John McMullen and Assistant Surgeon Paul Mossman, for the very valuable work done for our suffering people.

The state is under obligations for the very valuable services thus rendered by the U. S. public health service for which the health department pays a comparatively insignificant amount. It should be generally understood that the patients are treated absolutely without pay at the Welch hospital and wherever clinics are held. These patients should, therefore, be encouraged by all who come in contact with them to seek relief at the hospital, where they are sure to be benefited and may be enabled again to resume their active duties in life.

Nuisances.

The subject of nuisances never ceases to attract attention, and much of our time is taken in correspondence rendered necessary by complaints that reach us from all parts of the state. While sanitarians have ceased to look upon the ordinary nuisances as so serious a menace to health as in former years, yet they are the indirect cause of ill health in many cases and certainly tend to reduce the joy of living, and hence should not be permitted to exist. But in the great majority of cases nuisances can and should be abated by the action of local health authorities, municipal and county. These officials have the same power as that possessed by the State health department, and they should exhaust their efforts before permitting complaints concerning comparatively trifling matters to be reported to this department.

Public Health Day and Clean-up Week.

This department, while recognizing the value cf constant efforts for the bettering of sanitary conditions, believes that a special effort is needed at times to get the people into a fixed habit of cleaning their premises. Hence the annual Fublic Health Day was inaugurated in 1914, and we believe the results have justified our expectations. At our suggestion His Excellency, Governor Cornwell, early in April, 1917, issued a proclamation, of which the following is a copy:

Proclamation:

By the Governor of West Virginia.

The State Department of Health has named Monday, April 16th, as Public Health Day, the beginning of what they term Clean-Up Week. I believe this to be a wise act, one which should have the earnest support of every good citizen. In years past the question of public health was not regarded as a proper function of the State or Nation, but as Governmental activities have multiplied every civilized country and State have given more attention to it and made more earnest efforts for the preservation of the health of their people. In this State, especially in the industrial sections, it is of pressing importance. The frequency of diseases of a serious nature arising from unsanitary conditions which take a horrible toll of human lives unnecessarily, and cost, in the aggregate, huge

sums of money, emphasizes the importance of taking every possible step to obtain better sanitary conditions and to instill into the minds of the people the importance of making conditions in and around their homes as sanitary as possible. It is well understood by every intelligent layman that a very large percentage of disease is preventable. Hence the importance of a Public Health Day and a Clean-Up Week, when all the people may unite in a harmonious effort for better sanitary conditions.

Therefore I, John J. Cornwell, Governor of the State of West Virginia, do hereby designate and set apart Monday, April Sixteenth, of the year Nineteen Hundred and Seventeen, as Public Health Day.

I respectfully urge the newspapers of the State to call attention to the importance of the work of that day and the following week, and the teachers of the Public Schools to make the question of Public Health a subject of discussion for one afternoon. We can assume that every physician will co-operate in creating a public interest in the work and that all good citizens will unite in the worthy effort of the public health officials to bring about better sanitary conditions in the State.

(SEAL)

In Testimony Whereof, I have hereunto set my hand and caused the Great Seal of the State to be affixed.

Done at the Capitol, in the City of Charleston, this the tenth day of March, in the year of our Lord, one thousand nine hundred and seventeen, and in the fifty-third year of the State.

By the Governor:

HOUSTON G. YOUNG,

Secretary of State.

JNO. J. CORNWELL.

April 16th was named as Public Health Day, and the week following as a clean-up week, and in many communities special efforts were inaugurated by civic clubs and other organizations to bring about improvement in the sanitary condition of communities. The smaller towns imitate the larger, hence the importance of our cities inaugurating sanitary work suggested by this department from time to time. Experience in every state has demonstrated that the weak place in sanitary administration is the municipality. And this is due to two causes, viz: The local health officer is not a whole-time official and he is very inadequately paid. Hence his efforts need to be supplemented by lay organizations, and the most effective are those that are composed chiefly of women who are so often active in efforts for civic betterment. It is a question worthy of consideration whether or not it would be best for all smaller cities and towns to choose live, enterprising women for their health officers instead of physicians who too often hesitate to enforce the law lest they give offense and thereby lose patronage. Nor need we be greatly surprised at this, since they receive a salary of but $50.00 to $100.00 or $200.00 per annum. No one, how

ever, should accept an cffice unless he is willing to perform its duties to the best of his ability.

Unlicensed Physicians.

There has been a large correspondence caused by the fact that there are still a number of physicians in practice in the state who have never secured a license. Some of these have tried to pass an examination and failed. Some have made no effort to secure a license. Others have been brought into the state by contract or hospital physicians who in some cases, as there is good reason to believe, have given them employment, knowing that they had no legal right to practice. Notwithstanding this fact, practitioners frequently apply to this department to protect them from this illegal competition, which we always make efforts to do, although it is rather discouraging when we know some of our own licensed physicians are guilty of doing viclence to the spirit of the law by encouraging its violation. Still, we believe that the state has fewer quacks and fraudulent practitioners of varicus kinds than any state in the country. If we would have this very desirable condition continue, every practitioner who has received a license should be careful himself strictly to observe the law, and in every way possible discourage its violation by others.

Conferences of Health Officers.

The law provides for an annual conference of health officers with the members of the Public Health Council. Two of these so-called "schools of Instruction" have been held annually, one to accommodate the health officers in the northern and the other those in the southern section of the state. Good programs have been prepared and generally one or more of the local health cfficers have been put on the program. In the hope of inducing a fuller attendance, speakers have on several occasions been brought from other states. And yet as a rule the attendance has been disappointing. Not more than fifty have been present at any meeting, and generally the number does not exceed thirty, this notwithstanding the fact that the law provides that the expenses of attending these conferences shall be paid by the municipality or county represented. However, that the result of these meetings has been good is unmistakeable. A growing interest in sanitation is manifest, and public health work is becoming more and more a matter demanding serious attention.

Recommendations.

In concluding this brief report, I desire to make some suggestions which I believe to be in the interest of the public health. A number of these were presented in the last annual report, but I believe them to be of sufficient importance to be repeated here in the hope that they make an impression upon the members of our next Legislature.

1. The department should have authority to examine all contemplated water supplies and sewerage systems, and to negative any proposed plan for the construction of either sewerage or water supply plants when deemed by it necessary for the protection of the public health. To this end a law

should be enacted requiring that all plans for a water supply or for a sewerage system for any municipality or for any state, county or municipal building be submitted for approval to the State health department.

2. The department should also be given the authority, by an amendment to the health law, to compel the laying of a sewer or to change the location of a sewer already constructed, when found to be necessary for the health and comfort of a neighborhood. For want of such authority we have been hindered from abating a number of grave nuisances during the past years.

3. In order to secure an approximation to correct reports of vital statistics, the very basis of all sanitation, a new registration law is necessary, and the passage of what is known as "The Model Law" is urged. This law has the approval of the United States census bureau, it is now in force in a number of states, and is found to give excellent results. This law successfully passed the Senate at its last session, but failed of passage in the House of Delegates.

4. Ophthalmia neonatorum is an eye disease of new-bcrn infants that causes twenty-five per cent of all blindness of children and entails a very large expense on the state. This can be prevented by the application to the eyes of babies immediately after birth of a disinfectant solution. It is urged that a law be enacted compelling the use of such a solution by all persons who are engaged in the practice of obstetrics.

5. The pure food laws needs modification, granting to the department authority to condemn and destroy foods and drugs that are found to be misbranded, adulterated or spoiled.

6. We still feel the urgent necessity of branch laboratories at convenient points in the state. These are already provided for by law, but to secure the aid of the State health department it is necessary for municipal or county Boards of Health to make provision to share in the expense of conducting them.

7. Better results will be secured and politics be permanently eliminated from the State health department if it be provided by law that at no time shall more than three of the six members of the Public Health Council (the commissioner being an ex-officio member) be from one political party, and that the term of office shall be six years, one member retiring each year, instead of one-half of the membership, as at present.

8. A law should be enacted requiring that all women who purpose engaging in the practice of midwifery shall be examined, since many lives of infants and some of mothers also are now sacrificed because of the gross ignorance of women calling themselves midwives.

The following suggestions are made for the consideration of municipalities or counties desirous of promoting the interests of public health: (a) Since the open privy is generally regarded by sanitarians as the greatest menace to public health, wherever an adequate sewerage system exists privies should be entirely abandoned. In other cases a modern sanitary, fly-proof privy should be required.

(b) An ordinance should be adopted requiring the pasteurizing of all milk that is marketed at a distance from the place of production.

(c) Every large community should have at least one public health

nurse, and in the larger cities a tuberculosis nurse also should be employed. Such nurse is regarded by sanitarians as the most important single agency, except the sanitarium, in the control of tuberculosis.

(d) The appointment of a medical inspector of schools in every school district, or in a group of the smaller districts, is urged as a health measure of the very greatest importance, and in the more populous districts a school nurse should also be employed.