of our own State, and two others into the penitentiaries of other States. It is the overcrowding of the profession and the supposedly consequent beneficent competition which are responsible for the court of fee-splitting that is spreading in our own State, as well as in many other States. By slowing somewhat the rate of increase of the members of the medical profession. I believe, the Council has rendered a substantial service to our people. As to the quality of our licentiates: There has been a striking improvement in this respect. About six years ago, when I first joined the State Board of Health, many of the examination papers were so bad in their English, as well as in technical knowledge, that one felt it a punishment to have to read them. The average janitor or orderly about a hospital or medical school could have done no worse at our examinations than did some of our applicants. A large number of this class, of course, failed, but I fear that many slipped through. It is quite different now. Nearly all of the examination papers can lay claim to fair English and the technical deficiencies are comparatively small in number. Thus the number of failures in 1915 was only 6% per cent. Contrast this with the 42 per cent of 1906. In addition to these two regulations we have instituted a practical examination and have used it with much satisfac tion for the last two years.

As you see, we have fared quite well under the law of 1907, but this cnly because the members of the Council have dared to interpret and apply the law in a manner to harmonize with the spirit of the time and the needs of our people. We believed that the people of West Virginia, although largely of rural character. were entitled to competent medical services as much so as the people of large cities. The idea that any sort of a doctor is good enough for West Virginia has not been entertained. ' The plea of the poor man's boy has not had much if any force with the Council when it meant to turn loose an incompetent physician. But other States have found it unsafe to leave such important matters to the discretion of the examining boards. You can never tell what may happen to the personnel of such a board. In our own State we have had good boards and we have had indifferent boards, and history is very likely to repeat itself. During the period of my connection with the Board there were men on it of the very highest attainments and ideals, but for a time at least they were cutweighed by men with low standards, either on account of small attainments, or on account of indifference to ideals. While I can recall with pleasure the association with fellow-members who would have been an ornament in professional circles anywhere in the country, I regret to state that no such pleasure has been vouchsafed to me of all the members. For these reasons efforts are being made in many States to have all the requirements for the practice of medicine written into the law. A number of States have had it this way for some time. Recently our neighboring State of Virginia did so, as well as California, Tennessee, New Hampshire. New Jersey, Pennsylvania, etc. There is no question in my mind that all other States will soon adopt the same view and will refuse to reciprocate with any State whose requirements are all, or in part, subject to the discretion of the ever-changing members of politically constituted examining boards. These were the considerations

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which led me to persuade the Public Health Council to become sponsor for the pre-medical education bill which was passed by the last Legislature, exactly as drawn up by Dr. F. F. Farnsworth and myself and has since become a law, thanks to the efforts of Dr. Chas. A. Sinsel and Dr. H. R. Werner, respectively Chairmen of the Committees on Medicine and Sanitation in the Senate and House. This law provides that after the year 1920 all applicants to practice medicine in this State will have to present evidence of a high school education or its equivalent and one year's courses in chemistry, physics and biology of a college grade. I wish to call your attention particularly to the additional provision of this law that the evidence of this preliminary education must be passed upon by our State department of education and not by the Public Health Council. This, I believe, is a it ought to be. These requirements are not quite as far advanced as they are in some States, where on the side of preliminary education two years of college work in addition to high school are required, and on the side of medical education a hospital year in addition to four years of medical school. In the course of time these requirements will become general, and I have no doubt that we will not lag behind very long. In the meantime, however, for the next four years the degree of preparedness of our medical licentiates will continue to be determined altogether by the Council. It is, therefore, to be hoped that the appointive power will exercise particular caution at this time to select the fittest for membership on the Council.

I will merely mention here the amendment of 1915, which gave a legal definition, and an excellent one, to the term, practice of medicine. That amendment was passed as part of the law which reorganized and changed our board of health into a State department of health. But as I have already dwelt upon this in my address, "Our Public Health Law-A Brief History of Its Genesis and Its Important Provisions," I shall stop with this reference.

The evil of secret fee-splitting has invaded our State many years ago, but of late years it has assumed considerable proportions. An inquiry into this matter has convinced me on the one hand that this evil has not yet reached the extent that it has in several nearby States, but, on the cther, that it was threatening to become infinitely worse, if not checked. Educational methods have been tried and failed to such an extent that from the platforms of some of our medical societies men have ventured to argue in favor of fee-spliting. A few years ago our State Board of Health passed a resolution declaring this practice as dishonorable conduct within the meaning of the law and threatened to revoke the license of anyone found guilty of it. This, too, failed to have any deterring effect. Drs. J. R. Hunter, J. E. Cannaday and myself, at the suggestion of the first-named, agreed to try legislation as a remedy. In consequence a law prohibiting this practice was passed by the last Legislature. The draft of this law was drawn up by Mr. Harry Irons, a prominent attorney of Huntington, and was put into its final form by the able jurist, the Hon. W. B. Kittle, Judge of the 19th Circuit, to both of whom thanks are hereby extended.

I presume that this sketch of medical legislation will be grossly de

ficient without stating the fact that in some respects our State has become verily ultra-progressive, if you will permit such a characterization of the law passed by our last Legislature creating the new profession of chiropody and placing it under regulation of the Public Health Council. And in this connection we should congratulate the people of the State that they have been spared the affliction of the chiropractor.

Passing for a moment from medical legislation to the broader subject of public health, it is with extreme regret that we have to chronicle the defeat at the last Legislature of the vital statistics bill. This bill was virtually the well known model law on this subject which has proven successful wherever it has been adopted, and the number of States which have adopted it is large. The bill was introduced in both Houses. It passed the Senate. In the House on the second reading on a test vote it mustered up a strength of 67 against 13. I was in Charleston at that time locking in on the Legislature and when I saw what happened on the second reading, I left for home and jubilantly reported over the State the certain passage of the bill, soon to learn that it had been overwhelmingly defeated on the third reading. Just why this radical change in the attitude of the House towards this bill I have not been able to learn, except perhaps that between the time of the second and third reading some members of the department of health had incurred the displeasure of certain members of the House on account of an effort to oppose the passage of the chiropractor bill. This was very unfortunate, as the need of reliable vital statistics in our State is sorely pressing. That a civilized commonwealth should go on without an accurate accounting of its vital assets is remarkable; that thousands of our citizens should be indifferent to the fact that they can not officially prove the dates of their birth is puzzling; and that the legal profession of the State should not have shown their interest in the passage of a bill which would have gone a long ways towards simplifying many a legal procedure, and what is more important, would have added a substantial safeguard against the concealment of crime is not merely remarkable and puzzling but truly provoking. On behalf of the Public Health Council I wish to extend thanks to all those who tried to help the passage of this bill, and particularly to the United States Census Bureau which has gone to the trouble to write a letter to every member of the Legislature explaining the desirability of the vital statistics bill and urging its passage.

However, as I look back and recall our very meagre medical legislation prior to 1907, and particularly when I recall the merely nominal public health code as it existed prior to 1913, and when along with all these I recall the fact that up to the last named year the total appropriation of money for all the functions of our State Board of Health did not exceed $2,500,-I rejoice in the progress that we have made and rejoice in the fact that a kind Providence has favored me with the good fortune to have a share in the promotion of it. We have set the pace. It is up to our successors to maintain it, and. if possible, surpass it.

REPORT OF COMMISSIONER OF HEALTH.

S. L. JEPSON, A. M., Sc. D., M. D.

At the close of another fiscal year we meet with the old embarrassment of not being able to give definite information as to the value to the State of the State Health department. Has the department justified its existence and the appropriation made for its maintenance by the state legislature? In short, has it paid? Those of us who are on the inside, and who positively know cf outbreaks of disease whose origin has been traced, remedies applied and the outbreaks checked or ended, who know of numerous water supplies previously unsafe that have by our efforts been rendered entirely safe, to say nothing of the many nuisances that have been abated and municipal sanitary conditions improved by the State department in cc-operation with local health authorities, have no hesitation in claiming that disease has been lessened, lives have been saved, and living has been rendered more comfortable by the efforts of this department.

That we are unable to demonstrate the truth of us statement is due to the very imperfect reports of diseases and deaths that come to us. To obviate this defect we made a very determined effort to induce the legislature of 1917 to enact what is known as the model registration bill, a bill that originated in the United States census bureau, and which has been enacted and in successful operation in quite a number of the states. This bill received favorable consideration in the senate but failed of passage in the house of delegates. With an effective law the registration of vital statistics would soon greatly improve, and the department would be able to show the benefits derived from its labors. In addition to this, we would be in a position to furnish on demand copies of birth and death records for which we have numerous requests, but with which we generally find ourselves unable to comply. Such records are needed for many purposes which need not here be detailed, but which will cecur to any intelligent man, and especially to attorneys, who so often find it necessary to make use of such records in the trial of legal cases. The war has caused a demand for correct records of the births of those who have been called to the military service, and not a few heart breaks have been caused by the inability of parents to show, by an official record, that a son drafted into the country's service was not within the age limit fixed by law. This is only one of the very many instances in which vital statistics are of value. As every lawyer and every physician knows. they are the very basis of sanitary science, and we shall ask the next legislature again to carefully consider the model vital statistics law or some modification of it.

Reports of Births, Diseases and Deaths.

In the absence of a proper law on this subject the department, and especially Dr. H. B. Wood, the assistant commissioner, has put forth very earnest efforts to secure better reports of births, deaths and disThe reports of sickness for former years have been so very im

eases.

perfect that to make comparison will seem to indicate a marked increase of sickness, which is not true in all cases. The figures that follow rather indicate that by our persistent urging a number of practitioners of medicine, by no means all, are trying to comply with the law as they have not heretofore done.

Cases of Infectious Disease Reported in 1915 and 1916.

Diphtheria Scarlet Fever Measles Smallpox Whooping Cough Poliomyelitis Typhoid Fever Tuberculosis

1915 193

1916 1,173

During the past year a very widespread epidemic of measles spread over not only this but a number of other states. This is perhaps the most infectious of all diseases, and from its general mildness one of the most difficult to control. Many cases are never seen by a physician and have never been reported to any health official. Such cases are the ones most liable to spread the disease, since little or no effort is made to prevent contact of the sick with the well. There was also more diphtheria in the state than during the previous year, as there was of whooping cough. Like measles, whooping cough is very fatal to infants and very young children, and we constantly make efforts to educate parents to isolate children with these diseases, preventing contact with well children.

A notable decrease occurred in the number of smallpox cases reported. This marks the closing of a wide spread outbreak of this disease that has afflicted this and other states since 1913. In three years or less prior to 1916 over 7000 cases were reported in this state. The type of the disease has been for years exceedingly mild, some cases escaping diagnosis until well advanced in convalescence and many others being diagnosed as chickenpox. This accounts for the many local outbreaks and the general spread of the disease. The imperfect records of this office seem to indicate that the mortality has been but less than one per cent. The mildness of smallpox in recent years has operated to prevent vaccination and hence the general prevalence of the disease. Like other epidemics, this one has shown but exceedingly few cases among persons who were ever vaccinated, and has thus emphasized the great value of this preventive measure. Many thousands of dollars have been needlessly wasted because of the neglect to take advantage of this means of preventing smallpox.

Winter Epidemic of Infantile Paralysis.

It will be noted that in 1915 there were no cases of poliomyelitis (infantile paralysis) reported, whereas in 1916 there were 83 cases. A widespread epidemic of this disease occurred in New York city and the near-by states during the summer of 1916, and while most of our cases were probably due to imported infection, so many of the cases occurred in isolated and sometimes strictly rural districts. that a number of these must have been of the so-called sporadic type. The 83 cases were distributed in 32 counties, there being 14 counties in which but one