expenses are borne by those bureaus. Under this provision, for instance, steps are being taken for the sanitary betterment of the Indians in Alaska, and inspections have been made of mines and the mining industry with particular reference to lung diseases among miners and the measures necessary for their control.

ORGANIZATION OF THE FEDERAL PUBLIC HEALTH SERVICE.

The Federal Public Health Service is a bureau of the Treasury Department. Through successive acts of Congress it has undergone a process of evolution so that all of its duties are essentially of a public health character, and it is organized with a view to their performance. The central bureau at Washington, which is presided over by the Surgeon General, has seven divisions, as follows:

1. Personnel and Accounts.

2. Foreign and Insular Quarantine and Immigration. 3. Domestic (Interstate) Quarantine and Sanitation.

4. Sanitary Reports and Statistics.

5. Scientific Research.

6. Marine Hospitals and Relief.

7. Miscellaneous.

Each of the six divisions first mentioned is in charge of an assistant surgeon general, who is directly responsible for administrative matters in connection with his division. In the absence of the Surgeon General the officer next in rank acts in his stead. This is the officer who has charge of the Division of Personnel and Accounts, and who has immediate supervision of the entire personnel and appropriations, and the preparation of the annual estimates therefor.

Through the Division of Foreign and Insular Quarantine and Immigration are administered all matters relating to maritime quarantine and medical inspections of aliens. In the field this division is represented by 44 quarantine and inspection stations scattered along the several coasts in the continental United States, 25 insular stations, and 37 stations located at foreign ports, and 83 immigration stations. Through the Division of Interstate Quarantine are administered all matters relating to the control of contagious and infectious diseases in interstate traffic. In the field this division is represented by officers engaged in the inspection of Government buildings, suppression of plague outbreaks, and control of epidemics of typhoid fever and other diseases in cooperation with State and local authorities. The Division of Sanitary Reports and Statistics handles all matters relating to the collection of morbidity reports, reports of epidemics, and of information pertaining to the geographic distribution of disease, and to climate in relation to health and disease. It prepares and publishes the weekly Public Health Reports and reprints therefrom.

In the field it is represented by officers of the service wherever stationed, and through the Department of State by American consuls at foreign ports. In the United States it depends largely on the voluntary cooperation of State and municipal authorities to furnish information and forward reports of sanitary conditions within their respective jurisdictions.

The Division of Scientific Research administers all matters relating to investigations of contagious and infectious diseases and matters pertaining to the public health wherever made. In the field it is represented by the Hygienic Laboratory with its four divisions, the plague laboratory in San Francisco, the leprosy investigation station in Hawaii, the pellagra investigation station at Savannah, Ga., the station at Wilmington, N. C., for the investigation of the parasites of man, and by officers engaged in investigations of typhoid fever, Rocky Mountain spotted fever, poliomyelitis, etc., in different parts of the country, and sanitary surveys of navigable waters wherever conducted.

In the Division of Marine Hospitals and Relief are administered all matters connected with the care and treatment of seamen and recruiting for the several bureaus of the department. In the field it is represented by 22 marine hospitals and 121 relief stations.

In the Miscellaneous Division are handled all matters in relation to the care and distribution of publications, and to the examinations of surfmen of the Life-Saving Service, and to claims for disability in that service.

To-day the Public Health Service has a corps of approximately 450 medical officers, 50 pharmacists, and a total personnel of about 2,000.

Advisory conferences on administrative matters.-Under the Constitution and existing statutes, the Federal Public Health Service is restrained from assuming duties that properly devolve upon State and municipal authorities. But their relations are so intimate that Congress has made provision not only for cooperation, but for conferences on public health matters. In the public health law of July 1, 1902, provision is made for annual conferences between the Public Health Service and State boards and departments of health. Provision is also made for special conferences with all or a part of the State health organizations, and upon the application of not less than five State health authorities, a special conference must be called. The deliberations pertain particularly to administrative measures. In effect, there is thus provided an advisory council on administrative matters, which in its development will insure cooperation and be an arbiter on vexed sanitary questions, and in which each State is entitled to representation.

Advisory conferences on scientific matters. In the previously mentioned law Congress also provided for an advisory board for consulta

tion relative to investigations to be inaugurated and the methods of making them in the Hygienic Laboratory. This board consists of 9 members, 4 of whom are officers of the Government, the remaining 5 being scientists eminent in laboratory work and connected with the leading endowed institutions of the country. By this means the service is brought in touch with the great scientific laboratories, and may avail itself of advice from the highest sources.

Congress has thus made provision for councils in respect to both administrative and scientific matters. Their utilization in the highest degree is one of the most important means of development of public-health organization and public-health work.

The foundations have been laid for further development and for the performance of a greater amount of efficient sanitary work. In order that health administration shall be effective, however, it must be adequately supported by appropriations, and it is the securing of these and their wise expenditure that constitute efficient administration.

HOOKWORM DISEASE.

NUMBER OF TREATMENTS AND NUMBER OF FULL DOSES OF THYMOL ADMINISTERED IN 61 HOSPITAL AND 22 HOME-CURED CASES OF HOOKWORM INFECTION.1

By Ch WARDELL STILES, Professor of Zoology, and GEO. F. LEONARD, Assistant, Hygienic Laboratory, United States Public Health Service.

In this paper the term "cured" means that a week or more after treatment a microscopic reexamination of the patient gave negative results.

In practical hookworm-eradication work the question is frequently asked, "How long does it take to cure a case?" This question has a practical basis from the standpoint of the patients, for many of them refuse to take a second course of medication. From the standpoint of the person giving the treatment the question has a double significance: (1) The greater the number of patients who can be cured in a single treatment the more rapidly will a certain-and a very important part of the work be finished. (2) Many patients are, however, very ignorant and can not be relied upon--as experience shows-to carry out directions; accordingly, the clinician has his choice between (a) assuming a certain amount of risk by giving a larger dose, and (b) giving repeated treatments with smaller doses, thus giving to himself and to the patient a greater amount of trouble but at the same time increasing the factor of safety for his patient; running the risk, however, that his patient will not return for more than one treatment, and therefore possibly leaving one more uncured case at large to infect other people.

1

Read at the XVth International Congress on Hygiene and Demography, Washington, September, 1912. - North Carolina State Board of Health since June 1, 1912.

There are known to us not less than 11 deaths in this country, due, so far as it has been possible to determine, either to following thymol with castor oil instead of with salts, or to carelessness in respect to following out the usually adopted procedure. But whatever the explanation of these deaths may be, the fact remains that many patients whom we treat are exceedingly ignorant and illiterate and are unreliable when it comes to following out instructions.

It is therefore more than an academic matter to determine how small a dose can cure or does cure a case of hookworm infection, and the extent of the infection in question.

The present paper contains two series of cases--one series treated in the hospital, the other at home.

In a certain cotton-mill village in eastern North Carolina, 267 inhabitants (140 males, 127 females) out of a population of 700 volunteered for microscopic examination. Thus 38.1 per cent of the population volunteered.

Of these 267 (white) inhabitants, 140 persons (or 52.4 per cent) were found infected with hookworms.

Of 140 males, 79 persons (or 56.4 per cent) and of 127 females, 61 persons (or 48 per cent) showed hookworm infection.

Most of the patients mentioned in this paper came from the cotton mill in question

Number of treatments of females.-A number of the females were treated at their homes, with a mill nurse to visit them during the day of medication. In some instances it was impossible to obtain specimens to determine whether or not the treatment was complete in results, but the following data may be reported:

Total number of females examined, 127; found infected, 61 persons, or 48 per cent; treated, 52; cured, 19; data incomplete in 33; not treated, 9.

Treated 1 or more times, 52; cured in 1 treatment, 12; not cured in 1 treatment, 21; data incomplete in 19.

Treated 2 or more times, 21; cured in 2 treatments, 7; not cured in 2 treatments, 5; data incomplete in 9.

Treated 3 or more times, 5; cured in 3 treatments, ?; not cured in 3 treatments, 1; data incomplete in 4.

Treated 4 times, 1; data incomplete.

Number of treatments of males.-The following tabulation gives the male cases treated at the hospital and also [in brackets] male cases treated at home.

Treated 1 or more times, 94 [+9]; cured in 1 treatment, 45 [+3]; not cured in 1 treatment, 15 [+1]; data incomplete in 34 [+5]. Treated 2 or more times, 29 [+1]; cured in 2 treatments, 6; not cured in 2 treatments, 14 [+1]; data incomplete in 9.

Treated 3 or more times, 14 [+1]; cured in 3 treatments, 6; not cured in 3 treatments, 6 [+1]; data incomplete in 2.

Treated 4 or more times, 6 [+1]; cured in 4 treatments, 1; not cured in 4 treatments, 5 [1].

Treated 5 or more times, 5 [+1]; cured in 5 treatments, 1; not cured in 5 treatments, 3 [+1]; data incomplete in 1.

Treated 6 or more times, 3 [+1]; cured in 6 treatments, 0; not cured in 6 treatments, 2 [+1]; data incomplete in 1.

Treated 7 or more times, 2 [+1]; cured in 7 treatments, 2; not cured in 7 treatments, [1].

Comparing the male hospital cases with the male home cases and the female (home) cases, it is clear that a greater proportion (45 in 94 equal 47.8 per cent) of cures on 1 treatment are known for the hospital than for the home cases (15 in 61 equal 24.5 per cent). That this result is not due entirely to incomplete data is rendered probable by two facts: (1) That there is a smaller number of known incomplete cures in 1 treatment (15 in 94 equal 15.9 per cent) for the hospital than for the home cases (22 in 61 equal 36 per cent), and (2) in leaving thymol at the home the tendency in all cases is to leave smaller doses so as to increase the factor of safety to the patient, in view of the risks necessarily connected with leaving the drug among people who can not be relied upon to carry out directions, even when printed directions are given. In other words, a larger dose of thymol. given under hospital conditions involves less of a risk to a patient in a given physical condition than it does to the same patient at home, and we are fully justified in giving larger doses in hospital practice.

Total size of dose used.-Tabulation of the cured cases in question, according to the total amount of thymol used per age of patient gives the following results:

Tabulation of 19 cured female cases, treated at home.