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It is hardly within the province of this report to deal with the construction and method of operating sand filter beds, as this is for engineers to consider.
The description of these filter beds has been promulgated now for several years, and is common property. Anyone can inform himself of the details of construction and operation if he care to manifest a sufficient interest. A proposition has been advocated to send a commission to Europe to study this system of water purification, and to report on its adaptability for the water supply of Washington. While such a commission may by personal inspection gather facts concerning the best method of constructing and operating European filters, little that is new will be added to our present knowledge.
Three cities of the United States have already followed the example of Lawrence, Mass., and have filter beds in successful operation. All these cities are within twelve hours' travel of Washington.
I can not agree that the situation is not serious, or that it can admit of further delay by reason of the fact that the death rate from water-borne diseases has shown no material increase within the past three or four years. The best that can be said is, it is bad; we have a remedy, and the sooner it is applied the more lives will be saved-lives which are being sacrificed by delays or negligence which should be characterized by no less a term than criminal.
During the past eleven years ending March 1, 1898, there have been 2,150 deaths reported from typhoid and typhomalarial fevers, not including those from diarrheal diseases, of which at least one-half are direct?y due to polluted water. If during this time a purer water supply could have been furnished, it is believed that the death rate from typhoid fever alone would have been diminished 80 per cent, a saving of 1,720 lives, and the prevention of over 16,000 cases, not to mention the expense incidental to sickness.
It is considered a crime to buy and sell human beings, yet there are worse crimes being enacted here in Washington. There are persons who have deliberately prevented the establishment of hospitals for the care and treatment of the poor little unfortunates, and have made it impossible so far by creating a sentiment against providing a filter plant unless the sewer system be extended and improved.
No one will attempt to deny the necessity of an adequate sewer system, but more good will come from purifying the water supply than from the renewal of the present sewers or their extensions, especially to outlying farm lands.
Munich, celebrated for its former high death rate from water-borne diseases, had no house sewer system until two years ago. Neither had Paris (now constructing). Notwithstanding this, the death rate was far below the cities which use raw river water. In Baltimore, Md., which still clings to her cesspools and surface drains, the water is reasonably pure, and the death rate is far below Washington.
The construction of a filter plant for Washington appears to be easier than for most cities. The Government already owns the land, and has already constructed the reservoirs and basins, one of which could be readily changed and converted into filter beds.
The' Delecarlia or the distributing reservoir could be converted into a filter, perhaps the latter, and the water could be allowed to sediment in the Delecarlia before it is filtered. This might be an advantage at times when the water is very muddy.
It is further suggested that a small filter bedsay 100 feet square—be erected in a corner of the reservoir for experimental purposes, in order to determine synchronously with the construction of the filter beds the best material for filtration, as well as the rate of flow, etc. In this way the question could be settled without delay. When the filter beds are ready to receive the filtering material sufficient data would be gathered to determine the best plan of construction and operation.
A part of the receiving reservoir could be used, as now, for storing a supply.
It would seem to be an easy matter to enlarge the filter beds from time to time by utilizing the land just to the north and south of the receiving reservoirs, and in this way be able to furnish all the water required. Respectfully submitted.
J. J. KINYOUN, Passed Assistant Surgeon, Marine-Hospital Service, Director, SURGEON-GENERAL MARINE-HOSPITAL SERVICE.
The inquiry was continued until August 1, 1898, to complete the year, and the additional data collected only went to confirm the conclusions already drawn.
This investigation was intended to be preliminary to the general subject of the pollution of public water supplies, where the interest of one or more States are involved, which it is hoped the Service will be able to undertake at as early a date as possible.
LABORATORY INSTRUCTION TO OFFICERS OF THE SERVICE.
The usual course of instruction in clinical microscopy and sanitary chemistry was begun on January 4 and continued until May 1. Two officers of the Service availed themselves of this course. The time of the year when it is practicable to give this course precludes the study of the malarial organism except by prepared specimens. This is quite unsatisfactory. Some arrangement should be perfected by which this instruction could be given, as it is highly important that this subject should be well understood by the officers of the Service.
The revised regulations permit the officers of the Service to receive laboratory instruction from time to time as their services can be spared. Some further provision should be made by which the laboratory should be open to officers and others for special research work. The laboratory is now so well equipped in instruments and apparatus that exceptional facilities can be offered for this work.
The subject of car sanitation is still under investigation. It has been now nearly two years since it was begun. It has proven a far more difficult task than was first supposed, so many obstacles have from time to time arisen which have caused repeated delays in obtaining satisfactory data regarding the sanitary conditions existing in the railway coach. So far the results of the investigation are more satisfactory than was at first thought possible. They all point to there being not so much danger to the public health from the railway coach as was at first supposed. It is expected to finish this work within two or three months.
The experiments undertaken at the same time to demonstrate the best methods of disinfecting railway coaches have been brought to a successful termination, and as a result of this, cars are now being
disinfected at little cost and without injury-quite a contrast to former methods.
MEASURES TO OBTAIN MATERIAL FOR PATHOLOGICAL INSTRUCTION.
In view of the fact that considerable difficulty has arisen from time to time in providing sufficient pathological material for instruction and study, it became necessary to draw upon the marine hospitals for this material, and accordingly, upon my representation to the Bureau of the necessity, the following circular was issued:
JUNE 28, 1898. Medical Officer in Command, United States Marine-Hospital Service:
In addition to Bureau circular of June 30, 1896, requiring post-mortem examinations to be made in all cases possible, etc., you are further directed to send to the Hygienic Laboratory, Washington, D. C., specimens from the several organs and pathological processes of each case upon which a post-mortem examination has been made. The specimens should not be larger than 2 to 3 centimeters square, and should be prepared after the following methods:
Two sets of specimens should be prepared, one set to be placed in 50 per cent alcohol for two weeks, and then placed over in 95 per cent alcohol for a week or ten days. The other to be placed in Müller's fluid (bichromate of potash, 1 part; sodium sulphate, 2 parts; water, 100 parts) for three days, and then changed to fresh fluid and allowed to remain a week. The specimens should then be washed for several hours and then placed in 95 per cent alcohol for a week or more.
The specimens are best labeled by wrapping each in paper, using a lead pencil for labeling.
In preparing the specimens for the laboratory a special mailing case will be sent you.
After the specimens are placed in the glass jar a quantity of absorbent cotton should be placed around the specimens sufficient to maintain them in place, after which a small quantity of 95 per cent alcohol should be poured over the cottonjust sufficient to keep them moist. A label should be affixed to the jar containing the specimens, giving the name of hospital, name of patient, permit number, and date of death. You will acknowledge receipt of this circular.
WALTER WYMAN, Supervising Surgeon-General, M. H. S.
It is anticipated that within a short time the laboratory will be amply supplied.
It is proposed that these pathological specimens be examined, classified, and catalogued as soon as received, and in this way to gradually build up different series of pathological specimens in which can be shown the severe disease processes.
MICROSCOPICAL AND CHEMICAL EXAMINATIONS.
Microscopical examinations have been made of nine specimens, as well as employing the Widal test eighteen times for suspected typhoid fever.
Independently of the above, chemical and bacteriological examinations have been made by direction for the purveying division, as well as for the Treasury Department and for boards of health.
PROSPECTUS OF LABORATORY WORK DURING 1899.
With your approval the following investigations will be instituted during the ensuing year:
1. A study of the bacillus tuberculosis and the allied species, for the purpose of determining the relations they bear one to another.
2. The investigation into the cause, nature, and treatment of the fevers incident to the southern part of the United States. Coincident with the studies on tuberculosis, I would recommend that the study of leprosy in the United States be also included.
My previous recommendations regarding the removal of the laboratory from the Bureau building and providing suitable buildings properly located and equippedfor scientific research are again respectfully urged.
On account of the great increase of the work now devolving upon the laboratory I would recommend (1) that an additional officer be assigned for duty; (2) that the working force should increased by an additional attendant; (3) that a clerk who is proficient in stenography, typewriting, and translating French, German, and Italian should be also assigned. Respectfully submitted.
J. J. KINYOUN,
Passed Assistant Surgeon SURGEON-GENERAL MARINE-HOSPITAL SERVICE.
REPORT ON BEST METHOD OF DISINFECTING MAIL MATTER.
Washington, D, C., March 3, 1898. SIR: I have the honor to acknowledge your reference of March 1, 1898, requesting a report on the best methods of disinfecting the mails, and in accordance there with would state that the most convenient and practicable method for disinfecting letter mail is with formaldehyde gas, applied in one of the following ways:
First. By placing the letters in a closed receptacle, such as a wooden box provided with a tight-fitting lid, and sprinkle over the letters formalin or formol, which are commercial articles of a 40 per cent solution of formaldehyde. The receptacle should then remain closed for three or four hours, it depending upon the amount of mail matter to be disinfected; the greater the quantity the longer should be the exposure.
Second. By using a mixture of formalin or formol and sawdust-one part of the former to two parts of the latter. The sawdust can then be used in the same man
ner as the formaldehyde. The exposure, however, should be somewhat longer, say, six hours.
Third. By the generating of formaldehyde gas from wood alcohol by means of special lamps. The lamps employed for this purpose should be capable of transforming not less than 1 liter of wood alcohol per hour. The disinfection of letters, etc., by this method is more applicable to large quantities where the exposure can be made in a room, using not less than 600 grams (750 cubic centimeters: 14 pints) for each 1,000 cubic feet of space, the time of exposure to be not less than twelve hours.
Fourth. By the evolution of formaldehyde gas from formalin or formol in combination with some neutral salt, such as chloride of calcium or nitrate of soda; this mixture to be used in an autoclave. The disinfection accomplished in this manner is very effective, but is applicable only for disinfecting large quantities of mail.
Fifth. By the application of formaldehyde gas by means of a closed cylinder provided with a vacuum apparatus and special apparatus for generating and apply. ing the gas. The gas should be applied in a dry state in not less than 20 per cent per volume strength, and the time of exposure not less than two hours.
It is understood that in any of the above methods letters, etc., must not be put up in packages, but should be placed loosely in the receptacles or rooms in such a manner as to allow a free access of the gas to all the surfaces. Newspapers and packages tightly wrapped should be opened before disinfecting.
Individual letters being sent from places where contagious or infectious disease exists can be thoroughly disinfected in the following simple manner:
By taking a small piece of blotting paper or some similar absorbent substance, dipping it into a solution of 40 per cent formaldehyde, and placing this in the envelope with the letter. This method has been in practice for some time by the officers of the Marine-Hospital Service in their work in smallpox. Respectfully, yours,
J. J. KINYOUN,
Passed Assistant Surgeon, M. H. S., Director. SURGEON-GENERAL MARINE-HOSPITAL SERVICE.