The purpose of collecting reports of the presence of communicable disease is to learn where danger exists that it may be averted, and to discover what communities are afflicted, so that they may receive needed help to check further spread of the infections. For this purpose it is absolutely essential that the department knows where infectious diseases exist when they exist. For this purpose it must receive accurate reports promptly, and all health officers are, therefore, required to submit weekly reports of the cases of disease which are brought to their notice. Cases of certain diseases, as poliomyelitis and epidemic cerebrospinal meningitis, must be reported immediately to the department. Those health officers who were most prompt in submitting weekly reports were as follows:

* These figures indicate that in comparison with the total number of cases existing but few were reported.

At the request of the county health officer an investigation was made by Dr. H. B. Wood, October 3 to 7, twenty-six cases of typhoid fever had appeared. Each family was visited, as were ten dairies farms, the ice cream parlors, the waterworks and city spring. In the investigation very material assistance was rendered by Dr. W. T. Henshaw, county health officer.

The outbreak was due to typhoid carriers and milk bottle infection. The outset of the 26 cases of typhoid fever was as follows: July 8th, one case; July 12th, one case; August 1st, four cases; August 9th, two cases; August 13th, three cases;,August 15th, two cases; August 26th, two cases; August 28, one case; August 30th, one case; September 4th, two cases; September 10th, two cases; September 24th, two cases; September 27th, one case; September 28th, two cases; September 30th,

one case.

The distribution of the cases did not represent any explosive outbreak as due to a single distributing agent nor did it represent water-carriage. The water supply is derived from springs and is treated by calcium

hypochlorite in amounts of 0,53 parts available chlorine per million. The water supply is considered safe, mcreover, the outbreak had more the appearance of being the result of one or more typhoid carriers or too much bottle infection. The involved families were obtaining their milk from eight different dairymen, and five had their own cows. The dairies were, however, visited, and at one was found a man who was taken ill with typhoid August 11th, and left his bed September 12th, to go back to the dairy; his only customer who contracted typhoid was taken sick September 3rd. However, the dairyman was ordered away from his dairy, pending the results shown by three fecal examinations. There was some indication that some of the persons were infected by milk bottles which had become contaminated in other households. Except for the washing of the bottles by the milkmen no precautions had been taken to prevent this transmission. Many of the patients had been eating ice cream, four exclusively at cne store. Of three girls who worked at this ice cream parlor, one had typhoid in 1910 and one in 1915. The latter was requested to submit to an examination, pending which she was temporarily suspended from work. The examination was never obtained. Two of the cases were secondaries in infected families following in fourteen days. Spotting the cases on a map showed an irregular distribution of cases. None were located near certain springs along Tuscarora creek, which had previously been condemned. Recommendations: Placard every house harboring a typhoid patient. Placard, also, with a milk card reading: "Notice to milkman. A case of communicable disease exists in this house. Bottles of milk are not permitted to be left here. The householder may place outside a pitcher into which milk may be pcured. This card shall not be removed except by the health officer." Dairymen were asked to more thoroughly cleanse their bottles. One man was excluded from a dairy farm and a sales girl from an ice cream salcon. Vaccination was urged for all members of the infected familties. Maycr E. W. Leiter had the milk placards printed immediately. The result of the work was as follows:

August-Reported cases of typhoid, 15 cases.

September-Reported cases of typhoid, 10 cases.

Investigation made October 3-7.

October-Reported cases of typhoid, 5 cases.

November-Reported cases of typhoid, 6 cases.

December-Reported cases of typhoid, none.

January-Reported cases of typhoid, none.

February-Reported cases of typhoid, none.

The following year there was but one case of typhoid reported from Martinsburg for the entire summer.

Penmar-Typhoid Fever.

Penmar, a small coal mine town on the Elk river, consisted of twelve families, eight of which were found in response to an anonymous telephone request on July 14, 1916, to be infected with typhoid fever. Ten cases of typhoid fever with one death had occurred. The attending physicians had not reported any of the cases. The first case appeared in February,

the second as a contact in the same family in March. The discharges of the patients were thrown upon the ground untreated. All six involved families obtained their water from a spring at the water's edge of Elk river, and which is overflowed by high water.

Cloride of lime in solution was supplied each family for use in sterilizing typhoid discharges. Each family received special instructions. The infected spring was sterilized with chloride of lime and condemned. A typhoid poster was conspicuously displayed.

The outbreak was abated at once.

White Sulphur-Typhoid Fever.

A typhoid outbreak cccurred in May in an apartment house near the ' mouth of Dry Run. The investigation made May 15 showed the presence of six cases of typhoid fever, which, however, had no possible connection with the hotels. The origin of the first case in February could not be determined. One contact and four others occurred. A dug well, receiving surface waste from the first family involved, was incriminated and ordered closed. The typhoid outbreak subsided at once, no other cases appearing during the year.

Marion County-Trachoma Investigation.

The foreign miners and their families at Grant Town and Barrackville were examined August 20 for trachoma. Among 76 adults and 54 children examined, 3 cases of trachoma were found. At Monongah 74 adults and 77 children were examined, with the finding of 3 cases of trachoma and 5 suspicious cases. A total of 6 cases were found among 281 persons examined in Marion county. Cases of trachoma had not previously been reported from the vicinity.

Trachoma Clinic.

A trachoma clinic was held at Williamson October 30 to September 1, under the auspices of the United States public health service. Forty-three persons came to the clinic, of whom twenty were found to have trachoma. Dr. John McMullen, surgeon U. S. P. H. S., in charge of the clinic, made nine grattage and three entropion operations. Dr. McMullen examined 201 school children in the Williamson schools, discovering 16 cases of trachoma. Previous to the clinic a large poster advertising it was sent to every pcstoffice in the county.

Camp Cornwell-Streptococcic Sore Throat.

At the request of Lieutenant C. C. Rusmissel, Medical Reserve Corps, an investigation was made of the second regiment N. G., W. Va., at Camp Cornwell, encamped on the Fairmont fair grounds, May 25. For some weeks since the beginning of the camp a highly contagious, infectious sore throat had been attacking the troops, beginning with soreness and coughing. The infection gave moderate fever, faucial hyperemia, engorged tonsils, bronchial rales and spitting of blood, with occasionally a tendency

to collapse. A few cases of peritonsillar abscesses appeared. There were uyward of one or two hundred cases. When a company became involved the infection traveled very rapidly down the line. At the time of the investigation cultures were obtained from seven throats and forwarded to the State Hygienic laboratory. The findings were short-chained streptococci in four cases, staphylocci in twc, and no pathogenic organisms in one. The laboratory work was done by Mr. M. L. Bonar, state bacteriologist.

RECIPROCAL NOTIFICATION.

When cases of reportable diseases are imported into West Virginia the State department of health notifies the local health officer of their point of origin that proper action may be taken to check the infection at the focus. When cases of reportable disease leave the state the department notifies, if possible, the health officer at the destination or the state health authority. This department welcomes corresponding notification from other states. The Maryland State department of health sent a notice of a glass worker with trachoma as having left Lonaconing for West Virginia. The man was discovered in a glass house at Fairmont and two other unknown contact cases were found. An outbreak of typhoid in Wetzel county was traced to a typhoid carrier who had left for Marion, Indiana. The Indiana State board of health was notified in order that a control could be established over this woman.

PUBLIC HEALTH EDUCATION.

A health exhibit designed and made by the assistant commissioner, supplemented with some purchased infant welfare placards, was displayed at Philippi, the county fairs of Ritchie, Wood, Marion, Pleasants and Kanawha counties, at the Chautauqua at Tunnelton and Terra Alta, and at the Middlebourne Home Coming. The total counted attendance was 9500 persons.

Posters on consumption and on typhoid fever were designed, printed and mailed to the postoffices of small villages and to rural stores; 2190 posters on consumption and 2214 on typhoid fever were distributed. These were printed to be displayed permanently.

Pamphlets on "What You Should Know About Tuberculosis," prepared by the American Medical Association, were ordered by the commissioner, and are mailed to every person reported as having tuberculosis.

Addresses were delivered before ten county medical societies, four schools with an attendance of 420, to 1187 teachers at four teachers' institutes and to nine public audiences, at which there were by actual count 905 persons present.

Newspaper publicity received much attention.

NUISANCES INVESTIGATED.

Nuisances usually have no direct bearing upon health. Local nuisances are, therefore, of local concern and for local solution. A state health department should not be expected to take action against local nuisances, but