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plague, but verification of the diagnosis was not possible on account of the body having been embalmed. The first infected rat was dis covered within a month of the outbreak of human cases, namely, on November 7, 1907, and during the succeeding year other infected rodents were obtained. There then followed several breaks in the continuity of infected rodents discovered until the fiscal year 1916, when three plague rats were reported. No further infection was found until March, 1917, when three plague rats were discovered about the same time and all at a focus which had previously yielded plague infection. These were the only plague rats found in Seattle during the fiscal year just closed.
History of plague measures.-During a part of the fiscal year ending June 30, 1908, plague suppressive measures in Seattle were under the direct supervision of the Public Health Service, but when human cases ceased to occur the work against the disease in rodents was continued by the city health department. A joint laboratory, city and Federal, having been established, the service furnished the greater part of the equipment and the services of a bacteriologist trained in the diagnosis of plague, while the city maintained the laboratory, providing helpers and supervising the necessary trappers. This plan continued until the marked recrudescence in rodent plague, in the latter part of the calendar year 1913, when it became necessary to augment the force of trappers, which had previously been reduced, to 25. By mutual agreement the supervision of this force was transferred to the Public Health Service, and 5 trained rodentologists were brought by the service from San Francisco to have the immediate direction of the 25 men furnished by the city of Seattle. Immediately upon the recrudescence in question maritime measures, consisting of successive fumigation of vessels, fending and rat guarding, and regular inspections, were inaugurated to prevent the spread of the disease to other ports, these measures likewise being made applicable to vessels engaged in intrastate traffic. At the present time fumigation is no longer required on account of plague conditions in Seattle, but is performed from time to time on local vessels when it is found that they are becoming rat infested. Fumigation of vessels from plague infected ports is performed as a routine measure upon request of the United States quarantine officer at Port Townsend. Fending-off and rat-guarding on all vessels was continued up to and including a part of the present fiscal year, when, upon the recommendation of the officer in charge, concurred in by the city and State health authorities, fending and guarding were limited to vessels from plague-infected ports.
In January, 1914, upon the urgent injunction of the bureau, the examination of the bodies of persons who had died of an acute illness lasting less than seven days was agreed to by the city and State health authorities. Undertakers were accordingly enjoined from embalming dead bodies in such cases until released by an officer of the Public Health Service. This measure was continued until the present fiscal year when, by agreement with this bureau, it has been limited to the bodies of persons dying from septicemia (or "blood poisoning"), pneumonia, and cases which might be suspicious of plague.
In March, 1914, the entire work of plague suppression and prevention was transferred to the Public Health Service, the city fur
nishing inspectors, trappers, traps, bait, transportation, etc., the service providing the necessary officers and employees for supervising the work, and continuing the services of a bacteriologist in connection with the examination of rodents and of suspicious cases. This arrangement has been satisfactorily continued and is still in operation at the present time, there having been a gradual reduction in force to eight city trappers and two Federal inspectors, the latter having numerous other duties.
Present operations.-Shortly after the work was turned over to the Public Health Service the city council passed, upon the recommendation of the service, an ordinance requiring the rat proofing of all new buildings and all buildings undergoing repairs to the value of 40 per cent of the building being repaired. This rat proofing is either by elevation (18 inches), or by both concrete foundation walls and concrete-floor areas. Immediately after the passing of this ordinance the plague work on Puget Sound was reorganized, with the following objectives in view:
(a) The prevention of the introduction of plague from other ports (continued from previous plan).
(b) Trapping and poisoning operations, including the collection of dead rats (continuation).
(c) Laboratory examination of rodents and suspicious cases (continuation).
(d) Educational work by means of lectures, illustrated and otherwise, and by mailing circular letters to persons who make complaints about rats.
(e) Intensive trapping on the part of residents in given districts (rat-drive campaign).
(f) Trapping operations in cities outside of Seattle.
(g) The extermination of existing foci in Seattle (continued from previous plans, but reinforced).
(h) The rat proofing of buildings in cities outside of Seattle. (i) The rat proofing of buildings in Seattle.
The maintaining of the full cooperation of State and local authorities.
Two of these measures deserve more than passing mention. The extermination of existing foci is pressed hard whenever a plagueinfected rat is found. Sometimes this means the razing of an old building, sometimes it is the tearing up of wooden floors and replacing them with concrete, the tearing out of double walls and ceilings, covering with metal lathing, double-layered floors reinforced by wire netting, etc. This work is laid out jointly by the city health department and the Public Health Service and is pursued quietly but relentlessly with at present very little opposition on the part of property owners on whom the expense, which is often considerable, falls.
The rat proofing of new buildings and of buildings undergoing extensive repairs is supervised by the service. A notice of every permit for a new building and for repairs is filed, and a copy of the rat-proofing ordinance is mailed to the owner (or agent), and the contractor. Subsequently, the city inspectors, acting under service supervision, visit these places as often as may be necessary to see that the ordinance is complied with. All restaurant permits are
referred to headquarters, these places to be visited and rat proofing required as a routine measure, regardless of whether they come under this particular ordinance or not.
Trapping operations have been carried on from time to time by the service in Tacoma, Bellingham, and Everett. Everett was the first city on Puget Sound, outside of Seattle, to pass the rat-proofing ordinance (the same as the Seattle ordinance), and her example was subsequently followed by Tacoma. This work was inaugurated in Everett and Tacoma by the service and supervised for a time, but on account of a lack of funds it was later given over to the local authorities in these two cities, the work being discontinued at Everett on December 7, 1916, and at Tacoma on February 15, 1917.
SUMMARY OF PLAGUE SUPPRESSIVE MEASURES AT SEATTLE, WASH.
New buildings inspected__
New buildings reinspected.
Basements concreted, new buildings, (749,022 square feet)
Floors concreted, new buildings (1,071,020 square feet).
Yards, etc., concreted, new buildings (87,225 square feet)
Premises rat proofed, concrete, old buildings (169,815 square feet) -
Rat-proofing notices sent to contractors_.
PLAGUE PREVENTIVE MEASURES AT TACOMA, WASH.
New buildings inspected.
New buildings reinspected..
New buildings rat-proofed by concrete foundations_
New buildings, basements concreted (6,133 square feet)
Old buildings, floors removed (3,310 square feet)
Classification of Rodents.
138 3, 426
Rodents examined for plague infection_.
Rodents proven plague infected__
PLAGUE PREVENTIVE MEASURES AT EVERETT, WASH.
New buildings inspected__.
New buildings reinspected_
New buildings rat-proofed by concrete foundations.
New buildings, basements concreted (19,985 square feet)
Field investigation. - The investigation of the distribution of Rocky Mountain spotted fever was continued during the spring and early summer of 1917 by Surg. L. D. Fricks, through personal investigation of cases reported, by correspondence with the different health officials throughout the Rocky Mountain region, and through the submission of reports of cases occurring within the respective States.
In southeastern Montana where there occurred a serious outbreak of the disease in 1915, with 22 reported cases, in territory previously considered uninfected and the greater part of which was supposed to be free from tick infestation, no increase in the number of cases
or dissemination of the infection occurred, either in 1916 or 1917. As a matter of fact, although a campaign of tick eradication was not undertaken in this territory at any time, a considerable decrease in the number of cases was observed during the past two years. The possibility that this extension into southeastern Montana was accomplished, in part at least, by the interstate movements of live stock. and particularly by the bringing into Miles City each month of several hundred horses from near-by States, was pointed out in a previous report. A wide variation in tick infestation in different years has been observed throughout this section and it is probable that this natural variation in the abundance of ticks has influenced the spread of the infection.
A survey of Modoc and Lassen Counties, in northeastern California, was made during the year by the health authorities of that State in order to determine the extent of spotted-fever infection in those areas. The survey showed that the majority of the cases occurring in the past had not been reported. The same condition is probably true for the greater number of the existent foci of infection, although the Bitter Root Valley is a notable exception to this statement. The health authorities of California during the year forwarded to the Victor, Mont., laboratory a strain of spotted fever in guinea pigs inoculated from a human case infected in Ventura County. This infection was first suspected of being typhus fever, but, when tested against the Bitter Root strain of spotted-fever virus in laboratory animals, it was shown to be the same. No case of Rocky Mountain spotted fever had been previously reported from this section of the State of California.
In the following table is given the number of cases and deaths from Rocky Mountain spotted fever, reported by States, during the season of 1916:
This is a great reduction in the number of cases from that reported the previous year and probably is due more to incomplete returns than to any abatement of the disease.
Eradication.-Efforts to eradicate Rocky Mountain spotted fever from the Bitter Root Valley, Mont., were continued by the Public Health Service for the seventh consecutive year. No changes were made in the methods of eradication first adopted by the service, i. e., (1) Education, (2) securing of proper grazing laws, (3) tick eradication, primarily by small animal destruction and sheep grazing. In the seven years that this eradicative campaign has been carried on in the Bitter Root Valley the seasonal incidence has been reduced from more than 30 to 5. How much of this decrease has been due to education of the people concerning the danger of tick bites and how much to tick eradication is difficult to say, but undoubtedly