sular bill of health. The consul can legally refuse a bill of health if the regulations are not complied with.

In this connection it may be said that officers of the Public Health Service are stationed constantly at such ports as Hongkong, Shanghai and Amboy, in China; Yokohama and Kobe in Japan; Salina Cruz, Manzanillo and Puerto Mexico in Mexico; Guayaquil, Ecuador; La Guaira, Venezuela, and Havana, Cuba. During the summer of 1911, on account of cholera conditions prevailing in Italy, Russia and France, there were officers of this service detailed in the offices of the American consul at Naples, Genoa, Palermo, Messina and Catania, in Italy, at Libau in Russia, and at Marseilles, France. In addition to this, officers were ordered to several other foreign ports of departure, there to confer with the American consular officers as to the enforcement of the regulations for foreign ports, and for the purpose of insuring uniformity of procedure.

The State Department has done much to assist in the quarantine and sanitary work in foreign ports, through the interest it has aroused in the said work on the part of its consular corps.

THE OBSERVANCE OF INTERNATIONAL SANITARY TREATIES.

These treaties or conventions establishing them have been ratified by the Senate of the United States, as well as by the other governments.

The International Sanitary Bureau of American Republics at Washington was founded by the International Conference of American States held in the City of Mexico in 1901. That conference also called for international sanitary conventions, which are now held every two years. Two have been held in Washington. The object of the conventions is to freely discuss all matters relating to the public health and particularly those which affect the American Republics, and the purpose of the International Sanitary Bureau is to encourage the execution of the resolutions or agreements decided upon by the conventions. The convention. held in Washington in 1905 drew up a treaty with regard to the quarantine treatment of cholera, plague and yellow fever, which was signed ad referendum by the official delegates, and has been confirmed by practically all of the American Republics. At the meeting in Mexico in December, 1907, action was taken which has brought the International Sanitary Bureau at Washington into relations with the International Office of Public Hygiene at Paris.

The International Office of Public Hygiene at Paris was formally inaugurated December 9, 1907. It is the outgrowth of international sanitary conferences at Rome, Venice and Paris, with regard to the bubonic plague. The following governments are represented: Algeria, Argentina, Australia, Belgium, Bolivia, Brazil, British India, Bulgaria, Egypt, Canada, France, Great Britain, Holland, Italy, Mexico, Peru,

Persia, Portugal, Roumania, Russia, Servia, Sweden, Spain, Switzerland, Tunis, Turkey and the United States.

Each of these governments has agreed to pay its pro rata of the expenses necessary to maintain the international office. The principal object of the office is to collect and bring to the knowledge of the participating States facts and documents of a general character relating to public health, especially as concerns infectious diseases-notably cholera, plague and yellow fever-as well as the measures taken to combat these diseases.

PREVENTION OF THE SPREAD OF INFECTIOUS AND CONTAGIOUS DISEASES.

These operations are conducted under two laws. One is the national quarantine act of 1893, already referred to, which contains practically the same provisions for interstate as for maritime quarantine. The other is the annual law passed by Congress appropriating an "epidemic fund" which contains a provision that it may be used in aid of State and local boards of health in the enforcement of their quarantine regulations, as well as those of the national service to be used, however, only against certain specified epidemic diseases, viz., cholera, yellow fever, smallpox, typhus fever and bubonic plague.

Now, with these two laws in hand, and when the appearance of any of the above-named diseases in any State so require, the officers of the Public Health Service are at once upon the scene with the double object of seeing that the Treasury Interstate Quarantine Regulations are enforced by the State or local authorities and to offer aid, as authorized by law.

When aid is extended, the Government's funds must be expended by its own officers, and the latter are therefore placed in charge and have the coöperation and assistance of the State or local authorities. They have, therefore, the support of the State and local laws and regulations. as well as those of the Federal Government. This is fortunate, since experience has shown the importance, in a Republic like ours, of local sympathy and support.

THE COLLECTION AND DISSEMINATION OF SANITARY INFORMATION.

The Public Health Bureau, through its Division of Sanitary Reports and Statistics, compiles and publishes each week a pamphlet called the Public Health Reports. It contains a statistical report from all cities in the United States of more than 10,000 inhabitants, and some others, giving the morbidity and mortality in each city with regard to twelve diseases and the total mortality from all diseases. It contains also a statement of the weekly mortality in some 120 foreign cities from thirteen communicable diseases. It gives special information concerning quarantinable diseases and sanitary measures in the United States and

foreign countries. The foreign information is received through the United States consuls and service officers abroad.

Collective investigations are being made of the prevalence of pellagra, infantile paralysis and leprosy.

A compilation has been prepared of state laws bearing upon reporting diseases, with a view to increasing the collection of morbidity statistics and bringing about improved methods and greater uniformity in their collection.

CONDUCT OF SCIENTIFIC RESEARCH.

In the District of Columbia, in a commodious building, the Public Health Service has its hygienic laboratory, a research laboratory exclusively for public health investigations. It is conducted in four divisions, viz., bacteriology and pathology, chemistry, zoology and pharmacology. This organization brings under the same roof, and in intimate association, scientific workers in each of these several branches, interesting facts developed in one line of investigation being made freely known. to the investigators in other lines of research.

Officers are detailed to receive instruction in this laboratory, thus enhancing the scientific attainments of the corps and giving opportunity for selection of those best qualified for permanent detail in research work. In this manner specialists have been and are being developed on various subjects, such as typhoid fever, pellagra, hookworm disease, infantile paralysis, scientific disinfection, etc.

Public Health Service officers may be found in the States investigating other diseases than those named in the epidemic law, viz., typhoid fever, infantile paralysis, cerebro-spinal meningitis, hookworm disease, malaria, pellagra, dengue fever, milk sickness, etc. These investigations are usually made at the request of State health authorities. The bureau at Washington, on receiving a request from a city or locality for expert aid, invariably refers the request to the State Board of Health before compliance.

The laws permitting these investigations are, first, the interstate section of the quarantine law of 1893; and second, the act of Congress approved March 3, 1901, providing a building for the hygienic laboratory for investigations of contagious and infectious diseases and matters relating to the public health. As the investigations require laboratory examinations, they come within this last-named law and the appropriation which supports it.

In various States of the Union, there are thirteen establishments engaged in the production of vaccines, antitoxins and serums, which play so important a part in modern therapy. The variation in the potency and the occasional impurity of these products caused Congress

to pass an act July 1, 1902, requiring a license for their manufacture for sale in interstate traffic.

ENFORCEMENT OF SANITATION IN FEDERAL TERRITORY.

In the Philippine Islands, where the government is by commission. and a legislature, much work of value to the public health is performed in the bureau of science under the insular government. There are, however, in the several ports of the Philippines medical officers of the Public Health Service under appointment from the Treasury Department in Washington, engaged in the transactions of both incoming and outgoing quarantine. Two of these officers, in addition to their supervision of the national quarantine, are also director and assistant director, respectively, of the public health of all the Philippines.

In Hawaii you will also find medical officers conducting the national quarantine. They are also assisting the territorial health board in preventing the recurrence of plague by the extermination of rats and continuous bacteriological examination of those captured. One of these officers is the official sanitary adviser of the Governor of Hawaii, and is carrying on a campaign for the eradication of disease-bearing mosquitoes.

Here also may be observed the leprosy investigation station, also controlled by our officers, both on the island of Molokai, where hospital and other accommodations have been erected under the law of March 3, 1905, appropriating $100,000 for this purpose, and at the receiving station at Honolulu, where cases are seen in the earlier stages.

In Porto Rico public health officers are enforcing the United States quarantine regulations under the acts of Congress relating to Porto Rico and national quarantine. The campaign which has practically eradicated plague from San Juan is being conducted by the Federal Public Health Bureau.

In the Canal Zone you will find two commissioned officers enforcing quarantine regulations at Ancon on the Pacific and Colon on the Atlantic. These officers are loaned to the Isthmian Canal Commission. This is an important adjunct to the work of the canal, because it would be useless to clean the zone if fresh importations of disease were permitted.

I will now devote a few words to the Health Bureau organization in Washington by means of which all the functions or activities above. described are administered under one head.

THE ORGANIZATION OF THE BUREAU OF PUBLIC HEALTII SERVICE.

The law which changed the name of the Marine Hospital Service and made it a Public Health Service was approved July 1, 1902. This law

fixed the status of the officers, enlarged the hygienic laboratory and gave it an advisory board, provided for the conferences with the State and Territorial Boards of Health, provided for compilation and publication of statistics, and directed that the President should prescribe rules for the conduct of the service and the uniforms of its officers and employes. It also provided for a Public Health and Marine Hospital Bureau at Washington.

By an act of the Congress approved August 14, 1912, the name of the Public Health and Marine Hospital Service was changed to Public Health Service. The public health functions and duties of the service were extended and certain changes were made in the salaries of the officers.

The Public Health Service is under the supervision of the Secretary of the Treasury, and is in charge of the Surgeon-General, who has six Assistant Surgeons-General in charge of the Bureau Divisions. These divisions are as follows:

1. Foreign and Insular Quarantine and Immigration.

2. Domestic (Interstate) Quarantine.

The above lengthy description of our present public health activities has been necessary not only in order to demonstrate their character and scope, but also as an illustration of the variety of legal authority existing for the enactment on the part of the general Government of public health work.

This paper will not admit of the incorporation into it of the national laws relating to public health which are now operative, but a careful inspection of these laws will demonstrate that they will admit of such interpretation as would make possible an almost unlimited amplification of our present public health activities, the limit being only one of appropriations and officers.

Careful analysis of the present health laws and activities will also show that the Government is seeking to control nothing which any other public health organization would wish to control. The foundation of the national public health service is in the quarantine law of February 15, 1893, referred to above. The quarantine service is today almost entirely national, notwithstanding a local sentiment for State or municipal control, which exists in two or three cities only, and which it is believed is destined to a short tenure for the following reasons:

It must be admitted that maritime quarantine should be a national affair. It is a concomitant to commerce, over which under the Constitu