CHOLERA, YELLOW FEVER, PLAGUE AND SMALLPOX-Continued.

Reports Received from Dec. 27, 1912, to Jan. 3, 1913-Continued.

PUBLIC HEALTH REPORTS

VOL. XXVIII.

JANUARY 17, 1913.

No. 3.

CEREBROSPINAL MENINGITIS EPIDEMIC.

Cerebrospinal meningitis has become epidemic in certain localities in Arkansas, Tennessee, and the southern part of Illinois.

In Arkansas 25 cases, with 17 deaths, were reported at Lepanto, Poinsett County, during December and the first 6 days of January, and a few sporadic cases have been notified in other parts of the State. In Tennessee there were 108 cases, with 47 deaths, reported in Dyer County to January 13. In Lake County there were 13 cases, with 9 deaths, to January 13. In Carroll County there were 4 cases during the 2 weeks ended January 11, with sporadic cases elsewhere in the State. There were 13 counties in the State in which 1 or more cases were reported during the month ended January 14.

In southern Illinois there were 11 cases, with 7 deaths, reported at Dale, in Alexander County, to January 10. Cases have also been reported at Cairo. Considerable agitation has arisen in connection with the appearance of the disease, and certain communities have established quarantine against other communities.

FEDERAL PUBLIC HEALTH ADMINISTRATION.

ITS DEVELOPMENT AND PRESENT STATUS IN THE UNITED STATES.

By J. W. KERR, Assistant Surgeon General, United States Public Health Service.

The jurisdiction of the Federal Government in public health matters extends over foreign intercourse, interstate intercourse, Federal territory, and Federal administrative affairs, including protection of the Indian tribes.

FEDERAL HEALTH ADMINISTRATION IN RELATION TO FOREIGN INTER

COURSE.

Federal health administration had for its fundamental object the prevention of the introduction of pestilential diseases. As long ago as May 27, 1796, a national law authorized the President to direct the

revenue officers and revenue cutters to aid in the execution of quarantine, and also in the execution of the health laws of the States. As a further means of aiding foreign commerce, provisions were made in successive navigation laws to promote the health and comfort of passengers at sea, and in 1798 provision was also made for the care and treatment of persons employed in the merchant marine.

Foreign and insular quarantine. The necessity for more and more extensive Federal supervision over international traffic was made apparent by repeated epidemics. The first permanent quarantine law, passed April 29, 1878, was a result of the widespread and severe epidemic of yellow fever during the previous year. The passage of the law of February 15, 1893, was intimately associated with the outbreak of cholera in Europe in 1892, and the quarantine act of June 19, 1906, followed the epidemic of yellow fever in the Southern States in 1905. Under the above-mentioned laws and a few minor ones, there was finally developed the national system of quarantine as it exists to-day-a system the development of which occupied approximately 100 years.

All quarantine operations are conducted under the supervision of the Federal Government, and, with two or three exceptions, all stations are conducted by Federal officers. Under the above-mentioned laws, regulations have been issued which automatically become operative on the occurrence of outbreaks of infectious diseases. The necessity for the promulgation of quarantine against a particular foreign port is thus obviated.

Quarantine regulations prescribe the measures that shall be observed at foreign ports, at sea, and at domestic ports to prevent the introduction of infectious diseases. In foreign ports these regulations are required by law to be enforced by American consular officers, and at certain ports medical officers of the United States Public Health Service are detailed by the President for duty in American. consulates to issue bills of health to steamships and to make reports on sanitary conditions and the prevalence of diseases. Among the ports where such medical officers are stationed may be mentioned Santiago, Chile; Callao, Peru; Guayaquil, Ecuador; Rio de Janeiro, Brazil; La Guaira, Venezuela; Habana, Cuba; Libau, Russia; Naples, Italy; Calcutta, India; Hongkong and Shanghai, China; and Yokohama, Japan. In order to facilitate the shipments of fruit, these officers are also on duty during certain seasons of the year in the ports. of Central America and the West Indies.

Officers of vessels en route to the United States are required to observe specific regulations to preserve health, and, in the event of outbreaks of disease aboard, to take precautions to prevent its spread.

On arrival at domestic ports from abroad vessels are subject to quarantine inspection. The detailed requirements specified in quar

antine regulations are not here described. Suffice it to say they include the hygienic measures to be taken with vessel, cargo, crew, and passengers to prevent infection from being carried ashore. The provisions of law relating to quarantine apply not only to the continental United States but to its island territory, and possessions.

International sanitation.-With the view to aiding commerce by the prevention of the spread of disease, the Federal Government participates in the benefit derived from international sanitary agreements. It contributes annually to the support of this work, the Public Health Service conforms to the agreements entered into, and through official channels strives to perfect them. As a means to this end, representatives of the Public Health Service are assigned as delegates of the United States to international sanitary conferences.

Sanitary supervision of immigration.-A long series of immigration laws have been enacted between the periods March 20, 1819, and February 20, 1907, their general objects from a hygienic standpoint being the improvement of the health and comfort of arriving aliens, and the development of a stronger race in the United States.

The medical inspection of immigrants is a Federal function performed by Federal officers. Some of these inspections are made. abroad. In addition, the ship's manifests are required to contain certain data respecting the physical and mental condition of each alien, and reports must be made by the ship's officers of all diseases, injuries, births, or deaths occurring during the voyage.

On arrival at domestic ports, all aliens are required to undergo medical inspection, and for those suffering with disease, hospitals are maintained. The object of the medical supervision of immigration is to exclude the physically and mentally unfit, and especially the latter, who will endow their offspring with an unstable mentality, thereby bringing about the futher increase of insanity in the United States.

FEDERAL HEALTH ADMINISTRATION IN RELATION TO INTERSTATE

INTERCOURSE.

The administrative procedures in international sanitation having been established, and their further improvement assured, the great public health problems of the Nation are now of an interstate and intrastate character.

The Federal public health statutes are based upon, or are carefully in accord with that clause of the Constitution which gives the right to Congress to regulate commerce between the States. On account of the far-reaching effect of interstate intercourse on our national life, the field for public health activities on the part of the Federal Government is wide. But it must not be occupied in such manner as to usurp the power of the States or impair the efficiency of State and local public health authorities.