132

REVOCATION 0-F PHYSICIAN'S CERTIFICATE. Rule 29. If any physician fail or neglect to conform to quarantine regulations or to properly report cases of contagious diseases, tq which he has been called professionally, the same shall .be liable to prosecution and revocation of his license, asprovided for by the statutes of thei State of Delaware, and the Local Board of Health, or the local health authorities, or the health authorities in control in the district where the offense has been committed, may bring charges against such physician and prosecute the same.

CHAPTER 2. DISINFECTION. Rule r. Definition: The term "Disinfection"· has reference to the destruction of disease producing bacteria. The agents used for such are called "Disinfectants" or "Germicides." An ''.Antiseptic'' is an agent which prevents the development of bacteria, but does not necessarily de.stray them. A ·"Deodorant" is a substance which has power to remove offensive odors, but is not necessarily a disinfectant. "Sterilization" is a term used to designate the destruction of germs by heat, whereas "Disinfection" refers more properly to their destruction by chemical agents.

DISEASES· IN V/HICH DISINFECTION IS REQUIRED.

Rule 2. Disinfection of the premises, patient, patient's se­ cretions, excretions and oxidates, books, clothing, furniture and everything- used by the patient shall be carried out in the> follow- ing infectious diseases : - Anthrax Asiatic Cholera Bubonic Plague · Cerebra Spinal Meningitis Diphtheria (Membraneous Croup) Leprosy Polio Myelitis Scarlet Fever (Scarletina, Scarlet Rash) 133 Smallpox (Varialoid) Tuberculosis ( Pulmonary and Bronchial) Typhoid Fever Typhus Fever Yellow Fever . and it is stro;1gly recommended that disinfection also be carried out in Influenza.

PRELIMINARY PRECAUTION$. Rule 3. Before beginning· disi1~.,fection, the 'requirements prescribed i11tbe following· secti<;ms shall be complied with:

Section I. The person employed to do the disinfecting, ex­ cept in Tuberct1losis and Typhoid Fever, shall wea11 a cap and gown so constructed as to completely cover the clothing. After· all arrangements are complete, these garments shall be left on the premises and disinfected in the same maimer as other infedcJ articles, or packed in a satchel and thoroughly sprayed with for- maldehyde: · ·

Section 2. All holes, cracks and other external apertures shall be sealed by pasting over them pieces o,f paper, or filling theni with clean, damp cotton rags. Section 3. All bedding and· other clothing, carpets and rugs should be hung on chairs, or upon lines stretched across the room for that purpose. Books shall be placed on edge, or hung upon · a line in such a. n1anner as to spread the pages. Drawers, cup-· boards and trunks shall be opened, and while their contents need not be unnecessarily disarranged, they shall be loosened in sud1 a manner as to give free access to the disinfecting gas. vVindows should be securely closed, but left unlocked, in order to admit of their being opened from the outside after the disinfection is com­ plete. Section 4. vVhen using formalcld1yde, no open vessel c.on­ taining water shonlcl be left in the room ( except as provided in Rule 12). Section 5. The temperature of the room shall in no case be below 60 degrees F. (preferably 70 degrees F. or above). If 134 the atmosphere is unusually, dry, the amount of moisture should bl:!increa.secl by boiling a kettle o'f water in the room, or by pour­ ing boiling wate1: from one vessel to another for five or ten min- utes before beginning the disinfection. ·

.. Section\ 6. A large wash tub should be placed near the center of the room, conveniently situated so as to be seen through · on the windows. In this shoulcli be placed a tin or iron pail about 12 to 16 inches deep. ( It is advisable to cover the outside\ of the pail with asbestos paper, leaving the top open.) ·

MATERIAL TO BE USED FOR DISINFECTION.

Rule 4. For every 1,000 cubic feet of spac~ to be disin- fected, the following materials and quantities shall be used:

40 per cent. Solution of Formaldehyde, 20 ounces. Permanganate· of Potash! ( Fine Crystals), 8,Yi ounces. These quantities are to be used to disinfect premises follow-· ing cases of: Asiatic Cholera Bubonic Plagne Cerebro Spinal Meningitis Diphtheria (,:1\/Iemb~aneous Croup) Scarlet Fever ( Scarlet Rash, Scarletina) Smallpox Tuberculosis ( Consi.unption) Typhoid Fever Typhus F\'!ver Erysipelas . Puerperal Fev,;.r In cases of Chicken Pox M easies ( German Measles) l\1umps .. Vi/hooping Cough Pneumonia ' only haH the above quantities are required. 135

MODE OF OPERATION.

Rule 5. ' Section r: , YVhen the room 01: house to be disin­ fected has been properly prepared in accordance with the require­ ments of Rule 3, the propei· quantity of Permanganate· of Potash as prescribed in Rule .f should be placed in the paiL The solt1- tion of 40 per cent. Formaldehyde should be placed in a tin clip­ per qr other vessel cqnvenient for pouring rapidly. The operator,. when everything is in readiness, should pour the Formaldehyde tipon the crystals of Permanganate of Potash contai"ned in the pail, and immediately lea,,e the room, dosing the door and stop­ ping all cracks in the manner indicated in Rule 3. This opera­ tion should be performed quickly, as the gas generates very rap­ idly. The door should be locked in order to prevent accidents, ai1clthe room or building, as. the case may be, kept closed for at least eight hours. At the expiration of that time the win.dows should he opened from outside 1 and in the space of r 5 or 20 rnin- . utes the door may he opened, allo\ving the air to blow through the room. If the odor remaining is very strong, a little ammonia water sprinkled upon the floor will soon neutralize the Formalde­ hyde and hasten the disappearance\ of the odor.

Section 2. After the fumigation, as prescribed in this Rule. · . -has been completed, all bedding, .clothing, etc., that will not. be harmecll by boiling, should be boiled for at least half· an hour. . When possible mattresses, rugs and heavy curtains should be sterilized by steam under pressure at r20 C. for thirty (30 )1 min- , utes. \1Vhen.this is not possible, these articles should be taken out of doors and thoro11ghly aired and exposed to the rays of the sun for some hours. · Note. In disinfecting, 1t is necessary to see that the shoes worn: or used by the opera~or and all persons upon the premises are properly. disinfected, as these articles are frequently over­ .looked and become the conveyors of infectious diseases. They may be readily disinfected by using Standard Solutions I and 2.

ARTICLES TO BE DESTROYED. Rule 6. Under the method prescribed in Rule 5, it is un­ necessary to desttoy any articles .of value. Papers, rugs, cheap books and other. articles of little or no value should be. burned. 136 In cases of Scarlet Fever; Smallpox and Diphtheria, in addition to the requirements of Rule 5, all woodwork and, if possible, the walls should be ,,;ashed with a liquid dsinfectant, such as a solu­ tion of Bichloride of Mercury, one part Bichloride of Mercury. to I ,ooo parts of water. \i\There the ·wall pa pert is loose or delapi­ dated,. it should. be ,removed and burned:.

DISINFECTION OF PERSONS WHO HAVE BEEN AFFECTED WITH OR EXPOSED TO INFECTIOl!S. OR CONTAGIOUS DISEASES:. Rule 7. Before the release from guarantine, all persons who have been affected with or exposed to ·an infectious or contagious disease shall be subjected to the following requirements: · They ~hall be removed ~o a room tha.t has been disinfected according to Rule 5. · '.fhe entire body, including the hair, shall be washed with a solution of Bichloride of Mercury, one part Bichloride of Mercury to 3,000 parts of water (see Standard Disinfectant No.· 2r They shall then be subjected to. a full bath with plenty of soap and hot water 1 after which they shall be provided with cloth­ ing that has been properly disinfected, or that has not. previously been upon th_einfected premises.

DISINFECTION OF THE DEAD .. Rule 8. The ·remains of all pe1:sons who die from infe~tiou~ or contagious diseases should be thoi·oi1ghly injected with a dis­ infecting embalming· fluid,. External orifices must be securely closed ·with absorbent cotton, and the entire body,. including the hair,. thoroi.1ghly cleansed with a reliable· disinfectant, such as a Standard Soluti_on No. 3. · In cases where it is impracticable to prepare a dead body as indicated by this rule, the body must be wrapped in a sh<;et or . cloth satttrated with Standard Solution No. 3 before being placed in the casket. · · · ·

DISINFECTION . OF VEHICLE!S. · . Rule 9. Section I: All cabs, hearses and other vehicles used in the removal o,f a patient or the body of a person affected with, or who has died from, any contagious _orinfectious disease, 137

shall be disinfected in the manner defined 111 Section 2 .of this Rule.

Section 2. Remove all cushions, curtains and other acces- . sories and place them in _a smaU room or tight cupboard, and dis­ infect them in accordance with the requirements ptescribed in Rule 5. If the vehicle can -be closed up, it should be fumig:itecl in the same manner as prescribed in Rule 5. If this· is imprac:.. ticable it should be washed inside and out with a solution ·of Bichloride of n·Iercury, one part to I,cioo parts of water.

PET ANIMALS.

Rule IO. All cats and dogs and other pet animals kept upon the premises infected with any contagious. or infectious· disease shall be thproughly washed in a tub of warm water containing I to 2,000 Bichloride Solution.

ADDITIONAL REQUIREMENTS.

Rule. II. \Vhen it is .necessary to disinfect any premises, and the presence of bed bugs or other vermin is suspected, 'Sul­ phur must be used in addition to. Formaldehyde. The following is the most convenient and effective manner of using the same: Place in the room a washboiler containing about 6 to 8 inches of boiling water. Place a brick· in the center of the water, and upon this a sulphur candle. Light the candle and be sure that. it is burning-well before starti11g the Formaldehyde. fumigation. If possible the water in the washboiler should be kept boiling by means of a stove or gas lamp.

NOTES. Sunshine isiNature's best disinfectant, and shoulcli be utilized as much as possible. Let it enter the sick room freely. · Many of the so-called disinfectants that have been placed upon the market are absolutely worthless and should be avoided. Local Boards of Health should buy t,heir Formaldehyde and Peclmanaganate of Potash from reliable firms. If these articles are purchased in sufficiently large quantities the wholes1le price can be obtained. · 138 . . .· . . I . • Disinfection should always be done. under the direction of the, Local Board of Health, and under the pehional super~isiori of the B:ealth Officer. . The person employed to· do, the disinfecting. should be one specially traihed to understand the various meth­ od~ to be used, and the precautions to be observed, and should be held personally responsible to the Local Board o.f Health;

STANDARD DISINFECTANTS. · (All should be plairily labeled "POISON.'.') .

·.So-Iti.tion No .. 1. Carbolic Acid. · Five per cent .. · Carbolic · Acid, one-half pint; water, five quarts, May be used for sputum cups, washing furniture, metal surfaces, :various ·secretions; ex­ cretions and exudates. · CAUTIONc-This should not be used fo.r the face' or delicate skin. · ·

· c Solution No. 2. _Carbolic Acid; 2 1-2 per· cent. solution. Mix one part of Solution No. 1 with one part of wat.er. May be i.tsed for washing. hands, face or entire b~dy.

Solution No; 3. Bichloride of Merciiry Solution, I to 1,000. Prepare by dis~olving one dradim ( 6o gtains) of Corrosive Sub­ limate in one .gallon of soft boiled water. ( The ordinary solution· of Bichloride of Merctiry deteriorates in a very short time.} A convenient way of using Bichloridel is by the use of specially pre- . pared tablets which may be I purchased at any drug store, or to · have on. hand .a stock solution which will not deteriorate. · This may be prepared as follows: · "-· . Bichloride ...... , .... 330 1 -2 grams Citric Acid ...... ·.... I 56 grams · Water ...... 20 liters or 5 gallons A little ·colorii1g · i11ateria.L M. Sig": One ounce of this solution mixed with one pint of water makes a solutio_n of 1-1,000. ·

I • Prepare in . glass, earthen or wooden vessel .( not in. m,etal vessel) ; it must. not be used for disinfecting metal surfaces. Use for disinfecting hands, clothing,. woodwork, discharges,, etc. Good for sprinkling floors of offices and public buildings before sweeping. · · " Solution. No. 4. Bichloride .of Mercury, 1-3,000. Mix one 139 part of Solution No. 3 with t,vo parts of water. May be used for bathing entire, body. Solntion No. 5. Chloride of Lime. Dissolve six ounces of fresh Chloride: of Lime. (best quality) in one gallon of water. Especially useful for faces, urine and sputum . . CHAPTER 3. SMALLPOX. Vaccination is the only preventative for Smallpox. ·Hence it is important that· the vaccination be thoroughly done, with re­ liable lumph, free from all .impurities.' · - Immediate vaccination after exposure is important for safety. It should be done within five clays after exposure. Everv infant should be vaccinated within: three months after its birth. - Should the first attempt fail, .it should be repeated at intervals of a fortnight until a true sore is produced. Every child _should be re~vaccinated b~fore it rec1ches its twelfth year. ( See Chapter r, Rule 2, Sections 4 and 5.)

RULES. AND REGULATIONS FOR THE PREVENTION OF SMALLPOX.

. Rule· I. Physicians called to attend persons suffering from Smallpox cir V arialoid ( modified Smallpox) shall report the fact immediately to the State and Loc~l Boards of Health within whose jurisdiction such persons are found, giving their names and addresses.

Rule 2. \Vhen there is good reas6n to suspect the existence of Smallpox in any house or place fr.om a report other than from a physician it shall be the duty of the Board of Health to at once make an investigation by sending a physician to examine and re­ port upon suspected cases. Rule 3. In the case of Smallpox or/ Varialoid it shall be the duty of the Board of Health receiving such: report to at once i40 placard the house in' which' the patient resides oi· is found, an­ no!mcing fo large· letters the existence of SMALLPOX WITH­ IN, which placard shall not be removed until after recovery of the patient and disinfection of the. house; .6r the. Board may re­ ri10ve the patient to an infectious disease hospital, disinfect the . house and contents; arid quarantine the iimiates whcl'are not pro~ tected against Smallpox by a previous attack of the disease or by recent successful vacci~ation, for seventeen days from the com-­ pletion of .such disinfection. · Or .su~h inmates, after vaccination; ·~may be kept under a "quarantine o'f observ.ation" as noted in Ruie 7-. · · Rule 4. ·in Smallp~x a qua~antine ·notice shall. be served · upon the hc:ad of the household forbidding any· one to enter or leave the premises except-the attending physician or other person c1uthorized by the Board, ofHealth. . Rule 5; 1t sl~all be the duty of the Local Board ~f Health to strictly en.force this oi·der, which shall be done by placing a· day_· and night guard .ov:er quai·antined house ,vhenever necessary. Rule q. AU persons unpro~ectel against Smallpox'by a for­ mer attack of the disease, or by recent successful vaccination, known· to have been exposed t_oa person su.:ffering.from Smallpox in the eruptive stage of the disease, shall be ·quarantined for sev-: . ent.een days from the time of last exposure, and shall be vac­ cinated; or such quarantine inay consist of a "quara;ntine of ob-. · servation," as describe!l in the following rule (Rule 7),:. ·· · Rule 7. After vaccination and the disinfection of the cloth­ ing worn at time of exposure, such exposed person,s, if not re­ niaining in the house with the Smallpox patient or ih any way exposed to Smallpox after such disinfection, 111ayb~ given their liberty .and kept under a ""quararitine of observation" ~hat is_,, they must be .examined .by a physician, who must take the tem- perature daily for seventeen (17) "days from the .time of last · expost'tre. Any person who, during tlJis period of observation, shows fever or :any symptoms .suspicious · of Smallpox, must be prnmptly isolated until the true nature of his cli'sease can be de-· termit1ed. Rule 8. Quarantine of Smallpox patients shall be ~ain~ fained until they have completely desquamated or scaled off, as certified by a reputable physician, _and until the hous,e and its con- ' . . 141 tents have been properly disinfected under the supervision of the· Board of Health. Persons in the house with the patient who are not protected against Smallpox by a recent successful vaccination or a former attack of the disease, shall be vaccinated and he quarantined for_ seventeen (i7) clays from the time disinfectiori of the house is completed. Rule 9. Persons who have recently recovered from Small­ pox or suspected Smallpox, the nature of their malady not hav­ ing been known or recognized at the time of their illness, shall be returned to their home until their dwelling·s and contents, includ­ ing the clothing of all the inmates, are properly disinfected under the supervision o.f the Board of Health.

Rule ro. - It1 shall be the duty of the Local Board of Health or its health officer receiving a report of a case of Smallpox within the jurisdiction of such board to at once .report the case, by telegram or telephone when possible, to the State Board of . Health. After such telegTaph or telephone notice is given, health· officers or clerks of Boards of Health shall make weekly detailed report of all cases and deaths ,occurring during the week. These reports slnll- be 'made on blanks furnished by the State Boai-d cif Health for the purpose.

Rule r I. The Secretary of the State Board of Health, as its Executive Officer, is hereby authorized and directed to secure the strict enforcement of the above rules and regulations, -with such modifications thereof and such additions thereto as theJ exigencies of any particular case. may demand.

DIPHTHERIA. Diphtlieria is a most contagious and infectious disease. It is produced by a specific bacillus which produces blood poisoning. It attacks persons or all classes and ages, but l'nost frequently children under sixteen years of age. In ordinary cases the germ producing· Diphtheria probably attacks the person by way of the mouth and the air passages. The period of incubation of Diphtheria, or the time fro~11a persons' exposure to the disease to his coming clown with it, like Scarlet Fever, varies somewhat-being usually from a few hours ' ' ' 142 to seven or eight days; in some cases it is twelve or fourteen days. It has been conclusively demonstrated that the germs of Diph­ theria retain their vitality in dried dust for an h1definite period of time, and th;it' colcl--even ·to freezing-:-cloes not affect their vital­ ity. Hence the importance of destroying these germs by burning all the discharges, or thoroughly disinfecting them. . Its most frequent manifestations are in! the motith, throat and air passages. \i\Then in the mouth, or upper part of the throat only, the disease is, as a rule, less dangerous and fatal, but no less · infectious and cohtagious, than when in the air passages, below · the fauces. Avoid. exposure to the disease. . . Observe rigidly every measure as given· for Scarlet Fever. Beware of troweled asseniblies in ill-ventilated rooms. · AH influences which depress the vital pmv~rs arid vitiate. the fluids of the body, tencl to promote the development and spread of this disease by lessening the powers of resistance. ( See Rule 18; Chapter 1.) ·

.SPECIAL NOTICE. Membraneous Croup is Dii)htheria and must be treated as infectious and contagious, and be considered for all sanitary pur­ poses as identical with Diphtheria, and all rules applying fo the fatter equally ilPply to· Membraneous Croup.

Disinfection, see Chapter 2 ..

SCARLET FEVER. Scarlet Fever is one of the most dangerous contc1.gious and infectious diseases. One attack does not always prevent subse­ qu,ent attacks. The greatest number of deaths from this disease is of children under ten years of age. Adult persons do some~ times have the disease. Scarletina and Scarlet Rash are icle1;ticil with Scarlet Fever, equally dangerous and equally contagious and infectious. They are one and the same disease. · 143 Avoid this special contagion .of this disease. This is espe­ cially important to be observed by children. Children under ten years of age are in much greater clanger 6'f death from Scarlet Fever than are adults, but adult persons often get and spread the disease, and sometimes die from it. Mild cases in adults may thus ca11se fatal cases among children. Because qf these facts it is dangerous for children to go where adult persons go with al-' most perfect safety to themselves. It is probably that the contagion of Scarlet Fever may re­ tain its virulence for some time, even for years, and be carried for a long distance in various substances and articles in which it may have found lodgemnt. ( See Rules 2, 4 and 7, Chapter I.)

Disinfection, see! Chapter 2.

MEASLES. Measles is an infectious, highly contagious and often fatal disease, hence it is dangerous to the pbulic health. The specific poison of Measles is in the rash which invades the membranes of the nose, throat, lungs and bowels, before, and often more severely than it· invades the skin, so that it is con­ tagi~us before the eruptio11 appears on the skin .. In no one of the infectious diseases can the mother give greater aid, and in none· is her co-operation more desirable. All persons affected with this disease must be isolated and . the premises placarded as provided in Rule 4 of Chapter I.

T'YPHO ID FEVER. Typhoid Fever is caused by micro-organism, and in the opin­ ion of the best and most experienced sanitariums· it is a disease which need not. exist. This germ enters through the. mouth, 'lvith food or drink, and is carried to the small intestines, where it mul­ tiplies enormously, and then throws, off in the excreta, to again multiply under the favorable conditions of moisture and heat. Hence the. proper disposal of the excreta of a Typhoid Fever patient is of the highest importance. 'rhe most dangerotis source of infedion is from water and milk. If the discharges from the patient are thrown into a. privy vault, or on a manure: pile, or on 144 the ground, they sink into the earth through the soil and often contaminate the neighboring wells.· .. The ordinary house fly may be the means of carrying the infection from place to place. , There are many other ways in which water may be contami­ nated. The soiled clothing of a patient. is· washed and the water thrown upon the earth near; a well, or poured into a leaky drain. Some kjncls of food are very absorbent of disease germs. Th~ most suitable is milk, which beconres contaminated by being kept too near a patient. Several instances are known where milk men have carried the germs of this disease in milk kept where the sick were, or by. rinsing' their cans with contaminated water. Protect the water supply from any possible source of con­ ·tamination. The water supply of cities and towns should be pro-­ cured. from sources where there can be no contamination, imme­ diate or remote, from privies, cesspools, stables or cemeteries. Great care should be· had to prevent the contamination of the ,vater supply by discharge from th~ bowels of a person sick with Typhoid Fever, as by drainage into wells, springs; streams or o.ther water supply from a privy vault, sewei·, drain or cemetery. Privies often drain into wells, unsuspected by those who use the water. Should Typhoid Fever discharges pass into such' a privy an outbre9.k of Typhoid Fever among those using the water from a neighborin'g well woulc1 be likely to occur. If such a well were the source .of the general water supply of a city, Typhoid Fever might soon be epidemic there. The public water supply should• be analyzed at least .once each year, ancf freq11ently thereafter; when Typhoid is pi·esent in the neighborhood. · There is a good reason to suspect the water of a well when­ ever a vault is situated within less than a htmclred feet of it. Par- . ticularly if the soil be porous.. In numerous instances fluids from excreta have reached into wells from much greater distance; and it has been proven that a v':eill thirty rods · from a cemetery re­ ceived water which hacl filtered through the soil of the cemetery. The use of water fron1 a source likely to be infected with excreta from a Typhoid Fever patient should be .promptly stopped. Great care should also be given to the milk supply. 145 Dangerously contaminated ,vater may be, and often is, found to be cl~ar and colorless, and to have: ho bad taste.

Keep the premises pure and clean. Of all forms of filth none 1 · are so dangerous to houses as the "hole-in-the-ground" privy and the sink drains. All discharges from the patient should be received in a vessd· containing a pint or i11ore of the solution: of Chloride of Lime ( six ounces of lime to one gallon of water)· and kept covered . three or four hciurs, and then buried in. the earth, at such a dis­ tance from wells, springs or streams that they cannot possibly he drained therein. NEVER MINGLE THEM WITH ·ANY KIND OF FIL TH IN A PRIVY OR ELSEWHERE. All soiled clothing and bedding soiled with discharges from. the patient should be af once removed and placed in a tub and completely. covered with a solution of Chlori.de of Lime or other reliable. disinfectant, andl kept there until they can be boiled., or put iii boiling water as soon as removed from.the patient. It is importarit this should be closely observed, otherwise the sub­ stance on the clothing dries, becomes dust; floats in the air and endangers the attendants. It is probably in this way that washer~ \VOmen o.ften become infected and have Typhoid Fever. After this disinfection,• the clothing may be boiled and washed with. safety. During $ickness, disinfectant at once carefully any spots on the floor, carpet or rug acci1entally soiled. · . There is no necessity for burning the clothing, ·bedding and bed of a Typhoid Fever patient even when death occurs, nor fpr a private funeral, but the coffin niust not be opened ip any church, hall, place of public assembly or residence. · . Strict isolation of the sick is not necessary, but it is wise for all who can properly do so to keep away. After death or recovery; disinfect the sick room with For~ maldehvde and then wash· the floors and woodwork with a soln-· tion o{ CorrosiYe Sublimate, ( See Chapter 2.) Nurses and others i111the family should eat nothing in the room where the patient is, nor of anything that has been there. The food for the family. and attendants. should be prepared andw 146 · kept as. far as possible foom the sick. As boiling will kill all dis-. ease germs it is safer when the disease is in ,Lhquse to .boil all water and milk just before using. All dishes used by 'the patient should be kept separate and used by no, one else. ( See Rules 2 and 4, Chapter I.) · ·

Disinfection, see Chapter 2.

PUERPERAL FEVER. Puerperal Fever is a.dangerous infection, he1ice every attend­ ant upon cases of ·labor should, by the 'use of. antiseptic measures, seduloiJSly guard against the occurrence· 01f the disease. The hands and all instrume11ts and application should be thoroughiy . disinfected, and all discharges subject to decomposition. and cap­ able of producing infection, should be promptly removed and de­ stroyed: The only way tO! avoid this disease is for every prac­ titioner and nurse to recognize their personal responsibility in the matter. ( See Rules 2 and 4, Chapter r.)

LEPROSY. . Persons afflicted with Leprosy; are required by the State. Board of Health to remain on their own premises. ( See Rule . 19, Chapter I.)

T.UBERCULOSIS__:_CONSUMPTION. This is an infectious and therefore a communicable disease due to a genn----the Bacillus Tuberct1losis. The disease is propa­ g-ated and disseminated by i'nfected meat and milk;: and especially by the excretions and sputum of persons affected by it. INFECTION. "The consumptive in himself is almost harmless, and only becomes harmful through bad habtis.)' The virus is largely contained in the sputum, which; when dry, is dis­ seminated in the form of dust, and constitutes .the great medium for the transmission of the disease: In the last sta·ges df Con­ sumption the patient is weak, the sputt1m is expelled in1properly; pillows, sheets, handkerchiefs, etc., are soiled. If a male, the beard or mustache is smeared. Even in the hands of the cleanly, without special precautions, such circumstances all tend. to the production around the patient of a halo of infected dust, main~ tained by every process ofbed making or cleaning, which in- 147 eludes the per111c10ushabit of. "dusting." Jn the hands of the . careless and djrty, the infectivity is, of course, greatly aggra­ vated. . · · · · · .· · · . . . . It attains its maximth11 of intensity where the filthy habit of spitting on ,the floor prevails, especially H it is. carpeted. .. . Ail. rooms frequented by persons suffering· from Tubercu.,- ·1osis very soon become infected, and consequently dangerous, such as hospitals; jails, poor houses, etc., all such rooms where ventilation and disinfection are neglected .are very dangerous, as proven by the great numb.er of deaths of those who are confined in. these abodes. Boats and cars onl our .great lines of · travel, without great care being used, become ve~itable pe~t houses. . Means of prevention : . Sunlight is one of the most; powerful agents indestroying the tubercle bacilH. Avoid imperfectly ven­ ~ilated dwellings, dark, damp, musty rooms. Let your dwellings be ·light, dry, arid well. ventilated with an abundance of sunlight. The sputum should always be kept moist and disinfectesl,. In all public places, cuspidors, partly filled with water, to which may be added some. disinfectant; such as carbolic -acid, a two per cent. solution of forn1aldehycle, should be freely clistribtuecl, and which all persons, who spit should be required to. use. Spitting in the street an.d in all public places is prohibited. When coughing. or sneezing, a piece of gauze/ or handkerchief should be used to prevent clisfributing the infective material.. There. is great clanger in kissing and even in handshaking with · tubercular' patients, and consequently the face and hands of such· persons should be frequently disinfected. No child should be al- . lowed to sleep with a person suffering with Tube'rculosis, espe- · cially if of the pulmonary variety. · · · Person; suffering ~ith Tuher~ulosis should not drink out of the san1e cup used by other members of the family, and when traveling should carry his own cup, as the bacilli will adhere to the cup in g·reat ntimbers, and thus endanger others; · · . . ·' ~ All soiled clothing from . Tubercular patients should · be thrown into a tub of water; to which some disinfectant has been added; preventing the sputum fron11drying and thus protecting others. · · · Quara1i.tining those afl;ected,. or. placarding the prerqtses, are 148 not requii-ed in this disease; nor are public funerals prohibited. The presence of this disease must always be niported to the Health authorities in order that instruction may be given to the patient and relatives as to the cause of the disease and the best means of preventing- its further spread. ( See Rules r, 2, 3, 2 r,. 22, 23, 24, Chapter I.)

. Disinfection, see Chapter 2.

CEREBRO SPINAL MENINGITIS. Cerebro Spinal Meningitis is an infectious disease. It is sometimes very reaclilv transmitted to those who take care of or ckls~ly associate with ·the patient having the disease. The germs are found in large numbers in the discharges from the nose of persons affected. Such discharg·es should. there­ fore always be collected on pieces of cloth; these should be burned as soon as possible. (See Rules, r, 2 and 7, Chapter r.)

.MALARIA. Malaria. is an infectious disease caused by a germ which is usually transmitted from person to person throug·h the bite of· a mosquito. It requires a special variety called anopheles, which is found in large numbers in the Southern States. The most ef·­ fective way of nreveri.ting Malari:i. is to destroy) the breedim;· places of mOSCJt1itoes,by not permitting: water to remain stand­ ing- in open vessels 3S cans, barrels. etc .. and to drain all stacr­ n;:mt nools ancl swamps. 'Persons affected with M-:ilaria. or weil neople living- in 1\lfabrial districts. should be protected from the bi;es of mosrruitoes. This can be clone hy srreening- the cloors anc1 windows with ordirnirv mosquito bar; and beds shouci be covered with the same ri1<1terial. ·· -- -- .-,,•,"'.'lt"'··- ...... - ...... z~~;i:,,r,c. ···-·--··--·~-,~- ---~- · ·

ITCH------6CABJES. Scabies or Itch is caused bv a sm::i.11aninnl parisite, which burrows into the skin. It nsually affects rhilclren, and occ3sion­ ;:illy ad11lts. It is ouite readily tr~nsrnitted from nerson to person h; close ;issoci::ition. (:hildren affected with the Itch are not to be 11rcn11ittedto attend srhoo1. and should receive proPer treatment without delay. ( See Section 5, Rule 4, Chapter r.) 149

PNEUMONIA. Pneumonia or lung fever is a very common and quite fatal infectious disease. It .is not readily transmissible from one per­ son ,to another, and ther'efore only· slightiy contag·ious. The geq11s of pneumonia are found in large numbers jn the ·sputum of pneumonia patients. Such sho,uld therefore be collected on pieces of cloth or in vessels and disinfected. These germs are also frequently found in the mouth of well people and may pro­ duce the disease if the resistance of the system· is lowered by exposure to wet and cold, or the too free use of strong alcoholic liquors. ·

During the past dec~de, pneumonia , has. increased in fre­ quency and fatality, until at this time there are about as many deaths annually from pneumonia as Tuberculosis. Great care must be exercisecl in the disinfection of the sputa and discharges from pneumonia patients, and the bedding and room should be· disinfected, after cl'eath or recovery of the patient. ( See Rule .I and Section 4, Chapter L)

VENEREAL DISEASES. Ven~real Diseases are all infective and ·contagious, and are often the source of a life of misery. The consequences are often of the gravest charactei'. No person who realizes such will per­ mit himself to be exposed to infection. Once infected, it often requires months and even years before one can be certain of be­ ing cured of the disease, ancli until cured shotild use evei-y means · possible not to infect others.

INFLUENZA.· Influenza is a widespread infectious. and very contag·ious dis­ ease, which affects: principally the ri~piratory tract, · The &is­ charges from the nose and throat contain the. specific germs in large numbers, and should therefore be collected on pieces of cloth which are later bttrned or disinfected. J\!Iany of the severe common colds are caused by the influenza basillus: VI/e should therefore not associate too closely with people having severe colds, and it is better if' children ha'ving such do not attend school. (See Rules .2 and 4, Chapter 2.) . 150

TETANUS OR LOCK-JA\iV. Tetanus or Lock-Jaw is an infectious disease which is not contagious. The gern~ ,which produces tetanus usually gains en­ trance through' some. punctured .wouhd produced by a dirty in~ strnment as a rusty nail. Fourth of July injuries are especially prone to result in Tetanus. Jn all cases of such woimds; a physi­ cian should be immediately called, no matter how slight the in­ jury may appear.

CHAPTER 4. CARE OF THE DEAD. IN CASE OF SMALLPOX. Rule r. A dead body from Smallpox must be ini.t'nediately wrapped in a cloth saturated with the strongest disinfectant solu­ tion, without previous washing, and· cremated· or btiried deep, and no body dead from this disease shall under any circumstances, or· any lapse of time, be disinterred, except by special perri1it fron: the State Board 'of Health.

IN CASE OF OTHER SPECIFIC DISEASES.

Rule 2. The body of a person who has died from Anthrax Asiatic Cholera Bubonic Plague Cerebro Spinal Meningitis Diphtheria ( Membraneous Croup) Leprosy . Scarlet Fever ( Scarletina, $cadet Rash) Typhus Fever · Yellow Fever must not be removed' from the sick room until it has been em­ balmed as prescribed in Rule 8, Chapter 2; or if this -be imprac­ ticable, the body must be wrapped in a doth saturated with a so­ ultion of Corrosive Sublimate ( one ounce to six gallons of water), and then tightly enclosed in a coffin. The body shall then 151 be cremated or buried within' thirty hours without the attendance of any person other than is_necessary to assist at the interment thereof, provided that bodies dead from Diphtheria, Scarlet Fever and Puerperal Fever, if prepared in accordance with Section 3, ·. Rule S, of Chapter Ci, a.dopted by the Board for the transporta- · tion of corpses, .may be deposited in a receiving vault or be shipped by a public conveyance. The Unclertal

EMBALMING FLUID.

Rule 3. No embalming fluid or other agent containing Ar 0 senic or Metcnrv shall be used within the State of Delaware in the embalming o~ preservation of dead human bodies for crema­ tion, burial :or shipment, except as provided for external use in Rule 2 of this Chapter. The National Funeral Directors' Association has adopted the following formula as the standard Embalming Fluid, and the same is recommended by the Delaware State Board of Health.

STANDARD ElVIBAUVIING FLUID . . Foni.mla No. 3, Formaldehyde ...... 14 per cent. Glycerine ...... 5 per cent. Borax ..... : ...... 3 per cent. Boracic Acid ...... I lb. Saltpetre ...... : ...... 3 per cent. Eosine ...... , ...... I per cent. solution. RECIPE FOR MAKING TEN GALLONS OF.THE ABOVE.

Formaldehyde ...... r I lbs .. Glycerine ...... 4 lbs. Borax ...... , ... ·.. : ...... 2·.5 lbs, 152

Boracic Acid ...... : , ...... I lb. Saltpetre ...... : ...... 2.5 lbs. Eosine ( I per cent. solution) ...... r oz. vVater to make total of ...... , ...... ro gaL .. The simplest way of compounding this fltticl is as follows: Dissolve the powdered borax and powdered acid in water. Stir- · ring and warming will hasten the solution. Adel the powdered Saltpetre. '\i\Then completely' dissolved, add the Glycerine and· Formaldehyde. Lastly add the Eosine of color solution.

CHNPT·ER 5. BURIAL OF THE DEAD. Rule r. All human dead within the State of Delaware shall either be incinerated or buried. No person under six yea.rs of age shall be buried at a less depth than 4 feet; over six years, not t\velve years, at a less depth than 6 feet. Any undertaker or per­ son violating this rule shall be liable to the penalties attached to exceeding twelve years, at a less depth than 5 feet, arid· over other violations of the Rules and Reguations of the State Board of Health of Delaware.

Rule 2. All bodies dead of Anthrax Asiatic Cholera Bubonic Plague I Cerebra Spinal Meningitis Diphtheria ( Membrane.ous Croilp) Erysipelas Glanders Leprosy Scarlet Fever ( Scarietina, Scarlet Rash) Smallpox Typhus Fever Yell ow Fever must be buried within thirty (30) ho,u{·s after death. 153

CHAPTER 6. BURIALS .. . DEATH CERTIFICATES REQUIRED. Rule r. Upon the death of any person withinthe State of Delaware, it. shall be the duty of the undertaker or othet person ·superintending the btfrial ·or other disposition of said decedent, to proc1.1refrom the physician in attendance at the time of de:ith, or the Coroner when the case comes ·under his jurisdiction, a certificate stating further the name,. age, etc., and a burial permit as required by the State Law.

DUTIES OF SEXTON.

. Rttle 2. N:o sexton or other person having charge or control of any cemetery, burying place, tonib or vault,. or no undertaker or other person shall inter or entomb or. place in any 'vault the dead body of any person, or remove such body from or out of any city, town or htmdred without having procured a certificate of death and burial pennit,as .provided in· Rule I of this Chapter, and it shall be. the

FUNERALS NOT TO BE HELD IN CHDRCHES,SCHOOt HOUSES, ETC.·.· Rule 3. No person, company, corporation or assodation having charge of, or control of any school house; or church, or any building, room; or place, used for school cir church purposes, or for any public assemblies, shall permit the body of any person dead from any of the contagious or: infectious diseases, named h1 these regulations, or any other dangerous or infectious clis'eases, .except Typhoic1 Fever ancl.Tuberculosis, to be taken in such school• house, church, building, room or .place for thel purpose of holding ' funeral services ocver such body, and ·110 sex.tour unclertak~r or other person having charge of, or supervision over the burial of . any .body,· dead from any of the said' diseases, shall pennit the. coffin or casket, containing such body, ,to be opened. Nor shall 154 any child be permitted to'. act as pallbearer or carrie1' at any such funeral.

PUBLIC FUNERAL PROHIBITED.

. Rule 4. Section I. Public funerals over the remains of person~ who have died from Anthrax Asiatic Cholera Bubonic Plague Cerebra Spinal Meningitis Diphtheria Leprosy Measles Polio Myelitis Scarlet Fever . Smallpox . Typhus Fever Yellow Fever are hereby prohibited. Adtilt persons from the infected premises may, at the d'iscretion o.f the Local,or State Board of Health, un­ der prescribed restrictions, be· permitted to. attend the funeral ..of thqse dying upon the premises; provided they ride to and from the cemetery in a closed conveyance, and do not leave the same until returned to the quarantine·. · Conveyances so used shall be. properly c!i,sinfected 11nder the personal supervision; of the Healtl'i Officer before being used for. any purpose whatsoever. The un­ dertaker, officiating at such funeral, shall be held responsible for the violation, of this rtile. ·

Section 2. No public furieral shall be held in a house or upon any premises where there is a case of any of the diseases mentioned in Section I o1f this Rule, or where a death has re­ cently occurred therefrom.

FALSE STATEi\![ENT AS TO CAUSE OF DEATH. Rule 5. If any physician, or other person, knowingly at­ tempt to secrete or withhold the true character of any disease specified in these regulations, or shall in any manner whatsoever attempt to deceive or make any false statement in a certificate as toothe cause of death, by certifying to other than the true cause 155 of such death; or, if the decedent was affected with any con~ tagious or infectious disease during his last sickness, and the at- . tending physician shall neglect or refuse to state such fact in the certificate, the said physician shall be held to have violated the rules of the State Board of Health, and shall be prosecuted ac- cordingly. · ·

CHAPTER 7. TRANSPORTATION OF DEAD. TRANSPORTATION OF THE DEAD IN AND THROUGH THE ST ATE OF DELA WARE. Rule r. The transportation of, bodies dead of Anthrax Asiatic Cholera Bubonic Plague Cerebra Spinal Meningitis Diphtheria ( lVIembraneous Croup) Erysipelas Glanders Leprosy Scarlet Fever ( Scarletina, Scarlet Rash) Smallpox Typhus Fever Yellow Fever from one territory, district or prnvince, or from this State to another, is absolutely prohibited, except as hereinafter specifically prescribed .

. Rule 2. All persons dying of disease~ mentioned in Rule I 1'.mstbe buried within thirty (30) hours after death. Rule 3. The bodies dead ·of PuePperal Fever may be trans- . ported after being ,vashed with a good sanitary fluid, all orifices· of the body clo,sed with cotton, and embalmed with a gocd stand­ ard embalming fluid (by a licensed embalmer, or one having had · three years' practical experience in embalming), afterwards wrap­ ped in cotton one inch thick 1 fastened securely with a sheet, or a 156 standard sanitary transportation sheet or blanket, placed in a good cof£m or casket, to be encased in a zinc, iron or lead lined strong, hermetically sealed wooden or metallic box. Rule 4. The bodies dead from other causes not mentioned in Rules. I and 3, and not embalmed, can be transported by mil­ road after having been bathed with. a good sanitary fluid and wrapped in cctton one inch i1rthickness, and fastened with a sheet , or a standard sanitary transportation sheet, placed in a good strong ~ coffin or casket, encased in a hermetically sealed iron, zinc or lead lined wooden or metallic box. Rule 5, The bodies dead from all other causes not men­ tioned in Rules I and 3 may. be transported by railroad, after hav­ ing been wacihed with a good antiseptic solution, and all otifices of the body closed with cotton, and embalmed by a licensed em­ balmer, or one having had three years' practical experience in . embalming, enclosed in.a good strong coffin, or casket, encased in a gcod strong wooden box made of not less tha·n seven-eighths or one inch· in thickness. Rule 6. Bodies taken from receiving vaults, or disinterred bodies shall be classed as infectious, and may be transported by railroad, ,provided they are encased in a zinc, iron or lead lined strong hermetically. sealed wooden .or metal1ic box. ' The disinterring of bodies dead of Anthrax Asiatic Cholera Bubonic Plague Glanders Leprosy Smallpox Typhus Fever Yellow Fever is absolutely prohibited, except by a spe~ial permit from the -State Board of Health of Delaware. The disinterring and .transporting of boclies dead of Cerebra Spinal Meningitis Diphtheria ( Membraneous Croup) Erysipelas Scarlet Fever . ( Scarle~ina, Scarlet Rash) 157 may be done after having been· buried for three or more years, provided they are prepared and encased as called for in Rule 4. Rule 7. ,i\Then deaclbodies within or from outside the State of Delaware are to be taken frcm train to train in the same sta­ tion, or from one railroad station or boat .to another, the removal or burial permit. accompanying the body from the ,place of ship­ ment shall be sufficient authority to continue to the place of destination.

IMPORTATION OF DEAD BODIES .. Rule 8. The importation of bodies dead f~om either Asiatic Cholera Bubonic Plague Leprosy Smallpox Yellow Fever · into the State of Delaware, is hereiby prohibited. by the State Board of Health of Delaware, except by a special permit from the State Board of Health of Delaware.

DUTIES OF RAILWAYS AND EXPRESS COM­ PANIES, ETC. R~le 9. Railroad companies and express companies, and their agents, conductors, baggage agents and messengers, and other transportation companies and private individuals are here­ by forbidden to accept for shPpment, or to irnport into the State of Delaware, the dead body of any h\mian being dead from any of the diseases named in Rule I of this Chapter, and the afore­ mentioned companies, their agents, c011ductors a:nd all other per­ sons are hereby forbidden to export' or import or bring into the State of Delaware any bodies unless the certificates attached to the outer box containing such body be in strict accordance with the provisions and requirements of the State Board of Health of Delaware. · · , . · 158

CHAPTER'·8. ·DISINTERMENTS . . PERMITS. REQUIRED IN ALL CASES. Rule r. . No person shali disinter. the dead bodyof a human being unless he be in possession of a written permit issued by the . State. Board of Health and countersigned by the Health Officer of the local Board of Health, in whose jurisdiction the disinter­ ment. is to be made, and signed by. the undertaker in charge of said disinterment. · ·

PARTICULARS RJ:<:QUIRED.

. Rule 2. When it is desired to disinter a body for removal from one grave to another in the same cemetery, or for removal to another cemetery, application for permit ·therefore must be tnade to the State Board of Health. Such application ·shall. give the name of the person whose body is to be disinterred; together with the age,. date of burial and cause of death, the name and lo-. · cation of the cemetery, :hundred and county from which it is· to , be removed, and the name of the cemetery and location thereof where such body is to be re-interred. All applications provided · for in thfa rule must be made upon the proper blank forms pro.:. · vided bv the State Board of Health and must in all cases be issued by the ·state Board. of Health. and countersigned by the Health Officer of the local Board of Health and be signed by.the Under- taker who is to do the disinterment. ·

DISINTERMENT 'PROHIBITED. Rule 3. · No· pe~·mit,shall be granted for·the disirtterment of a body ~ead from either Anthrax . . Asiatic Cholera Bubonic Plague Leprosy Small Pox Y elfow Fever except by a special permit from 'the State Board. of Health of Delaware. 159

SPECIAL PERMITS GRANTED. Rule 4·, Bodies dead from Diphtheria, including Membrane­ ous Croup, Scarlet ·Fev~r, including Scarletina and Scarlet Rash, Cerebr.o Spinal Meningitis, may be disinterred upon a ·special per­ mit· granted by the State Board· of Health, but aU such disinter­ ments shall be done in strict conformity with the following re- . quirements : Section i. The. disinterment and removal must be under the .direction of an undertaker, and in accordance with the Rules governing the Transportadon of the Dead. .

Section 2. The removal shall be clone at an hour when there · is the least possible exposure of other persons. · · Section 3. No <:hilclrenshall be 'present, and only such per- sons as are actually neq:ssary. · .. Section 4. . The coffin shall not be opened, either at place of disinterment or place of destination . . Section 5. . When the body is to be removed from the ceme­ tery where disinterred, the coffin and .remains must be inclosed in· a metallic-lined box ... Sectio~ 6, 'The sexton and all other persons engaged in such removal shall. imniediately thereaftet" change their clothing and properly disinfect or burn the same and shall thoroughly dis".' infect their hands, head and face and shoes. Section 7. The undertaker authorized to C01Jductthe dis­ .. interment shall be held personally responsible for the enforce- ment of these requirements. · Section 8. · No disinterment of bodies named _in Rule 4 shall be made within. three years after burial of same.

GENERAL PERMITS. Rule· 5. ·. Bodies dead from diseases other than named in Rules 3 and 4 may be disinterred upon receipt of a written per­ mit issued by the Secretary of the' State Board of Health, pro­ vided such permit is couritersignecl by the Health Officer of the Local Board of Health and signed by the undertaker in charge of said disinterment. · ·· · · 160

ALL DISINTERMENTS ~UST·BE DONE BY'A. LICENSED UNDERTAKER.

1 Rule 6. · All disinterments provided for iii this Chapter shall be done under .the personal supervision of a regul~rly Ii.tensed . undertaker or one of at least three years' experience.. . ·

; . . . . ._ : . BODIES. DEPOSITED IN A RECEIVING VAULT. :Rule 7. Bodie-s that. have been temporarily deposited in a receiving vault may be. 1;emoved· therefrom without a disinter­ ment permit, provided; that such body, before being deposited in • · said receiving vault, was properly embalmed, by a licensed under­ taker, and provided that not more than 30 days has. expired since the date upon which ,such body was so deposited: After the ex­ piration. of. 30 days,. a disinterment pt;!rmit shall be obtained· be- • fore removal of any dead body named in this rule.. ·

. SEPARATE. APPLICATIONS. . Rule 8. 'A 'separate application must be i;nade for each bod; to be disinterred.

CHAP'~ERl 9; . BEAD A2NIMALS. No dead animal ·or part thereof shall be allowed to decay in any open field or lot. . All dead animals must b.e buried two. feet under the surface of the ground before putrefactjori. takes place. ·, ,,:

CHAPTER IO.· PUBLIC WATER SUPPLY .. With the view to prevent Typhoid Fever and other ailments caused by polluting drinking water, the State. Board! of _Health. l1creby :makes and adopts the following -regitlation concerning aualysis of water supplied to the public, and it is hereby ordered . that all local Boards of Health enforce thes_e regulations within their jurisdiction. ' SAMPLES FOR ANALYSIS. Rule I. The local manager of any private corporation· own- ·, . . 161 ing or operating a plant from which water is supplied to the pub- · lie, and the superintendents of any water works or public wells, owned or operated by any: municipality in the State of Delaware, shall cause a sample of the. water so supplied to be submitted to the Chemist of the State Board of Health for sa11itary analysis. Said sample shall be accompanied with the collection blank prop­ erly filled out.

Rule 2. The samples provided for in Rule I ofl this Chapte·r shall be subr11itted between the last day oJ. August and the first day of November of each year, and at such other times as the State or local Board m,ay direct. All samples for analysis shall be in accordance with the instructions set forth in Rule 5 of this · -Chapter. · REPORT AND FEES. Rule 3. The Che1frist of the State Board o:11Health shall make a written report of each analysis conducted under the pro­ visions of this Chapter, said report shall be: niade in duplicate and upon proper forms adopted by this Board, one copy being filed with the Secretary of the State Board of Health, and one copy · with the Clerk of the local Board from whose jurisdiction the sample of water was obtained.

HOTELS, RESTAURANTS, ETC.

Rule 4. The provisions of Rules I, 2, 3 of this Chapter shall also apply to hotels, restaurants and boarding houses, and to the proprietors of every such establishment, whenever the water furnished to the patrons there.of is procured from private wells or ?ources other: than the public water supply of the city or town.

ACTION TO BE TAKEN ON REPORT. Rule 5. Whene~er any analysis provided for in this Chapter shall reveal the presence of sewage, or other forms of pollution, rendering such water unfit or dangerous for domestic use, the Secretary of the State Boartl of Health shall so notify the proper officials of the city, town or township concerned and direct them to make a proper investigation as ·to the. cause of such pollution and forthwith repor~ their findings. All such reports shall be forwarded immediately toi the Secretary of this Board, who will advise. as to the proper and most economical method to be pur- . . · 11 162 sued to protect the public health, and if in his j1.1dgment the rem­ edy is not sufficient, he shall order said source of supply imm~­ cliately clis'cori.tinued,· al'lcl he shall immediately report his findings · to the. President of the State Bo.arc! of Health.

GOLLECTION BLANKS. Rule 6. The following circular of instruction concerning eollection and shipment of samples of ,vater for sanitary analysis shall be supplied to local Boards upon application ..

MANNER OF LABELING AND SHIPPING. All bottles, jugs and containers shall ·be labeled distinctly .and · numbered. : . Collect immediately before the time for shipment and express prepaid, direct and by the shortest route to Labor­ atory of the Delaware State Board of He'llth, Newark, Delaware.

COLLECTION OF SAMPLES. (a) From \Vell-vVater should be pumped out freely for a few minutes before. collecting. The previously thoroughly cleaned bottle is .placed in such . a position that the water from tl~e spout may fall directly into the bottle; rinse out the bottle thoroughly three times with the· water to be analvzecl, before the trial collection. The bottle is then to be filled to overflowing, a small quantity poured out so as to leave ari air space of about an inch under the stopper. The stopper should then be thoroughly rinsed with the flowing water ancl inserted firp1ly while wet. The stopper is then seemed by tying over it a piece of clean cotton cloth, and ends of the strings . used must be sealed on top of the stopper with shling wax. Uncler no circunistances must the inside of the neck of the iJottle or the stem of the _stopper be touched with the hand or wiped with a cloth: (b) .Froi:n vVaterworks, Hydrants or Taps-Allow the water to run freely a few minutes and then proceed precisely as given above under (a). If the sample· is to represent the average water of a town, it should not be taken from a "dead encl" of a main, reservoir or tank, other than the main source of s1.1pply,but from a tc1p.direct- 163 ly connected wi.th the street main in active use arid circulation. If it is desired to get the extremes in any water system, the samRles should be taken as follows ; one from tapi on a dead, and the other from the pumps directly. In cases where the high reser~oir tank; system is used for fire protection, the tanks are often left uncovered, where dust, dead sparrows, dead algae, and all sorts of debris collect. Sam­ ples should be collected with ·this condition in mind. If the tanks are not frequently cleaned out it. furnishes a dangerous culture bed for the whole water system. Iri such cases the water should be collected as near the bottom of the tarik as possible. · (c) From Stream, Pond, Tank or Reservoir-The bottle and stopper should be rinsed with the water to be collected, if . this can be clone wifhout stirring up, the sediment on bottom. The bottle, with the stopper in place, should then be entirely sub­ merged in the ,water and the stopper taken out at a distance .of twelve inch'es or more belo,v the surface. vVhen the bottle is full the stopper is replaced ( below the surface, if pos:.ible) and finally secured as above. It is important that the sample should be obtained kee from the sediment at the bottom of a stream and from the· scum on the surface. I( a stream should not be deep enough to admit of taking a sample in this way, the water must be dipped up with an absolutely clean vessel and poured into the bottle after it has been rinsed. . If the sami)le be ice, melt the ice naturally-not by artificial , heat-in a porcelain-lined, or ,glass or vitrified vessel, and pour the entire contents ( with sediment) into the bottle. It is important that the sample reach the laboratory as quick­ ly as pos·sible after collecting, and all care must be used to secure this encl. Prior notice of. at least a day· should be sent the chem­ ist that the sample will reach the city on such and such a train if possible. In. case an interpretation of the · results of an . analysis is desired a certificate for collection will. be forwarded .and on its return properly filled out~the character of water w.ill be reviewed. ' An explicit statement of what is desired. in the sending of each sample! is requested, that the work may be expedited and no misunderstanding occur. In some cases a baderiological exam- 164 ination of the water is desired, in ·which cases specially collected samples are necessary and can not be taken from the sample for chemical analysis. If a microscopical analysis 1s desired it should be in like manner indicated. For a mineral analysis. o'f water or for boiler scale, hardness. or other determination not .less than two gallons must be sent. Price and directions will be forwarded on application. The expense of a sanitary analysisi for .private use will be $10.00 and must be paid by the parties for whom it is. made, re­ mittance for which should be made at time of sending sample. Inquiry regarding the chemical analysis of any ·substance. will re­ ceive prompt attention, · communication regarding which should be add ressecl. direct to the Chemist. · ·

DIRECTIONS FOR THE COLLECTION OF SAMPLES OF WATER FOR SANITARY ANALYSIS. Containers for samples of water must be perfectly clean, ground glass stoppered bottles-if possible bottles that have never been used. and not less than one gallon) in size. H it. is im­ possible to obtain tbe above, a clean new' gallon jug may 1:Jeused. Jugs can be sent directly:, by express by pt'operly tagging, but bottles must be properly boxed and packed for shipment Corks used in cases of necessity must be i1ew and well washed. Our own containers, prepared, boxed and packed, will' be sent out on request. .The parties making the request must pay for expressage of same.

REPORTS TO BK PUBLISHED AND RECORDED. \i\Then the analysis is .made for any municipality. or Board. of Health or in the interests of the public health, the report should be published in some local paper and filed with the Local Health Board or Clerk for future reference. Record of. analysis 'is also filed with tbe Secretary of the St?-te Board of Health. 165

CHAPTER 11. CE·METERIES, CREAMERIES, LAUNDRIES AND MANUFACTORIES. SEWAGE AND W'ASTES FROM.

Rule I. No creamery,· laundry or manufactory shall dis~ charge its wastes or sewage into 1my river, stream, pone\ or other body of water, neither ·shall any such waste or sewage be dis­ charged into an cpen ditch or upon any lot, .alley or street, until such wastes or sewage shall have been purified to such a degree as to be free from substahces dangerous to the public health. LOCATION OF.

Rule 2. No cemetery shall be so located or established as to become a probable menace to the public health. No cemetery shall be established without a permit issued by the State Board of Health, having the signature ·of the President, Secretary and the seal of said Board. STATE BOARD TO DETERMINE LOCATION. Rule 3. vVhen any question arises concerning the location of any creamery, .cemetery, laundry or manufactory, the health authorities of the village, town or city shall call the State Board of Health to determine the question at issue in the interest of the public health. ·

CH.4'\:PTER 12. BARBER SHOPS: AND PUBLIC BATH ROOMS. INSPECTION.

Rule I. All barber shops and barber schools, public hath . ·rooms and public bath houses shall be opened for inspection at any time dnring business hours to the inspection of the. State Board of Health or to any local sanitary or health officer. GENERAL SANITATION. Rule 2. All .places mentioned in Rule I, together! with their furniture, fixtures, instruments and j.1tensils, are required to be kept in a clean and sanitary condition. 166

INSTRUMENTS. ··Rule 3. Mugs, shaving-brushes, razors, scissors, clipping machines, pinchers, needles, the contact cup or pad of vibrating or massaging machines, and all other instruments shall be ster­ ilized, either by irnmersiori in boiling water or in alcohol of at least sixty per cent. strength, or by formaldehyde gas or solution, after each separate use. · Combs and brushes shall be thoroughly . cleansed· with soap and water at Jeast once daily.

, TOWELS. Rule 4. . Clean towels shall be us~d for each person. served. Towels shall not be used for more than one person until laun-. dered.

ALUM, . Rule 5. Alum or other material used to stop the flow of blood shall be applied only on a clean cloth or to\vel or other clean appliance. The use of styptic sticks or pencils is prohibited.

POWDER-PUFFS. Rule 6. The use of powder-puffs and sponges for public use is prohibited.

HANDS. Rule 7. Every barber shall (horoughly cleanse his hands immediately before serving eacl1 customer.

RAZOR STRAPS. Rule 8. · Any barber when shaving any person having an eruption on the face of any kind or nature shall be required to . disinfect the razor by dipping it in a I 5 per cent. solution of formaldehyde before stropping. · ·

AIR AND WATER. Rule 9. Every barber shop and bath room shaUbe well ven­ tilated and provided with running hot a11clcold water. 167

SLEEPING ROOM. Rule ro. No barber shop, school or public bath room shall be used as a sleeping· rcom. ·

SKIN DISEASES. ·Rule r r. After .serving persons who have eruptions on the face or ·scal1:i,or afflicted with contagious skin disease, all metal tools and instruments, bi"ushes and combs that have b~en used on such person shall be thoroughly sterilized by boiling water or tlTe use of formaldehyde gas before using again, and the hands shall be thoroughly Cleansed with disfofecting solution, and all towels and damp cloths used shall be thoroughly boiled before being lam1dered.

BATHTUBS.

Rule I2. All bath tubs shall be thoroughly cleansed with hot water .and soap .after each sepa·rate use ..

DISINFECTION . . Rule 13. Every public bathroom or public bathhouse shall be thoroughly and efficiently disinfected with formaldehyde gas or sulphur fumes at least oi1ce in every three. mo~ths.

- VENEREAL DISEASES. · .Rule· 14. No· person shall be· served in any barber shop, . public bath room or public bath house, .vho. is suffering frcim Syphillis, such prchibition to continue until more than six f\1onths have elapsed from date of infection. No person shall be served in any public bathr.00111or public bath house who is suffering_ from Gonorrhea. ·

' ' ' CONTAGIOUS DISEASES. , Rule 15. No person suffering from Measles, Scarlet Fever, Small Pox, Diphtheria or Diphtheria Sore Throat, Barber's Itch. or Ringworm shall be served in any barber shop, barber school, public bath roci1i.1or public bath· house. .

DISINFECTION OF TQOLS, ETC. · Rule r6. All tools or instruments ~sed by barbers outside . • . ! 168 the shop in serving any person suffering from infectious or, con­ tagious diseases or used on a corpse are required to be thorough­ ly and efficiently disinfected with formaldehyde solution or for­ maldehyde gas immediately -after using the same. ·

BARBERS MUST BE FREE FROM INFECTIOUS DISEASES. Rule I]. No person suffering from any infectious or con­ tflgious disease, including Tuberculosis, shall serve any person in any barber shop, barber school, public bath room or public bath house in· this State.

RULES POSTED. Rule 18. 'l'hese rules and regulations shall be conspicuous­ ly displayed in each barber shop, barber school, public bath house and public bath room in. Delaware.

PENALTY.· Any person violating any of these rules and reg~tlations shall, . upon conviction, be fined a sum not to exceed fifty dollars or less than five dollars.

CHAPTER 13. LODGING HOUSE REGULATIONS.

Rule I. For the purposes of this regulation any place with sleeping accommodations for four or more persons, that nightly rents for twenty~five cents or less per person, shall be known as a lodging house.

Ruic 2. The owner, agent, manager or keeper of every lodg.:. ing house shall provide at least 300 cubic feet of air space for each person for whom accommodations are maintained in every · room or apartme1;it used for this purpose. · Rule 3. In each room or apartment used for sleeping pur­ . poses in every lodging house there shall be a window or door opening to out-of-door air of a size of not less than one~tenth ·of the floor space surface of said room or apartment. · Rule 4. Upon each floor of every building used as a lodg~ 169 ing house there shall. be maintained a sink, and the s~me shall be . · · kept in a sanitary· condition. · ,Rule 5. The 'floors and walls of each room, apartment and . hall shall be kept clean and shaR be thoroughly· aired daily:

CHAPTER. 14. SCHOOL A.NDSCHOOL GROUNDS. SANITARY REGULATIONS FOR SCHOOL GROUNDS AND BUILDINGS .

.I. . Every wat~r closet and privy shall be at least 100 feet from th.e school well or spring. 2. Every water doset or privy shall .be built ·over a "well" or "vault" at least three feet deep. 3. No watei"closet .or privy shall be allowed to fill nearer than within twe!ve inches of the level of th.e surface of the ground. 4. All seats and floors in water. closets or. privies must be kept clean by washing or ·scrubbing. 5. No stable, pig pen or other building, liable to be~ome a nuisance may be placed within 200 feet of a school house or with- in 100 feet of any school yard. · 6. No open bucket or vessel from which school children get water shall be· permitted in a school. A closed bucket with a, faucet or "Cooler" with a faucet shall be used; · i S~hool children must not use a comm011drinking cup,but · individual cups must be used. .· : · . . . 8. -Children must not sit in school within six feet of the stove unless protected from the direct heat by.means of a Russian jacket. A stove should be surrounded by a Russian Jacket. 9. School children must not sit facing a window. ·

IO. All windows must lower from the t?P and raise from the bottom. ·

r I. All school buildings must be well, ventilated, and never crowded. . , . 170

12. Every school roofn should be kept at a temperature of .. · 70 degrees in cold weather. , 1-3. Every school house ·shall have two· water :closets, one for the boys and one for the girls,· and ·said closets shall be en­ tirely separate buildings, and said buildings shall be so constructed so as to insure privacy, and said buildings shall not be nearer to each other than twenty feet. · ·.

CHAPTER 15. ISSUED BY THE DELAWARE STATE BOARD OF. HEALTH. . Rules and Regulations regarding sanitaticfo of reiigious and work camps incident to the canning industry, and such other con- • gregations of people, as may b~ covered by a general rule:

I. Camps for· employes should be on high grouqd, and' in, the open and not contig~tous·to swamps and cl,itches.

2. The water supply shall be abundant for all purposes, in~ . eluding baths, and if .said water is from a spring or springs, the source and course thereof must be kept free £~om pollutio11. 3. The health of employes shall be carefully guarded, and · 110 employe, suffering from Tuberculosis, ,shall be allowed to sleep in the· same shack or other abode as those not so infected: · . . . 4. , Camp . garbage shall be placed in boxes and barrels or other container with. tight lid, and hauled away or burned or . buried at least every other da,y. 5. F;r the disposal of body waste, there shal.l be vaults dug, net less tha11 three f e.et deep, with suitable buildings, which shall fit tight to the ground, to cut off the excursions of flies:. Said . vaults shall,. at no time, be allowed to fill neare; than· within 12 · ·, inches of the surface· of the ground, and in no case ·shall they be placed nearer than mo fel!t from .the sleeping quarters of the empl_oyes,nor within 200 feet 0£ a canning indu'sti:y. 6. · Any case of sickness, giving rise to suspicion that it may be contagiotts should be reinov:ed at once, and all .proper dis­ in'fectiori carried ouL . Observance of this rul~ may save the clos­ ing of a camiing industry, at a time when it would be very in­ convenient so to do. 17i 7. ·where a stationary or movable cook house is used; the same should be well ventilated, a11d all food supplies carefully screened to prevent contamination from dust and Hies. No slop should be thrown on the ground near the cook house. 8. · It shall be the duty of every physician, visiting the sick in places covered by these h1les, to report unsanitary conditions, so that they may be thoroughly investigated and corrected. 9. · The ab9ye rules and regulations apply equally well to all cases where people gather to work and if carried out, will repay owners and employees by diminishing sickness.

CI--IAPTER 16. TELEPHONE BOOTHS. . All public telephone booths shall have proper ventilation thereto, and when not ii1 use, if no other means of thorough ven­ tilation exists, the door thereof shall remain open a distance of ,it least six inches. ·

CHAPTER 17. EMERGENCIES.

Rule l. The Secretary of the State Board of Health is em­ powered when exfraordinary conditions arise, endangering the health of the citizens of the State, and immediate action is neces­ sary, to act and enforce the rules and l'egulations of the State Board of Health, ·and when necessary to designate and appoint some member of said. Board or any ot!'1er suitable person to act as an executive officer of said Board, with full power to enforce the rules and regulations of said Board. Rule 2. _ vVhen any .person is appointed under conditions named in Rule r of this Chapter, the actual expenses -together with compensation of not over $5.00 per diem shall be allowed such persons. ·

CHAPTER r8. RABIES. Rtile r. Any person bitten by a clog or other animal that 172 had· Rabies, or was suspected of it, may be treated under the, direction of the Pathologist and Bacteriologist ; the treatments to be given by a member of the State Board of Health\ or by a physician appointed so .to cl~ by the President or Secretary of the State Board of Health. .Said treatments shall be made only after a deposit of. $25.00 has been made with the State Board of1 Health.

RULES AND REGULA T'IONS COVERING THE , SHIP­ MENT OF THE HEADS OF DOGS OR OTHER ANI-1 MALS BY EXPRESS TO THE LABORATORY . . OF THE ST ATE BOARD OF HEALTH OR OTHER LABORATORIES.

Section L That 110 express company or its agent shall ac­ cept for transport'.'ltion, the head of a clog or any other animal unless it shall have been prepared! for shipment as hereinafter provided.

Section 2. That the head of a clog· or other animai shall be placed in a tiq or other metal container which will not permit the leakage of fluids; such containei- shall be placed in a second wooden or metal ·container with ice packed around it and so con­ structed that it will not permit the leakage of ice1 water resulting from the melted ice .. · Section 3. That ~11 such packages sl1all.. be labeled as fol~ lows: "Caution! This package contains the head o'f' a dog ( or name of other animal) suspected to have died of hydrophobia .." Section 4. That any express company that accepts the head of a clog or other animal for transportation prepared other than hereinbefore required, shall upon conviction be deemed' g·uilty of a_misdemeanor and subject to the penalty as.provided" by statute. Section 5. These Rules and Regulations are adopted under · the authority vested in the State Board of Health. 173

CHAPTER 19.

RULES GOVERNING THE TRANSPORTATION OF THE .SICK IN AND THROUGH THE STATE OR DELA:WARE ..

Rule I. The transportation of any person/ sick with Anthrax Asiatic Cholera Bubonic Plague _ Cerebro Spinal Meningitis Diphtheria ( Membra_neous Croup) Erysipelas Glanders ·Leprosy Polio Myelitis Puerperal Fever Scarlet Fever ( Scarletina, Scarlet Rash) Smallpox Typhus Fever Yell ow Fever

from one territory, district or province, or from this State to another, is absolutely prohibited,· unless permission so to do is specially given by the State Board of Health. · ·

Rule. 2. · Any person sick with Typhoid Fever may be trans~ ported by a comii1011.carrier, provided said patient is accom­ panied by a physician or nurse; and that no discharges from said · patient are in any way scattei·ed en route, and that all discharges are thoroi1ghly disinfected before being disposed of. Rule 3. No common carrier shall knowingly transport in any public conveyance any person suffering with ·whooping Cough, Measles or Mumps, but said persons may be transported · in the baggage car or in a sriecial or private car. 174 •;t ·, CHAPTER 20.

DIPHTHERIA ANTITOXIN. AN ACT TO PROVIDE FOR THE DISTRIBUTION OF ANTITOXIN BY THE ST ATE BOARD OF HEALTH OF DELA WARE. Be it enacted by the Senate and House of Representatives of the State of Delaware in. General Assembly niet: Section r. That the State Board of I-Iealth of Delaware is hereby authorized to procure and distribute Diphtheria Antitoxin to the people of the several counties of Delaware, when such per­ son or persons are placed under quarantine for Diphtheria, and desire Diphtheda Antitoxin for the treatment thereof. The ex..: pcnse so incurred shall be paid by the person or persons quaran-. tined, when able to make such payment, and ~vhen not, by the city, town or county in which he or they are quarantined.· All of such Diphtheria Antitoxin thus. distributed by the State Board of Health. shall be furnished only after certification to the distribt1t­ ing agency, by the physician in attendance upon such case, and upen the forms adopted by the State Board of ·Health of Dela­ ware.

Section 2. The Sta~e B0arcl. of Health of . Delaware may make such- rules and regulations governing the requisitions and distribution of the above-mentioned Diphtheria Antitoxin as they deem fit and proper, and said rules and regulations shall have the force of law. Section 3. Any person making false certification for the secvring of the above-named Diphtheria Antitoxin shall, upon conviction· thereof, be liable to a fine of n_ot less than $5.00 nor more than $50.00, the same to be recovered before any Justice of · the Peace of the State of Dela,vare, and from whose decision there shall be no appeal. That all fines recovered under this Act shall be paid to the Treasurer of the State, and applied. to the Generai Fund of the State. Section 4. That the State Board of Health shall furnish the above said Diphtheria Antitoxin, and have the same labeled "Delaware Str,te Board of Health Diphtheria Antitoxin." 175

Section 5. That. the sum of $1,000 ·is hereby appropriated to the State Beard of· Health of, Delaware for the carrying into effect of the provisions of this Act, and the same is hereby appro­ priated out of any fonds in the hands of the State Treasurer not otherwise appropriated. Th@ said appropriation shall be paid to the State Board of Health of Delaware, and shall be known as "Diphtheria Antitoxin Appropriation," and the State Board of Health shaU keep the accounting for said appropriation as a dis­ tinct and separate account from ot,her appropriations which they _receive. Approved April 4, r9r I.

RULES AND REGULATIONS GOVERNING THE REQUI­ SITION AND DISTRIBUTION OF DIPHTHERIA ANTITOXIN, PASSED BY THE STATE BOARD OF HEALTH OF DELAWARE, IN COMPLIANCE WITH 'THE ACT PASSED BY THE LEGISLATURE OF DEL­ AW ARE AND APPROVED BY TI-:IE GOVERNOR, APRIL 4, r91 r. Rule r. State Board of Health Diphtheria Antitoxin will be furnished in r ,ooo, 3;000 and 5,000 unit packages.

Rule 2. State Board of Health Diphtheria Anitoxin will be supplied only on the order of a physician, upon properly executed forms furnished by the State Board of Health. Rule 3. State Board of Health Diphtheria Antitoxin will be· supplied to indigent poor, and be charged to the city, town or county in which. said remedy is used. · Rule 4. State Board of Health Diphtheria Antitoxin will be supplied to the poor of the State who are able to pay for the same, but who are not able to pay for the Diphtheria Antitoxin as sold by the trade, mid at the same time supply their families with the necessaries of life. · · Rule 5. Any incorporated town may buy a -supply of Dela- 176 ware State. Board of ~Iealth Diphtheria Antitoxin from the State Board of Health, but a strict report of each package as used must be immediately made to the Secretary of the State Board of Health, and the rules of the State Board of Health, relating to State Board of Health Diphtheria Antitoxin, must be strictly observed. · Rule 6. No physician sha!J ordGr Delaware State Board of Health Diphtheria Antitoxin for any person unless he or she, in his opinion, is indigent poor, or is too poor to buy the -same at trade prices and at the same time supply their family with the necessaries of life. · Rule 7. No distributor of Delaware State Board of Health Diphtheria Antitoxin shall dispense any of said Antitoxin with­ out an order properly filled ont by a physician, but sha!J furnish same on the written order. of a physician. Rule 8. No physician shall sign an order for Delaware State Board of Health Diphtheria Antitoxin unless the case on which it is to be used has been reported to the Secretary of. th·e State Board of Health, or the physician immediately does so. Rule 9. Any physician using State Board of Health Diph­ theria Antitoxin shall furnish such inforniation as to the Date of Use; Name of Par!!nt and Patient; address (Hundred, County, town or City) ; Sex; Color; Ages; number of children in the family ( and their ages) ; the number attending school; and prop­ erly placard the house and immediately report to the Secretary of the State Board of Health when fumigation is made and such other information as the State B,oard of Health may at any time require,

Rule IO. That the contract for the purchase of .State Board of Health Diphtheria Antitoxin shall be left in the hands of. the President, Secretary and one other member of the State Board of Health; that the amount purchased at any time thereafter, under such contract, shall be left in the hands of the Secretary of the State Board of Health, arid that the distributing points shall be left in .his hands, and that the detail .work shall be attended to by him, and the accounts kept by him in the manner prescribed by law. Rule I I. That each physician · in the State of Delaware, whose practice extends to rural districts, may secure, from his

'\ 177 nearest distributing agency, and keep on hand for emergency use, one 2,000 unit package of State Board of Health Diphtheria Anti­ toxin, but must sign his requisition for same, stating that said package is for "Emergency Use," and that not more than one such package shall at any time be in his possession, or be fur­ nished to him, and that said "Emergency Package," when used, shall be reported immediately by said physician to the distributing · agency from which he received the same, and on a properly exe­ cuted report of the case on whichsaid "Emergency Package" was used, the distributing agency shall supply said physician with a renewal '.'Emergency Package" of Delaware State Board of . Health Diphtheria Antitoxin. All rules relating to State Board of Health Diphtheria Antitoxin shall apply to the "Emergency Package." Rule 1.2. All State Board of Health Diphtheria Antitoxin is the property of the\ State of Delaware, .and no physician or distributing agent shall sell or give to any person any of said property, except in compliance wi.th the law and the rules of the State B.oard of Health. Rule 13. All rules and regulations of the State Board of Health, relating hereto, "have the force of Law," see Laws of Delaware. · Rule 14. The distribti10rs of "Delaware State Board of Health Diphtheria Antitoxin" will be! furnished with stamped envelopes and postal cards. and the same shall not be used for any other purpose but business relating to said distribution. Rule r 5. All distributors of "Delaware State Board of Health Diphtheria Antitoxin'' shall make full quarterly reports of all packages dispensed to the indigent, and settlement for all packages sold to the poor, on January 1st, April 1st, July rst and . October rst of each year. R11le. 16: A.nY distributor of "Delawa.re State Board of Health Diphtheria' Antitoxin" wishing- to relinquish his office as distributor, must give the Secretary of the State Board of Health at least ten clays' notice thereof. Rule' 17. No credit shall at any time be extended to any person for "Delaware State Board of Health Diphtheria Anti­ toxin" for any cHstributor. Approved April r8, 19u. 12 178

INSTRUCTION TO DISTRIBUTORS REGARDING THE DISTRIBUTION AND USE OF DIPHTHERIA ANTITOXIN. In the distribution of Diphtheria Antitoxin there are THREE PRINTED forms which MUST be :filled out. First in Importance are Forms A and B, known as the Ap­ plication and Receipt. They are in a small bQok containing mo numbered pages-50 white and 50 yellow-the white to be sign­ ed by the physician and forwarded. to the State Board of Health after the amounts of Antitoxin secured by him are proj)erly :filled out in the space reserved for this purpose ; the yellow on which the carbon copy is taken remains in the book for th,e distributor's 'own record. A space .is specially provided in the lower left-hadd corner of these forms A and B for a statement of Distributor's stock of _Antitoxin on hand, the :filli11gout of ·which space will prevent the distributor from ever allowing his stock of Antitoxin to become entirely exhausted, as' a careful examination is -made of each ·For_m immediately upon _its receipt, and if stock is found to be low, additional supply is at once forwarded. This avoids the expense of letter, telegraph or telephone messages to the State Board of Health for additional stock . . . A physician having a case o"f Diphtheria among the ind_igent or iJoor should immediately apply to the nearest Distrib11tor, sign a receipt, Form A (when indigent) or B ( when poor, but able to_ pay for the Antitoxin as indicated in the law), and secure all the ' Antitoxin he needs for the treatment of the case. · . . Phvsicians must sign for the Antitoxin before 8ec"nring same. unless they send for it when the form pr9vicled must be signed and delivered to the Distributor. · Second Form.. Inside of the box of Antitoxi·n is found the clinical report. The physician fills this out, signs and returns it to the State Board of Health at the termin::ition of the case. The Distributor_ has nothing whatever to do with this form. Should an epidemic of DipJ1theria break out in your locality, when a large quantity of Antitoxin might be needed at once, you are then authorized to telegraph or to telephone, reversing charges to this office for the necessary additional supply. 179 Accurate records mqst be kept, as the Antitoxin is charged to the Town or County (when used in Rural Districts), when the · party is indigent poor. When the patient is poor, but able to pay for Antitoxin, as indicated in the Law, the distributor shall· sell the Antitoxin to such·. person at the State Board of Health Diphtheria· Antitoxin prke, an9 remit the same to the State Board of· Health on Jan­ uary 1st, April 1st, July is.t and October 1st o'.f each year. (See Rule 15);·· · · Additional supplies of stationery can be secured from the Secretary of the State Board of. Health. When a physician sends in a Deputy to secure State Board of Health Diphtheria Antitoxfo,. the Deputy must have with him Form C, and deliver same to you. You then fill otit Form A or B, · and have the Deputy sign for. same. Return F,orm A or B to the State Board of Health, and retain Form C. as your voucher. . . · · Immediately on giving out any Diphtheria Antitoxiri send

to the State Board of Health the postal card notification ( this 1 card will be kept by the State Board of Health in a card index . case)', also send the Form A or B.

DIPHTHERIA ANTITOXIN I FUR:t:-JISHED l)"NDER THE SUPERVISION OF THE DELAWARE STATE BOAR.D OF HEALTH The great value of Diphtheria Antitoxin as an. immu~izing and curative agent being generally recognized, it is·the desire of . this Board that the State of Delawar,e shall profit to the fullest extent by its use.. · · · ' City o.r tbwn health dfficials are urged to have their re­ spective city councils or commissioners provide Antitoxin free to the poor .. Believing that there is also a large rtmnber of per- · sons' who; while not strictly "poor," woul<;lfind it impossible to ' pay the regular retail prices of Antitoxin, and realizing the pos­ sibility of obtaining a special price through the State Board of Health, this Board, under the law, has planned to distribute Artti­ to~in under its supervision. Arrangements hhe been made accordingly, and the great ·

• 180 saving thus effected on the severali dosages selected by this Board, as shown by. the following figures, will certainly place Antitoxin within the reach of all, except those who are indigent poor. · 1000 Units ( Immunizing Dose) ...... $ .50 3000 Units ( Curative Dose) ...... r.35 5000 Units ( Cnrative Dose) ...... ; . 2.00 To measure, as far as possible, the.success of this plan, there is enclosed in each package a blank form on: which the physicion is requested to send to the State Board of Health! Office a clini­ cal report of each case treated. This will enable the State Board of Health to compile most interesting and valuable statistics. Physicians can, therefore; obtain Delaware State Board of Health Diphtheria Antitoxin by applying to any one of the dis­ tributing stations, signing the requi1'ed papers, arid in other ways observing the State Laws and the Board of eHalth Rules ( which have the force of law relating thereto).

CARE OF ANTITOXIN You are reminded that Antitoxin is a perishable product­ i. e., it deteriorates with age, and this deterioration is very much more rapid when the Antitoxin is exposed to heat. It is best stored in refrigerators or other cool places. Physicians are urged to observe these precautions. The antitoxin is guaranteed for a certain time, and each packag-e is stamped with a "guarantee date," after the expiration of which time the Antitoxin must not be used. Should ai1y of these packages become "out-dated" before be­ ing used, they may be exchanged for fresh stock if returned un- op~ned. ' All letters and inquiries, relative to Delaware State Board of Health Diphtheria Antitoxin. should be addressed to the Dela­ ware State B?arcl of Health, \,Vilrnington, Delaware.

DOSAGES AS 'RECOJ\:IMENDED BY THE DELAWARE STATE BOARD OF HEALTH. The early use of Antitoxin is essential. Inirnunizing Dose, 10,00 Units. Curative Dose, 2000-3000-5000 Units:

• 181 If improvement is not manifested within six hours, repeat the initial dose. If there is no marked improvement within the next six hours repeat the dose again. Then continue to repeat , the· dose every eight hours until improvement is noticeable: 3000 to 5000 units should always be used· as the initial dose in severe cases,. and especially when there has been ·delay in giving. the Anti­ toxin Treatment. STATE BOARD OF ~HEALTH OFDELAWARE, A. E. Frtintz, M. D:, · Secretary .

. DISTRIBUTORS OF DELAWARE STATE BOARD OF BEALTH DIPHTHE,RIA ANTITOXIN. New Castle County. ' . Wilmington · ...... ~., .. Watson Pharmacy. Samuel H. Chadwick. Harmonsori Drug Co. Union Drug Co. · T. H. Cappeau. . City Board of Health. Hockessin ...... •...... John .Ball,. M. D. · Newark ...... ; .. George W. Rhoades: New Castle ...... E. Challanger & Sons . . Del.. City .... : ...... ·; ..... , .. W. B. Jester. · Middleto,vn .•...... : ...... Bi;agdon & Co. . . . _· Kent Co1.1nty. Smyrna ...... Clifton & Jones. Dover ...... Atkinson Drug Co.- Camden · ...... •...... H. A. Nicker-son. Frederica ; ...... ' ...... W. F. Hoey, M. D. Felton ... : ...... J. M. Luff, M. D. · Harrington ...... Sharp & Fleming. Milford ..•...... Red St?i-Pharmacy.

Sussex County. ' Bridgeville ...... ' ... : .... , . ; . : E. J .. Elliott.

Seaford ...... '~:. ~ ,~.::':.. ;.-;N.~·F~,J-:::a~i1-es~·,M.D. ~ 0 L~urel ...... !:').(,. -~-'n.~t.[Iv:I,-a~\?51.~\'i/,\ . C C

( (' C ( 0 (' :, (' 0 C ~ C;; :.: ,:, 0 (. r: CC l' t:: <.: '- C 0 ,~ C Q C C' C (. (' C C C' 0 :: CC'' C O ,; O • C C C G(, C (' " (. ( (' ,.' C O co r C- (' C' C' " ', 0 c, C C C ~- 0 0 (' re -:;{; c, 182 Lewes ...... •..... ; .... : .... Handy. M. Long. Delmar ...... , .. ; .. Robert Ellegood. Georgetown ... ·...... , ..... Marshall & Chiprnan Co ..

I • Mpton...... : ...... W .. T. Starkey. , Millsboro ... , ; ...... , .. ; , .• J. K. Frame, ·M. D.. Selbyville ...... H. E. Evans, M. D. . G1!m~or() .. : ...... ; ... Oliver V. James,M. D. M1llv1lle ... _...... K. James Hocker; M. D,

. ) PROCEEDINGS .·.. .of the STATE BOARD' OF HEALTH o'F DELA WARE. Wilmington, Del., Sept. 23d, 1912. A Special Meeting ofl the State Board. of Health was held · ai: 504 Delaware. . . . · Present: Drs. William P. Orr, James A. Draper, C.. A., Ritchie, A. E., Frai1tz; · . · · . , .· On Motion of Dr. Draper, seconded by Dr. Ritchie, the· f~l~ l@wing resolutions ~vere passed :- · ·whereas, It has com~ to the knowledge of the State Board ··of Health that a large nurnber cif dogs in New. Castle Coul.).ty ·· are infected with ·Rabies; that'. an entire kennel of dogs in Mill. Creek Hundred were it:t£ected ,with Rabies, and the same· were· killed; that from the thi1:teenth to the nineteenth of September, a dog s11fferi11.gwith Rabies, wandered from Montchanin in . . Christiana Hundred and possibly part of Brandywine. Hundred, and said dog was killed at his. home on September 19; that the bacteriological examination of the dog's brain showed. that' he hc1dRabies.' ; . . . ·This dog bit at least seven people in the city of ~Vilmington alone, and, no doubt, a number of ·dogs. On September 22, a dog was shot near Claymont andUhat an examination' of its: brain showed that it was suffering· with Rabies. This dog bit· . on,e,ch_il(l, ,anc! 1 no, qoµbt,; a,~r.u;r~hf,~ of> }:)~gs' .through Brandywine "f:?r~\ed;,i/.:\i'/~~,)l;L:~~,~,:~T:i 1. · .. · ·

') ) ~' ,) o:,.:, ,-, );J0, -:, ') :., .) ;) 0 .;;,. ;: J ., :;, 0 ' ) ). _, ;) .-,· s} • ,) ~:;, .') 0) ~ "J ;' ,..,~ ' 'J,).) .' c: .:, C, :, ) ,) ., ) ) • O .1)) ;J,'.;l ,1 . \ 183 In view of these facts the acting m conjttnction with the State Live Stock Sanitary Board, the· State Board of Health, acting under the po\ver given it in Chapte11 642, Volume 19, Sec­ tion 3, Laws o.f Delaware "It .may make a11cl execute orders necessary to protect the people against diseases of the: lower animals," and considering that a real clanger exists from the causes ennmeratecl, hereby makes _the following orders :-

. Wilmington, Del., Sept .. 23, 19,12. The owners .of all clogs in ·Brandywine Hundred, city of Wilmington, Christiana Hundred; Mill Creek Hundred, vVhite Clay Hundred and N~w Castle Hundred; Pencacler Hundred and. Red Lion Hundred, in the $tate of Delaware, are hereby ordered to keep their cl9gs in· leash or imprisoned from Septei11ber 23, 1912 to Noveinber 1, 1912. All police dfficers o~ said city and hmidrecls are hereby, authorized to shoot 01~ kill or inipouncl any dog· found at large dm;ing the above named period, unless the clog is in leash. · · The Secretaty of the State Board of Health is hereby author­ ized to advertise the above named orders in the papers.· of Wil­ mington· and Newark. Approv:ed: WILLIAM P. ORR,, M. D., .President. Attest: A. E. Frantz, M. D., ·S,ecretary- .

.On Motion, the Executive Offi'cer of the State Boar.cl of Health is hereby authorized to appoint and to. employ, if neces­ sary, men to cai-ry out the above orders. A. E. Frai1tz, M. D., Secretary.

Wilmington, Del., Nov. 7; 1912. The Regular Stated Meeting of the State Board of Health was held this day at Ainscow's Restaurant, 802 J.\lbrket St., vVil­ mington, Del. 184 Present: Drs. William P. Orr, J. vV. Clifton, W. F. Haines; E. R. Steele, C. A. Ritchie, A. K Frantz .. The minutes of the last meeting and the last Special Meet­ ing were read and approved .. _ A letter from G. 'vV. K. Forrest, M. D., Secretary of the Delaware State Medical Society, -relative to the reporting) of Tuberculosis; was read. On Motion of Dr. vV. F. Haines, the following resolution was1passed :- · · Resolved, "That hereafter Tuberculosis, Typhoid Fever, Measles, 'vVhooping Cough, Mumps, Chicken Pox and Infantile Paralysis shall and the same are hereby included tinder the list of reportable diseases." The physicians to be ·furnished with blank forms for reporting diseases. The Secretary of the Board is hereby authorized to send to each physician in the State blank forms for reporting diseases. On Motion, the Secretary was ordered to take up the ques­ tion with H. K, Mulford & Co., for the securing of fresh stock of State Board of Health Diphtheria Antitoxin, in exchange for that which is outdated. · The question of the removal of the State Board of Health Laboratory from Newark to Wilmington was discussed, but. no definite action was taken. · The use of the Cornrnori Drinking Cup was discussed, but no. further action outside of that already taken by this Board, was ordered. · · The Secretary made a report on Rabies and its quarantine, which expired on November 1st. Adj ournecl. A. E. Frantz, 1\!LD., Secretary.

I Newark, Del., April 3, 1913. The regular Stated Meeting of the State Board of Health was held at Newark, and adjourned to Wilmington. Present: Drs. Orr, Clifton, Haines, Steele, Ritchie and Frantz. 185 Doctors Haines, Steele and Frantz present~d their re-appoint~ ment as members of the State Board of Health frorndVIarch 25th, 19;13. . The minutes of the previous meeting. were read and approved. The address of the President with its advice on health mat- . ters was highly appreciated. On motion, the following Interstate Quarantine Regulations were made part of our State Regi.1lations.

INTERSTATE QUARANTINE REGULATIONS. Paragraph 8. L~pers may be acc~ptecl for transportation under proper supervision when en route to a seaport for deporta- · tion; also ·for transportation to a designated· place for care and treatment, with the necessary consei1t of the proper health au­ thorities, provided proper sanitary precautions are enforced with regard. to the leper en .route to destination. Paragraph, 9. Common carriers shall not, under authority of Paragraph 8, accept for transportation nor transport in inter- . state traffic any person suffering from or afflicted with leprosy unless there has b_een obtained from the Surgeon General of the Public Health ancr Marine-Hospital Service or his accredited rep- . resentative a permit stating that said person may be received un­ der such restriction as will prevent the spread of the disease, and said restrictions shall be specified in each instance: PROVID .. D, That, in addition to the above, permits shall also be obtained from the health authorities of the States, Territories or districts to and from which the patient intends to travel. .

Paragraph IO. No person knowing or having reason to be~ lieve that he is a leper shall accept transportation ·nor engage in travel in interstate traffic unless permits _have been obtained, as · set forth in the. preceding -section, and unless said person shall have agreed in writing to comply with the restrictions as specified in the permits mentioned above.

Paragraph IL Any person who presents symptoms of lep­ rosy and who is traveling or who has left the State where he re­ sides, in violation of the above regulations, shall be detained, and if proven to be a leper shall be returned to such State or removed 186 to such Federal quarantine station .as ti1e Secretary of the Treas­ ury may designa_te and ,the. proper health authorities notified.

Paragraph 12. Compartments or places in· car~, vessels· or conveyances operated in. interstate traffic and that have been occupied by persons afflicted with leprosy shall 1:ie immed.iately closed after being vacat~d by the patient and so kept until after proper disinfection. · Paragraph. 13. Co'mmon carriers shall not provide in cars,· vehicles, vessels. or conveyances· operµted in interstate traffic, or · . in depots,. waiting rooms, or ether places used by passengers trav­ eling from one State or Territory or the Disti-ict of Columbia to · another· State cir Territory or the District of Columbia, any drink­ ing cup, glass or vessel for common use; PROVIDED, That this 'regulation ~hall not be held tci preclude the use of _drin\dng cups,· glasses or vessels, which are thoroughly cleaned by washing in · . boiling wate.r after use by each individual, nor shall it be held to· preclude the use of sanitary devices for individual use only, Paragraph 14. Com1;1on carriers· shall not provicl~ in ca1:s, vehicle.;, vessels or conveyances operated in interst~1..tetrafn.c, or in depots, waiting -rooms or other places used by passengers trav­ . eling from one State or Territory or the District or Columbia to . another State or Territory or the· District of Cqlumbia, any towel . for use by more thf!n one perscn; PROVIDEP, That towels may be used again after having been stei·ilized with. boiling water. . . Paragraph 15. Water p1~ovidedby common carrier.3_on cars; vessels or vehicles operated ii1 interstate traffic for the use of ' pa~sengers ·shall be hirnished under the foBowing conditions : (a) _Wate·r shall be certified by the State or municipal health. authority within whose jurisdiction it is obtained as incapable of conveying: di·sease; PROVIDED, That water in regard to the. safety of which a rea~cina:ble doubt exists may be used. if the same has been treated in such a manner as to rendei· it incapable of c.onveying disease, and the fact of such treatment is certified by the aforesaid .health officer, · . (h) Ice used for cooling such water shall be from·a:·source . the safe~y of which. is certified by the Sfate er municipal health authority within whose jurisdiction it is obtained, and before the ice is placed in the water, it shall be ·first c~refully washed with 187 water of known safety, and handled in such manner as to prevent . its becoming contaminated by the organisms of infectious or con- . tagious disease: PROVIDED, That the foregoing shall 1iot apply to ice which does not come in contact ;with the water which is to be cooled. ( c) \i\Tater containers shall be. cleanse.cl and thoroughly scalded with live steam at least once in each week that they are in operation. On motion, th'e Regulatiens of the Delaware. State Board of Health, relating to Jhe public drinking cup, were further amended as follows :- . · · · \i\Therea·s, The use of the Common or Public Drinking Cup · is known to be a soi.wee of disease and menace to·the public health, Therefore, Be it ruled by the State Board of Health of Dela­ ware that the use cf the Common Drinking Cup on railroad trains, in railroad stations,. in the .public or private schools and State . educational institutions of Delaware is hereby prohibited from and. after May 1st, 1913. No person or corporation in charge of any raikoad .train er station or public. or private school or State educational institution or State or county institution shall furnish any drinking cup for public use, and rio such person or corporation shall permit on said train or. at said station or public or private school o·r State edu­ cational institution er State or county institution, the use of the public drinking cup. · Dr. Haines reports all cases of Rabies at Seaford well. . That he. had treated five cases all successfully, no abcesses or 'other complications. The action of the President and Secretary in establishing a quarantine for dogs at Seaford was approved. A report on Diphtheria Antitoxin was made .. The report on the removal of the Laboratory from Newark to Wilmington reported-"no action having been taken by the last Legislature." Dr. Orr reported the Scarlet Fever at Milton to be well in hand, ct·, the cases were. all quarantined. · Hope Farm Drainage was taken up and on motion a Com- · mittee of Three was ordered appointed to look into the sanitary 188 conditions of Hope Farm, with authority to act. The chair ap­ pointed the following committee: . Drs. Ritchie, Draper and Frantz. ·

t On Motion, the action of the Secretary in issuing a blanket removal permit for bodies that had been interred in King St. Cemetery, between 9th and 10th, was approved. The new Bill approved by the Governor, March 31, 1.913, en­ titled, "An Act to Provide for a Uniform System of Registration of Births in the State of Delaware," was taken up for considera- · tion and action . .On Motion'. the following was passed :-Under power given imder Section 22 of "An Act to Provide for a Uniform System of Registration of Births in the State uf Delaware," the following section;; are hereby declared to be in force :-SeC;tions 1, 2, 3, 4, 9, IO, 13, 16, I 7, 18, 22. On Motion, the annual salary of, the Registrar of Vital Sta­ tistics for the Registration of Births shall be $500.00. On Motion, the Secretary \.vas authorized to have printed the necessary forms and blanks, addressed envelopes and postal cards, and attend to such other matters as are necessary for the . proper carrying into effect the Law for the uniform -system of Registrations .of Births.· On Motion, the following \vere ol'dered to be the Vital Sta­ tistics Birth Registration Districts of the State: · NEW CASTLE COUNTY- 1st District ' Brandywine Hundred Christiana Hundred Mill Creek ,Hundred vVhite Clay Creek Hundred New Castle Hundred Pencader' Hundred Red Lion Hundred . 2d District St. Georges Hundred Appoquinimink Hundred Blackbird Hundred . 189. 3d District· .· . Wilmington Hundred KENT COUNTY_:_ :ist District .. Duck Creek Hundred· Kenton Hundred 2d District' Little Creek Hundred · E. Dover Hunch:ed Vv.Dover Hundred N. Mi1rderkill Hundred C\' 3d District S. MurderkiH Hundred Mispillion Hundred . Milford Hundred SUSSEX COUNTY_: Ist District Cedar Creek Hundred · ~roadkiln Hundred. ·.Georgetown Hundred Nanticoke Hundred , _2d District Northwest Fork Hundred Seaford Hundred Broad Creek Hundred Little Cree}< Hund.red 3d District · · · Rehoboth Hundred Indiari River Hundred Dagsboro Hundred Baltii'nore H unclrecl G11mboro Htmdrecl • The following- Local. Registrars are hereby appointed· for the . •Vital Statistics Birth Registration Districts as follows: NEW CASTLE COUNTY_: rst Distri~t_:._A. E:.Frantz, M. D. 190 2d District-E: M. Vaugha1~; M,. D. . . 3d District-Secretary 6f Wilmington Board· of Healt~ '.KENT COUNTY- 1st District-). W. Clifton, M. D. 2d Distr'ict-E_. R. Steele, M: D. 3d District-R L. Lewis, _M. D . . StTSSE2\ COUNTY- . 1st Disfrict-Rowla~d G. Paynter, M, D. 2d District-'W. F. Haines, M. D; 3d District-W. P. Orr, M. D . .·The new Bill appro~~d .by the Goven'J.cir,March 31, 1913, entitle·d, "An Act to Provide for a Unifo-rm System of Regis­ frati.oh of Marri

·/ 191 . Red Lion Hundred 2d District St. Georges Hundred Appoquinimink Hundred Blackbird Hundred 3d District \iVilmington Hundred KENT COUNTY- rst District Duck Creek Hundred Kent, Hundred 2d District Little Creek Hundred E. Dover Hundred Vv'. Dover Hundred N. Murddkill Hundred 3d District S. Murderkill Hundred Mispillion Hundred l\Iilford Hundred SUSSEX COUNTY­ r st District Cedar Creek Hundred Broadkiln Hundred ·· Geprgetown Hundred Nanticoke Hundred · 2nd District N orth\vest Fork Hundred Seaford Hundred Broad Creek Hundred Little Creek Hundred 3rd District Rehoboth Hundred Indian River Hundred Dagsboro Hundred Balti1;11oreHundred 192 Gumboro I-Iundred The follo-wing Local Registrars are l1ereby appointed for the Vital Statistics Marriage Registration Districts as follows: NEW CASTLE C:OUNTY- rst District-A. E. Frantz, M. D. 2nd District-E. M. Vaughan, M. D. 3rd District-Secretary of vVilmington Board of Health.

KEN 1T COUNTY- Ist District- J. W. Clifton, M. D. 2nd District;---E. R. Steele, M. D. 3rd District-'-B. L. Lewis, M. D. SUSSEX COUNTY- 1st District-Rowland G. Paynter, M. D. 2nd District-:VV. F. I-Iain'es, M. D. 3rd District-W. P. Orr, M. I). H. J. Watson, the Bacteriologist and Pathologist, made the following rep0rt :---'

REPORT OF BACTERIOLOGIST STATE BOARD OF HEALTH LABORATORY.' To the President and Members of the State Board. of Health. Gentlemen :-,-The Laboratory is gradually forging ahead. The work is being 'submitted in a greater variety and volume than ever. Specimens requiring a special technique ai-e sometimes tested daily. Blood work having noticeably increased. . During the 1912-1913 year ending April 1st, 2455 cases were submitted, while 2262 were examined or submitted during the previotis year. The force of the Laboratory has remained the same through­ . out the year. Mr. Herdman, Laboratory Assistant, Mr. Dean a:ssisting on Tuesday afternoons, Saturday and holidays. Q'•.N ,;',• ' The Wasseman reaction will be added to the list of tests now applied by the Laboratory, Specialblood and other medium used in this -test are now being prepared in Philadelphia. 193 The examination of milk was taken up and inspection at dif­ ferent ·places through the State and will continue this year as work at the Laboratory permits. The supplies· of New Castle, . Dover, Seaford, Lewes a11d Milford were examined, and with the exception of New Ca~tle, were found to be fair. A second in­ spection of the Dover si.1pply showed a marked improvement. The New Castle milk was particularly off standard. No com­ plaints have been received lately, except from Wilmington, and · I proposed to wait and place this case before the Board. Town waters are being. constantly examined' for pollution and reported on. 'Samples cf water are taken when making in­ spections of milk. Mailing cases are distributed in the usual manner and have but few broken since the introduction of the parcel post. Marked increase in the number of cases examined for Rabies was recorded. The number of Pasteur Treatments was also above averagE;. Twenty-eight cases received treatment. No ab­ scesses were reported. All cases were successful. Resp~.ctfully submitted, HERBERT JAMES WATSON, P. D.

On Motion: the Secretary of the State Board of Health was orcle1'ed to enforce the Law relative to the Registration of Deaths in the State of Delaware, and the rulings of the State Board of Health thereon. · Dr. William P. Orr was elected President of the Board for th·e ensuing year. H. J. Watson was elected Pathologist and Bacteriologist for the ensuing year. · On Motion, adiourned. A: E. Frantz, M. D., Secretary. A special meeting of. the State Board of Health was held at the Hotel DuPont, Wilmington, at r r A. M .. Present :-~rs. Orr, Haines, Steele, Ritchie, Frantz. The minutes of the previous meeting were read a~d approved. 13 194 A general' discussion was had 011 the Interstate Quarantine Regulations passed at the last meeting. Also a discussion on the new Bill approved by the Governor March 31, 1913, relative to the Registration of Births, and the new ~ill passed at the same time relative to the Registration of marriages. The work of the Secretary, so far as it had gone fo the direc~ tion of getting up fon11s, etc., for the carrying into effect the laws, was approved. The work of the State Board of Health Laboratory was gone . over, and the work for the past year approved. · The question of drainage at Hope Farm, together with the report of the Committee, was received. The Committee reported conditions at Hope Farm in a healthful condition. · Dr. Orr reported on the epidemic of Scarlet Fever in exist- ance at Milto~ and reported it as under control. . ·· After a general discussion of health matters throughout the State, the Board on motion .adjourned. . A. E. Frantz, M. D., Secretary.

Wilmington, Del., November 6th, 1913. The regular Stated :Meeting of the State Board of Health was held at Hotel DuPont. · Present: Drs. vVilliarn P. Orr, J. W. Clifton, vV. F. Haines, E. R. Steele, J. A. Draper and A. E. Frantz.. · ' The minutes of the last meeting were read and approved. On ]'vlotion, it was ordered that the Registrar of Vital Sta-· tistics be ordered to put into absolute operation the' Law for Registration of Births, Deaths and lVIarriages. The Secretary reported on the condition of Rabies through­ out the State. Also reported on Diphtheria Antitoxin in the State. Also the Birth Registration in conformity with the Law, which went' into effect on July 1st,, 1913, was taken up and dis- 195 · c.ussed with the consensus of opi!J.ion among. the Board that its provisions were being lived up to; as well as could be expected in so short a length ott time ; and that some p]:iysicians were. still negligent in. their duties of reporting births. The Marriage Registration Law,· which went into effect July 1st,· 1913, is believed to be in good' operation; and' reports from the ministers I are believed to be practically full. ·

The Registration of Deaths is practically IOO% ; no Deaths' in the State, to the knowledge of any of the Loc~l Registrars, being unrecorded. . · . · · · · . . . : . . . On M.otion of Dr. Draper, seconded by Dr. Haines the fol­ lowing rule or regulation governing the milk supply in the State ~was adopted:. All Milk offered for sale in the State of Delaware, whether · wholesale or retail( shall meet the following standard: . Fat, 3.25% Solids (not fat), 8.5% Bacteria not over 250,000 per cubic centimeter No preservatives of any des·cription 'to be placed in the milk or cream. Carried. · It was brought to the attention o.f the. Board that some un­ dertakers if].the ~tate were violating the Rule of the State Board of Health, relative to the depth that dead bodies must be buried, and the Secretary was ordered to notify the undertakers of the Lawgoverning this matter. . After a general ·discussion of the health conditions in the . State, the Bo~rd on Motion adjourned. A. E. I

Wilmington, Del., April 2d. 1914. A Stated Meeting of ·the State Board of Health was held at Newark. Not q,eing a quorum present, the Board adjourned to' Hotel DuPont, \i\Til111ington,Delaware. . · I • ~resent: Doctors William P. Orr, J. W. Clifton, E. R. Ste_ele,.w. f. Haines, C A. Ritchie, A. E. Frantz. 196 Th~ miputes o.f the previous meeting were read and approved. The President made a short .address. On Motion of Dr. Haines, seconded by Dr. Ritchie, tlie fol­ iowing preamble and resolution was passed : vVHEREAS, a quarantine on clogs has been established· by the State Live Stock Sanitary Board in Reel Lion and St. Georges 'Hunclrecls, and whereas, there are other sections of New Castle Country where rabid dogs have lately been destroyed, and where~ as, ·the Pennsylvania Live Stock Sanitary Board is 110\v co1i.duct­ ing a. quarantine of clogs in Chester and Delaware counties, Pa., the. State Board of Health hereby requests the Delaware State Live Sfock Sanitary Board to extend the quarantine now in op­ eration for Rabies, to include all of New Castle County. In case the State Live Stock Sanitary Board does not· establish such a . quarantine of all dogs in New Castle County, said quarantine to continue for ninety clays froni the elate of the establishing of said quarantine, and said time and said quarantine shall elate from the elate of an order given Qy the President of this Board. All clogs, during said quarantine, must be strictly: confined or firmly secured on the premises of their owners, and not allowed to run at large oi· enter any public highway excepting when led_or' when muzzled with· a well-fitting inuzzle that will effectuaily prevent biting, and· any dog not being· secured or muzzled as aforesaid . may be secnrecl' and. confined or may b,e shot or otherwise de­ stroyed by ;my officer of the Law or by any person without lia­ bility therefor. The following preamble and· resoilution was adopted and · passed: WHERE,AS. a lari;"e number, of ·the cattle furnishing- milk for the people of this State are reported, by the State Tubercu­ losis Society, to be tubercular. and having in mind the protection of the health of the people of this State, THEREFORE, BE IT RESOLVED, that ·the State 'Live Stock S::initar_vBoard be requested to have all cattle tested for Tuberculosis. . The Secretary made a report on the existence of Smallpox at Toughkenamon, Pa:, and i·eported having establjshed a quar- 1~7 . antine against trolley riders from said infected town to points in Delaware. : The report of Herbert J. Watson, Pathologist and Bacteriol­ ogist of th~ State· Board of Heil.Ith, was read, accepted and order­ ed to be .filed. . . On Motion; the Secretary was authorized to appoint, when and where necessary, deputy milk' inspectors or collectors in the State of Delaware. ' William P. Orr, M. D.,was elected President for the ensuing· year. On motion, Herbert J. ·Watson, P. D., was elected Patholo­ gist and Bacteriologist for the ensuing year at a ,salary o.f $500.00 per quarter. ·0~ Motion, the Secretary was ord~red to prepare the follow­ . ing amen_dmepts to our Laws for .presentation at the next session of the Legislature.. · Amend Volume 27, Chapter 84, Section 8. By inserting the words· "or .any Local. Registrar" in the first line of said Section 8, immediately after the word "Registrar." . . Amend Volume 27, Chapter 85, Section 14. By inserting the words "or any Local Regist~ar" in the first

Jine of said I Section. 14, immediately after the word ('Registrar." · Amend Volume 20, Chapter 240, Section 5. By striking out the words ·"at Newark," and ihserting the. words "at_ the place designated by the P1.. esident. of the Board." WHEREAS, the object of Volume 27, Chapter 85, Laws 6£ Delaware, is to secure full and complete returnsot all Births oc- curing in Delaware, and;.:.._, · I . WHEREAS, Section· I empbwers the State Board of Health to "promulgate any additional forms and amendments that may be necessary for this purpose." Therefore, on Motion of Dr. Clifton, seconded by Dr.'Ste~le, the following amendment was p~ssed : 198 The State Registrar of Vital Statistics, or any Deputy he may appoint for the purpose, or any Local Registrar shall have access to the Minntes, Records or other memoranda pertaining to the record of any Birth occurring, or which has occurred in this State, that are or should be on file or on record in any religious denomination, or any religious society or any other organization or body, or any family record, or any physician's record or mid­ wife's record, or other places where births may. be recorded. WHEREAS, the object of Volum¢ 27, Chapter 84, Laws of Delaware, is to secure full and coniplete returns of all Marriages occurring in Delaware, and;- · WHEREAS, Section r empowers the State Board of Health to "promulgate any additional forms and amendments that may be necessary .for_this purpose." Therefore, on Motion of Dr. Haines, seconded by ·Dr. Clif- ton, the following amendment was passed: · The State Registrar of Vite~! Statistics, or ,any Deputy he may apr.,oint for. the purpose, or any Local Registrar, shall have access to the Minutes, Records or. other 111emoranda pertaining to the record of any marriages performed in this State, that are or should be on file in any Clerk of the Peace's office, any Jus­ tice of the Peace's office, any religion de·nomination or. any re­ ligious society, or other organization or body keeping records of. marriages.· . . ·A. E. FRANTZ, M. D., Secretary.

·Wilmington, Del., Nov.' 5th, 1914. The regular stated meeting of th.e State Board of Health was held at the Hotel DuPont, Wilmington. Present :-Doctors William P. Orr, J. W. Clifton, W. F. Haines, E. R. Steele, P. A. Di-aper, C. A. Ritchie, A E. Frantz. The minutes of the last meeting ,v.ere read and approved .. The President made a short address.

· 01_1 Motion of Dr. W. F. Haines, seconded by Dr. J. W. Clif­ tot1, the following rule and regulation, f-elative to -Postal Card Reports from undertakers or p~rsons acting as such, ..was passed: 199 · Any undertaker, or person acting as such, shall, immediately or within twenty-four hour,s after receiving an order for the burial or other disposition of a dead human body, and securing the death certificate thereof, notify the State Registrar of Vital Statistics of such fact on a form supplied by the State Registrar of Vital Statistics. This forn1 shall contain the following infor- mation;-, · rst-Full name of Deceased . . 2nd-Place of Death. 3rd-Date of Death. 4th-Age. 5th-Color. 6th Cause of Death. 7th-Physician or Coroner giving the Death Certificate. 8th-N arne of undertaker and his address. This postal card report shal! in no way supplant the La,vs . cf Rules and Regulations now in force. An.y violation of this rule and regulatipn shall be punished as provided for other violations of the Law or Rules and Regula­ tions of the State Board of Health. On Motion of Dr. J. A. Draper, seccnded by Dr. Steeie, the following rule and regulation was passed:- , The following diseases are hereby declared by the State Board of Healtl;i of Delaware to be dangerous to the public health, and n111stbe reported immediately to the Bureau of Vital Statis­ tics of the State of Delaware, upon blanks provided for that pur-. , pose. The. report, signed by the physician in charge of the case, or if no physician is in charge, then by the householder or other person in charge of or ministei·ing the case, building or institution, shall state the disease, the name, the age, the sex, the color of ·the patient, the durati.cn of the. illnesss and the exact location of the house or room occupied by the patient, and when more than one.,case· exists in the same household or on the same premises, each case shall irnm(:!diately be separately reported. Anthrax Asiatic Cholera . Bubonic Plague Cerebra Spinal Meningitis · Chicke11 Pox ; 200. '-" Cholera Irtfantum . . Diphtheria ( Membraneous Croup) Erysipelas Glanders .·1 Hook Worm. Disease 't · Leprosy Malaria . · Measles ( all forms) · Mumps Opthalmia N eonatorum Pellagra · Pneumonia. Polio Myelitis' Puerperal Fever Rabies · · ' Scabies1 . . . . Scarlet .Fever ( Scarletina, ·.Scarlet Rash) .. Small Pox (Varialoid) · Tetanus. . · 1 Trachoma . . Tuberculosis (A11 respiratory f?nns) · Typhoid Fever· Typhus Fever Whooping, Cough ' · · Yellow Fever On Motion, the following rules and regulation was adopted: No person, firm·or corporation-shall et).gage in i:he·prodi.tction · of milk or <;rea1i1for sale without first registering their name _and address with the State -Board of Health. of' Delaware, and said · person, firm or corpo1-ation shall on i:he.first day of January in, each year notify tbe State Board of Health of Ist.:._The nt~mber of cows in their dairy .. · 2d-The Breed or Breeds, and the number of each Breed . . 3d-I£ whqlesalers of milk or cream, the name of the party

. -or parties. to whom. the. milk or. cream is ) sold: On Motion, the f_~llowingRule and Regitlation was adopted : . No person, .firm·. or corporation· shall engage in the sale of milk or cream in the State of Delaware without first registering ·their name and address with. State Board ofl Health, and in. regis-: 201 tering shall specifically state whether they retail or wholesale milk or cream. On Motion, the following rule and regulation was adopted : Any person who sells milk, either t~ milk dealers, or private families or to' a creamery, shall report within twenty-four hours to the nearest Local Board of Health, and also to the. State Board of Health, the existence of any of the following contagious or infectious diseases: · Anthrax Asiatic Cholera Bubonia Plague " Cerebro Spinal Meningitis Diphtheria (-Membraneous Croup) Erysipelas Glanders J;_;eprosy, Pellagra Polio Myelitis Puerperal .Fever Scarlet .Fever ( Scarletina, Scarlet Rash) · · Small Pox Typhoid Fever Typhus Fever · Yellow Fever

which eixsts on the premises; from which said milk originated, tog·ether with the names and addresses of any persons served · with said milk. If said premises, from wliich said milk is se­ cured, is a. source of danger of infection to the milk supply, said milk shall not be sold or delivered to anyone. If, however, the location 9f the dairy and milk house and _attendants is such as not to endanger the infection of said ·milk, then said milk may, after securing a written permit from the State or Local Board of Health, be: sold or transported. All reports m~st be made on blanks furnished by the State Board of Health. · Failure to comply with this rule invokes the penalty to comply with the rules ancl regulations of' the State Board of Health. · 202 011 Motion of ,Dr. J. A. Draper, seconded by Dr. C. A. · Ritchie, the follcivving rule and regulation was adopted: Every house1 in which a case of Ai1thrax Asiatic Cholera Bubonic Plague Cerebro Spinal Meningitis Chicken Pox Diphtherra (Membraneous Croup) Leprosy · Measles Polio Myelitis Scarlet Fever ,( Scarletina, Searl.et Rash) Small Pox Typhoid Fever Typhus Fever Whooping Cough Y eltow F ~ver has occurred or exists, shall be immediately properly placarded by the Local Board of Health, in· all incorporated towns, and when outside such health limits, then by the physician or person in 'charge of the case, and remain so until the end of the quarantine. The follmving diseases shall be quarantined by. the following colored placards : · Red __:_ScarletFever Blue -Diphtheria ·white -Chicken Pox Measles Typhoid Fever Vlhooping Cough Green -Cerebro Spinal Meningitis Polio Myelitis · · ' Yellow-Anthrax Asiatic Cholera Bubonic Plague . Leprosy . Small Pox Typhus Fever Yellow Fever 203 All the requirements as at present provided for by the Law and other rules and regulations of the State Board of .Health must be complied with. · On Motion of Dr. J. A. Draper, seconded by Dr. C. .A. Ritchie,· the follow·ing Rule and Regulation was adopted: Ev~ry house in \vhich a case of Anthrax Asiatic ·cholera Bubonic Plague Cerebra Spitpl Meningitis Diphtheria .( Membraneous Croup) Leprosy · · Measles Polio Myelitis Scarlet Fever (Scade.tina, Scarlet Rash) Small Pox (Varialoid) Yellow Fever· exists shall be immediately quarantined by ti1e Local· Board of · Health in all incorporated towns, and .when outside such health limits, then by the ,physician or person in charge of the case. On · Motion of Dr. VI/. A. Draper, seconded by Dr. C. A. Ritchie, the following rule and regulation was adopted:- Every house 111which a case of Anthrax Asiatic Cholera Bubonic Plague Cerebra Spinal Meningitis· Diphtheria ( Membra11eous Croup) Leprosy Polio Myelitis . Scarlet Fever ( Scarletina, Scarlet Rash) Small Pox (Varialoid) Tuberculosis (Pulmonary) Typhoid Fever Typhus Fever Yell ow Fever has occurred or exists, shall be completely disinfected upon the recovery, death or removal from such house of the patient or . patients having any of the above mentioned diseases. All the , 204 requirements as a:t present provided for by the Law a1id other ru\es and regulations of the State Board of Health must be com­ plied with. On Motion the Secretary was ordered .to prepare, have printed and distribute the necessary forms, letters, etc., to carry into effect the above passed rules and regulations. · · The Secretary reported 011 the health conditions throughout the State . · . ' The Secretary reported that the Vital Statistics were being well reported throughout the State. · The Secretary reported having fully gone over the revised code of the State of Delaware, before its passage, and. that its provisions comply with, the former health laws of the State. The Secretary reported· the violation and resistance to the State Quarantine Laws by the family of Benjamin.McNatt, living \vest of Harrington in Kent County. He also reported that Dr. Steele was placed in charge .of this quarantine, and it was the consensus of the opinion. of the bo.ard that after the family had been fumigated, the Law should be fully enforced relative to.pun- ishment of this case. · The report of H. · J. vVatson, Pathologist and Bacteriologist, for the past six months, was received. Said report showed tlie good workings of our Laboratory, and the good work it is doing. A. E. Frantz, Secretary;

Wilmington, Del., April r, 1915. . . .The Annual Meeting of th~ State Board of Health was called for Newark. There not being a quorum .present; the Board ad- journed to Hotel DuPont, vVilmington, Del. · Present: Doctors \Vm. P. Orr, vV. F. Haines, E. R. Steele, C. A. Ritchie, A. E. Frantz .. The minutes of the previous meeting were read and apprnved. · The President made a short address. \Vm. P. Orr, M. D., was elected President for the ensuing year.· ·205 A. E. Fi·antz, M. D., was elected Secretary arid Executive Officer. · · Herbert. J. Watson,· ,Ph. D., was elected Pathologist and Ba~teriologist for the ensuing year at a salary of $500 per quarter .. · On Motion, Doctors Ritchie, Draper and Steele were .ap­ pointed a Committee to. audit the acccunts of the State Board of Health. - · ' · The Secretary made a report on hea:lth conditions in ' the State. · · . · · . , · . . The report of H.J. Watson, Pathologist and Bacteriologist for the ,past six months was received. · The report showed the gcod workings of our Laboratory, and ·specially noted the i,n­ creased work being clone at that institution. A. E. Frantz, Secretary.

Wili11ington, Del., May 6th, 191,5. A Special Meeting of the State Board of Health was held this day at 504 Delaware .Ave. · Pr~sent: Doctors Wm. P. Orr, J. W. Clifton, C. A.,Ritchie, E. R. Steele, A. E. Frantz. The minutes of ·the previous meeting were read and ap­ proved. The report of the Specia.} Committee appointed at the last 111eeti11gwas read, and the· recommendations of the 'Committee were adopted. On Motion the following was adopted: On and after this date all bills shall be paid quarterly. G~i1eral health conditions of the State were discussed and on · motion adjourned. A. E. Frantz, Secretary.

Wilmington, Del., July :rst, 1915. ' . . A Meeting of the State Board of Health was held at 504 Delaware Ave. 206 Present: Doctors Wim. P. Orr, W. I<.Haines, E. .R. Steele, J. W. Clifton, C. A. Ritchie, A. E. Frantz. · ·

The minutes of the previous meeting were read and approved, 1 On Motion of Dr. Haines, seconded by Dr. Steele, the fol­ lowing was passed : That in the future the State Board of Health shall purchas~ only returnable Diphtheria Antitoxin. On Motion of Dr. Haines· ,seconded by Dr. Steele, the fol- · lowing was passed: ' . That the office o,£ the State Board of Health be moved .to Dover within the next sixty clays. • On :Motion of Dr. Ritchie, the tallowing was passed: That each member be allowed Ten Dollars and expenses for special services at each\ special meeting of the State Bi;:iarclof Health. · After a general discussion of health matters, the Board on · motion adjourned. A. E .. Frantz, ·secretary.

Wilmington, Del., July .8th, 1915. A Special Meeting of the State Board of Health was held this day at Dover, Delaware. Present: Doctor~ Wm. P. Orr, J. W. Clifton, 'N. F. Haines, 'E. R. Steele, C. A. Ritchie, A. E. Frantz. The minutes of the previous meeting were read and approved. . . . The report of Dr. Ritchie, as a special committee on the advisability of electing a Treasurer, was. read, and 'bis recom­ mendation of not changing the present methods was approved. 'Governor Miller was present at the meeting,, and conferred with the Board on a number of matters pertaining to the wel­ fare of the Boa1'd of Health. , . On Motion .of Dr. Ritchie, seconded by Dr. Clifton, the elate 207 :of the removal of the State Board. of Health office ¥:as po;tported · to October 1st, 1915. .· A-'E.. fratJtz, Secretary.

Wilmington, Del., October 7th, 1915: A Special -Meeting ·of the State· Board of Health was held this day af the DuPont Hotel, Wilmington, Del. , · · Present: 'Doctors Wm. P. Orr, W. F. Haines, J'. A. D'r~per, · E. R. Steele, C. A. Ritchie, A. E. Frantz. The ri:1inutes of the previous meeting/ were read and · ap- . ·proved.' · · . On Motion of Dr. Draper, seconded by Dr. Hai~es,. the · President was authorized to appoint a Committee of. three, one of whom shall. be the Secretary, to look into quarters for the office of the. State Board of Health at Dover, and that the titne of the removal of the office of the State Board of Health shall be held in abeya11te un.til the. report of. the Committee. Tli.e President appointed Dr, Orr, Dr. Steele _and',Dr. Frantz. Th~ Secretary reported that the insanitary ditch ~onditions in Delmar had been abated and that plans were being formulated for the sewering and a disposal plant in conjunction with Mary­ land, Delmar. ' . Tl~e Secretary reported that tl~e railroad camp ~t Elsmere, • which 'was fpund to be in an insanitary condition, had all the nuis;mces ,abated and that-the camp was now in good condition. ·

" · · T-he Secretary n1ade a :report on th1e. ·Rabies quarantine in Ken~ County. · The Secreta~y reported pr.ogress relative, to State Board ~f Health Diphtheria Antitoxin. · After a general discussion of the_ public health matters in · the State, the Board on ·Motion: adjourned. ·

A. 0E. Frantz, Secretary.

Wilmington, Del., Noveinber 4th, 1915._ The ·r~gt~lar Stated Meeting' of the Stat~ Board of Health·· 208 was held at the• office of the State Board of Health, 504 Dela­ ware Ave~ Present: Doctors J. ;N. Clifton, W. F. Haines, C. A. Ritchie, J. A. Draper, E. R. Steele, A. E. F'rantz. · ·

. The President, Dr. Orr, not being present, Doctor l W 1 Clifton was chosen to preside. The minutes of the last rneeting were read and approved. ' . On Motion the following preamble and resolution was passed:. \i\Tbereas, the National Bureau of Education and the Chil­ dren's Bm'eau of the Department of Labor have been invited by . the State Beard of Education to make a survey of the school con,­ dition and home environment, as reflected .by the schools in the State of Delaware. , Be it resolved, that the State Board of Health requests the Surgeon-General of the United Sfates·.Public Health Service to ·co-operate with the above mentioned agencies in a survey of· school conditions in such parts of the State of Delaware as may be deemed expedient from the standpoint of sanitation, which subject is of interest to both the State Board of Education and ' the State Board of Health. · · The Secretary of the State Board of Health is hereby author­ ized to take such steps as may be necessary to secure such a co­ operation, and the Secretary is hereby anthorized to deputize such representatives of the Dnjted States Public Health Servi~e, as may be necessary for a thorough and coniplete survey of the abcve mentioned subjects. On Motion, Dr. C. A. Ritchie and A. E. Frantz we~e ap­ pointed a .Committee to investigate the Jute .Mill, situated at 14th & Railroad. Ave., vVilmington, Del., and give their opinion as to whether the dust, arising in the process of manufacture there, was detrimental to the health of any employees under six~ teen years of age. The findings to be reported to the Labor Commission of Delaware, in response. to the said Labor Commis- sion's letter of .inquiry, elated October r rth, 1915. · · The Chairman of the Committee, appointed at the October 7th Meeting to look into quarters for an office for the State Board 209 of Health at Dover, being absent, there w1as no report from the Committee. After a general consideration of health conditions through­ out the State, the Board on motion adjourned. A. E. Frantz, Secretary. !

REPORT" OF THE PATHOLOGICAL AND BACTERIO­ LOGICAL LABORATORY FROMJULY 1st, 1912, TO DECEMBER 31st, 1914. Newark, Delaware. State Board of Health of Delaware- Gentlemen : I beg leave to submit the following report or. the Pathological and· Bacteriological Laboratory for the biennial period from July 1st, 1912, to July ISt, 1914. This report also includes the six months ending December 31st, 1914. I remain, Respectfully yours, HERBERT JAMES WATSON, P. D., Bacteriologist & Pathologist. The Laboratory is located on the third floor, of the east wing, of the main building of Delaware College. These rooms are as follows: Office :ind Library, Chemical, Water, Storeroom, and a large room for various purposes. With the above mentiol)ed · rooms, the Laboratory has ample space to execute the functions of this department of the State. The large room has been thor­ oughly overhauled to t'neet the increasing number .of applicants taking the pha3:maceutical examinations. . The State Board of Pharmacy continue to hold their writ­ ten and practical examinations in the ·State Board of Health Laboratory at Newark. These examinations ,are held quarterly and om; rooms are almost indispensable, as closets are beneath the tables to store the· apparatus and utensils necessary for the practical examination. · Many thanks are due to the College for the use of these rooms. The Trustees of Delaware College also supply the Lab­ . 14 210 oratory with free light, heat, gas and water. The rel~tions with the College have been exceedingly plea~ant. · During the ,last two years, an ·unusual increase ·in specin1ens - is recorded. The value of the Laboratory is rapidly being rec- · ognized. Twenty-six hundred, thirty-nine specimen.s' being sub- " mitted during the r9i2-r9r3 year. Twenty-eight hundred,.eighty · were recorded for the· 1913-1914 year. Giving a total of 5519 15pecimensfor the two years against 4377 specimens for .the two previous yea1's, making an increase of JI42 within the la:st two years. Twenty-two thousand, five hundred being si.tbmitted dur­ ing the fifteen ye;;trs. Sixteen thousand, five hundred of this· number being tested within the past eight years. Six Months Ending Decemb.er 3r, r9r4. In order to ·conf~rm with other States, the Laboratory has . · adopted the plan of ending the year on December 31st, instead of · June 30th: · ·

.YEARLY RECORD·. OF SPECIMENS SUBMITTED TO THE STATE BOARD OF HEALTH LABORATORY • I ' • • OF DELA WARE Year Ending June 30, 1899 Specimens " " " " 1900 " " " " " 1901...::...1067 " " " " . " 1902 _;_ 873 ." " " " , " 1903 - 777 '" " " " " r904·~ ro23 " .. " " " 1905 .,- 1072 " " "· " " I 906 -,-- . 869 " " " " " 1907 ~ rr-57 " " " " " 1908 ·-:- 1644 . " " " " 1909-: 1664 " " " " " 1910 - 2040 " " " " " . r9rr - 2072 " " " " r9r2 - 2305 H " " " " J9r3....,...2639 " " " 1914 - 2880 " " " ·". Six Mo. " Dec. 3r, 1914 - 1847

Total 23,929 " .1 · 211 At the rate the specimens are being .submitted during the present year, marked gains over past years, are assured for the. future. Since the Parcel Post has been established, we· very seldom have a· broken container. About one specimen every two 1-veeks and sometimes a longer period is passed before we have another broken case. · The Laboratory is preparing and shipping free of cost, ex­ cept in a few instances, five thousand, five hundred mailing tubes to the various mailing-case stations throughout the State. A list of these stations will be mentioned in this report. Very ft;w changes have been made in these tubes. The urine and water cases contain a three ounce bottle instead of the four ounce bottle previously used. Water bottles with wooden cases for shipping by. express have also been prepared and. found satisfactory. The cases in many instances are shipped by Parcel Post with a saving of twenty to forty cents a shipment. A case for transmitting blood,. urine and feces is under· preparation. Such cases being used for typhoid suspects. The number of Pasteur Treatments given by the State Board of Health Laboratory appears to double. every two years. Fifty­ four ~ases were treated during the· last two years. The number for the two years ending in 191 Iand 1912 was twenty-five Pasteur Treatments, while in 1909 and 1910 but six patients took the treatment. During the two years, thirteen hundred, fif.ty closes of Pasteur Vaccine were prepared by the Laboratory with only one abscess reported.. Forty-five hundred dollars being saved to the citizens of the State of Delaware. One Thousand Dollars more than the Laboratory Appropriation for a year. All treat­ ments successful. The survey of milk and water supplies of the entire State is still in progress and unlooked for results are being obtained. The detailed reports of these inspections being submitted in1- . mediately on cornpletionof the analysis. The collaboration with the \i\Tilmington Inspect9r of Milk, Mr. Grantland, was under­ taken with much success. The State inspections shall be con­ tinued regardless of season. Much work has been received from the Attorney-General's Offi.ce.·. 212 Mr. Rowland Herdnn~1 was Laboratory Assistant during the two years. Mr. Simpsoi1 Hoffecker assisting! Mr. Herdman from July 1st, 19r3 to May, 19r4. 1Vfr. Archie De::in assisting during the summer months both years. Gilbert George, P. S., c.onducted. the Laboratory during August, 1913 .. A trained assistant in bac­ teriology is necessary if the ,vork of the Laboratory and surveys are to continue satisfactorilv. . ' The inst::illation of a Fraes Electric Incubator has been a decided improvement over the gas incubator nsecl, many years. As the pa·st si.x months are to be included in this report, the changes in the Laboratory force, should be mentioned. Rowland Herdman and Archie Dean, B. S., have resigned during the past six months. George James acts as Laboratory helper.

SUMMARY OF ANALYSIS-LABORATORY YEA~ JULY

l, 1912 TO JULY 1, 1913. I July, '1012 :-Sputum, 41; Typhoid, 31; Diphtheria, 7; Urine, 62; vVater, 42; Miscellaneous-Calculus, 1; Fece~, 2; Malaria, 7; Ptis, 5 ; Typho Bacterin, 1 ; Uterine Discharge, 2; . Rabies, 1 ; Milk, L Total, 203. Town \Vater-Dover. August, 1912 :-Sputum., .30; Typhoid, 84; Diphtheria, 12; Urine, 67; \Nater, 26; Miscellaneous-Milk, 6; Pasteur Treat­ ment, 3; Rabies, 4; Feces, 3 ; '1\!Ialaria,2; Blood, 2 ; Duck, 1 ; Bux, · 1; U:terine discharge, 3; Vaginal Discharge, 1; Typho~Bacterin, r. Total, 246. · Town \i\Tater-Newark. September; 1912 ::-Sputum, 39; Typhoid, 69; Diphtheria, 26; Urine, 47; Water, 53; Miscellaneous-Malaria, 4; Rabies,· 5 ; Malthop, 1 ; Milk, r ; Organs for Poison, r ; Pasteur Treatment, 7; Typho-Bacterin, r. Total, 254. Town vVater-Dover. October, r9r2-Spt1tum, 4r ; Typhoid, 35; Diphtheria, 25; Urine, 55; vVater, r8; Miscellaneous-Stomach Contents, I; Bacterin, :t; Rabies, 2; Malaria, IO; Pus, 4 ;. Milk, 1; Vaginal Discharge, I. Total, 194. 213 November, 1912 :-:-Sputum, 28; Typhoid, 39; Diphtheria, 49; Urine, 69; \tVater, 14; Miscellaneous-Pasteur Treatment, IO; Bacterin, I ; Solution, I ; Stomach, I ; Malaria, 8; Rabies, 5 ·; Pus, 8; Blood, 2; Cider, I ; Bervine, 1 ; Stomach Contents, 3. Total, 233. December; 1912 :-Sputum, 35; Typhoid, 13; Diphtheria, 44; · Urine, 51; Water, 17; Miscellaneous-Milk, 5; Rabies, 2; Ma­ laria, 2; Pus, 2; \tVhiskey, I; \tVorms, 2; Beer, r. Total, 175. I January, 1913 :-Sputum, 26; Typhoid, 16; Diphtheria, 32; Urine, 64; \hlater, 9; Miscellaneous-Pus, 6 ;_Rabies, 2; Malaria, 3; Secretion, 1 ; Milk, 1. Total, 160. Town \Vater_:Seaford. February, 1913 :--Sputum, 48; Typhoid, ·15; Diphtheria, 32; Urine, 77; Water, 12; Misce]laneous-Feces, 1; Pus, 3; Blood Coi.mt, 1; Malaria, 5; Milk, 8; Rabies, 6; Vaginal Pus, 3; Pas­ teur Treatment, 6. Total, 217. Tcwn Water-Nevv Castle, Dover. :i\1arch,. 1913 :-Sputum, 38; Typhoid, 15; Diphtheria, 18; Urine, 84; Water, 6; MisceUaneous-Milk, 1; Blood, 5; Poison, l ; Rabies, 2; Mabria, 6; Pus, 5. Total; I 18. · April, 1913 :-Sputum, 40; Typhoid, 26; Diphtheria, 12; Urine, u9; \tVater, 14; Miscellaneous-Pus, 8; Rabies, 3·; Poi­ son, 2; Food, 2; Pus, 2; Feces, 2.; Malaria," 4; Tissue, 1; Stomach, l; Blood Count, I. Total, 237. May, 1913 :-Sputum,· 34; Typhcid, •42; Diphtheria, 25; Urine, 139; \tVater, 16.; Miscellaneous--Meat, 1 ; Ducks, 1; Feces, 1 ; Discharge, 1 ; Calculus, 1 ; Medicine, 1 ; Blood Count, 1 ; Cider, I; Stomach Contents, 2; Rabies, 3; Pus, 3; Pasteur Treatment, 5; Milk, 7; Malaria, 9. Total, 293.

June, 1913 :_:Spt1tum, 41; Typhoid, 38; Diphtheria, 22; Urine, 85; ·water, 37; Miscellaneous-Malaria, 7; Pus, I; Milk, 4; Feces, 2; Liquor, I ; Rabies, 4. Total, 246. Town \Vater-Dover, Laurel, Newark. July, 1913 :-Sputum, 39; Typhoid, 58; Diphtheria, 22; Urine, 100; ·water, 51; :Miscellaneous-Blood COLrnt, I; Malaria, 26; Rabies, 4; Pasteur Treatment, 8; Ccw's Milk, IP; Goat's 214 Milk, 1 ; Pus, 3; Food; 1 ; Bacteria, 11 ; Liquor, 1 ; Feces, 1 ; Blood, ' I. Total, 338. · August, 1913 :-Sputum, 29; Typhoid, 55; Diphtheria, 13; Urine, 70; Water, 40; Miscellaneous-Malaria, 22; Bacterin, 5; Blood Count, 1 ; Milk, 9; Rabies,,3; Pus, 2; Pus from Abscess, 1 ; Pasteur Treatment, 2. Total, 252.

September, 1913 :-Sputum, 25; Typhoid, 69; Diphtheria, 19; Urine, 80; vVater, 12; Miscellaneous-Bacterin, 2; .Malaria, 5 ; Parasite, 1 ; Pus, 2 ; Anthrax, r ; Rabies, 4; Pasteur Treatment, 3; Chickens, 2; Human Milk, 3; 'Milk, 3; Blood Count, 3; Tis­ sues for T. B., I. Total, 238. October, 1913 :-Sputum,' 26; Typhoid, 42;. Diphtheria, 19; Urine, 94; \A,Tater,1_6; Miscellaneous-Malaria, 7; Human Milk, _ 7; Pasteur Treatment, 1 ; Rabies, 4; Cat head, 1 ; Milk, 2; Blood Count, 1 ; Hori Ale, 1 ; Pus, 2. To_tal, 223. November, 1913 :-Sputum, 42·; Typhoid, 41; Diphtheria, 35; Uririe, 81; vVater, 20. Miscellaneous-Malaria, 7; Rabies, I; Pus, 5; Blood Count, I ; Urine for T. B., I; Pasteur Treatments, 3; Pus for T. B. (Cow), I. Total, 238. December, 1913 :-Sputum, 28; Typhoid, 43; Diphtheria, 19; Urine, 97; vVater, 19; MisceHaneous--Baderin, 2; Malaria, I; Rabies, 3; Pasteur Trt;atments, 3; Human Milk, I ; Pus, 4. Total, 215. January, 1914 ::-Sputum, 35; Typhoid, 21'; Diphtheria, 38; Urine, 92; \A,!ater, 5 ;:Miscellaneous-'-Blood Count, 1; Malaria, 2; Milk, 1 ; Pus, 5; Calculus,_ I. Total, 202.

February, 1914 :-Sputuni, 36; Typhoid, 13; Diphtheria, 27; Urine, 100; Water, 9; Miscellaneous--'1/falaria, 2; Urine T. B., 1 ; Blood, I ; Rabies, 3; Pasteur Treatment, I ; Milk, 2; Human Milk, 2; Pus, 3; Semen, 1 ; Stomach Contents, I. Total, 202. Town Water-Dover. March, 1914 :-Sputum, 38; Typhoid, 22; Diphtheria, 36; Urine, 108; Water, 1 I; Miscellaneous-:Cacterin, I; Blood Count, I ; Malaria, 2 ; Rabies, 4; Milk, 8; Human Milk, I ; Pus, 7; Feces, I; Stomach Contents, 2; Liquor I; Urine for T. B., I; Nasal· Discharge for gonoccus, 2; Ascetic Fluid, I. Total, 247. Town. Water-Smyrna.

._/ 215 April, 1914 :-Sputum, 46; Typhcid, 23; Diphtheria, 18; ·urir;ie, 75 ;' Water,· 14; Miscellaneous-Malaria, 6; Rabies, 3; ;Milk, 2; Human Milk, 1; P11s,8; Urine for Gonococcus, 1; Stom­ ach Contents for Blood, I ; Tissue, ·2. Total 200 . . Town \i\Tater-Dover, Delaware. Ice Water-Georgetown. , May, 1.914:-Sputum, 5 I ; Typhoid, 42; Diphtheria, 23; Urine, 90; Water, 23; MisceHaneous-Blood Count, 1; Malaria, 3; Rabies, 3; Milk, 1; Human Milk, 1; Pus, 8; Semen, 1; Scrap- ings, I. Total; 247. · June, 19i:4 :~Sputum, 39; Typhoid, 30;. Diphtheria, 13; Urine, IOI; Water, 27; Miscellaneot\s-Blood Count, 1; Malaria:, 5; Rabies, r ; Pa,steur Treatnient, I ; Milk, 46; Cream, 3; Pus, 8; Liquor, 1; Drugs, l. Jotal,°278. Town vVater-:-Dov·er., Milk--:-Wilmington-D6ver. · , June,. 1914:-Sputum, 39; Typhoid, 30; Di)?htheria, 13; Urine, IO~; Water, 27; Miscellaneous...:...... BloodCount, 1; Malaria:, 5; Rabies, I ; Pasteur Treatment, 1 _;Milk, 46; Cream; 3 ; Pus, 8; Liquor, 1 ; Drugs, I. Total, 278. Town Water-Dover. Milk-Wilmington--,-Dover.

SUMMARY OF ANAI,:.YSES-LABORATQRY SIX ·MONTHS

. July 11, 1914, to December 31, 1914. July, 1914 :-Sputum, 37; · Typhoid, 57; Diphtheria, 9; Urine, 109; Water, 58; Miscellaneous...:...... BacterinTest, 3; Malaria, 6 i Rabies, 4; Pasteur Treatmeht, 1 ; Milk,· 48; Pus, 3 ; Cream, 6; Liquor, 4~ 1:'otal, 345._. ' Tov\;n Water-Dover; Milk Survey-Wilmington, 'Rehoboth, New Castle. August, l9IJ :~Sputum, 26; · Typhoid, 50; Diphtheria, 19; 216 -Urine, 91; Water, 61; Miscellaneous--Bacterin Test, 7; Malaria; 6; Rabies, 4; Pasteur Treatment, 3; l\il_ilk,24; Human Milk; .r ; Pus, 4; Cream, 4; Tissue, r. Total, 301. To,vn Water-Dover, Camden. Milk Survey-Newark, Middletown, Camden. September, 1914 :-'-Sputum, 36; Typhoid, 76; Diphtheria,· 32; Urine, 87; \i\Tater, 53; Miscellaneous-Bacterin Test, 7; · Blood, Count, 1 ; Malaria, 9 ; Rabies, 3 ; ·Pasteur Treatment, 4; Milk, 18; Pus, 8; Stomach Contents, I; Mucus, I.; Urine for T. · B., 1 '; Paratyphoid, l ; Miscellaneous, r. Total, 339. October, 1914 :-Sputum, 48; Typhoid, 52; Diphtheria, 49; Urine, 97; Water, 48; Miscellaneous-Basterin Test; 5; Blood Sount, 1 ; Malaria, 7; Rabie·s, 2; Pasteur Treatment, 4; Milk, 1 ; Pus, 9; Stomach Content, 1 ; Tissue, l ; Miscellaneous, r. Total, 326. . November, . 1914 :--Sputum, 26 ;· Typhoid,· 28; Diphtheria, 26; Urine, 80; ·water, 18; Miscellaneous-Blood Count, 2 .; .Ma­ laria, 2; Milk, 3 ; Pus, 9; Tissue, 2; Miscellaneous, 3. · Jotal, 209, December, 1914 :-Sputum, 24; TyplJQid, 35 ; Diphtheria, 34; Urine, 89; \i\Tater,. 22 ; Miscellaneous...... :.Blood . Count, 2 ; · Malaria, I; Rabies, I ; Pasteur Treatment, 2; Human Milk, I; Pus, 14; Tissue, 2. Total, 227.

INSTRUCTION FOR USE OF THE DELAWARE STATE BOARD OF HEALTH- LABORATORY, NEWiARK, DELAWARE. The Laboratory occupies five rooms on the third floor of the east wing of the main building of Delaware College. These have been provided and newly fitted up by the Trustees of the Col- . lege. They include, ( 1) an office and library; ( 2) a room for microscopic and pathological work ; ( 3) a general clinical and bacteriological Laboratory; (4) a. food and water laboratory, and ( 5) a storage and washroom. · · 1.-THE GENERAL FUNCTIONS OF THE LABORA- TORY. . , 217 The general functions of the! Laboratory . are clearly set forth in the act ( Chapter 240, Laws of Delaware) creating it., The title of this act reads: "An Act to Prevent the Spread of Disease and to Establish a Pathological and f::acteriological Laboratory for such Purposes at Delaware College."

Section I reads: "that in addition to the duties and powers with which the Board of Health of the State: of Delaware is now invested by the Constitution and Laws of this. State, it shall further be, and hereby is authorized and empowered to establish and supervise a Pathological arid Bacteriological Laboratory at Delaware Colleg·e, ,and to· supplerpent the equipment already there with any ad.ditional appliance necessary to make it perfectly safe and reliable for the thdrottgh use of any 01' all of these means of protecting the citizens of the State against the spread of disease." Again in Section 4, we read: "That all physicians, dentists, veterinary surgeons, or others practicing 111edicine or surgery or any branch thereof under the. laws of this State shall be required to give prompt notice to the local State Board of Health of :my and all cases of contagious or infectious disease that may come under their prnfcssional notice, and shall have free access to the work of the Laboratory ,for the determination of the diagnosis of any doubtful or suspicious case by forwarding, prepaid, a suf~ ficient sample of urine, blood, sputum, or other specimen of such · case, to the said Pathologist and Bacteriologist at Newark for examination, who shall examine the substances so sent, and report to the physician, dentist, or others, as aforesaid sending the same, .the result of said exa111inatioi1 without any delay and without further charge; the said physician, dentist or others! aforesaid shall report the result imi11ediately as herein above required."

It is clear from the title of the act, ancl/ from the words quoted from Sections r and ·4, that the primary function of the Laboratory is the invesigation of those diseases which are Lnown as infectious or contagious, for the purpose, first, "Of protecting the citizens of the State against the spread of disease," as stated in the last lirie of Section I ; and second,, "In order that all physi~· cians, dentists, veterinary surgeons or others practicing medicine or surgery or any branch thereof may give prompt notice to the local or State Board of Health of any ,or all cases of contagious or infectious disease that may come under their profession:tl 218 notice, a1;idthat to this encl they shall have free access. to the work . of .the Laboratory for the diagnosis of any doubtful or sus­ picious case" as provided f01: in Section 4. The reasons for making use of the Laboratory that the pro­ visions of the Law i11ay,be fulfilled are stated in the -preamble which reads : "\i\Thereas, by niiscrosoopic and biological investi­ ,gation the presence of these diseases can be maclei manifest when symptomatology fails, thus enabling the Board of Health to make timely provisions against the spread of the _disease and by so _doing save the health and the lives of, many ,citizens, and whereas these investigations can only be safely made in a Laboratory fully , equipped, etc."- There can be, therefor no doubt as to the purpose of. the Laboratory and that its examination and investigations are for the benefit of the public .health and the prevention of the spread of infectious diseases. The physicians have the free use of the Laboratory for the examination of specimens from infectious cases, but in return

1 are required to give _prompt notice to the local or State Board of Health of the findings of the Laboratory .. In this way the wcirk1of the Laboratory has a direct bearing . on the work of every Health Boat~clof the State. · . Take mi example: Dr. A. sen.els a swab from the throat of Mary B., of Dover. Dr. A. received a report by wire that the case is one of Diphtheria: he at once notifies the Local ,Board of Health of the facts. The home is immediately quarantined, and every precaution taken to prevent its further spread. The child convalesces in clue time, and if the local Board of Health does its duty it will insist that the quarantine be maintained until bacteriological examination of the throat shows the absence of Diphtheria g·errns. The same working of the law· could be applied to all the other contagiqus diseases, and would show the relation of the Laboratory to the control of infection among the people of the State. The Laboratory, however, is only an instrument; h has no power to initiate or to execute ; these rest with the Boards of Health, and their action is largely dependent upon the efforts of 219 the physicians in using the Laboratory for the diagnosis of in­ fectious diseases, and in their prompt notification· to the local Boards. · The Laboratory, furthermore, is a co_nvenient source of a11thority. A physician suspects, and is himself quite certain, that he has a case of Diphtheria, but he hesitates, especiallv if the case be a mild one, to give a diagnosis which will necessitate a burden:come quarantine. · He, therefore, .refers. the case to the Laboratory, reports its finding as he is required to do by law; and thus relieves himself of personality in the matter. The entire text of the law up to the 15th line of Section 4 has reference exclusively to the investigation of infectious dis­ eases. It, however, empo,vers the State Board of Health. to make such provisions as it sees fit for the examination of samples from cases which are not of an infectious nature. Secticn '4 further reacls-''.Pi·ovided, however, that nothing in this Act shall be so construed as to prevent the Board of Health of the State from making full provision for the free use of ~he Laboratory for the examination of any matter or substance. so as to determine the diagnosis of disease neither contagious nor infec­ tious, and neither local nor constitutional, and for the examination of water or food suppty for any citizen of the State." The lives of individuals, citizens of the State, are sometimes jeopardized for the want of certain laboratory investigatio"ns which vvoulcl throw valuable light on the cases under treatment. In that event the laboratory would not refuse to render any assist~ ance in examination which may lie beyond the ability of the physi­ cian to perform, due to lack of skill or fac_ilities in chemical or microscopic research. But the examination should be so re_. stricted that it shall be evident that the real purpose of sending such specimens is to obtain information regarding the condition of the patient. beyond that which can be obtained by the physician himself, rather than to save himself the trouble of doing what he can. All physicians, for instance,· have been and are capable ·of making their cwn qualitative examinations of urine. Hence, at a meeting of the State Board of Health in December, I90I, it was decided to limit the urine work to the more important exam­ inations such 'as could not easily be performed in the physician's 220 office by himself, with ordiriary facilities; and the. decision was embodied in the following resolution : Resolved, That hereafter physicians be requested to make their own examinations for.the ascertainment of the specific grav­ ·ity, presence of albumen or sugar' in urine or such other, matters. · so easily ascertained by themselves . . The other lines of pathological worl~ are outlined in the pages \vhich follow, under separate heads. · WHO CAN USE THE LABORATORY. The facilities of the Laboratory within the lin'es set forth in this Bulletin are open to all physicians, dentists and veterinary surgeons practicing within the limits of the State. The Labora­ tory shall not be used for private purposes not connected :with the health of the citizens of the State,, viz.-no examination for in­ surance purposes or for citizens of other States, exqept as may be necessary- by reason of immediate contact of residence. The Laboratory is open to the use of local Boards of Health for san­ itar.y examinations of any kind. Individt1als. not physicians, den~ tists or veterinary surgeons, desiring examinations made, must submit .with the sample the recommendation of spme one duly authorized to use the Laborato,ry, to the effect that such an 'exam-' ination would be advisable. · · (Note: Specimens submitted for examination which ·are not prepared in accordance with the directions given in those instruc­ tions will not be examined by the Laboratory); Specini.ens improi)er!y sent are a menace to the health of all who are compelled to handle them either en route or in the Lab-­ oratory, and may cause the United· States Government to deprive that person of mailing privileges.· · Therefore, specimens must be sent in laboratory containers. · When samples are forwarded by express· the charges must be prepaid. · By a special order of the Post Office Departnient authorized . mailing packages shaH be treated as. letter mail, hence the Lab­ oratory ai:tthorities will endeavor to demand from the mail ser.vice the prompt delivery of. all packages. The report sent to the physician stat~s when the specimen 221 was received and the postmark shows when mailed, hence any considerable delay in transit can be detected. Special cases, for the examination of Blood. or Pus, Diph­ theria, Sputum, Typhoid, Urine and Water, may be had at the various. agents free of charge, Bottles for the analyses of town r · supplies will b.e ,forwarded on request. The several mailing packages are properly·. labeled and ad­ dressed, but in case others are sent, all specimens and comm1mica- · tions should be addressed "State Board of Health Laboratory_,· Newark, Del." TUBERCULOSIS. Import. · It is quite unfortunate for. the patient, the com­ munity and the physician when the diagnosis of tuberculosis is based on the pronounced clinical symptoms .. For the patient­ because tuberculosis is curable only in its incipient stage and in proportion to the . incipiency; . for the community-because an · unrecognized case of tuberculosis is a. constant source of infec­ tion; for the physician-because liis reputation suffers and he may be iustly held responsible for the neglect of a disease which at one . stage might have ·been cured. Therefore, in all cases .in which 1.here is the least suspicion that tuberculosis may exist, samples of sputum shoulq be sent to Laboratory for examination. Repeated examinations of the expectoration are frequently necessary to demonstrate the presence of tubercle bacilli iri incipient cases; foi: this reason physicians shculd not hesitate to make free use of the Laboratory foi· frequent examination,s. Outfit for sending specimens. A round pasteboard box with a pink label. The box contains a tin box, enclosing a 4 drachm vial, filled with r drachm of 5 per cent. carbolic acid solution. This case answers the requirements· of the pcstoffice and must be used in place of bottles, jars, etc., in mailing tubercular material to Laboratory. Method. of preparing specimen. r. Collect the· sputum which is coughed up ,preferably in the morning on rising, avoiding the more superficial naso-pharyi1- geal secretion. · ·

2. Have the patient rinse his or her mouth thoroughly be- fore expectorating. 222 3. Pour the expectorated sputum into a vial and shake vig- orously until a fairly uniform emulsion is obtained. 4. Place the vial in the tin case. 5: Fill out the accompanying blanl<:. 6. Enclose in the case and forward to the Laboratory. To _obtain sputum from infants proceed as follows: The index finger of the left hand moistened with a 3 per cent. solu­ .tion of boracic acid is introduced into the mouth of-a childralong the base of the tongue until it reaches the larynx. The finger is held to one side, so as not to obstruct breathing. With the right hand a piece of cotton on a tampon holder is introduced, using the left index finger as a guide. As soon as the cotton touches the .vocal ccli"ds, a reflex cough is caused, and the1expectoration is cauglit by the cotton. This method requires only a fe'w seconds and offers the advantage that the sputum can be collected at any time. To 0btain urine for examination for tubercle bacilli proceed as follows: vVash the external gentials with soap and warm water and withdra)v the. urineJ by means of a sterile catheter. If tu­ berculosis of the kidneys is suspected and cystitis is present, the bladder should be first irrigated with a sterile saturated ~olution of boric acid. To secure the urine from each kidney separately, use Harris' instrument. Place the urine obtained as .above out­ lined in Otlr 4 OZ. bottle designated for m'ine ai1d forward t; the Laboratory. · . Should it be found necessary to resort tci animal experimenta- tion to establish the presence of tubercle bacilli, a especially pre­ pared bottle will be sent to the physician and instructions given as· to the modus operandi of obtaining the specimen of urine. EXAMINATION OF. FECES FOR TUBERCLE BACILLI. The detection of tubercle baci!U in the feces is not always possible even in cases of priniary intestinal tuberculosis. Never­ theless, such examination should be invariably made, and made repeatedly in suspected cases. Method of preparing specimens. Give the patient an.opiate until the bowels are well constipated. Examine the evacuations and collect any white particles or mucus adhering to the surface 223 of the well formed feces. Place them in the vial acc01npanying the outfit for Tuberculosis. Examination of' Milk, Butter and other substances of Tu­ bercle Bacilli: The detection of tubercle bacilli in these instances is extremely difficult and not always successful. The more re­ liable method is to inoculate a guinea; pig with the ~uspected ma­ terial and await the results of the inoculation. All such substances should be sent in clean preferably sterilized bottles or ointment jars,,,avo.idii?-g the addition of any antiseptic. Don't send s;liva for Sputum. Don't forget to .mark ·the specinien so it can be 1.dentified.· . . . . ., Dori't send a specimen poorly corked. Don't send speciniens with transit chai:ges .collect.

PNEUMONIA. Import. The niajority of cases of pneumonia are catised by a diplococcus observed independently by Sternberg and Frankel, the so-called Frankel's pneumoooccus. · In case;, of- suspected pneumonia, where corroborative bacteriological evidence is want-. ed, t_he sputum should be exai11in~clfor the presence of pneumo­ cocc1. Outfit: The same as ·for Tuberculos.is. Directions fpr preparing 'specimen: The same. as for Tu- berculosis. /. . . DIPHTHERIA. Import. Diphtheria is an acute infectious and contagious . disease produced by the Klebs-Loeffler b::i.cillis. Acq:irding to this modern definition, all cases of sore throat, even with the formation of a pseudo-111embrane, butl in whi.ch after careful and. repeated s~arch no diphtheria bacilli ;:i.refound, are not cases of true diphtheria. On the other hand this definition includes those cases of angina in which· no. membrane is fon:ned but the Klebs­ Loeffler bacilli are present, the presence or absence of the bacilli being the determining factor of the existence or non-existence of diphtheria~ 224 As for the presence or absence of diphtheria bacilli cannot be determined. in a large number of cases from' the clinical symptoms alone, a bacteriological examination is by far the most important aid in diagnosis, and sho1ikl be resorted to in every suspicious case. Outfit. A sq1:1arescrew-top wooden block or paper fibre case, . , contaning a tin can in which is enclosed a small glass ttibe hold­ ing· a· swab made of ~opper wire with a piece of non-absorbent cotton rolled around one encl. Label marked "Diphtheria." Method of preparing specimen. Don't use any local anti­ septic within two hours.

I. Straighten the wire without touching the cotton swab'.

2. Rub the swab against the exudate, 1:igorously avoiding contact with any parts other than the inflamed surface.

3. In the absence. of membrane, rub the swab ag·ainst 111- flamed surface. 4. Bend ,vire to original position and place in. tube. 5. Pack tube in cotton. Interpretation of i·esults. The presence of diphtheria bacilli in the secret.ions of the .mucous membrane of the upper respira­ . -tory passages of persons suffering from some foi·m of inflamma­ tion in these regions estab_lishes the diagnosis of diphtheria, . . . A negative result of the examination, on the other hand, may be clue: · . \ I. To the case not being one of Diphthe1'ia ..

·2. · To the use .of antiseptic washes, sprays or gargles short- ly before the swab is made. · 3. To the improper pr~paration of the swab. 4. To the absence of. the .baciHi from the surface of the . mucous membrane, while present within the deeper layers. 5. Tb :the bacilli not being reached by the swab, as in the case of laryngeal or exclusively nasal diphtheria.

Therefore, 111 all cases in which negative results have been 225 obtained in the presence of suspicious symptoms, repeated ex­ aminations should be made. Release Cultures. Diphtheria bacilli persist in the throat for varying periods, after the disappearance of the clinical symptoms ar\d so long as they persist, the pei-son who harbors tl~ern i.s Q constant source of infection. It is therefore an inj us.tice to the cbmn1unhy to release a patient convalescent from diphtheria from q11arantii1e without having obtained evidence of. the. absence of diphtheria bacilli. No quarantine should be lifted without a ·bacteriological examination,· showing the absence of the bacilli. For this purpose one or more swabs should be submitted to the laboratory during convalescence. TYPHOID ·FEVER. Import. The investigations of Pfeiffer, Gruber and Widal have show\1 that the blood serum of persons ill with typhoid fever exercises a peculiar aggfotinating actio'n over the typhoid bacilli. This special action appears as a rule about the fifth or seventh clay of the disea,se; and persists during convalescence and may per­ sist for as long as seven years after recovery. The cessation of rnotillity and the aggregation of the bacilli in dumps can be ob­ served under the microscope when the blood serum and a bouillon culture conti!ining motile typhoid bacilli are mixed in proper dilution. Numerous investigations by competent observers have shown that the so~called \!Vidal reaction is by far the most pathognoh1onic evidence. of typhoid fever, occurring as it does in about 95 per cent. of the cases, which cannot be said of any of the other clini-. cal symptoms. Outfit. Small sdf-addressed ~nvelOipe ;oontaining several strips of all white filter paper. Typhoid outfits supplied imme­ diately by mail to all physicians, therefore enabling him to have a supply on .hand at all times. Malaria outfits may be used or .white filter paiJer to avoid delay, 1 Send at least one drop of blood·' on the filter paper. Interpretation of results : A positive reaction, providing the proper.dilution was used and a previous attack of typhoid fever can be excluded _ispositive evidence of typhoid fever .. 15 226 A negative reaction may be clue (I) to the case not being one. of typhoid fev;er; ( 2) to the absence df so-called agglutinin from the blood, this being possible in three to five per cent. of the cases; (3) to the early elate in the disease wheri the specific ag"' glutinating substance has not'yet made its appearance in the blood ; (4) to the case being one in which the agglutinating substance appears late inJ the disease ( during the second or third week). Therefore, in cases in which negative results are obtained not­ withstanding the persistence of suspicious symptoms, repeated examinations should be made. · · · ·

ADJUNCTS IN THE L1ABORATORY DIAGNOSIS OF T'YPHOID FEVER. (a)~EXA

LABORATORY DIAGNOSIS OF· NON~INFECTIOUS DISEASES. URINE. 1. Eve1'y ·sample 11-iustbe accompanied by a foll clinical his­ tory of the case. · 2. The .. samples must be a portion of the urine collected during a period of 24 hours, since specimens voided at one time are of comparatively little value. 3. \i\There no special requests are made the report will be limited to a -microscopic examination of the secjirnent. \ . , . . Deficiencies·' in such examination can then be made up by subsequent request . . Outfit. A fo~r-ounce bottle containing a few ch'.ops of 40 l)er cent. formalin enclosed in a mailing case. ·. Method of preparing si)ecimen. The. urine should be col~ lected during 24 hours in a clean stoppe1:ed bottle or closed fruit jar, containing about _I draclmi of a 40 per cent. solution of forma­ lin.. This insures not only against evaporation, but what: is of the · utmost importance, fermentation. Of this urine· a fot1r-ounce sample should be sent for thedetermination of uric acid and tvvo four-ounce bottles should be sent for complete analysis.· · Method of examination. The methods employed· for the · .quantitative determination of urinary constituents are too elab- '233 orate ·to be briefly and interrigibly described. Those interested in, the subject.should co_nsult special text books on uranology. . Interpretation of results. Our knowledge o·f the urinary . ~pnshtuents both in health and· disease is still incomplete, and the risults obtained, therefore, are of relative and not of absolute value. ,' The proper interpretation of the results must be based on a careful analysis of .the symptoms of each individual case;_and the .work done by the Laboratory in this line. will only be of value to him who has ·made a carefol study of the clinical manifestations in. a given cas:e. The Laboratory cannot and should not make a diagnosis from the mere analysis of a sample mine. The Labora­ tory can only aio. in the diagnosis by 'furnishing valuable data which· could not be obtained in any other way. 2-BLOOD COUNTS. Owing .to the difficulty of obtaining specimens of blood for the enumeration of red and ·white blood-cells, only a differential blood-count will be made. For this purpose specimens shou,ld be prepared in the same manner as recqmmended for malaria. Here, howev'er, perfect cleanliness and the greatset possible care in mak­ ing the film are still more essential to a satisfactory examination . . 3-FECES. There should always be a definite object i_nview in sending feces for examination. There are a number or particular objects sought in the examination of feces, and unless the pathologist knows what is wanted, he cannot proceed with the examii1ation .. Feces should be examined for the presence ..of undigested food, foreign bodies, pus, blood, .and other abnormal tissue. elernents, and animal• parasites. The specimen should be sent in a clean: vial or a wide m~uth bottle enclosed in .a mailing case. 4-STOMACH CONTENTS. A chemical and microscopic examination of the contents of the stcmach is in tnany cases an almost indispensable aid in· diag­ .nosis; and· every physician should avail ·himself of the opportunity afforded by the Laboratory to have the stomach contents analyzed in doubtful ·or obscure cases: For this pi.1Ppose· Ewald's test breakfast, consisting of .two rolls of white bread well masticated, 234 and a glass of ·water, is employed, and the contents expressed by means of a stomach tube one hour after the test-meal. They should then be filtered and the filtrate forwarded to the Labora­ tory in a clean bottle. In case a niicroscopic examination is de­ sired, the stomach should be washed out with a normal salt solu­ tion and a small amount of the last washing, containing shreds of mucus, and in many instances pieces of gastric muco.ns mem­ brane, fo_rwarded in a small widecrnouth bottle. · 5-TEXICOLOGICAL EXAMINATIONS Texicological Examniations will be made by the request of the coroner's physisian under condition, however; that the speci­ mens must be prepared strictly in accordance with the directions given in the text books 011forensic medicine. 6-0THER EXAMINATIONS. The Laboratory is ready to assist the physician in the diag­ nosis or in the scientific investigation of ai1y disease ii1 so far as it lies in its power, But in all such cases the physician should first communicate with the Laboratory, stating the circumstances in the case. He will then receive instructions as to the method · of coll~cti~g specimen, etc. · · HYGIENIC WORK. r-ANALYSTS OF MOTHER'S MILK AND COW'S MILK. Milk is justly considered to be an ideal food. It contains all the organic and inorganic si.tbstance ina quantity and p1;oportion, which makes it not only assimilable but highly nutritious. The four foo'dstuffs essential to nutrition ari:l found in milk. Proteids . are represented by the case-in and serum-albumin, otherwise called lactalbumin. Carbon-hydrates are represented by the milk sugar, hydrocarbons by the fat (butter) .. The inorganic salts are chiefly calcium phosphate, potassium and sodium chlorides, with small quantities of magnesium phosphate and iron. vVater forms 88 per cent. of the total quantity of milk. This ideal food is primarily intended for the nutrition of the young of all the mannalia, form-· ing their exclusive diet. The nursling derives from this food all ·that it needs, not only for carrying on metabolism, but for storing up materials necessary for rapid growth. This, however, can only be accoiTiplished when the milk is free. from any deleterious mate­ rial, be it of bacteria or adu\terations. Should it fail to come up .235 to the normal standard it become~ either deficient in nutritive\ value or distinctly poiso11ous ; in either case a very 1.mdesirable . food for the infant. The great mortality of infants during the first year of their life, especially in large cities, i~ directly attri­ butable to the ni.ilk which comes either from a: diseased cow, a poorly nourished mother,1 an unsanitary milk depot, or an 11n~. · scrupulo1.1smilk dealer. The cow or the nurse may be free fro.m gross diseased conditions, perfect cleanliness may be rigorousl), observed, adulterati6n in case. of cow's milk eliminated, and yet . the infant fails to thrive arid. falls a ready, victim to any of the · diseases of early childhood. The milk in this case is either de-­ ficient in case-in or "fats. · A deficiency in fats in n:iilk will pave . rhe way for scrofula and tubercitlosis, while an increased propor­ tion of case-in will explain• many _an obscure case of infantile constipation. Many protracted cases of . dyspepsia in the adult are brought about by· improper diet, :similarly many, it not most cases of irdantile .dY,spepsia are due to the same ·ettolog_icfactor, . the diet in the latte1' instance being exclusively inilk. . In both instances the malady can only be corrected by a proper regula­ ti9n of the diet, this being especia.11y easy to accompJish in the case of the infant, since the milk can be. readily teste,d, its deficiencies discovered and modified accordingly, either directly or by the ad<;l­ tion of. the substances which ate found wanting, or indirectly by the modification of the diet and regime of the mother. An ex­ amination of mother's milk may .also show: 'in some cases that a substitution of cow's milk is"essential for the welfare of the child. On the· other' hand tl-ie cow's milk may ,be fotinq wanting in ·the' normal proportions of solids, thus rendering the classical . dilu~ tions unnecessary, or even distinctly harmful. Jf the child thrives, it may·be safely ·assmned that the milk is good, _and no examin~­ tion is necessary, .but should the infant be suffering from mal­ nutrition, or presen't ·symptoms of chronic gastro-intestinal irrita­ tion, the· mil}<:sho11ld be at once examined, the evil discovered and if possible remedied. In such cases a sample of either .the mother's or cow's milk, as the case may be, should .be sent to this Labora:fory for a.microscopic and. chemical examin~tion. Delay in these cases may mean either a· fatal gasfro~e11teritis, a low state of vitality, or enstting rickets or scrofula. The physician therefore owes itto the patient as well as to the community which depends for· its welfare on healthy offspring to seek the cause of the affection and remove it if at all possible. It is therefore hoped that the physicians of this State will a,vail themselves of the op~ ~ \ ' ' . ',

'236 portumties afforded to them by this Laboratory, and by sub­ mitting sa{nples of milk for examination, will materially diminish ·the high rate of infant mortality by removing one of its chief etiologic factors, namely, poor milk. · Method of preparing specimen. Procure in any of the sup- - · ply stations a 4 oz. ~11ailingpackage used ,for sending sample of ·water. In the case of mother's milk, wash the breast in the neighborhood of the nipple with soap and water and remove the milk by a suet.ion pump which has been rendered sterile by boil­ ing·. 2 oz. shoulcl be collected. In case of cow's milk, send a sample of the milk usually. consumed by the child. ( 4 oz.).

ANALYSIS OF 1VIOTHER'S MILK AFTER HA:MMERSTEIN. Ash (Min- Total Proteicls Fat era! Salts) Sugar Solicfs Authorities 2.2 3.8 0.29 6.l 12,4 Biel 2.3 2.5 5.5 Tolmatscheff

I.8 3.3 I 0,42 5-4 10.9 Gerber 1.9 4.3 0.28 5.9 12.7 Christenn r.6 3.2 0.16 5.7 10.8 'vVomen 20-30 Yrs. Pfeiffer 1.7 2.9 0.2.I 5.0 10.9 'vVomen, 30-40 Yrs. Pfeiffer 2.5 3-9. 0.25 5.5 12.2 Mendes de Leon I.O 3-4 0.23 5.7 10.0 Averages Cow's milk varies considerably in. composition, depending upon breed, feeding and period of lactation. I11the feeding, of infants the mixed milk of a here! will vary· less in composition from week to week than that of a single cow ; on the other hand the former is more dang·erous from the · ·standpoint of tubercular infection than the milk from a single healthy cow. · - 'vVhen the milk comes from cows whose record of health is uncertain it should be Pasteurized, by heating to 140 F. for 15 minutes before being, fed to infants. The followings table gives the results from the analysis of large nl1mbers qf samples of cow's milk. 237

COMPOSITION OF COW'S lVIIL'K. Total Whole Milk r Solids Fat Curci Albumen' Ash Sugar. Average l\ S. I 3.0 4.0 2.6o 0.70 0.75 4.95 Maximum, U.S. 17.0 8.o ·3.6o 0.90 0.90 5.50 Minimum, U. S. · ro.o 2.0 1.60 0-.40 0.60 4.00 Massachusetts two · Averages of 1738 analyses whole milk- . I 3-49 3.20 .. 0.70 New Yark three Averages from 15,000 cows, whole mil.k- 12.67 3.75 o.68 5. 78 milk, su- gar,. ash. r. Vermont Ag. Expt. Sta. Report 1891. 2. :Mas_s.Ag. Expt. Sta. Report 1893. 3. New York Ag. E:x:pt. Sta. Btill. 65. 2-WATER ANALYSIS. Import. Drinking water is frequently a meditun of infection. Typhoid Fever is in the majority of cases conveyed by .means of water. It has also been an important agent in the spread of cholera. Containinatecl water is also in many cases· responsible . for certain intestinal troubles simulating typhoid. When typhoid fever appears in a household the physician should at once direct his suspicions to the water supply, and have an ex­ amination made by the Laboratory. Local health boards should assiduously guard the .purity of their public supplies, and should. have occasional examinations made. · The sai'ne holds good of boards of educati.on when pupils use v;ater from the wells on school premises. The importance of water analyses in the prevention of disease is too apparent to all to need further comment. Suffice it to say that physicians and health authorities should make inore frequent use of the Labora­ :ory for such purposes. Outfit for sending samples. The character o,f the bottle in 238 which water is. sent is of great importance, m the first place it shall be absolutely clean and in the second it should be sterile. Experience has taught that· we cannot depend upon these condi- . tions being fulfilled in bottles sent to us, hence we will refuse. to examine the water sent in anv than our own bottle. Therefore, when a water analysis is wari'ted communicate with the Labora­ tory, when a bottle. properly prepared will be sent. The party desirin 5 the analysis must pay express charges both ways. Instructions for collecting the sample. 1st. From a water tap or pump. The water should run freely from taip or pump for a few minutes before it is collected. The bottle is then to be placed directly under the tap or sproi.1t, and rinsed out with the water at least twice, pouring out the water completely each time. It is then again filled to overflowing, and then a small quantity poored out, ·so that there shall be left an air space pnder the stopper of about an inch. The stopper must be rinsed off with flowing water and in­ serted into the bottle while still wet, and secured by tying over it a clean piece of cotton cloth. Under no circumstances n;iust the in­ side of the neck of the bottle cir the stem of the stopper be touched by the hand or wiped with a cloth. 2nd. From a ,stream, pond or reservoir. The bottle and stopper should be rinsed with the water, if this can be clone with­ out stirring up the sediment at the bottom. The bottle, with the stopp~r in place, should then be entirely submerged in the water and the stopper taken out a distance of about 12. inches below the surface. When the bottle is full, the stopper is replaced be­ lew the surface, if possible, and finally secured as above. · 'It will be found convenient in taking samples in this way to · have the bottle weighted so that it will sink below the surface. It is important that the sample should be obtained free from the sediment on the bottom of a stream and from the scum on the surface. If a stream should not be deep enough to admit of this method of taking a ·Sample, the vvater must be clipped Up with an absolutely clean ves.sel and poured into the bottle after it has been rinsed. · The sample of water should be collected irilmecliately be­ fore shipping by express so that as little time as possible shall· intervene between the collection of the sample and its examination. The blank acccmpanying ea7h bottle should be filled out in 239 full, as it is necessary to know this data before a reliable interpre- •. tation of the analysis can be made, and results will be withheld unti these conditions have been. complied with. · . Special mailing cases. to be sent by mail may be had at the various stations to forward 4 oz. of water to Laboratory. J--:--FOOD ANALYSIS.

The Laboratory is prepared' to analyze f~ods, liquors; condi- 1 ments and confectionery for the ,purpose of determining their purity cir.the presence of adulteration. ··· These examinations must, howe~~r, be· in the interest of health, and not for commercial purposes . . Samples .where· possible should be·.sent in unbroken original packages. · · ' · ···

. TOXICOLOGICAL EXAMINATIONS: .( SPECIAL.) . The Laboratory is prepared to take up this work. Numerous requests for such examinations. are made ye~rly. The larger number of specimens re·ceived from physicians and others not authorized to send_ such specimens are simply ·rejected. Toxicological specimens· must be· sent or ordered to be sent· by the Attorney General or the Cornoer and delivered .personally . and not expressed. · Specimens of a1I th~ organ~ ·are to be submitted. Stomach, 3 or 4 feet of intestines, kidneys, ,liver, are to be placed separate-. ly in new qt1att Mason jars and properly marked and sealed. .

Results of ·such examinations· given within 2 to 5 weeks .. MAILING CASE ST A TIO NS. The suppiy of mailing cases of the various kinds may be ob­ tained from the following stations, ex,cept those marked private, free of charge. . · · · No. cases are to 'be delivered, water cases excepted; by the stations to any .person but a ·physician or veterinariai1, These cases· are the property of the State. Board of Health·. 240 · Laboratory and must not be uesd for any other purpose than the transmission of material to the above Laboratory. · Bridgeville -F. R. Palmer, M. D. Edw. J. Elliott, M, D. Clayton -W: R. Keys & Co. (Pharmacy) Dagsboro -E. C. West, M. D. Del. City -W. W. Ellis, M. D. Delmar -Robert Elleg6od, M. D. Dover -E. R. Steele, M. D. E. H. Atkinson (Pharmacy) . H. C. Taylor ( Secretary Board of Health) Felton . -J.M. Luff, M. D. , . . Frederica ~J.B. Derrickson, M. D. W.·F. Hoey, M. D. (Private) Georgetown -Marshall & Chipman (Pharmacy) Harrington -Sharpe & Fleming (Pharmacy) Kenton -P, M. Money, M. D. (Private) Kirkwood --W. E. Cann, M. D .. (Private) · Laurel -J. W._Fooks, M. D. Leipsic -W. S. Vaughn, M. D. (Private) Lewes --c-W. P. Orr, M. D. James Beebe, 1\;L D. (Private) Magnolia· ~J. lVL Martin, M. D. Marshall ton -I-fope Farm (Tuberculosis Cases) Middletown -'-E. A. Truitt (Pharmacy) Bragdon & Co. (Pharmacy) H. L. Beale, M. D. Milford -..:..Wm. Marshall, Jr., M. D .. J. G. Dawson, M. D. Milton -W. E. Doug-las, M. D. (Private) B. H .. F. Wilson, M. D. Millville ' -K. James Hooker, M. D: (Private) New Castle -E. Challenger & Son (Pharmacy) C. E. Ferris & Son (Pharmacy)· ·'Odessa· -Joseph Carrow, M. D. Rehoboth -W. R. Messick, M: D. Seaford -W. F. Haines, M. D. Selbyville -G. F. Campbell, M. D. (Private) E. E. Bell, M. D. (Private) Smyrna· -Clifi:on & Raymond (Pharmacy) Townsend -;-J- D. Niles, M. D. (Private) ,·.

24:1 .. . Wilmington -Aller). Drug Co., WestTenth St. Associated. Charities, 6o2 West St. Belt Drug 'Store, 700 King St. N. B. Danforth, 2d & Market Sts. ·. J. A. Draper, M. D., rn15 Washington St. A. E Frantz, M. D,, 5P4 Delaware Ave. J.M. Harvey, 407 Delaware Ave .. J. S. Brokaw, 803 Market• St. ·wyoming _;_J.L. Crossmo~e, M.: D .. (Private)

. . . TUBERCULOSIS...... SPECIMENS 0.F SPUTUM FOR DE.TERMINATION OF · TUBERCLE BhCILLI.

' ' The Labqratory years 1912~1913 and 1913-1914 show 895 specimens of. sp1.1tumwere submitted to the Laboratory for the . presence of the .tubercle bacilli; 134 of this nui:nber. were male and 130 were female that gave positive results, making a total of . · 264 specimens showing the tubercle bacilli. · SPECJMENS OF SPUTUM SHOWING TUBERCLE BACILLI. .During the. two yea~s, the number of specimens of sputum showing-the tubercle bacilli, were submitted from the' following places through011t the. State: · · Angola ...... • • . • .... • I · Marydel . . • ...... • . . . I Bear Station ... ; . . . . . l Middletown .... ; .... ; 3 Bridgeville ...... I Milford ...... : . 5 Camden ...... ·. :·.. 2. Milton ...... : ...... 4 Centreville ... ; ...... I Nassau .... : .. : ...... 2 Clayton ; ...... S.. Newark ...... · .. · 4 Coolspring .•.....•.. , I N e,w Castle ; .. : .. ; . . • . 8 Delaware City .. ; .. : . . 8 Ocean View . . . . . • . . . . 2. Delmar .... : ...•... ".'·: 3 Odessa ..... ; .•. ·.... ·. . . I Dover· . .-...... , . . . 6 · ' Port Penn ... ~ ..... ; .. ; I Edg$1oor ...... 1 Rehoboth ...... · 2 Farmingti;:m ...... •·.. I Robinsville . ; ...... I Frankford .... ; .. : . . . . I. Richardson Park ..... : I. . · Georgetown ...... ; . . . 9 SJa?-ghter N eek ...... I Greenbank ...... 4 Smyrna...... '...... · 3' 16. 242 ·Hockessin ...... 3 Seaford ...... 3 Hope Farm ...... 5 Stockley ...... 1 Laurel ...... : ...... IO Selbyville ...... 3 Lewes ...... ·...... I Townsend ...... 1 Lincoln City ...... 2· Wilmington ...... 126 Marshall ton ...... 11 \i\Tyoming . : ...... 3

OCCUPATIONS OF TUBERCULAR PATIENTS In the 189 of the cases, showing the tubercle bacilli, the following occupations were given. The figure indicating the number of patients engaged in that particular vocation:

Agent ...... 2 Merchant ...... 3 Barber ...... 3 Mechanic · ...... 8 Blacksmith ...... ,I Milliner ...... 2 Boiler Maker ...... 1 Mill worker ...... I Bookkeeper ...... I lVIinister ... , ...... I Cabinet Maker, ...... 2 Moroccp Worker . . . . 2 Carbuilder ...... I Musician ...... 1 Carpenter ...... 2 Nun ...... 7 Chemist ...... I Nurse ...... I Clerk ...... 7 Painter ...... 1 Cooper ...... I Railroad ...... 3 Draftsman ...... 1 Physician ...... 2 Driver ...... 1 Salesman ...... I Electrician ...... 1 Seai:nstress ...... 5 Farmer ...... 13 School Girls ...... 2 Gas Operator ...... 1 Stone·Maker ...... 1 Housewife ...... 46 Street Car Conductor. . 2 House Servant ...... 27 Student: .. .'...... 4 Iron Worker ...... 1 Tailor ...... I Tanitor .. '...... 2 Teacher , ...... 3 ·Laborer ...... 18 Upholsterer ...... 1 Laundress ...... 1 \i\Tatchman ...... 1 Leather Sorter ...... 1 Waiter ...... 1

SPUTUM FOR TUBERCLE BACILLI. Six Months. Beginning July 1, 1914, and ending December 31, 1914. Number of. Specimens, 197. Showi~1g Tubercle Bacilli, 70 speci­ mens. Showing towns having positive cases : 243

Bridgeville ...... I · Newark ...... ·.. 2 Delaware City .... : . ·. . . I Ocean View ...... ·: I Dover ...... ·... ' I Seaford ...... I Farnhurst ...... I Smyrna .. ·... : ...... I Georgetown· ...... 2 Townsend •...... 4 Hope Farm' . . • ...... I Wilmington ...... 49 Laurel ... ·, .. ·..... ·· . • . 3 Workhouse ...... ,.. . 8 ·Middletown ...... I Wy01i1ing ...... ·: . : /. I New Castle :··...... 3 occuPATION OF THOSE s·aowrNG TUBERCLE BACILLL

Baggage· Agent ...... I Housewife ...... 6 Barber •.....• ,...... 1. Bouse Serva~t . , .... : : 16 Boilermaker ...... ;I · Lineman • ..: ...... F Carpenter ...... • . . . . I Laborer ....•....•..... · 5 Chatiffetir ...... I Machinist ...... ·. . . . . I Clerk ..... ·..... •... ·... I Niin ·..... ·...... 2 Car Builder ...... I P.orter ...... :...... ·. . . I Draftsman ...... 2 Prisoner ...... : ... ·. · II.

Electrican ...... I . Salesman 1 • , •• , ••••• , i , 2 Errand Boy ... ; ...... I Saleswomen· ...... • . . . . I .Farmer ...... I Servant ...... -. . . . . · I Grocer ...... I Woodworker ...... r

DIPHTHERI.f\.. ' . The total number of ·swabs_for the detection of the diph­ theria bacilli, during the Laboratory years, r9i2,..:r9r3 and 1913- · 1914 was 570 for the two years. Of this. number 230 showed the• diphtheria .bacilli.. · Places from which positive diphtperia .bacilli specimens were submitted: · · ·

Bladies ..... ~ .. ~· ... ~ . I Lewes ...... 8 Bridgeville ...... I Little Creek . .... , ..... I ·Clayton ...... 6 Milford ...... 9 Concord ....· .·...... 2 MacDonough ...... I Delaware City ...... I Middletown . . •.• ... •.• I7 ·Dover ...... ~ ..... 4· _Newark ...... 9

Frankford ...... I New Castle . ..., ' . -: ~ .. 14 244

Georgetavvn ...... 3 Ocean View ...... 2 Harring-fan ...... 13 Seaford ...... 16 Hillcrest ...... I Selbyville ...... 6 Ir011hill ...... 2 Townsend ...... I Kenton· ...... I Wiln;ington ...... 49 Laurel •...... IO

Diphtheria, 6 m~nths July I, 1914, to December 31, 1914. Total, 179 specime~s. 8S) specimens showed diphtheria bacilli.

Clavton ...... 2 Little Creek ...... I Deiaware City ...... • 7 Milford ...... 4 Dover ...... 4 Milton ...... ·...... I Farnhurst ...... I New Castle ...... 5 Kirkw.oocl ...... I State Road ...... I Harrington ...... 19 Summit Bridge 3 Laurel ...... 15 Wilmington ...... 1'4 l,ewes ...... 8 Welsh Tract ...... I

TYPHOID FEVER Number.of specimens, 191~-1913 and 1913-1914, 880. Number of specimens showing the typhoid readion, 513. Positive Wiclal's reaction for typhoid. The positive \Viclal's rea:etion. for typhoid were submitted from the following towns. The figures indicating the number of positive specimens received from each place during the two years 1912-1913 a~cl 1913-1914. Bethel ...... 1 Lincoln ...... 5 Bishopville, Mel. 5 Marshallton ...... Blades ...... 2 lVIagnoliai ...... 3 Bi-inforcl ...... r ·Mai:Donough ...... l Can1clen ...... 2 Middletown ...... 13 Centreville .... : ... , . I Milford ...... 31 Christiana ...... I Millville· ...... l Clarks~ill~ ...... I Mt. Pleasant ...... I Coolspring ...... I Newark ...... 38 Clayton ...... 6 Newport ...... Dag-sboro ...... 25 . New Castle ...... Ir Dela ware City ...... IO Ocles,sa ...... 2 245 Dover · ... .-.... :...... 31 Rehoboth ...... 8 Edgemoor ...... 1 Richardson Park 1 Felton ...... 2 Seaford ...... 14 Frederica ...... 22 Selbyville · . ; ...... : · 3 Georgetown ...... 3 St. Georges ...... '. . . . 2 Glasgow ...... • . . . I Strickersville ...... r Greenville ...... 1 Smyrna ...... : . . . . 6 Harrington ...... 1 7 St.tmpiit Bridge ...... I Hockessin ...... I · Taylor's Bridge ...... 2 Kenton ...... I Townsend ...... 5 Laurel· · ...... 25 Wilmington ...... 156 Lewes ...... ,. : ... 14 Woodland· ...... 1 Leirsic ...... 5 Yorklyn ...... 1

TYPHOID FEVER Six· Months Specimens 'fr01~ July 1, 19~4, to Decembe~ 31, 1914: . Total, 298 speciri1ens.. 188 specimens si1owing typhoid.

·Cannon ...... · ...... 2 Lewes ...... · .... 9 I ' I Christiana · ...... ·· Leipsic .• ~ ...... 4 · Claymont ...... I ·Magnolia ••••• ,i ...... I Clayton ...... 2 Middletown .., ...... 5 Dagsboro . . ~ ...... 9 Milford ...... I8 Delaware.. City ...... 5 Millsboro ...... 1. Dover ...... 13 Newark , ...... 9 Elsmere, ...... I New Castle ...... 3 Edgemoor ·...... I Ocean: View . . , ...... I · Felton ...... ··· .... 5. Overbrook ...... I / Frederica . . •.• ...... 10· Porters ...... : ...... 2 Georgetown ...... 2 Rehoboth . .. •.• ...... 9 Glasgow ...... ~ Seaford ...... I .Harrington · ...... Selbvville ...... ,. 5 ,, 5 Hickman ...... 3 Townsend ...... 4 - Hockessin ...... 2 Viola · ...... ,·.... I Holly Oak ...... I Wihnington ...... 46 Kimblesville ...... •.•. I Wyoming ...... 2 Laurel ...... 5

··.·•:',! •..J, 246 NEW CASTLE COUNTY

First Quarter Ending September 30, 1912. Deaths, Births and ' l\farriages

Abscess ...... ' ...... : : ...... ; l Accidents ••••. j ••••.•••••••••• • .•••••• ._• •••••• 14

Alcoholism ...... ~ .' .... • .... • ... l Anae111ia ...... ' Agcina Pedoris ...... I Apoplexy ...... 24 Appendicitis ...... I A,.phyxiation .... : ..... \ ...... , 0 1\stl1<.~11ia ~ ...... 0

A::;thma ...... - ...... ~ . . . . . •, ...... 5 Biliary Calm Ii ...... 0 Bright's Diseaoe ...... IO Bronchitis -0 Broncho Pneumonia ...... 4 Burns ..··· ...... 4 Cancer ...... 14 Carbuncle: ...... 0 Carci1ion1a ...... 2 Cerebro Spinal Meningitis ...... , ..... '...... o Chicken Pox ...... · o Cholera Infantum ...... 30 Cholera Mor bus ...... o Cirrhosis of Liver ...... 7 Convulsions ...... 15 Dentition ...... ·...... o Diabetes ...... 2 Diarrhoea ...... 3 Diphtheria .. , ...... : . . o Dropsy ...... -...... 2 Drowned ...... 8 Dysentery ...... 8 En1bolis111 ...... o · Emphysema ...... :-...... o Encephalites ...... o Endocarditis ...... 3 Enteritis ...... 23 Entero-Colitus ...... 23 Epilepsy_ ...... 2 247 Erysipelas ...... o Exhaustion ...... , ...... 4 Gall Stone· ...... ·...... o Gangrene ...... S Gastritis ...... · ...... , . . . . . 6 Graves' Disease · .... · ...... : ...... o Haern:ol'rhage · ...... 18 · . Heart Disease ...... 31 I-Iepatitis ...... ·...... 2 I-Iernia ...... , ...... I Hydrophobia...... o Hydrocephalis ...... o Inanition ...... S Indigestion ...... 2 LaGrippe ...... o Locomotor Ataxia ...... 2 l\1arasn1us ...... 19 Malarial Fever . ,...... , . . . . o Measles ...... o lVIeningitis . ·...... ·...... r S Myocarclitis ...... o Natural Causes ...... o Nephritis ...... 21 Obstruction of Bowels ...... I O.Jd Age ...... iI Operation ...... ·. . . I Paralysis ...... 9 Paresis ...... I · Pericarditis ...... o Peritonitis ...... 17 Pleurisy ...... o Pneumonia ..... , ...... ·.. ; . ·. I 7 Poisoned ...... ·...... I Premature Birth ...... 14 Puerperal Fever ...... o Pyaen1ia ...... I Rheumatism ...... ·.,...... o Scarlet Fever ...... : ...... o Senile Debilitv...... l . . 13 Septicaemia "...... , 2 S1nall Pox ...... o Still Born ...... -...... 29 248 Suicide .·...... 4 Sunstroke ...... o Syphilis ...... o Tetanus ...... 2 Thrombosis ...... o Tonsilitis .. ·...... o Typhoid Fever ...... 13 Typhoid Pneumonia ...... : ...... o Typho Malarial Fever ...... o Tuberculosis ...... 52 Tun1or ...... o Ulcer .. ·...... I U raen1ia ...... I I Whoopii1g Cough ...... i •• .". • • • • • • • • • • • • • • • I ·Other Diseases ...... 50 Not Stated ...... 2

Total. DECEDENTS JVIale ...... 332 ·Fen1ale ·...... 255 Not Stated ...... ·...... _... .. 5

T~~ ~2 vVhite ...... ·...... 47.8 Black· ...... ·...... 104 Not Stated ...... ·. ·...... IO

Total 59r2 Native Born ...... 476 Foreign Born ...... -...... 68 Not Stated ...... 48

Total 592 Married . ·...... I 54 Divorced ..... ·...... 2 "\i\:7iclow~d· ...... 91 Single _...... , ... ·...... 294 Not Stated ...... 51

Total 592 249 AGE OF DECEDENTS

Under I year · ...... : ...... I 33 From I to 5 years ...... 30 From 5 to IO years ...... · 7 From IO to 20 years ...... ··'"...... 29 From 20 to 40 years ...... , ...... 89 From 40 to 60 years ...... 98 From 6o to So years ...... 131 From So to 90 years ...... 27 Over 90 years ...... : .·... . ··.... , ..... :.. 7 · Still Births ...... : ...... ~ 29 Not Stated ...... : ...... 12

Total 592 BIRTHS J\ilale ... ·...... ·...... ·. · 79 Female, ...... 83 Not Stated ...... o

Total White ...... : ...... 151 'Black ·...... 9 Not Statecl ...... , 2

Total MARRIAGES'

White ...... ; ...... -...... 1209 Black ...... 21 . Not·Stated ...... , ..... ·..... ,...... 4

Total · 1234.

Second Quarter,' Ending De.cember 31, 1912 Deaths, Births and Marriages

Abscess ...... : ...... 1 Accidents' ...... 25 Alcoholism I Anaen1ia ·...... 1 250

Angina Pectoris ...... I Apoplexy .. '...... • : .. , ... ·...... · 36 Appendicitis ...... 2 Asphyxiation ...... I A.sthenia ...... 2 Asthn1a .. _...... · ...... ·...... · 5 Biliary Calculi ...... o Bright's Disease ...... 8 Bronchitis ...... 5 Broncho Pneumonia ...... IO Burns ...... 7 Cancer ...... , ...... I2 Carbuncle ...... ·...... I Carcino1na ...... · I 3 Cerebro Spinal Meningitis ...... o Chicken Pox ...... •...... ; ...... o Cholera Infanturn ...... o Cholera Morbus ...... o Cirrhosis of Liver ...... 5 Convulsions ...... 8 Dentition ...... o Diabetes ...... ·- 2 Diarrhoea ...... 2 Diphtheria ...... 3 ·Dropsy ...... 2 Drowned ...... • ...... 4 Dysentery ...... o Emb0Iis1n ...... o . ' . E111physema ...... I Encephalites ...... o Endocarclitis ...... 6 Eriteritis ...... 9 Entero-Cofitus ...... 3 Epilepsy ...... 3 ·Erysipelas ...... o Exhaustion ...... 3 Gall Stone ...... o Gangrene ...... o Gastritis ...... S Graves' Disease 0 Haemorrhage IO Heart Diseases 50. 251

:Hepatitis ...... 0 Hernia ...... I Hydrophobia ...... 0 Hyclrocephalis ._...... 0 Inanition ...... I Indigestion ...... 5 La Grippe ...... , ..... · ...... 4 Locomotor Ataxia ...... 0 l\1Iarasn1us ...... 9 Malarial Fever ...... 0 J\1easles ...... I Meningitis ...... Io lVIyocarditis ...... 3 Natural Causes ...... Nephritis ...... Obstruction of Bowels ...... , , . 2 Old Age · ... ·...... , ...... , 1 I Operation ...... , ...... o Paralvsis ...... 7 Ja .s ! 1·es·1· . . . . .' . ..~ ...... ' ...... '~ . .' . . 0 Pericarditis ...... 1 Peritonitis ...... 12 Plet1risy ...... , ...... l Pneu111onia ...... J.~6 Poisoned ...... ·...... Premature Birth ...... 20 Puerperal Fever ...... 0 Pyaen1ia ...... 0 Rhem'natism ...... 0 Scarlet Fever ...... , .. 0 Senile Debility ...... 15 Septicaemia ...... 1 Snw:11Pox ...... , ...... o Still Born ...... 18 Si1icide ...... 3 ·.Sunstroke ...... 0 Syphilis ...... -...... : ...... , .... . 0 Tetanus ...... ·.. 2. Thron1bosis ...... ·, . 0 Tonsilitis ... · ...... · .... . 0 Typhoid Fever ...... 12 Typhoid Pneunionia .... ; •· ..... ; . : ...... o 252 Typho Malarial Fever ...... o Tuberculosis ...... 76 Tumor l Ulcer 0 lJrae111ia ...... 18 ·whooping Cough ...... · 3 Other Diseases ...... 62 Not Stated ...... 8

Total DECEDENTS wJale ...... ·...... 351 Fen1ale . ·... , ...... · ...... 276 Not Stated ...... 14

Total . 641 vVhite .... ·...... ·...... 496 Black ...... , ...... ·...... 129 Not Stated· ...... 16

Total '641, ·· Native Born ...... 495 Foreign Born ...... : ...... 84 Not Stated ...... 62

Total 641 lV[arriecl ...... I68 Divorced ...... 1 ·vVidowed ... -.. : ...... n7 · Si1igle ...... ·...... ·...... 249 Not' Stated' ...... _...... : ...... :. 106

Total AGE OF DECEDENTS Under l vear ...... · ...... 86°- From 1. to 5 years ...... 19 From 5 to IO years ...... r 1 From IO to 20 vears ...... 33 From 20 to 40 years ...... , ... : ...... ·.. 107 From 40 to 60 years· ...... -..... '...... ; ...... 123 From 6o to 80 years ...... 177 253 From ~o to go years ...... , .. 38 Over ·C)o'vears ..... : •...... ; ...... '...... 1 8 , Still Bi rtl;s ...... ·...... ·...... ·18 . ·No.t· s.'ta't'_ed ...... • .. · ...... • .. 2I

· Total. • i BIRTHS .. lVfale .. .' ...... ·, ...... · ...... ·. . . 557 · Fen1ale ...... , ...... ·. . 520 Not Stated ... ; .. ·..... , ...... ·: ..... ·. ... ,3

To:tal. 1080 '\Vhite ... .-..... , ... ; .... , ...... 994 Black .. : ...... ·... . ·:., ...... :,, .. , 80 Not Stated ...... · .. , .... , . " . 6

Total · 1080 MARRIAGES White ..... ; ...... ·...... , 2048 Black...... 72· Not Stated ...... · ., ... , , ...... 2 ·

Total 21~2 Third Qtiarter, E,iding M.arch 31, 1913 Deaths, Births and Marriages · ·· Abscess ; ... .-...... ·...... 2 Accidents ...... , . , ...... · ...... 7 Alcoholism ...... ,...... : ... .- 1 Anaen1ia ·....•. ·...... o Angina Pec.toris : ...... ·-· ...... 2 Apoplexy ...... , .,... , ...... ·...... 44 Appendicitis · ...... < ...... ,.. · o Asphyxiation .. , ...... , ...... · ..... , ...... · · 2 Asthenia ~·...... ·... , ...... : : .. , ... :. : .. · .. , o

Astb1na ...... L, •• .'... • • • • • • • • • • • • • 8 Biliary Calculi · ...... ·; ; . ·.. , ..... : ... ; . . . . . o Bright's Disease ...... 12 Bronchitis ... , ...... ·· ...... 15 Broncho Pneumonia ..... , .... ; ...... 17 · 254

Burns ...... , , .. . 4 Cancer ...... I2 Carbuncle ...... o Carcinon1a ...... I 5 Cerebra Spinal Meningitis ...... I Chicken Pox ...... b Cholera In£anti1111 ...... ,...... 0 Cholera Marbus ...... 0 Cirrhosis of Liver ...... , ...... 3 Convulsions ...... 8 Dentition ...... 0 Diabe.tes ...... L ..... , ...... 2 . Diarrhoea ...... 0 Diphtheria ...... · 5 Dropsy· ...... ·...... 3 - Dr'owned ...... 10 Dysentery ...... · ...... -' ...... 2 En1bolis1n ...... 4 Emphysema , ...... · ...... , . ·...... I Encephalites ...... Endocarclitis ...... Enteritis ...... · Entero-Colitus ...... 3 . Epilepsy ...... · o . Erysipelas ...... ·. : ...... ,0 E.xhaustion ...... 5 Gall Stone ...... : ...... ; ., ... ~ ... '...... 0 Gangrene· ...... 6 · Gastritis ... -...... ·...... 9 Graves' Disease ...... o Haemorrhage ...... I 3 Heart Diseases ...... 71 I-Iepatitis ...... ; .... . 0 I-Iernia ...... ·...... J Hydrophobia· ...... 0 H yclrocephalis ...... , 0 Inanition ...... ·.' ...... ·...... ·. ; ...... 7 Indigestion ...... · ...... : ...... 2 La Grippe ...... ·.. ·. , ...... •...... 7 Locomotor Ataxia ...... I l\i[aras111us ..... , ...... 7 lVIalarial Fever ...... ; ... . 0 255

Measles ...... , ...... 1 · Meningitis ...... 11 Myocarditis .· ..... ·...... ; .-...... 6 Natural Cat1ses· ...... , ...... o 1.Nephritis ...... , ...... 32 Obstruction of Bowels .. .'...... · 1 Old Age ...... · ...... ·...... 6 ·Operation ...... , ...... , ...... · ... , 1 ·. Paralysis _...... 14 Pa'resis ...... ·...... , . .-...... 4 Pericarditis ...... ·...... o Perit9nitis ...... ,...... 13 Pleurisy ...... • ...... I Pneumonia ...... ·86 Poisoned ...... · ...... I Premature Birth ...... -: ...... ·...... 16 Puerperal Fever ..... ·...... o Pyc!-emia ...... ·...... ·.. ·3 Rheumatism ...... 3. Scarlet Fever ...... 9 Senile Debility ...... ' ...... , ...... 14 Septicaemia_ ...... · ...... 2 Small Pox ...... o Still Born ...... · ...... 29 Suicide ...... ·.. 2 _Sunstroke ...... · ...... ·...... , ...... · o Syphilis ...... ·...... •.. · .... ·.. ·O Tetanus· . ·-· . t . ·.•... '...... • ...... o Thrombosis ..... :. .. · ...•...... ; : ...... o Tonsilitis: ...... , ..·. :. . o Typhoid Fever ·... ; ...... ·; .' ... '...... : . · 3 Typhoid Pneun:10nia ..... , ...... ·...... o Typho Malarial Fever ...... , .. , . : ...... o Tuberculosis ...... : ...... 62 Tt1111or . . . . • ...... _...... _. 1. Ulcer . :: ...... •.• ...... ~ Uraemia ...... 15 Whoopin!s Cough ...... 2 Other Diseases ...... ; ...... _.... . 57. Not Stated ...... 6

Total 256 DECEDENTS tl[ale ...... ' ...... 387 Fen1ale · ...... : .. , ...... 324 Not Stated ...... : ...... : ....• .,. I4

Total 725 .\Vhite ..... ·...... •.... 563 Black .... : ...... 149 Not Stated ...... , ... 13

Total 725 Native Born . : ...... •...... 587 Foreign Born ... , ...... : .. 72 Not Stated ...... : ...... 66

Total 1/[arried ... ; ...... ·.. 217 Divorced ...... 2 '\Vidowed ..... , .....•...... 134· Single ...... , ...... ; ... 258 Not Stated .... , .... .' ...... II4

Total AGE OF DECEDENTS Under I year ... , ...... , ..... 99 From I to 5 years ...... : ...... 55 From . 5 to 10 years ·...... · .. ·...... 19 From ro to 20 years ...... ·.. ·...... 18 Fro'm 20 to 40 years ...... ·...... n9 From 40 to 60 years ... ·... ·...... ·...... 137 From 6o to 80 years ...... 168 From 80 to. 90 years ...... 58 Over 90 years . : ...... ·...... 9 Still Births ...... 29 Not Stated ...... 14

Total BIRTHS Jviale ...... 273 257 Female ·...... , ...... , ..... ·...... 243 Not Stated· ... ·...... ; . ; . 9 ·

Total 525 White .... ·..... ; ... ; .· ...... '.... · ...... , ..... 476 Black ...... , ...... ·46 . . Not Stated ...... • ...... 3

Total MARRIAGES White . ·...... · ...... ~ ... , .. · ...... 1071 , Black ... ·...... •. ·. , ...... , . .-...... 49 Not Stated ...... ; • ' .... ·...... l·

Total· ll2l Fourth Quarter,-Ending June 30, 1913 · Deaths, -Births and Marriages Absces~ ...... ; ...... , ...... 2 Accidents · 1 ...... • • • • • • • • • • •· • • • • • • • • • • 9 Alcoholism . ·...... ; ...... 3 Anaemia ...... : ...... ·.. : ...... : ... · o Angina Pectoris ·...... , .. '...... 2 Apoplexy ...... : .. . . 23 Appendicitis , ...... · o Asphy~iation . ; .... ; ; ...... 0 Asthenia ...... ··... , .. · .·...... l AStl1ma ...· ...... ·.... ~ ... : ...... 5 ;Biliary-Calculi ...... ,...... : ...... : ...... 0 Bright's Disease ...... ~ .. 5 Bronchitis ...... , ...... · ...... 3 Broncho Pneumonia ...... 6 Burns ...... 4 Cancer .. ·.; ...... ·,·...... 7 Carbuncle ...... ; ...... : ; ..... · l Carcinoma '.·...... · ...... ·...... ·... 14 Cerebra Spinal Meningitis .. ; . , ...... 0 Chicken Pox ...... · ...... ; . ;·...... ; 0 Cholera Infantum ...... 5 Cholera Marbus ...... : .. ; ...... • o Cirrhosis of Liver ...... , ...... 7 17 . '

· 258. 'convulsions' .....•.. ,.·.. · .. .-. ·...... ·.. ·.· ..... :,..... i. 8 D·entition ...... ·..... ·..•. : ... , : o

1 • Diabetes· ...... ·, .... : .. :...... 2 Diarrhtiea ·. ·...... : .. ·...... •...... ·...... :- o · Diphtheria '. .... ; ... ' ... ;_...... i .·...... :..... 6 g~~;::ed·: : : : : : : ·. ·.: ·. ~ ·. ·.·. ·. ·. : ·. ·.: ·. ·.":'. ·.·.: : ·. :: : : '. :: . ; Dysentery ..... : _...... ·.: ... ;, . o ·· En1bblis111 ...... ·.... -'·.. ; .... ·. . . . . 2 Emphysema ·...... : ·...... · .. ; o Encephalites .... ·..... ·...... ·. : : . ·...... _.. ·. . . . . · o Endocarditis ...... ' .... : ...... · .·.,..... 5· Eritetitis ..... , .. ·... : ...... ·.... · . ·: ..... ; . ·. . . . 6 Entero-Colitus · .....•. :': .' ; ...... 7 Epilepsy ...... ·...... : ; .. " ... : ...... ,, .~ . I Erysipelas ...... ·.. ; ...... : ...... ·... ·.... ·..... ·.. ,. 1 Exhaustion ...... : . ; .... :-...... ,·.. , , . . . .. I GaJI Stone. ,, ...... · ...... , ...... ,..... : .· ... ·.''. o Gai'l.grene .... •..... : •... •...... ' ..... ', .• . I . Gastritis .. ·...... ·. '. .. '. .... ·. : ...... : .... ·, 2 · Graves' Disease ...... '.... , .. : ; .. , ... '.... · ... ·...... o Hen1ord1age ...... : . , . , ...... ·.... i . 5 . Heart Diseases , .. , ...... '; ... : 29 ~:r!l!ti~.: : : : : : :: : : : : : : : : : : : : : : .: :: : : : : : : : : : : : : : Hydrophobia .... : ...... : ...... o H ydrocephalis ...... : ...... '. . . o Inanition . ; . : . : ...... , . , ... · . .-.--:...... · ... •. I Indigestion ·.... .-...... ,...... : ..... : .4,· La, Grippe ...... ·...... 2 Locomotor Ataxia ...... , ...... I Marasn1us · .. ,· ... , ..... : ..... ·.·...... ·: .. : 4 ·Malarial· fever ...... :...... ·...... : .....•. · o Measles ·...... , . ; ..... ·... ;· .3 , Meningitis · ...... ·...... : ...... : ..... _. , . 6 Myoca.rditis : ... '...... -.... '! ...... : . ·... .-... .. : . 4 · . N atur~I. Causes .. ·_...... -.... ·. , . . . . . o Nephntts :·······i .. _;...... ·.,... :_... , ... 32 Obstruction of Bowels ...... : ..... , ...... I g~~r~fo~1..:.·.·:,·:::·:.·:·.'::·.·.·.::: ·:::::::::::·:::: :·'. ~ · Paralysis . ·...... ·... ·...... ·..... ·...... : . . . .20 259 · ·.J j' Paresis ...... ·...... 2 .Pericarditis · ...... : ...... ·; . : ...... o Peritonitis ...... • : ...... ; .. '.': . .'. 7 Pleurisy ...... , ...... : ...... , .. ,· o Pnetnnonia: ...... ·. 3 I Poisoned.-.· .. : ...... • : , ...... ·.... : ...... I Premature Birth ...... •...... , ...... 13 Puerperal Fever'...... ; .... : ...... : ...... : .. ,.. 0 Pyaen1ia ..... , ...... ·...... ·. 0 _Rheumatism ._...... , .. , ...... '...... · ...... , . I . Scarlet Fever . , . ·...... : .. ·; ...... I Senile Debility .. : ...... ; ..... , ...... IO Septicaen1ia ...... : ...... ·...... ·.. ,. . . . 4 Sn1all Pbx ...... ·.... ·. , ...... •...... 0 StiU·Born' ...... : .. ·.' .... , ...... : ...... 26,. Suicide ...... ·... · ...... I . Sunstroke ...... ,· . ·... ·~ . ; .. _.. ,_:· · · · · · · ·.. · · · · · ·· · 0 Syphilis ...... •..... _;....•. _...... , .... . o· Tetanus ..... ·...... , . I Thron1bosis ·.·.... ·...... ·...... >...... ' .. ,: .... ·;.. , 0 Tonsilitis ...... , .... ·.·...... ,. : ;··...... -.. 0 Typhoid Feyer . ; ...... , ...... ; ... . 4 Typhoid Pneumonia ...... : .... : ...... : ... . 0 Typho Malarial Fever ...... '. ·'o. T-uberculosis ...... '. .... ·; ...... ·...... :...... 50

ir~;~r'_:: ...... ',: ...''.' .. :.. :•': : : : : : : : : : :. :: ~ :; : : : : : : •: :' ,~ I Uraeniia ·;:.: ...... · ... '..-.. ·, ...... 6 Whooping Cough ...... : , 0 Other D_iseases .. : : ...... ~ . . . . . 42

Total .. ·.. ·.. '. , .... , . .·: .. ..· •... : ...... 468

DECEDENTS. Male ...... : ...... ·.. ·. ;·., ...... '.269 Feinale ...... · .. ·... : ... '. .. ,...... , ..... -. , .. ·.. 197 .Not Stated: ... ·...... , .... : ...... ·...... ,. 2

Total ...... ·...... _.1 ••••••• ·•• : ••. ·•••••• ; ••••• 468 · \ . White ...... _... , ... ·.; ...... ; . ·. ·... 376 · Black : . _.. .': ...... : , ... .' ..... '...... , 92 260

Not Stated 0

Total' ...... ,...... , ...... 468 Native Born ...... 385 Foreign Born .. ,...... 67 Not Stated ...... : .... r6

Total ...... 468 Married ...... ' ...... 155 Divorced ...... , . ,, ...... r Widowed ...... 93 Single , ...... '...... 209 Not Stated ..... ; . ; ...... IO

Total ...... : ...... 468 AGE OF DECEDENTS. Under I years ...... : ...... : . . 64 From I to 5 years ...... 28 From 5 to IO years ...... '...... '12 From IO to 20 years ...... , .. , 17 From 20 to .40 years ...... 84 From 40 to 60 years ...... ror ·. From 60 to 80 years ...... 103 From 80 to 9o' year,s ...... 23 Over 90 years ...... 33 Still Births ...... 26 Not Stated ...... , ...... 7

Total' ...... ; ...... 468 Brought in for Interment ...... 66 BIRTHS. lVIale ...... '...... 362 Female ...... , ...... '... 345 Not Stated ...... '...... ' .. ,...... 12

Total ...... 719 :VVhite ...... ' ...... ,...... ' .. 647 Black ...... ,, ...... , ...... 61 Not Stated ...... r r 261 Total ...... 719 MARRIAGES. White ...... · ...... 805 Black ...... ;, ... : ... 38 Not Stated ...... 3

Total : ·...... ,.... 846 RECAPITULATION. of Deaths, Births and Marriages for tj1e year ending June 30th, 191~. rst Q. 2dQ. 3dQ. 4thQ. Total Abscess ...... ' I I . 2 2 6 Accidents ...... 14 25 7 9 55 Alcoholism ...... I I I 3 6 Anaemia ...... I I 0 0 2 Angina Pectoris ...... I I 2 2 6 Apoplexy, ...... 24 36 44 23 127 Appendicitis ...... I 2 0 0 3 Asphyxiation ...... 0 I 2 0 3 Asthenia ...... 0 2 0 l 3 Asthma ...... , ..... 5 5 8 5 23 Biliary Calculi ...... 0 0 0 0 0 Bright's Disease ... , ...... IO 8 12 5 35 Bronchitis ...... '·' ... 0 5 15 3 23 Broncho Pneumonia ...... 4 IO 17 6 37 Burns ...... 4 7 4 4 19 Cancer ...... 14 I2 I2 7 45 I Carbuncle ...... 0 I 0 l 2 Carcinoma ...... 2 13 15 14 44 Cerebro Spinal Meningitis .. 0 0 I 0 l Chicken P1ox ...... 0 0 0 0 0 Cholera Infantum ...... 30 0 0 5 35 Cholera Morbus ...... 0 0 0 .0 0 Cirrhosis of Liver ...... 7 5 3 7 22 Convulsions ...... 15 8 8 8 39 Dentition ... •,• ...... 0 ·o 0 0 0 Diabetes ...... ·..... 2 2 2 2 8 .. Diarrhoea ...... 3 2 0, 0 5 Diphtheria...... 0 3 5 6 14 Dropsy . •,• ...... 2 2 3 l 8 262

Drowned ...... , ...... 8 4 IO 7 29 Dysentery ...... 8 0 2 0 IO Embolism ...... 0 o· 4 2 6 Emphysema ...... 0 I i: 0 .2 Encephalites ...... 0 0' 0 0 .0 Endocarditis . •.• ...... 3 6 4 5 18 Enteritis ...... ·. ;', ... •.••, 23 9 6 6. 44 Enteno-Colitus ...... 23 3 3 7 36 Epilepsy ...... 2 3 0 I 6 .Erysipelas ...... 6 0 0 I I Exhaustion ..... ". .. •.• ..... 4 3 5 I 13 Gall Stone ...... 0 0 0 0 0 Gangrene ...... ·...... 5. ·o 6 1 / . I2 Gastritis ·... : ...... , 6 5· 9, .2 22 Graves' Disease .. : ...... 0 0 0 0 0 Hemorrhage ...... I8 IO 13 5 46 Heart Disease ...... 31 50 71 29 I8I ;Hepatitis ...... ·. 2 0 0 2 4 I I I Hernia • • • • • • • • • • • • • • • ' • • I • ~ 0 3 Hydrophobia . ~ ...... 0 0 ·O 0 ·c 0 Hydrocephalis ..... ·...... 0. 0 0 0 0 Inanition ...... 5 r· 7 I. 14 Indigestion •••••••••• I,•'••• 2 2 13 .. 5 4 LaGrippe ...... 0 4 7 2 13 Locomotor Axtaxi,a ...... 2 0 I 1. 4 Maras1i1tts . :' •.• ....·...... 19- 9 7 4 .39 Malarial Fever ...... 0 0 0 0 0 ·Measles ...... 0 I I 3 5 Meningitis . . . .' ...... 15 IO· II 6 42 '1 Myocarditis ..... · ...... 0 3. 6 4 13 Natnral Causes ...... ci .I 0 0 I Nephritis ...... 21 29 32 32 II4, Obstruction of Bowels: ...... I ,2 .I I 5 Old Age ...... · ...... II· II 6 4 3::! Operation ...... ' I 0 r 0 .2 Paralysis ...... 9 7 14 20 50 Paresis ... · ...... : . , . I 0 4 2· 7 Peri ca 1:ditis ..... ~ ... ·: ....' 0 I 0 0 I Peritonitis ...... : ...... 17. 12. 13 7 49 Pleurisy · ~ ...... o' I I 0 2 Pneumonia ...... 17 ·56 86 31 .-190 Poisoned ...... I, I I I 4 263

Premature Birth ...... 14 20 16 13 63 Puerperal Fever ...... 0 0 0 0 0 Pvaemia ...... I 0 3 0 4 Rheumatism . '...... 0 o·· 3 I 4 Scarlet Fever ...... o 0 9 I IO Senile Debility ...... 13 15 14 IO 52 Septicaemia : ...... 2 I· 2 4 9 Small Pox ...... 0 0 0 0 0 Still Born ...... 29 18 29 26 I02 Suicide ...... 4 3 ,2 I IO Sunstroke ...... 0 0 0 0 0 Syphilis ...... 0 0 0 0 0 Tetanus ...... 2 2 0 I 5 Thrombosis ...... 0 0 0 0 0 Tonsilitis ...... o 0 0 0 0 Typhoid Fever ...... 13 12 3 4 32 Typhoid Pneumonia ...... o 0 0 0 0 Typho J\falarial Fever ... : . o 0 0 b 0 Tuberculosis ...... 52 ' 76 62 50 240 Tun1or ...... 0 I l o. 2 Ulcer ...... •... ·.. . I 0 I 3 5 Uraemia ...... II 18 15 6 so Whooping· Cough ...... I 3 2 0 6 Other Diseases ...... 50 62 57 42 2Il Not St:ited ...... 2 8 6 0 16

Total ...... 592 641 DECEDENTS. Niale ...... 1339 Fe111alc ...... ; ...... 1052 Not Stated ...... 35 , Total ...... ·: ...... ·.2426 vVhite ...... 1913 Black ...... , 474 Not Stated ...... '...... 39

Total ...... '·...... 2426 Native .Born ·...... 1943 Foreign Born ...... 291 264 Not Stated ...... 192

Tota! ...... , ...... 2426 Married ...... 694 Divorced ...... ·...... ,... 6 Widowed ...... ; ...... 435 Single ...... ' ...... , : ..... 1010, Not Sta,ted ...... 281

Total ... · ...... ·...... ·.. · .. ·.2426 AGE OF DECEDENTS. Under i year ...... 382 From 1 to 5 years ...... : ...... 132 From 5 to IO years ...... ,; ..... 49 From IO to 20 years ...... , ...... 97 From 20 to 40 vears ...... - - ...... 399 Ffom 40 to 60 years .. ' ...... , , ...... 459 From 60 to 80 years ...... - ... 579 From 80 to 90 years ...... •...... 146 Over 90 years ...... : ...... 27 . Still Births ...... • . . 102 Not Stated ..... , ...... 54

Total ...... •...... 2426 · BIRTHS. Male ...... · ...... ; 1271 Fe1nale ...... ; ...... 1191 Not Stated ...... •·...... 24

. Total ...... 2486 White ...... ' ...... · .... .2268 Black ...... ,, ...... 196- Not Stated ...... • ...... 22

Total ...... , ...... 2486 MARRIAGES. White ·····.·············.··············· .. ·..... 5133 B1ack ...... -...... ·...... 180 265

Not Stated IO

Total ...... 5323 First Quarter Ending September 30th, 1913. Deaths, Births and Marriages. Ahs~ess ...... ,,.1...... , ..... I Accidents ..... , ...... : ...... II Alco,holis1n ...... : .. ·...... I Anaen1ia ..... ; ...... ·...... o Angina Pectoris ...... I Anthrax ...... : ; ...... I Apople~Y...... , ...... 19 Appe!1c~1c1~1s.. , ...... o Asph1xiat1011 ...... ·...... 2 Asthenia ...... 2 Asthri1a ...... 2 Biliary Calculi ...... : ...... o Bright's Disease ...... IO Bronchitis .·...... ·...... 2 Broncho Pneumonia ...... 9 Bun1s .. ·...... ·...... ; ...... , 2 Cancer ...... ·...... : ...... , ...... 7 Carbuncle ...... ·...... o Carcinon1a ...... 16 Cerebra Spinal Meningitis ...... ; . . . o Chicken Pox ...... , .-.. ; . . . . . o Cholera Infantum ...... 24 Cholera Marbus ...... ·...... r Cirrhosis of Liver ...... '...... 3 Convulsions ...... ·...... 2 Dentition ...... '...... o Diabetes ...... • ...... 2 · Diarrhoea ...... : ...... I Diphthe!'ia, ...... ·.·.. : ... I Dropsy. ·, ...... ·...... I Drowned ...... ·...... 7 Dysentery ...... : ...... : .... ·.... : ...... 3 E1nbolisn1 ...... o Emphysema •••••••••••••••••••••• 1...... I Encephalites 0 Endocarditis .....•...... •....•...•..••.•.•...... 2 266 Enteritis ...... 15 Entero--Colitus ...... ' ...... •...... 27 Epilepsy ...... , ,, ...... _.. . I Erysipelas ...... , ...... o Exhaustion .' ...... : ...... 2 Gall Stone ...... : . . o Gangrene ...... : ...... '...... I Gastrit\s ...... _...... , ._...... ·, . \" . . 8 Graves Disease ...... : ...... o I-Ien1orrhage ..... ·...... : . . . 9 I-Ieart Diseases ...... · ...... , ...... 42 I-Iepatitis ...... o I-Iernia ...... ·.... ·...... o Hydrophobia ...... o Hycl'.·~cephalis ...... ·. . . . o I11an1t1cn ...... 5 Inclig1estion ...... I La Grippe ...... ,, ...... o Locomotor Ataxia ...... -...... ·...... , . o Marasnn1s ...... : ...... 19 Malarial Fever ...... , ...... , ... ·...... o l\1easles ...... ·...... o Meningitis ...... : ...... I I Myocarditis ...... 7 Natural Causes : ...... ·...... o Nephritis ...... 24 Obstruction of Bowels ...... ,'., 3 -g~det~t~n· : .· .· .·.· .· i .·: : : : : : ; : : : : : : : : : : : : : : : : : : : : : : ~ Paralysis :...... , ...... · ...... , IO Paresis ...... ·· ..... ·.... 4 Pericarclitis ...... o Peritonitis ...... , ...... 4 Pleurisy , ...... o Pneuino·nia ... -..... · ...... , ...... 27 Poisoned ...... 4 Premature Birth , ...... 18 Puerperal Fever ...... • ...... o 'Pyae111ia ...... · ..... ·.. . . o Rhei.nnatism ...... : ...... o Scarlet Fever ...... 5 Senile Debility ...... I I.