INSTITUTE FOR GOVERNMENT RESEARCH SERVICE MONOGRAPHS OF THE ' UNITED STATES GOVERNMENT No. 10 "THE PUBLIC HEALTH SERVICE ITS HISTORY, ACTIVITIES AND ORGANIZATION BY LAURENCE F. SCHMECKEBIER . THE JOHNS HOPKINS PRESS BALTIMORE, MARYLAND 1923 Ww ee COPYRIGHT, 1923, BY THE INSTITUTE FOR GOVERNMENT RESEARCH PRINTED IN THE UNITED STATES OF AMERICA PUBLICATIONS OF THE INSTITUTE FOR GOVERNMENT RESEARCH STUDIES IN ADMINISTRATION The System of Financial Administration of Creat Britain By W. F. Willoughby, W. W. Willoughby, and S. M. Lindsay The Budget By René Stourm T. Plazinski, Translator; W. F. McCaleb, Editor The Canadian Budgetary System By H. G. Villard and W. W. Willoughby The Problem of a National Budget By W. F. Willoughby The Movement for Budgetary Reform in the States By W. F. Willoughby Teachers’ Pension Systems in the United States By Paul Studensky Organized Efforts for the Improvement of Methods of Ad- ministration in the United States By Gustavus A. Weber The Federal Service: A Study of the System of Personnel Administration of the United States Government By Lewis Mayers The Reorganization of the Administrative Branch of the National Government By W. F. Willoughby PRINCIPLES OF ADMINISTRATION Principles Governing the Retirement of Public Employees By Lewis Meriam Principles of Government Purchasing By Arthur G. Thomas Principles of Government Decounting and Reporting By Francis Oakey, C. P. Principles of Personnel Setstasasion By Arthur W. Procter SERVICE MONOGRAPHS OF THE UNITED STATES GOVERNMENT The Geological Survey The Reclamation Service The Bureau of Mines The Alaskan Engineering Commission The Tariff Commission The Federal Board for Vocational Education The Federal Trade Commission The Steamboat-Inspection Service The National Park Service The Public Health Service The Weather Bureau The Employee’s Compensation Commission The General Land Office 518319 FOREWORD The first essential to efficient administration of any enter- prise is full knowledge of its present make-up and operation. Without full and complete information before them, as to existing organization, personnel, plant, and methods of oper- ation and control, neither legislators nor administrators can properly perform their functions. The greater the work, the more varied the activities en- gaged in, and the more complex the organization employed, the more imperative becomes the necessity that this informa- tion shall be available—and available in such a form that it can readily be utilized. Of all undertakings, none in the United States, and few, if any, in the world, approach in magnitude, complexity, and importance that of the national government of the United States. As President Taft expressed it in his message to Con- gress of January 17, 1912, in referring to the inquiry being made under his direction into the efficiency and economy of the methods of prosecuting public business, the activities of the national government “are almost as varied as those of the en- tire business world. The operations of the government affect the interest of every person living within the jurisdiction of the United States. Its organization embraces stations and centers of work located in every city and in many local sub- divisions of the country. Its gross expenditures amount to billions annually. Including the personnel of the military and naval establishments, more than half a million persons are re- quired to do the work imposed by law upon the executive branch of the government. “This vast organization has never been studied in detail as one piece of administrative mechanism. Never have the foundations been laid for a thorough consideration of the re- lations of all its parts. No comprehensive effort has been made to list its multifarious activities or to group them in such a way as to present a clear picture of what the government is doing. Never has a complete description been given of the agencies through which these activities are performed. At vii viii FOREWORD no time has the attempt been made to study all of these activ- ities and agencies with a view to the assignment of each activ- ity to the agency best fitted for its performance, to the avoid- ance of duplication of plant and work, to the integration of all administrative agencies of the government, so far as may be practicable, into a unified organization for the most effective and economical dispatch of public business.” To lay the basis for such a comprehensive study of the or- ganization and operations of the national government as Pres- ident Taft outlined, the Institute for Government Research has undertaken the preparation of a series of monographs, of which the present study is one, giving a detailed description of each of the fifty or more distinct services of the government. These studies are being vigorously prosecuted, and it is hoped that all services of the government will be covered in a com- paratively brief space of time. Thereafter, revisions of the monographs will be made from time to time as need arises, to the end that they may, as far as practicable, represent current conditions. These monographs are all prepared according to a uniform plan. They give: first, the history of the establishment and development of the service; second, its functions, described not in general terms, but by detailing its specific activities; third, its organization for the handling of these activities; fourth, the character of its plant; fifth, a compilation of, or reference to, the laws and regulations governing its operations; sixth, financial statements showing its appropriations, expen- ditures and other data for a period of years; and finally, a full bibliography of the sources of information, official and private, bearing on the service and its operations. In the preparation of these monographs the Institute has kept steadily in mind the aim to produce documents that will be of direct value and assistance in the administration of public affairs. To executive officials they offer valuable tools of ad- ministration. Through them, such officers can, with a min- imum of effort, inform themselves regarding the details, not only of their own services, but of others with whose facilities, activities, and methods it is desirable that they should be fa- miliar. Under present conditions services frequently engage in activities in ignorance of the fact that the work projected has already been don, or is in process of execution by other services. Many cases exist where one service could make ef- fective use of the organization, plant or results of other serv- FOREWORD ix ices had they knowledge that such facilities were in existence. With the constant shifting of directing personnel that takes place in the administrative branch of the national government, the existence of means by which incoming officials may thus readily secure information regarding their own and other serv- ices is a matter of great importance. To members of Congress the monographs should prove of no less value. At present these officials are called upon to legislate and appropriate money for services concerning whose needs and real problems they can secure but imperfect infor- mation. That the possession by each member of a set of monographs, such as is here projected, prepared according to a uniform plan, will be a great aid to intelligent legislation and appropriation of funds can hardly be questioned. To the public, finally, these monographs will give that knowledge of the organization and operations of their gov- ernment which must be had if an enlightened public opinion is to be brought to bear upon the conduct of governmental affairs. These studies are wholly descriptive in character. No at- tempt is made in them to subject the conditions described to criticism, nor to indicate features in respect to which changes might with advantage be made. Upon administrators them- selves falls responsibility for making or proposing changes which will result in the improvement of methods of adminis- tration. The primary aim of outside agencies should be to emphasize this responsibility and facilitate its fulfillment. While the monographs thus make no direct recommenda- tions for improvement, they cannot fail greatly to stimulate efforts in that direction. Prepared as they are according to a uniform plan, and setting forth as they do the activities, plant, organization, personnel and laws governing the several serv- ices of the government, they will automatically, as it were, reveal, for example, the extent to which work in the same field is being performed by different services, and thus furnish the information that is essential to a consideration of the great question of the better distribution and cotrdination of activi- ties among the several departments, establishments, and bu- reaus, and the elimination of duplications of plant, organiza- tion and work. Through them it will also be possible to sub- ject any particular feature of the administrative work of the government to exhaustive study, to determine, for example, what facilities, in the way of laboratories and other plant and x FOREWORD equipment, exist for the prosecution of any line of work and where those facilities are located; or what work is being done in any field of administration or ‘research, such as the promo- tion, protection and regulation of the maritime interests of the country, the planning and execution of works of an engineer- ing character, or the collection, compilation and publication of statistical data, or what differences of practice prevail in re- spect to organization, classification, appointment, and promo- tion of personnel. To recapitulate, the monographs will serve the double pur- pose of furnishing an essential tool for efficient legislation, ad- ministration and popular control, and of laying the basis for critical and constructive work on the part of those upon whom responsibility for such work primarily rests. Whenever possible the language of official statements or re- ports has been employed, and it has not been practicable in all cases to make specific indication of the language so quoted. CONTENTS CHAPTER PAGE Forewonrp S00 as bo nities A Le ih I. History . . 1 The Unorganized Mita Hospital Service) os to a 2 The Organized Marine Hospital Service, 1870 to 1902 . 7 Reorganization of the Service, 1870 to > 1578 SEL Te Ng Quarantine Law of 1878 . . : Epis 0 National Board of Health, 1878 ol aa ad Cat Ey SER NS Personnel System of 1879 . vl veld Development of the Service from 1883 to 1889 | SRA ~ Interstate Control of Diseases, 1890 . . rME6 Medical Inspection of Immigrants, "0 and’ 18or Cela Quarantine Law of 1893 . . . aly vit Regulations of 1897 . . va a OT Growth of Service from 1898 to 1901 : 22 ' The Public Health and Marine Hosplial Service, 1902 to 1912 : : ; 25 The Act of July 1, "1902 at RT RE IE, He Naf Tests of Biologic Products Lay + Ae aT Development of the Service from 1902 to 1912 (rn WARES * The Public Health Service Since 1912 . . 32 The Act of Bagh 14, 1972, and the Events Leading A : 32 New Activities in 1913 and 1914 donde san ead Increased Field Investigations in 1914 . . . . . 39 Medical Aid to Deep Sea Fisheries, 1914 . . . . 40 Inoculation of Government Employees, 1915 . . . 40 Fumigation of Forecastles, 1015 '. .. '. 0. 0.0 04] Studies of Rural Sanitation, 1016... .. ‘0 i aii hal Controliof Biologic Products, 1916. "°. «ih. 00a National Home for Lepers, 1917 . 41 Hospital Treatment for Injured Government Employees 42 Medical Inspection of Immigrants, id al ra i A RAS General War Activities . . . . JET ASE ~~ Control of Venereal Diseases . . 2 a Hospital Relief for the Army and Navy . Suan fu tnd Influenza Epidemic of 1918 . . ow a ey Organization of Reserve Corps wae REAM Organization of New Administrative Units oe 53 Increasgd Compensation for Commissioned Officers . 354 Completion of National Quarantine System . . . 354 Medical Treatment of Discharged Soldiers . . ree Revision of Salaries of Commissioned Officers, 1922 . ig xi xii CONTENTS CHAPTER II. AcriviTiES Medical Treatment Beneficiaries General Treatment Special Treatment . Crews of Vessels in Deep Sea Fisheries Physical Examinations re Vie Control of Venereal Diseases . Legislation." '. °F. =. | Scope of Work - Prevention of Interstate Spread of Diseases J Legislation Regulations Affecting Interstate Carriers Sanitary Engineering Work . Control of Epidemics Medical Inspection of Immigrants ~Foreign Quarantine Rural Sanitation . Statistics » Control of Biologic Products : Scientific Work * Child Hygiene . * Occupational Diseases and Industrial Hygiene : Investigations of Specific Diseases » Public Health Organization and Administration Digests of Laws and Court Decisions . Stream Pollution Laboratory Investigations Other Scientific Work Conferences with State and Territorial Health Authorities . 144 . 146 . 146 . 147 . 147 . 148 . 150 TEL 4153 Work for Other Government Agencies . * Public Health Education Food Supply of Vessels . III. ORGANIZATION . : Office of the Chief Clerk . Inspection Service . Division of Personnel and Accounts . ~ Hospital Division : . -~Division of Venereal Diseases : ~Division of Domestic (Interstate) Quarantine : * Division of Foreign and. Insular Quarantine and Im- . . I55 . 156 - 159 +1162 .5102 . 103 . 163 migration y "Division of Sanitary Reports and Statistics 3 - Division of Scientific Research IV. PERSONNEL General Statement Commissioned Personnel Appointment and Promotion . Salaries and Allowances . Retirement “F101 «103 . 103 . 105 + IYI S122 . 120 . 120 - 133 - 133 + 130 . 138 . 140 . 141 AT 142 : 171 144 144 154 CONTENTS IV. PEersoNNEL—Continued Commissioned Personnel—Continued Leave of Absence . Discipline Reserve Corps . > . Non-Commissioned Personnel . Scientific Personnel * Hygienic Laboratory . Pharmacists . Administrative Assistants Other Employees . APPENDIX 1. Outline of Organization 2. Classification of Activities . 3. Publications 4, Laws 5. Plant and Equipment 6. Financial Statements 7. Bibliography INDEX xiii PAGE . 173 - 174 - 174 . 178 .. 176 . 178 . 179 . 180 . 192% . 192 . 105 . 254 . 260 273 . 203 ¥. An THE PUBLIC HEALTH SERVICE ITS HISTORY, ACTIVITIES AND ORGANIZATION CHAPTER 1 HISTORY The Public Health Service is a bureau of the Treasury De- es SU the following general activities: The operation of hospitals and the furnishing of medical relief to specified beneficiaries; the medical inspection of immigrants; the administration of aritine and border quarantine ; the pre- vention of the interstate spread of diseases; the examination of biologic products to determine purity and potency; the collection of morbidity and other statistics pertaining to health; and the study and investigation of the diseases of man and conditions influencing the propagation and spread of diseases, including sanitation and sewage and the pollution either di- rectly or indirectly of the navigable streams and lakes of the United States. Its Junctions, _therefore, fall into three, classes: (1) medical eter —_— designated persons; (2) the prevention of the spread of disease by virtue of the powers exercised by the federal government over interstate and for- eign commerce; and (3) making studies that will assist in controlling disease and furnishing a central agency for assist- ing state and municipal health officials in their work. The history of the Public Health Service may be divide into the following four well defined periods: (1) the unor- ganized Marine Hospital Service from 1798 to 1870; (2) the organized Marine Hospital Service from 1870 to 1902; (3) : : J NN 2 THE PUBLIC HEALTH SERVICE the Public Health and Marine Hospital Service from 1902 to 1912; (4) the Public Health Service from 1912 to the present time. The transition in 1870 from the unorganized to the organized service was entirely an administrative change result- ing in increased efficiency, but not involving any material change in function or volume of work. All the other periods represent either a definite broadening of the field of activity or a marked increase in the activity along particular lines. The Unorganized Marine Hospital Service, 1798 to 1870. The furnishing of medical relief to merchant seamen was one of the earliest of the federal activities that did not relate to “the actual operation of the government. The act of July 16, J (1 Stat. L., 605-606), provided that after September id 8, the master of every American ship arriving from a for- ign rt should pay to the Collector of Customs the sum of 3, cents a month for each seaman, which amount he was au- orized to deduct from the seaman’s wages. After Septem- ber 1, 1798, vessels engaged in coastwise. trade could not ob- tain a new license until payment had been made at the rate of 20 cents a month per seaman for the period covered by the license which had expired. The President was author- ized to use the money collected in this manner to provide temporary relief and maintenance for sick and disabled sea- “if no hospital was available provision for relief was to be sade in such manner as the President should direct. Special pro- vision was made that the money was to be expended in the district where collected. The President was also authorized to accept cessions of buildings and grounds and donations. The surplus after pay- ing expenses could be used to purchase buildings or grounds and to erect buildings. The President was authorized to ap- point directors of the marine hospitals of the United States in various ports at his discretion, who were to hold office dur- ing the pleasure of the President. Each director was to HISTORY 3 supervise the expenditures in the port to which he was as- signed, to provide accommodations and govern the hospital under general instructions of the President, and to render an account quarterly to the Secretary of the Treasury or some other person designated by the President. The directors were to receive no compensation except such as might be incurred in the actual discharge of their duties. The Col- lectors of Customs appear to have become directors ex- officio.? The act of 1798 referred only to merchant seamen, but on March 2, 1799 (1 Stat. L., 729), a new act was passed author- izing the Secretary of te Navy to deduct twenty cents a month from the pay of naval officers, seamen, and marines, who were made beneficiaries of the marine hospitals. These deductions were transmitted quarterly to the Secretary of the Treasury. This act remained in force until the passage of the act of February 26, 1811,(2 Stat. L., 650), which placed naval hospitals under the superintendence of the Secretary of the Navy and provided that the collection from officers and | seamen of the Navy should be paid into a separate fund for the Navy. It was soon recognized that proper relief could not be given by expending the money entirely within the district in which it was collected, and the act of March 2; 1799 (1 Stat. L., 729), romeo, authorized the President to expend the fund within a state ad- joining the one in which the money was collected, with the ex- ception of New Hampshire, Massachusetts, and Connecticut. All money collected in these three States was required to be expended within their borders. Three years later these limita- “tions on the expenditures were abolished, and the fund was made a general one to be used throughout the country for the benefit of sick and disabled American seamen. The first marine hospital operated by the government was the one at ‘Washington Point, Norfolk, purchased in 1800. By 1802 hospitals had been opened at Norfolk, Boston, New- 331 Cong. 2 Sess, S. Ex. Doc. 14, p. 5. 4 THE PUBLIC HEALTH SERVICE port, and Charleston.? The increasing use of the Mississippi River for transporting the lumber and other products of the Western territory to market made it desirable to provide hos- pital facilities at New Orleans, and the act of May 3, 1802 (2 Stat. L., 192), authorized the President “to take such measures as may be expedient” to provide medical assistance at that place if this could be done “with the consent of the government having jurisdiction over the port.” At this time France still had possession of the Louisiana Territory, as the treaty ceding this area was signed at Paris on October 31, 1803. The master of every boat or raft going down the Mississippi River was required to pay twenty cents per month for each person employed. The hospital tax was collected at Fort Adams, and no vessel or raft was to be cleared until the tax was paid. An appropriation of $3,000 was made for es- tablishing the hospital, and the President was authorized to appoint a director of the marine hospital at New Orleans whose duties were to be the same as those of directors of mar- ine hospitals in the United States. The act of February 24, 1804 (2 Stat. L., 252), extended the laws relating to sick and disabled seamen to the territory acquired from France. The act of May 3, 1802, also provided $15,000 for the erection of a hospital in Massachusetts, authorized the ad- mission of foreign seamen to hospitals at the rate of seventy- five cents a day, and allowed the directors of hospitals a com- mission of one per cent. on the money expended. The settlement of the Northwest and Louisiana territories and the development of transportation facilities on the Great Lakes and western rivers brought to the attention of Congress the necessity of establishing hospitals in that region. By the act of March 3, 1837 (5 Stat. L., 189), the President was authorized to purchase sites for not exceeding three hospitals on the Mississippi River, three on the Ohio, and one on Lake Erie. An appropriation of $15,000 was made for the pur- 2 Supervising Surgeon General, Marine Hospital Service, Annual Report, 1872, p. 7. HISTORY 5 chase of sites, and the President was authorized to call upon the “medical men” of the Army to select suitable locations. The Secretary of War was directed to prepare plans and esti- mates, which were submitted to Congress in December, 1837.3 Later acts provided funds for the erection of these western hospitals which were built under the direction of the Topo- graphical Bureau of the War Department. + New hospitals were built at various times, but no important legislation affecting the service was enacted between 1837 and 1870. The act of March 1, 1843 (5 Stat. L., 602), provided that seamen engaged in the coasting trade should be benefici- aries of the service. These seamen were entitled to this ser- vice under the original act of July 16, 1798, but for “some cause not apparent the provisions of the act of July 16, 1798, including coasting vessels under the general law, had been suspended, by construction, since the year 1831, and was merely renewed.” ® By the act of July 20, 1846, canal boats were exempted from the tax, and the persons employed on them were denied the use of the hospitals. The act of March 3, 1849 (9 Stat. L., 368), carried an appropriation of $1000 to collect facts and information in relation to marine hos- pitals and the marine hospital fund and to report to Congress what changes were necessary. Dr. George B. Loring, and Dr. T. O. Edwards were appointed to collect the necessary in- formation and their report, made in 1851, reviewed the gen- eral history of the service, described existing conditions, and made some recommendations, the most important being that the system should be placed under a chief surgeon. Sec- retary of the Treasury Chase in 1861 stated that the number of marine hospitals “has been increased far beyond necessity or utility.” © Subsequently the act of March 1, 1862 (12 Stat. L., 348), authorized the Secretary of the Treasury to rent * Secretary of War, Annual Report, 1837. pp. 195-203. +31 Cong., 2 Sess., S. Ex. Doc. 14, p. 25. Sibid., p. 3. 81hid., p. 30. " Secretary of the Treasury, Annual Report, 1861, p. 27. 6 THE PUBLIC HEALTH SERVICE marine hospitals to authorities of cities and to contract with hospitals for the medical treatment of seamen. By the act of April 20, 1866 (14 Stat. L., 40), the Secretary of the Treas- ury was authorized to sell or lease such marine hospital lands and buildings as he deemed advisable, except the hospitals at Portland, Maine, and Cleveland, Ohio; no hospital was to be sold or leased if suitable accommodations could not be ob- tained. This act was amended by the act of June 27, 1860 (14 Stat. L., 76), which provided that no hospital should be sold or leased if the relief furnished amounted to twenty cases a day. The tax on seamen was collected continuously from 1798 to 1870 except for the period of one year beginning April 1, 1837. The proceeds of the tax, however, were sufficient for the expenses of the service during only thirty-four of the seventy-three years. During the other years it was necessary to appropriate money from the general funds of the govern- ment in order to maintain the service, and from 1841 to 1870 deficiency appropriations were made each year with the ex- ception of 1846 and 1854. In addition, specific appropria- tions were made for the purchase of sites and the erection of buildings. During this period medical relief was given in the hospitals operated by the service, in contract hospitals, and in_ private dwellings under contract with local physicians. Thirty-one hospital projects had been undertaken by the government since the organization of the service, but only nine of these were in use in 1870, seven being operated by the government and two being leased to private parties. Of the remainder, fourteen hospitals had been sold, one transferred to the War Depart- ment, one abandoned, one burned, one destroyed by flood and one by hurricane, one injured by earthquake and abandoned, and two unfinished, the completion of one of these being re- garded as impracticable. Hospitals had been built at points ‘where there were no patients or not sufficient patients to justify the maintenance of the institutions. HISTORY 7 On the administrative side the service during these years was characterized by an entire absence of any central super-, wvisory authority. The act of 1 708 placed all authority in the President, who seems to have delegated control to the Sec- * retary of the Treasury,® who had no supervisory machinery, the routine transactions being, at the end of this period, under the Revenue Marine Division of the Treasury Department.® At first the President appointed the surgeons in charge of hos- pitals, but these appointments afterwards became a perquisite of the Collectors of Customs. In 1809 Secretary Gallatin authorized the Collectors of Customs to fix all rules for government of hospitals. Secretary Walker in 1848 pre- scribed general rules for the government of all hospitals, but they do not seem to have been followed.° In the absence of adequate supervisory authority each hos- pital was managed as an independent establishment. The di- versity ‘of conditions is well brought out by the following quotation from the report of Drs. Loring and Edwards made to Congress in 1851: The hospital at Mobile is as distinct and different from that at Norfolk or New Orleans as if one were a hotel and the other a hospital. . . . In one the surgeon resides in the hos- pital grounds, and in the other he pursues his private business in the circuit of his city, and an assistant represents him for months in the wards of his hospital. . . . Here the surgeon selects: his own steward, there the collector of his district makes the appointment himself.!* The Organized Marine Hospital Service, 1870-1902. The act of June 29, 1870 (16 Stat. L., 169), provided.a.cen-. tral administrative agency for the “Masite Hospital Service and is the foundation on which the hospital work of the present Public Health Service has been built. 231 Cong., 2: Sess, S. Ex. Doc. 14, p. 5. 9 Sup. Surg. Gen., Annual Report, 1872, p. 26. 10 21'Cong., 2 Sess., S. Ex, Doc. 14, p. 27. 11 Tbid., p. 29. 8 THE PUBLIC HEALTH SERVICE Reorganization of the Service, 1870 to 1875. This law authorized the Secretary of the Treasury to appoint a super- vising surgeon of the Marine Hospital Service at a salary of $2,000 in addition to necessary traveling expenses. The duties of this officer as stated in the law were to supervise under the direction of the Secretary of the Treasury “all matters con- nected with the Marine Hospital Service, and with the dis- bursement of the fund for the relief of sick and disabled seamen.” In the same act the hospital tax on seamen was increased from twenty to forty cents a month. The proceeds of the tax were to be placed in a separate fund, which was appropriated for the expenses of the Marine Hospital Ser- vice, and which was to be “employed under the direction of the Secretary of the Treasury, for the care and relief of sick and disabled seamen employed in registered, enrolled, and licensed vessels of the United States.” The office of supervising surgeon was first filled in April, 1871, by the appointment of Dr. John M. Woodworth, who promptly took steps to reorganize the service on a more efficient basis. The rules governing the service were gradu- “ally revised, and the new rules were codified in regulations approved October 1, 1873. Under the new regulations ap- pointments were made to the general service, and not to par- ticular hospitals or stations, the surgeons being transferred from the smaller to the more important stations as vacancies occurred. This feature emphasized the national character of the service, prevented appointments due to local political in- fluence, and gave the general service the benefit of the ex- perience acquired by its officers. More important was the requirement that appointments to the medical staff should be made only after examination by a board of surgeons, the ap- pointment being made by the Secretary of the Treasury on the recommendation of the Supervising Surgeon.'? Compensa- tion of all officers and employees was fixed by the Secretary of 12 Regulations, 1879, Par. 51 and 52. HISTORY 1g the Treasury, with the exception of the salary of the Super- vising Surgeon, which was fixed by statute. Supervising Surgeon Woodworth had been a medical of- ficer of the Army, and evidently believing that a military plan of organization gave the best results, he placed the ser- vice on what was practically a military basis. Officers were required to wear a regulation uniform when on duty, and the general discipline and administration of the hospitals were modeled on military lines. In their basic ‘features these regulations are in force at the present time, although modi- fications have been made in details as a result of the creation of additional grades of officers and changed conditions. The first annual report of the reorganized service was the one for 1872, which reflected the change in general character. The earlier reports contained only statements of receipts and expenditures, while the report for 1872 included detailed medical statistics on cases treated and brief reports on the history of surgical cases. In the report for 1873 was begun the publication of more detailed technical and scientific papers dealing with cases of special interest. These papers con- tinued to be published in the annual reports until 19o3, after which articles of this character were issued in separate form. The next legislation affecting the service was contained in the sundry civil appropriation act of March 3, 1875 (18 Stat. L.., 377), in which the head of the service is called the Supervising Surgeon. General, and which provided that he should be appointed by the President, subject to confirmation by the Senate. The salary of the office was fixed at $4,000 a year. No change was made in the method of appointing other officers, and they continued to be appointed by the Secretary of the Treasury, who also fixed their compensation. By this act some changes were made in the method of collect- ing the tax, and the term “seaman,” previously undefined, was made to include all persons employed on vessels, in so far as the benefits of the service were concerned. Foreign seamen were allowed to obtain treatment at the hospitals at ” 10 THE PUBLIC HEALTH SERVICE rates to be fixed by the Secretary of the Treasury, instead of at the rate of seventy-five cents a day prescribed by the act of May 3, 1802. Seamen on vessels not subject to the hospital tax were to be admitted on the same terms as foreign seamen, and under this provision persons employed on vessels of the Navy, Engineer Corps of the Army, Coast Survey, and Light- house Service !* were given treatment, the expenses being paid by the various services. This law provided also that in- sane patients of the service should be admitted to the Govern- ment Hospital for the Insane, now St. Elizabeth’s Hospital, and that the Secretary of the Treasury might lease hospital buildings and use the proceeds for the maintenance of the service. Quarantine. Law. of 1878. The first national quarantine law was the act of April 29, 1878 (20 Stat. L., 37), and the medical officers of the Marine Hospital Servite were charged with the enforcement of regulations to be promulgated by the Secretary of the Treasury. It is true that Congress had passed quarantine laws in 1796, 1799, 1832, and 1866, but these earlier laws merely extended federal aid in the enforce- ment of local regulations. By the act of May 27, 1796 (1 Stat. L., 474), the President was authorized to direct revenue officers and officers commanding forts and revenue cutters to aid in the execution of health laws of the states in such manner as may appear necessary. This law was repealed by the act of February 25, 1799 (1 Stat. L., 621), which pro- vided that any quarantine established by or in conformity with the health laws of any state should be observed by Collectors of Customs and all other officers of the revenue, by masters of revenue cutters, and by military officers as directed by the Secretary of the Treasury. The act of July 13, 1832 ‘(4 Stat. L., 577), gave the Secretary of the Treasury au- thority for one year to employ additional boats and officers if he deemed the revenue boats and officers insufficient to en- force the quarantine regulations. By the act of May 26, 18 Sup. Surg. Gen., Annual Report, 1875, p. 6. HISTORY 11 1866 (14 Stat. L., 357), the Secretary of the Treasury was directed to make quarantine regulations necessary to aid state or municipal authorities in guarding against the introduction of cholera. He was also authorized to direct revenue officers and commanders of revenue cutters to assist in the execution of the quarantine and health laws of the states. An epidemic of cholera in 1873 focused attention on the subject of quarantine and the Secretary of the Treasury on September &, 1874, issued a general circular calling attention to the act of February 25, 1799 (R. S. 4792), which for some years had been practically a dead letter. In this circular of- ficers of the Marine Hospital Service and customs officers were directed to inform themselves fully regarding local health laws and regulations, and directed to give prompt assistance in their enforcement. All the laws discussed above assumed that quarantine was a local function and that any action of the federal govern- ment should be merely for the purpose of assisting state or municipal authorities. The diversity in the regulations and the burden thrown upon foreign commerce by the unreason- able requirements at some ports led to the passage of the act of April 29, 1878 (20 Stat. L., 37), which gave authority to the Supervising Surgeon General of the Marine Hospital Service, subject to the approval of the President, to make rules and regulations governing the detention of vessels hav- ing cases of contagious diseases on board or coming from foreign ports at which contagious diseases exist. It was ex- pressly stipulated, however, that these rules and regulations must not “conflict with or impair any sanitary or quarantine laws or regulations of any state or municipal authorities.” This provision might seem to tie the federal regulations de- finitely to the local rules, but the Attorney General held that the law did not mean that nothing could be done except what ~ was authorized by the state law. “The only limitation is that the federal regulations must not interfere with the state 14 Tbid., p. 16. 12 THE PUBLIC HEALTH SERVICE laws . . . Suppose the [quarantine] period named by him [the State health officer] is deemed too short. It is in my opinion clearly competent under the acts of Congress above quoted to prescribe a longer period, both for persons and cargo, the regulations carefully providing that the federal jurisdiction should attach upon the expiration of state act- jon.1® \ Officers of existing state or municipal quarantine systems were authorized to act as officers of the national quarantine system, and if the quarantine was considered necessary at other ports, the medical officers of the Marine Hospital Serv- ice were directed to perform such duties as might be assigned to them by the Supervising Surgeon General. This act provided also that consular officers in foreign countries should advise the Supervising Surgeon General re- garding the appearance of contagious diseases in any foreign port or the departure of any vessel from such a port for the United States. They were also required to report the de- parture of vessels from such ports to the health officer at the port of - destination. In addition consular officers were re- quired to make weekly reports to the Supervising Surgeon General on the sanitary conditions at the ports where they were stationed. The Supervising Surgeon General was re- quired to notify the local authorities at the port of destination regarding the departure of any vessel from an infected port; he was also required to prepare and transmit to the medical officers of the Marine Hospital Service, to Collectors of Cus- toms, and to state and municipal health authorities in the United States, weekly abstracts of the sanitary reports re- ceived from consular officers, as well as other pertinent in- formation. The act of March 3, 1879 (20 Stat. L., 402), authorized the expenditure of $5,000 from the permanent ap- propriations of the Marine Hospital Service for the expense of collecting data for health bulletins. The provision for the distribution of the weekly abstracts 15 20 Op. Att. Gen. 474. HISTORY 13 of sanitary reports, contained in the act of April 20, 1878, was the first authority for the publication of the series now known as Public Health Reports. The first number, issued under the title “Bulletin of the Public Health,” appeared July 13, 1878.18 Dr. J. M. Woodworth, the first Supervising Surgeon Gen- eral of the service died on March 14, 1879, and was succeeded by Dr. J. B. Hamilton. “National Board of Health, 1878. The duties and powers relative to quarantine, reports from consular officers, and the distribution of health bulletins conferred on the Marine Hos- pital Service by the act of April 29, 1878, remained in force only until June 2, 1879, when a law was passed (21 Stat. L., 5) transferring these functions to the National Board of Health which had been created by the act of March 3, 1879 (20 Stat. L., 484). The act of June 2, 1879, which repealed the portions of the act of April 29, 1878, relating to the quar- antine and public health functions of Marine Hospital Service, provided that “this act shall not continue in force for a longer period than four years from its date of approval.” At the expiration of the four years the repealed sections of the act of April 29, 1878, were revived by the expiration of the re- pealing statute.” The duties of the Marine Hospital Service in relation to quarantine were thus again in effect after June 2, 1883. Personnel System of 1879. The methods of appointment and promotion of the commissioned personnel of the service were further refined by the regulations approved November 10, 1879, which in their basic features are in force at the pres- ent time although of course some modifications have been made in the details. The regulations of 1873 had provided that appointments should be made only after passing a techni- cal examination before a board of officers. The regulations of 1879 continued this provision, but in addition specified that 18 For resumé of history of this and other series, see pages 195-197. 1720 Op. Att. Gen., 467. 14 THE PUBLIC HEALTH SERVICE original appointments should be made to the lowest grade only—that of assistant surgeon—and fixed the age limits be- tween 21 and 30 years of age.'® A new grade—that of passed assistant surgeon—was es- tablished, and it was provided that after three years’ service an assistant surgeon should be promoted to the grade of passed assistant surgeon provided he passed a satisfactory ex- amination. Vacancies in the grade of surgeon were to be filled by promotion of passed assistant surgeons in order of seniority, but promotion was made only after the officer had passed an additional examination.!? Development of the Service from 1883 to 1889. After the control of “quarantine was restored To the Marine Hospital Service on June 2, 1883, sanitary inspectors were stationed at Habana, Vera Cruz, London, and Liverpool, in order to give notification of the sailing of vessels likely to carry infected passengers or commodities. Habana and Vera Cruz were important centers of yellow fever infection, while London and Liverpool were selected principally by reason of the dan- ger of disease being carried by vessels transporting rags and other similar commodities which were shipped from places where cholera was prevalent, and which were transshipped through English ports.?® Until 1884 the expenses of the service had been paid from the permanent indefinite appropriation derived from the pro- ceeds of the hospital tax on seamen, supplemented by specific appropriations. The act of June 26, 1884 (23 Stat. L.., 57), which took effect July 1, 1884, repealed all acts levying a hos- pital tax and provided that the expenses of the Marine Hos- pital Service should be paid from the proceeds of the tonnage States. The “receipts from these duties on tonn were made a permanent indefinite appropriation for fhe use of the Marine Hospital Service. In some later years the proceeds of 18 Regulations, 1879, Par. 24-26. 1% Tbid., Par. 30-32. 20 Sup. Surg. Gen., Annual Report, 1883, p. 52. HISTORY 13 the tax were insufficient to support the service, and deficiency appropriations were made. The act of June 26, 1884, made no changes in the organization or activities of the service. As a result of the growth of the service a small laboratory for the manufacture of some preparations had been main- tained in Washington as a part of the purveying depot, but no provision was made for systematic laboratory investiga- tions in the field of hygiene until Arh TE er. teriological laboratory was established at the Marine Hos- pital at New York.2! This laboratory was maintained at New York until 1891, when it was moved to Washington. In 1887 the service resumed the publication of the Weekly Abstract of Sanitary Reports, which had been discontinued in 18,9 when quarantine control was vested in the National Board of Health. The act of August 1, 1888 (25 Stat. L., 355), prescribed specific penalties for trespassing on quarantine reservations as well as penalties for masters or pilots of vessels who might enter any port in violation of the act of April 28, 1878. This law also provided for the establishment of national quaran- tine stations under the Marine Hospital Service at the mouths of Delaware and Chesapeake Bays, on the Georgia Coast, and at Key West, San Diego, and Port Townsend. The Secretaries of the Treasury and the Supervising Sur- geons General had repeatedly recommended that the rules of the service requiring examination prior to appointment be given the force of law, but not until 188g did Congress pass a law on this subject. The act of January 4, 1889 (25 Stat. L., 639), provided that all medical officers of the service should be appointed by the President, and be subject to con- firmation by the Senate. Prior to this act only the Supervis- ing Surgeon General was appointed by the President. This act provided also that original appointments could be made only to the rank of assistant surgeon and after an examina- tion before a board of medical officers of the service in ac- 21 Tbid., 1888, p. 11. 16 THE PUBLIC HEALTH SERVICE cordance with rules prepared by the Supervising Surgeon Gen- eral and approved by the Secretary of the Treasury and the President. It provided that an assistant surgeon could be promoted to the grade of passed assistant surgeon after four years’ service and after passing a satisfactory examination. An examination was required also in the case of passed assistant surgeons promoted to the rank of surgeon. The President was authorized to nominate all officers already in the service. The requirements of this act were embodied in the general regulations approved May 20, 1889, which provided also that the Supervising Surgeon General should be selected from the surgeons in the service.?? These regulations fixed the compen- sation of surgeons at $2500, passed assistant surgeons at $1800, and assistant surgeons at $1600. Longevity pay at the rate of 10 per cent. of the annual salary for each five years’ service was allowed to medical officers above the rank of assistant surgeon, with the limitation that the total longevity pay should not exceed 40 per cent. The beginning of a re- tirement system was evidenced by the provision that officers on “waiting orders” for more than two months should receive 75 per cent. of the pay of their rank, but there was no method prescribed for placing officers under “waiting orders.” 22 Interstate..Control of Diseases, 1890. The first effective measure in the direction of inferstate control of disease was the act of March 27, 1890 (26 Stat. L., 31), which provided that whenever he deemed it necessary the President was authorized to cause the Secretary of the Treasury to promul- gate necessary rules and regulations to prevent the spread of cholera, yellow fever, smallpox, and plague from one state or territory into “another. These regulations were to be pre- pared by the Supervising Surgeon General of the Marine Hos- pital Service, and the Secretary of the Treasury was author- ized to employ such inspectors as might be necessary to en- force the regulations. 22 Regulations, 1889, Par. 1. 28 Thid., Par. 24. HISTORY 17 Violation of the regulations made in accordance with this act was made a misdemeanor, punishable by fine or imprison- ment. It should be noted that this act does not confer gen- eral interstate quarantine authority, the diseases for which quarantine may be declared being cholera, yellow fever, small- pox, and plague. Medical Inspection of Immigrants, 1890 and 1891. The medical inspection of immigrants was added to the duties of the service in the early part of 1890, when this work at New York was made one of its duties, although legislation placing the medical inspection of immigrants at all ports under the control of the service was not passed until March 3, 1891. The first act placing restrictions on the admission of defec- tives was the law of August 3, 1882 (22 Stat. L., 214), which prohibited the landing of a “lunatic, idiot, or any person unable to take care of himself or herself without becoming a public charge.” As in the earlier legislation relating to quarantine, Congress looked to state organizations to furnish the machin- ery for the administration of the law. The Secretary of the Treasury was charged with the duty of executing the pro- visions of the act, and “for that purpose” he was given “power to enter into contracts with such state commission, board, or officers as may be designated for that purpose by ‘the governor of any state to take charge of the local affairs of immigration in the ports within said state.” These boards examined the immigrants, and Collectors of Customs were required to refuse admission to any immigrants whose entry was prohibited by the law. The Treasury Department was apparently unable to make general provision for the medical inspection of immigrants, as this work appears to have been carried on at New York only.?* In April, 1890, the contract with the Board of State Emigration Commis- sioners at New York was abrogated, and the Treasury Depart- ment undertook the inspection of immigrants at that port, the 24 Sup. Surg. Gen., Annual Report, 1890, p. 62; Annual Report, Secretary of the Treasury, 1890, p. Ixxiv. 18 THE PUBLIC HEALTH SERVICE medical inspection being assigned to the Marine Hospital Service. 3 More specific provisions for the control of immigration and the medical inspection of immigrants were contained in the act of March 3, 1891 (26 Stat. L., 1084), which took effect April 1, 1891. This law prohibited the admission, among others, of “idiots, insane persons, . . . persons likely to become a public charge, [and] persons suffering from a loathsome or a dangerous contagious disease.” *¢ It was provided that medical examinations were to be made by surgeons of the Marine Hospital Service, but if the services of a surgeon of the service could mot be obtained without unreasonable delay the inspector could cause the examination to be made by a civil surgeon whose compensation was to be fixed by the Secretary of the Treasury. Medical officers were immediately detailed for inspection of immigrants at the more important ports; at other places the regular officer on duty at the station was available for this service. The inspec- tion work at New York was made by a civil surgeon ap- pointed by the Secretary of the Treasury, as the technical point was raised that the term “surgeon” in the act of March 3, 1891, meant an officer with the rank of surgeon. The Treasury Department maintained that the word surgeon was used in a general sense and meant any surgeon of the service. The district court, however, sustained the point raised, and as there were not sufficient officers of the grade of surgeon available, it was necessary to suspend the inspection work at that port?” This technical objection appears not to have been raised at other ports, and the New York decision appar- ently was not used elsewhere to question the authority of the examining surgeons. This situation was remedied by section 8 of the act of March 3, 1893 (27 Stat. L., 570), which pro- 28 Tbid,, p..55. 26 Ag this monograph is devoted solely to the activities of the Public Health Service, the general restrictions on immigration are not discussed. 27 Sup. Sur. Gen., Annual Report, 1891, p. 18. HISTORY Hii gg vided that medical examinations might be made by any medical officer of the Marine Hospital Service detailed by the Sec- retary of the Treasury. On June 1, 1891, Dr. J. B. Hamilton resigned as Supervis- ing Surgeon General and was succeeded by Dr. Walter Wy- man. In this year the bacteriological laboratory was moved from New York to the Washington headquarters, which had recently been moved to the Butler Building at New Jersey Avenue and C St. S. E. Quarantine Law of. 1893. The necessity of an extension of the powers of the federal government in “preventing the in- trdduction of contagious diseases into the cotifitry- ‘and “theirs, spread from one state to another resulted in the passage of * the act of February 15, 1893 (27 Stat. I.., 449), which is still in force and which gives authority for all existing domes- tic and maritime quarantine regulations. While this act did not undertake to prohibit states or municipalities from main- taining quarantine stations, it provided that state officers might surrender local stations to the Secretary of the Treasury, who was authorized to receive and pay for them if he considered them necessary to the United States. It would probably have been impossible to pass a law prohibiting states from maintaining quarantine stations, and the best results were probably obtained by allowing the states to surrender their quarantine functions from time to time as they realized the advantages of the national system. Gradually the local stations have been surrendered by the states, the last one—agf fe New York—having been acquired in 1921. While the att authorizes the Secretary of the Treasury to pay for the state quarantine stations, this portion of the law is practically of no effect, as he cannot disburse money for this purpose with- out a specific appropriation by Congress. This act places upon the Supervising Surgeon General of the Marine Hospital Service the performance.of-all duties re-— lating to quarantine and nd quarantine regulations. That officer is specifically directed to examine the quarantine regulations - 20 THE PUBLIC HEALTH SERVICE of all state and municipal boards of health, and to cooperate with and aid the local boards in the enforcement of the regu- lations. If there are no regulations, or if the local regula- tions are insufficient, the Secretary of the Treasury is au- thorized to make additional regulations, which must operate uniformly and in no manner discriminate against any port or place. For the first time provision is made for quarantine regulations to prevent the introduction of contagious diseases other than cholera, yellow fever, smallpox, and plague, from one state or territory or the District of Columbia into another state or territory or the District of Columbia. The rules and regulations for both national and interstate quarantine pro- mulgated by the Secretary of the Treasury are to be enforced by the sanitary authorities of states and municipalities if these officers will undertake this duty, but if the local authorities fail or refuse to enforce the regulations the President is au- thorized to “execute and enforce the same and adopt such measures as in his judgment shall be necessary to prevent the intreduction and spread of such diseases, and may detail or appoint officers for that purpose.” This law provides also that vessels clearing from a foreign port for any port in the United States must obtain a bill of health from a consular officer or from a medical officer de- tailed for that purpose. The Secretary of the Treasury is authorized to make rules and regulations that must “be ob- observed by vessels sailing from a foreign port to the United States. Authority is given for the detail of medical officers to con- sulates for the purpose of furnishing information and giving bills of health. Consular officers at places to be designated by the Secretary of the Treasury are required to make weekly reports of sanitary conditions. The Secretary of the Treasury is also directed to obtain weekly reports of the sani- tary condition of ports and places within the United States, and to publish weekly abstracts of the consular sanitary re- ports and other pertinent information. Provision is also HISTORY 21 > made that the Secretary of the Treasury shall “by means of the voluntary cooperation of state and municipal authorities, of public associations, and private persons, procure informa- tion relating to the climatic and other conditions affecting the public health.” In order to furnish full protection against the introduction of contagious diseases the President was given authority ‘to prohibit, in whole or in part, the introduction of persons and property from such countries or places as he shall desig- nate and for such period of time as he may deem neces- sary.” Regulations of 1897. In 1897 the regulations of the service were again revised and provision was made for increasing the \C=T the service by dropping assistant surgeons who were unable to pass the examination for promotion. These provided that an assistant surgeon failing in his first examination should be given a second one at the end of the year; if he again failed to pass, it was further provided that he be reported to the Secretary of the Treasury as “not qualified for promotion” and “be requested by the Secretary of the Treasury to tender his resignation.” A passed as- sistant surgeon failing in two examinations was to be placed in the register as “not in line of promotion.” These regula- tions also provided for a retirement system for commissioned officers by placing them under “waiting orders.” An officer reported to be unfit to perform his duties by reason of disease, injury, or age could be ordered before a board of officers for examination. If his disability was incurred in line of duty the board was authorized to recommend that he be placed on waiting orders or given special duties of a light character. The pay of an officer placed on waiting orders was fixed at seventy-five per cent. of the salary of his grade. These regu- "lations likewise provided that acting assistant surgeons receiv- ing more than $300 a year should be appointed only after passing an examination prescribed by the Civil Service Com- mission. Previously these officers had been appointed by the 22 THE PUBLIC HEALTH SERVICE Secretary of the Treasury on the recommendation of the Supervising Surgeon General.?® Growth of the Service from 1898 to 1901. The Spanish- American War in 1898 presented grave problems to the quarantine division because troops were being moved to and from an area which was badly infected with yellow fever. In cobperation with tie War Department the Marine Hospi- tal Service assumed charge of the sanitation on transports, and later when the troops were returned to the United States, a national quarantine station under the direction of an officer of the Marine Hospital Service was established at Montauk Point at the request of the Secretary of War. At the conclusion of hostilities the quarantine laws of the United States were extended to Cuba and Porto Rico by the executive order of January 17, 1899.2 Medical officers of the Marine Hospital Service were immediately detailed to these islands, and quarantine service was organized at the principal ports. The inspection of immigrants at foreign ports was com- menced in 1899 when an assistant surgeon was sent to Naples for this purpose. This officer was detailed under the au- thority of the quarantine act of February 15, 1893, and he had definite authority only to issue bills of health and to re- quire the sanitary measures specified by the regulations. He was, however, instructed to note, for the benefit of the im- migration service, any physical infirmities or defects which might prevent the entry of the immigrant. There was no au- thority to prevent the embarkation of passengers who were not suffering from a communicable disease, but the trans- portation of defectives was generally prevented by calling the attention of the steamship company to the fact that the passenger would probably be refused admission under the im- migration laws. This plan worked well, although many 28 Regulations, 1897, Par. 17-52. 29 Sup. Surg. Gen., Annual Report, 1899, p. 468. HISTORY 23 persons who failed to pass inspection at Naples, went to French ports and embarked for Canada.® For some time the treatment of leprosy and the segregation of persons afflicted with this disease had been attracting con- siderable attention and on March 2, 1899, Congress passed an act (30 Stat. L., 976) directing the Supervising Surgeon General of the Marine Hospital Service to appoint a com- mission of medical officers of the service to investigate the origin and prevalence of leprosy and _.to report on legislation necessary to prevent the spread of the disease. The expendi- ture of $5,000 was authorized for this work, to be paid from the appropriation for preventing the spread of epidemic dis- eases. This commission submitted its report in 1902, and recommended the establishment of a national leprosarium to be maintained by the federal government.?* Provision for a national home for lepers was not made until February 3, 1917 (39 Stat. L., 872), and the institution was not opened until 1920. For several years the service had been considering the ad- visability of establishing a sanitarium for tuberculosis patients, and in 1899 it was decided that the abandoned mili- tary reservation at Fort Stanton, New Mexico, was the most suitable site in possession of the government that was not be- ing used for other purposes. The executive order of April 1, 1899, directed that this reservation be turned over to the Marine Hospital Service. The first patient was received at this institution on November 18, 1899, and on June 30, 1900, forty-seven patients were under treatment. When provision was made for civil governments in Hawaii and the former Spanish Islands the quarantine duties of the Marine Hospital Service were extended to these possessions. The executive order of January 3, 1900, placed the quaran- tine administration of the Philippine Islands under the Marine Hospital Service and set aside $300,000 from the revenues 30 Thid., 1899, p. 577; 1900, p. 523. #1 g7 Cong., 1 Sess, S. Doc. 269. 24 THE PUBLIC HEALTH SERVICE of the islands for that purpose. Section 10 of the act of April 12, 1900 (31 Stat. L., 80), creating a civil government for Porto Rico, and section 97 of the act of April 30, 1900 (31 Stat. L., 160), creating a government for the territory of Hawaii, provided that quarantine stations should be es- tablished as directed by the Supervising Surgeon General of the Marine Hospital Service, and that quarantine regulations should be under the control of the United States Government. The law relating to Hawaii stipulated that the health laws of the island should remain in the jurisdiction of the government of the territory, subject to the quarantine laws and regu- lations of the United States. A new building for the hygienic laboratory of the service was provided for in the sundry civil appropriation act ap- proved March 3, 1901 (31 Stat. L., 1137), but the building was not occupied until 1904. This act appropriated $35,000 for the erection of “necessary buildings and quarters for a laboratory for the investigation of infectious and contagious diseases, and matters pertaining to the public health.” The wording of this appropriation is significant in that there is recognition of the fact that the Marine Hospital Service was no longer concerned solely with medical treatment of specified beneficiaries, but had become the representative of the federal government in health matters. At first the in- vestigations made in the hygienic laboratory had been entirely in connection with the hospital branch of the service. Gradu- ally they had extended more and more into questions of public health and quarantine, owing mainly to demands made by state and municipal health organizations. For many years the results of its work had been published as appendices to the annual report of the Surgeon General, by 1899 the reports had increased to such an extent that it was deemed advisable to issue them in pamphlet form. Further authority over quarantine anchorages was con- 32 Sup. Surg. Gen., Annual Report, 1897, pp. 716-717. 33 Thid., 1899, p. 845. HISTORY 25 ferred on the Supervising Surgeon General by the act of March 3, 1901 (31 Stat, L.., 1086), which also made subject to quarantine regulations any vessel which might arrive with- in the territorial limits of the United States, but which did not attempt to enter any port. The act of February 15, 1893, applied only to vessels entering United States ports. In 1902 an appropriation of $250,000 was made for the purchase of the property used for a marine hospital at New York. At the most important port in the country, the hospi- tal had never been housed in a government building. Until 1870 seamen were treated at various hospitals under con- tract, in that year the use of Bedloes Island was obtained from the War Department, and the hospital was operated at that point for three years, when it became necessary to vacate because of the erection of the Statue of Liberty. After 1882 the hospital was quartered in rented buildings on Staten Island. In September, 1901, the Surgeon General submitted to the Secretary of the Treasury a plan for organizing a yellow fever institute composed of officers of the service and others specially qualified, who became members by invitation. The object of this organization was “to collect all facts concerning yellow fever, to designate the specific lines of inquiries to be made, and to make them.” This institute became a part of the Di- vision of Scientific Research which was organized at the same time.?* The results of the work were published in the series known as “Bulletin of the Yellow Fever Institute.” The Public Health and Marine Hospital Service, 1902 to 1912. The increase in duties of the service resulting from the supervision of quarantine, the medical inspection of immigrants, the prevention of the interstate spread of diseases, and the general investigations in the field of public health made it desirable to change the name of the service and give it more specific statutory powers. 34 Surgeon General, Public Health and Marine Hospital Service. Annual Report, 1902, p. 439. 26 THE PUBLIC HEALTH SERVICE The Act of July 1, 1902. Four bills relating to the service had been introduced during the first session of the Fifty- Seventh Congress, and on July 1, 1902, the President approved the act which changed the name of the service to the Public Health and Marine Hospital Service (32 Stat. L., 712). This act also changed the designation of the head of the service to Surgeon General, and fixed his salary at $5,000 a year. The salaries and allowances of the commissioned medical officers were to be the same as provided by existing regula- tions of the service. Commissioned medical officers de- tailed in charge of administrative divisions in Washington were to have the rank of assistant surgeons general. The President was authorized to utilize the service in time of war in such manner as would promote the public interest without impairing the efficiency of the service in filling the functions for which it was created. He was also given authority to prescribe regulations governing the administration, disci- pline, and uniforms of the service. A definite organization was provided for the Hygienic Laboratory, which had previously been operated under regu- lations of the service, and which had been doing work in the field of bacteriology and pathology only.®® Provision was made for a director of the laboratory detailed from the corps of commissioned officers of the service. The Surgeon Gen- eral was authorized to appoint heads of the Divisions of Chemistry, Zoology, and Pharmacology from outside the service at compensations to be fixed by the Surgeon General if commissioned medical officers were not available for this duty. An advisory board of nine persons was created for the purpose of consulting with the Surgeon General relative to the investigations to be undertaken and the methods of conducting the work. This board was made up of the direc- tor of the laboratory, five persons skilled in laboratory work in its relation to the public health and not in the regular em- ploy of the government, to be appointed by the Surgeon Gen- 35 Thid., 190s, p, 218. HISTORY 27 eral, and three experts detailed from the Army, the Navy, and the Bureau of Animal Industry, by the Surgeon General of the Army, the Surgeon General of the Navy, and the Sec- retary of Agriculture, respectively. An important provision for furthering the codrdination of national and state operations was made in this act by requiring the Surgeon General to call an annual conference of the health authorities of the states and territories and the District of Columbia. That officer was likewise authorized to call a special conference when ‘the interests of the public health would be promoted,” and required to call a special conference at the request of not less than five state or territorial Boards of Health, quarantine authorities, or state health officers. In order to secure uniformity in the registration of mortal- ity, morbidity, and vital statistics, it was made the duty of the Surgeon General to prepare and distributed after the annual conference of health officers “suitable and necessary” forms for the collection and compilation of such statistics, which were to be published in the Public Health Reports.®® Tests of Biologic Products. An additional duty was placed on the service by another act approved July 1, 1902 (32 Stat. L., 728), providing for tests of viruses applicable to the dis- eases of man and the licensing of manufacturers of these products. This law was passed in order to afford protection against infection from impure preparations and to establish a standard of strength and purity. The act provided for a board composed of the Surgeon General of the Army, the Surgeon General of the Navy, and the Supervising Surgeon General of the Marine Hospital Service, which was given authority, subject to the approval of the Secretary of the Treasury, to promulgate regulations governing the licensing of establishments engaged in the “propagation and preparation of viruses, serums, toxins, antitoxins, and analogous products, 3 The act of March 6, 1902 (32 Stat. L., 52), provided for the collection by the Census Bureau of annual statistics of births and deaths in registration areas. 28 THE PUBLIC HEALTH SERVICE applicable to the prevention and cure of diseases of man, in- tended for sale in the District of Columbia, or to be sent, car- ried, or brought for sale from any state, territory, or the Dis- tict of Columbia, into any other state, territory, or the District of Columbia, or from the United States into any foreign country, or from any foreign country into the United States.” The execution of the act was placed in the hands of the Sec- retary of the Treasury, but all tests and inspections have been made through the Public Health Service, as that was the only organization in the Treasury Department qualified to under- take work of this character. The first regulations under this act were promulgated on February 21, 1903, and as the law required an interval of six months before the regulations became effective, they were not in force until August 21, 1903.>" Since that time inspections and examinations have been made continuously. Development of the Service from 1902 to 1912. The Division of Zoology of the Hygienic Laboratory was organ- ized August 16, 1902, * and the first annual conference of the state and national health authorities was held on June 3, 1903.%° A new law regulating the admission of aliens, passed on March 3, 1903 (32 Stat. L., 1213-1222), did not materially change the status of the service as regards the examination of immigrants. Epileptics were added to the lists of persons to be excluded, and provision was made that physical and mental examination must be made by medical officers of the service, who shall have had at least two years’ experience in the practice of their profession after receiving the degree of doctor of medicine. If medical officers of the service were not available, civil surgeons of not less than four years’ ex- perience might be employed by the Commissioner General of Immigration. The medical officers certified the facts to the immigration officers and boards of inquiry, and were not 37 Surg. Gen., Annual Report, 1904, p. 370. 38 Tbid., 1903, p. 330. 89 Thid., p. 321. HISTORY 29 responsible for the execution of the statute. The Immigra- tion Service was required to reimburse the Public Health and Marine Hospital Service for all expenses incurred in making medical inspection of immigrants. The Division of Pharmacology in the Hygienic Labora- tory was established March 1, 1904, and several weeks later the laboratory moved into the new building provided by the act of March 3, 1901.* The act approved March 18, 1904 (33 Stat. L., 104), making appropriations for the legislative, executive, and judicial expenses of the government for the fiscal year ending June 30, 1905, contained a provision that the Public Health and Marine Hospital Service should re- main under the Treasury Department until otherwise speci- fically provided by law. This legislation was designed to prevent the transfer of the service to the new Department of Commerce and Labor, created by the act of February 14, 1903 (32 Stat. L. 825-830). Section 12 of this act provided that the President might transfer to the Department of Com- merce and Labor the whole or part of any branch of the State, Treasury, War, Navy, Justice, Post Office, or Interior Departments engaged in statistical or scientific work. A joint resolution approved February 24, 1905 (33 Stat. L., 1283), made specific provision for printing the bulletins of the Hygienic Laboratory and the Yellow Fever Institute. Authority was given to print not to exceed ten bulletins of the laboratory and five bulletins of the institute in any one year, the edition of each bulletin being limited to 5000 copies. Officers of the service had made a special investigation of leprosy in 1901, and at that time had recommended the es- tablishment of a national home for lepers, but no action was taken by Congress. The prevalence of leprosy in the Terri- tory of Hawaii led Congress to pass the act of March 3, 1903 (33 Stat. L., 1009), establishing a leprosy hospital and lab- oratory to be operated by the Public Health and Marine Hos- pital Service at Molokai, Hawaii. The Surgeon General was 40 Thid., 1904, pp. 36, 68. 30 THE PUBLIC HEALTH SERVICE authorized to receive not exceeding forty patients, committed under legal authorization of the Territory of Hawaii. Fifty thousand dollars were appropriated for the necessary build- ings and $50,000 for maintenance during the fiscal year ended June 30, 1906. It was not possible to make a contract for the erection of buildings within the amount appropriated, and the service undertook the necessary construction work by day labor. This procedure involved considerable delay, and the hospital was not opened until December 23, 1909.*! A change in the method of supplying money for the service was made in the deficiency appropriation act of March 3, 1903 (33 Stat. L., 1217). The permanent appropriation of the tonnage tax provided by the act of June 26, 1884 (23 Stat. L., 57), was repealed, effective June 30, 1906. The Sec- retary of the Treasury was required to submit detailed esti- mate for the fiscal year 1907 and annually thereafter. Since June 30, 1906, no permanent indefinite appropriations have been available, and the service has been dependent upon an- nual appropriations made by Congress. The organization of the Hygienic Laboratory was com- pleted on June 20, 1905, with the appointment of a Chief of the Division of Chemistry.** The extension of the national quarentine system was recommended by a conference of governors and representa- tives of the southern states held in Chattanooga on November 9 and 10, 1903, *® and had also been urged by President Roosevelt in his annual message to Congress on December 6, 1904. The result of the general demand for more effective national control was the passage of the act of June 19, 1906 (34 Stat. L., 299-301). While this act did not confer any additional authority on the Secretary of the Treasury, it did have the effect of extending the national system by the appro- priation of $500,000 for the purchase of local quarantine sta- 41 Tbid., 1910, p. 60. 42 Tbid., 1905, p. 227. 43 Tbid., 1906, p. 200. HISTORY 31 tions. By June 30, 1907, the service had taken over the quarantine stations of South Carolina, Mobile, and New Orleans, and made arrangements to establish a station at Galveston. At that time the national system controlled the Pacific Coast, the Gulf Coast with the exception of Texas, and the Atlantic Coast with the exception of Baltimore, New York, Boston, and a few of the neighboring minor ports. On February 20, 1907, a new law (34 Stat. L., 898-011) governing immigration was enacted, but the duties of the Public Health and Marine Hospital Service as regards the inspection of immigrants were not changed. Two years later the sundry civil appropriation act of March 4, 1909 (35 Stat. L., 1027), repealed the portion of the immigration act of Feb- ruary 20, 1907, requiring the Public Health and Marine Hospital Service to be reimbursed by the Immigration Service for all expenses incurred in making medical inspections of immigrants, and thereafter this expense was met from the specific appropriations of the Public Health and Marine Hospital Service. The marine hospitals maintained by the service gave ex- cellent opportunity for the study of many diseases, but it was felt that the scientific work of the service would be improved if patients could be admitted to the marine hospitals who were suffering from diseases that it was desirable to study, but who were not entitled to hospital service under the law. Accord- ingly Congress was induced to insert in the sundry civil ap- propriation act approved March 4, 1911 (36 Stat. L., 1304), a provision that persons with infectious or other diseases af- fecting the public health may be admitted to marine hospitals for the purpose of study, not to exceed ten cases in any one hospital at one time.** During the next two years several additional lines of general health activities were undertaken in cooperation with other government bureaus or in connection with new legis- 44 This provision was carried in each later appropriation act up to 1922, after which it was omitted. 32 THE PUBLIC HEALTH SERVICE lation. In January, 1911, a passed assistant surgeon was de- tailed to one of the mine rescue cars of the Bureau of Mines to make studies of the diseases of miners in West Virginia. In May of the same year the Chief of the Division of Zoology was detailed with a mine rescue car to study hookworm among miners, and an assistant surgeon was assigned to the mine rescue car at Pueblo in order to give advice regarding sanitary and medical matters and to make investigations of hygienic conditions in mines and of the influence of gases. In 1912 a medical officer was detailed to the Department of the Interior to assist the Bureau of Education in the super- vision of measures relating to the medical and surgical relief of the natives of Alaska. The Public Health Service Since 1912. It has been shown in the preceeding pages how the work of the Public Health and Marine Hospital Service had grown from the operation of hospitals for the benefit of seamen until this organization was administering foreign and interstate quarantine, making medical inspection of immigrants, and conducting general investigations in the field of hygiene and preventive medicine. Work relating to health was also being conducted by other bureaus of the government. The enforce- ment of the pure food and drug law had been placed in the hands of the Bureau of Chemistry of the Department of Agriculture; the federal inspection of meats entering inter- state commerce was made by the Bureau of Animal Industry of the Department of Agriculture; in 1902 the Bureau of the Census was specifically authorized to collect vital statistics in registration areas. The Act of August 14, 1912, and the events leading to it. Notwithstanding the progress that had been made, a strong sentiment had been developing for more extended activity on the part of the federal government in order to reduce the human and economic waste resulting from the spread of pre- ventable diseases. In 1904 the American Association for the HISTORY 33 Advancement of Science appointed a committee of one hundred to take such action as might be necessary to improve the health of the nation. Under the leadership of Prof. Irving Fisher this committee organized an extensive cam- paign to focus attention on the advantages of better super- vision of health problems. In 1908 both the major political parties took notice of this movement in their platforms. The Republican platform did not go further than to declare that “we commend the efforts designed to secure greater efficiency in national public health agencies and favor such legislation as will effect this pur- pose.” The Democratic platform was more specific and con- tained the following recommendation: “We advocate the organization of all existing national public health agencies in- to a national bureau of public health, with such power over sanitary conditions connected with factories, mines, tene- ments, child labor, and other subjects as are properly within the jurisdiction of the federal government, and do not in- terfere with the power of the states controlling public health agencies.” *° In 1908 President Roosevelt appointed a commission con- sisting of Charles D. Walcott, J. R. Garfield, W. L. Capps, William Crozier, and Gifford Pinchot, to study the organi- zation of the scientific work of the government. On No- vember 13, 1908, this commission made a report to the Presi- dent recommending that all bureaus relating to the public health be transferred to the Department of the Interior. President Roosevelt, in his last annual message to Congress on December 8, 1908, made the following recommendations: It is highly advisable that there should be intelligent action on the part of the Nation on the question of preserving the health of the country. Through the practical extermination 4561 Cong., 2 Sess, S. Doc. 637, p. 5. 46 Hearings before House Committee on Interstate and Foreign Commerce on bills relating to health activities of the general govern- ment, 1910, p. 23. 34 THE PUBLIC HEALTH SERVICE in San Francisco of disease bearing rodents, our country has thus far escaped the bubonic plague. This is but one of the many achievements of American health officers; and it shows what can be accomplished with a better organization than at present exists. The dangers to public health from food adulteration and from many other sources, such as the menace to the physical, mental and moral development of children from child labor, should be met and overcome. There are numerous diseases, which are now known to be preventable, which are, nevertheless, not prevented. The recent International Congress on Tuberculosis has made us painfully aware of the inadequacy of Amer- ican public health legislation. This Nation can not af- ford to lag behind in the world-wide battle now being waged by all civilized people with the microscopic foes of mankind, nor ought we longer to ignore the reproach that this govern- ment takes more pains to protect the lives of hogs and of cattle than of human beings. The first legislative step to be taken is that for the concen- tration of the proper bureaus into one of the existing depart- ments. I, therefore, urgently recommend the passage of a bill which shall alithorize a redistribution of the bureaus which shall best accomplish this end. President Taft repeatedly recommended the development and unification of the health activities of the federal govern- ment. In his first annual messages submitted to Congress on December 7, 1909, he called attention to this subject in the following words: For a very considerable period a movement has been gather- ing strength, especially among the members of the medical profession, in favor of a concentration of the instruments of the National Government which have to do with the promotion of public health. In the nature of things, the Medical De- partment of the Army and the Medical Department of the Navy must be kept separate. But there seems to be no reason why all the other bureaus and offices in the General Government which have to do with the public health or subjects akin thereto should not be united in a bureau to be called the “Bureau of Public Health.” This would neces- sitate the transfer of the Marine Hospital Service to such a “ HISTORY 35 bureau. I am aware that there is wide field in respect to the public health committed to the States in which the Federal Government can not exercise jurisdiction, but we have seen in the Agricultural Department the expansion into widest usefulness of a department giving attention to agriculture when that subject is plainly one over which the States properly exercise direct jurisdiction. The opportunities offered for useful research and the spread of useful information in re- gard to the cultivation of the soil and the breeding of stock and the solution of many of the intricate problems in pro- gressive agriculture have demonstrated the wisdom of estab- lishing that department. Similar reasons, of equal force, can be given for the establishment of a bureau of health that shall not only exercise the police jurisdiction of the Federal Gov- ernment respecting quarantine, but which shall also afford an opportunity for investigation and research by competent experts into questions of health affecting the whole country, or important sections thereof, questions which, in the absence of Federal governmental work, are not likely to be promptly solved. In March, 1910, Senate Bill 6049, providing for a Depart- ment of Public Health, under the supervision of a Secretary of Public Health was introduced into the Senate. This bill proposed to make it the duty of the new department “to supervise all matters within the control of the federal govern- ment relating to the public health and to diseases of animal life,” and to transfer to it “all departments and bureaus be- longing to any department, excepting the Department of War and the Department of the Navy, affecting the medical surgi- cal, biological or sanitary service, or any questions relative thereto.” Specific provision was made for incorporation in this department of the Public Health and Marine Hospital Service, the medical officers of the Revenue Cutter Service, of the Pension Office, of the Indian Service, and of Soldier’s Homes, all hospitals, the Bureaus of Entomology, Chemistry, and Animal Industry of the Department of Agriculture, and the emergency relief service of the Government Printing Office. This bill found many warm advocates, but it also encountered determined opposition. Other bills introduced 36 THE PUBLIC HEALTH SERVICE about the same time proposed creating an independent es- tablishment for public health work, changing the name of the Public Health and Marine Hospital Service to the Public Health Service, and the creation of a Bureau of Health in the Department of Commerce and Labor. Beyond holding public hearings Congress took no action on any of these bills. *" In his second annual message, transmitted to Congress December 6, 1910, President Taft again recommended the creation of a single bureau to deal with health activities, in the following words: In my message of last year I recommended the creation of a Bureau of Health, in which should be embraced all those Government agencies outside of the War and Navy Depart- ments which are now directed toward the preservation of public health or exercise functions germane to that subject. I renew this recommendation. I greatly regret that the agi- tation in favor of this bureau has aroused a counteragitation against its creation, on the ground that the establishment of such a bureau is to be in the interest of a particular school of medicine. It seems to me that this assumption is wholly un- warranted, and that those responsible for the Government can be trusted to secure in the personnel of the bureau the ap- pointment of representatives of all recognized schools of med- icine, and in the management of the bureau entire freedom from narrow prejudice in this regard. In May, 1912, the President transmitted to Congress a re- port of the Commission on Economy and Efficiency on government services pertaining to public health, in which it was recommended that provision be made by law for a public health service which should be an independent establishment 47 For text of Senate Bill 6049 and papers advocating it see 61 Cong., 2 Sess. Senate Doc. 637. See also Hearings before House Committee on Interstate and Foreign Commerce on bills relating to health activities of the general government, 1910, 651 pages; Hear- ings before Committee on Public Health and National Quarantine U. S. Senate on Bill. S. 6049, to establish a department of health and other purposes, 1910, 130 pages. HISTORY 37 and not subject to any existing executive department, but which should not have the rank of a department. It was proposed to transfer to the new establishment the following existing organizations: (1) the Public Health and Marine Hospital Service; (2) the Bureau of Chemistry of the De- partment of Agriculture, or that fart of it charged with the investigation of the adulteration of foods, drugs, and liquors and with the execution and enforcement of the act for pre- venting the sale or transportation of adulterated, misbranded, poisonous, or deleterious foods, drugs, medicines, and liquors; and (3) the Division of Vital Statistics of the Bureau of the Census. It was further proposed to grant authority to the President to transfer to the new establishment, the whole or part of any existing government organization engaged in work pertaining to the public health, with the exception of the Medical Department of the Army and the Bureau of Medicine and Surgery of the Navy.*® Congress did not see fit to pass any legislation creating a new department or establishment or consolidating any of the national agencies doing health work. The act of August 14, 1912 (37 Stat. L., 309), the latest general act relating to the service, did not go further than to change the name of the Public Health and Marine Hospital Service to the Public Health Service, to give the service definite statutory authority to make extensive investigations in the field of public health, and to increase the salaries of the commissioned officers. The act of August 14, 1912, expressly provided that all laws relating to the Public Health and Marine Hospital Service should apply to the Public Health Service, and it extended the field of activity by the provision that the Public Health Service “may study and investigate the diseases of man and conditions influencing the propagation and spread thereof, in- cluding sanitation and sewage and the pollution either directly or indirectly of the'navigable streams and lakes of the United States, and it may from time to time issue information in the #862 Cong., 3 Sess., H. Doc. 1252, pp. 909-915. 38 THE PUBLIC HEALTH SERVICE form of publications for the use of the public.” Under this law the service has ample authority to make any studies re- lating to health and diseases for which funds are available, The law of July 1, 1902, had provided that the salaries and allowances of the commissioned officers of the service should continue as fixed by the existing regulations of the service. The act of August 14, 1912, which was the first law in which the salaries were stated, fixed them as follows: Surgeon General, $6000; Assistant Surgeon General, $4000; Senior Surgeon, $3500; Surgeon, $3000; Passed Assistant Surgeon, $2400; Assistant Surgeon, $2000. The grade of senior sur- geon was a new one; the number being limited to ten. Pro- vision was also made for longevity pay for officers below the rank of surgeon general, at the rate of ten per cent. of the annual salary for each five years’ service, but the longevity pay was not to exceed forty per cent. of the basic salary, and total of the basic salary and longevity increase was not to exceed $5000 for Assistant Surgeons General, $4500 for Senior Surgeons, and $4000 for Surgeons. Compensation was at the rates given above until January 1, 1920.*? New Activities in 1913 and 1914. Duties in connection with the law imposing a tax on matches made of common poisonous white or yellow phosphorus were imposed on the: service by regulations issued by the Commissioner of Internal Revenue on May 10, 1913, in accordance with the provisions of the act of April 9, 1912 (37 Stat. L., 81).5° The pur- pose of this tax was to prevent the manufacture of matches made of common poisonous white or yellow phosphorus, the Commissioner of Interral Revenue being authorized to make the necessary regulations. As the officer had no adminis; trative machinery for making the scientific examinations re- quired by the statute, he delegated that portion of the work to the Public Health Service. The regulations provided that 4 See page 54. 50 United States Internal Revenue Regulations No. 32. May 1913. Regulations governing white phosphorus matches under internal- | revenue law. HISTORY 39 each manufacturer should furnish samples of his product and material for examination whenever deemed necessary. In addition the Surgeon General was authorized to buy matches in the open market in order to determine whether poisonous material was being used. If the Surgeon General found that white or yellow phosphorus was being used in any form he was to make an examination of the factory and materials, as well as of the persons employed. The results of these ex- aminations were to be reported to the Commissioner of Inter- nal Revenue as a basis for determining whether the factory was subject to the tax.5! The Indian appropriation act for the fiscal year 1913, ap- proved August 24, 1912 (37 Stat. L., 519), appropriated $10,000 to enable the Public Health Service to report on the prevalence of contagious diseases among the Indians of the United States. Fourteen officers were assigned to this work, and over 39,000 Indians were examined.’? The results of the survey were published.? The deficiency act approved March 4, 1913 (37 Stat. L., 915), provided that the Director of the Hygienic Laboratory = should receive the pay and allowances of a Senior Surgeon. Increased Field Investigations in 1014. The sundry civil act for the fiscal year 1914, approved June 23, 1913 (38 Stat. L., 25), contained for the first time an appropriation for field investigations reading as follows: “Field investigations of public health matters: For investigations of diseases of man and conditions influencing the propagation and spread thereof, including sanitation and sewage, and the pollution of navigable streams and lakes of the United States, including personal services, $200,000.” This appropriation resulted from the increase in the activities of the service incident to the passage of the act of August 14, 1912. During the fiscal year ending June 30, 1914, the additional 51 Surg. Gen., Annual Report, 1913, p. 46. 52 Thid., p. 25. 53 62 Cong., 3 Sess., S. Doc. 1038. 40 THE PUBLIC HEALTH SERVICE work authorized by the act of August 14, 1912, and made possible by the increased appropriations, was conducted along two general lines, (1) diseases of man and sanitation and (2) investigations of water supplies and sewage disposal.’ Among the general diseases of man investigated were beri- beri, diptheria, endemic goitre, hookworm disease, leprosy, typhoid fever, malaria, pellagra, trachoma, tuberculosis, and typhus fever. The following studies of occupational diseases were made: (1) Health of garment workers in New York City, (2) tuberculosis in Cincinnati as related to certain in- dustries, (3) sanitary survey of Indiana industries employing woman labor, (4) trachoma among steel mill workers, (5) mine sanitation studies, and (6) metallurgical plant investi- gations; the two last being in coOperation with the Bureau of Mines.” In addition, systematic investigations of rural sani- tation, school hygiene, industrial hygiene, and health organi- zation and administration were taken up and enlarged. The investigations of water supplies and sewage included three distinct lines of research, (1) pollution of rivers and coastal waters, (2) disposal of sewage, and (3) treatment of indus- trial wastes. All the work undertaken had a direct bearing on the protection of water supplies and the shellfish industry, and the sewage studies were of practical benefit to house- holders and small communities in the prevention of disease.’ Medical Aid to Deep Sea Fisheries, 1914. Medical aid to crews of American vessels engaged in the deep sea fisheries was authorized by the act approved June 24, 1914 (38 Stat. L., 387), which provided that the Secretary of the Treasury . might assign a revenue cutter (Coast Guard vessel) to this work and detail such surgeons and other persons of the Public Health Service as might be necessary. Inoculation of Government Employees, 1915. In order to protect government employees against typhoid fever and smallpox, the Secretary of the Treasury on February 12, 54 Surg. Gen., Annual Report, 1914, p. 16. 55 Tbid., pp. 46-52. 58 Tbid., p. 17. HISTORY 41 1915, issued an order directing medical officers of the service to perform vaccination against typhoid fever and smallpox for all civil employees engaged in interstate travel or regularly engaged in handling mail or other material to be carried in interstate traffic.?” Fumigation of Forecastles, 19015. The seamen’s act of March 4, 1915 (38 Stat. L., 1166), provided that the fore- castles of merchant ships should be fumigated at such inter- vals as may be provided by regulations of the Surgeon General of the Public Health Service, with the approval of the Department of Commerce. Studies of Rural Sanitation, 1916. Studies of rural sani- tation had been undertaken soon after the enlargement of the activities of the service resulting from the passage of the act of August 14, 1912, but the first specific appropriation for this work was made in the deficiency appropriation act ap- proved February 28, 1916 (39 Stat. L., 21), which made $25,000 available for this purpose. An appropriation has been made for this work in each subsequent annual appropria- tion act. Control of Biologic Products, 1916. The sundry civil act for the fiscal year 1917, approved July 1, 1916 (39 Stat. L., 279), contained the first specific appropriation for expenses of regulating the propagation and sale of viruses, serums, toxins, and analogous products required by the act of July 1, 1902.7% Up to this time the expenses of this work had been paid from the appropriations for traveling expenses and for the mainte- nance of the Hygienic Laboratory. 5° National Home for Lepers, 1917. As early as 19o2 the service had recommended the establishment of a home for lepers, but this institution was not authorized until February 3, 1917 (39 Stat. L., 872). The Secretary of the Treasury was authorized to obtain a suitable site and erect necessary 57 Ibid., 1915, p. 277. 58 See page 27. 5 Sundry Civil Bill 1917. Hearings before subcommittee of House Committee on Appropriations, p. 129. 42 THE PUBLIC HEALTH SERVICE buildings for a home for the care and treatment of persons afflicted with leprosy, this institution to be under the adminis- tration of the Public Health Service. This act provides that the home shall receive any person afflicted with leprosy, who presents himself or herself, who may be apprehended under the authority of the quarantine acts, or who may be “con- signed” to the home by the proper health authorities of any state, territory, or the District of Columbia. The Surgeon General is authorized, at the request of the state or territorial authorities, to send for persons afflicted with leprosy and to convey them to the home for detention and treatment; authority is given to pay transportation expenses if the transportation is undertaken for the protection of the pub- lic health. The war interferred with the selection of a site and the home at Carville, Louisiana, was not opened until 1020. Hospi Treatment for Injured Government Employees. Compensation to employees of the government injured in the performance of their duties was provided for in the act ap- proved September 7, 1916 (39 Stat. L., 742-750). The ad- ministration of this act was placed under an independent commission, which was organized March 17, 1917, but the actual work of the commission did not begin until April 1, 1917.8 Section nine of the act of September 7, 1916, pro- vides that “United States medical officers and hospitals” shall furnish reasonable medical, surgical and hospital services and supplies to any government employee injured while in the per- formance of his duty. This act added to the beneficiaries of the hospitals of the service, as the marine hospitals were gener- ally closer to the homes of injured employees than those of the Army and Navy. Out-patient relief was given and physical examinations made at the other stations of the service. During the fiscal year 1918 this class of patients received 15,201 hospital days relief and 6181 office treatments; during UU. S. Employees’ Compensation Commission, Annual Report, 1918, p. 5. HISTORY 43 the fiscal year 1921 this service had grown to 61,811 hos- pital days relief and 66,793 office treatments. Medical Inspection of Immigrants, 1917. The present law governing the medical inspection of immigrants was passed February 5, 1917, and became effective May 1, 1917 (39 Stat. L., 874-898). The classes excluded on medical grounds are “idiots, imbeciles, feeble-minded persons, epileptics, in- sane persons, persons who have had one or more attacks of insanity at any time previously, persons of constitutional pyscopathic inferiority, persons with chronic alcoholism; . . . persons afflicted with tuberculosis in any form or with a loathsome or dangerous contagious disease, [and] persons not comprehended within any of the foregoing ex- cluded classes who are found to be and are certified by the examining surgeon as being mentally or physically defective, such physical defect being of a nature which may affect the ability of such alien to earn a living.” The general supervision of the admission of aliens is con- tinued under the Bureau of Immigration of the Department of Labor, but the physical and mental examination of all arriving aliens is required to be made by medical officers of the Public Health Service who have had at least two years’ experience in the practice of their profession since receiving the degree of doctor of medicine. If medical officers of the Public Health Service are not available, civil surgeons of not less than four years’ experience may be employed by the Im- migration Service. An alien certified by the examining officer for insanity or mental defects may appeal to a board of medical officers of the Public Health Service to be con- vened by the Surgeon General. As this act requires the physical and mental examination of all “arriving aliens” (section 16) it applies also to all alien seamen. Under the earlier law it was necessary to examine only those seamen who desired to land, but the necessity of ex- amining all alien seamen on incoming ships added greatly to the work. For instance, at New York during one month 44 THE PUBLIC HEALTH SERVICE there were inspected 6799 immigrants and 16,028 alien sea- men.®! The Secretary of the Treasury was given authority to de- tail medical officers of the Public Health Service to duty in foreign countries in connection with the enforcement of the layv. General War Activities. On April 3, 1917, when it be- came evident that war would be declared against Germany the President put into effect the provisions of section 4 of the act approved July 1, 1902, and issued the following executive order making the Public Health Service a part of the mil- itary forces of the United States: ¢* Under the authority of the act of Congress, approved July 1, 1902, and subject to the limitations therein expressed, it is ordered that hereafter in times of threatened or actual war the Public Health Service shall constitute a part of the mili- tary forces of the United States. and in times of threatened or actual war, the Secretary of the Treasury may, upon re- quest of the Secretary of War or the Secretary of the Navy, detail officers or employees of said service for duty either with the Army or the Navy. All the stations of the Public Health Service are hereby made available for the reception of sick and wounded officers and men, or for such other puroses as shall promote the public interest in connection with military operations. Owing to defective health administration in many parts of the country it was felt that the military effectiveness of the country might be seriously handicapped through the spread of disease. It was concluded that this danger could be over- come only by an intensive system of federal health super- vision in the zones surrounding military camps and import- ant industrial centers engaged in war work. In the summer of 1917 the Public Health Service was doing sanitary work in twenty-six extra-cantonment zones; by the end of 1918 operations were being conducted in forty-seven such areas. $1 Surg. Gen., Annual Report, 1917, p. 152. 2 Ibid, p. 317. HISTORY 43 In this work effective aid was given by sanitary units main- tained by the American Red Cross. In many cases the states and local authorities supplied additional funds, but the greater part of the cost was paid by the federal govern- ment. *3 The work undertaken included the control of malaria by the establishment of zones free from mosquito-breeding places, the improvement of local water supplies, provision for the disposal of human excreta, vaccination against typhoid fever and smallpox, the collection of morbidity statistics, and general health education. By the end of 1918, there were engaged in this work forty-nine commissioned officers, seventy-two acting assistant surgeons, and approximately four hundred technical employees, in addition to a large force of laborers.®* In order to prevent the interstate spread of disease by either the military forces or the civil population, the Sec- retary of the Treasury on May 16, 1917, issued an order that vaccination against smallpox, typhoid fever, and para- typhoid fever might be obtained free of charge by any person at places designated by the Surgeon General of the Public Health Service.% After the acquisition of the Virgin Islands a medical officer was sent to St. Thomas on July 24, 1917, with orders to report to the governor for duty as quarantine officer. The existing regulations were continued in force until the promul- gation of the executive order of September 27, 1917, which extended the national quarantine laws and regulations to the islands.%® In order to codrdinate all activities dealing with public health matters, the President on July 1, 1918, issued the fol- $s 1hid., p. 15. 64 War activities of the Public Health Service, by B. S. Warren and C. S. Bolduan: Reprint 531, from Public Health Reports, 1919, pp. 5-11. 65 Surg. Gen., Annual Report, 1917, p. 251. 66 Tbid., 1918, pp. 227-8. 46 THE PUBLIC HEALTH SERVICE lowing executive order placing all such work under the Pub- lic Health Service: Whereas, in order to avoid confusion in policies, dupli- cation of effort, and to bring about more effective results, unity of control in the administration of the public health ac- tivities of the Federal Government is obviously essential, and has been so recognized by Acts of Congress creating in the Treasury Department a Public Health Service, and specially authorizing such Service “to study the diseases of man and the conditions influencing the propagation and spread thereof” and “to cooperate with and aid state and municipal boards of health ;” Now, therefore, I Woodrow Wilson, President of the United States, by virtue of the authority vested in me as Chief Executive, and by the Act “authorizing the President to co- ordinate or consolidate executive bureaus; agencies, and of- fices, and for other purposes, in the interest of economy and the more efficient concentration of the Government” approved May 20, 1918, do hereby order that all sanitary or public health activities carried on by any executive bureau, agency, or office, especially created for or concerned in the prosecution of the existing war, shall be exercised under the supervision and control of the Secretary of the Treasury. This order shall not be construed as affecting the jurisdic- tion exercised under authority of existing law by the Sur- geon General of the Army, the Surgeon General of the Navy, and the Provost Marshal General in the performance of health functions which are military in character as distinguished from civil public health duties, or as prohibiting investigations by the Bureau of Labor Statistics of vocational diseases, shop sanitation, and hygiene.” The work taken over as a result of this order included the maintenance of sanitary conditions in 170 shipyards; supervision over medical and sanitary matters in industrial plants having contracts with the Ordnance Department; medical supervision over nitrate plants at Nitro, West Vir- ginia, Muscle Shoals, Alabama, Ancor and Toledo, Ohio, 67 1bid., p. 10. HISTORY 47 Nashville, Tennessee, and Richmond, Virginia; and the formulation, in cogperation with the Working Conditions Service of the Department of Labor, of general sanitary codes to protect the workers in war industries. In the field of scientific research the war activities included studies of the relation of industrial fatigue to efficiency undertaken in cooperation with the Council of National De- fense; the detection and prevention of trinitrotoluol poisoning; the nutritive value of various kinds of flour and bread ; the in- fluence of heat on the vitamine content of beef; the develop- ment of a protective varnish against dermatitis from parazol; the preparation of an antitoxin against gas gangrene; the ex- amination of specimens of food supposed to have been contam- inated by enemy agents ; and the formulation of toxilogical and chemical standards for arsphenamine.®® Control of Venereal Diseases. The spread of venereal dis- eases has always been an accompaniment of war, and the mil- itary and civil authorities both took prompt steps to control the disease in order to protect the health of the military forces. The treatment of infected enlisted men was a function of the medical departments of the Army and Navy, but as the dis- ease was acquired in areas outside of military and naval camps and stations, it became the duty of the civil authorities to stamp out the sources of infection. The acts of May 18, 1917 (40 Stat. L.., 83), and October 6, 1917 (40 Stat. L. 393), conferred upon the Secretary of War and the Secretary of the Navy respectively, police powers for the suppression of prostitution in the immediate vicinity of military and naval stations of every character, but these acts made no provision for the medical treatment of infected persons or for any general educational measures. The pre- valence of prostitution in areas that could not be brought under the control of the military and naval authorities resulted in the infection of many enlisted men, as well as of men who had not been called to the colors. 68 Warren and Bolduan, p. 15. 48 THE PUBLIC HEALTH SERVICE In the sanitary work in the extra-cantonment areas, the American Red Cross, at the beginning of the war, provided funds for the operations of venereal disease clinics, which were under the supervision of the Public Health Service. These clinics were started in December, 1917, and by July, 1918, 25 were in active operation and 10,370 persons had been treated.®? At the beginning of 1918 only two states—California and Massachusetts—had adopted a comprehensive plan for com- bating venereal diseases. \Early in January, . 1918, the Surgeon General of the Public Health Service sent a telegram to all state health officers, requesting their cooperation in a campaign for the control of these diseases.) The hearty and universal reply encouraged the preparation of suggestions to state boards and the outline of regulations. This work was under the direction of the Division of Domestic Quarantine, which had authority to prohibit the transportation of infected persons in interstate traffic, but had no police power within the separate states. The Division of Domestic Quarantine, however, developed a plan for cooperation between the Public Health Service and the State authorities. Briefly summarized, the plan provided for the appoint- ment of an officer in each State to direct the work of venereal disease control. e salary of such officer, selected by the State health officer, was to be paid by the State and Federal Governments jointly.) Each State was at once to provide for the notification of all cases of venereal disease, and to make provision for the extension of facilities for early diag- nosis and treatment. Repressive measures, looking to isola- tion and treatment of dangerously infected individuals, and educational measures for the general public as well as for the infected persons, were also to be provided for.” In addition, arrangements were made for (1) better coopera- tion between the Commission on Training Camp Activities and % Surg. Gen., Annual Report, 1918, p. 98. Warren and Bolduan, p. 20. HISTORY 49 the Public Health Service officer in charge of extra-cantonment sanitation; (2) provision for treatment of United States pris- oners, and (3) distribution of free arsphenamine to clinics op- erated under joint state and federal control. As the work developed it became evident that the states would not have sufficient funds to carry on any educational propaganda. At the annual meeting of the state health officers in June, 1918, the matter was discussed and a bill was drafted which had the approval of the Council of National Defense, and of the Surgeons General of the Army, Navy, and Public Health Service. This bill was introduced in the Senate as Senate bill 4608, but was incorporated in Chapter XV of the army appropriation act for the fiscal year 1919, approved July 9, 1918 (40 Stat. L., 886). Section 3 of this act created a Division of Venereal Dis- eases in the Public Health Service “to be under the charge of a commissioned medical officer of the United States Public Health Service detailed by the Surgeon General of the Public Health Service, which officer while thus serving shall be an Assistant Surgeon General of the Public Health Service, sub- ject to the provisions of law applicable to assistant surgeons general in charge of administrative divisions in the District of Columbia of the Bureau of the Public Health Service. There shall be in such Division such assistants, clerks, investigators, and other employees as may be necesary for the performance of its duties and as may be provided for by law.” Section 4 prescribed that the “duties of the Division of Venereal Diseases shall be in accordance with rules and regu- lations prescribed by the Secretary of the Treasury, (1) to study and investigate the cause, treatment, and prevention of venereal diseases; (2) to cooperate with State Boards or De- partments of Health for the prevention and control of such diseases within the states; and (3) to control and prevent the spread of these diseases in interstate traffic ) Provided, That nothing in this chapter shall be constructed as limiting the func- tions and activities of other departments or bureaus in the pre- 50 THE PUBLIC HEALTH SERVICE vention, control, and treatment of venereal diseases and in the expenditure of moneys therefor.” Section 7 appropriated $200,000 for the establishment and maintenance of the Division of Venereal Diseases during the fiscal year 1919. This act provided also for other agencies for the suppres- sion of venereal diseases. Section 1 created the Interdepart- mental Social Hygiene Board consisting of the Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury as ex-officio members, and of the Surgeons (General of the Army, Navy, and the Public Health Service, or of rep- resentatives designated by the heads of the War, Navy, and Treasury Departments. Section 2 authorized and directed the Secretary of War and the Secretary of the Navy “to adopt measures for the purpose of assisting the various states in caring for civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal diseases.” Section 5 appropriated $1,000,000 for the fiscal year 1919 to be expended under the joint direction of the Secretary of War and the Secretary of the Navy to carry out the provis- ions of section 2 quoted in the preceding paragraph. These secretaries authorized the Interdepartmental Social Hygiene Board to administer this fund.™ Section 6 of the act appropriated $1,000,000 for each of the fiscal years 1919 and 1920 to be paid to the states for the use of boards or departments of health in the prevention, control, and treatment of venereal diseases. This sum was to be allotted to each state, in accordance with rules and regu- lations prescribed by the Secretary of the Treasury, in pro- portion to the population of each state. For the fiscal year 1920 it was provided that each state should specifically appro- 71 U. S. Interdepartmental Social Hygiene Board, Annual Report, 1920, p. 171. HISTORY 51 priate or set aside for the same purpose an amount equal to the money allotted by the United States. The original draft of the bill” 7 provided that the Interdepartmental Social Hy- giene Board should recommend rules and regulations for the expenditure of this sum, but the act as passed did not give that Board any part in preparing the regulations, which were drafted by the Public Health Service and approved by the Secretary of the Treasury. As the fund was to be disbursed by the Interdepartmental Social Hygiene Board the regula- tions provided that the state allotment must be expended in accordance with an accounting system to be prescribed by that Board. There was appropriated also to the Interdepartmental So- cial Hygiene Board $100,000 for each of the fiscal years 1919 and 1920 to be paid to institutions for scientific research for discovering “more effective medical measures in the preven- tion and treatment of venereal diseases” and $300,000 to be paid to suitable institutions “for the purpose of discovering and developing more effective educational measures in the pre- vention of venereal disease, and for the purpose of sociologi- cal and psychological research related thereto.” The Interdepartmental Social Hygiene Board was directed to recommend to the Secretary of the Treasury, the Secretary of War, and the Secretary of the Navy, such general measures “as will promote correlation and efficiency in carrying out the purposes of this chapter by their respective departments.” An appropriation of $100,000 was made for the fiscal year 1919 to be used under the direction of the Interdepartmental Social Hygiene Boards for any purpose for which any of the other appropriations in the same chapter were available.” The Division of Venereal Diseases was organized immed- iately after the passage of the act of July 9, 1918, described 72 Army Appropriation bill 1919. Hearings before Committee on Military Affairs, U. S. Senate, 1918, p. 59. 78 For statements of the work of the U. S. Interdepartment Social Hygiene Board see Manual for the various agents of the Interde- partmental Social Hygiene Board, 1920, and Annual Report, 1920. 52 THE PUBLIC HEALTH SERVICE above. On September 4, the Secretary of the Treasury issued the regulations under which the state boards could obtain their shares of the million dollar fund;** and on November 19, 1918, regulations governing the interstate travel of persons infected with venereal diseases were issued. ™ Additional clinics were established, the aid of physicians and druggists was enlisted, the state and city authorities were urged to sup- press prostitution, and an extensive educational campaign was carried gn by means of pamphlets, lectures, and motion pic- tures. / Hospital Relief for the Army and Navy. The executive order of April 3, 1917, provided that all the stations of the Public Health Service should be available for the reception of sick and wounded officers and men. This work, however, did not throw any extraordinary burden on the Public Health Service, as during the fiscal year 1918 the relief extended to Army and Navy patients amounted to only 31,267 hospital days out of 534,991 hospital days and the office treat- ments were only 4455 out of 96,004; during the fiscal year 1919, the Army and Navy relief amounted to 46,197 hospital days out of a total of 757,018 and 2697 office treatments out of 104,763. The hospital work did not increase materially until after the men were discharged from the Army and be- came beneficiaries of the Bureau of War Risk Insurance. Influenza Epidemic of 1918. Early in the fall of 1918 influenza became prevalent in the United States, and by the middle of September had spread throughout the eastern states. In order to supply information regarding methods of prevention, six million copies of a pamphlet for the use of the laity were widely distributed. On September 26 the state health officer of Massachusetts requested immediate aid from the Public Health Service, as not enough doctors and nurses were available. There was a shortage of doctors and nurses in other places, and by the first of October the situation had 7¢ Public Health Reports, September 13, 1918. 75 Surg. Gen. Annual Report, 1919, p. 238. - HISTORY 53 become so serious that Congress appropriated a million dollars to enable the Public Health Service to combat and suppress the disease (40 Stat. L., 1008). Even after the money was provided, it was difficult to obtain medical and nursing per- sonnel. The Service could not undertake to provide enough doctors and nurses to treat individual cases, although this was done wherever possible. The work of relief was decentral- ized by appointing a director for each state, and the local re- sources were organized in advance of the height of the epi- demic. “Plans were made for opening emergency hospitals as needed, volunteer nurses were organized, emergency kitchens established, etc., and in this way many communities were able to take care of themselves when the epidemic was well established.” During the epidemic sixty-four commis- sioned officers were on influenza duty, in addition to 1085 other physicians, 703 nurses and nurses’ assistants, and 328 persons doing work of a miscellaneous character.” Organization of Reserve Corps. On October 27, 1013, Congress authorized a reserve for the Public Health Service along lines similar to the Officers’ Reserve Corps of the Army and Navy (40 Stat. L., 1017). This act provides that the President, after such examination as he may prescribe, may commission officers in the reserve for a period of five years. Reserve officers are subject to call to active duty at any time, and when called to active duty receive the pay and allowances of the grade in which they hold commissions. Organization of New Administrative Units. In order to extend and coordinate the educational work of the service a section of Public Health Education was organized on April 751910," 17 The growth of the hospital work resulting from the treat- ment of discharged soldiers greatly increased the number of complaints of mistreatment of patients or mismanagement, and it was deemed advisable to create a separate administra- "6 Surg. Gen., Annual Report, 1919, pp. 81-3. 7 Ibid. p. 213. 54 THE PUBLIC HEALTH SERVICE tive unit for the investigation of charges. Accordingly the inspection section was created on February 20, 1920, with a commissioned officer of the rank of Assistant Surgeon General in charge. On August 29, 1920, the title of this unit was changed to that of General Inspection Service. 7s Another administrative unit resulting from the growth of the work was the Purveying Service, organized April 9, 1920. Formerly there had been a purveying depot attached to the Division of Marine Hospitals and Relief. As this depot purchased supplies for all stations, and not for the hospitals exclusively, a seperate unit reporting directly. to the Surgeon General was created. *° Increased Compensation for Commissioned Officers, 1920. Increased compensation for commissioned officers of the Public Health Service, Army, Navy, Marine Corps, the Coast Guard, and the Coast and Geodetic Survey was provided by the act approved May 1, 1920 (41 Stat. L., 601-605). The increases granted to officers of the Public Health Service were $600 for Assistant Surgeons General and Senior Sur- geons, $840 for Surgeons, $720 for Passed Assistant Sur- geons, and $600 for Assistant Surgeons. The increased pay was to continue until June 30, 1922. A special committee con- sisting of five members of the Senate and five members of the House of Representatives was provided in order to make an investigation and report recommendations relative to the read- justment of the pay and allowances of the officers in these organizations. Section 12 of this act provided also that the government should furnish transportation for the wife and dependent children of officers of the organizations mentioned above, whenever they are ordered to make a permanent change of station. Completion of National Quarantine System. Provision for the completion of the national quarantine system, begun by the act of February 15, 1893, was contained in the sundry 8 Tbid., 1920, pp. 13-14. 70 The Purveying Service was discontinued in 1922, when a general supply bureau for the entire Treasury Department was organized. HISTORY 55 civil act for the fiscal year 1921, approved June 5, 1920 (41 Stat. L., 875), which carried an appropriation for the pur- chase of the New York, Baltimore, and Texas quarantine stations. The Baltimore and Texas stations were already being operated under lease, and after the acquisition of the New York Station on March 1, 1921, quarantine functions at all ports came under the jurisdiction of the Public Health Service. Medical -Freatment-of-Discharged. Soldiers. etc. A discus- sion of the activities of the Public Health Service in giving medical and hospital relief to discharged soldiers 8° and sailors has been deferred to this point in order that all of this legisla- tion may be considered together. Section 302 of the act of October 6, 1917 (40 Stat. L., 406), granting compensation to disabled soldiers through the Bureau of War Risk Insurance provides that in addition to compensation the “injured person shall be furnished by the United States such reasonable govern- mental medical, surgical, and hospital services and with such supplies, including artificial limbs, trusses, and similar appli- ances, as the director [of the Bureau of War Risk Insurance] may determine to be useful and reasonably necessary.” 8! Section 303 of the same act provided that persons applying for compensation should be examined by a “medical officer of the United States or by a duly qualified physician designated or approved by the director.” Section 304 provided for voca- tional training, but this section was repealed by the act of June 27, 1918 (40. Stat. L., 617-620), which conferred this duty on the Federal Board for Vocational Education. Prior to the passage of the act of October 6, 1917, the functions of the Bureau of War Risk Insurance were con- 80 The term discharged soldiers as used in this discussion in- cludes discharged sick and disabled soldiers, sailors, and marines, and Army and Navy nurses (male and female) entitled to com- pensation under the War Risk Insurance act. 81 For discussion of the compensation features of this and later acts and the activities of the Veterans’ Bureau, see Monograph on Veterans’ Bureau to be published by Institute for Government Re- search. 56 THE PUBLIC HEALTH SERVICE fined solely to the insurance of vessels, cargoes, seamen, and personal property of officers and seamen against war risk. This work did not require a medical staff, but the act of Oct- ober 6, 1917, which granted compensation to disabled soldiers, required an extensive medical organization in order to make the necessary physical examinations and to determine the degree of disability. In order to carry on this work the Med- ical Division of the Bureau of War Risk Insurance was organ- ized by the detail of medical officers of the Public Health Service. The Bureau of War Risk Insurance also delegated to the Public Health Service the physical examination of men in the field and the task of providing hospital facilities and treatment. Section 302 of the act of October 6, 1917, did not specify the agency that should furnish hospital treatment, and there was some doubt whether the Marine Hospitals main- tained by the Public Health Service and the private hos- pitals under contract with that organization were available for this class of patients. This question was settled on March 28, 1918, by a decision of the Acting Comptroller of the Treas- ury, who reached the conclusion that by reason of the executive order of April 3, 1917, making the stations of the Public Health Service available for sick and wounded officers and men, and by reason of the general authority conferred on the Director of the Bureau of War Risk Insurance, the ques- tion as to the availability of any particular class of hospitals did not come within his jurisdiction, this matter being entirely one to be decided by the Director of the Bureau of War Risk Insurance, under the general direction of the Secretary of the Treasury. He decided, however, that where it was deemed necessary to utilize Marine Hospitals or contract relief stations the expenses were properly chargeable to appropriations made to the Bureau of War Risk Insurance.3? It should be borne in mind that the mere fact of military service did not entitle a person to treatment by the Public Health Service. To obtain medical treatment at a Public 82 24 Comp. Dec., 556. HISTORY 57 Health Service Hospital the discharged soldier must be a bene- ficiary of the Bureau of War Risk Insurance or its successor, the Veterans’ Bureau, the hospital treatment being given in ad- dition to the compensation provided by law. Persons entitled to compensation from the Bureau of War Risk Insurance and, therefore, entitled to treatment in Public Health Service Hospitals were those embraced in the following classes who were rated as having a disability of at least ten per cent. ac- cording to the schedule of disability ratings adopted by the bureau. (a) Any soldier, sailor, marine and Army nurse discharged after April 6, 1917, who is suffering from injury or disease contracted in line of duty and not the result of his own will- ful misconduct. However, a person is ineligible to compen- sation if he received a dismissal or dishonorable or bad con- duct discharge from the service, if he was discharged or dismissed from the military or naval forces as an enemy alien, a conscientious objector, a deserter or by reason of being guilty of mutiny, treason, spying, or any offense involving moral turpitude or willful and persistent misconduct. (b) Any person who, after induction by a local draft board, but before being accepted and enrolled for active ser- vice, became disabled as the result of disease contracted or injury suffered in the line of duty, and not the result of his own willful misconduct involving moral turpitude, or a re- sult of the aggravation in line of duty and not because of his own willful misconduct involving moral turpitude of an existing disease or injury. Persons who had a claim pending before the Bureau of War Risk Insurance were given treatment while their claims were being adjudicated, provided they did not fall within the class of persons who are denied compensation as outlined above. The beneficiaries of the bureau who were not taking voca- tional training were treated only for conditions definitely con- nected with their military service or for conditions having an untoward effect upon the cure or amelioration of conditions 58 THE PUBLIC HEALTH SERVICE definitely connected with their military service. Discharged soldiers receiving vocational training were entitled to treatment for any disease which might interfere with their training regardless of whether the disease had any relation to military service. In the medical treatment of discharged soldiers, the service acted for the Bureau of War Risk Insurance—up to August 9, 1921, under authority of the Secretary of the Treasury, who had supervision over both the organizations. The activities of the Public Health Service in connection with the work of the Bureau of War Risk Insurance included not only hospital and dispensary treatment but also the medical examination of claimants in order to determine their degree of disability, and until the latter part of the fiscal year 1 the medical review of claims in the office of the Director e Bureau of War Risk Insurance.®? Vocational rehabilitation of disabled soldiers was to be pro- vided by the Bureau of War Risk Insurance under the pro- visions of section 304 of the act of October 6, 1917, but that bureau did not develop this work, and the act of June 27, 1918 (40 Stat. L.., 617-620), transferred this activity to the Federal Board for Vocational Education, an independent es- tablishment not under the control of any executive department. When this work was first undertaken by the board, physicians were generally employed on part time, and were paid as a rule on the basis of individual examinations. At this time the board depended largely on transcripts of medical examin- ations from the files of the War and Navy Departments and * the Bureau of War Risk Insurance. Under the act of June 27, 1918, a disabled soldier was entitled to vocational training only after he had been awarded compensation by the Bureau of War Risk Insurance. On July 11, 1919, an act was passed (41 Stat. L., 158-159) making the board the sole judge of need for vocational education. As this change made many reexaminations necessary the medical staff had to be increased. 83 Secretary of the Treasury, Annual Report, 1920, p. 208. HISTORY 59 On account of the limited number of salaries at $2500 and above available for the use of the board, it was difficult to secure good doctors on full time. In order to supply medical personnel the Public Health Service assigned medical officers to the main office of the board in order to direct the medical work, and arranged for the physical examinations to be made at the stations of the Public Health Service.®* On August 28, 1919, medical officers in charge of Public Health Service hospitals and stations were directed to make physical examination of disabled soldiers when requested by the Federal Board for Vocational Education, #¥ and on Sep- tember 30, 1919, they were instructed to give hospital service to disabled soldiers undergoing a course for vocational educa- tion, when request the district officers of the Federal Board for Vocatio ducation.®® The work done for the Federal Board has small compared with that carried on for the Bureau of War Risk Insurance. Unfortunately no general hospitalization program had been worked out by Congress or the executive officers of the gov- ernment, and the Public Health Service soon found that the demand for hospital treatment far exceeded the capacity of its hospitals. In the middle of March, 1918, the Director of the Bureau of War Risk Insurance requested the Public Health Service to give hospital service to discharged soldiers as far as pos- sible.8” At that time there were in all the Marine Hospitals 1704 beds, of which 1171 were occupied, leaving 533 available for patients of the Bureau of War Risk Insurance.®® In July the Public Health Service was requested to provide ac- comodations for 14,000 tuberculosis soldiers. On September 84 Fadera) Board for Vocational Education, Annual Report, 1920, p. 281. 88 Bureau Circular Letter, 179. 86 Thid., 188. 87 Hearings before Committee on Public Buildings and Grounds, House of Representatives on . .. H. R. 13,026, 1918, p. 28. 88 House Hearings on Sundry Civil Bill for 1919, p. 154. 60 THE PUBLIC HEALTH SERVICE 11, 1918, a committee of medical officers of the Army, Navy, and Public Health Service reported that in addition to the 14,000 men suffering from tuberculosis already discharged 20,000 men would be rejected during 1918 and 1919 at the military camps after induction into the service. As the men accepted by the draft boards but afterwards rejected at the training camps became beneficiaries of the Bureau of War Risk Insurance, it was necessary to provide hospital facilities for these men. It was estimated that three-fourths of these men, or 26,000, would apply for sanitarium treatment, and that the average length of treatment would be six months. This would require 13,000 beds. The War and Navy De- partments had made no provision for treatment of patients other than those of the active forces, and the Public Health Service had available a total of 1704 beds to take care of 13,000 cases.’ On September 20, 1918, the Secretary of the Treasury transmitted to the Speaker of the House of Rep- resentatives a draft of a bill appropriating $10,500,000 for providing additional hospital and sanitarium facilities. Hearings on the proposed measure (House bill 13,026) were held before the House Committee on Public Buildings and Grounds, but the act was not approved until March 3, 1919 (40 Stat. L., 1302-1305). This act transferred to the Pub- lic Health Service a number of army hospitals, and author- ized the transfer of other hospital property which might be vacated by the army. The Secretary of War was authorized to transfer hospital equipment, medical supplies, and motor dri- ven vehicles, and the President was given power to transfer to the Treasury Department land and buildings which were under the control of other departments, but which were not needed by them. A number of specific hospital projects were author- ized and the Secretary of the Treasury was empowered to con- tract with existing hospitals for the use of all or part of their equipment. The act carried an appropriation of $8,840,000 for hospital projects, $210,000 for furniture and equipment, 80 65 Cong., 2 Sess., H. Doc. 1294. p. 4. HISTORY 61 and $785,333 for operation and maintenance during the remainder of the fiscal year 1919. The regular annual appro- priation for the maintenance of hospitals during the fiscal year 1920 was $4,845,000; several deficiency acts for the same year made additional appropriations of $15,166,187.14. The act of March 3, 1919, was the first law which recog- nized the Public Health Service as the instrumentality for fur- nishing medical relief to the beneficiaries of the Bureau of War Risk Insurance, as up to this time this work had been assigned to the service at the direction of the Secretary of the Treasury. The sundry civil appropriation act for the fiscal year 1920, approved July 19, 1919, further confirmed this by appropriat- ing to the Public Health Service the money necessary for the medical and surgical treatment of discharged soldiers and by providing that no appropriations made to the Bureau of War Risk Insurance should be used to reimburse “any expenses in- curred by any government owned hospital or hospital under contract with the Public Health Service for examination, care, or treatment of beneficiaries of the Bureau of War Risk In- surance (4o Stat. L., 173). This left the Bureau of the War Risk Insurance free to contract with non-government owned hospitals not already under contract with the Public Health Service, but it seemed inadvisable to divide the hospital work, and all discharged soldiers in private hospitals were placed there under the supervision of the Public Health Service. The result of the legislation of March 3, 1919, was that the hospital work in the next three months expanded more than ever before in the history of the service.?* Between April 1 and June 30, 1919, the service opened ten new hos- pitals with a capacity of 5693 beds. In March, 1918, the bed capacity of the old Marine Hospitals was 1704, and it prob- ably increased very little until the new hospitals were taken over. During the fiscal year 1919 reserve officers to the num- ber of 222 were assigned to active duty, and the number of acting assistant surgeons increased from 383 to 701, most 90 Surg. Gen., Annual Report, 1919, p. 2109. 62 THE PUBLIC HEALTH SERVICE of these officers being assigned to hospital duty. The number of hospital attendants increased from 578 on June 30, 1918, to 2296 on June 30, 1919. By the end of the fiscal year 1919 there were in operation thirty hospitals compared with twenty at the beginning of the year. Notwithstanding the fact that increased hospital facilities were not available until late in the fiscal year, the number of patients treated at hospitals operated by the Public Health Service amounted to 26,091 in the fiscal year 1919 compared with 12,797 in the fiscal year 1918, an increase of 14,194 or 112 per cent. In the same institutions the number of days hospital treatment was 622,827 against 415,465 in the pre- vious year—a gain of 207,362 or 50 per cent. In addition patients were treated at contract hospitals during both years. By December 5, 1919, the number of available beds had increased to 7200, but the service was still unable to supply sufficient hospital facilities, and the Secretary of the Treas- ury transmitted to Congress the draft of an act providing for the appropriation of $83,445,000 which it was estimated would supply the 23,400 additional beds thought to be nec- essary within two years.”! The deficiency appropriation act approved March 6, 1920 (41 Stat. L., 508), appropriated the additional sum of $5,000,000 to be expended at hospitals acquired under the authority conferred by the act of March 3, 1919. Three acts approved on June 5, 1920, provided for additional hospital projects. The sundry civil appropriation act for the fiscal year 1921 (41 Stat. L., 835) appropriated $295,000 additional for remodeling the hospitals acquired from the War Department under authority of the act of March 3, 1919. The Army appropriation act for the fiscal year 1921 (41 Stat. L., 963) authorized the Secretary of War to turn over to the Secretary of the Treasury, for the use of the Public Health Service, the military reservation of Whipple Bar- racks, Arizona, which had already been occupied by the Public 9166 Cong., 2 Sess., H. Doc. 481. HISTORY 63 Health Service for hospital purposes. Another act on June 5, 1920 (41 Stat. L., 1060), reappropriated for other pro- jects some of money previously granted. On June 30, 1920, there were in operation 50 hospitals com- pared with 30 a year earlier. During the fiscal year the number of patients treated at hospitals operated by the service amounted to 68,791 and number of days hospital treatment given was 2,387,884. This was an increase in patients of 155 per cent. over the fiscal year 1919 and of 437 per cent. over the fiscal year 1918; in days hospital treatment the in- crease was 283 per cent. over the fiscal year 1919 and 475 per cent. over the fiscal year 1918. By June 30, 1921, the number of hospitals had increased to 62. During the fiscal year 1921 the number of patients treated at the hospitals operated by the service amounted to 113,496 and the number of hospital days treatment to 4,921, 314. Compared with the previous year this showed a gain of 65 per cent. in patients and 106 per cent. in number of days hospital treatment; in the three years since 1918 the increase in patients treated was 788 per cent. and in number of days hospital treatment 1084 per cent. In addition to the work carried on at the old Marine Hos- pitals and the new hospitals the service also had supervision over patients placed in contract hospitals, and the rate of in- crease in this work was greater than for the service hospitals. The number of days hospital treatment in contract hospitals in- creased from 134,191 in the fiscal year 1919 to 1,763,454 in the fiscal year 1920, a gain of over 1200 per cent.; during the fiscal year 1921 the number rose to 2,850,357, a gain of 61 per cent. The number of dispensary treatments at places other than service hospitals rose from 46,915 in the fiscal year 1919 to 467,355 in the fiscal year 1920, an increase of almost goo per cent. In the fiscal year 1921 it increased to 1,120,168, a gain of 140 per cent. over the preceding year. The number of physical examinations made at the hospitals and at other stations of the service was 513,203 in the fiscal year 1920 com- 64 THE PUBLIC HEALTH SERVICE pared with 41,185 in the fiscal year 1919, an increase of almost 1200 per cent. During the fiscal year 1921 the number of ex- aminations was 1,004,551, an increase of 96 per cent. over the fiscal year 1920. During the fiscal year 1920 the number of reserve officers called to active duty increased from 222 to 485, and the number of acting assistant surgeons employed rose from 70I to ISII. At the end of the fiscal year 1921 the reserve officers on duty numbered 966 and the acting assistant surgeons 1679. This increase was due almost entirely to the increase in the hospital work and to the necessity of appointing medical personnel at localities where there was a large number of beneficiaries of the Bureau of War Risk Insurance. During the fiscal year 1920 the attendants on duty at hospitals increased from 2296 to 6471; in addition 2379 attendants were assigned to district work at the end of the fiscal year 1920. The growth in the hospital and dispensary work from 1917 to 1921 is shown in the following table: Hospital AND DispENsary Work 1017 TO 1921 L Fiscal Year Class of Work 117 1018 1919 1929 1921 Patients treated \ In service hospitals ti. uvinaiiei 11,325 12,797 | 26,901 68,791 113,49€ In contract hospitals* ........... 6,666 7,812 11,364 50,266 69,520 In dispensaries at service hospitals . 23,836 | 23,197 | 30,928 76,088 155,431 In other dispensaries ............ 22,194 | 30,402 | 24,436 194,808 473,729 otal, icant sav bvns 64,021 | 74,208 | 03,719 | 389,053 | 812,176 Hospital days treatment In service hospitals ............... 391,172 | 415,465 | 622,827 | 2,387,884 | 4,021,314 In contract hospitals ............ 109,406 119,526 | 134,191 | 1,763,454 | 2,850,357 Totals ove svi oi dunia es 500,578 | 534,991 | 757,018 | 4,151,338 | 7,771,671 Dispensary treatments At service hospitals «...<.e.uversin 42,919 | 36,780 | 57,848 181,873 352,804 At other dispensaries ............. 59,309 | 59,275 | 46,915 467,355 | 1,120,168 Botal. co invrinvin vedi vividons 102,228 | 96,064 | 104,763 649,228 | 1,473,062 Persons physically examined ..,..... 28,356 | 30,055 | 41,18: 513,293 | 1,004,551 * Including visits to patients by private physicians. i id a HISTORY 65 By far the greater part of the increased activity during the fiscal year 1921 was on account of patients of the Bureau of War Risk Insurance, as is shown by the following statement : Work FOR BUREAU oF WAR Risk INSURANCE AND OTHER PATIENTS DURING F1scAL YEAR 1921 Bureau of Federal Treatment War Risk | Board for Other Total Insurance | Vocational Classes Education Patients treated In service hospitals 751949 1,210 36,337 113,496 In contract hospitals 60,544 548 8,428 69,520 In dispensaries at pitals .......... on 85,352 15,656 54,423 155,431 In other dispensaries 382,228 39,394 52,107 473,729 Xotal iii sus sssicsiss suits} 604,073 56,808 151,295 812,176 Hospital days treatment In service hospitals ............ 3,923,381 30,562 967,371 4,921,314 In contract hospitals ,.......... 2,689,105 7,362 153,800 2,850,357 Total ....ves- aor __ 6,612,576 37,924 1,121,171 7,771,671 Dispensary treatments At service hospitals .....ccuunae 203,169 22,273 127,452 352,804 At other dispensaries .......... 920,735 63,564 135,869 1,120,168 Total... oshisvaivnns snvnnrves 1,123,004 85,837 263,321 1,473,062 Persons physically examined ..... 883,912 40,882 59,757 1,004,551 After 1918 the hospital work not only increased in quantity, but changed considerably in character, as the treatment of ex-service men involved many phases of medical work not commonly encountered in the cases formerly received in the Marine Hospitals. Special disorders affecting the mind and nervous system made it necessary to pay particular attention to work in the field of neuropsychiatry. From March 3, 1919, to June 30, 1920, there were treated 9769 nervous and mental patients—4128 in service hospitals and 5641 in con- tract institutions. The treatment of these cases in contract hospitals was not entirely satisfactory to the patient, the gen- eral public, or the government. Prior to the war the service maintained only one sanitarium for tuberculous patients—the hospital at Fort Stanton, New Mexico, opened in 1899. On June 30, 1920, the service 66 THE PUBLIC HEALTH SERVICE was operating nine hospitals and sanitariums, with a capacity of 4274 beds, exclusively for tuberculous cases. These pa- tients were, however, admitted to all the general hospitals for purposes of diagnosis and for treatment when it was inad- visable to move the patient. In September, 1919, work in physiotherapy and occupational therapy was introduced into the hospitals in order to improve the physical and mental condition of patients. The work in occupational therapy should not be confused with the voca- tional training under the direction of the Federal Board for Vocational Education. The occupational therapy given by the Public Health Service was administered purely for medical reasons in order to establish and maintain a high standing of morale and to hasten the restoration of the patient to a state of functional and economic usefulness. Occupational therapy as mental work and manual handicraft for curative and diver- sional purposes were given to all bed and semi-ambulant pa- tients and to such ambulant patients as were not potential trainees of the Federal Board. During the week ending September 6, 1919, physiotherapy was given to 92 patients and occupational therapy to 147, with 1114 physiotherapy treatments and 1625 hours of occupational therapy. This work was gradually extended and for the week ending June 26, 1920, physiotherapy was given to 1886 patients and oc- cupational therapy to 2976, with 18,714 physiotherapy treat- ments and 33,982 hours of occupational therapy. On June 30, 1920, there were on duty 102 reconstruction aides and ar- rangements had been made to increase the personnel to 290. Dental treatment is another line of activity that was de- veloped after February, 1919.°2 Dental work was done both by service officers in the hospitals and by private dentists who were paid on a fee basis. A patient of the Bureau of War Risk Insurance was entitled to dental treatment if he had been 92 Hearings before House Committee on Appropriations on Sundry Civil Appropriation Bill for 1922, p. 278. HISTORY 67 awarded compensation for dental disability, if dental treat- ment was necessary for the cure or amelioration of some other condition was definitely connected with the military service and on account of which compensation has been awarded, or if the dental defects endangered the life of the patient or caused great pain or discomfort.”® The estimated cost of dental work authorized from January to October, 1920, amounted to $2,071,551.71.%¢ s In giving treatment to discharged soldiers the Public Health Service acted as one of the agencies of the Bureau of War Risk Insurance, which reimbursed the service for the cost of treat- ment and which determined whether the beneficiary was en- titled to medical relief. From October 6, 1917, to June 30, 1920, all hospital treatment for the beneficiaries of the Bureau of War Risk Insurance (now the Veterans’ Bureau) was car- ried on either in hospitals operated by the service or in private institutions under contract. During that period the Public Health Service was responsible for the treatment of all bene- ficiaries of the Bureau of War Risk Insurance placed in hos- pitals. After July 1, 1920, the hospitals of the National Homes for Disabled Volunteer Soldiers and of the Army and Navy were also available for this work, and the Public Health Service was not responsible for the medical treatment of men in these institutions, that responsibility developing on the med- ical officers attached to the services mentioned. Up to April 19, 1921, the district supervisors of the Public Health Service had charge of the assignment of patients to hospitals, and the service was responsible for the treatment of patients as- signed to hospitals under its control or to private institutions with which contracts had been made. On April 19, 1921, the Secretary of the Treasury transferred to the Bureau of War Risk Insurance the work being done by the district super- visors in assigning patieats to hospitals and also the super- 93 Hospital Division Circular No. 77, July 9, 1920. 94 Hearings before House Committee on Appropriations on Sundry Civil Appropriation Bill for 1922, p. 278. » 68 THE PUBLIC HEALTH SERVICE vision of all private hospitals under contract with the service. The order of the Secretary of the Treasury of April 19, 1921, was reaffirmed in the act of August 9, 1921, creating the Vet- erans’ Bureau and the primary responsibility for the hos- pital treatment was placed in the director of that organiza- tion. During the fiscal year 1919 the expenses of the medical treat- ment of beneficiaries of the Bureau of War Risk Insurance were paid partly from funds appropriated to the bureau and partly from funds appropriated to the Public Health Service. During the fiscal year 1920 the entire expense was paid from the appropriations of the Public Health Service. During the fiscal year 1921 and the portion of the fiscal year 1922 in which this work was carried on by the Public Health Service the expense was charged to the Bureau of War Risk Insurance, which allotted funds to the Public Health Service for this purpose. This allotment, however, included only ex- penses of treatment. Capital expenditures for additional plants and buildings continued to be charged to specific appropriations for this purpose made to the Public Health Service. The hospitals maintained by the service comprised the Marine Hospitals, which were established before the war for the treatment of seamen, and the Public Health Service Hos- pitals opened after 1918 to take care of the beneficiaries of the Bureau of War Risk Insurance. Both classes of hos- pitals treated seamen and ex-service men, but in general the seamen were sent to the marine hospitals and the ex-service men to the Public Health Service Hospitals. The assignment of beneficiaries to hospitals was generally determined by the location and capacity of the institution. The greater part of the hospital work in establishments operated by the service was carried on in the Public Health Service Hospitals, as is shown by the following classification of work of the two classes of service hospitals during the fiscal years 1920 and 1921. HISTORY 69 Work AT MarINE HospiTaLs AND Pusric HEALTH SERVICE HosprTALS, FiscAL YEARS 1020 AND 1921 Fiscal year 1920 Fiscal year 1921 Class of work Public Public Marine | Health Marine Health Hospitals| Service |Hospitals | Service Hospitals Hospitals Number of patients Treated in. ‘Hospital. (i. ive dvmennins sini 27,369 41,422 26,688 86,808 Treated in dispensary ......v.vveiivinn 48,096 27,992 66,397 89,034 BOM ssh v anni crnniiassiinnns atieie 75,465 60,414 93,085 175,842 Hospital days. relief '.......000000v0sees 708,513 | 1,679,371 771,000 | 4,150,314 Dispensary’ {treatments .....covvosss viens 105,023 76,850 145,447 207,447 As the Public Health Service was acting for two other agen- cies—the Bureau of War Risk Insurance and the Federal Board for Vocational Education—in the medical examination and treatment of disabled soldiers, it became necessary to create new administrative machinery separate from the hospi- tals to look after the physical examinations and the assignment of men to hospitals. In the early part of the fiscal year 1920 the continental United States was divided into fourteen dis- tricts, each of which was placed under the charge of a district supervisor. These districts in general included the same terri- tory as the districts of the other two government offices, and in most cases the district offices of the three organizations were located in the same building, so that no time would be lost in arranging conferences and transmitting papers. The district supervisors had nothing to do with hospital management, their function being to arrange medical examinations, give out-pa- tient care and treatment, and assign beneficiaries to hospitals where treatment might be obtained. Notwithstanding the great increase in number of patients treated, as shown by the above tables, the Public Health Service at the end of the fiscal year 1920 did not have suffic- ient facilities to care for all the discharged soldiers. In order to supply additional beds, to avoid the great expense incident to new hospital construction, and to reduce the ex- 70 THE PUBLIC HEALTH SERVICE penditure for treatment in private hospitals, Congress de- cided to make use of the available facilities in the National Homes for Disabled Volunteer Soldiers and in the hospitals of the Army and Navy. The sundry civil appropriation act for the fiscal year 1921, approved June 5, 1920 (41 Stat. L., 881-884), made the appropriation for hospital and medical treatment to the Bureau of War Risk Insurance, and provided that such sums as might be necessary should be allotted by the Bureau of War Risk Insurance from time to time to the Public Health Service, the National Home for Disabled Vol- unteer Soldiers, and the War and Navy Departments and credited to the appropriations under the control of those organ- izations. During the fiscal year 1921 the amounts transferred from the appropriation of the Bureau of War Risk Insurance for medical care were as follows: To the Public Health Service, $38,364,300; to the War Department $590,000; to the National Home for Disabled Volunteer Soldiers $5,070, 000. The amount expended directly by the Bureau of War Risk Insurance was about $5,000,000. The sundry civil appropriation act for the fiscal year 1922, approved March 4, 1921 (41 Stat. L., 1374), continued the appropriation under the same plan. As the result of this legislation the Public Health Service no longer gave hospital treatment to all the beneficiaries of the Bureau of War Risk Insurance. The dis- charged soldiers in the hospitals maintained by the Public Health Service and in private hospitals under contract came under the supervision of the Public Health Service, but those in the Volunteer Soldiers Home and in Army and Navy hospitals were under the care of the medical officers of those institutions. From July, 1920, to April 19, 1921, the district supervisors of the Public Health Service acted as distributing agencies of the Bureau of War Risk Insurance, and the Pub- lic Health Service was responsible for placing beneficiaries of that bureau in hospitals. The facilities of the hospitals of the Public Health Service, the National Home for Disabled Volunteer Soldiers, the Army HISTORY 71 and the Navy were still not sufficient to care for the increasing number of beneficiaries of the Bureau of War Risk Insurance, and on March 4, 1921, an act was approved (41 Stat. L., 1364-1366) appropriating $18,600,000 for additional hos- pitals. The President was authorized to assign for the use of the Public Health Service, any lands or buildings owned or leased by the United States, except the property under the jurisdiction of the National Home for Disabled Volunteer Soldiers. In the early part of 1921 there were thus three organizations concerned with disabled soldiers—the Bureau of War Risk Insurance, the Public Health Service, and the Federal Board for Vocational Education. The Bureau of War Risk Insur- ance made all awards of compensation for disability, {paid for hospital treatment, exercised general supervision over the wel- fare of men in hospitals not operated by or under contract with the Public Health Service, and had charge of the medical examinations that were made at places where there were no physicians of the Public Health Service. The Federal Board for Vocational Education had charge of the vocational educa- tion of all disabled soldiers and determined the amount of compensation to be paid to men in course of training. The Public Health Service acted as the agent of the Bureau of War Risk Insurance and of the Federal Board for Vocational Education by furnishing hospital treatment and dispensary re- lief, by making physical examinations, and by assigning bene- ficiaries to hospitals, the entire distribution being in the hands of the district supervisors, regardless of whether the men were sent to Public Health Service hospitals or to other institutions under the general supervision of the Bureau of War Risk Insurance. The Public Health Service and the Bureau of War Risk Insurance were bureaus of the Treasury Department, while the Federal Board for Vocational Educa- tion was an independent establishment not under the super- vision of any executive department. Notwithstanding the extent to which unification of the 72 THE PUBLIC HEALTH SERVICE agencies was effected through the offices of the district super- visors of the Public Health Service there was great dissatis- faction on the part of the veterans because of division of con- trol between three separate agencies. There was much com- plaint regarding delay in obtaining hospital treatment and the insufficiency of hospital accommodations, and the three gov- ernment bodies concerned with soldiers were subject to much criticism. The charges directed against the Public Health Service were in regard to the placing of patients in private hospitals where they were not given proper care, the utilization by the Public Health Service for hospital purposes of buildings that were subject to a great risk from fire, the lack of beds, and dereliction of duty or improper use of authority by officers or attendants in specific cases. It is not within the province of this monograph to attempt to pass judgment on these topics, but in passing it seems desirable so call attention to certain outstanding facts. Use of private hospitals, the fire risk in government hospitals, and the lack of beds were all incidental to the unparalleled demand for hospital treatment. The con- struction of fireproof buildings meant considerable delay, and as it was imperative that accommodations be provided at once recourse was necessarily had to the use of such buildings as could quickly be adapted to hospital purposes and to the placing of patients in private institutions. Any other course would have yielded fewer beds, and the criticism resulting from lack of facilities would have been much greater. As regards the criticism of the conduct of hospitals consideration should be taken of the very rapid expansion. The number of hospital days treatment in hospitals operated by the service rose from 415,465 in the fiscal year 1918 to 2,387,384 in the fiscal year 1020, an increase of 475 per cent.; the number of hospital attendants increased from 578 at the end of the fiscal year 1018 to 6471 at the end of the fiscal year 1920, a gain of over 1000 per cent. With such rapid expansion in a technical HISTORY 73 organization it is not unlikely that the personnel in some in- stances fell below the standard of earlier years. The division of responsibility between the three organiza- tions concerned with soldier relief was the greatest difficulty in the way of efficient administration and it became evident that steps must be taken to effect unification. Therefore, on April 19, 1921, the Secretary of the Treasury issued an order which transferred to the Bureau of War Risk Insurance all the activities of the Public Health Service affecting the bene- ficiaries of the Bureau of War Risk Insurance, except the management of hospitals and dispensaries which were oper- ated by the Public Health Service. The effect of this order was to transfer to the Bureau of War Risk Insurance the offices of the district supervisors, the medical examination of claimants, the assignment of bene- ficiaries of the Bureau of War Risk Insurance to hospitals, and the supervision of private hospitals giving medical treat- ment to discharged soldiers. The Public Health Service still continued to operate its own hospitals and to supervise private hospitals having contracts for the medical relief of seamen and beneficiaries other than those of the Bureau of War Risk In- surance. The district supervisors were by this order directed to continue all work previously done by them for the Federal Board for Vocational Education.?® As the Federal Board for Vocational Education was not under the supervision of the Secretary of the Treasury, he had no authority to control its activities. His authority as re- gards this organization was limited to prescribing the sub- division of the Treasury Department that should conduct the work being done by the Department for the board. The unification of facilities for the relief of disabled soldiers had now progressed as far as was possible without legislation. A bill for the establishment of a Veterans’ Bu- reau was introduced in the House of Representatives on May 9 For text of this order see foot-note on page 238. 74 THE PUBLIC HEALTH SERVICE 25, 1921, and was approved by the President on August 9, (Public Act No. 47, 67th Cong). This act created an inde- pendent establishment to be known as the Veterans’ Bureau, to which were transferred the Bureau of War Risk Insurance and the activities of the Federal Board for Vocational Edu-/ cation dealing with the vocational rehabilitation of disabled soldiers authorized by the act of June 27, 1918. The act also specifically affirmed the transfer to the Veterans’ Bu- reau of the offices of the district supervisors and the super- vision of contract hospitals as provided in the order of the Secretary of the Treasury of April 19, 1921. The Director of the Veterans’ Bureau is made “responsible for the proper examination, medical care, hospitalization, dispensary, and convalescent care” of discharged soldiers, but the act does not transfer the hospitals of the Public Health Service to the Veterans’ Bureau, although the President is authorized to transfer specifically designated hospitals if he deems such action necessary. The Director of the Veterans’ Bureau is authorized to utilize the facilities of the Public Health Service and other specified government agencies, and these agencies are authorized and directed to furnish such hospital services and supplies as the director may deem necessary; if the hos- pital facilities of the Government are not sufficient for medical care and treatment the director is authorized to improve or extend existing hospitals, acquire additional hospitals, or to contract with state, municipal, or private hospitals. It should be noted that this act does not set up a separate hospital organization in the Veterans’ Bureau, but gives the director of that organization authority to take this action if he deems such a course necessary. The Director of the Vet- erans’ Bureau is made primarily responsible for the medical treatment of beneficiaries and to accomplish this purpose he is authorized to use the facilities of the Public Health Service or any other government organizations. The Public Health Service became in effect a contracting agency for giving hospi- tal treatment. The detailed hospital management still re- HISTORY 75 mained for a time under the Public Health Service, but the Director of the Veteran's Bureau is directed to maintain an inspection service, which is authorized to examine all facilities and services utilized for medical relief. The President was authorized to transfer to the Veterans’ Bureau specifically designated hospitals under the control of the Public Health Service, and by the executive order of April 29, 1922, there were transferred to the Veterans’ Bureau the annexes to the Marine Hospitals at Mobile (No. 13) and New Orleans (No. 14) and all Veterans’ Hospitals.?® The non- commissioned personnel was transferred to the Veterans’ Bu- reau, but the commissioned personnel of the Public Health Service on duty in the hospitals was detailed for similar duty under the Veterans’ Bureau. By this order the Public Health Service was relieved of all responsibility for the treatment of veterans of the War with Germany, and the nature of the hos- pital work reverted approximately to the condition in the early part of 1917 although greater in extent. Revision of Salaries of Commissioned Officers, 1922. On June 10, 1922, there was approved an act (Public No. 235, 67th Congress) which established a new basis for fixing the salaries of the commissioned officers of the Public Health Service, Army, Navy, Marine Corps, Coast Guard, and Coast and Geodetic Survey. By this act the pay is fixed by rank and length of service, while the allowances for subsistence and quarters are determined by the rank, length of service, and whether or not the officers have dependents. Details regard- ing the pay and allowances of the several grades are given on page 169. 9 Prior to January 17, 1922, the hospitals which had been opened after 1918 had been known as Public Health Service Hospitals, while the older hospitals were known as Marine Hospitals. On January 17, 1922 the hospitals at Sewall’s Point, Virginia, Ellis Island, New York, Carville, Louisiana, and 67 Hudson Street New York, which had been known as Public Health Service Hospitals were designated Marine Hospitals, all the other hospitals were designated Veterans’ Hospitals. A complete list of the hospitals is given on page 254-257; the executive order of April 29, 1922, is given in full on page 244. CHAPTER II ACTIVITIES Medical Treatment. Medical treatment for merchant seamen was the purpose for. which the Marine Hospital Service was created in 1798, and this continued to be its only function for over three-quarters of a century. Gradually the service enlarged its activities in the field of quarantine, medical inspection of immigrants, sanitation, hygiene, and general in- vestigations relating to the public health, until by 1918 the hospital work, measured by personnel and expenditures, was a relatively minor activity of the service. By 1920 the medical and hospital treatment of patients of the Bureau of War Risk Insurance had become the major activity of the organi- zation in terms of persons employed and money expended. In the spring of 1922, the treatment of discharged soldiers was transferred to the Veterans’ Bureau, and the hospital work was materially reduced although it still has an important place in the activities of the service. Beneficiaries. Hospital treatment and out-patient relief are given to the classes of persons listed below. If hospital treat- ment for any class of patients is specifically authorized by law the date of the act and the references to the statute are given. If not specifically authorized by law, reference is made to the earliest regulations authorizing treatment. It will be noted that treatment for seamen on several classes of government vessels is not provided for specifically by statute, these patients presumably being treated under the general authority of Section 6 of the Act of March 3, 1875 (18 Stat. L., 486), which is as follows: That sick and disabled seamen of foreign vessels and of vessels not subject to hospital dues may be cared for by the 76 ACTIVITIES 77 Marine Hospital Service at such rates and under such regu- lations as the Secretary of the Treasury may prescribe. In view of the fact that men on these vessels were given treatment under the general authority of the act of March 3, 1875, the special legislation relative to seamen on vessels of the Bureau of Fisheries appears to have been unnecessary. In the case of the Coast Guard and the Lighthouse Service persons other than seamen are made beneficiaries. The ex- penses of treatment are borne by the Public Health Service unless otherwise indicated. 1. Persons employed on vessels registered, enrolled, or licensed under the laws of the United States (July 16, 1798, 1 Stat. L., 605; June 29, 1870, 16 Stat. L., 595; March 3, 1875, 18 Stat. L., 485). Persons employed on canal boats are denied the privilege of relief by the act of July 20, 1846 (9 Stat. 1.., 38), and the joint resolution approved February 10, 1871 (16 Stat. L., 595). 2. Seamen employed on yachts which are enrolled, licensed, or registered under the laws of the United States. (Same acts as above.) 3. Seamen employed on vessels belonging to the Army, when not enlisted men of the Army (Regulations of 1902). 4. Officers and enlisted men of the Coast Guard (August 4, 1894, 28 Stat. L., 229; January 28, 1915, 38 Stat. L., 8or). 57 Officers and men employed on vessels of the Bureau of Fisheries (July 1, 1918, 40 Stat. L., 604). 6. Officers of the Public Health Service and employees de- voting all their time to field work (January 23, 1913, 33 Stat.'L., 24). 7. Seamen employed on vessels of the Mississippi River Commission (Regulations of 1897). 8. Seamen employed on vessels of the Engineer Corps of the Army (Regulations of 1897). 78 THE PUBLIC HEALTH SERVICE 9. Officers, crews of vessels, keepers, and assistant keep- ers of the Lighthouse Service (August 28, 1916, 39 Stat. L., 538). 10. Officers and seamen on vessels of the Coast and Geod- etic Survey (Regulations of 1902). 11. Civil employees of the United States who are injured in the performance of their duties (September 7, 1916, 39 Stat. L., 743). At hospitals maintained by the service no charge is made for ordinary services and supplies. If the patient is supplied with special appliances or if he is given service in a contract hospital the expenditure is reimbursed to the Public Health Service by the United States Employees Compensa- tion Commission. 12. Officers and enlisted men of the Army and Navy (April 25, 1914, Bureau Circular Letter No. 36). The cost of treatment is repaid to the Public Health Service from appro- priations made to the Army and Navy. 13. Foreign seamen (March 3, 1802, 2 Stat. L., 193; March 3, 1875, 18 Stat. L., 486; December 26, 1920, 41 Stat. L., 1082). The cost of treatment is charged to masters of vessel to which seamen belong. The acts of March 3, 1802, and March 3, 1875, merely gave permission to treat foreign seamen in the marine hospitals. The act of December 26, 1920, provides that alien seamen afflicted with idiocy, imbecility, insanity, epilepsy, tuberculosis, or a loathsome or dangerous contagious disease must be placed in a hospital by the immigration officials at the port of arrival. The cost of treatment is charged to the vessel on which the seamen shipped. This act does not specifically provide for treatment at service hospitals, but these seamen may be admitted to these hospitals under the older acts. 14. Discharged soldiers of allied nations (December 24, 1919, 41 Stat. L., 374). Expenses are reimbursed to the Pub- lic Health Service by foreign governments through the Vet- erans’ Bureau. 15. Immigrants at port of New York only. The service ACTIVITIES 79 having assumed charge of the Immigration Hospital at New York, a portion of the establishment is used for the relief of immigrants committed by the Immigration Service. 16. Discharged sick and disabled soldiers, sailors, marines, and Army and Navy nurses, male and female, who are bene- ficiaries of the Veterans’ Bureau! (Acts of October 6, 1917, 40 Stat. L., 406; March 3, 1919, 40 Stat. L., 1302; March 4, 1921, 41 Stat. L., 1397; August 9, 1921. Public No 47, 67th Cong). Notwithstanding the fact that the hospitals main- tained primarily for discharged soldiers were transferred to the Veterans’ Bureau, the Marine Hospitals are still available for the care and treatment of the beneficiaries of that bureau whenever space and facilities are available, and the officers ot the Veterans’ Bureau request that treatment be given. Ex- penses for the treatment of beneficiaries of the Veterans’ Bu- reau are reimbursed by that organization. 17. Persons suffering from trachoma (June 23, 1913, 38 Stat. L., 25). 18. Persons suffering from leprosy. (March 3, 1905, 33 Stat. L., 1909). 19. Government employees at specified plants. 20. Crews of vessels engaged in deep sea fisheries (June 24, 1914, 38 Stat. L., 387). The medical treatment may be divided into three classes: (1) What may be termed general treatment, which includes hospital and dispensary relief to classes 1 to 16 mentioned above, and which is furnished at Marine Hospitals, contract hospitals and dispensaries, and other relief stations for these classes of patients; (2) special treatment for classes 17 to 19 at hospitals established for particular work or in field clinics, and (3) treatment of crews of deep sea fisheries. General Treatment. The treatment given to the beneficiaries of classes 1 to 16 and to beneficiaries of the Bureau of War 1 Created by the act of August 9, 1921, which transferred to the Veterans’ Bureau the Bureau of War Risk Insurance and the work of the Federal Board for Vocational Education relating to voca- tional rehabilitation of disabled soldiers. 8o THE PUBLIC HEALTH SERVICE Risk Insurance and the Federal Board for Vocational Educa- tion during the fiscal year 1921 is shown in the table below. After May 1, 1922, the Public Health Service no longer was responsible for the treatment of discharged soldiers, included in this table under the first two classes—Bureau of War Risk Insurance and Federal Board for Vocational Education. The extent of the hospital service in the near future can therefore best be judged if the first two classes are disregarded. The term “Service hospitals” includes all hospitals maintained and operated by the service; the term “Other stations” indicates contract hospitals, special dispensaries and other forms of re- lief. RELIEF FURNISHED SPECIFIED BENEFICIARIES, FiscAL YEAR 1021 Patients treated Hospital | Dispensary iari days treat- Bensaniaries Total In aie reliet ments hospitals saries | furnished | furnished Total evans annus 812,176 | _ 183,016 629,160 | 7,771,671 | 1,473,062 Bureau of War Risk In- surance A Service hospitals . 161,301 75,949 85,352 | 3,923,381 203,169 Other stations ... 442,772 60,544 382,228 | 2,689,195 920,735 Total... iin 604,073 136,493 467,580 | 6,612,576 | 1,123,904 Federal Poard fcr Voca- tional Education Service hospitals ........ 16,866 1,210 15,656 30,562 22,273 Other stations .......... 39,942 548 39,394 7,362 63,564 Petal s ieviin sans 56,808 1,758 55,050 37,924 85,837 American Seamen Service hospitals ....... 42,664 12,842 20,822 547,878 65,861 Other stations .......... 34,327 5,641 28,686 101,308 68,018 Total -....svvvssueas 76,001 18,483 58,508 649,186 133,879 Coast Guard Service hospitals 3,226 1,274 1,952 36,807 3,417 Other Stations ......«... 4,31 339 3,976 4,635 9,197 Total ......c.c0sens 7,541 1,613 5,928 41,442 12,614 Navy Service hospitals ........ 218 173 45 7,602 54 Other stations .......... 346 81 265 1,242 719 Sotal *,.......:..... 564 254 310 8,844 773 Army Service hospitals ........ 161 108 53 2,091 93 Other stations .......... LE 2,425 146 2,279 | 3,257 4,708 Total"... 00d. 0a: 2,586 254 2,332 5,348 4,801 “vo ACTIVITIES 81 RELIEF FURNISHED SPECIFIED BENEFICIARIES, Fiscal YEAR 1921 Patients treated Hospital | Dispensary Beneficiaries In In rs er Total hospitals Jisgen: furnished | furnished Engineer Corps Service hospitals ........ 226 107 119 4,982 248 Other stations s.r ivioe 716 169 547 2,725 1,019 Total =’. cove eonnninys 942 276 6661 _ 7.707 1,267 Mississippi River Commis- sion Service hospitals ........ 990 163 827 4,254 1,118 Other stations’ .......u.. 245 33 212 472 393 BOtAl as oleanions »uinis 1,235 196 1,039 4,726 1,511 Lighthouse Service ervice hospitals .... 532 163 369 4,716 610 Other stations .......... 550 79 471 1,361 859 Total ‘wuviivvinis oles 1,082 242 840 6,077 1,469 Coast and Geodetic Survey Service hospitals ........ 97 36 61 816 116 Other stations .......... 236 49 187 572 310 Total .......000000 333 _ 85 248 1,388 426 Employees’ Compensation Commission Service hospitals ........ 15,490 1,871 13,610 51,673 37,912 Other stations ......v:... 11,356 658 10,608 10,138 28,881 Total i): miiviinas 26,846 2,520 24.317 61,811 66,793 Discharged allied soldiers Service hospitals ........ 1,150 563 587 34,552 1,410 Other stations ...... sis ee 705 210 495 8,600 0983 Total .............. 1,855 773 | 1,082 43,152 2,393 Immigration Service Service hospitals ........ 16,447 16,415 32 195,049 35 Other stations .......... 464 456 8 5,281 13 Total oe.viusiviees 16,011 16,871 40 200,330 48 Public Health Service em- ployees Service hospitals ........ 3,067 1,508 1,469 30,338 3,749 Other stations .......... 2,600 343 2,347 10,946 4,41 Total ovsisnioriss 3.787 1,041 3,816 41,284 8,167 Foreign seamen Service hospitals ........ 864 832 32 25,560 59 Other stations ..c.c...... 684 222 462 3,212 1,830 Total tees cdvmoris iy 1,548 1,054 ee) 28,772 1,808 Miscellaneous Service hospitals ...... 5,628 102 5,436 21,053 12,770 Other stations ......... 1,476 2 1,474 51 14,512 otal, iuiansnivaiis 7,104 104 6,010 21,104 27,282 Hospital and dispensary treatment is given at hospitals operated by the service; dispensary treatment is furnished also 82 THE PUBLIC HEALTH SERVICE at relief stations maintained by the service and at contract hospitals; and hospital treatment is given in private hospitals under contract. During the fiscal year 1921 the total service rendered at each class of stations was as follows: TorAL SERVICE AT EACH CLASS OF STATIONS DURING FiscAL YEAR 1021 Patients treated Hospital Dispensary In days treat- Total In dispen- relief ments hospitals saries furnished furnished Hospitals operated by Pub- lic Health Service ....... 268,027 113,496 155,431 4,921,314 352,894 Relief stations operated by Public Health Service 543,249 4 572940, es 1,120,168 69,520 2,850,357 Contract hospitals .......... Total. ocviccernnnicniodns 812,176 183,016 629,160 7,771,671 1,473.062 The supervision of the treatment of discharged soldiers in contract hospitals ceased on April 19, 1921, when this work was transferred to the Bureau of War Risk Insurance, but other classes of beneficiaries are still assigned to contract in- stitutions at places where the service does not operate a hos- pital. The number of patients treated in contract hospitals, however, will be much smaller, as the greater part of the con- tract patients were discharged soldiers. The service rendered in contract hospitals during the fiscal years 1920 and 1921 for discharged soldiers and for other beneficiaries is shown in the following table : D1SCHARGED SOLDIERS AND OTHER BENEFICIARIES TREATED IN CONTRACT HospiraLs Fiscal YEARS 1020 AND 1021 Beneficiaries Patients treated in Hospital days relief ! hospital furnished Fiscal Fiscal Fiscal Fiscal year year year year 1020 1921 1920 1921 Discharged soldiers .............. 43,312 60,544 1,651,263 2,680,195 All other beneficiaries ........... 6,954 8,976 112,191 161,162 Total covvsnivinsvnsvsnnnssnns 50,266 69,520 1,763,354 2,850,357 er — ACTIVITIES 83 Special Treatment. Investigations of the prevalence of trachoma were begun in 1912. Hearings before the Com- mittee of the House of Representatives on Expenditures in the Department of the Interior called attention to the presence of that disease on Indian reservations in Minnesota, and it was also reported that the disease existed among the miners of the Mesaba and Vermilion Ranges. In April the State Board of Health of Minnesota requested the service to study the dis- ease. In June the American Medical Association requested the service to make a nation-wide investigation of the preva- lence of the disease, and it was accordingly planned to extend the scope of the Minnesota investigation to all states from which the disease was reported. In July a study in the rural districts of Kentucky was begun at the request of the state health authorities. In addition to making field studies of the extent of the disease, hospitals were opened at Hindman, Hy- den, and Jackson, Kentucky, in the fall of 1913 and the spring of 1914 under authority conferred by the sundry civil ap- propriation act for the fiscal year 1914, approved June 23, 1913 (38 Stat. L., 25). In this act the item for preventing spread of epidemics authorized the President to aid state and local boards in preventing and suppressing the spread of cer- tain epidemic diseases, trachoma being expressly mentioned. In June, 1915, the hospital at Hyden was transferred to Lon- don, and on June 30, a fourth hospital was opened at Colburn, Va. A fifth hospital was opened at Welch, West Virginia, on October 1, 1915. In September, 1916, the hospital at Hindman, Kentucky, was moved to Pikesville, Kentucky, as Knott County, in which Hindman is situated, had been practi- cally cleared of the disease. While the hospital had been main- tained at Hindman the county health officers had been in- structed in methods of diagnosis and treatment, and had be- come qualified to treat any additional cases that might de- velop. About this time an additional hospital was opened at Tazewell, Tennessee. The hospitals at Colburn, Virginia, and London, Kentucky, were closed toward the end of the 84 THE PUBLIC HEALTH SERVICE fiscal year 1918, as the disease was under control in these localities. A new hospital was opened at Greenville, Ken- tucky, and on December 13, 1918, a hospital was opened at La Moure, North Dakota. During the fiscal year 1921 trachoma hospitals were oper- ated at Greenville, Jackson, and Pikesville, Kentucky, Morris- town, Tennessee, and La Moure, North Dakota. The work at the five hospitals included 11,479 dispensary treatments, 19,334 hospitals days relief and 1858 operations. The trachoma hospitals are maintained for two purposes: (1) to suppress the disease in places where it is wide spread, and (2) to educate the local physicians in method of treatment. The fact that general practitioners as a rule have little knowl- edge of methods of diagnosis and treatment of this disease has been one of the factors that have favored the spead of tra- choma. As the methods of treatment are comparatively simple the disease is easily controlled after the local physician is instructed in the technique of treatment. All of these hos- pitals are small and are generally located in buildings sup- plied by state or local authorities. When the disease is un- der control in one locality the hospital is moved to another point. In addition to the hospitals, investigations of the prevalence of trachoma have been made and field clinics are maintained in several states. During the fiscal year 1920 surveys were made of thirty-six counties in Missouri, Texas, Ohio, Ala- bama, Florida, and South Carolina. Examinations were made of 52,491 persons and 1163 were found to be suffering from the disease. In connection with the surveys 397 opera- tions were performed. The field clinics maintained during the year numbered fifty-five, at which 20,882 persons were examined, of whom 1330 were found to have trachoma. The clinic work included 1526 operations, as well as demonstra- tions of methods of diagnosis and treatment to 250 physicians. Hospitals for the treatment of persons suffering from leprosy are operated at Kalihi, Hawaii, and Carville, Louisi- rg? ACTIVITIES 85 ana. The hospital at Kalihi was authorized by the act of March 3, 1905 (33 Stat. L., 1909), but was not opened until December 23, 1909. The work at this station includes clini- cal and laboratory studies for the purpose of finding remedies as well as medical care and treatment of persons suffering from the disease. A national home for lepers was authorized by the act of February 3, 1917 (39 Stat. L., 872). That act provides that there shall be admitted to this home any person afflicted with leprosy who presents himself, who may be appre- hended under authority of the United States quarantine laws, or who may be “consigned” to the home by the proper health authorities of any state, territory, or the District of Columbia. The war interfered with the selection of a site for this insti- tution, and the hospital at Carville, Louisiana, was not opened until 1921. The following statement regarding the work at this insti- tution is taken from the annual report of the Public Health Service for 1921. This property was formerly known as the Louisiana Leper Home and was transferred to the Public Health Service from the State of Louisiana on January 3, 1921. The station is essentially a “home” and not a hospital, there being no facili- ties available for the proper hospitalization of patients. It is planned to convert this institution into a National Leper Home capable of accomodating 500 lepers. Its present capacity is 120 beds, 116 of which are occupied. Considering the character of this institution, its location, etc., it is evident that great difficulties must be encountered in operating it. The personnel situation is particularly bad, the Civil Service Commission finding it next to impossible to supply the station with proper help. At its acquisition, the - buildings, grounds, and mechanical equipment were in a very poor state of upkeep. Since its occupancy by the Public Health Service a very considerable amount of sanitation work has been done, redigging ditches, clearing underbrush, etc., and placing the reclaimed territory under cultivation. About half the plantation has been cleared, and the work is progress- ing rapidly. Sanitary conditions have been greatly improved as the result of drainage, and the mosquito nuisance has been 86 THE PUBLIC HEALTH SERVICE considerably diminished. Eighty-eight acres have been put under cultivation. The lack of quarters for personnel was met by the erection of nine portable houses. Construction is now under way which will increase the bed capacity by about 75 beds. At the request of the United States Employees’ Compensa- tion Commission, physicians have been placed at a number of stations to give medical and surgical care for injuries received by civilian employees. Field and laboratory studies of pellagra had been made for some years by the service, and in the latter part of the fiscal year 1914 a hospital was opened at Spartansburg, South Caro- lina, in connection with this work. This hospital was oper- ated more for the purpose of enabling clinical studies to be made of the disease than for the purpose of affording medical relief, as the disease was too widespread to allow one hospital to be of material benefit. This special work was discontinued on December 31, 1920. Crews of Vessels Engaged in Deep Sea Fisheries. Crews of vessels engaged in deep sea fisheries are entitled to treat- ment at hospitals under the general provision of law applying to seamen on registered, enrolled, or licensed vessels of the United States. The act of June 24, 1914 (38 Stat. L., 387), provides that revenue cutters (Coast Guard vessels) may be used to extend medical and surgical aid to the crews of these vessels, and that such surgeons and other officers of the Public Health Service shall be detailed for this work as may be nec- essary. This relief is thus given on the fishing grounds. The reports of the Public Health Service do not give any de- tails regarding this work. Physical Examinations. Many physical examinations are made independent of the usual examination to determine the necessity of hospital treatment. Before April 19, 1921, all beneficiaries of the Bureau of War Risk Insurance and of the Federal Board for Vocational Education were examined by officers of the Public Health Service, or by physicians desig- ACTIVITIES 87 nated by the Public Health Service in order to determine the degree of physical disability. After April 19, 1921, physical examinations of ex-service men were made when requested by the officers of the Bureau of War Risk Insurance. After the creation of the Veterans’ Bureau on August 9, 1921, physical examinations continued to be made when specifically requested by officers of that organization. Federal employees injured in the discharge of their duties are examined on behalf of the United States Employees’ Com- pensation Commission in order to determine the extent of their injuries. Applicants for licenses as pilots are examined for sense of hearing, color blindness, and general visual capacity at the request of the Steamboat Inspection Service. American seamen are examined at the request of a United States Ship- ping Commissioner or the master of any American vessel. Foreign seamen are examined at the request of a foreign consul or the representative of the line; for this examination a charge of one dollar is made. Applicants for appointment as cadets in the Coast Guard are required by law to be examined by offi- cers of the Public Health Service (34 Stat. L., 452) ; officers of the service also make the physical examination of all officers of the Coast Guard before promotion and form part of the boards of that organization which determine the eligibility of officers and enlisted men for retirement (32 Stat. L., 100). Applicants for appointment in the branches of the government service are examined physically at the request of the Civil Service Commission or the appointing agency whenever the nature of the employment makes such an examination desir- able. The total number of physical examinations made during the fiscal years 1920 and 1921 is shown in the follow- ing table: PHYSICAL EXAMINATIONS DURING F1scAL YEARS 1020 AND 1921 Organization Fiscal year | Fiscal year 1920 1021 Bureau of War Risk Insurance .............. 445,293 883,912 Federal Board for Vocational Education .... 1,597 40,882 88 THE PUBLIC HEALTH SERVICE PHYSICAL EXAMINATIONS DURING FISCAL YEARS 1020 AND 1921—Continued Organization | Fiscal year | Fiscal year 1920 1921 AATIETICHI SORINEN (hv alesis sien s oh Saas a a ais 21,947 29,957 Foreign (Seamen . uu vie dudes ans sa adn a L bid 3,233 4,473 USE RIIY Ca vias valerie teins sade om dibs hts a 72 784 U.S. Army Engineers |... virverensaiisonss bo otis 169 BJ, 5S. NAVY viaivir ih dere va vars tesa 402 136 Coast iiQuard.. oui. Juniors is sana sivs nian 3,798 5,384 U. 8S. Public Health Service ........ceo0uiuen 249 4,331 Li htHOUSE Service + vats unc enssnaaisvn rn casas 153 253 Coast and Geodetic Survey ................. 653 314 Employees’ Compensation Commission ......... 3,039 13,392 Mississippi River Commission ................. 164 264 Immigration | Service. vias varies seninssan 6,362 4,838 Allied soldiers... dude vides sina rina ts ae 95 1,260 Miscellaneous (not classified) ............... 26,236 14,202 OB Mt in ss sia v mao Maen isto oe oan 4 aint Coa 513,293 1,004,551 Control of Venereal Diseases. Work looking to the control of venereal diseases began as a war activity and was first undertaken in December, 1917, when through the co- operation of the American Red Cross, venereal disease clinics were opened in the districts adjacent to large Army camps. Early in 1918 the Public Health Service urged the State Boards of Health to make specific provision for the control of persons afflicted with venereal diseases. By June 30, 1918, twenty-four states had made arrangements with the Public Health Service to have a service officer take charge of ven- ereal-disease control under the joint supervision of the state health department and the Public Health Service. Legislation. In order to supply additional funds a bill was drafted and introduced into the Senate as Senate Bill 4608. This bill, with some changes, was incorporated in Chapter XV of the army appropriation act for the fiscal year 1919, ap- proved July 9, 1918 (40 Stat. L.., 886).2 Section 3 of this act provided for the creation of a Division of Venereal Diseases of the Public Health Service, while Section 4 described the duties of this division to be * For more detailed review of history of this legislation, see pages 47-52. ll ACTIVITIES 89 (1) to study and investigate the cause, treatment, and pre- vention of venereal diseases; (2) to cobperate with State boards or departments of health for the prevention and con- trol of such diseases within the States; and (3) to control and prevent the spread of these diseases in interstate traffic: Provided, That nothing in this chapter shall be construed as limiting the functions and activities of other departments or bureaus in the prevention, control, and treatment of venereal diseases and in the expenditure of moneys therefor. Section 7 provided $200,000 for the establishment and main- tainment of the division during the fiscal year 1919. The same amount was appropriated in subsequent sundry civil ap- propriation acts for the fiscal years 1920, 1921, and 1922. Section 6 of the act of July 9, 1918, appropriated $1,000,- 000 for each of the fiscal years 1919 and 1920 to be paid to states for the use of boards or departments of health in the prevention, control, and treatment of venereal diseases. This sum was to be allotted to each state, in accordance with rules and regulations to be prescribed by the Secretary of the Treas- ury, in proportion to the population. For the fiscal year 1920 it was provided that each state should specifically appropriate or set aside for the prevention, control, and treatment of venereal diseases an amount equal to the money allotted by the United States. The actual disbursement of the money to the states was made by the Interdepartmental Social Hygiene Board, which had authority to prescribe an accounting system, but which did not direct the field activities under this appro- priation. In a later act $450,000 was appropriated for the fiscal year 1921 (41 Stat. L., 888) in addition to the unex- pended balance for the fiscal year 1920. No appropriation was made for the fiscal year 1922, but for the fiscal year 1923 the sum of $250,000 has been appropriated to the Public Health Service for allotment to the states in codperative work in the prevention and control of venereal diseases. The act of July 9, 1918, created also the Interdepartmental Social Hygiene Board, consisting of 90 THE PUBLIC HEALTH SERVICE ~The Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury as ex officio members, and of the Surgeon General of the Army, the Surgeon General of the Navy, and the Surgeon General of the Public Health Service, or of representatives designated by the Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury, re- spectively. An appropriation of $100,000 for each of the fiscal years 1919 and 1920 was made to this board to be paid to scientific institutions for discovering more effective medical measures in the prevention and treatment of venereal diseases. The Board also received an appropriation of $300,000 for each of the years 1919 and 1920 to be paid to suitable institutions for the purpose of discovering and developing more effective educational measures in the prevention of venereal diseases and for the purpose of sociological and psychological research related thereto. A later act (41 Stat. L., 838) appropriated $85,000 for medical research and $250,000 for educational research for the fiscal year 1921, with the limitation that the institutions receiving the grants must set aside a similar amount for the same purpose. No appropriation for medical or educational research was provided for the fiscal year 1922. Section 5 of the act of July 9, 1918, appropriated $1,000,- 000 for the fiscal year 1919 to be expended under the joint di- rection of the Secretary of War and the Secretary of the Navy “for the purpose of assisting the various states in caring for civilian persons whose detention, isolation, quarantine or com- mitment to institutions may be found necessary for the pro- tection of the military and naval forces of the United States against venereal diseases.” The administration of this fund was placed in the hands of the Interdepartmental Social Hy- giene Board by these two secretaries. The balance of this ap- propriation unexpended on June 30, 1919, was by a later act (41 Stat. L., 178) reappropriated for the fiscal year 1920. The sundry civil appropriation act for the fiscal year 1921 appropriated the unexpended balance and $150,000 additional —— ACTIVITIES 91 for similar purposes during that year (41 Stat. L., 888). For the fiscal year 1922 there was appropriated $200,000 for assisting the states in protecting the military and naval forces against venereal diseases, and $25,000 for the ex- penses of the board.? No appropriation has been made for the Interdepartmental Social Hygiene Board for the fiscal year 1923, the supervision of the codperative work with the states being turned over to the Public Health Service. To sum up it may be stated that the Interdepartmental So- cial Hygiene Board had supervision over the medical and educational researches in the field of venereal diseases and made grants of money to universities for carrying on this work. It has also had supervision over all the work resulting from the appropriation for assisting the states in caring for civilian persons whose detention, isolation, or quarantine, or commitment to institutions may be found necessary to protect the military and naval forces against venereal diseases. In connection with the latter work a field force was maintained which was entirely distinct from forces maintained by the states or the Public Health Service for the prevention, control, and treatment of venereal diseases. The original allotments to the states for the prevention, con- trol, and treatment of venereal diseases were disbursed by the Interdepartmental Social Hygiene Board, but the regulations for this work are made by the Secretary of the Treasury, and the directing agency is the Public Health Service. The scope and extent of this work alone will be discussed below. Scope of Work. The following regulations governing the method of operation were approved by the Secretary of the Treasury on September 4, 1918, and have been effective since that date. The act provides that $1,000,000 shall be distributed to the States for the use of their respective boards or depart- 8 For account of the work of this board see Manual for the various agents of the U. S. Interdepartmental Social Hygiene Board, 1920, and Annual Report, 1920. 92 THE PUBLIC HEALTH SERVICE ments of health in the prevention, contol, and treatment of venereal diseases, this sum to be allotted to each State, in ar- cordance with rules and fegulations prescribed by the Secre- tary of the Treasury, in the proportion which its population bears to the population of the continental United States, ex- clusive of Alaska and the Canal Zone, according to the last preceding United States census. State boards or departments of health receiving their re- spective allotments shall agree to the following cooperative measures under which their appropriation shall be extended : I. Put into operation through a legislative enactment or a State board of health regulation having the effect of law, regu- lations in conformity with the suggestions approved by the Surgeons General of the Army, Navy, and United States Public Health Service, for the prevention of venereal diseases. The minimum requirements of these rules are: (a) Venereal diseases must be reported to the local health authorities in accordance with State regulations approved by the United States Public Health Service. (b) Penalty to be imposed upon physicians or others re- quired to report venereal infections for failure to do so. (¢) Cases to be investigated, so far as practicable, to dis- cover and control sources of infection. (d) The spread of venereal diseases should be declared unlawful. (e) Provision to be made for control of infected persons that do not coGperate in protecting others from infection. (f) The travel of venereally infected persons within the State to be controlled by State boards of health by definite regulations that will conform in general to the interstate regu- lations to be established. (9) Patients to be given a printed circular of instructions informing them of the necessity of measures to prevent the spread of infection and of the importance of continuing treat- ment. 2. An officer of the Public Health Service shall be as- signed to each State receiving allotments for the general pur- pose of cooperating with the State health officer in supervising the venereal-control work in the State. This officer to be selected by the State health authorities and to be approved and recommended for appointment by the Surgeon General of the Public Health Service. The salary of this officer will be paid by the State out of the funds made available from the ACTIVITIES 03 allotment, except a nominal sum of $10 per month, which will be paid by the United States Public Health Service. In those States where a bureau of venereal diseases has already been established, with a full-time medical officer in charge, the pres- ent incumbent may be recommended for appointment by the States health officer, and, with the approval of the Surgeon General, United States Public Health Service, he will be ap- pointed as an officer of the Public Health Service. The gen- eral plan of work for the State bureau of venereal diseases will be: (a) Securing reports of venereal infections from physi- cians and others required to report, in accordance with State laws. (b) Suppressive measures, including the isolation and treat- ment in detention hospitals of infected persons who are un- able or unwilling to take measures to prevent themselves be- coming a menace to others, the establishment of free clinics for the treatment of venereal diseases, and the elimination of conditions favorable to the spread of venereal infections. (¢) Extension of facilities for early diagnosis and treat- ment through laboratory facilities for exact diagnosis and scientific determination of condition before release as nonin- fectious, in accordance with the standardized procedure that will be prescribed by the United States Public Health Service. (d) Educational measures to include informing the general public as well as infected individuals, in regard to the nature and manner of spread of venereal diseases and the measures that should be taken to combat them. (e) Cooperation with local civil authorities in their efforts to suppress public and clandestine prostitution. The clinics referred to under (b) will form centers from which the other measures may be conducted by discovering the presence of infections, the securing of data for enforcing the regulations for reporting these diseases, and the institution of educational measures appropriate to particular communities. The im- mediate reduction in venereal-disease foci resulting from clinic treatment will result in a marked decrease in the prevalence of such diseases in both the military and civil population. (f) Accurate detailed records must be kept of all the activ- ities of the venereal-disease work. These will include careful records of each case treated, amount of arsphenamine used, final results, and disposition made of patients. Copies of 04 THE PUBLIC HEALTH SERVICE these records must be forwarded to the Surgeon General, United States Public Health Service, as a report at such inter- vals as they may be requested, and in accordance with instruc- tions regarding the form of report. 3. Local funds that may be available, or that may become available from legislative appropriations or any other source for venereal-disease control, shall be used by the State or city health authorities having jurisdiction for the extension of the work, and such local funds must not be conserved through the expenditure of the funds that are allotted by the Congress through the United States Public Health Service. 4. In extension of the educational measures the State's health authorities and its bureau of venereal diseases shall exert their efforts and influence for the organization of a State venereal-disease committee that will be unofficial in character, but a valuable agency for furthering the comprehen- sive cooperative plan for nation-wide venereal-disease control. 5. The State health authorities shall take such measures as may be found practicable and decided upon in conference be- tween the Public Health Service and State board of health representatives for the purpose of securing such additional legislation as may be required for the development of control of the spread of venereal infections. Action shall be taken to limit or suppress the activities of advertising “specialists” and quacks by prosecuting them under State laws, or such other measures as may be applicable and effective. 6. In expending the sum allotted a State, the rules and regulations to be promulgated by the Interdepartmental Social Hygiene Board for the expenditure of the $1,000,000 civilian quarantine and isolation fund under control of the Secretary of War and Secretary of the Navy shall be given considera- tion by Public Health Service and State board of health repre- sentatives, so that the military necessities of each particular State may receive the consideration due its relative importance, and so that funds from the two sources may be correlated. 7. The State allotment shall be expended along general standard lines for all States and in accordance with an ac- counting system, to be forwarded by the Interdepartmental Social Hygiene Board, approximately as follows: (a) For treatment of infected persons in hospitals, clinics, and other institutions, including arsphenamine and other drugs, 50 per cent. of the allotment, ACTIVITIES 5 (b) In carrying out educational measures, 20 per cent. (¢) In carrying out repressive measures, 20 per cent. (d) In general administration and other activities of ven- ereal disease control work 10 per cent. (‘This distribution is provisional and subject to modification after conference and agreement between each State and the United States Public Health Service to best meet the needs of the particular State.) 8. In carrying out the general government program the administrative organization of the United States Public Health Service will be available at all times to State or- ganizations in cooperative work, and assistance will be given to States whenever possible through the detail of employees, the securing of arsphenamine, providing litera- ture for the educational measures, and in such other ways as may be found practicable as the work develops. By June 30, 1920, 46 states had made appropriations en- titling them to receive all or part of their federal allotment, only the District of Columbia, Nevada, and New Mexico having failed to secure any of the funds. By June 30, 1921, all the states had made the necessary appropriations, but no funds had been provided by the District of Columbia. In general the work that is being done falls into three main_groups:. (1) Medical relief; (2) stimulation of taw- enforcement; and (3). educational activities... I. ~The medical relief has been extended through clinics organ- ized in the states which have received allots oF Tedbral funds. On June 30, 1919, there were 237 clinics in operation, —ard by June 30, 1920, this number had increased to 408; the maximum number open during the year being 427. At the end of the fiscal year 1921 there were 624 clinics in opera- tion. At all these clinics treatment is given to all persons suf- fering from venereal diseases, with the purpose of rendering the patient noninfectious rather than of effecting a cure. Not all of the clinics, however, give treatment free of charge, as many are at hospitals, where a nominal charge is made. Dur- ing the fiscal year 1920 a total of 126,131 patients were ad- mitted to these clinics and 1,576,542 treatments were given. 96 THE PUBLIC HEALTH SERVICE In order to stimulate the reporting of venereal diseases a circular letter was sent to each of the 40,000 registered den- tists of the country asking them to report all cases of venereal disease coming under their observation and to advise all pa- tients suffering from venereal disease to undergo treatment either at a clinic or by a competent physician. By the end of the year 38 per cent. of the dentists had replied to this re- quest and agreed to take the action requested. The states were urged to increase the educational facilities available to dentists so that they might be better able to recognize syph- ilitic symptoms. During the previous fiscal vear an appeal was made to all physicians to codperate by giving scientific attention to cases of venereal diseases in order to prevent infected persons from becoming the victims of quack doctors and nostrum manu- facturers. A campaign was carried on among druggists, in or- der to eliminate the sale of nostrums for self treatment and the prescribing of remedies by druggists. As a result of this cam- paign over 28,000 druggists, or nearly 60 per cent. of those to whom the appeal was sent have agreed to the following (1) Not to prescribe or recommend remedies; (2) not to purchase and sell any proprietary remedies; ( 3) to refill only such pre- scriptions as were given originally to the customer by a reput- able physician; (4) to distribute Public Health Service litera- ture to person asking for remedies, and to direct such per- sons to a reputable physician, an approved clinic, or the state board of health. The newspapers were asked not to print advertisements of doctors to treat venereal diseases or of nostrums for self treatment. Of 20,000 papers circularized, 19,800, or 9g per cent., agreed to codperate at once. Of the 200 remaining sixty agreed to change their policy, leaving only 140 carrying venereal disease advertising. Educational measures have included lectures, motjon-picture exhibits, and the distribution of pamphlets. Manufacturers “were interested by showing the decrease in efficiency result- ing from the prevalence of venereal diseases, and many firms a ACTIVITIES 97 have distributed literature among their employees, have placed placards in rest rooms and toilets, or have agreed to co- operate in other ways. In cobperation with the Bureau of Education, conferences with educators were arranged for the purpose of stimulating proper instruction in sex hygiene. The pamphlets distributed by the Public Health Service and the state boards of health numbered 4,000,000 copies during the fiscal year 1921 compared with 8,000,000 copies in the fiscal year 1920 and 14,000,000 during the fiscal year 1919. In the field of law enforcement the Public Health Service can take no direct actiofl, except to control the interstate travel of persons known to ‘be infected. Activities along this line-consist in giving g legal advice to states and cities in connec- tion with the enforcement of the laws governing the control of venereal diseases and the suppression of prostitution. An analysis was made of the law enforcement activities, and the cities were graded according to the completeness of their ac- tivities. The ultimate purpose of this survey was to stimulate greater interest on the part of state and city officers and through them to develop public interest in the suppression of prostitution and the control of venereal deseases. The activities of the Public Health Service and the co6per- ating states in this work during the fiscal years 1919, 1920, and 1921 are summarized in the following table: AcTiviTIES OF Division oF VENEREAL Diseases, FiscAL YEARS 1919 To 1921 1919 1920 1921 Medical activities I. Cases of venereal diseases reported to state boards of health: A. Gonorrhea ........c.iiviiniininanena, 131,193 172,387 203,281 B., Syphilis | us rsvvrnnvasotarinsa vis nse sh 100,466 142,869 217,817 C, ‘Chancroid and others -.... cecevvrvres 7,843 10,861 13,606 a A 239,502 326,117 434,704 II. Doses of arsphenamine (or similar product) administered by state boards of health ...... 118,055 328,382 532,778 III. Clinics: A. Clinics operating under joint control of state boards of health and the Public Health CEVICHE 0s = v's via +s win wis a0 nir ain ain tums 237 427 483 98 THE PUBLIC HEALTH SERVICE Activities oF Division oF VENEREAL Diseases, Fiscal YEARS 1919 To 1021 —Continued 1919 1920 1921 Medical activities—Continued III. Clinics—Continued B. Clinics included under A established during the year... uusis veins ne 145 190 90 C. Clinics reporting activities .............. 167 383 442 D. Reports received from clinics— (1) Patients admitted ...... oe ine ore 59,002 126,131 140,748 (2) Patients discharged as non- BI IOUS ts ai dinnin seh a4 aw 3x x aot vie rier 6,022 34,215 55,467 (3) Treatments given ......civvsivines 527,392 | 1,576,842] s.iaeiie. (4) Wassermann tests made ........... 63,929 175,872 251,885 (5) Microscopic examinations made for gonococcus. Infection ...evarsssiareivas 89,419 155,275 185,325 Educational activities. . I. Pamphlets: A. Pamphlets distributed— (1) By the Public Health Service (a) In response to requests from— (1a) Individuals «.. i veveins es eee 422,961 108,332 49,238 (2a) Public officials and Organizations: .. u,v. cxvsex en "a vinin .| 2,666,070 403,126 122,227 (3a) Industries ....... Weve oasis eis 224,793 100,667 7,067 (b) Directly to— (1a) The public (official mailing lists and general circularizations).. | 2,183,655 982,334 120,641 (2a) State boards of health ........ 831,029 667,534 34,241 (3a) States in draft campaign ..... 3, 143,72000 05,00 La, reve (4a) Public Health Service field OBCRIE iv vnivssskenvssiinsvwudion 242,658 52,687 7,769 (sa) Other field agencies ......... 408,006 | viniunns ely waits Total .uuiivnshvinsivnssness oni] 10,120,272 | 2,314,680 342,083 (2) In the field by— (a) State boards of health ...........| 5,817,042 | 6,488,333 3,818,670 (b) States in draft campaign ........ 2,286,012" ave siinn PEA fc) Clinics: ...v Ce ee. NR 13500010 saat] wine eleie ROYAL caf v's wien slaiv nle's eereesaanea. | 8,234,963 | 6,488,333 | 3,818,670 (3) Gross total pamphlets distributed . | 18,355,735 | 8,803,013 | 4,160,753 Minus pamphlets distributed by the Public Health Service to— (a) State boards of health ....... 831,029 667,534 34,241 (b) States in draft campaign ......| 3,243,700] ..ccvven] vreeens (¢) Public Health Service field officers 242,658 52,687 7,769 Total substracted ....covnsversnnes | 4,217,387 720,221 42,010 (4) Net total pamphlets distributed ...... 14,138,348 8,082,792 4,118,743 ACTIVITIES : 99 AcTIvITIES OF DIVISION oF VENEREAL DISEASES, F1scAL YEARS 1919 TO 1921 —Continued 1919 1920 1921 Educational activities—Continued I. Pamphlets—Continued B. Framed placards posted .........eeuvus 64,802 | «ivsns inf usisieny C. Pamphlets purchased and reprinted by state boards of health ..........c00veene 10,510,524 | 5,816,830 | 4,081,697 D. Pieces of the industrial program pur- chased &cosvrornvnsinsin sn rent sisesiesnisey 668,668 186,588 84,763 E. Separate educational venereal disease pamphlets issued by the Public Health SErVICE Jusilve cs enss da tnvianva ve sesmrrnsy 50 5 9 II. Lectures and addresses reported .......... 8,209 12,360 8,001 III. Conferences reported by the Public Health SEIVIORT (vieivis oe v0inin's seid snr sos vsiesedsss ssn 16 25 16 IV. Exhibits and lantern slides: A. Exhibits and slides loaned by the Public Health Servite ..vesveeevsrrisnnssersss 551 130 1,056 B. Exhibits and slides purchased by agencies other than Public Health Service ..... 221 676 |v enusiaen C. Exhibits and lantern slide showings TEPOTLEA vevverisensrsnsssnsnnrissnnnnnes 2,186 11,033 4,442 V. Motion-picture films: A. Motion-picture films loaned by the Pub- lic. Health Service’ viu.isisssvivi vasa 405 4 136 B. Motion-picture films purchased by state boards of health ........con00iuivnennss 65 85 {i an eermne C. Motion-picture showings reported ...... 1,398 2,157 1,684 VI. Publicity material: A. Articles furnished magazines .......... 3,228 || 302 4,192 B. Periodicals containing articles received . 157 118 176 C. Circulation of articles published ....... 4,470,756 | 3,190,786 | 1,780,795 Law-enforcement activities. I. States qualifying for Chamberlain-Kahn FUndS Cuesta re ream 46 46 46 II. States enacting legislation for venereal- disease cOBLIOl .cvvivvvecnnecinsrrcrrncanss 40 *13 39 III. City ordinances for venereal-disease COMEIOL: less issinnianvavnsesavinnnsnnsmmne vere 222 102 28 * This does not include states making appropriations entitling them to federal allotment. Prevention of Interstate Spread of Diseases. For many years the Marine Hospital Service had been active in assisting local authorities in the South in controlling epidemics of yel- low fever, but the first effective measure in the direction of the interstate control of disease was passed in 1890. Legislation. The act of March 27, 18go (26 Stat. L., 31), gave authority for regulations to prevent the spread of cholera, yellow fever, smallpox, and plague from one state or territory 100 THE PUBLIC HEALTH SERVICE to another. These regulations were to be prepared by the Supervising Surgeon General of the Marine Hospital Service, and a violation of the regulations was made a misdemeanor punishable by fine or imprisonment. It should be noted especially that this applies only to the four diseases mentioned and does not confer any general power with respect to other communicable diseases. The authority for the work now car- ried on is conferred by the act of February 135, 1893 (27 Stat. L., 449), which provides that the service shall cooperate with and aid state and municipal boards of health in the execution and enforcement of the rules and regulations of such boards and in the execution and enforcement of the rules and regulations made by the Secretary of the Treasury to prevent the introduction of contagious or infectious dis- eases . . . into one state or territory or the District of Co- lumbia from another state or territory or the District of Co- lumbia; . . . and . . . where such regulations are, in the opinion of the Secretary of the Treasury, necessary to prevent the introduction of contagious or infectious diseases . . . into one state or territory or the District of Columbia from another state or territory or the District of Columbia, and at such ports and places within the United States where quaran- tine regulations exist under authority of the state or munici- pality which, in the opinion of the Secretary of the Treasury, are not sufficient to prevent the introduction of such diseases . into one state or territory or the District of Columbia from another state or territory or the District of Columbia, the Secretary of the Treasury shall, if in his judgment it is necessary and proper, make such additional rules and regula- tions as are necessary to prevent the introduction of such diseases . . . into one state or territory or the District of Columbia from another state or territory or the District of Columbia, and when such rules and regulations have been made they shall be promulgated by the Secretary of the Treas- ury, and enforced by the sanitary authorities of the states and municipalities, where the state and municipal health au- thorities will undertake to execute and enforce them; but if the state or municipal authorities shall fail or refuse to en- force said rules and regulations the President shall execute and enforce the same and adopt such measures as in his judg- ACTIVITIES hey ment shall be necessary to prevent the introduction or spread of such diseases, and may detail or appoint officers for that purpose. It should be noted that this act does not attempt to create machinery for the prevention of the interstate spread of dis- eases if the work of state and municipal authorities accom- plishes this purpose. It is only when the local regulations are inadéquate,.or.when a distinctly national problem is involved, that the federal power is invoked. Recognizing that the method outlined in the law is one productive of the best re- | sults, the Public Health Service has confined its activities to the formulation of regulations.gexerning the interstate transporta- tionof commodities and persons, the upbuilding of divisions of communicable diseases and sanitary engineering in state health departments, giving advice and assistance to local au- * thorities, and to regulatory measures when the local regulations | or resources are inadequate to meet the situation. Regulations affecting Interstate Carriers. Regulations affectifig_ interstate carriers provide that vehicles and vessels must be cleaned, ventilated, and supplied with adequate toilet facilities; that forecastles of vessels must be fumigated; that clean bedding must be furnished; that spitting must be pre- vented except into receptacles provided for that purpose; that common drinking cups and towels must not be used~-that drinking water and ice of a definite standard must be provided, and that all articles of food and drink must be obtained from a source free from infection. Carriers are forbidden to trans- port in interstate traffic milk from an infected source, oysters or clams grown or handled under insanitary conditions, shav- ing or lather brushes handled under insanitary conditions, or any article known to have been exposed to contagion unless a certificate has been obtained from the proper health authority that all necessary measures have been taken to render the article free from infection. From March 15 to June 15 cattle, horses, sheep, goats, elk, deer, or hogs cannot be shipped from any locality where Rocky Mountain spotted fever is known to 102 THE PUBLIC HEALTH SERVICE exist unless the shipment is accompanied by a certificate that the animals are free from wood ticks. The transportation of persons suffering from plague, cholera, yellow fever, smallpox, typhus fever, scarlet fever, poliomyelitis (infantile paralysis), Rocky Mountain spotted or tick fever, and epidemic cereo- bro-spinal meningitis, is prohibited. Specific regulations are provided governing the transportation of persons suffering from typhoid fever, diphtheria, whooping cough, measles, tuberculosis, leprosy, and venereal diseases. The only general regulation, in addition to those affecting interstate carriers, is the one providing that camps of migratory workers must be kept in a proper sanitary and vermin-free condition. The control over water for drinking purposes used by inter- state carriers is effected by requiring the carrier to use water from a source which is certified and approved as producing water of satisfactory sanitary quality and safety. These cer- tificates may be issued by officers of the Public Health Ser- vice or by the state department of health having jurisdiction over the supply, and must be filed whenever the Surgeon Gen- eral of the Public Health Service may direct but not less than semi-annually, in March and September of each year. These certificates are based upon the relative freedom of the water “from contamination or exposure to contamination, by micro-organisms and substances recognized as harmful or deleterious to the consumer’s health or liable to spread in- fectious or contagious disease, as determined through a sur- vey of the sanitary conditions under which the supply is pro- duced and the results of bacteriological and chemical analysis of samples of the water.” * During the fiscal year 1920 in- terstate carriers obtained water for drinking purposes from 2990 sources of supply, of which 2111 were found satisfactory and 243 polluted. No determination was made of the char- acter of the water from the remaining 636 sources. As inter- state carriers generally use municipal water supplies the super- + Amendment No. 8 to Interstate Quarantine Regulations, July 14, 1919. \ “apn” ACTIVITIES 103 vision of the water used by them often indirectly results in improvement in the character of the water used by municipal- ities. Sanitary engineering work. As the most effective method of preventing the interstate spread of disease is to eliminate sources of infection within the states, the Public Health Ser- vice has supported the state authorities in establishing and developing divisions of sanitation for the of water, sew- age, and other public health engineering problems. During the fiscal year 1920 the Public Health Service assisted in building up the engineering work of the public health depart- ments of eleven states by furnishing the services of trained sanitary engineers. These officers make specific investiga- tions of water supplies and sewage disposal problems, and or- ganize or make recommendations regarding the establishment of sanitary engineering divisions. The aim of the Public Health Service is not to work out all the problems involved in local sanitary measures but to render assistance in planning the most urgent work and to point out the desirability of having a definite “organization to carry on such work continually: Very largely as a result of the work done by officers detailed from the Public Health Service new sanitary divisions were organized during the fiscal year 1920 in eight states. Control of . Epidemics. While the Secretary of the Treas- ury has | power under the act of February 15, 1893, to declare a general quarantine prohibiting interstate traffic from moving from communities where contagious disease is prevalent it has not been found necessary to exercise this power within recent years. During the epidemic of poliomyelitis in the fall of 1916 a modified form of quarantine was put into effect in the principal centers of the disease by requiring the railroad companies to refuse interstate transportation to children under sixteen years of age who did not possess an identification cer- tificate issued by the Public Health Service. This certificate was made in duplicate and one copy was mailed to the local authorities at the place of destination, so that they might keep 104 THE PUBLIC HEALTH SERVICE in touch with all children coming from infected areas. This certificate of identification did not compel local authorities to allow children to detrain, but after the first panic had passed the local authorities generally recognized that the plan adopted was sufficient to prevent the spread of the disease.” The epidemic of influenza of 1918 called for an entirely dif- ferent line of effort. This disease could not be combated by even a modified quarantine and efforts were limited to supply- ing information and to organizing the work of communities in advance of the height of the epidemic. During the several epidemics of bubonic plague that have visited seaport cities in recent years the greatest stress has been placed upon local measures of sanitation, particularly the de- struction of rats and ground squirrels, which are carriers of the disease. Under the federal law a quarantine might have been declared against the port at which the disease existed, but it was recognized that the interference with commerce resulting from a quarantine would cause immense losses.® Instead of quarantining such ports and forcing the local auth- orities to bear all the expense of remedial measures, it was deemed advisable to cooperate with the local authorities or to undertake entirely the trapping of rats and other carriers of the disease. Pressure was also brought to bear upon the local authorities to require all buildings to be made rat- proof. Plague suppressive measures were carried on during the fiscal year 1920 at San Francisco, Oakland, Berkeley, and the surrounding area; New Orleans, Pensacola, Galveston, Beaumont, and Seattle. 5 In the case of the better known communicable diseases aid is given to states with the idea of building up a strong division of communicable disease control in each state health depart- ment rather than to expand federal activities. The work of 5 Surg. Gen., Annual Report, 1917, p. 189 et seq. 6 Hearings before House Committee on Appropriations on Sundry Civil Bill for 1921, p. 37. ACTIVITIES 105 the service is based on the principle that the prevention of the spread of diseases is best effected by exercising remedial meas- ures in the early days of an epidemic. To accomplish this it is necessary to establish an endemic index; that is, the normal rate of prevalence of each disease. The second step is to ob- tain prompt, frequent, and reliable reports of morbidity or the occurrence of the disease. By comparing the morbidity re- ports with the endemic index, the state health officer can readily see whether any particular disease is prevalent to an abnormal degree, and can take steps to control the disease before the epidemic becomes widespread. In many states an endemic index has not been established and morbidity reports are mea- ger or unreliable. The development of adequate local mach- inery is therefore the most important step to be taken in pre- venting the spread of disease. Assistance to local authorities is extended in order to aid in the establishment of better re- porting systems, and to give state and local officers the bene- fit of the wider experience of the national service in making an analysis of the causes of epidemics and pointing out the remedial measures necessary. Medical Inspection of Immigrants. The medical in- spection of immigrants was begun by the service in the early part of 1890, when this work was undertaken at New York, by direction of the Secretary of the Treasury under the pro- visions of the act of August 3, 1882 (20 Stat. L., 214). The act of March 3, 1891, made more specific provision for the medical examination of aliens and placed this duty definitely on the Marine Hospital Service. The inspection of immi- grants at foreign ports was begun in 1889. A second act providing for the medical examination of aliens was passed on March 3, 1903 (32 Stat. L., 1213-1222). The authority for this work at the present time is contained in sections 3 and 16 of the act of February 5, 1917 (39 Stat. L., 875-885). The classes denied admission by section 3 are “idiots, imbeciles, feeble-minded persons, epileptics, insane persons, persons who 106 THE PUBLIC HEALTH SERVICE have had one or more attacks of insanity at any time pre- viously, persons of constitutional psychopathic inferiority, persons with chronic alcoholism, . . . persons afflicted with tuberculosis in any form or with a loathsome or dangerous contagious disease, [and] persons not comprehended within any of the foregoing classes who are found to be and are certified by the examining surgeon as being mentally or physi- cally defective, such physical defect being of a nature which may affect the ability of such alien to earn a living.” This work includes the medical examination of all alien seamen, regardless of whether they desire to land or not. Section 16 of the act requires the physical and mental ex- amination of arriving aliens to be made by medical officers of the Public Health Service, who have had two years’ ex- perience in the practice of their profession since receiving the degree of doctor of medicine. If, however, medical officers of the Public Health Service are not available, civil surgeons may be employed by the Commissioner General of Immigra- tion, who has general supervision over the admission of im- migrants and has direct charge of all examinations that are not physical or mental. It is the function of the proper immigration officers of the Department of Labor “to determine whether an alien may be- long to any one or more than one of the excluded classes.” 7 It is the duty of medical officers of the Public Health Service to submit to the immigration officers evidence of two kinds: (1) certification as to findings of fact and (2) testimony in the form of professional opinions. For instance the ques- tion whether an alien has a particular defect or disease “is purely medical and is therefore for the medical officer to de- termine; the question of the effect of such a disease on the alien’s earning capacity is a practical one, and therefore for the immigration officer to determine, although such immigra- tion officer may desire, and having obtained, may consider 7 Regulations governing the Medical Inspection of Aliens, Public Health Service Miscellaneous Publication No. 5, 1917, p. 6 ACTIVITIES 107 an expression of opinion by the medical officer on the practical phase of the matter.” ® The specific duties of the medical officers are defined in the regulations of the service as follows: » 9. To conduct physical and. mental examinations of all arriving aliens, including alien seamen subject thereto, and to certify for the information of the immigration officers and boards of special inquiry any and all physical and mental de- fects and diseases. [Secs. 16 and 35, act. Feb. 5, 1917.] 10. To furnish the required information in such form as to enable the proper immigration officers to determine whether the alien concerned belongs to one of the excluded classes. [Secs. 3 and 17, act Feb. 5, 1917.] 11. To convene medical boards for the consideration of appeals made in the cases of aliens certified for insanity or mental defect; also in other cases as provided for by these regulations. 12. To submit such opinions as may be necessary to assist. the Secretary of Labor in determining whether certain pen- alties shall be imposed in connection with the certification for certain classes of physical and mental diseases and defects in cases of arriving aliens. [Secs. 9 and 33, act Feb. 5, 1917.] 13. To certify, when requested and when the facts so just- ify, that an arriving alien who has been excluded is helpless from sickness, mental or physical disability or infancy, in order that the deportation of an accompanying alien may be effected. [Sec. 18, act Feb. 5, 1917.] 14. To certify, when the facts so justify, that an excluded or deportable alien is in need of special care and attention or of the services of a special attendant. 15. When requested by the proper immigration officers to submit in writing for the information of the Secretary of Labor estimates as to the probable length of time medical treatment may be necessary to effect a cure in cases of arriving aliens who may be adjudged to have come to the United States in violation of law. [Sec. 18, act Feb. 5, 1917.] 16. To render when necessary a certificate in regard to the condition of insane aliens which will enable them to be held 8 Ihid., p. 8. 9 Ibid., p. 10-12. 108 THE PUBLIC HEALTH SERVICE for treatment at the expense of the United States until they may be safely deported. [Sec. 18, act Feb. 5, 1917.] 17. To render opinions when requested by the proper im- migration officers as to the curability of a “contagious disor- der” affecting the wife or minor children of a domiciled alien or certain minor children of a citizen. [Sec. 22, act Feb. 3, 1917. ] 18. To give an opinion as to the age of an alien, when requested to do so by the proper immigration officers. [ Sec. 3, act Feb. 5, 1917.] 19. To render opinions, when requested to do so by the proper immigration officers, as to whether an alien may be “physically capable of reading.” 20. To designate to the proper immigration officers such aliens as may be in need of hospital care and treatment, as provided under the law and these instructions, and to recom- mend their transfer to hospital or other suitable place and there supervise or conduct such care and treatment as may be necessary. [Sec. 18, act Feb. 5, 1917.] 21. To designate to the proper immigration officers such arriving aliens as it may be necessary to transfer to hospitals for the purpose of completing their medical examination. [Sec. 16, act Feb. 3, 1917.] 22. Upon request of the proper immigration officers, and in accordance with such special departmental authority as may be necessary, to determine the physical and mental con- dition of aliens charged with being unlawfully in the United States, and who have been taken into custody by the immi- gration officers under departmental warrants of arrest. Also, when requested, to submit in writing for the information of the Secretary of Labor estimates as to the length of time that medical treatment may be needed in such cases. [U. S. Im- migration Regulations. ] 23. To conduct the physical and mental examination of aliens along the borders of Canada and Mexico, subject to such special rules and arrangements as the Commissioner General of Immigration, with the approval of the Secretary of Labor, may prescribe. [Secs. 10 and 23, act of Feb. s, 1917. ] During the fiscal year 1921 physical and mental examina- tions of 2,004,410 immigrants and alien seamen were made % I —— Ca ACTIVITIES 100 at seventy-four places in the continental United States, and at eight in Canada, one in Alaska and several in the insular possessions. The number of aliens certified for defects was 46,880. More than half of the examinations, 1,023,791, were made at New York; the second port in number of exam- inations being Boston with 95,076. The examinations made at the various ports are shown in the following table: ALiENs ExaMINED AND CerTIFIED FOR DEFECTS, FrscaL YEARS 1020 AND 1021 Aliens examined Aliens certified Place Fiscal Fiscal Fiscal Fiscal year year year year 1920 1921 1920 1921 BIO ARIZ. Sei vrivs savsunh dinviinnen | see BOI “amie valeie 3 Baltimore, < Md, ior. ovens r nse viensn 20,631 35,328 1,003 987 Bellingham, Wash... didi dis svrrneres J vas vinies 33 ivan 1 Biscayne Bay, Pla. so suosisie vinnie sn des 6,747 0,448 Z {cv me ii Blaine, “Wash. ous vensrvnes dineansin 172 193 46 50 Boston, Mass, oud. creeks srensaney 49,444 95,976 1,314 4,267 Brownsville, (Tex. 5. ciccnnsussinninn 4,518 8,223 550 364 Brunswick, 'Ga... yas évinnvnrinnssnoive 8 A i ida EL Sie Buffalo N.Y. co svaiinsinsnravnnes 10,743 11,420 420 467 Calais, Me i iorvornsnonvnsnavsinnss 215 182 19 14 Calexico, :: Calif. | «ovis sos dinsvsvesvoi ea 1,399 2,976 22 15 Charleston, 8. Cu ls veinvt vrs vrsiinvvnie 4,183 3,912 7 31 Columbia River, Oreg. ..vivivivnces } vrvines 508] erriines 10 Del Rio; Tex. ih vais cosine a vivnsis vicammvin 3,268 2,855 21 14 Detroit, Mich. i ccaiase sss arvn sat sors 3,944 3,028 330 323 Douglas, Ariz. sucess vssnivseprssirse 2,870 2,323 22 21 Dltrth, MINN. cov ica rr coniaine dor vis 8,128 7,638 73 46 Bagle Pass, Tex. ics rernnnascersnes 17,259 15,616 124 69 Eastport, TAaho vis covers vavsnssivins 2,810 2,311 131 81 EY Paso, Texas, vidvevvsivenssnsvat's 39,188 24,420 790 368 Ball River, Mass. lic ican vrsinnnns ol aap vnnlk B07 1.0 lle 1 Freeport,s TeX. “evvvvvsis inves vmmnivns oe blades LESO{ Soh eaten 4 Galveston, TeX. is sv svrssonessisvrins 14,280 26,882 1,057 Goz Gloucester, Mass. «.. vnc vsiveimvoyr | nla on S11 | a anate 2 Halifax, "Nova ‘Scotia, +. .coxvivesvien 6,410 4,729 144 133 Hidalgo, Tex. ..ivivrirvisnsunarnvnas 2,823 17,765 114 70 Honolulu, Hawaii. ........... 0.00 3,624 3.914 151 035 Houlton, Me, oi civerinsls dseriivrraies 40 44 6 2 International Falls, Minn. ............ 837 281 72 52 Jacksonville, Fla ......vsevsnesriene 1,689 3,703 12 15 Ketchikan, Alaska. .......covvvvvnnnnn 1,326 1,421 1 1 Key "West, ‘Fla, © ....00uvumey, Say 45,436 46,882 1 ain TI Laredo, Tex. «de eusvsivuesvnessavoy 35,711 28,071 11 479 Lewiston, N.Y. se cusis vin vidovaisinesvaiss 1,047 689 68 47 Los Angeles, (San Pedro) Calif. ..... 6,805 11,372 8 3 Marcus, Wash, .....vvivvuinnnennnnes 829 733 73 3 Mobile, Ala. ..cvisesenrsannsansanvinn 6,271 2,304 1 vad JAN 286 Montreal, Canada. ........cec0cuennn 19,068 17,5158 1,370 1,069 Naco, Ariz. «.covivvrsssninrransnees 3,204 2,038 17 13 110 THE PUBLIC HEALTH SERVICE Ariens ExaMINED AND CERTIFIED FOR DEFECTS, FISCAL YEARS 1020 AND 1921—Continued Aliens examined Aliens certified : d rat 7 Place Pisa in A Mises ny 1920 1921 1920 1921 New Orleans, La., quarantine ........ 47,424 68,006 520 395 New Orleans, La., City ...vcvuuunis 7,058 ‘6,422 94 59 NeW York, N,V lL bey anh evinvrms 694,795 | 1,023,791 8,209 26,478 Newport, Vt ois ivin Coie nnle ale alsiv'y 4,298 3,331 256 240 Newporti'News, Va. ‘oivruircireness 16,446 35,966 106 268 Niagara Falls, N, VY, 0dothecde svn 3,134 3,838 158 181 Nogales, Ariz, ...... Senate wef nd 24,348 26,678 235 180 INOYEOHE, Va. vats ss ceive slsli minim aaleinie 77,711 79,824 896 2,120 Ogdensburg, “N,N. . ces avalde sien Fal ran 646 627 53 54 Oroville, Wash. .c:v000v000s iat inia ibuntle 71 156 9 13 Pascagoula, Miss. ..... due stele seen eine 190 188 4 2 Pensacola, Fla. ........ rely eee 1,792 3,276 61 122 Perth AmMBoy, N. J." cdo sibianioninsaiesfin ses viele ie ve 7 Philadelphia, Pa, «ic. cvivvdenvncersn 49,700 63,495 712 1,131 Philippine Islands ...ccorverisses on 9,879 TE 7 i : Yieiee Port Angeles, Wash. ............ trent] ed ere 123 re a a ey . Port Arthur, TeX. i vreessievaneesses 4,998 2,812 458 252 Port Huron, Mich, ....cvvvvenviasars 2,000 1,860 286 233 Port Tampa, Fla... vdveciesssanenne fins snnies CL RL 2 Port Townsend, Wash, .ivyvainsvuny 10,804 7,827 67 52 Portal, N. Dak. .ocvvsrcvvsvss Aa 401 532 54 95 Portland, SMe. «ov ire vin sssmdennvis 11,653 9,001 43 65 Portland, i Oreg. cc. vsvirsniavsssssss 19 46 4 29 Porto Rico (other than San Juan) .... 5,976 5,325 aie yor whee time Presidio, Tex. cox vvsvansivsrnes rari ee ee 6,838 [8 anssnss 2 Providence, R. 1. ........ ane eine vive 10,521 17,296 136 244 Quebec, Canada. ....... vn siaies Lp, 6,671 13,145 138 228 Rio Grande City, Tex. ...... x olay eiuin ate 548 247 15 13 Sabine, Tex ..vsisirveress Crate mr ay on ale Rete 3 20,0041 vuniswn . 131 St. Albans, Vt. coves PIRI SOR 484 348 65 54 St. Johns, New Brunswick. .......... . 1,386 12,476 187 474 St.Thomas, V.' 1. A board of three or more commis- sioned officers is convened from time to time for the purpose of recommending reserve officers for promotion. Vacancies in the higher grades are ordinarily filled by promotion from the lower grades, but they may be filled by original appoint- ment.?? The annual reports of the service do not show the total number of persons holding commissions in the reserve corps. On July 1, 1919, there were 222 reserve officers as- signed to active duty. Owing to the expansion of the hospi- tal work during the fiscal year 1920, the number on active duty at the end of the year was 483. By June 30, 1921, the number on active duty had grown to 966 distributed in the following grades: Two assistant surgeons general, sixteen senior surgeons; 342 surgeons; 455 passed assistant surgeons; and 151 assistant surgeons.?* Non-commissioned personnel. All non-commissioned employees are appointed by the Secretary of the Treasury or under authority granted by him, and in most cases certification by the Civil Service Commission is necessary. -Internes are 32 Tbid., Par. 46-56. 53 Thid., Par. 76. 34 Surg. Gen. Annual Report, 1920, p. 290. 176 THE PUBLIC HEALTH SERVICE appointed after an examination by a board of officers of the service. The positions that are not subject to examination are the minor places that are generally excepted from the classi- fied civil service and places which require only temporary ap- pointments. The salaries of the scientific personnel, phar- macists, administrative assistants, nurses, dietitians, and re- construction aides are fixed by the regulations. As the reg- ulations are promulgated by the President the salaries fixed by regulations may be changed at any time. In a matter of this kind the President is generally guided by the recommen- dations of the chief of the bureau and department con- cerned. The salaries of other employees are fixed by the Secretary of the Treasury, with the exception of seventy-two persons employed in Washington, only a small part of the force now in that city, whose salaries are fixed by statute. Non-commissioned employees are granted the same leave of absence as employees in other branches of the federal service, namely thirty days annual leave and thirty days sick leave. Neither sick nor annual leave is cumulative. Non-commis- sioned employees receive allowances only as specifically indi- cated below. Spicntiic.Lasonuel The scientific personnel, in the tech- nical sense used here and in the regulations of the service, in- cludes all persons engaged in scientific work with the excep- tion of commissioned officers and the personnel of the Hy- gienic Laboratory. Both of these excepted classes are en- gaged in scientific work, but methods of appointment and pro- motion are provided for separately in the regulations and are discussed elsewhere in this monograph.®® Employees engaged in scientific investigation are designated according to the character of the work for which they are qualified, such as sanitary engineers, chemists, bacteriologists, zoologists, etc. Each main designation is divided into six co- 35 See page 163 for commissioned personnel and page 178 for personnel of Hygienic Laboratory. PERSONNEL 177 ordinate classes, with appropriate prefixes to designate the class. The classes for sanitary engineers are given below, the chemists, zodlogists, etc., being similarly graded: I. Directing sanitary engineer. II. Senior sanitary engineer. III. Sanitary engineer. IV. Associate sanitary engineer. V. Assistant sanitary engineer. VI. Junior assistant sanitary engineer. Original appointments are ordinarily made to the lowest grade, but if an applicant has special qualifications and has had previous experience adapting him to the work, he may be ap- pointed to any class below Class I. After two years’ service in Class VI and three years’ service in Class V, a member of the scientific personnel is entitled to promotion to the next higher grade provided he passes a satisfactory technical and physical examination and has had a good record for efficiency, honesty, and sobriety. If he fails in his first examination he may be given a second one at the expiration of a year, but if he fails the second time he is separated from the service, the report of the board of examiners being used as the basis for charges. An appointee of Class I'V is entitled to promotion to Class III in order of seniority after twelve years’ service from date of original appointment. Those who had honorable service in the Public Health Service at any time between April 6, 1917, and November 11, 1918, are entitled to promotion at the expiration of eight years from date of their original appointment; however, they must pass a satisfactory physical and technical examination. As in the case of Class VI and V an appointee is separated if he fails to pass the second examination after the expiration of one year. The number in Class II is limited to five, and vacancies are filled on the recommendation of a board of regular commis- sioned medical officers by promotion of an appointee of Class III according to seniority, subject to a physical examination and a review of his fitness. No appointee who is over sixty- 178 THE PUBLIC HEALTH SERVICE four years of age or who is not physically fit or whose record does not show meritorious service may be promoted to this grade. In exceptional cases original appointments may be made to this grade. The number in Class I is limited to four, and vacancies are filled on the recommendation of a board of regular commis- sioned medical officers by the promotion of an appointee from Classes II and IIT according to seniority, subject to a physical examination and a review of his fitness. No one over sixty- four years of age, or who is not physically fit and whose record does not show meritorious service, may be promoted to this grade. The salary of the scientific personnel is fixed by the regula- tions as follows: 3¢ Class VI' . . .| . $1960 Class V. . . . . $2,500, $2,800, $3,150, and $3,250 Class IV. . . . . $3,600, $3,800, $4,040, and $4,275 Class IIT . . . . $4,550, $4,850, $5,150, and $5,450 Class IT . . . . $5600, $5950, and $6,300 Class I 2 all $60ys The regulations are silent regarding the method of grant- ing increases in pay within a class. Scientific personnel on permanent change of station are entitled to ship not exceeding 7,200 pounds of baggage at government expense. They are also reimbursed for packing and drayage at a rate not exceeding $2 per hundred pounds of freight.?7 Hygienic Labordtory. The director, assistant director, and the HET GT "the division of pathology and bacteriology are commissioned medical officers of the service detailed by the surgeon general. The act of July 1, 1902 (32 Stat. L., 712), provides that the director must be a commissioned medical officer, but the detail of officers to the positions of assistant director and chief of the division of pathology and bacteriol- 36 Amendment No. 4, approved July 10, 1922, to Regulations of 1920. 37 Regulations 1920, Pars, 79-86. PERSONNEL 179 ogy is provided for by the regulations of the service.?® The act of July 1, 1902, also provides that the chiefs of the di- visions of chemistry, zoology, and pharmacology shall be ap- pointed by the Secretary of the Treasury when commissioned medical officers are not available. Commissioned medical of- ficers in the service above the rank of assistant surgeon are eligible for detail for duty in charge of these divisions. The pay of the director of the laboratory is fixed by the act of March 4, 1913 (37 Stat. L., 915), as that of a senior surgeon. The pay of the assistant director and the chief of the division of pathology and bacteriology is that of their rank. The regulations of 1920, as amended, provide that thereafter the chiefs of the divisions of chemistry, pharmacol- ogy, and zodlogy shall be known as professors of chemistry, pharmacology and zoGlogy, and that their pay shall be as fol- lows: During first five years of service computed from date of appointment as chief of division $3,600, during second five years, $6,650, and thereafter $6,375.39 If commissioned medical officers are detailed as chiefs of division they receive the pay and emoluments of their rank. 40 The compensation of all other officers and attendants is fixed by the Secretary of the Treasury. On June 30, 1920, there were on duty in the hygienic laboratory, in addition to the director and assistant director, three chiefs of divisions, four surgeons, five passed assistant surgeons, two assistant sur- geons, two pharmacists, two professors, three technical assis- tants, two physiologists, three special experts, two pharmacol- ogists, one assistant pharmacologist, one scientific assistant, one chemist, one chemical laboratorian, two bacteriologists, three sanitary bacteriologists, one artist, thirteen other tech- nical employees, fifty attendants and other employees. whhiauaacists. The regulations approved August 29, 1920, 38 Ibid, Par. 520, 522. 39 Thid., Par. 544, as amended July 10, 1922. “0 Act of July 1, 1902 (32 Stat. L., 728). 180 THE PUBLIC HEALTH SERVICE as amended March 31, 1922, provide that pharmacists in the service shall be divided into three classes, but that no further appointments shall be made to this class of employees. After three years’ service pharmacists of the third class are pro- moted to the grade of pharmacist of the second class after passing a physical and professional examination. If they fail to pass the examination, they are allowed a second one at the expiration of one year, and if they fail the second time they are separated from the service. After ten years’ service from the time of their original appointment pharmacists of the second class are examined for promotion to the grade of pharmacists of the first class, If they fail they are allowed a second examination at the end of a year, but if they again fail they are separated from the service. The salaries of pharmacists are as follows: Pharmacists of the first class $2,060 with quarters and $3,500 without quarters; pharmacists of the second class $2,460 with quarters and $3,000 without quarters; pharmacists of the third class $2,140 with quarters and $2,500 without quarters. On per- manent change of station pharmacists are allowed to ship at government expense not exceeding 7,200 pounds of baggage and personal effects; they are also reimbursed for packing and drayage up to $2 per hundred pounds of freight. Administrative Assistants. The regulations approved Au- gust™30, 1656. "45 amended March 31, 1922, provide that ad- ministrative assistants, shall be divided into four classes. Administrative assistants of class 1 are employed only in hospitals with a capacity of more than 200 beds, or at a field station where the duties are of equal importance to those at a hospital of similar size. Administrative assistants are placed in classes 2, 3, and 4 in accordance with the responsi- bility and difficulty of the work, and the efficiency of the in- dividual. The salaries of administrative assistants are fixed by the reg- ulations as follows: administrative assistants of class 1, $2,- PERSONNEL 181 200; administrative assistants of class 2, $2,000; administra- tive assistants of class 3, $1,800; administrative assistants of class 4, $1,500. These employees are entitled to quarters, heat and light, but if quarters are not available, rooms may be rented at the expense of the government for not exceeding $15 per month per room. The number of rooms is deter- mined by the surgeon general on the basis of the family needs of the employee, but the maximum number of rooms al- lowed in any case is four. On permanent change of station administrative assistants are allowed to ship at govern- ment expense not exceeding 7,200 pounds of baggage and per- sonal effects; they are also reimbursed for packing and dray- age up to $2 per hundred pounds of freight.*! Other Employees. The regulations make no provision for longevity pay or method of promotion for employees other than those referred to above. The salaries of nurses, (dietitians, and reconstruction aides are fixed by the regulations as follows: Superintendents of nurses and dietitians, $3,000; assistant superintendents of nurses and of dietitians, $2,400 (without bonus) ; chief nurses, dietitians, and reconstruction aides employed only in hospi- tals of 200 beds or more, $1344; assistant chief nurses, dieti- tians, or reconstruction aides, or acting chief in hospitals of less than 200 beds, $960; head nurses, dietitians, and recon- struction aides, $780; nurses, dietitians, and reconstruction aides, $720. Student nurses and dietitians, $375 during third year of training and $225 during first two years of training. Nurses and reconstruction aides serving in a hospital for con- tagious diseases, or as a nurse to neuro-psychiatric or tuber- culous patients receive increased compensation at the rate of $60 a year. Nurses, dietitians, reconstruction aides, internes, and atten- dants are entitled to quarters, heat and light, subsistence, and laundry, but when these cannot be supplied by the service, these employees may be reimbursed in a sum not exceeding #1 Tbid., Par. 91, 123%, 124, as amended. 182 THE PUBLIC HEALTH SERVICE $25 a month for quarters, heat and light, $5 for § igi and $35 for subsistence. The pay of all other employees is fixed by the Secretary of the Treasury with the exception of seventy-two persons employed in Washington, only a small part of the force in that city, whose salaries are fixed by statute. No employees except those mentioned on the preceding pages receive addi- tional allowances as commutation for quarters, heat and light, subsistence, or laundry. Acting assistant surgeons are appointed for temporary work, for work requiring only part time, or for general or hospital duty when the personnel of the service is not sufficient. Of- ficers of this class receiving more than $480 a year are ap- pointed after certification by the Civil Service Commission; those receiving less than $480 a year are appointed by the Secretary of the Treasury on the recommendation of the surgeon general. Their salary is fixed by the Secretary of the Treasury, and as they are not commissioned officers they are not entitled to quarters or to allowances if quarters are not furnished. On June 30, 1921, the number of acting as- sistant surgeons was 1,679, compared with 1,511 a year earlier, and 701 on June 30, 1919. This increase was due to the great expansion of the hospital work resulting from the treatment of patients for the Bureau of War Risk Insur- ance. Acting assistant dental surgeons are appointed in the same manner and have the same status as acting assistant surgeons. APPENDIX 1 OUTLINE OF ORGANIZATION EXPLANATORY NOTE The Outlines of Organization have for their purpose to make known in detail the organization and personnel possessed by the several services of the national government to which they relate. They have been prepared in accordance with the plan followed by the President’s Commission on Economy and Efficiency in the preparation of its outlines of the or- ganization of the United States Government." The Outlines of Organization heretofore published in the monographs of the Institute for Government Research differ from those pre- pared by the President's Commission, however, in that while the commission’s report showed only organization units, those heretofore published by the Institute have been carried far enough to show the personnel embraced in each organization unit. In the case of the Public Health Service there was difficulty in obtaining information regarding the personnel in each organization unit on a specified date, and therefore it has been decided not to carry the outline of organization any farther than the organization units. These outlines are of value not merely as an effective means of making known the organization of the several services. If kept revised to date by the services they constitute exceedingly important tools of administration. They permit the directing personnel to see at a glance the organization and personnel at their disposition. They establish definitely the line of ad- ministrative authority and enable each employee to know his 162 Cong., 2 Sess., H. Doc. 458. 183 184 THE PUBLIC HEALTH SERVICE place in the system. They furnish the essential basis for mak- ing plans for determining costs by organization division and subdivision. They afford the data for a consideration of the problem of classifying and standardizing personnel and com- pensation. Collectively, they make it possible to determine the number and location of organization divisions of any par- ticular kind, as for example—laboratories, libraries, blue-print rooms, or any other kind of plant possessed by the national government, to what services they are attached and where they are located, or to determine what services are maintain- ing stations at any city or point in the United States. OUTLINE OF ORGANIZATION PUBLIC HEALTH SERVICE TREASURY DEPARTMENT JULY 1, 1922. 1. Office of the Surgeon General 2. Office of the Chief Clerk 1. Office proper of the Chief Clerk 2. Office of the Appointment Clerk 3. Office of the Administrative Clerk 1. Office proper of the Administrative Clerk 2. Mail room 3. Telephone operators 4. Duplicating Unit 5. Messenger and custodian force 6. Motor transportation 4. Stationery and printing requisition Section 1. Administrative office 2. Shipping and Stock Unit 5. Office of purchase and supply clerk 6. Bureau Library 7. Files section and office of Administrative Clerk for the Butler Building 3. Division of Personnel and Accounts 1. Office of Chief of Division 2. Personnel Section 1. Medical and scientific personnel Unit 2. Reserve board Unit 3. General and technical personnel Unit 3. Finance and Accounts Section 1. Allotment and Encumbrance Unit OUTLINE OF ORGANIZATION 185 2. Transportation Unit 3. Voucher Unit 4. Voucher auditing Unit 5. Payroll Unit 6. Bookkeeping Unit 4. Property Section 4. Inspection Service 1. Office of Chief of Service 2. Atlantic General Inspection Area. (Office, New York, N. Y.) 3. Central General Inspection Area. (Office, Cincinnati, Ohio.) 4. Southern General Inspection Area. (Office, New Orleans, La.) 5. Pacific General Inspection Area. (Office, San Francisco, Calif.) 5. Hospital Division 1. Office of Chief of Division 2. Office of Executive Officer 3. Miscellaneous Unit 4. Maintenance Unit 5. Nursing, Dietetics, Reconstruction, and Library Unit 6. Dental Unit 7. Statistical Unit 8. Authorizations and Contracts Unit 9. First Class Stations-Hospitals 1. No. 2. Boston, Mass. 14. No. 16. Portland, Me. 2. No. 3. Buffalo, N. Y. 15. No. 17. Port Town- 3. No. 5. Chicago, Ill send, Wash. 4. No. 6. Cleveland, 16. No. 18. St. Louis, Ohio. Mo. 5. No. 7. Detroit, Mich. 17. No. 19. San Fran- 6. No. 8. Evansville, cisco, Calif. Ind. 18. No. 20. Savannah, 7. No. 9. Fort Stanton, Ga. . N. Mex. 19. No. 21. Stapleton, 8. No. 10. Key West, N.Y. Fla. 20. No. 22. Vineyard 9. No. 11. Louisville, Haven, Mass. y. 21. No. 43. Ellis Island, 10. No. 12. Memphis, N..Y. Tenn. 22. No. 66. Carville, La. 11. No. 13. Mobile, Ala. 23. No. 70. New York, 12. No. 14. New Orleans, N.Y. (Hudson La. Street) 13. No. 15. Pittsburgh, 24. No. 82. Norfolk, Va. Pa. (Tanners Creek) 10. Second Class Stations! 1. Balboa Heights, 5. Honolulu, Hawaii Canal Zone 6. Los Angeles, Calif. 2. Charleston, S. C. 7. Manila, P. I. 3- El Paso, Tex. 8. Norfolk, Va. 4. Galveston, Tex. 9. Pensacola, Fla. t In charge of a commissioned officer. 186 THE PUBLIC HEALTH 10. Philadelphia, Pa. 11. Portland, Oreg. 12. Providence, R. I. 13. St. Thomas, Virgin Isl'ds 11. Third Class Stations ? Albany, N. Y. . Ashtabula, Ohio . Astoria, Oreg. . Bangor, Me. .Bay City, Mich. . Beaufort, N. C. Bellingham, Wash. Boothbay Harbor, Me. 9. Brunswick, Ga. 10. Burlington, Iowa 11. Cairo, 111. 12. Cambridge, Md. 13. Cincinnati, Ohio 14. Cordova, Alaska 15. Crisfield, Md. 16. Duluth, Minn. 17. Eastport, Me. 18. Edenton, N. C. ON Sth N= 19. Elizabeth City, N. C. 20. Erie, Pa. 21. Escanaba, Mich. 22. Eureka, Calif. 23. Fernandina, Fla. 24. Gallipolis, Ohio 25. Georgetown, S. C, 26. Gloucester, Mass. 27. Grand Haven, Mich. 28. Green Bay, Wis. 29. Gulfport, Miss. 30. Hancock, Mich. 31. Hoquiam, Wash. 32. Jacksonville, Fla. 33. Juneau, Alaska 34. Ketchikan, Alaska 35. La Crosse, Wis. 36. Lewes, Del. 37. Little Rock, Ark. 38. Ludington, Mich. 39. Machias, Me. 40. Manistee, Mich. 41. Manitowoc, Wis. 42. Marquette, Mich. SERVICE 14. San Juan, P. R. 15. Seattle, Wash. 16. Washington, D. C. 43. Marshfield, Oreg. 44. Menominee, Mich. 45. Miami, Fla. 46. Milwaukee, Wis. 47. Nantucket, Mass. 48. Nashville, Tenn. 49. Natchez, Miss. 50. New Bedford, Mass. 51. Newbern, N. C. 52. New Haven, Conn. 53. New London, Conn. 54. Newport, Ark. 55. Newport, Oreg. 56. Newport, R. I. 57. Nome, Alaska 58. Odgensburg, N. Y. 59. Oswego, N. Y. 60. Paducah, Ky. 61. Perth Amboy, N. J. 62. Petersburg, Alaska 63. Ponce, P.. R. 64. Port Angeles, Wash. 65. Port Arthur, Tex. 66. Port Huron, Mich. 67. Provincetown, Mass. 68. Richmond, Va. 69. Rockland, Me. 70. Saginaw, Mich. 71. San Diego, Calif. 72. Sandusky, Ohio 73. San Pedro, Calif. 74. Sault Ste. Marie, Mich. 75. Seward, Alaska 76. Sheboygan, Wis. 77. Solomons, Md. 78. South Bend, Wash. 79. Superior, Wis. 80. Tacoma, Wash. 81. Tampa, Fla. 82. Toledo, Ohio 83. Valdez, Alaska 84. Vicksburg, Miss. ? Acting assistant surgeon on duty for examination or relief. OUTLINE OF ORGANIZATION 187 85. Washington, N. C. 87. Wrangell, Alaska 86. Wilmington, N. C. 12. Fourth Class Stations 2 1. Apalachicola, Fla. 7. Ellsworth, Me. 2. Ashland, Wis. 8. Hartford, Conn. 3. Bath, Me. 9. Portsmouth, N. H. 4. Beaufort, S. C. 10. Reedville, Va. 5. Bridgeport, Conn. 11. Salem, Mass. 6. Chattanooga, Tenn. 12. Unalaska, Alaska 13. Arsenal Stations 1. Rock Island, Ill. 14. Coast Guard Stations 6. Division of Foreign and Insular (Maritime) Quarantine and Im- migration 1. Office of Chief of Division 2. Domestic Quarantine Stations having buildings and other equip- ment 1. Portland, Me. 20. Tampa Bay, Fla. 2. Boston, Mass. 21. Pensacola, Fla. 3. Providence, R. I. 22. Mobile, Ala. 4. New York, N. Y. 23. Gulf, Miss. 5. Marcus Hook, Pa. 24. New Orleans, La. 6. Reedy Island, Del. 25. Galveston, Tex. 7. Delaware Breakwater, 26. Sabine, Tex. Del. 27. Laredo, Tex. 8. Baltimore, Md. 28. Eagle Pass, Tex. 9. Hampton Roads, Va. 29. El Paso, Tex. 10. Cape Fear, N. C. 30. Brownsville, Tex. 11. Georgetown, S. C. 31. Hidalgo, Tex. 12. Charleston, S. C. 32. Port Aransas, Tex. 13. Beaufort, S. C. 33. Presidio, Tex. 14. Savannah, Ga. 34. Rio Grande City, Tex. 15. Brunswick, Ga. 35. San Diego, Calif. 16. Cumberland Sound, 36. San Pedro, Calif. Fla. 37. San Francisco, Calif. 17. St. Johns River, Fla. 38. Columbia River, Oreg. 18. Key West, Fla. 39. Port Townsend, Wash. 19. Boca Grande, Fla. 3. Domestic Quarantine Stations, without equipment, inspection only 1. Eastport, Me. 4. Newport, R. 1. 2. Vineyard Haven, 5. Perth Amboy, N. J. Mass. 6. Philadelphia, Pa. 3. Gloucester, Mass. 7. Alexandria, Va. 3 All other relief stations, mostly in charge of deputy collectors of customs. Zapata, Tex. Santa Barbara, Calif. Monterey, Calif. Port Hartford, Calif. (same as Port San Luis) Fort Bragg, Calif. Eureka, Calif. Redondo, Calif. Florence, Oreg. Newport, Oreg. Coos Bay, Oreg. Gardner, Oreg. South Bend, Wash. Hoquiam, Wash. Port Angeles, Wash. Ketchikan, Alaska Skagway, Alaska Humacao, P. R. Mayaguez, P. R. Fajardo, P. R. Guanica, P. R. St. Thomas, V. IL Frederiksted, V. I. Christiansted, V. I. Cavite, P. I. Cebu, P. 1 Iloilo, P. I. Jolo, P.:1. Manila and Mariveles, P.1 Olongapo, P. I. Zamboanga, P. I. Habana, Cuba Hamburg, Germany Havre, France Hongkong, China Libau, Latvia Liverpool, England London, England Marseille, France Messina, Italy Naples, Italy Palermo, Italy Patras, Greece Port Lobos and Mata Redondo, Mexico Progreso, Mexico 188 THE PUBLIC HEALTH SERVICE 8. Newbern, N. C. 25. 9. Washington, N. C. 26. 10. Darien, Ga. 27, 11. Biscayne Bay, Fla. 28. 12. Cedar Keys, Fla. 13. St. Georges Sound, Fla. 14. St. Joseph, Fla. 29. 15. St. Andrews, Fla. 30. 16. Atchafalaya (Morgan 31. City), La. 32, 17. Pascagoula, Miss. 33 18. Orange, Tex. 34. 19. Beaumont, Tex. 35. 20. Port Arthur, Tex. 36. 21. Freeport, Tex. 37- 22.-La Jitis, Tex. 38. BE 23. Minera, Tex. 39. 24. Santa Helena, Tex. 40. 4. Insular Quarantine Stations 1. Honolulu, Hawaii 16. 2. Ahukini, Hawaii 17. 3. Kahului, Hawaii 18. 4. Lahaina, Hawaii 19. 5. Koloa, Hawaii 20. 6. Mahukona, Hawaii 21, 7. Makaweli, Hawaii 22. 8. Kihei, Hawaii 23. 9. Hilo, Hawaii 24. 10. San Juan, P. R. 25. 13. Ponce, P:R. 20. 12. Aguadilla, P. R. 27. 13. Arecibo, P. R. 14. Arroyo, P. R. 28. 15. Central Aguirre, P. R. 29. 5. Foreign Quarantine Stations, inspection only 1. Amoy, China 16. 2. Antwerp, Belgium 17: 3. Athens, Greece 18. 4. Barcelona, Spain 19. 5. Bergen, Norway 20. 6. Bremen, Germany 21, v. Callao, Peru 22. 8. Cherbourg, France 23. 9. Christiania, Norway 24. 10. Constantinople, Turkey 25. 11. Copenhagen, Denmark 26. 12. Danzig +27 13. Genoa, Italy 28. 14. Goteborg, Sweden 15. Guayaquil, Ecuador 29. 30. 31. 32, 33. 34 6. Immigration Inspection Stations . Aguadilla, P. R. . Ajo, ‘Ariz, . Arecibo, P. R. ;:Arroyo, P. R. . Baltimore, Md. . Bellingham, Wash. . Biscayne Bay (Fla.) Ooo NONAWNH OUTLINE OF ORGANIZATION 189 Puerto Mexico, Mexico Rotterdam, Holland Shanghai, China Southhampton, England Stavanger, Norway quarantine . Blaine, Wash. . Boston, Mass. . Brownsville, Tex. . Brunswick, Ga. . Buffalo, N.Y. . Calais, Me. . Calexico, Calif. Cebu, P.-1, . Central Aguirre, P. R. . Charleston, S. C. . Columbia River, (Oreg.) quarantine . Columbus, N. Mex. . Del Rio, Tex. . Detroit, Mich. . Douglas, Ariz. . Duluth, Minn. . Eagle Pass, Tex. . Eastport, Idaho . El Paso, Tex. . Fall River, Mass. . Fajardo, P. R. . Freeport, Tex. . Galveston, Tex. . Gloucester, Mass. . Guanica, P. R. . Halifax, Nova Scotia . Hidalgo, Tex. . Honolulu, Hawaii . Houlton, Me. . Humacao, P. R. . Hloflo,P.. 1. . International Falls, Minn. . Jackman, Me. . Jacksonville, Fla. (Mayport) 35 36. 37: 38. Tampico, Mexico Trieste, Italy Tuxpam, Mexico Vera Cruz, Mexico . Jolo, PI . Ketchikan, Alaska . Key West, Fla. . Laredo, Tex. . Lewiston, N. Y. . Los Angeles, Calif. (San Pedro) v Manila, P. 1 . Marcus, Wash. . Mayaguez, P. R. . Mobile (Ala.) quaran- tine Montreal, Canada . Naco, Ariz. . New Orleans (La.) quarantine . New Orleans (City), La. . Newport News, Va. . Newport, Vt. . New York, N. Y. . Niagara Falls, N. Y. . Nogales, Ariz. . Norfolk, Va. . Ogdensburg, N. Y. . Oroville, Wash. . Pascagoula, Miss. . Pensacola, Fla. . Perth Amboy, N. J. . Philadelphia, Pa. . Ponce, P. R. .. Portal, -N. Dak. . Port Arthur, Tex. . Port Huron, Mich. . Portland (Me.) quar- antine . Portland, Oreg. . Port Townsend, Wash. . Providence, R. I. . Presidio, Tex. . Quebec, Canada . Rio Grande City, Tex. . Sabine, Tex. .. St, - Albans, Vt. . St. John, New Bruns- wick 190 THE PUBLIC HEALTH SERVICE . San Diego, Calif. 94. Tia Juana, Calif. . San Fernando, Ariz. 95. Tucson, Ariz. . San Francisco, Calif. 96. Van Buren, Me. . San Juan, P. R. 97. Vancouver, British . Sault Ste. Marie, Mich. Columbia . Savannah, Ga. 98. Victoria, British Col- . Seattle, Wash. umbia . Sumas, Wash. 99. Wilmington, N. C. . Sweet Grass, Mont. 100. Winnipeg, Canada . Tacoma, Wash. 101. Yarmouth, Nova Scotia . Tampa, Fla. 102. Zamboanga, P. I. . Tampa Bay (Fla.) quarantine 7. Division of Sanitary Reports and Statistics 1. 2. 3, 4. 5. 6. 7 Office of Chief of Division Administrative Section Editorial Section Morbidity Reports Section 1. United States 1. Collaborating and Assisting Collaborating Epidemi- ologists at various places 2. Foreign Legal Section Section on Public Health Education General Statistical Office 8. Division of Scientific Research 1. 2. Office of Chief of Division Hygienic Laboratory 1. Division of pathology and bacteriology 2. Division of zodlogy 3. Division of pharmacology 4. Division of chemistry 5. Control of biologic products Rural Sanitation 1. Office of Surgeon in Charge 2. Work in the Field Malaria Control 1. Office of Surgeon in Charge 2. Work in field Child Hygiene 1. Office of Surgeon in Charge 2. Work in the Field Industrial Hygiene 1. Office of Surgeon in Charge 2. Work in the Field Pellagra Investigations 1. Office of Surgeon in Charge 2. Work in field Sewage Disposal 1. Office of Professor in Charge 2. Work in the Field OUTLINE OF ORGANIZATION 191 9. Stream Pollution 1. Office of Surgeon in Charge 2. Work in the Field 10. Mental Hygiene 11. Leprosy Investigations 12. Studies of Public Health Administration 13. Morbidity Statistics 14. Rocky Mountain Spotted Fever 15. Botulism 16. Influenza and pneumonia 9. Division of Venereal Diseases 1. Office of Chief of Division 2. Administrative Section 3. Educational Section 4. Field Personnel 10. Division of Domestic Quarantine (Interstate sanitation) 1. Office of Chief of Division 2. Plague Suppressive Stations 1. New Orleans, La. 2. Galveston, Tex. 3. San Francisco, California 3. Water Certification Districts 1. District 1. Maine, New Hampshire, Vermont, Mass- achusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania. (Office, New York, N. Y.) 2. District 2. Delaware, Maryland, Virginia, West Vir- ginia, District of Columbia, North Carolina, South Carolina. (Office, Washington D. C.) 3. District 3. Ohio, Indiana, Illinois, Michigan, Wisconsin, Great Lakes, St. Lawrence River. (Office, Chicago, IIL.) 4. District 4. Kentucky, Tennessee, Florida, Mississippi, Alabama, and Georgia. (Office, Atlanta, Ga.) 5. District 5. Texas, Louisiana, Oklahoma, Arkansas. (Office, New Orleans, La.) 6. District 6. Missouri, Iowa, Nebraska, Minnesota, North Dakota, South Dakota. (Office, St. Louis, Mo.) 4. Sanitation of National Parks 1. Yellowstone National Park 2. Yosemite National Park 3. Sequoia and General Grant National Parks 4. Grand Canyon National Park 5. Trachoma Prevention 1. Office of Surgeon in Charge 2. Work in the Field APPENDIX 2 CLASSIFICATION OF ACTIVITIES EXPLANATORY NOTE The Classifications of Activities have for their purpose to list and classify in all practicable detail the specific activities” engaged i in by the several services of the national government. Such statements are of value from a number of standpoints.” They furnish, in the first place, the most effective showing (7 that can be made in brief compass of the character.of work performed by the service to which they relate. Secondly, they lay the basis for a system of accounting and reporting that will permit of the showing of total expenditure classified according to activities. Finally, taken collectively, they make possible the preparation of a general or consolidated statement of the activities of the government as a whole. Such a statement will reveal in detail, not only what the gov- ernment is doing, but the services in which the work is being performed. For example, one class of activities that would probably appear in such a classification is that of “scientific research.” A subhead under this class would be “chemical research.” Under this head would appear the specific lines of investigation under way and the services in which they were being prosecuted. It is hardly necessary to point out the value of such information in planning for future work and in con- sidering the problem of the better distribution and coordina- tion of the work of the government. The Institute has it in contemplation to attempt such a general listing and classifica- tion of the activities of the government upon the completion of the present series. 192 CLASSIFICATION OF ACTIVITIES 193 Wl CLASSIFICATION OF ACTIVITIES 1. Prevention of spread of disease 1. By preventing transmission from foreign countries (Foreign and insular quarantine) 1. Inspection of passengers and crews in foreign and American ports and at border stations 2. Disinfection and fumigation of vessels in foreign and American ports 2. By preventing transmission between states (Domestic quar- antine) 1. Through regulations governing the transportation in inter- state commerce of infected persons or commodities 1. Venereal diseases. 2. Other diseases 2. Through regulations prescribing standards of food and drink supplied by common carriers engaged in inter- state commerce 3. Through regulations prescribing sanitary standards for vehicles and vessels engaged in interstate commerce 4. Through regulations prescribing sanitary conditions of camps of migratory workers 3. By studying causes of diseases and developing remedies 1. Venereal diseases 2. Other diseases 4. By disseminating information regarding means of infection and remedies 1. Venereal diseases 2. Other diseases 5. By cooperation with state and local authorities in order to prevent and control diseases within the States 1. Venereal diseases 2. Other diseases 6. By fumigation of forecastles of American vessels 2. Medical treatment in hospitals and dispensaries 1. Persons eniployed on registered, enrolled, or licensed vessels of the United States Seamen employed on vessels belonging to the Army Seamen employed on vessels of the Engineer Corps and the Mississippi River Commission Officers and seamen of the vessels of the Bureau of Fisheries and the Coast and Geodetic Survey Officers and enlisted men of the Coast Guard Officers of the Public Health Service and employees devoting all their time to field work Officers, crews of vessels, keepers, and assistant keepers of the Lighthouse Service Civil employees of the United States injured in the per- formance of their duties 9. Beneficiaries of the Veterans’ Bureau 10. Officers and enlisted men of the Army and Navy 11. Foreign seamen OEE Own nO 104 THE PUBLIC HEALTH SERVICE 2. Medical treatment—Continued 12. Discharged soldiers of allied nations 13. Immigrants at port of New York 14. Persons suffering from trachoma 15. Persons suffering from leprosy 16. Crews of vessels engaged in deep sea fisheries 3... Making physical examinations 1. Aliens 1. Immigrants 2. Alien seamen Beneficiaries of the Veterans’ Bureau Federal employees injured in discharge of their duties Applicants for licenses as pilots American and foreign seamen Applicants for appointment as cadets or enlisted men in Coast Guard Officers of Coast Guard before promotion or before retirement Applicants for appointment in various branches of the govern- ment service .__Scientific_Research 1. Chemistry Bacteriology Pharmacology Pathology Stream pollution Rural sanitation Diseases of man 1. Venereal diseases 2. Child and school hygiene 3. Industrial hygiene and occupational diseases 1. Diseases of miners; mine hygiene and sanitation 2. Other occupational diseases 4. Other specific diseases of man Studies of public health organization and administration . Other scientific research 5 Collection_of Statistics Y. eekly morbidity statistics 2. Special statistical studies in field of morbidity 6. Licensing of estalishments engaged in the manufacture of viruses, “serums, toxins, antitoxins, and analogous products applicable to the prevention and cure of diseases of man 7. Compilation of court decisions and state laws relative to public health problems 8. Conference with state and territorial health authorities 9. Public health education 10. Surveying of food supplies of vessels at request of judge of a federal court when complaint is lodged against vessel 11. Work for other government departments not included under other classifications 1. Determination of curative or therapeutic effects of drugs (through detail of officers to Bureau of Chemistry of De- partment of Agriculture) 2. Sanitary surveys of buildings and grounds 3. Other work for government departments I OONLL OWL N NORD QP » APPENDIX 3 PUBLICATIONS The publications of the Public Health Service are dis- tributed free until the supply available for the use of the serv- ice is exhausted. Publications that cannot be supplied by the service can generally be purchased from the Superintend- ent of Documents, Government Printing Office. The Public Health Service issues from time to time a list of both classes of publications. The various series are described briefly be- low: Annual Report of the Surgeon General. This publication contains a review of the operations of the service during the. year. It has been issued continuously beginning with 1872. The reports prior to the one for 1906 included articles on tech- nical subjects, but since that year this publication has been a strictly administrative report. Public Health Bulletins. This series includes the results of studies in various lines of work in the field of hygiene, sanitation, and public health. Some are of general interest, but others are decidedly technical in character. This series was started in 1910, with No. 32. Nos. 1-31 were assigned to various publications relating to public health issued from 1881 to 1910. The serial number does not appear on the title page of Nos. 1-31. Bulletins of the Hygienic Laboratory. In these bulletins are embodied the results of the technical and research work carried on in the Hygienic Laboratory. In general they are more technical than the Public Health Bulletins. The pub- lication of this series was begun in 1900. 195 196 THE PUBLIC HEALTH SERVICE Public Health Reports. This series, issued weekly, con- tains current mortality and morbidity statistics for states, cities, and counties, as well as information regarding the prev- alence of infectious diseases in foreign countries. Fach issue includes also one or two special articles on public health topics, abstracts of laws and decisions, or summaries of investigations being made by the service. This series is mailed free to state and municipal health officers, other sanitarians, and collectors of customs. Others may obtain the reports from the Super- intendent of Documents, Government Printing Office, for $2.00 a year. Special articles of general interest in the Public Health Re- ports are also issued separately under the title “Reprints from the Public Health Reports.” The Public Health Reports are also issued in bound volumes, each one containing the issues for six months. This series has been issued under its present title beginning with 1896. From July 13, 1878, to May 24, 1879, it was pub- lished by the Marine Hospital Service by manifold process under the title “Bulletins of the Public Health.” * The early issues were printed in 1881 and designated as Volume 1 of the series. From July 5, 1870, to July 1, 1882 the series was superseded by the weekly bulletins of the National Board of Health. There were no issues in this series between July T, 1882, and January 20, 1887, when publication was resumed by the Marine Hospital Service under the title “Weekly Ab- stracts of Sanitary Reports.” The title Public Health Re- ports has been used since the first issue in 1896. Supplements to the Public Health Reports. This is a ‘Separate series started in 1913. These publications do not form part of the weekly issue of Public Health Reports, nor are they included in the bound volumes. The subject matter of this series does not differ materially from that of the Public Health Bulletins. ! These must not be confused with the series known as Public 3 Health Bulletins. PUBLICATIONS 197 Yellow Fever Institute Bulletins. These bulletins em- body the results of the work of the Yellow Fever Institute which was organized within the service in 1901 for the pur- pose of studying questions relating to yellow fever. Seven- teen bulletins were issued—the last one in 1909. As the causes of yellow fever and the methods of treatment are now well established, it is not likely that there will be any further issues in this series unless some new facts regarding the dis- eases are developed. Venereal Disease Bulletins. This series consists of short popular articles dealing with the subject of venereal diseases. The publication of this series was started in 1918 as a result of the special attention being paid to venereal diseases in con- nection with the war. Keep Well Series. This is a popular series on sanitation and prevention of diseases designed especially for the general public. Its publication was started in 1919. Miscellaneous Publications. This series includes pam- phlets intended primarily for administrative use, such as quar- antine regulations, instructions for medical inspection of aliens, official list of officers and stations, lists of publications, ete. It should be noted that successive issues of each of the regulations, lists of officers, etc., bear the same serial number, the date indicating which is the later publication. Other publications. Other publications, mostly for official use, are issued from time to time as occasion arises. These include a weekly list of changes of station, the general regulations of the service, regulations regarding uniforms, regulations governing hospitals, etc. APPENDIX 4 LAWS A. INDEX TO LAWS Creation and Status / Establishment of marine hospitals............ 1 Stat. L., 603 / Organization of Marine Hospital Service. ....... 16 Stat. 'L., 160 Name changed to Public Health and Marine Hospital Service... ...; 0. viiveivs seine 32 Stat. L.,'712 Service to remain under Treasury Department until otherwise specifically provided by BW 2 iaeiid oasis Fomine imo ni ai ea aaa 33 Stat. L., 650 Name changed to Public Health Service. ....... 37 Stat. L., 309 Personnel Positions established Directors of marine hospitals.............. 1 Stat. L., 60s Director of marine hospital at New Orleans..2 Stat. L., 192 Supervising Surgeon, Marine Hospital Ser- VIBE 13 4ici + tis ovis mits te mr Moiese se 16 Stat. L., 169 Supervising Surgeon General, Marine Hos- pial Service. cia. a 18 Stat. L., 377, : 485 Surgeon General, Public Health and Marine Hospital Service... ,...0, aiaines 32 Stat. L.,-712 Surgeon General, Public Health Service. ...37 Stat. L., 309 Acting Surgeon 'General....... .. . covins 32 Stat. L., 712 Assistant Surgeons General................ 32 ‘Stat. L., 712; 40 Stat. L., 886 Advisory Board for hygienic laboratory. ...32 Stat. L., 712 Chiefs of divisions of chemistry, zoblogy, and pharmacology of the hygienic JEDOLAOTT ah vis wisn is esa me airs 82.Stat. L., 712 Director of hygienic laboratory........... 32. Stat, L712 SCOr SUTEEONS. |i. ii ve ints sais 37 Stat. L., 309 Commissioned officers in reserve corps. ...40 Stat. L., 1017 Assistant Surgeons General at large. ..... 41 Stat. L., 174 Method of appointment Directors of marine hospitals.............. I Stat. L., Gos Director of marine hospital at New Orleans. .2 Stat. L., 192 Supervising Surgeon of Marine Hospital Servioe:. a 16 Stat. L., 169 LAWS Supervising Surgeon General of Marine Hospital Service ........coveisnnsvon 18 Medical officers .......vvvuseenavensvissn 25 Assistant Surgeons General............... 32 Advisory Board for hygienic laboratory. ...32 40 Chiefs of divisions of chemistry, zoology, and pharmacology of the hygienic abOratory et es a sf ns ear 32 Director of hygienic laboratory............ 32 Commissioned officers in reserve corps....40 Qualifications of Medical officers... .civeinn sain vinnie 26 Assistant Surgeons General............... 32 Chiefs of divisions of chemistry, zodlogy, and pharmacology m “hygienic labor- ALOTY "tvs s sini sin aisleiny aan ee 32 Advisory Board for hygienic laboratory... .32 Duties Directors of marine hospitals. ............. 1 Director of marine hospital at New Orleans i: hives vrs ve rg vd demas 2 Supervising Surgeon, Marine Hospital Ser- vice, as regards marine hospitals. ..... 16 Supervising Surgeon General, Marine Hos- pital Service, as regards maritime and foreign quarantine .................. 20 Supervising Surgeon General, Marine Hos- pital Service, relieved of duties re- lating to maritime and foreign quar- antine for a period of four years...... 21 Supervising’ Surgeon General, Marine Hos- pital Service, to prepare regulations to prevent spread of cholera, yellow fever, smallpox or plague............ 2 Supervising Surgeon General, Marine Hos- pital Service, as regards interstate and foreign quarantine .................. 27 Surgeon General Public Health and Marine Hospital Service. .....votuvibncneriess 32 Advisory Board for hygienic laboratory. ...32 Salaries and allowances Supervising Surgeon of Marine Hospital SEIVICE |. Linnea tian wie hies nish oe 8 16 Stat. Supervising Surgeon General, Marine Hospi- tal Service i... vides ociiain svn seinen 18 Stat. 485 Surgeon General, Public Health and Marine Hospital Service ......... ccocevrses 32 Stat. 485 Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. Stat. 6 Stat. Stat. Stat. Stat. Stat. 199 L., 377, L.,:639 L., 712 l., 712 L., 886 L., 712 L., 712 L.; 1017 L. 31 L., 712 L., 712 L., 712 1.608 L., 449 L., 712 TL. i722 L., 169 L., 377, L., 712 200 THE PUBLIC HEALTH SERVICE Surgeon General, Public Health Service...37 Stat. L., 309; Public 233, 67th Cong. Commissioned lofficers ...........iuavanns 32-5mt. 1., 712; Public 233, 67th Cong. Advisory Board for hygenic laboratory. ...32 Stat. L., 712 Chiefs of divisions of chemistry, zodlogy, and pharmacology of the hygienic JaDOEaEOTY ke. os ih aw 13k Hina thie 32 Stat. L., viz Director of hygenic laboratory............ 32 Siat. 1.712; 37 Stat..L., 91% Commissioned and noncommissioned officers on duty at leprosarium in Hawaii or in- vestigating leprosy in Hawaii........ 33 Stat. 1.., 1009; 36 Stat. L., 13094 Surgeon General, Assistant Surgeons Gen- eral, senior surgeons, surgeons, passed assistant surgeons, and assistant sur- BOONE ili clive hale is mn Sabie sae 37 Stat. L., 309; Public 235, 67th Cong. Officers detailed to home for lepers in con- tinental United “States: . ou vvus vvpeiss 30 Stat. 1,872 Commissioned officers in the reserve COLDS wi viiars Stain atidnn ol Tain is oth iv Se drenn 40 Stat. L., 1017 Officers to be credited with service in Army, Navy, Marine Corps, Coast Guard, and and Coast and Geodetic Survey in com- puting 10NZevity Pay .... ui. sei rasmins 41 Stat. L., 507, 601 Transportation to be furnished to wife and dependent children of officers........ 41 Stat. L., 601 Temporary increase for assistant surgeons general, senior surgeons, passed assistant surgeons, and assistant surgeons...... 41 Stat. 'L., 60% Commission to report on readjustment of pay and allowances of commissioned OHCs iv ir onus imate tess rahe oe 41. Stat. L., 6o1 Money not to be used for payment of com- mutation of quarters, subsistence and laundry or quarters, heat and light and longevity to any employee other than the commissioned medical officers pro- vided for by statute.............05, 41 Stat, L., 1374 Miscellaneous provisions Promotion of assistant surgeons and passed ASSISLUNE SUTTCONS. ... + vs visite nvin 4s x nina 25 Stat. L., 630 Leave of absence to medical officers. ....... 29 Stat. L., 554 Status of officers serving with Coast Guard, Army, or Navy in time of war...... 40 Stat. L., 242 LAWS 201 Officers may purchase quartermaster’s sup- plies from Army, Navy and Marine COLDS: . Joti sls et aliie va in Br ir inh ns 41 Stat. 'L., i507 Details of medical officers Lo Bureau of Mines. ........dd san 40 Stat. L., 671 To Department of Agriculture. ....... 40 Stat. L., 992 To Veterans” ‘Bureau “.<... 0h 5 Public 47, 67th Cong. Activities General administration President to prescribe rules regarding con- duct of service, internal administration, discipline, and uniforms ........ co.ui 32. Stat. L., 712 President may utilize service in time of actual or threatened warfare.......... 32 Stat. L., 712 President may transfer specified hospitals to Veterans’ Bureau... vesioveiv sive Public 47, 67th Cong. Transfer of certain activities to Veterans’ BUTEA. hh iets soins ee Public 47, 67th Cong. Source of funds and limitation on expenditure Hospital fund from tax on seamen to be expended in district where col- JECLed i ise vivis tins wins wivire ntilety wale I Stat. 1.,60s President authorized to receive donations for hOoSDHAIS 1. vi ohne tmn soi dante 1 Stat. 1.603 Hospitals fund from tax on seamen may be expended in state next adjoining that: in -which collected....... ..... Tr Stat. 'L., 720 Tax on officers, seamen, and marines OF NAYY 2 ivivsloin bins nagln ssisningioh viv 1. Stat. 'L., 729 Hospital fund made a general fund to be expended where needed........ 2- "Stat. “L.,r192 Hospital tax on seamen of vessels navigating Mississippi River...... 2 Stat. L., 102 Hospital tax on seamen increased. ..... 16 Stat. L., 169 Tax on seamen not to apply to persons employed on canal boats.......... 16 Stat. L., 595 Tax on seamen repealed and tax on tonnage provided .... 5. ...qcc cones 23 Stat, 1, 57 Permanent appropriation of receipts from tonnage taxes repealed; service to be maintained by annual appro- priations |. li. con a. es 33 Stat. 1.1217 Appropriations for Bureau of War Risk Insurance not to be used to reimburse government owned hos- pitals or hospitals under contract with Public Health Service........ 41 Stat. I... 173 Appropriations not to be expended for advertising for any purposes other than ‘to procure bids... .'...... ..... 41 Stat. L., 508 202 THE PUBLIC HEALTH SERVICE Appropriation for medical and hospital relief of patients of Bureau of War Risk Insurance made to that bureau and allotments to be made to Public Health Service and other govern- ment organizations... ji. ut sdins 41: Stat. '1..,/881 Officers in charge of administrative divisions to be assistant surgeons general ....... 32: Stat. L., 712 Division of venereal diseases established ...40 Stat. L., 886 Officers permitted to make allotments from Heir PAY a a sa als esha 40 Stat. L., 644 Medical and hospital relief Medical relief for merchant seamen. ......... 1 Stat. L., 605 16 Stat. L., 169 Medical relief for officers, seamen, and marines of the NAVY.......r. vedere I Stat L., 1720 Hospital at New Orleans authorized. ..... 2:Stat. L., 192 Foreign seamen to be admitted to hospitals at rate of seventy-five cents a day...... 2 Stat. L.,|192 Foreign seamen to be admitted to hospitals at rate prescribed by the Secretary OF the Treasury. ./...o vis ovssmeeroes 18 Stat. L., 485 Separate naval hospitals established. ....... 2:Stat. 1..,6%0 Dehnition of term vessel... ......cvriivy sen 16 Stat. L., 169 Medical relief not to be given to persons employed On canal boats. ..........esn 16 Stat. 'L., 505 Definition of term seamen................ 13: Stat. L., 43s Insane patients to be admitted to Govern- ment hospital for the Insane at rate of OF SABO BH WEE « civ. viv visite sas binoeinie 18 Stat. L., 485 Insane patients in St. Elizabeth’s Hospital (Government Hospital for the Insane) to be paid for at actual cost of main- tenance. Li ul Se ee 40 Stat. L., 644 Keepers and crews of life saving stations {Coast Guard)... ..... lob 28 Stat. 'L., 229 Lepersiin Hawall..... .. 0.00.00 icin ivansns 33 Stat. L., 1009 Persons with infectious or other diseases affecting the public health........... 36 Stat. L., 1394 Commissioned officers, pharmacists and those employees of the service engaged whollyiin fieldwork. .........vaivsonn 38 Stat.’ L., 24 Crews of vessels engaged in deep-sea fish- BITES ir + oo He Sins sin sins + miiase malate ese ales 3S: Stat: L., 3% Light keepers and assistant light keepers of the Lighthouse Service............ 39 Stat. L., 538 Federal employees injured in the perform- ance of their duties... .fosve srs sisnnis 39 Stat. L., 743 747 LAWS 203 Persons in United States afflicted with JODTOBY 5, i avn sean sn aie ATR ae 39 Stat. L., 872 Officers and crews of vessels belonging to the’ Bureau of Fisheries.............. 40 Stat. L., 694 Patients of Bureau of War Risk Insurance. .40 Stat. L., 1302 Patients of Veterans’ Bureau.......... Public 47, 67th Cong. Physical examinations Officers of Coast Guard examined for promotion or retirement.............. 32 Stat. L., 100 101 Applicants for appointment as cadets in Coast Guards: sn fois snisnis bai ohh 34 Stat. L., 452 Medical inspection of aliens............ccveunns 39 Stat. L., 885 892, 896 National quarantine Duties placed in Marine Hospital Service. ...20 Stat. L., 37 Duties transferred to National Board of Health for a period of four years...... 21 ‘Stat, L.'s Penalties for violating regulations.......... 25 Stat. L. 3355 Grant of additional powers and of authority to take over local quarantine stations. ...27 Stat. L., 449 Quarantine powers not to apply to vessels plying between frontier ports.......... 28 Stat. L., 372 Establishment of quarantine system in Boric RICO, «ove vs sles viata adios ati 31 Stat. 1.,1%0 Establishment of quarantine system in HEEL EN RANE ES SAREE WE RE 31 Stat. 1." 160 Establishment of quarantine system in Phil- Viopine: Islands...) .... 5. vivo Executive Order of January 3, 1900 Authority to designate boundaries of quaran- Hine anchorages. . . iu ov sain sun sins avidin 31 Stat. L., 1086 Quarantine measures for vessel sailing with- out Bill of health. lL... . oi gee anatels sess 31 Stat. L., 1086 Quarantine laws to apply to vessels from Philippine Islonds.l, .. conic vu Chnsons 32 Stat. L., i711 Methods of acquiring title to quarantine stations, authority for establishing disin- fecting plants and detention quarters, penalties for violating quarantine reg- ulations, extension of national quaran- tinelSsystam. col LLL LL I 34 Stat. L., 290 Establishment of quarantine system in Vir- gin) Islands... idiaien Bde vii shins Executive Order of September 27, 1917 Cost of fumigation and disinfection of vessels to be charged at rates fixed by the Secretary of the Treasury....40 Stat. L., 6 Bill of health in duplicate required........ 41 Stat. L., 1149 204 THE PUBLIC HEALTH SERVICE Preventing interstate spread of diseases Cholera, yellow fever, smallpox or plague. ...26 Stat. L., 31 Contagiotis 'diseases: . ius veils va lil, 27 Stat. L., 449 Venereal diseases.i.........000 ceedo sates 40 Stat. L., 886 Scientific investigations Hygienic laboratory authorized.......... 31:Stat. 'L., 1137 Study. of 1eprosyi’. . oi vl aia Srinaiees 33 Stat. L., 1009 Study of diseases of man, sanitation, sewage, and pollution ‘of streams... ...«.ue'svvy 37 Stat. L., 300 Study of venereal diseases.........c suis 40 Stat. L., 886 Regulation of biologic products................ 32 Stat. L., 728 Inspection of provisions of vessels. ............. 30 Stat, L.,.757 Supervision of fumigation of forecastles........ 38 Stat. L., 1166 Annual conference of state and territorial health AHOEIIes , 0 hase wns Cana ii defen 32 Stat. L., 712 Cooperation with state boards or departments of health to prevent or control venereal dis- eases within‘the states. ........ 0 aussie criss 40 Stat. L., 886 Collection of statistics Surgeon General to distribute forms for collection of statistics ........« conver 32 Stat. 'L,, 712 Publications Weekly abstracts of sanitary reports........ 20 Stat. L., 37 Publication of weekly abstracts of sanitary reports transferred to National Board of Health for a period of four years....21 Stat. L., 5 Weekly abstract of sanitary reports and other “Information, . .. co conishis ceive vite 32 Stat. L., 449 32 Siat. L., 712 Bulletins of hygienic laboratory, size of edition and number to be issued...... 33 Stat, L., 1283 Bulletins of Yellow Fever Institute, size of edition and number to be issued........ 33 Stat. L.,1283 Annual Report to be made to Congress by Secretary of the Treasury............ 27 Stat. L., 449 Annual Report to be made by Surgeon General to Secretary of the Treasury and transmitted to Congress............ 32. Stat. L., 712 Annual report, size of edition............ 33 Stat. L.,1283 Information to be issued in the form of PUDHCAIONS. 0 os ah ovis vine Caisson bis 37 Stat. °L., 300 Plant and equipment * President authorized to sell or lease hospitals. H Sek L. “40, 1% Be L., 485 (Rev. Stat., Sec. 4806) ! Many acts in addition to those given in this monograph provide for additional plant and equipment. The laws cited comprise only those which mark a definite new activity and those providing ad- ditional facilities for discharged soldiers. LAWS 205 Local quarantine stations may be acquired. ..... 27 Stat. L., 449 34 Stat. L., 299 Erection of hygienic laboratory................ 31 Stat. L,, 1137 1.cprosy hospital In Hawall. ...c. cues diviniinm'se 33 Stat. L., 1009 Leprosy hospital in Continental United States..39 Stat. L., 872 Additional hospital facilities authorized or plant and equipment transferred to Public Health BEPVICE , ois 3niiinistoin iin ss ee TRS Saris on 40 Stat. L. 1302 41 Stat. L., 45, 378, 508, 530, 963, 1025, 1060, 1364 Plant and equipment may be acquired by gift..41 Stat. L., 1364 President may transfer specified hospitals to Veterans’ Buream ... vcs ruses snes ainsi nors 42 Stat. L., 147 Items of Appropriation? Salaries and allowances Pay, allowance, and commutation of quarters for commissioned medical officers and PHALMACISIS iv'ovivuin sitive s wivin ain dleviomia ni Public 145, 67th Congress Pay of acting assistant surgeons.......... Public 145, 67th Congress Pay of all other employees(attendants, BLL. lvls irene aiiies e site mig are duis lalate wile Public 145, 67th Congress Salaries, Offices of Surgeon General Chief Clerk. :.u swans ss weiitmaia ban Public 145, 67th Congress Private Secretary i... o.oo sinecsnis prises Public 145, 67th Congress Principal hookKeeper «......vvsvvrvsns Public 145, 67th Congress SBStICIan soi sinanin sun sates deinaistiaie Public 145, 67th Congress Technical assistant ...... in wrliinr one Public 145, 67th Congress ASSIgtant dior vives sie s esie ed aitene ons Public 145, 67th Congress TADEATIATED on ole sie oy vt wia Briain wot tein Sree Public 145, 67th Congress CIETE (BA) +5 vhs on vnivns ont daiminn subi Public 145, 67th Congress Elevator conductor eve cvissiasss nn Public 145, 67th Congress MeEssaBgers (3). ous via s vnissldvulvant voi Public 145, 67th Congress Assistant Messengers (3) ............ Public 145, 67th Congress L All items under this head are found in the act making appropriations for the Treasury Department for the fiscal year ending June 30, 1923. 206 THE PUBLIC HEALTH SERVICE Telephone operator .................. Public 145, 67th Congress Laborers (3 cis os onesie sien sist aie Public 145, 67th Congress General Expenses Freight, transportation, and traveling ex- PEASESY uri ih le Ll LS, Public 145, 67th Congress Preparation and transportation of remains OF OFICEIS /.. vivre. iain eins nana vainie Public 145, 67th Congress Journals and scientific hooks ....... co evnst Public 145, 67th Congress Specific activities Medical, surgical and hospital services and supplies for beneficiaries......... Public 145, 67th Congress Maintaining hygienic laboratory........... Public 145, 67th Congress Control of biologic products ......... ...- Public 145, 67th Congress Onarantine' Service... ou ii erro viiinrass Public 145, 67th Congress Prevention of epidemics .................. Public 145, 67th Congress Field investigations of public health........ Public 145, 67th Congress Interstate Quarantine Service ............. Public 145, 67th Congress Studies of ‘raralisanitation .........0 0 Public 145, 67th Congress Division of venereal diseases ............ Public 145, 67th Congress B. CoMPILATION OF LAWS This compilation includes the text, titles or abstracts of all laws in force at the present time that relate specifically to the organization and activities of the Public Health Service. The basic acts and the shorter laws are given in full, for the less important acts abstracts are given or merely titles when those , are self-explanatory. For historical purposes there have been included several important general acts which are no longer in force. Laws of a temporary nature or those author- izing the purchase or construction of specific hospitals or quar- antine stations have been omitted, with the exception of the LAWS 207 laws passed since March 3, 1919, providing the greatly in- creased hospital construction resulting from the treatment of disabled soldiers who are beneficiaries of the Veterans’ Bur- eau. 17908—Act of July 16, 1798 (1 Stat. L., 605)—An Act For the relief of sick and disabled seamen.? [Sec. 1.] That from and after the 1st day of September next, the master or owner of every ship or vessel of the United States, arriving from a foreign port into any port of the United States, shall, before such ship or vessel shall be admitted to an entry, render to the col- lector a true account of the number of seamen, that shall have been employed on board such vessel since she was last entered at any port in the United States, and shall pay to the said collector at the rate of 20 cents per month for every seaman so employed; which sum he is hereby authorized to retain out of the wages of such seamen. Sec. 2. That from and after the 1st day of September next, no col- lector shall grant to any ship or vessel whose enrollment or license for carrying on the coasting trade has expired, a new enrollment or license before the master of such ship or vessel shall first render a true account to the collector, of the number of seamen, and the time they have severally been employed on board such ship or vessel, during the continuance of the license which has so expired, and pay to such collector 20 cents per month for every month such seamen have been severally employed, as aforesaid ; which sum the said master is hereby authorized to retain out of the wages of such seamen. And if any such master shall render a false account of the number of men, and the length of time they have severally been employed, as is herein required, he shall forfeit and pay $100. Sec. 3. That it shall be the duty of the several collectors to make a quarterly return of the sums collected by them, respectively, by virtue of this act, to the Secretary of the Treasury; and the President of the United States is hereby authorized, out of the same, to provide for the temporary relief and maintenance of sick or disabled seamen, in the hospitals or other proper institutions now established in the several ports of the United States, or, in ports where no such insti- tutions exist, then in such other manner as he shall direct: Provided, That the moneys collected in any one district shall be expended with- in the same. SEC. 4. That if any surplus shall remain of the moneys to be col- lected by virtue of this act, after defraying the expense of such temporary relief and support, that the same, together with such pri- vate donations as may be made for that purpose (which the President is hereby authorized to receive), shall be invested in the stock of the 1 This act has been entirely superseded by subsequent legislation with the exception of the portion embodied in section 4801 Revised Statutes, which reads as follows: “The President is authorized to receive donations of real or personal property, in the name of the United States, for the erection and support of hospitals for sick and disabled seamen.” 208 THE PUBLIC HEALTH SERVICE United States, under the direction of the President; and when, in his opinion, a sufficient fund shall be accumulated, he is hereby authorized to purchase or receive cessions or donations of ground or buildings, in the name of the United States, and to cause buildings, when necessary, to be erected as hospitals for the accommodation of sick and disabled seamen. Skc. 5. That the President of the United States be, and he is hereby, authorized to nominate and appoint, in such ports of the United States, as he may think proper, one or more persons, to be called directors of the marine hospital of the United States, whose duty it shall be to direct the expenditure of the fund assigned for their respective ports, according to the third section: of this act; to provide for the accommodation of sick and disabled seamen, under such general instructions as shall be given by the President of the United States, for that purpose, and also subject to the like general instructions, to direct and govern such hospitals as the President may direct to be built in the respective ports; and that the said directors shall hold their offices during the pleasure of the President, who is authorized to fill up all vacancies that may be occasioned by the death or removal of any of the persons so to be appointed. And the said directors shall render an account of the moneys received and expended by them, once in every quarter of a year, to the Secretary of the Treasury, or such other person as the President shall direct; but no other allowance or compensation shall be made to the said directors, except the payment of such expenses as they may incur in the actual discharge of the duties required by this act. 1799—Act of March 2, 1799 (1 Stat. L., 729)—An Act In addition to “An Act for the relief of sick and disabled sea- men.” Provides for expenditure of fund in next adjoining state; also for hospital services for naval seamen, superseded by later acts. 1802—Act of May 3, 1802 (2 Stat. L., 192)—An Act To amend an act, entitled “An act for the relief of sick and disabled seamen,” and for other purposes. Provides that funds shall be applied generally, for hospital at New Orleans, for collection of hospital dues on Mississippi River vessels, and for treatment of foreign seamen; entirely superseded by later legislation. 1811—Act of February 26, 1811 (2 Stat. L., 650)—An Act Establishing navy hospitals. Establishes separate hospitals for naval seamen. 1866—Acts of April 20, 1866, June 27, 1866, and March 3, LAWS 209 1875—Revised Statutes, section 4806, Sale of Marine hospitals. Authorizes Secretary of the Treasury to lease or sell hospitals. 1870—Act of June 29, 1870 (16 Stat. L., 169)—An Act To reorganize the marine hospital service, and to provide for the relief of sick and disabled seamen.? [Sec. 1.] That from and after the first day of August, eighteen hundred and seventy, there shall be assessed and collected by the collectors of customs at the ports of the United States from the masters or owners of every vessel of the United States arriving from a foreign port, or of registered vessels employed in the coasting trade, the sum of forty cents per month for each and every seaman who shall have been employed on said vessel since she last entered any port of the United States, which sum said master or owner is hereby authorized to collect and retain from the wages of said employees. Sec. 2. That from and after the first day of August no collector shall grant to any vessel whose enrollment or license for carrying on the coasting trade has expired a new enrollment or license unless the master of such vessel shall have first rendered a true account to the collector of the number of seamen and the time they have been employed on such vessel during the continuance of the license which has so expired, and shall have paid to such collector forty cents per month for every seaman who shall have been employed as aforesaid, which sum the said master is hereby authorized to retain out of the wages of such seaman; and if the master of any registered, enrolled, or licensed vessel of the United States shall render a false account of the number of seamen so employed or of the length of time they have severally been employed as is herein required he shall forfeit and pay fifty dollars, which shall be applied to and shall make a part of the general fund created by this act, and all needful regulations for the mode of collecting the sums hereinbefore mentioned shall be prepared under the direction of the Secretary of the Treasury by such person as by him may be designated. Sec. 3. That it shall be the duty of the several collectors to de- posit the sums collected by them respectively under the provisions of this act in the nearest United States depositary, to the credit of “the fund for the relief of sick and disabled seamen,” making returns of the same with proper vouchers monthly on forms to be furnished by the Secretary of the Treasury. Sec. 4. That all moneys received or collected by virtue of this act shall be paid into the Treasury like other public moneys, without abatement or reduction; and all moneys so received are hereby appro- priated for the expenses of the Marine-Hospital Service, and shall be 2 The law providing for a tax on seamen was repealed by the act of June 26, 1884; thereafter the Marine Hospital Fund was credited with receipts from tonnage taxes until the fund was abolished by the act of March 3, 1905. 210 THE PUBLIC HEALTH SERVICE credited to the marine-hospital fund, of which separate accounts shall be kept. SEC. 5. That the fund thus obtained shall be employed, under the direction of the Secretary of the Treasury, for the care and relief of sick and disabled seamen employed in registered, enrolled, and licensed vessels of the United States. SEc. 6. That the Secretary of the Treasury is hereby authorized to appoint a surgeon to act as Supervising Surgeon of Marine Hospital Service, whose duty it shall be, under the direction of the Secretary, to supervise all matters connected with the Marine-Hospital Service, and with the disbursement of the fund provided by this act, at a salary not exceeding the rate of two thousand dollars per annum and his necessary traveling expenses, who shall be required to make monthly reports to the Secretary of the Treasury.’ Sec. 7. That for the purposes of this act the term “vessel” herein used shall be held to include every description of water craft, raft, vehicle, and contrivance used or capable of being used as a means or auxiliary of transportation on or by water. And all acts and parts of acts inconsistent or in conflict with the provisions of this act be, and the same are hereby, repealed. 1871— Joint Resolution of February ro, 1871 (16 Stat. L., 595)—Joint Resolution To Exempt certain boats from the payment of marine hospital dues, and for other purposes. Exempts seamen on canal boats from payment of hospital dues and provides that they shall not obtain relief in hospitals. 1875—Act of March 3, 1875 (18 Stat. L., 377)—An Act Making appropriations for sundry civil expenses of the gov- ernment for the fiscal year ending June thirtieth, eighteen hundred and seventy-six, and for other purposes. [Sec. 1.] . .. That hereafter the salary of the Supervising Sur- geon General of the United States Marine-Hospital Service shall be paid out of the marine-hospital fund, at the rate of four thousand dollars per year; and the Supervising Surgeon General shall be ap- pointed by the President, by and with the advice and consent of the Senate. ¢ 1875—Act of March 3, 1875 (18 Stat. L., 485)—An Act To promote economy and efficiency in the marine hospital serv- ice. 3 Appointment vested in President by act of March 3, 1875. Salary increased to $4,000 by act of March 3, 1875, to $5000 by act of July 1, 1902, and to $6,000 by act of August 14, 1912. 4 Salary increased to $5,000 by act of July 1, 1902, and to $6,000 by act of August 14, 1912. LAWS 217 Defines term seaman, authorizes Secretary of the Treasury to rent or lease marine hospital buildings, provides for treatment of in- sane patients at Government Hospital for the Insane, authorizes Secretary of the Treasury to prescribe rates for treatment of foreign seamen, fixes salary of supervising surgeon general at $4,000.° 1878 —Act of April 29, 1878 (20 Stat. L., 37)—An Act To prevent the introduction of contagious or infectious dis- eases into the United States. [SEc. 1.] . . . That no vessel or vehicle coming from any foreign port or country where any contagious or infectious disease may exist, and no vessel or vehicle conveying any person or persons, merchan- dise or animals, affected with any infectious or contagious disease, shall enter any port of the United States or pass the boundary line be- tween the United States and any foreign country, contrary to the quarantine laws of any one of said United States, into or through the jurisdiction of which said vessel or vehicle may pass, or to which it is destined, or except in the manner and subject to the regulations to be prescribed as hereinafter provided. Sec. 2. That whenever any infectious or contagious disease shall appear in any foreign port or country, and whenever any vessel shall leave any infected foreign port, or, having on board goods or pas- sengers coming from any place or district infected with cholera or vellow fever, shall leave any foreign port, bound for any port in the United States, the consular officer or other representative of the United States at or nearest such foreign port shall immediately give information thereof to the Supervising Surgeon General of the Marine-Hospital Service, and shall report to him the name, the date of departure, and the port of destination of such vessel; and shall also make the same report to the health officer of the port of destination in the United States, and the consular officers of the United States shall make weekly reports to him of the sanitary condition of the ports at which they are respectively stationed; and the said Surgeon General of the Marine-Hospital Service shall, under the direction of the Secretary of the Treasury, be charged with the execution of the provisions of this act, and shall frame all needful rules and regulations for that purpose, which rules and regulations shall he subject to the approval of the President, but such rules and regulations shall not conflict with or impair any sanitary or quarantine laws or regulations of any State or municipal authorities now existing or which may hereafter be enacted. Sec. 3. That it shall be the duty of the medical officers of the Marine-Hospital Service and of customs officers to aid in the en- forcement of the national quarantine rules and regulations established under the preceding section, but no additional compensation shall be allowed said officers by reason of such services as they may be re- 5 Sections 1 and 2 and portion of section 4 appropriating proceeds of rents or leases, repealed by act of June 26, 1884. 212 THE PUBLIC HEALTH SERVICE quired to perform under this act, except actual and necessary traveling expenses. SEC. 4. That the Surgeon General of the Marine-Hospital Service shall upon receipt of information of the departure of any vessel, goods, or passengers from infected places to any port in the United States, immediately notify the proper State or municipal and United States officer or officers at the threatened port of destination of the vessel and shall prepare and transmit to the medical officers of the Marine-Hospital Service, to collectors of customs, and to the State and municipal health authorities in the United States weekly abstracts of the consular sanitary reports and other pertinent information received by him. Sec. 5. That wherever at any port of the United States any State or municipal quarantine system may now or may hereafter exist the officers or agents of such system shall, upon the application of the respective State or municipal authorities, be authorized and em- powered to act as officers or agents of the national quarantine system and shall be clothed with all the powers of United States officers for quarantine purposes, but shall receive no pay or emoluments from the United States. At all other ports where, in the opinion of the Secre- tary of the Treasury, it shall be deemed necessary to establish quaran- tine the medical officers or other agents of the Marine-Hospital Serv- ice shall perform such duties in the enforcement of the quarantine rules and regulations as may be assigned them by the Surgeon General of that service under this act: Provided, That there shall be no inter- ference in any manner with any quarantine laws or regulations as they now exist or may hereafter be adopted under State laws. Sec. 6. That all acts or parts of acts inconsistent with this act be, and the same are hereby, repealed. 1879—Act of March 3, 1879 (20 Stat. L., 484)—An Act To prevent the introduction of infectious or contagious dis- eases into the United States, and to establish a National Board of Health. Provides for a National Board of Health to have charge of inter- state and foreign quarantine, repeals portion of act of April 29, 1878, giving quarantine powers to the Marine Hospital Service. Act to continue in force for four years only. 1884—Act of June 26, 1884 (23 Stat. L., 57)—An Act To remove certain burdens on the American merchant marine and encourage the American foreign carrying trade and for other purposes. SEc. 15. Sections forty-five hundred and eighty-five, forty-five hundred and eighty-six, and forty-five hundred and eighty-seven of the Revised Statutes, and all other acts and parts of acts providing LAWS 213 for the assessment and collection of a hospital tax for seamen, are hereby repealed, and the expense of maintaining the Marine Hospital Service shall hereafter be borne by the United States out of the receipts for duties on tonnage provided for by this act; and so much thereof as may be necessary, is hereby appropriated for that purpose.® 1888 Act of August 1, 1888 (25 Stat. L., 355)—An Act To perfect the quarantine service of the United States. Provides penalties for trespass on quarantine reservation and for vessel entering port in violation of the act of April 29, 1878. 1880—Act of January 4, 1889 (25 Stat. L., 639)—An Act To regulate appointments in the Marine Hospital Service of the United States. [Sec. 1.] That medical officers of the Marine-Hospital Service of the United States shall hereafter be appointed by the President, by and with the advice and consent of the Senate; and no person shall be so appointed until after passing a satisfactory examination in the several branches of medicine, surgery, and hygiene before a board of medical officers of the said service. Said examination shall be conducted according to rules prepared by the Supervising Surgeon General, and approved by the Secretary of the Treasury and the President. Ske. 2. That original appointments in the service shall only be made to the rank of assistant surgeon; and no officer shall be promoted to the rank of passed assistant surgeon until after four years’ service and a second examination as aforesaid; and no passed assistant sur- geon shall be promoted to be surgeon until after due examination: Provided, That nothing in this act shall be so construed as to affect the rank or promotion of any officer originally appointed before the adoption of the regulations of 1879; and the President is authorized to nominate for confirmation the officers in the service on the date of the passage of this act. 18go—Act of March 27, 1890 (26 Stat. L., 31)—An Act To prevent the introduction of contagious diseases from one state to another and for the punishment of certain offences. [Sec. 1.] That whenever it shall be made to appear to the satisfac- tion of the President that cholera, yellow fever, small pox, or plague exist in any State or Territory or in the District of Columbia, and that there is danger of the spread of such disease into other States, Territories, or the District of Columbia, he is hereby authorized to 6 Permanent appropriation of receipts from tonnage taxes for use of Marine Hospital Service repealed by act of March 3, 1905. 214 THE PUBLIC HEALTH SERVICE cause the Secretary of the Treasury to promulgate such rules and regulations as in his judgment may be necessary to prevent the spread of such disease from one State or Territory into another, or from any State or Territory into the District of Columbia, or from the District of Columbia into any State or Territory, and to employ such inspectors and other persons as may be necessary to execute such regulations to prevent the spread of such disease. The said rules and regulations shall be prepared by the Supervising Surgeon General of the Marine Hospital Service under the direction of the Secretary of the Treasury. And any person who shall willfully violate any rule or regulation so made and promulgated shall be deemed guilty of a misdemeanor, and upon conviction shall be punished by a fine of not more than $500, or imprisonment for not more than two years, or both, in the discretion of the court. Sec. 2. That any officer, or person acting as an officer, or agent of the United States at any quarantine station, or other person employed to aid in preventing the spread of such disease, who shall willfully violate any of the quarantine laws of the United States, or any of the rules and regulations made and promulgated by the Secretary of the Treasury as provided for in section 1 of this act, or any lawful order of his superior officer or officers shall be deemed guilty of a misdemeanor, and upon conviction shall be punished by a fine of not more than $300 or imprisonment for not more than one year, or both, in the discretion of the court. Sec. 3. That when any common carrier or officer, agent or em- ployee of any common carrier shall willfully violate any of the quarantine laws of the United States, or rules and regulations made and promulgated as provided for in section 1 of this act, such common carrier, officer, agent, or employee shall be deemed guilty of a mis- demeanor, and shall, on conviction, be punished by a fine of not more than $500, or imprisonment for not more than two years, or both, in the discretion of the court. 1893—Act of February 15, 1893 (27 Stat. L., 449)—An Act Granting additional quarantine powers and imposing addi- tional duties upon the marine hospital service. [SEc. 1.] That it shall be unlawful for any merchant ship or other vessel from any foreign port or place to enter any port of the United States except in accordance with the provisions of this act and with such rules and regulations of State and municipal health authorities as may be made in pursuance of, or consistent with, this act; and any such vessel which shall enter, or attempt to enter, a port of the United States in violation thereof shall forfeit to the United States a sum, to be awarded in the discretion of the court, not exceeding $5,000, which shall be a lien upon said vessel, to be recovered by pro- ceedings in the proper district court of the United States. In all such proceedings the United States district attorney for such district shall appear on behalf of the United States; and all such proceedings shall be conducted in accordance with the rules and laws governing LAWS 215 cases of seizure of vessels for violation of the revenue laws of the United States. Sec. 2. That any vessel at any foreign port clearing for any port or place in the United States shall be required to obtain from the consul, vice consul, or other consular officer of the United States at the port of departure, or from the medical officer where such officer has been detailed by the President for that purpose, a bill of health, in duplicate, in the form prescribed by the Secretary of the Treasury, setting forth the sanitary history and condition of said vessel, and that it has in all respects complied with the rules and regulations in such cases prescribed for securing the best sanitary condition of the said vessel, its cargo, passengers, and crew; and said consular or medical officer is required, before granting such duplicate bill of health, to be satisfied that the matters and things therein stated are true; and for his services in that behalf he shall be entitled to demand and receive such fees as shall by lawful regulation be allowed, to be accounted for as is required in other cases.’ The President, in his discretion, is authorized to detail any medical officer of the Government to serve in the office of the consul at any foreign port for the purpose of furnishing information and making the inspection and giving the bills of health hereinbefore mentioned. Any vessel clearing and sailing from any such port without such bill of health and entering any port of the United States shall forfeit to the United States not more than $5,000, the amount to be determined by the court, which shall be a lien on the same, to be recovered by proceedings in the proper district court of the United States. In all such proceedings the United States district attorney for such district shall appear on behalf of the United States; and all such proceedings shall be conducted in accordance with the rules and laws governing cases of seizure of vessels for violation of the revenue laws of the United States. $ Sec. 3. That the Supervising Surgeon General of the Marine Hos- pital Service shall, immediately after this act takes effect, examine the quarantine regulations of all State and municipal boards of health, and shall, under the direction of the Secretary of the Treas- ury, cooperate with and aid State and municipal boards of health in the execution and enforcement of the rules and regulations of such boards and in the execution and enforcement of the rules and regulations made by the Secretary of the Treasury to prevent the introduction of contagious or infectious diseases into the United States from foreign countries, and into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia; and all rules and regulations by the Secretary of the Treasury shall operate uniformly and in no manner discrim- inate against any port or place; and at such ports and places within the United States as have no quarantine regulations under State or municipal authority, where such regulations are, in the opinion of the Secretary of the Treasury, necessary to prevent the introduction of contagious or infectious diseases into the United States from foreign countries, or into one State or Territory or the District of 7 This paragraph amended by act of February 27, 1921. 8 Additional paragraph to this section added by act of August 18, 1804. 216 THE PUBLIC HEALTH SERVICE Columbia from another State or Territory or the District of Columbia, and at such ports and places within the United States where quarantine regulations exist under the authority of the State or municipality which, in the opinion of the Secretary of the Trea- sury, are not sufficient to prevent the introduction of such diseases into the United States, or into one State or Territory or the District of of Columbia from another State or Territory or the District of Columbia, the Secretary of the Treasury shall, if in his judgment it is necessary and proper, make such additional rules and regulations as are necessary to prevent the introduction of such diseases into the United States from foreign countries, or into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia, and when said rules and regulations have been made they shall be promulgated by the Secretary of the Treasury and enforced by the sanitary authorities of the States and munici- palities, where the State or municipal health authorities will under- take to execute and enforce them; but if the State or municipal authorities shall fail or refuse to enforce said rules and regulations the President shall execute and enforce the same and adopt such measures as in his judgment shall be necessary to prevent the intro- duction or spread of such diseases, and may detail or appoint officers for that purpose. The Secretary of the Treasury shall make such rules and regulations as are necessary to be observed by vessels at the port of departure and on the voyage, where such vessels sail from any foreign port or place to any port or place in the United States, to secure the best sanitary condition of such vessel, her cargo, passengers, and crew; which shall be published and communicated to and enforced by the consular officers of the United States. None of the penalties herein imposed shall attach to any vessel or owner or officer thereof until a copy of this act, with the rules and regulations made in pursuance thereof has been posted up in the office of the consul or other consular officer of the United States for 10 days, in the port from which said vessel sailed; and the certificate of such consul or consular officer over his official signature shall be com- petent evidence of such posting in any court of the United States. SEC. 4. That it shall be the duty of the Supervising Surgeon General of the Marine Hospital Service, under the direction of the Secretary of the Treasury, to perform all the duties in respect to quarantine and quarantine regulations which are provided for by this act, and to obtain information of the sanitary condition of foreign ports and places from which contagious and infectious diseases are or may be imported into the United States; and to this end the consular officer of the United States at such ports and places as shall be designated by the Secretary of the Treasury shall make to the Sec- retary of the Treasury weekly reports of the sanitary condition of the ports and places at which they are respectively stationed, accord- ing to such forms as the Secretary of the Treasury shall prescribe; and the Secretary of the Treasury shall also obtain through all sources accessible, including State and municipal sanitary authorities throughout the United States, weekly reports of the sanitary condi- tion of ports and places within the United States, and shall prepare publish, and transmit to collectors of customs and to State and muni- LAWS 217 cipal health officers and other sanitarians weekly abstracts of the consular sanitary reports and other pertinent information received by him, and shall also, as far as he may be able, by means of the voluntary codperation of State and municipal authorities, of public associations, and private persons, procure information relating to the climatic and other conditions affecting the public health, and shall make an annual report of his operations to Congress, with such recommendations as he may deem important to the public interest. Sec. 5. That the Secretary of the Treasury shall from time to time issue to the consular officers of the United States and to the medical officers serving at any foreign port, and otherwise make publicly known, the rules and regulations made by him, to be used and com- plied with by vessels in foreign ports, for securing the best sanitary conditions of such vessels, their cargoes, passengers, and crew before their departure for any port in the United States and in the course of the voyage; and all such other rules and regulations as shall be observed in the inspection of the same on the arrival thereof at any quarantine station at the port of destination, and for the disinfection and isolation of the same, and the treatment of cargo and persons on board so as to prevent the introduction of cholera, yellow fever, or other contagious or infectious diseases; and it shall not be lawful for any vessel to enter said port to discharge its cargo or land its passengers except upon the certificate of the health officer at such quarantine station certifying that said rules and regulations have in all respects been observed and compiled with as well on his part as on the part of the said vessel and its master, in respect to the same and to its cargo, passengers, and crew; and the master of every such vessel shall produce and deliver to the collector of customs at said port of entry, together with the other papers of the vessel, the said bils of health required to be obtained at the port of departure and the certificate herein required to be obtained from the health officer at the port of entry; and that the bills of health herein prescribed shall be considered as part of the ship’s papers, and when duly certi- fied to by the proper consular or other officer of the United States, over his official signature and seal, shall be accepted as evidence of the statements therein contained in any court of the United States. Sec. 6. That on the arrival of an infected vessel at any port not provided with proper facilities for treatment of the same, the Sec- retary of the Treasury may remand said vessel at its own expense to the nearest national or other quarantine station, where accomoda- tions and appliances are provided for the necessary disinfection and treatment of the vessel, passengers, and cargo; and after treatment of any infected vessel at a national quarantine station, and after certificate shall have been given by the United States quarantine officer at said station that the vessel, cargo, and passengers are each and all free from infectious disease, or danger of conveying the same, said vessel shall be admitted to entry to any port of the United States named within the certificate. But at any ports where suffici- ent quarantine provision has been made by State or local authorities the Secretary of the Treasury may direct vessels bound for said ports to undergo quarantine at said State or local station. Sec. 7. That whenever it shall be shown to the satisfaction of the 218 THE PUBLIC HEALTH SERVICE President that by reason of the existence of cholera or other infec- tious or contagious diseases in a foreign country there is serious danger of the introduction of the same into the United States, and that notwithstanding the quarantine defense this danger is so in- creased by the introduction of persons or property from such country that a suspension of the right to introduce the same is demanded in the interest of the public health the President shall have power to prohibit in whole or in part the introduction of persons and property from such countries or places as he shall designate and for such period of time as he may deem necessary. Sec. 8. That whenever the proper authorities of a State shall surrender to the United States the use of the buildings and disinfec- ting apparatus at a State quarantine station the Secretary of the Treasury shall be authorized to receive them and to pay a reasonable compensation to the State for their use, if in his opinion, they are necessary to the United States. SEC. 9. That the act entitled “An act to prevent the introduction of infectious or contagious diseases into the United States and to establish a national board of health,” approved March 3, 1879, be, and the same is hereby, repealed. And the Secretary of the Treasury is directed to obtain possession of any property, furniture, books, papers, or records belonging to the United States which are not in the possession of an officer of the United States under the Treasury Department which were formerly in the use of the national board of health or any officer or employee thereof. ? 1804—Act of August 4, 1894 (28 Stat. L., 229)—An Act Extending the benefits of the marine hospitals to the keepers and crews of life-saving stations. . 1894—Act of August 18, 1894 (28 Stat. L., 372)—An Act To amend section two of an act approved February fif- teenth, eighteen hundred and ninety-three, entitled “An act granting additional quarantine powers and imposing addi- tional duties upon the Marine Hospital Service.” That section 2 of the act approved February 15, 1893, entitled “An act granting additional quarantine powers and imposing addi- tional duties upon the Marine-Hospital Service” is hereby amended by adding to the end of said section the following: The provisions of this section shall not apply to vessels plying be- tween foreign ports on or near the frontiers of the United States and ports of the United States adjacent thereto, but the Secretary of the Treasury is hereby authorized, when, in his discretion, it is expedient for the preservation of the public health, to establish re- gulations governing such vessels. 9 Sections 10 to 12 added by act of March 3, 1901. 10 Life Saving Service and Revenue Cutter Service conselidated under name Coast Guard by act of January 28, 1915 (38 Stat. L., 1 5). LAWS 219 1897—Act of February 19, 1897 (29 Stat. L., 554)—An Act making appropriations for the legislative, executive, and judicial expenses of the Government for the fiscal year end- ing June thirtieth, eighteen hundred and ninety-eight, and for other purposes. ~ [Sec. 1.] . . . That the Secretary of the Treasury is hereby author- ized, in his discretion, to grant to the medical officers of the Marine- Hospital Service commissioned by the President without deduction of pay leaves of absence for the same periods of time and in the same manner as is now authorized to be granted to officers of the Army by the Secretary of War. 11 1898—Act of December 21, 1898 (30 Stat. L., 757)—An Act To amend the laws relating to American seamen, for the protection of such seamen, and to promote commerce. Provides for surveyors to be appointed by judge of district court to investigate complaints against vessels; if the complaint is in re- gard to provisions one of the surveyors to be a surgeon of the Marine Hospital Service, if service is established at place where complaint is made. 19o0—Executive Order of January 3, 1900.—Extending quarantine service to Philippine Islands. 1900—Act of April 12, 1900 (31 Stat. L., 80)—An Act Temporarily to provide revenues and a civil government for Porto Rico, and for other purposes. Sec. 10. That quarantine stations shall be established at such places in Porto Rico as the Supervising Surgeon General of the 11 The leave of absence granted to officers of the Army is regulated by Section 1265, Revised Statutes and the act of July 29, 1876. Section 1265, Revised Statutes is as follows: “Officers when absent on account of sickness or wounds, or lawfully absent from duty and waiting orders, shall receive full pay; when absent with leave, for other causes, full pay during such absence not exceeding in the aggregate thirty days in one year, and half-pay during such absence exceeding thirty days in one year. When absent without leave, they shall forfeit all pay during such absence, unless the absence is excused as unavoidable.” The act of July 29, 1876, reads, “That . . . all officers on duty shall be allowed in the discretion of the Secretary of War, sixty days’ leave of absence without deduction of pay or allowance: Provided, That the same be taken once in two years: And Provided further, That the leave of absence may be extended to three months, if taken once only in three years, or four months if taken only once in four years.” (19 Stat. L., 102) 220 THE PUBLIC HEALTH SERVICE Marine-Hospital Service of the United States shall direct, and the quarantine regulations relating to the importation of diseases from other countries shall be under the control of the Government of the United States. 1900—Act of April 30, 1900 (31 Stat. L., 160)—An Act To provide a government for the Territory of Hawaii. Sec. 97 provides for establishment of quarantine stations in Hawaii. 19o1—Act of March 3, 1901 (31 Stat. L., 1086)—An Act To amend “An act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service,” approved February fifteenth, eighteen hundred and ninety-three. Adds three sections to act of February 15, 1893; authorizes Super- vising Surgeon General to designate the boundaries of quarantine grounds and anchorages; provides that vessels arriving in waters of United States, but not attempting to enter shall be subject to quaran- tine regulations; authorizes quarantine officers to administer oaths. 1902—Act of April 12, 1902 (32 Stat. L., 100, 101 )—An Act To promote the efficiency of the Revenue Cutter Serv- ice, ® Sec. 5 provides for retirement of officers of Revenue Cutter Service by board composed of officers of Marine Hospital Serv- ice and Revenue Cutter Service. Sec. 8 provides that physical ex- amination of officers of the Revenue Cutter Service be made by board of medical officers of Marine Hospital Service before promotion. 1902—Act of July 1, 1902 (32 Stat. L., 711)—An Act tem- porarily to provide for the administration of the affairs of Civil Government in the Philippine Islands and for other purposes. SEC. 84. . . . The provisions of law relating to the public health and quarantine shall apply in the case of all vessels entering a port of the United States or its aforesaid possessions from said islands [Philippine Islands], where the customs officers at the port of depar- ture shall perform the duties required by such law of consular officers in foreign ports. 12 The Revenue Cutter Service the Life Saving Service were consolidated under name of Coast Guard by act of January 28, 1915 (38 Stat. L. 801). LAWS 221 1902—Act of July 1, 1902 (32 Stat. L., 712)—An Act to increase the efficiency and change the name of the United States Marine-hospital service. [SEc. 1.] That the United States Marine-Hospital Service shall hereafter be known and designated as the Public Health and Marine- Hospital Service of the United States, and the Supervising Surgeon General and the officers now or hereafter commissioned under the act of January 4, 1889, entitled “An act to regulate appointments in the Marine-Hospital Service of the United States,” and acts am- endatory thereof, shall hereafter be known as the Surgeon General, surgeons, passed assistant surgeons, and assistant surgeons of the Public Health and Marine-Hospital Service of the United States. Nothing in this act contained shall be held or con- strued to discharge any of the officers above named, or any of the acting assistant surgeons, pharmacists, and other employees of the Marine-Hospital Service, or to deprive any officer of his commission or the benefits derived by longevity of service. The care of sick and disabled seamen and all other duties now required by law to be performed by the Marine-Hospital Service shall hereafter be per- formed by the Public Health and Marine-Hospital Service, and all funds and appropriations now provided by law for use by the Marine-Hospital Service and all properties and rights pertaining to said service shall be available for use for like purposes and in like manner, under the Treasury Department, by the Public Health and Marine-Hospital Service. Sec. 2. That the salary of the Surgeon General of the Public Health and Marine-Hospital Service shall be $5,000 per annum? and the salaries and allowances of the commissioned medical officers of said service shall be the same as now provided by regulations of the Marine-Hospital Service.'* Sec. 3. That commissioned medical officers, when detailed by the Surgeon General for duty in the Public Health and Marine-Hospital Bureau at Washington, District of Columbia, in charge of the ad- ministrative divisions thereof, namely, Marine hospitals and relief, domestic quarantine, foreign and insular quarantine, personnel and accounts, sanitary reports and statistics, and scientific research shall, while thus serving, be assistant surgeons general of the Public Health and Marine-Hospital Service, but their pay and allowances shall be the same as now provided by regulations of the Marine- Hospital Service for officers in charge of said divisions; and the senior officer thus serving shall be the assistant within the meaning 13 Salary of Surgeon General increased to $6,000 by act of August 14 1912. 14 Salaries provided by the regulations when this act took effect were as follows: Surgeon, $2,500; Passed Assistant Surgeon $2,000; Assistant Surgeons, $1,600. In addition longevity pay was provided at rate of 10 per cent. of annual salary for each five years service for commissioned officers above the rank of Assistant Surgeon, not to exceed 40 per cent. Salaries of commissioned medical officers were increased by acts of August 14, 1012, May 18, 1020, and June 10, 1022. 222 THE PUBLIC HEALTH SERVICE of section 178, Revised Statutes of the United States: Provided, however, That no such officer shall be detailed in charge of said divisions who is below the rank of passed assistant surgeon. SEC. 4. That the President is authorized, in his discretion, to utilize the Public Health and Marine-Hospital Service in times of threat- ened or actual war to such extent and in such manner as shall in his judgment promote the public interest without, however, in any wise impairing the efficiency of the service for the purposes for which the same was created and is maintained. Sec. 5. That there shall be an advisory board for the hygienic laboratory provided by the act of Congress approved March 3, 1901, for consultation with the Surgeon General of the Public Health and Marine-Hospital Service relative to the investigations to be in- augurated, and the methods of conducting the same, in said laboratory Said board shall consist of three competent experts, to be detailed from the Army, the Navy, and the Bureau of Animal Industry by the Surgeon General of the Army, the Surgeon General of the Navy, and the Secretary of Agriculture, respectively, which experts, with the director of the said laboratory, shall be ex officio members of the board and serve without additional compensation. Five other mem- bers of said board shall be appointed by the Surgeon General of the Public Health and Marine-Hospital Service, with the approval of the Secretary of the Treasury, who shall be skilled in laboratory work in its relation to the public health, and not in the regular employment of the Government. The said five members shall each receive compensation of $10 per diem while serving in tonference, as aforesaid, together with allowance for actual and necessary travel- ing expenses and hotel expenses while in conference. Said con- ference is not to exceed 10 days in any one fiscal year. The term of service of the five members of said board, not in the regular employment of the Government, first appointed shall be so arranged that one of said members shall retire each year, the subsequent appointments to be for a period of five years. Appointments to fill vacancies occurring in a manner other than as above provided shall be made for the unexpired term of the member whose place has become vacant. Sec. 6. That there shall be appointed by the Surgeon General, with the approval of the Secretary of the Treasury, whenever, in the opinion of the Surgeon General, commissioned medical officers of the Public Health and Marine-Hospital Service are not available for this duty by detail, competent persons to take charge of the divisions, respectively, of chemistry, zoGlogy, and pharmacology of the hygienic laboratory, who shall each receive such pay as shall be fixed by the Surgeon General, with the approval of the Secretary of the Treasury. The director of the said laboratory shall he an officer detailed from the corps of commissioned medical officers of the Public Health and Marine-Hospital Service, as now provided by regulations for said detail from the Marine-Hospital Service and while thus serving shall have the pay and emoluments of a sur- geon: 1% Provided, That all commissioned officers of the Public 18 Act of March 4, 1913 provides that Director of Hygienic Laboratory shall receive pay and allowance of a Senior Surgeon. LAWS 223 Health and Marine-Hospital Service not below the grade of passed assistant surgeon shall be eligible to assignment to duty in charge of the said divisions of the hygienic laboratory, and while serving in such capacity shall be entitled to the pay and emoluments of their rank. Sec. 7. That when, in the opinion of the Surgeon General of the Public Health and Marine-Hospital Service of the United States, the interests of the public health would be promoted by a conference of said service with State or Territorial boards of health, quaran- tine authorities, or State health officers, the District of Columbia included, he may invite as many of said health and quarantine authorities as he deems necessary or proper to send delegates, not more than one from each State or Territory and District of Col- umbia, to said conference: Provided, That an annual conference of the health authorities of all the States and Territories and the Dis- trict of Columbia shall be called, each of said States, Territories, and the District of Columbia to be entitled to one delegate: And provided further, That it shall be the duty of the said Surgeon General to call a conference upon the application of not less than five State or Territorial boards of health, quarantine authorities, or State health officers, each of said States and Territories joining in such request to be represented by one delegate. Sec. 8. That to secure uniformity in the registration of mortality, morbidity, and vital statistics it shall be the duty of the Surgeon General of the Public Health and Marine-Hospital Service, after the annual conference required by section 7 to be called, to prepare and distribute suitable and necessary forms for the collection and compilation of such statistics, and said statistics, when transmitted to the Public Health and Marine-Hospital Bureau on said forms, shall be compiled and published by the Public Health and Marine- Hospital Service as a part of the health reports published by said service. . Sec. 9. That the President shall from time to time prescribe rules for the conduct of the Public Health and Marine-Hospital Service. He shall also prescribe regulations respecting its internal admini- stration and discipline, and the uniforms of its officers and em- ployees. It shall be the duty of the Surgeon General to transmit annually to the Secretary of the Treasury, for transmission by said Secretary to Congress, a full and complete report of the transactions of said service, including a detailed statement of receipts and dis- bursements. 1902—Act of July 1, 1902 (32 Stat. L., 728.)—An Act To regulate the sale of viruses, serums, toxins, and analo- gous products in the District of Columbia, to regulate inter- state traffic in said articles, and for other purposes. (Sec. 1.] That from and after six months after the promulgation of the regulations authorized by section 4 of this act no person shall sell, barter, or exchange, or offer for sale, barter, or exchange in 224 THE PUBLIC HEALTH SERVICE the District of Columbia, or send, carry, or bring for sale, barter or exchange from any State, Territory, or the District of Columbia into any State, Territory, or the District of Columbia, or from any foreign country into the United States, or from the United States into any foreign country, any virus, therapeutic serum, toxin, anti- toxin, or analogous product applicable to the prevention and cure of diseases of man, unless (a) such virus, serum, toxin, antitoxin, or product has been propagated and prepared at an establishment holding an unsuspended and unrevoked license, issued by the Sec- retary of the Treasury as hereinafter authorized, to propagate and prepare such virus, serum, toxin, antitoxin, or product for sale in the District of Columbia, or for sending, bringing, or carrying from place to place aforesaid; nor (b) unless each package of such virus, serum, toxin, antitoxin, or product is plainly marked with the proper name of the article contained therein, the name, address, and license number of the manufacturer, and the date beyond which the con- tents can not be expected beyond reasonable doubt to yield their specific results: Provided, That the suspension or revocation of any license shall not prevent the sale, barter, or exchange of any virus, serum, toxin, antitoxin or product aforesaid which has been sold and delivered by the licentiate prior to such suspension or revocation, unless the owner or custodian of such virus, serum, toxin, antitoxin, or product aforesaid has been notified by the Secretary of the Treasury not to sell, barter, or exchange the same. Sec. 2. That no person shall falsely label or mark any package or container of any virus, serum, toxin, antitoxin, or product afore- said; nor alter any label or mark on any package or container of any virus, serum, toxin, antitoxin, or product aforesaid so as to falsify such label or mark. SEC. 3. That any officer, agent or employee of the Treasury De- partment, duly detailed by the Secretary of the Treasury for that purpose, may during all reasonable hours enter and inspect any establishment for the propagation and preparation of any virus, serum, toxin, antitoxin or product aforesaid for sale, barter, or exchange in the District of Columbia, or to be sent, carried, or brought from any State, Territory, or the District of Columbia into any other State or Territory or the District of Columbia, or from the United States into any foreign country, or from any foreign country into the United States. Sec. 4. That the Surgeon General of the Army, the Surgeon General of the Navy, and the Supervising Surgeon General of the Marine-Hospital ‘Service be, and they are hereby constituted a board with authority, subject to the approval of the Secretary of the Treasury, to promulgate from time to time such rules as may be necessary in the judgment of said board to govern the issue, suspension, and revocation of licenses for the maintenance of es- tablishments for the propagation and preparation of viruses, serums, toxins, antitoxins, and analogous products, applicable to the pre- vention and cure of diseases of man, intended for sale in the Dis- trict of Columbia, or to be sent, carried, or brought for sale from any State, Territory, or the District of Columbia into any other LAWS 225 State, Territory, or the District of Columbia, or from the United States into any foreign country, or from any foreign country into the United States: Provided, That all licenses issued for the main- tenance of establishments for the propagation and preparation in any foreign country of any virus, serum, toxin, antitoxin, or product aforesaid for sale, barter, or exchange in the United States, shall be issued upon condition that the licentiates will permit the in- spection of the establishments where said articles are propagated and prepared, in accordance with section 3 of this act. Sec. 5. That the Secretary of the Treasury be, and he is hereby, authorized and directed to enforce the provisions of this act and of such rules and regulations as may be made by authority there- of; to issue, suspend, and revoke licenses for the maintenance of establishments aforesaid, and to detail for the discharge of such duties such officers, agents, and employees of the Treasury Depart- ment as may in his judgment be necessary. Sec. 6. That no person shall interfere with any officer, agent, or employee of the Treasury Department in the performance of any duty imposed upon him by this act or by the regulations made by authority thereof. Sec. 7. That any person who shall violate, or aid or abet in violating, any of the provisions of this act shall be punished by a fine not exceeding $500 or by imprisonment not exceeding one year, or by both such fine and imprisonment, in the discretion of the court. Sec. 8. That all acts and parts of acts inconsistent with the provisions of this act be, and the same are hereby, repealed. 1905—Act of February 3, 1905 (33 Stat. L., 650)—An Act Making appropriations for the legislative, executive, and judicial expenses of the Government for the fiscal year ending June thirtieth, nineteen hundred and six, and for other purposes. [Sec. 1.] . .. said [Public Health and Marine-Hospital] Service shall remain under the jurisdiction of the Treasury Department until otherwise hereafter specifically provided by law.18 1905—]Joint Resolution of February 24, 1905 (33 Stat. L., 1283)-—Joint Resolution Providing For the publication of the annual reports and bulletins of the hygienic laboratory 16 Act of February 14, 1003 (32 Stat. L., 830), creating the Department of Commerce and Labor, provided that the President might transfer to the Department of Commerce and Labor the whole or part of any bureau, office, division or other branch of the Treasury Department engaged in statistical or scientific work, 226 THE PUBLIC HEALTH SERVICE and of the yellow-fever institute of the Public Health and Marine-Hospital Service. Also provides for printing 4000 copies of annual report of the Surgeon General. 19o5—Act of March 3, 1905 (33 Stat. L., 1009)—An Act To provide for the investigation of leprosy, with spe- cial reference to the care and treatment of lepers in Hawaii. Provides for the establishment in Hawaii of a hospital station and laboratory for the study of the methods of transmission, cause, and treatment of leprosy; authorizes additional pay for commissioned and noncommissioned officers detailed to the leprosarium. 1905—Act of March 3, 1905 (33 Stat. L., 1217)—An Act Making appropriations to supply deficiencies in the appro- priations for the fiscal year ending June thirtieth, nineteen hundred and five, and for prior years, and for other pur- poses. [Sec. 1.] . .. That so much of section fifteen of an act entitled “An act to remove certain burdens on the American merchant marine and encourage the American foreign-carrying trade, and for other purposes,” approved June twenty-sixth, eighteen hundred and eighty- four, as makes a permanent appropriation of the receipts for duties on tonnage provided for by said act for the expenses of maintain- ing the Marine-Hospital Service is hereby repealed, to take effect from and after June thirtieth, nineteen hundred and six. And the Secretary of the Treasury shall, for the fiscal year nineteen hun- dred and seven, and annually thereafter, submit to Congress, in the regular Book of Estimates, detailed estimates of the expenses of maintaining the Public Health and Marine-Hospital Service. 1906—Act of June 19, 1906 (34 Stat. L., 2g9)—An Act To further protect the public health and make more effective the national quarantine. Further defines the powers and duties of the Secretary of the Treasury in relation to quarantine stations; provides for acquisition of local stations by the United States. LAWS 227 1906—Act of June 23, 1906 (34 Stat. L., 452)—An Act To promote the efficiency of the Revenue-Cutter Service.'? Sec. 2 provides that applicants for appointment as cadets in Rev- enue-Cutter Service be physically examined by a board of officers of the Public Health and Marine Hospital Service. 1911—Act of March 4, 1911 (36 Stat. L., 13904)—An Act Making appropriations for sundry civil expenses of the Government for the fiscal year ending June thirtieth, nine- teen hundred and twelve, and for other purposes. [SEc. 1] . . . That there may be admitted into said [marine] hospitals, for study, persons with infectious or other diseases affect- ing the public health, and not to exceed ten cases in any one hos- pital at any one time ...1® That the provisions of section seven of the act of March third, nineteen hundred and five, as to compensation shall apply to said officers while engaged in investigations of leprosy at Kalihi and other places in Hawaii. 1912—Act of August 14, 1912 (37 Stat. L., 309)—An Act To change the name of the Public Health and Marine- Hospital Service to the Public Health Service, to increase the pay of officers of said service, and for other purposes. [Sec. 1.] That the Public Health and Marine-Hospital Service of the United States shall hereafter be known and designated as the Public Health Service, and all laws pertaining to the Public Health and Marine-Hospital Service of the United States shall hereafter apply to the Public Health Service, and all regulations now in force, made in accordance with law for the Public Health and Marine-Hospital Service of the United States, shall apply to and remain in force as regulations of and for the Public Health Service until changed or rescinded. The Public Health Service may study and investigate the diseases of man and conditions influencing the propagation and spread thereof, including sanitation and sewage and the pollution either directly or indirectly of the navigable streams and lakes of the United States, and it may from time to time issue information in the form of publications for the use of the public. Sec. 2. That beginning with the first day of October next after the passage of this act the salaries of the commissioned medical officers of the Public Health Service shall be at the following rates 17 Revenue-Cutter Service consolidated with Life-Saving Service and name changed to Coast Guard by act of January 28, 1915 (38 Stat. L, 801). 8 First provision for patients of this character, this language repeated in appropriation acts for the fiscal years 1913 to 1922; thereafter omitted. 228 THE PUBLIC HEALTH SERVICE per annum: Surgeon General, $6,000; Assistant Surgeon General, $4,000; senior surgeon, of which there shall be ten in number, on active duty, $3,500; surgeon, $3,000; passed assistant surgeon, $2,400; assistant surgeon, $2,000; and the said officers, excepting the Surgeon General, shall receive an additional compensation of ten per centum of the annual salary as above set forth for each five years’ service, but not to exceed in all forty per centum: Provided, That the total salary, including the longevity increase, shall not exceed the following rates: Assistant Surgeon General, $5,000; senior surgeon, $4,500; surgeon, $4,000: Provided further, That there may be employed in the Public Health Service such help as may be provided for from time to time by Congress.1® 1913—Act of March 4, 1913 (37 Stat. L., 915)—An Act Making appropriations to supply deficiencies in appropria- tions for the fiscal year nineteen hundred and thirteen and for prior years, and for other purposes. [Sec. 1.] . . . That hereafter the director of the hygienic labora- tory shall receive the pay and allowances of a senior surgeon. 1913—Act of June 23, 1913 (38 Stat. L., 24)—An Act Mak- ing appropriations for sundry civil expenses of the Gov- ernment for the fiscal year ending June thirtieth, nineteen hundred and fourteen, and for other purposes. [Sec. 1.] . .. That hereafter commissioned officers and pharma- cists, and those employees of the service devoting all their time to field work, shall be entitled to hospital relief when taken sick or injured in line of duty. 1914—Act of June 24, 1914 (38 Stat. L., 387)—An Act To provide for the construction of two revenue cutters. -.. That, in the discretion of the Secretary of the Treasury, any of the revenue cutters provided for in this act, or any other revenue cutter now or hereafter in commission, may be used to extend medical and surgical aid to the crews of American vessels engaged in the deep-sea fisheries, under such regulations as the Secretary of the Treasury may from time to time prescribe, and the said secretary is hereby authorized to detail for duty on revenue cutters such surgeons and other persons of the Public Health Service as he may deem necessary, 1915—Act of January 28, 1915 (38 Stat. L., 801)—An Act 19 Salaries increased by acts of May 18, 1920, and June 10, 1922. LAWS 229 To create the Coast Guard by combining therein the exist- ing Life Saving Service and Revenue-Cutter Service.** Sec. 2. . .. Except as herein modified all existing laws relating either to the present Life-Saving Service or the present Revenue- Cutter Service shall remain of force as far as applicable to the Coast Guard and the officers, positions, operations, and duties shall in all respects be held and construed to impose the same duties upon the positions and their incumbents in the Coast Guard as are now imposed upon the corresponding positions and incumbents in the said two existing organizations. 1915—Act of March 4, 1915 (38 Stat. L., 1166)—An Act To promote the welfare of American seamen in the mer- chant marine of the United States; to abolish arrest and im- prisonment as a penalty for desertion and to secure the ab- rogation of treaty provisions in relation thereto; and to pro- mote safety at sea. SEC. 6. . . . That forecastles shall be fumigated at such intervals as may be provided by regulations to be issued by the Surgeon General of the Public Health Service, with the approval of the Department of Commerce, and shall have at least two exits, one of which may be used in emergencies. 1916—Act of August 28, 1916 (39 Stat. L., 538)—An Act To authorize aids to navigation and for other works in the Lighthouse Service, and for other purposes. Sec. 5. That hereafter light keepers and assistant light keepers of the Lighthouse Service shall be entitled to medical relief with- out charge at hospitals and other stations of the Public Health Service under the rules and regulations governing the care of sea- men of the merchant marine: Provided, That this benefit shall not apply to any keeper or assistant keeper who receives an original appointment after the passage of this act, unless the applicant passes a physical examination in accordance with rules approved by the Secretary of Commerce and the Secretary of the Treasury. 1916—Act of September 7, 1916 Stat. L., 743,747)—An 9 p 7, 19 39 743 Act To provide compensation for employees of the United 20 This act made employees of the Coast Guard beneficiaries of the hospitals, as the keepers of crews of life saving stations were made beneficiaries by the act of August 4, 1894. 230 THE PUBLIC HEALTH SERVICE States suffering injuries while in the performance of their duties, and for other purposes. Sec. 9 provides that medical, surgical, and hospital services and supplies shall be furnished to injured employees by United States medical officers and hospitals. Sec. 21 provides that injured em- ployees shall be examined by a medical officer of the United States. 1917—Act of February 3, 1917 (39 Stat. L., 872)—An Act To provide for the care and treatment of persons afflicted with leprosy and to prevent the spread of leprosy in the United States. 1917—Act of February 5, 1917 (39 Stat. L., 885, 892, 896)— An Act To regulate the immigration of aliens to, and the residence of aliens, in the United States. . Sec. 16. That the physical and mental examination of all arriving aliens shall be made by medical officers of the United States Public Health Service, who shall have had at least two years’ experience in the practice of their profession since receiving the degree of doctor of medicine, and who shall conduct all medical examinations and shall certify, for the information of the immigration officers and the boards of special inquiry hereinafter provided for, any and all physical and mental defects or diseases observed by said medical officers in any such alien; or, should medical officers of the United States Public Health Service be not available, civil surgeons of not less than four years’ professional experience may be employed in such emergency for such service upon such terms as may be prescribed by the Commissioner General of Immigration, under the direction or with the approval of the Secretary of Labor. All aliens arriving at ports of the United States shall be examined by not less than two such medical officers at the discretion of the Secretary of Labor, and under such administrative regulations as he may prescribe and under medical regulations prepared by the Surgeon General of the United States Public Health Service. Medical officers of the United States Public Health Service who have had especial training in the diagnosis of insanity and mental defects shall be detailed for duty or employed at all ports of entry designated by the Secretary of Labor, and such medical officers shall be provided with suitable facilities for the detention and examination of all arriving aliens in whom insanity or mental defect is suspected, and the services of interpreters shall be provided for such examination. Any alien certified for insanity or mental defect may appeal to the board of medical officers of the United States Public Health Service, which shall be convened by the Surgeon General of the United States Public Health Service, and said alien may introduce before such board one expert medical witness at his own cost and expense. . . . SEC. 23. . . . and, upon his request [the request of the Com- LAWS 231 missioner General of Immigration], approved by the Secretary of Labor, the Secretary of the Treasury may detail medical officers of the United States Public Health Service for the performance of duties in foreign countries in connection with the enforcement of tng act, . Sec. 35. That it shall be unlawful for any vessel carrying pas- sengers between a port of the United States and a port of a foreign country, upon arrival in the United States, to have on board employed thereon any alien afflicted with idiocy, imbecility, insanity, epilepsy, tuberculosis in any form, or a loathsome or dangerous contagious disease, if it appears to the satisfaction of the Secretary of Labor, from an examination made by a medical officer of the United States Public Health Service, and is so certified by such officer, that any such alien was so afflicted at the time he was shipped or engaged and taken on board such vessel and that the existence of such affliction might have been detected by means of a competent medical exam- ination at such time. 1917—Act of April 17, 1917 (40 Stat. L., 6)—An Act Mak- ing appropriations to supply deficiencies in appropriations for the fiscal year ending June thirtieth, nineteen hundred and seventeen, and prior fiscal years, and for other pur- poses. [Sec. 1.] . . . Hereafter the cost of fumigation and disinfection shall be charged vessels from foreign ports at rates to be fixed by the Secretary of the Treasury. 1917— Joint Resolution of July 9, 1917 (40 Stat. L., 242)— Joint Resolution to fix the status and rights of officers of the Public Health Service when serving with the Coast Guard, the Army, or the Navy. That when officers of the United States Public Health Service are serving on Coast Guard vessels in time of war, or are detailed in time of war for duty with the Army or Navy in accordance with law, they shall be entitled to pensions for themselves and widows and children, if any, as are now provided for officers of cor- responding grade and length of service of the Coast Guard, Army, or Navy, as the case may be, and shall be subject to the laws pre- scribed for the government of the service to which they are respect- ively detailed. 1917—Executive order of September 27, 1917.—Establish- ing quarantine service in Virgin Islands. 1918—Act of July 1, 1918 (40 Stat. L., 644, 671, 694)— 232 THE PUBLIC HEALTH SERVICE An Act Making appropriations for sundry civil expenses of the Government for the fiscal year ending June thir- tieth, nineteen hundred and nineteen, and for other pur- poses. [Skc. 1.] ... The Secretary of the Treasury is authorized to permit officers of the Public Health Service to make allotments from their pay under such regulations as he may prescribe. . . . That the Public Health Service, from and after July 1, 1918, shall pay to Saint Elizabeth’s Hospital the actual per capita cost of maintenance in the said hospital of patients committed by that service... . . The Secretary of the Treasury may detail medical officers of the Public Health Service for cooperative health, safety, or sanitation work with the Bureau of Mines, and the compensation and expen- ses of officers so detailed may be paid from the applicable appropria- tions made herein for the Bureau of Mines. . . .2 Officers and crews of the several vessels belonging to the Bureau of Fisheries may be admitted to the benefits of the Public Health Service without charge upon the application of their respective com- manding officers. 1918—Act of July 9, 1918 (40 Stat. L., 886)—An Act Mak- ing appropriations for the support of the Army for the fis- cal year ending June thirtieth, nineteen hundred and nine- teen. CuAPTER XV [Skc. 1.] That there is hereby created a board to be known as the Interdepartmental Social Hygiene Board, to consist of the Secretary of War, the Secretary of the Navy, and the Secretary of the Trea- sury as ex-officio members, and of the Surgeon General of the Army, the” Surgeon General of the Navy, and the Surgeon General of the Public Health Service, or of representatives designated by the Sec- retary of War, the Secretary of the Navy, and the Secretary of the Treasury, respectively. The duties of the board shall be: (1) To recommend rules and regulations for the expenditure of moneys allotted to the States under section 5 of this chapter; (2) to select the institutions and organizations and fix the allotments to each institution under said section 5; (3) to recommend to the Secretary of the Treasury, the Secretary of War, and the Secretary of the Navy such general measures as will promote correlation and effi- ciency in carrying out the purposes of this chapter by their respective departments; and (4) to direct the expenditure of the sum of $100,- 21 Repeated in later appropriation acts. LAWS 233 ooo referred to in the last paragraph of section 7 of this chapter. The board shall meet at least quarterly, and shall elect annually one of its members as chairman, and shall adopt rules and regulations for the conduct of its business. Sec. 2. That the Secretary of War and the Secretary of the Navy are hereby authorized and directed to adopt measures for the purpose of assisting the various States in caring for civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the mil- itary and naval forces of the United States against venereal diseases. Sec. 3. That there is hereby established in the Bureau of the Public Health Service a Division of Venereal Diseases, to be under the charge of a commissioned medical officer of the United States Public Health Service detailed by the Surgeon General of the Pub- lic Health Service, which officer while thus serving shall be an assistant surgeon general of the Public Health Service, subject to the provisions of law applicable to assistant surgeons general in charge of administrative divisions in the District of Columbia of the Bureau of the Public Health Service. There shall be in such division such assistants, clerks, investigators, and other employees as may be necessary for the performance of its duties and as may be provided for by law. SEC. 4. That the duties of the Division of Venereal Diseases shall be in accordance with rules and regulations prescribed by the Sec- retary of the Treasury (1) to study and investigate the cause, treatment, and prevention of venereal diseases; (2) to cooperate with State boards or departments of health for the prevention and control of such diseases within the States; and (3) to control and prevent the spread of these diseases in interstate traffic: Provided, That nothing in this chapter shall be construed as limiting the functions and activities of other departments or bureaus in the prevention, control, and treatment of venereal diseases and in the expenditure of moneys therefor. Sec. 5. That there is hereby appropriated, out of any money in the Treasury not otherwise appropriated, the sum of $1,000,000, to be expended under the joint direction of the Secretary of War and the Secretary of the Navy to carry out the provisions of section 2 of this chapter: Provided, That the appropriation herein made shall not be deemed exclusive, but shall be in addition to other appropri- ations of a more general character which are applicable to the same or similiar purposes. Sec. 6. That there is hereby appropriated, out of any moneys in the Treasury not otherwise appropriated the sum of $1,400,000 an- nually for two fiscal years, beginning with the fiscal year com- mencing July 1, 1918, to be apportioned as follows: The sum of $1,000,000, which shall be paid to the States for the use of their respective boards or departments of health in the prevention, con- trol, and treatment of venereal diseases; this sum to be alloted to each State, in accordance with the rules and regulations pre- scribed by the Secretary of the Treasury, in the proportion which its population bears to the population of the continental United States, exclusive of Alaska and the Canal Zone, according to the 234 THE PUBLIC HEALTH SERVICE last preceding United States census, and such allotment to be so conditioned that for each dollar paid to any State the State shall specifically appropriate or otherwise set aside an equal amount for the prevention, control, and treatment of venereal diseases, except for the fiscal year ending June 30, 1919, for which the allotment of money is not conditioned upon the appropriation or setting aside of money by the State, provided that any State may obtain any part of its allotment for any fiscal year subsequent to June 30, 1919, by specifically appropriating or otherwise setting aside an amount equal to such part of its allotment for the prevention, control, and treatment of venereal diseases; the sum of $100,000, which shall be paid to such universities, colleges, or other suitable institutions as in the judgment of the Interdepartmental Social Hygiene Board are qualified for scientific research, for the purpose of discovering, in accordance with the rules and regulations prescribed by the Inter- departmental Social Hygiene Board, more effective medical measures in the prevention and treatment of venereal diseases; the sum of $300,000, which shall be paid to such universities, colleges, or other suitable institutions or organizations, as in the judgment of the Inter- departmental Social Hygiene Board are qualified for scientific re- search, for the purpose of discovering and developing more effective educational measures in the prevention of venereal diseases, and for the purpose of sociological and psychological research related thereto. Sec. 7. That there is hereby appropriated, out of any money in the Treasury not otherwise appropriated, the sum of $300,000 for the fiscal year ending June 30, 1919, to be apportioned as follows: The sum of $200,000 to defray the expenses of the establishment and maintenance of the Division of Venereal Diseases in the Bureau of the Public Health Service: and the sum of $100,000 to be used under the direction of the Interdepartmental Social Hygiene Board for any purpose for which any of the appropriations made by this chapter are available. Sec. 8. That the terms “State” and “States” as used in this chapter shall be held to include the District of Columbia. 1918—Act of October 1, 1918 (40 Stat. L., 9g92)—An Act Making appropriations for the Department of Agriculture for the fiscal year ending June thirtieth, nineteen hundred and nineteen. Hereafter the Secretary of the Treasury may detail medical officers of the Public Health Service to the Department of Agri- culture for codperative assistance in the administration of the food and drugs act, approved June thirtieth, nineteen hundred and six, and amended August twenty-third, nineteen hundred and twelve, and the compensation and expenses of the officers so detailed may be paid from the applicable appropriations made herein for enforce- ment of said act.?? 22 Repeated in later appropriation acts. LAWS 235 1918—Joint Resolution of October 27, 1918 (40 Stat. L., 1017)—]Joint Resolution To establish a reserve of the Pub- lic Health Service. 1919—Act of March 3, 1919 (40 Stat. L.., 1302)—An Act To authorize the Secretary of the Treasury to provide hospital and sanitorium facilities for discharged sick and disabled soldiers, sailors, and marines. Transfers specified army camps to Public Health Service, author- izes lease of hospitals, makes appropriations for purchase, construc- tion, and operation, 1919—Act of July 11, 1919 (41 Stat. L., 45)—An Act Mak- ing appropriations to supply deficiencies in appropriations for the fiscal year ending June 30, 1919, and prior fiscal years, and for other purposes. Directs Secretary of the Treasury to acquire and complete im- mediately the hospital at Broadview, Cook County, Illinois; author- izes remodeling of buildings purchased. 1919—Act of July 19, 1919 (41 Stat. L., 174)—An Act Mak- ing appropriations for the sundry civil expenses of the Gov- ernment for the fiscal year ending June 30, 1920, and for other purposes. [Sec. 1.] . . . PusLic HEALTH Service. For pay, allowance, and commutation of quarters for commissioned medical officers, includ- ing the Surgeon General, Assistant Surgeons General at large 2® not exceeding three in number and pharmacists, $850,000. 1919—Act of December 24, 1919 (41 Stat. L., 378)—An Act Making appropriations to supply urgent deficiencies in appropriations for the Employees’ Compensation Com- mission, the Bureau of War Risk Insurance, and the Public Health Service for the fiscal year ending June 30, 1920. Contains further legislation relative to hospital at Broadview, Cook County, Illinois. 23 First provision for Assistant Surgeons General at large; similar provision has been carried in later appropriation acts. 236 THE PUBLIC HEALTH SERVICE 1920—Act of March 6, 1920 (41 Stat. L., 507, 508)-An Act Making appropriations to supply deficiencies in appro- priations for the fiscal year ending June 30, 1920, and prior fiscal years, and for other purposes. Authorizes officers of Public Health Service to purchase quarter- master supplies from the Army, Navy, and Marine Corps; provides that officers of the Public Health Service shall be credited with serv- ice in Army, Navy, Marine Corps, and Coast Guard in computing longevity pay; makes additional appropriations for hospital projects. 1920—Act of March 15, 1920 (41 Stat. L., 530, 531)—An Act to authorize the Secretary of War to transfer certain surplus motor-propelled vehicles and motor equipment and road-making material to various services and departments of the Government, and for the use of the states. Authorizes transfer of motor equipment to the Public Health Service. 1920—Act of May 18, 1920 (41 Stat. L., 601)—An Act To increase the efficiency of the commissioned and enlisted per- sonnel of the Army, Navy, Marine Corps, Coast Guard, Coast and Geodetic Survey, and Public Health Service. Secs. 1 and 13 provide for increased pay for commissioned officers of the Public Health Service from January 1, 1920 to June 30, 1922.4 Sec. 2 provides that commissioned officers of the Public Health Serv- ice on duty in the field shall, until June 30, 1922, be entitled to com- mutation of quarters, heat and light, if they maintain places of abode for their wives, children or dependent parents.?> Sec. 11 provides that longevity pay for officers in the Army, Navy, Marine Corps, Coast Guard, Public Health Service, and Coast and Geodetic Sur- vey shall be based on total of all services in any or all of said serv- ices. Sec. 12 provides that on permanent change of station a com- missioned officer of the Public Health Service shall be allowed transportation for his wife and dependent child or children. 1920—Act of June 5, 1920 (41 Stat. L., 963)—An Act Mak- ing appropriation for the support of the Army for the fiscal year ending June 30, 1921, and for other purposes. 24 Obsolete. 25 Superseded by act of June 10, 1922. LAWS 237 That the Secretary of War may, in his discretion, transfer to the Secretary of the Treasury, for the use of the Public Health Service. the military reservation of Whipple Barracks, Arizona, now occupied by said services for hospital purposes. 1920—Act of June 5, 1920 (41 Stat. L., 1025)—An Act Making appropriations to supply deficiencies in appropri- ations for the fiscal year ending June 30, 1920, and prior fiscal years, and for other purposes. [Sec. 1.] . . . The Secretary of War is authorized and directed to transfer to the Secretary of the Treasury for use of the Public Health Service, and without payment therefor such hospital furniture, equipment, and supplies as may be required for hospitals of the said service at Fort McHenry, Fort Bayard, Whipple Barracks, and in Cook County, Ill. The total value of the material transferred here- under shall not exceed $1,000,000. 1920—Act of June 5, 1920 (41 Stat. L., 1060)—An Act To amend paragraph (e) of section 7 of the act approved March 3, 1919, entitled “An act to authorize the Secretary of the Treasury to provide hospital and sanatorium facil- ities for discharged sick and disabled soldiers, sailors, and marines.” Authorizes additional sum for purchase of hospital in the District of Columbia. 1921—Act of February 27, 1921 (41 Stat. L., 1149)—An Act To amend “An Act granting additional quarantine powers and imposing additional duties upon the Marine Hospital Service,” approved February 15, 1893. Amends first paragraph of section 2 of the act of February 1s, 1893, and provides that bill of health must be in duplicate. 1921—Act of March 4, 1921 (41 Stat. L., 1364)—An Act Providing additional hospital facilities for patients of the Bureau of War Risk Insurance and of the Federal Board for Vocational Education, Division of Rehabilitation, and for other purposes. Authorizes the acquisition of additional hospitals by purchase, gift, 238 THE PUBLIC HEALTH SERVICE lease or condemnation; transfers Fort Mackenzie, Wyoming, Fort Walla Walla, Washington, and Fort Logan H. Root, Arkansas, to Public Health Service; authorizes President to transfer lands and buildings of the United States to the Public Health Service; appro- priates $18,600,000 for additional hospital facilities. 1921—Act of August 9, 1921 (42 Stat. L., 147)—An Act To establish a Veterans’ Bureau and to improve the facilities and service of such bureau, and further to amend and modify the War Risk Insurance Act. Section 1. There is hereby established an independent bureau under the President to be known as the Veterans’ Bureau,?” the director of which shall be appointed by the President, by and with the advice and consent of the Senate. The director of the Veterans’ Bureau shall receive a salary of $10,000 per annum, payable monthly. The word “director,” as hereinafter used in this Act, shall mean the director of the Veterans’ Bureau. Sec. 2. The director, subject to the general direction of the President, shall administer, execute, and enforce the provisions of this Act, and for that purpose shall have full power and authority to make rules and regulations not inconsistent with the provisions of this Act, which are necessary or appropriate to carry out its purposes and shall decide all questions arising under this Act except as otherwise provided herein. Sec. 4. All personnel, facilities, property, and equipment, includ- ing leases, contracts, and other obligations and instrumentalities in the District of Columbia and elsewhere of the Bureau of War Risk Insurance, of the United States Public Health Service, as described and provided in a written order of the Treasury Department issued and signed by the Secretary of the Treasury on April 19, 1921, and designated “Order relative to the transfer of certain activities of the United States Public Health Service, relating to the Bureau of War Risk Insurance, including the trainees of the Rehabilitation Division of the Federal Board for Vocational Education.” ?® and of the Rehabilitation Division of the Federal Board for Vocational Edu- 26 Only the portions of this act relating to the Public Health Service and medical treatment are quoted. 27 Name changed to United States Veterans’ Bureau by Joint Resolu- tion of August 24, 1921. (Public Res. No. 19, 67th Cong.) 28 The order of the Secretary of the Treasury of April 19, 1921, is as follows: 1. All of the activities of the United States Public Health Service, with the exception of such hospitals and dispensaries as are operated by that Service, in so far as they affect the beneficiaries of the Bureau of War Risk Insurance, including trainees under the Federal Board for Vocational Education, are hereby transferred to the Bureau of War Risk Insurance, and the Director of the Bureau of War Risk Insurance is hereby directed to assume and administer such activities and shall here- after be respopsible for the examination, hospitalization and proper and LAWS 239 cation, as a result of the administration of the Act approved June 27, 1918, and amendments thereto, are hereby transferred to and made a part of the Veterans’ Bureau under the control, manage- ment, operation, and supervision of the director, and subject to such change in designation and organization as he may deem necessary in carrying out the provisions of this act: Provided, That all com- missioned personnel detailed or hereafter detailed from the United States Public Health Service to the Veterans’ Bureau, shall hold the same rank and grade, shall receive the same pay and allowances, and shall be subject to the same rules for relative rank and promotion as now or hereafter may be provided by law for commissioned per- sonnel of the same rank or grade or performing the same or similiar duties in the United States Public Health Service. Sec. 5. All records, files, documents, correspondence, and other papers relating to service rendered or to be rendered by the United States Public Health Service in the medical examination, assign- ment to hospitals, and treatment of persons who are now or have been patients and beneficiaries of the Bureau of War Risk Insurance or of the Rehabilitation Division of the Federal Board for Vocational Education, as a result of the administration of the Act approved satisfactory medical care and treatment, including supplies, for the said beneficiaries. 2. Personnel. (a). Such regular and reserve commissioned officers of the United States Public Health Service concerned in or with the activities to be assumed and administered by the Bureau of War Risk Insurance are hereby detailed and assigned for duty to and shall be under the direction and subject to the orders of the Director of the Bureau of War Risk In- surance. Such officers shall be immediately notified of such detail by the Surgeon General of the United States Public Health Service. As soon as practicable the regular commissioned officers will be released from duty with the Bureau of War Risk Insurance. In the event that the services of any reserve commissioned officer shall become unnecessary, the Surgeon General of the Public Health Service shall be so advised. (b) All personnel of the United States Public Health Service other than that mentioned in paragraph (a) who are employed in the District of Columbia and elsewhere and who are engaged in the activities to be assumed by the Bureau of War Risk Insurance are hereby transferred to and shall be carried on the rolls of the Bureau of War Risk Insurance. 3. All papers, records, files, documents and correspondence of the United States Public Health Service pertaining to the activities to be assumed by the Bureau of War Risk Insurance, together with all facilities, includ- ing vehicles and other equipment now on hand and in use by the United States Public Health Service for the administration and execution of such activities, shall be delivered into custody of the Director of the Bureau of War Risk Insurance. 4. The offices and buildings now occupied by the United States Public Health Service, which are used for the activities to be assumed by the Bureau of War Risk Insurance, shall be made available for the use of the Bureau of War Risk Insurance in such manner and to such extent as, in the opinion of the Director, may be necessary for the proper adminis- tration of such activities. 5. All Treasury Department orders and circulars in conflict with this order are hereby modified to accord herewith. 240 THE PUBLIC HEALTH SERVICE June 27, 1918, and amendments thereto, and as described and pro- vided in a written order of the Treasury Department issued and signed by the Secretary of the Treasury on April 19, 1921, and designated “Order relative to the transfer of certain activities of the United States Public Health Service relating to the Bureau of War Risk Insurance, including the trainees of the Rehabilitation Division of the Federal Board for Vocational Education,” shall be transferred to the Veterans’ Bureau. Sec. 9. The director, subject to the general directions of the President, shall be responsible for the proper examination, medical care, treatment, hospitalization, dispensary, and convalescent care, necessary and reasonable after care, welfare of, nursing, vocational training, and such other services as may be necessary in the carrying out of the provisions of this Act, and for that purpose is hereby authorized to utilize the now existing or future facilities of the United States Public Health Service, the War Department, the Navy Department, the Interior Department, the National Homes for Disabled Volunteer Soldiers, and such other governmental facilities as may be made available for the purposes set forth in this Act; and such governmental agencies are hereby authorized and directed to furnish such facilities, including personnel, equipment, medical, surgical, and hospital services and supplies as the director may deem necessary and advisable in carrying out the provisions of this Act, in addition to such governmental facilities as are hereby made available. In order to standardize the character of examination, medical care, treatment, hospitalization, dispensary, and convalescent care, nursing, vocational training, and such other services as may be necessary for beneficiaries under this Act, the director shall maintain an in- spection service, with authority to examine all facilities and services utilized in carrying out the purpose of this Act, and for this purpose, with the approval of the President, may utilize such other Govern- ment or private agencies as may be deemed practicable and necessary. The head of the inspection service shall report to the director in the manner the director may prescribe the result of each examination of facilities and services, and shall recommend to him the methods of standardizing such facilities and services. When, in the opinion of the director, the facilities and services utilized for hospitalization, medical care, and treatment for bene- ficiaries under this Act are unsatisfactory, the director shall make arrangements for the further hospitalization, care and treatment of such beneficiaries by other means. In the event that there is not sufficient Government hospital and other facilities for the proper medical care and treatment of bene- ficiaries under this Act, and the director deems it necessary and advisable to secure additional Government facilities, he may, within the limits of appropriations made for carrying out the provisions of this paragraph, and with the approval of the President, improve or extend existing governmental facilities, or acquire additional facilities by purchase or otherwise. Such new property and struc- tures as may be so improved, extended, or acquired shall become part of the permanent equipment of the Veterans’ Bureau or of LAWS 241 some one of the now existing agencies of the Government, including the War Department, Navy Department, Interior Department, Trea- sury Department, the National Homes for Disabled Volunteer Sol- diers, in such a way as will best serve the present emergency, taking into consideration the future services to be rendered the veterans of the World War, including the beneficiaries under this Act. In the event Government hospital facilities and other facilities are not thus available or are not sufficient, the director may contract with State, municipal, or private hospitals for such medical, surgical, and hospital services and supplies as may be required, and such contracts may be made for a period of not exceeding five years and may be for the use of a ward or other hospital unit or on such other basis as may be in the best interest of the beneficiaries under this Act. The President is hereby authorized, should he deem it necessary and advisable for the proper medical care and treatment of bene- ficiaries under this Act, to transfer to the director the operation, management, and control of specifically designated hospitals now under the jurisdiction of the Public Health Service. Such hospitals when transferred shall be used exclusively for beneficiaries under this Act and shall be under the operative control of the director for such period of time as the President may prescribe. Sec. 11. The director is hereby authorized to make such rules and regulations as may be deemed necessary in order to promote good conduct on the part of persons who are receiving care or treatment in hospitals, homes, or institutions as patients or bene- ficiaries of said bureau during their stay in such hospitals, homes, institutions, or training centers. Penalties for the breach of such rules and regulations may, with the approval of the director, extend to a forfeiture by the offender of such portion of the compensation payable to him, not exceeding three-fourths of the monthly install- ment per month for three months, for a breach committed while receiving treatment in such hospital, home, institution, or training center as may be prescribed by such rules and regulations: Provided, That the offender shall have the right to appeal the decision involving the forfeiture of a part of his compensation to a board of three persons which shall be established and appointed by the director in September of each year for each regional district. Such board shall be known as the Board on Discipline and Morale. It shall serve without compensation, and at least one of the members of such hoard shall be an ex-service man and a member of some war veterans’ organization. No person who is in the employ of the United States shall be a member of such board. The decision of such board, after hearing all the evidence presented by the offender and those charging a breach of the rules and regulations, shall be final. Sec. 13. In addition to the care, treatment, and appliances now authorized by law, said bureau also shall provide without charge therefor hospital, dental, medical, surgical, and convalescent care and treatment and prosthetic appliances for any member of the military or naval forces of the United States separated therefrom under honorable conditions disabled by reason of any wound or injury received or disease contracted, or by reason of any aggravation of a preéxisting injury or disease, specifically noted at examination 242 THE PUBLIC HEALTH SERVICE for entrance into or employment in the active military or naval service, while in the active military or naval service of the United States on or after April 6, 1917: Provided, That the wound or injury received or disease contracted, or aggravation of a preéxisting injury or disease, for which such hospital, dental, medical, surgical, and convalescent care and treatment and prosthetic appliances shall be furnished, was incurred in line of duty and not caused by his own willful misconduct: Provided further, That application for such care and treatment and appliances provided for in this section shall be made within one year from date of separation from service or from the date this Act goes into effect, whichever is the later. 1922—Act of February 17, 1922 (Public 145, 67th Con- gress) An Act Making appropriations for the Treasury Department for the fiscal year ending June 30, 1923, and for other purposes. [SEc. 1] * * * PUBLIC HEALTH SERVICE Office of Surgeon General: Chief clerk, $2,250; private secretary to the Surgeon General, $2,000; principal bookkeeper, $2,000; statis- tician, $2,000; technical assistant, $2,000; assistant editor, $1,800; librarian, $1,600; clerks—five of class four, six of class three, fifteen of class two (one of whom shall be translator), nineteen of class one, six at $1,000 each, three at $900 each; elevator conductor, $840; three messengers, at $840 each; three assistant messengers, at $720 each; telephone operator, $720; three laborers, at $660 each; in all, $92,970. For pay, allowance, and commutation of quarters for commissioned medical officers, including the Surgeon General, assistant surgeon gen- erals at large not exceeding three in number, and pharmacists, $913,560. For pay of acting assistant surgeons (noncommissioned medical officers), $300,000. For pay of all other employees (attendants, and so forth), $840,000. For freight, transportation, and traveling expenses, including the expenses, except membership fees, of officers when officially detailed to attend meetings of associations for the promotion of public health, $50,000. For maintaining the Hygenic Laboratory, $45,000. For preparation for shipment and transportation to their former homes of remains of officers who die in the line of duty, $3,000. LAWS 243 For journals and scientific books, $500. For medical examinations, including the amount necessary for the medical inspection of aliens, as required by section 16 of the Act of February 5, 1917, medical, surgical, and hospital services and supplies for beneficiaries (other than patients of the United States Veterans’ Bureau) of the Public Health Service, including necessary personnel, regular and reserve commissioned officers of the Public Health Serv- ice, personal services in the District of Columbia and elsewhere, maintenance, equipment, leases, fuel, lights, water, printing, freight, transportation and travel, maintenance and operation of motor trucks and passenger motor vehicles, transportation, care, maintenance, and treatment of lepers, court costs, and other expenses incident to pro- ceedings heretofore or hereafter taken for commitment of mentally incompetent persons to hospitals for the care and treatment of the insane, and reasonable burial expenses (not exceeding $100 for any patient dying in hospital), $5,627,304: Provided, That no part of this sum shall be used for the quarantine service, the prevention of epi- demics, or scientific work of the character provided for under the appropriations which follow. All sums received by the Public Health Service during the fiscal year 1923, except allotments and reimbursements on account of pa- tients of the United States Veterans’ Bureau, shall be covered into the Treasury as miscellaneous receipts. Quarantine service: For maintenance and ordinary expenses, ex- clusive of pay of officers and employees, of United States quarantine stations, including not exceeding $500 for printing on account of the quarantine service at times when the exigencies of that service require immediate action, $739,000. Prevention of epidemics: To enable the President, in case only of threatened or actual epidemic of cholera. typhus fever, yellow fever, smallpox, bubonic plague, Chinese plague or black death, trachoma, influenza, Rocky Mountain spotted fever, or infantile par- alysis, to aid State and local boards, or otherwise, in his discretion, in preventing and suppressing the spread of the same, and in such emergency in the execution of any quarantine laws which may be then in force, $400,000. Field investigations: For investigation of diseases of man and conditions influencing the propagation and spread thereof, includ- Jing sanitation and sewage, and the pollution of navigable streams and lakes of the United States, including personal service, $300,000. Interstate quarantine service: For cooperation with State and municipal health authorities in the prevention of the spread of con- tagious and infectious diseases in interstate traffic, $25,000. _ Rural sanitation: For special studies of, and demonstration work in, rural sanitation, including personal services, and including not 244 THE PUBLIC HEALTH SERVICE to exceed $5,000 for the purchase, maintenance, repair, and operation of motor-propelled passenger-carrying vehicles, $50,000: Provided, That no part of this appropriation shall be available for demonstra- tion work in rural sanitation in any community unless the State, county, or municipality in which the community is located agrees to pay one-half the expenses of such demonstration work. Biologic products: To regulate the propagation and sale of viruses, serums, toxins, and analogous products, including arsphenamine, and for the preparation of curative and diagnostic biologic products, in- cluding personal services of reserve commissioned officers and other personnel, $50,000. For the maintenance and expenses of the Division of Venereal Diseases, established by sections 3 and 4, Chapter XV, of the Act approved July 9, 1918, including personal and other services in the field and in the District of Columbia, $400,000, of which sum $225,000 shall be allotted to the States for cooperative work in the prevention and control of such diseases. 1922—Excutive Order of April 29, 1922. —Transferring cer- tain hospitals to Veterans’ Bureau. WHEREAS, Section 9 of the Act of Congress entitled “An Act to Establish a Veterans’ Bureau and to improve the facilities and serv- ice of such Bureau, and further to amend and modify the War Risk Insurance Act”, approved August 9, 1921, provides that— “Section 9. The director, subject to the general directions of the President, shall be responsible for the proper examination, medical care, treatment, hospitalization, dispensary, and convalescent care, necessary and reasonable after care, welfare of, nursing, vocational training, and such other services as may be necessary in the carry- ing out of the provisions of this Act, and for that purpose is hereby authorized to utilize the now existing or future facilities of the United States Public Health Service, the War Department, the Navy Department, the Interior Department, the National Homes for Dis- abled Volunteer Soldiers, and such other governmental facilities as may be made available for the purposes sect forth in this Act; and: such governmental agencies are hereby authorized and directed to furnish such facilities, including personnel, equipment, medical, surg- ical, and hospital services and supplies as the director may deem necessary and advisable in carrying out the provisions of this Act, in addition to such governmental facilities as are hereby made avail- able, % *» *» AND WHEREAS said Section g further provides that: “In the event that there is not sufficient Government Hospital and other facilities for the proper medical care and treatment of bene- LAWS 245 ficaries untler this Act, and the director deems it necessary and ad- visable to secure additional Government facilities, he may, within the limits of appropriations made for carrying out the provisions of this paragraph, and with the approval of the President, improve or extend existing governmental facilities or acquire additional facilities by purchase or otherwise. Such new property and structures as may be so improved, extended, or acquired shall become part of the perma- nent equipment of the Veterans’ Bureau or of some one of the now existing agencies of the Government, including the War Department, Navy Department, Interior Department, Treasury Department, the National Homes for Disabled Volunteer Soldiers, in such a way as will best serve the present emergency, taking into consideration the future services to be rendered the veterans of the World War, in- cluding the beneficiaries under this Act.” Now, Therefore, By virtue of the authority vested in me by said law, I direct that the following specifically described hospitals now under the supervision of the United States Public Health Service and operated for hospital or sanatoria or other uses for sick and disabled former soldiers, sailors, and marines, are hereby transferred to the United States Veterans’ Bureau and shall on and after the effective date hereof operate under the supervision, management and control of the Director of the United States Veterans’ Bureau: No. 13 Southern Infirmary Annex, Mobile, Alabama No. 14 Annex to New Orleans Marine Hospital, Algiers, La. No. 24 Palo Alto, California No. 25 Houston, Texas No. 26 Greenville, South Carolina No. 27 Alexandria, Lousiana No. 28 Dansville, New York No. 29 Norfolk, Virginia (Sewall’s Point) No. 30 Chicago, Illinois (4649 Drexel Boulevard) No. 30 Chicago, Illinois (Annex-7535 Stoney Island Avenue) No. 31 Corpus Christi, Texas No. 32 Washington, D. C. (2650 Wisconsin Avenue) No. 33 Jacksonville, Florida No. 34 East Norfolk, Massachusetts No. 35 St. Louis, Missouri (5900 Arsenal) No. 36 Boston. Massachusetts (Parker Hill) No. 37 Waukesha, Wisconsin No. 38 New York, New York (345 West soth Street) No. 39 Hoboken, Pennsylvania No. 40 Cape May, New Jersey No. 41 New Haven, Connecticut No. 42 Perryville, Maryland No. 44 West Roxbury, Massachusetts No. 45 Biltmore, North Carolina No. 46 Deming, New Mexico . 47 Markleton, Pennsylvania No. 48 Atlanta. Georgia No. 49 Philadelphia, Pennsylvania (Gray's Ferry Road & 24th St.) 246 THE PUBLIC HEALTH SERVICE No. 50 Whipple Barracks, Arizona No. 51 Tuscon, Arizona No. 52 Boise, Idaho No. 53 Dwight, Illinois No. 54 Arrowhead Springs, California No. 55 Fort Bavard, New Mexico No. 56 Fort McHenry, Baltimore, Maryland No. 57 Knoxville, Iowa No. 58 New Orleans, Louisiana (439 Flood St) . No. 59 Tacoma, Washington No. 60 Oteen, North Carolina No. 61 Fox Hills, Staten Island, New York No. 62 Augusta, Georgia No. 63 Lake City, Florida No. 64 Camp Kearney, California No. 65 St. Paul, Minnesota (Dayton & Virginia Avenue) No. 67 Kansas City, Missouri (11th and Harrison Streets) No. 68 Minneapolis, Minnesota (914 Elliot Avenue) No. 69 Newport, Kentucky No. 71 Sterling Junction, Massachusetts No. 72 Helena, Montana (Fort William Henry Harrison) No. 73 Chicago, Illinois (Annex to U. S. Veterans’ Hospital No. ) 30 No. 74 Gulfport, Mississippi No. 75 Colfax, Iowa No. 76 Edward Hines, Jr. Hospital (Maywood, Illinois) No. 77 Portland, Oregon No. 78 North Little Rock, Arkansas (Fort Logan H. Roots) No. 79 Dawson Springs, Kentucky No. 80 Fort Lyon, Colorado and The Purveying Depot at Perryville, Maryland I hereby direct that the following hospitals now under construc- tion by the Treasury Department or projected under existing law shall, when and as each is completed, be transferred to the United States Veterans’ Bureau, and shall on and after the respective dates of such transfer be operated under the supervision, management and control of the Director of the United States Veterans’ Bureau: Fort McKenzie, Sheridan, Wyoming Fort Walla Walla, Walla Walla, Washington Excelsior Springs, Excelsior Springs, Missouri Catholic Orphan Asylum, (Bronx) New York Central New England Sanitorium, Rutland, Massachusetts Hospital at Tuskegee, Alabama Hospital in Western Pennsylvania Hospital on Jefferson Barracks Reservation, St. Louis Missouri Hospital in Metropolitan District, New York All facilities, property and equipment now in the possession of the United States Public Health Service in the hospitals above mentioned and all supplies in said hospitals and in the purveying depots at LAWS 247 Perryville and North Chicago purchased from funds allotted to said Service by the Director of the United States Veterans’ Bureau are hereby transferred to the United States Veterans’ Bureau. It is hereby directed that the Surgeon General of the United States Public Health Service, the Director of the United States Veterans’ Bureau and the Director of the Bureau of the Budget, shall each designate a representative to form a Board, which Board shall allo- cate to the United States Veterans’ Bureau and to the United States Public Health Service, with due regard to their respective present and future needs, all supplies transferred to the United States Public Health Service by the War Department, Navy Department or other governmental agencies, in accordance with law, and said Board shall also allocate to the United States Veterans’ Bureau and to the United States Public Health Service the buildings and facilities at the Purveying Depot at North Chicago, Illinois, according to their respective needs. All leases, contracts and other obligations and instrumentalities of the United States Public Health Service in the District of Columbia or elsewhere and all records, files, documents, correspondence and other papers relating to the service rendered by the United States Public Health Service in the operation of the hospitals and purveying depots hereby transferred or relating to the medical examination, assignment to hospitals, and treatment of persons who are now or who have been patients and beneficiaries of the United States Veterans’ Bureau are hereby transferred to the United States Veterans’ Bureau as of the effective date of this Order. The Secretary of the Treasury, with due regard to the needs of the United States Public Health Service, shall authorize and direct the Surgeon General of the United States Public Health Service to detail to the United States Veterans’ Bureau for duty until released by the Director of the Bureau, the commissioned personnel now on duty at the hospitals and purveying depots above mentioned and such other commissioned personnel as may be required for the operation of the Veterans’ Hospitals and purveying depots, provided that the regular commissioned officers of the United States Public Health Service shall be subject to recall in the discretion of the Surgeon General of that Service. Such other personnel of the United States Public Health Service as are now paid from funds allotted by the Director of the United States Veterans’ Bureau shall, subject to the approval of the Director of the Bureau, be transferred and given appointment in the United States Veterans’ Bureau in the manner prescribed by Civil Service laws and regulations. _ So that the transfer herein directed may be made with minimum inconvenience this order shall be construed to allow administrative adjustments hereunder to be made effective May 1, 1922. This order shall not be construed as in any way limiting or cur- tailing the authority conferred by existing law whereby the Director 248 THE PUBLIC HEALTH SERVICE of the United States Veterans’ Bureau may utilize the now existing or future facilities of the United States Public Health Service, the War Department, the Navy Department, the Interior Department, the National Homes for Disabled Volunteer Soldiers, or such other gov- ernmental facilities as may be made available for the use of the United States Veterans’ Bureau. 1922—Act of June 10, 1922 (Public 235, 67th Congress).— An Act to readjust the pay and allowances of the commis- sioned and enlisted personnel of the Army, Navy, Marine Corps, Coast Guard, Coast and Geodetic Survey, and Pub- lic Health Service.?® Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That, beginning July 1, 1922, for the purpose of computing the annual pay of the commissioned officers of the Regular Army and Marine Corps below the grade of brigadier general, of the Navy below the grade of rear admiral, of the Coast Guard, of the Coast and Geodetic Survey, and of the Public Health Service below the grade of surgeon general, pay periods are prescribed, and the base pay for each is fixed as follows: The first period, $1,500; the second period, $2,000; the third period, $2,400; the fourth period, $3,000; the fifth period, $3,500; and the sixth period, $4,000. The pay of the sixth period shall be paid to colonels of the Army, captains of the Navy, and officers of corresponding grade *° who have completed twenty-six years’ service, or whose first appointment in the permanent service was in a grade above that corresponding to captain in the Army, or who were appointed to the Regular Army under the provisions of the first sentence of section 24, Act of June 3, 1916, as amended by the Act of June 4, 1920; to officers of the Staff Corps of the Navy advanced by selection under existing laws to the rank or pay of captain; to lieutenant colonels of the Army, command- ers of the Navy, and officers of corresponding grade, and lieutenant commanders of the line and Engineer Corps of the Coast Guard who have completed thirty years’ service; and to the Chief of Chaplains of the Army. The pay of the fifth period shall be paid to colonels of the Army, captains of the Navy, and officers of corresponding grade who are not entitled to the pay of the sixth period; to lieutenant colonels of 29 Only the portions of this act relating to the Public Health Service are quoted. 30 The corr»sponding grade or relative rank of commissioned officers of the Public Health Service is not determined by law, but is fixed by the Regulations as follows: Surgeon General with Surgeon General, United States Army; Assistant Surgeon General with colonel; senior surgeon with lieutenant colonel; surgeon with major; passed assistant surgeon with captain; and assistant surgeon with first lieutenant. (Regulations 1920, Par. 8) LAWS 249 the Army, commanders of the Navy, and officers of corresponding grade who have completed twenty years’ service, or whose first appointment in the permanent service was in a grade above that corresponding to captain in the Army, or who were appointed to the Regular Army under the provisions of the first sentence of said sec- tion 24; to officers of the Staff Corps of the Navy advanced by selec- tion under existing laws to the rank or pay of commander; and to majors of the Army ( lieutenant commanders of the Navy, and officers of corresponding grade who have completed twenty-three years’ service: Provided, That lieutenant commanders of the Staff Corps of the Navy who were appointed between the dates of March 4, 1913, and June 7, 1916, in a grade above that of ensign, shall re- ceive the pay of this pay period after completing twenty years’ service. The pay of the fourth period shall be paid to lieutenant colonels of the Army, commanders of the Navy, and officers of corresponding grade who are not entitled to the pay of the fifth or sixth period; to majors of the Army, lieutenant commanders of the Navy, and officers of corresponding grade who have completed fourteen years’ service, or whose first appointment in the permanent service was in a grade above that corresponding to second lieutenant in the army, or who were appointed to the Regular Army under the provisions of the first sentence of said section 24; to captains of the Army. lieutenants of the Navy, and officers of corresponding grade who have completed seventeen years’ service, except those whose promotion is limited by law to this grade and who are not entitled under existing law to the pay and allowances of a higher grade; and to lieutenants of the Staff Corps of the Navy, and lieutenants and lieutenants (junior grade) of the line and Engineer Corps of the Coast Guard whose total com- missioned service equals that of lieutenant commanders of the line of the Navy drawing the pay of this period. The pay of the third period shall be paid to majors of the Army, lieutenant commanders of the Navy, and officers of corresponding grade who are not entitled to the pay of the fourth, fifth, or sixth period; to captains of the Army, lieutenants of the Navy, and officers of corresponding grade who have completed seven years’ service, or whose first appointment in the permanent service was in a grade above that corresponding to second lieutenant in the Army, or whose present rank dates from July 1, 1920 or earlier; to first lieutenants of the Army, lieutenants (junior grade) of the Navy, and officers of corresponding grade who have completed ten years’ service; and to lieutenants (junior grade) of the line and Engineer Corps of the Coast Guard whose total commissioned service equals that of lieu- tenants of the line of the Navy drawing the pay of this period. The pay of the second period shall be paid to captains of the Army, lieutenants of the Navy, and officers of corresponding grade who are not entitled to the pay of the third or fourth period; to first lieu- tenants of the Army, lieutenants (junior grade) of the Navy, and officers of corresponding grade who have completed three years’ service, or whose first appointment in the permanent service was in a grade above that corresponding to second lieutenant in the Army; and to second lieutenants of the Army, ensigns of the Navy, and 250 THE PUBLIC HEALTH SERVICE officers of corresponding grade who have completed five years’ service. The pay of the first period shall be paid to all other officers whose pay is provided for in this section. Every officer paid under the provisions of this section shall re- ceive an increase of 5 per centum of the base pay of his period for each three years of service up to thirty years: Provided, That the base pay plus pay for length of service of no officer below the grade of colonel of the Army, captain of the Navy, or corresponding grade, shall exceed $5,750. Nothing contained in the first sentence of sec- tion 17 or in any other section of this act shall authorize an increase in the pay of officers or warrant officers on the retired list on June 0; 1022. 4... 3 a 4. That the term “dependent” as used in the succeeding sec- tions of this Act shall at all times and in all times and in all places a lawful wife and unmarried children under twenty-one years of age. It shall also include the mother of the officer provided she is in fact dependent on him for her chief support. Sec. 5. That each commissioned officer on the active list, or on active duty below the grade of brigadier general or its equivalent, in any of the services mentioned in the title of this Act, shall be entitled at all times, in addition to his pay, to a money allowance for subsist- ence, the value of one allowance to be determined by the President for each fiscal year in accordance with a certificate furnished by the Secretary of Labor showing the comparative retail cost of food in the United States for the previous calendar year as compared with the calendar year 1922. The value of one allowance is hereby fixed at 6o cents per day for the fiscal year 1923, and this value shall be the maximum and shall be used by the President as the standard in fix- ing the same or lower values for subsequent years. To each officer of any of the said services receiving the base pay of the first period the amount of this allowance shall be equal to one subsistence allow- ance, to each officer receiving the base pay of the second, third, or sixth period the amount of this allowance shall be equal to two sub- sistence allowances, and to each officer receiving the base pay of the fourth or fifth period the amount of this allowance shall be equal to three subsistence allowances: Provided, That an officer with no de- pendents shall receive one subsistence allowance in lieu of the above allowances. Sec. 6. That each commissioned officer on the active list or on active duty below the grade of brigadier general or its equivalent, in any of the services mentioned in the title of this Act, if public quar- ters are not available, shall be entitled at all times, in addition to his pay, to a money allowance for rental of quarters, the amount of such allowance to be determined by the rate of one room fixed by the President for each fiscal year in accordance with a certificate fur- nished by the Secretary of Labor showing the comparative cost of rents in the United States for the preceding calendar year as com- pared with the calendar year 1922. Such rate for one room is hereby fixed at $20 per month for the fiscal year 1923, and this rate shall be the maximum and shall be used by the President as the standard in fixing the same or lower rates for subsequent years. To each officer receiving the base pay of the first period the amount of this allowance LAWS 251 shall be equal to that for two rooms, to each officer receiving the base pay of the second period the amount of this allowance shall be equal to that for three rooms, to each officer receiving the base pay of the third period the amount of this allowance shall be equal to that for four rooms, to each officer receiving the base pay of the fourth period the amount of this allowance shall be equal to that for five rooms, and to each officer receiving the base pay of the fifth or sixth period the amount of this allowance shall be equal to that for six rooms. The rental allowance shall accrue while the officer is on field or sea duty, temporary duty away from his permanent station, in hospital, on leave of absence or on sick leave, regardless of any shelter that may be furnished him for his personal use, if his dependent or de- pendents are not occupying public quarters during such period. In lieu of the above allowances an officer with no dependents receiving the base pay of the first or second period shall receive the allowance for two rooms, that such an officer receiving the base pay of the third or fourth period shall receive the allowance for three rooms, and that such an officer receiving the base pay of the fifth or sixth period shall receive the allowance for four rooms, but no rental allow- ance shall be made to any officer without dependents by reason of his employment on field or sea duty. Sec. 7. That when the total of base pay, pay for length or service _and allowances for subsistence and rental of quarters, authorized in this Act for any officer below the grade of brigadier general or its equivalent, shall exceed $7,200 a year, the amount of the allowances to which such officer is entitled shall be reduced by the amount of the excess above $7,200: Provided, That this section shall not apply to the Captain Commandant of the Coast Guard nor to the Director of the Coast and Geodetic Survey. Sec. 8. That commencing July 1, 1922, the annual base pay of a brigadier general of the Army and of the Marine Corps, rear admiral (lower half) of the Navy, commodore of the Navy, and Surgeon General of the Public Health Service shall be $6,000; and the annual base pay of a major general of the Army and of the Marine Corps, and rear admiral (upper half) of the Navy shall be $8,000. Every such officer shall be entitled to the same money allowance for sub- sistence as is authorized in section 5 of this Act for officers receiving the pay of the sixth period and to the same money allowance for rental of quarters as is authorized in section 6 of this Act for officers receiving the pay of the sixth period: Provided, That when the total of base pay, subsistence, and rental allowances exceeds $7,500 for officers serving in the grade of brigadier general of the Army and of the Marine Corps, rear admiral (lower half) of the Navy, commodore of the Navy, and Surgeon General of the Public Health Service. and $9,700 for those serving in the grade of major general of the Army and of the Marine Corps, and rear admiral (upper half) of the Navy, the amount of the allowances to which such officer is entitled shall be reduced by the amount of the excess above $7,500 or $9,700, respectively. Rear admirals of the Navy serving in higher grades shall be entitled, while so serving, to the pay and allowances of a rear admiral (upper half) and to a personal money allowance per year as follows: When serving in the grade of vice admiral, $500; when 252 THE PUBLIC HEALTH SERVICE ve in the grade of admiral or as Chief of Naval operations, 2,200... .. Sec. 12. That officers of any of the services mentioned in the title of this Act, when traveling under competent orders without troops, shall receive a mileage allowance at the rate of 8 cents per mile, dis- tance to be computed by the shortest usually traveled route and existing laws providing for the issue of transportation requests to officers of the Army traveling under competent orders, and for de- duction to be made from mileage accounts when transportation is furnished by the United States, are hereby made applicable to all the services mentioned in the title of this Act, but in cases when orders are given for travel to be performed repeatedly between two or more places in the same vicinity, as determined by the head of the execu- tive department concerned, he may, in his discretion, direct that actual and necessary expenses only be allowed. Actual expenses only shall be paid for travel under orders outside the limits of the United States in North America. Unless otherwise expressly pro- vided by law, no officer of the services mentioned in the title of this Act shall be allowed or paid any sum in excess of expenses actually incurred for subsistence while traveling on duty away from his desig- nated post of duty, nor any sum for such expenses actually incurred in excess of $7 per day. That heads of the executive departments concerned are authorized to prescribe per diem rates of allowance, not exceeding $6, in lieu of subsistence to officers traveling on official business and away from their designated posts of duty. In lieu of the transportation in kind authorized by section 12 of an Act entitled “An Act to increase the efficiency of the commissioned and enlisted personnel of the Army, Navy, Marine Corps, Coast Guard, Coast and Geodetic Survey, and Public Health Service,” ap- proved May 18, 1920, to be furnished by the United States for de- pendents, the President may authorize the payment in money of amounts equal to such commercial transportation costs when such travel shall have been completed. Dependent children shall be such as are defined in section 4 of this Act. . . . Sec. 15. That existing laws authorizing increase of pay for for- eign service and commutation of quarters, heat, and light are hereby repealed, effective July 1, 1922. Sec. 16. That nothing contained in this Act shall operate to re- duce the pay of any officer on the active list below the pay to which he is entitled by reason of his grade and length of service on June 30, 1922, not including additional pay authorized by the Act entitled “An Act to increase the efficiency of the commissioned and enlisted personnel of the Army, Navy, and Marine Corps, Coast Guard, Coast and Geodetic Survey, and Public Health Service,” approved May 18, 1920; and nothing contained in this Act shall operate to reduce the total of the pay and allowances which any enlisted man of the Army, Navy, Marine Corps, or Coast Guard is now receiving during his cur- rent enlistment and while he holds his present grade or rating. The provisions of this section shall apply in like manner to each person not commissioned whose pay is based by law on that of a com- missioned officer. Sec. 17. That on and after July 1, 1922, retired officers and war- LAWS 253 rant officers shall have their retired pay, or equivalent pay, com- puted as now authorized by law on the basis of pay provided in this Act: Provided, That nothing contained in this Act shall operate to reduce the present pay of officers, warrant officers, and enlisted men now on the retired list or officers or warrant officers in an equivalent status of any of the services mentioned in the title of this Act. Sec. 22. That the provisions of this Act shall be effective be- ginning July 1, 1922, and all laws and parts of laws which are in- consistent herewith or in conflict with the provisions hereof are hereby repealed as of that date. APPENDIX 5 PLANT AND EQUIPMENT The headquarters of the Public Health Service are in the Butler Building, at the corner of New Jersey Avenue and C Streets, S. E., Washington. At present the larger part of the administrative personnel is housed in a temporary build- ing at 16 Seventh Street, S. W., erected during the war and known as C Building. Other property in Washington in- cludes the Hygienic Laboratory, which occupies several build- ings at Twenty-fifth and E Streets, N. W. The plant and equipment of the service outside of 'Wash- ington are extensive and valuable. Quarantine stations are shown on p. 187. The quar- antine service owns also four steamers, one barge, 46 launches, and 5 hulks. The following table shows the hospitals operated by the service on April 29, 1922, as well as those which had pre- viously been operated, but which had been closed. On that date an executive order transferred to the Veterans’ Bureau the annexes to the Marine Hospitals at New Orleans and Mo- bile and all the Veterans’ Hospitals. MARINE AND VETERANS’ HOSPITALS ON APRIL 29, 10922 Laren xe E48 | Date open- Charac- | Capac- Character of Hospital ed (0) or] ter of | ity Ownership | hospital and closed (C)| hospital | Beds ward Suid ings Marine Hospitals 1. Baltimore, Md. O. 1887 General C. July, Landandbuild- | Wood and 1920 ings owned brick Brick and 2. Boston, Mass. | O. 1804 do 175 dc stone 254 PLANT AND EQUIPMENT 255 MARINE AND VETERANS’ HOSPITALS ON APRIL 20, 1922—Continued Date open-| Charac- |Capac- Character of Hospital ed (0) or ter of ity Ownership hospital and closed (C)| hospital | Beds ward buildings Marine Hospitals General 60 |Land and build-| Brick —Continued ings owned 3. Buffalo, N. Y. | O. 1909 do do do 4. Cairo, Il 0. 1886 C. Nov. 1915 O. June 1919 C. Nov. 1919 5. Chicago, Ill. 0. 1852 do 130 do Stone 6. Cleveland, Ohio, | O, 1852 do 86 do do 7. Detroit, Mich. 0. 1857 do 80 do Brick 8. Evansville, Ind.| 0. 1856 Tuber- 40 do Wood culosis 9. Fort Stanton, 0. 1899 do 261 do Stone N. M. 10. Key West, Fla. 0. 184s General 45 do Masonry stuc coed 11. Louisville, Ky. 0. 1852 do 6o do Brick 12. Memphis, Tenn. [ O. 1884 do 8s do Wood 13. Mobile, Ala. 0. 1843 do a9 do Brick 14. New Orleans La.| O. 1837 do 358 do Wood 15. Pittsburgh, Pa. 0... 1851 do 09 do Brick and wood 16. Portland, Me. O. 1852 do 46 do Brick 17. Port Townsend, | O. 1883 do 160 do Wood Wash, 18, St. Louis, Mo. O. 1838 Tuber- 70 do Brick and culosis wood 19. San Francisco, | O. 1854 General | 256 do Wood Calif. 20. Savannah, Ga. 0. 1906 do 100 do Brick 21. Stapleton, Staten| O. 1882 do 295 do Stone Island, N. Y. 22. Vineyard Haven,| O. 1879 do 24 do Wood Mass. 23. Wilmington, N, C.] O. 188: do do do C. 1916 43. Ellis Island, N. Y.| O. Sept., do 650 [Land and build-[| Brick (Immigration 1919 ings owned, Station) transferred from Depart- ment of Labor 66. Carville, La. 0. Jan., Lepro- | 120 [Land and build-| Wood 1921 sarium ings purchased 70. New York, N. Y.| O. Feb., General 40 do Brick 67 Hudson St., 1021 82. Tanners Creek, |O. May, do 115 |Land and build-| Brick and Va, 1922 ings owned stone 256 THE PUBLIC HEALTH SERVICE MARINE AND VETERANS’ HOSPITALS ON APRIL 29, 1922—Continued Date open-| Charac- Hospital ed (0) or| ter of closed (C)| hospital Veterans’ Hospitals : 24. Palo Alto, Calif O. April,| Tuber- (Camp Fremont) 1919 culosis 25. Houston, Texas 0. April | General 1919 (Camp Logan) Cons 1919 0. Feb. 1920 26. Greenville, S. C. O. April,| Tuber- (Camp Sevier) 1919" culosis 27. Alexandria, La O. April do (Camp Beaure- 1919 gard) 28. Dansville, N. Y. O. June, do (Jackson Health 1919 Resort) C. Sept. 1920 29. Norfolk, Va. O. June, | General 1919 30. Chicago, IIL 0. June, do (Cooper Monotah 1919 Hotel) 31. Corpus Christi, 0. June, do Texas 1919 C. Sept. 1919 32. Washington, D. C. 0. June, do 1919 33. Jacksonville, Fla. 0. June, do (Camp Johnston) 1919 C. Nov. 1919 34. East Norfolk, 0. June, Neuro- Mass. (State 1919 psychia- Hospital) tric 35. St. Louis, Mo. 0. July, General (City Infirmary) 1919 36. Boston, Mass. 0. July, do (Parker Hill 1919 Hospital) ings leased Capac- Character of ity Ownership hospital and Beds ward buildings 570 [Land and build- Wood ings owned, transferred from War De- ‘partment 1,015 do do 654 do do 630 (Land owned by do State; huild- ings owned by U. 8S. Land and build- Brick ings leased 300 |Land and build-{Wood; perma: ings owned nent build- transferred ings to be from War De-| erected on partment new site 550 |Land and build-|Fireproof ings leased Land and build-|Destroyed by ings pur- hurricane chased 170 do Wood Land leased; |Wood; build- buildings ings salvaged owned, trans-| for use at ferred from other places War Depart- ment 230 |Land and build- Brick ings leased from State 650 Land, buildings do and equip- ment leased from city 508 [Land and build-| Fireproof PLANT AND EQUIPMENT 257 MARINE AND VETERANS’ HospiTALs oN APRIL 29, 1922—Continued Date open- Charac- |Capac- Character of Hospital ed (0) or ter of ity Ownership hospital and closed (C) hospital Beds ward buildings Veterans’ Hospi- tals—Continued ' 37. Waukesha, Wis. | 0. July, Neuro- | 200 [Land and build-| Fireproof (Resthaven San- 1919 psychia- ings purchased itarium) tric 38. New York, N. Y.| 0, Aug, General 270 |Land and build- do 345 W. soth St.| gig ings leased (Polyclinic Hos- pital) 39. Hoboken, Pa. 0. Sept., do do Brick (Parkview Hos- 1919 pital) C. Sept. 1920 40. Cape May, N. I.| 0. Sept. do Land leased; Wood (Naval Station) 1919 buildings C. Sept., owned, trans- 1920 ferred from Navy Depart- ment 41. New Haven, 0. Sept., Tuber- soo {Land and build-| Brick Conn, (New 1919 culosis ings leased Haven Hospital) 42. Perryville, Md. | 0. Sept., Neuro- 430 |Land and build-| Wood (Nitrate plant) 1919 psychia- ings owned, tric transferred from War De- partment 44. West Roxbury, | O. Dec. do 237 [Land and build-| Brick Mass. (West End 1919 ings leased Hospital) from city 45. Biltmore, N. C. [O. Dec, General 388 |Land and build-| Stucco on (Kenilworth Inn) 1919 ings leased frame 46. Deming, N. M. | O. Dec. do Land leased, Wood (Camp Cody) 1919 buildings C. June, owned; trans- 1920 ferred from War Depart- ment 47. Markleton, Pa. |O. Jan. do Land and build-| Brick (Markleton Ho- 1919 ings leased tel) C. Feb. 1921 48. Atlanta, Ga. 0. Feb, do 100 |Land and build-| do (Chester Xing 1920 ings pur- Sanitarium) chased 49. Philadelphia, Pa.|O. Feb, Neuro- 450 |Land and build-| do (Naval Hospital) 1920 psychia- ings owned, tric transferred from Navy TET Department so. Prescott, Ariz. |O. Feb, Tuber- 765 |Land and build-| Stucco and Whipple Bar- 1920 culosis ing owned, wood racks) transferred from War Department 258 THE PUBLIC HEALTH SERVICE MARINE AND VETERANS’ HOSPITALS ON APRIL 29, 1922—Continued Date open-| Charac- | Capac- Character of Hospital ed (O) or ter of ity Ownership hospital and closed (C)| hospital Beds ward buildings Veterans’ Hospi- tals—Continued . 51. Tucson, Ariz. 0. March,| Tuber- 32¢ [Land and build{ Wood (Pastime Park) 1920 culosis ings leased 52. Boise, Idaho 0. April, General | 200 |Land and build: de (Boise Barracks)| 1920 ings owned, transferred from War De partment 53. Dwight, IIL 0. June, do 165 |Land and build- Fireproof (Keeley Insti- 1920 ings leased tute) 54. Arrowhead 0. June, do 118 do Semi-fire. Springs, Calif. 1920 proof (Arrowhead Springs Hotel) 55. Fort Bayard, 0. June, Tuber- | 1,000 |Land and build| Wood N. M. (Army 190 culosis ings owned, Sanitorium) transferred from War De- partment 56. Fort McHenry, | OQ, July, General | 1,012 do do Baltimore, Md. 1920 57. Knoxville, Towa [0O. Aug., Neuro- 172 |Land and build do (Inebriate farm) 1920 psychia- ings leased tric from State 58. New Orleans, La.| O. Sept., do 80 |Land and build: do (Belvidere Men- 1920 ings leased tal Infirmary) 50. Tacoma, Wash. [O. Sept., Tuber- 245 |Land and build- do (Cushman In. 1920 culosis ings leased dian School) from Interior Department 60. Oteen, N. C. O. Oct., do 1,100 [Land and build- do 1920 ings owned; transferred from War De- partment 61. Fox Hills, 0. Oct., General | 1,077 | Land leased; do Staten Island, 1920 buildings N.Y. owned; trans- ferred from War Depart- ment 62. Augusta, Ga. O. Nov. Neuro- 200 | Land and build- i (Lenwood Hotel] 1920 psychia- ings leased Brick and Camp Han- tric cock) 63. Lake City, Fla. |O. Dec., General | 130 |Land and build-| Semi-fire- (Columbia Col- 1920 ings purchased proof lege) PLANT AND EQUIPMENT 259 MARINE AND VETERANS’ HOSPITALS ON APRIL 29, 1922—Continued Date open-| Charac- |Capac- Character of Hospital ed (0) or ter of ity Ownership hospital and closed (C){ hospital | Beds ward buildings Veterans’ Hospi- tals—Continued 64. Camp Kearny, 0. Jan. Tuber- 550 | Land leased, Wood Calif. 1921 culosis buildings owned; trans- ferred from War Depart- ment 65. St. Paul, Minn. | 0, Jan., General 290 [Land and build-|( Brick (Aberdeen Ho- 1921 ings leased tel) 67. Kansas City, Mo.| O, Jan., do 125 do do (Wesley Hos- 1921 pital) 68. Minneapolis, 0. Feb., do 310 do do Minn. (Asbury 1921 Hospital) 69. Newport, Ky. 0. Feb., do 100 do do (Altamont Hotel) 1921 71. Sterling June- 0. March, do 53 do Wood tion, Mass. 1921 (Worcester Red Cross Lodge) 72. Helena, Mont. 0. June, do Land and build: Brick (Military reser- 1921 ings owned, vation) transferred from War De. partment 73. Chicago, IIL 0. July, do 100 |Land and build] Brick and 1921 ings leased stone 74. Gulfport, Miss. 0. July, Neuro- 160 do Brick, stone 1921 psychia- and wood tric 75. Colfax, Iowa. O. July, | General 240 do Brick and 1921 wood 76. Maywood, Ill. 0. Aug., do 925 [Land and build-| Brick and 1921 ings owned stone 77. Portland, Ore. 0. Nov., do 150 [Land and build-| Brick, stone 1921 ings leased and wood 78. North Little O. Dec., Neuro- 240 |Land and build- do Rock, Ark. 1921 psychia- ings owned tric 79. Dawson Springs,| O. Feb., Tuber- 500 do Brick and Ky. 1922 culosis stone 80. Fort Lyon, Colo.| O. March, do 700 do Brick, stone 1922 and wood 81. The Bronx, O. April, Neuro- 1,000 do do N.Y. 1922 psychia- tric APPENDIX 6 FINANCIAL STATEMENTS ExprrLANATORY NOTE Statements showing appropriations, receipts, expenditures and other financial data for a series of years constitute the most effective single means of exhibiting the growth and development of a service. Due to the fact that Congress has adopted no uniform plan of appropriations for the several services and that the latter employ no uniform plan in res- pect to the recording and reporting of their receipts and ex- penditures, it is impossible to present data of this character according to any standard scheme of presentation. In the case of some services the administrative reports contain tables showing financial conditions and operations of the service in considerable detail; in others financial data are almost wholly lacking. Careful study has in all cases been made of such data as are available, and the effort has been made to present the results in such a form as will exhibit the financial oper- ations of the service in the most effective way that circum- stances permit. Regular annual appropriations for the maintenance of the hospitals were not made until 1907. From 1798 to 1884 funds received from the tax on seamen and from 1884 to 1906 money received as tonnage tax formed a permanent in- definite appropriation known as the Marine Hospital Fund. In many years this was not sufficient, and specific appropri- ations were made by Congress to provide money for opei- ating expenses. Specific appropriations were made from time to time for the purchase of sites, erection of buildings, or extensive alterations. The expenses of quarantine work have 260 FINANCIAL STATEMENTS 261 been paid from specific appropriations from the beginning of that activity. For some years the appropriations for the service were made in two acts—the Legislative, Executive, and Judicial and the Sundry Civil. The Legislative, Executive, and Judi- cial Act included only one appropriation—for salaries in the office of the Surgeon General. For the fiscal year 1923 all the appropriations are carried in one act—the one mak- ing appropriations for the Treasury Department. This change was made as a result of the general revision of appropria- tion acts resulting from the creation of the Bureau of the Budget. Some of the appropriations under specific heads do not in- clude all the funds available for the purposes mentioned as payments for services are made from the appropriations, “Pay, allowances, and commutation of quarters of commis- sioned medical officers and pharmacists,” “Pay of acting assistant surgeons,” and “Pay of all other employees.” Payments for salaries are not confined to these three appro- priations, as the specific appropriations are likewise used for that purpose. For instance, during the fiscal year 1920 there was paid from the appropriation “Field Investigations of Public Health,” $190,377.70 on account of salaries and $01,204.36 for other objects of expenditure. In addition salaries amounting to $43,063.41 were paid on account of field investigation of public health, from the three pay ap- propriations mentioned above. Several of the appropriations have heretofore been credited with receipts which were available for expenditure. Receipts ‘from pay patients were so credited to' the appropriations “Maintenance, Marine Hospitals,” “Medical examination, Care of seamen, etc,” and “Fuel, light, and water.” Re- ceipts from steamship companies for subsistence furnished to detained passengers and for fumigation were credited to the appropriation “Quarantine Service.” The appropriation act for the fiscal year 1923 provides that receipts from these 262 THE PUBLIC HEALTH SERVICE sources shall not be available for expenditure, but must be carried into the Treasury to the credit of miscellaneous re- ceipts. } Appropriations for the construction of hospitals and quar- antine stations have generally been made to the Supervising Architect of the Treasury and disbursed by him. However, the appropriations for construction of Public Health Service hospitals during the fiscal year 1919 and later years have been made direct to the service. During these years, however, the appropriations for additions to Marine Hospitals have been made to the Supervising Architect. The tables on the pages 265 to 272 show the appropriations made directly for the benefit of the service for 1875, for every fifth year from 1885 to 1910, and from 1914 to 1922. No account is taken of appropriations for “certified claims” made as a result of the exhaustion or lapse of an appropriation, These are generally small. Expenditures are shown only for appropriations disbursed by the Public Health Service. The service also shares in several general appropriations made to the Treasury Department. For the printing of publications and for minor repairs and equipment for marine hospitals and quarantine stations, the service is entirely dependent on appropriations made to the Treasury Department or to the Supervising Architect of the Treasury. The following state- ment of expenditures for the fiscal year 1920 shows the ex- tent to which these appropriations were used during that year. Printing and blading... LL ee TRS $146,206.97. SEHonCIY dr, IT ah a hia ri ra 13,999.79 Repairs and preservation of Public Buildings Marine Hospitals..." .. a.nd eh Th ee 47,188.19 Ouatantine Stations)... v. ovr cir ov 35,277.11 Other stations... hie snes oa en He 3,481.06 Mechanical Equipment for Public Buildings Marine HosDlalsi. ....o00 0s nrerrnnses ress trios: 56,324.56 Ouatantine Stations ..0 0. ihn ae aa 10,667.95 Other stations ni 3 ii re as 586.05 FINANCIAL STATEMENTS 263 In the following statements the expenditures for the fiscal years 1914 to 191g are given, unless otherwise noted, on the accrual basis—that is, the statements show all expenditures on account of the appropriation for the year mentioned re- gardless of whether the disbursements were made during the current fiscal year or in the two succeeding fiscal years during which the money was available. The figures for expenditures for the fiscal years preceding 1910 show the disbursements actually made during the year plus the outstanding liabilities. The expenditures for the fiscal years 1910, 1920, and 1921, are given on the cash basis—the figures showing the disburse- ments made during the year; as appropriations are available during the two following years for payments of outstanding liabilities, the figures are not final for these years. The financial statements in the annual reports of the Public Health Service give figures for one year only on the cash basis, and do not contain a final statement of the expenditures from each appropriation. For the fiscal years 1914 to 1919, the figures on expenditures have been compiled from the Treasury Department report entitled “Combined statement of the receipts and disbursements, balances, etc., of the United States.” That report shows the amount carried to the surplus at the end of the second year succeeding the one for which the appropriation is made, and the difference between the amount appropriated and the amount carried to the surplus is the amount expended on the accrual basis. As that report did not show the amount carried to the surplus during the fiscal year 1910, it is not possible to give figures for that year on the ac- crual basis. In the tables giving figures for 1910 and later years the ex- penditures by agencies other than the Public Health Service have not been given, as most of these appropriations are avail- able until expended and the reports do not show the amount expended each year. FE] 204 THE PUBLIC HEALTH SERVICE The appropriation act for the fiscal year 1923 made several changes in the method of appropriation. Some of the minor items were consolidated with other general appropriations, and several of the appropriations were increased by reason of the fact that the receipts were no longer made available for expen- diture, all receipts of every character being covered into the Treasury as miscellaneous receipts. The several heads of ap- propriation and the amounts appropriated for the fiscal year 1923 are as follows: Salaries, Office of the Surgeon General $ 092970 Pay, allowance, and commutation of quarters of commissioned medical officers and pharmacists 013,560 Pay of acting assistant surgeons 300,000 Pay of all other employees 840,000 Freight, transportation and traveling expenses 50,000 Maintenance, Hygienic Laboratory 45,000 Medical examinations, including miscellaneous ex- penses of hospital operation 5,627,394 Quarantine Service 739,000 Expenses, Division of Venereal Diseases 175,000 Allotments to States for cooperative work in pre- vention and control of venereal divisions 225,000 Field investigations of public health 300,000 Prevention of the spread of epidemic diseases 400,000 Interstate Quarantine Service 25,000 Studies of rural sanitation 50,000 Control of biologic products 50,000 Preparation and transportation of remains of officers 3,000 Books 500 APPROPRIATIONS AND EXPENDITURES: 1875, AND BY 5 YEAR PERIODS, 1885 TO 1905, IN CLUSIVE Fiscal Years 1875 18853 1890 1895 1900 1905 Marine Hospital Fund Balance from previous year .......... $329,977.87 a $104,425.40 $71,330.41 $682,024.33 $255,643.25 Appropriation .......cieeeeeen oe cerivsese $140,000.00 | aveiiee | seveecesns [0 seseeasenn 200,000.00 Receipts from tax on seamen ...... 438,803.78 Sal ne Receipts from tonnage tax ....... oa ain ned wre IE ee ene 387,852.59 565,749.73 521,240.78 876.445.93 856.012.57 Receipts from patients, Immigration Service, etc.. 9,867.09 9,000.00 ,947.80 12,527.91 39,915.67 102,096.39 Total available ....cvveuene. 773,738.74 a 679,122.93 605,009.10 1,598,385.93 1,413.752.21 Expenditures? .. 414,257.69 b 438,443.91 566,848.31 575,569.87 825,072.51 1,183,627.23 Balance carried over 364,481.05 | a 112,274.62 29,529.23 773,313.42 230,124.98 Buildings, equipment, and alterations at Marine Hospitals ¢ ...vevvrennnerianennn ce Ne Goiken A ay . 29,264.00 101,250.00 1,607.41 20,050.00 33,000.00 Buildings, equipment, and alterations at quaran- tine Stations € ......ecccierenrsanaierenneananes esas en ey evenseerse ii anrnnnes 30,462.59 73,500.00 49,300.00 Preventing the spread of epidemic diseases alance from previous year ......ccecesceccne es . rs imas ie 112,264.44 601,773.79 284,996.08 277,590.17 Appropriation . oe aa d 98,426.0 100,000.00 | sissseeenn 500,000.00 200,000.00 Repayments .voueue-eeeeeesssssesenasnnsennnee| oosannres | errerresse Lo roioiice 5,000.00 20,112.88 | ....... rs Total available «.voveeessesscaaannes . 98,426.03 212,264.44 606,773.79 805,108.96 477,590.17 Expenditures ® ........ ares snsrensar rans rans 50,828.30 38,103.28 | _ 562,742.61 336,527.00 | 146,113.48 Quarantine service ApPropriation ....e.eseeececiseiiiaiiinreiinan | caren v's TT ’ 50,000.00 125,000.00 210,000.00 335,000.00 Receipts ..... evar e Te SEE GE aber kes in) re er een rere Be dee aston 979.30 430.00 1,084.16 Total available .. te reals bs Seite a 50,000.00 125,979.30 210,439.09 336,084.16 Expenditures? ......... ise ets sees 49,806.54 124,478.11 210,159.36 304,978.33 Total available sv osvisesnssnvrannivnserss 1 1773,738.94 e 041,386.93 | 1,337,852.21 2,613,033.98 2,227,426.48 Total expenditures .......eeeeveese cones | 414,357.69 ‘ 654 738.13 | 1,262,790.50 | 1,371,758.87 | 1.634,719.04 a Not given in annual report. b Total of expenditures and encum ¢ Each project was appropriated for specifically; construc berances on June 30. tion work generally done by the Supervising Architect of the Treasury and money expended by him. d Balance from two previous fiscal years Dy oral. e Data incomplete. SINANHLVLS TVIONVNIA Sgz APPROPRIATIONS AND EXPENDITURES. FiscAL YEARS 1910 AND 1914 TO 1922, INCLUSIVE National quarantine and sanitation b Interstate Quarantine Service ......... Maintenance of Leprosy Hospital, Hawa National Home for Lepers 1910 1914 1915 Appropriation : Appropria- a Expendi- Appropria- Expendi- Appropria- Expendi- tion ture tion ture tion ture ApproDeistions Bpended by Public Stealth Service: $ alaries ce oO e Surgeon General ...... Seine 40,980.00 | § 0. 16 80.00 8,758.8 870. E Pay, allowances and commutation of quarters of ’ 10:595 3. a0 ? 4B7sRisle stBoc0l$ surge commissioned medical officers and pharmacists .. 325,000.00 299,025.42 597,640.00 572,369.64 679,858.00 638,554.84 Pay of acting sssistant SUTZEONS vu vsvssrey Caen %09,000.00 188,782.65 200,000.00 183,632.00 ay of all other employees .................... 06.00 80.21 606. . Pay of garsonnel and maintenance of hospitals, Pub- id 74s $02:906.99 493108.35 lic Health Service ..::vcc0ve... eR ve CERT wen eR re ove . erie fdditonal compensation Se LirereaFisaoss arin . ‘ Cres eE sedan rrr Yds saat md oe weil te reight, transportation and traveling expenses .... 35,000.00 26,112.05 30,000.00 26,463.87 0,000.00 25,019.80 Fuel, light and water ........ rr 70,000.00 62,636.06 74,000.00 72,914.40 pin ES oo Repayments (receipts from patients) wreevs Creve awe Soy RR su ernne nb ee ve deh vy eA Furniture and repairs to same . 15,000.00 6,945.26 8,000.00 7,992.28 8,000.00 7,959.98 Purveying depot supplies .... "ee . 43,000.00 41,326.82 45,750.00 45,663.55 45,000.00 44,973.00 Rent purveying depot .......ccocecocenes Mra rus 3,250.00 3,250.00 nse aetl abe sewn nh eer vars ‘ Ever eseena Maintenance, Hygienic Laboratory ................ 15,000.00 12,115.22 20,000.00 19,907.83 20,000.00 19,650.16 Fauipment, Hygienic Jfboretory esky teens cererasres evil rye sess mapen ensrsaeann FASTA Sees eee aintenance, arine OPIS cr sse ene RRA 12,121.42 256,000.00 Repayments (receipts from patients) ............| 240,000.00 § 226,951.32 } 9,989.12 { 259,666.86 { FL8%00 } 261,823.60 Medical examinations, care of seamen and other dg persons entitled to_relief, and miscellaneous ex- penses other foun Marine Hospitals not included under special BAS Srinivvs crv tenes inns vn 130,000.00 - Repayments (receipts from patients) ......... 3 "703.30 §| 118,178.21 § di } 121,787.35 { 1268/30%.00 } 121,537.16 Hospital construction, Public Health Service hospitals | ,.,........ salsidu nye Elin woven — 70:35 Hospital furniture ......... tesseeenrtairrresanas chilean aie » eres yen seernwane sb Cuneene or mm Quarantine SErviCe ....ccrsssesrissarssnses “ese 400,000.00 155,000.00 55,000.00 Repayments (receipts from vessels for fumigation, } 390,019.58 149,362.64 } 151,495.55 subsistence of persons detained, etc.) ........ 1,343.52 1,421.97 944.85 “ive b 212,095.22 VAs sna 244,078.82] ....... rn a 17,765.87 99¢ HOIAYAS HLIVHH JI'1dNd AHL APPROPRIATIONS AND EXPENDITURES: FISCAL YEARS 1910 AND 1914 TO 1922, INCLUSIVE—Continued 1910 1914 1915 Appropriation Appropria- a Expendi- Appropria- Expendi- Appropria- Expendi- tion ture tion ture tion ture Appropriations Expended by Public Health Service: Protecting health of military forces ...... vases dreserv re Beane “res “esi ae aioe wiweie sevens wy Relief and transportation of American citizens in eXienie Li. areas aint savory ale any anan se tr arian ” 4,000.00 a 2,530.65 CH eiee . a 895.07 Suppressing Spanish influenza and other communi- Cable QISeases .., . Jovan, ive stnnsn sion nnne ven swans Soll Ciel, Cor Piedra reves ee Expenses, Division. of Venereal Diseases ...ccocvoi J 7 carverree] trvennrnceld «corns WIR | Raa SN | RAMA IR LET . Field investigations of public health ..... ele Ade 200,000,00 166,674.20 200,000.00 187,389.5 Preventing the spread of epidemic diseases . 277,897.63 | e 300,000.00 199,426.16 420,000.00 464,859.29 Special studies of pellagra ....... ux .. £37,00000 7 vovseseen ‘ re Uominees 40,584.09 Studies of rural sanitation Control of biologic products Preparation and transportation of remains of officers Books Total Appropriations Expended by Other Agencies: Butler Building & Building, Hygienic Laboratory ® Buildings, equipment and alterations, Marine Hos- PRAISE ors viineves Vrnnisinsios dean sree sus bares Buildings, equipment and alterations at quarantine stations Total owl a ey 500.00 468.07 _2,1 _2,604,536.74 | _2,361,228.10 | _2,784,008.33 | 2,785,446.51 Cenee weey nevy reves 7,000.00 vevvevieve 25,000.00 » euint tein fe viel > oe ov ree 230000} cevecisven fb rwnaner FIRS SBR, . 4,500.00 | ....... re 86,743.00 . 63,000.00} ...... ee 125,700.00 88,843.00 ? 88.200.00 137,200.00 a Figured on a cash basis. b Appropriation of $500,000 made during the fiscal year 1907 for the purchase of local quarantine ¢ Available until expended. d In addition $228,013.87 balance from previous year was available. : e Includes deficiency appropriation of $100,000 which continued to be available in fiscal year 1915. t Deficiency appropriation available also in fiscal year 1915; no expenditures in fiscal year € Each project appropriated for specifically: money expende: 1914. by the Supervising Architect of the Treasury. stations, available until expended. SINIWHLVLS TVIONVNIA loz APPROPRIATIONS AND EXPENDITURES: FISCAL YEARS 1910 AND 1914 TO 1922, INcLUSIVE—Continued 1916 1917 1918 Appropriation | Appropria- Expendi- Appropria- Expendi- Appropria- Expendi- tion ture tion ture tion ture Appropriations Expended by Public Health Service: Wy Office of the Surgeon General .......... $ 56,750.00 ($ 56,347.14 |$ 61,550.00|$ 60,008.95|$ 63,830.00|$% 63,665.44 Pay, allowances and commutation of quarters of commissioned medical officers and pharmacists . 695,000.00 683,869.59 786,550.00 698,319.62 751,490.00 736,002.70 Pay of acting assistant surgeons 200,000.00 187,044.93 200,000.00 191,015.33 300,000.00 257,497.97 Pay of all other employees ..... # 502,606.00 491,475.59 517,160.00 501,178.67 540,000.00 517,424.17 Pay of personnel and maintenance of hospitals, Pub- lic Health Service ...... RI SIRT crema ie Sisnneni avin eu onan rr “ Additional compensationa .............. re trea Jr Sheree] Levee sy ewes ine Sr ian eee 85.283.55 85,283.55 Freight, transportation and traveling expenses .. 30,000.00 26,339.65 0,000.00 26,625.05 30,000.00 26,517.65 Fuel, Hight and Waler . ..cscrrinsassssnesns 75,000.00 73,433.5 i 0,000.00 78,440.11 105,000.00 106,683.77 Repayments (receipts from patients) ..... 11.30 ASS Ld esr i ane ee ne 10,724.92 yI03y Furniture and repairs to same 8,000.00 7,236.00 8,000.00 7,897.87 8,000.00 7,719.79 Purveying depot supplies ........ 45,000.00 44,956.49 51,000.00 50,562.06 70,000.00 68,646.90 Rent, DUIVEYING GEPOL c2s cane svscssonsivsnnrersan | © .osnaseionss ow Ravi . Pads nnn en eet] ere eee Maintenance, Hygienic Laboratory . 20,000.00 19,779.33 20,000.00 19,910.67 20,000.00 19,521.61 Pavioment, BYsienic aC horatory . 5 me ea ry en arirsio es Eien ons seal Ar aintenance, arine Hospitals ......... 256,000.00 4 276,000.00 ; 356,000.00 { Repayments (receipts from patients) .......... 13,050.09 t 267,729.09 26,907.29 283,755.26 43,228.00 381,608.15 Medical examinations, care of seamen and other per- sons entitled to relief, and miscellaneous ex- pefises other {hen Msttne Hospitals not included s under special “heads... .c..ccncrersrrrarans 170,000.00 185,000.00 214,000.00 Repayments (receipts from patients) .......... 4,005.83 } 143,652.24 { 8,732.97 b 188,312.51 § 14,073.86 217,783.00 Hospital construction, Public Health Service Hos- Pitals iG vedas rvs Su seni . Weseew aw snihi lesen ene) rate 7 Hospital furniture . . "a we . .s oot] aware seni IT ere neee os . OUArantine SEEVICE “uiiiiisi ovis seis iemmimiveic sins wit are 155,000.00 185,000.00 195,000.01 Repayments (receipts from vessels for fumigation, 153,696.39 187,405.21 199,714.13 subsistence of persons detained, etc.) ........ 3,279.71 2,841.86 35,086.90 National quarantine and sanitation aay b 1,290.84 Series. DOI 3A ee een cecie Interstate Quarantine Service ......... 15,000.00 14,969.39 100,000.00 81,583.28 315,000.00 312,374.36 Maintenance of Leprosy Hospital, Hawaii ...... serie seein Clan aR ews. ve bin ra ees wre see mere ne ese 892 HOIAYEIS HITIVAH OI'TdNd dHL APPROPRIATIONS AND EXPENDITURES: FISCAL YEARS 1910 AND 1914 TO 1922, INCLUSIVE—Continued Appropriation Appropriations Expended by Public Health Service: National Home for Lepers .....c.ceversrrinsnsns Protecting health of military forces ceerseraaes Relief and transportation of American citizens in Mexico on i. or adsense neva a Suppressing Spanish influenza and other communic- able diseases ....... .diivarens seme rene ene Expenses, Division of Venereal Diseases Field investigations of public health ...... Preventing the spread of epidemic diseases ...... Special studies of pellagra ....... Studies of rural sanitation Control of biologic products Appropriations Expended by Other Agencies: utler Building t Building Hygienic Laboratory £ Tr ‘ Buildings, equipment and alterations, Marine Hos- PI al er ne Bes Ar wits sant aaa wanes Buildings, equipment and alterations at quarantine SlRLONE fe ii rrenirs bo ie svar ess vse Purchase of State and local quarantine stations .. Payment to states for prevention of venereal diseases Total 1916 1917 1918 Appropria- a Expendi- Appropria- Expendi- Appropria- Expendir tion ture tion ture tion ture wire Nay I Cis ase € 250,000.00 b66.48 sus weninaely b 192.29 Se en Sialnane RE AE tsessssses | d 500,000.00 491,657.95 200,000.00 190,777.35 250,000.00 236,135.88 "200,000.00 197,807.35 500,000.00 469,155.09 400,000.00 383,999.88 400,000.00 267,251.34 40,000.00 35,934.93 40,000.00 27,872.59 40,000.00 28,691.97 25,000.00 24,960.13 25,000.00 24,922.33 150,000.00 132,724.90 ese 10,000.00 9,957.26 20,000.00 19,220.31 C4890 soo.00 |" Jogz.01 2,970,279.79 |_4,467,217.32 | 4,138,383.21 23,620.00 385,200.00 {i 4 ave sarnit senna . euivs ; 150,000.00 150,000.00 rast sanre ! » iar tiusee Cenprving . | 1,319,800.00 23,620.00) ..... rine 207,720.00 nats 1,319,800.00 sev sine .e a This appropriation is the increased compensation is the amount appropriated. b Figured on a cash basis. ¢ Available until expended. d Available also for the fiscal year 1919. e Balance of $280.74 transferred to same object under f Each project appropriated for specifically, a general one for certain grades of em: “Foreign intercourse.” money expended by the Supervising Architect of the Treasury. ployees in various services; it is indefinite in that the amount necessary to pay SINHWHLVLS TVIONVNIA 69¢ APPROPRIATIONS AND EXPENDITURES. FISCAL YEARS 1910 AND 1914 TO 1922, INCLUSIVE —Continued » s | 1919 a 1920 a 1921 1922 © Appropriation Appropria- Expendi- Appropria- Expendi- Appropria- Expendi- Appropria- tion ture tion ture - tion ture tion Appropriations Expended by Public Health Rene ya} Salaries, Office of the Surgeon IT General .c.reiec ssn mrs nena $ 80,500.00 $ 74,223.55|$ 092,9070.00|$% 88,857.41|$ 92,970.00 |$ 89,322.12 |$ 92,970.00 tr Pay, allowances and commutation of quarters of commissioned medica ro officers and pharmacists ........ 825,000.00 810,651.42 895,000.00 881,316.40 995,080.00 962,195.77 | 1,020,000.00 Pay of acting assistant surgeons ... 340.000.00 | a 326,728.61 300,000.00 277,605.13 343,200.00 333,387.64 300,000.00 c Pay of all other e miloyess eds . 650.000.00 638,370.00 744,000.00 706,554.28 749,089,508 661,995.14 840,000.00 wd Pay of personnel and maintenance | = | ...... .t ma AS Coven . an = of hospitals, Pabiie Health csvnerrer il ewes enrens Faerie aaa. ry Service ...... . sess. 785,000.00 715,332.03 19,166, 187.14 18,756,134. 43 4,000, 000.00 | 3,974,866.58 by,080, 0 a Medics) and hospital “services, Pub- Ho HEA hl Servite vee ccsaevns] aesnesnnnn [i sosnanevme ds wonsesvrrs]l dongrswney 38,364,300.00 35:437.847.37 .37 95,810,608, 66 Additional compensatione .......... 177,303. 33 177,303.23 ,556,004.55 1,536,904. 55 | 3,003,638.92 3,003,63 ET on ir Freight, transportation and travel: | °° | iceiiel] eeieesenn] enaeeeeiea] deeniaesan | seanaeenos Seven . tI ING EXPENSEE ivy iivressnnsin ‘ 40,000.00 230,034.47 48,000.00 47, 643.97 40,000.00 "49,001. 87 55,000.00 > Fuel Hint and water ..cs icone . 110,000.00 125,000.00 135,000.00 135,000.00 Repayments (receipts from 111,324.05 124,832.04 133,982.39 - PRtIEntS) . uve i sn ara as 19,273.19 31.42 6.06 2,526,512.16 ee) Furniture and repairs to same ..... 8,000.00 7,911.48 8,000.00 7,646.68 8,000.00 7,066.98 8,000.00 asd Purveying depot gupDlies Sassen . 80,000.00 78,051.40 85,000.00 82,000.00 85,000.00 84,705.35 85,000.00 Rent, purveying depot ... is re wriantiey Arr sane rie er sea lem an ely vere ae hes ean i Ceili ors Maintenanc ygienic Laboratory . 27,000. 00 “25, 835. 19 36,000.00 34,780.46 45,000.00 "T4%s 22440 50,000. 00 wn Equipment, “u gienic Laboratory ....| ..... ve RIE ie he 35,000.00 d 15,000.00 80 TER Seren a = Maintenance, Marine Hospitals ..... 540,000. 00 625,000.00 625,000.00 625, 000.00 = Repayments (receipts from a 606,406.59 619,838.31 ,180,000.00 = patients) .........ieeeeiaiaiian 78,459.12 8,528.56 577,116.03 556,218.43 Medical examinations, care of sea- — men and other persons entitled 0 to relief, and miscellaneous ex- =i penses other than Marine Hos- pitals not included under spe- cial heads ...sscivensvssivsiee . 210,000.00 220,000.00 220,000.00 220,000.00 Repavmaits (receipts from wl 518,511.04 oil 335,567.27 c 223,019.74 patients) .....iesevssrrscnersnes 165,850.94 169,807.04 ,514.16 17,679.00 Hospital construction, “Public Health Sis 417,899 Service Hospitals f .. 8,840,000.00 a 180,000.00 500,000.00 | 3,735,431.81 | 20,845,000.00 | 3,828,500.47 cans vanu ey Hospital furniture .... f2r0,000.00} ...... Creed Cuvee . 18,972.75 rae 75133070] evens * APPROPRIATIONS AND EXPENDITURES: FISCAL YEARS 1910 AND 1914 TO 1922, INCLUSIVE—Continued 1919 2 1920 ® 1921 1922 Appropriation Appropria= | a Expendi- Appropria- Expendi- Appropria- Expendi- Appropria tion ture tion ture tion ture tion Quarantine service ......... v 200,000.00 218,226.03 200,000.00 255,000.00 739,000.00 Repayments (receipts from vessels for fumigation, 257,478.52 500,112.13 subsistence to persons detained, tc.) ......;. 47,889.29 66,265.33 247,276.52 342,003.35 National quarantine and sani- BHON vc view srvvinnisi nse VC ween “e iis mah Cy evs vee ven sie ei ue a rsvavs iss Cereus cessesrsene Interstate Quarantine Service 1,500,000.00 tess e,231.81 25,000.00 18,529.80 25,000.00 24,204.38 25,000.00 Maintenance of leprosy hos- pitals, Hawai] Le oP] edd didinef cervsmniese wry be Cx vee rN evi keene ey a eee ee “vss iesere National Home for Lepersf . | .......... * a 837.05 xiii, a 1,848.70 wow ei ’ a 41,436.30 Sede a Protecting health of mili- a a Bary OrCeS Rca visas dvr eerrervise Coun assess cnr asa Seterens or 2a . cenveeee v vessrvsseme Relief and transportation of American citizens in Te UL SHE. SEA CM . Tesi wad ees “enn ermine dreds Ae ive . ol . Suppressing Spanish influenza and other communicable QiSeHses ©. Jiveiio mn cvenrs 1,000,000.00 839,004.44 “vane nne iain we EAA oy ea - EE see wear Expenses, Division of Venereal DISeaREs {lease sn onsasss 200,000.00 198,889.62 200,000.00 183,109.16 200,000.00 197,331.11 200,000.00 Field investigations of public health be cis seas nds 200,000.00 199,999.70 300,000.00 279,089.24 300,000.00 -295,777-48 300,000.00 Preventing the spread of epidemic diseases ....... 400,000.00 190,808.97 500,000.00 496,000.00 1,114,000.00 1,108,681.68 500,000.00 Special studies of pellagra .. 30,000.00 26,107.97 30,000.00 28,118.39 16,250.00 8,277.20] vise rivun . Studies of rural sanitation 150,000.00 149,549.20 50,000.00 484616,53 50,000.00 49,238.32 50,000.00 Control of biologic products .. 30,000.00 29,664.12 50,000.00 49,695.35 50,000.00 46,136.60 504000.00 Preparation and transportation . of ‘remains of officers .. J i iecsinnn . verve Paw 5,000.00 200.40 5,000.00 ans nee 5,000.00 BOOKS vaievsiwssswwambscinesss 500.00 458.31 500.00 190.79 500.00 496.12 500.00 Total ................. 16,944,865.87 | 7,437 ,451.37 | 27,453,694.04 | 28,637,262.60 | 73,691,551.69 | 52,375,994.86 | 30,575,612.39 a Figured on a cash basis. b Of this appropriation not exceeding $80,000 may be used for National Home for Lepers. ¢ Transferred from War Risk Insurance. d Figures not available, e Indefinite appropriation based on the amount necessary to pay increased compensation. f Available until expended; part expended by Public Health Service and part by upervising Architect of the Treasury. SININILVLS TVIONVNIL lz APPROPRIATIONS AND EXPENDITURES: FiscAL YEARS 1910 AND 1914 TO 1922, INCLUSIVE—Continued 1919 a 1920 a 1921 1922 Appropriation Appropria- Expendi- Appropria- Expendi- Appropria- Expendi- Appropria- tion ture tion ture ‘tion ture tion Appropriations Expended by Other Agencies: Butler ‘Building ............. 20,000.00 Ie ares ie 2,800.00. vecrrsensenl oven. rx ne) en . ees woe Building, Hygienic Labora- 10PY 8B i sencccsursont nse 250,000,007 + une diel ot eR a dnaidy savarrevesh FON Cesseas nee Yen denyeane Buildings, equipment and al- terations, Marine Ios- pals a=, 17,500.00 acid inves 264,000.00 | ........ vs 133,700.00 | ...... reins 415,000.00 Butlin equipment and al- terations at quarantine stations a’ Ail ey 204,000.00 | cavrr craves 145,000.00 Ces ensrarns b 704,000.00] .......... . 500.00 Purchase of state and local quarantine stations... ic. J anssvaserrn) eave vanris arses} eve tH . 1,662,121,00] sv ersesnias Meriden Payment to states for pre- vention of venereal . diseases civ i id... 1,000,000,00 '.ussie snecas 4 1,087,837.32 |. vecveversien @340,345. 31 [CC icine yeas Total “ive cisvnivain 1,581,50000] ..... Srniwen Y,A400,331.32 70" La ei aise 3,046,166.31 eves prove w 415,500.00 ¢ Disbursements made by te Interdepartmental Social Hygiene Board; work done under the direction of the Public Health Service. d Includes unexpended balance of $87,831.32 trom previous year reappropriated. e Includes unexpended balance of $96,345.31 from previous year reap, ropriated. € Each project appropriated for specifically; money abd by the Supervising Architect of the Treasury. h $675,000 available during 1922. zlz HOIAYAS HLUIVAH OI'1dNd dHL APPENDIX 7 BIBLIOGRAPHY EXPLANATORY NOTE The bibliographies appended to the several monographs aim to list only those works which deal directly with the services to which they relate, their history, activities, organization, methods of business, problems, étc. They are intended pri- marily to meet the needs of those persons who desire to make a further study of the services from an administrative stand- point. They thus do not include the titles of publications of the services themselves, except in so-far as they treat of the services, their work, and problems. Nor do they include books or articles dealing merely with technical features other than administrative of the work of the services. In a few cases explanatory notes have been appended where it was thought they would aid in making known the character or value of the publication to which they relate. After the completion of the series the bibliographies may be assembled and separately published as a bibliography of the Administrative Branch of the National Government. Books AND PAMPHLETS ! Anderson, John F. Organization, powers and duties of the United States Public health service to-day. 1913. 9 p- Reprinted from the American journal of public health, v. 3, no. 9. Armstrong, P. B. The care of the public health a national 1 There have been omitted from this bibliography a number of routine reports to Congress prior to 1870. 273 274 THE PUBLIC HEALTH SERVICE duty; a national bureau of health. (/n Pan American medical congress. Transactions, Washington. 1893. pt. 2, p. 1972-5) Bates, John L. Public health bureau or service, address . . ., with relation to S. 1 and 5972, proposing establishment of Public health bureau or service. April 15, 1912. Washington, Govt. print. off., 1912. 27 p. 62d Cong., 2d sess. Senate. Doc. 560) Serial 6176. Blue, Rupert. The problem of the public health. Chicago. American medical association, 1912. 6 p. Reprinted from the Journal of the American medi- cal association, Aug. 10, 1912, v. 59, p. 413-15. Bureau of public health, memorandum presented to Com- mittee on public health and national quarantine rel- ative to S. 1, to establish Department of health. 1912. 5p City and state boards of health and the proposed federal de- partment of health. (/n National conference for good city government. Proceedings, 1910. p. 446-9) Clark, Taliferro. Some child hygiene activities of the United States Public health service. Public health reports, Jan. 13, 1922, v. 37. 35-44. Comegys, C. G. On proper status of medical profession in Government of nations. (In Pan American medical cong- ress. Transactions, Washington, 1893. pt. 2, p. 1932-38) Cumming, Hugh S. The work of the Public health service in care of disabled veterans of the world war. Wash- ington. Govt. print. off., 1921. 12 p. (Reprint no. 682 from the Public health reports, v. 36, no. 32). Dalton, Charles IF. Relation of state health departments to federal and volunteer health agencies. Public health re- ports, Aug. 5, 1921, v. 36: 1793. Fisher, Irving and Robins, E. F. Memorial relating to con- servation of human life as contemplated by S. 1, pro- viding for United States Public health service . . . April BIBLIOGRAPHY 27% 5, 1912. Washington, Govt. print. off., 1912. 82 p. 62d Cong., 2d sess. Senate. Doc. 493) Serial 61706. Fisher, Irving. Statement [before Committee on interstate and foreign commerce, on S. 6102 and H. 9123] on na- tional health legislation, Feb. 13, 1909. Washington, Govt. print. off., 1909. 14 p. Gauss, H. C. The Public health and marine-hospital service. (In his American government. New York, 1908. p. 731-33) Geddings, H. D. Research work in the Hygienic laboratory of the Public health and marine hospital service. Chi- cago, 1904. 6 p. Reprinted from the Journal of the American medi- cal association, June 25, 1904. Goodnow, F. J. Constitutional foundations of federal pub- lic health functions. Washington, Govt. print. off. 1919. 10 p. (Reprint no. 559 from the Public health reports, v. 34, no. 40) Haskin, Frederick J. The public health. (In his American government. New York, 1911. p. 183-95) Herdliska, C. V. Venereal disease control activities. Edu- cational and medical campaign of the Division of venereal diseases during the fiscal year ended June 30, 1919 . . . Washington, Govt. print. off., 1919. 8 p. (Reprint no. 561 from the Public health reports v. 34, no. 41) Kerr, J. W. Federal public health administration; its de- velopment and present status in United States. Wash- ington, Govt. print. off., 1913. 12 p. (Reprint no. 112 from Public health reports, v. 28, no. 3) Published also in International congress of hygiene and demography. Transactions, 1912. v. I, pt. 2, Pp. 566-575; — Some activities of the Public health service in relation to scientific investigation. Cleveland, 1909. 14 p. Reprinted from Cleveland medical journal, Dec., 1909. 276 THE PUBLIC HEALTH SERVICE Lumsden, L. I. Cooperative rural health work of the Pub- lic health service in the fiscal year 1920. Washington, Govt. print. off, 1920. 15 p. (Reprint no. 615 from the Public health reports, v. 35, no. 40) Cooperative rural health work of the Public health service in the fiscal year 1921. Public health reports, Oct. 7, 1921, v. 36: 2472-87. —— Post-war duties of the U. S. Public health service. (In Indiana sanitary and water supply association. Proceedings, 1920. p. 100-10) McLaughlin, Allan J. Proper relation of federal and state governments in public health work. Washington, Govt. print. off, 1919. 7 p. (Reprint no. 558 from the Pub- lic health reports, v. 34, no. 39) Medical society of the state of California. The relations of the Marine hospital service of the United States to com- merce, the public and the medical profession . . . San Francisco, F. Eastman & co., 1881. 12 p. Moore, H. H. Four million dollars for the fight against ven- ereal disease . . . New York city, American social hy- giene association, 1919. p. 15-26. (American social hygiene association. Publication no. 164) The national government and the public health. New York. Appleton, 1897. 7 p. Reprinted from the New York medical journal for Dec. 25, 1897. National health council. Membership and program. Wash- ington, D. C. 1921. 3I p. [Descriptive statement covering organization and activities of the Public Health Service, p. 29-31] National public health. Papers, opinions, letters, etc., re- lative to the national public health, in the consideration of Senate bill (S. 6049) ‘“‘a bill establishing a department of public health and for other purposes.” Washington, Govt. print. off., 1910. 240 p. (61st Cong., 2d sess. Senate. Doc. 637) Serial 5660. BIBLIOGRAPHY 277 Pan American medical congress, 1st, Washington, 1893. Report of committee . . . on department of public health for the United States. Feb. 4, 1897. 4 p. (54th Cong., 2d sess. Senate. Doc. 110) Serial 3470. Reprinted as Senate Doc. 38, 55th Congress, Ist. session. Pierce, C. C. Public health service program for nation-wide control of venereal diseases. Washington, Govt. print. off., 1919. 8 p. (Reprint no. 524 from the Public health reports, v. 34, no. 20) Rucker, W. C. Legal aspect of the federal protection of the public health. Chicago, 1913. 15 p. Reprinted from the Journal of the American medical association, Nov. 15, 1913, v. 61: 1768-72. ——— Public health administration; the factors upon which its efficiency depends. Washington, Govt. print. off. 1914. P. 555-559. (Reprint no. 171 from the Public health reports, v. 29, no. 10) ——— Common sense in public-health administration. Washington, Govt. print. off, 1914. 8 p. (Reprint no. 173 from the Public health reports, v. 29, no.12) ——— The United States Public health service as a career. Washington, Govt. print. off., 1914. 18 p. (U. S. Public health service. Miscellaneous publication no. 13) —— and Pierce, C. C. United States Public health service exhibit at the Panama-Pacific international exposition, San Francisco, 1915. Washington, Govt. print. loff., 1916. 29 p. (Supplement no. 27 to the Public health reports, Dec. 31, 1915) Sercombe, P. H. Health conservation and well communities v. materia medica and sick communities, memorial to Congress relative to S. 1, to establish a national health service; presented by Mr. Owen, May 7, 1912. Wash- ington, Govt. print. off., 1912. 14 p. (62d Cong, 2d sess. Senate. Doc. 647) Serial 6177. 278 THE PUBLIC HEALTH SERVICE Trask, J. W. The federal Public health service. Rochester, N. Y., Lawyers’ coop. pub. co., 1913. p. 153-157. From Case and comment, Aug., 1913, v. 20, no. j. U.S. Bureau of education. Guide to United States govern- ment publications. Washington, Govt. print. off., 1918. 206 p. (Bulletin 1918, no. 2) “Bureau of the Public health service,” p. 20-23. —+— Congress. House. Committee on appropriations. Hospitals for the Public health service. Hearing . . . on Sundry civil appropriation bill for 1920. June 24-25, 1919. Sixty-sixth Congress, first session. Washington, Govt. print. off., 1919. 96 p. Sundry civil appropriation bill, 1922. Hearing . . . Sixty-sixth Congress, third session. Washington, Govt. print. off.,1921. 2 pts. “Public health service,” p. 312-406. Similar data will be found in earlier hearings before same committee. Committee on interstate and foreign com- merce. Divisions of mental hygiene and rural sanitation, Public health service. Report to accompany H. R. 721. Washington, Govt. print. off., 1916. 3 p. (64th Cong. Ist. sess. House. Rept. 462) Serial 6904 Efficiency of Public health and marine hospital service. Report to accompany H. R. 18704. Jan. 30, 1909. Washington, Govt. print. off., 1909. 12 p. (60th Cong., 2d sess. House. Rept. 2000). Serial 5384. Efficiency of the Public health service. Report to accompany H. R. 204 [Washington, Govt. print. off., 1916] 5 p. (64th Cong., 1st sess. House. Rept. no. 655) Serial 6904 Efficiency of the Public health and mar- ine hospital service. Report to accompany S. 2117. Jan. 16, 1912. Washington, Govt. print. off., 1912. 9 p. (62d Cong. 2d sess. House. Rept. 233) Serial 6129. BIBLIOGRAPHY 279 Hearings . . . Dec. 16, 1908 on sub- stitute for S. 6101 and H. 18794 on Public health and marine hospital service, relating to personnel. Wash- ington, Govt. print. off., 1908. 24 p. Hearings [Jan. 18, Feb. 13, 1909, on S. 6101 and H. 18794] on Public health and marine hos- pital service. Washington, Govt. print. off., 1909. 28 p. — rte, Hearings . . . on bills relating to health activities of the general government. Washington, Govt. print. off., 1910. 651 p. —— Hearings on H. 18792 and 18794, to further protect public health and to promote efficiency of Public health and marine hospital service. State- ment of Walter Wyman . . . Washington, Govt. print. off., 1908. 35 p. Malaria and typhoid fever, hearings on S. 4573, appropriating $500,000 for use of Public health service in prevention and suppression of malaria and ty- phoid fever. Washington, Govt. print off., 1914. 89 p. Prevention of leprosy in United States, report to accompany H. R. 20040 [for care and treatment of persons afflicted with leprosy] . . . Jan. 15, 1915. Washington, Govt. print. off., 1915. 2 p. (63 Cong, 3d sess. House. Rept. 1286) Serial 6766. Report . . . favoring S. 2162, to in- crease efficiency and change [to Public health and marine hospital service] name of Marine hospital service. June 7, 1902. Washington, Govt. print. off., 1902. 5 p. (57th Cong., 1st sess. House. Rept. 2415) Serial 4406. Report . . . amending by substitute H. 18792, to further protect public health and imposing ad- ditional duties upon Public health and marine-hospital service. May 12, 1908. Washington, Govt. print. off., 1908. 4 p. (6oth Cong., 1st sess. House. Rept. 1670) Serial 5226. 280 THE PUBLIC HEALTH SERVICE Report . . . amending H. 30292, to change name of Public health and marine hospital service to Public health service [and] to increase pay of officers of said service. Jan. 27, 1911. Washington, Govt. print. off., 1911. 3 p. (61st Cong. 3d sess. House. Rept. 2000) Serial 5847. To promote efficiency of Public health service, report to accompany H. R. 6204. Dec. 15, 1913. Washington, Govt. print. off., 1913. 5p. (63d Cong, 2d sess. House. Rept. 139) Serial 6558. To promote efficiency of Public health service, report to accompany S. 2616. Sept. 28, 1914. Washington, Govt. print. off., 1914. 5 p. (63d Cong., 2d sess. House. Rept. 1171) Serial 6560. To promote efficiency of Public health service, report to accompany S. 2616. March 12, 1914. Washington, Govt. print. off., 1914. 5p. (63d Cong., 2d sess. Senate. Rept. 328) Serial 6552. Committee on military affairs. Increase of efficiency of Army, Navy, Marine corps, Coast guard, and Public health service. Report to accompany H. R. 11730. Washington, Govt. print. off., 1920. 10p. (66th Cong. 2d sess. House. Report. 555) Serial 7652. Special committee on the readjustvient of pay of the Army, Navy, Marine Corps, Coast guard, Coast and geodetic survey, and Public health service. Readjustment of pay of the Army, Navy, Marine corps, Coast guard, Coast and geodetic survey, and Public health service, report to accompany H. R. 10972. May 1, 1922. Pt. 1, 9p, pt 2, 19 p. (67th Cong., 2d sess. House. Rept. 926) —— Senate. Committee on commerce. Extending the benefits of care and treatment by the Public health service to seamen on vessels used in the service of the United States. Report to accompany S. 994. [Wash- ington, Govt. print. off., 1917] 2 p. (65th Cong., 2d BIBLIOGRAPHY 281 sess. Senate. Rept. 1871) Serial 7304. Commitee on military affairs. Increase of pay for the Army, Navy, Marine corps, Coast guard and Public health service. Report to accompany S. 3383. Washington, Govt. print. off., 1919. 14 p. (66th Cong., 2d sess. Senate. Rept. 318) Serial 7649. Committee on public health and national quarantine. Divisions of mental hygiene and rural san- itation in United States Public health service. Report to accompany S. 2215 [Washington, Govt. print. off., 1916] 4 p. (64th Cong., 1st sess. Senate. Rept. 425) Serial 6898. Establishment of a reserve for the Public health service. Report to accompany S. J. Res. 63. [Washington, Govt. print. off., 1917] 2p. (65th Cong., 1st sess. Senate. Rept. 65) Serial 7249 ——— Proposed department of public health. Hearings . . . on the bill S. 6049 to establish a depart- ment of health and for other purposes. Washington, Govt. print. off., 1910. 219 p. Public health service. Report to ac- company S. 1597 [to establish Tuberculosis division and advisory council] Washington, Govt. print. off., 1919. 5 p. (6sth Cong, 3d sess. Senate. Rept. 681) Serial 7452. Public health service. Report to ac- company S. 1660 [to establish a Tuberculosis division] Washington, Govt. print. off., 1919. 5p. (66th Cong, Ist sess. Senate. Rept. 147) Serial 7590. Report . . . amending by substitute S. 2162, to increase efficiency and change [to Public health and marine hospital service] name of Marine hos- pital service . . . May 14, 1902. 4 p. (57th Cong, Ist sess. Senate. Rept. 1531). Serial 4262. ey Report . . . amending S. 6101 to promote efficiency of service. May 6, 1908. Washing- 282 THE PUBLIC HEALTH SERVICE ton, Govt. print. off., 1908. 11 p. (60th Cong., 1st sess. Senate. Rept. 610) Serial 52109. Report . . . amending by substitute S. 1, to establish independent Public health service. April 13, 1912. Washington, Govt. print. off., 1912. 7 p- (62d Cong., 2d sess. Senate. Rept. 619) Serial 6121. Report . . . favoring S. 2117, to promote efficiency of Public health and marine hospital service. June 12, 1911. Washington, Govt. print. off. 1911. 3 p. (62d Cong., 1st sess. Senate. Rept. 61) Serial 6077. Report . . . submitting substitute S. 2680, amending act granting additional quarantine pow- ers and imposing additional duties upon Marine hospital service, and adverse to S. 1703, to establish department of public health, and S. 2343, to create executive de- partment of public health. Jan. 31, 1898. Washing- ton, Govt. print. off., 1898. 6 p. (55th Cong., 2d sess. Senate. Rept. 521) Serial 3620. Status of officers and members of the Public health service when serving with the Coast guard, etc. Report to accompany S. J. Res. 67. [Washington, Govt. print. off, 1917] 5 p. (65th Cong., 1st sess. Senate. Rept. 66) Serial 7249. Suggestions with reference to Senate bill 1 [relative to establishing a bureau of health] sub- mitted by Hon. Franklin MacVeagh . . . Hon. James Wilson . . . and Hon. Charles Nagel . . . Washing- ton, Govt. print. off., 1912. 8 p. To further protect the public health and imposing additional duties upon Public health and marine hospital service. Report to accompany S. 6102. May 6, 1908. Washington, Govt. print. off., 1908. 11 p. (60th Cong., 1st sess. Senate. Rept. 609) Serial 5219. To promote the efficiency of the BIBLIOGRAPHY 283 Public health service. Report [to accompany H. R. 204] Washington, Govt. print. off., 1916. 3p. (64th Cong. Ist sess. Senate. Rept. 745) Serial 6899. Special committee on readjustment of serv- ice pay. Readjustment of pay of the Army, Navy, Marine corps, Coast guard, Coast and geodetic survey, and Public health service. Report to accompany S. 3326. March 22, 1922. 7 p. (67th Cong. 2d sess. Senate. Rept. 572) Readjustment of pay of the Army, Navy, Marine corps, Coast guard, Coast and geodetic survey, and Public health service. Report to accompany H. R. 10972. May 16, 1922. 6 p. (67th Cong., 2d sess. Senate. Rept. 719) Special [Joint] committee on readjustment of service pay. Readjustment of service pay, Hearings . . . Washington, Govt. print. off., 1921. 483 p. “Public Health Service,” p. 421-50 Readjustment of pay of the Army, Navy, Marine corps, Coast guard, Public health service and Coast and geodetic survey. March 2, 1922. 41 p. (67th Cong., 2d sess. House. Rept. 753) Pages 1-11 printed also as Senate Rept. 526 Interdepartmental social hygiene board. Codperation of Division of venereal diseases, United States Public health service, state boards or departments of health and the Interdepartmental social hygiene board. (In its Report, 1920. Washington, Govt. print. off., 1920. p. 100-7) Joint commission on laws organizing executive depart- ments. References to laws organizing executive depart- ments . . . Washington, Govt. print. off., 1893. 175 p. (53d Cong., 1st sess. Senate. Rept. 41) Serial 3148. “Office of the Supervising surgeon-general, Marine- hospital service,” p. 50-52. President (Wilson). Executive order making Public health service part of military forces of United States in 284 THE PUBLIC HEALTH SERVICE times of war and authorizing Secretary of the treasury to detail officers or employees of said service for duty with Army or Navy and making all Public health service stations available for use in connection with military op- erations. April 3, 1917,. 1p. (no. 2571) President's commission on economy and efficiency. Establishment of an independent public health ser- vice . . . report to the President on the establishment of an independent public health service. Washington, Govt. print. off., 1913. 4 p. (62d Cong., 3d sess. Sen- ate. Doc. 1002) Serial 6364. Published also in “Message of the President . . . transmitting the reports of the Commission on economy and efficiency . . . Jan. 8, 1913. Washington, 1913. p. 909-15. (62d Cong., 3d sess. House. Doc. 1252) Serial 6470. —— Public health service. Annual report of the surgeon- general, 1st, 1871-72—Washington, Govt. print. off, 1872— The annual reports give an account of the work done during each year. The following reports contain historical material relating to the service: 1872. Historical sketch of the service. 1806. Historical sketches of the hospitals at Detroit, Boston, San Fran- cisco, Vineyard Haven, Evansville, Louisville, and Cleveland. 1897. Historical sketches of the hospitals at St. Louis, Memphis, Port Townend New Orleans, Chicago, Cincinnati, and Portland, aine.) Bureau circular letters, 1913-1920. Washington, Govt. print. off., 1921. 228 p. The Division of sanitary reports and statistics bureau of the Public health service. Washington, Govt. print. off., 1915. 8 p. (Reprint no. 3ro from the Public health reports v. 30, no. 45) Epidemic influenza and the United States Public health service. Public health reports, Oct. 25, 1918, Vv. 33: 1821-3. BIBLIOGRAPHY 285 Hospital facilities for soldiers, sailors and marines . . . request from the surgeon general for cer- tain amendments in the act approved March 3, 1919 . . to provide hospital and sanitorium facilities for discharged sick and disabled soldiers, sailors and marines . . . Washington, Govt. print. off., 1920. 3 p. (66th Cong,. 2d sess. House. Doc. 620) Serial 7768. Institute of venereal disease control and social hygiene. Washington, D. C. Nov. 22 to Dec. 4, 1920. Conducted by the United States Public health service. Preliminary announcement with tentative schedule of courses. Washington, Govt. print. off., 1920. 16 p. (Official circular V. D. no. 1) Instructions to medical officers in charge of state control of venereal diseases. Washington, Govt. print. off., 1918. 18 p. (Miscellaneous publication no. 19). Interstate quarantine regulations of the United States. Washington, Govt. print. off., 1916. 41 bp. (Miscellaneous publication no. 1). Interstate sanitary districts; their establishment by the Secretary of the treasury in connection with the enforcement of the interstate quarantine laws and regula- tions. Washington, Govt. print. off., 1915. p. 1601- 1602. (Reprint no. 276 from the Public health reports, ¥. 30; no. 22) Manual of the mental examination of aliens. Washington, Govt. print. off., 1918. 118 p. (Miscella- neous publication no. 18). Official list of commissioned and other officers of the United States public health service, also list of U. S. marine hospitals, public health service hospitals, quaran- tine stations and quarantine vessels. Feb. 15, 1920. Washington, Govt. print. off., 1920. 105 p. (Miscel- laneous publication no. 11) Organization chart of the United States Public health service. Tan. 1915. Washington, Govt. print. 286 THE PUBLIC HEALTH SERVICE off., 1915. fold chart. (Miscellaneous publication no. 15) Program of the Public health service intended es- pecially to meet after-the-war needs. Washington, Govt. prin. off., 1919. 8 p. (Supplement no. 35 to the Public health reports, May 9, 1919) Public health activities of the Public health ser- vice. Washington, Govt. print. off., 1919. 4 p. (66th Cong., 2d sess. House. Doc. 486) Serial 7768. The Public health and marine hospital service of the United States. 1904. 16 p. Prepared for use at Louisiana purchase exposition, St. Louis, Mo., April 30,-Dec. 1, 1904. Public health service official circular V. D. no. I. Washington, 1920. Publications of the United States Public health service. Washington, Govt. print. off., 1921. 99 Pp. (Miscellaneous publication no. 12) Quarantine laws and regulations of the United States. Washington, Govt. print. off, 1920. 73 p. Regulations for the control of arsphenamine, neoarsphenamine, and sodium arsphenamine in the Dis- trict of Columbia and in interstate traffic. Washington, Govt. print. off., 1920. 10 p. (Miscellaneous publica- tion no. 22). Regulations for the government of the United States Public health service, approved Aug. 29, 1920. Washington, Govt. print. off., 1920. 214 p. Regulations for the sale of viruses, serums, tox- ins, and analogous products in the District of Columbia and in interstate traffic. Washington, Govt. print. off. 1919. 15 p. (Miscellaneous publication no. 10). Regulations governing the uniforms of officers and employees of the United States Public health service. Washington, Govt. print. off., 1914. 35 p. Regulations governing the hospitals and relief BIBLIOGRAPHY 287 stations of the United States Public health service. Washington, Govt. print. off., 1920. 146 p. Regulations governing the medical inspection of aliens. Washington, Govt. print. off., 1917. 91 p. (Miscellaneous publication no. 5) Regulations governing the reserve of the United States Public health service. Nov. 1918. Washington, Govt. print. off., 1919. 7 p. Report of the Commission of medical officers of the Marine-hospital service, appointed . . . to investi- gate the origin and prevalence of leprosy in the United States in compliance with an act of Congress approved March 2, 1899. Washington, Govt. print. off., 1899. 119 p. (57th Cong., 1st sess. Senate. Doc. 269) Serial 4239. Reserve of the United States Public health serv- ice. Public health reports, Feb. 7, 1919, v. 34. 230-2. Printed also in Medical record, May 24, 1919, v. 95: 863-73. ——— Statement of Surgeon-General Blue, United States Public health service to Chairman, Committee on naval affairs House of representatives, [with] Memoran- dum in support of the provisions of H. R. 9204 so far as it pertains to the personnel of the Public health service. Washington, Govt. print. off, 1919. p. 591-614. Transactions of the 1st-18th annual conferences [1903-1920] of state and territorial health officers with the United States Public health and marine hospital serv- ice. Washington, Govt. print. off., 1903-1921. (Public health bulletins no. 11, 12, 15, 17, 18, 21, 31, 40, 46, 59, 63, 67, 72, 82, 93, 96, 105, 111) Transactions of the first-2d annual conference of sanitary engineers and other officers of the Public health service directing antimalaria campaign . . . 1919-1920. Washington, Govt. print. off., 1919-1920. (Public health bulletins, no. 104, 115) 288 THE PUBLIC HEALTH SERVICE United States Public health service: its evolution and organization. Washington, Govt. print. off., 1921. 16 p. (Reprint no. 661 from the Public health reports, v. 36, no. 21) War program of the Public health service, in- tended especially for extra-cantonment areas and war in- dustrial centers. Washington, Govt. print. off., 1918. 8 p. (Reprint no. 486 from the Public health reports, v. 33, no. 39) —— Treasury dept. Additional hospital facilities for dis- chatged soldiers, sailors, marines, and army and navy nurses . . . draft of a bill . . . together with statement of the needs of the enactment of such legislation by the Surgeon-general of the Public health service . . . Washington, Govt. print. off, 1919. 54 p. (66th Cong. 2d sess. House. Doc. 481) Serial 7768. Hospital and sanitorium for treatment of soldiers and sailors by Public health service. Letter . . . trans- mitting a tentative draft of legislation . . . Sept. 20, 1918. Washington, Govt. print. off., 1918. 7 p. (65th Cong., 2d sess. House. Doc. 1204) Serial 7444. Report of the Secretary of the treasury in com- pliance with a resolution of the Senate in relation to the expediency of a change in the system of marine hospitals. Washington, 1839. 7 p. (26th Cong., 1st sess. Scnate Rept. 8) Serial 354. eee Report of the Secretary of the treasury, com- municating . . . the report of Dr. George B. Loring and Dr. T. O. Edwards, who were appointed to collect facts and information in relation to marine hospitals and the marine hospital fund. [Washington, Govt. print. off, 1851] 48 p. (31st Cong., 2d sess. Senate. Ex. Doc. 14) Serial 589. Reports in regard to the transfer of the bureaus and divisions of the merchant marine in the Treasury BIBLIOGRAPHY 289 department to the Navy department. Washington, Govt. print. off., 1883. 69 p. “Marine-hospital service,” p. 33-41. —— War dept. Report of the Secretary of War. Dec. 2, 1837. Washington, 1837. p. 181-562. Published also as Senate Doc. 1, 25th Cong., 2d sess. Serial 314. “Report of Medical board on Marine hos- pitals,” p. 210-15: Plans and estimates for marine hos- pitals, p. 216-19. Warren, Benjamin S. Coérdination and expansion of federal health activities. Washington, Govt. print. off. 1920. 21 p. (Reprint no. 575 from Public health reports, v. 34, 10. 49) A unified health service. Washington, Govt. print. off., 1919. 11 p. (Reprint no. 506 from the Public health reports, v. 34, no. 9) Warren, Benjamin S. and Bolduan, C. F. War activities of the United States Public health service. Washington, Govt. print. off., 1919. 27 p. (Reprint no. 531 from the Public health reports, v. 34, no. 23) Wyman, Walter. Advantages offered by the Public health and marine hospital service of the United States to recent graduates in medicine. Address before the stu- dents of the Jefferson medical college, Philadelphia, Pa., Dec. 16, 1903. 8 p. —— The present organization and work for the protection of health in the United States. 2d ed. Washington, Govt. print. off., 1912. 12 p. (Reprint from Public health reports, no. 49) — Public health service in the United States. 20 p. Reprinted from the Cleveland journal of medicine, Feb. 1897. —— Quarantine system of United States and description of service. (In International sanitary convention of American Republics, 1902. Transactions, 1903, p. 138- 156; 308-329) 200 THE PUBLIC HEALTH SERVICE —— What the federal government is doing for public health. Paper read before State conference of sanitary officers held at Rochester, Nov. 10, 1900. p. 20 —— What the medical profession can do for the Public health and marine hospital service. Chicago, 1004. 4 P- Reprinted from the Journal of the American medical association, June 25, 1904. PERIODICAL ARTICLES Blue, Rupert. Are we physically fit? United States hand- icapped in coming period of commercial and industrial competition. American journal of public health, Sept., 1919, Vv. 9: 641-5. [Program of Public health service to meet after-the-war needs] Dean, W. H. Uncle Sam, M. D., at your service. Ladies home journal, Oct., 1920, v. 37: 154-7. Doyle, A. Development of federal public health functions in the United States. Public health nurse, Sept.-Oct., 1920, v. 12: 723-7, 876-83. DuPuy, W. A. Uncle Sam fighting the diseases of the world. American review of reviews, March, 1914, v. 49: 301-7. Fisher, Irving. Department of dollars vs. a department of health. McClure’s magazine, July, 1910, v. 35: 320-30. Kerr, J. W. Relation of the Public health service to prob- lems of industrial hygiene. American journal of public health, Sept., 1917, v. 7: 776-82. —— Scientific research by the Public health service. Amer- ican academy of political and social science, Annals, March, 1911, v. 37: 270-85. Knopf, S. A. Owen bill for the establishment of a federal department of health, and its opponents. Popular science monthly, Oct., 1910, v. 77: 373-8. McLaughlin, A. J. Proper relation of federal and state governments in public health work. American journal of public health, Aug., 1919, v. 9: 586-8. BIBLIOGRAPHY 291 Published also as Reprint no. 558 from the Public health reports, v. 34, no. 39) Minnigerode, Lucy. United States Public health service. American journal of nursing, July, 1920, v. 20: 796-804. Pierce, C. C. Public health service campaign against vene- real diseases. Social hygiene, Oct., 1919, v. 5: 4I5- 39: —— Venereal disease control in civilian communities [by the Division of venereal diseases] American journal of public health, May, 1919, v. 9: 340-5. Place of the Public health service. Survey, April 6, 1918, v. 40: 16-17. Price, G. M. Nationalization of public health; war program of the United States Public health service. Survey, Oct. 19, 1918, v. 41: 62-3. Program of the United States Public health service. Public health nurse, Sept., 1919, v. II: 734-41. Public health service reserve. Scientific American, Nov. 30, 1918, v. 119: 432. Reed, C. A. United States Public health service. Popular science monthly, April, 1913, v. 82: 353-75. Reserve of the Public health service. American journal of public health, Dec., 1918, v. 8: 934. Schieffelin, W. J. Work of the Committee of one hundred on national health. American academy of political and social science. Annals, March, 1911, v. 37: 32I- 30. Sprague, E. K. United States Public health service. Out- look, Aug. 16, 1916, v. 113: QII-I5. Taylor, G. R. Washington at work; national yard sticks for health. Survey, Jan. 15, 1916, v. 35: 461-4. Trask, J. W. Work of the United States public health ser- vice in relation to the present war. American journal of public health, Dec., 1917, v. 7: 987-04. United States public health service and the influenza epidemic. Science, Nov. 15, 1918, n. s. 48: 487-8. 202 THE PUBLIC HEALTH SERVICE Welliver, J. C. Our national board of health. Munsey’s magazine, Jan., 1913, v. 48: 610-20. Wiley, H. W. Sentinels of health [the Public health ser- vice] Good housekeeping, April, 1919, v. 68: 54. INDEX Activities, classification of, 193— 194; description of, 76-146. Administrative assistants, ap- pointment, promotion, and sal- ary of, 180-181. Agriculture Department, assist- ance to, 145. Alaska, surgical and medical re- lief for natives of, 32. Aliens. See Immigrants. Allied soldiers, authority to give medical service to, 78; physical examinations of, 88; relief fur- nished, 81. American Association for Ad- vancement of Science, health work of, 33. Antitoxins, control of, 27, 41, 129-133. Appointments, method of, 8, 13, 14, 15-16, 163-169. Appropriations, annual required, 30; statements of, 264-272. Army, authority to give medical service to men of, 52, 77, 78; relief furnished officers and men of, 0; physical examina- tions for, 88. Assistant surgeons, appointment and promotion of, 13, 15-16, 164; salaries and allowances of, 15, 38, 54, 170. Assistant surgeons general, ap- pointment of, 166; positions established, 26, 49; salaries and allowances of, 38, 54, 170. Bacteriological laboratory, estab- lishment of, 15; removal to Washington, 19. See also Hy- gienic Laboratory. Bacteriology, work in, 143. Biological products, control of, 27, 41, 120-133. Blue, Rupert, appointed Surgeon General, 168. Bolduan, C. S., and Warren, B. S., cited on war activities, 45, 47, 48. Boston, establishment of hospital at, 3. Bubonic plague, work in suppres- sion of, 104. Bulletin of the Public Health, first publication of, 13. Bulletins, description of, 195, 197. Bureau. See next word of name. Canal boats, seamen not to re- ceive medical relief, 5. Carriers, interstate, regulations affecting, 101-102. Charleston, establishment of hos- pital at, 4. Chase, S. P., quoted on number of hospitals, 5. Chemical researches, work in, 144. Chemistry Bureau, transfer to Public Health Service proposed, 35, 37- Chemistry, Division of, organ- ized, 30. Chief Clerk, organization of of- fice of, 147-148, 184. Child hygiene, work in, 133-136. Coast and Geodetic Survey, au- thority to give medical service to, 10, 78; physical examina- 293 204 tions for, 88; relief furnished officers and men of, 81. Coast Guard, authority to give medical service to, 77; physical examinations for, 88; relief furnished employees of, 8o. Collectors of Customs, duties as directors of hospitals, 3, 7. Commission on Economy and Ef- ficiency, recommendations re- garding consolidation of health activities, 36-37. Commissioned personnel, appoint- ment, 8, 13, 14, 15-16, 163; pro- motion, 14, 16, 21, 164-168; salaries and allowances, 15, 38, 54, 160-171; retirement, 16, 21, 171-173; leave of absence, 173; discipline, 174. Consular officers, reports on sani- tary conditions by, 12. Contract hospitals, relief fur- nished at, 82. Court decisions relating to health, digests of, 141. Cuba, quarantine activities in, 22. Cummings, H. S., appointed Sur- geon General, 168. Decisions relating to health, di- gests of, 141. Dental treatment, work in, 66. Department. See next word of name. Dietitians, salaries of, 181. Director of Hygienic Laboratory, salary of, 39, 178. Discharged soldiers, medical treatment of, 55-5, 79, 8o. Discipline, method of enforcing, 174. Diseases, investigations of, 136- 140. Division. name. Domestic quarantine, work in con- nection with, 16, 99-105. See next word of INDEX Domestic Quarantine Division, organization of, 154-155, 191. Drugs, assistance in detecting misbranding of, 14s. Education, Bureau of, detail of officer to, 32. Edwards, T. O., and Loring, G. B., quoted on hospital adminis- tration, 7. Employees’ Compensation Com- mission, authority to give med- ical service to beneficiaries of, 42, 78; physical examinations for, 88; relief furnished bene- ficiaries of, 81. Engineer Corps, authority to give medical service to, 10, 77; phys- ical examinations for, 88; re- lief furnished officers and men of, 81. Engineering, sanitary, activities in connection with, 103-105. Epidemics, control of, 103-105. Examinations, physical, extent of, 86-88. Expenditures, statements of, 264 272. Federal Board for Vocational Education, physical examina- tions for, 87; relief furnished beneficiaries of, 58-59, So. Fisheries, medical aid to crews engaged in, 40, 86. Fisheries Bureau, authority to give medical service to employ- ees of, v7. Food supplies of vessels, inspec- tion of, 146. Forecastles, supervision of fumi- gation of, 41. Foreign and Insular Quarantine and Immigration Division, or- ganization of, 155-156, 187-190. Foreign countries, work in, 12, 14, 20. 22, 121. INDEX Foreign seamen, authority to give medical service to, 4, 9, 78; physical examinations of, 88; relief furnished to, 81. Fort Stanton Sanitarium, estab- lishment of, 23. Government employees, authority to give medical service to, 42, 78; inoculation of, 40; physical examination of, 83; relief fur- nished to, 81. Government Hospital for the In- sane, admission of patients of service to, 10. Hamilton, J. B., appointed Super- vising Surgeon General, 13; resignation of, 19. Hawaii, leprosy hospital in, 29— 30, 84; quarantine operations in, 24, 119. Health education, work in, 146. Health organization and adminis- tration, studies of, 140-141. Hospital Division, organization of, 151-153, 185-187. Hospital service for discharged soldiers, discussion of, 55-75. Hospitals, classification of, 68, 75; transfer to Veterans’ Bu- reau, 75. See also Marine Hos- pitals; Veterans’ Hospitals. Hygiene. See Child hygiene; In- dustrial hygiene. Hygienic Laboratory, erection of building for, 24; organization of, 26; publications of, 29, 195; salaries of personnel of, 39, 179; work of, 143-144. Immigrants, authority to give medical service to, 78; medical inspection of, 17-18, 22, 28, 31, 43, 105-111. Immigration. See Foreign and 295 Insular Quarantine and Immi- gration Division. Immigration Inspection Stations, list of, 189-190. Immigration Service, physical ex- aminations for, 88; relief fur- nished to, 81. Indians, investigation of conta- gious diseases of, 39. Industrial hygiene, work in, 136 138. Infantile paralysis, control of epi- demic of, 103. Influenza, control of epidemic of, 52-53, 104. Inspection Service, creation of, 54; organization of, 148-150, 185. Interdepartmental Social Hygiene Board, creation and work of, 50-51, 89-91. Interior Department, recommen- dation that health work be transferred to, 33. Interstate spread of diseases, ac- tivities to prevent, 16, 99-105. Keep Well Series, description of, 196. Laboratory. See Bacteriological Laboratory, Hygienic Labora- tory. Lake Erie, authority for hospitals on, 4. Laws, index to, 198-206; com- pilation of, 206. Laws, health, digest of, 141. Leave of absence, regulations governing, 173. Lepers, National Home for, 41- 42. Leprosy, commission to investi- gate, 23; hospitals for treat- ment of, 29-30, 85. Lighthouse Service, authority to give medical service to, 10, 78; 206 physical examinations for, 83; relief furnished officers and men of, 81. Loring, G. B., and Edwards, T. O., quoted on hospital adminis- tration, 7. Malaria, control of, 139-140. Marine Hospital Fund, source and use of, 2, 3, 8, 14. Marine Hospital Service, history ‘of, 1-25. Marine hospitals, establishment of, 1-7; list of, 184, 254-255; per- sons with infectious diseases to be admitted, 31. Matches, duties in connection with tax on, 38-39. Medical treatment, extent of, 8o- 81; history of, 1-7, 31, 41, 42, 51, 55-75; persons entitled to, 76-79. Military forces, Public Health Service made part of, 44. Miners, study of diseases of, 32. Mines Bureau, detail of officers to, 32, 145. Mississippi River, authority for hospitals on, 4. Mississippi River Commission, authority to give medical sery- ice to employees of, 77; phys- ical examinations for, 88; re- lief furnished officers and men of, 81. Morbidity statistics. tics. Mortality statistics. See Statis- tics. See Statis- National Board of Health, history and duties of, 13. National Home for Disabled Vol- unteer Soldiers, use of hospitals for discharged soldiers, 7o. National Parks, sanitary surveys of, 146. INDEX Naval establishment of, 3. Navy, authority to give medical service to men of, 3, 9, 52, 78; physical examinations for, 88; relief furnished officers and men of, 8o. New Orleans, establishment of hospital at, 4. New York, purchase of property for Marine Hospital at, 2s. Newport, establishment of hos- pital at, 4. Norfolk, establishment of hospital at, 3. Nurses, salaries of, 181. hospitals, Occupational diseases, work in, 136-138. © Occupational therapy, work in, 66. Officer. sonnel, Ohio River, authority for hos- pitals on, 4. See Commissioned Per- Passed assistant surgeon, appoint- ment and promotion of, 164; grade created, 14; salaries and allowances of, 170. Pathology, work in, 143. Pellagra, hospital for study of, 86. Personnel and Accounts Division, organization of, 150-151, 184- 185. Pharmacists, appointment, pro- motion, and salaries of, 179- 180. Pharmacology, work in, 143. Pharmacology Division, establish- ment of, 29. Philippine Islands, quarantine operations in, 23, 120. Phosphorus matches, duties in connection with tax on, 38-39. INDEX Physical examinations, extent of, 86-88. Physiotherapy, work in, 66. Plague, work in suppression of, 104. Poliomyelitis, control of epidemic of; 103. Pollution of streams, work on, 142. Porto Rico, quarantine activities in, 22, 24, 120. Promotions, provision for, 14, 16, 21, 164-168, 177, 180. Public Health and Marine Hos- pital Service, history of, 26-32. Public Health Bulletins, descrip- tion of, 195. Public Health Education Section, creation of, 53; organization of, 159. Public Health Reports, descrip- tion of, 196. Public Health Service employees, authority to give medical serv- ice to, 77; physical examina- tion of, 83; relief furnished to, 81. Public Health Service Hospitals names changed to Veterans’ Hospitals, 75. Publications, description of, 195- 197. Purveying Service, creation of, 54. Quarantine, domestic. See In- terstate spread of diseases. Quarantine duties, extent of, 111— 121; history of, 10-12, 15, 19- 21, 23, 25, 30, 54. See also For- eign and Insular Quarantine and Immigration Division. Quarantine stations, list of, 187- 189. Reconstruction aides, salary of, 181. 297 Relief. See Medical Treatment. Research, Scientific, work in, 133— 146. Reserve Corps, appointment to, 174-175; creation of, 53. Retirement, provisions for, 16, 2I, 171-173. Roosevelt, Theodore, appointment of commission on scientific work, 33; quoted on health ac- tivities of government, 33-34. Rural sanitation, work in, 41, 122. St. Elizabeth’s Hospital, admis- sion of patients of service to, 10. Salaries, provisions for, 15, 38, 54, 164-168, 178, 179, 180, 181. Sanitary engineering, activities in, 103. Sanitary Reports and Statistics Division, organization of, 156— 159, 190. Sanitation, rural, work in, 41, 122. Scientific personnel, appointment, promotion, and salary of, 175- 178. Scientific Research Division, or- ganization of, 159-161, 190-191. Scientific work, discussion of, 133-146. Seamen, authority to give medical service to, 1, 77; history of medical relief of, 1-7; physical examinations of, 88; relief fur- nished to, 80; tax on, 2, 6, 14; See also Foreign seamen. Senior surgeon, appointment and promotion of, 165; establish- ment of grade, 38; salary and allowance of, 170. Serums, control of, 27, 41, 120- 133 Soldiers, discharged, medical treatment of, 55-75, 79, 80. State health authorities, annual conference with, 27, 28, 144. 208 States, funds for control of ven- ereal diseases by, 50-52, 89-95. Stations, relief furnished at classes of, 82. Statistics, collection of, 27, 126 129. See also Sanitary Reports and Statistics Division. Stream pollution, work on, 142. Supervising Surgeon, appointment of, 8. Supervising Surgeon General, ap- pointment of, g. Surgeon General, appointment and term of, 167-168; salary and allowance of, 26, 170. Surgeons, appointment and pro- motion of, 164; salaries and al- lowances of, 170. Syphilis, control over remedies for, 132. See also Venereal diseases. Taft, W. H., quoted on health ac- tivities of government, 34-33, 36. Tax. See Seamen; Tonnage tax. Tonnage tax, repeal of appropria- tion of, for support of hospitals, 30; use of, 14. Toxins, control of, 27, 41, 129- 233. Trachoma, hospitals and clinics for treatment of, 83-84. Treasury Department, Public Health Service to remain in, 29. Tuberculosis sanitarium, estab- lishment of, 23. Venereal Disease Bulletins, de- scription of, 197. Venereal diseases, control of, 47- 52, 87-99. Venereal Diseases Division, crea- tion of, 49, 88; organization of, 153-154, 191. INDEX Vessels, food supplies of, inspec- tion of, 146. Veterans, medical treatment of, 55-75, 79-80. Veterans’ Bureau, authority to give medical service to bene- ficiaries of, 79; creation and duties of, 73-75. See also War Risk Insurance Bureau. Veterans’ Hospitals, change of name of, 75; list of, 256-250. Virgin Islands, quarantine work in, 45, 120. Viruses, control of, 27, 41, 129 133 Vital statistics, transfer to Pub- lic Health Service proposed, 37. Waiting orders, provision for, 16, 21, 171-173. War activities, history of, 44-47. War Department, use of hospitals for discharged soldiers, 7o. War Risk Insurance Bureau, physical examinations for, 87; relief furnished beneficiaries of, 55-75, 80. See also Veterans’ Bureau. Warren, B. S., and Bolduan, C. S., cited on war activities, 45, 48. Water, control over supplies used by interstate carriers, 102. Weekly Abstract of Sanitary Re- ports, publication of, 13, 15. Woodworth, J. M., appointed supervising surgeon, 8; death of, 13. Wyman, Walter, appointment as surgeon general, 19. Yellow Fever Institute Bulletins of, 29, 197; establishment of, 250. Zoology, Division of, established, 28; work in, 144. (1) (028729331