prevention of the introduction of typhus from Mexico were very comprehensive. As evidence of the magnitude of this work, there were 110,000 persons vaccinated and 154,000 disinfected for the destruction of vermin.

On account of the prevalence of an epidemic of cholera in Japan, bacteriological examination of all incoming steerage passengers from the Orient was instituted, both at the quarantine stations on the Pacific coast and at Manila, and several cholera carriers were discovered. The measures carried out were successful in preventing the entry of the disease into the United States.

Yellow fever was reported from various ports of South America and from Mexico. It is believed that the Yucatan Peninsula especially is an endemic center of this disease. Appropriate measures were enforced against travel from yellow-fever infected countries and two cases of yellow fever were apprehended at the New Orleans quarantine station. Effective measures were applied against the personnel and infected vessel.

Plague continued to be reported from practically every country in the world, and as precautionary measures against the introduction of this infection into ports of the United States, extensive fumigation of incoming vessels was practiced. As a result of this system of fumigation, plague infection was discovered on one vessel entering New Orleans and on one vessel leaving Hongkong.

During the year assistance was rendered to the War Department, Navy Department, and Department of Labor in affording to them facilities at quarantine stations at certain ports to such extent as would not seriously interfere with the effectiveness of quarantine administration. Part of the barracks at the Boston quarantine station were utilized by the Immigration Service for the internment of a number of German seamen. Quarters and transportation only were furnished, the Immigration Service attending to the maintenance and general supervision of these interned aliens. The Fishermans Island reservation was temporarily turned over to the Army. The quarantine reservation at Port Royal was also temporarily loaned to the Navy Department for use as a training camp. At Reedy Island quarantine station assistance was extended to the customs, immigration, and naval authorities in boarding vessels at that place, quarters being provided for the representatives of the Customs and Immigration Services. Facilities of the San Diego quarantine station were extended to the forces of the United States Naval Reserve, and similar provisions were made at the Tampa Bay quarantine station for assisting the patrol forces in that neighborhood. Medical supervision of the interned alien enemies under charge of the Bureau of Immigration was exercised by officers of

the Public Health Service, who also rendered aid in making sanitary surveys of the proposed detention camps for the internment of aliens. Medical inspection of immigrants. During the fiscal year ended June 30, 1917, medical officers of the service examined 521,611 immigrants for the purpose of detecting such physical or mental defect as might render them deportable under the provisions of the immigration law. Of this number 20,231 were certified to as having a mental or physical defect. The number of officers assigned to the medical inspection varied during the year, but on an average 81 were exclusively engaged in this duty. On account of the lessened amount of immigration during the past two or three years, service officers have been able to institute more intensive examination of arriving aliens, and have engaged in studies of various subjects pertaining to the physical and mental examination. The results of these studies made possible the preparation of a manual for the "mental examination of aliens," and a treatise on the normal mentality of the various immigrant races.

The provisions of the immigration law of February 5, 1917, made necessary a revision of the regulations governing the medical examination of aliens. The new medical regulations have been thoroughly prepared and fully cover all points involved in such examination.

The requirement in the new immigration law that all alien seamen on arriving vessels shall be given medical examination regardless of whether they intend to land or not has increased the work of the medical inspection of aliens to a very considerable degree. It not only increases the examinations numerically but necessitates the procedure being performed (on board ship) at widely separated points, oftentimes inconvenient of access and without adequate provision for an effective examination. It is estimated that some forty additional officers will be required to carry out effectively the provision of the medical examination of alien seamen. At some of the quarantine stations, however, it has been found practical for the quarantine officer to perform not only the quarantine inspection but also the medical examination of alien crew for immigration purposes.

Division of Domestic (interstate) Quarantine.

During the summer of 1916 an epidemic of poliomyelitis (infantile paralysis), which began in the congested districts of the city of New York, swept over a large area of the United States, the total number of reported cases being more than 27,000. In order to limit as far as possible the dissemination of the disease in interstate traffic a notification system was established at New York City on July 18 and maintained until October 2 for the certification of outgoing travel of

all children under 16 years of age. Through the adoption of this system unnecessary and dangerous travel was curtailed and health officers throughout the United States were promptly notified of the destination address of all children departing from the infected city. The total number of children certified during the period the system was in operation was 85,242, destined to 3,870 different localities in this and foreign countries. In addition, 22,647 adults were certified upon their own request.

The plague suppressive measures at New Orleans have been continued for the third consecutive year with encouraging results. No case of the disease in man has developed during the fiscal year, and rodent infection has shown a material decrease, the last infected rat having been discovered on April 24, 1917. The total number of rodents killed was 387,732, of which 77,071 were exainined for plague infection. Rat-proofing operations on 75,335 buildings were instituted during the year, 39,715 of which were completed to the satisfaction of the inspecting officer, the remaining operations still being under way.

Measures for the prevention of plague in California, resulting from the possible introduction of the disease into communities by infected ground squirrels, have been continued as heretofore. It is worthy of note, as illustrative of the dangers which may arise from this source, that on May 21, 1917, a plague-infected ground squirrel was shot within 1 mile of the city limits of San Francisco. Antiplague operations at Seattle and its immediate vicinity, consisting of the enforcement of rat-proofing ordinances, the inspection of shipping, and the examination of rodents, have been carried on as in previous years.

The control of Rocky Mountain spotted fever in the Bitter Root Valley was transferred at the termination of the present season to the State Board of Health of Montana, there having been a steady decrease in the number of cases since preventive measures were instituted.

The enforcement of the interstate quarantine regulations has been continued, several amendments to the existing regulations for the better protection of the health and lives of the traveling public having been promulgated.

The number of sources from which common carriers derive water in the United States has been reduced to 4,156, thus evidencing the greater care exercised in the securing of water for the use of interstate passengers. Through the cooperation of State and local health authorities 3,713 of these sources have been surveyed and the water examined during the year, 211 of the supplies being condemned and the use of the water in question prohibited on interstate carriers. Additional laboratory facilities have been provided for this work.

The usual sanitary inspection of Government buildings in the District of Columbia has been carried out as heretofore, and special investigations of the sanitary condition of other Government buildings have been made from time to time as required.

Division of Sanitary Reports and Statistics.

Sanitary legislation. During the fiscal year ended June 30, 1917, the compilation and study of court decisions and State and city laws, ordinances, and regulations relating to public health was continued. The current publication of this material in the Public Health Reports was, however, temporarily discontinued in January, 1917, owing to the scarcity of print paper and the need for economy in its use.

Laws or regulations intended to secure more prompt and complete reporting of cases of communicable diseases were adopted during the calendar year 1916 in the States of California, Colorado, Delaware, Illinois, Kansas, Maine, Maryland, Massachusetts, Mississippi, Minnesota, Montana, New Hampshire, New York, Rhode Island, Virginia, and West Virginia.

In the following-named States laws or regulations designed to provide for the control of one or more communicable diseases were adopted during the same period: California, Colorado, the District of Columbia, Illinois, Iowa, Kansas, Maine, Massachusetts, Mississippi, New Jersey, New York, Virginia, and West Virginia. These laws and regulations provide rules for quarantining cases of disease and prescribe means to be adopted to prevent the spread of the diseases and the occurrence of outbreaks and epidemics.

Prevalence of disease in the United States.-The most disturbing epidemic which has occurred during the year was one of poliomyelitis (infantile paralysis), which developed during the summer of 1916. About the first of July, 1916, reports from New York City indicated that an unusual number of cases were developing in that locality. Within a few days increasing numbers of cases were reported in Newark and Jersey City, N. J., and neighboring communities. By July 15 the disease was on the increase in Philadelphia, Pa., Bridgeport, Conn., Camden, N. J., and even extending to Toledo, Ohio. By the 1st of August cases were being reported in Baltimore, Boston, Chicago, St. Paul, Minneapolis, Providence, Syracuse, and other cities. The disease was at its height in July, August, and September. In December, after the disease had subsided elsewhere, an outbreak developed in West Virginia, with foci at Elkins, Grafton, and Fairmont. There has been no important epidemic of the disease since January 1, 1917, although small outbreaks have occurred in Washington County, Vt., Haverhill, Mass., New Castle, Pa., Allegany, Md.,

Braxton and Marion Counties, W. Va., Rockingham County, Va., Belmont County, Ohio, and Pope County, Minn.

The mild type of smallpox has continued to prevail throughout the country. Its prevalence, however, does not seem to be on the increase. The virulent type of smallpox was present mainly in States along the Mexican border.

During the spring of 1917 cerebrospinal meningitis was unusually prevalent in a number of localities. Of the cities in which there were outbreaks the most important were Philadelphia, Cleveland, St. Louis, Hartford, and Minneapolis. The largest outbreak in the country was in Philadelphia. However, less information is available of the disease in this locality than of an outbreak which occurred in Minnesota. In the latter outbreak special attention was given to the reporting of cases and their subsequent observation and control. The prevalence of this disease threatened to offer particular difficulty in the mobilization of troops, as it is prone to spread in army camps.

Aside from tuberculosis and pneumonia, malaria and typhoid fever are the communicable diseases which have occurred in the greatest numbers and been most prevalent.

Division of Marine Hospitals and Relief.

During the fiscal year 1917, 64,022 patients received treatment as beneficiaries of the service. Of this number, 17,991 were treated in hospitals and 46,031 were treated as dispensary or out-patients. The hospital patients received a total of 500,578 days' treatment. During the year the service operated 20 marine hospitals, all of which are owned by the Government, and maintained 118 other relief stations where medical relief was furnished patients.

At the tuberculosis sanatorium of the service at Fort Stanton, N. Mex., 327 patients were cared for during the year. Of these, 66 were discharged, 43 died at the sanatorium, and 218 remained under treatment at the close of the year.

Aid was extended to other branches of the Government in the physical examination of 8,183 persons, of whom 2,020 were rejected. In addition, 17,362 merchant seamen were physically examined to determine their fitness for service on American vessels, of whom 1,350 were rejected, and 2,805 foreign seamen were examined, of whom 239 were rejected.

Division of Personnel and Accounts.

Under authority of the act of Congress approved July 1, 1902, and Executive order dated April 3, 1917, 13 commissioned medical officers were detailed to the Navy for duty, upon the request of the Secre