REPORT OF DIVISION OF EPIDEMIOLOGY, AUGUST 1, 1912, TO DECEMBER 31, 1913. A. J. Chesley, M. D., Director. INTRODUCTION. An account of the establishment, duties, objects and equipment of the division was given in the third biennial report (new series) of the State Board of Health and in the fourth, the detailed procedures of routine field and statistical epidemiological work, were described. Limited space excludes repetition and the previous reports must be consulted for ful explanation of routine methods, since in this report, only new features and certain modifications of old methods in routine work can be included. The special epidemiological studies of the period are given most space, while ordinary investigations are merely listed and a few cited which relate to the work of other divisions. Many changes have taken place in the staff and one whole-time epidemiologist has been added to it. Nevertheless, it has been impossible to make all the investigations requested by local health authorities or demanded by the emergencies of communicable disease work. Men with adequate preliminary training in public health work are scarce. Our lack of funds makes it difficult to obtain the services of such men when found. Our staff should be increased at once. At no time during the seventeen months covered by this report, have the field workers been able to prepare properly, their reports on investigations completed, without being interrupted to take up new field duties. The routine work of the division has been greatly extended, but it is to be regretted that since the resignation of Dr. H. W. Hill, director of this division previous to August 1, 1912, it has been impossible to continue the publicity campaign by which he so greatly advanced popular interest in public-health work. PERSONNEL. Dr. Geo. A. Geist was appointed epidemiologist August 1, 1912, from the laboratory division and resigned October 15, 1912, on account of the great personal sacrifice which continued service would entail. The division lost a trained veteran leader when Dr. Hill left and a well fitted, enthusiastic worker of great promise, when Dr. Geist resigned. Dr. Herbert A. Burns succeeded Dr. Geist and was immediately sent to join Dr. Taliaferro Clark of the United States Public Health Service, then in Minnesota investigating the prevalence of trachoma, tuberculosis, and other diseases among the Indians. A glance at the lists of field investigations will show that Dr. Burns has seen hard, continuous service since then. Dr. Willard P. Greene joined the division June 1, 1913, from the United States Indian Medical Service in which he had enjoyed unlimited opportunities for the examination and treatment of cases of trachoma and tuberculosis among the Indians of the White Earth reservation. Mr. A. R. Blakey, for several years in charge of the traveling tuberculosis exhibit, has divided his time between the executive office and this division, since the lack of funds compelled the discontinuance of the exhibit. Owing to his long study of the tuberculosis problem and his wide acquaintance in the state, he was chosen to conduct, during the thirty-eighth session of the legislature, the State Board of Health's part of the campaign for the laws and appropriations necessary for the establishment of county sanatoria. The successful issue of this campaign was due, in a large measure, to Mr. Blakey's efforts. Dr. H. G. Lampson, who had recently completed a tuberculosis survey in Minneapolis, was engaged August 1, 1912, to make a similar survey in rural communities. At the end of five months, lack of funds cut short a most valuable and necessary piece of work. Dr. Harold B. Wood, a well trained expert in public health work, was selected to fill the dual position of deputy to Dr. C. H. Mayo, health officer of Rochester, and of supervisor in Olmsted county for the State Board of Health. After a year of exceedingly aggressive work, Dr. Wood resigned August 1, 1913. Dr. Burns was detailed to act as deputy health officer until a successor to Dr. Wood could be found and while so engaged prepared, from Dr. Wood's excellent records, a report (see page) which reflects great credit upon Dr. Wood's ability, although it covers only a part of his innumerable activities. Dr. H. G. Lampson became Dr. Wood's successor and has rendered very satisfactory service. Aside from the regular members of the staff of the division, two men have assisted in field work during periods of unusual stress-Dr. I. J. Murphy, epidemiologist of the Duluth health department and health officer of St. Louis county, for a fortnight in February, 1913, when the director. was out of the state on official business, and Dr. A. V. Leonard of the laboratory division, for a fortnight during Dr. Clark's Indian investigation. Dr. Murphy deserves special thanks since he gave up his vacation in order to assist in the work of this division. NEW AND MODIFIED METHODS. Unless otherwise specified, the items mentioned under this heading date from August, 1912. The regular reporting postcard for notifiable diseases was modified in respect to the arrangement of the blanks for written data, in order that the original cards filled out by physicians or health officers may be used as final records. Previously, each disease had a different colored card for final record, upon which the data were transcribed. A special postcard report was prepared for smallpox, allowing for entry of the data on vaccination and type of disease, desired by the United States Public Health Service. A sheet for entry of similar data was printed for monthly reports of smallpox in Minneapolis, St. Paul and Duluth. Arrangements were made to have health officers forward all morbidity reports directly to this division instead of to the executive officer. MONTHLY REPORTS TO THE UNITED STATES PUBLIC HEALTH SERVICE. In accordance with a resolution passed at the tenth annual Conference of State and Territorial Boards of Health, with the Public Health and Marine Hospital Service, the prevalence and geographic distribution of notifiable diseases in Minnesota, have been reported monthly to Surgeon General Blue, beginning with June, 1912. Other states complying with the resolution, waited for the blanks prepared by the conference committee and made their first reports for October which were published in the Weekly Public Health Report of December 6, 1912, with Minnesota reports for June, July, August, September and October. Such reports will be of great usefulness when a majority of states submits the data. Since August, 1912, the proper health authorities, state, federal or provincial, have been notified of reported cases treated in Minnesota, but infected elsewhere, or leaving Minnesota while still infectious, and of nonimmunes exposed to infection here, going out of Minnesota before the incubation period of the disease concerned has expired. This practice was approved by the surgeon-general, when, in the course of time, typhoid cases, infected during the annual cruise of the U. S. N. training ship, "Gopher," were referred for further investigation to the United States Public Health Service. A note was published in the Weekly Public Health Report of December 5, 1913, as follows: TYPHOID MORBIDITY REPORTS. PRACTICE IN MINNESOTA IN CASES EXTRA-STATE IN ORIGIN. "The Minnesota State Department of Health is making a practice. where possible, of determining, in reported cases of typhoid fever, whether the infection was received in Minnesota or elsewhere. The cases receiving infection from outside the state are being reported by the Minnesota authorities to the health authorities of the states in which the infection was received. "In the control of typhoid fever, co-operation of this kind is desirable. and the practice of the Minnesota authorities is highly commendable. In time the notification of extra-state cases in this way will undoubtedly become general." Later (January 2, 1914) another note was published, together with specimen letters, as follows: MORBIDITY REPORTS. PRACTICE IN MINNESOTA IN CASES EXTRA-STATE IN ORIGIN. "In the public health reports of December 5 reference was made to the practice of the Minnesota State Department of Health in regard to the cases of typhoid fever reported in Minnesota in which the patients had apparently received their infection outside the state. The practice referred to was that of notifying the health authorities of the states in which the infection had been received." |