plementing this exhibit were models demonstrating the construction of rat-proof houses and stables, each model illustrating the various methods of rat proofing by the use of cement, metal flashing, brick walls, and the proper screening of openings. The pollution of wells from insanitary toilets was also demonstrated, a second model showing the improper and the proper construction of wells. Greatly enlarged models of the eggs, larva, and adult house fly were exhibited, together with similar models of the various stages of development of the Anopheles mosquito. With this latter group there were shown methods for the elimination of mosquito breeding places by filling, draining, oiling, and the stocking of pools with fish. A model of a sanitary contrasted with an insanitary dairy was an interesting feature of the exhibit, not only to milk producers but to milk consumers also. The most approved methods for the disposal of human excrement were demonstrated by models of sanitary toilets and sewage-disposal tanks, and in addition other models brought to the attention lessons in personal and community hygiene, such as the prevention of smallpox, the dangers of careless coughing, and the use of the common roller towel. A display of public health literature published by the service proved to be a most valuable part of the exhibit, resulting in many thousands of requests for pamphlets and reprints, and greatly augmenting its instructive features. Motion pictures and stereopticon lantern slides on health subjects were also provided and shown when opportunity developed.

The attendance exceeded all expectations. The total number of visitors for the two months ending June 30th was more than 348,000, a daily average of 6,500. In addition many thousands who could not be accommodated were turned away. The motion picture audiences varied, the average being about 2,000, but frequently the gatherings were composed of from 3,000 to 4,000 persons.

At the inception of the idea of a Government safety-first train the director thereof requested that an officer of the service be detailed to act as sanitary and medical officer. Accordingly, Senior Surg. Charles E. Banks was directed to assume this duty. A daily inspection of the entire equipment was made, including Pullman and dining cars, and all insanitary features noted were remedied. Pullman cars were in several instances disinfected with formaldehyde and special attention was given to cleanliness and order. The health of the men was looked after to the fullest possible extent, both the members of the crew and those in charge of the Government exhibits receiving the typhoid prophylactic. Water, milk, and other food supplies were regulated and careful inquiry made in advance concerning the healthfulness of the different communities, the occurrence of epidemics of smallpox necessitating the abandonment of stops at two different localities. Before the contemplated itinerary was completed Senior Surg. Banks was relieved by Asst. Surg. Liston Paine, who, with two attendants previously detailed to care for service exhibits, were continued on duty until the end of the fiscal year.

SANITARY WORK AT THE PANAMA-PACIFIC INTERNATIONAL EXPOSITION.

The work of sanitation at the Panama-Pacific International Exposition, outlined in the annual report for 1915, was continued during the year under the supervision of Senior Surg. C. C. Pierce.

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Although a large number of horses, cattle, and other animals were kept in the live-stock section, fly breeding was obviated by proper collection and disposal of stable manure and general cleanliness, particular care also being exercised in the collection and disposal of garbage in all parts of the exposition grounds. Places where food was prepared and sold were screened to prevent access of flies from outside sources. Close attention to the numerous fountains and other artificial collections of water prevented mosquito breeding.

During the latter months of the exposition rat evidence was observed in many of the buildings, necessitating poisoning and trapping operations. After the close of the exposition and during the demolition of the buildings extensive rat eradicative operations were conducted, a record of this work being found in the report dealing with service activities at San Francisco. All rodents obtained were examined for plague infection at the Federal laboratory, none being found infected.

The inspection of employees of the various commissions and of the exposition company was continued, no communicable diseases being discovered during the year. A number of cases of diphtheria occurred among guests at one of the hotels. The patients were sent to the San Francisco Isolation Hospital and proper precautions taken to prevent secondary cases, none of which developed.

The customary control of the water supply and purification plant was continued by means of bacteriological examinations, both before and after chlorination, showing that the purifying process was effective.

Sanitary inspections of over 150 concessions were made each month, the reinspections totaling over 1,200 monthly. The insanitary conditions corrected under orders from the inspectors averaged 150 each month.

THE SERVICE EXHIBIT AT THE PANAMA-PACIFIC INTERNATIONAL

EXPOSITION.

A description of the service exhibit at the Panama-Pacific International Exposition was included in the annual report for 1915. Some few additions were made to the exhibit material during the fiscal year. A total of several hundred thousand persons visited the exhibit, the usual number of officers having been present to explain its various phases and to demonstrate working processes.

Upon the termination of the exposition a portion of the material was sent to Panama to be installed under the direction of the chief quarantine officer as a service exhibit at the international exposition held by the Panama Government. The remainder, constituting the greater part of the material, was shipped to the Panama-California Exposition at San Diego, to remain during the calendar year 1916.

THE EMERGENCY HOSPITAL, PANAMA-PACIFIC INTERNATIONAL

EXPOSITION.

The operations of the emergency hospital at the Panama-Pacific International Exposition were continued during the year. This hospital was established and operated on the exposition grounds in order that first aid might be effectively provided without undue delay

and as a necessary adjunct to the proper sanitation of the fair, the prompt recognition and isolation of cases of infectious disease being an important consideration in disease prevention. The institution as organized was strictly an emergency hospital under the control and management of the Public Health Service, but with the expenses of maintenance paid for by the exposition authorities. The equipment was complete in every respect and was installed as a working exhibit of the service.

From the beginning of the fiscal year until the close of the exposition, December 4, 1915, 4,025 patients were treated or cared for, this number not including those who were re-treated or patients receiving their second or third injection of typhoid prophylactic. From the date of establishment of the hospital until the close of the exposition 14,337 treatments were recorded, the greater number of these cases during the preexposition period being accidents and injuries, while during the time the exposition was open the usual emergency medical and surgical cases were most numerous. An adequate ambulance service was maintained and accurate records were preserved of all cases treated.

After the close of the exposition the Public Health Service retained control of the hospital during the period of demolition, at the request of the exposition authorities. The operating force was reduced to the regular employees, the medical officer visiting the institution from time to time as necessity required. During this period the hospital became practically an out-patient clinic, patients requiring hospital treatment being immedately transferred to various hospitals in San Francisco. The total number of patients treated during the postexposition period was 1,240, most of whom were workmen injured while engaged in the removal of exhibits or the demolition of buildings.

STEREOPTICON LOAN LIBRARY.

As mentioned in the annual report for 1915 the facilities of, the stereopticon loan library, originally established for service officers, were extended to scientific investigators, health departments, and social workers throughout the country. The number of lantern slides has steadily increased, over 3,000 views being on file, with a total of approximately 12,000 slides. The usefulness of the loan library has been commensurate with its growth and extension. Slides are forwarded to lecturers in every portion of the country, used before public gatherings or scientific bodies, returned to the library, and again placed in circulation. During the fiscal year 372 loans of this character were made, requests in many instances being denied on account of lack of material. Occasionally the slides are retained for several weeks, and in the case of service officers for several months, being shown to many different audiences. The number of slides in circulation at the end of the fiscal year exceeded 5,000, and the total number loaned during the year was 21,480. If the average audience consisted of 200 persons, and each set of pictures was shown twice, figures which are the very minimum, over 148,000 persons profited from these visual lessons in sanitation.

During the year two additional motion-picture films were acquired, and the limited number of reels on hand have been in constant use.

Requests for good motion-picture films on health subjects are being constantly received, the public interest in motion pictures being at its height, and a far larger supply of films is urgently needed, particularly by service officers engaged in field work. Only 6 films are in possession of the bureau, and the total number of reels is less than 10. When it is considered that motion pictures constitute one of the best methods of teaching the lessons of sanitation and disease prevention, the inadequacy of this supply becomes all the more apparent.

EDUCATIONAL WORK.

Lectures by service officers on health topics have been given in connection with the field work in various sections of the country, and on different occasions upon request. Public-health lectures of this character are highly important adjuncts to the effective performance of the duties of the service, besides being of assistance to other health organizations, in their campaigns for reform. Audiences in poliomyelitis centers have been instructed in each of several foreign languages as to the measures to be adopted for the suppression of the disease. The Spanish-speaking population along the Mexican border have had the story of the transmission of typhus explained to them in terms which they could easily comprehend, while scientific organizations have heard discussions on the technical phases of many public-health problems. It is to be regretted that requests for addresses by officers can not be complied with in every instance, owing to the limited number of men available for this duty.

The press service has been continued throughout the year with a steadily increasing number of newspapers, magazines, and even of medical journals using the material on health topics furnished. During the last month of the fiscal year 702 newspapers voluntarily forwarded clippings showing the use of Health News items on 1,205 occasions, and many times that number have utilized material of this character, of which no record has been made. Extensive circulation has been given by the press of the country to articles on such subjects as the following: "The prevention of pneumonia," "How the Government is meeting the malaria problem,"" Housing and health," "Pellagra prevention," "Give the baby a chance," and other topics. In addition, information has at all times been freely furnished the press for special articles relating to health or disease prevention.

SANITARY REPORTS AND STATISTICS.

The work of the division of sanitary reports and statistics consists principally of (1) the collection of information of the prevalence and geographic distribution of preventable diseases throughout the United States and of certain major epidemic diseases throughout the world; (2) the collection of laws and regulations adopted by States and cities on matters pertaining to the public health; and (3) the publication (a) of current information regarding the prevalence of diseases, (b) of laws being enacted and court decisions rendered on matters pertaining to the public health, and (c) of other information useful to the health officer in his work. The medium of publication is the Public Health Reports, which are issued weekly and sent to health officers and others engaged in sanitary work."

REGISTRATION AREA OF KNOWN DISEASE PREVALENCE.

The fourteenth annual conference of State and Territorial Health Authorities with the United States Public Health Service, held in Washington, May 13 and 15, 1916, adopted the following resolution:

Resolved, That this conference believes it is now feasible to create a “registration area of known disease prevalence," and recommends that the Surgeon General inquire into its practicability from the standpoint of the Public Health Service and determine the standard for admission of States and cities thereto.

The establishment of such an area would be a decidedly progressive step. It would mark the turning point in public health administration. It would be an incentive to intelligent, effective work in the control of disease, inasmuch as it would make available that first essential of such control, a knowledge of where preventable diseases were and the conditions under which cases were occurring. Such a registration area could be established and supervised and the morbidity data compiled simply by the addition of a few clerks to the present personnel of the division.

COLLABORATING EPIDEMIOLOGISTS.

Collaborating epidemiologists have been appointed in the following States: Maryland, Massachusetts, South Carolina, Arkansas, Louisiana, Virginia, Minnesota, Kansas, Washington, Mississippi, and Connecticut. These officers are appointed one to a State, and their duties are to keep the bureau currently informed of the occurrence of preventable diseases in their respective jurisdictions.

In Kansas the collaborating epidemiologist distributes monthly to the practicing physicians of the State reply post cards on which they report the number of cases of notifiable diseases treated by them during the preceding month. These serve as a useful check upon

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