epidemiological investigations with a view to gaining further knowledge of the nature of the disease and possible methods of its prevention or cure. The Division of Sanitary Reports and Statistics gathered and published currently in the Weekly Public Health Reports statistics relating to the occurrence of cases, thus enabling health officers in all sections to keep informed of the progress of the epidemic.

Another instance of the kind is the work of the service in preventing the entrance of typhus fever from Mexico. Measures to prevent possible carriers of the disease from entering the United States were supervised by the Division of Foreign and Insular Quarantine and Immigration. Precautions against its spread in interstate traffic from the localities in this country where cases occurred were taken through the field organization of the Division of Domestic (interstate) Quarantine.

Because of this joint supervision of some functions of the service these operations are discussed in the portions of this report devoted to the work of the several divisions. They are taken up, however, from the point of view of the relation of the respective divisions to the work accomplished. In the conduct of such work the possibility of duplication of effort is eliminated by close cooperation between division heads under the direction of the Surgeon General.

Following the declaration that a state of war existed, every effort was made to assist the other departments of the Government in their measures of defense. In accordance with law, the personnel and facilities of the service were by Executive order made available to the military forces. The efforts of its sanitary organization have been devoted largely to problems relating to sanitation and public health in areas surrounding military establishments and cantonments. Numerous sanitary experts have been detailed to the Army and Navy for special duty, on request of the military and naval authorities. Statistical information relating to disease prevalence has been currently supplied to the Counsel of National Defense and Army and Navy officials. Medical officers have been supplied vessels of the Coast Guard, now operating as a part of the Navy. Other special work has been undertaken and in certain instances successfully completed.

SCIENTIFIC RESEARCH.

As in previous years, laboratory and field investigations of the diseases of man and other public-health matters have been carried on during the past fiscal year through the Division of Scientific Research. For the final three months of the year, the administrative force of the division was principally occupied with health problems arising out of the entrance of the United States into the war. The date of the annual conference of State and Territorial health authorities with the service was advanced in order to effect a cooperation of these bodies as early as possible for the sanitation of the country in relation to war activities. Furthermore, as soon as the location of cantonments and training camps was decided upon by the Army authorities, sanitary surveys in the vicinity of such camps were commenced by the service in cooperation with the Army and the State and local health authorities. Four such surveys were being made at the end of the fiscal year, and plans had been completed for their extension to areas near all the camps. To permit of these activities, a large part of the personnel previously engaged in studies of the pollution of streams and other investigations was gradually transferred to the survey work. It was found that previous investigations in malaria, typhoid fever, rural sanitation, public health organization and admínistration, and pollution of streams were of value in the making of these surveys of extra cantonment areas, both because of the training the field workers had previously received and because of the data accumulated by the service as to the general status of sanitary conditions in the United States. Moreover, work in industrial sanitation prepared the way for cooperating in the supervision of the health of employees in industries related to the war. In other words, a large part of the public health work previously undertaken by the Government was of direct use to it in conducting its activities following the outbreak of the war.

Now that the country is engaged in raising a large army and assembling it at different points in the country, the problem of eradicating or controlling communicable disease is of even more importance than previously. Antityphoid inoculation and known means of preventing the spread of excreta-borne diseases will make the question of typhoid fever less significant than formerly, but the necessity for using every means to combat trachoma, a disease which has proven to be a grave menace to the fighting forces in all European wars, is evident. Careful inspection of recruits by the military authorities and treatment of those found to have the disease must be supplemented by efforts of health officials to keep the disease from being transmitted from civil to military populations at the different cantonments. Malaria is another disease which will reduce the efficiency of the troops to a great degree unless every precaution is taken. The great prevalence of tuberculosis in France at the present time makes the treatment of this disease of singular importance. In a war re

quiring the utilization of every resource in order to secure success, conservation of health, both on the part of the individual and the various governmental authorities, takes its place beside the problems of raising armies, producing supplies, and transportation. It is felt that investigations of diseases and sanitary matters should therefore be continued along as broad lines as possible.

During the year a large number of such investigations were made through the division, the service using slightly increased appropriations for studies which appeared to be necessary in the light of its other public health work. In the field investigations every effort was made to cooperate with State and local authorities to the fullest extent possible, and the scientific studies were planned to relate closely to problems of immediate public health importance. For instance, as a result of research studies in malaria control it has been possible to advise local authorities as to the best means of reducing the prevalence of the disease. Demonstrations of these measures have been conducted in a number of places during the past year and have shown conclusively the effectiveness of the measures. Rural areas, where mosquito reduction seemed impracticable, have been practically freed from malaria by the use of screening and quinine, while in more thickly settled communities it has been possible practically to eliminate the Anopheles mosquito. A record of the results obtained will be found on page 19.

On account of the continuance of a special appropriation for rural sanitation, this important work was carried out effectively in a large number of counties. As it became evident that more assistance from localities was necessary for the ideal demonstration of methods in rural sanitation, Congress was asked to make an arrangement by which the Government would pay half of the expenses of such demonstration if the State and locality paid half. An appropriation of this nature has been made for the coming year, and it is expected that the rural sanitation work will therefore be even more helpful in the future. Increased attention is being given by the service to problems of occupational diseases and industrial hygiene. It is realized that the necessity of maximum production during the period of the war will make this work even more significant and will also have a tendency to increase general interest in the health of workers. The service is obtaining a large amount of data which will be available to industries of all kinds in securing proper hygienic conditions.

School and mental hygiene studies have been continued on a somewhat larger scale. The examination of recruits during the past few months has indicated the presence in the general population of a vast number of defects which could have been corrected in childhood if they had been known. This fact emphasizes the need of surveys such as are being made by the service, as well as the need for systematic medical examination of school children and supervision of their health while engaged in what is really a compulsory occupation.

The exhaustive survey of pollution of the Ohio River watershed was completed during the year, and laboratory studies have been directed toward the further evolution of problems developed in this preliminary work, while the field studies have been extended to. include a general survey of the conditions and effects of stream pollution in the Northeastern States.

A special appropriation by Congress has permitted the service to exercise greater control over the manufacture of biological products, and has permitted further development in the work of producing standards by which some of these products may be judged. The above forms only a brief outline of the work done during the year. The field and laboratory investigations in full may be classified under the following headings:

(1) Surveys of the sanitary condition and needs of extra-cantonment areas; (2) diseases of man, including cerebrospinal meningitis, diphtheria, malaria, pellagra, poliomyelitis, scarlet fever, trachoma, and typhoid fever; (3) occupational diseases and industrial hygiene, including health insurance; (4) public health organization and administration; (5) school and mental hygiene; (6) rural sanitation; (7) pollution of streams; (8) pollution of coastal waters; (9) industrial wastes; (10) sewage disposal; (11) viruses, serums, toxins, and analogous products. In this report, headings are included for the Hygienic Laboratory (at which studies in connection with the field work and research problems were conducted) and also for the Leprosy Investigation Station at Honolulu.

SURVEYS OF EXTRA CANTONMENT AREAS.

The importance of protecting the health of both the civil and the military populations at this time can not be overestimated, and prompts the consideration separately of the work of the division relating to sanitary surveys of extra cantonment areas. It is to be noted, however, that such surveys are closely related to much other work of the division, including investigations in malaria, rural sanitation, public health administration, and sewage disposal. Recommendations are made on the basis of experience gained in work along these different lines.

At the end of the past fiscal year surveys were being conducted at Little Rock, Ark., Louisville, Ky., Petersburg, Va., and Hopewell, Va., but plans had already been completed for greatly extending this work, which was being developed in close cooperation with the States and localities, as well as with the military authorities. At the end of the year the following personnel had been detailed to this work: Asst. Surg. Gen. H. R. Carter, Surg. W. H. Frost, Passed Asst. Surg. Paul Preble, Asst. Surgs. C. E. Waller, and H. F. Smith, Epidemiologist A. W. Freeman, Sanitary Engineers H. R. Crohurst, J. K. Hoskins, J. A. A. Le Prince, H. W. Streeter, R. E. Tarbett, and H. H. Wagenhals, and Asst. Sanitary Engineer C. P. Rhynus. This force was largely increased early in the present year. In addition, several prominent sanitarians have been employed as consulting experts at nominal salaries while actually on duty.

CEREBROSPINAL MENINGITIS.

STUDY OF CASES AT SALUDA, VA.

On request of the State health authorities a small epidemic of cerebrospinal meningitis at Saluda, Va., was investigated by Passed Asst. Surg. J. P. Leake in March and April, 1917. Five cases occurred, two of which died before Dr. Leake's arrival. Improvement in the

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others was manifest following the use of antimeningococcus serum furnished by the State board of health. The local authorities were advised with in regard to the measures to be taken to prevent the further spread of the disease.

STUDY OF CASES AT GREAT LAKES NAVAL TRAINING STATION.

On request of the Surgeon General of the Navy, Surg. G. W. McCoy was detailed on June 13, 1917, to investigate outbreaks of cerebrospinal meningitis at the Naval Training Station, Chicago, Ill., in cooperation with the State and local health authorities, and Asst. Surg. G. C. Lake was detailed to assist him. The sanitary conditions of the station and hospital were reported upon, and advantage was taken of this opportunity to make laboratory studies of the disease. Special attention was necessarily devoted to the detection of healthy carriers and the length of time convalescents remain carriers. In the absence of a speedy test to determine the virulence of cultures from these cases a highly important problem has arisen as to how long such cases should be segregated and their effect on the civil and military population when finally released. Further work along this line is indicated.

DIPHTHERIA.

OUTBREAK IN FLOYD COUNTY, GA.

In cooperation with the health authorities of Floyd County, Ga., and the city of Rome, Asst. Surg. W. H. Slaughter was detailed to make a study of an outbreak of diphtheria and to assist the local authorities in handling the situation. The outbreak commenced in October, 1916, resulting in the closing of the schools in Rome and of many in the county generally. By the middle of November most of the schools had been reopened. Only one fatal case occurred during the epidemic, and a vast majority of the clinical cases were mild. The service officer made an epidemiological study of the cases, assisted in the taking of cultures, and advised the authorities as to the best procedure in ending the epidemic. This procedure may be summarized briefly as follows: All suspicious cases were submitted for laboratory examination, all clinical or highly suspicious cases were treated with antitoxin, all homes in which clinical cases occurred were kept in quarantine, two successive negative cultures were required before release, infected quarters were required to be fumigated, all children in homes in which there were clinical cases were kept from going to public gatherings, social intercourse in general was interdicted or discouraged. The success of this procedure is indicated by the fact that when the work was brought to a close on December 8 no clinical case existed in the county.

MALARIA.

Investigations of malaria have been conducted with headquarters at the United States Marine Hospital, New Orleans, La. Active charge of the investigations was exercised by Surg. von Ezdorf until his sudden death in the field in September, 1916, and in April, 1917, supervisory direction was assumed by Asst. Surg. Gen. H. R. Carter.