HEALTH IS NATURAL, DISEASE IS UNNATURAL.

MONTHLY BULLETIN Indiana State Board of health Entered as second-class matter at the indianapolis Postoffice,]

INDIANAPOLIS, OCTOBER, 1914. NUMBER 10 VOLUME XVII. 25 Cents a Year

T. HenrY DAVIS. M. D., President ...... Richmond. ABSTRACT OF MORTALITY STATISTICS JAMES S. BOYER8. M. D., VlCe-PReSIDeNT...... Decatur. FOR OCTOBER, 1914 .!. L. FrEELAND, 31. D. ....Indianapolis. H. H. SUTTON, M. D Aurora. Total number of deaths, 2,736; rate.. U.S. In the pre­ J. N. HURTY, M, D.. pHAR. D„ Secretary . Indianapolis. ceding month, 2,713 deaths: rate. 11.8. In the same month last year, 2.S33 deaths; rate 12, Deaths by important ages WM. f. KING. M. D Asst. SECRETARY AND EPIDEMIOLOGIST. were: Under one year of age. 448, or 16.3 per cent of total: J. L.ANDERSON - .CHIEF CLERK. CHAs, A. CARTER. M.d statistician 1 to 4. 184: 5 to 0, 00; 10 to 14, 41 ; 15 to 10, 55; 05 and WM. SHIMER, AB.J. D...... Supt. BACTERIOLOGICAL LABORATORY. ADA E. SCHWEITZER, M. D...... ASSISTANT BACTERIOLOGIST. over, S61, or 31.4 per cent, of total. W. V. BOYLE. M. D..... ASST. PATHOLOGIST. H. E. BARNARD B. s .STATE FOOD AND DRUG COMMISSIONER AND CHEMIST. SANITARY SECTIONS: THE NORTHERN SANITARY SEC­ H. E. BISHOP. B. S .... ASSISTANT CHEMIST. TION, population 972,129. reports 985 deaths; rate, 11.4. In JOHN C. DIGgs • ...... ENGInEER AND WATER chemist. WILL H. McABEE.. ••••••\ ....DRUG CHEMIST. the preceding month, 914 deaths; rate, 11.4. In the same R. L. SACKETT, C. E •••••• •• • SANITARY ENGINEER. month last year, 920 deaths; rate. 11,4. THE CENTRAL SANITARY SECTION, population 1,152,277, re­ The MONTHLY BULLETIN will be sent to all health officers and dep­ uties In the State. Health officers and deputies should carefully read and ports 1,212 deaths; rate 12.3. In the preceding month, file each copy for future reference. This is very Important for we expect 1,187 deaths: rate, 12.8. In the same month last year. to print instructions, rules and general information, which it will be necessary tor officers to preserve. 1,138 deaths; rate 12. THE SOUTHERN SANITARY SECTION, population 672,551, re­ ports 5S9 deaths; rate 10.3. In the preceding month, 012 CONTENTS, deaths; rate 11. In the same month last year. 075 deaths: rate, 12.2. Page REVIEW OF SECTIONS; The highest death rate oc­ Births for October. 1914 109 curred in the Central Section 12.3. It is 0.7 higher than Abstract of Mortality Statistics for October 109 Summary of Morbidity and Mortality for October...... 109 the rate for the whole State. The Central Sanitary Sec­ Report of the Department of Food and Drills for October...... 110 tion presents the highest death rate for tuberculosis, diph­ Inspectors' Reports for October... 110 theria, pneumonia, diarrhea and enteritis under 2 years, Report of Bacteriological Laboratory for October ill influenza, cancer and external causes. A Model Monthly Health Report 112 Patients Who Have Taken Pasteur Treatment in October...... —. 112 RURAL: Population, 1.550,^42, reports 1,290 deaths; Mrs. Goforth 112 rate 9.8. In the preceding month, 1,343 deaths; rate, 10.2. The Necessity for Efficient, Properly Paid, All-Time Health In the same month last year, 1,290; rate. 10.1. Officers. •• 113 Sleepy Town...... 113 URBAN: Population. 1,240,815, reports 1,110 deaths; Government Expenses ..,,..... —...... 113 rate, 13.6, In the preceding month, 1,365 deaths; rate, 13,3. The Health Side Show 114 Canneries, Good and Bad..... — —...... 114 In the same month last year, 1,437; rate 14.3, The cities Not Reported 118 named show the following death rates: Indianapolis, 1G.1; Chart Showing- Geographical Distribution of Deaths.. .,— 117 Evansville, 12.2: Fort Wayne. 13.1; Terre Haute, 13.7; Table 1. Deaths in Indiana by Counties 118 South Bend. 14.7; Gary, 11.4: Muncie, 10.8; Richmond, 13.4; Table 2. Deaths in Indiana by Cities... —...... 119 Mortality of Indiana for October 120 Hammond, 12; Anderson. 13.2; E. Chicago, 11.8; LaFayette. U. S. Weather Report for October. 120 15.9; New Albany, 13.7: Elkhart, 9.1; Michigan City, 12.7.

BIRTHS FOR OCTOBER, 1914. SUMMARY OF MORBIDITY AND MORTALITY FOR OCTOBER, 1914, Total births, 4f9SS (stillbirths excluded), State rate, 21,0, Males, 2.599; females, 2,389. Typhoid fever, as in the three preceding months, was re­ White males, 2,560; white females, 2,300. ported as the most prevalent disease. The order of preval­ Colored births. 62; males. 39; females. 23. ence for the month was as follows: Typhoid Fever (En­ Stillbirths, 164: white, 102; colored, 2. teric), Scarlet Fever, Diphtheria and Croup, Tonsilitis, Northern Sanitary Section, population 972,12?>. reports Acute Rheumatism, Pulmonary Tuberculosis, Acute Bron­ 1.931 births: rate 23,3. chitis, Diarrhea and Enteritis, Smallpox, Malaria Fever, In­ Central Sanitary Section, population 1,152,277. reports fluenza, Measles, Chickenpox, Dysentery. Intermittent and 1.S60 births: rate 19,0. Remittent Fever, other forms of Tuberculosis, Bronchial Southern Sanitary Section, population 072,551. reports Pneumonia. Whooping Cough Lobar Pneumonia. Cholera 1,197 births: rate 3.9. Morbus- Poliomyelitis, Erysipelas, Puerperal Fever, Cerebro­ Highest rate. Lake County, 37.9. spinal Fever. Rabies In Human, Rabies in Animals, Lowest rate. Newton County, 112*1 SMALLPOX : 232 cases in 23 counties with no deaths. Total births to date for 1914—51.SS2. In the preceding month, 140 eases in 24 counties with no 110 MONTHLY BULLETIN, iNdIAnA STATE BOArD OF HEALTH,

deaths. In the same month last year, 12<» cases.< in 21 REPORT OF THE DEPARTMENT OF FOOD AND counties with 4 deaths. The disease appeared this DRUGS, INDIANA STATE BOARD OF HEALTH, month in the following counties: Allen. 1.1 «-;i>e> : Blackford FOR OCTOBER, W4. 1.1; Clark T: Clinton r»: Delaware 47: Floyd 1: Foun­ H.E. Barnard State FOOD anD drug commissioner, tain .1: Gibson i\; Hancock 1: Harrison .">: Howard 1: Jef­ ferson 2.1; Johnson 2; Knox 17: Lake 4*»; Marion 1: Mar­ During the month of october special work in connection shall 1; Owen 1: Parke 1; Pike 1: Porter 22: Shelby 1: with the foot and mouth epidemic occupied much of the Washington 1. time of the laboratories. Pot 40 samples of food were an­ Tuberculosis: 2]*J1 deaths, oi which 222 were of the alyzed, and of fills number »M were reported as legal : twi> pulmonary form, and .11* other forms. The male tuberculo­ maple syrups were found to contain an excess of moisture: sis deaths numbered 14-1: females. 14*J. Of the males, 22 two vinegar samples were low in acid content : 4 honeys were married in the age period of l,s to 40 and left 44 sent in on suspicion proved to he genuine. orphans. Of rile females, 4«i were married in the same aire of the L" drug samples analyzed all were pure and properly labeled, period and left iw.» orphans'. Total orphans under 12 years of age made in one month hy this preventable disease. VM, Number of homes invaded. 27*1. RESULTS OF ANALYSES OF FOODS AND DRUG? during THe MONTH OF OCTOBER, 1914, Pneumonia: *4 deaths: rate 21.2, In the preceding _____ month. .is deaths: rate 2.1.2. In the same month last year. Number number Total 121 deaths: rate .1J.4. CLASSIFICATION. Illegal j DIPHTHERIA: .1S1 cases reported in 14 counties with -__

lit) deaths. In the preceding month. 240 eases in 47 counties Foods with 28 deaths. In the same month last year. 727 eases in (JO counties with t'»1 deaths. Orange cider, Tea. .. . TYPHOID FEVER: 414 eases in <><> counties with 7.1 Apple batter.. . Canned gooseberries: deaths, In the preceding month, 222 eases in *>2 counties Honey ...... with 70 deaths, In the same month last year. 4SU eases in Maple syrup... sugar 00 counties with 12f> deaths. Meat Products Meat SCARLET FEVER: Mil eases in 10 counties' with s Sausage.. . MilkProduct sButter. , . . deaths. In the preceding month, 14S eases in ot> counties with Milk . (J deaths. In the same month last year. 4K:j eases in 02 vinegar counties with II deaths.

Total . ,* MEASLES: 122 eases in 2;* counties with 4 deaths. In drugs. She preceding month, 42, eases in 12 counties with no deaths. Alcohol... ,. , . . oilss_ POLIOMYELITIS: II cases in 7 counties with 2 deaths. Linseed oil., Olive oil.,, In the preceding month, 1 cases in «! counties with .1 deaths. Oil peppermint In the same month last year. 14 eases in S counties with 4 Oil turpentine Silver nitrate,..,.,. deaths. The deaths tins month occurred in Lawrence coun­ Miscellaneous.. . ty, l male 1 year old: Lake county. 1 female 2 years old: Total , . Posey county, 1 male 1 year old. EXTERNAL CauSES: Total deaths. 22o: males UK!: females 14. suicide total, 47: males, 32.: females, 14. INSPECTORS REPORTS FOR THE MONTH OF Means of suicide— poison, 10: asphyxia. 1: hanging or OCTOBER, 1914. strangulation. 7: drowning, 2: firearms, Hi; cutting or piercingA seriou s ouinstrumentst break of , the1 : so-callecrushingd foo. 1t . anAccidentald mouth diseasor eUndefined Total. 172: males. 12i>: females, .",'i. Poisoning hy food, 2; appeared in St. Joseph and Laporte Counties early in Oc­ other acute poisonings, 11; conflagration. ,1: burnstobe (conflagrationr and made it necessar excepted)y , to10 concentrat: ahsorptioe thn e oworf deleteriouk of the s gases (conflagration excepted). 12: accidental drowning. .1: trau­ inspection force in northern Indiana, where it was able to do excellent service in organizing the force necessary to matism by firearms, .1; traumatism by cutting or piercing control the epidemic. On account of this service hut 100 instruments. l: traumatism by fall. ,12: traumatism by inspections were reported during the month. Six places machines. 2: traumatism in mines, 3: railroad accidents visited were 'found to be in excellent condition. -S."» were and injuries. 41; street car accidents and injuries, 1; goodautomohile. 1*0 fair, 22 accidentpoor ansd anhudt injuries0 had. . Seventy-on0; injuries e bycannin otherg vehicles. 7: other crushing. 4: injuries by animals, 2: electricity factories were visited. Of this number - were in excellent (lightning: excepted). ."»: fractures (cause not specified). 1: condition. 24 were good. 'V2 fair. In poor and .*J bad. Of tin* other external violence, 12. Homicide Total 1.1: males, 12 : till grocery stores visited. 2 were in excellent condition, s."» females, 2, Homicide by firearms. 7; homicide by cutting good, 01 fair and one poor, Conditions in meat markets. or piercing instruments, 1 ; homicide by oilier means, 7. bakeries and hotels were for the most part satisfactory, hut few places being reported as in poor condition and none as had.

LIST OF PROSECUTIONS during. THE MONTH OF OCTOBER, 1914.

Date of county Names and Addresses of Defendants Why Prosecuted Trial Final Disposition

Pike . Charles W, Butler, Petersburg Soiling adulterated drug. HM5-14 I Uined S-19 5f! Pike .. Charles W Butler, Petersburg Selling misbranded drug Il»-15-lt Fined >\M .")») Washington Ira G, Short, Pekin...... selling misbranded food ii>^ o-ll ! Fm.H -IS 20 MONTHLY BULLETIN, INDIANA STATE BOArD OF HEALTH.

During the month 10 condemnation notices wore issued Throat cultures for diphtheria bacilli— against canning factories, grocery stores, meat markets and Negative restaurants, in 18 cases because of improper construction Positive and as well in cases for unsanitary condition. Suspicious But three prosecutions were brought during the month, unsatisfactory one because of the sale of misbranded food, one a mis- branded drug, and one an adulterated drug. The fines and costs imposed amounted to 157.20. Epidemic diphtheria— Positive INSPECTORS' REPORTS FOR THE MONTH OF OCTOBER, 1914 ' • Negative ......

No No No No No. No INSPECTIONS, Inspected, Excellent Good Fair. Poor. Bad. brains for rabies— Dogs Dairies... . Grocery stores Positive ...... '..... + ...... Meat markets...... Negative ...... Drug stores Bakeries and confectioneries Unsatisfactory ...... Hotels and restaurants Milk depots...... cats: Creameries, Positive Fish market Wholesale grocery Unsatisfactory ...... Slaughter houses Bottling works Ice cream parlors..... Flour mills...... ,...,. Poultry houses Feces for typhoid bacilli - Produce company. . . Pharmaceutical company. .... Negative ...... Beet sugar factory.... Fruit store. Chemical company. , . . Feces miscellaneous ...... Canning factories

Total Blood for counts

NOTICES OF CONDEMNATIONS DURING THE [MONTH OF OCTOBER, 1914 Blood for malaria plasmodia— Positive Reasons for Condemnation. CLASSIFICATION Total. Negative Unsanitary Improper « Conditions. Construction. Pus miscellaneous Canning factories Grocery.,,.... . Meat markets...... Pathological tissues— Restaurants Restaurants and bakeshop Carcinoma of neck Restaurants and confectionery. Carcinoma of breast Carcinoma of eyelid ...... Carcinoma of liver and pancreas ...... Carcinoma. location not given ...... REPORT OF BACTERIOLOGICAL LABORATORY, Sarcoma, location not. given INDIANA STATE BOARD OF HEALTH, Miscellaneous FOR OCTOBER, 1914. Sputum for tubercle bacilli— Positive ...... Urine for chemical analyses ...... Negative Pus for gonococci— Urine for tubercle bacilli— Females: Negative ...... Positive ...... ,....•...... ;...... Pus for tubercle bacilli— Negative ...... Positive Males: Positive ...... Cerebrospinal fluid for tubercle bacilli- Negative ...... Negative Sex not given: Miscellaneous fluids for tubercle bacilli- Positive ...... Negative Negative ...... Widal tests for typhoid fever- Positive Worm for Identification ...... Negative ...... -.--.-....•••«•*" Tape worms ...... Paratyphoid tests for typhoid fever- Positive Total number of specimens examined.... Negative ...... «•.•••••• Doses of antityphoid vaccine sent out...... 112 MONTHLY BULLETIN, INDIANA STATE BOArD OF HEALTH,

OUTFITS SENT OUT durinG OCTOBER, 1914. FIELD. Tuberculosis ...... 490 Smallpox. Diphtheria ...... 2,342 A trip was made to Chesterton and Porter, accompanied Widals 256 by Dr. S. J. Young, to investigate an outbreak of smallpox Gonococci , 42 at these places. Blood counts . 12 A trip was made to two schoolhouses in the northern Malaria 30 part of the county and to the homes of two of the patrons Bile Media ...... 7 of these schoolhouses to study the smallpox situation. Hookworm ...... 0 Typhoid. Total number ...... 3.170 An investigation was made in Valparaiso to determine the source of Infect on of a number of typhoid cases. This in­ volved thirty-two investigations in or near the city of Val­

PATIENTS WHO HAVE TAKEN PASTEUR" TREATMENT paraiso. Cclcry fields OCTOBER, 1914, Complaint was made to this office regarding the unsani­ tary condition of celery fields near the city. Two celery Began Finished fields were inspected, involving four different trips. NAME. Town. Comity, Age Sex. Treatment. Treatment Nuisances. Number of nuisances inspected or reinspected. 13 Joseph risley.,..,,. J Indianapolis. Marion.. Edna Risley., ! Indianapolis. Marion.. Notices served » • • * JO W. A, Vaughn.. j Indianapolis. Marion.. Duplicate notices served • «> Walter Glenn Beaman Indianapolis. Marion.. Phoebe craft...... ,! Indianapolis. Marion.. Elisabeth Lohrman..,, Indianapolis. Marion., Pure Food Inspections. Glenn Hoop...... ,.| Indianapolis, Marion.. This department has started a regular inspection of all A. D. Pinkstaff J Vincennes... Knox... food-purveying establishments in Porter County, wherein an attempt will be made to maintain a regular monthly in­ A MODEL MONTHLY HEALTH REPORT. spection of all groceries, meat markets, confectioneries, shops, hotels, restaurants, lunch rooms, soda fountains, etc., MONTHLY REPORT, OP DEPUTY HEALTH COMMISSIONER OP etc. As soon as possible all dairies and slaughterhouses sell­ PORTER COUNTY, OCTOBER 12-31, 1914, ing meat and milk within the county, will also be inspected Assumed duties of Deputy Health Commissioner of Porter regularly. During October, fifty-two food-purveying estab­ County, Indiana, on October 12, 1914. lishments were inspected. Spent the day of October 12th in the laboratories of the SUMMARY OF FIELD EXAMINATIONS. Indiana State Board of Health investigating the chemical Smallpox ....,....,.:.,...• 5 and bacteriological methods of analyses used by them. Typhoid 32 Arrived at Valparaiso October 13th and started work Celerimmediately.y fieldsA summary of *wor k done durin• g 4th e month- of October follows. Nuisances 13 Pure food 52 LABORATORY. The laboratory has been partially overhauled and put in Total ...... 10G shape for making chemical and bacteriological analyses. The laboratory is now in shape to make the following an­ quarantine and disinfection alyses : Quarantine for smallpox 1 Examination of milk. Disinfection after diphtheria (six rooms) ...... 1 Examination of water (bacteriological). Total .... 2 Examination of contaminated foods (to a limited extent). Examination of sputum and urine for tubercle bacilli. mileage traveled. Examination of throat and nasal cultures for diphtheria By automobile CO bacilli On foot 80 Examination of pus for gonococci, Interurban ...... 8 Widal test for typhoid. Examination for pneumococci. Total 140 Examination for pus organisms. Respectfully submitted, Outfits. LEX B. CLORE. The following outfits have been made and distributed dur­ Deputy Health Commissioner. ing the month of October: Number Number MRS. GOFOrTH: Mrs, Isaac R. Goforth desires greatly Made. Distributed. to secure information concerning the death of her husband. Widals .21 8 He was an old soldier and probably died six or seven years Diphtheria 8 ago somewhere in Indiana. Owing to the fact that the Pus for gonococci ...... 10 death certificates in the State Board of Health are not in­ dexed by name, it was impossible to secure the information Examinations. desired by Mrs. Goforth. The State Board of Health has Sanitary examinations of water 2 asked permission of the legislature to make this index sev­ Examinations for diphtheria bacilli 1 eral times, but has always been refused. Mrs. Goforth is Widal tests ..,..,.,,, 1 not the only person who has needed in court transcripts of deaths which could not be furnished simply because the Total laboratory examinations ...... 4 State Board of Health was not permitted to make an index. MONTHLY BULLETIN, indiana STATe BoarD OF HEALTH. US

THE NECESSITY FOR EFFICIENT, PROPERLY PAID in the conservation of the public health, that the cause is ALL-TIME HEALTH OFFICERS. popular with the people, that it is the most important ques­ A review of the health laws of the State of Indiana dis­ tion before the people today, and that he hopes the legisla­ covers, on the whole, they are very good, but a chain is DO tors, in the name of economy, and in the name of good stronger than its weakest link, and the weak link found in business, and in the name of the best interests of the peo­ the health laws is the public health officer, At the pres­ ple, will support all good health legislation and will stand ent time practitioners of medicine are selected as health for the merit system in the public health service. The citi­ officers, No matter how excellent tlie character, personali­ zen who will write such a letter to his legislators will cer­ ty and training of the physician is, he cannot possibly se~ tainly be doing a good thing, and so all readers of this euro the cooperation of his brother physicians with whom article are appealed to to not forget to perform this im­ he is in competition while he practices medicine. Without portant service for their State. this cooperation he cannot succeed,, except partially, in pub­ lic health administration. Being a practitioner, the health officer very frequently finds himself called upon to abolish SLEEPY TOWN, unsanitary conditions upon the premises of men who are 1 live in Sleepy Town with my children, brothers and sis­ his patrons. It is natural, under such conditions, for him ters. We number more than twenty. Our home is located ro halt and overlook the fault of his present system. The on an alley in the rear of a large residence, and there we third objection is that no man can serve two masters. The have spent many happy days. From a grocery store nearby health officer, under the present system, must, earn his living we obtain potatoes, cheese, crackers, and pieces of meat, and practicing medicine and doing a little health work on the many a choice morsel is secured from an uncovered garbage side for very small pay. lie must perforce give the greatest can near our home. Occasionally, one of us will bring home part of his time and energy to earning his living, and so It a fresh egg or some young chicks from a neighboring hen happens that he must serve himself and also the public. house, and then what a feast we have. This cannot, be successfully done. The remedy is to make Living as we do, crowded in small quarters and denied the health officer an all-time officer. The new law will be bathing facilities, we find it exceedingly hard to keep clean, up to date and scientific, and would provide trained sani­ and sometimes vermin are discovered in our home and even tarians to do the work of public sanitation. All-time health in our hair. But despite our unsanitary surroundings we officers would give their entire time to keeping away disease are healthy and strong and have splendid appetites. The and improving the public health, and should not practice people near whom we live do not object to our unsanitary medicine. Such officers should be appointed by local au­ home and encourage us to remain, In fact, they themselves thorities from an eligible list upon which they find recogni­ are not as clean as they should be. Their yards are littered tion through physical and mental examinations by the State and garbage is frequently strewn on the ground to our Board of Health, Each county should appoint its own delight Even the grocer from whom we obtain most of county health commissioner; his salary should be graded. our food is very careless is displaying it. Flies swarm regulated by the number of people he serves; his duties and about, sometimes walking over the uncovered foods on the powers should be fully defined; he should keep full and dirty counter, and sometimes swimming in the molasses and accurate record of all work done; he should be a deputy of milk. I heard him say the other day that much sickness the State Board of Health and subject to dismissal for such prevailed among his customers. reasons as the law sets forth; he should be held responsi­ ble for the public health in his county. In Sleepy Town the people are not wide awake, their busi­ ness does not prosper, their streets and alleys are unclean, A modern health law. as above outlined, would not create garbage is exposed in uncovered cans, trash heaps are pres­ a new office, but would make an old office up to date and ent smells abound and much illness prevails. But 1 and efficient. It would abolish all town health officers and all my family are content to Jive here. Why? Because we city officers and boards of health, except in large cities; say cities of 10,000 and over. Officers for small towns and are rats (Signed) MRS. FLEA RODENT. cities would be unnecessary under the new system, and their abolition would he a saving of money, with increased good results. A modern health law requiring trained health offi­ GOVERNMENT EXPENSES are not infrequently in­ cers giving their entire time to the work would not be an creased because of failure of citizens to fulfill their duties excuse, but a true investment. The system would bring to the public. Here is a case in point. Margaret Duncan splendid returns in freedom from epidemics, in increased died July 1. 1914, in Washington County, Monroe Township. health with its increase of wealth and happiness. In one The certificate of death was promptly made out by the at­ Indiana city very lately an efficient veterinarian who had tending physician, a burial permit was issued by a deputy acted as meat and milk inspector was discharged and a health officer, but said deputy health officer failed to send drug clerk appointed. This was a case of miserable poli­ the certificate of death promptly to the county health com­ ties, from which the city now suffers. It is interesting to missioner. This failure brought a considerable and unnec­ speculate as to how long it will be before Indiana will throw essary expense to the State; for, the State Board of off the yoke and burden of politics and ordain that merit Health to find all of this out, and secure the data of the and efficiency only shall be considered in the appointment of death, as the law commands, spent probably $20.00, which officials, The mayor who displaced the competent man and of course comes out of the treasury of the State. Had the put; in the untrained druggist is surely opposing the best citizen named promptly sent in the certificate of death as interests of his city, and he will find he Is opposing his own commanded under the law and not have forgotten it or best interests, Now the question arises, how can good citi­ neglected It. then the extra expense as above set forth would zens aid in the securing of the new condition in the public not have been necessary. This has happened so frequently health department which will, produce large results? in the State of Indiana that the State Board of Health feels It is not difficult to answer this question, for each citizen constrained to make this incident public, that people may who Is so disposed should act as an individual. Let such have a concrete example of how necessary it is for every citizen write to his legislators and tell them he believes one to fulfill his duties as a citizen. MONTHLY BULLETIN, INDIANA STATE Board OF health.

THE HEALTH SIDE SHOW, night with only a slight intermission at noon. One audi­ ence followed another. It was estimated that 20,000 people The Indiana State Fair was held September 7 to 12, 1914, passed through the tent in the four days of the fair. There The State Board of Health had a "Health Side Show"' at was some hesitation on the part of the Board at first to this fair. A large "side-show tent" was procured and flam­ ing advertising posters prepared. Cut No. 1 shows the adopt this method of promoting the public health cause, thinking perhaps the dignity of the cause would suffer. We exterior of the tent pretty well hidden by the large painted now feel that no dignity was lost and that we know how to banners in the style of the ordinary side show. The pic- secure large audiences, Many thousand health circulars hire show the Indianapolis News Newsboys" Baud playing in front of the show to attract a crowd. Near the bass were distributed by a special distributing clerk near the drum will be seen the barker or ballyhoo, who, upon the ces­ door. From every point of view we found the public health sation of the music, told the crowd in stentorian tones side show was a great success.

WORLDS GREATEST SIDE SHOw

Exterior of the Health Side Show at the Slate Fair, Band playing 'in front of tent to attract a crowd* through a megaphone of the wonderful show the State Board CANNERIES, GOOD AND BAD. of Health had to present, admission to which was "free of Another canning season is closed. Whether it has been charge for nothing' a success financially for Indiana canners is not yet deter­ In the interior of the tent was an exhibit of the State mined, but if the canner can find satisfaction in viewing the stock of splendid canned goods in his warehouses, he Board illustrating many phases of hygiene and disease prevention. The bacteriological and pathological laboratory should be content From the point of view, of the offi­ had a booth where methods of examination were explained, cial, the inspector who theoretically is more or less respon­ Microscopes were at hand to show those who desired to sible for sanitary conditions, the season of 1914 is by far know, various microbes, and the placards within the booth the best the Indiana canner has ever known. made plain the processes and methods of the laboratory. Last fall the chief criticism was that the conditions sur­ The pure food and drug laboratory was represented in like rounding the operator in the cannery were not as good as is manner, also the weights and measures department. the quality, both as to material and sanitation of the goods A prominent, feature of the side show as illustrated in produced. That we might improve these conditions in the Cut No. 2 was the illustrated lectures. By means of a fall of 1913 a notice was served upon canners and packers recent invention it was possible to show still and moving which read as follows : pictures in daylight, Members of the staff of the State "All factories in which fruit and vegetables are prepared Board of Health were constantly on hand and lectures went or packed for human consumption shall be provided with on continuously from ten in the morning until eight ar modern toilets, technically known as 'closet combinations,' MONTHLY BULLETIN, INDIANA STATE BOARD OF Health. 115 operated by water under pressure and connected to a sewer Not every canner in the State obeyed our orders. A few and properly trapped. made no attempt to obey them. They will not he in opera­ tion in 1015, but every canner who had any respect for his Sinks supplied with water under pressure shall he provided adjacent to such toilets at which all employees shall business, any plans for the future, any appreciation of his he compelled to wash their hands after visiting toilet's. responsibility as a manufacturer of food stuffs did earnestly Soap and clean towels shall be provided in sufficient work to the end we had in view. Many entirely new toilets quantity. and dressing rooms were installed. We have been delighted "Sanitary drinking fountains supplied with pure drink­ to find small country plants operated for but a few weeks ing water shall be provided for the use of operatives. The in the year splendidly provided for in this respect. With use of water buckets and dippers is forbidden." possibly one exception all the plants constructed this past In order that the operators of factories intent he guided season have considered the installation of toilets as care­ in the construction and installation of the improvements fully as the installation of boilers. Where the plans suggest

Inside of the Health Side Show at the State Fair. The lecture department where still and moving pictures were shown and health lectures delivered.

ingested were not carried out this past season we have suggested. we prepared plans and specifications for the promisconstructione of compliance , whic«»hf toiletswill .hav The et oplait bo s madweree madgoode only after study­ ing what we believe to he model installations already in use before next season opens. If they are not made good there in Indiana. They called for a detached building which. will he no next season and canners who are not prepared to although advisable, is net necessary. The building is suffi­ provide decent clean, fiyproof toilets which meet the ap­ ciently large 10 provide washrooms and suitable dressing proval of our inspectors, adequate washing facilities and rooms. In order that the operator might have some idea of pure drinking water should not go to the trouble of con­ the cost of construction of the buildings suggested we made tracting acreage which when grown they cannot pack. three sets of specifications, the first set calling for a cement The plants in the State which have* made a profit this floor. the second a cheaper roof and the third a wood floor. past season are the good plants, the plants which were properly lighted in which the workers were able to produce a The cost of the installation could of course be approximated maximum yield, plants where the waste product in the only as labor and material costs differ so. greatly In different pars of the state. shape of peelings and small tomatoes were worked up into trimming stock, pulp or catsup rather than being: thrown We ,isv glad to say that she inspectors" reports covering the away. condition of the factories during the season of VM4 chow a very invar improvement in respect to the construction and Some conditions are not operating to the benefit of the operation of toilets washrooms and dressing rooms. canning industry of this state. 116 MONTHLY BULLETIN, Indiana STATE BOArB OF HEALTH.

In the first place we must admit that a cannery cannot which the operation of the factory can be directed so thai be successful where acreage is not available. Nevertheless the bad run of Monday is not repeated on Tuesday. there are a number of canneries in this State which cannot Eventually the canner must be scientifically trained. It get sufficient acreage within a reasonable hauling distance will not suffice that he is a large stockholder or that he of the home plant to make a profitable season's run, no has the backing of the local bank. We are asking of our canning factory should be established in territory where it superintendents that they bring to their work a thorough will not be possible to secure acreage. knowledge of their business, that they know how to handle Second, although this statement may be contrary to the men, that they can see waste and stop it, and. above all, thai views of some canners present, no plant should be estab­ they appreciate their responsibility as an important part of lished in a locality not provided with an adequate water the organization that is making the Indiana pack its splen­ supply. We have visited canneries this past season where did reputation and the Indiana canner a leader in the in­ the water supply was so short that it was hardly possible dustry. to keep steam in the boiler- Tomatoes, for instance, were Our inspectors report that 38 canning factories have good, not washed, they were dipped in a tank of yellow mud and that is, sanitary, properly ventilated, clean toilets, and in went to the peeling tables in such condition that we cannot *»«*» plants, the toilets are in fair condition, In 11) plants, understand how the goods there packed will ever pass they are poor, Eighteen of these 10 plants where the toilet Government inspection. We appreciate the fact that water facilities are poor have said that they would build model is hard to get in some of the finest tomato districts in the toilets and dressing rooms before the season of 1915 opens. State, Nevertheless it; must be had, for under present In 12 plants we found new and thoroughly satisfactory in­ methods of operation, an ample supply of water under stallations. pressure is an absolute essential to bacterial cleanliness. in one plant in Indiana we found the superintendent Third, the disposal of factory wastes, either in the form making pulp by the old process of sedimentation, allowing 4 of wash water or vegetable matter subject to decay, is a the tomato solids and tomato liquor to separate and then problem which must IK? solved. It is not enough for the turning the liquor into the sewer, wholly ignorant appar­ canner to say that he is doing everything in his power to ently of the fact that this water liquor contained practically relieve a bad situation. This waste must be taken care of all the sugar acid and valuable mineral constituents neces­ In such a way that it does not become a nuisance. The sary to make a satisfactory pulp or palatable catsup. time to make provision for proper disposal is before damage In a few plants we found sorters trying to pick out rot­ suits are filed. Without a doubt the money the canner ten and sacked tomatoes after they had passed through spends in defending damage suits and employing lawyers the steam chest. Such work is costly and utterly useless. and experts, if properly applied, would take care of bis The sorting must be done after the tomatoes have received wastes. During the past year a number of septic tank sys­ their first wash, and to be done properly the sorter should tems have been installed. Some of the systems are working see every tomato passing before him. This means that fairly well, others are not working at all. There are sev­ they must not be fed to the belt in a layer more than one eral reasons why the systems refuse to work, but which tomato deep. the average canner knows nothing of. They will not work In general, we hare little criticism to make of sorting until the necessary bacteria are present in enormous num­ methods. By far the bulk of our pack was well washed bers. Usually this inoculation takes a month or more. By and sorted, The quality of that pack should insure a that time the season is half over and much damage has profitable sale. Another year we shall demand more of the been done. The bacteria are easily killed by heat. Hot canners than in years past; not because we want it par­ water discharged into a septic tank will ruin its efficiency. ticularly, but because the best, interests of the business de­ The bacteria must be allowed time to complete their work. mands it. A septic tank if overcrowded is no better than an open We shall require ail tomatoes to be washed in running ditch. For these and other reasons we doubt the advisability water, that all toilets must be sanitary, convenient and of installing septic tanks at the canning factories which cleanly, that clean towels and soap must always be avail­ are operated but a few weeks in the year. Coarse mater­ able, that sanitary drinking fountains must he provided. ial can be screened out, heavy solid matter can be precipitated.We shal l notTh alloe practicw the e usoef orunninf commog sucn drinkinh refusge cupsas th. e debris from the cyclone can be stopped. If the only material from We urge all canners to so revise their contracts that the tomato cannery for instance, which is allowed to flow growers will understand more clearly than now that un­ upon the ground of the cannery is wash water, there should sound fruit and vegetables will under no circumstances be be no serious complaint from neighbors. accepted. What we may be able to do in helping the can­ ner to control the quality of the raw materials which Fourth, if any Indiana canners complain of a bad season comes to his platform we shall do,, but we cannot go into and are unable to meet their obligations at the bank, in our the fields nor can we station inspectors at the factory. opinion they can look for a reason no further than faulty management. Anyone who has visited, as our men have NOT REPORTED: The birth of 'Martin Estelle Miller, done, the canning factories of the State year after year, born at Elberfeld, August 29, 1898, was not reported by the knows almost at a glance whether or not the factory manage­ attending physician, Br. Henry Nenneker. Now the in­ ment is adequate or unsatisfactory. A sanitary plant and fant, grown to young womanhood, wishes to secure a posi­ a good pack depends not so much upon the equipment as tion, but is prevented on account of lack of her birth cer­ it does upon the man in charge. Many companies have not tificate. Probably neither the mother nor the doctor knew learned that a canning factory cannot be operated by un­ any more than the new-born child did about the necessity trained day laborers, and that there is anything more to of legally recording a birth. The young woman, and proba­ the canning business save their ability to so process goods bly her mother too, by tills time, appreciate the import­ that they will not develop "swells" in the warehouse. Many ance of this matter, The physician who fails to properly other plants so appreciate the necessity for scientific man­ report births he attends is very likely attacking the infant agement and control that they are installing and operating and the mother, for the probability of their needing this laboratories where every run is carefully checked and from record in after life is very great. MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH 11?

CHART SHOWING GEOGRAPHICAL DISTRiBUTION OF DEATHS FROM CERTAIN COMMUNICABLE DISEASES FOR OCTOBER, 1914.

NORTHERn SANITARY SECTION. Total population 972,129 Total deaths 935 Death rate per 1,000 1L3 Pulmonary Tuberculosis, rate per 100,000. 71.4 Typhoid, rate per 100,000 .. 25.4 Diphtheria, rate per 100,000 12.1 Scarlet fever rate per 100,000 Diarrheal diseases rate per 100,000 87.1

CENTRAL SANITARY SECTION. Total population 1,152,277 Total deaths 1,212 death rate per 1,000, 12.3 PULMONARY Tuberculosis, rate per 100,000 118.5 Typhoid, rate per 100,000 31.6 Diphtheria, rate per 100,000 20.4 Scarlet fever ratepe r 100,000 1.0 Diarrheal diseases,rat e per 100,000 .. • 96-0

SOUTHERN SANITARY SECTION. Total Population...... 672,551 Total deaths 589 Death rate per 1,000 ..... 10.8 Pulmonary Tuberculosis, rate per 100,000.. 103.0 Typhoid rate per 100,000. 40.2 Diphtheriarat e perr 100,000...... 17.5 Scarlet fever ratepe r 100,000...... 12.2 diarrheal diseases rate per100,00 0 89.8

Indiana TABLE 1. Deaths in Indiana by Counties During the Month of October, 1914. (Stillbirths excluded.)

Annual Death Rate Per 1,000 population. important Ages. Deaths from Important Causes.

Popu­ lation* STATE AMD Esti­ COUNTIES. mated* 1914. Date . Yea r 191 3 t o Bern e Date . September . 1914 october , 1913 . myelitis . October , 1914 . th e Yea r 101 4 to Date . pneumonia . iti s (unde r 2 years) . Rat e fo r Yea 1913 to Sam Date . death s i n Institution Rat e fo r Yea 191 4 to Acut e Anterio r Polio ­ Smallpox, , Death s o f No n residents. October , 1913 . October , 1914 . 1 5 t o 9 Inclusive Whoopin g Coug h Cancer . Externa l Cause* . Tota l Death s reporte d fo r Puerpera l Septicemia . Tota l Death s Reporte d fo r Othe r Form s o f Tuberculosis . Measles . loha r an d Broncho ­ diarrhe a an d Enter ­ Unde r 1 yea to 4 inclusive. Influenza . Tota l death s Reporte d for i Tota l Death s Reporte d for I Tota l Death s Reporte d for Scarle t Fever . Diptheria and Croup. 65 Year s an d Over . cerebro-Spina l Fever , Typhoi d Fever , 5 t o 9 Inclusive 1 0 4 State of Indiana .. .

Northern Counties..

Adams...... Allen. Benton. • •• Blackford...... Carroll...-•.••.. CASS... • • Dekalb.... Elkhart...... ^. Fulton...*..- — . Grant...... Howard...... Huntington...... Jasper...... jay... • ... Kosciusko...... Lagrange»...... • Lake...... — •• Laporte...... Marshall • <•- Miami.. - - • > Newton...... Noble...... Porter...... •• Pulaski...... Starke...... Steuben —...... St. Joseph... Wabash...... Wells...... White...... Whitley Central Counties....

Bartholomew Boone...... •• .... Brown,, - ... Clay..... Clinton...... Decatur...... Delaware.. •...*.. Fayette...... Fountain • • Franklin..... Hamilton.,. — Hancock...... Hendricks..-. .... Henry....•-...... Johnson Madison.... Marion Monroe...... Montgomery Morgan. •. Owen... Parke..... Putnam,.... — Randolph., Roan.... Shelby Tippecanoe Tipton...... Union...... Vermillion. Vigo. Warren.,.. Wayne.,. Southern Counties

Clark..., Crawford Daviess.... Dearborn....,... Dubois...... Floyd...... Gibson...,. Greene, • Harrison. Jackson , Jefferson. jennings...... Knox...... Lawrence...... Martin...... Ohio...... Orange Perry.... —. ... Pike...... Posey...... Ripley...... Scott Spencer. •-• Sullivan. Switzerland...... Vanderburgh...... Warrick Washington......

Urban ...... Rural...... TABLE 2. Deaths in Indiana by Cities During the Month of October, 1914, (Stillbirths excluded.)

Annual Death Rate Per 1,000 Population. Important Ages. Deaths from Important Causes.

Popu­ lation. CITIES. Esti­ mated. 1914. Dale . Sam e Date . Yea r 191 3 t o Sam e Date . october 1913 Rat e fo r Yea 191 3 t o 1 t o 4 Inclusive . Rait s fo r Yea 1914 t o 5 t o 9 Inclusive . Tota l Death s Reporte d fo r <».:octobe r 1914 . September , 1914 . October . 1913 , Diphtheri a am i Croup . Diarrhoe a an d Enteriti s (unde r 2 years) . Death s i n Institutions. Tota l death s Reporte d fo r Cerebrospina l Fever . Externa l Causes . Tota l Death s Reporte d fo r Scarle t Fever , Cancer . Smallpox . Tota l Death s Reporte d fo r Death s o f non residents. i Unde r 1 Year , ( 1 0 t o 4 inclusive . i Tota l Death s Reporte d fo r | octobe r 1914 , ; th e Yea r 191 4 t o Date . | 1 5 to 9 Inclusive . i Typhoi d Fever , | Whoopin g Cough . | Pneumonia . | Acut e Anterio r Poliomyelitis . '• • Influenza . | Puerpera l Septicemia . ! 6 5 Year s an d Over . ; Pulmonar y Tuberculosis ' Othe r Form s o f | Measles . | Loba r an d Broncho - Cities of the First Class. Population 100,000 and over .. Indianapolis Cities of the Second Class. Population 45 000 to 100 000 , Evansville. Fort wayne Terre Haute South Bend Cities of the Third Class. Population 20 000 to 45,000 ... Gary ...... Muncie Richmond Hammond ...... Anderson Fast Chicago . . .. Lafayette . . . New Albany elkhart - - • Michigan City Cities of the Fourth Class. Population 10 000 to 20 000.. Marion . . - Logansport . . Kokomo - • Vincennes , .... . Mishawaka ... . Peru Laporte... • Elwood Huntington .. . Jeffersonville .... . Shelbyville . -• • Crawfordsville . . New Castle. - - Cities of the Fifth Class. Population under 10 000 . Brazil • •• Bloomington. Bedford Frankfort . Columbus . . Goshen Wabash ..... Connersville Washington . Whiting. Clinton. ., Valparaiso . .... Madison - .. Linton • • Princeton Hartford City.. . Seymour Lebanon Mt. vernon Greensburg Kedallville Portland . Noblesville Bluffton Alexandria Rushville Martinsville Franklin Aurora • • • Decatur Warsaw Greenfield Winchester Sullivan Garrett Boonville Tipton • • Auburn Mitchell Lawrenceburg Plymouth. Greencastle Columbia City Tell City Attica Rochester Union City. Jasonville Gas City... - Dunkirk.... North Vernon.... Bicknell .... Montpelier. . • Angola ...... Rockport... Crown Point Huntingburg .. Rensselaer Loogootee Batesville Monticello .. Ligonier Delphi. . Cannelton Covington . - - Butler City .. ... Veedersburg Rising Sun Vevay Mortality of Indiana for October, 1914. (Stillbirths excluded,)

Annual Death rate Per 1,000 Important Population.

POPULATION BY Coder 1. 1 to 4, 5 to§ . 10 to 14 15 to 19, 65 and Over GEOGRAPHICAL Population Section AnD Estimated AS URBAN AMD 1914. RuRAL. Ill II ijli;!!'!!1!!1!!!! 191 3 to Sam e Date . 191 4 t o Date , ber . 1914 , Date . 1913 , sam e date, •g ! O g : Q •§ O | . Q I ; U J I U September, 1914 . Octobe r 19 13 Rate fo r Yea 191 4 t o Rat e fo r Yea 191 3 t o Tota l Death s Reporte d fo r Yea Tota l Death s Reporte d fo r Yea Tota l Death s Reporte d for October 1914 . Tota l Death s Reporte d fo r Septem ­ Tota l Death s Reporte d fo r October , ss I fc z ! &• z eu z a. ss , &• fe i &< state.. Northern Counties..., Central Counties Southern Counties.... All Cities...... Over 100,000...... 45,000 to 100,000 .... 20,000 to 45,000...... 10.000 to 20,000...... Under 10,000...... Country.,...,, _,,,

Deaths and Annual Death Rtles Per 100,000 Population from important Causes.

Diarrhoea Pulmonary Other Diph­ Whoop­ and Cerebro­ Acute Puer­ POPULATION BY Typhoid Anterior Tuber­ Forms of tuberculosis. theria Scarlet Measles. ing Enteritis spinal Polio­ Influenza peral Cancer. External Small­ GEOGRAPHICAL culosis. Fever. and Fever. Cough, (Under Fever. Septi­ Causes. pox. SECTIONS AND Croup, 2 Years.) myelitis. cemia. AS URBAN AND RURAL Number . Deat h Rate . Deat h Rate . Deat h Rate . Deat h Rate . Deat h Rate . Number . Deat h Rate . Deat h Rate . Deat h Rate . Deat h Rate . Deat h Rate . Deat h Rate . Number . Deat h Rate . Number . Number . Number . Number . Number . Number . Number . Number . Deat h Rate . Number . Deat h Rate . Number . Number . Deat h Rate . Number . Deat h Rate . Number .

State...... Northern Counties... Central Counties Southern Counties... All Cities......

Over 100.000...... 45,000 to 100,000.... 20,000 to 45,000 10,000 to 20,000..... Under 10,000...... Country......

U. S. Department of Agriculture, Weather Bureau, Condensed Summary for Month of October, 1914.

J. H. ARMINGTON, SECTION DIRECTOR, INDIANAPOLIS, IND.

TEMPERATURE IN DEGREES FAHRENHEIT.

Extremes. Departure Section from the average. normal. Station. Highest. Date. Station. Lowest. Date.

Hammond..... Collegeville.. Hickory Hill...

PRECIPITATION—IN INCHES AND HUNDREDTHS.

Extremes. Departure Section from the average. normal. Greatest Least Station. monthly Station. monthly amount. amount.

Princeton Monticello Vincennes