be coordinated and their enforcement imposed on a single State health organization. To bring about such coordination Dr. Fox, in a report published in the Public Health Reports and issued as Reprint No. 315, made necessary recommendations to the State authorities.

PUBLIC-HEALTH ADMINISTRATION IN FLORIDA.

A survey of the public-health organization and administration in Florida was made by Surg. Fox from November 28, 1915, to February 28, 1916. As a result of this study it was concluded that the State board of health was engaged in many important activities, but that certain changes are desirable in order to increase efficiency and to secure quicker and more certain results.

In Reprint No. 340 from the Public Health Reports, Dr. Fox gives the results of his investigation and includes detailed recommendations covering the needs of the State health organization. The report deals with the State board of health, the executive division, including State health officer, the registration of births and deaths, the notification and control of diseases, diagnostic laboratory, the field force, the division of public health engineering, publications, exhibits, health supervision of schools, the veterinary division, control of the milk supply, the treatment of crippled children, hotel inspection, abatement of nuisances, licensing of embalmers, and receipts and expenditures.

In the course of the investigation Jacksonville, Tampa, Pensacola, Miami, Key West, St. Augustine, and Tallahassee were visited and their health administration inquired into.

PUBLIC-HEALTH ADMINISTRATION IN NEBRASKA.

From March 11 to May 1 Surg. Fox conducted an investigation of public-health organization and administration in Nebraska, the results of which were published after the close of the fiscal year (Reprint 348 from the Public Health Reports). The studies were made along the lines of those reported above, and similar recommendations prepared. These recommendations provide for an adequate organization for carrying on the public-health work immediately required and for additions to this organization in the future.

During the course of the study the following places were visited: Omaha, Lincoln, Grand Island, Hastings, North Platte, Kearney, Seward, Columbus, and Ashland.

PUBLIC-HEALTH ADMINISTRATION IN COLUMBIA, S. C.

A study of public-health organization_and_administration in Columbia, S. C., was made by Senior Surg. J. C. Perry from September 9 to November 1, 1915, and a report with recommendations submitted to the State and local health authorities. The appointment of a fulltime health officer, whose tenure of office should depend on efficiency, was recommended.

Immediately after the survey, steps were taken by the local authorities to obtain a full-time health officer and to carry out many of the other recommendations contained in Dr. Perry's report.

PUBLIC-HEATH ADMINISTRATION IN ST. PAUL, MINN.

On request of the State and local health authorities, Surg. George B. Young was detailed on April 3, 1916, to make an investigation of the public-health organization and administration of St. Paul, Minn. The investigation contínued for over two months. It was found that the present city charter does not permit St. Paul a central health agency of adequate scope, and that the existing charter powers regarding matters affecting the public health have not been sufficiently utilized. A full-time health officer was recommended. When completed the report of this investigation will be furnished to the city authorities.

PUBLIC-HEALTH ADMINISTRATION IN MINNEAPOLIS, MINN.

During the same period Surg. Young made a study of the publichealth organization and administration of Minneapolis, Minn. Among other things, Dr. Young found that the system of controlling communicable diseases was defective in plan, that there was no proper system in effect for utilizing the general morbidity and mortality records as a basis for departmental activity, and that there was a lack of supervision of the sanitary food and dairy inspection. When completed the report of this investigation will be furnished to the city authorities.

PUBLIC-HEALTH ADMINISTRATION IN YOUNGSTOWN, OHIO.

From May 15 to July 1, 1916, Surg. Fox made a study of publichealth organization and administration in Youngstown, Ohio. A report of this investigation was published in the Public Health Reports and issued as Reprint No. 365. As in the other studies of public-health administration detailed recommendations were made on the basis of information obtained in this and in other public health administration investigations. These have to do with the subdivision of the work of the health department, personnel, expenditures, supervision of the milk supply, and other public health problems.

SANITARY SURVEY OF RICHMOND, IND., WITH SPECIAL REFERENCE TO TUBERCULOSIS.

The survey of sanitary conditions in Richmond, Ind., with special reference to tuberculosis, which was commenced in the fiscal year 1915, was completed during the last fiscal year and a report of it published as Supplement 26 to the Public Health Reports. Senior Surg. J. C. Perry, who made the investigation, found that the prevalence of tuberculosis did not differ materially from the incidence of this disease in similar cities in the same geographic location. As has been noted in all other investigations of this subject, a large proportion of the cases occurred where housing conditions were unsatisfactory and among the less financially able.

Dr. Perry's recommendations included phases of the subject of public-health organization and administration.

SANITARY SURVEY OF WINSTON-SALEM, N. C.

From May 2 to 8, 1915, a sanitary survey of Winston-Salem, N. C., with reference to excreta disposal was conducted by Prof. C. W. Stiles, of the Hygienic Laboratory. It was found that the sanitary conditions of this city in regard to excreta disposal are not unusual, but are complicated by such factors as the rapid growth of the city from rural to urban demands and the presence in the laboring population of a large number who were not in the habit of remaining long in one city.

Among the recommendations made were those for the establishment of a license privy system, with uniform-sized cans, to be supplanted later by the extension of the present sewerage system through the whole city, and for a full-time health officer and increased personnel and expenditures, pending the combining of the city and county health authorities into one body.

SANITARY CONDITIONS OF HOPEWELL, VA.

A sanitary survey of Hopewell, Va., was made during the year by Sanitary Engineer Leslie C. Frank. This survey was of peculiar interest in view of the nature of the growth of Hopewell, which has been rapid and due almost entirely to the establishment in September, 1914, of a large branch of the ammunition plant of a large powdermaking company. Up to February, 1916, the sanitary conditions of the town were supervised by the company; but at that time the State'. legislature passed acts granting the city a charter, giving it a temporary government under the direct control of the governor of Virginia, and appropriating money for its expenses. Thus the sanitary conditions came under the supervision of the new government and a survey by the service was requested.

Mr. Frank found that the present conditions of Hopewell were beyond any doubt such that immediate action, almost military in nature, was imperative. The worst features of these conditions were the lack of proper privy control, the utter impassibility of many of the roads and streets, and the lack of adequate milk and food control. Mr. Frank recommended as satisfactory, if rigorously enforced, the adoption of a plan submitted by the State board of health on request of the local government. This plan was adopted, subject to the approval of the governor of Virginia, on April 1, 1916.

SANITARY SURVEY OF LEXINGTON, KY.

In connection with studies of the pollution of the Ohio_River watershed, a sanitary survey of Lexington, Ky., was made by Passed Asst. Surg. L. R. Thompson and Sanitary Engineer R. E. Tarbett. The survey dealt primarily with water supply, sewage disposal, and sanitary administration. A report covering these points was submitted to the local authorities.

In this report it was recommended that a chemical and bacteriological laboratory be established at the water plant; that daily analyses of the raw and treated water be made at the plant, in addition to daily analyses of the tap water actually supplied the city at

the city laboratory. In regard to sewage disposal, it was recom mended that the city undertake a campaign having for its object the connection of all premises in the city to the public sewerage system. A detailed report on a sewage-disposal project was made later as a result of a further survey. (See p. 82.) Pending the carrying out of the sewerage campaign, it was recommended that all privies should be made rigidly fly proof and that regular and systematic cleaning should be insisted on.

In regard to sanitary administration it was stated that the complete reporting of all contagious and communicable diseases should be insisted upon and that all such reports should be filed and studied systematically; that all records of sanitary, milk and food, and other inspections should be filed in such a manner as to be readily accessible; that the reports of all cooperating agencies should also be filed and utilized as fully as possible; that the office of registrar of vital statistics under the State board of health might well be consolidated with that of clerk to the city board of health; and that reports of the board of health published in the city magazine should be made as popular and readable as possible.

PUBLICATIONS.

Of the publications of the service during the past fiscal year, the following relate to public health organization and administration:

REPRINTS FROM PUBLIC HEALTH REPORTS.

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.

315. Public Health Administration in North Dakota. By Carroll Fox. December 17, 1915.

317. Public Health Administration in Nevada. By Carroll Fox. December 31, 1915.

340. Public Health Administration in Florida. By Carroll Fox. June 2, 1916.

SUPPLEMENT TO PUBLIC HEALTH REPORTS.

26. Public Health Administration in Richmond, Ind.

A report of a survey to determine the incidence of tuberculosis. By J. C. Perry. October 8, 1915.

COOPERATION WITH FEDERAL AND STATE GOVERNMENT AGENCIES.

Throughout the section of this report dealing with the division of scientific research, mention is made of cases of cooperation with State and local health authorities. Nearly all of the field work is conducted in this way. Certain instances of cooperation with Federal and State governmental agencies should be mentioned more at length.

The facilities of the Hygienic Laboratory have been extended to a few State and local officials for purposes of instruction. The laboratory, as mentioned on p. 85, was used also as a means of instructing the officers of the service.

The practice was followed of cooperating with a number of other governmental departments and bureaus in the conduct of investigations. Among these are the Indian Service, the Bureau of Mines,

and the office of Public Roads. Cooperation of a similar nature was also extended to the Hawaiian and Porto Rican health authorities and to the authorities of certain States.

COOPERATION WITH INDIAN SERVICE.

Since late in 1914 the servce has extended to the physicians of the Indian Service the facilities of its laboratories by making examinations of such specimens as might be submitted from time to time to aid in the diagnosis of communicable diseases. Diagnoses have been made at the following laboratories: Hygienic Laboratory, Washington, D. C.; Seattle, Wash.; San Francisco, Cal.; Fort Stanton, N. Mex.; St. Louis, Mo.; New Orleans, La.; Chicago, Ill. The work includes ordinary examinations and tests of a bacteriological or clinical nature.

Antityphoid vaccine is furnished through the Hygienic Laboratory to the Office of Indian Affairs on request.

Correspondence was had with the Department of the Interior and service officers in regard to conducting an investigation of mottled enamel and brown stain among Indians and others in the Southwest.. Although not detrimental to health, as the brown stain does not destroy the integrity of the enamel of teeth, this condition is very disfiguring and is quite prevalent among Indians. In view of the fact that an investigation of this condition is being made by the Colorado State Dental Association, it was deemed wise to postpone any investigation by the service until the results of this work are known.

COOPERATION WITH HAWAIIAN AUTHORITIES.

As mentioned in the section of the report dealing with the leprosy investigation station, the service has cooperated with the Territorial board of health of Hawaii in the medical care of patients in isolation at Kalihi. In further cooperation, 77 lepers have been officially examined by medical boards convened by the Territorial government, and in nearly every instance at least one of the officers of the Public Health Service has not only served on the boards but has in each case performed the bacteriological examinations for the boards at the latter's request. In addition to this, at the request of the Territorial board of health, the medical officers of the leprosy investigation station have made 135 unofficial examinations of leper suspects; of these suspects 92 of the cases coming up for examination have been found not to be lepers, while the remainder have been recommended for official examination by a formal board according to law.

On request of the Territorial health authorities, also, specimens have been examined in the laboratory and other assistance has been rendered. One of the officers of the station has served as sanitary advisor to the governor of the Territory and is a member of a sanitary code commission created by the last Territorial legislature.

COOPERATION WITH PORTO RICAN AUTHORITIES.

At the request of the Governor of Porto Rico, Surg. W. W. King was detailed on September 20, 1913, for duty with the Institute of