lumbia, S. C., one at Des Moines, Iowa, and one at Petersburg, Va.an officer has been stationed there to act in cooperation with the State and local health authorities. In the zone, for instance, around Louisville the local authorities have raised $26,000 to be expended in cooperation with and under the direction of our force.

The CHAIRMAN. In what way?

Dr. RUCKER. Not in the zone which is under the military authorities, but in the zone which is under the control of the civil authorities. The town of Highland Park, right in the area of the Louisville zone, has raised $40,000, and they have asked us to assist them in this work, but with no expense to the Government, merely asking us to cooperate with them. In the zone around Little Rock, Ark., and the town of Argenta they have set out to do similar work. At the request of the governor and the mayors of both cities and the Board of Commerce of Little Rock they have raised in that way some $80,000.

At Columbia, S. C., the work is also going on. There is an officer in charge. We are undertaking to assist them in maintaining these zones in such a condition so that the troops coming in there`shall not contract disease and so that the troops going away, which is the important thing, will not carry disease back into the civilian community. We know that some of these zones are unfortunately in localities where malaria exists, and men being brought in there are liable to contract malaria and go back to their homes, where the anopheles abound, and will become infected, and we will then have started all over the country malaria, just exactly as following the Civil War we found typhoid fever spread all over the South, and saw it changed from an urban to a rural disease.

The CHAIRMAN. Which one of these camps is in a pest-infected district?

Dr. RUCKER. I do not know of any that is in a pest-infected district. That is not the question. The question is this

The CHAIRMAN. The suggestion you made is likely to convey the impression that unless extraordinary precautions are taken the men would be subject to malaria or some other disease. From your knowledge, are any of the camps that have been located, located in places. that are unhealthy or where the conditions are, from the standpoint of health, unsatisfactory?

Dr. RUCKER. No; I do not think any of the camps have been badly located, nor do I mean to convey the impression that in any of the camps do conditions exist which would not necessarily follow the gathering together of large bodies of men from various portions of the country. I did not mean to convey the impression that any of these camps at all were so situated that they were in diseasebreeding sections, or that the people were unduly neglectful of health conditions, but an extra burden has been placed upon the sanitary balance of these localities by reason of the gathering together in them of large bodies of soldiers and the people who inevitably follow in the train of troops.

The CHAIRMAN. If the sanitary conditions in these camps are proper, would not that eliminate these questions?

Dr. RUCKER. The camp itself might be in a very good sanitary condition, but we must remember that in these zones surrounding the camp the sanitary balance has been very greatly changed and the

men who come there will bring disease in their bodies. There will be typhoid carriers, there will be malaria carriers, and these men when they are without the military zone will endanger the civil population, and if they infect the civil population the civil population will in turn infect them. The thing works in a vicious circle. The CHAIRMAN. Is not that true of the movement of people generally, anywhere?

Dr. RUCKER. Yes; it is true of the movement of people generally, and that is why there is an appropriation for the prevention of the interstate spread of disease. But here we have an extraordinary movement. Men will be coming into these camps. They may stay in these camps only a very short time, and then may be rejected for one reason or another, and then they will be returned to their homes. Men will be coming in there who carry in their blood the organism of malaria. We will say there has been no malaria there in a given area for years, but there are anopholes mosquitoes, and when you put a man with the organism of malaria in his blood in the same environment with large numbers of anopholes mosquitoes, you are bound to have planted there malaria and malaria is bound to spread. the same way, if men come in there who are chronic typhoid carriers and they are careless about the distribution of their discharges, they will infect water supplies and they will place their fecal deposits in such a way that flies have access to them, and then we will find typhoid fever spreading outside of the camp and into an area which is not under the control of the military authorities at all.

In

Dr. BLUE. Mr. Chairman, it is a matter of history that every great war in which this country has been engaged has been followed by epidemic outbreaks among the civil population, and the experts who have investigated this important question have shown that it was due to the concentration and mobilization of large numbers of young men in camps. It is also well established that the movement of sick and wounded or disbanded soldiers has been responsible for wide dissemination of disease in this country; and I simply want to call your attention to the fact that our sanitary forces, provided by Congress up to this time, and that provided by the States, are too small to cope with the serious situation likely to arise as a sequence of the

war.

Mr. CANNON, Doctor, you spoke of typhoid fever. I supposed, while I do not know about it, that typhoid fever was now harmless?

Dr. BLUE. Harmless only to those who have been carefully vaccinated against it, and the civil population has not been so vaccinated. Mr. CANNON. For instance, down on the border, under what I suppose were very objectionable conditions, I understand there was no typhoid fever.

Dr. BLUE. Granted there was no typhoid among the soldiers who have been immunized against it by antityphoid vaccination, but there were a great many cases among the civil population.

Mr. CANNON. How could they spread the disease if they were immunized?

Dr. BLUE. I do not expect the Regular soldiers who have been immunized to spread it, but these men will be assembled from civil life. before they are immunized against typhoid.

Mr. CANNON. Are you not going to immunize them at once?

Dr. BLUE. Yes, sir; in the camps.

Mr. CANNON. And even before they get to the camps?

Dr. BLUE. I presume that will be the very first thing Gen. Gorgas's assistants will do to the men who have been selected by the draft, immunize them against smallpox, typhoid, and paratyphoid fever.

The CHAIRMAN. The first thing they do when they take a man into the service is to vaccinate him and immunize him against typhoid

fever.

Dr. BLUE. There are probably carriers among these men although they have no symptoms themselves and they are capable of conveying it to other people.

The CHAIRMAN. Even after they have had the treatment?

Dr. BLUE. Yes.

Dr. RUCKER. Vaccination against typhoid fever does not in any way cure a man of being a chronic typhoid carrier. When you go to work and collect a large number of men from all parts of the country in that way you are bound to collect a large number of typhoid carriers among them. Now, a man who is a typhoid carrier does not constantly excrete typhoid bacilli. There may be lapses in between, and he may pass them to-day and may not pass them again for 20 days or perhaps 15 days, so that an examination of this man's fecal contents to-day may not show typhoid bacilli, but in a week or 10 days they might be there. They are intermittent in their discharge of these bacteria, and vaccination does not affect a chronic typhoid carrier at all. It does not cure him and that is where the danger comes in, in spite of the vaccination.

Mr. CANNON. If that is so a man who has not typhoid and is practically immune may through his discharge, spread the disease, is that it?

Dr. RUCKER. Yes. There are people who are chronic typhoid carriers who perhaps have never knowingly had an attack of the disease, and these people spread the disease wherever they go, just like Typhoid Mary did in New York. The best medical talent in this country tried to cure Typhoid Mary and they were unable to do so, and she will probably continue to be a typhoid carrier as long as she lives. There are many, many such people, and these are the people who create the danger. Now, if sanitary conditions are good and immunization against typhoid is widely practiced-and that is one of the things that is being done at the present time-then we can reasonably hope for control of the disease.

Mr. CANNON. Now, Gen. Gorgas seems to have made the statement that all these places where there has been malaria trouble will be drained and fixed up so as to be comparatively healthy places. Dr. BLUE. That is true.

Mr. CANNON. Now, if the Army and the Navy, especially the Army, does that work, would you supplement their work?

Dr. BLUE. We would; yes, sir. We propose to work in the areas outside of the camps in cooperation with State and local boards. The Army medical men will look out for the sanitation of the camp itself. Mr. CANNON. Now, let us take one place as an illustration. It has been alleged-of course I do not know anything about it—that the Little Rock cantonment is in a mosquito center and swampy, I do not know whether that is true, but that is alleged. Now, how far are you going to make it sanitary. If the medical officers of

the Army go down there and drain that site and put up cantonments, you do not propose to do any work there; or do

you? Dr. BLUE. We propose to do work on the outside of the camp itself. Mr. CANNON. How far outside. Have you got to go to work all over that swamp?

Dr. BLUE. The operations in draining that area are going on now. They are ditching and draining that camp site there at the present time, but we are only looking out for the protection of the civil population and guarding against the spread of disease on the outside by the incoming recruits; not in the camp; and there will be a malarial problem on the outside as well as on the inside of the camp.

Mr. CANNON. But if you are down in that southern section in the summer season the mosquitoes are bound to cover several counties. Dr. BLUE. We propose to organize what we call a sanitary unit there consisting of a Federal health officer and State and local authorities for the purpose of controlling malaria by up-to-date antimosquito measures such as oiling, draining, filling, and screening.

Mr. CANNON. Will you provide screening on the outside for the civil population?

Dr. BLUE. We can only recommend it, and it is then up to the State and local authorities to enforce it.

Mr. CANNON. I am not at all antagonistic, but I just want to see what the extent of the work is to be. Now, there is an aviation cantonment in the county of Champaign in Illinois which is extensive and will soon be occupied. There are mosquitoes there now, but of course not like it used to be before it was drained out. Now, would you go to all these cantonments?

Dr. BLUE. We propose to work in cooperation with State and local authorities at 32 camps, 16 Federal and 16 State. We have been requested by the State and local authorities and also by the military authorities to cooperate with them in excluding communicable disease from these camps.

Mr. CANNON. That is an official request, is it?

Dr. BLUE. Yes, sir.

Mr. CANNON. I have very great confidence in your service and you have done a great work. This request comes from the military authorities?

Dr. BLUE. Yes, sir.

Mr. CANNON. And the naval authorities?

Dr. BLUE. And the naval and the State and local authorities.
The CHAIRMAN. How is this money to be expended?

Dr. RUCKER. The Federal appropriation will be expended for travel expenses and for salaries.

The CHAIRMAN. Salaries of whom?

Dr. RUCKER. Salaries of sanitary engineers, sanitary bacteriologists, inspectors, and public-health nurses for inspection work. The States will take care of the matter of supplies and things of that sort, and it will be a cooperative plan, and in the great bulk of these places the expenditures made by the States will be greater than those made by the Federal Government.

The CHAIRMAN. What are sanitary engineers paid?

Dr. RUCKER. Sanitary engineers are paid from $1,600 to $2,500. The CHAIRMAN. And bacteriologists?

Dr. RUCKER. Bacteriologists are paid from $1,800 to $2,400 a year.
The CHAIRMAN. And the nurses?

Dr. RUCKER. The nurses are paid from $900 to $1,200 a year.
Mr. GILLETT. Are they male or female nurses?

Dr. RUCKER. These public-health nurses are female nurses, used in the follow-up work.

Mr. SHERLEY. As I understand it your work is on a cooperative basis similar to what has been done heretofore in connection with rural sanitation?

Dr. RUCKER. In a measure. You see the rural sanitation work can only be done in the rural districts according to the law, and this must include urban districts as well.

Mr. SHERLEY. I did not mean that. I meant there is the same sort of cooperation and the same direction of activity between State and local agents under the United States authorities?

Dr. RUCKER. Yes; that is the idea.

Mr. SHERLEY. If I understand you, the idea contemplates, in connection with all the cantonments, the careful survey and sanitation of an area of 10 or 15 miles contiguous to that cantonment? Dr. RUCKER. Yes; contiguous, in a sanitary sense.

INCREASED MARITIME QUARANTINE FACILITIES UPON ATLANTIC SEABOARD.

The CHAIRMAN. For increased maritime quarantine facilities upon the Atlantic seaboard, to continue available until expended, $559,270. Dr. BLUE. Mr. Chairman, we desire to place several of our quarantine stations in a condition to meet any situation that may arise as a result of the war. The facilities at Boston, Reedy Island, which is on the Delaware River, Norfolk, and Savannah are very much in need of improvement and additions.

Mr. GILLETT. Was not this submitted to us before?

Dr. BLUE. Part of it, but not this entire estimate.

The CHAIRMAN. We would like to have the details of this.

Dr. BLUE. For the details I would like to refer you to Dr. Creel, of the bureau.

The CHAIRMAN. Have you a statement showing the details?

Dr. CREEL. I have a detailed statement here: yes, sir. I may say, in the first place, Mr. Chairman, it is apprehended that during the course of the war that inevitably, from time to time, transports, troop ships, and supply ships will be coming back to this country with a certain amount of infection of a quarantinable nature on board, and it is desirable, in so far as practicable, to avoid the experiences in the Spanish-American War when from first to last a large number of transports and troop ships were held up in quarantine and detained a number of days, simply because we had not adequate detention facilities at the stations. The quarantine law contemplates that when infections appear on board a vessel that the vessel with its personnel shall not enter the port until after detention of a certain number of days; for smallpox 14 days from time of last exposure, typhus fever 12 days, cholera 5 days, plague 7 days.

Now, if we have ample capacity at the quarantine stations we can take off the troops, or the crews, or the personnel, disinfect the ship and release it, whereas otherwise we would have to hold that vessel to accommodate the troops or the crew that are on board. We have