lar government; secondly, the fight against tuberculosis is universally recognized as part of the proper duties of the sanitary department; and finally, it is not to be expected that the municipalities would treat this matter intelligently for the reasons

above stated.

SANITARY REGULATIONS.

Of the regulations promulgated during the past year, the three most important were those governing dairies and milk supply, bakeries and the sale of bread, and the protection of foodstuffs from contamination. The regulations governing bakeries refer to reconstructions and to new constructions, to the conditions of preparation and material of which bread is to be prepared, and are so drawn as to leave practically to the discretion of the director of sanitation all the conditions of their enforcement. Remembering the large number of bakeries which exist upon the island, the exceedingly varying conditions as to location, amount of bread produced, capital invested, and the fact that in very few instances the owner of the building was also the one who carried on the preparation of the bread, the exceedingly great difficulties and the great danger of committing an injustice by leaving the interpretation of the regulation to subordinate officers compelled the director of sanitation to make a personal inspection and to determine personally the conditions which must be required in each instance.

These visits of inspection and the campaign carried on for cleanliness in the preparation and handling of the bread have had a very noticeable effect in the improvement of the quality and appearance of the bread sold all over the island. There is still, however, a great deal to be done in this respect, the most difficult problem being that of guaranteeing the use of a pure yeast. In the course of the inspections made of the bakeries specimens were taken from yeast from the dough and from the finished bread which was ready for sale, which specimens were examined by Dr. Bailey K. Ashford, United States Army, who found in many of them the organism which is believed by him to be the cause of sprue. The yeast universally used all over the island has been carried on from day to day, using as a culture each day what was left on the previous day, and this, after going on for years, has resulted in the production of a ferment that does not by any means contain the proper yeast organism necessary for the production of good bread. The regulation is of sufficient force to enable the officers of this service to destroy any yeast that is not fit for use, but up to the present time I have not found any rapid way of determining the quality with sufficient accuracy to justify the summary destruction of the whole supply of a town as would be necessary in order to secure the use of a pure product.

DAIRIES.

The difficulties in securing a supply of pure milk are exceedingly great. The conditions which exist in different parts of the island are so entirely different as to necessi tate a modification of the regulation for each individual case. I have personally ridden horseback over considerable sections of the island in the investigation of these conditions and have been compelled to abandon temporarily the enforcement of the regulations in many places. With respect to the larger towns, however, such as San Juan, Ponce, Mayaguez, and Arecibo, a very great gain has been made in the purity of the milk and the conditions under which it is sold.

EASTERN DISTRICT.

Dr. W. R. Watson, Medical Inspector.

So far as sanitation is concerned, the towns of the eastern district reflect to a very decided degree the general financial slump from which the whole island has suffered during the last year. It being impossible for the municipalities to obtain sufficient money, such towns as had planned to install waterworks, sewers, new municipal buillings, etc., have been unable to do so, not withstanding their good intentions. In fact, the only important sanitary improvement to be recorded in the whole district during the year was the construction of the sewer system in Caguas, which, however, has not to this date been entirely finished. Knowing that the munici palities were unable to obtain funds, the hands of the sanitation service were tied, and for the time being the usual custom of bringing pressure to bear upon the alcalde and municipal council with the end in view of requiring them to install certain sanitary appliances was postponed to a future period.

For example, although everything was prepared for the construction of sewer systems in Rio Piedras and Humacao, both towns having the assurance that they would

receive funds for the purpose, at the last moment they were disappointed, and now such projects are postponed indefinitely.

The jails in the eastern district are practically in the same sanitary state as they were last year. In roofing the new insular jail in Humacao, they have used an inferior grade of tar paper, and during some of the heavy rains in May and June of last year the rooms where the prisoners sleep were mostly flooded over several days at a time. It would seem as if a building of such importance should have been roofed with better material.

The hospitals in the eastern district have at least not improved. The so-called hospital in Fajardo has, if possible, deteriorated to a still further extent. Rio Piedras is at present building a new hospital to be finished in September. This construction will be an important addition to the municipality, as the old hospital was a disgrace to the community.

No new slaughterhouses have actually been built in the eastern district during this last year, but plans for new construction have been sent in for approval by the sanitary engineer. Severai towns have funds for the purpose of constructing new slaughterhouses and it is supposed that during this year they will be built. No new meat shops have been built, though those in most of the towns in the eastern district are in very good condition. There was considerable improvement in the sanitation of dairy establishments during the past year. Such improvements are still continuing and it is to be expected that within a comparatively short time this enterprise may be all that is to be expected so far as sanitation is concerned.

The sanitation service has been especially active in compelling the bakeries in the eastern district to observe the rules and regulations pertaining to the baking of bread. Many thousands of loaves have been destroyed on account of not being sufficiently cooked, or being sour, etc. On stated occasions the food inspectors made endeavors to obtain samples of bread from every bakery, during which time the bread found unfit for consumption was condemned and destroyed.

As a general thing the streets of the towns are not as clean in the eastern district as when the work was done by the sanitation service.

During last year Naguabo suffered from a fire which destroyed practically half the town. This allows the sanitation service opportunity to improve the sanitation of Naguabo greatly, and considerable improvement is to be expected within the next year.

SOUTHERN DISTRICT.

Dr. Pedro Malaret, medical inspector.

At the end of the fiscal year of 1913-14 the cleaning of streets and the removal of garbage was turned over to the municipalities, care being taken to see that all the streets, patios, and ground under the houses in the southern district were clean. Unfortunately the towns have not been kept in the condition maintained when in charge of this service. Outside of the small towns, in which the cleaning of streets and removal of garbage is comparatively easy, in the more important towns, such as Ponce, Mayaguez, Guayama, Yauco, and others there is much left to be desired, as the streets are very dirty and overgrown with grass and the gutters are almost stopped up. The ditches which carry off the surface waters through a number of these towns are very dirty, and often have so little slope that puddles are formed where mosquitoes are bred. These insects, whose number had been very noticeably decreased, have multiplied enormously since this service had to discontinue oiling ditches, puddles, latrines, and other breeding places, causing an increase in the cases of malaria in towns, such as Yauco, where this disease had almost been eradicated.

During the preceding year no new water supplies or sewers have been constructed in this district. Some of the towns have been trying to get funds for the construction of water supplies but, due to the financial crisis through which the country is passing, a decrease of revenue, or for some other cause, they have not been able to do so. Yauco has the necessary money for the installation of a sewer system which has not yet been started because of difficulties as to the way in which the money should be advanced, but it is practically certain that it will be put in. Ponce, though in urgent need of a sewer system, makes no move in that direction nor toward anything related to sanitary improvements. The city has under study the construction of a municipal jail, a hospital for tuberculosis, and another for the insane, having appropriated the sum of $50 for each of these projects.

The same conditions are found in the other towns with the exception of Barranquitas and Lajas, where they are endeavoring to put in water supplies. When the attention of the mayors is called to the necessity of sanitary improvements the answer is that there is no money available, though, disagreeable to relate, it is not lacking for other things not nearly so necessary for the health of the public.

They have not only not built water supplies or sewer systems but have not made other sanitary improvements. The exceptions to this are the market completed at Cabo Rojo, the slaughterhouse completed at Barros, the hospital for insane, and the improvements to the water supply completed at Coamo, and the hospital for insane completed in the asylum for the poor at Mayaguez. The Ponce market, which produces such a good income for the municipality, and the slaughterhouse are both in very bad condition from a sanitary point of view, but it has been impossible to have the deficiencies corrected.

During the year the methods of handling the milk for public consumption have been improved, as this is a work that has been going on for some years now and the regulation about dairies, approved during the year, has been of assistance. The number of sanitary dairies in the district has increased, the greatest proportion of them being found in Ponce, Yauco, and Cabo Rojo. It is nevertheless important that a special personnel be appointed for the inspection of dairies, as this is a work of prime importance. The places where milk is sold in the towns are all fly-proot and are inspected at frequent intervals, but these inspections are not so effective as the inspections of the dairies.

The anemia work has been carried on in all the towns, but had to be discontinued in some in October, 1914, and in almost all the others in May, 1915. The work was only continued in Ponce, Yauco, and in the mountains. The work recently done in the settlement known as Rosario was very satisfactory.

There was a slight outbreak of typhoid fever in Cabo Rojo, due to the fact that the first case did not receive any medical attention and the necessary precautions were neglected, as the sanitary authorities were not notified. There were a few cases of typhoid in Añasco, Sabana Grande, and San German. Only five cases were reported in Ponce, a very small number compared to former years. There were also isolated cases of chicken pox, diphtheria, infantile tetanus, mumps, dysentery, and erysipelas. With the exception of the large number of cases of tuberculosis the sanitary condition of the district has been excellent for the past year. This terrible disease is on the increase, Ponce having had 225 cases, Mayaguez 88, and Yauco 76.

It has not been possible to make the routine inspections of restaurants, hotels, provision stores, barber shops, etc., as often as could be desired, so that most attention has been given to the protection of food from contamination. The bakeries are also being repaired in accordance with the regulations or, in some instances, closed because they are unable to do so.

NORTHERN DISTRICT.

Dr. A. Ruiz Soler, medical inspector.

The general sanitary conditions of the towns of the northern district has been given in detail in former reports. These conditions have been the same, with small variations, during the fiscal year 1914-15.

IMPROVEMENTS OBSERVED.

Milk inspection.-Strict compliance with regulation No. 29, which governs the dairies and places where milk is handled, has been required with very satisfactory results, as this article now reaches the public in excellent condition. Nevertheless there are still some towns in which lack of the necessary care is to be found.

Inspection of stores.-The results obtained from the inspection of the stores have also been satisfactory. All have improved noticeably and the food offered to the public is of good quality.

The largest amounts of food destroyed during the year in this district have been 40,000 pounds of codfish and 13,400 pounds of flour found in wholesale establishments. The total number of pounds of food destroyed during the year has been 75,365, compared with 103,417 for the year before and 141,451 for the year 1912-13.

Constructions. The public has begun to take note of the advantages obtained in health due to living in houses built according to sanitary principles, and it is noted that they are showing great interest in making the improvements that increase the comfort and salubrity of their houses. The entire personnel of the service in this district has worked hard to see that the constructions and repairs made comply with the necessary requirements.

Bakeries. The campaign being carried on to improve the conditions existing in the bakeries has met with the approval of the public and good progress has been made.

DEFICIENCIES OBSERVED.

Hotels. It is necessary to carry out a vigorous campaign for the correction of the deficiencies found in hotels, as with few exceptions they are in very bad condition. The public itself, now more exacting in sanitary matters, has begun to show its disgust at the lack of hygiene and comfort provided.

Butcher shops. Great lack of cleanliness has been noted in the butcher shops, particularly those owned by the municipalities. This is due, more than anything else, to the lack of sufficient water to clean the places daily. The ice boxes required by the regulations do not give the results desired, as, due to their size, they are seldom used. This defect has been the cause of the destruction of a quantity of meat and a number of complaints to the courts.

Service of the poor.-No details of this work need be given, as it has not improved in any way during the year. This is due primarily to the small appropriations devoted to this important service.

Drug stores.-Investigations made by the medical inspector and the inspector of food and drugs show that very little attention is given to the cleanliness of the drug stores or to the utensils used in filling prescriptions. Great lack of care has also been noted in the containers used as the druggists have even gone to the extent of putting the medicines in old match boxes.

BOARD OF PLUMBING EXAMINERS.

The organization of the board of plumbing examiners includes among its members a master plumber not belonging to the service of sanitation. Mr. George Spaven has served without remuneration of any kind, and I desire to express my appreciation of the interest shown by him in the work of the board and in all matters affecting plumbing. Provision should be made for the payment of the usual per diem expenses for the civilian member of the board.

Examinations were held at San Juan in January and June and one in Ponce in February. During the year the board of health passed regulations authorizing the licensing of apprentice plumbers, who are allowed to do simple plumbing work in towns having no master or journeymen plumbers. They are not required to pass an examination, but their application must be signed by three reputable citizens of Porto Rico and also by the local health officer. Sixty-three men have received such appointments during the year. The board of health also authorized the licensing of engineers to prepare plans for and take charge of plumbing work. They are required to pass an examination.

Since the introduction of gas in San Juan last year, the gas fitters are examined by this board and licenses are granted to those who receive a mark of 70 or more. The construction of a gas plant in Ponce, which is now in progress, will further increase the necessity for this class of workmen.

The following table gives the details of the examinations for the year:

There were four engineers examined for certificates, of whom two passed. The total number of men examined during the year was 139, and 27 received certificates, having obtained an average of 70 or more in the examinations.

The master and journeymen plumbers are required to be examined in practical work as well as in written examinations. All other examinations are in writing only. There are now 60 licensed master plumbers in the island and 109 journeymen plumbers; all of them, however, are not actively engaged in the business."

DIVISION OF SANITARY ENGINEERING.

F.W.Dalrymple, sanitary engineer. W.P. C. Lippitt, assistant engineer. Manuel Font, assistant engineer.

The approval of plans for buildings, waterworks, sewers, urbanizations, and plumbing, together with their inspection during construction and on final completion, necessarily constituted a large part of the activities of the division of sanitary engineering during the year. The inspection of bakeries under the new regulations took up much time and involved a large amount of travel. Every bakery on the island was requested to submit a plan of the building for approval or suggestions as to alterations necessary. Assistance was given to San Juan in the investigation and report of the Bayamon River as a new source of water supply to serve not only San Juan and Rio Piedras as at present, but also Bayamon and Cataño as well. Sanitary surveys were made of the Bayamon River and of the watersheds of Arecibo, Caguas, Ponce, Guayama, and Mayaguez. Special plans were made for sewage disposal by means of subsurface drainage for the market at San Sebastian and the municipal hospital at Bayamon. Plans and suggestions for sewage disposal were also made for numerous other places. Additional plans were made for several new types of latrines and septic tanks, and also for dairies, vehicles for the transporation of milk, bakeries, slaughterhouses, and hospitals. Plans were drawn of the watersheds of Caguas, Guayama, Ponce, and Mayaguez. Office standards have been established for the approval of building plans, water and sewer works, and various details connected therewith. The business depression of the island (in common with the rest of the world) during the past year is indicated by the tabulated statement given below of the number of buildings and other plans approved.

Building and other plans approved year ending June 30, 1915.

Municipalities for which less than 25 plans were approved are not enumerated in the above list. The statement of building plans last year contained the names of 12 towns with 25 plans or more. This year the number is reduced to 8, and most of the towns show a decrease. A comparison by months of the number of building plans approved, however, shows a decided gain in the latter part of the year, and June was the largest month.

NUMBER OF BUILDING PLANS APPROved.

For the purpose of comparison, the following statement is given of the number of building plans approved during the past three years.