in riie.'Srain 
and Counties of Virginia COMMONWEALTH OF VIRGINIA 
DEPARTMENT OF HEALTH 
I. C. RIGGIN, M. D,, Commissioner 
Public Health in the State and Counties 
of Virginia 
By 
J. F. KENDRICK, M. D., Dr. P. H. 
u, 
INTERNATIONAL HEALTH DIVISION 
THE ROCKEFELLER FOUNDATION 
RICHMOND, VIRGINIA 
1939 CONTENTS 
Page 
FOREWORD 5 
I. INTRODUCTION 7 
A. General Considerations 7 
1. Description of State 7 
a. Political Subdivisions 8 
b. Population 8 
c. Industries 10 
d. Transportation 11 
2. State Government 13 
a. General Divisions of Government 13 
b. Education Facilities 14 
c. Virginia Fiscal Affairs 16 
3. County Government 19 
a. Constitutional Form or County Organization and Government 19 
b. Optional Forms of County Organization and Government 21 
II. STATE AND COUNTY HEALTH ORGANIZATIONS 22 
A. Introduction 22 
B. The Central Health Organization 22 
1. The State Board of Health 22 
2. The Commissioner of Health 26 
3. The State Department of Health 27 
a. The Bureau of Administration 27 
1) The Division of Health Education 29 
b. The Bureau of Rural Health 29 
1) The Division of Tuberculosis Out-Patient Service 31 
c. The Bureau of Communicable Diseases 32 
1) The Division of Venereal Disease Control 34 
d. The Bureau of Public Health Nursing 35 
e. The Crippled Children’s Bureau 37 
f. The Bureau of Industrial Hygiene 38 
g. The Bureau of Sanitary Engineering 39 
1) Engineering 41 
2) Shellfish Sanitation 44 
3) Mosquito Control 45 
h. The Bureau of Vital Statistics 46 
i. The Bureau of Maternal and Child Health 49 
1) The Division of Mouth Hygiene . 53 
j. The Bureau of Laboratories 54 
k. The State Tuberculosis Sanatoria 55 
l. Vital Statistics 57 
m. Health Department Finances 58 
C. Local Health Organization 60 
1. Introduction 60 
2. County Boards of Health 64 
3. County or District Health Officers 64 CONTENTS—Continued 
Page 
D. Related Functions of Other State Departments 66 
1. State Department of Public Welfare 66 
2. State Department of Education 68 
3. The Department of Agriculture and Immigration 70 
4. The Department of Labor and Industry 71 
5. The Department of Workmen’s Compensation 72 
E. Recommendations 72 
APPENDIX 81 FOREWORD 
With the emphasis which is being placed on public health activities 
and the rapid expansion to which such services have been subjected 
during the past few years, it seemed especially fitting that a study be 
made at this time as the present represents possibly the end of one 
era in public health and the beginning of another, based on the broader 
concept that certain medical activities are the proper sphere of public 
health. 
The Virginia Department of Health welcomed the opportunity of 
having a detailed study of its work made by the International Health 
Division of the Rockefeller Foundation. To that end an agreement 
was made with the Foundation by the Department in September 1937 
for such a study. 
The following report of the Department’s present activities, with 
recommendations for the future development of both State and local 
health services, is the result of that study. 
The document is historical, factual, and highly constructive. 
Emphasis is placed upon consolidation of health districts, increased 
coordination of activities, and measures adapted to meet the official 
public health needs of the future. 
The State Department of Health appreciates the practical value of 
this study and thanks the International Health Division for making it 
possible. 
To Dr. J. F. Kendrick, of the Foundation, whose painstaking and 
effective investigations are reflected in this study, the Department 
also wishes to extend its sincere appreciation. 
I. C. Riggin, M. D., Commissioner, 
Virginia Department of Health PUBLIC HEALTH IN THE STATE 
AND COUNTIES OF 
VIRGINIA 
I. INTRODUCTION 
A. GENERAL CONSIDERATIONS 
1. Description of the State 
Virginia lies just south of the Potomac River between the parallels 
36 degrees 30 minutes and 39 degrees 37 minutes north latitude, and 
between 75 degrees 15 minutes and 83 degrees 40 minutes west longi- 
tude. With a gross area of 42,627 square miles, of which 2,365 square 
miles are water, its area is about the same as that of Maine and New 
Hampshire combined and only 605 square miles greater than that 
of Tennessee. The State has a much indented coast line of nearly 800 
miles on the Atlantic Ocean and the Chesapeake Bay, which receive 
many rivers with long tidal estuaries. The greatest distance from the 
Atlantic Coast to the western boundary is about 440 miles, and the 
extreme breadth of the State is about 200 miles. The area is crossed 
by three distinct physiographic provinces—the Coastal Plain, the 
Piedmont Plateau, and the Appalachian Mountain Province. 
The Coastal Plain, or Tidewater Virginia, slopes gently seaward 
from an elevation of about 200 feet at the fall line of its three great 
rivers, the Potomac, the Rappahannock, and the James, to 20 feet or 
less near the seashore. The main drainage is into broad tidal estuaries 
extending southeastward across the plain, dividing it into several 
peninsulas. The two Virginia counties on the Eastern Shore of the 
Chesapeake Bay have physical characteristics very similar to, and are 
included as a part of, the Coastal Plain. 
The Piedmont Plateau lies between the fall line, roughly indicated 
by a line drawn through Fredericksburg, Richmond, and Petersburg, 
and the Blue Ridge. This region contrasts with the Coastal Plain in 
its higher elevation and in possessing elevations which rise above its 
general level. Along the eastern slopes of the Blue Ridge, near the 
Carolina boundary, the general level of the Piedmont Plateau is 1,000 
to 1,500 feet above sea level, and in the northern part of the State the 
elevation is 500 to 750 feet. The drainage of the Piedmont region is 
to the southeast by the Potomac, the Rappahannock, the James, and 
the Roanoke Rivers, and their tributaries. 
The Appalachian Mountain Province embraces the Blue Ridge 
and Alleghany ridges with the Great Valley between. The latter 
extends from the Potomac on the north in a southwesterly direction 
and merges into the Plateau of Southwest Virginia. The topography of 
this area is characterized by sharp linear ridges extending northwest- 
southwest and separated by relatively broad valleys. The peaks of 
some of these ridges have elevations ranging upwards of 4,000 feet. 8 
Public Health in the State and Counties of Virginia 
The Great Valley, including the southwestern Plateau, is drained by 
five great rivers, each with its separate valley. The northern third is 
drained by the Shenandoah River and other northeastward flowing 
tributaries of the Potomac. Drainage of the central part of the valley 
and ridge region is through the James and Roanoke Rivers which 
pierce the Blue Ridge on their eastward course to the Atlantic Ocean. 
The southwestern part of the valley and ridge province drains to the 
Gulf of Mexico through the New and Tennessee Rivers. 
The climate of Virginia is remarkably free from sudden and severe 
extremes of heat and cold. Temperatures in various parts of the State 
are influenced by the large bodies of water along the coast and by the 
altitude in the west. The annual temperature of the State as a whole is 
about 58 degrees, and the annual average rainfall about 42 inches. 
a. Political Subdivisions.—Virginia has one hundred counties, 
twenty-four independent cities, and, according to the 1930 census, 
191 incorporated towns. In addition to these, each county is divided into 
magisterial districts, varying in number from three to ten. The location 
of the several counties may be seen from the accompanying map. 
Details with regard to the area, population, and assessed values of each 
county will be found in Table No. 1 of the attached appendix. Of the 
100 counties, only two have areas as great as 1,000 square miles each. 
The average county area in the United States is 985.6 square miles. 
The average for Virginia is 402.2 square miles. All but two of the 100 
counties have areas smaller than the national average, and fifty-two 
are below the average area for the State. Seventy-two counties have 
less than 500 square miles and four have less than 100. 
Cities in Virginia are autonomous and independent of the counties 
in which they are situated, and, as such, county taxes do not apply 
within the boundaries of cities. All incorporated places are classified 
as towns and cities. All incorporated communities having within 
defined boundaries a population of 5,000 or more are known as cities, 
and such incorporated communities having less than 5,000 are known 
as towns. Due to certain constitutional and statutory provisions, 
however, Virginia has several towns with more than 5,000 inhabitants 
and at least two cities with less than 5,000 inhabitants. Towns are not 
independent of the counties in which they are located, and they are 
subject to both county and municipal taxation. 
b. Population.—The estimated population of the State of Vir- 
ginia as of July 1, 1936, was 2,459,180—the proportions of white and 
colored persons being 73.4 and 26.6 per cent, respectively. According 
to the United States Census of 1930 the total population of the State 
was 2,421,581, of which, 73.1 per cent were white, 26.8 per cent were 
Negro, and 0.1 per cent were other races. The average Virginia county 
has 17,189 inhabitants as compared with an average of 39,992 for the 
counties of the United States as a whole. Ninety-seven of the Virginia 
counties have fewer inhabitants than the national average, and fifty- 
nine counties have fewer than the average for the State. According 
to the 1930 census thirty-one counties had less than 10,000 inhabitants 
each. Of these, twenty-two counties had less than 8,000, and five had 
less than 5,000 inhabitants each. The percentage of Negroes in the Outline map showing the 100 Counties into which the State of Virginia is divided 10 
Public Health in the State and Counties of Virginia 
State’s population has decreased from 31.6 in 1913 to 26.6 in 1936. 
The percentage of Negroes in the several counties (1930 census) varied 
from 0.4 in Craig County to 79.6 in Charles City County. The Negro 
population was 10 per cent or less in 25 counties, from 10 to 25 per cent 
in 18 counties, and from 25 to 50 per cent in 36 counties, and over 50 
per cent in 21 counties. 
Illiteracy among persons ten years old and over in the State was 
5.0 per cent among the native whites, 7.4 per cent among the foreign- 
born whites, and 19.2 per cent among Negroes. 
The 1930 census classifies 1,636,314, or 67.6 per cent of the State’s 
population as rural, and 785,537, or 32.4 per cent, as urban. Of the 
rural population, 948,746, or 58 per cent were actually living on farms; 
and 687,568, or 42 per cent, were listed as rural non-farm residents. 
The total number of gainfully employed persons in the State was 
880,276, of which 270,836, or 30.8 per cent were engaged in agriculture; 
207,207, or 23.2 per cent, were engaged in manufacturing and mechanical 
industry; 98,720, or 11.2 per cent were engaged in trade; and 92,577, 
or 10.5 per cent, were engaged in domestic or personal service. No other 
single occupation engaged as many as 10 per cent of the total of those 
gainfully employed. 
The populations of the twenty-four cities of Virginia, as listed in 
the 1930 census, are as follows: 
CITIES 
Population 
1930 Census 
CITIES 
Population 
1930 Census 
182,929 
129,710 
69,206 
45,704 
40,661 
34,417 
28,564 
24,149 
22,247 
15,246 
11,990 
11,327 
10,855 
10,271 
7,857 
7,705 
7,232 
6.839 
6,819 
6,382 
6,227 
4,002 
3.840 
3,778 
Suffolk 
Roanoke 
Newport News 
Petersburg 
Clifton Forge 
Alexandria 
Hampton 
Charlottesville 
Staunton 
Hopewell 
Buena Vista 
Bristol 
c. Industries.—Virginia’s industry is varied: agriculture, manu- 
facturing, mining, and fishing are important. The chief of these basic 
industries, however, is agriculture, and the welfare of the people of the 
State largely depends upon the prosperity of the farmers. The land area 
of the State is approximately 25,767,680 acres, of which 17,644,898 
acres, or 68.5 per cent, were in farms in 1935. The number of farms 
increased from 170,612 in 1930, to 197,632 in 1935—an increase of 27,- 
020 farms. In 1930 the average size of farms was 98.1 acres, as compared 
with 89.3 acres in 1935. The United States census of agriculture for 
1935 shows that 121,490, or 61.5 per cent of all farms, were operated Public Health in the State and Counties of Virginia 
11 
by owners. White farmers operated 154,421 farms, and colored 
farmers operated 43,211. The value of farm lands and buildings in 
1935 was 3593,854,761, as compared with 3855,849,672 in 1930. The 
principal crops grown are corn, tobacco, hay, wheat, peanuts, and 
truck crops. About 40 per cent of the cash farm Income is derived from 
livestock and livestock products, poultry and dairying being large 
contributors. The United States Department of Agriculture estimated 
the gross Income from crops and livestock in 1935 at 3158,819,000. 
The addition of 33,188,000 as rental and benefit payments by the Ag- 
ricultural Adjustment Administration brought the total income to 
3162,008,000. 
The State produces great quantities of coal, and it has various 
building stones and commercial clays. The Chesapeake Bay fisheries 
yield a large proportion of the country’s oysters and other fish. Trans- 
portation equipment works and other metal works, tobacco factories, 
and silk and cotton textile mills employ most of the industrial popula- 
tion; there are also many furniture factories and pulp and paper mills, 
dependent upon the State’s extensive forests. Providing for tourists, 
vacationists, and health seekers also amounts to an industry, the 
State’s historical places, scenery, seashore, mountain climate, springs, 
and natural wonders attracting thousands of visitors. In point of 
monetary value, tobacco leads, textiles and their products are second, 
and transportation equipment and repairs are third. The following 
table, compiled from the 1935-1936 report of the Department of Labor 
and Industry, indicates the importance of certain of these industries to 
the State. 
INDUSTRY 
Average 
Number 
Wage Earners 
Total 
Wages 
Paid 
Value 
of 
Products 
150,833 
8,429 
13,075 
4,624 
2,727 
$ 110,413,751 
12,642,700 
11,194,595 
2,914,989 
1,612,364 
$ 786,424,110 
38,575,669 
16,746,554 
7,059,303 
5,193,101 
Other Mining and Quarrying 
d. Transportation.—The public highways in Virginia comprise 
two systems—the primary system and the secondary system. The 
primary system embraces approximately 9,225 miles of road of which 
about 7,400 miles are hard surfaced, and the remainder of which is 
conditioned. The secondary system of the State roads consists of all 
public roads that were previously under county jurisdiction, except 
those in three counties. These roads were taken over by the State Roads 
Commission under an Enabling Act passed by the General Assembly in 
1932, as a means of relieving the counties of the financial burden of 
constructing and maintaining roads. The three counties of Henrico, 
Arlington, and Warwick specifically rejected the provisions of this 12 
Public Health in the State and Counties of Virginia 
Act and continue to maintain their county roads. The roads coming 
within the scope of this Act total about 37,000 miles, of which more than 
7,000 miles have been subjected to some type of surface treatment. 
These two systems constitute a network over which almost every com- 
munity in the State is easily accessible by automobile. Funds for the 
construction and maintenance of State roads are derived principally 
from the gasoline tax, motor vehicle registration fees, and the Federal 
post roads subsidy. Expenditures for these purposes in 1936-1937 
amounted to $26,086,867.14, or 36.4 per cent of the State’s expenditures 
for all purposes. The policy of pay as you go which has been adopted 
by the State in constructing and maintaining its roads has obviated 
the accumulation of large road debts. 
Railway facilities in Virginia compare favorably with those of al- 
most any State in the Union, although there are fifteen counties without 
railway facilities actually within their boundaries. In all, there are 
thirty-one railroads operating in the State, but many of these are 
actually feeders or distributing lines of larger systems. Those operating 
the greatest mileage and serving the widest field in Virginia are: the 
Chesapeake and Ohio, the Virginian, and the Norfolk and Western, 
which traverse the State from east to west and have terminals at 
Hampton Roads; the Richmond, Fredericksburg and Potomac, which 
operates between Washington and Richmond, and connects with the 
Atlantic Coast Line and Seaboard Air Line railroads at Richmond; 
the main line of the Southern Railway which traverses the Piedmont 
section from Alexandria to Danville; the Norfolk and Western’s Shen- 
andoah and Radford division which passes through the Great Valley, 
from Hagerstown, Maryland, to Bristol, Virginia; and the Pennsylvania 
Railroad, connecting the Virginia port area with the north. Serving 
the southwest coal field are: a branch of the Norfolk and Western, 
the Louisville and Nashville, a branch of the Southern, the Carolina, 
Clinchfield, and Ohio, and the Interstate Railroad. Furthermore, 
the Hampton Roads ports are served by trunk lines of the Atlantic 
Coast Line, the Seaboard Air Line, the Norfolk-Southern, and the 
Southern, in addition to those already mentioned as having terminals 
in the port area. 
The commerce of Hampton Roads is handled through two ports— 
the port of Norfolk, comprising the cities of Norfolk and Portsmouth, 
and Newport News. These ports are equipped with excellent piers, 
wharves, and railway terminals, including modern mechanical con- 
trivances to facilitate loading and unloading, and warehouses for the 
storage of commodities. From these ports more than fifty steamship 
lines are engaged in foreign freight and passenger service to practically 
all important trade zones of the world. In addition, local and coastwise 
vessels supply transportation to and from the river and bay ports and 
to and from numerous ports on the Atlantic and Pacific Coasts and the 
Gulf of Mexico. The principal products handled through these ports 
include grain, petroleum products, cotton, tobacco, and fertilizers. Public Health in the State and Counties of Virginia 
13 
2. State Government 
a. General Division of Government.—The present constitution of 
Virginia, exclusive of several amendments made principally in 1928, 
dates from 1902. Amendments to the constitution may be proposed in 
either house of the General Assembly, but to become a part of the 
constitution such amendments must be passed by both houses of that 
and the succeeding General Assembly and be approved by the majority 
of the votes polled at the next general election. The constitution pro- 
vides for the three grand divisions of government, namely, the legis- 
lative, the executive, and the judicial, and specifies that they shall be 
separate and distinct except as therein provided. 
Legislative power is vested in a General Assembly, consisting of a 
Senate of thirty-three to forty members and a House of Delegates of 
ninety to one hundred members. By 1927 the membership of both 
Senate and House had reached the maximum allowed by the constitu- 
tion—forty senators and one hundred delegates. The State is divided 
into districts according to population, and senators are elected from 
each of these for four years and delegates for two years. 
The General Assembly meets at Richmond on the second Wednes- 
day in January of each even numbered year. The regular session of 
sixty days may be extended for a period not to exceed thirty days by 
a vote of three-fifths of the members of each house. 
The chief executive power of the State is vested in the governor, 
who is elected by popular vote for a term of four years, beginning on the 
third Wednesday of January succeeding his election. The governor is 
ineligible to succeed himself. 
The lieutenant governor is elected for a term of four years at the 
same time and in the same manner as the governor. He assumes the 
responsibilities of the chief executive in case of removal of the governor 
from office, or of his death, resignation, failure to qualify, removal from 
the State, or inability to discharge the powers and duties of the office. 
He presides over the Senate, but he is allowed to vote only when it is 
necessary to break an evenly divided ballot. 
Bills passed by the Senate and House of Delegates must be presented 
to the governor before they can become laws. When the General As- 
sembly is in session, such bills must be signed, vetoed, or returned for 
amendments, by the governor, within five days—Sundays excepted— 
otherwise they automatically become laws. A bill passed by the Gen- 
eral Assembly and presented to the governor after that body adjourns 
must be signed within ten days after adjournment for it to become a 
law. Bills, or items of any appropriations, vetoed by the governor 
may be passed over his veto by a two-thirds vote of those present in 
each house of the General Assembly. 
Constitutional amendments adopted by the people in 1928 per- 
mitted a complete reorganization of the State Government based on a 
survey by a commission appointed by the General Assembly. Of about 
one hundred boards, commissions, and departments, more than thirty 
were abolished and the rest were reorganized and consolidated into the 
governor’s office and twelve administrative departments, namely, 14 
Public Health in the State and Counties of Virginia 
the departments of: taxation, finance, highways, education, corpora- 
tions, labor and industry, agriculture and immigration, conservation 
and development, health, public welfare, law, and workmen’s compen- 
sation. The governor exercises control over these departments either 
by virtue of his power to appoint the directors or to supervise their work. 
The governor’s office consists of five major divisions: the division 
of the budget, the division of statutory research and drafting, the 
division of records, the division of military affairs, and the division of 
grounds and buildings. The directors of these five divisions are ap- 
pointed by the governor, usually subject to the approval of the Gen- 
eral Assembly, and are responsible for such duties as are implied by 
the enumerated designations. 
The Virginia constitution provides that the judicial power of the 
State shall be vested in a Supreme Court of Appeals, circuit courts, 
city courts, and such other courts, inferior to the Supreme Court of 
Appeals, as are authorized, or may be established by law. The Supreme 
Court of Appeals consists of seven judges, but any three of them may 
hold a court or they may sit in two divisions of not less than three judges 
each except in cases involving constitutional questions. The judges 
are chosen for a term of twelve years by the joint vote of the two houses 
of the General Assembly. 
The State is divided into thirty-four judicial circuits and in each 
of these a circuit judge is chosen for a term of eight years by a joint vote 
of both houses of the General Assembly. Similar to the court circuit is 
the corporation court in each city having a population of more than 
10,000, the judge of which is chosen by a joint vote of both houses for 
a term of eight years. 
b. Educational Facilities.—The State constitution provides that 
the General Assembly shall establish and maintain an efficient system 
of public free schools throughout the State, and that white and colored 
children shall be taught in separate schools. General supervision of 
the school system is vested in the State Board of Education which con- 
sists of seven members appointed by the governor, subject to confirma- 
tion by the General Assembly, to serve for a term of four years. The 
terms of office of the board members overlap so that each member 
holds office under two governors. The chief administrative officer of 
the State Department of Education is the superintendent of public 
instruction, who is required to be an experienced educator, and who is 
appointed for a term coincident with that of the governor making the 
appointment. 
For administrative purposes the State Board of Education divides 
the State into appropriate school divisions which may not consist of 
less than one county or one city each, nor may a county or a city be 
divided in the formation of such divisions. During the school year 
1936-1937, there were 109 divisions, of which 73 were composed of 1 
county each, 11 of 2 counties, 1 of 3 counties, 22 of 1 city, and 2 of a 
city and a county. This consolidation of political subdivisions of the 
State for functional purposes appears to bear no relation to such func- 
tional consolidations as have been undertaken by other departments of Public Health in the State and Counties of Virginia 
15 
the State Government. The supervision of the schools in each county 
or city is vested in a school board composed of as many members as 
there are magisterial districts in the division, or wards in the city. 
The school board is appointed by a school trustee electoral board for 
a term of four years. 
The administrative duties in each local school division are dele- 
gated by each local school board to a division superintendent, ap- 
pointed by the board for a term of four years from a list of eligibles 
certified by the State Board of Education. To be eligible for appoint- 
ment applicants must meet the minimum qualifications set up by the 
State Board of Education. These are considered strictly professional 
appointments, requiring successful teaching experience, professional 
training, and administrative ability. 
During the year 1936-1937, there were 4,801 primary and secondary 
schools in the counties and cities of the State. Of these 2,268 were 
one-teacher schools and 633 high schools, 469 of which were fully 
accredited. Enrolled in the public schools were 587,486 pupils under 
the charge of 16,835 teachers, exclusive of supervising principals and 
supervisors. Based on the 1935 school census of 731,043, the 1936- 
1937 enrollment represented slightly over 80 per cent of the State’s school 
population, or persons between 7 and 20 years of age. The average 
daily attendance for 1936-1937, was 488,692, or 83 per cent of the 
number actually enrolled. Attendance is compulsory for children 
between the ages of 7 and 15, except for those who live more than two 
miles from school. Compulsory attendance is applicable to the latter 
also, if transportation is provided within one mile of the child’s home. 
The school term for the past few years has extended over a period of 
170 days. 
The average annual salary for all teachers (white and colored), in- 
cluding supervisors, principals, and special teachers in 1936-1937 was 
3841. The average salary for all teachers, excluding supervisors and 
supervising principals, was 3613 in the counties and 31,232 in the cities. 
The State maintains a pension fund for retired teachers toward which 
each teacher contributes monthly a sum equal to 1 per cent of his salary. 
The maximum quarterly pension that may be paid to anv teacher is 
3!25. 
The receipts for public school purposes from all sources in 1936- 
1937 amounted to 328,873,135.39, and expenditures to 325,747,668.80, 
of which 32,285,377.58 was for debt service. The several sources from 
which funds were received were as follows: 
Source 
Amount 
The State 
$ 7,447,144 93 
Counties 
7,202,783 
36 
Districts 
1,045,119 
11 
Cities 
6,116,504 83 
Loans and bonds 
2,529,456 46 
Other sources 
4,432,126 70 
Total 
328,873,135 
39 16 
Public Health in the State and Counties of Virginia 
In addition to the public schools, there are four State Teachers 
Colleges for white women, one coeducational college for Negroes, and 
five other institutions of higher learning under State control, namely, 
the University of Virginia, College of William and Mary, Medical Col- 
lege of Virginia, Virginia Military Institute, and Virginia Polytechnic 
Institute. Under private control there are fourteen colleges, twelve 
junior colleges, twenty-two accredited secondary schools for girls and 
seventeen for boys, and twenty-four accredited coeducational secondary 
schools in the State. Virginia maintains two special schools for the deaf 
and blind, one for white children at Staunton and one for colored children 
at Newport News. 
c. Virginia Fiscal Affairs.—Administration of the Virginia budget 
system is vested in the governor and the director of the division of the 
budget. Estimates of funds required for each year of the ensuing two 
years are submitted to the budgetary officers biennially by all State 
departments and institutions. These estimates are then studied by 
the governor, the director of the budget, and the governor’s advisory 
commission on the budget, and a composite statement of the requests, 
with the recommendations of the governor, are sent to the General 
Assembly for legislative action. The bill, when passed by the legis- 
lature, fixes appropriations and becomes a law. 
Under the reorganized State Government the Department of Fi- 
nance embraces four divisions, namely, the division of accounts and 
control, the treasury, purchase and printing, and motor vehicles. 
Each of these divisions has a director appointed by the governor, sub- 
ject to confirmation by the General Assembly. 
The comptroller is the chief executive officer of the division of ac- 
counts and control. Under him there has been established a complete 
system of general accounting and control of all State funds, and all 
transactions in public funds must clear through his office. State funds 
in State depositories can be withdrawn only upon warrants issued by 
the comptroller, who is required to audit bills and to satisfy himself 
that all claims are just and lawful and have not been paid previously. 
The State treasurer is custodian of all revenues collected for State 
purposes. All such funds are deposited direct to the treasurer of Vir- 
ginia in State depositories protected by surety bonds or approved 
securities, and this money may be withdrawn only by check drawn 
upon warrant of the comptroller. The treasurer is custodian of securi- 
ties required by statutes to be deposited by insurance companies 
under the Workmen’s Compensation Act of Virginia; he handles all 
investments of the Literary Fund and Commonwealth investment 
funds for retired teachers. He is secretary of the State Finance Board 
composed of the governor, the comptroller, and the treasurer, which 
designates State depositories. 
An amendment to the Virginia constitution in 1928 provided for 
practically complete separation of the sources of State and local revenue. 
With the exception of the rolling stock of public service corporations, 
it segregates real estate, tangible personal property, machinery and 
tools, and merchant’s capital for local taxation only. Taxes on in- Public Health in the State and Counties of Virginia 
17 
tangible property, income taxes, certain corporation taxes, insurance 
and inheritance taxes, and several license taxes are reserved exclusively 
as revenues for the State. The State also levies an annual capitation 
tax of 31.50 on every resident in the State 21 years of age and over. 
This tax is a prerequisite to the exercise of suffrage. Two-thirds of 
the capitation tax is applied in aid of the public free schools, and one- 
third is returned by the State to the county or city in which it was col- 
lected, to be appropriated by the proper authorities to such purposes 
as they may determine. The total of all revenues collected and paid 
into the treasury for the fiscal year ended June 30, 1937, amounted to 
378,823,888.12, as the following summary from the report of the 
comptroller shows: 
CLASS OF REVENUE 
Amount 
Per Cent 
$ 35,879,389 59 
10,093,621 96 
16,922,981 90 
157,142 98 
308,929 84 
6,481,279 11 
506,663 94 
6,643 98 
7,757,130 04 
437,545 73 
272,559 05 
45.5 
12.8 
21.5 
.2 
.4 
8.2 
.6 
2. Rights and privileges 
5. Assessments for support of special services 
9.8 
.6 
.3 
$ 78,823,888 12 
99.9 
From the above table it will be seen that the revenues derived from 
taxation (items 1 and 2) amounted to 345,973,012, representing a per 
capita tax of 318.701. Of the aggregate collections, 3577,521.46 was 
returned to local governing bodies, in accordance with State laws, as 
a share of the capitation tax, motor vehicle fuel tax, etc. The actual 
amount of tax collected by the State Government for State purposes, 
therefore, was 345,395,491. 
The total expenditures by the State during the fiscal year 1936- 
1937 amounted to 371,614,336. Highways and education represented 
by far the greatest burden upon the State treasury. The combined 
costs of these services amounted to 342,991,378, or 60 per cent of the 
total expenditures. One explanation for the very considerable outlay 
of State funds for highways is that the county roads in ninety-seven 
of the counties have been taken over as a secondary system of State 
highways by the State Department of Highways. This leaves only 
three counties to receive their respective shares of the motor vehicle 
fuel tax, the shares of the remaining ninety-seven counties being ex- 
pended directly by the State. During the year 1936-1937 a total of 
310,678,758.18 of the revenue collected by the State was earmarked for, 
or returned directly to, the localities, as follows: 
on an estimated population of 2,459,180. 18 
For public free schools $ 8,029,172 90 
For county roads (3 counties) 266,585 52 
For other purposes 2,382,999 76 
Total 310,678,758 18 
The following table, adapted from the 1936-1937 report of the 
State comptroller, shows the total State disbursements with the per- 
centage expended under each classification: 
Public Health in the State and Counties of Virginia 
Expenditures of the Commonwealth of Virginia for the Fiscal Year 1936-1937 
Amount 
Per Cent 
$ 26,086,867 14 
16,904,510 59 
12,266,056 65 
4,432,851 20 
1,420,882 92 
1,406,561 06 
1,223,877 00 
1,179,545 05 
1,158,568 81 
815,787 97 
797.153 71 
729,831 77 
596.153 50 
582,798 62 
577,521 46 
526,699 84 
409,736 67 
385,444 16 
113,487 77 
36.4 
23.6 
17.1 
6.2 
2.0 
2.0 
1.7 
1.6 
1.6 
1.1 
1.1 
1.0 
.8 
.8 
.8 
.7 
.6 
.5 
.2 
Health 
Unemployment Compensation Commission 
Total 
$ 71,614,335 89 
100.0 
Notwithstanding the magnitude of these comparatively large dis- 
bursements, there remained in the General Fund of the State treasury 
at the close of the year an unobligated cash surplus of 31,623,273.68. 
Virginia’s experience in financing the cost of public improvements, 
especially the development of railroads, prior to the war between the 
States, was such as to inculcate in future legislators a policy of extreme 
caution. To avoid the recurrence of unwise or unjustifiable borrowing, 
the constitution was amended in 1928 to provide that the General 
Assembly may contract debts only to meet casual deficits in the revenue, 
to redeem a previous liability of the State, to suppress insurrection, 
repel invasion, or defend the State in time of war. Indebtedness for 
any other purpose must, before authorization, be voted upon by the 
General Assembly and approved by the people at a general election. 
The constitution limits indebtedness for new capital outlay to 1 per cent 
of the value of all taxable real estate in the Commonwealth. This meas- 
ure, with adoption of the plan oi/pay as you go in the maintenance and 
construction of highways, has prohibited the accumulation of massive Public Health in the State and Counties of Virginia 
19 
public debts and the accompanying debt service burdens. At the close 
of the fiscal year ending June 30, 1937, the outstanding bonded in- 
debtedness of the State Government was 322,608,151, against which 
there were sinking funds totaling 35,006,782, leaving a net public debt 
of 317,601,369. This represents a per capita1 net State debt of 37.15. 
3. County Government 
a. Constitutional Form of County Organization and Government.— 
The county is one of the units of local administration of the Common- 
wealth of Virginia. It also exercises some degree of local autonomy. 
The constitution defines the type of organization and government to 
which, prior to the constitutional amendment of 1928, each county was 
required to conform. This amendment authorized the General As- 
sembly to provide by general law for complete forms of county organiza- 
tion and government, different from that provided by the constitution, 
to become effective in any county when submitted to the qualified 
voters thereof in an election held for such purpose and approved by a 
majority of those voting thereon. Accordingly, a somewhat modified 
form of government was provided in Chapter 167 of the Acts of 1930, 
and two complete optional forms in Chapter 368 of the Acts of 1932. 
Reference will be made to these later. 
On January 1, 1938, ninety-seven of the one hundred counties 
continued to operate under the constitutional form of organization 
and government. All counties are divided into magisterial districts, 
varying in number from three to ten. From each of these districts 
certain officials or board members are elected by the qualified voters 
of such districts or are appointed by the circuit court or other appointive 
agencies. The constitution provides that one member of the board of 
county supervisors shall be elected from each of these districts, and, 
under State laws, each district may elect three justices of the peace, 
one constable, and one overseer of the poor, all for a term of four years. 
All other elective officers are chosen by a county-wide poll and not by 
the electorate of separate districts. The following table classifies the 
county officials under this form of government in terms of number, the 
tenure of office, constitutional or statutory, elected or appointed, and 
by whom appointed: 
■ 
Number 
Term 
Years 
I. Constitutional Officials 
a. Elected 
County Board of Supervisors 
3-10 
4 
Commissioner of Revenue 
1 
4 
Treasurer 
1 
4 
Clerk 
1 
8 
Commonwealth Attornev 
1 
4 
Sheriff 
1 
4 
4 
'Population basis 2,459, 180. 20 
Public Health in the State and Counties of Virginia 
Number 
Term 
Years 
b. Appointed by Circuit Court 
Surveyor 
1 
4 
County Electoral Board 
3 
c. Appointed by County Electoral Board 
Precinct Registrars 
2 
Judges of Elections 
Clerks (election) 
d. Appointed by School Trustee Electoral Board 
County School Board 
3-10 
4 
e. Appointed by County School Board 
Division Superintendent of Schools 
1 
4 
II. Other Elected Officials (Statutory) 
Constables (by districts) 
3-10 
4 
Overseers of the Poor (by districts) 
3-10 
4 
III. Appointed Officials (Statutory) 
a. Appointed by Circuit Court 
1 
4 
1 
Commissioner in Chancerv 
25 
1 
3 
4 
1 
4 
b. Appointed by Governor 
Notaries Public 
c. Appointed by State Tax Commissioner 
1 
Examiner of Records 
1 
4 
<1. Appointed by Commissioner of Game and Inland 
Fisheries 
1 
e. Appointed by County Supervisors 
County Health Officer 
1 
f. Appointed by the State Board of Health 
County Board of Health 
3 
1 
The county board of supervisors consists of a member from each of 
the magisterial districts into which the county is divided, elected for a 
term of four years. Each member receives a nominal salary and a 
modest traveling allowance. The board of supervisors is generally 
considered the head of county government, although with its power of 
appointment restricted, and with functions of county administration 
dispersed among numerous other elected officials, it has little direct 
control over most of the county officers. The duties of the board of 
supervisors are numerous—including the preparation of the county 
budget, determining the tax rate, making appropriations, supervising 
the construction and maintenance of public buildings, auditing claims 
against the county, except claims required to be audited by the county 
school board, and the issuing of warrants in settlement of valid claims. Public Health in the State and Counties of Virginia 
21 
As has been stated elsewhere, the construction and maintenance of 
public roads has been taken over by the State, and the public free 
schools are operated by the county school board under the general 
supervision of the State Board of Education. 
b. Optional Forms of County Organization and Government.—The 
constitution of Virginia was amended in 1928 to permit the legislature, 
regardless of the many cumbersome specifications for a decentralized 
system of county government, to set up alternative plans of county 
government. The legislature, following the advice of the Virginia Com- 
mission on County Government, made the county manager and county 
executive forms of government optional with any county of the State. 
The plan adopted is one strictly in accordance with local self govern- 
ment. It removes the constitutional restrictions imposed upon the 
counties and opens the door to progressive reform in a county govern- 
ment. 
The Act1 provides two forms of county organization and govern- 
ment—the county executive form and the county manager form. 
Either form may be adopted in any county when submitted to the 
qualified voters thereof in an election held for the purpose and approved 
by a majority of those voting thereon. Each form provides for the 
election of a board of county supervisors by the county at large, the 
board to consist of one member from each magisterial district, provided 
the number of districts is not less than three nor more than seven. Each 
form also provides for the election by the voters of the county of a clerk, 
a sheriff, and an attorney for the Commonwealth. The principal, 
and practically the only, difference in the two forms is that under 
the county executive form the board of supervisors appoints the county 
executive and all other appointive officers, whereas, under the county 
manager form the board appoints the county manager and the appoint- 
ment of all other county officials is left to the county manager. Both 
forms abolish the offices of county surveyor, coroner, superintendent 
of the poor, overseers of the poor, constables, the school trustee electoral 
board, and the inheritance tax commissioner. The number of justices 
of the peace is reduced to one for each magisterial district, and the 
jury commissioners, the examiners of records, notaries public, and 
election officials remain unaffected. 
At the beginning of 1938, Arlington County was operating under a 
county manager form of government, set forth in an Act of 1930, under 
the provisions of which constitutional elective officers are retained; 
Albemarle County was operating under the county executive form; 
and Henrico County was operating under the county manager form of 
government. The remaining ninety-seven counties were continuing 
under the constitutional form of government. 
Each county adopting the county executive form or the county 
manager form is required to establish and maintain the following seven 
governmental departments: finance, public works, public welfare, law 
enforcement, education, records, and health. In addition, each county 
board may create a department of assessments and a department of 
farm and home demonstration. 
iChapter 368, Sections 2773N to 2773-N56, 1932. 22 
Public Health in the State and Counties of Virginia 
County executives and county managers are appointed for indefi- 
nite terms by the respective county boards of supervisors. The appoint- 
ments are made with regard to merit only, and they are not restricted 
to persons who are county residents at the time of their appointment. 
Upon assuming office the county executive or the county manager, as 
the case may be, becomes the administrative head of the county govern- 
ment, responsible to the board of county supervisors for the proper 
administration of all the affairs of the county which the board has 
authority to control. A county executive or a county manager is 
removable from office at the pleasure of the board of county supervisors. 
II. STATE AND COUNTY HEALTH 
ORGANIZATIONS 
A. INTRODUCTION 
Official public health activities in the State of Virginia are con- 
ducted both by the State and by its political subdivisions, the counties 
and cities. Unlike the counties, cities are established under separate 
charters which, among other things, provide for the protection of the 
public health. The concentration of people and of wealth within small 
areas which is characteristic of cities, makes it possible and desirable that 
these local governments should finance and administer their own health 
activities with as little assistance or interference from the State as pos- 
sible. In rural areas, on the other hand, the people are widely scattered, 
have far less taxable wealth, and sufficient funds to provide adequate 
public health facilities, which are relatively more costly than in cities, 
often are not available. For these reasons it has been the policy of the 
State to leave health administration in cities in the hands of their 
respective governments, but to stimulate and promote health work 
in rural areas both by granting financial assistance and by providing a 
central staff of administrative and technical experts to advise county 
health officials and to direct and coordinate their health programs. In 
certain instances cities and counties unite and conduct their activities 
on a cooperative basis. Under such circumstances the city, as well as 
the county, would receive the benefit of State aid and the local health 
officer would be responsible to the State Commissioner of Health. 
Since it is intended to deal here only with the organization and 
administration of the State Department of Health and with those of such 
local organizations as the State Department is directly concerned, all 
reference to city health departments will be incidental. 
B. THE CENTRAL HEALTH ORGANIZATION 
1, The State Board of Health 
An Act1 creating the State Board of Health of Virginia was passed 
by the General Assembly in 1872 and was approved by the governor 
on February 13th of the same year. This State, therefore, was the 
third in the United States to create such a board. The membership 
of the board as provided by that legislation consisted of seven physicians, 
Chapter 91, Acts of the General Assembly, 1872. Public Health in the State and Counties of Virginia 
23 
appointed by the governor for a term of four years. Among the pre- 
scribed duties of the board were: to communicate with the local 
boards of health, the hospitals, and public institutions throughout the 
State, to take cognizance of the interests of health and life among the 
citizens generally; to make sanitary investigations and inquiries respect- 
ing the causes of disease; to devise some scheme whereby medical and 
vital statistics of sanitary value might be obtained, and act as an 
advisory board to the State in all hygiene and medical matters; and 
to make an examination of and report upon the effect of the use of 
intoxicating liquor as a beverage upon the industry, happiness, health, 
and lives of the citizens of the State. The board was required to elect 
a permanent secretary, who, as its executive officer, was to perform 
and superintend the work prescribed in the Act, although the law made 
it clear that the Board should in no way be a charge upon the State. 
An Act passed in 19001 provided for a State Board of Health con- 
sisting of seven members appointed by the governor upon the recom- 
mendation of the Medical Society of Virginia. The salary of the 
secretary was to be fixed by the board. No salary was provided for 
the other board members, but each was allowed four dollars a day, 
plus the traveling expenses incurred, while engaged in the discharge of 
his duties. The total annual expenses of the board were not to exceed 
35,000. 
This Act provided also for the appointment of boards of health in 
every county and city in the State, each board consisting of three 
regularly licensed physicians of the county or corporation, the clerk, 
and the chairman of the board of supervisors of the county, or the mayor 
of the corporation. Appointment of the three physicians was to be made 
by the judge of the county or corporation court upon the recommenda- 
tion of the local medical society. Where a city or county failed to 
appoint a board the State Board of Health was authorized to perform 
the required duties and to charge the expenses incurred to the local 
government. 
In 19082 the membership of the board was increased to twelve. 
Appointments, restricted to members of the State Medical Society, 
were made by the governor for terms of four years. Provision was 
made for the appointment of a commissioner by the governor for a 
term of four years. The commissioner, who was to serve as the execu- 
tive officer of the board but was not to be a member of the board, was 
required to be versed in bacteriology and sanitary science and otherwise 
fitted and equipped to execute the duties incumbent upon him by law. 
The commissioner was authorized to appoint an assistant commissioner, 
a skilled bacteriologist, and other assistants and clerks, with the approval 
of the board. Section 4 of this law required the State Board to establish 
suitable laboratories in Richmond for the free examination ot clinical 
material submitted by the medical profession of the State, and an 
appropriation was granted the board for the erection of buildings for 
the treatment of tuberculosis. The total annual allotment for all 
purposes was 340,000. 
xActs of 1900, Chapter 1146. 
2Acts of 1908, Chapter 361. 24 
Public Health in the State and Counties of Virginia 
Without further changing its membership, Chapter 179 of 1910 
enlarged the powers of the board by authorizing it to make, adopt, 
promulgate, and enforce reasonable rules and regulations for the pro- 
tection of the public health. 
In 19161 the membership of the State Board of Health was in- 
creased to fourteen by the appointment of two members from the 
State at large, one of which was to be a member of the State Dental 
Association. This arrangement persisted until 19202, when the law 
was amended so as to require that at least five of the fourteen members 
of the board should be members of the Medical Society of Virginia. 
The law3, as it now stands, provides for a board of seven members, 
one to be chosen from each of the five grand divisions of the State— 
Tidewater, Middle Virginia, Piedmont, the Valley, and Southwest 
Virginia—'and two from the State at large. At least two appointees 
must be members of the Medical Society of Virginia and one a member 
of the State Dental Association. Appointments are made by the gover- 
nor for a term of seven years, and one term expires annually. Va- 
cancies are filled in the same manner as original appointments are made. 
The State Board of Health is required to meet annually in Rich- 
mond, and at such other times and places as it may determine. An 
executive committee, consisting of three board members, usually trans- 
acts any business required of the board that may arise between the 
annual meetings. The members of the board receive no salary, “. . . 
but each member shall be paid a per diem of eight dollars for the time 
actually engaged in the discharge of his duties, together with his actual 
expenses incurred therein, to be paid out of the board’s funds.” 
Under the authority of legislative enactments the State Board of 
Health has certain powers and functions which may be enumerated as 
follows: 
Powers and Functions of the Board 
1) “The State Board of Health shall have the power to make, adopt, promulgate, 
and enforce reasonable rules and regulations from time to time requiring and 
providing for the thorough sanitation and disinfection of all passenger cars, 
sleeping cars, steamboats and other vehicles of transportation in this State, and 
also of all convict camps, penitentiaries, jails, hotels, schools, and other places 
used by or open to the public; to provide for the care, segregation and isolation 
of persons having, or suspected of having, any communicable, contagious, or 
infectious disease; to regulate the method of disposition of garbage, or sewage 
and any like refuse matter in or near any incorporated town, city, or unincorpo- 
rated town or village of this State; to provide for the thorough investigation 
and study of the causes of all diseases, epidemics and otherwise in this State, 
and the means for the prevention of contagious disease, and the publication and 
distribution of such information as may contribute to the preservation of the 
public health, and the prevention of disease; to make separate orders and rules 
to meet any emergency, not provided for by general rules and regulations, for 
the purpose of suppressing nuisances dangerous to the public health and com- 
municable, contagious, and infectious diseases and other dangers to the public 
life and health; provided, however, that nothing herein contained shall be con- 
xActs of 1916, Chapter 192. 
2Acts of 1920, Chapter 106. 
3Acts of 1924, Chapter 234. Public Health in the State and Counties of Virginia 
25 
sidered as in anywise preventing or restricting any person so segregated or 
isolated from choosing his own method of treatment, or in any wise limiting 
any diseased person in his right to choose or select whatever method or mode 
of treatment he may believe to be the most efficacious in the cure of his ailment; 
provided, however, that nothing herein contained shall be construed as in any- 
wise limiting any duty, power or powers now possessed by or heretofore granted 
to the State Board of Health by the statutes of this State, or as affecting, modify- 
ing or repealing any rule or regulations heretofore adopted by said Board.” 
(Chapter 179, Acts of 1910.) 
2) “The State Board of Health shall prepare and promulgate from time to time a 
list of diseases considered as infectious, communicable or dangerous, and pre- 
scribe the manner and time of reporting the same to the State Board of Health.” 
(Chapter 66, Acts of 1910). 
3) “The Board shall establish and maintain in the City of Richmond suitable 
laboratories for the examination of clinical material submitted by members of 
the medical profession of the State, and such examination shall be made free of 
charge.” (Section 4, Chapter 361, Acts of 1908, Code, Sec. 1491). 
4) “The Board shall also make research and studies of infectious diseases, of 
epidemics, and of methods of preventing and curing diseases. It shall forth- 
with make inquiry into the altitude, moisture, and other climatic conditions in 
various parts of the State and . . . the Board shall begin the erection and main- 
tenance of temporary buildings or camps for the treatment of tuberculosis in 
such localities as are proper, and at such sanatoriums they shall provide for the 
treatment by the most advanced methods of the tuberculosis patients in the 
State at a minimum expense to the patient.” (Code, Section 1491). 
5) “The State Board of Health shall annually appoint three residents of each county 
or corporation, at least one of whom shall be a regularly licensed physician, 
who shall, with the county clerk and the chairman of the board of supervisors, 
or the mayor of the corporation, as the case may be, constitute a county, town, 
or city board of health; but where the charter of any city or town already pro- 
vides for the creation of a board of health, the provisions of this section shall 
not apply.” (Virginia Code, Section 1492). 
6) “If any city, town, or county authorized by law to appoint a local board of 
health or health officer omit to do so, the State Board of Health may exercise 
the authority and perform the duties . . . until such local board of health 
be established or such health officer be appointed.” The expenses incurred 
by the State Board shall be charges upon the city, town, or county. 
7) “If any case of infectious, contagious, communicable or dangerous disease be 
reported as existing in any locality in the State, the State Board of Health, 
shall, as soon as possible, investigate said disease. It shall then confer with 
the local health authorities and make such suggestions as it may deem proper. 
If these suggestions are not carried out, and the disease is, in the judgment of 
the State Board of Health, in danger of spreading to another city, town, or 
county, the said State Board of Health, or its executive officer, subject to the 
action of the said Board, shall have the right to assume exclusive control of the 
disease, ... ”, (Code, Section 1497). 
8) “The State Board of Health shall have charge of the registration of births and 
deaths . . . The said Board shall be charged with the uniform and thorough en- 
forcement of the law throughout the State, and shall from time to time pro- 
mulgate any additional forms and amendments that may be necessary for the 
purpose.” (Code 1919, Section 1561). 
9) “The State Board of Health shall have general supervision over the bureau of 
vital statistics, heretofore established by said board, and which shall be under 
the immediate direction of the State Registrar of Vital Statistics.” (Code, 
1919, Section 1562). 26 
Public Health in the State and Counties of Virginia 
10) “The State Board of Health shall have general supervision and control over all 
water supplies and water works In the State in so far as the sanitary and physical 
quality of waters furnished may affect the public health and comfort.” (Section 
2, Chapter 360, Acts of 1916). 
The office of commissioner of health was created by Act1 of the 
General Assembly in 1908, since when the position has been held by 
only three executives. The commissioner is appointed by the governor 
for a term of four years. He serves as executive officer of the State 
Board of Health but he is not a member of that board. Legally2, the 
appointee shall be a physician, a graduate of a medical college, which 
is now, or was at the time of his graduation, recognized by the Vir- 
ginia State Board of Medical Examiners as a college giving proper 
instruction. He shall be skilled and experienced in the administration 
of public health duties and versed in sanitary science, and otherwise 
fitted and equipped to execute the duties incumbent upon him by law. 
In addition to having had ample experience in public health administra- 
tion, the present commissioner holds the degree of Doctor of Public 
Health from the Johns Hopkins School of Hygiene and Public Health. 
The commissioner is required to reside and have his headquarters 
in the City of Richmond, and to devote his entire time to his official 
duties. 
The powers and duties of the commissioner as prescribed by law3 
are as follows: 
1) The. Commissioner shall perform such duties as the State Board of Health may 
require, in addition to the other duties required by law. 
2) He shall be vested with all the authority of the Board when it is not in session, 
and subject to such rules and regulations as may be prescribed by the Board. 
3) It shall be his duty to institute and, together with his assistants, to carry out 
such a course of lectures and demonstrations as he may deem advisable in various 
sections of the State and in the State educational institutions, to the end that 
the medical profession and the people of the Commonwealth may be instructed 
in manners of hygiene and sanitation. 
4) To furnish to the Governor and to the General Assembly, when in session, such 
Information as may from time to time be required. 
5) To make an annual report to the Governor of all expenditures made by the 
State Board of Health, by himself, and of persons under him. 
6) The Commissioner, with the approval of the State Board of Health, shall 
appoint and may employ such clerical and other assistants as are necessary for 
the proper performance of his duties as executive officer of the State Board of 
Health. The salaries of assistants and employees shall be fixed by the State 
Board of Health. All persons appointed by the Health Commissioner shall 
be primarily responsible to him and may be removed by him for good cause. 
(Code 1936, Section 1490). 
7) The Commissioner is specifically charged with the duty of exercising sanitary 
control over the harvesting, handling, storing, packing, and marketing of fish, 
shellfish, and crabmeat in the State. 
2. The Commissioner of Health 
xActs of 1908, Chapter 361. 
2Code, 1936, Section 1489. 
3The Virginia Code, 1936, Section 1489. Public Health in the State and Counties of Virginia 
27 
3, The State Department of Health 
The early establishment and the continued maintenance of a State 
Board of Health has been discussed at some length. Active health work 
under that board was largely restricted to the control of epidemics, 
principally of smallpox, and the dissemination of limited quantities of 
health literature. As scientific knowledge concerning the control of 
preventable diseases became more general, however, and the ineffective- 
ness of such health measures as had been undertaken formerly was 
recognized, the General Assembly of 1908 provided for what is now 
known as the State Department of Health. Under that legislation the 
personnel of this new department was to consist of a commissioner, an 
assistant commissioner, a bacteriologist, and a clerk. Moreover, the 
commissioner was authorized to appoint, with the approval of the 
State Board of Health, such assistants as may be necessary for the 
proper performance of his duties as the executive officer of the board. 
With this nucleus as a start, the growth of the department has been 
gradual but continuous and, at present, it consists of: the commissioner 
of health and ten departmental bureaus, and four bureau divisions as 
follows: (See page 105 for organization chart). 
Departmental Bureaus Bureau Divisions 
Bureau of: Division of: 
a. Administration Health Education 
b. Rural Health Tuberculosis Outpatient Service 
c. Communicable Diseases Venereal Disease Control 
d. Public Health Nursing Mouth Hygiene ' 
e. Crippled Children 
f. Industrial Hygiene 
g. Sanitary Engineering 
h. Vital Statistics 
i. Maternal and Child Health 
j. Laboratories 
Prior to the establishment of a State Department of Health, the 
State Board of Health constituted the only State health organization. 
Many of the present health laws were formulated and enacted with the 
idea that they were to be administered by the State Board of Health, 
and through them the board still is vested with full administrative 
authority. With the appointment of a commissioner, however, and with 
the establishment of several technical bureaus, practical administrative 
considerations have made it essential for the board to function more 
and more as an advisory and policy forming body and to relinquish 
its administrative authority to its trained executive officer. 
The offices and the central laboratories of the State Department of 
Health are located in the State office building at Richmond. 
The bureaus of which the State Department of Health is composed, 
and such divisions of these bureaus as now exist, are described in the 
following sections: 
a. The Bureau of Administration.—The commissioner of health is 
the director of the Bureau of Administration which, as at present 
organized, consists of the bureau proper, and the Division of Health Edu- 28 
Public Health in the State and Counties of Virginia 
cation. The personnel of the bureau proper includes the commissioner, 
an administrative assistant, an executive secretary, a statistical assistant, 
a stenographer-clerk—in charge of the sale (at cost) and distribution 
of arsenicals and biologicals to the physicians of the State—and four 
clerks including a telephone operator. The functions of the bureau 
include: 
1. The formulation of the general policies of the department. 
2. General supervision of the department and enforcement of the public health 
laws and the rules and regulations of the State Board of Health. 
3. Coordination of the activities of the bureaus and divisions. 
4. Administration of the three State tuberculosis sanatoria. 
5. Supervision over department finances (including those of all cooperative county 
health departments), preparation of the budget, control of expenditures, ac- 
counting and recording of all financial transactions. 
6. Purchase, through the division of purchase of the State Department of Finance, 
of all departmental supplies and equipment, etc. 
7. Purchase, and distribution of biologicals and arsenical preparations to physicians 
of the State at cost. 
8. Receipt and dispatch of all department mail, parcels, etc. 
9. Keeping records of vacations, sick leave, etc. 
10. Rendering specialized statistical services to bureaus and divisions. 
11. Maintaining relations with other departments of the State Government, with 
the United States Public Health Service, and other Federal agencies, and with 
non-official organizations. 
Since the State of Virginia does not maintain a civil service, the 
duty of selecting properly qualified technical assistants for employment 
in the department devolves upon the commissioner, but when desirable, 
he, of course has the advice of directors of the several bureaus. The 
selection of clerical and other non-technical employees may be made 
by the commissioner upon the recommendation of certain members of 
the staff of the department. Official employment of an applicant is 
made by the commissioner, with the approval of the State Board of 
Health. If, however, the monthly salary of a prospective employee is 
3100, or more, the permission of the governor must be obtained before 
such an employee may be placed on the State payroll. 
Employees are allowed an annual vacation of twelve working days 
for each year of service, provided, however, that no employee is eligible 
for any vacation who has not served in the department for at least six 
months. In calculating vacation periods each Saturday is considered 
a half day, and legal holidays are not counted. Sick leave, amounting 
to twelve working days during each calendar year, is allowed. Additional 
sick leave, either with or without pay, may be obtained only with the 
approval of the commissioner of health. 
The State provides the commissioner with an automobile and pays 
such traveling expenses as he may incur in the performance of his 
official duties. Other members of the staff of the department traveling 
out of Richmond by automobile on official business are allowed five Public Health in the State and Counties of Virginia 
29 
cents per mile. Except under unusual circumstances, employees 
traveling on trains are expected to use coaches, and reimbursement is 
granted on that basis. Reasonable charges for meals and hotel rooms 
also are permissible. 
The department supplies no free drugs or biological supplies either 
to physicians or to county health departments for the treatment or 
immunization of any elements of the population whatever, except 
drugs for the treatment of syphilis which are supplied to all physicians 
on request. Such products are purchased at favorable rates and supplied 
to localities at cost, but never free. 
1) The Division of Health Education.—The present Division of 
Health Education was organized in September, 1936, as a division of 
the Bureau of Administration. The personnel consists of a chief of 
the division and a librarian. 
Considerable emphasis had been placed on health education by the 
department since 1910, and creditable results had been accomplished 
through the efforts of the various publicity officers and the directors of 
the several bureaus. Withal, however, no regular full-time staff officer 
had been employed to systematize and develop a health education 
program for the department until the present division was established. 
The program of the division, which is still in its formative stage, 
includes the following activities: 
1. Virginia Health Bulletin.—The division prepares, has printed, and distributes 
each month an edition of a health bulletin designed to meet the needs of the 
general public, and Illustrated with appropriate pictures and cartoons. It is 
regularly circulated to more than 10,000 of Virginia’s approximately 2,500,000 
inhabitants. Included among the recipients are all of the State legislators and 
principal public officials, all physicians and dentists, and many nurses, social 
workers, school teachers, and other citizens. 
2. Weekly Health Talks.—The division releases, through the commissioner, a weekly 
health talk as a regular syndicated feature to all newspapers in Virginia. In 
the preparation of these talks controversial subjects are avoided, technical 
terms are reduced to a minimum, and advice regarding treatment is left to 
practicing physicians. 
3. Press Releases.—The division supplies news items for local newspapers, for the 
Associated Press, and for the International News Service. 
4. Health Information Bureau.—Health information is supplied from this office 
in response to numerous queries from schools, colleges, and the general public. 
This service includes the loan of numerous books and periodicals from the de- 
partment’s library. 
5. Miscellaneous Activities.—The services of the division are available to members 
of the staff of the State Department of Health and to county health officers who 
wish to have their reports, scientific articles, or addresses edited prior to publica- 
tion or delivery; it edits the department’s annual report; revises, rewrites, and re- 
edits health pamphlets; assists in the preparation of exhibits; assists in the 
preparation of routine news items, that are sent out from time to time, dealing 
with the activities of the State Department of Health. Radio and motion 
picture facilities have not been utilized to an appreciable extent as yet. 
b. The Bureau of Rural Health.—During the period 1910 to 1932 
State Department activities concerned with rural health were pursued 30 
Public Health in the State and Counties of Virginia 
by bureaus under several different designation's, such as the bureau of 
rural sanitation, bureau of inspections, bureau of sanitary demonstra- 
tion, bureau of tuberculosis, and others. From activities principally 
involving the control of hookworm infection and the protection of rural 
water supplies from contamination with human discharges, the work 
has expanded into generalized programs of disease prevention and 
health promotion requiring well organized, full-time, local health de- 
partments to administer them. With the growth and development of 
these local units the need of a single responsible agency in the central 
office of the department to direct and coordinate county work for the 
State as a whole became increasingly apparent, and general direction 
was consolidated, in 1932, under the Bureau of Rural Health. As a 
part of this reorganization scheme the Division of Tuberculosis Out- 
Patient Service was made a division of the Bureau of Rural Health. 
The authorized personnel of the bureau consists of a director, two 
assistant directors, three supervisors of rural sanitation, one milk sani- 
tarian, two secretary stenographers, and one clerk. 
The duties of the Bureau of Rural Health, as defined in the State 
Department’s Bulletin of September, 1933, and revised to conform 
with present practice, are to; 
1. Organize new county health departments and secure initial appropriations. 
2. Assist counties in securing competent personnel, and appraise the qualifications 
of personnel. 
3. Render advice to county health departments and county authorities in matters 
of public health administration. 
4. Assist in the development of a program for local public health activities. 
5. Maintain the policies, standards and program of the State Department of Health 
as applied to local health work. 
6. Maintain the administrative, technical, and professional supervision over local 
health organizations that the State Department of Health exercises. 
7. Review programs and evaluate services of local health departments for the 
State Department of Health, the extra-state contributing agencies, and local 
appropriating bodies. 
8. Prepare and submit reports of activities and accomplishments of the local 
health departments to the contributing and appropriating agencies. 
9. Represent the State Department of Health and all extra-state contributing 
agencies in financial, technical, and administrative affairs. 
10. Approve budgets and expenditures for local health work. 
To enable the bureau to perform these duties as efficiently as pos- 
sible, the director has assumed personal responsibility for certain duties 
relating to all counties in the State, both organized and unorganized. 
These include: policy determination, matters relating to personnel, 
relations with other bureaus of the State Health Department, relations 
with counties not having health departments, development of new de- 
partments, and administration of the tuberculosis out-patient service. 
Other bureau responsibilities have been assigned to the two assistant 
directors and, for administrative purposes, one officiates in the counties Public Health in the State and Counties of Virginia 
31 
with organized health departments in Southwest Virginia and the 
other in the organized counties in the rest of the State. 
The three sanitation supervisors employed by the bureau are 
engaged in supervising the work of sanitation officers employed by the 
various county or district health departments throughout the State. 
They also supervise similar work that is being undertaken under WPA 
auspices in counties where there are no organized health departments. 
Prior to 1937 this work principally consisted of the construction and 
maintenance of sanitary privies, and the protection of wells or other 
water supplies in rural areas. More recently the attention of these 
officers has been directed toward food sanitation and the sanitation of 
food establishments. Such work is being satisfactorily undertaken in 
eighteen counties. The first-mentioned activities are undertaken 
under the State Sanitary Law. (Ch. 465, Acts of 1924, as amended by 
an Act approved March 15, 1926). This law has been accepted and 
may be enforced in sixty-five counties of the State. The sanitation of 
food and food establishments is being promoted in suitable localities by 
inducing local authorities to adopt and enforce ordinances which have 
been prepared for the purpose by the Bureau of Rural Health. 
Until very recently the sanitation officers attached to this bureau, 
as well as those on the staffs of county and district health departments, 
have been laymen especially trained for these positions. To qualify for 
these appointments in the future, however, all applicants must be 
graduate engineers. 
The duty of safeguarding the sanitary quality of milk and milk 
products in the State is a responsibility of the State Department of 
Agriculture (Ch. 155, Acts of 1934). The provisions of this Act do not 
apply to persons keeping two milch cows or less, nor to cities and 
towns which have ordinances regulating the protection and distribu- 
tion of milk and cream with provisions more rigid than those incorporated 
in this Act. In view of the importance of a safe supply of wholesome 
milk to the public health of a community, the Bureau of Rural Health 
added a milk sanitarian to its staff in February, 1935. The purpose of 
this step was not to augment the work of the dairy and food division 
of the Department of Agriculture, but to supplement that work by 
promoting the adoption and enforcement of effective milk ordinances by 
large communities in counties and districts that are served by full-time 
health departments. Counties without organized health services are not 
included in this program because of the lack of local machinery neces- 
sary to insure the uniform application of ordinance requirements. 
Activities on a full-time basis are being conducted in fifteen communities, 
the standard milk ordinance of the United States Public Health Service 
having been adopted by twelve. 
1) The Division of Tuberculosis Out-Patient Service.—Up until 
1932, field control of tuberculosis was conducted successively under 
the Bureau of Tuberculosis Education (1914 to 1920) and the Bureau 
of Tuberculosis Out-Patient Service (1921 to 1932). In 1932 the latter 
bureau was discontinued, as such, and the retrenched staff was trans- 
ferred to, and became a division of, the Bureau of Rural Health. With 32 
Public Health in the State and Counties of Virginia 
this change, responsibility for active tuberculosis control measures was 
assumed by county health departments as a part of their generalized 
programs, and the nursing services of this division were restricted to 
counties without organized health services. 
While the Bureau of Rural Health exercises general supervision 
over the Division of Tuberculosis Out-Patient Service, the Bureau of 
Public Health Nursing renders aid by supervising the activities of 
the tuberculosis nurses, by planning their schedules, and by maintain- 
ing the State tuberculosis register of deaths, active cases, suspected 
cases, persons living in contact with cases, of infected cases moving 
from one locality to another, and of all cases discharged from sanatoria. 
The personnel of the division consists of two clinicians, one super- 
vising nurse, eight district nurses, two x-ray operators, two stenog- 
raphers, and three clerks—a total of seventeen. 
The program as now carried out includes a diagnostic service 
available to every county in the State, and a follow-up nursing service 
available to those counties that have no organized health services. In 
counties with health departments such service is undertaken by nurses 
on the local staffs. The diagnostic service provides chest examination, 
x-ray examinations, tuberculin tests, and consultation service. These 
examinations are undertaken by the clinicians only at the request of 
a physician. No treatment is ever given, and all opinions and advice 
in regard to cases are transmitted to the family physician immediately 
after each clinic. 
c. The Bureau of Communicable Diseases.—This bureau was 
organized in 1923 and functioned for about three years as the Bureau 
of Epidemiology. In July, 1926, the director assumed responsibility, 
also, for supervision of cooperative county health units in Eastern 
Virginia and of the malaria bureau. With the resignation of the di- 
rector on July 1, 1932, his successor was appointed and placed in charge 
of the Bureau of Epidemiology, without the additional duties mentioned 
above. The designation of the bureau was changed to the Bureau of 
Communicable Diseases in 1935. 
The personnel of the bureau consists of a director—the State 
epidemiologist—an assistant epidemiologist, a secretary-stenographer, 
and two clerks. The Division of Venereal Disease Control, discussed 
below, is a division of this bureau. 
The functions of the bureau include: the collection, tabulation, 
and analysis of reports of communicable and preventable diseases that 
occur in the State; the investigation of all outbreaks of unusual prev- 
alence of communicable diseases to determine the source of infection 
and to institute control measures; the provision of a free consulting 
diagnostic service, upon request, to physicians and health officers 
throughout the State; the promotion and direction of field studies to 
determine the immunity status of various population groups in the 
State with reference to certain communicable diseases, and to determine 
the most satisfactory immunizing agents and the best methods of ad- 
ministering them; the direction of epidemiological, bacteriological, and 
serological studies of certain endemic diseases in order to advise methods Public Health in the State and Counties of Virginia 
33 
for their prevention; cooperation with local health departments in the 
preparation of programs for the control of communicable diseases; 
the compilation of current information concerning communicable 
diseases that is of interest to the public and of general educational value; 
and general oversight of the program and activities of the Division of 
Venereal Disease Control. The more extensive special studies that 
have been undertaken thus far have related to diphtheria, dysentery, 
and smallpox. Activities to determine the status of the typhoid carrier 
and the prevalence of different types of pneumococci in various sections 
of the State have just been arranged for. 
The relation of this bureau to local health authorities is an ad- 
visory one. The law1 makes it mandatory for the State Board of Health 
to investigate outbreaks of communicable diseases, to confer with the 
local health authorities, and to make such suggestions as it may deem 
proper. If these suggestions are not carried out, and the disease is, in 
the judgment of the State Board, in danger of spreading to another 
city, town, or county, the said State Board of Health, or its executive 
officer, subject to the action of the said board, shall have the right to 
assume exclusive control of the disease. Under ordinary circumstances, 
however, disinfection, isolation, and quarantine are undertaken either 
by local health authorities or by the family physicians. 
Chapter 66 of the Acts of 1910 requires “. . . that every physician 
practicing in the State who shall know or suspect that any person whom 
he or she is called upon to visit, or who comes to him or her for examina- 
tion or treatment, is suffering from any infectious, contagious, com- 
municable and dangerous disease shall make report in writing on blanks 
to be furnished for that purpose by the State Board of Health, to the 
executive officer of the Board of Health of the county, town, or city in 
which such person may be located, over his or her own signature, stating 
the name of the disease, and the name, color, sex, and age of the person 
suffering therefrom, together with the street and number or such other 
sufficient designation of the house, room, or other place in which said 
person may be located, and such other information as may be deemed 
necessary by said health authorities.” The present rules and regula- 
tions of the State Board of Health require every physician or any 
person having patients under his care and observation to report weekly 
to the local or State health officer having jurisdiction the occurrence of 
any cases or suspected cases of any of the twenty-four diseases that are 
specifically enumerated. These regulations also require that any 
outbreak in influenza, septic sore throat, infectious jaundice, food 
poisoning, or any rare or unusual disease of importance to the public 
be reported. Occupational diseases and those caused by lead, phos- 
phorus, or arsenic are not included in the reportable list. 
Each week the bureau forwards special report forms to all physi- 
cians in counties both with and without organized health departments. 
In counties with organized health departments weekly reports are sent 
to the county or district health officer, who records the information in 
his local register and forwards the original reports to the State De- 
partment of Health. In all other counties physicians send their weekly 
1936. Section 1497. 34 
Public Health in the State and Counties of Virginia 
reports direct to the State Department of Health. Should a physician 
have no cases to report he is expected to return the blank form, and all 
reports from all counties are expected to reach the State Department of 
Health by a given day each week. Reports of the occurrence of com- 
municable diseases in the twenty-four cities of the State are forwarded 
weekly by the respective city health authorities to the State Depart- 
ment of Health. 
In the office of the Bureau of Communicable Diseases morbidity 
reports are tabulated in specially prepared registers in which data are 
classified for each disease according to age, sex, color, and month, by 
State and county, for each year. By the use of this and three other 
registers, the limited personnel of this bureau has been able to maintain 
complete and accurate records of communicable disease occurrence in 
the 100 counties of the State without the extra expense and labor 
required in connection with punched cards. Moreover, these data are 
immediately available, together with estimated populations, rates, etc., 
for each year commencing with 1909. 
Reports of communicable disease occurrence in the State as a whole 
are prepared and sent to the United States Public Health Service 
weekly, monthly, and annually. 
1) The Division of Venereal Disease Control.—The earliest 
official efforts directed toward the active control of venereal disease in 
Virginia appear to have been undertaken in 1918 through a cooperative 
enterprise inaugurated by the United States Public Health Service, the 
Commission on War Training Camp Activities, and the Virginia State 
Board of Health. The immediate purpose of this work seems to have 
been the control of vice in extra-cantonment zones, intended primarily 
to protect soldiers, sailors, and marines during the war and demobiliza- 
tion periods. 
Following the demobilization period, work was continued by the 
State Department of Health and the United States Public Health 
Service. In 1920 the General Assembly passed a venereal disease law 
which required physicians and others to report all cases of syphilis, 
gonorrhea, and chancroid to the State Board of Health. This law vested 
health officers with as much authority to exercise control over venereal 
diseases as they had for the control of any other communicable disease. 
At that time venereal disease control activities were conducted under 
the bureau of social hygiene. In 1922 the support of the United States 
Public Health Service was withdrawn, leaving the work entirely in 
charge of the State Department of Health. From 1922 to 1932 the work 
was carried on as a division of the Bureau of Rural Sanitation. In the 
latter year, however, the activities, which then consisted of distributing 
drugs to physicians and health officers at cost, were transferred to the 
Bureau of Epidemiology (present Bureau of Communicable Diseases). 
On December 1, 1936, a Division of Venereal Disease Control was 
created as a division of the Bureau of Communicable Diseases. 
The personnel of this division consists of a director, a secretary- 
stenographer, and a clerk. A representative of the United States 
Public Health Service has been assigned for duty with the division for Public Health in the State and Counties of Virginia 
35 
an indefinite period to assist the director in the preparation and in- 
auguration of his program. 
During the coming biennium the division hopes to inaugurate in 
Virginia the program recommended by the advisory committee of the 
United States Public Health Service for venereal disease control in 
State and local health departments. Actual application of these 
measures, however, depends upon financial participation by the Federal 
Government, since the budget was prepared and submitted as a State- 
Federal cooperative project. The annual budget covering the cost of 
activities contemplated for the next few years has been estimated at 
3130,000. _ 
Pending consideration and possible approval of funds for a more 
comprehensive program than has been possible thus far, the division 
is continuing to promote activities by local official and non-official 
agencies throughout the State. Close contact has been established with 
the medical profession and, to some extent with lay groups, and clinics 
have been promoted through funds raised by local political or civic 
groups. By the end of 1937, eighty-three such clinics were in active 
operation. These were conducted by: 
1. Local health departments 
2. Health departments and hospital staffs 
3. Health departments and medical societies 
4. Groups of private physicians 
5. Health departments and civic organizations 
6. Medical colleges 
7. County public health associations 
At present the division is in position to render advisory service to 
these clinics and to private physicians, the State Department of Health 
furnishes drugs free, and the staffs of county health departments are 
available for investigating sources of infection and contacts and re- 
turning lapsed cases for treatment. A very complete new system for 
reporting cases of syphilis and gonorrhea by case number, of contacts, 
and of cases that have lapsed from treatment was inaugurated in or- 
ganized counties on January 1, 1938. 
d. The Bureau of Public Health Nursing.—Public health nursing 
as a State Department of Health activity was conducted from 1916 to 
1932 as a division of the bureau of child health. In January, 1932, a 
separate bureau, coordinate with the other bureaus of the department, 
was created and the present director was appointed. The personnel 
consists of a director, five generalized supervisors (three in the central 
office and one each in the Valley and Southwest districts), one super- 
visor of tuberculosis nursing, eight field nurses with the tuberculosis 
out-patient service, and two stenographers. The sixty-four nurses 
engaged in generalized nursing in counties with organized health 
services are under the direct supervision of the respective county health 
officers and do not constitute a part of this bureau. The services 
rendered by the bureau to county health departments are entirely 
advisory, and are undertaken only at the request of the respective county 
health officers. 36 
Public Health in the State and Counties of Virginia 
The functions of the bureau, as summarized in the Virginia Health 
Bulletin of September, 1933, and subsequently modified, are as follows; 
1. Promotes interest in, and assists in organizing public health nursing services 
throughout the State. 
2. Guides the committees, where nursing services have been established, in de- 
veloping their local programs which embody the principles set forth by the 
National Organization of Public Health Nursing as adapted to county nursing 
services in Virginia. 
3. Seeks to maintain a high standard of professional efficiency among public 
health nurses of the State by: 
a. Keeping them informed as to the methods of obtaining opportunities for 
continual development, and stimulating them to take advantage of all such 
opportunities. 
b. Offering a personal service to each nurse in the solving of her individual 
problems. 
c. Recommending only qualified, registered nurses, for public health positions. 
4. Assists public health nurses In obtaining positions, assists associations in ob- 
taining nurses to fill vacancies, and advises graduate nurses as to methods of 
obtaining public health training. 
5. Standardizes reports and daily record keeping, and stimulates the correct re- 
porting of nursing activities. 
6. Compiles, through surveys, material helpful to the administration of nursing 
work. 
7. Supervises the activities of the tuberculosis nurses, plans their schedules, and 
maintains the State tuberculosis register. 
As has been stated previously, the relation of the director of this 
bureau to the sixty-four nurses on the staffs of county health depart- 
ments is advisory only. The same is true with respect to nurses employed 
by schools (of which there is a record of thirty-five), cities, towns, and 
counties without organized health departments. However, the latter 
always request advice in connection with the selection of nurses. 
In addition to the six supervising nurses in the State, and the eight 
nurses on special tuberculosis duty, the State Department employs seven 
other nurses. Of these, two are associated with the bureau of maternal 
and child health, three with the crippled children’s bureau, and two are 
engaged in a special demonstration project in Northumberland County. 
The director of the bureau exercises at least partial supervision over all 
of these except the two nurses attached to the bureau of maternal and 
child health. 
In the selection of nurses for appointment to positions in the 
State Department of Health or on the staffs of cooperative county 
health departments, the director of this bureau renders valuable as- 
sistance. The present minimum qualifications for appointment to such 
positions are: 
1. Graduation from an accredited high school 
2. Graduation from an approved training school 
3. Registration in Virginia 
4. Possession of a certificate in public health training Public Health in the State and Counties of Virginia 
37 
Public health nursing experience is also an important consideration 
in making these selections, but preference is given those applicants who 
have had training in theory, but no experience, rather than those who 
have had experience but no theory. Salaries range from 31,500 to 
31,800 for nurses on the staffs of cooperative county health departments, 
to 32,000 for supervising nurses on the staff of the bureau of public 
health nursing. County nurses are required to furnish their own cars 
and are allowed 320 per month plus upkeep, while advisory nurses are 
paid five cents for each mile traveled on official business. 
e. The Crippled Children’s Bureau.—Beginning in 1918, with an 
appropriation of 310,000, the State Legislature has continued to make 
annual allotments for the treatment of orthopedic cases. Soon after 
the original appropriation was made, the Crippled Children’s Hospital 
Association was organized. For a number of years thereafter State 
appropriations were supplemented by funds raised by this association 
and activities, including local clinics and hospital care, were conducted 
under the joint auspices of the State Board of Health and the Asso- 
ciation. The State appropriation was increased to 325,000 in 1922, 
and was continued at that figure until July 1, 1936, when the Crippled 
Children’s Bureau was organized. 
The personnel of the bureau consists of a director, three nurses, and 
one clerk. The bureau is charged with responsibility for the administra- 
tion and supervision of services for the physical rehabilitation of crippled 
children. The work is financed from funds provided by the State and 
the United States Children’s Bureau. 
The present program includes diagnostic clinics for both white and 
colored children, hospitalization for those having remedial defects, a 
follow-up service, and active cooperation with the State Department of 
Education in the vocational training of these children. The State 
Department of Health has adopted the definition that “a crippled child 
is one who by reason of a congenital or acquired defect of development, 
disease, or injury, is deficient in the use of his body or limbs.” This 
definition has the force of law. All crippled children are eligible for 
examination at the diagnostic clinics, but limitation of funds has made 
it essential to restrict hospitalization and the free provision of braces 
and other orthopedic appliances to indigent children under sixteen 
years of age who present definite orthopedic conditions, contraction 
deformities, harelip, or cleft palate. Preference is given to rural children 
of normal mentality who have remedial deformities. 
The diagnostic service is made possible through a cooperative 
arrangement between the Crippled Children’s Bureau and the State 
Orthopedic Society. The State has been divided arbitrarily into eight 
districts and the surgeons assigned to such districts conduct all clinics 
held therein. These clinics are intended for diagnostic purposes, but 
frequently the surgeons find it necessary to apply casts, fit braces, or 
give other simple treatments. Sustained efforts are being made to 
place these clinics on a permanent and regular schedule. Surgeons 
are granted a travel allowance of 315 for each clinic conducted. Other- 
wise their services are entirely free. To insure prompt and complete 38 
Public Health in the State and Counties of Virginia 
records of each clinic, the surgeons are permitted to utilize their private 
secretaries, to whom the bureau pays $5 per clinic. During the year 
ending June 30, 1937, a total of 136 clinics were held, with 2,667 visits. 
Facilities for hospitalization have been provided at two State 
owned institutions, namely, the University of Virginia Hospital, at 
Charlottesville, and the Hospital Division of the Medical College of 
Virginia, Richmond. Each of these hospitals is paid $3 per day for 
each crippled child hospitalized with the approval of the State De- 
partment of Health. Recently arrangements were made on a contract 
basis with the Jefferson Hospital at Roanoke to accommodate a limited 
number of children. 
Notification of the discharge of patients from hospitals, with 
recommendations for aftercare, are sent promptly to the Crippled 
Children’s Bureau. These, in turn, are forwarded to local health 
officers who provide the necessary follow-up services. In counties 
devoid of organized health facilities, the duty of conducting such follow- 
up service devolves upon the three special orthopedic nurses on the 
staff of the central bureau. Copies of discharge records also are sent 
to the family physicians of discharged patients in order that con- 
tinuity of treatment may be maintained. As a special project, efforts 
are being made to have an orthopedic surgeon see every case of in- 
fantile paralysis reported to the department. 
f. The Bureau of Industrial Hygiene.—This bureau was created 
on July 1, 1936, for the purpose of assisting industry in the prevention 
and control of occupational diseases. The cost of the work is being 
financed from joint State and Federal appropriations. The personnel 
of the bureau consists of a medical director, an engineer, a chemist, 
and a secretary. 
The principal activities of the bureau thus far have been devoted 
to a preliminary state-wide survey which involved recording the 
number of persons who by occupation are exposed to various materials 
which may be a hazard to health. The accumulated information also 
includes certain data on the welfare facilities afforded these workers 
in the industrial environment. 
The 1930 census of the United States records 880,276 gainfully 
■employed workers in Virginia. Experience has shown, however, that 
persons engaged in such occupations as agriculture, forestry and 
fishing, building, postal service, etc., are, as a rule, not exposed to 
specific occupational disease hazards. So, for the purpose of this survey, 
■658,017 persons engaged in such occupations were excluded. The remain- 
ing 222,259 workers were classified into seventeen industrial or service 
groups, and a representative sample (87,640) was selected for survey. 
This sample represented 39.4 per cent of the 222,259 persons engaged 
in potentially dangerous occupations, or 10.0 per cent of the 880,276 
gainfully employed persons enumerated in the 1930 census. The workers 
surveyed were engaged in 746 industrial plants located throughout 
the State, and, of these, 571 plants, with 71,793 employees (81.9 per 
cent of the total surveyed, or 35.2 per cent of the workers in this group) 
were in the manufacturing and mechanical groups. The study elicited Public Health in the State and Counties of Virginia 
39 
the fact that for the 87,640 workers surveyed, there were 129,178 
exposures to one or more of the materials considered. The total of 
these estimates indicates that there are 358,095 exposures among the 
222,259 workers in the types of industries included in the survey, or 
an average of 1.61 exposures per worker. 
The survey showed that 60.6 per cent of the plants employed less 
than 51 workers, and 73.9 per cent employed less than 101 workers, 
while only 11.5 per cent of the employees were engaged in plants em- 
ploying over 2,500 workers. The percentage of plants with more than 
2,500 workers was only 0.3. The largest percentage (23.4) of workers 
was employed in plants having 250 to 500 workers, and 60.2 per cent 
of the working population surveyed were employed in plants with 
500 workers or less. The latter fact is of importance since the National 
Industrial Conference Board has shown that establishments employing 
more than 500 workers can carry on a more economical medical service 
than the so-called smaller plants and that such services have been 
existent only in these larger plants. Subsequent to the completion of 
this survey the bureau staff has engaged in certain detailed studies 
with a view to determining the degree of danger that these potential 
hazards actually represent. As yet, the bureau is not fully equipped 
with laboratory and other facilities to expedite these studies, but such 
developments are under consideration. The plan, thus far, has been 
to provide a separate laboratory for the bureau, rather than equip the 
department laboratories to undertake this additional work. 
g. The Bureau of Sanitary Engineering.—This bureau was created 
in 1910 and has been continuously under the supervision of the present 
director. For many years the principal duties of the bureau involved 
general supervision over public water supplies, sewerage, sewage treat- 
ment, and swimming pools. In May, 1933, the bureau became respons- 
ible to the State Health Commissioner for all supervisory work required 
for the certification of shellfish and crabmeat shipped to other States 
for sale as food, and in December, 1933, for all drainage projects author- 
ized by government relief agencies for the control of both malaria- 
transmitting and pest mosquitoes. 
In addition to the director, the personnel of the bureau on January 
1, 1938, numbered ninety-two employees. Of these, twelve were on 
the State payroll, four were being paid by the United States Public 
Health Service, and seventy-six by the Public Works Administration. 
The accompanying chart shows the duties to which the several employees 
are assigned. 
Activities along the four lines of work—engineering, shellfish 
sanitation, control of malarial mosquitoes, and control of pest mosqui- 
toes—necessitate the use of three branch offices in addition to the 
headquarters office at Richmond. Engineering activities involving 
public water supplies, sewerage, and other related technical matters 
are usually dealt with by the central office staff. The other three projects 
however, are confined for the most part to the eastern seaboard, and, 
for purposes of efficiency and economy, branch offices and laboratories 
for their promotion have been established locally, where they are readily 40 
Public Health in the State and Counties of Virginia 
Shellfish Sanitation 
Water, Sewage, Miscellaneous 
Malaria Control 
Pest Mosquito Control 
1 Assistant Engineer* 
1 Senior Bacteriologist* 
1 Assistant Bacteriologist* 
1 Chief Clerk Inspector* 
1 Inspector (Part time)* 
1 Assistant Bacteriologist 
4 Stenographers 
1 Assistant Inspector 
3 Clerks 
2 Boat Operators 
1 Draftsman 
3 Laborers 
Temporary at Experimental Plant 
1 Foreman 
1 Carpenter 
2 Plumber Helpers 
1 Senior Assistant Engineer* 
3 Assistant Engineers* 
1 Assistant Engineer* 
(Part time on shellfish 
sanitation) 
1 Secretary-Stenographer* 
1 Stenographer-Clerk* 
2 Stenographers 
1 Assistant State Directorf 
1 Office Engineerf 
1 Office Manager 
1 Clerk 
1 Draftsman 
1 District Supervisor! 
1 Local Supervisor 
10 Foremen 
1 District Supervisorf 
1 Superintendent 
1 Engineer 
2 Foremen 
4 Local Supervisor 
8 Foreman 
1 Assistant Director 
1 Senior Clerk 
2 Superintendents 
2 Senior Foreman 
17 Foremen 
5 Labor Foremen 
Monthly Payroll, 32,154.40 
Monthly Payroll, 31,362.80 
Monthly Payroll, 32,550.66 
Monthly Payroll, 32,073.20 
Total Monthly Payroll, Including Director, 38,377.10. 
*On State Payroll. 
fPaid by Public Health Service. 
Remaining Personnel Paid by W. P. A. 
Bureau of Sanitary Engineering, Virginia Department of Health 
Chart Showing Activities and Personnel (As of January 1, 1938) Public Health in the State and Counties of Virginia 
41 
accessible. Two of these branch offices are located at Norfolk—one 
for shellfish sanitation and the associated laboratory work, and one for 
malaria control projects at the Marine Hospital. The third branch 
office, for shellfish sanitation and malaria control, is located at Parksley, 
in Accomac County. 
1) Engineering.—The State Board of Health is authorized1 to 
assume general supervision and control over all water supplies and water 
works in the State in so far as the sanitary and physical quality of 
waters furnished may affect the public health and comfort. The term 
water works is defined as any plant or system for the collection, purifica- 
tion, or distribution of water for drinking or domestic use to the public 
or to more than twenty-five individuals; provided, however, that nothing 
in the Act shall be held to apply to any water above the intake of such 
water works. This provision was inserted in order to make it clear that 
provisions of this particular law were confined to the water works as 
defined and should not apply in any way to the pollution of streams 
from which supplies are taken. However, any city or town which 
obtains its water for drinking and domestic use from a catchment area 
not exceeding fifty square miles above the intake is amply protected 
against pollution by a law enacted in 1891. Pollution by bathing, 
casting out of dead animals, discharge of sewage, trade wastes, or any 
human or animal wastes, noxious or putrescible substance whether 
solid or fluid, and whether same be buried or not, within 200 feet 
of any such stream or tributary thereof is deemed a misdemeanor 
punishable by a fine not exceeding 3100 or imprisonment not exceeding 
thirty days, or both, for each offense. 
In addition to the usual provisions that the State Board of Health 
may confer with and advise cities, towns, and persons, having or 
intending to have a waterworks, the Act of 1916 requires that an ap- 
plication for a permit, accompanied by plans and specifications, shall 
be filed to construct new water works or for the extension of existing 
water works, excepting extensions to the systems of pipes for distributing 
the water within the community. Upon approval of the plans and 
specifications a written permit is issued, revocable later if deemed 
necessary by the board. Furthermore, the board has authority to 
issue an order requiring such changes in the source of supply, or altera- 
tions in the water works, as are deemed necessary in the interests of the 
public. With such orders, the board designates a time and place for 
a hearing, after which a final order is made. Provision is made for an 
appeal and a modified order by the Court. Failure to comply with the 
provisions of the Act is punishable by a fine of 320 to 3100 for each 
offense. A municipal corporation is proceeded against by mandamus or 
other appropriate remedy by any court of competent jurisdiction. 
No legislation has been enacted giving the State Board of Health 
authority over installations for the treatment of sewage and industrial 
wastes nor over the methods of their disposal. With few exceptions, 
however, the sewage treatment plants installed by cities, towns, in- 
stitutions, and the larger unincorporated communities have been 
1Chapter 360, Acts of 1916. 42 
Public Health in the State and Counties of Virginia 
approved by request prior to construction. This is true also for the 
majority of new systems of sanitary sewers. In connection with the 
construction of sewerage systems and sewage treatment plants under 
Works Progress Administration auspices, the government requires that all 
plans and specifications, except for such construction in the proposed 
Hampton Roads Sanitary District, shall be submitted to the bureau 
for examination and approval before funds are made available. 
The State Board of Health has not been vested with any authority 
regarding the pollution of streams, nor have any appropriations been 
made specifically for study of stream conditions. In the case of nuis- 
ances in the vicinity of sewer outfalls believed to be harmful to health, 
it is possible that the board has authority to take action under the Act 
by which the board was created. 
The board is authorized by law to adopt such rules and regulations 
as it may deem necessary regarding plumbing, the disposal of garbage, 
and the sanitation of swimming pools. 
The Bureau of Sanitary Engineering does not undertake the prepa- 
ration of plans and specifications of water works, nor the construction 
of such plants. Its most important function is the constant super- 
vision which it exercises over all public water supplies. Beginning with 
a careful study of the plans and specifications of all prospective new 
plants prior to issuing permits for their construction, continuous 
supervision is maintained over all plants and their operators. With a 
view to promoting close cooperation in matters relating to the opera- 
tion of plants, the bureau has fostered a spirit of friendliness and 
goodwill with plant operators throughout the State. Practical evidence 
of the effectiveness of cooperative efforts between the bureau staff and 
the plant operators is reflected in the fact that during the past twelve 
years no cases of typhoid fever have been ascribed to the pollution 
of public water supplies. Since many supplies are subject to contamina- 
tion prior to treatment, this result could hardly have been achieved 
except by the exercise of constant and effective operating methods. 
Special efforts have been made to locate cross connections between 
water distributing pipes with privately owned or emergency supplies. 
It is believed that the bureau now has a record of practically all such 
connections, with a detailed description of the conditions under which 
their use is being permitted, and inspections of these are made from 
time to time. 
As of January 1, 1938, there were listed 407 public water supplies 
in Virginia, serving approximately 1,047,248 persons. This list does 
not include an appreciable number of supplies for public schools, but 
it does include 141 places, each with estimated populations of less than 
250, representing an aggregate of 18,110 persons. Since it is frequently 
impractical for communities with populations of less than 250 to pro- 
vide public water supplies, the bureau’s records of communities without 
such supplies refer only to places with more than 250 inhabitants. 
There are 121 such places in the State with an aggregate population 
of about 50,000. Of these communities, 3 have populations of more 
than 1,000; 29 have populations of more than 500; and 89 have popula- 
tions of less than 500. These figures show that of a total population of Public Health in the State and Counties of Virginia 
43 
1,047,205 for which it would be practical theoretically to provide 
public water supplies, 1,047,248 or 95.5 per cent, actually have such 
supplies, and 49,957, or 4.5 per cent, are without this service. Thus, 
43.2 per cent of the State’s 2,421,851 inhabitants (1930 census) are now 
provided with safe public water supplies. 
Of the 407 public water supplies in the State, 218 systems supply 
water untreated to the consumers; 90 systems employ chlorination 
alone, and 99 employ a combination of filtration and chlorination. Of 
the filtration plants, twelve have laboratory facilities for daily chemical 
and bacteriological examinations, and samples from two others are 
examined bacteriologically in a local laboratory. Samples from two 
other supplies are examined several times weekly in one of the depart- 
ment’s branch laboratories. Samples from the other supplies are 
examined weekly, fortnightly, quarterly, or semi-annually in the State 
laboratories, in accordance with a schedule prepared by this bureau. 
Of the 1,047,248, estimated as being supplied from public sources, 
71.6 per cent are furnished with water purified by filtration supplemented 
by chlorination; 18.7 per cent with water treated with chlorine alone, 
and 9.7 per cent with water regarded as safe without treatment. Munici- 
palities having supplies that meet certain requirements established by 
the bureau are entitled to post the sign Public Water Approved on the 
main highways at the corporate limits. Such signs are now being 
displayed by ninety-one municipalities. Plant operators in Virginia 
are not subject to license, nor are they required to meet any special 
qualification standards. Many of them, however, have become fairly 
proficient through practical experience and knowledge acquired by 
association with engineers from this bureau. As a means of further con- 
tributing to their knowledge and efficiency as plant operators, the 
bureau in cooperation with the League of Virginia Municipalities, the 
Virginia Section of the American Waterworks Association, and the 
State Division of Trade and Industrial Education, started a series of 
two-day schools for water works superintendents and operators in 
1935. For 1938 this course has been revised in order to provide more 
intensive training. 
In addition to the short schools, home study courses are being 
started which when completed will entitle those taking the course to 
a certificate of competence from the sponsoring agencies. Instruction 
is being offered in four grades, and two more probably will be added 
later. The first school under the new set-up was held at the Virginia 
Polytechnic Institute, Blacksburg, on December 2 and 3, 1937, for all 
water works personnel in the western part of the State. At this school 
the home study idea was introduced and sixteen men enrolled for these 
courses which are now getting under way. Schools for operators in 
the northern and central parts of the State will be held at the Vir- 
ginia Military Institute at Lexington, and for those in Eastern Virginia, 
at Richmond, 
As previously stated, the State Board of Health has no legal au- 
thority over sewage treatment plants nor over the methods of sewage 
disposal. However, the many voluntary requests received from local 
authorities, and the requirement that all Works Progress Administra- 44 
Public Health in the State and Counties of Virginia 
tion projects be approved, entail a large amount of supervisory and 
advisory work on the part of the staff of the Bureau of Sanitary Engineer- 
ing. During the period of 1934 to 1938 the bureau has examined and 
approved plans and specifications for public water supplies and sewerage 
improvements, already built or now under construction, costing in the 
aggregate 311,012,300. These include ten new water filtration and 
eighteen sewage treatment plants, the operation of which requires 
general supervision by members of the staff. The number of sewage 
treatment plants increased from fifty-two in July, 1934, to eighty-nine 
in January, 1938. The population served by such plants increased 
from 74,185 to 145,047. 
No special laws have been enacted for the control of stream pollu- 
tion. Laws are in effect, however, prohibiting pollution of certain 
waters approved for shellfish growing areas. The pollution of streams 
in Tidewater Virginia has provoked a great deal of discussion because 
of its effect on shellfish areas and certain popular bathing beaches. In 
this connection the Hampton Roads Sewage Disposal Commission 
has recommended the creation of a sanitary district to include the cities 
and counties bordering Hampton Roads. The estimated cost of pro- 
viding sewage collection and treatment facilities for the district is 
38,000,000. 
2) Shellfish Sanitation.—The first law for State supervision of 
shellfish growing areas and marketing of oysters was enacted in 1916. 
Responsibility for administering the provisions of the law was vested 
in the Dairy and Food Division of the Department of Agriculture 
until 1927, when an amendment to the law transferred the responsibil- 
ity to the State Health Commissioner. The law was further amended 
in 1930 to include crabmeat, scallops, and clams. In the State Depart- 
ment of Health, shellfish sanitation was carried on under a separate 
bureau until May 1, 1933, when the work was delegated to the Bureau 
of Sanitary Engineering. 
From July 1, 1928, to July 1, 1934, the annual appropriation for 
shellfish sanitation was 325,000 per annum, obtained from a special 
tax on oysters. This allotment was reduced to 315,000 a year for the 
next two years and then to 37,400. All funds now needed over and 
above 37,500 are derived from the appropriation of the State Health 
Department. 
The State Health Commissioner through his authorized representa- 
tives has authority to conduct surveys of shellfish producing areas, 
to formulate sanitary regulations, to set sanitary standards and make 
such examinations, analyses and inspections as are necessary in the 
enforcement of these regulations and standards. Authority is given 
to enter any premises on which shellfish are being stored, handled, or 
prepared and, where there is evidence of violation of the related laws 
or regulations, to take such steps as are necessary to prevent further 
preparation or marketing of any product found to be illegally handled 
or prepared. 
In Virginia there is an annual production of shellfish of an estimated 
value of 32,000,000 consisting roughly of two million bushels of oysters Public Health in the State and Counties of Virginia 
45 
and 1,500,000 pounds of clams. Approximately fifteen thousand persons 
are engaged in the industry, taking oysters from 290,000 acres of shell- 
fish grounds and working in nearly four hundred plants, shucking and 
packing shellfish. This activity is general over Tidewater Virginia, 
and the larger part of the water area in this section is either producing 
or potential shellfish producing area. 
While the activities of the bureau in this connection are of very 
great importance to the health of the people of Virginia and of those in 
other States to which they are shipped, as well as to the local industry 
itself, space does not permit a detailed discussion of them here. Briefly 
stated, control is exercised over the shellfish industry from the growing 
areas, through the shucking and packing plants, to the point where the 
product is ready for shipment to the consumer. In broad outline this 
program includes inspection of growing areas from which samples of 
oysters and clams and of the overlying waters are collected for bac- 
teriological examinations; surveys of the shore lines along the growing 
areas to detect and eliminate possible sources of pollution; the delinea- 
tion of restricted areas, prohibition of harvesting shellfish from these 
areas for direct marketing; supervision of the removal and relaying of 
shellfish from polluted areas to approved areas of clean water, under 
authority of official permits, for cleansing purposes, prohibition of 
removal from cleansing areas until cleansing is complete, and.examina- 
tion of sufficient samples of these stocks to insure that the product is 
ready for market; supervision of shucking and packing plants and of 
their operation, and of practices related to holding and storage of shell- 
fish prior to shucking; and certification that shippers have complied 
with the minimum requirements of the United States Public Health 
Service. 
3) Mosquito Control.—The State Department of Health has 
authority under the law creating the State Board of Health and several 
amendments thereto, to conduct surveys, make investigations, consult 
with and advise cities, towns or persons regarding malaria and methods 
of its control And the board may adopt such rules and regulations as 
it deems necessary for the protection of the public health. No special 
laws have been enacted for the control of malaria unless an Act entitled 
An Act to Authorize Certain Cities and/or Counties in This State to Estab- 
lish a Mosquito Control District be considered as such. This law, passed 
in 1930, appears to have been intended for the control of pest mosquitoes. 
In 1929, the State Board of Health adopted a rather comprehensive 
set of rules and regulations governing precautions to be taken in con- 
nection with the impounding of waters. 
Soon after the Federal Civil Works Administration was organized 
the Federal Government allotted certain funds to the United States 
Public Health Service to be used for drainage projects to control 
malaria. Under this arrangement the Public Health Service was the 
sponsor of projects in each State and in Virginia the State Department 
of Health was agent. From the beginning of the work on December 1, 
1933, to July 1, 1935, drainage operations for the control of malaria 46 
Public Health in the State and Counties of Virginia 
mosquitoes were conducted along with those for the control of pest 
mosquitoes. Subsequent to the latter date, however, a change in policy 
divorced pest mosquito control from malaria control. All of these 
activities have been under the immediate supervision of the Bureau of 
Sanitary Engineering from the start, but, whereas the Public Health 
Service sponsored both malaria control and pest mosquito control in 
the early part of the work, sponsorship of the latter activity was handed 
over to the State Department of Health in 1935. At the present time 
the salaries and traveling expenses of the supervising personnel of the 
malaria control staff are paid by the United States Public Health 
Service. All other personnel engaged on malaria drainage projects, 
and all personnel on pest mosquito control projects are paid from 
Works Progress Administration funds. During the past four years 
approximately 1,785 miles of ditches have been dug at a cost to the 
sponsoring agencies of 3616,133. 
h. The Bureau of Vital Statistics.—The collection and preservation 
of records of marriages, births and deaths were accepted officially as 
functions of the State Government for the first time in 1853. In that 
year the General Assembly enacted a law1 requiring the clerk of every 
county and corporation court to maintain three books, to be called, 
respectively, the register of marriages, the register of births, and the 
register of deaths. Information regarding births and deaths was to 
be collected by the commissioners of revenue and transmitted to clerks 
of the court. At a designated date during the ensuing year, the clerk 
of the court was required to furnish the auditor of public accounts with 
a copy of each of his three registers, and it was the duty of the auditor 
to tabulate all records for the State and to preserve the registers. Such 
records were collected from 1853 to 1896, when the law was repealed, 
or, for some reason which is not now apparent, its operation was dis- 
continued. Thereafter for about sixteen years this important work was 
entirely suspended, and it was not until 1912 that an effective vital 
statistics law was passed and adequate central and local machinery 
was established for the proper registration of births and deaths. This 
law, with subsequent amendments, is a modification of the model law 
recommended by the United States Census Bureau and is the law under 
which the bureau now conducts its activities. 
The duties imposed upon the State Registrar of Vital Statistics are 
performed by the Bureau of Vital Statistics, of which the State Registrar 
is director. These duties include enforcing the State registration law; 
recording and making studies of all births and deaths that occur in the 
State; collecting and preserving records of all marriages and divorces 
that take place in the State; enforcement of the Act of 1924 to preserve 
racial integrity; the issuance of permits to, and supervision of, midwives; 
and distribution of ampules of 1 per cent silver nitrate solution to 
doctors, hospitals, and midwives to be instilled in the eyes of newborn 
infants. Certificates of birth registration are sent to the parents of 
all children born in Virginia, and certified copies of birth and death 
certificates are supplied to those requiring them upon the payment of a 
xActs of 1853, Chapter 25. Public Health in the State and Counties of Virginia 
47 
fee of fifty cents. Such certified copies are supplied to veterans and 
members of their families, and to certain other persons free of charge. 
The personnel of the bureau consists of a director, an assistant 
director, one statistical assistant, sixteen clerks, and two secretary- 
stenographers—a total of twenty-one persons. 
The originals of all birth and death certificates issued in Virginia 
since June, 1912, are on file in the office of the State Registrar of Vital 
Statistics, and a cross index of all such certificates is being maintained. 
A punch card system for recording data relating to births and deaths, 
and an electric machine for sorting the cards, have been in use since 1922. 
The State Board of Health is required by law1 to have charge of the 
registration of births and deaths; to prepare the necessary instructions, 
forms, and blanks for obtaining and preserving such records; to insure the 
faithful registration of the same in each registration district and in the 
Bureau of Vital Statistics in the capital of the State; to enforce the law 
uniformly and thoroughly throughout the State; and to promulgate 
from time to time any additional forms and amendments that may be 
necessary for this purpose. “For the purpose of this Chapter2, the 
State shall be divided into registration districts as follows: each city, 
town, and magisterial district shall constitute a registration district, 
provided that the Registrar may combine two or more registration 
districts into one registration district.” 
In cities the principal executive officer of the local board of health 
is the local registrar of vital statistics, while in towns and magisterial 
districts the local registrars are appointed by the State Registrar. The 
tenure of office of a local registrar is not stated in the law. Presumably 
continuation of office is dependent upon efficiency of service and good be- 
havior as determined by the State Registrar. At the present time there 
are 1,250 local registrars. Local registrars receive the sum of twenty-five 
cents for each birth or death certificate properly made out and registered 
with him, correctly recorded, and promptly returned by him to the State 
Registrar, as required by law. In case no births or deaths are registered 
during the month, the local registrar is paid a fee of twenty-five cents 
for informing the State Registrar of that fact. The salary paid the princi- 
pal executive officer of a local board of health may be in lieu of such fees 
as are designated by this law. Each registrar is required to make a com- 
plete and accurate copy of each birth and each death certificate registered 
by him, in a record book furnished by the State Registrar. Such record 
books are to be preserved as permanent records which must be trans- 
ferred to succeeding registrars. On the tenth day of each month each 
local registrar is required to transmit to the State Registrar all original 
certificates of births and deaths which have occurred to the end of the 
preceding month. If no births or deaths occurred during any month 
the local registrar must report that fact to the State Registrar on the 
tenth day of the following month. 
The State Registrar annually certifies to the county treasurer the 
number of births and deaths properly registered and the amounts due 
each registrar, and such amounts are paid to the respective registrars 
out of the county treasuries. 
Virginia Code, 1919, Section 1561. 
2Virginia Code, 1919, Section 1563. 48 
Public Health in the State and Counties of Virginia 
Undertakers, or persons acting as undertakers, are responsible for 
obtaining and filing certificates of death with local registrars, and for 
securing burial or removal permits prior to any disposition of a dead 
body. It is their duty to obtain the personal and statistical information 
and then present the certificate to the attendant physician, if any, or 
to the health officer or coroner, as directed by the local registrar, for 
the medical certificate of the cause of death. The certificate is then 
completed by adding the required facts, relative to the date and place 
of burial, over his signature and with his address. The completed 
certificate is then filed with the local registrar, who issues a burial 
permit in exchange. Since a body may not be held pending burial or 
other disposition more than seventy-two hours after death, certificates 
must be filed and burial permits obtained within that time. If death 
occurred in a remote or sparsely settled district however, or when it is 
impractical to file a death certificate and obtain a burial permit, a 
body may be buried or removed from the district without a permit, 
but a certificate of death must be filed within ten days. Deaths due 
to violence or occurring under suspicious circumstances are referred to a 
coroner for his investigation and certification. For the purpose of 
reporting deaths the standard certificate and the international list of 
causes of death are employed. 
Birth certificates are required to be filed with local registrars by the 
attending physician or midwife within ten days after the date of the 
birth. If there is no attending physician or midwife, it then becomes the 
duty of the father or mother of the child, the householder, manager, or 
superintendent of a public or private institution in which the birth oc- 
curred to notify the local registrar within ten days. It is then the duty 
of the local registrar to secure the necessary information and signature 
to make a proper certificate of birth. Stillbirths are reported as births 
and deaths and the registrar is paid a fee of twenty-five cents for each 
certificate. Certificates of births and deaths that occur in cities are 
sent direct to the respective city health departments and thence to the 
State Registrar, in whose office they are preserved permanently. 
Transcripts of all birth, death, and stillbirth certificates are made for 
the United States Bureau of the Census each month, and tabulations of 
certain vital statistics for the State are sent to the United States Public 
Health Service monthly and annually. Since 1935 the State Depart- 
ment of Health has received from the United States Bureau of the 
Census transcripts of certificates of births to, and deaths of, Virginia 
residents that occurred outside of the State. These are sorted by 
States, bound and stored in the bureau vaults. Since 1935 tabulations 
of births and deaths have been issued in the annual reports of the depart- 
ment both on the recorded and corrected basis. The additional labor 
thus entailed enormously increased the routine duties of the bureau staff. 
Recently arrangements have been made whereby original birth and 
death certificates issued in certain counties are routed by local registrars 
through the respective county health officers to the State Registrars. 
This procedure permits the health officers to review the certificates, to 
effect the correction of certain errors and omissions, and to prepare 
such records for use in their offices as may be desirable. Public Health in the State and Counties of Virginia 
49 
The handling and tabulation of routine statistical data for 1936 
involved the following units: 
Classification 
Number 
Birth certificates 
51,117 
Death certificates 
32,169 
Stillbirth birth certificates 
2,248 
Stillbirth death certificates 
2,248 
Reports of marriages 
30,118 
Reports of divorces 
4,178 
During 1936 a total of 5,528 searches were made, and certified 
copies issued, of birth and death certificates; 1,282 of marriage and 
divorce certificates; and 376 searches in connection with records relative 
to Racial Integrity data; a total of 7,186 searches. The cash income 
accrued from this work amounted to 32,802.50. 
i. The Bureau of Maternal and Child Health.—The personnel of 
this bureau consists of a director, an assistant director, an obstetrician, 
a pediatrician, two instructional nurses, a secretary-stenographer, a 
stenographer-clerk, and a clerk—a total of nine. The Division of 
Mouth Hygiene, discussed below, is a section of this bureau. 
The program of the bureau is largely of an educational character, 
the objectives of which are the promotion of maternal, infant, and child 
hygiene. Service to individual patients is rendered by the staff pric- 
cipally through the promotion of prenatal, infant, and preschool clinics 
and some home visiting by nurses on behalf of these groups through the 
cooperation of county and city health officers. 
Educational Activities.—The educational program is a diversified 
one, planned to impart practical knowledge and assistance to all elements 
of the population that may be of service in the promotion of the hygiene 
of maternity and child life. The staff seeks to promote service to 
mothers and children through combined educational and service ac- 
tivities. Their aims are to mobilize the assets of each community and 
to utilize societies, clubs, or other State and local groups for the per- 
formance of those services for which they are best equipped. Insofar 
as possible definite programs are assigned to such State-wide organiza- 
tions as Parent-Teacher Associations, Federation of Women’s Clubs, 
and others, but in counties that have no local counterparts of such 
State organizations, programs are undertaken in cooperation with 
whatever local organizations may be found. Briefly stated, the major 
features of the bureau’s educational program, which is entirely a 
cooperative one, include: postgraduate instruction in obstetrics and 
pediatrics to physicians; group instruction of midwives; instruction of 
lay groups and supervision of the health programs undertaken by them; 
cooperation with the State Department of Education in carrying out 
the provisions of the so-called West Law, and the distribution of ap- 
propriate literature to individuals and groups throughout the State. 50 
Public Health in the State and Counties of Virginia 
Postgraduate Instruction.—This work is undertaken in cooperation 
with the Medical Society of Virginia, the University of Virginia Medical 
School, and the Medical College of Virginia. The obstetrician and 
pediatrician conduct a series of classes, consisting of brief lectures 
followed by discussion, for the benefit of physicians in numerous lo- 
calities of the State. Courses are conducted over a period of five weeks, 
during which three or more weekly meetings are held at each center. 
In the intervals between meetings the clinicians endeavor to contact 
individual practitioners with a view to ascertaining the type of instruc- 
tion that would best meet local needs. Each clinician also places him- 
self freely at the disposal of these local physicians for consultation 
purposes. Although this work has been in progress only since the 
latter part of 1936, the interest manifested by physicians who have 
availed themselves of the opportunities offered indicates that the service 
promises to do much for the improvement of the practice of obstetrics 
and pediatrics. 
Instruction of Midwives.—Under the laws of the State, midwives 
are required to register their names with the State Registrar of vital 
statistics and to secure a permit from the Registrar before engaging 
in the practice of midwifery for pay. No special qualifications are re- 
quired to enable midwives to secure these permits, nor are there any 
definite provisions for systematic supervision of activities undertaken 
by them. Apart from certain printed instructions for the guidance 
of midwives, which are not required by law, it would appear that the 
only supervision exercised by the State Registrar relates to the report- 
ing of births and the prevention of ophthalmia neonatorum. 
For some years the Bureau of Maternal and Child Health has been 
attempting to place the services rendered by the State’s approximately 
3,875 midwives on a higher level of efficiency. Classes for midwives 
are being held in many of the counties with full-time health services 
by local nurses. In counties that do not have organized health depart- 
ments, classes for midwives and their patients are conducted by one 
of the bureau’s field nurses. The primary purposes of the classes are: 
to teach the midwives the rudiments of midwifery; to organize the 
classes for the study of natal care and child health; to plan some definite 
health work to be done under the supervision of the county school 
supervisors and the local Negro Organization Society; and to teach the 
mothers what to expect of the midwives. 
The local colored supervisors of schools arrange for the classes, 
and the groups are organized into health committees of the Negro 
Organization Society. The health committees then continue to meet 
at regular intervals for group study and community health work 
under the direction of the supervisors of schools. Among the popular 
projects undertaken by these clubs are diphtheria immunization, 
screening of houses, making layettes, and the preparation of food to be 
used for hot lunches in the winter, for both home and school con- 
sumption. The field nurse endeavors to visit each group at least once 
a year, to give demonstrations and to suggest new lines of health work. Public Health in the State and Counties of Virginia 
51 
Instruction of Lay Groups.—This work is undertaken throughout 
the State, but the staff of the bureau directs its major attention to 
counties that have no organized health departments. In general, 
these activities are sponsored and supervised by the staff of this bureau, 
but the actual work is undertaken by the local branches of such state- 
wide organizations as the State Federation of Parents and Teachers 
Association, State Federation of Women’s Clubs, Homemakers Clubs 
of Virginia, Four-H Clubs, Adult Education Groups, Home Economics 
classes, and others. Each of these groups is given a definite program 
annually, or as often as necessary, which it undertakes to carry out 
under the supervision and with the assistance of the Bureau of Maternal 
and Child Health. While the details of these programs are too exten- 
sive for discussion here, it may be added that they are of a very practical 
nature and that all have as their objectives the promotion of the health 
and well-being of maternal and child life. Moreover, the methods 
employed in teaching health essentials through these groups include 
the performance of many practical health services, thus accomplishing 
the very desirable result of teaching by actual experience. Work 
with lay groups, such as certain church organizations, that have no 
State-wide affiliations is promoted by one of the educational nurses. In 
the recent past this nurse has devoted most of her attention to work 
with the Cradle Roll Superintendents of the churches. Through 
these local workers the nurse has been able to disseminate widely a 
great deal of practical knowledge to mothers about themselves and 
their children. 
School Health Work—Health education and health service in the 
public schools of Virginia are joint responsibilities of the State depart- 
ments of education and health. Legislation providing for these in- 
timately related services is to be found in Chapter 327 of the Acts of 
the General Assembly of 1920. This Act, commonly known as the 
West Law, reads in part as follows: 
“In order that the teachers of the Commonwealth shall be prepared for 
health examinations and physical education of school children, every teacher 
training institution in the State is hereby required to give a course, to be ap- 
proved by the Superintendent of Public Instruction and the State Health 
Commissioner, in health examinations and physical education, Including pre- 
ventive medicine, physical inspection, health instruction and physical training, 
upon which course every person graduating from such an institution must 
have passed a satisfactory examination.” 
In the preparation of courses of .health instruction for use in the 
teacher training institutions of Virginia the State departments of edu- 
cation and health work in close cooperation. Likewise, intimate 
working relations exist between the two departments in regard to the 
health material and procedure to be employed throughout the public 
school system—for both white and colored pupils. Although other 
bureaus of the State Department of Health are available for consulta- 
tion with the Department of Education, it appears that the responsibili- 
ties of the State Department of Health have been discharged in the past 52 
Public Health in the State and Counties of Virginia 
principally by the Bureau of Maternal and Child Health. At any rate, 
a well coordinated program of health education representing the group 
judgment of the several bureaus of the State Department of Health, 
and fully utilizing the facilities of the department’s Division of Health 
Education, has not been presented for the consideration of the State 
Department of Education. 
In addition to the above mentioned services of the Bureau of Ma- 
ternal and Child Health in the field of health education, the staff 
sponsors numerous practical schemes for health promotion and disease 
prevention among school children. Accomplishments resulting from 
the execution of these projects, which are carried out largely by the 
pupils themselves, have been found to exert a potent and lasting 
influence upon the lives of the pupils. 
Prenatal, Infant, and Preschool Clinics.—Early in 1936 social 
security funds became available for the inauguration of a maternal 
and child health program in Virginia. By July of that year the State 
Department of Health had been able to secure the approval of several 
local medical societies to organize and establish prenatal clinics in 
their respective counties. It was not until October, 1936, however, 
that the department’s plans were approved by the State Medical 
Society and the Bureau of Maternal and Child Health was in position 
to direct its efforts seriously to the inauguration of its plan. 
Although the plan as submitted and approved provides for pre- 
natal, infant, and preschool clinics, the sponsors feel that prenatal care 
is fundamental in any maternal and child health undertaking, and 
efforts are being made to place initial emphasis upon that feature of 
the program. Prenatal clinics, either alone or in combination with 
clinics for infants and young children, are conducted in cities, and in 
counties with organized health departments. The work is not under- 
taken in counties without full-time health service because of the ab- 
sence of responsible personnel to take care of administrative details 
and to carry out the necessary follow-up work. These clinics, which 
are conducted under the supervision of the assistant director, are organ- 
ized only with the approval of the local medical societies, which appoint 
the clinicians. In view of the fact that the clinics are intended only for 
those who are unable to pay for such services the clinicians are granted 
honoraria rather than a regular medical fee. The establishment and 
maintenance of clinics, including honoraria for clinicians, are made 
possible by contributions from the United States Children’s Bureau. 
Patients are admitted to these clinics only by appointment, and they 
are referred directly by physicians or approved social agencies, or by 
midwives. Clinics have been organized as rapidly as has been deemed 
expedient, and at the end of the fiscal year, 1937, a total of forty-six 
prenatal, or combination prenatal and well-baby clinics, were in opera- 
tion in counties with full-time health departments. In addition, eight 
cities were receiving funds to strengthen and extend similar clinics. 
Each of these clinics has been supplied with adequate equipment 
for the performance of a high standard of work. Proper records are 
kept on all patients, and Wassermann tests are made as a routine on Public Health in the State and Counties of Virginia 
53 
every prenatal case. Antisyphilitic drugs are supplied for all indigent 
mothers and children needing such treatment. 
The efficiency of this work has been materially strengthened by 
assistance rendered by the Bureau of Public Health Nursing. The 
director of the latter bureau has held regional meetings for nurses on 
the staffs of county health departments and has figured prominently in 
group instruction of pregnant women. By these activities local nurses 
have been taught to give group instruction at prenatal clinics, thus 
obviating the necessity of making a burdensome number of home visits 
to these patients. Furthermore, the director of the Bureau of Public 
Health Nursing has done much to promote midwife institutes and to 
increase their practical value. 
1) The Division of Mouth Hygiene.—Following the passage of 
the West Law in 1920, teachers in the public schools of the State re- 
ported such a high percentage of dental defects among the pupils that 
the Virginia State Dental Association was asked to make recommenda- 
tions as to what steps should be taken for the alleviation of these con- 
ditions. A survey was undertaken by a representative of the associa- 
tion who reported that in his opinion some form of corrective clinic 
was necessary, and that such clinics should be held under the direction 
of the State Department of Health. As a result, the Division of Mouth 
Hygiene was created in April, 1921. 
The present personnel of this division consists of a director, a 
secretary, and twenty dentists, of which seventeen are white and 
three colored. 
The objectives of the division are: to educate teachers, parents, and 
children in the importance of good teeth; and to furnish a means of 
correcting dental defects in rural areas where dental services are not 
readily available. The clinics are conducted on a cooperative basis, 
the State, the county, and the pupils participating. The plan provides 
that a county shall make application to the State Department of Health 
for a clinic, agreeing to pay half of any portion of the cost not covered 
by receipts from pupils, on the understanding that the State will pay 
an equivalent sum, but not in excess of 3500 in any one year. Each 
pupil who is financially able contributes to the cost at the rate of 
fifty cents for a cleaning, a filling, or an extraction. The county’s 
share of the cost may be paid by the Board of Supervisors, by the 
School Board, or by each school in which clinics are conducted. There 
is an average deficit to be shared by State and county of about 3100 
per clinic per month. 
In 1924 Virginia adopted what is known as the Five Point Program. 
This plan provides that every child who has no evidence of defective 
hearing, vision, throat defects, is not more than 10 per cent under or 
20 per cent over normal weight, and has no dental defects, receive a 
Five Point Certificate signed by the Superintendent of Public Instruction 
and the State Health Commissioner. This plan has been responsible 
for the correction of many thousands of dental, as well as other, defects. 
Teacher training in oral hygiene is effected through lectures 
given by the director of the Division of Mouth Hygiene at State teachers 
colleges in connection with the provisions of the West Law. Education 54 
Public Health in the State and Counties of Virginia 
of laymen is accomplished by lectures to parent-teacher organizations, 
civic clubs, and other groups, and through the distribution of literature. 
A brief summary of the cost of the work done during the year 
1937, the clinics held, and the children examined and treated follows: 
Counties holding clinics 30 
White clinics held 29 
Colored clinics held 6 
Children examined 61,336 
Children treated 15,562 
Total number of operations 51,535 
Total cost of clinics $ 44,333 
Amount contributed by pupils $ 21,667 
j. The Bureau of Laboratories.—Public health laboratories main- 
tained by the State Department of Health consist of the Central 
Laboratory at Richmond, three branch diagnostic laboratories at 
Abingdon, Norton, and Luray, respectively, and a laboratory at 
Norfolk for the bacteriological examination of shell-fish, crabmeat, and 
samples of sea water collected from areas where seafoods are harvested 
or stored. 
The Central Laboratory is financed jointly by the State and the 
City of Richmond and, as such, offers free diagnostic service to health 
officers and physicians of the State in the vicinity of Richmond as well 
as to those actually living in the city. This laboratory is under the 
immediate charge of an acting director who is assisted by five bac- 
teriologists, one serologist, two assistant serologists, one chemist, one 
technician, five clerks, and two laboratory helpers—a total of eighteen. 
The acting director of the central bureau has no authority over the 
three branch diagnostic laboratories, nor over the shellfish laboratory 
at Norfolk. Administration of the former is a joint responsibility of 
the Bureau of Rural Health and of the health officers of the respective 
districts, while that of the latter is a responsibility of the Bureau of 
Sanitary Engineering. The State Department of Health exercises no 
supervision over any private laboratories. 
The types of work undertaken by the bureau for the State and for 
the City of Richmond differ somewhat. Bacteriological and serological 
examinations for the diagnosis of diseases of public health importance 
are undertaken for both State and city, whereas examinations of foods, 
including principally milk and seafoods, are undertaken regularly for 
the city but seldom for the State. On behalf of the State, examinations 
to determine the sanitary quality of public water supplies are conducted 
principally in this laboratory while those for the city are made at the 
water works laboratory. Safeguarding the sanitary quality of public 
milk supplies and other foods is a legal responsibility of the State 
Department of Agriculture except where communities have adopted 
local ordinances with more stringent provisions than those contained 
in the State ordinance. For this reason the bacteriological examination 
of most of the milk samples from the State at large is undertaken in 
the laboratories of the State Department of Agriculture. However, Public Health in the State and Counties of Virginia 
55 
Richmond has its own milk ordinance and has its milk samples examined 
in the city-supported laboratory of the State Department of Health. 
The laboratory is not equipped for pathological work, nor does it prepare 
any biological products. 
On behalf of other bureaus of the department and of county health 
organizations the Bureau of Laboratories undertakes the preparation 
and standardization of chemicals and reagents, prepares tuberculin 
and sterile saline solutions in glass ampules for local health officers 
and clinicians, supplies certain reagents and media for use in branch 
laboratories, and prepares field kits for the Bureau of Communicable 
Diseases. 
With a staff whose time is fully occupied with routine work, and 
with no funds for special studies, the bureau has not been able to under- 
take an appreciable amount of research. Recently, however, the 
bureau has collaborated with the United States Public Health Service 
in the evaluation of tests for the serodiagnosis of syphilis. Also, studies 
to differentiate between agglutinins due to vaccination and those re- 
sulting from active typhoid infection, by the use of H and O antigens, 
have been in progress. 
The number of examinations undertaken in the central laboratory 
during the year 1936 totaled 106,033 for the State and 35,152 for the 
City of Richmond. Some of the more important of these, with the 
number of each, were as follows: 
Wassermann 55,662 
Water 8,349 
Tuberculosis 4,482 
Intestinal parasites 3,179 
Blood cultures 2,601 
Kahn 1,337 
Milk 141 
k. The State Tuberculosis Sanatoria.—Virginia maintains three in- 
stitutions for the care and treatment of patients suffering from pul- 
monary tuberculosis. Each of these institutions is under the immediate 
charge of a medical superintendent specially trained in tuberculosis, 
while general administration and control are vested in the State Com- 
missioner of Health. Funds for capital outlay, maintenance, and opera- 
tion are appropriated by the State to the State Health Department. 
Two of the sanatoria are reserved exclusively for the use of white 
patients, but applicants must be legal residents of the State of Virginia 
in order to be eligible for admission to any of the three institutions. 
Suitable patients are admitted upon the recommendation of private 
physicians in the order of their applications, except that preference 
is given to applicants who reside in homes where there are young 
children. 
Approximately one-third of the beds available in each sanatorium 
are free. In the white Institutions pay patients receive board, medical 
and nursing care, and lodging at a cost of only one dollar per day each. 
At the colored sanatorium, patients are charged $20 on admission which 56 
Public Health in the State and Counties of Virginia 
covers x-ray, board, laundry, medical and nursing care, and a thermom- 
eter, for a period of twenty-eight days. After the expiration of this 
period the charge is fifty cents a day. Expenses in excess of the modest 
charges borne by patients are met from State appropriations. 
The State tuberculosis sanatoria, and the number of free and pay 
beds at each are as follows: 
Name of Institution 
Locality 
Beds 
Pay 
Free 
Total 
Catawba Sanatorium 
230 
190 
100 
110 
80 
50 
340 
270 
150 
Blue Ridge Sanatorium 
Piedmont Sanatorium 
Charlottesville 
Total 
530 
240 
760 
Members of the staffs of these sanatoria take no part in the county 
clinics conducted by the tuberculosis division of the Bureau of Rural 
Health. They do, however, cooperate closely with the Bureau of Rural 
Health and keep the latter informed when patients from the several 
counties die or are discharged from these institutions. All of the 
sanatoria maintain schools of nursing from which those who complete 
training may become certified nurses in tuberculosis after passing the 
State Board of Examiners for Nurses. Nurses from the white sanatoria 
may qualify themselves to become registered nurses by satisfactorily 
completing a third year of training at the University of Virginia Hospital 
or the Memorial Hospital at Richmond. The University Hospital 
medical staff is available for consultation at Blue Ridge Sanatorium, 
and surgeons from the university undertake much of the chest surgery. 
In 1930 the General Assembly (Chapter 179) appropriated 350,000 
from which the State Health Commissioner was authorized to pay to 
local sanatoria which complied with certain requirements, one-half of 
the actual per diem cost of maintaining all Virginia residents at such 
sanatoria. Subsequently this appropriation was reduced to 335,000 
per annum, but was again restored to 350,000 by the General Assembly 
at its 1938 session. 
The hospitals receiving subsidies from this fund at present, with 
the number of beds available for tuberculosis patients are as follows: 
Name of Institution 
Locality 
Beds 
Hilltop 
Danville 
45 
Lynnhaven 
51 
Norfolk 
100 
Pine Camp 
Richmond 
286 
Total 
482 Public Health in the State and Counties of Virginia 
57 
These, with the 760 beds in the three State sanatoria, give a total 
of 1,242 beds, or an average of about one bed for every two deaths 
(average annual number of deaths during the five year period 1932-1936 
was 2,003) that occurred each year during the period 1932-1936. 
In addition to the increased allotment, mentioned above, in sub- 
sidies to local sanatoria, the 1938 session of the General Assembly 
provided 325,000 a year for the biennium 1938-1940 for the surgical 
treatment of tuberculosis, and funds for capital outlay to provide an 
additional 280 beds at the three State sanatoria—100 beds each at Blue 
Ridge and Piedmont, and 80 at Catawba Sanatorium. 
1. Vital Statistics.—The average annual birth rate per 1,000 
population in Virginia during the decade 1927-1936, was about 22.3. 
The colored birth rate has been slightly but persistently higher than 
the white rate, and there has been a slight downward trend of both 
white and colored rates. The general death rate for the State during 
this decade has stood at an annual average of about 12.4 deaths per 
1.000 population. With an annual average rate of 10.5 and 17.4 per 
1.000 for white and colored, respectively, there has been no noticeable 
downward trend. 
Statistical analyses of the deaths caused in recent years in Vir- 
ginia by some of the more important communicable diseases have been 
prepared and may be found in the appendix to this report. (See tables 
4 to 29, appendix). As will be seen from Table No. 7, the six communi- 
cable diseases—typhoid fever, scarlet fever, measles, whooping-cough, 
diphtheria, and cerebrospinal meningitis were responsible for only 
3,307, or .022 per cent of the 150,325 deaths from all causes during the 
period 1932-1936. On the other hand, pneumonia and influenza were 
responsible for 11,048 and 4,825 deaths, respectively, during the same 
five-year period. 
Diseases of the heart, and cerebral hemorrhage and softening 
cause nearly one-third of the approximately 30,000 deaths that occur 
annually in the State. Other major causes of death, in the order of 
their importance are nephritis (101.3 deaths per 100,000 population 
in 1935), cancer (84.7 per 100,000 during the period 1932-1936), ac- 
cidents (83.7 per 100,000 in 1935), and tuberculosis (all forms, 81.8 
per 100,000 population, 1932-1936). The infant mortality rate has 
declined from 88.0 per 1,000 live births for the period 1917-1921, to 
70.0 for the five years 1932-1936. The maternal death rate has declined 
from 8.3 per 1,000 live births for the period 1917-1921, to 6.3 for the 
period 1932-1936. 
In spite of Virginia’s sustained efforts against tuberculosis during 
the past thirty years, this disease continues to be one of the State’s 
major public health problems. Virginia is one of a group of States, 
including Maryland, Kentucky, and Tennessee which is burdened with 
one of the highest resident tuberculosis death rates of any State in the 
Union. Even after due allowance is made for the influence of the Negro 
population on the death rate, it appears that climatic or other con- 
ditions prevailing in certain sections of the group of States mentioned 
above are particularly favorable to the propagation of tuberculosis. 58 
Public Health in the State and Counties of Virginia 
The tuberculosis death rate (all forms) in Virginia has declined from 
an average of 155.2 for the five year period 1917-1921 to an average 
of 81.8 for the period 1932-1936. The death rates among white persons 
for these respective periods were 102.3 and 52.4, while among Negroes 
the rates were 278.7 and 163.6. 
The 1936 resident tuberculosis death rates by congressional districts 
vary from a minimum of 33.0 to a maximum of 64.3 for white persons, 
and from a minimum of 111.1 to a maximum of 179.0 for Negroes. In 
general, the rates among white persons are highest in Southwest Vir- 
ginia, through the Great Valley, and toward the northern border, 
while almost the exact opposite is true among Negroes—their highest 
rates (and incidentally the highest proportions of the Negro population) 
prevailing in the eastern and southern counties of the State. The above 
figures for 1936 exclude deaths that occurred in a number of institu- 
tions. Further statistical details may be found in Tables Nos. 8 to 72, 
of the appendix. 
m. Health Department Finances.—The fiscal year of the State 
Department of Health is the same as that of all other departments of 
the Government of Virginia, namely, from July 1, to June 30th of 
the following year. State funds available each year for expenditure 
by the State Department of Health comprise the annual appropriation 
made by the legislature from the State’s general fund plus unexpended 
balances from funds available for the previous year. The appropriation 
bill for the biennium 1934-1935 provided for a reduction in the annual 
compensation of each official and employee of the State Government, 
except officials and employees in the legislative department and the 
judiciary, amounting to 10 per cent of the basic rate of all salaries 
or wages. Such reductions were effective during the period July 1, 
1934, to June 30, 1937, amounting in the latter fiscal year to a total 
of 312,500. In addition to the State funds, just referred to, the depart- 
ment receives through the State Department of Finance expendable 
allotments from federal, local, or other sources which, added to the 
State funds, constitute all funds available to the State Department of 
Health for expenditure. Funds available to the State Department of 
Health proper, not including the State tuberculosis sanatoria, for the 
four fiscal years ending June 30, 1937, may be shown according to the 
sources from which they were derived as follows: 
Fiscal Year 
Total 
State 
U.S.P.H.S. 
U.S.C.B. 
Local 
Other 
1933- . 
1934- . 
1935- . 
1936- . 
3 475,373 17 
504,851 29 
706,683 67 
1,014,601 21 
3347,594 08 
363,511 40 
395,644 73 
427,934 47 
3 664 95 
38,171 07 
119,864 38 
223,049 95 
3127,114 14 
103,168 82 
124,874 65 
187,404 79 
3 56,299 91 
176,212 00 
310,000 
The State appropriation to the Health Department, exclusive of the 
State tuberculosis sanatoria, for the fiscal year ended June 20, 1937, was 
$411,755. From this a total deduction of $12,500 was made from the Public Health in the State and Counties of Virginia 
59 
salaries of the employees, leaving a balance of $399,255. Balances 
from the previous year, plus receipts from the United States Public 
Health Service, the United States Children’s Bureau, and from cities, 
towns, and counties made a total of $1,014,601.21 available for ex- 
penditure. These receipts, with the respective percentages from the 
various sources, were as follows: 
Source of Funds 
Amount 
Per Cent 
State appropriation 3411,755 00 
Less deductions 12,500 00 
3399,255 00 
28,679 47 
Balances from previous year 
3 427,934 47 
223,049 95 
176,212 00 
187,404 79 
42.2 
21.9 
United States Public Health Service 
United States Children’s Bureau 
17.4 
Local contributions 
18.5 
Total 
31,014,601 21 
100.0 
The allocation of funds to the various bureaus and divisions of the 
State Department of Health to cooperating county health departments, 
and to local hospitals as State aid for the treatment of tuberculosis 
patients during the period July 1, 1936, to June 30, 1937, was as follows: 
Central Administration 
Sub-Total 
Total 
Expenditures 
Per Cent 
of Total 
Bureau of Administration 
Division of Health Education 
Rotating fund for biologicals and arsenicals. . 
3 23,351 63 
6,459 31 
17,617 74 
3 47,428 76 
9.0 
Bureau of Rural Health 
Division of Tuberculosis Out-Patient Service.. 
3 55,428 45 
43,783 94 
99,212 39 
18.8 
Bureau of Communicable Diseases 
Division of Venereal Disease Control 
3 13,997 17 
5,956 06 
19,953 23 
3.8 
12,951 39 
124,862 45 
13,168 19 
43,171 17 
2.5 
Crippled Children’s Bureau 
23.8 
Bureau of Industrial Hygiene 
2.5 
Bureau of Sanitary Engineering 
Shellfish Sanitation 
3 22,254 62 
20,916 55 
8.2 
Bureau of Vital Statistics 
39,305 07 
7.5 
Bureau of Maternal and Child Hygiene 
Division of Mouth Hygiene 
3 52,376 60 
44,239 33 
96,615 93 
18.5 
Bureau of Laboratories 
28,314 12 
3524,982 80 
377,808 42 
33,748 47 
5.4 
100.0 
Allocations to county departments of health 
State aid to local tuberculosis sanatoria 
Total expenditures from funds avail- 
able from all sources 
3936,539 59 60 
Public Health in the State and Counties of Virginia 
Of the total basic appropriation for the year 1936-1937 of $399,225 
from the general fund of the State, $64,312.48, or 16 per cent, was spent 
to support health activities in cooperating counties and districts of the 
State. From the above table it will be noted that a total of $377,808.42 
was spent for the maintenance and operation of these local health de- 
partments. This represents 40.3 per cent of the $936,539.59 spent by 
the department during the year ended June 30, 1937. The source of 
these funds may be tabulated as follows: 
Source of Funds 
Amount 
Per Cent 
United States Public Health Service 
$156,384.02 
118,034.02 
64,312 48 
39,077 90 
41.3 
31.2 
State Appropriation 
17.0 
United States Children’s Bureau 
10.4 
$377,808 42 
100.0 
The statutes of the Commonwealth of Virginia do not contain a 
law defining the basis for rendering State aid to counties. The annual 
appropriation bill, however, provides a lump sum for this purpose, 
and the responsibility of making allocations to counties and districts 
is placed upon the commissioner and his assistants. 
In addition to the budget of the State Department of Health proper, 
the Commissioner of Health is responsible for the fiscal transactions of 
the three State tuberculosis sanatoria, and funds for their maintenance 
and operation are allocated to the State Department of Health. Ex- 
penditures by these three institutions for the year ended June 30, 1937, 
as shown in the report of the State Comptroller, amounted to $494,976.64 
as follows: 
Catawba Sanatorium 
$ 
225,838 
70 
Blue Ridge Sanatorium 
167,887 
83 
Piedmont Sanatorium 
101,250 
11 
Total 
3 
494,976 
64 
The total of all expenditures by the department, including the State 
sanatoria, during the year ended June 30, 1937, was $1,431,516.23, 
or 2.0 per cent of the $71,614,336 spent by the Commonwealth for all 
purposes. 
C. LOCAL HEALTH ORGANIZATION 
1. Introduction 
As stated in the general introduction to this section the cities in 
Virginia are organized under separate charters which provide specifically 
for the establishment of public health services by those local govern- 
ments. Principally for this reason the State Department of Health Public Health in the State and Counties of Virginia 
61 
has centralized its attention to the counties, or the rural sections of the 
State, although some of the cities actually have only part-time health 
services or none at all. 
With the exception of Chapter 368 of the Acts of 1932, providing 
for optional forms of county organization and government, the laws of 
Virginia do not make it mandatory that a county shall maintain a health 
department, either part-time or full-time. Sections 1496 and 1498 
of the Virginia Code, 1936, read in part as follows: 
1496. If any city, town, or county authorized by law to appoint a local board 
of health or health officer shall omit to do so, the State Board of Health may 
exercise the authority and perform the duties of such local board or health 
officer until such local board of health be established or such health officer 
regularly appointed, whereupon the jurisdiction of the State Board of Health 
or its officer shall cease. 
1498. Each local board of health may elect a health officer for its city, town, 
or county, but if no local health officer be so elected the secretary of the local 
board of health shall act as health officer for his city, town, or county. 
In Henrico and Albemarle Counties where the county manager 
and county executive forms of government, respectively, have been 
adopted, it is mandatory that each maintain a health department as 
one of the established departments of the county government. Arling- 
ton County has adopted a county manager form of government, set 
forth in an earlier act (Chapter 167 of 1930), under the provisions of 
which constitutional elective officers are retained. Although this law 
does not specifically provide for a county health department, Arlington 
has had full-time health service since 1919, when it was first established. 
Public interest in rural health work dates back to 1910, when the 
Bureau of Rural Sanitation was organized within the State Health 
Department. The activities of this bureau were concerned chiefly with 
the campaign against hookworm and typhoid fever. As time passed 
this work was intensified and expanded by the establishment in many 
counties of a trained sanitation officer, and later by the addition of a 
nurse. As the value of the services rendered by these employees grew 
in the appreciation of local officials and of the general public, the need 
of a trained health officer to direct local health activities was gradually 
recognized and the first full-time health officer was appointed to Nor- 
folk County in 1916. As a means of stimulating organized health 
work in rural areas under a trained or experienced health officer, the 
State established the principle of allowing State aid to counties or 
groups of counties known as health districts that agreed to set up and 
partially finance an approved county or district health department. 
Prior to the appointment of the present commissioner State aid has 
been given to a number of counties that employed a sanitation officer, 
a nurse, or both. In 1914 this practice was discontinued and there- 
after State aid was granted only to counties that provided for full-time 
health departments consisting of a minimum staff—a medical health 
officer, a nurse, a sanitation officer, and a clerk. Practically throughout 
this developmental period the work has been assisted by financial 
grants from such extra-State organizations as the Rockefeller Founda- 
tion and the United States Public Health Service, such funds being 62 
Public Health in the State and Counties of Virginia 
administered through the State Department of Health. In the three 
counties that have adopted optional forms of local government, funds 
granted as State aid are paid into the county treasuries to be ad- 
ministered by the county health officer under the supervision of the 
county manager or the county executive. In return for this State aid 
the Commissioner of Health reserves the right to pass upon the qualifica- 
tions of the health officer to be employed. Of course the State Depart- 
ment of Health always is ready and willing to render advisory and 
technical services to these counties, but it assumes no administrative 
control. 
Plans for financing all other county health departments are made 
by the director of the Bureau of Rural Health in consultation with the 
boards of supervisors of the several counties. At these conferences an 
agreement is reached as to what proportion of the total cost of operating 
the department is to be borne respectively by the county, the State, 
and such other organizations as currently may be contributing funds 
in support of these activities. Funds for the maintenance of such de- 
partments are paid into the State treasury and are disbursed by the 
State Department of Health in the same manner as it disburses all other 
expendable funds. Under this arrangement the county health officers 
are appointed by the county supervisors for an indefinite term. Selec- 
tions must be made, however, from a list of applicants approved by the 
State Commissioner of Health, to whom the appointee becomes directly 
responsible. 
During the year 1936-1937, funds amounting to 3377,808.42 were 
expended through the State Department of Health for the maintenance 
of cooperating district departments of health. This sum includes all 
amounts paid to Albemarle, Arlington, and Henrico Counties to support 
their local health activities, but it does not include amounts expended 
by the counties themselves since these three counties administer their 
health funds through their local treasuries. These funds were received 
from the following sources: 
Source of Funds 
Amount 
Per Cent 
3156,384 02 
118,034 02 
64,312 48 
41.3 
31.2 
17.0 
United States Children’s Bureau 
90 
10.4 
Total 
3377,808 42 
100.0 
On March 1, 1938, there were 27 cooperating district departments 
of health operating on a full-time basis. These districts comprised 48 
counties, organized as follows: Public Health in the State and Counties of Virginia 
63 
Total 
Districts 
Districts Comprising 
One 
County 
Two 
Counties 
Three 
Counties 
Four 
Counties 
Seven 
Counties 
27 
18 
2 
5 
1 
1 
Although, as stated elsewhere, cities in Virginia are separate and 
distinct from the counties in which they happen to be located, a number 
of cities are cooperating with one county or a group of counties to form 
a single health district. In such cases the cities bear varying propor- 
tions of the cost of the health department. Based upon the 1930 census, 
the population of these districts varies from a maximum of 96,205 in 
the district comprising seven counties, to a minimum of 12,100 in the 
single county health district of Sussex. The percentage distribution 
of the State’s population receiving health service in 1938 was as follows: 
Population 
Percentage 
of Total 
1,099,014 
395,164 
219,319 
708,354 
45 4 
Population in cities with full-time service 
16.3 
Population in cities with part-time service 
9.1 
29.2 
2,421,851 
100.0 
The consolidation of counties, or of counties and cities, for the 
purpose of more efficient and more economical administration of health 
services has been effected on an arbitrary and entirely functional basis. 
No group of counties has as yet undertaken geographical consolidation 
under the Permissive Act passed by the 1932 session of the General 
Assembly, nor have several departments of the State Government 
agreed upon a plan for the functional consolidation of their several 
services which would prevent the overlapping of functional boundaries. 
In its report to the governor and General Assembly, January 1936, 
the Virginia Commission on County Government offered what would 
appear to be a very logical plan for regrouping the counties of Vir- 
ginia into larger districts. Any such regrouping would, of course, 
depend upon the result of popular votes, but public support of this 
measure might be strengthened if such functional consolidation as may 
be undertaken by departments of the State Government were applied 
on a uniform basis. 64 
Public Health in the State and Counties of Virginia 
2. County Boards of Health 
The State Board of Health is required by law1 to appoint annually 
three residents of each county who, with the county clerk and the 
chairman of the board of supervisors, will constitute a county board of 
health. The law specifies that at least one of the appointed members 
of the board must be a physician. Each board must select from its 
members a secretary who must be a physician and who must serve for 
one year or until his successor is appointed. 
Duties of the County Boards of Health 
County boards of health are not required by law to elect county 
health officers, but they are authorized to do so if they see fit. If no 
local health officer is elected the secretary of the local board of health 
acts as health officer for the county. This procedure is in effect in the 
52 counties of the State that are not maintaining full-time county 
health services. The duties of these boards, as defined by law are: 
1. To have charge of the sanitary affairs of the county. 
2. To have control of the prevention and eradication of contagious and Infectious 
diseases, and the removal and quarantine of suspects. (Code, 1936, Section 
1493.) 
3. To adopt and enforce reasonable rules and regulations as they may deem neces- 
sary for the control of communicable diseases. (Code, 1936, Section 1494.) 
4. To report weekly to the State Board of Health all cases of infectious, contagious, 
communicable, or dangerous diseases which have occurred under their jurisdic- 
tion. 
5. To confer with representatives of the State Board of Health upon the occur- 
rence of dangerous communicable diseases and to cooperate with them in the 
suppression of such diseases when there is danger of their spreading to adjoin- 
ing jurisdictions. (Code, 1936, Section 1497.) 
Full-time district health officers are employed at present by 18 
single counties and by nine districts comprising from two to seven 
counties. These districts sometimes also include one or more cities. 
In the three counties that have adopted optional forms of county 
organization and government under the Permissive Acts of 1930 and 
1932, respectively, the health officers are appointed by the county 
manager or by the county executive to whom the health officer becomes 
responsible. In view of the State aid received by these counties for 
local health work, however, these appointees must be approved by 
the State Health Commissioner. 
In those counties or groups of counties that have retained the con- 
stitutional form of government local health officers are usually appointed 
by the boards of county supervisors from a list of applicants approved by 
the State Health Commissioner. For districts comprising several 
3. County or District Health Officers 
JThe Virginia Code, 1936, Section 1492, Public Health in the State and Counties of Virginia 
65 
counties these appointments are sometimes made outright by the 
commissioner. In each case, however, the health officers become di- 
rectly responsible to the Commissioner of Health in return for the State 
aid which each county receives. 
The qualifications, tenure of office, and salaries of county or dis- 
trict health officers have not been fixed by law. Under the present 
arrangement State aid is granted only to those counties or districts 
that agree to the appointment of a health officer whose qualifications 
are approved by the State Health Commissioner. The present demand 
for trained health officers makes it somewhat difficult to obtain entirely 
suitable candidates, but the commissioner has endeavored to recom- 
mend only those who by training or experience are best qualified for 
the positions to which they are to be appointed. In furtherance of 
the plan to provide well-trained local health officers, the State Depart- 
ment of Health in cooperation with the United States Public Health 
Service has recently extended the opportunity of special training to 
as many district health officers as possible. 
County health officers are appointed for a period of one year. 
Renewal of appointment is subject to the continued availability of 
funds and the quality of service rendered during the preceding year. 
The duties of county health officers as defined by law are to be 
found in Section 1498 of the Code of Virginia, 1936, which reads in part 
as follows: 
“. . . Every such health officer or secretary acting as such health officer shall 
have power to enter and inspect both public and private premises where he has 
reason to suppose any nuisance or any contagious or infectious disease exists, 
when the protection of the public health demands it. He shall collect and pre- 
serve such vital statistics, including marriages, births and deaths, as may be 
required of him by the State Board of Health, and shall execute and enforce 
the orders of his local board.” 
The programs undertaken by county and district departments of 
health are formulated with the object of providing generalized health 
services to the communities within the several health jurisdictions. 
The principal activities are concerned with the control of the communic- 
able diseases, including tuberculosis and, in some counties, the venereal 
diseases. The amount of time devoted to the physical inspection and 
medical examination of school children is perhaps somewhat less than 
that practiced in the counties of many other states. The teachers in 
Virginia schools are trained to make physical inspections, and, con- 
sequently, they are able to screen out pupils that have physical defects 
or other conditions that require the attention of the health officer. Pre- 
natal and infant care, which prior to the advent of social security 
funds had made slow and indefinite progress, is being extended as 
rapidly as possible under the guidance of the Bureau of Maternal 
and Child Health. Tuberculosis and orthopedic clinics are conducted 
by the State Department of Health at the request of county health 
officers. Preliminary arrangements and follow-up activities required 
in connection with these clinics are undertaken entirely by the local 
departments of health except in counties that have no health organiza- 66 
Public Health in the State and Counties of Virginia 
tions. The State Department of Health also cooperates with local 
departments in the development of venereal disease clinics and other 
activities necessary for the control of these diseases. In a number of 
counties venereal disease clinics are conducted personally by the 
health officers and in organized counties all of the follow-up work is 
undertaken by them and their staffs. Dental clinics are available 
through the State Department to all counties that are prepared to 
guarantee 50 per cent of the cost of the work, and the Virginia Com- 
mission for the Blind conducts free eye clinics for children at the request 
of the local health authorities. As yet no machinery, either central 
or local, has been developed to cope with the problem of mental hygiene. 
Sanitation of the home and school environment is undertaken by trained 
sanitation officers under the direction of the county and district health 
officers. This work includes activities to insure the provision of safe 
water supplies and methods of sewage disposal at all homes and schools 
within the area under the jurisdiction of the department. Other activ- 
ities include the sanitary supervision of public swimming pools and of 
tourist, recreation, and labor camps. These departments also function 
in a cooperative capacity with the State Department of Health in 
exercising sanitary control over public water supplies and sewerage 
systems. In general, local health departments have no control over 
the sanitary quality of milk and other foods. This responsibility 
is vested in the dairy and food division of the Department of Agri- 
culture. If, however, cities and towns adopt milk ordinances with more 
stringent provisions than those contained in the State law, the pro- 
visions of the latter cease to apply and the local authorities thereupon 
become responsible for the administration of the new ordinance. By 
the adoption of such local ordinances the public milk supplies of fifteen 
communities recently have been placed under the supervision of county 
health departments and, of these, twelve communities adopted the 
standard milk ordinance of the United States Public Health Service. 
D. RELATED FUNCTIONS OF OTHER STATE 
DEPARTMENTS 
There are several other departments of the State Government 
vested with powers and duties that have a definite bearing on public 
health. Reference has been made to some of these in preceding sec- 
tions of this report, but the following summaries serve to complete 
the picture of the health interests of the State Government as a whole. 
1. , State Department of Public Welfare 
This department performs numerous functions that have an 
intimate bearing upon the health and the physical and mental welfare 
of the public. The powers and duties of the department may be sum- 
marized as follows: 
1. It Is required by law to visit all State institutions, except educational institu- 
tions, semi-annually, and to investigate the condition of State institutions when 
required by the governor. Public Health in the State and Counties of Virginia 
67 
2. It inspects and licenses all child-caring institutions and agencies in the State. 
3. It must inspect all jails and almshouses at least once a year and report conditions 
to county and city officials. It has no executive power over such institutions. 
4. It is the agency for the care of all dependent, delinquent, and neglected children 
committed by the courts to the State. 
5. It has supervision of all county and city social agencies of a governmental 
character. 
6. It is responsible for the handling of all cases of dependency and defectiveness 
between Virginia and other states. 
7. It is the sole agency for the investigation of charitable and penal cases in the 
State, including pardon and parole cases. 
8. Under the reorganization act, all State institutions and agencies of a penal, 
eleemosynary, or corrective nature and all institutions for the mentally dis- 
turbed are grouped in the Department of Public Welfare as associated institutions 
and agencies. 
In 1932 the Assistant State Health Commissioner was designated 
as medical adviser to the State Department of Public Welfare for 
specific duty in connection with medical and sanitary service in the 
jails of the Commonwealth, and general duty in- the public welfare 
institutions and agencies. The medical adviser is assigned by the 
Health Department to the Department of Welfare. Under the inter- 
departmental agreement, however, he acts as liaison officer between the 
two departments in matters relating to the medical care and health 
protection of persons segregated in county and city jails, convict 
camps, and various public institutions under the supervision of the 
Department of Public Welfare. 
In connection with the care of dependent, delinquent, and neglected 
children, the Department of Welfare maintains a bureau of mental 
hygiene. For several years the bureau conducted mental hygiene 
clinics in various localities in the State in cooperation with health de- 
partments, school authorities, social agencies, and other recognized 
agencies, but insufficiency of funds has made it necessary to curtail 
drastically or discontinue this service. The major function of the 
bureau at present consists of careful physical, psychological, social, 
and psychiatric studies of all children committed by the courts to the 
Department of Welfare. 
The 1938 session of the General Assembly enacted a bill known as 
the Public Assistance Act of 1938. The purpose of this act is “to pro- 
vide financial aid and assistance to and for certain needy persons in need 
of public aid or assistance.” The act requires every county and city, 
or combination thereof, to have a welfare department and to make 
sufficient appropriations to carry out the purposes of the act. State 
administration of the act is vested in the State Board of Public Welfare 
and the Commissioner of Public Welfare, except the program of Aid 
to the Blind, which is vested in the Virginia Commission for the Blind. 
State administrative functions include general supervision, establish- 
ing and maintaining personnel standards, promulgating rules and 
regulations, making allocations and reimbursements, keeping reports, 
records, and statistics, and assuring uniform and efficient administra- 
tion of the act in the counties and cities. 68 
Public Health in the State and Counties of Virginia 
The Public Assistance Act of 1938 provides for relief under the 
following three Federal categories: Old Age Assistance, Aid to De- 
pendent Children, and Aid to the Blind. Funds for these purposes 
are provided by Federal, State, and local governments. The act does 
not provide a pension system. Payments vary according to the needs 
of each case, due allowance being made for property, income and 
actual or potential support from any and all sources. All assistance 
is supplementary to other income and in no case may old age 
assistance in excess of 320.00 per month be granted. 
Benefits under the General Relief section of the act are not limited, 
as under the 1936 Act. The funds for providing these services are 
supplied by the State and the counties or cities, the latter being required 
to appropriate an amount equal to 60 per cent of the State appropria- 
tion. Under the governor’s rules and regulations, formulated in ac- 
cordance with this legislation, public assistance funds may be used for 
medical care and hospitalization in any and all relief cases. 
State schools for deaf and blind children are maintained at Staunton 
and Newport News, the former for white children and the latter for 
colored. These institutions are governed by their own boards of di- 
rectors, appointed for terms of four years by the governor with the con- 
sent of the senate. The Virginia Commission for the Blind, an asso- 
ciated agency of the Department of Public Welfare, maintains work- 
shops at Charlottesville, Lynchburg, and Norfolk, where vocational 
training is provided for the blind. In addition the commission con- 
ducts eye clinics throughout the rural sections of the State at the 
request of local health or school authorities. The nominal cost of 
glasses supplied and drugs used for indigent children is met by the 
local authorities or by some local organization interested in helping # 
2. The State Department of Education 
Responsibility for the health program in the public free schools of 
Virginia is vested jointly in the State departments of education and 
health. Legal authority for these two departments to undertake this 
important work is found in Chapter 327 of the Acts of 1920, commonly 
known as the West Law. Sections 3, 4, 5, and 6 of this act read as 
follows: 
3. That after the first day of September, nineteen hundred and twenty, all pupils 
in all the public elementary and high schools of the State shall receive as part 
of the educational program such examinations, health instruction, and physical 
training as shall be prescribed by the State Board of Education and approved 
by the State Board of Health, in conformity with the provisions of this Act. 
4. In order that the teachers of the Commonwealth shall be prepared for health 
examinations and physical education of school children, every normal school 
of the State is hereby required to give a course, to be approved by the Superin- 
tendent of Public Instruction and the State Health Commissioner, in health 
examinations and physical education, including preventive medicine, physical 
inspection, health instruction and physical training. Upon which course every 
person graduating from a normal school must have passed a satisfactory ex- 
amination, and every normal school certificate shall, therefore, indicate as a 
prerequisite a knowledge of preventive medicine, physical inspection, health 
instruction and physical training. Public Health in the State and Counties of Virginia 
69 
5. The State Board of Education, with the approval of the State Board of Health, 
shall establish regulations whereby on or after September, nineteen hundred and 
twenty-five, no applicant may receive a certificate to teach in the schools of this 
State who does not present, first, satisfactory evidence of having covered 
creditably an approved course in general physical education In a training school 
or course for teachers recognized by the State Board of Education as a school 
or course in good standing. But the State Board of Education may modify or 
waive entirely the requirements of this section whenever in its opinion such 
modifications or waiver is necessary to prevent the impairment of the teaching 
force of the public school system. 
6. The State Board of Education, with the approval of the State Board of Health, 
shall appoint a supervisor of physical education qualified and authorized to 
supervise and direct a program of hygienic instruction and physical education 
for elementary, secondary, and normal schools of the State, and shall appoint 
such other employees and authorize such expenses for personal service, printing, 
and so on, as may be necessary to the proper and effective administration of the 
program authorized by this act. 
In carrying out the mandates of this legislation the education and 
health departments work in close cooperation, the Department of 
Education placing principal emphasis on health education and the 
Department of Health emphasizing health service. The Department 
of Education employs a supervisor of health and physical education 
whose entire time is devoted to the physical and health education of 
pupils in the public schools of the State. The responsibilities of the 
health department for cooperating with the Department of Education 
in matters relating to disease prevention, health promotion, and health 
education are discharged by the director of the Bureau of Maternal 
and Child Health. These cooperative efforts include the preparation 
of the courses of health instruction to be employed in the teacher 
training institutions of the State as required by the West Law. They 
also include the preparation of suitable programs of health instruction 
to be instituted as part of the curriculum in the public free schools. 
In view of the marked variation in conditions prevailing in different 
sections of the State, it has not been found practicable to adopt a 
standard or uniform program of health education and health service 
in the schools of the State as a whole. In lieu of this, the authorities 
have endeavored to study the needs of various localities and to devise 
ways and means that appeared to offer the best solution of each local 
problem. Programs involving dental hygiene, the sanitation of school 
buildings and premises, the provision of safe water supplies, immuniza- 
tion campaigns, and the rehabilitation of crippled children have been 
undertaken in practically every school in the State. But perhaps the 
only project that has been applied uniformly in all schools of the 
State is the so-called Five Point Program which serves as a minimum 
standard of the physical fitness of each pupil. Inspections or tests are 
conducted by the teachers, and any pupil found to meet the minimum 
standard adopted by the State in respect to vision, hearing, teeth, 
throat, and weight is classified as a five point pupil. Any pupil with 
remediable defects can qualify for this classification by securing the 
necessary corrections. The plan has been credited with producing 
many thousands of corrections of physical defects. 70 
Public Health in the State and Counties of Virginia 
The State Department of Education conducts a quinquennial 
census of all persons in the State between the ages of 7 and 20 years. 
This census classifies deaf, blind, and other physically handicapped 
children and makes it possible for the proper authorities to locate 
and render assistance to many children that would otherwise be neglect- 
ed. Except in a few of the cities very little has been done toward the 
provision of special classes or other facilities for physically and mentally 
handicapped children. Another problem that awaits attention is that 
of the school child that presents various conduct disturbances, delin- 
quent tendencies, or other mental disorders. 
3. The Department of Agriculture and Immigration 
The work of this department in the control of bovine tuberculosis, 
Bang’s disease, and other animal diseases, and through the sanitary 
control of food and milk supplies in enforcing the pure food laws, has 
a most important bearing upon public health. In respect to bovine 
tuberculosis, Virginia is now a fully accredited area, tubercular infection 
among cattle having been reduced to less than one-half of one per cent, 
A practical program for the eradication of Bang’s disease has been 
worked out, and, with the cooperation of the Federal Government 
and under a new statute enacted by the 1938 session of the General 
Assembly, control measures are being extended throughout the State 
as rapidly as possible. At the close of the year 1936-1937, tests had 
been completed in fifty-five counties and were in progress in nineteen 
others. From the beginning of the work on July 1, 1934, to the end 
of the year 1936-1937, some 28,000 diseased animals had been removed 
for slaughter. 
State administration of the laws governing the production and 
distribution of milk and dairy products, as well as other foods and 
food products, including the sanitation of places used in the manu- 
facture, packing, storing, sale, and distribution of food and food products, 
is vested in the Dairy and Food Division of the Department of Agri- 
culture and Immigration. The only exception to this is the adminis- 
tration of the laws relating to the sanitation and marketing of shell- 
fish and crabmeat which was transferred to the State Health Commis- 
sioner in 1927 and 1930, respectively. The duties of the Dairy and 
Food Division include enforcement of the laws prohibiting the per- 
petration of frauds on the public, such as the adulteration and mis- 
branding of foods. 
The present law governing the sanitation of dairies and dairy 
products make it unlawful for any person, firm, or association to bring 
into or receive in the State for sale, or to sell or offer for sale, or dis- 
tribute therein, or to have in his possession with intent to sell any milk 
or milk products, with certain specified exceptions, who does not possess 
an unrevoked permit from the Commissioner of Agriculture. The 
provisions regarding dairies, cows, milkers, utensils, water supplies, 
capping, and other important items are applicable in all cases where 
more than two cows are kept. But the provisions of the act do not 
apply to cities and towns which have ordinances regulating the pro- Public Health in the State and Counties of Virginia 
71 
duction and distribution of milk and cream with provisions more rigid 
than those incorporated in this act. 
Permits to sell milk and milk products to the public are issued to 
dealers free of charge after the dairy has been scored by an inspector 
from the Dairy and Food Division of the Department of Agriculture. 
The several grades under which raw and pasteurized milk legally may 
be labeled and sold are specified in the act, and all milk sold in the 
State must conform to one of these grades and be so labeled. In April 
1938 a total of 781 dairies were operating under these official permits. 
Supervising these were three full-time dairy inspectors, each engaged 
in one of the three divisions into which the State has been divided for 
inspection purposes. During the year 1936-1937 a total of 1,027 
samples of milk were collected by the inspectors for bacteriological 
examination. These were examined in the laboratories of the Depart- 
ment of Agriculture at Richmond, Harrisonburg, Nassawadox, Lynch- 
burg, and Danville, and at the health department laboratory at Abing- 
don. 
As was stated on page 31, the milk sanitarian attached to the 
Bureau of Rural Health is endeavoring to promote the adoption 
and enforcement of effective milk ordinances by towns located in counties 
that have full-time health departments. It is believed that efficient 
local control over the production and distribution of milk will do far 
more to safeguard the public health than any system of central control 
that would be economically practical. To enable local health authorities 
to administer these ordinances effectively, the sanitarian gives special 
training to and works in close cooperation with the county sanitation 
officers. 
4. The Department of Labor and Industry 
This department is charged with the enforcement of all laws 
relating to the inspection of mines, factories, mercantile establishments, 
mills, workshops, and commercial institutions in the State. Many of 
these services improve the health and welfare of the industrial worker 
and exercise considerable bearing upon the public health. Through its 
division of mines and quarries the department administers the regu- 
lations governing the operation of mines in the interest of safety. 
Inspectors may close any mine found operating under dangerous 
conditions, and investigations of serious accidents or explosions are 
followed by recommendations for the prevention of similar occurrences 
in the future. 
Through administration of the laws governing conditions under 
which women and children work, the department insures that women 
and children work only the limited number of hours allowed by law, 
that children are properly certified as to age and physical fitness for 
indoor and outdoor occupations, and are not permitted to work at 
night, at hazardous occupations, or under morally degrading con- 
ditions. It is a responsibility of this division of the Department of 
Labor also to see that the proper number of chairs, stools, or other 
suitable seats are provided in various industrial establishments for the 
use of female employees. The factory inspection division inspects 72 
Public Health in the State and Counties of Virginia 
factories, restaurants, mercantile establishments, shops, laundries, etc., 
to enforce the laws regulating safety and sanitary conditions in industry, 
including fire escape regulations which are applicable to public build- 
ings and schools. 
The newly created Bureau of Industrial Hygiene of the State 
Department of Health has been engaged recently in studies of materials 
and conditions that may be detrimental to the health of Virginia’s 
industrial population. The degree or seriousness of the exposures to 
which workers are subjected, however, has not been sufficiently deter- 
mined as yet to justify the formulation of a cooperative control program 
between this bureau and other State departments concerned. 
5. The Department of Workmen’s Compensation 
The Workmen’s Compensation Law is administered by a com- 
mission of three members appointed by the Governor for overlapping 
terms of six years. The commission is empowered to approve agree- 
ments as to compensation, to hear contested cases, and to supervise 
the general application of the law. Either employers or employees 
may elect not to operate under the act. If an employer so elects, and 
suit is instituted against him by an employee subject to the act, such 
an employer is not permitted to defend the suit on the grounds that 
the employee was negligent, that the injury was caused by the neg- 
ligence of a fellow employee, or that the employee had assumed the 
risk of the injury. In a suit against an employer who accepts the act 
by an employee who elects not to operate under the act, the employer 
may avail himself of the defenses of contributory negligence of a fellow 
servant and assumption of risk, as such defenses exist at common law. 
The present Virginia statute applies solely to injuries by accident 
arising out of and in the course of the employment. It does not include 
a disease in any form, except where it results naturally and unavoidably 
from the accident. Realizing the importance of accident prevention, 
the Department of Workmen’s Compensation devotes a great deal of 
attention to such work. 
E. RECOMMENDATIONS 
As a result of a careful study of public health administration in 
Virginia, certain conclusions have been reached and are made the basis 
of the following recommendations: 
1. That no major changes be made in the membership and methods of appoint- 
ment of members of the State Board of Health, but that the law be amended to 
provide that the Commissioner of Health shall be the administrative head of 
the State Department of Health and that the State Board of Health shall 
exercise legislative functions and otherwise act in an advisory capacity to the 
Commissioner. 
This board of seven members, selected from the several grand 
divisions of the State, is appointed by the governor for overlapping 
terms of seven years. It is vested legally with both legislative and ad- Public Health in the State and Counties of Virginia 
73 
ministrative functions. In the discharge of its duties, however, the 
board has recognized that its members neither have the time nor the 
technical training necessary to enable them intelligently to undertake 
administrative responsibilities. It has, therefore, very wisely placed the 
department’s technical responsibilities upon its trained and experienced 
executive officer—the State Health Commissioner—and has limited its 
own activities to legislative, policy-forming, and advisory services. Such 
procedure constitutes sound public health policy, and the amendment 
recommended would bring the provisions of the law in conformity with 
present practice. 
A board of seven members, comprising representative, outstanding, 
public-spirited citizens from the various divisions of the State would 
appear to be sufficiently large to bring to the problem wide interest 
and a broad general knowledge of the public health needs of the State. 
Moreover, the requirement that at least two members of the board 
shall be members of the Medical Society of Virginia, and one a member 
of the State Dental Association, insures representation on the board 
of two groups whose work is closely related to that of the State De- 
partment of Health. 
2. That the law providing for county boards of health (see Page 25, section 5) be 
amended so as to provide for boards consisting of seven members (three ex- 
officio and four appointive) instead of five; that the terms of office of the four 
members appointed by the State Board of Health be four years instead of one 
year, the appointments being staggered so that one member shall retire each 
year; and further, that provision be made for the abolition of boards of health 
in counties comprising health districts and for their replacement by a single 
district board of health to serve in an advisory capacity to the director of the 
district department of health. 
For the most part, Virginia legislation pertaining to county boards 
of health was enacted prior to the establishment of any full-time county 
or district health departments in the State. They were the only official 
health organizations in the counties, as indeed they still are in about 
half of the counties. Each board consists of three members appointed 
for a term of one year by the State Board of Health, and the county 
clerk and the chairman of the board of supervisors, ex-officio. According 
to the law at least one of the appointive members must be a physician, 
but in some counties two, or even three, of these appointees are physi- 
cians. The duties imposed upon these boards are both executive and 
legislative, and in counties in which there are no organized health de- 
partments the local boards of health assume responsibility for what- 
ever health activities may be undertaken. In counties that have 
established local health departments, however, the functions of these 
boards are limited to advisory and legislative functions only. 
Whether such a board exercises executive functions or acts in an 
advisory capacity to the director of an organized county health de- 
partment, it is obvious that the value of its services would be enhanced 
by increasing the terms of the members appointed by the State Board 
of Health to at least four years. Under the present one-year terms 
these members hardly have time to become interested in health matters 74 
Public Health in the State and Counties of Virginia 
before their terms expire. Moreover, the duty of selecting annually 
several hundred suitable persons to appoint to the membership of 
county and corporation health boards consumes unnecessarily a large 
amount of the State Board of Health’s time. 
The recommendation has been made above that the membership 
of these boards be increased to seven. Such a board would bring 
greater breadth of interest and more varied points of view. The pro- 
vision for four appointive members, also, would permit application of 
the conventional plan of having only one member retire each year. 
As to which three local officials should be designated as ex-officio 
members of the boards, consideration should be given to the division 
superintendent of schools, the county superintendent of public welfare, 
and, in organized counties, to the county health officer. Because of the 
intimate relationship of the services performed by these officials any 
of them probably would render greater services to the board than would 
the county clerk. These boards, if composed of public-spirited, civic 
minded persons who have the welfare of their communities at heart, can, 
with their diverse contacts and local influence, contribute immeasurably 
to the building up of informed public support, and can assist in the 
development of sound public health policies and practices. 
3. That State aid to local health departments be continued and extended, but that 
preference be given to health departments organized to serve groups of counties 
(districts) as recommended by the State Department of Health. 
4. That the State Department of Health, in cooperation with other departments 
of the State government, group the counties of the State into districts best 
suited to the functional consolidation of their services as a whole as a basis for 
more uniform developments in this direction In the future. 
The experience of the State Department of Health has been that 
many counties, individually, have not been able to support an efficient 
full-time health department and that the area and population of other 
counties were too small to justify burdening them with the additional 
expense of a health department. At the present time 48 of the 100 
counties in Virginia are receiving State aid in support of their local full- 
time health departments (see page 62). Health services in the other 
52 counties are limited to such activities as may be undertaken by 
their respective county boards of health, some of whom employ a sani- 
tation officer or a nurse, or both, and to certain state-wide services 
rendered by the State Board of Health. 
Special studies have shown that a great many of the counties are 
too small (see pages 8 and 63) to permit the economical operation 
of efficient, modern governmental services. The economic wisdom of 
the geographical consolidation of several adjoining counties into a 
single local government unit has been demonstrated, and an act pro- 
viding a method for such consolidation by popular vote was passed by 
the General Assembly in 1932. Thus far, however, the provisions of 
this act have not been applied in a single case. On the other hand 
the plan of so-called functional consolidation, in which certain govern- 
mental functions are performed in districts composed of two or more 
counties (see pages 14 and 62), has been tried by several departments Public Health in the State and Counties of Virginia 
75 
of the State government. Admittedly, this plan presents some very 
practical difficulties and fails to provide a simplified plan of county 
government. Yet, it would appear that many of these difficulties 
could be obviated, and better and more widespread services could be 
provided if each department of the State government, now contemplat- 
ing or actually practicing functional consolidation, were to consolidate 
its services in identical groups of counties and thereby avoid the 
overlapping of functional boundaries. Moreover, if such a plan could 
be satisfactorily applied by the health authorities throughout the 
State, perhaps it would offer a means of providing efficient health service 
in all the counties of Virginia at a cost that the State and local govern- 
ments could afford. Assuming that the counties could be grouped into 
35 consolidated functional areas or less, in each of which a well-trained 
health officer (with perhaps a deputy in a few of the larger groups), 
a staff of several nurses, and a sanitation officer could provide adequate 
health service, the amount now being spent on rural health work 
would go a long way toward meeting the cost of this State-wide service. 
5. That the State Board of Health, in cooperation with the State Commissioner of 
Health, be empowered to establish minimum qualifications for directors, nurses, 
and technical employees of the State Department of Health; for superintendents 
of public tuberculosis sanatoria; and for directors, nurses, and sanitation officials 
of county and district health departments, whether such departments receive 
State aid or not. 
6. That employment on the staffs of the State and local departments of health be 
made more attractive by providing better salaries, facilities to enrich routine 
health activities by the inclusion of worthy research projects, security of tenure 
in office, and opportunities for postgraduate study. 
7. That the State Department of Health adopt and apply the principle that all 
work of a given character required by any bureau in the department or by a 
local health department should be done by the bureau established to perform 
that, or closely related specialized services, thus insuring the functional integra- 
tion of the component parts of the entire health organization. 
In the application of this principle: 
a. That the Bureau of Laboratories be provided with adequate trained personnel 
and facilities to perform all the laboratory services required by other bureaus 
of the State Department or by county departments of health, and that all 
branch laboratories, including those engaged in shellfish work, be placed 
under the supervision and control of the central bureau of laboratories, and, 
b. That the Bureau of Vital Statistics be provided with sufficient trained per- 
sonnel to enable it to render such technical guidance and specialized statistical 
services as may be required by other bureaus or county health departments, 
so that this bureau may function as the department’s bureau of statistical 
methods. 
Adoption of recommendation (a) would mean that the director of 
the bureau of laboratories, with his assistants, would be in a position to 
render such laboratory services as may be required in connection with 
communicable disease control and research, in the study and control 
of industrial hazards and diseases, and in the study and control of con- 
ditions affecting the purity of water, milk, shellfish, and other foods, 76 
Public Health in the State and Counties of Virginia 
and the analysis of sewage, as well as the ordinary routine bacteriological 
analyses. In other words, this bureau would be functionally integrated 
with other bureaus and county health departments in such a fashion 
as to make it unnecessary for any other bureau to maintain a separate 
laboratory to undertake special investigations. 
In connection with the supervision of local laboratories, the duties 
of the director would involve the frequent inspection of all branch 
laboratories to determine the efficiency of the work being performed, 
the laboratory needs of the different sections of the State, and the com- 
pleteness with which these needs are being met. 
At the present time the services of the Bureau of Vital Statistics 
consist principally of the collection, compilation, analysis, and preserva- 
tion of data pertaining to marriages, divorces, births, and deaths. 
Morbidity data are similarly dealt with by the Bureau of Communicable 
Diseases, and special studies of a more technical nature are undertaken 
by a statistician attached to the Bureau of Administration. These 
activities constitute the department’s bookkeeping and as such represent 
closely related functions. There is no question here of the efficiency 
of the services now being performed. The object is rather to raise the 
question as to whether closer coordination resulting from the consolida- 
tion of these services in a single well-staffed statistical bureau would 
achieve a more complete service with even greater efficiency and in- 
volve good economy. Of course such questions as the importance to 
the epidemiologist of having ready access to his records must be taken 
into account, but it would appear that such a bureau, properly integrated 
with the other bureaus, could undertake to advantage the greater 
portion of the routine compilations and analytical work now being done 
by them. Relief from these duties would frequently allow directors of 
other bureaus to devote more time to problems of greater immediate 
importance. Such a bureau also would be in a position to conduct 
special technical studies for other bureaus and county health depart- 
ments and to render technical guidance in the set-up of statistical 
procedures, and services in the collection, analysis, and interpretation of 
data. 
8. That the responsibility pertaining to the sanitation of milk and other foods, 
and of places where food products are produced, handled, stored, and sold, 
now vested in the Dairy and Food Division of the Department of Agriculture, 
be transferred to the.State Department of Health. 
9. That there be created in the Bureau of Sanitary Engineering a division of sani- 
tation which shall, in cooperation with the county and district health depart- 
ments, be responsible for general rural sanitation, including the sanitation of 
milk, shellfish, crabmeat, and all other foods and food establishments. 
10. That the milk sanitarian and the sanitation officers now attached to the Bureau 
of Rural Health be transferred to the proposed division of sanitation of the 
Bureau of Sanitary Engineering. 
11. That the State Department of Health be empowered to adopt and enforce a 
minimum sanitary code for the regulation of all food-handling establishments. 
12. That educational and other appropriate means be undertaken I to promote more 
widespread pasteurization of milk. Public Health in the State and Counties of Virginia 
77 
In several previous surveys, notably one by the New York Bureau 
of Municipal Research in 1927, the recommendation was made that 
the inspection of foods, dairies, cold storage, hotels, etc., be transferred 
from the Department of Agriculture to the Department of Health. 
An amendment to the law in 1927 transferred responsibility to the 
health department, and in 1930 the law was further amended to include 
crabmeat, scallops, and clams. Despite the fact, however, that the 
State Department of Health is the department of the State Govern- 
ment commonly regarded as the agency responsible for the protection 
and promotion of public health, that department is vested with almost 
no control over the sanitary quality of the public milk supply. 
Milk is the most important and widely consumed single article in the 
human dietary, and, because of the ease with which it is contaminated, 
and of its importance in infant mortality and in the transmission of 
certain dangerous communicable diseases, any health department 
lacking authority to exercise sanitary control over its production and 
distribution is greatly handicapped. It is true that no serious outbreaks 
of communicable disease ascribable to the contamination of public 
milk supplies have occurred recently in Virginia. This, however, 
does not mean that adequate barriers against any such occurrences in 
the future have been built up. The need for the establishment of such 
barriers still exists, and probably will continue to do so until the State 
Department of Health is provided with the necessary facilities and 
vested with adequate authority to execute the functions for which it 
was established. 
Responsibility for determining the health of the animals from 
which milk is to be obtained and for promoting the economic aspects 
of the dairying industry would appear to be logical functions of the 
Department of Agriculture. But after the exercise of these functions 
its jurisdiction over milk should cease, and the duty to inspect, regulate, 
and supervise the sanitary quality of all milk and cream consumed or 
sold within the State should be vested in the State Department of Health. 
The recommendation that food sanitation should be undertaken 
by the Bureau of Sanitary Engineering is in line with the performance 
of similar functions by this bureau, namely, the protection of water 
supplies, the sanitary disposal of sewage, and the sanitation of oysters, 
crabmeat, scallops, and clams. Moreover, this bureau has certain 
State-wide functions to perform, and if it were properly integrated 
with county and district health departments no doubt a highly effective 
cooperative sanitation program could be placed in operation. In his 
relations with local health departments, the director of the Bureau of 
Sanitary Engineering would work through the central bureau of rural 
health. 
13. That a program incorporating the fundamental objectives of the Bureau of 
Maternal and Child Health and integrating the services of this bureau with 
those of the other bureaus of the department, of county health departments, 
and of other State departments and agencies, be drawn up for uniform applica- 
tion throughout the State. 78 
Public Health in the State and Counties of Virginia 
14. That in the preparation of the courses in hygiene for the teacher training in- 
stitutions, and in the preparation of the health program for the public schools. 
The State Department of Health be represented by a committee from the 
department, one member of which shall be the director of the Division of Health 
Education. (See pages 51, 52, 69 and 70.) 
15. That the Crippled Children’s Bureau, as such, be abolished, and that this service 
be transferred to the Bureau of Maternal and Child Health. 
The activities now engaged in by the Bureau of Maternal and Child 
Health are concerned with the welfare of mothers during and after the 
child-bearing period and with the hygiene of child life from the pre- 
natal period through infancy and the preschool and school ages. Sup- 
plementing the services rendered by this bureau, there are in the State 
Department of Health other bureaus and divisions whose activities 
are intimately related to the welfare of mothers and their children, and 
the same is true of the county and district health departments. 
Responsibility for the health program in schools is shared jointly 
by the State Departments of Health and Education. Theoretically 
the Department of Health is responsible for health service in the 
schools and the Department of Education is responsible for the health 
education program in the schools. In reality this division of responsi- 
bility is in theory only, for, although two departments are concerned, 
the program is administered as a single service. 
The diversified aspects of the health, economic, social, and mental 
problems that present themselves for adjustment in maternal and child 
life challenge sharply the intelligence, resourcefulness, and energy not 
only of the entire State government but of the State’s private citizens 
as well. 
It is no surprise, therefore, to find that steps are being taken by 
several of the other State departments to help to solve some of these 
problems. There have been developed in the Department of Labor 
and Industry facilities to provide at least a modicum of protection for 
women and children engaged in industry. In the Department of 
Public Welfare facilities are being developed to assist needy mothers 
in procuring medical, hospital, or material assistance for themselves 
and their children, and to provide medical and psychiatric examinations 
and custody or other appropriate care for dependent, delinquent, and 
neglected children. Other agencies of the State Government provide 
special eye clinics for needy children with poor vision, and schools for the 
deaf, blind, and feebleminded. The concern of lay organizations and 
groups in maternal and child welfare is manifested by the activities of 
such organizations as the State Federation of Parent-Teachers Asso- 
ciation, Federation of Women’s Clubs, Home Makers Clubs of Virginia, 
and others. 
In the discharge of the duties for which the Bureau of Maternal 
and Child Health was created, the director of the bureau has consistently 
regarded this branch of public health as a cooperative enterprise. 
Accordingly, he has endeavored, with considerable success, to utilize 
the services of both official and non-official organizations in promoting 
the work. In planning for the future, however, the question arises as 
to whether it would be possible to utilize further and more effectively Public Health in the State and Counties of Virginia 
79 
the services of the other bureaus and divisions of the Department of 
Health, of the county and district health departments, of other depart- 
ments of the State government, and of official and non-official organiza- 
tions if a well-rounded integrated program were prepared for united 
action. In the preparation of such a program first consideration 
should be given to the objectives to be accomplished and the funda- 
mental services that would be required for the accomplishment of those 
objectives. After determining through conferences what contributions 
can be made by the various agencies concerned, a program should be 
drawn up in broad outline which should be sufficiently elastic to permit 
its application regardless of local conditions and circumstances. The 
details of the programs adopted in different localities of the State will 
doubtless vary considerably, but the virtue of the kind of program 
suggested here is that it would define objectives, provide for funda- 
mental services, encourage cooperative action, and insure the inaugura- 
tion of a balanced program. 
16. That there be created in the State Department of Health facilities for the 
conduct and integration of the general tuberculosis program. 
17. That the scope of the services of the Division of Health Education be broadened 
by closer integration with the other services of the department and those of 
cooperating agencies, and by the provision of more personnel and funds. 
18. That the Bureau of Industrial Hygiene, in cooperation with the Department 
of Labor and Industry and the Department of Workmen’s Compensation, 
formulate a cooperative program for the prevention of illness and the protection 
of the health of industrial workers in the State. 
19. That the rules and regulations of the State Board of Health anent the reporting 
of certain diseases be enlarged to include any disease which in fact arises out 
of employment, and that the Department of Workmen’s Compensation be 
authorized to make awards in cases of such occupational diseases as it now does 
in accident cases. APPENDIX APPENDIX 
Table No 
The Counties of Virginia, Showing Area, Population (according to the 1930 
Census), and Assessed Value as of June 30, 1936 1 
Population of the State of Virginia (Estimated as of July 1), by Color, with Per- 
centage Distribution according to Color for the Years 1913-1936 2 
Population of the State of Virginia and the United States with Number and Per 
Cent In Certain Age Groups, according to the United States Census of April 
1, 1930 3 
Births and Deaths, with Rates per 1,000 Estimated Population, in the State of 
Virginia for the Years 1932-1936, with Average for the Five-Year Period 1932- 
1936 4 
Number of Deaths and Death Rates per 1,000 Estimated Population for the 
State of Virginia, by Color, for the Years 1913-1936 5 
Number of Deaths and Death Rates per 1,000 Estimated Population (as of July 
1, 1930), by Age Groups, for the State of Virginia and the United States 
Registration Area for Deaths, 1930 6 
Cases and Deaths in the State of Virginia from Certain Important Diseases during 
the Years 1932-1936, with Annual Average Number of Cases and Average 
Death Rates for the Five-Year Period . 7 
Deaths from Pulmonary Tuberculosis and Other Forms of Tuberculosis in the 
State of Virginia with Rates per 100,000 Estimated Population, by Color, 
for the Years 1917-1936, with Average for the Five-Year Period 1932-1936 8 
Deaths from Tuberculosis (all forms) in the State of Virginia, by Color, with 
Rates per 100,000 Population, by Five-Year Periods from 1917-1936 9 
Deaths from Tuberculosis (all forms) in the State of \ irginia according to Certain 
Age Groups, with Rates per 100,000 Estimated Population, for the Five- 
Year Period 1932-1936 10 
Deaths from Pulmonary Tuberculosis In the State of Virginia, with Percentage 
Distribution According to Certain Age Groups, by Color, for the Five-Year 
Period 1932-1936 11 
Deaths from Pulmonary Tuberculosis in the State of Virginia, with Rate Distribu- 
tion per 100,000 Population according to Certain Age Groups, by Color, 
for the Five-Year Period 1932-1936 12 
Deaths from Cancer in the State of Virginia, by Color, with Rates per 100,000 Popu- 
lation by Five-Year Periods from 1917-1936 13 
Deaths from Cancer in the State of Virginia by Age, Color, and Sex for the Five- 
Year Period 1932-1936 14 
Deaths from Cancer in the State of Virginia, according to Certain Age Groups 
with Rates per 100,000 Population, by Color, for the Five-Year Period 1932- 
1936 IS 
Deaths with Death Rates per 100,000 Population for Pneumonia (all forms) in 
the State of Virginia by Five-Year Periods from 1917-1936 16 
Deaths from Pneumonia (all forms) in the State of Virginia by Age, Color, and 
Sex for the Five-Year Period 1932-1936 17 
Deaths from Pneumonia (all forms) in the State of Virginia according to Certain 
Age Groups, with Rates per 100,000 Population by Color, for the Five-Year 
Period 1932-1936 18 
Deaths from Diarrhea and Dysentery (all ages) in the State of Virginia, by Color 
with Rates per 100,000 Population, by Five-Year Periods from 1917-1936, 
and for Separate Years 1932-1936 19 
Deaths from Diarrhea and Dysentery in the State of Virginia, by Month of Oc- 
currence, for the Five-Year Period 1932-1936 20 84 
Public Health in the State and Counties of Virginia 
Table No 
Percentage Distribution of Deaths from Diarrhea and Dysentery for Infants 
Under One Year and Under Two Years, by Color, in the State of Virginia 
for the Five-Year Period 1932-1936 21 
Cases and Deaths, with Death Rates per 100,000 Population, for Syphilis, by 
Color, in the State of Virginia by Five-Year Periods 1917-1936 22 
Stillbirths (all causes) with Rates per 1,000 Live Births in the State of Virginia 
by Five-Year Periods from 1917-1936 23 
Deaths from Typhoid Fever in the State of Virginia, by Color, with Rates per 100,- 
000 Population for the Years 1913-1936, with Average for Five-Year Period 
1932-1936 24 
Maternal Mortality in the State of Virginia, according to Color, by (Five-Year 
Periods from 1917-1936 25 
Puerperal Deaths, with Percentage Distribution by Cause, in the State of Virginia 
for the Five-Year Period 1932-1936 26 
Deaths of Infants Under One Year in the State of Virginia, by Color, with Rates 
Per 1,000 Live Births by Five-Year Periods from 1917-1936 27 
Deaths of Infants Under One Year in the State of Virginia, by Color, with Per- 
centage Distribution of Ages Under One Month, and One Month to One 
Year, for the Five Year Period 1932-1936 28 
Deaths of Infants Under One Year in the State of Virginia with Percentage Dis- 
tribution by Cause, for the Five-Year Period 1932-1936 29 
Departmental Chart 
APPENDIX—Continued Public Health in the State and Counties of Virginia 
85 
TABLE No. 1 
The Counties of Virginia, Showing Area, Population (according to the 1930 Census), 
and Assessed Value as of June 30, 1936 
COUNTY 
(Square 
Miles) 
Area 
Population 
Assessed Values 
Total 
Per Cent 
Colored 
Aftiount 
Per Capita 
Accomac 
502 
35,900 
39.0 
312,798,434 
$ 356 
96 
Albemarle 
747 
26,981 
23.0 
12,609,383 
467 
34 
Alleghany 
457 
20,188 
11.8 
13,596,605 
676 
85 
Amelia 
371 
8,979 
51.4 
3,409,362 
379 
70 
Amherst 
470 
19,020 
31,5 
5,413,676 
284 
63 
Appomattox 
342 
8,402 
27.3 
3,658,108 
435 
39 
Arlington 
25 
26,615 
12.2 
26,455,083 
993 
99 
Augusta 
1,003 
38,163 
10.6 
24,010,923 
629 
17 
Bath 
545 
8,137 
14.6 
5,573,744 
684 
99 
Bedford 
791 
29,091 
24.0 
15,037,403 
516 
91 
Bland 
360 
6,031 
1.7 
1,570,105 
260 
34 
Botetourt 
548 
15,457 
14,3 
7,390,404 
478 
13 
Brunswick 
557 
20,486 
56.1 
8,328,640 
406 
53 
Buchanan 
514 
16,740 
1.2 
3,936,333 
235 
15 
Buckingham 
584 
13,315 
43.6 
3,245,547 
243 
75 
Campbell 
544 
22,885 
28.8 
9,725,095 
424 
95 
Caroline 
529 
15,263 
50.9 
5,366,882 
351 
63 
Carroll 
458 
22,141 
1.8 
3,426,592 
154 
76 
Charles City 
188 
4,881 
79.6 
1,813,303 
371 
50 
Charlotte 
496 
16,061 
42.0 
5,334,869 
332 
16 
Chesterfield 
469 
26,049 
27.1 
23,701,926 
909 
90 
Clarke 
171 
7,167 
22.2 
4,933,914 
688 
42 
Craig 
333 
3,562 
0.4 
1,390,108 
390 
26 
Culpeper 
384 
13,306 
32.3 
7,725,843 
580 
63 
Cumberland 
293 
7,535 
57.8 
2,098,243 
278 
47 
Dickenson 
325 
16,163 
1.9 
4,451,796 
275 
43 
Dinwiddie 
517 
18,492 
60.5 
7,077,375 
382 
73 
Elizabeth City 
53 
19,835 
30.8 
8,044,928 
405 
59 
Essex 
258 
6,976 
54.9 
2,000,807 
286 
81 
Fairfax 
416 
25,264 
19.3 
16,983,581 
672 
24 
Fauquier 
666 
21,071 
29.8 
16,272,021 
772 
25 
Floyd 
376 
11,698 
4.4 
1,795,209 
153 
46 
Fluvanna 
285 
7,466 
39.5 
3,801,067 
509 
12 
Franklin 
697 
24,337 
15.5 
5,013,455 
206 
00 
Frederick 
431 
13,167 
6.2 
6,063,660 
460 
52 
Giles 
369 
12,804 
3.9 
9,121,392 
712 
39 
Gloucester 
223 
11,019 
39.5 
3,999,868 
363 
00 
Goochland 
287 
7,953 
51.7 
3,725,429 
468 
43 
Grayson 
425 
20,017 
3.5 
2,257,972 
112 
80 
Greene 
155 
5,980 
16.6 
1,173,601 
196 
25 
Greensville 
307 
13,388 
60.4 
5,079,344 
379 
40 
Halifax 
814 
41,283 
45.8 
13,821,980 
334 
81 
Hanover 
512 
17,009 
36.6 
7,970,975 
468 
63 
Henrico 
255 
30,310 
21.2 
34,043,995 
1,123 
19 
Henry 
442 
20,088 
29.3 
4,802,908 
239 
09 
Highland 
422 
4,525 
3.4 
2,856,425 
631 
25 
Isle of Wight 
314 
13,409 
51.6 
4,340,785 
323 
72 
James City 
163 
3,879 
36.8 
2,565,978 
661 
51 
King George 
180 
5,297 
35.5 
1,644,116 
310 
39 
King and Queen 
320 
7,618 
54.8 
1,794,548 
235 
57 
King William 
263 
7,929 
50.6 
3,036,553 
382 
97 86 
Public Health in the State and Counties of Virginia 
The Counties of Virginia, Showing Area, Population (according to the 1930 Census) 
and Assessed Value as of June 30, 1936 
TABLE No. 1—Continued 
COUNTY 
(Square 
Miles) 
Area 
Population 
Assessed Values 
Total 
Per Cent 
Colored 
Amount 
Per Capita 
Lancaster 
130 
8,896 
44.6 
$ 2,895,050 
3325 
43 
Lee 
446 
30,419 
1.6 
4,870,582 
160 
12 
Loudoun 
519 
19,852 
21.9 
14,963,467 
753 
75 
Louisa 
516 
14,309 
40.8 
4,929,839 
344 
53 
Lunenburg 
430 
14,058 
44.3 
5,592,622 
397 
82 
Madison 
324 
8,952 
27.1 
3,316,103 
370 
43 
Mathews 
94 
7,884 
25.3 
1,806,729 
229 
16 
Mecklenburg 
669 
32,622 
52.9 
9,890,651 
303 
19 
Middlesex 
146 
7,273 
46.2 
2,377,398 
326 
88 
Montgomery 
396 
19,605 
10.0 
8,448,100 
430 
92 
Nansemond 
421 
22,530 
58.1 
10,231,394 
454 
12 
Nelson 
473 
16,345 
27.9 
6,681,101 
408 
76 
New Kent 
191 
4,300 
59.1 
2,437,181 
366 
79 
Norfolk 
373 
30,082 
39.2 
22,404,043 
744 
77 
Northampton 
239 
18,565 
53.8 
9,597,195 
516 
95 
Northumberland.... 
205 
11,081 
41.9 
3,620,908 
326 
77 
Nottoway 
310 
14,866 
45,0 
6,377,577 
429 
00 
Orange 
359 
12,070 
31.4 
6,999,257 
579 
89 
Page 
322 
14,852 
5.4 
5,435,726 
365 
99 
Patrick 
485 
15,787 
8.7 
2,405,899 
152 
40 
Pittsylvania 
1,012 
61,424 
34.1 
17,696,739 
288 
11 
Powhatan 
273 
6,143 
51.4 
2,225,477 
362 
28 
Prince Edward 
356 
14,520 
52.0 
6,937,001 
477 
75 
Prince George 
289 
10,311 
25.7 
6,595,369 
639 
64 
Princess Anne 
285 
16,282 
46.6 
9,192,360 
564 
57 
Prince William 
345 
13,951 
18.6 
6,957,637 
498 
70 
Pulaski 
333 
20,566 
11.1 
7,876,059 
382 
97 
Rappahannock 
274 
7,717 
24.3 
2,724,534 
353 
06 
Richmond 
204 
6,878 
38.7 
1,884,483 
273 
99 
Roanoke 
295 
35,289 
9.5 
22,850,339 
647 
52 
Rockbridge 
611 
20,902 
10.4 
13,658,587 
653 
46 
Rockingham 
874 
29,709 
4.8 
16,902,486 
568 
93 
Russell 
496 
25,957 
3.0 
6,092,835 
234 
73 
Scott 
543 
24,181 
1.1 
4,554,082 
188 
33 
Shenandoah 
510 
20,655 
2.4 
9,060,322 
438 
65 
Smyth 
435 
25,125 
2.4 
5,893,427 
234 
56 
Southampton 
604 
26,870 
61.0 
9,388,344 
349 
40 
Spotsylvania 
412 
10,056 
25.6 
4,382,042 
435 
76 
Stafford 
274 
8,050 
18.5 
3,198,910 
397 
38 
Surry 
278 
7,096 
60.1 
2,531,820 
356 
80 
Sussex 
515 
12,100 
66.2 
6,072,975 
501 
90 
Tazewell 
531 
32,477 
8.3 
8,884,766 
273 
57 
Warren 
216 
8,340 
9.9 
3,021,016 
362 
23 
Warwick 
65 
8,829 
28.4 
6,028,563 
682 
81 
Washington 
602 
33,850 
6.3 
7,824,811 
231 
16 
Westmoreland 
252 
8,497 
43.8 
2,983,608 
351 
14 
Wise 
420 
51,167 
6.2 
14,250,000 
278 
50 
Wythe 
479 
20,704 
6.8 
6,824,784 
329 
64 
York 
136 
7,615 
39.8 
2,558,491 
335 
98 
40,123 
1,718,895 
3740,622,712 
(av)$430 87 Public Health in the State and Counties of Virginia 
87 
Population of the State of Virginia (.Estimated as of July 1), by Color, with Percentage 
Distribution according to Color, for the Years 1913-1936 
TABLE No. 2 
YEAR 
Population 
Per Cent 
Total 
White 
Colored 
White 
Colored 
1913 
2,143,428 
1,465,190 
678,238 
68.4 
31.6 
1914 
2,168,929 
1,488,685 
680,244 
68.6 
31.4 
1915 
2,194,430 
1,512,180 
682,250 
68.9 
31.1 
1916 
2,219,931 
1,535,675 
684,256 
69.2 
30.8 
1917 
2,245,432 
1,559,169 
686,263 
69.4 
30.6 
1918 
2,270,934 
1,582,665 
688,269 
69.7 
30.3 
1919 
2,296,436 
1,606,161 
690,275 
69.9 
30.1 
1920 
2,314,683 
1,625,350 
689,333 
70.2 
29.8 
1921 
2,325,674 
1,640,231 
685,443 
70.5 
29.5 
1922 
2,336,665 
1,655,112 
681,553 
70.8 
29.2 
1923 
2,347,657 
1,669,994 
677,663 
71.1 
28.9 
1924 
2,358,648 
1,684,875 
673,773 
71.4 
28.6 
1925 
2,369,640 
1,699,756 
669,884 
71.7 
28.3 
1926 
2,380,632 
1,714,637 
665,995 
72.0 
28.0 
1927 
2,391,624 
1,729,517 
662,107 
72.3 
27.7 
1928 
2,402,615 
1,744,398 
658,217 
72.6 
27.4 
1929 
2,413,607 
1,759,280 
654,327 
72.9 
27.1 
1930 
2,425,000 
1,774,000 
651,000 
73.2 
26.8 
1931 
2,430,000 
1,782,000 
648,000 
73.3 
26.7 
1932 
2,435,000 
1,789,000 
646,000 
73.5 
26.5 
1933 
2,441,000 
1,796,000 
645,000 
73.6 
26.4 
1934 
2,446,000 
1,803,000 
643,000 
73.7 
26.3 
1935 
2,453,172 
1,801,726 
651,446 
73.4 
26.6 
1936 
2,459,180 
1,806,118 
653,062 
73.4 
26.6 88 
Public Health in the State and Counties of Virginia 
TABLE No. 3 
Population of the State of Virginia and the United States with Number and Per Cent in 
Certain Age Groups, according to the United States Census of April 1, 1930 
AGE GROUPS 
Number 
Per Cent 
Virginia 
United 
States 
Virginia 
United 
States 
All Ages 
2,421,851 
122,775,046 
100 0 
100 0 
Under 5 
257,138 
11,444,390 
10.6 
9,3 
(Under 1) 
(49,366) 
(2,190,791) 
(2.0) 
(1.8) 
5-9 
291,875 
12,607,609 
12.1 
10.3 
10-14 
269,626 
12,004,877 
11.1 
9.8 
15-19 
255,757 
11,552,115 
10.6 
9.4 
20-24 
217,603 
10,870,378 
9.0 
8.9 
25-29 
176,938 
9,833,608 
7.3 
8.0 
30-34 
156,596 
9,120,421 
6.5 
7.4 
35-44 
294,235 
17,198,840 
12.1 
14.0 
45-54 
236,090 
13,018,083 
9.7 
10.6 
55-64 
148,131 
8,396,898 
6.1 
6.8 
65-74 
80,750 
4,720,609 
3.3 
3.8 
75 and over 
35,928 
1,913,196 
1.5 
1.6 
1,184 
94,022 
0.1 Public Health in the State and Counties of Virginia 
89 
TABLE No. 4 
Births and Deaths, with Rates per 1,000 Estimated Population, in the State of Virginia for 
the Years 1932-1936, with Average for the Five-Year Period 1932-1936 
YEAR 
Population 
(Estimated 
as of 
July 1) 
Births 
Deaths 
Number 
Rates Per 
1,000 
Population 
Number 
Rates Per 
1,000 
Population 
1932 
2,435,000 
55,245 
22.7 
28,873 
11.9 
1933 
2,441,000 
51,460 
21.1 
28,410 
11.6 
1934 
2,446,000 
52,198 
21.3 
30,519 
12.5 
1935 
2,453,172 
51,373 
20.9 
30,354 
12.4 
1936 
2,459,180 
51,117 
20.8 
32,169 
13.1 
Average for Five-Year Per- 
iod 1932-1936 
52,279 
21.4 
30,065 
12.3 90 
Public Health in the State and Counties of Virginia 
TABLE No. 5 
Number of Deaths and Death Rates per 1,000 Estimated Population for the State of Virginia 
by Color, for the Years 1913-1936 
YEAR 
All Deaths 
Death Rate Per 1,000 
Population 
Total 
White 
Colored 
Total 
White 
Colored 
1913 
29,647 
16,997 
12,650 
13.8 
11.6 
18.7 
1914 
30,117 
16,918 
13,199 
13.9 
11.4 
19.4 
1915 
30,727 
17,288 
13,439 
14.0 
11.4 
19.7 
1916 
32,144 
18,404 
13,740 
14.5 
12.0 
20.1 
1917 
31,527 
18,017 
13,510 
14.0 
11.6 
19.7 
1918 
*41,272 
24,687 
16,585 
18.2 
15.6 
24.1 
1919 
31,397 
18,445 
12,952 
13.7 
11.5 
18.8 
1920 
30,514 
18,353 
12,161 
13.2 
11.3 
17.6 
1921 
28,534 
17,225 
11,309 
12.3 
10.5 
16.5 
1922 
28,688 
17,274 
11,414 
12.3 
10.4 
16.7 
1923 
30,760 
18,773 
11,987 
13,1 
11.2 
17.7 
1924 
29,175 
17,710 
11,465 
12.4 
10.5 
17.0 
1925 
29,343 
17,523 
11,820 
12.4 
10.3 
17.6 
1926 
30,818 
18,866 
11,952 
12.9 
11.0 
17.9 
1927 
28,772 
17,503 
11,269 
12.0 
10.1 
17.0 
1928 
30,211 
18,458 
11,753 
12.6 
10.6 
17.9 
1929 
31,229 
19,297 
11,932 
12.9 
11.0 
18.2 
1930 
30,374 
18,647 
11,727 
12.5 
10.5 
18.0 
1931 
29,996 
18,443 
11,553 
12.3 
10.3 
17.8 
1932 
28,873 
18,255 
10,618 
11.9 
10.2 
16.4 
1933 
28,410 
18,004 
10,406 
11.6 
10.0 
16.1 
1934 
30,519 
19,288 
11,231 
12.5 
10.7 
17.5 
1935 
30,354 
19,263 
11,091 
12.4 
10.7 
17.0 
1936 
32,169 
20,537 
11,632 
13.1 
11.4 
17.8 
*Deaths of 2,669 soldiers, sailors, and marines not included. Public Health in the State and Counties of Virginia 
91 
TABLE No. 6 
Number of Deaths and Death Rates per 1,000 Estimated Population {as of July I, 1930) 
by Age Groups, for the State of Virginia and the United States Registration Area for 
Deaths, 1930. 
AGE GROUPS 
Number* 
Rate Per 1,000 Popula- 
tion 
Virginia 
U. S. 
Registration 
Area 
Virginia 
U. S. _ 
Registration 
Area 
All Ages 
30,315 
1,343,356 
12.5 
11.3 
Under 5 
(Under 1) 
5,641 
(4,226) 
195,200 
(145,374) 
21.9 
(85.5) 
17.7 
(68.1) 
5-9 
520 
22,956 
1.8 
1.9 
10-14 
412 
17,652 
1.5 
1.5 
15-19 
796 
30,990 
3.1 
2.8 
20-24 
1,110 
41,515 
5.1 
3.9 
25-29 
991 
42,006 
5.6 
4.4 
30-34 
1,024 
43,913 
6.5 
5.0 
35-44 
2,515 
114,590 
8.6 
6.9 
45-54 
3,660 
155,142 
15.6 
12.3 
55-64 
4,215 
197,791 
28.5 
24.5 
65-74 
4,454 
238,213 
55.7 
52.9 
75 and over 
4,923 
241,521 
135.3 
127.3 
Unknown 
54 
1,867 
*U. S. Census Figures. 92 
Public Health in the State and Counties of Virginia 
Cases and Deaths in the State of Virginia from Certain Important Diseases during the Years 1932-1936, with Annual Average Number of Cases and 
Average Death Rates for the Five-Year Period 
DISEASE 
Total 
Deaths 
1932- 
1936 
Average 
Death 
Rate 
1932- 
1936 
Total 
Number 
Casesf 
Annual 
Average 
Number 
Cases 
1932 
1933 
1934 
1935 
1936 
Cases 
Deaths 
Cases 
Deaths 
Cases 
Deaths 
Cases 
Deaths 
Cases 
Deaths 
Typhoid fever 
512 
4.2 
4,324 
865 
1,155 
138 
1,025 
114 
777 
93 
781 
84 
586 
83 
Measles 
449 
3.7 
64,451 
12,890 
4,269 
26 
9,172 
59 
29,589 
175 
18,171 
153 
3,250 
36 
Scarlet fever 
179 
1.5 
13,523 
2,705 
3,032 
31 
3,449 
54 
3,034 
51 
2,095 
26 
1,913 
17 
Whooping-cough... 
1,034 
8.5 
25,112 
5,022 
11,777 
339 
2,607 
124 
5,449 
225 
3,355 
218 
1,924 
128 
Diphtheria 
746 
6.1 
8,939 
1,788 
2,057 
149 
2,139 
179 
1,989 
172 
1,502 
133 
1,252 
113 
Influenza 
4,825 
39.4 
121,116 
24,223 
51,318 
1,004 
25,468 
986 
4,820 
733 
18,152 
993 
21,358 
1,109 
Epidemic 
Meningitis 
387 
3.2 
958 
192 
73 
37 
88 
35 
115 
48 
276 
111 
406 
156 
Tuberculosis 
(all forms)J 
10,013 
81.8 
14,473 
2,895 
2,172 
2,165 
3,862 
2,034 
3,723 
1,948 
2,333 
1,948 
2,383 
1,918 
Pneumonia 
(all forms) 
11,048 
90.3 
11,659 
3,886 
3,767 
1,982 
3,359 
1,792 
4,533 
2,189 
2,260 
2,825 
Syphilis § 
2*223 
18.2 
22*638 
5',660 
*399 
4*703 
*458 
5; 725 
*468 
5,546 
*419 
6,664 
479 
Diarrhea and 
Dysentery 
3,535 
28.9 
22,354 
4,471 
5,940 
777 
4,843 
719 
4,241 
789 
3,580 
545 
3,750 
705 
Diarrhea and 
Dysenterv 
(Under 2 yrs.)... 
2,434 
19.9 
2,585 
646 
516 
860 
498 
963 
559 
373 
362 
389 
499 
Maternal deaths.. . 
1,636 
6.3 
396 
317 
337 
290 
296 
Infants under 1 
18,303 
70.0 
3,667 
3,499 
3,794 
3,565 
3,778 
*Rates for diseases per 100,000 population: for maternal and infant deaths per 1,000 live births. 
fCases for pneumonia not reportable after 1934; annual average is for three-year period. Cases for syphilis not reportable prior to July, 
1932; annual average is for four-vear period. 
Cases of diarrhea and dvsentery not tabulated according to age until 1933; annual average for 
under 2 years is for four-year period. 
JCases are for pulmonary tuberculosis only. 
§Syphilis includes locomotor ataxia and general paralysis of the insane. 
TABLE No. 7 Public Health in the State and Counties of Virginia 
93 
Deaths from Pulmonary Tuberculosis and Other Forms of Tuberculosis in the State of Vir- 
ginia with Rates per 100,000 Estimated Population, by Color, for the Years 1917-1936, 
with Average for the Five-Year Period 1932-1936. 
TABLE No. 8 
Tuberculosis of Lungs 
Tuberculosis 
(Other Forms) 
YEAR 
Number 
Rates per 
100,000 
Population 
Number 
Rates per 
100,000 
Population 
T 
W 
C 
T 
W 
C 
T 
W 
C 
T 
W 
C 
1917 
3,243 
1,437 
1,817 
144.9 
92.2 
264.8 
539 
262 
277 
24.0 
16.8 
40.3 
1918 
3,594 
1,726 
1,868 
158.3 
109.1 
271.4 
499 
234 
265 
21.9 
14.7 
38.5 
1919 
3,012 
1,381 
1,631 
131.2 
86.0 
236.3 
433 
186 
247 
18.8 
11.6 
35.8 
1920 
2,888 
1,333 
1,555 
124.8 
82.0 
225.6 
431 
212 
219 
18.6 
13.1 
31.8 
1921 
2,800 
1,257 
1,543 
120.4 
76.6 
225.1 
331 
166 
165 
14.2 
10.2 
24.1 
1922 
2,745 
1,268 
1,477 
117.5 
76.6 
216.7 
347 
189 
158 
14.8 
11.4 
23.2 
1923 
2,612 
1,221 
1,391 
111.3 
73.1 
205.3 
289 
160 
129 
12.3 
9.6 
19.0 
1924 
2,417 
1,155 
1,262 
102.5 
68.6 
187.3 
302 
153 
149 
12.8 
9.0 
22.1 
1925 
2,407 
1,134 
1,273 
101.6 
66.7 
190.0 
308 
165 
143 
13.0 
9.7 
21.4 
1926 
2,359 
1,150 
1,209 
99.1 
67.1 
181.5 
294 
144 
ISO 
12.3 
8.4 
22.6 
1927 
2,274 
1,123 
1,151 
95.1 
64.9 
173.8 
261 
128 
133 
10.9 
7.4 
20.1 
1928 
2,223 
1,069 
1,154 
92.5 
61.3 
175.3 
271 
134 
137 
11.3 
7.7 
20.8 
1929 
2,180 
1,065 
1,115 
90.3 
60.5 
170.4 
238 
117 
121 
9.9 
6.7 
18.5 
1930 
2,022 
953 
1,069 
83.4 
53.7 
164.2 
219 
108 
111 
9.0 
6.1 
17.1 
1931 
2,020 
927 
1,093 
83.1 
52.0 
168.7 
236 
94 
142 
9.7 
5.3 
21.9 
1932 
1,947 
932 
1,015 
80.0 
52.1 
157,1 
218 
104 
114 
8,9 
5.8 
17.7 
1933 
1,835 
836 
1,009 
75,2 
46.0 
156.4 
199 
110 
89 
8,1 
6.1 
13.8 
1934 
1,763 
817 
946 
72.1 
45.3 
147.1 
185 
91 
94 
7.5 
5.1 
14.6 
1935 
1,762 
860 
902 
71.8 
47.7 
138.5 
186 
85 
101 
7.6 
4.7 
15.5 
1936 
Average, 5 
years 
1932- 
1,715 
796 
919 
69.7 
44.1 
140.7 
203 
94 
109 
8.3 
5.2 
16.7 
1936.... 
1,804 
846 
958 
73.7 
47.0 
147.9 
198 
97 
101 
8.1 
5.4 
15.7 94 
Public Health in the State and Counties of Virginia 
TABLE No. 9 
Deaths from Tuberculosis (all forms) in the State of Virginia, by Color, with Rates per 
100,000 Population, by Five-Year Periods from 1917-1936 
PERIOD 
Number 
Rates per 100,000 Population 
Total 
White 
Colored 
Total 
White 
Colored 
1917-1921 
17,781 
8,194 
9,587 
155.2 
102.3 
278.7 
1922-1926 
14,080 
6,739 
7,341 
119.4 
80.0 
217.9 
1927-1931 
11,944 
5,718 
6,226 
99.0 
65.1 
190.2 
1932-1936 
10,013 
4,715 
5,298 
81.8 
52.4 
163.6 
TABLE No. 10 
Deaths from Tuberculosis (all forms) in the State of Virginia according to Certain Age 
Groups, with Rates per 100,000 Estimated Population, for the Five-Year Period 1932-1936 
AGE GROUPS 
Total 
White 
Colored 
Deaths 
Rates 
Deaths 
Rates 
Deaths 
Rates 
All Ages 
10,013 
81.8 
4,715 
52.4 
5,298 
. 163.6 
0-19 
1,536 
28.3 
421 
10.8 
1,115 
72.8 
20-44 
4,959 
116.0 
1,939 
60.8 
3,020 
253.7 
45-64 
2,350 
120.8 
1,380 
94.4 
970 
200.5 
65 and over.... 
1,162 
198.1 
972 
211.9 
190 
148.5 
6 
3 
2 Public Health in the State and Counties of Virginia 
95 
Deaths from Pulmonary Tuberculosis in the State of Virginia, with Percentage Distribution 
according to Certain Age Groups, by Color, for the Five-Year Period 1932-1936. 
TABLE No. 11 
AGE GROUPS 
Total 
White 
Colored 
Deaths 
Per Cent 
Deaths 
Per Cent 
Deaths 
Per Cent 
All ages 
9,022 
100.0 
4,231 
100.0 
4,791 
100.0 
0-19 years 
1,123 
12.5 
232 
5.5 
891 
18.6 
20-44 years.... 
4,606 
51.2 
1,801 
42.8 
2,805 
58.6 
45-64 years.... 
2,186 
24.3 
1,277 
30.3 
909 
19.0 
65 and over.... 
1,101 
12.0 
918 
21.3 
183 
3.8 
Unknown 
6 
3 
3 
Deaths from Pulmonary Tuberculosis in the State of Virginia, with Rate Distribution per 
100,000 according to Certain Age Groups, by Color, for the Five-Year Period 1932-1936. 
TABLE No. 12 
AGE GROUPS 
Total 
White 
Colored 
Deaths 
Rates 
Deaths 
Rates 
Deaths 
Rates 
All ages 
9,022 
73.7 
4,231 
47.0 
4,791 
147.9 
0-19 years 
1,123 
20.7 
232 
6.0 
891 
58.0 
20-44 years.... 
4,606 
107.8 
1,801 
56.6 
2,805 
257.3 
45-64 years.... 
2,186 
112.3 
1,277 
87.3 
909 
187.9 
65 and over.... 
1,101 
187.7 
918 
200.1 
183 
143.1 
6 
3 
3 96 
Public Health in the State and Counties of Virginia 
TABLE No. 13 
Deaths from Cancer in the State of Virginia, by Color, with Rates per 100,000 Population 
by Five-Year Periods from 1917 to 1936 
PERIOD 
Number 
Rates per 100,000 Population 
Total 
White 
Colored 
Total 
White 
Colored 
1917-1921 
6,232 
4,607 
1,625 
54.4 
57.5 
47.2 
1922-1926 
7,376 
5,565 
1,811 
62.5 
66.1 
53.8 
1927-1931 
8,249 
6,360 
1,889 
68.4 
72.4 
57.7 
1932-1936 
9,887 
7,713 
2,174 
80.8 
85.7 
67.1 
Deaths from Cancer in the State of Virginia by Age, Color, and Sex for the Five-Year Period 
1932-1936 
TABLE No. 14 
AGE GROUPS 
Total 
White 
Colored 
Male 
Female 
Male 
Female 
All Ages 
9,887 
3,288 
4,425 
780 
1,394 
Under 25 
188 
76 
59 
24 
29 
25-34 
321 
68 
140 
26 
87 
35-44 
891 
169 
390 
72 
260 
45-54 
1,847 
440 
810 
205 
392 
55-64 
2,451 
778 
1,094 
225 
354 
65-74 
2,419 
991 
1,078 
158 
192 
75 and over 
1,765 
765 
852 
70 
78 
5 
1 
2 
2 Public Health in the State and Counties of Virginia 
97 
Deaths from Cancer in the State of Virginia according to Certain Age Groups with Rates 
per 100,000 Population, by Color, for the FiveYear Period 1932-1936. 
TABLE No. 15 
AGE GROUPS 
Total 
White 
Colored 
Deaths 
Rates 
Deaths 
Rates 
Deaths 
Rates 
All ages 
9,887 
80.8 
7,713 
85.7 
2,174 
67.1 
Under 25 
188 
2.9 
135 
2.9 
53 
2.9 
25-34 
321 
19.0 
208 
16.3 
113 
27.5 
35-44 
891 
60.0 
559 
51.4 
332 
83.7 
45-54 
1,847 
’ 154.4 
1,250 
142.5 
597 
187.2 
55-64 
2,451 
326.8 
1,872 
320.0 
579 
350.9 
65-74 
2,419 
594.6 
2,069 
647.8 
350 
400.4 
75 and over.... 
1,765 
981.2 
1,617 
1,160.0 
148 
365.5 
5 
3 
2 
TABLE No. 16 
Deaths with Death Rates per 100,000 Population for Pneumonia (all forms) in the State of 
Virginia by Five-Year Periods from 1917 to 1936 
PERIOD 
Number 
Death Rates per 100,000 
Population 
Total 
White 
Colored 
Total 
White 
Colored 
1917-1921 
13,342 
7,138 
6,204 
116.5 
89.1 
180.4 
1922-1926 
10,528 
5,936 
4,592 
89.3 
70 5 
136 3 
1927-1931 
10,434 
5,850 
4,584 
86.5 
66.6 
140.0 
1932-1936 
11,048 
6,417 
4,631 
90.3 
71.3 
143.0 98 
Public Health in the State and Counties of Virginia 
TABLE No. 17 
Deaths from Pneumonia (all forms) in the State of Virginia by Age, Color, and Sex for the 
Five-Year Period 1932-1936 
AGE 
Total 
White 
Colored 
Male 
Female 
Male 
Female 
All ages 
11,048 
3,506 
2,911 
2,556 
2,075 
Under 5 
3,112 
872 
727 
843 
670 
(Under 1) 
(2,199) 
(612) 
(503) 
(613) 
(471) 
5-19 
720 
218 
178 
156 
168 
20-44 
2,048 
603 
332 
652 
461 
45-64 
2,264 
644 
460 
650 
510 
65 and over 
2,900 
1,169 
1,213 
254 
264 
Unknown 
4 
1 
1 
2 
TABLE No. 18 
Deaths from Pneumonia {all forms) in the State of Virginia according to Certain Age Groups 
with Rates per 100,000 Population by Color, for the Five-Year Period 1932-1936. 
AGE GROUPS 
Total 
White 
Colored 
Deaths 
Rates 
Deaths 
Rates 
Deaths 
Rates 
All ages 
11,048 
90.3 
6,417 
71.3 
4,631 
143.0 
Under 5 
3,112 
239.8 
1,599 
169.3 
1,513 
428.6 
(♦Under 1) 
(2,199) 
(882.3) 
(1,115) 
(604.5) 
(1,084) 
1,673.6 
5-19 
720 
17.4 
396 
13.4 
324 
27.4 
20-44 
2,048 
47.9 
935 
29.4 
1,113 
102.1 
45-64 
2,264 
116.3 
1,104 
75.5 
1,160 
239.7 
65 and over.... 
2,900 
494.3 
2,382 
519.2 
518 
405.0 
4 
1 
3 
♦Rates computed per 100,000 live births are: 
Total 841.3; white, 603.2; and col- 
ored, 1,415.9. Public Health in the State and Counties of Virginia 
99 
TABLE No. 19 
Deaths from Diarrhea and Dysentery (all ages) in the State of Virginia, by Color, with 
Rates per 100,000 Population, by Five-Year Periods from 1917-1936, and lor Separate 
Years 1932-1936. 
PERIOD 
Number 
Rates per 100,000 Population 
Total 
White 
Colored 
Total 
Total 
Colored 
1917-1921 
9,546 
5,820 
3,726 
83.3 
72.6 
108,3 
1922-1926 
6,662 
4,005 
2,657 
56.5 
47.5 
78.9 
1927-1931 
5,089 
3,016 
2,073 
42,2 
34,3 
63.3 
1932-1936 
3,535 
2,149 
1,386 
28.9 
23.9 
42.8 
1932 
777 
494 
283 
31.9 
27.6 
43.8 
1933 
719 
437 
282 
29.5 
24.3 
43.8 
1934 
789 
474 
315 
32.3 
26.3 
49,0 
1935 
545 
295 
250 
22.3 
16.4 
38.4 
1936 
705 
449 
256 
28.7 
24.8 
39.2 
TABLE No. 20 
Deaths from Diarrhea and Dysentery in the State of Virginia, by Month of Occurrence, 
for the Five-Year Period 1932-1936 
TOTAL 
Jan. 
Feb. 
Mar. 
Apr. 
May 
June 
July 
Aug. 
Sep. 
Oct. 
Nov. 
Dec. 
3,535 
90 
91 
106 
108 
219 
543 
664 
568 
441 
411 
182 
112 
TABLE No. 21 
Percentage Distribution of Deaths from Diarrhea and Dysentery for Infants Under One 
Year and Under Two Years, by Color, in the State of Virginia for the Five-Year Period 
1932-1936. 
COLOR 
All Ages 
Under 1 Year 
Under 2 Years 
(Inc. Under 1 Year) 
Number 
Per Cent 
of Total 
Number 
Per Cent 
of Total 
White 
2,149 
1,085 
50.5 
1,513 
70.4 
Colored 
1,386 
762 
55.0 
921 
66.5 
Total 
3,535 
1,847 
52.2 
2,434 
68.9 100 
Public Health in the State and Counties of Virginia 
TABLE No. 22 
Cases and Deaths, with Death Rates per 100,000 Population, for Syphilis*, by Color, in the 
State of Virginia by Five-Year Periods from 1917-1936 
PERIOD 
Casesf 
Total 
White 
Colored 
Total 
White 
Colored 
1917-1921 
1,841 
792 
1,049 
1,089 
1,348 
1,492 
16 1 
9 9 
30 5 
1922-1926 
1,816 
2,047 
2,223 
727 
15 4 
8 6 
32 3 
1927-1931 
699 
17.0 
8 0 
41 2 
1932-1936 
25,358 
731 
18.2 
8.1 
46.1 
TABLE No. 23 
Stillbirths (all causes) with Rates per 1,000 Live Births in the State of Virginia by Five- 
Year Periods from 1917 to 1936 
1917-1921 
1922-1926 
1927-1931 
1932-1936 
Number 
Rates 
Per 1,000 
Live Births 
Number 
Rates 
Per 1,000 
Live Births 
Number 
Rates 
Per 1,000 
Live Births 
Number 
Rates 
Per 1,000 
Live Births 
14,877 
45.2 
13,980 
43.5 
12,221 
43.5 
11,374 
43.5 Public Health in the State and Counties of Virginia 
101 
TABLE No. 24 
Deaths from Typhoid Fever in the State of Virginia, by Color, with Rates per 100,000 Esti- 
mated Population for the Years 1913-1936, with Average for Five-Year Period 1932-1936 
YEAR 
Number 
Rates per 100,000 Population 
Total 
White 
Colored 
Total 
White 
Colored 
1913 
709 
421 
288 
33.1 
28.7 
42.5 
1914 
586 
337 
249 
27.0 
22.6 
36.6 
1915 
514 
291 
223 
23.4 
19.2 
32.7 
1916 
550 
316 
234 
24.8 
20.6 
34.2 
1917 
465 
236 
229 
20.7 
15.1 
33.4 
1918 
402 
246 
156 
17.7 
15.5 
22.7 
1919 
357 
210 
147 
15.5 
13,1 
21.3 
1920 
260 
157 
103 
11.2 
9.7 
14.9 
1921 
379 
229 
150 
16.3 
14.0 
21.9 
1922 
270 
140 
130 
11.6 
8.5 
19,1 
1923 
253 
125 
128 
10,8 
7.5 
18.9 
1924 
205 
123 
82 
8.7 
7.3 
12.2 
1925 
302 
174 
128 
12.7 
10.2 
19.1 
1926 
266 
162 
104 
11.2 
9.4 
15.6 
1927 
174 
115 
59 
7.3 
6.6 
8.9 
1928 
157 
102 
55 
6.5 
5.8 
8.4 
1929 
123 
76 
47 
5.1 
4.3 
7.2 
1930 
156 
93 
63 
6.4 
5.2 
9.7 
1931 
201 
119 
82 
8.3 
6.7 
12.7 
1932 
138 
88 
50 
5.7 
4.9 
7.7 
1933 
114 
78 
36 
4.7 
4.3 
5.6 
1934 
93 
52 
41 
3.8 
2.9 
6.4 
1935 
84 
43 
41 
3.4 
2.4 
6.3 
1936 
83 
51 
32 
3.4 
2.8 
4.9 
Average for 
Five-Year 
Period 1932- 
1936 
102 
62 
40 
4.2 
3.5 
6.2 102 
Public Health in the State and Counties of Virginia 
TABLE No. 25 
Maternal Mortality in the State of Virginia according to Color, by Five-Year Periods from 
1917-1936 
Maternal Deaths 
Rates per 1,000 Live Births 
Total 
White 
Colored 
Total 
White 
Colored 
1917-1921 
2,734 
1,581 
1,153 
8.3 
7.0 
11.3 
1922-1926 
2,252 
1,260 
992 
7.0 
5.6 
10.2 
1927-1931 
1,968 
1,062 
906 
7.0 
5.3 
11.1 
1932-1936 
1,636 
916 
720 
6.3 
5.0 
9.4 
TABLE No. 26 
Puerperal Deaths, with Percentage Distribution by Cause, in the State of Virginia for the 
Five-Year Period 1932-1936 
Int. Code 
CAUSES 
Number 
Per Cent 
No. 
Total 
White 
Colored 
of i otal 
140-150 
All causes 
1,636 
916 
720 
100.0 
146 
Puerperal albuminuria and eclampsia. . 
426 
209 
217 
26.0 
145 
Puerperal septicemia 
365 
196 
169 
22.3 
140 
Abortion with septic condition 
209 
129 
80 
12.8 
149 
Other accidents of childbirth 
187 
117 
70 
11.4 
144 
Puerperal hemorrhage 
179 
107 
72 
10.9 
141 
148 
Abortion without septic condition.... 
Puerperal phlegmasia, alba dolens 
86 
47 
39 
5.3 
(not septic) 
82 
56 
26 
5.0 
147 
Other toxemias of pregnancy 
44 
28 
16 
2.7 
142 
Ectopic gestation 
41 
20 
21 
2.5 
143 
150 
Other accidents of pregnancy 
Other and unspecified conditions of 
14 
6 
8 
0.9 
the puerperal state 
3 
i 
2 
0.2 Public Health in the State and Counties of Virginia 
103 
TABLE No. 27 
Deaths of Infants Under One Year in the State of Virginia, by Color, with Rates per 1,000 
Live Births by Five-Year Periods from 1917-1936. 
PERIOD 
Number 
Rates per 1,000 Liv 
e Births 
Total 
White 
Colored 
Total 
White 
Colored 
1917-1921 
28,988 
16,905 
12,083 
88.0 
74.3 
118.6 
1922-1926 
25,146 
14,770 
10,376 
78.3 
66.1 
106.2 
1927-1931 
21,195 
12,623 
8,572 
75.5 
63.3 
105.1 
1932-1936 
18,303 
11,055 
7,248 
70.0 
59.8 
94.7 
TABLE No. 28 
Deaths of Infants Under One Year in the State of Virginia, by Color, with Percentage Dis- 
tribution of Ages Under One Month, and One Month to One Year, for the Five-Year 
Period 1932-1936. 
COLOR 
Total 
Under 
1 Year 
Under 1 Month 
1 Month to 
1 Year 
Number 
Number 
Per Cent 
of Total 
Number 
Per Cent 
of Total 
White 
Colored 
11,055 
7,248 
6,623 
3,578 
59.9 
49.4 
4,432 
3,670 
40.1 
50.6 
Total 
18,303 
10,201 
55.7 
8,102 
44.3 104 
Public Health in the State and Counties of Virginia 
Deaths of Infants Under One Year in the State of Virginia with Percentage Distribution by 
Cause, for the Five-Year Period 1932-1936 
TABLE No. 29 
CAUSE OF DEATH 
Number 
Per Cent 
of Total 
All causes 
18,303 
100.0 
Infectious and parasitic diseases 
2,112 
(114) 
(7) 
(615) 
(83) 
(111) 
(393) 
(789) 
2,502 
1,847 
1,070 
8,045 
(4,977) 
(1,168) 
(1,900) 
338 
2,389 
11.5 
(a) Measles 
(c) Whooping-cough 
(d) Diphtheria 
Respiratory diseases (excl. tuberculosis) 
Diarrhea and dysentery 
13.7 
10,1 
5.8 
44.0 
Congenital malformations 
Early infancy 
(b) Iniury at birth 
(c) Other. 
Violent and accidental 
1.8 
13.1 
All other causes Public Health in the State and Counties of Virginia 
105 
RURAL 
HEALTH 
TUBERCULOSIS 
OUT-PATIENT 
SERVICE 
COMMUNICABLE 
DISEASES 
VENEREAL 
DISEASE 
CONTROL 
CRIPPLED 
CHILDREN 
HEALTH EDUCATION 
PUBLIC 
HEALTH 
NURSING 
Virginia Department of Health 
State Health Commissioner 
Administration 
VITAL 
STATISTICS 
Governor 
TUBERCULOSIS SANATORIA 
LABORATORIES 
State Board of Health 
INDUSTRIAL 
HYGIENE 
MATERNAL AND 
CHILD HEALTH 
MOUTH 
HYGIENE 
SHELLFISH 
SANITATION 
SANITARY 
ENGINEERING