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bility of knowingly accepting such passengers, thus providing an additional safeguard to the traveling public.
SANITATION OF CAMPS OCCUPIED BY MIGRATORY WORKERS.
OFFICE OF THE SECRETARY,
To medical officers of the U. S. Public Health Service, State and local health authorities, and others concerned:
The following addition is hereby made to the Interstate Quarantine Regulations promulgated by this department January 15, 1916, said addition and regulations being in accordance with the act of Congress approved February 15, 1893.
The following regulation, section 37, is hereby added to the Interstate Quarantine Regulations:
"SEC. 37. Persons, firms, or corporations maintaining camps of migratory workers shall at all times maintain such camps in a proper sanitary condition and shall take proper measures to maintain the camps so occupied in a verminfree condition and shall exercise such other precautions as shall prevent the interstate spread of disease from such camps, and the Surgeon General may from time to time detail officers or employees of the United States Public Health Service to make such inspections as shall be necessary for the enforcement of this regulation.
"W. G. MCADOO, Secretary."
The above section was made necessary by the threatening typhus situation and was aimed directly at railway and labor camps where insanitary conditions favoring the development of that disease prevailed. Since the outbreak of typhus fever in Mexico energetic measures have been instituted at border points toward the prevention of the introduction of the infection, but these measures were in large effect rendered nugatory by the fact that conditions conducive to the dissemination of typhus existed in construction camps in our country. Following the promulgation of the above regulation, and as a result of the cooperation of the State boards of health and the railroad companies concerned, the menacing conditions have been materially overcome.
PROHIBITING THE INTERSTATE TRANSPORTATION OF OYSTERS AND CLAMS GROWN OR HANDLED UNDER INSANITARY CONDITIONS.
(Amendment No. 5 to Interstate Quarantine Regulations, 1916.)
Public Health Service.
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 addition is hereby made to the Interstate Quarantine Regulations promulgated by this department January 15, 1916, said addition and regulations being in accordance with the act of Congress approved February 15, 1893. The following regulation, section 38, is hereby added to the Interstate Quarantine Regulations:
"SEC. 38. After notification in writing by the proper health authorities, common carriers shall not transport nor accept for transportation in interstate traffic, nor shall any person, firm, or corporation offer for transportation in interstate traffic, any oysters, clams, or other shellfish which have been grown, fattened, or handled in such a way as to render them liable to become agents in the interstate spread of disease, and the Surgeon General of the United States
Public Health Service shall from time to time cause sanitary inspections to be made by officers of the Public Health Service of beds used for growing or fattening oysters, clams, or other shellfish and of shucking houses and other similar places in which oysters, clams, or other shellfish are shucked or otherwise prepared for interstate shipment, and he may forbid the interstate shipment of any such oysters, clams, or other shellfish which are produced or handled in a manner which will render them liable to become agents for the interstate spread of disease."
W. G. MCADOO, Secretary.
As a result of the investigations of the pollution of coastal waters, referred to in another section of this report, conditions in reference thereto in certain areas where shellfish were grown or fattened were ascertained to be far from satisfactory, if not actually dangerous, and that food products originating from these polluted sources were frequently responsible for the interstate spread of disease. The purpose of the amendment as promulgated is to grant authority for the inspection of those places where shellfish are grown, fattened, or handled and to prohibit the interstate transportation of these food products when it is found that they are liable to become agents in the transmission of disease. This regulation has already given favorable results and numerous inquiries have been received from shellfish growers concerning the sanitary status of waters in which their products are grown.
WATER SUPPLIED BY INTERSTATE CARRIERS.
The certification of supplies from which water is derived for the use of interstate passengers has been continued as heretofore, although the scope of the examination covering these supplies has been considerably broadened. As previously noted sanitary surveys at periodic intervals of the watershed from which supplies are derived were made obligatory, so that under the present regulations entire dependence is not placed upon the results of bacteriological examination in judging of the quality of a given supply. This requirement has tended toward the maintenance of watersheds in a satisfactory condition and has encouraged State and local health authorities in the adoption and enforcement of the necessary provisions for the adequate protection of such sources. In many instances these authorities were already in possession of data relative to the sanitary status of all watersheds under their jurisdiction and exercised precautionary measures for their protection. In such instances the enforcement of the requirement referred to has entailed no additional labor. In other cases expenditure of time and effort has been necessary in surveying and safeguarding these supplies.
Conformatory to the amended regulation requiring sanitary surveys of water supplies as well as bacteriological analyses a new form for the certification of water has been prescribed, affording complete data regarding any given supply. The cooperation necessary on the part of State and municipal health authorities in the securing of these data is more manifest than at any previous time and the response afforded practically every request has been most gratifying. The point should not be overlooked, however, that information concerning the condition of water supplies is a valuable contribution to the records of any health office and frequently has considerable epidemiological significance.
The number of water sources listed from which supplies for interstate carriers are obtained has shown a material reduction during the
thus indicating that the securing of water from brooks, wells, and other sources indiscriminately without regard to its quality or the opportunities for contamination is being discouraged. On June 30, 1916, the listed supplies throughout the United States numbered 5,411, while on June 30, 1917, only 4,156 supplies were listed. Of the latter number 3,713, constituting 89.34 per cent, were examined and certified during the year. Of the total number of supplies examined 211 were either found contaminated or not to meet the Treasury Department standard, these supplies representing 5.07 per cent of those in use. In all instances where contamination was discovered the water was either ordered discontinued or provision was made for its purification in an approved and satisfactory manner. The following table indicates by States the number of supplies listed, those examined, and the number found polluted:
Statistics concerning the certification of water provided on cars and vessels by interstate carriers for the fiscal year ending June 30, 1917.
It will be noted from the foregoing table that for 11 States, at some time during the year, certificates were registered covering the entire number of supplies from which water for the use of interstate passengers was derived, while in 28 States more than 90 per cent of the supplies were certified. In comparison with what has been accomplished in previous years, and in view of the fact that hundreds of indiscriminate supplies have been eliminated, this constitutes a remarkably good showing. It should be understood that the report indicates only the number of certificates and not their worth; it is therefore in part misleading as an index of the condition of the water supplies of any particular State. It should be stated in passing, however, that there is good reason to believe that the certificates of examination received during the year have been based upon much more thorough investigation than at any previous time.
The number of supplies found polluted, as shown in the last column, is more or less of an indication of the efficiency of the examining authorities rather than a reflection upon the water supplies of the State. The low percentage of pollutions in Massachusetts can be attributed to the fact that that State has exercised absolute control over all water supplies for many years and has amply protected all public watersheds. The somewhat higher percentage in Ohio is an indication of the thoroughness and completeness of the work performed by the State board of health. The very high percentage of polluted supplies in Minnesota and Michigan is the result of concentrated and systematic effort in the examination of all sources from which water is obtained for interstate passengers, these examinations being carried out in the latter State through the use of the interstate sanitary car "Wyman."
OPERATIONS OF THE SANITARY DISTRICT OF THE GREAT LAKES.
The activities of the sanitary district of the Great Lakes during the year have related in the main to the supervision of the water supplied by interstate carriers for the use of passengers.
In July, 1916, Sanitary Engineer H. P. Letton visited all the State health departments within the district for the purpose of ascertaining what their practice was regarding the certification of water for the use of interstate carriers, their equipment for performing the work, and the difficulties encountered. These visits showed that while certain State boards of health were well prepared to handle the situation, others were not, and in the latter States the work would necessarily devolve, to a large extent, upon the service.
It was deemed advisable, in order to cope with the railway water supply situation to the best advantage, to make sanitary surveys of each source of supply, the data obtained to be filed and to constitute more or less permanent records of the quality of water derived from a particular source. Accordingly, a portable field laboratory was designed and used in the field for several months. This laboratory, while not proving entirely satisfactory, amply demonstrated that more than ordinary bacteriological examinations were required and showed the necessity, in order to form a proper opinion of the quality of a water, of adequate field surveys.
On November 13, 1916, bureau authorization was given for the construction and outfitting of a laboratory car. This car, which is a remodeled Pullman, consists of a completely equipped field laboratory adequately provided with every appliance for routine bacteriological investigation. The car also contains an office, officers' and attendants' sleeping quarters and toilet rooms, and a kitchen and dining room. It is lighted by electricity, which also furnishes energy for driving fans and for heating an incubator. The car was named the interstate sanitary car "Wyman," in commemoration of the late Surg. Gen. Walter Wyman, and was placed in commission March 20, 1917, the personnel consisting of a medical officer in charge, a sanitary engineer, clerk, cook, and laboratory attendant. The first trip of the interstate sanitary car was through the greater part of the State of Michigan. In this State the sources of 81 water supplies were surveyed, the necessary bacteriological examinations performed, and certificates issued covering the quality of these supplies. From Michigan the car proceeded through Wisconsin to Chicago, where it was inspected by the Association of Railway Chief Surgeons. It then traveled through Illinois and Indiana, the same line of investigations being conducted, until called to the Great Lakes Naval Training Station the 12th of June, where it was used in the control of an outbreak of epidemic cerebrospinal meningitis.
In the operation of the car in the investigation of railway water supplies, no attempt is made to take the car to each locality where water is obtained, but it is moved to a central point from which the officers radiate out to near-by towns, making sanitary surveys and collecting samples of water which are then returned to the car for analyses. An average of 4 or 5 supplies are inspected while the car is at a given locality. The movements, as a rule, average about 50 miles, and the car lies at one point for from 24 to 72 hours. Upon the return of the officer to the car, a description of the sanitary aspect of the supply is card indexed, and from this, together with the results of the analytical examination, certificates as to the quality of the supply are issued.
When a water supply does not conform to the standard, either because of bacteriological impurities, or because of potential danger of contamination, a letter is prepared to the municipality, or the owner of the supply, outlining the conditions found and making recommendations for improvement. As most of the sources of water are public supplies, the work has had a beneficial result in bettering the water supply of thousands of people in cities, as well as those using the water on railroad trains.
The work in connection with the enforcement of the Interstate Quarantine Regulations relating to water supplies of vessels operating on the Great Lakes has been continued during the fiscal year. Pursuant with recommendations of the bureau, and following thorough and complete investigations extending over a period of several years regarding the conveyance of disease from contaminated water supplies on vessels plying the Great Lakes, data which has been referred to in previous annual reports for a number of years back, the Secretary of the Treasury issued on February 12, 1917, the