To conclude, it has not yet been proven how long a person afflicted with this disease may be a source of infection to others. Among the cases observed and studied during the West Virginia epidemic, not one was found which showed a possible source of infection after 15 days from date of onset, if secondary cases may be taken as proof of the length of time for infection. We have no definite information as to how the presence of the infectious agent may be detected, but it has been proven by tests made upon monkeys that the washings from the nose and throat of a patient will produce paralysis when injected into the meninges of the brain. As it is impossible to make these tests in all cases, the best protective measure for the control of poliomyelitis aside from hospitalization, is a strict quarantine of all members of the family of the patient, without exception, for a period of 21 days from date of onset. In case of death of patient, or removal to a hospital, a quarantine of 14 days should be maintained over the house, and family. There is not as yet any scientific ground for maintaining a longer period of quarantine, and an arbitrary quarantine for six cr eight weeks has a tendency to cause an evasion of the rules regarding the reporting of suspicious cases of sickness, for fear of the inconvenience incident to such a long period. All mingling and congregating of children should be prohibited when poliomyelitis is known to exist in a community, and travel from that community should be so restricted as to exclude all persons under 16 years of age. A strict observance of the rules of restriction on travel during an epidemic is essential to its control, and no certificate for interstate travel should be issued by a physician employed for this duty, to any person who has not first procured a health certificate from the local health officer. Quarantine and travel restrictions should be instituted whenever three or more cases exist in a given locality. The rule requiring that all cases, known or suspected, be promptly reported by both physicians and laymen, should be strictly enforced. Under such conditions, an epidemic of this disease should quickly subside; for, as in epidemics of scarlet fever, measles, and small-pox, the control of contact with the human carrier means the control of the spread of the disease. While in Elkins at the time of the poliomyelitis epidemic, I was called upon to investigate several suspicious cases of sickness in outlying districts. Among these was a case at Burton, Wetzel county, visited on February 20; one at Evenwood, Randolph county, on February 27, and one at Harding. Randolph county, on February 29. A number of country trips were made in the vicinity of Elkins. Medical societies and public meetings in Elkins and Fairmont were addressed, and every physician of Elkins, Grafton, Fairmont, and Morgantown was visited personally for the purpose of enlisting the co-operation of each one in the interest of public health work, and to assist them in diagnosing any suspicious cases. A special effort was made to arouse the public interest in need for proper after care and treatment of persons afflicted by this dread disease, and to show the good that may be accomplished by this care and treatment. The assistance of all public officials in the infected districts was asked for, and was most freely and heartily given. Nuisances. On March 19, 1917, I investigated conditions existing at the plant of the Wheeling Bronze Casting company, Wheeling, W. Va., on complaint from a Mr. Bell, whose home is quite near this plant, and who claimed that the plant as now in operation is a menace to the health of his family and that cf his neighbors. After investigation, I asked Prosecuting Attorney McKee to bring action against this company as soon as it was possible to do so, meanwhile asking for a temporary injunction against the operation of the plant, as the gas fumes from the smelting department are undoubtedly a menace to the health of all persons living near said plant. A second visit was made to Attorney McKee on May 2, 1917, and he reported that the case would be tried on May 9, 1917. Inspection and Miscellaneous. During the fall of 1916, all the dairies of Brooke county were visited and inspected in company with Dr. J. B. Walkinshaw, county and city health officer. State Rules and Regulations concerning dairies were left at each one, and the proprietors requested to observe the same. Many samples of water have been collected and sent to the State Hygienic Laboratory for analysis. Active steps were taken in many towns visited by the director of this division to have made and enforced rules prohibiting the display upon sidewalks of any meat, fruit or other edible merchandise, unless securely covered from dust and flies. Morgantown and Wellsburg have made and are enforcing such rules, and at Keyser I found that such a rule had been in force there for six years through the efforts of the mayor of that city. I consider this an important and necessary measure, and one which should be enforced in every city and town in the state, as it is surely one of the great factors in the control of various diseases. Copy for circulars of information on the care and prevention of the various contagious diseases was prepared by the director of the division of preventable diseases, to be distributed by the State health department in the homes of persons living in districts where any such disease is prevalent. (For want of space these circulars are omitted but will appear in the Quarterly Bulletin.-Health Commissioner.) Referring once more to our recent epidemic of infantile paralysis, I would like to say that I think it necessary to formulate some scheme whereby state aid for after treatment may be furnished to persons who have been left paralyzed by this disease. Many such persons can not obtain the necessary expert advice, but might be restored to a great degree of usefulness by receiving such advice and the proper treatment. I now have in my possession a number of letters from persons asking my advice as to the after care and treatment of this disease. These people lock to the State Department of Health for assistance in this matter. What are we going to do for their relief? On May 28th, 1917, at the request of Dr. Beaumont, city health officer of New Cumberland, W. Va., I investigated a case of smallpox, a female aged 55 years, who was suffering from a discrete case contracted in Bridgeport, Ohio. All children of the vicinity were vaccinated, also adults, and a strict quarantine was established. No new cases developed, showing the efficacy of vaccination in this instance. On June 6th I inspected a school at Valley Grove in the Liberty District, Ohio county, which was reported as being unfit for use for school purposes. The following letters are self-explanatory. West Liberty, W. Va., June 4th, 1917. The State Commissioner of Health, Charleston, W. Va. DEAR SIR: At a regular meeting of the Liberty District Board of Education, June 1, 1917, the following order was passed by the said Board: "That the board of education of Liberty district, Ohio county, West Virginia, requests the State department of health to inspect the school buildings of the district and send the board a report of their inspection as soon as it can be conveniently done." The board of education thinks that the building at Valley Grove is not fit for school purposes and desires the opinion of the board of health. Yours truly, R. I. ROUDEBUSH, Secretary of Board of Education. (Notation)-Respectfully referred to Dr. C. R. Weirich with instructions to investigate the school buildings and report the results to Mr. Roudebush and this office. S. L. JEPSON, State Health Commissioner. June 5th, 1917. Charleston, W. Va. Wellsburg, W. Va., June 7, 1917. Mr. R. I. Roudebush, Secretary, Board of Education, MY DEAR SIR: Your letter to the State health Commissioner asking for an inspection of the Valley Grove and other schools in your district was forwarded to me with instructions to act for the State Department of Health, and I beg to report as follows: The building at Valley Grove is absolutely unfit for school purposes, being both dangerous and unsanitary, and a menace to the health of the pupils attending. In only one point does the building comply with the rules and regulations of the State health department, viz., there are in the building 39 new adjustable desks. But there are also 11 old desks, while 15 pupils must find accommodations on benches. The flooring is practically worn cut and is full of openings, the roof is in bad condition, and the heating system consists of two frost-killer stoves. The outside toilets are inadequate, and no provision has been made for urinal in boys' toilet; both toilets are open, with no properly built vault. The well for drinking water should have a cement base, as there is at present grave danger of surface pollution. In view of the present existing conditions you are hereby ordered not to open said Valley Grove school house the coming term for school purposes. Will arrange to inspect all other school houses in your district on Wednesday, June 13th. Please tell me in writing, as soon as possible, where to meet you. Respectfully yours, DR. C. R. WEIRICH, Director Division of Preventable Diseases. On June 7th I started on a tour of inspection cf dairies in the Moundsville, Sistersville and Middleburne districts, but found the country roads in such condition that it was impossible to visit the rural plants at that time. While in New Martinsville I went with Dr. Fankhauser, county health officer, to inspect a creamery run by a Mr. Vandemir. This plant is equipped for pasteurizing milk and making butter, and the handling of all products was done in a clean and sanitary manner, all construction being of the latest type. The washing of the cans was done by machinery and under steam. All the employees wore clean clothes and looked healthy. The milk used is received mostly from Ohio, and some from nearby farmers. Mr. Vandemir was given a supply of dairy rules and regulations for distribution. He said he was paying strict attention to the sanitary condition of the dairies. The milk cans used were clean and cf the latest pattern. I next called upon Dr. John A. Greer, city health officer of Sistersville, and found that his appointment notice had not been sent in to the State Department of Health. I saw Mr. Reitz, city clerk, and instructed him to send notice of Dr. Greer's appointment to the State health board for confirmation. Next called on Dr. Reppard, county health officer, at Middleburne, but finding him out of town arranged to make a survey of Tyler county at a later date. Martins Ferry, Ohio, opposite Wheeling, W. Va., was visited on June 23rd to inquire as to the disease (poliomyelitis) existing in that city, and to confer with Dr. F. G. Boudreau, State epidemiologist of Ohio. Dr. Boudreau had gone, but I ascertained from the city health officer that all cases were under strict quarantine, children confined to their own premises, and none allowed to attend moving picture shows, etc. Held conference the same day with Dr. Etzler, health officer of Wheeling. On June 26th I started on a tour of inspection of dairies and visits to county and city health officers in Marshall, Tyler, Wood and Pleasants counties. While in Marshall county I visited the county jail in company with Dr. Earle, and found excellent sanitary conditions prevailing there. All prisoners were forced to keep their own cells clean, while the "trusties" looked after the corridors. Dr. Earle also went with me to visit the dairies of the county, which were scored according to the scorecard prepared by the State health department, and suggestions for improvements were made to owners. A general tendency was noticed toward better sanitary surroundings of barns and cleaner handling of milk. The scorecards with names of owners of all dairies inspected were forwarded to the State health department's office at Charleston. Several slaughter houses were also visited and notices given to the owners to place surroundings in sanitary condition immediately. I also visited barber shops, ice cream plants and parlors, and distributed copies of the state rules and regula tions governing such places of business. I held an interview with the editor of The Echo, and gave him data for an item concerning the object of my visit. June 27th and 28th were spent at Middlebourne and in other parts of Tyler county, stopping at the following villages to call upon the physicians in company with Dr. Reppard, posting placards of the State health department concerning typhoid fever and tuberculosis, and distributing rules concerning dairies and the control of contagious diseases. Fifty-two farms were also visited. Towns and physicians visited: luka-No doctor. Lima (Alvy or Stringtown)-Dr. L. A. Baker. Shirley-Dr. J. A. Barker. Middlebourne-Drs. Parks, Campbell and Paul Engle. Alma or Centerville-Dr. E. B. Conaway. On June 28th I also called upon the doctors and the city health officer of St. Marys. Visited all confectionaries, barber shops, etc., and distributed rules and regulations. The physicians of Williamstown were visited on the same day. June 29th was spent in Parkersburg, where I called upon Dr. Crooks, county health officer, and Dr. Richardson, city health officer. Dairies were inspected and scorecards sent to Charleston. The National ice cream and milk plant was visited, and the superintendent of the Imperial ice cream and milk plant took time from his work to show us the entire plant. This plant is thoroughly up-to-date, every modern sanitary appliance being used to insure clean pasteurized milk and ice cream. The milk supply comes mostly from Ohio, and the dairies are inspected by representatives of the company. Dr. Rcse, the city bacteriologist, has made every effort to co-operate with the health officer in creating an active demand from the citizens of the city for clean and bacteriologically safe milk. The mayor and other city authorities are bringing to justice the dairymen who do not come up to the standard. Some prosecutions have been started, the dairymen fined and notice given that if certain requirements are not met, their licenses will be taken away. Much praise is due the mayor and Drs. Crooks, Richardson and Rose for their work done on behalf of the babies and children of Parkersburg. On July 6th I investigated a school site in the Triadelphia district, Ohio ecunty. The following letters explain the object of this investigation: Wellsburg, W. Va., July 3, 1917. Dr. S. L. Jepson, State Commissioner of Health, Charleston, W. Va. DEAR DOCTOR: Messrs. Charles B. Rice and D. M. Thornburg, residents of Elm Grave, W. Va., called upon me this morning in connection with the proposed site for a High School in the Triadelphia district, which is located near the Greenwood and Mt. Calvary cemeteries in Ohio county, W. Va. Judge Hervey, in a recent decision on this matter, rules that the State department of health has no jurisdiction over the purchase of this property by the school board of that district. As the use of this site for school |