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ANNUAL REPORT
Health Department
City of Richmond, Va.
Year Ending December 31, 1918.
Ci.VDE W. Saundeks, C:ty Printiii.
1919.
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Heatlh Department, City of Richmond, Va.
Chief Health Officer,
ROY K. FLANNAQAN", M. D.
^ Secretary, Tuberculosis Clinician and Diphtheria
Mies M. R. McLaughlin. Consultant,
Medical Inspector. P. D. Lipscomb, M. D.
Lieut. Henry S. Stern, U. S. A., Assistant CUnician (Voluntarv),
P. M. Chichester, M. D., Acting. R. S. Bosher, M. D.
DIVISION OF ADMINISTRATION.
DIVISION OF LABORATORY.
I Laboratory Assistant,
Mrs. Ethel Wright.
DIVISION OF PUBLIC HEALTH NURSING.
Chief Nurse,
Mrs. J. W. Farla.
, Miss Hattie Crist, Miss Bessie Irving,
' M1b3 Rutli Milton Miss E. G. Friend,
jMiss L. M. Hundley Miss Marie Daly,
DIVISION OF DAIRY INSPECTION.
DIVISION OF FOOD INSPECTION.
DIVISION OF PLUMBING INSPECTION.
DIVISION OF SANITATION.
Chief Banitary Officer.
W. A. Bowry. ^
S. A. Hall, John Donati,
T. M. Landers, Jr., K. C. Seargeant,
i Charles Sims, M. W, Lawrence, J. P. Waller.
> District Physicians,
'B. L. Phillips, M. D„ L. D. Batkins, M. D., Lawrence Ingram, M. D.
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ANNUAL REPORT
REPORT OF THE CHIEF HEALTH OFFICER.
Honorable George Alnalle,
Mayor of the City of Richmond.
Sir:
At the close of the first full year of my incumbency ae Chief Health
OfBcer of Richmond, which also marks the end of my service in that
capacity, it becomes ray duty, as it is my pleasure, to submit to you the
annual report of the Health Department for the year 1918.
Permit me to say, Mr. Mayor, that it is with feelings of real regret
that I have concluded to resign the position of Chief Health OfHcer. My
association with you and other city officials, as well as with those subordi-
nate to me, has been of the most pleasant character. Upon your part
and upon theirs, there has been manifest at all times a desire to co-
operate, and an arduous job has thue been rendered mnch less so by
this unmistakable good will.
Being fully assured, however, in my own mind that the health of
the city (my home city still) will be well looked after under the guid-
ance of Dr. Levy, its former competent Chief Health Officer, I have
reached the decision to return to Statewide health work, which has
always held my heart interest and which still appeals to me as the
greatest field for patriotic service that Is offered a Virginian. I have,
therefore, accepted the positions of Assistant State Health Commissioner
lor Virginia and Director of the International Health Board in the State,
taking up my new duties on January 15, 1919,
The war year, 1918, with Its disregard for precedents, has left upon
few clivistons of public activity such strong irapresalons as on that which
deals with the public health. War disorganizes, but it also has Its de-
velopmental aide. The Richmond Health Department has strongly felt
both of these tendencies.
Prom £be disorganizing aspect, the laboratory has been hit especla'ly
hard. Dr. K. D. Graves (now Capt. Graves), our Bacteriologist, and
his aiiecesEOr. Miss Margaret McCluer, have both entered the United
States Service, The division of Medical Inspection next suffered the loss
of Its Chief, (or Dr. H. S. Stern (now Capt. Stern), also followed the
flag to France. His successor. Dr. Luclen Lofton, waa, on July 21st, called
suddenly by death. .Miss Emily G. Friend, one of our nurses, joined the
Red Cross Service abroad. Dr. J. S. Weitzel, infant clinician of the De-
partment, enlisted in the Medical Reserve Corps of the Army, and Dr. T.
L. Driscoll, District Physician, has taken up work in the United States
Public Health Service.
Dr. H. C. Rucker, one of the District Physicians, has had to sever
his connection with the Department on account of ill health, due to over-
The shortage of physicians in the city, by reason of enlistment in
Army and Navy, has been so great as to prevent our securing the needed
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nelp lor district and Echool medical work. These changee have thrown
additional woik on the rest ol the Staff, but they have, without exception,
met the issue creditably.
So much for the disorganizing aide of war as it has affected the
Health Department. The developmental [actors are not leas apparent,
and, from their' character, are sure to manifest themselves more and
The proslmity of Camp Lee, Camp Eustis, Quantico, Camp Hum-
phreys and the Torktown Naval rendezvous, as well as the many sub-
sidiary camps of soldiers, sailors, marines, and aviators and the tremen-
dous munitions plants at Hopewell, Seven Pines and Feaniman, has
given our community an interest in the eyes of the general government
which has operated greatly to Richmond's advantage in a public health
way. The State Council of National Defense, through its intelligent
Initiative and by Its unfailing support of public health measures, has
brought the general public into greater accord with the purposes for
which health departments exist than could have been possible in years
of effort under different circumstances.
The greatest single achievement along this line is in the changed
attitude that has been brought about in the public mind in regard to
venereal diseases, the most violently contagious and the most socially
destructive of all infectious troubles. Through aid of the State Board
of Health and the State Council of National Defense, the United States
Public Health Service has granted to Eichmond the services of a whole-
time officer to deal with this problem alone, and his work baa abundantly
Justified itself. While these diseases had been made reportable to the
Department in January of this year, active control measures have only
been possible since the new and comprehensive State Board of Health
regulations went into effect In June. In order, however, to fully avail
ourselves Of Government help, more satisfactory quarters for the venereal
clinic must be provided.
The war has also forced upon our distinctively IndlviduallHtic peopl«
fhe necessity of getting closer together In all measures that make for
the common good. Public Health and all other public welfare activi-
ties have, therefore, naturally benellted by this new social consciousness.
This was shown In a remarkable manner during the calamitous influenza
visitation. While the onslaught of this disease was anticipated by the
Chief Health Officer In several published statements weeks before the
first case arrived, no amount of forethought, in the absence ot a sufll-
cient number of doctors and nurses, could have prepared ns for the tidal
wave of disease and death that all but overwhelmed the city. However,
with the people of Richmond prepared by Red Cross organization, War
Work Community Service, Liberty Loan patriotic fervor and the shoulder-
lo-shoulder comradeship engendered by the participation of all classes
of society in the preparation and manufacture of war necessities — the
Health Department had but to speak and the response was immediate.
Though almost certain illneaa and possible death awaited bedside ser-
vice, the stream of volunteers never ceased, and no reported case ot
Illness or need failed to receive attention.
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Within 2i hours, the John Marshall High School was turned Into-
an emergency hospital, and volunteer phyeictanB, nursea and helpers
fused themselves into a unit For life saving and relief, unexcelled in con-
secrated service and effectiveness by any like activity, in the history
ot any city. -
The Bafcer School emergency hospital, staffed by colored physicians
and nurses under the general direction of the director of emergency
Influenza work, made also a unique record ot efficiency and helpful ser-
vice. The immediate response of the Administrative Board, the Council
of the city, and the people, male and female, from all walks of life,
to the appeal for community service furnishes an example of devotion
to the public good and to the Chrietian ideal that cannot be too highly
commended.
The names of many of those who during the epidemic in Hfchmond
gave their lives in response to the call of duty and of love will never
be publicly known, but they were numbered by the score. The names
of those three devoted women, who while in the city's employ as nurses
gave up their lives should properly be recorded here. Miaa Grace Morris,
nurse at the Virginia Hospital, Miss Juliette Talcott, nurse at the John
Marshall emergency hospital, and Miss Vernell Hungerford, emergency
nurse at the City Home, made the supreme sacrifice, and the gratitude
of the City should be theirs.
Apart from the sad toll taken by iafluensa and its complications.
the death record of Richmond compares favorably with the lowest pre-
vious record of Richmond's health history. There have been 3,823 deaths
tn Richmond in 1918; of these, 1,118 were due to influenza and pneu-
monia, influenza's most important complication, and 18 from other causes
influenced by the disease, a total of 1,135. Deaths from the following
causes showed influenza as a recorded* complication; tuberculosis of the
lungs, 6; miscarriage, i; eclampsia, 1; Nephritis, 2; diabetes, 1; organic
heart disease, 4; total 18. This leaves 2,688 deaths from diseases in
which, so far aa the records show, influenza played no part.
In 1917 there were 2,936 deaths, and only 331 ot them traceable
to influenza and its complications, with a balance from other causes of
2,605 deaths.
Eliminating influenza as a cause of death from consideration, we
will note that there were 85 more deaths from all causes in 1918 In
Richmond than in 1917. In view Of the undoubted increase in popula-
tion of the city by reason of normal growth supplemented by war in-
dustrial activity, this increase is amazngly small.
It is too soon to properly estimate by comparison with other locali-
ties the relative effect of the influenza scourge upon us. The disease ia
playing return engagements everywhere, and nothing that is done by
health departments, whether of Army, Navy, State or City, seems to do
more than to temporarily check it. Renewed assaults by it apparently
mean to take in the whole susceptible public. We have learned, however
this important fact, that if a person attacked will go to bed and stay
there until all symptoms have <fisappeai'ed the danger to life is slight.
IS he resists the disease and presumes upon his strength, pneumonia and
perhaps death are to be expected.
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The death reate for Richmond per 1.000 of population this year
Is (for both races) 33.79
Last year It was 18.60
An increase of more than 5 deaths in the thousand was the toll Rich-
mond paid to the Influenza epidemic.
There bka been, during 1918, an Increase in the number of deaths
from all forms of tuberculosis, and of Bright's disease, acute and chronic.
There were 339 deaths from the former this year against 30* in 1917;
a difference of 36 deaths. In Bright's dUease the agurea are 301 in
1918, against 261 in 1917, a difference of 40. The combined increase
of these two more or less chronic maladies, over which health depart-
ments have no control, nearly accounts for the increased number of
deaths In Richmond in 1918. (I. e., exclusive of Influenza.)
The typhoid fever death rate, our sanitary barometer, almost strikes,
in point of number of cases, the low level of last year , (the lowest in
Richmond's history), and in the number of deaths exceeds it only by one.
There were 105 cases with 12 deaths in 1918. There were 98 cases
■with 11 deaths last year.
Of the 105 cases of typhoid fever reported to the Department this
year, 53 were directly traceable to sources outside of the city. In 1917,
of the 98 cases, only 28 were so traceable. The margin of city cases is
thus greatly in favor of the year 191S; 53 city cases this year a« against
70 in 1917. In the analysis of the city cases it Is found tiat 9 of them
habitually used well water.
The 13 deaths from typhoid are 7 whites and 5 colored, 6 being
contracted outside of city anri 6 probably within Its limits. The death
rate per 100,000 of population for out-of-city cases being the same as
last year, namely 3.8. The total death rate is 7.5 as against 6.9 last
year; .6 difference in .favor of the 1917 record. The month of Decem-
ber showed a clean slate as regards typhoid.
BIRTH RATE.
The birth rate 8hi.,ffs a slight increase over the 1917 figures, the
totals being 3,848 this year as against 3,837 last year, or an increase of
11 births.
It is worthy of note that the Increase was substantial; a total of 79
among the white population, while the colored births fell SS below last
year's record.
MEDICAL INSPECTOR.
Following the sudden death of Dr. Luclen Lofton. Medical Inspec-
tor of the Health Department, we were fortunate in securing the ser-
Tlces, in that capacity, of Dr. P. M. Chichester, a physician of excep-
tional training and experience in his profession. He has applied himself
to his duties assiduously and bis careful epidemiologic work, bis accu-
rate diagnostic ability and his unremlt^ting industry have brought forth
highly satisfactory results.
The visits made by the Medical Inspector in 1918 were in number
2,909 more than In 1917, the total being 6,665 against 3.756 last year.
This Increase occurred during the first six months of the year. In Df,
Lofton's regime, when there was a sharp rise in the incidence of measles,
necessitating 1,961 visits to these cases, and a surprising and unexplain-
ahle increase in miscellaneouB visits during this same period, totaling
2,676. The iast six months of the year only 193 visits (or unspecified
causes were made.
Typhoid fever 38 SB 105 212 7t 114
Diphtheria 398 565 207 603 191 38
Scarlet fever 139 139 171 486 32t 346
Measles 1,520 1.520 1,434 1,991 96 471
Chlctienpox 232 232. 120 144 112 '88
Smallpox 4 6 5 18 2t 12
Infantile paralysis -.--7 7 5 27 2 20
•Decrease.
flncrease.
MISCELLANEOUS VISITS.
If is very gratifying to the Department that by reasOB of the re-
duction in the number of the more common infectious diseases, the
Medical Inspector haa found it practicable to devote more attention to
individual cases than heretofore.
LABORATORY.
As indicated earlier !n this report, the laboratory of the Health
Department has been seriously disrupted.
Upon the departure of Dr. Graves, the Bacteriologist, for the war.
Dr. S. "W. Budd, Professor of Bacteriology at the Medical College of Vir-
ginia, was secured for part of his time as director of this laboratory,
with Miss Margaret McCluer as assistant. Miss McCluer resigning to
take up war work, Mr. R. D. Caldwell was appointed in her place. When
the session opened at the Medical College, Dr. Budd found it impossible
to coTitinue his relation with the Department; so, upon his recommenda-
tion, Mr. Caldwell was made Acting Bacteriologist. His work, both as
to character and amount, has been satisfactory. It is recognized, how-
ever, that the fact that his duties elsewhere prevent his being in the
laboratory throughout the day will necessitate some further readjust-
ment which will give continuous laboratory service.
Notwithstanding the readjustments in our laboratory staff, the total
number of microscopical specimens examined very nearly reached the
1917 mark. There were 4,082 diagnostic specimens examined In 1918
against 4,326 the year previous, and 2,207 milk and cream !
tested against 2,13p in 1917.
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10
The diseases for which laboratory teste have been made are steadily
coming under control. This year, however, we have added the venereal
dlseasee to our list, and the eiaminations for syphlllU and gonorrhea
(or tlie year totalled l,35(i. Typhoid fever specimens examined were
lesB this year by 94 than in 1917; and, owing to the comparatively dry
season, there were 73 fewer specimens examined for malaria.
It is a source of regret to report that there were ISO fewer speci-
mens of sputum examined for tuberculosis than last year. This can
only mean that the physicians are not using the laboratory as they should
in malting disi.gnoses for this disease, for there were 37 more deaths in
Richmond from consumption than in 1917. The laboratory can only
examine such specimens as are sent In by physicians, and It will gladly
examine any number that may be delivered to the culture stations.
These stations are conveniently located in widely separated parts of
the city, and' collections are made from them daily by our sanitary force.
To regard to diphtheria, there were 945 fewer specimens examined
than in 1917, and, tor the first time In the history of the laboratory,
the specimens examined For release exceeded those tor diagnosis. There
were 191 fewer cases of the disease reported in 1918 than in the year
preceding. It is with regret, however, that we report 13 deaths from
the disease against 9 of the year previous.
Examinations of milk and cream exceeded last year's total by 68
specimens.
The proximity of the laboratory of the State Board of Health, the
facilities or which are available to every citizen of Virginia, at no cost,
ralsi>s the question as to whether it would not be the part of wisdom
and economy to combine (if such combination can be effected), the
City and State laboratories, as is done in Maryland and elsewhere.
LABORATORY AT THE SETTLING BASIN.
While the Bacteriologist stationed at the settling basin of the city's
■water supply is not under the direction of the Chief Health Officer, he
renders a copy of his daily report to this office. During the year the
reports indicate a higher degree of purity than tor some years past.
THE CITY'S WATER SUPPLY.
It is again incumbent upon the Chief Health Officer to emphasize
the need tor an improved water supply. The necessity for the installa-
tion of a filtration system for city water has been recognized for years,
and has teen the subject of numerous investigations and reports. This
improvement cannot much longer be postponed. The present system of
purification for city water is out of date. Inadequate to the city's grow-
ing needs, and dangerous to the health of its citizens.
DAIRY INSPECTION.
War-time conditions have placed upon the Dairy Inspection Division
of city health work problems of the utmost difficulty. To conserve Rich-
mond's milk supply and to maintain our high standard of quality and
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11
pf cle&nlinesB in the face of an unprecedented demand from nearby
Army and Navy Cantonments and Munition Works, have proven no eaay
matters, eepecially when influential agencies were disposed to seize the
opportunity to break down, if possible, the restrictions which have given
HicIiRiond a reputation for the cleanest lailX supply in the country. By
dint of the hardest kind o£ personal effort on the part of Dairy Bnapector
Strauch, the milk supply of Richmond has been conserved, and though
the shortage has been decidedly felt, the quality has not been lowered
and the price has not reached the high figures obtaining in neighboring
cities.
As an Illustration of the efficiency both of our dairy inspection and
of Illchmond's pasteurizing plants, the following furnishes abundant
proof:
During the .summer, on three large farms furnishing milk to Rich-
mond, aggregating 100 gallons daily, lyphpid fever developed in the
milkmen theiuaelveB. The disease being promptly reported, the Dairy
Inspector and the Chief Health Officer, in each instance, made personal
inspection and Immediately suspended permits for the sale of milk
until the patients or the herds coutd be moved elsewhere.
The possibilities for an epidemic of typhoid fever latent in such a
situation is too plain not to be appreciatd by all. As it turnd out, no
single case of the comparatively few cases of typhoid contracted in Rich-
mond this year was traceable to impure milh. Without adequate in-
spection and pasteurization, no such result would have been possible,
and to the other woes of this war year, a typhoid epidemic would have
been added.
Taile Shounng the Percentage of Dairy Farms in the Various Classes from
May, 1907, Through December, 1919 — Summary ay Years.
CL-^SS
™'l5lHfffSS4«"'
1907 1908
7J~
1S0»
I91D ISll
im
1B13
1914 19
...,l..
i\V.
Scoring between 60aQrt70
Sconnv beiween70ftn(t80
Scoring between 80«nd90.
Scoring between 90 and 100
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il
47:4*6:;
3',
79:'
ia:9M
There was an apparent lowering of the scores in 1915 over previous
years for the reason that we adopteH a new score card in the year 1915.
The lowering of the average score in 1918 was due to war conditions.
Digitized .yCOOgle
Table Bhotoing the Percentage of Dairy Farms in the Various Classes for
Each Month During 1918-
PERCENTAGE OF AI,L DAIRY FARMS INSP-:. T«n-FOR THE
MONTH WHICH FELL IN EACH CLASS IXTRINU 1918.
Jan.
F«b,
Mar
Apr.
-1""
July
Aug.
Hep
Ool.
1:
Dee.
Scorlne flO to TO.
Scoring TO to 80.
HoorlogSOtoW.
ecorlngMtoloo
ATersBWotallDcorca
lortheniDiitb
■'ai.'
\\t
"i
ill
13
189 U.B
...
1
75 9
Ts'a
TS6
K
TO.
1.8
POOD INSPECTION.
The work of food Inspection bas been strengthened this year by the
BBslgnment of one of the sanitary offlcers to this work. This has made
it possible to increase the number and Improve the character of food in-
spections. The number of inspectiona made more than doubled those
of any previous year, totalling 27,907. The amount of food condemned
as unfit for human conHumption reached the enormous total of 394,&0'0
lbs. The total was swelled to these huge proportions by detailed inspec-
tion of the cold storage warehouses of the city in conjunction with
United States Government Inspectors, great quantities of spoiled meat
being found.
To prevent a recurrence of such conditions, regulations were framed
by the Chief Health Officer and submitted to the United States Food
Administrator tor suggestions and criticism. Upon his assurance that the
Government was framing rules to deal with the matter, and acting on
Ms request, these regulations were not submitted to the Board for
adoption. No further action, to my knowledge, has been taken. In my
judgment, some such rules should be promulgated.
A careful watch during the year has been kept on soft drink places,
restaurants and lunch counters, and much improvement has been ob-
served.
The Food Inspector again renews his recommendations that a
Municipal Abattoir be established for the slaughter of animals for the
local market, and that a meat inspector be employed. I heartily concur
in this recommendation. If it be not possible at once to build a city
owned abattoir, there should be no bar to designating one already in
existence that conforms to sanitary standards as the City Abattoir, and
requiring all animals brought to the city for slaughter to be killed and
inspected at that point. As it is, diseased animals may be killed and
sold on the Richmond market without any one being the wiser. One
central point for killing is eaaenttal in order to make it possible for the
inspector to do the work required of him. A scale of fees for inspection
could be assessed that would easily pay the coat of this necessary service.
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PLUMBING INSPECTION.
Owing to the goTernmental regulations against the erection of new
liouaeB, inepections ot new bulldinga have tallen oB during the year to
less than one-third of last year's total. The p-iumbing inspectors, how-
ever, have been kept sufficiently busy improving the character of plumb-
ing ic old houses, much of which is antiquated and worn out. The in-
spections in this dlFlsion of the Health Department have therefore not
lessened, but Increased by 99 over the previous year. Prosecutions In-
creased from 14 last year to 42 in 191.8.
it -is in the highest degree desirable that a more efficient system ol
inspection of the installation of water supply pipes be established if a
repetition of the condition which followed the freeze last winter Is to be
avoided.
INFANT WELFARE AND TUBERCULOSIS NURSIJJG.
This Important division of Health Work has this year continued to
grow in Importance and usefulness. Although Miss Edna Berry, one ol
our most efficient nurses, was transferred at the beglnnnlng of the year
to the Hospital Department of the City Home, and Miss E. Q. Friend
Joined the Red Cross Id France, their places were promptly supplied. by
Miss Bessie Irving and -Miss Hattle Crist, both of whom were familiar
with visiting nurse work.
The continuous service of experienced nurses during the summer
resulted in a decided falling oft in the deaths from diarrheal diseases
among infants. There la no branch of Health Work that will so certainly
give a return tn the saving of life than the Infant Welfare Work. I
most earnestly recommend that another nurse be added to the staff.
During the influenza outbreak, the nurses of the Department were
detailed to emergency visiting nurse work. They were furnished with
Red Cross kits, and tn the absence of doctors, gave both medical and
nursing care to hundreds of stricken people, until, in turn, each one of
them, from the Chief Nurse to the newest recruit, was forced to yield
to the malady. Fortunately, all have recovered and resumed work.
Two of the Department nurses were assigned to duty at the John Mar-
shall emergency hospital; one of them, Miss Ruth Milton, acting for a
time as Chief Nurse there.
SANITARY INSPECTION.
The detailed report of the Chief Sanitary Officer, found elsewhere
In this report, shows the first complete year's work under his adminis-
tration, and the comparison with previous years merits attention. There
have been 61,0S4 visits made this year as against 56,279 in 1917 and
62,144 In 1916.
Of the 25,633 Inspections made, in 14,001 of them the premises
are reported as entirely satisfactory. The total number of revisits neces-
sary, therefore, is greatly diminished, as are also the prosecutions In
Digitized .yCOOgle
14
Upon tho Chief Sanitary Officer has fallen the brunt ol the disagree-
able court work which the enforcement of the venereal disease taw of
the State Board of Health has made necessary. This he has performed
vith singular fidelity, and It has absorbed much of his time. It Is grati-
fying, therefore, to be able to report such satisfactory results in hla
diTision. His staff of inspectors has been both faithful and competent.
ADMINISTRATION.
In the budget estimate for last year, the Chief Health Ofllcer made
a strong appeal for increase in the pay of the staff of the Health De-
partment, omitting his own office from the estimate. It is with peculiar
pleasure that I report that this recommendation was carried out. Since
then an additional increase has been granted these employees, bringing
the piiy roll of the Department, generally, up to the standard set for
these poaitiona in health departments elsewhere. The notable exception
to this Is in the pay allowed the Chief Health Officer. No increase has
been made In the salary for this position In years, and no health officer
of the experience and ability demanded by Richmond can. In Justice to
himself, remain long in office unless this state of affairs Is changed.
One of the reasons assigned tor the resignation of the former Chief
Health Officer was the meagre pay of the office.
The present reporting officer has not found it easy to refuse a much
larger salary from a neighboring city, even though the war-time duty
to his city seemed plain. It should be stated that the Chief Health
Officer applied to the Surgeon General of the Army and later to the Sur-
geon General of the United States Public Health Service for assignment
to war duty, and was told in both Instances that htg highest duty to the
country was to remain at his post.
The capital of the State of Virginia, and the secon-d wealthiest city
per capita in the country, ia entirely too important a place not to assess
at a proper valuation the guardianship of its peoples' health.
The plans of the Department in regard to an educational bulletin
were m part carried out by the establishment last summer of a 16-page
quarterly publication dealing with timely public health matters. These
bulletins are distributed through the schools and by the sanitary force
on their rounds, and have proven both popular and valuable. In my
judgment, this publication should be continued as a monthly, and made
available to all citizens through the malls.
The Tuberculosis Extension Work which was planned by the Depart-
ment last year was made impossible by the shortage of physicians. This
Is also true in regard to extension work in Child Welfare. As the physi-
cians and nurses now in War Service return, it should be possible to so
develop these important clinics as to more materially reduce our mor-
tality rate.
CHANGES IN PERSONNEL.
Dr. E. T. Rucker. of South Richmond, an old and exceptionally
faithful District Physician, was called by death during the year, and Dr.
Lawrence Ingram was appointed in his place.
,,..u;.yCOOgle
. lf> ; '
Dr. Edward McCarthy, also a District Physician of long ataniilng,
1 his position and has moved from tbe City.
* Dr. T. L. Driseoll was elected as Dr. McCarthy's successor. He has
since been assigned to duty as Cliiet of the City Venereal Cliolc under
the United States Public Health Service.
Dr. H. C. Rucker, another District Physician, also resigned, owing
to ill health. His successor has not as yet been appointed.
The advent of Dr. P. M. Chichester as successor to Dr. Lofton
(deceased) has already been recorded.
The resignation of Mr. Frank W. Robins, for so long the efficient
Clerk of the Health Department, was a source of real regret to the whole
staff. It is gratifying, however, to know that he has secured a more
lucrative position with the Church Hill Bank.
Mr. Charles Hayward, who succeeded Mr. W. A. Crump as Sanitary
Officer when that officer resigned, was promoted to the-ofRce of Clerk.
He has proven exceptionally efficient. Mr. K. C. Seargeant has been
elected as Sanitary Officer in Mr. Hayward's place and is fulfilling his
duties moat satisfactorily.
Another change in the personnel of the Department occurred when
Mm. Wright was made laboratory helper. The appearance of the labo-
ratory and the character of the service rendered has greatly improved
during her Incumbency.
THE GENERAL DEATH RATE.
The general death rate of Richmond per 1,000 of inhabitants has,
in common with every other city in the United States visited by influenza,
apparently increased during the year IfllS.
Tn 1917, the general death rate was the lowest in Richmond's bis-
tory, 18.E, including both residents and noil-residents, land 16.93 with
non-residents (mostly hospital eases) excluded.
This year the rate was 23.79, all deaths included, and 21.92 when
we exclude the non-residents, an Increase of over 5 deaths in the 1,000
of population.
When, however, we take into consideration the excess to!l of lives
taker, by influenza and its s^quellae, pneumonia and broncho-pneumonia
(acondition prevailing over the whole world), the Richmond figures are
perhaps not excessive by comparison with other places.
In 1917, 2S people died of influenza in Richmond. The 1917 flgures
were: 123 for lobar, and 180 for broncho-pneumonia.
In 1918 the figures for these diseases are staggering.
Influenza alone was responsible for 586 deaths, increasing its death
rate from 11.3 to 364.6 in the 100,000 of population. Pneumonia went up
to 377 deaths, increasing its rate from 113.4 in 1917 to 234.6 In 1918.
Broncho-pneumonia claimed 155 this year. Its rate going from 77.5 to
96.4
These figures abundantly explain the Increase in Richmond's death
rate for the year 1918.
The following Ubles teli the story, by years, of Richmond's progress
in fighting disease.
Digitized .yCOOgle
YEAR
NUMBBB OP DEATHS
DEATH RATE PER 1,000
NoD-ReBl-
dentB
NOD-RMl
only
Excluded
Non-Hesi
Included
NOD-RMl
deuu
Only
Non-BMl-
dania
Excluded
if
, 2>18
li
3.081
IS
i
i
ZSD
309
im
II'
|:|
«:7B
:8g
>
j
i
SIB
i
103
DEATHS FROM SPECIAL CAUSES.
The followiiig table will be of special interest to those who appre-
ciate the fact that Health Departmeota are forced in the main to confine
their efforts at life saving to attacks upon special diseasea.
It will be seen that progress in disease prevention in Richmond has
been consistent all along the line until the "Flu'' came upon us like a
cyclone.
A reduction In the preventable diseases is the real index of work ac-
complished. The following table demonstrates this fact.
ANNUAL DEATH B*7K
PER 100,000 INHABI-
TANTS
1 908-1913
fsirsfj
Ml
Tio
88
2
i
8
D,„i,z,d, Google
The following table gives a record in five-^ear periods of the death
Tate from causes but slightly influenced by public health orsanlsatlon.
ANNUAL DEATH B*TE
PER 100,000 INHABI-
TANTS
ti^Tofl
AvaTKBe
isi4-iais
I»I1
8T.S
1
m-
1
2oa
1
«c
,GoOglE:'
3«-
6 5|
111
lis
ill
Hi
s'"ess3 gKffississHSs-'sa
"'iS^ gS!SSS£|sS^=: ss
"« B" = = ^E; gSSSSg5P=2S"55a
8 S-a»i«-=g |g;Sf|gSS2«'"'S32
»S ggS3gg^!S£:Sti'
■"S"*sag =5!SSSgSKS='
t^.
.11
ill
D,o,,„J:,COOl^lC
TYPHOID FEVER.
The following table, showing the annual number Ot ', aths from
typhoid fever for the past thirty-eight years, illuatratea in ije most un-
mistahable terms the value of defiled health work. When It is remem-
bered that during the year nineteen and eighteen the city was crowded
to thelimlt of ita housing capacity by workers in the numerous war work
enterprises In and around the city, as well as with visitors from all parts
of the country to the adjacent camps, and that for this increase of popu-
lation no account is taken in computing our death rate per 100,000, the
fact that only one more death from typhoid fever occurred during the
past year (12 against 11 last year) than in the year prevloue (the lowest
in Richmond's history) warrants us in saying that in typhoid [ever pre-
vention we have again broken the record.
DEATHS FRflM
The annual number of deaths from typhoid fever and the annual
death rate per 100,000 inhabitants are combined In the following table
giving the average annual number of deaths and death rate in five-year
periods:
PBKTOD
*^nist4??H%^D?
EVER
Number of DeathB
Rate
pet 100,000
IiVn-iHM<R«»n)
11
19.6
20
MALARIA.
Malaria as a cause of death in Richmond is a negligible factor ajid
ma]' now be dismissed from detailed consideration.
There were 8 deaths from measles in 191S against G In 1917. The
death rate for the year 19 IS thus rose from 3.8 per lOO.OOQ to 5.
Table Bhotoing the Annual yumber of Deaths and the Annual Death Bate
from, Measles, Richmond, Ta., 1880-1.918.
TEAK
Number
ofDeslliB
Anual
YBAH. ^
.?sa
100,000
3
12
24
ST
10
'I
ill
23.2
13.2
1
35
29
IB
10
SB
J J
The (ollowing table gives the annual average number of deaths and
the annual average death rate from measles by periods of five years:
PERIOD
MOBTAUTY FBOII
MEASLES
Number of
llealh*
Rate Pei
100,000
lB80-188HByMni)
8.0
1S«
.
D,„i,z,d, Google
SCARLET FEVER.
It is a pleasure to record that there was not a single death from
scarlet fever in Richmond during the year 1918. The following table
shows the progress made here in combating this one-time alayer of
childhood. There have been three other years in Richmond's history
Vhere no deaths were recorded from the disease, viz: 1901, 1907 and 1910.
Table Bhotcing the Anntial Number of Deaths from Scarlet Fever and the
Annual Death Bate per 100,000 in the City of Richmond. Va.. from 1873
^ 10 1918.
FKVKB
YKAR
DKATHa PHOM
FEVEH
Number
of DMtm
De«th Hate
Pet 100,000
Number
o/ Defttbi
Deith Hiwe
Per iwooo
38
1
1 '2
i 1
S:!
11.9
8B
110
11
3
I
i
&
3
S4
1S99
1»00
'I
Combining ths figures in the above table, we get the following ave-
rage annual number of deaths and average annual death rate from scarlet
fever in Richmond for Sve-year periods.
PEBIOD
KCAKLET KBVEB
"".a'.-
"aS"
■1
914-1918 (iMiBjein)..::::::::::::::::::::::;:::::::::;::::::':::::;'
.s
WHOOPING COUGH.
Whoopin« cou^h continues to be a aerlouB factor in preventing a
marked decrease in the Infant death rate. While the whooping cough
death rate is but half what it was tor the year 1917, It is etlll a great
reproach to us as a communlt]' that this really fatal disease is regarded
so lightly by many people. Twenty-two children died from whooping
cough in Richmond in the year 1918, largely because some citizen care-
lessly permitted his child to play with a child that had never had it.
Table Bhotcing the Annual Number of Deaths and the Annual Death Rate
from Whooping Cough, in Kieftmond, Ta., 1871-1918,
DEATHS FROM
WHOCPINS
l-OUGH
Digitized .yCOOgle
The following grouping of the figures in the above table shows the-
average annual number of deaths and the average annual death rate from.
whooping cough in five-year periods since 1871:
PERIOD
AVBRAGE ANNUAL.
MOKTALITY l-HOM
WFOOPING COUGH
D^atb»
Hftie Her
100,000
It*
II
81 1
1014-1918 (lMt6y»«rel
n:?
DIPHTHERIA.
The number of deaths from diphtheria In the year 1918 i
3 in i
cess ol that for 1917, the death rate being 8.1 against 5,7 the year pre-
viousi and yet there were 191 fewer cases of diphtheria reported to the
Department. In view of the fact that diphtheria antitoxin is practically
a specific for this disease, it would seem that a degree of carelessness is
here Indicated, either by parent or physician, that is utterly inexcu-sable. .
Free antitoxin Is obtainable at the Health Department for those who
cannot pay, aad not to use It in suspicious cases is criminal.
Table Bliowing the Annual J/umber of Deaths from Diphtheria (Including
Croup), and the An-niMl Death Rate per 100,000 in the City of Richmond,
Ta., from 1875 to 1918.
YEA*
DBATUd PKOM
YEAR
DIPHTHEKIA
Number
■■;;;!«,»•
Number
or Dealbs
DsBth Rate
par 100,000 .
31
i
■s
1
33t
9-7
20
'i
38
IB
13
1
e
240
1905
, ,„„.,Coogl<?'
In the following table the number of deaths from diphtheria and the
death rate per 100.000 inhabitants are given by flve-year periods.
PERIOD
'SS,''E,p"h'SSrS'F
Number or
'Sfvsr
lSre-lBT9 (5ye«rai
3!.0
u'.s
1
895-1899 (5re»rB)
TUBERCULOSIS.
As might have been expected, tuberculosis shows a slight increase
over last year, 385 deaths from tuberculosis of the lungs as against 248
last year, when there was no influenza epidemic to complicate the situa-
tion. The death rate was thus Increased from 156.3 in 1917 to 172,7
thia year.
Quite an important addition to the tuberculosis fighting equipment
of Richmond waa established during the summer of 1918 by the City Antl-
Tubereulosls Association in co-operation with the Federation of Mothers*
Clubs and the Richmond Education AsBoclatlon, the School Board, the
Administrative Board and the City Health Department. When a sum'
mer camp for delicate children was built and operated near Forest Hill,
this camp took care of 40 children from the open air schools of Rich-
mond, tiding them over the summer period, when the supervision fur-
nished at these schools Is necessarily withdrawn. The camp proved suc-
cessful from every point and should be continued and extended as an
Institution. By far, the greater number of cases of tuberculosis Is con-
tracted In childhood. In order to accomplish the best results In the pre-
tention of this deadly disease, we must pay more attention to the child
aspect of It than we have hitherto done.
INFANTILE DIARRHEA.
We had to report last year an increase over 1917 In the death of
children under two years for infantile diarrhea. This year we are able
to report a decided reduction over any previous year. There were only
82 deaths in the city of Richmond in infants from this cause in 1918,
while there were 113 during 1917; the death rate therefore for the year
is Bl per 100,000 as against 71 In 1917.
The lowest previous rate ever recorded in Richmond was in 1916,
when It was 65.1.
The following tables show in a very striking way the result of the
Health Department effort in the control of Infant mortality from diar-
rheal diseases.
Digitized .yCOOgle
(Under Tiro Yesre)
Number at
De&tiii
DeaUi Bale
Per 100 000
Inbatntsnu
Is
if "
1
Annual average
K:::::;:::"::::;:::;;:::;::::::::::::::::::::'::::;::-:::::-::
IS5
Auunalftver^emt-medaitByeMB)
Comparison of the Annual Death Rate from Infantile Diarrhea in Richmond
During the Five-Year Period, 1908-1912. and the Five-Year Period. 1913-1917.
PRRIOD
19TO-191B, In-
19H-I919. In-*
OluBlye
AnnuKl mvnnn
B4
SMALLPOX.
There were five cases of smallpojc In Richmond this year as against
four last year. All of these were promptly Isolated at the Smallpox Hos-
pital and no spread of the disease o
The leper, George Hodges, now isolated at the City Farm, seems to
have gotten throiwh the year remarkably well. His throat, however, is
still badly Inflamed and no real Improvement In his condition Is observed.
COMPARATIVE MORTALITY OP THE WHITE AND COLORED RACES.
The following table, showing the ratio of deaths among the negroes
US compared with that among the whites, constitutes a heavier indictment
against the whites than a'galnst the negroes.
The diseases of the respiratory tract, essentially diseases of over-
crowding, ill ventilation and bad bousing, take double toll from the col-
ored people.
Unless the white people, who rule Richmond, pay more attention
to the congested living conditions among these people, the death record
among them will continue to show the consequences of the neglect by
Christian people of a dependent race at their very door.
, ...u.yCoogle
Talle Bhowino Comparative Mortality of the White and Colored Racea from
Certain Causes in Richmond, Va., During 1918.
CAUSES OF DEATH.
NIKMBER OF
DKATHS
OBATH RATE
Rallo of
Deatu
'
White
colored
Wblf
Colored
While
TjphuldFsvet—
I
7
1
i
188
1
i
IS
3
1
1
38
1
383
S3
i
69
S.S
51
J
IT 7
,1
11
lt&'4
560
m:
n.e
2sa
11. s
HI
68.8
is
0.3
11
laaie
l!7.6
ieo'4
61B,8
«e.e
170
171 fl
OtbeidlseMeBOfitaeDervouHBystem
.89
Heart knd Brl^hi'HdlieBHecombined
?'S
All dlseHst^ of tbe respLratorv Byslem (con
BumpUon not [nciimed'; ihatli Group
2.62
urn
ilsao
l!95T
i.m
: White, 101,81A; colored, S8,B87
INFANT MORTALITY — ALL CAUSES.
The total number of deaths In infants imder one year from alt causes
was .t63 in 1918. while there were only 516 deaths among them the year
before. This shows an Increase of 47 deaths. Influenza, which caused
no deaths Id infants in 1917, proved fatal to 43 in 1918. Six more died
from pneumonia and broncho-pneumonia than in the year previous.
This more than accounts for tbe increase in the death rate. There is
shown also an unaccountable increase In deaths from congenital debility,
malformation, etc., there being 226 of these In 1918 and only 199 in
1917. Table No. IS gives In detail the complete story.
Digitized .yCOOgle
Deatlu of Infants
Under One
Year of Age.
Numborot
Deatm
DEATH HATE
YBA8
'SAT
Per 1.00O
ft[ Kii Asm
m
1
i
161
ii
il
BIRTHS.
The birth rate of Richmond is apparently at a standBtlll or on retro-
grade. There were but 11 more births recorded in the city during 1918
than in 1917, and 1917 showed fewer births than the 191S record.
There han been a large Influx Into the city of men without families.
and hence It ia not to be expected that our recent war time increase in
population should have any influence on the birth rate. The fact, how-
ever, that our birth rate remained nearly atationary for the past several
years furnlBbes food for thought and study. There were only 25 more
births in Richmond In 1918 than there were deaths— 3,848 of the former
and 3,S23 of the latter.
Number of Births
Reported Birth
Year.
Reported.
Rate Per 1,000
l&OO
818
9.61
1901
729
8.42
1902
752
S.55
1903
666
7.46
1904
636
7.02
1905
608
6.61
190e*
1,133
12.13
1907t
2,311
20.37
1908
2,806
24.44
1909
2,839
24.44
isiot
2,734
21.37
1911
2,940
22.74
1912
3,069
23.49
1913
3,135
23.74
1914t
3,155
23,38
1915
3,473
22.45
191)
848
*The present ordinance requiring the reporting at births went Into
effect in 1900.
fHealth Department reorganized July 1, 1906.
tAnnexatton of new territory in each of these years.
Digitized .yCOOgle
RECOMMENDATIONS.
la order to assemble in more conclae shape the recommendationB
contained in the foregoing report, I will recapitulate in the order in which
they appear In the report. I have recommended therein:
1. Better quarters for the Venereal Clinic.
2. Closer afflllatton between State and City Laboratories.
3. Installation oC a, modern filtration system for Richmond water.
i. City Abattoir and Meat Inspector.
5. Rules for storage and sale of meat products.
6. Closer inspection for water supply pipes upon installation.
7. Addition of another nurse to staff.
8. Increased pay (or Chief Health Officer,
9. Development of the Richmond Healtt^ Bulletin.
10. Establishment of District Tuberculosis and Child Welfare
Clinics.
CONCLUSION.
Owing to the enaction of new duties following so closely upon the
severance ot my connection with the City Health Department, time and
opportunity for close study of the comparative tables of statistics, so ably
compiled by the statistician of the Department, has been denied me. I
submit them to you, therefore, under their several heads, without ex-
tended comment, in full confidence that whatever they show they record
the facts and represent, as far as figures can, the sum of the year's effort
of as conscientious and as faithful a body of workers as ma? be found
within the city's employ.
With all good wishes (or the success of your administration, and the
e of my regard for you and your coadlutOBS,
Respectfully submitted,
ROY K. FLANNAGAN, M. D.,
Chief Health Officer.
Digitized .yCOOgle
FINANCIAL STATEMENT — SUMMARY.
Account. Appropriation. Expended. Balance.
Pay roll * 50,118 58 (49,287 70 f 830 88
Expense 13,000 00 12,999 99 01
Special yaceination. , 1,000 00 999 73 27
i 64. lis 5S ! 63,287 42 ( S31 16
Total appropriations as above f 64,118 i
Reimbursements.
Unexpended balance aa above i 831 16
Food permits
Miscellaneous receipts
Total reimbursements
Net cost of maintenance of tbe Health Depart-
ment for the year 1918
48600
126 25
$
1,442 41
D,„i,z,d, Google
D,„i,z,d, Google
TABLES
AND
SUBSIDIARY REPORTS
D,„i,z,d, Google
TABLE
Bliowing Nvmher of Marriage lAcen
1908
ISIB
leii
■„.
MONTH
1
J
2
B
2
1
1
1
1
1
5
8T
7S
36
~169
S
64
i
i
i
"lB9
60
T3
m
1
184
(8
m
B6
~18l
81
2SS
760
80
64
120
02
"~186
i
57
«>
«76
i
141
i
1«S
1
7»
46
36
68
~iB5
S
48
""l4S
SO
m
1
14«
M
60
ee
~196
1
3»
lM<tu>it«r
SpffiiiK
£69
.,-
Digitized .yCOOgle
No. 1.
aei taaued, 1909 to 1918, Inclusive.
....
„..
....
19ia
...,
1918
s
t
.
?
s
?
2
■i
f
?
s
s
A
&
^
»
^
^
6
s
S
»
s
S
s
(8
Bl
84
80
M
42
(B
73
182
ISO
Ul
l!5
183
H2
22B
238
224
198
270
215
«l
Tl
60
9«
107
<41
t»
71
Mi
106
90
154
102
100
145
2H
iOT
25!
214
265
227
365
SOB
138
314
384
214
64
54
65
74
122
181
m
181
192
lei
209
192
526
211
309
268
sn
321
«0
113
«B
89
106
82
182
127
115
141
2M
118
30it
SIS
314
243
424
284
384
318
ISO
304
308
2tB
873
761
BB9
778
ion
815
1,180
1,071
1.131
1.080
1,816
1.029
i,ess
1,842
1.918
2,254
2,511
2.315
D,„i,z,d, Google
TABLE No. 2.
Births Reported Djiring 1918, With Sex and Color.*
WHITB
COLORED
TOTAL
Grand
H&le
Female
Hale Pemkle
Hale
F«m>le
Total
J»nu«ry" '
91
1
118
,i
1,
BO
1
S9
1
m
1
ise
133
i
H3
3M
rebru&rr
S
May
3»
!S
— w
ijtii
I91£
>t Included in any of the tables of blrtbs oi
TABLE No. 2A.
Giving Birth Rate During 1918, fill Color,
POPUI.Al'ION
(Omolal Esll-
mat« tJ. a.
Bureau of tno
NUMBRR OP BlftTBS
BIBTH BATE
Uaia
F...1.
Total
INBAH1TANT8
White
101.816
1,311
1,301
2.B1B
1,233
160 713
M42
1,90«
,,,.
TABLE No. 3.
Attendants at Birth.
BY WHOM
WHITB
C0U>BH1D
TOTAL
uale 1 Female
Male { Female
Male 1 Female
Tot»l
ISSSi' :::■■.:■::
^•\k ! ''llo
390
Z
'■S
1,942
'■g
2.778
ion
Ull i 1.3W
83.
m
1.906
D,„.z.d, Google
TABLE No. 4.
Stillbirths by Months.
MONTH
w„,.
o.,.„a
Total
11
13
1
13
e
m
m
TABLE No. 5.
Stillbirths by Years, Since 1909.
v..a
.„,.
Uolored
Unknown
Color
T.,.,
1908
8T
■i
ii
186
2IB
ISO
132
■ „^
303
Z38
D,„i,z,d, Google
TABLE No. 6.
Cases Examined by Coroner and Assistant Coroner.
SBX
White
Colored
126
Unknown
Color
Tola]
Uaie
1
I
"^'"
196
^
^
«9
Fetuses Viewed by Coroner.
SEX
White
Colored
Color
Total
Hale
J
6
'?
Unknown MX..
'^°'"
8
e
^
n
Stilltiirths Viewed by Coroner.
SKX
White
colored
"".^o^'"'
Total
s
g
g
«
'
"
■
D,„i,z,d, Google
TABLE No. 7.
SEX
BBSIDENTa
RICHMOND
HLCHMOND
"'^sSlsr
Whlt«
Colored
Tolml
While
Oolorod
ToCM
White
Colored
Total
1,016
iii
!S
87
S
184
ilios
8ia
1.872
1.961
Tot»l.
1,M0
l,B30
sfia
2!4
78
300
2.,,
i,«oe
B8S8
•atlllblrthi are not Ihcluded In any of tbe tables or blrtbi or deaths.
TABLE No. 8.
Qiving Death Bate, with Non-BeHdent» IncWded and Excluded.
COLOR
(U. 8.*'Buteauof
(the CemuBi
ACTOAL NDMBBR
OF DEATHS
DBATU RATB
PBR 1.000
Reside Qti
Included
iron-
Besldenti
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TABLE No. 9.
Population of Richmond, Ta., 1870-1919.
(Official Estimates ol the U. S. Bureau of the Census.)
TEAR
Wbl.«
Calored
Tot^
YEAR
White
CDIored
Total
1
S1,S4A
|S
35,765
11
4 lima
12,400
49.034
li
J3".5o!
IS
26.842
27,358
27,S3B
28.287
28.7S9
29|H4»
30 096
30.999
ll:S
32.354
SI. 038
64,806
58;674
63.600
II
II
77,8!I2
79.611
II
60,9H
51.290
Siffi
52.418
II
B6;763
57,734
II
K
83,303
84.461
B5;49B
9B;294
100570
101846
K.804
32!2S4
E
33,600
^906
34 310
34.716
la
46,881
48,'784
56 6M
II
59,604
1904
90,688
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TABLE No. 10.
Civil Condition of Decedents.
CIVIL CONDITION
WHITE
COLOKKD
..„,
Mkh)
Female
M»le
Female
3:S!ii::.:::::::::::::::::::;::;::::
1
S78
i92
390
1
388
1
848
1.S3I
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1,11.
1.103
7B8
3.815
TABLE No, 11.
Nativity of Decedents.
NATIVITY
WHITE
COLORBD
Total'
Male
(female
Male
Female
883
185
1
1
. SO
13«
1
1
TBI
88
23
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1,114
1,103
TS8
848
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TABLE No. 13.
By 'Wnom. Certified.
WHITE
COLOEBD
Male
Female
Hale 1 Female
997
1,048
US;
73S
Total
1,114
1,1(B
TBS
818
3,821
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WUITB
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Total
BBiau™
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Female
Mftie
Female
1
1
1
.i
88
62
64
48
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=. , -- TABLB No, 19..-. ., -. - ■, ■_.-.
Giving Deatli tiate and Per Cent. 6f 'Deaths' from Different Causes.
ACTUAL
number of
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TABLE No. 21.
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Colored
Tot.1
NON-aSSIDBNTS
18?
819
Shoicing the Number of Persons Who Died Here and Were Buried Elsevihere
and Their Color.
TK*NS1P PEBMIrS ORANTKn
Whiw
398
Colored
Total
TABLE No. 22.
Showing the Number of Typhoid Fever Cases Reported to the Health Depart'
ment, and the Num,lier of Deaths for Each Month in 1918.
1
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Ulgheit
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Ma
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88
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D,gM,zed.yGOOgIe
REPORT OP THE MEDICAL INSPECTOR.
Dr. Roy K. Flanntigan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to report the work of the Medical Inspector for the-
year 1918.
This report covers the work done by Dr. Lucien Lofton from January
1st, 1918, to his death in the latter part of July, 1918, and ot myseW
from August 5th, 191S, to December 31st, 1918, with a short Interral
from Dr. Lofton's death to August 5th, which was filled by Dr. Phillips.
There is much evidence to show that in the death of Dr. Lofton the
Department has lost an energetic, capable officer. While I did not know
Dr. Lofton personally, I have learned from many sources of his valuable-
The report which follows is a summary of the year's work by the-
Medical Inspector, as olttained from the files In the olGce of' the Health
Department.
The following table shows the number of visits made by the MedicaL
Ifispector which have to do with contagious diseases and other causes.
TABLE No. 1.
Showing Visits Made by Medical Inspector in 1918.
s
—
MONTH
1
f
1
1
•
s
S
1
1
i
3
1
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1
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m
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18
110
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16
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1
!
t
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t
tl
212
18S
1,B91
144
18
81
328
n
'
2,769
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TABLE No. 2.
Showing Specimens Taken by Medical Inspector
BLOOD FOE-
ll
T"H''.i^l'c'i?..?JS-.
1918
a
1"
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1
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8
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10
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21
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TABLE No. 3.
Typhoid Fever in Richmond in 1918.
White
Colored
TotBl
OosM bo hi er Irom 1BI7
1
B6
SB
14
J
TABLE No. 3-A.
Deaths from Typhoid Fever in 1918.
WhItB
Colored
TotftI
Death Rate
Per lijO,000
T
i
12
TB
Cases ptobablr ociDtr*cled In city
H
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TABLE No; i.
Shoidng- Beatiiana Beath Jt^t'framTwtKHdFtver in 1918.
:"■; ''-:■ ' ::.:^''~ -•-■■'■• ■ -■
""d'SIT^'^
Per 100.000
IS
I
i
i
" coioTtd'.V.'.'.'.T.'.'.'.'.'.'.'.'.'.'.'.
i TABLE No. 6.
BhovjiKJf the Case FMaiifv of Typhoid Fever in 1918.
TABLE No. 6.
Shying tAe.Uftmher'of Cases, Deaths, aitd Death Rate irom Tw^ioH.^Levir
for Each Year from. 1907 to 1918, /«clt«i»8,- -■■■■■■ \-_-_ ,-' :'
. ._.. ..... -. .
CA8B8 -
BKFORTED
„™h,-
fKB 100,0CM
YEAR
5 :
1
■■a'
■I
s
-3 1
.1- i
1
i
1
18S
147
-S
s»
m
106
S3
: 1
— W
36
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1
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1
IS
1
1
la
j„-
23.S
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ill
11
8:&
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2
1813: ; :_
IS19 :
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■Ctllwed.: '/.<;> .f.i» ,,'- .--.i-.i, .
Total "ntnirber or Tleatts ^."
Case fatality . . . . -.j.^^-.l.
Death rate per 100,000.
;;13
TABLE No. 8.
INFANTILE PARALYSIS (PolfomyeHtJsh
Bhowing Case Incidence and Deaths by stontTia.
Jan.
Fab 1 Mar.
Ap,ll
M»y
June
July
Aug
Sept,
Oct,
Not.
Dei'
Tqlil
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sl I
3
.1
;a
TAgijajro.,,9.
'wHitE ■"■■■'
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TolU
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MUo
Female
M>ie
««na,e
COultractad In KlohmoiKl
CumractedoutuF Rlch-
I
a
s
-. ",
:,oo.o-.
' ■ Total
'
>
«
: *-
jSftowinif ,J7ase Incidence on<i FafaHfy 6j^ Age.
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ITr.'^
YI-.
YJB.
"vi
s.
Y?:
Ti.
VrV
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TABLE No. 11.
Showing Number oj Secondary Cases of Scarlet Fever, AUo the Number of
Days Elapging After the Eruption of the Primary Cage, or Caiea.
"s"" ''"""'
.1.
.
!
1 J M 1
Jl.
17
.11
22
..jl
1
No, o( Hecoiidar; owe*
1
•
0^ o'
■If
rlv"
..I.].
V
TABLE No. 12.
Sum,mary of Scarlet Fever Statistics for 1918.
Total number of cases reported 171
White 160
Colored 11
Total number of deaths
Case fatality
Death r^te per 100,000
MEASLES.
TABLE No. 13.
Summitry of Measles Statistics.
Total number of cases reported 1.434
White 1,213
Colored 221
Total number of deaths 8
Case fauiity .' 4.9
Death rate per 100,000 4.4
TABLE No. 1«.
Measles Epdiemics (1309-1918. Inclusive).
YEAR
Bpidemic
NO. I>e«lhB
Epidemic
CM8 FMsHly
Per Caul.
?r,S!Si
Prevalent
1,1S»
[ B.448
i.m
B5
38
:S
3.9
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65
Table No, 1 speaka for Itself, showing the number of vlaits made by the
Medical Inspector tor the year 1918. It also shows the number of
viaita for each month for each disease during the month and for the
year. There were a large number of visits made during the influ-
enza epidemic which ha\,e not been recorded.
Table No. 2 shows medical wort done other than visiting. There has
been a large amount of work done which cannot be tabulated.
TYPHOID FEVER.
The year 1918 holds a close second to 1917 in the number of typhoid.
caaes, there being only seven more cases reported In 191S.
The proportion of cases originating out of the city was much greater*
this year (1918) than for last year. There ,were 18 fewer cases origi- ,
nating in the city in 1918. The cases of typhoid were scattered very
uniformly over the city, no grouping of cases in any one section, all sec-
tions having their share. The strict supervision of milk and water sup-
plies, and the sanitary inspection of the city, have proven, as in former
yearE, to be great elements in controlling the disease.
I feel that greater emphasis could be laid on the more extensive uae
of typhoid vaccine with great advantage to the public.
DIPHTHERIA.
Two hundred and six cases of diphtlieria were reported in 1918;
lowering last year's number by 192. A study of Table No. 7 will give
one a clear idea of the diphtheria situation.
Of the deaths, which are 13 in number, I feel sure these conid have
been cut down at least 50% by the early and sutBcient use of antitoxin.
I feel sure that every suspicioua throat or "croupy" condition should
receive an initial dose of 10,D00 units, almost regardless of age. and
repeat In 12 to 24 hours if needed. With early and sufficient doses of
antitoxin, there is much less tendency for the bacilli, or germs, to remain
in the throat after the patient has apparently recovered.
We cannot urge upon parents too strongly the importance of calling
In a physician for the slightest sore throat or "croup." An excellent
plan is to inspect the throat and tongue of each child every morning.
INFANTILE PARALYSIS.
Only five cases were found in the city during 1918. These cases
were promptly isolated, and no secondary cases resulted. One case de-
veloped about the first of August and died a short time after It was dis-
covered. The diagnosis was doubtful in this case.
SCARLET FEVER.
There were 171 cases of scarlet fever reported in 1918. This runs
last year a close second foV a low mark. Most of the cases have been
very mild, and not a single death has occurred. This disease has been
more prevalent In South Richmond than elsewhere.
D,g,l,zed.yGOOgIe
SMALLPOX. -
There were 5 cases of emallpoi reported during 1918, all of which
-were very mild cases, and no deaths.
CHICKENPOX.
There were only 112 eases of chlckenpoz reported. Some of theea
were of a severe nature, and occasioned a great deal of anxiety for a time.
LEPROSY.
Richmond's leper. George Hodges, was fortunate enough last summer
to receive some special attention from Dr. Lawrence E. Flannagan,
-whose experience with this disease In Nicaragua and elsewhere made his
help peculiarly valuable, resulting In a decided Improvement in his coo-
dition. He is still a case of the city.
Let me take this opportunity to express my appreciation and grati-
tude to all with whom' I have been associated during my five months
Incumbency.
I wish also to express my deep regret at the loss of my Chief, Dr.
Roy K. Flannagan, whose resignation takes'effect January 15, 1919.
Respectfully submitted,
P. M. CHICHESTER,
Medical Inspector.
Digitized .yCOOgle
RKPORT OP BACTERIOLOGIST,
Dr. Roy K. Flannagan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit herewith my report as City Bacteriolo-
gist for the year ending December 3t, 1918.
There were 4,055 specimens examined during the year, a. decrease of
271 specimeos from last year. These specimens were as follows:
Diagnosis 613
Diphtheria Release 817
Total 1,429
Widal tests 226
Tphoid Fever Bloo^ cultures S2
Total , 288
Tuberculosis 636
Malarial fever 113
Syphilis 549
Gonorrhea 808
Meningitis 94
Water 139
In addition to the diagnostic work of the laboratory, 2,207 saAples
of milk and cream were examined, making a total ol 6,262 examinations
for the year. , : , ^"]^
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REPORT OF CONSULTANT IN DIPHTHERIA.
Dt. R07 K. Flannagan,
Chiel Health Officer.
Richmond, Va.
Sir:
I have the honor to submit herewith my report of caees ot laryngeal
diphtheria seen tor the Health Department during the year ending De-
cember 31, 1918, also appended tabulated statement ot laryngeal cases
seen (or the Health Department for twelve years, 1907-1918, inclusive.
I^/TUBATED
HOTINTUBATEtl
TOTAL
1
^
:
?
P
i
s
2
f
1
I
s
1
1
1
f
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' 3
33.3
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T 14.3
Two of the three cases intubated were intubated on first call. The
third case was postponed upon first call, but five hours later intubation
was required. The case that died was that of a young lady, 18 years
old, who had been ill for several days without medical attention — ^waa
deeply cyanotic when first seen, dyspnoea distressing, exhaustion marked,
toxemia profound. The tube instantly relieved the dyspnoea, color Im-
proved, the moribund condition disappeared, and hope of recovery waB
Inspired by general improvement, which, however, proved to be only
temporary, for the patient succumbed the following day to overwhelm-
ing toxemia. The cases that recovered made perfect recoveries, with no
seguellae. One of the cases coughed up the tube six hours after it was
llrst inserted. Reintubation was done and seven days later extubatioh
was done. The four cases in which intubation was postponed did not
subsequently require it. One case ot laryngeal diphtheria intubated out-
Bide the city and three cases intubated within the city for laryngeal
steno.'^ls due to causes other than diphtheria, all of which recovered, are
not included in my tabulated statement, but if included would lower my
case fatality per cent, for intubated cases to 14.2, which is not a bad
Hhow'Ug for intubation cases, and would give a total case fatality per
'tent, of 9.
There have been remarkably few case ot diphtheria this
year with severe laryngeal involvement, and only one intuba-
tion has occurred since influenza struck the city October the
first. The explanation of the in frequency of intubation caees
this fall is, I believe, found in the great dread of influenza.
Immediately upon detecting signs of Illness In the child, the
D,g,l,zed.yGOOgIe
73
parent has, within the past month, called the physician, fearing an attack
of Influenza. The doctor has, therefore, in most cases, detected diph-
theria in its early stages, and, by liberal administration of antitoxin, the
diphtheria came quickly under control before laryngeal symptoms de-
veloped. Our intubation cases almost invariably occur Lq children who
have been ill for days before the physician is called-in fact in most
cases ^he physician is not called until the onset of laryngeal symptoms
excit^ alarm.
In abolishing the roller towel and replacing the common dipper by
■drinking fountains in our schools, together with th-e establishing of many
other wholesome sanitary measures, the spread of infectious diseases
among children should be greatly reduced.
Upon discovering a laryngeal case the physician should immediately
Teport the fact to the Medical Inspector, who can render valuable assist-
ance in securing intubation if it should be subsequently needed, and
thereby reduce the number ot distressing fatalities that occur from time
to time, largely because of failui-e promptly to inform the Health Depart-
ment. It is far better to see one or two cases unnecessarily than to let
one die from lack of intubation.
KTPBATED
INT
NOT
TOTAL
1
1
1
P
1
1
1
1
X
1
IC6
{
m
11
lis
2
I
8
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m
1S&
..
m
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t Neilected sepclc case, laryngeal sj
n ImpoBKlble. Died In spite □
trenie: di^d from Eepsla In a fet
Respectful ly submitted,
P. D. LIPSCOMB, M. D.,
Consultant in Diphther
Digitized .yCOOgle
REPORT OF CHIEF NURSE,
Dr. Roy K. FlaDnagan,
Chief Health Officer.
Richmond, Va.
Sir:
I have the honor to submit herewith my report for the year ending
December 31, 191S, briefiy reviewing the work of the nursing BtatI of the
Department.
In looking back upon the past year and a halt, with its unprece-
dented demands, it is with a profound sense of relief that I am able to
tabulate so satisfactory a report.
The Army and Navy had to be supplied with nurses, regardless of
the burdens placed upon those who, for varions reasonB, chose the more
prosaic but. In many cases, the harder task of keeping things going at
Our organization, like all others, has felt fhe effect of the shortage
of nurses, and at times has had to be almost completely reorganized in
order to meet the demands put upon us.
SPANISH INFLUENZA.
When the epidemic of Spanish Influenza swept the country in Octo-
ber, our city suffered with the rest. Since it was practical work then
that was mostly needed. Miss Nannie Minor, Superintendent of the In-
structive Visiting Nurse Association, and I combined our staffs of nurses.
Through the Press, we made an appeal for volunteer help, and were re-
warded by a large number of untrained but willing workers. These were
utilized in the clerical work and as nurses' aids. Those who had auto-
mobiles assisted the nurses on their rounds, thus conserving all of their
strength for the bedside work. The Virginia Railway and Power Com-
pnay granted passes across the viaducts for these automobiles as long as
It was necessary for them to be used.
I appealed to the local chapter of the American Red Cross tor
nurses' kits for the volunteers, and tn less than two hours Mr. H. G.
Boykin and his secretary personally delivered them to my office.
Early In the epidemic it was realized that the local hospitals could
not care for all cases, nor could the nurses and their aids reach all homes
where they were needed. Under the management of the Chief Health
Officer the John Marshall High School was equipped tor an Emergency
Hospital. Four of our nurses were detailed to hospital work, thus turn-
ing almost all of the district work over to the Instructive Visiting Nurse
Association. We did not try to keep up any ol our routine work except
the Tubereuioais. Clinic. We closed our Child Welfare Clinics early in
October.
Unfortunately, at different stages of the epidemic, five of the six
staff nurses and myself succumbed to the disease, losing from one to
' five weeks from duty. During my illness the office work was carried on
Digitized .yCOOgle
76
br volunteers who had become familiar with the routine before It became
necessary for me to leave tbem. Mrs. Ghae. E. Boiling directed very
efTectively the volunteers working from the Health Department Office.
Below is a summary of the work done by the staff and volunteers
during the three weeks when the epidemic was at its height. Consider-
ing the small number of workers in the field — the Emergency Hospital
having taken almost all of the aids as well as the nurses — ^the results
are most gratifying. It was only by the close co-operation of all agen-
cies, the untiring efforts and self-sacrifice of all workers, both profes-
sional and volunteer, that these results were attained.
Reported cases of Spanish Influenza investigated S,434
Cases of, Spanish Influenza discovered by workers 3,9S4
Total number of Spanish Influenza cases visited 13,388
Of this number there were:
Referred to Instructive Visiting Nurse Association 840
Cared for by Health Department nurses 481
Hemoved to hospital 53
With the recrudescence of the epidemic In the latter part of Novem-
ber, the services of the Health Department nurses were required to help
investigate the infected homes and exclude the children from school.
Three hundred and flfty-tour visits of this kind were made.
It seemed that where nurses were not available for different work
the Health Department must handle the situation. All of the inmates
of the Male Orphanage were prostrated at the aarae time In November.
I was assigned the task of securing nurses for them or of detailing
members of my staff to nurse the children until assistance could be se-
cured. Fortunately there were enough available nurses to care for the
patients, and we did not have to render any assistance. There were
no fatalities.
On December 18th the report came' to us that several of the chil-
dren at the Children's Home Society of Virginia were suffering from
influenza. Again I was assigned the task of securing nurses. This
time I was not so fortunate, for only one nurse was available. We
found seventeen children suffering, five of them extremely III, and by
the -second day fifteen others had succumbed. Through the kindness of
Miss Martha Baylor, Superintendent of the Sheltering Arms Hospital,
we were able to move thirteen of the very 111 children to that institu-
tion. The remaining children we moved to the most convenient floor
of the "Home," and, with equipment borrowed from the City Home, turned
It into an inflrmary. The one nurse, with the assistance of our staff,
was able to give them adequate care. Miss Baylor furnished a pupil
nurse for night duty. Three of the children first removed to the hos-
pital died. There were no other fatalities.
Our one remaining staff nuree who had escaped the Influenza in
October, although she had worked both In the district and In the Emer-
gency Hospital, became Infected at the "Home" and was forced to lose
three weeks from duty.
Digitized .yCOOgle
76
PRENATAL AND INFANT MORTALITY WORK.
During the past year our prenatal and Infant mortality work has
been followed along practically the same lines as ia previous years, with
the exception of keeping infants under supervision until the end of the
second year. Previous to this we have dropped them from our visiting '
list at the end of the first year. This left them without supervision
until they reached the school age. It is most important during the
second year to supervise tbe child's diet. Many illnesses may In this
way be avoided. I hope that next year other nurses will be added to
our Department, thu.^ enabling us to supervise the pre- school- aged chil-
dren as well as the infants.
We gave our customary instructions about the disposal of excreta
and the disinfection of diapers as a means of preventing infantile diar-
rhea. The reoiiita bavp been most gratifying. A total of 172 cases have
been reported with SS deaths. This is the lowest number in one year
ever recorded by the Health Department.
The Child Welfare Clinics, under supervision of the Health Depart-
ment and conducted by Dr. J. S. Weitzel, have done much good work.
Clinic No. 1, located at 2429 Venable Sti'eet, has been attended by 473
patients. Three hundred and twenty-eight of these were in attendance
the year before and 145 were new patients for this year. Among the
cases diagnosed and treated were infantile diarrhea, whooping cough,
congenital syphilis, impedigo, scabies and gonorrhea.
Clinic Xo. 2, located in the left wing of the City Home, was opened
May 14, 191S. Prom that time until it was closed, October Ist, It
cared for 59 patients. Cases diagnosed and treated were as follows:
asthma, bronchitis, syphilis, richets, malnutrition, eczema, hernia, gas-
tritis, spastic paralysis, and intertrigo.
We had to close both clinics In October on account of the Influenza
epidemic. Before it was safe to again open them. Dr. Weitzel was called
to the "Colors." His work was entirely gratis. Because of the added
duties of the doctors who remained, we have been unable to secure a
specialist to take his place. We are in hopes that soon Dr. Weitzel
may be released from the Service and again resume his work.
There Iia; been no change in the method of caring tor the prenatal
cases, .4s many as possible have been referred to the clinic at the ■Medical
College of Virginia. Thosi? desiring bedside care have been referred
to the Instructive Visiting Nurse Association, while those only needing
instruction have been followed by the Department nurses.
The following table illustrates this branch of our work:
Number of prenatal cases carried over from 1917 73
Number of prenatal cases listed during 1918 293
Total number of prenatal cases instructed 364
Of this number there were:
Safely delivered 216
Moved ; unable to locate 10
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77
Left city i
Referred to Instructive VUlting Nurse AHsociation .' 11
Miscarriages 8
Number of prenata,] caaea forwarded 115
There were no cases of ophthalmta among the babies nor deatbs of
mothers at child bfrtb.
The infant welfare work is summariaed as folIowB:
Hours spent in work for prevention of infant mortality 21,080
Number ot visits for prevention of Infant mortality 12,996
Birth certificates investigated 217
Babies on list brought over from 1917 1.19S
Babies dropped from list for various causes 702
Number of babies on list at end of year 2,053
Deaths from diarrhea and enteritis among babies brought
over from 1917 13
Deaths from diarrhea and enteritis among new babies listed
during 1918 16
Total deaths from diarrhea and enteritis among super-
vised babies 29
Deaths from respiratory dNeases among babies brought over
from 1917 41
Deaths from respiratory diseases among new babies listed
during 1918 26
Total deaths from respiratory diseases among super-
vised babies 67
Deaths from all causes among babies brought over from 1917. 82
Deaths from all causes among new babies listed 73
Total number of deaths from all causes among super-
vised babies 154
TUBERCULOSIS WORK.
On July 1st we moved our tuberculosis clinic from the Medical Col-
lege of Virginia Into more desirable rooms at 1108 Capitol Street. The
work of the clinic will be fully dealt with elsewhere, in the report of the
Chief of Cllnica.
During the year there were 618 cases of tuberculosis reported to
the Health Department. The Richmond Anti-Tuberculosis Association
has recently been re-organlzed, with a graduate Durse as executive secre-
tary. We hope that through the clinics held by that organization, we
will have many more cases referred to us during the coming year.
It is very necessary that we have more Tiurses in our department.
The many duties which each one has to perform make It impossible to
devote as much time to tuberctilosls work as it should receive. Until
we do get other workers the development of this work will be retarded.
Following Is a. summary of the tuberculosis work
,,..u.yGoogIe
78
Hour? spent in tuberculosU work 2,1381
Hours Bpent at dlapenaary 721
Hours spent In district l,194i
Number of visits paid to tuberculosis cases 2,B08
SOCIAL SERVICE.
Last year during the severe weather, when the claims upon the
charity funds of the city became enormously heavy, the nurses of the
Department were asked to investigate all appeals. For a while this un-
expected duty completely swamped our Department, but we managed
to answer all requests and no one suffered. This year we have continued
the Investigations, but ha^'c had to let our legitimate work suffer in
consequence.
Prior to our handling this branch of work It was done entirely by
volunteers. With all due respect to these workers, I would not recom-
mend that it again be placed In their hands. Their sympathies were in
too many instances touched by fraudulent claims, and hundreds of dol-
lars of the city's money were needlessly spent.
This work is most important, and since it has been demonstrated
that many times the worker's salary can be saved by these investigations,
to say nothing ol the constructive work among the poor families, I
recommend that a social worker be attached to this or some other De-
partment, to care (or this branch of work, thus no longer diverting
the nurses from their own work.
Respectfully submitted.
JESSIE WETZEL PARIS, R. N..
Chief Nurse.
Digitized .yCOOgle
REPORT OF INSPECTOR OF MILK AND FOOD SUPPUBS'.
Dr. Roy K. Plannagan,
Chief Health Officer,
Richmond, Va.
Sir:
I herewith submit my report for the year ending December 31,
1918,
I regret to know that you are to leave the Department so Boon,
and I hope you much success in your new Held of labor.
I wish to state that unde^r your administration the high standard
maintained by the Division of Milk and Food Supplies during the year
Just ended has been In a large measure due to your active Interest in
the, worlc. That Major B. C. Levy has been elected Director of Public
Welfare of our city (this division of the city administration having
charge of (he Richmond Health Department) ia a real source of gratifi-
cation, and we re.lolce that Malor Lew continues to have the confidence
of the citizens of Richmond. His work (or eleven years as its ftrst Chief
Health Officer and fn re-organ'zlnji the Department of Health has en-
deared him to the people of this community, and we hail with pleasure
his return to us.
There are some vital recommendations In my report of 1917 which
I again wish to bring to your attention.
RECOMMENDATIONS.
1. That score cards be provided for the purpose of scoring bakeries,
bottling plants, soda fountains, restaurants, hotels, boarding houses,
candy and ice cream manufactories.
2. All locally slaughtered meats to be killed under competent In-
Bpection, and especially no veals allowed to be slaughtered or shipped
Into Richmond tinder four (4) weeks old and weighing less than seventy-
flve (75) pounds.
3. That places unsuited fur business be required to make such
alterations and improvement as to make said places meet the necessary
sanitary requirements of our Department.
I also desire to call your attention to the unsatisfactory conditions
existing at First, or Old Market, This market house should, in my
judgment, be remodeled at once to meet necessary sanitary standards.
The street on either side of the meat market should be pared with
granite spalls, to abate a nuisance existing there.
Notwithstanding the fact that the work under my supervision has
more than doubled this year, it Is very gratifying to report that, as a
_ whole, the work has been done, and in satisfactory manner.
It is also a source of pleasure to report that the work of my assistants,
Messrs. J. T. Gill and John Donati, has been in a high degree etBcient.
It is in a large measure through their efforts that 1 am able to report
that there is much improvement over all former reports of my divi-
sion of Health Work.
My tabular report follows:
Digitized .yCOOgle
REPORT OF FOOD INSPECTORS FOR YEAR 1918.
The following food establifihrnents were inspected during the year,
detailed card reports of each inspection having been furnished the office:
Visited Passed Notified
Abattoirs and Slaughtering Places... 150 66 S4
Retail Meat Dealers 4,997 4,562 435.
Vegetable and Fruit Dealers (retail) . . 746 476 270
Candy Factories and Retail Confec-
tio&erieB 721 301 420
Commission Houses 5,236 4,f)3S 298
Ice Cream Factories 615 133 482
Bottling Plants 230 129 .101
Soft Drink Merchants .'. 2,387 1,224 1,163
Flah, Oyster and Crab Dealers 1,030 797 233
Hucksters 5,452 3,352 2,100
Hotels and Boarding Houses 805 362 443
Restadrants 1,771 1,064 717
Grocers 3,498 1,809 1,689
•ies -..269 129 140
Total 37,907 19,332 8,575
MONTHLY INSPECTIONS.
19 18.
No. Places
Visited
January 3,179
February 968
April
May 2,498
June 2,253
July 1,885
August 2,452
September 2,306
October 2,971
November 2,595
December 3,148
Total 27,907
Monthly Average 2,326
No. Places No. Places
1,947
506
1,823
48S
2,196
775
1.970
625
2,461
687
19,332
8.576
1,611
715
D,„i,z,d, Google
81
FOOD PRODUCTS CONDEMNED.
Pounds ' Value
Poultry ,,.. 10,604 . f 3,523.2*
Fruits 9,090 990 . 00
Vegetables 217,201 3,806 . 39
Qame 5,B16 1,439 . 80
Milk and Cream 321 18.31
Fish -. 81,151 3,932.80
Oyaters (53 gallons) ,. 090 73.25
Eggs (1,220 dozen) 10,980 359.29
Candy 10 5.75
Canned goods 5,400 270.00
Meats 53,531 10,843.63
Total 394,500 ?2E,262.46
POOD PERMITS. '
Permits issued 227
Permits suspended or revoked 4
Amount to Treasurer (4 54.00
Cases In court 4
P^nes imposed (10.00
Samples— Milk . . .' 2,464
Samples — MUeellaneous 51
Total samples 2,515
Digitized .yCOOgle
SUMMARY.
191)6 to 1918, IncluHve.
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s
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1104,386.64
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10,440
li
1
251,
IS
1
201
1
387
287
28S
1
127
essoo
46E
534
see
604
70«
144^17
2,527385
3,321
ATNaseforlS rMn....
11,147
194.452
18,028.23
1,978
»
1610.92
Respectfullj' submitted.
, JL NOBLE,
Food Inspector.
Digitized .yCOOgle
REPORT OF DAIRY INSPECTOR.
Dr. Roy K. Flannagan,
Chief Health Officer.
Richmond, Va.
Sir:
I have the honor to present to you my report as Dairy Inspector
for the year ending December 31, 191S.
Ifumberor vlaltBtodalry fsrmd..,.,^ I 711
Number of dairies vlaltod and soared,. iia
Number of acoree made !'".'!"!!.'!.".'!.' 1 S41
CLASS Jan. Feb. Mnr. April May Jddo July Aub. Sept. Oct, Nov. Deo.
117 1D5 lOe TOa 109
Permits refused Ig
Permits sviapended j
Permits suspended and restored ]
Permits revoked 3
Permfta revoked and reatored 3
Average score of three places whose permits were revoked 60.8
AveraBe score of three places whose permits were revoked and restored.. 70.9
Diseased cows found and use of milk from same ordered discontinued
(E with cowpox, 2 giving stringy milk, 7 Inflamed bags) 14
Gallons of cream condemned 1,200
Gallons of milk condemned 340
Samples of milk taken for bacteriological examination 2,203
New barns built during year g
New milk houses butlt during year S
Seta of blue prints tor bam construction furnished during year 32
Number of new shippers to the Richmond market durlngr the past year 8
Number of shippers who have discontinued shipping to Richmond during
the past year 20
■ Cases In police court ]
Abnormal conditions during the past year have caused and are
causing many dairymen to sell their herds and discontinue dairying.
This is but natural when a man Is In a business and doesn't make any
money, or is unable to obtain sufficient help to carry on his business.
But we must bear in mind that conditions are abnormal and that times
wilt change for the better soon, now that PrUEsianism has been exterml-
nated.
Personally, T do not believe any dairyman was Justified In selllnE
his herd oa account of the price of feed, as the price of milk has In-
creased nearly in proportion to the increase In the price of feed.
There Is no subject more important to the dairy farmer than the
proper and economical feeding of the dairy cow, for it is only by careful
, ^,„ogle
84
feeding that we can develop and obtain the best results; her productive
capacity being largely governed by the feed given her. I do not mean
that breeding and care should be neglected.
It Is not a difficult matter to feed roughage, for all we need to do
is to give the cows all they will eat; but when It cornea to feeding grain,
this is another matter; the economical feeding ol grain to a dairy herd
requiring a great deal of experience and study. There ts a tendency on
the part of dairy farmers to underfeed their cows, but it la aleo possible
to feed more grain than the cows can uae economically.
Feeds are divided Into two classes, namely, roughage and concen-
trates. Roughage Includes all the coarse portions o( a ration, such as
silage, hay. stover, fodder, etc. ; while the term concentrates embraces
all grains and mill products.
Certain kinds of foods supply certain parts of the body. We need
feed to produce heat, others to replace the parts of the body which are
being used, and still others to be converted into milk.
PROTEIN. — ^The protein in feeds Is necessary for producing growth,
flesh, blood and the casein and albumen in milk.
CARBOHYDRATES. — The carbohydrates in feed produce heat,
power and tat in the body.
FAT, — The fat in feeds is either stored up in the body, or burned,
to furnish heat and energy.
In feeding cattle we have two things to feed for — maintenance and
milk. We must always bear in mind that some cows have not the
capacity lor high production and will prove unprofitable in spite of the
best system of feeding. It Is the business of the feeder to find these
cows In the herd and get rid of same.
Great care must be taken in feeding that we do not feed too much
protein, as there is no doubt that the feeding of too much protein Is the
cause of much organic trouble in cattle, causing abortion and making
cattle shy breeders.
In formulating a ration, we must take Into consideration Its palata-
billty and digestibility. Cows like variety in their feeds, therefore a
ration should be composed of a reasonable number of feed stuffs, since
a mixture is relished better than only one kind of grain or roughage.
The word "ration" is used to designate the kinds and quantities ot
foods to be given for a length ol time, usually a day.
The term "nutritive ratio" designates the ratio between the protein
and carbohydrates; for example. If we have 4 pounds of digestible pro-
tein and 20 pounds of digestible carbohydrates and fat, the nutritive
would be 4:20, or 1 to 5. In other words, it means that a feed contains
Ave times as great a quantity of digestible carbohydrates and fat as of
digestible protein. In speaking of nutritive ratios, the digestible fat is
always combined with the digestible carbohydrates, as they both serve
the same functions in the body, the most important of which is the pro-
duction of heat. As a heat producer, one pound of fat is worth as much
as 2.25 pounds of carbohydrates.
The object of formulating a ration is to provide a feed that will
provide sufDcient bulk to satisfy the appetite and provide food for the
work the cow Is doing. A very good rule to follow in feeding a ration
86
la to have earae contain one part of digestible protein to every five parts
of digestible carbohydrates and fata, or for every pound of digestible
protein we have in a teed there should be five pounds of dlgeatible car-
bohydrates and fats. Cows should have enough feed at all times to
satisfy the appetite, the proportion of coarse feed to grain being adjusted
to her actual needs.
When a cow Is dry or producing a very gmall flow of milk, the ration
should consl-Bt mostly of coarse teed with a small quantity o[ grain — 3 to
5 pounds per day; If doing medium work, about oue-thlrd of the nutri-
ents should be provided by the concentrates and two-thirds by the rough-
age; when producing a very large flow of milk, about one-half of the
nutrients should be provided by the concentrates. When a cow Is only
to be kept In the dairy for one or two years, the proportion of concen-
trate>i fed can be much higher.
The highest yield in most cows is secured by letting them go dry
for from six to eight weeks before the calf Is due, and this is the time
to start feeding the cow. Do not think that grain fed when a cow la
dry is wasted, as she will return larger proflt for feed given at this period
than at any other time. Cows that are in good condition when di? do
not need as much grain as if they are run down and In poor flesh. When
in the latter condition plenty of grain should be used to build them up,
for their year's work will depend a great deal upon the strength, stamina
and fat which Is stored up In their body when they freshen. About a
week before the calf Is born the grain ration should be reduced to the
use of a little oil meal and bran mixed up in a mash. Do not allow the
eow to drink any cold water during the calving period. See that the
chill Is taken from all her drinking water. Feed the cow lightly on a
bran mash until she has fully recovered from calving.
After the calf has been removed and the cow has fully recovered
from calving, this Is the time to s^rt feeding a heavy grain ration. The
cow should not be put on full feed as soon as the calf has been removed.
About thirty or forty days should' be taken in bringing the cow to the
maximum amount of feed she can consume profitably, the Increase In
the sraln ration taking place gradually. After the cow freshens and
she has been fed a mash of bran and oats (about one pound of oats to
every four pounds of bran), the time has now arrived to gradually start
her on the ration to he fed. ,
Remember, in feeding it takes about one-half of a full ration for
maintenance of the body, while the remainder Is utilized for milk pro-
duction. Therefore, If a cow Is only fed flity per cent, of what she Is
capable of eating, there will be nothing left for making milk. It la there-
fore very important that a cow be fed all she can take care of. We will
then obtain every pound of milk she can, by nature, produce.
In getting a cow on her full feed, a small amount of grain ts added
each day. We must gauge the amount by the Increase of milk and the
appetite of the cow. If the cow does not respond to an Increase In the
milk flow when the grain ration U increased, we must cut down the
grain ration until an Increase In the flow becomes evident. Sometimes,
from liberal feeding, a cow becomes fat and gives less milk. In cases
D,g,l,zed.yGOOgIe
of thU kind, either the grain ration should be reduced sradually or a teed
containing more protein substituted. The practice ot giving the grain
ration with the silage, spreading the grain over the silage. Is a very good
one.
There is no profit in cows that come fresh and yield a large flow of
miilc for a few months and then drop off to nearly nothing, or go dry.
The profitable cow is the one that gives milk steadily for about ten
months.
When a cow is gotten up to her capacity of milk production, the
increased feeding of grain after this period is wasted, and in some cases
n'lll even cause a (decrease in the milk, besides which there is also the
danger of iiaving the cows get off their feed entirely.
The making of a satisfactory price for milk seems to be the one bi£
problem of the milk business. The producer generally feels the price
he receives is too low; the consumer feels that the price he Is paying is
too high, and the distributor Is between the two, with business interestii
favoring low prices to both. It \s a problem in which the three distinct
grouns must be recognized; each with certain rights as well as certain
duties. Neither occupies the place of most importance, for the dairyman,
though producing the milk, is dependent upon the consumer's demand
as a market for his product and upon the distributor's facilities for de-
livering it to the consumer.
It is plain that the price of milk is governed by the same forces
that regulate the selling prices of most of our food products. The coa-
aumer has his own conception regarding the price he Is willing to pay
for milk. H^ begins to curtail consumption when the prices seem too
high.
The public took it for granted that with food price control by the
government the laws of supply and demand would no longer be a factor
in the price of food. In this they were mistaken, for It must always be
remembered that we must have a supply before the demand can be sat-
isfied. Consumers also took it for granted that control of prices would
make food abundar't, and therefore cheap.
We resent high prices because it makes us economize, something
which Is very hard for the average American to do.
Now that the war is over, there are bound to be radical economic
changes during the period of reconstruction. We must look for a slump
in prices. We are flying high, and sooner or later must land on the
level, and if we do not prepare a soft place to land, we are liable to
be mussed up a little. We must readjust our affairs now, when the
readjusting Is good. This is a good time to pay debts. Money is cheap.
Later on, when the changes come, money will be dear, and It will be
more ditBeulf to pay debts. If a farmer owes two thousand dollars
($2,000.), he can pay it with the proceeds from flve thousand gallons
ot milk, selling at 40 cents per gallon, or 1,000 bushels ol $3.00 wheat.
If he waits, it is liable to cost him the proceeds of ten thousand gal-
lons of 20 cent milk, or 3,000 bushels of $1.00 wheat to pay the same
debt.
There has been a serious shortage ot farm labor during the past
Digitized .yCOOgle
year. This caused many difficulties on tbe farm and the hardest prob-
lem for the dairy farmer to solve.
In the vicinity of Richmond labor trouble was seriously aggravated
by the fact that we were located in th© centre of war activities and
placed In tbe position of not being able to pay as high wage for farm
labor as other lines of business, which, owing to war conditions, were
very profitable.
The milk producer did not have all thp labor problems to solve,
aa the milk distributor also was seriously handicapped, owing to his
inability to obtain a sufficient force to conduct ^'s business. So serious
did this situation become during the early part of October that it looked
as though it would become necessary for the distributing plants in the
city to close down because sufficient labor could not be obtained to .
conduct them.
One great drawback in obtaining labor to work in milk distributing
plants, is that the work Is a continuous performance, seven days in
the week, three hundred and sixty- five days in the year. This does
not appeal to most man, and there are a largo number who would
rather work for leas money and have shorter hours In some other line
of business.
During the past year 37 herds, containing 1 ,592 cows, the pro-
duct from which is being sold on the Richmond market, were tested
for tuberculosis. Prom this number 48, or about 3 per cent, re-acted.
A summary ol the herfls tested is as follows:
Digitized .yCOOgle
ToUl 1,592 48 5 1,539
It is very gratifying to note that a number of the above herds are
tn the accredited Hat. An accredited herd is one that has successfully
passed two annual or three B«ml-annnal tuberculin tests applied bv reg-
ularly employed veterinary Inspectors of the Bureau of Animal Industry,
or or the State, where co-operative work Is conducted, and its owner
has otherwise complied with regulations govemlnp; the work.
The milk Inspection force of the Richmond Health Department,
which Is always working to conserve the health of the citizens of Rich-
mond by seeing that they are able to obtain a clean, safe milk supply,
expects, now that the labor conditions are improving, to be able to
obtain much better results tn the coming year than was possible In
1918.
Respectfully submitted,
T. J. STRAUCH,
Dairy Inspector.
D,gH,zed-.yGOOgIe
REPORT OF PLUMBING INSPECTOR.
Dr. Roy K, Flannagan,
Chief Health Officer,
Richmond, Va.
Sir:
T herewith submit to you my annual report as Plumbing Inspector
for the year ending December 31, 1918.
During the past year, on account o[ the war conditions and the
high cost of building material and labor, there was yery little new con-
struction work done, as compared with former years, but notwithstanding
that fact, there was a large amount of worlt done in plumbing altera-
tions and additions in old houses, in order to meet the demand for
housing accommodations for the larg:e number of persons engaged In
war work here.
The new Broad Street Station has Just been completed. This build-
ing required much of mJir time to make the many necessary inspections,
due to its magnitude. .It is equipped with all the most modern sanitary
arrangements known for the conyenience of the public, and in the con-
struction of the plumbing and drainage system every effort was made to
provide the very best material and workmanship. The character of the
work In all ts details compares favorably with that of any in the country,
and Richmond may well be proud of such a building.
The residence of John K. Branch, corner of Davis and Monument
Avenues, was also recently completed. It is equipped with the very
best and most highly improved sanitary fixtures suitably for a private
residence, but on account of the size of this building and the character
of construction, it required a great number of inspections before its
' completion.
My assistant, Thos. W. Mitchell, has been very efficient in the dis-
charge of hig duties, and during the busy season of the Sanitary Officers
occasioned by the very severe winter of last year he assisted these
oflicers In making inspections of the large number of complaints and
other work caused by freezing of water fixtures.
The building outlook for the coming year is somewhat encouraging
There la at present much work spoken of, and plans being drawn for
same, and the prospects are that by midsummer a good deal of building
win be well under way.
My tabular report follows:
Respectfully submitted,
THOS. M. LANDERS,
Inspector of Plumbing.
Digitized .yCOOgle
90
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D,„i,z,d, Google
REPORT OF THE PLUMBERS' EXAMINING BOARD.
Dr. Roy K. Flannagan,
Chief Health Officer.
Richmond, Va.
Sir:
I have the honor to submit herewith my report as Secretary o£ the
Plumbers' Examining Board for the year ending December 31, 1918:
Meetings held during the year 13
Journeymen plumbers examined 20
Number examined and found unqualified 6
Number examined and licensed 14
Number ot licenses renewed S4
Respectfully submitted,
THOS.. M. LANDERS.
Secretary of the Plumbers' Examining; Board.
Digitized .yCOOgle
REPORT OP WHITE TUBERCULOSIS DISPENSARY.
Dr. Roy K. Flannagan,
Chief Health Officer,
Rlclmtoad, Va.
Sir:
I have the honor to submit herewith my annual report of the work
done at the White Tuberculosis Dlspettsary and by the nurses of the
Richmond Health Department during the year 1918.
There were 399 visits to the Dispensary by patients, and IBO visits
were made by nurses to patients in their homes. In addition to these,
372 visits were also made by the nurses to pktients not attending the
Dispensary, making a total of 522 visits made by the nurses to Dis-
pensary patients. Of the patients attending in 1917, 24 returned in
1918, and 92 new patients presented themselves for treatment mahing
a total of 116 patients for the year. The greatest number attending
fn any one month was 29, In May, and the smallest number was 12, In
January.
The patients who attended are classified ^s follows:
Sex: 5G males; 61 females.
Age: .19 under 20 years; 51, 20 to 40 years; and 26 over 40 yearp
ot age.
Referred: 8 to other Dispensaries; 7 to City Hospital or sanatoria.
Of the 27 tubercular patients, 21 attended fewer than four times,
and hence are not classified below as to cfv^dition after treatment. Many
of these came only once, as did also many of those whose diagnoslB
was undetermined.
The condition after treatment ot the 6 tuberculous patients who
came four or more times was as follows: Improved, 2; unimproved, 3;
progressive, 1 . There were deaths among the Dispensary patients who,
on arwunt of illness, ceased to visit the Dispensary and were therefore
dropped, for we drop all patients who do not attend at least once a
month. Our summary shows that two who attended died, but they at-
tended fewer than four times.
There hap been excellent Increase In the number of new patients
this year. The White Dispensary has wonderfully Improved this year,
as well as last. Volunteer workers have found many new patients for
us. Their work is commended. A large number of tuberculous pa-
tients, unattended by any physician, are waiting for some kindly dis-
posed individual to find them and bring them to the Dispensary, where
many of them may be greatly helped, and all of us will be indirectly
benefited as a result of the knowledge Imparted to the patients, who
by learning how to protect their families and frlende will no longer
ignorantly infect their communities. The serious proposition Is that
of getting tuberculous individuals to attend the Dispensary. Material
reduction In the number of tuberculous cases may not t)e accomplished
so long as hundreds of cases walk our streets and enter our homes,
ignorantly spreading Infection broadcast. Preparation must be made
D,gM,zed.yGOOgIe
93
to spend moro money and to concentrate effort in preTentlng the spread
of tuberculosis.
Last summer tixe Dispensary was moved from the necesBarlly
cramped quarters at the Medical College of Virginia, to the commodious,
well lighted rooms at H08 Capitol Street, nicely fitted up and furnished
through the klndneea and generosity of the Administrative Board.
One of our greatest needs now ia more physicians to do Dispensary
work. Another crying need is more nurses to do follow-up work among
our patients.
The Indispensable work of my efficient and faithful associate, Dr.
R. S. Bosher, Jr., is greatly appreciated. Though, like most of us,
hard pressed by otlier duties, he always finds time for the Dispensary
appointments.
The untiring services of our nurses, particularly during the trying
months through which we have just passed, are greatly appreciated and
heartily commended.
The^ cheerful support and ready co-operation of our Chief Health
OOlcer has always been most gratifying and helpful Ln conducting the
work of the Dispensary.
The appended table of summaries give a detailed account of the
Dispensary work, month by month.
Respectfully submitted,
P. D. LIPSCOMB, M. D..
Chief of Clinic.
D,gM,zed.yGOOgIe
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REPORT OF COLORED TUBERCULOSIS DISPENSARY.
)jr. Roy K. Flannagan,
Chief Health Officer,
Rtchmond, Va.
Plr:
I have the honor to aubmit herewith my annual report of the work
done at the Colored Tuberculosia Dispensary and by the Nurses or the
Richmond Health Department during the year 191S.
There were 319 visits to the Dispensary by patients, and 140 visits
ware made by nurses to Dispensary patients in their homes. The nurses
also made 360 visits to patients not regularly attending the Dispensary,
making a total of 500 visltE made by the nurses to Dispensary patients.
Of the patients attending in 1917, 2(1 returned In 1918, and 66
new patients presented themselves for treatment, malting a total of
92 patients for the year. The greatest number attending in any one
month was 27, in March, and the smallest number was 9, in December.
The 92 patients who attended may be classilled as follows:
Sex: 44 males; 4S females.
Age: 22 under 20 years; 54, 20 to 40 years, and 16 over 40 years
of age.
Diagnosis: 29 tubercular: 3 non-tubercular; 60 undetermined.
Referred: 8 to other dispensaries; 3 to City Hospital or sanatoria.
Of the 29 tubercular patients, ]3 attended fewer than four times,
and hence are not classified below aa to condition after treatment. Many
of these came only once, as did also many of those wtiose diagnosis was
undetermined.
Th& condition after treatment of the 16 tuberculous patients who
attended four or more times was as follows: Improved, 10; unimproved,
5; progressive, 1. There were several deaths among Dispensary patients
who, on account of illness, ceased to attend the Dispensary, and, there-
fore, were dropped. We do not carry on our roll patients who fail to
attend the Dispensary at least once during the month.
We note an Increase in the number of new patients this year. This
Is fencouraging, considering the enormous handicap -under which we
worked during the last three months of the year. Although Influenza
raged and we were temporarily deprived of many of our nurses, the
Dispensary was not closed. Because of the wisdom and generosity of
our Chief Health OfReer, most of the time of the nurses who could
work was devoted, tor a considerable period, to nursin.g influenza, either
at John Marshall Hospital or in their districts, so that the regular
tuberculosis work was for a time practically suspended.
Social workers hjive frequently during the year brought patients
to the Dispensary for examination, and owing to their activities many
cases, either positive or suspicious, have come under the wholesome
influence of Dispensary instruction, given not only at the Dispensary
but also by the Health Department nurses on their regular visits to
the homes of the patients. While the D.iapenaary is an indispensable
, ^,„oglc
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(actor in the management of the tuberculoalB Bituatlon In eTery city,
the work of the visiting nurse is Just as important. To InBtnict patients
at the Dispensary is not sufficient. The Tlcdting nurse must see that
the patient Is learning to practice In the home what he has been taught
at the Dispensary. For various reasons patients drop out of the Dis-
pensary. The memories of such must be Jogged by the Tislttng nurses,
lest they forget the risk they subject their associates to wh«i they
become careless.
.Altogether, the work of the Colored Dispensary has progreaaed, and
no doubt Incalculable good to the community has resulted by preventing.
In some measure, the spread of tuberculosis. However, there are many
hundreds of tuberculosis cases In our midst, which are not receiving
treatment either by private physicians or at the Dispensary. Duless some
more efficient means than heretofore employed be used to get these in-
fected individuals under some control and direction, the solution of
the tuberculosis problem will be deferred many generations.
The appended table of summaries gives a detailed account of tha
Dispensary work, month by month. i
Respectfully submitted,
P. D. LIPSCOMB, M. D..
Chief of Clinic.
Digitized .yCOOgle
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REPORT OF THE CHIEF SANITARY OFFICER.
Dr. Roy K. Flannagao,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit herewith my report as Chiefs Sanitary
Officer (or the year ending December 31, 1918. This report includes
the reports of nine Sanitary Officers, two of whom only worked on sani-
tary Inspection four months each. In the month of May, Sanitary Officer
John Donati was transferred to Food Inspection work, and Officer James
F. Waller was assigned to office duties, working only four months during
the past rear as Sanitary Inspector.
Three vacancies Tiave occurred in the sanitary force in the past
year. These vacancies were filled by the election of Chas. W. Sims,
Chas. E. Hayward and K. C. Seargeant. These officers have performed
their duties in a very satisfactory manner. Mr. Hayward was appointed
on November 15, 1918, to fill the vacancy of clerk, caused by the resig-
nation o( Mr. F. W. Robins, who left the Department to accept the posi-
tion of teller with the Church Hill Bank. I wish to state that Mr. Hay-
ward proved to be an exceptionally good sanitary officer, and while I dis-
liked to see him leave the sanitary force, it was gratifying to me to
see him receive the promotion.
The house-to-house inspection was continued duirng the year as In
the latter part of 1917; tlve ofhcers being assigned to a district, leaving
two to answer complaints, and each Is held responsible for the condi-
tions within his territory.
There were 61,084 visits made hy the sanitary force this year
against 55,27S in 1917 and 52,144 in 1916. Of the 25,633 premises in-
spected, I am able to report that 14,001 of these were entirely satisfactory
from a sanitary standpoint.
Stables receiv°d the attention of two sanitary officers, who specialized
on this work during the Sy season, and from reports on &le, there is a
marked improvement in the conditions. This, I believe, was due to
educational work and close Inspection by this Department.
The stable problem has been greatly lessened by the general use
of automobiles by the public. This is shown by the following figures:
In the district east of Fifth Street and north of the river there
are 1,041 stables, 373 being occupied and 668 not now being used for
stable purposes, showing about 6I> per cent, either vacant or used for
other purposes.
The dry closet work received the whole attention of no less than
four officers from April until September. No extra help has been em-
ployed in this work, as has been done previously. A new record of the
location and number of dry closets In the city was also gotten during
the summer. There are 3,367 dry closets in the city, 1,837 being located
on the north side of the river and 1,430 on the southside. Notwith-
standing the scarcity ot labor during the past year, we had very little
Digitized .yCOOgle
trouble In having repairs made, and a very few casee were reported to
During the past year particular attention has been given to the
water supply In the sections where city water is not available. Many
wells were found to he In an Insanitary condition. A regulation was
passed requiring tight covers to all wells and pumps installed,
A great deal of time wae spent on this work by the Inepectors, and
as may be seen from the table below, there were 535 wells repaired
■ and pumps installed. 1 believe this work will have a good effect on our
typhoid rate.
The regulation requiring wells to be covered and city water installed
where same was available received closer attention the past year than
heretofore. This regulation has been rigidly enforced. The records
flhow that 31R wells have been covered, and, while no record was kept
of new hydrants installed, there were undoubtedly about 600 put In,
Many difficulties were encountered In enforcing this regulation, as a
great many citizeuE were unwilling to Oil their wells without having the
matter passed on by the court. The Police Court has upheld this regu-
lation in all cases which came before it. There are, however, two cases
now pending an appeal before the Hustings Court.
The practice of requiring weeds removed where there was no exist-
ing nuisance has been discontinued. We do, however, require them to
he removed where they are found to be detrimental to the public
health. A great deal of the inspectors' time has been saved by thi&
arrangement for more Important work.
Sanitary officers were given strict orders to report all houses where
sewers were available and water mains had not been extended. As a
result of these orders, it was found that many houses could have sewer
connections, and dry closets destroyed, If these extensions were made. I
at once sugeested these extensions to you, and they were ordered by
the Administrative Board on your recommendation. For some reason
a great deal of this work has not been started as yet by the depart-
ment responsible for these extensions, although ordered In some instances
more than a year ngo. I hope you will use your best endeavors to have
these mains promptly extended, and also recommend a sufficient appro-
priation for sewer extension. The 3,267 dry closets in the city are, in
my judgment, our greatest problem from a sanitary standpoint, and
I would like very much to see this number greatly reduced. Sewer and
water extension is the only solution of this problem.
The past summer being a very dry one. the stagnant water and
mosquito nuisance gave very little trouble. Where water was found to
be bre~"'ing mosquitoes, in accordance with our general custom, it was
promptly oiled with lierosine until permanent abatement could be had.
The removal of night soil heretofore has always been done between
the hours of 9 P, M, and 6 A, M,, but, on account of the severe freezing
weather of last winter, it was necessary to do a part of this work after
sunrise, during the warmer part of the day, and even then It was neces-
sary for the scavenger to use a crowbar and pickax to remove the frozen
material from the boxes. It was demonstrated In the months of Ja,a}iixY •
• ---'81'-'
100
and February that this class of work could be done better and witb
mot^ care, ajid with leas prejudice to the public health, by dayllKbt
than would be posaible at niglit, but, on account of complaints (rem
citizens, it was deemed beet to discontinue the day-time remoyals until
a better Informed public sentiment would permit same. In view of our
past experience with the daylight removals, and being satisfied that the
boxes and back-Saps would be handled with more care, I would recom-
mend that the dayliglit remoyals be .given another trial this winter.
The State venereal disease law, which went Into effect last June, .
requiring all persons charged with certain offenses to be examined by
the Health Department to ascertain if such persons were infected with
a venereal disease, added extra duties to the sanitary division. The
Chief Sanitary Officer was assigned the duty of keeping a court record
of these eases, to see that these reports were filed in tbe proper court
promptly. The transportatiou of such persons to the detention wards
for examination, to quarantine for treatment when found to be Infected,
and the returning of these persons to court for trial when they were
ready to be releaF.ed from quarantine, were also made part of his
duties. Many cases were required to be returned to court on several
occa'^ions. Patients had to be carried from quarantine to d«itists for
treatment and moved tor various causes. We gave a written order when
such persons were removed and required a receipt when thy were re-
turned. It required a very great deal of detail work. Nearly all of
this work waR done by the Chief Sanitary Officer personally, and it
required much time.
At the beginning of the recent Influenza epidemic, all Sanitary Offi-
cers (except the two complaint men) were assigned the duty of enforc-
ing the emergency regulations adopted by the Health Department. In-
spections were made ot soda fountains, street ■ cars, office buildings,
theatres, factories and work shops, to require the use of individual
drinking cups and towels, and to see that these places were properly
ventilated. I wish to state that a great, many of these places were
found to be using the public drinking cup and towel and were very
poorly ventilated. When the emergency ban was lifted, I Immediately
siiggested to you that aji ordinance be drafted and recommended re-
quiring the proper ventilation of these places. This ordinance, as you
know, is now pending before the City Council.
Before closing this report^ I wish to thank the Sanitary Officers for
their hearty co-operation, for without their untiring efforts such good
results could not have been obtained, and I would extend thanks to the
Plumbing inspector and his assistant for their hearty eo-operallon, they
having answered more than 800 sanitary complaints during the past
year which do not appear in my report. (See plumbing complaints
in Plumbing Inspector's report.)
In behalf of the Sanitary Officers. I want to thank you for your
courteous treatment during the past year, and wish you all the success
h In your future private and professional career.
Bespectfully submitted,
W. A. BOWRY.
Chief Sanitary Officer.
• ---'81'-'
YEARLY REPORT OF CHIEF SANITARY OFFICER— YEAR 1S18.
W. A. Bowry — Chief Sanitary Officer.
Premises inspected 25,633
Premises revisited : . . 17,515
Agents, owners aod plumbers visited 8,278
Miscellaneous visits 9,173
Sumif.ona served 225
Cases in court 260
Total number of visits ■ 61,084
Alleys ordered cleaned 115
Cellars ordered cleaned and drained 69
City water ordered on premises 697
Contagious disease cards pot up 1,392
Dry closets .ordered cleaned and destroyed 143
Dry closets ordered repaired 2,621
Dry closeta ordered (new) 45
Mosquito-breeding pools oi'ed by Sanitary Officer 15
Non-classified nuisances abated 689
Old wells condemned — ordered covered 318
Old wells ordered cleaned and repaired 525
Old plumbing ordered repaired 3,967
' Rain conductors, gutters and roofs ordered repaired 193
Stabler and manure boxes ordered repaired 306
Stables ordered cleaned — manure ordered carted away 371
Sewer connections ordered 188
Vacant lots ordered cleaned; weeda ordered cut 23
Yards ordered cleaned 1,173
Total number of orders Issued 13,850
Premises found Satisfactory 14,001
In addition to my work as Chief Sanitary Officer, the following
detail wort was also done by me during the year ending December
31, 1S18:
Premises inspected 1,123
Premises revisited 608
Agents, owners and plumbers visited 193
Miscellaneous visits 1,583
Summons served 13
Cases in court 22
Total number of visits 3,541
Alleys ordered cleaned ; . . 5
Cellars ordered cleaned and drained 7
City water ordered on premises , , 88
D^.^H.^Cooi^le
102
Contagious disease cards put up £76
D17 closets ordered cleaned and destroired lU
Dry cloBets ordered repaired H
Dry closets ordered (new)
MoBguito-breedlng pools oiled by Sanitary Officer 1
Non-clasBlfled nuisances abated 143
Old wells condemned — ordered covered IS
Old wells ordered cleaned and repaired 5
Old plumbing ordered repaired 411
Rain conductors, gutters and roots ordered repaired 36
Stables and manure boxes ordered repaired 3
Stables ordered cleaned — manure ordered carted away 4
Sewer connections ordered 10
Vacant lots ordered cleaned; weeds ordered cut 2
Yards ordered cleaned 65
Total number of orders issued 1,092
Premlsee found satisfactory 130
Digitized .yCOOgle
Dr. Roy K. Flaanagan,
Chief Health Officer,
Richmond, Vo.
Sir:
I have the honor to submit to you my report as Sanitary Officer for
the year ending December 31, 191S.
Premises inspected 2,935
Premiaea revisited 2,281
Agents, owners and plumbers visited 1,D7Z
Miscellaneous vlBlts 962
Summons served 57
Cases in court 37
Total number of visits 7,344
Alleys ordered cleaned 8
Cellars ordered cleaned and drained S
City water ordered on premises 107
Contagious diacaae cards put up 6
Dry closets ordered cleaned and destroyed 3
Dry closets ordered repaired 36S
Dry closets ordered (new) 8
Nan -classified nuisances abated >
Old wells condemned — ordered covered 93
Old wells ordered cleaned and repaired S2
Old plumbing ordered repaired 2&&
Rain conductors, gutters and roofs ordered repaired 7
Stables and manure boxes ordered repaired 1
Stables ordered cleaned — manure ordered carted away 7
Sewer connections ordered 27
Vacant lots ordered cleaned; weeds ordered cut 8
Yards ordered cleaned 240
Total number of orders issued 1,228
Premises found satisfactory 1.808
Respectfully submitted,
W. H. MOSLEY,
Sanitary Officfr.
Digitized .yCOOgle
Dr. Roy K. Flaonagan,
Ctilet Health Officer,
Richmond, Va.
Sir:
I have the honor to submit to you my report aa Sanitary Officer for
the months of January, February, March and to April 17, 1918.
Premises inspected 950
Premises rpvisited 411
Agents, owners and plumbers visited 340
Miscellaneous visits 243
Summons served 2
Cases in court 7
Total number of visits 1,953
Alleys ordered cleaned
Cellars ordered cleaned and drained
tity water ordered on premises 11
Contagious dipease cards put up 'i
Dry closets ordered cleaned and destroyed
Dry closets ordered repaired 31*
Dry closets ordered (new)
Moaquito-breec'ing pools oiled by Sanitary Officer
Non-classlfled nuisances abated 33
Old wells condemned — ordered covered 51
Old w»lls ordered cleaned and repaired 42
Old plumbing ordered repaired 184
Rain conductors, gutters and roofs ordered repaired 5
Stables and manure' boxes ordered repaired 19
Stables ordered cleaned — manure ordered carted away 76
Sewer connections ordered 1 ■
Vacant lots ordered cleaned; weeds ordered cut
Yards ordered cleaned 85
Total number of orders Issued 824
Premises found satisfactorj' 370
Respectfully submitted,
W. A. CRUMP,
Sanitary Officer.
Digitized .yCOOgle
lir. Hoy K, Flannagaa,
Chief Health Officer,
Richmond. Va.
Sir:
1 have the honor to eubmlt to you my report as Sanitary Officer for
the year ftnding December 31, 1918.
Premises inspected 2,212
Premises revisited S,615
Agents, owners and plumbers visited 519
Miscellaneo^us visits 896
Summons served 13
Total number of viaits 6,367
Alleys ordered cleaned
Cellars ordered cleaned and drained .'
City water ordered on premises 76
Contagloua disease cards put up 8
Dry closets ordered cleaned and destroyed 41
Dry closets ordered repaired 519,
Dry closets ordered (new) 24
Mosquito-bieeding pools oiled by Sanitary Officer.
Non-classified nuisances abated 8
CM wells condemned — ordered covered 39
Old wells ordered cleaned and repaired 174
Old plumbing ordered repaired 271
Rain conductors, gutters and roofs ordered repaired S
Rtabies and manure boxes ordered repaired
fttablea ordered cleaned — manure ordered carted away
Sewei connections ordered 86
Vacant lots ordered cleaned; weeds ordered cut 2
Yards ordered cleaned 150
Total number of orders issued 1,404 ,
Premises found satisfactory 892
Respectfully submitted,
S. A. HALL.
Sanitary Officer.
Digitized .yCOOgle
Dr. Roy K. Flannagan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit to you my rtport as Sanitary Officer for
the year ending December 31, 1918.
Premises inspected 3,107
Premises revisited 402
Agents, owners and plumbers visited 984
Miscellaneous visits i - ■ ■ 1,330
Summons served 20
Cases in court 46
Total number of visits 6,888
Alleys ordered cleaned 61
Cellars ordered cleaned and drained 40
City water ordered on premises 152
Contagious diEease cards put up 819
Dry closets ordered cleaned and destroyed 2
Dry closets ordered repaired 17
* Dry elosetB ordered (new) I
Mosquito-breedinK pools oiled by Sanitary Officer 10
Non-classified nuisances abated '. 257
Old wells condemned — ordered covered 11
Old wells ordered cleaned and repaired .- 20
Old plumbing ordered repaired 1.203
Rain conductors, gutters and roofs ordered repaired S9
Stables and manure boxes ordered repaired 16
Stables ordered cleaned — manure ordered carted away 21
Sewer connections ordered
Vacant lots ordered cleaned; weeds ordered cut 11
Yards ordered cleaned 157
Total number ot orders issued 2,886
iPremises found satisfactory 348
Respectfully submitted,
R. R. WRBNN,
Sanitary Officer,
D,gH,zed.yGOOgIe
33r. Roy K. FlanncLgan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit to you my report as Sanitary Officer for
the year ending December 31, 1918. ^
Premises Inspected 1,734 /
Premises revisited 3,386
Agents, owners and plumbers visited 1,814
Miscellaneous visits 1,120
Summons served 80
Cases In court Ill
Total number of visits 8,246
Alleys ordered cleaned 14
Cellars ordered cleaned and drained 6
City water ordered on premises 81
Contagious disease cards put up '..... 265
Dry closets oi'dered cleaned and destroyed 14
Dry closets ordered repaired 1
Dry closets ordered (new)
Mosqufto-breedlng pools oiled by Sanitary Officer 11
Old wells condemned — ordered covered 6
Old wells ordered cleaned and repaired 4
Non-classlfled nuisances abated 103
Old plumbing ordered repaired 700
Sewer connections ordered 11
Rain conductors, gutters and roofs ordered repaired ■. . 45
Stables and manure boxes ordered repaired 6
Stables orfered cleaned — manure ordered carted away 6
Tavant lots ordered cleaned; weeds ordered cut 3
Yardf! ordered cleaned 100
Total number of orders Issued 1,376
Premises found satisfactory 428
Respectfully submitted,
T. M. LANDBRS, JR.,
Sanitary Ojficer.
Digitized .yCOOgle
Dr. Ror K. Flannagan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit to you my report as Sanitary Officer for
(he year ending December 31, 1918.
Premises inspected 2,355
Premieea revisited 3,082
Agents, owners and plumbers visited 1,643
MiBcellaneous visits 699
Summons served 11
Cases in court 8
Total number of visits 7,798
Alleys ordered cleaned 2 *
Cellars ordered cleaned and drained 9
City water ordered on premises 116
Contagious disease cards put up 9
Dry closets ordered cleaned and destroyed 73
Dry closets ordered repaired 444
Dry closets ordered (new) 13
Mosquito-breeding rools oiled by Sanitary Officer 1
Non-classified nuisances abated 33
Old wells condemned — ordered covered 63
Old wells ordered cleaned and repaired 132
Old plumbing ordered repaired 291
Rain conductors, gutters and roofs ordered repaired 6
Stables and manure boxes ordered repaired
Stables ordered cleaned — manure ordered carted away 3
Sewer connections ordered 53
Vacant lots ordered cleaned; weeds ordered cut 2
Yards ordered cleaned 163
Total number of orders issued 1,43*
Premises found satisfactory 1,1S0
Respectfully submitted,
M, W, LAWRENCE,
Sanitary OffiCRT.
Digitized .yCOOgle
Dr. Roy K. Flannagan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit to you my report as Sanitary Officer tor
the monthB of May. June, July and August. The remalalng eight months
of the jear, 1918, were devoted to office work.
Premises Inspected 2,955
Premises revisited 119
Agents, owners and plumbers visited 40
Miscellaneous visits 24B
Summons served
Cases in court
Total number of visits 3,357
Old plumbing ordered repaired ' 28
Stables and manure boxes ordered repaired 8
Stables ordered cleaned — manure ordered carted away 58
Yards ordered cleaned 1
Total Tiumber of orders issued. .■ 95
Premises found Balisfactory 2,036
^ KespectfuUy submitted,
JAS. F. WALLER,
Sanitary Officer.
Digitized .yCOOgle
tn. Hoy K. t'la
Chief Health Officer,
Richmond, Va.
Sir:
I have the honor to submit to you my report as Sanitary Officer for
the months of January. February, March, April and to May 10. 1918.
Premises inspected 1,479
Prem'aes revisited 761
Agents, owneis and plutnbers visited 677
MiHcellaneous visits 503
Summons served
Cases in court 3
Total number o( visits .*. 3,42o
Alleys ordered cleaned
Cellars ordered cleaned and drained 1
City water ordered on premises 17
Contagious disease cards put up
Dtj' closets ordered cleaned and destroyed
Dry closets ordered repaired 458
Dry closets ordered (new)
Mosquito-breeding pools oiled by Sanitary Officer
Non-classified nuisances abated 73
Old wells condemned — ordered covered 5
Old wells ordered cleaned an repaired 30
Old plumbing ordered repaired 93
Rain conductors, gutters and roofs ordered repaired
Stables and manure boxes ordered repaired 2
Stables ordered cleaned — manure ordered carted away 8
3ewer connoctions ordered ,
Vacant lots ordered cleaned; weeds ordered cut 1
Yards ordered cleaned 2
Total number of orders issued 69"
Premises found satisfactory
Respectfully submitted,
JOHN A. DONATI.
BanitOTy Officer.
Digitized .yCOOgle
Dr. Roy K. Flannasan,
Chief Health Officer,
Richmond, Va.
Sir:
I have the lienor to submit to you my report as Sanitary Officer lor
the period extending Irom May 1 to November 15, 1918.
Premises inspected 2,82S
Premises revisited 1,0S2
Agents, owners and plumbers visited 418
Miscellaneous visits 871
Summons served £ 2
Cases in court 9
Total number of visits &,208
Alleys ordered cleaned 5
Cellars ordered cleaned and drained
City water ordered on premises 33
Contafiious disease cards put up 6
Dry closets ordered cleaned and destroyed
Dry closets ordered repaired 2
Dry closets ordered (new)
Mosquito-breeding pools oiled by Sanitary Officer 1
Non-classified nuisances abated 2
Old wells condemned — ordered covered 2
Old wells ordered cleaned and repaired 3
Old plumbing ordered repaired 115
Rain conductors, gutters and roots ordered repaired
Stables and manure boxes ordered repaired 252
Stables ordered cleaned — manure ordered carted away 188
Sewer connections ordered
Vacant lots ordered cleaned; weeds ordered cut I)
Yards ordered cleaned 3!i
Total number of orders issued 64ti
Premises found satisfactory 2,299
In addition to the above, venereal work was assigned to me, which
branch of work extended from September IG to November 1, 1918.
Respectfully submitted,
C. B. HAYWARD,
Sanitary Officer.
D,gM,zed.yGOOgIe
J)r. Roy K. Plannagan,
Chief Health Officer,
Richmond, Va.
Kir:
I have the honor to eubmit to yoa my report as Sanitary Officer for
the period extending from November 16 to December 31, 1918.
Premises Inspected 606
Premises revisited 73
Agents, owners and plumbers visited 93
Miscellaneous visits 434
Cases in court 1
Total number of visits 1,20»
Alleys ordered cleaned
Cellars ordered cleaned and drained
City water ordered on premises "^ 6
Contagious disease cards put up
Dry closets ordered cleaned and destroyed
Dry closets onlered repaired
Dry closets ordered repaired
Dry closets ordered (new)
Mosquito-breeding pools oiled by Sanitary Officer '
Non-classified nuisances ahatei? o
Old wells condemned; ordered covered
Old wells ordered cleaned and repaired
Old plumbing ordered repaired 113
Rain conductors, gutters and roofs ordered repaired
Stables and manure boxes ordered repaired
Stables ordered cleaned — manure ordered carted away
Sewer cminecflons ordered
Vacant lots ordered cleaned; weeds ordered cut
Yards ordered cleaned 123
Total number of orders issued 242
Premises found .satisfactory 425
Respectfully submitted,
K. C. SEABGEANT,
Sanitary Officer.
Digitized .yCOOgle
Dr. Roy K. Fiannagaa,
Chief Health Officer,
Richmoiid, Va.
Sir:
I have the honor to Bubintt to you my report as Sanitary OiBeer for
the months of May, June. July, August, September, October, Novem-
ber and December, 1919.
Premises inspected 3,346
Permlaea revisUed 2,715
AgenlB, ownere and plumbers visited 485
MlBcellaoeoua vfaits 289
Summons served 6
Caaes In court 8
Total number of visits 6,849
Alleys ordereil cleaned '.
Cellars ordered cleaned and drained ', "
City water ordered on premises 8
Contagious disease cards put up ,
Dry closets ordered cleaned and destroyed
Dry closets ordered repaired 492
Dry closets ordered (new) 2
MoBnulto-breeding pools oiled by Sanitary Officer
Non-classified nuisances abated 19
Old wells conrlemned — ordered covered 33
Old wells ordered cleaned and repaired 31-
Old plumbing ordered repaired 298
Rain conductors, gutters and roofs ordered repaired. .
Stables and manure boxes ordered repaired
Stables ordered cleaned — manure ordered carted away
Sewer connections ordered
Vacant lots ordered cleaned; weeds ordered cut
Yards ordered ejeaned .4
Total number of orders Issued 887
Premises found satisfactory 2,467
Respectfully submitted,
CHA3. W. SIMS,
__ . ■ Sanitary Officer.
Digitized .yCOOgle
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