GENERAL REPORT

STATE BOARD OF HEALTH.

OFFICE OF THE SECRETARY,

BURLINGTON, VT., July 1, 1916.

To His Excellency, Charles W. Gates, Governor:

SIR-I have the honor to submit the Twentieth Report of the State Board of Health for the biennial period ending December 31st, 1915.

Respectfully,

CHARLES F. DALTON, M.D.,

Secretary.

The record of the years 1914 and 1915 is one of progress in the work of the State Board of Health. The scope of activity has been widened and the work put upon a more systematic basis than ever before. During the first year of this biennial term, the Board adopted the plan of regular monthly meetings on a specified date and also adopted an order of business. Since August, 1914, these meetings have been held at the office of the Secretary in Burlington on the first Thursday after the first Wednesday of each month, and the following order has been carried out:

1. Reading of the minutes of the last meeting.

2. Report of the Secretary covering preceding month.

3. Report of the Director of the Laboratory covering preceding month.

4. Report of the Engineer covering preceding month.

5. Report of Inspector covering preceding month.

6. Discussion of communicable diseases.

7. Laboratory matters.

(Food, milk, dairies, waters, communicable diseases, medico-legal matters.)

8. Matters relating to public buildings.

(School-house matters, fire-escapes, depots, other public buildings.)

9. Tuberculosis work.

10. Appointment of Health Officers.

11. Miscellaneous matters.

12. Hearings, if any.

The adoption of this system has had the result of greatly increasing the efficiency of the Board. A further change has been the attendance of all the employees of the Board at these regular meetings and monthly reports from the heads of departments. The continued interest of all has been secured, besides which a continuous history of all the various activities is available in the reports.

While funds are not available for the addition of new departments of work, there has been a marked amplification of those lines already established, and, in many ways, Vermont holds a high position among the public health organizations of the country. This perhaps is best shown by a survey of State Boards of Health of the country made by Dr. Chas. V. Chapin of Providence, R. I., under the auspices of the Council on Public Health of the American Medical Association. During the year 1914, Dr. Chapin visited every State Board of Health in the United States. His visit to Vermont was in the month of July at which time he spent two days with the Secretary, inquiring minutely into all departments of work and securing figures and data for comparison with other Boards. His published report, which is now available, contains among other information, a rating sheet in which each State Board is scored on the basis of 1,000 points covering all the lines of work carried on by all the Boards. The highest rating of any state was that of Massachusetts which scored 745 points. Vermont received the second highest score in New England, attaining 486 points, and among all the State Boards of the country, we stood ninth, all the states rating higher than Vermont being both large and wealthy. It is also permissible to say that since this rating was made in the summer of 1914, our methods and results have been so much improved that a revised rating would, without doubt, place us still higher in the score.

An epoch-making event was the donation in November, 1914, of the sum of $25,000 for the use of the Board in the study and treatment of infantile paralysis. The donor of this.

money has preferred to remain unknown to all except one member of the Board, but, through this benevolence, the Vermont State Board of Health has been enabled to do a work which places it among the leaders in medical research. The advice of Dr. Simon Flexner, Director of the Rockefeller Institute, New York, was obtained in regard to the laboratory work, and Dr, Robert W. Lovett of Boston was secured to take charge of the treatment of cases. Under the counsel of these two men, the work has been continued and is still in progress. An epidemic, the like of which is not recorded in the history of the state, has been largely robbed of its dire consequences and gains have been made in the world's knowledge of this terrible disease. An extended report on this subject will be found elsewhere in this volume.

COMMUNICABLE DISEASES.

As intimated in the last biennial report, the control of communicable diseases is centering largely in the discovery and control of "carriers"; that is, persons apparently healthy, who harbor disease germs and distribute them by various means so that others are infected. While the " carriers" have an immunity which protects themselves from the disease, the germs which they carry are alive and virile, ready to produce their particular malady when they are planted on ground which favors their growth. More and more the problem of control of communicable disease is turning out to be a human problem, and less fear is attached to the danger of infection by intermediary objects, although in many cases where freshly infected by the patient, these must be considered. Thus the germs of typhoid fever are passed from the body of a patient or "carrier" in the feces and urine, and must reach the intestine of another person in order to cause the disease. The throat and nose is the growing place for the germs of diphtheria, scarlet fever, infantile paralysis, measles, whooping cough and probably other diseases, and these germs are discharged in virulent condition in droplets of sputum which are carried in so many different ways, not only in coughing and sneezing, but in wetting the fingers and then handling all the various objects which mankind makes common use of. Consumption or tuberculosis of the

lungs is carried in a similar manner. All this could be prevented by the simple methods of ordinary cleanliness.

DIPHTHERIA.

Diphtheria is the disease which best enables us to demonstrate the "carrier" theory. The germs of this disease are easily

found in the throat and nose, and a systematic examination of school children will seldom fail to discover bearers of the germs, averaging about 2% of the total number examined. This has been proven many times in Vermont during the past two years. Deaths from this disease show an increase over the previous biennial term, although strenuous efforts have been made to keep the disease in check. In the towns having medical inpection of schools, many lives and much suffering have undoubtedly been saved by recognition of early and carrier cases. In this connection a study of the cultures examined at the Laboratory of Hygiene will prove most instructive. On December 5, 1915, a new contract for furnishing diphtheria anti-toxin in the state was entered into with the Lederle Anti-toxin Laboratories of New York and arrangements were made to carry the principal stock in the Secretary's office, thereby materially reducing the cost.

SCARLET FEVER.

The continued mildness of scarlet fever makes its discovery and prevention extremely difficult. In the light of our present knowledge, it is altogether likely that many cases have only the manifestation of sore throat with no rash, or a rash which is so evanescent that it is entirely unnoticed. There is, of course, no method of diagnosis when such is the case, and infection is often widespread before a typical case appears to show that scarlet fever is the cause of the trouble. This mild form is shown by the small number of deaths as compared with the cases reported, one in 104 in 1915, but it is probable that this does not represent the sum of loss, as the sequelae of scarlet fever, even following mild attacks, are often severe and fatal, although the cause of death in such a case would frequently be so given as to show no connection with the original illness. A study of the tabulated statistics of scarlet fever is most enlightening.

TYPHOID FEVER.

Two years ago when we were able to announce the smallest typhoid death-rate on record, it was hoped that it might be possible to continue the good reports from year to year. Unfortunately, such is not the case as this report chronicles an increased number of deaths in both the years of the biennium. The explanation, however, is not far to seek. Apparently healthy "carriers' are the cause. Two epidemics in the City of Barre and two in Burlington were, on investigation, found to be confined to single milk supplies, although in all cases the suspected dairies were of unusually high order of cleanliness.