done. The delay in the printing of this report occasioned by war conditions which resulted in the loss of four men from the state health department, enable us to say here that the legislature of 1919 has enacted an amendment to the health law which we give below, which will probably add greatly to their work. The following new provision of the law we regard as wise and as bound to result in the bettering of local sanitary conditions and the prevention of disease.

"Said public health council shall consult with and advise the authorities of, cities and towns, and persons having, or about to have, systems of water supply drainage or sewerage as to the most appropriate source of water supply, and the best method of assuring its purity or as to the best method of disposing of their drainage or sewage with reference to the existing and future needs of other cities, towns or persons which may be affected thereby. It shall also consult with and advise persons engaged or intending to engage in any manufacturing or other business whose drainage or sewage may tend to pollute any inland water as to the best method of preventing such pollution, and it may conduct experiments to determine the best methods of the purfication or disposal of drainage or sewages. No person shall be required to bear the expense of such consultation, advice or experiments. Cities, towns and persons shall submit to said public health council for its advice their proposed system of water supply or of the disposal of drainage or sewage. In this section the term 'drainage' means rainfall, surface and subsoil water only, and 'sewage' means domestic and manufacturing filth and refuse. No city, town or village, and no person, firm, or corporation shall establish any system of drainage, sewerage, or water supply system until the same shall have been approved in writing by the state health commissioner; and any municipality, person, firm or corporation which shall violate the requirements of this secion shall be deemed guilty of a misdemeanor and upon convirtion thseof fined not less than one hundred dollars,, nor more than five hundred dollars."

HYGIENIC LABORATORY

This institution has been located, since its organization, at Morgantown in connection with the State University. While such association has some advantages both for the University and the laboratory, the location was found to be so distant from the center of population as to render speedy expressage and mail deiveries impossible. It was therefore determined by the Public Health Council to remove the laboratory to Charleston where are established the headquarters of the state health department. Suitable rooms were secured in July 1918, and these have been fully equipped with all apparatus necessary for the work of a state institution of this kind, and a competent bacteriologist and also a chemist have been secured. The profession of the state can be assured that all necessary work needed can now be done at this laboratory, and physicians are urged to make more free use of the facilities afforded than they have thus far done. Arrangements have been recently made for Wasserman examinations which will be made for any physician for a moderate fee.

Branch Laboratories

amount of money to aid a combination of counties to maintain a laboratory which The law gives to the Public Health Council the right to appropriate a limited would be used almost entirely for emergency work, such as the diagnosis of diphtheria, meningitis, typhoid fever, etc. Such examinations can be made at small cost and almost all of our larger cities should have a physician competent to make such investigations. Thus far, however, although considerable effort has

been made, we have not yet succeeded in sufficiently interesting any number of adjoining counties to secure a combined effort that would justify the Council in making an appropriation that the law provides.

TRACHOMA HOSPITAL

For several years past this institution, organized by the United States Public Health Service under the direction of Surgeon John McMullen, has been doing excellent work at Welch. A report of the last year's work will be found on another page. We regret to announce that recently the patronage had so largely diminished as to make it appear to the United States authorities scarcely necessary to continue it in operation longer. It has, therefore, been abandoned for the present. We desire here to express our appreciation of the valuable work done and hope that alɔration may be yet found nearer the center of population of those who are the unfortunate victims of trachoma, when the hospital may again be opened.

SCHOOL SANITATION

We continue to receive reports as to school houses improperly located and in bad sanitary condition. As samples of the complaints received, we quote the following:

“Our school building violates every provision of the health department as to nearness to barns, pig styes, noise-making industry, stagnant water, etc. There is one room under which the ground is frequently overflowed and the teacher developed symptoms of tuberculosis."

"This school house is an old ramshackle building. The floor is so badly worn that it is impossible to keep it clean. The insanitary privies join directly on to the building at the back, and the odor from them at times is almost intolerable. The building is open to the weather through cracks in the boards, and many window panes are gone. It is not a fit place for the lower animals and certainly not for young school children."

A lady writes of a private school building:

"The bath and toilet rooms are filthy and reek with odors. In one room noxious, ill-smelling, headache-producing gases rise up to about four feet above the floor, and as the principal refused to make any improvement I withdrew my son from the school."

In all such cases as this, we endeavor to have an investigation by the local health officer, and if the complaints are justified, efforts are made to bring about the necessary improvement, and in a number of cases these have been successful. We also occasionally receive complaints of a teacher who is suspected to have tuberculosis. Here is our reply to one such complaint:

"I suggest that it first be ascertained by a careful physical examination by a competent physician, and also by a bacteriological examination of the sputum of the teacher referred to, whether or not this teacher really has tuberculosis. If it is learned that the disease is present he should be waited upon by the trustees who employed him and informed that our rule No. 27 has been violated, and that he must retire from his position. If he claims he has a year's contract and declines to resign, you had better pay him a year's salary than to have him continue to teach."

MEDICAL SCHOOL INSPECTION

Although the law does not make it the duty of the state health department to supervise the medical inspection of schools, yet we have so fully recognized the very great value of this work that we have corresponded with the boards of education of all independent school districts whose legal duty it is to employ school inspectors, and were surprised to learn that about one-third of such districts have been and still are persistently violating the law. The old excuse for such violation is the alleged scarcity of money. The value of careful medical inspection of children can scarcely be over-estimated. Many physical defects are thus detected and may be remedied if properly attended to by skillful physicians. The life insurance companies realize the very great value of frequent physical examination of insured persons nearly all of whom are adults, and are adopting plans whereby annual examinations may be secured. How much more important to detect the physical defects in children when they may be so much more readily corrected. Every school, however small, should make provision for the annual examination of its pupils by intelligent physicians. Our judgment is that this work should be under the general supervision of the State Health Department. We feel quite confident that all the money expended for this purpose will be more than repaid by the improved health and earning capacity secured to pupils by early, careful medical attention to defects which would otherwise escape notice or be permitted to go too long unremedied.

DAIRIES

During the year we have endeavored to secure an improvement in dairies, but with our limited office force we can not hope to accomplish much in this direction. This burden of dairy inspection should fall upon the county and municipal health officers, but as these officials generally receive a very inadequate salary, not much extra work can reasonably be expected from them. Dr. Wood prepared a dairy score card and during the year inspected a number of dairies and endeavored to interest some of the health officers in the work. Not a great deal, however, has been accomplished in this direction. To a number of dairymen whose premises were found quite defective, the following notice was sent:

"The conditions of your dairy, as recently scored and reported to this department, is shown to be very much below the standard at which you should aim . Unless marked improvement is shown in your dairy at the next inspection, it may be necessary for us to make public the result of these inspections.'

In this connection we again refer to a custom all too common, of returning milk cans that have been shipped by rail without completely emptying the milk and cleansing the cans. This is bound to result in evil that may prove very seriousWe have endeavored to remove this condition of things, and the railroad com. panies are joining us in our efforts, one of them issuing the following order:

"This law requires that every person, firm or corporations receiving milk, cream or ice cream, which is delivered in cans, bottles or other receptacles, shall thoroughly cleanse and sterilize such receptacles with hot water or steam, or both, as soon as practicable after the contents are removed, AND BEFORE THE SAID RECEPTACLES ARE RETURNED TO THE SHIPPERS OR PERSONS FROM WHOM THE SAME WERE RECEIVED. The faiure to sterilize

and cleanse such receptacles in the manner specified, AND BEFORE THE SAME ARE RETURNED TO THE PERSONS FROM WHOM RECEIVED is a violation of this law, punishable by a fine of $5.00 for each bottle, can or other receptacle furnished or used, which has not been cleansed or sterilized as above provided.

You are hereby notified and warned that these requirements will be strictly enforced."

RAILROAD SANITATION

During the year a number of complaints have reached the department, especially as to the insanitary condition of the toilets at railroad stations, and we have personally noted on one railroad line that even the toilets on the coaches have been disgracefully filthy. Efforts by correspondence with the officials have been made to correct this evil, but we fear not with great success. Conductors and station masters do not seem to be sufficiently alive to the magnitude of this evil, and one or two with whom we have discussed the matter seem not to have been informed by the road officials as to the state health department's regulations or their duty to bring about better conditions.

NUISANCES

We still have to respond to may letters received from various parts of the state complaining of nuisances of various kinds, some of the most trivial character. A number of writers say that "this has been called to the attention of the local health officer but he does nothing." The local health officer is the proper authority to remedy such evils as those referred to, unless they are of such serious character that state intervention becomes necessary, and in such cases it generally becomes our duty to secure the intervention of the court before a nuisance can be abated. So it is almost never necessary to go higher than the county board of health, one of whose members is the prosecuting attorney, in order to have proper action taken to abate nuisances. It is necessary, however, for local health authorities to assume greater responsibility, since in matters of this kind they have the same authority as has the state health department.

TUBERCULOSIS SANITARIA

The State now has two institutions for the care of those sick with tuberculosis, one (located at Terra Alta) for the white patients and one for the colored at Denmar, Pocahontas county. The law provides that the Public Health Council "shall have advisory control" of the former, which the Attorney General has decided is no control at all, but we can advise the Board of Control as to its management if we care to do so. We have had a committee of our Council make several visits to the Terra Alta sanitarium and reports with suggestions as to improvements have been made to the Board of Control. It has not come to our knowledge, however, that any of these suggestions have produced results, hence the Council, since receiving the opinion of the Attorney General, has resolved to dispense with its visiting committee. We do, however, receive stated reports as to the number of patients dying at this institution and dismissed from it, and to each of the latter is sent a pamphlet on "What You Should Know About Tuberculosis", which contains much valuable information as the proper mode of living to improve the patients health and protect others from infection.

CONFERENCE OF HEALTH OFFICERS

For several years past the Public Health Council has held semi-annually what the law terms "schools of instruction for health officers" but which we prefer to call conferer.ce of health officers. Every health officer in the state is required by law to attend at least one conference annually. At these conferences various questions are discussed in which such officers should be interested. Unfortunately many health officers never attend these meetings, notwithstanding all their necessary expenses are paid by the various municipalities or counties represented. Particulars as to these meetings in the last fiscal year may be found in the minutes of the Council on following pages. After unusual effort and some intimation that discharge from office might result if health officers persisted in neglecting their legal duty, the conference held in Huntington in April 1918 was attended by sixtythree persons, constituting the largest and most interesting of all our meetings. We are quite sure that all who were present went home satisfied with the day's experience, and received some stimulus for the better performance of their official duties. So long as health officers are appointed for political reasons and receive extremely meager salaries, not much advance in local sanitation can be expected. We fully endorse the sentiments here expressed by a recent writer:

"Regardless of the sources of authority, whether federal, state, or local-appointments of health executives must depend wholly on professional qualifications and tenure of office be based on efficiency. Political considerations should have no part in the making of public servants of this character.

Furthermore, such servants should be prohibited by law from engaging in other than their official duties. If these duties, and funds available, in a particular health unit are not sufficient to justify the services of an all-time man, two or more units should be authorized, and in fact compelled by state law to unite in the employment of such a man.

By such provision, public health administration will become more attractive as a career, and physicians will be justified in taking special courses in preventive medicine. Moreover, universities will be compelled to perfect such courses, and public health will become more and more a paying investment."

HEALTH BULLETIN

The quarterly health bulletin issued by this department is becoming increasingly popular if we may judge from the many requests to be put on the mailing list that come to us. We now print 10,500 copies and almost all back issues are exhausted. We are glad to know that it is used quite extensively in the schools, and teachers often send for a sufficient number of copies to supply an entire class. This is an indication that the study of hygiene and sanitation is becoming much more common than formerly, and school children are learning that it is more economical to keep well by avoiding the causes of disease than to purchase health after sickness has once implanted itself. The basis of all advances in sanitation must ever be the education of the people in the principles of health preservation, and if these principles are implanted in the minds of the young we may hope that the coming generation of adults may be willing to have our legislature vote an apropriation for the state health department of considerable more than 2 cents per capita, the total amount with which we have had to work for the past year or two.