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Annual report of the Indiana State Board of Health. 1890 online

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|1UINSF£RRED TO LANE UBRAfiXj
STAhTORD UN'IV, >^




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LANE MEDICAL LIBRARY

300 PA5.1EUR DRIVE

PALO ALTO, CALIFORNIA 94304



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NINTH ANNUAL REPORT



State Board of Health



JAN 13 1892

INDIANA, 'Wsr.o




Fiscal Year Ending October 31, 1890.



TO THE GOVERNOR.



INDIANAPULliJ:

WM. B. BURrURD, CONTBACTOR FOR STATR PRIMTIKO AKD BINDINO.
1891.



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),).•)!



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THE STATE OF INDIANA, )

Executive Department, V

iNDiANAPOiiis, January 2, 1891. J

Received by the Governor, examined and referred to the Anditor of State for
verification of the financial statementR.



Office op Auditor of State, ]

Indianapolis, January 7, 1891. i

The financial part of the within report, so far as it relates to moneys drawn
irom the State Treasury, has been examined and found correct

BRUCE CARR,

Auditor of Slate.



Returned by the Anditor of State, with the above certificate, and transmitted
to the Secretary of State for publication, upon the order of the Board of Commis-
sioners of Public Printing and Binding.

WILLIAM B. ROBERTS,
Private Secretary.



Filed in the office of the Secretary of State of the State of Indiana January
10, 1891.

CHARLES F, GRIFFIN,

Secretary of State,



J)9<5 S\



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REPORT OF BOARD.



Hon. Alc'm P. Horaj, (Tin-Senior of IndiiOtd:

In accordance with the provisions of the statute we have
the lionor to submit herewit)i our Nintli Annual Report, for the
fiscal year endini^ October 81, 1890.

We again congratulate the people of the State l)ecause of a
year of good health, which was in some respects better than
the one which preceded it. Although this has been tlie case it
is nevertheless true that contagious diseases which are in a
great measure preventable, are always present in the State. It
is equally true that in nearly all cases such diseases have been
better managed and more successfully controlled the past year
than ever in the history of the State, and that this result is
<lue to better organization and conse(iuently better results by
health boards.

Local boards of health and the people are becoming better
informed concerning the [principles of preventive medicine.
Statistics at home prove incontrovertibly that the number of
<leaths from contagious and infectious diseases is gradually de-
creasing, though not as rapidly as they would were the rules
and regulations of boards of health more rigidly enforced.
The failure to enforce these rules is almost always due to neg-
ligence on the [>art of boards of health, as the pcoj)le generally
manifest a disposition to comply with any reasonable demands
made u[)or) them in matters that relate to the prevention of
<lisease.

The work of the l)oard since its organization has been unre-
mitting and the results are such as to afford cause for congrat-
ulation and fully justify the wisdom of the Legislature in
establishing the same. The effects of this work are not ob-
served by the general public, and is largely done in separate
localities, so that the full measure of good accomplished can not



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be seen from a single standpoint. It is plainly noticeable that
the work of sanitary societies and officers are each year better
appreciated, as their objects become better understood and the
results of their work are more clearly seen.

The bourd last year a<lopted a series of rules and regulations
for the government of station agents and baggagemen in re-
ceiving and transferring dead bodies. These rules forbid the
shipment of bodies dead from certain diseases, and in certain
other cases shipment only is permitted by complying with cer-
tain conditions intended to prevent the spread of contagious
diseases. By securing the aid of railroad officials these rules
are rigidly enforced throughout the State.

The Act to prevent the adulteration of vinegar, approved
March 5, 1889, has been the means of banishing from the mar-
ket a number of spurious and injurious so called vinegars, and
placed in their stead the pure article. County health officers
have been instructed to cause the enforcement of the provisions
of the act in their localities, and no good reason exists why
any vinegar should be permitted to be sold which is not up to
the standard required by the law.

During the latter part of last year and the first of this year
La Grippe or Russian inHuen/.a made its appearance and swept
over the entire State. While the mortality directly traceable
to the disease was comparatively light, yet the effect of it was
such as to leave the system of the victim in such a debilitated
condition that many deaths occurred from sequelae of the at-
tack. An effort was made to get complete statistics concern-
ing the disease, but owing to the fact that but few physicians
(from whom the information was sought to be obtained) had
any data at hand from which to give accurate information,
sufficient reports are not available to make any estimates from
which valuable deductions could be made. Only about 400
deaths are reported from this cause, which number is doubtless
too small, but the exact number can not be known. Following
is a report from J. F. Hibberd, M. D., Secretary of the Wayne
County Board of Health, which I believe is as nearly correct
as could be obtained under all the circumstances, and might be
applied to other portions of the State :



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LA (IRIPPK.

T(i the Editor of the Faladium ;

About the middle of Mareb tbe State Board of Health inau-
gurated an effort to obtain statistics concerning the extent of
the late epidemic of influenza — La Grippe — in the State of In-
diana. Pursuant to this purpose* the l)oard forwarded to me
blanks for the uniform record and return of the experience- of
each medical practitioner in the county, with instructions to
distribute them to the active practitioners witli the request
that the bhinks be tilled up and returned to me.

I have completed mv labors i!i this behalf and made my re-
port to the State Board.

The whole number of cases re})orted to me was 7,396, and of
these 3,909 were reported by the practitioners of Richmond,
leaving f^,487 for the remainder of the county.

There is no pretense by any reporter that he has been able
to give the exact number of cases prescribed for by him, because
no one claims to have ke[)t a record for the purpose, but each
<?laims to have made the most accuiate record possible from
the data in hand.

Assuming the population of Wayne county to be 43,000, the
returns imply that about one person in six of the population
of the county had an attack of grii»pe: and assuming 20,000 as
the population waited on by Richmond, the returns imply that
one person in about five was attended for grippe. And by the
same data the grippe attacked one person in 6.6 of the pop-
ulation of the county outside the professional jurisdiction of
the Richmond practitioners.

The popular idea is that a much larger proportion of the
citizens of the county were victims of the epidemic than is in-
dicated by the foregoing figures, and doubtless no inconsidera-
ble number of persons had a turn of the malady and recovered
by virtue of home medication or patiently awaiting the restor-
ative power of nature. What the real number of such persons
was can only be conjectured, but it would not seem extrava-
gant to estimate that one in four of our people suffered from
grippe, that is about 10,750 persons in Wayne county had an
attack of influenza during the late epidemic.

Jamks F. Hibbkrd, M. D.,
Richmond, April 29, 1890. H. 0., Wayne County.

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P. S. — If one may indulge in speculative ligures one might
estimate that those 10,750 people averaged each five days of ill-
ness, or an average of 53,750 days of suffering.; and if one-half
of those who were sick were bread winners whose income aver-
aged one dollar per day, the loss would be $26,875 ; and if the
doctor bills and other expenses incident to the illness equaled
one dollar per day for each person, the amount would be $5(J,-
750, making a grand aggregate of $80,625 as the measure of the
financial misfortune of the people of W«ayne county on account
of La Grippe.

J. F. II.

Assuming that the foregoing ''speculative figures" are ap-
/ proximately correct, and we make the application to the entire
State, the population being upwards of two millions, the finan-
cial loss to Indiana by virtue of this malady was a little more
than three million five hundred thousand dollars ($3,500,000).

The act regulating the practice of medicine^ has been the
means of elevating the standard of qualifications of j^ractition-
ers and driven many quacks from the State or compelled theni
to abandon business. According to its provisions, however, a
license is required by each physician for every county in which
lie desires to practice. This in many instances works hard-
ships, and we believe the law should be so amended that a
license issued in one county will entitle the possessor to prac-
tice in any or all the counties in the State.

We Avould respectfully urge upon the Legislature the neces-
sity of parsing a law rec^uiring all passenger coaches to be
heated by steam. The reason for this is apparent to every one
who has given the subject any thought and has noticed the loss
of life frequently caused in case of accident from stoves by set-
ting cars on fire and burning helpless victims.

We again call attention to the fact that the number of re-
ports pnnted for this board (8,000) is entirely inadequate to the
demand and should be increased to at least 5,000.

The penal and benevolent institutions are from time to time
, visited and their sanitary condition closely scrutinized by the
board. Because of this oversight and their eflicient manage-
ment they are generally kept in the best possible condition.
Considering the character of the inmates, they are kept in
much better condition than might be expected. The board



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9

caused a sanitary inspection to be made of the County Poor
Asylums and Jails, a summary of which is given elsewhere ia
this report. When the board first assumed oversight of these
institutions many of them were found in a condition which
was a disgrace to our civilization. Males and females, old and
young, were in some cases indiscriminately housed and the
legitimate results of such associations were plainly manifested.
Then, as now in a few cases, Superintendents wei'e selected
without any reference whatever to necessary qualifications for
such positions. Great improvements have been made, however,
in these particulars, and now these places of refuge for the
poor have been made more comfortable, and men better adapted
to the positions have been selected to superintend them, so
that they compare favorably with similar institutions in other
States.

Quarterly reports of marriages, births and deaths have been
received regularly from counties, with a single exception. These
reports are not as complete as they ought to be. Several causes
operate to make them so. The principal one is that county
health officers are in m:iny instances chosen from a number
who present competitive bids for the position, and " the lowest
and best bidder" is selected bv the County Commissioners.

It frequently happens that the salary thus paid is a mere pit-
tance, and the successful competitor renders service commen-
surate with the amount received. The evil can only be remedied
by paying a reasonable compensation for the work done and
select the best material at hand. We are fully convinced that
a stipulated salary should be fixed for these officers, as well as
for all others, and that the appointing power should be vested
in this board, as well as the power of removal in case of failure =
to perform the duties required by law. Their excuse for not
making them is that they are not paid for the work and there- ,
tore not compelled to do so. This opinion is prevalent, not-
withstanding eminent legal authorities have held that " the
duties imposed by the statute and the penalty for its violation
are within the police power of the State, and the statute is con- :
stitutional and valid. The statute confers on a physician cer-
tain privileges, and may impose corresponding duties."

It is further said : " We need not inquire whether the provis-
ions of the statute are unjust or oppressive. These matters
are for the consideration of the legislative, department of the



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10

govermnent. We may ohnurve that it is difficult to discover
oppression or injustice in requiring the medical profession to
make known to the world statistics which may promote and
are promoting tlie public liealtli/' ''A physician should hon-
estly endeavor to obtain and report all information required by
the regulations of the statute, and the Board of Health."

In some i?istances county health officers, when interrogated
upon the subject, admit that some physicians are not reporting
as required, but refuse to enforce the law because they " do not
wish to offi>nd their [)rofessional brethren." It is useless t<>
say that such an exeuse is })uerile, and unworthy one who has
assumed the duties of the officH' with the implied agreement
thgtt he will perform all the duties lequired of him. If he fails
to do his duty he ought to be superseded at once by one who
has the courage to require compliance with all the duties per-
taining to the position.

The Board is of the opinion that a labaratory should be
established in connection, with one of the iState Institutions for
the study of hacteriology.

It has frequently occurred in the past that amilysis of water
from different localities suspected of containing impuritieB
should be made, but the Board being wnthout apparatus for that
purpose was compelled to refuse to make analysis or procure it
done at heavy expense. Until provisions can be made for such
analysis by this Board, counties must bear the necessary ex-
pense themselves.

In relation to the collection ot vital statistics, the following
from the Twelfth Annual Report of the Wisconsin State Board
of Health is applicahle to this State :

Attention has been called in previous reports to the lack of
an effective system for collecting and recording the facts relat-
ing to the life and death of the individual citizen in our State,
and the increasing need for the adoption of such method, to
the end that these important points in connection with the
individual may be recorded as to be susceptible of legal estab-
lishment at any time should necessity arise. Two instances
have been recently brought to our notice which go to show
this defect in our registration methods in a strong light, and it
is probable that there are many others similar in kind, within
the knowledge of [)ersons occupying official positions. Both
eases were very similar and one which will serve to illustrate



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11

the position arose in connection with an application for a pen-
sion on the part of a woman whose hnsband was killed during
the war, or who died of injuries received therein. In the
course of the proceedings it became necessary to establish the
fact of marriage. The ceremony had been performed by a
justice of the peace who had long since retired from office, and
who had no recollection whatever of the fact, but declared no
doubt truly that if he performed the ceremony at the time in-
dicated he made an entry thereof on his docket, which he af-
terwards transfered to his successor. No further record has
been made of the fact, and in the course of years the docket
was lost, and no trace of it is now to be obtained, tliough dili-
gent search has been made by the parties interested :ind by the
woman's friends. No written record existing, the n(ixt attempt
was to prove the marriage by the evidence of witnesses present
thereat, but none could be found, and after all other means had
been exhausted, all that remained to be done was to fall back
upon such evidence as could he obtained to the effect that, prior
to the husbancrs entrance into the Hervice of the United States,
the fact that the marital i c lation existed was generally known
and admitted without question among the friends, relatives and
immediate neighl)ors of the two persons directly concerned.
This course was tak(^n under legal advice, but what the result
will be is not known.

For obvious reasons it is with births and deaths that boards
of health are chiefly concerned. It is by the collection and
comparison of data such as bills of mortality only can supply,
that the sanitarian is enabled to study the causes that underlie
the origins of disease; by showing exactly the points where
preventable disease of any kind is prevalent, such returns en-
able central boards to give information which will make it pos-
sible for local authorities to act intelligently and efficiently in
the prevention of sickness in the first instance, and in restrict-
ing it to the narrowest practicable limits in the event of its ob-
taining an entrance.

The health officer of a city of considerable importance writes :
" I can not give you statistics of death from any kind of dis-
ease." This city which boasts itself of the number of its in-
habitants, its Young Men's Christian Association, its social
clubs and business men's rooms, such a city has no system of
mortuary records from which statistics can be drawn, and the



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12

local board refused to recoiiinieiid to the Common Council the
adoption of an ordinance requiring certificates of death and a
system of l)uriat perniits based on such certificates, assigning;
as a reason sufficient for refusal that it is too much red tai)e
connected with so sacred a thing as death and burial/'

The imi)ortance of keei>ing correct and complete records by
the County Health officers can not be overestimated. Nuuier-
ous instances have come under our observation wliich go to
confirm' this view, (^uite frequently incjuries are made and
certified copies of death sought by relatives of <leceased soldiers,
to be used in the matter of jKUision claims and in the settle-
ment of estates. Too much care can not be exercised on the
part of the ])rt)per officers, to have the records properly made
and in<lexed so that easy reference can be made at any time
that occasion may require, and this record should be ''open to
the ins})ection of any visitor without fee.**

Tlie Board regards the folh wing ''suggestions'* in regard t(>
legislative action as important:

1. Kequiring l)urial })ermits in all cases of death in the State,
so tliat correct mortuary statistics can i)e obtained.

2. Providing by fees or salary for the [myment of County
Health officers, and })roviding a ])enalty for the non-perform-
ance of duty.

' 8. Vesting tlie a[q>ointing ]K>wer and removal of C%)untv
Health officers in the State Board of Health.

4. An increase in the number of annual rej)orts.

5. J^roviding for a contingent or (Epidemic fund, under the
control of -the Uovernor or other authority, provided for by
legislative enactment, to be used in cases of emergency.

6. Providing for the building of abattoirs and preventing
the slaughtering of animals elsewhere, and for inspectors of
cattle to be used for food, l)efore and after killing.

•FINANCIAL EXHIBIT.

The following is a statement of the recei[)ts and exi)endi-
tures for the fiscal year, ('ommeiicing November 1, 1889, and
ending October 81, 1890. All accounts have been submitted to
the b(mrd f(H- its consideration at its regular meetings, and
wheii allowed have been certified to by the I^'i'sident and Sec-
retAVy, and audited by the Auditor of State, before warrants
wei*e'(lrawn for the same.-



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13

Out of the uuiiual appropriation of live thousand dollars to
carry on the work of this department, the members have been
paid all actual expenses incurred by attending regular and
special meetings of the board, as well as expenses caused in
making sanitary inspections of various sections and the diflFer-
ent public institutions under the control of the State govern-
ment. Report^; of inspections made by members of the board
will l>e found in another part of this report. From our fund
we pay the current expenses of the office, the Secretary's and
clerks' salaries, printing bills, including all publications of the
board, except the annual report.

The hoard supplies all the town, city and (H)unty health
boards with physicians' blanks for the return of births, deaths,
contagious and infectious diseases, (bounty Clerks for the re-
turns of marriages, and furnishes county boards of health with
blanks to make regular quarterly reports, as well as Hants for
special reports of contagious and infectious diseases, blank
transit permits for the transportation of dead bodies, and
blank certificates for undertakers, preventable disease circulars
for general distribution among the people, the rules and regu-
lations of the hoard for the government of physicians and
health officers, programs, and all necessary printing for sani-
tary conventions held in the State; also printed postal cards on
which health officers and physicians in the different parts of
the State niake weekly reports to this board of the prevalence
of all preventable diseases, and blanks for the sanitary inspec-
tion of school houses, pooi- asylums and jails. Within the



Online LibraryNew York Chamber of CommerceAnnual report of the Indiana State Board of Health. 1890 → online text (page 1 of 28)