REGULAR QUARTERLY MEETING,

OCTOBER, 1883.

HELD in the office of the BOARD, in the State House, at Springfield, October 5, 1882. Present: Drs. Bateman, Ludlam, Clark and Rauch. Dr. Bateman presiding in the absence of the President. After the reading and approval of the minutes of the last meeting, the Secretary submitted the following

At the date of last report, June 30, there had been a total of 190 cities, towns and villages in which small-pox had appeared since November 1, 1881, of which number twenty-two had occurred in the preceding quarter, and there were still cases remaining at nine points. Since then there have been cases at Paxton, in Ford county, near Prairie du Rocher, in Randolph county, and on an island in the Mississippi river opposite Harrisonville, Monroe county. The disease has also been re-introduced into Jersey county through a suit of second-hand clothes bought in St. Louis.

The Paxton cases originated with a stock-dealer and importer of horses, who contracted the disease en route from France in the stock-boat Friga, on board of which was a mild case of varioloid. The boat, it is said, escaped inspection at quarantine in New York, and as Hefner, the importer, did not travel on an immigrant train in this country, he also escaped the inspection service. The disease was confined to Hefner's house, but his wife, son and daughter were attacked, and the son died.

The Monroe and Randolph county cases are believed to have originated from an infected mattress, supposed to have been thrown into the river and washed ashore on Staton's Island. Owing to failure of prompt recognition of the disease, a hired man who had been exposed was allowed to go to Randolph county, near Prairie du Rocher, where, together with himself, there have been in all nine cases, with five deaths. The disease seems to have been of a very mild type on Staton's Island, no deaths occurring out of the ten cases.

* Presented in detail, as fairly illustrative of the work in the Secretary's office. + Subsequently ascertained that the contagion was brought from Springfield, Mo. See Appendix.

It is worth while calling attention, in this connection, to the markedly different results obtained in counties under township organization and in those where, in the absence of town boards, the county commissioners are charged with the duties of health authorities. While, of course, the most efficient work is done and the disease is most promptly "stamped out" in localities where there are regularly organized boards of health, it is yet true that, as a rule, the town boards have been only less efficient, and the disease has been generally promptly mastered by their efforts. On the other hand, in counties where the county commissioners alone have charge, there has, as a rule, been delay in action or neglect, resulting in a spread of the contagion beyond the first cases or families and an undue prolongation of the disease. In Alexander county, for example, the first case near Commercial Point occurred in the latter part of April, and the contagion was not finally eradicated until the 20th of July. The recent outbreak and spread in Monroe and Randolph counties, are, to some extent, due to similar causes.

At this date there is one remaining case near Prairie du Rocher, and three in the hospital in Chicago. Aside from these, there are no cases known to exist in the State at present.

The decline of the epidemic in Chicago since the inauguration of the Immigrant-Inspection Service is clearly shown in the following table:

The members of the BOARD have been supplied from time to time. with my reports, as Supervising Inspector of the I.-I. S. in the Western District, to the Secretary of the National Board of Health, and it will, therefore, only be necessary, in this connection, to present a summary of the work done up to the close of the quarter, September 30, 1882, which is as follows:

Immigrants arriving and inspected over the P., Ft. W. & C. R. R., 14,825, of which number 12,676 were more or less perfectly protected, while 2,149 were found to need vaccination or revaccination.

Over the L. M. & M. S. R. R., arrived and inspected, 11,102; protected, 9,352; requiring vaccination or revaccination, 2,020.

Over the Michigan Central, 19,131; protected, 14,026; requiring vaccination or revaccination, 5,105.

Over the Grand Trunk, 8,237; protected, 6, 186; requiring vaccination or revaccination, 1,751.

Over the Baltimore and Ohio Railroad, 8,193; protected, 6,418; requiring vaccination or revaccination, 1,745.

Passing the Indianapolis station for points west, 10,413; protected, 9,50; requiring vaccination or revaccination, 853.

Crossing the Mississippi at St. Louis, 6,785; protected, 6,440; requiring vaccination or revaccination, 345.

From the foregoing it will be seen that of the total 78,986 immigrants who have arrived in or passed through this district since the 1st day of June, nearly 14,000 were susceptible to small-pox, and capable of conveying and propagating the contagion throughout the vast region of the Northwest. As has been before remarked, the Service is not only a protection to Illinois, but to the entire western region beyond, north to Minnesota and south to Texas.

During the season nine cases of small-pox and varioloid have been detected and removed from trains before reaching the State, and within three weeks one case was removed to the Chicago small-pox hospital by the inspector, and four others were properly cared for by the St. Louis inspector. The former patient was destined for Neenah, Wis., and the latter (a party of Bohemians) for Missouri.

Vaccination of School Children:

During the last ten days of the quarter, there have been distributed between 18,000 and 19,000 copies of a circular letter (No. 112) calling attention to the necessity of perfecting and perpetuating the results of the School-Vaccination Order of the BOARD, issued in December last. A copy of this circular has already been sent to each member of the BOARD, so that it is probably unnecessary to add anything more on this subject.

There will be sent out within a few days, 17,500 copies of the Vaccination Return, Form 52, and some 80,000 Vaccination Certificates, Form 51, these amounts being still on hand from last winter's supply.

It may be incidentally remarked that the necessity for this effort on the part of the BOARD, to protect the public-school interests of the State, will receive very striking proof in the forthcoming history of the small-pox epidemic of 1881-2, and in the tabulation of the returns of vaccination from the various schools. It is almost incredible that so large a percentage of unvaccinated children should have been found as these will show.

Even in Chicago, the tabulation of which has been completed since the last meeting, a much greater number of imperfectly protected. children were found than was anticipated.

The returns from Cook county alone, including Chicago, have occupied fully three months in tabulating. The amount of time required for this work will probably render it impracticable to tabulate in such detail the returns from the entire State, but the salient points, at least, will be collated in due season.

Vital Statistics:

During July the form for the condensed return of deaths, with its accompanying pamphlet of instructions and list of synonyms, was distributed to the county clerks. There was also sent to each a blank (No. 131) on which to return the totals of marriages, births and deaths, for the years 1878 to 1880, inclusive, Form 90 being reserved for deaths during the year 1831 only.

Up to date, complete return for the four years have been received from 73 counties, embracing 876 separate returns. From the remaining 29 counties there have been received 179 returns, and it is anticipated that before the tabulation of those now in hand is completed full returns will have been received from all but less than half a dozen counties.

From such examination of these returns as I have, thus far, been able to make, it is very apparent that there is not the degree of attention paid to the law concerning the registration of vital statistics, either on the part of physicians or county clerks, that a commonwealth of the general intelligence of Illinois should exhibit. Something of this is due, no doubt, to the BOARD itself, which has hitherto been prevented, by want of means and pressure of other duties, from giving the subject the necessary attention; but it is, also, largely the result of causes which are believed to be now susceptible of remedy at little cost.

I think it would be well that the BOARD call the attention of county commissioners to the importance of this work, to the law requiring it, and to the necessity of making proper clerical provision for its execution. Owing to the want of such provision, to failure to comprehend the character and practical utility of the work, and, in not a few instances, to ignorance of the legal requirement, the difficulty, labor and expense of securing the returns have been very considerably enhanced to the BOARD. Over 500 communications have been sent out on this one subject alone during the past six weeks. This, of course, should be entirely unnecessary in a matter which the law distinctly says the county clerks shall attend to annually. Litigation, growing out of the want of just such data, frequently costs a county and private individuals more, in a single year, than would defray the expense of their collection for a number of years. Burial-Permit Ordinance:

Of the circular letter and draft of an ordinance concerning burial permits, authorized to be printed and distributed, there have been 741 copies sent to various persons interested. Its reception has been quite satisfactory, and letters are now being received in almost every mail announcing the adoption of the ordinance, or making inquiry concerning it. A form of permit has been prepared and sent out as a guide to the officer charged with its issue. This has a counterfoil or stub attached, which being retained, may constitute the "suitable book" prescribed in section 4 of the ordinance. The expense is slight, and the form will answer very well for the smaller towns. For other places, the book used by county clerks as a register of deaths may be used, and this can be obtained at an expense of from $5 to $10 per copy, according to the number of pages.

Among the cities and towns which have already adopted the ordinance are Bloomington, Morris, Peru, Delavan, Pekin, Lemont, Girard and Canton.

Its importance, as a foundation for a very necessary class of sanitary work, can hardly be over-estimated, and I consider it one of the most satisfactory recent undertakings of the BOARD.

One of its valuable results will be to facilitate the collection of vital statistics-a matter which, as shown in another section of this report, is, at present, very far from perfect.

Prevalent Preventable Diseases:

An examination of the returns of causes of death during the past year reveals an undue prevalence of such more or less preventable diseases as typhoid fever, scarlet fever and diphtheria.

While such striking results may not be looked for in any attempts at the suppression and prevention of these diseases as in small-pox, still, enough is known of their origin, mode of propagation and the measures which have proven most successful in combating their spread, to warrant the BOARD in some effort toward popular education regarding such measures.

I would suggest that a committee be appointed to prepare a circular of instruction concerning the prevention of these three formidable diseases.

Local Boards of Health:

A number of local boards of health have recently been organized in the State, and, in many instances, have already done effective work. The want of a uniform code of sanitary ordinances is, however, seriously felt by these organizations, and hampers their influence.

I suggest that a committee of this BOARD be appointed, which, with the Attorney General, shall prepare such a code, and that the Secretary be authorized to distribute it, as soon as completed to the satisfaction of said committee, without awaiting further action by the BOARD.

Opposition to Vaccination:

That much discredit has been thrown upon vaccination from causes entirely foreign to the operation itself, is well understood. To a very great extent the opposition to the measure is due to these causes, and the anti-vaccinationists buttress their so-called arguments with alleged facts which, on investigation, are found to belong to the post hoc category. A child is vaccinated with a dirty lancet; or with virus containing pus globules, epithelial scales, red corpuscles, or other foreign matter; or while suffering from some cutaneous disease; or, being neglected afterward, is exposed to wet, cold or local irritation and in consequence suffers from a train of untoward symptoms which would as surely follow any simple abrasion under like conditions. Straightway the case is used to illustrate the risks, dangers and pernicious effects of vaccination. One or two such instances in a community have been known to arrest the progress of vaccination, and to cause an excitement only less harmful than an outbreak of small-pox itself.