In addition to the diseases reported on pages 18 and 19 of this Bulletin, we have to add, for the month of January:

Paper read at the second annual conference of the State Board of Health with county and municipal health officers, June 27, 1905, by Dr. J. W. GRAYBILL, county health officer of Harvey county, Newton, Kan.

One who is in a position to know is often impressed with the strained relations which sometimes exist between the medical man who has control of the health department of a county and some members of the profession. That such relations have in times past existed and do still becomes a self-evident fact to every health officer soon after he assumes the responsibility of his office.

I do not assume that I am a pessimist, neither do I care to have others present me with the appellation. But I am of the opinion that the county health officer is a much-abused piece of humanity; and that much of this can be charged to members of the medical profession cannot be denied. I am not prepared to say that this is ever done intentionally.

But how often it occurs, when we call at a residence to disinfect after a case of contagious disease, that the good housewife informs us the attending physician said "the spare bedroom need not be fumigated, as no one was in that room since Mary was sick." Or, again, when the young health officer appears at a wealthy home in the city where several inmates have been sick with smallpox, he is met with the gentle reminder that "Doctor Know-it-all [the family doctor] has seen to all that," and that his (the health officer's) services were not needed, and nothing short of the chief of police will secure his admission-all because the attending physician has not informed the family that his presence there was according to law.

Another factor, and one which is contributing much as a dis

turbing element, is the lack of confidence which many members of the profession place in the health officer; whether it is because of exaggerated ideas of their own abilities or lack of confidence in that of the health officer, or whether they fear it too much of a condescension on their part, and would thereby add to the popularity of this much-abused man, is a problem I am unable to solve. True it is, however, that many are the medical men who will treat cases of contagious diseases and will never mention that sooner or later the head of the health department will appear upon the scene, " and that his instructions must be regarded as final. Would it not be infinitely better for all concerned if the doctor informed the family, when a diagnosis of contagious disease is made, that the health officer, acting in his official capacity, would instruct them along sanitary lines, and that his advice could be accepted as being good and sound, and that they would work in harmony to prevent a spread of the disease.

There is another point I wish to emphasize before leaving the subject of the profession, and that is in regard to the vital statistics of the counties. Down in Harvey, the county from which I hail, we have in the neighborhood of twenty-five active, up-to-date physicians; and to prove to you that I am telling the truth, and that they are all I claim for them, these same physicians, with two or three exceptions, have not had a death in their practice this year, and it does not look as though there was going to be any. other natural sequence, in a county with such smart fellows as we are, is there would be no birth reports to send in, and it does not look as though there would be any of these very soon.

The greatest problem confronting the various state boards of health to-day is the collecting of vital statistics. Scarcely an assembly of the different state legislatures but what has endeavored to perfect some system whereby these reports could be correctly obtained. Thus far only nine states have given anything like a correct report. (Kansas is not in this list.) Why physicians, who are usually the foremost advocates of the enforcement of laws, should neglect this one that is so important to the advancement of medical science, is beyond my comprehension. It is to be hoped that some method will soon be placed on vogue that will insure prompt and proper returns of these reports.

I have endeavored in the foregoing to point out a few facts which tend to destroy the close relation which should exist between the profession and the health officer. I will also show a few weak points on the other side.

It does not require a very great stretch of the memory to recall a time when the office of the county health officer was a thing which appeared on paper rather than a reality in protecting the community from filth and ravages of contagious diseases.

The majority of you can recall times in your county when the man who presided over the health department was not capable of intelligently caring for a case of measles. I could recall many instances where the physician appointed by a lay board of county commissioners to fill this most important of all county offices was not even a graduate of any medical callege, and had not the slightest conception of hygiene or sanitary science.

I recall one instance where a neighborhood became infected with diphtheria, and half the children of the community contracted the disease; many died and the health officer never came to the infected district, and, so far as I know, never conferred with any of the stricken families or the physician having charge of these cases. The only protection that was afforded the uninfected family was fear; and were it not for the fact that an able physician had been called into the neighborhood, who made it his individual duty to assume control of the epidemic, a most deplorable condition would have soon existed.

In some counties it has been the custom to give this office to the older members of the profession, who were no longer able to meet the demands of the modern physician either from an intellectual or physical standpoint. It is argued "that there was nothing much to do but draw the salary, and most any one could do that."

Another lamentable fact is that in not a few cases political debts have been paid by this office. I could cite several cases in counties in Kansas where this has actually occurred.

Still another condition which is quite common all over the state, and one which is viewed with much disdain by the honorable members of the profession, is the littleness to which these unscrupulous doctors will stoop in cutting the salary of this office. They conclude that the commissioners, seeing an opportunity to save a few dollars for the county, will the more readily consider their applications, and it is striking how often their hypothesis proves correct. This cut-rate, department-store plan has advanced to that degree of avariciousness, in a few places at least, that the most-learned members of the profession will not consider the proposition of accepting the responsibilities of so important an office; and the consequences are that some of these positions have been

filled by professional imbeciles. Very little, if any, of this state of affairs now remains. The health officer is becoming better educated; laws are being enacted at every session of the legislature to give him wider scope and more authority.

The various county health boards are getting more enlightened and choose better men for their sanitary advisers. Physicians begin to recognize the value of health officers who are adepts on hygiene and sanitation, and especially is this true in the larger cities. With this revolution that is constantly going on, it is necessary for the relations between the profession and these men, whose duty it is to see that all the laws pertaining to the public health are enforced, to become closer and more professional than in times past.

The man chosen to fill this important position should be deliberate and always exercise his best judgment. If he is called by a brother physician to confirm a diagnosis of diphtheria, and after thorough examination he believes it to be a case of tonsilitis, he should not hesitate to tell the physician and the family his honest belief, no matter how much he wishes to protect his brother practitioner; for, by this false protection, the family, the county and the state are often the losers.

In some counties it is the rule to have the health officer verify the diagnosis where the attending physition is in doubt. In such communities, the relation of the health officer to the physician is indeed an important one, and he should keep in very close touch with the best men and consult them freely. In case he himself is in doubt, he should not be slow in saying so, and insist upon having a physician who can aid in clearing up the diagnosis. If, in the course of his duties, he should find a case of contagious disease cared for by an ignorant doctor, or one who is careless and negligent, the health officer should not hesitate to advise him and call his attention to the State Board's rules, and insist on a strict adherence to same. This can be done in such a manner as to cause no embarrassment to him or ridicule from the public.

It is almost needless to say that the laws pertaining to public health and the rules of the State Board should be at every health officer's tongue's end. It frequently occurs that a member of the profession wishes to be enlightened on this subject, and it saves some embarrassment and much valuable time if the health officer can give him the desired advice without having to make a trip to his office to find out.

The most-important factor to be considered in strengthening