also made of conditions which brought about the suspension of these dusts, and ways and means by which they could be eliminated or minimized were devised. Heat hazard.-During the preliminary work of this survey a large amount of data were collected regarding the exact conditions of temperature and humidity to which steel workers are exposed. Studies based on this data were instituted with a view to determining means of mitigating this health hazard. Drinking-water facilities.-Intimately related to the foregoing is the problem of furnishing drinking water in a satisfactory manner to those employed in this industry. A study was made of the requirements of the steel workers and of the problems to be overcome in connection with installing drinking-water systems. Hazards of illumination.-Another feature of the steel industry studied was the exposure of workers to various industrial lights of great intensity, accompanied in many instances by marked contrast, and to lights which have been suspected of injuriously affecting the eyes because of their spectral composition. Data and information were collected in order to determine the length of time to which steel workers must of necessity be exposed to these industrial lights while carrying on their duties, the precautions taken by the employers to protect the employees, and the precautions taken by the steel workers themselves to the same end. With the assistance of Assistant Physicist D. H. Tuck photometric readings were taken of the various industrial lights of this industry during the various stages of the manufacturing processes in which they occur. As a result of these studies valuable data were collected which will aid those in this industry concerned in mitigating the industrial-light hazard. A survey was also made of several plants in order to determine the systems of illumination at present installed. The particular needs of the workers in this industry in regard to illumination were taken up, and ways and means were considered by which the present system could be improved. Installation of a system of artificial illumination in a steel plant is attended by many difficulties, and the most efficient system must of necessity be determined as a result of some experimentation. Means by which this can be accomplished are now under consideration. Medical-relief stations. As the medical relief afforded the employees in an industrial establishment is a very important factor in the maintenance of the health of the employees, a study was made of existing medical-relief systems in this industry and the particular requirements which should be fulfilled by such a system. As a result of these studies data were collected which made possible certain recommendations regarding the organization and operation of a medicalrelief system in a steel plant, including construction and equipment of an emergency hospital, first-aid work, and instruction about the plant, medical supervision of employees, plant sanitation, industrial hygiene, and related subjects. HEALTH INSURANCE. The investigation of health insurance begun in cooperation with the Commission on Industrial Relations has been continued inde63887°-H. Doc. 1493, 64-2-4 pendently by Surg. B. S. Warren during the past fiscal year. He has had the assistance of Edgar Sydenstricker, public health statistician. Information and data have been collected along the lines previously reported and special attention has been paid to studies of the economic aspects of the problem of the health of wage earners. In addition to the foregoing, a review of health insurance plans in this country is being made as an aid in the consideration of health insurance from a public-health standpoint. Survey of health insurance in relation to the public health.-During the year a part of the results obtained in this investigation was published as Public Health Bulletin No. 76, "Health Insurance: Its Relation to the Public Health." The bulletin presents briefly the need for more adequate measures for the relief and prevention of sickness among the wage-working population, especially among the unskilled, low-paid group, and suggests a governmental healthinsurance system as a remedy worthy of careful consideration in this connection. It is emphasized that such a system should be based squarely upon the fact that all three groups-worker, employer, and public-are responsible in varying degrees for the conditions causing disease, and should therefore share in the efforts to improve them. The conclusion reached is that a health-insurance system would not so much introduce ideas and practices new to this country as it would utilize existing plans and principles in a more effective way. The real problem is declared to be one of organization. Coordination of health insurance system with health agencies.Further investigation of the operation of existing forms of health insurance will be made in order to determine the relation that should be borne by existing health agencies to any proposed healthinsurance laws. It is believed that the United States should avoid the mistakes which foreign countries have made in not making proper provision for correlating health-insurance agencies with other health agencies. As yet, however, none of the legislative measures proposed has contained anything more than provisions for the relief of sickness. It may be that the provision for the support of the insurance funds by contributions from employers, employees, and the State will create a continuous economic pressure to reduce these contributions by preventing sickness; but no machinery has been provided which may be used by the groups feeling this economic pressure to prevent sickness. In view of the possibility of the failure to include disease-preventing provisions in the laws, health officials should cooperate with those framing health-insurance measures. In this connection special consideration should be given to the report on health insurance adopted by the fourteenth annual conference of State and Territorial Health Officers with the United States Public Health Service, held in Washington May 13-15, 1916. This report summarizes the fundamental provisions which on the basis of the present investigation it has been concluded should be embodied in any health-insurance measure proposed for National or State Governments.1 Increase in interest in health insurance.-During the year there has been increasing interest in the subject of health insurance on the part of the public, employers, employees, and the medical profession. The 1 Reprint 352 from Public Health Reports. committee on social insurance of the American Association for Labor Legislation has drafted a model bill, slightly modified forms of which have been introduced in several State legislatures. The Legislatures of California and Massachusetts have passed laws providing commissions for the investigation of the subject. A resolution providing for a national commission for study of the subject has been favorably reported in the House of Representatives. In addition, various national organizations, including the American Medical Association, have appointed committees for the study of the various features of health insurance. In view of this active interest there is reason to believe that the enactment of health-insurance laws will eventually follow. Statistics of disability.-In connection with the investigation of health insurance statistics of disability in the United States have been compiled by Surg. Warren and Mr. Sydenstricker and published in the Public Health Reports, being issued as Reprint No. 335. STUDIES OF CHILD-LABOR PROBLEMS IN MASSACHUSETTS IN RELATION TO HEALTH. In January, 1915, on request of the Massachusetts Child Labor Committee and the Massachusetts State Board of Labor and Industries, Asst. Surg. M. V. Safford was instructed to cooperate with these agencies in studies of the influence of occupations on the health of persons during the period of adolescence, with the view to standardizing methods of oversight of such persons in order to protect their health in the industries. More efficient methods for determining the physical fitness of children to engage in given occupations and the matter of vocational selection in general were also considered. The cooperation requested is still being continued by Dr. Safford. In connection with his work with the Massachusetts Board of Labor and Industries possible occupational hazards for minors in various industries have been investigated, changes in existing methods of examining for employment certificates and changes in present practices in issuing such certificates have been recommended, a study of the effect on minors of employment in the cotton-manufacturing industry has been completed, and preparations have been made for a similar investigation of the rubber-manufacturing industry of the State. In the investigation of the cotton industry, the mechanical and chemical processes, the working conditions, and the actual physical condition of employees themselves were considered. For the lastnamed purpose there were subjected to careful physical examinations about 700 boys between the ages of 14 and 18 years. These boys were employed in 49 different kinds of work in the mills. They represented practically every race or nationality to be found employed in the industry in the State. Establishments were selected for investigation so as to secure employees for examination in mills of both old and modern construction in every cotton-manufacturing locality in the State. In each mill selected every male employee under 18 years of age was examined. Among the inferences to be drawn from this investigation are the following: Diseases and defects of a more serious character are less common among minor cotton-mill employees in Massachusetts than in the general school population of the same ages. In a measure at least this fact is to be credited to the Massachusetts requirements as to the issuance of employment certificates. Defects of a minor character are, however, very common, and in average physical development, with the exception of those between the ages of 15 and 16, the boys compare unfavorably with boys of the same ages in the general population. To a great extent the cotton mill represents a transitory employment for boys who are too young or too deficient in physical strength to do harder work. Apart from some possibly unfavorable effects of atmospheric conditions and noise, the occupational hazards of the industry are few. Whatever may be the possible effects of the occupation or working conditions, they are apparently relatively unimportant in comparison with bad heredity, bad home conditions, bad habits, and the sequelae of acute diseases of childhood in accounting for the physical defectiveness disclosed by the investigation. The results of this investigation were published as Public Health Bulletin No. 78. PUBLICATIONS. Of the publications of the service during the past year the following referred to occupational diseases and industrial hygiene: PUBLIC HEALTH BULLETINS. 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. March, 1916. 76. Health Insurance. Its Relation to the Public Health. By B. S. Warren and Edgar Sydenstricker. March, 1916. REPRINTS FROM PUBLIC HEALTH REPORTS. 302. Industrial Hygiene. A plan for education in the avoidance of occupational diseases and injuries. By J. W. Schereschewsky. October 1, 1915. 335. Statistics of Disability. A compilation of some of the data available in the United States. By B. S. Warren and Edgar Sydenstricker. April 21, 1916. 341. Health of Garment Workers. The Relation of Economic Status to Health. By B. S. Warren and Edgar Sydenstricker. With introduction by J. W. Schereschewsky. May 26, 1916. SANITATION OF CONVICT CAMPS. At the request of the Director of the Office of Public Roads, United States Department of Agriculture, the cooperative studies of convict camps have been continued throughout the fiscal year. In order that the practicability of establishing and maintaining a convict camp under strictly sanitary conditions might be demonstrated, a cooperative plan was carried out with the above-mentioned office and the officials of Fulton County, Ga. Passed Asst. Surg. W. F. Draper was placed in general supervision of the sanitary work and devoted the time necessary in addition to his regular duties. As a result of these studies it is believed not only that it is possible to maintain convict camps strictly in accordance with sanitary principles, but that the reduction in the sick rate, the improvement in the morale, and the increase in the general efficiency of the men make a sanitary camp an economic necessity. The data in regard to the demonstration camp will be embodied in a report which will be published upon completion of the study. PUBLIC-HEALTH ORGANIZATION AND ADMINISTRATION. Studies of public-health organization and administration in States and cities have been continued, in cooperation with State and local health authorities, and detailed reports have been published. Such studies have so far related to the States of Florida, Illinois, Kansas, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, North Dakota, Washington, and, West Virginia, and the cities of Baltimore, Md., Bowling Green, Ky., Chicago, Ill., Columbia, S. C., Richmond, Ind., St. Joseph, Mo., Toledo, Ohio., Youngstown, Ohio, and Winston-Salem, N. C. In addition exhaustive compilations and analyses have been made of the legislation relating to this subject. The information thus obtained, as was stated in the last annual report, seems to justify the conclusion that the two greatest sanitary needs of the Nation at the present time are: (1) Employment of properly qualified, full-time health officers for every community; (2) appropriations sufficiently large to conduct efficient health work. It would appear that at least 2 per cent of the public revenue should be spent for public-health work. In fact, in most of the States the need is not so much for more health laws as for coordination of those already on the statute books, grouping of direct health functions under one executive officer, and adequate funds to enforce existing legislation. PUBLIC-HEALTH ADMINISTRATION IN NEVADA. An investigation of public-health administration in Nevada was made by Surg. Carroll Fox from July 22 to August 21, 1915, and included a study of the health organizations of eight towns in seven. counties: Reno and Sparks, in Washoe County; Elko, Elko County; Winnemucca, Humboldt County; Goldfield, Esmeralda County; Tonopah, Nye County; Carson City, Ormsby County; and Virginia City, Storey County. As a result of this study Dr. Fox reached the conclusion that a wellorganized department of health, to strengthen the present board of health and to correlate the various public-health activities which are now being carried on by different State organizations, is an essential in Nevada. Recommendations were made to bring about this change in an effective manner. These, together with a complete discussion of the investigation, were published in the Public Health Reports and issued as Reprint No. 317. PUBLIC-HEALTH ADMINISTRATION IN NORTH DAKOTA. From September 17 to November 3, 1915, Surg. Fox carried on a similar investigation of public-health organization and administration in the State of North Dakota. As a result it was concluded that there is a great lack of organization and funds with which to carry on public-health work in this State. Such health measures as have been enacted, Dr. Fox found, are more or less scattered among different branches of the government, whereas all these measures should |