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TABLE IV.-Average monthly costs and other items in the operation of automobiles in

county sanitary work in Virginia.

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SANITATION OF TOURIST CAMPS. With constantly improving roads and the ever increasing use of the automobile in tourist travel, the problem of the intercommunity and also the interstate spread of disease, particularly from insanitary conditions in tourist camps, is one that is occupying the attention of health authorities all over the United States.

The Legislature of the State of Minnesota, in 1923, conferred broad general powers upon the State board of health with a view toward correcting present unsatisfactory and dangerous conditions, but failed to appropriate funds for this purpose.

The regulations adopted under authority of section 4640, General Statutes, 1913, as amended by chapter 227, laws of 1923, have the force of law. Chapter 227 grants power to regulate tourists' camps by adding a new paragraph to section 4640, which paragraph reads as follows:

The general sanitation of tourists' camps, summer hotels, and resorts in respect to water supplies, disposal of sewage, garbage, and other wastes, and the prevention and control of communicable diseases, and to that end may prescribe the respective duties : of county and local health officers, and all county and local boards of health shall make such investigations and reports and obey such directions as the State board may require or give, and under supervision of the State board shall enforce such regulations.

The following regulations have been made by the State board of health in accordance with the authority granted:

230. Every person, organization, or municipality establishing or having control of a tourist camp shall provide such camp with an adequate water supply, toilet facilities, refuse disposal, camp site, as follows:

Water supply. Every tourist camp shall be provided with an adequate supply of water of good sanitary quality from a source which will meet the requirements of the Minnesota State Board of Health as to sanitary location, construction, and operation. The water supply may be used from a municipal system provided such a system has been installed and is operated in such a manner as to meet with the requirements of this board. If a supply from an approved municipal source is not available, a supply shall be obtained from a well or spring or other source which must be located, constructed, and operated in accordance with the requirements of this board for a safe water supply. A water supply shall be easily obtainable from a faucet on the municipal system or from a well, spring, or other source, as above described, at a point not more than 400 feet from the portion of the tourist camp actually used by the tourists for camping purposes.

Toilets.-Water-flush toilets shall be provided wherever a municipal sewerage system is available or where conditions are such that a sewage disposal plant or cesspool can be operated and water under pressure is available for the operation of water-flush toilets. Privies may be used where no municipal sewerage system is available or where the conditions are such that a sewage-disposal plant or cesspool can not be operated satisfactorily or where water under pressure is not available. These privies should be of the pit type and fly tight. All toilets and privies must be well ventilated and lighted and provided with some means of artificial lighting at night. Thesc toilets and privies shall be maintained in a clean and sanitary condition. The contents of the privy vaults shall be sprinkled with dry earth, chlorinated lime, or lime at least twice each week during the period when the privies are in use. Toilets and privies shall be supplied with toilet paper at all times. Separate toilets shall be provided for men and women. The location of all toilets shall be plainly indicated by suitable signs. The toilets shall be located at a distance not more than 400 feet from the sleeping quarters.

Refuse disposnl.-Suitable galvanized-iron garbage cans with covers shall be provided at convenient points for the disposal of garbage and refuse. The contents of these cans shall be removed daily, and the material disposed of in a suitable manner 80 as not to create a nuisance or provide a breeding place for flies. The cans shall be thoroughly washed.

Camp site. Every tourist camp must be located on a site that is well drained and shall be selected with regard to its healthfulness.

Owing to failure of the legislature to provide funds, the State board of bealth has circularized the local health authorities of Minnesota in the following language:

It is necessary * * * that local boards of health pay special attention to tourist camp sanitation. When camps are located within the corporate limits of cities or villages in which organized boards of health exist, this duty may be discharged by the local health officer. If camps are not located within city or village limits, then

either the township board of health would be concerned or the county board of health in case the territory where the camp is located is not organized as a township. Town boards are not in a position to handle this problem satisfactorily, except, perhaps, in the larger cities. The best plan would be for the county health officer to assume responsibility for sanitation of all tourist camps in the county. This new duty would necessitate a special arrangement with the county board of health, which has “jurisdition over all unorganized towns * * * and * * * such other powers and duties in reference to the public health as the State board shall, by its published regulations, prescribe.".

THE DEMAND AMONG SANITARIANS AND PRACTICING PHY

SICIANS FOR SUPPLEMENTAL ACADEMIC TRAINING. In 1920 the Public Health Service conducted a venereal disease institute extending over a period of two weeks of intensive study. The following year 16 general public health institutes were held at various geographical centers, in cooperation with State departments of health. At the venereal disease institute there was an attendance of fully three times the number expected, and a large number were present at the general institutes.

These experiences have led the Public Health Service, at the suggestion of the Advisory Committee on the Education of Sanitarians, to send a circular letter of inquiry to members of the staffs of health departments, to public health nurses, and to practicing physicians in various parts of the country to determine what their interest might be in one or more institutes covering a period of six to eight weeks. Letters were mailed to approximately 3,500 employees of health departments, to about 6,000 public health nurses, and to the members of State medical societies in five States (approximately 9,500 practicing physicians). They were asked to express their opinions regarding (1) the need for supplemental academic training, (2) the season of the year at which they considered it would be wisest to hold public health institutes, (3) whether it would be more desirable, in their opinion, to have several institutes at various medical centers or one at Washington, and, finally, whether they could probably attend, would endeavor to attend, or wished additional information.

The accompanying table gives a summary of replies received to August 1, 1923. It will be observed that there were over 6,000 replies to 20,571 letters, and that of this number 5,746 express a belief that there exists a need for the type of public health institute proposed.

It is especially interesting to note that approximately 1,000 employees of health departments, 1,000 nurses, and 2,000 physicians, a total of over 4,000, say “I could probably attend an institute if it is not held too far from my home.” The 1,970 physicians so expressing themselves represent the responses from only five States. Maine, Virginia, Ohio, Colorado, and Washington were chosen both because

they are well separated geographically and because mailing lists were easily available. It will be observed that a majority recommend the summer season in preference to other seasons of the year.

The deans of medical schools and leaders in the medical profession generally will doubtless be interested—and perhaps some will be surprised—to learn that there is so marked an interest in preventive medicine on the part of practicing physicians as the responses of the physicians of five States indicate.

Announcement will be made later of plans for public health summer schools to meet the demand for supplemental academic training revealed by this inquiry. Tabulation of replies from employees of health departments, nurses, and certain physicians to an inquiry regarding the advisability of establishing one or more public health institutes.

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DEATHS DURING WEEK ENDED AUGUST 18, 1923.

Summary of information received by telegraph from industrial insurance companies for

week ending August 18, 1923, and corresponding week of 1922. (From the Weekly Health Index, August 21, 1923, issued by the Bureau of the Census, Department of Commerce.)

..................

Week ended Corresponding

Aug. 21, 1923. week, 1922. Policies in force......

........ 54, 688, 492 49, 817, 308 Number of death claims..

7, 425 Death claims per 1,000 policies in force, annual rate...... 8.4

7.8 Deaths from all causes in certain large cities of the United States during the week ended

August 18, 1923, infant mortality, annual death rate, and comparison with corresponding week of 1922. (From the Weekly Health Index, August 21, 1923, issued by the Bureau of the Census, Department of Commerce.)

[graphic]

Week ended
| Annual Deaths under

Deaths under Infant Aug. 18, 1923. death 1 year. morrate per

tality 1,000,

rate, corre- Week Corre week Total Death sponding ended sponding ended deaths. rate. week, Aug. 18, week, Aug. 18,

1922. 1923.1 1922. 1923.2

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Akron, Ohio.....

5.5 4.0

11.6 12.6 Atlanta, Ga..

15.0 20.6 Baltimore, Md....

13.0 12,2 Birmingham, Ala.

16.2 10.4 Bridgeport, Conn..

10.2 10.2 Buffalo, NY

10.8 Cambridge, Mass..

13. 6

8.0 Camden, N. J3....

11.8 11.1 Chicago, ni.......

9.7

9.4 Cincinnati, Ohio..

13.2 13.3 Cleveland, Ohios.

10.8

8.4 Columbus, Ohio...

11.4 13.0 Dallas, Tex...

12.9 10.6 Dayton, Ohio...

12.3

8.7 Denver, Colo.

13.0 13.3 Des Moinos, Iowa..

10.4 Detroit, Mich...

11.3 Duluth, Minn....

10.3 Erie, Pa.....

9.7

142 Fall River, Mass...

17.2
16.4

142 Flint, Mich.

15.0

318 Fort Worth, Tex...

8.3

8.6 Grand Rapids, Mich

9.3

9.1 Houston, Tex....

11.1 10.1 Indianapolis, Ind..

12.0 11.7 Jacksonville, Fla..

19.3 11.2 Jersey City, N.J.

11.0 12.6 Kansas City, Mo..

11.3 11.1 Los Angeles, Calif.

12.3 12.7 Louisville, Ky...

75 15.2 11.0 Lowell, Mass.....

35 15.9
11. 4

139 Lynn, Mass......

9.1 Memphis, Tenn....

22.4 18.0 Milwaukee, Wis.....

8.1 7.4 Minneapolis, Minn..

9.0

11.2 Nashville, Tenn.3.

17.2 14.7 New Bedford, Mass...

12.8 11.9 New Haven, Conn...

8.4 15.6 New Orleans, La....

117 15. 1 17.4 New York, N. Y....

1,058 9.3 9.3 Bronx Borough

127 7.9

7.0 Brooklyn Borough ..

356 8.6

8.6 Manhattan Porough

457
10.5

10.7 Queens Borough.

85 8.3 8.5 Richmond Borough..

13.5 13.8 Newark, N. J....

89 10.6

9.5 1 Annual rate rer 1,000 population.

: Deaths under 1 year per 1,000 births—an annual rate based on deaths under 1 year for the week and estimated births for 1922. Cities left blank are not in the registration area for births.

3 Deaths for week ended Friday, Aug. 17, 1923.

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