In addition to the members of the Board of Health, there were in attendance, and at the request of the Governor, Dr. W. B. Mack, Director of the State Hygienic Laboratory; President Hendrick of the State University, and Attorney-General Geo. B. Thatcher.

The first subject brought up for consideration was that the Board of Health promulgate an order for the muzzling of all dogs throughout the State.

The Attorney-General at once decided that the law did not invest the board with power to issue such radical rules and regulations as the exigency of the case demanded.

Upon this ruling, the Board of Health ceased to be a factor in the premises, and the burden of ridding the State of rabid coyotes, and protecting the public from rabid dogs, fell upon the shoulders of the Rabies Commission and Federal Biological Survey.

From the records of the Hygienic Laboratory it will be seen that Pasteur treatment was given to 35 patients at that institution during the year 1915, the first case having been treated on the 7th day of June of that year. In 1916, 54 cases were treated. The laboratory records fail to show a single death from rabies since the disease made its first appearance in the State, and the records of the State Board of Health show but one well-authenticated case of rabies in the human family. This single exception (reported by Dr. T. H. Harper) was Miles McKinnon, age 60 years, a native of Palisade, Eureka County, Nevada. He was bitten by a rabid dog in Canada, while visiting there, in August or September, 1914. He was immediately taken to Toronto, and given a full Pasteur course of treatment, and dismissed supposedly cured. Two weeks after his discharge from the Pasteur institution he returned to Nevada. On the 17th day of December, 1914, symptoms of rabies developed, and he died in violent convulsions on the 20th of the same month.

PASTEUR TREATMENT AT THE HYGIENIC LABORATORY

Dr. R. H. Mullin, Director of the State Hygienic Laboratory, wrote me as follows on the 8th day of December, 1916:

We treated thirty-five patients in the year 1915, the first patient appearing for treatment on June 7. So far this year we have treated fifty-four patients. I will correct the latter figures if any more appear for treatment. So far as I have been able to determine, there have been no deaths in the treated cases. I do not know of any other reported deaths from rabies than those you mention. The case Dr. Mullin alludes to was that of a child of 20 months, that died at Amos, Humboldt County, on the 3d day of February, 1916. The certificate of death filed with the local health officer stated that rabies was the cause of death. It was not claimed that the child had been bitten, but that it had been playing with dogs that were supposed to be infected.

The length of time the child lived after the development of the disease (13 days), and the general symptomatology, fail to confirm the diagnosis.

As stated above, 89 patients were given Pasteur treatment at the Hygienic Laboratory during the years 1915 and 1916. Since that was

written, 2 more cases have been treated, bringing the total up to 91. The patients came from the following counties:

It will be seen by the above table that from only three counties were patients treated in 1915, while nine counties were inflicted with the disease in 1916.

TYPHOID FEVER

It will be observed that there were 10 deaths from typhoid fever during the year 1916, the same in number that terminated fatally in 1915.

The disease was sporadic in character. from Washoe, 2 from Esmeralda, and 1 each chill, Elko, Lyon, and Nye Counties.

Of the 10 cases, 3 were from White Pine, Chur

It was epidemical in Elko County only. There the disease broke out in the latter part of October, and developed rapidly. The local health officer for Elko County strongly suspected a "typhoid carrier" as being responsible for the genesis and the spread of the infection. He wrote to the State Board of Health for information and advice as to the best methods of handling the problem. He was advised to have a sanitary survey made of the dairies supplying the town of Elko with milk, also to have Widal tests made from all suspected parties.

At the request of Dr. Worden, Professor Sanford C. Dinsmore, of the Food and Drug Department of the State University, visited Elko, and after a thorough investigation reported his findings, and through whose courtesy I am permitted to publish the following letter:

DR. S. L. LEE, Carson City, Nevada.

RENO, NEVADA, December 29, 1916.

DEAR DOCTOR LEE: I have your letter of December 27, and concur in the statement made by Dr. Worden, of Elko, regarding the epidemic of typhoid in the city of Elko.

In my annual report regarding this particular instance, I am stating the facts in this particular case as follows:

One of the first questions asked by the public health officer to whom all contagious diseases must be reported by the attending physician, is the source of milk supply. If several cases are reported on the same dairyman's route, the dairy at once comes under suspicion, and is due for a most careful and searching inspection, and the possible head of the infection.

Recently this department was called upon by the health officer of Elko County to make a thorough investigation of conditions in the town of Elko for the purpose of tracing to its source the typhoid fever infection which at the time had reached an alarming stage and threatened to assume the proportions

of an epidemic. I immediately went to Elko, at once got a complete history of all the cases from the attending physicians, and found that the milk supply in each of the seventeen cases recorded, with one possible exception, was from one common dairy. I then visited the particular dairy in company with Dr. Worden, made a careful survey of conditions attending the production of milk, and obtained samples of water from the well for bacteriological examination. Dr. Worden obtained for me a blood specimen from each individual connected in any way with the dairy, which together with the water sample were sent to the State Hygienic Laboratory, the blood samples to be submitted to the Widal test. The Widal test gave positive reaction on the specimen obtained from the owner of the dairy, who was the person most closely associated in the production and handling of the milk. Further questioning brought out the fact that this party had suffered from typhoid fever about eight years ago, and while apparently had completely recovered, nevertheless the disease germ was still in his system and he was unconsciously infecting the milk supply, directly or indirectly. This is a clear case of a "typhoid carrier," and while such cases are extremely rare, several instances of this nature are on record. The sanitary survey of the dairy revealed certain objectionable features, the most important being the location of the outhouse in reference to the well. The outhouse, with open vault, was located about one hundred and fifty feet from the well, on higher ground, and the character of the subsoil was such as to allow ideal conditions for the well water to become contaminated with sewage matter by seepage. Especially would such contamination occur during the spring or during periods of heavy rains or snow. That the water was highly contaminated with sewage matter was demonstrated by the bacteriological examination, which showed the presence of the B. Coli group of organisms and gave an extraordinary high count of bacteria per cubic centimeter. The water from this contaminated well was used in washing bottles, cans, pails, and other utensils, and as there was no provision for sterilizing with steam, the possibilities of the milk becoming indirectly infected through the water supply are apparent. The dairy farm, which was under lease, was abandoned the day following the public report of our findings, the cows and the equipment moved to more approved quarters, and the business taken up under more sanitary surroundings. The party regarded as responsible for the spread of the disease will have no connection with the dairy in the production and handling of its products until such time as he is pronounced safe by the local physician under whom he is at the present time taking treatment.

At the time the above investigation was made, I also visited the other dairies supplying milk to the city, and in general found them to be in poor condition. A portion of the city is supplied by ranchers in Lamoille Valley, and at those places most unsatisfactory conditions were found to exist. I went over the situation very carefully with each of the dairymen, pointed out what changes should be made in order to produce a safe market milk, and emphasized the necessity of scrupulous cleanliness in all parts of the dairy, and the great importance of installing some method for the adequate sterilization of all utensils used in any way in the handling of milk for public consumption. I had with me the "homemade sterilizer," a galvanized iron tank, made in any convenient dimension with false bottom and tight-fitting cover, the manipulation of which was explained. This piece of apparatus can be obtained at a small cost, and for a small dairy where the expense of installing a steam boiler and sterilizing cabinet is not warranted answers the purpose satisfactorily. The worth of this simple piece of apparatus has been proven by experiments, showing an enormous reduction in the bacteriological count of milk when all the utensils used in its production have been subjected to sterilization for a period of ten or fifteen minutes. The work of the department on the milk supply of Elko has resulted in a cleaner and safer product for the consuming public of that town. At the present time there is under construction a central milk depot which, when completed, will be modern in every respect. The owners of the

plant inform me that they will demand certain requirements as to the sanitation from those of whom they purchase milk, that all milk will be pasteurized before placed on the market, and that up-to-date equipment is to be installed for properly washing and sterilizing bottles used in retail trade. This plant when once in operation will fill a much needed want in that city.

The above is briefly the work of this Department in reference to the particular case in question. If you would like a complete report of the different cases examined, or more detailed information, I shall be very glad to furnish it to you.

Very truly yours,

S. C. DINSMORE.

This particular case so clearly and forcibly presented by Professor Dinsmore, and other cases of kindred character that are constantly making their appearance as a menace to the public health throughout the State, call aloud for such legislation as will add an epidemiologist to the State Department of Health.

POLIOMYELITIS

While many sections of the United States during 1916 were stricken with that scourge of scourges, infantile paralysis, Nevada was almost exempt. Only three cases were reported during the year, one from Elko County and two from Washoe County. All recovered.

In 1915 three cases were reported, and resulted in two deaths. One of the fatal cases was reported from Douglas County and one from Ormsby County.

MEASLES

An epidemic of measles prevails in Lyon County as this report goes to press. Its origin was from a family recently arrived from Idaho. The children started to school, and within two weeks 71 cases were reported, with 1 death.