REPORT OF THE PROCEEDINGS OF THE MEETING 
I 
of 
STATE - AND - LOCAL - BOARDS = OF - HEALTH 
held in the 
Y. M. C. A. Building, Columbus, O., Jan. 24 and 25, 1895. 
FIRST SESSION. 
Thursday, 10:30 a. m., January 24, 1895. 
The meeting was called to order by Dr. Byron Stanton, President of the 
State Board of Health, who, on taking the chair, spoke as follows: 
Gentlemen - It is not expected that I shall address you at length in open- 
ing the work of this meeting. The object of our coming together is, doubtless, 
known to all of you. We have met as the representatives of the various boards 
of health of the State, for the purpose of conference upon matters relating to 
sanitary science, to increase our knowledge of the fundamental principles of 
health, to stir a little leaven into the public mind and give an increased impetus 
to all sanitary activities, to bring into harmonious action our various health or- 
ganizations, to the end that sanitary laws and regulations may be better 
enforced. 
It is a matter of great gratification that our meeting is so well attended, and 
on behalf of the State Board of Health I thank you for this manifesta+:/'n of 
your interest. 
Our program shows some departure from the usual custom, and it is believed 
that by this means we may assist in clearing up some of the problems that loom 
up before those engaged in our line of work and give more practical range to 
the discussions, and thus meet more particularly the difficulties that beset the 
way of the practical sanitarian. 
We are anxious to have those who have come here from the different parts of 
the State discuss the topics with which they are familiar, and I am confident 
that valuable knowledge will come from a free exchange of thought. Work in 
this and other directions that may suggest themselves will well repay us for the 
time and money expended for this meeting. 
I now call upon Dr. Kahle, who has had experience as a health officer, to tell 
us something about the duties of that office. 
WHAT ARE THE DUTIES OF A HEALTH OFFICER? 
Dr. R. D. Kahle, Member State Board of Health, Lima. 
Mr. President and Gentlemen - On the efficiency of the health officer 
much depends. If he is a man of ability and a good sanitarian, he can do much OHIO SANITARY BULLETIN. 
/ advance the cause of hygiene and hold in check those diseases that decimate 
our State. 
The community in which he lives naturally looks to him to ferret out contag- 
ious and infectious diseases, and to use all means within his power to stamp 
them out of existence, and to use his office to make the place healthy, pleasant 
and happy. 
It is not likely that any great epidemic will again visit our country, such as 
small-pox, cholera, typhus fever, or the plague, although cases may occur in 
different localities. We must not forget that scientific, rational, intelligent 
hygiene is a thing of the present generation; yet we have made rapid progress 
in that time, and few subjects are more popular or more calculated to advance 
the interests of the State, or to yield larger returns both as to material wealth 
and happiness for the labor and money spent. The measures looking to the 
prevention of disease by the use of scientific methods is modern. The maxims 
of Hippocrates, the ceremonial of the Hebrew law as to bathing, and the estab- 
lishment of quarantine are almost the only exceptions. For the most part suf- 
fering has been regarded as an infliction of the gods, or a dispensation of 
Divine Providence. 
The law passed March 14, 1893, creating a board of health in each township 
of the State, as well as each city and village, is certainly a wise provision ; as 
working in harmony with the State board, it gives concert of action that bears 
fruit in our State. It is mandatory for the city and village boards to appoint a 
health officer, and the township boards may, and I believe should, appoint one. 
The law only in part defines the duty of the health officer, but gives the board 
of health power to do so. He is powerless without the action and co-operation 
of his board, as he is an officer of said board, and must execute the order and 
rules passed upon by them. He has no authority within himself, but his juris- 
diction is given him by the board of health of which he is the executive. 
Where possible, the health officer should be a physician. The perfecting of 
sanitary science depends largely upon the physician, who has done more than 
all others in the cause of hygiene; and to him we must look for advancement 
in the future. 
It is unnecessary to call your attention to the progress sanitary science has 
made, more than to mention that man's lease of life has been lengthened, and 
his surroundings made more healthful and pleasant, as well as more secure. 
When the periods of infancy and youth are made as secure and free from dis- 
ease as adolescence, when contagious diseases are held in check, such as small- 
pox, or obliterated completely, then we will have reached a triumphal period 
in our history. There has been inaugurated international hygiene, a system of 
sanitary adminisitation which in my judgment is destined to control, suppress, 
and finally exterminate contagious and infectious diseases. 
The people should be alive to the fact that a well paid health officer, sup- 
ported by well framed and comprehensive laws, is as much of a necessity to the 
common weal as a well paid mayor, police, sheriff or township clerk. Where 
it is rightly understood, hygiene is to-day one of the most popular of subjects. 
The local Board of Health naturally looks to the health officer to keep it in- 
formed on sanitary matters, and through him most all communications reach 
the board. The members of the board are not selected on account of their 
sanitary knowledge, but are frequently men of sound judgment, who are 
anxious to do all within their power for the best interest of the community, and 
can readily discern what is meritorious, and what is not, when rightly presented 
to them; and very properly they rely on their health officer for advice and direc- 
tion. 
Not the least important duty of the health officer is his dealings with con- OHIO SANITARY BULLETIN. 
5 
tagious diseases. It is very essential that smallpox, diphtheria, scarlet fever, 
measles and kindred diseases, be promptly reported to the health officer, who 
should, without delay, have the house placarded and properly quarantined, and 
use every available means known to prevent the spread of these diseases. 
Quarantine should be so regulated as to give the greatest safety with the least 
interference possible with the public. There are times when a house to house 
inspection should be made, for all contagious diseases are not reported by those 
in attendance, they either failing or refusing to report the same. There are 
places where the number of deaths from a contagious disease is greater than the 
number of cases reported. 
The principal of schools, or school teacher, should be notified, and children 
from families where contagious diseases exist should be prohibited from attend- 
ing school as long as there is danger of contagion. In case of death, public 
funerals should be absolutely prohibited. The health officer should either see 
personally, or through a competent sanitary policeman, that the room in which 
an infectious disease has been is properly and thoroughly disinfected. Those 
exposed to smallpox, cholera, typhus or yellow fever, should be kept under 
surveillance until all danger is passed. Railway cars, steamboats and other con- 
veyances should be disinfected after carrying persons afflicted with any of these 
diseases. 
A burial permit should be required in all cases, and an accurate record kept 
of all deaths, with the cause and duration of the illness. Death reports are of 
but little value unless they are full, accurate and complete. A partial report 
of the deaths is misleading and can not be relied upon. 
The way to obtain data on these subjects is by thorough registration of vital 
and mortuary statistics. All births, deaths and contagious diseases should be 
accurately recorded. The cordial co-operation of physicians and undertakers 
should be solicited in making the data of these reports accurate and complete. 
It is desired to make these vital statistics an unanswerable argument in favor of 
systematic public sanitary work, and the granting of State and municipal funds 
necessary for maintaining such work. Prompt reports should be made to the 
Secretary of the State Board of Health, where a complete report of the State 
is compiled. Every locality should secure to its inhabitants homes so healthful 
that they would defy the potency of filth diseases. It is incumbent upon the 
health officer to see that all nuisances are abated, not only those which are 
detrimental to health, but those that are offensive to the sight or disagreeable 
to the sense of smell. 
A few years ago an effort to instruct the public in the management of their own 
homes, such as plumbing, drains, cisterns, cellars, water supply, light, heat and 
clothing, especially any intimation that kitchen, yard, alley or out-houses was 
filthy, would have been regarded as an impertinence. Such suggestions are 
now received, often solicited, and made the basis of action. It is the duty of 
the health officer to keep the public informed as far as possible on these sub- 
jects. Where not otherwise provided for, he should inspect dairies, slaughter 
houses, slops, water and food supplies for animals, and kindred subjects relating 
to public health. 
He should also collect scientific data in regard to altitude, climate, water 
supply, density of population, sewerage, proportion of sewered and non-sewered 
areas, and other points bearing on the healthfulness of the place, which will 
permit of interesting comparison with the sick and death rate, and he should 
trace, as far as possible, the source and means of conveying diseases. He 
should be familiar with the health laws of the State, with the rules and regula- 
tions of the State Board of Health, and see that they are properly and promptly 
enforced. Wherever sanitary laws have been enforced, the death rate has di- 6 
OHIO SANITARY BULLETIN. 
minished. Sanitary rules are worthless if not faithfully executed, and yet no 
class of laws is so difficult of enforcement as those designed to protect the public 
health. In their practical application to be effective in the control of con- 
tagious and infectious diseases, individual rights, religious observances,'com- 
mercial interests, and even national customs, must be subordinated to the exi- 
gencies which these pestilences create. It has been held that health laws are 
anomalies in civilized governments. They arbitrarily set aside ordinary laws 
because they are adapted to anomalous conditions of the people. 
Section 2136, of the Revised Statutes of Ohio, reads as follows: 
" It shall be the duty of the Board of Health, or health department, on or before 
the first Monday of March in each year, to make a report, in writing, to the 
council of the corporation and to the State Board of Health upon the sanitary con- 
dition and prospects of such city or village, which report shall contain the statis- 
tics of deaths, the action of the board and its officers and agents, and the names 
thereof for the past year; and it may contain other useful information, and the 
board shall suggest therein any further legislative action deemed proper for the 
better protection of life and health; and it shall be the duty of said Board of 
Health, and health departments, to promptly furnish special reports as may be 
called for by the State Board of Health." (O. L., Vol. 90, March 14, 1893.) 
This is an important section of the State law, and the health officer should 
see that it is fully complied with. 
To recapitulate, the health officer- 
1. He should be a physician where possible. 
2. He should keep the local Board of Health informed on sanitary 
matters. 
3. He should placard and quarantine contagious diseases. 
4. He should notify the principal of schools, or school teacher, of con- 
tagious diseases. 
5. He should see that places where contagious diseases have been are 
properly disinfected. 
6. He should prohibit public funerals when death has occurred from 
contagious diseases. 
7. He should require a burial permit in all cases. 
8. He should see that accurate records are kept of births, deaths and 
contagious diseases. 
9. Prompt reports should be made to the Secretary of the State Board 
of Health. 
10. He should inform the public on sanitary matters. 
11. He should inspect dairy and food supplies. 
12. He should collect scientific data. 
13. He should trace the source of disease. 
14. He should be familiar with, and enforce the health laws and rules of 
the State Board of Health. 
15. He should make a complete and comprehensive annual report. 
I thank you, gentlemen, for your attention. 
The Chair - Gentlemen, this paper is now before you for discussion. It is 
desired that every paper presented shall be fully discussed. That is what we 
are here for. I think it would be desirable to have short speeches in order 
that each may have a chance to say something. 
A Member - Mr. Chairman, I move the time to be limited to five minutes. 
(Motion seconded and carried.) 
The Chair - I would request that all rising to speak for any purpose, shall OHIO SANITARY BULLETIN. 
7 
speak distinctly, so that the stenographer may be able to accurately report the 
remarks that are made. Also, please give the name so that the record of the 
proceedings will show who has taken part in the discussion of the various sub- 
jects on the programme. 
This paper is now before you for discussion. It is in my opinion a very im- 
portant subject, and I hope that some of you who have had experience will say 
something on the subject. 
After the lapse of five minutes, no one desiring to discuss the subject, the 
Chair announced the next topic. 
HOW MAY THE HEALTH OFFICER OBTAIN CORRECT AND FULL NAMES 
OF INFANTS? 
{Proposed by Board of Health of Hartwell-) 
Mr. President - The question proposed, "How may the health officer ob- 
tain correct and full names of infants?" might, in the present state of affairs, 
be very properly answered by asking the question, "How may health officers 
obtain a report of the birth of a child at all ? " It is a notorious fact, that this 
requirement of the health department of municipalities is almost totally ignored 
by physicians and midwives. It is only in the larger cities that birth reports 
can be obtained, and I believe that I am safe in making the assertion that the 
rule of the State Board of Health requiring mortality reports, is to an equal 
extent violated; hence vital statistics, as now obtained by our State Board of 
Health, are totally unreliable and worthless for the purposes intended. The 
State Board of Health is doing all in its power to correct this evil, but with the 
limited authority it has, cannot be expected to accomplish the desired end. 
The law creating Boards of Health would appear in theory a sufficient guar- 
antee to secure a full and satisfactory report of vital statistics, but, practically, 
it is to a great extent a failure. Howr many municipalities in .the State report 
to the State Board of Health statistics of any sort? I will venture that not one 
in fifty do it. The law now constitutes township trustees Boards of Health, 
with about the same authority possessed by boards in towns and cities; but how 
many townships in the State return to the State Board a report of vital sta- 
tistics-very few, I fear. What is the matter that such a state of affairs should 
exist? Something certainly is wrong, either with the law itself or the execu- 
tion thereof. Both are perhaps at fault. Now, if we cannot obtain reports of 
births, as now required, how can we hope to get such a report with the addition 
of the full name of infants, thus adding very greatly to the trouble of making 
such reports. In this matter we must look chiefly to physicians for aid. My 
experience has been such as to cause me to feel that little can be hoped for from 
the medical profession in this line under the present laws or regulations. Many 
physicians refuse to make reports without remuneration, others, for various 
reasons best known to themselves. In fact, I have found many physicians op- 
posed to nearly all of our health regulations, and especially birth reports, 
for they will tell you that the assessor looks after the births in his rounds once 
a year, and many other excuses are offered for the purpose of avoiding the little 
trouble it makes them to fill out the blank furnished by the Board of Health. 
Discussion opened by Dr. W. B. Hedges, Health Officer, Delaware. 8 
OHIO SANITARY BULLETIN. 
I am well aware of the fact that Boards of Health and health officers have the 
power delegated to them by the authority creating them to prosecute delin- 
quents; but, after all, this is a very unpleasant thing to do, especially in the 
smaller places. The health officer is usually a physician, and he will hesitate a 
long time before arresting a brother physician, one that is, perhaps, his warmest 
personal and professional friend The duty thus devolving upon him is a very 
unpleasant one, and one from which the bravest may shrink. To obtain the 
full names of infants, it appears to me that we must look to other sources than 
physicians and midwives. A State law making it obligatory upon parents to 
report to the health officer or Board of Health, the full names of infants, with 
sex, date of birth, etc., within a certain specified time after birth, with a severe 
penalty attached in case of failure to comply with such law, might, perhaps, 
secure the desired end. But I am fully convinced of the fact that the collec- 
tion of vital statistics will not be full, and anything like complete, until the 
United States government takes the matter in hand and passes such laws as will 
make this subject uniform throughout the country. 
A national board of health should be established by Congress, and a commis- 
sioner of health or national health officer appointed, and made a cabinet officer, 
whose duty it shall be to administer the national health laws. Boards of health 
should be required in every State and territory, and made auxilliary to the national 
board, and municipal and township boards auxilliary to the State boards. The 
State boards should be required, under heavy penalty, to make returns of vital 
statistics, contagious, infectious and epidemic diseases. To State boards should 
be delegated authority to compel township and municipal boards to faithfully 
report such statistics. Laws governing the health department of the country 
should, to be effective, be made by the national government, and executed 
under the supervision of a national health officer. If such laws can be made 
under our peculiar form of government to not conflict with the Constitution, 
and at the same time apply to the States, they could be much better enforced 
than State and municipal acts. Moreover, it appears that laws governing the 
collection of vital statistics should be uniform throughout the Union to make 
such statistics valuable, upon which to base an estimate of the health, etc., 
of our people. In this way only can the question, "How may the health 
officer obtain the correct and full names of infants?" be answered. 
The Chair - This paper, gentlemen, is now before you for discussion. I 
would like to have each paper thoroughly discussed. Are there any remarks? 
Dr. Waltz, of Collinwood - There are some things contained in that paper 
with which I agree, and others I don't like at all. In the first place it lacks 
backbone. Now, it seems to me that if the law is properly enforced such records 
of vital statistics could be obtained. In the first place you can pass a resolu- 
tion requiring physicians to report, and if they do not report, arrest them. 
About a year ago I found a number of physicians who did not report their 
cases. I simply notified them that unless they reported every one of them they 
would be arrested. There is another thing I think is worse than all that, and 
that is to get reports of births where physicians are not employed. There are a 
number of that kind of cases. I say that a physician that is a health officer 
should have plenty of backbone, and I believe that is all we want and need - 
to have the moral courage and not be afraid to make them come to time, and 
they will think as much of you in the end. OHIO SANITARY BULLETIN. 
9 
The Chair - Are there any further remarks? 
Dr. Hoover, of Columbus -What I am going to say might, perhaps, place 
me in a peculiar position, being a member of the State Board of Health, and 
consequently desirous that all of its rules shall be properly enforced. You 
may think strange that I am going to present a plea in behalf of the 
violators of some of the rules, but I am a doctor also. I want to state in 
the beginning that (I was going to say ninety per cent., but I guess, perhaps, I 
will not miss it very much when I say one hundred per cent.) of everything 
that is done for the benefit of the public health is done by the medical profes- 
sion, and it has been done in the face of the strongest opposition from the very 
persons who are most benefitted by it. I have been a member of the State 
Board since its organization, and the laws that have been passed since the origi- 
nal bill have been secured by most persistent effort on the part of those in- 
terested in sanitary science, and they have been almost without exception doc- 
tors. Whenever we can educate legislators up to the point where the value 
of the life of an individual is regarded anywhere near equal to the value of a 
short-horn bull, then we may expect to get such laws passed as will preserve 
the public health. The very minute anything is done looking toward the con- 
servation of the public health, the very minute a bill is offered in the legisla- 
ture, that very instant it is announced that it is some doctor's measure, and 
they proceed at once to kill it. Doctors have enough to do, and they do more 
than their duty every time without hope of reward; and if they did not, God 
help humanity. While I admit, and this may make my position seem some- 
what anomalous, it is a rule of the State Board of Health requiring doctors to 
make these reports; and while I am glad to see that some of our health officers 
have pluck, I want to say frankly that there is no use in going behind the fact 
that it is a successful case of bluff*, and it is not anything else. I question very 
seriously if any doctor could be compelled to make that report without com- 
pensation. It is a question of personal right that has never been tried as yet. 
I say this before a class of men in whom I have confidence enough to believe 
that they are not taking advantage of anything of that kind; we are here not 
because the law says we shall meet here, but because every one of us has enough 
interest in the public health to take the time and bear the expense to come here 
and discuss matters of public importance. I believe, gentlemen, that it is the 
duty of the health officer to collect these names, and I believe that he ought to 
be paid enough to justify him in getting the names. I think Dr. Hedges' paper 
a good one, and I think Dr. Hedges lacks just about as much backbone as I 
would lack, simply because there is the fact that stares you squarely in the face, 
that you cannot require labor of anyone for nothing. Try it on the laboring 
man if you want to find out. You come to the doctor, as our friend over there 
said, and you say, " You have got to report so and so, or I will have you 10 
OHIO SANITARY BULLETIN. 
arrested." Why, the doctor simply reports. In the first place, because he is 
wholly a man and he doesn't want even to shrink from such a small duty, 
however irksome it may be. Secondly, because he is accustomed to work for 
for the good of humanity without hope of reward. 
Dr. Davidson, of Hilliards -I want to say that I am in favor of backbone as 
much as anyone in the world. There are a number of cases which are not at- 
tended by physicians, especially among the German people, and I don't know 
what we would do if we had to run around and look after names. If we were 
paid for gathering these statistics we would make the effort. I think Dr. 
Hoover is right, that we ought to be paid, and it is not our duty unless we are 
paid. 
Dr. Ebright, of Akron - Some things in that paper I agree with, and with 
some things Dr. Hoover has said; other things he has said with which I do not 
agree. First, I do not agree with the doctor when he says that all physicians, 
or that any physician does more than his duty. I don't believe that any man 
who follows a profession like this, the medical profession, can ever do more than 
his duty as a citizen. He may possibly do more than he should do so far as his 
family is concerned, but I don't believe he can do more than his duty. The 
question, however, is not as to whether Dr. Hoover is right. It occurs to me, 
in my experience of a number of years in the health office of a populous city, 
that it is not much trouble for a health officer to do anything he wants to do. 
In the first place he should understand that in an epidemic or anything of that 
kind that the people will, so far as they can, aid him in doing that which is 
best for the interest of themselves and their children, and the health of the 
community. I believe that every health officer can secure the hearty co-opera- 
tion of every physician with whom he comes in contact. In the first place the 
physician, through education, gets to be a generous hearted animal, and is wil- 
ling to do anything he can to assist a brother physician in carrying out what 
the physician deems to be his duty. Now as to vital statistics, the birth statis- 
tics ; I promise you gentlemen that next year there will be a report of nearly 
all the births in my city; they will not fall short five. Our board is now pre- 
paring an ordinance for that work. We will send every physician in the city a 
blank book on which in a minute and a half he can place the birth, the name of the 
father and mother, the residence, and date of birth, and drop it in the post-office. 
The busiest man I can find is the best man I can get to do what I want done. 
A busy man is an energetic fellow, and is ready to work. A man who has no 
business is either idle from necessity, by reason of his indolence or a lack 
of qualification. An energetic doctor always has business, and is always willing 
to do everything he can. God bless the doctors. They are always willing to 
work. They don't get blessed in the right way. They get blessed enough in 
one way, that's true. The busy physician will always find time to make out his OHIO SANITARY BULLETIN. 
11 
report, and I want to say to you that the busiest physician in the city of Akron 
with whom I come in contact as health officer, is the first man to send in his 
report. 
Dr. Hoover, of Columbus - I want to ask our friend from Akron if that is 
not an exceptional town. [Laughter.] 
Dr. Bridinger, of Tiffin - I cannot exactly agree with what the doctor said 
in his paper. I think it is a little " off," defective in some things, in other 
matters it may be all right. I believe very much the same as does the gen- 
tleman who just sat down. I have been health officer of Tiffin for ten years, and 
I can say that I have had no difficulty in collecting reports of births and deaths. 
Neither do I find any difficulty there to have physicians report contagious dis- 
eases. We are working in unison, and it is true, as the gentleman said a 
moment ago, it is the energetic physician, the one who has the largest prac- 
tice, who is willing to work and who can be relied upon for first reports. I 
would not hesitate a moment to arrest a physician, although I am one myself, 
if he did not comply with our rules and regulations. A short time ago I had 
a physician arrested for failing to report a case of scarlet fever-physician and 
his son. The rest of the physicians, twenty-four in number, stood right by me 
and said I was right, because this physician and his son were negligent in re- 
porting. The only trouble is the collection of births, but for the last four 
years I have not had much trouble because I collected them once every month. 
I i ave been since the first of January collecting reports, and they are not all 
in yet. A good many feel that they should be compensated for it. My idea 
is, and I shall lay it before the next board meeting, to furnish the physicians 
with postal cards, and whenever they attend a birth instruct them to fill the 
card out and send it in. I am satisfied in that way we will get every one. 
Really I don't think I have missed five births in the five years. I have 
never had any difficulty in getting the physicians to co-operate with us in the 
matter. 
Dr. Young, of Chicago Junction-That is very much the same system we 
have adopted at our place. I furnished each one of the physicians a blank, 
together with a stamped envelope. Every month the report is sent to me. 
Physicians failing to report, I see personally, and it is required that the under- 
takers shall procure the doctor's death certificate before the burial of a person, 
consequently I have reports of every death. Those are filed away every 
month. 
Dr. Shaw, of Sidney-That is about the same kind of an arrangement that 
we have in our place. The health officer receives $100 per year for his work. 
I remember a few years ago that there was a case of contagious disease 
in the family of one of our citizens, and the physician neglected to report 
the case as was his duty, but our health officer notified him to appear before 12 
OHIO SANITARY BULLETIN. 
the board and show cause why he did not make the report, and since that time 
we have had no trouble at all, and our reports are made in due time. 
Dr. Hopkins, of Ashtabula - I have been much interested in the discussion. 
1 agree with Dr. Ebright in regard to the matter. The fact is this: We can 
all get, if we are trying and working on the right track, the reports without 
any trouble. I find that in our city a few of the births have not been reported, 
for the reason that we have quite a good many foreign population. Among 
those we have many midwives, from whom I get reports. Our physicians to a 
man have come down with their reports very well. I adopted this plan: I 
furnished them a postal card on which to make their reports to the health 
officer of births and deaths, and receive the reports in twenty-four hours. I 
also compel certificates to be furnished undertakers before they can bury the 
dead, and I get the deaths in that way also. I get reports very thoroughly, I 
think, from all our physicians. It is difficult for us at all times to obtain re- 
ports of births where there is not a recognized physician or midwife in attend- 
ance. It is supposed to be a State law, or an inflexible rule of the State Board 
of Health that our physicians shall report, that they must report, under the 
law. If Dr. Hoover thinks that there is no compulsion about that, and thinks 
they could not be compelled to make reports, what is the use of our State 
Board making such rules? We have made rules to correspond as far as possi- 
ble with the rules made by the State Board of Health. We endeavor to strictly 
live up to them. If a doctor in my place should refuse to make a report, I 
would have no hesitancy in promptly arresting him. I don't care whether he 
is a doctor or what he is; that is my duty. Now, if he should say to me, "Ar- 
rest and be hanged," I should feel a little chagrined. If we can't back that 
thing up, I want our State Board, Brother Hoover, to back out and say that 
that law is not law, 
Dr. Hoover, of Columbus - I think the gentlemen have been a little off on 
this paper. This paper does not refer to the report of births. It did not say 
anything about that. How many of the health officers get the accurate and 
full names of infants? In Columbus, even such an obscure town as this, we 
succeed in getting more or less accurate reports of births, but I know of two or 
three instances where I was a party to the transaction that the child has not 
been named yet, and I am not going to find out when it is. I don't think you 
can compel me to. Now, as far as the enforcement of the law is concerned, 
that is all right; and I am glad to find out-that so many of our brethren have 
got backbone. So far as the reporting of births is concerned, that is all right, 
but I will not go around and ascertain the name, or name the child. Now, 
gentlemen, speak to the point. 
Mr. Truex, of New Straitsville - At our place I get accurate reports, I 
think, of births. What bothers me is to get the names. I was assessor five OHIO SANITARY BULLETIN. 
13 
years, and I ran across a child five months old that was not named. I named 
it for them. I would like to find out how to get the names. So far as the 
births are concerned, I get them every month on blank certificates furnished 
for that purpose. 
A Member - As Dr. Hoover has said the paper refers to the obtaining of 
the full names of infants. The law of the State, if there is a State law upon 
the subject, requires all births reported within the first ten days of the month 
succeeding that in which the birth occurred. I believe that is the substance of 
the State law on that point. Very few children are named within ten days 
after they are born, and sometimes longer, in which case it is of course impos- 
sible to obtain the name. The important thing is to record the births and 
names of the parents. In my experience as health officer, there has been no 
trouble whatever to obtain reports of births, but the greatest difficulty I had was 
in obtaining reports from physicians. They are very negligent in regard to 
reports. 
Dr. Hedges, of Delaware - I have been much entertained with this discussion. 
I desire free discussion and free criticism of what I say. My own experience 
has been rather unfavorable in the way of collecting reports. In our town we 
have twenty-five physicians and four or five undertakers, and in some manner 
the reporting of vital statistics and statistics of contagious diseases and deaths 
has dropped out. But I became health officer and I have endeavored to have 
it re-established on a sound basis, and I hope yet to have it done; but up to the 
present time it has been a failure. Our undertakers have refused to ask for 
burial permits. Some of our physicians refuse to make reports; and I will dis- 
agree with some of the previous speakers that it is the busy physician who 
gives the best attention to reports. I find it the other way. One who has the 
largest practice in the town refuses to make the required reports. Of course, I 
can have him arrested, but it is not a pleasant thing to do. I have asked our 
board of health to support me in having these rules strictly enforced, and am 
sorry to say I have failed to get the support that I expected, but hope yet in 
the future to do so. As to obtaining full names of infants born, I do not see 
how we can do such a thing. I have no idea that any such a rule could be en- 
forced at all to be anything like satisfactory. 
The Chair - The next paper on the program, gentlemen, is a paper by Dr. 
Ebright, Health Officer of Akron. I will say, in explanation, that when this 
letter was transmitted to Dr. Ebright asking him to open this discussion, the 
word "school" was omitted, and he has prepared his paper on the ventilation 
of public buildings. 14 
OHIO SANITARY BULLETIN. 
TO WHAT EXTENT, IF ANY, IS A BOARD OF HEALTH AUTHORIZED TO 
REGULATE THE SANITARY CONDITION-LIGHT, HEAT 
AND VENTILATION -OF SCHOOL BUILDINGS? 
{Proposed by Board of Health of Sycamore.) 
Dr. L. S. Ebright, Health Officer, Akron, 0. 
Mr. Chairman and Gentlemen - I want to tender my sincere thanks to 
the President for the kind apology made to you for me. However, there is 
another thing he omitted to say in connection with this paper and myself-to 
apologize for selecting me to open this discussion. Why a doctor should have 
been asked to discuss questions of law I can't understand. I have studied law, 
but do not discuss it very much, and if you gentlemen want to disagree with 
me, I have no objection. However, I shall do the best I can and leave the 
matter with you people to rake me over the coals as we did Bro. Hedges. 
[Laughter.] 
The importance of any branch of sanitary science in connection with the 
powers of boards of health may be determined, first, by the dangers arising from 
unsanitary conditions; second, the number of persons who may be affected by 
such conditions; third, the expenditure necessary to a fair and impartial trans- 
action of the business involved, measured by either of these standards. The 
subject before us is of exceeding importance to the people of this great common- 
wealth, and especially to those residing in our most populous towns and cities. 
First, because it involves, as is indicated, the power of boards of health to 
regulate and improve the conditions of all public buildings, namely, places 
where the people generally are in the habit of congregating. Secondly, the 
health and comfort of not only those who frequent these places, but of all with 
whom they may come in contact. 
With the former we have most to do in this discussion. And, indeed, to dis- 
cuss the latter in all of its multifarious forms would require more time and 
space than would be alotted to us, since I take it that our worthy President 
does not intend a single individual to monopolize all the time of this meeting. 
It will be impossible, however, to discuss the subject intelligently without in- 
quiring, first, as to what the rights of the public are in a moral sense. It is 
presumable that our law makers, when framing a law, take the moral rights 
of the people into consideration, and endeavor to enact laws that will secure 
these rights, regardless of the few who may feel that they are being injured 
or imposed upon. 
What then should be the rights of the people morally ? First, they should 
have the right to say, through properly appointed officers, where public build- 
ings should be located in order to secure the best sanitary conditions. These, 
of course, consist of sewerage, ventilation, light, heat, cleanliness, modes of in- 
gress and egress; and there can be but little doubt that our legislature intended 
that such powers should be vested in the State and local boards of health. 
And, while it may be offered that the language of the sections which I shall 
take the liberty of quoting you presently is, perhaps, somewhat ambiguous, I 
believe it is an axiom in law that the legislative intent is to be considered in 
the construing of it, as well as the language itself. 
The genesis of all law, in so far as the rights of the people under this govern- 
ment are concerned, is to be found in the Declaration of Independence, our 
magna charta of civil and religious liberty, and it declares in language too plain 
to be misconstrued, that all men are entitled to certain inalienable rights-life, 
liberty, and the pursuit of happiness. OHIO SANITARY BULLETIN. 
15 
Now if life is one of our inalienable rights under the declaration, the framers 
of that document must have meant and intended that that life should be physio- 
logical, or as near that condition as it is possible for man to obtain, else they 
would not have added " the pursuit of happiness," since healthy life is one of the 
requisites of happiness. 
Assuming, therefore, that our interpretation of the language of the declara- 
tion is correct, we find that the rights of the people to protect themselves in a 
sanitary sense are clearly established, and that there can be no equivocation. 
Indeed, he who constructs a public building in such a manner that those who 
occupy it from time to time, or who live in close proximity to it, are forced to 
breathe an atmosphere so poisoned that they are in danger of malaria, typhoid 
fever or diphtheria, not only restricts, but in fact deprives them of that which 
is their inalienable right-life. This, it is needless for me to say to an intelli- 
gent body like this, may be easily done, if the sewers, drains and plumbing are 
so constructed that siphons are formed, that cesspools are made instead of 
properly constructed traps, so that gasses from the closets and sewers are carried 
into instead of out of the building. 
It is equally important that the ventilation of such buildings receive the at- 
tention of proper authorities. It is true, with the electric light science has 
been throwing upon the question of ventilation, that there is at least the shadow 
of a doubt as to whether air that has been breathed a number of times is dan- 
gerous to life and health or not, but since it is proven beyond a peradventure 
of a doubt that contagious diseases are from two to three times more numerous 
in tenement houses where bad ventilation and bad sewerage exist, and where 
the environments are generally bad, it is safe for us to assume that these are 
important factors in the production of disease and consequent deaths, and are, 
therefore, well worth our most careful study and investigation. 
No man in this presence, indeed, there is no intelligent or humane person 
anywhere but that will object most strenuously, and call in the aid of the law, 
if necessary, to prevent his neighbor from scattering in a reckless manner such 
deadly agents as strychnia, morphia, or other poisons, if his own or other 
people's children might come in contact with them. 
For nearly a century it has been accepted as a truism that vitiated air is dan- 
gerous to health, and that the proper ventilation of living rooms, bedrooms and 
public buildings of all kinds, is an important sanitary measure, and therefore 
calls for the highest architectural and engineering skill, and the most careful 
and comprehensive legislative enactments. 
With well grounded principles facing them on every hand, our legislators 
enacted the following statutes covering this subject, and with these we have to 
deal in this discussion. A careful examination of the several sections relating 
to the powers of State and local boards will, in our judgment, establish clearly 
the fact that their powers are almost without limit, and that they are untrue to 
themselves and recreant to their duties when they fail to examine carefully into 
the construction of public buildings, and insist that the sanitation 'of such 
structures be complete in the smallest detail. 
Section 2116 of an act entitled "An act to amend and supplement certain 
sections of the Revised Statutes, relating to the powers and duties of the State 
and local boards of health," provides that the board may compel the owners, 
agents, assignees, occupants or tenants of any lot, property, building or struct- 
ure, upon or in which any nuisance may be, to abate and remove the same. 
It further provides that said boards may regulate the location, construction, 
repair, use, emptying and cleaning of all water closets, privies, cesspools, sinks, 
plumbing, drains, yards, pens, stables or other places where offensive or danger- 
ous substances or liquids are, or may accumulate. 16 
OHIO SANITARY BULLETIN. 
You will observe that while the language of this section does not explicitly 
refer to public buildings, that it is so general in its description that they are 
necessarily included ; for it says from any lot, building or structure, a nuisance 
may be abated, and even indicates the parties liable for the maintenance of the 
same. It seems clear to our mind that if the boards of health have power to 
abate a nuisance once found, it is also within the jurisdiction of the board to 
prevent the formation of the same. 
This section further says that boards of health may regulate the location, con- 
struction, repair, use, emptying and cleaning of all water closets, privies, cess- 
pools, sinks, plumbing, drains, yards, pens, etc., etc. 
Now, while we do not claim that this section does grant absolute power, we 
feel assured that the intent of the law, and especially of other sections to which 
we will call your attention later on, is being so clearly indicated that their 
power is made absolute by the act of 1893. 
This section, you will observe, declares distinctly that the board of health 
may regulate-what? The location and construction of all plumbing - not 
meaning, therefore, simply the plumbing in private buildings, but since it has 
failed to indicate the character of the buildings, it necessarily means buildings 
of a public as well as of a private character. It seems superfluous to add that 
the plumbing here spoken of must mean that of buildings, for the reason that 
work of that character is not done in open fields or lots. 
Section 2122 says, " The board of health of any city, village or township may 
make such orders and regulations as it may deem necessary for its own govern- 
ment, for the public health, the prevention or restriction of disease," etc. We 
find here that any board of health may establish such orders and regulations as 
it may deem necessary for the prevention of disease. They have, therefore, 
the power to legislate in such a manner that the construction of a public build- 
ing must be of such a character that its strength and sanitary condition are 
not such as to endanger life, or be conducive to the spread of disease. 
Section 2128 declares that, "When any building, erection, excavation, prem- 
ises, business matter or thing, or the sewerage, drainage, plumbing or ventila- 
tion thereof, is, in the opinion of the board of health, in a condition dangerous 
to life or health, and when any building or structure is occupied or rented for 
living or business purposes, and sanitary plumbing and sewerage are feasible 
and necessary, but neglected or refused, the board of health may declare the 
same a public nuisance, and may order the same to be removed, abated, sus- 
pended, altered, or otherwise improved or purified, by the owner, agent or 
other person or persons having control of the same or being responsible for the 
condition ; and the refusal or neglect to obey such order shall be a misdemeanor, 
punishable as hereinafter provided." 
The board may also, by its officers and employes, remove, abate, suspend, 
alter or otherwise improve or purify the same, and certify the cost and expense 
thereof to the county auditor, to be assessed against the property, and thereby 
made a lien upon the same and collected as other taxes. 
This section is much more explicit, for it points out plainly the exact char- 
acter of the building or thing - saying plainly: "any building where the 
sewerage, drainage, plumbing or ventilation is in such a condition as to be 
dangerous to life or health." 
It seems evident to us that, in the very inception of this enactment, the leg- 
islative intent is clearly indicated, and that it is proposed that boards of health 
shall have and are given power to regulate and control the sanitation of all 
public buildings, the first section apparently clearing the way for what eventu- 
ally follows in the section just quoted. 
It may possibly be urged that no power is given to interfere in the construc- OHIO SANITARY BULLETIN. 
17 
tion of a building, but it seems self-evident that a body of intelligent men would 
not place a destructive power in the hands of a man or body of men, without 
at the same time meaning that that same body should have also the constructive. 
Indeed we find but a single word in the entire section, which, in our judgment, 
limits in even the smallest degree, the almost absolute power of these bodies, 
and that is the word feasible, the language being "where sanitary plumbing 
and sewerage are feasible and necessary," and even this is largely shorn of its 
strength further on, for this language is used, "may order the same to be re- 
moved, abated or suspended." Here the feasibility of drainage, sewerage and 
ventilation was not considered, but the question which seemed paramount to all 
others was: "Is the building or thing, by reason of faulty construction and 
location, dangerous to life and health, and therefore a public nuisance, if so, 
remove or abate it. 
Section 2 of the act establishing the State Board of Health declares " That 
the State Board of Health shall have supervision of all matters relating to the 
preservation of the life and health of the people of the State. 
In the entire domain of sanitary science are the people of the State no 
less interested than in this special branch-the proper construction and sani- 
tation of the public buildings of the State, and to the State Board of Health is 
given the power to delegate or transfer its powers to the local boards. W 
Regretting exceedingly that your worthy Secretary was not more fortunate 
in selecting some one more capable to open this discussion upon so important 
a subject, and especially where a point of law is involved I leave the subject 
in your hands. 
The Chair - The paper is now open for discussion. This is a very impor- 
tant subject, and one upon which I should like to hear considerable discussion. 
Dr. Davidson, Hilliards - Mr. Chairman, it occurs to my mind that it needs 
no discussion unless there is some lawyer present who is conversant with such 
matters. It might be proper to discuss the subject, but it seems to me that it 
has been discussed very thoroughly. 
Mr. Purinton, of East Liverpool-Mr. Chairman: Concerning this paper 
just read, I wish to state that our board at the present time is in controversy 
which relates to this subject. It is quite likely that a judicial decision will be 
arrived at regarding it. We have a hotel in our city and the sewer passes the 
rear part of it. The hotel is not connected with the sewer but has been using 
a cesspool. The board passed a resolution declaring sewerage to be both leas- 
able and necessary under that building, in as much as the cesspool has become 
filled up within four feet of the top - eighteen feet deep. The building is a 
frame structure of three stories and sides of brick, and the matter was declared 
a nuisance. There is also another point involved that I will call attention to. 
The point is here. The owner of the building resides outside of the State. 
The building is occupied by a tenant. Is that tenant, for failure to comply 
with our rules liable to punishment by a fine, and imprisonment if necessary, 
or are our hands tied so far as he is concerned? There will be a judicial de- 
cision in the matter, because the parties interested are going to contest it. We 18 
OHIO SANITARY BULLETIN. 
are perfectly clear that we can clean this out, and as a matter of fact we have 
cleaned it out and filled it up. But what about the plumbing? We cleaned 
it out and filled it up, and have taken proper steps to certify the amount to 
the county auditor, and have it placed on the'tax duplicate. Now comes the 
question of complying with the remainder of the notice, that they shall put in 
the plumbing. The landlord is out of the State, and the question is whether 
we can compel the tenant to put in sewer connections. We don't know that he 
is the agent. We want to make him do it if we can, and we are going to do 
it if we can. 
Dr. Hoover of Columbus - I believe I was accused of not having backbone. 
Now here is where I have backbone. If you want my opinion, worth what it 
may be, the proper thing is to put that in and make them pay for it. If you 
put in plumbing there you can make it just as expensive as you please, and 
the next fellow will not let you put it in for him. 
Mr. R. S. Galleher of Sycamore-Mr. Chairman, at the time the circular let- 
ter that was sent out by our worthy Secretary reached me, as health officer of 
Sycamore, we were in the midst of what I expected at that time to be impor- 
tant litigation, but since that time everything has blown over and at present 
is all quiet. We have one building there that has been complained of for 
some time. I speak particularly of the high school room. The building is 
not of the most modern construction. The room is about 28 by 30 feet, with a 
ceiling 13 or 14 feet high. The stove by which this room was heated was lo- 
cated in the center of the room. On either side of the stove within 23 inches 
I measured, the end of the seats stood within 23 inches of the stove. The 
stove is one of those large family stoves, somewhat higher than my head, and 
during the weather when it was necessary to have fires at all in the stove the 
heat became so disagreeable close to the stove that it was impossible for 
pupils to sit there. There were at that time 80 or 90 pupils in the room. The 
seats were somewhat similar to the ones we have in this room. Every seat in 
the room was occupied, and in addition to these chairs were put along the 
aisles. The ventilation of the room in the summer time was all right, from the 
the fact that on south and north there were large windows which could be 
raised from the bottom and also from the top, making the ventilation in the 
summer time very good. But in the winter time, in order to have any fresh 
air in the room at all it was necessary to either raise or lower the windows on 
the side,of the room either north or south. When that was done pupils sit- 
ting next to the window got cold, and they had to come up closer to the stove. 
In order to make the room comfortable back a distance from the stove it was 
necessary to have a pretty good fire, so that it kept the school in a continual 
commotion. Now, then, our School Board at Sycamore had been spoken to 
concerning this matter a number of times during last winter. When school OHIO SANITARY BULLETIN. 
19 
commenced this winter there was no change made except instead of the seats 
running as they formerly did, across this way (indicating), they ran across this 
way (indicating). Now, school commenced, and the school board decided that 
they could not afford to make any change in the ventilation of the school room. 
We had three rooms that were about in that condition. The superintendent of 
the schools came to my office and wanted to know of me what could be done in 
the mattei-. He said there seems to be a question of law connected with this, and 
if this ventilation can be improved I think it ought to be done. I want you, 
as health officer, to look after it. Well, there was no question in my mind, 
because I had considered the matter, and I met the school board at their next 
meeting and laid this proposition before them, and that was that one of two 
things would happen, and that very quick, that those school rooms should be 
properly kept and ventilated or the school stopped. That was about what I 
said to them. I did not make any further explanation, because I well knew 
that they had been talking about the matter and had been considering it, and 
the only reason they could give me was that they had not money enough to do 
it with. We all well know the fact that a great many of the diseases of chil- 
dren are contracted in the school room, and we should, therefore, have the 
school rooms properly ventilated and heated, especially this time of the year; 
and it should be the duty of the School Board, without any directions from 
anybody, to make a comfortable place for the children while they are there. 
They held another meeting the following week and decided that they would 
not do anything. They said they could not possibly do anything because they 
had no money to do anything with. They came to me and had a conference. 
They did not want any trouble about it. At this stage of the game I received 
the circular letter from the Secretary and the question popped into my 
head to submit it for discussion at this meeting. I began to get uneasy about 
it. I have a boy in school myself. He would come home feeling sick and 
said he could not study because he had to sit too close to the stove or window. 
Now, gentleman, there was no question but that they could get money. They 
certainly could have made arrangements to purchase a furnace, and the parties 
could wait until they had money. I wanted them to go ahead and fix it. 
They refused to do so at the time, and I expected litigation with regard to the 
matter. But they appointed a committee at the next meeting of the board. 
They investigated some school rooms there that were heated by the means of 
furnaces, and finally decided to purchase furnaces and put them in, and did 
so, and have them in perfect working order, and a nicer ventilated room you 
never saw. The teachers in the school room have each come to me and re- 
turned their thanks for the step I took in the matter of securing proper venti- 
lation and heating of these rooms. I was very much pleased with the paper 20 
OHIO SANITARY BULLETIN. 
read by Dr. Ebright, because I believe that all public buildings should be 
looked after by Boards of Health. 
The Chair - Are there any further remarks on this subject? 
A Member - I move, Mr. Chairman, that we adjourn until after dinner. 
(Motion seconded and carried). 
The Chair - The convention will take a recess until 2 o'clock P. M., and it 
is desired that we shall promptly meet at that tune. 
SECOND SESSION. 
Thursday, 2 p. m., January 24, 1895. 
Dr. Byron Stanton, President of the State Board of Health, in introduc- 
ing Governor McKinley, spoke as follows: 
Sanitary organizations have always been cordially welcomed to the capital of 
our State, and we felt assured that we would be welcome here, but our Gover- 
nor has done us the honor to come to our meeting to say to us in words that 
we are welcome and to extend to us a hospitable greeting. I have the honor 
and pleasure of presenting to you Governor McKinley. [Applause.] 
Governor McKinley spoke as follows : 
Mr. President, and Gentlemen of the Convention - I am glad to meet 
the State Board of Health and members of the local boards of health, and to 
congratulate them upon the good work they have already accomplished, and 
upon the efforts they are making to do still better things for the health of the 
people of the State. They have resting upon them - all of you have resting 
upon you - the most difficult as well as the most delicate of duties. There 
can be no graver responsibility resting upon a public board than that which re- 
lates to the life and health of the people, and there is no better way of promot- 
ing the real welfare of the State than by promoting the health of the people. 
[Applause.] Public safety is the supreme law everywhere, and public health 
is indispensible to public safety. It is a source of great gratification to me, as 
I am sure it is to the people of the State at large, that we have a State Board, 
and back of that the local organizations, so able and active and vigilant, so 
thoroughly and scientifically equipped for preserving, as far as possible, the 
public health. The annual reports of the Ohio State Board show what a great 
work they are doing, and the interest in these respects is increasing from year 
to year. The statistics furnished are of the utmost value and importance, fog 
they give to the health officer everywhere an experience to guide future action. OHIO SANITARY BULLETIN. 
21 
We cannot too strongly, gentlemen,-for I know something of the members - 
commend the State Board of Health. I have known of their work for now 
three years, have followed it with the closest interest and concern, and know 
they have accomplished much for the public good and for the welfare of the 
State. The whole State knows of the efficiency of the able Secretary of the 
State Board of Health. The board has met every exigency that has arisen, 
and have done much to prevent the introduction of contagious diseases in the 
State. Another thing the board have done : they have succeeded in dispelling 
a great amount of popular prejudice against the work of the State and local 
boards of health, and they have won the confidence of the people and of the 
representatives of the people, and in doing that they have accomplished one 
great essential in the successful performance of any public trust. If they could 
have the earnest and active co-operation of the local boards, municipal and 
other pubic officers in every section of the State, they would still accomplish 
better results for the people, and I am glad to learn that that co-operation is 
greater now than ever before, and is all the time growing. We are making 
great progress in sanitary education in this country, and the school of instruc- 
tion has only just begun. We have yet much to learn. The papers which 
have been written and presented by members of the State Board and scientific 
men everywhere, have done much to educate the masses in this most important 
field, and with this it is made easier for the State and local boards to advance 
in their reform. Frequent meetings by the State Board and National and local 
boards will have a tendency to promote progress in the line of sanitary instruc- 
tion. 
I am pleased, gentlemen, with this opportunity to be publicly associated with 
you in a work of such vast importance. I thank you for the good you have 
already accomplished, and to bespeak for you even more satisfactory results in 
the future. I shall cheerfully co-operate with you in your work and efforts in 
every possible and proper way to aid you in securing the best results from your 
important official trusts. I bid you welcome to the Capital of the State, and 
trust your sessions will be profitable, as I am sure they will be interesting and 
agreeable. [Applause.] 
Responding to the address of welcome by Governor McKinley, Dr. Stanton 
spoke as follows: 
Allow me to thank your Excellency, in the name of this body, for the hearty 
welcome you have just accorded us. I am sure I speak the sentiments of all 
when I say that our pleasure is greatly augmented and we feel much encouraged 
by your presence, and by the expressions of your favor that have been given. 
On behalf of this meeting I gratefully thank you for this cordial greeting, and 
on behalf of the State Board of Health I especially thank you for your words 
of commendation of the work it has accomplished. We look forward to a useful 22 
OHIO SANITARY BULLETIN. 
ami important meeting. We feel that it is good for us to be here. We have 
come for a common purpose - an interchange of thoughts and opinions, and 
for a fair and impartial consideration of such subjects and measures as will 
tend to lengthen life, prevent disease or mitigate suffering. This is the fifth 
annual meeting of this sort, and their growing popularity has added greatly to 
our numbers from year to year. Good as have been the papersand discussions 
of preceding meetings, we indulge the hope that those of this year may be still 
better; that this organization may extend its usefulness by the thorough discus- 
sion of the practical questions that are set forth in the admirable program ar- 
ranged by our worthy Secretaay. I sincerely hope that this may be an occasion 
of great interest and profit. 
As this is not a medical meeting, it may not be proper for us to consider here 
the immediate causes of the preventable diseases from a medical or bacteriolog- 
ical point of view, but there are remote or predisposing causes of great import- 
ance which, as they belong to preventive medicine, we may consider. Pre- 
ventive medicine may be said to be of recent creation. The men who have 
given it its scientific character are men of the present age. Its domain is 
enlarging, and this has much to do with the fact that, within the last quarter of 
a century, in nearly all civilized countries the death rate has been lowered, the 
duration of life materially increased, and living freed from many of its pains 
and terrors, and it is believed that the time will come when many of the diseases 
now termed "preventable" will be extirpated. While some of the lowering of 
the death rate may be due to improvements in medicine and surgery, much of 
it is due to public sanitation, and this beneficent work is the chief glory of 
modern medicine. 
The importance to the State, especially to villages and rural districts, of the 
law for the compulsory establishment of legally constituted local health author- 
ities as a means of protecting life and health, is becoming more and more appar- 
ent. But little opposition to the law is now manifested. The law was in 
advance of public demand, but the criminal indifference and ignorance, which 
were formerly the worst enemies of sanitary science, have given place to a better 
state of affairs. The general public has been educated to the real value of this 
sanitary legislation. A few boards have been ignorant of their prerogatives 
and declined to act, but the health laws have been pretty generally enforced, 
and it is hoped and believed that with increased experience, a greater uniform- 
ity of sanitary organization and a fuller registration of vital statistics through- 
out the State, interest will be added to the work and greater value given to our 
reports. The thorough organization of the sanitary authorities and health 
officers under the present law has resulted in much good, and not only are the 
laity being educated to the importance of sanitation, but in the medical profes- 
sion the great problems involved in the prevention of disease are being more OHIO SANITARY BULLETIN. 
23 
studied, and our medical colleges are better educating their students in hygiene. 
The present era of medicine is preeminently distinguished as aiming rather to 
prevent than treat disease. 
The State Board of Health has been industriously at work in the line of its 
duties. It has sought to awaken public attention to the danger of neglecting 
that clealiness which is akin to godliness; it has collected, classified and dis- 
tributed information looking to the conservation of public health, and has ever 
encouraged and co-operated with local boards in this interest; it has published 
and freely distributed among local boards and the people, circulars on the pre- 
vention of consumption, diphtheria, scarlet fever, typhoid fever and smallpox ; 
it has collected and published the vital statistics from the different parts of the 
State; it has investigated local outbreaks of disease; the members of the board 
and its Secretary have visited many places in the State to make investigations 
in regard to special causes of sickness, and to inspect new systems of water 
works or sewers; it has by committees, inspected several of the public buildings 
in regard to which complaints as to their sanitary condition have been received 
and called -attention to their defects and advised as to how they might be 
remedied. Wherever outbreaks of the more dangerous infectious diseases have 
occurred, our.Secretary or some member of the board has gone to render the 
local authorities such assistance as was in his power to prevent the spread, and 
it is a matter of congratulation that the greater diffusion of knowledge in regard 
to the prevention of these diseases through the State, and especially those 
clothed with power in such matters, has rendered such visits less frequently 
necessary than in former years. Of some of these outbreaks special reports will 
be made during our meeting. The board has endeavored, as far as has been in 
its power, to disseminate knowledge among the people upon matters relating to 
public, municipal and domiciliary hygiene through the Monthly Sanitary Record, 
the publication of which was kept up so long as the financial affairs of the board 
would permit, but the reduction of our appropriation by the legislature, from 
ill-judged motives of economy, compelled us to give up this important work, 
which we would be glad to resume if we were able so to do. 
Statistics could be adduced to show that the kind of sanitary work done 
by the health organizations throughout the State yields a rich reward for the 
dollars and cents expended, but even if my time were not too limited to permit me 
to give such statistics, it would not be necessary here, for you are as well aware 
as I am of the fact that sanitary work is accomplishing its object in a way that 
yields a good profit in the preservation of life and health. 
If, in carrying out the programme arranged for this meeting, we are able to 
disseminate useful knowledge, if we are able to bring out thoughts and sugges- 
tions of a practical nature, which we may work out after going to our homes, 
our meeting will have yielded good fruit. 24 
OHIO SANITARY BULLETIN. 
On behalf of this body I again thank your excellency for the warmth of your 
welcome, a welcome which we hope not to abuse. We will not take the atmos- 
pheric temperature of this January day as an indication of the warmth in your 
heart. [Applause.] 
The Chair - Gentlemen, the next subject for discussion is one proposed by 
the Board of Health of Bucyrus, namely, "The best means for the prevention 
of tuberculosis in man and animals," the discussion to be opened by Dr. I). N. 
Kinsman, Health Officer of Columbus. 
Dr. Kinsman - Mr. President and Gentleman of the Public Health Asso- 
ciation of Ohio: Consumption, two hundred years ago, was believed to be 
contagious, and the first book written on consumption in the English language 
held that view. Morgagni said while young he feared the bodies of those 
dead from consumption, and when old he avoided them. There was no ques- 
tion as to the contagiousness of consumption until about the time that Sir 
Thomas Watson gave his lectures on the practice of medicine. The inocubil- 
ity of consumption or of tubercles was demonstrated in 1865 by Villemin. In 
1882 Koch discovered the bacillus known bv his name. This he isolated, cul- 
tivated, and inoculated, and thus proved this bacillus, and this alone, was the 
cause of consumption. Before there were many factors supposed to enter into 
its cause, as poor food, bad air; in other words, physiological poverty or mis- 
ery in the world, and without which consumption would be a thing of the 
past. These we know may prepare a soil on which the bacillus may grow, 
but without which bacillus consumption never exists. All warm-blooded ani- 
mals are subject to tuberculosis. Some resist it better than others. Some, 
like the Gerbille, are able to resist it completely. Men have various degrees 
of resistance ; some yield easily and some resist very strongly. Tuberculosis 
may be communicated by the process of respiration, digestion or by inocula- 
tion. This tuberculous material is produced in the lungs. It is spat out upon 
the ground, or upon the floors, or upon the walls of buildings. It becomes 
pulverized, and it is carried by the air. It is inhaled. It effects a lodgment 
in the lungs, and there it grows. This expectoration thrown out upon the 
ground has been known to be dried and wet, alternately for six weeks at a 
time, and yet the same material mingled with the dust of the street has been 
inoculated and proven fruitful at the end of this time. All our flesh-pro- 
ducing animals are subject to tuberculosis. The sheep is the most resist- 
ant of all, but it has been inoculated. Cattle feeding in the same manger where 
cattle have previously had tuberculosis and died, have become infected 
by inhalation of this tuberculous matter that was left by the former occupant 
of the manger adhering thereto. Animals, kittens fed upon the milk of 
tuberculous cows have become tuberculized. Dogs who have licked the 
sputum of their tuberculous masters have become tuberculized and died OHIO SANITARY BULLETIN. 
25 
Calves fed upon tuberculous matter from men and other animals have become 
infected. Fowls also have become infected by devouring tuberculous infected 
food. Having ascertained that the tubercle bacillus is the cause of consump- 
tion, that it is reproduced in persons who are affected with it, that the bacillus 
is spat out of the lungs of those persons who are infected, and that every per- 
son who is affected with tubercles is the focus for further infection, it is evi- 
dent that hygienic measures will have much to do with the spread of this 
dsiease. How important this subject is may be recognized by the tact that 
one-seventh to one-fifth of the entire mortality of any community is due 
to tuberculous diseases. How shall we prevent this? Every patient should be 
quarantined, not isolated; and they should be instructed to carry with them a 
receptacle that contains a disinfectant, into which all of their expectoration, 
charged with bacilli as it is, can be thrown. They should be instructed that 
they should not soil cloths with their sputum without burning them, or spit 
upon the floors of the rooms in which they reside. There should be a system- 
atic inspection of all flesh that is used for food in order to prevent contamina- 
tion by way of the digestive organs. That the spread of tuberculosis in the 
human race depends to no small extent upon infection by the milk of cows 
may be readily inferred when we recall the statement of Fleming that the ma- 
jority of cows above seven years of age are tuberculized. There ought to be 
specific legislation looking to the inspection of all our meat-producing animals. 
The Chair - .Gentlemen, we have now one of the most important subjects 
for discussion that will come before us. I think it would be profitable for us 
to thoroughly discuss it. 
Dr. H. L. True, of McConnelsville - I fully concur in Dr. Kinsman's 
remarks. I think I have observed cases of infection that might have been 
prevented had the people been informed. I wish to relate one that occurred 
in our town. A young lady came back from the West and stopped at her 
sister's in McConnelsville. There was no consumption in the family that they 
knew of before that, and she must have brought the infection with her. She 
lingered for some time and died. Her sister did not use the feather bed she 
lay on after that, but she put it away for another sister that was going to 
school at that time some place in Tennessee. After awhile that one came 
home, and got married, and her sister gave her the feather bed that the other 
one died on. She took that, and she slept on it one winter, and next spring 
she took the disease and died with it. I was called to see her, and called 
attention to that, and, as I mentioned it, the sister was satisfied that that was 
the way she got the disease. Now, in Dr. Whittaker's practice, he stated that 
in Berlin attention was called to feather beds as a source of tuberculosis. 
They took the feathers out of a bed that a patient had died on, and sent them 
to the renovator and had them renovated by five different renovators in the 26 
OHIO SANITARY BULLETIN. 
usual way, and even after the feathers had been renovated they gave consump- 
tion to nearly every one who slept on them. Now, it seems to me, gentlemen, 
that the days of feather beds have about gone by, and I would like to have 
the State Board of Health say a word upon the subject. 
Dr. Young, of Chicago Junction -About sixteen months ago I had in my 
care a young boy twenty years of age, who came home from school and was in 
very poor health. On examination it proved to be tuberculosis. Death ensued 
in a few months. There is no history of tuberculosis in the family on the 
father's or mother's side. To-day the father is dying with tuberculosis con- 
tracted from that case. The time he came in my care they were in the habit 
of spreading newspapers on the floor and allowing the young man to expectorate 
on the newspaper; of course when he came under my care that was changed. 
I had them procure spittoons and use them. They were thoroughly disinfected, 
the expectoration being thoroughly cooked, but it was too late. The father is 
slowly dying of tuberculosis. The sisters broke down and were sent away. 
Whether the mother will escape it or not is a question. I am satisfied that it 
is contagious, consequently 1 have taken all precaution possible in the care 
of those afflicted with tuberculosis, and I am very anxious to have, this matter 
discussed at great length, because I am deeply interested. 
Mr. Hartzell, of Canton-I have never heard the subject more ably pre- 
sented, it appears to me, than was done by Dr. Kinsman. I only regret that 
he did not go a step further and give us the results of the attempt that is being 
made by law to suppress tuberculosis among the cattle in the States of New 
York and Massachusetts. My impressions of this subject are derived mainly 
from reading agricultural papers. Of course there are many agricultural 
papers which lack information, and there are certain agricultural and other 
papers that are conducted upon a very high plane of intelligence, such as the 
American Agriculturalist, and the continuous reading of these newspapers has 
impressed me with the fact that in undertaking the prevention of tuberculosis 
among cattle, we should adhere to the old Roman maxim - go slow. When 
the law was passed in 1893 in New York, the people entered upon this sub- 
ject with great zeal and enthusiasm, and committees were appointed to make 
investigations. It is apparent from some of the reports that where there has 
been great destruction of cattle, there has been no cases of consumption at all. 
I am as much in favor of the law as Dr. Kinsman could be, and I hope that in 
cases where it is necessary to kill cattle on account of tuberculosis, the farmers, 
when settlement is made, will be allowed & fair price in cash for their stock in- 
stead of half price, as indicated in those states; thus obviating one of the great 
objections that would be in the way of those undertaking this great reform. 
Prof. Nelson, of Delaware -We have left our homes and come to this place 
to listen to these papers. The question comes to my mind, what good are we OHIO SANITARY BULLETIN. 
27 
to take to our several homes from these papers. Dr. Kinsman has very ably 
discussed the cause of tuberculosis. I suppose we will all agree that there is 
such a disease. We don't need any further light in that particular. He has 
shown us that the disease is due to the bacilli. I think we are all agreed there now. 
He has told us that the disease is communicated by the means of expectora- 
tion. We have agreed there, but how about the people in the several towns 
where we live - is it generally known - is it believed by the people of these 
towns, by the school children, by the boys and men on the street, that the dis- 
ease is communicated by the disgusting habit of Spitting? We are a nation of 
the greatest spitters in the world. You may walk up and down the streets of 
Paris for hours without seeing a man, certainly not a woman, expectorating on 
the street. You cannot go through an American town, at least any that I have 
been in, without seeing it practiced every five minutes. Now, gentlemen, I 
don't believe that we have been educated yet up to the point where we can 
check tuberculosis. It is all right to talk about working with the cattle. Let 
us begin there if we cannot begin anywhere else, for we must be doing some- 
thing. I think it is greatly a matter of education. I think the matter should 
be brought up in every public school. I think that, as health officers, we should 
see to it that the teachers of the public schools where we live should talk upon 
this subject, that the children may be enlightened and instructed as to where 
the danger lies in this direction. It seems to me there are two or three other 
things that we should 'emphasize at the same time. I think we ought to em- 
phasize one thing that Dr. Kinsman says, that consumption is not hereditary. 
I find this, that statistics show in cases of consumption that nine pei 
cent, of such cases are rated in families where there is no trace of the disease. 
You may explain that nine per cent: by the fact that the sputa has been dis- 
charged around the house carelessly, and children and grown people have come 
in contact with it in such a way as to produce consumption. I think another 
thing right along there should be done, and that is our people should be con- 
vinced and taught that consumption can be cured, certainly if taken early 
enough. In hospital experience we find a good many subjects where there has 
been tuberculosis and the tubercules have been destroyed where the disease has 
found lodgement, and the disease has been checked. And we all know of cases 
of people afflicted with tuberculosis who have gone west to Mexico and Cali- 
fornia, and have lived good sound lives after that. I am inclined to think we 
ought to have a health investigation of our families that are tuberculized. It 
seems to me that the time ought to arrive when the family physician, if not the 
health board, should take it upon himself to visit families and say, here is a 
child and from its constitution it is liable to this disease, and should be sepa- 
rated from the other children. You ought to put special limits on such cases. 28 
OHIO SANITARY BULLETIN. 
Now put on your precautionary measures in regard to school life, in regard to 
habits of flress, and in regard to diet. I have been delighted to read that one 
of our health officers in the United States, a physician in St. Louis, claims to 
have found a perfect cure. I am somewhat acquainted with the St. Louis doc- 
tor, and he claims that he has discovered an anti-toxine that for consumption is 
as perfect as the anti-toxine for diphtheria. He has been working upon it for 
years. The same thing has been prepared in Paris and in Berlin. Of course 
it is too early to judge of this new remedy, but let us hope that success may 
come; there are two sides to this problem always. There is the individual 
side and the diseased side, and I think the individual side is more important. 
I want to build a house as nearly fire proof as possible within the limits of the 
means I have at my disposal. I want to give that house as good a chance as 
possible. At the same time I want the town where I live to have a good fire 
department. I want to build up just as good a constitution as I can for my- 
self and all my friends, so that they will be prepared to withstand the disease. 
In addition to that, I want to stop the disease somewhere, so it will not come 
to my home or town. Two things are indispensable; we must begin at home, 
and we must begin with children. It must be a constant course of education. 
At the same time the doctors and health officers must do all they can to ward 
off the disease, to learn how to control it after its comes, and to learn how to 
cure it. I believe, then, that two lines of work are open to each one of us 
as we prosecute these labors in the various towns where we live. 
Dr. Kinsman, have you faith in tuberculin as a diagnostic? 
Dr. Kinsman - I have. 
Prof. Nelson - Could not we introduce that into the practice in this State and 
thus ascertain to what extent our herds of cattle are afflicled? 
Dr. Kinsman - I believe it can be done. We are using that in cases of inoc- 
ulation to decide cases of glanders. 
The Chair - The next subject for discussion is one proposed by the Board 
of Health of Weston, "Is the Dry Closet System to be Recommended for 
School Buildings?'' the discussion to be opened by Dr. William T. Miller, 
member State Board of Health, Cleveland. 
[Dr. Nliller here discussed, without notes, the " dry closet " and other systems 
of disposing of excreta. The stenographer failed to report his remarks, and it 
has been necessary to omit this part of the discussion.-Editor.] 
Dr. Clark, of Ashtabula - I have had the honor of being a member 
of the school board of our city since 1884, and within that time we have built 
three buildings and introduced the dry closet system, and I must say that it 
has given entire satisfaction. I am not speaking on the subject in a scientific 
way, but none of our teachers or pupils have ever complained of any smell about 
those buildings. We are entirely satisfied with that system. OHIO SANITARY BULLETIN. 
29 
A Member - Dr. Miller neglected to tell you concerning the air that is car- 
ried over the fecal matter for the purpose of discarding it through the venti- 
lating flues. Some times this foul air in being discarded comes down the flue 
into the school room. I know of a school where this system is used where this 
was the case. In two or three instances I have known of persons in school who 
were made sick by this foul air. The Hues do not always carry the air upward. 
In some cases it is almost impossible to prevent this, and I think it is sufficient 
to condemn any system of dry closets. 
Mr. Schachleiter, of Ironton - That is exactly the case with the Kingsbury 
building at Ironton. There are about 800 scholars there, and more or less 
of them are affected by this foul air in the building, and we are awaiting the 
result of this investigation to-day to see whether we can find out by the origi- 
nator, or through some genius who is here, to tell us what to do with this system. 
Dr. Miller, of Massillon - This whole matter resolves itself into the 
question whether a practically reliable draft can be maintained in a chim- 
ney or stack, the chimney or stack being constructed on the best principles and 
in the best manner known at the present time. The warming of houses, the 
running of machinery by steam, all systems of natural ventilation (whether 
connected with the air closet or not) are based on the affirmative answer which 
is given to this question by science as well as by experience. If facts justified 
a negative, the wheels of imperial industry would stop; in fact would never 
have started. If reliable ventilation can be obtained by means of a draft in a 
warm chimney, the air moving toward the stack will not be turned back by the 
necessity of passing over excreta. The air closet (or dry closet) is one of the 
methods by which we may hope to be able to safely dispose of human excreta. 
The safety of sewer connections and plumbing arrangements in our houses de- 
pends on the proper application of recognized scientific principles and the hon- 
esty and capability of the mechanic and the one who plans his work. Is the 
water carriage disposal of excreta to be indiscriminately condemned because a 
large percentage of the plumbing nowr in the houses is faulty in principle or 
botched in the construction ? The safe and inoffensive disposal of excreta by 
burning within the building depends on a correct application of the same prin- 
ciple, to-wit: that warm air is lighter than cold air. If this were not true, I sup- 
pose the earth would be uninhabitable. The same principle is invoked in suc- 
cessful and safe plumbing. 
School children are probably the healthiest class in any community, and are 
not, probably, to an alarming extent, entertaining and throwing off disease 
germs. If they are each a laboratory for the manufacture of germs, however, 
are not these germs as likely to be cast off from unclean bodies, covered and 
lined with extensive excretory surfaces, in the school rooms as in the closets? 
The percentage of absent sick in buildings using the air closets and those using 30 
OHIO SANITARY BULLETIN. 
other systems would be interesting data for comparison, other conditions being 
as near equal as possible. I have observed this to a limited extent, (personal 
observations are necessarily quite limited), and the comparison was not to the 
hurt of the air closet system. So far as known at present, I think, none of the 
three systems of disposal of excreta by earth, air, or water, can claim to be 
practicably applicable in all cases. It becomes sanitarians to recommend such 
methods of disposal of excreta as shall be most feasible and effective and least 
offensive and hurtful under specific circumstances; when all this is done, the 
great question of the disposal of the waste products of civilization, without hurt 
or danger to health or life, will remain to confront the sanitarian so long as 
civilization and its admirable product, the sanitarian, shall continue to exist. 
In the meantime impprtant business interests ought not to be imperiled by 
unripe statements made here in the supposed interests of sanitation. 
A Member- We came here to get definite knowledge on these subjects, and 
if our State Secretary has some definite knowledge I think the convention 
would like to hear him. 
Dr. Probst - I can only give you definite information in regard to buildings 
I have inspected where the dry closet system is in use. There are, undoubt- 
edly, times when this system does not work properly. I was called to Carey 
a few months ago on account of an outbreak of diphtheria that had occurred in 
one of their school rooms. When I talked to the members of the school board 
about investigating the ventilation of the building they thought it would be 
entirely unnecessary because they had had the dry closet system in use for the past 
eight years, and it has given entire satisfaction. They had had numerous 
committees to examine the school building in regard to heat and ventilation, 
and they had always reported favorably regarding the operation of the system. 
It happened, however, to be an exceedingly windy day when 1 was there. We 
went through the building - the board of education, and health officer, and 
myself-testing the outlet and inlet registers in every room. 
In all of the rooms, in one-half of the building, those on the leeward side, we 
found currents of air coming into the room through the foul air registers. At 
the same time currents of air were passing out of the room through the fresh 
air registers. The direction of air currents was shown by using long strips of 
tissue paper. It was interesting to see those strips blown into the room or 
pulled tightly against the registers when there were changes in the direction 
of the currents of air. 
1 have found these back currents of foul air in other school buildings where 
the dry closet system is in use. I have no knowledge of such conditions hav- 
ing been the cause of disease, but, on theoretical grounds, there is a possibility 
that this may occur. Typhoid fever has been caused by the escape of sewer 
air into dwelling houses. In this case we must suppose that typhoid fever OHIO SANITARY BULLETIN. 
31 
stools have been thrown into the sewer, and that the typhoid germs, having 
been liberated by drying of the stools, were carried by air currents into the 
house. If this be possible - and there is good authority for it - it is also pos- 
sible for germs of disease to be carried into school rooms by currents of air 
passing through the dry closets in the wrong direction. 
Dr. Hopkins, of Ashtabula - I would like to ask Dr. Probst, then, why we 
use water closets if we get typhoid fever into our homes ? I don't see but 
we may find fault and pick flaws with almost any system for the disposal 
of night soil. In my own city we have three of those systems in working 
order If I thought they were a detriment to our people and children I should 
think we ought to get something better. The fact that we may get some smell 
from them is true. That I concede; but we also can get that from our sewers. 
From all kinds of water closets we get smells, and we can condemn them on 
that ground if it is detrimental to health. If we can say to our people, or to 
the inventor of the system, that we get the air contaminated a great deal more 
and a great deal oftener than we would in any other way, I think we should 
condemn it. If not, I don't believe in a wholesafe condemnation of a thing 
that in the main works well. We feel as though we have been doing the best 
we could for our school children. 
Dr. Hoover - I have about come to the conclusion that water closets should 
not be an integral part of a house, whether it be a public or private building, 
unless it is constructed in such a way that there can be no possible opportunity 
for unpleasant smells to arise which would find their way in the living part of 
the house, or part that is occupied. I believe that will be the solution of this 
question eventually. We have had different systems here in Columbus for 
heating the public buildings, and in a majority of instances they are satisfac- 
tory, but in a few instances they have failed. Now, whether it is the differ- 
ence in construction, or whether they should all be alike, or what the difficulty 
is, it is hard to solve. In our Central High school here one of the sys- 
tems is a failure, I am satisfied, because of ignorance in its management. And 
in one or two of the new buildings that we have constructed the systems have 
proven satisfactory, have had no trouble and no fault to find with their opera- 
tion. I think, myself, the proper thing to do is to separate the closets from 
the building in such a way that it is utterly impossible that there should be 
anything obnoxious or dangerous to the building. 
Dr. Miller, of Cleveland - I will say that fecal matter should be sterilized. 
You can do that by hot water or fire, but you can never do it by air at a tem- 
perature of sixty-five degrees. I don't care whether it goes out in the stack or 
back in the room. It contains the germs of disease. 32 
OHIO SANITARY BULLETIN. 
THIRD SESSION. 
Thursday, 7:30 p. m., January 24, 1895. 
The Chair - Gentlemen, the first ti ing on the programme is a paper on 
the subject, "The Disposal of Night Soil and Garbage at Warren," by Mr. 
William T. Fee, Mayor and President of the Board of Health of Warren, O.: 
THE DISPOSAL OF NIGHT SOIL AND GARBAGE AT WARREN. 
By Mr. William T. Fee, Mayor and President of the Board of Health of Warren, O. 
Mr. President, Members of the State Board of Health and Gen- 
tlemen- Your worthy secretary has invited me to explain what disposition 
our city of Warren makes of her "night soil." 
This has become a very serious problem, especially in cities of about or un- 
der ten thousand inhabitants. By hauling it to the " dump grounds " it soon 
accumulates and becomes a nuisance. Its disposition by chemicals or incinera- 
tion in a crematory is, by reason of its expense, impracticable for the munici- 
pal economy of a community of our size. And, besides, it would then thereby 
be reduced to a worthless waste and lost as a fertilizer. 
Being somewhat interested in this sanitary question, and we having given 
the subject some consideration, permit me to give, somewhat in detail, our 
"modus operandi," that a more intelligent understanding may be had of our 
solution of this problem. 
Our board of health has prohibited the construction of any water closet with- 
out a permit from the board, and that they shall conform to one of three 
kinds, namely : First, those connected with the public sewer; second, water 
tight vaults built of stone or brick and cement, with an extension back, cov- 
ered with a flag stone, so as. to permit of emptying without disturbing the 
building or injuring the walls; third, water-tight drawers or receptacles in 
which daily use of dry earth, ashes, or air-slacked lime is required. The last 
two kinds of closets require frequent cleaning -the drawer system more often 
than the vaults. 
We have a night soil contractor, employed by the year, to empty all vaults 
at a cost of nine cents per cubic foot, and ordinary sized drawers for one dol- 
lar each. This work is done mostly in the night time or very early morning. 
The owner of a closet desiring the same cleaned, applies to the sanitary office, 
where, in a book for that purpose, is kept a record of the drawers and dimen- 
sions of all vaults in the city. The sanitary policeman gives the owner a check 
or slip from a stub-book of blanks, whereon is stated the name, street and num- 
ber, the amount in vault or drawer, as the case may be, and the amount of money 
to be paid. The holder takes this check or slip to the bank, pays the amount 
required, the bank stamps the slip "paid," and drops it in a board of health 
metallic safety-box, with Yale lock-similar to government letter-box, only 
smaller - fastened in the bank or some convenient place. The contractor, who 
has a key to this box, goes to it and gets the slip. This slip indicates to him 
his order for work, and place where, and also the important fact that the cost 
of said work is deposited in the bank. At the end of each- month the Presi- 
dent of the Board of Health gives the contractor, in exchange for the month's OHIO SANITARY BULLETIN. 
33 
slips, a check on said bank for the amount. The contractor has a large plat- 
form wagon, furnished by the board, upon which he carries the night-soil, in 
well made, strong, oak barrels, with water-tight covers, fitted in rubber gaskets. 
We have a dump-ground owned by the city, and under the control of the 
board, situated on the low lands that drain from and just outside of the city 
limits, containing about fifteen acres of land, to which the night-soil is taken 
by the contractor. At the dump-ground our board had constructed two rec- 
tangular reservoirs or pits of earth. These reservoirs are 20x40 feet in dimen- 
sions, and made parallel to each other, with space enough between for a passage- 
way. They are about three and one-half feet deep, side and end walls slant- 
ing, and made of the earth from the pits. Drain-tile are placed below the sur- 
face of the bottom, at a sufficient grade to carry off the surplus urine and water. 
A narrow, long platform is built from the end of the pit, extending over the 
wall and down the center, for the purpose of aiding the unloading and dump- 
ing of the contents of the barrels from the wagon. Over each pit or reservoir 
is erected a board roof shed, gable ends, with sides boarded down far enough 
to give strength to the structure and prevent rain and snow from blowing iny 
and yet leaving open space sufficient to permit easy access to the pits and the 
passage of an abundance of air. These structures have been made of cheap, 
rough material, and been given a heavy coat of iron paint and oil. The total 
costs of the two structures, together with the pits, is about $250. The con- 
tractors are required to use air-slacked lime, or better, dry, pulverized earth, 
or both, on the night soil as soon as dumped. This serves the purpose of tak- 
ing up the moisture, holding the gases and ammonia, and decomposing the 
night soil. By the time the second pit is nearly filled, the first pit, if properly 
drained of surplus water, and lime and loam has been liberally used, is com- 
posted, and becomes a valuable fertilizer. This compost sells readily in the 
pits to farmers and gardeners at twenty-five cents per cubic yard. When the 
utility of this product becomes better known we expect to obtain better prices, 
as one of our farmer friends, who was first to use it, now wishes to contract for 
the entire product of the future. Those who have used it commend it for its 
lasting quality and great strength as a fertilizer. To obtain best results from 
its use it should be thinly spread over land and thoroughly mixed with the 
soil. Pulverized dry earth will completely decompose fecal matter, and without 
offense. This property of mother earth, by which dead organic matter is a 
converted into inorganic matter has long been known. Research has shown 
that it is due to the germ life or the myriads of microbes which live in the soil 
and feed upon such matter. This germ life abounds almost exclusively in the 
upper layers of the soil. For this reason when a large amount of fecal matter 
is placed in a deep hole in the ground it is then below the level of germ 
action, where much of it remains a constant source of danger. 
In our dry earth closets ashes are often used; but they do contain the germ 
life which produces decomposition of organic matter, their action being simply 
mechanical - absorbing the moisture - not vital, as is the case with rich, loamy 
soil. Fecal matter deposited in the upper layers of the soil, or thoroughly mixed 
with it, is quickly decomposed and converted into food for plant life. 
If the night soil is composted in the pits, and when removed well mixed with 
the soil and used on lands that drain from source of water supply, it seems 
there is little if any danger in point of health, or at least not more than would 
be from the use of many of the commercial fertilizers now on the market. 
In this simple, systematic and inexpensive way we defecate our city, mate- 
rially reduced our death rate, and making typhoid fever almost unknown in 
our midst, save and return to the soil a valuable fertilizer, receiving from 34 
OHIO SANITARY BULLETIN. 
which a considerable money return for what would otherwise be considered a 
waste and a nuisance. 
We do not claim perfection for our system, but believe we have taken a 
long stride in advance of the poisonous pit of fecal putrefaction that is a dan- 
gerous source of contamination and constant menace to the health of any com- 
munity. 
The ('hair - Gentlemen, this brings before us for discussion, the subject of 
disposal of night soil .and garbage. We will be glad to hear from you upon 
the subject. 
Dr. Probst - I simply want to thank Mr. Fee for presenting this paper on 
the disposal of night soil and garbage, and I can endorse it for even more than 
is claimed for it. The town is in perfect sanitary condition. They take care 
of their night soil in a way that any town of that size might do, and I think 
that we have had a most profitable paper read to us on that subject. 
fhe Chair - Gentlemen, inasmuch as the next subject is similar in character 
to the one just discussed, how would it do to go on with the next subject? If 
you deem it advisable, I will call on Mr. W. B. Gerrish, city engineer of Ober- 
lin, Ohio : 
A Member - Mr. President, I move that that be done. I think it will 
save time and be profitable also, as the subjects are closely related to one an- 
other. [Motion seconded and carried.] 
SEWAGE PURIFICATION AT OBERLIN. 
W. B. Gerrish. City Engineer, Oberlin. 
Mr. President and Gentlemen: After the water-works were built in 
Oberlin, in 1887, the people were constantly reminded that a sewerage system 
was a necessity. The question would arise : What shall we do with our sew- 
age ? There was no stream of water near the town. The only possible outlet 
was Plum creek, a stream which was dry during the summer months. If the 
sewage were turned into this stream it would become an elongated cesspool; a 
menace to the health of the farmers along its course, as well as a serious con- 
tamination of the water supply of Elyria, since that village draws its supply 
from Black river, below the mouth of Plum creek. It was evident to all that 
if Oberlin was to have sewers it must purify its sewage. In the construction of 
its sewers the separate system was adopted, namely: No storm water is ad- 
mitted to the sewers and only the household waste is conveyed by them. Con- 
sequently we have nothing to purify except actual sewage, and the amount of 
this, of course, is not large. 
Twenty acres of land were purchased a mile and a half from town, and a 
trunk sewer was given as small a grade as was safe, so as to deliver the sewage 
upon the farm as high as possible. We were able, however to reach a point 
only ten feet above the bottom of the creek, with five acres of laud below the 
grade of the sewer. The balance of the land was very much above this eleva- 
tion. We studied all we could find on sewage purification by irrigation, but OHIO SANITARY BULLETIN. 
35 
the cost, as the irrigation fields were usually prepared, rather appalled us, so 
we began experimenting to see if we could not accomplish the desired results at 
less cost. The first thing done was to dig a small pit in the earth, and we 
were surprised to see how much of the solid matter was removed from the sew- 
age by mere sedimentation. After passing through the pit the sewage was 
allowed to pass over the ground among the grass roots-the field was formerly 
a meadow - and the sewage was rendered very clear, about 70 per cent, of the 
total organic matter having been removed. 
If a small pit and running the sewage through the grass would accomplish so 
much, surely allowing it to pass through the ground would accomplish much 
more. We then set about preparing the field, as shown on the blackboard, 
which I will explain later. Pits were dug four feet by twenty-five feet by 
three feet deep, and two and a half acres on the west side of the drive were 
underdrained by two and a half inch and four inch tile, three or four feet deep 
and twenty feet apart. This land has been divided into twelve areas by small 
ridges. A system of carrier ditches convey the sewage to the different areas 
where the sewage enters distributing ditches ; by overflowing the tops of these 
the sewage is spread upon the area. It then seeps through the soil to the 
drainage tile and thence flows to the creek. The areas on the upper part of 
the tract are larger because the soil is largely clay, while on the lower ground 
it is a sandy loam. 
Colonel Waring, in his new work on "Modern Methods of Sewage Disposal," 
calls particular attention to the necessity of puddling the back filling in the 
trenches where the drainage tile have been laid. The book, however was not 
published until after we had learned this fact by experience. Without puddling 
the trench the sewrage will form rills through the soft earth and find its way to 
the tile without purification. 
The land is seeded to alfalfa, Italian rye grass and common red clover. 
Thus far the Italian rye grass appears to be the best crop to seed with. What- 
ever the farm will produce is accepted with thanks, but the crops are placed 
secondary. The farm is intended for sewage disposal, and everything is made 
to bend to that end. The land on the east of the drive is used when cleaning 
the sludge pit on the west side. A little tiling has been laid here to drain a 
few low spots where the sewage was likely to settle and sour. The sewage is 
conveyed to different parts of this land by carrier ditches having a slight fall. 
Then by placing small dams at different points the land below is overflowed. 
No masonry was used upon the work, the pit has no lining and neither have 
the ditches, and for many reasons they are much better with their earth sides. 
The total cost of preparing the land, tool house and necessary equipment was a 
little over $500 00. 
The care of the farm consists in changing the flow each day from one area to 
another, and about once in a week or ten days the accumulated sludge in the 
pits is pumped into a tank on a wagon and hauled on to the high ground, 
where it gives most astonishing growth to the grass. The grass and weeds 
around the bed are kept well trimmed and many little things done to give the 
farm a neat and tidy appearance. During the summer season a man was em- 
ployed practically all the time at $7.50 per week. As before stated, a great deal 
of his time was occupied in improving the farm. Between 300 and 400 trees have 
been set out, and it is proposed to make it an attractive place. During the winter 
the man who changes the flow receives $3.00 per week. A team is hired one- 
half day when we clean sludge for $1.50. The farm has now been in operation 
during both cold and hot weather and the residents in the neighborhood are 
satisfied with the way it is conducted. There is no odor about the farm except 
directly over the sewage as it is spreading out and right around the pit when 36 
OHIO SANITARY BULLETIN. 
cleaning sludge. It might be supposed that in the winter the frost would 
cause trouble, but you will remember that sewage is always warm. We never 
found it at Oberlin below 44 degrees Fahrenheit, and it will melt its way un- 
der the snow, leaving a crust of snow and ice supported on the tufts of grass, 
while the sewage will percolate through the soil as in the summer. A sewage 
farm will not care for itself, but requires intelligent oversight. The amount 
of work to be done at any one time in caring for the sewage is small, but that 
little must be done just at the time it is needed. The results, however, amply 
repay all the trouble, and the village is enabled to enjoy the advantages of a 
sewerage system without injury or detriment to its neighbors. 
[The speaker then explained the methods of operation at the Oberlin sewage 
disposal plant, using the blackboard for the purposes of illustration.] 
The Chair - Gentlemen, this brings before us the disposal of night soil and 
garbage and also the purification of sewage, which we will be glad to have dis- 
cussed now. Have you any remarks? 
Mr. Hartzell, of Canton-The subject of the pollution of streams, or rather 
of the prevention of the pollution of streams, is one that has always interested 
me greatly, and I have waited, and watched, and hoped these many years to 
read the details of a successful experiment such as we have heard here this 
evening. My interest in this has been considerably stimulated by the fact that 
in Canton, where I live, we were compelled, before we built sewers, to provide 
for the disposal of the sewage. We were not allowed to do any taxing, or 
raise any money, until we had arranged to dispose of the sewage in a manner 
satisfactory to the farmers living below Canton. While we adopted a dif- 
ferent system - a system of purification by a chemical process - it is apparent 
and is proven by this experiment that this is a cheaper plan, where it can be 
employed, and better adapted to a great many small places in need of sewage 
purification. 
The engineer of Oberlin has shown us that this thing can be done. He 
has shown us how it can be done, and the result of doing it. And the paper 
by Mr. Fee, of Warren, shows us why it is that the sewage is purified by the 
upper layers of the soil. But because this is true, it must not be inferred that 
it is adapted to all towns, because there may be great differences. That is to 
say, suppose a commission was appointed that had full control over the cities in 
the State, and suppose that commission would say: Oberlin disposes of her 
sewage in this way, therefore this, that, and every other town, and any town 
coming under the supervision of it, must do it exactly in the same way. That 
would be an impossibility, because this is a very variable science, or application 
of science -the disposal of sewage. It is an art which calls to its help engineer- 
ing and chemistry, and is really the application of science to the solution of a 
great sanitary problem, and a great many things have to be taken into con- 
sideration. There is a difference in the outputs of towns. For instance, Ober- OHIO SANITARY BULLETIN. 
37 
liu has 40,000 or 50,000 per day, while Canton has a million gallons a day. 
One town may be on the lake and one on the Ohio river, on the border of the 
State where there is a divided control. One town may be situated so that the 
sewage reaches the field where it is to be drained, by gravity, and in another 
case it has to be pumped. There is, also, a financial problem; I found these 
things were to be considered when we were compelled to adopt some system for 
Canton. We had to grope in darkness, so far as our own country was con- 
cerned, there being only one place where sewage wTas treated, viz., at Pullman, 
Illinois. But now there are many such disposal systems. I visited one at 
Farmington, near Boston, where the conditions are almost the same as at Ober- 
lin, and there was no trouble from freezing, the warmer sewage running under the 
snow and ice, and undergoing purification as well as in summer. In Rhode 
Island I saw one place where sewage is disposed of by broad irrigation; in 
another place by intermittent filtration. All the sewage of Berlin, and nearly 
half the sewage of Paris is so treated - 14,000 acres are used in that way. At 
Pullman, Illinois, the same experiment was tried, and a great deal was said 
about it years ago, but it has been abandoned for the last three or four years. 
At Worcester, Massachusetts, they undertook something of the same kind, but 
they now dispose of the sewage by chemical precipitation, as at Canton, in this 
state. So far as American experience goes, it would seem that places having, 
approximately, over about 500,000 gallons a day, have preferred to dispose 
of the same by chemical precipitation, that being better adapted to large quan- 
tities of sewage, whereas in smaller places they dispose of it as they do at Ober- 
lin In Canton we adopted chemical precipitation, and I believe, at any rate I 
hope, that inside of five years steps will be taken in many towns in the state 
of Ohio to introduce either one of these, or some other plan that will save our 
inland streams from pollution. The construction of water works and sewers has 
assumed large proportions. If these laudable enterprises are not supplemented 
by purification, there is danger that our natural streams will be converted into 
open sewers, especially in periods of low water. This is an important matter, 
and should be well weighed by every town which creates a sewage effluent; 
and viewed in this light the facts that have just been placed before us by Mr. 
Gerrish, demonstrating the success of the Oberlin experiment, should have a 
wide and careful hearing. 
Dr. Bridinger, of Tiffin - I have sat here and listened to the matter of dis- 
posing of sewage. Of course all cities have a way to dispose of their sewage. 
Now then the thing occurred to me wa1, what is a city going to do when it can- 
not run sewage up hill? You cannot make water or sewage run up hill. What 
are you going to do when a city is so constructed that you have to run the 
sewage into a stream, or else probably eight or ten miles in a stream before it 
could get on the farm ? It would make it rather expensive to do that. I sup- 38 
OHIO SANITARY BULLETIN. 
pose there are some cities that are situated that way. Mansfield, for instance, 
can run sewage on a farm close by with little expense in the way proposed here. 
The way we are situated at Tiffin is, we have hills all around us, so that the 
sewage would have to go up hill in order to get on the farm, and consequently 
we have no place to put it except in the river. That is the difficulty there, 
and I would like to get some information with regard to the disposal of our 
sewage. During the winter time, and when there is plenty of water in 
the river, we have no trouble at all, and no complaint from the farmers below 
the city. We have 35 miles of sewers; our city is completely sewered. We 
flush out our sewers every two weeks, and rush everything in the river. Here 
is our difficulty. In the Summer time, during the months of July and August 
especially, the river gets very low. We have our water works right above the 
city, and they hold the water back for the purpose of water power, and con- 
sequently in the day time the water don't run down, and it gets so low that 
you can hardly float a newspaper. When it gets low it becomes very obnoxious 
and offensive, and people want to know what to do with it. I suggested a dam 
to be built of sufficient height to back up the water. Some proposed a chan- 
nel, which would be very expensive, as the bottom is solid rock, and others 
claimed that the dam would fill up and would require great expense to build it. 
Mr. Ghaster, of Fostoria - We find that we have reversed the Canton sys- 
tem of sewerage, or their modus operands. In other words, we have built our 
sewerage system and now we want to dispose of our sewage. We have a small 
stream in which our sewage empties. We pump from a half to three-quarters 
of a million gallons of water per day. The mouth of the sewer is on a level, 
or, possibly, a few inches lower than the stream, and I would like to know 
how we could dispose of the sewage. The mouth of the sewer is below the 
city, and we don't feel that we are treating our farmer friends right below 
town to force this sewage upon them, as we have done for a year or more. 
We had members of the State Board of Health to visit us and examine into 
the matter, and plans were made by the city engineer which were elaborate. I 
believe the secretary of the State Board of Health would bear us out in that; 
but nothing has been accomplished. Our board of health is solicitous that 
something should be done, and I would like to know the best system of dispos- 
ing of this sewage. We are in a level country as well as our friend from Tiffin, 
who is a neighbor, and we are at a loss how to dispose of it. 
Mr. Wickham, of Findlay - I am not the health officer from our city, but I 
see him here, and I guess he is too bashful to say anything. We have a sys- 
tem of sewage disposal that we are quite proud of. Our city, on the north 
side, is quite well sewered. This sewer empties down below the main part of 
the city. The south one empties close to the business part of the town, right 
in the main street. That is a nuisance; but to a certain extent we obviate this OHIO SANITARY BULLETIN. 
39 
nuisance by not permitting water closets to be connected with the sewer. 
There may be a few' that are, but it is the intention of the board of health to 
keep the water closets oft of the sewer. Our night soil is gathered by scav- 
engers and hauled to the crematory, at which place it is disposed of. All 
matter of that sort is hauled to the crematory and destroyed. All dead 
horses, cows, dogs and everything of that kind is taken to this crematory and 
destroyed. I hold here in my hand the report of 1892, which shows that in 
1892 there were 4,089 cubic yards of common garbage burned, 5,541 barrels 
of night soil, 85 dead horses, 154 dead dogs, 16 dead cows and 4 hogs were 
cremated. Nothing of the kind is permitted to lay upon the streets or permitted 
to be thrown out on the streets, but everything must be taken to this crema- 
tory and burned. Since we have had this crematory we have considerably re- 
duced our death rate. I simply make this statement, gentlemen, to tell you 
what we are doing. 
Dr. Whitmar, of Millersburg - A question in regard to this system of sewer- 
age at Oberlin. It is said that the sewage is spread over a number of acres 
of ground; I would like to know' whether that soil might not become saturated 
in that way, and how long it might last ? It looks to me that by emptying a 
large amount of sewage on to flat ground, it would finally become saturated 
and become a sort of cesspool. If such would be the case it would be rather a 
serious matter, but I am satisfied that the system is a very good one and well 
adapted to a great many of our inland towns of the state, providing that will 
not become a stagnant pool in the course of time. If some of our chemists 
will show us that the vegetation will destroy that condition, we would probably 
be satisfied that it might be done for many years. 
Mr. Gerrish, of Oberlin - You remember my saying that when the sewage 
goes down the water flows off in the drain tile, and the air will follow it. The 
earth will then be full of air ; of course, such a thing is possible as running on 
too much, but we don't depend on the vegetable or plant life to decompose the 
organic matter. It would take too long to go into details, however, about that. 
Mr. Hartzell, of Canton-It is a hopeful sign when people are inquiring 
what they shall do to be saved in different parts of the state. Mr. Gerrish 
could tell you how it is done, but he is too modest. Get a first-class engineer, 
if you have problems of this sort to solve - get a good one. [Laughter.] 
The Chair - We will pass to the next subject, namely, " Report of the Diph- 
theria Epidemic at Ashtabula," by Dr. William T. Miller, member State Board 
of Health, Cleveland. 40 
OHIO SANITARY BULLETIN. 
DIPHTHERIA EPIDEMIC AT ASHTABULA. 
By Dr. William T. Miller, Member State Board of Health. Cleveland. 
Mr. President and Gentlemen - On December 13, 1894, I received a 
telegram from Dr. Stanton, our President, notifying me of an epidemic of diph- 
theria at Ashtabula, and requesting me to visit that place immediately. I 
was tolerably familiar with the situation from a former experience with the 
same disease, which occurred there two years ago in an epidemic form, and also 
from the daily press reports, which indicated a grave situation. Appreciating 
the gravity of the condition, I procured the assistance of an expert in bacteriol- 
ogy, Professor William T. Howard, late associate and collaborator of Professor 
William Welch, of Johns Hopkins University, whose work in this special line 
received universal commendation at the eighth international Congress of Hy- 
giene, held at Buda Pesth last year. 
Upon our arrival we met Mayor McKinnon, the board of health and the 
health officer, Dr. Hopkins. The conditions, as found, were as follows: 
The disease had been somewhat prevalent throughout the year, in the first 
and sixth wards especially, thirty cases occurring, an average of two and eight- 
elevenths cases per month in the latter; fifty-seven cases, an average of five and 
two-elevenths per month in the former. These two wards constitute the harbor, 
separated from the main portion of the city by a distance of several miles, and 
populated by the ore handlers largely, whose habits of living favor the exten- 
sion of contagious diseases. The cases reported for eleven months prior to 
December 1st, in the different wards, were as follows : In the third ward, four 
cases; in the fourth ward eleven cases, and in the fifth ward one case. From 
December 6th to the 9th, to the date of our arrival, on the 13th, inclusive, 
there had been reported in the second, third and fourth wards, fifty-six cases in 
forty-eight houses. This alarming condition had caused wide-spread fear among 
the people, and unusual activity on the part of the local authorities. 
From a study of the situation, the board of health and Dr. Hopkins, the 
efficient health officer, decided that there must be a common source of infection, 
and that it was the milk supply to the infected families. Acting upon this 
opinion they ordered the discontinuance of the sale of milk for fifteen days, 
pending further examination. The history of the onset undoubtedly pointed to 
a common source of infection, fifty-six cases occurring in people of all ages, 
not intimately related by social or family ties or proximity of dwellings. The 
problem, as it was presented to my mind, was capable of study from several 
standpoints. First, the food and water supply. Second, the rapid extension 
of the disease by means of schools or public gatherings. The consideration 
of the first proposition immediately established the fact that the primary cases 
were all customers of one milk farm. The water supply of the infected families 
was from wells and the water works. 
The question was next examined from the standpoint of extending by means 
of the public schools. An examination of the records demonstrated the fallacy 
of this position, for although it is conceded by the authorities that children are 
more prone to the disease, the opposite condition obtained in this instance. 
The first three cases reported in each ward were as follows: 
Second Ward. 
Third Ward. 
Fourth Ward 
Fifth 
Ward. 
20 years. 
13 years. 
30 " 
12 years. 
25 years. 
30 " " 
3 " 
4 
u 
2 " 
16 " 
13 " 
25 
<< OHIO SANITARY BULLETIN. 
41 
Giving an average of 21 years. Although this disposes of the idea of origi- 
nating in the schools, I found several cases that could be traced to school com- 
panions eating an apple with a little girl who at the time complained of sore 
throat, and was afterwards treated for diphtheria. 
The consideration of the different church and Sabbath school gatherings was 
non-productive, the people being of a variety of faiths and religious habits. 
There were two gatherings of people by means of which the disease might have 
been communicated, but the authorities on this subject very much doubt if the 
disease can be transmitted by the air of the room. Grimm, a notion dealer, 
drew large crowds of people to his display of Christmas toys, by giving each 
child a present. The people also attended en masse an entertainment known as 
the Swiss Village, but it is doubtful whether such an extensive contagion could 
be propagated by means of the atmosphere. The clinical evidence was all in 
favor of the extension of the disease by means of contaminated milk. 
The history of the Henry Smith (the milkman) case, is as follows, as given 
by Dr. Hopkins. He felt ill on December 1st, with pains in the throat, 
neck and limbs, with difficulty in swallowing, but did not consult a physician 
other than to obtain a sidewalk prescription from a doctor for quinine and 
whiskey. He sold milk on December 2d, 3d, 4th and 5th; on the 6th and 7th 
he felt indisposed and remained at home, but not in the house. On the 8th he 
resumed his route again, and on the 9th, by an order from the health board, he 
was removed from his wagon, being replaced by another man who sold the milk 
on the 9th, 10th and 11th, when the health board ordered the sale discontinued 
for fifteen days. The milk was sold from ten gallon cans, and long-handled 
dippers were used for measuring. The cases all occurred on Smith's route, 
although there were four other men selling milk in the same ward, no diphtheria 
having occurred on any route other than Smith's. A thorough investigation 
of the Smith farm was made by Professor Howard, Dr. Hopkins and myself. 
The cows were well housed and fed, and in excellent condition as shown by ex- 
amination of nose, tongue, throat and joints. Everything evidenced great care 
and cleanliness in and about the dairy; the cans, buckets, pans, etc., being ex- 
ceptionally clean, as were also the house and people. Professor Howard made 
cultures from the nose and throat of Henry Smith, noses and throats of the 
-cows, cans, bell and handle, cash box, tickets, milk, butter and water. Cultures 
were also made from the throats of two patients. 
At a meeting of the board of health in the evening, Dr. Hopkins reported 
that the board had closed the schools and churches, and placed a rigid quaran- 
tine against the infected houses, preventing any one from leaving the house 
without a permit from the health officer ; had ordered that no mail should be 
received from the infected houses, and had given explicit orders as to the sani- 
tary care of the patients with reference to isolation and clothing. The board, 
at the solicitation of many citizens, ordered a stock of anti-toxine, and Professor 
Howard kindly offered to superintend its use. He reports very favorably, and 
will be pleased to give the results in detail to the State Board. He also offered 
to make cultures from the throats of the new cases, and also the cases before 
their discharge from quarantine. This offer was accepted, and no case was dis- 
charged from quarantine until bacteriological examination showed that there 
were no Loeffler's bacilli present. Professor Howard's report of the exami- 
nation of the various cultures made at the Smith farm was negative, there being 
no Loeffler bacilli present. Large colonies were present, however, in the two 
cultures obtained from the diphtheria patients. The examination of Henry 
Smith's nose occurred thirteen days after the disease was manifest. 
Receiving notice on December 20, that the towns of Warren, Kingsville, 
North Sheffield, Andover, Jefferson, Perry, Conneaut and Geneva had declared 42 
OHIO SANITARY BULLETIN. 
quarantine against Ashtabula, I called a conference of the health officers of these 
towns to meet at Ashtabula on the 22d, to consider the situation. Drs. Merriam, 
of Conneaut, and Tibbets, of Geneva, were present. The situations were dis- 
cussed, showing the thoroughness of the quarantine, and the limitation of the 
disease to the primary centers of infection. It was the opinion of those pres- 
ent that the situation did not warrant the declaration of quarantine. Letters 
were sent to the health officers, with a request that the quarantine be removed. 
The request was cheerfully complied with, with the exception of Warren. 
The number of cases occurring in the 2d, 3d, 4th and 5th wards, the epidemic- 
area, during the month of December, was as follows: 
Number of cases in males, 48 
" females, : 51 
" " sex not given, 1 
Total number of cases, 100 
Number quarantines December, 1894, 51. 
Deaths - Adults, males, 2; Females, 3; Total, 5- 
" Children, " 13; " 4; " 17 
" One baby, sex not obtained, 1 
Total deaths, 23 
Number of deaths, males, 15 Number of cases, males, 48- 
" " females,.... 7 " " females,.... 51 
Babe, sex not obtained, 1 
Total deaths, 22 
Total number of cases,... 100 
Total number cases over 21 years of age, 32 Deaths,.... 5 
" 18 years to 21 years, 12 " .... 2 
" . " 15 " 18 " 11 " .... 2 
" " 12 " 15 " 7 " .... 2 
" " 10 " 12 " 6 " ....none. 
" " 6 " 10 " 14 " .... 7 
" over 1 and under 6 years, 17 " .... 4 
" " under 1 year, 1 " .... 1 
Totals, 100 23 
Death in males, 31 1-4 per cent. 
" females, 13 7-10 " 
The total number of cases for the*year was 216; deaths 41, quarantines 119. 
The same ratio of cases and deaths, according to population, would be : Colum- 
bus, 2,160 cases, deaths 410; Cincinnati, 8,000 cases, deaths 1,517 ; Cleveland, 
6,480 cases, deaths 1,230. This accounts for the great business depression, es- 
timated by a conservative business man as a shrinkage of $225,000 in the gen- 
eral volume of business of the year. 
The question as to the cause of the epidemic is yet an open one, although 
the clinical evidence is against the Smith milk; the positive evidence, the pres- 
ence of a specific germ could not at that late day be determined. Kline claimed 
at Buda Pesth that when cows were inoculated with the Loefler bacillus, the milk 
would contain the germ. Abbott, in experiments made a year later, disproves 
the claim. There is no authority for opinion that milk from the cows contains the 
germ, but of course milk would form a rich culture medium for genus acci- 
dentally added, and such milk would prove a fertile source of infection. It is 
believed that Henry Smith had the diphtheria, infected the milk, and caused 
the almost simultaneous appearance of the disease in forty-eight different houses. 
With reference to duration of quarantine, I think the examination of Dr. 
Biggs, which shows the variable length of time before the disappearance of the OHIO SANITARY BULLETIN. 
43 
germ, demonstrates that no person should be dismissed from quarantine until 
the bacteriological examination of the throat and nose shows the part free from 
germs. I would recommend to the State Board the establishment of a number 
of distinct stations where bacteriological examinations of diseased conditions 
could be made. This would not only make a diagnosis positive, but also quar- 
antine effective. I would also recommend the change of the section providing 
for the declaration of quarantine by one town against another, which should 
read as follows: 
"That the local board of health may, with the advice and consent of a rep- 
resentative of the State Board of Health, order and declare," etc. 
Although the epidemic is over, the fact that there are always cases of 
diphtheria in Ashtabula is a constant menace to the health of the community, 
and all the energy and wisdom of her very efficient mayor, health board and 
health officer should be directed to stamping out every vestige of the disease. 
This can only be accomplished by the authorities assuming charge of the 
infected premises, cleansing, boiling or burning everything that has been in 
the infected room. 
Dr. Hopkins, of Ashtabula-In the investigation of the recent epidemic of 
diphtheria in our city, which has been very nicely stated by Dr. Miller, we 
found matters just as stated by him. These one hundred cases reported to us 
received their infection primarily from the milk, or from others in the home. 
We found, also, that all the quarantines that were put up for these one hun- 
dred cases should have been put up as soon as the 10th of the month. I don't 
mean to say that we neglected doing our duty, but we found afterward that 
we would get cases as late as the 12th and 13th, possibly the 15th, of the 
month, in new homes. I questioned them to find out whether persons in these 
quarantined houses had been visiting other homes, and from the bacteriological 
examination I found what had been called sore throat at the first, and should 
have been quarantined, ultimately resulting in diphtheria. In two or three 
instances we found that mothers who had been in the habit of drinking this 
milk had sore throats at first, but thought it was just simply sore throat and 
were running about the house and doing their work, and did not have a physi- 
cian at all; but when we went there and examined their throats we found the 
bacilli there, and we were satisfied they had the disease. It has been very 
interesting to one who can look back upon it now. It was not interesting, 
however, at the time, I assure you, because it was too much of a serious matter 
to me. One mother had a grown up daughter 16 or 17 years old. She had a 
husband who did not like milk. She did, and had all she wanted. She was 
one of the first cases Dr. Howard examined. We found her throat to be in a 
very serious condition. Now, we got no anti-toxine until we had been up 
there ten days or two weeks, so that none of these cases were treated with anti- 
toxine; but speaking of another case where a father and two children were 
fond of milk and were fond of bread and milk. He left for New York state, 
but got a telegram saying his two boys were down sick with diphtheria, and 44 
OHIO SANITARY BULLETIN. 
when he reached home he also complained of sore throat, and had the diphthe- 
ria. The mother and her mother drank no milk, and although they were 
exposed to the disease, did not catch it. I can mention other cases where per- 
sons no doubt contracted the disease from this milk. There is no doubt in our 
minds that this man's milk was at the bottom of the whole trouble. 
I want to say that Professor Howard is here with us. He aided us materi- 
ally in this epidemic of diphtheria, and I want to thank him most heartily 
myself for his aid. I believe he has got something here tonight that would 
interest you and be a benefit to you. I asked him as a favor to come, because 
our board of health had delegated me to see to the handling of it - the use of 
auti-toxiue, which I asked him as a favor to superintend, and I call upon Pro- 
fessor Howard to talk to you awhile. 
Professor Howard, of Cleveland - Mr. President and Gentlemen: I 
hardly expected to be called on to do anything this evening, but I will be glad 
to relate to you my experience at Ashtabula if you think it will be of value to 
others. It was a matter in which I was very much interested. As Dr. Miller 
told you, I went there on December 13, on his invitation, to investigate the 
epidemic purely as a matter of interest. After I got there I became actively 
engaged in the work and spent three weeks of my time there. 
Now, as to the spread of diphtheria in this case, there is little doubt in my 
mind that Henry Smith, the milk peddler, infected his milk and was the cause 
of the whole epidemic, and the way that he probably did it is also very inter- 
esting to you as health officers. There is no escape from a clinical study of 
the epidemic from the fact that Henry Smith infected this milk. Although 
careful bacteriological examinations failed to show bacilli in his throat or nose 
that does not at all detract from the probability that diphtheria bacilli had 
been present. The only thing that keeps it from being a certainty is that we 
failed to find the bacilli. It is well-known to those who study and make cultures 
from cases of diphtheria that the diptheria bacillus often disappears from the 
throat in a very few days. On the other hand, in other cases it remains quite 
a number of days, and in one case that I know of seven weeks after the disap- 
pearance of the false membrane. In most of the cities and towns in Ohio, I 
am informed, the milk peddlers dip milk with a long dipper from the large 
milk can, and instead of obtaining milk from these cans by means of a faucet 
they dip it up with long-handled dippers. The probabilities are in favor of 
the fact that Henry Smith frequently had diphtheria bacilli on his hands, and 
every time he splashed this dipper in the can the milk in the can was infected 
from it. I think there is little doubt that this epidemic of diphtheria was 
caused by milk infection in this manner. The extreme rarity of milk epi- 
demics of diphtheria makes this one peculiarly interesting from the epidemio- 
logical standpoint. OHIO SANITARY BULLETIN. 
45 
Now, as regards treatment with anti-toxine. That is one thing that chiefly 
interests us. On the 17th of December Dr. Hopkins procured some anti-tox- 
ine from New York. There was in the town at that time three cases which 
were said to be of the most malignant form. These were the most malignant 
cases I saw while I was there. Out of these three cases, two died. The first 
case was a child six years of age. After anti-toxine was administered he 
lived two days, and I have no doubt that, while it was a severe case, that anti- 
toxine prolonged his life. The second case was very severe - a woman 27 
years of age, who had been sick for six days. She was attended by Dr. 
Flower. He was so much impressed with the gravity of the case that he called 
in another physician with a view of getting his opinion. The physician 
agreed with him, and they thought the woman could not possibly recover. 
That was three days before I saw her - on the 17th of December. We gave 
her two injections of anti-toxine that day, and on each of the four succeeding 
days we gave her one injection of anti-toxine. On the morning of the fifth 
day after the first dose of anti-toxine she appeared better than at any time dur- 
ing her illness; certainly better than at any time I had seen her. Her pulse 
was good and strong and the heart sounds quite strong. The false membrane 
had entirely disappeared from her throat and she looked quite well. Sud- 
denly, late in the afternoon, we called to see her, and found her gasping for 
breath, pulseless at the wrist, the heart sounds scarcely audible, and her lungs 
soon clogged up and she died in a short time. That was the second fatal case, 
although I have no doubt that her life was prolonged several days by anti-tox- 
ine. The third case was a child four months old. I saw it on the third day of 
the disease. This child had lost its father and grandmother of diphtheria. 
The child's temperature was 105, and the third day after anti-toxine was ad- 
ministered the membrane disappeared. This was a severe case of "mixed in- 
fection," and the child probably recovered from the diphtheria and died of 
septicaemia. 
Now, these were all the deaths we had in cases we treated with anti-toxine. 
Twenty-eight cases received the anti-toxine treatment, and out of this number 
three died, which was, of course, very much less than 24.4 per cent, which 
had characterized the epidemic before that. Since I have rendered my report 
to Dr. Hopkins there* have been six other cases at Ashtabula that I learned of 
since which were treated with anti-toxine; so the last six cases, added to the 
28 that I previously mentioned, makes 34 cases, with only three deaths. So 
that brings down the mortality of the anti-toxine cases to 8.82 per cent. Of 
the 28 cases, of which I have notes, treated with anti-toxine, 5 were mild cases. 
There were 10 severe cases - and 7 cases being very severe - a question of 
almost life or death, and at any time during the illness very severe cases. 
Now, the amount of anti-toxine given varied, according to the case. We 46 
OHIO SANITARY BULLETIN. 
used it as we would any other remedy, as the condition of the patient seemed 
to require. We gave ordinary doses on the first day, and the second day we 
repeated it. If the case was a severe or malignant one we would give a 
strong initial dose and would return in a few hours to see how the case was 
getting along. 
It would be of interest, if time permitted, to say a few words about the 
different varieties of anti-toxine that are on the market, and which, I am glad 
to say, can be obtained now by physicians for the treatment of their cases. 
The anti-toxine used at Ashtabula was obtained by Dr. Hopkins from the 
Pasteur Institute of New York City. In our hands it proved satisfactory, the 
patients reacting typically. We usually injected it into the soft tissues of the 
buttocks. The patients rarely complained of pain, and we have had no 
abscesses following the injections, though we have had several cases of luticoria. 
I am inclined to think that eventually anti-toxine will absolutely cure a large 
portion of cases of this disease if administered at the proper time. It is 
beyond the experimental stage, but many thousands of cases must be studied 
before its exact value is determined. 
Dr. Linden, of Brooklyn-While the papers have been very interesting and 
the discussions have been interesting, especially from a medical standpoint, 
still, we should not lose sight of a preventive treatment for this disease. These 
troubles, I think, in these cases, could have been avoided by boiling this milk. 
If the milk had been thoroughly boiled these people would certainly never 
have had diphtheria. I believe the representatives of boards of health should 
caution the people in their communities to be more careful in the preparation 
of their food. Inasmuch as these epidemics occur not only in Ashtabula, but 
in other places, it would be well for us to warn the people against the danger 
of milk infection and other food supplies. The milk should be thoroughly 
boiled, especially during a time an epidemic is threatened. I think we should 
take every means possible to prevent these diseases, and not wait until the 
disease comes and then try to procure some remedy which will cure. I say 
that prevention is worth a good deal more than cure. 
Dr. Sutton, of Zanesville - Mr. Chairman, I wish to say that a few months 
ago a physician reported a case of diphtheria to me, and he stated that it was a 
very malignant case; that he had no idea where it had come from, there being 
no cases of the sort there in the neighborhood, so I went right to the house 
myself and put a card on it. When I went to record the case I saw the last 
case was recorded eight months before, because I attended it myself, it being 
right across the street; and I remembered having seen some changes made 
about the place where I had attended this case of diphtheria, and I drove back 
up there and went into the house and asked if they had been having some 
buildings moved or torn down, and the lady of the house informed me that OHIO SANITARY BULLETIN. 
47 
last week - the week before - they had their vault cleaned. Thereupon I 
went and saw the man who had cleaned the vault and asked him if there had 
been any children around there when his men were doing this work, and he 
said that this little boy was there and they could not keep him away. He said 
he was in the way all the time. That is the history of the case. There can 
be no doubt of the way he caught the disease. 
Mr. Walton, of New Burlington-I simply want to say that I am very 
thankful for the instruction and information that our physicians have given 
us, and I believe that a little warning to the doctors might not be out of place. 
I have had a remarkable experience with diphtheria myself. In 1869 I had 
three interesting little children. One of them was a little indisposed, and we 
called in a physician. He thought there was but very little the matter with the 
child, but in a day or two diphtheria in a malignant form developed, and inside 
of nine days our house was left childless. We knew of no way the children 
could have got the diphtheria but by being carried by the physician. None of 
us were so afraid at that time of this disease. Subsequently we learned that 
this physician had been attending a malignant case of diphtheria, and there 
seemed to be no other way by which they could get it except by being carried 
in his clothing. So, while I feel that our physicians have the interest of the 
sick in their hearts in this matter, I think the experience which I have related 
might be a caution to some who have not had experience with diphtheria. 
FOURTH SESSION. 
Friday, 9 a. m., January 25, 1895. 
The Chair-In the absence of Dr. Woods, the first subject we will discuss 
this morning will be, "What precautions are necessary in the burial or trans- 
portation of a corpse when death was caused by typhoid fever?" The discus- 
sion will be opened by Dr. S. P. Wise, member of the State Board of Health, 
Millersburg. 
WHAT PRECAUTIONS ARE NECESSARY IN THE BURIAL OR TRANS- 
PORTATION OF A BODY WHEN DEATH WAS CAUSED 
BY TYPHOID FEVER. 
Dr. S. P. Wise, Member State Board of Health, Millersburg. 
In estimating the danger of contracting disease from dead bodies we have 
but very limited data from which to draw our conclusions. It seems that bac- 
teriologists have not proceeded very far in the direction of ascertaining the 48 
OHIO SANITARY BULLETIN. 
virulency of specific germs contained in the bodies of persons who have died 
of acute infectious diseases. So far our knowledge is limited to a few stray 
facts which have been incidentally discovered in the course of investigation of 
epidemics. There is, no doubt, a large unexplored field before us which will 
yield valuable knowledge whenever the subject is brought fully under the 
light of scientific research. We know from practical experience the extreme 
danger of contracting small-pox from the bodies of persons who have died of 
that loathsome disease. Even after having been buried many years the malady 
has been communicated to the living where such bodies were exhumed. We 
also have many authenticated instances on record in which persons who came 
in close contact with the bodies of those who died of scarlet fever and diphthe- 
ria have contracted those diseases. These facts have all been practically dem- 
onstrated, and there is no doubt concerning them. In the management of 
cholera epidemics the rule is universally adopted and strictly enforced that the 
cholera dead shall be promptly disinfected and speedily buried, with all the 
possible precautions. I apprehend that the transportation of the body of a 
victim of cholera would be considered absolutely criminal by all sanitary 
authority, and yet there is no scientific proof that the disease can be communi- 
cated by a dead body. The only medium of communication is, in fact, the 
clothing and bedding of the patient which have been soiled with choleraic 
discharges. 
Now, when we come to consider the question of post-mortem transmission of 
the specific contagion of any of the infectious diseases from a scientific 
standpoint we are at once confronted by the question, How long will the germs 
of disease survive in the body after death ? Will they retain their virulency 
for any length of time after decomposition has begun? Unfortunately we have 
no knowledge on this point with regard to typhoid fever, for the reason that 
the disease cannot be produced in the lower animals. We are therefore obliged 
to form our conclusions by analogy. The comma bacillus of cholera infests 
the intestinal tract; so, also, does the bacillus of typhoid fever. In either 
case it is necessary that the specific germ gains access to the intestinal canal in 
order to produce the characteristic disease. It is, of course, clearly demon- 
strated that it is not the germs themselves that produce the toxic effects, but it 
is the ptomaine or poison which they secrete. In other words, it is not the fly 
which does the mischief, but it is the "speck." There is another point of 
similarity between the two diseases; that is, that the contagious principle is 
contained in the bowel discharges in the most active form in typhoid fever, as 
well as in cholera. We see, then, that cholera may be fairly taken as an 
analogue of typhoid fever in so far as the parts affected are concerned. They 
differ widely, however, in the nature and malignancy of the germs which pro- 
duce them. The cholera bacillus is by far more malignant than is the bacillus 
of typhoid fever, and we would naturally suppose that it would retain its 
potency for a longer period of time in the cadaver. Dr. Vincent Richards, of 
India, made some experiments which throw light on this question. He removed 
the contents from the bowels of persons who had died of cholera and adminis- 
tered them to pigs. He found that the animals died in a few hours with 
cholera, providing the fluids were taken from the corpse of a patient who had 
died quite recently - within two hours. But where a longer time had elapsed 
and the fluids were in the least offensive, the animals remained unaffected. 
These experiments prove conclusively that decomposition will destroy the 
cholera poison quite promptly and effectually. In view of these facts, we are 
justified in the conclusion that the same result takes place in the bodies of 
persons who have died of typhoid fever. This would especially seem reason- 
able when we consider that the typhoid germ is far less virulent than the OHIO SANITARY BULLETIN. 
49 
cholera germ, and would in all probability be less resistant to the action of the 
bacteria of decomposition. 
It would appear, then, that there are no scientific reasons why the cholera 
dead should not be transported without extra precautions, no more than there 
are in the case of typhoid fever. In either disease the contagious principle is 
contained within the alimentary canal, and in a few hours after death it is ren- 
dered inert by the process of decomposition. Moreover, there is no doubt but 
that many thousands of autopsies have been held on the bodies of persons who 
have died of typhoid fever and cholera, and yet we never hear of a physician 
who has contracted either disease in that manner. The reason is simplv be- 
cause the autopsies are held after the process of decomposition has accom- 
plished its work. 
The rule that should guide us, however, in all sanitary questions of this 
character, is that we should always err on the side of absolute safety. As I stated in 
the beginning, we have a great deal to learn yet on this subject. When life 
becomes extinct - no matter from whatever cause - the human body becomes 
a decomposing mass of organic matter. In the process of decomposition 
ptomaines are generated which, in their effects on the living organism, resemble 
the venom of the most poisonous reptile known to mankind. We can well 
imagine that the effluvia arising from a corpse may contain poisonous elements 
which are highly dangerous to health. It is therefore nothing more than good 
sanitation that every possible precaution be taken to prevent the diffusion of 
those gases, even if it cannot be proven that they contain the elements of con- 
tagious disease. I would therefore insist that all bodies, no matter what the 
cause of death may have been, should be hermetically sealed before they are 
accepted for transportation by any common carrier. I would urge the adoption 
of this rule for aesthetic reasons, in the name of good sanitation and common 
decency. 
For instance, let us take a view of the conditions which often necessarily 
arise in the average express car while a corpse is en route to its destination. 
Here is the box containing the body placed on the floor of the car. On top of 
the box, piled up to the ceiling, are crates of strawberries or boxes containing 
oranges or other fruit. By the side of the rough coffin, nestled closely up to 
it, rests a dainty little basket containing some choice rolls of butter which some 
kind country matron is sending to her city friend. Perhaps on the other side, 
setting on edge leaning against the box, we find a large Swiss cheese. Now, I 
beg leave to ask who would want to partake of those eatables if they knew the 
circumstances attending their transportation. The mere thought of such a 
condition of things would create a disgust in the mind of the average person, 
even if they knew that no perceptible odor had escaped from the corpse. I do 
know, however, and I think every express messenger will bear me out in the 
assertion, that in the majority of shipments there is more or less odor, and 
oftentimes it amounts to an actual stench if the containers are not hermetically 
sealed. 
As regards the burial of persons who have died of typhoid fever, the same 
conclusions heretofore mentioned are applicable as far as the direct contagion 
from the body itself is concerned, but a different class of conditions are present 
at funerals which deserve special consideration. Without entering into a 
scientific discussion of the subject, I would briefly say that we have no positive 
assurance that the typhoid germ may not be found floating in the air of the 
room in which the patient was sick, especially where the necessary precautions 
of absolute cleanliness and the disinfection of stools have not been strictly ob- 
served. The bedding and clothing of the patient, and other fabrics contained 50 
OHIO SANITARY BULLETIN. 
in the apartment, may harbor the contagion. There is no reason why this may 
not be the case in typhoid fever as well as in cholera. Therefore the corpse 
and the sick room should be subject to the same sanitary measures that apply 
to all other contagious diseases. In order to insure absolute safety, persons 
would do well not to eat or drink in a house where the disease has recently 
prevailed, especially where the same members of the family who have nursed 
the sick also engage in the preparation of the meals. The reprehensible cus- 
tom which is still in vogue in some of the rural districts of holding a feast at 
the home of the deceased, to which neighbors and friends are invited, should 
therefore be abolished. 
Dr. Hopkins, of Ashtabula - I am somewhat interested in this matter. I 
have been a little anxious to have this matter of contagious diseases brought 
before us ami to discuss the methods of handling them in a way to protect our 
people. Now, if there is danger of funerals at a house, why, of course, we 
find that same danger to a certain degree in some other places, because we have 
not gone through certain processes of disinfection for protection. If we should 
allow that, would we allow a scarlet fever case, after we had thoroughly disin- 
fected the body, to be carried to a church? It there is an element of danger, 
I am like the speaker - I believe in going cautiously. If there is any element 
of danger, let us not have any such funerals. I do not mean to say that we 
should not have any funerals, but I think in cases of contagious diseases 
funerals should be prohibited. 
During the diphtheria epidemic at Ashtabula we buried many a little child 
inside of six to eight hours, and no one went to the funeral - none from the 
house went to the funeral. 
Now, as to the transportation of bodies. I got into a little trouble myself 
in transporting one of these little bodies to Cleveland. I did not think at the 
time that I had endangered anybody, and don't think so now; but I found out 
before that body got to Cleveland that I had transgressed the laws of our State 
Board of Health, though the body was disinfected thoroughly and wrapped in 
a sheet wet with bi-chloride solution and the casket hermetically sealed. I 
thought I would bring that matter up before our meeting. 
Mr. Ranney, of Columbus -If there is no danger of diphtheria, scarlet 
fever or typhoid fever to parties who may attend funerals, from the dead body, 
it seems to me there is danger from another source; that is, the apparel worn 
by the members of the family where this disease existed may become infected. 
I can see very readily how the health of those may be impaired who have not 
even been near the house. Therefore I should be opposed to public funerals 
where death has been caused by contagious diseases. 
Dr. Wise, of Millersburg - I would like to have heard more expression on 
this subject in reference to transportation of those dying with contagious dis- 
eases, and it seems to me it would be well, as I stated in my paper, to be on 
the side of safety. I believe that public funerals ought to be discarded. OHIO SANITARY BULLETIN. 
51 
The Chair - Our next topic for discussion will be, "When smallpox alights 
in a village, then what?" The discussion will be opened by Dr. J. T. Woods, 
health officer, Toledo. 
WHEN SMALLPOX ALIGHTS IN A VILLAGE, THEN WHAT? 
Dr. J. T. Woods. Health Officer, Toledo. 
This query presents such a variety of probabilities and possibilities that even 
an approximate answer can be made only on the basis of conjectural grouping 
of circumstances. 
But before entering on this task 1 may be pardoned a brief preliminary, 
bearing more or less on the general features of the subject. I think it both 
safe and proper to say that the mass of the interested public are but illy 
informed as to the loathsomeness, as well as the danger, of this disease. Few 
of them have seen a case at any period, and fewer still when in its worst stage. 
Their conception of it is of necessity based largely on hearsay and conjecture 
derived therefrom, both of which are liable to be discounted in their final con- 
clusion as to its character and quality. They have but faint idea that the 
poison may lurk in the most costly fabric as well as in rags; that its traces may 
be found in hotels, carriages, street and railway cars; that the air in an in- 
fected district is far from safe; in brief, that it is possible to become contami- 
nated in the most unexpected ways and places; that this disease is thoroughly 
cosmopolitan, making no distinction as to age, sex, or condition of life. 
Whether it be from a lack of knowledge and appreciation or not, the fact 
remains that the general public are to a great extent practically somewhat 
reckless, for whether the purpose be business or pleasure, few persons decline 
to visit a locality where the disease is known to be rife, probably presuming, as 
do soldiers when going into battle, that the party to be injured is anyone but 
themselves. 
The manufacturer of clothing pays little heed to the possibilities of his sweat- 
shop made garments being infected, and therefore certain to develop the disease 
in the wearer. The second-hand clothing dealers push their business with but 
little regard to the terrible possibilities. A large part of the public are negli- 
gent of their own vaccination and revaccination, and shrink from the vaccina- 
tion of their children as if it were a fatal poison, and to a great extent submit 
only because school boards may and do prohibit the unprotected from attending 
school, while on the other hand the truant officer is a terror that they cannot 
escape. 
The knight of the highway, whether he tramps to obtain work or to avoid 
it, is totally indifferent as to his clothing and company, eats and sleeps in any 
kind of a den. Wholly innocent of soap and water, he dons any kind of 
clothes that will hide his worthless carcass, that he may be in the best form to 
ask alms at the doors of the frugal innocents, whose pity for the forlorn liar 
prompts them to contribute to his needs, possibly to receive in return a contri- 
bution from his pathetic raggedness - a contribution that will cause them to 
remember him to the eud of their lives. Thus through legitimate travel and 
trade, through both travel and trade that should be illegitimate, but especially 
through the ever-weary pilgrim of the highway, the most remote and unsus- 
pecting community is liable to a shocking surprise. 
It is true that those situated on the chief lines of transit are the most liable, 52 
OHIO SANITARY BULLETIN. 
but it is equally apparent that the liability extends to the most secluded home 
and hamlet. 
If these facts were appropriately considered by those in authority it would 
result in more or less preparation for the unwelcome visitor, preparations that 
in the trying hour would be of infinite comfort and value, and if that hour 
failed to come, an appreciative community would still have ample cause to be 
thankful. But I am expected to deal with things as they are, instead of as 
they should be, and to make such answer to the query as I may be able. 
The circumstances will necessarily vary, and what is to be done must be 
so adjusted as to as nearly as possible, meet the demands of the hour. If we 
suppose a town or city in which preparation has been made for a possible 
visitation - where an active health board has taken time by the forelock - we 
will find a capable and energetic health officer, a more or less trained and 
fearless sanitary force; a detention hospital for homeless or other suspects 
during the period between arousing of suspicion and the time when the diag- 
nosis can be made certain; and apart, and some distance removed, a contagious 
disease hospital for treatment of the cases that proved to be genuine. An 
ambulance, or some other appropriate means for transportation of patients, 
must be provided and in readiness. Whether the patient is quarantined in his 
own home or in the detention hospital, all persons, however slight the expos- 
ure, are to be vaccinated. All those to whom the exposure is deemed in the 
least perilous are placed under strict guard, and all others, however remote the 
possibilities, are kept under observation. If the case in hand proves to be 
smallpox and the patient is taken to the hospital, dangerous clothing and 
bedding are burned and the house thoroughly fumigated, and every possible 
trace of contamination removed from the persons and clothing of the occupants 
that are to be continued in quarantine. The sanitary men thus engaged must 
be protected by either having had the disease or a very recent successful vacci- 
nation, and, when handling the patient or fumigating the house, should wear a 
complete outer suit of rubber clothing, including a rubber cap, with cape and 
face cover, and rubber gloves for the protection of the hands. The same is 
demanded of the attending physician, and this whole protection outfit is to be 
fumigated after each exposure, and thus kept in readiness for future service. 
All attendants, either at home or in the hospital, being continually exposed, 
must be protected by vaccination, or, preferably, should be those who have 
had smallpox. 
This recital, somewhat brief and incomplete in detail, serves to show the 
nature of the barrier to be maintained by the health department between the 
patient and the public, the omission of any part of which is fraught with 
danger. If, on the other hand, we supposed that a case occurs in which few or 
none of these preparations are made, embarrassment is found on every hand, 
but the line of action should be in accord with and as nearly as possible attain 
the same end as I have just detailed. A person having his own home may be 
quarantined there, and a little time taken to secure any protective articles that 
may be necessary, as well as the services of a physician, but he and all con- 
cerned should be required to observe the caution and care I have just indi- 
cated. 
The real difficulty, however, arises when the party is homeless, perhaps a 
stranger. Humanity and duty unflinchingly demand that he be cared for and 
the public afforded a full measure of protection. He may be found in a 
boarding house, a saloon, in prison, or anywhere; but wherever it may be, the 
health authorities are called upon to remove him at once. No family will 
accept him, and he can be forced under no man's roof. Tliere being no deten- 
tion hospital, no smallpox hospital, no sanitary force, they must be improvised. OHIO SANITARY BULLETIN. 
53 
A niedical man must be found who will take charge of the case, a cook and 
nurse who enjoy protection and are willing to undertake the service. These 
parties must be faithful, fearless and willing men-men of good judgment 
and steady nerve. An airy, a flighty or a drinking man will almost certainly 
lead you into difficulty. From a moderate experience I have learned to rely 
only on staunch, thoughtful and strictly temperate sanitary men. I have also 
learned that the larger part of those who offer their services are valueless, or 
worse, but in an emergency such as I have supposed, the best that can be done 
must be accepted and a sharp lookout kept to detect and correct negligence 
and any possible variation from strict duty. 
But to be more specific as to detail, the first embarrassment lies in determin- 
ing positively that we have a case of smallpox and nothing else. A stranger 
comes into your village. He is perfectly well at the time. After a few days 
he feels somewhat ill; suffers from headache and aching of the back, has more 
or less fever and a high temperature. All these indications may be slight. 
Presently certain spots appear about the face, and in a short time small papules 
appear on the forehead. He may or may not have some soreness of the throat. 
With the appearance of the papules he feels better. There is little in this and 
other symptoms to arouse the suspicion of an unsuspecting physician. If sus- 
picion is aroused, that is not sufficient; it must be a certainty. The first 
patient is to be treated as a victim of smallpox, or he is not, and even an 
expert hesitates until the vesicles form and commence to pit. Capable men 
have felt sure, sent the patient to an hospital, and have had occasion to bitterly 
regret it. Unfortunately a large portion of medical men have never seen a 
case of the disease, especially in its early stage, when accurate diagnosis is the 
all important question. The protection of a community demands that as few 
persons as possible should be exposed to a suspicious case, thus depriving med- 
ical men of an opportunity to learn that which they afterward may be blamed 
for not knowing. 
I have just stated that a suspect who has a home may be quarantined there, 
at least until it is clear that he is certainly afflicted with the disease; and it 
may be best under certain circumstances to continue treatment there. In the 
case of the homeless, who must be secluded, I can only suggest that possibly 
an empty house that is worth but little may be found, that is so situated 
that it would be appropriate for use. All that is absolutely necessary is to 
protect the patient from the inclemency of the weather for the brief period 
during which he remains a suspect. In the absence of such a house or shed, a 
good tent with fly might be quickly obtained that would in warm weather 
serve every purpose, and if supplied with a floor and stove and placed in a 
position that would protect it from chilly winds, would answer very well for 
the entire course of the disease. The attendants who have charge of the 
patient during this preliminary stage should be continued to the end; and if 
the detention hospital be used, the attendant there should go with him to the 
smallpox hospital as his nurse, thus saving the quarantining of one person. If 
either the old house or tent be used for detention, and the case proves to be 
smallpox, they should be thoroughly cleansed and fumigated, or, preferably, 
destroyed by fire. Of course there should be a free display of cards and a 
yellow flag plainly marked with the word "Smallpox," that all may be warned 
of danger. 
After death or recovery, too much care cannot be taken in destroying or 
cleansing and fumigating the building and all its appurtenances, including 
every article within or without the structure. In this particular I fancy that 
mistakes are liable to be made, and the work should either be done or overseen 
by an exceedingly careful, persistent and level-headed man. In fact, these are 54 
OHIO SANITARY BULLETIN. 
qualities required in all parties directly interested from the beginning to 
the end. 
As a substitute for an ambulance I have known a patient in the papular 
stage to be taken to an hospital in a buggy, having been dressed in a rubber 
outfit, as previously described, and a sanitary man equipped in the same man- 
ner acting as driver. 
In conclusion I desire to say that I have not attempted to lay down rigid 
and indexible rules, but rather to suggest what would seem best to be done, 
always remembering that circumstances alter cases, that to do the best that the 
situation admits of relieves the performers of all reasonable responsibility, be 
the results what they may; but, withal, urging health boards and health officers 
throughout the state to make such preparations as are possible before the 
calamity is at their doors. 
The Chair - The subject is now before you for discussion. Has anyone 
anything to say upon this subject? 
Dr. Probst-Mr. President: I wish, if possible, to emphasize one or two 
points made in the admirable paper just read. The doctor advises us to select 
only careful, temperate men for guards or sanitary policemen when dealing 
with smallpox. This is very important, as careless or drunken guards may 
themselves spread the disease. I have known several instances of this kind. 
A man set to guard a smallpox patient often imagines that he requires a little 
black jug to keep up his courage, or his circulation in cold weather. 
An instance at Akron shows how easily smallpox may be spread by careless 
guards. One case there was being guarded by a German who had had small- 
pox. There was also a German nurse who had had the disease. On one or 
two occasions, as we afterwards learned, the nurse came out of the house and, 
standing on the inside of the fence, talked to the guard who was outside. This 
guard carried the disease home to his wife. She had been well vaccinated, and 
had such a mild attack of the disease that no physician was called. They 
claimed, in fact, that they did not know she had the smallpox. A couple of 
weeks later her young babe, which had not been vaccinated, was taken sick, 
and had a severe attack of smallpox. A physician was then called, and it was 
not till then that the exposure of the guard to the nurse was known. Another 
lesson to be derived from this case is the necessity of vaccinating all members 
of the families of those who have in any way to deal with smallpox. 
Another thing with reference to guards and nurses should be remembered- 
we always select, where possible, those who have had smallpox. These persons 
should be vaccinated, for it is not so very rarely that a person has the disease 
a second time, and may thus spread it. One of the nurses employed as nurse 
at Akron, and who had had smallpox, contracted the disease from his patient. 
Fortunately he came down with the disease while still in quarantine. 
When you are quarantining a family at home, and guards are employed, OHIO SANITARY BULLETIN. 
55 
you should have both day and night guards. It is impossible, otherwise, to 
insure that someone will not enter or leave the house. 
I remember an instance at Pomeroy, during their smallpox epidemic, illus- 
trating this point: Two or three cases of smallpox occurred in a large family 
of Germans who lived in an isolated house on the outskirts of the town. A 
guard watched the house from daylight to dark. A week or more after the 
guard was placed there we found that the grandmother of the children who 
were sick went regularly to the house every night, and returned to her home 
before morning. 
It is only by the most careful oversight of smallpox cases that we can suc- 
cessfully quarantine this disease in the house of the patients. 
Dr. Hopkins, of Ashtabula - Mr. Chairman, I have been very much inter- 
ested in this paper. We had one outbreak of smallpox in our town, since I 
have been health officer, and we kept that in the home. We had at that time 
an old building that we called a pest house, and it was a pest, and thank the 
Loid it has burned down. But I have thought a good many times since then 
what would I do if smallpox should alight in our town. I have talked with 
our board of health and our council in regard to a detention hospital, or pest 
house. We have a population of about 10,000 or a little over, and I should 
like to know whether it is advisable for us to go to work and build a detention 
hospital, or whether, as suggested in the paper, we should get some old house 
or a tent or something of that kind. Of course we have come here to learn 
something and get some practical suggestions, and we certainly have got a 
good many out of this paper, and a good many from Dr. Probst. I would like 
to ask just one more thing. Dr. Probst says we should have our guards there 
night and day. I know I got a nurse to help out a family who had smallpox. 
She was not afraid of it, but she was one of the kind that needed a small jug 
to keep her from taking it, or to cheer her up, and one night the family 
reported that their nurse was gone. I scoured the town to find my nurse, but 
could not find her. I worked faithfully for several hours and finally gave it 
up. The next morning I found her and I tried to find everybody with whom 
she had come in contact. I vaccinated everybody I could find who had been 
in that part of the ward. I insisted that she must return. This she declined 
to do. Thereupon I told her that I would have to do something with her- 
that I should have to put her under arrest, and would make her all the trouble 
I could. She finally agreed to come back and did so. We were lucky enough 
in that case not to spread it. We had a guard on duty at all times, and it 
was in the dead of winter. You know we have got to have some place for the 
man to stand. In the evening, on that bitter cold night, our guard had a 
room just across the street, where he could keep warm, and still keep over- 
sight. However, he did not have his eye on that nurse I will promise you. 56 
OHIO SANITARY BULLETIN. 
The guard should have a temporary building right by the house in order that 
he can watch such cases, and keep people who are in the house from leaving 
the house and thereby spreading the disease, as is the case in a great many 
instances. I should like to hear from a good many others and their opinion as 
to whether it is wise to go ahead and put our city to the expense of construct- 
ing a permanent pest house. 
Mr. Shachleiter, of Ironton - Gentlemen, with reference to a pest house. 
I would like to know at Ironton what distance the pest house should be built 
from the city, and whether on lofty ground or on a meadow. There is quite a 
difference of opinion in reference to their location. We have several isolated 
places selected for a pest house, but we have not yet come to a conclusion which 
one to purchase. The trustees are in favor of dedicating a certain park out of 
the city for pest house purposes. In the discussion I would like to know the 
distance generally of those isolated places from a city, and also what mode of 
transportation is usually adopted to get back and forth. We should be very 
much pleased to hear from the Doctor in reference to the work there and else- 
where, so that if we apprehend any great epidemic we can be prepared for it. 
We live down on the Ohio and we cannot tell what may happen, but so far we 
have been very fortunate through the efforts of our competent health officer in 
seeing that we have a good sanitary condition existing in Ironton to avoid 
epidemics. 
Mr. Fee, of Warren - We had a little experience in the way of a pest 
house. A number of years ago, outside of the city we selected a place in 
which there was a beautiful grove, and it was only accessible by passing 
through the cemetery and across two railroads. The authorities built a 
pest house, a frame structure, one story high, and about 20 by 12 feet, plast- 
ered inside, windows and doors, and a partition in the middle, making two 
rooms. We supposed this to be ample for us in case of necessity, and kept it 
there in repair for a number of years. Fortunately we never had occasion to 
use it. The house has gone into decay, been injured very greatly by tramps, 
who frequented that isolated spot, and it has been a source of great trouble. 
They carried oft the windows and window sills and doors, and used them for 
kindling, and camping fires. We have repaired the building once, but I un- 
derstand that it is in a very deplorable condition today. 
Dr. Hedges, of Delaware - I was very much pleased with the doctor's state- 
ment. I think he covered most of the ground in reply to this question. As 
to the question of pest houses, I don't believe that small cities, or even large 
cities, can *maintain and keep up a pest house. I don't believe that it is neces- 
sary for a city of from 8,000 to 10,000 people to have a pest house. I am 
informed by members of the board of health at Delaware that two pest houses OHIO SANITARY BULLETIN. 
57 
had been built and were both destroyed - burned by somebody. The people 
naturally have a dislike for those things. Some one eventually will burn them. 
If you have a pest house the only thing to do is to have it occupied by 
somebody living in it who can take care of it. It is the only way you can 
keep up one. If a person has a good home the people can be isolated in the 
home. It has been done in our city, and without the spreading of the disease 
at all. A few years ago a man came to my office covered with smallpox pim- 
ples- a student in the university. I told him he had smallpox and advised 
him to go to his room and I would turn him over to the town authorities. The 
City Council took care of the case. The young man went to his room, and 
his room-mate remained with him and took care of him. The house was 
quarantined thoroughly and the young man was cured and there was no 
spreading of the disease. The student was vaccinated immediately, as was 
also the physician who attended the smallpox patient, and the disease was 
stopped there. Other cases have occurred in the city and been treated that 
way. 
A Member - The subject of a pest house or hospital is something I believe 
the majority of the smaller cities are considering at the present time. Our 
attention has been called to a hospital used by the German army. I will not 
go into details. It seems to me that somebody - some member of the State 
Board interested in the subject - should look into this matter more in detail. 
This hospital spoken of can be taken down and fumigated and made absolutely 
proof against contagion. I simply refer to this in the discussion. 
A Member - From a business standpoint I consider it a very important 
matter to look after the proper methods of taking care of and quarantining 
cases that may come to our respective towns. I think the matter of a tent 
hospital is a very good one, and I came to the conclusion that it was a most 
valuable way of taking care of most of these cases - think it makes a splendid 
temporary pest house. After you are done with it it can be thoroughly fumi- 
gated, so there is no possibility of contagion from it thereafter. For my own 
part, I think temporary hospitals are all that are needed. 
Mr. Wickham, of Findlay - Gentlemen, I want to say to you, in case we 
had smallpox at Findlay - arid I presume that a majority of the towns repre- 
sented here are in the same fix - that we have a number of vacant houses, 
large and small, standing in the suburbs of the town and isolated from one 
another, and I would say to our brother health officers, should they come to 
me, that I would seize one of those houses, and have it repaired if necessary, 
and use it for an hospital. And after the case had been disposed of, I would 
have it condemned and burn it down. 
The Chair - Gentlemen, the next subject for discussion is, "Well pollution 58 
OHIO SANITARY BULLETIN. 
in relation to typhoid fever," the discussion to be opened by Mr. Josiah Hart- 
zell, member State Board of Health, Canton. 
WELL POLLUTION IN RELATION TO TYPHOID FEVER. 
By Mr. Josiah Hartzell, Member State Board of Health. Canton. 
The existence of micro-organisms has been known ever since the discovery 
of the microscope in 1675. This knowledge had no special interest to physi- 
cians until about 1850, when DaVaine, a provincial French doctor, demon- 
strated that certain infectious diseases of animals are due to microbic action. 
It happened that one of these diseases - anthrax - was common to both 
animals and men. Thus was the key to facts underlying the germ theory 
given a real turn, and a new gateway, opening upon realms of unspeakable 
import to the human family, for the first time in the world, stood slightly ajar. 
Among thinking men there had been a settled belief that sudden and 
simultaneous outbursts of contagion were due to living, reproductive organ- 
isms. There had been, also, an indescribable craving and yearning for light 
and hope. Both came to those who grouped in the darkness, not with a 
flourish of trumpets on the mountain top, but hope with Jenner, the humble 
English doctor, and light with DaVaine, the equally humble French 
physician. 
Closely following the differentiation of the bacillus of splenic fever, and 
more especially after Pasteur had silenced the doubting Thomases by the 
crushing logic of his sterilized cultures, there was a tumult of prophecy. The 
bewilderment of immediate and unfulfilled expectation was fraught with dis- 
couragement, and theorists and anti-theorists pulled apart harder than ever. 
It was only another example of the niggardliness with which Nature doles out 
the treasures of knowledge from her storehouse of mysteries, and even then 
without permitting a "why" or "wherefore." 
We ask, why does the apple fall? Gravity. Why does gravity pull the 
apple down instead of up? That is the end. Again: Why is grass green ? 
Because of the action of the sun's rays on the clorophyl. Why does the sun- 
light turn the clorophyl green, instead of red or brown ? Again, we find the 
door slammed in our faces. Why does quinine neutralize malarial poison ? 
There is no response. Edison was not so far wrong when he declared that "we 
don't know the millioneth part about anything." The wisest men are those 
who know that they know the least. 
Thirty years of unremitting experiment and research had to elapse after 
DaVaine before the romance of the invisibles had been in any way pushed aside 
to make way for scientific truth. Then for a few years some of the authors of 
the woes of mankind were caught in pairs. First the inciting causes of leprosy 
and gonorrhoea in 1879; of typhoid fevei' and pneumonia in 1880; of con- 
sumption and glanders in 1882; of cholera and diphtheria in 1884. Since the 
date last named there has been but one addition to the list, namely, the microbe 
of influenza in 1892. 
It may be said that this rate of progress has been slow. Measured by our 
desires that is true, but the list of diseases that can be diagnosed by the miscro- 
scope is gradually lengthening. If an accounting is taken of the difficulties 
that have had to be surmounted, that which has been accomplished is the 
marvel of the closing century. The invisible world swarms with micro-organisms OHIO SANITARY BULLETIN. 
59 
whose functions are mostly benign. Their habitat is in the body and out of the 
body. Almost all the phases of organic life, of growth and death, of assimila- 
tion, of decay and rehabilitation, are due to them. If from these families of 
organisms, the numbers of which are identifiable only by infinitissimal, and 
almost indefinable traits, it has been possible to select out some of the culprits, 
and to fix their guilt by the irrefragible test of isolation in sterilized cultures, 
it has been due to deft hands, to an infinite patience, and to a faith and a cour- 
age which should challenge the admiration of the philanthropic heart. 
If statues and monuments have been built to poets, and statesmen, and 
orators, why not also to those who have placed the conservation of the public 
health on a rational foundation. It is time that our world of to-day abates 
something from its worship of the chiefs of war; of those who by the accident 
of battle, or by the skill of intrigue have filled historic pages, and bear a more 
willing testimony of gratitude to those whose mission it has been to save and 
not destroy. These, too, have fought a good fight. They have braved preju- 
dice. They have fought the invisible enemies of death, and have fought on 
while the world laughed. They have vanquished enemies ten thousand times 
more potent than the hosts of Xerxes and Caesar. They have chased away 
the blinding phantasms and empiricisms that enshrouded the foundations of a 
noble calling, and have thrust into their places the granite rock of established 
science. Into the world's life ; into the houses of the highest and lowest alike, 
they have flashed, not the lurid gleam of hate, nor the conscript's terror, but 
the glorious and healing gleams of safety and hope. 
These observations may be styled irrelevant. They are not. It is due that 
the instrumentalities that have rendered possible the rational discussion of a 
subject of this nature; that have ferreted out and exhibited to us the causes 
and results of certain phenomena, should receive proper mention. Typhoid 
fever is not the only water-borne, parasitic disease that may be derived from a 
well. In the interest of the conservation of health, the biologic origin of con- 
tagious disease should be adhered to; not letting go of experimentally estab- 
lished truth on the one hand, and not failing to seize upon every proper occa- 
sion to improve on the sanitary lessons which are warranted by such truth. 
Along the route of the inner lining of the alimentary canal are distributed 
from twenty to thirty generally circular patches, or aggregations of glands. 
These are called "Peyer's patches," in honor of their discoverer, Johan Peyer, 
a Swiss professor of eloquence and dissection, in 1653. In these later days 
one has to pause and hold his breath in admiration of the wide-apart functions 
which were so harmoniously fused together in the person of Professor Peyer. 
His eloquence, like that of myriads of others, has died away with the sound of 
his voice, and, but for the encyclopedia, would have long since been forgotten ; 
but his anatomical discovery, linking his name with the development of science, 
has assured the perpetuation of his memory in the hearts of the benefactors of 
mankind. He was the Stanley who explored the darkest recesses of the ileum, 
while Eberth, with the instinct of the true naturalist, pointed out the formid- 
able propensities of certain organisms if they were carelessly given admittance. 
In a recent address by Dr. S. P. Wise, a member of the Ohio State Board of 
Health, it is intimated that the Eberth microbe has some very wicked partners. He 
does, however, emphasize the fact that that, whether it be the chief, or only a 
partner, that engages in the business, the lesson is just the same. All have 
the same tendency to fix their homes in such soluble, decomposing organic 
matter as may ultimately float them over the patches of Peyer, and all, alike, 
give a wide berth to the homes of the clean. 
These patches are most numerous in the ileum, hence the tenderness of 
typhoid patients in the right side, where these inflamed and ulcerated patches, 60 
OHIO SANITARY BULLETIN. 
or glands, are, to use a common phrase, the favorite feeding-ground of the 
bacillus typhosus. 
All living things have their preferences in the way of alimentation and 
reproduction, and the invisible bacterial family is no exception. The inciting 
causes of leprosy, of pneumonia, of phthisis, of cholera and of diptheria have, 
each one of them, their organs, or set of organs, which constitutes their strong 
citadel, and in which, when once intrenched, they elaborate those formidable 
poisons which heavily tax, and perhaps destroy, the vital powers of their most 
unfortunate victims. 
I quote from Sternberg's recently published "Manual of Bacteriology" as 
follows: 
"Eberth demonstrated the presence of the typhoid bacillus in the spleen 
and diseased glands of the intestine in 1880. The disease is due to a micro- 
organism which is capable of multiplication outside of the human body in a 
variety of media, at comparatively low temperatures, and is widely distributed, 
and is a hardy microbe. Eberth's bacillus complies with all these conditions. 
"The pathogenic power of this bacillus depends on the formation of a 
ptomaine rather than upon a special faculty for multiplying in the tissues of 
the living animal. This bacillus retains its vitality for many months. Stern- 
berg preserved bouillon cultures for more than a year in hermetically sealed 
tubes, and found that development occurred promptly in nutrient gelatine 
inoculated from these." 
Speaking of disease transmission, Sternberg says: "Among the pathogenic 
bacteria which are liable to find their way into drinking water, the most impor- 
tant, from a sanitary point of view, are the bacillus of typhoid fever and the 
spirillum of Asiatic cholera. Both of these micro-organisms are present in 
great numbers in the excreta of persons suffering from the specific forms of 
disease to which they give rise, and are consequently liable to contaminate 
wells and streams which receive surface water. Epidemics of diseases have 
been frequently traced to the use of such contaminated water. Laboratory 
experiments indicate, however, that continued increase of these pathogenic 
bacteria in drinking water is not likely to occur, except under special con- 
ditions, and that they die out after a time, being at a disadvantage in the 
struggle for existence constantly going on among the numerous species which 
have their normal habitat in water." 
rhe inciting cause of typhoid fever is, therefore, a micro-organism. Microbes 
are very small, varying from a 500th to a 50,000th of an inch in length. The 
bacillus of Eberth is about half way between. They can hardly be classified 
as vegetable or animal-they are microbes. Water carries them long distances, 
and they may live a long time. Prudden found them alive after being im- 
bedded in ice thirty-seven days. Warmth and the presence of organic matter 
promote their growth. A bacterium will divide into two in an hour; these 
two become four in another hour - a rate that gives 17,000,000 as the increase 
of one day. In less than five days they would, at the same rate, fill all the 
great waters of the earth. 
But they have their enemies. Pasteur found that oxygen attenuates and 
extinguishes them. As we ascend the mountain, or push out into the sea, the 
air-borne microbes become fewer and fewer. In midocean and on the mountain 
top the air is freed of their presence. Also the waters of deep springs and 
artesian wells are generally found to be meagerly peopled by water-born 
micro-organisms. 
On the other hand, river and other surface waters swarm with them. Stag- 
nant and defiled waters constitute their ideal habitat. Filtration through sand 
beds and porous porcelain is ascertained to have reduced the proportion of OHIO SANITARY BULLETIN. 
61 
them, sometimes from forty-three to one. Of course, boiling and distillation 
kill them. 
Three-fourths of the weight of the human body is water, a mineral which 
becomes fluid at a lower temperature than most minerals, and stays melted, 
like quicksilver, at ordinary living heat. It not only constitutes part of the 
body, but it is the mechanical agent for the admission of nutrition into the 
body; it distributes the same to its various destinations; it gathers up and 
carries away the debris. And yet water receives as little, and often less, atten- 
tion than anything about the house. There are those who, in these later days, 
filter or boil where there is the slightest suspicion; but they are, comparatively, 
the rare exception. Outside the city supply, and often inside its reach, the 
well is depended on for drinking water, and contaminated wells constitute a 
prolific source of disease. The general subject of wells can be reviewed more 
intelligently after presenting a few examples, or modes of water infection. 
More than fifty years ago, in 1843, the little village of New Boston, Erie 
County, New York, furnished the most striking illustration of the dangers 
that may lurk in such a well as that just adverted to that has yet been re- 
ported. A young merchant had bought goods in New York City and was 
returning home westward by stage coach when sickness compelled him to stop 
at the village tavern, where he died of typhoid fever. Two weeks later there 
were sick persons in every family of the village except three Of the forty- 
three inhabitants composing the village twenty-eight were sick and ten died. 
All the families got their drinking water at the tavern pump except the three 
families above referred to. The three families that escaped were those of a 
father, his son and son-in-law. The father had had a quarrel with the land- 
lord, and thereafter he and his avoided both the landlord and his pump. The 
landlord brought suit against his enemy for poisoning the well. Dr. Austin 
Flint, of New York City, was sent for. 
Dr. Flint was one of the early pioneers in that field of investigation which 
occupies your attention here to-day. He was a representative of those ad- 
vanced thinkers who believed that contagions were due to a cause common to 
all; in fact, were due to air, water or food that had been infected by specific, 
living, reproductive micro organisms of greater or less virulence. Both he 
and Gerhard and Pennocke, of Philadelphia, and others that might be named, 
on both sides of the Atlantic, had publicly sustained the germ theory - only a 
theory then - by arguments that left a profound impression. They must not 
be forgotten. If the methods employed by modern state and local health 
boards have anything in them worthy of commendation; if the destroying 
angel has turned a more kindly face toward the children; if men sicken less 
and live longer; if cholera has been barred out of enlightened society; if the 
pestilence that stalketh at noonday has been pushed back into his lair and 
shorn of his mysteries and his terrors by the sharp scimeter of experimental 
truth, then let us not forget the early watchmen who, from out of the night of 
fear and ignorance and superstition, hailed the first dawn of a new era and 
electrified their fellows by pointing the finger of well-grounded prophecy to the 
aurora that streaketh the approaching day. 
Dr. Flint's investigation established the following sequences: The dejecta 
of the fever patient had been thrown into the privy pit. The latter was a 
pocket in the sand, its bottom only a few feet above a clay-seam; its leachings 
reached the clay-bed and ran along seventy-five feet to the well. The inner 
surface of the well, at the depth of the clay, and from that point down to the 
water, was coated over by a greenish-brown streak of filth. The well was 
closed and the fever stopped. The man who had been accused of poisoning 
the well had a good case for damages for slander, and did commence proceed- 62 
OHIO SANITARY BULLETIN. 
ings, but in view of his complete vindication by Dr. Flint, and of the calami- 
ties that already overwhelmed the community, he voluntarily relented. 
Scarcely second to the above in dramatic incident was the experience of 
Lausen, a Swiss village that was suffering sorely from an epidemic of typhoid. 
The water supply was a spring bursting from the base of a mountain, noted 
far and wide for its beauty and purity. Certain observing persons had noticed 
that the volume of its water swelled and shrank according as there was high or 
low water in a stream running through a valley on the other side of the moun- 
tain, several miles away. In a hamlet on the bank of this stream there had 
been a fever epidemic. The scoffers scoffed, but the aforesaid observers threw 
flour into the stream. The spring was not affected. The insoluble suspended 
particles were detained by the earth-filter. They then threw salt into the 
stream, and the spring promptly became salt water, clearly showing by what 
route the fever which prevailed in the village had reached the city. 
Parenthetically, it is worth while here to remark that while salt ceases to be 
appreciable to the taste when diluted in water beyond the ratio of 426 parts to 
one, there is now in use in Germany a new disinfectant, and detective as well, 
named saprol, which, being thrown into the privy vault, reveals whether wells 
are affected by soakage with much certainty. Both the smell and taste of this 
chemical are perceptibly present when it has been diluted in the proportion of 
2,000,000 parts to one of water. It is the everlasting, untiring German who 
keeps "pegging away, and pegging away," and thus, now and then, bringing 
to light new safeguards to health and life. 
A visitor carried the fever to Iron Mountain, Michigan. From him it 
reached a well, and from this well it went, through a sandy seam, to all the 
wells in the town, carrying sickness and death on its way. 
In digging a deep sewer trench in Canton a strong water-seam was encount- 
ered, and the wells supplying a row of houses on a street lower down promptly 
went dry. If, on refilling the trench and restoring the water, the fever had 
subsequently broken out among the residents of that street, the old way would 
have been to attribute the calamity to inscrutable Providence, instead of to a 
leaky sewer. It would have been, in fact, not the act of God, but the lack of 
God's pure water. 
A young man who had spent the holidays in Philadelphia returned to his 
home, located on the banks of a stream several miles above Plymouth Penn., 
in January. Among the things he took home with him from the city were the 
seeds of typhoid fever. His dejecta were thrown out upon the snow. It was a 
rough, sparsely settled region, and a thaw in March washed the hillsides oft 
into the stream. A month later there had been eleven hundred cases of fever 
and one hundred and ten deaths in Plymouth. The wells in the town were 
dug in the sand, their water-levels rising and falling with the volume of the 
river. The users of well water were stricken the same as the rest. 
Dr. Ashmun, formerly health officer of Cleveland, visited a house in which 
fever was present. Finding the cess-pool full he ordered it to be emptied. As 
the level of the contents of the pool went down, he noticed that the water in 
the house well subsided also. Further inquiry established the fact that this 
criminal intercourse between wTell and cess-pool had been going on for a long 
time and had borne large fruitage of disorder and death. 
Only several months ago a spring broke out of the mountain side close by a 
hospital near San Francisco. The water was clear and there was great joy 
among the officials, who ordered the new spring to be safely guarded. Dr. J. 
R. Laine, secretary of the California State Board of Health, aware of the 
little likelihood of such a spring; and also knowing the route of the hospital OHIO SANITARY BULLETIN. 
63 
sewer, suggested the possibility of a leak in the latter as the source of the 
spring. There was a leak. It was-repaired and the spring went dry. 
In one of Dr. Probst's missionary tours he found a village located on a bed 
of porous limestone, only a few feet from the surface. Excavations in this 
rock constituted both wells and privy vaults. Twenty-one years of health 
were succeeded by seven years of fever. The doctor prescribed the dry-earth 
system, instead of vaults below, and for the surface above the removal of all 
garbage and manure. The good gospel of cleanliness bore fruit in complete 
salvation. 
It may be here remarked that the water from wells in New York City has 
been found to be polluted at the depth of 1,000 feet, because the dip of the 
rock is nearly vertical; while that from only a few hundred feet below Paris 
and London is pure, because the rock-seams are horizontal and the water comes 
from a distance. 
As a result of the information gained and published there has been, on the 
part of thinking people, a decided interest taken in the subject of drinking 
water. I say thinking people; and these are as one to one hundred of those 
who act from impulse only. Therefore this phase of educational campaigning 
has barely commenced. 
Even these few thinkers have commenced their thinking none too soon. 
While the country remained sparsely settled and agriculture absorbed the 
attention of the great body of the population, dangers to drinking water were 
comparatively rare. In emerging from country to village, and from village 
into city, personal environments are changed. Farmers may do, and keep on 
doing, things which urban residents may not do. The city affords superior 
advantages and attractions. It is also the target for many venomous foes from 
which the ruralist goes scot free. Many suppose that they can go on living in 
the city as they did in the country, and their children after them, taking no 
other precautions to insure their health than before. This would be a great 
mistake-a fatal mistake. If persisted in either they or their successors will 
pay the forfeit with their lives. It is a fact to be well remembered that with 
people came trouble, and in swift ratio. The hardest enemy we have to fight 
is ourselves. 
When the attention of reading men had been once fixed on the subject by 
published investigations there was a sudden and simultaneous outburst of 
literature on the subject of water contamination. Physicians, and occasion- 
ally other people, had hundreds and thousands of cases to report; epidemics, 
the inciting causes of which had been beclouded in mystery, but now new 
truths and a new dispensation had partially lifted the clouds and gave promise 
of a brighter day. I have presented a very few of the published cases, select; 
ing the same with the special purpose of exhibiting some of the incidents which 
may lead to the infection of a well by Eberth's bacillus, and showing that the 
poison may, as the result of carelessness, enter the well in each one of the 
following methods, namely: It may enter the well at the top, or it may go 
from a cess-pool and enter at the side or bottom; it may go from one to the 
other through many feet of limestone rock; it may descend 1,000 feet through 
a seam in the rock; or it may reach the interior by leeching down from the 
surface; or it may travel from one well to another on the same water-bearing 
seam; or it may break through a leak in a sewer and emerge as a surface 
spring; or it may sail down a river two miles and then pass into wells located 
near the water stream; or it may travel an equal distance under a mountain 
and emerge on the other side fully fanged for the work of human destruction. 
As I have already stated, the examples presented above were chosen with 
the design of illustrating certain modes of transmission. Because typical cases 64 
OHIO SANITARY BULLETIN. 
were taken it must not be inferred that new ones are not occurring. The con- 
trary is true. Here are some that have fallen under my eye very recently: 
" Indianapolis, Ind., November 7.- Reports to the State Board of Health 
from different sections of the state indicate an unusual amount of typhoid 
fever as a result of the low temperature and bad water during the summer. 
In many counties the mortality reaches from 33£ to 40 per cent, of the cases 
reported." And so on, showing up a sad state of affliction. 
"London, December 12.-The origin of the typhoid fever epidemic that 
raged here for several months has been discovered. A delegation of health 
officials got wind of something wrong on a watercress farm. They paid a visit 
to the farm and made the extraordinary discovery that the water that flowed 
through the ditches for the propagation of the cress was strongly permeated 
with sewage, and that consequently the germs were absorbed by the plant and 
thus likely to be communicated to the individual partaking of the cress." 
"Middletown, Conn., Dec. 4.-An epidemic of typhoid broke out among 
the students of Wesleyan University, and its cause has been carefully traced 
by Dr. C. A. Lindsley, Secretary of the State Board of Health, working in 
conjunction with others, to oysters eaten by the students. These oysters were 
placed for a time in a fresh water creek at New Haven for refreshing and fat- 
tening, within 300 feet of the outlet of a private sewer from a house where 
there were two cases of typhoid." 
These three are only a tithe of the aggregates, but consider what they repre- 
sent I More than a hundred deaths; more than a thousand sick beds ! Think 
of the loss to society; of the inexpressible sorrow to the homes! And all this 
might not have been-would not have been, had intelligent precautions held 
the places of carelessness and ignorance. With what new and startling signi- 
ficance does the mind revive the opening paragraph in one of the reading les- 
sons of boyhood : "We must educate ; we must educate! " 
There is a town in Ohio noted for the intelligence of its people. Its well 
water formerly came from wells about 30 feet deep, with a shelving rock 
bottom. There was no live water-all was leechings. In time typhoid declar- 
ed its presence. Water works were built, the supply being taken from a large 
hole dug to a low pocket of the shelving rock. This drained the wells above, 
and underdrained the town. The fever went right on. Some of the proprie- 
tors whose wells had been drained by the water works well, excavated pockets 
in the rock in their well-bottoms, thus catching and retaining es much of the 
drained water as possible for their domestic use. They suffered from typhoid the 
same as before. Dr. Probst advised the town to get a better water supply 
years ago. It was not done ; neither has the fever relaxed its attentions- 
especially has the year just passed been fraught with heavy calamity. 
The most stunning recent indictment of typhoid-breeding wells is a docu- 
ment entitled : "Typhoid Fever in the District of Columbia, by the Medical 
Society of the District." From this report, which is startlingly precise in its 
statements, it appears that the fever rate of Washington is one of the highest. 
The Capital City of our boasted republic! "'Tis strange, but 'tis true, and 
pity 'tis, 'tis true." Red spots on a good city map show the lots on which there 
have been deaths from typhoid between 1888 and 1892; blue spots indicate 
the locality of public wells ; and other spots show the place of each privy. 
The ratio of frequency is almost exactly the same in all. 
While it would seem to be almost impossible to exterminate the zymotic 
diseases with a known cause as completely as theory would indicate might be 
possible, and while this is especially true of typhoid fever, the success of intel- 
ligent effort in exterminating these calamities, constitutes one of the most 
hopeful and glorious pages in modern history. Thorough purification is the OHIO SANITARY BULLETIN. 
65 
key to that success. There is no half-way house. The soil is the foundation. 
Clean the soil and then you will have pure water, and air fit to breathe. Take 
the cases of Memphis and Vienna: 
Memphis washed and scrubbed in '78, the first of her two cholera years. She 
was the cleanest city in America. It was a surface polish. The plague re- 
doubled its onslaught in '79, nor would it stay its hand until the streets had 
been ripped up and the wells and cess-pools abolished together. 
Vienna, with excellent sewers, had a death rate from dysentery of 70 per 
1000. With the introduction of spring water the rate fell to, and remained 
at, about one per cent. Brooklyn, with good sewers, and water double-filtered 
through the sands of Long Island, has the lowest typhoid death rate in 
America ; and Washington, with many bad sewers, and many wells, has one of 
the highest. 
There are wells and wells; wells which supply water drained from the con- 
tiguous surface area, and wells furnishing water from a distance. The latter 
may be classed as springs; springs whose source is relatively high, as in the 
case of artesian wells ; springs which are popularly known as such, and whose 
supply-source is about as high as the point at which the water emerges from 
the earth. As the source is generally lower than the surface, so a well has, 
in most cases, to be dug in order to reach the water level. 
Every dug well is a drain for the reception of water from the surrounding 
earth. The impurities will go along, unless filtration takes place. The filter- 
ing may be effective for a time, but the fouling process reaches farther and 
farther down, year after year, until the water is reached. At considerable 
depths below the surface the oxidation, which near the surface keeps the 
filter effective in intermittent filtration, goes on slowly, or not at all. The 
action of the earth is mainly that of a sieve which removes only suspended 
impurities. Whatever is in solution remains in the water. Mineral waters, 
heavily laden with soluble salts, as well as waters thoroughly impregnated with 
cess-pool or barn-yard products, may be as clear as crystal, sparkle temptingly, 
and taste well. Clearness is no proof of purity. 
For every foot of the well's depth it will drain from three to six feet in 
width, owing to the nature of the soil. A well 25 feet deep will drain the 
surface from 50 to 200 feet in all directions. If it reaches or penetrates a 
shelving rock or clay stratum it may receive leeching waters from a cess-pool 
or barn-yard 1,000 feet away. 
A dug well is rendered more susceptible to injury than a driven well by the 
double fact that it is a more capacious drain and a poorer filterer. Copious 
wetting, or rains, carry impurities farther down, also bring the water-level up, 
thus facilitating an evil contact. When once infected the period of drouth 
and consequent low water is most dangerous, owing to the greater concentra- 
tion of the contents. The low water period has been the most fruitful of 
epidemics. 
The presumption should be that'water coming from the sky above and from 
the depths of the earth is good. Rains over cities bring down plenty of non- 
pathogenic germs, but is not generally liable to objections which cannot be 
corrected by a good filter. If well water is from a live source, that is, if it 
comes from a distance, and if its impurities are only dissolved minerals, not 
sufficient in quantity to affect its palatability, then it is presumably good. The 
general supply from wells is of this character. 
There are on record some notable cases of the restoration of infected spring 
and well water to purity. In a wide valley in England the rural inhabitants 
had been supplied by underground water, partly from artesian wells, partly 66 
OHIO SANITARY BULLETIN. 
from springs and partly from dug wells. On each lot, as in this country, 
there was a privy to carry things down, and a well to bring the water up. 
After centuries of earth defilement this water stratum became polluted. 
Diarrhoeal diseases made it evident that no part of the valley was exempt. 
The protection of the soils and streams of the drainage district by police 
authority has resulted in lowering the sick and death rate to a degree which 
indicates a wholesome water supply as the benign result of burdens and restric- 
tions which aroused great opposition in England, and the application of which 
would be impossible under the constantly changing regime of our political 
system. 
Statistical reports showing the benignant fruits of the purification of water 
are more abundant than they used to be, and yet comparative views indicate 
that only a beginning has been made. We all think of war as a thing full of 
horrors. In twenty-two consecutive years of war England lost 79,700 lives. 
An epidemic of filth disease carried off 144,000 lives in one year. In the five 
years of our civil war 500,000 lives were lost. In an average of five years 
more than S00,000 persons died of preventable diseases. 
Tables are often seen showing death rates before and after the taking of cer- 
tain sanitary precautions. These tables show the saving of a great many lives 
that would otherwise be lost. In nine cases out of ten the resultant lessons 
from these tables is predicated either upon a change of water supply or on 
some other phase of effort having an ultimate relation to the subject now 
under review. 
Long before the discovery of any of the baleful micro-organisms, Dr. Ben- 
jamin Rush said: "The means of preventing pestilential fevers is as much 
under the power of human reason as the means of preventing the evils of 
lightning or common fire." Dr. Rush is reported to have also said that when 
a case of typhoid developed an indictment of somebody should follow. Rail- 
roads and other corporations are required to exercise due diligence in protect- 
ing against personal injury, and society may sometime demand that corporations 
exercising a wider scope of power shall be held responsible for permitting the 
existence of any cases of filth disease. 
Healthy living not only lowers the death rate, but also promotes immunity 
from disease. This was clearly proven by Dr. Wise in his article above referred 
to. The infection first weakens, then kills. Whatever cause saps vital resist- 
ance, pushes the door open so much wider. The women and children of 
Plymouth were just emerging from the confinement of a long and rigorous 
winter, with its consequent vital depression, when the enemy stole among them 
and laid waste their homes. 
In taking this cursory review of the relations of wells and typhoid fever I 
could not know what special lesson those who assigned me the subject desired 
to have taught. They certainly expected the suggestion of no specific remedy. 
That is clearly impossible. There are as many wells as houses. The differ- 
ences in situation are infinite. Many phases can hardly be touched upon, such 
as rainfall, evaporation and absorption, geologic formations; tests of waters; 
mechanical filtration ; relations to the subject of diarrhoea, dysenteries and 
lowered vitality which precede typhoid, and the general subject of resistance 
and receptivity ; cost of doing, or not doing; co-operation in cleanliness ; is the 
infection air-born as well as water-born? are animals susceptible to it? rela- 
tions to water supplies and sewers in cities. 
Efforts to suppress an epidemic are occasionally favored by an accident. 
Between July 7th and September 7th, 1873, there were 107 cases of typhoid 
at Arinley, England. The health officer found that all the cases occurred on 
the rout of one milk dealer. Milk is only rarely accountable for the disease. OHIO SANITARY BULLETIN. 
67 
The health officer chained and locked the milkman's pump handle. The handle 
stopped, and so did the fever. 
First of all it might incidentally be said, and should always be said, isolate 
and disinfect. These things will not be neglected by any physician worthy of 
the name. Give to charlatans and mushroom sanitarians a wide berth. If you 
have given due attention to the subject of healthy living, if you have been 
spreading the gospel of pure air, pure water and pure soil, you will know that 
the prime factor in locating your well is its surroundings. An ounce of preven- 
tion is worth a pound of cure. Let no puffed up conceit about looks and taste, 
or forked-stick oracle, lead you to ignore the environments of your well. Even 
a chemical analysis should not blind your eyes to surroundings. It is of little 
consequence to know exactly how many grains of earthy alkaline salts are in 
the water; but don't drink water that comes from under the city, or the barn- 
yard, or the cess-pool, or factory. Eliminate surface wash and impurities by 
filtering, and sterilize if possible danger by boiling. 
If the typhoid poison is in the vicinity, boil and filter-distill if possible. In 
case of doubt get the opinion of a chemist. There is no chemical, or patent 
nostrum, which, by addition to a polluted water, will make it pure and whole- 
some; but a correct analysis will dissipate mystery. Aeration, sedimentation 
and Alteration will not render fever-tainted water safe. Boil it also until a 
pure supply is made available. 
The safest general prophylactic is a sound common sense, grounded on a 
knowledge of what typhoid fever is, and its possible methods of transmission. 
It is an ubiquitous foe. It has every country, and season, and clime, for its 
own. The campaign against filth and disease, and in behalf of pure drinking 
water, should have universal co-operation. Forewarned by the lessons of the 
past, and forearmed by a stout determination, and sustained by an enlightened 
and discriminating public, the enemy can be kept at bay, and victory will 
crown the efforts of those who deserve it. 
It is true that great men, following the lead of Jenner and Pasteur, are 
making grand discoveries which tend to place therapeutics among the exact 
sciences, but they are only the advance guard in this most noble crusade. If 
the invading enemy is to be overthrown, it must be done by the local board of 
health. To the real student of this phenomena nothing can be of more point- 
ed interest than the reports of our health boards. One officer named eight cases 
of scarlet fever as having occurred in his town, but said "they were too mild 
to report to the local board." This was in 1892. In 1893 there were 27 cases 
of the same fever in the same town. Scarlatina may be mild, but never too 
mild to report. Another report concludes with this admirable statement: "All 
■contagious diseases have been cared for, and we know of no instance where 
infection has been carried outside of the houses in which the disease originat- 
ed." And still another secretary of a local board, reporting on six cases of 
typhoid fever in six houses, says the precautions taken were : 1st, boil all 
water ; 2d, give patients their own dishes and scald after using; 3d, no person 
to eat anything in the sick room, or that had been there; 4th, disinfection of 
soiled clothing and excreta." Useless to say that there were no secondary 
■cases either in or outside of the six houses. Again I say that if this is 
to be a millenium of good health it must come through you, the representatives 
of the local boards of health. To you it is given to enforce the old English 
common law of cleanliness, viz: the law that no man has a right to injure his 
neighbor. The great discoverers may plant, and state boards may water, but 
you must give the increase. It is you who have been placed on guard over 
the homes and lives of the people. When the insidious foe creeps in, and 
danger threatens, fail not, and fail never, to fling out the red flag of impend- 68 
OHIO SANITARY BULLETIN. 
ing calamity, and thus assure safety to society, and to yourselves the grateful 
remembrance of your fellowmen. [Applause.] 
Dr. Garrigues, of Massillon - Mr. President, I have listened with a great 
deal of interest, indeed, to the article read by Mr. Hartzell. I think a great 
many points of much interest are contained in the article, and the gentleman 
most certainly has my thanks for the very able article he has written, and I 
expect he has the thanks of every person present who is interested in these 
matters. 
Dr. Young, of Chicago Junction - I would like to relate something con- 
cerning five cases of typhoid fever in our town. The house wherein the first 
case occurred was directly back of my house. Our water supply is from 
cisterns. The first case was an old German lady, who complained of diarrhoea, 
but she recovered after being sick some time, and in twro weeks from that date 
a son-in-law was taken sick and died from hemorrhage of the bowels. The 
slops, etc , were carried around to the side of the house and thrown onto the 
ground-the discharges from the bowels and everything else. His brothers 
went there to take care of him. Two brothers died, and there were five cases 
altogether in the family and four deaths. There was a defective cistern there, 
and there can be no doubt but that that was the way the sickness was caused- 
from drinking impure water. 
Mr. Carey, of Wilmington-Gentlemen, I am not an M. D.; simply presi- 
dent of the local board of health of my town, and I would like to ask what 
would be the proper course to pursue in a case of this kind: Suppose a health 
officer wanted to inspect a well. Where would be the proper place to have the 
examination made, and what authority should pay for it? 
Dr. Probst-There is no provision in the statutes for such cases, and unless 
local boards are prepared to pay for such examinations, I don't know what to 
suggest. I mean to say, there is no fund set apart for that purpose that we 
could use. In the State of Michigan they have a laboratory connected with 
their college at Ann Arbor, under the direction of the State Board of Health. 
Anyone can send in samples of water, or anything of that kind, and a proper 
examination is made by the authorities. It would be an excellent thing, in- 
deed, if the people of Ohio could see the advantages of having such facilities 
here. We have arrangements with a chemist who does work at very moderate 
rates, and occasionally have examinations made by him. It is not always pos- 
sible to tell whether a well is polluted with typhoid fever germs. There is 
some doubt as to discovering the germs by bacteriological examination. 
Mr. Walton, of New Burlington - I simply want to say that I have been 
very much interested in Mr. Hartzell's paper, and am somewhat surprised at 
the power of the bacilli to penetrate the earth. We have been troubled on OHIO SANITARY BULLETIN. 
69 
account of shallow wells in some parts of our township. In some localities 
where those shallow wells are we have dug through from four to six feet of 
loam and clay, striking a bed of gravel, which varies from twelve to thirty 
feet. At the bottom of the gravel a reasonable supply of water is found'- 
sufficient all the time except during extremely dry seasons. In some localities 
during the dry season typhoid fever has appeared. We thought there might be 
a remedy for this by penetrating the earth deeper, and a couple of persons 
drilled two wells in one of these localities, going through the clay some thirty 
feet, and drilled the other one into a fine sand, from which came an abundant 
supply of water, so that all surface water was shut off, and we find that it has 
been of great benefit to the neighborhood; at least, there has not been much 
typhoid fever since that was done. We supposed, naturally, that it would shut 
off all this source of disease, and we hope it may. We had a family in the 
village using water from a surface well, a well supposed to be pure, good 
water, coming from pure, clean gravel, and yet the whole family became sick, 
six or seven of them taking typhoid fever. That family has been using water 
out of one of those deep wells since, and they have had no trouble or sickness. 
I feel that where this can be done it is a good thing. 
Dr. Hoover - Before referring to the paper, I want to say a word or two 
that I think is proper at this particular time. I hope that no township officer 
who is interested enough in sanitary affairs to come here feels that we expect 
him to say nothing simply because he is not a doctor. One of the most grati- 
fying evidences that the doctors have been able to educate people up to the 
necessities of these things, is that a great many of the best sanitary officers 
that we have in this state are not professional men, but laymen - men who 
are, in their walks in life, of the same class as the man who has just read this 
paper, which was so excellent in every way. He is a man who has given a 
great many years to the study of sanitary matters, and you can see from the 
character of his paper that he has studied for a very wise purpose. It was an 
excellent paper, and covers a great deal of ground. I only want to say that I 
am in hearty accord with the views promulgated by Mr. Hartzell in his paper; 
that we cannot help but believe that one of the most prolific sources, among 
numerous others in this country, of typhoid fever, is through the water 
supply. There is no doubt about it. It is an appalling thing when we think 
of it. We cannot get along without water. We are so constructed that water 
is an essential to the physiological functions of the body, and yet we are going 
right ahead with our eyes wide open and persistently and continuously polluting 
our very source of life. There is not a stream in the State of Ohio that is big 
enough for the outlet of a sewer that is not used for that purpose. I am firmly 
of the opinion, gentlemen, that municipalities, wherever it is possible, should 
have a public water supply, and that supply should be selected with special 70 
OHIO SANITARY BULLETIN. 
reference to its fitness. I believe that wells, in small towns and villages even, 
are a menace to health, and cannot be otherwise. Especially is it the case 
when we take into consideration the abominable methods that have been in 
vogne, ever since communities began to form, for the disposal of night soil. I 
know in country towns the world over the common practice is to dig a square 
hole in the ground for a privy vault and set a small frame structure over it, 
and when the vault is filled within a short distance of the surface, the house is 
removed to another vault and the old one is filled up to the common level. 
They may escape for an indefinite length of time, but finally they will pay the 
penalty for their carelessness. 
Dr. Probst has reminded me of an incident that I had forgotten. Some 
cases of typhoid fever occurred in a certain house. The sanitary inspector 
was sent to investigate the premises, and found that this family were using 
water from a well on the lot, the privy vault only being 30 some odd feet 
away. It was a very deep well, some 35 or 40 feet in depth, and you know 
that a well will drain for quite a large area around it. He very carefully 
made measurements, reported the well and condemned it. He did not ascer- 
tain that there was another vault on the adjoining lot within ten feet of the 
well. 
About ten years ago I traced nine cases of typhoid fever to a well at East 
Park Place. It had been one of the sources of water supply for the old 
Central Ohio Lunatic Asylum on East Broad Street. When that was burned 
down, the grounds were converted into building lots and this old well was left 
open, and was so located that it came on the line of the street, within the 
pavement line, and was left there and used by the public I traced nine cases 
of typhoid fever one season directly to that well, and finally succeeded in hav- 
ing it abandoned and filled up. 
Dr. W. S. Bookwaiter, health officer, of Miamisburg, not being present, the 
subject assigned to him, namely, "Do hogs fed upon offal from slaughter 
houses, afford wholesome food for man ? " was not discussed. 
Dr. Hoover, of Columbus - Mr. President, I am going to ask a favor of 
the convention. I do not like to do it, but I am so situated that it is impossi- 
ble for me to be here this afternoon. I am on the program to discuss the sub- 
ject of Expenses of Boards of Health. It will not take me over ten minutes 
to say all I want to say with reference to this matter, if I may be permitted 
to consume that much time at this time. [Cries of Go on 1 ] 
Mr. President, I feel very grateful, and haven't very much to say on this 
subject. I was assigned to this subject by the secretary. He is the autocrat 
of the board of health, and whatever he says we have to do. [Laughter.] We 
know better than to refuse. In order to introduce this subject, I want to call OHIO SANITARY BULLETIN. 
71 
your attention to the sections of the law, which provides for the payment of 
expenses of boards of health, and I am going to do it as briefly as possible. 
In the chapter of the Revised Statutes which directs how the levying of taxes 
shall be performed, the section starts off as follows: 
"Section 2683. In addition to the taxes specified, in the last section, the 
council in each city and village may levy taxes, annually, for any improvement 
authorized by this title, and for the following purposes: " 
Sec. 1. Does not concern us. 
Sec. 2. For sanitary and street cleaning purposes, and for street improve- 
ments and repairs. 
Now it is not necessary to take up your time in explaining how taxes are 
levied. This is one of the items for which the council may levy a tax under 
the direction of the proper persons. 
In cities of the second grade of the first class, such part of the funds raised 
for any of these purposes, as the council deems necessary, shall, upon the rec- 
ommendation of the board of improvements, be appropriated monthly for 
keeping in repair the paved streets of such city. Under the laws governing 
the State Board of Health, or sanitary organizations of the State of Ohio, the 
law that was passed two years ago, and amendments and revisions of all pre- 
ceding laws, thereto, reads as follows : 
" Section 2140. When expenses are incurred by the board of health, under 
the provisions of this chapter, it shall be the duty of the council, upon appli- 
cation and certificate from the board of health, to pass the necessary appropri- 
ation ordinances to pay the expenses so incurred and certified ; and the council 
is hereby empowered to levy subject to the restriction contained in the ninth 
division of this title, and set apart, the necessary sum to carry into effect the 
provisions of this chapter." 
One of the unfortunate things in connection with this ninth chapter referred 
to, is that the sanitary and street cleaning affairs are united under one section. 
Thus when councils do see fit to set aside a certain sum of money for sanitary 
and street cleaning purposes, the street cleaning department gets the bulk of 
the appropriation, because that is for something that people can see, and the 
majority of people don't look out for the welfare of the community, its health. 
It does not say which shall receive the greatest amount of this money, and it 
does not say that the council cannot expend money beyond the appropriation. 
I am more inclined since thinking this matter over, that this is a very fortu- 
nate thing for the local board of health. If the council neglects to make an 
appropriation of a specific amount for the expenses of the local board of health, 
then you are strictly in it, because you can spend all that is necessary and the coun- 
cil has to pay it. They will kick, and say they won't doit, but they will have to 
do it just the same. There have been several decisions in that matterat differ- 72 
OHIO SANITARY BULLETIN. 
ent times. They have no option in the matter. The law is plain, and it don't 
make a particle of difference what the intention of the author was It says 
that when expenses are incurred, by the board of health, * * * it shall 
be the duty of the council, upon application and certificate from the board of 
health, to pass the necessary appropriation ordinances to pay the expenses so 
incurred and certified. There is simply no condition there except the certifi- 
cate of the local board of health. It does not say anything about whether it 
may be deemed necessary in their judgment, whether it is a requisite expendi- 
ture or whether it should be considered excessive or anything about it. It 
simply says they shall pay it, and they have no option in the matter. Councils 
as a rule do not consider sanitary matters. They have matters before them 
that are more interesting and they have tried to obstruct the health department 
in the cities and towns in every possible way, but several decisions have been 
rendered in favor of the boards of health. I will ask the gentlemen from 
East Liverpool what their experience was with the amendment. Of course, 
gentlemen, I do not mean to indicate that I am in favor of extravagance. I 
do not feel it is necessary and 1 do not think that the health officers as a rule 
can be accused of that thing, when we can get good officers for the munificent 
salary of $100.00 per year, and they are expected to attend to everything in 
the way of sanitary matters. When the people were threatened with an epi- 
demic like the one in Ashtabula, they didn't hesitate to spend any amount of 
money, while prior to that a little generous expenditure might have saved 
them many thousands of dollars and many valuable lives. 
People should be educated up to the necessity of preventing trouble, of look- 
ing far enough ahead to anticipate what might naturally occur by the neglect 
of natural laws. 
I want to say to you before I leave this point, however, that some councils 
have argued that you cannot expend money unless it has been previously 
appropriated. Well, unfortunately for the man who drew up that bill that 
provides for the duties of councils in levying taxes, he does not use the right 
word. He does not say they "shall," but he says they "may." It is not 
mandatory. It leaves it optional with councils. That is unfortunate for 
councils, but good for us. 
The compensation of health officers throughout the state is wonderfully, ex- 
ceedingly low. I have always felt, gentlemen, that it was entirely too low, 
but in thinking this over since I have had to talk upon the subject, I have 
concluded that perhaps we had better not say much about it. If a man is 
willing to make sacrifices, such as are demanded of the health officer in the 
discharge of his duties, for the sum of money that the board of health agrees 
to pay, while he may not receive a reward in this life, he is laying up treasure OHIO SANITARY BULLETIN. 
73 
in heaven. Most of us, gentlemen, cannot have too much credit in that 
country. It may be that in the future a health officer in a city of good size 
will be quite a soft snap, paying a handsome salary and having large perqui- 
sites. One other point that is not entirely apropos to this, and yet is indirectly 
so, is that a member of a local board of health cannot be the health officer. 
This question is suggested by the secretary because he has been so frequently 
asked about it. It is illegal, because he would be required to fix his own 
salary. 
Just a word about the appropriation for the State Board of Health. Ever 
since this State Board of Health has been organized we have been forced to 
use the strictest economy. We have appealed to members of the legislature to 
increase the appropriation from the original sum of $5,000 annually to $10,000. 
During the cholera excitement, when we had to expend an unusual amount of 
money to guard the borders of our state against the invasion of cholera, we got 
as much as $10,000. Last year, although we had asked it and had given good 
reasons for asking it, because of the tremendous increase in the work of the 
board, the increasing demands upon the time of the Secretary to travel in 
different parts of the state to investigate outbreaks of disease, the increase 
necessary in our office force to take care of the work there - correspondence, 
etc.,-so we could answer your demands when you called upon us, and con- 
fidently supposed we were going to get an increased appropriation, when the 
time came we were cut off $2,000. Gentlemen, I want to say emphatically 
that it is an outrage that the State of Ohio has to put up with the paltry sum 
of only $8,000 to preserve the public health, the most important office in the 
state. I say again it is simply an outrage. 
You can help us to get more. None of us get a salary that compensates us 
for the time that is taken up, but we are eager and willing to give that time 
provided we will not be handicapped by an appropriation which is entirely in- 
adequate to meet the demands of the people. 
Each of you can use some influence with your local representative. Those 
gentlemen, when they come to Columbus, think that whenever a man says 
anything about getting a bill through that he has an ax to grind. They don't 
know, in fact, that bills asked for in this direction are of a direct local interest 
to them, and to you, and you can use your influence in this direction to secure 
an increase, and you can enable the board to be that much more effective in 
the future. Gentlemen, I am very much obliged to you for your patience. 
Dr. Sutton, of Zanesville - I have been health officer in Zanesville for 
several years, and I want to say that our town council has never refused us 
anything that we have asked for. We get everything promptly. A few years 
ago, at the time of the cholera scare, we asked for $1,500 on short notice, with 
which to make special inspection. It was appropriated forthwith, and we have 74 
OHIO SANITARY BULLETIN. 
never served any notice that has not been complied with very promptly. We 
have never asked our county commissioners for anything that has not been 
granted. The same may be said of all boards in our county. 
And thereupon the convention adjourned until 2 o'clock in the afternoon. 
FIFTH SESSION. 
Friday, 2 p. m., January 25, 1895. 
The Chair - Gentlemen, we will now take up the discussion of Dr. Hoover's 
subject on expenses of boards of health. Are there any remarks ? 
Mr. Walton, of New Burlington - This question has been ably discussed, as 
far as it has gone, but it has not reached the condition of a good many here 
today. I trust and hope that there are a good many township trustees here 
today, and consequently members of township boards of health, and we have 
no doubt searched the law to find whether we were authorized to create a 
sanitary fund in our respective townships. So far we have been unable to 
find anything warranting us in making a special levy for this special work that 
has been recently laid upon us, and I have thought whether or not there should 
be a law passed by the legislature making this matter plainer, so that we could 
make .a special levy for this particular work. There is perhaps no work in 
which we are engaged in the township that is of any more importance than the 
health and prosperity of our people. In our township (we are in a rural dis- 
trict) we have but about a million and half, perhaps a little less than that, to 
levy on, and the law says that we shall not exceed certain bounds. We are 
only permitted to levy $400 a year to care for our poor, and perhaps a sum 
like this for a general township fund, and so on. And that is the largest fund 
that we can levy according to law. We found some difficulty in having suffi- 
cient means to carry out all the different branches of the work, having to draw 
largely for extras upon the general fund. We have concluded that our legis- 
lature has not laid upon us a duty without the expectation that we would be 
backed up with means, somehow or other, to meet the expenses, so we have 
concluded to levy a sanitary fund, and if it is in violation of law, somebody 
will find it out and stir us up on it. If the people refuse it we will appeal to 
the legislature. 
I want to ask this question, and I trust this meeting will indulge me if I ask 
it now: We were a little at a loss to know just how, in our rural district, we OHIO SANITARY BULLETIN. 
75 
were to find what was really a reasonable compensation for the health officer. 
Last year we employed a health officer and conferred with him in reference to 
what was a reasonable compensation for his services, and he thought perhaps 
$75 for our township would be very reasonable, and we could not see that 
there was $75 worth of work - only about a dozen, or maybe fifteen, reports 
to make during the year to the State Board, and we reduced the compensation 
to $50. At the close of the year we could not find where he had really done 
$50 worth of work, and are at a loss to know what the law would say was a 
reasonable compensation for a health officer in a district like ours. I suppose 
in large cities he is paid $600 or $700 or $1,000 a year. In rural districts, 
you know, there is but little to do. 
Dr. Hopkins, of Ashtabula - Mr. Chairman, I think that some times we get 
paid for what we do and more times in the sanitary work we get nothing. Our 
boards of health get nothing but "cussings," and our health officers get their 
pay largely in that kind of stuff. As Dr. Hoover has said, the compensation 
of many of us has been but meager. I have done in my own city for $50 
work that I would not have done in some places for $1,000. I told our board 
at home, I will work for you for $50, although it is just a drop in the bucket; 
it is not pay, but I will work for you for that price. Finally they raised it to 
$100. I went through last month what I would not go through again for $500. 
Nobody could hire me to do it. Anybody doing this kind of work has to do 
it for small pay. He does it simply because he loves to see something done - 
because he loves to see our children and our homes prosper and enjoy good 
health. We have had no trouble in raising our funds. Our board asked our 
council to pay their bills, and there has been no "kicking" about them. Dur- 
ing the epidemic we asked for $10,000, and told them that probably we would 
need more than that. And there were no "ifs" and "ands" about it. They 
did not hesitate one second; we got our money. For the last six years I have 
acted as their health officer, and it certainly has been work of education. The 
people are educated up to the point where they see there is some good in it. 
That has got to be done all over the state. One of the grandest things we can 
make mention of in our state is that we have got such boards of health as our 
brother talks about. I am glad he has got good sense and backbone to make 
the levy for money. 
I have been very much interested in this discussion. We must have funds 
to work with. We have been handicapped a great deal in the work by lack of 
funds. I do hope, gentlemen, that every one of our health officers and mem- 
bers who are present here today will do their utmost with the legislators who 
come from their districts to work for adequate appropriation for our State 
Board. We have got what I consider to be a very efficient State Board of 
Health, and with the money they have had at their command they have been 76 
OHIO SANITARY BULLETIN. 
doing noble work, and we should back them in all ways possible. I want to 
emphasize what Dr. Hoover said in his able speech - every word of it. We 
want to have good men appointed oh our boards of health, and if we work 
things right we will have such men appointed. 
Mr. Spear, of Mt. Gilead - I simply want to say a few words in this connec- 
tion. We certainly have had a very interesting discussion. We have had 
some trouble at times with our town council. We had an epidemic of scarlet 
fever at one time. Few families were quarantined, and all the necessary ex- 
penses connected with the quarantining of those families were submitted to the 
council, but they would not allow the bill. The bill included expenses for dis- 
infectants, for persons running errands, for quarantining, and all that sort of 
thing. There is another epidemic there this year. As I am a member of the 
board of health I would like to have some light on the subject. Five or six 
families have been quarantined in cases of scarlet fever, and of course bills 
were sent in for cleaning up, for disinfectants, and everything, in fact, con- 
nected with it. Now, who should pay them? The board of health or the 
council? 
Dr. Hopkins, of Ashtabula - I think it is an important suggestion con- 
cerning the members of the board. In our place the mayor has suggested the 
names of men for these nominations. I know that our boards of health were 
chosen by the council, but there are ways of getting around that, and we can 
get good men to fill their places if we work for them. I will say as to the 
payment of bills, in cases of poor families being quarantined and the husband, 
of course, not being able to work. As I told you we have no trouble about 
that. Those bills are paid. If it is necessary to shut them up, we tell them 
that you will not starve, will have enough to eat and drink, and we will see 
that proper care of you is had, and if they are not able to buy disinfectants, 
we buy them ourselves. We audit those bills and submit them to the council 
for payment. However, if the man is able to stand the quarantine, and has 
got sufficient money to carry himself along, we say to him that he must bear 
the expenses. We tell him you are not town poor, and have got funds and we 
will expect you to bear your own expenses. We have had no trouble what- 
ever. But a man living on his day labor from day to day we say to him, don't 
you worry, your family will not suffer for anything that is needful. You won't 
get any delicacies, but you will get good wholesome food, and all fuel and 
everything that is necessary. As I say, the council never object to these bills. 
The Chair - I suggest if you want to be safe you had better have your 
members elected by the council. In some larger cities they are acting under 
special laws, but in the smaller towns and villages, there is a method prescribed 
for the election of boards of health, they being elected by the council, and OHIO SANITARY BULLETIN. 
77 
appointment by the mayor has no force whatever, and sometimes your boards 
are not legally constituted. 
Dr. Hopkins, of Ashtabula - Our council chooses our members of the board 
of health. They are elected by the council, but it is customary for the mayor to 
suggest the names for nomination. 
1 The Chair - Well, I thought you said the mayor appointed them. 
Mr. Walton, of New Burlington - I think the councils should pay all bills 
which are reasonable. There is such a thing though, as a board of health pre- 
senting an unreasonable bill, in which case the council is justified in not 
approving the same. I want to say in reference io the management of such 
cases, in our county we are in the habit of paying for our county poor who are 
not able to foot the bills. We certify them up to the infirmary directors, and 
draw part of the money back that we expend in caring for them, and conse- 
quently it does not come so heavy on the township. I suppose the same thing 
might be done in a village corporation. At any rate we take charge of those 
that are supposed to be taken to the infirmary, and instead of taking them to 
the infirmary we say to them, that we will foot the bills, and then you give us 
as much as it will cost to keep them there and we will see that they are properly 
taken care of. We get along first rate with the infirmary directors, and they 
commend us for the course we pursue in taking care of the poor. 
A Member - I think that all bills submitted to the council after being certi- 
fied to by the board of health, should be paid. I think if the council can re- 
ject a part of a bill, they can all of it I don't believe they have the right to 
reject any part of the bill, but must pay it all. If six men on the board of 
health decide it must be paid, I don't think they have any discretion in the 
matter. 
Mr. Truex, of New Straitsville - The mayor in our town does not appoint 
the board of health, but he comes to me and asks me who I want on the board. 
Not long ago he asked me to name some men, and I gave him a few names 
and he says, I will appoint them. We have no trouble in getting good men. 
Now when it comes to the bills-we had to quarantine a house and appoint a 
sanitary policeman. The mayor told us that he did not believe in appointing 
a sanitary policeman. We called the board together and appointed the police- 
man, but have not yet sent in our bill, but we anticipate no trouble in having 
our bills allowed. 
Mr. Purinton, of East Liverpool - The law recognizes two distinct ways in 
the selection of officers. One is to be appointed by the mayor and affirmed 
by council; and the other appointed by the council. Now then let those who 
have not looked into this matter, carefully look up the subject and see if their 
various boards are legally constituted, because there is a distinction. 
The Chair - The next subject for discussion is "The best method to prevent 78 
OHIO SANITARY BULLETIN. 
the spread of contagious diseases in towns and cities," the discussion to be 
opened by Dr. P. H. Aldrich, health officer, Defiance. 
Dr. Aldrich-Gentlemen, this subject of mine has been pretty well gone 
over since our meeting has been in session, but there are some little matters 
yet to be considered in the way of the prevention of contagious diseases, and 
the spread of contagious diseases throughout the various cities and towns. Now 
without the assistance of our bacteriologists, and finding out what the real 
cause of these diseases are, we would be of little account. In the first place, 
it is absolutely necessary for us to know what we are fighting, what we have to 
combat, before we commence our work of stopping the spread and ravages of 
diseases. Now, gentlemen, under this subject I will take diphtheria and scarlet 
fever. They come the nearest together of any two that are contagious. In 
the first place as the health officer receives notice from the physician that he 
has a case of diphtheria in a certain section of the town, he immediately sends 
his sanitary policeman with a card, naming the disease, to nail up in some con- 
spicuous place on the front of the house, or the door, or where every person 
will be likely to observe it. That card should be of such a nature and printed 
in such style that it attracts the attention of every passer by. When a person 
comes within sight of the dwelling where the cards are tacked up, the first 
thing that catches his eye is the card, if it is rightly gotten up. The letters 
on the card should be at least an inch in size and he will see that he is strictly 
forbidden by the board of health of that city to enter that house. Now here 
I have such a card as we have in our city [exhibiting card ]. It appears that 
this card is a little different from the most of cards. I never saw one just like 
it. The card, as you have observed, is a "diphtheria" card. Now, in addition 
to the word "diphtheria," it reads below: "All persons not occupants of this 
house are notified to avoid entering it until this card is removed. By order of 
the Board of Health." Now any person can see that card for quite a distance 
and they know at once that it warns'people to keep away, warns them to keep 
a certain distance from the house. When I get a notice that we have a case of 
diphtheria in our town, I immediately go there myself with a sanitary police- 
man. I tell every occupant of that house what they must do and what they 
must not do. I do not consider it absolutely necessary to quarantine every 
case of diphtheria or scarlet fever, or those diseases that we come in contact 
with almost every day. I have no difficulty in stopping the ravages of diphthe- 
ria in our city in a short time. I have had two cases I think within the last 
year and that is all, and they were stopped, checked right in the house in which 
it originated or broke out. Nobody left the house and consequently the dis- 
ease was not spead. 
When we have diphtheria it is eight chances out of ten that you find that it 
comes from decayed bodies. Vegetable matter is the most productive of the OHIO SANITARY BULLETIN. 
79 
diphtheria. When the sanitary policeman goes on his rounds to clean up 
■cellars and lots, and every filthy place in the city that can be found, he 
frequently finds cellars with five or six bushels of potatoes which, perhaps, 
have decayed, and lots filled up with decayed potatoes, turnips, cabbage, etc., 
and it makes lively work for the garbage-gatherer and the sanitary policeman; 
and if they are good, level-headed men, they will work until they get this all 
nicely cleared up. Then when we come to stop this ravage of the disease it 
has got a little start. As I told you in the first place, gentlemen, we will put 
this card on the house and positively forbid any one from entering or coming 
out. Give the inmates of the dwelling instructions that if any of them are 
seen on the street they will be promptly arrested and locked up until twenty- 
one days have passed for the incubation of that disease. If you do catch them 
out, do just as you say. A health officer has got to have a great deal of 
x'sand" and he wants to be pretty sharp, and when you start in for a thing 
never give it up. You may not have a friend in the city to back you in the 
start, but if you do good, they will be your friends in the end. You have got 
to do things regardless of friend or foe. Don't back down for any one, not 
even the mayor of the city. If you do any good in a city as a health officer 
you have got to pursue a course and go straight ahead and do your duty in the 
face of everything. In the first place, ascertain if you are right, and then go 
ahead, not be as I was a year ago when I came into this meeting, and I got the 
w'orst roasting of any man that ever came to this house. Brother Probst can 
tell you so. I got it for quarantining three individuals who had been exposed 
to smallpox. They threatened to lock me up. Fortunately, one of them com- 
mitted suicide before I got back. I went to our City Solicitor to look up the 
law to see what right I had to do that. He told me to let it alone - that there 
was no law whereby I could quarantine those men. I found out afterward 
there was. 
Well, now, perhaps I have said all that is necessary on this subject. It is 
getting late. I want to leave this now for discussion. I want to hear what 
you have all got to say, for I want to learn something. Now, gentlemen, with 
these few remarks I will leave the matter to yourselves, hoping that I will hear 
from almost every health officer in this house. 
Prof. Nelson, of Delaware - I don't know of anything that is of more inter- 
est to us than this subject. What shall we do when an epidemic conies to pre- 
vent the spread? Those of us who were here last night will remember that 
Dr. Miller, of Cleveland, claimed that the epidemic of diphtheria at Ashtabula, 
w'hich lasted less than a month, cost that city, I believe, $500,000. I have 
just been talking to my friend, the health officer of the city, and asked him if 
he would verify those figures. His answer was that it would be impossible 
to tell exactly w'hat was th j. bss to the city as a result of that epidemic. It 80 
OHIO SANITARY BULLETIN. 
came just at Christmas time, during the Christmas trade, but he finally said 
that he had no doubt that it cost the city $100,000 at least. There were one 
hundred cases of sickness, and if that epidemic cost $100,000, it is perfectly 
clear, if I remember anything about mathematics, that each one of those cases 
of diphtheria cost the city $1,000. 
Now, it is very evident to me that there is only one thing to be brought 
clearly before our minds this afternoon, and that is, that it is our duty as 
health officers, leaving out every other consideration, to avoid that enormous 
weight upon us. 
Now, there is no question as to the right of the board of health to contract 
debts. We found that out this afternoon, and there is nothing for the council 
to do but to stand behind us and see that the bills are paid. There are certain 
things we can do and must do in order to prevent epidemics of any sort coming 
to a community. The first thing is to placard the house, as the gentleman said 
this afternoon. Make people understand that. Last year it was brought to 
my attention that an officer in one of our towns-a local officer - had an- 
nounced that if the house was placarded he would tear it off. If he came the 
second time he would have the officer arrested. I would like to have been 
health officer there a little while and see whether that man was going to come 
out ahead or not. I think that placard would have gone up the second time, 
and if it was disturbed, somebody certainly would have been arrested. 
In the second place quarantining must be done. To a man who has been 
earning his bread by daily labor, we say, if you will put this sick child in a 
room and have the mother take care of it and stay away from other members 
of the family, that will answer. But we are simply playing with that case. It 
is our duty to see that the house is thoroughly quarantined and kept so until 
everything is over. Some people are not willing to admit that diphtheria is 
contagious, especially in cases of their own, so they insist on a public funeral. 
There should be no public funerals in such cases, or in case of any contagious 
disease; we should not even allow the body to be taken to a church. Say to 
the friends we are sorry, but this is a contagious disease, and a public funeral 
is forbidd n, for the living have some rights as well as the dead, and we must 
not have a public funeral under any circumstances. I mean they must refuse 
to allow any person to come near the funeral except those absolutely necessary 
for carrying the body to its place of burial. 
I wish we were on higher ground this afternoon than we are, and yet friends 
it does seem to me that we to be encouraged. I have been looking back 
this afternoon eight years. Some wanted us to organize a sanitary association 
and we met in this city. We had only about a half dozen. We expected 
that the people of Ohio would rally to the cause and thought we W' M have a 
house full, but werefl'adly disappointed. That was eight years ; And