PUBLIC HEALTH SERVICE. 43 Permeability of walls of gas tubing and gas connections to illumi- The results of these tests show, (1) that none of the tubing tested The rubber ends used to connect gas hose with gas irons and with Hygienic significance of small amounts of carbon monoxid.-It was evident from the foregoing studies that the opportunities are numerous for the contamination of the air of workshops of the women's garment trades with carbon-monoxid gas, and that pressers must frequently be exposed to the risks of chronic poisoning. This gas possesses such affinity for the hemoglobin of the blood that even small quantities in the air of interiors may be detrimental to Wealth. While we are, as yet, without exact standards as to the minimum amount of carbon monoxid which may be present, without causing harmful effects, in the air of interiors, it is probable that quantities of this gas in excess of 200 parts per million of air exert a deleterious influence upon those continuously exposed to such atmosphere. Carbon monoxid in excess of the proportions just given was found present in a number of instances in the air of the workshops studied. Freedom from the hazard of carbon-monoxid poisoning due to the use of gas-heated pressing irons can be secured only by the use of approved types of gas irons, carefully selected rubber tubing, gastight connections, and a well-devised system of frequent inspection and constant maintenance. The hazard of chronic carbon-monoxid poisoning may be eliminated by the use of electrically heated pressing irons. The results of this investigation are being published as Public Health Bulletin 81. ECONOMIC STATUS. in New York Statis alth Montgomery, Morgan, Ohio, Owsley, Perry, Pike, Powell, Rockcastle, Rowan, Washington, Wolfe. Virginia: Dickenson. West Virginia Wayne. Hindman Hospital.-Kentucky: Boyle, Breathitt, Carter, Floyd, Harlan, Jessamine, Johnson, Knott, Lawrence, Lee, Letcher, Madison, Magoffin, Perry, Pike, Powell, Pulaski. Virginia: Dickenson, Wise. London Hospital.-Kentucky: Adair, Bell, Carter, Clay, Garrard, Graves, Harlan, Hart, Jackson, Knox, Laurel, Leslie, Letcher, Madison, Marion, Morgan, Perry, Pulaski, Rockcastle, Trigg, Wayne, Whitley. Tennessee: Claiborne. Welch Hospital.-West Virginia: Cabell, Kanawha, Lincoln, Logan, McDowell, Mingo, Raleigh, Roane, Wayne, Wyoming. Virginia: Buchanan, Tazewell. Ohio: Jefferson. Kentucky: Boyd, Lawrence. Coeburn Hospital.-Virginia: Buchanan, Dickenson, Lee, Russell, Scott, Tazewell, Washington, Wise. Kentucky: Bell, Harlan, Leslie, Letcher, Pike. The number of cases of trachoma recorded as cured during this year was 916 and represents only those who were actually seen by the medical officer in charge, and therefore known to be cured. great number of the cases live long distances from the hospital and when relieved of their disease, and therefore not compelled to return, are not seen after a cure is effected, and their record cards remain incomplete as to the result obtained. This is true in a large number of cases, and it is believed that 50 per cent more than the recorded number would be a conservative estimate of the actual number of cures. A very large percentage of these trachoma cases are helpless adults unable to earn a livelihood and children denied an education. Apart from the public-health and humanitarian aspects, the relief of this large number of eye sufferers has an economic importance impossible to estimate. Prevention. The work of sanitation, which is, of course, of equal importance to that of eradication, has been carried on much in the same manner as during the previous year. The gradual perfection of the organization, however, has made it possible to extend this phase of the work and to reach a much larger number of people. Besides the house to house visits made by the hospital doctors and nurses, one nurse was detailed exclusively for the district work. During 10 months, beginning September 1, she visited 2,820 homes in the vicinities of the London, Ky., and Coeburn, Va., hospitals and in neighboring counties. There were 15,510 persons in these homes, and 494 of them were reported by the nurse to have diseased eyes. She also visited 117 schools, with an aggregate attendance of 2,940 pupils, and reported 346 of them to be suffering with diseased eyes. The water supply of these homes consisted of 1,338 wells, 2 cisterns, and 1,453 springs. Twenty-one families depended upon polluted surface water. Of these 2,820 homes visited by this district nurse, only 414 or less than 15 per cent of them had any pretense of toilet arrangements, the remainder being reported as having "no accommodations." Of the 117 schools visited only 17 had closets that could be classed as sanitary, 38 had surface closets, while the remaining 62, or 53 per cent, had no accommodations whatever. The great majority of these homes and schools visited were remotely situated. During the year the district nurse rode 4,094 miles on horseback to reach the homes visited. In addition to the work done by her, house to house visits were carried on from the hospitals by the doctors and other nurses at such times as they could be spared from their hospital duties. During the year a total of 328 public-health talks were given to audiences of more than 21,000 people. Three thousand five hundred and seventy-one homes were visited, with a total population in the families of 24,982. A total of 624 schools were visited and 26,975 pupils examined. A grand total of 51,957 people were therefore reached by means of the district work. Of this number 3,666 were found to be suffering with trachoma. These district visits were used as a means of educating the people in the simple rules of hygiene, the prevention of disease, necessary procedures to be taken when ill, and practical points in caring for the sick. The old hospital cases were also followed up and advice given as to the further care of their eyes. All trachoma cases were told of the communicable nature of their disease and advised to seek relief at one of the service hospitals. A total of 11,286 pamphlets on "Trachoma, its nature and prevention," were distributed during the year. Field clinics.-As in the past, field clinics were held as a means of carrying the prevention and eradication work into various infected localities. Preliminary to these clinics the service officer would go to the locality selected and interview the health officer and the educational authorities. He would then examine the children in the school and any others who might apply. After arranging for a temporary "hospital" in the locality, which was frequently improvised, the officer would perform operations for the relief of cases and for the instruction of physicians in attendance. When he departed a trained nurse would be placed in charge under the direction of the local physicians. The expenses of these clinics, including the care and after-treatment of the cases, were borne by the community, with the exception of the expenses of the service officer and the nurse accompanying him. As a further means of education illustrated lectures were given in the towns visited. There were 12 such field clinics held during the year and 122 operations performed during these clinics. Of these, 77 were performed under general and 45 under local anesthesia. A total of 145 local physicians were present at these clinics and were instructed in the diagnosis and treatment of trachoma. A number of them operated under the direction of the service officer in charge. An endeavor was always made to have the antitrachoma work continued, and permanent trachoma clinics have resulted in some of the places visited. The local physicians have adopted the methods followed by the service and conduct these clinics at stated periods. The field clinics of the service are usually attended by representatives from the State board of health and other public-health organizations, and the interest the clinics arouse is used to promote the general public health. An effort will be made to increase the number of these clinics during the next fiscal year. How Financial side of hospital and clinical work.-The strict economy with which this work was commenced has been adhered to. ever, as the people become educated to the importance of these hos pitals and the prevention of disease generally, more apply for relief and adequate provision has to be made for the increased numbers. The total cost of maintaining these five hospitals, including the increased amount of district work, was $19.50 per day each. The States of Virginia and West Virginia, however, contributed $1,800, which makes the actual cost to the service only $18.50 per day. Importance of trachoma work.-There is no doubt that trachoma is increasing in the Appalachian Mountain region, and special effort should be made to prevent its further spread and to reach it among the school children, where it is usually incipient and readily curable. Cases of cured trachoma, people saved to usefulness and society, are to be found in all sections of the country where this work is being done. In all of these little hospitals in the mountains and in the homes of former patients can be seen the far-reaching results of the public-health work that is being accomplished in connection with the trachoma campaign. Expectoration on the floors of the hospitals, so common at the outset, is very noticeably less. The individual drinking cup, basin, towel, toilet articles, etc., now in use, are much more appreciated than formerly. The field, however, is extensive, the difficulties many, and this work will therefore be continued and enlarged. TRACHOMA AMONG SCHOOL CHILDREN IN ARKANSAS. In the course of a survey to determine the prevalence of mental defects among school children in Arkansas, made on request of the governor, the Arkansas Commission for Feeble-minded, and the State board of health (see p. 62), Asst. Surg. W. L. Treadway made inquiries into the prevalence of endemic diseases in the communities studied, notably trachoma. These investigations show a widespread distribution of the disease throughout the State and indicate that it is more prevalent in rural than in urban communities. The disease was encountered in 1.1 per cent of the boys and 1 per cent of the girls in the rural schools, and in 0.2 per cent of the boys and 0.3 per cent of the girls in the city schools. TRACHOMA AMONG SCHOOL CHILDREN AT NOGALES, ARIZ. In an examination of 534 school children for trachoma at Nogales, Ariz., made unofficially, Asst. Surg. A. L. Gustetter found 27 pupils with the disease, a percentage of 5.05. PRESENT STATUS OF TRACHOMA PROBLEM. In view of the demonstrated prevalence of trachoma, its chronicity, and marked resistance to treatment, the control of this disease is a serious problem in the United States. The measures to be taken must have a twofold object, viz., the elimination of foci of the disease and the improvement of community sanitation. Trachoma is largely a disease of insanitary surroundings, and their abolishment will depend in great measure on improving the social and economic conditions in infected communities. The bringing about of these improvements will therefore be slow, and the education of children in individual prophylaxis is essential to success. Not only should children be taught, but they should be examined regularly in schools, in order that their health and vision may be safeguarded. The care of the individual case is largely a surgical matter. These points are brought out in a short paper printed in the Public Health Reports and issued as Reprint No. 296. TRICHINOSIS. The recent occurrence of several outbreaks of trichinosis in the United States serves to direct attention again to this disease. In 1901 Prof. Stiles, of this service, compiled about 900 cases of the disease for this country from 1841 to 1900, inclusive, and Dr. B. H. Ransom, of the United States Bureau of Animal Industry, has brought the compilation down to 1915 by adding about 650 cases, making a total of about 1,550 cases, with 240 deaths. The States which have had the highest number of recorded cases are: New York, 355 cases, 62 deaths; Pennsylvania, 261 cases, 16 deaths; Massachusetts, 145 cases, 13 deaths; Minnesota, 101 cases, 12 deaths; California, 91 cases, 9 deaths; Illinois, 90 cases, 24 deaths. According to results of microscopic examination by the United States Department of Agriculture more than 14 out of every 1,000 hogs slaughtered in this country contain a small parasite, known as Trichinella spiralis, and more than 25 out of every 1,000 of these hogs contain either this worm or bodies resembling the cysts of this worm. If taken alive into the human body this parasite, known ordinarily as trichina, is capable of producing trichinosis, and statistics of 14,820 cases in man collected by Prof. Stiles, of this service, show that 5.6 per cent were fatal. But if the worms are killed by thoroughly cooking the pork, they will not produce this disease. Uncertainty of microscopic inspection.-The meat inspection conducted under the Federal laws and under the regulations promulgated by the Department of Agriculture does not include an inspection for the presence of trichina in hogs. Experience shows that the microscopic inspection for trichina conducted in some countries is weakened by such an incidence of error and uncertainty that it is untrustworthy and eliminates from the trade only part of the trichinous meat. Neither meat-inspection systems nor meat dealers are in a position to give scientific assurance that pork, even if inspected microscopically, does not contain this infection. The service has therefore issued the warning that in spite of any assurance to the contrary it is not safe to eat even microscopically inspected pork unless this has been thoroughly cooked or treated by some other safeguarding process that kills the trichinæ. TYPHOID FEVER. EPIDEMIC AT GALLUP, N. MEX. Study of an epidemic of typhoid fever at Gallup, N. Mex., during September and October, 1915, was made by Surg. F. C. Smith, on directions from the bureau. It was determined that the epidemic, which was mild in character, was almost certainly caused by milk infection. A flood occurred early in September, washing out of the |