Appendix 3 - The Michigan State Board Of Health

I served on the Michigan State Board of Health from 1883 to 1919 with an interval of two years. In the State I have always been known as a Democrat, although as I have elsewhere indicated, my politics, both State and national, has fluctuated from time to time. Any one acquainted with the political complexion of Michigan will understand that my appointment on this Board must have been largely in the hands of Republican governors. I have heard those interested in public health work urged to steer clear of party affiliation. I can say that the leading Republicans in Michigan have, for the most part, been above petty polities in all matters pertaining to the health and welfare of the people. My first appointment on this Board was made by a Democrat, Governor Begole. Much good-natured chaff was thrown at this man on the ground that he was not educated. Be this as it may, he was not devoid of either wisdom or wit. In addressing the American Public Health Association at an annual meeting in Detroit, he spoke of physicians coming together for the purpose of limiting the spread of disease and said: “If I should be called upon to address a gathering, of lawyers assembled for the purpose of preventing litigation, I would say with Simeon of old, “Lord, let thy servant depart in peace for mine eyes hath seen thy salvation.’”

At the expiration of my first term, the Republican candidate for Governor, Mr. Luce, was a warm personal friend and coworker in health matters. I went to the polls intending to vote for him but on my appearance at the booth a group of Republicans shouted out that I must vote the Republican ticket or they would see that I would not be reappointed. Angered by their threat, I picked up a straight Democratic ticket the only unscratched ticket I ever voted and deposited it in the box. At the expiration of my term Governor Luce reappointed me and with my commission handed me a protest signed by a number of Republicans in my own ward saving: “Take this and have some fun out of it. I would have reappointed you if every Republican in the county had signed it.” I did have some fun out of it.

One Republican, Governor Bliss, did ask me if I voted for Bryan or McKinley. I told him that I had voted for McKinley. He took up his pen to sign my commission but I held his hand and said: “Governor there is one more question you should ask me. Did I vote for you? I did not.” Laughingly he said: “I did not ask you that question “ and signed the paper. Repeatedly I went before the legislature asking appropriations for the State Board of Health and the university and I never felt the least embarrassment on account of the political party to which I was accredited. Michigan Republicans, at least those with whom I had to deal, regarded a man”s political affiliation as a personal right. Possibly their magnanimity might be accounted for by the fact that during most of this time Democrats in Michigan have been so few that they have been negligible.

The Michigan State Board of Health was fortunate in having for its secretary and executive officer for so many years Dr. Henry B. Baker. I have never known a man more thoroughly devoted to his work than he. To him the health of the people of the state was meat, drink, and raiment. In it he forgot self and every other interest. Moreover his devotion was not blind nor actuated by sentiment but intelligently directed. Dr. Baker deserves high rank among that small group of American pioneers in preventive medicine who set in motion the machinery by which human life has been greatly prolonged and human suffering greatly reduced. The present generation is enjoying the fruits of their labors and should not forget those to whom they owe these blessings.

When the Board was organized by act of the legislature of 1871 kerosene lamps were generally used in the illumination of houses, and frequent explosions destroyed in the twinkling of an eye, as it were both property and lives. Doctors Baker and Kedzie went to work at this problem in a practical and scientific way. They discovered methods of determining the burning and flash points of kerosene and thus enabled the state to exclude from the market dangerous illuminating oils. Then they took up the matter of the resuscitation of the drowned and devised a method which is still superior to all others. For many years this was known as the “Michigan method.” Recently it has been rediscovered by Professor Schafer of Edinburgh and is known under his name. The two methods are practically identical even in detail.

Dr. Baker made an early contribution to the world-old problem of the effect of weather upon disease. He showed that in Michigan at least the death rate from pneumonia goes up as the mercury in the thermometer goes down. This does not mean that this rate is invariably higher in cold than in warm regions, but it does mean that in a given place the pneumonia death rate increases as the temperature falls. Of course, temperature is only one of the factors in the cause and spread of pneumonia. In the early ‘80‘s some one suggested that salted food might be a factor in the causation of pneumonia. Dr. Baker decided to put this theory to a test and asked my assistance. Inasmuch as these experiments have never; been published, I will give a brief summary. We secured six fine monkeys. These were kept for some weeks in an air-tight compartment, all the air entering being passed through sterilized cotton. The temperature of the air in the cage was kept constantly at about 80” F`. The food consisted solely of milk and fruit without addition of salt. Suddenly the animals were transferred to a similar box in which the temperature stood below 10” F., kept there for from two to six hours and returned to the warm box. Not one showed any ill effects. Then they were kept for three weeks in the warm compartment and fed upon milk and fruit heavily salted. Exposure in the cold air was repeated and again without any evidence of pneumonia. Apparently, increase in the salt in the food did not predispose to pneumonia. I should add that these animals did slowly develop arthritis, but the salt in the food probably played no part in this.

The Michigan State Board of Health has been from the first an advisory and not a legislative or mandatory organization. It has sought to educate the people in sanitary matters anti not to enforce its teachings by legal enactments, leaving the latter to the initiative of the people as they advanced in knowledge. The value of isolation and disinfection in the infectious diseases was shown by comparative statistics in communities where these measures were and were not practiced.

Early in its existence the Board asked the legislature for an annual appropriation for the holding of sanitary conventions in different parts of the state. These were held for many years and did much to enlighten the people. The intelligent members of each community in which these conventions were held attended. The audiences were generally small but they made up in quality for what they lacked in numbers. The doctor who did not attend was likely to be faced by embarrassing questions from his patients who did. Lawyers and preachers took an interest in the matter, spread the gospel and prodded their village and city authorities into action. This was many years before the university provided extension lectures. The time was much more propitious for this form of instruction than the present. The automobile, the graphophone, the movie, and the radio were still unknown and even so serious a matter as a talk on public health was a welcome diversion. Besides, now, even public health talks are being overdone and every crank is airing his views and advertising his wares under this title. In my opinion, the Federal Government, the states, universities and certain benefactions are squandering thousands of dollars annually in so-called public health courses, child welfare and health demonstrations. When the Michigan legislature of 1915 appropriated $100,000 for the State Board of Health to use as it saw fit in the combat against tuberculosis wise men from the east hurried to the west to tell us how to spend this money. They were ready to supply us with so many speakers at so much a day to tell the people of Michigan that it had been demonstrated that tuberculosis is a contagious and therefore a preventable disease; that Koch had isolated the causative agent; and that disinfection of the sputum of tuberculous patients should be practiced. The Board thanked these wise men for their altruistic interest in the matter, but informed them that every intelligent man, woman and child in Michigan was already aware of these facts and that the Board would start a traveling clinic through the state to find out about the prevalence of the disease and help the physicians in its recognition and prevention. Because a procedure was wise and beneficial in the “80”s is no proof that it is suitable at the present time.

As I have indicated the Michigan Board, founding its teachings on the unimpeachable world of Villemin in the sixties, began preaching the contagiousness of tuberculosis years before Koch discovered the bacillus. In doing this, quite naturally came an enumeration of the measures necessary for the restriction of the disease. This accounts for the marked fall in the death rate from this disease in the state in the past forty years; so marked has this been that one enthusiastic statistician has been led to predict that the region of the Great Lakes may be the first part of the nation from which tuberculosis will disappear. What we now need above all things for the protection and betterment of the health of the people is the establishment of a health center in every county, consisting of a hospital with a diagnostic laboratory, and the whole under the management of a staff of experts skilled both in preventive and curative medicine. Such a health center should provide an ample library with standard books of reference and current scientific journals. Every progressive city already has such facilities more or less developed but all in progress of growth. When similar conditions are provided for rural communities there will be less need of the cry “Back to the farm.” The lure of country life will call to many and not in vain. The ideal land is that in which each citizen owns his own home and dominates his own affairs, so far as the rights of others are not abridged.

In his desire to educate the people in health matters, Dr. Baker (1895) framed a bill providing for instruction in all public schools in the nature of each infectious disease and the avenues through which it may be transmitted. The publications in which this instruction is provided are supplied to the teachers by the Board. Of course, generations must pass before the full effects of this provision can be reached, but it means progress. However, all progress is liable to many jolts and not infrequently there is retrogression. I do not dream that the people of Michigan or any other state are nearing the sanitaria millennium, and I am fully aware of the fact that there is a limit below which the death rate from disease is not likely to fall. Then, there will always be new methods and devices for killing off the population. The automobile is now more deadly than smallpox and in the number of murders we are equalled only by our sister republics of the south with a fair chance of our winning the cup.

In the “80”s cases of poisoning from cheese, ice cream and other milk products became so numerous not only in Michigan but in adjacent states that a search for the cause was amply justified. The Board instituted this investigation and the bulk of the work fell upon me and my laboratory helpers. In its prosecution I had the aid of the cheese makers, especially that of Mr. Horton, of Lenawee County, who put his factory at my disposal. An inspection of the dairies supplying this factory with milk furnished the clue. In many of these the cows were plastered with dung and other forms of filth. The animals were not submitted to even a pretense of cleaning. From unclean udders with filthy fingers the mill: was drawn into unclean receptacles. There was no thought of keeping the milk cool. It stood for hours in the barn and the cans were carted often in the hottest season and during the hottest hours of the day to the factory. Here these cultures, containing the bacterial flora of the neighborhood were poured into a common vat in which bacterial growth continued under optimum conditions. Small wonder that cheese and ice cream made from these cultures should prove poisonous. Rules were drawn up for dairy inspection, for cleaning the animals, for attention to the hands of the milkers, for sterile receptacles, for cooling the milk before and during transportation, etc. Poisoning from cheese, ice cream and other milk products became rare and soon ceased so completely that some say the whole thing is a fairy story and never occurred.

The Board, backed by the Michigan Business Men”s Association, memorialized the Board of Regents of the University to ask the legislature of 1887 to make an appropriation of $40,000 for the building and equipment of a hygienic laboratory at the university. The purposes for this request were stated in the following order: (1) research into the causation of disease; (2) the examination of suspected waters and foods on the request of health officials; (3) instruction of students in bacteriology. The Regents of the university reluctantly complied with this request from the Board of Health and put this item in their request for appropriations. The bill passed the legislature, was vetoed by the Governor and then passed over the veto. Thus was established the first hygienic laboratory in this country and the second in the world-the one at Munich, under the direction of Professor Pettenkoffer, being the first. I wish to make the plain statement that this laboratory owed its existence to the State Board of Health and not to the Regents of the University. This appropriation was expended in the erection and equipment of a building in the rear of the library, the basement and first floor were devoted to physics while the second floor and the attic were allowed for the purpose for which the appropriation was designed by the legislature. This building was known to collegiate students as the physical laboratory and to the medical students as the hygienic laboratory. When the new medical building was occupied in 1903 the hygienic laboratory and its work were transferred to it. I was made director of the hygienic laboratory and began to carry out the purposes as mentioned in the memorial of the Board of Health. In this work I had the most valuable assistance of Dr. Novy who has since become director of the laboratory. Samples of suspected water and food came in great numbers. During the following ten years reports including descriptions of the bacteria, both harmless and harmful, found in 700 suspected waters, were made. It was in one of these reports that I coined the word “toxicogenic” (poison-producing) for those organisms which elaborate poisons. When I first used this word in a paper before the Association of American Physicians in Washington some of my friends and critics assailed me. But I knew that etymologically it is correct because it had the sanction of Professor Kelsey and the word has found its way into standard dictionaries as have other words suggested under like conditions thus showing that the use of our language is not in the exclusive keeping of those who reside east of the Alleghenies. These samples came from a wide range of territory; as far west as Arizona; as far south as Mississippi; and from Canada. At that time bacteriologic laboratories were few and far between. Now, even small cities enjoy these facilities. In making these examinations we employed what we designated as: “The Michigan Method.” This like my new words did not receive the sanction of my eastern friends and I admit that it has been supplanted by better methods, but at the time it served my purpose in discriminating between safe, doubtful and dangerously polluted waters. It was the means successfully employed in detecting, checking and eradicating typhoid epidemics in both small and large communities. That those whom I served had confidence in my findings is shown by the following incident, which has both a humorous and a tragic aspect. A superintendent of a private water company in a small town in the Northern Peninsula sent a sample of the water supply. I telegraphed him that the sample was dangerously polluted. He said nothing about this report. The people continued the use of the water. Two weeks later after many cases of typhoid had developed the health officer of the locality sent a sample. I telegraphed him the facts. The people went after the superintendent with a rope and the last definite information was to the effect that the pursuit was still on in the woods of northern Michigan. This incident had an awakening effect upon private water companies as to their responsibilities. Beginning in 1888 frequent examinations of the drinking water supply of Ann Arbor were made, and the citizens and the students kept informed. On May 4, 1894, it was found that the water contained a toxicogenic bacillus, resembling the typhoid organism in cultural reactions but not identical with our laboratory strain. A bulletin was issued advising the use of only boiled water and the superintendent of the water company, then a private company, was notified. This superintendent was a physician of intelligence, a brother practitioner of mine. He came to my laboratory in wrath and made disparaging remarks about me and my method. I advised him to personally visit each of the sources of his supply. He soon returned with an apology. Five cases of typhoid fever resulted from this contamination.

In 1895, Dr. McClymonds and I examined 65 samples of cheese from as many factories located in Michigan, Wisconsin, Illinois, New York and Ontario. During the eighties and early nineties one or more bacteriologists and chemists were kept busy at the hygienic laboratory of the university examining cheese and other milk products. During the nineties the number of samples sent in rapidly decreased and in the past twenty years only one sample of poisonous cheese has found its way to this laboratory.

During the eighties and early nineties a bacteriologic laboratory was regarded by the uninitiated with more respect and fear than a menagerie of wild beasts. At Hagenbeck”s show one is protected from the lions and tigers by their cages and the iron railings but what protection can there be from invisible germs that are supposed to be floating through the air, seeking entrance to one”s body through the mouth, nose, eyes, ears and even through the unbroken skin and ready to feed upon one”s tissues bringing disease and death? I had many annoyances and occasional fun out of this phobia.

In 1888 I crossed the ocean from Bremen to New York on the Lahn with a wire basket full of a choice collection of pathogenic bacteria. Indeed, I had everything complete for the opening of the new laboratory in the fall. Koch”s laboratory and the Pasteur institute had denied Dr. Novy and me nothing. My stateroom chum was a university colleague, Professor Denison of the engineering department. He had examined my scaled tubes and had convinced himself that no harm could come unless the tubes should be broken. He occupied the lower and I the upper berth. We anchored the basket to the sofa and deemed ourselves quite secure. One night in a storm he called to me that the twine holding the basket had broken, that the tubes were being tossed from one side of the room to the other and that we would be infected with Asiatic cholera before morning. I was seasick; he was not. I replied that Asiatic cholera would be a relief to me and that I would not crawl down to save myself from any or all infections. He, brave fellow that he was, secured the basket with straps taken from his valise and I was saved not only my prize collection but from paying useless tribute to Neptune.

In 1891, Mrs. Vaughan and I landed at Liverpool with the same basket. The inspector of customs paid but little attention to our trunks and valises and stamped his approval; but the basket was too much for him. The more I labored to explain the more suspicious did he become. He hinted rather plainly that we looked like Fenians-whatever these beasts might be-on our way to London with the intention of dynamiting Westminster and the houses of Parliament; or, horrors, our destination might be Windsor and our intention to expedite the translation to Elysium of that good old German woman who then ruled the empire. The inspector sought the counsel of his superior and he, his, in turn, until we had the whole customs force about us while we saw ourselves interned in the Tower of London and finally expiating our guilt after the manner employed by Henry VIII in getting rid of his numerous wives. Finally, one man, more widely versed in current literature than the others, solved the riddle by saying: “ Oh, I know ; them are them Koch things.” The basket was stamped and we were soon complacently dining in a good English hotel.

Much of the reluctance exhibited by the authorities in accepting the appropriation for the laboratory was due to their fear of the germs. Of course, their solicitude was not for themselves but for the students under their guardianship. This was openly expressed a few years later when I proposed an effort be made to secure the location at Ann Arbor of the State Sanatorium for Tuberculosis, provided for by the legislature. When in the fall of 1888 Dr. Novy and I had stored away our dangerous germs, imported from Europe, and were giving to the medical students the first comprehensive course in bacteriology offered in the United States, our laboratory became the fons et origo of all kinds of spooky stories, some quite surpassing in their hair-raising potency those told me of ““raw-head and bloody bones” by black mammy in the old Missouri home. Even the dissecting room lost its pre-eminence in this particular. Mothers frightened their rebellious offspring into seemingly good behavior by threats of exposure to the hungry germs in the laboratory. Older children in crossing the campus gave our building a wide berth. Students in other departments shunned us. Learned professors looked at us with suspicion. The professor of physics whose laboratory was beneath us complained of the handicap under which he labored. One day an expressman in bringing a large carboy of suspected drinking water up to us stumbled on the first floor and delivered his burden short of its proper destination. Shrieks of terror from below brought me to the stairway where I saw the heels of fleeing professors assistants and students. To add to the joy, I shouted: “Every drop contains a million typhoid bacilli.” There was no return until my janitor had mopped up the water and scrubbed the floor with bichlorid. Some days later I was summoned to appear before the august Board of Regents. I faced nine grave-looking men and was solemnly asked if I was not endangering the lives of collegiate students working in the physical laboratory beneath mine. In my reply I tried to be humorous-a fault I seldom display. I said: “Your question implies a great compliment. Dr. Novy and I and our students work in the midst of bacteria and you express no solicitude for our health and lives. There must be a divinity that throws a protective mantle about the person of a young man when he graduates in the college and enters the medical school.

So far as I know there were only two eases of accidental infections in the laboratory. I was inoculating guinea pigs with a typhoid culture while my assistant, Dr. Wheeler held the animals. A drop fell from the syringe on her hand. Both of us saw it and she promised to sterilize her halide when we were through. We proceeded with our task and both forgot the drop until ten days later when she developed a mild attack of the disease. Of course the bacilli did not penetrate the skin but found their way into her mouth. There have been many accidental infections with this bacillus in other laboratories and none so far as I know have proved fatal.

The other instance was more serious. A young doctor not a student and supposedly already well grounded in laboratory technic wanted to work with the plague bacillus. Our culture of this organism was old attenuated and quite nonvirulent but would serve his purpose; so it was given him and he was assigned to a room in which he could prosecute his investigations which were to be continued indefinitely. During this time the Surgeon General of the United States Public Health Service sent Doctors Novy, Flexner and Barker to San Francisco to study the plague. On his return Dr. Novy brought fresh, virulent cultures of the bacillus. The young doctor purloined one of these and through faulty technic became infected. Doctors Novy, Dock and I spent some anxious days in caring for this patient who fortunately recovered. This, so far as I know, is the only case of laboratory infection with this bacillus which has ended in recovery. The details of this case have been published.

The relation between the State Board of Health and the Hygienic Laboratory of the University of Michigan was abruptly broken in the first decade of the present century. It happened in this wise. Health officers and others who sent samples of suspected water and food were charged $10 for each examination - to cover expenses. Some failed to remit promptly. It was my custom to report by telegram when a bad water was found. About the time mentioned, the secretary of the university, a village tradesman selected by the Regents to manage the finances of the university and incidentally to dictate to professors instructed me not to report on my findings until the fee had been paid. Thus if typhoid was epidemic in a city and the health officer sent me samples from several sources and I found one or more infected I could not report until the said health officer had remitted to the said secretary. Naturally the disease did not wait while these transactions were in progress. I was shocked by the instructions received from the secretary and immediately conspired with my fellow members on the Board of Health in securing an appropriation for a laboratory at Lansing where the analyses are now made and reports are sent without awaiting remittances. In fact the Board of Health now has a branch laboratory in the Northern Peninsula. I would like to say more about this secretary but I am restrained by the old Latin proverb which may be translated thus: “Say “nothing about the dead unless it be good. “

The hygienic laboratory of the University of Michigan continues its work in studying the causation of disease and in giving instruction to students under the wise directorship of Dr. Novy, whose valuable contributions are well known to the scientific world. The examination of samples of water, food and other infected material on the request of health officers has been transferred to laboratories conducted by the State Board of Health, the efficient state health commissioner Dr. Olin, doing his work most creditably. Possibly my instructions from the secretary of the university, so odious to me at the time, have resulted not so badly after all since the laboratory at Ann Arbor has been relieved of routine work and given more time for research.