Specific measures were outlined to the authorities for improving the sanitary environment of the workmen, and for the systematic delousing of all laborers of the class involved. Following the adoption of these measures no additional cases developed.

SANITARY, EDUCATIONAL, AND RELIEF WORK IN ALASKA.

The act of Congress making annual appropriations for the sundry civil expenses of the Government directs that the medical and sanitary relief of the natives of Alaska shall be under the direction of the Secretary of the Interior, with the advice and cooperation of the Public Health Service. Under this provision Passed Asst. Surg. Emil Krulish was detailed in 1912 for duty in Alaska to study the diseases and sanitary conditions in the native settlements in order to intelligently and economically inaugurate measures for relief. These studies were carried on throughout a period of approximately three years, and all sections of Alaska were visited, some time being spent in each native community. These surveys indicated that the native population was decreasing at an alarming rate, chiefly from tuberculosis; and that venereal diseases and eye affections, including trachoma, were very prevalent in the Territory. The homes with but few exceptions were found to be insanitary and responsible in a great measure for much of the illness and high death rate. The remedy advocated to improve these conditions and to check the ravages of these diseases was the establishment of well-equipped hospitals, the employment of competent physicians and nurses, the isolation of the sick, and the education of the natives in hygiene and sanitation.

The area of the Territory of Alaska is one-fifth that of the United States, and the transportation facilities are inadequate and expensive; consequently the erection of one central hospital was deemed impracticable. The difficulties encountered in reaching even a small percentage of the population can be appreciated when one considers the vast territory over which the native population is scattered, in groups rarely exceeding 200 in number. The establishment of a chain of small hospitals along the coast and on the Yukon River at points most convenient to the greatest number of natives was therefore recommended, and in estimates submitted to Congress the officer in charge indicated the places at which hospitals would serve the greatest number of people at the least expense. Upon the completion of the surveys of the native villages in 1915, the station of the officer in charge was changed from Juneau, Alaska, to Seattle, Wash., in order that he should be in closer and more direct communication with the officials of the Bureau of Education in charge of the Alaska school service, whose headquarters are at Seattle, thereby facilitating the direction and supervision of the proposed medical service.

Throughout the fiscal year the officials of the Bureau of Education have been advised on matters pertaining to hygiene, sanitation, erection and maintenance of the several hospitals, and the administration of the medical service in general. The requisitions for medical supplies for hospitals and for the 70 schools which are the relief stations of the service were prepared as usual; applicants for the position of physician or nurse were examined and the names of those found qualified submitted to the commissioner for appointment.

The annual estimates for medical service were also prepared and submitted to Congress.

The plans for the proposed hospital for southwestern Alaska on the Kuskokwim River were drafted by the officer in charge, who likewise selected the fixtures, furniture, and the complete equipment of the institution. This hospital, which is now nearing completion, will accommodate 12 patients, in addition to the living quarters for the staff, and a camp for tuberculous patients will be established in the near future in connection therewith.

The new 22-bed hospital for southeastern Alaska, at Juneau, which was completed and opened the latter part of last year, has been taxed to its capacity, and it has been necessary to carry a waiting list of patients desiring surgical operations. The records for the last nine months of the year indicate that 164 patients were treated in the hospital and received 3,476 days' hospital care. Forty-six major operations were performed, including 32 laparotomies, in addition to many minor and major operations on the eye. In the out-patient department 1,750 patients received attention. At the beginning of the fiscal year, upon the request of the Commissioner of Education, the officer in charge made a special trip to Juneau to inspect this hospital and assist in its organization.

During the year the Alaska medical service operated 5 hospitals and employed 9 physicians and 10 nurses. Two of the institutions are modern and well worthy of the name of hospital, but the other 3 are only improvised hospitals and are maintained in school buildings. The first appropriation of $25,000 for medical relief in Alaska was granted by Congress in 1915. The sum for the following year was increased to $50,000, while the appropriation for this year is $62,500. Although this is inadequate to the demand, it is encouraging to note that Congress appreciates the need and importance of this work by increasing the appropriation each year.

With the exception of an epidemic of measles, the reports of the teachers in the Alaska school service indicate that during the past year the health of the natives has been exceptionally good, and that the sanitary conditions in the villages and homes are improving. The morbidity and mortality statistics continue to show a marked decline over previous years. The elimination of the common towel and drinking cup from the schools, the efforts of the teachers in teaching hygiene and sanitation in addition to the regular classroom studies, and the increase in medical appropriations are responsible for these encouraging reports. The epidemic of measles mentioned occurred during the winter in all the villages in southeastern Alaska. Approximately 300 cases of the disease were reported.

A special lecture on the cause and prevention of tuberculosis, adapted to conditions in Alaska, was prepared at the request of the Commissioner of Education. This is to be used by the teachers in combating the white plague. A special set of slides was also prepared from views taken in Alaska to illustrate this lecture, inasmuch as the customary lectures and slides were found to be entirely foreign to conditions in Alaska.

The Bureau of Education, with the aid and cooperation of the Public Health Service, has demonstrated its ability to economically care for the natives' needs, and it is hoped that Congress will make it possible to establish small hospitals in other sections of the Terri

tory. Tuberculosis sanitariums are especially needed, for tuberculosis is the most prevalent disease from which the natives suffer.

INTERSTATE QUARANTINE REGULATIONS.

In order to place the administration of the Interstate Quarantine Regulations upon a more effective basis and for the convenience and closer cooperation of State authorities, an order was approved and promulgated by the Secretary of the Treasury, under date of January 12, 1917, redistricting the interstate sanitary districts in such a manner that no single State would be in more than one district. As arranged the revised sanitary districts are as follows:

District of the North Atlantic: Maine, New Hampshire, Massachusetts, Vermont, Rhode Island, and Connecticut.

District of the Mid-Atlantic: New York, Pennsylvania, New Jersey, Delaware, Maryland. and the District of Columbia.

District of the Ohio: Virginia, North Carolina, West Virginia, Kentucky, and Tennessee.

District of the South Atlantic: South Carolina, Georgia, and Florida.

District of the Great Lakes: Ohio, Michigan, Indiana, Illinois, Wisconsin, and Minnesota, together with jurisdiction over vessels operating on all of the Great Lakes and the St. Lawrence River, and on the Mississippi River and its tributaries north of Cairo, Ill., and the Ohio River and its tributaries between Cairo, Ill., and Pittsburgh, Pa.

District of the Upper Missouri: Montana, North Dakota, and South Dakota.

District of the Missouri: Nebraska, Iowa, Kansas, and Missouri. District of the Gulf: Oklahoma, Arkansas, Louisiana, Alabama, and Mississippi.

District of the Rocky Mountains: Utah, Wyoming, and Colorado. District of the Rio Grande: Arizona. New Mexico, and Texas. District of the North Pacific: Washington, Oregon, and Idaho. District of the Pacific: California and Nevada.

AMENDMENTS AND ADDITIONS TO INTERSTATE QUARANTINE REGULATIONS.

During the year three amendments and two additional sections to the Interstate Quarantine Regulations have been promulgated:

WATER FOR DRINKING OK CULINARY PURPOSES PROVIDED ON CARS AND VESSELS BY INTERSTATE CARRIERS.

(Amendment No. 1 to Interstate Quarantine Regulations, 1916.)

Public Health Service.

TREASURY DEPARTMENT,

OFFICE OF THE SECRETARY,
Washington, February 12, 1917.

To medical officers of the U. S. Public Health Service, State and local health authorities, and others concerned:

The following amendment is hereby made to the Interstate Quarantine Regulations promulgated by this department January 15, 1916, said amend

ment and regulations being in accordance with the act of Congress approved February 15, 1893.

Section 13, Interstate Quarantine Regulations, is hereby amended to read as follows:

"SEC. 13. Water for drinking or culinary purposes provided on any car, vessel, vehicle, or other conveyance, by any person, firm, or corporation while engaged in interstate traffic, shall conform to the bacteriological standard for drinking water, as promulgated by the Secretary of the Treasury on October 21, 1914, and shall not be from a supply that is exposed to contamination.

66

(a) The person, firm, or corporation before mentioned shall procure from the interstate sanitary officer, or the State or other health authority within whose jurisdiction the water is obtained, a certificate showing that the water supply conforms to the foregoing requirements. The aforesaid certificates shall be executed semiannually, or as often as the Surgeon General of the United States Public Health Service may direct, and shall be filed with the United States Public Health Service.

"(b) Ice used for cooling such water shall be clear natural ice, ice made from distilled water, or ice made from water certified as aforesaid, and before the ice is placed in the water it shall be first carefully washed with water of known safety, and handled in such manner as to prevent its becoming contaminated by the organisms of infectious or contagious diseases: Provided, That the foregoing shall not apply to ice which does not come in contact with the water which is to be cooled.

"(c) Water containers shall be cleansed at least once in each week that they are in operation.

"(d) The provisions of this section shall also apply to water provided for drinking or culinary purposes on vessels plying between foreign ports on or near the frontiers of the United States, and adjacent ports in the United States, in accordance with article 4, Foreign Quarantine Regulations of the United States, promulgated October 20, 1910, and amendments thereto.

The foregoing amendment requires that only water used for drinking or culinary purposes shall be certified in the manner indicated, and that this provision shall apply not only to common carriers but to persons, firms, and corporations engaged in interstate traffic, it having been ascertained that certain of these firms were not common carriers under the strict sense of the term. The section further provides that in addition to the bacteriological analysis of any supply from which water is derived for use on conveyances engaged in interstate traffic a sanitary survey of the watershed from which such water is obtained shall be made to determine whether the supply is subject to contamination, thus placing the work upon a more scientific basis. It has been found that certain supplies which conformed at stated intervals to the bacteriological standard were, nevertheless, subject to dangerous pollution which might occur and produce disease in the interim of examinations. The final paragraph of the section, making the requirements apply to vessels plying between foreign ports on or near the frontiers of the United States and adjacent ports of the United States, was appended in order to include in its provisions vessels navigating the Great Lakes and the St. Lawrence River, which carry passengers destined for interstate traffic in this country, as is prescribed for United States vessels in the same area. This not only protects passengers but obviates unfair restrictions upon United States vessels in comparison with those under other flags.

WATER FOR DRINKING PURPOSES PROVIDED AT STATIONS BY INTERSTATE CARRIERS. (Amendment No. 2 to Interstate Quarantine Regulations, 1916.)

Public Health Service.

TREASURY DEPARTMENT,

OFFICE OF THE SECRETARY,
Washington, February 12, 1917.

To medical officers of the U. S. Public Health Service, State and local health authorities, and others concerned:

The following amendment is hereby made to the Interstate Quarantine Regulations promulgated by this department January 15, 1916, said amendment and regulations being in accordance with the act of Congress approved February 15, 1893.

Section 14, Interstate Quarantine Regulations, is hereby amended to read as follows:

"SEC. 14. No person, firm, or corporation engaging in interstate traffic shall maintain or permit to be maintained at or near any station or other ordinary stopping place over which the aforesaid person, firm, or corporation has control, any tank, cistern, receptacle, hydrant, pump, well, stream, brook, pool, ditch, or other place or article containing water which may be contaminated by organisms likely to cause a contagious or infectious disease, and which water may conveniently be obtained by employees of the aforesaid person, firm, or corporation, or by the general public engaging in interstate traffic, unless approved signs, prohibiting the use of such water for drinking purposes, be properly placed and properly maintained."

W. G. MCADOO, Secretary.

It

The object of this amendment is to protect employees, passengers, and others from unknowingly consuming contaminated water. was found that nonpotable water provided for commercial uses frequently existed in proximity to safe supplies and without placarding persons were quite as apt to drink from the polluted source as from the other.

INTERSTATE TRANSPORTATION OF PERSONS HAVING CONTAGIOUS OR INFECTIOUS

DISEASES.

(Amendment No. 3 to Interstate Quarantine Regulations, 1916.)

Public Health Service.

TREASURY DEPARTMENT,

OFFICE OF THE SECRETARY,
Washington, February 12, 1917.

To medical officers of the U. S. Public Health Service, State and local health authorities, and others concerned:

The following amendment is hereby made to the Interstate Quarantine Regulations promulgated by this department January 15, 1916, said amendment and regulations being in accordance with the act of Congress approved February 15, 1893.

Section 18, Interstate Quarantine Regulations, is hereby amended to read as follows:

"SEC. 18. No person knowing that he is in the communicable stage of any of the diseases enumerated in section 1 shall travel on any car, vessel, vehicle, or other conveyance engaging in interstate traffic, except as hereinafter provided, nor shall any parent, guardian, physician, nurse, or other person allow or procure such transportation for any minor, ward, patient, or other person under his charge."

W. G. MCADOO, Secretary.

This amendment places the responsibility regarding travel of persons suffering from communicable disease upon the affected passenger or his agent, while in no sense relieving the railroad of the responsi