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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 enforcir:g 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 germs 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 tlie 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 iinportance 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 s'l};ply 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 made within a few hours if the brain is in good condition. These reports will be sent by telegraph at the expense of those concerned whenever requested.
6. Examination of water supplies. The examination of private wells will be undertaken at the request of a health officer when the physician has good reason for suspecting the water to be the cause of some water-borne disease. Public water supplies will be examined for their fitness for drinking purposes as frequently as our facilities will permit. The samples must be sent in containers furnished by our laboratory and must be accompanied by data cards carefully filled out. Full information is sent with every outfit. The outfit will be sent in care of the health officer. The examinations require about five days.
7. Anthrax, actinomycosis, glanders and trichinosis. These examinations will be made on request of a local health officer, physician or state consulting veterinarian. Glanders material must be packed in Ice and sent to the laboratory labeled “SUSPECTED GLANDERS,” as such material is very dangerous to handle.
8. Diagnosis of syphilis. The laboratory will make microscopic examinations of smears from suspected syphilitic lesions for the presence of the spirochaeta of syphilis. Slides. in proper mailing cases with data cards will be sent on requet.
9. Intestinal parasites. Feces will be examined for the hookworm, lapeworm, round worm, and threadworm. For this purpose outfits will be sent to any physician on request. Outfits will also be found at the distributing stations in each county.
10. Diagnosis of meningitis. Specimens of meningeal fluid will be examined for meningococcus in suspected meningitis. The sample must be sent in a sterile vial, with a history of the case. Reports will be made by telegraph at expense of those interested.
11. Toxicological examination and chemical analysis of milk, food and drugs. Toxicological examinations of stomach contents, foods and drugs will be made by the chemist, state hygienic laboratory.
Our laboratory is prepared to do special work in pathology and bacteriology, such as urinalysis, blood examinations, examinations of tumors, preparation of vaccines, etc. For such private work a charge is made, as this is in no way connected with State Board of Health work. For such work all communications must be addressed to Bacteriologist and Pathologist, West Virginia University, Morgantown.
The Pasteur treatment for the prevention of rabies will soon be given at the hygienic laboratory. For this treatment arrangements must be made with the Bacteriologist. The laboratory is prepared to make investigations of matters regarding the public health when they concern bacteriology, hygiene or epidemiology, at the request of the State Board of Health.
I have already mentioned that we hope soon to distribute typhoid vaccine to physicians of the state. We shall soon be prepared to send outfits for the preventon of ophthalmia neonatorum, and I hope we shall soon be able to distribute antitoxins for diphtheria and tetanus. But all these will depend upon the future action of the State Board of The field of activity of this laboratory will be extended as rapidly as possible, and we hope that it will supply a long felt need in the state. Our greatest duty will be the protection of the public health. To this work the hygienic laboratory is dedicated, and in the performance of this great service we shall need the co-operation of every member of the medical profession in the state of West Virginia.
The following is a copy of the Bulletin of Information of the Hygienic Laboratory of the West Virginia Board of Health, which has been sent to every physician of the state, when the laboratory was organized. It was prepared by Dr. Aaron Arkin, Ph. D., M. D.
STATE BOARD OF HEALTH,
Hygienic Laboratory Force.
JOHN N. SIMPSON, M. D., Director.
The state Laboratory of Hygiene has been organized under the authority of the University and the State Board of Health for the study and prevention of contagious diseases. It is at all times ready to assist physicians, veterinarians, and health officers in making diagnosis of contagious diseases and in advising measures for their prevention. In other words, its work is essentially directed toward the preservation of public health. We constantly receive specimens of tumors of various sorts, urine, and materials on which an examination for poisons is asked. Further than this, not infrequently we have bottles of medicine, patent and otherwise, foods, whiskeys, etc., sent in to us for analysis. Such examinations do not come under public health work and will be made at a moderate charge for the work required. In the case of tumors and pathological specimens, the laboratory is able to make the examination at a moderate cost and is willing to do this to help physicians throughout the state. The laboratory is equipped to do any special work in bacteriology and pathology at a moderate cost.
We give below the examinations which are regularly made free of charge for physicians, veterinarians, and health officers. Such specimens as are not mentioned are not examined by the laboratory is routine work, and in case any one wishes an examination made which is not mentioned in this list, it will be well to correspond with the chief bacteriologist and pathologist of the laboratory before sending in the specimen.
The laboratory is prepared to do the following work:
The examination of sputum for tubercle bacilli from suspected cases of tuberculosis.