the neighborhood of Shinnston, due largely to carelessness in diagnosing the cases. No further report was made as to the prevalence of the disease.

Gilmer County.

On January 9th, 1915 smallpox was reported in Gilmer County by Dr. W. A. Rymer, President of the Board of Health, who sent the following action to the Board:

"It is ordered that Dr. W. A. Rymer be, and he is hereby authorized and directed to lay and maintain, as long as necessary, a quarantine at all places in Gilmer County for any person infected with smallpox or any person liable to spread such disease, and if it shall become necessary to do so, he shall summon and employ a sufficient guard for the enforcement of the said quarantine * ****** and it shall be the duty of said guard to report regularly the conditions of all infected persons and new exposures, and further to report when, in his opinion, it is proper for the infected persons to be disinfected."

The outbreak in this County seems to have been well managed, since no further report was heard from the health authorities.

Fayette County.

On January 28, 1915, Dr. E. J. Grose County Health Officer, of Fayetteville, reported as follows: "We have at this time an epidemic of smallpox at Oak Hill, and many of the inhabitants have been exposed. We have instituted strict quarantine and I think have the situation under good control. Have discontinued the schools and public meetings, instituted compulsory vaccination, and from all accounts the quarantine is being strictly enforced". To this letter I replied as follows: "I am glad to know of your activity in the management of smallpox, as I have complaints from other parts of the State of a want of vigilance. I do not regard it as necessary to close the schools in case of a smallpox outbreak, because this interferes with the progress of the children in their work. I prefer to make public announcement that all children can have a certain preventive in vaccination, and that no children will be admitted in the schools if the parents decline to have them vaccinated. If parents prefer to run the chances of having their children contract smallpox they have that privilege, but it is not right that a prejudice against this preventive measure should be permitted to interfere with the progress of the schools."

Lewis County.

On January 13, at the request of Dr. King, Health Officer of Weston, I visited that city to determine the diagnosis in some cases of eruptive disease, concerning which there was a difference of opinion. I found three children who had convalesced from this disease, and one woman in the early febrile stage, but without eruption. The evidence of smallpox in the case of one of the children was so unmistakable that I did not hesitate to make a positive diagnosis. The case of the woman a day

or two later became unmistakeable. A physician of the city, notwithstanding my positive opinion, given in a lecture to the school children after visiting the patients, persisted in calling the cases chickenpox. A physician of long experience, he of course had his followers. He went into the newspapers with long articles on the subject, even denouncing vaccination as of no avail. As a result the disease spread until nearly forty cases occurred in the town. It also extended to Harrison County. The physician was finally arrested for failing to report his cases, and when the day of trial arrived and I was present to testify in the case, he plead to the court that he was physically unfit to undergo the trial and the case was postponed.

No physician is greatly to be blamed for calling the first case he sees of this very mild form of variola chickenpox, if it occur in a child. He certainly is to be blamed if he stubbornly adheres to a mistaken diagnosis and thus aids in propagating the disease, and he is doubly guilty if he rushes into print to discredit the diagnosis of those of much greater experience, thus creating a doubt in the minds of readers and assuring the spread of a vile disease. Such conduct has been the means of scattering smallpox throughout the State, and entailing a very large expense upon the people for quarantining and feeding infected families and destroying infected property.

Mingo County.

Under date of February 2nd I received a letter from Surgeon-General Blue of the U. S. Public Health Service enclosing a communication from the Secretary of the Kentucky State Board of Health, complaining that the West Virginia Board was not properly managing the smallpox in Mingo County. A little later I received a complaint from a layman in Kentucky that a case "of black smallpox" existed at Devon, W. Va. Communicating these facts to Dr. A. G. Rutherford, Health Officer at Thacker, I received the following reply:

"Thacker, W. Va., Feb. 9, 1915.

I

DEAR DOCTOR JEPSON: I have your letter of February 6th. regarding a complaint from Kentucky about the existence of smallpox at Devon. wish to assure you that every precaution has been taken in this instance, rigid quarantine has been established and every known exposure properly vaccinated. This infection came from McDowell County and the disease spread considerably before the real facts were brought to light, but now the outbreak seems to be under control and every effort is being made to keep it so * * * * * * *. Personally I feel that the Kentucky health authorities have little right to make any complaint against the health department of our State, because Kentucky, through lack of enforcement of their health law, has been responsible for no less than a dozen outbreaks of smallpox on this side of the river within the last two years. I have copies of letters, written by myself as health officer to the author. ities of White County and to the State Health Department, and the copy of a letter from our prosecuting attorney to the Secretary of the Kentucky State Board, praying that they meet us half way in an effort to stamp out these communicable diseases, and I must say that our efforts were not even considered to the extent of a reply to our correspondenc."

The above facts were communicated to the Secretary of the Kentucky State Board of Health, with the suggestion that the desired result would be more quickly reached by a communication directed to this office rather than to the Surgeon-General of the U. S. Public Health Service. Later

it became necessary to send our epidemiologist, D. Weirich, to Mingo County, and he learned that the small pox had been well controlled by Dr. Rutherford, but three cases having occurred in Mingo County in the past six months, while a great number had occurred in Pike County, Kentucky, just across the border.

Harrison County.

On February 18th. I received by telephone from Clarksburg a report of the existence of smallpox in that city, with the statement that no proper sanitary control was being exercised. Unfortunately there has existed for some time a dispute as to who was the legal health officer of that city, and it became necessary for me to write to his Honor the Mayor, as follows:

HIS HONOR THE MAYOR,

Clarksburg, W. Va.

"February 18, 1915.

DEAR SIR:—I have just received by telephone information as to the existence of smallpox in your city, and the statement is made that no proper sanitary control is being exercised over it. As I have before written you, the records of this office show that Dr. Lynn Osburn was elected city health officer for the 'term of four years from January 1st, 1912'. I am aware that there has been local dispute as to who is your legal health officer, but unless Dr. Osburn has been legally deposed from office for cause, he is the only Health Officer of Clarksburg whom we can recognize. A division of responsibility can only result in disaster to your city. I therefore earnestly urge that it be made plain to Dr. Osburn that he is expected to manage this outbreak of smallpox and to do it vigorously. If any proper legal authority can determine that some one other than Dr. Osburn is your health officer, then that person should be urged to move actively in the suppression of the disease, but this office has never been informed of any such legal decision and hence has always regarded Dr. Osburn as the legal health officer. This matter will not admit of any delay, if my information is correct, since smallpox seems to have gotten quite a start in your city. Yours respectfully,

S. L. JEPSON, Sec. State Board of Health."

His Honor, Mayor W. H. Cole, replied to the above, saying that there was but a single case in the city and that he has "recognized Dr. Lynn Osburn as Health Officer and still does," and that there is no "dispute as to who is our legal health officer". I therefore wrote to Dr. Osburn February 20th as follows: "Since the Mayor has written that he recognizes you as the legal health officer of Clarksburg, I must insist upon your assuming full control and performing the duties of the office to the extent of your ability. It will not do to divide responsibility with physicians or any one who may claim to be a health official. You must see that it is to your own interest to take an active stand in this matter, and there is no doubt that you will be compensated in accordance with the provisions of the law, since there can be no doubt as to the legality of your tenure of office." The cases first appearing in Clarksburg were imported directly from Weston, and were the result of the mistaken diagnosis there made. Only a few cases occurred in Clarksburg and Harrison County.

Mercer County.

On February 20, 1915, Dr. W. H. Wallingford, President of the Mercer County Board of Health, reported that five cases of smallpox existed in that town. No further report has since been received.

Wyoming and Raleigh Counties.

On March 13th, the Board of Health of Wyoming County reported an epidemic of smallpox "on the line between this County and Raleigh County about seven miles from Herndon." There seemed to be some difficulty between the Board of Health of the two counties because of cases passing from one county to the other, and after receiving reports from the health authorities of both counties I found it necessary to send Dr. Lind to investigate the situation. I had some weeks before had official information as to the existence of smallpox in those two counties. Dr. Lind spent several days in the infected region visiting different infected localities with Dr. Stiltner, County Health Officer of Wyoming County. He reported to me that he found the outbreak under good control, quarantine having been established at all infected houses. Dr. Stiltner had vaccinated 470 persons. He stated that the Raleigh County authorities had not ordered general vaccination but had established quarantine where they thought necessary. Dr. D. W. Snuffer of Beckley, health officer of Raleigh County. reported that the health authorities of that county had done everything that was necessary.

Pleasants County.

Dr. John E. Womack, County Health Officer of this County, on March 8th, reported two cases of smallpox in that County, one at Belmont and the other at Maxwell. Both cases were contracted in East Liverpool, O. I have received no report since this communication was sent to me.

Roane County.

On March 25th I was requested by the local health authorities at Spencer to visit that place, on account of the existence of smallpox. As in so many other cases, there was a local dispute between physicians as to the true nature of the eruptive disease that existed in Spencer and the surrounding country. With the health officials I rode seven miles to the country and found several unmistakeable cases of smallpox. In the town I saw at least one unmistakable case of chickenpox in a baby. The fact that both diseases existed in this community, and that the smallpox was in such extremely mild form, made the situation more difficult, but the disease did not spread very extensively and since my visit I have had no detailed report.

McDowell County.

On April 10th Dr. H. D. Camper, of Welch, Health Officer, of the County, wrote to me as follows: "I am having trouble in and around Berwind, this County, by people coming in from Virginia who have had smallpox there and who have not been fumigated. After questioning these patients I find that they have been released to go where thy choose without having their persons or clothing properly disinfected. In the past three weeks I have had three bring smallpox to this county, two from Richlands and

REPORT OF

one from Norton, Virginia. As this is an inter-state affair I hope you

will take it up with the Virginia authorities."

I at once wrote to the Secretary of the Virginia State Board of Health, givng the fact above stated and asking the Board to "Kindly look into this matter and have the defective management corrected." No reply has been received and no further report of the smallpox in McDowell County, or indeed in any other counties than those above reported.

SCHOOL FOR HEALTH OFFICERS.

were held by the Council during the past year, one at Clarksburg in OcAs noted in the minutes, two Schools of Instruction for Health Officers forty-nine health officials were present, and at the latter twenty-eight. tober, 1914, and the other in Charleston in April, 1915. At the former Many questions of vital interest were presented in prepared papers or addresses, and these were very fully discussed. It was sought to ascrtain the difficulties and troubles of the local health officials, and efforts were made to alleviate these by proper counsel. Instruction in the health clearly their authority and duties, and the necessity of prompt action in laws was also given, and efforts made to have local officials understand outbreaks of infectious disease, and the importance of the speedy initiation of proper sanitary measures rather than waiting for specific special instructions from the State Health Department.

* at least

The interest in these meetings is on the increase, and they serve to indicate to the State Board of Health who are the efficient and interested local health officers. There are quite a number of local officials who have lous far failed to attend a single meeting or to give an excuse for absence. The law fails to prescribe any punishment for this violation of the law, which distinctly says that "it shall be the duty of every county or municipal health officer to meet with the State Board of Health * once a year". But the health law of 1914 provides that "the failure or refusal of any local health officer to carry out the lawful regulations of the Public Health Council shall be sufficient cause for the removal of such local health officer from office." It is sincerely hoped, however, that all officers who have thus far failed to comply with the law will appreciate the importance of attending the school of instruction, and that it will not become necessary for the Council to exercise the authority given it by the law, and resort to extreme measures to compel the attendance of any.

PUBLIC HEALTH BULLETIN.

This quarterly publication of the Board is proving exceedingly popular, Almost daily requests are received from those who desire their names on our mailing list. The bulletin is quite extensively used in the public schools in connection with instruction in physiology and hygiene, and we are glad to learn, as we have done from numerous letters from teachers, that this instruction in a number of schools includes the teaching of the general principles of sanitation. We have had requests from teachers for as many as fifty to a hundred copies of the Bulletin, and have been informed that in some schools it has been used for supplementary