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Entered October 21, 1901, as second-class matter, Post Office at Brattleboro, Vt.,

under act of Congress of July 16, 1894.

CONTENTS:

Introductory Remarks at the Opening of the Eighth Annual School for Health Officers, by Charles S. Caverly, M. D.

Address by Governor Charles J. Bell.

Address by Hon. Frederick G. Fleetwood, Morrisville, Vt.

Address by Dr. H. D. Holton, Secretary of the State Board of Health.

Sewage Disposal, by George C. Whipple.

Public Opinion and Preventive Medicine; or Cause and Effect in Sanitary Administration, by H. L. Stillson, Health Officer of Bennington.

Advisability of Notification in Tonsilitis, Pneumonia, and Cerebro-Spinal Meningitis, by S. H. Miner, M. D., Rutland, Vt.

News Items.

BRATTLEBORO, VT.

INTRODUCTORY REMARKS AT THE OPENING OF THE
EIGHTH ANNUAL SCHOOL OF INSTRUCTION FOR
HEALTH OFFICERS, MONDAY EVENING,
JULY 9, 1906.

BY CHARLES S. CAVERLY, M. D., President of THE STATE BOARD OF HEALTH.

Health Officers of Vermont, Ladies and Gentlemen:—

It is a genuine pleasure to greet you for the eighth time at the Annual Health Officers' School. This School is yearly becoming more a feature of sanitation here in Vermont. I know, from inquiries that come to the State Board, that many health officers look forward to these sessions for various reasons: some expect to get perplexing practical questions answered, others expect to get the latest views on some growing subject, and all are sure of getting encouragement to face the prosaic duties of practical hygienic work. Modern sanitation, public hygiene, preventive medicine (by whatever name we know it) means more every year. The methods and instruments which are being devised to protect life and conserve physical health multiply rapidly. Science is working over hours. He must be a many-sided man who would put into practical operation every device which bears the endorsement of science to promote human health. He must always be on the alert for late discoveries and developments.

Sanitary science, in its practical workings, touches and includes many other sciences. The practical sanitarian must be something more than a doctor, he must be somewhat of a chemist, an engineer, an architect, yes, a lawyer, and above all, a tactful and resourceful man. He must know the laws of science, the laws of the state, and human nature. So, when we ask a mechanic, a merchant, a farmer, a lawyer, or a doctor to serve as health officer, we invite him to undertake something that should involve studious preparation. There is no single activity or vocation which in itself fits a man in these days to safeguard the physical health of a town or a city, according to the rules of modern knowledge.

The registration of vital statistics, the selection and protection of safe water and ice supplies, the disposal of sewage, the heating, lighting, ventilation and plumbing of buildings, both public and private, school sanitation, the guarding of food supplies, and the management of infectious diseases is each a science in itself. Yet our laws expect all this knowledge of local health officers. We have no university that furnishes this post-graduate instruction to the medical man. The state of Vermont has furnished to its health officials the best substitute for this university instruction which has yet been devised: it has provided real practical instruction for its health guardians.

Here, at this School of Instruction, our state has for eight consecutive years been educating a corps of health officials. The instructors have, every year, been men of the highest standing in their specialties. The universities and health departments of the large cities of many states furnished us these teachers. First and last, we have had here the best talent the country affords. Those who have attended all these Schools have had the advantages of a liberal education in all departments of practical hygiene, such as no other state, I believe, has given its health officials.

I am led to recount these facts for two reasons. First, that you who are the recipients of these advantages may not be unappreciative; and second, that the public generally may see the advantage of utilizing the services of officials who have attended these Schools. Every health officer who has attended these Schools uninterruptedly has enjoyed better facilities for fitting himself for his office than any one else in his community can possibly have had. He should not be displaced without very good reasons. The converse of this proposition is equally true; viz., that those health officers who do not show a disposition to utilize the advantages of this School should give place to those who will. These facts are commended to the attention of the selectmen and aldermen of all our towns and cities.

In arranging our program for this School, we have aimed to maintain the standard of its predecessors. The subjects treated are all such as we may profitably consider.

The Super

School Hygiene should be a live subject in rural Vermont. intendent of Education will speak of the schoolhouse, and the school as a distributor of disease will be treated by one of our oldest health officers. Every health officer should be interested in these papers, for the schoolhouses are, by law, in their care. The role of the school in the spread of epidemic diseases is of the greatest importance.

Methods of Sewage Disposal is a subject about which we, in Vermont, have everything to learn. The discharge of untreated sewage into the nearest available body of water is an abomination that is working hardship in all directions, and cannot be tolerated always. The State Board has given this subject careful attention. Act No. 115 of Laws of 1902 specifies that:

"No sewage, drainage, refuse or polluting matter of such kind and amount as either by itself or in connection with other matter will corrupt or impair the quality of the water of any pond or stream used as a source of ice or water supply by a city, town, village, public institution or water company for domestic use or render it injurious to health, shall be discharged into stream, pond or upon their banks."

The general enforcement of this section would undoubtedly solve the question of public water supplies for many of our towns, but, on the other hand, it could work hardship and entail great expense on most of the villages and cities of the state already equipped with sewerage systems. The State Board has determined to allow no sewerage systems, hereafter built, to empty into any body of water used for domestic purposes, but it has not

seen its way clear to take action against all the municipalities and companies which already have such systems.

It is a theoretical truth that every body of surface water in our state should be a safe water supply. It remains a practical truth that none, of any size, are. This subject of the modern methods of sewage disposal deserves our closest attention. It is to be treated at this School by one of best authorities on the subject.

Preventive medicine and public opinion is a theme that will appeal to all of us. The successful enforcement of preventive measures is largely dependent on such public opinion. This is to be treated by a health officer of wide and successful experience, as we all know.

The subject of the Public Peril from Venereal Diseases is one that is second only to the tuberculosis problem. It is now receiving wide attention all over the world. The secretary of the State Board has given this matter much attention, and he has distributed to all physicians of the state blanks for reporting on the prevalence of these diseases. It is generally agreed, I think, that this class of diseases is more widespread than the unthinking public is aware of, and that they lead up to many organic diseases whose causes were formerly unrecognized. This subject, too, will be treated by an expert.

The list of notifiable diseases is yearly becoming longer. Some recent additions are tonsilitis, pneumonia and cerebro-spinal meningitis. It is a sanitary axiom that the first step in the prevention of any disease is to secure its notification to the health authorities.

Tonsilitis is a common and often harmless malady; it is infectious, however, and preventable. Furthermore, its coincidence with that other and severer disease, diphtheria, and the difficulties sometimes encountered in differentiating between them give it interest to the sanitarian.

Pneumonia is perhaps our most fatal disease. Its bacteriology is known. No apology is necessary, therefore, for placing it here for consideration. Cerebro-spinal meningitis has been under close scrutiny the past two years. Its disastrous effects have at times created widespread alarm. Vermont has for one hundred years been a favorite field for its ravages. It is a disease to the restriction of which we should give careful thought.

The Public Health Laws is a subject of perennial interest to the health officer. Every health officer must know these laws. They multiply fast. It is often a question if they are regarded seriously by the public.

I regret to say that there are excellent reasons for thinking that the medical profession does not seem to interpret our public health laws literally. There seems to be a reluctance on the part of health officials to taking active measures to secure proper respect for these health enactments, by prosecuting plain violations. During the past two years, there were six prosecutions in the state reported by health officers, under these laws. If every infraction of these laws had been prosecuted, there would have been many more; how many can only be guessed.

Take, for instance, the matter of the notification of infectious diseases:

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