Meetings of the State Board.

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.

Very respectfully,

(Signed)

WILLIAM LARRABEE."

The communication was

referred to a special committee, whose

report will be found on another page of this volume.

In view of the large number of deaths reported from Membranous Croup, Croupous Diphtheria and Diphtheritic Croup occurring in communities where Diphtheria is prevalent, it was the unanimous opinion of the Board that the practical effect of isolation, quarantine and disinfection in all cases of "Membranous Croup" or "Diphtheritic Croup", would be not only to greatly lessen the number and restrict the spread of Membranous Croup itself, but also lessen the number of cases of Diphtheria. The Board therefore adopted the following resolution:

Resolved, That Membranous Croup be and the same is hereby included in the rules and regulations of this Board for the restriction and prevention of Diphtheria, and for sanitary purposes is to be deemed and considered as dangerous to public health.

A resolution was adopted authorizing the Secretary, upon notice received of the outbreak of epidemic or contagious disease, to notify some member of the Board, whose duty it shall be to visit the infected locality, investigate the cause and assist the local board in its removal, and to make such further orders and regulations as may be deemed necessary in the premises.

The committee to whom was referred the subject of a milk standard, reported the following as the standard of pure milk for the purposes of the State Board, and the same was adopted:

Infectious Diseases-Diphtheria.

At the annual meeting, held May 1, 1889, the subject of contagious diseases was thoroughly discussed, and, as an additional means to aid in prevention of the same, rules and regulations directed to public school teachers were adopted, and ordered printed for distribution. The pollution of rivers and lakes, transportation of corpses, and quarantine, were duly considered, and the result will be found in another place.

INFECTIOUS DISEASES.

DIPHTHERIA.

In October, 1888, an outbreak of Diphtheria of serious nature was reported at Rochester. Owing to mistaken diagnosis, efforts to conceal the pernicious custom of treating Membranous Croup as noncontagious, and the laxity of the local board, the disease assumed alarming proportions, and an appeal was made to the State Board for assistance. Dr. J. C. Shrader visited the place, and the following is his report:

IOWA CITY, October 18, 1888.

DR. J. F. KENNEDY, Secretary State Board of Health, Des Moines, Iowa: DEAR SIR-I have the honor to report the receipt of your communication of October 10th, and also the letter of Dr. Atkins, of Rochester, Cedar county, Iowa. I was not able to report in person until yesterday, when I proceeded to visit Rochester and surrounding country, and would respectfully report: Rochester was the original county seat of Cedar county, and is situated on the east bank of the Cedar river, in a wooded country, and a sandy, porous soil, and is some eight miles from Tipton, the present county seat. About the first of September Diphtheria made its appearance in a brick house in the town. The father, mother, and one child have died of the disease, which spread through the town and into the surrounding country. There have been in all, as near as I could learn, about thirty cases, occurring within a radius of six miles, mostly within two miles of the village. I saw twelve cases, some convalescing, some yet very sick. In one family of eleven (Thomas Wilkinson's) all had it. There had been two deaths; one boy of

Infectious Diseases Diphtheria.

time of visit, dangerThere had been nine The public schools

fifteen had been taken two days before, and was, at ously sick. The disease is Diphtheria, of a severe type. deaths, showing a death rate of about thirty per cent. were closed September 18th. At that time there were three cases in town; the disease commenced to spread rapidly soon after that date. Quarantine had been attempted, and fairly well carried out. The doctors claimed that it had been very difficult to get nurses to care for the sick, insomuch that they were compelled to relax their established rules to prevent the sick being seriously neglected. Disinfection had been resorted to in all cases, they claimed, by the use of burning sulphur, chloride of lime; in fact, the most of the best disinfectants had been used after the cases terminated either by death or recovery. The board of health had been in session, but not until their regular meeting on the first Monday of October. This meeting should have occurred at least three weeks sooner.

Dr. Atkins, of Rochester, and Dr. D. Donnelly, of Tipton, have been indefatigable in their care and attention upon the sick. Other doctors have seen and attended upon a few cases, but I saw none of these cases, and so cannot speak further in regard to them. I visited and carefully inspected the premises where the disease made its appearance, in the family of John Kester, who has since died, also his wife and one child. The house, a brick, is situated on the northwest corner of a block. East of the house is an old blacksmith shop full of filth. There is a dense row of cedar trees running eastward from the blacksmith shop to a barn and cow-stables, a distance of some eighty to a hundred feet; there was also a hen-roost adjoining. All of the premises described were very filthy. I do not think the manure and accumulated filth had been removed since these buildings had been erected, some twenty years ago. The well is situated about ten feet from the east side of the house. It is said to be about thirty feet deep, and dug in the loose, sandy soil. There is also a water-closet, without vault, twenty-five steps from the well. The lot is covered with apple trees, and some other trees, while there is a thick undergrowth of currant bushes, small cedars and weeds, so that during the summer months the sun cannot get to the ground. The well is situated in the lowest place on the lot, and there is good drainage from all the accumulated filth into this well, there being no protection at the top to prevent the surface drainage into it.

Now, it is perfectly clear to me that this well was the source from which all this disease, and so many deaths, can be directly traced. The children from this house were attending the school, and upon inquiry, I learned that some of the children of Thos. Wilkinson, the family who have suffered so much, were attending the school in town and sitting in the same seat with one of John Kester's children, thus in this instance, at least, tracing the disease to the Kester well. Afterward 'I learned that water had been obtained at this well and taken to the school-house for the children to drink. I thereupon issued the following order:

Infectious Diseases-Diphtheria.

Dr. D. Donnelly and Dr. L. P. Atkins:

TIPTON, Iowa, October 17, 1888.

DEAR SIRS-You are hereby ordered to proceed to the house formerly occupied by John Kester, in the town of Rochester, and cause the well on said premises to be effectually closed, so that the water thereof cannot be used for any purpose whatever; and to remain closed until the premises are thoroughly renovated, the well cleaned and filled around with clay or cement so that there can be no surface drainage into it whatever.

(Signed)

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

It is unfortunate that the disease was not diganosed upon its first appearance, and an examination instituted at once to ascertain the source of the infection, and thus have prevented many cases of sickness and several deaths. The disease has been decreasing for the last week, and the new cases are of a milder character. All of which is respectively submitted.

J. C. SHRADER.

Subsequently four additional cases developed, but there were no more deaths.

During the same month, a serious outbreak of Diphtheria occurred at Oxford Junction, in Johnson county. Dr. Shrader went there on request of the health board, and the following is his report:

IOWA CITY, November 2, 1889.

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

DEAR SIR-Your letter to me of October 30th, also letters from Dr. Geo. R. Moore and John G. McConahy, Recorder, both of Oxford Junction, Jones county, Iowa, were duly received October 31st, and according to request and your instructions, I at once started for that place, arriving there early in the morning of November 1.

I first walked out by myself, taking a general survey of the town, and then made myself and business known to Mayor A. Stratelek, who took special pains to give me all the information he could, and afford all the means at his command for investigation of the causes and spread of the terrible outbreak of Diphtheria from which they have been suffering.

Oxford Junction is situated in the valley of, and about three quarters of a mile north of the Wapsie river, and north of the railroad. It has a population of about 1,000 inhabitants; was laid out twelve to fourteen years ago. From the railroad north, for a fourth of a mile, or more, the ground ascends, then slopes to the north, for considerable distance. The natural drainage is good. The soil is loam and sand, underlaid with magnesian limestone; the soil varing in depth from three to fifteen feet. The water supply is from wells.

Infectious Diseases-Diphtheria.

and cisterns-mostly wells that are from fifty to sixty feet in depth. Water found in crevices of rock filled with gravel. Dr. Moore has a well in the business part of town, sixty feet deep, tubed, thus shutting off the surface drainage. He informs me there has been no deaths from persons using water from this well. With a few exceptions, the town presented a clean appearThe lots, streets, and most of the alleys had been cleaned. As near as I could ascertain there had been in town and vicinity about one hundred and seventy-five cases in all, and thirty-nine deaths, or about 221 per cent of fatal cases.

ance.

There were two cases in November 1887, when the disease subsided for a time, then made its appearance again, and again subsided, when finally, a great number were taken sick, with a mild form of sore throat, that was considered a simple tonsilar inflammation and required but little treatment to effect a cure, many cases, perhaps, not having any treatment, except some domestic remedies. There were perhaps at least forty of these mild cases before death occurred. In this instance there was a public funeral. Soon the disease began to assume a more serious form, and the mortality became very great, but it was not until a number of deaths occurred, that any precautions whatever were taken to arrest the progress. Children from houses where the disease existed, were constantly on the streets playing with other children from houses where the disease had not made its appearance. People were visiting from house to house, without any regard whatever to the disease. In fact, it was stated to me by some of the citizens, that a child was sick with the disease in the building in which the post-office was located; that a door between the sick room and the post-office was frequently left open while there would be congregated there twenty to thirty persons in waiting, while the morning mail was being distributed. For a time every facility was offered for the spread of the disease, viz., the free communion of the people, including the children of the town, one or more puplic funerals; a disagreement among the physicians as to the nature of the disease; no health officer; no cards posted to warn the people of the location of cases; no quarantine; and no proper disinfection.

Finally some diphtheria cards were put up, quarantine was fairly established, and in most cases disinfection of clothing, bedding and houses. Within a very short time after these precautions were taken, the disease began to subside, showing conclusively that with proper care, and attention to the most ordinary rules of sanitary science, the disease can be restricted and soon stamped out. After getting at all the facts I could, I saw the mayor of the town and the trustees of the township in which the town is located, and issued the following order to each, varying only so as to be applicable:

HON. A. STRATELEK, Mayor, and Trustees of Oxford Junction, Iowa:

GENTLEMEN-You are hereby ordered to immediately convene as a board of health and proceed to elect some competent physician as health officer of your town, and to adopt rules and regulations necessary to protect the citizens of your town from the ravages of diseases, of whatever nature, that are