Infectious Diseases-Diphtheria.

dangerous to the life and health of your people, insisting and enforcing a thorough and efficient quarantine of all such cases as are dangerous to the public health; and also in completely disinfecting all premises, clothing and persons that have been infected; and perform such other duties as may properly come before you as health officers, for the proper protection of your people.

Respectfully,

J. C. SHRADER, M. D., Member of the State Board of Health.

OXFORD JUNCTION, IOWA, November 1, 1888.

Dr. Moore promised to accept the position of health officer of the town, and I have entire confidence that he will faithfully perform his duties as such. The disease was already subsiding at the time of my visit, and I have no doubt it will soon be stamped out of existence.

QUERY.-Could the spread of this disease in town and surrounding country have been prevented?

Have the legally constituted authorities done their duty in this matter? Is any one responsible for the financial distress of the people caused by so great an amount of sickness?

Could this sickness and these deaths have been prevented by proper and well directed efforts in the commencement of this epidemic?

Let those specially interested answer.

In conclusion, I would say that the disease was probably carried there from some town on the line of railway. That after the first cases in November, 1887, the disease was held in abeyance until house-cleaning the following Spring, when the clothes that had been in use the previous Autumn were brought out, when it again made its appearance; or it may have again been brought into the town, or there may have been, and probably was, some filthy cess-pool in the town, where it was generated. Be this as it may, it has been a terrible lesson; and it is to be hoped that the lesson so deeply engraven in the hearts of so many parents may not soon be forgotten; that it may stimulate them to look out for their water supply; to keep their houses clean and well ventilated from cellar to garret; to allow no open cess-pools or other sources of filth near their houses; and so far as possible, strictly avoid coming in contact with persons suffering from contagious diseases, physicians and nurses alone excepted; and that other localities throughout the State may profit by this unfortunate experience.

Respectfully submitted,

J. C. SHRADER, M. D.

Dr. Shrader procured samples of water from the well, which was the water supply of the family where the disease first appeared. They were submitted to the chemist of the State Board, who made the following report of the result of his analysis:

Infectious Diseases-Diphtheria.

DES MOINES, Iowa, October 25, 1888.

Secretary of Iowa State Board of Health:

DEAR SIR-The water which you sent me on the 22d inst., for analysis, contained the following:

Such

The foregoing reports of Dr. Shrader need no comment. neglect and malfeasance in office by local boards, is nothing less than criminal. The statute regarding their duty is mandatory. There is no defense to such wanton dereliction of duty.

At no time since the creation of the State Board was Diphtheria so prevalent as during the winter months of 1888-9, yet in but few localities did it become epidemic, and wherever it assumed serious proportions, its spread was traceable to neglect of duty of health boards, and the utter want of knowledge or realization of the horrible nature of it, by the people, and even physicians, who either ignorantly or willfully, sought, either to secret it, or mask it under the name of "Membranous Croup," or "Sore Throat."

In November, 1887, the following communication was received from Governor Larrabee:

To the Honorable, the State Board of Health, Des Moines, Iowa:

GENTLEMEN Infectious diseases, especially Diphtheria, Typhoid and Scarlet Fever, appear to be prevalent this Fall to an unusual degree throughout the State.

I take this opportunity to request that your Board exercise whatever power the law confers upon it to guard against the further spread of these diseases,

Infectious Diseases Diphtheria.

and at the same time diffuse such sanitary knowledge among local boards and the people generally as will tend to prevent the development of the virus in localities hitherto free from such pestilential influences.

Very respectfully,

WM. LARRABEE.

The communication was referred to a special committee, who made the following report:

MR. PRESIDENT-We, your committee, appointed to consider the communication of his Excellency, Governor Larrabee, in relation to the existence and dissemination of infectious diseases within the State, have the honor to submit the following report:

We commend the efficient work of the secretary of this Board, and his assistant, in the manner in which they have conducted the affairs of the office. The people of the State are to be congratulated that there has been no case of Small-pox reported since our last semi-annual meeting.

Your committee think that in view of the prevalence of Typhoid Fever in the State during the present Autumn that all outbreaks of the disease, with the causes where ascertainable, should be promply reported to the secretary of this Board, the physicians attending those cases, or the proper health officers of local boards of health where the disease exists, in order that proper measures may at once be adopted to arrest and stamp out the disease, and that instructions may be sent as to the most efficient preventives for arresting its progress, and removing its causes.

The same recommendations are also made in regard to Scarlet Fever and Diphtheria.

Your committee also think that the spread of infectious and communicable diseases is often due to the following causes:

1. A desire on the part of physicians to shield their patients and their friends from quarantine and isolation.

2. Mistakes in diagnosis, and indifference to sanitary precautions and regulations.

3. Insufficient and inefficient isolation and quarantine, for a sufficient period.

4. A want of rigid adherence to the rules of this Board in regard to public funerals of all persons dying of infectious diseases.

5. From physicians calling Scarlet Fever "Scarlatina," intending thereby to make the people believe it a less dangerous disease.

These are one and all to be condemned by this Board, and the physicans of this State are called upon to do all in their power to correct these several abuses.

Your committee would recommend that the law in regard to reporting births and deaths shall be so amended that all persons specified in chapter 151, laws of the Eighteenth General Assembly, shall make a report on the first day of each month of all births and deaths occurring in the previous

Infectious Diseases-Diphtheria.

month in their families or houses; or, where attended by a physician or midwife, he or she shall be required to make said report to the clerk of the district court of the county on the tenth of each month. All who are delinquent and fail to make said report, shall be reported by said clerk to the county attorney, whose duty it shall be to prosecute the same in the name of the State, as provided by law. Where physicians persistently neglect or refuse to make those reports, the State Board of Medical Examiners may, on presentation of the facts, revoke their certificates. It shall be the duty of the clerk of the district court of each county to make a report on the 15th of each month of all marriages, births and deaths reported for the previous month to the secretary of the State Board of Health,

In regard to the communication of his Excellency, Governor Larabee, relative to the prevalence of contagious and infectious diseases in this State, and calling attention to the work of the Board in limiting their spread, would say:

The Board has most diligently, and they think effectively, endeavored to educate the general public in the best of methods of prevention by isolation, disinfection, quarantine and general hygienic measures. They consider, however, that more stringent measures are necessary, in order to bring about the desired results, by enlargement of the powers of the Board, and a greater control over local boards of health. As the law now stands, the State Board has only advisory powers, without anthority to enforce their decisions.

To this end, your committee recommend that an appeal be made to the General Assembly, to amend the law so as to make the work of the Board more efficient for the preservation of the public health, and to confer such additional powers as will make their recommendations and decisions binding on local boards and the people, and that a penalty be provided for the violation of the rules of this Board.

We also recommend that the directions in circulars regarding the prevention of Diphtheria and Scarlet Fever, be changed as regards isolation and quarantine so as to make them more rigid, and consequently more effective, in preventing the spread of these diseases, requiring forty days as a minimum of quarantine.

Your committee also recommend that the Committee on Legislation take proper steps to have amended section 13, chapter 151, laws of 1880, so as to make it obligatory upon townships, towns and cities to organize local boards of health, and to report such organization to the secretary of the State Board.

Resolved, That we heartily commend the following wise and timely circular issued by Governor Larrabee to the various state institutions, respecting the removal of causes of sickness and sources of danger from fire and other casualties, and demand with all the legal power vested in this Board their faithful observance:

Infectious Diseases-Diphtheria.

NOVEMBER 16, 1887.

DEAR SIR-This season of the year requires special vigilance on your part to protect the lives and property intrusted in your care. Decaying vegetation readily breeds disease. All rubbish should therefore be removed from the premises; cellars, closets and dark corners should be carefully cleaned, and wells and cisterns should be well secured against surface drainage. The constant fire in the stove, grate and furnace, fanned by high autumnal winds; the dryness of the atmosphere; the parched condition of the roofs, and the scarcity of water--all combined to increase the danger of a conflagration. I would therefore suggest that smoking be prohibited on the premises of your institution; that chimneys be cleaned whenever this is feasible, that officers, watches and guards should be admonished to increase their watchfulness during windy weather; that lights and explosive oils be trusted only to cautious and responsible persons; that apparatus for extinguishing fire be carefully examined and repaired, if found deficient; in short, that every possible precaution be taken for preventing, and every possible provision be made for extinguishing fire. As the property of the State is, as a rule, not insured, the responsibility of those in charge of public institutions is great indeed. Very respectfully,

WILLIAM LARRABEE.

The report of the committee was accepted and adopted.

At the November meeting of the State Board, 1888, the following communication was received from the Governor:

DR. J. F. KENNEDY, Secretary State Board of Health, Des Moines:

DEAR SIR-In view of the recent outbreaks of Diphtheria in different parts of the State, it becomes the duty of your Board to exercise the utmost vigilance to prevent the spreading of this terrible disease. It occurs to me that a great deal of good could be accomplished, if, as soon as information is received by your Board that Diphtheria has made its appearance in any part of the State, and threatens to become epidemic, one of your members would at once resort to the infected place to assist the local health officers in tracing out if possible the cause of the disease, and in taking prompt and proper measures to prevent its spreading. I also trust that you will not relent your efforts to impress upon the local boards of health the importance of a strict enforcement of all laws and regulations relating to the prevention of epidemic diseases.

(Signed)

Very respectfully,

WILLIAM LARRABEE."

Recognizing the full import of the suggestions of the Governor, the State Board adopted the following resolution: