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ANNUAL REPORT OF THE SURGEON GENERAL OF

THE PUBLIC HEALTH SERVICE.

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TREASURY DEPARTMENT,
BUREAU OF THE PUBLIC HEALTH SERVICE,

Washington, D. C., October 5, 1916. SIR: In accordance with the act of July 1, 1902, I have the honor to submit for transmission to Congress the following report of the operations of the Public Health Service for the fiscal year ending June 30, 1916. This is the forty-fifth annual report of the service, and covers the one hundred and eighteenth year of its existence.

As heretofore, the administrative work of the bureau has been conducted through seven divisions, in accordance with the organization provided by the act of July 1, 1902. In the following report the operations of the service have been set forth under the titles of the respective bureau divisions in the following order:

(1) Scientific research.
(2) Foreign and insular quarantine and immigration (mari-

time quarantine)
(3) Domestic (interstate) quarantine.
(4) Sanitary reports and statistics.
(5) Marine hospitals and relief.
(6) Personnel and accounts.

17) Miscellaneous. The administrative personnel of the bureau during the year has consisted of the following:

Surg. Gen. Rupert Blue.

Asst. Surg. Gen. A. H. Glennan, in charge of Division of Personnel and Accounts.

Asst. Surg. Gen. W. G. Stimpson, in charge of Division of Marine Hospitals and Relief.

Asst. Surg. Gen. L. E. Cofer, in charge of Division of Foreign and Insular Quarantine, July 1, 1915, to April 20, 1916.

Asst. Surg. Gen. J. W. Kerr, in charge of Division of Scientific Researchi.

Asst. Surg. Gen. W. C. Rucker, in charge of Division of Domestic Quarantine.

Asst. Surg. Gen. J. W. Trask, in charge of Division of Sanitary Reports and Statistics.

Asst. Surg. Gen. R. H. Creel, in charge of Division of Foreign and Insular Quarantine and Immigration, May 15, 1916, to June 30, 1916. Chief Clerk, D. S. Masterson.

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SCIENTIFIC RESEARCH.

The laboratory and field investigations of diseases of man and other public health matters have been conducted during the year through the Division of Scientific Research. The scope and progress of these investigations are described under subsequent appropriate headings. The investigations have been generally of a systematic character, but some have been undertaken in emergency situations. Among the diseases studied in the several laboratories and in the field are diphtheria, filariasis, malaria, pellagra, pyorrhea alveolaris, scarlet fever, trachoma, typhoid fever, typhus fever, and certain occupational diseases. In addition, studies have been made of problems of industrial hygiene, mental hygiene, school hygiene, rural sanitation, public health organization, and water supplies and sewage disposal. Numerous inquiries received through correspondence and otherwise indicate a growing interest on the part of the public in these subjects. In the case of pellagra, for instance, the demonstration that the disease can be cured and prevented by means of a properly balanced diet, and produced experimentally by an unbalanced diet, has attracted widespread attention. In consequence, physicians and health officers are making practical application of the results here and there where the disease is prevalent.

The problems of vocational diseases and industrial hygiene have likewise received increasing attention and have been subjects of enlarged studies; and these studies looking to the safeguarding of the health of industrial workers and the improvement of living conditions are of great importance to both employer and employee.

By reason of a special deficiency appropriation of $25,000 having been made available February 28, 1916, studies of rural sanitation previously begun were somewhat enlarged and special demonstrations undertaken. Health officials and the public generally have manifested an active interest in these studies and their results, and requests are being received from counties throughout the country for the undertaking of similar studies. A fundamental object of such work is the development of efficient sanitary organization and administration by counties and municipalities, without which no assurance can be had that rural sanitation will be permanently advanced. Malaria, pellagra, tuberculosis, and typhoid fever are types of the diseases in rural districts requiring intensive study. In fact, from the standpoint of these districts they may be regarded as the most important of all preventable diseases. Enlarged facilities for the conduct of investigations and encouragement of local health organization are therefore indicated.

DIPHTHERIA.

OUTBREAK AT MARTINSBURG, W. VA. On request of the State and local health authorities, Surg. Carroll Fox was detailed November 6, 1915, to make a study of an outbreak of

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diphtheria occurring in Martinsburg, W. Va., and vicinity and to recommend measures of control. While cases of the disease had been reported in August, 1915, with some increase in September, it was not until the schools opened during the latter month that a rapid increase in the number of cases was reported.

Advice was given by Dr. Fox as to restrictive measures. In addition to the isolation and quarantine of patients and contacts, it was advised that the release of patients from isolation be based on the findings of two negative cultures taken not less than 24 hours apart. In practically every case diphtheria antitoxin was used, and many of the contacts were given an immunizing dose. As a means of reopening the schools, which had been closed October 25, it was decided to open them by grades, a culture to be taken from the nose and throat of each pupil in order to detect and exclude carriers. Other measures were taken by the local authorities and the citizens in accordance with the recommendations made. In order to insure the use of cultural methods for purposes of diagnosis in release of patients from contact, arrangements were made for shipments of specimens regularly by the local authorities to the Hygienic Laboratory. The extent and results of this cultural work are referred to on page 89.

FILARIASIS. In the Southern Medical Journal for July, 1915, Dr. F. B. Johnson reported that out of 400 individuals examined by him at Charleston, S. C., 77 had been found infected with microfilaria (Filaria Bancroftá), the percentage of infection being 19.25. The seriousness of this tropical disease, better known as elephantiasis, and its marked prevalence in one southern city caused the service to take cognizance of the matter, with special reference to the possibility of prevention of the spread of the disease.

On August 13, 1915, Surg. Edward Francis was therefore instructed to undertake systematic investigations of the subject, using the marine hospital at Savannah, Ga., as headquarters for the necessary field and laboratory studies. The plans for the investigations contemplated (a) filarial surveys of a number of southern towns for the purpose of determining the extent and degree of prevalence of the infection; (b) a determination of the species of mosquito-carrier in the United States; and (c) means of prevention of the spread of filariasis.

Filarial surveye.—Blood examinations of a number of persons were made by Surg. Francis in seven southern towns, with the results indi. cated in the following table:

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Culex fatigansthe carrier.-In considering the species of mosquito responsible for the transmission of filaria, first attention was given by Surg. Francis to a survey of the mosquitoes found in the buildings of an infected institution. Of 1,000 mosquitoes captured in rooms occupied by inmates of such an institution, 902 proved to be Culex fatigans. Of 65 Culex fatigans caught on the walls and ceilings of rooms of the institution occupied by filarial patients, 13 were found on dissection to be infected with filariae. Of 100 Culex fatigans caught in rooms of the same institution occupied by patients in whose blood no microfilariae were found, 5 were found on dissection to be infected with filariae.

Of 81 Culex fatigans which bit the hands of filarial patients who introduced their hands into cages in which the mosquitoes were confined 54 were found on dissection to be infected with filariæ.

Prevention.-Inasmuch as filariasis is incurable and no means is known of ridding the blood of microfilariae, preventive measures are necessarily dependent upon mosquito eradication. This in the case of Culex fatigans is not difficult, because Culex fatigans is a domestic mosquito, breeding in fresh water, especially in cisterns, rain barrels, tubs, tin cans, and other unnecessary artificial containers of rain water in back yards. A municipal water supply, piped to every street, alley, and home of a town, coupled with ordinances requiring the use of the city water exclusively and the destruction of all collections of rain water, will rid any community of filariasis. A report of the findings and the measures to be taken was submitted to the city authorities.

HOOKWORM DISEASE.1

Status of hookworm campaigns.The five-year period of intensive campaign against hookworm disease, conducted by the southern State boards of health and financed by the Rockefeller Commission, has come to an end. Some of the States stopped the work on December 31, 1914, and by June 30, 1915, all of the State boards had either closed the campaign or changed the plan.

Some of the State boards have continued a plan of intensive community work looking to a reduction of soil pollution. This work is in a certain sense a continuation of or an outgrowth from the hookworm campaign.

Soil potłution.—That the ultimate eradication of hookworm disease lies in the prevention of soil pollution is not to be doubted, and with the gradual reduction of soil pollution a similar reduction of new cases of infection with hookworm disease is to be expected.

In the last annual report statistics were given showing that 250,680 rural homes presented an average sanitary index of only 6.3 per cent. Similarly, extensive statistics for the present fiscal year are not available, but there can be no doubt that certain of the country districts are awakening to the necessity for better home sanitation. This is notably so in those counties in which studies of rural sanitation have been made and in States in which these counties are located.

1 Clinical studies on hookworm disease are reported on page 91,

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