firearms, including toy-pistols, and torpedo-canes. It is not thought that any of these explosives themselves contain the tetanus germ; for the raw materials do not necessarily contain the bacilli, and the mode of manufacturing fireworks would tend to destroy the germs, should they chance to be present in the raw materials. Moreover, it is well known that certain grave powder explosions do occur, where grains of powder enter the flesh but where no infection from tetanus occurs. It is known that the tetanus germ exists and thrives in the incrustation or dust of filth; and midsummer, in July, the atmosphere is laden with such dust which settles on the skin of persons. A wound, then, permits the dust so laden with tetanus germs to enter the abrasion of the skin, and, sealed in this excellent medium, tetanus germs become prolific, causing the death of human beings within a short time. It is believed that by passing ordinances to control the sale and use of blank cartridges, toy-pistols, and other dangerous fireworks; by arousing public spirit, so that merchants are reluctant to sell harmful goods; by inciting parents to a careful and wise supervision of the fireworks to be used by children; and by a more prompt and universal use of antitoxin and prophylactics; by such action, we can prevent this dread and fatal disease, tetanus, from undue prevalence, and guard against what seems to be needless sorrow. TOTAL AMOUNT AND CLASSIFICATION OF EXPENDITURES BY THE STATE BOARD OF HEALTH (UNDER PUBLIC ACT NO. 18 OF 1905), DURING THE FISCAL YEAR ENDING JUNE 30, 1906. NOTE. The appropriation ($9,000.00) at the disposal of the State Board of Health for certain specified purposes, does not include clerk hire, or the expenses in the examination of plans for public buildings; these expenditures on account of, but not by the Board, are provided for by other acts of the legislature than those appropriating money to be expended by the Board; and the accounts are kept in other offices, not in the office of the State Board of Health. The accounts for clerk hire are kept by the Auditor General, and are reported in his annual report; the accounts for the examination of plans for public buildings are kept by the Board of State Auditors, and are published in the annual report of that Board. Respectfully submitted, Secretary. TOTAL AMOUNT AND CLASSIFICATION OF EXPENDITURES BY THE STATE BOARD. OF HEALTH (UNDER SECTION 7 OF ACT 132, LAWS OF 1903), EMBALMERS' FUND, AS ALLOWED DURING THE FISCAL YEAR, 1906. PROPOSED STATE SUPERVISION OF THE WATER SUPPLIES AND METHODS OF DISPOSAL OF EXCRETA IN MICHIGAN.* BY FRANK W. SHUMWAY, M. D., SECRETARY MICHIGAN DEPARTMENT OF HEALTH. To add to what has already been said and written upon the subjects of water supply and sewerage, in their relations to the public health, would seem superfluous, were it not for the fact that the pollution of the natural watercourses of our State, with its concomitant evils, is an ever present and vital question in the minds of those intimately connected with public health administration. Typhoid fever has not been eliminated from our midst, but annually prostrates, approximately, three thousand of the inhabitants of this State, of which number nearly one-fifth are added to the list of decedents from preventable diseases; and the people are burdened to the extent of a loss of tens of thousands of dollars and incalculable suffering thereby. In dealing with this subject we are not groping in the dark. Science and repeated research have long since placed at our disposal weapons with which to combat the active principle in typhoid fever and many other preventable diseases, and to render impossible their communication, from person to person, through well known channels of infection. Thus far the measure of success attending the efforts of those who have engaged in this warfare has not reached the limit of what might reasonably have been anticipated. True we have succeeded in stemming the tide of sickness and mortality, but the recollection of past achievements, coupled with the knowledge of far greater possibilities, demand a more vigorous *Read at the meeting of the Michigan Engineering Society, held at Lansing, January 10, 1906. and persistent continuation of the contest in the future. The old straw must, if necessary, be threshed over, even at the expense of being considered wearisome, until, by the constant wearing process, the last vestiges of apathy or opposition on the part of the people have peen removed. The subject which I have chosen as the basis of my remarks is not, in its general sense, a new one, at least to the members of this society and to others who have followed the trend of public health administration in other states in recent years. I will endeavor, therefore, to confine my remarks, principally, to a brief consideration of some reasons why the powers, duties and responsibilities of the Michigan Department of Health should be extended to include the active supervision of the water supplies and the methods of disposing of excreta in this State, together with an outline of what, I believe, should be the nature and extent of the proposed supervision, at least until a further extension of such supervision may prove to be necessary. THE NEED FOR STATE SUPERVISION. The State Department of Health is required by law to have the general supervision of the interests of the health and life of the inhabitants of this State. Pure water being one of the most important essentials to health, and impure water being one of the most important factors in the spread of typhoid fever, and possibly of other diseases, the supervision of the water supplies should, very properly, claim a large share of attention in the work of the Department, as outlined in the law. Within the limits of the appropriations for public health purposes, the Department has, in the past, endeavored to comply with the requirements of the law in this particular, of which mention will be made latter. But a general supervision, by the State, of the water supplies has its limitations and imperfections, as the experience of upwards of thirty years has proven. Investigations conducted at long range, begun only after outbreaks of typhoid fever have been reported to the State Health Department, and carried on through the medium of a correspondence between the State Department and the often poorly paid, and in many instances untrained, local health officials, are seldom productive of lasting beneficial results, as the status of the typhoid fever situation would seem to indicate. The effectiveness of the present State supervision of the water supplies being dependent upon the information derived from the reports of the local health officials, it follows that the neglect to make such reports, or the making of unintelligent or incomplete reports, will seriously interfere with the proper working of the system, and vitiate the statistical work of the State Health Department. Local supervision, upon which, under the present plan, the purity of the water supplies mainly depends, also has its limitations and imperfections, chief among the latter of which may be mentioned the lack of special training in many of those who are entrusted with the solution of problems which. should properly come within the scope of the municipal or sanitary engineer. The tenure of office of the average health officer is too short, and the compensation far too small to encourage him to devote the time necessary to a thorough understanding of local conditions which may, at any time, give rise to and favor the spread of typhoid fever within his jurisdiction. For the same reasons, after the occurrence of typhoid fever in the locality, permanent remedial measures may be neglected and indefinitely postponed. Notwithstanding that the efficiency and enthusiam of the health officer may not have been called in question, a lack of cooperation on the part of the inhabitants may operate to prevent the adoption of measures designed by him for securing or protecting the purity of the water supplies in his locality. Local supervision may also be limited by reason of the location, in an outside jurisdiction, of sources, or possible sources, of contamination of the water supplies. This would be true in every case where the water supply is taken from a stream or river, or from any of the great lakes. În deciding upon any system of water supply or sewage disposal for a locality, or in any controversy relative to the pollution of a water supply, by reason of its personnel, the State Health Department is eminently fitted to offer a valuable opinion or render an impartial decision thereon. Such action by the Department is now limited by reason of the lack of provision for making the necessary investigations, which would properly include a visit, or visits, to the locality. In many other states, the necessity for State control of the water supplies has been recognized by the enactment of laws, more or less stringent in their nature, some of which include the appropriation of large sums of money to defray the cost of making extensive preliminary experiments, and for conducting investigations necessary to a proper understanding of existing conditions. In the operation of these laws, abundant evidence of the wisdom of such legislation has been secured. NATURE AND EXTENT OF THE PROPOSED STATE SUPERVISION. 1. To examine and offer an opinion upon the plans for any proposed new system, or alterations in existing systems, of water supply or disposal of excreta. This plan has, for many years past, been successfully carried out in respect to the sanitary engineering details of the buildings of state institutions in this State, and might, with equal advantage, be applied to many other buildings and works of a public or quasi-public character. 2. To make investigations, upon request or when deemed necessary, relative to the purity, or otherwise, of any water supply. 3. To cooperate with local authorities in securing the discontinuance of any source of water supply deemed unsafe, or that is a menace to health, and in the substitution of a new supply from a desirable source. 4. To make a detailed survey of the water supplies in this State, so that the Department may be able to act promptly and intelligently upon all cases requiring its aid or interference; also to aid in the study of the local prevalence of typhoid fever and the institution of measures for its restriction and prevention. In the absence of a thorough knowledge of the existing conditions, little progress could be made in the institution and prosecution of measures for securing and maintaining the purity of the water supplies. PAST EFFORTS OF THE MICHIGAN DEPARTMENT OF HEALTH FOR KNOWLEDGE RESPECTING THE WATER SUPPLIES IN THIS STATE. In the past, principally owing to a lack of funds, the operations of the Department in the matter of securing definite knowledge respecting the condition of the water supplies in the State have been necessarily limited. With the view of collecting facts for a study of this question which might, at some future time, furnish data for the choice of locations for wells in towns and villages, and for determining the question when, in larger towns and cities, a system of water works, bringing water from a distant source, replies to thirty-six questions relative to the water supply of the particular locality in which each correspondent resided. The letters were responded to quite generally, but the number of localities represented was but a small fraction of the total localities in the State. In January, 1896, upon a suggestion from Prof. F. S. Kedzie, of the Chemical Department of the Michigan Agricultural College, relative to a systematic study of natural waters of Michigan streams, springs and wells, a report was made to the State Board of Health, by its Secretary, and referred to Prof. Delos Fall, who was at that time a member of the Board and the committee on water supply. To those of you who may not be conversant with the proposed nature and extent of this systematic study, the following quotations from the report in question may prove interesting: "The great drouth during the past few years, and especially during the last year, has forced many people to obtain their supplies of drinking water from streams. The question as to the safety of such water supplies is an important one which sanitarians and chemists are not properly prepared to meet. Are the vast amounts of sewage and other contaminating substances which find there way into the streams, oxidized and rendered innocuous, or are they so contaminating the streams as to make it dangerous to use such water in cities and villages? Are the dangers to life greater in times of drouth than at other times? How far below a city situated on the bank of a stream do these contaminations of the water which are dangerous to life and health extend? To properly answer such questions, such a systematic study should have been commenced years ago. Should it not be commenced at once? "When this subject was put before the Secretary of this Board a few years ago, his reply was that the State Board of Health could not, from its meagre appropriations, spare anything for this investigation. Prof. Kedzie now suggests methods whereby it is hoped that the study may be commenced in a comparatively inexpensive manner, and the work divided up, some portion of it allotted to each of the many laboratories in Michigan. He suggests that the regular correspondents of the State Board of Health be asked to make the collections of the water, that students at different colleges be employed in these investigations under the direction of their expert teachers, and that the State Board of Health pay, out of its appropriations, for the jugs or other receptacles of the water, also the express charges, and for such other expenses as shall be required. He asks that the Secretary present this subject to the State Board of Health; also the question, relative to each sample of water, what shall be determined? "A year or two ago Prof. Fall, of this Board, proposed to determine the amount of chlorine in the natural waters in springs in different parts of Michigan. This should be done for the streams; also the amount of organic matter; perhaps, also, the presence or absence of pathogenic bacteria. If this last item is to be undertaken, probably it could best be done at the State Laboratory of Hygiene. Other branches of the work might be done at other laboratories, and perhaps bacteriological laboratories may well be started at several of the colleges in Michigan; it is understood that one will soon be established at the State Agricultural College. "Prof. Kedzie mentioned an investigation by a student at the Agricultural College of the amount of chlorine in the farmers' wells, in one locality in Michigan. It would be an interesting item of information if this question could be answered for a great many localities in Michigan." I am informed by Prof. Fall that he did considerable work on the examination of spring waters, but not enough for a final report, and that he has recently taken up this work again and will push the matter along. In addition to the special efforts of the State Health Department, before mentioned, for knowledge respecting the water supplies of this State, the Department has continually labored with the local health officials for information relative to the sources of infection in outbreaks of typhoid fever reported to this Department, to the end that this information might be 6 |