some diseases the tables also show averages based on data of previous years. In the tables relating to States, the number of cases reported and the number of deaths registered are presented by months.

REPORTS FROM VENEREAL DISEASE CLINICS.

The Chamberlain-Kahn Act approved July 9, 1918, appropriated the sum of $1,400,000 annually for two fiscal years, beginning with the fiscal year commencing July 1, 1918, to be apportioned to States on the basis of population, for the use of their respective boards of health in the prevention, control, and treatment of venereal diseases. To secure its quota for the fiscal year ending June 30, 1920, it was necessary for each State to raise an equal amount and to conform to certain other requirements. During the previous fiscal year the State quota was not dependent upon the State setting aside an equal amount of funds. Part of the money thus appropriated was used for establishing venereal disease clinics which are being operated under the joint control of the United States Public Health Service and the State boards of health. These clinics make monthly reports, showing the number of cases admitted and readmitted, the disposition of the cases-discharged, discontinued treatment at clinic, hospitalized, etc.--and other data relating to the business of the clinics. Cases are classified by sex and by cause of admittance— syphilis, gonorrhea, or chancroid. The reports are tabulated and published quarterly in the Public Health Reports in summarized form. The summary for the year is published in the Annual Report of the Surgeon General.

REPORTS FROM SICK-BENEFIT ASSOCIATIONS OF INDUSTRIAL ESTABLISHMENTS.

In accordance with a resolution adopted at the meeting of the American Public Health Association, section of Vital Statistics, held on October 18, 1917, a committee of the association was appointed to cooperate with the Public Health Service in developing plans for the collection, tabulation, and publication of information concerning the prevalence of disease among the wage-earning population. As an outgrowth of this cooperation considerable progress has already been made in the subject by the Public Health Service; and the interest manifested, and the enlarged program now being developed insure the permanence of the inquiry as a regular undertaking.1

1 The section of the Public Health Service chiefly responsible for the statistics of disease among industrial employees is the Statistics Office of the Scientific Research Division. The compilation of State and city morbidity and mortality reports, discussed above, as well as of foreign reports, discussed later, is carried on by the Division of Sanitary Reports and Statistics.

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For the purpose of this inquiry, illness is defined to include cases of disability due to sickness or nonindustrial injuries causing absence from work for a period of not less than one day. Nonindustrial injuries are interpreted to include only those occurring outside the establishment and when the employee is not at work. It is believed that records of such illnesses furnish a far better basis for statistics of morbidity than is afforded by notifications from physicians regarding disease prevalence among the general population. This is not only for the reason that the cases of illness are reported more fully, but also because it is possible to ascertain the age, sex, nationality, and occupation of the sick population.

Since January, 1920, the Public Health Service has secured reports on schedule forms from sick-benefit associations of industrial establishments. The schedule forms vary in accordance with the records available in the different associations and with the extent to which each association is willing to cooperate. Some associations report the number of male and female members employed within the industrial plant and a record of each case of disability for which sick benefits are paid. Such records show the date on which the disability began, the date on which it ended, and the diagnosis. Other associations report in addition the number of members employed (exposed) in each occupation (or department within the plant) and, in the record of each disability, give the occupation (or department in which employed) of the individual disabled. Still other associations—as yet few in number-give on individual cards all this information and, in addition furnish detailed data concerning the age, race, marital status, nationality, length of time in occupation, etc., for all individuals reported upon as well as for the cases of illness among them.

Altogether, in one or another of the above forms, information now reaches the Public Health Service regarding illness among approximately 214,000 employees in about 70 industrial establishments in the United States. Prominent among the establishments covered are those engaged in the manufacture of steel and steel products, and those engaged in the manufacture of rubber.

As the inquiry is still in the development stage, no publication at regular intervals is made of the data collected and tabulated. Tables, with accompanying text and graphic charts, presenting part of the information for the first half of the year 1920 are found in the issue of the Public Health Reports for December 3, 1920.

CURRENT REPORTS FROM FOREIGN COUNTRIES AND INSULAR POSSESSIONS.

The Public Health Service currently receives information regarding the prevalence of cholera, plague, smallpox, typhus fever, and

yellow fever, outside the continental United States, from three sources: American consuls, Public Health Service officers stationed abroad, and foreign governments.

1

The consuls, stationed throughout the world, report by telegraph the outbreak of any of the above diseases occurring in their respective localities. Also, from each consular station, a weekly report is forwarded by mail to the Public Health Service 1 on a schedule form furnished by the latter. The schedule elicits information as to the number of new cases of and number of deaths from each of 14 communicable diseases 2 reported during the week at the place where the station is located; also the number of deaths from all causes, and the officially estimated population. The schedule provides also for a general statement of the prevailing diseases and general health conditions in that place and in surrounding territory.

Officers of the Public Health Service stationed outside the continental United States inform the Washington Office by telegraph whenever they learn of the occurrence of any cases of cholera, plague, smallpox, typhus fever, or yellow fever, or of an unusual prevalence of any communicable disease at or in the general vicinity of the places at which they are severally stationed. In ordinary times, about 20 service officers are stationed at foreign and insular posts, but at present, due to unusual conditions abroad, the force has been augmented to about 40.

Information is received from foreign governments through the interchange of official publications. Also, under sanitary treaties, the Public Health Service receives, through diplomatic or consular channels, from governments signatory to the treaties, prompt notices of occurrences of cholera, plague, or yellow fever.

The data received from these three sources are brought together for publication in the last 10 or 15 pages of each issue of the Public Health Reports. Most of the data are summarized in tabular formgiving under cholera, plague, smallpox, typhus fever, and yellow fever, respectively, the country and locality for which reported, the date of the report, and the numbers of cases and deaths. Two series of tables are given, one made up from the reports received during the week ending on the day of issue of the Public Health Reports, and the other giving cumulative figures for preceding weeks.

In addition to furnishing its officers stationed in different ports of the United States with copies of the Public Health Reports containing the data outlined above, the Public Health Service frequently

1 Addressed to the Secretary of the Treasury.

* Cerebrospinal meningitis (epidemic); cholera, Asiatic; cholera nostras, cholerine, or gastro enteritis; diphtheria; measles; plague, human; plague, rodent; poliomyelitis (acute anterior poliomyelitis, or infantile paralysis); scarlet fever; smallpox; tuberculosis; typhoid fever (enteric fever, typhus abdominalis); typhus fever (typhus exanthematicus); and yellow fever.

gives such officers immediate notice of any unusual prevalence of diseases in countries from which vessels are likely to arrive at American ports before the receipt of the published data.

REPRINTS FROM OTHER SOURCES.

The Public Health Reports from time to time contain tables reprinted from the Statistical Bulletin of the Metropolitan Life Insurance Company, giving the death rates from principal causes, based on the records of approximately 13,000,000 insured persons.

The Public Health Reports also contain each week the "Weekly Health Index" issued by the Bureau of the Census.

Statistical Research.

Public health problems are of two classes: those which can be met by known measures, and those which can not be solved by any measures yet known. The latter require investigations on a large scale in order to discover the best methods of coping with them. Such investigations are carried on by the Division of Scientific Research of the Public Health Service. At present they include investigations of child hygiene, industrial hygiene and sanitation, public health organization and administration, neuropsychiatric researches, rural sanitation, influenza and respiratory diseases in general, pellagra, trachoma, and other diseases of man. While it has long been recognized that the nature of many of these investigations requires the statistical, as well as the laboratory, method of approach, it was not until the winter of 1918-19 that a Statistical Office was created in the Scientific Research Division.

The purposes for which this office was established are: to furnish technical (statistical) advice required by the scientists and others engaged in investigational work, including assistance in drawing up schedules and in the tabulation and analysis of the collected data; and to conduct certain investigations independently but in close coordination with other field and epidemiological studies carried on by the Public Health Service.

To each investigation necessitating the handling of considerable statistical data is assigned an assistant statistician or a specially trained statistical clerk to conduct the purely statistical phase of the work. These statistical investigators are under the general supervision of the statistician in charge of the Statistical Office so far as their purely statistical activities are concerned, but they work in close cooperation with the scientists and others who are detailed to the same investigation. In some of the researches only a small amount of statistical data is collected. Unless this material requires analysis by trained statisticians it is usually left to the scientists who are making the

investigations. In a number of instances, however, the results ob tained by these scientists are turned over to the Statistical Office for review.

One of the most important features of the work of the Scientific Research Division is its investigation in the field of child hygiene, undertaken from the point of view of assisting the States in the establishment of child hygiene departments. This investigation embraces nutritional studies of children, studies of the physical conditionheight, weight, etc.-of children, and studies of the incidence of disease among school children in relation to their scholastic progress and physical condition.

Probably next in importance is the study of industrial hygiene and sanitation, embracing, as it does, occupational disease hazards, physical conditions, etc.

These are the principal regular investigations of the Division of Scientific Research.

Of the many special investigations conducted by this Division, those relating to pellagra and influenza are nearly wholly of a statistical nature. The former embraces studies of the incidence of pellagra as affected by dietary, economic, sanitary, physical, and other factors.1 The latter is of equally wide scope, embracing studies of the incidence of influenza as affected by color, age, sex, housing conditions, economic status, and other factors. Studies have also been made of the correlation between the explosiveness and the destructiveness of the influenza epidemic of 1918 as manifested in 39 American cities and the gross mortality rates from pulmonary tuberculosis, organic heart disease and nephritis in previous years in these same cities. The correlations between the explosiveness and the destructiveness of the influenza epidemic and various other factors have also been worked out.2

The more important investigations conducted independently by the Statistical Office at the present time consist of studies of the morbidity and mortality from tuberculosis, and of the morbidity and mortality from respiratory diseases. A study is also being made of the methods of reporting disease in the various cities and States, for the purpose of suggesting improvements in report forms and the better utilization of the data currently collected. Besides these independent investigations, a number of incidental studies requiring relatively short periods of time are continually being made in the Statistical. Office.

1 Some of the results of these studies are published in the Public Health Reports of March 19 and November 12, 1920.

2 The results of more important influenza studies are to be found in the Public Health Reports of August 8, 1919, and February 18, 1921.