ANNUAL REPORTS.

This report contains a concise but thorough summary of the operations of the Public Health Service for the year, outlining the activities of the service in its various fields of work.

HYGIENIC LABORATORY BULLETINS.

The bulletins of this series are technical in nature and consequently are distributed only to those showing a need for them, such as laboratories, libraries, and technical workers engaged in research work. During the fiscal year there were issued in this series bulletins as follows:

101. 1. Complement Fixation in Tuberculosis. By A. M. Stimson.

2. Report of an Investigation of Diphtheria Carriers. By Joseph Goldberger, C. L. Williams, and F. W. Hachtel.

3. The Excretion of Thymol in the Urine. By Atherton Seidell.

4. The Sterilization of Dental Instruments. By H. E. Hasseltine.

5. A Modification of Rose's Method for the Estimation of Pepsin. By Maurice H. Givens.

1. In this article the literature on the subject of complement fixation as applied to tuberculosis is analyzed and original work reported. Although the test is inconstant, positive results with certain antigens appear to be highly specific and a field for the test especially in institutional work is anticipated. The value of repeated tests in the same individual is emphasized, and consecutively negative results in apparently cured or arrested cases are interpreted as corroborative of the clinical findings.

2. In this paper the cultural findings with respect to the diphtheria bacillus in over 400 apparently healthy people are recorded. The examinations were made shortly after a time of greatly increased prevalence of diphtheria, with the object of determining how great a proportion of the population had become carriers. Nearly 1 per cent were found to harbor organisms morphologically diphtheria bacilli, but virulence could be demonstrated in only a small proportion of the cultures tested. The Hoffman bacillus was found in over 40 per cent of individuals. The advantage of taking cultures from the nose is emphasized.

3. A method for determining quantitatively the thymol content of the urine after administration of the drug is described in this article. Taken in conjunction with a similar analysis of the feces, the results of applying this test indicate that from one-half to two-thirds of the thymol administered is destroyed or fixed in the body. These facts are valuable in considering advantageous substitutes for thymol in the treatment of hookworm disease.

4. It has been recognized by dentists throughout the country that some efficient means for the sterilization of dental instruments should be devised and with this object in view the officials of several dental societies asked the Surgeon General of the Public Health Service to work out in detail a method for sterilizing dental instruments and appliances. As a result of this request the laboratory undertook an extensive series of experiments with this end in view. A simple sterilizing apparatus was devised by the use of which the various instruments used in the dental profession may be quickly and effi

ciently sterilized. The paper also makes suggestions as to dental hygiene. A wide demand for this bulletin among dentists has been

shown.

5. The fifth article describes a modification of Rose's method for estimation of pepsin.

102. 1. Digitalis Standardization. The Physiological Evaluation of Fat-Free Digitalis and Commercial Digitalis. By George Roth. 2. Preliminary Observations of Metabolism in Pellagra. Hunter, Maurice H. Givens, and Robert C. Lewis.

By Andrew 1. The necessity for satisfactory standardization of digitalis preparations has long been recognized, and with the object of devising a satisfactory standard, an extensive series of investigations has been carried on in the division of pharmacology. The results are contained in the first paper of this bulletin.

2. The second article gives the results of certain observations of metabolism in pellagra, which constitute valuable additions to the bulk of evidence on the subject from which one day statistical conclusions can be derived.

103. 1. Chemical Changes in the Central Nervous System as a Result of Restricted Vegetable Diet. By Mathilde L. Koch and Carl Voegtlin. 2. Chemical Changes in the Central Nervous System in Pellagra. By Mathilde L. Koch and Carl Voegtlin.

The two papers in this bulletin compare the chemical changes in the nervous system resulting from restricted vegetable diets, with those observed in pellagra. Certain points of close resemblance are demonstrable by chemical examination. In pellagra the changes are most marked in the spinal cord and principally involve certain lipoids.

104. Investigation of the Pollution and Sanitary Conditions of the Potomac Watershed. With special reference to Self-Purification and the Sanitary Condition of Shellfish in the Lower Potomac. By Hugh S. Cumming; Plankton Studies by W. C. Purdy and Hydrographic Studies by Homer P. Ritter.

This bulletin records the results of one of a series of investigations made and contemplated by the Service, the chief object of which is to determine the sanitary features of various interstate streams of different types both physically and in relation to the population and human activities on their basins. When general facts applying to streams of a given type have been determined, the work of ascertaining the sanitary condition of other streams of the same type is much facilitated.

The Potomac River really represents two very different types of stream; the one relatively rapidly flowing, traversing mountainous sparsely populated country, with nevertheless a considerable amount of manufacturing activity along its banks; and the other, represented by the lower portion, essentially a tidal estuary, having a large city with heavy crude sewage pollution at its head, and supporting a large shellfish industry in the lower saline reaches.

The bulletin records a sanitary survey of the upper watershed and the effects of the sewage and industrial pollution on the condition of the water at various sections. The most interesting feature of the lower river is the degree and manner of purification accomplished by natural agencies. The to-and-fro motion of the tides has the effect of greatly lengthening the time during which a given particle of

!

water is subjected to the agencies inimical to pollution, so that before the shellfish bearing area is reached, the water has been restored to a good sanitary condition. The very few instances of pollution of oyster beds are traced to local conditions.

Incidentally, important contributions to the bacteriology and chemistry of water, to the methods of securing samples, and the flora and microscopic fauna of the river, having sanitary significance, are included. The text is well illustrated with maps, charts, diagrams, etc., and pictures of aquatic forms of life.

105. Digest of Comments on the Pharmacopoeia of the United States of America and on the National Formulary. By Martin I. Wilbert.

This bulletin is a continuation of previous digests of comments and brings the work up to December 31, 1914. Previous bulletins along this line have been in great demand.

PUBLIC-HEALTH BULLETINS.

These bulletins are less technical in character than the preceding series. In fact, many of them are popular in style and prove very useful in connection with the vigorous campaigns for rural sanitation being carried on by the service in the Southern States. However, generally speaking, and especially with regard to the compilations of State laws on various subjects, these bulletins are found extremely valuable by health officers and officials who are charged with the duty of combating epidemics of disease.. They frequently learn from these documents that the problems which trouble them have already been solved by other States, and avail themselves of the example of salutary legislation by which the desired result is accomplished. An accurate idea of these documents can be best obtained by reference to the following list issued during the last fiscal year:

71. Studies in Vocational Diseases. I. The Health of Garment Workers. By J. W. Schereschewsky. II. The Hygienic Conditions of Illumination in Workshops of the Women's Garment Industry. By J. W. Schereschewsky and D. H. Tuck.

This bulletin reports a comprehensive investigation of the health of workers in the cloak and suit, and dress and waist industries in New York City and of the hygienic conditions under which they work. The scope and results of this investigation were described in the last annual report, pages 46–49.

72. Transactions of the Thirteenth Annual Conference of State and Territorial Health Officers with the United States Public Health Service, Washington, May 13, 1915.

The following subjects were taken up at the conference: Interstate Quarantine Regulations, morbidity reports, pollution of navigable waters, malaria, sanitation of public conveyances, transportation of tuberculous persons, rural sanitation, pellagra, sickness insurance, and leprosy.

73. Tuberculosis Among Industrial Workers. Report of an investigation made in Cincinnati, with special reference to predisposing causes. By D. E. Robinson and J. G. Wilson. 143 pages.

The investigation here reported was described in the last annual report, pages 49-50. The study was not limited to the industries

alone, but was extended into other fields in an attempt to determine the most important causes predisposing to the high mortality from tuberculosis.

74. Investigation of the Pollution of Tidal Waters of Maryland and Virginia, with special reference to shellfish-bearing areas. By Hugh S. Cumming. This is the second comprehensive report on the pollution of coastal waters, the first having been published as Hygienic Laboratory Bulletin No. 104. The investigation here reported was described in the annual report for 1915, pages 108-110.

75. Studies Upon Leprosy, XXVIII-XXXIII. By G. W. McCoy, H. T. Hollmann, W. J. Goodhue, M. T. Clegg.

The results of investigations made at the leprosy investigation station, Hawaii, are presented in these six papers. They comprise articles on the chaulmoogra oil treatment of leprosy, carbon dioxide snow in the treatment of leprosy, B. Lepre in the circulating blood of lepers, leprosy in a nineteen months old child, the cultivation of a nonchromogenic acid-fast bacillus from a case of nodular leprosy, and a note concerning the favorable influence of glucose on the growth of acid-fasts.

76. Health Insurance. Its relation to the public health. By B. S. Warren and Edgar Sydenstricker.

This bulletin deals with the prevalence and cost of sickness among wageworkers, the conditions causing it, the responsibility for those conditions, and the need of cooperative action for relief and prevention. A scheme of health insurance is proposed and discussed.

PUBLIC HEALTH REPORTS.

These reports are issued on Friday of each week, and in accordance with law are distributed to "health officers," "collectors of customs, and "other sanitarians." It is in these weekly reports that the health officers of the country find much of their best material for safeguarding the health of their respective communities. The reports contain each week statistics on the prevalence of disease throughout this and foreign countries, together with sanitary legislation enacted by States and municipalities to meet these diseases and insanitary conditions and court decisions construing various laws, State and national, relating to public health. The weekly editions during the past year reached a maximum of 15,650 copies.

REPRINTS FROM THE PUBLIC HEALTH REPORTS.

The reprints are "separates" of leading articles appearing each week in the Public Health Reports. By reissuing them as separates in pamphlet form, it becomes possible to distribute them in large quantities at comparatively small expense and thus reach a very large number of readers who do not receive the weekly Public Health Reports. The value of these "reprints" to the public will become evident from a reading of the following list of titles of those issued last year:

285. The Model State Law for Morbidity Reports. As amended by the thirteenth annual conference of State and territorial health authorities with the United States Public Health Service, Washington, May 13, 1915. July 2, 1915.

286. Zooparasitic Intestinal Infections.

An analysis of infections found among

1,287 school children (776 white, 511 negro) of the city of X. By

C. W. Stiles. July 2, 1915.

287. The Practical Use of Disinfectants. By H. E. Hasseltine. July 2, 1915. 288. Intestinal Infections. The school grades attained by 2,166 white school children (1,062 boys, 1,104 girls) in the city of X, classified by age, sanitation, and intestinal parasites. By C. W. Stiles. July 2, 1915. 289. Post-Vaccination. Studies on its relation to vaccine virus. By John F. Anderson. July 16, 1915.

290. Anopheles as a Winter Carrier of Plasmodium. The mosquito as a prophylactic indicator. By M. Bruin Mitzmain. July 16, 1915.

291. The Notifiable Diseases. Prevalence during 1914 in cities of over 100,000. Diphtheria, gonorrhea, leprosy, malaria, measles, epidemic cerebrospinal miningitis, poliomyelitis, rabies, scarlet fever, smallpox, syphilis, tuberculosis, and typhoid fever. Cases reported, case rates per 1,000 population, and fatality rates per 100 cases. July 23, 1915.

292. Embalming. Indefinite preservation of the body. By Edward Francis. July 30, 1915.

293. Methods of Destroying Lice. Abstract of article by J. Parlane Kinloch, M. D. August 6, 1915.

294. The Number and Kind of Drug Addicts. By Martin I. Wilbert. August 6, 1915.

295. Standard for Determining the Purity of Milk. The limit of error in bacteriological milk analyses. By H. W. Conn, Wesleyan University, Middletown, Conn. August 13, 1915.

296. The Trachoma Problem. By J. W. Kerr. August 20, 1915.

297. The Pharmacy of Useful Drugs. By Martin I. Wilbert. August 27, 1915. 298. The Notifiable Diseases. Reported prevalence during 1914 by States.

Dengue, diphtheria, gonorrhea, leprosy, malaria, measles, epidemic cerebrospinal meningitis, poliomyelitis, rabies, Rocky Mountain spotted fever, scarlet fever, septic sore throat, smallpox, syphilis, tuberculosis, typhoid fever, and typhus fever. Cases reported, indicated case rates per 1,000 population and indicated fatality rates per 100 cases. September 3, 1915.

299. Essentials of Swimming-Pool Sanitation. By Wallace A. Manheimer, Ph. D. September 17, 1915.

300. Public Health Administration in Chicago, Ill. A study of the organization and administration of the city health department. By J. C. Perry. August 20-September 24, 1915.

301. Tobacco and Snuff: Their use by white school children in the city of X. By C. W. Stiles and D. N. Richards. October 1, 1915.

302. Industrial Hygiene. A plan for education in the avoidance of occupational diseases and injuries. By J. W. Schereschewsky. October 1, 1915. 303. Heights and Weights of Children. Classification, by age and by sanitation, of 1,652 white school children (771 boys, 881 girls) in the city of X. By C. W. Stiles and George A. Wheeler. October 8, 1915.

304. An Efficient Liquid Disinfectant. A formula by which one can be readily prepared. By Albert F. Stevenson. October 8, 1915.

305. Cosmetics as Drugs. A review of some of the reported harmful effects of the ordinary constituents of widely used cosmetics. By Martin I. Wilbert. October 15, 1915.

306. Lung Capacity of Children. Spirometer tests of 1,618 white school children (751 boys, 867 girls) in the city of X. By C. W. Stiles and Floyd Graves. October 15, 1915.

307. The Prevention of Pellagra. A test of diet among institutional inmates. By Joseph Goldberger, C. H. Waring, and David G. Willets. October 22, 1915. 308. The Prevalence of Pellagra. Its possible relation to the rise in the cost of food. By Edgar Sydenstricker. October 22, 1915.

309. Tuberculosis: With special reference to its epidemiology transmissibility and prevention. By George M. Kober, M. D. October 29, 1915. 310. The Division of Sanitary Reports and Statistics. Bureau of the Public Health Service. November 5, 1915.

311. Experimental Pellagra in the Human Subject Brought About by a Restricted Diet. By Joseph Goldberger and G. A. Wheeler. November 12, 1915.