection of the eyes of the newborn. Dr. ('. W. East who had served the State Board of Health in the capacity of district health officer and as acting chief of the division of tuberculosis initiated the child Ingienc work and served as the chief of the dix'isidn unlil Februarv, I'.i'.'l. Dr. R. t'. Cudk was acting chief from l-'ebruars- td jul\- 1.") when Dr. b'.dith H. Dowry was ap]idinte(l tcmjiorarily to the pdsitinn. In October. \'>'i'>. Dr. (irace S. W'ightnian of Cliicagd liecame chief of the di- vision as a result of the civil service e.NaminatidU lu Id fur the purpuse of till- 2'3() l'\JUL\C HEALTH ADMIN ISTUATIOX iiiij the ]in>^itinn on a ]K'rniaiK'nt basis. She has continued to fill the place to (late. X II I .^1111/ Srrrirr. In IIM'.I a slate siiperxisur dt' pulilic health niu'ses was first employed. Two more cities were added to the list of cities having a piihlic health nurs- ini;- st-rvice. A movement I'nr the standardization of public health nursing service was initialed in I'.i'.'O. This initial step tonk the fcjrm of an agree- ment lietween Slate agencies and private and local governmenial agencies employing public health nurses. r.\- this time the division had influenced and assisted nine cities in establishing well organized public health nursing services. In addition to this a large number of visits were made by the dilterent members of the division to nursing associations for demonstrations and instructions. It was not easy to measure specifically the value of this service but face to face con- tact and personal service was found to be the very strongest agenc}- avail- able in liuilding up the public health throughout ihe State. In lUV'i the pulilic health nurses in the Slate were organized into dis- trict associations through the activity of the Slate supervising nurse. Twelve new communities wei-e infiuenced to establish public nursing services. The next vear a survev of public health service in the State was car- ried out and a successful campaign for enlarging this service was conducted. E\-er}- cilv in Illinois with S. ()()() or more population with the exception of two had some form of acli\e nursing service in the ])ul)Iic schools in ^'.)^i3. In l!i-^L the Slate was divided into foiu" pulilic health nnrsing districts and a State mirse assigned to e;ich. The policy of the Department was that the State nurses shculd \-isit the counties in turn in a consulting and advisorv capacitv. Realizing that the various communities had somewhat different jjroblems, the division allem])te'-'iO children wert' examined. With ih.e inauguration of the division this work natiiralh- fell under its supervision. PUBLIC HEALTH ADM I X ISTKATIOX 237 In VJ21 the holding of better liaby conferences, which had previously lieen confined largely to the State fair was extended to include any point in the State where demands existed. I'hysicians and nurses assisted in thirteen such conferences in as man\- cmnities during that \'ear. The next few years showed a rapid development of this acti\ity. In 1922 a physician from the division organized and directed 65 better baby conferences in the State with a total of l.iii; children examined. In li)23 seventy-nine conferences were held at which i,S.")l children were ex- amined. In a number of wavs the l!t2(i conference at the State Fair differed from those held in former years. In (inler tii do l)Oth careful and painstak- The State Fair Better Babv Conference in action — 1925. ing work the number of children entering it was definitely limited. The Illinois State Medical Society cooperated in selecting a pediatrician who acted as consultant to mothers whose babies presented defects and fault\' habits about which they should be especially advised. A total of (ilM chil- dren were examined against 1,485 in 1925. The limitation of numbers did not appear to produce the advantages anticipated, however, so that in 1921 the conference was again thrown open to as many as desired to come. The opportunity for research and investigation was unexcelled in con- nection with these conferences. In order lu determine the relative health conditions prevailing among rural and urban children, an analvsis was made in 1923 of the babv conference records which "ave sufficient detail V.'iN ITIll.ir lll-.AI.rii ADM I MSTRATION to hv classiTicd. As a rusull of this undrrtakini^r il was found thai a ,u;r(jup of .'i.ilt:! rural i)r(.'-school-a,ne children had a total of li.sdii hii^rniticant physical defects, while a t,n''"il' "'" '-.l-i" e'il\ children of similar age had a total of onlv :'i.lSS defects. This indicates that children in rural areas ha\e ,i,nealer net-'d for an extension of the pnhlic health service than do their city consins. Mali ri/il // (iiul I njtuil II i/iiii iir Sciricf. Althoui;li the State of Illinois did not accept the provision of the Shepherd-Towner Act. maternity and infant hytjiene services were not neu;- Iccted. In r.)".'l a special maternity and infant hygiene program involving the promotion of public health nursing ser\ice and infant welfare stations was inaugurated. In 11)33 four new infant welfare stations were opened, one at Wilmington, one at Steger, ami two at I'reeport, one of the latter was for white children and the other for colored. A series of nine prenatal letters were i)repared covering the important phases oi ])renatal care, and sent to any prospective mothers in the State who made application or were listed for the series. The first "Young Mother's Cluh" was formed at St. Charles and the ]ilan is to form similar clubs in e\ery county in the State. The object of these cluhs is to bring to young mothers the very best scientific informa- tion available on the subject of child care and to stimulate frequent examina- tion of baljies b\' the familv physician. Eight additional _\oung mother's clubs were organized the same vear ; two at Duquoin, two at Alounds and others at Hamilton, Dallas Citv and I'lowen. Medical K.idUiiiKitiiiii (if Sclioiil ( 'li/hl It'll. The medical examination of school children was a logical se(|uence of the work done at the better baby conferences. In lic.'l a unif(irni "school record card" lor this work was adopted. The next vear members of the staff assisted with the medical examination of the .")(), 0(10 rural school chil- dren, while the nnnil)er in I'.i'i:! reached 60,000. In 1!'".'"), the uniform record card was somewhat modified to assist in obtaiiiiiig tin- ci rrection of delects. This class room health card was designed to meet the request of teachers for a record to be left in the School room and also to impress upon the children the imjiortance of ob- taining and maintaining a clehnite standard. .\n especirdh- designed button having on it "Illinois 1 lealth lit'.'.")" was presented to the children coming u[) to the standard requirements. Gloria June Esper. The first of the two children who were each stiven a one hundred per cent perfection rating at the Illinois State Fair. Examined in 192:!. 240 ruiiLic iii;.\i,Tii adai ixisikatiox P.i cause of a ^ap l)L't\vi.cii ilii' l)etler l)al)y conferences and the examina- tion of school children, in nc.'-"i ihc jjre-school examination of children was inanj^'u rated. A |)re-scho! 1 examination card was adopted after careful consideration hy a committee from the Illinois Stale Aledical Society, Illinois State Den- tal Society. Illinois [''ederation of Women's Chihs and rejjresentatives from the division. ! )nrini; the year I'.r.'C, more than 40,000 cards were requested hv public health mn-ses. club women and parent-teacher association groups. .\ ri\e ve.ir pre-school health campaign was undertaken jointly by the Illinois Federatic-n of Women's L'Inbs, Illinois State JMedical Society, Illi- nois State Dental Society and the Illinois State Department of Public Health. Up tf) date members of the disision ha\'e assisted with the examination of over :,(KI0 pre-school age children ;nid abotU 10,000 school children. K(l iirciKiudl Act I rifles. The educational acti\itics of the division of child hygiene and public health nursing h;i\e been numerous and dix'erse. Very early in its history, the (li\ision prejiared literature on a variety of subjects much of which is still being distributed .-ifter m;iny reprinlings and re\ision. Demonstration work naturally centered around the public health ex- hibits and in connection with special health programs in local communities. At the State fair in I'.Us a total of aSO consultations were given to mothers b\ the chief of the (li\ision ;tnd the medical assistant and in 1923 this num- ber reached '.H)(). Similar consultation work was conducted at ])ractically every fair and exposition where better liaby conferences were held. j\ very imjiortant and rather new activity w'as the inauguration in 1037 of a breast-feeding demonstration in McLean County. This was done under the aus])ices ami with the full coo]ieration of the McLean C'ountv Medical Society and is intended to function for two years. A nurse from the di- vision especiallv trained for the work was assigned to work in the county. Lectures assumed a large place in the educational work. Either with or without moving picture reels and lantern slides, members of the divi- sion wvvf in ,great demand not onl\- in connection with fairs and expositions lint ;it meetings of women's clubs, parent-teacher organizations and the like. The subjects included in these lectures covered a wide range, such as child hv.giene :ind nursing problems and allied subjects such as the model milk' ordin;inci- and tln' toxin-antitoxin campaign. Courses of instruction to nurses and teachers seemed to be especially popidar. An t-ight wt'eks course for graduate nurses in commntiit\- nurs- ing service was conducted in IHL'^. '<.r* i James Robert Craycrott. The second of tlie two children who were considered perfect in pliys- ical development at the Illinois State Fair. Examined 1924. 242 rUBLIC HKAI.TIl AD.MIMSTKATIOX In l!>"?.j an infant mortality survey was made in the counties rejjorting an infant iK'ath rate for 1923 of 100 or more, 'i'here were nine such counties. Personal visits or addresses at county medical society meetings afforded the opportunity to present the matter to physicians, women's clubs, parent-teacher associations, etc. A goitre survey was made during 11)27 in the Western lllin(jis Univer- sity at Normal, Illinois; also at Decatur among both high schocil and grade school pupils. In this survey over 3,000 pupils were examined. .\ child hygiene committee consisting of Dr. Harold X. Smith. Chair- man, representing the Illinois State Dental Society, Dr. B. \'. McClanahan. Galesburg, representing the Illinois State Medical Societ)% Dr. Lena K. Sadler, Illinois Federation of Women's Clubs and Mrs. Blanche Buhlig, the council of Illinois Parent-Teacher As.sociations met with the chief of the division once every month to discuss ways and means, policies, cooperative plans and other important measures related to child health needs in Illinois. Among the specific accomplishments of this committee was its work in promoting the toxin-antitoxin campaign. The chairman of the educational committee of the Illinois State Medi- cal Society sent letters of information to the officers of the county medical societies. The Dental Society through letters and its official journals urged the cooperation of dentists in distributing literature. The president of the parent-teacher association sent out over 700 letters to officers of her or- ganization asking their help in distributing 80,000 circulars on toxin-anti- toxin to the membership. The child welfare chairman of the federated clubs wrote letters to the child welfare chairmen of the 750 component clubs, outlining the plans of the State Department for the toxin-antitoxin campaign and jilacing 80,000 educational leaflets for distnliiition to parents of young children. Of Jut Adivitics- In 11123 pnictical demonstrations in oral hygiene were carried out in four of the largest cities in the State, namely Mattoon, Decatur, Elgin and Spring- field by a federal field service unit working at the request of the State Department of Public Health. The unit consisted of Major Butler (who died during his stay in Mattoon) and Miss Verna Thornhill. From 200 to 300 children were examined in each city. In connection with these demonstrations the staff' of the dental unit carried out a very definite educational program in the schools and gave talks on mouth hygiene before organizations wherever opportunity was pre- sented. PUBLIC HEALTH ADMINISTRATION •^43 An important expansion of the activities of the division in 1926 was the creation of a section on dental hygiene. This new undertaking was financed tor one year by the IlHnois State and the Chicago Dental Societies. The major emphasis of the program was educational, aiming at prevention of dental disease through fundamental requirements for securing the develop- ment of hard, durable teeth. The State Dental Society through letters and its ofiicial journal urged the cooperation of dentists in distriljuting literature. The 1927 General As.sembly provided for taking over tiiis work by the State. Among the many miscellaneous activities of the division was the render- ing of emergency nursing service in the area devastated by the tornado in Murphysboro and West Frank fcrt in 192o. Nurses were stationed in this territory for niunths and assisted in the prexention of epidemics, school ins])ections and made home visits. Division of Sukveys and liCHAL Hygiene. The division of surveys and rural hygiene came into lieing in IHI ; w lien the sanitary zones established around military posts created a demand for sanitary surveys of an intensive character. Its functions included the mak- ing of house to house sanitary sttidies of communi- ties that expressed a desire for that sort of research as a jireliminary step toward improving local health con- ditions. Such sttidies were carried on in Rockford, I'^reeport, Waukegan. East St. Louis, .Mton, Moline, and Ouincy in the order named, the first being done in 1!M; and the last in 1921. The surveys were ex- liau>ti\e in character requiring from four to six months in one community. Personnel attacjied to the division was never P:uii L. .Skoog. large. Sometimes the division chief bad an assist- ant and sometinies not. fie aKva)'s had a steno- grapher. Field work was accomplished on a cooperative plan, the local community ])r(ividing ;i corps of five to ten investigators. 1';hi1 L. Skoog b;id rli;irt;e of thr division from llie time it was created uiiiil .\birch. 192n. JM-om that time until the divisi(]n lost its identity, being fused with the division of sanitary engineering in tlie spring of 1921, B. K. Rich.'ii'dson acted ;is its chief. 2i-k PUBLIC liF.ALTII AD.M IMS I KATIOX IjABOKATOKY W()I!K. The year l.STT has a double significance fur lUinuis. When the State Board of Health was established one of the first undertakings was the laboratory examination of water supplies, — an activity that later grew into the modern laboratory. The same year at Urbana I'rof. Thomas J. Burrill introduced into his course of Ijotany at the Uni\ersit\- of Illinois the study of bacteria. Prof. Burrill was the first teacher in the United States to officially recognize bacteriology by including it in a college course and thus initiate what was to develop into an entirely new science having a profound influence on pulilic health ])ractice. The foundation of jiublic health laboratory work was laid by Pasteni in France in the period of 1SG."> to JS7(). when he demonstrated the germ theorv of disease. In England Lister began his studies on aseptic surgery in 1867 transforming surgical methods "from a purgatory to a paradise". In 1875 Koch first grew the anthrax bacillus in pure culture while other investigators were working with other diseases. In 1881 Koch discovered the poured plate method of isolating bacteria, following which in rapid succession came the demonstration of the bacilli of tuberculosis (1882), Asiatic cholera (1883). diphtheria, tetanus and better recognition of the typhoid bacillus (1884) followed by many others. Development in the United States was not rapid at first. In 1870. the year before the founding of the Illinois .'-^tate Board of Health, Bow- ditch pul)lished a Cciitciiiiial Surrey af tin- State of Public Hyciienc in Auurica in which no mention of bacteria was made and Imt one reference to the germ thenry of disease which was in connection with yellow fever. Allhough Burrill liegan teaching his students about bacteria in 187 1. it was appariiitly un{ until 1884 that the term "bacteriology" was cdined. In 1.S84 and 1885. several colleges and universities began teaching the new science as a separate course. TIk- lirst nniiiicipal ])ublic health laboratory was opened in 1888 in Pro\ idence, R. I. liul for several years this devoted it.self entirely to the study of water sup])lies. Credit for the first modern municipal diagnostic laboratory, therefore, goes to New York Citv in 1S!>:1, followed closelv bv the laboratory of the (liicago health deparlnieiit in ISiM. The first state public health laboriitory was that of KIicmIc Island established the same vear. I'URLIC HEALTH AD.MIXISTRATIOX 245 Lalxirafori; ]\'iiiJi hi/ Illinois Stoic Boar/I of Health. The liistor\- uf lal(()rator\- work uf the IlHnois State Board of Health begins with the estahHshnient of the Board. In ISi;. the linancial state- ment of expenditures included an item of $19.85 for collecting water samples which were submitted for analysis to Prof. BI. .\. Weber, chemist of the Industrial Univer- sity of Champaign. In 1880 the records of the Board mention the investigation of water supplies at Chicago, Springfield, Peoria. Quincy, Rock Island and Rockford. In 1885 the legislature appropriated a contingent fund to secure the services of analysts, observers and other assistants fur examination (jf water supplies. The same year a systematic obser vation of tlie varying character of the water su])])ly of Chicago was made under the direc- tion of the ]-5oard. Chemical examinations were made weekly by Dr. John H. Long. Pro- fessor of Chemistry, Northwestern University in. w aitt-i o. Bam. Medical School. For the next fifteen years Prof. Long conlintied to analyze water at intervals for the State Board of Health, culminating in the siud\ in ]s;)!l and lilOO in connection with the Chicago Drainage Canal. Dr. V . Robert Zeit, Professor of Bacteriology and Dr. Gustav Friitcrrer, Pro- fessor of I'athology. at the Northwestern L^niversity Medical School also look jiart in this in\estigation. Since no laboratory was available in the earlv days for the routine anah'sis of water samples, citizens were given a method wherebv thev could test their own sample. Report of committee on school hygiene min- utes of State Board of Health, 1894. "For examining water by a simple method take a sample of the water in a bottle cleansed by boiling water and provided with close fitting glass stopper, and a lump of loaf sugar and place it in summer temperature in the rays of the sun. if the water becomes turbid after a weeks exposure organic matter has decomposed and bacterial multiplied, the water cannot be regarded as whole- some and must be boiled or filtered." ( )n Decemljer (!. 1S!M the committee on legislation of the Slate B)oard of Health .\uxiliary Sanitary Association prepared a report on "needed legislation", and, among other recommendations, passed the following reso- luiions ; "Whereas. It is a fact of familiar knowledge, that certain diseases of great fatality are caused by elements of poUuIioii in drinking water: "Whereas, Such diseases are plainly ineventable by proper attention to the purities of the sources of supply: 246 I'UBLIC' lllLAl/ril All.MIXlSTRATIO.N "Whereas, Such attention can be given with maximum efficiency anil mini- mum expense by the I'niversity of Illinois, under the direction and authority of the State Board of Health; therefore, be it "Resolved, that the Illinois State Board of Health and its Auxiliary Sani- tary Association, earnestly recommend the legislature of the State to make suit- able appropriation for the establishment and maintenance of work of this kind in the Institution." Also the following resolution : "Resolved, That any question as to purity of food and medicines, be also re- ferred for analysis to the authorities of the University of Illinois under the direction of the State Board of Health." While there is no record of any action taken on the latter resolu- tion, the legislature in 1895 provided -^.j.OOU to e(|uii) and maintain a water laboratory at the State University. Professor A. W. Palmer of the De- [lartnient nf chemistry was put in charge. The .^tate Water Survey, as it was known, continued as the agent of the State Board of Health until 1915, working in close co-operation with the State and local boards of health. In the latter year the bureau of sanitation and engineering of the State Board- of Health was formed, which took over the analysis of water for the Board although the Water Survey still continued sanitary examina- tion for many local boards of health. Food analysis ap])ears in the records of State Board of Health in 1885, when on July ol. I'rof. John H. Long reported the results of a chemical analysis cf meat in a ])tomaine poisoning outbreak causing the death of one person .ind the illness of lhirt\-se\en others. He also made micro- scopical examination of sections of the meat, reporting the presence of bacteria. Food laws had been on the statute liooks since IS IT. In 1885 the legislature passed an additional act to protect the ]iul)lic from im])osition in relation to canned or preserved foods. Since no laboratory facilities were a\ail:il)le. the resolution i|uote(l abo\e in regard to analysis at the State L'niversitv was recommended, jjut a]>i)arently not accejited bv the legislature. In the earl\- nineteen hundreds the .^tate food commission was or- ganized with a lal)oratory in Lhica';ii. In 1!)()7 this Commission was re- organized with bro;'.d powers concerning ftod control and ample laboratory facilities. Co-o])eration between the food commission and Stale lioard of Health was intended by Section 32 of the jnire food law, which reads: "The State Board of Health may sulimit to the superintendent or any of his assistants samples of food and drink for examination or analysis, and shall receive special reports showing thr n suits of such examination or analysis". The first mention of the examination of di])htheria cultures appears in the recor(l> of the Hoard for 189 1. ( )n the program of the State Board PUBLIC HEALTH ADMINISTRATION 247 of Health Auxiliary Sanitary Association for Nov. 14, of that year, ap- peared the name of Dr. Adolph Gehrniann, bacteriologist of the newly formed laboratory of the Chicago health department. In his paper on the "Bacteriological Diagnosis of Diphtheria" he ])resente(l the feasibility of establishing in every city and town which has a board of health, facilities for the prompt and positive diagnosis of every case of diphtheria, at trifling expense. Demonstrations of his method were carried on in the laboratory of St. Johns' Hospital at Springfield. In 1S95, according to the Board minutes for January, 18'.>6, measures had lieen adopted in the city laboratorx- in C hicagd fur the pr(jnipt and accurate diagnosis of all cases of diphtheria as soon as reported, and stations established where a supply of diphtheria antitoxin could be promptly ob- tained, free of charge to those unable to pay. This work was started in September of the preceding year. The above incidences naturally stimulated a demand for laboratory assistance in the diagnosis of diphtheria in other conmiunities, for the fol- lowing item is found in the minutes mentioned above : "Requests were received from Dixon and Grayville, III., for bacterial ex- amination of membranes from typical cases, from diseases prevailing in those cities, with a view to settle the dispute as to their character. As is known, the Board has no facilities for making such diagnosis, but through the kindness ut Dr. L. C. Taylor, Bacteriologist of St. John's Hospital. Springfield, your secre- tary was enabled to furnish the desired information." Ldbiinitniics Esta1)HsJit'(J. In I'.MII the State diagnostic laboratory was organized, and in 19] 5, the first branch laboratory was established. In inn, when the division of sanitation and engineering, as it was then called organ- ized as part of the State Department of Public Health, a water and sewage laboratory was created which has worked in close connection with the diagnostic laboratory, but as a sep- arate unit. The biological and research laboratories were e-tablished in liJli). In lli'^l, the division of social hygiene ob- tained money fcir additional laboratory service, whereby the services of three technicians for venereal disease work in Chicago were made Dr. Thomas i available to the Chicago health department. 248 I'UHI.IC HF.AI.TIl AD.MIMSTKATION Tlie lalmratiiry work of the State I X'liarlniciit of I'uhlic Health is (hvided as follows : Division of diagnostic laboratories. This includes two branch and eight diphtheria diagnostic laboratories. Division of biological and research laboratories. For the purposes of convenience the above are referred to as the di- vision of laboratories and administered under the direction of the chief bacteriologist of the biological and research laboratories. Division of engineering. Water and sewage laboratory. Division of social hygiene. Three laboratory workers loaned to the Chica.go health department. Laics ruder Which the Laboratories Operate. The original Act of the legislature creating the State Board of Health in IST', did not specify the maintainence of a laboratory. In \'M)' the fol- lowing was enacted by the legislature: "The State Board of Health may establish and maintain a chemical and bacteriologic laboratory for the examination of public water supplies, and for the diagnosis of diphtheria, typhoid fever, tuberculosis, malarial fever and such other diseases as they may deem necessary for the protection of the public health." \\'hen the Department of Public Health was formed in lUlT, the Civil Administrative Code (Sec. 55, p. 39) included the follow-ing: "To maintain chemical, bacteriological and biological laboratories, to make examinations of milk, water, sewage, wastes, and other substances, and to make such diagnosis of diseases as may be deemed necessary for the protection of the people of the State; "To purchase and distribute free of charge to citizens of the State diphtheria antitoxin, typhoid vaccine, smallpox vaccine and other sera, vaccines and prophy- lactics such as are of recognized efficiency in the prevention and treatment of communicable diseases; "To make investigations and inquiries with respect to the causes of disease, especially epidemics, and to investigate the causes of mortality and the effect of localities, and to make such other sanitary investigations as it may deem neces- sary for the preservation and improvement of the public health." Bit)l(i(/ieiir:it(ir\ w aN j^ivcn up Minti alter this, fur there IS HI) furthet" record nf it in the miimles of the I'.dard. The jnirchase i.if smal'pn.x vaccitie is noted fnini time lo time, itiitii in 1 !•".':> it was itichided iti the sjiecificatidns for biolciyical products lu be purchased under contract and disttihuted free of charge. Diphtheria antitoxin, dating from ISiMI, catiie into general use after 18!)4. In IS'J.j the L'hicago HeaUh Deiiartment jiroNided stations through- out the city where it could he ohtained without delaw and where it was giveti free of charge to those unaMe to pa\'. In 11)11.") the legislature atuended the Act of IS^; creating a Board vi }leallh. providing that "it shall he the duty of the l'o;ird of Health of the State of Illinois to appoint one agent in the count}- seat of each county in the State who shall lia\e for (rslrihulioii ;i supph' of diphtheria antitoxin, certi- hed to hy >aid Itoarcl, etc." and finllier proviilin;; for the sale at a reasonable ])rice or for the free distribtttion lo ])oor persons on certilicate of the over- seers of the poor. In l!i()'.) ;nitiloxin was given free to all. .Massachusetts was the on'y state up to this time which distribuled diphtheria antitoxin in this manner. In IDL), tNphoiil vaccine and silver mtrate weie added to the free list to In- distributed by agents. Smallpox vaccine in IDl."), Schick test material in lIMii. diphtheria toxin-antitoxin in l!):^! and antirabic vaccine to poor per- sons in l!lv;i. came in turn. PUBLIC HEALTH ADM I XISTKATION 251 Provision for the free treatment of jKior persons bitten by rabid animals was provided for as early as UK),"), when the legislature passed "an act to provide for the treatment and care of poor persons afflicted with the disease called rabies." It was necessary for >ucb persons tci £;(i to a hospital with which the State had a contract for the administration of anti-ral)ic material. the long trip often being inconvenient to the patient as well as expensive to the county in railroad fare and maintainence (d" patient and attendant. In 1923 the distribution of the vaccine to the local i)hysician who could admin- ister it to the patient at home was inaut;urated and proved a great saving in expense to all concerned. In l!il!i the biological and research laboratories were established to manufacture the various biological products which heretofore had been pur- chased under contract and to investigate problems pertaining to public health work. Because of the lack of proper personnel and quarters, this idea has never been fully realized. In 1!)20 quarters were tibtained in the plant of the former hog cholera serum laboratory five miles from the Stale House and i)reparations made for the manufacture of typhoid vaccine and some other products. It was later decided however, to continue the purchase of these materials. The (juarters there were used for a few years for W'asserniann work. ]ire]iara- tion of mailing containers, housing of animals and the like, but later gi\en up because of inaccessibility. RESE.\RCH work: The necessity for research has always 1)ecn recog- nized. In the Annual Report uf llu Stati- Baanl of Health in I'.KIO the following statement is made. "It is the belief of tlie Board that, had the laboratory not accomplished, in its two years existence, anything more than it has done in placing aerial disin- fection upon a sound and scientific basis, tlie time and money devoted to it would have been well spent." Research activities have been somewhat limited due to inade(iuate personnel and quarters. It has been necessary to use the personnel of the biological and research laboratories largeK- for routine diagnostic work, devoting wliat little time was available lo iirolilems that could lie jiicked u]i and dropped according to pressure of routine. In fact, a stud)' made in V.m by the Carnegie Foundation on research facilities of the State of Illinois recomtnended that all research acti\ities of the State be confined to the State University, while other branches of the State government devote themselves strictly to routine activities. This of course, was impossible to put into practice. 'dij'/i I'UIiLIC lil'.ALTII ADMIMSTKATIOX The first result of research was pubhshed in 1920, since which time eighteen other contributions have appeared, as shown by the following list: IXVKSTKIATIOXS CoNDt'CTEl) IX THE BlOLOGICAL AND ReSEAECH Laboratories. 1SI20. The Sachs-Georgi Test for Syphilis. Thomas O. HiiH and Kva E. Faught. Journal of Immunology, Xov, 1920, J, 521-527. This was an attempt to make more workable one of the ea^'ly preeipitation tests for syphilis. 1U22. Anthrax in Shaving Brushes. Thomas C. Hull. Fifth Annual Report. Illinois Department of I'ublic Health, p. inO-191. Ten cases of human anthrax led to a study •<{ shaving brushes. AVhile the more expensive brushes showed no contamination, many cheap brushes were found to be badly contaminated. 1922. A Study of the Typhoid Epidemic at Kewanee, 111. Thomas G. Hull and Kirby Henkes. Illinoi.s Health Xews, 1!]22, S, 196-199. Twenty-five cases of typhoid fever on one milk route led to the detection of a carrier on the farm. 1923. Preserved Cultures in the Widal Test. Thomas C!. Hull and Hugh Cassiday. Abstracts of Bacteriology, 1923, 7, 3. A report presented to the Society of American Bacteriologists to the effect that dead cultures were not as reliable as living typhoid cultures in the performance of the Widal test. 1923. The Widal Test in Tuberculosis. Thomas G. Hull and Kirby Henkes. Abstracts of Bacteriology, 1923, T, 28. .\ report presented to the Society of American Bacteriologists that persons afflicted with tuberculosis sometimes gave peculiar and characteristic re- actions with the Widal test. 1923. Intracutaneous Reactions in Pertussis. Thomas G. Hull and Ralph W. Nauss, Journal of American Medical Association, June 23, 1923, SO, 1S40-1S41. The intracutaneous injection of a dead culture of pertussis bacilli was found unreliable for the early diagnosis of whooping cough. 1923. Agglutination of the Flexner Dysentery Bacillus by the Blood Serum of Tuberculous Persons. Thomas G. Hull and Kirby Henkes. American Review of Tuberculosis, Xov. 1923, S, 272-277. Persons in the incipient stage of tuberculosis, apparently carry in their blood stream a substance capable of agglutinating the Flexner dysentery bacillus while persons in the advanced stage of the disease do not. 1921. Another Milk-Hc.riu- Typhcul Kpidemic, Thomas G. Hull. Illinois lleallh .News, .luly 1924, in, 1117-201). A lyphoid outbreak at Litchlidd. 111., where two carriers were found on the dairy farm. 1924. The Control of the Public Health Laboratory. J. J. McShane and Thomas Ci. Hull. American Journal of Public Health, Xov. 1924, r.}, 950-953. The report of a committee appointed by the advisory board to study methods emi)loyed in other states of co-operating with or controlling private labora- tories doing public health work. PUBLIC HEALTH ADM I XISTRATION 2i)3 1924. The Effect of Heat on the Staining Properties of the Tubercle Baoillvis. Thomas G. Hull, Kirby Henkes and Luella Fry. Journal of Laboratory and Clinical Medicine, Nov. 1924, 10, 150-153. Steam pressure at 15 pounds for S hours or dry heat at 150° for one hour and forty ininutes did not cause the tubercle bacillus to lose its acid-fast stain- ing properties. 1925. Agglutination Reactions of the Paratyphoid-Dysentery Group in Tuberculosis. Thomas G. Hull, Kirby Henkes and Hugh Cassiday. American Review of Tuberculosis, Mai'ch 1925, 11, 7S-S4. Agglutination reactions with blood serum from persons in various stages of tuberculosis were obtained with certain members of the paratyphoid — dysentery group. 1925. The Schick Test and Scarlet Fever. Thomas G. Hull. Journal of L.aboratory and Clinical Medicine, Dec. 1925, II, 260, 2ril. An attack of scarlet fever appears to destroy the diphtheria antitoxin in thi- blood streani, causing the Schick test to become positive. 192(i. Laboratory Differentiation of Smallpox and Chicktnpox. Thomas G. Hull and Ralph W. Nauss. American Journal of Public Health. Feb. 1926, 1«, 101-106. Smallpox may be differentiated from chickenpox by the intracutaneous in.iec- tion of iininune rabbits with serum from the pustule of the patient. 1926. The Widal Test as carried out in Public Health Laboratories. Thomas G. Hull. American Journal of Public Health. Sept. i;i26, 16, 901-905. The Widal test needs standardizing according to a study of methods used in 53 public health laboratories. 1926. The Control of Private Laboratories. Thomas G. Hull. The Nation's Health, Dec. 1926, s, SII9-10. A discussion of certifying private laboratories doing public health work. 1927. Undulant Fever as a Public Health Problem. Thomas G. Hull and Luther A. Black. Journal ol the American Medical Association, Feb. 12, 1927, 88, 463-464. Among 70 serums tested with bacillus abortus antigen, 5 reacted positively in high dilutions, indicating infection with bacillus abortus. 1927. Twenty-six Thou.sand Kahn tests compared with the Wassermann. Thomas G. Hull. Journal of the American Medical ^Association, June 11. 1927, N8, 1S65-1S66. The two tests gave relative agreement in about 9S percent of instances. Treated cases of syphilis' gave the inost discrepancies. 1927. Seasonal Prevalence and Control of Rabies. Thomas G. Hull. The Nation's Health, June 1927, !>, 21-24. Rabies is on the increase throughout many portions of the United States. March is the montli of greatest prevalence in many communities. I>i, which made jjossible the neces.sary expansion of activities. In the 2'-i years that the laboratory has existed, ten dififerent individ- uals liave been in charge as follows: W. H. Hoyt 1904- 5 H. C. fJlankenmeyer, M. D 19f)5- 7 Wallf^r a. Bain, M. D 1907- 9 Flint MoiKlurant, M. D 190!) W. a. Crowley, M, U 1909-10 N. E. WagBon, M. D ...1910 W. H. HolmeH. M. D 1910-11 Geo. F. Sorgalz, M. D 1911-18 .Martin Uijpray. M. S 191K-19 TboniaH G. Hull. I'h. U 1920-to date 111 l!»i)l when the laboratory was first started fjiijy IT! examinations were made during the fall months, covering dijjhtheria cultures, sputum examinations for tubercle bacilli, blood examination for malaria parasites and Widal tests for typhoid fever. The volume of work increased very markedly during the next dozen years, especially in sputum examinations l)Ut with almost no increase in scope. Unfortunately no records are avail- able for the years I90H and \'.)W). In 1917, came the war with its venereal disease program and free Wassermann tests and gonorrhea examinations, and general em])hasis on all things of a laboratory nature. With the return of physicians from military service the demands on the laboratory for all kinds of work in- A section of the main laboratory at Springfield where general diagnostic service is done free for the citizens of Illinois (1924t. 2-)(; iTKi.u iii;ai.iii AHM I XISI KATKIN creased markedly, lu V.y^O routine exaiiiinatidns for all contagious diseases for which laboratory tests were availalile wen- Ijeing made, including the complement tixation tests for gonorrhea and luhcrculosis. In \[>'iij. after considerable experimentation, the Kahn ])reci])itation test for s\ philis was adopted as a routine in addition to the Wassermann test. In June 1927, the Wassermann test was dropped as a routine pro- cedure ; except where there was a special request for it. It was soon found that there were no such re(|uests. The interest of veterinarians in j)ulilic health laljoratory work had been confined mainly to rabies for some years. In 1924 the contagiousness of bacillus abortus of cattle for man was sliown in several human cases in Illinois. A demand u])on the laboratory for routine testing of cattle for contagious abortion was immediately made by veterinarians. Since the Department had neither the facilities nor personnel for this additional bur- den, only a small number of blood specimens from cattle were examined. In all matters relating to animal diseases, the closest co-operation was maintained with the division of animal pathology at the University of Illi- nois. * Table 24. Diagnostic L.-\BORATC>RY- —Total Examin.\tions, 1904-27. Main laboratory Springfield. Branch laboratories. Social hygiene. Total. ■ 171 1.425 2.370 171 Iil05 1,425 2,370 111 - 3,275 ?? 1909. 1 ■'? 1909- 10. 1 4.024 ?? 4,024 4,037 1911-12 1912-13 1013 14 1014-lS 1915 Ifi 4,249 4,442 4,222 4,611 7.579 6.013 10.499 12.003 31.494 52.008 83.630 82.840 84,104 78,311 99,259 134,200 4,219 4,222 1,409 2.429 2,399 3.05S 3,412 7,691 8,442 4,576 5,520 4,611 9,037 5,845 8.988 8,482 ' ' 12,898 I'.llv VI 19l!l '211 ,,,.„ -Ji i!i:i ;- 19L':; :•! 1921 -'.■) 192.-, 21. 192fi 27 4,628 84,749 20.205 27,128 27.893 79,736 93,726 52.725 84,749 15.061 39.543 79.904 119,200 115.309 169.360 176,648 161,021 221,794 I'UBLIC HMALTII ADMINISTRATION V.)i TliL' lollDwinsj; is a list of exaniinalions made by the diagnostic laboratory showing the }'car when they were begun: Diphtheria cultures 1904 Dysentery cultures 1918 Sputum for tubercle bacilli 1904 Meningococcus cultures .... 1918 Widal tests 1904 Pneumococcus typing 1918 Malaria examinations 1904 Tuberculosis fixation tests 1920 Kabies examinations 1909 Gonococcus fixation tests 1920 Wassermann test.s — blood and spin- Colloidal Gold tests. ... 1920 al fiuid 1:117 Diphtheria virulency tests 1920 Pus for gonococci 1917 Kahn precipitation tests 1926 Treponema pallidum Iill7 Vincents' angina 1927 Typhoid cultures feces, urine and blood 1918 Occasional examinations have been made since the period lltlT to I'i-'o of specimens which have not been numerous enough to list as "routine", but classed under miscellaneous, including examinations for anthrax, chan- croid, glanders, streptococcus, sore throat. \'incents' angina, alscj the Weil- Felix test for typhus fever, blood cultures, oyster examinations, food poi- .soning investigation, etc. Previous to 1920 a certain number of routine urine analyses was done as were also blood counts, together with an occasional tissite examination. Since that time these activities have ]jeen confined to instances where a communicable disease was involved, leaving the routine specimens to clin- ical laboratories. Previous to lii'iv' very few milk examinations were made. In that year in conjunciimi with the milk campaign, bacterial plate counts and sefli- ment tests were made in several cities and since then milk specimens have been examined at irregular intervals in considerable numbers, culminating in the use of a mobile milk laboratory in 1927 for field work. BR.\NCH LABOR.ATORiEs: In 1915. it .seemed advisable to establish branch laboratories to improve the service, especially in diphtheria work. Accord- ingly, contracts were drawn up with the Burdick-Abel Laboratory in Chi- cago and with Dr. W. H. (iilmore in Mt. Vernon, to examine diphtheria cultures for diagnosis ,it the rale of 50 cents each. Cultures for quarantine release or for sur\ry \\(irk as in schools, were sent to Springfield. Similar contracts were later m.ule with other laboratories to includi; not only diph- theria diagnosis but al.-o Widal tests, malaria and gonorrhea specimens. Because of lack of funds the scojie of the branch laboratories was confined to diphtheria diagnosis. Later in l'.i2-.', instead of paying for each culture examined most of the l;il)oraliirics were paid a stated .sum each month on the basis of the ainoinil of wt>rk |)re\iiiuslv dcjne. In l!»2.j a definile change in br.anch laboratory policv occurred when the Palestine l.abor.-itory. connecte, a chest was built combining the minimum necessities for mak- ing diphtheria, txphoid, and meningitis cultures. Several trips each \ear were made with this eciuipment with very distinct advantage. Not onlv were tyjilioid. diphtheria and meningitis epidemics solved, but also other work such as glanders and venereal disease diagnosis, milk bacteriology and general kdioratorv work taken care of. Among the towns visited were Litchfield. .\una. C'arbondale. Peoria, Rock Island, Rockford, Kev^-anee, Marshall, Taylorville, Belleville, East St. Louis, Granite City-, Streator. Belvidere and Galena. Equipment and personnel for setting up a field diagnostic laboratory are ready at all times to respond to emersency calls. The picture shows the Hold unit about to be off from the fapilol Huildins; to Rook Island in litl':;. 2(i0 I'l'iii.ic iii:ai,tii Ai)Mixisri;A iihn An interesting trip was made in IH".':i in ]\(k]< Islanrl. A fi-w days be- fore Christmas a telephone call |-e(|iiesied urgent help in eontrnUinij a diphtheria outbreak. While the branch laboratory \\a>^ available at .Moline. supplies for several thousand cultures were not at hand nor could they be shipped b\- train because of the tremendous congestion of Chrislmas i)ack- ages in both ])osi office and express office. In but a few hours culture media for the entire work was ready and loaded into the laboratory car. P.y driv- ing all night two l.iactericlogists with necessary supplies and equipment were on the scene the next morning. The tornado of li>v!-j in southern Illinois caused an acute situation making the presence of laboratory ser\ice indispensable. Equipment suf- ficient to take care of any emergency that might arise was dis]-iatched Ijy automobile and installed in the I'dks' C'lul) at Carbondale. Through the co-nperation of the National Guard, the laboratory equip- ment of the IdSth Medical Regiment was pooled with that of the State De- partment of I'ublic Health and placed at the disposal of the Department. While the main laboratory was maintained at the Elks' Club ni Carbondale, sufficient technicians were a\ailable from the National Guard to establish sub-lal)oratories in the various emergency hospitals in Alurphysboro, West Frankfort and at Ifolden Hi sjiital in Carljondale. With th'_' closing of the emergency hospitals and the withdrawal of the Natimial (iuard, the labora- tory was mo\'ed from the Elks' Club tn the temporary oftices of the State Department cd' Public Health at ■.'■-'■.! ' 2 South Idimiis Street. So well did this laboratory function during the next tew months, not only in the storm area but all over the soinhern part of the State, that its abandonment was out of questiin. Definite arrangements were made with the Holden Hos- pital where commodious ijuarters were provided and the southern branch laboratory was thus established. The field laboratory equipment was angmentetl from time to time to take care of special emergencies s;i that it eventually consisted of more than half a dozen chests, packed ready with sterilizers, incubator, acetylene gas tanks for burners anrl other necessary materials. (Jne o-, ail the chests were taken according to the n.ature of the emergency and amoimt of equip- ment that might be found locally. The milk campaign initiated in l!l"25 resulted in various milk sur\eys in different communities. These were disci iitinued because of lack of laboratory personnel and funds to satisfy the demand. The campaign resulted in the pa>sage of the milk pasteurization law, the enforcement of which require been the basis of much critici.sui b_\ many clinical lalioralory workers. The controversy has centered largely around the Wassermann test. In l'.)','.') the Illinois Medical i^aboratory Association attempted to turn more \\(irk to the private l.'iboratoiy by passing a resolution re(|uesting the Director of the State De- partment of Public Health to re(|uire the name and address of the patient with every Wassermann specimen done in the state laboratory. The Director referred the matter to the .^tate Medical Society where adverse action was taken upon it. 'I here are four groups into which lalioratories in Illinois fall. 1. Clinical laboratories m.-iintaim d by a competent clinical pathologist with a rncdica! dej;rce. 2 Hospital laljoratories, either in charge of a competent clinical pathologist or, as is the case with small hospitals, a laboratory technician suijervised by a physician. ■',. t'ublic health laboratories either in charge of a competent pathologist, bac- terioloErist or chemist, or a laboratory technician supervised by a medical heal h officer. 4. Clinical laboratories outside of hospital.s in charge of technicians which have no medical supervision. Laboratories falling in the first groui.) are at present eligible for approval by the .\merican Medical .\ssociation. The program of the Illinois State Department of Public Health includes groups one. two and three. The two organizations, however, try to co-ordinate their activities so that a laboratory is not approved by one which does not meet the requirements of the other. The following lal)or;itories have been issued certificates of a])proval by both the .\merican Medical .\ssociation and the State Dejiartment of Public Health. ChicaKo L.aboratory — Chicago. Lincoln-Gardner Laboratory — Chicago. Medical Research Laboratory — Chicago. The Murphy Laboratories — Chicago. National Pathological Laboratories — Chicago. Dr. Homer K. Xicoll's Laboratory — Chicago. Quincy Clinical Laboratory — Quincy. Rockford Hospital Laboratory — Rockford. nockford Laboratories for Medical Research — Rockford. 2Gi PUHI.lt' HEALTH AD.MINIS'l'RATION ill additiiin t(i the ahdvc list tilt' t'lilhiwiiig lahoralnrics havf lifen ccrti- fietl for certain procedtires by the State Department of I'liMie Health; Kiiekford HL-alth Dyiartnient Laboratory — Rockford. Decatur and Macon County Hospital Laboratory — Utcatui-. Lake View Hospital Laboratory — Danville. Our Saviors Hospital Laboratory — Jacksonville. Lutheran Hospital Laboratory — Moline. Klgin Municipal Laboratory — Klgin. Aurora Municipal Laboratory — Aurora. Brokaw Hospital Laboratory — Bloomington. Pre.scription Shop Laboratory — Joliet. Holden Hospital Laboratory — Carbondale. Illinois Valley Laboratory — Ottawa. St. -Anthony's Hospital Laboratory — Rockford. St. Mary's Hospital Laboratory — Kankakee. Methodist Hospital Laboratory — Peoria. St. Francis Hospital Laboratory — Peoria. St. .lolin's Hospital Laboratory — Springfield. In lli'M. the State Department of Public Health took an active part in the formation of the Illinois Public Health Laboratory Association. The name was later changed to the Illinois Medical Laboratory .Association as being more descriptive, but the objects of the organization remained the same. Dr. Thomas G. Hull, chief of the diagnostic laboratory, served as president for two years and then as secretary. One of the tibjects was to reach the technician isolated in a laboratory in a small cit\', who if a member of a national technical society, rarely obtained the opportunity to attend. P^recjuent meetings in different ])arts of the State were intentled to interest and stimulate these technicians to better work. The certilicatit)!! of laboratories by the State Department of Public Health came about in lU'iii when the Illinois Medical Laboratory Association passed a resolution requesting the Director of the State Department of Public Health to issue certificates of approval to laboratories found com- petent to do jnihlic health laboratory work after proper inspections had been made. The Director agreed tii this arrangement, limiting inspections only to lalicr.-itories frr on October 1. 191:) and continued until 191T when the position of chief insjiec- tor was abolished and in its jilace, as the head of the division of lodging hijuse inspection, was established the position of su]ierintendent of lodging house inspection. To that place was appointed W. W. AlcCulloch. In October 1923 he was succeeded by .\rch Lewis who has continued to date. The work of this division has changed very little during the long |)eriod of its existence except in volume. Funds provided for carrying the scr\- ice have increased from $12,500 per year in 1901, to $35,G75 in 192;. :iUU I'Um.lC IIKALTII ADM I. MS I RATION Earl B. Searcy DlNISION 111' I'lT.l.lC I 1 I;aI,I1I 1 XSllilC'IKiX. Ediicalii 11 ill 1k;i1i1i matters was re.t;ar(lcf handhiig the matter from the outset and ciiiitiinirs to lie important. Ivhicatiiin was always stressed by Ur. Ranch as one of the most important resuks of his survey of the State during the middle eighties. He also dis- tributed millions of leaflets on smallixix and large numbers on other diseases. Vhv annual rejiorts of the Pioard which were issued with more regularitv than almost anything else that it ever undertook were prepared with a \iew til their educational \alue. I'rdiu lime til time attempts were made to publish a ]icnrdical bulletin jirior to 1110(1. The few numbers that came from press were called ,S"/(;/i' Alcdiciiir. This idea was revived in IIH):; when two numbers, the March and .\pril. nf a monthlv publication called the "Biil- Icliii" were issued. Ai^ain it dni]iped out of the acti\ities .:nly to be re\ived in I'.ioii on a permanent and more or less regular basis. I'rom that time un- til Uecember IHIS a number cif the "Bulletin" w;is published for everv month and bound by years. Then the publication succumbed to another lapse and was revived again in 1915 under the title of "Heal III A'c, l!)li) by Sanuiel ^^'. Kessinger wdio received a temporary appointment. As a re- sult of civil service examinations, B. K. Richardson was appointed to suc- ceed Mr. Kessinger on December 1, I'.c^O. Mr. Richardson has continueniinterrupted]\' since fanuarv 1, l!i-,'l. It exercised snp-er\ision over a moiinn pictiu'c librar\- in which are maintained xmie eighty odd films un health subjects. These are luaned free throughout the .'-^laie. and are found very useful in health educational work. 'ids I'l'lil.lC IIKAI.lll AliM I.MSI KA'I'IO.V The ili\isi(:r. was arraiiyint;' prugraius and haiuUinj^r jmbliciiv for spt-cial events like I lealtli riiinidtiou Week, diphtheria eradication and other cam- paigns: alscj the better baby conferences at the State fair. In addition it managerl the mobile (-■xhibil ct5lOO,0()O.UO. The work of the li\isioii has proceeded along lines established tlur- iiig ihe lirst year conforming in gcner.il to the \iiureal disi'.ase progr.im suggested b\ the Inter- de|)arlnu'nlal I-^ocial ll\gieiU' I'xiard, which was cre- ated bv act of coiiiiress. PUBLIC HEALTH AD.Ml XISTRATIUX 'ibV Treatment nf Disease Carriers. Duf m the acct-ptfil fact thai there exists a lack of i)rni:ei- inf(jrniati(in concerning the serious character of the comphcation and seque'lae wrought l)y venereal disease carriers, an endeavor was made to place before the public facts pertaining to these diseases, and along these lines, clinics were opened in the following cities : Chicago — 2 Decatur East St. Louis Springfield Rock ford In the year 1!J".'() there were in addition to the aljo\e named clinics the following: Alton Chicago Heights Rock Island Cairo Litchfield Waukegan Carlin\ille jMoline West Hammond Chicago — 5 Peoria The following year clinics were in operation at Princeton and (Juincy- Later clinics were opened at DuQuoin and Robinson. Froiii the year lil'.'l it has been the policy of the division t(.) operate clinics in such a manner as nut to pauperize the public or infringe u])Oii the legitimate practice of any ])hysician. This is obviated by ha\ing the endorsement of local medical societies before taking action upon applica- tion of city or county oflicials requesting that clinics be opened. Clinics are established whenever the Department is asstireil that for every clollar of State funds subsidized, there will lie (k'ulilc the amount appropriated from city, or county funds. Repressire Measures. It is a known fact that in order to prevent the sjjread of venereal disease, it is necessary to render non-infectious the carriers of the disease. In order to carry out such a program, it is essential to have the coo]ieration of city and county officials. In order to acquaint officials of the respective communities as to prevalence of these diseases, vice investigations ;ire made, and the results of such surveys are confidentiallv given them. In a number of instances, the city oflicials have seen fit to p;iss local ordinances which deal with male offenders .is well as pnisiilntt-s. From a public health viewpoint, every rednciion of the amount of irregular sexual in- tercourse means just so rnucli le>s exposure to veneri-al disease. Due of the main methods of reducin;; ihest- exposures is the |in'\entini; of pro- fessional prostitutes and loose women of all kinds from anv opportunil)- to do business, as these women are the most ])rolilic carriers of venereal disease. 2,(1 PUHLIC HEALTH ADMINISTRATION Eiliicdl ion. Svpliilis, i;e diseases mark them as one cif mankind's greatest scourges. When it is taken into consideration that fre(|uentl}' moi-e cases of venereal disease are reported than that of measles, it may gi\e the pulilic a general idea as to the prevalence of venereal disease. There ha\<.' lieen reported in Illinois from ])hysicians and clinics, 1!)4,8(1S cases of venereal disease during the period July 1, I'JIS to July 1, lli?(i, while the number of cases treated at the clinics showed a stupendous total of oi'.i.fti;. The number of lectures given during this ]ieriod was I. Sit. The educational measures used to combat these diseases are carried on by the Use of placards, pamplilets. motion ]iictures, exhibits and lectures. To show the interest manifeste''■'> due to decrease of appropriations for the hienniuuL Two very important bills relating to venere;d disease were passed hv the rtord General Assembly. The one aiiprt>\'cd jtme 'il. l!)v!3 amends section ~u of the Criminal Code to pro\ide that anv one who keeps, leases, or patronizes any disorderly hi use shall lie hned ncjt more than ■$200.00 or imprisoned not more than one \ear. The other, approyed June "27. l!l".'.'l. amends section 1 of the Divorce Act by adding as a ground for . The establishment of \ enereal disease clinics at various parts of the .State was begun. Six were established during this year. lliv!o. .\(l(liiional venereal disease clinics establidied in State, sufficient in number to bring the total to nineteen. lifl'i. A one week intensive coiu'se relating to social hygiene was con- ducted in Chicago. Alore than l.ooo persons registered as being in attendance on the K'ctnres. lilS;!, Stand.nrds of infecti\ity in reference to \enei'eal diseases, which were created by a special committee of experts at the re(|uest of the State Director of I'ublic I U'altb were adopted and put into effect. A stringent law jiertaining to vice v\as enacted. The "Social Hygiene Moiitlily" publication which began in I'.f.'d was discontinued diu'ing this year. .\ bill providing for the acceptance of federal aid to almost the amount of .$1 l.iiiKi.uo in social lugiene service, failed to nass the legislature. A decrease of $i!S.O((0 from the last ])receding appropriation limited the activities of the division for the biennium. 272 ruuLic health admixistratiox l9"2o. Law passed, jiiiHiuliiig Scctinn .')" of the Criminal Code, and which is directed at the very center of the venereal disease evil. Law provides heavy hnes and inipris' nnient for patrons, owners, leas- ors, proprietors or other persons directly influencing the opera- lion of houses or quarters for prostitution. If enforced, this will reduce very greatly the possibility of venereal disease in- fections. This, in turn, would make niore and more unneces- sary a large number of clinics for treating such diseases. Standards of infeclivity. relatixe to the treatment of venerally in- fected ])ersons, worked out by a committee consisting of Doc- tors W. A. Evans, Herman N. Bundesen. Louis Schmidt. C. C. Pierce and others. Standards of infectivity jiertaining to venereal diseases officially adopted as a jKU-t of the rules mk\ regulations of the Depart- ment. Standards printed in pamphlet form and available to phy- sicians, heallh officers, social wuiU\ into a lerritoi)- of the second .grade." Kepeat, ok Til K I SI!) Act. In [>■>]. the Act id' ISl!), which pro\ ided f(ir the urganizalion of medi- cal societies, with certain powers to regulate the jiractice r\ medicine, with the object of providing improved medical st.andards and attention to public 278 ENFOUCEMICXT OF MF.niCAI. PKACTICK ACT hcallh. was ri-|icaK(l. This was a Ircnu-iidoiis back-set to the regulation of iiirilical praclicr in lllinnis. An attenipt tn pass a law similar to the one that had been repealed was made in ls■^•), hul did not suecced. A second law. known as "an Act prt'scriliini; ihe nio(k- nf licensing; physicians" was jjassed in \!^'!'i. hnl was promptly i'e|iealed at the next session ol' the legislature. I low liadly a law rei^nlatinn medical practice was reallv needed is sug- gested by this stalenunt by William lUane in his "A d'our in Southern Illi- nois," published in Is;"-'; : "Persons who have not visited the western states cannot have any idea of the general ignorance ot the practitioners of medicine. A young man, after an apprenticeship of a year or two in tlie shop of some ignorant apothecary, or after a very superficial course of study at some school or college is entitled to cure (or kill) all the unhappy backwoodsmen who may apply to him for advice. To become a doctor it is only necessary to have a caliin containing .jO to 100 dollars worth of drugs." The foll( w inij partial statement fiiim Zeuch's "History of Medical Prac- tice" indicates ib.it wholes.ile barter in certificates to practice medicine de- veloped in the .Stati- in the absence of law> re^ulatint; the piactice of medi- cine : "When this Thomsonian system was at its height a great number of cer- tificates were sold, "Joseph Chapman was the holder of the certificate, which shows one of the methods employed in the olden times in creating a practitioner of medicine. When the tide of the Thomsonian school was at its flood, a large number of these certificates were sold, giving the holder thereof the right to practice medi- cine. Without any medical study except such as was furnished vi'ith this cer- tificate, any man who would pay the price was permitted to prescribe for the sick and administer such remedies as were endorsed by this particular cult, which was founded on the use of remedies ot vegetable origin only, discarding all remedies which belonged to the mineral Ivingdora. "No. 1398 Seventh Edition "This may certify that we have received of .liiseiili Chapman. Twenty Dollars. in full for the right ot preparing and using, for himself and family, the Medicine and System of Practice secured to Samuel Thomson, by Letters Patent from the President of the United States; and that he is thereby constituted a member of the Friendly Botanic Society, and is entitled to an enjoyment of all the privileges attached to membership therein, "Dated at Alton this 19th day of 1839. "R. P. Maxey. Agt. for Pike, Piatt & Co., .Agents for Samuel Thomson." I'jAiii.v EFi''(nri's TO (ii'.T .V Mi';iiic.\L Practice Act. That there rcm.iincd the hop.- of ^ecitrins; a medical society as the nn- cleits for pnnnotini; a ^nccessfid campaign for ;i Medical Practice Act, is indicated ]iy the I louse Records of the ( ieneral .\ssemblv for February ■']. l.s:;:). which >;iv ".Mr. Webb of While C'ountv ])re.sented the i)etition of J'. 11. I>r;idv, tor tlie incorporation ol a medica.l society, wl.icli on a motion was referred to C rnnnitlee on I'.ducation." EXFORCEMEXT OF MEDICAL PRACTICE ACT 279 Again in ISl".' efforts were made to get a Medical Practice Act passed. The reports of the General Assenibly show that: "Mr. Aiulerson from the select committee, to which was referred the pe- tition of sundry physicians of Shawneetown praying for the passage of a law regulating the practice of medicine, etc., made a report at length on the subject, and reported a bill for "An Act to incorporate the Illinois State Medical Society' which was read the first time, and a second time by its title. ■'Mr. Logan moved to amend the bill by striking out all after the enacting clause; and inserting the following: 'That no physician, surgeon or lawyer shall hereafter be entitled to sue for, or recover by action of law. his or their fees for services rendered as such physician, surgeon or lawyer.' "The report, bill and proposed amendment were laid on the table by yeas and nays; 55 yeas; 50 nays." The Illinois Aledical and Surgical Jotirnal in October, 18-14. in an edi- torial commenting on the ajiproaching meeting of the State Legislature re- specting medical jiractice. said in part as follows: "As the period for the session of the Legislature approaches we perceive a disposition of many members of the profession to agitate the subject of medi- cal legislation. * * * There is at present no special legislative enactments re- lating to the practice of medicine in the State of Illinois. Every one is entitled to assume to himself the title of 'M. D.' to prescribe any or all substances in the three kingdoms of nature to any who call on him for advice. * * * *" .\dded impetus to the agitation for a Medical Practice Act resttlted from the organization in 18,50 of the Illinois State Medical Society at Springfield in the lihriiry of the Capitol I'.uililing. The Chicago .Medical Suciety was organized the same year. In 1856 a cominittee was aiJiiointed by the .\esculapian .Society of the Wabash Valley from among its membership to go befcjre the Illinois legis- lature and urge upon that body the ])ruiiriety of enacting a law creating a State Board of Health regulating the practice of medicine and providing for the registration of births and deaths. The committee did the duty assigned to it, but its work was without immediate tangible effect. Early in ISiil a second committee was selected for the same ptirpose and consisted of Doctors D. W. Sterniont. \\'illiani M. (chambers and John Ten Brook. But the la- bors of this committee, bke that of it-, iiredecessnr, liore no immediate per- ceptible reports. However, at a meeting of the Illinois State Medical .Society held at Champaign in ]S1(i, a committee was appointed for a purpose similar to those of the .\escula])ian in Is.'iii and Isdl. The sentiment 'inr a n:edic,".i practice act expressed in ls5() did not ciystalli/e into concerted action by the medical profession until a (|uarter of a century had passed. Apparently the organized medical profession of that da\- finally became convinced that to enforce adequately a medical practice act. if secured, a State Board nf Health would be required. At least the following indicates that these two subjects were jointl\- in the minds of some oi the members of the State VSI) K.XFORCKMICXT Ol" M KDICAL I'RACTICK ACT Mrdical Society, 'riie Transactions of the 'iUh Anniversary Meetinjj of Illinois Meilical Societ)' in 1877, page 255, says: "The Jersey County Medical Society of Illinois sends greetings to the Illi- nois State Medical Society, pledging our vigilant exertions in helping to secure the enforcement of such laws as you may be able to secure the enactment of. by either the State or National Legislature, looking to the e.5tablishment of: "A State Board of Health. "Causing the registration of births and deaths and certificates as to the cause of the latter. "Preventing those persons unqualified to practice medicine from doing so "Creating a State Board of Medical Examiners." ( )n the twenty-first day of ]\Iay, 1S7T, the legislature — after a lapse of over fifty years from the date of the repeal of the short, imperfect Acts of ISI!) and IS-.','), placed upon the statute hooks an act to regulate the prac- tice of medicine in the State of Illinois, approved May '''K 1M17. and m force July 1. is;;. 'rh:it the Medical rr;ictice Act came none too soon and that the jjatient of is;; who c.'ime into the hands of the manv suh-standard practitioners of medicine fared none too well, are deductions that may well be permitted by the ideas exiiressed in the following quotation from the December 17, is;;, elition of the Chicago Inter-Ocean daily: "It is hardly necessary to say that the city of Chicago has become noted, not only for the immense number of villainous quacks, but for the ignorant and imperfect manner in which the register of births and deaths has been kept. The infant who was reported as having died of 'canker rash, diphtheria, dysentery and consumption.' and another whose cause of death was returned as 'five doc- tors,' doubtless had good reason to die; and 'delicate from birth.' 'infancy.' 'stop- page.' 'fits.' 'Colerafantum.' 'collocinphanton.' 'cholry fanton.' 'bled,' 'direars' (, diarrhea), 'billirm (delirium) fever,' 'artry lung busted.' 'feusson.' (effusion), 'canker on brane,' and 'infermation lungs,' probably convey some ideas to the persons who write the terms; but such returns cannot be of much use from a statistical point of view. The importance of correct and intelligent registra- tion cannot be underestimated, as modern sanitary science owes its existence to the registration of deaths and the localization thereby of insanitary conditions. It is right that the enforcement of the two bills, passed by the Legislature of the State, that will make such radical change both in medical profession and the method of registering births and deaths, should demand considerable attention." (io\ernor (^'ullom prom|itl\' appointed a ISoard i f llealth in confovmitv with the new law ot is;; and the appointees met in Springfield on julv 1"^ of that year when tlu-y organizeil with Dr. John H. Ranch as ])resident. The State i'io:ird of 1 le:iUh, imme(liatel\ after its apjiointnun'. weighed the urgencv of the duties and i lilii^ations placed ujion it In- the newly enacted laws and decided that its first dul\ was to enforce tin- Medical Practice Act. The knowledge tJKit o\er half of the ;.I00 |iersons jiracticing medi- cine in is;; were non-graduates (about :i.s()i)) and that 4!l(J were practicing medicine uncU-r fr;mdulent credentials, or even under assumed names, made this decision iel;ili\el\' easv. ENFORCEMENT OK MEDICAL PRACTICE ACT 281 Not only did the Board of Health decide first to center its chief atten- tion .on the enforcement of the Medical Practice Act, but a careful peru>al of the minutes of the Board of Health from IS" down to IHK. indicates clearly that this feature of their legally prescribed duties ciMisnmed fully three- fourths of the time, energy and resources of the Board, ()n Xovember l.'>, is;;, the following resolutions were adopted by the State Board of Health, "That on and after July 1, 1S7S the Board will not consider any medical college in good standing which holds two graduating courses in one year. "Also, that on and after July 1. 1878 the Board will not recognize the diplomas of any medical school which does not require of its candidates for graduation the actual attendance upon at least two full courses of lectures at an interval of six months or more." This was the first oflicial ste]) taken by the Board for higher medical education. During the first year (1S77) cei-tificates totalLng 5,3 74 were issued by the State Board to practitioners and midwives. By 1880, enforcement of the Medical Practice Act had materially reduced the number of ([uacks and itinerant vendors. Likewise the number of graduates in Illinois who were from reputable medical schools had increased from 3, 600 to 4,s-J,"), In the Annual Report of ISSl. the Board printed for the first time a com])lete ofitcial register by counties of physicians registered to practice medicine, also a directcry of medical societies in Illinois in 1881, and a roster of midwi\-es registered, listed by counties, .\n alphabetic index of physi- cians is also printed in this report. By 1882 the certificates issued to practitioners and miil\\i\es totalled 7,7GG, an increase of 2,392 since the md of is;;. Standards for Mkdicai. Education. In ISSl minimtmi standards for preliminar\- education of entrants into medical schools and requirement> for medical colleges in good standing were established. An examination of all candidates with diplomas from medical schools not meeting these re(|uirenients, w;is reiinireil, ,\t the ckjse of the year ISS,"i. ilu-re were in round numbers (),U1)U |)rac- titioners of medicine in the State. The < )fiicial Register, published and re- vised to February 10, 1886, contained the names, addresses, etc., of 5,11] 5. to which are added some 150 others, exempt from the clause requiring cer- tificates. Of this number 454 were added during the year; 114 applicants for certificates failed to comply with the law and were refused: and the certificates of eight practitioners were re\(iked fur unprofessional and di.-- honorable conduct. 282 ENFORCEMKNT OF MKDUAl. I'kACTiri': ACT ReVTSKU MkDK'AL I'liACTUE A("r Anol'TED. 'I'hc Aci 111 l\cL;iilaU' the Tractice (it .Medicine, addpli-d in ISTl, was amended mi June lii. l^s;. and in liree Jnly 1. l.^S^. Tile amendments strucl\ imt llie |ir(i\isinns dl' tiie (iriLjinal act relating tii the appointment of boards of examiners i)_\- State medii-al sdcieties, provided for three classes of certilicates instead of twu. The third class applied to [lersons who were licensed ti.i practice on accunnt nf lo vears ]irevi()ns exi)erience. It also pnixided that snch certilicates slidnld he applied for within six months after the act went intu el'feci, and that all pt-rsims hnldini; certilicates on account of It-i years (if previous practice, slujuld be subject to all re(|uirements and discijjline of the act. The fee for the issuance of certificates without examination was raised from line di liar tn h\e dollars, and a iirovision was made f(ir the issuance of certihcates to midwives, for a fee of two dollars. .Minimum requirements for schools of midwifery were adopted May 24, IS.S!). .\ comparative table published in 1S!I0 gives the status of the enforce- ment of the Medical Practice .\ct and the registration of jihysicians as fol- lows ; For purposes of comparison, the following totals from each of the five registers are here presented : Jan. 14, 18S0. Dec. 29, 1881. Dec. 1, 1884. Feb. 9, 1886. Jan. 1, 1890. Total number engaged in practice Graduates and licentiates of medical insti- 6,029 4,282 191 948 •608 6,037 4,488 183 896 •470 6.148 4,882 6,115 .5.098 6,215 5,524 Licentiates upon examination of State Board of Health 139 145 757 672 116 575 lO "* Since the completion of this Register, a careful examination has disclosed the fact that there were about fift.v more non-graduates in the state than were supi-oseii, consequently this num- ber has been addixl in the above tabic to the nuiuber of 'e.vempls, not certificated' for each of the years 1880. 1881, 1884, and 1886. "i No exempts under the law at this tune— and no teiliHciites ba.-. there was a gain of 1.1 li; graduates aiiil licentiates — these fiiiniing HI per cent of the total number in ISilO, as against about 7G per cent in Issii; the number of licentiates upon examination of the State Board was lar^elv diminished — mainl\- bv their transfer to the number of ENFOUCIiMEXT OK MEDICAL I'KACTICE ACT 383 graduates, very many of them having subsequent to their examination, at- tended lectures and ol)tnined diplomas ; also to the fact th:it few are added to this class owing to the increased severity of the examinations given by the Board. The following summary, from the first Register, and ciirresponding fig- ures from the 1S!H1 report, exiiibit these changes for tlie whole period since the Aledical Practice Act went into operation: July 1, 1877. .I:in. 1, 1S90. Tutal iiiiinlier ensas'ecl in practice 7,400 6,215 <:i:i.luntes anil licentiates 3,600 5,640 Non-grrailiiates - - 3,800 575 Percentaf^e of graduates and licentiates in 1877 - - "18 Percentage of graclu'ilule nf niininiuni re(|uircnients for the regulation of medical ccil- leges was also adopted. This year a hill was ])assed providing for the regu- lation of the practice of o.steopathy in the Stale of Illinois, hut ( iovernor Tanner vetoed this measure, because the "act is clearly in the nature of class legislation." The Hoard also agreed hereafter not to recognize any foreign diploma as a basis upon which to issue a certificate to practice medicine and surgery in the State, and that all a|iplicants holding such di])lonias shall be required to pass an examination. Interstate reciprocity was ailopted in 1899. The ;Medical Practice Act was amended again this year ;uid broadened so as to provide for the examina- tion and licensing of persons who desire to practice any other science or system of treating human ailments. At the annual meeting of the Illinois State Medical Society held at Quincv, Mav ■Jii--.'-j. Wwri, a proijosed Bill for an Act to Establish a State Board of Medical b-xaniiners was presented and received ai)]iroval of the Society as a whole. The Medical Practice Act was further amended in 19UT by embodying a i)rovision empowering the State Board of Health to determine the stand- ard of lilerarv and scientific colleges, high schools, etc.. to be accepted for prelinnnarv etlucation of medical students, and to require the enforcement of a standard of i)reliminary education by medical colleges; also providing for reciiirocitv and granting of the compensation to members of the examin- ing biard f(jr their services. In 19 1."i a law was passed amending the Medical Practice Act by giving the Hoard jurisdiction over certificates issued to all physicians licensed in the .'-^tatc under the various medical laws. ( )tiikk PiiAcrrnoXERS. Xeitlur the .\le, l!H).j, were promulgated and gi\en wiile pulilicitv in 11107, and all ciincerned were informed: "It is the duty of every Embalraer in the State of Illinois to thoroughly familiarize himself with every provision of these rules, the rigid enforcement of which is essential to the proper operation of the law under which they were created." REeujLATiox OF !Meiih'al PKA("ri( k Transferred to Department of Rkcisthatiox and Education. Through the enactment in 1'.I17 of tlu' .\dministrative Code, the re- sijonsibility for "the rights, powers and duties vested liv law in the State 2S6 KNFORCKMK.N'T OF MKDICAL PKACTICE ACT Board of Health relating to the practice of medicine, or any of the branches therrof, or midwifery, * * * * the regulation of the embalming and disposal of dead bodies, and for a system of examination, registration and licensing of enibalmers," was transferred to the Department of Registration and Edu- cation. Thus for the first tiiue since LSVT, the State Department of Public ilialth which w.is created Ijy this Act, was free to give the important sub- ject of jiulilic health the fair share of the attention it merited. AUXILIARY HEALTH AGENCIES. Jn the ])ninii tiiin of ln-alth in Illinnis the State and local dejiartmenls of health ha\e had the aid of nian\- health agencies. Some of these are arms of government and some are not. .^ome are known as health agencies and act directly as such. Others are known 1)\- other names and their con- tribution is more indirect. Some are naticjnal and some are local. The legislature in providing health laws and the courts in interj)reting them have made their contribution. The collateral administrative officers in other departments have made theirs. The contribution of go\-ernors and of the heads t'f the de])artments of education, agricultiu'e. imblic welfare and labor, have been outstanding. Among the national organizations that have helped to jjromote health in the State are the United States I'ublic Health .Service. Children's Bureau. U. S. Department of Labor. U. S. De- partment of Agriculture, the International Health Board, American Public Health Association, American Child Health Association, National Tubercu- losis Association and National Educational Association. Among the more active agencies operating principally within the State are those, some of the activities of which are detailed on the following j)ages. Quasi Public Health Agencies. Ilt.ix(ii,s Mkduwl Sdciktv. The Illinois Alcdical Society has been in continuous existence since 1850. While their main objective is the education ui ].)hysicians in the methods of curative medicine, keeping them abreast of the times and other- wise piromoting the professional interest of their mem1)ers. thev have not been unmindful of the duties of the medical profession in the field of pre- vention. For many years one of the sections of this Societv has been - that of preventive niecri])tiijns and dnnatidus hv iu(Hvidual nienil)ers of the profession. In llMi:; the Chicago Medical Society organized a course of lectinx's on hc:dih suiijrcls for lay hearers, 'i'hese lectures were held in the ])uhlic lihrary weekly for ahout two years. In 111-.'-.' ilu- Illinois .Mt-dical Society ])ro\ided tor a similar activit\- under ihe auspices of an h'.dncation Committee. This Committee began work in \'.>->'-\. Their report for January 1 to 'Mux 12. i'JT, made in Mav 111",'^ indicates the nature of tlu-ir slate wide activities. Seven counties in the State have made definite use of the service offered through the Educational Committee during these four and one-half months. The other counties have made use of the st'r\ice indirecth'. Eighty-eight requests for sjieakers have been tilled to date. The members of the speakers' Inirean have a])peared before such groups as Kiwanis, Lions, Rotary, Optimist clubs, women's clubs, churches, parent- teacher associations, teachers' institutes, home bureaus, Y. M. C. A., Y. \\'. C. A. groups, and boy and girl scouts. A speakers' bureau of colored physicians and another of foreign speak- ing physicians ha\e been organized in order to widen the circle reached through health talks. Thirty-nine new'spapers are using the health articles release;l from the office of the Educational Committee as a regular feature. These articles ai>ix'ar in all cases imder the signature of the local medical societies. Eight hiiudrt-d health articles ha\ e been released to the newspapers in the State. b"ifty-nine radio ])rogranis have been arranged for o\er stations, V\'CiN, WllT, W'l.S, W-MAO and WQ]. Reports have come from Wisconsin, Iowa, Michigan and Indiana as well as from manv parts of Illinois com- mending these programs most highly. Forty-tw'O moving picture films have been scheduled for use by lay groups. These have been obtained from the State Department of I'ublic Health, the American Dental Association, the University of Wisconsin, and the Society for Visual Education. Fi^■e communities have had splendid poster exhibits in connection with s])ecial health i\a\ |)rogr,ims through the courlesv of tlie lulucational Com- mittee. Coojieralion has been given to certain projects of the .^tate Depart- ment of Public Mealtli. such as furnishing speakers, films and posture exhibits for various groups during Health Week, The Connnittee has worked with the Illinois Federation of Women's Club^ in urging clul) women to cooperate with county medical societies in AUXILIARY HEALTH AGENCIES ^8!) all health activities. Letters have been sent out empliasizing the import- ance of educating the pubhc on the subject of cancer. .\l)proach has been made to all county societies where baljy ci infer- ences ha\c been held in cooperation with the child hygiene dixision of the State Department of Public Health. Through this introduction comity societies were enabled to work out their own plans with the State Depart- ment of Public Health. TIk' committee ser\cs as a clearing house in making ci^ntacts with la\ organizations. During National Baby \\'eek ])rograms were arranged and speakers supjilied for several department stores in Chicago. Special radio talks were also given by physicians and dentists. ( )ne hundred dentists were given complete [ihysical examinations at the amiual meeting of the Chicago Dental Society in V.'i'i'i. Twenty-five physicians were examined at the meeting of the Illinois State Medical Society at Aloline in May of the same year. The promotion of periodic physical examinations has been one of the more recent public activities of the Illinois Medical Society. Illinois Fkdeeation of AVomex's Clvbs. This organization has been of material sup])ort in furthering health measures. .\boiU 1012 when the war < n consumption down-state was in need of friends, the Federation through its local clubs and district or- ganizations made a survev of tuberculosis throughout the .State. The facts revealed by this survey and the local interest stimulated by it was largely res])onsible fcT the County Tuberculo>is .Sanitarium bill and for support of the county sanatoria throughout the State. At this time they are especially interested in promoting the physical and mental examination of children of preschool age. Illinois SoriExy for the Pkevention of Blindness. In I'.ilo in Chicago ten babies became blind as a result of neglected ophthalmia neonatorum. This led to the formation of the Illinois Society tor the Preventicn of Blindness. Before 1915 only 30 cases a year of ophthalmia neonatorum were reported. During 1926 nearly 600 such cases were reported. This does not mean that there is more of the infection. It means only that the cases are now recognized and properly treated. There has been a marked reduction in the mnnber made blind }earl\- and also in the number of graxe infections. 290 AUXII.IAUN mCAl.TH AGENCIES TIk' Society's lirst task was lo promote the juissagc of a law requiring that gonococcal infections of the eye be prevented by the compulsory use of nitrate of silver and that cases of the disease lie reported. They have helped in the enforcement of the law. The preventive is now supiilied free by the State Department of Public Health. The Society has promoted trachoma surveys and clinics, also examina- tion of children for usual defects. They have conducted work in Chi- cago and in the State outside Chicago. The other interest of this Society is in the poor vision found among school children. The Society works down-state as well as in Chicago, in making surveys of existing conditions, securing relief for those who are handicapped by eye defects and in helping them to useful occupations, and also in educating and interesting people in the prevention of poor vision. Chicago Tuberculosis Institute. The present Chicago Tuberculosis Institute had its begmning in the Visiting Nurses Association in 1902. Miss Fulmer, the superintendent of nurses wrote her board calling their attention to the gi'eat amount of time and money spent by their organization in nursing and otherwise helping persons sick with consumption. She suggested that some money, brains and energy spent in jirevention would eventually save something in money, brains and energy spent in care and occasional cure. As a result of this communication the Visiting Nurses Association called a meeting of physicians and other interested persons, members of their board to convene in the rooms of the Association on January 21, 1903. This meeting organized a committee on tuberculosis. The Association voted $2,000 as a part of funds necessary to start the work. The plan of activities adojjted was that proposed by Dr. A. C. Klebs. In ]\Iarch, 1903. this Com- mittee began to function in rooms adjacent to those of the Visiting Nurses Association. By October, 1903, the Committee reported 67 cases of con- sumption under their direction. In November, 1903 it was reported that a course of lectures on tuberculosis had been arranged for. In March 1905, this Committee sent a letter to the \'isiting Nurses Association proposing that the Tuberculosis Committee form a separate organization. The \'isiting Nurses Association replied that they consid- ered that the time had come to consummate that. At the third annual meeting of the Tuberculosis Committee of the \'isiting Nurses Association held January 27, 1906, the Chicago Tuliercu- losis Society was fonned to take o\er the activities of the Committee. This was in efTect nothing more than creating a new form and selecting a new name for the old Committee and its work. The change was made with the AUXILIAK^ iii:ai.tii agencies ^91 appnival of tlie Xisitint,^ Xiirses Assuciation ln-cause it was thought the wurk could be hcttur tlonc by a separate org'anization. Most of the old com- mittee members continued active in the new organization and two of them, Mrs. E. C. Dudley and Dr. W. A. livans have been in continuous service since and are still active. March 1, li'06, the name was changed to the Chicago Tuberculosis Institute. It was chartered March i;. 1 !(()(!. .\t first the Society did nothing except educational work, study and propaganda. On September 1. l!t()(i, they established a temporary sanitorium or camp on the grounds of the Dunning institutions. It was known as Camp Nor- wood and it served the jniljlic in a small wav from that date tmtil IMarch 31, 1907. The Institute inaugurated a free dispensary service on May 15, 1907. This was gradually extended as to the number of dispensaries operated and the variety of service given until .September 1. 1010 on which date the service in its entirety was handed over to the Mimicipal I'uljcrculosis Sanitarium. On May 27, 1907, after an interruption ied se|iarate rooms hut adjacent to those of the luslilnte. Later on thev employed a full-time suix-r- illtendent. still later the offices were removed to S|)rin£;tield. Decemher :)(i, I'.MS, the officers of the llliniiis Society for the Pre- vention of Tuherculosis completely se])arated the (.'hicago 'fuherculosis Insti- tute from affiliation with them creating Cook County as a separate juris- diction for the sale of Christmas seals and the doing of tuherculosis work. On Jannar\- 11. JItl!), this action of the Slate Society was ap]iro\ed by the executive comiuittee of the National Tuberculosis Society. .Among the acts and activities of the Chicago Tufjerculosis Institute found recorded in the minutes in addition to those narrated above are the following : Propaganda lie fore the legislature for a State sanitarium and for a tulierculosis bureau in the State Department of Health. Propaganda in su]i- port of the Glackin law for a municipal sanitarium in 1909. Activity in the camiiaign on the referendum under this law which vote established the i\Tuiiici])al Tuberculosis Sanitarium. Council in the organization of the sanitarium activities under that act. On Inly 17, 19ijT. the Chicago Tuberculosis Institute turned over to the city health de])artment their street index file of tuberculosis and the filing cabinet in which this was kept, the city health department promis- ing to keep this file alive. They helped in the passage of the Glackin county sanitarium bills, the pastt-urization ordinance and various laws for the repression of bovine tuberculosis, they organized stud\ classes for tuberculosis in industry and for the scientilic and clinical sliuh- of the disease. the\- conducted exhibi- tions and issued leaflets and ]iamphlets. Their present major activities are as follows : A general nursing service in more than one-half the countv. This service is acti\e in the control of all forms of contagion. 'J'his service is rendered in coo])eration with the county and local health departments. A health service rendered by physicians attending a number of health centers. A follow-np service for persons who have arrested tuberculosis. A health sur\-ey service. A course of leclnres I'li public health for nurses in training. .\n eniplo\nient agencv for nurses trained in tuberculosis \\(irk. An educational and propaganda service. A srniilarium service and ojier miscellaneous services. auxiliary health agencies 293 The Illinois Tuberci'losis and Health Assoclvtiox. The \oluntary organization which has done more to prumote general public health inijirovement than any other non-official agency in the Stale is the Illinois Tuberculosis and Health Association. Originally estalilished for the purpose of concentrating its efforts against tuberculosis this organi- zation became in time a [jowfrful factor in the general held of public health service through the stimulation of local public health nursing ser\ices. It changed its name three tinus but its functidus, while emphasizing tubercu- losis work in particular, ha\e included general activities for the greater part of its life. Through the sale of Christmas seals this organization has had more resources than any other volnntarv agency for doing health work in the State at large. These haye been used to gocd advantage, residting in the establishment of local voluntary health organizations, local nursing services, tuberculosis sanitariums and the promotion of health education. Always the policies and activities have conformed with standard practices set up by the organized medical profession and the public health authorities. The organization had its beginning in 1 !)().'! when Dr. J. W. Pettit of Ottawa, Illinois, read a paper on consumption before the lllimiis State Medi- cal Society. Following this he was appointed by the Society to the chair- manship of a committee on tuberculosis with instructions to carry out what- ever plans seemed practical and advisable. The National Tuberculosis Association had just been organized in New York and encouraged with the interest of the State Medical Sijciety, Dr. I'ettit sent out a letter on December li, IHO-I, calling a meeting for the jjur- pose of organizing an Illinois tuberculosis association. This meeting con- vened at the Great Northern Hotel. Chicago, December 14, I'.)(i4. Seven- teen attended. The outcome was a plan, which later materialized into reality, to organize an association t(.) function on a state-wide scale. The organization was called the Illinois .Xssociation for the I'reven- tion of Tuberculosis. Dr. .\. C. Klebs was elected ])resili. Its first stafT consisted of one nurse who had a desk in the wom.an's club in Chicago. In 1!M1 some adililional perse nnel was availed of hv means oi funds set aside for the purpose by the Lountv judge of Cook County. This work in the Cook County courts was taken over bv the court in 1!»1."). In ]'J'i-) the need of definite practical training in mental hygiene for social workers was demonstrated to the social service agencies in Chicago. A (healthj demonstration of the relation of meiUal hygiene to personality difficulties was made in a Chicago high school. Local meiUal h\giene com- mittees were organized in two Illinois communities. A survey was made of the mental hygiene conditions in the schools of LaSalle. Illinois. The .'Society helped to firing about the organization of the State In- stitute for Child Ivesearcb. Much of the energy of the Si;ciety is ex- pended in popnlar education and proijaganda for menial health. American Hkh Cross. The .\merican Red Cross first entered the field of rural nursing in I!)!".'. Their actiyities in home nursing were increased when the State troops were called to the border in I'.iKi. A program of dexelopinmi on a large scale was adopted in l!ll!». \\'hile most of the work of the rural nurses 298 AUXILIARY HEALTH Ar,i:NCIES takes the loriii of Ijedsidc luirsiiin- of the sick much of it is preventive in character. In April !!,•"-'■;, pubhc heahh nurses were employed in 1 V counties as county, school or community nurses. In lifly-nine of these counties the American Red Cross participated in inaugurating the service. There were seventeen Red Cross chapters employing public health nurses. Eight of these nurses are financed entirely by the Red Cross and nine jointly by the Red Cross and otlur agencies. The Red Cross conducts nearly five hundred classes yearly in home hygiene and care of the sick — issuing certificates to about 11,000 persons yearly. The following are some of the (jrinciijles of the nursing service: "The protection of the jjublic lualth is fundamentallv a governmental problem but at the same time, it is i ne that re(|uires the intelligent and active co- O])eration of the iiuli\idual citizen. The function of the Ived Cross is the pronK)tion of indi\iiich a thing is possihle. The work done in Illinois outside of Chicago is liiuiled to propaganda and edticalional acti\ities. Citii.niM'.N "s I Iiisi'i I'Ai. Socii'-.TV A.xn Mii.k Commission. In Decemlier 1!hi-^. folUnving the \isit of Dr. A. Lorenz of X'ienna, a movement was set on foot liy the WHnian'.s lluh reform de].)artinent to provide Chicago with facilities for sick children. This meeting resulted in the organization of the Children's Hospital Society of Chicago. Dr. Frank Billings was elected president. Mrs] Harold McCormick. secretary. Mr. E., G. Keith, treasurer and Mrs. Flora G. Moul- ton. chairman of the Membership Committee. In .May, lIMi:;, this Society organized the Milk Commission of Chicago. This .Milk (.ommission remainerl active thereafter although the parent society (the Children's llcjspital Society) appeared to have lapsed. Mr. and Mrs. Nathan Straus of New York donated to this Society a pasteiuizing ]ilain which through the conrtesv of the Chicago Board of liducation was located in the basement of the Thomas Hoyne .'School, Cass and Illinois streets. Chicago. Dr. 1. .\. Alit was chairman of this ( cinimission and Mrs. I'lummei anil .Mrs. .Moulton were in control of tlu' plant. They began distrilniting nnlk 1 n July ;, i:to:!. and continued until .\o\ember 28, 1!)03. In this time tbe\- distriliuted ■.'■.'■.'.( mm) bottles of pasteurizecl modified milk. It was sold below cost thiough thirt)-one milk stations. The lal)or.itor\ work on this milk was done without cost by the C'olum- bus Medical l.ahuratorv through Dr. .Vdolph ( lehrman. -\t a public meeting to promote this acii\it\' helfl at the Chicago Woman's Club. May 21i. 1903. speeches \vere made b\- Mrs. Chas. Henroten, Dr. V. Billings, Miss Jane Addams, .Mrs. Ceo. I'lunimei-. Mr. Steve Sumner of the milk drivers union. Mr. 11. B. Farmer of the milk shippers union, j. E. Allen, Chicago and North Western Railroad, Professor IC ( ). Jordan. Dr. -\. R. Reynolds. Dr. I. .\. Abt. James Cheeseman, Dr. W. S. Christopher, .Mr. II. 1'.. ( lurler ;ind Dr. Kosa lutgelnian. In l!Hi:') the C'ommission continueiect ol Stale supervision of milk b_\- E. i\. Eaton. Erom this article we learn that the Illinois legislature passed a law in 1S74 which prohibited the adulteration of milk under a penalty of $")(HI In 18T!) they passed a law prohibiting the selling of impure milk and also the selling of milk from diseased cows. The penalty was $10(i. In 1S97 they provided for State standards for milk. In IS'.MI another law created the office of State food commission and ga\e them some control over milk. An interesting report on the wi.rk of I'.KKl is a report of the home and dairy visits of a field worker. .Much of her time was s|)eiit in in- structing mothers how to keep their babies well. This t}-])e of actixitv was continued for sexeral vears. ( In |ul\ 'i I, l!t()S, the Commission was chartered. In its year book fur December -'11. 191! the Milk L'ommission says, "l""or eight \ ear> (since 19(i;!) the Milk Com- mission for Chicago has sitccessfully carried on its work." Chicago Infaxt A\'hlkai!e Society. On March 10, 1911, the Infant Welfare Society was foimed li\' a reorganization of the Milk Commission. The milk stations were closecl and the new organization continued the policy uf instructing mothers in the iiome and in stations, but stressing this type of activit\ especialK . Judge Julian Alack resigned as president Januarv '■'>]. 1911. and Mr. Lucius Teter succeeded him. Two im|)ortant conferences with represen- tatives of the Chicago Medical Society are referred to in the minutes. On December 28, 1908, a joint mei'ting was held to discuss the confusion which seemed to be arising relative to the use of the terms medical com- mission, milk and certitiefl milk, commission milk. This seems to have l:.een adju>ted by having the Milk Connnission rccoinniend some persons to membership of the Milk Certifying L'ommission of the Chicago Medical Society. This source of friction was cntii-ely rcmo\ed little more than two years later when the Milk Commission changed its name and stopped sup- [ilving milk'. 302 AUXILIARY HEALTH ACENCIES Another consultation willi rc]>rcsfiitativcs of the Chicago Medical So- ci(.-l\- was hclil l'\;hru,ir\ '.'. i:i have heen so i)ronouiicc(l as the differences between lieaUh con(htiiins that ])revailed fifty years before and fifty years after b'-;;';. I'rinr to that date tlie territory inchided \viliiin the boundary hues of ilir Stale went throULjh a ])erio of the L'nited States. I'racticaily no ini])ro\enK-nt in niortahty and siei that immigration poured in regardless of health liazards. It was true, further- more, that the diseases which beset humanity in Illinois after the plague of malaria became more tolerable were common everywhere so that there was no point in avoiding the State because of them. At the end of the first fifty years subsequent to \S]~,, Illinois enjo_\ed the re])Utation of being one of the most healthful commonwealths in the L'nited States. Mortality statistics uphold this reputation. While many factors are present that ]irevent mortality statistics from portraying an absolutely accurate picture of health conditions they do, nevertheless, reveal what may be accepted as ajiproximately correct information. The factors present in the Illinois statistics are, moreover, to be reckoned with in the data from every other State so that comparisons are justified. The mortality records iniblished by the United States Bureau of Census give lllinoi> a lower death rate for 1!)'26 than the United States and a rate lower than an\ other of the seven states with an estimated population of 4, ()()(), revalence of such diseases as cholera, typhoid fever, diarrhea and other intestinal disturbances. There are no general mortality data a\ailable which furnish a reliable basis for comparing health conditions in Illinois during the various |)eriods referred to. All of the statistics relating to the State as a whole are frag- mentary for the years prior to 1918. Th.-ii was the dale when Illinois was SOfi IIKAI.TII CD.NIHTIONS Al'TKU 1877 ailniiltrd to tlu- I'nitcd Slates death re,t,dstrati(in area, a manifestatinii that iiiniialil\- repdils were suflieieiitlv edinplete ti) warrant federal reeiif^iiition. Before that date they had ranged front sixty to eighty per cent ineomplete. That much disere]>ancy make unreliable any conclusion that might be drawn from general mortality rates based upon the published records of death. With all of their inc(]nipleteiiess, however, the statistics for specific dis- eases iiroviile \aluable basis for conclusions regarding the public health. These data, together with inforni.ition collected from other sources, iuniish material for tracing the trend of man's con(|nest of disease in Illinois and the success that has attended his eli'ort>. This is set forth in tln' chapters that follow. The two factors which contriiiUted more than any other to the fall of communicable diseases in Illinois after bs7; were the requirements of case reports and the development of bacteriological laboratory service. Quaran- tine and the isolation of patients helped, but nowhere in the wdiole category of infectious ailments was progress toward eradication so pronounced as it was with those diseases for which laboratory facilities provided aids in diagnosis and specific products for cure or prevention. Alalaria is a possible exception and in this case the great change in'environiuent that drove out the disease might be thought of as the unconscious operation of a great sociological laboratory. Smallpox is perhaps another exce])tion but here by a happy circumstance of clever observation man was able to employ a jiro- cedure stripped of s|)ecihc bacteriological information which in relation to another disease would have waited for the results of laboratory research. Tuberculosis, typhoid fever and diphtheria are the three diseases against which the luost phenomenal progress toward eradication w^as made. The marked receding prevalence of each set in after the introduction of labor- atory^ service concerning each. Toward the end of the period coveresence ot -mallpox, these measures were neg- lected and later even attacked in the courts w itli the usual result, that con-, ditions soon 1)ecame rijie again tor another oullireak. The history of smallpox in the Slate is ^raphicallv shown \)\ the chart in iMi^m-e IN-A. which shows the course of the disea>e from ISiiil in d.ite. as indicated by the decennial or animal mortality rales as far as these are avail- able. Hninllpox Not Preraloit. Smallpox, not being especialK- pie\aleiil during the first two \ears of the Board's existence, did not demand any special attention. L'ondilions soon changed, however. Immigration into llu- State from liurope was heavy. The population was umaccinaled. The apjiearaiice of an e]iideinic 308 IIILALTII COXDITIOXS AKTEK 1ST' was only a niallrr nf time. This time arrived about 1880. P.y 1.^81 tlie situation was eom])le;ely beyond control. Small]>ox was rampant. General conditions as well as tho.se in the State were grave enougli to lead Dr. |ohn 11. Kancli. .Secretary of the State Board of Health, to take it upon hiinsclt' to call a .t;eiieral conference to be held in Chicago on June 29-;iO, 18SI, to consider the smallpox situation. In answer to his call 18 health organizations from 14 different states responded. The federal gov- ernment was represented by members of the National Board of Health, an organization that was in existence at that time. The meeting was held SMALLPOX in ILLINOIS 1860-1926 STATISTICS UNAVAILABLE FOR OPEfl YEARS at the a|i])ointe(l time, and after full delilieiation, the Conference recom- mended that Cull!.; less incorporate into the laws regulating immigration, a provision reciuiring protection from smallpox by successful vaccination of all immigrants, also that the National Board of Health consider the pro])riety of re(iuiring the ins]iection of iinmigrants at ])orts of departure, the \accina- tion of those unprotected, and the deteiiiion of ;d] unprotected |>ersons who hatl been exposed; that measures be taken fur ihi- (|uarantine, by the deten- tion of all steamships bringing immigrants nut pi(i\ideil with proper evidence HEALTH CONDITIONS AFTER 18T7 309 of vaccinal protection ; that local health authorities also inspect all immigrants arriving in their respective jurisdiction and enforce proper protective and preventive measures when necessary, and that the National Board of Health take steps to secure the inspection of all immigrants and the vaccination of the unprotected hefore landing them at any jiort in the United States. A considerahle part of this program was carried out later. An immigrant in- spection service, fnr instance, was established in the United States for the six months of July U> December ISS-^. Physicians were posted at rail- way terminals thniughi ut the country. Dr. Raucli was superintendent for the Western District and caused the insiiecliun nl' 115.057 and the vaccina- tion of 21,618 immigrants bound for Illinois. This wi)rk was done largely at Chicago and St. Louis, the railway terminals leading into the State. Table 25. c ASEs OF Smallpox Reported in Illinois. Year. .Jan. Feb. Mar. Apr. Ma.v June 1 Jul.v Aug. Sei t. Oct. Nov. Dec. Total. 1917 1 S56 910 526 657 811 411 312 114 148 168 93 292 4,996 1918 742 744 645 557 571 189 103 73 26 42 36 114 3,842 1919 322 284 465 567 5-4 442 183 135 232 260 648 779 4,871 1920 776 842 748 1,063 1,232 909 383 212 198 326 553 1,294 8,536 1921 1,900 1,659 1,760 1,204 1,027 412 102 29 23 39 120 261 8,536 1922 3,3 360 228 197 238 115 175 40 8 75 176 133 2,118 1923 369 121 64 50 69 128 39 24 9 28 15 21 937 1924 37 46 95 HI 164 242 168 46 42 187 58 166 1,362 1925 210 299 220 215 150 194 46 30 20 30 79 137 1,630 1926 177 164 108 165 135 105 93 21 26 5 25 51 1,077 1927 172 118 213 113 150 63 67 1 1 ' Oiifhreal- nf 1SS1 and 18S2. The a\-eraj.;e pre\alence of sniallp(.)x during the _\ears 1S7T to ISSO was relati\ely lew, but early in ISSl it began to increase, and by the mil (if the year a tcjtal of :i.(iOO cases was reported, of which nunilier l.lso dccurred in Chicago. At a special meeting of the .^tate Board of Health, in November l.SS], the notihcatinn uf smallpox or other epidemic disease was made compulsory. Local health officers were required to collect the rep(jrts from practicing ])hy- sicians and transmit them |)rnnii)tly to the Board. It cannot be said, how- ever, that either cases or deaths were reported with any large degree of completeness because no machinery for collecting reports existed. There were very few local health officers. The situation was serious and re(|iiired vigorous action. Recognizing school children as a large section of the population which coujd easily lie 310 IIMAI.III CO.NDITIOXS AFTKK 1ST7 reached with the least etitirt and in the <|uickest time, the Board ordered that no child be admitted to ]nil)lic scimuls in the State after January 1 with- f)nt .yiNinij evidence of successful \accinaliun or a histor\- of >inanpox. The plan worked. Within sixlv days aftt'r the order went into effect the percentasie of \accinalcd school children rose from al)out l-"i to !i I jjer ci'nt. A consideralilc inimlier of adtills, particularly t-mployees of lar^e in- dnstrics like the railway companies and inniatt-s of State institutions were alsanish-.\nierican War in 1S!),S were vaccin.-iled against smallpox ihrough tin- acti\it\' of the State Hoard of Health. 1909 1910 .. 8 8 14 0.4 0.14 6.7 mil .. 8 0.13 1.4 1!I12 . 12 0.20 54,6 1913 3 0.05 Sl.S 1914 20 0.03 3.1 1915 5 0.08 .32 1916 6 0.09 1.8 1917 - - 10 0.02 191S 14 0.23 .51 1919 ... 0.08 1 3 1920 ... 16 0.23 2 6 1921 ... 26 0.37 4 7 1922 ... 23 0.34 2 5 1923 ... 2 0.03 0.03 1924 .... 16 0.23 09 1925 23 0.31 0.02 1926 -.- 8 0.11 312 TIF.AI.TII COXDITIOXS Al'Tl.k ISTT Smallpox in 19UH and After. In 1903, a total of 1,6G1 cast-s of smallpox were rrpuili-d and it was estimatc' inviihcd a cit\- ordinance which required vaccination as a contingent upon school attendance. Here again the Supreme Court de- cided in fa\iir of the plaintitf, holding that neillier local health ollicers nor cities had the authorilv to make or enforce such oi^dinances. Thus it was made very clear that compulsory vaccination w^ould not be tolerated in Illinois under prevailing laws. It was up to health officials to fnid some other wa\' to control smallpox. This situation resulted in the practice of requiring either vaccination or (|uarantine of exposed persons in a conimunit\ where smallpox was actually present. The courts have generallv uplield this procedtu'e. It is still in vogue and operates fairh- satisfactorilv when the .^tate health officials are alert. Practically ever^nne in a comnnuiitv ma\' l)e regarded as exposed to ^mall])ox when the disease is |iresent so that the method jjractically amounts to com])ulsory vaccination on the installment plan, the nistallments coming due when epidemics threaten. Since 190.J smallpox has Huctnated with the \eais, \ar\ing with the de- gree of .success that attended \arioirs schemes for stinnilating \accination. In general the disease has been mild although m.alignant cases were intro- duced into Illinois in lie.'".' and again in 111'.' I. Mortalitv has steadfastly remained below one death ])er loo.ooo peoi)le, howe\er, dm'ing the period. The last significant ste]i toward jirevenling smallpox in Illinois was taken in l!i'21 when the State Department of Public Health imder Dr. Isaac IX Rawdings began the practice of making a personal investigation of every reported case of smallpo.x and everv reported case of chickenpox in adults. Field physicians are assigned to these duties as they arise from time to time so that the control methods described aliove can be applied ])rompllv and ef- fectively. .State and local ln'altb offici-rs have indulged in sporadic campaigns agi- tating voluntary vaccination ,inil these efforts result in considerable success. P)y combining the last three methods mentioned the he.ilth officials have been able to m.inage smallpox aliout as satisfactoril)' as could be expected under existing conditions. .\o alarming outbreaks developed Uj) to this writing subse(|uent to \'.)'i\. HEALTH CONDITION'S AFTER 187 T .313 History of the Chicago Smallpox Epidemic of 189;1, 1894 and 181)5 With Side Lights and Eecollections. [Bi/ Arthur R. KriiiioMs-, M. £».*] A serious epidemic of snialljiox occurred in Chicago during the years 1S'.)3. 1894 and 1895. Not the most serious in the city's history, for three great epidemics had previously occurred, one in ISCl, another in 18T2 and a third in 1SS2. All were much nnjre serious than that of 1893-1S9"). Each had more cases C(inii)ared with the population, all were more fatal and nunc of them were so speedily suppressed. During the ])revalence of smallpox in 1880, 1881 and 1882, a total of (i,835 cases were reported. In the 1893-1895 epidemic the cases numhercd 3,754 in a population more than three times greater than ill the early eighties. There was no smallpox in Chicago during 1890 and 1S91. In the following year eight cases were reported, two in May, one in June, three in Se])temher and four in December. Concerning these the chief medical inspector. Dr. Garrott. in h\^ annual report, wrote "We were ahle in every instance to trace the source of contagion to other Oi/srt of Epi/Iiiiiir and Varciiiatidii. In January, 1S93. there were three cases fi)lli)wed liy three in I'^ehruary and live in Aijril. The onset of the epiilemic of 1S!)3-1S1)5 has ordinarily been given as June 12, 1893, because from that time un there w;is a contin- uous monthly occurrence of cases. Undoubtedly the disease had been smouldering for two years previously in the form of unrecognized cases for on July 6, cases w-ere found in three widely separated localities and none could be traced to their origin. In .\ugust there were nine cases, in Septem- ber three, October nine, November thirty-five and in December sixty-six. It was the year of the World's Fair. Throughout 189g the b'air was in course of Iniilding. Thousands of workmen and others came to the city and (if course they brought whatever contagion they had with them. Ex- hibitors and others from every country were coming for a year liefore the Fair opened in 1893. Indeed the formal opening of the h'air was in ( )ctober, 1892. It is, fair to assume that smallpox was one of lln' things the Fair brought to Chicago. • Dr. Arthur R. Reynolds vva.s appointed Conimis.sioner of Health for Chicago by the elder Mayor Carter H. Harriwm, .April 17, lS(i:!, and served until .lune 13, 1SS5. He was aRain ai)pointed by Carter H. Harris. ni. .!r.. April 1 M. 1S!i7. and reappointed every two years until ,Iune 27, IftO.";. 31-1 nicAi.iii KiMinioxs after 18TT There had hucn ,t;rcat iic.l;1<.-cI of vaccinaticm fcir K) years previously. In the last six months of IS!i;i nearly one hundnd thousand vaccinations were done bv the department and that was more than had been done in several years l)efore, all told. Mranwhile every means that the department could devise was employed lo arou>c the ])uhlic to the necessity of vaccination. Letters were written to the Miptrintendents of public schools, to the parochial schools, to private schools, to the head of btisiness concerns, factories, the railroads, etc., ur^int; that they see lo it that those whom they em])loyed or were under their control wvvv \accinated. h'roni all came hearty responses and pnmiises of cooprratii in. In newspaper inter\ie\\ s the necessity for vaccination was constantly stressed. The foreiijn lani^nage press was a])- pealed to and innumerable local publications were also addressed and from all valuable help and cooperation was obtained. By January 1, 1894, the public was thoroui^hly aroused. livery jihy- sician in the city was vaccinating;. This valuable start was m;i(le without any increased expense to the department cxcejit for the vaccine that was distributed free to all who would use it. The covtntry was in a period of ^reat llnancial stringency Repeated re- quests for a])propriations of money br(.night no results. I'inally the mayor told me to cut loose and do whatever was necessary. It was realized that the entire cit\' nnist be vaccinated immediately. Several hundred physi- cians and senior medical students were employed to vaccinate. The city was divided into districts and those again into sub-districts and men put to work until the entire cit\- was covered by \'accinators who went from house to house and from group to gmu]). h'ive hundred were employed at one time and more than half a million vaccinations were done in three or four months. .\mong this ccn'ps of vaccinators were some of the city's ablest medical men, others who later became ]jrominent practitioners. Dr. |iihn Dill Rob- ertson was a vaccinator for the department in 1894. In llil."> he became ce-mmissioner of health for Chicago and held the office seven years with a good record. He is still ])rouil of having been a vaccinator for the depart- ment in bis early career. Later the city council a|)propiiated $l()(),(ll)() but a rough estimate of ex- peiidilurt'S revealed that the enlire sum had l)een sjient or contracted for when ihe a|)iiropriation was made. Prcif/rcss, II (isjiitu'iintniii aii'l Oilier / iiciilnifs. .\n emergency hospital was ert-cted and soon beds were available for everN- patient and thereafter every case was hospitalized. Ly May, 1S94. the backbone of the epidi'mic was broken, b'rom then on there was a dimin- HEALTH COXDITIO.XS AFTER l!ST^ 315 ishing number of cases each nKintli. The last case Dccurred in December, 1895. It must nut be jjresumed tbere was no faultfindint; nr criticism nf tlie (iepartmciit and its head. There was jjlenty of it and it was persistent but we knew that we were on the right road and tliat the pubHc as a whole were with us and stood firmly behind us. There was in fact great apprehension in the city as there always is in time of peril, but it haul|iliur funii,i;atii)n. Durini^r the eoin'se nt the epidemic the flepartment was offered the use of a Ions; tuhiiiar steel chaniljer in a convenient location ihat had lieen used for (Iryinii hiniher. It was fitted with steam pipes, so that the interior could he raised to a high temperature and was therefore suitahle for use as a dis- infecting chamber. It had a conveyor that carried its load from the entrance to the exit at the other end: the front was fitted so that live steam could be turned in. This plant was accepted and tised for the disinfecting; of bed- ding, clothing and similar articles. 'I'he goods were hauled to it, put in the steam chamber and were taken ox was imminent. One \erv eharming lady visited the commissioner of health to \dice the objection of the religious organization in which she was a leader. .She said her people had other means of preventing disease and that they did not (|uail before smallpox. She also said she and her church w^ere law abiding 320 IlICAl.Tll IDNDITIONS AFTER 18TT I'Ut wanted tn talk ii (i\xt. AnKini,' others (if lu-r art;'uniems she said thai C'hrist did not sav anything about vaccination. She was told, with sacri- ligious ri>k, that vaccination was not known till Dr. Jenner discovered it less than one hundred years a.^n hut that nearly all the followers of Christ were in favor of it now. Later it was learned that her organization gave instructions to snlmiit to vaccination when the authorities demanded it but prayed that it might do ihem un harm. The department was frequently m-ged by this group or that to forcibly vaccinate the objectors. The fact was wi- never had the authority to vac- cinate b\' force nor does that power exist now. We did have the authority of law to quarantine any who refused to lie vaccinated. That ])ower was used in one notable instance where a hotel full of a religious grou]) were shut in for weeks. A total of 3754 persons had smallpo.x during the two and a half years of its reign. Of these IvKi dietl. The survivors had their usefulness im- paired in many instances. Many were seriously poc-marked and their faces less lovely to look upon. The ex]jense to the city was great. I'he imjiair- nient to traffic and commerce was, however, rendered almost nil. There was the toil and trial of thijse in the department who cared for the sick and suppressed the disease. Had it any influence on the jiresent or any lesson for the future? We think it had ami that not only Chicago Init the world learned a useful lessi.ui. The Lesson. The epidemic was due to the neglect of vaccination. It demonstrated anew that none who were truly vaccinated contracted the disease and that a successful vaccination left a scar typical of vaccination and unlike any other scar; also that in cases of skin eruplinn. where a diagnosis was difficult, the presence of a typical Jennerian scar, made the decision that it was not sm.allpox iiractically certain. It showed that everybody could be vaccinated when it was properly presented and hence vaccination by force was poor ])olic\- and unnecessary. Experience showed that vaccination with jnire vaccine did not cause a bad sore and left only a small scar and that large scars were due to extrane- ous infection and as a rule did not |)rotect. Cholera During the .")() years since the establishment of the .State I'oard of Health, a jjeriod which may be designated as one of suppression and control of disease, there is no better illustration of a comprehensive campaign car- ried on for the prevention of an epidemic by a state health department than the safeguards and sanitary [jrecautions taken by the Illinois State Board in HEALTH CONDITION'S AFTER 18T7 321 1884 and 1885, in its efforts to prevent the invasion of Asiatic cholera. Tliis disease had frequently invaded Illinois prior to 18;^. the year in which the State Board was estahlished. The ('Jidlcra Duiiijir in 1SS4. .\s early as July. 1883, the danger of an invasion of Asiatic cholera into the United States and Illinois was noted hy the State Board, and preliminary action was taken with reference to measures necessary to resist its introduc- tion and til prevent its sjjread. The safeguards determined U])on as the most promising for success were two- fold. The first was an intra-state measure and was to take the form of a state-wide sanitary survey to determine the sanitar\' needs, and a sanitary "clean-up" if data ohtained through the surve\' indicated that this was needed. 'Ihe second was inter-state and related to aiding and insist- ence upon enforcement of quarantine requirements and insjiection methods along the Gulf and Atlantic coast, together with efforts to secure inqjroved sanitation and cleanliness of the various neighboring states. 'ihe cleanliness campaign was based on the prevailing theorv in regard to origin and spread of cholera, and was possibly also conducted with a view that it would have a good effect in the saving of lives from other tilth diseases far in excess of the mortality from the cholera itself, unless it shonld spread beyond all expectation. The Board inaugurated this campaign witli the following statement to the public: "An epidemic spread of Asiatic cholera now seems inniiinent. Mention is m;ide of cases in hjigland and I'rancc Whether the disease will cross the .\tlantic fr(]m the luist will depend iqion the efficac\- of measiu'es emjiloyed to confine contagion to the ]iresent localities." To guard against the invasion, the secretary of the State B( ard made the following statement and recommendation: "My experience and observation lead to tlie conclusion that it is not judicious to place entire reliance on quarantine measures, no matter how administered, should the disease become epidemic in countries or points with which this country has close commercial relations. As Asiatic cholera, although it may invade places in good sanitary condition, tinds its most congenial habitat where filth in any form abounds, the best attainable sanitary condition; clean streets and premises, the prompt and proper disposal of organic refuse, night-soil, and all forms of sewage; well ventilated habitations, with dry. clean basements; a pure and sufflcient water supply; and good, individual hygiene, including personal cleanli- ness, proper diet, and regular habits of life — these are the best safeguards against Asiatic cholera. "I have to respectively recommend that a thorough and svstematic sanitary survey of the State be inaugurated by the first of January. 1SS5." The results of the efforts made in 1 .siS4 to secure a general inspection and improvement of sanitary eonrlitioiis were as follows: Reports Irom •.':>() cities, towns, and villages were received in re|iiv to the circular seiu out, and an innnense amouni of work was acconi])lished 32"3 iiEALTii coxnrTioxs akteu 1877 in remedying the detects disclosed by the inspections. The secretary per- sonallv inspected a number of the State institutions, and found them in as good sanitary condition as could be expected in view of faulty construction, or location, from a hygienic standijoint. Suggestions for imi)rovement were given and carried out as far as practicable. s.\.\iT.\RY survey: At the next meeting of the Board, the secretary by rcsdkniiin \\a^ auilmrized "'I'd prepare the necessary l)lank> and in>tnu'tii in>. and til distriljute the same to the proper authorities of cuunties. tii\\ii>hips. and municipalities, tdr a thorough and systematic sanitary survey of the State, to be begun by January 1. 1885, or as soon thereafter as iiracticable." The secretary explained that it was proposed to l)egin work in the southern portion of the State, and to work northward as rapidly as the weather would permit, so that by May 1 the sanitary condition of every dwelling in all of its parts, of all premises, outhotises. wells, cisterns, and other belongings should be made known, the remedy of defects be pushed, and the authority of the State Board be exerted wherever necessary in su])- plemcni the efforts of the local authorities of the State to reust the threat- ened invasion of Asiatic cholera. A much greater share than u^ual of the labor of the Pmard in ISS.") was devoted to purely sanitary work and efforts to prevent the invasion and spread of cholera. The records show that a total of 300,000 houses and premises were inspected in 395 cities, towns, and villages. These inspec- tions were made from March to December, 1885, and embraced '.Hi of the 102 counties. The thoroughness of these inspections made at that early ]X'riiid wnuld do credit to any state-wide sanitary survey, and the relati\-elv Inw cost of this survey is remarkable for even that period. These inspections embraced every material condition affecting health, individual and public ; site of house ; its age, material, ventilation, condition, especiallv of Ijasement or cellar, of cesspools, sinks, drains, outhouses and water supply; of the yard and stables, barns, etc.: tlie vaccinal status of occu])ants ; the occurrence of certain diseases, etc. They disclosed in 382 places from which reports were received at the end of the \ear. a total of 474,831 defective conditions and nuisances prejudicial to health, of which number 441,593, or over 90 per cent, were reported abated or remedied. The sanitary surveys of cities and towns were begun early in June, and the house-to-house inspection was resumed in the extreme southern ]Kirtion of the State as soon as the weather permitted, and was In- midsummer, suc- cess full v prosecuted throughout its entire area. These surveys were at first largely tentative and experimental; but they were the means of discovering, in many cases, a multitude of defects HEALTH CONDITION'S AFTER ISTT '323 and evils, the dangerous importance (if which had heen overlooked or whose existence had not been suspected. They gave a distinct impetus to the Ikiusc- to-house inspections. They aroused communities to the importance of their sanitary conditions. The series of circulars prepared by the secretary, and the Schedule of Questions — revised fium that originally prepared by a com- mittee of '28 prominent sanitarians under the direction of the American Public Health Associatii)n were, in not a few instances, the first sanitary instructidn to receive a practical application. The surveys included all data necessary to a complete descri])tion of the city or town as to its location, population and climate; topography, water supply; drainage and sewerage; streets, alleys and public grounds; habita- tions; gas and lighting; disposal of garbage and excreta; markets and food supply ; slaughter houses and abattoirs ; manufacturies and trades ; hospitals and public charities ; police and prisons ; fire establishments ; cemeteries and burials; public health laws and regulations; municipal officials; registration and statistics (.)f deaths and diseases; municipal sanitary expenses; and public schools; the whole embracing nearly 000 separate questions grouped under 19 general heads. The total cost of these insjiections was estimated at about $."iii,(l()() for everything except the work actually done or caused to be done bv the house- holder, tenant, or owner. In Chicago it was a little less than 1 T cents for each inspection, including pay of inspectors, wages of laborers, hire of teams, cost of disitifectants, printing, stationery, etc. Dr. Oscar De Wolf, health commissioner of Chicago, reported that the death rate from the filth diseases in Chicago was reduced 1') jier cent, and stated that there can be no (|uestion that much of this decrease in the preventable mortality was due to the house-to-house inspection and kindred efforts which were made jiossible ihrmigh the sjiecial a])pro]iriaiion in the anticipation of cholera. Il is believed to be entirely within the bounds to sav that at the close of ISS.") the State was in a cleaner and. consequently, healthier condition than any ei|ual poinilation liad ever been before at the same iieriod of occu- pancy of the Soil. During 188G the Board was still in feai" of invasion of .\siatic cholera. The work of the sanitary survey was continued. The house-to-house in- spections were completed where nol fnii'-Iicd the year before, and exlciided to new territory, so that they embraced an ;iggregale of nearly half a million inspections and reinspections of houses and premises, in .ibout hiu cities, towns, and villages. While the lioard had been thus successful in organizing and promoting sanitary work by nuuiicipalities and individuals, it continued the effort to 324 lll'.Al.TII CONDniONS AKTI'-.K 1ST* supplenifiit ^^cll local aciidii by ])r()>cciilin.L; the investigatiim iiitci tin- writer su])plies of the State, the (lis])iisal of se\\ai,'e. and ])olluti(in (if streams. These were matters alTecliiig large areas uf trrritury in eommcin, and yet. ill the nature of the case, they were such as cnnlil nut he cnntrnlled hy the independent action of the communities. At the close of the year, an at;i;ret;ate of 41)11, S:i';! ins])ections and ri'in- spections had been made, emhracini; e\ery importrml item pertaininij; to the sanitary status of li.'l."!..") n premises in :!1IS cities, towns and vill.ayes. with .an aggregate population of 1. ! inh.ahitants. In all hut three of these places \\(irk was lieytm prior to issi;, hut at the close of the previous year, the aggregate niimlier of inspections — exclusive of Chicago — was onh' 224,2()0, so that the increase (hiiing l.s.Sd was considerably o\er HIO per cent. A large number ( 1(1 1. '.'S-")) of these, however, were rt-inspections. the actual number of additional jiremises inspected, amounted to ll.'i.Kl-i. QUAK.\.\Tj\i-: .Mi-:.vsuRi''s I'LAXM-.ii: While this extensixc sanitary sur- vey and clean-tij) was going on within practicalK- e\ery comity of the ."^tate. the Board was also energetic in trying to keep cholera from entering th:_' United States and especially Illinois. Provision was made for guarding against any introduction of the dis- ease, by defining a system of border quarantine inspection, b'or this purpose the Thirty-fom-th Cicneral Assemlily made a contingent a])propriation of $40, OIK) to be used, upon the recommendatii n of the Board, in case of tlie outbreak or threatened outbreak of any epidemic or malignant disease, such as Asiatic cholera, smallpox, yellow fever, or to defray the expense of pre- venting the introduction of such diseases, or their spread froi.i ]ilace to place within the State, and suppressing outbreaks which might occur, and in inves- tigating their causes. In the event of such outbreak or thieatened outbreak, it w.is planned to establish quarantine inspection stations at '.'I designated points of enlranc-" of important railroad lines along the eastern and southern boimdaries of th;' State, and at points upon the Ohio and Mississippi Rivers — or at so many of these as mi'^ht be necessary — for ins])ecting. (piarantining. di.infecling and cariuL; lor cases ol e|)idemic disease. .\l the meeting of the .Sanitary Council of tlie .Mississippi \ .alley, similar action was urged u|ion the health ntficials of neighboring states. Satisfac- tory action was t.alsen b\' the CHuncil upon this recommendation, and thus another step was taken in perfecting the protection of the State agaiu'-t an epidemic of imported cont.a^iotts or infectious disease. Cliolcra liiradcs ['nit, ,1 States in 7W7. In the fall of Iss;. Asiatic cho'era was introtluced into the I'nited States, a disaster which had been feared by the State Hoard since 1 S,S;_J. HEALTH CONDITION'S AFTER 1877 '325 These cholera cases arrived late in the year ( end uf September) and a tulal of 34 cases had been recorded in New "S'ork and vicinity by October I 1, iss;. It is uncertain hnw nuich credit shdulil lie ijiven the Board and its activ- ities in preventing Asiatic cholera in the State, bnt it is nevertheless a fact llrit the Itical epidemic in the Xew ^'()rl^ (|uarantine zone did not reach Illi- nois. 'I he I'.oard toijk no chances, but made a determined effort to protect the health and lives of the people by maintaining a state-line quarantine by insjiections of passengers on railways coming from infected cities. CJiulrra Iiiradcs UiiltctI Stales in IS!):?. In IS!)-.' a conference of Western State Floards of Health was called, which met and drafted seven agreed rules for inter- and intra-state pro- cedure to be followed in the then existing emergencv in regard to elmlera. Dr. F. W. Reilly was elected to act as secretarv of the conference. He was authorized to act for the Hoard in the case of a threatened jiandemic of Asiatic cholera, in the interim pendmg the next meeting and to call an emergency meeting of the members at his discretion. After the adjournment the secretary engaged in a telegraphic corre- spondence with the Xew ^'ork City Hoard of Health and with Dr. John H. Ranch, who was at the time in that city. As a result of the information thus obtained, and after consultation with Dr. C/riftith, the secretarv fur- nished the following statement for publication: "Chicago. September 14, 1S92. "While the intelligence of five deaths from Asiatic cholera among residents — not immigrants — of New York City, one of these eight days ago, was a most unpleasant surprise to Western health officials, still there is nothing in the situa- tion to cause panic or even excitement. The delay in admitting the existence of the disease was natural, but it does not appear that any precaution has been neglected on this account. From tlie first suspicion the cases have been treated as it it was known that tliey were genuine Asiatic cholera. Premises have been disinfected, inmates kept under strict surveillance and the most rigid care has been exercised. "In its own interest New York cannot afford to have any spread from these cases, nor from others which may be now reasonably anticipated before the advent of cold weather. "As to any immediate danger to the country from these sporadic cases, there are these facts to be considered: "1. The cases have occurred among a class of persons not likely to start an exodus from the localities and so to spread the infection. "2. As already recited, reliance may he placed on the natural interest of New York to make every effort to prevent any spread. "3. Every day brings us nearer the season when cholera, at least in this country, is cliecked by a low temperature. "4. The history of the disease on this continent shows that, while it has repeatedly effected a foothold on the mainland in the fall of the year, it has never been until repeated introductions that it has spread as an epidemic. In the epidemic of 1854 it took eighteen months after the first cases on the mainland to effect a lodgement and become epidemic. "5. The sanitary defenses of the country were never so well organized to battle with and suppress an epidemic of any preventable disease. 32G llEAl.TIl COXDITIOXS AKTKU 1S7T "Tlic practiciil (IctUution from these considerations is that, as already said. there is no occasion for panic or even excitement. "What remains, as the lesson of the situation, is that every community and commonwealth should realize in practical effort, that its immunity from cholera, as from other preventable disease, rests with itself. It must work out its own salvation and not rely upon any vicarious protection of quarantine. Every source of filth, of pollution of water, soil or air, must receive prompt and effective atten- tion, and not only must municipalities exert themselves, but every householder for himself must put his own house and premises in order. "No cleanly city, town or villa.s;e — with a proper disposal of excreta and with a pure water supply — need apprehend a visitation of cholera. In all human prob- abilities there remains from now until next spring in which to perfect the work of sanitation already well under way throughout the length and breadth of Illi- nois. With the present warning, the municipality which fails to utilize these intervening months will be culpably criminally derelict in an obvious and im- perative duty. "The Illinois State Board repeats: There is no occasion for panic — there is every occasion for a general cleaning up." Ill view of this situation, it was decided to keep a strict check mi all iiiiiiiigrants enlering^ the State. In pursuance to this plan, all immigrant-car- rying transportaliciii cnnipanics were iintiticd in September, 189'2, not to bring into the State of lllinnis any inimigrant, imr the ])ersoiial effects and be- longings of am- immigrant, without first receiving satisfactory assurance that such immigrant and his or her personal etfects and belongings are free from the danger of introducing the contagion of an epidemic, contagious or infectious disease. The companies were further instructed to accejjt only, as satisfactory assurance, the certificate of an inspector of the L'nited States Marine Hos- pital Service, setting forth that the individual immigrant has been under observation long enough to determine that he or she has not the germs of cholera in the svstem, and that he or she is vaccinally protected against sniallpcjx : that all the ])ersonal effects and belongings of said immigrant have been sttbjected to ])roper disinfection; and, furthermore, that, in the pro- fessional jtid^menl of the inspector, the individual immigrant referred to and his or her belongings are free from any danger of conveying contagion or infection to others. At the December. 1S!)"2. meeting, the l:>oard ])assed a resolution reipiest- ing the legislature to provide a contingent fund to be used in case of the in- vasion or threatened invasion of cholera. .\t the lanuarv. 18i)3. meeting of the lioard. much concern was ex- pressed bv the secrctarv, Dr. F. W. Keilly. concerning Chicago's financial inability to coiuinue to inspect all trains carrying inniiigrants, in order to ])rotect Chicago and Illinois against invasion of cholera and smallpox. On March '^3, 18!);5, he wrote a letter to Governor Altgeld, informing him of this condition, and in reply received instructions to contintte the immigration inspection as ;i ])reventive measure against cholera, etc., the expense to be defrayed out of the contingent fund appropriated for kindred purposes. HEALTH CONDITIOXS AFTER 1877 327 The health commissioner of Chicago was duly advised of the Gov- eriKirV apijrnval. and was authorized to select and appoint eight inspectors, who should receive pay at the per diem rate of two dollars and a half ( $-2.r)0) for each day of actual service, the expense to be defrayed out (if the con- tingent fund of the State Board of Health. This service was cnntinued until the end of the following June. Thus ends the history of cholera in Illinois. In fact it was not a history of cholera at all, since the State Board was established in 1877, but a chron- icle of measures instituted to prevent the invasion of the State by this disease. No cases of the disease occurred in the State during this period. Twice chnlcra invaded the United States, once in 1887, and again in 1892. The elaborate precautions which were started by the State Board of Health in 1S83, under Dr. Rauch's direction, apparently helped to prevent the spread of cholera into the State in 1887, when immigrant inspection and the machinery for tlie control of epidemics, was not perfect or so well organized on a national basis as in later years. This was a time when every state- and community had to be on guard for such natiimal invasions of pestilence. The 18!)3 invasion of cholera and its prompt restriction and check at the vicinity of the port of entry, is evidence of the effectiveness of modern methods of disease control, based on accurate knowledge of the causes and mode of transmission of infectious diseases and augurs well of what would occur should the State again be threatened with the invasion of any such pestilential disease, now or in the future. Yellow Fever The panicky situation concerning yellow fever in the South in 1878 was the first big public health problem to divert temporarily the attention of the State Board of Health from its activities in the enforcement of the Med- ical Practice .Act. .\ description of the yellow fever epidemic of 1878 at Cairo, the puint of greatest incidence in Illinois, can best be visualized by quoting from Jdhn M. Lansden. a resident of Cairo at the time and an eyewitness of the out- break. In his history of Cairo, Illinois, he writes in part as follows con- cerning the epidemic : "The ten days begiuning with July 9. 1S7S. were probably the hottest ten successive clays in the history of the City. During that time the writer was kept at home by an attack of illness and was treated by Dr. W. R. Smith, whom most of us remember as one of our most prominent citizens and physicians. On enter- ing the room one of those days and while wiping the perspiration from his face, he said. 'John, we are likely to have yellow fever in the south within a month or two.' The doctor's prophecy came true. The first case occurred in the south about the first of August. It moved on nortliward and soon appeared at Nachez, Vicks- burg, -Memphis, and Hickman, and reached Cairo September 12. It is said by 328 HEALTH CONDITIONS AFTICK 1ST? miiiiy persons that Mr. OlKTly. the father of the Hon. John H. ()l)erly, died of the fever a few days before the 12th. On the 12ih there were two deaths; one of them, Mr. Thomas Nally. editor of the Bulletin, and the other, Mr. Isaac Mulkey, a son of Judge John H. Mulkey, and also of the Bulletin office. Those deaths caused a panic in the city, and the afternoon and evening of that dav witnessed the de- parture of hundreds of people from the city. "For some three or tour weeks prior to that time there had existed in the city an unseemly controversy as to whether the fever would probably reach Cairo or not. Were one to turn to the files of the Bulletin and the Cairo Evening Sun for the last half of August and the first twelve days of September of that year, he would see what a state of feeling existed in the city; the one party insisting that there was little or no danger and the other that there was very great danger and that every possible efl'ort should be put forth to keep the dreaded disease out of the city. The Bulletin led off as was its custom and criticised with unnecessary severity every one who chose to differ with it. It was strongly supported by a few of our prominent citizens who felt that it was their duty to maintain our supposed immunity. "I can best describe that peculiar state of things preceding September 12th by saying that it was not quite as bad as the yellow fever itself. I had been attending court at Jonesboro and was told by the conductor, on offering to go aboard the train at Jonesboro to come home, that he could not take 'me on account of the quarantine at Cairo. I prevailed upon him and came, and on reaching the northern part of the city I saw the levees patrolled by armed guards. One or two of them went through the train to ascertain who might and who might not be permitted to go on into the city. "When 1 reached the city, 1 was surprised beyond measure to see the state of things prevailing. On every hand were seen all kinds of vehicles carrying trunks and every other description of baggage to the railroad stations. They were driven, some of them, almost at furious rates of speed. In a word — there was a panic, which I need not attempt further to describe. "I left on the same Illinois Central train about eight o'clock that evening, on which were Mr. Oberly and hundreds of other citizens of the town. I remained away until the 2d of October, when I returned home, having seen in the Cairo Evening Sun, of September 24th, the following notice: "The Cairo public schools will open on Monday, September 30th under the superintendency of Prof. G. G. Alvord.' "The schools opened at the time announced, but were discontinued October 4th. On Sunday and Monday, October 6th and 7th. there were six deaths, among them Miss Marie Powers, one of the public school teachers. These deaths occa- sioned another exodus, not quite so panicky nor quite so large; and it was not until the latter part of October that the people began returning home, and it was not until far into November that all had gotten back. "The Bulletin had suspended publication with its issue of September 12tli, and did not resume publication until the first day of November. Mr. D. L. Davis, the editor of the Cairo Evening Sun, and his family had also gone from the city, and had left Mr. Walker F. McKee in charge of the paper. Walter, for most of us were accustomed to address him by that name, remained at his post and gave the city a very faithful account of what was daily taking place. As bad as the news often was which it contained, the residents were eager for its appearance in the evening, and most of them forwarded copies to their friends who had gone from town and who were anxious to know the state of things at home. Mr. Davis removed from Cairo to Chicago a few years afterwards, and kindly handed to me all the numbers of the 'Sun' which covered the yellow fever period. "The facts are just as above given. There were about one hundred cases and about fifty deaths. "I have devoted these few pages to the epidemic of the fever because it was an era in the city's history. One-third of the people left the city. Many remained who could and should have gone. Their reasons for remaining were various; and sometimes they could give none at all. It was a simple disinclination to leave HEALTH COXniTIOXS AFTKU ISTT 3'i9 lionie. There was a cuntmuing hope that the danger would soon pass, but it per- sisted instead. To some it was a question of means; for to go and remain away even for a short time required money for the trip and board. Many had no friends or relatives to whom they could go. Pew persons from the surrounding country desired to see any from Cairo. Many whole families would not go because they could not decide who should remain, and they feared leaving their homes unpro- tected. "Business was suspended; only just enough done as seemed actually necessary for the people at home. The days were unusually bright, in sharp contrast with the doubly dark and silent nights. Part of the time persons could not be abroad at night without passes of some kind from the authorities. In a word, everything spoke plainly of the reign of pestilential disease. "The city government of course went on. It had to. Mayor Winter was equal to the occasion, and to be equal to such an occasion seems capability for al- most anything, but he seemed made for it as for some special occasion. Jack, like so many public men of the country, liked to do things in a kind of showy way, not exactly spectacularly, but that word expresses something of the idea. Jack had been so harrowed by the Bulletin and others about the fever, that he seemed some- how to be glad that they and not he had proven false prophets; and when the fever came he met it with an undaunted face. He could not rescue its victims; but he and the few trusty men he had, buried them in the shortest possible time and yet with all the care and ceremony of which the deadly situation would admit. But it must not go on further or attempt to describe the pestilence that walked in darkness or the destruction that wasted at noonday. ".lack Winter was no better than many of the rest of us; but if at the end of all things there is a balancing of accounts for every man. Jack's account will have opposite September and October, 1878, a very large credit. Of the rather few persons on whom he relied for attention to families in need and for other aid to the city authorities, I may mention Mr. William H. Schutter. I do so be- cause of my personal knowledge of much of his work. Of the many persons who remained out of a sense of duty to those who could not go or did not choose to go, I may mention the Rev. Benjamin V. George, of the Prebyterian Church and Father Zabel of St. Joseph's Catholic Church, of whose constant care and devotion to the stricken families of the town it would be impossible to say too much. Doc- tor Roswell Waldo, of the Marine Hospital, gave up his life in the work he did, which extended alike to all persons needing his service. He died at St. Mary's In- firmary October 18th, after a long illness which kept the community alternating between hope and fear for his life. The Sisters of St. Mary's Infirmary did every- thing in their power, as they always do. It may not be so. but it sometimes seems that they take pleasure in such times as those were. They look upon every opportunity for doing good as a blessing to themselves. Did not this happiness come to them, how could they devote their lives to such work? "The Sun of Monday, November 25, 1S7S, gives an account of the presentation to Dr. J. J. Gordon of a gold medal in recognition of his very faithful services during the prevalence of the feveV. The presentation took place at the Arlington House, afterward The Illinois, and now The Marion. It gives the names of the thirty-five donors, and speaks of Mayor Winter, the Rev. Mr. George and other persons present." A yciifral rcpcirt on the yellow fever epidemic of is^s at Cairo \\;is made by Dr. Wm. R. Smith, .Sr., (.)f Cairo, Illinois, to Dr. John R. Ranch. President of the State Board. Dr. Smith was a practicing physician in Cairo at the time of the epidemic, and speaks from experience inasmnch as In- reni.iined in the infected territiu-y thron^hont the entire ontljri'.-il^ .-md took ;i lu-KJic ]iart in administering to the sick, and later as an inspector at Station :! in the Cairo district. 330 IIKAl.Tll CONDITIOXS AKTF.K 1877 In >uiiiiiiint; u]) liis (ilisurvaliuns in regard to the eindcinic. Dr. Smith re- jiortcd in part, as I'ulliiws : "Cairo is situated at the confluence of the Mississippi and Ohio Rivers at an elevation of 325 feet above the sea, in latitude 37, longitude S9.12. Its site is from eight to 15 feet below high-water mark, and to protect it from overflow. is surrounded by a levee. During high-water in either river, all the low ground within the levee is covered with "seep water' from one to six feet deep. To prevent th collection of rain water and to remove the 'seep water,' large sewers underlie Commerial and Washington Avenues, with outlets Into the Ohio River. Opposite Cairo, on either side, are extensive swamps, and all the land for eight to ten miles is subject to overflow. ()i Aii.v.NTi.NK: "On July 29, 1878, the city Board of Health established a quar- antine by visitation. All steamers from the South were visited by a physician, and if all were well, were permitted to land. Also all trains were visited. Dur- ing the quarantine, the steamer 'Porter,' from New Orleans, landed here and dis- charged her crew, shipped another, and went to St. Louis. One of the crew died at the hospital on Walnut Street, (see map), August the 12th. HEALTH CONDITION'S AFTER 18T7 331 "In about a week the 'Porter' returned from St. Louis with several cases of yellow fever on board. Part of her crew again left her here and she went up the Ohio River, spreading death wherever she touched. After the fever became epidemic at Memphis and Granada, no steamers were permitted to land and all trains were stopped at Cairo. There were two violations of quarantine by steam- ers the 'Jas. D. Parker' and 'Ratesville.' One of the passengers on the 'Parker,' a Mr. C , landed here and died of the fever at C, on Poplar Street, August 24th (see map). METEROLOGicAi.: "The year ISVS will be in after years reverted to by 'the oldest inhabitants' as 'the hot year.' Its winter was very mild and we had a summer temperature during its spring. The summer was excessively hot. And, furthermore, the high temperature was distributed over a wider belt than usual. "The following table shows the mean and highest thermometer, humidity, pre- vailing winds and rainfall at Cairo during the months of June, July, August, Sep- tember, and October, 1S7S: Thermometer. Humidity. "Wind. Rainfall. Mean. Highest. June July 74 83 81 76 59 89 96 94 88 81 69 ■79 70 70 69 S. N. S. W. s. S. 4.6 inches 2.81 inches 3.45 inches September 2.99 inches 2.59 Inches "The above table shows that we had for four months a temperature and just about enough moisture, to maintain 1 if not generate) yellow fever. "Although the quarantine was as perfect and as stringent as it was possible to make it, w^ith so much shore line to guard, violations of it by individuals were quite frequent, thp: begixnixc; "The first local case of yellow fever was J. M taken on September 7; next T. N September 8; next J. C September 12: next J. S September 13. T. N was editor of the Bulletin, and the other three were printers who worked in the same building (see B. B. on map). There were no more cases until the 21st. when M. H. M was taken at 1, The fever then gradually spread from the Bulletin center B. B. to 2, 3, 4, 5, 6, 7, 8, 9. On the 25th of September a case occurred at M. on 21st Street, and from that center the fever spread so fast that it is impossible to give names or location of cases, but the black on map will show the extent of territory it took in. "From whence came the fever? T. N visited C who died on Poplar Street, and 15 days afterward M was taken with the fever, and in 16 days afterward N was taken, and in 20 and 21 days C and S were attacked. They were all employed on the Bulletin and worked in the same room. "So we may safely say that the yellow fever was brought from Memphis by the steamer 'Jas. D. Porter.' " The quarantine establi.shed b\- ihe State I'.nard oi 1 lealtli practically exckided everything that came from the south unless it passed inspection. The transportation of freight and jiassengers across the Ohio River, between Fillmore, Kentucky, and Cairo was also subjected to the same regulations. Thousands of fugitives fnmi Mrinph.is and below were allowed to come into Illinois and Missouri, and althoui;h :iS ni these died of the disease in Illinois, there was not a single case Cdutracted from refugees nor their ctTects outside of Cairo. 33"^ iiicAi.rii coMiriio.Ns aft:;r 18TT 'l"lu- r(.-ii(irls lu the SiaH' I'.danl ni Health sIkiw that li'i otiieially report- ed deaths tnmi \ellii\v fe\-er neeurred ihiriiii; the oulhreak at Caird. I''ivc cases and three deaths friiin l"e\er occurred at Centraha. 100 miles north of Cairo, anioni; those who were t-n^a.^ed in transhiijjjini^ hides from Siireve- ]>ort. Louisiana. ( )ne fatal case was reported from Rockford. Illinois. The history of this case was that the hnshand C(]ntracted yellow fever and died in Mecattir, ,\lahama. 'The wife niu'sed him, ami the day after he died she riiiirned to h.er home in Rockfoiil and died in one week of yellow fever, con- tracted in Decatur, .\lahama. After Ihr Cairo Oiithrnih. Follow ini; this tragic experience in IS^S. the Board of Health was al- ways on iLjuard in suhst'{|Uent \-cars, to ]}revent the recurrence of this dread disease. In ls;it. Dr. |ohn 11. Ranch wa-- ap]>ointed delegate from the Illi- nois State r.oard of Health to attend tln' meetin;j; at Memphis on .\])ril :iO, of the various state hoards of health in the S(juth. to consider the hest methods for the control of the yellow fever scourge. Rules and regulations recommended hy the National Hoard of lledth were aclopted to secure the hest sanitary condition of steamboats and other ve.ssels, railroads, their station houses, cars, freight, and passengers. .\ system of sanitary ins])ection was maintained in the southern part of the State. One sanitarv policeman was stationed at Mound L'ity, and two at C'airo. One medical inspector w.as a|i|"iinleil to assist in carrying out the rules and regulations of the State llo.ird of Health. Dr. Frank \V. Ixeilly was appointed sanitary inspector July 28 and stationed at East Cairo. Dr. \\". R. Smith of Cairo was ajipointed insjiector and assigned to Station Xo. 3. Cairo, July I. Dr. |ohn 11. l\auch was electe 1 secretary-treasurer of an interstate organization, known as The Sanitru'y t/ouncil of the Mississippi \'alley. The function of this organization was to kee]) health officers in all states within the \ello\v fever zone informed concerning outbreaks of epidemic diseases, particularly of yellow fever, and to make rules and regulations which w-ere expected to be adopted liy all the member health officers. The Hoard adopted rules and regulations concerning yellow fever, re- (|uiring critical inspection of health certihcates of passengers on trains and boats. The regulations concerning the inspection of boats were strictly en- forced. In regard to these the ca])tain of the "Belle St. Louis" remarked: "H it wasn't for these insj)ections, boats wouldn't be paying expenses — they'd be shut off of so many ports, now open to them on account of their health bills." HEALTH COXDITIONS AFTER 18TT 333 The report of a single case of mellow fever in the south caused a shrink- age of the provision market in Cliicago alone, which amounted to a million dollars within 24 hours. .\ sunimarv of the (juarantine measures taken against yellow fever in liSTIt, is contained in the following letter to the Mayor of Cairo, giving in- structions as to necessary precautions: "Sir: "In transmitting the accompanying summary statement of inspection and other service at the Quarantine Inspection Station. Mississippi River, below Cairo, during the season this day closed, the Illinois State Board of Health begs to ex- press its appreciation of the aid, both material and moral, which the National Board of Health has rendered it in protecting the State, possibly not from an invasion of yellow fever, but most assuredly from such interruption of travel and traffic as have hitherto uniformly followed a threatened invasion of that disease. Precisely what such interruption amounts to it would be difficult to state in dollars and cents; but an inkling of it is given in the figures in the sum- mary statement, from which it will be seen that, whereas the average vessel tonnage arriving from below at the time the inspection system was begun, amount- ed to only 967.66 tons per diem, it had risen to 2.166.67 tons per diem during the last 31 days, and this in spite of an unusually low stage of water. La^t year the commerce of the port at Cairo during the month of October amounted to only 48,967 tons northwise and eastwise as well as southwise. while this year it amounts to 87.127 tons for the same period. (The tonnage of barges, lighters and Hats is not included in these figures, while it is in the figures in the summary state- ment.) "During the period while the Inspection Station was in commission this year. 1.162 vessels of all kinds (exclusive of barges, lighters and flats) entered at the port of Cairo: as against only 707 vessels during the same period last year: and notwithstanding this quarantine of exclusion in 1S7S, yellow fever obtained access to the port with a total mortality of 62 recorded deaths. This year not a single case of the disease has developed among the 3,098 persons allowed to come into Cairo, nor among the 20,776 persons passed through the Inspection Station from below, notwithstanding fever prevailed at 43 distinct points in the Valley during the period. "Intercourse with all ports below Tiptonville. Tennessee. 120 miles south of Cairo, was practically suspended at the port when inspections were begun; but as confidence in the system was established by observation of its workings and results, one by one the interdicts were removed, until by Sept. 1 the sole require- ment for entry of passengers or freight into the State of Illinois from southern ports, was a clean bill of health (or certificate of inspection) from the station. A comparison of the figures shows the steady restoration of river business from below. In August. .56 vessels, with an aggregate capacity of 44.966.87 tons, pre- sented themselves for inspection; in September. SO vessels, with an aggre ate capacity of 57,824.50 tons; and in October. 100 vessels, with an aggregate capacity of 69.667.85 tons." The sum of 'toOO.OOO was appropriated in is;;) and placed at the dis- posal of the Xational Board of Health for the control of vellow fever, of which sum $!()(), 000 was wisely and successfully emploved in c(.imhaling the epidemic that year. Measures to prevent the introduction of yellow fever from the South were continued in the summer of l.ssi. The Board ordered that after July 1. Dr. W. R. Smith, inspector at Stati(m No. :), helow- Cairo, put into commission said station and that after said station had been put into 33-1- iiiiAi.rii (oxiirnoxs ai't;:k ISTT cnmniissinii llu- M-crt-larx of llic Slalr I'.oanl (if llcallh be directed to notify tlie aiuiinrities cif all jxirts in ihi^ Stale noi to alUiw hoats to land from points below Cairo, iniless upon ])rcscntation of a clean certificate of inspection as to caryo. officers and crew. Till' Yi llnir Frrrr Srarr of ISSS. In tile fall of ISSS it was reported that yellow fever had develo]ied in the south. The secretar\- of the Hoard of Health found it necessary to niaUe active etforts to check the public alarm that developed immediately. The \ellow fever epidemic h.id occurred in Florida, but it was late in the b'all. .\e\-ertheless, millions df dollars were lost from foolish quarantines, interference of travel and a general feeling of apprehension, all unnecessary even in the li.i;hi of the then known facts aljout yellow fever. It is worthy of note that a status of public panic developed in southern Illinois, esjjeciallv in the vicinil\- of Cairo, as a result of reports of yellow fe\er in Decatur, Alabama, and th.il the secretary of the Board spent several days in that vicinitv resiorins^ public eonlidence and preventitig a costly qtiarantine from being- uimecess;iiily set u|). The secretary's stand was based upon meteorological gimtnds that were sound and were proved so by subsequent develojMiients. iianiely lh:it yellow fever does not spread to the North with the advent of cold weather. Till' Srarr ill 1807. The next vellow fever scare was in the fall of IS'.);. The first official information of the existence of yellow fe\'er in the south, reached the State I'xiard of Health on the morning of Se];tember 7. Under the circum.stances it was deemed urgently necessary to establish immediately an inspection ser- vice at Cairo. Upon reporting the matter to ( ioxenior Tanner, he advised: "Secure services of as many comiietenl medical men as may be necessary and use every endeavor to kee]> \ellow fever out of the State, and to control its spread should a case appeur in the .State. I'ayment of all expense incurred will be approved by me." On .September '-K 1 'r. I'hillip S. Do.ine. Chicago; A. 11. .Maini. .S|iring- fK-ld ; and Dr. \\ . V. ( irinslejid, (',iiro, were ,appointe. b'fnni lS!i,s 1(1 i;((i."i. tbe Illinois State Board of Health records are free of anv ^care of ycUnw fever until 1905. Late in July, l!i()5, yellow fever was reported in iiKirc or less epidemic form at New Orleans. The secretary. Dr. James .\. I'Lgan, left at once for Cairo, where he investigated the sanitaiy condition of the city and proceeded to Memphis where he ascertained that a qnarantine against New Orleans had already been established and thnt the situation was far more dangerous than comnionly supposed. The secretary determined to establish a train inspection service, and from the first of August every train antl steamboat coming from the sotith was boarded, and every ])assenger ins])ected. and only those permitted to land in tbe southern part of Illinois who could present proper credentials from health authorities and evidence as to his recent whereabouts. Com- ]ieteiit medical men were employed for this service. Within a short time after the establishment of train insjjection, the con- ditions in the south grew so much more seriotis, that the City Council de- clared a rigid quarantine against the south and admitted travelers only upon the presentation of permits issued at Cairo. Anticipating the invasion of the city by yellow fever patients, a well-ec|uipped isolation hospital was estab- lished in a houseboat, and under the care of a com])etent attendant, the boat was ready to be taken to a point of safety in midstream. It was not neces- sary to use this boat. Rigid t(uaratitine was maintained from August .'i until October K. Nine inspectors were employed and several watchmen. During this time hundreds of ]:ersons coming from infected points were diverted in other direct ioii>. ;ind in this manner, the State was saved from an invasion of fever. It is gr;itifving to report that regardless of the inconvenience and conse- quent de])re>sion of trade, the people of Cairo were in sympathy with the erf.^istant of the Ho.ard, was placed in charge of the qtiarantine service at Cairo, dtiring the enforced absence of 338 IIKAI.TII fOXDI TKINS A I- '1' i: K ISTT the sccrt-tary. In rcs])()nse to the \erv e\i(leiit need of such an officer who could relieve the secretary of sonii' of the details of the work of the of^ce, the General Assenihlv had made an a|ii>ro|)riation tor an assistant secretary, which went into effect on July 1, llio.".. In order that Dr. I'alnier niitjht have greater anth( rity in the performance of his duties at Cairo, the secretary ai)[)ointed him as assistant secretary to the State Hoard of Health and asked for the apj^roval of the luiard, which was L;ranted. Typhoid Fever. In followint; the history of the rise and fall of t\'i)hoid fever in Illinois, the theorit's prevailing,' at various times in regard to its cause must he kept in mind. The views as to the origin of the disease, and the early theories in re- gard to its cause, are set forth in the preceding part of thi> volume. For au understanding of the preventive measures taken to control typhoid fever since the establishment of the State Board of Health in is';?, reference is here made only to the theories and facts in regard to its course and transmis- sion of the disease, generally accepted for varying periods since that time. When the Board was first established, typhoid fever was tmiversally looked upon as a filth disease. The typhoid bacillus was not discovered until ISso, when it was first found in the tissues, by Ebert, and was not isolated until four years later, when GafYky grew it in pure culture. Although this and the other great discoveries in liacteriology were made in the early eight- ies, they were not generally accepted, nor did they modify the prevailing views in regard to the control of communicable diseases to any great extent, until the middle nineties, W hat the prevailing views of practicing physicians were during the first 1.5 vears of the Board's existence is shown from the following statement in regard to typhoid fever bv Dr. X. S. Davis in his Lectures tni the Principles and Practice of Mecliciiie. published in ISSl : "A careful adherence to well ascertained facts concerning the etiology of ty- phoid fever will require us to accept the three following propositions: " 'First, that cases of typhoid originate in dwellings or buildings of any kind in which, from either overcrowding the number of occupants, or the neglect of ven- tilation and cleanliness, the air, furniture, and walls, become strongly impregnated with the organic matter exhaled from the skin and lungs of the occupants, * * * * " 'Second, that the more the soil of any given locality becomes impregnated with the intestinal and urinary excretions by progressive increase of the density of the population provided the two conditions of drainage and water supply remain the same, the more frequent and severe will be the cases of typhoid among the inhabitants of such locality. * * * " 'Third, cases of genuine typhoid have occurred and are still occurring occa- sionally in every civilized community, in persons who have had no traceable com- munication with previous cases of that disease, or with any of the recognized or suspected sources of infection. * * * • HEALTH CONniTIONS AFTER 187 7 339 " 'Probably no fact is better established than that the disease under consider- ation generally originates from the use of air or water impregnated with some one or more of the products derived from the decomposition of organic matter. It does not follow, however, that such prodiict of organic change must necessarily be formed outside of the human body.' " Dr. Davis was a leafier of the liical medical profession at the lime, and had heen active in many movements for sanitary reform in the city n\ Clii- cago and the State, conseqnenth- it may Ije ])resume(l that his views are rep- resentative of the time. The views held were doubtless Ijased on those expressed by Dr. Charles Murchison in 1.S62, as enunciated in his famous theory of the pythogenic origin of typhoid, which held that it is "generated and probably propagated by certain forms of decomposing matter." In the succeeding 25 years the facts were tortured in every conceivable manner to fit this theory. Some- times the incubative period of the di.sease was shortened to a few hours when it "immediately followed" exposure to certain fetid contaminations. A favorite way of accounting for an epidemic was the finding of defective drains or nearby privy vaults, cess ]i()oIs or decaying matter of any kind. Some, who had been im])resse(l with Pettenkofer's observations on cholera, leaned strongly towards ground water and deteclivc drainage of the soil as a factor in the jiroduction of i\|ihoid. -\n examjile of such a view is that expressed by Health Commissioner Ware of Chicago in explain- ing the cause of the greatest typhoid e])idemic in the history of the city, namely that of 1S!»1 and 1S!I2. In his annual rejMrt to the mayor for the year 1SI)2, he says: "We have typhoid fever, and always will have so long as there remains so much tmdrained projjerty." In the Sanitarian, a leading British publication on sanitary science, ap- peare end in view, includes the pericd of activities of the State Board of llealth frcmi its estahlishnient in 1877 to approximately the time of the World's Fair in Chicago, in 1893. The official records of the Board prior to 18S)U, show that no special attention was given to the cintrol of ly])h()id fe\-er, outside of the extensive general campaign waged to clean u]) the State. Tahle 28. C.^SEs OF Typhoid Fever Reported in Illinois. Year. Jan. Feb. Mar. Apr. May. .Tune. Jul.v. Aug. Sept. Oct. Xov. Dec. Total. 1917 115 132 109 253 91 73 186 405 637 193 94 55 2,342 1918 89 82 55 52 51 64 212 241 286 102 24 86 1,344 1919 33 33 39 47 32 64 265 294 306 346 251 183 1,893 1920 124 80 88 115 103 138 162 211 284 257 198 109 1,869 1921 96 74 83 89 72 152 336 443 419 392 185 82 2,423 1922 79 73 81 74 135 116 182 255 254 273 173 103 1,798 1923 65 31 89 52 54 68 99 233 320 259 315 277 1,862 1924 159 72 43 59 63 63 124 168 191 176 125 231 1,474 1925 119 71 62 58 71 124 217 298 297 310 206 297 2,130 1926 111 50 44 44 34 65 106 214 303 386 203 113 1,677 1927 52 62 39 40 52 70 141 1.. . I 1 Tahle 29. Deaths fro.m Tvpiuud Fever in Illinois. Year. Jan. Feb. Mar. Apr. May. June. July. Aug. .Sept. Oct. Nov. Dec. Total. 1918 26 37 24 21' 33 27 37 84 75 86 44 39 533 1919 29 IS 19 9 22 13 35 37 52 41 45 41 383 1920 35 24 22 12 15 IS 38 34 53 58 47 24 380 1921 23 19 17 10 15 32 43 33 56 65 40 23 396 1922 18 15 16 12 23 10 21 33 33 38 32 29 282 1923 17 12 13 12 14 8 28 45 48 43 31 46 317 1924 33 9 13 10 6 22 23 17 37 23 43 241 1925 24 5 11 7 11 19 32 60 55 43 31 29 327 1926 9 4 5 9 6 24 30 37 44 41 14 230 The mortality records that were collected from 1880 to 1886, incom- plete a^ lhe\- adniilledh- are, show an annual average of 1,335 deaths from t\plihoid fever rates. How rajiid the rates fell is illustrated in Figure 19. I'roni about 1900 on outbreaks of typhoid fever drew attention first to local water supplies. Mimicipalilies (klayed the insl;illation of adequate 342 IIEAI.TII CONDITIONS AFTF-K IS,, ptililic watiT sii]i])lv .sati-t;uar(ls, as a rule, uiilil an i-|>i(lcinic fell upon them and then, alter the enuditioiis were pointed ntit hv a sanitarian, permanent improxements were made. 'I'liis is ahuut the hi>tor\- of typhoid fe\er until about nijd. L']) to that time polluted water had i^jrown to he rei^arded as the chief olt't'iidini; assent in the S])read of typhoid. ( )ne city after another went throut^h disastrous or very serious experiences and came ont with im- jjroved water su])|)hes that jjrevented recurrence on a large scale. H-. TYPMOID FEVER in ILLIhOIS HIi 1860-1926 STATISTICS LTIAVALABLE fDR OPEd YEARS ^ Period III Stisfi'iiKit i< ('inilrnl. With the increasing knowledge of typhoid fever and the study of many outlirealo in all parts of the world, the time arrived arouiiil lUin when seri- ous efforts were made to control all of the factors which pla_\-ed a role in the transmission of the disease. The si)read hy milk was found to be frequent, and pasteurization was inaugurated to check it. Flies were given a great deal of attention, and were tomid to play an im[)ortant ]:iart especially in rural coinmunities. lliiman carrier-, were detected as causes of certain outbreaks, and when the iinp(]rtance was fully recognized, steps were taken to prevent this source HEALTH CONDITIONS AFTER 18T7 343 of infection by the exaniinatidii df siouls and urine of convalescent cases. Contact infection was also controlled. especialK' 1)\ in-innniization and more general hospitalization of cases. One of the most otitstanding^ features of typhoid control durint; this period was the development and ajiplication of epidemiologic methods for the detection of epidemics, and tracing them to their sources, d'hus this ])eriod is characterized by a chronicle of one small local outbreak after an- other, discovered, traced to its source, and sto]iped, with the result that the typhoid mortality was low. yes, l."! or ",!() times lower than in the previous periods, during wdiich such occurrences were much less frequently heeded, or correctly traced to their origin. Table ;?(). Deaths and Death Rates from Typhoid Fever in Illinois. Riite I.or 100,000 No. deaths. iiopuliitioii. 917 16.5 1,039 18.4 893 15.5 744 12.7 liate per 103,000 Year. No. deaths. population. Year. 1860 1,183 65.7 1909 1870 1,758 70.3 1910 1880 1,652 53.6 1911 1881 2,082 66. 1912 1882 1,424 44.1 1913 1883 1,054 31.9 1914 1,884 1,066 31.5 1915 1885 1,379 39.9 1916 1886 1,689 47. S 1917 1890 1,700 44.4 19IS 1900 1,897 39.3 1919 1902 1,882 37.7 1920 1903 1,578 31. 1921 1904 1,300 25.2 1922 1905 1,047 20. 1923 1906 1,061 19.7 1924 1907 1,119 20 . 5 1!I1'5 1908 914 17.2 1926 Water supplies came under close bacteriologic scrutiny, and were only 1 iften found showing evidences of fecal jiollution. .V great step was taken in the ])urification of such water supplies around \'J\'> and after, by the use of chlorine in minute quantities as a disinfecting agent. Steplike declivities in the rate are noted following the adoption of the various measures. These are notetl es])eciallv in the death rate from this disease in Chicago, where the effects are more striking because the measures were effective in the whole ;irea, while in ihr St.ite, they were ailopted at various times in ditf'erent localities. .\nti-lyplioin;iril aiul its orgnnizalidii was llial of the I'.M:! lyplmid t\-vrr c'|ii(leiiii(.- al Kockl'dni. When ill tlu' jii\-\iiui> \rar, huiuhcck of cases (if tlie (hsease sU'ldeiily ilc- velopcd ill liial eit\-, an in\-esli.i;aliiin iiide]ieiident (if tlie StaU' Pjnard (if Heahh was made h\' ihe eil\- aiulKirilies aided hy outside experts, and at an expense of several thousand dollars. Impure water was assi^jned as the cause of the outhreak. When, however, in the late summer of 11)13 another epidemic of txiihoid threatened, the service of the Board was requested for the purpose of detennininsj the cause of its recurrence. Almost all the cases were traced t(j milk and hread from dairies and bakeries in which cases of typhoid fever had existed. The sale of milk and hread from these dairies and bakeries was st(i]iped and the epidemic ceased. F.xperiences of this kind attracted attention to milk su]i]ilies. This mitjht have been anticipated. As water supplies came to be more and more sanitary tliere remained considerable typhoid fever and investig-ators lie.gan to look for other media of transmission. Milk was next to water in im- portance so that it was logically the next in line to be sanitated. From li)15 onward a considerable number of typhoi(l fever outbreaks were traced to milk on the one hand while the sanitary ([uality of municipal milk supplies improved through the increasing use of ])asteuri/-atioii on the other. .\fter 1;M."i reliiieiiient in control lechni(|Ue was the dominating feature in efforts directed toward the eradication of typhoid fever. Free distribu- ti(Mi of anti-tviihoid vaccine was started in r.il4 but it was after the World \\"ar. during which emergency the efficacy of this pro])hylactic was adniir- ablv demonstrated li\' the military, before it was used to any significant ex- lent. Its use was promoted successfully after that time and it was generally appreciated and utilized subsequent to emergencies like the devastating tor- nado that swept southern Illinois in l!i-.'."i and the many floods that inundated considerable populated areas almost annually. An emergency sterilizing ontlit serviceable for temporary use in con- nection with local public water supplies was made available by the State Department of rublic Health in I'.M;. It was used from time to time. .\ field lal)orator\- outlit serviceable for the examination of sjiecimens helpful in the diagnosis of cases and in the location of carriers was made a\-ailable about this time. About r.i'.'l tw(i other iin|iortaiit rehnemeiits took jilace. One was a deterniiin-d campaign to locate and su]iervise carriers, 'flu" other was a revision in tlu- i|uarantine rules which among other things re(iuired negative lab(irator\- examinations of specimens i.aken from typhoid patients before raising (|uarantine. 'i'he ]irosecutioii of these ]irocedures had a very pro- nounced fa\(irable intluence over the trend of ty|ihoi(l prevalence in Illinois. HEALTH CONDITIONS AFTER 1S7T 345 The two following tables include most of the important outbreaks that occurred during the period covered. It is noteworthy to observe that the number of cases involved in epidemics grows smaller as the date become? more recent. Some Water-Borne Typhoid Fever Epidemics in Illinois. Count}-. Locality. Year. Monlhs. Cases. Deaths. Remarks. Winnebago Menard 1912 1915 1916 1916 1918 1920 1920 1922 1923 1924 1925 1923 1925 1925 Jan.-Feli - 185 200 200 130 125 300 10 200 12 3,000 13* 14 15 20 20 ? 24 24 3 20 2 3* 3 Old Salem .Si'iit.-Oct Aug:ust |.uM„ -uirl- «ell. Kl Iiiiu ni i.iililic water sup- pl\ utllt, ami no sterilization. Tuscola Moline Maywood Bloomington-... tion in Elgin Watch Factory between safe and polluted supplies. Rock Island Pumping of raw river water through a bypass. Spvop. .li^fntrrv ,\w tn leaky October Jan.-Feb Apr.-May I.,.:,; X , ,,,---, M.Hir. M..ri l.t-tWCeU ii,.lii-ln;il Mi].|.l\ .ni,l the ilvnikinu water supply. K'lood of wells duruig high Chicago Sterliif^r _. (ireenville Winona (Ind.).. water. K.\cessive pollution at the 68th Whiteside Bond Dec.-Ja.i January .June .St. pumping stations minus a sufficient increase in chlori- nation. Leaky valve in factory cross- connection between safe and polluted water supiilies. Severe dysentery and para- typhoid due to tile water ii;,ni[ .i)i-i.iMiiu sewage from Spii (.1 ml.. ' ii:lit states from AUK.-Sept liiijliiii.l \v:ii.-i supply used by ciuivention delegates". Polluted public water supply. s cases and deaths. Outbreaks of AIilk-Borne Typhoid Fever in Illinois. Locality. Year. Months Winnebago... Cook Macon DuPage Rock Island.. Morgan Douglas Madison Coles Hancock Carroll Macon Kane Bond Morgan Bond Henry..- Douglas Montgomery. Rockford Park Ridge.. Decatur Wheaton Molii Jacks Decatur Compto Twp. ille St. Charles 19111 1920 1919 1920 1920 1921 1921 M,i Aug., Sept.. Sept.-Oct.... June, July.. Jul,v, ,\ug... December... June, July.. .Uignst Bottle Polluted w Milk bottle Iter at dairy Convalescent Carrier Carrier 34G iii:altii co.mhtions aftkk li-i" As water and milk supplit's in recent \'ears became inure and more gen- erally of good sanitary (|naiity (itlier faclois in the s]jread of typhoid fever began to lake ])r(iminence. 'I'iuis in lli'.'i an unllireals. contined principally to Chicago and environs, was traced Id the eating ni raw nysters. This discovery uUimatelv led to drastic actinn in relation to shell lish. The State Director of Public Health issued an order in the early part of I If.'"), fin-bidding the sale of oysters for any except cooking purposes. This action in turn resulted in a general sani- tary reform of the oyster industry, referred to elsewhere in this volume. Little of significant importance concerning typhoid fever in Illinois has tran.spired since the sanitary reform of the oyster industry. Automobiles have become a larger and larger factor in the spread of the disease. This was demonstrated in liJSo when touring parties brought typhoid back from an Indiana town and caused mild outbreaks at Freeport and Polo. It is also indicated by the fact that foci of the disease are more and more widely dis- tributed and a growing diminution in the average number of cases involved in any one epidemic. With increased facilities for managing the disease mortalit}' has tended downward although it has fluctuated from year to _\ear as it always will so long as typhoid remains upon the earth. Indeed severe outbreaks will occur from time to time where preventive sanitary precautions are neglected lor any reason. This was demonstrated in 1037 when Montreal, Canada, experienced one of the worst epidemics ever rejiorted on the North .\merican continent. It involved more than 5,1)00 cases and nealv 30(1 deaths and extended over a period of more than six months. In Illinois the mortality and sickness from typhoid fever in lUiii was the most favorable ever recorded. Only 330 deaths were reported. The favorable record in 1930 was sim])ly another step forward in the improvement that has been going on fairly constantly since the opening of the century. As ultimate extinction of the disease approaches, the degree of annual decline grows smaller, but no less significant and valuable. Since l!Ms the decline in the mortalit}- rate has amounted to slightlv more than tSO jier cent. MORT/\LITY FROM Tvi'IIOID FeVER IN ILLINOIS. Ye:ir. !9I8. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. Number l>«iths Rate per 100 000 519 8.2 383 5.9 380 5.8 396 5.8 282 4.0 317 4.7 239 3.5 327 4.7 230 3 2 The fly in the ointment of the splendid 1936 experience is the bad record of the 3-1 counties which make up the extreme southern tlJrd of the State. HEALTH COXniTlOKS AFTKK IS, , 347 These 3-1 couiitifs. with Ixit httle mure than one iiiilHon people, lost 116 in- habitants to typhoid fe\er, whereas the uther 68 counties with a population of fully six million, lost nnly 111. There is some evidence that warm cli- matic conditions favor the projiagation of tyi)hoid. The fact that mild weather prevails much longer in southern than in northern Illinois ma\- he a factor in the unfavciralile typhoid rate in the sdutheni section. The rate per lOd.OiMl was only 1.:) in the -'i:! cuunties that make up the extreme northern third (if the State. Here nearly five million ])eople are concentrated. 3-1-S III-.. \l. Ill C'O.NDITIONS AFTEK 1ST7 In tlio central ihird. the rau- was ".'i. A little less than one and one (|iiarler million people dwell in the .'io counties here concerned. rile \rr\- faxorahle record in Cook County influenced the good showing in the north. In that ci niU\- where the estiniate di.-aths recorded I'rcjni l}-])hoid. That gives a rate of 0.7. 'The rate for the other :>■,' northern countie.-^ was 'i.]. considerahly more fav(n-ahle than either the cenlral or southern sections. There were ■.'0 cities of 10,0(10 (ir more population, and ''] counties from which no deaths at all from typhoid fever were reported. Indeed the inortalitv was confined largely to the small communities aitd rural areas. Tliese data jioint directlv to the wholesome influence of public health activities. Typhoid fever death rates ilecline as volume of jiublic health serv- ice increases. Scarlet Fever. When the State Board of Ilealth came into existence in ISTT, Chicago was passing through the greatest epiilemic of scarlet fever in its history. The in meilical knowledge concerning scarlet fever. A great deal was undertaken bv the public health .-i^eiicies. however, and ])articularly in Chicago where the best local organi/alion in ihe State was at work. HEALTH COXDITIOXS AFTKR 1 S 1 "i 349 The control measures einpU)yed included public etlucation, the retiuire- ment of case reports, the isolation of patients and the quarantine of premises, the medical inspection of school children and, to a less extent, the hospitaliza- tion of jiatients. None of these things developed uniformallv in the State nor were all of them begun simultaneously. The educational propaganda started first, about 1880, when the .'-^tate Board ])ublished and distributed literature freely. The Board also made the disease reportable but few notifi- cations were received except in Chicago where local ordinances were em- ployed. 9ol Mji'l'MM!! 1 Tl'i 11 Ili^^TII TTIT 1 1 1 M 1 "1 1 ■ ■ "" ' » lyjiJ^d-Lii-l^i^ , , ' I 1 1 ■ ' 1 °^ fT^! ,' ! '-Ttl- iMtbCAKL" 1 r LVLk: - ~ -Lii-4-^-^ ^" IPi ILLIhOIS"-^- 1 1 I 1 ■w " ^-rt : ,! : :' 1 louw I7CD :: 1 _;_ li^^^b"ATIbTIC5 UnWAILAtSLL hOW OCtn YLAK5 . : ! ; i ' 1 1 ir_ _ _: 1 :::.±_t r_ ^ __T ,__ F -^ ' ! 1 1 ll if- W-— +4^ < ^ ^— — — ■ — — ^— --— -'-rrr 1 ' ' < o ■" + ITi-^- --T d 1-^ , 1 't " ^ fY 20 _r Q. 1 '1 l' S " J ' ' • 1 i 1 1 : i 1 l-r 1 i ^ i f iiC Ui. ' M N -1 ^^^m 1 i ^^^^H f 1 1 r II ^^^^^^^^^^^H i 1 1 ! 1 1 Shortly before liJOO it became the practice of the Slate Board of Health to send medical inspectors to epidemic foci. These men promoted isolation of patients as their chief control measure and this appears to have been ac- companied by favorable results in reference to the spread of the disease. Scores of communities suffered from outbreaks during the first decade of the twentieth century so that the reports of the State Board are filled with accounts of investigations and resultant control measures, usually in the form of i|uarantine. 3:)ii lir.AI.rii tDNDITIONS AFTF.H IS" Another very impurtaiit factor in controlling scarlet fever began to assume importance about lims. This was the iiromotion of milk pasteuriza- tion. Dining the previous year Chicago went through a serious epidemic of scarlet fe\er and evidence gathered by the epidemiological investigators indicat^■d tile milk sup])ly as the means through which the disease was spread. 2Z0O - SCARLET FEVER CASE REPORTS Ih ILLlhOIS 2000 _ LEIGEHD "^---..^^ 7 Year Adjusted Median 1919-1923 — o^^^^^o-" \^ 1924- Cose Reports —o—^.-O-— ^ 1600 — \ 1400 --... m. 1200 1000 800 Va. ~~q /' X- '^ /'' 600 \, '\^ Jl 400 \\,^/>' 200 1 1 1 1 1 1 1 Jan. Feb Mar Apr May June July Auq 5ep Oct. Nov Dec. Pic. 22. Note tlie sliarp upward swing of the 1924 line for December. Table :'.]. C.ASES OF Scarlet Fever Reported BY Months in Illinois. Vfur. .liin. Feb. Mar. .\pr. 1 May. 1 June. JU1.V. Aug. Sept. Oct. Nov. Dec. Total. 1916 1,878 1,891 2,281 1,564 1,547 893 416 239 488 933 1,264 1 1,682 15,076 1917 2,284 2,625 3,403 2,488 2,230 1,329 699 351 528 401 232 j 648 17,220 1918 758 611 561 505 362 148 150 101 231 189 2C1 i ros 4,025 1919 440 588 662 586 495 289 99 97 304 656 893 1 1,101 6,210 1920 2,449 2,235 2,335 1,708 1,456 862 429 293 715 1,385 1,972 2,637 18,476 1921 3,116 2,525 2,241 2,113 1,629 710 330 412 857 1,569 1,77S 1,743 19,023 1922 1,967 1,817 1,388 936 671 465 240 370 526 1,143 1,419 1,314 12,256 1923 1,556 1,071 1,066 816 739 475 241 227 444 768 1,008 1,123 9,474 1924 1,435 1,317 1,508 1,148 1,003 780 383 208 396 891 1,105 1,516 11,690 1925 2,064 2,103 2,384 1,772 1,682 909 351 261 377 755 1,279 1,755 15,692 1926 1,847 2,129 2,051 1,507 1,397 947 488 297 376 816 1,124 1,265 14,244 This disclosure led the health commissioner of Chicago to require the pas- teurization of milk supplies ottered for sale in that city. The order became effective in linis but it was r.)l.'i bi'fore f;icilities were available to make the entire su|iply of the city coniplcteU p;isteurized except two percent which was certitied. HEALTH COXDITIOXS AFTER 187' 351 Observation of the inijjrovenieiit brought about in Chicago as an ap- parent result of pasteurization led to the gradual extension of this procedure throughout the State. It was ])ronioted with vigor by the State Depart- ment of I'ubHc Health subsequent to ID'-il, a fact referred to elsewhere in this volume. The medical insijection of school children doubtless was an important factor in controlling scarlet fever and other diseases as well. It has never Table -.Vi. Deaths FROii Scarlet Fen'er ix Illixois by AIoxths. Year. Jan. Feb. Mar. Apr. Ma.v. June. Jul.v. Aug. Sept. Oct. Nov. Dec. Total. 1918 28 17 22 23 11 8 5 4 2 10 13 6 149 1919 19 27 29 23 18 13 6 6 4 18 29 33 225 1920 50 53 55 29 33 22 8 4 13 24 41 30 370 1921 45 49 51 47 34 32 11 12 17 30 38 47 413 1922 57 48 37 31 16 13 7 15 9 18 21 30 305 1923 36 28 42 15 23 13 7 7 10 11 10 27 229 1924 27 27 25 27 18 10 8 4 6 9 15 30 206 1925 34 28 59 34 32 11 6 9. 5 10 20 20 268 1926 34 23 38 31 26 21 10 10 6 11 14 9 233 Table 33. Deaths and Death R.\tes from Scarlet Fever in Illinois. Rate per 100,000 No. deaths. population. Rate per 100.000 No . deaths. population. 516 9.2 575 10.1 608 10.5 694 11.9 1,022 17.2 1860 1,698 1870 2,162 1880 1.369 1881 856 1882 687 1883 1,048 1884 832 1885 802 1886 743 1890 442 1900 643 1902 735 1903 519 1904 368 1905 177 1906 602 1907 S8() 1908 533 83.1 1910 44.4 1911 27.1 1912 21.2 1913 31.7 1914 24.6 1915 23.2 1916 21. 1917 11.5 1918 IS. 3 1919 14.7 1920 10.2 1921 7.1 1922 3.3 1923 11.3 1924 16.3 1925 been practiced with a large degree of systematic regularity except in Chicago but infiuc-nce on communicable diseases there always has a pronounced effect on the iirexaleiice rates in the State. Manv other places enijiloyed |)ublic health nurses for work in the schools, especially after the \\'orld War. and tlu-ir work ])roduced marked improvement in the communicable disease in- cidence in the communities which they served. 3.V2 inc. \i. Til coxDrno.Ns ai-ti;k ]8TT The year of \'W, marks the heginnint;- of the jicrioil when statistics of a rcHable character became available fur the State i^enerall)'. In that year means for securing fairlv complete rejjorts of cases of scarlet fever, along with otln-r diseases, were employed. This enabled State health oili- cials to keep informed about the situation at all times and to be in a j)osition to exercise control measures. The most important step forward toward the control and ultimate elim- ination of scarlet fever came from bacteriological research in 1921. It is of especial interest here because two Illinois physicians, (ieorge F. and (Gladys H. Dick, working together in the McCormick research laboratories in Chi- cago, discovered that a certain strain of streptococcus is responsible for scar- let fever and that toxin from these organisms may be used to determine through skin tests susceptibility to the disease. Prophylactic and therapeutic agents were also developed from the toxins. The fundamental scientific facts in regard to the etiology of scarlet fever had been known for some time. The first was that some one or more of the streptococci were concerned in its symptomatology. As to the causa- tive relations of the streptococcus there were two schools. One held that the streptococcus was the cause of the disease. The other held that strep- tococci were so nearly ubiquitous and caused so many diseases that they could not be the specific cause of scarlet fever. This school held that the specific cause was some unknown organism, but that the streptococci con- tributed materially to the symptoms. The theory upheld by Bristol that the rash of scarlet fe\er was an anaphylactic phenomenon for which streptococci was the bacterial cause, lent more su|ii)ort to this side of the (luestion than it did to ethers. Dr. A. R. Dochez, by the use of certain culture methods, demonstrated the one variety of streptococcus which he claimed could i)roduce the disease, and in that wav seemed to establish tlit' priniac\- of tlie stre])tococcus as the ctiologic agent and, at the same time, to answer the i)(jint made by Jochmann that an organism which was so witle-spread and caused so many diseases eonlil not Ije the s]iecitic cause of scarlet fe\er. It reniained for the Dicks in l'.)"?1 to jirove experimentally that a certain strain of streptococcus grown from throats of persons having scarlet fever, when injected into suscejitible human beings, produced the disease. The Dicks extracted a toxin from this streptococcus which is now being used to make a skin test for determining the susceptibilit\- of persons to scarlet fever. This ])r()cednre. called tin' Dick ti'st. is done the same as the Schick test in reference to diphtheria. .\ toxin for ]ireventing scarlet fe\er has also been developed. It is given in mnch the same wav as to.xin-antitoxin HEALTH COXDITIOXS AFTER 18T7 SoS for the prexcntion of diphtheria. Not only that but there is now availal)le an antitoxin for the curative treatment of scarlet fever. The outlook for ridding the country of scarlet fever is therefore promis- ing. The greatest prevalence of scarlet fever is almost always experienced in mid-winter, usually in January or early February. Greatest freedom from it is enjoyed in August. The disease runs almost as true to this course as vegetation does to the seasonal changes which govern floral life. For some reasin which is not altogether clear, scarlet fever lost a good deal of its \irulency during the second and third decades of the twen- tieth century. In lil2G, for instance, there were 14,24-1: cases reported with only 233 deaths whereas 19,825 cases in 191T left TUl dead. Fatalities mounting to l.uOO or more per year were evidently common in Illinois prior to liliiO but it seems im])robable that the number of cases was correspond- ingly large. The trend of the disease both as a cause of death and sickness ma\- be observed from tables 31, 32 and 33. Its seasonal beha\ior is illustrated in Figure 22. A graphical illu.stration of the mortality record from scarlet fever is given in Figure 21. Diphtheria. The State Board of Health, in the years immediateh- after its organiza- tion in 187T, was especially concerned with the regulation of the practice of medicine, and the suppression of epidemics of yellow fever, cholera and smallpox. The other contagious diseases, including diphtheria, which were then attributed to filth and bad sanitation, \yere left largely under the con- trol of local health organizations or practicing physicians. There are no statistics available showing the prevalence of diphtheria or the death rate from the disease in Illinois for the years 18T7, 18';8 and 18:!). In l.^sl). the United States cen>us >h(iws thai in Illinois, with a jjupula- tion of a little oyer three million, there were M,7s:; deaths from diphtheria, or 123 for each 100,000 inhabitants. Chicago, too, in this \ear recorded a rate of 2!)0 per 100,000 jxipulatiim, the highest d:j)htheria death rate ever recorded for the city. The diphtheria death rate continued high in 1881, 18S2 and 18,s;i. In 18S3 the State Hoard of llcalih (li>trihuted an educational circular on the prevention anil control of diphtheria from which the following para- graph is quoted : "Diphtheria I'as so often appeared where uncleanly conditions have prevailed, when it could not be traced to continuous propagation b.v contagion that its rela- t'.n to tilth a? a cause may he assumed for sanitary purposes. It is immaterial 3:. 4 mCAl.TIl CONDITIONS AFTKR 1877 whether this tilth exists in visible and disgusting form such as the garbage heap, the cess-pool or the privy vault or in the invisible and possibly inodorous gases from an illy constructed sewer; from decaying vegetables in the cellar or in the poisonous exhalations from the human breath and body in unventilated rooms. All these undoubted causes of ill health should be at once abated." Tlii.s .same circular also stated that diphtheria frequently caused mure deaths' than tyi)hoid fever, smallpox, scarlet fever, and measles combined. During the first 10 years of the State Board of Health, from 1877 to 188(), Chicago anmially averaged i(i8 deaths fn>m diphtheria for each loii.ooo of population. Diphtheria was indeed a terrible disease, and today it can readily he ap- preciated how fuiile were the efforts, made at great expense, in trying to combat its sjjread b\- re-laying sewer pipes and drains, on the theory that it was a filth disease. In 1887 the health department of the city of Chicago declared that di]ih- theria wa-- not a filth hut a contagious disease like smallpox. Table U. Dii'iiTin:Ri.\ Including Croup, Chkaco Cases and Deaths, ]89:i-lS99. 1897 . 1898 . 1899 Keporterl. 1,4S1 1,406 1,632 1,098 Another step away from the filth theory took place in 18!)] when the State Board of Health ordered that bodies dead from diphtheria could no longer be transported by common carriers because of danger of sjireading the disease. In Chicago, diiihtheria was made a reportable contagious disease in 18!)2 Init this order was not comjilied with very extensively because neither the medical ]n-ofession nor the public was ready to accept the germ theory. Table ;!l, compileil from the annual reports of the health deiiartnient. shows how far shiut the ( tTori lo collect morbidity reports fell. .Meinl)rani'iis croup \\;is m.ade reportable in 1898. ' The filth ilieorv of the origin of diphtheria gave way completely before bacteriological research >o th;il by is'.i.'i the whole problem of prevention was regarded by forward looking sanitarian> m a new light. In that year anti- toxin as a sjiecihc cur.ative agent was introduced. On September iMh, Chi- cago opened (>0 stations at convenient points in the cit)- from which this new product could be bought at reasonalile prices and had free by the pocir. HEALTH COXDITIOXS AFTER ISTT 355 Althini.t,'h Uiere wcrt- nianv cases cif diphtheria and many deaths, and talk (if clcising simie nf the pnlihc schiidls because of e])idemic conthitions, yet not a single vial of the serum was called for at any station until October 5, ISII.'). This was true in spite of wide publicity given through the public press and illustrates the skeptical attitude of physicians toward the new treat- ment for diphtheria. Because physicians were slow to use the new remedy, and especially be- catise of the many deaths, the health department used all available mem- bers of its medical staflf in administering antitoxin, and in teaching the medi- cal profession the methods of using it. This practice soon made necessary 36 additional supply stations while 434 drug stores were authorized to act as agents for the distribution of diphtheria culture outfits. Between October 5, 1895, and April 1, 189(i, there were l.liis true cases f bacteriologically verified) of diphtheria treated with antitoxin of which number 1.3T4 recovered and 94 died, a fatality of U. 1 ])er cent. An analysis of 805 of the true cases referred to aljuve shows: Treateil on. Total. Recovered. Died. Death rate. (Per cent) 1st day - - 61 187 372 1C9 76 61 0.00 3rd (ia.v 4th da.v Over 4 days. 3e2 10 02 17 54 22 2.6S 1.5.60 2S.91 803 753 52 6.46 By Xdveniber. is:)."), antitoxin administrations were being used to such an extent that it was s|)iiken of as (jcucrallx adopted. The use of antitoxin as a preventive of di])htheria in Illiniii> began dur- ing the autumn of ISIl"). It was argued that a drug which could cause so prompt and complete recovery from diphtheria ought to be heliiful in its prevention. This proved to be the case so that the practice of injecting anti- toxin into susceptible persons exposed to di]ihtheria expanded coextensively with the use of this ]iroduct as a curative. Collecting Case Bcjiart.s a Pnihlctii. Once started the use of antitoxin became rouline practice and caused far less trouble for health officers than the matter of case reports. In the State at large very little pressure was brought upon the local doctor to get reports because there were no local health organizations of conseqiience but in Chicago first one expediency and then another was em])loyed to promote reporting. The medical profession was more or less recalcitrant on the whole so that Chicago was one of the last of the large cities in the countrv to reach the point where diphtheria quarantine was handled in an efficient 356 HEALTH COXniTIONS AFTER 18TT way from a pulilic lu-allh staiKl])<}iiit. Table '■'>') indicates hy the relatively small (liffereiice lietween case and death re])(irls that ndtilication was li_\- no means com])lele during the period. After llHi; im])rovement in case reports began to \iv noticeable tirst in Chicago and later throughout the State. This was stimulated by the activity of health officers, local and state, and the completeness of registration in- creased in direct ratio to the increase in public health facilities for enforc- Table ;i5. Diphtheria and Ckoup — Illinois and Chicago. Number of Cases and Deaths 1900-1907 and Death Rates per 100,000 Population. Entire State. Chicago. Year. Death.s. Rate. Cases reported. Deaths. Rate. 1900 3,033 2,237 2,760 3.300 2,607 2,901 4,457 5,338 840 615 627 637 409 433 654 655 49.5 1901 29.4 1902 1,079 1,175 881 825 1,022 1,015 21.6 23.1 17.1 15.7 19.2 18.9 34.8 1903 34.4 1904 21.5 1905 22.2 1906 27.7 1907 27.1 Table 36. Mortality from Diphtheria in Illinois. Year. 1921. 1922. 1923. 1924. 1925. 1926. \i 1,478 22.3 1,181 17.6 811 11.9 470 6.8 409 5.7 411 R: te pel' 100.000 , 5.7 ing the notilication requirements of health otticers. I'airlv satisfactoi")- case registration dates from ]!)(•; in Chica,go and from 191 1 for down-state. For all jn-actical pur])oses the case re|iorls were complete subse(|uent to these ye;ir.^. Free A)itil o.vni. ( hicago introduced a system for snp]>lying antitoxin at reasonable i)rices from convenient stations in is'.Ki. A -imilar >ystem was created for the State in l!H)."i by a legislative enactment. In I!Hi; iJu' State Board of Health began the free distribution of antito.xin to all citizens. I'or this purpose an a]5propriation of !i^l.'),0()0 was made in ihai \ear. 1 )istvibution was effected TiEALTII COXUITIOXS AKTRR ISTT :3:>: through a system of agents, usuall_\- hjcal druggists, one of whom was located in every county seat with two or more in all of the larger communities. This practice [irevailed continuously and is still in vogue. It was satis- factory except that unforseen epidemic conditions from time to time prior to l!i"M exhausted the funds apiiropriated and created a shortage in the anti- toxin >upply. This resulted in hard>hips the character of which may l)e readily surmised. An emergency ajipropriation was made hv the General Table 3T. Cases of Diphtheria in Illinois. Year. Jan. Feb. Mar. .\l.r. 1 May. 1 June. Jul.v. A,., •Sept. Oct. Nov. Dec. Total. ■ 1916 973 810 736 559 1 640 1 643 471 525 797 1,564 1,627 1,337 10,682 1917 1,263 1,072 1,312 1,124 1,141 930 890 722 1,212 814 2,046 1,161 13,687 1918 1,028 649 751 665 565 566 487 362 604 990 703 705 8^075 1919 731 769 665 635 668 470 541 528 992 1,898 2,050 1,505 11,452 1920 1,139 93S 1,058 778 793 I 656 624 454 904 1,907 2,700 2,343 14.294 1921 1,874 1,364 1,350 1,215 1,085 1 944 744 848 1,613 3,667 3,503 2,584 20,793 1922 1 1,918 1,361 1,211 863 820 i 793 576 •654 880 1,844 2,297 1,945 15,162 1923 1 1,697 1,090 1,032 727 678 1 532 392 411 607 1,114 1,318 1,118 10,716 1924 1 1,007 790 671 577 464 378 367 269 416 557 693 664 6,853 192,5 1 584 438 439 391 370 323 287 266 273 490 584 541 5,0C6 1926 486 392 357 327 300 367 232 204 273 493 381 519 4,531 Talile ;3S. Diphtheria — Morciditv, Mortality and Fatality Rates. Po|mlati..n. Cases. Ilea Ills. Per 100,000 people. IJeaths Cases. Deaths. i;er 100 cases. 1917-18 I91S-19 - 1919-20 1920-21 1921-22 1922-23 6,310,856 6,398,068 6,4,S5,2S0 6.572,492 6,659.704 6,746,916 6,834,126 6,921,344 7,092,000 11,000 8,060 12,876 16,764 19,901 13,883 8,853 5,330 4,666 1,527 979 1,061 1.243 1.25S 989 647 400 410 174.3 125.9 198.5 255.1 298.9 205.8 129.5 79.9 24.1 15.3 16.3 18.8 19.2 13.3 9.5 5.8 13.8 12.1 8.2 7.4 6.3 1923 24 1924-25 1925 26 -2 Assembly early in 1!)21 to cover immediate needs and subsequent to that time the biennial grants were ample to meet all requirements. With the discovery and use of diphtheria antitoxin ilic deaih rate throughout Illinois declined very rapidly. The rate of s.") per Kiii.ood i)opu- lation in 1886 was cut to only 1~, by lUO"^. This marvelous drop in the death rate caused many of the enthusiastic special workers in the field of preven- tive medicine anil public health to prophesy that the year of 1925 would find di])hlheria wijied oli' the face of the earth. Thev based this forecast on the 358 IIKAI.TH COXniTIONS AI-'TKR IS'l^ facts ihal cdinpl'lc in I'uniiation existed in rei^anl lu the causative at^ont of fliphtlieria. tlial anlituxin wniild cure it and that anliluxin wuuld t;i\'e tem- [lorary inmnniiiy id exiiii>ed person^. A >tU(ly iif the Chicago tii^uro and alsd the State ligures (see Fig. 23) show tiiat Ironi 11)()",> to \'J22 the rechicticm in diplitheria mortality was very small. The failure to lower the diphtheria death rates cluriniL;- the two de- cades may he t-xplained in part hy the following factors: I. Ignorance (hiring ])art of this time of the role ]>layed h_\- diphtheria carriers in sjjreading the disease. Tahle :;!!. Diphtheria Carriers. Year. Jan. Feb. Mar. Apr. Ma.v. June. Jul}-. Aug. Sept. Oct. Xov. IJec. 1921 1 1 1 179 136 346 340 242 118 174 117 227 2S9 ISl 67 292 257 286 262 167 92 480 429 432 337 2=9 145 516 676 522 417 310 164 420 1922 1 270 239 306 383 207 119 235 255 327 259 134 165 249 285 186 122 139 3.;3 284 287 126 214 288 227 244 89 477 1923 455 527 577 292 137 1926 148 242 Table 4U. Deaths from Diphtheria in Illinois bv Months. Year. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. NOV. Dec. Total. 1918 146 100 121 137 181 133 83 47 38 105 92 108 122 108 88 34 23 37 100 91 68 93 120 74 41 29 35 94 63 83 88 74 59 38 33 32 83 69 76 92 88 36 36 29 26 66 44 47 84 45 27 32 27 24 66 60 44 56 43 26 33 23 32 53 48 47 81 46 36 16 25 14 77 89 64 92 75 45 31 24 24 159 135 126 231 132 89 37 46 53 102 141 181 223 130 107 44 51 52 91 112 165 179 139 91 55 52 44 1919 1923 1924 811 480 1925 2. Self-medication of illnesses regarded as nothing more serious than severe sore throat. ;). Delayed medical service in cases of diphtlieria. 4. Too >mall doses of antitoxin. 5. Inahility to produce in susce])til)le persons anything hut temporary immunity. The ne.xt great ste]) toward controlling diphtheria hegan in l'.)i:l when Schick di^co\■ered tlu' skin leM that hears hi^. name and which nia\' he used to determine which persons are >u^ceptihle to di])htheria and which are not. In the same year I'.ehring started to using a mixture of toxin and antito.xin as a pernianmi pre\enli\e against diphtheria. In tlie course of time hoth HEALTH CONDITIONS AFTllR 187^ 359 of these procedures came to be part of the routuie practice in fighting diph- tiieria in lUindis and it is to the prdnidtiim and practical appHcation of these two things that credit is given for tlie remarkable decline in diphtheria since P(ipiil(iri-iiif/ T nxiu-Antitoxin . Like anlitoxin at first toxin-antitoxin was regarded with distinct skepti- cism (in the part of doctors and the public so that it came into more or less general use (|uite gradually. The Schick test required time and considerable skill but its empldyment before administering toxin-antitoxin was advocated. This was ruKither ditticully in the wav nf generalizing immunization against diphth.'ria. Table 41. , Deaths and Death Rates from Diphtheria in Illinois. Rate per 100,000 Year. Xo. ilealhs. iiopulatiiin. Year. I860 1,109 70.0 1009 --- 1870 1,1S9 59.0 1910 1880 3,7S3 122.9 1911 1881 2,924 92.7 1912 1882 ---- 2,172 67.2 1913 1883 2,2111 66.6 1914 1884 2,J19 68.6 1915 1885 - . 2,7;5 79. ,S 1916 1886 .- 3,997 113.3 1917 1890 3, .561 93. 191.S 1900 2,067 42.8 1919 1902 - - . 1,076 21.6 1920 1903 - ... 1.175 23.1 1921 1904 - .--- . 884 17.1 1923 1905 825 15.7 1923 1906 1,022 19.2 1924 1907 1,015 18,9 1925 190S 979 17.8 1926 Rate per 100,000 . .leaths. population 1,001 18. 1,332 23.8 1,302 22.7 1,414 23.4 1,347 22.8 1,092 18.2 1,130 18.5 1.356 21.8 1,725 27.7 1,142 17.9 1,044 16.2 1,128 17.2 1,478 22.2 1,181 17,4 811 11.9 Experience came tn the rescue. .\ few pioneers all over the cnuntry began giving toxin-antitoxin t(i all children under their cniitrol without ref- erence to the Schick susceptibility test. One nf these was the medical offi- cer of the fraternity school at Mooseheart, Illinois, where more than l,t>(i() children are constantly enrolled. Beginning with 1 '.(•;;() all children in the in- stitution have been immunized with toxin-antitoxin, newcomers getting the immunizing doses upon arrival. No case of diphtheria developed there to date subse(|uent to V.)'M although the previous history showed Ki to .'iD cases annually. Statistics al'-o came in with helpful suggestions. Thev pointed out that by far the heaviest losses of life from iliplitheri:i were among children less than si.x ^-ears old. 3fi0 IIKAI.TII COXDITIOXS AKTKR ISTT TIius aboul \'>'i'i the Slati- IX-parlmcnt of Public Health began to ad- vocate tbe use of toxin-antitoxin in children under eight without regard to the Schick test, A mnnber of voluntary and professional organizations elected lo lend ibeir influence to the cause of diphtheria eradication and some, like the federation of women's clubs and the parent-teacher associations be- came quite active in the campaign. In the meantime the State had beyun to distribitte material for making the Schick test and toxin-antitoxin without local cost to any citizens who desired to use either or both. Previously a field laboratory equipment had ! rnTrnrriTrrinT'r diphtheria; in iLLinois 1860-1926 Fk; been ])urchased and the .Slate I'mployed bacteriologists who were prejiared to go at once to the scene of ontiireaks which had got beyond local control. Not onl\- so but branch laboratory service had been developed liy the State for tbe i)uriK)se of expediting the diagnosis of diphtheria. .Ml of these factors counted in the manifest success toward ridding the State of diphtheria. The first step was the realization that diphtheria is con- tagious and is spread from person to person. That took place about ISOO. 1 lien came antitoxin, placed on the market in lsii."i. The next imiiort- aiit iiieaMue was tbe laboratory diagnosis of diphtheria. This Ijegan as an HEALTH COXDITIOXS AFTER ISTT 3(51 official function of the State in I'JOi when the laboratory was started. It developed until five branch laboratories located at convenient points offered prompt service in diphtheria cases to all parts of the State without local cost. In liilT a field diagnostic laboratory ovitfit was put into service also. Following the introduction of free laboratory service came the free distrilnuion of antito.xin, undertaken b_\' the State in I'.H)', and continued. Then came the Schick te>t and toxin-antitoxin in IDl.'! and the adoption of both by the State about lii-20. The downward trend of di])htheria was due to the organized use of these factors. As each came into prominence a nt-w advantage over the disease was gained and a new declevity in mortality from diphtheria dated from its use on a considerable scale. Reference to Figure ^^i and the various tables accompanying this article tell the story of how rapid the progress against diphtheria has lieen. Not only has the prevalence ftnd mortalitv declined but the jiercenlage of fatal cases has gone down. After l!i-2i improvement in the mortality rate from di])htheria was phe- nomenal. The number of deaths reported for li)26 in Illinois was less than one-third of the number reported in I!I51. Figures for the intervening years are shown in Table ;)ii. Tuberculosis. Tuberculosis in Tllimiis subsei|uent to is;;, may be viewed in two per- iods, the one prior to 1!M0, during which time n the level which characterized the diseases during the first decade of the twentieth cen- 3G2 lli:\l,rll CONDITIONS AI-'TI'l; \s',', tun'. This iiKTcase probribly had some rflaticui tn the Wdvld War. 'I'he strain of that ciiiergency together with deprivatimis in food, high pressure working cmiilititins and new kinds of cx])osures pr(ihal)ly caused a rekindhiig of tuiierculdsis in inaii\' people in whom il had lieen arrested or quiescent. .\t an\- rate I'.Ms was the jieak ninrtality year in the second period. After lliat dale a stead\' dechne marked the mortahty from tuberculosis. Not oni\- had tlie time arri\ed when resuUs from eonlrnl measures were to be expected hut a new zeal and added mdinenlum characterized anti-tuber- culosis campaigns in the Slate. Good economic conditions also prevailed. TUBERCULOSIS-ALL FORnS in iLLinas ,n 1860-1926 ^^ C STATISTIC? UrtAVAILABLE FOR OPEh YEARS) making pussible the extension of pre\enti\e work on a larger scale than would otherwise have been the case. Earlij Altitii'lr. The carK \iilumes of the annual reports of the State Moard of Ilealtb contain practicalK- no reference to tuberculosis. This is evidence thai the disease pro\dkeil little thoughl among saniiarians then. The efforts of health officials concerned |iidhlem-, which were regarded as more urgent at that time. These included the protection of the inhabitants against the invasion HEALTH CONDITION'S AFTER 187 363 of such pestilential diseases as cholera, yellow fever, and smallpox, and li- censing of practitioners of medicine. Furthermore, the fact that the infectious nature uf tulierculusis had not been definitely proven, while the sanitary precauliun to ])revent the spread of cholera and similar diseases had apparently been effective where they had been carried out, gave everv cause for the Board to proceed along these established lines at the time. Table 53. Cases of Tuberculosis Reported bv Months IN 1 LLINOIS. Year. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. L.._...L_.... 1 1 ; 1917 172 2,485 2,415 1,976 1,720 2,249 2,619 2,495 2,484 892 311 1 4,111 23,929 1918 1,840 1,142 1,722 1,446 1,602 1,353 1,.563 1,182 973 891 1,208 1 637 15.559 1919 1,390 1,397 1,430 1,923 1,586 1,723 1,720 1,447 1,627 1,719 1,693 1 1,580 19,241 1920 1,433 1,164 1,.S20 1,320 1 1,295 1,46.S 1,065 729 1,209 1,012 938 1 1,114 14,563 1921 989 1,103 1,366 1,253 1,208 1,283 1,508 1,003 1,237 1,100 1,142 1,235 14.427 1922 1,153 1,111 1,685 1,229 1.640 1,417 1,464 1,171 1,164 1,429 1,634 1,386 16,483 1923 1,775 1,161 1 2,489 1,403 1,610 1,351 1,151 1.122 1,096 1,385 1.083 886 16,512 1924 1,328 1,077 1 1,111 1,482 1,239 1,223 1 1.582 1,799 1,135 1,2.37 880 1 925 15,018 1925 907 1.182 1 1,143 1,101 1,151 1,190 1 1,051 825 1,166 1,015 1,332 1 1,941 14,004 1926 954 1,132 1 1,359 1 1,755 1,853 1,793 1,463 1,738 1,291 1,399 1,131 1 1,129 16,997 1927 1,518 1.175 1 1.329 1 1.414 1,157 1,362 1.040 Table 'A. Deaths FROM Tuberculosis in I LLINOIS BY Months Year. 1 Jan. ! Fell. 1 Mar. Apr. May. June. July. Aug. Sept. Oit. Nov. Dee. Total. 1916 ' 1 1 1917 1918 724 677 876 939 818 671 596 585 581 742 720 650 8,579 1919 728 721 756 768 712 612 610 553 454 509 459 513 7,395 1920 639 737 631 626 628 563 524 468 450 423 431 448 6,568 1921 506 455 571 505 548 428 447 444 449 435 375 456 5,617 1922 492 477 576 551 547 468 445 440 384 408 395 437 5,620 1923 489 506 559 542 527 474 448 421 410 410 408 378 5,572 1924 544 469 560 505 543 482 446 416 409 420 424 424 5,642 1925 505 433 555 504 502 511 470 386 1 415 407 408 441 5,537 1926 454 407 579 531 556 486 441 410 1 408 438 347 438 5,495 1927 1 i At the beginning of the semi-centennial period in the year 1877. little was known about the cause and prevention of tulierculo^is. Ihiwcver. as early as ]S(i], France had established h(>si)itals for the poor tuberculous children of Paris. In I.S(i.") it was demonstrated that ttiberculosis could be transmitted to the lower animals by inoculating them with diseased tissue from tuberculous luini,-ni lungs. The attention of the people of Illinois was first attracted lo the serious- ness of this disease bv the high death rate at .state instiuuioits, .\s earlv 364 iii:.\Lii[ lO.vDiTioxs a1'-ti:k 1is at llie State iieiiilentiary Ijegan to concern the inaiia.i,'enieiit nl' that iii>tituticin. A rejjort made in 1899 showed a 10-year averat^e nicrlaHly of Jii.o per thuusand inniates ; the average age of inniate> lieing ;)"i years and the average term of commitment being two years. Warden Mnrphy's re])ort in 1(S9.') showed 'A) cases of tuberculosis, 29 deaths, and ■.'(; discharges; and of those sulTerinL; from lul)erculosis as high as ^'-i ]jcr cent had died from this disease in this institution. Unfortunately there are no accurate records available during this early ]>eriod showing the [Prevalence of tuberculosis in the State as a whole, except the I'nited States decennial census reports of deaths. These give the Table 55. Anxu.vl De.vtiis .xNii De.atii Rates from Tuberculosis in Illinois. — All Forms. Rate per Rate per 100,000 100,000 Ycir. No. ilciths. jiopulation. Ycav. No. deaths. population. 1860 , 113.7 1906 6,899 129.8 7,142 1S70 145.6 1908 6,944 126.8 1909 7,078 1880 4,645 150 '.. 1910 7,049 1881 - 3,624 111.7 1911 6,509 1S,S2 2.385 73.8 1912 .- 6,212 106.5 ISS'i 3,2.55 98.5 1913 6,371 107.6 ISM 3,452 102.5 1914 6,521 104.8 ISS.i 3,S66 111.9 1915 7,816 128.1 1SS6 - 4,472 126.7 1916 8,408 135.6 1917 8,065 129.4 1890 . 5,69S 14S.9 1918 8.579 128.7 1919 .- 7,395 114.7 1900 6,7S8 140.7 1920 6,568 6,S95 138.3 5,617 1902 _. 1922 -- 5,620 83.8 1903 - 7,032 13S.7 1923 1904 .... 7,234 140.5 1924 1905 .- 6,.S91 131.7 1925 5,537 1926 5,495 76.2 deaths from tuberculosis as follows: I,n May 'i2. ISIKI, Dr. ('. W. Olson of Lombard, Illinois, read a paper on "School Hygiene an[ dfclared tubcrculiisis to he a contagious disease in IIMIl . A second report was siilmiilleil lo the (iovcrnor in I'.H)-.'. recommending the estabhslnnt'!ii of a Stale sanatorinm. .Vttenlion was calle(l to the fact tliat the records of the State showed from 7,()t)U to 8,t)()0 deaths ])er year from tuberculosis and that there were tnore deaths from tuberculosis than from typhoid fever, whoopiing cougii, measles, scarlet fever, and smalliiox com- liined. Numerous attempts were made to gi't pu1)Hc appropriations for a State sanatorium but these efforts failed. Tuberculosis was the suljject of a symposium on the occasion of the annual meeting of tiie Illinois State Medical Society held at Bloomington, Illinois, in I'.iOI. This was participated in li\' members of tlie State Board of I lealth. {'"ollowing this a circular was printed liv the Board entitled "Cause. Prevention and Cure of Tuberculosis." 'i'his was distributed in July, and during the year it was necessary to turn out four editions, the last consisting of lOO.OOii cojjies. '{"his circular was distributed freely dur- ing the following year. It was in 1IK)1 also that Dr. T. B. Sachs published the report of his intensive studies on the incidence of tuberculosis in the Jewish district on the west side of Chicago. The cases found in a house- to-house survey and through dispensary records were shown on a spot map. and were so numerous that the study attracted a great deal of attention. The report and charts a|)iiealed especially to State Senator Edward J. Glackin. himself a resident of the district, and his interest later found ex- ]>ression in the drafting of bills for sanatoria which he introduced in the legislature. The first of these was for a .State sanatorium, in 1!)05. which failed to pass. The next one provided' for the establishment of municipal sanatoria which will be referred to later. ^1 iili-t ilhi iciildsis E If arts Oriidttizcil. A meeting was held at Chicago on December 1."), 1!H)4, for the purpose of bringing together all of the organizations activeU- engaged in the pre- vention of tuberculosis in Illinois. This meeting was attended by represent- atives of the State Board of Health, of the State Board of Charities, the Chicago Medicrd Society ;in',', It was in l!HMi alsn that llir iiKivcnu'iil against tutjerciilusi.s in the schools began. Tliis started in Chicago where nursing services, mechcal examination and \entilaling facihties were proniuteil. The Chicago Tuhereuhjsis Institute secured the consent uf the ccininiis- sioners of Cook County in the summer of 1906, for the estahhshnient of an open-air camp for consum])tives at the Dunning institution. 'i"he camp was designed for poor consuni|)tives and particularly for those living in the congested poorer quarters of the city. A great deal of interest at- tached to the results attainerove that out-of-door treatment was therapeutically and economically sound. The developments mentioned thus far had their effects. One commmiitv after another began to pass ordinances re(|uiring case reports and move- ments resulting in the establishment of sanatoria, preventoria, open-air school rooms and dispensary service began to take cii momentum. Thus in liidii. I'eoria passed an ordinance requiring case reports. The same year Sangamon County appropriated $200 for providing tents in which local hospitals could isolate tuberculous patients. Abovtt the same time the Illinois Homeopathic ^ledical Association established an open-air sanatorium at Buffalo Rock in LaSalle County. A little later, about 1908, the State Board of Health attempted to stimulate reporting by requiring the names of persons from whom s]iuluni was collected f(n' examination at the State diagnostic laboratory. Lcfjishifiiin Si'ciirciJ. All (jf these things brought ])ressin'e en(.)Ugh on the Ceneral .\ssembly to result in a law enabling cities to build and maintain sanatoria. This took ])lace in 1908 after faihu"e had ])ursued all efforts to secure a State tuberculosis sanatorium. The act, known as the "Glackin Law", jirovided that u|)on the ado])tion of the propositon Ijy a referendum vote by any city a tax of not to exceed one mill on e\erv dollar of the assessed valuation might be levied to defray the cost of establishing and maintaining such sanatoria, and for the care and treatment of jjersons suffering from tuberculosis. The citv of Chicago took advantage of the law in 1909, proceeding at once to build a s;inatorium. The same year Lake Count\' estaljlished a tubercti'osis sanalorium, to lie maintained by the county, which meant that indi,'.;eni pi'rson> (jnl\- could be admitted \\ilhont charge. The (.'li'icago I'resh .\ir Hospital, a piixale inslilution conducted li\- Dr. L.than .\. Cray, was opened this year. In 19(i;i and 191 L bills were .again iiUrodnced in the legislature jinnid- ing for the establishment of a State sanatorium, but were not enacted. Thus HEALTH COXDITIOXS AFTER 1877 369 the establishment of niuiiicipal -sanatoria had td he rcHed upim uniil ll)l."i, when the legislature passed a law providing for the estatjlishment of such institutions by counties. The movement against tuberculosis gathered considerable momentum by the work done in Chicago between 1907 and 1911. Under Health Commis- sioner Evans an ordinance prohibiting the sale of milk from tuberculous cattle was passed, the requirements of case reijorts was rigidly enforced, disjiensaries for diagnosis and treatment were e^talilished, and a ^pecial- ized nursing service was inaugurated, an anti-spit crusade was conducted and withal a general public sentiment against the disease was created and Will You Become a Crusader? In the interests o! Health, Gleanlinpss and The La>v, you are earnestly requested to co-operate m enforcing the reasonable and- sanitary regulation embraced in the City Ordinance, Number 1493; "Spitting is prohibited upon sidewalks, in public conveyances, theatres, halls, assembly rooms, public buildings, or buildings where any considerable number of people gather or assemble together, and in similar places " ^{ZuT. /^^irz^f^A^^ Commissioner of Chicago .\ii«i-S|>;Hiiiii I.ea)!ue Reproduced from a circular used in Chicago's anti-spitting campaign. ptit to wijrk. Alortality began to decline and this made other folks take notice. The Association fur the Prevention of Tuberculosis took on new life and reorganized in l'.)|n with Dr. W. .\. Evans as president. From that time forward a close cooperation between voluntary and official agencies was observed with telling results. The law enabling counties to erect and main- tain sanatoria came in 191.5. After that the story is one of increasing fa- cilities for fighting tuberculosis and ultimately a long anticipated and wel- comed decline in mortality which gave evidence of iiermanent advantage. Following a well-established rule, the rate of progress in tuberculosis control did not conform to a straight line. Ijut was interrupted bv a break 370 iii:al]ii co.nditioxs akthk 187T or st(.'|) liackward in l!)ll. Thai year llu- milk (irclinancc, unik-r which Chicas,'c) was making- stu'h hcadwav in its li^ht a.i;ainsi tuhnauldsis, was in- validated, hy an act iil' the leijislatuie which iiruhiliited am niiiihcipahty in the\Stale from re(|uirini; a tuhercnHn test for tiie cattle I'mtn which its milk supply was derived; the so-called "SliurtlelT I-aw." After a year's delay, another ordinance was passed which provided that nnlk sold must he of a jjrade defined as "inspected," or else be pasteurized according to methods set forth in the ordinance. No tuberculin test could be required for cows usetl f(]r the production of inspected milk, but the standard for this class of milk was so hi.<,di, that the real elTect of the ordinance was general pasteurization. But the elTect of the State law as a win le was that dela\- and pro- crastination occurred in the purification of the milk snppl\- of the largest city in tin- ."^tate ; in fad comiilete pastetirization of the milk sujiply was not obtained until nearly li\e years later when Dr. John Dill Robertson, on July "i".', r.iHi. issued an order dnrini;- an epidemic of infantile paralysis, definitely rei|uiriiig the pasteurization of all milk except certified. L'pon the recommendation of Dr. John Dill Robertson, Comnfissioner of Health i f Chicago, the Municijjal Tuberculosis Sanitarium in I'.ilG made a house-to-house survey for tuberculosis, in the central district of Chica.go. .\ total of 1 Ci."),'; 0(1 persons were examined, of wliich number l^.G per cent were found to be tuberculous. .V total of ll.'.'S'i unregistered cases were found and listed for superxision. In l:i|(i the sanitarium .-uigmented the school inspection service of the luallh department by adding "id doctors and ."lO nurses to the force, with the understanding that a |iart of the wi rk of the entire force would be devoted to the diagnosis and ])re\ention of tuberculosis among pupils in the schools. A comprehensive program for the fintling and reporting of all cases of tuberculosis ; and the segregation of all open cases not under the care of familv physicians ; and the jirevention of the ex])osure of open cases of tuber- culosis to children under 1(1 \ears of age, was also instituted at this time in C hic;iL;o li\- Dr. Robertson. This resulted in the lowering of the tubercu- losis (K-ath rate i;f tlu' city to such an extent that it attr.acted the attention of health ofiicers in man\- cities in the Tnited Slates, and health from for- eign countries who \isileil C'hicago to stiuh the methods of tuberculosis con- trol followed there. beginning in l'.M."i. at KO.d per loo.ddd population, the death nite from tuberculosis (all forms) dropped year b\- \ear to ;s.:! in \'^'''i. a reduction of "i I |ier cent in se\en years, 'Ihis showed wh.il could be accomplished by com])rehensi\(.' and \ igoroiis elTorts to control the disease. HEALTH CONDITIONS AFTER ll^TT 371 A health survey of White County was made in 1 '.)]."'). under the auspices of the Illinois State Association for the freventicm of Tuljercuhjsis. and the Illinois State Board of Health. The work was done by Dr. I. H. Foster, inspector tor the Board of Health, and Miss Harriet Fulmer, R. N., exten- sion secretary of the Association f(jr the Pre\-ention of Tuberculosis. The tuberculosis cases and deaths from the disease in White County in lOl.j are shown bv the spot map. reproduced in I<"isj;ure '^'>. Three progressive steps were taken by the State in the campaign against tuberculosis in IDlo. The one was an order making tuberculosis a reportable disease, the second the promulgation of rules and regulations for the control of pulmonary tuberculosis, and the third was an enactment of the county sanitarium law, also introduced by Senator Glackin of Chicago. In the November election of llUti, Adams. Champaign. Morgan. Mc- Lean. Ogle, Livingston and LaSallc Counties, voted to buikl sanatoria. At the next regular election the counties of Boone, Bureau, Christian, Clark, Clay, DeWitt, Coles, Crawford, DeKalb, Douglas, Fulton, Grundy, Henry, Jackson, Jeft'erson, Kane, Lee, Logan McDonough, Macon, Madison, Mar- ion, Piatt, Pike, Randolph, Scott, Stephenson, Tazewell, Vermilion, White- side, Will. Winnebago, and Woodford took ailvantage of the tuberculosis sanitarium law. Since the Ori/cnnzaf inn nf flir Stdic DrjKutiiifiif nf Puhlic llcditli. "\\'hen the State Civil Administrative Code was passed in IIHT, and the State Board of Health was abolished and the State Department of Public Health created, in the Department a division of tuberculosis was established as a sjiecial unit. The assistant director of the Department, Dr. George T. Palmer, was assigned as acting chief of the division, a clerk and steno- grapher were employed and the division of tuberculosis began to take an active ])art in the state-wide anti-tuberculosis campaign. ( )n accoimt of shortage of nurses for tul)erculosis and other health work, the State Deiiartment of Pu1)lic I lealth, the State Department of Welfare, and the Illinois Tuberculosis Assn-iation as it was now called, established a school for public health ninses, gi\ing brief l)Ut comiirehensive courses several times a year. To secure a more definite idea of the extent of the tuberculosis jiroblem in Illinois the division of tuberculosis outlined a plan of sur\ey to be em- plii\(.(l by nurses and others engaged in this work. Through this plan a large numljcr of tuberculosis surveys were made in \arious localities in the State. Shortly after the United States engaged in the World War, there was created a subcommittee of the State Council of Defense, devoted to tubercu- WHITE COUNTY, ILLINOIS. /V- 2 J 052 - /9/0 Census. • L/W//70 Cases of7udern//os/s-/S/S a/7TJ^ y j: . r ■ ■ Dea^fys- from Tu^erca/os/s /9/47/S c^ses ma/f//?/i/ ^mm was Sl.S jier liH),000 population, and tuberculosis stood liftli fr(ini the top of the list of causes of death. Ouestionnaires were sent in I'.i'.^'i to all private, county and municipal tuberculosis sanatoria in the Slate to obtain up-to-dale data fur a revised directory. Stn-v(\s weri- m;ide of iul)crculosis cases on record in the coun- ties of the Stale with the object of pmviding befter home c:nv and In protect 3'i'4 iiicAi.rii coxniTKiNs aftiik IS*? others frcim infcctinii. 'Ihr suivcv> slmwrd that iciL;ular and periodic tuber- culosis clinics wcic in dpcralion in IM conniics and that 1 o county sanatoria with 1,3T5 l)cds \\cic in operation. The Mel Idnout^h and Madison county tulierculosis sanatoria were ojK'ned in i:i".M). Tliree ini]>orlant hills relating to the control of tuljerculosis were enacted by the legislature in 1 '.)".' "i. One niaecoiid was a law regulating the pasteurization of milk and requir- ing a permit from the State Department of Public Health. The third law api)ropriated -Isi.OOU.OOii for the purpose of imiemnifying owners of tuberculous cattle destroyed under the provisions of the law of 1!)1!), which autliorizcs the slaughter of domestic cattle found to be infected with tuberculosis. This had been practiced before but never Ijefore had so much been appropriated at one time. The latter was the so-called "Tice Mill" which ])rovided for the tul)er- culin testing of cattle, the establishment of accredited herds, and for the en- rollment of counties under the county-accredited plan, under which it is obligatory for the remaining herd owners to test, whenever rnore than seventy-live per cent of the cattle in any county have been tested, and proper certitication of this fact has been made to the county authorities, in accord- ance with the provisions of the law. Tuberculosis eradication among dairy cattle had progressed very rapid- ly, and by the end of 1926, the situation was approximately as follows: Sixty-five counties were under federal and State supervision for the eradi- cation of bovine tuberculosis; 21 counties had herds T5 per cent free from bovine tuberculosis ; ;uid one county was IIH) per cent free from bovine tuljer- culosis. Miscellaneous Ccmvnunicable Diseases. The comprehensive sanitary surveys made in apitroximately four hun- dred cities and villages duritig the years 1882-1885 indicate in a general way that very little attention was given by local authorities in these municipali- ties at that period to control, su]i])ress or jireyent the so-called minor contagious diseases such as measles, whoo|iing cough, chickenpox, etc. The statistical data available for that early period are given in the spec- ial comments under I'ach of these diseases (ir in the chart accompanying each. In fact the data mi these .so-called mincir diseases are very fragmentary until about IIMI-.'. In all sections of tlu' ."^taie exci-pt Chicago they were far from com])lele until \ery recent years. ( )nly since l!i"iO have the statistical data 1)\- moiuhs been made accessible in tabular t(n'in Ijv counties. HEALTH COXDITIONS AFTER 187 7 3r:i Table 56. Cases of Cerebrospinal Fever Reported in Illinois. Year. Jan. Feb. Mar. Apr. May. June. July. Mxg. Sept. Oct. Nov. Dec. Total. 1917 1918 1919 1920 1921 1922 1923 1924 12 1 14 1 2S 1 42 4S 1 5S 1 69 62 16 [ 15 14 12 31 1 33 1 28 12 20 1 25 1 25 11 19 ] 22 1 26 27 15 1 8 1 25 17 11 1 2 1 9 j 7 9 ! 9 1 S 3 7 1 SI 7 1 11 65 33 18 14 18 15 9 4 15 32 57 19 12 13 15 15 6 4 5 8 41 61 26 14 19 6 11 5 36 37 14 16 11 16 12 15 12 16 11 11 11 1 3 11 1 8 36 8 27 16 21 6 11 9 8 29 4 22 20 18 6 11 6 a 33 12 9 9 19 14 4 2 26 14 450 3S9 186 210 219 178 131 81 SO 1926 13 20 3 11 8 ; 12 ...| 117 1 1 Table 57. De.'vths from Cerebrospinal Fever in Illinois. Year. i Jan. 1 Feb. Mar. Apr. May. 1 June. July. .\ug. Sept. Oct. Kov. Dec. Total. 1918 i 51 47 67 S9 46 35 ^:^ 37 24 39 27 33 500 1919 30 27 36 22 23 16 30 22 16 23 18 26 239 1920 29 29 15 23 9 22 4 17 3 19 6 21 7 21 6 18 4 18 7 18 7 13 5 248 1921 3 76 1922 4 3 6 10 H 6 4 2 2 2 2 1923 8 5 9 HI 6 1 * 2 7 4 4 1921 3 ? 5 8 6 3 4 2 3 2 4 1 1 43 1925 1 3 5 9 2 9 3 1 4 5 4 4 1 <' 56 1926 1 6 5 9 6 6 » 3 3 6 3 58 Table 58.* Deaths and Death Rates from Meningitis, Cephalitis, Cerebrosimnal Fener a.m) Encephalitis in Illinois. Rate per lOO.OOO Year Xo .leatl ^■ lopulation Year. I8fin 701 41.2 1910 1870 1,975 77.8 1911 .... ISSIl 872 28.3 1912 1881 2,863 90.8 1813 1XS2 2,310 71.5 1918 ----- 1K83 1.535 46.4 1919 --- 1X,S1 1.97! 58.3 1920 - 18W 2.1C6 60.9 1921 1886 2.276 64,5 1922 190(1 1.195 31.0 1923 - 1907 06S 17.91 1924 19(18 782 14.28 1925 -- 1909 744 13.38 ni\i of diseases has been included becau . .Machinery for col- Icclini;' rc|ioris with any satisfactory dcj;;rec of completeness was not estab- lished until r.in. Case reports from l!)"il) on sj;ive a fair conception of prevalence trends. l'"rom mortality records one may gather some idea of epidemic cycles but the ratio of deaths to cases has doubtless declined in reference to several diseases so that the actual number of deaths is not al- ways a reliable index to prevalence. 'I'liere follows a brief mention of these various diseases so far as any interesting facts are obtainable. C'KKi'-.iiiiospix.M. Fkver. Long before i'^'i'i cerebrospinal fever had ceased to be an imjiortant cause of death in Illinois. By that \ear mortality had dropped to less than 1 per 100,00(1 while evidence pointed toward total disappearance. Fifty years earlier, as shown liv the graph in b^igure 'ia. this disease was one to be greatly dreaded and a frequent cause of death. Figure 25. HEALTH CONDITIOXS AFTER 1ST7 3TT Prior t(i ]8e in the early eighties as shown on the chart, were reallv due to the true form of this disease. 'J"he next nation-wide eijidemic occurred in ISU.S-T.mhi. This manifested itself in Illinois by a death rate of a little over 3 per IdO.iiiMi population. By this time the disease was well established as a clinical and etiulngic entity. The rate recorded is one obtained from the census returns and is therefore probably not very accurate. Nevertheless, it shriws that Illinois was swept by the epidemic at that time. Another outbreak was recorded in I HI".' and .an increased incidence wa-^ shown beginning about 1'.)".'."), but insignificant in ci)m|iarison to the jireva- lence <.f the disease in the first decade of this .Ml year period. Diarrheal Dise.ases. Nomenclature for diseases of the intestinal tract was so thoroughly abused that it is difficult to arri\-e at any satisfactory conclusions concerning the prevalence of what are usually referred to as diarrheal disorders. In the mortality returns for 1880, for example, there were listed cholera in- fantum, cholera morbus, diarrhea, dysentery, enteritis and bowels as the re- sponsible agents for 1.(10(1 out of l.'i.on fatalities registered from all causes. This corresponded to a rate of about 118 deaths ])er l()l),()(i() population. 3T8 TIKALTII COXDiriO.NS Al-'ll-K 1S77 AnothiT chu' 1(1 what may have heen the case is found in the high fatal- ity rates aninnt^ chihh-cn. It is common knowledge that intestinal difticul- ties constitute cmc df the greatest hazards to child life. It is easy to believe therefore, that an excessively high mortality ann mg children is evidence of a high prevalence of s than one year old and lil,(i()T less than five, reported in ISSO. These figures amounted to twenty-four and forty-three percent respectively of all registered mortality in that year. Using mortality figures found under the same nomenclature referred to above it is found that the incomplete returns for the years ISSl to 1886 in- clusive give an average mortality rate of iri.'i.K per lOO.OOo pojjulation. Stat- tistics for the five years ended with r.f.'."i give an average mortality rate of Table 39. De.vtiis and Death R.\tes from Diarrheal Disea.ses in Illinois. Year. 1860 X.). ileatlis. 2,320 Rate per 100,000 population. 128. 8 1SS.3 148. ISl.o 107.7 109.7 110. 106.5 119.9 Year. 1905 1906 1907 1908 1909 Xo. ileatlis. 4,552 4,612 4,S57 5,224 5,6S6 Rate per 100.000 population. 87. 86.8 90. 1880 95.4 102.3 1881 5,723 3,478 3,624 111.8 1882 1911 4,973 86.5 1883 1912 -- 1913 1918 1919 1920 1921 1922 1923 . 1924 - 1925 .- 4.970 5,520 4,2S4 2,993 3,532 3,250 2,241 2,369 1,938 2,208 85.2 1884 93.2 1885 1886 - 3,677 67.4 1S90 46.4 54. 1900 49.1 33.4 1902 1903 1904 3,967 4,296 4,320 79.5 84.7 93.9 34.8 2S.1 31.1 3o.3 from diarrhea and enteritis. This classification includes practicall)- all mortality of the period that might be called "diarrheal" in character. Still another evidence that diarrheal diseases were highly prevalent dur- ing the last (|uarter of the nineteenlh century is the fact that summer was the most unhealthful season of the _\ear then. Year after year the great- est number of deaths monthly occurred in .\ugust and September. Diseases of the inteslin;il tr;ict ;ire ahva\s prune to reach highest prevalence in the warm weather. Ini])r(ivenu-nt in ihe sanitary (luality of milk supplies and especiallv the introdiutiim and extension of pasteurizatinn. the development of refriger- ation, the ])virilic;uiiin of water supplies, the advancement in personal hy- gienic habits, the screening against flies and the general improvement in HEALTH COXDITIOXS AFTER 187' 379 economic conditions have all been important factors in bringing about more favorable mortality rates from diarrheal disorders. The substitution of the Fig. 26. Deaths due to diarrhea, dysentery, cholera infantum, cholero mor- bus, enteritis, teething and bowel complaint are included in the statistics illustrated in this figure. automobile for the horse, a change that roblied the hnuse fly of his most pro- lific breeding ])lace, doubtless was an important factur in preventing the spread of diarrhea. IxFANTiLE Paralysis. Infantile paral)'sis first appeared on the vital statistic records of Illinois in 1912. In that \ear -"iS deaths were charged against it. This does not imply that the infection never existed or that it never proved fatal in the State prior to that time. Public attention however had never been specifical- ly called to the fact that it was an infectious disease and doubtless its jires- ence in the early acute .stage was often overlooked by physicians. It is alto- gether likely that cases developed from time to time without ever assuming alarming epidemic ijvoportions for the crippling ;ifter effects of this disease were frequently seen. After 19i;i jjoliomyelitis went down into recorded obliviim with the con- fusion that prevailed in Illinois vital statistics until 191(i. In that \ear over ■i'^iO IIICAI.TH CONDITIONS AFTMK IST" ri, 000 cases wtTc rL-])ortc(l in Xrw ^'ork and about l.niX) in Illinois. A gen- eral panic prevailed. In \'J\: a reL-urrenee of the epidemic dceurred result- in.c^ in S3() deaths. Since that time mortalit\- fidni infantile parahsis has \-aried from •.'■") in ll)"2(l, ihe Idwest to 1-Ml in l!)-*l. 1 he crippling etiects nf the disease created a grave problem in curative medicine that recpn'red the services of specially trained physicians. So great was public demand for this type of work that the State Board of Health, later the State Department of Public Health, established cHnics at various piiints in the State in 1916 for the benefit of victims of poliomyelitis. New and old patients continued to demand this type of service so that it remained a fimction of the State Dei)artnient of Public Health until l'.i-.'."> when the Table (;ii. De.\tiis and Death Rates from ruLioMVELiTis in Illinois. Rate per Rate per 100,000 100,000 Su. .leatlis. population. Year. Xo. deaths. population. 58 .99 1922 52 0.8 236 3.8 1923 48 0.7 113 1..S 1924 26 0.4 73 1.2 1925 41 .57 57 .9 1926 23 .34 150 2.3 Year. 1912 1917 191S 1919 1920 1921 curative clinical work was taken over liv the Illinois Society for Crippled Children. In the meantime poliomyelitis continued to occur from year to year in cyclic waves that characterize almost every communicable infection. Sub- sequent to 191(5 and 1917 the outbreaks were less extensive in magnitude and the disease appeared to lie generallv mibler in character, the percentage of f.atal cases being lower. Poliomyelitis is another of the warm weather infections. Case reports for September are usually greater in numlier than for any other month. It rises quickly to its maximum incidence once it begins to spread. Indeed the prt'v.ilence in .Sejitember is fre ' . . - ' ■ ' T T 1 1 1 ■ lAAD-iqPA . - "^l 'X 30 E p i ^^ i" in r f , ,1 ,1 1 1 ■ ■ 1 1 il"X 1 1 ill ' II i 1 1 _i_ ' T U- t 1 1 ' 1 1 ! 1 ! 1 IP 1 1 I M 1 i i 1 i : i i ill! 1 j 1 1 !; 11 RTir+ "^ ;i 1 |l 1 1 1 1 i St+"- li' I j |!|| ^rti'i 1 M ' j 1 j 1 1 1 ; 1 1 ' 1 ' F h 1 .:iL_:_: ii iii'i 1 1 jl 1 j \\j\\ 1 ' ' 1 ■■ 1 , 1 1 ; 1 1 1 1 ^H~ 1 ' 1 1 1 ' ' ' ' 1 +u ^H 1 ' i ' 1 '''ill T+ ill ^H til ' 1 ; 1 ' ' ' ' 1 ' ' 1 i I ,< ^H~ til ;' 1 ■ ■ ■ ' ' ' I ■ ' I T 'q ^H ' ■ ■ ' 1 ■ |0 5 T T ^H i_i ' ' r ■ ' h ' 1 T T SH-' J ■ 1 ' ' M ' ' 1 1 1 i~ \ :^^B; ■ B ' ' ' ' 1 1 1 ' M 1 1 1 — ttt . . ■ Tiafl^ 2i:±::::"" I ;±i _^Hii 1 ■ IIBi^»*fTTi-rT i i i i i i i i i i 1 8 i i Figure .\ftcr it Ijecame known that nio,-,(|uit(ies are the carriers of malaria, pre- veiitixe work was directed against that insect. Undertakings of this kind have been confined largely to the extreme southern counties of the State. There alone does malaria still exist to any significant extent. Elsewhere drainage destroyed the breeding places of the malaria-bearing mos(|uito and with his disappearance the disease vanished. In lillG the chief sanitary engineer of the .Stale Department of Public Health called attention in an article in llcaltit Sews to the heavv economic losses caused bv malaria in -.duihern llliudis. No systematic malaria-preven- 382 IlKALTll COXniTlOXS AFTI'.K 1S7T 'I'able C>\. Cases of Malaria Reported in Illinois. Year. .I.in. Feb. Mar. Apr. May. June. .Iw!y. 1 Aug. Sept. Oct. Nov. Dec. Total. 1917 60 81 30 49 53 121 162 2 102 1 121 3 11 89 1,510 2.389 1919 18 20 55 97 2 1 417 294 265 170 97 63 1,499 1920 59 112 84 114 142 194 171 279 117 132 87 123 1,614 1921 80 14 82 44 68 138 257 148 129 66 63 37 1,156 1922 50 60 22 30 60 54 43 78 61 11 22 9 500 1923 3 3 26 6 4 5 11 14 10 2 4 3 91 1924 1 2 1 I 4 12 11 13 3 4 6 58 1925 5 18 2 12 8 20 6 6 2 1 34 114 1926 7 5 4 8 6 8 7 15 10 5 11 86 1927 5 1 1 9 16 4 U 1 i Table V>->. Deaths from Malari.\ in Illinois. Year. Jan. Feb. Mar. Apr. Ma). June. July. Aug. Sept. Oct. Nov. Dec. Total 1918 3 4 3 6 8 7 12 14 11 8 2 3 81 1919 4 2 8 4 2 6 15 10 9 17 6 6 89 1920 6 2 3 3 4 8 14 8 11 8 2 76 1921 4 5 3 3 1 5 12 14 10 15 3 3 78 1922 3 1 2 3 1 5 S 7 9 9 8 4 60 1923 7 4 3 4 5 3 9 4 9 5 2 4 59 1924 4 1 4 5 6 6 3 16 11. 6 2 3 67 1925 2 2 1 2 3 10 9 9 10 4 4 6 62 1926 1 1 2 2 4 1 8 7 6 ' 3 42 1S60 1870 1880 1881 1882 1883 1884 1885 1886 1890 1900 1902 1903 1904 1905 Table G3. Deaths and De.\tii Rates from Malaria in Illinois. 1906 1907 1908 1909 1910 1911 1912 1913 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 deaths. Rate per 100,000 population. 1.146 66.9 9.030 35.5 1,114 36.1 23.8 11.3 11.3 19.1 10.3 Rate per 100.000 populalion. HEALTH CON'DITIOXS AFTER ISTT 383 tion \v(irk by mosquito eradication was undertaken, however, until li)22, but in thf meantime the matter was given consideration by the Southern Illinois Medical Society, and as the result of a resolution of that society, studies of mosquito-breeding places and the types of mosquitoes prevalent in some southern Illinois communities were made b_\' entomologists of the State Nat- ural History Survey. Proposed and recommended by the State Department of Public Health, sponsored by the Lion's Club of Carbondale and receiving financial assistance from that club, the International Health Board and the Illinois Central Rail- road, and directed by the sanitary engineering division of the State Depart- ment of Public Health, Carbondale carried cm systematic mosquito-control work for the season of 1922, and for the first time in history of the city en- joyed practically complete relief from the pestiferous insects. The results from the standpoint of reduction in malaria cases were equallv gratifying. \'ital statistics and house-to-house canvasses had shown that prior to 1!)22 the city suffered an average of over 250 cases of malaria a year (267 during 11121 ). Following the close of the mosquito-control work for 11122 it was found by a house-to-house canvass that onlv 1 i) cases of malaria had occurred during that year in the entire citv. This was the beginning of mosquito-malaria control work in snuthern Illinois which has continued at Carbondale and extended into half a dozen other counties with increasingly satisfactory results. During the first fifty years of the existence of State public health service in Illinois medical research workers discovered the causative organism of malaria, found out how the disease is spread and prescribed very positive methods for its prevention. Thus so far as practical possibilities are con- cerned it may be said that malaria was cunqjletely conquered during this [leriod. ^Ieasles;. Measles was very generally ignored in reports concerning epidemic con- ditions in Illinois during the last quarter of the nineteenth century. It was included in a list of diseases for which epidemic information was requested in the sanitary surveys of 1882-188.5 but practically none of the local re- ports mentioned it. Account was given of outbreaks of typhoid fever, chol- era, diphtheria and scarlet fever but never a word about measles. Evidentlv it was regarded either as too common or too insignificant to mention. To lie sure it appeared in the mortality tables where these were supplied but withnut comment. In the general mortality statistics available for Illinois, measles is credit- ed with 10!) deaths in 1860 and T02 in 1870. These figures give rates of 6.3 and 2;.() per 1(10.000 population for the two years respeclivelv. For the six 384 IIKALTII COXDITIOXS AFTICR 1877 years of ISSd-lSS,") the avcrasix- annual nidrtalily rate, as n-pnrtc-d in the sta- tistics which were regarded at the lime as alxjul III per cent ineoniplele. was i;3.5 per TOO.OOO people. Measles is distinctly seasonal in character. More cases occur during the three months of March. Ai^ril and May than during all the rest of the year. September is ordinarily the month of lightest prevalence in Illinois. The number of deaths per 100 eases, however, is greatest when the prevalence is least. Figure 2S. Measles also travels in epidemic c\cles. Thns every three or four years there are general outbreaks of major proportions. This e.x]ierience is gen- eral. It is attributed to the probable fact that practically all susceptible persons get the disease during the big epidemic years and another wide- spread outbreak must necessarily await a new croj) of susce])tible children. .\lthinigli verv little ad\aiu-emenl in knowledge concerning measles took place imlil the second decade of the twentieth century, progress in medical science generallv was very rapid toward the close ot the nineteenth century and this imiirovemeiit probably explains wli\- the a\erage yearly death rate from measles was only .'i.-.' for the six year period ended with HEALTH CONDITIONS AFTER 1877 385 Table 64. Cases OF M EASLES Reported in Illinois. Year. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dee. Total. 1917 4,959 6,483 11,106 10,534 9,415 4,255 1,331 312 189 122 389 417 49,512 1918 1,150 939 1,237 1,278 1,501 641 273 121 56 141 67 IVl 7,575 1919 711 1,073 2,453 5,754 5,204 3,142 1,110 255 118 342 706 1,727 22,594 1920 4,366 4,610 4,982 5,343 5,542 4,434 1,573 542 233 510 1,280 1,985 35,400 1921 3,932 4,527 5,911 5,894 4,854 2,435 531 129 85 164 271 560 29,293 1922 918 1,340 2,167 2,658 3,285 2,744 1,182 373 141 205 606 921 16,540 1923 2,154 4,011 6,604 10,345 12,055 6.320 1,420 306 125 363 1,053 1,953 46,709 1924 2,475 2,296 2,659 3,606 3,825 2,693 926 205 120 181 343 815 20,144 1925 1,575 2,664 4,615 5,985 6,237 4,010 982 169 151 273 682 868 28,211 1926 1,825 3,337 4,514 4,299 5,095 4,813 1,980 499 236 615 1,368 2,930 31,511 1927 6,041 8,469 11,126 7.622 4,562 2,084 562 1 Table 65. Deaths from Measles in Illinois. Year. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 1918 22 12 22 29 42 30 60 49 74 70 30 37 14 27 6 14 5 5 17 5 12 6 13 22 317 1919 306 1920 47 112 72 59 59 37 22 9 4 15 25 35 496 1921 33 47 XO 49 50 20 12 3 3 2 4 6 309 1922 10 13 27 30 30 26 21 9 9 6 13 12 206 1923 24 29 79 116 165 87 31 20 3 9 2 11 576 1924 19 25 39 54 32 26 9 7 1 1 4 11 228 1925 11 19 36 28 52 25 13 7 4 7 3 12 217 1926 22 28 50 78 68 33 16 11 5 2 16 17 346 Table 66. Deaths and Death Rates from Measles in Illinois. Rate per Rate per 100,000 100,000 Year. No. deaths. poiiulatiuTi. Year. No. deaths. population. 1860 109 6.3 1907 413 7.6 1908 336 6.1 1870 702 27.6 1909 - 1910 385 549 6.9 9.7 1880 - 603 19.5 1911 325 5.6 1881 625 19.4 1912 191 3.2 1882 . 451 13.9 1913 . 63S 10.7 1883 148 4.4 1914 217 3.6 18S4 629 18.6 1915 ...- 286 4 6 191 5.5 4.6 1917 - 766 12.3 1890 . 314 8.2 1918 . . 1919 -. 317 306 5.6 4.8 1902 180 3.6 1922 - 206 3.1 1903 593 11.7 1923 - 576 S.5 1904 393 7.6 1924 228 3.3 1905 340 6.5 1925 . 217 3.0 1906 230 4.3 1926 346 4.8 386 }ii-:alth conditions aftek 1877 !!»()■;. l*'oi- the six \(.ars ciulcd with 192G a still more favorahlc rate, an average of 1.1, prevailed. Better medical care of patients ciiu|)led with better public health service are the only two factors to which the improve- ment mav reasonably be attributed. While mitliing has transpired that jjrovides mankind with means tor preventing and controlling measles on a large scale, research work charged with hoiieful premise has been done. In 1914 Hermann suggested the ac- tive immunization of infants by inoculating the nasal mucosa with the fresh swabbings of the nasal mucus of patients just coming down with measles. The purpose was to introduce the virus at a time when the infant was still carrying a certain degree of inherited immunity, .\lthough he apparently had good success with the method on seventy-five children so treated, it has never been considered practical for general use. In 1918 Nicolle and Conseil first reported favorable results with the blood serum of convalescent measles patients. Such serum given subcu- taneously or intramuscularly in amounts of 5 cc to 10 cc as soon as possible after exposure is quite effective in preventing the disease. Passive immunity is established for three to six weeks. In some cities ettorts have been made to collect a supply of convalescent serum taken usually five or more days after defervescence of the fever. Since at best such supplies are limited, some attempts have been made to use blood serum or whole blood of adults who have had the disease some years before. Much larger amotmts must of course be used and the results have not been so uniform. In 1921 Zingher recommended the production of active immunity by delaying administration of convalescent serum till the fifth to the eighth day from time of exposure. Symptoms of the disease arc nut jire vented but the attack is very mild and the immunity established is permanent. W hen the serum is delayed till symptoms appear, no beneficial results are obtained even with large amounts. In 1926 Tunnicliff and Hoyne produced a serum in goats by repeated inoculation of Tunniclifif's green producing diplococcus. The goat serum is ap])arently as efficacious as human convalescent serum in preventing measles and has the added advantage of unlimited supply. Degkwitz in Germanv has used sheep instead of goats, injecting them with the Berkfeld filtrations of nasal secretions and simtum of measles patients. The ])re\ention of measles by immune serum or the production of per- manent immunity b}- a mild attack have been demonstrated as important factors in measles control. For the treatment of the established disease no curati\e agent has been discovered. HEALTH COXniTIOXS AFTER 18TT 387 Pneumonia. Pneumonia was prohahlv nioix- prevalent fifty years ago than is indi- cated by the 1880 rate of ll'ir! per 100,000 inhabitants. There was consid- erable confusion at that time in classification of deaths from the disease be- cause of such nomenclature as typhoid-pneumonia and typhoid-malaria. While the 1890 rate of 1"2S.;) seems to indicate some progress, we note that ten years later (11)00) the rate of 113.9 was higher than in either 1880 or 1890. .-\gain the pneumonia rate in I'.Mo was higher than ever before recorded as far as available recrrds bear evidence. In fact, tlie 1910 rate is the high- est ever recorded in Illinois with the exception of that for 191S, the great influenza }'ear. It is of passing interest to note that never in the historv of Illinois was the recorded pneumonia death rate under lOK [ler UIO.OIIO of i)o]Hilatinn prior to 1921. Since 19'^0 the a\erage annual death rate from pneumonia has been iSi.5. and only once in the si.x years ended with l't2(i did the rate reach imi. The excejrtion was 192:5 when the rate was 1(18.8. Whether we can say that we have finally reached the point when we are making ])erma- nent ]irogress against this major agent of death, the future must determine. The rather elongated period of waning mortalitv at least lends encourage- nunt to hope. New [jrocedures employed against pneumonia only since 1913 and principally since l!''2u include t\ping of the causative organism, the use of vaccines and sera and quarantine. Tjfpiiiff. Var many years the ]irobIem nf pneumnnia wa^ ci:implicated 1)\- the fact that organisms indistinguishable frcmi virulent pneumococci were found in the months of normal persons. In 1!M:! wurkers at the Rockefeller In- stitute for Medical Research in New York found that all pneumococci could be divided into four groups, types I. 11. Ill and I\". This wa.s of tremendous assistance not onl\- in stimulating the use of six'cific antiserums in established cases of ])neumiinia. but of soKing prubknis (jf epidemidlogv and control ( f the disease. The determination of ]ineumococcus lyjies was \ery [lojiular during the ])eri(i(l r.ill to 1M2(I, but fell off so that it was almost unused in ci\il life after that. The reason for this was the fact that the physician could do only a very little more for the patient if the t>])e was known and the pro- cess was considered a useless e.xjjense. In 1 '.)■.'.") the State Department of Public Health jjronuilgated rules and regulaticjns for the control of pneu- niduia \\hereb\- all cases should be "typed" where facilities for such a ]iro- cedure were available, and release from (|uaranline should be allowed onlv 388 ili'.Al.ril CO.NDITIDNS AFTKK IS" I Tabic Cr. Casks ov Pneumonia Reported in Illinois. Year. Jan. Feb. Mar. AP... May. 612 June. July. Aug. Sept. Oct. Nov. Dec. 1 Total. 1 1918 602 560 1,242 1,409 163 142 68 225 10,375 2,274 2,596 1 20,298 1919 1,160 820 890 600 562 355 308 185 233 451 601 1,275 1 7,440 1920 7,012 4,049 1,655 1,066 936 485 282 215 266 335 604 980 1 17,885 1921 1,568 1,222 1,345 992 738 429 319 305 334 614 541 824 1 9,231 1922 1,250 2,629 2,942 1,621 1,113 548 433 820 448 736 989 1,659 1 15,189 1923 2,687 3,508 3,205 2,439 1,497 718 388 330 471 814 1,012 1,239 1 18,308 1924 1,713 1,798 2,048 1,643 1,217 738 815 822 559 677 747 1,440 1 14,217 192o 1,715 1,681 2,100 1,718 1,228 767 451 380 413 687 1,031 3,044 1 15,215 1926 1,819 2,028 4,208 1,961 1,470 1,223 897 531 477 684 987 1,344 1 17,629 1,787 1,515 1,802 1,609 1,240 959 418 i 1 Table 68. Deaths from Pneumonia in Illinois. Year. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Kov. Dee. Total. 1918 984 902 1,181 1,348 683 232 185 171 453 5,197 1,571 1,548 14,455 1919 1,235 1,027 1,192 697 453 268 199 158 190 278 461 Vb/ 6,915 1920 2,218 2,169 893 678 583. 267 179 171 177 273 479 643 8,730 1921 857 743 691 500 389 196 178 171 195 319 432 545 5,216 1922 758 782 1,053 712 482 242 179 171 195 357 471 740 6,142 1923 1,105 1,301 1,02B 798 589 278 212 186 230 315 469 558 1924 764 748 812 699 459 322 182 150 231 323 385 655 5,730 1925 792 763 906 630 488 290 198 188 196 326 560 573 5,900 1926 780 742 1,473 824 540 295 194 161 206 295 460 657 6,627 Table 69. Deaths and Death Rates from Pneumonia in Illinois. Rate per Rate per 100,000 100,000 Y'ear. No. deaths. population. Year. No. deaths. poitulation. 1860 .- . 1,357 79.2 1905 5,877 112.3 2,8S2 113.4 1906 6,136 115.5 1907 7,386 136.9 4,378 142.2 6,008 109.7 1880 1909 7,327 131.8 3,723 118. 92.7 1910 1911 . 8,938 S,06S 158.5 1882 2,994 140.4 1883 2.51S 76.2 1912 . 8.141 139.5 1884 ..- 2.671 79. 1913 - S.237 139.1 1885 2.764 3,438 80. 97.4 1918 . 1919 . 14.445 6.915 247. 107.3 1890 1,912 12S.3 1920 . S,730 133.7 1921 . 5,216 78.8 1900 6,492 143.9 1922 6,142 91.6 1923 7.067 104.1 1902 6,888 138.1 1924 5,730 83.3 1903 6,830 134.7 1925 5,900 1904 6,887 133.7 1926 6,627 92.5 HEALTH COXDITIOXS AFTER 187T 389 upon the absence of imeumococci of that type from the throat of the patient. Standard laboratory methods were ch-awn up for the use of private laliora- tiiries, 1)ut Httle demand has come from the i)hysicians for aid in this con- nection. Vaccines. The jirevention of pneumonia by prophylactic \accinatinn with killed cultures of the organisms was placed upon a practical Ijasis with the dis- covery of the various types of pneumococci. During the World War and Pig. 29. For the years prior to 1900 the death figures used in this illustra- tion included pneumonia, influenza, pleurisy and broncliitis. immediately folldwing the value ( f the process was definitelv established. It is recommended for those people who are especially susceptible to pneu- monia because of age, undue exposure or other causes. Since immunity will last only about eight months, the time nf choice for administration is at the beginning of the pneumonia season eacli year. Under certain cimdi- linns. however, the State Department of Public Health has provided in il> rules and regulations on pneumonia, for the compulsory immunization of individuals. 390 iJiiAi.iii coxuiTioNS Ai-Ti:u 18T7 Seriiins. Aiili>cniiii 111 'Jy|ic I inicumococinis has xielded very encouraging re- sults, 'lliis tyiir causes more than a third of all cases of pneumonia with a mortality of ".'.J to 2!) per cent withdut serum. The administration of specilic antiserum has reduced the mortality to less than 5 per cent. Un- fortunately many cases of pneumonia go untyped, hence do not get the benefit of serum. I'mhaliK- •,;,0(M) lives which are now lost annually in Illinois could be sa\ed 1)\ this agent alone. .Antiserums for Types 11 and 111 lia\e ii fatalites were recurded. .\ luore peculiar phenomenon than the epidemic waves of this disease is its uiiii|ue seasonal character. Instead of reaching one ])revalence peak dur- ing the year it climbs to a secondary high point in February, then recedes and rises again to the maximum high level of the year about July first. Whether the incidence is great or small the case re])orts follow this un- usual seasonal course Iroiu \ear to Aear. After twenty-live years of State health supervision, we find no improve- ment in the luiniber of deaths from whooping cough. The average annual HEALTH CONDITIONS AFTER 187(' Table TO. Cases of Whooping Cough Reported in Illinois. 391 Yc-ar. Jan. Feb. Mar. Apr. May. June. 1 Jnly. Aug. Sept. Oct. Nov. Dec. 1 Total. 618 1,650 802 1,214 723. 929 554 957 818 1,059 1,206 4,721 1920 1,143 1,222 2,061 1,204 1,460 1,464 1,290 1 15,653 1921 1,530 1,327 1,482 1,440 1,466 1,821 1,928 899 606 341 378 343 1 13,561 1922 412 442 551 610 657 1,153 1,H5 t 1,069 747 563 621 786 1 8,756 1923 1,103 973 1,214 1,095 947 892 953 1 694 490 488 494 501 1 9,844 1924 579 620 680 550 528 524 847 782 662 641 875 950 8,238 1925 1,191 1,04S 1,121 1,352 1,184 1,172 1,149 767 547 478 453 . 612 11,074 1926 739 804 939 870 827 801 894 717 714 1 773 958 838 9,874 779 S96 1,015 850 906 1,089 1,224 1 1 Table 71. De.\ths from Whooping Cough in Illinois by ^Months. Year. Jan. Feb. Mar. Apr. May. June July. Aug. Sept. Oct. Nov. Dec. Total. 48 26 44 45 15 45 32 26 30 65 11 83 57 20 76 43 28 36 76 25 50 43 22 68 48 24 52 83 15 43 57 22 42 48 40 58 68 21 66 68 23 44 24 33 27 58 23 29 50 13 40 19 27 19 |53 1 44 47 58 18 1 45 31 37 23 44 35 47 39 29 45 26 36 29 41 23 22 27 15 34 25 20 21 71 21 35 18 24 33 15 22 14 58 11 41 22 16 19 19 15 35 31 15 56 11 22 30 23 7 23 696 1919 270 553 495 239 1 .-21 353 315 367 Table ;2. Deaths and Death Rates from Whooping Cough in Illinois. 1S60 1.S70 Rate per Rat? per 100,000 100,000 population. Year. No. deaths. l»->pulation 22.3 1905 692 13.2 1906 496 9.3 25.2 1907 530 9.8 1908 491 8.9 448 8. 14.7 1910 393 6.9 281 4.8 7.2 1912 402 6.8 8 2 388 6.5 7.5 10.8 WIS .. . 696 11. 1919 270 4.2 9.3 192(1 553 8.5 1921 . . 495 7.5 10.3 1922 239 3.6 1923 .. . 521 7.7 10.9 1924 . 353 14.2 1925 315 4.4 6.7 1926 367 5. 392 IIKAI.TH CONDITIONS AKTKR IHTT rate for 19()"*-II)07 was lo.T. The rate twenty-five years earlier was about the same. Here ai^ain lluciuatidn in nidrtalitv is shown with ','-H) deaths in 1903 and l)iit 34S in I lid I. At lliis time pnlilic health authorities were busy with attempts at eontnilliiii;' diphtiieria. snialliiox. typhoid and even in a large city like C hicago did little or nothing tnwards isolation of whooping eough patients. While it is generalK- considered that results are not yet satisfactory in our efforts at control of whooping cough, progress is apparently lieing ^ti^^WMOopinG ^ cougH '^mv^ in iLLinois ' Fui. 30. ( The 1S60 Hue should indicate a rate of 22.3. ) made. ( ertainly the death rate has declined. Control measures have included isolation of cases, control of contacts, exclusion of cases from school and some use of prophylactic serum. The average annual death rate for years 1921-192G was 5.5. It was 10.3 fifty years earlier and 10.6 about the turn of the century. Marked fluctuations in the annual mortality from whooping cough are still charac- teristic. There were twice as many deaths in 1921 as in 1922, the 1921 figures being 195. against 238 for 1922. HEALTH CONDITIONS AFTEK IS^T 3il."i At this writing we are still relying on early quarantine and isolation as chief means of control. How much, if any, credit should be given to vaccine treatment for the improved death rate or as a prophylactic measure is uncertain. The results of the use of vaccine are conflicting. Workers are agreed that the product should be freshly prepared, — preferably not more than two or three weeks old. As a prophylactic measure, vaccina- tion has shown considerable promise in the hands of several investigators. Less can be said of it as a cure, once the disease has become established. In 1022 Orgel reported a method of intracutaneous injection of vaccine bv which the disease could be diagnosed in its early stages and thus pre- ventive measures taken before the appearance of the characteristic whoop. Hull and Nauss and others, however, had no success with the method. Infant MoirrALiTV. A considerable numlier of sanitarians regard infant mortality rates as indexes to general health conditions. Some go further, expressing the opinion that infant death rates reflect the character and efliciency of public health service. The facts fit the retiuirements in either case so far as Illinois is concerned. Fifty years ago infant mortality in Illinois was fully twice what it is now. At that time puljlic health service had scarcely survived the labors of birth and it remained an infantile organization for twenty-hve years. Neither birth nor death registration was complete fifty years ago but there is abundant evidence that infant mortality was high. In 1881 there were 218.8 deaths among infants under one year of age for every 1,000 l>irths re]iorted. Birth reports were estimated to be from -JO to 50 per cent incomplete and death reports from :iO to -10. In r,i2G there were 69. IJ infant deaths registered for each 1000 births recorded. Statistics for births and deaths were complete for all practical purposes. In ISSl a irifle more than 2 I per cent of all deaths recorded were among infants less than one year old. In 1l»2(i a irifle less than 11 per cent of all deaths were among persons of the same age group. This is positive evidence of substantial improvement in infant mortality. Then there is the evidence of actual numbers. For the six years ended with 188G. when the population of Illinois was about half what it was in li)2T. there were ()';,iSll infant deaths reported. For the six years ended with l!i2() there were onlv G0,.")2.') infant deaths re])orted. The ratio to population in the more recent vears is less than one-half of that for the earlier period. Probably the greatest single factor in the saving of infant life was ihe improvement that took place in the sanitary quality of municipal milk sup- 3SI4 lir.AI.I II CONDITIONS AFTER 1877 plifN (luring tlic lilty year peridd. rp unlil IH^I there is no record of less than 1 ],(•()() infant deaths pi'r annum cxce])! in the years prior to 1884. Since 1!)"-^1 tile ]X'riod during which the safe milk campaign has been stressed, the total numher of infant (k-aths has never reached 11,000 in any one year while for each of the three years ended with 1926 it was less than 10,000. The ptriod during which the most improvement in infant mortality occurred is ihe saiiu' period in which tlie greatest improvement in the sanitary ipi.ditv cif municipal milk supplies took place. The danger to infants and children of using a poor milk supply is well known. Tliere are two factors concerned — the presence of disease produc- ing hacteria .and the presence of enormous numbers of other bacteria, not necessarily iiathogenic. hut which ii\er\\helm the digestive tract of the infant Table 73. Dk.\ths of Infants* and R.vtes per 1,000 Births Reported in Illinois. 1880 10,968 1911 1881 n,.S26 218.8 1912 1882 -... 10,772 229.2 1913 Kate per Infant 100.000 leaths. population. 10,968 11,.S26 218.8 10,772 229.2 10,3K2 224.8 11.305 246.4 11,277 237.5 12.749 215.3 1S84 11.305 246.4 1916 1885 11,277 237.5 1917 1886 12.749 215.3 1918 1019 1890 1920 1921 1900 - .- 1922 1923 1907 11,947 140. 1924 1908 11,774 154.3 1925 1909 11,49-1 144.7 1926 1910 - 12,281 149.1 Rate per Infant 100.000 leaths. population. 11.113 124. 11,155 108. 11,607 109.8 14,518 119.9 14,029 118.9 13,109 105.7 11,148 94.4 11,641 87.5 10,644 76. 10.187 74.9 10,810 78.9 9,743 69. 9,S44 71.8 9,297 69.3 * Less than one year of age. Ijy mere numbers. In the summer time, especially when the weather is hot and ice difficult to obtain in sufficient (|uantities, infant diarrhea due to bad milk has been in the ]iasi extremel)- ]ire\aleiU. The i)asteurization process was tirst prjicticed secretly by milk men to improve the keeping ([uality of the milk. Its merits however were soon recognized. As early as JSItV Nathan Straus began the distribution of pasteurized milk in New York City, .\lthough the process passed through a long experimental stage with much faulty technic and unreliable apparatus. there was a marked improvement in milk supply with a consequent reduction in the infant death rate. In IIM)8 Chicago passed a law re(|uiring compulsory pasteurization of milk except that received from tuberculin tested cows. This was the first large city in the country to pass such an ordinance. In HMii by an executive HEALTH CONDITIONS AFTER I .S , 395 order pasteurization was extended to all milk in Chicagu and snK\- then it has been strictly enforced. Other cities in the Stale likewise have gradually been supplied with more and more pasteurized milk. In 1922 the State Department of Public Health initiated a pasteuriza- tion program with so-called model milk ordinance intendetl for the imjjrove- ment of milk supplies in the State. During the next five years 60 cities adopt- ed this ordinance. An outgrowth of the campaign was the ])asteurization law of 1925 which required all plants selling pasteurized milk in Illinois to ol)- Figure 31. tain a license from the State Department of Public Health. Not onlv was the quality of pasteurized milk imijroved but there was a large increase in amount. In 1927 there were 352 such plants in the State (not counting the plants supplying milk to Chicago) pasteurizing 390.702 gallons, an increase of 59,000 gallons over the previous year. It is estimated that 50 per cent of the people downstate drink pasteurized milk, while all of Chicago receives it, or a total of more than four and half million of the seven million people in the State. SUMMARY AND CONCLUSION. Since the year 11)".'^ ends a liflv year jieriod in the Hfe of the Board and Deparlnieni of l'nl)lie i leaUh of the State of Illinois, it is proper that the Department should use the occasion to gather together some of the out- standing events in the hi alth history of the State to make them easily availal)le for those interested. To those who have an interest in studying the suhjici more exhaustively, this histiiry may stimulate inquiry and offer suggestions as to soin-ces of material. The narrative and ap]iraisal of what has l)een done was written in consultatii'n with a few of the men who have had something to clo with the effort. It is to be regretted that it was not possible to ha\e had the advice of man\- who did not jiarticipate hut time and tide do not wait. Mow valuable the apijraisal would ha\ e 1)eeil had it been possible to summon to the Boar onK |iarti;ill\ true as to ^uch items as ph\ sical \ igor. birth rates, size of families, length . At times cholera caused conditions to be \ery liad but just how Ixid they might have lieen had the local health departments and the indi\i(>nini; once ranlro\ement came before 187 T. The great era of betterment l)egan about I'.Ho. Tiie health agencies can justly claim credit for half of the gain, the other part being divisible between better medical service, elevations of standards and improvement in environment. 'i'he largest single factor in bringing about the improvement was the improve- ment in the milk supply which stimulated improvement in other foods and a decrease in the prevalence of flies. The health agencies fought the bat- tle for better milk. Diarrhoeaf: and Difsenterles In Adults. 'i'hese disorders were responsible for heavy deatli rates and sickness rates among the Indians, the French-Canadians and the .American settlers living in Illinois. This continued up to and after is:; but not very long thereafter as an important ailment. They have \irinall\- disajjpeared. Im- provement in standards of living and in food and water supplies and better medical service are the principal factors which have brought about this improvement. The contril)Ution of health activities consisted in impro\ing i04 Sr.MMARV AND C'dXCI.USION water ami iuod supplies, in i-(lm-aliiii; the people and ccnitrilniting indirectly to the elexalion of stan lO.VCr.l'SION' ^\\v till' iiu)>l huiiKUK- and scienlil'ic care it can. lint snch assnniption of (Inly as tlic care nf tlir >>ick implit-s is merely a tiMiiporarN- expedient and one from which it is seekint;- al\va\s to esra])e. The \arioiis schemes for heahii insniance so cahed are reall\- i)knis for the economic cru'e of the sick. Soini' of them have some excellent fea- tures for the pre\eniion of disease. llo\ve\er, curative care is their chief objective and snch heint;- the case the\- are lie\'ond the domain of this De- partment. If this Deiiarlment shonld he called on to cooperate with such a scheme it w i uld hold that it was its dut\' to do so in so far as the pre- vention part of the proj^'ram is concerned. .\ few years ago the De- partment found itself jjiving reparative or after care to persons wIkj had recovered from infantile paralysis. Since these persons were not infec- tive the problem of giving them reparative care w-as beyond the held of the Department. Forttmately, the State Rotary Clubs and the Sb.rin^-rs were found willing to assume the duty of giving this after care. The Department stands on the same platform with relation to su[)ply- ing drugs free. It is its duty to supply vaccines and nitrate of silver so- lution and other drugs fir pre\ention. It should not supply any drug for cure. The State Dejiartment of Public Welfare maintains a line of hos- pitals and other institutions for the care of those who are mentally or phvsically sick. The I'epartment of Public Idealth has no dut\ that calls it to intrude into the field cf the Department of I\iblic Welfare. When cjuestions of prevention arise in that field the Department of Health is willing and anxious to assume its full measiu'e of responsibility. The law establishes educa- tion of the ])nblic and ])ropagan(la for health as among the duties of the Department of Public Health. This is a pro])er prox'isicn above all in a democracw It is a fundamental factor in prevention. The State Depart- ment of Public Health is an ad\isor of the legislature in matters of health promotion. This is a recognized function of a 1 )ei)artnient and is the basis of (he relations between it and the legislative branch of government. ."^ince the meaning and force of laws are determined by the judiciary. the Department carries some responsibility for keeping that bocly informed as to what is coninion information on health subjects an 1 giving it information more dirt-clly when called in to do so. Tin- Stale Department of Public Health considers that the duty of j/lanning campaigns against disease and promoting health rests on its should- ers. .Much of tlu' attack and defense is commanded and executed by local health departments. The State Department of Public Health promotes the interests if local lu-altb departnn'nts where\-er it can do so. It lends them all the aid it can. It ba^ the right to interfere localp- onl\- when SUMMARY AM) CONCLUSION -107 the local department is so derelict that tlie people of other coinniunities are endangered. A breakdown in Icical adniini.stratiun ilial has local effect only is a local matter calling; for nci State interxentiun. The people pro- gress fastest when thev reap their own rewards and snft'er their own punishments. But if the local department is inefficient to such a degree as to imperil the State generally the State Department has the right to intervene. If the enemy is jiouring through a certain gaj) and over the State generally the State has the right to stop the gap regardless of where it may lie. The same princi])les apply tn the relati( n i)f the Department to the practitioners of medicine. In the battle line against disease tlie indi\idual is in the outermost skirmish line. Next comes the home and then the school. Then comes the first professional line of defense, the doctors and the hospitals. Still further back are the first line of Ilealth Department workers. The service rendered by physicians and hospitals is constant — never ending and valuable. The State Department of Public Health never interferes in the domain of any practising physician or hospital except where it becomes necessary for the protection of society. In almost all cases a satisfactory adjustment between these cooperating agencies is matle and it is of a kind that works efficiently, economically and satisfactorily. The Fiitiiir. This narrative may give the impression that the ultimate in attain- ment has been reached and that health can nut be further improved. It is largely to correct any such tenilencv that this \cnture in forecasting the future is made. Some i)roblems have been met and solved. Some diseases have been eradicated and more are (-n the wa\- toward eradication. Some diseases are satisfacturiK under control and some are certainly headed that way. But there will lie new diseses to take the place of some old ones. Some diseases not now under control nnrst be brought to heel; some diseases now disregarded must be tackled: the span of human life and efficiency must be increased: the solution of new problems and old problems long neglected must be undertaken. The etfect which should follow the reviewing of the battles of the jiast is to gird us for those of the future. It is hope.l that the Director of Public Health in ]'.•:;; ean promote the health of the people and the de- velopment of health departments. hi> own .md llie local de|iartnienls, with even greater satisfaction, than now pre\ail> in the mind of present Di- rector. 4()S SUMMAKV AND CONCLUSION Till- I'uriher (lr\ rliii)iiuiu iii cviTy division now in the Department and ilu- inansjuralion of several iu-\\ divisions can be foreJeen within the next few years. There must be a dix'ision to promote what is sometimes erroneously called positive heahh. Such a (Hvision would begin operation by promoting periodic ph\sical examinations at lirst in large groups of in- dustrial workers which is called closed groU])s ; later in more open groups and thiallv among the general population. In time this division would take on such activities as the promotion of winter sports, the promotion of all sports regardless of season; the planning of vacations for the renewal of hddilv vigor; the promotion of play for adults as well as for children, the ])rnniiitinn of some movement such as the Turner and vcrein of Germany and the Swedish societies for cooperative physical development and finally, the advancement of the knowledge and practice of the rules of health. Such a division would have for its motto "Keep the Adult Well" — parodying "Keep the Well Baby Well" — the slogan of infant-welfare work. Somewhere in the Department, genetics will Ije undertaken licfore manv years. (!iii3: will ha\r ;m outlined plan of cani|iaign for repressing or at least harrow- ing this I'uemy, which plan cumplele en general lines will be in a pigeon hole re.aclv for use as soon ;is ihe disease appears. SUMMARY AND CONXLUSION 409 So III I' Ciiiis'idcratidii of DcatJi Bates. At the present time the crude or uncorrected death rate is unnatur- ally low. \\'hen the calculated death rate hased on the average age at death is compared with the death rate as calculated on the basis of re- ported population, the two are found in marked disaccord. This is prin- cipally because of the instability of the population, migration back and forth between counties, between the states and between the urban and rural districts. Industrial changes have come to be large factors in this. Within the life-time of men now living a good part of this instability will have ended. There will be a better accord between the death rate indicated by the average age at death, the average age of the jitipulation and the death rate calculated on population. This will nut mean a death rate materially lower than the present one. It will mean the prevalence of one that is nearer an index of sanitation, hygiene, health work, freedom from disease, bodily vigor and good heredity than the present one is or can lie corrected to be. Old Age as a Cause of Death. In the earlier vital statistics old age was given as a cause of death with great frequency. As employed in that period the term was loosely used and it served as a catch bag for deaths in people fifty years of age and older from a multitude of causes. Because its use prompted loose diagnosis vital statisticians and health officers brought enough pressure to cause its partial abandonment. Before many years, old age as a cause of death will be used with the approval of health officers because it will then have a scientific meaning. Deaths from heart disease, apoplexy, Bright's disease and such occur- ring among old iieople will be properly recorded. The disorders due to bacterial and other causes likewise. There will remain a large number of people who will die because of senility and tlu-y will lie pnrperly classi- fied under that head. Bv that time the direct and the ultimate eft'ecls of bacterial infec- tions will be so well understood and so many nf these infections will iit wiped out or will be avoidable that the jimblems of senectitude can be studied. Many of the bacterial disurders which now- threaten men will have been brought under contrn]. This does not mean, bnwever, that there will be none such. Even then disorders which are endemic and mild in cer- tain regions will periodically break out and swfep n\er the world. \'ellow fever once existed on this basis in Cuba and jieriodicallv broke a\\a\- lo sweep as a highh fatal disease (j\er parts of the L'nited States. Inlluenza 410 SUMMARY AM) I'ONCI.USION made a grrat swct'p ovtT the world as lati- as lOlS. IVriodic waves of dis- orders of the saiiU' type ina\ still he expected. There will l>e ehaii.i;es in vinileiire of the existint,' haeteria in the territory which the\- nrniially inhahit. And there will lie new hacterial diseases esolved to lit new conditions. All in all there is no reason for thinking- that we shall soon see an end of the age-long strife between man and germs. I ii(r((isii/>/ SiKiii (if Lilc Tin- average age at death is said to he ahont .")S years now. This is interpreted as the average span of human life. In the pioneer days in Illinois few men were over 41) )ears of age. Men "lO years of age were regarded as old. It is said that somewhere in that early [jeriod. the average span of life was about 33 years. If men were occupied with preparation for work for twenty years only thirteen \ears were left for productive work. When the average span of life is 58 there are about thirty eight years for productive \vork. Before long the average span of life should l)e at least seventy. This would mean fifty years for productive work. W hen the average span of life reaches seventy years there will be large num- bers of men and women working i)rotitahly at eighty years of age and of centenarians there will be many. The State Department of rnblic Health has no thought that the future will be free from health problems. Such ])rol)lems will alwavs be present. They will not be those of yesteryear, nor those of today. The}- will be new in man\ of their aspects but they will be ini]>ortant to the happiness of the individual and the welfare (if the State. When the Department Ijegan in 181 7 health standards were low. An individual was satisfied with rather poor health because neither he nor his neighbor knew of the ]3ossibilities of a better standard. The ,-anie w-as true in even greater measure of collec- tive health called the health of the State, l^iday. the standards of individual and community health are far higher. It has been one function of the De- partmeiit to create reasonable discinitent with low standards. This will continue to be one of its functions. In time, health standards will be far higher, ^len will be discontented with conditions that now satisfy. Out of this, improveiuent will flow. .\ survey of the past gives us ground for facing the future with confidence. EXECUTIVE OFFICERS AND MEMBERS OF STATE BOARD OF HEALTH. Presidents. Date.' John H. Rauch. M. D 1877-1S79 1877 H. Wardner, M. D 1S79-1SS1 1877 J. M. Gregory, LL. D 1881-1884 1877 Newton Bateman, LL. D 1884-1887 1877 W. A. Haskell. M. D 1887-1S93 1881 John A. Vincent, M. D 1893-1894 1893 Wm. E. Quine, M. D 1894-1896 1893 B. M. Griffith, M.D 1896-1897 1890 L. Adelsberger, M. D 1897-1898 1897 A C Corr M D 1898-1899 1898 C. b'. Johnson, M. D 1899-1902 1897 Geo. W. Webster. M.D 1902-1914 1900 J A. Rcbison, M. D 1914-1917 1913 Secretarys. E. W. Gray*. M. D., (from July to Dec.) 1877-1877 1877 John H. Ranch, M. D., Act. Sec— Dec. to May 1877-1878 1877 Anson L. Clark, M.D 1878-1879 1877 John R. Rauch, M. D 1879-1891 1877 Wm. R. MacKenzie, M. D Aug. 4 to Sept. 24, 1891-1891 1883 F. W. Reillv, M. D. 1891-1893 1891 J. W. Scott*, M.D 1893-1897 1893 J. A. Egan, M. D 1897-1913 1897 Amos Sawyer*, Act. Sec 1913-1914 1901 C. St. Clair Drake, M. D 1914-1917 1914 :>t the Board. Dr. Egan h< iber of the Board Board Members. Date.' R. Ludlam, M.D 1877 W. M. Chambers. M. D 1877 John McLean, M. D 1881 R. L. McCain, M.D 1SS2 Wm. R. MacKenzie, M. D., Sec. August-September, 1891 1883 Geo. N. Kreider, M, D 1884 A. W. H. Reen, M. D 1884 H. V. Ferrell, M. D 18S7 D. H. Williams M. D 1888 Geo. Thilo, M.D 1893 Sarah Hackett Stevenson, M. D.. ..1893 J. B. McFatrich, M, D 1893 Julius Kohl, M.D 1893 Oscar O. Haines, M.D 1895 D. R. Brower, M. D 1896 Florence W. Hunt, M, D 1897 P. H. Wessel, M. D 1897 M. Meyerovitz, M. D 1897 Board Members. Date.' G. R. Schater, M. D 189fi E. P. Cook, M.D 1896 Z. D. French, M, D 1897 C. H. Starkel, M.D 1896 R. P. Bennett, M. D 1898 J. C. Sullivan, M. D.. . 1901 W. Harrison Hipp, M. D 1901 Wm. 0. Forbes, M.D 1901 Henry Richings. M. D 1902 R. E. Niedringhaus, M. D 1905 W. R. Schussler, M.D 1907 C. J. Boswell, M. D 1909 Adam Szwajkart, M.D... 1913 ! 1 Luster, M, D 1913 T. B. Lewis, M.D 1913 Thos. O. Freeman, M.D 1914 J. J. Hassett, M.D 1914 Enos S. Spindel, M. D 1914 Felix Kalacinski, M.D 1916 (•ill) ILLUSTRATIONS. PAGE Adult physical examination, Stat.- l;iii 208 Annual appropriation, 1879-192" 207 rerebro-.spinaI fever, meningitis 37C Chicago mortality rate, acute respiratory diseases, 1870-1910 93 course of the total mortality in Chicago, 1867, 1SG8 90 decennial mortality rates — all causes — Chicago, 1S70-1910 94 mortality rates — Chicago — 1871-1879, 1922 91. 92 Diarrhoea and Enteritis In Illinois 379 Diphtheria rates in Illinois 360 Field laboratory equipment 259 Dr. George Fisher's neglected grave in Randolph County 275 Health exhibit at fair 227 Malaria in Illinois 3Sl Map — typhoid mortality in Illinois 347 Map — White County, Illinois, on tuberculosi.s 372 Map — Yellow fever districts in Cairo 330 Number inspections all sanitary purposes 224 .Number investigations proposed sewerage installations 223 Number investigations public water supplies 223 Number water analyses 224 Organization State Board of Health, 1877 138 Organization State Board of Health, 1901 16.t Organization State Board of Health, 1915 177 Organization State Board of Health, 1927 199 Population served from public water supplies 229 rrevalence of venereal disease in Illinois 272 Public water supplies installed 229 Scarlet fever case reports 350 Scarlet fever deaths in Illinois 349 Seasonal distribution of deaths, 1843-1925 95 Section of main laboratory at Springfield 255 Smallpox in Illinois 308 State fair better baby conference in action 237 Tuberculosis deaths in Illinois 362 Typhoid fever deaths in Illinois 342 PHOTOGRAPHS. Adelsbers'i', Dr. l^oui.s, Waterloo 176 Bain, Dr. Walter O., Springfield 245 Bateman, Newton, LiL. D., Galesburg 124, 146 Black, Dr. Carl E., Jacksonville 1". 1 1 ■'* Brainard, Dr. Daniel ■"' Bundesen, Dr. Herman N., Chicago 203 Burrill, Prof. Thomas J., Urbana 244 Cadwell, Dr. George, Kaskaskia 126 Chambers, Dr. William M., Charleston 124 Clark, Dr. Anson L., Elgin 124, 140 Copeland, Dr. C. C Springfield 26S Cook, Dr. E. P., Mendota '19 Corr, Dr. A. C. Carlinville 1^'^ Corr, Dr. L. H., Carlinville S7 Craycroft, James Robert, first 100 per cent boy 241 Cullom, Governor Shelby Moore 128 Davis, Dr. N. S *" (412) PHOTOGRAPHS -ll-> PAGE Dilly, Orrin. Springflelcl 2S1 Doan, Dr. Thomas D.. Palmyra 203 Drake, Dr. C. St. Clair, Chicago 162, 190 Drake, Dr. Daniel 37 East, Dr. C. W., SprlngHeld 222 Egan, Dr. James A., Chicago 1*2 Esper, Gloria June, first 100 per cent girl 231) Evans, Dr. William A., Chicago 19", 2»3 Ferguson, Harry F., Springfield 222 Goodbrake, Dr. C, Clinton 40 Gregory, John Milton, L.Ii. D., Champaign 124, 14G Griffith, Dr. B. M., Springfield 155 Haller, Dr. F. B., Vandalia 61 Hamill, Dr. Robert C, Chicago 66 Hansen, Paul, Chicago 221 Haskell, Dr. W. A 1S5 Hemenway, Dr. Henry B., Springfield 266 Howard, Sheldon L., Springfield 232 Hoyt, W. H., Chicago 230 Hrdlicka, Dr. Ales, (Washington. D. C.) 17 Hull, Dr. Thomas G., Springfield 247 Jewell, Dr. J. S., Evanston 41 Johnson, Dr. C. B., Champaign 175 Kessinger, Samuel W., Litchfield 267 Leonard, Dr. Thomas H., Springfield '. 220 Lillie, Dr. Charles W., East St. Louis i:t7 Lowden, Governor Frank O., Oregon 183 Ludlam, Dr. Reuben, Chicago .... 124 MacKenzie, Dr. William R., Chester 140 Mannheimer, Dr. Michael, Chicago 89 Marquette, Father 117 Massie, Dr. William. Edgar County 53 McShane, Dr. J. J., Springfield 210 Monroe, Mrs. E. X., Quincy 197. 203 Palmer, Dr. George Thomas, Springfield 220 Prince, Dr. David, Jacksonville. . 75 Quine, Dr. William E., Chicago 15.t Rauch, Dr. John H., Chicago 124, 140, 14 6 Rawlings, Dr. Isaac D., Chicago 190 Reilly, Dr. Frank W., Chicago 162 Reynolds, Dr. Arthur R., Chicago 313 Richardson, Baxter K., Springfield 267 Robertson, Dr. John Dill, Chicago 1 :i7 Robison, Dr. John Albert, Chicago 175 Ryan, Charles, Springfield 210 Sawyer, Amos, Hillsboro 162 Scott, Dr. John W., Springfield 162 Searcy, Earl B., Springfield 266 Skoog, Paul L., (California) 243 Sloan, Dr. Edwin P., Bloomington 197, 203 Small, Governor Len, Kankakee. ... 4 Taylor, Dr. G. G.. Chicago 26S Vincent, Dr. John A., Springfield ' 155 Wardner, Dr. Horace, Cairo. 124. 146 Webster, Dr. George W., Chicago. . . 175 Woodward. Dr. J. J.. (Washington. D. C.) 79 Wright, Dr. John, Clinton 75 INDEX. PACK — A — Abel, Ur. Theodore C, Chicago 25S Adelsberger, Dr. Louis, Waterloo 175, 411 Advisory Board, members of 192, 196, 197, 203, 252 Ague 2G, 35 Allen, Dr. J debate on cholera 45 American Bottoms 19, 23, 24, 30, 32, 34, 36, 41 Amei'ican colonists 14, 403 American Regime, The 27 Amoebic dysentery, see Dysentery. Anders, Dr Chicago, on typhoid fever 76 Andrews, Dr. C. N., Rockford 74, S5, S7 Andrews, Dr. Edmund, Chicago 51, 53, 104 Anemia 30, 33 Anthrax 244, 252, 257 Antitoxin distributed and Pasteur treatments 169, 215, 217, 219 see Vaccines. Appropriations 133, 135, 137, 13!i, 143, 166, 169, 171, ISl, 185, 206, 207. 211, 216, 26S division child hygiene and public health nursing 235 communicable diseases 211 lodging house inspection 165, 265 sanitary engineering 223 tuberculosis t 220 vital statistics 233 for State Board of Health 133, 137, 157, 160, 168 for State Department of Public Health 189,206 graph on 207 for vaccine farm. University of Illinois 157, 249, 311 for water laboratory. University of Illinois 246 for yellow fever epidemic 143 Arnold, Dr. Lloyd, Chicago 25S Asthma 18 Atwater, Dr. R. M 50 Autumnal fever 34, 35, 36, 39 Auxiliary health agencies 14, 171. 191, 220, 2S7-303 — B — Baily, Dr. F, K., Joliet 69, 85, 86 Bain, Dr. Walter G., Springfield 245, 254 Baines, Dr. Oscar O., Chicago 411 Barbee, Dr. Thomas, Marshall 67, 6S Bartlett, Dr. Elisha on typhoid fever 71, 73, 76, 77 Bateman, Newton, LL. D., Oalesburg: 124, 125, 137, 146. 153, 411 Beaumont, Dr 23 Bemiss, Dr. S. M., (La. ) 143 Bennett, Dr. R. F., Litchfield 411 Berg, Elin, Springfield 10 Better baby conferences 137, 178, 236, 267, 2S9 Bilious fevers 32, 35, 3 6, 72 Births 40S and infant deaths 113 rales 19, 23, 29 registration drive in Illinois 201, 234 Black, Dr. Carl E., Jacksonville 118 Black, Dr. Luther A., Chicago 233 Black fly 19 Black Hawk War 17, 31, 43, 102 Black tongue 52 Ulanc, William . . . .' 30, 278 (414) INDEX 415 PAGE Blankenmeyei-, Dr. H. C, Spiingfield 254 Board of Health, see State Board of Health. Boggess, 30 Bondurant, Dr. Flint 254 Borendel, Dr. F., Peoria County 41 Boswell, Dr. Chas. J., Mounds ■ill Boudin, Dr., , on typhoid fever and malaria 78 Bovine tuberculosis 369, 374 Bowen, Dr Joliet 39 Brainard, Dr. Daniel 47, 48 Breast feeding demonstration 240 Breed, Dr Princeton SO Breen, Clara, Springfield 2, 10 Brennan, Dr. Earl, East St. Louis 25S Bridges, Dr. T. B., Chicago 104 British Regime, The 13, 26, 28 Bronchitis 65, 90. 109, 408 Brower, Dr. Daniel R., Chicago 411 Buhlig, Mrs. Blanche, Chicago, committee on child hygiene 242 Bundesen, Dr. Herman N., Chicago 203, 272 Burns, Dr Mackinaw 38 Burrill, Prof. Thomas J., Urbana 244,249 Butler, Jlajor, (Washington, D. C. ) on dt-ntal hygiene 242 — C — Cadwell. Dr. George, Kaskaskia ,. 126, 130 Cahokia .' 23. 32, 34 Cairo 32, 141, 172, 212, 377-338 Cancer 17, 298, 305, 408 Carr, Clark E., (1S50) 43 Carroll, Dr , on typhoid fever. . . . .' 76 Cassiday, Hugh, Springfleld 252 Catlin, Dr. George 38, 49 Cerebrospinal fever 64, 375 graph on 376 Chamberlain, Dr Kane County 42 Chambers, Dr. William jr., Charleston 124, 125, 137, 279, 396, 411 biography of 125 Chancroid, see venereal diseases. Chapman, Dr. H. W., Whitehall 85 Cheneoweth, Dr. W. J., Decatur 86 Chicago, chronicle health and sanitation in ., 101—114 fire (1S71) 106 DeWolf, Dr. Oscar C 105,323 drainage canal, sewage from 168, 245 Evans, Dr. W. A 2, 196. 197, 203. 272. 291, 294, 302, 369 health department 43, 44, 47, 50, S9, 247. 250, 261, 405 annual reports of 87, 105 Health history prior to 1877 101-114 Mannheimer, Dr. Michael, charts by 89 milk 300,301 prohibiting sale of from tuberculous cattle 369 Ranch, Dr. John H., appointed sanitary superintendent 105, 106, 107 Reynolds. Dr. Arthur R 105. 166. 313 Statistics 50, 51, S3, 87, 89. 90, 99, 102, 103, 104. 106. 107-114, 313, 320, 397 annual death rates (1843-1877) 107 consumption Ill diphtheria 109, 354. 356 erysipelas 114 malaria 113 measles 112 pneumonia 110 respiratory diseases 110 4:16 INDEX- PAGE Chicago, chrdiiuk- lu-:iUli ami sanitation in — Concluded. scarlet fever 103, lOi), 348 smallpox Ill typhoid fever S3, 108, 16G, 33i). 340. 351 whooping cough 112 annual reports of, deaths all ages 87, il9 deaths under 1 1)9 deaths under 5 87, 89 first death rates from 83 graphs on , 89 survey, tuberculosis 370 Will you become a crusader, chart 369 Chi.kenpox 253, 374 investigation every reported case of 202, 312 Chills 31, 32, 35, 38, 78 see Malaria. Chirac (1742) on typhoid fever 71 Cholera ■ • • • 9, 17, 31, 53. 70, 78, S4, S5, 103, 105, 127, 136, 139. 141. 244. 305. 339. 353, 363, 383, 400 death of Governor Ninian Edwards from 44 debates on 45 epidemics in Illinois • 321-327 infantum 86, 104, 106 morbus 72, 86, 104 pandemics of 43 prohibit transportation of bodies dead from 150 rules and regulations for control of 150 Civil Administrative Code, adoption of 134, 135. 182, 1U2, 207, 211, 225 powers and duties under '. 184 Clark, Dr. Anson L,, Elgin 124, 125, 137, 139, 140, 153, 411 biography of 125 Clark, George Rogers 13. 14 Clay. Dr. A. J.. Hoopeston 67. 68 Colburn. Dr Bloomington 3 6. 52 Coleman, Dr. J. W., LeRoy 85 Colonial pei-iod 28 Communicable diseases, rules and regulations concerning 132, 148, 150, 156, ISO, 185,210 curative measures for 166 Consumption IS, 19. 20, 24, 32, 41, 60, 97. 404 annual death rate from, in Chicago llo Cook, Dr. K. P.. Mendota 49, 69, 75, 76, 80, 86, 249, 411 Cook, Dr. P. M., Chicago 44 Cook, Dr. Robert C, Springfield 235 Coolidge, Dr (Washington, D. C.) 64 Copelan, Dr. C. C. Springfield 268 Corr, Dr. A. C, Carlinville 175,411 Corr, Dr. Lucinda H.. Carlinville 87. 88 County health departments 195. 196. 198, 257 deCourey. Dr. .lames, assigned to Cairo 336 Crawford. Dr on typhoid fever 74, 75, 76 CrawforO. 1 ir. ('litis !•:., Koekford 211 Crippled rhildren's cliliii-s ilisciintinued 199. 235. 380, 406 Croghan 26 Crothers. Dr Bloomington 64 Crowley. Dr. W. .S 252 Cullom, Governor Shelby Moore, Springfield. 128, 280 Cunningham, Dr. V\'. H.. Rockford 25s Cynanche. death of George Washington caused by 55 Pappert. A. F.. Springfielil 2 Davis. Dr. X. S 40, 4.t. .")L>, o7. 70. 74, 7fi. 8.5, SS, 3SS debate on cholera . 45 Dawson, Dr on typhoid fever 70 Deaths, see Mortality deLiesseps 2n Deneen, Governor Charles S., Chicago 169 Dengue, pandenic of 4fi Dental demonstrations 200. 242 Development of State health service 133 three periods 133, 13S, 16.t, 177, 199 four personalities 134 DeWoIf. Dr. Oscar C. Chicago 103, 323 Diarrhoeal infections 14, IS, 20, 21, 25, 30, 41, 72, 81, 85, 90, 305, 377, 398, 403 among Indians - S3 annual death rates, Chicago 104, IDS, 354 in adults 84, 86 infant mortality due especially to S6— S8 mortality from 377 graph on 379 Dickinson, Dr Peoria 39 Dickson, Dr. S. H on typhoid fever 79 Diehl, Dr. C. H., Effingham 29 6 Dilly, Orrin, Springfield 231,233 Diphtheria 9, 96, 136, IGS, 247, 250, 253, 304, 3S3 among Indians 55 Annual death rate.s, Chicago 104, 108, 354 cases of 357 carriers , 358 distribution of antitoxin for 216, 217, 244, 353, 401 mortality from 353, 357, 360 graph on 360 outbreak at Rock Island 259. 260 phenomenal progress in eradication of 3{ 6 prohibit transportation bodies dead from 150 rules and regulations for control of 150 Directors, State Department of Public Health 182, 190 Division of child hygiene and public health nursing 189, 199, 231 committee on child health needs in Illinois 200, 242 of communicable diseases 185, 210 of general oflice 185, 209 of laboratories, biological and research 189, 247 diagnostic , 181, 186, 193, 245, 247 of lodging house inspection 164, 171, 173, 186, 265 of public health ins ruction 189, 192. 286 of sanitation 185, 221, 243, 247, 381 of social hygiene 188, 247, 268 of surveys and rural hygiene 189, 206, 243 of tuberculosis 185, 220 of vital statistics 186, 230, 254 Doan, Dr. Thomas D., Palmyra 203 Doane. Dr. Phillip S., Chicago 334 Drainage, see American Bottoms Drake, Dr. C. St. Clair, Chicago 135, 162, 225, 411 appropriations under 191 biography of 1 9(i regime 135, 174-194 Drake, Dr. Daniel 19, 36, 37, 38. 39. 43, 47, 52, 54, 57, 60, 64, 67, 6S, 73, 78, S4, 397 41 S INDEX I'AUK Dropsy IS Driide, Dr. Francis. Quincy 33 Dunne, Govermir lOdward F., Chicago 174, 181 Dupray, Martin . 254 Dysentery '.I, 14, IS, 20, 21, 2r.. 2S, 30, 72, 78, 86, lis, IGS annual deaths and rates in Chicago 104, 114 mortality from 84 Dyspepsia 57 — E — East, Dr. C. AV., Springfield 1S7, 211, 2:!4 lidgar, rapt. I. D., (Washington, D. C.) .«4 Edgar, Dr. W. S. debate on cholera 45 Educational propaganda ... 135, 176. 206 Edwards, Governor Xinian, death from cholera 44, 129 Egan, Dr. James A., Chicago 78, 177, 232, 253, 336, 337, 411 appropriations under 135 regime 134, 159-174 Egyptian mummies 21, 5» Ellis, Dr. C. C, Moline 233 Embalmers, law passed regulating practice 2S5 English, Dr Jacksonville 3S Epizootic, horses died from in Chicago lOG Krasmus. scientist, on t.vpho'd fever 72 Ergot paralysis 64 Erysipelas 50, 52, 54, 65, 104, 1C.5, 4I12 annual death rates in Chicago 114 Evans. Dr. Wm. A.. Chicago 2, 1!16, 197, 203, 272, 2!)1, 294, 302, 369 Exhibits 135, 176, 178, 206, 267 Eye troubles 33 — F — Fancher, Homer C, Chica.i^o 1*14. 265 Faught, Eva E., Carbondale 252, 25S, 263 Felder, Dr, W. Ij , on fevers 78 Ferguson, Harry F., Springfield 222 Ferrell, Dr. H. V., Carterville 411 Fisher, Dr. George, Kaskaskia 130, 273, 275 Fitch. Dr (Ind.) 52 Flagg. Dr Edwardsville 32 Flint, Dr. Austin on typhoid fever and malaria 7S Fluxes 18, S6 Food poisoning 81, 24(1, 257 Forbes, Dr. Wni. ()., Chicago 411 Fordham, Dr (England) 32 Forry, Dr. . .' (Washington, D. C.) 64, 102, 397 Fort Cbartres 26, 34 Foreword 9 Foster, Dr. I. H., Chicago 211, 371 Freeman, Dr. Thomas O., Maitoon 411 French-Canadian Regime, The 13. 15. 22. 28, 29, 49. 53, 39S, 403 French, Dr. A. W., Springfield 115 French, Dr. Z. D., Lawrenceville 411 Fruterrer. Dr. Oustav, Chicago 245 Fry, Luella, Springfield 253 Frye. Dr. J. C. Peoria 38, 39 Fults. Dr. J. C, Waterloo 335 — G — Callhrieth. Dr un pui-rp.ral fever 65 (landr.lphr, Tir. .Mi.hel mi ..ligin of syphilis 59 INDEX 419 PAGE Ganott, Dr. Erasmus, Chicago 315 Gates, Dr. JoseiJh, Marine 68 Gehrmann, Dr. Adolph, Chicago 247 General health history prior to 1S77 15 Genesis of public health law 127 Genetics 408 Gerhard, Dr (Penn.) on typhoid fever 71, 73 Gerhard, Dr. Frederick, Chicago 41, 61 Gilchrist, Dr. (1735) on typhoid fever 71 Gilmore, Dr. "W. H.. Mt. Vernon 257 Glackin, Senator Edward J., Chicago 179, 220, 291, 366 law for tuberculosis sanatoria 163, 172, 179, 365, 368, 371 Godfrey, Dr. E. S., (Xew York) 211 Goitre sufvey 242 Gonorrhea ^ -'-'. 24. 60, 254, 270, 298 Goodbrake, Dr. C, Clinton 40, 85 Goodell, Dr. W. L., Effingham 86 Gorgas, General William Crawford 25 Gout 18 Graphs, see Illustrations Graves, Dr. X. A , Chicago 293 Gray, Dr Jefferson County 57 Gray, Dr. Elias \V., Bloomington 130, 131. 132, 137, 139, HO, 411 Gray, Dr. Ethan A., Chicago 368 Gregory, Dr. John Milton, Champaign ' 124, 125, 137, 146, 411 biography of 125 Griffiths, Dr. B. M., Springfield 153,155,411 Griflitts, Dr. T. H. D 233 Grinstead, Dr. W. F., Cairo 334 Guiteras, Dr. John (.Ala.) 335 Gumston, Dr. C. G on typhoid fever 70 — H — Haines. James 31, 43 Hale, on unity of fevers 73 Hall. Dr. L, , Kane County 40 Hall. Dr. Thomas. Toulon 64, 84, 85 Haller. Dr. F. B., Vandalia 40, 61, 118 Hammill, Dr. Robert C, Chicago 33. 53. 61, 66, 89 Hamilton, Dr. John B., Chicago 335 Hamtranmck, Major 26 Harmon, General J 26 Hansen, Paul, Chicago 221 Harris, Dr. J. O.. Ottawa 87 Haskell. Dr. W. A., Alton 153, 155, 411 Hassett, Dr. J. J., McLeansboro 411 HauU, Dr on puerperal fever 66 Health conditions in Illinois after 1S77 304 promotion week 135, 179, 294 Heart disease 305, 408, 409 Hemenway, Dr. H. B.. Springfield 266 Menkes, Kirby, Springfield 252 Hennepin, Dr on milk sickness -. 67 Henry, Dr Springfield 38 Henry, Dr. Alexander 18, 19 Henry, Dr. J. F., Bloomington 36, 52 Hepatites, chronic 57 Hewins. Dr. L. T., Loda 46, 86 Hildreth. Dr. S. P., (Ohio) 33, 65 Hipp, Dr. W. Harrison, Chicago 411 420 INDEX PACE Hiisch, Dr 43. 14. 47. 49, 50, 55. 56. 57. 63, 64, 65, 71, 7S History of certain diseases prior to 1S77 35 after 1S77 304 steps in establishment of typhoid fever as a specific disease 70 Hoffman, (1728) on typhoid fever 71 Hoffman, J3r. T. A.. Heanl.stown 41 Holder. A. H 19 Hollister, Uv. .1. H., on niir.sing sore mo\ith '69 Holmes. Dr. Oliver Wiiulcll ..43, 66, 73, 74 Holmes, Dr. \V. H 254 Holsten. Dr , on puerperal fever 65 Howard. Shehinn b . SpriMSfiekl 232 Howland, Dr Ottawa 39 Hoyt, W. H., Chicago 20S, 232, 233, 253 Hrdlicka, Dr. Ales, (Washington, D. C.) 17, IS, 1!), 20, 49, 53, 55, 58, 60 Hubbard, Gordon S., Chicago 22. 23, 102 Hull, Thomas G. Springfield 247, 252 Hunter. Dr. I. \V.. on origin of syphilis 60 Hunt, Dr, Florence W., Chicago 411 HurUiert, Dr Ottawa 39 Huxhaiu (17S4) on typhoid fever 71, 72 — 1 — Ilkemire, Dr. J. A.. Palestine 258 Illinois and Michigan Canal 40, 42, 101, 106 Illinois Medical Society formed 39 debates on cholera 45 Immigrants 29, 35, 47, 66, 101, 136, 142, 147, 154, 172 measles brought in by 54 smallpox carried by 50 Indians 13, 15, 17, 19, 21, 39, 53, 39S diarrhoea! diseases among S3 high death and low birth rates 29 smtillpox, disease of 49 syphilis among 58 Indigestion IS Infantile paralysis 187, 234, 370, 379 clinics for 199, 235, 3S0, 406 table on 3S0 Infant mortality 19, 30, S6-8S, 242, 393, 403 among Indians 19 annual death rates in Chicago 113 detailed rates on 201 Infants, diseases among 14 Influenza 90, 96, 191, 404. 40S and pneumonia, epidemics of 62 mortality from in Chicago 109 Ingals. Dr. E debate on cholera 45 Intermittent fever 26, 35, 36, 40, 72, 78 annual death rates, Chicago 113 Intra-departmental organization 208-272 Introduction 13 Isthmus of I": on unity of fe Jayne, Dr Springfield. Jenner, Dr. Edward, (England) . . 320 Jenner, Sir U., (1849) (England), on unity of fevers 72 Jesui's 24. 32, 42 Jewell, Dr. .1. S.. iOvanston 41, 70 INDEX 421 PAGE Johnson. Dr. C. B.. Champaign 42. .->5. 64, SO, 82, 17.">, 390, 411 Johnson, Dr. Hosmer A., Chicago 10.5, 143 debate on cholera 45 Jonas, M. M., Chicago 1C4 Jones, Dr Jacksonville 3S Jones, Dr. H. W.. Chicago 66 Jones, Dr. Joseph, (Ohio Valley) .").S — K — Kalacinski, Dr. Felix, Chicago 411 Kaskaskia 23, 26, 32, 34, 273, 277 bottoms 115. lis removal of capital from ^ US survey of prior to 3 877 116 Kessinger, Samuel W., Litchfield 267 Klebs, Dr. A. C, Chicago 2S0, 293 Koch discovery of anthrax and tuberculosis bacillus by 244, 364 Koehler. Dr. C.ottfried, Chicago 2, 102 Kohl, Dr. Julius, Belleville 411 Kramer on origin of syphilis .59 Kreider, Dr. George X., Springlield 411 — I. — Laboratoi-ies, branch 258 certificates of approval for 262 diagnostic, biological and research 1S6, 1S9, 193, 247, 24S, 254 examination of water supplies 244 equipped tor making diagnostic examinations 166, 173, ISl investigations conducted by 252 total examinations, table on 256 LaFeve French trader 39 Lakes and ponds, stagnant 34 Lancise (171S) on typhoid fever 71 Laub, Wm. G., Chicago 265 Leasure, Dr (Penn. ) on puerperal fever 65 LeBlanc, on malaria 25 Legi-slation 129, 130, 132, 133, 198, 215, 24S, 311, 404 important health laws enacted 179, 214, 216, 271, 272, 374 medical practice acts 273—286 organization of State Board of Health 127, 137, 404 regulating practice osteopathy 284 requiring pasteurization of milk 204 Leonard, Dr. Thomas H.. Springfield 220 Lewis, Arch, Chicago 265 Lewis, Dr. T. B., Hammond 411 Liller, Dr. J. (',., Woodford County 41 Lillie, Dr. Charles \V., East St. Louis 196, 197 Lincoln, Abraham 67, 115, 137 Lincoln, Nancy Hanks, death from milk sickness 67 Lister, Lord, (England) 131, 244 Local boards of health, creation of 172, 1S9 attempts to improve 196 Local health district and law providing for establishment of 179, 215 Lodging house inspection 171, 173, 208 act creating 164 chart on 165 Long, Dr. Esmond H on consumption among Puritan fathers 20 Long, Prof. John H., Chicago 245 Lortel on origin of syphilis 59 Lot.ery, see American Bottoms Louis (1829), treatise on typhoid fever 20, 70, 71, 73, 75 422 INDEX PAGE Lovvden, Oovcrnor Frank t)., Oregon 135, 179, 182, 183 Lowry, Dr. Kdith H., St. Charles 236 Ludlam, Dr. Reuben, Chicago 124, 137, 153, 411 biography of 125 Luster, Dr. R. D., Granite City 411 — M — MacCulIiK-li, .IcliM (1S2!1) 35 MacKenzie, Dr. Wni. R., Chester 140, 152. 153, 411 Malaria 9, 13, 19, 20, 21, 24, 25, 26. 28, 30, 33. 39, 12. 47, 73. 74. 77. 78. 84. 90. 118, l(i8, 254, 399 and typhoid fever 69-83 annual death rates in Chicago 104, 113 cases of 382 French no immunity to 25 history of prior to 1877 35 mortality and rates 382 graph on 381 noticeable decline in 304 Mann, A. H., Springfield, inspector at Cairo 334 Mannheimer, Dr. Michael. Chicago, concerning charts by 89, 105 Manse, Dr. Hiram, Lafayette 87 Marquette, Father IS, 23, 42. S3. 117 Marriages 13. 23, 26, 397 Massie, Dr. Wm., Grand View 53 Maternity and child hygiene 199, 238 advisory committee on 200 Sheppard-Tovvner Act 200, 238 Matthews, Dr. J. P., Carlinville 85 McCain, Dr. R. L 411 McClanahan, Dr. B. V., Galesburg, committee on child hygiene 242 McCulloch, W. W., Chicago 265 McFatrich. Dr. J. B., Chicago 411 McGarragh, Dr , on milk sickness 68 Mcllvaine, Dr. T. M., Peoria 150 Mcintosh, Dr. Donal, Urbana 249 McLaughlin, Dr. R. G., Heyworth 85 McLean, Dr. John. Pullman 411 McShane. Dr. John .1., Springfield 210-219 McVey, Dr Morgan l^>unty 53. 57 Measles 33. 96, 366. 374. 383. 402 annual death rates in riiicuRo 104, 112 brought in by iiuniigiants 54 cases of 385 Medical examination of school children 238 Practice Act, The 127, 130, 132, 156, 159. 273 acts of 1817, 1819, 1877 273-286 divorced public health service and I'cgulation of 182 minimuin retiuirements 282 standards for medical education 281 Meeker, Dr , Chicago 52 Members, State Board of Healt^h 124, 137, 411 biographies 125, 137, 190 Menard, Pierre, ^TCaskaskia 273, 276 Meningeal fever 57 Meningitis 56. 64, 375, 403 graph on 376 Merriman. Dr , Springfield 38 Mettaurer, Dr , (Va.) on fevers 7S Meyerovitz, Dr. M., Chicago 411 Midwives, certificates to practice required 2S5 INDEX 423 PACK .Milk 164, ISl, 202, 204, 227, 2.52, 257, 260, 301, 342, 350, 369 niudel ordinance for 202, 204 pasteurization of 202, 226, 260, 395 sickness 66, S4, 400 mortality from 67 prevalence of 66 Miller, Dr. Ben S., Chicago, appointed .'ianilary .supeiintendent 106 Missionaries 13, 22 Mitchell, Dr. R. W., (Tenn.) 143 Model milk ordinance adopted 202, 204 Modern health crusade 290, 294 Modified Quarantine 213 Monette, Dr. J. W., (Miss.) 73 Monroe, Mrs. E. N., Quincy 19(1, 197. 203 Morbidity, decrease in summer sickness rates 404 general unhealthfulness , 29, 39S see various diseases. Morg-an, (176S), on ague and fever 26 Morgaginni (1761) on typhoid fever 71 Mortality 25, 62, 202, 230, 234 all causes 96, 97 certain causes, Illinois and Chicago, tables on 96, 304 children under 5 years, table on 88, 89 cholera 43-46 diarrhoeal infections 377, 378 diphtheria 55, IDS, 353 increasing span of life 410 infant 19, 30, 86, 113, 201, 242. 393, 394, 395, 403 measles 43, 385 milk sickness 67 pneumonia and influenza 62, 388 population and number deaths, tables on 98—100 rates 29, 304, 398, 409 all causes 96, 343, 351, 354. 364 annual, certain diseases 107 infant . 394 Springfield 116 tuberculosis 364 typhoid fever 108 see Chicago statistics scarlet fever 351 smallpox 310 tuberculosis 361 typhoid fever 82, 108, 338 see illustrations, Chicago statistics Mosquitoes 19, 25, 35, 36, 46, 101, 381, 400 Mound builders 13, 15, 58 Murchison, Dr. Chas. (1862) on typhoid fever 71, 339 Murphy, Dr. J., Peoria ! 39, 87 — N — Nance, Dr Lafayette 53 Nauss, Dr. Ralph W 252 Neely, Dr. John B., Chicago 334 Nelson, Dr. C. S., Springfield 211,335 Neuralgias 57 Niedringhaus, Dr. R. E., Uranite City 411 Noble, Dr. Harrison, Bloomington 61, 70 Notthaft (Cermany) on origin of syphilis 59 Nursing service 230 Nursing sore mouth 69 451 INDF.X PAGE — o— Olson, Dr. (_'. \V., I, ..ml. aid 364 Ophthiilmiu neonatoitnii 33, 289 epideniif ^'^ Osborne. Governor Chase (Xrii-h.) ^1 Osier, Dr. Wm "•• Outbreak of yellow fever starts machinery for control of epidemics 141 Owen, Dr. Dale, (Ind.) 6S Oysters, typhoid fever .-ittributed to 204, 214, 257, 34C — P — Palmer, Prof. Arthur Wra., Urbana 221, 246 Palmer, Dr. George Thomas, Springfield 1 S5, 220, .■!36, 371 Panama canal, deaths in 25 Paralysis, ergot 6* Parkman IS, 23 Parran, Dr. Thomas, .Ir., (Washington, D. C.) 198 Parrish, Randall 44 Pasteurization, law passed re(iuiring 202 milk supplies 164, ISl, 260, 301, 342, 350, 395 Pasteur (France) 131, 169, 244 Payne, Dr. H. R., Marshall 40 "Petechial fever" (typhoid) 70 Petit (1814) on typhoid fever 71 von Pettenkofer, JIa.x, (Germany) 105, 114, 131, 137, 339 Pettit, Dr. J. W., Ottawa 293 Pettit, Dr. Roswell T., Ottawa 258 Phillips, Dr. G. W., Dixon 61 Physical examinations, annual 206, 242, 298 scientific examination of returned soldiers 373 Pickett (Ala.) 13 Pierce, Dr. C. (".. I Wasbiiiut.in. D. ('. ) 272 Plague 400 Pleurisy 33, 109 Pneumonia 19, 20, 25, 30, 33, 62, 96, 387, 398, 404 and influenza • - • 62 annual death rates in Ghicag.. 109 cases of .* 3 8 S graph on 389 Poles, in Illinois , 28 Poliomyelitis, see infantile paralysis Ponds and lakes, stagnant 3 4 Population of Illinois, increase in 100 and number of deaths, tables on 9S Powers and duties, under State Board of Health Act 184 under ophthalmia neonatorum act 185 under vital statistics act 184 under miscellaneous acts 185 Preface 7 Presidents, State Board of Health 146, 155, 175, 411 Prince, Dr. David, Jacksonville 75 debate on cholera 45 Prosser, Dr Jacksonville 38 Prost, (1804), on typhoid fever 71 Public health administration in Illinois 127-272 intra-departmental organization 208-272 Puerperal fever 50, 51, 53, 54, 74, 202, 402 epidemic of 65 Puritan fathers, suffered from i.insumption 20 "Putrid fever" 53 IXDEX 425 PAGE — Q— Quaife 31. 102 Quarantine, during: yellow fever epidemic 142, 327, 3:i0 modified 213 rules and regulations pertaining to 132, 150, 180, 210, 212 yellow fever committee appointed 143, 334 Quine, Dr. W. E., Chicago G6, 150. 411 Quinine 42, 77 — R — Rahie.s 215, 251, 253, 256 vaccine for 219 Ranch, Dr. John H., Chicago 102, 105, 106. 107, 124, 125, 131, 231, 266, 2S0, 303, 339, 396, 411 appropriations under 137, 139, 141 biography of 125 general State sanitary survey ■. 147, 198, 339 regime 134, 139-159 resignation of 153 yellow fever outbreak at Cairo 141, 327 Rawlings, Dr. Isaac D., Chicago 2, 161, 190, 312, 407 advisory board appointed 196, 197, 203 appropriations under 206 biography of 190 regime 135, 194 Raymond, (1911) scientist, on origin of syphilis 59 Reed, Dr. Silas 63, 86 Reen, Dr. A. W. H.. Peoria 411 Reeves, Dr. J. E., (Va.) 70 Regime, American, The 27 British, The 26, 28 Drake, The 135, 174-194 Egan, The 134, 159-174 French-Canadian. The 13, 15, 22, 28, 29, 53 Rauch, The 134, 139-159 Rawlings, The 135, 194 Reilly, Dr. Frank W., Chicago 105, 152, 156, 162, 315, 332, 396, 411 Respiratory diseases 110, 408 Reyburn, (1856) on fevers 75 Reynolds, Dr. Arthur R., Chicago 105, 166 article by 313 Reynolds, Governor John, Belleville 32, 67 Rheumatism 21, 25, 33, 50, 398, 408 Richardson, B. K., Springfield 2, 243, 267 Richings, Dr. Henry, Rockford 411 Ridley, Dr , on puerperal fever 65 Ringland, Dr. Geo , on epidemic of dysentery i S6 Robertson, Dr. John Dill, Chicago 196, 197, 370 Robison, Di". John Albert, Chicago 175, 411 Robson, Dr. R., (Ind.) 39 Roe, Dr. Edward, Blooniington 70 Ross, Alexander l.S, 59, 381 Rouse, Dr I'eoria 39 Rowe, John (1838) on milk sickness 6S Rush, Dr. Benjamin, Chicago 71, 72, 73, 74 Ryan, Charles, Springfield 210 — S — Sachs, Dr. T. B., Chicago 366 Sadler, Dr. Lena K., Chicago, committee on child hygiene 242 Sandburg, Carl 36 Sanitation, provisions relating to ■.132. 139, 221 stream pr.llution, invcsliga I inns ..r 163. 172 426 INDEX I'AGK Sawyer, Amos. Hillsboro 162, 174, 21U. 411 Scarlet fever 17, 33, 50, 55, ^ti, .136, 253, 348, 366, 3.S3, 4IJ1 among: Indians 53 annual death rates in Chicagro 109 c:ase reports 350 epidemic of in Chicagro 103, 106 mortality from 351 grapli on 349 Scrofula 19, 60 Scurvy 69 Searcy, Earl B., Springfield 266 Seasonal distribution of disease S9 Secretaries, State Board of Health..: 140, 162, 411 Senility, as a cause of death 409 Serres (1S14) on typhoid fever 71 Sewerage in City of Chicago, prior to 1877 101 Schafer, Dr. G. R., Morton 411 Schackford, Dr. B. S., Decatur 258 Schermerhorn, Dr Ottawa 39 Schmidt, Dr. Louis, Chicago 272, 299 Schoolcraft 21, 22, 31 Schoolfield, Dr Joliet 39 Schussler, Dr. \V. R.. Orland 411 Scott; General troops enroute to Black Hawk War 102 Scott, Dr. John W., Springfield 156, 162, 365, 411 Shattuck, Dr. Lemuel, (Mass.) 131 Shawneetown, survey of prior to 1877 118 Sheppard-Towner Act - 200, 23S Schoemaker, Dr. S. H., Monroe County 85 Silver nitrate, distribution of vaccine 218 Singleton, Dr (Va.) 63 Skoog, Paul (Calif.) 243 Sloan, Dr. E. P., Bloomington 196, 197, 203 Small, Governor Len, Kankakee 4. 7 Smallpox. .9, 21, 22, 24, 25, 26, 33, 39, 7S, 105, 136, 141. 167, 194, 253, 306, 353, 363, 366, 401 and vaccination 307 annual death rates in Chicago Ill cases of 309 deaths from 49, 50. 61 disease of Indians 49 free vaccination against 49, 156, 248, 250, 307, 401 of scliool children required 148 vaccine for, distributed 219 general epidemics of 156 history of epidemics in Chicago, article 313 investigation of every reported case of 202, 312 pay for field work undecided 161 prohibiting transportation of bodies dead from 150 troops immunized against 182, 188, 311 Smart, Dr. Charles on typhoid fever 79 Smejkal, Dr. Edward J.. Chicago 164, 265 Smith, Dr .lacksonville 3S Smith, Dr. C. K., Decatur 25S Smith, Prof. George W., Carbondale 34 Smith, Dr. Harold, Chicago, committee on child hygiene 242 Smith, Dr. Nathan on unity of fevers 73 Smith, Dr. Stejihen, (New Yi.rk) 105 Smith, Dr. W. R.. Cairo 332 Snakebite 47, 401 Snuck, Dr Darwin 39 Social hygiene, see venereal disease Sorgatz, Dr. George K 254 437 Spalding:, Dr Oalesburg 64 Spalding, Dr. Heman. ("hicago 315 Spanish fever (dengue) 46 Spanish Influenee. The 27 expedition 14 Spindel. Dr. Enos S., Springfield 411 Springfield, survey of prior to 1877 lln Stahl, Dr. Daniel, Quincy 4!. Sfi Starkel, Dr. C. H., Belleville 411 Standard railway sanitary code 226 State Board of Health, future of 407 machinery 1.33, 136 members of 124, 137. 411 organized 127. 137, 404 presidents of 146, 155, 175, 411 secretaries of 140, 162, 411 State water survey, Urbana, to make investigations 170, 173. 221, 246 Statistics, see mortality, vital statistics, Chicago statistics Stearate of Zinc toilet powder 205, 214 Stermont, Dr. D. W., 279 Stevenson. Dr. Sarah Hackett. Chicago 411 Stewart, Dr. J. T., Peoria 85 St. Martin. Alexis 23 Strothers (1729) on typhoid fever 71, 72 Summary and conclusion :196-411 Summer complaint 86 Sullivan. Dr. J. C, Cairo 411 Survey of certain Illinois cities, prior to 1S77 101-119 fifteen cities in Illinois 19S State sanitary 147, 1S7, 243. 322. 370. 374 Sydenham (1661) on typhoid fever 71. 72 Syphilis 17, 21, 22. 24. 252, 256, 270, 298 origin of 58 Synechia (malaria) 78 Szwajkart, Dr. Adam, Chicago 411 — T — Tanner, (iovernor .John K., .Springfield 284 Tanner, Dr. P. W., Urbana 258 Taylor, Dr. G. G., Chicago 268 Taylor, Dr. L. C. Springfield C3. 247, 261 Ten Bi-ook, Dr. John 270 Tetanus infections 65, 168, 244 Texas tick fever 105 Thilo, Dr. George, Oak Park 249, 411 Thompson, Dr. Samuel, Edwards County 40, 52. 84 Thornhill. Verna (Washington. D. C.) on dental hygiene 242 Thwaite 32 Tillson : 31, 35 Todd. Dr , Springfield 38 Tornado zone, relief work in ' 243. 260, 263 Trachoma surveys 289 Traders 22 Trappers 13, 22. 24 Treacy. F. A 210 Trembles, Indian 67 Tuberculosis 17, 20, 36, 60. 168, 244, 252, 294 annual death rates in Chicago Ill cases of, table on 363 mortality from 89,362 graph on 362 in White County, map on 371, 372 428 INDKX PAGE Tuberculosis — Conoluded. phenomenal progress in ei'MdiiMtion of 30fi sanatoria, establisliment of 163, 172, 17it, 220, 2S9, 2;n, 365, 368, 373 Tuberculin testing of herds 163, 202, 301, 369, 374 Typhoid fever !), IS, 20, 21, 31, 33, 35, 40, 44, 47, 69, 90, US, 136, 16S, 244, 252, 304, 366, 383, 400 and malaria 69-83 attributed to contaminated oysters 204 carriers 214 cases -and deaths from 338, 340, 347 epidemics of 69-83, 341 milk-borne and water-borne 345 food poisoning as a source of confusion 81 graph on 342 history of steps in establishment of as a specific disease 70 investigation every reported case of 202 phenomenal progress in eradication of 306, 338 prevalence of after 1S50 82 rules and regulations for control of 150 troops immunized against 182, 188 vaccine distributed 217 see Chicago statistics Typhus fever 17, 33, 35, 73, 74, 75. 78, 84, 257, 400 in Illinois 47 mortality in Chicago 104 — U— ITnited States Public Health Service. JIarine Hospital Service created 172 University of Illinois, appropriations to equip and maintain water laboratory at... 246 State Water Survey to make investigations water supplies 170, 173, 221, 246 vaccine farm established at 157, 249, 311 Utesch, John W., Chicago 265 — V — Vaccination against smallpox 49, 156, 307, 401 history of epidemics of smallpox in Chicago, arliile 313 required of school children 148 Vaccines, distribution of 148, 1S2, 18S, 218, 248, 250. 356, 389, 401 farm established for propagation of 157, 249, 311 Vandalia, survey of prior to 1877 118 removal of capital from 115 Vaughan, Dr. Victor C, (Mich.) 42, 79 Veatch, Dr. W. P., Roodhouse 79,85 Venereal di.sease 17, 21, 22, 24, 58, 60, 186, 253, 257, 262, 268, 298, 306, 408 chart on 272 establishment of clinics 271 Vincent, Dr. John A., Springfield 155,411 Vital statistics and mortality rates, all causes 96, 173, 186 collection of 130, 135, 141, 159, 193, 200, 230 decennial census reports 397 in Chicago 50, 51, 83, 87, 89, 90, 99, 102. 107-114, 313, 320, 397 Vollmer, Di-. Maude, Moline 258 Voluntary health agencies 14. 171. 191, 220, 287-303 — w — 129, 130, 137, 146, 411 125 339 Waiclu.-r. Dr. lloiacc, Cairo l^-», biography of Wai-e, Dr. John S., Chicago, on typhoid fever Washington, George, death of from cynanche 56 Water supplie.s, investigations of 17, 151, 170, 244, 245, 343 Weber, Prof. H. A., Ui-bana 245 Webster, Dr. Geoi-ge W., Chicago 169, 175, 411 Webster, Noah (1799) on pestilential diseases "'^ Welles (lf.S2l on lyi>li..id lever 71,72 429 Wells, Dr. Wiiltei- A., (Washington, D. C.) 56 Wentwortli, John, Chicago 101 Wenzel, Dr. F., Belleville 41 We.s.sel, Dr. P. H., Moline 41! Whistler, Dr Chicago 102 Whitehead, Dr LaSalle 3SI Whitmore, Dr. J. S., Metamora 53 Whooping- cough 25, 33, 252, 366, 374, 330, 402 annual death rates in Chicago 112 cases of 3!)1 mortality and rates 331 graph on 332 Wightman, Dr. tJrace S., Chicago 235 Wilkins, Colonel (1768) 26 Will, Dr. Conrad, Jackson County 130 Williams, Di-. Daniel H., Chicago 153, 411 Williamson, Dr. T. S., (Ohio) 21 Winter, S. G., Galesburg 25S Wolcott, Dr. Alexander n malignant fevers 102 Woodward, Dr. J. J., (Washington, D. C.) 79. 84 World war activities 182, 186, 373 .social hygiene a problem 1S6 troops immunized against typhoid fever and smallpox 182, 188, 311 Worrell, Dr. T. F., debate on cholera 45 Worthington, Mrs. Sarah M., Sterling. Wright, Dr Warren County. Wi-ight, Dr. John, Clinton — y — Yates, Governor Richard. Jacksonville 167 Yellow fever 3, 46, 72, 73, 136. 157, 168. 244, 353, 363, 400 appropriation for 143, 333 epidemics of , 46 inspectors at Caii-o, cut of 337 map of Cairo 330 outbreak of at Cairo 32. 141, 172, 212. 327, 33S prohibiting transpoi-tation of bodies dead from 150 rules and regulations for control of 150 Young, Dr. D. W., Aurora S7 debate on cholera 45 — Z — Zeit, Dr. F. Robert. Chicago 245 Zeuch. Dr. Lucius H.. Chicago 15, 24, 26, 27, 32, 42, 44, 50, 53, 54, 55, 57, 68, 84, SS, 278 AUXILIARY HEALTH AGENCIES. PAGE Aiiu-lican Cliild lU-;illli Association 287 American Dental Association 288 Aesculapian Society of Wabash Valley 74. 130, 279, 404 American Medical Association 262,397 American Public Health Association 130, 131, 171, 287 American Red Cross 297, 373 American Society for Control of Cancer 298 Carnegie Foundation 251 Chicago Dental Society 200,243 Chicago Heart Association 296 Chicago Infant Welfare Society 301 Chicago League for Hard of Hearing 296 Chicago Medical Society 40, 103, 2SS, 301, 366. 405 Chicago Tuberculosis Institute 290, 36S, 405 I 'liiklren's Bureau 287 Cliildren's Hospital and Milk Commission 300 Conference of State and Provincial Health Authorities 171 Illinois Council Parent-Teacher Associations 200, 242 Illinois Dental Society 200, 240. 242 Illinois Federation of Women's Clubs 200, 201, 240, 242, 2SS, 289 Illinois Health Society 303 Illinois Medical Society, Transactions 30, 44, 47, 54. 55, 57, 63, 65, 69, 74, 76, SI, 85, 87, 130, 159, 200, 240, 242, 279, 280, 283, 287. 2SS, 2S9. 293, 397, 404 Illinois Social Hygiene League 298 Illinois Society for Crippled Children 235, 380 Illinois Society for Mental Hygiene 297 Illinois Society for Prevention of Blindness 289 Illinois Tuberculosis and Health Association 220, 293. 303, 373 Industrial and practicing physicians 297 International Health Board 287 Jersey County Medical Society 130, 132, 280 Laboratories and Universities 296 Tjawrenceville Aesculapian Society 130, 397 Elizabeth McCormick Memorial Foundation ^ 302 National Board of Health 139, 143 National Educational* Association 287 National Health Board 383 National Safety Council 295 National Tuberculosis As.sociation 287 Parent-Teacher Associations 295 State and local dental societies 296 State Board of Health Auxiliary Sanitary Association 245, 247, 249 State Health Society 296 United States Public Health Service 204, 270, 287, 299 Visiting Nurse Association 290, 291, 366 REFERENCES AND BIBLIOGRAPHY. A Doctor's Memories, Vaughan 42 Adventures of BMrst Settlers, Boggess IS, 59, 381 A Journey up the Illinois River, Schoolcraft 31 American Medical Association Journal, Hrdlicka 58 American Journal of Hygiene, Atwater 50 American Journal of Medical Sciences 65, 73, 78, 397 American Medical .lourn.il 65 American Notes 32 Annals of Health and .Sanitation. Kochler 102 (430) EEFEREXCES AND BIDI.IOGRAPHY 431 PAGE Army Statistical Reports t>4 Bloomington Intelligencer 45 British Research Council, Savage and White SI Bulletin Society Medical History of Chicago, 1912 105 Buffalo Medical Journal, Flint 7S Bureau of Ethnology, Bulletins 30, 34, Hrdlicka 17, IS, 19, 20, 49, 53, 55, 5S, 60 Cairo Bulletin 46 Centennial Survey of the State of Public Hygiene in Ameri<-a 244 Chicago and the Old North West, Quaife 102 Chicago Health Department Report 43, 49, 50, 54, 56, S7 Chicago Inter-Ocean 280 Chicago Bledical Examiner, Veatch 79 Classical Work on Fevers, Bartlett 43 Committee on Practical Medicine .... 40. 44. 46, 47, 52, 57, 61. 63, 66, 67, 70. 76, S4, 83, ,S6 Continued Fevers, Murchison 71 Epidemiology and Public Health, Vaughan 79 Egyptian Republican 45, 50 Handbook of Geographic and Historical Pathology, Hirsch 43, 50, 55, 56, 63, 71 Health News (State Medicine) (Bulletin) 169, 177, 192, 266, 267 Historic Illinois, Parrish 44, 53 History of Alabama, Pickett 13 History of Continued Fevers, Bartlett 73, 77 History of Illinois and Her People, Smith 34 History of Indian Tribes of United States, 1857, Schoolcraft 22 History of jNIorgan County, Short 45 History of Practice of Medicine, Zeuch 15, 24, 26, 32, 42, 44, 50, 53, 54, 55, 57, ^68, 84, 88, 278 mini, A Story of the Prairies, Carr 43 Illinois & Indiana Medical & Surgical Journal 52, 75, 78, 279 Illinois as It Is, Gerhard 61 Illinois Historical Collection, Alvord Carter 26 Illinois Historical Library Publications 31. 43, 118 Lectures on the Principles and Practice of Medicine, Davis 338 Life of Lincoln, Sanburg 36 London Lancet 78, 153 Lyon Medical, 1912, Gandolphe 59 Medical and Surgical History of the War of the Rebellion, Smart ...79, 84 Medical Repository of Original Essays 63 Military Surgeon ■ 64 Military Tract Medical Society, Kgan 78 Monmouth Atlas 46 Morgan's Journal 26 My Own Times, Reynolds 32 New Orleans Medical & Surgical Journal 58 New York Journal of Medicine 64 New York Medical Board 339 New York Medical Journal and Record 19, 70 New Y'ork Medical & Surgical Journal 58 North American Indians, Catlin '. 49 Northwestern Medical & Surgical Journal 74 Philadelphia Medical & Surgical Reports 57 Pictures of Illinois, 100 years ago 118 Pioneer Health Conditions 36 Pioneer History of Illinois, Reynolds 67 Pioneer Mothers in Illinois, Worthington 31 Practice of Medicine, Anders 76 Practical Treatise on Enteric Fever 70 Reminiscences of a Pioneer Woman, Tillson 31, 35 Report on Practical Medicine 40. 44. 46. 47, 52, 57, 61, 63, 66, 69, 70, 76, 84, S5, 86 Sanitarian (1880) 339 Sanitary History of Chicago, Hauch 102 Sanitary Investigations of the Illinois River and Tributaries 222 132 RICrKklCNCKS A-NU UUILIOCUAPII V PACK Settk-nuMit of mine. is. The SO Sixty Years in Medical Hainess, Johnson 42. 55. SO, 82 Springrfleld Journal (1852) 45 St. Louis Medical and' Surgical Journal (1849) 40. S5 Systematic Treatise on Diseases of the Interior Valley of North America, Hiake.... " 3S. 47. 49. 52, 53, 54. 60, 64, 84 Transactions, American Medical Association 75. 78, 79 Transaction.s. lIliM.iis .Medical Society ... 39. 44, 47. 54. 55, 57, 63, 65, 67, 74, 76, 81. 85. 87 Western iMedical and Physicians Journal 39, 52, 63. 64, 70. 73. 76, 86. 397 LJ THE RISE AND FALL OF DIs'MluiNOIS 3 0112 025313070