Ohio History Journal

NOTES

 

Contributors to This Issue.

Roy F. Nichols is Professor of History in the University of

Pennsylvania, Philadelphia.

Raymond F. Fletcher is Business Manager of the Portsmouth

(Ohio) Times.

Howard H. Peckham is Director of the Indiana Historical

Bureau and Secretary of the Indiana Historical Society, Indian-

apolis.

William Alexander Mabry is Professor of History in Mount

Union College, Alliance, Ohio.

Cathaline Alford Archer (Mrs. John Clark Archer) of Ham-

den, Conn., interests herself in local and family history of the

Western Reserve of which she is a native.

Frederick C. Waite, Professor Emeritus, Western Reserve

University, now located in Dover, N. H., is the author of two

volumes of Western Reserve University history. (See reviews

in this issue.)

John William Scholl is Professor Emeritus, University of

Michigan, Ann Arbor.

Curtis W. Garrison is Director of Research, Hayes Memorial

Library, Fremont, Ohio.

Book reviewers, represented by initials, are Robert C.

Wheeler, James H. Rodabaugh, John O. Marsh, Bertha E.

Josephson, and Harlow Lindley of the Society's staff, and Mary

Jane Meyer of the Ohio War History Commission.

 

 

 

 

 

 

 

 

 

 

 

 

310

• 1
 



THE DECLINE OF EPIDEMIAICS IN OHIO

by ROBERT G. PATERSON

Executive Secretary, Ohio Public Health Association

Secretary, Ohio Committee on Medical History and Archives

Introduction

When one considers the intimate relationship between disease.

particularly epidemic disease, and the individual it is a source of

wonder as to the almost complete absence of reference to this

phase of daily life in the standard histories of Ohio. From

Salmon P. Chase's A Preliminary Sketch of the History of Ohio

published in 1833 and Caleb Atwater's History of the State of

Ohio, Natural and Civil, issued in 1838 down to our own time,

the impact of medicine and disease upon the people of the State

has been all but ignored.

Change in Historical Perspective

A careful examination of the latest and most complete history

of the State of Ohio published in 1941-44 by the Ohio State

Archaeological and Historical Society reveals an awareness of the

social and scientific aspects of medicine never equalled in any of

the previous histories of the State. The nearest approach to this

latest history was the six-volume history of Ohio by Emilius O.

Randall and Daniel J. Ryan published in 1912. They secured

the collaboration of Dr. D. Tod Gilliam of Columbus, Ohio, to

contribute a chapter on "Medical Ohio." His discussion was

devoted largely to the institutional aspects of medicine.

"Historian's Note-Book"

The reason for the increased emphasis upon disease and

medicine in this latest history is, in my opinion, due to the per-

sistent effort exerted by Dr. Jonathan Forman.  In 1936, he

began the conduct of "The Historian's Note-Book" in the Ohio

State Medical Journal. Late in 1936, Dr. Forman became the

editor of the Journal and in 1937, he turned the "Note-Book"

311

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312   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

over to Dr. David A. Tucker, Jr., of Cincinnati. Practically no

issue of the Journal has been published since then without a con-

tribution to the "Note-Book." This publishing outlet has been

the means by which a score or more historical medical writers

have been stimulated to explore the medical history of Ohio.

Ohio Committee on Medical History and Archives

But perhaps more influential than the "Note-Book" have

been the contributions of the Ohio Committee on Medical His-

tory and Archives of the Ohio State Archaeological and Histori-

cal Society. This committee was organized in 1939 with Dr.

Forman as chairman and with the whole-hearted support of Dr.

Harlow Lindley, Secretary of the Society. Since 1939 the Octo-

ber-December issues of the Society's quarterly journal have con-

tained papers dealing with various phases of medicine and the

allied professions in Ohio.¹

These papers were drawn upon substantially in the writing

of the latest history of Ohio. While much of the same informa-

tion had been available for many years, it was hidden in the

primary sources exclusively medical in character. These sources

were the medical journals, proceedings, and transactions of medi-

cal societies which did not enjoy much, if any, circulation among

the professional historians. But with the advent of this material

in the Ohio State Archaeological and Historical Quarterly the

attention of the Ohio historians to this hitherto overlooked

material was caught and held. For example: Professor William

T. Utter in Volume II of the recent History of the State of Ohio

covering "The Frontier State--¹⁸⁰3-1825" devotes an entire

chapter of twenty-three pages to the discussion of "Sickness and

Doctors." The other volumes of the series contain repeated ref-

erences to specific diseases and medical institutions together with

their social impact as they occurred throughout the State.

Modern Discussion Lacking

The validity of these remarks is born out by an examination

of Volume VI, a compilation of seventeen monographs dealing

 

1 Ohio State Archaeological and  Historical Quarterly, XLVIII-LIV.

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EPIDEMICS IN OHIO              313

 

with various phases of life in Ohio in the twentieth century, 1900

1938.  The raw  materials for dealing with the diseases and

health of the people of Ohio are available in the annual reports

and bulletins of the Ohio Department of Health, in the Ohio

State Medical Journal, and in other kindred professional sources.

No one, as yet, has taken the time to collate this material into a

monograph. There is no subject of greater social significance

or more dramatic value in the history of Ohio than the growth of

medicine and public health service since  1900.  The immense

increase in scientific knowledge of medicine and the successful

social application of that knowledge in the control of disease.

particularly epidemic disease, has almost been taken for granted

by our people.

 

Title of Discussion

The title of this discussion, "The Decline of Epidemics in

Ohio," is perforce a "tongue-in-cheek" one. In the present state

of our knowledge an epidemic of a communicable disease may

break out in any part of the state at any time. However, the

fact remains that we have not had a major state-wide epidemic

of any disease since the pandemic of influenza in 1918-1₉. This

is the longest epidemic-free period in the history of Ohio.

It seems worth while to examine the causes for this freedom

which society has enjoyed for so long a period of time, and to

consider such questions as: What has been the past history of

epidemics in Ohio? How can we account for the decline of epi-

demics? What are the factors which seem to be our safeguards

against devastating epidemics?

Division of Discussion

There are three broad and arbitrary periods of time since

the first settlement of the state in 1788 which appear as marking

the advance society has made in this field of social well-being.

The first period embraces the years 1788 to 1873 or 85 years; the

second period covers the years 1873 to 9000 or 27 years; and

the third period spans the years from 1900 to 1945. These broad

time periods follow those adopted in the.latest history of Ohio.

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314  OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

An over-all examination of the evidence will warrant the

conclusion that more effective advance in the control of epidemics

in Ohio has been made within the past forty-five years than was

made in the entire one hundred and twelve years prior to the

beginning of this century.  There are many and complicated

reasons why this is so. It is hoped that a brief review of these

three periods will throw some light upon the developments in

epidemic control that have occurred during the past one hundred

and fifty-seven years.

In order to keep this discussion within reasonable limits it

will be confined to a few selected epidemic diseases and a few

chosen episodes to point their destructive effects. These epidemic

diseases are influenza, yellow fever, cholera, small-pox, typhoid

fever, diphtheria, and two endemic diseases--malaria and tuber-

culosis. These have been the fear-provoking diseases among our

people. They are the diseases which have caused the greatest

mortality at varying periods of time. They are the ones which

have caused the greatest social disorganization.  Finally, they

are the ones which have challenged "the spirit of adventure" of

the human mind to unravel their mysteries.

Today, as we examine this list of diseases, we find yellow

fever and cholera completely gone as causes of either morbidity

or mortality in Ohio; malaria, typhoid fever, diphtheria, and

small-pox almost at the vanishing point; while tuberculosis is

being reduced rapidly in its relative destruction of life and health.

Influenza, alone, stands as an uncontrolled threat in the epidemic

field.

In the following Table I it will be noted that the Ohio figures

begin with 1910. Ohio did not pass a comprehensive vital sta-

tistics law until 1908.  The figures for the first full year of

collection cover the year 1909. While these figures were a vast

improvement on any previously reported the 1910  figures come

more nearly reflecting the true mortality situation than those of

1909. It will be seen that Tuberculosis and Infant Mortality are

the two disease situations confronting Ohio.

• 5
 

EPIDEMICS IN OHIO                     315

 

Table 1

SPECIFIC DEATH RATES FOR SELECTED CAUSES

1910 - 1941

1. TUBERCULOSIS                        4. DIPHTHERIA

Year                               Deaths                            Rates       Year                                    Deaths                          Rates

1910                   7,179                   150.6   1910                      474                     122

1915                               6,668                               126.5       1915                                   673                                 12.8

1920                               5,932                               103.0       1920                                   6:39                               11.2

1925                               4,816                               74.9         1925                                   389                                 6.1

1930                               4,233                               64.1         1930                                   160                                 2.5

1935                               3,602                               52.8         1935                                   178                                 3.6

1940                               2,785                               40.8         1940                                      29                                 0.4

1944                               2,754                               39.2         1944                                      32                                 0.4

2. INFANT MORTALITY                                          5. SMALL POX                 (U.S. RATES)

Year                                Deaths                            Rates       Year          Deaths            Rates

1915                               11,463                            91.0         1910                                                                           0.4

1920                               10,160                            82.9         1915                                                                           0.1

1925                               8,841                               69.6         1920                                                                           0.6

1930                               7,209                               60.7         192                                                                              0.1

1935                               5,080                               50.4         1935                                                                           0.0

1940                               4,739                               41.4         190                                                                              0.0

1944                               5,136                               39.0         19                                                                                0.1

1944                                                                           0.1

3. TYPHOID      FEVER                     6. MALARIA

Year                                Deaths                            Rates       Year         Deaths             Rates

1910                               1,327                               27.5         1910                                                                           0.8

1915                                   718                              13.7         1915                                                                           0.5

1920                                   436                              7.5            1920                                                                           0.2

1925                                   325                              5.2            1925                                                                           0.2

1930                                   236                              3.4            1930                                                                           0.1

1935                                   97                                1.4            1935                                                                           0.1

1940                                   47                                0.7            1940                                                                           0.0

1944                                   10                                0.2            1944                                                                           0.7

I.  The Period from      1788 to 1₇83--Confused Speculation

The general characterization of this period may be said to be

"confused speculation."     A brief review of the available primary

sources of information about epidemic diseases in Ohio during

this period will convince any investigator of the aptness of this

phrase.   The entire period is full of prolonged and oft-times

heated discussions in the realms of causation, diagnosis, treat-

ment, and prognosis.

As in so many other areas of medical history, we perforce

begin with Dr. Daniel Drake of Cincinnati.           His mind. spirit,

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310    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

and indefatigable zeal led him to publish in 1810 a booklet setting

forth the results of his observations of life in Cincinnati under

the title of Notices of Cincinnati, Its Topography, Climate and

Diseases.   Five years later he published that remarkable book

about Cincinnati which established him as the foremost author

of the Ohio country. It was entitled Natural and Statistical View

or Picture of Cincinnati and the Miami Country. Drake's Pic-

ture of Cincinnati, as it is called, contains seven chapters and an

appendix covering in all 250 pages. In chapter five he devotes

his attention to the consideration of medical questions, the pre-

vailing diseases and their courses, in the region around Cincinnati.

So far as can be ascertained, the best single source of in-

formation available on the incidence of early epidemic diseases

in Ohio is contained in the presidential address of Dr. Samuel

Prescott Hildreth of Marietta. This address was delivered be-

fore the third session of the Medical Convention of Ohio held in

Cleveland on May 14, 1839. In his discussion of "Diseases of

the Early Settlers of Ohio" he says in part:

They sometimes were attacked with malignant remittants in the

summer, and pneumonias and pleurisys in the winter, but no serious epi-

demics appeared until partial openings had been made in the primeval

forests, and the wet low grounds exposed to the action of a summer sun . .

From the year 1788, the period of the first improvements in Ohio, to the

year 1807, the date of the first great epidemic, a large proportion of the

diseases originated in exposures to wet, cold, hunger, and fatigue, and

were generally of an inflammatory type, such as Rheumatisms, Pleurisys,

Pneumonias, Scarlatina and Small-pox.2

The great epidemic of 1807 was influenza. Dr. Hildreth

continues:

The winter following the epidemic of 1807, was mild, and the summer

months were marked with no prevailing diseases. From the years 1807 to

1813, the country was very healthy. The few fevers which did appear were

generally typhoid, or synochal. Bilious cholics for several years after the

epidemic, was a very common disorder.

Phthisis pulmonalis, also became rather more frequent after the In-

fluenza, but was still a rare occurrence. During the heats of summer

 

2 Samuel Prescott Hildreth, "Address of the President," in Journal of the Pro-

ceedings of the Medical Convention of Ohio, May 14-15, 1839, 16-7.

• 7
 

EPIDEMICS IN OHIO                     317

 

cholera infantum was greatly more frequent than it is at present, and often

proved fatal. It probably arose from the same malarious state of the

atmosphere which produces intermitting fevers, as we find it most prev-

alent in regions favorable to the latter disease ....

By the first of August [1822] the epidemic [yellow fever] was general

in this portion of the valley, and especially in Marietta. The largest number

of attacks was in September, and at one time there was not less than four

hundred cases within the area of one square mile. They were composed

of all, from the mild intermittent to the most malignant remittant, with the

usual symptoms which attend the yellow fever. During the season I had

about six hundred patients under my care. For four months in succession,

I ate but two meals a day, and spent from sixteen to eighteen hours out

of every twenty-four in attending the sick. Through a merciful Providence

my own health was good, and the only suffering was from exhaustion and

fatigue through the whole of this disastrous season. The proportion of

deaths was about six in every hundred cases, where proper medical atten-

tion was given the sick; but so general was the disease that many lives

were lost from a lack of nurses. All other disorders were swallowed up

by this.3

We come now to the epidemic of Asiatic cholera of 1832-34.

This epidemic was so devastating and created so much fear,

that with each recurring epidemic of the disease until the end of

the third quarter of the century this fear was the motivating force

which led to an anxious desire to do anything that promised relief

from its effects. Here again we quote from Hildreth:

Early in that year [1832] the people began to be alarmed with the

accounts from Europe of the ravages of Asiatic Cholera, . . . and it made

its appearance on the N. E. coast of America about the last of May, and

spread with fatal rapidity along the great water courses which border the

northern side of the United States. . . . With us no cases occurred this

year, but a few appeared late in the season at Cincinnati. . . . Either

from a nervous dread of the disease, or some morbific constitution of the

atmosphere, a large majority   of the inhabitants this summer were

troubled with bowel complaints, generally a moderate diarrhea. . . . No

disease which ever visited the civilized world held such control over the

nervous system and moral faculties of man; and during the period when the

great mass of our citizens believed it to be contagious, I have no doubt that

one-half of its victims took the disease, and actually died from the de-

pressing effects of dispair and fear. . . . In 1833 and 1834 this epidemic

scourge still continued to visit our most populous towns and cities in the

 

3 Ibid., 23-6.

• 8
 

318    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

west, while the sparse and thinly settled portions of the country scarcely

felt its effects; . . . I think it was found that the cleanly and well venti-

lated portions of our cities suffered the least, and the filthy and ill-aired

the most.⁴

We can recognize today, from this account, how keen were the

observations of the leading medical men of that era.

In March 1933, Dr. Jonathan Forman prepared a paper on

"The First Cholera Epidemic in Columbus, Ohio (1833)."  It was

later published in the Annals of Medical History in 1934. His

description of the disease is of such a vivid character that the

deep-seated fear created by an attack of cholera is readily under-

standable. He says:

The epidemic of Asiatic cholera which swept over our City one

hundred years ago this summer, for its mortality and terror, surpassed any

pestilence that ever afflicted Columbus before or since.

Cholera, because of its sudden appearance, its high mortality, and

the frightful appearance of its dead, has always been a dramatic character

in the history of the human race. Those who die of this disease are a

gruesome sight. It attacks the bowels and causes a stupendous loss of body

fluids in the typical "rice-water stools." The whole body becomes covered

and dank moisture. Cheeks become hollow, nose ipnched, eyes sunken,

voice husky. Death's rigor sets in quickly. Muscles literally become as

hard as a board. Sometimes a stiffening corpse jerks about; it may kick

out a foot, wave an arm, flap its jaws or roll its eyes. Of such things is

the natural terror of man for this loathsome disease.5

With such a graphic picture of the disease, and it was en-

countered daily by the physicians in the epidemic of 1832-34,

we meet Dr. Daniel Drake again. He persuaded the city council

of Cincinnati not to attempt to shut out the disease by erecting

barriers against it. Then he set to work to devise a substitute

plan of defense. The first step in this plan was public education.

He proceeded to write a book of 180 pages entitled A Practical

Treatise on the History, Prevention, and Treatment of Epidemic

Cholera, addressed both to the profession and to the people of

the Mississippi Valley in which he presented the existing know-

 

4 Ibid., 30-1.

5 Jonathan Forman. "The First Cholera Epidemic in Columbus, Ohio (1833),"

in Annals of Medical History, n. s. VI (1934), 410-26.

• 9
 



• 10
 

320   OHIO ARCHAEOLOGICAL AND ^HISTORICAL QUARTERLY

 

ledge and theories pertaining to cholera.⁶ It is in this book that

Drake cane very close to anticipating the later discoveries as to

the origin of infectious diseases. He did not accept the popular

miasmatic theory or its modifications, the malarial theory, as the

cause of the disease. He believed the animalcular theory the most

rational of all and by citations and his own experience established

the existence of animalculae everywhere, but especially in de-

caying organic matter.

Not content with his efforts in this direction, Drake wrote

a broadside of one page which was issued as an extra insert to

the Cincinnati Chronicle.  It was issued Saturday afternoon,

October 13, 1832. This broadside was probably the first such

attempt at popular health education in Ohio. The contents of

this broadside are typical of the period we have chosen to call

"confused speculation."

Drake later estimated that four per cent of the population

of Cincinnati was destroyed in three years, 1832-34. This meant

a total of 831 deaths.

In the second cholera epidemic in Ohio which struck between

1848 and 1850, there were two events that made a deep im-

pression upon the minds of the people throughout the State.

The State Board of Agriculture created by the General Assembly

in February 1846, planned a large state fair to be held in Cin-

cinnati in 1849. The outbreak of cholera caused its postpone-

ment until 1850 when the first Ohio State Fair was held in Cin-

cinnati.⁷ But in July 1850, another outbreak of cholera (result-

ing in the death of one of the Executive Committee of the State

Board) led to the holding of the second state fair at Franklinton

(Columbus) in September 1851.

The other event was curiously a reversal of the course fol-

lowed in the transfer of the State Fair from Cincinnati to Colum-

bus. The Ohio Constitutional Convention met in the State House

in Columbus, May 6, 1850, to draft a new state constitution for

 

6 Daniel Drake, A Practical Treatise on the History, Prevention, and Treatment

of Epidemic Cholera . . . (Cincinnati, 1832).

7 Francis P. Weisenburger, The Passing of the Frontier, 1825-1850, Carl Wittke,

ed., The History of the State of Ohio (Columbus, 1941-44), III (1941), 71-3.

• 11
 

EPIDEMICS IN OHIO                 321

 

Ohio. On July 9, 1850, the convention adjourned because of the

cholera epidemic in the city.    It reassembled in Cincinnati,

December 2, where it finished its work on March 10, 1851.8

Both of these episodes had a tremendous effect upon the

people throughout the State. Dr. Edwin W. Mitchell in his dis-

cussion of cholera in Cincinnati⁹ estimated that between May 1,

and August 30, 1850, there were 4,114 deaths from cholera out

of a total of 6,459 deaths from all causes for the same period. The

population of the city at this time was estimated at 100,000.

By 1850, many observers drew attention to water as a means

of conveying the disease. By 1873, the year of the last visita-

tion of cholera, contamination of the water supplies was generally

recognized as a source of infection and the belief in its bacterial

origin common among the advanced thinkers of the day.

These few selections of the periodic recurrent epidemics, it

is hoped, may convey an idea of the constant fear, nay even

terror, which possessed the people of Ohio from   1788 to 1873.

This fear was not allayed by the confused explanations as to cause

offered by the medical profession.  But it is clear now that the

leaders of the profession were not idle in their constant search for

a better understanding of these scourges. In addition to rugged

battles among themselves and fighting against quacks and charla-

tans, they were busy establishing medical journals, conventions,

colleges, and hospitals and constantly striving to raise the educa-

tional standards of the profession. Their etiological explanations

were those that were current elsewhere--that the diseases arose

from miasms in the atmosphere. Their therapeutic ideas were

heroic. When Prime Minister Churchill coined his striking

phrase, "Blood, Sweat and Tears," one who knew the history

of medicine in this period must have gained the impression that

the Prime Minister was familiar with the therapeutic practice of

that day--which was "bleed; purge; puke; and sweat."

Throughout this period the dependence of society in com-

 

8 Ibid., 207, 479; Eugene H. Ruseboom, The Civil War Era, 1850-1873, Carl

Wittke, ed., The History of the State of Ohio (Columbus, 1941-44), IV (1944), 130.

9 Edwin  W. Mitchell, "Cholera in  Cincinnati," in Ohio State Medical Journal,

XXXIII (1937), 69-70.

• 12
 

322   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

batting epidemics was upon isolation of the patient, quarantine

of contacts, and the abatement of nuisances. The main idea was

to clean up the environment to reduce to a minimum the poisoning

of the air by miasms.   Boards of health    were more or less

ephemeral bodies hastily organized during a threat of an epidemic

and as hastily disbanded when the epidemic had passed on. There

was also discernable a gradual shift in emphasis from systems of

medicine to schools of therapeutics. The rise and struggle for

supremacy between the so-called allopathic (regular), homeo-

pathic, and eclectic schools of treatment had a retarding effect

upon medical development in Ohio.      Finally, during the latter

part of this period, there was a continual controversy between

those who believed in contagion as an explanation as to the cause

of the epidemic diseases and those who denied any such idea.

 

Table II

EPIDEMICS IN OHIO, 1788-1873

 

Year                                Population                                   Disease                                                  Period

1810                               230,760                                        Influenza                                                1807

1820                               581,295                                        Yellow Fever                                        1821-23

1830                              937,903                                        Influenza                                                1826

Cholera                                                  1832-34

184                                1,519,467                                     Typhoid                                                 1840-42

1850                               1,980,329                                     Cholera                                                  1849

Cholera                                                  1854

1860                              2,339,511         Diphtheria          1856-59

1870                              2,665,260         Cholera               1865-66

Small Pox                                              1868

Cholera                                                  1871-73

II. Period from 1873 to 1900 -- Scientific Demonstration

The establishment of the germ theory as an explanation of

the causation of a large number of epidemic diseases brought to

a close the long conflict between contagionists and anticontagion-

ists. It made possible what we have chosen to call the period of

"scientific demonstration."   Improvements in the microscope

made it possible for the French chemist, Louis Pasteur, the

German country physician, Dr. Robert Koch, and the English

surgeon, Dr. Joseph Lister, to lay the foundations for attacks

• 13
 

EPIDEMICS IN OHIO             323

 

upon communicable diseases and advances in surgery, which have

gone on from 1865 to the present day.

But the birth of new ideas and the death of old established

and cherished beliefs are ever fraught with painful struggles.

Ohio's physicians as well as the people at large were slow to

accept the new ideas. Throughout this entire period the annals

of medical thought in Ohio are replete with the continual con-

tention between acceptance or rejection of the idea that pathogenic

microorganisms were the explanation of many of the diseases

which afflicted the people.

Medicine moved away from being solely an art into the realm

of science. The rise of bacteriology created the laboratory where

scientific procedures could be established for the detection of the

organisms in specific diseases. There ensued a veritable furore of

investigations which discovered a long list of causative organisms

and gradually established the various avenues of infection--

personal contact, food and drink, and biting insects. The science

of immunology sprang up as a collateral branch of bacteriology.

The interval from 1873 to 1892 was the most fruitful in the gross

benefits of medical science to mankind of any like interval in

history.

While there was no cholera epidemic in Ohio recorded dur-

ing this period, yet it was cholera which led to a new approach

in control. Koch discovered the comma-bacillus in 1884 as the

causal organism in cholera. From  1884 to 1892 cholera was

prevalent throughout Europe. The epidemic culminated in the

great Hamburg outbreak of 1892 with 17,000 cases and a half

as many deaths. New York was threatened in 1892 and as a re-

sult a city laboratory was established by Drs. Biggs and Prudden

in the Health Department. The laboratory dictated the policies

of quarantine and sanitary matters; it was arbiter on questions

of diagnosis.

That the new science was effective is evident; eight badly in-

fected ships, which had lost 76 passengers came to the New York

quarantine and discharged their passengers both sick and well; yet

with proper care only forty-four deaths occurred at quarantine

• 14
 

324   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

and from the ten cases that were found in the city not a single

instance of secondary infection was discovered.

In the meantime (in April 1886) the Ohio General Assembly

had passed a bill to create a State Board of Health.¹⁰ Efforts to

achieve this objective had been exerted vainly at spasmodic in-

tervals for the preceding ten years. The obstacles were the dif-

ferences between the allopathic and homeopathic schools of medi-

cine, each fearful of losing supremacy, as well as the state of

public opinion as reflected by the legislators over the question

whether diseases were or were not caused by the "so-called

germs." This act placed Ohio thirty-second in the list of states

to establish a state board of health; Massachusetts had been the

first state to set up such an authority in 1869. The total appro-

priation for the new state activity in Ohio was the huge sum of

$5,000!

Dr. Charles O. Probst became the first real secretary of this

State Board of Health. He was its guiding mentor for twenty-

five years. To read the annual reports of the work of the State

Board of Health from 1886 to 1911 is to read the record of hope

deferred, unflagging courage, intelligent maneuvering, and a

splendid spirit of adventure. To the present generation of Ohio-

ans skimming blithely over the highways of the State and streets

of our cities there is no realization of the vast debt they owe to

this pioneer public health administrator of Ohio.

Let him tell us in his own words about the threat of the

1892 cholera situation:

From an epidemic of cholera in Hamburg and Altoona [Germany],

originated the legislation which has pushed Ohio to the front in the pro-

tection of her streams, lakes and public water supplies. It came about in

this way . . . a codification of the health laws was made which was em-

bodied in a Bill that was introduced in the House of Representatives. It

contained many new provisions, and made a document of fifty or more

pages. Cholera from Hamburg appeared at New York about this time,

and the whole country was alarmed. A patrol guard was organized on all

railway lines going west through Ohio, with inspection of all passengers,

night or day, with camp equipment for the care of cases that might be

 

10 Ohio  Laws, LXXXII, 77.

• 15
 

EPIDEMICS IN OHIO                   325

 

found. . . . Ohio was naturally greatly concerned.      Our Health Bill

was before the House. It was so long I didn't believe any one would

read it, so, with the consent of the member who introduced it, the fol-

lowing addition was made . . . "and no city, village, corporation or

person shall introduce a public water supply or system of sewerage or

change or extend any public water supply or outlet of any system of sew-

erage now in use, unless the proposed source of such water supply or out-

let for such sewerage system shall have been submitted to and received

the approval of the state board of health."  The Bill, with this amend-

ment, was passed March 14, 1893.11

This act gave to the State Board of Health sufficient author-

ity to ensure that when an order was issued to a local sub-division

for such change or improvement of a water supply the tax limit

could be increased, within limitations, without a vote of the people

to carry out the Board's order. Thus was brought about the

effective control of cholera and typhoid fever in Ohio.

Typhoid fever epidemics were usually of a local character

and were constantly present in this period. Cincinnati and Co-

lumbus appear to have had the sternest battles with the disease.

Dr. Probst has left us a clear picture of the forces at work in

Columbus for and against the necessary steps to control typhoid.

He says:

 

Columbus had for years taken its water supply from the Olentangy

river a little above the city, and for years had had, at intervals, outbreaks

of typhoid fever. When Mr. Jacobs was Director of Public Works, he

conceived the idea of getting a ground water supply, already purified, he

used to say, by intercepting the ground water by laying a system of large

iron perforated pipes along the river shores. He installed very consider-

able lengths of this. As this was an "additional supply," under the Bense

act, it had to be approved by the State Board of Health. An unprecedented

epidemic of typhoid fever occurred about this time and gave a favorable op-

portunity to make a thorough investigation of the Columbus water supply

question with an eye to its satisfactory improvement. The Board author-

ized me to employ Mr. Allen Hazen of New York . . . and after a de-

tailed study of the situation he recommended an impounding dam in the

Scioto river with a softening and purification plant. I think Mr. [Julian]

Griggs had previously suggested this, but of this I am not certain . . . .

 

11 Charles O. Probst, Recollections and Reminiscences of Public Health Service

and Public Health Workers, Columbus, Ohio (mimeographed for private circulation,

Columbus, 1912), 5.

• 16
 

326    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

Mr. Robert Jeffries, Mayor, and Mr. James [M.] Butler, City Solici-

tor, came to my office to urge approval of the dam alone as funds for puri-

fication were not available. Finally, we reached a "gentleman's agree-

ment" which was later accepted by the Board. They promised to have

prepared plans for purification works without delay and to submit the

question of sufficient funds to install the plant to a vote of the people. They

agreed further to use all of their influence in support of it. They fully

carried out their promise.

Some time before the vote was to be taken there appeared in the Ohio

State Journal a long article urging the people to vote against this un-

necessary expense, because no system of water purification could remove the

germs of typhoid fever or other disease germs. This article was signed by

Dr. Starling Loving, the foremost physician in Columbus and the Dean of

Starling Medical College, Dr. D. N. Kinsman . . . Dr. J. F. Baldwin, Dr.

[E. B.] Fullerton, Dr. N. R. Coleman, Dr. J. M. Dunham and Dr. Will

[D.] Hamilton; the latter with a reservation. These were the leading med-

ical men of the city, and they did not realize that (they were all honest

men) they were proposing to lead the people against the most important

life saving measure Columbus ever had before it. And this illustrates how

poorly informed about sanitary matters were the physicians of that day,

especially the older ones who had had no sanitary instruction.

There was but one course left -- to educate the people. Accordingly, a

lecture bureau, you might call it, was organized and several of us arranged

for and spoke before public gatherings urging the people to support the

bond issue, explaining the process of water filtration, and proving what it

had done in other places. The bond issue was carried, and typhoid fever

has almost disappeared from Columbus.¹²

Out of this controversy there grew not only the splendid

water purification plant but the sewage treatment works and the

garbage disposal plant, all of which have given Columbus a

sanitary control over its environment so effective that epidemics

of cholera, typhoid fever, and indirectly, other communicable

diseases have been reduced to a minimum or entirely eliminated.

What happened      in  Columbus    was also    occurring   elsewhere

throughout Ohio and the nation. It was a transition period from

the old to the new. The citation of the episode merely gives a

local flavor to a nation-wide phenomenon.

Dr. Probst had other problems crowding for attention. In

the first annual report of the State Board of Health he pointed

 

12 Ibid., 21-3.

• 17
 

EPIDEMICS IN OHIO          327

out, among other things, the absolute necessity for a compulsory

system of local organization of boards of health throughout the

State; the dire need for an adequate state system of vital statistics;

the obligation of the State to assist local communities in the con-

trol of epidemic diseases; and the indispensable requirement for

the preparation and distribution of educational literature dealing

with the most pressing of the epidemic diseases.

The slow development of a state system of vital statistics in

Ohio is presented here as an illustration of the character of the

struggles that confronted Dr. Probst in this period. It has been

an axiom of public health that the collection, tabulation, analysis,

and interpretation of vital statistics is the cornerstone of success-

ful control of health conditions. Yet, it almost passes present-

day belief that the State of Ohio took so long to provide an

adequate system of registration.13

The act creating the State Board of Health provided that the

Board should have supervision of the state system of registration

of births and deaths; that the secretary of the Board should be

superintendent of such registration; but that the clerical work and

safekeeping of the records should be provided by the Secretary of

State. Mr. James E. Bauman, Assistant Director of the Depart-

ment of Health of Ohio, put this early situation very well when

he wrote:

In commenting on the subject in his first annual report, Dr. Probst

called attention to the gross inefficiency and inaccuracy of the system in

use. In only one city (Cincinnati) did the law require reports by physicians

to the Board of Health. The information that came to the Secretary of

State was that collected by the assessors on their annual visit on taxation

matters. The returns for 1885 showed a death rate [for the State] of

about 10 to 1000, while the rate for Cincinnati that year was 18.37 per

thousand, which would indicate that not more than one-half the deaths

were recorded in the state, and accuracy as to the cause of death could not

have reached a high percentage.

. . . In each of his annual reports and in papers he prepared for

various meetings, the matter was discussed.14

 

13 State of Ohio, Department of Health, Thirty-First Report (43rd Year), Part I,

Report of July 1, 1915 to December 31, 1928 (Columbus, c1931), 135-7.

14 James E. Bauman, "Doctor Probst and Public Health in Ohio," in Robert

G. Paterson, ed., Charles Oliver Probst--A Pioneer Public Health Administrator in

Ohio (Columbus, 1934), 39-40.

• 18
 

328   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

The epidemic diseases with which the State Board of Health

had to contend during this period were influenza, smallpox,

typhoid fever, and diphtheria. At first, investigations of out-

breaks of these diseases were conducted by Dr. Probst and

members of the Board. Gradually dependence was placed upon

various physicians throughout the State who were employed on a

day-by-day basis. Dr. H. M. Platter of Columbus was one of

these early diagnosticians. There was a growing recognition of

the need for a laboratory where chemical and bacteriological

examinations could be made. Again dependence was upon an

opportunistic basis. Curtis C. Howard, Professor of Chemistry

at Starling Medical College, was called in and for several years

did all of the chemical work, Dr. J. H. J. Upham was employed

to do the bacteriological work. He had just come to Columbus

from Johns Hopkins Medical School where he had studied under

Dr. William H. Welch who brought the bacteriological laboratory

to this country from Germany.

This work grew in volume and in value to such an extent that

the General Assembly passed an act on April 25, 1898, which

established the chemical and bacteriological laboratory in the State

Board of Health. The appropriation was just sufficient to employ

a bacteriologist and equip two office rooms as a laboratory. Dr.

Elmer G. Horton served as bacteriologist from 1898 to 1907.

The first line of work was the examination of water and sewage

in an effort to give the public more adequate protection against

water-borne diseases. However, it was only a short time until

physicians began to request examinations for the diagnosis of

such diseases as diphtheria, tuberculosis, and typhoid fever.

There were two other developments during this period to

which attention should be called as having a direct bearing upon

the control of epidemics in Ohio. The first deals with the laws

or lack of them regulating the practice of medicine in Ohio. Dr.

Platter has presented this situation quite clearly in "The Histor-

ian's Note-Book" in the April 1936 issue of the Ohio State

Medical Journal. He says:

From 1833 until 1868 there was no law regulating the practice of

medicine in Ohio.

• 19
 

EPIDEMICS IN OHIO        329

From  October 1, 1868, to February 27, 1896, one might practice

medicine legally upon submission of any one of the following credentials:

First--A certificate from a state or county medical society.

Second--A diploma from a school of medicine either in the United

States or a foreign country.

Third--From   1880 to 1885, a diploma from a medical school issued

after attendance at two full courses of at least 12 weeks each, and from

1885 to 1896 a diploma of graduation from a reputable school of medicine.

During the entire period from 1868 to 1896 the continuous practice

of medicine over a period of 10 years entitled a person to practice medicine

in Ohio.

Many times the State Medical Association endorsed the passage of

an act to regulate practice by the state and on February 27, 1896, the

present Medical Practice Act became effective.

By its provisions the Governor was authorized to appoint a board of

seven members, representative of the schools of medicine in Ohio at that

time. No school of medicine was permitted to hold a majority membership

on the board. As first created it was composed of three regulars, two

homeopaths, one eclectic and one physio-medical practitioner....

One hundred and forty medical schools were rated as in good stand-

ing by the original board. Approximately 7,000 physicians received certi-

ficates to practice upon presentation of their credentials and 700 more gained

a certificate by proof of 10 years continued practice in the state ....

At present the number of men engaged in the practice of medicine

in Ohio does not quite reach 9,000. Is it not possible that many of the

duties and obligations imposed upon physicians then are now being dis-

charged by other agencies? And is it not possible that we may suffer

further encroachment into the field of medical practice? Cultists we had

then as now; no period in medical history has been free from them.15

The act of 1896 was a great step forward in establishing minimum

qualifications for the practice of medicine in Ohio. It was and

is basic to any control of epidemics by the State.

The other development has to do with the hospitals of the

State.   Throughout this period hospitals were viewed          with

suspicion by the general public. They were a last resort in any

kind of illness. There was a widespread belief that if one went

in the front door of such an institution one was sure to go out the

 

15 Herbert M. Platter, "The Present Ohio Board of Medical Registration and

Licensure," in Ohio State Medical Journal, XXXII (1936), 347-9.

• 20
 

330   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

back door into the hands of the undertaker. Even with the in-

troduction of cellular pathology, ether anaesthesia, and anti-

septic surgery in the earlier period, this situation prevailed until

the end of the era under discussion. Between 1890 and 1900 the

addition of the laboratory to the more progressive institutions be-

gan to change their character. Suspicion and fear began to give

way to a feeling of trust and confidence. Epidemic diseases

which were segregated in the old "pest houses" now were provided

with isolation hospitals.

 

Table III

EPIDEMICS IN OHIO, 1873-1900

 

Year                                Population                                   Disease                                                  Period

1880                              3,198,062                                     Influenza                                                1879-80

Small-pox                                              1882-83

1890                              3,672,316                                     Influenza                                                1889-91

1900                              4,157,545                                     Diphtheria                                              1896

Small-pox                                              1898

III. Period from 1900 to 1945--Social Organization

The form of present-day organizations and institutions upon

which society depends for protection against epidemic diseases

began to be foreshadowed in the final decade of the previous

period. In this third period the tempo of social organization in-

creased rapidly with respect to existing organizations and institu-

tions and by adventures into new avenues of approach to old

problems.   The public generally, and the medical profession

particularly, gained increasing confidence in the validity of the

methods employed. The tests were a decrease in the mortality

rates as well as in the morbidity rates. There are presented here

a few of the influences which have developed in this period merely

to indicate the trends.

Tuberculosis

Tuberculosis had been, and still is, one of the outstanding

problems for the medical profession and for society as well. In

1900 it was far and away the leading cause of death. Koch dis-

covered the tubercle bacillus in 1882, but the application of that

• 21
 

EPIDEMICS IN OHIO                 331

 

discovery did not take place on an effective basis until the period

under discussion. Again it was Dr. Probst who became the leader

in Ohio against this menace. He followed the pattern set in

Pennsylvania by Dr. Lawrence F. Flick in 1892. In 1901 Dr.

Probst organized a state-wide voluntary association of medical

and lay workers to employ popular education as a means of de-

feating the "tubercle bacillus." The Ohio Society for the Pre-

vention of Tuberculosis became the spearhead of the movement

to control this endemic and communicable disease.16 This use of

popular health education as a method of attack upon a specific

disease was unique in the world.  It has set the pattern for the

host of similar organizations which have been organized since

against specific diseases or menaces to the health of our people.

 

Vital Statistics

In 1908 Dr. Probst prepared the final draft of what is now

our vital statistics law. The bill became a law without much op-

position since the Secretary of State, Carmi Thompson, was in

accord with the idea. The Bureau of Vital Statistics was estab-

lished as a part of the Secretary of State's Department until 1921,

when it was transferred to the Department of Health. Ohio was

admitted into the United States Death Registration area in 1911

and into the Birth Registration area in 1917. In order to become a

part of the registration area, the state must collect records of more

than 90 per cent of its births and deaths. So has ended the long

struggle to place this cornerstone in the system to control epidemic

diseases in Ohio.

 

Vitality

Perhaps one of the most important public health reports

issued in this country from the point of view of its influence

upon public opinion was that made by Professor Irving Fisher

in 1909. The document was entitled "Report on National Vitality,

Its Wastes and Conservation." It was prepared for the National

Conservation Commission created by President Theodore Roose-

 

16 Ohio Society for the Prevention of Tuberculosis, 1901-20; Ohio Public

Health Association, 1920-46; Ohio Tuberculosis and Health Association, 1946--.

• 22
 

332             OHIO ARCHAEOLOGICALAND HISTORICAL QUARTERLY

 

velt.      The burden of the prophetic argument, in brief, was as

follows:

There is no  need, however, of waiting a century for this increase

[in the average duration of life]. It could be obtained within a genera-

tion. Three-fourths of tuberculosis, from which 150,000, Americans die an-

nually, could be avoided.... From these data, it is found that fifteen

years at least could be at once added to the average human lifetime by

applying the science of preventing disease. More than half of this ad-

ditional life would come from the prevention of tuberculosis, typhoid, and

five other diseases, the prevention of which could be accomplished by purer

air, water, and milk.17

That Professor Fisher, at the time thought to be radical, was con-

servative in his estimate has been demonstrated by the actual re-

sults achieved during the period under review.

 

Contrasts 1910-1886

On the occasion of the twenty-fifth anniversary of the crea-

tion of the State Board of Health in 1910, Dr. Probst embraced

the opportunity to contrast the health conditions in that year

against those obtaining in 1886. He wrote:

Twenty-five years ago the people generally paid but little attention

to health questions.  They were afraid of smallpox, yellow  fever and

cholera, and to a less extent of diphtheria and scarlet fever, and asked

protection from such diseases when quarantine measures did not interfere

too much with business. Sewer gas and things and places that created bad

odors, were more feared than disease germs.

The law authorized council to appoint boards of health with authority

to enforce quarantine measures for the prevention of dangerous diseases

and to abate nuisances, but in only a few cities and villages, about 45 or

50, had this been done. No one had authority to act in the township except

in smallpox the trustees had certain powers.

Consumption was almost universally regarded as an inherited disease,

and little or no effort was made for its prevention. Even diphtheria was

still considered as a non-communicable disease by many members of the

medical profession, and "membranous croup" was quite generally considered

as a distinct affection requiring no preventive measures.

The people in a general way knew that impure water was a cause

 

17 Irving Fisher, Bulletin 30 of the Committee of One Hundred on National

Health. Being A Report on National Vitality, Its Wastes and Conservation (Washing-

ton, D. C., 1909), 1.

• 23
 

EPIDEMICS IN OHIO                     333

 

of disease, but took scant heed of the necessity for protecting the sources

from which it came. No community had undertaken to purify the water it

drank, nor the sewage which it turned into the stream from which its

water supply was taken. Infected or dirty milk as a cause of disease, and

especially its relation to infant mortality, was scarcely spoken of outside

of medical circles. School hygiene and medical inspection of schools had no

public support and few advocates.

There was practically no conception, except among the few interested

in sanitary science, of the intimate relation of sociological and industrial

conditions to health problems. Neither the State nor the municipality felt

any special responsibility for the health of its citizens; and the conception

that the public health is a valuable asset and like other property should be

protected for purely economic reasons, if for no other, was entertained by

few, and had had no public expression.

At the end of this quarter of a century we find great changes. Health

officials with large powers and charged with weighty duties, are a neces-

sary part of the government of every city, village and township.

Antitoxin for the cure and prevention of diphtheria, unknown twenty-

five years ago, is now, through the agency of the State Board of Health,

within easy reach of every physician in the State, and is supplied free to

the poor and needy.

Tuberculosis is being fought everywhere. A State Sanatorium has

been provided for the cure of its victims, and many county and district

hospitals have already been established, with others under way, for the

care of advanced cases.

A state society (organized in the office of the State Board of Health)

and many local tuberculosis societies are engaged in combating this disease.

Ohio has become a leader in the protection of its water supplies, and

its fame in this direction has spread to most parts of the world. The

State, through its State Board of Health, has entered upon a policy which

will prevent further injurious contamination of its streams and lakes

and must eventually free them from all sources of defilement.

The purity of milk supplies, once unquestioned, is receiving more

and more official and public attention. Great gains have been made in

school hygiene and school sanitation. Medical inspection of schools, now

authorized everywhere, has been undertaken in most of our larger cities.

The most hopeful sign of advancement is the change in opinion as re-

gards health matters. Indifference, and even, to some extent, hostility has

been replaced by keen interest and a desire for help.

Twenty-five years ago a visit by a representative of the State Board

of Health was often looked upon as an unwarranted interference and a

• 24
 

334    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

reproach to the community where this was necessary. Today the difficult

is adequately meeting the many demands for such assistance.

Public education in health matters has been immeasurably extended.

Hygiene is taught in all schools; the press and lay magazines are devot-

ing more and more space to health subjects.

It is only by thus contrasting conditions as they were in 1886 with

what may be seen today that a fair estimate can be made of our growth in

power and service in protecting the public health.

Much of what has been done must be regarded as simply the founda-

tion, soon to be buried, upon which will rest the magnificent superstructure

which should, and we trust will, be erected. The future should see the

sovereign state chiefly concerned about the health of its subjects.

The next quarter of a century should bring about immense improve-

ments in the public health.18

 

Medical Education

In 1910 Dr. Abraham Flexner issued a report on medical

education in the United States and Canada based upon a survey of

the medical schools as they were operated. Flexner pointed out

that among a total of 155 medical schools in these two countries--

a larger number than existed in the rest of the world--only a

small fraction provided proper medical training. Less than a

third were integral parts of universities.19 This report had a

tremendous effect upon medical education, and Ohio did not

escape its impact.

Out of the 140 medical schools recognized by the Ohio State

Medical Board in 1896 there were 26 in Ohio whose diplomas

were recognized.    Today there are but three medical schools in

the State, each an integral part of a university.

 

United States Public Health Service

No account of the efforts put forth by Ohio to control

epidemic diseases would be complete without taking into account

the development of the United States Public Health Service.

 

18 Twenty-Fifth Annual Report of the State Board of Health of the State of

Ohio for the Year Ending December 31, 1910 (Columbus, 1911), 5-7.

19 Abraham Flexner, Medical Education in the United States and Canada. A

Report to the Carnegie Foundation for the Advancement of Teaching. Bulletin No. 4

(New York, 1910), passim.

• 25
 

EPIDEMICS IN OHIO                   335

 

Until 1912 the earlier Marine Hospital Service (1798), later

the Public Health and Marine Hospital Service (1902), was ex-

clusively a medical relief and quarantine agency. In that year

the beginning was made for providing on the federal level a public

health organization which has since grown into an effective safe-

guard against epidemic diseases being introduced from outside

the United States as well as exercising control over interstate

communication of epidemic diseases.20

 

State Department of Health

The laws of Ohio relating to the organization of the State

Board of Health received a thorough overhauling at the hands

of the General Assembly in 1917. There emerged essentially the

present form of organization which is known as the Department

of Health of Ohio.²¹

 

Influenza Epidemic

In 1918-19 there occurred in Ohio and throughout the world

the pandemic of influenza. This epidemic nearly reproduced the

same degree of fear and social disorganization that had been

produced by the previous cholera epidemics. A high mortality

rate and an enormous amount of illness forced upon every one ??

realization of the thin dividing line between the years of com-

parative good health and the sudden onset of a devastating

epidemic.²² As one outcome of that epidemic, the General As-

sembly in 1919-20 completely revamped the ancient system of

local health organization in Ohio. A reduction from 2,150 local

health units to some 200 was effected.23

There is discernible in this period a gradual shift from

etiology to therapeutics.  The exploration of the gross patho-

genic microorganisms gradually exhausted itself under the pat-

tern laid down by Pasteur and Koch. We are today face to face

with the virus diseases which have not yielded thus far their

 

20 Cf. H. S. Mustard, Government in Public Health Commonwealth Fund

(New York, 1945).

21 Ohio Laws, CVII, 522-5.

22 Forrest E. Lindner and  Robert D. Grove, Vital Statistics Bates in the United

States, 1900-1940 (Washington, D. C., 1942), passim.

23 Ohio Laws, CVIII, Part 2, 1085-93.

• 26
 

336   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

full secrets.  Astonishing discoveries in the field of chemo-

therapy are at the moment holding the center of attention. The

speed with which the sulfa compounds, DDT, penicillin, and

streptomycin have become common in popular discussion is al-

most breath-taking. The next shift may be in the field of physics

as we speculate concerning the application of atomic energy to

the realm of medicine.

 

Table IV

EPIDEMICS IN OHIO, 1900-1945

 

Year                                Population                                   Disease                                                  Period

1902                               4,321,527                                     Small-pox                                              1901-3

1905                               4,458,354                                     Small-pox                                              1905-13

1919                               5,683,124                                     Influenza                                               1918-19

1921                              5,921,257                                     Diphtheria                                             1921

1923                              6,182,537                                     Influenza                                               1921-23

1926                              6,503,581                                     Measles                                                 1926

IV. Future Outlook

As we look back over the long trail that epidemic diseases

have blazed in Ohio there are certain broad trends which seem

to mark the reasons for the decline of such diseases. There has

been an amazing growth in scientific knowledge in the areas

of etiology and therapeutics. There has been an equally astonish-

ing improvement in medical education, in hospitals, and public

health. There has also gone along with these improvements an

unprecedented diffusion among all the people of better standards

of daily living.

There has never been in the history of the world such a

vast migration of human beings from the temperate zone to the

torrid zone and even to the arctic zone as we have witnessed

within the past seven years. Nor has there been less threat from

epidemics to the lives and health of our people.   If ever we

needed a demonstration of the degree of our control over such

diseases, we have just lived through one never equalled in the

world before.

But to say this is not without recognizing that there are

many unsolved problems before us. The discovery of a specific

• 27
 

EPIDEMICS IN OHIO                 337

 

for tuberculosis or a complete understanding of the virus diseases

or the cause of cancer may be right around the corner.

If we can project ourselves into the future on the basis

of our present knowledge and past experience in the control of

epidemic diseases it seems. clear we shall follow somewhat along

the following lines:

I.  Organization of research coordinated closely on a

national basis.

II.  Extension of conditions for the establishment of

higher standards of living for all our people.

III.  Synthesis of our present separate entities of medical

school, laboratory, hospital, and public health organiza-

tion within a university to comprehend a truly theore-

tical and applied biological science.

IV.  Integration of our local, state, and federal public

health services.

V.   Improvement in technics and content of health educa-

tion both on an individual and mass basis.

 

As Pasteur himself said at the evening of his long and use-

ful life, "Much has been done; but there is still a great deal

to do." And the people of Ohio must needs join in the doing.

• 28