Doctor KOBER. By cooperation and assistance when called upon to do it in case of emergency. Whenever they need expert advice that is not at their own disposal, they should be allowed to obtain it from the Federal Government.

Mr. RICHARDSON. What is your idea: If the board of health of the State of Massachusetts determines upon a certain policy to be pursued, this national board would not interfere with it, would it? Doctor KOBER. Not at all, except in quarantinable diseases and in matters involving interstate and foreign quarantines.

Mr. RICHARDSON. Your idea is to establish cooperation between the States and the Federal Government by making uniform rules? Doctor KOBER. Yes; purely advisory. There are, however, certain problems of which I will speak that are purely matters for the Federal Government to assume, notably, the pollution of interstate

waters.

Mr. RICHARDSON. That would be purely a matter of interstate commerce?

Mr. BARTLETT. It would be a matter of disease, and not of commerce, although the diseases may be spread by interstate commerce or travel.

Doctor KOBER. One of the most important problems which must be solved by the Federal Government is the prevention of pollution of interstate waters. In the language of the North American Conservation Conference on February 23, 1909: "Facts which can not be questioned demonstrate that immediate action is necessary to prevent further pollution, mainly by sewage, of the lakes, rivers, and streams throughout North America." The prevalence of typhoid fever, dysentery, diarrheal and other water and milk borne diseases is intimately connected with water pollution. It has been estimated that the total loss in the United States from typhoid fever alone. amounts to $353,790,000 per annum, and that the prevalence of this disease can be reduced fully one-half by the substitution of pure water for previously contaminated supplies.

I have a chart here which clearly indicates the value of pure water, and the baneful influence of polluted water is shown by the excessive typhoid rate known to exist not only among the cities that are supplied by our Great Lakes, but also by the cities that are supplied by our great interstate waters.

The following is an abstract from my statement "Conservation of life and health by improved water supply," before the conference on the conservation of natural resources, White House, May 13-15,

1908:

THE HYGIENIC VALUE OF PURE WATER-ANNUAL COST OF TYPHOID FEVER IN THE

UNITED STATES.

According to the census of 1900 there were 35,379 deaths from typhoid fever during the census year throughout the United States, and, based on an estimated mortality of 10 per cent, it is within reason to assume a yearly prevalence of 353,790 cases of this disease. If we calculate the average cost for care, treatment, and loss of work to be $300 and the average value of a human life at $5,000, we have a total loss in the United States of $283,032.000 from one of the so-called preventable diseases. Mr. George C. Whipple a presents some striking evidence to indicate that a loss of $10,000 for every death from typhoid fever is a conservative estimate, in which case the decrease in the "vital assets" during the census year of 1900 would amount to $353,

a The Value of Pure Water. New York, 1905 (p. 5).

790,000. Reduce the prevalence of this disease one-half (which has been accomplished in Europe and our own country) and the question of the hygienic value of pure water will be answered from an economic point of view.

MEAN DEATH RATES FROM TYPHOID FEVER, 1902 TO 1906, IN 66 AMERICAN CITIES AND 7 FOREIGN CITIES. GROUPED, AFTER FUERTES, ACCORDING TO THE QUALITY OF THEIR DRINKING WATER. THE

RATES FOR FOREIGN CITIES ARE TAKEN FROM JAMES H. FUERTES.

The CHAIRMAN. You say also of "interstate waters." What do you mean by "interstate waters?"

Doctor KOBER. I mean a river that has its source in one State and which may traverse several States before it enters the ocean; and by an "interstate lake" I mean one that is located within the boundaries of several States, or even of nations.

The CHAIRMAN. What greater power has Congress over that than it has over other waters?

Doctor KOBER. It seems to me that one State is practically helpless to protect itself against the misdeeds of its neighbors. If the State of Maryland, for example, chooses to dump its sewage into the Potomac River, it can do so without restraint on the part of Virginia or the District of Columbia.

Mr. RICHARDSON. Is there any way of enjoining them from doing that?

Doctor KOBER. My impression is that there is no established law now, except that the matter has been recognized as important by the individual States, and probably in the course of time each State will dispose of its sewage in the proper sanitary manner.

Mr. BARTLETT. Will you hold the United States Government responsible for determining in what manner each of the States and localities shall conduct their health drainage?

Doctor KOBER. We deem it extremely desirable that whenever the secretary of the department of health shall ascertain that the interest of interstate or foreign commerce and the health of the persons conducting the same so require, he may direct in writing the commissioner of public health, in addition to conducting investigations now authorized by law, to make a special investigation into the prevalence of typhoid fever, dysentery, diarrheal diseases, and other water and milk borne diseases, the condition influencing their propagation and spread, and the methods necessary for their prevention and suppres

sion.

Mr. STAFFORD. Before you get away from that subject I would like to ask you a question in connection with the chart before the committee. What is the significance of the figures in the last column there? I notice in the water consumed by cities on the Great Lakes, Milwaukee has less than any of the other cities enumerated.

Doctor KOBER. Milwaukee probably has local environments that are unfavorable to the development of typhoid by personal contact. Mr. STAFFORD. There are some Prohibitionists on this committee, but do not mention it too strongly. [Laughter.]

Doctor KOBER. These figures come from two independent sources; one set from the Geological Survey as to the character of water supply, and the Division of Vital Statistics furnished the mortality rates from typhoid fever. The rate is only 4 per 100,000 of population, where people have the benefit of pure water, and the rate in communities where people are compelled to drink water subject to pollution is as high as 61.6 per 100,000. Water, of course, is not the only factor in the spread of typhoid fever, and it is desirable always to go into each community and analyze the factors which are operating outside of the water supply. The chart here [indicating a large chart on the wall] illustrates the value of pure water very effectively.

The CHAIRMAN. Who prepared that diagram?

Doctor KOBER. I. It was made by my clerk, based upon statistics, given me by the Geological Survey and the Census Office.

The CHAIRMAN. In your judgment this matter of investigating the water supply should not be carried on by the Geological Survey, but by the department of health?

Doctor KOBER. By the department of health, the new agency; yes.

The CHAIRMAN. That helps me some.

Mr. BARTLETT. Do you mean to say that in your view one State can not protect itself from the pollution of the water and atmosphere by any means at its command now?

Doctor KOBER. If they can, they have not exercised their privilege, I am sorry to say.

Mr. BARTLETT. What makes you say they have not?

Doctor KOBER. Simply because we know that the people of Cumberland and other Maryland towns have dumped their sewage into the Potomac River, and we have stood it for years until we finally protected ourselves by filtration.

Mr. BARTLETT. I know that the State of Georgia did protect its citizens from the fumes of copper mills in Tennessee that were destroying its vegetation and crops, and the Supreme Court of the United States upheld the right of Georgia in behalf of its citizens to proceed against those people and enjoin operations, so far as that is concerned. I do not know whether you are a lawyer or not, but I suggest that before you say the States can not do it you had better investigate. The State of Georgia did do it, acting through its legislature and through the United States courts. It protected its citizens against a nuisance like that on the part of the State of Tennessee.

The CHAIRMAN. Doctor, do you know whether you and your collaborators have examined how far the Government under its power to regulate commerce can control the water supply of streams where the matter that is thrown into the stream does not fill up the bed of the stream and does not therefore affect the navigation of the stream? Doctor KOBER. I think that Mr. Shiras, of the Committee of One Hundred, has prepared a brief on the police powers of the States as well as upon what the Federal Government can do under its power, and I refer you to the brief filed in the Senate hearings by him.

Mr. RICHARDSON. That has been a question ever since the Government was established-the relation between the federal and the state governments.

RIVER POLLUTION.

Doctor KOBER. An investigation into pollution of interstate waters will involve the establishment of a division of water supplies and sewage, the appointment of a sanitary engineer competent to solve. technical problems connected with the purification of water and sewage, and the appointment of a law officer familiar with existing federal and state health laws, and competent to compile existing laws and to assist in the formulation of uniform laws for the protection of the public health.

OTHER FEDERAL HEALTH PROBLEMS.

We are likewise of the opinion that in the interest of interstate or foreign commerce and the health of the persons conducting the same, the secretary of the department of health may direct a special

investigation into the sanitation of railway and marine travel, the prevalence of tuberculosis, malarial fevers, rabies, leprosy, cancer, hook-worm disease, pellagra, and loathsome, contagious, or infectious diseases, the traffic in habit-forming drugs, and study the methods necessary for their prevention and suppression. The results of such investigations should be disseminated by means of sanitary bulletins, and may form the basis for enlightened federal or state legislation for the prevention and suppression of these evils.

The bill should contain a provision authorizing on request of the health authorities of any State or Territory, or the District of Columbia or Porto Rico, to detail officers of the public health service to cooperate with the said authorities in the protection and improvement of the public health. This cooperation may be further extended

1. By authorizing cooperative experimental work with state health departments in some such relations as now exist between the national and state agricultural experimental stations.

2. By a consolidation of the three independent schools or courses of instruction for medical officers of the Army, Navy, and Public Health and Marine-Hospital Service, and extending the privilege of instruction to representatives of state and territorial boards of health.

The chief object of all these service schools is the study and prevention of diseases. Consolidation of faculties will result in economy, and there is a distinct need for special instruction of health officers in preventive medicine.

From the foregoing it appears that there are a number of problems which the Federal Government may very properly investigate and even regulate in the interest of public sanitation, notably the pollution of interstate waters, water and milk borne diseases, tuberculosis, malarial fevers, rabies, hookworm diseases, pellagra, cancer, and loathsome contagious diseases, all of which involve the possibility of being spread by means of interstate and foreign commerce, railway and marine travel, and no authority now exists for the investigation of these problems.

No effort should be made to supersede the work of state authorities, but the General Government may and can accomplish a most beneficent work by acting in a cooperative and advisory capacity, "especially in questions which, in the absence of federal government work, are not likely to be promptly solved" (from Mr. Taft's message), and thus provide the motives for intelligent and uniform sanitary laws throughout the States.

QUESTION OF COST.

There is every reason to believe that to maintain an efficient federal health service the funds now appropriated for existing health agencies will be more than sufficient to carry on the work in a more efficient manner. Duplication of work which now exists would be avoided, and the consolidation of all the chemical and bacteriological laboratories alone would result in marked economy.

In conclusion let me emphasize the fact that this movement has received its greatest impetus from the committee of one hundred and the American Health League, prominent insurance companies,