SANITARY SURVEY 0 F ELYRIA, OHIO. June, 1923, Alexander T. Bunts, Fourth Year, Harvard Medical School, INTRODUCTION* History: At the beginning of the Revolution Virginia claimed all lands northwest of Ohio, Connectiout claimed title to all lands lying between the parallels 41 and 42 degrees 2 min. north latitude from the Atlantic to the Pacific. Pennsylvania, New York, and Massachusetts also claimed this land. By 1784 all states but Connecticut had re- linquished their claims to the United States. On September 14, 1*786 Connecticut relinquished to the United States all claim to lands lying west of a line running north from the 41st degree of north latitude to 42nd degree, 2 min., and being 120 miles west of the western line of Pennsylvania. The land between Pennsylvania and thi3 line was reserved, the Western Reserve of Connectiout. In 1792 Connec- ticut set apart and donated to those people of the state who had suffered at the hands of the British, aided by Benedict Arnold, 500,000 acres of the western part of the Reserve, to compensate them for the losses sustained. In 1795 Connecticut sold the remainder of the lands of the Reserve to Oliver Phelps and thirty-five others (The Connecticut Land Compamr) for $1,200,000. In order to sever the ownership in common, a draft of townships was held in April, 1807; Town #6, in range 17, was drawn by Justin Ely, Roger Newbury, Jonathan Brace, Elijah White, Enoch Perkins, and others. Thw town was divided up, Ely receiv- ing the southern part, about one-third of the whole. Ely conveyed to his son, Heman Ely, who left his home in Springfield, Massachusetts, in 1816, to visit these lands. He had a saw-mill and gri3t-mill erected 2 on the east branch of the river, near the foot of the present Broad Street. Then he returned to Massachusetts. In February, 1817, he came back to his traot with a party, by May there were at least eleven persons here, and work was commenced at once in earnest. On Ootober 20th, 1819, the township of Elyria, comprising towns #5 and #6 in Range 17, (Carlisle and Elyria) was 9et off into a township by the same authority. It was named after its founder, b'-r adding to his name the suffix "ria ’. Elyria was selected as the county seat in 1823, Mr. Ely donated i2,000 toward the erection of a court-house and a jail. In 1822 he dedicated the Public Park to the inhabitants of the township. In 1828 a new oourt-house was erected. This was torn down in 1880, and the present building was erected in its stead. Geographio position: Lorain County, of which Elyria is the oounty seat, is one of the northern counties of Ohio, situated on the border of Lake Erie, half way between Sandusky and Cleveland. Elyria is located in the central part of the count;/ at the junction of the east and west branches of the Black River, which flows across the county from south to north to empty into Lake Erie. Climate: The climate of Lorain County is the average for the northern sections of the United States, The precipitation during 1922 was 33,18 inches. There were 133 clear days, 99 days with rain or snow, and 123 cloudy days. The temperature ranged six decrees below 3 zero on January 25th, to ninety-six degrees above zero on August 17th. The average yearly temperature was 50.6 degrees. The last killing frost in the spring occurred May 1st, and the first killing frost in autumn, October 13th. The year 1922, with the exception of one (1921) was the warmest recorded since 1883 when the records were started. The prevailing direction of wind W8S northeast. Lorain County is out of the path of seasonal storms, and blizzards are of rare occurrence. Geology: Lorain County is on© portion of the Erie basin which in the near future will need a satisfactory solution ofits interesting problems in drainage and sewage disposal. Its plane surface sloping gently downward from the south to the cliff at the margin of Lake Erie on the north is an area of youthful drainage characterized by narrow steep- sided valleys, tapid streams, end large undrained areas marked by local swamp3 and muck beds. Three rivers drain this area; Blaok River and its tributaries, near the center dissecting the major portion of the county, with the Vermillion River taking in a smaller area in the western portion, and the west branch of Rocky River draining the eastern portion. The lowest rocks underlying the whole of Lorain County belong to the Devonian formation, which occupies about the middle portion of the geological scale. They consist of soft shales with occasional thin beds of limestone. The total thickness of these shale deposits is several hundred feet, and they are evidently composed of sediment which settled on the bottom of a deep sea, for the particles are exceedingly fine, and the fossils both of plants and animals are marine. The shales 4 are made up of clay and carbonaceous matter. The top member of these shales is of a red color which can be easily detected. It has a thickness of about 100 feet, Waverlv sandstone overlies the shal ell deposits. A post-glacial shore line was formed all across the state of Ohio at about 200 feet above the level of the lake at present. A 150-ft. ridge is well shown all across Lorain County, and is known under the name of Middle or Center Ridge. It enters the county at the northeast corner of Ridgeville and is followed by the main travelled road to Elyria, where for a space it is interrupted by the valley of the Black River. It begins again in the northwest corner of Elyria Township and runs north to within two miles of Lorain, The three parallel ridges south of the lake are separated by level areas, which were lake bottoms during the successive stages of the recession of the ice. In these depressions occur the accumulations of vegetable materials called muck beds. Elyria on the Middle Ridge is 150 feet above the lake and 730 feet above tide. To the sanitary engineer this combination of mantle rock and under- lying strata offers several interesting problems, for the clay permits but very slow percolation of water and the shale is practically im- pervious. The sand and gravel ridges offer rapid drainage possibilities, the sand and gravel lenses form natural cisterns, the muck beds natural sponges, while water passes readily through and along the seams of the sandstone but with more difficulty in the sandy shales. Population: The population of Elyria was 20,474 at the 1920 census, as con- trasted with 14,825 in 1910 and 8,791 in 1900, The estimated population for July, 1922, was 21,929. Almost three-quarters of the people are 5 native white, while somewhat over one-quarter 8re foreign-born white, including Polish and Italians; there is also a small negro population. Other Information about the town: The city is a thriving manufacturing center and is exoeriencing a rapid growth. Three of the most important industries are The Elyria Iron and Steel Company, the Fay Stocking Company, and the Harshaw-Fuller-Goodwin Chemical Company. 6 ORGANIZATION OF THE HEALTH DEPARTMENT The members of the Health Department of the oitv are aopointed by the mayor, who is figurative president of the department, They include a Health Commissioner, who at present is Dr. G. E. French, a Sanitary Officer, a Food and Dairy Inspector, a City Chemist, two distriot physicians, and two public health nurses. The nurses are appointed for an indefinite period of time, the duration depending on the capability shown and the desires of the mayor. The duty of the Health Commissioner is the general administration of the activities of the Department. The Sanitary Officer has oharge of the actual machinery of the public health work, investigates sanitary conditions of the city, and controls the use of medicines in public health work. The duties of the Food Inspector and of the City Chemist are implied in their official titles. The two di3triot physicians and the public health nurses work under the direction of the Health Commissioner. The nurses hold two clinics for children every week and are thus enabled to keep in touch with the poorer families of the city, These clinics have been establiahed quite recent- ly and are as vet rather poorly attended. The organization of the Health Department seems to be quite adequate for the needs of the city. The annual budget of the Health Department is $10,940, The appropriations from the Public Health Fund for the fiscal half year ending on June 30, 1921 were as follows: General Administration Salary of Commissioner *- $900.00 Secretary to Health Commissioner -—•*»* — 300.00 Incidentals —— 50.00 Stationery — —— — —-——— 25.00 Legal Advertizing —25.00 7 Sanitary Salary of Sanitary Officer $900.00 Medical Supplies — ——-—--— 250,00 Incidentals 50,00 Total $1200.00 Food Inspection Salary of Inspector —- $660,00 Expenses of Inspector 60,00 Incidentals — 50,00 Tots! 770.00 Chemist Salary of Chemist — --$1050,00 Incidentals — 100.00 Total 1150.00 District Physicians Pay of Physicians ----- -- $150,00 150,00 Public Health Nurse Nurse's Salary $900,00 900,00 GRAND TOTAL PUBLIC HEALTH FUND - - $5470.00 Additional appropriation for maintenance of nurse's car 300.00 8 WATER Elyria is located on a ridge 150 feet above Lake Erie, at the confluence of the East and West Branches of the Black River, and is about 8 miles south of Lake Erie. The two branches have their con- fluence in the north central section of the city. The Black River drains the city, running north in a narrow and deep valley with pre- cipitous sides, and follows a meandering course, eventually discharg- ing into lake Erie in the city of Lorain. The water supply of the city is not derived from this river, because it is polluted by sewage from the city and by industrial wastes from several manufacturing plants • The city is provided with a public water supply of municipal ownership which is obtained from Lake Erie and purified by means of a filtration plant of the gravity rapid sand filter type. Improvements in the supply in the way of enlargement of the pumping station and filter plant in the amount of about $1,000,000 were completed in Movember, 1922, and the plant has been in operation since that time. The water works are situated on the shore of Lake Erie two miles west of Lorain. A low service pump brings the water from the lake to the purifi- cation plant, and thence a high service pump forces the water to Elyria under 125 pounds pressure. The raw water intake pipe is 20 inches in diameter and extends 1500 feet out. The lake water is polluted by the Black River and by sewage from the towns of Lorain and Vermillion, which are located along the lake shore. Preliminary to filtration the water is treated with a coagulant, either alum or lime and iron. After filtration the water is directly 9 by means of chlorine gas, which is allowed to bubble through the water in the amount of 1 to 2 lbs. per 1,000,000 gals, of water. The plant has a maximum capacity of 8,000,000 gallons per day. The average daily output to Elyria and to the small town of Amherst (population 2000) is 4,000,000 gallons. Water Report by City Chemist, June 11, 1923: Turbidity Alkalinity Color Raw Applied Raw Filtered Raw Filtered Total Phenol 30 20 100 85 0 20 5 A thirty day test from March 10th to April 10th, 1923, W8S made of the efficiency of the filtration plant in removing bacteria. In raw water the average bacterial count at 37° C, was 160 colonies per c,c. In the filtered water the average was 8 colonies per c.c. The average percentage of removal for the thirty days was an excellent result for a rapid filtration plant, although not quite equal to the 99# efficiency of the slow sand filters. There are no public wells in Elyria and very few nrivate wells except on the outskirts of the city. 10 SEWAGE The problem of sewage dispose! in this city assumed interesting proportions in the soring of 1923, when an investigation was oarried out by the State Department of Health, after complaints had been lodged with that Deoartment by qualified electors of Elyris township and by the Board of Trustees of Elyria Township to the effect that the City of Elyria, the Elyria Iron and Steel Company, the Fay Stock- ing Company, and the Harshaw-Fuller Goodwin Company, with the indus- trial plants located within the City of Elyria, were oermitting sewage (including chemical and industrial wastes) to be discharged into Blaok River and were thereby oreating a public nuisance detrimental to health and comfort. Except the area between the two branches of the Black River, the City of Elyria is sewered completely on the separate plan. The area mentioned constitutes the older section of the city which was provided with combined sewers prior to 1904, Thi3 area also includes the busi- ness district of the city* Intercepting sewers have been installed to collect the dry weather flow from the majority of these combined sewers. The sanitary sewerage system is divided into two parts, one including the area west of Black River in the drainage basin of the West Branch, and the other, the east side of the river. The west area is served by a 30-inch trunk sewer which discharges into the river about 2700 feet north of the confluence of the two branches. The area tributary to this system is 2,230 acres and includes 20,0 miles of sanitary sewers ranging in size from 6 inches to 30 inches. There sre three storm water overflows in the West Branch which have no connection to the sanitary sewerage system; some of these serve areas which are 11 too lew to drain to the existing system, end pumping would be required. There ere some industriel wastes discharged into the westerly system, the most pronounced being those from the Columbia Steel Company, which contain acid iron wastes from the piokling process. The easterly system is served by a 36-inch outfall sewer and outlet located direotly across the river from the westerly outlet. This outlet serves an area of 2,240 acres and has a total of 29.3 miles of sewer ranging f-om 6 inches to 36 inches in size. This easterly system provides an outlet for the intercepting sewer serving the combined sewers which drain toward the East Branch. There are seven storm water overflows into this stream serving sanitary sewerage system. There is a total sewer mileage in the city of 66,1 miles, of which 49.3 are sanitary sewers, 12,0 miles 8re combined sewers, and 4,8 miles are storm sewers. The sewer records show that 2,623 sewer connections have beer- made since 1907, This figure is low, as it does not include connec- tions to the old combined sewer system prior to 1907, of which there are no records. The percentage of dwellings not provided with sewer connections is stated to be quite low, and it is estimated that in the neighborhood of 16,000 persons are connected to the sewerage system. In addition to these, there are quite a few private sewer outlets into the two branches of the Black River. There are no means of estimating the sewage flow reaching the river from the city. The water consumption is around 3,000,000 gallons daily# Such losses as might occur would easily he made up by the smount of industrial wastes which are added to the sewage, and it is likely that the sewage flow is upwards of 3,000,000 gallons daily. 12 The State investigation disclosed very offensive conditions in the Black River below the City of Elyria. The stream was heavily polluted by the sewage of the city which was discharged into the river at two main outlets in the north section of the corporation. The investigation also disclosed the fact that acid iron wastes from the Elyria Iron and Steel Company had a deleterious effect on the West Branch of the Black River, The stream was discolored red throughout its entire oourse, an evidenoe of the acid wastes, and this was accompanied by almost total absence of dissolved oxygen. This rendered the stream incapable of caring for any organic matter and, therefore, these wastes should be considered as jointly responsible with the sewage for the pollution. The wastes the Fay Stocking Comoany and the Barshaw-Fuller-Goodwin Company being discharged into the East Branch impart a heavy color and render the stream unsightly. This could be prevented by discharge into the city sewerage system. In order to improve conditions, it will ne necessary for the city to install sewer connections and pumping equipment for areas not now- draining to the sewerage system and also to install sewage treatment works, It will also be necessary for the Elyria Iron and Steel Company to improve the quality of the wastes from that plant so ss to cease the pollution of the Black River, Recommendations to the State Director of health by the Chief Sanitary Engineer were followed and orders have been issued to the City of Elyria and to the industrial plants requiring correction of the pollution of Black River. 13 Dissolved Oxygen Determinations at Elyria August 11, 1922 August 16,1922. Temp • Parts per Per cent Temp, Parts per Per cent Time of Million Saturation Million Saturati on Samp. WEST BRANCH 1 27 6,2 77 12-Noon 2 25 6.8 81 27 7.4 92 11-A.M. 3 29 0 0 2-P.M. 4 24 4.6 54 28 2.8 35 2:40-P.M, EAST BRANCH 5 27 10.8 123 29 8.6 110 Ils30-A.ll. 6 27 6.2 77 2;20-P.M. 7 25 1.2 W 29. 4.0 51 2:45-P.M, BLACK RIVER 8 27 6.8 84 28 6.4 81 3:00-P.M. 9 29 0 0 3:30-P.M, 10 29 1.4 18 4:00~P.M, 11 29 7.6 98 10:30-A.M. 12 25 9.4 111 26 4.4 54 10:00-A.M. 30 8.4 110 4:30-P.M. 1. West Branch Over1in Road 2, tt Tl Muasey Avenue 3 , ti IT West Sixth Street 4. tt Tt Confluence 5. East Branch Coonville Road 6. H ti East Fourth Street 7. tl TT Confluence 8. Bla ck River Cascade Park 9. w Tl Stocking Farm, S, Side 10. Tt IT " " N. Side 11. Tl tt Hollis Farm 12. IT Tl Ford Bridge (See numbers on accompanying map) 14 GARBAGE, REFUSE, ASHES. The garbage is collected once a week from private houses by- city wagons, and from hotels and restaurants as often as necessary. It is transported to a rendering plant outside the city. There is one public dump where sanitary material may be taken and disposed of. Refuse and ashes are taken care of by each individual. The Board of Health of the City has issued the following orders providing for the regulation of the care, keeping, collection, and disposal of garbage: - 1, It shall be unlawful for any person to keep or have within bis or her possession in the City of Elyria, any accumulations of garbage in excess of one gallon, unless the same is enclosed in non- leakable, metal garbage cans tightly covered with metal covers so as to exclude the contents from oontact with and contamination by flies, 2, It shall be unlawful for any person transporting garbage through and upon the streets and alleys of Elyria to stop and delay the same in and upon said streets and alleys for a longer time than is necessary for its collection and removal to its place of destination, 3, It shall be unlawful for any person within the City of Elyria to keep, or have upon any lot or premises within his control, within the City of Elyria, any garbage in excess of ten gallons, for a longer period than one hour,unless said garbage is garbage produced from his own residence, blook or place of business, in distinction f’-om garbage produoed by and collected from others, 4, It shall be unlawful for anyone collecting and hauling garbage in the City of Elyria, to drain liquid from the receptacle in which the same is contained, upon any lot or lands within said city, 5, All receptacles for the holding and transportation of garbage within the City of Elyria shall be thoroughly washed as often as once a week to prevent the accumulations on the sides and surfaces therebf, contributing to the breeding of flies. 15 6* Whoever violates any provision of this order, or obstructs or interferes with the execution thereof, or wilfully or illegally omits to obey said order or any of its provisions shall be fined not to exceed one hundred dollars or imprisoned for not to exceed ninety days, but no person shall be imprisoned under this order for the first offence. The provisions for the care and disposal of garbage seem to me to be quite adequate and they are apparently well carried out in that city, but I think that some definite system of disposal of refuse and ashes should be established in order that laxity in this regard may not occur, as it wfcll may if left in the hands of private individuals. T did not, however, notioe any nuisance or signs of uncleanliness in the city resulting from private disposal or lack of disposal. 16 VITAL STATISTICS Death rate 11.3 per 1,000. Infant mortality —— 41 per 1,000 births. The specific death rates were unobtainable, because of the small size of the city* The general desth rates, as received from the Division of Vital Statistics in Columbus, were,for the year 1922, in the State of Ohio, as follows: - Typhoid fever 4.6 per 100,000 population Tuberculosis 72.4 Measles 4.6 Scarlet fever 9,1 The birth and death certificates 8re sent to the Bureau of Vital Statistics at Columbus, Ohio, where they are kept on file. These certificates are valuable for statistical purposes and are so used. The birth certificate is also a legal document. The Bureau of Vital Statistics issues to each mother a certificate, the data for which is taken from the original birth certificate. The morbidity, mortality, and other vital statistics are carefully reported in this city, but I see no reason why these figures should not be recorded and filed in the local Department of Health, as well as in the State Deoartment at Columbus. PLACE OF BIRTH STATE OF OHIO County of Lorain bureau of vital statistics Township of Elyria- certificate of birth Village of QUy Registration District No File No ; .. ® 5C- "Broad- s-t-v Primary Registration District No Registered No -4.th Ward. ci ii ■ . ur (Tf child is not yet named, make FULL NAME OF CHILD AntOfli-O- ‘ supplemental report, as directed Sex of itrn -i Twin, triplet Number in order _ Legit- Date T - • o -r Child Ma±e , or other? of birth 2 i imate? YeS birth JulX..., J.&., 192.J1. I (To be answered only In event of p'ural hlrths) | (Month! (Day) (Year) F|JL~ FATHER = MOTHER name Sebastian Dleli maiden Virginia Candela RESIDENCE RESIDENCE Including P. 0. Address 50 Broad St. 50 Broad St. o°BArr WVlItia AGE AT LAST lo COLOR WVi 1 t ® AGE AT LAST pi OR RACE Wnibe BIRTHDAY _2.Q OR RACE Wm LCt BIRTHDAY fT.J.. — (Years) (Years) BIRTHPLACE Italy BIRTHPLACE Sicily SSSSSSv Tailor I SSwElStStt Housewife number of children born and living Was Prophylactic against Ye*? Number of children born alive Number of children of this Ophthalmia Neonatorum USed? including « mother living, including o (On request. Prophylactic and literature furnished free by this child (if born alive). 1 this child (If born alive) jd OHIO STATE BOARD OF HEALTH ) CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE * I hereby certify that I attended the birth of this child born to ... Virginl&...I)l.e.li and that the (Mother’s Name) —■ *• ?■»•«■»" “ ...a-. T.,.....hunts-, m,.d, — 1 e*°.V 8llo,,,d »nafec this return. A stillborn f Date 7//l£ / ion , Address .4. .Jiiddle...Ave....Elyria Given name added from a supplemental report 192 MIDWIFE Filed 192 REGISTRAR REGISTRAR o-V- y r„r*— r/rfs fs a r'ermanenr /record /V. B. —incase of more than one child at a birth, a SEPARATE RETURN must be made for each, and the number of each child, in order of birth, stated TO REGISTER A CHILD’S BIRTH MAY SAVE ITS LIFE, HEALTH, LIBERTY OR PROPERTY To Physicians, Midwives and Registrars: This Birth Certificate is valuable not only for statistical purposes, but it is a LEGAL DOCUMENT and as such every care should be used to get data exact. The Bureau of Vital Statistics is issuing to each mother a certificate, the data for which is taken from this original. Some common errors which compel the Bureau to write for additional information are: 1. Misspelled name. 2. Incorrect date of birth. 3. Failure to give maiden name of mother. 4. Statement as to legitimacy. 5. Ages of parents. 6. Number of children born, and number now living. 7. Whether born alive, or stillborn. 8. Failure to write legibly, and with unfading ink. Certificate of Informant This is to certify that I furnished the Statistical Particulars re- lating to the father and mother of the child whose birth is recorded on the other side of this certificate and that the information given is true to the best of my knowledge and belief. (Signed) (Address) (Relationship, if any, to child). Dated , 192 N. B. VVFIl'F PEAINET WITH UNFADING INK—THIS IS A PERMANENT RECORD. Every item ° should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS of °OC(yLTPAOF °EATH in plain terms’ 80 that h may be Properly classified. Exact statement ot OCCUPATION xs very important. See instructions on back of certificate. BUREAU OF VITAL STATISTICS STATE OF OHIO County XiQ-Fain Registration District No File No Township.... Elyria Primary Registration District No Registered No or Village No , St., Ward (If death occured in a hospital or institution, give its name instead of street and number) or City of 2 FULL NAME GO-14-l-€ -John&OFt (a) Residence. No .4.2L.W.G.C..t St., ...2ndward (Usual place of abode) . (If nonresident give city or town and State) Length of residence incity or town where death occurred 2 yrs- Amos. P, ds. How long in ll.S., if of foreign birth? yrs. mos. ds. PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH 3 SEX 4 COLOR OR RACE S'li&teuS’lSri) 16 DATE OF DEATH (month, day and year) July 201S23 Female Negro , T, ____ x HEREBY CERTIFY, That I attended deceased from Sa If married, widowed or divorced | r\ 1Qo-z Tii T ** r>-z HUSBAND of UUJL.* W to J-Uiy # > 19-2> (or) WIFE of _ _ t„*» «■ o/m that I last saw h.G.F.-. alive on....JU..wLLy 2.U , > DATE OF BIRTH (month, day, and year) Mfl/pp.Fi * 2 1 and t^iat death occurred, on the date stated above, ®!.r...m. 7 AGE Years i Months Days If than The CAUSE OF DEATH* was as follows: Q i A O 1 day '.'"hrs' c i*r O or min. ; i “ Measles ; ~ 8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work HOR8 (b) General nature of Industry, ' (duration) yrs mos IQ.ds. business, or establishment in _ - . which employed (or employer) CONTRIBUTORY BrOD.CllOpneUDiOD (secondary) r j (c) Name of employer (duration) yrs mos .TT. ds. 18 Where was disease contracted 9 BIRTHPLACE (city or town) ElyPi& if not at place of death? at SCIlOOl (State or country) Ohio. Did an operation precede death? Date of NAME OF FATHER Kphr-fil*! .TohoBOn W“ *h"' “ W 11 BIRTHPLACE OF FATHER (city or town) MaCOIl What test confirmed diagnosis? , .11011© g (State or country) GeOTfila (Signed) M. D. | 12 MAIDEN NAME OF MOTHER LHy Black Jllly !\ Middle AV&. .3 BIRTHPLACE OF MOTHER (city .own) llaCOO IS.'sKEE (State'or country) GeOPgia Suicidal or Homicidal. (See reverse side for additional space.) 14 19 PLACE OF BURIAL, CREMATION, OR DATE OF BURIAL Informant REMOVAL (Address) I Elyria. Ohio. I July P2J125 15 20 UNDERTAKER, License No. ADDRESS Filed ,19 : Registrar 4698 27 Broad St. 1 PLACE OF DEATH CERTIFICATE OF DEATH REMISED DRYTED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association.] coma, eXc., oi ot'\£vc\.*, “Ca.Tv.c.«C \s less definite; avoid use of “Tumor” for malignant neoplasms); Measles; Whooping cough; Chronic val- vular heart disease; Chronic interstitia nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds.; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as “Asthenia,” “Anaemia” (merely symptomatic), “Atrophy,” “Collapse,” “Coma,” “Convulsions,” “Debility” (Congenital,” “Senile,” etc.), “Dropsy,” “Exhaustion,” “Heart failure,” “Haemorr- hage,” “Inanition,” “Marasmus,” “Old age,” “Shock,” “Uraemia,” “Weakness,” etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as “Puerperal septichaemia ,” “Puerperal peritonitis,” etc. State cause for which surgical operation was under- taken. For violent deaths state means of injury and qualify as accidental, suicidal, or homicidal, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train—accident; Revolver wound of head—homicide; Poisoned by carbolic acid—probably suicide. The nature of the injury, as fracture of skull, and conse- quences (e. g., sepsis, tetanus) may be stated under the head of “Contributory.” (Recommendations on state- ment of cause of death approved by Committee on Nomenclature of the American Medical Association.) Note — Individual offices may add to above list of undesirable terms and refuse to accept certificates containing them. Thus the form in use in New York City states: “Certificates will be returned for additional information which give any of the fol- lowing diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, haemorrhage, gan- grene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis, pyaemia, septichaemia, tetanus.” But gen- eral adoption of the minimum list suggested will work vast im- provement, and its scope can be extended at a later date. 11—3184 Statement of occupation. —Precise statement of oc- cupation is very important, so that the relative health- fulness of various pursuits can be known. The ques- tion applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is neces- sary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return “Laborer,” “Foreman,” “Manager,” “Dealer,” etc., without more precise specifications, as Day laborer, Farm laborer, Laborer—Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, House- work, or At home, and children, not gainfully employ- ed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, House- maid, etc. If the occupation has been changed or given up on account of the disease; causing death, state oc- cupation at beginning of illness. If retired from busi- ness, that fact may be indicated thus : Farmer (retired, 6 yrs.). For persons who have no occupation what- ever, write None. Statement of cause of death.—Name, first, the dis- ease causing death (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is “Epidemic cere- brospinal meningitis”); Diphtheria (avoid use of “Croup”) ; Typhoid fever (never report “Typhoid pneumonia”) ; Lobar pneumonia; Bronchopneumonia (“Pneumonia,” unqualified, is indefinite) ; Tuberculosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN. 17 MILK The milk supply of Elyria comes from about sixty farms, which are located in the countryside surrounding the city. Most of these are small farms with few cows, except for the large Forest View Farm, which is very well managed and is provided with the most modern equipment. The farm visited was that of A. M.Johnston, situated on the West Ridge three miles from Elyria. The herd of this farmer included twelve cows, all tuberculin-tested; it was a so-oalled ’’accredited" herd, i.e., one in which there had been five negative tuberculin tests on each cow. The cows appeared healthy; the stable, wash room, and milk room were clean, well-designed, and apparently operated ,under the most sanitary conditions, I gave the establishment a score-card rating of 94.5. The farm supplied 35 gallons of ’’inspected’’ milk daily to a dairy in Elyria; the milk was carried in sanitary cans on a trailer behind a Ford car. One-fifth of the milk supply of Elyria is pasteurized by heating to 140° F. for 30 minutes, followed by immediate cooling to 40° F, The Board of Health orders that pasteurized milk shall not contain in exoess of 60,000 bacteria per c.c, when delivered. Four-fifths of the milk supply is "inspected"; this milk is not pasteurized, but comes under the following ruling of the Board of Health: - "Only milk which is produced and handled under the rules and regulations of the Board of Health and only after the Board is assured that it comes from cows free from disease and tuberculosis, as determined by the tuberculin test once a year and a physical examination by a 18 qualified veterinarian and that it is oroduced and handled by employees free frar disease or exposure thereto, as determined by i a qualified physician by medical inspection and under sanitary conditions such that it will reach the ultimate consumer fresh and unadulterated and with not more than 40,000 living bacteria ner cubic centimeter or any pathogenic baoteria whatsoever, may be sold in the City of Elyria without being pasteurized." The Tattersall Dairy in Elyria, which was visited, was small but clean and well-designed. It was equipped with a modern Dasteuriza- tion plant and automatic bottling and capping machines, so that no hands touched the milk from the time it reached the dairy until it was delivered to customers. The bottles were cleaned by running them through alkalinized water at 80° - 100° F, then through clear water at 160°, and finally through steam. The milk contained 3.6 per cent of butter fat. ORDERS of the BOARD of HEALTH of the CITY OF ELYRIA OHIO Regulating the Production, Sale and Care of Milk Effective April 1922 Providing for the Regulation of the Production, Sale and Care of Milk in the City of Elyria, Ohio. RESOLUTION shall in addition to the above, state the route of his shipments. Section 8. Any dairyman, milk deal- er or other person, upon application to to the Health Office for a permit to sell or deliver milk shall file a sworn statement giving his name and address, the number of cows he owns or has charge of, the average amount of milk (estimated) which he sells each day, the names, addresses and license num- bers of all persons from whom he buys milk, the average amount of milk (estimated) which he buys from them each day. Section 9. The Board will not issue any permit unless it is satisfied, after inspection, with the cleanly and sani- tary conditions of the stables, cows, wagons, store or place of business of the applicant therefor, and with all the utensils used by him, from which his milk or cream is obtained; and that the food given the cows is pure and whole- some, and that all persons engaged in the care and handling of the milk are free from any contagious diseases and that said persons use due cleanliness in their work. Section 10. All permits must be signed by the applicant and when re- ceived by the Food Inspector, shall be placed on file and the name of such applicant shall be entered in a book of registration kept for such purpose. As soon as possible within sixty days, after an application is received at the Health Office for a permit to sell milk, the Sanitary Police or Food Inspector shall visit the dairy or place of busi- ness of such applicant and make such observation and gather such informa- tion as to enable the Board to satisfy Be it Resolved by the Board of Health of the City of Elyria, State of Ohio: Section 1. No person shall bring into the City of Elyria for sale or shall sell or ofifer for sale any milk or cream without a permit from the Board of Health. Section 2. No person shall bring into the City of Elyria for sale or shall sell or offer for sale, any milk which has been obtained from any milk dealer, dairyman or other person not having a permit issued by the Board of Health. Section 3. A fee of fifty cents shall be charged for each permit and the same shall be credited to the sanitary fund. Section 4. Permits shall be renewed annually in January. The applicant must state his name, residence, post office address and location of his busi- ness place or places. Section 5. The applicant must state the number of cows from which milk is obtained for sale, and the number of quarts (estimated) sold daily. Section 6. ' If the applicant buys part or all of his milk supply, the names and addresses of all persons from whom he obtains milk or cream, and the quantity (estimated) shall be stated. Section 7. If the applicant be a ship- per of milk or cream into the City he themselves of the sanitary condition of his dairy. Should the applicant live at such distance from the City of Elyria as to make it impracticable for the Food Inspector to visit such dairy premises, such applicant shall furnish evidence to the Board of the sanitary condition of his dairy. Section 11. If after issuing a permit to sell milk and cream, the Board of Health shall become satisfied that the provisions of the sanitary code are be- ing violated, it will at once revoke the permit issued to such person or per- sons and no new permit issued until all unsanitary conditions have been recti- fied, and all other provisions of the sanitary code are complied with. Any one doing business under a permit from the Board of Health, who shall change the location of such busi- ness without notifying the health office of such change, shall have such permit revoked at the option of the Health Board or Food Inspector. Milk Tickets Section 12. If dairymen or other persons offering milk for sale use tickets as representations of value, these tickets must be in coupon form and must be destroyed after once using. The Stable and Surroundings. Section 13. The surroundings to the stable must be kept in a sanitary con- dition. Cows must not be allowed to stand in manure and filth. Section 13A. All parts of stable except floors and windows must be painted in some light color, or white- washed at least twice a year. Stables must be kept free from dirt, dust, cob- webs and odor. Manure and urine must be removed from stable at least once daily and if not taken to field daily, must be removed at least thirty feet, from stable and placed where cows cannot get into it. Manure must not be thrown out through stable windows. No other animals or fowls will be allowed in the cow stables. Floors must not be laid less than one foot higher than outside surface level, so that good drainage can be procured: floors must, be constructed of asphalt, concrete, brick, with surface flushed with cement, or of wood, water tight. They must be kept in good repair at all times and also constructed with a gutter not less than twelve (12) inches wide and six (6) inches deep; a four (4) foot walk back of cows and not less than a twenty (20) inch manger in front. Ceiling must be dust tight and kept free from cobwebs. Light At least three (3) square feet of unobstructed window glass must be provided per cow and equally distri- buted; at least five hundred (500) cubic feet of space must be provided per cow; windows must be left partially open if no other method of ventila- tion is provided for. Stable yard must be well drained and kept clean. Cows Section 14. Cows must be kept clean. Manure, litter, etc., must not be allowed to become caked and dried on them; they must not be allowed to stand in nor wade through filth and manure. The bedding must be kept sweet and clean at all times and of sufficient quantity to protect the animals from filth. Feed and Water. Section 15. Cows must be fed on clean dry feed, neither decayed, mouldy, dusty, distillery waste nor starch waste. If malt is fed, it must not be fed when sour. Pure running spring water or ordin- ary well water, free from contamina- tion, pumped into clean tanks must be provided. Milkers. Section 16. The milkers must thoroughly wash and wipe their hands and the cow’s udders before they be- gin milking. They must not use pails, cans, strainers, etc., unless they have been thoroughly washed in hot water and soap, or hot water and soda and afterwards sterilized with boiling water or steam. Care must be taken that the seams of the vessels are thoroughly cleaned with a brush. They must refrain from milking or handling milk in any way, when in themselves or their families there is even a suspicion of any contagious or infectious disease, such as smallpox, scarlet fever, diptheria, typhoid, tuberculosis or the like. Handling the Milk. Section 17. Immediately after milk-. ing, the milk shall be removed from the stable into a milk room, screened from flies and other insects, aerated and cooled to at least 60 degrees tem- perature, and put into perfectly clean bottles and cans. Dairymen who use both bottles and cans in delivering milk shall not fill bottles while on their delivery route. Section 17a. The milk house or milk room must pot be attached by doorway to any other building, and must be at least twenty-five (25) feet from any cesspool or vault. Must be provided with a tight floor, either con- crete or wood, laid so as to provide drainage. It must be kept clean at all times and free, from any odor. Care of Cans and Bottles Section 18. All cans or bottles used in the distribution of milk must be thoroughly cleaned either by hot water and soap or hot water and soda or other alkalies, rinsed and sterilized by boiling water or steam before they are again used as receptacles for milk. Extreme care must be exercised in cleaning the faucets to cans by use of a brush. Milk cans must be washed and cleaned immediately after the milk or cream is emptied therefrom and in no case shall the washing be later than twenty-four (24) hours after the re- ceipt of can. No person shall use a milk bottle for other than milk purposes. Section 19. No person shall bring into the City for sale, or shall sell or offer for sale any milk, (a) Containing less than 12 per cent of milk solids. (b) Containing more than 88 per cent of water or fluids. (c Containing less than 3 per cent of milk fats. (d) Having a specific gravity of less than one and twenty-nine thousandths (1.029). (e) Containing any dirt, foreign matter or sediment. (f) Containing any boracic or sal- icylic acid, formalin or other foreign chemicals. (g) Containing any pathogenic bac- teria. (h) Containing bacteria of any kind more than five hundred thousand (500,000) per cubic centimeter. (i) Drawn from any cow having a communicable disease or showing clinical symptoms, of tuberculosis, or from a herd which contains any dis- eased cattle, or are afflicted with or have been exposed to any communi- cable disease. (j) Drawn from any cow within 15 days before and 12 days after par- turition. (k) Drawn from any cow which has been fed on garbage, refuse, swill, moist distillery waste or other im- proper food. (l) Having a temperature or which has been kept at a temperature higher than fifty-five (55) degrees Farenheit. (m) Which has existed or has been kept under conditions contrary to the provisions of this Code. (n) No milk shall be kept, sold or offered for sale, drawn from cows suffering with sore and inflamed ud- ders and teats, or from cows dis- eased. Provided that the subdivisions a, b, c and d of this section shall not ap- ply to milk sold under the name of skimmed milk. Skimmed Milk Section 20 (a). No person shall bring into the City of Elyria for sale or sell, or offer for sale, milk from which the cream has been removed, either in part or in whole, unless sold as skimmed milk and unless plainly marked “Skimmed Milk.” (b) No person shall bring into the city for sale or sell or offer for sale any so-called skimmed milk contain- ing less than nine and three-tenths (9 3-10) per cent of milk solids Milk Delivery Wagons Section 21 (a). No one shall use any vehicle for the delivery of milk in the City of Elyria which has not painted thereon in legible Roman letters and on both sides of the ve- hicle in a conspicuous place, the name and location of his dairy and the number of his permit. (b) Every person using in the sale or distribution of milk a delivery wagon or other vehicle, shall keep the same at all times in a cleanly con- dition and free from any substance to contaminate or injure the purity of the milk and from May 1st to Oct- tober 1st shall have and keep over such delivery wagon or other vehicle, a covering of canvas or other mater- ial so arranged as to thoroughly pro- tect the contents thereof from the rays and heat of the sun. Original Container Section 22. No person or milk dealer shall sell, deliver, sell or offer to sell, or keep for sale in stores, milk or cream, in quantities less than one gallon unless delivered and kept in the original package or container. (Exception—Original packages of not greater capacity than one quart may be broken for sale if the unsold portion is kept in the original package, proper- ly closed.) The compartment where milk or cream is kept shall be separ- ated by an impervious water and odor proof partition from all other compart- ments, of any ice box or refrigerator, neither milk nor cream shall be kept in the same compartment with any. other foodstuffs except butter and cheese. Contagious Disease Section 23 (a). Should scarlet fever, smallpox, diptheria, typhoid fever, tu- berculosis or other dangerous or in- fectious disease occur in the family of any dairyman or among any of his employees, or in any house in which milk is kept for sale or in the family or among the employees of any person who ships milk into the City of Elyria for sale, such dairyman, such venders or shippers of milk shall immediately notify the health officer of the facts of the case, and the health officer shall at once investigate and order the sale of such milk stopped, or sold under such regulations as he thinks proper. (b) Should dairymen, venders, or shippers of milk fail to notify the health officer when contagious diseases exist in their families or in the families of their employees, or who, after such information is given the health officer, fail to obey his directions, the milk and dairy inspector shall seize and destroy all milk sent into the city by such persons, and he shall, when acting in good faith be held harmless in damages therefor, in any suit or de- mands made. (c) In delivering milk to families in which there exists any of the above named contagious or infectious disease the dairyman shall not enter, neither shall he permit any of his milk bottles or vessels to be taken into such houses, but shall pour such milk as each family wishes into vessels fur- nished by such family, or if bottles are left must remain until quarantine has been raised, then sterilized by order of sanitary policeman. Milk Inspectors. Section 24. The milk or dairy inspec- tor, the health officer or any person authorized by the Board of Health, may examine all dairy herds, utensils for handling, milk, of all dairymen or other persons engaged in selling or shipping for sale, milk or cream to the city of Elyria. These inspectors shall have power to open any can, vessel or package containing milk or cream, whether sealed (locked) or otherwise, and take samples of the milk or cream for testing or analysis; and if, upon inspection, the milk or cream is found to be filthy, or the can or other con- tainers are in an unclean condition, the said inspector may then and there condemn the milk or cream as deemed by him to be filthy and pour the con- tents of such bottles, vessels or pack- ages upon the ground forthwith, and he shall, if done in good faith, be held harmless in damages therefor, in any suit or demand made. Cream Section 25. No person shall bring into the City of Elyria for sale or shall sell or offer for sale any cream unless such cream is produced from milk which must conform to all rules and regulations of this code, relating to milk, nor unless such cream be kept at or below fifty (50) degrees F., free from foreign substances, and shall not contain more than 1,000,000 bacteria per cubic centimeter and shall not con- tain less than sixteen (16) per cent of milk fat. Rules Governing the Inspection of Milk by the Dairy Inspectors in Connection with Score Card Section 26. Rule 1. The dairies of all persons shipping milk for sale in Elyria will be inspected and rated according to the following provisions, (a) COWS Condition and Healthfulness—Per- fect Score 10. (Two points will be deducted if cows are in poor flesh, and eight points if not tuberculosis tested.) Cleanliness—Perfect Score, 5. (All cows clean, 5; good, 4; fair, 3; medium, 2; poor, 1; bad, 0.) (b) STABLES Construction of floors—Perfect Score, 5. (If the floor is of cement or stone flag in good repair, 5; brick or matched board in good repair, 4; ordinary wooden floor in good repair, 3; one- half wood and one-half cement, 3; half wood, cement or other material and half dirt, 2; any material in poor repair, 1; if no floor allow 0. Cleanliness—Perfect Score, 5. (If stables are perfectly clean, in- cluding windows, walls and ceiling, 5; deduction will be in proportion to dirt, cobwebs, etc.). Light—Perfect Score, 5. (For four square feet per cow, 5 points will be given; three square feet per cow, 4; two square feet per cow, 3; one square foot per cow, 2; six square inches per cow, 1; less than six square inches per cow, 0). Ventilation—Perfect Score, 4. (If ventilation is good 4 points will be given; deductions will be made in proportion to lack of ventilation, if all windows are closed and no attempt at ventilation is made 0 will be allowed. Cubic Space Per Cow—Perfect Score, 3. (If five hundred cubic feet per cow, 3 points will be allowed; less than five hundred and over four hundred cubic feet per cow, 2; less than four hund- red and over three hundred cubic feet per cow, 1; less than three hundred cubic feet per cow 0 will be allowed. Removal of Manure—Perfect Score, 2. (If manure is hauled to the fields daily 2 points will be allowed; removed thirty feet from stable, 1; otherwise 0). Stable Yard—Perfect Score 1. (If stable yard is in good condition and well drained 1 point will be allow- ed; otherwise, 0). (c) WATER SUPPLY For Cows—Perfect Score, 5. (If cows are supplied with pure run- ning water, 5 points will be allowed; running well water from windmill or otherwise, 4; ordinary well water, 3; pond or other muddy water, 0). For Milk House—Perfect Score, 5. (If milk house is supplied with pure clean running water,, 5 points will be allowed; pure well water, 3; otherwise, 0). (d) MILK HOUSE Construction—Perfect Score 5. (If the floor is of cement or tight boards well drained, if the walls and ceiling are sound and the milk house is well lighted and ventilated and not attached by doorway to any other building, 5 points will be given; if the milk house is in a barn or house 2 points will be deducted and deduc- tions will be made in proportion to deficiency in construction, light and repair. If there is no milk house 0 will be allowed. Equipment—Perfect Score, 5. (If hot water is installed for clean- ing utensils, 1 point will be given; proper pails used for no other pur- pose, 1; proper strainers, 1; areator, 1; soda or washing powder for utensils, 1; 1 point will be deducted for absence of any). Cleanliness of Interior—Perfect Score, 5. (If the interior is absolutely clean, including windows, 5 points will be allowed; good condition, 4; medium 3; fair, 2; poor, 1; bad, 0). Care and Cleanliness of Utensils— Perfect Score, 5. (If all utensils are thoroughly clean and kept on suitable racks, 5 points will be allowed; 2 points will be de- ducted for absence of rack; deductions will be made for rusty utensils or careless washing. The lighting and ventilating of the milk house together with its location in regard to other buildings will be taken into consider- ation). (e) MILKERS AND MILKING Health of Attendants—Perfect Score 5. (If attendants are all in a healthy condition, 5 points will be allowed; if any of the attendants are sick or a contagious disease exists in the family, 0 will be allowed). Cleanliness of Milking—Perfect Score, 10. (If milking is done in special suits for milking, with clean, dry hands and with special attention to cleanliness of udders and teats before milking, 10 points will be given; all of the above except special suits, 7; in addition 4 points will be deducted for unclean teats or udder and 3 points for dirty hands; if wet milking will be done, 0 will be allowed). (f) HANDLING THE MILK Prompt Cooling—Perfect Score, 5. (If milk is poured from pail into cool receptacles as soon as milked, 5 points will be given; if poured into can and can is put into cold water as soon as filled, 2; otherwise, 0). Efficient Cooling—Perfect Score, 5. (If milk reaches a temperature of 60 degrees before being shipped, 5 points will be given; a temperature of 65 degrees, 3; a temperature of 70 degrees, 1; above 70 degrees 0 will be allowed). Storing at Low Temperature—Per- fect Score, 5. (If milk is stored at a temperature of 60 degrees, 5 points will be given; a temperature of 70 degrees, 1; above 70 degrees, 0 will be allowed). Rule 2. All dairies will be scored by the inspector upon a card in the follow- ing form: Owner or lessee of farm Town State Number of Cows Quarts of milk produced daily Is product sold at wholesale or retail? If shipped to dealer give name and address Permit No Date of Inspection. 192.. Perfect COWS Score Condition (2), Health (8) 10 Cleanliness 5 STABLES Construction of floors 5 Cleanliness 5 Light 5 Ventilation 4 Cubic space per cow ...._ 3 Removal of manure (2), Cleanliness and drainage, stable yard (l) ... 3 WATER SUPPLY For cows 5 For milk house 5 MILK HOUSE Construction 5 Equipment 5 Cleanliness 5 Care and cleanliness of utensils.... 5 Is house detached? Lighted? Ventilated? MILKERS AND MILKING Health of attendants 5 Cleanliness of milking 10 HANDLING THE MILK Prompt cooling 5 Efficient cooling 5 Storing at low temperature 5 Total score 100 Sanitary conditions are Excellent.... Good Medium Poor Suggestions by Inspector Milk or cream from dairies falling be- low forty-five (45) in the rating as indi- cated above, will be excluded from sale in Fdyria during 1911-12, milk or cream from dairies falling below fifty (50) will be excluded from sale in Elyria during 1913, and thereafter. Penalty Section 27. Whoever violates any provision of the above resolution, or obstructs or interferes with the execu- tion thereof, of wilfully or illegally omits to obey any provision of said resolution,shall be fined not to exceed One Hundred Dollars, or imprisoned for not to exceed ninety days, or both; but no person shall be imprisoned hereunder for the first offense, and the prosecution shall always be as and for a first offense, unless the affidavit upon which the prosecution is instituted con- tains the allegation that the offense is a second or repeated offense. Section 28. This resolution to be in force and effect from and after Octo- ber 1st, 1911. Passed July 28, 1911. THOMAS A. CONWAY, Mayor. G. E. FRENCH, Clerk Board of Health. LEGAL NOTICE ORDER OF THE MUNICIPAL BOARD OF HEALTH, CITY OF ELYRIA, COUNTY OF LORAIN, STATE OF OHIO, FURTHER REGULATING THE PRODUC- TION, SALE, CARE AND HAND- LING OF MILK IN SAID CITY. BE IT ORDAINED by the Board of Health, City of Elyria, County of Lorain, State of Ohio: SECTION 1. That any person offering milk for sale from a wagon or other vehicle within the City of Elyria, Ohio, shall be required to have painted on both sides of said wagon, in a conspicuous place, the name in full of the owner thereof, the Board of Health permit number of his dairy and the exact location of the same; if a street, the number, and if a road or pike, the name all in letters each not less than two (2) inches in height. SECTION 2. Every person, firm or corporation offering milk for sale in the City of Elyria from a wagon, or using any vehicle or conveyance to deliver same, shall at all times keep the same in clean and sanitary con- dition and free from any substance which might contaminate or injure the purity of the milk. SECTION 3. All vehicles or wagons used in the transportation, sale, or delivery of milk or milk pro- ducts for sale in the City of Elyria, shall be covered wagons or vehicles, so that the milk or milk products will be protected from the rays and heat of the sun and the dust and dirt or other contamination which might collect on the containers. SECTION 4. No person, firm or corporation and no servant or agent of such person, firm, or corporation shall give, furnish, sell, offer for sale or deliver in the City of Elyria, any milk, skimmed milk, or cream in quantities of less than one gallon unless the same shall be kept offered for sale, exposed for sale, or given away, sold or delivered in sanitary transparent glass bottles or such other containers or receptacles of a similar character as may be approved by this board, the same to be sealed with a suitable cap or stopper. SECTION 5. That said bottle or containers shall be sealed immediately after the filling of same which filling and sealing shall be done only in a milk-house or creamery, the sanitary conditions of which has been approved by this board. SECTION 6. It shall be unlawful for any person, firm or corporation to sell, offer for sale, give away, or have in his possession for the purpose of selling or giving away to any person or persons in the City of Elyria, any milk, skimmed milk, or cream which has riot been clarified or filtered and pasteurized as hereinafter required. SECTION 7. Milk, cream or skim- med milk shall be deemed pasteurized within the meaning of this regulation if the same has been uniformly heated to a temperature of between 140 de- grees and 146 degrees Fahrenheit, and maintained uniformly at this tempera- ture for thirty (30) minutes. The milk or milk products thus pasteur- ized shall be cooled immediately to a temperature of 45 degrees Fahrenheit or leSs. All parts of the apparatus used for filtering, clarifying, pasteurizing and cooling shall be so constructed that they are readily accessible for inspec- tion, cleansing and sterlizing, and shall be inspected and approved by the Dairy Inspector at least once during each calendar month. SECTION 8, The above described pasteurization shall be required in all cases unless those wherein milk or its by-products are obtained from dairies under the direct control of the Board of Health, and this exception shall apply only to products known as cer- tified and inspected. SECTION 9. Pasteurized milk shall not contain in excess of 60,000 bacteria per cubic centimeter when delivered. SECTION 10. Upon its appealing to the Board of Health that any per- son is violating Sections 6, 7, 8 or 9 hereof, his permit to vend milk or its products shall be immediately revoked. SECTION 11. Only milk which is produced and handled under the rules and regulations of the Board of Health and only after the Board is assured that it comes from cows free from disease and tuberculosis, as de- termined by the tuberculin test once a year and a physical examination by a qualified veterinarian and that it is produced and handled by employees free from disease or exposure thereto, as determined by a qualified physician by medical inspection and under sani- tary conditions such that it will reach the ultimate consumer fresh and un- adulterated and with not more than 40,000 living bacteria per cubic centi- meter or any pathogenic bacteria whatsoever, may be sold in the City of Elyria without being pasteurized. SECTION 12. No person shall bring into the City or shall sell or offer for sale in the City of Elyria any milk. (a) containing more than 88.5 per cent of water or fluids. (b) containing less than 11.5 per cent of milk solids. (c) containing less than 3 per cent of milk fats. (d) having a specific gravity of less than 1.029. (e) containing any boracic or salicy- lic acid, formaldehyde, or other -preservative or foreign chemicals. (f) from which any part of the cream has been removed, unless plainly labelled, skimmed milk. (g) containing any pathogenic bac- teria. (h) drawn from any cow having a communicable disease or from a herd which contains any diseased cattle or cattle exposed to any communicable disease, or from a herd the attendants of which are affected with or have been expos- ed to any communicable disease. (i) drawn from any cow within 15 days before parturition or 6 days after parturition, or from any cow suffering from retained placenta. (j) drawn from any cow which has been fed on moist distillery waste, decomposed garbage or other im- proper food. (k) having a temperature of or which has been kept at a temperature higher than 60 degrees Fahren- heit or lower than 34 degrees Fahrenheit, if on examination or test it shall be found to exceed 60 degrees Fahrenheit it shall be confiscated, forfeited and immedi- ately destroyed by, or under the direction of the Food and Dairy Inspector. SECTION 13. Any person who shall violate or interfere with the execution or wilfully or illegally omits or fails to comply with any of the provisions of this order, shall be guilty of a, misdemeanor ,and on conviction thereof shall be fined not to exceed One Hundred ($100.00)' Dollars and the costs of prosecution, or imprisoned not more than sixty days (60) days, or both but no person shall be imprisoned hereunder for the first offense and the prosecution shall always be as and for a first offense, unless the affidavit upon which the prosecution is instituted contains the allegation that the offense is a second or repeated offense. SECTION 14. All resolutions, or- ders or regulations, or parts thereof, in conflict with this order hereby repealed. SECTION 15. This order shall take affect and be in force and effect from and after the earliest period allowed by law. Passed July 28, 1916. JAMES H. LEONARD, President Pro Tern. G. E. FRENCH, Clerk Board of Health. Order of the Municipal Board of Health, City of Elyria, County of Lorain, State of Ohio. Further Regu- lating the Production, Sale Handling of Milk in Said City. Be it Ordered by the Board of Health, City of Elyria, County of Lorain, State of Ohio: REGULATIONS GOVERNING THE PRODUCTION AND DISTRIBUTION OF IN- SPECTED MILK Section 1. No milk shall be sold in the City of Elyria, Ohio, after March 1, 1916, unless it has been pasteurized in accordance with previous sections, except such milk as is of the grade hereinafter defined as inspected milk. Inspected milk: (a) The farms on which inspected milk is produced must score at least 80 points in an official score of the Health Department. (b) The milk must be drawn into small topped milk buckets. (c) The milk shall not contain more than 40,000 bacteria per cubic centimeter at the time of delivery to the consumer. In case a count of bacteria exceeding 40,000 is found, daily counts shall be made and if nor- mal counts are not restored immedi- ately the certificate shall be suspended and the sections requiring pasteuriza- tion complied with. (d) The bottles or other contain- ers in which the milk is stored or de- livered shall be marked, with plain black letters, “inspected milk,” in ad- dition to the name, of the producer or dealer. (e) No person shall be permitted to work or be employed on such farms unless and until it shall have been determined to the satisfaction of the Board of Health of the City of Elyria, Ohio, that said person is not a typhoid, tuberculosis, or diphtheria carrier. All persons so employed shall first obtain a certificate signed by the Health Officer of the Board of Health of the City of Elyria, Ohio, certifying that they have been examined by a physi- cian approved by the said Board of Health of the City of Elyria, Ohio, and that they are not typhoid, tuber- culosis, or diphtheria carriers. (f) The hands of the milkers shall be washed with soap and water and carefully dried on a clean towel im- mediately before milking. The prac- tice of moistening the hands with milk is forbidden. (g) Clean overalls, jumper and cap shall be worn during milking. They shall be used for no other purpose and when not in use they shall be kept clean in a place protected from dust and dirt. (h) Milk from all cows shall be excluded for a period of 45 days be- fore and 7 days after parturition. (i) If milk from any cow is bloody and stringy or of an unnatural appear- ance, the milk from that cow shall be rejected and the cow isolated from the herd until the cause of such abnormal appearance has been determined and removed, special attention being paid in the meantime to possible injuries. If dirt gets into the pail the milk shall be discarded and the pail washed be- fore it is used again. (j The milk shall be cooled im- mediately after milking to a tempera- ture not higher than 50 degrees F. until delivered to the consumer. (k) The milk after being cooled shall be bottled and immediately sealed in a manner satisfactory to the Board of Health of the City of Elyria, Ohio, but such seal shall include a sterile hood which completely covers the lip of the bottle. (l) The dairy building shall be pro- vided with approved apparatus for the cleansing and sterilizing of all utensils used in milk production. All bottles and utensils used shall be thoroughly cleansed by hot water and sal soda, or an equally pure agent and rinsed until the cleaning water is entirely re- moved, then exposed to live steam or boiling water at least 20 minutes, and then kept inverted in a place free from dust and other contaminating material, until used. (m) In transit the milk packages shall be kept free from dust and dirt. The wagon trays and crates shall be kept scrupulously clean; no bottles shall be collected from houses in which communicable disease prevail, unless a separate wagon is used and undei conditions prescribed by the Board of Health of the City of Elyria, Ohio. All inspected milk shall reach the consumer within 20 hours after milk ing. (n) The herd shall be free from- tuberculosis as shown by the proper application of the tuberculin test. The test shall be applied in accordance with the rules and regulations of the U. S. Government and the reactors shall be removed immediately from the herd and the farm. No new animals shall be admitted to the herd without first having passed a satis- factory tuberculin test, made by an approved veternarian in accordance with the rules and regulations men- tioned. Immediately after the tuber- culin test has been made the cow stable and exercising yards shall be disin- fected in accordance with the rules and regulations of the U. S. Govern- ment. Tuberculin tests shall be made annually. o) The fat standard for Inspected milk shall not be less than 3.5% butter fat. (p) Same as Section 13 of the pasteurization order. Issued By ELYRIA BOARD OF HEALTH. SECTION 3. All vehicles or wag ons used In ithe transportation, sale, or delivery of milk or milk products for sale in the City of Elyria, shall be covered wagons or vehicles, so that the milk or milk products will be protected from the rays and heat of the sun and the dust and dirt or other contamination which might collect on the containers. SECTION 4. No person, firm, or corporation and no servant or agent of sudh person, firm, or corporation shall' give, furnish, sell, offer for sale or deliver in the Oiity of Elyria, any milk, skimmed milk, or cream in quantities of less than one gallon un- less the same shall be kept offered for sale, exposed for sale, or given away, sold or delivered In sanitary transparent glass bottles or such oth- er containers or receptacles of a similar character as may be approv- ed by this board, the same to be sealed with a suitable cap or stopper. STCTtON 5. That said botttle or containers shall be sealed immediate- ly after the filling of same which filling and sealing shall be done only in a milk-house or creamery, the sanitary conditions of wihicth has been approved by this board. SECTION 6. It shall be unlawful for any person, firm or corporation to sell, offer for sale, give away, or have in his possession for the purpose of selling or giving away to any per- son or persons in the City of Elyria, any milk, skimmed milk, or cream which has not been clarified or filt- ered and pasteurized as hereinafter required. LEGAL NOTICE. ORDER OF THE BOARD OF HEALTH, CITY ELYRIA, COUNTY OF L° STATE OF OHIO, FURTHER ULATINO THE PRODUCTION, SA ‘ CARE AND HANDLING OF M[L IN SAID CITY. BE IT ORDAINED by .the Board Health, City of Elyria, County oi rain, State of Ohio: SECTION 1. That any Per&01* 0*1 ferering milk for sale from a . 0f or other vehicle within the Li Elyria, Ohio, shall’ be requi i(1 have painted on both sides ° wagon, in a conspicuous Plac®’» tiie name in full of the owner ther > Board of Health permit numo« q{ his dairy and the exact loc,eir and the same; iif a street, the numjet_ if a road or pike ,the name £tw0 (2) ters each net less than inches in iheighit. SECTION 2. Every in corporation offering nailk ! 0r the City ot Elyria from e%ga°nc'e to using any vehicle or rum . deliver same, shall’ at all times i the same in a clean and sanit ,■ . dition and free from any su o which might contaminate or the purity of the milk. SECTION 7. Milk, cream or skim- med milk shall (be deemed pasteurized within tihe meaning of this regulation 4f ,th|e same has been uniformly heat- ed to a temperature of between 140 degrees and 14 6 degrees Fahrenheit, and maintained uniformly at this tem- perature for thirty (30) minutes. The milk or milk products thus pasteur- ized shall be cooled immediately to a temperature of 45 degrees Fahren- heit oh less. 411 parts of the apparatus used for filtering, clarifying, pasteurizing and cooling shall be so constructed that they are readily accessible for in- spection, cleansing and sterilizing, and shall be inspeted and approved by the Dairy Inspector at least once during each calendar month. SECTION 8. The above described pasteurization shall be required in al cases unless those wherein milk or its by-products are obtained from dairies under the direct control of the Board of Health, and this exception shall apply only to products known as cer- tified and inspected. SECTION 9. Pasteurized milk shall not contain in excess of 60,- 000 bacteria p/er cubic centimeter when delivered. SECTION 10. Upon its appearing to the Board of Health that any per- son is violating Sections 6, 7, 8 or 9 hereof, his permit to vend milk or its products shall be immediately re- voked. SECTION 11. Only milk which is produced and 'handled under the rules and regulations of the Board of Health and only after the Board is assured itihat it comes from cows free from disease and tuberculosis, as determined by the tuberculin test once a year -an a .physical examina- tion by a qualified veterinarian and that it is produced and handled by employees free from disease or ex- posure thereto, as determined by a qualified physician by medical in- spection and under sanitary con- ditions such that it will reach the ul- timate consumer fresh and unadult- erated and with not more than 4 0,- tOO living bacteria per cubic centi- meter or any pathogenic bacteria whatsoever, may be sol'd in the City o. Elyria without being pasteurized. SECTION 12. No person shall Dnns City or shall sell or oner for sale in the City of Elyria any milk. f“_ and for a first offense, nnlosstbea lidavit upon which the PyosecuUon is instituted, contains the allegation t the offense is a second or repeated o fense. Section 7. All orders and regula- tions and parts of orders and regula Cons inconsistent with the of this order shall be and the are hereby repealed. Section 8. This order shall he m force and effect from and after earliest period allowed by law. Adopted July 18th, 1916. JAMES H. LEONARD President Pro Tera- G E. FRENCH Cl’erh Board of Healtn ■public ,sewer, in the City of Elyria, any dead animal or parts of the same liable to putrefaction and disinteg- ration. Section 4. It shall be a misdeamor subjecting th e offender to the penal- ties hereinafter provided, to deposit within the City of Elyria, upon the lands of another, any dead animal without the consent of the owner or occupyer of said land. Section 5. It shall he a misdeamor, subjecting the offender to the penal- ties hereinafter provided, to bury within any dot or lands in the City ol Elyria, any dead animal or animal products weighing over tw'enty-five pounds. Section G. It shall be a misdeamor subjecting the offender to the penal- ties hereinafter provided, to bury within any lot or lands in the City of Elyria, any animal or animal pro- ducts unless the same is thoroughly covered with at least two feet of earth. Section 7. It shall be a misdeam- or subjecting the offender to the pen- alties herenafter provided, to haul or transport through or over the public streets and alleys of The City of Elyria, any dead animals, un- less the same ,is completely covered so as to protect the same from view and from the action of flies. Section 8. It shall be a misdeamor subjecting the offender to the penal- ties hereinafter provided, for any person hauling or transporting dead animal's and animal refuse, through and over the streets and alleys of the City of Elyria, to stop or delay the LEGAL NOTICE. AN ORDER of THF POARD OF HEAI.TH OF THE CITY OF ELY- RIA, LORAIN COUNTY', OHIO, TO REGULATE THE TRANSPOR- TATION AND DISPOSAL, OF THE CARCASSES OF ANIMALS OTHER THAN GAME AND ANIMALS SLAUGHTERED FOR FOOD. Be at Ordained by The Board of liealth of The City of Elyria, Lorain County, Ohio, that: Section 1. Rendering plants and fertilizer plants ,for the rendering and treatment of refuse animal products, within the City of Elyria, are hereby declared to be nuisances, and are pro- hibited. Section 2. It shall be unlawful for any person within the City of Elyria, to have, or to allow to be on premises owned or conibiolled by such person, within the City of Elyria for a period longer than five hours, any dead ani- mals, weighing over twenty-five pounds, other than game arid animals slaughtered for food. Section 3. It shall be a misdeamor subjecting the offender to the penal- ties hereinafter provided, to deposit, except in receptacles for its immedi- ate removal, upon or within the streets, alleys or public parks, or with- in any river, creek, ditch ,stream or public water course or within any same (for a longer period than i necessary for its immediate transfe to its place of destination. Section 9. Whoever violates an provision of this order, or obstruct or interferes with the execution theb of, or wilfully or illegally omits 11 obey said order or any of its provit ions islhall be fined not to exceed on hundred dollars or imprisoned for nc ito exceed ninety days or both; but n person sihall be imprisoned under thi ordler for the first offense, and tt prosecution shall' always be as an for a first offense, unless the affidav upon which the prosecution is ins! tuted, contains the allegation tin the offense is a second or repeats offense. Section 10. All orders and regut tions and parts of orders and reguli tions inconsistent with the provi ions of this order shall be and tl same are hereby repealed. Secton 11. This order shall be > force and effect from and after tl earliest period allowed by law. Adopted July ISth, 191G. JAMES H. LEONARD, President Pro Tem. G. E. FRENCH Clerk Board of Heal* 19 SANITARY NUISANCES The Health Commissioner volunteered the information that the city could complain of no great sanitary nuisances. There are no offensive odors, except in the Black River below the outlets of industrial wastes and the city sewers. Dust and rubbish offer no problem, and the large public dump for sanitary material is so located as to offer no ground for complaint. Flies seem to be few in number, and no special measures are required to combat them. Mosquitoes are not in evidence, although the muck beds in the vicinity of the city would seem to offer excellent breeding places. Rats and vermin are not complained of. There are very few stable3 in the city, so that manure is not a sanitary nuisance. There are no factories in the city proper, so that smoke is not a con- stant nuisance; smoke from the steel mills looated on the southern edge of the city is occasionally blown through the city with a south wind, but as the prevailing wind is northeast, this occurs infrequently. The only unnecessary noise which I noted in the city was the shrill grinding sound of the wheels of the interurban cars as they rounded the corners of the Public Park in the heart of the town; otherwise the city was only too quiet. Piggeries are nowhere to be found. The definition of "nuisance” in the Ohio Public Health Manual for 1920 i3 as follows: "Whoever erects, continues, uses or maintains a building, struoture or place for the exercise of a trade, employment or business, or for the keeping or feeding of an animal which, by occasioning noxious exhalations or noisome or of en3ive smells, becomes injurious to the health, comfort or property of individuals or of the public, or causes or suffers offal, filth or noisome substances to be 20 collected or remain in any place to the damage of others or of the public, or unlawfully obstructs or impedes the passage of a navigable river, harbor or collection of water, or corrupts or renders unwholesome or impure, a watercourse, stream or water, or unlawfully diverts such watercourse from its natural course or state to the injury or prejudice of others, shall be fined not more than five hun- dred dollars.’' A notice to abate nuisance is presented to an offender, and on his failure to have the nuisance removed in the required time, legal proceedings are instituted against him. The form of this notice is inserted in this reoort. NOTICE TO ABATE NUISANCE NOTICE TO ABATE NUISANCE Office of THE BOARD OF HEALTH Office of The Board of Health No Elyria, O., 191__ To Owner, Agent, or Occupant of Premises, situated No. Street Order to abate within days Nuisance arising from By Order of THE BOARD OF HEALTH. Clerk Served 191__, by No Elyria, Ohio, 191 To Owner, Agent or Occupant of Premises situated1 No Street You are hereby notified and required to have removed within days from the date of the service hereof, a certain NUISANCE on the above described prop- erty, arising from which nuisance is prejudicial to the public health. On failure to do and perform which, legal proceedings will be instituted against you. By Order of THE BOARD OF HEALTH. Served 191 — Py , Health Officer 21 INDUSTRIAL HYGIENE The Elyria Iron end Steel Compenv is located in the southern pert of the oity directly west of the West Branch of the Black River and is engaged in the manufacture of steel oipe and strips. The laborers the and Italians, who, together with their families, are housed in small dwellings owned by the company# The manager informed me that there were no important industrial poisons or hazards connected with the work; there was no dust problem and rarely was there a case of heat exhaustion# Occasionally workmen received severe burns from contact with red hot metal. The company did not have a phvsician on duty at the plant, and any accident oases were sent in to Elyria physicians. The only problem was that of the disposal of industrial wastes, which were polluting the Black River. In the manufacture of the pipe, there is a considerable amount of piokling and galvanizing. The pickling room of the pipe mill contains one acid tank and two rinsing tanks, one tank for caustio soda treatment and the galvanizing tank. The galvanizing is accomplished by the electrolytic method. The aoid tank which contains by far the stronger liquid is discharged weekly, usually at noon on Saturday, The rin3e tanks are discharged twice daily. A measure of the amount of pickling done in a day is indicated by the consumption of 1B00 pounds of acid oer day. The strip mill also includes pickling, the equipment including one acid tank and two rinse tanks; the acid tank is discharged weekly, while the flow through the rinse tanks is continuous; these are emptied completely several times a week. The consumption of aoid at this mill i3 1200 pounds oer day. 22 The problem of the discharge of these wastes into the Black Kiver has been studied by the State, and measures have been taken to correct it. 23 HOUSING A visit was made to two of the houses furnished by the "Elyria Iron and Steel Comoany f°r their employees* They were small two- story houses, clean and well-cared for* One housewife informed me that her children slept two in a bed, a rather undesirable, but not uncommon condition. Rubbish was thrown out into the back yards of these houses and collected once or twice a year. This is an unwholesome condition and should be better cared for. The ventilating system of a new bank building was investigated; it was of a modern suction type, and, according to the .ignitor, served its puroo3e well# Air entered a room near the ceiling on one side and made its exit near the floor on the opposite side. This is not the best method of ventilation. 24 INFECTIOUS DISEASES Notification of the following diseases is required by the Health Department: Class "A” Chic’-cenoox Diphtheria Influenza Ma la r ia Measles Measles, German Meningitis, epidemic Mumps Paratyphoid fever Pneumonia Poliomyelitis Scarlet fever Smallpox Tuberculosis, all forms Typhoid fever Whooping cougt Class nBw Chanoroid Gonorrhea Syphilis Class "C,f Erysipela s Puerpera1 s eptica emia Diarrhea and enteritis under two years of age C1933 "D" Ophthalmia neonatorum, 9ny inflammation of the eves of the newborn* Class "E" Anthrax Cholera, Asiatic Dysentery Lepr os y Pla gue Rabies, in man Septic sore throat Tetanus Typhus fever Yellow fever 25 Class "F" Any disease or disability contracted as a result of the nature of the person's employment, including the following diseases or disabilities and not excluding others: Anilin poisoning Arsenic poisoning Benzine (gasoline) poisoning Benzol poisoning Bisulphide of carbon poisoning Brass ooisoning Carbon monoxide poisoning Compressed-air illness Dinitrobenzine ooisoning Lead poisoning Mercury poisoning Naphtha poisoning Natural gas poisoning Phosphorus ooisoning Turpentine poisoning Wood alcohol poisoning The following quarantine regulations are quoted from the Ohio Publio Health Manual for 1920: "In time of epidemic or threatened epidemic, or when a dangerous communicable disease is unusually prevalent, the board of health after a personal investigation by the members or executive offioer thereof to establish the facts in the case, and not otherwise, may impose a quarantine on vessels, railroads, stages, or other public or private vehicles, converving persons, baggage 0r freight, or used for such purpose. It may make and enforce such rules and regulations as such board deems wise and necessary for the oroteotion of the health of the people of the community or state, but the running of any train or car on any steam or eleotrio railroad,or of steamboats, vessels or other public conveyances shall not be prohibited. A true copy of such quarantine rules and regulations adopted by such board of health, shall be immediately furnished by it to the state hoard of health, and there- after no change shall be made except by the order of the state board of health or by the local board to meet a new and sudden emergency. "When a case of smallpox, cholera,plague, yellow fever, typhus fever, diphtheria, membranous croup, scarlet fever or other communicable diseases declared by the board of health or state department of health to be qua rant insble is reported within its jurisdiction, the board of health shall at once cause to be placed in a conspicuous position on 26 the house wherein such disease occurs a quarantine oard having printed on it in large letters the name of the disease within, and prohibit entrance to or exit from such house without written permission from the board of health, or shall enforce such restrictive measures as may be prescribed by the state department of health. Ho person shall remove, mar, deface, or destroy such quarantine oard, which shall remain in place until after the patient has been removed from such house, or has recovered and is no longer capable of communicating the disease, and the house 9nd the contents thereof have been properly purified and disinfected by the board of health or treated in such manner as may be prescribed by the state department of health, "Baoh physician attending a person affected with any such disease shall use such precautionary measures to prevent the spread of the disease as is required by the board of health. Ho oerson quarantined by a board of health on account of having a contagious disease or for for having been exposed thereto, shall leave such quarantined house or place without the written permission of the board of health, and where other inmates of such house hsve been exposed to and are liable to become ill of any such diseases, for such period," The annual report of the Sanitary Police of Elyria for 1922 shows that the following number of cases were quarantined during that year: Scarlet fever 36 Diphtheria 1R Smallpox 5 Measles •••••••••••«,•• 33 Chickenpox 107 Whooping-oough 83 Sixty-eight houses were fumigated during 1922. The spread of tuberculosis is prevented by sending the recognized incipient cases to the State Hospital at Mt. Vernon; tre advanced oases are 3ent to the State Hospital at Columbus. Children with active tuberculosis are excluded from school until they oresent a certificate of recovery oountersigned by the Health Commissioner. Children who have been exposed to tuberculosis are not required to stay out of school• 27 Venereal diseases are, of course, reportable in this city, but oases are very rarely reported by physicians. Laxity in this regard should not be tolerated by the Health Commissioner, and stringent measures should be taken to ensure immediate notification of venereal oases. Data as to the prevalence of these diseases was not obtainable at the office of the Health Commissioner. IIoarb of Healtf) Citp of Clpria, ®f)to TJ’o Superintendent ‘Public Schools: Re-admit to SchooL Address Street, who has been absent on account of Contagion. Date 192 Health Commissioner City of Clpria ©fjio DEPARTMENT OF HEALTH This is to certify that_ ree from all contagion. HEALTH OFFICER, ELYRIA, OHIO. Date of Report Disease or Suspected Disability Disease Date of Onset (Probable) Patient’s Name —- - Age: Yrs Mos Days Home Address Street or P. O — Sex Color City or Village Township - County Present Address Report made by. Address CD1—500M—11-19—880 7-29—106,1 State Department of Health division of tuberculosis Hospital Case Number H. D. Case Number 4857 8*47 NOTIFICATION OF DISCHARGE Ohio State Sanatorium. 3-28-23 (Date of Discharge) (Name of Institution) Name of patient >^U0* ®eO A# Age. .??.. Sex mal9 Street and No. 233 Sixteenth city Slyria County. Lorain (Home Address) RELEASED LEFT VOLUNTARILY DISOBEDIENCE TRANSFERRED ARRESTED apparently ARRESTED quiescent IMPROVEDX UNIMPROVED DIED Cause of discharge *Condition putum POSITIVE X NEGATIVE *Condition on admission—Incipient Mod. Advanced jBfiX Advanced...x Acute Miliary Patient is returning to ... Elyria City Lorain County State Street and address £#£33 Sixii.0QIltitl Patient expects to be employed by (Name of Employer) At. (Give occupation and trade process) Supported in institution by Conduct during residence in institution (Name of Medical Superintendent or other Responsible Officer). Remarks: *lJse classification of the National Tuberculosis Association. 5M—TB3—1-14-22 Hospital Case Number State Department of Health Division of Tuberculosis H. D. Case Number 11474 NOTIFICATION OF ADMISSION National Military Home 3-E7-E3 (Name of Institution) (Date of Admission) SINGLE MARRIED X WIDOWED DIVORCED SEPARATED Name of patient Qsoar Konnenhaj?er Age £8 Sex male Street and No. H.H. #1 City or Village Slyria Township County Lorain How Long At Above Address 2 CIOS* Is Above Address Home yQS Rooming House Home Address Nativity: State Ohio Foreign Color white Type of Disease How long resident of Ohio lifQ County TUBERCULOSIS OF LUNGS LARYNX Last Occupation Machinist YEAR ENTERED YEAR LEFT lymph glands peritoneum BONES Industry YEAR LEFT Former Occupation YEAR ENTERED intestines SKIN Industry Last Employer Address Where Employed When Sickness Developed Where When Previous Sanatorium Treatment Family; No. Persons Tuberculosis: in father, mother, brothers, sisters, husband, wife, children, associates (State whether Living or Dead) Name of Physician (Name of Medical Superintendent or other Responsible Officer). 28 SCHOOLS St. Mary’s Parochial School in Elyria includes a primary school and a high school. There are 400 pupils in the nrimary department and 100 in the high sohool. Architecturally, the school is not of the most modern type, but is well lighted and heated. Ventilation is effected by means of the windows and transoms. The school rooms are high and capacious, 8nd there is no overorowding; the desk seats are adjustable. In connection with the school there is an ample playground, where the daily recess offers the children an opportunity to exercise in the fresh air. There is no lunch room in the sohool and most of the children return to their homes for lunch or bring a liprht meal with them. The school is provided with 12 toilets for girls and 6 toilets for boys. In this school the pupils do not receive regular systematic medical examinations by a physician. The sisters at the school informed me that the children are thoroughly examined once a year by a nurse and that the weight of each one is taken and recorded by 8 nurse every month. Children are excluded from school fo*- the following diseases: Chiclcenpox Diphtheria Me9s3.es Meningitis, epidemic Poliomyelitis, scute Scsriet fever Sms 1lpox Trachoma Tuberculosis Typhoid fever Whooping cough Fa vus Tinea Impetigo contagiosa Scabies Mumps 29 All cases of communicable diseases are readmitted to sohool only upon certificates from the Health Commissioner, Children who live in the house with the patient are excluded while the patient is quarantined and for the additional period specified in the State Sanitary Code* 30 MISCELLANEOUS The markets and provision stores of the city are operated under satisfactory conditions. The Board of Health has issued specific regulations regarding the sale of vegetables, fruit, bread, pastry, and confections. Meat is brought into the city from Cleveland, where it has been previously inspected; it is, however, again inspected in the markets. The Board of Health requires that "all meat brought into market must be placed within the stall or stalls of the owner of such meat, snd all meat must be removed from the market at the close of each market day, unless the meat is placed within cold storage." There are no slaughter houses in Elyria, as the slaughter of animals within the city is prohibited by the Board of Health. The Food Inspector makes frequent inspections of the markets, stores, bake shops, restaurants, and bottling works, investigates complaints, makes arrests, and confiscates improper food material. Below is the annual report of the Food Inspector for the year 1922: InsDectiona Milk Plants 113 Groceries 721 Restaurants 248 Bake shops 142 Meat Markets 541 Confectionary stores 192 Bottling works 19 Farms 172 Complaints investigated 134 Arrests and convictions 5 (a) For selling adulterated maple syrup 1 (b) ” " misrepresented fish 1 (c) " " adulterated hamburger 1 (d) M n " vinegar 1 (e) " " n butter 1 Confiscations Fish 424 Ihs Fruit & vegetables 63 bu. Sausage 177 lbs Beef 715 " Oysters 7 gal. Maple syrup 11 qts Liver 75 lbs Melons 143 Berries 38 qts Salad dressing 5 dz, bottles Hamburg 45 lbs Mutton 110 n Chickens 45 " Veal 125 " A RESOLUTION. OF THE BOARD OF HEALTH OF THE CITY OF ELYRIA REGARDING THE MANNER OF KEEPING, EXPOS- ING, DISPLAYING AND OFFERING FOR SALE FRUITS, BERRIES AND VEGETABLES IN THE CITY OF ELY- RIA. Section 1. It shall and is hereby made the duty of the Health Officer and the Food Inspector of the City of Elyria, to inspect all fruits, berries and vegetables, which may be offered for sale within the City of Elyria, and to cause the arrest and punishment of any person, firm or corporation, who shall violate any pre- vision of this regulation. The Health Officer and Food Inspector are each authorized and directed to im- mediately confiscate and destroy any such fruits, berries and vegetables when offered for sale in violation of this reg- ulation. Section 2. No person shall bring into the City of Elyria for sale, or shall sell or offer for sale any decayed or damaged fruits, berries or vegetables. Section 3. All fruits, berries and vege- tables offered for sale in the City of Elyria whether kept, exposed or displayed in a store room, upon the walk or street in front of a store or upon a vehicle in a street of said city, and which fruits, berries and vegetables are generally or frequently eaten while in their raw state or condition, shall be so covered or screened as to be protected from dust are! flies ar.d from contact with animals and the same shall not be exposed or displayed in any street, public place in- side or in front of any store room, or from anv vehicle in a street, unless the receptacle containing said fruits, berries or vegetables is elevated at least two feet above* the sidewalk, platform, floor or landing upon which said receptacle rests. While being brought into the city of Elyria for sale or to be offered for sale, all fruits, berries and vegetables shall be covered or screened from dust and dies. In delivering to a purchaser within the City of Elyria, any fruits, berries or vegetables, the seller shall keep the same covered or screened from dust anil flies. . ... Section 4. All persons exposing or dis- playing for sale within the City of Elyria, anv fruits, berries or vegetables shall protect the same from being handled bv the public hv means or suitable covers or screens. „ , - ■ Section 5. No person shall keep toi sale or offer for sale in the City of Ely- ria, any fruits, berries or vegetables, which are generally or frequently eaten while in their raw state or condition, while contained in any box, basket or other receptacle, which has one or more times been used as a receptacle for fruits berries or vegetables. All receptacles containing fruits, berries or vegetables, displaved or offered for sale in the Citv of Elyria, shall free from decayed matter of every kind. Section 6. Anv person round guilty ot vidlation of any of the provisions of this regulation shall be fined in any sum not exceeding One Hundred Dollars (SI00.00), or imprisoned in the city jail for a term not exceeding Sixty (60) days, or both, but no person shall he impris- oned for anv violation of this regulation for his first offense, and the prosecution shall always be as and for a first of- fense, unless the affidavit upon which the prosecution is instituted, contains the allegation that the offense is a sec- ond or reneated offense. Section 7. This resolution shall be in force and effect from and after the ear- liest neriod allowed by law. Passed Mav 30. 1913. JAMES H. LEONARD, Pres. Pro Tern. GEORGE E. FRENCH, Clerk. AN ORDER T0^r?R*OHIBIT THE SLAUGHTER OF ANIMALS IN THE CITY OF ELYRIA, OHIO, AND THE PEN- ALTY THEREFOR. BE IT ORDERED by the Board of Health of the City of Elyria, Ohio: SECTION 1. That it shall be un- lawful for any person, firm, or cor- poration to slaughter any animal or animals within the City of Elyria Ohio, and the slaughtering of any such animal or animals within said' city is hereby declared to be a nuis- ance. SECTION 2. That whoever vio- lates any provision of this Order, or any order or regulation of the Board of Health made in pursuance there- of, or obstructs or interferes with the execution of such order, or wil- fully or illegally omits to obey such order, shall be fined not to exceed one hundred dollars, or imprisoned for not to exceed ninety days, or both but no person shall be imprisoned under this section for the first of- fense, and the prosecution shall al- ways ne as and for a first offense unless the uffiduvit upon which the prosecution is instituted contains the allegation that the offense is a sec- ond or repeated offense. SECTION 3. That if such viola- tion, obstruction, interference, or omission be by a firm or corporation any member, officer, or agent of such firm or corporation permitting such violation shall be subject to fine or imprisonment, or both, as heretofore provided. SECTION 4. That if within ten days after any person, firm or cor- poration has been guilty of violating any of the provisions of this order and the nuisance caused by such person, firm or corporation, as a re- sult thereof, has not been abated to the satisfaction of the Board of Health, the board may cause such nuisance to be abated and certify the costs and expenses to the Auditor of Lorain County for collection with the taxes of such person, firm, or corpor- ation. SECTION 5. That all orders or regulations or parts of orders and regulations inconsistent with the provisions of this order, shall be and the same are herebv reDealerl SECTION 6. This order shail take effect and be in force from and after the earliest period allowed by law Adoptde February 22, 1918. ASAPH R. JONES Mayor G. E. FRENCH, Clerk of Board of Health. 3-1-8 31 The following report of the City Chemist for the year 1922 will give some idea of the varied duties of that official: Number of city water examinations (Chemical and bacteriological) filter plant and Elyria tap water samples 300 Number of well, cistern and soring water examinations . # 29 Asphalt samples tested 36 Milk " " 335 Cream ” ” * * .... 6 Liquor !t " 42 Throat cultures examined 100 Food samples suspected of containing poisons 6 Medicines (suspected poisons) 2 Poison determinations (post-mortem) 2 Swimming pool tests .,••••••• 12 Cheese * * 1 Butter * 20 Sausage 4 Maple syrup * Ice oream 20 Gas * * 1 Honey • • 1 Maple sugar 1 Drugs • • • * 2 Gasoline Hamburg steak 12 Linseed oil 1 Soft drinks *. * * 5 Vinegar * Ice ••••*••.*'••• 3 Lime Sand 1 Coal 1 Salad dressing 1 Chow 1 Dates l Lard * Oils 2 Total The two public health nurses, appointed by the Board of Health, carry on the usual district visits and also hold olinics every week. One orenatal clinic, one babies' welfare clinic, and one tuberculosis clinic are held every week. Thesehave been recently established, and ss yet they have not been well attended, since there is poor oo’ineration 32 between the nurses on the one hand and the families and physicians on the other. The effort on the oart of the nurses is very laudable, and it is to be hoped that a closer rapoort will soon be established. The "Amerioanization Association of Elyria, Ohio" supports a Settlement House in the steel mill district. This house is in charge of a director and her assistant, who are employed by the Association, The Board of Education furnishes a young woman kindergartner, snd other volunteer workers aid in the work. Classes are conducted in kindergarten, sewing, cooking, handcraft, toy-making, dramatics, folk dancing, gym- nasium, English, and citizenship. One clinic, of little account, is held there every week. The House loans books and magazines from its library, treats first aid oases, and assists unemployed to find jobs. This House is supplying a great need among the foreigners of that district. During one year 29,986 was the total attendance at the Settlement House at community meetings, entertainments, lodges, library, lectures, parties, patriotic programs, playground, etc. The Elyria Memorial Hospita, an up-to-date and progressive institution, was founded in 1907. It is located on the corner of East River and Broad Street, in a beautifully landscaped tract of fourteen acres. It has a capacity of 175 beds for the care of diseases in every branch of medicine. Its physical equipment includes complete clinical, microscopical and X-rev laboratories, phvsio -therapy end occupational therapy departments. The Gates Hospital for crippled children, which is able to take care of fifty children, is associated with the Elyria Memorial Hospital. The Hospital hss a nursing school and is affiliated with Western Reserve University in Cleveland. 33 Other institutions and organizations of the city, which are performing important and valuable services are the Y. M. C. A#, Y. W, C. A#, the Associated Charities, the Old Ladies' Home, the Salvation Army, the home Garden Association, and fifteen churohes of all denominations# THE ELYRIA MEMORIAL HOSPITAL 34 GENERAL SUMMARY Elyria, Ohio, is the county seat of Lorain County end is situated about eight miles south of Lake Erie, half-way between Cleveland and Sandusky, The oity has a population of approximately 22,000, a large proportion of which is composed of foreigners, who work as laborers in the many industries of the city. There are 42 diversified indus- tries employing approximately 6,000 men and manufacturing many products. The city is progressive and is experiencing a rapid increase in copula- tion, The business district is well arranged, and there are many beautiful streets and homes in the city. The public health conditions are, on the whole, unusually satisfactory. HeaIth Department: The Board of Health is appointed by the mayor and includes a Health Commissioner, a Sanitary Officer, a Food and Dairy Inspector, a City Chemist, two district physicians, and two public health nurses. The annual budget if $10,940, which seems to be sufficient to cover the needs of the department. Besides his official duties, the Health Commissioner also carries on a private medical practice. The work of the Board is undoubtedly efficient, but T do not think that the effi- ciency is more than commensurate with the size of the budget and with the size of the town. 35 Water: The city is provided with a public water supply of municipal ownership which is obtained from Lake Erie and purified in a gravity rapid sand filtration plant of modern construction. The recently improved and enlarged plant has been in operation since November, 1922. After Infiltration, the water is disinfected with chlorine gas. The average percentage of removal of bacteria is a very orediteble result. The plant has a maximum capacity of 8,000,000 gallons per dsy. The average daily output is 4,000,000 gallons. The City Chemist makes fegular examinations of the water. The water supply of the city deserves nothing but favorable criticism. Sewage: The problem of sewage disposal is the largest arid most important public health problem of the city, Within the last five years com- plaints have been made by citizens and by farmers living below the city along the course of the Black River, that said river was being polluted by sewage from the City of Elyria and by industrial wastes from three large olants, There is no sewage purification plant, and the sewage of the city and of the industrial works is emptied directly into the Black River, whence it is carried to Lake Erie. A recent investigation by the State Sanitary Engineer disclosed very offensive conditions in the river below Elyria, 36 Reoommendstions: (1) The Fay Stocking Company and the Harshaw-Fuller- Goodwin Comoany should discharge their wates into the city sewerage system. (2) The City of Elyria should install sewer connections with pumping equipment for areas not now draining to the sewerage system. (3) The City should install sewage treatment works. (4) The Elyria Iron and Steel Company should improve the quality of its wastes so as to cease the pollution of the Black River. Garbage, Refuse, Ashes: Garbage is collected once a week from private houses by city W8gons, and from hotels and restaurants as often as necessary. It is transported to a rendering plant outside the city. The regulations for the oare and disposal of garbage are well obeyed and enforced. The disposal of refuse and ashes is left in the hands of eaoh individual; this is a lax procedure, and in a city of less civic pride might lead to unsanitary conditions, A more definite system of disposal should be established by the Board of Health, Vital Statistics: The death rate of the city is 11.3 per 1,000, and the infant mortality is 41 per 1,000 births. The vital statistics of this city are. well reported to Columbus, but they are apparently not recorded and filed in the local Health Office, a matter that should be and can be easily remedied. 37 Milk: Four-fifths of the milk iupply is "inspected”, a term correspond- ing to "certified”; it is produced and handled under strict regulation of the Board of Health and must come from tuberculin-tested cows* One-fifth of the city's milk supply is oasteurized• The farm and the dairy which were visited were dean and well managed; if their sanitary condition is any indication of the conditions in other similar establish- ments supplying milk to the city, the inhabitants need fear no soresd of disease from this source* Sanitary Nuisances: The city boasts of greet civic pride, and as a result no nuisances are in evidence# The regulations are strict in this regard and are well enforced. Industrial Hygiene: The Elyria Iron and Steel Company, which is engaged in the manu- facture of steel pipes and strips, has no problems of industrial poison or hazard with which to cope* No physician is on duty at the mill* The only problem is that of the disposal of industrial wastes, which are at present polluting the BlacV River, a nuisance which is detrimental to public health and comfort. The State has investigated the problem and has ordered the Company to correct the condition. The houses of the company employees are in very satisfactory sanitary condition. 38 Infectious Diseases: The spread of communicable diseases is combatted by rigid en- forcement of the regulations for reporting and for quarantine, under the direction of the Sanitary Officer, The following number of cases were quarantined during the year 1922: - Scarlet fever, 36; diphtheria, 13; smallpox, 5; measles, 33; ohickenpox, 107; whooping-cough, 83, Incipient cases of tuberculosis are sent to the State Hospital at Mt. Vernon, while advanced cases are sent to Columbus. Venereal diseases are reportable, but physicians gre very lax in this regard, stringent measures should be taken by the Health Commissioner to ensure the prompt notification of venera1 diseases, so that the cases may be properly controlled during the infectious stages. Schools: There ere eleven public school buildings and three parochial school buildings in the city# The parochial school, which was visited, exhibited very satisfactory sanitary conditions. The pupils, however, should, in my opinion, be examined regularly by a physician and not by a nurse. A.11 cases of communicable diseases are excluded from school and are readmitted only upon certificates from the Health Commissioner. Miscellaneous: The markets, stores, and restaurants of the city are operated under satisfactory sanitary conditions and are subject to frequent inspection by the Food and Dairy Inspector, 39 No slaughtering of animals is permitted within the city. Prenatal, babies' welfare, and tuberculosis clinics are held weekly by the two public health nurses, who have not received satis- factory cooperation from the families and from the physicians of the city. This work, in my estimation, is of great importance to public health, and it should, and undoubtedly will receive better attendance as soon as it is more widely known by the people. The Americanisation Association of Elyria has a settlement house r in the steel mill district and is serving a very useful purpose among the foreign population under the guise of so-called "Americanization". The Elyria Memorial Hospital (175 beds) and the Gates Hospital for Crippled Children (50 beds) are both up-to-date, well equipped institutions, which are closely associated with each other. The hospital and nursing school are affiliated with Western Reserve University in Cleveland.