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white and one for the colored. A new set of health laws for the county was drawn up and adopted, their enforcement meeting with a satisfactory degree of success. Clean-up campaigns were conducted in four of the five principal towns in the county. This work will be continued, special emphasis being placed upon quarantine of diseases, school inspection, hygiene and sanitation; and educational work in the county.
COOPERATION WITH INDIAN SERVICE.
As in the past, examinations of specimens to aid in the diagnosis of communicable disease have been made at the service laboratories for physicians of the Indian Service. The work includes ordinary examinations and tests of a bacteriological nature.
Antityphoid vaccine is furnished through the Hygienic Laboratory to the Office of Indian Affairs on request.
COOPERATION WITH HAWAIIAN AUTHORITIES.
A great deal of field and laboratory work has been performed at the leprosy investigation station for the Hawaiian authorities, among which may be mentioned examination of a large number of leper suspects and of 1,734 persons arriving from the Orient to see if they were infected with the spirullum of cholera; examination of samples of blood for Wassermann or Widal reactions, swabs for diphtheria, samples of condensed milk and carbonated water supposed to have caused outbreaks of disease; investigation of typhoid fever outbreaks at Honolulu and Hilo and an outbreak of anthrax among beef cattle at different points on the islands; inspection of a large area of wet lands near Honolulu as to its effect on health; and cooperation. in drawing up a revised code of sanitary laws for the Territory.
COOPERATION WITH PORTO RICAN AUTHORITIES.
At the request of the governor of Porto Rico, Surg. W. W. King was detailed on September 20, 1913, for duty with the Institute of Tropical Medicine and Hygiene of Porto Rico. This detail was in addition to his duty as chief quarantine officer for Porto Rico.
The institute is an organization of the Government of Porto Rico for the study of diseases of that country and climate, and is composed of physicians with special experience in such lines.
Skin diseases.-Dr. King has continued his studies on tropical skin diseases, and an article entitled "Some observations upon the skin diseases of Porto Rico," published in the July, 1917, number of the Journal of Cutaneous Diseases, deals with this subject.
Dengue. Two articles on dengue have been published in the New Orleans Medical and Surgical Journal, February, 1917, entitled "The epidemic of dengue in Porto Rico, 1915," and "The clinical types of dengue in the Porto Rico epidemic of 1915." Further studies on dengue, particularly dealing with certain blood changes, are in progress but not yet completed.
Some data have been collected on such diseases as malaria, filariasis, meningitis, intestinal infections, etc.
ASSISTANCE TO HEALTH AUTHORITIES OF KENTUCKY AND MISSISSIPPI.
At the request of the State health authorities of Kentucky, Passed Asst. Surg. H. E. Hasseltine was detailed on February 17, 1917, to confer with these authorities and to give advice in regard to the inauguration of a State-wide system of Wassermann examinations in the bacteriological laboratory of the State board of health. Dr. Hasseltine was at the laboratory of the State health authorities, Bowling Green, Ky., on February 26 and 27, and from March 12 to 17. On request of the State health authorities of Mississippi, Dr. Hasseltine was directed, while on the same detail, to advise with them in regard to the manufacture of typhoid vaccine. He gave instruction to the laboratory force of the Mississippi Hygienic Laboratory in the manufacture and testing of typhoid vaccine from March 1 to 11. During this time one lot was made under his personal supervision, and sterility and potency tests were commenced. At the present time, the entire output of the State laboratory is tested by the Hygienic Laboratory of the service before release, thus providing a central check on this activity.
SANITARY SURVEY OF ESTABLISHMENTS UNDER NAVY AT CHARLESTON, W. Va.
On request of the Navy Department, a sanitary survey of Charleston, W. Va., was made, with special reference to the armor plant and other establishments under the Navy. Comprehensive reports, with recommendations, were made to the Navy Department, covering in particular water supply, sewerage, sanitary administration, milk and food supplies, communicable diseases, vital statistics, housing, and conditions in territory around Charleston. The study was undertaken by Epidemiologist A. W. Freeman, following an investigation of typhoid fever at this place (see p. 36), and at the end of June, 1917, Prof. E. B. Phelps was detailed to make a study of the water supplies and sewage disposal in relation to the proposed establishments of the Navy. This latter study was likewise the subject of a full report, copy of which was submitted to the Secretary of the Navy.
SCHOOL AND MENTAL HYGIENE.
Extensive investigations of school and mental hygiene were continued under the direction of Surg. Taliaferro Clark, and the year was marked by an increasing popular interest in the supervision of the physical and mental health of school children, as indicated by requests for information or for assistance in making surveys. Furthermore, physical defects found among men called to the national defense have served to emphasize the need for such surveys by showing that the defects observed among children in the course of these surveys have to a large degree remained uncorrected. Increasing attention is being given to the high percentage of feeble-mindedness and the considerable number of insane or potentially insane children without intelligent mental prophylaxis.
BOSTON PSYCHOPATHIC HOSPITAL.
On invitation of the director, an officer was detailed to make, during July and August, 1916, a study of the methods of diagnosis, treatment, and prevention of mental disorders practiced, in the Boston Psychopathic Hospital, in order to adopt such of them as were applicable to the work of the service. It is felt that advice, discipline, and training suitable to the needs of children potentially insane will save many of them from an ultimate mental breakdown, if such cases are recognized during school age, and that advantage should be taken of every opportunity to study the methods of other agencies concerned in mental prophylaxis.
MENTAL STATUS OF INMATES OF FOUR COLORADO INSTITUTIONS.
On request of the Colorado Survey Committee of State Affairs and the Colorado Committee on Provision for the Feeble-minded, a mental examination of the inmates of four State institutions was made by the service during August and September, 1916.
State institution for mental defectives. Of the 80 inmates of this institution, 28 boys (68 per cent) and 24 girls (61 per cent) were found to be of such low mental development that neither educational or vocational training could be successfully applied to them.
State industrial school for girls. Of the 119 girls in this institution, 18 (15.1 per cent) were retarded and 9 (7.55 per cent) were definitely feeble-minded.
State industrial school for boys. Of the 274 boys examined in this institution, 73 (23.7 per cent) were found to be retarded and 25 (9.1 per cent) feeble-minded.
State home for dependent and neglected children. Of the 250 inmates of this institution, 23 were retarded and 21 feeble-minded. Six exhibited characteristics of mental maladaptation which, if uncorrected, would later result in antisocial reactions.
Conclusion. These investigations have shown that Colorado has not made adequate provision for the care and training of mental defectives.
MENTAL AND PHYSICAL STATUS OF SCHOOL CHILDREN IN NASSAU
COUNTY, N. Y.
On request of the New York State health and educational authorities, the service conducted from October through December, 1916, a survey of the mental condition of selected groups of school children in Nassau County, N. Y., as a part of a general mental survey undertaken by the National Committee for Mental Hygiene. A study of the physical condition of this group and of the sanitation of the schools attended by them was included.
Of the 1 309 boys and 1,191 girls examined in 12 schools, 23 boys and 16 girls (1.56 per cent) were feeble-minded; 8 boys and 2 girls exhibited mental maladaptation and antisocial tendencies; 1 boy and 1 girl exhibited well defined psychotic symptoms; 1 girl was epileptic; 12 boys and 2 girls were probably feeble-minded; and 59 boys and 57 girls (4.6 per cent) were mentally retarded.
Uncorrected and, in some instances, unrecognized physical defects were observed in such numbers as further to strengthen the impression created in the course of similar surveys that the part-time medical services of a practicing physician are inadequate properly to supervise the health of any large body of school children.
HEALTH ADMINISTRATION IN PUBLIC SCHOOLS OF FRAMINGHAM, MASS.
On request of the local school authorities, an investigation of health administration in the public schools of Framingham, Mass., was conducted during February, 1917. These studies, advisory in character, were principally for the purpose of securing to the community, through improved methods, a maximum benefit from health supervision of school children. Specific recommendations were made to the authorities and adopted practically in toto.
MENTAL AND PHYSICAL STATUS OF RURAL SCHOOL CHILDREN IN . DELAWARE.
New Castle County.-The studies of the mental status of rural school children in New Castle County, begun in 1916,1 have been supplemented by a physical examination of the children in these schools and a sanitary survey of the buildings occupied by them. During the survey, January 1 to April 10, 1917, 3,115 rural school children were examined physically and the sanitary condition noted in the case of 95 rural school buildings, containing 155 classrooms.
Sussex County.-The investigation of the prevalence of feeblemindedness in the school population has been extended to Sussex County.
One hundred and fifty four white and 32 colored schools were visited. Of the 6,004 white children inspected, 46 boys and 21 girls (1.1 per cent) were feeble-minded, and of the 855 negro children inspected, 13 boys and 16 girls (2.95 per cent) were feeble-minded.
Of 67 feeble-minded white children recorded 9 boys and 1 girl (6.7 per cent) had been "placed out" in Delaware homes by outside agencies. This practice has resulted in a material increase in the number of feeble-minded children in the county, the potential results of which may be of far-reaching and disastrous effect, and shows the necessity for the determination of the mental and physical status of such children prior to commitment to private homes.
MENTAL STATUS OF INMATES OF COUNTY ALMSHOUSES IN DELAWARE.
Sussex County Almshouse.-A study to determine the mental status of the inmates of Kent and Sussex County almshouses was undertaken to show primarily the need of a special institution for the care of the feeble-minded. Incidentally these studies likewise show a distinct relationship between dependency and feeble-mindedness. Of the 36 inmates of this institution (21 white; 15 negro) but 3 were of normal mentality, 19 were feeble-minded, and 11 were insane. This institution is without modern equipment for the care
Report published (Reprint 377 from Public Health Reports.)
of the sick. The inmates not only have irregular medical attention, but are practically without supervision.
Kent County Almshouse.-Of 18 white males, 5 were feeble-minded; of 12 white females, 7 were feeble-minded; of 8 negro males, 4 were feeble-minded and one doubtful; of 11 negro females, 9 were feebleminded. Nine white adults were suffering from a psychosis. In other words, of 49 inmates only 14 were normal mentally. The sexes were segregated in this institution, and some attempt to supervise them was observed in the employment of a matron. There are no modern facilities for the treatment of the sick.
The commitment of the insane and the feeble-minded to county almshouses is a relic of the dark ages and should not be tolerated in any enlightened State.
COMMUNITY INVESTIGATIONS OF FEEBLE-MINDEDNESS,
Supplementing investigations of mental status of rural school children in Sussex County, Del., the service has diagnosed cases of suspected feeble-mindedness observed by the Children's Bureau in their social survey of the general population of this county. Eighty white families were visited and 110 suspected feeble-minded persons examined, of which 85 (77.2 per cent) were definitely feebleminded. Forty-two negro families were visited and 73 suspected feeble-minded persons were examined, of which 57 (78 per cent) were feeble-minded.
In this survey 0.4 per cent of the white population of the county was found to be feeble-minded, whereas in the school survey 1.1 per cent of the white-school population and 0.96 per cent of the general white population between 5 and 20 years of age were found to be feeble-minded. In the total negro population 1 per cent and between the ages of 5 and 20 years 1.9 per cent were found to be feeble-minded.
It was found that:
1. An examination of the school population was a satisfactory method for determining the prevalence of mental defectives in the county at large.
2. The percentage of feeble-mindedness in the school population approximated that in the general population from 5 to 20 years inclusive, where the school attendance was not less than 80 per cent. of the total enrollment.
3. The percentage of mental defectives in a school population with an attendance of 80 per cent of the enrollment was double that of the general population.
4. The number of feeble-minded males was greater than that of feeble-minded females in both the school and the general population.
MENTAL STATUS OF BOYS OF NATIONAL JUNIOR REPUBLIC.
On request of the superintendent, mental examinations were again made (May, 1917) of boys admitted to the National Junior Republic. Annapolis Junction, Md. During the past three years 100 “citizens" of the republic have been examined, of which 25 per cent were