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SCARLET FEVER AND DIPHTHERIA.

Both of these diseases have prevailed in many parts of the state during the past year. The former especially has existed in several places in a virulent form. In Tucker county many cases occurred with a large mortality. In and near Thomas there were about 70 cases with a mortality of over twenty per cent. I visited the town of Horton in Randolph county in July with Dr. Harper, the county health officer, to investigate this disease which had been imported from Tucker county. There had been quite a number of cases of a severe type and a number of deaths occurred. Many cases have existed in Mason, Kanawha, and several other counties, but the reports reaching this office are so very meager that no definite information can be drawn from them. No doubt that both diphtheria and scarlet fever are spread sometimes by carriers, but chiefly, I think, through children attending school in the incipient stage of the disease, or with attacks so mild that their gravity fails to be appreciated and the disease goes undiagnosticated. We have recently learned of a child in one of the larger cities who attended school several days with a mild sore throat that attracted little attention, but which was later, by a bacteriological examination, shown to be diphtheria. A rule should be adopted in every community and rigidly adhered to, to exclude from school every child who presents any evidence whatever of sore throat, even in the mildest form. In this way many cases will undoubtedly be prevented.

We would be glad to present a table of infectious diseases reported to this office to July first, 1914, but, as remarked above, the reports received are so very imperfect as to convey no accurate information as to the amount of infectious disease prevailing in the state. Some improved method of collecting our morbidity statistics will have to be found before we can expect to institute preventive measures that will be at all effective. We must know where disease exists and know it promptly in order to be of service to the people.

TYPHOID FEVER.

During the year 1913, and early in 1914, this disease prevailed quite extensively in various parts of the state, but few reports of local outbreaks, however, have been communicated to this office, hence we are unable to present anything approaching a complete report as to the prevalence of the disease. It is a well recognized fact that West Virginia has every year entirely too much of this disease, and its control is one of the great sanitary problems of the state. On this point we shall have something further to say before closing this report.

On September 26th, 1913, I was summoned to Dallas, Marshall county, on account of a local outbreak of typhoid fever. The only physician of the village, Dr. E. W. Woodruff, with his wife and only child, were all down with the disease in a Wheeling hospital,

Sammons of Calis, a neighboring village. Dallas is located on very high hills and has a population of about 225. The total number of cases of typhoid fever in the village numbered 23. They were of a mild type and but one death occurred. The large majority of the cases occurred among children. Dr. Sammons used

the prophylactic typhoid vaccination in many of the young people of - the village. In but one case where this injection was used did the fever occur.

The cause of this outbreak was not definitely determined. The town has no sewerage. It has no common water supply, each family having its own pump. It has no common milk supply, many families having their own cow. There was nothing particularly bad in the sanitary condition of the village with one exception, and that is common to all rural districts, namely, the imperfect and unsanitary privy system. I was informed that there was but a single vault in the village. The other privy accommodations consisted of the ordinary building erected on the ground, open in the rear where was found the usual accumulation of fecal matter. There were several suspected wells in the village and the water of these was at my request analyzed by Dr. Arkin of the State Hygienic Laboratory, whose report is as follows:

"Well No. 1, Crider well 700 bacteria ped c. c.; 500 B coli, 200 B. Subtilis.

“Well No. 2, Hart's well, 8000 bacteria per cc. of which 2/3 were bacillus coli and 1/3 B. proteus.

“Well No. 3, Miller well, 13,900 bacteria per cc. of which 1/4 were B. coli and 3/4 streptococci.”

The water of the above wells was thus shown to be polluted and of course unfit for use without boiling, but as the water of these wells was used by a limited number of persons, it does not account for the fact that 10 per cent of the population became the victims of typhoid infection. It probably did give rise to the origin of the outbreak. Contact of the well with the sick, which is always entirely too common in rural communities, is probably responsible for some of the cases, and it is almost certain that the free exposure of the excreta from typhoid cases, together with the fly, the weather being very hot, will account for a number of other cases.

A recent letter from Dr. E. W. Woodruff who is practicing in this village, under date of November 6th, 1914 says, that "no cases of typhoid fever have occurred here this year. This is due, I believe, 'to a general cleaning up and the use of prophylactic vaccine.” I would add, that something is also due to the fact that many of the susceptible young persons of this community were attacked last year, and, as already told, a number of others were vaccinated against the disease. It may be also worthy of note, that the past summer has been notable for the scarcity of flies, as communicated to me from different parts of the state.

During the several years past typhoid fever has prevailed to a greater or less extent in the regions supplied by the Potomac River and its surgeon general of the U. S. Public Health Service and this office contains information that should reach the public. It is therefore, here presented. Suffice it is to say that we at once requested the detail of an officer of the U. S. Public Health Service, and, as will appear later, we have received invaluable aid from this source. The state is under a debt of gratitude to the U. S. Public Health Service.

· Washington, D. C., Oct. 6, 1913.
Dr. S. L. Jepson,
Secretary State Board of Health,

Wheeling, W. Va.
Dear Doctor:-

I am in receipt of a preliminary report of October 1st, from two officers of this service who are now engaged in systematic investigations of the pollution of the Potomac River and its tributaries. Their report is in part as follows:

"We have made a sanitary survey of the South Branch of the Potomac River, including the towns of Romney, Hampshire County; Moorefield, Hardy County; Petersburg, Grant County; and Franklin, Pendleton County, all in the state of West Virginia, together with the surrounding rural districts.

While more detailed data is reserved for the final report the serious sanitary conditions in the valley warrant, indeed demand, such a preliminary report as may bring action by proper authorities toward lessening the heavy morbidity and mortality with consequent sorrow and no less serious economic loss, due to preventable disease, especially typhoid fever.

The “South Branch” arises near Monterey, Highland County, Virginia and flowing rapidly in a northerly direction, joins the Potomac below Green Springs, West Virginia, having received sewerage effluents from the towns inspected, several small hamlets, and from the rural population most of whom live in the valley near or immediately upon the banks of the river or its tributaries which together have a drainage area of about 1490 miles. The river is about 100 miles long and its valley varies in width from mere gorges cut through rock such as “The Trough” to beautiful and fertile areas five or ten miles wide bordered by precipitous mountains rising in some places to a height of 300 deet.

A descent of 12 to 15 feet per mile makes the stream rapid throughout and the time required for pollution to descend from town to town even to the Potomac may in consequence be reckoned in hours rather in days.

On this watershed, especially in the valleys, live about 27,000 people who are as a rule prosperous, industrious and intelligent, but who have, particularly in the rural sections, an annual mortality from typhoid fever which is appalling. For instance, in a radius of seven miles known as Upper Tract there live about 500 persons among whom, according to local physicians, there have been this year, twenty-four cases of typhoid fever with two deaths, a ratio of 6400 cases with 533 deaths per 100,000 per annum. Of 14 persons who camped on the stream below Brandywine, another epidemic center, 9 contracted typhoid fever.

None of the county health officers could even approximate the number of cases in their districts but we think it conservative to reckon the annual typhoid morbidity at from 500 to 600 and the resultant mortality at 40 to 50. Whipple in his classic “Typhoid Fever” concludes: “It may be fairly assumed therefore that $600.00 is a very moderate estimate of the financial that disease.” The state therefore loses annually by a preventable disease in this valley alone $240,000 of its valuable and productive rural citizens.

The people whom we met are not apathetic nor do they consider typhoid fever unavoidable, but they are in a receptive mood toward questions of sanitation and are anxious for instruction."

On account of the conditions mentioned in this report and the evident necessity of some systematic measures for their correction, the matter is brought to the attention of your board. I wish also to inform you that it is the desire of the Bureau to co-operate with your board to such an extent as may be practicable in public health matters, and on receipt of a request, I should be pleased to detail an officer to co-operate with you in work for the improvement of sanitation in the places mentioned in the above quoted report.

Respectfully,

RUPERT BLUE.

Surgeon General.

SECRETARY'S REPLY.

Wheeling, W. Va., Oct. 11, 1913. Surgeon General Blue, U. S. Public Health Service,

Washington, D. C. Dear Sir:

Your letter of the 6th inst. received and I thank you for the information you convey. You may be assured of the hearty cooperation of the State Board of Health in all such matters as long as I have any connection with it. As a new member of the board, I am not quite certain as to the extent of our authority in effecting desired improvements in sanitary conditions. Heretofore, the appropriations for the board have been so trifling as to prevent the board from doing effective work in this direction. It amounts now to but $15,000, but we hope to do enough with this small amount to show the members of our legislature the necessity of increasing the amount appropriated.

You will pardon the suggestion that not all the typhoid fever which you report is due to the assigned causes (here the secretary gave an account of the outbreak at Dallas where the disease could not possibly be attributed to the causes named in the letter from the surgeon-general). I hear incidently of cases not unlike this. My predecessor as secretary of the board, Dr. H. A. Barbee, of Point Pleasant, wrote me recently that he had in his own practice 18 cases of typhoid fever, and that the disease is prevailing in the country districts about his town. Dr. Golden, of Elkins, the president of the board, writes me that the same is true in his neighborhood and the counties near him. These facts cause me to attach less importance to the causes which your reporter assigns for the prevalence of the disease in the South Branch Valley, but of course, I am in a measure an amateur in such investigations, and I of course, recognize the connection between the conditions reported in that region and the prevalence of typhoid, and therefore the necessity of effecting such changes as may be within our power in the hope of at least diminishing the morbidity and morality from this very prevalent cause.

direction, and promising to do what is in my power to make valuable to our people these investigations, I remain,

Sincerely yours,

S. L. JEPSON, M. D., Sec'y.

On October 17th, 1913, at the suggestion of Dr. Henshaw, County Health Officer of Kerkeley County, I visite 1 Martinsburg on account of the prevalence of typhoid fever in Berkeley county. On the 18th, in connection with Dr. Henshaw, Surgeon Lumsden of the U. S. Public Health Service, and Drs. Lefever and Hoffman, of Berkeley county, I visited many parts of the county by automobile, calling at many houses in which typhoid fever existed. In one family we found the mother and two children in bed with the disease. The usual unsanitary privy was found at all of the houses and at some of them the well in dangerous proximity. On the night of the 18th, a public health meeting was held in the Bunker Hill school house, which was filled to its capacity with the people of the neighborhood. An address on Typhoid Fever, Its Causes and Prevention, was delivered by Dr. Lumsden, after which I delivered an address on Smallpox and the Preventive Power of Vaccination, nearly one hundred cases of small-pox having recently existed in the county. Dr. Henshaw closed the meeting with some remarks touching the work that he is doing as county health officer, and in seeking the co-operation of the people in his unselfish efforts for their good. It was after 10 o'clock when the meeting closed and the people with apparent reluctance departed for their homes.

Unusual interest was manifested by the large audience, and it is hoped that much good seed was sown.

As typhoid fever continued to prevail for weeks after my visit to Berkeley county, and the county health officer was determined to do all in his power to control the disease, the following letter was, at his suggestion, sent to the surgeon-general of the U. S. Public Health Service:

Wheeling, W. Va., Nov. 1, 1913.
Surgeon General,
U. S. Public Health Service,

Washington, D. C.
Dear Sir:-

You will confer a great favor upon our board if you can detail an officer to visit Dr. W. T. Henshaw, county health officer at Martinsburg, with a view to an investigation of the typhoid situation in that neighborhood. The county is having a large number of cases of this disease and Dr. Henshaw desires to find its origin if this be possible. I had the pleasure of visiting a part of the county with Dr. Henshaw and Surgeon Lumsden some days ago, and we appreciate the help that has been given to us by your department.

With thanks in advance for anything that you may be able to do, I remain,

Very sincerely yours,

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