CONTENTS. 1,191 births; rate, The Southern Sanitary Section, population 686,443, reports

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1 MONTHLY BULLETIN Indiana State BoardofHealth [Entered as second-class matter at the Indianapolis Postoffice.] [Acceptance for mailing at special rate of postage provided for in Sectioni 1105, Act of October 3, 1917, authorized August 9, 1918.] VOLUME XXIII. INDIANAPOLIS, JULY, Number 7 HUGH A. COWING M. D.. PRESIDENT Muncie JOHN H. HEWITT. M. D., VICE-PRESIDENT Terre Haute FREDERICK HENSHAW, D. D. S Indianapolis J. N. HURTY. M. D. f Phar. D., SECRETARY... Indianapolis CHAS. BRUCE KERN, M. D Lafayette WM. F. KING, M. D., ASST. SECRETARY AND DIRECTOR BUREAU OF VENEREAL DISEASES. H. R. CONDREY ACCOUNTANT H. M. WRIGHT REGISTRAR-STATISTICIAN WM. SHIMER, A. B., M D..SUPT. BACTERIOLOGICAL LABORATORY J. P. NICODEMUS, M. D ASSISTANT BACTERIOLOGIST I. L. MILLER, A. B...STATE FOOD AND DRUG COMMISIONER AND CHEMIST. V. C STARNER, B. S ASSISTANT CHEMIST JOHN C. DIGGS. B. S SANITARY ENGINEER EDWARD C. HELWIG, M. D DIRECTOR DIVISION OF SCHOOL HYGIENE ADA E. SCHWEITZER, M. D., DIRECTOR, DIVISION OF INFANT AND CHILD HYGIENE H. W McKANE, M. D,... DIRECTOR DIVISION OF TUBERCULOSIS LEO J. RAIL STATE INVESTIGATOR The MONTHLY BULLETIN will be sent to all health officers and deputies in the State. Health officers and deputies should carefully read and file each copy for future reference. This is very important, for we expect to print instructions, rules and general information, which it will be necessary for officers to preserve. CONTENTS. Births for July Abstract of Mortality Statistics for July Summary for Morbidity and Mortality for July Health Officers, Attention Report of Bacteriological Laboratory for July Things of Interest from Laboratory Report of Food and Drug Department What is a Public Nurse, What Are Her Duties? July Bulletin Official Opinion of Committee on Milk Standards Concerning Milk Pasteurization City Health Officers Read This Section of Statutes Carefully. Red Cross Nurses Receive Appointments for County Work.. Diagnosis of Pulmonary Tuberculosis in Adults with Sputum Summary Weekly Disease Reports Weather Bureau Report Chart Showing Geographical Distribution of Deaths Table 1. Deaths and Births in Indiana by Counties Table 2. Deaths and Births in Indiana by Cities BIRTHS FOR JULY, births, 5,264 (stillbirths excluded); State rate, Males numbered, 2,741; females, 2,523. White males numbered, 2,670; white females, 2,461. Colored births, 133; males, 71; females, 62. Stillbirths, 144; white, 138; colored, 6. The Northern Sanitary Section, population 1,042,514, reports 1,964 births; rate, The Central Sanitary Section, population 1,219,131, reports 2,109 births; rate, The Southern Sanitary Section, population 686,443, reports 1,191 births; rate, The highest birth rate, Howard County, The lowest birth rate, Delaware County, 6.4. births to date for 1919, 33,177. births to date for 1920, 37,828. ABSTRACT OF MORTALITY STATISTICS FOR JULY, deaths reported, 2,538; rate, In the preceding month 2,614 deaths; rate, In the same month last year, 2,647 deaths; rate Deaths by important ages were: Under 1 year of age, 309, or 12.1 per cent of total, 1-10, 164; 10-20, 104; 65 and over, 929, or 36.6 per cent of total. SANITARY SECTIONS: The Northern Sanitary Section: Population 1,042,514, reports 888 deaths; rate, In the preceding month, 896 deaths; rate, In the same month last year, 905 deaths; rate, THE CENTRAL SANITARY SECTION: Population 1,219,131, reports 1,118 deaths; rate, In the preceding month, 1,172 deaths; rate, In the same month last year, 1,160 deaths; rate, THE SOUTHERN SANITARY SECTION: Population 686,443, reports 532 deaths; rate, 9.3. In the preceding month, 546 deaths; rate, 9.5. In the same month last year, 582 deaths; rate, REVIEW OF SECTIONS: The Central Sanitary Section presents the highest death rate, 11.0, which is 0.7 higher than that for the entire state. The Central Section also presents the highest death rate for diarrhea and enteritis, poliomyelitis, influenza and cancer. The Northern Section presents the highest death rate for other forms of tuberculosis, typhoid fever, diptheria, measles, lobar and bronchopneumonia, cerebro-spinal fever and external causes. The Southern Section presents the highest death rate for pulmonary tuberculosis, scarlet fever, whooping cough and puerperal septicemia. RURAL: Population 1,701,179, reports 1,321 deaths, rate, 9.3. In the preceding month 1,276 deaths; rate, 9.0. In the same month last year 1,406 deaths; rate, 9.9. URBAN: Population, 1,246,909, reports 1,217 deaths; rate, In the preceding month, 1,338 deaths; rate, In the same month last year, 1,241 deaths; rate, The cities named present the following death rates: Indianapolis, 13.3; Fort Wayne, 10.4; Evansville, 13.5; South Bend, 9.5; Terre Haute, 10.7; Gary, 8.8; East Chicago, 8.7; Hammond, 10.3; Richmond, 7.6; Anderson, 14.7; New Albany, 10.2; Elkhart, 13.8; Kokomo, 10.6; Michigan City, 13.4; Lafayette, 18.3; Logansport, 8.9; Marion, SUMMARY OF MORBIDITY AND MORTALITY FOR JULY, Measles, as in the preceding month, was reported as the most prevalent infectious disease. The order of prevalence was as follows: Measles, smallpox, scarlet fever, gonorrhea, syphilis, diphtheria, tuberculosis, typhoid, pneumonia, meningitis and poliomyelitis. SMALLPOX: 254 cases in 43 counties with no deaths. In the preceding month 421 cases in 56 counties with no deaths. In the same month last year 131 cases in 26 counties with 2 deaths. The counties reporting smallpox

2 74 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. present were: Bartholomew, 1; Boone, 7; Cass, 9; Clay, 6; Clinton, 3; Daviess, 8; Decatur, 4; Delaware, 1; Elkhart, 6; Grant, 4; Greene, 14; Hamilton, 2; Hancock, 2; Hendricks, 4; Howard, 1; Huntington, 17; Jackson, 2; Jasper, 1; Jennings, 2; Johnson, 1; Knox, 9; Kosciusko, 1; LaGrange, 1; Lake, 21; Lawrence, 22; Madison, 13; Marion, 11; Martin, 6; Orange, 1; Pike, 4; Porter, 1; Ripley, 2; Shelby, 8; Steuben, 1; St. Joseph, 10; Sullivan, 11; Tippecanoe, 1; Tipton, 7; Vermillion, 3; Vigo, 7; Wabash, 11; Warrick, 5; Wayne, 3. TUBERCULOSIS: 228 deaths, of which 185 were of the pulmonary form and 43 other forms. The male tuberculosis deaths numbered 97, females 131. Of the males, 19 were married in the age period, 18-40, and left 38 orphans under 12 years of age. Of the females, 41 were married in the same* age period as above, and left 82 orphans under 12 years of age. number of orphans made in one month by this preventable disease, 120. Number of homes invaded, 214. PNEUMONIA: 85 deaths; rate, 34.6 per 100,000. In the preceding month, 133 deaths; rate, In the same month last year, 55 deaths; rate, Males numbered, 50; females, 35. INFLUENZA: 13 deaths reported. In the preceding month, 34 cases in 6 counties with 23 deaths. In the same month last year, 45 cases in 9 counties with 12 deaths. TYPHOID FEVER: 56 cases in 24 counties with 18 deaths. In the preceding month, 83 cases in 17 counties with 21 deaths. In the same month last year, 113 cases in 43 counties with 28 deaths. DIPHTHERIA: 96 cases in 22 counties with 16 deaths. In the preceding month, 110 cases in 29 counties with 10 deaths. In the same month last year, 181 cases in 38 counties with 20 deaths. SCARLET FEVER: 215 cases in 43 counties with 7 deaths. In the preceding month, 374 cases in 49 counties with 11 deaths. In the same month last year, 100 cases in 29 counties with 1 death. MEASLES: 274 cases in 44 counties with 4 deaths. In the preceding month, 1,494 cases in 21 counties with 22 deaths. In the same month last year, 234 cases in 25 counties with 1 death. POLIOMYELTIS: 1 case in 1 county with 1 death. In the preceding month, 5 cases in 3 counties with 2 deaths. In the same month last year, 1 case in 1 county with 2 deaths. SYPHILIS: 140 cases in 23 counties with 14 deaths. In the preceding month, 271 cases in 43 counties with 12 deaths. GONORRHEA: 154 cases in 29 counties. In the preceding month, 383 cases in 36 counties. EXTERNAL CAUSES: 233; males, 169; females, 64. SUICIDES: 40; males, 25; females, 15. Suicide by poisoning, 10; by asphyxia, 2; by hanging or strangulation, 5; by drowning, 4; by firearms, 14; by cutting or piercing instruments, 3; by jumping from high places, 1; by crushing, 1. ACCIDENTAL OR UNDEFINED: 183; males, 136; females, 47. Poisoning by food, 2; other acute poisonings, 5; burns, conflagration excepted, 10; absorption of deleterious gases, 1; accidental drowning, 19; traumatism by firearms, 2; traumatism by fall, 21; traumatism in mines, 5; railroad accidents and injuries, 32; street car accidents and injuries, 3; automobile accidents and injuries, 43; landslide, other crushings, 3; injuries by animals, 5; effects of heat, 6; lightning, 5; electricity, lightning excepted, 6; fractures, cause not specified, 6; other external violence, 9. HOMICIDES: 10; males, 8; females, 2. Homicide by firearms, 10. HEALTH OFFICERS, ATTENTION. Delayed Birth and Death Returns. Each month the statistical department receives certificates for births and deaths that have occurred during the preceding month, which are not sent to this department in time to be tabulated with the report for the current month. With the report for July, the following counties named below were delinquent in this matter: BIRTHS. Adams, 2; Allen, 3; Benton, 3; Boone, 2; Cass, 1; Clark, 2; Clay, 3; Clinton, 1; Crawford, 2; Daviess, 1; Decatur, 1; Dekalb, 6; Delaware, 1; Floyd, 3; Franklin, 3; Gibson, 2; Grant, 8; Greene, 9; Hamilton, 1; Hendricks, 3; Henry, 5; Howard, 2; Jasper, 1; Jay, 3; Jefferson, 2; Jennings, 1; Johnson, 1; Knox, 5; Kosciusko, 3; Lake, 41; Laporte, 9; Lawrence, 3; Madison, 5; Marion, 2; Miami, 2; Monroe, 5; Montgomery, 3; Noble, 1; Orange, 3; Owen, 1; Parke, 4; Pike, 1; Porter, 3; Pulaski, 1; Putnam, 1; Randolph, 1; Ripley, 2; Rush, 2; Scott, 1; Shelby, 3; Starke, 1; Steuben, 2; St. Joseph, 5; Sullivan, 8; Tippecanoe, 3; Tipton, 3; Vanderburgh, 8; Vermillion, 5; Vigo, 3; Warrick, 1; Washington, 2; White, 5; Whitley, 2. DEATHS. Adams, 1; Allen, 2; Bartholomew, 1; Benton, 1; Blackford, 1; Clark, 1; Clay, 5; Crawford, 5; Dekalb, 3; Delaware, 4; Dubois, 1; Floyd, 2; Gibson, 8; Grant, 8; Greene, 3; Hamilton, 1; Harrison, 3; Hendricks, 5; Jasper, 1; Jefferson, 3; Johnson, 1; Kosciusko, 1; Lake, 6; Madison, 1; Martin, 2; Miami, 3; Montgomery, 3; Noble, 1; Orange, 1; Owen, 1; Parke, 1; Pike, 1; Porter, 1; Randolph, 1; Ripley, 3; Rush, 1; Spencer, 1; Sullivan, 2; Vanderburgh, 1; Vermillion, 1; Vigo, 1; Wayne, 1; White, 1; Whitley, 1. REPORT OF BACTERIOLOGICAL LABORATORY INDIANA STATE BOARD OF HEALTH FOR JULY, Will Shimer, M. D., Superintendent. Sputum for tubercle bacilli- Positive Urine for tubercle bacilli Spinal fluid for tubercle bacilli Pleural fluid for tubercle bacilli Ascitic fluid for tubercle bacilli Pus for tubercle bacilli Milk for tubercle bacilli v

3 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 75 Throat cultures for diphtheria bacilli Positive... Unsatisfactory Widal tests for typhoid fever Positive... Widal tests for paratyphoid fever "A" Widal tests for paratyphoid fever "B" Wasserman tests for syphilis Positive.. Anticomplementary Brains for rabies: Dogs: Positive Cats: Unsatisfactory 1 Hogs: Blood for counts Blood for malaria plasmodia Positive Pus for gonococci Females: Positive Suspicious Unsatisfactory Males: Positive. Suspicious Unsatisfactory Pathological tissues Carcinoma: Carcinoma of neck... Carcinoma of mammary gland Carcinoma of uterus Carcinoma location not given Miscellaneous tissues Gasserian ganglions Urine for general analysis Feces for hook worm, negative Feces for parasites, negative number examinations made OUTFITS PREPARED AND SENT OUT DURING JULY, Tuberculosis Diphtheria... Widals Wassermanns... Malaria Blood counts Gonococci number. PATIENTS TAKING "PASTEUR" TREATMENT DURING THE MONTH OF JULY 1920 Treatment Treatmen Name Town County Age Sex Began Finished Robert E. Sharp.. CarlFrisbie Frank Jackson... Weslie Crozi. Bertha Thomas... Edna Thomas Clarence Thomas. Albert Decker Beatrice Johnston Muncie... Shelburn... Jeffersonville. Terre Haute.. Ewing... Ewing Ewing Freetown Terre Haute.. Delaware.. Sullivan... Clark Vigo Jackson... Jackson... Jackson... Jackson... Vigo REPORT ON "NEOSALVARSAN" SENT TO THE CLINICS DURING THE MONTH OF JULY 1920 U.S.P.H.S. Clinic Anderson Brazil Columbus East Chicago Evansville. Fort Wayne Hammond Indianapolis Clinic Indianapolis Hospital.. Jeffersonville. Kokomo Marion Madison Muncie, Michigan City New Castle South Bend, Terre Haute Richmond.., to Clinics.. Miscellaneous sent... THINGS OF INTEREST FROM THE LABORATORY. The rapid spread of influenza and pneumonia among soldiers in camps has been explained in many ways. The conclusions of Lt. Col. J. S. Cummings 1 with reference to dishes as the source of infection are convincing. 1. The successful operation of the theory of the cause and elimination depends upon the identification and blocking of the major avenue of saliva-borne disease distribution. Inasmuch as this blocking prevents more than half of the cases, it consequently eliminates an equal number of sources and since by its continuous operation there is a cumulative effect in eliminating cases and sources for each successive human cycle of the infection, we have in the universal application of the principle a means of eventually eradicating this group of infections. Jour. A. M. A. July, pg. 576

4 76 MONTHLY BULLETIN, INDIAN A STATE BOARD OF HEALTH. 2. Epidemiological observations in institutions, in civil population and in the army indicates that eating utensils are the major avenue of saliva-borne disease distribution. 3. The major avenue of distribution can be effectively blocked by the use of boiling water in the process of dish washing. 4. Healthy adult carriers of pneumonia producing groups of organisms are more susceptible than non-carriers to the influenza virus infections. 5. The greater susceptibility of the pneumonia carrier and the fact that this group of organisms is almost wholly responsible for the mortality of influenza virus epidemicindicates that as a public health measure the prevention of pneumonia transmission is more important than influenza transmission. Both of the infections are saliva-borne. 6. In the institutions where machine dish washing was used the mortality was 55% less than in those where handwashed dishes were used. Many believe that the crowded conditions of barracks and amusement halls favored transmission of respiratory disease. F. Huddleston and T. G. Hull 2 arrived at the following conclusions with reference to amusement halls: 1. During the height of an epidemic of bad colds and coughs the air of an amusement hall filled with soldiers was so badly contaminated that an average of 82 organisms fell on blood agar plates exposed one minute. Among the organisms were pneumococci and numerous staphylococci. 2. Eight days later, after the epidemic had subsided, only an average of 16 colonies developed from plates exposed under similar conditions, but for a period of ten minutes; 16% of these colonies were streptococci. 9. Excellent ventilation and prevention of overcrowding by limiting the size of the audience to the number of seats did not prevent enormous bacterial contamination of the air. 4. Any man susceptible to prevailing respiratory diseases, under such conditions, could not help but contract these diseases by sitting through a performance of one to two hours length. REPORT OF THE DEPARTMENT OF FOOD AND DRUGS FOR THE MONTH OF JULY, I. L. Miller, State Food and Drug Commissioner. State Food and Drug Inspectors, operating in co-operation with the United States Bureau of Chemistry in the enforcement of federal laws, participated in the collection of a large quantity of drug samples, which will be analyzed by the government for misbranding and adulteration. This activity centered principally in Indianapolis. Recently the inspectors also assisted the federal bureau in the taking of fruit and vegetable samples and containers, at Evansville, with a view to establishing the question whether the regulations relative to standardized containers is being observed. During the month of July, the county fairs at Edinburg and Middletown, were inspected and many refreshment stands given orders to "clean up or quit business." The food and drug inspectors will make a special effort to enforce sanitary regulations at.the county fairs, where such abuses as the continued use of "sanitary cups" and the like, are ordinarily quite common. The food and drug division assisted the Indiana Live Stock Sanitary Board in eliminating the pollution of a stream, which threatened the health of 200 fine dairy cows on the Wallace farm, near Peru, Indiana, where a reduction plant was forced to provide for another place for a disposal of its waste. During July there were inspected 1,249 food-handling establishments, including 319 groceries, 104 cream stations, 132 drug stores, 156 hotels and restaurants, 96 meat markets, 77 soft drink parlors, 80 confectioneries, and 22 ice cream factories. In connection with the drug store inspections, a large number of apothecaries scales were tested and many weights ordered destroyed because of their irregularity. Of the establishments inspected 2 cream stations were condemned, and 25 given a limited time to make improvements. Ten groceries were directed to make immediate improvements or quit business, and 12 drug stores promised a similar penalty unless they improved their quarters. During the month nine bakeries were found violating the labeling law, 28 cream stations were found improperly constructed, and a total of 79 "conditional condemnations" which means that specific improvements must be made within a specified time returned by the inspectors. Of the 65 food analyses made during the month, 28 were found illegal, of which 8 were pop, 4 other soft drinks, 3 hamburger, 1 cream, 3 milk, 7 ice cream, 1 ice cream powder and 1 oleomargarine. There were four convictions for violation of the pure food law during the month, two for selling meat preserved with sulphite and two for selling ice cream below the legal standard. During the month 1 case of oleomargarine, 7 gallons of crushed fruit and 6-1/2 gallon cans of crushed fruit were ordered withdrawn from the market, because of their containing benzoate of soda, an unlawful preservative. SUMMARY OF SANITARY INSPECTIONS MADE DURING THE MONTH OF JULY, 1920 Number Number Number Number Number Number CLASSIFICATIONS Inspected Excellent Good Fair Poor Bad Bakeries Bottling Works Canning Factories Confectioneries Creameries Cream Stations Drug Stores Fish Stores Fruits and Vegetables... Flour Mills Groceries Hotels and Restaurants.. Ice Cream Factories Ice Cream Parlors Meat Markets... Milk Plants, Poultry and Produce Slaughter Houses Soft Drink Parlors Candy Kitchens Packing Plants follow-up Jour. A. P. H. A., July 1920, Fig. 582.

5 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 77 SUMMARY OF CONDEMNATION NOTICES ISSUED DURING MONTH OF JULY, 1920 CLASSIFICATION Bakeries Confectioneries... Cream Stations... Drug Stores Groceries Ice Cream Factories Meat Markets... Poultry Houses... Restaurants Slaughter Houses. Soft Drink Parlors Reasons for Condemnation Number Unsanitary Improper No Health No Bread Issued Conditions Construc- Certificates Labels tion Orders Complied with and Cases Closed NUMBER OF FOLLOW-UP INSPECTIONS MADE DURING THE MONTH OF JULY, 1920 Bakeries.-. Confectioneries Cream Stations Drug Stores Groceries Hotels and Restaurants. Meat Markets Slaughter Houses Soft Drink Parlors Number Number Number CLASSIFICATIONS Inspected 0. K. N. S. ANALYSIS OF FOODS AND DRUGS DURING THE MONTH OF JULY, 1920 Baking Powder Beverages Pop Condiment Extract- Lemon Fruit Products Current-Apple Jam.. Flour Gelatin Meat Products Hamburger Sausage Freezem Pickle Milk Products Butter Cream Milk (Dairy) Milk (Mothers') Milk Powder Ice Cream Ice Cream Powder... Oleomargarine Water Vinegar No analysis of drugs made. Number Number CLASSIFICATION Legal Illegal GOODS ORDERED WITHDRAWN FROM SALE DURING THE MONTH OF JULY, Case Good Taste Nut Margarine Contains Benzoate of Soda 7 1-Gallon Jars Crushed Fruit Contains Benzoate of Soda 61/2-Gallon Jars Crushed Fruit Contains Benzoate of Soda COUNTIES Rush... Rush Delaware. Delaware. LIST OF PROSECUTIONS DURING THE MONTH OF JULY, 1920 Names and addresses of defendants Edward Lyons, Rushville, Ind Edw. Haywood, Rushville, Ind A. Pieronie, Muncie, Ind. A. Turricchi, Muncie, Ind. Why Date of I Final prosecuted trial disposition Sulphites in hamburger. ; Sulphites in hamburger Ice cream below standard Ice cream below standard WHAT IS A PUBLIC HEALTH NURSE, AND WHAT ARE HER DUTIES? By Ina M. Gaskill, Assistant Director, Public Health Nursing Service, State Board of Health and Red Cross. The chief work of the public health nurse is to help people to be well, to get well, to stay well. She is the friend of the family and the community, and seeks to provide equal and adequate care for all the people in time of sickness; but more than this she emphasized the guarding of health. Any form of community work in which the health of the public is concerned is hers. As nurse and teacher of healthful living she enters the home where there is illness, nursing the people who are sick, protecting from sickness those who are well and showing the well members of the family how to take care of its ill between the visits of the nurse by actually demonstrating how the things are to be done. Her problem is combined in the nursing of the sick and the protection of the well against sickness. She may work in schools, homes, public playgrounds, industries, department stores and factories in the tenements of the very poor and the homes of the well-to-do. Her work lies in small towns and big cities, rural districts and lonely mountain regions. She is a public servant, found wherever there is need for her service regardless of race, religion, social or financial condition of those she serves. She teaches mothers how to look after their babies, and school children how to look after their bodies. She endeavors to locate tuberculosis patients, gives them nursing care, and tells the sick and those who come in contact with tuberculosis of the best methods of care and prevention. She assists the school medical inspector in the physical inspection of school children and follows the child with defects into its home, where she persuades the parents to act upon the advice of the school doctor and secure proper treatment immediately. As an industrial nurse she looks after the health of workers in industrial plants, renders first aid service in cases of emergencies and visits and gives nursing care to the employes in their homes when sick. She is interested in the baby before its arrival and tries to prepare for his coming by giving the mother her best advice. She may build for the future by forming little Mothers' Leagues and shows the girls of various ages how to bathe, feed and care for the baby. She tries to bring about sanitary living conditions in a friendly way and carries the message of health from one individual to another, establishing a feeling of friendliness on the part of the family she is helping. There is a known shortage in the United States today of several thousand public health nurses and one of the

6 78 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. important phases of any health promotion program is to arouse the interest of qualified young women in taking the training necessary to fit them for this vital and absorbing calling. "JULY BULLETIN." A Conference of Public Health Nurses, in collaboration with the State Board of Health, will be held at the Hotel Severin, Indianapolis, October 5-6, 1920, preceding the meeting of the State Nurses' Association, October, 7-8-9, A program is being formulated which will interest and be of benefit to all public health nurses. The following appointments have been made in the Public Health Nursing Service: Miss Mildred Williamson, city of Elkhart. Miss Emily Hopkins, New Albany, Floyd Miss Ethel Hatfield, LaFayette, Tippecanoe Mrs. Gladys Nonomaker Drake, Shelbyville, Shelby Miss Nell Hughes, Aurora, Dearborn Mrs. Nellie Sedgwick, Ligonier, Noble Miss Mary Shipman, Madison, Jefferson Miss Lydia Jordan, LaPorte, LaPorte Miss Claudia Achtenhagen, Tipton, Tipton OFFICIAL OPINION OF THE NATIONAL COMMITTEE ON MILK STANDARDS CONCERNING MILK PASTEURIZATION. In 1917 the Commission adopted a resolution to the effect that in its opinion the pasteurization of milk at 145 degrees for thirty minutes destroys none of its food constituents. Inquiry conducted by the New York City Health Department, into the records of the infant milk depots, where sometimes over 25,000 infants were fed daily on pasteurized milk, appears to bear out this assumption. Since that time there has been much careful research on the relation of scurvy to the lack of a protective substance in the food. It has been demonstrated to the satisfaction of all of the most eminent authorities in nutrition that scurvy is due to the lack of a specific dietary factor which is easily destroyed by heating, and that milk which has been pasteurized has lost, in. part at least, its protective action against this disease. It has been likewise demonstrated that there may be pronounced differences in the value of fresh, unheated milks in their anti-scorbutic value, depending on the nature of the diet of the cow or lactating woman. The antiscorbutic substance is found abundantly only in fresh fruits, vegetables, green grass and other forage. Cooked foods are of little value and the milk of a mother whose diet consists largely of cooked or dried or preserved foods will not protect her infant against this disease unless some substance rich in anti-scorbutic properties be included. The milk of cows will be more effective as an anti-scorbutic food when they are fed green foods. In view of these new discoveries concerning the possibility of milks varying in their nutritive value, to some extent, with the diet and the seasons, and in view of the possible reduction of the food value of milk with respect to the anti-scorbutic factor in the process of pasteurization, the Commission recommends that orange juice be added to the diet of infants that are fed on pasteurized milk. The Commission also wishes to reaffirm its advocacy of the adoption of pasteurization by municipalities as a public health measure. CITY HEALTH OFFICERS READ THIS SECTION OF THE STATUTES CAREFULLY (3476) Legislative Power Appropriations 52. The common council of every city shall have power to pass all ordinances, orders, resolutions and motions for the government of such city, for the control of its property and finances and for the appropriation of money. No appropriation shall be made for the payment of money otherwise than by ordinance, specifying by items the amount thereof and the department for which the appropriation is made. The council may prescribe by ordinance its own rules. No ordinance, order or resolution of the council shall become a law, or operative until it has been signed by the presiding officer thereof, and approved in writing by the mayor, or passed over his veto, as hereinafter provided, and, whenever necessary, promulgated according to law. No ordinance shall be passed on the same day, or at the same meeting, that it is introduced, except by unanimous consent, and then only in case there are present and voting at least two-thirds of all the members-elect of the council. Every ordinance imposing a penalty or forfeiture for the violation thereof shall, before the same shall take effect, be published, once each week, for two consecutive weeks, in a newspaper of general circulation printed in such city: Provided, That in case of insurrection, riot, pestilence, conflagration or in other case of urgent necessity requiring the immediate operation of any such ordinance, it shall take effect as soon as proclamation is made thereof by the mayor, and copies are posted in three public places in each of the wards of the city: Provided, further, That whenever any city shall publish any of its ordinances in book or pamphlet form such publication shall be of itself sufficient and such ordinance or ordinances shall,be in force in two weeks from the date of publication of such book or pamphlet. Burns R RED CROSS NURSES RECEIVE APPOINTMENTS FOR QOUNTY WORK. Seventeen Red Cross Nurses have been appointed in various counties of the state to do Public Health Nursing, and seventeen to do special emergency work, or the class work in Elementary Hygiene and Home Care of the Sick. The majority of these nurses are paid almost entirely by the local Red Cross Chapter funds. During the school year, as a general thing, work in the county schools has been emphasized. During the summer the nurses are planning to make follow-up visits to the school children who have physical defects and whom they have not been able to follow while school was in session. Many of them are planning to do special Infant Welfare work during the summer. We feel that the average Indiana community has awakened to the necessity of having a Public Health Nurse. There are some thirty counties where committees are organized and funds are available to establish this service, but there is not a sufficient number of qualified Public Health Nurses to fill these positions. All of this work is a part of the peace-time program of the American Red Cross, and certain principles and lines of organization have been set down for us to follow. This action on the part of the American Red Cross is perhaps a temporary measure. Since

7 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 79 this great national organization realizes that it is not alone in the field of constructive Public Health Nursing work, but is willing to do its share until governmental agents are organized and prepared to take over the work. Many cities and a few of the small towns in Indiana have had Public Health Nursing for some considerable time, but the work in the rural communities has been almost untouched. It is this rural and small town work that the American Red Cross wishes to emphasize. It is thought best that this work be developed with the county as the unit, with the exception of such counties as contain cities of 20,000 or over. The seventeen Red Cross Public Health Nurses who have been appointed are: Miss Matilda Steilburg, Paoli, Orange Miss Bertha Lipps, Salem, Washington Miss Blanche Lillpop, Corydon, Harrison Miss Frances McGee, New Albany, Floyd Miss Stella Barnes, Jeffersonville, Clarke Miss Grace Shaffer, Noblesville, Hamilton Miss Anna Anderson, Fowler, Benton Miss Velma Carpenter, Brook, Newton Miss Nettie Jordan, Rensselaer, Jasper Miss Isobel Carleton, Rochester, Fulton Miss Florence Sage, South Bend, St. Joseph Miss Louise Krause, City of Elkhart. Miss Emma Maddux, Kendallville, part of Noble Miss Grace Lewis, Auburn, Dekalb Miss Ellen Zirkle, school nursing, City of Fort Wayne. Miss Jeanette Storey, Decatur, Adams Miss Ada Hornaday, Huntington, Huntington The most of these nurses are emphasizing the work in the rural schools. In the case of Fort Wayne and Elkhart it is entirely a city service. The following Red Cross Nurses are doing the class instruction work in Elementary Hygiene and Home Care of the Sick, or special emergency work that is planned over a period of a few months: Mrs. Anna Simms, Evansville, Vanderburg Miss Katherine Relsteiner, Evansville, Vanderburg Miss Beuma V. Fagan, New Albany, Floyd Miss Juanity Edwards, Brazil, Clay Miss Lydia Jordan, Danville, Hendricks Miss Edna O. Stuart, Brookville, Franklin Mrs. Lucille R. Baker, New Castle, Henry Miss Ella R. Wright, Greenfield, Hancock Miss Frances M. Ott, Huntington and Wabash Counties. Miss Martha Garrison, Bluffton, Wells Miss Pauline Huser, Fort Wayne, Allen Miss Maude Hutchinson, Warsaw, Kosciusko Mrs. Nellie K. Sedgwick, Ligonier, Noble Miss Edna Yoder, LaGrange, LaGrange Miss June Gray, Indianapolis. Miss Clara Justice, Gary, Lake Miss Ellen Zirkle, Fort Wayne, Allen The following changes were made in Public Health Nursing Service: Miss Blanche Lillpop of Corydon, resigned. Miss Frances McGee of New Albany, resigned. Miss Edna O. Stuart of Brookville, resigned. Miss Nettie Jordan of Rensselaer, resigned. Miss Louise Krause of Elkhart, resigned. Miss Emily Hopkins, appointed for New Albany, Floyd Miss Helen Teal, appointed for Brookville, Franklin Miss Maude Tindor, appointed for Franklin, Johnson Miss Ella Wright, appointed for Greencastle, Putnam Miss Lydia Jordan, appointed for LaPorte, LaPorte Miss Linnie Best, appointed for Monticello, White Miss Elizabeth Melville, appointed for Newcastle, Henry "NURSES TAKE UNIVERSITY TRAINING." The following nurses have entered universities to take special work in Public Health Nursing this summer. Practically all of them will return for work in Indiana. Mrs. Anna E. Simms, Western Reserve University at Cleveland. Miss Juanity Edwards, Western Reserve University at Cleveland. Miss Martha Garrison, Western Reserve University at Cleveland. Miss Pauline Huser, Western Reserve University at Cleveland. Miss Edna Yoder, Western Reserve University at Cleveland. Miss Florence Sage, Western Reserve University at Cleveland. Mrs. Nellie Sedgwick, Cleveland Normal School. Miss Martha Arthur, Cleveland Normal School. FEW PHYSICIANS UNDERSTAND the very great importance of making out birth certificates, and this is a strange fact indeed. If the physicians who do not think about the matter at all, or, thinking a little, conclude that birth certificates are unnecessary, would study the matter a little, they would probably change their minds. We will say further if non-reporting physicians could hear the opinions expressed of them by mothers and relatives who have found it necessary to secure transcripts of birth certificates, their ears would burn almost off. One poor woman, who needed a transcript of the birth of her daughter to prove legitimacy, found her trusted physician had never reported the birth. She said some things in regard to that physician which were not complimentary. Physicians should remember that birth certificates or transcripts of birth certificates are now required before young people may begin work under the provisions of the child labor laws. Birth certificates show when a child is old enough to enter school. They show whether individuals have attained an age when they may marry without the parents' permission. They show when a person is old enough to vote and when they are subject to jury duty. The birth certificates establish ages in connection with liability for military service and the granting of pensions. They are sometimes necessary as mentioned above, to prove legitimacy. The lack of a properly recorded birth certificate has again and again caused great inconvenience and very serious consequences to the individual many years after birth. The recording of all births from the public health administration point of view is highly desirable. When a physician fails to report a birth, he causes an error in the birth rate, also an error in the infant mortality rates, so it appears that the physician who neglects or refuses to make birth reports is an enemy to his patients, is an enemy to the public and he is also an enemy to the profession which he is practicing.

8 80 MONTHLY BULLETIN, INDIAN A STATE BOARD OF HEALTH. STANDARDS TO DETERMINE THE DIAGNOSIS OF PULMONARY TUBERCULOSIS IN ADULTS WITH NEGATIVE SPUTUM. (Adopted by the National Association for the Study and of Tuberculosis for the Experiment at Farmingham). Definitions. 1. Loss of weight. By "loss of weight" should be understood as unexplained loss of at least 5 per cent below normal limits for that particular individual within four months time. 2. Loss of strength. By "loss of strength" in its pathological sense is meant undue fatigue and a lack of staying power which are unusual for the individual patient and which cannot be satisfactorily explained. 3. Fever. An occasional temperature of 99 should not be considered "fever." A temperature which persistently runs over 99.4 when taken at least four times a day over a period of one week (by mouth five minutes) should be considered of significance and to constitute "fever." 4. Elevation of pulse. Where the average normal pulse of the patient is already known, an elevation of 15 beats per minute when the pulse is taken quietly at home during various periods of the day should be considered abnormal. In cases where the average pulse is not known, and of course this constitutes the majority of cases, one should consider an average pulse of 85 or over in men and 90 or over in women to be abnormal. The combination of a subnormal temperature and an elevated pulse as defined here should be considered of great importance. 5. Hemorrhage. Any amount of expectorated blood, with or without sputum, may mean that tuberculosis is present and requires careful and through medical investigation as to its source. Blood streaks, blood spots, etc., may or may not mean tuberculosis. On the other hand a hemorrhage of one or two teaspoonsful is presumptive evidence of the disease. * 6. Family history. An occasional case of tuberculosis in the patient's uncles, aunts, cousins, etc., should not be considered of importance, unless there has been intimate exposure and personal contact with such a case. It is an important fact when the patient's immediate relatives such as brothers, sisters, father, mother, or grandparents have been tuberculous, and especially so, when there has been prolonged and intimate contact. 7. Exposure. Childhood exposures are of the greatest importance. Moderate exposure among normal, healthy adults of cleanly habits is of less importance. Of course, prolonged contact, with unhygienic habits or surroundings, may be a dangerous factor at any age. 8. Cough. There is no cough characteristic of tuberculosis. Every cough that persists for six weeks or over requires investigation. Tuberculosis may exist without any cough whatsoever. 9. Sputum. The presence of sputum is not necessary for a positive diagnosis. The constant raising of sputum with or without cough, requires investigation. Absence of bacilli in the sputum after one or several laboratory examinations is not necessarily proof against the presence of active tuberculosis. 10. Hoarseness. Any hoarseness or a persistent "huskiness" requires investigation. A DIRTY PASSENGER is not infrequently in evidence on dining cars and sleeping cars. Of course, dirty passengers are dirty people. They are dirty in their minds or they would not be dirty in their bodies and in their acts. A correspondent asks us if "there is not a law in Indiana to prevent a hog in human disguise blowing his nose into the table napkin in the dining car?" He also asks if "there is not a law in Indiana forbidding people to blow their noses into the wash basin and into the towels on sleeping cars?" We were compelled to answer our correspondent that all of our efforts to secure a law penalizing the public for befouling passenger cars and stations had failed. We have appealed to the traveling public over and over to support us and to the newspapers and have so far received but very little support. The president of a certain college called at the office of the State Board of Health and told of the pollution of a closet on an interurban car and demanded the State Board of Health should take the matter in hand. He was told why it was the board, under the present general law, could accomplish nothing and how a special law penalizing' the public for befouling interurban cars and passenger coaches and stations must be passed. He was asked to give his support and in reply he said: "I would give my support most heartily, but I am afraid it might militate against the institution with which I am connected." There is the rub. His institution receives contributions from the owner of the suburban railway against which he complained. We hope some time that Indiana will progress morally to such a degree that its laws will penalize the public for befouling the public conveyances and public places. The railroads are culpable only in part. One railway superintendent said: "We railroad men do not befoul the cars; it is the nasty, dirty public that does this objectionable work, and we cannot keep up with the public, for the tariffs allowed to us by the law will not permit. We prefer cleanliness, but the public evidently does not." There is much truth in these remarks. IS CANCER CONTAGIOUS? It may safely be said that cancer is not contagious nor infectious. To demonstrate this fact recently an eminent surgeon, to show his faith, made a cure in his left arm and inserted a small portion of undoubted cancerous material. He sewed up the wound and showed himself to his classes every day for months. The wound healed over absolutely and without scar. Among thousands of operations for cancer which are on record, there is not a single report of a case acquired from the patient by any surgeon or nurse. When attending cancer patients, it of course would be wrong not to observe ordinary care and cleanliness, but isolation and fumigation and disinfection as in the case of a contagious disease are unnecessary. The only prevention for cancer is to have the same removed at the very earliest day possible. Cancer has been defined as a lawless growth of body cells which destroy life if allowed to run their course. While cancer is limited to one spot, it can easily be cured. Unless removed with the knife it next invades the surrounding tissues and if allowed to run its course some of the cells composing the cancer are carried by the blood or lymphatic vessels to other parts of the body where they start secondary growth. When this stage is reached, the cancer is beyond control and there is little hope of cure. In certain types of superficial cancer, such as those which appear on the skin, radium and X-ray are found efficient. In some cases they are of use following an operation. In some cases in which the cancer is quite inaccessible or in which there is some contraindication to operation, radium has been used with success. Only a very few doctors possess enough radium for proper treatment and only a very few know how to administer it safely.

9 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 81 July, Summary of Weekly Disease Reports From Health Officers. July, 1920 Tuberculosis Diphtheria Influenza Measles Meningitis Poliomyelitis Pneumonia Scarlet Fever Smallpox Typhoid Syphilis Gonorrhea July, 1920 Tuberculosis Diphtheria Influenza Measles Meningitis Poliomyelitis Pneumonia Scarlet Fever Smallpox Typhoid Syphilis Gonorrhea Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Clay Clinton Crawford Daviess. Dearborn Decatur Dekalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings. Johnson Knox Kosciusko Lagrange Lake Laporte Noble Ohio Orange Owen... Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush Scott Shelby Spencer Starke Steuben St. Joseph Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley s. U. S. Department of Agriculture, Weather Bureau. Condensed Summary for Month of July, TEMPERATURE-IN DEGREES FAHRENHEIT. Section Average. Departure from the Normal.}: Temperature extremes. Station Highest. Date Station.* Lowest. Date Wheatfield...'.. Hickory Hill... PRECIPITATION-IN INCHES AND HUNDREDTHS. Section Average. Precipitation extremes. Departure from the Normal. Greatest Least Station monthly Station monthly Amount. Amount. Bluffton Noblesville.., Goshen.. Always use plus sign (+) before positive departures. When more than one station reports the same, state, infigures,the number of stations, lf more than one date, use the earliest placing a dagger after it.

10 82 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. CHART SHOWING GEOGRAPHICAL DISTRIBUTION OF DEATHS FROM IMPORTANT CAUSES FOR JULY NORTHERN SANITARY SECTION. population deaths Death rate per Pulmonary Tuberculosis rate per Other forms of Tuberculosis rate per Typhoid Fever rate per Diphtheria and Croup rate per Scarlet Fever rate per Measles rate per Whooping Cough rate per Lobar and Broncho-Pneumonia rate per Diarrhoea and Enteritis (under 2 yrs.) rate per Cerebro-Spinal Fever rate per Acute Anterior Poliomyelitis rate per Influenza rate per Puerperal Septicemia rate per Cancer rate per External causes rate per Smallpox rate per CENTRAL SANITARY SECTION. population deaths. Death rate per Pulmonary Tuberculosis rate per Other forms of Tuberculosis rate per Typhoid Fever rate per Diphtheria and Croup rate per Scarlet Fever rate per Measles rate per Whooping Cough rate per Lobar and Broncho-Pneumonia rate per Diarrhoea and Enteritis (under 2 yrs.) rate per Cerebro-Spinal Fever rate per Acute Anterior Poliomyelitis rate per 100,000 Influenza rate per Puerperal Septicemia rate per Cancer rate per 100,000. External causes rate per Smallpox rate per SOUTHERN SANITARY SECTION. population deaths Death rate per Pulmonary Tuberculosis rate per Other forms of Tuberculosis rate per Typhoid Fever rate per Diphtheria and Croup rate per Scarlet Fever rate per Measles rate per Whooping Cough rate per Lobar and Broncho-Pneumonia rate per Diarrhoea and Enteritis (under 2 yrs.) rate per Cerebro-Spinal Fever rate per Acute Anterior Poliomyelitis rate per Influenza rate per Puerperal Septicemia rate per Cancer rate per External causes rate per Smallpox rate per INDIANA

11 TABLE 1. Deaths and Births in Indiana, by Counties and Sections, During the Month of July, (Stillbirths Excluded.) STATE AND COUNTIES. Estimated Population, Deaths Reported for July, Deaths Reported for July, Deaths Reported for the Year 1920 to Date. Deaths Reported for the Year 1919 to Same Date. ANNUAL DEATH RATE PER July, This Year. July Last Year. IMPORTANT AGES. Under 1 Year. Age 1 to 10. Age 10 to Years and Over. Pulmonary Tuberculosis. Other forms of Tuberculosis. Typhoid Fever. Diphtheria and Croup. Scarlet Fever. DEATHS FROM IMPORTANT CAUSES. Measles. Whooping Cough. Lobar and Broncho- Pneumonia. Diarrhoea and Enteritis (under 2 years) Cerebro-Spinal Fever. Acute Anterior Poliomyelitis. Influenza. Puerperal Septicemia. Cancer. External Causes. Smallpox. Institution Deaths. Births. BIRTHS Rate per 1,000 Population. State of Indiana.. Nothern Counties.. Adams Allen Benton Blackford... Carroll. Cass Dekalb Elkhart Fulton Grant Howard Huntington. Jay Jasper Lagrange... Kosciusko... Lake... Laporte Marshall... Miami Newton Noble Porter Pulaski Starke Steuben St. Joseph.. Wabash Wells White Whitley Central Counties... Bartholomew Boone... Brown Clay Clinton Decatur Delaware. Fayette. Fountain. Franklin Hamilton Hancock Hendricks Henry Johnson Madison Marion Monroe Montgomery... Morgan. Owen Parke Putnam Randolph... Rush Shelby Tippecanoe. Tipton Union Vermillion Vigo Warren. Wayne Southern Counties.. Clark Crawford Daviess Dearborn Dubois Floyd Gibson, Greene Harrison Jackson Jefferson Jennings, Knox Lawrence Martin, Ohio Orange Perry Pike Posey Ripley Scott Spencer Sullivan Switzerland Vanderburgh Warrick Washington

12 TABLE 2. Deaths and Births in Indiana, by Cities and Groups, During the Month of July, (Stillbirths Excluded.) STATE AND COUNTIES. State of Indiana. Estimated Population, Deaths Reported for July, Deaths Reported for July, Deaths Reported for the Year 1920 to Date. Deaths Reported for the Year 1919 to Same Date. ANNUAL DEATH RATE PER 1000 July, This Year. July, Last Year. Under 1 Year. IMPORTANT AGES. Age 1 to 10. Age 10 to Years and Over. Pulmonary Tuberculosis. Other Forms of Tuberculosis. Typhoid Fever. Diphtheria and Croup Scarlet Fever. DEATHS FROM IMPORTANT CAUSES. Measles. Whooping Coungh. Lobar and Broncho- Pneumonia. Diarrhoea and Enteritis (under 2 years). Cerebro-Spinal Fever. Acute Anterior Poliomyelitis. Influenza. Puerperal Septicemia. Cancer. External Causes. Smallpox. Institution Deaths. BIRTHS. Births. Rate per 1,000 Population. Rural Urban... Cities of First Class Population 100,000 Indianapolis Cities of the Second Class Population 45,000 to 100,000 Fort Wayne Evansville South Bend Terre Haute Garv Cities of the Third Class Population to East Chicago Hammond Muncie Richmond Anderson New Albany Elkhart Kokomo... Michigan City Lafayette Logansport Marion Cities or the Fourth Class Population 10,000 to 20,000. Mishawaka Vincennes New Castle Laporte Peru Bloomington Crawfordsville Sbelbyville Huntington Elwood Bedford Brazil Jeffersonville Cities of the Fifth Class Population 5,000 to 10,000.. Frankfort Columbus Goshen Wabash. Connersville Clinton Whiting Washington Linton Valparaiso Lebanon Madison Princeton Hartford City Seymour Kendallville Mt. Vernon Greensburg Failed to report. Mortality of Indiana, July, (Stillbirths Excluded.) DEATHS AND ANNUAL DEATH RATES PER 100,000 POPULATION FROM IMPORTANT CAUSES. POPULATION BY GEOGRAPHICAL SECTIONS AND AS URBAN AND RURAL. State of Indiana... Northern Counties. Central Counties... Southern Counties. All Cities Over 100, to 100, ,000 to 45, to 20,000.. Under Country Estimated Population I Diarrhoea I I Pulmonary Other.. Diph-. Whoop- Lobar and and Cerebro-.Acute Puer- Tuber- Forms Typhoid theria Scarlet. Measles. ing Broncho- Enteritis Spinal Anterior influenza. peral Cancer. External Smallculosis. Tuber- Fever and Fever Cough. Pneumonia. (Under Fever. Polio- Septi- Causes. pox. culosis. Croup 2 Years.) myelitis. cemia.