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entered upon the clinical record. It is estimated that about 1,500 cures were effected during the fiscal year. The total days relief furnished was 21,691 and 29,542 rations were furnished at a total cost at the six hospitals of $8,904.37, making the average cost per ration $0.30.
Dispensary and hospital treatment, operations, etc.
Field clinics.-The field clinics have been continued for the purpose of stimulating interest among the doctors and the general public, 9 being held in various sections during the year. At these clinics 272 operations were performed. About 100 physicians were in attendance, and these were instructed in the diagnosis, prognosis, and treatment of trachoma and its sequelæ. In the course of the clinics 2,388 persons were examined and 466 trachoma cases found. It is hoped that during the next year more of these field clinics will be held in the various States where the work is being conducted.
District work. The district work was conscientiously conducted by the doctors and nurses and 449 public talks were given to audiences estimated at 21,805 people and 1,227 house-to-house visits were made. The total number of schools visited was 325 and 11,508 pamphlets, describing the nature and prevention of trachoma, were distributed.
Cooperation of States and localities. The States in which the work is being conducted_contributed as follows: Virginia $1,200, West Virginia $300, and Tennessee $495. In addition to the money contributed, the State boards of health have given their thorough cooperation in the prosecution of this work. The local health authorities have furnished buildings and other assistance.
SPREAD OF TRACHOMA INTO OTHER STATES.
Reports from various sections of the United States are constantly being received to the effect that trachoma is found more or less prevalent and in some instances is proving a serious menace to the public health of the community and is preventing the children from attending school. This is an indication that trachoma is more widely spread than is generally believed. That it is constantly on the increase is not to be wondered at when the contagious character of the disease is considered. The work of eradication and prevention will, therefore, necessarily have to be extended into other States.
TRACHOMA AMONG SCHOOL CHILDREN AT NOGALES, ARIZ.
In an examination of 617 school children for trachoma at Nogales, Ariz., made unofficially, Asst. Surg. A. L. Gustetter found 20 pupils with the disease, a percentage of 3.24, as against 5.05 the previous year.
In addition to rural sanitation, which relates primarily to the reduction in the prevalence of typhoid fever, the following investigations of that disease were made:
EPIDEMIC AT BIRMINGHAM, ALA.
Owing to the unusual number of cases of typhoid fever at Birmingham, Ala., in June and July, 1916, the State health department asked the assistance of the service in investigating the epidemic, and Surg. L. L. Lumsden was detailed to this duty. He found that 451 cases occurred from June 1 to July 18, whereas the average for this period in previous years was 113. It was concluded that the epidemic was caused in large part by ice cream made by one manufacturer, and that in all probability the infection came from milk or cream secured from some dairy or dairy farm outside of Birmingham. Local factors other than the ice cream, such as insanitary privies, were considered partly responsible for the outbreak of the disease. Recommendations were made to the authorities for the purpose of preventing a similar epidemic in the future.
EPIDEMIC AT BRUNSWICK, MO.
On request of the health authorities, Surg. M. J. White was detailed on August 26, 1916, to investigate a small outbreak of typhoid fever at Brunswick, Mo. He found that 25 to 30 cases had occurred, and that the water and factory ice cream were the principal sources of infection.
RELATION OF TYPHOID FEVER IN PHILADELPHIA TO OYSTERS.
On request of the health department of Philadephia and the United States Bureau of Chemistry, Surg. H. S. Cumming was detailed to make an investigation of the suspected relation between oysters and cases of typhoid fever in Philadelphia. He was unable to establish any definite connection, although it appeared possible that some of the cases were the result of infected oysters.
On request of the State health and other authorities, a study of typhoid fever at Versailles and Burnside, Ky., was made by Epidemiologist A. W. Freeman from April 16 to 19, 1917. In the case of Margaret College at Versailles, where the cases occurred, it appeared most probable that the infection was due to the presence in the kitchen or pantry of the college of a chronic carrier of typhoid bacilli, but the evidence, although not pointing to any other cause, was not conclusive. In the case of Burnside, it was concluded that the outbreak was due to an infection of the city water supply.
EPIDEMIC AT CHARLESTON, W. VA.
In cooperation with the State and city boards of health, an investigation was made of an epidemic of typhoid fever occurring during May, 1917, at Charleston, W. Va. The study included the collection of the usual epidemiological evidence regarding all reported cases and unreported cases located during the investigation. In addition investigation was made of the public water supply, the milk supply, and the general sanitary environment. Epidemiologist A. W. Freeman was in charge of the study, and associated with him were Prof. E. B. Phelps and Sanitary Bacteriologist E. E. Smith. It was concluded that the epidemic was due to infection conveyed by the city water and that this infection reached the city water through failure properly to operate the filtration and chlorinating plants. A report of this investigation was published.1
OCCUPATIONAL DISEASES AND INDUSTRIAL HYGIENE.
Studies in occupational diseases and industrial hygiene were continued under the general direction of Surg. J. W. Schereschewsky. Laboratory examinations necessary to the field studies have been conducted in the Marine Hospital Building at Pittsburgh.
SURROUNDING EMPLOYMENT OF WOMEN IN
This study was begun in November, 1915, to assist the Wisconsin Industrial Commission in obtaining data upon which the hours of employment for women might be fixed under the State law providing that such working hours shall not be prejudicial to their health, safety, or welfare."
Public Health Reports, Aug. 17, 1917,
To secure an idea of the general industrial environment, hours of labor, and sanitary status of the establishments, there was first made a survey of the women-employing industries of the State. One hundred and forty-one establishments, covering practically every industry employing female labor, were surveyed. The total environment of female workers was next studied by a special female field investigator, under the supervision of Passed Asst. Surg. Robert Olesen. This was followed by a special study of the fatigue curve in women workers as reflected in the hourly production. Records of the production of individual operators throughout each hour of the day were collected in order to study the onset of fatigue. Studies were pursued in 19 departments of 15 manufacturing establishments by a force of 7 special female field investigators under Passed Asst. Surg. Olesen. The studies were entirely concerned with piecework operations, as these are the only kind which lend themselves readily to such studies. Under the conditions of the work performed in the departments studied, although signs of fatigue were apparent during the day, there was no evidence of cumulative fatigue. This was undoubtedly due to the fact that the number of hours worked by no means corresponded to the theoretical factory day, because of time losses, which were 14.2 per cent in the case of the 10-hour industries. All time not actually devoted to the piecework was included in this percentage.
In the shorter working periods the time losses tended to become less, being relatively much less in the special case of a group of operators working in an incandescent-lamp factory on an 8-hour day and a 45-hour week. It was evident from the studies that the women worked considerably below the pace it was possible to attain. Besides trips to the toilets, to the dressing rooms, and for drinking water, premature stopping of work, early washing up, and an inclination to gossip were all responsible for considerable loss of time in factories operating on the 10-hour basis. From careful observation the conclusion seemed warranted that these time losses were protective or defensive measures instinctively practiced by the operators in order to ward off the accumulation of fatigue.
Because of the facts obtained by a study of the time losses, the manager of one of the establishments studied voluntarily placed 10of the operators in one department on an 8-hour day, with the result that in a short space of time the operators not only attained the production of the 9-hour day, but exceeded it slightly. So far as piecework operations were concerned, the conclusion seemed inevitable that by efficient management, thus preventing time losses due to the breaking down of machinery, waits for material, and shortage of material, as much work could be done in an 8-hour day as in a 10 hour day if the employees also eliminated unnecessary time losses. On the other hand, it seems justifiable to conclude that attempts to eliminate these losses, so far as the longer working periods are concerned, might well result in a speeding-up process which in the end would be detrimental to the health of operators.
In view of the fact that it seems practicable to accomplish by proper management as much work in an 8-hour day as in the 10hour day, the shorter working-day must be regarded as advantageous both to the woman worker and the manufacturer under the conditions as they exist in Wisconsin industries.
HEALTH HAZARDS OF CHEMICAL INDUSTRY AND HEALTH OF CHEMICAL WORKERS.
In 1916 the Public Health Service was requested by a large chemical company to study the health hazards in its various plants in order to make recommendations which would result in the elimination of health hazards and assist in maintaining the health of the personnel. This company operates some 22 plants in the United States, of which 9 have been studied in detail. Seven of these plants were devoted to the manufacture of the so-called heavy chemicals, which include the manufacture of sulphuric, nitric, and mixed acids, muriatic acid, and various salts. Two of the plants manufactured coal-tar products such as nitrobenzol, dinitrobenzol, aniline, and similar products.
In addition to careful sanitary surveys in these factories, the physical condition of 918 chemical workers was studied by means of careful physical examination, special attention being paid to the effects upon health of work in the manufacture of nitro and amido derivatives of benzol. During the course of the study, it was practicable to make important recommendations to the superintendents of the various plants to enable them to improve the conditions surrounding the workers.
These studies were carried out by Surg. J. W. Schereschewsky, Passed Asst. Surg. Robert Olesen, Scientific Assistant Allen R. Howard, and Scientific Assistant Harmon West.
HEALTH HAZARDS IN CONNECTION WITH MANUFACTURE AND DISTRIBUTION OF ILLUMINATING GAS.
Following the studies of the effect of gas-heated appliances upon the air of workshops (reported in Public Health Bulletin No. 81), the service undertook at the request of the Federal Bureau of Standards a study of the health hazards connected with the distribution and manufacture of gas, so that the necessary recommendations for the protection of workers might be incorporated in a national gas safety code which was being prepared by the Bureau of Standards. Accordingly, Passed Asst. Surg. J. A. Watkins was detailed to make a study of this matter, having obtained permission from one of the largest gas-making companies in the country to study, from the health standpoint, the conditions surrounding the workers engaged in this industry. Studies of the health hazards in connection with the manufacture and distribution of carbureted water gas, the type of illuminating gas most in use at the present time, have been carried on since February, 1917. The work had the following scope:
1. Study of all the processes concerned with the manufacturing of carbureted water gas, with special reference to the exposure of the workers to heat, dust, and gas poisoning.
2. Special studies of the hazards due to exposure to weather conditions and to gas poisoning in the distribution of gas.
3. Studies of the physical condition of gas workers by means of physical examinations, and careful hæmatological studies.