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From the fall of 1912, when the wells were completed, until May, 1915, water was obtained exclusively from this source but typhoid and diarrheal diseases continued and B. coli were invariably present in the water examined. After investigation the State sanitary engineer recommended the installation of a liquid chlorine plant, and following the equipping of the same there was an immediate decline in the typhoid fever and dysentery death rate.

The outbreak in question commenced about October 28, 1916, approximately 500 cases of diarrhea developing within a period of 10 days, reaching a maximum of 1,500 cases, the estimate of the health officer, within a short time. The disease was widespread, occurring equally in all portions of the city with the exception of a section receiving its water supply from individual wells; here there were fewer cases, although it was impossible to entirely exclude the use of city water in the washing of vegetables and for other purposes. The symptoms were the same in every instance, the disease being characterized by sudden and uncontrollable diarrhea, accompanied by abdominal pain, and followed by weakness, the condition in some instances continuing for a number of weeks. Upon stopping the use of the city water the symptoms nearly always abated.

Questioning of the superintendent of the waterworks elicited the fact that just before the epidemic outbreak developed, owing to the breakage of one of the valves of the chlorinating apparatus, no chlorine had been added to the water and during this time water from both the wells and the spring had been pumped into the mains. Further investigation determined that the amount of chlorine added was not efficiently regulated and that the effectiveness of the plant, even when in operation, was not controlled by bacteriological analyses, so that there was no way of determining whether the amount of chlorine going into the water was sufficient to render it safe. Samples of the spring water collected and examined showed 10,000 bacteria in 1 cubic centimeter and B. coli in 1 cubic centimeter. In samples which had undergone proper chlorination B. coli were not found.

For the control of the epidemic it was recommended that all water used for drinking and culinary purpose be boiled until assurance could be given that the city supply had received proper treatment; that the chlorinating plant be scientifically operated, the effectiveness of the apparatus to be controlled by bacteriological examinations; that the use of the spring water be abandoned and that all surface privies be eliminated and the sewage system repaired. It was further advised that if for any reason necessity arose to pump untreated supplies into the city mains the people should be notified to boil their water until it was reasonably certain that all of the untreated water had been forced out of the system and the chlorinated water was again in circulation.


In the work of certification of water supplies for use on interstate carriers it was reported to the Public Health Service by the Maryland State Board of Health that the water supplied common carriers in the city of Baltimore failed to conform to the standard promulgated by the Treasury Department and that it was therefore impossible to issue a certificate covering this source. This fact being

reported to the commissioner of health of Baltimore a request was received from this official, concurred in by the secretary of the State board of health, for a thorough investigation of the water supply with the possibility of determining the conditions at fault. In accordance with this request Passed Asst. Surg. H. E. Hasseltine and Sanitary Engineer W. D. Wrightson were detailed to proceed to Baltimore for this purpose. At the termination of the fiscal year this investigation was still in progress.


In October, 1916, in compliance with a request received from the Commissioner of the Lighthouse Service an officer was detailed to investigate an alleged case of typhoid fever occurring in the family of the assistant keeper of the lighthouse at San Luis Obispo. Cal., Asst. Surg. D. S. Baughman being assigned to the duty in question. The facts elicited are well worthy of record.

It was ascertained by the investigating officer that the patient, a young girl of 15, had previous to her illness been in the habit of visiting a small village of 250 inhabitants 4 miles distant. Her illness was abrupt in onset, with severe headache, pain in the back of the neck, and general weakness, more pronounced in the lower extremities. Within a short time the weakness of the limbs became accentuated and other symptoms of a serious nature developed, the case terminating fatally on the fifth day of illness. These facts, elicited from the family and the physician, failed to thoroughly establish the diagnosis of typhoid fever to the satisfaction of the inspecting officer, and, indeed were more indicative of death from some other cause. Accordingly it was decided to investigate conditions in the near-by village where the child had visited.

Upon inquiry from the townspeople it was ascertained that there had been no cases of suspicious illness in the village or vicinity, but it was recalled upon further questioning that a child had recently been ill. This child was examined, and the mother informed the inspecting officer of another child who had been similarly afflicted, while the second mother was able to recall a third who had also been ill. In this manner three additional cases, resulting in two deaths, were brought to light, all more or less typical of poliomyelitis. Upon attempting to determine the source of the infection it was learned that nearly three months previously a woman with four children had come to the village from New York City, where the children had been definitely exposed to poliomyelitis. During the course of the journey one of the children became suddenly ill with high fever and paralysis, death resulting before the final destination was reached. The mother, with the remaining members of the family, completed her journey, and soon after her arrival the first cases developed. Definite instances were recalled where the older children of the families in which the disease appeared had associated with the children of the New York woman, thus establishing the chain of infection. The fact that the true nature of the disease had not been determined and that the infection was unquestionably transferred directly from the Atlantic to the Pacific seaboard are the striking features of what was regarded as an ordinary occurrence of a case of typhoid fever.


On December 2, 1916, the Assistant Secretary of the Interior requested that an officer of the Public Health Service be detailed for the purpose of making an examination as to the sanitary and other related conditions in the Yosemite National Park, and to suggest such measures as were necessary for the betterment thereof. In as much as national parks are places of congregation of persons from all parts of the United States, and since the occurrence of insanitary conditions in those localities greatly favor the interstate spread of disease, Senior Surg. L. L. Williams was detailed for the purpose of making the sanitary inspection requested. Passed Asst. Surg. C. L. Williams was directed to examine in the interstate sanitary laboratory at San Francisco water samples collected from the more important sources. Senior Surg. Williams made a careful survey of those portions of the park which could be visited at that season of the year. The water samples collected by him were examined and a report of the entire operation transmitted to the Department of the Interior.


In consonance with a request received from the Chief of Engineers, United States Army, a sanitary inspection was conducted November 20, 1916, of the United States dredges Maumee and Burton and the tender tug Spear. A report was submitted by Surg. John M. Holt, who made the inspections, covering the vaccination of the crew against smallpox and typhoid, the system of handling and storage of water supplies, the complement of medicine chests, and other items having a bearing upon the health of the officers and men.


Conformable with Executive Order No. 1498 of March 15, 1912, all buildings of the executive branch of the Government within the District of Columbia, excepting those of the War and Navy Departments, have been inspected during the year with reference to their hygienic and sanitary condition. These inspections were made by Surgs. M. H. Foster and E. A. Sweet and Passed Asst. Surg. J. R. Hurley. A gratifying improvement is everywhere noticeable since the inspections were instituted, evidencing each year attainment of higher standards. In a certain number of buildings expensive structural alterations are required in order to have them conform with modern conceptions of hygiene and sanitation, but even in these the standard of cleanliness and order is excellent and complaints are relatively infrequent.

Ventilation. The majority of the buildings are ventilated from natural sources, and in most instances this means would be satisfactory were free use made of open windows. Unfortunately, this method is not always utilized to the necessary extent, owing to the fact that many employees, on account of their age or physical condition, are very sensitive to drafts. However, through the installation of the glass wind deflectors in window bases these objections have been largely overcome.

Lighting. The most satisfactory type of semi-indirect lighting is in use in but few of those buildings where artificial light is needed

in the daytime. In most instances, however, save on dark days, ample daylight to carry on the work is available. This is supplemented, where needed, principally by the use of fixtures of the direct type. Where these produce glare in the employees' eyes, troublesome shadows, or an insufficiency of light, such matters are reported upon with accompanying suitable recommendations for the improvement of existing conditions.

Heating. As commented upon in previous reports the prevailing and almost the only defect found in this regard is the creation of too high a temperature in offices, coupled with too low atmospheric humidity. This defect undoubtedly contributes to an increased morbidity among the employees from affections of the respiratory tract. It is practically impossible to overcome the defect mentioned without an expenditure of funds that in most cases are unwarranted under the circumstances.

Overcrowding and congestion. The conditions of overcrowding and congestion noted in many buildings in previous years were found to be markedly improved during the past winter, brought about through new construction and the securing of additional quarters in rented buildings. However, due to the additional work thrown on the departments following the declaration of war, necessitating a greatly increased personnel, despite the securing of new office space, the congestion in some offices has again become marked. Plans are on foot to remedy this condition, and in the meantime every effort possible is being made to secure free ventilation and otherwise protect the health of the employees.

Drinking-water supplies.-Special care is taken in all buildings to supply employees with a chilled water which is protected from contamination. This is secured through cooling the water by other means than by permitting the ice to come directly into contact therewith, by furnishing each employee with an individual drinking glass, and the issuance of regulations prohibiting leaving these at coolers for common use.

Toilets and lavatories.-These conveniences, as regards facilities and maintenance, are in most instances above reproach. Cakes of hand soap for common use are prohibited in the majority of the buildings and liquid soap with individual towels are generally provided.

Cleaning and general cleanliness. As regards general cleanliness the Government buildings in Washington have reached a high state of excellence. This has been secured in part by the centralization of the authority responsible for results in this regard by placing the cleaning force in each building under a capable person_and partly by the introduction of improved methods of cleaning. Electric floor-scrubbing machines and vacuum cleaners have been installed in many instances, by which means much better results are obtained without additional labor.

Welfare of employees.-The fitting up in the larger Government buildings of lunch rooms and women's rest rooms and the installation of emergency hospitals, safety devices, shower baths, etc., in those buildings where large-scale mechanical processes are carried on have been of great benefit in both conserving the health of employees and producing contentment.


In conformity with a request submitted to the Treasury Department by the custodian of the old post-office building at Pittsburgh, Pa., an officer was detailed May 21, 1917, to investigate sanitary conditions in that building with special reference to rat infestation, Asst. Surg. C. V. Akin being assigned to the duty in question. It was ascertained that rat infestation existed to such an extent that damage to the mails was of frequent occurrence, although the general sanitary condition of the building was excellent, the rodents in most instances gaining access to the structure from outside sources. Specific recommendations for the correction of existing conditions were advanced, these comprising the elimination of rat harborage beneath floors, the screening of ventilating flues, and the pointing up of unnecessary apertures with cement mortar.

Under date of May 23, 1917, Passed Asst. Surg. J. H. Smith was directed to proceed to Columbus, Ga., for the purpose of making an inspection of the post office at that city and to submit through the usual channels a report relative to infestation of the building by rats and also concerning the methods of lighting, heating, and ventilation. It was ascertained that the difficulty with rodents apparently originated with the handling of food products by parcel post. Recommendations were submitted for the elimination of the rat population and the correction of other defects of construction and operation.

The group of buildings, 14 in number, comprising the Columbia Institution for the Deaf at Washington, D. C., were surveyed by Asst. Surg. C. V. Akin in compliance with orders of February 14, 1917, the investigation being conducted at the request of the president of the college on account of trouble from rat infestation. After a careful investigation of conditions with reference to the storage of food supplies and facilities for the harboring of rodents, measures for the correction of the evil were recommended.


The Government safety-first train, depicting the various activities of the Federal Government in the conservation of human life, continued its itinerary from July 1 to August 29 of the present fiscal year, the States of Oklahoma, Kansas, Nebraska, Colorado, Wyoming, and Utah on the lines of the Missouri, Kansas & Texas, and Union Pacific Railways being visited. The itinerary, as extended, was completed at Beatrice, Nebr., and the train was immediately returned to Washington for disbandment.

From the date of the inception of the trip, May 1, 1916, to August 29, 1916, a total distance of 9,093 miles was traveled and 87 cities and towns in 16 States were visited. The number of visitors was 531,982 and the average daily attendance 5,215. Had it not been for the limited capacity of the train these numbers would have been considerably larger as many thousand visitors were turned away. Motion pictures, illustrative of governmental activities along humanitarian lines, with special reference to health and safety, were shown to 140,600 persons. Everywhere the extent and instructiveness of the exhibit were highly praised, it being the consensus of opinion among visitors that the exposition was of great educational value.

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