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Annual report of the Indiana State Board of Health. 1887 online

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serving, and also to demand of the physicians practicing in
their respective jurisdictions, that they report all births and
deaths occurring in their practice, within a period of fifteen
days after coming to their notice. They must strictly enforce
the rules adopted by the State Board, requiring contagious and
infectious diseases to be reported as soon as recognized. As
soon as elected these officers should make themselves familiar
with all the sanitary laws of the State, and carefully study and
intelligently interpret the rules and regulations issued by the
State Board, and require a compliance with the same. The
annual changing of health officers is a circumstance to be
lamented, because it requires new men some time to familiarize
themselves with their official duties and acquire a knowledge
of the laws, rules and regulations, pertaining to the public
health. . It too frequently happens that good and efficient
officers, who thoroughly understand their duties, and are not
afraid to enforce the laws, and competent in every respect, are
removed because their political views are difiTereut from those
of the appointing power.

If civil service should prevail anywhere it should be. in the
health service of the State, and especially when it is so difficult
to procure good men for the position. It is the duty of local
health officers to anticipate diseases, by having a thorough
knowledge of their causes, and compel a removal of the same,
and by ^oing this, prevent sickness and death.

They should acquaint the people with the nature and best
means of prevention of contagious and infectious diseases, and
use every possible effort to educate the masses in the latest
methods employed to preserve the public health by distributing
among them literature treating upon the subject. "An out-
break of an infectious disease, extending beyond its first vic-
tims unchecked, is an evidence of neglect or ignorance of duty
by local boards, inexcusable because a knowledge of methods



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84 STATB BOARD OF HEALTH.

of prevention or control, and the legal power to enforce regu-
lations to these ends have been abundantly provided." Their
duties extend to the home of every citizen, and demand the
exercise of intelligence, good judgment and a knowledge of
human nature. They are called upon to make '^ sanitary in-
vestigations and inquiries respecting the causes of mortality
and the effects of localities, employments, conditions, ingesta,
habits and circumstances on the health of the people." Exam-
ine, also, into the condition of dwellings, tenement houses, and
the water supply of towns, cities and public institutions, and
consider methods to be employed for the purpose of enforcing
the abatement of nuisances. These embrace some of the more
important duties of a health officer. In order to acceptably fill
the office with benefit to the people, they must be energetic,
faithful and fearless in the performance of their work, and pos-
sess the courage to compel friends as well as enemies to obey
the law.

The position is one that should not be occupied by a "drone,"
a timid man, or one with mercenary proclivities, who is only
in search of the money he may make out of the position. We
have many health officers in the State who meet all of the re-
quirements of the office, while there is a considerable of a mi-
nority who pay very little attention to the performance of their
duties, and apparently take no interest in sanitary work. It is
only when a great emergency arises and the citizens of their
respective localities demand that something be done to relieve
them of an intolerable nuisance, or prevent, if possible, the
spread of an epidemic, that they have aroused from their
lethargic state and made a pretense of performing the work
devolving upon them. Such officers are the cause of the oppo-
sition and niggardly support which Boards of Health receive in
some localities.

Our present law should be amended, so that this class could
either be removed or some form of penalty imposed when they
fail to properly do their work. A few give as an excuse for
this neglect that they are so poorly remunerated for the amount
of work required. All are well aware of the amount they are
to receive, but are ignorant of the manifold requirements of
the office before assuming its duties. This being a fact, we
suggest that they be compelled to faithfully do their work, or
else "step down and out," and let someone have the place who



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secrbtary's rbport. 85*



will attend to it. There are medical men in the State who have
made great sacrifices of time and labor in serving as secretaries^
of health boards without any local encouragement, either in
the form of thanks or pay. They have earnestly performed
the duties, nursing the hope that some day the people would
be sufficiently educated to appreciate the necessity of loca>
health organizations and liberally compensate some one in a-
financial way for the services required. 'The law specifies how
these officials are to be appointed and that they shall be paid^
but does not stipulate what salary they are to receive, leaving-
it entirely with the appointing power to fix the compensation-
Experience has proven that county commissioners, town trus-
tees and city councils are usually composed of a class of mett
who are unwilling to vote any money for sanitary work, or sucb
an insignificant amount as to be out of all proportion to the-
service rendered. As a result of such parsimonious dealings-
with the health interests, many of the best men in the service
have been obliged to abandon the work, and their places have-
been supplied with indifferent and ofttimes incompetent men*
These authorities, however, have but little trouble in fixing the-
salaries to be paid those whose only requirements are that the^
shall be able to read and possibly write their names, and be-
capable of adding a column of three or four figures. The law
should also be amended so that health officers should have a-
fixed compensation. It might be difficult to arrive at aD
equitable equalization of salaries. The salaries of other county^
town and city officials*are fixed by statute, and why not that of
health officers? Perhaps the best plan would be to grade the
pay according to the population, localities, trades and business^
interests of the people of the different communities they are-
called upon to serve. At present, a few of the counties allow
the position to be filled by the lowest bidder, without any re-
gard whatever to the qualifications of the applicant. This is a-
pernicious practice, and one that should be condemned by every
reputable man in the profession. The Sanitary News correctly
states the case when it says: ^^ There are some commodities*
that are suitable for the auction block, but brain is not one of
them. It is an old theme, this competition bugbear, and it ha»
been written up and written down and written all'around^
Brain and its intelligent service can not be measured by the
foot, the pound or the cord, and inasmuch as it has no unit of



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STATB BOARD OF HBALTH.



measure as to its value except experience, and that a very elas-
tic one, it follows that it can not be compared or bought oa
the same market as iron pipe, cement or paving blocks/'

The health officers of Marshall and Wabash counties, who
had been elected to look after the sanitary condition of their
respective jurisdictions, and furnish this department with such
sanitary and vital statistics as it might require, completely failed
to obey the law, after being frequently urged to do so, there-
fore the spaces opposite these counties have been left blank in
the statistical tables.



CHOLERA.



Cholera having prevailed for several years in Europe, it was
confidently expected by many that the history of this pestilence
would repeat itself, and that our country would receive a visi-
tation of this dreadful disease within the present year. These
anticipations have been realized, for on the 7th of September
the steamer Alesia, bearing Italian immigrants, arrived in the
New York harbor with cholera-infected patients. Several had
died with the disease on the voyage ; others were at death's
door upon its arrival. The passengers of the fated ship were
all sent to the quarantine station. Several died, and others
were taken with the disease after they were placed there.

The quarantine officers report that the ship has been
thoroughly disinfected, and all of its passengers, the sick and
healthy, are being well cared for, and say that all possible
means are being taken to prevent a spread of the pestilence,
but whether they will be able to keep it from reaching inland
is a matter which the future alone can develop. Sanitarians
throughout the country have not an abiding faith in the New
York quarantine, believing that they have not the means at
their command to hold the disease in its present quarter, and
ultimately stamp it out, therefore the future is looked, to with
gloomy forebodings, and it is apprehended that the coming
year will find cholera claiming its victims in various parts of
the country. The fact that it did not reach our shores at an



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secretary's report. 87



early day is probably due to the extra precautions taken by the
Government. Foreign consuls have been instructed to care-
fully watch all ships leaving for America from ports of infected
countries, and also to keep the home government well informed
as to the progress of the disease. The Indiana State Board of
Health, feeling that there is greater danger from the disease
the coming year than at any time during the last, and compre-
hending the destruction of human life, that a visitation of this
pestilence would cause, and recognizing it as a disease whose
poison is capable of being carried from place to place, and that
filth and dirt furnish suitable soil in which to propagate its
peculiar germs, have great hope to be able to place the State
in such a good sanitary condition, that if it does obtain a foot-
hold in our country, that it will find no soil within our borders
to breed its pestilential microbes. Maintaining a good sanitary
condition throughout the State will lessen the prevalence of
other diseases peculiar to warm weather.

For the purpose of placing the State in the best possible
hygienic condition, county, city and town boards of health are
directed to be diligent in observing the following instructions
of the State Board :

1. Make a thorough sanitary survey of their respective
jurisdictions.

2. See that all accumulations of filth, depaying animal and
vegetable matter in roads, streets, alleys, door yards, vacant
and occupied lots are removed.

3. That all gutters and drains are kept open and clean, and
that they are frequently flushed and disinfected whenever prac-
ticable.

4. That all privy vaults, sinks, cess pools, foul cisterns,
stagnant ponds, hog pens, foul stables, unwholesome cellars,
manure piles, dirty yards or lots, foul sewers and all other
places suspected of being injurious to the public health, are
thoroughly cleaned, disinfected and purified.

6. That all rank vegetation along streets, sidewalks and
gutters of cities and towns is cut and destroyed and not left to
rot.

6. Attention is directed to the importance of compelling the
proprietors of steamboats and those in control of railway
property, owners of hotels and boarding houses, landlords,
school officials, sherifis, city councils, town trustees and others



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:88 STATB BOARD OF HBALTH.

in control of property to thoroughly clean and disinfect their
premises, prepare suitable water closets for their patrons, em-
^ployes, tenants and pupils, and frequently disinfect them.

7. Attention is called to the necessity of making frequent
inspections of all vegetables, fruits and other articles of food
•ofiPered for sale. Tainted ^vegetables and fruits are frequently
the source of disease during warm weather.

8. See that the carcass of any dead animal, or the offal
€rom slaughter houses, putrid animal substance, or the contents
•of privy vaults, be not placed upon public grounds, common,
1fi.eld, lot, road, street or alley, or into any river, pond, canal or
<lake.

There should be thorough whitewashing, drying, ventilating
And disinfecting of all parts of habitations by the citizens of
the State, so that a high standard of health be maintained.
The water supply of the State should receive especial attention,
4ind be very carefully protected from pollution by seepage from
foul places and surface washings. Water being the readiest
medium through which cholera and typhoid fever spread, the
4kbsolute necessity of protecting it from contamination is ap-
parent.

Anyone failing to comply with the foregoing should be
prosecuted as provided in sections 2065 to 2075 of the Revised
Statutes of 1881, inclusive.



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SIXTH ANNUAL REPORT



OF THE



Bureau of Vital and Sanitary Statistics^

FOR THE YEAR ENDING SEPTEMBER 30, 1887;







BY C. N. MBTCALF, M. D., SECRETARY.



Herewith is presented a tabulated statement of marriages^
births and deaths reported for the statistical year ending Sep-
tember 80, 1887. It is scarcely necessary to remark that these
tables are incomplete, the number reported in each case falling^
far short of the actual number occurring. The causes leading^
to this result have been fully discussed in former reports and
need not be reiterated here. This Board is fully acquainted
with the difficulties which beset physicians in the matter or
making reports of deaths, especially those who do a country
practice.

We are convinced that under the present law there is no-
remedy. County health officers refuse to enforce the law, for
the reason, as many of them allege, that they do not wish t(y
incur the displeasure of their brethren in the profession.

In counties where it is known that such a course will be
pursued the reports are very meagre, and the secretaries of
Boards of Health acknowledge that the; are not receivings
half as many reports as they should receive.

With a full knowledge of these facts, and with a view oir
providing a remedy, the following bill was prepared and in-
troduced in the Senate at the last session of the General As^
sembly :



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90 STATB BOABD OF HBALTH.



SENATE BILL No. 218.

AN ACT providing for collecting reports of births, deaths and marriages, re-
quiring a burial permit, and fixing penalties for the violation of its provisions.

Section 1. Be it enacted by the General Assembly of the State
of Indiana^ That all births, deaths and marriages shall be reg-
istered in records for that purpose, and reported as hereinafter
provided.

Sbc. 2. It shall be unlawful for any undertaker, sexton or
other person to bury any dead body without first having pro-
cured a permit so to do ; said permit may be issued by any
town or city cl6rk, township trustee or justice of the peace in
the township in which said death may occur. No such permit
ehall be issued by any of said officers except upon presentation
of a death certificate, as hereinafter provided.

Sec. 8. It shall be the duty of all physicians, upon the death
of persons, in their practice, to make out a report containing
the following facts : (I) Ifame of deceased, (2) age, (3) sex,
(4) color, (5) residence, (6) single, married, widow or widower,
(7) cause of death, (8) occupation, (9) birthplace, (10) date of
death, (11) father's name^ (12) father's birthplace, (18) mother's
maiden name, (14) mother's birthplace, (15) name of person
making the return, (16) postoffice address of person making
the i*eturn. In all cases where coroners 'are called upon to
hold an inquest, the report of death is to be made by said cor-
oner.

Sbc 4. It shall be the duty of all persons solemnizing mar-
riages to make out, within five days thereafter, a report con-
taining the following facts : (1) Name of groom, (2) place of
residence, (3) age next birthday, (4) color, (5) occupation, (6)
place of birth, (7) father's name, (8) mother's maiden name, (9)
number of groom's marriage, (10) name of bride, (11) place of
residence, (12) age n^ext birthday, (13) color, (14) place of birth,
(15) father's name, (16) mother's maiden name, (17) number of
bride's marriage, (18) place of marriage, (19) by whom mar-
riage ceremony was performed, (20) date. Said report, when
€10 filled out, shall be returned to the clerk by whom the license
was issued, who, on the first day of each month, will forward
all such reports to the Secretary of the County Board of Health.

Sec 5. It shall be the duty of physicians and accoucheurs



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VITAL AND SANITARY STATISTICS. 91

to make out a report of all births occurring under their super-
vision, containing the following facts : (1) Name of child, if
named, (2) number of child of this mother, (3) sex, (4) color,
(5) date of birth, (6) place of birth, (7) born dead or alive, (8)
legitimate or illegitimate, (9) mother's maiden name, (10) moth-
er's age, (11) mother's birthplace, (12) father's name, (13) father's
age, (14) father's occupation, (15) father's birthplace, (16) name
of physician or accoucheur, (17) post office of physician or ac-
coucheur.

Sec. 6. All reports of deaths received by any Township
Trustee, Town or City Clerk, or any other person entitled to
issue a permit to bury any dead body, and all reports of births
shall, on the first day of each month, be returned to the town,
city or county health officer in which said deaths or births have
occurred : Provided^ however^ That nothing in this act shall af-
fect the laws now in force in cities where burial permits are
required.

Sec. 7. Any person or persons violating or refusing to per-
form any duty imposed upon him by the provisions of the fore-
going act shall be deemed guilty of a misdemeanor, and upon
conviction thereof, shall be fined in any sum not less than five
nor more than twenty-five dollars.

Sec. 8. All laws and parts of laws in conflict with this act
are hereby repealed.

February 4, 1887, the bill was read the first time and referred
to the committee on public health. February 10, 1887, it was
reported back to the Senate with the r.ecommendation that it
do pass. But the unfortunate ^^dead lock" came on and it
went down in the general wreck. By reference to Section 2 of
said bill it will be seen that it is made unlawful for any person
to bury any dead body without first having secured a permit
so to do, and no permit might be issued except upon presenta-
tion of a death certificate. In the event that the bill would
have become a law, it would have made it necessary for the
friends of the deceased to come to the physician for the report,,
instead of the vice versa process under the present law. No-
change need now be expected before the meeting of the next
Legislature in January, 1889.



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192 STATB BOARD OF HEALTH.



ZYMOTIC DISEASES.



The whole number of deaths registered within the year from
:all causes, exclusive of still births, is 16,181, being 578 more
than have been reported in any one year since the organization
-of this Board. Of this number the zymotic diseases caused
4,714 deaths, of which 2,384 were males and 2,330 females. In
1882 for nine months the number of deaths caused by this class
-of diseases was 3,200; in 1883, 3,835; in 1884, 3,950; in 1885,
4,375, and in 1886, 3,733. The number of deaths from these
-diseases within the year, as shown by the above figures, is 339,
tnore than for any year since the Board was created. The
mortality from zymotic diseases for the past year will not show
4in increased per cent, over former years, when compared with
"the total number of deaths from all causes. The reason for
this, in our judgment, is due to the improved sanitary condi-
tion of the State, which has been brought about by the uniform
•efforts put forth by the State and local boards of health, and
the harmonious manner in which all have worked to accom-
f)lish one purpose, viz : The prevention of disease, and an im-
j)roved hygienic condition of the State.

It is a well-known fact to sanitarians and medical men that
unsanitary surroundings not only tend to originate and develop,
but to spread all of the diseases classed under the head of the
:25ymotic.

Below we present a comparative statement showing the per
•<5ent. of mortality during the past five years from nine princi-
pal zymotic diseases. The comparison is first made with the
^whole number of deaths from this class of diseases, and second
^with the total mortality from all causes.



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VITAL AND SANITABY STATISTICS.



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Online LibraryBoston and Worcester Railroad CorporationAnnual report of the Indiana State Board of Health. 1887 → online text (page 8 of 40)