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To the above, the following reply was received:

Washington, November 10, 1913.
Dr. S. L. Jepson,
Secretary State Board of Health,

Wheeling, W. Va.
Dear Doctor:-

Your letter of the 1st inst. is at hand, and in accordance with the request contained therein Surgeon L. L. Lumsden has been directed to undertake investigation of typhoid fever in Berkeley County, W. Va., in co-operation with Dr. W. T. Henshaw, county health officer. It is the expectation that these investigations shall be continued, not only to determine the prevalence of typhoid fever and its methods of spread, but the measures necessary for its control. Preliminary surveys will accordingly be made this fall, and intensive studies subsequently taken up as the typhoid situation may require.

Respectfully,

RUPERT BLUE,

Surgeon General.

It may be interesting to state in this connection that 230 cases of typhoid fever occurred in Berkeley county during the recent outbreak, resulting in many deaths.

In June, 1914, Governor Hatfield inclosed to me a letter from a citizen of Piedmont, complaining of the prevalence of typhoid fever in that place. From the information contained in the letter I was led to believe that an epidemic prevailed in that community. On June 17th, I visited Piedmont and called into conference all the physicians practicing in the place. Each physician was carefully questioned as to the number of typhoid patients under treatment.

The result of the investigation showed that but three patients were in bed with the disease at that time, and there were three others convalescent who were able to sit up. It was ascertained, however, that this was about the close of an outbreak that had prevailed for some time, not only about Piedmont, but even more extensively across the Potomac in Maryland in and near the town of Westernport. A report recently received from the health officer of Piedmont, Dr. D. J. Long, gives the total number of cases occurring during this outbreak from June, 1913, to June, 1914, as 81, with two deaths, indicating that the type of the disease was very mild.

The prevailing opinion in Piedmont, among the physicians, as to the cause of this outbreak was as follows:

The water supply of the town comes from a small river, the Savage, two miles distant, the water of which is believed to be pure. At times, from some defect in the system of transportation, it becomes necessary to have water pumped into the reservoir from the Potomac River whose water can never be considered as potable.

Prior to this outbreak, one of these interruptions in the water supply had occurred, when the people of the community were compelled to drink Potomac River water.

I urged the necessity of having the water from the ordinary source Board of Health, has since expressed to me the opinion that this water supply is not pure, and later this opinion was verified by analysis of the water. An analysis of water from four local sources was made at the State Hygienic Laboratory at Morgantown, and the result was as follows:

No. 1. From school house spring, unsafe. No. 2. From Savage river, unsafe. No. 3. From artesian well, safe. No. 4. From Wilson spring, unsafe. This examination was made in August, 1914.

In November, 1914, the health officer of Piedmont, reports that he does “not know of a single case in the city at the present time.”

The above outbreaks are all of those which we have been requested to investigate. A letter, however, comes to us from Dr. C. C. Watson, of Albright, a small town of Preston county, which so well describes a condition that exists in many rural districts, that I qnote as follows:

"I think that the main cause of typhoid infection here is in the water. Our water supply is from wells and is gotten at a depth of about 15 feet, making it hard to keep out surface water. These are all dug wells, and some of the old ones are simply walled up with rock. There are 10 or 15 suspicious wells in the town.”

In my sanitary investigations I have learned that the above is by no means a rare condition. Too many of the wells in villages and on farms are dug wells, many of them shallow, not carefully located with reference to the stable and vaults, and not properly walled or securely covered. It is a well-known fact that well water may become contaminated by drainage from a vault located quite a distance from the well. To prevent such contamination it is necessary to see that the well is properly located with reference to any surrounding source of contamination. It should then be carefully walled from the bottom up with cement joints, and covered either with cement or with tongued and grooved boards to prevent surface contamination. The life and health of the people in rural communities very frequently depend upon the adoption or neglect of the precautions here suggested.

It may be here remarked that, judging from the reports that reach this office, there has been very much less of this disease in the state during 1914 than in the previous year. Some of this is no doubt due to improved sanitation, but I can not but think that there are causes operating some years concerning the exact nature of which we are still somewhat in the dark. There is no doubt, however, that if the people would adopt generally the preventive measures now well understood by physicians, and which we have endeavored to lay before the people in the October issue of the Board of Health Bulletin, the amount of typhoid fever in the state could be very greatly reduced.

TRACHOMA.

· The United States Public Health Service, in the pursuance of an investigation as to the prevalence of trachoma in the mountain regions a suggestion from that service, sent into this state in September, 1913, Surgeon Taliaferro Clark for this purpose. Dr. Clark began his investigation at Wheeling where the school children were examined, and out of 2,224 children but one case of trachoma was found. The following table, extracted from the official report of Surgeon Clark, indicates the great prevalence of this disease in our state.

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... 2,947

ant

....

35

273

Number

Examined
Boone

297
Cabell. ........... .........
Fayette ... .................. 1,638
Grant
Greenbrier

435
..................
Kanawha

2,662

.......... Logan

1,078
Marshall .....

1,195
Mason ..
McDowell.

703
Mercer.
Mingo .....
..............

781
Monroe.........

32 Ohio

2,224 Pendleton .....

45 Pocahontas

171 Raleigh

811
Summers ......

756
Wayne .........
.....

1,001
Wood

.. 1,269 Wyoming

..... 472

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....

2:153

5.89

.63 16.94

TOTAL ...................... 20,848

340

1.63

The above table clearly indicates that in Wyoming, Wayne, Mingo, MCDowell, Logan and Boone counties an excessive amount of this very serious disease exists. It may be well here to explain that trachoma is a chronic inflammation of the eye-lids of an infectious nature. For years the disease has prevailed extensively in the neighboring counties of Kentucky and Virginia. As Dr. Clark remarks in his report, “a sharp line of demarkation, represented by the Clinch mountains, separates the infected territory from the other counties of this section of the state. The infection, as in similar territory in West Virginia, is wide-spread in the counties where the disease was found to prevail. From a public health point this is one of the most important and significant facts brought to light by this survey. The wide dissemination throughout a large part of the population of this state of a disease so potentially damaging to vision as is trachoma, and the threatened economic loss to infected communities, should be a matter of serious concern to those in charge of the public health administration of these communities.”

Dr. Clark states that by far the largest number of cases examined by him were among school children, but that he also found a number of cases among adults in his house-to-house inspections. The fact

in very many cases in impairment of vision, makes this a question of very serious consideration and one that demands the attention of the state health authorities. Dr. Clark states that he could obtain no definite information as to how long this disease has existed in the region surveyed. It is a not uncommon belief that the disease was introduced by foreigners, as it is known to prevail very extensively in those parts of southern Europe from which many of our immigrants come. It is the opinion of Dr. Clark, however, that the disease in West Virginia is of very long standing, as he was told by some of the residents that their grand-fathers “had been blind by reason of 'granulated lids.'”

It is believed that before this disease can be eradicated or materially diminished, special hospitals will have to be erected or houses rented where the cases can be scientifically treated. Already the state board has had an application for the establishment of such an hospital in Wyoming county from the active health officer of that county, Dr. H. E. Stiltner. Were means available for this purpose, the secretary believes that skilled assistance may be received from the U. S. Public Health Service. Already he has received a partial promise from that department that an experienced surgeon with one or more nurses may, at some future time, be furnished by the government, if one or more hospitals are provided and the expenses of conducting them be guaranteed. When we consider the enormous economic loss attending the wide prevalence of this disease, it becomes a matter of the greatest importance to institute some means whereby the spread of the disease will be prevented and as many cases as possible be cured. The recommendations of Surgeon Clark, who has had very wide experience in the investigation of trachoma in the different states, may with propriety be here presented.

“1. Systematic examinations for trachoma should be made of all school children of the state.

“2. All children suffering from active trachoma should be excluded from school under medical supervision, until pronounced in condition to return without danger to others.

“3. The expense of such medical supervision of school children should be borne by the state whenever necessary.

“4. A school nurse should be employed wherever practicable, whose duty it would be to visit the homes of children debarred from school by reason of trachoma, and put into practice, under the physicians direction, the principles of control of the disease from the standpoint of the individual and the public.

5. A campaign of education should be instituted in infected territory, through talks to school children and the distribution of printed information relative to the dangers and prevention of trachoma.

“6. A free hospital of inexpensive construction for the treatment of trachoma should be located at a point near the junction of Logan, Mingo, McDowell and Wyoming counties.

7. The co-operation of the mining companies should be secured in order that a systematic examination of all miners may be made by “8. A systematic effort should be made to improve the sanitary conditions of rural schools, to the end that the dangers of school infectious may be lessened.”

Before closing this reference to the prevalence of trachoma in this state, the State Board of Health and its secretary desire hereby to acknowledge their indebtedness to the U. S. Public Health Service, not only for sending Surgeon Clark to make this investigation, but also for aid extended in many other ways, and especially for the very valuable work done in Berkeley county, of which more detailed statements will appear in our next published report.

SCHOOL OF INSTRUCTION FOR HEALTH OFFICERS.

In the amended health law of 1913, it was provided that "it shall be the duty of every county or municipal health officer to meet with the State Board of Health or its representatives at least once a year, due notice having been given, at such time and place as such State Board of Health may designate, to attend a School of Instruction for the purpose of familarizing such officers with their duties in the interest of public health. In pursuance of the object here stated, the board held its first School of Instruction in the assembly room of Hotel Chancellor, Parkersburg on November 28, 1913. The members of the board present were the following: Drs. J. L. Pyle, S. L. Jepson, W. W. Golden, J. H. Shipper, J. E. Robins, J. A. Rusmisell, H. M. Rymer, W. J. Davidson, H. A. Barbee, H. A. Brandebury and D. D. Lind. The following health officers were present: Drs. R. H. Boise, Sistersville; C. L. Boyers, Ellenboro; C. E. Clay and W. T. Henshaw, Martinsburg; H. W. Daniel, Elkins; W. C. Etzler, Wheeling; U. S. T. Ferrell, Cairo; John Folk, Bridgeport; J. B. Grove, Petersburg; J. B. Hodges, Harper's Ferry; F. M. Kearns, Hundred; W. J. Leahy, Mannington; J. S. Kennedy, Salem; T. F. Lanham, Grafton; W. H. Lemley, Littleton; John L. Meyers, Shepherdstown; F. E. Martin, New Martinsville; A. L. Peters, Fairmont; S. J. Posten, Morgantown; J. A. Reyburn, Ravenswood; M. R. Stone, Parkersburg; S. M. Scott, Terra Alta; J. A. Striebich, Moundsville; J. W. Strothers, Belington; H. R. Werner, Thomas; H. C. Whistler, Smithfield; C. R. Weirich, Wellsburg; J. V. Woofter, Troy; W. H. Yeakley, Keyser; O. L. Aultz, Charleston; E. W. Crooks, Parkersburg; J. M. Kearney, Wirt county; U. L. Dearman, Roane county; W. T. W. Dye, Grantsville; E. E. Fankhauser, New Martinsville; A. L. Grubb, Berkeley Springs; U. G. Harper, Beverly; M. M. Hoff, Philippi; A. P. Jones, Pennsboro; J. N. Judy, Petersburg; R. W. Love, Moorefield; C. H. McLane, Morgantown; T. E. Rymer, Ripley; M. M. Reppard, Middlebourne; C. N. Reger, Roanoke; C. F. Shafer, Grafton; J. W. Shull, Romney; R. A. Reger, Upshur county; J. T. Thornton, Wheeling; J. E. Womack, St. Mary's; E. E. Watson, Preston county, and L. N. Yost, Fairmont.

An address by His Excellency, Governor Hatfield, was expected, but he was detained by pressing business. The remainder of the program was carried out as follows:

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