REPORT OF THE BACTERIOLOGICAL DEPARTMENT Dr. S. L. Jepson, Secretary State Board of Health, Dear Sir: I have the honor to present the following report of the bacteriological department for the year ending November 30, 1914. In November, 1913, Gov. H. D. Hatfield and a committee of the State Board of Health visited the laboratory of pathology and bacteriology and decided to locate the hygienic laboratory in connection with the university. We immediately began to organize and equip the laboratory to handle the work required of a hygienic laboratory. This was a difficult task in view of the fact that our state in the fifty years of its existence had never before had a state hygienic laboratory. The laboratory had to be equipped, and all circulars, data cards, etc., printed with nothing to guide us. After a visit to a few of the better equipped hygienic laboratories, I obtained the necessary equipment for the bacteriological work. The next task was the publication of a "Bulletin of information concerning the hygienic laboratory of the West Virginia Board of Health," a copy of which is embodied in this report. We sent a copy of this bulletin to every registered physician in the State last April. Following the issue of the Bulletin, permission was obtained from the postmaster general to receive pathological specimens in containers which comply with the postal regulations. These containers were obtained after considerable difficulty and prepared for distribution, containing all the necessary information, data cards, etc. The next step was the establishment of distributing stations for the free distribution of outfits for tuberculosis, typnoid, diphtheria, etc. I established a station in each county of the state. The list of stations is given at the end of this report. On April 1st Mr. E. B. Fink, Sc. B., was appointed assistant bacteriologist of the department. We are now prepared to do the work required by the physicians of the state. Our greatest handicap is lack of space because of our crowded quarters and the increase in the amount of work. If the work continues to increase at the same rate we shall need more assistance, especially in the manual labor required in the preparation of outfits, media, glassware, etc. We hope soon to have larger quarters for our work, as arrangements have been made to carry on this work in the new medical building. In addition to the routine work done by the laboratory as described below, we are now engaged in the study of several problems in hygiene and preventive medicine. A careful analysis of over 300 complete bacteriological examinations of water from 35 counties in the state will bacteria, tests for bacillus coli, tests for acid forming colonies, were carried out. Furthermore, valuable data concerning the kind of well, depth of well, formation of the soil, relation to possible sources of contamination, a study of the relation of the unsanitary privy to water pollution, the prevalence of intestinal diseases in the community, etc.. have been collected. This investigation when completed will give us a knowledge of the source of our cases of typhoid fever, thus forming a working basis for the proper sanitation in the country districts. A complete bacteriological survey of the water supplies of the state should be made, and we are prepared to do this work, with aid from the state. Comparative results on sputum examinations are being collected to determine the best method for determining the presence of the tubercle bacillus in sputum. Studies on the bacteriology of food products, especially bread and fruits, are under way in an effort to obtain data concerning these foods as the possible source of the spread of infectious diseases. The hygienic laboratory is now prepared to make the following examinations free of charge for physicians and health officers: 5. 6. Examination of brains of animals for the diagnosis of rabies. eral fitness for drinking purposes. 7. Examination of specimens for anthrax, actinomycosis, glanders, or trichinosis. 8. Examination of smears for the spirocheta pallida of syphilis. 9. Examination of feces for intestinal parasites, as hookworm, tapeworm, roundworm. 10. 11. Examination of spinal fluid for meningococcus. Toxicological examinations and chemical analysis of milk, food, and drugs. Complete details concerning the preparation and sending of specimens are given in a bulletin of “information concerning the hygienic laboratory of the West Virginia Board of Halth," which has been sent to every registered physician of the state, and a copy of which is given below. An inspection of the list of examinations made by the hygienic laboratory reveals the fact that these are limited to transmissible diseases. It is obviously unfair to expect the community to pay for what is of benefit to a few, so if an examination is desired by an individual for personal reasons, such examination is regarded as private. The examination of sore throats for diphtheria, of sputa for tubercle bacili, of blood for evidence of typhoid fever, etc., are of importance to the entire community, for the presence or absence of the disease in question determines the spread. On the other hand, the examination of urine the type of anemia, diagnosis of tumors, etc., are not of importance to the entire community. The investigation of public water supplies is of public interest, but the examination of a local supply used and owned by a private individual is not a public health matter, except as disease from such a source may be disseminated to the rest of the community. For example, the presence of contamination in a well supplying a dairy may be of considerable importance. The hygienic laboratory of the West Virginia State Board of Health is prepared to deal with health matters of public interest. It was created and is maintained by the State Board of Health in the interest of the entire people of the state. We are trying to protect the well rather than aid the sick. The laboratory findings will, of course, be helpful to the physician in his diagnosis, but the chief interest is the location and localization of foci of disease and contagion in order to protect our community. When a sample of sputum is sent to the laboratory our chief interest is in determining whether or not the sputum is endangering the public health. Demonstration of tubercle bacilli means that the patient is subjecting his community to infection; that the patient is discharging daily millions of the germs of tuberculosis which, if they are not properly destroyed, are an unseen source of danger. It is the duty of enforcing the laws of preventive medicine, laws gained through the toil of members of our own profession in the discovery of the etiology of the contagious diseases, that each physician is called upon to perform whenever he receives a positive report on a contagious disease. The diseased individual is not the only source of the spread of the infectious diseases. We must now take into consideration the healthy disease carriers, also indirect transmission. We know that diphtheria bacilli may be found in the throats of apparently normal individuals, organisms capable of producing the typical disease in others. In fact every patient with diphtheria is surrounded by a few temporary carriers who may have no symptoms of the disease, but who may be more dangerious to the community than the patient himself. For the patient is in quarantine, while the carrier is at large. Further evidence for the above statement that apparently normal people harbor the diphtheria bacillus has just been obtained by an investigation, which has revealed the fact that a certain number of normal individuals, who have never had diphtheria, show the presence of diphtheria antitoxin in the blood. There is probably sufficient antitoxin in the blood to render these individuals immune, although they can infect others. We know that a typhoid patient may discharge typhoid germis for months or even years after complete recovery, or may harbor the typhoid bacillus in the urinary tract or gall bladder without even having shown symptoms of the disease. It is in the release of dephtheria patients from quarantine and the examination of suspected carriers that the hygienic laboratory may be of service to the health officers of our state. No physician should discharge a diphtheria patient until two negative results are obtained from the throat; no typhoid patient should be turned loose on the community until the feces and urine are free from typhoid The hygienic laboratory is able to furnish facts which will be an aid to the health officer in his work. The relative value of the laboratory findings varies under different circumstances. Often the results are not specific and require interpretation. It is in such cases especially that all possible information should be carefully recorded and sent with the specimens. The best example is in the case of water sent for bacteri ological examination. Here the data called for in the outlines sent out by us for each sample must be compiled with great care and sent with the sample before a reliable interpretation of the bacteriological examination can be made. Such data are of even greater inportance in the thorough investigation of epidemics of typhoid and other water-borne or milk-borne diseases. In an outbreak of an epidemic the local health officer can be of great service to us by investigating the conditions before requesting examination of the drinking water. He should (1) make a thorough study of the outbreak and get careful case histories; (2) inspect the general sanitary conditions; (3) examine the sources of the water, milk, food supplies; and (4) request laboratory assistance, as the indications may require. Such a procedure would prevent many unneces sary examinations and more valuable results could be obtained. Epidemics caused by water, milk or flies have their individual peculiarities which can easily be observed by the health officer. Laboratory findings are of little value in milk-borne epidemics, but the examination of local conditions usually makes the source very evident. Water analysis is more valuable and the importance of the condition of the water supply is well known. Many samples of water are sent to me with the request that they be examined for typhoid bacilli. The isolation of the typhoid bacillus from water is attended with great difficulty and has been accomplished but a few times. It does not remain alive as long as the colon bacillus, and it is the latter organism which is used as the index of contamination of water. In other words, a water supply the cause of a typhoid epidemic usually shows the presence of colon bacilli and not B. typhosus. The importance of the purity of the water supplies in the prevention of typhoid fever requires no demonstration, for not only is the death rate from typhoid fever generally reduced by purification of the water supply, but also the death rate from other associated diseases. Typhoid fever is one of the greatest sanitary problems of our state as well as of our country. In the United States typhoid fever ranks fourth on the list or mortality statistics. The order is tuberculosis, pneumonia, cancer, typhoid. In 1910 there were 25,000 deaths from typhoid in the United States. This is a very serious situation when one considers that the death rate is about 10 per cent, which means that in 1910 we had 250,000 cases of typhoid fever in the United States. This means an economic loss of upwards of $100,000,000 per year. But there is a more serious phase than this. To me the most serious side of the typhoid situation is the fact that of the 250,000 people suffering from typhoid fever in 1910 alone, hundreds of typhoid carriers are produced, people who are turned loose on the community to infect means prevention of the production of typhoid carriers, unknown sources of infection. In this great work the physician has a dual duty, first to protect the community, second, to assist the patient. Every case of typhoid fever means a short circuit between the discharges of one person and the mouth of another. From the standpoint of preventive medicine the prevalence of typhoid in a community is a reflection on the sanitation of that community. To aid the physicians and health officers the hygienic laboratory will perform a two fold duty. First, we are prepared to diagnose the disease by means of the Widal or agglutination test and thus aid the physician in locating the foci of infection; second, we examine the water and milk supplies for evidence of contamination, and, what is more important, we hope to prevent water-borne infections by making routine examinations of the water supplies of the state. A report of the bacteriologic examinations of over 300 samples of water from 35 counties will soon be published. This work is now under way. We may in the future prepare to distribute typhoid vaccine for prophylactic use. The value of anti-typhoid vaccination has been demonstrated beyond the question of a doubt. It protects against the disease for a period of two to four years. I would suggest that each county be required to buy a container for the regular examination of public water supplies in the county. I shall consider briefly each of the routine examinations made by the hygienic laboratory for physicians and health officers: 1. Diagnosis of tuberculosis. The diagnosis of tubercular sputum is accompanied even under the most favorable conditions with some danger. To protect those making the examinations the samples must be sent in outfits furnished by the laboratory. The glass bottle contains some 5 per cent carbolic acid, which should not be thrown away. Reports are sent on the day specimens are received. 2. Diagnosis of diphtheria. The diphtheria outfits consist of a double mailing case containing a sterile swab. The swab is inoculated from the throat or nose, as the case may be, replaced in the sterile test-tube and immediately sent to the laboratory. Laboratory outfits must be used and data cards returned properly filled out. Reports are sent out in 24 hours, by telegraph or telephone if requested. 3. Diagnosis of gonorrhea. Smears of pus will be examined for the gonococcus. Outfits for sending the slides can be obtained by physicians on request. Reports are made on the day specimen is received. 4. Diagnosis of typhoid fever. The agglutination test for typhoid fever will be made for physicians. Complete outfits with directions are furnished to any physician on request to the laboratory, and will be found in stations established in each county. 5. Diagnosis of rabies. The brains of animals which have bitten humans will be examined for rabies. Wherever possible the animal should be kept alive until it develops symptoms. This occurs within ten days if the animal has rabies. The head should be carefully packed in ice or else placed in glycerin in a jar. The diagnosis is made by examination of the brain for the Negri bodies and by inoculation of a |