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Investigations of sewage disposal have been under the general supervision of Prof. E. B. Phelps of the Hygienic Laboratory and the immediate direction of Sanitary Engineer L. C. Frank.
RESIDENTIAL AND SMALL COMMUNITY SEWAGE.
Experiments in regard to residential and small community sewage have been carried out at two experimental plants, one located at Chevy Chase, Md., and the other at the Hygienic Laboratory. Special attention has been given to a study as to wherein this problem differs from that of sewage disposal in large cities. Various modifications of well-known and successful processes of treatment of city sewage have been tried experimentally. Many of these have been found wholly unsuited to the problem in hand, while others have shown themselves adaptable with modification. Excellent results have been obtained from the lath filter, a modification of the ordinary trickling filter, when provided with special apparatus for distribution. It is now believed that this process will be applicable to almost all practical conditions, and will be capable of operating with a minimum of attention and expense. The results of this investigation, which has been carried on continuously for about three years, are being prepared for publication.
STERILIZATION OF STEAMBOAT WASTES.
The steam disinfector previously installed on the lake steamer, D. G. Kerr, was continued in operation throughout the summer and fall of 1916. Bacterial examinations were made during frequent trips of inspection and under varied conditions of temperature and weather. In all cases the results were entirely satisfactory. They were confirmed by an examination of samples by the bacteriologist of the Detroit city board of health. A report of this investigation is being prepared for publication.
STUDIES OF SEWAGE DISPOSAL IN CITIES IN OKLAHOMA.
On request of the local authorities, Sanitary Engineer H. W. Streeter was detailed to review a plan for a sewage-disposal extension at Okmulgee, Okla. A report containing conclusions was sent to the authorities. On request of the corresponding authorities in the cities of Beggs and Henryetta, studies were made of sewage-disposal systems at these two places.
TREATMENT FOR DRUG ADDICTION.
In cooperation with the Conference on Drug Addiction, Surg. E. H. Mullan conducted in June, 1917, an investigation of a therapeutic method for lessening or eliminating the symptoms which ordinarily occur when drug habituaries are deprived of their drug. The studies consisted of observations of patients under usual treat
ment and under the treatment evolved by Dr. C. F. Stokes, former Surgeon General, United States Navy. The observations were not complete enough to justify final conclusions, but it appeared that the patient who had undergone the Stokes treatment was stronger, more comfortable physically, and more contented at an earlier period than the patient who had received the usual treatment.
COOPERATION WITH BUREAU OF CHEMISTRY.
Cooperation with the Bureau of Chemistry, Department of Agriculture, was continued, Surg. M. V. Glover being detailed to that bureau as in the previous fiscal year for the enforcement of the Sherley amendment to the food and drugs act of 1906. This is an excellent example of useful cooperation on the part of the two bureaus.
LEPROSY INVESTIGATION STATION.
Investigations of leprosy have been continued at the leprosyinvestigation station, Honolulu, Hawaii, under the direction of Surg. D. H. Currie. The personnel of the station remained practically unchanged during the year.
The more important of the studies conducted at the station may be thus summarized:
1. Attempts to cultivate an acid-fast bacillus, morphologically identical with the bacillus of leprosy, have been continued, and similar work has been done in connection with the bacillus of rat leprosy, an analogous organism.
2. Uniformly unsuccessful attempts have been made to convey the disease to some of the lower animals. With every year of experience it becomes more certain that leprosy is a strictly human disease.
3. A number of experiments were conducted on tubercular rabbits and guinea pigs with a copper cyanide compound manufactured in Japan by Prof. Koga. As it appeared that the preparation was without appreciable curative value for tuberculosis, it was not considered advisable to administer it to lepers.
4. Experiments to ascertain why iodin and its salts brought about the softening of the nodules of lepers, accompanied by the appearance of new nodules, were conducted.
5. Experiments on the complement deflection tests, using the blood of the lepers under the care of the station, were continued. 6. A number of tests were performed to ascertain the degree of permeability of the kidneys of lepers in comparison to the kidneys of normal persons.
7. A series of experiments to ascertain what became of acid-fast bacilli when injected into the circulating blood of rabbits were conducted. It was found that they were gradually filtered out by the viscera.
In addition to the studies Widals and Wassermann tests were made and other work done at the request of the chief quarantine officer of the service, several articles were prepared for publication, the photographs of 94 lepers were collected, and a large amount of work was done for the Territorial government.
In addition to routine relief furnished to the patients at the station and at the branch at Kalihi, a number of substances were employed in the treatment of leprosy in an experimental way. Among these may be mentioned the use of chaulmoogra oil hypodermically (Heiser's formula); the use of chaulmoogra oil containing iodin in chemical combination (Currie's and Hollmann's formula) by hypodermic administration; the administration of Koch's old tuberculin and the analogue of Koch's old tuberculin, prepared from the acidfast bacilli isolated from the nodules of lepers by the method of Clegg. For the first time in the recorded history of the treatment of this disease, several cases of leprosy were placed on the form of treatment commonly employed in the treatment of pulmonary tuberculosisrest in bed in the open air and forced feeding. No beneficial results were observed from any of the above treatments except in the case of chaulmoogra oil.
Personnel. Surg. G. W. McCoy has continued as director of the laboratory. At the end of the fiscal year the personnel consisted of the director, assistant director, 7 surgeons, 3 passed assistant surgeons, 4 assistant surgeons, 3 professors, 2 pharmacists, 6 technical assistants, 1 artist, 1 sanitary chemist, 1 organic chemist, 4 sanitary bacteriologists, 1 sanitary engineer, 1 assistant sanitary engineer, 2 special experts, 4 laboratory aids, and 36 attendants, a total force of 78. There has been one death among the personnel, that of Dr. Martin I. Wilbert. One case of typhoid fever due to accidental infection in the line of duty developed.
Instruction. The course of instruction was again given to 10 commissioned officers, and covered a wide field of public health and laboratory work. Informal discussion and criticism were encouraged at all times. The medical bureaus of the Army and Navy and the scientific bureaus of the Department of Agriculture detailed lecturers for the course, and several eminent scientists outside the Government services addressed the class and the laboratory staff.
A number of research workers not connected with the service were granted the facilities of the laboratory during the year. Among these should be mentioned Dr. J. W. Penfold, director of the Government serum laboratories, Melbourne, Australia; Dr. S. M. Woo, of Pekin, China; Dr. F. C. Yen, Changsha, China; and Dr. Solliway, of Providence, Wash.
Inventions and apparatus. From time to time necessity has arisen for apparatus particularly adapted to the laboratory needs. At such times the idea has been worked out by some member of the staff and the detailed drawings tunrned over to the mechanical personnel for construction. Chief among these pieces of apparatus has been device designed by Surg. Stimson for making multiple inoculations of culture media. By means of this machine 15 inoculations may be made simultaneously. The machine is in practical use in connection with the testing of disinfectants.
Aid to other branches of Government.-Aid has been extended to various branches of the Government outside the Public Health Service. This aid has covered a wide field, ranging from routine water examinations to matters of an advisory nature involving policies to be carried out.
Aid from other branches of Government. Mention should be made of numerous instances in which other branches of the Government have contributed to the routine work of the laboratory. For instance, the libraries of the Capital kindly loaned their scientific books and the Zoological Park has been of material assistance in housing and caring for a large number of stock monkeys.
Need of hospital connections. The serious handicap of the lack of clinical facilities in connection with the laboratory has never been more acutely felt than during the past year. In studies of both poliomyelitis and epidemic meningitis, it has been necessary to depend on casual opportunities to secure material.
Library. The total number of bound volumes in the library at the end of the fiscal year was 7,056, 423 having been received during the year. There were 2,288 books issued, not taking into account the books and periodicals constantly in use within the library proper. Of the books issued, 1,367 were borrowed from other libraries, 728 from the library of the Surgeon General's Office, 362 from the library of the Department of Agriculture, 235 from the Library of Congress, and the rest from various department libraries in Washington. A few volumes have been loaned to other libraries. There have been received 1,007 pamphlets, etc., from official sources and 4,883 from other sources. Many of these have been classified and catalogued. From the Library of Congress, 3,831 printed cards have been received, making a total of 18,528 printed cards now in the catalogues. In addition, 5,073 typewritten cards were prepared and added to the catalogue.
At the beginning of the calendar year, through a subscription to a clipping bureau, an effort has been made to secure authentic information with reference to poisoning cases reported in the public press. From January 1 to June 30, 1917, some 952 clippings were received, and, based upon these, 707 reports of poisoning cases have been received from physicians, hospital and police officials, and others.
DIVISION OF PATHOLOGY AND BACTERIOLOGY.
Poliomyelitis. The epidemic of poliomyelitis in New York and vicinity last year, which the service investigated, threw a large amount of work on the division of pathology and bacteriology, where the laboratory studies were conducted. These studies have been carried on almost continuously throughout the fiscal year, supple
mented by material and data collected in an epidemic in West Virginia which occurred in the winter of 1916-1917.
The studies have consisted chiefly of attempts to produce the disease in animals other than the monkey and of efforts to cultivate the specific organism. The results have been substantially negative. Investigations have thrown no light, other than that of a negative nature, upon the possible relationship between paralytic diseases of domestic animals and epidemic poliomyelitis.
Rocky Mountain spotted fever.-Studies of this disease have been conducted in conjunction with field investigations in the West under Surg. Fricks. Various attempts to grow the organism and to inoculate a calf and a sheep with the virus of spotted fever, with the object of preparing a curative serum, have given negative results.
Plague.-A number of cultures isolated from rats diagnosed as plague infected by service officers stationed at the plague laboratory at New Orleans were referred for study and verification morphological, cultural, and inoculation (including protection) tests demonstrated beyond doubt that the organism was B. pestis.
Disinfection and disinfectants. The revision of Public Health Bulletin 42 (Disinfectants: Their Use and Application in the Prevention of Communicable Diseases) has been completed and is now in press.
Wassermann reactions.-As in previous years, a considerable number has been submitted to the usual serological test for syphilis. Service stations furnish the great majority of these.
Specimens have been furnished from two institutions in sufficiently large numbers to make the figures of interest. From the United States Marine Hospital in Boston specimens were received from 560 patients, of which 87, or 15.5 per cent, were positive, while of 209 specimens from the National Training School for Boys 8 were positive, 3.7 per cent. The large difference is doubtless due to the fact that the Marine Hospital patients were adults, while those at the training school were minors, the majority not having reached the age at which syphilis is likely to be acquired.
Examination of specimens. A large number of specimens were received for examination. Aside from those coming in for research purposes only, the following table gives the list of the specimens examined: