case occurred. In only one or two instances did a secondary case occur in the same family or neighborhood. In Randolph county quite an epidemic occurred, one case cocurring on each of the following dates. viz: August 29th, September 30th. October 9th, and November 25th and during December 30 cases, with a number in January. 1917. In Taylor county one case occurred December 1st. five from December 9th to 1st. and in and near Grafton and Fairmont (Marion ecunty) occurred quite a number of cases. A full account of these outbreaks will be found in Dr. Weirich's report in this volume.

Dairy and Food Inspection.

Considerable work has been done in the inspection of dairies as is detailed in the report of Dr. Wood. We have endeavored also to enlist the interest of the county health officers in this work. Great need exists for education along the lines of improvement in the production and marketing of milk, and especially in the physical improvement of dairies. Not all producers of milk are willing to make the improvements we suggest, but as a rule the intelligent farmer or dairyman shows a willingness to progress as information reaches him as to what are really the most important needs to insure a pure milk supply.

During the past year not a little work has been done by Dr. Wood in the inspection of provision stcres, and a considerable amount of impure or spoiled goods has been condemned. We need greater authority in crder to secure the destruction of such food products when found, as it is doubtful if the law confers the right to destroy damaged and unwholesome goods when found on sale. To condemn. with no authority to destroy, will effect but little, and this only with the strictly conscientious dealer.

Work of Engineering Division.

The work of our engineering department has been most valuable in many directions. and attention is called to the report of this division in another part of this volume. We call special attention to the improvements in water supplies. It is always advisable, where at all practicable, and especially in the case of cities which so often are compelled to depend upon a polluted stream for their water supply, that a filtration plant be erected. In some cases, however, lack of funds renders this impossible; while in other communities the water supply, generally safe. is liable only at times to pollution. In such cases chlorination is a cheap and effective safeguard. Our engineering department has, therefore, as will be seen from its report, sought to encourage the institution of chlorinating plants where needed, and in this way has succeeded in many cases in rendering a polluted water safe with a consequent noticable improvement, in the health tone of many communities.

Attention is also called to the fine work of this division after the Cabin Creek filcod of August. 1916. Information as to this flood reached me at 6 o'clock A. M. of August 10th. Chief Engineer Tolman being out of the city, Assistant Tisdale was called by me from his bed and tock the 7 A. M. car for the stricken district. Assistant Wardle and myself

following later. Mr. Tolman, in Pittsburg, at once grasped the seriousness of the situation and started immediately for Cabin Creek, first sending a telegraphic order for a stock of typhoid preventive vaccine, since he knew that typhoid fever had prevailed to some extent in the flcoded district. I personally went over a part of the district on the 11th, walking twelve miles in an effort to learn the points where aid was most urgently needed. It may be justly claimed that a typhoid outbreak was prevented by the most unusual and arduous work of our Engineering Division, the account of which may be read with interest.

Attention is also called to a work of the greatest importance done by the engineering division of the health department, namely, a complete sanitary survey of the capital city of Charleston. This work occupies too much space to be included in this publication, but it has been printed and issued as a separate document, and we feel quite sure that it can be read with interest and profit by those in authority in any of our cities, if they care to learn the sanitary defects common to most large communities, and how best to remedy these defects.

School Sanitation.

Since the adoption of our regulations as to schocl sanitation, many complaints have reached us as to the very bad condition of school buildings and grounds, the proper location of schocl houses, their proper heating, ventilation and furnishing and even the physical condition of teachers and pupils. As an example of the kind of school buildings in which children are sometimes housed. I quote from the report of an investigation made by my direction by Dr. Weirich of our department.

"The Building at in Ohio County is absolutely unfit for school purposes, being both dangerous and insanitary, and a menace to the health of the pupils. It contains, in addition to a number of adjustable desks, eleven old desks, and fifteen pupils must find accommodations on benches. The flooring is practically worn out and is full of openings, the roof leaks badly, the outside toilets are inadequate, open and with no vaults, and no provision for boys' urinal. The well water is in grave danger, as there is no protection against surface pollution."

The school trustees were directed to discontinue the use of this building, but a lawyer was employed and a compromise effected by which some repairs were made to a house which should have been torn down.

Here are other complaints that have reached us:

"The school house at

leaks, in short the rain just pours in. I have taken my children

The house has been condemned by carpenters. away and sent them to another school." "Our school room has a large window pane cut and the trustees have put a piece of dirty cloth in it. The stove has no grate in it, the weather is cold (October) and the children have to wear their wraps to keep warm."

These are only a few of the many complaints that reach us, and while perhaps evidence at times cf a shortage of funds, they are more frequently proof of a want of intelligent foresight in providing for future necessities. While we attempt in all cases to improve the situation, we sometimes fail

because we find that no money is in the treasury with which to make necessary changes, and in some cases the court has been appealed to with the result that our efforts to improve sanitary conditions have been defeated. Complaints such as those here given have entailed a voluminous correspondence, but we believe some advance in school sanitation has been made, and school trustees are slowly learning that some approach toward proper sanitary regulations in the erection and management of school buildings must be shown.

In this connection we desire to refer to the law of the state requiring "that the board of education of each independent school district in this state shall, and other boards of education may, within ninety days from the passage hereof, appoint one or more legally qualified practicing physicians in said school district to be known as medical inspectors of schools, etc." Although this law was enacted in 1911, a number of independent districts have not yet complied with it. The following letter was sent to the different school districts of the state.

To the School Districts:

The Public Health Council notes with pleasure the increasing interest manifested by the educators of the State in the physical welfare of the children under their care. The Health Commissioner has frequent requests from teachers for the Health Bulletins issued by the Council and letters suggesting improvements in school sanitation, clearly indicating that they are not only interested in the mental but also in the physical development of school children.

Our attention having been called to the very great benefit that has resulted to the physical condition of the pupils of those schools employing medical inspectors, who detect and urge the correction of physical defects, and who not unfrequently diagnose cases cf infectious disease in its incipiency and thus limit its spread, we desire to urge the employment of inspectors in every school district of the State. We believe that if this advice is followed much ill health will be corrected and prevented, and thus the cost of the inspector's services will be saved to the communities. Until all the school districts are supplied with inspectors, teachers are urged to examine carefully the pupils at the opening of every term with the purpose of discovering physical defects, and that every morning care be taken to exclude children giving any evidence of having fever, sore throat or other signs of acute illness. In this way outbreaks of diphtheria, scarlet fever or other disease may be prevented.

We have recently been gathering the facts as to compliance with the state law requiring the appointment of medical inspectors, and shall try to secure such appointments in all the districts as soon as possible.

During the year we have prepared and sent to the schools of the state placards containing the early symptoms and means of prevention and control of scarlet fever, measles, diphtheria and whooping cough. These are to be posted in the school rooms for the instruction especially of teachers, in hope that they may be able to detect commencing disease and by excluding the pupil may be able to prevent further infection.

Railroad Sanitation.

Our attention has occasionally been called to sanitary defects on raiiroad property and trains. One of the most common of these is the insanitary condition of the toilets at the smaller stations. Another is the habit of

We

spitting in cars, and a third is the return of uncleaned milk cans. have also had complaint of the sweeping of cars while occupied by passengers. The spitting habit has been almost abandoned, but we have had occasion to call the attention of conductors to a violation of the law on this point. The practice of returning to dairies uncleaned milk cans has been a very common one. Generally these cans contain a small quantity of milk, and they often stand on station platforms for hours, even in the warmest weather. The result need not be pictured, but it is quite certain that this is one cause of the early souring of milk of which housewives cften complain. We have found it necessary to seek the aid of railway companies in remedying this evil. At least one company-the Chesapeake and Ohio-issued instructions to its agents not "to accept from consignees empty milk cans to be returned to shippers unless said cans have been thoroughly sterilized and cleaned by the consignees before returning to the railway company." The Kanawha and Michigan has also shown an active interest in this matter. We are glad to say that the railroad companies have always shown a willingness to co-operate with the health department in measures suggested for the improvement of sanitary conditions. The sanitation of local stations and their toilets, however, is under the care of the station agent and should receive the constant attention of the local health authority in order to relieve the bad condition that too frequently exists.

The Hygienic Laboratory.

This institution, which is under the direct control of the State Health department, is doing an excellent work, and is now equipped with both men and apparatus to do much more and even better work than in the past. The report in this volume shows what has been done during the past fiscal year. We have lost from our laboratory force the former director, Dr. John N. Simpson, and Mr. M. L. Bonar, cur bacteriologist. Arthur Lederer, chemical engineer, M. D., C. P. H., now occupies the position of director and bacteriologist. He is widely known as a bacteriologist of first rank and can be depended on to make thoroughly reliable examinations and do the work promptly. A. A. Cook B. S., continues as chemist. We have found his work to be entirely reliable. Physicians are therefore urged to make more free use of this institution than they have heretofore done. By doing so they can often gain aid in making correct diagnoses, and by taking proper precautions may prevent the spread of infectious diseases.

The location of the laboratory at Morgantown is rather unfortunate on account of its inaccessibility and the time lost in sending specimens. The connection with the University has, however, brought some advantages, but it seems a better arrangement to have the laboratory in closer connection with the administrative office of the health department, and it is hoped that an arrangement may be effected during the coming lear whereby the laboratory may be located in the capital city of Charleston, which is much nearer the center of the state and with far better railroad connections than has Morgantown. If this is accomplished a larger number of people can be served and the desired results can be more speedily reached.

Publicity Work.

Believing that the education of the pecple is the leading factor in advancing the cause of sanitary science, the department is constantly making efforts to comply with the health law which provides that the commissioner shall "promulgate information to the general public in all matters pertaining to the public health." During the past year lectures have been given on various health topics by the commissioner and three of his assistants. A number of county teachers' institutes have thus been reached, as also civic clubs, meetings of farmers, and the general public. Several thousand persons have thus had the gospel of health and good sanitation preached to them. The quarterly health bulletin goes to a mailing list of ten thousand. Many on this list are teachers, many members of farmers' clubs and ladies' civic clubs, in addition to all the physicians and all the newspapers of the state. We have also made frequent use of the newspapers for spreading information deemed valuable, and in emergencies the service of the Associated Press has been made use of to send out information that seemed urgent. The department is always ready, when more important duties permit, to have one of its representatives respond to invitations to address health meetings or aid in any way possible in advancing the cause of improved sanitation throughout the state.

We have recently purchased a number of moving picture films which will be made use of as opportunity offers. All of these illustrate some phase of health work or the necessity for it, and teach valuable health lessons. The department is gradually accumulating a health exhibit consisting of models, posters, mottoes, pictures illustrative of good and bad sanitary conditions, etc. This has in the past year been shown at a number of county fairs and public health meetings. Many valuable features have been added recently, and others will be secured as funds are available. We hope in time to send this exhibit on a tour through the state, accompanied by one of our force as a lecturer.

The Trachoma Hospital.

The Trachoma hospital at Welch, established, with some financial aid from this department, by the U. S. public health service, Surgeon John McMullen in charge, has continued in successful operation during the past year. It has done a very valuable work in the operation for and cure of trachoma cases. Unfortunately many sufferers are residing at such a distance from the hospital and are in such reduced financial circumstances that it is impossible for them to reach the hospital and secure its benefits. To overcome in a measure this trouble, Dr. McMullen has held a clinic at Williamson and expects to do so at other places tc which those afflicted will be urged to come for treatment. Visits have also been made to other parts of the state and public lectures given by Dr. McMullen and his assistant, Dr. Paul D. Mossman, for the purpose of inducing patients to come to the hospital for treatment. During the fiscal year ending June 30th, 1917, relief was afforded sufferers as detailed in another part of this report. The State and this Department of Health are certainly greatly indebted to the U. S. Public Health Service and its representatives, Surgeon