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that the advice of Federal Health Officer should be had before constructing proposed sewer.”

The following reply was sent in answer to Dr. Brandebury's telegram:

“Wheeling, W. Va., April 14, 1914. Dear Dr. Brandebury:

* Your night letter just received, and I have sent to the Mayor of your city the following letter:

“The surgeon general of the U. S. Public Health Service will send an officer of his department to advise with reference to your sewerage system. Please have nothing done until his arrival, as his services will be most valuable to you, and a great error may be committed if you do anything toward locating the proposed sewer until you have his advice. Under no cir. cumstances should the sewage be emptied into the river above the intake of your water supply.”

Yesterday I received from surgeon general Blue of the U. S. Public Health Service a telegram requesting our permission to send an officer to your city for the purpose of advising in reference to your sewerage system. I at once telegraphed that we would greatly appreciate any aid that his department might render to the city of Huntington. No doubt your Mayor will hear from Surgeon General Blue very soon. Very sincerely yours,

S. L. JEPSON, Secretary State Board of Health.”

A sanitary engineer was sent to Huntington by Surgeon General Blue as reported later by Dr. Brandebury. This engineer made a careful study of the situation and later sent to the Huntington authorities a full report of his findings, and, as was reported to the secretary by Dr. Brandebury, his conclusion was that the sewer proposed should not be constructed so as to empty its contents into the river above the present water intake.

Notwithstanding this advice the secretary was informed by Dr. Brandebury, ever active in his interest in the future health of the people of Huntington, that the authorities were preparing to make contracts for the construction of the sewer, its location being unchanged.

The amended health law of 1913 contains the following:

“The State Board of Health shall also examine into and advise as to the water supply, drainage and sewerage of cities, towns and villages, etc.”

While no positive authority is hereby given to the board to prevent the construction of sewers that it believes may endanger the health of a community, yet the above provision of the law seemed to . justify a positive protest against the construction of this proposed

sewer at Huntington. The matter was brought before the board at its meeting in July, and it approved the action thus far taken by the secretary. The following letter was written by the secretary to the mayor of Huntington, and he also requested the president of the Hon. Floyd S. Chapman,

Mayor, Huntington, W. Va. Dear Sir:

I have this morning received a Huntington paper containing a, report of the action of your city commission which seems to indicate a decision so to construct your new sewer as to empty its contents into the Guyan river. You will recall that I wrote a protest against this plan, or the building of any sewer whose contents would flow into the river above the intake of your water supply.

The official of the U. S. Public Health Service who visited your city and made a careful survey of the existing conditions, I am informed, took the same position that I had taken.

This matter was discussed before the State Board of Health at its last meeting and my position was endorsed. I desire again to call attention to this matter which is one of vital interest to the future health of your citizens, and to point out to you the danger of your proposed plan.

Wheeling in two years lost 332 of her citizens in a typhoid epidemic, which physicians of the community believe was due solely to the fact that the sewage from the upper part of the city, which includes a large hospital, emptied into the river above our water intake. When the intake was removed to a point a inile above the city typhoid fever almost entirely disappeared and we have had comparatively little of it since.

Recently, however, since a large increase in population above our present water intake, typhoid fever is again on the increase. I write these facts in an effort to impress upon you the seriousness of the action you are about to take. This proposed sewer is to be put down for a long future, and although your city may escape an early outbreak of typhoid, it is bound to come sooner of later

I want to put myself and the State Board of Health on record as protesting aaginst the locating of your sewer as is proposedin violation of all sanitary laws. Hoping that you may see the immense importance of avoiding such a grave error as is here alluded to, I am,

Yours sincerely,

S. L. JEPSON, M. D., Secretary State Board of Health.

Elkins, W. Va., August 25, 1914. Hon. Floyd S. Chapman,

Mayor, Huntington, W. Va. Dear Sir:

As Dr. Jepson states in his letter to you, his views on the sewer problem in your town have been fully endorsed by the whole State Board of Health. I beg leave, however, to emphasize these views by this additional note of appeal to you as the head of one of our most populous and most modern cities. I take it that these must be some technical difficulties which have led your commission to the decision referred to by Dr. Jepson, as otherwise, it is inconceivable that anyone could be guilty of even the contemplation to commit such a gross sin against public health. But I cannot think of any considerations that would justify such a decision under any circumstances. Dr. Jepson has cited you as an object lesson the experience of the city of Wheeling. I could cite to you a similar experience of the city of Elkins some years ago with the results even more disastrous and could give you within and outside of the state. Should your city continue to disregard the expert advice given you and carry into effect the construction of a sewerage system that will poison your water supply on a wholesale scale, it will not only prove a direct harm to thousands of your citizens, but in an indirect way it will do much harm to hundreds of thousands in our state. The sanitary conditions of our state are not any too good, and our State Board of Halth is doing its utmost to improve them. A step such as in contemplated by your city will prove a bad example for the state at large, for the people of our state have come to look upon Huntington as progressive and modern and a model in many respects. I hope that in addition to the consideration of the safety of the life and health of your citizens, the civic pride of your city will cause a change in the contemplated plan of sewage disposal.

Yours very tiuis (Signed)

W. W. GOLDEN. President State Board of Health.

The last report received indicated that these letters had not made much impression upon the Huntington authorities, who were proceeding with the work of constructing the proposed sewer. Whatever may be the ultimate result, Dr. Brandebury, the local member of the State Board of Health, is to be commended for his active interest in this matter which so vitally concerns the health of the community.

In this connection it may be worth while to suggest that in Ohio and other states positive authority is given to the State Board of Health to interfere and prevent the construction of either waterworks or sewerage plants when, in their opinion, they are not in accordance with the laws of sanitation. The West Virginia board should possess such authority, so that under no circumstances private interests could be permitted to interfere with the public good.

HOOKWORM INVESTIGATION.

At the regular meeting of the board held in Charleston May 7th, 1914, the secretary read a letter from Governor Hatfield, stating that it was reported to him that the hookworm disease exisits in the Pocahontas coal fields. The Governor expressed a desire for an investigation for the purpose of ascertaining the truth or falsity of the report. The secretary stated that upon receipt of this letter he at once coinmunicated with Dr. J. N. Simpson, director of the hygienic laboratory at Morgantown, requesting him to send a competent member of the laboratory force to the coal fields named for the purpose indicated. Professor W. H. Schultz made a visit to that region, and in a preliminary report received from him after a hasty survey, it was stated, that he had found evidence of the presence of the hookworm disease. On hearing these statements the board unanimously resolved to ask Dr. Schultz to visit that region again at his earliest convenience, spending as much time there as may be necessary to make a thorough investigation and put into operation the means necessary to eradicate the disease. He is also to have such additional help from the laboratory salary per month that he is now receiving as a professor in the University, with whatever additional expenses may be necessary in the conduct of the investigation.

In pursuance of this action Dr. Schultz visited the Pocahontas coal fields at the close of his work in the University in June, taking with him three senior students, and remained there until the middle of September. He made a careful survey of that region, visiting the different coal mines, consulting with the operators, coming into close contact with the miners and their families, and made a large number of examinations in suspected cases, a full account of which is contained in the report of the investigation printed on another page. Dr. Schultz did thorough and conscientious work, and, as will be seen from his report, he demonstrated the presence of the hookworm disease in the coal fields investigated, and in addition, the presence of a large number of other intestinal parasites. He gave a number of public lectures with stereoptican views illustrative of his remarks, and, with the aid of the supeintendents of some of the mines, succeeded in instituting some very necessary sanitary reforms. It is deemed necessary that this investigation be pursued next summer, and that other mining regions of the state be carefully examined with a view of discovering the presence of hookworm disease and the institution of measures for its eradication before it secures a firm foothold. Thus far, as shown by the report of Dr. Schultz, the miners and their families have not become so badly infected as materially to influence their general health and earning capacity. It is only a matter of time, however, when such a condition will result if radical measures are not adopted for its prevention.

In many parts of the south the ravages of the disease have been very great, whole families being stricken with it and so reduced in health and strength as to be rendered unfit for the active duties of life. The means adopted for the cure of patients are simple and certain, and with the co-operation of mining companies and the adoption of sanitary measures such as have been recommended by Dr. Schultz, the spread of the disease and its ultimate extinction can be made certain. It is hoped that the report of Dr. Schultz will receive the careful attention that it so richly deserves. The extinction of this disease is one of the most important sanitary problems of the state.

UNLICENSED PRACTITIONERS.

The fact that this state has many unlicensed physicians in active practice, has caused no little annoyance to the board and especially to its secretary. These people are of various kinds. Quite a number are men who have pursued the study of medicine, some of them receiving the degree of M. D. from the poorer class of medical colleges, and who have failed to pass the examination before the board. This has been partly due to their defective preliminary education, and partly to the poor equipment and defective teaching of the medical schools from which they have been graduated. Other illegal prac

medical institution, but who set themselves up as specialists in the cure of cancer or "female troubles.” Then we have the advertising quacks, licensed physicians, and therefore not illegal practitioners, who are yet defrauding the public by lying advertisements and false promises to cure. Through the machinations of all of these practitioners the public is imposed upon, not a few lives are lost by delay in treatment by skilled physicians, and many others are made to suffer longer than necessary for the same reason. The State Board of Health therefore considers it its duty, although one not laid down in the law, to put these people out of business as far as lies in its power. Frequently complaints come to the secretary from local physicians in different parts of the State, asking the aid of the board in ridding their communities of these imposters. It is exceedingly difficult for the Board or its secretary to do any effective work in this direction except in the immediate vicinage of the several members. The secretary has, therefore, sought to enlist the interest of the county health officers who should, we think, assume the responsibility for the prosecution of such cases, and the physicians of the various localities must assist in the collection of evidence if they would hope for any successful results.

Unfortunately, grand juries are not always willing to indict illegal practitioners even when positive evidence of their guilt is presented. They are too apt to think that charges against such men are founded upon jealousy. And we sometimes find prosecuting attorneys quite unwilling to assume any responsibility in such cases, or to take an interested part in their prosecution, even when reliable evidence is presented to them.

An opinion has prevailed in different parts of the state that an unlicensed physician may legally be employed as an assistant to a licensed physician. To correct this impression as well as to stimulate the interest of the prosecuting attorneys of the state, the following communication was sent to the attorney general by the secretary of the board:

“Wheeling, W. Va., Sept. 23, 1913. Hon. A. Lilly,

Attorney General,
My Dear Sir:-

For the information of the State Board of Health, I would like your opinion on the following points:

First. Has an unlicensed physician any legal right to practice medicine under the protection of a licensed practitioner, whether in the office of, or located at a distance from the latter?

Second. Has the board any recourse when a prosecuting attorney declines to prosecute an unlicenssed practitioner, even when abundant evidence as to the violation of the law by the latter is presented ?

Very sincerely yours,
(Signed)

S. L. JEPSON,
Secretary State Board of Health.”

In reply to this communication, the following opinion was ren

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