SANITARY REPORTS AND STATISTICS.

The work of the division of sanitary reports and statistics during the year has been of special importance because of its essential relation to the control of disease, the advancement of public health administration, and the improvement of sanitary conditions in general throughout the United States.

FUNCTION.

The function of the division of sanitary reports and statistics is (1) to collect sanitary information essential to the work of the Public Health Service or necessary to State and municipal health administration, (2) to compile in statistical form sanitary data which can in this way be made more useful, and (3) to publish for the information of health authorities and others engaged in public health work such of the collected sanitary information and statistics as will be of assistance in their work. In the division are prepared the Public Health Reports, which are published weekly, the supplements to the Public Health Reports, and reprints.

Through this division is collected current information as to where communicable diseases are present throughout the United States and where cholera, plague, yellow fever, smallpox, and typhus fever are present throughout the world. Copies of the laws and regulations being enacted or adopted by State and municipal authorities for the safeguarding of the public health are secured, that information may be available concerning the legislative action being taken to safeguard the public health and that the laws and regulations adopted by each State and city may be available to all health authorities and the trend of health legislation, administration, and practice may be known.

SUMMARY OF ACTIVITIES DURING THE YEAR.

Current information of the relative prevalence and geographic distribution of preventable diseases throughout the United States has been collected in so far as information on the subject was obtainable, either through the activities of officers of the Public Health Service or through the records of State and local health authorities. Although a knowledge of the occurrence of a disease is necessary to its control, and no health department, Federal, State, or local, can effectively prevent or control a disease without knowledge of when, where, and under what conditions it is occurring, records of the occurrence of diseases and the collection of data as to their prevalence are being made only by the most efficient of the State and municipal health departments. It is probably true that even an understanding and appreciation of the suffering and loss being caused by diseases

and of the advantages of and need for their control will be made possible only as a result of definite knowledge of their prevalence.

During the year a special effort has been made to collect current data relative to pellagra, smallpox, tuberculosis, cerebrospinal meningitis (cerebrospinal fever), diphtheria, erysipelas, gonorrhea, malaria, measles, plague, pneumonía, poliomyelitis (infantile paralysis), Rocky Mountain spotted fever, scarlet fever, syphilis, tetanus, typhoid fever, and typhus fever.

For the purpose of preventing the introduction of dangerous epidemic diseases from abroad careful attention has been given to the ports and places in foreign countries in which such diseases were present, the extent of their prevalence, the measures taken for their control, and the existing routes by which their importation into this country would be possible.

Cognizance has been taken of sanitary legislation adopted by States and cities. Regulations, laws, and ordinances affecting or having for their purpose the protection of the public health have been obtained as soon after their adoption as possible; published currently for the information of the health officers and health workers of the country; and, classified according to the particular matters in public health administration to which they relate, compiled and published by calendar years for the purpose of convenient reference.

The decisions of the courts of last resort in the several States relating to public health laws or to matters affecting the public health have been watched, collected, and published for the information of those interested. These court decisions are of special importance, as they show the application of the laws and the construction placed upon them.

PUBLIC HEALTH REPORTS.

The Public Health Reports have been issued weekly pursuant to the acts of Congress approved February 15, 1893, and August 14, 1912. During the year the editions have averaged 72 pages. The average amount of matter published in each issue has slightly increased. The Reports have been sent to State health officers, members of State boards of health, officials in State departments of health, members of municipal and county boards of health, local health officers, and officials in local health departments. Copies have also been sent upon request to persons interested in public health work and identified with organizations, associations, or clubs actively interested in the control of disease and the protection of health.

In the Public Health Reports the nature and trend of public health legislation and of court decisions relating to public health laws have been made currently available to the health officers and health workers of the country.

There has also been made available information of the occurrence in the United States of epidemics of diseases dangerous to the public health and of the current prevalence and geographic distribution of diseases which, because possible of control, should be controlled. The facts regarding the occurrence of dangerous epidemic diseases in foreign countries were likewise made available to quarantine officers and others whose duty it is to prevent the introduction of such diseases into the United States. This information makes it

possible for quarantine officers to effectively prevent the importation of such diseases from infected foreign ports without placing burdensome restrictions upon commerce.

The Public Health Reports have also contained other matter of interest to health officers, such as reports on methods of health administration and articles dealing with the control of disease. Supplements to the Public Health Reports have been issued as separates. These supplements contain discussions of general interest in regard to the preservation of health and the control of disease and were issued for distribution to the public in general, their purpose being particularly educational.

EDUCATIONAL SUPPLEMENTS.

There were eight supplements issued during the year. Their combined editions aggregated 84,000 copies. Their educational purpose and nature may be judged from the titles, which are given under the chapter "Publications" in this report.

REPRINTS.

Many of the articles which appear in the Public Health Reports are of such a nature that a wider distribution of them is desirable. These articles are reprinted in the form of separates to avoid the unnecessary expense of printing larger editions of the Public Health Reports themselves. Their issue in reprints makes possible the satisfying of an extensive demand for them, which otherwise could not be met. Eighty reprints of this nature have been issued, the aggregate of the editions totaling 659,500 copies. For further information regarding reprints and their titles see chapter on "Publications."

SANITARY LEGISLATION.

The nature and effect of legislation relating to the public health adopted by States and cities have been kept under observation, and the trend of sanitary legislation has been studied and, where opportunity offered, guided into channels of practicability and proven efficiency. Copies of municipal ordinances and regulations and of State laws and regulations pertaining to the public health have been obtained currently as adopted by the several States and cities. Information of the trend of sanitary legislation and of the nature of the laws and regulations being adopted has been made available to State and local health authorities and legislative bodies by the publication of the text of such laws currently in the Public Health Reports. In this way all persons interested in public health legislation and administration have been able to keep advised regarding the legislative action and administrative practices throughout the country. It has made possible a helpful criticism of these laws and regulations and the gradual selection of those most suited to accomplish the purpose for which they are intended. With the copying and adoption of the better-drafted laws and regulations the effect has been a marked tendency toward uniformity in legislation.

STATE HEALTH LAWS AND REGULATIONS.

The observation, collection, and publication in the Public Health Reports of State health laws and regulations dates back to July 1, 1911. During the past year the State laws and regulations to December 31, 1914, have been compiled and classified in three volumes, one containing the laws and regulations adopted from July 1, 1911, to December 31, 1912, one including the laws adopted during the calendar year 1913, and one those adopted during the calendar year 1914. The following is a brief discussion of the more important legislation adopted during the year ended June 30, 1915:

STATE HEALTH ORGANIZATIONS.

During the fiscal year ended June 30, 1915, the health departments of Massachusetts, New Jersey, West Virginia, and the Philippine Islands were reorganized.

Massachusetts.-The Massachusetts Department of Health has replaced the former "board of health." The executive officer is the commissioner of health, who is appointed by the governor for a term of five years. He must be a "physician skilled in sanitary science and experienced in public health administration." His salary is $7,500 per annum.

The public health council consists of the commissioner of health and six other members, who are appointed by the governor for threeyear terms. The members receive "$10 a day while in conference and their necessary traveling expenses while in the performance of their official duties." It is the duty of the public-health council to "make and promulgate rules and regulations; to take evidence in appeals; to consider plans and appointments required by law; to hold hearings; to submit annually to the general court, through the governor, a report, including recommendations as to needed health legislation; and to discharge other duties required by law," but it has no administrative or executive functions.

The State is divided by the commissioner of health into eight health districts, with a health officer in charge of each district. (Public Health Reports, Oct. 30, 1914, p. 2941.)

New Jersey.-The New Jersey act provides for a department of health governed by a board of eight members, appointed by the governor for four-year terms. Three of the members must be physicians, one a veterinarian, and two sanitary engineers.

The executive officer is the director of health, who is selected by the board. He must be a resident of the State of New Jersey, skilled in sanitary science, and must have had "actual experience in an administrative or executive capacity in some well-organized department of public health." His term of office is four years, and the salary $5,000 per annum.

The department is required to enact a State sanitary code, embodying rules and regulations "the observance of which, in its opinion, will promote health and prevent disease." It is given power to enforce the laws of the State and the sanitary code in localities where, after notice, the local authorities fail to enforce them.

The board is required to codify the various laws of the State of New Jersey relating to the health of the people, and to continue the

work from year to year "with the idea of preserving in concrete form the history and development" of the department of health of the State," and contributing materially to a better and more comprehensive understanding of all laws relating thereto." (Public Health Reports, July 16, 1915, p. 2139.)

West Virginia.-The State of West Virginia has also substituted a department of health, with a commissioner of health and a publichealth council, for its State board of health. The law establishes two divisions in the department, one of preventable diseases and the other of sanitary engineering, with a director in charge of each division.

One provision of the law authorizes the commissioner of health, when in the opinion of the public health council any local health authority fails or refuses to enforce necessary laws and regulations to prevent the spread of diseases, to enforce the rules and regulations of the State department of health within the territorial jurisdiction of such local health authority. The public health council is also authorized to remove from office any local health officer who refuses to carry out the lawful orders and regulations of the council. (Public Health Reports, Apr. 9, 1915, p. 1119.)

Philippine Islands. The bureau of health of the Philippine Islands has been superseded by the "Philippine Health Service," under the direction of a director of health and a council of hygiene. The act took effect July 1, 1915. (Public Health Reports, May 7, 1915, p. 1415.)

MORBIDITY REPORTS.

A large number of laws relating to morbidity reports have been adopted within the last few years. This is an indication that members of legislatures and others interested in the welfare of communities realize the importance of prompt notification of cases of communicable diseases in order that measures may be taken to prevent their spread.

During the calendar year 1913 more than half of the States of the Union adopted or amended laws or regulations requiring that cases of controllable diseases be reported to the health authorities. print No. 264 from the Public Health Reports.)

(Re

The State Board of Health of Ohio on October 21, 1914, adopted nearly all the provisions of the model law for morbidity reports in the form of a regulation. (Public Health Reports, Nov. 6, 1914, p. 3007.)

During the fiscal year ended June 30, 1915, the Legislatures of Maine and Michigan amended the laws of those States requiring the notification of cases of communicable diseases. (Public Health Reports, Apr. 30, 1915, p. 1365, and June 18, 1915, p. 1853.)

Regulations providing for the reporting of communicable diseases were adopted in Delaware (Public Health Reports, Apr. 16, 1915, p. 1201) and in Illinois (Public Health Reports, June 4, 1915, p. 1723).

Additions to the lists of notifiable diseases were made in Louisiana, Montana, Porto Rico, and Vermont.

An amendment to the Massachusetts law requires more complete records to be kept by local health officers of cases reported to them,