is not taken of the opportunity fully to utilize the capacity of the plant. There is no evidence, however, that the omission is directly chargeable to the laboratory.

Diphtheria cultures are not collected by the city. They are sent to the laboratory by physicians, and if the laboratory is closed they are deposited in a box at the door. When the bacteriologist comes on duty he removes the cultures, makes the smears, and telephones results. If smear is negative the culture is incubated five to six hours and reexamined.

The method of handling cultures is very wasteful of time, the most precious thing in diphtheria control, and would be much worse except that the bacteriologist usually visits the laboratory during the evening. The city hall watchman has a key to the laboratory, and if the doctor or his messenger hunts him up he can be admitted to the laboratory and can put cultures in the incubator, but this is almost never done. For about $15 an electric incubator could replace the present box and practically all cultures received after office hours would be ready for final examination the next morning.

When final examination of a culture is made it is reported by telephone to physicians and confirmed by mail, but no record is made. of the report. Prior to January 1 the record was a letter sheet form kept in a letter file; since that date a card record has been begun, indexed alphabetically. It would be much better to index by street and number.

A daily report of the results of examinations is made out, which goes to the chief sanitary inspector, who assigns the positive cases for placarding by the sanitary policemen.

The first terminal cultures are handled in about the same way. The second is brought in by sanitary policemen who make out the white record card and turn it in with culture; the results are telephoned as above without a record being made, and the card goes into the alphabetically indexed file, but it is not in any way connected or identified with the diagnostic culture. For instance, all Jones cards. are indexed "Jo," and if one wishes the history in any given Jones case one must look at possibly every card filed for months before under "Jo."

The Widals come, as a rule, from physicians. Sending in either a positive diphtheria or Widal is treated as being the formal report of the case required by the State law. This is certainly opposed to all sound practice.

Water Examinations.

The water examinations made at the laboratory are bacteriological, the chemical analyses being done by the city chemist.

Two samples of the city water are examined each week. The samples are taken by the water department, one at different points in the pumping plant and one at taps in different locations in the city. The bacteriological status of the St. Paul water supply is of the very highest. Recently there have been some examinations of the water in swimming pools. Strangely enough no examinations are made of the water at the Harriet Island baths operated by the health bureau itself. Samples several years ago are said to have shown very high counts and 200 colon bacilli or more per 1 c. c.

Milk Examinations.

No card or other record is kept in the laboratory for milk samples examined. It was stated by the bacteriologist that the cards were formerly kept in the laboratory, but that the "milk inspector thought he ought to keep them," and so the laboratory gave them to him. They were found in a box among a clutter of files, letter books, etc., on a mantlepiece in the office, the cards of several years all together without any arrangement as to name or date. The laboratory report for 1915 says that the 47 samples of milk were examined bacteriologically, but it was learned that practically none of these were collected by the bureau, being sent in by private parties.

It appears that there were 495 milk samples examined in 1913, but in 1914 the number fell to 43. About the beginning of 1914 the policy of concentrating all endeavor upon improving the sanitary status of the dairy farms was approved by the health officer, and sampling was stopped.

Neither the laboratory nor the milk division has any tabulation of counts or any other data of value in obtaining an idea of the quality of the milk supply. All the cards on file were examined, but they were too scattered and incomplete to be of use; incidentally, no cards could be found for 41 of the 47 samples referred to in the annual report. Just six imperfect cards constituted the record of a year's bacteriological work in milk for a city of over a quarter of a million people.

It is not possible to go into laboratory findings in detail. Speaking generally, it appeared that the staff was competent, worked faithfully, and were poorly paid for very long hours.

[This report will be continued in a subsequent issue of the Public Health Reports.]

PREVALENCE OF DISEASE.

No health department, State or local, can effectively prevent or control disease without knowledge of when, where, and under what conditions cases are occurring.

UNITED STATES.

ANTHRAX.

Massachusetts-North Adams.

Collaborating Epidemiologist Kelley reported that a case of anthrax was notified December 16, 1916, at North Adams, Mass., in the person of C. A. C., aged 49 years, living at 304 Beaver Street, who worked at unloading hides for the Barber Leather Co. The patient first noticed a pustule on his left breast December 13, was admitted to hospital December 14, and died December 17, 1916.

Dr. Kelley further reported January 5, 1917, that another case of anthrax had been notified at North Adams, in the person of O. B., who was also an employee of the Barber Leather Co.

DIPHTHERIA.

See Diphtheria, measles, scarlet fever, and tuberculosis, page 82.

City Reports for Week Ended Dec. 23, 1916.

During the week ended December 23, 1916, two fatal cases of malaria were reported in Mobile, Ala., one case was reported in Newark, N. J., and one case in Newton, Mass.

MEASLES.

See Diphtheria, measles, scarlet fever, and tuberculosis, page 82.

West Virginia-Elkins and Grafton-Winter Epidemic.

Passed Asst. Surg. Leake reported January 9, 1917, that during the period from December 15, 1916, to January 8, 1917, 38 cases of poliomyelitis, with 9 deaths, were notified at Elkins, W. Va., and that 3 cases of the disease were notified at Grafton, W. Va.

The following is taken from a previous report made on January 7 by Passed Asst. Surg. Leake, who is investigating the outbreak: