thereby marked a' wide extension of the field covered. Too much importance cannot be attached to the value of this service. Epidemics of doubtful character were determined definitely to be or not to be diphtheria; doubtful cases were cleared up and antitoxin sent when necessary; convalescent cases still dangerous to those about them were kept in quarantine until the bacilli of diphtheria had disappeared and the cases were safe to release from quarantine. And here again every doctor using the services was taught the value of a new instrument of precision to be used in the fight against the disease. In the diagnosis of tuberculosis, a large increase in the number of specimens examined is also reported. The value of bacteriological examinations of tuberculosis is too well known to need emphasis in this report. A number of specimens were also examined for malaria. This work is hampered by the fact that it is difficult for the average practicing physician to prepare a specimen from which examinations can be made successfully for malaria. The agitation regarding hookworm resulted in a large increase in the number of specimens of feces submitted, particularly towards the close of the year. Further developments along this line may be expected during the coming. year. Chemical and Bacteriological Examinations of Water. During the year laboratory examined 382 specimens of water, either chemically, bacteriologically, or both. These specimens represent a wide variety of conditions, and came from practically every section of the State. While, as has been stated, too much emphasis should not be laid upon water analysis in cases with typhoid fever, it is very important where investigations by other means throw suspicion upon the water that laboratory analysis should be available for settling the question. The number of water specimens examined increases as information regarding the service becomes more and more disseminated, and can be expected to further develop during the coming year. Special Investigations. In addition to the work in connection with preventable diseases and water examination, a considerable number of special investigations were undertaken in the laboratory during the year. The oyster investigation, for example, necessitated an enormous amount of bacteriological work which was done in the special laboratory aboard the steamer Commodore Maury, and which resulted in valuable contribution to our knowledge of shell fish contamination. This study was fully reported in the April issue of the Health Bulletin (1909). In connection with epidemic typhoid fever a large amount of experimental work was done during the year, some problems being constantly under investigation at the Richmond laboratory, and some being studied by the two field laboratories which were sent out. The department was fortunate to secure the co-operation of Dr. Harry T. Marshall, professor of bacteriology in the University of Virginia, in this connection, and was also fortunate in engaging Mr. J. A. Waddill, of the University of Virginia, who rendered faithful and valuable service during the summer months. Needs of the Laboratory. There is no phase of the work of the department which is in need of extension and enlargement more than that of the laboratory. The growth of the routine work has taxed to the fullest the energy of the bacteriologist. Indeed, the amount of work which he has accomplished single-handed is much larger than he should be reasonably expected to do. The growth of this work alone requires an immediate increase in the laboratory staff in order to carry on the routine work of the department. In addition, practically every phase of work which has been outlined in other parts of this report relies upon bacteriological and chemical examinations for information and support. The investigation of typhoid fever alone require a larger laboratory force, and it is highly desirable that there be available during the coming summer three laboratory corps for field work. The study of hookworm disease, likewise, relies upon microcsopic investigation, and should be undertaken without delay by a worker especially detailed for that purpose. Moreover, the oyster inspection and the inspection of water supplies, sewage disposal and vended waters will also require a large amount of laboratory work during the coming year. Besides these immediate and pressing needs, the more general needs of laboratory investigation should not be overlooked. The State Department of Health should not be content with the application of our present knowledge of sanitation to the prevention of disease, but should make frequent and large contributions to that knowledge. The amount of material available for study, which cannot be studied at present for lack of sufficient laboratory force, is very large. Its careful and intelligent study will result in a more effective application of preventive measures, not only in Virginia, but throughout the world. The inability of the department to take advantage of this opportunity is deplorable. In the single question of typhoid fever, despite the contributions to knowledge which have already been made from the department, there are enormous possibilities for study and for discoveries, which will prove of the highest value in the fight of the disease. It is to be hoped that an awakening of public sentiment and a generous legislature will see fit to make the laboratory of this department, a laboratory of hygiene in the broadest sense, fully adequate to the work before it. Local Health Organizations. The ultimate result of all health work in Virginia must depend on the efficiency and energy of the local boards of health throughout the State. Since the local boards are in closest touch with the situation in their several communities they must direct any detailed preventive work that is carried on. Present Condition of Local Boards. Under the present law, a county board of health is composed of five members, three of whom are physicians resident in the counties. The chairman of the county board of supervisors is ex-offico president of the board of health, and the county clerk is ex-officio a member. In towns the mayor is ex-officio president of the board. One of the physicians is chosen as secretary and executive officer of the board. The law directs that the board of supervisors of the county or the council of the town shall fix the compensation of the secretary. In practice, usually no fixed compensation is paid, special allowances being made for special services. While the local boards are in many instances alert and energetic, the defects of the present law render efficient work very difficult. The powers of the local boards, while apparently broad, are in reality very limited. They may make "reasonable rules and regulations," but no penalty is fixed for violating or failing to obey the rules and regulations when made. They have general charge of the sanitary affairs of their respective districts, but money for the execution of any measure must be specifically voted by the supervisors of the county. The compensation of the secretary and members of the board for any services rendered is paid or not paid by the supervisors as they see fit. The physician must usually appear before the supervisors in person to secure the payment of his bill, and in many cases the amount paid is arbitrarily reduced by the supervisors. The effect of these limitations on the power and authority of the local boards is to render them slow to take energetic steps for the improvement of conditions until the necessity is dire. They are busy practitioners, usually not especially skilled in sanitary work, and in many instances their duty as health officers conflicts directly with their private interests as physicians. It is a tribute to their devotion to duty that they so frequently sacrifice their private interests, face hostile public opinion, give freely of their time and energy, knowing that their reward will come only in their consciousness of duty performed. Needs of Local Boards. For the more efficient working of the local health organizations it is desirable that the following changes in the law governing them be made: 1. To provide a fixed compensation for the secretary, which shall not be less than $100.00 per annum for any county. 2. To provide penalties for violation of or failure to comply with reasonable rules and regulations of a local board of health. 3. To provide for the expenditure of reasonable amounts necessary for the protection of the community which shall be a charge on the county, when approved by the judge of the circuit court having jurisIdiction and the Commissioner of Health. These changes have been embodied in a law which will shortly be presented to the General Assembly for approval. TEPARTMEN HEALTH Vol. II. MARCH, 1910 BULLETIN CONSUMPTION How Virginia Is Fighting It TWO YEARS AGO THE STATE HAD NO To-day the State has A Sanatorium, Soon to Accommodate 110 Patients. An Effective Organization to Educate A State Anti-Tuberculosis Association. No. 3. Entered as second-class matter July 28, 1908, at the post-office at Richmond, Virginia, under the Act of July 16, 1894. |