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The object of this investigation was to determine the exact condition of the quarantine stations, with a view of their future development and improvement.

Officers have been stationed, as usual, in the American consulates of the principal ports of Italy and Asia.

Víedical inspection of immigrants.-During the fiscal year 562,263 aliens were inspected, and 17,840 were certified for rejection on account of physical or mental defects. Inspectors were stationed at 93 stations in the United States, Hawaii, the Philippines, and Canada, and while practically every officer in the service has taken part, more or less, in the work, 82 medical officers (28 commissioned officers and 54 acting assistant surgeons) were assigned to this duty exclusively.

The marked decrease in immigration during the year is due to the European war, but while the volume of work performed by the medical officers in the examination of aliens has been decreased, the scope of the examination given has been widened on account of the relative increase of examination facilities, including the number of medical officers available for the work.

Division of Domestic Quarantine. Bubonic plague.—The not unexpected occurrence of plague upon the Atlantic coast materialized June 19, 1914. From the date of the recognition of the disease in New Orleans until June 30, 1915, 30 human cases were notified and 244 instances of infection among rodents discovered. The significance and importance of the outbreak, controlled so far as human cases were concerned in the shortest possible time, can only be appreciated by those most familiar with the disease. The epidemic found the service prepared with experienced officers, scientific investigators, and trained men, and from this nucleus there was evolved an organization which capably met every development. Due credit for its success must be accorded State and municipal officials whose cooperation was secured, and also to the citizens of New Orleans, who met the crisis in admirable spirit.

The plague-preventive measures on the Pacific coast at San Francisco and its environs and at Seattle, Wash., have been continued.

Rocky Mountain spotted (tick) fever.-The increasing economic importance of Rocky Mountain spotted fever, and the occurrence of the disease in widely different sections of the West, have demanded that more thorough investigation be undertaken to determine its prevalence. This work is now in progress. The virulent form of the disease in the Bitter Root Valley, a type of the disease which renders a large section uninhabitable, has been strenuously combated, and it is believed that the measures adopted will in time greatly lessen its prevalence.

Sanitation of interstate carriers.--Enforcement of the interstate quarantine regulations has been continued and officers have been assigned to duty in the prevention of the interstate spread of disease in the newly created interstate sanitary districts. Two amendments relating to water supplies have been promulgated during the year, and a bacteriological standard for water supplied by interstate carriers has been adopted. Revision of the present regulations has been

in progress by the interstate sanitary board appointed for the purpose. At the annual conference of State and Territorial health officers with the Public Health Service, the provisional requirements were the subject of consideration and their adoption was recommended.

Sanitary work in Alaska.-In cooperation with the Bureau of Education, officers have again been detailed to prevent the spread of epidemic diseases in Alaska, and for the instruction of the native population in matters of sanitation. The work has had gratifying results.

Inspection of public buildings. The periodical sanitary inspection of Government buildings in the District of Columbia has been performed as in previous years.

Public lectures, sanitary education, etc.- Educational measures have been furthered by means of an extensive exhibit at the PanamaPacific International Exposition, lectures by officers of the service before health organizations and public gatherings, the use of a stereopticon loan library, and by health news items in the daily press.

Cooperation with authorities of the Panama-Pacific Exposition. The assistance rendered the Panama-Pacific Exposition in caring for sick and injured has been continued, and the sanitation of the exposition grounds and buildings has also been conducted by officers of the service.

Division of Sanitary Reports and Statistics.

Prevalence of disease in the United States. Section 3 of the act approved February 15, 1893, provides for the prevention of the interstate spread of "contagious or infectious diseases," and section 4 of the same act requires the Secretary of the Treasury to obtain and distribute to State and municipal health officers and other sanitarians current information of the prevalence of dangerous diseases.

Pursuant to the provisions of the law every effort has been made to keep currently informed of the prevalence of communicable diseases. Not only have the records of State and local health departments been used as a source of information, but it has been made the special duty of all medical officers of the Public Health Service, wherever they may be detailed, to use every possible means of learning of the unusual prevalence of disease and to report regularly on the subject. All sources of information have been used and wherever possible new sources have been developed.

More nearly complete information of the prevalence of dangerous communicable diseases has been collected than ever before. The chief limitation to still more complete knowledge of the subject is the lack of information on the part of many local and State authorities as to the prevalence of disease within their respective jurisdictions. The importance of such information in the control of disease has been brought to the attention of these authorities, and they have been assisted, wherever assistance has been sought, by advice and encouragement.

The information of the prevalence of disease obtained from all sources has been published currently in the Public Health Reports for the benefit and use of all the health authorities, State and local.

Public health legislation.-Cognizance has been taken during the year of public health legislation. The laws, regulations, and ordinances of States and cities affecting or having for their purpose the pro

the past.

tection of the public health have been obtained and published currently for the information of the health officers and health workers of the country. Compilations of these laws have been prepared, and digests are in preparation to render their better study possible and that future legislation may benefit by the experience and mistakes of

Advice regarding the proper kind of sanitary legislation has been given to the many health authorities seeking it. The noticeable effect of this work has been the selection of the good and practicable laws and regulations for adoption and the discarding of the impracticable, worthless, or unenforceable ones. Another result has been a strong tendency toward uniformity—a much desired end.

As a part of this work the decisions of courts of last resort in the several States on matters relating to the public health have been watched and all those having a direct bearing have been published for the general information of State and local health authorities and other sanitarians. These decisions are of special importance, inasmuch as they show the application and construction of legislation.

World prevalence of quarantinable diseases.—That quarantine officers might effectually prevent the introduction of dangerous communicable diseases from foreign countries cognizance has been taken of the world distribution of quarantinable diseases, and every effort has been made to obtain complete information of outbreaks through the agency of officers of the Public Health Service and the cooperation of the Department of State, and more particularly of American consuls stationed throughout the world. Reliable information of the foreign ports and places at which these diseases existed or were epidemic has made possible the maintenance of an effective maritime quarantine without the placing of unnecessarily burdensome restrictions upon maritime commerce.

Public Health Reports. The medium used for the dissemination of information to State and municipal health officers and other sanitarians on the matters enumerated has been, as in previous years, the weekly Public Health Reports. The demand for this publication has greatly increased, as has also its usefulness.

Popular educational pamphlets.—Popular educational pamphlets have been issued in the form of supplements to the Public Health Reports. These supplements treat of such subjects as the prevention of malaria, the control and prevention of scarlet fever, and the disposal of waste at unsewered homes. Their usefulness, as well as the demand for them, has been great.

Division of Marine Hospitals and Relief. During the fiscal year, 55,782 patients received medical treatment as beneficiaries of the service. Of this number, 15,439 were treated in hospitals and 40,343 were treated as dispensary or out-patients. The hospital patients received a total of 446,227 days' treatment, and the out-patients were treated a total of 68,466 times. During the year the service operated 23 marine hospitals, all of which are owned by the Government, and maintained 120 other relief stations where hospital and dispensary relief were furnished patients.

23871-Ab. 1915—vol 1-11

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At the tuberculosis sanatorium of the service located at Fort Stanton, N. Mex., 329 patients were cared for during the year, a total of 79,251 days. Of these, 79 were discharged, 48 died at the sanatorium, and 202 remained under treatment at the close of the year.

Aid was extended to other branches of the Government in the physical examination of 2,094 persons, of whom 180 were rejected. In addition, physical examinations were made of 3,412 pilots and 665 merchant seamen to determine their fitness for duty on American vessels. Of these, 74 and 15, respectively, were rejected.

Coast Guard claims.-During the year, 474 claims for benefits under the act of May 4, 1882, by keepers and surfmen of the Coast Guard have been passed upon by the officer in charge of this division, based upon the medical evidence submitted. Physical examinations of such keepers and surfmen have been continued.

Division of Personnel and Accounts. Commissioned and other officers.--The commissioned medical officers at the close of the fiscal year numbered 186, as follows: The Surgeon General, 1 Assistant Surgeon General at large, 12 senior surgeons, 70 surgeons, 41 passed assistant surgeons, and 61 assistant surgeons. The acting assistant surgeons numbered 241, in addition to 21 acting assistant surgeons appointed for duty in the physical examination of applicants for enlistment or reenlistment in the United States Coast Guard, making, all told, 448 medical officers. The total personnel of the service, including 50 pharmacists, 1,418 attendants, and 129 other employees, numbered 2,045.

Expenditures. The appropriations for the ordinary maintenance of the Public Health Service were $1,942,964. The receipts from all sources, repayments for care of foreign seamen, etc., were $19,526.47. The expenditures were $1,882,716.98, including outstanding liabilities, leaving an estimated balance of $80,073.49.

The appropriations for preventing the introduction and spread of epidemic disease made by Congress during the fiscal year amounted to $420,000. In addition thereto the sum of $100,000, an appropriation made May 25, 1914, was available, making a total of $520,000 available. The repayments were $256.99. The expenditures, including outstanding liabilities, were $ 464,547.43, leaving an estimated balance of $55,709.56.

The appropriation for the maintenance of the quarantine service was $155,000. The amount of repayments was $944.85. The expenditures were $153,038.59, including outstanding liabilities, leaving an estimated balance of $2,906.26.

The unencumbered balance of the appropriation for national quarantine and sanitation at the beginning of the fiscal year was $18,719.19; there was transferred to the books of the Supervising Architect $11,409; other expenditures, including outstanding liabilities, were $6,356.87, leaving an unencumbered balance June 30, 1915, of $953.32.

The appropriation for field investigations of public health matters was $200,000. The expenditures were $184,028.88, including estimated outstanding liabilities, leaving an estimated balance of $15, 971.12.

The appropriation for interstate quarantine service was $15,000. The expenditures were $11,944.85, including outstanding liabilities, leaving an estimated balance of $3,055.15.

The appropriation for special studies of pellagra, $47,000, made April 6, 1914, was available during the fiscal year. The expenditures were $44,246.34, including outstanding liabilities, leaving an estimated balance of $2,759.66.

Miscellaneous Division.

Publications.—The fiscal year has witnessed another increase in the quantity of public health literature distributed. During the period in question the service issued 148 publications, dealing with a wide range of subjects relating to public health and sanitation. These documents were issued in editions aggregating 1,728,500 copies and were distributed to the public in all parts of the country. This number does not include those bulletins sold by the Public Printer. The increase over the previous year was approximately 241,485 copies.

Because of the increased activities of the service in its various fields of work, with the resulting increased demand for educational literature, the editions of service publications were quickly exhausted. As a consequence the bureau was obliged to refuse many requests, and could only suggest to the applicants that the documents could be purchased from the Public Printer.

UNITED STATES COAST GUARD.

Lives saved or persons rescued from peril..

1, 507 Persons on board vessels assisted...

10, 952 Persons in distress cared for..

813 Vessels boarded and papers examined..

24, 817 Vessels seized or reported for violation of law.

772 Fines and penalties incurred by vessels reported.

$220, 500 Regattas and marine parades patrolled, in accordance with law.

37 Vessels to which assistance was rendered..

1, 504 Instances of miscellaneous assistance..

556 Derelicts and obstructions to navigation removed or destroyed.

26 Value of vessels assisted (including cargoes).......

$10, 927, 730 Value of derelicts recovered and delivered to owners.

$161, 000 Appropriations for 1915, including repairs to cutters and establishing stations: Revenue-Cutter Service...

$2, 536, 716. 25 Life-Saving Service....

2, 550, 525. 36 Total for Coast Guard...

$5, 087, 241. 61 Net expenditure for maintenance for 1915: Revenue-Cutter Service...

$2, 530, 371, 17 Life-Saving Service...

2, 497, 381. 54 Total for Coast Guard......

$5, 027,752. 71 Estimated unexpended balance: Revenue-Cutter Service..

$6, 345. 08 Life-Saving Service.....

53, 143. 82 Total for Coast Guard......

$59, 488. 90

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A total of 1,507 persons were saved, or rescued from peril, and on all the vessels to which assistance was given there were a total of 10,952 persons whose lives may or may not have been jeopardized, according to the subsequent circumstances attending each incident.

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