following circular letter to owners and others concerned in the use of water for drinking and culinary purposes on board lake vessels: 1917. Department Circular No. 72. Public Health Service. TREASURY DEPARTMENT, To Owners, Agents, and Masters of Vessels Operating on the Great Lakes: On and after the official opening of navigation in 1917, any person, firm, or corporation operating vessels in interstate traffic on the Great Lakes will be required to furnish on such vessels water for drinking or culinary purposes under one of the following conditions: (a) If water for drinking or culinary purposes is not obtained ashore, it must be treated by an approved method. (b) If water for drinking or culinary purposes is obtained ashore, it must be from an approved source. On and after the official opening of navigation in 1917, the piping system on all vessels must be so arranged that no connection can be made between the drinking-water system and any other water system. On and after the official opening of navigation in 1917, an approved sign, reading "DO NOT DRINK THIS WATER," must be properly placed at every tap or other outlet not connected with the drinking-water system. Lake carriers are requested to acknowledge the receipt of this letter. Following the issuance of this letter lake carriers have very generally complied with its requirements and have installed the necessary treatment apparatus. Three methods for the purification of water have been approved, namely, distillation, sterilization by heat, using a steam jet, and sterilization through the use of the ultra-violet ray apparatus. Owing to the fact that the demand for appliances of this character was very great, following the promulgation of the order in question, the equipment of all vessels before the opening of navigation was not possible, hence those vessels which were unable to meet the requirements were permitted to resume operation upon presenting evidence that arrangements had been made to install the necessary equipment as soon as it could be provided. It is believed that the result of the enforcement of this regulation will materially reduce the incidence of typhoid fever and other water-borne diseases which have for many years been common as the outcome of infection contracted on board lake vessels. Numerous conferences have been held with shipping concerns regarding the interpretation of the regulation referred to. During the year a number of special investigations have been carried out by the personnel of the district. In January, Sanitary Engineer H. P. Letton made a complete study of the sanitary quality of the public water supply of Milwaukee, Wis. On February 7 a comprehensive sanitary survey of the municipality of East Chicago was made by Asst. Surg. R. R. Spencer. During May, 1917, Sanitary Engineer Letton reported on the quality of the water supply of Bismarck, N. Dak. At two different times during the year, in accordance with bureau orders, he also consulted with organizations in Chicago relative to the sanitation of their swimming pools. A special investigation relative to the intake of the water supplied to the city of Keokuk, Iowa, was made by the office personnel of the laboratory car on May 19, 1917. During August a number of bacteriological examinations were made for the purpose of testing an ozone apparatus which was pro posed by the owners to be used aboard trains and vessels. These tests showed that the apparatus, in its present form, would not produce a water meeting the Treasury Department standard. A close study has been made of the sanitary features of all the railroad coach yards in Chicago with particular reference to the matter of handling, filling, and cleaning water coolers. This study has demonstrated the necessity of devising a standard type of water cooler and establishing standard methods of handling drinking water in all coach yards throughout the country. On October 16, 1916, at the invitation of the Association of Railway Chief Surgeons, the following papers were read: "Activities of the U. S. Public Health Service Pertaining to Water Supplies of the Interstate Common Carriers," by Surg. J. O. Cobb; "A Short Discussion of Certain Technical Details and Difficulties Encountered in Making Analytical Examinations of Railway Water Supplies," by Asst. Surg. R. R. Spencer; "The Method of Handling Drinking Water Aboard Railway Trains" (illustrated), by Sanitary Engineer H. P. Letton. In accordance with bureau orders of December 19, 1916, Surg. J. O. Cobb was directed to proceed to Indianapolis and Princeton, Ind., for the purpose of consultation with the State health authorities regarding the handling and disposition of a case of leprosy occurring at the latter place. During the year Asst. Surg. Spencer has made numerous diagnostic examinations for Indian schools situated within the district, and performed many complement fixation tests in connection with the work of the marine hospital. On June 12 the interstate sanitary car "Wyman " was hurriedly dispatched by telegraphic orders to the Great Lakes Naval Training Station, Great Lakes, Ill., to assist in the control of an epidemic of cerebrospinal meningitis at that point. On June 13 the officer in charge of the car reported to Medical Inspector De Valin, United States Navy, at the Great Lakes station and to Surg. G. W. McCoy, who had been detailed from the Hygienic Laboratory to take charge of the service investigations. The control of the epidemic necessitated an enormous amount of laboratory work, and therefore the laboratory car proved itself of the greatest utility. As it was necessary to take a large number of throat cultures in order to locate and isolate carriers, the laboratory of the sanitary district of the Great Lakes was used as a base for the preparation of media and for the final agglutination tests of suspicious organisms, the car "Wyman" being used for the taking of cultures and the first 24 hours incubation of the plates. At the close of the fiscal year the "Wyman" is still engaged in this work. Four hundred and thirty-seven cultures have been taken, most of which were from men who had not been in contact with the disease. At the request of Medical Inspector DeValin, toward the close of the fiscal year, Sanitary Engineer H. P. Letton made a sanitary survey of the Great Lakes Naval Training Station. On June 22 Asst. Surg. R. R. Spencer was directed to report to the Surgeon General of the Navy for duty and orders in connection with the sanitation of certain naval districts. On June 27 the construction of a second laboratory car, which will soon be in commission, was authorized, OPERATIONS OF THE SANITARY DISTRICT OF THE PACIFIC. During the past fiscal year the operations of the interstate sanitary district of the Pacific have consisted mainly in the examination of samples of water from all sources of supply for interstate carriers within the limits of the district. This work heretofore had been done by the California State Board of Health and by various local health officers in the State of Nevada. These examinations were made at the Federal laboratory in San Francisco. The samples were collected at various points and shipped in special containers to the laboratory. In accordance with the Interstate Sanitary Regulations, these examinations are now being made regularly every six months. On account of the great press of other work it was found impossible during the year to complete the sanitary surveys of watersheds that had been begun in the previous year. However, a comprehensive survey was made of the water supply of the city of Sacramento, and recommendations were made to the city health authorities in regard to proposed improvements. On December 1, 1916, the Federal laboratory in San Francisco became the Interstate Sanitary Laboratory of the Pacific. For convenience all of the operations of this laboratory for the year, with the exception of water analyses, have been tabulated under the report of plague-suppressive measures. Below is a tabulated account of water analyses made during the year: Examination of water supplies on interstate carriers. Number of sources of water supplies in the District of the Pacific_. 136 183 Number of samples conforming to Treasury Department standard__ 151 32 Number of sources of supply certified__ 87 Number of sources of supply certified after improvements were installed__ 6 11 Number of sources of supply not used during the year____ OPERATIONS OF THE SANITARY DISTRICT OF THE NORTH PACIFIC. 32 The work of the interstate sanitary district of the North Pacific was continued under the direction of Surg. B. J. Lloyd. The laboratory is at Seattle, Wash. The work in this district consists at present of water examinations (bacteriological) of supplies used on common carriers, sanitary surveys of watersheds from which these supplies are derived, the supervision of the interstate travel of persons suffering from communicable diseases, special scientific surveys, educational work along sanitary lines, and the enforcement of the interstate quarantine regulations generally. Examinations are conducted in the laboratory of specimens submitted by the Indian Service, specimens derived from patients in marine hospitals, together with such laboratory procedures as are required in the medical examination of arriving aliens. During the year supervision of travel of 9 persons suffering from minor contagious diseases and 2 persons afflicted with leprosy was arranged for. One railroad coach was fumigated. One hundred 18643°-17-16 and sixty-four persons were vaccinated against smallpox and 40 were vaccinated against typhoid fever. An investigation to determine the presence or absence of spirochaetes in rats (in view of the relation of this parasite to Weil's disease) was begun during the latter part of the fiscal year, but nothing had been determined at the close of the year. One fatal case, reported as Weil's disease, was investigated. Blood, taken aseptically, about two hours before death gave a streptococcus in pure culture in lactose bouillon (no growth in agar or plain bouillon). Inasmuch as this patient had just (apparently) recovered from an operation for cholecystitis it is believed that true epidemic jaundice may be excluded. Animals inoculated for spirochaete (Weil's disease), negative.... Blood smears examined, human, for spirochaetes (negative). OPERATIONS OF THE SANITARY DISTRICT OF THE GULF. 127 38 During the past fiscal year the activities in this district have been confined almost entirely to the examination of water supplied vessels for drinking purposes. On several occasions samples of water have been received for examination from places distant from New Orleans, but this has not become a routine procedure. During December, 1916, a field survey was made by Asst. Surg. J. B. Laughlin of the water supply at Talladega, Ala., and in May, 1917, Asst. Surg. Teufel made a field survey of the water supply at Gallatin, Tenn. The following is a detailed report of the water samples received at the laboratory and the results of the examination : Vessels from which supplies were obtained_ Total samples collected___. Number of samples confirmed. Number of samples nonconfirmed_ Number of samples badly polluted.. Probability of contamination in handling_ Number of supplies untreated.... Filtered Distilled Other methods 366 479 303 162 28 72 409 70 67 0 3 New equipment is now being installed in the laboratory which will enable it to meet all requirements. A number of requests have been received for the examination of the water supplies of nearby towns and the work of the Interstate Sanitary Laboratory should continue to increase as it becomes better known. OPERATIONS OF THE SANITARY DISTRICT OF THE SOUTH ATLANTIC. The work of this district for the fiscal year included laboratory examinations of 85 specimens of the city water supply of Savannah and sanitary surveys conducted in conjunction with the local health authorities of the sources of this supply. During the latter part of May, 1917, it became necessary to prohibit the use of this water by interstate carriers owing to failure to comply with the Treasury Department standard. Following the use of an additional amount of hypochlorite in the treatment of this water and the correction of certain insanitary conditions, the supply was brought to conform to the standard promulgated and its use was again permitted. Plans are now under way for extensive permanent improvements in the waterworks system involving an expenditure estimated at $500,000. INVESTIGATION OF AN EPIDEMIC OUTBREAK AT TALLADEGA, ALA. In December, 1916, a request was received from the health officer at Talladega, Ala., through the State board of health, for the detail of an officer to assist in the control of an outbreak of diarrhea and enteritis occurring in that city, presumably caused by a contaminated water supply. Accordingly, Asst. Surg. Jas. B. Laughlin was directed under orders of December 6, 1916, to proceed to Talladega for that purpose. For a number of years Talladega, a city of 6,000 people, had suffered excessively from typhoid fever, the mortality rate averaging well above 100 per 100,000 population. In addition there had been frequent outbreaks of diarrhea and enteritis, particularly among newcomers, and conclusive bacteriological evidence had been offered of a marked degree of pollution of the city water supply. At this time the water was derived from a spring. The geological formation was limestone, more than 400 surface privies existed in the community, and the sewer system was defective. Believing that the presence of disease was due to a contaminated water supply brought about by these conditions, action was taken and two wells, each in proximity to the spring, were sunk to a depth of more than 400 feet. |