THE EMERGENCY HOSPITAL, PANAMA-PACIFIC INTERNATIONAL

EXPOSITION.

The operations of the emergency hospital, established for the relief of the sick and injured at the Panama-Pacific International Exposition, were not terminated until November 15, 1916, the process of demolition of numerous buildings on the grounds necessitating the continuance of an institution of this character although during the post-exposition period the hospital was conducted practically as an out-patient clinic. Throughout the period of operation only emergency cases were handled and all patients requiring prolonged treatment were either referred to various hospitals or to private physicians designated by the exposition management.

From the date of opening of the hospital, February 18, 1914, to the date of closing, November 15, 1916, 10,794 persons received medical or surgical attention, an average of slightly more than 10 a day. In addition to this number 1,729 patients were retreated, the retreatment aggregating 4,997, so that relief was furnished on 15,791 occasions. A summary of the relief furnished and work accomplished is as follows:

In the latter part of February, 1917, it was reported to the Secretary of the Navy by the supervisor of naval auxiliaries for the fifth naval district that the coal wharves and piers at Newport News, Sewalls Point and Lamberts Point (Norfolk), Va., were heavily infested with rodents which migrated to and from vessels in large numbers whenever they docked for coal. The matter had previously been brought to the attention of Dr. P. S. Schenck, commissioner of health for the city of Norfolk, who, appreciating the urgent need of protecting the city's health, and also the danger of the interstate spread of disease from potentially plague-infected rodents, appealed to the bureau for assistance. Following an interchange of communications between the Navy and Treasury Departments, Asst. Surg. C. V. Akin was ordered, March 23, 1917, to assume charge of the situation.

Upon the arrival of the officer in charge at Norfolk a preliminary survey of the harbor was instituted to determine the points of heaviest rat infestation. It was ascertained that the wharves and docks maintained by the several shipping interests were in poor

structural condition and provided well-prepared harbors for rodents coming from coastwise and foreign vessels lying alongside. At Lamberts Point it was found that the three skeleton steel coaling piers offered little opportunity for rat infestation, but that a fourth pier afforded comfortable and safe harborage. At the landward ends of these piers there was a collection of wooden-box constructed buildings used as offices and storerooms, erected on "made land” of loosely packed composition, which offered favorable conditions for the easy living of rats. These buildings rested upon, or slightly below, the surface of the ground. Similar surroundings were discovered at Sewalls Point and Newport News, the only difference being the extent of the conditions favoring rat harboring. At the latter place each laborer had been permitted to construct an individual locker, in which was kept tools, clothes, and lunches. While none of these huts was large, their multiplicity and the fact that food products were stored therein made rat hiding easy and comfortable.

Upon completion of the inspection a written report of the conditions, as found, and recommendations advanced was submitted to the railway officials in immediate charge of the property concerned and immediately plans were formulated for making the necessary structural changes to bring about a reduction in rat infestation. A sufficient amount was appropriated for by the common council of the city of Norfolk to institute trapping and poisoning operations and over 2,600 rodents were captured. To prevent the ready running of rodents from vessels to shore and from shore to vessels all ships were fended off a distance of 8 feet from the wharf while lying-to or loading and provided with metal rat guards on all lines, orders being issued by the supervisor of naval auxiliaries to this effect. In order to insure proper compliance with these requirements a copy of Public Health Bulletin No. 86 was sent to each yard and regular inspections were made. The rat proofing of buildings by elevation and the construction of concrete flooring was recommended and met with a ready response on the part of owners. In this manner 24 buildings were elevated and 2,738 square feet of concrete laid, together with the installation of 998 linear feet of chain wall. A policy of concentration was recommended for the property at Newport News, and the owners, agreeing, constructed a large building of corrugated iron, providing it with a concrete floor, in place of the many smaller buildings which previously existed. This was surrounded with a wall of concrete, extending from a point 2 feet below the ground level upward to 1 foot above the floor. Within the structure lockers were built, one being assigned to each laborer. This single building fulfilled the best requirements for rat proofing and at once did away with at least 100 unsightly and dangerous other structures, to say nothing of the total elimination of a dangerous fire hazard. These facts necessarily appealed to the owners as economically advantageous.

VACCINATION OF THE GENERAL PUBLIC AGAINST SMALLPOX, TYPHOID, AND PARATYPHOID FEVER.

During the fiscal year 1915 a department circular was issued by the Secretary of the Treasury offering to all civil employees of the Government whose duties obliged them to engage in interstate traffic,

or who were concerned in the handling of mail, free vaccination against smallpox and typhoid fever. Since the issuance of this circular the difficulties encountered in the enforcement of general sanitary measures in times of great national stress and the expenditure of money and time necessary for the improvement of sanitary conditions in order to bring about a reduction of the incidence of disease have led to the more widespread adoption of individual immunization toward the accomplishment of this end. In conformity with this tendency, and in order to attain the greatest benefit in the shortest possible time, a department circular was issued by the Secretary of the Treasury, under date of May 16, 1917, offering to the general public free vaccination against either smallpox, typhoid, or paratyphoid fever, this vaccination to be administered at any one of the 168 stations of the Public Health Service:

1917.

Department Circular No. 83.

Public Health Service.

TREASURY DEPARTMENT,
OFFICE OF THE SECRETARY,
Washington, May 16, 1917.

To medical officers of the United States Public Health Service, and others concerned:

Hereafter, as a means of preventing the interstate spread of disease either by military forces or the civil population, any person in the United States may receive, without cost, upon applying in person at those places designated by the Surgeon General of the United States Public Health Service, vaccination against any one or all of the following-named diseases: Smallpox, typhoid fever, paratyphoid fever.

Medical officers and others charged with the duty of performing such vaccinations should make requisition for the materials necessary therefor, and shall render a monthly report showing the names of those so vaccinated, their addresses, and the date of said vaccination. Upon the request of any person so vaccinated certificate of vaccination may be issued.

W. G. MCADOO, Secretary.

While the effect of this order at the time of the submission of this report has not had time to manifest itself, it is believed that ultimately not only will many thousands receive the preventive treatment for these diseases, which is now on a well-proven and satisfactory basis, but that direct stimulation of vaccination by private physicians will result. It is expected that in the sanitation of extra-cantonment zones, where it is desirable to reduce the incidence of disease to the lowest possible minimum in the least possible time, that vaccination will prove a useful adjunct to other sanitary measures. It is contemplated that all vaccines other than smallpox virus will be manufactured in the Hygienic Laboratory, thus insuring purity and potency of the product.

ESTABLISHMENT OF A NATIONAL HOME FOR LEPERS.

The long-continued agitation for the establishment of a national home for lepers was consummated February 3, 1917, with the enactment of legislation authorizing the founding of an institution of this character and appropriating $250,000 therefor. The passage of this measure is particularly gratifying and marks another forward step in public health legislation. The constantly increasing difficulties in dealing with the leprosy problem have long been apparent to public health officials in nearly every section of the country, and it has been realized that only by proper segregation could the

solution of the problem be accomplished. Not only is segregation demanded for reasons of health, but it is fully as important on economic and humanitarian grounds.

The legislation as enacted authorizes the Secretary of the Treasury to select and obtain a site suitable for the establishment of a home for the care and treatment of lepers, to be administered by the Public Health Service, and to cause such buildings to be erected thereon as may be necessary. Provision is made for the reception into said home, under regulations prepared by the Surgeon General, of any person afflicted with leprosy who presents himself for care and treatment, those who may be apprehended under authority of the United States quarantine acts, or those who are duly consigned to the home by the proper health authorities of any State or Territory, the expenses of transportation to be paid from funds set aside. for the maintenance of the home. The regulations governing the institution are to be prepared by the Surgeon General, subject to the approval of the Secretary of the Treasury.

COOPERATION WITH SOUTHERN SOCIOLOGICAL CONGRESS.

Upon request of the secretary of the Southern Sociological Congress, an officer was detailed to assist the Congress in a health and welfare extension campaign carried on in various sections of the country, orders being issued October 7, 1916, to Surg. B. W. Brown to this effect. The following cities were visited: Winston-Salem, N. C.; Farmville, Va.; Petersburg, Va.; Hopewell, Va.; Richmond, Va.; Charlotte, N. C.; Spartanburg, S. C.; Rock Hill, S. C.; Greenville, S. C.; Seneca, S. C.; and Chattanooga, Tenn. Public meetings were held in the cities mentioned, at which health and welfare subjects were discussed and exhibit material relating to health and community betterment, a portion of which was contributed by the service, was displayed. The attendance at meetings of this character totaled 51,090, and approximately 47,000 people viewed the exhibits, civic organizations, churches, and woman's clubs cooperating in the work. At all of these gatherings special stress was laid on the manner of dissemination and the methods of control of the particular diseases prevalent in that locality and the various phases of public health work were especially emphasized.

In addition to the educational features, upon request of State and local health agencies, brief sanitary surveys of the majority of communities visited were instituted. These consisted of the examination of city ordinances relating to health, the determination of housing conditions, the inspection of public and private water supplies and the watersheds from which they were derived, the disposal of waste. the number and condition of surface toilets, and other easily obtained data bearing upon health. Upon conclusion of the investigations specific recommendations were advanced for the correction of the more obvious defects noted.

COOPERATION WITH STATE CIVIL SERVICE COMMISSIONS IN EXAMINATIONS FOR HEALTH OFFICERS.

During the year examinations have been conducted by the Public Health Service for the Illinois and California State Čivil Service Commissions for the purpose of selecting competent persons as dis

trict health officers in those States, and also for the position of director of the bureau of communicable diseases, State of California. The examinations have included in their scope such subjects as epidemiology, bacteriology, and public health administration, the questions covering these subjects either being formulated and forwarded to the examining board or the candidates appearing before boards of commissioned officers convened for that purpose in representative cities, these boards basing their ratings not only upon the results of the written and oral examinations but also upon the experience and general fitness of the applicants. Through the assistance rendered in this manner civil service commissions have been able to secure candidates for important positions from other districts than their own and a higher standard of administrative officers has undoubtedly been secured.

FIRST-AID INSTRUCTION.

At the request of various schools and organizations interested in the principles governing medical and surgical relief first-aid instruction has been given during the year to a number of classes in various sections of the country. The membership of these organizations has included Red Cross units, high-school students, women undergoing training for national service, officers and men of the merchant marine, to whom the courses have been of particular advantage, and others. The following officers have been detailed to duty of this character: Surgs. G. B. Young, M. H. Foster, A. D. Foster, and E. A. Sweet; Passed Asst. Surgs. J. R. Hurley and E. R. Marshall, and Asst. Surgs. O. H. Cox and H. A. Spencer.

EXTENSION OF STEREOPTICON LOAN LIBRARY.

More extensive use has been made during the year of the stereopticon loan library, established for the purpose of teaching important lessons in sanitation and demonstrating the principles governing disease prevention, than at any previous time. Loans have been made to 549 individuals and organizations and more than 27,000 slides have been in circulation. Based upon voluntary, but altogether incomplete, returns it is estimated that these health views were shown to audiences numbering more than 120,000 persons, and examination of the records proves that the slides have been sent to practically every State in the Union. The slides now in circulation number 2,500. These photographs have been extensively copied and the manufacturer reports that he is frequently in receipt of requests from foreign countries for these health pictures. Lectures to accompany the views have been prepared upon at least two subjects and as time affords other subjects will receive attention.

The library itself has recorded a material growth in the number of the slides and the character of the views has been correspondingly improved. Sets of slides relating to the hygiene of infants, the sanitary production and care of milk, and kindred subjects have been prepared and found particularly useful during Baby Week celebrations, at farmers' conventions, health meetings, and on other occasions. The motion-picture films in possession of the service, although limited in number, have been in constant use and the necessity for further equipment of this character is again evident, frequent requests for films having to be refused.