WORK OF THE AUXILIARY MEDICAL CORPS (ANTITOXIN STAFF) OF THE HEALTH DEPARTMENT: 1895-96. BY E. P. MURDOCK, M. D., MEDICAL INSPECTOR AND IN submitting the report of the Auxiliary Medical Corps of the CHICAGO HEALTH DEPARTMENT for the treatment and prevention of diphtheria, I beg to refer in brief to the origin and progress of the work as it became a part of the system for a more complete supervision of contagious and preventable diseases in our city. The rapid increase in the number of cases of diphtheria reported during August and September, 1895, gave warning of the approach of a serious epidemic of the disease. At the · same time, the demand upon the part of the medical profession for assistance through the DEPARTMENT OF HEALTH to prevent the rapid spread of the contagion in the thicklycrowded districts led the ASSISTANT HEALTH COMMISSIONER to request me to answer the calls of physicians and render such assistance as in my judgment would contribute most toward staying the ravages of this disease. I began my work by responding to the requests for the administration of antitoxin, the verification of diagnoses by bacterial examination and the relief of laryngeal stenosis by intubation. In connection with this work I also investigated the causes which led to the rapid spread of the contagion, gave directions for isolation, made notes of environment, immunized children exposed, co-operated with the attending physicians in all respects to restore patients suffering from diphtheria and to protect the public from further exposure. Careful observations were made to determine the sources of infection and the agencies which led to the spread of the contagion and the following conclusions were submitted: 1st. Failure to isolate patients and prevent unrestricted visiting and open communication with friendly neighbors, and even the public schools. 2d. Failure to destroy or properly disinfect clothing and other material which had been in contact with the patient, and the lack of proper fumigation and cleansing of premises. 3d. The public character of funerals to the extent of exposing the body of a child dead from diphtheria to public visitation of friends and neighbors-they not only viewing the body themselves, but permitting their children to come in immediate contact and even kiss the dead child's face. Nor was this all, but bodies of children who had died from malignant diphtheria were taken into churches for public funeral services and their little playmates acted as pall-bearers without even an effort to cleanse or protect the mouth or nostrils of the corpse. 4th. The unsanitary condition of water-closets, especially in districts where old outside vaults are still in use without wash-outs or sewer connections. 5th. Failure to report the so-called "mild cases" which were exposed to indiscriminate contact with their little friends from which many malignant cases developed. From these causes I traced over eighty cases of diphtheria with twenty deaths, all of which might have been avoided by proper precautions. A few notes from my daily register may be of special interest: At the request of a physician I attended a funeral of a child known to have died with malignant diphtheria, in the southwest portion of the city. Services in the chapel; over two hundred persons present, eight little girls acting as pall-bearers. Twenty others marched in procession from the house to the chapel where the corpse was carried by the children; all passed around the open coffin and viewed the remains and many kissed the corpse. I secured the names and addresses of fifteen children present, and traced nine cases of diphtheria from this source with four deaths. Recommended funeral inspection. Was called into the 17th Ward to treat a case of diphtheria by Dr. M. C. MORAN; found seven people living. in two small rooms, three children sick with diphtheria in one bed, one died while I was there; on that same bed were two large bunches of bananas, still green but ripening, for the purpose of being peddled upon the streets and bought by unsuspecting people. Was called in the night to see a family in a basement on Austin avenue. Five children sick, one dead; nine visitors present, some of whom were women with their nursing babies in their arms. From this one source I traced thirteen cases of diphtheria with five deaths. My attention was called by Dr. F. E. THORNTON to a "mild case" of diphtheria which had not been reported, being able to attend school and visit friends, but a culture proved the case to be one of diphtheria. From this case four other children in the same family and the mother and father were all taken down with diphtheria, but all being treated with antitoxin early, because of the report from the bacterial examination, all recovered. Mrs. B. having lost her only child with diphtheria, used what she considered the ordinary means of cleansing her house (which looks to be scrupulously clean at all times). Soon afterward gave away the clothing belonging to the dead child. From this source I traced five cases of diphtheria and one death. I visited a room in one of the public schools and noticed two children with flannel cloths around their necks who complained that they were not very well. The children were all writing a spelling lesson. After the exercise was finished and the papers and pencils were collected, I asked permission to take half a dozen pencils home with me, from which cultures were carefully made. From two of these pencils I obtained Klebs-Loeffler bacilli, and one of the Inspectors was called upon to treat the deskmate of one of these children for diphtheria a few days afterward. The character of the epidemic, the variety of sources for the spread of the contagion and the demand on the part of the medical profession for assistance became so great that the COMMISSIONER applied for and obtained an appropriation for the appointment of an emergency staff for the purpose of perfecting an organized system to control the ravages of this disease. A special appropriation having been secured for this emergency, the following physicians were appointed to enforce the necessary measures for the control of diphtheria: Drs. SAMUEL K. WALKER, WM. K. JAQUES, G. E. KRIEGER, MARTIN M. RITTER, ROSA ENGELMANN, HAMILTON H. FORLINE, H. H. LATIMER, W. A. MACFARLANE, R. W. HARDON, J. A. EGAN, FRANK S. CHURCHILL, J. W. WALKER, J. J. CLAUSEN, A. H. ROLER, J. C. BRYDGES, and the city was divided into districts with a physician placed in charge of each district, three of the number being detailed to supervise funerals and prevent as far as possible the spread of contagion from this source. The members were called together and organized the "Auxiliary Medical Corps of the CHICAGO HEALTH DEPARTMENT," with Dr. E. P. MURDOCK as President and Dr. MARTIN M. RITTER as Secretary. Regular meetings were held to hear reports of cases, to note the effects of antitoxin in the various complications of the disease, and to determine the best methods of procedure in diagnosis and treatment. They were instructed to obtain the facts about all cases of diphtheria in their respective districts, and to use all means in their power consistent with professional ethics, and under authority of law, to conserve the true interests of the public in the control of this disease. They were also instructed, wherever it was possible, to determine by bacterial examination the true character of the disease; to learn whether antitoxin had been used or not, and if so on what day of the disease, and the results; and at all times, so far as it lay in their power, to subserve the interests of the family physician while protecting the public health. Incubators and culture tubes or boxes were furnished for bacterial examinations, and such other supplies as were necessary for the work. A system of rules was formulated for the isolation of patients and the care of sick rooms, which would justify the removal of diphtheria warning cards by the Medical Inspector when, in his judgment, all sources of the spread of the contagion were absolutely shut off, and a communication was addressed to the medical profession and the public, setting forth these points, and asking their co-operation. In this communication attention was directed to the fact that it was as yet an unsettled point as to where the duty of the family physician ended and the obligations of the HEALTH DEPARTMENT began, and as to what extent the DEPARTMENT could with propriety and justice to itself aid the practitioner in the control of contagious diseases and the protection of the public health, by systematic efforts to prevent the spread of the contagion, and thus secure the greatest benefits to the community with a minimum expense to the municipality. The efforts of the past had been confined to smallpox, and |