MONTHLY BULLETIN Indiana State Board of health [Entire*:! as second class matter at the Indianapolis Postuffice 1

VOLUME VII. INDIANAPOLIS, OCTOBER, 1905. JV'MBKv '''

T. HENRY DAVIS. M. d.. PRESIDENT ...... Richmond. BY COUNTIES: The county showing the lowest C. M. eisenbEISS, M. D., Vins-lliKsiunxT...... Elkhart. W.N. WISHArD. M. d ...... Indianapolis. death rate was Brown County, 2.4. and the highest in F. A.Tucker, M. d...... Noble»Tilie.

J. N. HURTY.M. D , PHAR. D.f SKCRKTARY iBdi&n&poliF. Ohio County, 20. The comities showing death rates above the average for the whole State, which average The MONTHLY BULLETIN will be sent to all health officers and dep- was 11.9, were: Cass, 13.4; Elkhart, 12.4; Jay, 14.6; uties in the State, Health officers and deputies should carefully read and file each copy for future reference. This Is very important, for we expect Kosciusko, 18.8; Lake, 15.4; Newton 12.4; Steuben, to print instructions, rules and general information, which it will be 15.9; St. Joseph, 13.8; Bartholomew, 18.4; Boone, 12.1; necessary for officers to preserve. Decatur, 12.6; Delaware 12.1; Fayette, 1.6.1; Franklin, 15,8; Hamilton, 12.7; Jackson, 12,6; Marion, 14.2; ABSTRACT OF MORTALITY STATISTICS Monroe, 13.8; Putnam, 12; Randolph, 12.2; Rush, 12.6; FOR OCTOBER, J905* Tippecanoe, 15; Vermillion, 19.8; Vigo, 16.9; Warren, 14 J; Clark, 12.3: Baviess, 14.2; Dubois, 12.7; Floyd, Total number of deaths reported, 2.681, annual rate- 15-5; Green, 12.8; Jefferson, 15.9, Jennings, 16; Knox, 11.9, In the preceding month, 8,018, rate 13.6. In 16.3; Lawrence 13.4; Ohio, 20.0; Pike, 15.5; Posey, 17.1; the corresponding month last year, 2,702 deaths, rate 12. Ripley, 12.9; Sullivan 18.7; Vanderburgh, 14.6. Deaths by important ages were: Under 1 year, 426 or 16.9 per cent, of the total; 1 to 5, 221; 5 to 10, 89: 10 to CITIES: All of the cities of the State, population 15, 46: 15 to 20, 88; 65 and over, 659 or 26.2 per cent, 977,812, report 1,195 deaths, rate 14.4. This is 2.& Mgber than the State rate. In the corresponding of the total. Some important causes of death were: month last yesu\ 1-,2'H deaths, rate 15.4. In the preced­ Tuberculosis, 807 (252 pulmonary and 55 other forms): ing month, 1,256 ileaths. rate 15.8. The cities had the typhoid fever, 152; diphtheria, 76; croup, 3: scarlet fever, highest rate in the following diseases as compared with 5: whooping cough. 14; pneumonia, 138; diarrhoeal the country: Tuberculosis, diphtheria, scarlet fever, diseases, 167; cerebrospinal meningitis, 29; influenza, pneumonia, diarrhoeal diseases, cerebrospinal meningi­ 4; puerperal fever. 9; cancer, 100; violence, 159; small­ tis- influenza, cancer and violence. pox, none. SANITARY SECTIONS: THE NORTHERN SANI­ COUNTRY; Population 1,670,737, reports 1,486 TARY SECTION, population 887,882. reports 849 deaths, deaths, rate 10.4, In the corresponding month last rate 11.2. In the corresponding month last year, 860 year, 1,491 deaths, rate 10. L In the preceding month, deaths, rate 11.4. In the preceding month. 1,038 762 deaths, rate 12.7. The country shows a higher deaths, rate 14.2. The rate was a little lower than the death rate as compared with the cities for whooping corresponding month last year and 3 lower than the cough, puerperal fever, and typhoid fever, preceding month. CITIES BY CLASSES: CLAS« A, having 50,000 THE CENTRAL SANITARY SECTION, population 1.087.- population and over, a total population of 256.046. re­ 620. reports 1,103 deaths, rate 11.9. In the correspond- ports 804 deaths, rate 18.7. In the corresponding ing month last year. 1,133 deaths, rate 12.2. In the month last year, 288 deaths, rate 18.2. In the preced­ preceding month, 1,209 deaths, rate 13.5. This section ing month, 822 deaths, rate 15.1. This class includes shows an improvement by both of these comparisons. Indianapolis, rate 18.7; Evansville, 13.8. THE SOUTHERN SANITARY SECTION, population CLASS B, having from 25,000 to f0,000 population, 673,097. reports 729 deaths, rate 12.7. In the corre­ total population 159,349, reports 188 deaths, rate 13.9, sponding month last year, 709 deaths, rate 12.4. In In the corresponding month last year 182 deaths, rate the preceding month, 771 deaths, rate 13.9. 18.9. In the preceding month. 196 deaths, rate 15. REVIEW *~OF SECTIONS: As is usual the North­ This class includes Ft. Wayne, rate 8.5: South Bend, ern Sanitary Section shows the lowest death rate. This 12.3; Terre Haute, 22.7; Muncie, 13.4. is also true in regard to the following diseases: Pulmo­ CLASS C, having from 10,000 to 25.000 population, nary tuberculosis, typhoid fever, diphtheria and pneu­ 16 cities in all, total population 231,707, reports 261 monia. The Central Sanitary Section shows the lowest deaths, rate 13.2. In the corresponding month, last death rates in diarrhoeal diseases, puerperal fever and year, 313 deaths, rate 15.6, In the preceding month, violence. 312 deaths, rate 16.4. 118 •MONTHLY BULLETIN, INDIANA STATE BOAED OF HEALTH.

CLASS D, having under 10,000 population, 08 cities killed with fire-arms, 1 by cutting, 2 by blunt instru­ in all, total population 326,7J0, reports 442 deaths, rate ments and 1 justifiable homicide. Of the 80 suicides. 15.7. In the corresponding month last year, 433 18 were males and 12 females. The methods used deaths, rate 16.3. In the preceding month. 426 deaths were : Gun-shots, 6 males and 2 females; drowning, 1 rate 16.5. Chart showing deaths by sanitary sections female; cutting throat, 1 female; hanging, 6 males on page 125. and 1 female: poisons, 6 males and?.females. Of the accidental deaths, 81 were on railroads; 2 on interur- ban trolleys; 25 fractured bones or crushing injuries; SUMMARY OF MORBIDITY AND MORTAL­ 8 by gun-shots ; 3 by broken necks; burns and scalds, ITY IN OCTOBER. 10; burning, 5: horses and vehicles, 4; poisons, 9; DISEASE PREVALENCE: Typhoid fever, as in mine accidents, 4; powder explosions. 2. the preceding month, was the most prevalent disease. It existed in every county. Rheumatism, which is always prevalent, stands second. On the wholes the THE DIAGNOSIS OF PULMONARY TUBER- health for October was as good as in September. The CULOSB.* following is the order of disease prevalence: -Typhoid The diagnosis of tuberculosis involves the careful fever (enteric), rheumatism, bronchitis, tonsilitis, in­ elimination of nearly every acute or chronic disease the fluenza, scarlet fever, intermittent and remittent fever, human race is heir to; and also a most exhaustive diphtheria and membranous croup, diarrheal, pneumo­ study of the physical and clinical condition of the nia, pleuritis, erysipelas, typho-mahma fever, whoop­ patient. ing cough, inflammation of the bowels, dysentery, The advent of tuberculosis in a given case is not cholera morbus, cholera infantum, cerebrospinal men­ always attended with the same symptom complex. ingitis* puerperal fever, measles, smallpox. The man of mature years is just as susceptible as the "SMALLPOX: Not a single ease of smallpox was girl of sixteen, and only requires the infection to pro­ reported in the whole State for the month. It must duce the results, not be concluded from this that there were no cases, In formulating our diagnosis every condition of the for without doubt, not a few mild eases existed. Of patient must be considered and a careful physical ex­ course, no deaths were reported, and the fact that amination supported by a most exhaustive clinical smallpox did not cause a single death, is true. study of the case, will, as a, rale, demonstrate the con­ TUBERCULOSIS: Tuberculosis deaths numbered dition we have to encounter. This requires repeated 307, of which 252 were of the pulmonary form. Of the examinations and observations of the patient. We total number, 54 were women in the age period of 18 must study our case from three points of view; namely, to 40, and left 111 orphans; 22 were males, were the "Previous Condition,%1 the "Physical Condition/' married and in the same age period as above, and and ''Clinical Findings," Upon these we-base our they Jeft 45 orphans. In all, this disease made 156 conclusions. The "Previous Condition" embodies the orphans in the month under 12 years of age, and in­ individual's family histoty* occupation and manner vade*! 286 homes; 219 of the 807 deaths, or 71 per of life. cent., were in the age period of 15 to 50; 28 were in From the "Physical Condition/5 of our patient we the age period of 60 to 70; 10 in the age period of 70 make observations as to his normal resistance, general to 80, and two were over SO. build and cone of constitution, and the evidence n-f • TYPHOID FEVER : Typhoid fever existed in every exposure and dissipation; also the state -and condition •county in the State, and there were 152 deaths. In the Q{ the general nutrition, •corresponding month last year, the disease existed in The "Clinical Study*5, of «onr patient brings- ns to the- all but 14 counties, with 164 deaths. There is an absolute appreciation of the morbid influences iweaent improvement, therefore, by this comparison. Several unci enables m to measure the degree of damage jpmv considerable epidemics were reported, but were not dueed, and at&o, to estimate the value of the Individ- especially investigated. u&ra recuperative power. PNEUMONIA: Pneumonia caused 138 deaths. 71 The physical aspect of the patient is sal ways maggest- males and 67 females. By certain age periods, the ive, even in the earliest stages of the disease, and h deaths were: Under 1 year, 21: 1 to 5, 27: over 40, art aid to the recognition of the condition. The' genera t 66. There were 13 deaths by pneumonia of persons tone of the patient k a warning of approaching danger. -between 80 and 90, and one over 90 years of age. In In the early history of the malady, before it 3a possible the same month last year there were 108 deaths from to determine the point of localization* there m great pneumonia, loss ol bodily weight and strength, which may progress VIOLENCE: There were reported 155 deaths trom to extreme we&knees mid emaciation. The skin loses violence—9 murders. 30 suicides and the remaiiicler its natural -color growing pale, there is dyspnea, due to accidents; 121 of the violence deaths were males, and 34 females. All of the murders were of mates., S befog MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 11© anemia; the pulse Ls always accelerated and feeble; jerky or cog-wheel respiration are common signs. the patient suffers from indigestion, J*nd finally fever Crackling rales and eonsonating rales attending these is manifested some lime during the twenty-four hours. modifications of the breath sounds are of the greatest In the most latent forms of tuberculosis fever is regu­ diagnostic importance. It is necessary in the early larly present and. will show some rise at some time if stages of the disease to compel the patient to cough, the thermometer is diligently used, In the fibroid and then take a full inspiration before we are able to forms of the disease the temperature is frequently sub­ hear these sounds ordinarily. normal. In young women the development of anemia, Auscultation may show only a slight diminution in and later amenorrhea is very suspicious and should the clearness of the vesicular inspiratory murmur at the elicit the most scrutinizing attention. Increasing apices, but this is of the utmost importance arid should, anemia, with marked and gradual loss of strength and elicit the most investigation. The expiratory effort weight, are very important factors in the tubercular becomes more and more prolonged and of a higher involvement; where other plausible causes are not in pitch. In the early stages the breathing may simply evidence. be harsher than normal. As infiltration and consoli­ Local contractions and a restricted movement at an dation progresses the bronchial quality of the breath­ apex with inspiratory depression above the clavicles, ing and voice becomes more manifest, but it is never decreased respiratory movement upon one side, with a so marked as. in pneumonia. Rales, chiefly subcrepi- flattened chest, forms the characteristic picture of a tant, mucous, squeaky and rubbing in character, axe tubercular .suspect. highly significant when -confined to an apex. The If these conditions occur in an individual with a most important of all the breath sounds in the early suspicious family history, or a tuberculous environment pulmonary tuberculosis is the prolonged and higher without other especial cause, a tubercular condition is pitched expiration. our only conclusion. It is also necessary to consider As the disease progresses these sounds become more carefully the general conditions of the patient. We evident and conspicuous. These sounds are not confined inquire* into the age, the occupation, the history of an to the apices, but may be distinguished first at the exposure to the disease, the history of a family predis­ base, at the apex of the lower lobe, and that portion position, the history of a previous, now arrested tuber­ of the lung which is near the heart's apex; so our ex­ culosis; or the occurrence of a previous disease which amination should include every portion of the lung may have furnished the necessary attenuation, favoring before a decision is given. If, therefore, any modifica­ a tubercular complication. No one sign is of diagnos­ tions of the vesicular inspiratory murmur, or any ad­ tic value. The combination of signs and the orderly ventitious sounds are heard limited to an apex, exist, procession by which they advance, as the physical or in the supra-spinous fossa; if these coincide with a conditions progress, are the most diagnostic. flattened anterior chest surface, especially on one side, In the diagnosis of pulmonary tuberculosis the physi­ with defective expansion, short breath, cough, general cal examination must he directed to a determination falling off in health, the physical diagnosis of a be­ of the size of the lung, its degree of expansion by which ginning tuberculosis is almost positive. we estimate the quantity of air entering the lung, as As these symptoms advance the patient develops well as the presence and degree of consolidation. The chills, fever, night sweats, hemoptysis, cough and ex­ tuberculous process is usually associated with a dimi-» pectoration, which will show the tubercle bacillus and nut ion in the bulk of the lung. By inspection we are conclude the diagnosis. But, unless we had found the able to compare the relative respiratory movements of tubercle bacillus in instances supposed to be tubercular, both lungs. By palpation we are enabled to de­ we would have no reason to associate these interesting termine the changes in vocal fremitus, and by percus­ conditions with a future tuberculosis. sion some idea can he had as to the changes present A catarrhal disturbance confined to an apex is under in resonance and infiltration. alb circumstances very suspicious of incipient tubercu­ In auscultation we have one of the most valuable losis. This catarrh is nearly always, as is proved by means of physical aids in the diagnosis of tuberculosis. the most recent sputum examinations, the sign of the The experienced ear can hear and detect the changes entrance of the bacilli into the organism, and with the in the lung often before any very pronounced symptoms catarrh slight dullness in the supraclavicular region can are evident from the patient's appearance. By this in the majority of eases be demonstrated. method we are able to determine the amount of lung Leube?s, however, makes exceptions to this rale, such tissue involved and to a certain extent the degree and as catarrh of the apices without demonstrable bacilli, character of the process. Auscultation reveals to the without change in the percussion note, and infiltration examiner in the earliest stages of the disease the of the apices. slightest impairment of respiration and quality of the However, he sajrs, it is well to consider all of these breath sounds. On auscultation in the early stages of conditions as exceptions, and to exclude the diagnosis tuberculosis, roughness of respiratory murmur, with of incipient tuberculosis in any case only after repeated prolonged expiration, feeble respiratory murmur and a examinations. 120 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH.

After the physical examination has been completed In the presence of an abscess low counts indicate a we can substantiate our findings by a careful study of pure tubercular pus collection. Incipient cases of simple the clinical condition of our patient, Careful and tuberculosis infiltration and pure lung cirrhosis are repented blood, examinations will determine the degree not accompanied by a leucocytosis. In acute, general of anemia present and furnish a guide as to the prog­ miliary tuberculosis we have a good illustration of the ress of the disease. failure of pure tuberculous inflammations to induce Anemia, being one of the most common and reliable leucocytosis. The absence of a leucocytosis is of vast indications in early tubercular involvement, is a most importance in differential diagnosis, and forms one of important measure in the* differential diagnosis. The our most substantial clinical findings. The eosinophile hemoglobin per cent, is always reduced in pretubcr- has come into prominence by its appearance in in­ cular manifestations without much disturbance to the creased numbers in the blood and sputum of patients number of red cells, other than a feeble affinity for with an arrested tuberculosis. Nuesser believes that stains. This anemia is also marked by a low color eosinophilia indicates relative immunity to tuberculosis. index. Poikilocytosis is rarely present, but poorly General experience seems to show that eosinophils are stained and small corpuscles are numerous; other frequently present, usually in normal number, in the structural changes are absent. blood, in chronic tuberculosis, and sometimes absent In the early manifestations of tuberculosis marked in the acute cases or where there is fever, and leucocy­ increase in the number of blood olaques is a very com­ tosis. They are increased sometimes to an extreme mon picture. As the disease advances these qualitive degree in the febril period following injections of tuber­ changes do not progress in the same proportion to the culin, (Jappert.) Many writers claim that an increase gravity of the symptoms. The variations in the qnali­ of eosinophils in the blood and sputum of tubercular tive changes of the blood are not always constant, subjects is of good prognostic value. general tuberculosis shows little alteration in the The specific gravity of the blood is usually reduced quality of the blood stream, much depends upon the in tuberculosis and corresponds very closely to the individuals power to withstand the constant drain upon degree of anemia present. the system. The leucocyte in tuberculosis, as in other The urine shows nothing of interest in incipient diseases, is of relative diagnostic importance. In tuberculosis and is of value only in diagnosis as exclu­ early, uncomplicated pulmonary tuberculosis the leuco­ sive evidence. .In some instances the diazo-reaction cyte is unusually normal. The differential count, is present, but it is of little value. however, shows some very interesting and practically Much information can be gained from repeated ex­ constant changes. Holmes believes that it. is possible aminations of the sputum, even if the specific agent m not only to estimate not only the degree of the tuber­ not found, because the character of the expectoration cular process, but the degree of the individuals recru- corresponds closely to the morbid processes which pro­ perative powers by a careful study of the leucocytes, vince it. A negative examination witli regard to the using a special technic of staining with acid and basic tubercle bacillus, may become a very potent factor in dyes. He considered that the pretubereular stage is prognosis. characterized by an absence of leucocytosis, a slight- A great many negative examinations' should be re- decrease in the lymphocytes, little or no increase in ported positive, because the elements present in the the polynuclear neutrophils, more or less abundant sputum indicate an impending, which experience shows debris from cell disintegration, and feeble differenti­ to be very constant and convincing. ating of the cells. In the stage of early incipiency he An ugly, tenacious, grayish yellow or reddish sputum finds that there may or may not be a leucocytosis, ac­ may not contain the tubercle bacillus, but does contain companied by a gain in the polynuclear neutrophiles the elements which produce a lowered vitality and at the expense of the lymphocytes, as the disease ad­ •lessened resistance on the part of the lungs to the in­ vances, together with well marked signs of cell disinte­ vading organisms.- There are two potent factors in the gration. In the advanced stage, with cavity formation production of pulmonary tuberculosis—one the power and extensive distribution of the lesion through the of the bacillus to invade the lung tissue, and the other lungs, the preceding signs are still more strongly the ability of the cells to withstand their attack and emphasized, especially these relating to the quantity .destroy their virulence. Any morbid process which of debris derived from the cells undergoing dissolution. produces continual irritation to the bronchi lessens A sudden high leucocytic count in pulmonary tuber­ their vitality and renders them more vulnerable to a culosis means the development of a cavity. High future infection. count, especially those of rapid development, point to Upon many occasions I have examined sputum and a secondary pyogenic infection while slowly develop­ made a negative report, and later received a specimen ing, moderate leucocytosis appear to be compatible from the same patient which contained the specific: or­ with simply a sudden increase in the activity of the ganism in great numbers, together with an increased tubercular process. number of the original organisms which produced the MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. iM primary disturbance. A sputum wbicb persistently tubercle bacillus, but acts upon the tuberculous tissue, contains tbc pneumoeoccus, tbe streptococcus, the augmenting the poisonous influence upon the cells bacillus of influenza, the micrococcus tetragenous, pus surrounding the bacilli, destroying their vitality and cells and bronchial epithelium under ordinary circum­ removing the condition favorable to baeilliary growth, stances Is a dangerous sputum, and the patient Is in which for a time is checked. This action is accom­ great danger of a tubercular involvement in the near panied by marked hyperemia of the peri tuberculous future. tissue with transudation of serum, softening of the The common practice of waiting for the appearance tuberculosis mass, and its absorption into the blood, a of sputum laden with tubercle bacilli to complete the* marked febril reaction resulting from the intoxication. diagnosis certainly wastes much valuable time for the Virehow demonstrated that the use of tuberculin as a patient and greatly lessens his chances of recovery. diagnostic agent in man was attended by grave danger*?, Much damage has been done to the lung when sputum There is little doubt but that tuberculin has the appears filled with pus cells of tubercle4 bacilli. The power of producing an active tuberculous from a significance of bacteria in the sputum becomes ap­ healed, or arrested, tubercle, when injected into the parent when we consider the condition which produce. system for diagnostic purposes. It is true that we do It Is well known that a patient with sputum full of not have an agent which is specific, at our command, pathogenic organisms has less chance of recovery than for the recognition of tuberculosis, that is free from one with a. simple tubercular infection. If anything danger, and reliable in the early stages of the disease, would be gained by waiting for the appearance of the Soma observers show good results in the use of tuber­ bacilli, then such a procedure might be excused; but culin as a diagnostic and curative agent, but in the failure to find them does not preclude against tubercu­ hands of most physicians it certainly is a dangerous losis. The fact has been demonstrated many times remedy. that the failure to find the bacilli in sputum micro­ In doubtful cases where other measures fail to scopically, that animal inoculation would produce demonstrate the presence of tuberculosis from the clini­ positive results. Therefore, to produce the best results cal or physical conditions, Inoculation of susceptible the condition must be recognized before the bacilli can animals will often produce positive results and estab­ be found and the septic conditions are manifested* lish a conclusive diagnosis. With the appearance of septic bacteria, along with the In conclusion, I may point to a few facts which arc tubercle bacillus in the sputum, indications are the worth remembering when examining any case of a sus­ presence of ulceration and destruction of lung tissue to picious character. The physical condition of an indi­ such an extent that repair is very dillicult, if not im­ vidual and his manner of life, which Is known to favor possible. tuberculosis will assist in the diagnosis, A positive The development of these bacteria in the lungs gives tubercular environment with a tubercular family history rise to constitutional symptoms over a sufficiently long greatly increases the chances of an infection, and period of time to enable the physician to form con­ renders the individual more susceptible. Progressive clusions without the appearance of cough, great ema­ loss of weight and strength, with increasing anemia, a ciation and cachexia. slight disturbance of the digestive tract, and an even­ Most specimens examined for the State Board of ing temperature, are symptoms of marked value in a Health are full of tubercle bacilli, streptococci, sta­ tubercular suspect. phylococci, pneumococci, Friedlander's bacillus and Localized -ant! persistent bronchial catarrh, adventi­ the micrococcus tetragenous. Not alone do we find tious apical sounds, slight cough, and finally infiltration this Interesting group of septic bacteria, but pus cells. and consolidation of lung 4lssue, compose a picture of bronchial and alveolar cells and yellow elastic tissue, convincing evidence of an approaching tuberculosis. which is positive evidence of extreme ulceration and One or all of these symptoms may be present in a given abscess formations. With such findings present in a case, and the progressive tendency of the conditions in given case little can be done to restoration and bodily proportion to the involvement of the tissues is within comfort. certain bounds diagnostic of tuberculosis. After the disease has progressed suillciently to pro­ duce such pathology, the clinical symptoms of the TYPHOID FEVER AND MILK INFECTION.* patient are so marked as to make the diagnosis eiisv$ and the prognosis equally so. But we fail in our duty There is a misapprehension in many minds, even of to them when we permit their decline without recog­ some health officers, as to the role of milk in the spread nizing their true condition. of typhoid fever. We often find in suspected milk Tuberculin tests for tuberculosis in man is a positive epidemics suspicion directed to the cows themselves, force and is easily carried out, but Is fraught with and the conditions under which they are kept and fed. great danger to the patient. McFarland conclude? These are very well to be looked after, but cow's milk that tuberculin does not have the influence upon the * Monthly Bulletin of - New York State Board of healthkralt.li . 122 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. does not reeeive its typhoid infection in this way, and no Here a convalescent from typhoid fever came to board matter how unsanitary their condition or poor their state near by where the cans of the village dairy were washed of health cows will not give typhoid infected milk. On and exposed for hours to the sun, and doubtless the the contrary, typhoid fever may be communicated the latter were infected by flies which had access to the through the medium of milk from perfectly healthy dejecta from this person. Infected water may be put cows kept under the most sanitary conditions. The into the milk or used to rinse the cans; cows may be investigation must be prosecuted along different lines milked by persons who are in contact with the sick; or the cause of an outbreak of typhoid fever of milk dust containing bits of typhoid excreta in not fully dried origin will be overlooked and the remedy fail of ap­ condition may be borne by the wind to the milk—in plication. It should be remembered that the germs some such way the infectious material can roach the of typhoid fever are of human origin, that if they gain milk or its vessels, and should be looked for. The access to milk it is after it has been drawn from the common practice of exposing milk pans* or cans to the animal yielding it and the search for the source of in­ open air after washing should be doubtless reprehended. fection of a milk borne epidemic must be prosecuted The source of infection is not likely to be far away, ex­ along these lines and no other. cept as it may be carried by persons employed about These disease germs enter the body by the avenue of the dairy who may live at a distance. It must also not the alimentary canal—they are taken into one's system be overlooked that milk may likewise be infected after with food by way of the stomach. Various ingesta thus leaving the dairy at a creamery or depot of supply, and act as carriers of these germs, the only condition as to in the same manner. their so doing effectively being that they do not inter- A milk borne epidemic of typhoid fever has certain fore with the vitality of the germs. Cooked foods do characteristics. It is generally abrupt in its onset, A not so act, unless infected after cooking, since heat fulminant outbreak of typhoid fever in a previously destroys the disease germs. Water is by far the most healthy locality always suggests it, and while any other common medium, because of its widespread exposure infected food may have a similar effect, and even a to infection and its customary use unsubjected to heat. public water supply may be infected on the instant, Ice likewise, raw vegetables, oysters, any uncooked an epidemic in which numerous cases come to light food; but milk more frequently than these exceptional within a few days may be suspected as of milk origin. media causes epidemics of typhoid fever, since like Then it is widely distributed, as much so as the milk water it is taken raw into the stomach, is more exposed from one source usually iss not affecting a whole com­ than solid foods to infection, will maintain the germs munity as when a public/water supply is at fault, nor in living condition for a long time and is widely dis­ limited to a compact neighborhood where a local cause tributed. It is second in importance to water in the is acting. Several members of a family, of susceptible spread of this disease, but while many epidemics have age, are likely to be affected. All or nearly all of those been traced to it, it should be emphasized that it comes affected will be found to have had milk from one very far after water as the originator of epidemics. vendor or possibly from a special part of his milk And one may note here, for the investigator, that just kept separate from the rest, and a considerable propor­ as ice may contain vital germs of this disease, so may. tion of the families using .the same will likewise be other derivatives of water or milk; they will live in affected. With such characteristics of an outbreak the seltzer or other bottled waters; soda water fountains suspected milk should be investigated along the lines will spread them; and ice cream, buttermilk and pos­ which have been suggested. The acting cause was sibly butter and cheese though we have no knowledge operative two weeks before the outbreak set in, and as of the latter so acting. in a recent case may have ceased to exist; this ought How does milk become infected? In most cases by to be borne in mind. the existence of a case of typhoid fever on the premises Milk lends itself so readily to infection and when in­ where it is produced or where it is handled. The fected may spread the disease so widely, that no one fourth annual report of this State Board of Health eon- who has or in any way comes in contact with typhoid tains an elaborate report of such an outbreak which is fever should be allowed ever to be about a dairy or to a typical example. Here three cases of typhoid fever be in any capacity connected with this industry. And existed in a household; milk produced from twelve it should be remembered that this prohibition must cows on the farm was distributed in a neighboring vil­ continue for two or three months after recovery. lage; members of the family drew and handled the Typhoid fever mortality has risen, as usual, from milk; the milk cans were brought to the house and June about fifty per cent,, and will continue to increase washed in a room adjoining the sick-room, by those through August and September. The mortality from all causes is excessive, the largest for the month of any caring for the sick (the milk itself never coming near year on record. It is chiefly clue to an excessive the house); 150 cases of typhoid fever were traced to diarrhoea! mortality, 21 per cent, of the deaths brin* this source. Here the milk cans alone became infected from this cause, and 21 per cent, of all deaths were by being carried directly from the sick on the hands of under one year of age. The maritime district reports their care-takers. Another instance occurred last fail. about all of this increase. MONTHLY BULLETIN, INDIANA STAte board Of HEALTH. 188

SANITATION CORRESPONDENCE SCHOOL ''Where disease and premature death exist, there LECTURES, should be found the sanitarian. 4'Our resources are to be found in the wonderful Dr. William R. Batt, of Philadelphia, a sanitarian fund of knowledge which the patient researches of sci­ of wide reputation and connected with the Pennsyl­ entists have placed at our disposal, a storehouse whose vania State4 Board of Health, has opened a correspond­ doors are always open and whose treasures are at the ence school for health officers. The course covers command of those who seek them. twelve lectures, upon the following subjects: ** Our victories shall be the preservation of human Consideration of the General Principles In­ life, that volved in Sanitation. *s * Jjife which all creatures love and strive to keep; Contagious and Infectious Diseases. Wonderful, dear and pleasant unto each, Quarantine. Even to the meanest — ' Nuisances. not physical immortality, but physical life which shall Garbage and Sewage Disposal. he lengthened to the uttermost. Wafer Supplies. " Surely to labor in such a cause and for such a Milk Supplies. glorious end should be sufficient to call forth the best Food and Ice. we have to give. Diseases Transmitted by Insects. " We must have our ideals, and they must be set so Disinfectants and Disinfection. high that they will be beyond the reach of occasional Municipal Hospitals. defeats, for without their inspiring influence we must Tliis correspondence method of instruction in hy­ falter; and, above all, we must approach our task with giene and sanitation is very practical. It enables a devotion born of a prophecy of ultimate victory. persons to acquire knowledge necessary in their work "The following lectures are designed to furnish the which they would probably not acquire in any other personal knowledge which every sanitarian should way. The price of the course lias been placed at possess, if he would discharge the duties of his posi­ $15.01) which is certainly cheap enough. Dr. Batt, in tion with credit to himself and profit to his people. his th'^i lecture, makes the following remarks under the u It has been the aim to present the subject-matter head of "Suggestions for Studying Sanitation Lectures": tc so that it would be alike intelligible to both physician The study of any subject should be both entertain­ and layman. ing and instructive. 44 Such parts as are necessarily somewhat technical tu In order to secure these results in the present in­ have been introduced solely on account of their abso­ stance, we suggest that the examination blanks be laid lute importance to a general understanding of ^the aside temporarily and the lecture read from beginning subject. to end, 4< It is to be hoped that the information given may 14 It should then be entirely re-read and studied care­ not only serve its immediate purpose of broadening fully, paragraph by paragraph. . the vision and strengthening the hands of those en­ "The examination blanks should then be taken up gaged in sanitary work, hut that it may provide the and the questions answered on one blank from mem­ necessary stimulus for a continued study of future dis­ ory, after which a reference may again be made to the coveries in the field of sanitation." lecture for the purposes of correction. v'One of the corrected blanks should then be for­ warded to us for examination and criticism, "INDOOR HUMIDITY:" This is the title of an "Questions concerning any part of the subjects article by Dr. Henry Mitchell Smith, of .Brooklyn, read treated, which may not he thoroughly understood, will before the Brooklyn Medical Society, It deals witli the be cheerfully answered." necessity of moisture in the atmosphere of houses, Dr. Dr. Baft's Introductory to his lectures is excellent Smith says: The neglect of the element of watery vapor reading, and we reproduce it herewith and invite all in the air is the greatest, cause of overheating our houses. health officers to carefully peruse it : A low humidity is the great cause of discomfort, the " In approaching the study of sanitation, it. may not source of much ill health, catarrhs, colds and other dis­ be inappropriate to pause for a moment and survey the eases of the mucus membranes, skin, etc. Experience field we are about to enter, observe its difficulties, arid special tests show that we are perfectly comfortable consider our resources and estimate the value of our in a temperature of 65 to OS degrees if the relative hu­ prospective victories. midity is 50 per cent, to 05 per cent. If the relative 44 Disease is the enemy we seek to vanquish: its humidity falls below 50 per cent- we get cold and strongholds must be assaulted, and its secret hiding chilly at 65 to 68 degrees, and call for more heat, and places laid bare. Death must be robbed of all tri­ we are not satisfied with a temperature below 70 to 72. umphs, except such hollow victories as the inevitable The fact that we are uncomfortable at 65 to 68 proves hand of time and natural decay must award. there is insufficient moisture in the atmosphere of the 124 MONTHLY BULLETIN, INDIANA STATE HOARD OF nKALTit. room or that we are below par In health. If the latter order to protect the general public from infection, or have the quarantine laws been' left to take care of themselves is the trouble we will know it by slight fever, lassitude, where the afflicted family is concerned? a tired feeling, headache, etc. Not only does indoor "Owing to financial conditions there was a week's delay humidity affect the health unfavorably if deficient, but in securing the antitoxin remedy, and on the morning upon the poeketbook is also unfavorably affected. This which it was administered the other one lay dead. Would plainly appears when we learn that about 25 per cent. promptness have saved his life? Possibly, He was sick of diphtheria, from Sunday to Monday following—perimps of the cost of heating occurs in raising the room tem­ longer.11 perature from 60 to 70 decrees, so if we can keep com­ fortable at a temperature of 05 degrees we shall have Ill reply to the above we wrote to Mr. Pierce that when saved at least I2i percent, of the total cost of heating. people were placed In quarantine it was done fur the A further health consideration, depending upon moisture benefit of the community, and in accordance with this in the air, lies in the fact that living in an atmosphere fact the Legislature had passed a law commanding that of U'ss than 50 per cent, humidity the mucus surfaces all of the expenses of quarantine he paid hy the county are sun? to lose moisture and invasion of infection is when incurred outside of cities and towns, and by the invited. respective cities and towns within whose corporation the expense might he made necessary. This command >;- "° * will he found in the quarantine law passed by the Leg­ QUARANTINE: The following letter from the Rev, islature of 1903 -•$. section 11.. Mr. Pierce was entitled to Albert e. Pierce, of Springville. is interesting, as it support while he was under quarantine. brings up an important phase of quarantine. Mr. Pierce says: " Will you kindly give me a little information concerning DIPHTHERIA AT CORYDON* the quarantine laws and their administration incase of diph­ theria? Dr. Win. IT. Davis, of corydon, reported a ease of •'We lost a little one recently (at Cincinnati, Ind.), membranous croup and the health'officer established quarantine being established for about three weeks—perhaps quarantine. Dr. Davis, being an up-to-date doctor, a few days over. The child had been sick over two weeks wanted to administer antitoxin, but the father of the previously, during which time every available dollar, and some borrowed, was spent. When the diphtheria developed child, although amply able, would not buy the remedy, it came at a time when my business demanded my presence so Dr. Davis gave np the case. Dr. Habermel was called every day. Consequently all supplies were shut off, except in, and she declared the disease was not diphtheric and for credit, and I was soon given to understand that it, too, was not infectious. Dr. Habermel was so positive and was at an end. Finally the Township Trustee gave me an so certain, and felt so deeply in the matter, that she order for $4.00, In the meantime the physician had used the antitoxin treatment, fixe in number,"one of which had some tore down the quarantine card, which only the health symptoms of the dread disease appearing. officer or his deputies have a right to. do. The fine is "When the quarantine was declared off three children ten to one hundred dollars for anyone other than those started to school. Owing to lack of work and money they just named to tear down or discharge a legal quaran­ were ill supplied with neccessary clothing, and contracted tine. The next day after this occurrence the child died, severe colds, and for about or nearly two weeks another season of enforced idleness was upon me. and a public funeral was held, This m one of the ways "Now, please tell me if a poor man, dependent on work through which diphtheria is spread and children mur­ from day to day, must bear all this burden of expense in dered. Dr. Habermel will be prosecuted. .MONTHLY INDIANA STATE HOARD OF HEALTH, tm

CHART SHOWING GEOGRAPHICAL DISTRIBUTION OF DEATHS FROM CERTAIN COMMUNICABLE DISEASES FOR OCTOBER, 1905,

NORTHERN1 SANITARY SECTION. Total population ...... S.s7,&>2 Total deaths ..,•..,•...„•„,... 849 Death rule per 1,000 ...... 11.2 Consumption, rato p?r 100,000 79.7 Typhoid, ralo p?r 100,000 71.7 Diphtheria, rate per 100,000 23.9 Scarlet fever, rato per 100.000 2.(1 Diarrheal diseases, rate per 100,000 112 9

CENTRAL SANITARY SECTION. Total population ...... 1,087,020 Total deaths. 1,103

Death rate per 1?000 11.9 Consumption, rate per 100,000 123.6 Typhoid, r&te per 100,000 57.5 Diphtheria, ratepe r 100,000. 24.9 Scarlet few, rate per 100,000 2.1 Diarrheal diseases, rate per 100,000 45.5

SOUTHERN SANITARY SECTION. Total population 673,097 Total deaths 729 Death rate per 1,000...... 12.7 Consumption, Rite per 100,000 .... 13G.7 Typhoid, rate per 100,000 78.8 Diphtheria, rat* per 100,000 61.3 Scarlet fever, rate ptr 100,000 ...... 1.7 Diarrheal diseases, rate per 100,000 .... 70.1 hoiAI^A. Deaths In Indiana by Coyntles, During tie Month, of October, 1905*

I IMPORTANT AGES. j DEATHS FBOM IMPORTANT OAUSIS,

.STATE AND COUNTIES. tutions . Accor d inj r t o U.S . \ Meningitis . eapos , unde r 5 . (..'enBU S Bureau . f«- r October , 19(0 . Tuberculosis . J l,0«« i Population . Consumption . [ Typhoi d Fever . : Violence . Den t h a i n Insti ­ Unde r . 1 Year 1 t n f , iiicdusivc . Measles . Influenza . Puerpera l Popuhiti'i n Estimate d i 1 0 t o 14 . inclusive Diphtheria . Pneumonia . Diarrhea ] Dis - C o r e bro-spina l Cancer . Smallpox . 1 5 t o 19 . inclusive Othe r Form s o f ! Croup . f Scarle t Fever , Annua l Deat h K;i.t e pe r • Stillhirths . Tula l Denth s Reporte d r > t o 9 , inclusive . fir . Year s an d ove r Pulmonar y septicemia. Mat© Of ludinnu. 2,648,54!! 2,68 1 11.9 169 426 221 89 46 88 659 232 55 152 76 3 5 .... 14 138 |l67 29 4 9 106 155 ... 131

f Northern Co s 1 881,832 849 45 161 62 22 18 26 225 60 17 54 18 2 2 .... 3 j 30 [ 85 8 1 j 3 1 34 S3 36 l Adams 23,352 8 7 3 1 1 8 2 . 1 1 ...... ! 1 Allen..... 81502 l?t "5'! 10 6 1 1 6 15 6 1 2 5 j 5 i 3 8 !....! 8 Benton . 13,611 "i 4.8 1| 1 1 1 1 1 Blackford...... 19,914 8.8 1 3 "•"1" 2 3 | 1 L.. * 15 1 1 1 i Carroll ...... 19,953 15 8.8 1 2 6 3 Cass —,...... 13.4 6 18 2 3 1 1 1 3 3 j \ 35,902 41 2 2 i Dekalb ., 26.272 24 10.7 2 2 1 1 9 4 1 1 1 4 3 elkhart ...... 47.392 50 12.4 3! 3 1 20 4 3 1 2 1 Fulton ...... 17,736 5.8 1 2 1 1 1 8 0 Grant ...... 63,973 61 11.2 4 7 1 3 1 i2 2 2 7 1 1 2 1 3 1 3 i 3 1 i Howard ...... 29,531 27 10.7 1 11 2 2 1 4 2 1 1 6 ! 4 Huntington ...... 29,404 10,8 2 1 1 8 2 1 1 4 1 2 Jasper 15,535 Y 5.3 1 2 1. 1 1 Jay ...... 28,154 35 14.6 13 " 4 1 2 3 1 1 1 9 1 1 i Kosciusko,...... 29,295 28 11.2 1 1 1 11 .... 1 2 3 2 : 2 13.8 1 3 1 1 Lagrange...... 15,284 18 1 1 2 7 ""2* 2 15.4 1 ; 17 8 1 2 2 5 9 1 Lake"*.... 43494 57 2 10 1 1 4 9 8 Laportc ...... 39,962 11.5 1 7 2 1 14 3 1 1 6 1 2 3 39 0 1 1 Marshall 25.639 25 11.5 1 6 1 "2 1 6 1 3 1 3 2 11.6 i 10 1 1 2 3 5 Miami , 29,352 29 9 1 1 1 Newton. 11,106 5 3 1 1 1 2 2 Noblo...... 23,(503 25 12.4 3 3 8 1 8 2 2 2 1 1 Porter 19,624 18 10.8 ! 4 1 2 1 8 2 1 1 4 2 Pulaski. 15,153 7 5.4 1 1 1 1 1 1 1 " 1 1 1 1 Starke , 11,668 10 10.1 1 i 2 2 2 2 3 1 Steuben ...... 15,515 21 15.9 3 2 1 9 7 1 1 1 1 St. Joseph.. 05,451 77 13.8 ""9' *22* 4 1 2 19 4 2 3 3 10 I 3 3 1 Wabash ...... 28.679 29 11.9 2 5 2 1 6 3 1 2 4 1 Wells...... 24,22-1 19 0 2 1 3 2 1 1 1 3 1 1 1 1 1 1 2 3 Whites 20,525- 20 11.4 2 8 I 1 3 1 3 1 Whitley ...... 17,328 17 11.5 2 3 "*i 1 6 1 1

Central Co's , 1,087,620 1,103 11.9 '75 1 52 72 32 31 285 114 23 53 23 2 6 64 42 11 2 2 45 62 78

Bartholomew .... 24,885 39 18.4 6 ! 5 1 4 2 9 4 1 2 1 2 1 1 Boon© ...... 20,321 12 1 3 2 3 6 1 4 2 1 1 J 1 Brown 9,727 2 2.4 1 i 1 .... Clay ...... 35,785 20 6.5 | 3 1 v 1 1 1 2 2 3 L.J--'" 25 1 1 I 6 2 1 Clinton 28,535 10.3 5 2 1 3 1 1 Decatur 19,014 21 J 2.6 1 6i 2 1 ,.,.4 L..|..... Delaware 57,42! 59 12.1 6 ; 1 4 4 1 13 2 1 8 1 2 2 2 2 1 Fayette. 13,811 19 16.1 1 i 13 4 1 5 ! 4 1 1 1 2 1 2 ;.... ; 1 Fountain — 22.201 13 6.9 1 1 5 3 2 1 Franklin ...... 22 15.8 1 'l 10 3 1 1 lj.... 16388 i 1 3 34 2 1 1 11 9 Hamilton 12.7 7 2 1 5 1 1 2 1 i 10 4 ' 1 !.... Haneook 31430 9.5 1 1 j 1 1 2 13 3 Hendricks? 19755 2 1 4 1 ' 1 1 1 1 i.... 19 1 j 1. Henry ...... 21.292 S.1 4 2 2 1 1 % 3 1 3 22 12.6 1 5 5 1 .... f Johnson ...... 25572 4 1 2' I 1 1 53 7.4 1 7 2 2 Madison...... 20488 12 5 13 3 1 2 4 1 31:::: v 265 14 2 13 2 4 Marion ...... 84.063 29 17 60 27 6 8 6 2 1 18 5 1 1 11 f/.' Monroe 26 13 8 3 1 1 10 3 1 1 1 1 219.655 23 4 A- Montgomery 22.153 9 0 4 1 3 6 1 1 1 ...| 1 Morgan. . 16 8 9 " 1 "'1' 6 2 1 1 29,933 9 3 Owen ...... 21,183 6.11 2 5 1 1 I It:. Parke ...... 21 10.2 2 3 1 1 15,193 22 6 1 1 i i.... Putnam 12.0 "l| 1 1 1 2 24.082 80 6 3 Randolph 12.2 1 3 2 14 3 1 2 1 1 ;.... 21,478 22 ••••! 1 Rush 28,880 12.6 3 1 1 1 9 3 1 1 2 3 1 1 Shelby...... 20,594 16 7.0 6 4 1 1 1 1 51 ! 15.0 2 1! 1 4 k 3 Tippecanoe .. 26906 11 1 ">i 2 2 "3 Tipton...... 40091 19 j 11.4 3 7 2 1 1 | Union 4 6.9 1 2 1 j i 19,50(1 2 Vermillion 6,748 °7 19 8 6 4 ft I 2 | 3 2 .... i 1** 1 !*"" Vigo 16.001 96 16.9 10 14 j 8 3 4 13 11 3 j 6 j " 7* 3 1 10 j 6 Warren...... 66,771 14 14.3 3 2 ! 6 2 1 3 i 1 | ""6" Wayne ...... 11537 3S It 3 2| 3 2 20 4 .3 2 3 J i .. j 3 1 1 1 39,507 i i ! 23 Soathern Co*s 613,097 120 12.7 49 113- §7 35 15 31 149 78 IS 45 I 35 1 1 5 44 40 10 2 4 ! 21 ! 40 ! f 1 Clark..... 82,465 34 4 2 ! 1 1 1 4 2 2 2 2 ; \ 4 ' Crawford...... 13,476 8 i 7.0 6 ;...,. 1 1 1 1 1 1 t 1 ;.... Daviess. 1 31.389 38 14.2 2! 5 i 2 1 3 5 7 *":V 1 2 1 1 1 2 1 f.... Dearborn 1 22.194 18 9.5 3 1 3 ..... 3 7 3 1 i \ ? i 1 ',.... Dubois 20,399 °i 12.7 "" 2 4 i 5 3 1 ....|....| 2 5 ! i 1 ..... Floyd 40 153 4 j 6 1 10 4 y 2 '"" 1 1 . 2 1 2 i.... 2 Gibson ...... 32,171 26 9.5 2 • 5 ; 10 "i" 2 4 i 2 t ...... ! 1 Greene ...... 30.190 33 12.8 1 6 ! 9 2 3 2 3 5 "*2" Harrison ...... 22,068 8.0 2 5 2 2 ! 15 3 1...... ' "2' I ...... 27.631 28 I 119 3 6 4 ! ....{ I Jackson : 3 | 2 **1 1 2 [....[ 1 I 5 2 [ Jefferson I 22913 31 ' 15.9 2 ! 2 | 5 3 4 3 8 ' 1 2 1....;..... Jennings . ! 16,217 22 ' 16.0 2 1 6 1 1 1 .:::•••' I 1 ..... 2 Knox...... I 34,627 48 '< 16.3 2 '"4 5 3 4 ~1 1 1 4 1 . f 1 Lawrence ...... ! 28,104 82 • 13.4 ! ?! i 1 2 • 2 1 2 ...... l 1 {....j 1 Martin ...... I 15,006 8 ! 6.2 I ..... i ; 2 ... 1 i 1 ...... Ohio | 4,724 8 ' 20.0 ! ; 1 9 "Y :::: 1 1 17,?24 15 • 9.9 1 4 1 . Orange | 1 ! 2 1 ..... I .... 1 1 .....j...... Perry. f 18993 10 ! §2 1 1 1 1 ^ 1 1 2 i 1 1 ; Pike....,..,....-. 1 21,263 28 ! 15.5 2 i 1 ft L 4 2 ? 4 2 2 i f 1 0 ! ..... Posey...... [ 22,655 33 ; 17.1 7 i 4 3 1 4 1 1 s 1 2 I 2 ..... 1 Ripley ...... i 20,093 22 < 12.9 ' 4 1 2 4 ' 1 ..... "Y ?!•:••::::: Scott i 8,497 7 l 97 : 1 ' 1 ..... 2 : 1 1 1 Spencer ...... i 22,546 14 j 7.3 1 5 i 2 5 i 3 1 1 ::::: :::' 2 Sullivan.... 26,456. 42 18.7 1 i 13 ! 6 4 1 1 2 3 3 4 4 2 2 2 [ Switzerland...... ? 11.840 11 1 10.9 . 2 1 r 2 2 r i 10 Vanderburgh .... ! 76.558 95 i 14.6 4' 1 1 3 4 5 19 16 8 18 ; "**3 .....j.... 3 f 22,796 1 1 2 2 Warrick. ....— 21 ' 10.8 "1 1 "9 i ( 19,725 20 11.9 4 2 ...•*.'.... 1 1... Washington.. — 5 6 TABLE No. 11. Deaths in Indiana bv Cities During* the Month of October, iooc.

IMPORTANT AGES I • IMPORTANT CAUSES.

CITIES. rdlii R t o U . S LOW ) Population . 'Tuberculosis, ] Census Bureau. Over . eases , Unde r 5 . MeningitiB . fo r October , 1905 . Consumption . I stitutions , Unde r 1 Year , Annua l Doat h Kat e pe r 1 to 4 , inclusive . Btillbirtha . Population, Estimated Acco Tota l De n th a Koporte d 1 5 t o 19 , i n e l naiv Pulmonar y j Othe r Porai i o f j Group. j 1 0 t o 14 , inclusiv e 6 5 Year s an d Diphtheria . 5 to 9 , Inclusive . Typhoi d Fever*©r . Measles , Pneumonia . Violence . Scarle t Fever . Diarrhea l Dis ­ Influenza . Puerpera l Cancer . Smallpox . Beath i n In ­ —— — \

•Cities over 50,000 Fopu- : intion 260046 304 !3.7 16 I 39 21 J4 4 5 62 27 5 1 8 8 2 1 19 1 9 3 1 13 20 St Indianapolis...... 196,914 230 13.7 11 1 2S 16 11 2 4 49 18 5 1 7 6 2 !"** l 15 6 1 10 39 Evansville 1 63,132 74 13.8 5 11 5 3 2 1 13 9 1 2 4 3 I 14 I 4 1 2 t 6 13 •Cities from 25,000 to 1 50,0011 Population.. 159,349 188 13.9 20 34 17 5 6 6 29 16 5 10 7 1 13 12 | ... 6 14 12 2 5 1 1 2 Ft. Wayne 4U.975 8.5 7 4 ..... 1 | 4 ! 2 1 \ 3 3 8 Muncie .-...... 26,310 30 13.4 2 1 3 2 1 4 1 ! 0 ! i "Y . * i ! South Bend...... 43.163 45 12.3 7 14 3 ..... 1 2 I 8 5 1 5 I !' "r 2 1 39,901 77 22.7 9 12 6 2 4 1 1 Terre Haute ...... 1 10 1 7 3 2 5 7 | 3 ; 1 1 9 3 •Cities from 10,000 to 1 1 25,000 Population.. 231,707 13.2 15 39 17 5 5 5 62 15 8 14 3 1 1 2 I 13 I 12 ^ 1 1 I 1 1 9 20 13 1 24,898 20 9.4 6 1 1 I 1 1 Anderson ...... 3 1 1 l i 1 2 1 Elkhart...... j 17.094 20 13.8 2 4 1 " i" 6 1 2 1 1 j 1 El wood 15,529 6 4,5 1 1 1 Hammond 15,648 21 15.8 1..... 8 1 1* i 4 1 2 1 i ! 2 2 1 i 3 7 Huntington...... 10,356 11 13.6 !..... 6 1 1 1 Jeffersonvillo...... 10,828 13 1 1! 1 2 1 Kokomo...... 11,782 15 15.0 1 3 "T *2 1 2 2 1 1 1 1 1 3 Lafayette 1 19,041 32 19.2 3 "i* 6 3 1 1 2 I * 1 2 Logansport 17,642 24 16.0 2 i 9 2 i 1 3 1 21,620 i 1 3 Marion ...... — 20 10.9 3 i i 1 2 3 1 1 ,».... 1 1 Michigan City...... 16,885 11 7.6 1 2 3 1 3 New Albany ...... 20,403 31 17.9 : o 2 5 1 1 "3" 1 i 1 1 1 l 1 2 ] 2 Richmond f 19,03 i 15 9,2 ; T 1 3 1 "Y 9 2 1 1 2 Vincennes j 10,949 22 23.7 1 1 3 4 2 2 3 i 3 2 1 | 3 i 1 i Cities from 5,000 to ' 20 44 10.000 Population.. | 196,771) 275 16.4 32 1 12 67 27 7 14 21 2 1 15 23 7 1 ; 9 i 13 | 2 Alexandria 8823 . 6 8.0 2 2 1 1 1 Bedford...... 7,221 14 22.3 1 2 174 2 2 4 1 2 1 1 7,437 10 15.8 2 1 1 4 . ... c 1 bloomington...... : i 1 Brazil 8,538 8.2 1 I | 1 i 2 Columbus — 8694 13 17.6 ! 4 3 1 2 2 1 "Y Connersville...... 7,751 12 t l$-2 1 I 3 4 3 1 1 3 ; 1 Oruwfordsville... i 6.873 5 ! 8.5 1 !.'\TT 1 ?!•••• 2 ***** ..... f East Chicago ...... i 7,500 13 : 20.4 4 ""4 *Y 2 3 2 3 1 ...... Frankfort...... 7,572 8 i 9.3 ! 9. 1 2 1 1 goshen ...... 8,521 14 | 19.3 I 1 2 6 i "Y greensburg...... 6 12.6 3 "*J2 -r .....1..... Hartford City...... 7,302 9 14 4 1 "Y ""2" 2 i : 2 "'2' ....!..... " 1 J Laporte ...... 7,136 18 ! 29,7 3 1 2 1 1 2 i 1 1 1 Linton ...... 9,767 15 i 13.1 : 1 4 1 1 1 1 1 2 2 91 1 0 Madison ...... i 8,936 14 1 17.1 i... . 4 4 2 2 2 i 1 1 Mishawaka 6,436 16 29.3 ! 2 1 6* -1 3 I 1 4 "Y j 1 Mt. Vernon 5,303 17 1 37.8 1 3 4 1 1 4 2 1 9 1 1 Peru...... 8,397 '13 ! 17.0 4 ! 4 2 3 1 Portland 5.507 6 12.8 i . . 2 11,,, 1 Princeton...... 7,227 10 J6.3 | "i" 5 ! 1 a I Sevmour ...... 6.838 11 18.8 1 1 1 | 1 1 1 j.... 2 Shelbyvillo ...... 7,856 8 12.0 i' 1 2 3 ;..... 1 :::;:[;;;:: Valparaiso.... i 6,756 12.2 .... n....|.... 1 4 2 Wabash...... 9023 8 10.4 1 i ! 2 ; ... 1 1 ....i"" - " .....j '*!***•* 9,546 16 1 19.7 1 2 i 2i 3 1..... "1' 1 Wishington. — ] ...... j • •..}...."..,.,. i { Whiting...... 5,500 1 i 2.1 1 , "Y 1 Cities under 5,000 Popu­ i 1 1 lation ...... 129,931 167 | 15,1 23 ! 15 6 . 19 44; 17 7 8 , 4 1 1 ....j 1 11 8 1 1 ..... 1 s 8 Attica..-...... 3,279 2 1 7.1 1 i 1 i v • • • .... J ...... j4-- Auburn ...... 3,788 1 1.... 1 .... Aurora ...... ! 3,929 11 : 1 "Y 1 4,335 8 •' 19.5 1..... Bluffton ... 2 1 ;;'1 1 | YY.L! Y"" Cannetton i 2.2C 1 5.2 .... .^ 1 ! | 3.539 9 ••••j ;;; ....[....|.....j **"**! Clinton ... ; 30.0 1 ... Columbia City...... I 3,027 3 11.6 1i ...... r...r....j •Coving-ton...... 2,342 4 20.1 1 2 0 : •::::;.:::|:::::i "Y Decatur 4.542 5 12.9 1 1 ! 1 .... ; :;i:iii- Delphi ; 2,220 3 15.9 1 1 ! j 1 Dunkirk ...... 4,052 6 17.4 .... 1 : l 1 t Franklin...... ; 4,095 5 14.4 1 • ;;;;•""[ garren...... 4,367 10 ! 27.0 2 i 1:2 i....!.... 2 1 1 ; j j 1 . : Gas City..,.. 4,222 4 I H .1 ""l | ' 1 r JJ;; ! ..... greencastle 3,661 5 ! 16.1 1 ... .j...,. " '2I 1 1 Y::z:: "i"\ ... . ?,. * greenfield 4,945 3 7.1 1... 1 1 r Huntingburg.... 2.527 5 23.3 1 I t ;, ! i 3.1 «...

Deaths and Annual Death Rates par IttWttO Popu-

Important Ages. I ,atton from important Causes. 1 I 1 I I 1 I Other I I

Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 65 and Overl Consumption uJ Typhoid Diphtha- tt ICAL u I1 * tuberculosis Fever. | diarrhrea. SECTIONS AND AS £3 m O fit URBAN AND —a, RURAL. 35 1,00 0 Population . | October , 1905 . - ' Population , Censu s 1900 . Annua l Deat h Rat e s>e r | Deat h Rate * | Number , j Pe r Cent . Number . 1 Pe r Cent . Deat h Est© . Deat h Eat© . Tota l Death s Reporte d fo r Number . Pe r Cent . Number . 1 Number . Numb«r » Deat h Rate . Number . Number . Number , Pe r Cent . Number . Stillbirths . j Pe r Ce n . __ Pe r Cent . | ! State. 2,648,549 2,681 11.9 169 428 16.9 221 8.8 89 3.5 46 1.8 ! 88 3,5 659 |26.2 252112. 2 : 55 | 24.6 152! 67.? 76 38.8 1 Northern Go's 887,832 849 11.2 45 161 20,0 ! 62 7.7 22 2.7 118 2 2 '• 26 3.2 225 27.9 79.7 17 22.5 54 71.7 18 ! .23.9 : 60 Central Go's.. 1S087,620 1,103 11.9 75 152 14.7 72 7.2 .12 3.1 ! 18 1.2 31 3.0 .28-5 27.7 114 123.6 23 24.9 53 57,5 23 i 24 J Southern Co*s 673,097 729 12.7 49 11s 16.0 ! 87 12,8 35 5.1 i 15 | 2.2 1 31 4.5 149 21.9 78 136,7 15 26.2 45 78.8 35 i fil.3

All rltlea... 971,812 1,195 14.4 SO 179 16.0 104 9.1 4T [ 4.4 [l7 j 1.5 1 3? 3.3 264 I 23.6 102 1*23.0 32 38.6 54 65.1 43 1 51.8 i Over 50,000 ... 260.046 "04 13.7 16 » 13.5 21. 7.4 14 4.8 4 I 1.3 5 1.7 62 21.5 27 122.5 5 22.6 S 86.3 8 36.$ 25,000 to 50,000 159,349 188 13.9 20 34 20 2 17 1C.1 5 3.0 6 3.5 6 13.5 20 17.8 16 118.4 „ 5 37.0 10 74.0 7 51.8 10,000 to 25,000 231,707 261 13.2 15 | 39 15.8 17 6.9 5 i 2.0 5 ! 2.0 5 J 2.0 62 29.2 15 76.3 8 40.7 14 71.2 ! 8 15 2 5.000 to 10.000. 196,779 275 16.4 20 44 17.2 32 12.5 17 i 6.0 i ; .4 12 i 4.7 67 26.2 27 101.9 7 41.9 14 83.9 1 21 125.9 Under 5,000.. 129.931 167 15.1 9 23 14.5 15 9.5 fi , 3.3 1 I .6 9 5.7 44 27.8 17 154.3 63.5 8 72.6 4 36.3 : ~ Country 1,670,737 1.486 10 4 89 247 17.6 119 8.5 42 1 8.0 29 2.7 51 j3.6 395 28.2 150 105.9 23 16.2 m 69.2 S3 24.3

Deaths and Annua! Death Rates per 100,000 Population from Important Causes.

POPULATION Diarrheal Cerebro­ Puerperal BY Croup. Scarlet Me isles. Whooping- Pneu­ Diseases, spinal Infl uenza. Septi­ Cancer. Violence. Small­ GEOGRAPH­ Fever. Cowgh, monia Under 5 Yrs Meningitis. caemia. pox. ICAL SECTIONS AND AS " S3 | © © © o © © URBAN AND ! i i i i RURAL. erf . 1 "e3 C Us CO 1 ^ © © a to m © © o *> XI JO B a 1 •» B 1-3 s ! 1 a S 8 Is B * 0 s "3 B "a B 3 © 2 i * & S3 © S3 St © 3 7k ft 83 | £ ft 0 ft ft a ft 9 !Z5 S3 ft fc 1 ft 53 ft £3 __ SB ft 12.9 State...... 3 1.3 5 2.2 14 ! 6.2 138 61.4 167 74.4 29 4 1.7 9 1 4.0 100 44.5 155 69.0 j

Northern Go's... 2 2.6 2 2.6 3 ; 3.0 30 39.8 85 ! 112.9 8 10.6 3 3.9 : 34 45.1 53 s 70.4 ! Central Go's..... I 2.1 1 i 6.4 61 69.4 42 , 45.5 11 11.9 2 2,1 2 2.1 45 48.8 62 67.2 i Southern Go's ... 1 '1.7 1 1.7 5 8.7 44 77.1 40 70.1 10 17.5 2 3,5 4 7.0 21 36.8 40 70.1

All cities 8 3.6 4 4.8 5 6,0 11 85,6 64 77,2 14 j 16.8 3 3,6 2 ! 2,4 45 | 54.3 75 90,5 _ — Over 5O.0OO...... 2 9.0 1 | 4.5 19 88.2 9 ! 40.8 3 13.6 1 4,5 | • 13 \ 58.9 20 90,7 .....L.... 25,000 to 50,000 ... 13 j 96.2 12 i 88.8 2 ! 14.8 1 I 7.4 6 44,4 14 103.6 10,000 to 25,000 ... 5.0 1 5.0 2 ; 10.1 13 66.2 12 ! 61.1 1 5.0 1 5.0 1 j 6.0 9 45.8 20 101.8 5,000 to 10.000 .... i 11.9 1 ' 5.9 15 89.9 23 J37.9 7 41.9 1 5.9 9 53.9 13 77.9 : .....L...: Under 5,00)...... 2 1 9.0 1 i 9.0 11 99.8 8 i 72.6 1 8 72.6 8 72.6 | ...,j.. . Country,...... 1 .7 9 1 6,3 67 ! 47.3 103 ! 72,7 15 10,5 1 .* 7 ! 4,9 55 38.8 SO 56.5

Meteorological Summary "for Octotier, 1005. Furnished by the Central Office, Indiana Section, Climate and Crop Service, U. §* Weather Bureau, Indianapolis, Ind.

W, T. BLYTHE, SECTION DIRECTOR.

TiMPiiATumstemperature, . [I]; PRECIPITATION. [j I conditioncondition ofof skysky !i Wind,.

h I! Highest. i LowtstLowest. ji; la lechesInches.. j g§ IKamberofDays.iJNamber of Day*.;li da

SECTIONS, « Normal . Degrees . Average . Mean . Departur e fro m 1 Date . Departur e fro m Doy B wit h .0 1 iii c Date . Snowfal l Ifn - Clear . Parti ? Cloudy . I molted , j Cloudy , I Pr e f ai l i n $ D ree

S Bluffton ) | 1 Northern Section,...... 52.0 j -1.6 •188 8 20 m 'Bluffton...... 2.91 +1,43 ; T S 15 { 5 11 ; SW. Rensselaer..) ; ! 1 Central Section...... j 53,8 1 -0.3 ! 90 • 8 Farmersbufg..; '22 30' 'Northfield.,... 5.05 1 -1-2.07 ! T 10 | ; 14 [ 6 11 i sw. 2* ' 30 ColumbiQi. .) Soiithtrm Section...... j 56.5 1 0.0 ; a . S Columbus..."*. ; 28 f 21 Greesibarf. r 6.58 +4.14 X 10 ] I6 4 11 i sw. s li 28 | 12 Paoli...... j i I5 1 State...... j 54.1 ! -0.6 ; 91 S Columbus, — \ m : 90 Blafftou,.,,*..' 4«i5 j +2.51 , f & 1 ! 1 5 11 j SW. am