LIST OF INVESTIGATIONS. Diphtheria. Thirty-two epidemiological investigations of diphtheria were made during the period Aug. 1, 1912 to Jan. 1, 1914, in fourteen counties. The field work required seventy days. Diphtheria, Windom City, Cottonwood County, November 13, 14, 1912. BY DR. C. C. PRATT, Bacteriologist in Charge, Mankato Branch Laboratory All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health) Reason--To find and exclude diphtheria carriers from the Windom schools. History-Almost continuous presence of a few cases among the pupils, which last winter, 19111912, amounted to several cases at one time. Since Feb. 1, 1912, the Mankato Branch Laboratory has found B. diphtheriae in cultures from twelve cases. The recent cases were High School pupils. spector, assisted by health officer and three physicians, took combined nose and throat tures from all pupils and teachers. C-Dr. A. J. Chesley. G-Dr. W. P. Greene. M-Dr. I. J. Murphy.. B-Dr. H. A. Burns. cul Results-338 cultures examined in the Main Laboratory Nov. 15th show 2 positives, one from 6th grade, one from 8th grade; 8 "reserved," one in 3rd grade, on account of suspicious bacilli; one each in 5th, 6th and 8th grades, on account of spore bacilli; one in 8th grade on account of no growth; one in High School on account of suspicious bacilli; one in Normal Dept. on account of no growth. 132 cultures examined in the Main Laboratory Nov. 16, show one reserved on account of suspicious bacilli and 131 negatives. Absentees' cultures will be taken by the health officer. Pupils "positive" with symptoms will be quarantined; without symptoms will be kept at home. The health officer believes that concealed and unrecognized mild cases in Windom, rather than rural cases, account for the trouble. Diphtheria, Leaf Valley and Ida Townships, Douglas County, July 30, 31, 1912 (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-Many persons were sick with sore throats; three had died. History-Dr. C. A. Lester said there were many "sporadic" sore throats during the winter in Leaf Valley, Ida, La Grand and Moe townships, and had treated them as quinsy and tonsillitis, neither taking cultures nor using anti-toxin. He prescribed for Herman S's sore throat in Dec., examined him in Jan. finding albuminuria, cyanosis, aphonia, aphagia, paresis of legs; ailed six weeks; many visitors, no quarantine. Henry S., 70, died in March from the "same sickness." Dr. Lester treated the John K. and S. families. Dr. L. M. Keene, Alexandria, saw W. B., (f), 50, June 17, sick seven days, diagnosis, diphtheria. Report to health officer, culture negative. *Dr. A. D. Haskell, Alexandria, saw Mary V., (f), 7, June 21; sick two days and diagnosis, diphtheria; reported to health officer, gave antitoxin. Culture reported "reserved". *Members of H. W. V. family got sick and exposed public at (1) fire sale, general merchandise; (2) church picnic, July 4. Emma V., (f), 20, sick at store, went home (Wm. V.'s). Dr. H. H. Leibold, Parkers Prairie, saw her, diagnosis, diphtheria, reported to health officer, antitoxin given, culture report "negative". *Dr. Lester treated (a) Rev. J. K. s family for quinsy; two died, no cultures; *public funeral July 25; (b) J. J.'s family (11), one died July 28, private funeral at church, quarantined July 30; (c) Emil B. s girl, 15, "positive" culture, antitoxin given, quarantined July 30. Inspectors, with chairman Board of Supervisors, Ida township, visited all directly exposed, taking forty-five cultures from seven families, and with chairman Board of Supervisors, Leaf Valley township, took thirty-one cultures from six families. Visited creameries, Leaf Valley and Ida townships. Left Regulations No. 10. Results-Dr. Geo. W. Gray, Garfield, appointed Health Officer of Ida township; Dr. J. C. Drex ler, Brandon, appointed Health Officer, Leaf Valley township. Specific directions re management of the situation written to the health officers, based upon laboratory reports. Chairman, board of superwisors, La Grand and Moe townships, given instructions, laws and regulations, etc. Inspectors left Minneapolis 5-55 p. m.; arrived Alexandria 9:40 p. m., July 30. Left Alexandria 3:20 a. m.; arriving Minneapolis 7:30 a. m., Aug. 1, 1912. *No quarantine. Health Officers misunderstood Regulation No. 25. (Index No. 60-XII.) SUMMARY Diphtheria, Leaf Valley and Ida Townships, Douglas County, October 22, 23, 1912 BY DR. A. J. CHESLEY (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-Two deaths from diphtheria in Leaf Valley township. History Disease was disregarded until three deaths occurred. An investigation was made July 31, cultures taken and directions given. Carriers and convalescents were released and permitted to attend school without negative cultures. Our offer to culture schools was disregarded. Alexandria required "negatives" from township pupils attending city schools. Later other cases and two more deaths occurred. Inspector telephoned Dr. C. A. L., re Ida township cases; learned that A. K. had been quarantined by Dr. G. W. G., H. O., but cultures were not taken, town board refusing to pay H. O.. for same; therefore, Dr. L. took cultures, charging expense to town board. Saw Dr. A. D, H., attending physician to V. and K. families, where deaths occurred. Went to V.'s store met Dr. J. C. D., H. O., and Chas. J., C. B. S., Leaf Valley township. Discussed situation, found that they had acted in good faith and meant to do everything right. R. F., age 11, attended school Oct. 14, taken sick Oct. 16, died Oct. 20 of diphtheria. H. V., age 3, Oct. 10, fell on an umbrella point which entered her throat through the mouth. Dr. H. was called Oct. 14, gave antitoxin, Oct. 15, child died. O. V., age 1, developed diphtheria Oct. 16. The funerals were private. The V. s were quarantined and the K. s through a misunderstanding about the culture report, were kept on the premises but no sign was put up by the H. O., the child having died before he got to the house to quarantine. Other precautions have been carried out against infection by both families. Results-H. O. was advised how to proceed. Co. Supt. of Schools and township officers were advised that cultures from pupils and teachers be taken Nov. 4th from schools Nos. 23, 28, 59, 68, 100 and the German Lutheran Parochial School, and possibly the Parochial School in Effington township, Otter Tail county, as well. (K. family quarantined on positive reports Oct. 24th.) nspector left Minneapolis, G. N. Ry., 5:50 p. m., Oct. 22. Arrived Alexandria 10:20 p. m. Left Alexandria, Soo Ry., 11:55 a. m. Arrived Minneapolis, 7:20 p. m., Oct. 23, 1912. (Index No. 61-XII.) SUMMARY Diphtheria, Leaf Valley and Ida Townships, Douglas County, November 3, 4, 5, 1912 BY DR. A. J. CHESLEY (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-Outbreak of diphtheria; two deaths occurred after schools were opened. Town Boards then began to appreciate the value of cultures for detection of diphtheria "carriers" and requested that cultures be taken at the schools concerned. History-See Summaries Nos. 52-XII and 60-XII. The advice in regard to the release of quarantine on negative cultures rather than time limit, and the offer of this Division to take cultures when the schools concerned opened, had been disregarded by the Town Boards. Inspector had given detailed instructions by letter to Health Officers of Ida and Leaf Valley townships, to teachers of Districts Nos. 68, 100, 28, 53, 23 and Parochial school, and had consulted attending physicians and county superintendent in arranging for examinations. The school officers were present at all the schools and Dr. J. C. Drexler, H. O., Leaf Valley township, accompanied Inspector in that township. Results-'Phoned culture reports to Health Officers Nov. 6. Advised Health Officers by letter: (1) to take separate nose and throat cultures; (2) that two successive negatives of persons once positive and one negative of persons once suspicious or unsatisfactory, be required before admittance to school; (3) to quarantine positives with symptoms and except for trips to Health Officer for cultures, to require positives without symptoms to stay at home; (4) to take cultures from all absentees; (5) to issue Health Officer's certificates for admittance to school only to those once positive or suspicious. Inspector left Minneapolis 5:20 p. m., G. N.; arrived Alexandria 9:40 p. m., Nov. 3. Left Alexandria 3:10 a. m., G. N.; arriving Minneapolis 7:30 a. m., Nov. 5, 1912. (Index No. 4-XIII.) SUMMARY Diphtheria, State School for Deaf, Faribault City, Rice County, January 15 and 16, 1913 BY Drs. H. A. BURNS AND A. J. CHESLEY (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-Several deaf pupils had diphtheria. History-First case went to hospital Dec. 17, 1912. No cultures were taken. Dec. 18 one case, Dec. 19 one case, Dec. 21 one case, Dec. 23 one case, then advice was asked. Executive Officer instructed Dr. Chesley to investigate and advise. 140 pupils were to visit homes Dec. 25. It was stated that no cases had developed for five days, that only a few had been closely associated with cases which were mild, school physician examined throats and took some cultures which were sent to Dr. Moulton, at School for Feeble-Minded for examination and reported negative. Pupils went home. Two families visited by M. J. and C. J. developed diphtheria. Report received here of this Jan. 11. By phone and letter, more information was obtained. Cultures from M. J. and C. J. were positive Jan. 14. Then Inspectors went to Faribault. Inspectors interviewed Supt. J. N. Tate and school physician W. W. Robillard Jan. 15. Jan. 16 took cultures from 324 pupils and employees. Results Facts indicate that one or both J. children are chronic carriers. They entered the school in September. All early cases developed in their classes. Had Regulation No. 27 been carried out when first case appeared, and patient, classmates, and other intimate associates included in the group examined, much trouble might have been avoided. Cultures examined Jan. 17 showed 22 positive, 19 reserved, 283 negative. Phoned and advised Supt. re above. Sent Dr. Burns there Jan. 17, p. m., to again take mass cultures. Inspectors left Minneapolis 3:00 p. m.; arriving Faribault 5:15 p. m., Jan. 15. Left Faribault 5:00 p. m.; arriving Minneapolis 8:45 p. m., Jan. 16, 1913. Index No. 158-XIII.) SUMMARY Diphtheria, Litchfield Village, Meeker County, December 2, 3, 1913 BY DRS. H. A. BURNS AND A. J. CHESLEY (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-To assist in management of diphtheria epidemic. History Source of infection unknown; Collinwood township had two cases in July, two in August, two in September and one in October; Kingston township had one case in August, but no chance for carriage of infection into Litchfield could be traced. Dr. W. E. C. attended the first case, L. P., (m), 6, first symptoms Oct. 4, but did not recognize the disease until the sixth case of diphtheria appeared in the P. family. First culture taken Oct. 26 was "positive." Quarantine was established Oct. 27. Between Oct. 4 and 27 ample opportunity for exposure existed and a number of families developed diphtheria. Volunteer school inspection by local physicians was begun. Suspects were excluded to be followed up by School Nurse for cultures, etc. The nurse refused to obey the Health Officer's orders re infectious cases and could not devote whole time to school work thus impairing the efficiency of the sanitary measures prescribed. Public opposition arose due to misunderstanding of the need for restrictions upon infected persons apparently well. Inspectors discussed situation with Dr. J. J. Donovan, Health Officer, and interested physicians. visited certain quarantined families and took cultures. At a public meeting in the Opera House the Health Officer reviewed the epidemic and Dr. Chesley outlined the routine procedures used by the State Board of Health in diphtheria epidemics, explaining in detail the various measures used in Litchfield, showing the reasons for use and the object to be attained and discussing duties of teachers, parents and the general public during the epidemic. Results-General discussion by citizens cleared up misunderstandings and public confidence in the health work seemed to be restored, also some opposition to the work was withdrawn. The Nurse resigned and a well trained nurse was employed on full time by the School Board. The School Board had supported the Health Officer throughout and the teachers had assisted the physicians. Diphtheria, Independent District No. 13, St. Louis County, (including schools in Aurora Village, White Township, Mesaba Village and Mesaba Township, St. Louis County), September 6, 7, 8, 9, 1913. BY DRS. W. P. GREENE AND A. J. CHESLEY (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-To obtain cultures from pupils, teachers and other persons, in Independent Dis o. 13. History-Clinical cases of diphtheria occurred during the summer, fifteen families being affected. Sept. 7 there were 10 cases in 8 families. The opening of school was delayed from Sept. 2 to Sept. 8, because of the prevalence of diphtheria. Inspectors, with Dr. R. P. Pearsall, H. O., Aurora village, and White township, also Medical Supervisor of Independent School Dist. No. 13, took cultures of 548 pupils and teachers distributed as follows: |