EPARTMENT HEALTH HEALTH BULLETIN No. 5. PROCEEDINGS OF THE Third Annual Conference of the Boards of Health OF THE COUNTIES, TOWNS, CITIES AND STATE OF VIRGINIA, HELD IN THE AUDITORIUM OF THE JEFFERSON HOTEL, RICHMOND, VIRGINIA, THURSDAY EVENING, OCTOBER 22, 1908. DR. RAWLEY W. MARTIN, Lynchburg, Presiding. The Work of the State Health Department, DR. E. G. WILLIAMS, Health Commissioner for Virginia. Discussion by DR. H. R. DUPUY, Health Commissioner, Norfolk. Remarks by Invited Guests, SURGEON C. P. WERTENBAKER, U. S. Public Health and Ma- HON. W. W. BAKER, Member of the House of Delegates from Entered as second-class matter July 28, 1908, at the post-office at Richmond, Virginia, First Congressional District. CHAS. R. GRANDY, M. D...... Second Congressional District. J. B. FISHER, M. D....... Third Congressional District. O. C. WRIGHT, M. D..... Fourth Congressional District. LEWIS E. HARVIE, M. D...... Fifth Congressional District. R. W. MARTIN, M. D...... Sixth Congressional District. S. P. LATANE, M. D..... Seventh Congressional District. W. M. SMITH, M. D.... . . . Eighth Congressional District. J. H. DUNKLEY, M. D.... Ninth Congressional District. REID WHITE, M. D.... Tenth Congressional District. .Norfolk. . Midlothian. .Jarratts. .Danville. .Lynchburg. Winchester. Alexandria. .Saltville. .Lexington. GEO. BEN JOHNSTON, M. D.; STUART MCGUIRE, M. D. City of Richmond. Third Annual Conference of Health Officers of Virginia. This conference was called by the State Department of Health for the purpose of securing a better acquaintance among the health officers of the State, and of advancing the work of public health in Virginia. The meeting was held in the auditorium of the Jefferson Hotel on the evening of October 22, 1908. The attendance was gratifyingly large, both medical and lay members being present, and great interest was manifested in the proceedings of the conference. Owing to the fact that only one evening could be secured for, the meeting, but few speakers could be heard, and much discussion had to go over to the next meeting. It is believed that this conference can be of great value to the work in the State, and at future meetings opportunity for several sessions and much fuller discussion will be provided. THE WORK OF A COUNTY BOARD OF HEALTH. Dr. H. S. Hedges, Secretary, Board of Health of Albemarle County. The Albemarle County Board of Health was organized in the fall of 1898, at the time of the widespread epidemic of small-pox following the return of our men from the Spanish war. Up to that time there had been no attempt to systematically control the spread of contagious or infectious diseases; but the need of organized action was so acutely felt at this time that the Board was appointed, and has continued practically the same in membership up to the present day. Our efforts at that time were directed almost entirely to the control of the small-pox situation. For years there had not been a case re ported in the county. Most of the physicians had never seen a case, and a large part of the people, both white and colored, were unvaccinated. The trouble spread rapidly at first, and in many places the people began to become panicky. Quarantines, with night and day guards, were established at infected places all over the county, a general vaccination was undertaken, and after the expenditure of several thousand dollars, largely for guards and the care of the quarantined poor, the trouble subsided. During the epidemic the work of the Board consisted in I. Inspection of reported cases, isolation of cases where found, immediate vaccination of all persons exposed, and the appointment of a guard or guards to serve the double purpose of preventing intercourse with the rest of the neighborhood, and attending to the procuring of needed supplies for the quarantined family. Cases able to do so were expected to provide their own supplies; others were supplied by the county. Medical attendance was provided as needed. II. General vaccination of the county. Physicians visited all the schools, and as far as possible a house-to-house vaccination was carried out. Much opposition was met in many quarters, but the work was effectively done. III. The Board undertook the disinfection of all houses in which trouble had existed. As most of the places were openly-built cabins, it was felt that disinfection by gas was of little value, so formalin was used but little in this way. Old bedding, and the like, that could not be well cleaned, was burned and replaced. The ex-patients were given bichloride baths. and clean clothes, and the floors, walls, furniture, etc., were well scrubbed with one per cent. formalin, or 1-2000 bichloride. We have no record of a case of re-infection occurring in any one of these houses, crude as the methods may seem. With this start the Board has kept on its work. It has servedFirst. As the agent of the State Board of Health to attempt the collection of the vital statistics of the county, but in this it has sadly failed. But few of the physicians of the county would send us reports, and most of those sent in were plainly so imperfect that we finally stopped reporting them. Until the registration of all births. and deaths is made compulsory, the same state of things will continue. 1 Second. It has promptly investigated all reported or rumored cases of contagious diseases. In many cases a physician may be in doubt as to diagnosis, or if not in doubt himself, wishes the moral support of some one in authority. In these cases a visit from a member of the County Board is often of great help. Many times utterly unfounded rumors of trouble have been disposed of, or else really dangerous cases found out and placed under the care of a responsible physician; and in cases already diagnosed and reported by the attending physician, we find that the moral support of an officer of the law for such the Health Board really is-is of great help in the car. rying out of the doctor's instructions. Third. In connection with this part of our work, in cases where the poor have to be quarantined, the Board makes arrangements for their support during the quarantine, and provides medical attendance as needed; and on dismissal of the quarantine either sends the attending doctor the materials for disinfection, or sends out a man qualified to do the work. In cases of diphtheria, antitoxin is furnished on the demand of a responsible physician, the ability of the patient to pay for it being left entirely to the physician's judg ment. Fourth. The Board has tried to carry out the State law requiring the protection by vaccination of all the public school teachers and scholars. To this end, every three or four years a list is gotten of all the public school teachers in the county. In October a return postal card is sent to each teacher. On the card is printed an outline of the law requiring vaccination of all public school children, and they are notified that a physician will soon inspect the school, and vaccinate those needing it. They are asked to give on the return card the number of scholars in the school, the number not vaccinated, and the address of the nearest doctor. On receipt of the return cards, the schools are divided into groups, and a physician assigned to each group. Vaccine-the best we can get sufficient for his group of schools is furnished each man, and letting the teachers know in advance when to expect him, he visits all the schools in his district. Any scholars refusing vaccination are excluded from the school, unless their physician will give a certificate stating that their health is such that it would not be well to have it done. Of course, in all |