| C H
A P T E R I
DESCRIPTION OF MANTENO STATE HOSPITAL
A description
of the institution, including location and geology of
the area, is necessary to provide a proper background
for a thorough understanding of the epidemic and the many
unusual problems involved in its control.
GENERAL.
The Manteno State Hospital is an institution for mentally
ill persons. It is located in Kankakee County, approximately
40 miles south of Chicago and 10 miles north and east
of the City of Kankakee. Situated 2 miles from the nearest
municipality (Manteno) on a tract of ground comprising
approximately 1,000 acres, its 100 buildings virtually
comprise a small municipality. At the time of the
epidemic the institution generated its own power, furnished
its own water supply and maintained a system of sewers
and sewage-treatment works. Fig.
1 is a map showing the general layout of the institution.
HISTORICAL.
Construction on the Manteno State Hospital started in
the year 1929, additional buildings, utilities, and other
facilities being provided in the ensuing years up to the
time of the outbreak. Building construction was
in progress at the time the epidemic occurred. The
accompanying Table
I shows the growth of population for the institution.
It will be noted that the population at the time of the
epidemic was approximately 6,200.
ADMINISTRATION
AND OPERATION. Prior to the 1939 typhoid fever outbreak,
the administration and operation of the institution were
characteristic of procedures followed at other State institutions
of this kind. The institution was under the direct
supervision of a managing officer, who was directly responsible
to the director of the Department of Public Welfare.
The medical
department was under the supervision of a clinical director,
who supervised the activities of 20 staff physicians and
the laboratory technicians. The nursing department
was directed by a trained nurse, who was assisted by a
number of supervisors all of whom were untrained lay persons.
The registered nurses in the administrative plan took
their orders from the lay supervisors, who, in turn, were
responsible for contacting the staff physicians,
The attendants in this department consisted of lay persons
who also were responsible for nursing care.
The dietary department
was under the supervision of a dietitian. Approximately
85% of the workers in the dietary department were patients,
the remainder, only, being paid employees. The institution
maintained its own farms, operated primarily for the growing
of vegetables. Most of the meat was purchased from
packing houses, but a hog farm furnished a portion of
the meat supply. An institution dairy herd furnished
about 100 gallons of raw milk daily, which was used only
for cooking purposes, the main milk supply coming from
an outside pasteurization plant.
The institution
maintained its own bakery. All meals were prepared in
the central kitchen, except for a few hospital cases requiring
special diets. At the time of the epidemic approximately
19,815 meals were being served daily. Food prepared
in the central kitchen was transported in aluminum food-containers
by trucks to the various ward kitchens, from which it
was usually served in a cafeteria style.
The mechanical
department was under the supervision of a master mechanic
whose responsibilities included the operation of the water
supply, sewerage, garbage- and rubbish-disposal, and the
insect- and rodent-control, in addition to the maintenance
of the power plant, and care of the grounds.
Table II shows the number and classification of hospital
employees from the year 1937 to 1940. It will be
noticed that the number of employees in the mechanical
department decreased from 19 in June, 1937 to 14 in June,
1939, while Table
I shows that the population of the institution increased
during that period from 3,208 to 6,152.
Page 1 of Chapter 1
(Click for larger image.)
GEOLOGY.
The subsurface formations at the institution are extremely
important in the study of this epidemic. The area
in which the institution is located is underlain near
the surface with limestone which is cracked, creviced,
and filled with solution channels. Such formation
is universally credited by geologists with the character
of conveying water and likewise pollution for great distances
with effecting purification. The glacial drift covering
the creviced limestone in the area is relatively thin,
on the institution grounds varying from 0 to 30 feet in
thickness. In the southern portion of the institution
grounds the rock outcrops, while at a distance of several
hundred feet north the drift is 20 feet thick. Fig
2 gives the depth and thickness of underground formations
at the site of one of the institution wells. During
construction of the institution, some of the building
foundations has to be excavated in the rock; likewise
it was necessary to lay sewers in trenches excavated in
the rock formation. Extensive studies by State geologists
were made both before and after the epidemic occurred
so that the general shallowness of the glacial drift and
the creviced character of the underlying limestone have
been very definitely established.
WATER SUPPLY.
The institution water supply was obtained from 4 drilled
wells, all located within a few hundred feet of each other
on the institution grounds. The wells all discharged to
a concrete ground storage reservoir, from which the water
was pumped to the institution distribution system on which
pressure was maintained by an elevated tank. Three
of the wells obtained their water solely from the creviced
limestone, the wells being cased from the surface to only
a short distance into the rock formation. THe other
well penetrated deeper rock formations, but that portion
of the well passing through the creviced limestone was
not cased out so that this well, likewise, received a
portion its water from the creviced limestone formation.
Fig 2
gives logs and casing records of all the wells.
For a month prior to the epidemic all water furnished
the institution was obtained from one well only - that
known as "No. 4" - which was drilled in 1938
and was located approximately 50 feet north of the power
plant. This well had a total depth of 225 feet and
was cased with 14-inch casing from the surface to a depth
of only 19 feet, the casing penetrating into the limestone
for a depth of only 1 foot. Thus, the glacial drift
at this well was only 18 feet thick and all water4 which
this well supplied was developed from the creviced
limestone. The static water level was reported at
the time of the epidemic at 26 feet below the ground
surface. A sanitary sewer line serving the power
house passed only 35 feet south of the well casing.
This sewer was constructed of vitrified sewer pipe, with
ordinary cement mortar joints. Fig
3 is a detailed layout of the water supply, and shows
the location of sewers in respect to the wells.
The water consumption at the institution was approximately
1,000,000 gallons per day. Although water distributed
to the hot-water system was softened by the zeolite process
and boiler water was conditioned by a hot-lime process,
the remainder of all water furnished the institution was
distributed without treatment of any kind previous to
the epidemic.
SEWERAGE.
The institution was served by a system of separate sewers,
one for sanitary wastes and the other for storm water.
As previously indicated, some of these sewers were laid
in creviced limestone because of the thin glacial drift
covering at certain points on the institution grounds.
Sewage from the sanitary sewer system was treated in the
institution sewage-treatment plant, of the activated sludge
type, which was built in 1930 and was designed to give
complete treatment to the wastes for a population of 3,000;
however, at the time of the epidemic, the sanitary wastes
from approximately 6,200 persons were being discharged
to the plant, which so heavily overloaded it that it was
not possible to produce a satisfactorily treated effluent.
The out let from the sewage treatment works discharged
to a small creek, which flowed through land used for agricultural
and dairy purposes. Fig.
1 shows the system of sanitary and storm sewers, and
gives the location of the sewage-treatment plant.
BACK TO TOP |
TABLE OF CONTENTS
Cover
Introduction
Chapter 1
Description of Manteno State Hospital
Chapter 2
Onset of Epidemic
Chapter 3
Preliminary Observations
Chapter 4
Water-Supply Study
Chapter 5
Control Methods Adopted
Chapter 6
Amoebiasis-Control Methods
Chapter 7
Epidemiology
Chapter 8
Discussion
Chapter 9
Legal Action Resulting From The Epidemic |
