Pellagra was conspicuously present, as was also typhoid fever. Surgeon C. S. Butler was the first senior medical officer sent to the islands, and it is largely due to his efforts that such tremendous success has crowned the work of our officers in improving the health conditions among the people of the Virgin Islands of the United States.

Under the Danes, the people had been protected by vaccination against

Realizing that pellagra is a fooddeficiency disease, it was difficult for our medical officers to understand why it should be so prevalent among people surrounded by an abundance of suitable food such as eggs, chicken, meat, milk, and edible fish. It was found that, on account of the extreme poverty of the natives, they subsisted largely on the two cheapest foods available, cornmeal and sugar. Occa

not only to the medical officers who are making clinical and epidemiological studies, but to the natives as well.

Other problems being studied and solved by our officers on duty in these islands are those of the prevention of malaria, filariasis, dengue, leprosy, and, especially, the venereal diseases.

In Haiti, our medical officers are now carrying out a public health program which will not only redound

rôle they played we do not know, so complete was the white man's extermination after 1804.

When we first took charge of the health work we found an institution in Port au Prince, which had neither hospital facilities nor opportunities for treatment of its patients. Now we have there a well-administered 500 bed hospital, which patients enter to be cured instead of to die. Not only is

the treatment modern but we are training Haitian physicians in the art of medicine and conducting a school for nurses which will provide health missionaries to guide public opinion in all parts of the republic. There are 10 other hospitals being operated in different provinces and along with hospital and dispensary service go various sanitary measures, such as mosquito control, vaccination against smallpox, and community health activities. In response to the In response to the request of the High Commissioner and the Bureau of Medicine and Surgery, the Rockefeller Foundation has recently decided to enter this wonderful field of opportunity. In addition to our hospital, public health and educational activities, we plan to establish research work.

As you all know, we withdrew from participation in the government of Santo Domingo a few months ago after having carried on health activities in that republic similar to those we are still conducting in Haiti. It is most gratifying to learn from outside. sources that the demonstration of the value of modern medicine, conducted by our naval medical officers, has made a deep and, we hope, lasting impression on the people of that country.

It is an interesting but not wellknown fact that the naval medical officers with the Marine Expeditionary Force sent to the Isthmus of Panama in 1903 were the first to find that the dread Chagres fever was really either malaria or dengue and could be controlled. They also first reported the leucopenia and relative lymphocytosis so characteristic of dengue. They demonstrated that the cachexia so prevalent among the people, particu

cal officers have advanced the knowledge of the effects of breathing poor air and deleterious gases.

The Navy was among the pioneers in the use, on a large scale, of salvarsan and neosalvarsan and its voluminous reports have been of assistance in arriving at a true estimate of the

value and safety of these drugs in syphilis.

The Naval Medical School is training young doctors in laboratory procedures, tropical medicine, and hygiene and is making experts whose value to American medicine will increase as time goes on.

T

HE subject on which I am to address you is so large that one can not hope to cover it in more than a rather general manner in the time that is available.

While our present public health activities (with the exception of vaccination against smallpox and the use of quinine for malaria) belong almost wholly to the past half century, they have their origin in the ancient world. Before the days of Hippocrates even, men had sought to prevent the outbreaks of diseases which threatened to, and most frequently did, overwhelm them; and down through the Middle Ages the scourges of leprosy, plague, cholera and smallpox compelled the attention of persons whose minds were inclined to investigation. Eventually man perceived that without definite knowledge of the nature of disease, especially of the cause and mode of spread, he was without hope of discovering a rational means of prevention.

The history of the seeking and finding of these fundamentally essential facts is the history of preventive medicine, and the aid in their discovery and the application of their principles by developing a proper technique and

rate in 23 American cities declined at a rate of 10.4 per cent per year. Then, between 1905 and 1918, the