lation that analyses of the laws in force have been made and investigations of State and local public health administration conducted in various States and communities at the request of the authorities concerned.

HEALTH ORGANIZATION IN MINNESOTA.

On request of the State Board of Health of Minnesota Surg. Carroll Fox was detailed to conduct a study of public health activities and needs in that State. The investigation continued for a period of about three months from June 4, 1914, embracing the following matters: Organization of the board; executive officers; divisions of the board and their duties and facilities; control of preventable diseases; control of water supplies; disposal of sewage and other municipal wastes; sanitary regulation of public institutions, lodging houses, etc.; control of milk supply; registration of vital statistics; educational functions, literature, lectures, and exhibits; school hygiene and child welfare; field work; local health organization; appropriations available for health work; and health activities carried on by other agencies.

As a result of his studies Dr. Fox was able to formulate a number of recommendations in regard to changes deemed necessary to secure in Minnesota that efficiency in protection against disease to which its citizens are entitled.

The complete report of Dr. Fox's investigation, with his recommendations, has been published in the Public Health Reports and issued as Reprint No. 223.

HEALTH ORGANIZATION IN WASHINGTON.

Following the Minnesota investigation Surg. Carroll Fox was directed, at the request of the State Board of Health of Washington, to conduct a similar study in that State. This study lasted from September 17, 1914, to January 13, 1915, and was carried on along lines similar to those followed in Minnesota.

As a result of his study Dr. Fox concluded that the adoption and enforcement of measures for the protection of the public health in the State of Washington had not kept pace with the growth in population and wealth of the State, and that coordination of health activities scattered among different branches of the government and providing the necessary legislation and funds for health work were imperative. These conclusions were embodied by him in a series of detailed recommendations.

The complete report of this investigation has been published in the Public Health Reports and issued as Reprint No. 255.

HEALTH ORGANIZATION IN WEST VIRGINIA.

In accordance with requests from the governor and the State Board of Health of West Virginia Surg. Taliaferro Clark was detailed on November 4, 1914, to make a study of public-health organization and administration in that State. The undue prevalence of such diseases as typhoid fever and trachoma in West Virginia, and the expressed desire of the authorities of the State for the improvement of

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existing conditions made this study of special interest, in view of the possibility that legislation would be adopted to provide better protection for the public health.

In his investigation Dr. Clark considered especially the provisions governing State and local health organization, control of communicable diseases, regulation of the practice of medicine, registration of vital statistics, pollution of water supplies, control of nuisances, sanitary control of foods and drugs, hotel inspection, school hygiene, industrial hygiene, etc.

The conclusion reached was that both State and local public-health administration in West Virginia was in evident need of reorganization and strengthening by means of legislation supplying the necessary additional powers and adequate funds to carry on health work. Specific recommendations in regard to measures were made by Dr. Clark in his report of the investigation. This report has been published in the Public Health Reports and issued as Reprint No. 252. Legislation embodying most of Dr. Clark's recommendations was subsequently enacted in West Virginia. While this law has some excellent features, one obvious defect was its failure to provide the minimum amount of funds which are, in the opinion of this bureau, required to perform effective public-health work.

HEALTH REORGANIZATION IN ILLINOIS.

On requests from the efficiency and economy committee of the General Assembly of the State of Illinois and the State Board of Health of Illinois Surg. S. B. Grubbs was detailed to make a study of the Illinois health agencies. This study covered a period of over three months from November 9, 1914, and embraced not only the work of the State and local boards of health, but also the sanitary functions of other departments, such as the State board of pharmacy, the board of dental examiners, the State barbers' examining board, the State food commissioner, the State department of factory inspection, the Illinois Rivers and Lakes Commission, the State water survey, State charities commission, and such unofficial sanitary agencies as the association for the prevention of tuberculosis.

As a result of this study, the conclusion was reached that the present State board of health is primarily a licensing board, with insufficiently developed public-health functions, and that many duties that should devolve upon it have been either assumed by other agencies or left unattended. A reorganization to remedy this fault is therefore desirable, and new legislation enacted to strengthen the authority of the State in discharging sanitary responsibilities already recognized and performing other work so far neglected. One obvious need is the grouping of related health functions of the State into one State department of health.

The specific improvements deemed necessary were enumerated in detail by Dr. Grubbs in the report submitted by him to the efficiency and economy committee. While the majority of these changes, and these the most important, required new legislation, in a number of administrative matters the recommendations made could be immediately carried out and were adopted; in fact many of these changes had been recognized as desirable by the executive office of the State board of health before the recommendations were made.

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The complete report of Dr. Grubbs's investigation has been published in the Public Health Reports and issued as Reprint No. 275.

HEALTH ADMINISTRATION IN KANSAS.

On request from the public health commission appointed by the governor of Kansas and the Kansas State Board of Health, Asst. Surg. Gen. J. W. Kerr was directed on November 3, 1914, to proceed to that State to confer with the authorities mentioned in regard to the public-health organization and administration of the State.

A study of the activities of the State and local boards of health showed that Kansas has a rather well-planned State health organization. While some parts of it are as yet undeveloped and other parts only partially developed, the amount of work accomplished by the State board is large, considering its limited facilities.

As a result of the conferences held and observations made, the conclusions were reached: (1) That, from a public-health standpoint, the greatest need of the State of Kansas is an efficient field organization composed of full-time health executives, (2) that local units of health administration should be made sufficiently large to justify the employment of full-time health officers, (3) that adequate funds should be available for use of health authorities in preventing disease and an emergency fund placed at the disposal of the State health authorities for the suppression of epidemics.

In cooperation with the officers of the public health commission and the State board of health, a proposed measure was examined providing in substance for the division of the State into not more than 30 sanitary districts, consisting of one or more counties, constituting the county and city authorities in each district into district boards of health, and requiring in each district the appointment after competitive examination of a full-time health officer with a compensation of not less than $2,000 per annum.

STUDY OF THE CHICAGO HEALTH DEPARTMENT.

At the request of the efficiency commission of the Chicago Civil Service Commission, the service undertook a study of the organization and administration of the health department of the city of Chicago. Senior Surg. J. C. Perry was detailed for this investigation, and his work, which commenced on December 2, 1914, was continued for four months, for the purpose of making recommendations in regard to improvements deemed advisable.

Among the features of the system which Dr. Perry commended were the organization of the bureaus, the membership of the health commissioner on unofficial health bodies, the particular stress laid on educational work in fostering improvements in living conditions, the school of sanitary instruction for employees of the department with its facilities for others interested, the probationary period of six months for new employees, the employment of full-time supervisors in the bureau of medical inspection to check up work performed by health and quarantine officers and similar methods in other bureaus, the supervision over the public bath system and public lodging houses, and the means of dealing with communicable diseases, especially tuberculosis.

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Most of the changes suggested by the investigator were individually of minor importance but cumulative in effect. He found that the city was backward in providing funds for infant welfare service, that the dental dispensaries were insufficient, that there was lack of uniformity in the scoring of dairy farms and unsatisfactory arrangements for the transportation of milk to the city, that in some bureaus additional men were needed to carry out necessary work, and that in others some changes in routine would improve the service rendered. It was found that the municipal garbage plant had not been in operation long enough for a statement as to its real efficiency.

At the completion of the investigation the mayor of the city of Chicago sent a communication expressing appreciation of the work of Dr. Perry and stating his belief that the investigation would be of lasting benefit.

A complete report of the results of this study has been published in the Public Health Reports and issued as Reprint No. 300.

PUBLIC HEALTH ADMINISTRATION IN TOLEDO.

A study of the health organization and administration in the city of Toledo, Ohio, was made by the service at the request of the Ohio State Board of Health, the Toledo Board of Health, and the Toledo Commerce Club. Surg. Carroll Fox was designated for this work, and his investigation, carried on for a period of about four months, from January 21 to May 8, 1915, included a study both of the office and field work of the city department of health.

At the present time health affairs in Toledo are administered by a board of health the members of which receive no salary. A health officer is appointed by the board; but on January 1, 1916, a radical change is to be made in the health organization as the result of a new charter. Under this charter the division of health is made a subdivision of the department of public welfare and authority to make regulations is vested in the council. The management of municipal hospitals is placed in a division of the department of public welfare, known as the division of charities and corrections, and is not under the health division. As a result the division of health will virtually become a body for the correction of nuisances. The most important recommendation of Surg. Fox was that the health division be made a regular department of the city and include under it the division of charities and corrections and also the supervision of the health of school children, now under the board of education.

The investigator found that the city of Toledo, like other Ohio cities, is limited in resources owing to a State law which limits city revenues to a 10-mill tax levy to provide for its ordinary maintenance as well as to assume its share in the support of the State and county governments. He, nevertheless, suggested that a larger percentage of the funds be devoted to health work and recommended that the minimum amount allowed be not less than 15 per cent of the city's available revenues. This would be for the year 1915, $292,505. Two-thirds of this sum, he believed, should go to the department of service for the collection of garbage and rubbish, street cleaning, and comfort stations.

Among the other recommendations made by the investigator were that the health officer be required to devote his full time to his duties and be paid a salary equivalent to that received by other department heads; that a better supervision be maintained over the milk supply of the city and all market milk pasteurized; that all catchbasins, privy vaults, and surface wells within the city be abolished; that the practice of emptying sewage into creeks be discontinued; and that the educational work of the department be extended.

Despite the misconception of the duties of a health department by the framers of the new charter, Dr. Fox reports that the recently appointed health officer, with the support of the board of health, the newspapers, and many citizens, has already attempted a reorganization in accordance with the foregoing suggestions.

A report of this investigation has been published as Reprint No. 284 of the Public Health Reports.

SANITARY SURVEY OF RICHMOND, IND., WITH SPECIAL REFERENCE TO TUBERCULOSIS.

On request of the State and local health authorities, Asst. Surg. Gen. L. E. Cofer was directed on March 31, 1915, to make a study of the tuberculosis situation at Richmond, Ind., and formulate such preliminary recommendations as might seem advisable.

In the somewhat limited time at Dr. Cofer's disposal, an examination of the available data seemed to indicate that in those sections of Richmond occupied respectively by the wealthy and the poorer classes there was very little tuberculosis, the disease being apparently confined to the localities where people of moderate means resided, and that a careful and prolonged survey would be necessary before the causes responsible for the prevalence and distribution of tuberculosis in Richmond could be determined and corrective measures applied. Accordingly, on request of the State and local health authorities, Senior Surg. J. C. Perry was detailed on May 21, 1915, to conduct an investigation of sanitary organization and administration in Richmond and advise the city authorities in regard to the measures which should be adopted to prevent the spread of communicable diseases, especially tuberculosis.

This investigation began on May 27 and was still in progress at the end of the fiscal year.

SANITARY SURVEY OF BOWLING GREEN, KY.

On request of the secretary of the State Board of Health of Kentucky, Passed Asst. Surg. W. H. Frost was directed on September 12, 1914, to make a sanitary survey of Bowling Green, Ky. The survey lasted from September 26 to October 1, 1914, and its chief object was to determine the causes responsible for the excessive prevalence of typhoid fever in Bowling Green and to recommend remedial

measures.

The city is an important educational center, about 2,500 students attending its various colleges every year, and its population numbers over 9,000 inhabitants. A study of local sanitary conditions showed that, in spite of certain natural advantages, the death rate from