G. Herbert (George Herbert) Rodwell.

The memoirs of an umbrella, online

. (page 8 of 21)
Online LibraryG. Herbert (George Herbert) RodwellThe memoirs of an umbrella, → online text (page 8 of 21)
Font size
QR-code for this ebook


Digitized by



Google



78



Twenty-eighth Annual Report



Improper
VentUation



Commoii
Drinkinff Cup
Common
Towel



pupil's desks, it was impossible to see the exercises which the
teacher had written upon the black boards of a rural school,
there was such a profusion of crossed lights and shadows.
Quite often the amount of window space is insufficient and
were it not for the fact that the climate is mild and they can
be kept open practically all the time, the ventilation would be-
come a serious problem. Equally fortunate is this for the
heating. When the weather is cold, the stove at the center
of the room probably makes it as uncomfortable for those
seated nearby as the cold does farther away. Such a con-
dition could be easily corrected if these stoves were jacketed
properly.

The crusade against the common dipper and towel is
beginning to bear results. The inability to secure responsible
janitor service in the country districts has had a telling effect
in the unclean class rooms, and often badly littered playground.
The privies are of the open unscreened type and are in that
condition which follows continued neglect. Several teachers
have reported that it was impossibl to employ any one to give
them the proper regular attention. Still others say that they
have been unable to get the trustees to take any interest in this
branch of local sanitation. If the condition of the schools is
to remain satisfactory they should occasionally be subjected
to an inspection by some independent authority. A law should
be enacted requiring that the plans of all new buildings as well
as the remodelling of old ones, be submitted to the Engineering
Department of the Board. In this way many mistakes in
school architecture can be prevented.



MUNICIPAL SANITATION

While I have not been assigned to a particular district until
recently, still, sufficient time has elapsed for me to observe the
excellent progress that is being made in the constant better-
ment of municipal sanitation. Practically all of the larger
and many of the smaller towns have awakened to the realiza-
tion of the fact that the care of the public health is one of
their first duties. Many of tbem have passed ordinances
authorizing the appointment of Boards of Health, election of
a Health Officer and have enacted a very creditable code of



Digitized by



Google



State Board of Health of Florida 79

sanitary laws. Still others have appointed a committee which
they have designated the sanitary committee and some of the
regular officials have had added to their customary duties, the
responsibility of a regular and thorough sanitary inspection.
The interest, and compliance with regulations which has fol-
lowed the passage of the screening and privy laws is surpris-
ing. There is a good sized town not very far distant which a
few months ago did not have a single thoroughly screened
grocery store, market or food stall; which had over seven
hundred open, unscreened and insanitary privies and there
were apparently only a very few people in it, who were seriously
interested in the betterment of health conditions. Today they
have a Health Department, a health officer, and a number
of excellent ordinances. It is one of the best screened towns
in the State and those open privies have disappeared like
magic. And that isn't all, their Health Officer is engaged in
at least a score of other activities which have for their aim the
improvement of the local health.

Other places have taken an interest in the correction of a Referrinrto
faulty sewage disposal, are rebuilding the unscreened privy JfiiSdc^Iir
as is required by law, enforcing sewer connections, defining JTSJItSion
and requiring definite specifications for the construction of
septic tanks, compelling the keepers of food stalls to properly
screen them, and have passed some splendid laws which make
for the promotion of the physical welfare of their people.

INVESTIGATION OF PREVALENCE OF DYSEN-
TERY IN LAKELAND

The investigation of the prevalence of dysentery in Lake-
land was imdertaken at the request of the President of the
State Board of Health and in compliance with the wishes of
the State Health Officer.

In the report which follows, an attempt has been made to
bring together such information as was available concerning
the occurrence of dysentery in Lakeland and to study the
cause of the disease with reference to the individual cases for
the purpose of making recommendations for the diminution
of those causes found responsible for the spread of the malady.



Digitized by



Google



80



Twenty-eighth Annual Report



ProTaieaoe As the Health Department, which later made the disease a

reportable one, had not been organized at the time of the
inquiry, it was necessary to visit the different physicians to
gain some idea of its frequency and collect data from them
regarding the cases under treatment as well as those that had
been discharged as cured. They reported that sporadic cases
had been occurring from time to time but that the infection
had not assumed epidemic proportions until about the first of
November, 1915. Their records showed that at the time of the
investigation they had thirty-three cases under treatment, that
since November 1st, 1915, they had discharged twenty-eight
more as cured. It was estimated that some thirty cases had
been so mild that they had not consulted a physician, making
the total number of cases for the period about ninety-one, seven
of which had died, giving us a death rate of 7.69 per cent, a
rate but a little lower than that of typhoid.

Viewed from an economic standpoint, by estimating the
loss of time, income, expense of medicines, doctors and nurses,
together with the loss of life, it is calculated that the epidemic
cost the city about $20,000.00 — an amount sufficient for the
building of a modern hospital of dimensions sufficient for its
present needs ; to have organized and financed a health depart-
ment with whole time officials; or it would have built some
much needed extensions to both the water and sewerage sys-
tems. No attempt has been made to place a valuation in dol-
lars and cents upon the distress and suffering which those
affected with the malady have experienced, all because of a
sewage-borne disease, which, in the light of our present knowl-
edge of sanitation, could have been either prevented entirely,
or reduced to more controllable limits.

Etioioffr As some differences of opinion appeared to exist in the

minds of the local medical men regarding the exact nature of
the cause, or the particular type of the malady, whether it was
a bacterial or protozoan organism, numerous specimens of
blood and feces were obtained by the doctors from their patients
(both recent and old cases) located in the different sections
of the place, and forwarded to the laboratory, where, after a
series of agglutination tests with several strains of dysenteric
bacilli, microscopic examinations for protozoa. Dr. Birge



Digitized by



Google



State Board of Health of Florida 81

declared, that in his opinion, we were dealing with the bacillary
type of dysentery due to an infection with the bacillus dysen-
teriae (Shiga).

In their discussion of the etiology of bacillary dysentery
Castellani and Chalmers hold that it is due to organisms which
are allied with two main types.

Type 1. Shiga-Kruse — Bacillus dysentenae, which does not ferment

mannite.
Type 2. Flexner. Bacillus dysenteriae, which does ferment mannite.

These organisms they claim are readily found in the intesti-
nal discharges of a patient and quite easily by scraping off
the surface of the bowel during a post mortem. In addition to
the two main types, there are several varieties of each type, but
of less importance and not so widely distributed. A number
of psuedo types have also been classified.

According to them, these various bacilli are differentiated
by their varying fermentative actions upon carbohydrates, by
agglutination, Pfeiffer's reaction and Castellani's absorption
methods.

They further state that while these organisms are dis-
tributed in the intestinal discharges of those suffering with the
disease, as is the case in typhoid, cholera, and a host of intesti-
nal parasitic infections, that the dysentery carrier is probably
a most potential factor in the dissemination of the trouble;
while many people excrete the bacilli when suffering with mild carrier caias
relapses, they are frank enough to admit that up to the present,
an epidemic has never been conclusively proven to be due to a
carrier case. One can, however, reasonably assume that this
is due more to the systematic failure to ascertain by bacterial
examination that the intestines of the patient have been freed
of the organism, than the falsity of the theory.

Strong and Musgrave proved that the infection takes place
by the mouth, by feeding a man with pure cultures of the
dysentery bacillus, which quickly produced an attack of
dysentery, characterized by motions containing blood and
mucous from which typical bacilli were grown.

A common method of infection is from contact with a Method* of
patient or carrier, or with articles or food which have been ^'"*****
contaminated by them. The bacilli are carried to the mouth



Digitized by



Google



82 Twenty-eighth Annual Report

on dirty hands or in polluted food and drink or in the utensils
used in preparing and serving the same, which have been soiled
by some cook or other person, who is a carrier, assisting in the
preparation of the food. In sections where the soil is badly
polluted it is said that the dust is a disseminator of the malady.
Flies have been experimentally proven to be capable of carry-
ing the bacilli and are held to be a most prolific source of infec-
tion in countries where they are troublesome. The water sup-
ply is rarely found to be at fault.

It appears that the organisms can exist in the canal for
some time without causing symptoms of the disease until the
vitality is lowered by some agency, such as a chill, attack of
indigestion, when they are capable of producing their ill
effects.

It is clear then, that the presence of an epidemic of this
complaint is not an unexpected sequence of bad sanitation and
is incontrovertible evidence of a defective method of sewage
disposal, pollution of food and drink by flies which have had
access, to human discharges, careless personal hygiene, in-
different disinfection of the excreta of infected cases, soil
pollution, etc. -

The disease prevails all over the world, more particularly
at the end of the dry, and at the beginning of the wet, season,
and at times, due to causes not yet explained, becomes un-
usually virulent, and is accompanied by a mortality rate which,
may be as high as 25 per cent.

EPIDEMIOLOGY

In order to obtain accurate information regarding the
sanitation surrounding the cases as well as other data which
would be helpful in solving the mystery of their infection and
the means of its transmission, blanks were supplied the attend-
ing physicians covering all the points under investigation.
These blanks were filled out and returned for 20 out of the 33
cases. A summary of the information which was gathered in
this way is as follows:



Digitized by



Google



State Board of Health of Florida



83



O2ISCS

White Colored Total
19 1 20



Date of onset
Jan. 23, 29, 26, 29, 20, 24,
19,26,26,29,31,29,
30, 27, 24, Feb. 1, 1,
1. 1, 1.

Water
City Local Patient exposed by contact
12 2 7

Raw foods,
fruits, etc.
taken within Meals taken away

4 days of Soft from home 4 days

onset Drinks prior to onset

Yes 17 Yes 9 Yes 7

No 3 No 11 No 12

Don't know 1



Male Female Ages Occupation
14 6 20,25,12 Clerk, Clerk

13, 22, 35 Student, House-
20, 28, 24 wife, Student,
16, 13, 52 Minister, Actor,
12, 15, 70 Child, Laundry-
26, 50, 17 man, Clerk,
30, 1^ Student, Student,
Housewife, Printer
Student, Retired
Farmer, Baby,
Yard Clerk, Train
Master, Student,
Housewife.

Residence Sewer Open

Screened Unscreened Connection Toilet
16 4 17 3



Not exposed by contact
13



Milk Supply

(Dairy)

Yes, source not given 3

Brannen's 1

Lakeland 5

Jackson 3

Milk from country . . 1

No milk 3



In the study of the information gained through the ques-
tionnaire one is impressed with what seems to be an apparent
deviation from the usual method of the conveyance of an in-
testinal infection. In the examination of the premises but
little fault was to be found with the sanitation surrounding
the homes in which many of the cases had occurred, indeed,
many of them were elegantly appointed and reflected in a pleas-
ing manner the refined tastes of the occupants. In only one
home, which was made the subject of a special investigation,
and in which three cases had developed at intervals, it was
found that the isolation of the patients had not been complete
and that the discharges had not been disinfected with any de-
gree of thoroughness. Flies were noticed in considerable num-
bers swarming about the sick room and in the dining room.



Digitized by



Google



84 Twenty-eighth Annual Report

Reverting again to the data summary sheet, it is seen that
the disease has prevailed almost entirely among zvhite people
(95%) of whom 65 per cent were male and 30 per cent female.
In the sections of the town in which the sewage disposal is
notoriously bad, where there were long rows of open insanitary
toilets, which were cleaned largely by the flies and chickens, only
one case had developed. The cases with one exception ranged
in age from 12 to 70 years. The infantile population which
subsists largely on the milk from the dairies had practically
escaped the infection. Significant also was the occupation of
those who contracted the malady; only four of the number
were more or less continuously engaged about their homes.
It is thought, however, that of these, at least two, were accus-
tomed to occasionally visit the business section. All others
were employed in different business industries or in school,
and spent their daylight hours in or near the business center.
One-half of the cases developed suddenly between January
28th and February 2nd. About 33% per cent had been ex-
posed to previous cases and 85 per cent had eaten raw foods,
fruits and vegetables four days before the onset; 35 per cent
had taken meals away from home. The infected were not num-
bered among the customers of any one dairy, but were fairly
well distributed among the different dairies.

Though a sanitary survey had been recently completed of
Lakeland, it was deemed advisable to make some further ex-
aminations covering part of the ground previously gone over
but with more special reference to the subject under considera-
tion.

Lakeland has a population of 7,287.

SEWAGE DISPOSAL

A rather small, considerably overloaded and badly operat-
ed Imhoff tank is placed near the west-central shore of Lake
Parker. To it, through a system of piping which in one section
has been difficult to keep open, is carried the sewage from 40
per cent of the corporate area and about 60 per cent of the
population. It is estimated that about 700 houses are connected
with this system, that 700 more have open, insanitary privies.
A few, unable to reach sewers have constructed cesspools. The



Digitized by



Google



State Board of Health of Florida 85

night soil was collected at irregular intervals and carried to the
dump ground where it was emptied into shallow trenches. It
was learned that a nearby farmer had been hauling a part of it
away and using it as fertilizer. The trenches were open and
it had not been the practice to cover each dumping with a
layer of sand to prevent fly pollution and breeding. The
bucket system was not in vogue.

WATER PLANT

The water supply is derived from a 10-inch well 610 feet
deep, cased 500 feet, located in the center of the town. TTie
air lift capacity was 900 G. P. M. The construction of the two Referrinr to
circular covered reservoirs was poor. About 1,000 families Rewnroir.""^
were using the water, the remaining 640, local pumps. A few
were said to have cisterns. Samples of water were collected
from the air lift outlet at the plant under the usual precautions
and shipped to the laboratory for examination. The report
was that they were free from intestinal bacteria.

ICE
(Investigated by Special Request)

This product is made from distilled and reboiled water and
from the raw water of Lake Weir. The Superintendent of the
ice company affirms that this last ice is used only for refrigera-
tion purposes and not a pound of it is used in Lakeland. Bac-
terial examination of the ice made from distilled water was
negative; while that made from the raw lake water was positive
for intestinal bacteria. It is the practice (and it is a bad one)
to store these two ices in the same room, often side by side.
As has been remarked by Dr. Rosenau, "because surface impuri-
ties can be washed from the surface of a cake of ice, there is
no excuse for uncleanly methods in handling." A separate
room should be provided for the ice used in food and drink and gu»^«tioM for
it should not come in contact in any manner with the ice made o??m^'"*"*
from the lake water. The suggestions of Dr. Wilson of that
place, that metal covers replace the dirty water-sogged covers
of the cans, that walking over the tanks be prohibited, except
by those wearing rubbers, the soles of which have been care-
fully cleansed, are excellent ones and should be enforced.



Digitized by



Google



86 Twenty-eighth Annual Report

MILK

SnduioM*of As cases of dysentery had been reported on the premises of

Dairies ^^^ q£ ^.j^^ dairies, an inspection of all dairies was made. The

report was true of only the Lakeland Dairy. A helper who
had just recovered from the disease, had that morning re-
sumed his work of milking the cows. An open toilet, despite a
former request that it be moved, stood about forty feet from
the bottling room, in the interior of which flies were swarm-
ing about. The inspection covered the different details of the
dairy business and many defects were noted and called to the
attention of the different proprietors. The habit of the dairy-
men of delivering milk and leaving the bottle at the houses
where patients with infectious diseases are confined, is a
dangerous one. The milk should be poured into some con-
tainer provided by the housekeeper and the bottle retained by
the milk man.

FOOD SUPPLIES

An examination was made of the various places handling
food supplies which are consumed in the raw state or which
are eaten without further preparation. A few of them were
screened, but not with that thoroughness necessary to keep
the different eatables free from fly pollution. In many places
the vegetables were lying on the floor, at others, they were
placed in various containers about the doorway and in some
instances on the outside. The fruit stands were all open. No
effort was made to protect the fruit from either the dust or the
flies. The winter had been rather a warm one. Fly breeding
had continued with but slight interruption since summer. A
few days before the investigation a light cold wave had de-
veloped and the change in temperature had been sufficient to
drive the flies indoors. They were noticed in unusual num-
bers in practically every place visited, and their sudden increase
was almost invariably commented upon by the different shop-

inoreaMd keepers. Simultaneously, there was a flare-up of dysentery.

i^nteryDne Q£ |.j^^ twcuty recorded cases, eleven of them developed be-
tween January 28th and February 2nd. Residual infection
had been increased by an influx of tourists and further intensi-
fied by a season of dry weather. The bomb was ready for the
transmitting agent which had bred in its midst and which, with



Traaimission



Digitized by



Google



State Board of Health of Florida 87

the oncoming of cooler weather became more certain in its
results.

For the protection of the individual against an attack of
dysentery, it is recommended :

That all food be well cooked and well protected from flies before aeoommenda-
being eaten. **®°"

That drink from sources of questionable purity be boiled.

"Precautions against flies and vermin and care as to personal hygiene,
especially diet are indicated." (Castellani and Chalmers.)

The eating of any raw food during the prevalence of dysentery is a
dangerous practice.

FOR MUNICIPAL PREVENTION AND CONTROL
L That recommendations made in a recent sanitary survey for the
improvement of the sewage disposal, especially that part dealing with the
construction, fly proofing and sanitary maintenance of all open surface
privies, be enforced as soon as possible.

2. That a Board of Health be organized and a Health Oflicer ap-
pointed who shall undertake at once an anti-fly crusade — the destruction of
breeding places and the effective screening of all food products for direct
consumption; and a systematic inspection of places handling and produc-
ing food products.

3. That dysentery be made a reportable disease and that the Health
Officer upon receipt of information as to the whereabouts of a case take
such steps as may be necessary to assure himself that the discharges are
being disinfected and that the general management of the patient is such
as wK>uld tend to prevent an extension of the infection.

In compliance with the suggestions, a City Board of Health
was organized and a city health officer, appointed, Dr. J. F.
Wilson, the appointee has been most enthusiastic and untiring
in his efforts for the improvement of local conditions. How
well he is succeeding one can see from the attached letter re-
ceived in response to a request for a brief survey of sanitary
conditions, together with an enumeration of the activities of his
department during the time which has elapsed since the investi-
gation.

"I regret very much delaying the information you wanted but as you Letter from
understand the disadvantage I am working under at present, I will not go 5}jj^*5^*^
further into apologies but give the information as I have been able to JSwiand
get it"

No. sewer connections (estimated) 500

No. Stevens cans in operation at present 500

No open closets unprotected from flies 300

No septic tanks

Per cent populated area covered by sewer system 25%

No. buildings in 200 ft. sewers unconnected 150

WATER
Artesian well 618 feet deep cased with ten inch pipe to depth
of 500 feet

No. connections with city water 1,500

No. surface pumps (estimated) 1,000

No. cisterns



Digitized by



Google



88 Twenty-eighth Annual Report

I am unable to say how many cases of dysentery we have had since
February, 1916, as the doctors have not reported any, though I know that
we have had a few cases from time to time but no epidemic.

We have passed the following ordinances :

Regulating the use of and construction of sanitary fly-proof privies;
recommending the use of the Stevens cans as complying with same.

Regulating the sale of milk and other dairy products, fbdng the stand-
ards of same and the dairies.

An ordinance requiring the screening of all foods offered for sale,
also drug stores and cool drink stands, restaurants, etc.

An ordinance requiring the reporting of communicable diseases, their
control, school attendance, quarantine, etc.

An ordinance regulating and requiring sanitary barber shops.

SCREENING DONE

All butcher shops, groceries, fruit stands, restaurants, etc., have
screened their places of business and all places selling fresh meats and
vegetables have made special screened compartments for same in addition
to the screening of doors and windows, etc. However, the drug stores
and cool drink stands have not complied yet.

DAIRY IMPROVEMENTS

The Lakeland Dairy, Brannin's Dairy, and Jackson's Dairy have done
something towards improving their dairies and I find the Lakeland Dairy
making efforts to do more.

Any other information you desire, I will gladly supply, and I also
hope to, in a short time, be able to furnish you with a copy of the several
ordinances passed.



Digitized by



Google



State Board of Health of Florida



89



REPORT OF DR. W. P. CRIGLER,
Assistant to the State Health Officer, Central District

Dr. Joseph Y. Porter, ^^^^^^ ^^^'^ J^^^^y ^^ ^^^7.

State Health Officer,
Jacksonville, Fla.

(Through Dr. C. H. Dobbs,

Chief of the Bureau of Communicable
Dear Doctor: Diseases.)

I have the honor to submit the following report of my


1 2 3 4 5 6 8 10 11 12 13 14 15 16 17 18 19 20 21

Online LibraryG. Herbert (George Herbert) RodwellThe memoirs of an umbrella, → online text (page 8 of 21)