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The world war was in progress at the time the institution was nearing completion, and the need of opening as soon as possible seemed to be iniminent. On May 1, 1918, I took up my duties as superintendent of the institution. During the month of May twenty-two women were transferred from the Anamosa institution. The administration building, cottage one, and the power house were completed at this time. The furniture was slow in arriving, however, we made the best of the situation.
At this time we had men prisoners helping in grading the grounds and completing the work around the buildings. We found the natural law of affinity to exist here as elsewhere between men and women, in a short time the men were returned to Anamiosa and the women completed the work about the buildings. A landscape engineer was employed. On June 1st, we were officially declared open for new admissions. Our first summer was a busy one as building was still being continued. Trees and shrubbery were planted, fence lines marked out, cottage two was completed and opened for occupancy the first of August. The industrial building and school house were completed in early fall. The summer was devoted mostly to gardening and farm work, and getting ourselves well established in our new roundings.
During the winter months school work was conducted in writing, spelling, english, shorthand and typewriting. A course of lectures in domestic science was given by the county agent, Mrs. Richardson, and an effort was made to keep each girl occupied in the line of work that seemed to be most interesting to her.
During the first year we received forty-three admissions, and from June 1919 to June 1920 we received thirty-eight making eighty-one admissions during our first biennial year. During the summer of 1919 the girls assisted in laying walks about the grounds, and during the winter months we cemented the basements of the buildings. Boulders were collected for a gateway at the entrance to the grounds.
The institution has gradually grown and our average population during the last year has been about one hundred, during the summer months we had one hundred and fifteen. Cottage three, or pathological building, has now been completed and occupied for about two months.
We have had comparatively few changes among the employes, some of them have been here since the beginning of the institution, and others have been added from time to time as the institution increased in size.
The aims of the institution have been to lead the girls to see life from a higher moral standpoint, to give them a vocation with which they can make an honest living, to make them take an interest in reading, and music of a higher class, and to restore them to good physical conditions. We find that quite a large number of our girls are suffering from diseases at the time of their admission to the institution. Intensive medical treatment has been given along this line. At the present time there are only a very small per cent of our girls suffering from disease. The outdoor life, early hours, and wholesome food cause the girls to show rapid physical improvement.
As a whole the girls are quite cheerful. It had always been my idea that people who had committed great wrongs would suffer mentally as the result of the same. I have found that most of the inmates either have a way of explaining that what they have done was due to the influence of someone else, that they are not guilty, and in some instances they are unable to see that the things they have done are crimes for which the state should be punishing them.
The majority of our inmates come from broken homes. They have lost either one or both parents during early life or have been married two or three times while they were young. Marriage vows are not held by the majority in any degree of sacredness.
This class of people are rather emotional and are easily influenced. Quickly brought to tears or laughter. Appreciating this emotional side of the life we have not forgotten the entertainments. During the summer months they have basket ball, tennis, croquet and other outdoor games. We have been able to secure chautauqua numbers, and lectures as they come to the city. The people of Rockwell City and vicinity have been most generous in giving us entertainments, and the girls have put on some very splendid numbers.
The club women have taken considerable interest in the institution, and have presented us with three splendid pictures. The W. C. T. U. have held their annual flower day at the institution each year, and the girls have learned to look forward to the day with a great deal of enjoyment.
During the winter indoor games are furnished, and music has been used as a great factor in recreation hours. At the present time we have a music teacher employed, from town, who is giving vocal lessons. Cooking and sewing are taught in the school. Our third class in shorthand and typewriting is now in progress. During the past few months basket weaving, painting and the making of novelties has been added as a department in the school. Fancy work of all kinds is taught and at the present time we are preparing for a bazaar to be held in the institution.
In addition to the state prisoners we have cared for a number of federal prisoners, most of whom have come from the west or
south. A state agent is employed to look after the paroled girls in the field.
Farm buildings have been built as they were needed. The farm group consists of a dairy and horse barn, two silos, hog barn, granary, machine shed and chicken houses.
The institution has a good accredited dairy herd. Pigs and chickens are raised. The farm land is used to produce corn, oats, fruits and vegetables.
No appropriations for buildings, have been asked for the next two years, so that the institution has reached its physical growth for the present.
INFECTION IN TUBERCULOSIS.
C. G. Field, M. D., Oakdale, Iowa.
So much of our knowledge regarding the causes of tuberculosis is indefinite and hazy that it is not without considerable trepidation that I approach a discussion of this important and interesting subject, especially in a short paper. Many vital points have always been controversial, and the pendulum has swung back and forth so many times, regarding the views on certain aspects of the problem, that one can scarcely tell on which side it now hangs. I will try to confine myself to well established facts and the more or less unequivocal views of those who ought to know.
When Robert Koch discovered the tubercle bacillus in 1882 it was at once concluded that the problems of phthisogenesis were settled. He had, it is true, discovered the sine qua non of tuberculosis for, so far as we know, this disease never occurs without the presence of the tubercle bacillus. In new lands there is never tuberculosis until civilized peoples bring the tubercle bacillus. That this parasite, however, is not the crux of the situation is shown by the fact that a large percentage of people, especially city dwellers, are known to be invaded by it and yet do not have phthisis.
At the time of Koch it was thought that since the tubercle bacillus was the essential cause of the disease that they had only to search out the bacterium, wherever it occurred, destroy it, and the world would be rid of phthisis. Such simple procedures have been eminently sucessful with typhoid fever, diphtheria, etc. Time has shown, however, that with tuberculosis the problem is more complicated. There are apparently two kinds of diseases produced by the tubercle bacillus, depending upon the state of immunity in which it finds its victims.
In young children the tubercle bacillus produces an acute febrile disease with a fairly definite symptom complex more or less easily recognized during life and practically always terminating fatally. In children, then, the cause of tuberculosis is the tubercle bacillus and that is about all there is to it. Children are rarely, if ever, born with tubercle bacillus already in their tissues and, so far as we know, never possess any appreciable amount of natural immunity. When attacked by the bacterium, especially in large numbers, as is usually the case, their relative lack of defense-mechanism causes them practically always to have acute or sub-acute, fatal, tuberculosis. This frightful scourge is called acute miliary tuberculosis and is as sure of killing as cancer is. Fortunately it occurs much less frequently than phthisis, the chronic form of this disease from which adults usually suffer. There are only two sources of any importance from which children can become infected. These are
the open cases of phthisis which are always shedding myriads of bacilli in their sputum and the milk of tuberculous cattle. At this point I want to state advisedly that no matter how careful an open case may be, contact with an infant will almost surely result in infection of the latter. Children are therefore to be protected from tuberculous milk, and open phthisis cases at all costs.
In older children massive infections are less likely to occur and they seem to possess a considerable degree of natural resistance enabling them to more or less thoroughly encapsulate tubercle bacilli entering their tissues. Within these barriers the bacilli lie dormant a variable period; usually during the remainder of the individual's life. Under certain circumstances, however, they may be liberated by factors, of which we will speak later, and phthisis results. The lowest morbidity and more tality is found between the ages of four and fourteen.
This encapsulation of living tubercle bacilli within the tissues, renders the bodies immune to further infection. Some modern writers have therefore termed it "benevolent infection" since it protects from further invasion by so deadly a parasite. The fact that adults suffer from chronic forms of tuberculosis, limited more or less to one organ, and usually' causing little or no inconvenience, is undoubtedly due to resistance, acquired through this early “benevolent infection”. Adults who have not received this initial dose, die quickly from acute forms of the disease when infected. This is what results when aboriginal races suddenly come into contact with civilized (and tuberculized) races.
How futile have been our attempts at preventing infection in adults is shown by the well established fact that fifty per cent to seventy-five per cent of city dwellers are infected with tubercle bacilli. No matter what the cause of death, post mortem section practically always reveals evidence of tuberculosis, active or healed, which, in the majority of cases, was not recognized during life. Infection, is therefore practically universal and we are all carrying the enemy constantly within our bodies.
Now since only a comparatively small percentage of us suffer from phthisis it is evident that "infection” and “disease" are very different. We are all infected, but few are sick with tuberculosis. Many are called but few are chosen, as it were. Most people
, therefore, while carrying this deadly organism within their bodies,