considered necessary to determine to what extent the home environment and the habits of these men outside the mill affected their health. Accordingly, a general survey of the residential sections of five mill towns and a detailed study of two typical mill towns were made. Data were collected relative to the following subjects: Water supply, sewage and waste disposal, public health administration, morbidity and mortality reports, hospitals and physicians, housing conditions, and habits of the steel workers while off duty, particular attention being given

the saloon.

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In the course of the investigation a study was made of each condition that might adversely affect the health of the employees. The officials of the plants offered every convenience and their cooperation was very valuable. Dr. Watkins, when requested, gave advice on sanitary matters and suggested ways and means of altering certain conditions for the mutual benefit of employers and employees. planned to supplement the data and information so far collected with data relative to the physical condition of the steel workers. Finally, reports of practical use to steel workers will be prepared for disposition by the Bureau of Mines, in cooperation with which the studies are being made.

COOPERATION WITH THE COMMISSION ON INDUSTRIAL RELATIONS.

Surg. B. S. Warren continued on duty with the Commission on Industrial Relations as sanitary adviser until July 1, 1915, and has submitted to the commission a final report on "Sickness insurance" and its relation to the prevention and cure of disease among industrial workers and, also, a final report on "Economic conditions and their relation to the public health.”

Sickness insurance. The final report on this subject was a joint report by Surg. Warren and Mr. Edgar Sydenstricker, a member of the commission's staff of special investigators. This report was not final in the sense that the study of the subject was considered complete, but final in the sense that it was as complete as the money available for the work would permit. The investigations were sufficiently extensive and intensive to show that sickness insurance had been in operation in many European countries long enough to prove its usefulness. Furthermore, the experience in this country was found to show a great demand for it, and to show that practically all of the essential features were in operation in some of the labor unions, business establishments, fraternal orders, or commercial insurance. But there was found to be great need for governmental supervision to the end that uniformity would be brought about and sickness insurance given national application.

The report includes a consideration of the problem of the wageearners' health, the conditions underlying this problem, the adequacy of sickness insurance as a remedy, as well as a plan for the basis of a National or State law on the subject.

The subject of sickness insurance in relation to public health will be further studied in detail and a report of the findings published. The problem of the wage earners' health.-The problem of sickness among wage earners is so closely related to economic conditions

that a study of the one can not leave out of consideration the other. Provision for medical relief of the sick wage earners is so often useless without provision for financial relief, because so many of them can not afford to stop work to avail themselves of medical relief before it is too late. It is not until these economic conditions are considered in their relations to sickness, both as cause and effect, that the magnitude of the problem can be realized.

The inability of the average wage earner to meet the expense of medical treatment is pointed out by the fact that more than half of them are receiving incomes barely sufficient to meet the average family expenditures without a reasonable chance to save for sickness when it comes. The relation of poverty and disease is further shown by the fact that the death ratio in the poorest sections of cities is often double that of the best sections, that the death rate of infants of fathers earning less than $10 per week in various cities is often three times that of the infants of fathers earning $1,200 or more per year, that the tuberculosis rate is roughly in inverse ratio to the income, that over 11 per cent of all unemployment is due to sickness, and that nearly 40 per cent of cases requiring relief give sickness as a cause.

Economic conditions and their relation to the public health.-In his report on this subject, submitted by Surg. Warren to the Commission on Industrial Relations, it was shown how intimately the problem of disease prevention was related to industrial and economic problems and the necessity for cooperation between public-health workers and those endeavoring to solve our economic problems.

Hygienic standards were defined and outlined according to responsibility. The most important of these were discussed in order to show the relation of insanitary conditions in places of employment, long hours of labor and fatigue, poor living conditions, cost of living, wages and income, and woman and child labor, to the health of the individual worker and the community. This was especially shown by the sick and death rates according to occupation and their effect upon the infant mortality. The relation of sickness to labor unrest was pointed out.

Sanitary surveys of certain industries.-At the request of the Commission on Industrial Relations four officers were detailed during the year to make brief sanitary surveys of certain industries, in order to obtain information regarding working conditions, influences detrimental to the health of workers, and whether or not such influences were a necessary concomitant of the industries surveyed. Among the industries studied were the following: Boot and shoe manufacturing, at Brockton, Mass.; writing-paper industry, at Holyoke, Mass.; silk manufacturing and dyeing, at Paterson, N. J.; bituminous-coal mining, at Shenandoah, Pa.; glass manufacturing, at Charleroi, Pa.; steel industries, at Johnstown, Pa.; copper mining, at various localities in Michigan; the manufacture of rubber tires and rubber goods, at Akron, Ohio; iron-ore mining, at Hibbing, Minn.; and the manufacture of agricultural implements, at Moline, Ill.

Upon completion of the surveys the Industrial Commission was furnished with the information collected.

STUDIES OF CHILD-LABOR PROBLEMS IN MASSACHUSETTS IN RELATION TO HEALTH.

In January of this year the Massachusetts State Board of Labor and Industries requested that Asst. Surg. M. V. Safford should be authorized to assist the board in the problems which confronted it with respect to the employment of child labor in the State, and he was accordingly detailed with the board under instructions contemplating a study of the effect of various occupations on persons during their period of adolescence.

By recent State legislation the administration of practically all laws and regulations relating to the conduct of industries and the employment of labor in Massachusetts has been placed in the hands of this board, together with complete jurisdiction in matters of industrial hygiene, which were formerly under the State board of health or the district police. As the medical work of the State board of labor and industries had not been fully organized, it was not until May that actual investigations in the direction of the study contemplated in Dr. Safford's instructions began. There were then undertaken under his direction comprehensive physical examinations of minors employed in the textile industries of the State in accordance with a prescribed scheme of examination calculated to bring out and record any abnormal conditions in the persons examined possibly attributable to the individual's particular occupation or working conditions. In addition to actual physical examinations of employees there have been made available for purposes of study case records of the hospitals of Lowell and Lawrence, to which practically the entire mill population of these cities resort in sickness or accident for either dispensary or hospital treatment.

This investigation of the textile industry is still in progress. It has been subject to interruptions by reason of the fact that Dr. Safford is also in charge of the immigration work of the service at Boston and because of temporary reduction of the medical staff at the station.

While sufficient data has not yet been accumulated to warrant positive deductions as to the effect or noneffect of the various kinds of work in the textile industry upon minors employed therein, enough has been done to make a prediction as to conclusions fairly safe in certain matters of practical interest.

An undue proportion of the boys employed have, for instance, been found to be under height and weight for the ages given, but such deficiencies have been found to bear no relation to the duration of employment in the textile industry. To some extent such deficiencies are more apparent than real and are to be accounted for by successful evasion of the State laws with respect to the age and hours of employment of minors. The same thing is apparent, however, in groups of boys whose ages would not seem open to question and would appear to be accounted for by the fact that mill work is chiefly a "woman's work" and is likely to attract males who by reason of lack of physical strength or other cause are ill-fitted to do anything else, or, in other words, that in an investigation of this sort in the textile industry one is dealing to a great extent with material that was pathological from the start.

An attempt was made to carry on in conjunction with the physical examination some systematic tests of mental capacity similar to those used in the preliminary mental examinations of arriving aliens, but it was found impracticable to combine the two procedures. Record is still being made, nevertheless, of suspicions of lack of normal mental capacity which have been brought out in the course of the physical examinations, and if such cases were to be followed up it is believed that some of them would prove to be instances of clearly demonstrable mental defectiveness. On the whole, however, considering that much of the work of mill employees calls for no greater degree of intelligence than of physical strength, there would not appear to have been found thus far a surprising proportion of persons deficient in one or both of these respects.

MENTAL TESTS OF FACTORY CHILDREN IN MARYLAND.

At the request of the chief of the Maryland Bureau of Statistics and Information, Surg. J. A. Nydegger was instructed to render such assistance as might be practicable in regard to making tests of the mental development of children employed in factories, especially in connection with the enforcement of child-labor laws. In a number of cases this was done from time to time during the year by Dr. Nydegger.

SANITATION OF CONVICT CAMPS.

At the request of the Director of the Office of Public Roads, United States Department of Agriculture, Passed Asst. Surg. W. F. Draper was detailed on August 17, 1914, to conduct an investigation of the sanitary conditions of convict road-construction camps in the United States and the health of the convicts therein.

The purpose of the investigation was to determine by close observation the actual conditions which exist in convict camps, and with the knowledge thus gained, to make whatever recommendations might be necessary for the improvement of sanitary conditions and of the health of the convicts, and to prepare plans and specifications for a model camp.

Convict road camps were inspected in the States of Alabama, Arizona, Colorado, Florida, Georgia, Michigan, New Jersey, New Mexico, New York, North Carolina, South Carolina, Texas, Utah, Virginia, Washington, and Wyoming. Housing, water supplies, disposal of sewage and other wastes, feeding, working conditions, and health of the inmates were thoroughly investigated at each camp. Many camps were found to be in good sanitary condition, but others were in a most deplorable state.

A report of the sanitary and health conditions observed in the various camps has been prepared by Dr. Draper, with definite recommendations in regard to the sanitary principles which should govern these institutions.

It is intended to continue studies of the sanitation of industrial camps generally, with the view to the preparation of a comprehensive report on the subject.

PUBLIC HEALTH SERVICE.

MECHANICAL DEVICES AS AIDS TO RESPIRATION.

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From time to time, at the request of the General Superintendent of the Life-Saving Service (now consolidated with the RevenueCutter Service into the United States Coast Guard), investigations have been made by this service of certain mechanical devices recommended for the resuscitation of apparently drowned persons. A request from the same official was received in January, 1915, that tests be conducted of an apparatus called "lung motor " to determine its merits for use in resuscitating the apparently drowned.

The investigations of the apparatus were conducted at the Hygienic Laboratory by Surg. J. W. Schereschewsky and Technical Assistant G. B. Roth from May to July, 1915, when a report was rendered. It was in substance the opinion of the investigators that, while manual methods of resuscitation should be primarily relied on and can not be dispensed with by any mechanical device thus far known, mechanical means for producing artificial respiration should be available in places where accidents may occur from drowning or exposure to poisonous gases. Mechanical methods of respiration are especially indicated in cases of great relaxation, collapse of the lungs, and gas poisoning, and also when signs of reanimation fail to appear shortly after the application of manual methods.

While, in so far as actual ventilation of the lungs is concerned, mechanical methods are superior to manual, it was the opinion of the investigators that the delay incident to the application of mechanical methods at a time when every second is of value constituted a serious argument in favor of manual methods. They therefore recommended that in all cases of submersion or exposure to poisonous gases manual methods should be applied without delay and let the use of mechanical respiration be decided by the condition of the subject.

As a device for mechanical respiration in appropriate cases, the investigators concluded that the lung motor is a satisfactory device provided the suction stroke is not used. They were in accord with the committee on resuscitation from mine gases, who, in their report to the United States Bureau of Mines, condemned expiration produced by repeated suction of air from the lungs. It was recognized that the lung motor may be used as a device for producing inspiration only, the suction stroke being dispensed with. In this case the apparatus should be provided with a release valve, which will allow air to escape outside whenever inspiratory pressure reaches a maximum of, say, 20 millimeters of mercury. Used in this manner and by persons having the requisite skill and experience the investigators were of the opinion that an apparatus similar to the lung motor would be free from danger and in suitable cases have a field of usefulness.

PUBLIC HEALTH ORGANIZATION AND ADMINISTRATION.

For a number of years the service has been emphasizing the fact that the strengthening of State and local health organization is one of the great needs of the Nation. It is with a view to disclosing how this may best be accomplished and advocating remedial legis