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sumed in the country from surface sources. Speaking generally the day seems to be not far distant when practically all surface waters in inhabitated districts will be filtered before being used as a public water supply. In Germany this is practically the law of the land and at other places in Europe, particularly in Great Britain, filtration of surface waters is becoming the regular procedure.

Even where there is very little pollution of a water supply stored in large. impounding reservoirs where germ life gradually disappears, the use of filtration is being adopted in connection with aerating plants in order to secure water suitably free from objectionable tastes and odors.

As to the thought that copper sulphate or ozone or some other germicide will do away with the necessity of filters on the grounds of hygienic efficiency and lower cost, it is safe to state that filtration will not be displaced by such treatment, although it is undoubtedly true that the broad field of water purification will each year see filters combined with various other treatments which will permit satisfactory results to be obtained with skillful supervision from practically any source of supply.

TYPHOID FEVER DEATH RATES PER 100,000 POPULATION IN CITIES BEFORE AND AFTER ADOPTING MECHANICAL FILTRATION.

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THE STATE LABORATORY OF HYGIENE AND ITS WORK.

BY B. H. STONE, M. D., DIRECTOR AND PATHOLOGIST OF THE LABORATORY OF HYGIENE, VERMONT STATE BOARD OF HEALTH.

The growth of public hygiene or state medicine is a development of the last two decades, although many of the ideas which find embodiment in our modern methods of fighting disease had been germinating for many years previous to this time. The knowledge which led to the phenomenal developments of preventive medicine in these two decades was the epoch-making discovery of Pasteur, Koch, Lister, and their contemporaries of bacteria and the causal relation to the diseases which had been the scourge of the world for so many centuries. Rational methods of fighting these diseases, and that is what sanitation is in its essential, could only come with a correct knowledge of their etiology; with this knowledge the subject becomes an exact science.

Thus we see sanitation was dependent for its very existence on the laboratory, for all of these investigations were worked out there by the tireless efforts of those pioneer scientists. This was the problem of the research laboratory, and splendidly has it been met in the past and ably will its function be fulfilled in the future. We can safely predict that the cause of small pox, syphilis, scarlet fever, measles, whooping cough and the other communicable diseases will be made clear in the near future and that great light will be thrown on the nature, cause and prevention of cancer.

But there is another function of the laboratory which, while perhaps not so spectacular or attractive, is none the less valuable. Almost every discovery in science, every advance in engineering, has contributed some fact or condition of practical interest or importance to general hygiene. These advances in the knowledge of sanitation increase the responsibilities of the sanitarian and the demand for a special training, is constantly growing greater. The ordinary education of a physician is not adequate for the ever-growing problem of sanitation.

The health officer must be prepared to answer questions regarding plumbing which puzzle an expert plumber; questions on ventilation which will stagger an architect; questions regarding water supplies which will baffle a chemist or engineer; and questions on the diagnosis of disease which are beyond the specialist. In fact he must be an expert of experts in all of these and many other lines.

In America, educational opportunities in public hygiene are few and unsatisfactory. Sanitation is allowed only a modicum of time in our medical schools and little or no place in schools of engineering. The University of Ottawa, McGill and the University of Pennsylvania are the only American

educational institutions which offer special courses in the subject to-day. The reason for this is partly at least because there are so few lucrative positions which will tempt men to take the long and expensive training required by such a course. When the demand exists, the college will not be found wanting.

In England the country is divided into rural and urban sanitary districts having a population of over fifty thousand. In each of these districts a medical officer of health is elected by a district council appointed by the government. For these positions, no one is eligible unless he be a full graduate of medicine and is the holder of a diploma from some university body in sanitary science, public health, or state medicine. He must not engage in private practice except by special permission from the council. Of course he receives a remuneration in proportion to his training and duties.

In small American communities like these of Vermont, conditions are decidedly different. Here the sanitary officials must be men whose principal vocation is something else and any man who accepts the responsibility of the protection of the public health in such communities must do it at something of a sacrifice to himself. That medical men whose incomes depend upon treating the sick are willing to take these positions and use their efforts in the struggle to eliminate the very diseases upon which their incomes depend is an example of professional philanthropy seen in no other profession or class of men.

Such men cannot be expected to acquire the special training which is involved in all the questions which confront the official. They should not under the present régime be expected to do so. Much can be learned by experience, but unfortunately these positions in Vermont are too much at the mercy of local politics, and political changes are likely to remove a man when he has become most efficient and replace him with an entirely untrained successor.

These are the conditions which call for the establishment of a state laboratory. This makes available for the health officials in the small towns a corps of men of special training to answer some of the perplexing questions which it is difficult or impossible for the general practitioner or health officer to answer. It supplements his work, shares his responsibilities, lightens his tasks and supplies him with the resources needed to make him the equal of the university trained sanitarian. It is simply an application of the business principle of economy in centralization.

Vermont is a state admirably suited for the maintenance and use of such an institution. Her large percentage of small towns and villages, her comparatively small area, her multitude of free mail delivery routes and the average high intelligence of her population all go to render the need of a centralized laboratory great and the possibility of its success large.

It would be hard to estimate in dollars and cents or in human lives, the boon which was conferred upon this state by the work of that enthusiast,

Dr. Jo H. Linsley, for none can doubt that it was largely due to his unquenchable enthusiasm, his boundless energy and his herculean efforts that the Green Mountain State was almost the first in the Union to have a state laboratory, and only those who stood nearest to him will ever know how much of his life he put into the fight for this institution or against how much opposition or, harder yet, inertia of indifference he fought.

He early foresaw the tremendous significance to sanitation of bacteriology and appreciated the technical problem which must be answered by the state sanitary officials and realized the impossibility of answering some of these without laboratory resources.

The laboratory is an institution established to aid and supplement, never to replace your work, and should be so regarded by you. It behooves you to meet it half way. In sending specimens for examination, you should furnish all the possible information tending to throw light upon the results. The laboratory worker needs this if he is to form any opinion on the results of his examination. You should never withhold information or give misleading statements if you honestly wish assistance. If you ask aid in this spirit, you may rest assured that such assistance will be given you if it is possible. But the limitation of a laboratory should be appreciated by you. Laboratory methods are not supreme and oftentimes the best that can be furnished you is a simple statement of the findings, leaving the conclusions entirely to you. Your interpretation would, other things being equal, always have greater weight for you, in addition to all the facts which the laboratory man can furnish, have a knowledge of the other factors in the case which is denied him. Negative results should always be given less weight than positive ones. If you are at all conversant with methods of laboratory work, you will immediately appreciate that many things may work together to cause a failure of positive findings. But positive results, if on the other hand these are obtained, are practically conclusive. You should never be offended if the laboratory refuses to give you a diagnosis of your case, for it is often the part of honesty for the analyst to say frankly that such a diagnosis is impossible from his standpoint. It stands to reason that a diagnosis based on the combined results of his examination of the specimen and your examination of the patient is of much greater weight than the opinion of either of you without the knowledge possessed by the other. Never rely on laboratory examinations of the secretions from, to the exclusion of physical examination of, your patient. True, your opinion from such an examination may be entirely reversed by the laboratory results, but it never can fail to be of value.

I need not tire you with long statistics to show what this institution has done in the past. These have been published in our annual reports, but I will venture to lay before you a bare outline of the growth of the work during the first nine years of the institution's existence: 2,726 specimens were examined the first year; 5,920 during 1906; and 4,721 during the first six months of 1907, an increase of something over 300 per cent in the

annual number of examinations. These figures fail to do justice to the actual increase in the work, for a large part of the increase in the last years has been in the longer and more expensive chemical examinations.

Based upon the money value of the work, which measure in a rough way the time required for these examinations, we find that in 1898 work valued at $14,775 was done in the twelve months, while in the first six months of 1907 the work done, at the same valuation, amounts to $23,770.50. These valuations are based upon the very lowest prices at which work is done in private laboratories in adjacent cities and do not include the testimony of the expert in criminal cases which have been investigated here.

Our laboratory, established as an adjunct to the State Board of Health for the investigation of sanitary matters, has been given new work by nearly every legislature since its beginnings. The session of 1900 added an important department in opening the laboratory for chemical and pathological examinations in state criminal cases, thus placing its resources at the service of the courts. The Local Option Law passed by the legislature of 1902 made it the duty of the license commissioners to collect and have analyzed at the laboratory, specimens of liquor from the licensees. The session of 1904 added the Pure Food Law and all the work implied therein, and the last legislature has made it obligatory for all wholesale dealers supplying Vermont retail liquor sellers, to have their products examined at the state laboratory. The same legislature gave to the state pathologist, the duty of performing the autopsies in cases of suspicious death. Thus at the present time, the work of the laboratory comprises the examination of cultures from suspected diphtheria cases, blood from suspected typhoid and malaria cases, sputum and other excretions for evidence of tuberculosis and, in short, specimens from any suspected infectious or contagious disease, water for its purity, milk and all other food products, liquor from license commissioners and from wholesalers desiring licenses, and any sort of material from criminals cases in which a chemical, miscroscopical or pathological examination is desired by the prosecuting officer. In addition to this a laboratory official performs the autopsies in all criminal cases requiring such an examination. Furthermore, in any such case coming to court, the pathologist and chemist making the examination are at the service of the state as witnesses.

All of these lines of work are of great value to the people of the state and their relegation to a central laboratory was a good business measure. It may be safely asserted that in no other state in the United States is such an economical and efficient system in operation. Certainly no other laboratory is doing the variety of work that ours is. All of these new departments have added very materially to the work of the institution and these additions, we regret to say, have been out of proportion to the increase in the appropriation for running expenses.

In 1900 $12,000 was estimated as being necessary to meet the expenses of the work then being done. The legislature of that year made an annual

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