David J. (David John) Lewis.

Annual report of the Indiana State Board of Health. 1915 online

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507

i.oei

396
1.089

849
661
289
565
611

340
3.919
1.199

590

578
252
496
423

299

262

240

2.451

553
462
396
337



23.491

524
483
137
594
575

362
1.037
290
424
301

553
339
387
672
438



61.850

31 .701

30.149

60.883

967



23.7

24.6
21.1
22.4
24.1
20.2

20.9
20.0
20.8
23.5
20.8

23.7
22.5
22.0
21.1
21.7

22.4
36.4
24.9
24.3

19.1
24.0
20.1
20.3

22.4
24.6
16.6
25.9

20.5
20.4
22.4
19.7



20.1

20.9
19.2
17.1
17.8
21.0

19.1
19.7
19.6
20.5
19.6

20.3
17.2
18.5
21.8
21.2



21.9



Cbntbal Counties—
Continued.



Madison

Marion

Monroe

Montgomery .
Morgan



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Southern Countii



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Jackson..



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Knox

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Orange.
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Posey. .



Ripley..

Seott

Spencer.
Sufttran.



Switzerland . .
Vanderbiu'gh .

Warrick

Washington . .



1.441

5.819

690

549

432

264
410
397
593
374

521
831
894
111

563

• 1.842

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909

15.031

515
311
685
411
545

523

678
814
415
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396
303
1.083
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324

68
475
457
492
463

381
182
472
861

197

1.748

459

371



Highest Rate. Lake
County

Lowest Rate. Ohio
County



3.919
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28.
18.
20



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19.3
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15.9
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36.4
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INDIANA STATE BOARD OF HEALTH

TENTH ANNUAL REPORT
of the

Bacteriological and Pathological
Division

of the

Laboratory of Hygiene

for the

YEAR ENDING SEPTEMBER 30, 1915.

Will Shimer, A.B., M.D., Superintendent.
Board Members:

James S. Boyers, M.D,, President.

H. H. Sutton, M.D., Vice-President.

J. L. Freeland, M.D.

Chas. Bruce Kern, M.D.

J. N. HuRTY, M.D., Phar.D., Secretary.



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LABORATORY STAFF.

Will Shimer, A.B., M.D., Superintendent.
Ada E. Schweitzer, M.D., Assistant Bacteriologist.
W. V. Boyle, M.D., Assistant Pathologist.
Hervey M. Hooker, Clerk and Stenographer.
Etta M. Dolan, Stenographer.
Talitha a. Gerlach, Scientific Assistant.
Robert P. Johnson, Technical Assistant.



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TABLE OF CONTENTS.

PAGE

Introduction , 4

Summary of Work of Laboratory for Year (October 1, 1914-October 1,

1915) 8

Summary of Work of Laboratory for Ten Years 7

Tuberculosis, Description 11

Tuberculosis, Tables 13

Diphtheria, Description 17

Diphtheria, Tables 22

Typhoid Fever, Description 26

Typhoid Fever, Tables 28

Paratyphoid Fever, Description 31

Paratyphoid Fever, Tables 32

Typhoid Feces, Description 33

Typhoid Feces, Tables 34

Urine Examinations, Description 34

Urine Examination, Tables 35

Oonococci Si>ecimens, Description! 35

Gonococci Specimens, Tables 36

Patholofirical Specimens, Tables 36

Tubercle Bacilli in Other Than Sputum Si>ecimens, Description 38

Tubercle Bacilli in Other Than Sputum Specimens, Tables 39

Guinea Pigs Inoculated for Tuberculosis, Table 40

Outfijis for Specimens, Description 41

Outfits for Si>ecimens, Tables 42

Hydrophobia, Description 45

Hydrophobia, Tables 46

Pasteur Treatments, Description 48

Pasteur Treatments, Tables 49

Rabies in Indiana for the Last Ten Years 55

Tuberculosis, A Study of 5,000 Positive Specimens 67

Diphtheria Diagnosis by Means of Potassium Tellurate Medium 70

Typhoid, Prevention 73

Vacation Typhoid 101

Ptomain Poisoning 99

Typhoid Epidemic at Vawter Park, Lake Wawasee, Ind 95

Typhoid Epidemics, Prevention of 90

Whooping Cough, Vaccine Treatment of 87

Pelvic Inflammations, Aids to Diagnosis 80

Wasserman Test for Syphilis 79

Malaria, A Study of 78

Gonococci, Pus for 75

Blood Counts, A Few Differential 103



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INTRODUCTION.

After three years of delay the Bacteriological Laboratory has
adequate quarters. The first room assigned to the laboratory was
entirely inadequate when the antirabic treatments were begun and
space outside the State House had to be used. The antirabic treat-
ments are given by the laboratory staff. This necessitated consider-
able running back and forth between the two laboratories and much
time was lost. In the middle of June the two laboratories were united
on the second floor of the Gallup Block at the comer of Market and
Capital Ave., opposite the east entrance of the State House. The
Gallup Block is admirably located for laboratory purposes, as it
fronts on Market and Capital and has alley ways to the south and
east, giving the building almost perfect ventilation and Ught from all
sides.

There are three rooms for microscopical work along the north end
of the building. The north end of the large corridor is used as a wait-
ing room for the rabies patients. This waiting room opens into the
general office used by the two stenographers, and into the room in
which the antirabic treatments are given. One large room on the
east side of the building is used for making up mailing outfits and an-
other as a store room.

The present arrangement of rooms is almost ideal for a laboratory
and will help in arranging permanent quarters for the laboratory in
the new State building that must soon be built to make room for the
additional State departments being created from time to time.

Although a number of laboratories both private and public are
being established all over the State our work has continued to in-
crease.

Almost 21,000 specimens have been examined and many of
these were examined two or three times so that the amount of work
done is much greater than these numbers would indicate.

There has been a steady demand for typhoid vaccine from all
parts of the State in spite of the cheapness of the commercial product.

Two hundred and thirty-nine persons have received the Pasteur
treatment and we have not had a single death to record. Two varie-
ties of vaccine have been used, one prepared according to the old
Pasteur dessication, the other according to Dr. D. L. Harris' method.
No difference can be noted between the two kinds of virus.



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In December we began the use of Loeffler's blood serum containing
Potassiiun tellurate. In the diagnostic cultiures both the old and the
new kind of blood serum were used. The potassium tellurate medium
gives 2 per cent more positive than the ordinary Loeffler's blood
serum and the combination of the two medias gives almost 4 per cent
more positives than the old mediiun used alone. All of the blood
serum media used have been made in the laboratory using copper
slanting racks, coagulating and sterilizing in the autoclave. By this
method it is comparatively easy to make 1,500 tubes in one day.

There has always been considerable difl5culty in getting physi-
cians to use the outfits furnished by the laboratory. In some in-
stances in the past this was no doubt due to the difl5culty of obtain-
ing outfits. At present the outfits are so standardized and their as-
sembling so well systematized that any demand for outfits can be met.

In order to make this report as valuable as possible each kind of
specimen has been arranged according to counties from which they
came, to monthly positives and negatives for 1915, and the nine
previous years of the laboratory and to the percentage positive for all
previous years of the laboratory. This method of tabulating the
work done gives information as to the geographical source of the
specimens, their character and a comparison of the results of this
year's work with that of previous years.

The sputum, diphtheria, typhoid, pus, blood, rabies and pathologi-
cal specimens have been arranged in this manner in the present report.

Detailed information is given concerning persons receiving the
Pasteur antirabic treatment as to county, town, name, age, sex, kind
and location of bites, kind of animals that did the biting, the virus
used for treatment and the result of the treatment in each case.
The clinical history sheets in the cases contain information concern-
ing any complication that came up. These clinical sheets are num-
bered in the order in which the patient came to the laboratory for
treatment and are substantially bound. These volumns are an
authentic and valuable record of the rabies situation in Indiana and
will no doubt solne day be a valuable source of information on
hydrophobia in Indiana.

The remainder of the report is made up of special contributions by
the members of the laboratory staff.

Table 1 summarizes the work of the laboratory for the last ten
years.

Each year shows some increase in the number and kind of ex-
aminations made. Beginning with an average of seven specimens
examined per day in 1906, the work has increased to an average of



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66 per day in 1915. That is to say that the laboratory is doing ahnost
ten times as much work per day as in the first year. Dming the first
year only examinations of sputmn for tubercle bacilli, swabs for
diphtheria bacilli and blood for JiV^idals were made.

Now in addition to these, blood is examined for malaria for
leukemia or anaemia, blood counts are made, pus is examined for
gonococci, urine and feces examined for typhoid bacilli, hookworm
and other parasites, pathological tissues examined for malignancy and
brains for rabies.



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TABLE 2.

Showing Number, Kind and Result of Specimens Examined.
October 1, 1914-October /, 191S.



Kind of Bxamination.



Result of Bxamination.



PositiYe.



Negative.



Total.



Sputum for tubercle bacilli

Blood for Widal reaction

Blood for Widal paratyphoid

Blood for malaria

Blood for counts

Throat cultures for diphtheria bacilli .

Epidemic diphtherias

Pus for gonococci

Pathological tissues

Brains for rabies

Fluids, miscellaneous

Feces, miscellaneous

Pus, miscellaneous

Urine for tubercle bacilli

Urine, miscellaneous

Miscellaneous specimens



1,190

279

8

6



3.740

1.304

764

140



885
165
258



2.887

6.972

509



201
15

7

4
3

1
4



99
46
96
67
49
401
48



4.930

1.583

772

146

138

3,772

7.137

767

430

300

61

103

71

52

402

52



Total.



20.716



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Table 5 shows the {btal number of specimens examined each month
during 1915.

The average per month during the whole year is 1,725. In June
and July the work was the Ughtest and it was heaviest in October.
There is not a great deal of difference in the number of sputum speci-
mens examined from month to month.

Widal specimens are most numerous during July, August and
September.

Diphtheria specimens are most numerous during the months of
October, November and December.



TABLE 4.

Total Amount of Work Done by the Laboratory.

October 1, 1914-October 1, 1915,



Month.


Specimens.


Typhoid
Vaccine.


Outflts.


PaUents
treated.


Guinea
Pigs.


October


4.781
1,693
1.262
1.062
2.807
1.762
1.035
1.067
958
907
1,181
1.301


335
326
251
244
63
166
169
163
396
690
683
869


3,179
1,661
2,373
1,146
2.860
1.119
1.165
1.052
2.979
968
1.171
1.452


6
27
10
12
11
21
19
26
31
24
36
16





November


1


December


3


January





February


26


March





April


6


May


6


June


7


July


3


AuiTust


10


September


4


Totalfl


20,716


4,134


21,094


239


64







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TABLE 5.

Showing Number of Examinalions Each Month,
October 7, WH-October 1, 1916,

Month, Number of Specimens.

October 4,781

November 1,693

December '. 1,262

January 1,962

February 2,807

March 1,762

April 1,035

May 1,067

June 958

July 907

August 1,181

September 1,301

Total 20,716

TUBERCULOSIS.

Four thousand nine hundred and thirty specimens of sputum were
examined for tubercle bacilli and 1,190 or 24 per cent of these speci-
mens contained tubercle bacilli. It is remarkable how uniform are
the number of sputum specimens examined from year to year. In
1914 there were 4,947 sputum specimens examined and of these 1,255
were found to contain tubercle bacilli.

The following method is used in examining sputum specimens:
Antiformin is added to the sputum in the proportion of three parts
sputum to one part antiformin. This mixture is then shaken on a
Rickard sputum shaker for five minutes after which it is poured into
50 c.c. centrifuge tubes, 30 c.c. of water added and then centri-
fugated at 3,000 revolutions per minute for ten minutes. The
supernatant fluid is poured off by turning the tube upside down very
quickly. The residue in the tube is then smeared on a large glass
slide which has been previously smeared with Meyer's albumin.
This slide is then stained with carbolfuchsin and decolorized with a
20 per cent solution of hydrochloric acid in 95 per cent Ethyl alcohol
and then counterstained twice with Loeffler's Alkaline Methylene
blue.

There has been some criticism of the method of examining sputum :
viz. that we fail to find tubercle bacilli in positive specimens. There
are acid-fast bacilli in air and food stuflfs that closely resemble tubercle



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bacilli and which ordinary Gabbet's blue will not decolorize but acid
alcohol will. Antiformin will not destroy tubercle bacilli under any
circumstances but it does seem to destroy some of the other acid-fast
organisms. It is possible that the ordinary method of sputum ex-
amination may give too many positives.

The following is the method used for making up antiformin:

Sodium carbonate 15 grams.

Chloride of lime 10 grams.

Sodium hydroxide 15 grams.

Water 100 c.c.

(a) Dissolve 15 Grams of sodium carbonate in 25 c.c. of water.

(b) Add 10 Grams of chloride of lime to 25 c.c. of water.

(c) Dissolve 15 Grams of sodium hydroxide in 50 c.c. of water.

(d) Add equal parts of supernatant fluid (a and b) to "c." Only the
best chemicals should be used.

We have found that if 30 Grams instead of 15 Grams of sodium
hydroxide are used the finished product can be diluted one half and
the results will be just as good as if the full strength solution had been
used.

The stock solution should be put into brown bottles and stored in
the ice box.

We have been able to make antiformin with a drug cost of only
about 10 cents per pint. The market price for the proprietary is 50
cents.

Recently we have adopted a routine method for examining our
sputum smears. The individual smears are made on the slide and
are 1 centimeter wide and 5 centimeters long. The microscopic sta^e
is moved 2 milimeters each time the microscope travels from one end
of the smear to the other. This means that each smear is examined
from one end to the other ten times. This method will under ordina-
ry circumstances give 30 per cent positives and 70 per cent negatives.
Of the negatives not less than 10 per cent will contain particles re-
taining the carbol fuchsin stain. One per cent of these substances
will resemble tubercle bacilli to some extent so that one who is not
accustomed to seeing tubercle bacilli might call them positive.

This simply proves the contention of experienced consultants that
acid-fast bacilli in the sputum without clinical symptoms does not
always mean tuberculosis. In these uncertain cases another speci-
men is requested for examination.

Many physicians want to know all of the varieties of bacteria in
the sputum. Bacteriologists have contended that these findings
were of little value because most of the sputum organisms were mouth



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bacteria. The recent discovery that pneumococci ordinarily found
in the mouth are not virulent seems to point more than ever to the
lack of value of ordinary sputum bacterial findings.



TABLE 6.

Showing the Number of Specimens of SpxUum Received From Each County,
October 1, 1914-October /, 1916.



County.


Posi-
tive.


Nega-
tive.


Total.


County.


Posi-
tive.


Nega-
tive.


Total


Adams


6

53

13

1



Online LibraryDavid J. (David John) LewisAnnual report of the Indiana State Board of Health. 1915 → online text (page 28 of 58)