rabid animals. There is every reason to believe that these losses could have been entirely prevented by the adoption of muzzling ordinances in communities originally infected, thus avoiding the dissemination of the infection to virgin territory. A similar situation holds true for Alaska at the present moment. Rabies does not exist among the dog population of the territory, and the establishment of an adequate quarantine would preclude the possibility of its introduction. If quarantine restrictions are not established it is believed that it is only a matter of time before the disease becomes endemic, if not epidemic, thereby bringing about serious losses to the people of that territory.

SANITARY, EDUCATIONAL, AND RELIEF WORK IN ALASKA.

The sanitary and relief work among the natives of Alaska has been continued throughout the year in cooperation with the Bureau of Education, Department of the Interior, as provided for by an act of Congress. In order to be in closer and more direct communication with the officials of the Bureau of Education in charge of the Alaska schools, whose headquarters are at Seattle, the station of the medical officer in charge, Passed Asst. Surg. Emil Krulish, was changed at the beginning of the year from Juneau, Alaska, to Seattle, Wash., thereby facilitating the supervision of the medical service.

The medical officer has been in constant communication with the officials of the Bureau of Education on matters pertaining to hygiene, sanitation, maintenance of hospitals, and the general administration of the medical service in Alaska. The requisitions for medical supplies for hospitals and the 70 schools which are the relief stations of the service were prepared by the medical officer and applicants for the position of physician and nurse were examined and the names of those qualified submitted to the commissioner for appointment. A large number of letters from teachers in the field regarding the treatment and care of the sick were answered. Estimates for the medical service were prepared and submitted to Congress.

The plans for the proposed hospital to be erected at Juneau were drafted by the medical officer, who also selected the furniture, fixtures, and the complete equipment of the institution. The hospital mentioned is completed and is a modern two-story frame structure; one story is devoted to the care of patients and the other is used as living quarters for the staff and attendants. This hospital was opened to receive patients in May and promises to become one of the most important factors in checking the ravages of disease among the native population. Following the completion of the institution the medical officer in charge, upon the request of the Commissioner of Education, proceeded to Juneau and made an inspection of the hospital and assisted in its organization.

The annual reports of the teachers of the Alaska school service indicate that the health of the natives has been exceptionally good and that the sanitary conditions in the villages and homes are improving. The elimination of the common towel and drinking cup from the schools, the medicine chest and medical handbook with which are teachers are supplied, and talks on hygiene and sanitation are responsible in a great measure for these encouraging reports. The teachers are the only "doctors" and health officers in most of the villages, and their work has greatly promoted the comfort and general welfare of the communities in which schools are located.

The first Territorial Legislature enacted a law authorizing all teachers employed under the Bureau of Education to serve as health officers in their respective native settlements. No epidemics of serious disease have been reported during the year; likewise the morbidity and mortality statistics show a marked decline over previous years.

To those interested in the welfare of the natives of Alaska the work in sanitation and medical relief is very gratifying; the prospects for the uplift and preservation of these people are favorable, provided proper support is received from Congress. Tuberculosis of all forms, eye troubles, and venereal diseases are still very much in evidence, and immediate action is necessary to eliminate them from the various communities. A liberal appropriation for medical relief is required in order to extend the work to other localities; at present only a small portion of the 25,000 natives can be reached by this intensive campaign of disease eradication and the current appropriation of $25,000 is entirely inadequate to the demand.

The supervision over health activities in white settlements is vested in the governor of Alaska as ex officio commissioner of health; four assistant commissioners of health, each in charge of one of the judicial divisions of Alaska; and the local boards of health. The assistant commissioners of health are physicians appointed by the governor and serve without compensation, and the members of local health boards are appointed by the mayor of the town or elected by the people.

The health laws and regulations of the Territory of Alaska are modern in every respect and compare favorably with those of any State, but their execution outside of the modern towns is difficult and at times impracticable on account of the nature of the country, climate, and the more or less floating population.

An unusual number of cases of typhoid have been reported in Juneau, the largest town in Alaska, which, in the opinion of the medical officer, were due to imported cases polluting the water supply of the town. The population of Alaska is increasing annually, and it is to be expected that unless proper precautions are taken infectious diseases will become more prevalent and occur in serious epidemics.

INTERSTATE QUARANTINE REGULATIONS.

Revision of the interstate quarantine regulations, referred to in the annual report for 1915, was completed during the year and the revised regulations were promulgated by the Secretary of the Treasury January 15, 1916, becoming effective from that date. The regulations were promulgated pursuant to the act of Congress approved February 15, 1893, entitled "An act granting additional quarantine powers and imposing additional duties upon the Marine Hospital Service," and have for their object the prevention of the introduction of contagious or infectious diseases from one State of Territory into another State or Territory or the District of Columbia and the maintenance of cars, vessels, vehicles, or conveyances operated in interstate traffic in a clean and sanitary condition. All preexisting regulations were revoked from the date of issuance of the revised requirements.

The regulations as promulgated were drafted by the interstate sanitary board, convened under bureau orders of February 2, 1915,

and were approved by the annual conference of State and Territorial health authorities with the service, held in Washington May 13 of that year. They have been issued as a service publication.

As an appendix to the Interstate Quarantine Regulations information relating to the use of disinfectants was also published. This comprised data concerning physical, gaseous, and chemical disinfectants, the methods of production, application, and limitations of each, together with descriptive methods of the disinfection of compartments, bedding, cooking utensils, and other material of cars and vessels. Agents for the destruction of vermin, with their mode of application, were similarly described.

Already a noticeable improvement in the sanitation of common carriers has been effected since the issuance of these regulations and in time it is believed that this effect will be even more salutary. It is realized, however, that the mere presence of certain regulations does not guarantee their observance and that additional efforts and administrative facilities will be required before ideal conditions can be brought about. The necessity for an adequate inspection service for the purpose of reporting violations or nonobservance of existing regulations and variations from recognized standards of cleanliness or other derelictions, has long been apparent. Under bureau order of October 4, 1913, and paragraph 138 of the regulations governing the Public Health Service, commissioned_medical officers when traveling under official orders on trains and vessels engaged in interstate traffic are required, when practicable, to make observations of the sanitary conditions thereof, forwarding to the bureau immediately upon the completion of the journey a report of the findings. During the year over 200 reports of this character have been received, this information only covering the more important routes of travel in the United States. Many of these reports showed favorable sanitary conditions but a certain proportion described unhygienic and even dangerous surroundings; in these instances the transportation lines concerned were immediately notified of the insanitary features with the request that so far as possible they be corrected. While this system has accomplished considerable toward the bettering of sanitary conditions it naturally has very distinct limitations, one of which is the inability of officers to conduct reinspections. In addition to the aforementioned inspections officers performing various lines of duty, more particularly those engaged in the investigation of water supplies, have similarly studied the sanitary condition of trains and vessels at certain terminal stations. While advantage has been taken of every opportunity to perform inspections on both trains and at terminal stations, the work is recognized as wholly inadequate, especially in view of the total mileage, the number of carriers, and the passengers carried. In their efforts to bring about improved conditions on cars and vessels common carriers have found the existing regulations of practical value. Heretofore transportation lines under the provision of common law have had the right to refuse for transportation persons suffering from communicable disease, but the exercise of that right was seldom practiced. Now that specific provision has been made prohibiting common carriers from accepting for interstate traffic persons afflicted with certain communicable diseases and permitting the transportation of other infected persons only upon the exercise of

proper sanitary precautions, more reasonable and satisfactory rulings will obtain. In the same manner the proscribing of definite sanitary standards for cars, vessels, and vehicles will invite attention to these matters and should result in improved conditions.

WATER AND ICE SUPPLIED BY INTERSTATE CARRIERS.

The enforcement of the various amendments to the interstate quarantine regulations relating to the purity of water and ice furnished by common carriers to passengers on board cars, vehicles, and vessels operated in interstate traffic has continued during the year. The amendments referred to, with the exception of those parts of amendment No. 6 requiring the certification of ice and the cleansing of containers by live steam, were incorporated in and became a part of the existing interstate quarantine regulations as promulgated January 15, 1916.

In 1913, following the issuance of requirements for the bacteriological examination of ice brought into direct contact with water for human consumption, a widespread introduction of separate containers for ice resulted, transportation lines finding it more economical to furnish separate containers than to provide for bacteriological examinations every six months. This was an extremely important outcome, inasmuch as it was realized that clear ice was rarely of danger unless contaminated in handling and that the double-tank system would obviate this difficulty. Moreover, it was believed that specific provision for the safe handling of ice each day of the year was in reality more important than the results obtained from semiannual bacteriological examinations. For these reasons that portion of the regulations bearing on this subject was so modified as to require that the ice used for cooling water shall be clear natural ice, or ice made from distilled water, or water properly certified and further providing that before the ice is placed in the water it shall first be carefully washed with water of known safety, and handled in such a manner as to prevent its becoming contaminated by the organisms of infectious or contagious diseases; the foregoing requirements not to apply to ice which does not come in contact with the water which is to be cooled.

The same system of water certification has been followed as in previous years. Tabulated lists are maintained of all railway and steamship supplies, the certificates as received being checked against these lists. Compliance with the recently promulgated bacteriological standard of purity has been required, and common carriers have been obliged to conform to the standard there set forth, fewer complaints having been received during the fiscal year than at any previous time of inability to meet these requirements. The cooperation of State and municipal health authorities has been essential in the enforcement of water regulations, and the aid and assistance rendered by those bodies has been of inestimable value. Wherever polluted supplies have been discovered their use has been immediately discontinued or provision made for their purification in such a manner as to render them incapable of conveying disease, the latter procedure seldom being required, owing to the elasticity of railway supplies. Water of a suspicious nature is reexamined until its quality is definitely determined.

The following table indicates by States the number of water supplies used by common carriers in each State, the number of water

supplies covered by certificates on file, the percentage of water supplies examined, the total number of certificates for these supplies, and the number of polluted sources where the use of the water was forbidden. This table in no way indicates the measure of success of the enforcement of the regulations governing water supplies on interstate carriers, for it must be remembered that the discontinuance of uninvestigated sources of supply, such as wells, brooks, pools, and streams, has been of far greater importance than the relatively few polluted sources determined by examination. Further, the noticeable improvement in the methods of handling water in order to avoid contamination has been of inestimable benefit, although the necessity for more rigid adherence to sanitary principles is still evident.