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4. Examination of air samples for their content of carbon monoxide, collected in various working locations.

5. Studies of the body temperature of workers in heat exposed situations.

HEALTH HAZARDS OF TEXTILE INDUSTRY.

The State Department of Labor and Industry of Pennsylvania requested the cooperation of the service in making a study of the textile industry in that State to the end that a code for the regulation of the industry from the safety and health standpoints might be drawn up. Studies of the industry were accordingly begun about March 30, 1917, the field work being in charge of Surg. F. C. Smith, assisted by Scientific Assistants William P. Bramlett and Lloyd W. Johnson. As there is a high proportion of women among the textile workers, two special female field investigators were employed. The cooperation of the Industrial Disease Clinic of the University of Pennsylvania Hospital was obtained, and Dr. T. Grier Miller, in charge, was appointed a scientific assistant on half time, in order to conduct special studies of the physical condition of workers.

The work, which is now practically complete, has had the following

scope:

1. Intensive survey of a silk mill, a lace mill, a carpet mill, and a blanket mill.

2. Complete physical examinations of some 350 textile workers. 3. Studies of the daily temperature of 440 workers.

4. Studies of the amount of dust in the air of textile mills.

5. Radiographic examinations of workers exposed to organic dust in the textile industry.

6. Studies of the total environment of textile workers.

7. Extensive surveys of various textile 'establishments.

On the whole it may be said that, so far as the textile processes studied are concerned, these processes present but few hazards to the health. The results of the physical examination of textile workers show that the industry per se can readily be conducted so as to be practically devoid of any essential hazard to the health. On the other hand, numerous defects in regard to ordinary factory sanitation were found in some of the establishments visited.

VISUAL CONDITION OF WORKERS ENGAGED IN OCCUPATIONS LIKELY TO CAUSE EYE STRAIN.

In the last annual report reference was made to studies of vision, conducted as part of an illumination survey of Federal departments. As the Federal bureaus employ a large body of employees who perform exacting eye work, it was thought that a study of the ocular condition present in such workers should yield data of interest. Accordingly Surg. G. L. Collins was detailed to make these studies, a room in the Treasury Building being fitted with the equipment necessary to make complete eye examinations. Representative groups from the Treasury Department, the Bureau of Engraving and Printing, and the Government Printing Office were carefully examined

and full records made of the ocular conditions found. During the fiscal year 502 such examinations were made, bringing the total to about 1,500.

The scope of the study has now been amplified by studying the effect in different cities of various occupations on the eyes of workers and the incidence of eye tests in different industries.

HYGIENIC CONDITIONS OF SHOP LIGHTING.

At the request of the Wisconsin Industrial Commission, the service undertook a study of the hygienic conditions of illumination in workshops in the State, special attention being paid to industries engaged in supplying the Government with war materials. Assistant Physicist Davis H. Tuck was detailed to this work.

The general scope of the study consists in careful illumination surveys of various industrial establishments by means of photometric measurements in various working locations; studies of the arrangement of working planes, with reference to sources of light; studies of glare effects and other impediments to easy vision, arising either from defects in the illuminating system or from peculiarities of the industrial process considered, followed by recommendations for the correction of existing defects. This work was begun May 14, and so far complete surveys have been made in three establishments. It is worth noting that as a result of these surveys extensive changes have been made in the illuminating conditions in these plants.

CHILD-LABOR PROBLEMS IN RELATION TO THE HEALTH OF MINORS IN MASSACHUSETTS.

In the studies of child-labor health problems in Massachusetts, the cooperation of Asst. Surg. M. V. Safford with the Massachusetts State Board of Labor and Industries has been continued. The results of an investigation of health conditions among male minors employed in the cotton mills was published in August, 1916, as Public Health Bulletin No. 78. Preparations had been made by the State board of labor and industries for a similar investigation in the rubber manufacturing industry under the personal direction of Asst. Surg. Safford, but the work was interrupted by his detail to New York City during the summer for duty in connection with the poliomyelitis epidemic. His cooperation with the State authorities has been virtually confined to consultations with the board of labor and industries regarding actual situations in which the health of minor employees has been involved.

MINE SANITATION.

Investigations of the occupational diseases of the mining industry and of mine sanitation, conducted in cooperation with the United States Bureau of Mines, were continued during the last fiscal year. The report of the prevalence of miners' consumption and tuberculosis among miners in the Jopiin district was published as Public Health Bulletin No. 85.

Butte (Mont.) district.-The investigation of the prevalence of miners' consumption among the miners of the Butte district, begun in May, 1916, is still being carried on.

The Butte mines are large and deep, and it has become evident that the incidence of miners' consumption is influenced not only directly by the amount of siliceous dust present, but also indirectly by the high temperatures and high humidity underground together with lack of adequate ventilation. The scope of the underground investigation was therefore extended to include these and any other factors that might affect the health of the miners.

An office for the physical examination of miners was established in the central part of Butte, in cooperation with the Butte Antituberculosis Society. About 1,000 miners have been examined during the year. Statistics of these examinations have not yet been compiled, but it appears that miners' consumption is prevalent, though clinically it does not seem to be as aggravated in form as that seen in the Joplin district. Visiting nurses are employed by the Butte Antituberculosis Society, and these in the course of their work record the living and housing conditions among miners' families. It is expected later to combine with this public health and antituberculosis work the activities of the school nurses and the medical supervision of school children.

HEALTH INSURANCE.

The investigation of health insurance was continued by Surg. B. S. Warren and Statistician Edgar Sydenstricker. In addition to the study of existing and proposed health-insurance systems, collection of data from establishments operating sick benefit funds was continued. The work for the year was planned after conferring with the Commissioner of Labor Statistics, Department of Labor, in order to avoid duplication of activities, and during the year frequent conferences were had with Mr. Boris Émmet, assigned to this work by the Commissioner of Labor Statistics.

Data have been collected from about 622 establishments. Of these, 450 paid cash benefits only, 147 furnished medical and surgical relief, and 25 combined the two. Attention has been centered on the first group.

Owing to the fact that the health-insurance systems proposed in this county provide for a waiting period of three days, tabulations have been completed for all of the funds which had this waiting period. Nineteen such funds were found, 15 of which reported for the threeyear period 1914-1916. The funds had an average of about 215,000 employees with a membership of about 155,000. Membership was not compulsory. The results appear in the following table:

Benefit associations having a three-day waiting period before cash benefits are paidSummary for the three years 1914, 1915, and 1916.1

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The days of sickness are the totals for three years. The membership is the sum of the averages for each year. The approximate number of persons can be obtained by dividing the total membership by 3.

About 90 per cent of the membership shown in the above table was among funds which limited their benefit period to 52 weeks. Where it was possible to ascertain the proportion which the amount of benefit paid bore to the wage it was found that the cash benefit ranged from one-half to one-third of it.

The results of this study have been very encouraging, the cooperation of all the establishments, except one, being most gratifying. When the desirability of continuing the collection of the data along more intensive lines became apparent, proposals in this respect were made to several of the establishments, and their physicians promised cooperation. Accordingly plans have been prepared for the collection of morbidity and mortality statistics of industrial establishments willing to cooperate with the service. It is proposed to secure from such establishments information relating to the age, sex, and occupation of all employees, and the cause, date of onset, length of disability, and result of all sickness and nonindustrial accidents occurring therein.

PUBLIC HEALTH ORGANIZATION AND ADMINISTRATION.

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SURVEYS.

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In cooperation with State and local health authorities, studies of the organization and administration of health departments were continued. Surveys were made by Surg. Carroll Fox in the city of Birmingham and the county of Jefferson, Ala., the State of Colorado, South Bend, Ind., Piqua and Springfield, Ohio, Quincy, Ill.,® and Richmond, Va., and by Surg. G. B. Young in the cities of Kansas City, Mo., and Charlotte, N. C. Detailed recommendations were made to the authorities in the course of the surveys, and either the final report of the studies was published or a typewritten copy of it was submitted to the authorities. In addition to the surveys a special study of county health orgainzation is being conducted in Edgecombe County, N. C.

So far systematic studies along this line have been made in the following States:

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1 Report published. (Reprint 375 from Public Health Reports.)
2 Report published. (Reprint 383 from Public Health Reports.)
Report published in Public Health Reports of May 25, 1917.
Report published in Public Health Reports of June 22, 1917.
Report published. (Reprint 417 from Public Health Reports).
"Report published. (Reprint 427 from Public Health Reports).

Nevada.
North Dakota.
Washington.
West Virginia.

St. Joseph, Mo.
St. Paul, Minn.
South Bend, Ind.
Springfield, Ohio.
Toledo, Ohio.
Winston-Salem, N. C.
Youngstown, Ohio.8

7 Places are listed in the order in which the surveys were made. The survey of Richmond, Va., was discontinued before completion owing to the detail of Surg. Fox as sanitary adviser to the Surgeon General's office, Navy Medical Corps.

8 See p. 44 for list of counties and cities where brief surveys were made in connection with the special study of county health organization in Edgecombe County.

A large amount of data as to laws and ordinances governing health departments, organization of such departments, epidemiological activities, methods as to registration of births and deaths, sewage disposal, water supply, administration of laboratory, medical inspection of schools, communicable disease activities, food inspection, and appropriations and finances have been secured. Knowledge of existing conditions in regard to these matters enables the service officers to point out to each State or city surveyed what improvements in public health organization and administration will be productive of the best results. Emphasis is laid on two fundamental necessities: (1) the employment of properly qualified, fulltime health officers for every community, whose term of service should depend upon their efficiency; (2) appropriations sufficiently large to conduct efficient health work. Included in each report are a number of recommendations dealing with specific problems presented by the situation in the State or city surveyed. The information obtained has been of assistance to the service in surveys of cities near cantonment areas (see p. 17).

STUDY OF COUNTY HEALTH ORGANIZATION.

For the purpose of working out principles of public health organization and administration which are feasible of adoption in county or municipal public health work, Asst. Surg. K. E. Miller was detailed to make a study of county health work in Edgecombe County, N. C., serving in the capacity of acting health officer.

Surveys of local health organization and administration.-Asst. Surg. Miller commenced his study on January 3, 1917, and before going to Edgecombe County, made brief surveys of the following counties, in some cases studying also municipal health organization: Norfolk, Va.; Walker and Tuscaloosa, Ala.; New Hanover, Robeson, Guildford, Davidson, Vance, Wilson, and Durham, N. C.; Greenville and Richland, S. C.; and Jefferson and Mason, Ky. It was found that one of the greatest hindrances to the efficiency of the health officer's work was the almost universal lack of office help and office régime. A large amount of data was obtained which was later found applicable to the situation in Edgecombe County. An attempt was also made to obtain expressions of opinion as to cooperation in health work between the county, State, and Federal authorities.

Preliminary survey of Edgecombe County.-A preliminary survey in Edgecombe County indicated that the county from the standpoint of health organization and administration was average, but that there was a stronger sentiment in this county than in many others for progressive health work. It was found that the matter of quarantine constituted an emergency and that in general the problems were the same as those of counties similarly located.

Intensive study in Edgecombe County.-The county health work under Asst. Surg. Miller was begun about March 1, 1917. The bulk of the work up to the end of the fiscal year was educational, 50 public meetings having been held, with a total attendance of over 1,500 people, 45 articles supplied to newspapers, several thousand letters sent to individuals, and two baby welfare weeks held, one for the

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