The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.
ANNUAL REPORT
OF THE
SURGEON GENERAL o/ the
PUBLIC HEALTH SERVICE
of the UNITED STATES
•
FOR THE FISCAL YEAR
1932
,
~
: , .:.,
, .,
,
:
~ ·
,
-
,
.....
I
,
,
'
,
·,
,
.,
., ,.
..,
a
.
,.
l
:, ., .,: .... .,"
...
.,' ',
,
,
,
.
'.,
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON: 1932
For oale by the Superintendent of Documenta, Wa,hinaton, D. C.
•
• • • • • •
Digitized by
• •
•
•
Google
Pric, $1.00 (cloth)
TREASURY DEPARTMENT
Document No. 3053
Public Health Service
·.:·~·:•·
... . ... ........... .~~
~
• • • =•.•. ~... .. .. .
~
: . •. ; ~....=::: ... : .
••• #: ;: ~ _:._ .....
. .. .. . ..
~
'
,:.
Digitized by
Google
LEITER OF TRANSMITTAL
TREASURY DEPARTMENT,
OFFICE OF THE SECRETARY,
Washington, December 5, 1932.
Sir: In accordance with section 9 of the act of Congress approved
July I, 1902, I have the honor to transmit herewith the report of
the Surgeon General of the Public Health Service for the fiscal
year 1932.
Respectfully,
OGDEN L. MILLS,
Secretary.
The SPEAKER OF THE HousE OF REPRESENTATIVES.
Ill
f
l
8
"'
0
t
U')
Digitized by
Google
Digitized by
Google
CONTENTS
Foreword ____________________________________________ . __________ _
Division of Scientific Research _____________________________________ _
Cancer ______________________________________________________ _
Heart disease ________________________________________________ _
Nutritional diseases __________________________________________ _
~i~ri!======================================================
Plague
______________________________________________________ _
Rocky Mountain spotted fever _________________________________ _
Tularaemia, __________________________________________________ _
Tick paralysis _______________________________________________ _
Colorado tick fever ___________________________________________ _
Relapsing fever ______________________________________________ _
Child hygiene investigations ___________________________________ _
Dental studies _______________________________________________ _
Industrial hygiene and sanitation ______________________________ _
Milk investigations ___________________________________________ _
Studies of public health methods ___ ..: ___________________________ _
Statistical investigations ______________________________________ _
Stream pollution _____________________________________________ _
National Institute of Health ___________________________________ _
Division of pathology and bacteriology _____________________ _
Division of zoology _______________________________________ _
Division of pharmacology _________________________________ _
Division of chemistry _____________________________________ _
Control of serums, vaccines, and analogous products ______________ _
Miscellaneous ________________________________________________ _
Division of Domestic (Interstate) Quarantine ________________________ _
Plague-suppressive measures in California. _______________________ _
Plague in ground squirrels _________________________________ _
Measures ta.ken against rats _______________________________ _
Public Health Service plague laboratory ____________________ _
Tra.choma.-prevention work ____________________________________ _
Supervision of water supplies used by common carriers ____________ _
Shellfish sanitation ___________________________________________ _
Cooperative public health engineering work _____________________ _
Rural health work ____________________________________________ _
Surgeon General with the State and Territorial_
Conference
of the
health officers
______________________________________________
Division of Foreign and Insular Quarantine and Immigration __________ _
Quarantine transactions _______________________________________ _
General prevalence of qua.ra.ntina.ble disea.!!es ____________________ _
Changes in quarantine procedure _______________________________ _
International agreements ______________________________________ _
Psittacosis __________________________________________________ _
Meningococcus (cerebrospina.l) meningitis _______________________ _
Sanitary control of aerial navigation ____________________________ _
Construction of quarantine facilities ____________________________ _
Floating equipment __________________________________________ _
Quarantine
transactions at continental and insular quarantine_
stations ___________________________________________________
Transactions at continental maritime stations ________________ _
Transactions at United States airports of entry for airplanes ___ _
Mexican border stations __________________________________ _
Transactions at insular quarantine stations __________________ _
Transactions at forei~n ports __________________________________ _
Summary
of quara.ntme
transactions at continental, insular, and for-_
eign stations
_______________________________________________
Medical inspection of a.liens ___________________________________ _
Division of Sanitary Reports and Statistics __________________________ _
Morbidity and mortality reports _______________________________ _
Inquiries as to health conditions _______________________________ _
V
Digitized by
Google
Page
1
22
22
26
27
31
33
35
36
38
39
39
40
40
43
43
46
50
51
54
57
58
65
65
70
72
72
73
73
73
74
74
75
77
82
82
87
89
91
91
91
92
94
94
95
95
96
97
98
99
101
103
103
104
107
107
124
124
129
VI
CONTENTS
Division of Sanitary Reports and Statistics-Continued.
Directories of health officers ___________________________________ _
Sanitary legislation and court decisions ______________________ ~ __ _
Publications issued by the division _____________________________ _
Public health education _______________________________________ _
Publications distributed by the division _________________________ _
Division of Marine Hospitals and Relief_ ___________________________ _
Classes of beneficiaries and a.mount and character of services rendered_
Summary of services by class of beneficiary __________________ _
Dental treatment ________________________________________ _
Coast Guard ____________________________________________ _
Opera.ting costs ______________________________________________ _
Abstracts of reports from marine hospitals and selected relief stations_
Consolidated and detailed reports ______________________________ _
Division of Venereal Diseases ______________________________________ _
Scientific research ____________________________________________ _
Studies at the marine hospital, Stapleton, N. Y ______________ _
Studies at Chicago, Ill ____________________________________ _
Malaria. treatment of neurosyphilis _________________________ _
Clinical research _____________________________________________ _
· Cooperative clinical studies ________________________________ _
Hot Springs (Ark.) clinic __________________________________ _
Prevalence studies ____________________________________________ _
Cooperation with other divisions of the service ___________________ _
Cooperation
with the Office -_________________________________
of Indian Affairs, Department of the_
Interior _________________
Page
Studies
of syphilis_____________________________________________
among rural negroes __ ----------------------- __
Health education
Cooper_a.~ive a?t~v!ties with States ______________________________ _
Clime activities __________________________________________ _
Tabular summaries ___________________________________________ _
Division of Mental Hygiene _______________________________________ _
Studies of the nature of drug addiction and methods of treatment_ __ _
Dissemination of information __________________________________ _
Studies
of drugs
the abusive
use and the medical and scientific needs of_
narcotic
_____________________________________________
164
165
166
166
167
Administration of narcotic farms _______________________________ _
and ________________________________________________
psychiatric services in Federal penal and correctional_
Medical
institutions
Studies and investigations of the causes, prevalence, and means for
the prevention and treatment of nervous and mental diseases ___ _
Division of Personnel and Accounts ________________________________ _
Public health districts_. ______________________________________ _
Personnel ___________________________________________________ _
Commissioned officers ____________________________________ _
Reserve officers _____________________ . ____________________ _
Acting assistant surgeons__________________________________ _
Attending specialists _____________________________________ _
Internes. ____________ . _- ________________________________ _
Pharmacists and administrative assistants ___________________ _
Nurses, dietitians, and reconstruction aides __________________ _
Contract dental surgeons __________________________ . _______ _
Epidemiologists __________________________________________ _
National Institute of Health _______________________________ _
Property records _____________________________________________ _
Accounts section. _____________ - _- - - - - -- - - - - - - - - - - - - - - - _- - - _- __
Personnel statement ____________ - __ - ___ - -- - _- - - __ - - _- ___ - _____ _
ChiefBureau
Clerk'spersonnel
Office ____________
- - - -- - - - - - - - - - - - - - -- - -- - - - - - - - - - - -- -_
____________________________________________
Printing and binding __________ - - - - - -- -- - - --- - - - - - -- - ___ ---- - __
Public Health Service Library ___ - _- - -- - - - - ______ ---- __________ _
New administrative building at W a.shington _____________________ _
Appendix _______________________________________________________ _
Financial statement ____________ - -- __ - ___ -- ___________________ _
Quarantine service-Expenditures by stations _______________ _
Miscellaneous receipts ____________________________________ . ___ _
Funds transferred from other departments ______ --------- ___ _
Digitized by
Google
129
130
130
131
132
136
137
137
137
138
139
140
150
158
158
158
159
160
161
161
162
162
163
164
171
171
171
172
172
173
173
174
174
177
177
179
179
179
179
179
180
181
181
181
181
182
182
189
189
189
189
189
190
190
191
192
192
ANNUAL REPORT OF THE SURGEON GENERAL OF THE
PUBLIC HEALTH SERVICE
TREASURY DEPARTMENT,
BUREAU OF THE PUBLIC HEALTH SERVICE,
fVashington, D. 0., October 15, 1932.
Sm: In accordance with the act approved July 1, 1902, I have the
honor to submit for transmission to Congress the following report of
the transactions of the Public Health Service of the United States for
the fiscal year ended June 30, 1932. This is the sixty-first annual
report of this service, covering the one hundred and thirty-fourth
year of its existence.
Among the duties imposed upon the Public Health Service by law
is the prevention of the introduction and spread of infectious diseases
from foreign countries into the United States. This is one of the
important public health functions of the Federal Government. It
has long been recognized that the spread of epidemic diseases is related to commercial intercourse. In protecting our territory from
invasion by diseases from foreign countries, in accordance with the
requirements of law, it has been necessary to keep currently advised
as to the prevalence of disease throughout the world in so far as
practicable. The increasing use of international aerial transportation
makes it of special importance that current information relating to
the prevalence of disease in foreign countries be available.
WORLD HEALTH CONDITIONS
During the calendar year 1931, cholera. was not reported outside
of Asia and the adjacent islands. In the Philippine Islands, 936 cases
of cholera were reported, as compared with 4,600 cases during 1930.
The prevalence of cholera in the Philippine Islands continued to
decrease during the first six months of 1932.
The total number of cases of plague recorded in 1931 in those parts
of the world in which vital statistics are compiled was 56,000, as compared with 45,000 cases in 1930. All of the grand subdivisions of the
world except Australia reported plague in 1931. In North America
no case of human plague was reported, but plague-infected ground
squirrels were found in California. In South America plague was
reported from Argentina, Chile, Peru, and Ecuador. In Europe a
few cases of plague were reported in Spain, and there were scattered
cases in other countries. Asia is the great reservoir of plague as well
as of cholera. During the calendar year 1931, plague was reported
from many Asiatic ports, and this disease caused more than 28,000
deaths in India. In Africa plague was present during the year 1931
along the Mediterranean Sea in the north; in the Union of South
Mrica in the south; in the Canary Islands, Senegal, Nigeria, and the
Belgian Congo in the east; and in Uganda, Kenya, Tanganyika, and
the island of Madagascar in the west.
.
1
Digitized by
Google
2
PUBLIC HEALTH SERVICE
The number of recorded cases of yellow fever is now small, but this
disease exists in endemic form in extensive regions in Africa and South
America. It is· still a menace which must be carefully watched, as
· its appearance in a nonimmune population might be disastrous. Yellow fever was reported during the calendar year 1931 in several States
of Brazil and in Colombia. In Africa, yellow fever was reported in
Senegal, the Ivory Coast, the Gold Coast, French Togoland, Nigeria,
Upper Volta, Niger Territories, and British Cameroons. During the
first six months of 1932 there was an outbreak of yellow fever in
southern Bolivia, and competent observers find indications that yellow fever has been endemic in this region for many years.
The incidence of smallpox showed a remarkable decrease during
the calendar year 1931 as compared with 1930 and preceding years.
International health agencies recorded a total of 160,000 cases of
smallpox for 1931 and 315,000 cases for 1930. The total number of
recorded deaths from smallpox decreased from 65,000 in 1930 to 33,000
in 1931. The decline in the incidence of smallpox was general, only
a few countries reporting increased prevalence m 1931. The general
trend of smallpox prevalence has been downward since 1920, with
some temporary reactions and with a noteworthy exception in England
and Wales, where smallpox increased from 1920 to 1927. In Great
Britain the disease has been of mild form and there has been some
opposition to vaccination.
Little change was noted in the world prevalence of typhus fever '
in 1931 as compared with 1930. Just after the World War, in 1919
and 1920, several million cases of typhus fever were reported annually,
most of the cases being in eastern Europe. From that time to the
present the reported incidence of typhus fever has steadily decreased.
In 1930 about 26,000 cases were reported, more than half of these
being in the Union of Socialist Soviet Republics. These reports cover
the older form of typhus fever, usually spread by lice. Comparatively
few cases of this form of typhus fever have appeared in the Umted States
in recent years.
HEALTH CONDITIONS IN THE UNITED STATES
The general health of the people of the United States as reflected
by mortality rates has been mamtained at a very high level during
the last two and one-half years of unfavorable economic conditions.
Data on any present effects or incipient untoward conditions caused
by the depression have not been collected for the country as a whole.
With no unemployment benefits or other contact by which the families
of the unemployed can be followed for a. period of time for close medical
observation, it is doubtful that extensive worth-while data could be
assembled without unwarranted expense. It is quite probable that
the present remarkably good health conditions are, to some extent,
the direct result of efforts on the part of health agencies, which have,
no doubt, retarded the evil effects of unemployment and_ econo~c
hardships upon health. The fortunate absence of any senous widespread epidemics has also been a factor.
Reports to the Public Health Service for the calendar year 1931
and the first half of the year 1932 indicate that health conditions in
the United States have continued generally good.
A new low record was established for ~u berculosis, reports from
45 States giving an aggregate tuberculoslS death rate of 66.3 per
Digitized by
Google
PUBLIC HEALTH SERVICE
3
100,000 population, as compared with 68.8 per 100,000 population
in 1930, which was the lowest rate for tuberculosis deaths recorded
by the Public Health Service up to that year.
During the summer and fall of 1931 a serious epidemic of poliomyelitis (infantile paralysis) occurred. It was most severe in the
~ ortheastern States. The peak of the epidemic occurred in September. The States having the highest case rates were as follows:
Connecticut, 70 cases per 100,000 population; New York, 48 cases;
Massachusetts, 33; Minnesota, 32; Vermont, 31; Rhode Island, 24;
Wisconsin, 24; New Jersey, 24; Michigan, 23; New Hampshire, 16;
:and Maine, 15 cases per 100,000 population. In Ohio, Kansas, California, and some other States the prevalence of poliomyelitis was less
in 1931 than it was in 1930, but the aggregate case rate in 1931 for
42 States was 15 cases J?er 100,000 population, which is the highest
poliomyelitis case rate smce 1916, when reports from 27 States gave
.an aggregate rate of 41 cases per 100,000 population.
In 1931 there was a sudden drop in the incidence of smallpox as
-compared with preceding years. Reports from 46 States give an
aggregate rate of 24.4 cases of smallpox per 100,000 population for
the calendar year 1931. This is the lowest smallpox case rate re-corded by the Public Health Service since 1916. As usual, there is
a great difference in the number of cases of smallpox reported by
different States. Indiana reported more than 3,000 cases; Kansas,
2,500 cases; Iowa, 2,225; nine States reported between 1,000 and 2,000
eases; while Delaware, the District of Columbia, Maryland, and
Rhode Island did not report any cases of smallpox, and eight other
States reported less than 50 cases each.
In 1930 there was a slight reaction from the steady decrease in the
prevalence of typhoid fever which has been recorded since comparable
:annual statistics have been compiled. The case rate for 1930 was
22.1 per 100,000 population and the death rate was 5.0 per 100,000.
For the calendar year 1931 the typhoid fever case rate was 21.4 per
100,000 and the death rate 4.6. During the first six months of 1932
the incidence of typhoid fever increased, 5,900 cases bein~ reported,
as compared with 4,500 cases during the corresponding penod of 1931
and 5,600 cases in 1930. Just after the close of the fiscal year (in July
:and August, 1932) the number of typhoid fever cases reported was
-considerably greater than the number for the same months of the
preceding year.
· The peJlagra death rate, based on reports from 46 States, was 6.2
per 100,000 in 1929, 5.9 in 1930, and 4.8 in 1931. This disease is
~xpected to increase when the diet is deficient in certain essentials.
The fact that there was a decrease in the pellagra death rates for 1930
.and 1931 indicates that preventive measures taken by health departments in localities where the disease threatened were successful.
· In the year 1930 the lowest diphtheria death rate (4.9 per 100,000)
was registered. In 1931 the rate rose to 5.0 per 100,000. However,
this rate is the lowest ever recorded by the Public Health Service
-except that for 1930. In 1900, for the death registration area, the
diphtheria death rate was 43.3 per 100,000 population. If the 1900
diphtheria death rate had prevailed in 1931, there would have been
in the latter year 47,000 more diphtheria. deaths than actually occurred
in that year.
Digitized by
Google
4
PUBLIC HEALTH SERVICE
The incidence of meningococcus meningitis (epidemic cerebrospinal
meningitis) increased in the United States each year from 1924 to
1929. In the latter year 8.6 cases per 100,000 population were reported
to the Public Health Service. For the year 1930 the rate dropped to
7.0 cases per 100,000 population, and during the calendar year 1931
this rate was 4.7 per 100,000. During the first six months of 1932 the
decrease in the prevalence of meningococcus meningitis continued,
only 1,900 cases being reported, as compared with 3,500 cases during
the corresponding period of the preceding year.
Tularaemia was reported from 37 States and the District of Columbia during 1931, a total of 675 cases being reported, as compared with
660 in the preceding year. Reports were received from all States.
Undulant fever1 with a total of 1,578 cases, was reported from 45
States and the District of Columbia, reports being received from all
States. In 1930, there were 1,450 cases.
Rocky Mountain spotted fever, a milder, eastern type of which
was identified in 1930 in the eastern part of the United States by
Public Health Service workers, was reported during 1931 from 15
States and the District of Columbia. Preliminary reports show 203
cases.
According to preliminary figures, 44 States (out of 47 reporting) and
the District of Columbia reported 374 cases of typhus fever in 1931.
The mild form of the disease is endemic along the Atlantic seacoast.
Neither cholera nor yellow fever appeared in the United States
during the year, but yellow fever is endemic in parts of South America
and it appears from time to time in out-of-the-way places. Natives
of these places acquire an immunity to yellow fever, but when
the infection is introduced into populations which are not immune,
the disease is capable of producing epidemics as serious as those which
swept through large sections of the United States during the nineteenth century. It has not appeared in epidemic form in the United
States since 1905.
·
No case of plague was reported in continental United States during
the calendar year 1931 or the first six months of 1932, but a fatal case
of plague occurred in August, 1931, on Maui Island, Territory of
Hawaii. Six plague-infected rats were found in the Territory of
Hawaii during 1931 and seven durin~ the first six months of 1932.
Fourteen plague-infected ground sqmrrels were found in California
during 1931 in the course of plague-eradication work which has been
carried on by State and Federal health authorities for many years.
In April, May, and June, 1932, four plague-infected rats were found
in Los Angeles, Calif.
One item which helped to keep the general death rate low in 1930
and 1931 was the fact that the influenza death rate was low for both
years. Reports for 46 States gave an aggregate influenza death rate
of 18.7 per 100,000 population in 1930 and 26.1 per 100,000 in 1931.
The 1930 death rate was the lowest since 1924.
The birth rate for 1931 was 17 .8 per 1,000 population, and there
were 61.7 deaths of infants under 1 ye.ar of age per 1,000 live births.
Both of these rates are the lowest recorded.
Final death rates for 1931 are not available at the time of writing,
but preliminary reports and data from several sources indicate that
this rate will be ]ow. For 1929 the death rate in the registration area.
was 11.9 per 1,000 population. For 1930 it was 11.3 per 1,000. For
Digitized by
Google
PUBLIC HEALTH SERVICE
5
1931 reports to the Public Health Service from States having an
aggregate population of over 63,000,000 give a death rate of approximately 11.0 per 1,000 population.
PREVENTION OF THE INTRODUCTION OF DISEASES FROM ABROAD
During the fiscal year no instance occurred of the importation from
abroad of any quara.ntina.ble disease into the United States. One case
of smallpox and ~me case of typhus fever reached our quarantine stations and were detained. Two cases of cholera. occurred a.boa.rd a
steamer arriving at Manila; the patients, together with all contacts,
were detained at the quarantine station.
.
Plague was reported to exist in the islands of Ha.we.ii and Maui in
the fall of the fiscal year, and vessels arriving from ports in the infected
areas of these islands were required to undergo quarantine inspection
.upon arrival at ports in the United States, and were subjected to
fumigation when required. These restrictions remained in force until
the latter part of the fiscal year, when quarantine officers were
authorized to exem:{>t such vessels from mandatory fumigation when
careful rat-infestation inspection was negative and appreciable
amounts of cargo of a rat-harboring or rat-attractive nature were not
loaded at ports serving the infected areas, provided that bills of health
_issued at such ports showed suitable precautions ta.ken as regards both
the vessel and its cargo in such ports.
The epidemic of cholera which began a.bout May 1, 1932, in the
vicinity of Shanghai and Canton, began spreading southward and
threatened to assume serious proportions. Special precautions were
adopted to protect United States territory, particularly the Philippine Islands, against the introduction of this disease from China.
The disease was subsequently reported in Japan, probably having
been imported from China.
·
During the year there was a reported increased prevalence of smallpox in the Onent, particularly in Shanghai, Hong Kong, and Amoy,
and appropriate quarantine restrictions, includin~ vaccination, were
enforced against these ports. The sanitary condition existin~ in these
ports is of particular significance, owing to their close proximity to the
Philippine Islands.
At domestic ports during the year 13,256 vessels, 718,596 passengers, and 998,471 seamen were mspected on arrival by quarantine
officers; at insular ports 2,619 vessels, 122,617 passengers, and 205,146
seamen were inspected; and at foreign ports 2,173 vessels, 201,563
passen~ers, and 160,761 seamen were inspected prior to embarking for
the Umted States. In addition, 2,205 airplanes arrived at official air
ports of entry in the United States from foreign ports requiring quarantine inspection. These planes carried 24,694 persons; of this number 17,387 were re!luired to undergo medical examination by medical
officers of the Public Health Service, prior to entry.
Of the passengers who embarked at European ports, 26,564 were
vaccinated and 10,190 were deloused under the surveillance of medical
officers of the service. Clothing and baggage of these passengers,
amounting to 24,489 pieces, were disinfected.
A total of 2,455 vessels were fumigated either because of the occurrence of disease aboard or for the destruction of rats as a plague-:preyentive measure. Of the rodents retrieved following fumigation,
Digitized by
Google·
6
PUBLIC HEALTH SERVICE
4,371 were examined for evidence of plague infection; none were found
to be infected.
Executive Order No. 5264, issued on January 24, 1930, restricting
for the time being the introduction of parrots into the United States,
and the regulations promulgated thereunder remained in force during
the fiscal year. A slight outbreak of psittacosis occurred in New
York City during October and November, 1931, and subsequently a
more senous outbreak of this disease occurred in Califorma. Following this outbreak the health authorities of California drafted a
resolution providing State-wide prohibition of importation or exportation of birds of the parrot family in that State. This resolution
was designed to prevent the further introduction of psittacosisinfected birds from foreign sources and allow time to determine
whether the disease was already established in local aviaries. Officers
of the Public Health Service cooperated with the State authorities
in the enforcement of these regulations, and consideration is being
given to the advisability of a further revision of the special Federal
regulations to extend the present regulations governing the importation of parrots to include specifically all birds of the parrot family _
and possibly to impose some additional restrictive requirements, or
else place a complete embargo against the importation of all birds
of the parrot family. In the meantime research studies are being
continued in an endeavor to obtain additional information respecting the causative or~anism of this disease and a means for the prevention of its introduction and spread.
The problem of the satisfactory control of psittacosis is receiving
international attention, resulting in a commission being appointed
by the permanent committee of the International Office of Public
Hygiene in Paris to make a study of this problem and make recommendations. While the commission did not come to any definite
conclusions, it recommended that temporary prohibition be maintained and that the subject receive further study.
The special studies of the fumigation of ships as a plague-preventive
measure conducted at the New York quarantine station continued
during the past year with marked progress. A resume of these
investigations was prepared for the information and guidance of the
members of the special commission appointed by the health committee
of the League of Nations, who visited the United States in the fall of
1931 to study the methods in use at United States ports with particular
reference to the fumigation of ships with various forms of hydrocyanic
acid upon arrival from plague-infected ports while cargo laden.
Experience has shown that fumigation of a loaded vessel destroys
approximately 80 per cent or more of the rats on board, and it is now
not an unusual procedure to fumigate a cargo-laden vessel when
indicated following rat-infestation inspection.
The problem of the sanitary control of aerial navigation also has
been receiving international attention for several years, finally culminating in a proposed International Convention for the Sanitary
Control of Aerial N avigntion, which was prepared and its adoption
recommended by the permanent committee of the International Office
of Public Hygiene in Paris in May, 1930. This proposed draft was
presented during the year for the informal consideration and recommendation of various interested governments. The comments and
recommendations submitted by responding governments received the
Digitized by
Google
PUBLIC HEALTH SERVICE
7
further consideration of the permanent committee at its meeting in
Paris in April, 1932, resulting in some modification of the draft and
its approval as modified. It is anticipated that the revised draft
convention will soon be formally presented to the various interested
governments for ratification.
MEDICAL EXAMINATION OF ALIENS
At domestic ports, 373,034 alien passengers and 897-,788 alien seamen were examined by medical officers under the immigration laws.
Of this number, 15,115fassengers and 1,367 seamen were certified
for various diseases an disabilities. The most important causes
and the numbers of alien passengers certified therefor were as follows:
Trachoma, 346; tuberculosis, 119; feeble-mindedness, 96; insanity,85;
syphilis; 273; gonorrhea, 394. Of the alien seamen examined, 39 were
certified for trachoma; 7 for tuberculosis; 146 for syphilis; 162 for
chancroid; and 332 for gonorrhea.
During the year, Public Health Service procedure at United States
ports with respect to the certification by medical officers of the
detectability of conditions making aliens inadmissible into the
United States by competent medical examination performed at time
of embarkation or employment on board, was modified. This modification was the result of a joint conference between representatives
of the Bureau of Immigration and the Public Health Service to bring
the practice into accord with recent court decisions interpreting the
immigration laws, and it is anticipated that the new procedure will
serve greatly to reduce potential litigation based upon such cases.
As a result of an amendment to the immigration rules and regulations of the Department of Labor, following a conference between the
Department of Labor and the Public Health Service, paragraphs 2
and 3 of the Regulations Governing the Medical Examination of
Aliens, revised August, 1930, were amended. The amendment of
these paragraphs represents no change in policy but merely a technical change in phraseology, regarded to be necessary in order to be
correlated properly with the new language resulting from the amendment to the immigration rules and regulations of the Department of
Labor. Similarly, in response to a request made by the Secretary of
State, paragraphs 97 and 98 of these regulations were amended, again
representing no change in policy but only a change in technical
phraseology in order that these regulations may conform to the
consular regulations relating to the same subject, and to certain
provisions of an interdepartmental agreement bet.ween the State,
Labor, and Treasury Departments.
During the fiscal year ended June 30, 1931, a total of 42,831 applicants for immigration visas were given medical examination in thE\
country of origin. Of this number, 26,560 were examined by medical
officers of the Public Health Service attached to American consulate!'!
in Europe; the remainder, .or 16,271, were examined by medical
officers of the Public Health Service attached to American consulates
in the Western Hemisphere. Of the number examined in Europe,
7,129 were found to have mental or physical defects; and 3,454 of these
were refused visas for medical reasons. Of the number examined in
the Western Hemisphere, 1,950 were found to have mental or physical
defects, and.1,002 of these were refused visas for medical r~asons. 0~
Digitized by
Google
8
PUBLIC HEALTH SERVICE
38,375 aliens who had been given a preliminary medical examination
abr(?ad and to "'."horn visas ~ad been issued, only 7 were finally
certified 1;1pon amval f!,t a _Uruted States port as bemg afflicted with
class A diseases, resulting m mandatory deportation.
PREVENTION OF THE SPREAD OF CONTAGIOUS AND INFECTIOUS
DISEASES IN INTERSTATE COMMERCE
The slight changes in procedure in carrying out the certification of
urinking water sup_plies used by common carriers made during 1931
tended further to mcrease the efficiency of this work. DurinK the
year, 92.75 per cent of the 2,360 supplies used by rail and bus lines,
'95.87 per cent of the 242 supplies used on vessels engaged in interstate
traffic, and 85.83 per cent of the 120 supplies used on·airplane carriers
were inspected and reported upon. This is a material mcrease over
previous years. Some gain was made in the number of inspections of
vessels engaged in interstate traffic, with a considerable mcrease in
the number of vessels meeting the requirements of the regulations.
Of the 1,924 vessels in active service, 1,096 were inspected, of which
number 1,069 were given favorable certification.
During the year the report of the Joint Committee on Railway
Sanitation of the American Railway Association was completed and
made available to all members of that association as well as to the
health authorities of the various States. With the recommendations
of this committee available more uniform measures of railway sanitation as applied to watering points, coach yards, and terminals will
be possible.
Cooperation with and assistance to other Government bureaus and
agencies in connection with public health engineering problems a~ain
increased. This work has become an important part of the activities
of the sanitary engineering personnel of the service. During the fiscal
year over 34 per cent of the time of the field force of sanitary engineers,
equivalent to 5.4 engineer years, was devoted to assisting other Federal
agencies with problems in environmental sanitation.
Regular cooperative rural sanitation studies and demonstrations
were conducted in 144 projects in 28 States. The annual survey made
by the Public Health Service showed that on January 1, 1932; there
were 616 counties in the United States operating_ permanent local
health service under the direction of a full-tune medical health officer,
an increase of 59 over the number recorded for the preceding year.
The emergency fund for studies of and demonstrations in rural sanitation during the period February 6, 1931, to June 30, 1932, proved a
valuable aid to pro~ess in health work in this country, not only in the
immediate protection of the health of the people in the droughtstricken areas, but also in the lasting effects of the demonstration that
local rural health organizations are of vital importance in maintaining
a high standard of health in a community.
A special feature of the regular cooper'ative work in rural sanitation
included the inauguration of advisory service to State health departments on methods of local administration in the fields of child and
maternal health and environmental sanitation. Many of the States
took advantage of the availability of this service, with the result that
improvements were made in the organization of State supervision
over the work, with a corresponding improvement in content and
character of the activities of the local units.
Digitized by
Google
PUBLIC HEALTH SERVICE
9
As a result of the gradual reduction in the prevalence of trachoma
in the re~ons w:tiere the ac~iviti~ of the Publi<? Health S~rvice have
been earned on m cooperation With the States, 1t was possible to curtail to some extent the expenditure of Federal funds for trachoma
work. This work undoubtedly has prevented thousands of cases of
blindness which would have become a burden to the public; and while
progress in eradicating the disease has not been rapid, owing to the
chronic nature of the malady and the difficulty in reaching many
families in which it exists, there is ample evidence that the joint
efforts of the service and the State health authorities are slowly but
consistently clearing up the local foci in which trachoma has been
widely prevalent for many years.
The State of California again remained free of human plague, but
the disease appeared in rats in Los Angeles. Prompt measures were
taken by the local authorities, with the result that there was no spread
of rat infection to other areas and no additional rodent case has been
demonstrated by extensive trapping operations in the original focus
of infection. However, this reoccurrence of rat plagtie emphasizes
the necessity for continuous activity of the Public Health Service
toward the control of rodent infection in the areas adjacent to cities
on the California coast.
INVESTIGATIONS OF PUBLIC HEALTH PROBLEMS
Studies of cancer have been continued both at the Harvard Medical
School and at the National Institute of Health. Those at the Harvard
Medical Schoolhave been a continuation of the program for research
begun in the preceding fiscal year and have included (1) stu_dies of the
biological effects of radiation, (2) studies of immunity to malignant
growths, (3) biochemical studies, (4) cytological studies, and (5)
studies of susceptibility to malignant growths. At the National Institute of Health the work has been based on the assumption that cancer
is a chemical abnormality of living cells. The various phases of the
investi_gation have included (1) the hydrogen-ion concentration of
normal and malignant tissues in the living animal, (2) influence of the
oxygen tension on the proteolysis of tumors and normal tissues, (3)
tissue cultures, (4) chemistry of cell division, and (5) chemotherapy.
Studies of heart disease were begun early in the fiscal year, with the
selection of the experimental features of rheumatic heart disease for
the initial study.
At the leprosy investigation station in Hawaii, steady progress is
being made in an endeavor to improve methods of treatment and
diet. An analysis of the food eaten by a group of patients during a 5day week indicates that the patients choose a diet which is suboptimum in protein and fat, and definitely low in fruits and vegetables.
The 10-day dusting study, using Paris green, over a county-wide
.area has been completed. It is interesting to note that in spite of
heavy mosquito production the malaria rate in this area has fallen
about 90 per cent. Studies on the feasibility of supplying malarial
infection to hospitals for use in the treatment of paresis have been
continued.
Through a study of the airplane convection of mosquitoes it has
been established that approximately 20 per cent of all planes arriving
from tropical countries brought one or another species of mosquito
Digitized by
Google
10
PUBLIC HEALTH SERVICE
with them. There is thus not only danger of the introduction of yellow fever by means of infected mosquitoes, but greater danger is.
apprehended in the introduction of new species of insects not indigenous to the United States.
Pellagra studies were concerned largely with the determination of
the probable pellagra-preventive value of individual foodstuffs.
In addition, chemical studies were made on methods for the quantitative estimation of the antipellagra vitamin.
. At the request of the Governor of Hawaii and with the approval of
the Secretary of the Interior, work was undertaken in connection with.
the control and eradication of bubonic plague in the Hawaiian.
Islands following the report of a human case.
The demand for the Rocky Mountain spotted-fever vaccine manufactured at the spotted-fever laboratory at Hamilton, Mont., continues to increase, and was 75 per cent greater than in 1931, the entiresupply available being exhausted soon after the middle of the 1932
tick season.
Studies of tick parasites as a possible agency for the control of
Dermacentor andersoni in the Rocky Mountain re~on were begun by
the State of Montana in 1926. In connection with the purchase of
the Hamilton Laboratory from the State of Montana, the Public
Health Service took over the conduct of these studies at the beginning of the fiscal vear.
Epidemiological investigations of Rocky Mountain spotted fever,.
eastern type, have revealed a somewhat wider geographic distribution of the eastern type than known a year ago. The disease has.
now been found in Pennsylvania, New Jersey, Delaware, Maryland,
the District of Columbia, Virginia, North Carolina, South Carolina,.
Georgia, Louisiana, Minnesota, and possibly in Tennessee. Criteria
were established for the diagnosis of spotted fever in laboratory
animals.
.
Child hygiene investigations have included (1) a study of children.
of psychotic parents, (2) a study of e mental status of children of
various types of birth, (3) a study o dental caries in relation to diet
and climate, and (4) a study of the earing of school children. This.
latter study, which was begun e y in the fiscal year, is of importance, because there seems to
a rather high incidence of defectivehearing in childhood. The handicap of deafness may seriously inter-fere with material and intellectual advancement and early discovery
of the defect offers the best chance for improvement, adjustment, or·
training.
Dental studies were undertaken at the beginning of the fiscal year,.
with the assignment of a dental officer whose initial problem is the•
distribution of mottled enamel in the United States.
Studies of the health of workers in the following additional dusty
trades have been conducted: Marble stone :finishing, slate quarrying and milling, talc mining and milling, and granite stone quarrying.
A study of air pollution is being made in the cities of Washington,.
Baltimore, Philadelphia, New York, Boston, Buffalo, Cleveland, De-troit, Chicago, Pittsburgh, St. Louis, San Francisco, Los Angeles, and
New Orleans, in order to obtain data on the condition of the air in
the average American city.
.
A study of the loss of light due to smoke in Baltimore, Md;, cov:.
ering a period of 12 months, showed a large relative loss of light due,
to smoke.
Digitized by
Google·
PUBLIC HEALTH SERVICE
11
The investigation of industrial skin diseases has so far covered the
following industries: Rubber, dyeing of silk, wool and fur, oil refineries,
and candy making.
.
The office of milk invest~ations has been engaged in the followin~ investigations: (1) Studies of the bactericidal treatment of contamers and eguipment in connection with milk production, processin~, and distnbution; (2) studies of the public health significance of
nnlk cooling; (3) studies of the value of chlorine disinfection of udders
and hands as compared with simple cleansing; (4) studies of the relative value of the direct microscopic count, the standard plate count,
-&.nd the methylene blue reductase test as measures of milk sanitation; (5) studies of the effect of heating upon the growth-promoting
characteristics of cow's milk; and (6) studies of the extent of pasteurization and tuberculin testing in American cities of 10,000 population and over in 1927 and 1931.
A detailed analY,sis of the program of the health agencies in Brunswick and Greenville Counties, Va., is being conducted by the office
of pubJic health methods. The initial phase of the study is designed
so as to determine the health needs of people living in rural areas
and the manner in which an average small county health department
is meeting these problems.
The office of statistical investigations has been tabulating data on
the incidence and cost of illness in about 9,000 families located in 17
States and the District of Columbia. An incidence of 850 illnesses
per 1,000 population per year was recorded. Of the cases serious
enough to cause the patient to go to bed for one or more days, the
incidence rate was 461 per 1,000 persons per year, or 52 per cent,
and of those that caused the patient to lose time from his usual work
or school there were 545 per 1,000 persons per year, or 61 per cent.
At the stream pollution laboratory at Cincinnati, Ohio, particular
attention is bein~ paid to the rounding out of experimental evidence
and the summat10n, in permanent form, of the more important conclusions developed from the research studies in water purification and
natural stream purification upon which it has been engaged in recent
years. It has appeared advisable to give increased consideration to
the subject of sewage treatment, and in furtherance of this plan an
experimental activated sludge treatment plant is being constructed
for the research study of certain of the biochemical and biological
factors OJ.>erative in this method of sewage purification.
Followmg the discovery, in 1931, that rat fleas, taken on premises
where cases of endemic typhus were occurring, contained the virus of
the disease, studies were carried out to determine the behavior of the
virus in the flea and the exact mechanism of transmission from rat to
rat. It was found that the virus could survive in Xenopsylla cheopis
as long as 52 days, this being the limit of the experiment. It is
thought possible that fleas once infected may remain infected through
life.
The virus was found to undergo multiplication in the flea. After
the lapse of some days, titrations showed that the virus present in }{28000
of an infected flea was sufficient to infect a guinea pig.
Endemic typhus is readily transmissible from rat to rat by means
of fleas when the fleas are allowed free access to the rat. Efforts to
transmit typhus by feeding infected fleas on rats and guinea pigs
144391-32--2
Digitized by
Google
12
PUBLIC HEALTH SERVICE
through chiffon were without result. The feces of infected fleas were
found to contain the virus; when this material was rubbed into the
abraded skin of guinea pigs, the disease was transmitted.
· A vaccine prepared from an emulsion of typhus-infected fleas conferred some. immunity upon guinea pigs.
Evidence has been obtained that psittacosis is occasionally transmitted from person to person, particularly from patient to nurse.
Epidemiological studies appear to show that, in California, the shell
parrakeet is the great reservoir of infection. Cases of the disease
occurring in New York City were investigated, and the infection was
traced to shell parrakeets obtained from a bird dealer in San Francisco. The fact was revealed that psittacosis is present in the pa.rrakeet-breeding aviaries of southern California.
The possible danger to health from cold-storage wild rabbits has
been shown by experiments in which rabbits stored for 5 months
at 3° C. and those stored for 10 months at minus 15° C. still harbored virulent Bacterium tularense.
The National Institute of Health received 120 new strains of meningococci during the year; workers there have now made an intensive
study of the cultural characteristics and serological interrelationships
of 492 strains of the organism. Experiments with rabbits showed
that both a clinical and an histopathological meningitis can be
produced by intracisternal injection of large doses of virulent
meningococci.
A pharmacological study of phenol esters has disclosed certain relationships between the rate of hydrolysis of these compounds in vitro,
their stability and hydrolysis in vivo, and their pharmacologic action
in the animal organism.
A lar~e number of sugar compounds were prepared and studied,
with a VIew to enlarging our knowledge in the field of sugar chemistry,
which may throw light upon some of the obscure problems of disease.
The building program of the service includes two additional
buildings on the present site of the National Institute of Health, to be
used as administration and laboratory buildings respectiv£1ly, which
are now under construction, a laboratory building at Hamilton,
Mont., for use in connection with Rocky Mountain spotted fever
studies, plans for which were practically completed at the end of the
fiscal year, and a laboratory building on the site of the new marine
hospital at San Francisco, Calif., where studies of mycotic diseases
and plague work will be carried on.
THE MARINE HOSPITALS AND OTHER RELIEF STATIONS
Hospital and out-patient care were furnished to all legal beneficiaries in 25 marine hospitals, 16 second-class, 102 third-class, and
14 fourth-class stations, and to Coast Guard personnel and lighthouse
keepers at 108 other points. Twenty-four medical and dental
officers were also assigned to exclusive duty with the Coast Guard
at sea and elsewhere. A total of 343,054 persons applied for treatment and other medical services which aggregated 1,734,508 hospita.l
days, 972,110 out-patient treatments, and 76,179 physical examinations. The usual assistance was given to the Civil Service Commission, Steamboat Inspection Service, Bureau of Immigration,
Bureau of Industrial Alcohol, Employees' Compensation CommisDigitized by
Google
PUBLIC HEALTH SERVICE
13
sion, Veterans' Administration, Army Engineer Corps, Coast and
Geodetic Survey, Shipping Board, and other Government establishments. Sixty-one patients were admitted at the request of various
'State health officers, to the National Leper Home, where at the close
,of the year there were 366 leper patients.
Contracts have been let by the Supervising Architect for the con,struction of all the principal marine hospital buildings for which
.appropriations have been made except at Stapleton, Norfolk, and
Memphis, where plans have been completed and construction will
:Shortly begin.
PREVENTION AND CONTROL OF VENEREAL DISEASES
The work conducted during the year relating to the venereal
-diseases has been outstanding, considering the limited funds available
for this work. Some of the most important of these activities are as
follows: Extensive laboratory research on personal prophylaxis of
·syphilis, including determination of the relative efficacy of a large
number of chemical and pharmaceutical preparations that offer
promise of protection; inquiries into the origin and nature of the
-substance or substances in the blood responsible for the Wassermann
reaction; studies in the biology of the Treponema pallidum; and
-experimentation for the development of biologic products for use
in the diagnosis and treatment of gonorrhea. Several papers giving
the results of research into these problems are now in preparation for
publication.
Clinical research has been limited largely to inquiries into the
most effective treatment of early syphilis, conducted in cooperation
with five of the leading venereal disease clinics of the country. The
published results of some of these studies that have been completed
during: the year indicate the early formulation of improved and greatly
,simplified methods of treatment of this enormously prevalent and
tragically devastating disease.
The venereal disease clinic at Hot Springs, Ark., has been maintsined on a high plane of efficiency. The year has witnessed not
-only a marked increase in the number of applicants for free treatment but also a change in the type of applicant, apparently of a
higher social status who are induced to seek free treatment because
-of the present period of economic stress.
Valuable cooperation has been extended to the marine hospitals,
Federal penal and correctional institutions, and the Office of Indian
Affairs, Department of the Interior, for improving the quality of
antiluetic treatment for service beneficiaries, in Federal penal and
-correctional institutions, and the organization of effective syphilis
control measures among Indians.
Increased attention has also been given to the malaria treatment of
·general paralysis of the insane. The central malaria depot maintained at Columbia, S. C., continued to function smoothly and to
:supply the increasing demands for infectious material for therapeutic purposes.
During the year, 2,458,932 laboratory examinations were made in 43
·States cooperating with the service in reporting on the-prevalence of
the venereal diseases and the measures employed for their control,
.representing an increase of 15 per cent over the preceding year.
Digitized by
Google
14
PUBLIC HEALTH SERVICE
In addition, these States reported 422,191 cases of venereal diseases
under treatment-260,564 cases of syphilis, 158,083 cases of gonorrhea, and 3,544 cases of ch!.mcroid. This represents an increase for
all venereal diseases over the preceding year of 8.4 _J)er cent-for
syphilis 13.4 per cent, and ~onorrhea 1.4 per cent. There was an
increase in the number of clmics reporting during the year, and an
increase also of 3.4 per cent of new cases admitted to these clinics
over the preceding year.
NARCOTIC FARMS AND MEDICAL AND PSYCHIATRIC CARE OF FEDERAL
PRISONERS
The fiscal year marks the second full 12 months' activities of the
Division of Mental Hygiene, occupied with administrative duties
incident to the establishment of United States narcotic farms, and
with supervising and furnishing the medical, psychiatric, and
technical services for Federal prisons. The investigative functions
have involved special studies dealing with the subject of the abusive
uses of narcotic drugs; the quantities necessary for the medicinal and
scientific needs of the country; and of the nature of narcotic drug
addiction.
Th.e collection of data dealing with the medico-social aspects of drug
addiction was continued, and brief abstracts of laws and regulations
of the several States and local jurisdictions, dealing with the narcotic
drug situation, were prepared during the course of the year. Further
analysis has been made of the legal distribution of narcotic drugs
throughout the United States in connection with the studies of the
abusive uses of such drugs, and of the quantities necessary for supplying the medicinal and scientific needs of the country.
Construction of the first United States narcotic farm, in the
vicinity of Lexington, Ky., was begun in January, 1932.
The Public Health Service has continued to supervise the medical
services at the several penal and correctional institutions operated
by the Department of Justice. The service assumed the medical
services at three additional institutions during the past year: The
Federal correctional camp, Fort Eustis, Va., on January 1; and at the
Federal jail, New Orleans, La., and the Federal detention farm, La
Tuna, Tex., on March 1, 1932. Requests were received for the
service to supervise and furnish the medical service at the Federal
detention headquarters, New York City, N. Y., and the Hospital
for Defective Delinquents, Springfield, Mo.
Special studies have been made with reference to an appropriate
dietary for hospital prisons, the administrative problems involved in
connection with the care of the ambulant sick prisoner, standards
for the J?hysical and mental examinations of prisoners, and the
psychiatnc phases associated with the disciplinary and other problems
of penal and correctional procedure.
COOPERATION WITH OTHER AGENCIES
Durin~ the fiscal year the Public Health Service continued its
cooperative activities with official and unofficial organizations in
matters concerning the public health. A number of these cooperative activities are req).lll"ed by law and the remainder are deemed
Digitized by
Google
PUBLIC HEALTH SERVI CE
15
necessary in the interest of economical and efficient administration.
By means of this cooperation similar or related activities a.re coordinated and duplication of effort is avoided. Among the more important cooperative activities of the service, the following may be
mentioned:
1. With the Department of State in detailing medical officers for duty at
consulates in Europe, Canada, Mexico, and Cuba to examine medically intending
immigrants for visa purposes, and in the issuance of bills of health by American
consuls and related quarantine work; in the treatment of sick, destitute seamen
returned from abroad; in advising with the Department of State in problems
arising incident to certain international problems of the narcotic drug situation;
notification of the occurrence of plague or cholera in the United States or its
possessions.
2. With other bureaus of the Treasury Department in hospital care and medical and hospital services to the Coast Guard, including retired personnel; by the
assignment of medical and dental officers for duty at shore stations and on
vessels of the Coast Guard; in the development of venereal disease control activities among Coast Guard personnel; in making sanitary surveys of Coast Guard
stations; in furnishing permits to ships for medicinal liquor and narcotics; service
of officers on committees for the examination and disposition of narcotic drugs;
with the Office of the Supervising Architect in the preparation of plans for the
first narcotic farm near Lexington, Ky.; with the Office of the Supervising Architect with regard to air conditioning apparatus and in the preparation of plans
for water supply and sewage disposal systems at border stations; with the Bureau
of Customs in adjudication of violations of the act of February 15, 1893, resulting
from failure of masters of vessels to present American consular bills of health;
in issuing port sanitary statements to outbound veBBels; and in standardizing
and administering procedures required of aircraft arriving in the United States
from foreign countries; with Bureau of Narcotics in advising relative to administrative problems.
3. With the War and Navy Departments in physical examination of applicants
for Officers' Reserve Corps and citizens' military training camps; medical and
hospital services for civilians employed on vessels of the Mississippi River Commission, Army Engineer Corps, and Army transports; treatment of officers and
enlisted men of the armed forces (as pay patients); in making examinations of
the drinking water systems on vessels of the United States Army engineers;
with the United States naval hospital, League Island, Pa., on the therapy of
paresis.
4. With the Department of Justice and local United States district attorneys
in matters related to the protection of the interests of the United States in which
the administration of the quarantine laws and regulations is concerned, or in
which the proper care and preservation of public property are concerned; with
the Bureau of Prisons in furnishing the medical and psychiatric services in
Federal penal and correctional institutions; in treating Federal prisoners in and
from jails and prisons lacking proper medical facilities; making sanitary surveys
of water-supply and sewerage systems and milk supplies at penal institutions;
in the standardization of the treatment of the venereal diseases in Federal penal
and correctional institutions.
5. With the Post Office Department in supplying first aid and special physical
examinations; inoculation of employees handling mails against typhoid fever
and vaccination against smallpox; medical testimony in the suppression of frauds.
6. With the Department of the Interior, Office of Indian Affairs, in a study
of dental caries in relation to diet and climate; in the investigation of water
supply and sewerage systems on Indian jurisdictions; in the development and
organization of the mass control of syphilis among reservation Indians; with the
National Park Service in the supervision of sanitation in the national parks
and mountains; in maintaining a venereal disease clinic for indigents at Hot
Springs; in the examination of water supplies and advice regarding sanitation
in connection with the Hoover Dam.
7. With the Department of Agriculture in inoculating certain field employees
against typhoid fever and vaccinating against smallpox; assisting in the local
enforcement of plant and animal quarantine on vessels arriving from foreign
ports; in making sanitary surveys of national forests and watersheds; in the
enforcement of the pure food law in relation to the adulteration of shellfish; and
in the investigation of the disposal of industrial wastes at the experimental
station at Houma, La.
Digitized by
Google
16
PUBLIC HEALTH SERVICE
. · 8. With the Department of Commerce in standardizing and administering
procedures required af aircraft arriving in the United States from foreign countries and the development of marine standards, in cooperation with the American
Marine Standards Committee, relating to ship sanitation; physical examination
and instruction and examination in the principles of first a.id of applicants for
license as ships' officers, at the request of the Steamboat Inspection Service;
treatment of lighthouse keepers and sea.men from vessels of the lighthouse establishment, Coast and Geodetic Survey, and Bureau of Fisheries; furnishing medical
supplies to lighthouse vessels; in ma.king sanitary surveys of lighthouse and airway
stations; in the examination of drinking water systems on vessels; and in ma.king
a sanitary survey of the helium plant at Amarillo, Tex.; with the Bureau of Standards by detail of an officer in charge of the dispensary a.nL for the investigation
of health hazards in industry; with the Bureau of Mines by the detail of medical
personnel.
9. With the Department of Labor by examining immigrants in the United
States and furnishing medical ca.re to detained aliens; also standardizing and
administering procedures required of aircraft arriving in the United States from
foreign countries; with the Children's Bureau by representation on the advisory
committee on the regulation of employment of minors in hazardous industries.
10. With the Civil Service Commission by physical examination of applicants
and employees and of applicants for reinstatement and retirement.
11. With the United States Shipping Board by physical examination of crews;
in the development of a program for prevention of venereal diseases among the
sea.men in the American Merchant Marine.
12. With the United States Employees' Compensation Commission in supplying
hospital and out-patient treatment of disabled Federal employees; physical
examinations and special investigations; a permanent boa.rd of medical officers
for disputed and difficult claims; medical assistance in oa.!!Ying out the longshoremen's and harbor worker's compensation a.ct and the District of Columbia
Workmen's compensation a.ct.
13. With the United States Veterans' Administration in physical examinations and hospital and out-patient treatment of patients; physical examinations
of applicants for military pensions requested by the Bureau of Pensions.
14. With the Office of Chief Coordinator by detailing medical officers for
service on committees of the Federal Specifications Board, and on the Federal
Standard Stock Catalogue Boa.rd.
15. With the Office of Public Buildings and Public Parks of the National
Capital in the sanitary inspection of Government office buildings in Washington,
and in mosquito control work on Government reservations in the District of
Columbia..
16. With the House of Representatives in an investigation of the air conditioning in the House Chamber and several committee rooms and with the Committee on Claims, House of Representatives in physical examinations of subjects
of special bills.
17. With the Boa.rd of Health of the Territory of Hawaii in the ca.re and
treatment of lepers and in the control and eradication of bubonic plague.
18. With the Office International d'Hygiene Publique, Paris, and the Pan
American Sanitary Bureau, Washington, D. C., in matters relating to public
health and maritime quarantine and the exchange of information relative to the
prevalence of qua.ra.ntina.ble diseases.
19. With the health section of the League of Nations in supplying information
as to the prevalence of diseases in the United States and data relative to syphilis
in this country, to be used in a world wide clinical study of syphilis.
20. With all States of the Union in the collection of morbidity reports and
epidemiological data relating to communicable diseases.
21. With all States in the supervision and certification of water supplies used
by common carriers in interstate traffic.
22. With State departments of health in securing reports of oases of venereal
diseases and compiling and publishing reports of State control and clinic activities.
23. With the State departments of health in segregating lepers at the National
Leper Home, Carville, La.
24. With the New York State Department of Health in the development of
educational work on the prevention of venereal diseases.
25. With Mississippi, Alabama, Georgia., Tennessee, North Carolina., and
Virginia. in the development of State venereal disease control activities.
26. With 21 States in the conduct of a school of instruction regarding studies
of stream pollution.
Digitized by
Google
PUBLIC HEALTH SERVICE
17
27. With Alabama, Connecticut, Delaware, Florida, Georgia, Louisiana,
Maine, Maryland, MissiBBippi, New Hampshire, New Jersey, New York, North
Carolina, Pennsylvania, Rhode Island, South Carolina, Texas, Virginia, and
Washington in the investigation of shellfish growing areas and the development
of local sanitary control machinery.
28. With Kentucky, Missouri, Tennessee, Georgia, Illinois, Oklahoma, and
Texas in measures for the prevention and eradication of trachoma, and with
Kentucky, MiBBouri, and Tennessee in maintaining hospitals for trachoma.
29. With Alabama, Arizona, Arkansas, California, Florida, Georgia, Idaho,
Iowa, Indiana, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, MiBBissippi, Missouri, Montana Nevada, New Mexico, North Carolina,
Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas,
Virginia, and Washington in making cooperative demonstrations in county
health work in counties in these States.
30. With Alabama, Arkansas, Georgia, Illinois, Indiana, Kansas, Kentucky,
Louisiana, MissiBSippi, Missouri, Montana, North Carolina, North Dakota, Ohio,
Pennsylvania, South Carolina, Texas, Tennessee, Virginia, and West Virginia in
cooperative county health work in the drought-stricken areas.
31. With Montana, Oregon, Wyoming, Idaho, Washington, Nevada, California, Colorado, Utah, New Mexico, South ·Dakota, Nebraska, Minnesota, and
Pennsylvania in furnishing vaccine for protection against Rocky Mountain
spotted fever.
32. With Illinois, Arkansas, West Virginia, Kentucky and Oregon in venereal
disease prevalence surveys.
33. With New York, New Jersey, and Connecticut in the formulation of a TriState Treaty Commission for the regulation of pollution of the harbor in the
vicinity of New York City.
34. With Louisiana, Tennessee, and Kentucky in pellagra control measures.
35. With Pennsylvania, West Virginia, and Ohio in connection with a survey
of the sanitary condition of the Upper Ohio River.
36. With Massachusetts and Virginia in making surveys and furnishing adviceconcerning mosquito-control measures.
37. With Tennessee and Georgia in county-wide malaria control experiments.
38. With Missouri for advice concerning a study of the Missouri River.
39. With the District of Columbia, in an investigation of the hearing of school
children and in mosquito-control work.
40. With Idaho in a study of the problem of the pollution of the Coeur d'Alene
River.
41. With Texas in a mosquito survey of Galveston and its environs.
42. With Georgia in the reorganization of the Richmond County Board of
Health.
43. With Virginia in a survey of salt marsh mosquito production areas in
southeastern Virginia.
44. With California in the investigation of an outbreak of psittacosis.
45. With Maryland in a survey of the milk supply of Anne Arundel County.
46. With Minnesota in the reorganization of the Duluth health department.
47. With Kansas in a survey of the work and organization of the State board
of health.
48. With South Carolina in furnishing biological products used in the prevention of epidemic diseases.
49. With the cities of Wilkes Barre, Pa., Baltimore, Md., and Seattle, Wash.,
in surveys of health service.
50. With the cities of Baltimore, Md.; Birmingham, Ala.· Dallas, Tex.·
San Francisco, Calif.; Charleston, W. Va.; and New Orleans, La., in venereaf
disease prevalence surveys.
51. With San Francisco, Calif., and with the cities and counties in the vicinity
of San Francisco Bay in rodent control and the operation of the plague laboratory
at San Francisco.
·
52. With the Baltimore Health Department and the Baltimore Chamber of
Commerce in a study of the loss of light due to smoke in Baltimore, Md.
53. With Rocky Mount, N. C., in a survey of mosquito production.
54. With the Canadian Health Department in the enforcement of Canadian
and American regulations concerning water supplies, water supply systems of
foreign v688els operating on the Great Lakes, and in shellfish sanitation work.
Cooperation has also been carried on with a number of organizations engaged
in public health activities, namely, the Julius Rosenwald Fund in the promotion.
of syphilis control among rural Negroes in the Southern States; the Milbank
Memorial Fund in research of syphilis and in studies of morbidity in a rural anct
Digitized by
Google
18
PUBLIC HEALTH SERVICE
an urban area; the Gorgas Memorial Laboratory in malaria research; the National
Research Council by representation on its committees; with the international
health division of the Rockefeller Foundation in cooperative county health work
and emergency health work resulting from the drought; with the health division
of the Department of Public Welfare of the General Federation of Women's Clubs
through membership on the National Advisory Committee; with the National
Parent-Teachers Association through membership on the Advisory Council on
Child Health; with the reorganized Committee on Clinical Research in Syphilis,
comprising the directors of the syphilis clinics of Johns Hopkins University, Mayo
Clinic, University of Michigan, University of Pennsylvania, and Western Reserve
University; with the Marine Library Association in the distribution of educational
material to seamen in the merchant marine; the American Railway Association in
the completion of the report with recommendations concerning the sanitation of
rail water supplies and coach yards; the American Association of Railroad Surgeons
for the better control of the venereal diseases among railway employees; the Brotherhood of Railroad Trainmen in the investigation of an eye condition occurring
among railroad employees in Kansas; the International Commission on Zoological
Nomenclature in connection with questions on nomenclature and terminology;
the National Conference on the Nomenclature of Disease in developing a standard
system of nomenclature of disease for the United States; the New York Loose
Milk Commission in a determination of the hazard involved in the sale of loose
milk in New York City; the President's Conference on Home Building and Home
Ownership through membership on its committees; the Committee on the Costs
of Medical Care in the tabulation of data on the incidence and cost of illness;
Brookings Institution in a study of the public health organization in Mississippi
and Alabama as a part of their general survey of the State governments; the
American Standards Association in assisting in the formulation of standard
specifications for household refrigerators; Johns Hopkins Hospital in the study
of the mental status of children of various types of birth; the Girl Scouts of the
District of Columbia in physical examination of girl scouts; the Ohio River
and Great Lakes Drainage Basin Boards in the formulation of suitable analytical
procedures for stream examinations; the Del-Mar-Va Eastern Shore Association
in connection with an antimosquito campaign; the Academy of Medicine of
Long Beach, Calif., in a survey of the social and medical agencies of Long Beach;
the Milledgeville (Ga.) State Hospital in connection with studies of pellagra;
the drug committee of the National Research Council, the statistical committee
of the American Psychiatric Association, the psychiatric committee of the
American Medical Association, and a special committee of the American Hospital
Association concerning the best methods of safeguarding the use of narcotic
drugs in American hospitals to indispensable purposes; the commission of the
League of Nations in standardizing methods of opium assay.
Cooperation between the various divisions of the service enables any particular
division to take advantage of service facilities, including hospital and laboratory.
The Public Health Service desires to acknowledge assistance
received from the following agencies:
The Department of Health of Puerto Rico for the use of its laboratories; the New York State Institute for the Study of Malignant Diseases for the care and study of cases of suspected cancer; boards of
health of Florida, Indiana, and Washington, and city health departments of Baltimore, Buffalo, Milwaukee, and the University of Kentucky for Wassermann tests performed; themedicalschoolsofHarvard
and Yale Universities and the State hospital for the insane, Columbia,
S. 0., for laboratory space; Jackson Memorial Laboratory at Bar
Harbor, Me., for assistance in cancer studies; Crocker Institute for
Cancer Research for strains of transplantable tumors; Pan American
Airways for cooperation in a study of the airplane convection of
mosquitoes. The cooperation rendered by these several agencies has
made practicable the conduct of certain important activities.
RECOMMENDATIONS
The promotion of the public health and the prevention of disease are
of fundamental importance to the Nation. Recommendations as to
Digitized by
Google
PUBLIC HEALTH SERVICE
19
the methods of protecting the public health in the most economical
and efficient manner are necessary from time to time.
New problems relating to the prevention and control of disease are
constantly arising; as recent examples may be mentioned the identification of Rocky Mountain spotted fever of the eastern type along the
Atlantic seaboard of the United States and the recognition of parrot
fever, or psittacosis, as an endemic disease among birds of the parrot
family in certain sections of the Pacific coast. Constant vigilance is
required for the detection and prevention of new dangers to the public
health that arise from time to time.
The recommendations submitted herewith constitute the most
important needs at the present time.
SCIENTIFIC RESEARCH
In connection with the development and expansion of the research
activities of the National Institute of Health, there is an increasing
need for an animal farm for the breeding of animals necessary in these
investigations. At the present time the limitations of supply and the
loss of animals due to intercurrent infections present a senous problem
and handicap in the conduct of experiments. If an animal farm could
be made available it would be possible to regulate the supply to meet
the demand and to insure the propagation of known strams free from
infections.
In connection with the present economy program of the Federal
Government, it has been necessary to postpone a number of studies
which could be profitably pursued and which are of general public
health importance. There is practically no field of public health
research which does not contain rmportant problems, but in some fields
there is a pressing need to extend the work now under investigation.
Among such studies are those in connection with the control and
standardization of biologic products, the investigation of many chemical products, especially new compounds which have come into general
and industrial use without adequate knowledge of their toxicity, and
extended inq_uiry into the field of nutrition as it relates particularly
to the vitamins.
.
RURAL HEALTH WORK
Sanitarians now generally concede that attempts to prevent the
spread of highly conta~ous and infectious diseases through the application of local quarantme measures are effective only to a very limited
degree. The control of communicable diseases has become largel7 a
matter of community-wide activity in which environmental sarutation, ~eneral immunization, and intensive educational work play the
most important part. Therefore, it is believed that the best way for
the Public Health Service to control the interstate spread of diseases,
and incidentally to bring about a betterment in tbe status of the
health of the citizens of the United States as a whole, is to render
assistance to State and local authorities in the development and
extension of adequate local health organizations.
Since the Public Health Service began its coop~rative activities in
studies and demonstrations in rural sanitation, there has been a constant increase year by year in the number of efficient local health
.organizations rendering service to the rural· populace of the United
States. As yet, however approximately only 30 per cent of the
people residing in the rurai sections of the United States are enjoying
Digitized by
Google
20
.PUBLIC HEALTH SERVICE
the health and economic advantages of such service. The continued
cooperation on the part of the Federal Government in this activity
is deemed essential, and the participation in the demonstration work
on a larger scale by the Public Health Service is justifiable to the end
that the area of rural territory under health service may be extended
more rapidly.
MARITIME QUARANTINE
In order to carry out existing provisions of quarantine and immigration laws relating to the medical examination of persons from foreign
eountries, all airplanes from foreign countries should be required to
to undergo guarantine and medical immigration inspections upon
.arrival at designated airports of entry; and it is recommended that the
designation of airports as airports of entry should be limited in number
.and confined to the principal airports possessing adequate facilities
along the frontiers, at many of which locations personnel are already
available. The designation of numerous airports as airports of entry,
particularly those in interior locations without adequate facilities for
the conduct of quarantine and immigration functions, practically prevents the proper and necessary medical inspection of planes and their
passengers, inasmuch as medical personnel are not available for this
work. A :proposed International Convention for the Sanitary Control of Aenal Navigation has recently been prepared under the auspices of the-International Office of Public Hygiene in Paris and will
·shortly be referred to participating governments for ratification and
adoption. Under this convention the designation of airports of entry
would be limited in adhering countries to airports possessing medical
personnel and quarantine facilities, as prescribed by the convention.
In recognition of the performance of foreign quarantine operations
,as a Federal function, several States relinquished their performance
to the Federal Government with the understanding that facilities
,adequate to the needs of such work would be maintained and supplied
by it. In some instances adequate facilities are not available, and in
,order properly to perform quarantine duties for the protection of ports
in these States in particular, and the country in general, against the
possible introduction of exotic and pestilential diseases from infected
places abroad, it is recommended that facilities adequate to the needs
-of such ports be provided.
The International Sanitary Convention of Paris, revised in 1926,
ratified by the Senate on March 22, 1928, imrosed upon adhering
-countries the obligation to provide their principa ports with personnel
trained in the examination of ships for rat-infestation purposes and the
disinfestation of those determined to be rat infested. For over a score
-0f years the United States has maintained a leading position as regards
personnel and equipment for the deratization of vessels, but personnel
for the examination of vessels for rat-infestation purposes had to be
provided. It was requested that 25 new positions be authorized for
the fiscal year 1931 to provide personnel trained in the rat-infestation
inspection of vessels at the most important United States ports, in
-compliance with tliese treaty requirements, of which number 15 were
·subsequently authorized. It had been possible to :procure and train
.about 10 of these 15 inspectors prior to the prohibition against new
positions, made effective during the spring of 1932. As soon as
.:fiscal conditions permit, 15 additional mspectors, 5 of whom have
Digitized by
Google
PUBLIC HEALTH SERVICE
21
already been authorized, should be provided in order that the United
States may carry out its treaty obligations in regard to the ratinfestation inspection of vessels arriving from foreign ports, in
accordance with treaty requirements.
KAJUNJll HOSPITALS
The need for additional hospital buildings at the National Leper
Home has become urgent, as the institution 1s now full and additional
facilities are needed, especially for bedfast patients for whose care a
suitable building is lacking. To complete the buildin~ program,
quarters should be constructed at certain marine hospitals as an
economical measure to save rentals and allowances, and ward buildings are required in a few places to remove fire hazards and improve
facilities. The hospitals chiefly concerned are those at Boston,
Buffalo, Fort Stanton, Pittsburgh, Portland (Me.), and St. Louis.
PRINTING
The expanding activities of the Public Health Service imposed by
law, particularly with respect to the Division of Mental Hygiene in
relation to the development of the narcotic farms and the furnishing
of medical and psychiatric care to Federal prisoners, have made imperative for administrative use much additional printing of blank forms
and similar matter. Because a considerable amount of the printing
allotment has necessarily gone to new activities, a lar~e number of •
manuscripts of important studies conducted by the service of interest
to public health workers, have not been published by reason of the
lack of necessary printing funds. The allotment of funds for printing
for the fiscal year 1933 has been reduced by almost 50 per cent. This
will seriously handicap the work of the Public Health Service. It is
recommended that as soon as possible the allotment of funds available
for printing be restored to the normal amount.
PERSONNEL
The scope of service activities and the obligations imposed upon it
call for additional specialized personnel. The diversity of obligations imposed upon the service makes pressing demands for enlarging
the regular medical corps of the Public Health Service so as to permit
and provide specialization in certain lines of its essential work. Fourteen additional regular medical and dental officers are needed for
assignment to new units of Federal penal and correctional institutions.
Additional conmrissioned medical officers are needed in the marine
hospitals to devote themselves to special professional services that
can not, in the present advanced state of medicine, be satisfactorily
performed by officers whose hospital duties alternate with other
assignments. A number of high-salaried acting assistant surgeons
would be thus replaced. Additional commissioned medical officers
are also needed for assignment to important investigative studies.
H. s. CUMMING,
Surgeon General.
Hon. OGDEN L; MILLS,
Secretary of the Treasury.
Digitized by
Google
DIVISION OF SCIENTIFIC RESEARCH
In charge of Asst. Surg. Gen. L. R.
THOMPSON
CANCER
Medical Director J. W. Schereschewsky continued in charge of tho
field investigations of cancer-with headquarters at the Harvard Medical School. The work carried out during the fiscal year consisted in
the continuation of the program for research begun in the year before.
Studies of the biological effects of radiation.-The scope of thesestudies includes the investigation of the biological action of the whole
spectrum of radiation from high-frequency X rays down to electromagnetic radiation.
Studies of the biological action of X rays.-Progress during the fiscal
year on the biological action of X rays was limited to preparatory
work.
Mitogenetic radiation.-The apparatus for detecting and measuring
extremely small quantities of radiation, constructed by Biophysicist
Lorenz, the so-called "Geiger radiation counter" was further devel_oped and improved durin~ the year. Further attempts were made to
demonstrate this radiation by photographic means. The results
were negative.
Biological studies oj mitogenetic radiation.-Further effort was also
made to demonstrate the presence of mitogenetic radiation through
biological means.
Siebert had reported that tetanized frog's muscle was an activesource of this radiation, the increase in the percentage of budding in
yeast cells being used as an indicator. Siebert's experiments were
carefully repeated a number of times at tho cancer investi~ations
laboratory, using the methods and technique described in Siebert's
paper, but with negative results.
With the aid of Assistant Surgeon Binford, a study was made of
the natural variability in the percentage of budding cells taken from
different areas in the same yeast culture, all cultures utilized being
grown under standard conditions. As the result of a very large
number of counts, the conclusion was reached that, in the same yeast
culture, there might be a variation of ± 10 per cent in the percentage
of budding yeast cells in samples taken from different parts of a culture presenting an entirely homogeneous appearance.
Electromagnetic radiation.-Further studies were undertaken on the
biological action of very high frequency electromagnetic radiation.
Studies were also made (a) as to the direct heating effects of such very
high frequency currents upon mice; (b) of the heating effects on solutions of electrolyte (KOi) in relation to frequency and to concentration; (c) of such currents on solutions of electrolyte to which various
organic materials, such as serum albumen had been added; (d)
studies of the heating effects of high frequency electrostatic fields
upon various tissues and organs (brain, liver, spleen, muscle, blood)
22
Digitized by
Google
PUBLIC HEALTH SERVICE
23
in relation to frequency, and (e) studies, at high frequency (1.08 X
108 cycles per second) of the dielectric constants of various tissues,
organs, and organic fluids. The data derived from these studies are
now being assembled with a view to publication.
·
BIOLOGICAL INVESTIGATIONS
Study of the general problem of immune reactions to malignant
~owths was continued by Biologist H. B. Andervont. They have
mcluded (1) studies of immunity to malignant growths; (2) effects of
temperature upon the growth of tumors and the development of resistance; (3) timerequiredforproduction of maximum resistance; (4)
sex differences in induced immunity; and (5) inhibition of the immune
reaction. The results of these studies have been prepared for publication in the Public Health Reports.
Gross immunity studies.---A. natural extension of the immunity
studies is the investigation of the extent to which resistance to the
implantation of a tumor of high growth energy, such as mouse sarcome 180, confers resistance to other transplantable tumors, and
conversely.
In the case of two epithelial tumors propagated at the cancer
laboratory, namely, mouse carcinoma M 63 and a strain of transplantable adenocarcinoma developed there, it was found that, while
both the~e tumors give a hi~h percentage of takes in control animals,
from 65 to 70 per cent of mice which had previously been immunized
to sarcoma 180 were likewise resistant to the implantation of both of
these strains of carcinoma. On the other hand, mice resistant to
either of these carcinomas were not rendered resistant to sarcoma 180.
Because of the results of these experiments, other strains of transplantable tumors have been obtained through the courtesy of Dr.
Francis C. Wood, director of the Crocker Institute for Cancer Research, and preliminary experiments with respect to cross immunity
between sarcoma 180 and these various strains are in progress.
Ejfects of immunity to a transplantable tumor upon the subsequent
development of spontaneous tumor.-Reference has already been made
to the circumstance that acquired immunity to sarcoma 180 conferred
at the same time resistance to several strains of transplantable
carcinoma. Since, morphologically, these tumors resemble the
spontaneous mammary carcinoma, both of the Buffalo mouse colony
and of the Agourti strain obtained from the Roscoe B. Jackson
Memorial Laboratory, at Bar Harbor, Me., it is obviously of interest
to determine the effect of immunization to mouse sarcoma 180 upon
.the subsequent development of spontaneous mammary carcinoma
in strains of mice havin~ a high spontaneous tumor rate.
It has not been practicable to carry out this line of inquiry at the
cancer investigations laboratory, because the tumor rate in both
colonies of spontaneous tumor mice being propagated there is still
insufficiently stable to furnish suitable control experiments. Moreover, it has been found that the Buffalo strain of mice can be immunized
only with difficulty to mouse sarcoma 180. For these reasons, and
through the kind cooperation of Dr. C. C. Little, director of the
Jackson Memorial Laboratory, arrangements have been made to
pursue this line of investigation at that institution, where strains of
mice are available, having both a high and stable spontaneous tumor
Digitized by
Google
24
PUBLIC HEALTH SERVICE
rate and which, at the same time, may be readily immunized to sarcoma 180.
Rous fowl sarcoma.-Work on the problem of imm.umzing chickens
against the Rous fowl sarcoma, in order to study further the natureof resistance to this type of tumor, was resumed in the spring of 1932'
upon a larger scale.
Cytological studies.-Concurrently with the work now in progress
at the Jackson Memorial Laboratory, and in consultation with Dr.
and Ml"s. Warren H. Lewis, of the Carnegie Foundation, Biolo~st.
Andervont is conducting, at the Mount Desert Island Biological
Laboratory, cell culture studies with the object of ascertaining the
effect, if any, upon tumor cells of mouse sarcoma 180, of growing these
cells in tissue cultures in a medium containing the plasma of mice-.
immune to this tumor.
BIOCHEMICAL STUDIES
The primary concern during the first part of the fiscal year has been
the equipment and organization of the biochemical laboratory.
The necessary apparatus and supplies have gradually been obtained
and installed, and through the cooperation of the department of preventive medicine and hygiene of the Harvard Medical School, the
necessary physical facilities have been supplied.
Critical review of the literature on the inorganic constituents of malignant tissues.-Biochemist M. J. Shear began a review of the literature
upon the inorganic constituents of malignant tumors, particularly
with respect to sodium, potassium, calcium, and magnesium, since
these bases occur in the body in large amounts and have frequently
been asserted to play: a significant part in cancer. The literature was,
exhaustively and critically surveyed, and a manuscript was prepared
which will be submitted for publication under the title of "The R~le·
of Sodium, Potassium, Calcium, and Magnesium in Cancer: A Critical
Review."
Studies of the ir,jf,uence of calcium salts on tumor growth.-Reports.
in the literature of the retarding influence of calcium salts upon tumor~owth warrant further study. Calcium salts were therefore admintstered by various routes. They were dissolved in the drinking wateror mixed with the food, and were also injected subcutaneously,
intraperitoneally, and intravenously. The salts employed were the,
carbonate, the chloride, the lactate, and the gluconate. They were _
given for various periods before and after inoculations with mousecarcinoma M 63 and mouse sarcoma 180. The dosage and frequency of administration were also varied.
Although 1,000 mice were used in these various experiments, the,
net results were negative. At times a slight retarding effect appeared
to be obtained, but the results were neither regular nor clear cut.
Determination of the calcium ion.-ln recent years a number of'
investigators have published data purporting to show that in cancerthere is a decrease in the calcium ion concentration of serum. However, the data as to the calcium ion concentration of serum havebeen obtained by calculations based on formulas of dubious validity.
Two types of methods were investi~ated during the year: Th&
first, and most desirable, was the possibility of the direct measurement.
of calcium ion activity by means of a first order calcium electrode.
Although the results so far have not been encouraging, the attempt.
Digitized by
Google
25
PUBLIC HEALTH SERVICE
to devise a satisfactory first order electrode has not yet been abandoned.
.
The second is an indirect method in which serum is saturated with a
calcium salt of low solubility and the calcium ion concentration calculated with the aid of the solubility product constant. Such a
method, in which CaHPo4 is the saturating salt, has already been
used provisionally by Shear and Kramer. However, further study
is necessary to determine whether by such method accurate data on
calcium ion concentration may be obtained. A basic investigation
of the equilibria involved when CaHPo4 is equilibrated both with
inorganic serum solutions and with serum has·_ been begun. Interesting results which concern interaction with the magnesium have already
been obtained. These studies of the equilibria involving Ca, Mg,
Po,, HCo 8 , and pH are still in progress.
Action of organic extracts upon tumor growth.-Another line of investigation pursued during the year has been the preparation of extracts
and fractions from biological material, and the testing of their action
upon the growth of tumors. Extracts of various sorts were made
from the Rous fowl sarcoma, mouse sarcoma 180, and mouse embryo
under conditions minimizing the possibility of oxidation, i. e., the
operations were carried out in an atmosphere of nitrogen and cysteine
was added to the solutions.
. These substances were administered to tumor-bearing mice with a
view to observing any possible effects in reduction of percentage of
takes, retardation in tumor growth, or production of immunity.
While most of the experiments gave negative results, some encouragement was given when one particular extract of mouse sarcoma 180
was found, in one experiment, to have rendered a number of mice
resistant. Although the immunity could not be produced at will,
the results were sufficiently encouraging to warrant further experimentation along this line.
The technique devised by Professor Abel, of Johns Hopkins University, to obtain active fractions from biological material has also been
employed. A large amount of tumor tissue (sarcoma 180) was
obtained and subjected to the fractionation process. At the same
time the spleens of the tumor-bearing animals were treated in the
same way and the same number and types of extracts prepared from
them as from the tumor tissue. The effects of these preparations on
the growth of sarcoma 180 were studied upon a large number of mice.
The net result was negative.
Action upon tumors of ba.cterial washings.-Gratia and Linz found
that bacterial washings are capable of producing hemorrhage in
liposarcomas of guinea pigs, followed by subsequent regression of the
tumors. Shwartzman and Michailovsky extended this work and
have obtained similar results with mouse sarc·oma 180. In collaboration with Biologist Andervont, Biochemist Shear tested Shwartzman's
filtrates on mice bearing mouse sarcoma 180, confirming Shwartzman's
findings: The filtrate produces hemorrh~e in the tumor and, apparently, nowhere else in the mouse; regression of the tumor frequently
follows. In some cases recrudescence occurs after a period of regression; in other cases the tumor completely recedes.
Unfortunately this material kills a large proportion of mice when
given in doses large enough to produce regression. Attempts were
made to produce recession by the repeated administration of wellDigitized by
Google
26
PUBLIC HEALTH SERVICE
tolerated doses. These experiments have yielded essentially negative
results.
.
Studies of fluid exchange in malignant tissue.-Toward the end of
the fiscal year studies were begun of the relation of tumor growth to
certain physicochemical processes concerned in fluid exchan~e. Such
phenomena as permeability, oncotic pressure, imbibition, ana diuresis
are being studied in vitro, while, at the same time, parallel investiga-:tions are being carried out in mice. Inasmuch as calcium salts and
acid salts have an influence upon fluid exchange and upon the coagulation of colloids, in carrying out this line of inquiry, attention i~
being paid to the possibility of finding interesting relationships between the inorganic constituents of cells and these physicochemical
processes.
Spontaneous tumor colonies.-Two strains of mice, the well-known
Buffalo strain and an Agouti strain obtained from the Jackson
Memorial Laboratory at Bar Harbor, Me., have been propagated
for the last two and one-half years at the laboratory. Unfortunately,
since these strains have been propagated, they have failed to maintain the spontaneous tumor rate to which they were subject in their
original environment.
·
During the past fiscal year an effort has been made, by means of
selective breeding, both to increase and to stabilize the spontaneous
tumor rate. Until this has been accomplished, it will not be practicable to use these colonies for studies in tumor susceptibility which
have been planned.
Cytological laboratory.-Cytologist L. C. Fogg joined the staff at
the cancer investigations laboratory on May 23, 1932. He has been
enga~ed in organizing and equipping a cytological laboratory and in
certain preliminary studies.
HEART DISEASE
Medical Director A. M. Stimson was detailed in charge of studies
of heart disease effective July 16, 1931, with headquarters at the
National Institute of Health.
Much of the work of the year was necessarily of an orienting and
organizing character. The officer in charge spent several months in
reviewing literature and in making contacts with and consulting
specialists in this branch of study before deciding upon the most
suitable approach to this complicated problem.
In accordance with the preliminary findings, the experimental
features of rheumatic heart disease were selected as the subject of
the initial studies, and by the end of January, 1932, active experimentation was well under way. The force consisted of the officer in
charge, a medical officer assistant, a bacteriologist, and an attendant.
The plan of work has been restricted to a check on the recent
bacteriological investigations in the etiology of rheumatism. While
these investigation have been highly suggestive that the right track
has been selected for the solution of the problem, the results have
apparently been inconsistent in the hands of different observers and
have certainly lacked finality. An attempt has been made to combine the favorable methods used by previous investigators and to
introduce certain features from which better results might be expected.
Digitized by
Google
·
I
1
1
27
PUBLIC HEALTH SERVICE
egative'
end of
wth to,
Such'
1ures1S
estigats and
coagu:ion is ·
ps be-:
miical
:nown
ckson
gated
'ttely,
naintheir :
1
ns of
The procedure in general has been to secure blood from patients
suffering from acute rheumatism with or without heart involvement,
to cultivate if possible organisms therefrom, and to expose animals
to these organisms by various methods of inoculation. In consideration of what appears to be a strong possibility of a nutritional element
in the etiology of rheumatism, a number of these animals were placed
on vitamin A deficient diet. ·The results of this diet constitute a byproduct of the principal study of considerable interest in itself, which
1t is intended to publish when the work is a little further advanced.
Blood specimens have been secured from 32 patients with frank
acute rheumatism or with strongly suggestive symptoms. From
these, 55 cultures have been secured with which it seemed profitable
to work. Twenty-four dogs have been exposed to one or another of
these cultures by various methods of inoculation, and the virulence
of the organisms for mice and rabbits has been determined. Three
monkeys have been used. While several animals have developed
cardiac lesions under this treatment, with the exception of one there
has been no strong reason to suspect that the lesions were of rheumatic
type. In this one case further study, now in progress, will be necessary before a decision can be reached.
1eous
)fRC·
hich
rat
>een
1 in
lies
the
nd
in
ng
)St
;al
of
-iin
t.
1t
le
:k
,e
.d
1-
0
I.
LEPROSY
The conduct of studies at the leprosy investi~ation station at Honolulu, Hawaii, has been continued under the direction of Surg. N. E.
Wayson; and the medical activities of the adjoining Territorial
receiving station and hospital have been directed and executed by
him with the assistance of Passed Asst. Surg. J. R. Murdock.
The treatments used during the past year may be classified as
hygienic, stimulative, corrective, and symptomatic. Hygienic measures include those which are customarily so regarded, and the routine
administration of cod-liver oil. All patients have an established rest
period during the middle of the day. An adequate diet is provided,
but the adjustment of the dietary remains a troublesome problem.
Stimulation to the general metabolism and to special tissues, such as
those of the skin, have been obtained by the injection of irritant
substances into the muscles or skin; but an increasing use has been
made of prolonged hot baths, ultra-violet light exposure, and diathermy for this purpose. By each of these methods an attempt is
made to induce a febrile reaction of several hours' duration, or to
effect an active congestion of the blood vessels in the surface ormember
treated. The corrective and symptomatic treatments are applied for
the relief of complicating conditions.
The progress of each patient is watched through systematic weekly
inspections and monthly examinations, to which are added such
special examinations as may be indicated.
These changes in methods have been made possible durin~ the past
six months by the construction and equipment of a 44-bed mfirmary,
and a dispensary, and by the provision of a small group of trained
nurses and attendants .
Clinical studies.-An investigation was made of the therapeutic
effect of the addition of a definite amount of an extract of wheat, or of
yeast to the customary diet of patients. Three groups of about 20
patients each, whose ages and leprous condition were comparable,
144391-32--3
Digitized by
Google
28
PUBLIC HEALTH SERVICE
were selected, and to each of two grou11s was given daily during a
period of six months either 15 grams or an extract of whole wheat,
evaporated to the consistency of a heavy sirup, or 3 grams of dried
brewers' yeast suspended in a coffee decoction. The third group was
used for control. To all three groups 10 cubic centimeters of codliver oil (U. S. P.) has been routinely administered daily. The purpose of the test was to determine the effect of such amounts of the
vitamin B complex in the dietary. Both groups showed changes
which may be rated as slightly greater improvement than the control
group, but it is not felt that the differences are such as would permit of
definite deductions.
An analysis of the food eaten during a 5-day week was made on 10
patients who were selected as representatives of the different age
groups and nationalities included among the residents of the hospital.
Analyses were made of duplicate samples of each meal consumed for
their content of protein, fat, carbohydrates, and ash. The conclusions of the study were that all the patients consumed an ample
quantity of food in terms of calories, and that both adults and children
were prone to select and eat a higher carbohydrate diet than is customary among American and European families. . However, though
the adults showed a retention of the dietary tendencies of their
respective races, they included a larger intake of protein and of fat
in their selection than seems customary among them. It seems justifiable to conclude from this study that the patients eat a diet which is
suboptimum in protein and fat, and definitely low in fruits and
vegetables.
The presence of the bacillus in the circulating blood has apparently
been demonstrated in 8 of 12 selected cases examined. The examinations have been made of preparations on slides from the entire sediment of 3 cubic centimeters of blood, which has been withdrawn from
a superficial vein into a sterile syringe by puncture through the skin;
and hemolyzed with acetic acid and distilled water which has been
sterilized in the autoclave. The criteria for the acceptance of the
finding have been that the bacilli shall be in the white blood cells, or
in clumps of two or more.
This very suggestive evidence of a bacteremia of high grade has been
of particular interest with regard to the explanation of acute manifestations of the disease which have been considered phenomena of allergy.
The positive results have been obtained usually from the blood of
cases showing acute clinical changes.
Epidemiological investigations.-During the year a survey was made
of features bearing on the epidemiology of leprosy in Hawaii. Epidemiologist Theodore Rhea carried out the details of the work. The
survey consisted of the compilation and analysis of the hospital admission records of the past 40 years, of those of 420 families from whom
a representative was in segregation or under supervision, and of a
house-to-house field investigation of 100 of the 420 families. The
economic status, housing, environment, dietary, and family contact
of the 100 families were appraised.
The results of the survey have been confirmatory of some hypotheses which have been advanced to explain phenomena of the disease,
and have thrown much doubt on the validity of others which have a
rather wide acceptance. There seems to be ample evidence that the
incidence of leprosy is declining in the native people, and that an
Digitized by
Google
PUBLIC HEALTH SERVICE
increasing proportion of the admissions during the past 10 years have
arisen from among those who have been imported to the islands, until
at the present time about 40 per cent of the admissions originate
among this latter group. It also appears that the rates of admission
among native children of the younger ages have been much higher than
those for individuals of the older ages, or in other words the rate of
attack among young children, 5 to 15 years of age, is probably the
highest of any age period. The decline in admissions has also been
greater in this young group.
There was no selective predilection to attack apparent amongst
families of Hawaiian, part Hawaiian, or Portuguese composition; but.
there is a greater percentage of males than females of all ages admitted ..
The proportion has averaged 100 females to 160 males.
The period of exposure to the disease which is followed by its:
development seems to vary with the age of the individual ex.posed
and with the :r.robable intimacy of the contact with the case. Amongfifty-odd families, there were 25 to 35 per cent of the children under
10 years of age who were admitted with leprosy subsequent to their·
exposure to leprous parents. A relatively large number of these
were admitted by the time they were 15 years of age. The period of
incubation or that from the probable date of exposure to the recognition of the disease also seems to have some correlation with the age
of the individual at the time of his exposure, and the degree or intensity of his contact with a case.
It was found that the average standard of living prevailing among
the 100 families would be classed as one of indigence by the local welfare agencies. Their diet is not balanced, and is lacking in milk and.
meat proteids, butterfat, and fresh vegetables. Housing conditions,
environment, and personal habits are conducive to a very intimate
and rather promiscuous contact among members of the household
who may be sick or well. While these conditions would appear favorable to the dissemination of the disease, there did not seem to be any
correlation among this group of families between the better and loweraverage standards and the frequency of leprosy. However, theaverage frequency of leprosy within the families d1d seem to have a.
direct relation to the history of contact with extrafamilial cases.
Experimental investigations.-Experiments have been continued on a
larger scale in the attempt to isolate and to grow the bacillus of leprosy,.
and to determine the effects of poorly balanced diets on rats with regard
to the readiness with which rat leprosy will grow in the individual rat,.
or to the development of infection from inoculations of materials
from the lesions of leprosy in man.
Forty types of culture media were prepared and inoculated with
material from leprous individuals and from rats infected with thebacillus of rat leprosy (Stefansky's bacillus). Different sources and
types of bacillus-bearing material were used for the inocula. The
culture media included albuminous products, potato, carbohydrates,.
glycerine, soaps, fatty acids, amino acids, dyes, embryonic tissues,
and fluids and were adjusted to various reactions frQm 6.0 to 7 .5
pH. The cultures were maintained under anaerobic and aerobicconditions, and under conditions of definite mixtures of carbon dioxideand oxygen for periods as long as five months. In but one instan,cewas an acid-fast bacillus cultivated which resembled the bacillus of
leprosy in its morphology.
Digitized by
Google
30
PUBLIC HEALTH SERVICE
The organism cultivated produces an orange-colored pigment in
the presence of air, and its growth on media is that of a dry, wrinkled
pellicle. Egg-mixture media are slowly liquefied by its growth. Its
pathogenicity to rats and guinea pigs is under test. An attempt to
make a vaccine of it has not been successful, because of its tendency
to agglomerate, even after treatment with acetone, chloroform, ether,
and alcohol. There is no conclusive evidence that the organism is
identical with the bacillus of leprosy, but it js an acid-fast bacillus
and was obtained from cultures inoculated with material from a
leprous case. When injected into animals it produces nodules at the
site of inoculation, which ulcerate in most instances, and the organism
can be recovered from the lesion. The cellular response within the
peritoneal cavity to intraperitoneal injections of the organism is
similar to that obtained by the injection of material from rat leprosy
and from leprosy in man.
In addition to these efforts at cultivation in media, attempts have
been made to grow the bacilli of human leprosy and of rat leprosy in
tissue cultures. The tissue cultures were made of chick embryo, the
plasma of guinea pigs, with tyrode solution and the embryonic juice
of chicks. Material from seven sources of human leprosy and three
sources of rat leprosy has been planted in such cultures. In three
instances of the. cultures of human material there has apparently
been a proliferation of the acid-fast bacilli planted and a definite
growth of a diphtheroid in from five to seven days after inoculation.
All of these cultures have been carried through several transplants,
and one of them through 15 transplants. The acid-fasts in the last
transplants seem to be as numerous as in the original culture, but
colonies visible to the unaided eye have not been obtained. The
material from rat leprosy has been under observation but a short
time, but in one instance there has apparently been a proliferation of
the acid-fast bacilli accompanied by a growth of a diptheroid.
Different sites of inoculation of rat leprosy in rats have been studied in an effort to determine the probable route of invasion in nature.
Intranasal installations of tissue suspensions of the bacilli of human
or rat leprosy are rather consistently followed by the appearance of
the organisms in the adjacent lymph glands. In one instance a definite take of rat leprosy was obtained by this method in a cervical
lymph node and the surrounding tissues, and scattered organisms
have been found in remote tissues; but with the one exception there
has not been satisfactory evidence of a take.
During the latter nine months, investigations were in process on
the effects of diet on the course of rat leprosy, and on the development of infection in rats, guinea pigs, rabbits, and cats from the injection ·of material from human leprosy. These experiments have
been conducted by feeding rats and gumea pigs on a deficient diet,
inoculating them, and, after four to five months of a continuation
of the diet, examining them in comparison with animals fed on a
balanced ration. The results of these experiments will not permit
of definite conclusions at this time.
Educational and cooperative activities.-A series of clinics has been
presented to physicians, and clinical demonstrations and lectures
have been given to public health nurses and social workers, as well as
lectures to educational groups. Ward walks have been conducted
for all applicants for medical licensure in the Territory.
Digitized by
Google
31
PUBLIC HEALTH SERVICE
The junior medical officer, Passed Asst. Surg. J. R. Murdock, acted
as the medical officer for the Board of Leper Hospitals and Settlement
for a period of eight weeks, during which time he took a group of
patients to Manila,. P. I.
MALARIA
Field investigations of malaria have continued under the direction
of Surg. L. L. Williams, jr.
During the fiscal year 10,000 blood indices were taken in the experimental areas, with the general average of almost 5 per cent positive.
We can not deduce from these figures that the malaria rate has
fallen from areas where active control has been in operation for at
least three years. Analysis of all the available figures of the blood
indices shows that the rate is probably not in excess of 10 per cent.
This figure indicates something over 2,000,000 cases of malaria
annually in the southeastern part of the United States.
DUSTING STUDIES
Paris-green dusting at 10-day intervals.-This study was continued
in Dougherty County, Ga., under the direction of Surg. T. H. D.
Griffitts, and was completed toward the end of the fiscal year. It
will be made the subject of a separate report. The work has been so
satisfactory and the results so apparent that the county has taken
over this experiment as a permanent means of county-wide malaria
control.
Twenty-one day dusting interval.-This is the third year of the intermittent dusting with Paris green in Dyer County, Tenn., under the
supervision of Senior Sanitary Engineer J. A. LePrince and Passed
Asst. Sanitary Engineer H. A. Johnson. The results of the, 1930
drought had not worn off in 1931, and so this experiment was continued for another season to check the present figures. The results
indicate that the method is proving successful.
Flotation of Paris green.-The study of floating Paris green has
been continued. The observations of the past year have confirmed
previous studies indicating that three to five days is the longest
period we can expect one application of floating dust to keep the
breeding areas free of larvae. Occasionally there was no appreciable
interval between the killing of the crop of larvae in the water and
the reappearance of a new one. Some experiments were tried of
mixing Paris green in plaster of Paris and allowing it to set on a
piece of cork which was then placed in the water. Anopheles seemed
to feed freely upon the poison liberated from the slowly disintegrating
mass. Although inconclusive, the results of these studies are sufficiently interesting to warrant their continuation.
OTHER MALARIA STUDIES
Malarial inoculation in paresis therapy.-In cooperation with the
Division of Venereal Diseases, the preliminary observations commenced last year on the feasibility of supplying malarial infection
from a central point to hospitals using malarial infection in the
treatment of paresis were continued.
Special Expert Bruce Mayne has succeeded in readily infecting
Anopheles quadrimaculatus and Anopheles punctipennis with benign
Digitized by
Google
32
PUBLIC HEALTH SERVICE
tertian by bites on a good malaria carrier, but not from blood drawn
from such patients. He has experimented with various methods of
shipping malaria by means of blood drawn from the patients, by live
infected mosquitoes, and by suspensions of sporozoites from the
salivary gland of infected mosquitoes. The~re tests have been carried
,on on 62 paretics in 7 hospitals. So far 36 of these cases have been
reported upon, with 8 positives and 28 negatives.
A strain of quartan malaria has been established at the State
:hospital for insane in Columbia, S. C. A little less than 3 per cent
of the mosquitoes (Anopheles punctipennis) subsequently showed
evidence of infection, but none of the mosquitoes fed upon new
patients proved themselves to be infected with quartan.
During the progress of these studies and in cooperation with
Surg. T. H. D. Griffitts, it was definitely proved that Anopheles
.atropos (the salt water Anopheles of the Gulf coast) is easily infectihle
with benign tertian and is capable of transmitting the infection to
man. (Public Health Reports, December 25, 1931.)
Plasmochin.-Sanitary Engineer W. H. W. Komp, with head-quarters at Panama in the Canal Zone, has been carrying on biological
-observations on anopheline mosquitoes, testing certain prophylactic
measures and cooperating in the research work in malana carried on
through the Gorgas Memorial Laboratory. One problem has been
to test the value of plncmochin as 11 prophylactic agent in the prevention of malaria. Although not yet definite, results are very
,encouraging.
Preliminary tests in the treatment of benign tertian made with the
new synthetic drug "Atebrin" seem to give such good and almost
startling beneficial results that a relatively large amount of the
drug has been secured and extensive tests have been begun.
In addition, many biological observations and studies have been
initiated and new species of mosquitoes have been found. Assistance
to the Army has been given in directing their successful efforts to
dust large swamps by airplane, and preliminary tests have been
made of oiling by airplane.
Airplane convection of mosquitoes.-In cooperation with the Division of Foreign Quarantine, a study of the transportation of mosquitoes bJ airplane was begun in July, 1931. Surg. T. H. D. Griffitts
examined the planes arriving at Miami, Fla., and established the fact
that approximn,tely 20 per cent of all planes arriving from tropical
countries brought one or other species of mosquito with them. (Public Health Reports, November 20, 1931.)
Surgeon Griffitts and Sanitary Inspector Fred Franz then went to
San Salvador, Central America, and liberated Aedes aegypti into
planes going both to Brownsville, Tex., and Miami, Fla. Although
many of these flights included three stops, the planes upon arrival
would yield from 5 to 20 per cent of the initial loading of mosquitoes.
It is of interest to note that altitudes of 15,000 and 16,000 feet seemed
to have no deleterious effect on the Aedes aegypti.
Subsequently Mr. Franz was sent to Panama to repeat the loadings.
Similar work will be pursued from ports in South America in an
at tempt to determine whether there is any limit to the length of
flight beyond which Aedes aegypti may not survive.
The Pan American Airways are cooperating in devising a chemical
means of automatically spraying every plane so as to destroy all
mosquitoe5l .en route.
Digitized by
Google
33
PUBLIC HEALTH SERVICE
There is danger of the introduction of yellow fever by means of
infected Aedes aegypti; but greater danger, however, is apprehended
through the introduction of new species of insects not indigenous to
the United States, one or more of which may prove dangerous.
The staff of field investigations of malaria have advised concerning
impounded water problems, made surveys of salt marsh mosquito
breeding areas at Mullet and Egmont Keys, Fla., the coastal areas
about Galveston, Tex., and the southeastern coast of Virginia and
aided in similar work in Delaware and Maryland, and have tested
the effectiveness of numerous larvicides and methods of mechanical
distribution of oils. The most interesting results in these tests were
the negative results obtained with ferric chloride, which will not floe
in acid waters, and the positive results with pyrethrum extracts, some
of which, even in nonvolatile oils, have proved efficacious in destro_ying
both anopheline and culicine larvae. In cooperation with Dr. H. G.
Grant of the Virginia State Board of Health, a portable mechanical
pressure spraying apparatus is being developed.
NUTRITION AL DISEASES
The studies in nutrition have continued to be centered largely on
pellagra with, however, increasing emphasis on the problem of its
control. But to combat successfullv this disease under the econoinic
and dietetic conditions which prevail in many sections of the rural
South, preventive measures must be further simplified and the
methods of their application rendered more feasible. To this end,
work is being directed to the determination of the relative pellagrapreventive potency of the foodstuffs which may be most easily and
cheaply produced at home, especially those which may be made
available during the late winter and early spring when the diet is
normally most restricted and the foundation is laid for the seasonal
crop of pellagra.
As in previous years, these studies have been conducted both at
the Milledgeville State Hospital (formerly the Georgia State Sanitarium), Milledgeville, Ga., and at the National Institute of Health,
Washington.
The work at the Milledgeville State Hospital was under the supervision of Surg. G. A. Wheeler until July 15, 1931, since which date it
has remained under his general direction with Asst. Surg. D. J. Hunt
in local charge.
The study of the pellagra-preventive value of green peas, collard
greens, and cabbage greens was completed during the year. Green
peas and collard greens were found to be satisfactory preventives.
Cabbage greens contain the preventive factor, but are somewhat inferior to green peas and collard greens in this respect.
Similar studies of mustard greens and kale greens, begun during
the first half of the fiscal year, are still in progress.
The results of the study of the pellagra-preventive value of turnip
greens, spinach, green beans, and mature onions (described in last
year's report) were published in the Public Health Reports (vol. 46,
November 6, 1931, pp. 2663-2668).
A paper on the history of pellagra in the United States, presenting
historical data collected in the course of field studies, was published
in the Public Health Reports (vol. 46, September 18, 1931, pp. 22232229. Reprint 1510.).
Digitized by
Google
34
PUBLIC HEALTH SERVICE
A paper on the control of pellagra, together with an exhibit setting
forth information on its nature and prevention, was presented at the
meeting of the American Medical Association in New Orleans, La.
The policy of extending cooperation to various agencies concerned
in combating pellagra, as well as those concerned with nutrition
problems generally, has been continued and to an increasing degree.
This has included a study of the conditions, with appropriate recommendations for the control of pellagra, in Richland Parish, La.,
Hamilton County, Tenn., and Bell and Whitley Counties, Ky.
Public talks on pellagra were made in all these counties, and pellagra
clinics were held in Bell and Whitley Counties, Ky. Lectures on
pellagra were delivered at the conference for county health workers
for western Kentucky and at the State school for health officers conducted under the auspices of the University of Kentucky. A paper on
pellagra was presented before the Society of Hygiene, Baltimore, Md.
Assistance was furnished the Committee on Standardization, United
States Pharmacopoeia X, and to the nutrition service of the American
Red Cross.
A survey was made of dietary conditions and pellagra incidence in
portions of the soft coal mining diiitrict of southeastern Kentucky and
the hard coal mining section of northeastern Pennoylvania. The diet
of the soft-coal miner was found to be the characteristic diet of the
rural South, the dominant items being corn bread, biscuit, salt pork,
lard or lard subotitutes, and small quantities of dried beans and the
cheaper canned foods; while that of the hard-coal miner is more
typically northern in character, being dominated by fresh meats,
· milk, and vegetables. In the former area pell&gra was found to be
quite prevalent, while in the latter it is very rare.
The laboratory studies at the National Institute of Health were
under the immediate supervision of Passed Asst. Surg. W. H. Sebrell
until July 15, since which date the work has been in charge of Surg.
G. A. Wheeler, with the assistance of Passed Assistant Surgeon
Sebrell.
As for the past several years, the laboratory studies have been
correlated with those in the human and for the most part have been
concerned with the determination of the probable pellagra preventive
value of individual foods and foodstuffs by tests in the dog.
Tests of canned mustard greens, canned spinach, canned turnip
greens, green lettuce leaves, canned collards, Irish potatoes, canned
corned beef, and canned evaporated milk were completed during the
fiscal year.
The canned corned beef, canned evaporated milk, canned turnip
greens, and canned collards dhowed satisfactory preventive value.
Canned spinach and canned must~rd greens showed some degree of
protection, but were less satisfactory. The Irish potatoes showed
little or no protective value.
Tests of navy beans, red kidney beans, canned chicken, buckwheat
flour, and peanut meal, begun during the fiscal year, are still in
progress.
The detailed report of the studies on fatty degeneration of the liver
in dogs was completed and submitted for publication. The results
indicate that the condition is based on a dietary deficiency.
In collaboration with Senior Chemist E. Elvove, of the Division
of Chemistry, studies were continued on rat methods for the quanti-
Digitized by
Google
35
PUBLIC HEALTH SERVICE
tative estimation of the antipellagric vitamin, and a few crude fractions were prepared and studied.
A special report was made of studies on the toxicity of several amino
acids. (Public Health Reports, vol. 47, January 8, 1932, pp. 75-83.)
PLAGUE
At the request of the Governor of the Territory of Hawaii, and with
the approval of the Secretary of the Interior, the Public Health Service undertook, in cooperation with the Territorial health authorities,
work in connection with the control and eradication of bubonic
plague in the Hawaiian Islands. Surg. C. R. Eskey was detailed in
charge of these studies and work was begun upon his arrival in Honolulu on November 24, 1931.
The last human case of plague on the island of Hawaii, Hamakua
eoast, occurred August 13, 1929. In July, 1931, a case of human
plague was found on the island of Maui, several miles from the port of
Kahului. Plague-infected rats have been found on these islands
during the fiscal year.
Plague suppressive measures instituted by the Territorial health
authorities, including poisoning, trapping, and laboratory examination of rats, and the ratproofing of bmldings, have been continued and
extended. In addition a flea survey and a study of the flea infestation of rats have been undertaken.
There follows a report of the flea survey covering the period April
1, 1932, to June 30, 1932.
Report of flea survey conducted as part of plague studies in Hawaii from April 1,
1932, to June 30, 1932
RODENTS AND MONGOOSES SEARCHED FOR FLEAS
Honolu• Kahultli Honokaa Hilo lab•
Ju labo- labors• labors• oratory
ratory
tory
tory
Total
________________,_____ - - - · - - - - - - - - Rats.................................................
Mice................................................
Mongooses . .•• •• ... ••••..•.•.. .. ..•••. ... . . . .•.. .•..
Total..........................................
1,327
267
92
1.172
200
30
846
216
273
65
64
13
1,116
341
3,618
SM
189
l---l----1---1----11---
1,686
1,498
4, Ml
CLASSIFICATION OF FLEAS
Honolu• Kahultli Honokaa Hilo labJu labo- labors•
labors- oratory
ratory
tory
tory
.
Total
________________,___ - - - - - - - - - - - Xenopsy!la cheopis..................................
3, 731
947
Leptopsylla segnls................................... ..........
252
-Ceratophyllus fasclatus.............................. ..........
351
Unknown 1..........................................
75
394
Echidnophaga gal!inacea... ........•..•..........•..
953
497
-Ctenocephalides lelis................................
806
204
Pulex lrrltans........................................ .......... .••...••..
402
4M
868
4
36 ....•.....
320
7
273
11
162
90
I
1
6,630
1,124
387
796
1, 734
1,262
2
l---ll---1----1----1---
Total..........................................
1
5,566
2,M5
2,062
Probably belongs to Xenopsy!la family.
Digitized by
Google
563
10, 835
36
PUBLIC HEALTH SERVICE
RocKY MouNTAIN SPOTTED FEVER
The study of Rocky Mountain spotted fever and other tick-borne
diseases of the western United States has been continued at the
Hamilton (Mont.) field station under the direction of Special Expert
R.R. Parker.
During the year there was an unusual augmentation of the volume
of work performed. This has been occasioned in part by a necessary
increase in routine required by the production and distribution of a
much larger amount of Rocky Mountain spotted fever vaccine than
heretofore, in part by an expansion of the scope of the station work,
and by the increase in demands made upon the station for information
and for diagnostic tests of various kinds.
On February 2, 1932, the building which had been occupied previously by the Hamilton station under lease was purchased by the
Public Health Service from the State of Montana as provided by the
act of February 27, 1931. It is expected that the cornerstone for the
new laboratory building which was also included in the provisions of
this act will be laid early in the spring of 1933.
Vaccine.-Three hundred and eighty-three lots of 400 cubic centimeters each (totaling 153.2 liters, gross) were manufactured, as
compared with 293 cubic centimeters (117.2 liters) in 1931, and
125 cubic centimeters (55 liters) in 1930. Of the 1932 supply, 222
lots, netting approximately 73 liters, were suitable for use. This was
about 58 per cent of the gross production.
Two improvements in the manufacture of this vaccine have been
made: (1) A technique has been developed by which phenol alone can
be used as the preserving agent instead of the phenol formalin mixture
now employed; and (2) a mechanical grinder suitable for comminuting
the tissues of infected ticks, an essential part of the process of vaccine
production, has been secured.
The demand for vaccine, which has increased each year, was 75
per cent greater than in 1931, the entire supply of 73 liters being entirely
exhausted soon after the middle of the 1932 tick season. The
resources of the present laboratory were heavily overtaxed, however,
to produce even this amount. It is likely that at least 100 liters
could have been used had it been available.
Tick parasites.-Studies of tick parasites as a possible agency for
the control of Dermacentor andersoni in the Rocky Mountain region
were begun by the State of Montana in 1926. These studies were
taken over by the Public Health Service on July 1, 1931, and are
being carried on under the immediate supervision of Entomologist
R. A. Cooley. During the year this work has consisted mainly of the
biological study, mass rearing, and experimental liberation of a
chalcid fly, Ixodiphagus caucurtei du B. The earlier liberations were
confined to Montana, but this year colonies are being started in
Colorado, Idaho, and Oregon, following necessary preliminary surveys
to select suitable localities and secure needed information pertaining
to the local tick complexes.
Thus far it has been definitely shown that the parasites attack
D. andersoni in nature; and in the Bitterroot Valley, where most of
the experimental work has been carried on, survival over winter has
been demonstrated in two successive years. The data, however, do
not yet justify an assumption that this parasite will be able to perpetuate itself indefinitely under Montana conditions.
Digitized by
Google
PUBLIC HEALTH SERVICE
37
Experimental studies.-The transmission experiments begun in
1929, to determine what western species of ticks other than Dermacentor andersoni are actual or potential carriers of Rocky Mountain
spotted fever virus in nature or to man, are still being carried on.
In the transmission experiments, the following tick species have
been tested, using highly virulent Bitterroot Valley (Montana) strains
of virus: With D. variabilis, transmission has been secured by each
successive stage from the larva of one generation through the larva
of the next; with D. parumapertus (tests just begun) transmission by
adults infected as adults; with D. occidentalis, by adults reared from
larvae infected as such (tests begun in 1929), and by larvae hatching
from eggs laid by infected adults; with A. americanum, infected as
adults, by the resultant larvae and nymphs; and with R. sanguineus,
by each successive stage from the larvae of one generation through
the nymphs of the next. With three of the species concerned, these
results merely confirm or extend those of other workers.
The results of these tests in conjunction with others previously
made show that one or more proved or potential tick carriers of Rocky
Mountain spotted fever to either man on animals occur in all 48 States.
Tests of species from nature shown to be potential carriers have
been limited by the difficulty of securing material in sufficient quantities to make them worth while. In 1931, tests of over 11,000
specimens of D. veriabilis and Haemaphysalis leporis-palustris from
Minnesota were made in cooperation with Dr. R. G. Green, of the
University of Minnesota Medical School. With over 1 per cent of
the former and 2 per cent of the latter, reactions were secured in
guinea pigs, which, had they occurred in tests of ticks from a known
endemic area, would have been considered indicative of a low~grade
Rocky Mountain spotted fever virus. Similar, though slightly less
suggestive, results have been secured with D. occidentalis from
California. Decision as to the full significance of these tests must
await further study.
Additional observations of the agglutination of proteus X 1rg and X2organisms by the sera of persons acutely ill of Rocky Mountain spotted
fever and by convalescent sera suggest that the value of this test for
diagnostic purposes in the Rocky Mountain region is limited by the
following findings: (a) The affinities of the agglutinins of such sera
are so broad that no one strain or group of strains can yet be desig'nated safely as most advantageous for routine work; and (b) though
apparently diagnostic in a fair percentage of cases when the sera are
secured later than the middle of the second week after onset, there is
nevertheless a considerable proportion of cases in which the agglutinin
titer is never higher than that frequently encountered with supposed
normal sera. This test has little or no value if the sera are secured
after a considerable interval following recovery. The agglutinin
titer is not related to degree of immunity. Convalescent sera have
no bactericidal action on proteus X organisms.
Tests to determine the limitations and diagnostic value of protection tests with convalescent sera are being made. S(') far as the
Rocky Mountain region is concerned, the data thus far secured
su~gest that, if the sera used are secured shortly following recovery
this test is more accurate for diagnostic purposes than either the
above agglutination reaction or, all contingencies considered, attempts
Digitized by
Google
38
PUBLIC HEALTH SERVICE
to recover infection by the injection into guinea pigs of the blood of
persons acutely ill.
Sexual transmission (infection of normal ticks of one sex by an
infected tick of the opposite sex during copulation) of the virus of
Rocky Mountain spotted fever has been demonstrated in D. andersoni.
Observations relative to the factors underlying the difference in
virulence of Rocky Mountain spotted fever in various areas are being
continued. For several years this study has centered in the Bitterroot Valley, where a highly fatal type of infection has long existed on
the west side and a very low-grade, inapparent type has been supposed
to be the only type on the east side. It now appears possible that the
value of these studies may be impaired by the facts that during the
past few years several frank cases of apparent east side origin have
-occurred and that in several instances strains of considerable virulence
have been recovered from east-side ticks. Whether or not these
typical infection-producing east-side strains are of recent introduction
is not clear.
Attempts to grow the virus of Rocky Mountain spotted fever in
"K" and other media have failed. Negative results have also been
-secured in attempts to isolate proteus X organisms from the urine of
patients and guinea pigs acutely ill.
Epidemiology.-The season of 1931 was one of low prevalence of
Rocky Mountain spotted fever throughout the greater portion of the
Rocky Mountain region. Although the 1932 records are incomplete,
they indicate an increased incidence in certain sections, but particularly in eastern Montana, where the number of cases has been the
largest since the disease was first recognized in this section in 1914.
In conjunction with the increased prevalence of Rocky Mountain
spotted fever in 1932, infection has been reported from an unusually
large number of areas in which it had not been known previously.
Whether this is the result of intensive spread, of a rise in the level of
virulence of long resident local strains of the virus, or is due to other
causes, is not apparent. In at least some of the sections concerned
there has been an unusual abundance of ticks.
Reports of the last few years, as previously noted, have suggested
that the highly fatal type of Rocky Mountain spotted fever that has
long been resident in the Bitterroot mountain region of western
Montana, actually exists in nature over a much larger section of
western Montana and the greater part at least of the mountainous
section of northern Idaho.
For the first time cases proved or suspected to be Rocky Mountain
spotted fever were reported from various sources during 1931 in the
following States lying west of the Mississippi River: Louisiana, Texas,
Arkansas, Missouri, Iowa, Minnesota, and Arizona. So far as known,
the Texas report is the only one to have been fully substantiated by
laboratory tests.
During the spring of 1932, two fatal cases of presumed secondary
infection incidental to bites of D. andersoni have been reported-one
from Colorado, the other from Montana.
TULARAEMIA
During the late summer of 1931 an epizootic among sage hens, near
Roy, Fergus County, Mont., was investigated and a report of the
findings published in the Public Health Reports, February 26, 1932.
Digitized by
Google
PUBLIC HEALTH SERVICE
39
As a result of reports of several instances of human tularaemia.
infection in which mosquitoes were mentioned as possible agents of
transmission, experimental studies were made to determine whether
or not these insects may function in this manner. Tests made with
Aedes aegypti and several local species of mosquitoes have shown that
occasionally infection can be transferred mechanically between
infected and healthy laboratory animals by undelayed interrupted
feeding, by crushing infected insects on the unbroken skin, or by
deposition of excrement on the abraded skin of such animals. Infection was recoverable for varying periods up to 39 days in one lot as.
demonstrated by inf' ection of the macerated bodies of infected mosquitoes into norma guinea pigs. It was concluded that suitableconditions to effect such transfers in nature are likely rare, and that.
it is probable that at most only infrequent infection of man would
occur in this manner.
Incompleted transmission experiments with various species of ticks
and with blood-sucking insects other than mosquitoes have given the
following results: Horseflies ( Tabanus ruprestris and T. septentrionalis), mechanical transmission between guinea pigs by interrupted
feeding; black flies (Simuliidae), preliminary tests inconclusive, although one test by interrupted feeding was negative with a fly shown
to be infected by subsequent injection; sucking louse of the Columbian
ground squirrel (Neohaematopinus laeviusculus), positive results
between ground squirrels; American dog tick (D. variabilis), infected
as larvae, transmission by resultant nymphs, but not by adults, though
the latter were proved infected by injection into guinea pigs; Pacific
coast tick (D. occidentalis), transmission by adults infected as adults;
D. parumapertus, same as with D. occidentalis; brown dog tick (R.
sanguineus), infected as larvae, transmission by resultant nymphs
and adults.
Two instances of complete loss of agglutinins following tularaemia.
infection in man and two cases of reputed second infections have been
reported to the station.
The badger (Taxidea taxus), which preys upon rodents highly
susceptible to tularaemia, has been tested for susceptibility and found
resistant.
TICK p ARAL YSIS
During the spring and early summer of 1932 a number of reports.
of tick paralysis were received from western Mont.ana, northern
Idaho, and eastern Washington. A greater incidence than is usual
has been indicated. Two reports were of paralysis in dogs. All
were induced by D. andersoni. In several instances the tick responsible was sent to the station, but none accepted a second feeding,
doubtless due to injury received when removed, or to the application
of turpentine or other chemicals.
COLORADO TICK FEVER
Colorado tick fever was prevalent during 1932 in several sections of
Colorado. A few cases occurred in northern Wyoming and northeastern Utah, and two possible cases in southeastern Oregon. Fortunately, a female tick supposed to be responsible for a Colorado caS&
was forwarded to the station; and though it has failed to, pronuo&
Digitized by
Google
40
PUBLIC HEALTH SERVICE
symptoms in a guinea pig while completing engorgement, it is hoped
that the progeny will prove infected and that an opportunity for
etiological studies will thus be afforded. Sera received from supposed
cases and convalescent sera have failed to agglutinate proteus X
organisms except in low titer, nor has blood from patients ill of this
disease caused any observable symptoms in either guinea pigs or
white rats.
RELAPSING FEVER
An infestation of Ornithodorus turicata in a summer cabin in the
mountains near Moscow, Idaho, has been reported by Prof. Claude
Wakeland, of the University of Idaho. Two undiagnosed illnesses
suggestive of relapsing fever, have occurred in the owner's family in
the past two years during periods of residence at the cabin. Ticks
collected by exposing laboratory animals in the cabin are under test
at the present time for the possible recovery of relapsing fever.
The nearest previously known locality infested by this tick is in the
vicinity of Lake Tahoe, Calif.
CHILD HYGIENE INVESTIGATIONS
The activities of the Child Hygiene Office were continued under
the direction of Acting Asst. Surg. E. Blanche Sterling.
A STUDY OF CHILDREN OF PSYCHOTIC PARENTS
.A study of children of psychotic parents, begun in the last quarter
of the fiscal year 1931, was completed in April, 1932.
The psychotic patients were selected from the Spring Grove
State Hospital, Catonsville, Md., the psychopathic section of the
Baltimore City Hospital, and the Springfield State Hospital, Sykesville, Md.
In order to evaluate properly the findings in respect of the children
of psychotic parents, it was necessary to compare them with other
groups of children. These control groups were selected from the
Henry Watson Children's Aid Society and the Jewish Children's
:Society, representing children from broken homes; from the Child
Guidance Clinic of the Maryland Mental Hygiene Society, repre,senting problem children; and from a previous study made by the
_public Health Service, representing normal children.
The generous cooperation of these Maryland agencies was obtained
:through Dr. George H. Preston, the director of the study, who is the
Maryland State commissioner of mental hygiene.
The major purposes of the study were to determine whether
these children indicated by their behavior any serious need for
_psychiatric assistance, and whether the children of psychotic patients
,constituted a profitable foundation on which to base a mental hygiene
program.
The study brought out the significant facts (corroborating studies
of other inv.estigators) that, among psychotic patients, there is a low
marriage rate, a high sterility rate, and a tendency to small families.
It seemed f.airly clear that the psychotic patients of the preceding
generation oonstituted only about 3 per cent of the present Maryland
State Hospital population.
Digitized by
Google
PUBLIC HEALTH SERVICE
41
In spite of the fact that the children of psychotic parents were
subject to a double handicap, having both a poor heredity and an
unfavorable environment, they showed less frequent deviations from
an accepted "normal behavior pattern" than did the group of
unselected children from a rather better-than-average public school.
It was also shown that, on the whole, the children of psychotic
parents showed far less deviations from so-called "normal behavior"
than the children in the problem group.
On the basis of accumulated evidence it seems fair to assume
that the children of psychotic patients do not constitute a large
or increasing element in the community, and that they would not
represent a profitable special field for a mental health program.
THE MENTAL STATUS OF CHILDREN OF VARIOUS TYPES OF BIRTH
This study, in cooperation with the Johns Hopkins University
Hospital, made steady progress during the fiscal year. Through the
Baltimore Social Service Exchange it has been possible to secure such
sociological data on the total group of ap-proximately 5,000 cases as
the agency was able to supply. The supenntendent of the Baltimore
public schools has made it _possible to add to the study the school
record of any child in attendance at the city schools.
DENTAL CARIES IN RELATION TO DIET AND CLIMATE
The fiscal year 1932 marked the completion of the field work
on this study. Oral examinations of school children during this
period increased the amount of material to be studied to more than
8,000 records. These data covered sections of South Dakota, Idaho,
Arizona, Oklahoma, California, and New Mexico.
It is felt that the material in hand is representative of varying
climatic conditions, and of different Indian tribal habits, and is
sufficiently large in amount to have definite statistical significance.
Through the cooperation of Dr. Leslie W. Foster, a field dentist
of the Indian Service, 400 records were secured.
AGE AND BEX DIFFERENCES IN THE PREVALENCE OF DENTAL CARIES
Two statistical studies in these phases of dental caries were published during this fiscal year: Studies in Dental Caries No. 1. Prevalence of Dental Deca;y and Corrections Among School Children of
Different Ages. (Pubhc Health Reports, October 30, 1931.) Studies
in Dental Caries No. 2. Sex Differences in the Prevalence of Dental
Caries. (Public Health Reports, January 1, 1932.)
THE HEARING OF SCHOOL CHILDREN
An intensive study of the hearing of school children was begun
early in the fiscal year. The importance of such a study is evident,
because (1) there seems to be a rather high incidence of defective
hearing in childhood; (2) the handicap of deafness may seriously
interfere with material and intellectual advancement and individual happiness; (3) early discovery of the defect offers the best
chance for improvement, adjustment, or training; and (4) a study
of causal or related factors furnishes a basis for preventive measures.
Digitized by
Google
42
PUBLIC HEALTH SERVICE
Throug_h the courtesy of the District of Columbia Board of Health
and the Board of Education, it has been possible to undertake this
investigation in the public schools of Washington.
It is planned to test the hearing of all children over 8 years of age
with the phonograph No. 4-A audiometer. This is in the nature of a
screening process, by which, roughly, the hard of hearing are separated from the normals. Every child showing a hearing loss in this
test of nine or more sensation units is tested with the No. 2-Aaudiometer, an instrument of greater accuracy, which is helpful in determining
not only the degree but the type of impairment. In addition, each
child is given an examination of the ears, nose, and throat, and a
history of past illnesses is obtained.
To evaluate properly the findings in this group of children, it was
necessary to compare them with control material. For this purpose
an approximately equal number of children with normal hearing were
selected, having approximately the same age and sex distribution.
These children are tested with the No. 2-A audiometer, given the ear,
nose, and throat examination, and their history of past illness is
recorded just as in the case of the group with defective hearing.
At the present time more than 4,500 children have been tested with
the No. 4-A audiometer. Of this number, about 750 have been
tested with the No. 2-A audiometer, and it is these children which
comprise the study groups. It is planned to study not only the incidence of hearing defects but possible causative factors.
STUDIES IN VISION, PHYSICAL STATUS, GROWTH, AND DEVELOPMENT IN SCHOOL
CHILDREN
Vision of school children.-Marked progress was made during the
year in the tabulation of the data on the vision of school children. In
cases where the eyes have been found to be different, the degree of
visual defect in the two eyes was compared. The condition of the
eyes found in the first examination was compared with those found in
the second and in the third examinations. When a change had
occurred, the amount of change was calculated and its direction indicated. Especial care was taken to study the length of time apparently necessary to bring about definite degrees of change.
Physical status, growth, and dei,elopment of school children.-The
statistical work on the physical status, growth, and development of
school children, together with the seasonal morbidity among the
group, progressed steadily in the first part of the fiscal year, but was
later retarded through the resignation of the statistician in charge of
this study.
COOPERATIVE WORK
During the fiscal year the Child Hygiene Office cooperated with the
Girl Scouts of the District of Columbia, conducting physical examination of the girls who registered for attendance at the Girl Scouts
camp.
MISCELLANEOUS
Health education in maternal and child hygiene through direct correspondence by the Child Hygiene Office was continued. The service extends to all parts of this country, with occasional extension to
foreign countries.
Digitized by
Google
PUBLIC HEALTH SERVICE
43
Considerable data on the subject of maternal mortality were col•
lected. These will form the nuclei for any study of this subject which
the Public Health Service may be able to undertake.
·
DENTAL STUDIES
Dental Surg. H. Trendley Dean was assigned to duty in char~e of
dental studies September 12, 1931, with headquarters at the Nat10nal
Institute of Health.
Field investigations were begun in October, 1931, on the problem of
the distribution of mottled enamel in the United States. Prior to this
study, mottle<l enamel had been reported in the literature as occurring
in areas which totaled 67 counties, scattered through 13 States. By
means of a questionnaire survey, Doctor Dean added to this total H
counties in 24 States, with 25 more counties in 9 States where its
presence is as yet not fully determined. At present mottled enamel
has been reported in the literature by dental societies or individual
dentists or by survey in 24 States, and in 2 additional States it proba•
bly is present.
Surveys of mottled-enamel areas were conducted by Doctor Pean
in Virginia, North Carolina, Kentucky, Illinois, Tennessee, and South
Carolina.
INDUSTRIAL HYGIENE AND SANITATION
The activities of this office have been carried out under the direction
of Senior Surg. J.P. Leake.
DUST STUDIES
Health of workers in the dusty trades.-By means of X rays, physical
examinations, and dust determinations, a study has been conducted
in certain additional dusty trades (marble-stone finishing, slate quarry•
ing and milling, talc mining and milling, granite-stone quarrying).
Reports of the investigations of municipal and cotton dust were sub•
mitted for publication as public-health bulletins. Laboratory studies
on the effect of dust on animals were continued.
Impinger apparatus.-A paper describing the design and construe•
tion of an apparatus for the sampling of atmospheric particular matter
was published in the Public Health Reports for March 18, 1932. This
device, known as the impinger apparatus, possesses the advantage of
high dust-catching efficiency when sampling air over the full range of
dustiness (from relatively pure outdoor air to that found in very dusty
coal-mining operations) at the relatively rapid rate of 1 cubic foot per
minute. The dust is caught in a liquid medium in which it may then
be counted and analyzed microscop1cally, gravimetrically, and chemically. Three forms of the instruments were described, viz, the electrically driven, the compressed-air driven, and a hand-actuated form,
POLLUTION OF AIR AND ILLUMINATION STUDIES
Pollution of the air of cities.-This study is being made for the pur.
pose of obtaining basic data on the condition of the air in the average
American city as to the J?resence in the air of soot, ash, sulphur, lead,
iron, and carbon monoxide. Its object is not to compare one city
144391-32-4
Digitized by
Google
44
PUBLIC HEALTH SERVICE
with another, since such a comparison might lead to false conclusions,
but rather to obtain a general picture of the conditions of air pollution
as they exist at the present time throughout the whole country.
The study is being made in Washington, Baltimore, Philadelphia,
New York, Boston, Buffalo, Cleveland, Detroit, Chicago, Pittsburgh,
St. Louis, San Francisco, Los Angeles, and New Orleans. In 10 of
these cities automatic instruments have been installed, which give a
continuous record of the smokiness of the air.
It is planned to continue the field part of the study until sometime
during 1933, in order that all seasons of the year may be adequately
covered.
A paper on the "Solid Constituents of the Atmosphere of Possible
Hygieruc Significance" was read before the American Association for
the Advancement of Science in December..
Loss of light due to smoke.-The study of the loss of light due to
smoke in Baltimore, Md., has been completed and submitted for
publication in the Public Health Reports. This study, covering a
period of 12 months in the years 1929 and 1930, was made at the
request of the committee on air pollution of the Baltimore Association
of Commerce, with the cooperation of the city commissioner of health.
The study showed a large relative loss of light due to smoke. In some
cases the average hourly or daily loss was greater than 50 per cent.
The average loss for the whole year was 13.2 per cent for clear days,
15.9 for cloudy days, and 14.1 for all days.
Ultra-violet and infra-red radia-tion.-An ultra-violet meter has been
installed in Washington and continuous simultaneous records are being made with this instrument and the usual daylight recorder.
Work is being done on the develorment of an infra-red recorder
so that records of all three kinds o radiations can be made simultaneously.
METHANOL AGREEMENT
Methanol as an antifreeze and for other purposes.-Following recommendations from the conference of State and Territorial health officers,
an agreement was reached with the various manufacturers of methanol
(methyl alcohol, or wood alcohol) safeguarding its use as an antifreeze
in radrntors and for other purposes. As revised on June 2, 1932, this
agreement provides that(a) Persons shall not sell or give away any substance containing
more than 15 per cent of free methanol for use as antifreeze in automobile radiators unless it contains specified amounts of methyl violet,
chloracetophenone, antimony-potassium tartrate, and additional stabilizer (to protect the color and the chloracetophenone), contains 20
per cent water by vol_ume, and ~s in a container having prominently
displayed a warnmg sign of spec1~ed nature.
(b) Persons shall not sell or give away any substance containing
more than 15 per cent methanol for any p1;1rpose other than to prevent
freezinO' in automobiles, unless the contamers have prominently displayetl"'a warning sign of specified nature.
(c) All sales shall be made ~~h the understanding that the purchaser will carry out these proV1s10ns._
(d) There shall be n_?. new extens10~ of the use of methanol in
industry until the cond1t10ns_ under wluch the substance can be used
safely are scientifically established.
Digitized by
Google
PUBLIC HEALTH SERVICE
45
INDUSTRIAL DERMATOSIS
The investigation of industrial skin diseases was continued. The
industries covered so far are as follows: Rubber (8,300 workers
examined), dyeing of silk, wool, and fur (6,000 workers), oil refineries
(4,500 workers), candy making (1,235 workers), and small numbers
in certain other industries.
Gandy making.-Among 1,235 workers kept under observation for
a year there were 32 cases of skin conditions thought to be due to
the occupation. The chief skin hazards in this industry, outside of
burns from hot candy and sirup, are a dry, fissured, scaly condition
of the hands due to sugar and dermatitis in individuals hypersensitive
ti? the essential oils used as flavoring agents, particularly oil of
cinnamon.
Oil refineries.-The chief skin hazards in this industry were burns
of the skin from explosions and fires, and from acids and alkalies; the
development on the hands of about 10 per cent of all workers of
certain peculiar papillomata; the occurrence of oil acne and wax warts
amoJJ.g the· men working in the wax presses in those plants where
paraffin is prepared, and. an unusual prevalence of epithelioma.
Brazilian walnut.-A paper on a dermatitis associated with the use
of Brazilian walnut wood was published in the Public Health Reports
of August 14, 1931.
STUDIES OF SICKNESS AND PHYSICAL IMPAIRMENT
Pneumonia.-A report of the study of pneumonia among steel
workers is being published as Public Health Bulletin No. 202. (See
annual report for 1931, p. 50.)
Health of women in industry.-This study was continued, but no
specific data have yet been obtained.
Frequency of sickness among industrial employees.-For the eleventh
consecutive year, reports of cases of sickness and nonindustrial acci. dents causing disability for more than one week have been received
from a group of about 35 companies in which some form of sickness
insuni.nce requires a record of the cases occurring. These reports
have been analyzed for each quarter year and for the year as a whole,
and a mimeographed copy of the analysis was sent as soon as possible
after the close of the quarter to each cooperating company and to
industrial physicians and hygienists interested in the health of the
industrially employed population. Among about 150,000 men included in this sample of the wage-earning population, the sickness
incidence rate in 1931 was slightly higher than in 1930, but still
somewhat below the average rate for the 10 preceding years. Respiratory diseases as a whole decreased from the IO-year average
relatively more than did total sickness, and no year of record showed
a lower rate of sickness exclusive of influenza than occurred in 1931.
A similar result was found also in the first quarter of 1932, when comparisons were made with the corresponding period of each of several
preceding years. The more detailed results are available in the articles presented quarterly in the Public Health Reports.
Survey of the work of employee mutual benefit associations.-A report
of this survey, described in the last annual report, was published in
the Public Health Reports for September 4, 1931 (Reprint No. 1506).
Digitized by
Google
46
PUBLIC HEALTH SERVICE
Physical impairments in specific occupations.-The report of this
analysis was published in the Public Health Reports for January 1,
1932.
The physical examination as an instrument of research.-A paper on
this general subject was published in the Public Health Reports for
July 17, 1931 (Reprint No. 1492).
COOPERATIVE ACTIVITIES
Cooperation with the Bureau of Standards.-As in the previous year,
an officer has been detailed to the Bureau of Standards for the purpose
of cooperating in the care of injuries and for the laboratory investigation of health hazards in industry. Among such studies may be
included osmium tetroxide and compounds used in dry cleaning.
Cooperation with industrial and other agencies, attendance at meetings,
etc.-Members of the staff have represented the Public Health Service on various technical committees engaged in the preparation of
specifications and codes relating to industrial-hygiene activities; for
example, the medical officer in charge has served on an interdepartmental board as the result of which, it is believed, improvements will
be made in sterilizers furnished to hospitals and other health units,
and hn.ve given lectures on request of various organizations. Representatives of the section served on committees and subcommittees of
the President's Conference on Home Building and Home Ownership.
Meningitis on shipboard.-The office cooperated with the Division
of Fureign Quarantine in an investigation of outbreaks of epidemic
cerebro-spinal meningitis on ships carrying steerage passengers between the Philippines and Hawaii.
Cooperation with the Bureau of Mi',,r?,G, -Surg. R.R. Sayers continued
as chief of the health and safety branch of the Bureau of Mines and
as chief surgeon of the health divisi.on, the medical personnel assisting
him being detailed from the Public Health Service.
The work of the health division has included (1) a study of silicosis
among the lead and zinc miners of the tri-State district of Kansas,
Missouri, and Oklahoma; (2) the examination of substances to determine their suitability as refrigerants for local air conditioning in mines
from the standpoint of nontoxicity or low toxicity, Ji,nd nonflammability; and (3) an investigation of the amounts and effects of air pollution
by automobile exhaust at busy corners in Pittsburgh, Pa., to serve
as a basis for recommendations as to the length of time at different
periods of the day that traffic officers can be on duty safely at the
principal corners thrnugh the city.
MILK INVESTIGATIONS
The activities of this office were carried on under the direction of
Sanitary Engineer Leslie C. Frank, with headquarters at Washington,
D.C.
'
BACTERICIDAL TREATMENT OF CONTAINERS AND EQUIPMENT IN MILK PRODUCTION
The existing regulations of health departments with reference to
the sterilization of milk utensils and equipment are based largely on
residual agar plate counts. Since these do not necessarily measure
the efficiency of sterilization with regard to pathogenic organisms,
such regulations are not satisfactory from a public-health viewpoint.
Digitized by
Google
PUBLIC HEALTH SERVICE
47
The-present studies were undertaken to remedy this deficiency. Two
general methods were available for determining the efficit!D.cy of removal of pathogens: (1) By using the most heat-resistant and
-chlorine-resistant milk pathogen as a test organism, or (2) by usin~ a
nonpathogenic test organism of at least equal thermal and chlonne
resistance. The latter method was selected. Sanitary Engineer
A. W. Fuchs is working on this problem.
With the assistance of the New York City Health Department
Research Laboratory, a B. coli strain was found which survived 140°
F. for 30 minutes, and a substrain was finally found which usually
survives 0.19 ond sometimes as high as 0.27 p. p. m. of chlorine gas
in water for 15 to 30 seconds, hence is more chlorine resistant than
most of the pathogens tested by Tonney.
Since it would be necessary in all the laboratory and plant tests to
work with known concentrations of test organisms, the next problem
was the standardization of cultures. Several methods were experimented with, and the method adopted depends on preparing all agar
slants from the same batch and all broth tube cultures from the same
batch, and consists of inoculating a broth tube with a uniform loopful
from a 24-hour agar slant culture, and incubating at 37° C. for 18
hours. As now used, a concentration of 500,000,000 to 1,000 1000,000
,
-organisms is obtained in the 18-hour broth culture.
Expermients were then conducted to determine the most suitable
medium for rapid routine enumeration of the index organisms. It
was concluded that where precautions could be taken to keep inci-dental contamination relatively low, agar plates were satisfactory.
To overcome the skip results inherent in the thermal and chlorine
tests used by determining the last survivor, it is planned to determine
the temperature or the chlorine concentration of different compounds
necessary to produce a 99.99 per cent reduction of a standard coneentration (over 300,000 per cubic centimeter) of the test organism
in a standard period of time.
Objections to the precipitate test for determinin~ the concentration
. -of chlorine, as described in the Public Health SerVIce milk code, have
been raised by manufacturers of chloramine T compounds. To over-come these a series of tests has been begun, as part of the present
studies, to determine the chlorine concentrations of different compounds determined by (a) the iodide-thiosulpho.te method, (b) the
A. P. H. A. standard color method, and (c) the precipitate method.
Before the actual plant tests are begun, it is planned to conduct
preliminary laboratory experiments to determine which of two proposed methods of recovering test organisms applied to surfaces is
most satisfactory, and to standardize the variable factors involved in
-determining the efficiency of sterilization.
STUDIES OF THE PUBLIC HEALTH SIGNIFICANCE OF MILK COOLING
These studies are being conducted by Associate Milk Specialist
F. A. Clark. The tentative conclusions thus far reached are as
follows:
(a) That milk placed cold in a refrigerator kept at 50° F. or less
will show less than twofold growth in 24 hours and less than tenfold
growth in 48 hours.
Digitized by
Google
48
PUBLIC HEALTH SERVICE
(b) That milk in pint bottles placed we.rm (80 to 90° F.) in a refrigerator 41Will show over eightfold growth in 24 hours, thirteenfold
wowth in 24 hours, and 750-fold growth in 48 hours if the refrigerator
1s kept at 60° F.
(c) That milk in quart bottles placed warm (80 to 90° F.) in a
refrigerator will show over sixteenfold growth in 24 hours and over
fortyfold growth in 48 hours if the ice box is kept at 46° F.; and over
210-fold growth in 24 hours and over 2,300-fold growth in 48 hours
if the refrigerator is kept at 60° F.
It is believed that the results of these studies thus far completed
indicate clearly the importance not only of keeping milk in a refri~erator but also the importance of receiving it cold and of placing
it rmmediately in a refrigerator which is kept at a temperature of not
less than 50° F.
CHLORINE DISINFECTION OF UDDERS AND HANDS COMPARED WITH SIMPLE CLEANSING
The objective of this problem being studied by Milk Specialist
W. H. Haskell is the determination of the value of chlorine disinfection of udders and hands as compared with simple cleansing with
water, and with soap and water cleansing.
Tentative findings.-The following tables give certain results thus
far obtained:
Numberof Average
specimens plate count
Group
1. Unwashed udders ••..••••.•.•••.•••••.•••••.•••••••••.•••••••••••••••••••••••
2. Water washed udders •.•.•..•••.•••.•••••••...••••••••••••••.••••••••••••.•.•
3. Chlorine washed udders (chlorine 50 to 100 p. p. m.) ••••••••••••••••••••..••••
122
283
280
6,112
1,108
116
Discussion of findings.-The results so far obtained indicate the
following tentative conclusions:
(a) That the visible cleanliness of the udder is no indication of its
bacteriological cleanliness.
(b) That proper washing with clean water and proper drying with
clean cloths brought about a 78 per cent reduction in the surface
bacteria on the udder.
(c) That washing the udder with a chlorine solution, between 50
and 100 p. p. m., brought about a 98 ·per cent reduction of the udder
surface organisms.
The work on udders is being continued so as to secure a lar~er and
more dependable number of observations, and future work will mclude
studies of hand washing and chlorination.
RELATIVE VALUE OF THE DIRECT MICROSCOPIC COUNT, THE STANDARD PLATE
COUNT, AND THE METHYLENE BLUE REDUCTABE TEST AB MEASURES OF MILK
SANITATION
The objectives of this research project being studied by Asst. Milk
Specialist R. C. Thomas, are-(a) To determine which of the three tests is most responsive to
variations in initial contamination; and (b) to determine which of the
three tests is most responsive to variations in the length of time milk
has been kept warm.
This work has not yet proceeded sufficiently far to justify a statement of conclusions.
Digitized by
Google
49
PUBLIC HEALTH SERVICE
EFFECT OF HEATING UPON THE GROWTH-PROMOTING CHARACTERISTICS OF
MILK
cow's
Information upon the growth-J.>romoting characteristics of cow's
milk was secured from 39 municipalities located in 10 States, and
embracing over 3,700 children 10 months to 6 years of age. A questionnaire was filled out for each child, giving information as to age,
weight, height, kind of milk used in the diet, and duration of use for
each kind, kind of supplementary food used in the diet, and duration
of use for each kind, number of rooms and number of persons in the
house, race, and incidence of diseases which might have been milk
borne.
It is believed that a careful statistical study of the information
secured justifies the conclusion that the growth-promoting C1tpacity
of heated milk plus the supplementary diet received by the average
American child of 10 months to 6 years is not measurably less than
the growth promoting capacity of raw milk plus the supplementary
diet received by the average American child of 10 months to 6 years.
EXTENT OF PASTEURIZATION AND TUBERCULIN TESTING IN AMERICAN CITIES OF
10,000 POPULATION AND OVER IN 1927 AND 1931
The Public Health Service receives many inquiries from local
health authorities and others regarding the extent of pasteurization
and tuberculin testing in American cities, and it was therefore deemed
advisable to bring up to date the data collected for the year 1927.
Furthermore, such a review affords valuable measures of the rate
of progress attained between 1927 and 1931 by these two important
public health measures.
Therefore a questionnaire was sent during the summer of 1931 to the
health officers of all cities of 10,000 population and over.
· A study of the returns justified the following conclusions:
(a) The percentage of milk pasteurized in American cities of 10,000
or more population, increased from 81.8 per cent in 1927 to 87.5 per
cent in 1931.
(b) The percentage of milk from tuberculin-tested cows in American
cities of 10,000 or more population, increased from 68.1 per cent in 1927
to 88.0 per cent in 1931.
(c) The percentage of milk which was either pasteurized or from
tested cows in American cities of 10,000 or more population increased
from 99.1 pel'"cent in 1927 to 99.83 per cent in 1931.
(d) The percentage of milk which was both pasteurized and from
tuberculin-tested cows in American cities of 10,000 or more population
increased from 50.8 per cent in 1927 to 74.5 per cent in 1931.
STUDIES OF THE INCIDENCE OF MILK-BORNE OUTBREAKS OF DISEASE
During the year 1931 the following outbreaks of milk-borne disease
were reported to the Office of Milk Investigations by State and city
health authorities: Typhoid fever 21, paratyphoid fever 1, scarlet
fever 1, septic sore throat 8, diphtheria 1, dysentery I, and gastroenteritis 1.
APPOINTMENT OF THE PUBLIC HEALTH SERVICE ADVISORY MILK COMMITTEE
During the year it was decided to appoint a board of consultants in
milk composed of the following members: Mr. H. A. Whittaker,
Minnesota State Health Department, Mr. C. A. Abele, Alabama State
Digitized by
Google
50
PUBLIC HEALTH SERVICE
Health Department, Mr. E. S. Tisdale, West Virginia State Health
Department, Mr. H. A. Kroeze, Mississippi State Health Department,
Mr. V. M. Ehlers, Texas State Health Department, Dr. Paul B.
Brooks, New York State Health Department, Mr. Loomis Burrell,
Dairy and Ice Cream Machinery and Supplies Association (Inc.),
Dr. D. B. Peck, International Association of Milk Dealers, Mr. Seth
W. Shoemaker, Certified Milk Producers Association of America,
Mr. Ernest Kelly, United States Department of Agriculture, and
Mr. Leslie C. Frank, United States Public Health Service.
This Public Health Service Advisory Milk Committee is to study all
proposed amendments to the Public Health Service milk ordinance or
code and to advise the Public Health Service regarding them.
The first meeting of the committee was on May 16, 1932, and a
number of proposed amendments were considered and passed upon.
PUBLICATIONS
During the year the following publications were prepared:
The Temperature Behavior of Milk Pasteurizer of the Thirty Minute Holding
Type. By L. C. Frank and F. J. Moss. Twentieth Annual Report International
Association of Dairy and Milk Inspectors, 1931.
Do Children Who Drink Raw Milk Thrive Better than Children· Who Drink
Heated Milk? By L. C. Frank, F. J. Mos~ W. H. Haskell, F. A. Clark, M. M.
Miller, and R. C. Thomas. Conference of i::state and Territorial Health Authorities, June 6, 1932.
The Extent of Pasteurization and Tuberculin Testing in American Cities of
10,000 Population and Over in 1927 and 1931. By L. C. Frank and F. J. Moss.
Mimeographed publication.
The Public Health Service Milk Sanitation Program. By L. C. Frank.
Mimeographed publication.
Importance of a National Unified Milk Sanitation Program. By F. A. Clark.
Texas Public Health Association, 1931.
STUDIES OF PUBLIC HEALTH METHODS
The office of studies of public health methods has continued under
the direction of Surg. Joseph W. Mountin. Its purpose is to determine
the value of various public health procedures and to devise ways and
means for more effective and economical application of information
concerning the prevention of disease and the promotion of health.
Two methods of approach are used: (I) A detailed analysis of
selected operations in the programs of health agencies; and (2) the
tnore comprehensive survey of local health problems and community
services.
A study conforming to the first definition is being conducted in
Brunswick and Greensville Counties, Va. The initial phase of this
study is designed so as to determine the health needs of people living
in rural areas and the manner in which an average small county health
department is meeting these problems. A separate but closely
related study is being made of the work of the health department
personnel from the administrative point of view. One nurse and two
field canvassers have been engaged in the work since August, 1931.
Passed Asst. Surg. J. 0. Dean was placed in immediate charge of the
Virginia study during the month of February, 1932. The field
canvassers have visited 1,005 families comprising a representative
sample of the population. A comprehensive schedule has been completed on each family covering such points as social and economic
Digitized by
Google
PUBLIC HEALTH SERVICE
51
circumstances, sanitary conditions, sickness experiences during the
preceding 12 months, medical services, contact with different members
of the health department, and various public health measures which
were put into effect.
·
A job analysis is being made of the work of the county health officer,
the county nurses, and the county sanitary officer. The plan of study
is essentially the same for the workers in the three classes. The data
being assembled will show (1) the amount of time devoted to the
several operations; (2) the source of calls; (3) the problems found on
each visit; (4) the service rendered; and (5) the result which came as a
consequence of the visit. The group of community activities of the
health department are being subjected to the same type of analysis
as is the individual case work. Prior to beginning the study proper
it was necessary to make observations on the content of the local
program and the method of approach in order to set up a study and a
system of records which would bring out the points enumerated above.
It is planned to continue the study so as to cover a full year of operation for each worker.
Surveys of the health services in Wilkes-Barre, Pa., and Baltimore,
Md., in progress at the close of the last fiscal year, were completed
and recommendations were made to the local authorities. A similar
service was rendered to the city of Seattle, Wash. The public health
organizations in the States of Mississippi and Alabama were studied
for the Brookings Institution as a part of their general survey of the
State governments.
A special report on rural health and housing was prepared for the
President's Conference on Home Building and Home Ownership.
Assistance was rendered to the Committee on Rural Health Practice
of the American Public Health Association in connection with the
development of the appraisal form for rural health service. In
cooperation with the American Public Health Association and other
national health agencies, a study is being made of the requirements of
health departments with regard to records and reports. This
information is being used as a basis in formulating definitions for
those activities which are common to most health departments and in
developing uniform methods for recording and reporting these
activities.
STATISTICAL INVESTIGATIONS
The office of statistical investigations continued under the direction
of Senior Statistician Selwyn D. Collins, with Principal Statistician
Edgar Sydenstricker and Consultants W. H. Frost and Lowell J.
Reed in close touch with all important phases of the work.
STUDY QF THE INCIDENCE AND COST OF ILLNESS
A considerable part of the year was spent on the tabulation of a
mass of data on the incidence and cost of illness in about 9,000 families
in 17 States and the District of Columbia. These data were collected
by the Committee on the Costs of Medical Care and made available
to the Public Health Service through a cooperative arrangement.
The data to be used and published by the Public Health Service relate
to incidence and the type of care which the patient received; items
relating to cost are to be used by the Committee on the Costs of Medical Care.
Digitized by
Google
52
PUBLIC HEALTH SERVICE
An incidence of 850 illnesses per 1,000 population per year was recorded. In some instances these illnesses consisted of two more or
less distinct diagnostic entities occurring simultaneously, such as
measles and whooping cough, and if these entities be counted separately, there is a total of 889 cases per 1,000 persons. These rates
approximate those found for Hagerstown some 10 years ago of 1 case
per person per year. Of the cases serious enough to cause the patient
to go to bed for one or more days, there were 461 per 1,000 persons
per year, or 52 per cent; and of those that caused the patient to lose
time from his usual work or school, there were 545 per 1,000 persons per
year, or 61 per cent.
Facts about the care received for these illnesses are of interest.
Seventy-nine per cent of the cases had the care of a physician or some
other practitioner, such as an osteopath or a chiropractor-75 per
cent had the care of a physician with only 4 per cent attended by these
other practitioners without a physician on the case. Eleven per cent
of all the cases were reported as having a specialist on the case, and
this must be considered a minimum statement, inasmuch as some physicians who are specializing on certain types of cases were not so reported by the family. Eight per cent of all the cases were treated in
a hospital for one or more days. This is in striking contrast to the
1.3 per cent of the Hagerstown cases that were treated in a hospital,
but the present ~roup includes a great many families from large cities
where the facilities for hospitalization are much better than in Hagerstown. Forty-one per cent of the deliveries were made in hospitals
as compared to 3 per cent in the Hagerstown study. Of the total
cases of illness, 8 per cent were surgical. Surgery, as used in this
study, included both major operations and such minor operations as
the lancing of a boil or the removal of a wart. A careful record was
also kept of bone surgery in the case of fractures, etc., and it is believed that the record of surgery is reasonably complete. The 2,607
surgical cases represent a rate of 6.8 surgical cases per 1,000 population. Of the total surgical cases, 60 per cent were in a hospital, and
of the total hospital cases 61 per cent were surgical.
Data on the place of treatment were also included in the study.
Thirty-seven per cent of the total cases had one or more home calls
by a physician or other practitioner; 8 per cent were treated in a
hospital; 34 per cent were treated at the office or clinic without any
home calls or hospital care, and 21 per cent had no physician or other
practitioner in attendance. It is surprising to find that of the total
cases of illness only about 4 per cent had any treatment at a public
clinic.
FIELD STUDIES OF MORBIDITY
The study of sickness in a distinctly rural area of Cattaraugus
County was continued throughout this fiscal year. The area studied
is strictly rural, the largest village having a population of less than 1,000
persons and the other villages being unincorporated clusters of houses
with populations of 50 to 200. The study was undertaken to find
the extent and causes of illness among farm families and other rural
dwellers. For comparative purposes a shorter study covering a
period of one year was made in an industrial city, Syracuse, N. Y.
In both studies the method was the periodic canvassing of a group of
Digitized by
Google
PUBLIC HEALTH SERVICE
53
about 1,500 families to keep a continuous complete record of illness
and medical care durin~ the period of the study.
These studies of morbidity in a rural and urban area have been conducted on a cooperative basis with the Milbank Memorial Fund.
It is expected to make a study of diphtheria carriers in this rural area.
The diphtheria case and death rates have declined during the past 10
years to a very low level, but there is no evidence that the number of
diphtheria carriers has declined to any considerable extent. The
diphtheria carrier is, therefore, becoming increasingly important in
the spread of diphtheria. A rather extensive study of diphtheria
carriers was made in Baltimore by the Johns Hopkins School of
Hygiene some years ago, but there are no data on the prevalence and
distribution of diphtheria carriers in the rural part of the country.
INFLUENZA STUDIES
The studies of influenza were continued throughout this fiscal year.
A paper on the age and sex incidence of sickness and mortality from
influenza and pneumonia during the epidemic of 1928-29, with comparative data for the epidemic of 1918-19, was published in the
Public Health Reports for August 14, 1931, and two other papers on
influenza and other respiratory diseases are in proof. One further
paper on the 1928-29 epidemic is practically completed and it is expected that it will be published during the coming fiscal year. The
studies of influenza during the 1928-29 epidemic indicate an entirely
different age distribution of cases and deaths from the 1918-19 epidemic. The most outstanding thing about the great pandemic of
1918-19 was the very high peak of pneumonia cases and deaths among
young adults. The 1928-29 epidemic did not show any such peak.
This young adult peak in the 1918-19 epidemic was higher for males
than for females, but the 1928-29 mortality and the pneumonia incidence were practically identical for the two sexes at the young adult
ages. With the exception of the 1920 epidemic, none of the five or six
influenza epidemics that have occurred since 1918 have shown any
large excess mortality among young adults.
CURRENT MORTALITY AND DISEASE PREVALENCE STATISTICS
The collection and publication of monthly mortality statistics from
such States as could furnish data to the Public Health Service was
continued throughout the year, in cooperation with the Division of
Sanitary Reports and Statistics.
The mortality report for the year 1931 with provisional rates by
cause of death and by State was published in May of 1932. This
report indicated that, in spite of the unfavorable economic conditions,
the year 1931 had been one of low mortality-in fact, the death rate
from all causes of 10.9 per 1,000 population in 18 States was lower
than in any preceding year. The death rates from typhoid fever,
tuberculosis, and diarrhea and enteritis likewise continued their
steady decline. These preliminary reports with data about a year
ahead of the final reports have been found to be very useful.
Monthly summaries have also been published on the prevalence of
disease in the United States. These summaries are based on weekly
telegraphic reports received from the States.
Digitized by
Google
54
PUBLIC HEALTH SERVICE
COOPERATION WITH OTHER OFFICES AND DIVISIONS OF THE SERVICE
A considerable part of the work of the Office of Statistical Investigations consists of the rendering of assistance to other offices and divisions
of the service.
STREAM POLLUTION
Field headquarters of Stream Pollution Investigations have been
maintained at Cincinnati, Ohio, under the direction of Sanitary Engineer J. K. Hoskins. As a guide to the formulation and development
of the general policies to be pursued, a special board of consultants
frequently reviews progress and advises with the scientific personnel.
Particular attention has been devoted to the rounding out of experimental evidence and the summation, in permanent form, of the more
important conclusions developed from research studies in water
purification and natural stream purification upon which the stat.ion
has been engaged during recent years. With the advancement of this
program, and in accordance with the advice of the consultants, it has
appeared advisable to give increased consideration to the third of the
three major phases of stream pollution, that of sewage treatment.
In furtherance of this plan, an experimental activated sludge treatment plant is being constructed on the station grounds, which it is
intended will furnish a continuing supply of material for research
study of certain of the biochemical and biological factors operative
in this method of sewage purification.
·SURVEY OF THE PRESENT SANITARY CONDITION OF THE OHIO RIVER BETWEEN
CINCINNATI AND LOUISVILLE
The extensive data collected during the resurvey of the Ohio
River made in 1929-1931 have been critically analyzed and summarized in a monograph prepared for publication as a Public Health
Bulletin by Sanitary Engineer H. R. Crohurst, who has been in
immediate charge of this study.
By suitable arrangement of these data it has been possible to make
some interesting comparisons of the sanitary conditions observed
during the two surveys. In general, during the winter periods of unobstructed flow, the bacterial pollution was somewhat higher in 1930-31
than that observed in 1914-1916, although .the organic pollution as
measured by the oxygen demand was considerably less. In the summer periods, when the stream is a virtual series of pools, this retardation of flow has the apparent effect of intensifying the conditions of
pollution in the immediate vicinity of the sewage discharge and, by
mcreasing the time of flow, improving the water at places farther
downstream. While these decreased bacterial loads at waterworks
intakes make the production of a bacterially satisfactory effluent less
difficult, the effects of decreased turbidity and increased volumes of
microscopic organisms, resulting in shortened filter runs and possible
taste and odor production, more than offset the good effects of lower
bacterial content. The concentration of decomposition products due
to fermentation of organic deposits within the pools, when the dams
are in continuous operation, may have public-health aspects not heretofore appreciated. Reference is made to the suspected water-borne
outbreak of gastroenteritis along the Ohio River at the time of and
following the low-water conditions in the fall and winter of 1930-31.
Canalization, at least between Cincinnati and Louisville, has had a
Digitized by
Google
PUBLIC HEALTH SERVICE
55
tendency to complicate, rather than simplify, the problems connected
with sewage disposal, nuisance production, the operation of water
treatment devices, and the preservation of the public health.
STUDY OF STREAM OXIDATION
A statistical and experimental study of stream oxidation phenomena
has been undertaken by Sanitary Engineer H. W. Streeter, with the
purpose of elucidating the fundamental principles governing the
processes of natural oxidation in polluted streams and the extent to
which these processes are modified by various physical and biological
conditions. The present study is, in effect, an extension of that of the
Ohio River (Public Health Bulletin 146), made possible by more
comprehensive data and additional experience concerning the effects
of certain factors, notably those of sludge deposits and biological
growths in the channel, on the progressive rate of recovery of streams
subject to a depletion of their natural oxygen supply by polluting
wastes.
Basic data for a study of this kind are now quite extensive, having
been accumulated over a period of several years past from laboratory
surveys of the Ohio, Illinois, and upper Mississippi Rivers by the
Public Health Service, and from similar surveys of other streams by
various State and local sanitary authorities.
Supplementing the field data above noted, an extensive series of
controlled experimental observations has been instituted in the
artificial stream channel located at this station in which the rates of
reaeration and oxidation in a flowing stream of polluted water may
be measured under varying conditions of depth, velocity, and turbulence. It is planned to measure also the rates of deoxygenation
in a sewa~e-polluted stream of river water flowing through the channel, both m the absence and in the presence of sewage-sludge deposits
of various depths, and to determine the influence of attached biological growths and the effects of the more common forms of algae known
to liberate oxygen in water through their photosynthetic action.
Observations of this kind, on a quantitative basis, are possible only
under experimental conditions such as are afforded by a controlled
artificial stream.
·
The analysis of field data, though still only in its preliminary stages,
has indicated quite definitely that the process of progressive deoxygenation in sewage-polluted streams is governed very largely by three
main factors: (1) The biochemical oxygen demand of the suspended
oxidizable matter present in the supernatant water; (2) the rate of
formation and liberation of directly oxidizable decomposition products
resulting from bacterial action in sludge deposits; and (3) the rates
at which both these products and those of similar nature resulting
from septic conditions in the wastes discharged into streams are
oxidized directly in the flowing stream. An effort is being made to
develop a general method for evaluating these factors by means of
the usual laboratory tests as applied to the stream water.
EXPERIMENTAL STUDIES OJI' NATURAL PURIJl'ICATION IN POLLUTED WATER
The activities of biological life in the oxidation of organic matter
·in water are not only of fundamental importance in the processes of
natural stream purification, but underlie the biol~gical methods of
Digitized by
Google
56
PUBLIC HEALTH SERVICE
sewage treatment as well. For this reason, increasing attention has
been devoted to the phases of the problem directly related to sewage
purification.
Activity of algae in pure culture.-The study of organisms in pure
culture has been concerned chieflv with the functions of unicellular
algae of the kinds usually prevaient in natural water. Excluding
atmospheric aeration, it was demonstrated that, in dilute liquid media,
followmg inoculation with B. aerogenes only, the dissolved oxygen
gradually diminished to depletion, whereas in companion cultures
which contained both B. aerogenes and a minute green alga, the latter
organism produced sufficient oxygen by photosynthesis to prevent
such exhaustion and to restore gradually the content of oxygen present
at the start. Bacterial growth meantime was practically identical
in the two sets of cultures. The quantity of algal growth required
to produce such results did not exceed the amount frequently found
under natural conditions. Further similar work is in progress, designed to determine any essential differences in results when atmospheric aeration is available to these same organisms.
Nitrification studies.-An essential difference between the biological
systems of sewage treatment and the so-called mechanical or electrolytic processes is that the purification of the sewage by microorganisms
may be carried out to the point of securing complete nitrification of
the nitrogenous materials. A study of the nitrification process was,
therefore, undertaken to supplement the existing meager information.
regarding this phenomenon, particular attention being paid to the
effect of variations in the pH value of the medium on the rate and
extent of nitrification. Valuable information has also been obtained
in regard to the amount of oxygen which disappears in the course of
the nitrification of sewage matter so that the possibility now exists of
making a fair estimate of the residual oxygen requirements of a partly
nitrified effluent on the basis of readily determined constituents.
The catalysis of biological oxidations.-It is well established that the
air oxidation of numerous forms of organic matter in solution may
readily be accomplished if the pH value of the medium is suitably
raised. In practice the cost of purifying sewage by such a procedure
would be prohibitive, although the effect in question is easily demonstrated on a laboratory scale. Considerable interest has therefore·
been evinced in the claims of several experimenters to the effect that,
in the presence of certain catalytic agents, the oxidation of organic
matters could be made to proceed at ordinary pH values without the
addition of lime or similar reagents. A repetition of these experiments lmder carefully controlled ,conditions has failed to support the
claim for the catalytic activity of the ferropyrophosphates at ordinary
pH values, wherever bacteria are rigidly excluded from the solutions ..
Neither does it appear that bacterial activity is greatly stimulated
by the presence of the supposed catalytic agents.
Bulking of actimted sludge.-A preliminary study of the phenomenon
of "bulking" in the activated sludge process of sewage treatment has
led to the conclusion that special methods of sewage analysis, now
unavailable, would have to be developed before this source of difficulty in plant operation could be successfully differentiated from other
possible causes of poor performance. In one plant studied, however,
1t was determined that bulking occurred where the filaments of the·
fungus Sphaerotilus attached to the floe particles exceeded a total
Digitized by
Google
PUBLIC HEALTH SERVICE
57
length of about 10 feet per cubic millimeter of the solid matter constituting this floe. Under normal operation conditions, these filaments did not exceed about 4 feet per cubic millimeter. It was further observed that, when bulking was in progress or about to occur,
the distribution of the fungus growth became general, affecting the
large majority of the floe particles.
Development of methods.-In the course of research studies it frequently becomes necessary to devise methods or to modify existing
technique for application to the particular problem in hand. During
the past year, modifications of the usual Winkler method were proposed 1 for the more accurate determination of dissolved oxygen in
water containing certain forms of or~anic matter, hypochlorites, and
sulphite wastes. Comparati,e studies of various types of dilution
waters for bacterial examinations indicated a wide divergence in
results attributable to this factor. A suitable, easily reproducible
water for the purpose was recommended. 2
MISCELLANEOUS ACTIVITIES
In addition to the research activities in which the station is engaged,
requests have been complied with for technical advice and assistance
• from States, municipalities, and organizations confronted with special
problems in water sanitation. Another important activity has been
service on committees of technical organizations interested in many
phases of stream improvement, water supply, sewage treatment, and
the standardization of competent analytical procedures.
Cooperation with interstate watershed boards.-During the year
assistance has been rendered to the Ohio River and Great Lakes
• Drainage Basin Boards in the formulation of suitable analytical procedures for stream examinations. Further aid is being rendered the
Ohio River board of State en~eers in the systematic collection and
interpretation of data pertaimng to the sanitary quality of the water
of the river in connection with their comprehensive .PrograI!l for the
protection of the raw-water supplies of Ohio River cities.
Coeur d'Alene River and ,Lake lead-pollution study.-The Coeur
d'Alene River in Idaho is seriously polluted by the waste slimes discharged by the lead-mining industry in that area. Assistance is being
rendered to a special State legislative commission appointed to study
the problem.
Instruction in stream-examination procedures ...c..-A 2-weeks' school of
instruction in methods and interpretation of data of stream-pollution
examination has been given to a class of scientific employees of State
health departments for the fourth successive year. One representative from each of 21 States, selected by the Conference of State
Sanitary Engineers, was in attendance. This method of instruction
aids individual States to inaugurate and carry forward studies of their
stream-sanitation problems with some assurance that the procedures
they employ are in general use and well adapted for the purpose.
NATIONAL INSTITUTE OF HEALTH
The administration of the National Institute of Health for the
fiscal year 1932 continued under the supervision of Director George W.
McCoy and Assistant Director R. E. Dyer.
I
1
Ind. & Eng., Chem. Alllllytlcal Edition, vol .•4., pp. 59-64 (Jan. 15, 1932).
Jour1181 or Bacteriology, vol. 23, pp. 365-368 (.May, 1932).
Digitized by
Google
58
PUBLIC HEALTH SERVICE
Library.-During the fiscal year 1932 the library continued under
the immediate supervision of Miss Carrie Myers. There is a total of
15,570 volumes now on the shelves. Many annual reports and other
publications from State and municipal health departments were
received. Numerous publications issued by scientific institutions
throughout the world were added to the collections.
DIVISION OF PATHOLOGY AND BACTERIOLOGY
STUDIES OF NUTRITIONAL DISEASES
Studies on nutritional diseases at the institute were continued
under the direction of Surg. G. A. "\\'neeler, assisted by Passed Asst.
Sure;. W. H. Sebrell.
The laboratory studies were carried out on dogs and correlated
with those in man, and were concerned with the determination of the
probable pellagra-preventive value of individual foodstuffs.
In collaboration with the Division of Chemistry, studies were made
on methods for quantitative estimation of the antipellagra vitamin.
Typhus-Rocky Mountain spotted fever.-The investigations of
typhus-Rocky Mountain spotted fever were continued during the
fiscal year under the direction of Surg. R. E. Dyer. Associated in~
the investigations throughout the year were Passed Asst. Surg.
A. Rumreich and L. F. Badger. During the first half of the year
Asst. Surg. E. T. Ceder was one of the group, being replaced during
the second half by Asst. Surg. W. G. Workman.
Following the discovery, in 1931, that rat fleas, taken on premises
where cases of endemic typhus were occurring, contained the virus of
the disease, studies were carried out in the laboratory to determine ·
the behavior of the virus in the flea and the exact mechanism of transmission from rat to rat.
It was found that two species of rat fleas, Xenopsylla cheopis and
Geratophyllus jasciatus, became infected with typhus when fed on
typhus-infected rats. As the incidence of human cases of endemic
typhus corre;;ponds more closely to the prevalence of Xenop8ylla
cheopis than to that of Geratophyllus jasciat1ls, the former flea was
made the subject of intensive study.
It was found that the virus of endemic typhus could survive in
this flea (Xenopsylla cheopis) as long as 52 days, this being the limit
of the experiment. It is thought possible that fleas once infected may
remain infected through life.
The virus was found to undergo a definite multiplication in the
flea. For the first three days after an infective feeding, it required
the amount of virus present in more than one-half of a flea to mfect
a guinea pig. After three days, one thirty-second of a flea contained
an infective dose for a guinea pig. Later titrations showed that the
virus present in n-looIT of an infected flea was sufficient to infect.
Under experimental conditions 1mdemic typhus is readily transmitted from rat to rat by means of fleas when the fleas are allowed
free access to the rat. Efforts to transmit typhus by feeding infected
fleas on white rats and guinea pigs through chiffon were without
result. In these experiments the chiffon apparently kept the flea
feces from intimate contact with the skin. The feces of infected
fleas were found to contain the virus, and when this material was
rubbed into the abraded skin of guinea pigs, the disease was transDigitized by
Google
59
PUBLIC HEALTH SERVICE
mitted. From the fore&'oing it seems that a possible method of transmission of endemic typnus by the rat flea is through the scratching
or rubbing of infected flea feces into the skin.
Late in the fiscal year it was found that a vaccine, prepared by
treating an emulsion of typhus-infected fleas with phenol (0.4 per
cent) conferred some immunity upon guinea pigs.
Studies on the epidemiology of Rocky Mountain spotted fever
(eastern ty_pe) were continued throughout the year. It was found
that the disease was present in Maryland, Virginia, District of
Columbia, New Jersey, .Delaware, Pennsylvania, North Carolina,
South Carolina, Georgia, Louisiana, Minnesota, and possibly Tennessee. Efforts were made to determine the presence of spotted
fever in wild rodents and ticks obtained from their normal habitats.
These attempts were without success. However, in prosecuting this
work an infection was recovered (its probable source being stock
guinea pigs) which in some ways simulated Rocky Mountain spotted
fever in laboratory animals. This infection was determined to be
due to a new type of SalmoneUa enteritidis. This particular :phase of
the work serves to stress the importance of the following criteria in
the di~nosis of spotted fever in laboratory animals: Typical clinical
course m guinea pigs, production of a positive Weil-Felix reaction in
rabbits or monkeys, negative blood cultures when taken at the
hei~ht of the infection in guinea pigs; the presence of characteristic
bram lesions in guinea pigs i and cross-immunity tests with known
strains of spotted fever VIrus..
M-icrobic variation.-Because of its possible influence on the epidemiology af communicable diseases, the question of whether or not
bacteria undergo a complicated life cycle in which they show marked
changes in morphology and behavior is of great concern to workers in
the field of public health bacteriology. During the past year Surg.
R. R. Spencer has been engaged in the study of the possible life cycle
of B. proteus X 19 and of the Streptococcus scarlatinae with the purpose
of developing, if possible, a simple technique for the production of
bacterial variants at will and which, at the same time, would be as
free as possible from the chance of contamination. The :possibility of
such contaminations has been the chief criticism of preVIous work in
this important field. Although such a technique has not been perfected to date, the organisms mentioned above have at various times
been placed in plain broth containing some single more or less harmful
substance (fuller's earth, charcoal, garden soil, sea sand, rattle-snake
venom, carnotite ore, and killed masses of various bacteria), and the
cultures studied at intervals for the presence of variants or mutants.
Suggestive but irregular results were obtained; but by submitting the
bacteria to the effect of the gamma rays of radium, very profound
changes in morphology and cultural characteristics have been observed. Further work is necessary before any definite description of
these changes can be made.
Undulant jever.-Field investigations of undulant fever have been
continued by Senior Surg. H. E. Hasseltine.
Reports from various State departments of health show t.hat
1,572 cases were officially reported during the year. These cases
occurred in 44 States and the District of Columbia.
144391-32--5
Digitized by
Google
60
PUBLIC; HEALTH SERVICE
Prolonged observation of undulant fever infection at a State
sanatorium for tuberculosis has revealed that several patients in
whom evidence of active tuberculosis was meager, or wanting, have
shown a positive agglutination reaction against Brucella antigens in
relatively high titer. This indicates that undulant fever may be
mistaken for early tuberculosis and should warn physicians that an
agglutination test for undulant fever should be made in all persons in
whom the presence of tuberculosis is suspected but not confirmed by
the usual methods of diagnosis.
Previous reports as to the methods of transmission of the disease
have been confirmed by the investigations of the past year, during
which special attention was given to the question of transmission
from person to person or by "carriers." No evidence of transmission
in this manner has been found.
The effectiveness of pasteurization in preventing the transmission
of undulant fever by dairy products continues to be shown by the low
incidence of the disease in cities that have a considerable portion of
their milk supply pasteurized.
Psittacosis.-Senior Surg. H. E. Hasseltine has made field investigations of outbreaks of this disease. In October, 1931, psittacosis
appeared in New York City and the infection was traced to shell
parrakeets obtained from a bird dealer in San Francisco. In two
mstances in New York the infection was transmitted to other birds
(parrots) that were temporarily housed in the same pet shop with
tbe San Francisco parrakeets. In both instances the parrots, which
had been in the possession of the owners for a long period, carried the
infection to the families when the birds were returned home from the
pet shop.
Early in December, 1931, an outbreak of psittacosis occurred in
California. Investigations revealed a total of 43 cases with 9 deaths.
While there was some evidence that the infection was brought in from
the Orient, there was also evidence that some human cases were
attributable to California-bred parrakeets. Subsequent investigations have revealed that the disease is present in the parrakeet
breeding aviaries of southern California. The control or eradication
of this infection from these establishments presents a difficult problem.
In California the shell parrakeet seems to be the great reservoir of
infection, though two cases were traceable to infection in canary
birds. It also apJ?ears that sheH parrakeets may transmit the infection without showmg evidence of illness. Evidence was also obtained
that the disease is occasionally transmitted from person to person,
particularly from patient to nurse. In the majority of cases where
person-to-person transmission has occurred, the primary case has
resulted fatally.
Relapsing fever.-The work on relapsing fever has been carried on
by Medical Director Edward Francis. Hereditary transmission of
relapsing fever from naturally infected adult ticks (OrnitlwdoML8
t'uricata, collected in Texas) through their eggs to their progeny was
demonstrated. This shows the practical impossibility of eradicating
this tick reservoir of infection. Probably 50 cases of relapsing fever
have been observed in Texas in the last few years and 10 cases were
reported from California in 1931.
Poliomyelitis.-Studies by Surgs. W. T. Harrison and Charles
Armstrong have been carried out experimentally in monkeys to_deDigitized by
Google
61
PUBLIC HEALTH SERVICE
termine the effect of nonspecific immunity upon later poliomyelitis
infection, with results that suggest some modifications of the virus
infection. Surgeon Harrison has carried out field studies relati11&' to
the effect of vaccination against smallpox, and of immunization agamst
diphtheria, on the incidence of poliomyelitis in two urban areas but
without conclusive results.
Trachoma.-Most of the active work on trachoma was suspendedat the laboratory in Rolla, Mo., and certain phases were transferred
to Washington, where the studies have been continued by SeniorBacteriologist Ida A. Bengtson. Efforts have been continued to
transmit the disease to Macacus rhesus monkeys by direct transfer
from active cases of trachoma, with the idea of comparing the lesions
thus produced with those induced by inoculation of Bacterium granu~
losis. It has been found very difficult to transmit the disease to
monkeys by either method. When once induced by the inoculation
of cultures of Bacterium granulosis, lesions are easily transmissible,
only one swabbing being necessary to transfer the infection. Thus
far the lesions produced by direct transfer of secretions from the conjunctiva! sac of trachoma patients to the eyes of monkeys have been
found to be less pronounced and less easily transmissible than are the
lesions produced by inoculation of cultures of Bacterium granulosis.
Tularaemia.-Studies under Medical Director Edward Francis may
be summarized as follows:
The State of New Hampshire was added in January, 1932, to the
area of distribution, leaving only the three States of Maine, Vermont,
and Connecticut in which the infection has not been found. Sweden
recognized her first case of tularaemia in March, 1931.
Tests upon artificially infected rabbits have shown the persistence
of virulence of Bacterium tularense in rabbits stored for five months
at 3° C. and in those stored for one year at -15° C., thus demonstrating the possible danger to health of cold-storage wild rabbits.
Antistreptococcus bacteriophaqe.-Studies by Senior Bacteriologist
Alice C. Evans have been earned out to determine what substances
in the body inhibit the action of bacteriophage. Complete inhibition
of the phage activity was found when in contact with blood serum,
purulent exudate, ascitic fluid, or bile.
Plaque.-Continuance of the observations by Medical Director
Francis have shown that plague cultures on plain agar stored nine
years at 10° C., but without transfer to fresh culture medium during
that time, grew promptly when transferred to fresh culture medium
and were fully virulent for guinea pigs and white rats. Plague guinea
pig spleens suspended in pure undiluted glycerin at -15° C. for
seven years harbored fully virulent B. pestu; at the end of that time.
Pathology.-Work in the section of pathology has been carried on
by Passed Asst. Surg. R. D. Lillie, aided by Asst. Surg. J. G. Pasternack. The histologic diagnostic servi~e to marine hospitals and
other agencies has been continued; 1,743 specimens from these sources
were examined and reports submitted.
In addition to this di~nostic work, specimens from 94 7 experimental animals, representmg 6,056 blocks, were subjected to histologic examination and reports were made. The subjects covered in
this material were toxicologic histology of poisonings by orthocresyl
phosphate and phosphite, by copper salts, by osmic acid v81por, by
Digitized by
Google
62
PUBLIC HEALTH SERVICE
carbon tetrachloride vapor and by arsphenamines; the diagnosis of
psittacosis in birds detained at United States quarantine stations;
studies in the pathologic histology of psittacosis in birds (in press),
studies on typhus and Rocky Mountain spotted fever in guinea pigs,
rabbits, and monkeys, on poliomyelitis in monkeys, on vaccima in
mice, rabbits and guinea pigs, on experimental malignant and benign
tumors, and attempts at production of malignant tumors by inoculation with a certain microorganism regarded by some workers as the
cause of cancer, on experimental meningococcus meningitis in rabbits
and guinea pigs, on rabbit syphilis and guinea pig tuberculosis, on
pseudotuberculosis in guinea pigs, on coccidiosis in rabbits, on experimental heart disease, on blacktongue of dogs, on plague in guinea pigs,
on tularaemia in guinea pigs and other animals, on the reaction to
the toxins of Vibrion septiq_ue and of B. diptheriae in rabbits, guinea
pigs, and monkeys, on experimental trachoma in monkeys, and on
various intercurrent morbid conditions in experimental animals.
Experiments on mounting media for thiazene dyes have been carried
out, and a further prolonged trial of the most satisfactory of these on
routine histologic material is being initiated. Experiments on the
control of eosin polychrome methylene blue staining have been carried
out, and a technique has been arrived at which is now under extended
routine trial.
A study on the gross and minute pathology of the eastern type of
Rocky Mountain spotted fever in man was completed and published
in the Public Health Reports for November 27, 1931, and a similar
study on human psittacosis is nearing completion.
There follows a tabulation of the specimens examined during the
fiscal year:
Surgical Autopsy
A. Tissue specimens or human origin:
1,154
Hospitals and relier stations_________________________________________
214
Prisons and other Federal agencies___________________________________
246
35
In cooperation with State and local health agencies__________________
26
0
Field Investigations of the service____________________________________
17
19
Miscellaneous ____________ ----------_------------------------------__
30
2
Total human______________________________________________________
1,473
270
B_ Pathology or experimental diseases ____________________ ---------------- ___________________ _
C. Prepared for other divisions, butnotexaminedlnsectionon pathology _____________________ _
Total histopathology __ -------------------------------------------- ___________________ _
D. Specimens routinely examined or tested:
Blood and spinal fluid ror Wassermann and Kahn test __________________________________ _
BloodCount ______________________________________________________________________________ _
Tularaemia_________________________________________________________________________ _
Undulantfever
fever
____ --------------------- _____ -------- ____ -------- ___________________ __
Typhus
_______________________________________________________________________
Typhoid fever, para A and para B------------------------------- ___________________ _
Urinalyses ______________________________________________________________________________ _
Cultures:
~i~:N:~!us:::
::: : : : :: : : : : :: : : : :: : : : : : :: : : :: :: : : ::::: : ::: ::: : : : : : : :: :: : : : : : : :: : : : :_
Sputum
________________________________________________________________________________
Brain for rabies, animaL ________________________________________________________________ _
Fooes__ ------- __________________ ----------------- ________ ------------ ___________________ _
Smears ____________ ---------- --- ------- -- ---- ------------------------ ---- ------ ---- -- ---Catgut_ - ----------- ------------- --------------- --- -- -- ------------- - -------- -- ---- -- --- Oauze ____________ ------------- ----------- ----------- ------ ---------- ---------- ---- -- ---Water _______________ --- ------------------------------- -- ------------ -- ------ -- ---------Total miscellaneous ______________________________ ------------------ ___________________ _
Digitized by
Google
Total
1,368
281
26
36
32
1,743
947
<l7
2,737
15,730
16
589
793
1,803
206
89
us
87
2
13
29
6
lG
2
62
19,580
PUBLIC HEALTH SERVICE
63
SPECIAL STUDIES ON PROPHYLACTIC AND THERAPEUTIC AGENTS
Scarlet fever.-Studies having to do with the control of biologic
products derived from the hemolytic streptococcus of scarlet fever
origin have been continued by Surg. M. V. Veldee, with the assistance
of Passed Asst. S1J.rg. G. L. Dunnahoo.
A clinical study of the therapeutic v9:lue of scarlet fever antitoxin,
begun last year, has been completed and the report published in the
Public Health Reports for December 18, 1931. The antitoxin-treated
patients developed 75 per cent fewer complications· than did the control group, which received no serum. However, 66 per cent of the
serum-treated patients developed serum sickness of varyin~ degree.
A study- of the immunizing quality of streptococcus toxo1d is being
made, with over 700 toxin-susceptible persons under observation.
These persons received either two or three immunizing doses spaced
at three or four week intervals. Retests one month following the
last dose showed 80 to 90 per cent with negative skin tests. Retests
will be repeated at intervals to determine the durability of the
immunity.
A study of the use of the ear of the white rabbit for standardizing
scarlet fever biologic products has been completed and the results
have been published in the Public Health Reports for May 6, 1932.
This is a neutralization test similar to the present standard humanskin test method. The new method gives results that may be compared with those obtained by the older method.
A new study was undertaken late in the fiscal year on the biologic
action of exotoxins derived from strains of hemolytic streptococci
other than those of scarlet fever origin.
Post vaccination complications.-Studies by Surg. Charles Armstrong have resulted in the collection of data concerning 83 proved
or probable cases of encephalitis after smallpox vaccination for the
Umted States during the past 11 years, 66 of which number occurred
during 1928, 1929, 1930, and 1931.
Attempts to produce the pathological picture of the human disease
in experimental animals have continued to give negative results.
Field studies have been continued and show that cases have not been
confined to any particular strains of vaccine virus or to any special
vaccination methods.
The relative rarity of postvaccination encephalitis following vaccinations performed during the first year of life and following.secondary
vaccinations, as noted for Europe, is apparently true also for the
United States. Since the vaccination reactions in both these relatively insusceptible groups tend to be less severe than do primary
vaccinations performed after the first year of age, an attempt has
been made to modify primary vaccinations in an effort to simulate
this milder type of reaction. It was found that when a sufficient
amount of diphtheria toxin was incorporated with vaccine virus to
produce a positive Schick reaction at the vaccination site in rabbits, the local "take" was largely inhibited and the general response
was less severe.
It was next shown that ~roups of mice previously inoculated with
two doses (0.5 cubic centimeter) of diphtheria toxoid, when subsequently given carefully titrated doses of vaccine virus intra.cerebrally, withstood the vaccine inoculations better than did control
groups.
Digitized by
Google
64
. \
PUBLIC HEALTH SERVICE
Based on these experimental results and owing to the fact that
in the United States diphtheria offers a far greater hazard of death
for children than has smallpox during recent years, it has been suggested that children be immunized against diphtheria and then
vaccinated against smallpox about one month after their last injection. It is deemed that the preliminary exercise or mobilization of
the defense mechanism makes for a more efficient antivaccinal
response on the part of the vaccinated individual.
Occasional cases of postvaccinal tetanus continue to develop, but,
in so far as information has been secured, are entirely confined to
dressin~-covered "takes."
Studies have been begun looking toward a possible elucidation of
the circumstances under which the occasional cases of postvaccinal
septic infections are occurring.
Meningitis.-Studies on meningitis were continued by Senior
Bacteriologist Sara E. Branham. One hundred and twenty new
strains of meningococci were received and studied during the year,
making a total of 492 strains which have been studied intensively in
respect to their cultural characteristics and their serological interrelationships. A discussion of this phase of the work, and of the
conclusions ·drawn from it, is embodied in a paper entitled "Serological Diversity Among Meningococci" now m press.
Investigation during the past year has followed two principal lines:
1. A study of some of the newer methods proposed for evaluating
antimeningococcic serum was undertaken. Junior Bacteriologist
Anna M. Pabst was associated in this phase of the work.
Special attention was given to the technique proposed by Shwartzman, involving the neutralization of a skin reaction produced by
injecting filtered meningococcus washings intravenouly into locally
sensitized rabbits. A high percentage of samples of antimeningococcic serum, obtained from manufacturers, neutralized this reaction,
but the usefulness of the technique in standardizing serums seems to
be limited.
2. Attempts to produce meningococcus infection in laboratory
anim~.
·
Experiments with rabbits showed that both a clinical and histopathological meningitis can be produced by intracisternal injection
of large doses of virulent meningococci. It was necessary that the
culture be. used for this purpose immediately after isolation, and it
was not possible to maintain its virulence in culture or by animal
passage. This phase of the work is still in pro~ess.
Gas gangrene antitoxin.-The work of establishing standards for the
various antitoxins contained in gas gangrene antitoxin has been
conducted by Senior Bacteriologist Ida A. Bengtson. The unit
for measuring the potency of Vibrion septiq_ue antitoxin has been
under consideration and a quantity of Vibrion septique serum of high
potency to be used as standard has been dried and a supply of dried
Vibrion septique toxin prepared. Tests in rabbits indicate that those
animals are suitable for testing purposes, though work on the suitability of other species is in progress. A comparison with the standards of other countries is being made with a view to establishing an
international standard.
Diphtheria toxin-antitoxin mixture.-An attempt was made by
Surg. W. T. Harrison to explain by laboratory methods a very eviDigitized by
Google
PUBLIC HEALTH SERVICE
65
dent spontaneous increase in toxicity of the 0.1 L + dose of certain
toxin-antitoxin mixtures. This increase in toxicity apparently was
not due to freezing. The results of the experimental work a.re not
conclusive.
Arsphenamines.-Studies by Asst. Pharmacologist T. F. Probey
on the therapeutic activity of neoa.rsphenamines in experimental
syphilis in rabbits have been continued. Previously reported observations that the trypa.nocidal activity in rats does not parallel the
spirocheticidal activity in rabbits are confirmed.
In the treatment of 156 cases of all stages of human syphilis, two
products of different trypll,nocidal activity were quite uniform in
their ability to influence the reacting substances in syphilitic sera.
DIVISION OF ZOOLOGY
Prof. C. W. Stiles, who served as chief of this division since it was
founded, retired from active duty in October, 1931, since which time
the work has been under the supervision of Junior N ematologist
Mabelle 0. Nolan.
Bulletins.-N ational Institute of Health Bulletin 159, on the
parasitic diseases of insectivores in relation to the diseases of man,
has been issued from the press.
A bulletin on the parasitic diseases of carnivores in relation to the
diseases of man has been completed.
·
An additional bulletin on the parasitic diseases of pinnipedia is
practically finished.
Examination o/ parasites for diagnosis.-This part of the routine
work of the division has been continued throughout the year, and
160 specimens have been examined for various Government hospitals,
State health departments and universities, and for practicing physicians. In addition, over 6,000 ectopa.rasites have been determined.
International Commission on Zoological Nomenclature.-Coopera.tion with the International Commission on Zoological Nomenclature
has continued as in preceding years.
Various questions on nomenclature and terminology have been
submitted to the division for advice or decision by a number of
governmental departments and universities in the United States and
abroad.
DIVISION OF PHARMACOLOGY
The following work has been pursued by the division of pharmacology under the direction of Pharmacologist Director Carl Voegtlin:
CANCER RESEARCH
As in the two preceding years, the work on cancer has been based on
the assumption that cancer is n9t an infectious disease in the strict
sense, but rather a chemical abnormality of living cells. Therefore,
it would seem that the discovery of new facts concerning the chemistry of normal and cancer cells in the body should gradually lead to a
better understanding of the nature of this disease and should ultimately
serve as a foundation for a rational chemical treatment. The discovery of an effective treatment of cancer by chemicals is obviouslv a
very difficult problem; but success along this line, even if partial,
would be a great step forward in the control of the disease. The
Digitized by
Google
66
PUBLIC HEALTH SERVICE
present methods of treatment-surgery and radiation-are confined
essentially to the removal Ol" destruction of tumors which a1."e still
more or less restricted to their point of origin. On the other hand,
the introduction of suitable chemicals into the body might act
destructively upon malignant cells irrespective of their location in
the body.
The available knowledge concerning the chemistry of cells is still
rudimentary. Very little information is available which could give
an adequate picture of the chemical :processes concerned in the multiplication of body cells and the chermcal factors which either favor or
inhibit cell division. And yet it is obvious that the uncontrolled
multiplication of malignant cells is one o{ the principal characteristics
of cancer. Nor is there much known about the hyd10gen-ion concentration (acidity) of normal and cancer tissue, a factor which is
generally accepted as an important controlling influence in the life
of all living cells. · Furthermore, little knowledge exists concerning
the building up of the specific cellular proteins which form such an
important part of protoplasm and which presumably determine to a
considerable degree the characteristics which differentiate different
types of cells from one another. Therefore, it was along these lines
that the various phases of the investigation were conducted.
(a) The hydrogen-ion concentration of normal and malignant tissues
in the living animal.-The new method for the study of this problem,
which was referred to in the 1931 annual report, was applied to a
systematic study of the acidity of cancerous and normal tissues. In
view of the great variation in tumors, malignant as well as benign, it
was essential to study as many different types as could be obtained.
The following were used: Eight standard transplanted malignant
tumors of the rat, benign tumors of the rat, a carcinoma of the rabbit,
and a spontaneous mammary carcinoma of the mouse. These different tumor strains were obtained through the kindness of Drs.
Burton T. Simpson, G. B. Walker, and Francis C. Wood. The
results so far obtained indicate that all the malignant tumors studied
are acid, probably due to the lactic acid formed in such tissue (Warburg). The benign tumors wel"e neutral or slightly alkaline in reaction. The normal tissues immediately surrounding the malignant
tumors appear to be more acid than the same tissue located at a
distance from the tumor. The normal tissues so far studied are
alkaline. These estimations may be of value in explaining the destructive action of malignant tumors on the surrounding normal
tissue, for it is possible that the increased acidity on the junction
between malignant and normal tissue may be injurious to the latter,
either directly due to an action of the acid on the normal cells, or
through a disturbing influence on the enzyme mechanism of the
normal cells. These acidity estimations are also useful for the study
of malignant tissue outside the body, when it is desired to study these
tissues at the same acidity as that within the body.
(b) Influence of the oxygen tension on the proteolysis of tumors and
normal tissues.-The important work of Warburg and coworkers has
emphasized the lactic acid fermentation of sugar as the main source
of energy for malignant tissue. The protein metabolism of cancerous
tissues has received but scant attention, and yet it would seem that
the growth of malignant tumors must involve the building up (synthesis) of proteins within the tumor cells. The protein metabolism
Digitized by
Google
67
PUBLIC HEALTH SERVICE
was therefore studied outside the body under conditions approximating those within the body. It was found that the oxygen tension (under constant pH) is a controlling factor in proteolysis. A low
oxygen tension favors and a high tension inhibits proteolysis.
Definite evidence was also obtained showing that protein synthesis
occurs if the split products of a tumor autolysate are exposed to a
high oxygen tension. Similar evidence of a reversal of autolysis
(protein synthesis) under the influence of oxy~en was also obtained
in the case of skeletal muscle. Further work is needed to ascertain
whether this fundamental observation applies to tissues in general.
The interesting aspect of these findings is that they do throw some
light on the way in which body cells build up their proteins. It
would seem that the oxygen tension of the tissues may play a deciding
regulating influence on this process. Under physiological conditions
the oxygen supply to the tissues is carefully regulated by physiological
means, whereas in cancer tissue it would seem that the physiological
mechanism fails. Further analysis of the oxygen effect on proteolysis
has shown that oxygen operates through the organic sulphur system
(glutathione and protein sulphydryl groups) of the tissues. For this
phase of the work, suitable methods were devised for the estimation
of reduced and oxidized glutathione and :protein sulphydryl. These
methods were also applied to the estimation of the glutathione content of various types of tumors and normal tissues. A striking difference was found between benign and malignant tumors, the former
containing a very low percentage of reduced and oxidized glutathione. It may be recalled that previous work of the division has
shown that glutathione has a pronounced favorable action on cell
division (Amoeba proteus).
(c) Tis8'Ue cultures.-Work has been continued on the chemical
control of the medium used for tissue cultures. Previous research by
the division had provided a satisfactory method for controllin~ the
hydrogen-ion concentration and carbon dioxide tension. A satisfactory method has now been worked out for controlling the oxygen
tension also. These methods have been applied to the cultivation of
mammary epithelium, both normal and malignant. While it is feasible to grow certain malignant epithelial tumors for prolonged periods,
it hJi,s not yet been possible to maintain continuously normal mammary epithelium in culture. This object is highly desirable for a
comparison of the behavior of malignant mammary epithelium with
its corresponding normal tissue. The successful cultivation of normal
epithelium would also furnish an opportunity to attempt the· transformation of normal into malignant cells in vitro.
(d) Chemistry of cell dii;ision.-Progress has been made in the study
of the action of various chemicals of physiological interest on cell
division of Amoeba proteus under chemically controlled conditions.
It has been found that very low concentrations of g]utathione increase
the rate of nuclear growth and increase the percentage of nuclear
division. This is accompanied, under the experimental conditions
employed, by a decrease in cytoplasmic volume. In last year's
report it was stated that minute amounts of copper exert an inhibiting
influence on celJ division. It has now been found that the copper
action is associated with a marked decrease in the growth of the cell
nucleus. Similar experiments on the action of iron, manganese, and
cobalt have shown that these metals do not possess in equivalent
Digitized by
Google
68
PUBLIC HEALTH SERVICE
concentrations the inhibiting action shown by copper. However,
lead inhibits cell division in very low concentrations, a fact which is
of interest in connection with the claims made for the lead treatment
of cancer. Clinical evidence concerning the value of this treatment
shows that while it may be of benefit to some patients, it is, in its
present form, undoubtedly too dangerous for general use on account
of the liability of lead poisoning. It is hoped that the study of heavy
metals and other compounds will ultimately furnish systematic
knowledge as to their function in the chemistry of cell division, not
only in Amoeba but also in other types of cells.
In order to promote the chemical studies on the Amoeba, a careful
study has been made of the morphology and certain physiological
aspects of the division process in Amoeba proteus. It was found that
division normally is mitotic and by binary fission. The time relations
of the various stages of cell division and the accompanying structural
changes have been established in great detail. This knowledge will
permit the study of the action of chemicals on cells ready to divide and
possibly also on the various stages of division. Information thus
obtained may lead to the discovery of chemical agents which, while
relatively nontoxic, may inhibit specifically the division of cells.
(e) Ohemotherapy.-The action of certain chemicals on the growth
of malignant tumors of the rat has been under investigation. Various
types of copper compounds were studied. Some of these appear to
have a slight inhibiting action on tumor growth, but the effect is not
sufficiently pronounced to be of therapeutic significance. However,
efforts along this line will be continued as further basic knowledge as
to the action of heavy metals on cell chemistry accumulates.
It may not be amiss to point out that the plan of cancer research
followed by the division, apart from its direct bearing on cancer, has
yielded by-products which are of more general biochemical interest.
The cancer studies being conducted at the Harvard Medical School
will be found reported on pages 22-26.
PHARMACOLOGY OP PHENOL ESTERS
In 1930-31 it was demonstrated that the curious type of multiple
neuritis, or the so-calJed ginger paralysis, was due to the hitherto
unknown effect of the phosphoric ester of orthocresol in the human
body. In view of the fact that rather closely related chemical compounds, such as phenyl salicylate, guaiacol carbonate and phosphate,
and creosote carbonate and phosphate, have been in use in therapeutics, it became a matter of practical as well as of theoretical importance to investigate the manner of action of the paralyzing ester in the
animal body. This investigation was conducted along two main
directions: First, the general pharmacologic behavior of a number of
chemically related compounda was studied in the hope of discovering
some underlying principle governing the relation of chemical constitution and physiologic action peculiar for this group of compounds;
and, second, the fate of the paralyzing eo1ter in the animal body was
studied in the belief that differences in distribution, fixation, and
detoxification of this ester as compared with chemically related esters
will ultimately account for its specific action.
With this plan in mind, 12 phenol esters were studied during the
past year. These included organic esters, phosphoric esters, thiopho.-iphoric esters, and phosphorous acid esters of the better known
Digitized by
Google
69
PUBLIC HEALTH SERVICE
phenols. Of all the esters so examined, only the thiophosphoric ester
and the phosphorous acid ester of orthocresol have been found to share
to any extent in the specific action of triorthocresyl phosphate. Moreover, the phosphorous acid ester of orthocresol has b.een found to produce in the experimental animal a condition of extensor rigidity in
many ways analogous to decerebrate rigidity, this being associated
with combined degeneration of the nervous system with more or less
specific involvement of certain well defined afferent and efferent tracts.
The studies on the fate of some of these esters in the animal body
have disclosed certain relationships between the rate of hydrolysis
of these compounds in vitro, their stability and hydrolysis in vivo, and
their phannacologic action in the animal organism.
VITAMIN B STUDIES
Since the demonstration of the dual nature of vitamin B in 1926,
there has been no satisfactory method of effectively separating the
complex into its two recognized components B 1 and B 2 other than the
destruction of B 1 by heating of the complex for several hours at 120° C.,
which procedure leaves B 2 largely unimpaired. The separation of
B1 and B2 by chemical procedure requires satisfactory methods of
assay of the two vitamins. Work was done during the past year
towards developing a quick and reliable method of assay of B 2 and
some observations have been made on the ,,differential solubility in
certain organic solvents of B 1 and B 2 as they occur in dried brewers'
yeast.
PHARMACOLOGY OF THE ARSPHENAIIIINES
Several years ago work carried out in this division led to the theory
that the chemotherapeutic action of the arsphenamines is due to the
conversion of these drugs within the body of the host into compounds
of the arsenoxide type, which latter can be considered as the active
parasiticidal and toxic agents. During the .fiscal year under report
confirmatory evidence of the essential correctness of this theory has
been procured by means of a color test which differentiates between
the arsphenamines and their oxides. The color test consists in ~
chemical reaction between arsenoxide and 1,2 naphthoquinone, 4,
sodium sulphonate. This test has been applied (a) to the oxidation
of arsphenamine, neoarsphenamine, and · i,ulpharsphenamine by
molecular oxygen in the test tube, and (b) to the demonstration of the
formation of arsenoxides in the tissues of the living animal. It was
found that in test tube experiments oxidation of the arsphenamines
proceeds within the physiological pH range with the formation of
arsenoxide. Similarly, evidence was obtained of the formation of
arsenoxide in the liver of the living animal. It is interesting that, in
confirmation of previous evidence indicating a definite latent period
in the chemotherapeutic action of the arsphenamines, a similar latent
period following the injection of the drugs was also necessary to demonstrate the presence of arsenoxide in the tissue.
The new color test for arsenoxide appears to be of value for testing
the g.uality of commercial arsphenamine and its deterioration on long
contmued storage.
ACTION OF HEAVY METALS ON SULPHYDRYL CONTAINING PROTEINS AND ON CYSTEIN
In view of the biological importance of sulphydcyl compounds, a
study was made of the heavy metal catalysts which are concerned in
Digitized by
Google
70
PUBLIC HEALTH SERVICE
the oxidation of certain SH-containing proteins and cystein. It has
been shown that copper salts added to cystein solutions cause an
oxidative breakdown of the molecule with the production of carbon
dioxide, ammonia, and sulphuric acid. Salts of iron or manganese
under similar conditions oxidize cystein to cystin. This is the first
evidence of a more or less complete oxidation of an amino acid by a
metaJlic catalyst in the absence of solid agents with lar~e surf aces
(charcoal). The oxidation of sulphydryl-containing protems (coagulated egg albumin) is also favored by copper salts and carbon dioxide
is produced. Manganese is less effective than copper and iron;
cobalt, tin, or zinc are practically inert. The addition of iron or
copper salts to dialyzed tissues brings about an oxygen consumption
which is largely concernPd with the oxidation of fats.
These observations are of interest as regards the function of heavy
metals as biochemical catalysts.
MISCELLANEOUS
The chief of the division has continued to serve as a member of the
committee on drug addiction of the National Research COlmcil.
Expert pharmacological advice and assistance were given to other
departments of the Federal Government and private organizations.
The chief of the division visited several cancer laboratories in Europe
and in this country for the pur-p.ose of discussing various problems
concerning cancer research with mvestigators interested in this field.
DIVISION OF CHEMISTRY
The work of the division of chemistry was continued under the
direction of Prof. Claude S. Hudson.
SUGAR RESEARCHES
A large number of sugar compo1mds were prepared and studied
during the fiscal year.
·
A method has been developed for the decomposition of acid phenylhydrazides by oxidation with copper sulphate which has the advantage
of rapidity and obviates many troublesome operations of the older
method. It has been employed successfully in the preparation of
such compounds as mannonic acid lactone, a-galaheptonic lactone,
and ,S-galaheptonic lactone sirups from the corresponding phenylhydrazides in yields of better than 80 per cent of theory.
A method has also been developed for the rearrangement of acetylated glycosides to form the a-acetates of the sugar. By this method,
glucose-a-penta-acetate has been prepared from tetra-acetyl-,S-methyl
glucoside and a-hexa-acetate of ,S-galaheptose from penta-acetyl-Pmethyl-,9-galaheptoside.
Improvements were effected in the preparation of anhydrous P-1rhamnose, ,S-tetra-acetyl-1-rhamnose, in the separation of the phenylhydrazides of a- and ,S-galaheptonic acids and in the method of isolating fucose from the seaweed Ascophyllum nodosum.
The reaction of trity l chloride with ,S-methyl-d-xyloside in pyridine
solution was studied and two isomeric di-trityl-,9-methyl-d-xylosides
were isolated. The isloation of the latter shows that trityl chloride
reacts with the secondary hydroxyl groups in ,9-methyl-d-xyloside and
that the views prevailing in the literature that it reacts only with
Digitized by
Google
PUBLIC HEALTH SERVICE
71
primary hydroxyl groups are incorrect. This conclusion was further
confirmed by a study of a-methyl-fucoside which contains only secondarv hydroxyls. For this purpose, a comparatively large quantity
of crystalline fucose was prepared. The pure a-methyl-fucoside
finally obtained, was found to condense readily with triphenyl methyl
chloride, thus proving the nonspecificity of the latter toward primary
hydroxyl groups.
It was proved experimentally that anhydrous ,S-1-rhamnose and
P-tetra-acetyl-1-rhamnose have the same ring, thus confirming the
prediction regarding these compounds as based on rotatory data.
ENZYM RESEARCHES
The genei'al object of these researches is to devise new methods, or
to improve old ones, for the purification of active principles of biochemical origin. The specific problem, during this fiscal year, has
been to separate the invertase of yeast. An improved procedure has
been worked out for concentrating the invertase of yeast to such an
extent that in the best preparation obtained, up to the present, the
ratio of invertase to total solid was about 450 times more favorable
than in the original yeast. Although a greater concentration of the
invertase has been effected by other methods, the procedure used in
the present investigation has the advantage that it avoids the need of
the lengthy process of dialysis or of electrodialysis required by th.a
other methods.
ANALYTICAL WORK
About 159 various analyses of miscellaneous material and 11
mineral analyses of waters were carried out. In addition, there were
examined about 34 arsenicals and several toxicological examinations
were made on body fluids and miscellaneous material. In connection
with this work, there was a continuation of the analytical work required in the studies of the relation of diet to pellagra. Analyses
were made of the salts used, the required standard acids were prepared, and chemical examinations were carried out on some of the
foodstuffs used.
COOPERATIVE WORK
The cooperative work of the division in the studies of the relation
of diet to pellagra was continued by supplying necessary material for
the development of a suitable biological method of testing the activity of various concentrates. There was also a continuation of the
cooperation with the Division of Pharmacology in the studies of socalled ginger paralysis and assistance was rendered in connection with
the problem of the distribution of triorthocresyl phosphate in the
animal organism. Assistance was rendered in connection with the
investigation of mottled enamel.
There were analyzed 202 samples of atmospheric dust from 14
different cities in the United States, in connection with an investigation conducted by the office of industrial hygiene and sanitation.
FELLOWSHIP
Under the terms of the gift of the Chemical Foundation (Ine.), to
the National Institute of Health for the establishment of a. research
Digitized by
Google
72
PUBLIC HEALTH SERVICE
fellowship in chemistry, Dr. Clifford B. Purves was appointed wr
research associate effective September 1, 1931, and has since been
engaged in enzym researches.
CONTROL OF SERUMS, VACCINES, AND ANALOGOUS PRODUCTS
Control of the manufacture and interstate sale of biologic products,
in accordance with the law of July 1, 1902, continued under the supervision of the Director of the National Institute of Health. The
testing was carried out by Laboratory Assistant B. T. Sockrider and
Assistant Pharmacologist T. F. Probey. The usual inspections of
establishments in the United States and Canada were made and, in
addition, European establishments holding or applying for license
were inspected. At the end of the fiscal year 46 licenses were outstanding, 10 of which were held by foreign producers. The licenses
cover 141 different preparations.
The following is a tabular statement of samples of products received and tested during the year. In many instances individual
samples were subjected to repeated tests:
Serums, vaccines, toxins, etc.:
Tested for sterility____________________________________________ 1, 809
Tested for potency____________________________________________
780
2,589
Arsphenamines:
Tested for toxicity____________________________________________
Tested for solubility and stability_______________________________
216
338
554
TotaL _____________________________________________________ =3, 143
MISCELLANEOUS
01,inical research in marine hospitals.-Advantage is being taken of
the excellent possibilities for clinical research in the marine hospitals;
and through cooperation with the division of marine hospitals ana.
relief, studies are being conducted in these hospitals where the available clinical material is suitable for the special subject of study. The
clinical facilities for research in the marine hospitals will be a most
valuable aid to laboratory research.
The second meeting of the National Advisory Health Council was
held May 20 and 21, 1932. There were nine members of the council
in attendance at this meeting. The work of the various divisions of
the Public Health Service was reviewed and the recommendations of
the council were secured as to the continuation and expansion of the
work along present lines and the development of new studies.
During the fiscal year there have been 6 public health bulletins, 3
National Institute of Health bulletins, and 161 scientific articles for
the Public Health Reports or for outside publication submitted to
this division for review and recommendation as to publication.
Digitized by
Google
DIVISION OF DOMESTIC (INTERSTATE) QUARANTINE
In charge of ABBt. Surg. Gen. C. E.
WALLER
PLAGUE-SUPPRESSIVE MEASURES IN CALIFORNIA
The work in plague-suppressive measures in California has been
pursued along the same lines as in recent years, as it has been demonstrated that the most satisfactory results are accomplished by this
procedure. No human case of plague was reported, but rodent
plague was reported in ~ound squirrels in San Benito County, and a
recrudescence of plague m rats occurred in the City of Los Angeles.
PLAGUE IN GROUND SQUIRRELS
Although plague was demonstrated by shooting operations in only
one county during the year, it is not believed that this indicates
freedom from infection in other counties in which plague was found
among ground squirrels during the preceding two or three years.
The work has been pursued in accordance with the definite program
followed in recent years, and the infestation of the counties specified
is materially less than it was a few years a~o. A zone practically free
from ground squirrels has been secured m the counties around the
port of San Francisco and East Bay communities.
The operations in other counties by the county horticultural commissioners, in cooperation with the State hoard of rodent control,
particularly in areas found infected with plague, have been prosecuted
with more vigor during the past three years than previously and much
more effective work is now being performed in the control of these
rodents.
Too great emphasis can not be placed on the necessity of continuous
operations in the control of ground squirrels; and if practically
squirrel-free areas have been created by continuous operations, it is
necessary that the work be continued on a lesser scale in order to
maintain such results.
.
The heaviest infestation of ground squirrels is on land devoted to
grazing that has not yet come under cultivation. Difficulty has been
experienced in successfully prosecuting extensive operations over these
lare-e areas and, although gratifying results have been accomplished
an<1 a diminution in rodents has been effected, at the same time such
areas have not yet reached a satisfactory condition for the control of
plague in these rodents.
The field operations carried out by the Public Health Service are
shown in the following tabulated statement:
Number of inspections ________ ------ ______________________ - ___ _
1,291
Number of reinspections ______________________________________ _
4,244
Number of acres inspected ____________________________________ _ 271,396
Number of acres reinspected ___________________________________ _ 1,015,794
Number of acres treated _________________________________ - _--- _ 373,133
73
Digitized by
Google
74
PUBLIC HEALTH SERVICE
MEASURES TAKEN AGAINST RATS
Similar operations have been pursued as in preceding years. These
are embraced under the following activities: (a) Trappmg and examination of rats, (b) inspection of premises where rat infestation has
been reported, and (c) inspection and report on buildings that are
insanitary and constitute rat harborages to the extent that they
have become a menace to the public health. The work was carried
on in San Francisco and Oakland.
Rat survey in Los Angeles.-Althou~h the Public Health Service
has taken no part in the rat survey which has been carried on in Los
Angeles, the officer in charge of pla~e-suppressive measures has
kept in touch with it. Through this survey rodent plague was
found in the spring of this year in rats around three old foci of infection. Confirmation of plague in rodents reported by the Los Angeles
Health Department has been made in the Public Health Service
laboratory in San Francisco. In accordance with suggestions made
in a cooperative spirit, energetic measures have been taken by the
city health department of Los Angeles to eliminate these foci of
infection.
Sanitary inspections in San Francisco.-This work, carried out in
cooperation with the San Francisco Department of Health, is directly
related to measures instituted for plague-suppressive operations.
Rat-infested/remises are inspected and those in insanitary condition
are examine and reported to the department of health for action.
The work accomplished is shown by the following tabulation:
Rat complaints investigated _______________________________________ _ 1. 115
Insanitary premises inspected ______________________________________ _
153
Number of buildings submitted to department of health for condemnation_
38.
Number of buildings acted on by department of health and condemned-31
Number
buildings acted on by department of health and not con-_
demnedof
_______________________________________________________
7
Number of buildings abated following condemnation proceedings: By
repair, 1; by demolition, 28 ______________________________________ _ 1 29
Number of buildings condemned and remaining unabated _____________ _
20
PUBLIC HEALTH SERVICE PLAGUE LABORATORY
The plague laboratory has been continued in rented quarters
during the year, and although the building is old, the operations have
been satisfactorily performed. A new laboratory building is now in
process of erection on the marine hospital reservation. This laboratory will be thoroughly equipped for all the activities required of
service stations, and will constitute a research center for diseases and
public health problems.
During the year examination was made of 28,761 rats trapped in
San Francisco, and 2,904 from Oakland. Examination was also made
of all re.ts recovered on vessels after fumigation. This is of importance
as some of the rats are on vessels coming from ports suspected of being
infected with plague. No plague infection has been found among the
rats examined, although a few cases of rat leprosy and some suffering
from hemorrhagic septicemia have been noted.
The laboratory operations performed during the year are shown in
the accompanying summaries:
1 These
Include some buildings acted upon during previous years, hence totals wW oot balance.
Digitized by
Google
75.
PUBLIC HEALTH SERVICE
Summary of laboratory operations
Received
Examination of rodents for plague:
Rats from San Francisco ••••••. ·---·---·-·---··----------------·-·-·-·-···-35,448
Rats from Oakland _________ ·-·-·---------·-·-·-··--·-------·-------·-·-·····
3,019
wa.!~:i!~mr~~l::Sted ships __ ----··-·-· __ -··-·· .•.•.•.•••.•.• ······-···-·-·-· __ -····· 687 _
Bacteriological examinations (culture and microscopic):
"'tttt; ....······.. ·-·· ----·--· -.-------------.-· -.---.---.-------.-----.-.--1------.. ---TRACHOMA PREVENTION
Examined
28, 76I
2,11()4.
687
6,871
li67
336,
w ORK
The trachoma problem in this country is not in our large cities or
our seaports; it is in the rural sections of the Appalachian Mountains
in Kentucky; the highlands of central and eastern Tennessee; in the
rural portions of what is known as the Ozark uplift, which comprises.
nearly all of southern Missouri, a large share of Arkansas; and in
southern Illinois. From the Ozark uplift the disease has penetrated
very definitely into Oklahoma and to some extent into northern
Texas.
• Trachoma presents a public health problem chiefly because it
produces blindness and damage to vision. The tendency to blindness
seems to differ in various sections of the United States. 'This point.
was brought out in a short published. report entitled "Trachoma.
Virulence in Different Areas of the United States" which appeared in
Public Health Reports May 20, 1932.
Treatment must always remain an important element in any
trachoma-prevention campaign. Each case is a focus of infection
and must have treatment in order that the spread to others may be·
prevented. Therapy and education in personal hygiene togethermake the ideal combination.
It is said that trachoma never becomes epidemic. There are,
sections, always rural, where many individuals suffer or have suffered
with the disease. Families can be found where every member has.
trachoma., with one or two members blind or partly blind from the
disease. Evidence so far indicates that trachoma is communicable.
However, it certainly does not have a high degree of communicability.
Apparently long intimate contact is necessary to contract trachoma.
The spread seems to occur chiefly within families. Exposure in
schools apparently is responsible for but very little spread.
During the year trachoma eradication activities were carried on by
the Public Health Service in cooperation with the State heslth
authorities in Missouri, Kentucky, Tennessee, Georgia, Oklahoma,
and Texas.
Missouri.-Field work was carried on intensively during the year
through the activities of a full-time field nurse furnished by the State
board of health and the ;t;>hysician in charge of the trachoma hospital
at Rolla. Treatment clinics were held at regular "intervals over a
period of time in four different areas of the State. · The number of
days of hospital relief at Rolla increased slightly over that for the
preceding year. The average stay in the hospital was reduced by
one day. The per capita cost of hospitalizing patients at Rolla was
144391-32--6
Digitized by
Google
76
PUBLIC HEALTH SERVICE
.$2.09 per day. The use of diathermy in treating trachoma at this
hospital so far shows no superiorty over older methods. Material
from fresh untreated cases of trachoma was furnished to trachoma
research workers of the National Institute of Health in Washington,
and the Washin~ton University Medical School at St. Louis, Mo.
Kentucky.-Field work in this State was conducted throughout
the year. Several county health units in the trachoma territory were
aided in establishing trachoma treatment clinics which were conducted
by the respective health officers. The health officers were brought to
the hospital at Richmond and trained intensively for several days
before undertaking these clinics.
The hospital at Richmond made very good use of its beds during
the year, with a resulting high bed capacity efficiency record. The
number of days of hospital relief increased as compared with the
preceding year.
Three different research groups were furnished trachomatous
material from the lids of fresh untreated cases during the year.
Tennessee.-Work did not start in this State until October, 1931.
An attempt is being made in this field to bring the work as near the '
homes of afflicted people as possible, most of the therapy being done
in regular clinics held at stores, schools, courthouses, etc. A few.
beds are available for the more severe and complicated cases. A
few counties are being worked intensively, one at a time. An
average of 11 treatment clinics have been held weekly.
Georgia.-Trachoma in this field is so mild that very little hospitalization is necessary. Damage to vision is seen only at infrequent
intervals. During the year several treatment clinics were maintained
in southwest Georgia. In September, 1931, a state-wide survey for
trachoma was started. Some trachoma was found in several counties
in southern Georgia, but it was confined largely to a group of nine
counties in the southwestern part of the State. Along the northern
border of the State a more severe type of the disease was found, but
fortunately it is not widespread.
Oklahoma.-During May and June a short intensive trachoma program was intiated in the northwestern part of Oklahoma in cooperation with the State board of health. Many severe cases of the disease
were found, and a temporary hospital was maintained at Picher,
Okla., for about one month, supported partly by a mine operators'
association and partly by the State board of health. Many cases
seen had extensive damage to vision. It is interesting to note that
the majority of these trachoma sufferers in this part of Oklahoma were
born in Missouri or Arkansas, and all are native whites.
Texas.-In the spring of 1932 a trachoma field nurse spent some
time in central east Texas in the counties of Polk, Angelina, Trinity,
and Walker. Several schools were surveyed in each county, but
only a few cases of suspected trachoma were found. This inspection
included the only tribe of Indians in Texas. It was interesting to
note that these Indians showed very little pathology resembling
trachoma.
RESEARCH
The cause of trachoma still remains undetermined. The Public
Health Service, through its several cooperative trachoma units
during the past year has actively aided trachoma research workers of
Digitize by
Google
PUBLIC HEALTH SERVICE
77.
the National Institute of Health, Wa.shin_gton University Medical
:School, and the medical department of Chica.~o University. Research in therapy, the influence of diet and cod-hver oil on the course
of the disease, and the public health aspects of tra.choma. has been
carried on by the workers in tra.choma.-prevention activities of the
Public Health Service.
Field work
Field clinics:
Number of clinics held ______________________________________ - _
Number of persons examined _________________________________ _
Trachoma cases seen (old trachoma) ___________________________ _
New trachoma cases seen ____________________ ---------------- Suspicious cases seen ________________________________ - __ - -- __ _
Treatments given at clinics ___________________________________ FieldPublic
nurse talks
activities:
given ___________________________________________ _
People (estimated) in audiences _______________________________ _
Homes visited ________________________________________ -- - - -- Peop}e. examined_ in homes ____________________________________ _
Suspicious cases m homes ____________________________________ _
Number pupils examined in schools ____________________________ _
Suspicious cases in schools ____________________________________ _
Number treatment clinics, nurse only __________________________ _
Number treatments by nurse _________________________________ _
DiBpensary and hoBpital relief, operations, etc.
Dispensary relief:
Number examined ________________________________________ ---Old cases, trachoma ____________________________________ -----New cases, trachoma _________________________ - _______ - _- _- __ _
Total attendance ____________________________________________ _
Average daily attendance of all stations ________________________ _
-COmbined dispensary and field clinic data: Total number of new individual trachoma cases discovered_________________________________
Hospital relief:
Hospital capacity____________________________________________
Cases admitted during the year (total)__________________________
Number cases first admission__________________________________
Days relief furnished_ _ _______________________________________
·Operations: Total number of operations_____________________________
SUPERVISION OF
w ATER
621
15,649
4,346
1,598
817
3,928
659
41,048
3,896
7,161
979
62,305
3,486
477
19,869
6,488
3,689
631
6,488
3. 4
2, 234
112
762
515
25, 404
1,115
SUPPLIES USED BY COMMON CARRIERS
The cooperative plan between the State health departments and
the Public Health Service for certification of water supplies used for
drinking and culinary purposes on interstate carriers continued in
•operation. Certain changes tending toward decentralization, bringing the district offices in more intimate contact with the work, brought
a.bout a considerable increase in the number of inspections and certifications as shown in the accompanying tables.
Durin~ the year sources of drinking water used on airplane carriers
-engaged m interstate traffic were added to sources requiring certification, and a majority of these new sources were inspected and reported
upon.
During the/a.st two years there has been a tendency toward requiring more rigi compliance with that section of the Treasury Department Standards covering undesirable features that might introduce
potential dangers. This has brought about a considerable increase
m the number of supplies receiving provisional certification pending
-correction of undesirable features. That the water supplies selected
:by the carriers are generally of good quality is shown by the fa.ct that
Digitized by
Google
78
PUBLIC HEALTH SERVICE
it was necessary to prohibit the use of only 2.8 per cent of such
supplies.
During the year assistance was rendered to the States in making
inspections of 178 water supplies used by interstate carriers and in
preparing 4,327 certificates of examination.
The inspection of a source of water supply by the State officials
has generally stopped with the delivery of the water to the property
of the carrier, the matter of proper handling of the water by the
carrier being left to the Public Health Service. Two States, Illinois
and Texas, have included in their inspections the handling of the
water by the carrier and base their recommendations as to certification on the water as delivered to the passenger rather than to the
carrier. The following comparative tabulation of the percentages of
completed certifications indicates the status of this work and shows
the increase in its completeness:
Per cent of completed certlllcations
1927
1928
1930
1929
Railroad supplies____________________________________
80
82
81
87. 5
75
78
78
88. 0_
Vessel supplies______________________________________
Airplane
supplies ___________________________________________________________________________
1931
92. 75
95.87
85.83
INTERSTATE CARRIER WATER SUPPLIES
The following tables covering the calendar year 1931 show the
status of this work by States:
Railroad supplies for calendar year 1931
Source classification
State
Alabama ____________________
Arizona ______________________
Arkansas ____________________
Califomi!L __________________
Colorado ____________________
Connecticut_ ________________
Delaware____________________
District of Columbia ________
Florida ______________________
Georgia ______________________
Idaho __________ __________ - - -Illinois ____ -------- ______ -- -Indiana ______________________
Iowa ______________ __________
Kansas _________________ _____
Publie I
Private •
Railroad
Per
cent
sources
Satis- Probib- Provi- Action
Total factory
ited
sional pending acted
upon
-Certification status
-----1
2
1
8
3
20
6
0
0
1
46
22
61
72
33
13
6
2
55
46
17
39
45
- -- -- 0
0
11
1
0
0
0
0
0
5
1
0
1
3
4
0
0
0
0
0
2
0
0
4
0
2
0
1
0
0
100
1
95
0
10 0
6
0
100
2
25
25
10 0
8
0
13
0
11
2
0
10 0
0
6
6
100
0
0
1
2
0
0
0
100
43
2
10
54
1
0
100
52
1
1
54
41
100
8
0
17
1
27
2.5
9
0
1
96
78
13
94
74
I 10 0
3
20
0
45
52
0
7
8
42
1
9g
60
1
10
71
35
27
6
92
69
75
68
3
0
0
6
100
16
50
41
28
6
7
2
96
ii~i~~~!r_-_::::::::::::::::::
35
46
41
3
8
3
2
96
Maine_______________________
21
21
0
7
28
7
0
100
Maryland ___________________
13
1
1
15
14
1
0
100
Massachusetts _______________
1
33
34
34
0
100
0
0
Michigan ____________________
66
11
80
75
3
3
0
100
Minnesota ___________________
52
5
22
79
36
43
46
0
31
2
5
38
34
4
0
100
6
57
69
43
22
6
0
10
0
Montana ___________ ____ _____
23
2
7
32
29
10 0
3
0
Nebraska ____________________
1
17
54
16
10
36
26
81
Nevada ______________________
21
10
1
13
24
100
3
0
New Hampshire _____________
19
0
1
20
14
100
5
0
New Jersey __________________
34
0
2
36
35
0
1
97
1 The column beaded "Public" includes supplies owned by municipalities as well as those used by
municipalities but owned by private companies.
• "Private" supply refers to a small well or spring used only by the carrier and the person owning it.
1 Based on watering point sanitation as well as source of supply.
44
12
56
46
2
~:~~~y~~::::::::::::::::::
Digitized by
0
4
11
26
Google
79
PUBLIC HEALTH SERVICE
Railroad supplies for calendar year 1931-Continued
-·
Source class!ftcatlon
State
Pub-
Pr!-
Rall•
road
vate
lie
Certiftcat!on status
Per
cent
sources
Satis- Prohlb- Prov!- Action acted
Total factory
slonal pending upon
ited
--- --- - - - - - - - - --- - - New Mexico.................
New York .••••.•••••...•....
North Carolina••••.•.•......
North Dakota •••••••...•....
Ohio .••••.•••.• ••••••...•....
Oklahoma..•...•••••.....•..
Oregon •. -·--·-·····-·· •..•..
Pennsylvania.•.•••••.•...•.•
Rhode Island ••..••.•.•......
South Carolina •..•.•••......
South Dakota ....••.....••..
Tennessee.--··---- ••••.••.••
Texas ..••..•....•...•••••.•.•
Utah ••••••.•.......•.•..••••
Vermont ••• • .•.•..••••.•.•••
Virginia. __ .....•...•.. ___ ..•
Washington ..•...•••.•.•.•••
West Virginia .••.•.•.• ····-Wisconsin •••.....•.•.•.•.•••
Wyoming •......••...•.•.•.•
11
100
46
21
72
43
28
130
2
28
Total ••.•••..•....•.•.•
1
21
104
43
10
58
34
1
5
4
6
11
3
23
117
49
41
84
48
31
148
2
31
30
39
191
16
14
48
29
47
68
16
400
2,360
12
15
2
18
12
4
2
16
0
1
8
8
57
23
34
49
13
0
2
1
2
0
1
1
3
0
2
0
2
11
0
1
3
2
7
8
0
1,863
97
22
29
123
12
12
40
4
2
12
3
2
14
8
3
0
0
0
0
1
1
0
11
2
30
12
35
83
16
11
41
24
44
56
15
3
2
0
0
0
0
1
0
0
0
1
2
0
5
0
3
108
0
3
3
3
1
7
1
1,713
62
415
26
118
6
0
0
2
29
1
3
0
60
0
1
12
0
0
0
0
3
0
100
100
96
29
99
94
100
66
100
97
60
100
1100
100
100
94
100
2
96
0
0
100
100
170
92. 75
Based on watering point sanitation as well as source of supply.
Vessel supplies for calendar year 1931
Source classlflcatlon
State
PrlPublic' vate
•
•-
Al abama •••.••..••••••••••..
Arkansaa •.••...•.•.•••••••..
C al!romla •••••••••••••••..••
C onnectlcut •••..••.•.•••••.•
D e!aware . .. .................
D btr!ct of Columbia •..•••••
Florida .•.•~ ....•............
Georgia......................
H awRJL •••.•.•...•.•..••....
Dllnols •••••••....•...•...••.
Indlsma.•..••.•.•....••...•..
2
2
22
7
2
1
5
2
3
Ke::l'J~~.".::::::::::::::::::
Lo
Maine .......................
Maryland .•.••.•.......•....
M assacbusetts •••.•.......•••
M lcblgan •..•.•.•.•.•••.•....
Mlnnesota.••.•.•••.•.•.••..•
M lsslsslrpL ••.••••...•....•
Ml!BOur .•......•.....•.•••.•
N ew H11mpshlre .•....•.•.•••
N
N
N ortb Carolina•..•.....•....
0 blo •••••..••.••.............
0 regon ••••••.•••..••.•......
Pennsylvania.•....••.••••...
Puerto Rico .••••.•••.•...•..
Rhode Island ..••.•••••••.••.
South Carolina ••••••••.•..•.
T ennessee •...•••.•.•...•••..
T 81:88••• • •••••• ••••.•.•...•..
V ennont.. _.••.•.•.•.•...••.
Virginia ...... _..............
Washington .•.•••..••.••.••.
w est Vl.rginla • ••.•.•.•••••..
wlsconsln. ·•••·•···• .•.•.••.
Total •••.•.••••••••••••
2
10
3
17
14
1
4
1
1
:: ~!~:::::::::::::::::::
Per
cent
sourOOII
Action
Com• Total Satis- Probl'I>- Prov!• pend• acted
pany
factory lted slonal
_ upon
, Ing
•-
---0 ---0
0
2
0
0
0
5
0
0
0
0
0
0
0
0
2
0
0
0
1
0
0
0
0
0
0
0
I
13
2
9
8
7
1
3
3
3
4
1
10
10
5
3
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
I
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
7
0
2
0
1
0
214
13
15
4
5
4
20
0
I
Certiflca&lon status
2
---2 ---0 ---0
11
6
1
12
11
6
3
0
10
10
6
3
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
1
0
0
242
197
4
2
26
7
2
1
11
2
3
4
6
4
2
10
6
17
15
1
4
1
1
24
13
2
9
8
7
I
3
3
3
1
16
7
2
1
11
2
3
2
0
2
2
8
5
17
14
I
4
0
1
24
12
2
8
6
0
0
3
3
3
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
7
0
0
0
0
0
0
2
0
0
0
31
10
1
10
0
0
0
0
0
0
2
4
2
0
2
0
0
0
0
0
1
0
0
I
0
1
2
0
0
0
0
0
4
I
--100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
~
100
100
100
100
100
100
100
100
100
0
100
100
100
100
100
100
83
100
100
100
96. 87
1 The column beaded "Public" Includes supplies owned by municipalities as well as those used by
municipalities but owned by private companies.
1 "Private" supply refers to a small well or spring used only by the carrier and the person owning It.
Digitized by
Google
80
PUBLIC HEALTH SERVICE
RECIPROCITY WITH CANADA
Reciprocity with the Department of Pensions and National Health
of Canada, covering both the certification of water supplies used by
common carriers crossing the international boundary and inspection
of vessels operating in the Great Lakes and border waters, continued
with increased efficiency. During the year certificates were received
from Canadian authorities covering 62 supplies used by United States
carriers operating in Canada, and 28 certificates were forwarded from
this office covering supplies used by Canadian carriers operating in
the United States.
SUPERVISION OF WATER-SUPPLY SYSTEMS ON VESSELS
Inspection of drinking and culinary water-supply systems on vessels
engaged in interstate traffic has been increased in all districts except
district No. 1, where press of other work prevented. As this work is
extended its value becomes more apparent to vessel owners. The.
number of favorable certificates issued was increased to 55.6 per cent,
an increase of 13.4 per cent over the figure for the calendar year 1930.
Requests for inspection and advice by companies operating vessels in
foreign traffic, as well as by Federal a~encies, indicate increased interest on the part of vessel-operating officials in properly protecting drinking water supplies aboard vessels.
The issuance of "Not approved" certificates was instituted during
the year. While the number issued, 27, was small, it had a very salutary effect in bringing about corrective action.
While it has been possible to inspect only 57 per cent of the vessels
listed as in an active status, all of the passenger-carrying vessels were
inspected.
Air carriers for calendar year 1931
Source classification
State
Pr!Public' vate
•
Arizona ________ ._. ___________
Arkansas .. __ ._. ________ ... __
California. __ • _______________
Colorado __________________ __
Connecticut_ ________________
Florida __ • __________ . ________
Georgia________________ ______
Illinois •. ______ . ___ ... . ..•. __
Indiana _____________________ _
Kansas. ___ •• ____________ -_-_
f~~~1~~t-~:::::::::::::::::
Maryland __________________ _
Massachusetts _______ __• _____
Michigan ______ _________ _____
Minnesota __________ _________
Mississippi. __________ ______ _
Missouri._ _____ __ ______ ______
Nebraskn. __ ____ ______. __ . . ___
Nevada________ _____ __ _______
New Jersey ______ _____ ____ ___
New Mexico _____ _____ _______
New York ___________________
North Carolina __ ___________ _
North Dakota __________ _____
Ohio ________________ __ ______ _ -
Company
Certification status
Per
cent
sources
Satis- Prohib- Provi- Action
acted
Total factory
ited sional pendupon
ing
- -- - - - - - - - - - - 5
I
2
3
2
1
3
0
3
2
0
4
1
2
2
2
3
0
I
I
2
1
1
1
2
1
5
1
l
2
0
4
1
0
5
l
0
1
0
0
0
1
0
0
0
0
1
0
0
2
1
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
6
2
6
4
j
7
3
5
2
2
1
3
1
1
1
3
1
,5
1
1
3
1
4
3
1
11
3
2
6
4
1
7
2
3
I
2
0
3
1
1
1
0
1
3
0
J
3
1
4
2
0
6
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
0
2
1
0
0
0
0
l
0
0
1 The
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
l
5
100
100
100
100
100
100
100
80,
50
100
100
100
100
100
100
0
1()(),
100
100
100
100
100
100
100
0
55
column headed "Public" Includes supplies owned by municipalities as well as those used by
municipalities but owned by private companies.
• "Private" supply refers to a small well or spring used only by the carrier and the person owning it.
Digitized by
Google
81
PUBLIC HEALTH SERVICE
Air carriers for calendar year 1931-Continued
Source classification
Certification status
State
Public
Pr!·
vate
Com•
pany
Per
cent
sourcesBatis- Prohlb· Prov!• Action
pend• acted
Total factory
slonal
lted
upon.
Ing
---Oklahoma.•.•...•..•.•.. , ..•
Oregon ••••••.••..•••••••••.•
PennsylvBI1ia.......••••..•..
South Carolina •.••••••••••••
Tennessee .•....••..•.•••.•••
Texas ••••••••...••..••..•.•••
Utah.··-··--·-···--··-· .••.•
Virginia •••••..••.•.•.•.•.•.•
1
3
Wyoming .• _-·-···-····· ....
1
1
10
1
0
1
1
1
0
0
0
1
0
0
1
0
0
0
0
0
Total. ••••...••...... ·-
71
45
4
;::~t:~:::::::::::::::::
3
0
2
2
2
2
5
0
2
0
1
4
1
2
2
5
4
3
16
1
0
2
2
2
2
1
2
1
2
1
0
0
0
0
0
0
0
120
81
5
10
1
1
1
1
0
0
2
0
0
0
0
5
0
0
0
0
1
0
1
6
0
0
0
0
0
17
0
0
0
17
100
100
0
100
100
100
100
50
100:
100
100
85.83
The health departments of certain cities located on the Great Lakes
and the Mississippi River continued the examination of water taken
from vessel drinking supplies, 2,169 such examinations having been
made. Of these, approximately 20 per cent failed to meet the Treasury Department bacteriolo~cal standards. On notification, the
vessel companies concerned immediately instituted corrective measures. All Great Lakes vessels taking their water supplies direct from
the Lakes were found to have proper treatment apparatus. During
the year 333 vessels received their first inspection, 961 were reinspected, and 1,069 favorable certificates were issued.
The following table gives the status of this work during the calendar
year 1931:
Vessels for calendar year 1931
District
1. •••••••••••.•...•••.
11 and 6.•••.•••.•••••.
826
104
480
151
363
Total..........
1,924
2•••••••••••••••••••••
3••••• ··---·-·········
4••••••••••••••••••••.
Certification 1
~!\
Vessels
0~!jt
on active vessels In
status
district
l------------1 :r8J1:rYJt
~1\
0~!jt
vessels
vessels
42. 93
5. 41
24. 95
7. 85
18.86
----1
Permsnen t
Tempo•
rary
Unap•
proved
ll8
95
433
117
306
317
0
32
10
28
20
1
1,069
397
27
8
1
5
Total
certified
435
104
470
147
335
52. 6
100
98
97
91
1,491 ..••••.•..
certified
22.60
6.4~
24. 42
7.64,
17. 41
77.62
1 Only the latest certificate issued on a vessel was counted In case that vessel was both temporarily and
permanently certified during the year.
All cases of typhoid fever reported among passengers or crews of
vessels, where indications seemed to implicate the water supply as a
possible source, were investigated. During the year a total of 65
cases were reported, an increase of 2 cases over 1930. Of this number,
however, only 26 occurred on vessels under the jurisdiction of the
interstate quarantine regulations.
RAILWAY SANITATION
During the year the Joint Cominittee on Railway Sanitation of the
American Railway Association published its report on railway sanitation. This report covered several years' study in which study
DigitizE)d by
Google
:82
PUBLIC HEALTH SERVICE
representatives of the Public Health Service played a very active
part. The report included in considerable detail description of
methods as well as devices and can be considered as a manual on the
·subject. With the distribution of this report to railroad officials, as
well as official State health agencies, greater uniformity in carrying
on this phase of the work is expected. In general, with the exception
-of Illinois and Texas, the States have considered control over all
phases of railway sanitation as a function of the Federal Government
rather than of the State. The question of jurisdiction has been
referred to a committee of the Surgeon General's Conference of State
and Territorial Health Officers.
Two hundred and sixty-five inspections of railway coach yards,
terminals, and water points were made by officers of this service, as
time would allow. Considerable attention has been given to the
-question of milk served on carriers. Conferences have been held with
railroad officials with reference to compliance with the interstate
quarantine regulations, and dining cars have been inspected from
time to time, special attention being paid to the grade and source of
milk served.
SHELLFISH SANITATION
This work was continued along lines described in previous reports.
Increased effort was necessary in maintaining proper control by the
producing States due to reduced State appropriations available for
this work. The distribution of lists of certified dealers continued to
be the principal factor in maintaining reasonably satisfactory control.
·Considerable activity was carried on in connection with sanitary
control over the clam industry in the New England coastal States and
in New Jersey, both as to growing areas and in treatment or conditioning. Increase in areas devoted to the growing of the Japanese
-oyster, Ostrea (Jigas, in the Pacific Coast States has brought about
increased activity in sanitary control of the shellfish industry in these
-States. During the year 997 certificates issued by the producing
·States were approved. At the close of the year the names of 1,504
·shippers were carried on the approved list.
In order to determine the efficiency of the control maintained by
the producing States, 10 growing areas and 539 shucking and packing
plants were inspected.
The reciprocal arrangement with the Canadian Department of
Pensions and National Health continued. Copies of all certificates
issued by the producing States were furnished that department,
which, in turn, has certified 44 Canadian shippers.
COOPERATIVE PUBLIC HEALTH ENGINEERING
w ORK
The cooperative public health engineering work with other divisions
•of the Public Health Service and other Federal and State agencies has
been further extended during the year. A total of 1,624 engineer
-days, or 34.25 per cent of the time of the engineers, was devoted to
this work.
Cooperation with the National Park Service and the Office of Indian
Aff&irs, in connection with surveys, reports, preparation of plans, and
Digitized by
Google
PUBLIC HEALTH SERVICE
83
advice, continued to occupy the major part of the time devoted to this
work, the time allotted amounting to 1,029 engineer days. Assistance
rendered the Supervising Architect's Office required the equivalent of
159 engineer days; the Bureau of Prisons, 64 days; the Forest Service,
36 days; and the Lighthouse Service, 31 days.
National Park Service.-With the organizing of an eastern division
of the National Park Service, interstate sanitary district No. 2
assumed charge of cooperative sanitary work in this division. The
principal activity in the eastern area during the past year was in
connection with the development of the Colonial National Monument
at Yorktown, Va. For the Yorktown Sesquicentennial Celebration,
held in October, 1931, it was necessary to prepare plans to care for
100,000 people and to supervise the work during the celebration. In
the sanitary work collaboration of the Public Health Service with the
National Park Service in this celebration was successful.
Two small sewage-treatment plants were designed for the George
Washington Birthplace National Monument and an inspection of
Great Smoky Mountain National Park relative to tentative locations
for headquarters and other facilities were made.
As in previous years the greater part of the cooperative work with
the park service was in the parks located in the West. This work
included the following general activities: (1) Inspections in 18 national
parks and 6 national monuments; (2) preparation of reports covering
general sanitary conditions for all the parks and monuments visited,
and plans, estimates, and bills of material for water supplies, sewerage,
sewage disposal, and garbage disposal for parks and monuments;
(3) conference with the chief landscape engineer and chief engineer of
the park service regarding plans for water supplies, sewerage, and
sewage disposal, etc., for the 6-year development plan; (4) conference
with the utility rate expert regarding rates to be paid by operators
for water, sewerage, sewage disposal, and garbage disposal where these·
utilities are owned and operated by the Government; (5) cooperatio:p
with the chief landscape engineer on standard plans for housekeeping
cottages in the parks; (6) conferences at headquarters with superintendents of parks and custodians of national monuments regarding
problems of sanitation; and (7) attendance at the conference of
national-park superintendents.
In carrying out these activities the following parks and monuments were visited, and plans, estimates, and bills of materials were·
prepared and advice was given relative to sanitary matters: Bryce
Canyon, Carlsbad Cavern, Glacier, Grand Canyon (south rim), Hot
Springs, Mesa Verde, Mount Rainier, Platt, Rocky Mountain, Yellowstone, and Yosemite National Parks and Casa Grande, Tumacocori,
Montezuma Castle, and Petrified Forest National Monuments.
Under the 6-year development program general plans for sewerage
and sewage disposal were prepared for Gran Quivera, Pipe Springs,
El Moro, and Devil's Tower National Monuments.
Public Health Service engineers continued general supervision over
the operation of the sewage reclamation plant at the south rim of the·
Grand Canyon National Park and new sewage disposal plant at.
Yosemite National Park.
Digitized by
Google
84
PUBLIC HEALTH SERVICE
Office of Indian Affairs.-The activities carried on in connection
with sanitation on Indian Reservations included general surveys of
agencies, subagencies, hospitals, schools, and the like with plans, estimates, and bills of matenal for such sanitary devices as were necessary, as well as special inspections. The district engineers also acted
as advisors to the superintendents in matters of environmental
sanitation.
This service was supplied to 1 jurisdiction in district No. 2, 27 in
district No. 3, 7 in district No. 4, and 52 in district Nos. 5 and 6.
Complete plans for a gravity type water treatment plant were prepared for Neopit, Wis., and general supervision was maintained over
-construction. This plant is now being operated under the general
direction of the distnct engineer.
The time devoted to cooperative work with this bureau has
increased 80 per cent over that of last year and has required 13 per
-cent of the time of the engineers. The greater part of this work has
been carried on in districts Nos. 3, 5, and 6, requiring 25 per cent of
the time of the engineers in these districts.
Supervising Architect's O.ffice.-Assistance was given the Supervising
Architect's Office in connection with water supply and sewage disposal at 23 customs and immigration stations being constructed along
the international border. In each instance field investigations were
made and reports with completed plans were prepared.
Bureau of Prisons.-,-Cooperative work with this bureau was carried
.on in conjunction with the work of the Mental Hygiene Division of
the Public Health Service and consisted of surveys, advice on matters
-of environmental sanitation, review of plans of sanitary devices, and
the like. General supervision was maintained over the operation of
the water treatment plant at Alderson.
Surveys were made of all prison camps and advice was given relative
to public health engineering matters.
·
Forest Service.-Cooperation with the Forest Service in matters of
sanitation was similar to that given the National Park Service.
Prior to the present year a relatively small amount of time was devoted
to work with this service, but the indications are that this activity will
increase to a considerable extent.
Lighthouse Service.-In cooperation with the superintendent of the
twelfth lighthouse district, studies were made of water treatment for
-small vessels using Great Lakes water. These studies were carried
out on the lighthouse tender Sumac. A small, economical treatment
plant was developed, consisting of a chlorinator, designed in the office
-of the district engineer, a sand filter, and an activated carbon filter.
Treatment consisted of superchlorination, filtration, and dechlorination.
Lectures at marine hospitals.-During the year a series of lectures on
public health engineering subjects was given to the class of internes
at six marine hospitals. Advice was also furnished relative to water
·supply and sewage disposal at service stations.
Advice was given this service in connection with water supplies
.and sewage disposal at airway weather stations.
Assistance was rendered to the following additional governmental
.agencies:
Digitized by
Google
PUBLIC HEALTH SERVICE
85
1. Coast Guard; investigation of water supply at a Coast Guard
:station.
,
2. United States Army Engineers; advice as to water supply on a
vessel engaged in United States lake survey.
3. Bureau of Plant Industry; investigation of the disposal of a
·sugar plant waste.
4. Bureau of Mines; investigation of water treatment and sewage
.disposal at the helium plant.
5. Bureau of Entomology; assistance in making a mosquito survey.
6. California and Arizona; conference and advice relative to disposal
-0f sewage in the Colorado River.
7. City of Los Angeles, Calif.; conference and advice relative to
air pollution.
8. Tri-State Treaty Commission; assistance in obtaining information relative to pollution of coastal waters in the vicinity of New York.
MosQUITO CONTROL, DISTRICT OF COLUMBIA
The mosquito control work continued as organized in 1930, with
the coordination and general supervision under the direction of the
Public Health Service. The major agencies interested in this work
.are the District of Columbia (sewer department) and the Office of
Public Buildings and Public Parks; but, in addition, there are some
28 other Federal and district agencies having jurisdiction over certain
areas. Through the cooperation of all agencies involved, well coordinated control has been possible.
With increased knowledge regarding the species of mosquitoes to
be dealt with, their characteristics, and their actual and potential
breeding places, and by the use of certain mechanical equipment so
-designed as to permit fixed labor charges to be materially lowered, it
has been/ossible to carry on the work at a material saving in cost as
compare with that of 1931. It is expected that certain other costs
can be materially lowered in 1933 by the employment of new methods
-of larvicidal treatment which are now in the experimental stage.
SUMMARY OF
w ORK CARRIED ON
BY THE VARIOUS DISTRICTS
Distribution of time in days of the field personnel under the engineering section
(ezclusi11e of mosquito control in the District of Columbia), fiscal year 1992
Interstate
quarantine:
Days
Office ___________________
1,684
FieldWater_______________
831
Shellfish--------~---233
National Park Service:
Office___________________
187
Field ____________________ , 224
Office of Indian Affairs:
Office___________________
436
Field____________________
182
Supervising Architect's office:
Office____________________ 116
Field ___ -- ------ __ ___ ___ _
43
Bureau of Prisons:
Office___________________
Field____________________
Other agencies:
Office___________________
Field____________________
Technical meetings__ _ ________
Leave_______________________
Days
39
25
136
236
54
315
Total days accounted for_ _ 4, 741
Digitized by
Google
86
PU.BLIC HEALTH SERVICE
TABULAR SUMMARY
TABLE
1.-Vessel water supply supervision
First inspections:
Passenger _______________ _
Freight _________________ _
Water boats ____________ _
Reinspections:
Passenger _______________ _
Freight _________________ _
Water boats ____________ _
Certificates issued:
Regular, favorable-Passenger ___________ _
Freight _____________ _
Water boats _________ _
Regular, not approved ____ _
Temporary, favorable-Passenger ______ ~ ____ _
Freight _____________ _
Water boats ________ _
TABLE
175
146
12
456
490
14
450
605
16
27
37
394
7
2.-Railroad sanitation supervision
Inspections:
Sources of water supply___
178
Coach yards______________
72
Terminals_______________
34
W:a~ering points__________
159
Dmmg cars______________
36
Certification:
Data reports reviewed _____ 2, 450
Certificates prepared for
States _________________ 4,327
TABLE
Water examinations made:
U. S. Public Health Service
laboratories ___________ _
Other laboratories _______ _
Major conferences:
With railroad officials ____ _
With others (principally
health authorities) _____ _
217
401
69
99
3.-Shelljish sanitation supervision
Inspections:
Area ___________________ _
10
Plants __________________ _ 539
State certificates:
Approved _______________ _ 997
Not approved ____________ _
0
Approval withdrawn ____ _
1
Cancelled _______________ _
45
TABLE
Cooperation with governmental
agencies:
Public Health Service-Surveys ____________ _
Conferences _________ _
Office of Indian Affairs-Surveys ____________ _
Conferences _________ _
National Park Service-Surveys ____________ _
Conferences _________ _
Federal PenitentiariesSurveys ____________ _
Conferences _________ _
Supervising Architect's OfficeSurveys ____________ _
Conferences ________ - 1 District
Major conferences:
With shipping officials ____ _
126
With others _____________ _
36
Water examinations made:
U. S. Public Health Service
laboratories ___________ _
0
Other laboratories________ _ 2,227
Typhoid fever cases reported:
U. S. Public Health Service
hospitals ______________ _
51
U. S. Public Health Service
quarantine stations ___ _
7
Health departments ______ _
7
Plans of vessel water systems
examined:
Approval withheld _______ _
2
Approval granted ________ _
3
Laboratory examinations made:
U. S. Public Health Service
laboratories ___________ _
114
Other laboratories _______ _ 11,130
Conferences _________________ _
75
4.-Miscellaneous
s
28
55
52
42
72
Cooperation with governmental
agencies-Continued.
Lighthouse ServiceSurveys ____________ _
Conferences _________ _
Forest ServiceSurveys ____________ _
Conferences _________ _
Other governmental
agencieeSurveys ____________ _
Conferences _________ _
15
22
23
42
No. 1 only.
Digitized by
Google
8
26
12
3
8
44
87
PUBLIC HEALTH SERVICE
wORK
RURAL HEALTH
One hundred and forty-four cooperative health projects in 28 States,
under the direction of local whole-time health officers, were carried
on for studies of and demonstration work in rural sanitation through
the use of the regular annual appropriation provided for the fiscal
year which ended June 30, 1932. The number of such projects was
69 less than the total for the preceding year, for the reason that a.
somewhat larger proportion of the fund available was used for special
research in methods of local health administration and for supervisory
work in the field.
The States, with their respective number of cooperative health
projects, are as follows:
State
Alabama... --···········
Arizona ................ .
Arkansas·-·-············
California.............. .
Florida __ .............. .
Georgia •• _••...•........
ldaho ••• ·-·---····-····lndiana•••••• _••••••••• _
Iowa. .................. .
Kansas................. .
Nwn•
ber or
projects
6
6
6
6
3
6
1
1
3
6
Num•
beror
projects
State
KentuckY·-··-···-·-·-··
Louisiana ....•••. _____ •.
Maryland ....•..• ·-·····
Massachusetts·-···-····
Michigan······--·······
Mississippi.. ••••••••••••
17
10
1
1
10
3
Montana.•..••......••••
New Mexico •..• _...... .
North Carolina •• -····-·
3
Missoun .•••..•.......•.
6
State
Nwn•
ber or
projects
Ohio ...•..... ·-·····-···
Oregon................ __
South Carolina.-···-····
South Dakota.·-········
Tennessee.............. .
Texas ..••••.•••.•...... _
Virginia ..•...•.•........
Washington ••••.........
1
2
1~
1
8
4
Total ••• ·-···-·-··
144
6
2
6
7
The regular appropriation for the rural sanitation work of the
Public Health Service for the fiscal year which ended June 30, 1932,
was $338,000. Against this amount appropriated, $2,300 was set
up as a budget saving, $318,748.47 was expended through specific
.allotments to the 144 cooperative health projects, and $19,788.88 was
used for special studies of rural sanitation and administration. As
provided in the appropriating act, no part of the fund was made
available to any community unless the State, county, or municipality
in which the community was located, agreed to pay at least one-half
the expense of the demonstration health work.
According to data collected by the Rural Sanitation Office from the
State health departments, the number of counties or comparable
·governmental divisions provided with health service reaching all
rural sections thereof, and under the direction of local whole-time
health officers, was 616 at the beginning of the calendar year 1932.
This represented a gain of 59 over the figure for the preceding year.
However, these projects are serving slightly less than 30 per cent of
the entire rural population of the United States. It is obvious that
progress in the development of county health work must be much
more rapid if the entire rural populat10n of the United States is to
provide itself with adequate health service within a reasonable time.
Since the assistance given by the Federal Government plays an important part in the establishment of permanent locally supported
1:'!ervice, continued cooperation on the part of the Public Health
Service on a. larger scale in this activity is essential to more rapid
-extension.
The emergency drought relief fund of $2,000,000, which was appropriated to the Public Health Service on February 6, 1931, for cooperation with the States in the drought-stricken areas in studies of
Digitized by
Google
88
PUBLIC HEALTH SERVICE
and demonstration work in rural sanitation, was available until June·
30, 1932. The act authorizing the emergency appropriation differed
from the regular rural sanitation act in tb.e following provisions:
1. The fund was limited to the drought-stricken areas.
2. The proportion of the expenses of such demonstration work in
any community was to be regulated by the Public Health.
Service with due consideration given to State and local
economic conditions and human needs.
3. The appropriation was available for purchase and distribution of medical supplies.
Reports from the Department of Agriculture on crop conditions,.
from the Weather Bureau on precipitation, and from the Red Cross
on their findings of economic conditions throughout the United.
States were used as guides in determining which areas would comeunder the provisions of this act. Twenty-two States were considered
to be partly or wholly within the drought-stricken areas.
The first cooperative budgets under the appropriation becameeffective March 1, 1931, and the work was extended through June
30, 1932. From the fund made available for this work, $1,954,024.30
was expended through specific allotments to the 472 cooperativehealth projects in the 21 States, while $33,963.20 was used for special
activities and administration.
The States in which the emergency drought relief cooperative·
health projects were conducted, under approved budgets, togetherwith the number and character of projects in each State, are as
follows:
Drought-relief cooperative health projectB
State
Total
projects Counties
Districts
Towns
Mobile
units
a~=t
tratlon
------------11----1·---t----1--- - - -- - -
1. Alabama_____________________________
2. Arkansas•--------------------------Georgia______________________________
Illinois_______________________________
Indiana______________________________
Kansas______________________________
Kentucky____________________________
Louisiana____________________________
3.
4.
6.
6.
7.
8.
t/t~~~~~::::::::::::::::::::::::
11.
Montana
___ -----------------------12. North
Carollna_____________________
32
31
(2) 1 _____________________________ _
71
(2) 1 __________
1
1
9
3
(7) 2 __________
1
3"
3 __________
2 __________ __________
1
21
19 ____________
1 __________
1
4
4 _________________________________________ _
67
66 ____________ ---------- __________
1
23
21 ____________ ---------- __________
2-
74
26
12
183
20
71
(2) 1 ---------- ----------
4
(46(4) 61 -_-_-_-_-_-_-_-__--_ _--_-_-_-_-_-_-_-_-_ ----------1
)
18 _________________________________________
_
13. North Dakota______________________
1 __________ ------------ ---------- ---------1
14. Ohio________________________________
27
24 ____________ ---------- "--------3
16. Oklahoma__________________________
12
9 ____________ __________
1
216. Pennsylvania_______________________
1 ________________________________ ---------1
17. South Carollna •-------------------- __________ ---------- ------------ ---------- ---------- ---------18. Tennessee___________________________
32
24
(11) 5 __________
2
1
30
8
(92) 19 ---------1
2
19. Texas_______________________________
20. Virginia_____________________________
48
34
(27) 9 ---------1
4
21. West Virginia_______________________
30
26
(4) 2 ---------- __________
2
TotaL. _____ • __ ------- --- • --- -- . -•
472
386
(196)
I
48
7
30
1 7 projects paid !rom regular rural sanitation funds last half of fiscal yesr 1932.
• Biologics only.
• Counties In "Districts," not Included under" Counties."
An endeavor was made to serve the States promptly and effectively,
and to meet their needs as completely as possible under the limitations
of the regulations which apply to all agencies of the Federal Government.
Digitized by
Google
89
PUBLIC HEALTH SERVICE
Following is a statement of a few of the outstanding and important
services which were rendered by the emergency health organizations
created within the drought-stricken areas through the cooperation of
the Public Health Service with the State and local governments:
Immunizations:
a. Complete antityphoid vaccinations ______________________ _ 1,663,496
b. Antismallpox vaccinations ______________________________ _
568,148
c. Diphtheria immunizations ______________________________ _ 875,331
d. Prophylactic diphtheria antitoxin ________________________ _
16,842
Child hygiene:
a. Prenatal cases given advice _____________________________ _
35,817
b. Children examined _____________________________________ _ 1,421,469
c. Number found defective ________________________________ _ 744,785
d. Number defects found __________________________________ _ 1,371,413
e. Corrections of physical defects induced ___________________ _ 225,975
f. Exclusions from school for communicable diseases _________ _
26,721
Communicable disease control:
a. Visits to cases, carriers, etc______________________________
126, 239
b. Cases isolated or quarantined____________________________
51., 882
Venereal
disease control:
a. Examinations
_________________________________________ _
50,893
b. Prophylactic treatments ________________________________ _
1,434
c. Curative treatments ___________________________________ _ 150, 248
Tuberculosis control:
a. Number persons examined_______________________________
38,002
b. Number found positive__________________________________
9,783
Sanitary privies installed_______________________________________
80, 532
Dwellings screened____________________________________________
13, 595
It is a great satisfaction to be able to report that the purpose of this
special appropriation act was fulfilled, since no unusual outbreak of
commumcable disease developed during the period for which the
appropriation was made, and health conditions in general were improved in spite of the economic distress which existed in the areas
where the work was done.
In an effort to improve the content and character of local service in
county health units in which the Public Health Service was cooperating, special advisory and consultant services were provided and
offered to State health authorities in connection with maternal and
child health work and certain phases of environmental sanitation.
Two officers detailed to this work visited States from which invitations were received, and they assisted in reorganization of State
health department facilities for supervising local activities in these
particular fields. The effect of this service has manifested itself in
improvement in many localities.
A special cooperative project in malaria control was carried on in
the State of Texas during the year. All but a very small part of the
cost of this work was borne out of a special fund appropriated by the
State legislature. Expert supervision was given by the Public Health
Service on request of the State health department with a view to
assisting in a demonstration of the value of a permanent local malaria
control program for certain sections where thio disease is unusually
prevalent.
CONFERENCE
OF THE SURGEON GENERAL WITH
TERRITORIAL HEALTH OFFICERS
THE STATE AND
In accordance with the act of July 1, 1902, the Thirtieth Annual
Conference of State and Territorial Health Officers with the Public
Health Service was held June 4 and 6, 1932, in Washington, D. C.
Digitized by
Google
90
PUBLIC HEALTH SERVICE
Delegates from 36 States, the District of Columbia, and the Canal
Zone were in attendance.
The following papers were presented and discussed:
1. The Determination of Public Health Needs and the Evaluation of Pro,cedure.
2. Minimum Standards of Qualifications as a Basis for Employment of Local
Health Personnel.
3. The Virginia Plan of Immunization Against Diphtheria.
4. The Certification of Water Supplies Used by Interstate Carriers.
5. Accidents and Accident Prevention.
6. Safeguarding Cyanide Fumigation.
7. Volatile Poisons.
8. Activities of the Public Health Service Relating to Narcotic Addiction and
the Public Health Aspects of the Problem.
9. Preliminary Report on Results of a Survey to Determine the Relative
Effects of Heated and Raw Milk Upon Child Weight and Height.
10. Specific Therapy in the Prevention and Treatment of Scarlet Fever.
11. The Present Status of the Morbidity Reporting Area.
12. The Registration of Births and Deaths on Indian Reservations.
13.. Induced Malaria in the Treatment of Paresis not a Menace to the Locality•.
Digitized by
Google
DIVISION OF FOREIGN AND INSULAR QUARANTINE AND
IMMIGRATION
In charge of Asst. Surg. Gen. F. A.
CARMELIA
QUARANTINE TRANSACTIONS
During the fiscal year 1932, medical officers of the Public Health
Service engaged in the administration of the United States quarantine
laws inspected 18,048 vessels and 2,407,154 persons. Of these, 13,256
vessels 630,444 passengers, and 998,471 members of crews were inspected at the continental maritime stations. At insular stations,
2,619 vessels, 122,617 passengers, and 205,146 membera of crews were
inspe~ted. At foreign stations, 2,173 vessels, 201,563 passengers, and
160,761 members of crews destined for ports of the United States were
inspected. There were 1,414 vessels fumigated or disinfected at continental stations, 626 at insular stations, and 415 at foreign stations.
At the border quarantine stationa there were 88,152 travelers inspected
exclusive of the local interurban traffic, numbering 8,798,598 who
were under surveillance. In addition, 2,205 airplanes arrived at
official airports of entry in the United States from foreign ports requiring quarantine inspection; a total of 17,387 persons carried on
these planes were accorded medical examination prior to entry.
GENERAL PREVALENCE OF QuARANTINABLE DISEASES
Yellow fever.-An outbreak of yellow fever was reported during
March, 1932, in a rural section in the hinterland served by the port
of Victoria, Brazil. Victoria is a port of call for many regular line
vessels trading between Gulf and Atlantic ports of the United States
and east coaat of South America, and the sanitary condition existing
in that port is consequently of particular significance. Yellow fever
is present also in other sections of Brazil and in the Gold Coast in
Africa; one case was reported in Nigeria and one case and one death
was reported in Dahomey.
Oholera.-As in previous years cholera was more prevalent on the
continent of Asia than elsewhere. The epidemic of cholera which began about May 1, 1932, in the vicinitv of Shanghai and Canton,
began spreading southward and threatened to assume serious proportions. Special precautions were adopted to protect United States
territory, particularly the Philippine Islands, against the introduction
of this diaease from China. The outbreak of this disease which occurred in the Philippine Islands in May, 1930, continued until the
early part of the calendar year 1932, although the number of cases
reported were not alarming. Cholera appears every year in parts of
Asia, and under present conditions outbreaks in the Philippine Islands
may be expected. The precautions taken to prevent the introduction
of this disease into the United States proved effective as no cases
made their appearance in the continental United States.
144391-32--7
91
Digitized by
Google
92
PUBLIC HEALTH SERVICE
Plague.-During the year plague in human beings was not reported
in the continental United States, although several cases of plague in
rodents occurred in Los Angeles, Calif. Human plague and rodent
plague were reported in the islands of Hawaii and Maui during the
fiscal year, and vessels arriving from ports in the infected areas of
these islands were required to undergo quarantine inspection upon
arrival at ports in the United States, together with any fumigation
required. These restrictions remained in force until the latter part
of the fiscal year, when quarantine officers were authorized to exempt
such vessels from mandatory fumigation when careful rat infestation
~howed nee;ative indications and appreciable amounts of cargo of a
_rat-attractive or rat-harboring nature were not loaded at ports serving
the infected areas, provided that bills of health issued at such ports
showed suitable precautions taken as regards both the vessel and its
cargo in such ports.
.
There was reported during October, 1931, an epidemic of bubonic
plague in the districts of Linhsien, Hsinghsien, and Paoteh, western
Shansi Province, China. The disease gradually swept eastward,
reaching Kolan Lanbsi in a short time. The disease had its highest
mortality at Hsinghsien, where 2,000 deaths occurred among the
thousands of victims. The Provincial Plague Preventative Bureau
despatched medical relief, and it was reported that complete isolation
of the areas concerned was ordered. This serious outbreak was of
considerable potential import from a quarantine standpoint. By
reason of its wide geographical distribution and the means of spread,
plague remains one of the major pandemic diseases which requires
the constant vigilance of health authorities in all countries. No cases
of this disease, however, occurred on board vessels arriving at United
States quarantine stations during the year.
Smallpox.-:-Smallpox is perhaps the most widespread of the quarantinable diseases. During the fiscal year cases of smallpox were
reported from nearly all countries of the world. There was a reported
increased prevalance of this disease during the year in the Orient,
particularly from Shanghai, Hong Kong, and Amoy, and appropriate
quarantine restrictions, including vaccination, were enforced against
these ports. The sanitary condition existing in these ports is of particular significance, due to their close proximity to the Philippine
.
Islands.
Typhus fever.-Typhus fever was reported during the fiscal year
from many ports which have commerce with the United States. It
is endemic in Mexico and in many eastern European countries. This
disease occurred in epidemic form in Poland, Egypt, Roumania,
Tunisia, Morocco, Algeria, Bulgaria, Lithuania, Y ol:;avia, Czechoslovakia, Greece, and Portugal, and appeared to a · ·ted extent in
the Irish Free State, Spain, Italy, Germany, and Austria. The number of cases occurring, howe"."er, ha~ decceased ~ually since the
World War, but the disease still contmues to be widespread.
CHANGES IN QUARANTINE PROCEDURE
During the past fiscal year a change has been made in the deratization requirements of vessels arriving at United States ports from
foreign ports, through the issuance of Foreign Quarantine Division
Circular No. 49, dated August 8, 1931. This modification has been
Digitized by
Google
PUBLIC HEALTH SERVICE
made under the provisions of the International Sanitary Convention
of Paris and in recognition of the improved sanitary conditions and
efficient administration in effect in many foreign ports. Prior to
the issuance of this circular, vessels arriving at ports in the United
States from foreign ports in which human or rodent plague had been
reported to exist were required to undergo fumigation for the destruction of rodents before free pratique was given at ports of arrival.
Under the present regulations, vessels arriving at United States ports
which have called at plague-infected ports within 60 days prior to
arrival may be exempted from fumi~ation, in the discretion of the
quarantine officer, if the vessel carnes an acceptable certificate of
deratization dated subsequent to date of call at such ports, or an
acceptable deratization exemption certificate based upon that degree
of rat proofing attaining control of rat infestation aboard, and the
vessel does not carry appreciable amounts of rat-attractive or ratharboringcargo, and the quarantine officer is satisfied following careful
examination of all accessible parts of the vessel and due consideration
of all factors involved that neither the vessel nor its cargo is ratinfested and does not present a potential danger of introducing plague.
It is now the established procedure at ports in the United States
to make inspections to determine the amount of rat infestation before
deciding upon fumigation, and discretion is vested in quarantine
officers to determine whether or not a vessel requires fumigation, who
base their decision upon the condition of the vessel upon arrival,
particularly as to whether the degree of rat proofing attains control
of rat infestation aboard and whether the vessel carries appreciable
·-. amounts of rat-attractive or rat-harboring cargo. Experience has
shown that fumigation of a loaded vessel destroys approximately
80 per cent or more of the rats on board, and it is now not an unusual
procedure to fumigate a loaded vessel when such is indicated following
rat infestation inspection.
Increasing attention has been given internationally in recent years
to the question of the fumigation of ships, particularly with hydrocyanic acid gal'l, for the destruction of rats. Article 28 of the International Sanitary Convention of Paris, revised 1926, provides that
vessels, except those employed in national coastwise service, must be
periodically deratized or be permanently kept in such condition that
the rat population is reduced to a minimum. Realizing the importance
of the subject from an international point of view, the health committee of the League of Nations, in consultation with the permanent
committee of the International Office of Public Hygiene, in Paris,
set up in the early spring of 1928 a Commission on the Fumigation
of Ships, under the chairmanship of the Surgeon General of the
United States Public Health Service. At their first meeting in Paris
on May 14, 1928, a program was drawn up, and the following spring
a preliminary report of the investigations, made in conformity with
these recommendations, was submitted by the chairman. In the
meantime the New York quarantine station was engage:! in carrying
out work along the lines recommended and much valuable information
was obtained, and in anticipation of the proposed visit to the United
States of the Committee of Fumigation Experts a resume report of
these investigations was prepared as a guide. The committee visited
the United States in the fall of 1931"and made some practical sturu,es
in ship fumigation, principally at the New York quarantine station.
Digitized by
Google
94
PUBLIC HEALTH SERVICE
At the close of their visit they prepared a very interesting and informative report on these studies, which formed the basis •for much
discussion at the meeting of the permanent committee of the International Office of Public Hygiene, in May, 1932, and it was proposed
that further discussion of the matter be made at future meetings.
INTERNATIONAL AGREEMENTS
Durin~ the early part of the fiscal year an informal agreement was
entered mto between the Public Health Service and the quarantine
service of Cuba, providing for the mutual recognition by the United
States quarantine authorities and by the Cuban quarantine authorities
of certificates of deratization and certificates of deratization exemption
given to maritime vessels by either authority, respectively. This
agreement is in accord with the provisions of article 7 of the Pan
American Sanitary Code and will ordinarily serve to relieve ships
which have been granted certificates of deratization exemption by
quarantine officers of the United States from the necessity of undergoing fumigation for deratization purposes upon arrival at Cubll,D
ports, as had been the practice heretofore.
Similarly, at the close of the fiscal year negotiations for a reciprocal
arrangement between the Government of the United States and the
Mexican Government were being perfected, through the State Department, whereby quarantine, customs and immigration inspection procedures may be accomplished in Mexican territory by employees of
the United States on certain northbound trains from Mexico entering
the United States at Laredo, reciprocal privileges being granted for
the performance in United States territory of similar procedures on
southbound trains from the United States to Mexico via La.redo by
employees of the Mexican Government.
PSITTACOSIS
Executive Order No. 5264, issued by the President on January 24,
1930, restricting for the time being the introduction of parrots into
the United States, and the regulations promulgated thereunder remained in force during the fiscal year. A slight outbreak of psittacosis
occurred in New York Cit;v during October and November, 1931, and
subsequently a more senous outbreak of this disease occurred in
California, which resulted in the drafting of a resolution by the health
authorities of California providing state-wide prohibition of importation or exportation of birds of the parrot family. This resolution was
designed to prevent the further introduction of birds infected with
psittacosis from foreign sources and allow time to determine whether
the disease was already established in local aviaries, and it was pro;.
posed that this restriction remain in effect at least six months. Officers of the Public Health Service cooperated with the State authorities
in the enforcement of these regulations, and consideration is now
being given to the advisability of a further revision of the present
Federal regulations governing the importation of parrots to specifically
include all birds of the parrot family and to possibly impose some
additional restrictive requirements, or else succinctly place a complete
embargo again~t the importati(!n of all. birds o! the parrot family.
In·the meanwhile, research studies are bemg contmued man endeavor
Digitized by
Google
95
PUBLIC HEALTH SERVICE
to obtain additional information respecting the causative organism
of this disease and a means for the prevention of its introduction and
spread.
The problem of the satisfactory control of psittacosis has become
of international interest in recent years, resultmg in the appointment
of a commission by the permanent committee of the International
Office of Public Hygiene, of Paris, to make a study of this problem
and to make recommendations. At the May, 1932, meeting of the
permanent committee, the commission examined the measures proposed at the previous meeting for the prevention of the spread of
this disease, which included the following: (a) In the countries of
origin of the birds, export only from designated ports, preceded b:y a
quarantine under veterinary surveillance; (b) regulations concern.mg
the care to be given to birds during transr.ortation by sea; (c) eventually a quarantine at the port of arriva, under veterinary control.
Since the psittacosis outbreak in 1929, various countries of the world,
including almost all the European countries, have promulgated regulations prohibiting the importation of birds of the parrot family; and
while the commission did not come to any definite conclusions, it
recommended that temporary prohibition be maintained and that
the subject receive further study.
MENINGOCOCCUS (CEREBROSPINAL) MENINGITIS
The special regulations prescribed under the provisions of Executive
Order No. 5143, approved June 21, 1929, restricting for the time being
the transportation of passengers from certain ports in the Orient,
remained in force during the fiscal year, particular attention being
given by quarantine officers at oriental ports of embarkation to section
B of these regulations, relating to the number of steerage allowed to
be carried under the nav~ation act of 1882, for the purpose of
making appropriate notations on bills of health issued to these
vessels for the information of quarantine officers at United States
ports. There was a reported increased prevalence of this disease
m the Orient, especially in Hong Kong, Canton, and Macao, in the
spring of the fiscal year, but this situation did not prove alarming.
SANITARY CONTROL OF AERIAL NAVIGATION
The sanitary control of aerial navigation has constituted one of
the major problems in recent years, not only in this country but in
the countnes of Latin America and of Europe, Asia, and Africa.
With steady increase in passenger traffic by air, the establishment
of airlines connect~ practically all countries, and the ever-increasing
speed with which a1r travel is being accomplished, more and more
has the public health aspect of air transport service assumed definite
proportions in the problems of these countries.
In 1920 the Public Health Service first took cognizance of the
danger, from a sanitary viewpoint, inherent in international aerial
navigation, and under the broad authority of the maritime quarantine
act of 1893 the Secretary of the Treasury included, by amendment
of the quarantine regulations issued thereunder, provision for a
modified quarantine procedure for aircraft coming from foreign ports,
including inspection upon arrival in United Stat.es ports. The
Digitized by
Google
06
PUBLIC HEALTH SERVICE
enactment of the air commerce act of 1926 definitely confers upon
the Secretary of the Treasury the authority to provide by regulation
for the application to civil air navigation of the laws and regulations
relating to the administration of public health laws to such extent
and upon such conditions as he deems necessary, and provides a
penalty of $500 for any violation thereof.
The problem of the sanitary control of aerial navi~ation has been
receiving international attention by leading sanitanans for several
years, finally culminating in a proposed International Convention
for the Sanitary Control of Aerial Navigation, which was drawn u_P
by the permanent committee of the International Office of Public
Hygiene, in Paris, at the May, 1930, meeting. This proposed convention formed the principal topic for discussion at the two meetings
of the permanent committee in May and October, 1931, as well as
at the meeting in April, 1931, of the Second Pan American Conference of Directors of Health held in Washington, D. C., under the
auspices of the,Pan American Sanitary Bureau. The views of these
two most important international public health bodies were incorporated in a final draft which was presented during the year for the
informal consideration and recommendation of various interested
governments; and the comment and recommendations submitted
by responding governments received the further consideration of the
permanent committee at its meeting in Paris in April, 1932. It is
anticipated that the revised draft convention will soon be formally
presented to the various interested governments for ratification.
Much interest has been manifested in the possible transmission of
disease by mosquitoes on airplanes; and for the purpose of determining
whether or not mosquitoes are carried on planes and the distance of
such transportation, the Public Health Service during the past year
carried out some experiments along these lines. To test the question
of the transmission of mosquitoes by planes, resort was had to the
expedient of collecting species of Aedes aegypti mosquitoes and putting
them on board airplanes at selected tropical ports, after staining
them with an aqueous solution of eosin to make them recognizable
at port of arrival. These experiments showed that approximately
one-fifth of the original number were transported long distances in
one day with repeated landing and opening of doors, hatches, and
windows, and refueling, unloading, and loading taking place. However, notwithstanding the fact that airplanes may and do transport
mosquitoes, this mode of introduction of mosquito-borne disease is
probably secondary in importance to the importation of an infected
person. With the relatively small number of mosquitoes carried by
aircraft and the facility with which airplanes may be freed from
mosquitoes at port of departure, it may safely be concluded that,
while there is a recognized danger, there is no obstacle to the efficient treatment of airplanes so as to destroy mosquitoes and avoid
retardation of air-traffic progress.
CONSTRUCTION OF QUARANTINE FACILITIES
The need for new quarantine facilities to serve the growing port
of Los Angeles has been recognized for many years, and in 1928 an
item for the acquisition of a site and funds for construction, in the
amount of $70,000, was included in the public-building program.
Digitized by
Google
PUBLIC HEALTH SERVICE
97
An act of Congress approved July 3, 1930, authorized the War
Department to transfer to the Treasury Department, without transfer of funds, a tract of land suitable for quarantine purposes in the
port of Los Angeles, and under date of June 6, 1932, the Secretary
of War transferred to the Treasury Department for this purpose a
rectangular tract of land comprising the southwestern corner of
Reservation Point.
Pursuant to the provisions of the second deficiency act approved
July 3, 1930, which authorized the Secretary of War to transfer to
the Treasury De:partment a tract of land suitable for a new quarantine station at Miami (Miami Beach), Fla., and carried an appropriation of $65,000 for the construction of such station, the Secretary of
War under date of June 20, 1931, transferred to the Treasury Department without transfer of funds, a tract of land of approximately
13.91 acres situated on Terminal Island at the south side of the
Miami Channel. Construction of this ·station is now under way.
During the past fiscal year a site comprising approximately 35 acres
has been offered to the Treasury Department at Point Hudson, ,Wash.,
by the Port Townsend Chamber of Commerce, for use as a quarantine
station. This site is immediately adjacent to Port Townsend, at
the entrance to Port Townsend Bay. Funds for the construction of
a quarantine station have not yet been appropriated; however, in
House Document No. 788, Seventy-first Congress, there is included
an item for the construction of a new quarantine station for Port
Townsend under the heading "allocated to be appropriated," at an
estimated limit of cost of $250,000. Negotiations are now being conducted between the Treasury Department and the Port Townsend
Chamber of Commerce concerning the actual transfer of this property.
FLOATING EQUIPMENT
During the year considerable progress has been made in bringing
up to an efficient standard the floating equipment used at quarantine
stations, now comprising 62 steam and Diesel tugs and launches.
Replacements and maintenance of this equipment continued to be
under the supervision of a graduate naval architect, employed in the
office of the Surgeon General, who not only planned and prepared
designs for new equipment, including detailed specifications for their
construction under contract, but also personall,}'.: supervised the actual
construction. In addition, plans and specifications covering all
major repairs of floating equipment have been prepared and the performance of the work has been supervised in the more important
repairs by the naval architect. The results achieved have been
noteworthy. Not only has the general maintenance of this equipment been improved, but the costs at the same time have been
lowered.
During the year a most modern Diesel electric tug, the Walter
·wyman, was completed and placed in service at the New York quarantine station. This vessel is notable by reason of its ruggedness,
and excellent efficiency and adaptability. The hull is constructed
of wrought-iron plates and rivets, giving assurance of reduced upkeep
and prolonged life. The Public Health Service pioneered in reverting
to the old-fashioned use of wrought iron in the construction of this
hull. The adoption of this old-time practice attracted considerable
Digitized by
Google
98
PUBLIC HEALTH 'SERVICE
attention, which precedent was followed in the recent construction
of several similar vessels for commercial use and the use of other
Government agencies.
Four small wooden work launches, 40 feet in length, and equipped
with full Diesel-type engines, were also constructed during the year
for general utility service. These boats, constructed of one design,
were designated the Q-15, Q-16, Q-17, and Q-18, and were assigned,
respectively, to the Galveston (Tex.), Mobile (Ala.), San Francisco
(Calif.), and Marcus Hook (Pa.) quarantine stations. These boats
are very economical, owing to their being equipped with Diesel engines and being arranged for I-man control and operation, and they
have low maintenance costs, owing to their specialized design and
extra. heavy construction.
QUARANTINE TRANSACTIONS AT CONTINENTAL AND INSULAR
QUARANTINE STATIONS
TABLE
!.-Summary of quarantine tranaactiona at continental and insular atationa
for the fiscal year 1932
(1) INSPECTIONS
Total
number
Vessels_
- - -- ------- ---- - - - - - - -- - - - - - -_
Seamen _____________________________
Passengers_______ -------. -- •• -- _____ -
Passed
provlslonal Detained
pratique pratlque
PB&'!ed
rree
Remarks
15, 87 5
11, 677
4, 198
188
1,203,617 ______________________________ Includes workaways.
841,213 __________ ____________________ Includes stowaways.
1
I
(2) DETENTIONS
Typhus
Number
.
1
0
Vessels
---·----------------- -- -- -- -- -- -- -- - - - -- - - - - --_
Seamen________________________________________________
Passengers ________________________________________ • __ _
Sick __________________________________________________ _
3
1
Smallpox
Cholera
Days
Number
Days
Number
1
0
41
17
1
196
506
2
1
196
506
3
115
2
Days
4
290
20
32
9
1
(3) LABORATORY
Number of rats examined ___________________________ ... ___ .... ___ _
Number of fleas classified ________________________________________ _
Number persons vaccinated (for smallpox) _____________________ . ___ _
Number persons vaccinated (for cholera) __ ._._ .. _________ . _________ _
Other examinations:
Stools examined for cholera ________________.____________ . ______ _
Nasal swabs examined for meningococcus ______________________ _
4,371
3,452
12,084
867
5,761
4,949
(4) TREATMENT OF VESSELS (FUMIGATING, TRAPPING, REMANDING)
(Al FUMIGATION
Cyanide
1,439
577, 785, 941
4,235,431
6,809
Sulphur
601
Total
2,040
38,093,282
1,346,038
615, 879, 223
5,581,469
1,583
8, 39'2
(Bl TBAPPING
Number of vessels ____________________________ ... ___________ .. ___ _
Net tonnage ____________________________________________________ _ 45,1336
Number of traps_. ___ .... ______ . ___ . __ ._ .... __ .. _-- - ______ - - . ---646
Number of rats ________ . _____________ .. _____ . ___ ----------------_
86
Digitized by
Google
99
PUBLIC HEALTH SERVICE
TABLE
!.-Summary of quarantine transactio118 at continental and insular stations
for the fiscal year 1932-Continued
(4) TREATMENT OF VESSELS (FUMIGATING, TRAPPING, REM.ANDING-Continued
(C) REMANDS i'OR FUMIGATION
Manda•
v~'!ls
From other ports .•... , ..............•....•................•.•..•.........
To other ports.•...........................................•......•.......
Period!• For other
c~er:s· purposes
76
28
297
2i8
203
222
(5) RESEARCH
The following,resear.ch.work was done at the New York quarantine station:
1. Rat infestation survey as fumigation control.
2. Study of fumigation methods and effectiveness.
3. Study of fumigation as applied to loaded ships.
4. Study of fumigation of cockroaches.
5. Study of ratproofing on ships.
.
.
(6) FINANCIAL REPORT
Total amount of bills rendered for quarantine services___________ $284, 341. 96
(7) PORT SANITARY STATEMENTS AND BILLS OF HEALTH ISSUED
Number issued ___________________________________________________ 45,522
(8) MEDICAL EXAMINATIONS OF ALIENS AT QUARANTINE STATIONS
Number
examined
Passengers.•...........•..................
Alien seamen .......•.....................
60,057
402,118
Class certified
Inten•
slve
A-1
3,693
131,382
A-11
5
49
553
40
C
B
66
147
246
114
Total
certlfled
366
854
TRANSACTIONS AT CONTINENTAL MARITIME STATIONS
TABLE
2.-Summary of tra118actions at continental maritime stations for the fiscal
year, 1932
Station
Aberdeen, Wash •.....•••............................
Angel Island, Calif. (San Francisco) •........•.......
Astoria, Oreg, ..•.....•......................•.......
Baltimore, Md •..•..••...•..........................
Beaufort, S. C ...•.......•...........................
Boca Grande, Fla...•................................
Boston, Mass ....................................... .
Brunswick, Ga ..................................... .
Carrabelle, Fla ..................................... .
Cedar Keys, Fla.•••..•.•....•.......................
Charleston, s. C.·-··································
Corpus Christi, Tex .••..............................
1::t~~c!'W::::::::::::::::::::::::::::::::::::::::
Fall River, Mass .•.•................................
Fernandina, Fla. (Cumberland Sound) .•............
Fort Bragg, Calif. ..•................................
Fon Pierce, Fla •••..................................
Fon Monroe, Va •••..........................•......
Freeport, Tex •.•....................................
Galveston, Tex .•....................................
8l1::ii~~~~~::::::::::::::::::::::::::::::::::::.
Vessels fumigated Pe.ssen•
Vessels 1 - - - ~ - - - I gers In•
inspected
Cyanide Sulphur spected
8
561
0
0
0
30,150
0
382
0
1
26,020
0
0
0
165
17
0
0
1
0
0
0
94
10
49
0
0
0
0
11,960
508
0
0
0
1,340
2
2,740
0
0
0
46
620
123
13
139
10
917
121
0
10
0
0
132
37
3
1
52
2
0
0
305
15
749
2
0
Digitized by
0
0
0
0
0
6
0
0
0
0
0
0
0
53
2
0
0
0
0
0
0
0
0
0
5
Crew in•
spected
5
0
0
Google
0
0
294
42,371
1,752
20,477
0
313
58,548
253
0
0
4,317
1,370
66
33
1,919
0
0
27,455
22
0
100
TABLE
PUBLIC HEALTH SERVICE
2.-Summary of transactions at continental maritime ,tations for the fiscal
year, 19SS-Continued
Station
Vessels Vessels fumigated
inspected
Cyanide Sulphur
Gulfport, Miss _____________________________________ _
Jacksonville, Fla. (St. Johns River) _________________ _
Key West, Fla. ____________________________________ _
Lewes, Del. (Delaware Breakwater). _______________ _
Marcus Hook, Pa___________________________________ _
Marah.fleld, Oreg. (Coos Bay) _______________________ _
~=e. ~~-- - - - - - - - - - - - - - :_ _ _ _ _ _
Montere~ Calif. ___________________________________ _
Morgan 1.Jlty, La. (Atchafalaya) ____________________ _
New Bedford, Mass ________________________________ _
New London, Conn _________________________________ _
i~x~S:."fex:::::::::::::::::::::::::::::::::::
17
Port Ever~des, Fla.•-------------------------------
121
15
ii~rii~fo~~IJ-~~:::::::::::::::::::::::::::::::::::
0
Port San Luis, Calif. (San Luis Obispo) ____________ _
Port Townsend, Wash.•----------------------------Provldence, R. 1_ ___________________________________ _
Sabine, Tex ________________________________________ _
San Diego, Calif. (Point Loma) ____________________ _
San Pedro, Calif.. __________________________________ _
• Opened Jan. 1, 1932.
2 Fumigated with formaldehyde
7
672
231
0
0
14
i:1ifif~:~;~::::::::::::::::::::::::::::::::::=
T otal. -- - --• -• --· -- - --- -- -- ---· -- --- --- ---- -- - -
683
4
1,242
0
3
3,821
0
18
0
49 •
4
0
~:~a,~t~====================================
New York, N. Y,•----------------------------------Ogdensburg, N. y _____________ ----------------------
~~~~.bl'{:'._~~~~::::::::::::::::::::::::::::::::
~:rir:!<1:"1wasii:::::::::::::::::::::::::::::::::::
Southport! N. C. (Cape Fear) ______________________ _
it:~!i[Javen, Mass _____________________________ _
;::i:~nB~cfF1ii:_"."::::::::::::::::::::::::::::
23
102
156
0
24
151
86
'JIJ7
462
1, 'J!Jl
0
103
8
3
43
216
2
0
98
0
12
0
0
104
0
27
19
0
0
0
0
140
0
0
283
0
0
0
8
0
0
0
0
8
0
0
69
0
10
0
132
0
30
0
0
0
24
0
0
0
3
0
5
0
0
3
0
1
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
3
0
0
4
0
0
0
0
1
6
0
0
0
0
Passengers Inspected
11
300
9,452
0
1,034
0
14,881
241
0
0
73
13
9,460
0
3
497,196
0
0
0
23
0
0
3,119
68
0
0
0
7
1,963
75
14,794
16,131
0
180
0
0
71
253
0
0
189
Crew inspected
783
3,425
10,375
0
24,M9
246
18,860
6,442
0
0
351
329
48,081
0
00
562,421
0
685
0
1,568
82
0
3,061
3,009
570
0
927
2,529
4,013
6,918
34,005
82,476
0
3,103
121
119
1,414
4,767
16
0
395
----1----+----l-----+---13,256
630,ffl
998,471
1,321
93
Includes Perth Amboy, N. J.
• Includes all ports on the Puget Sound.
I
Digitized by
Google
TRANSACTIONS AT UNITED STATES AIR PORTS OF ENTRY FOR AIRPLANES FROM FOREIGN PORTS
TABLE
Location
0
co·
N.
"'
~
~
0
0
a
~
I
3.-Summary of transactions at continental and in11ular stations for the fiscal year 1992
Xamc of ai rport
Distance in
miles to
nearest
Public
I Ilealth
Service
station
Date designatcd
I
Number of Number of Numberol
Number of airplanes persons ar- persons in- N".mbu o< N•m~,
aliens In- of aliens
air~la_nes inspected riving from spected by spected_
by certified
arrtVIIl!(
by Public
loreign
Public
Public
lor
from lore1gn H ealth
ports or
Health
ports
Service
i~~i~~ disease
places
Service
Akron, Ohio __ ___ ___ ____ __ ____ Muniripal Airport'--- - - · -- - -- -- ----- --- ---- -- ______ ______ Apr. 8, 1929
Albany, N. y ___ ______ ____ ____ ____ do __ ----------------- - ------ -- ---- - ---- - -- ________ ____ Sept. 28, 1928 ,_____ (')
___ ____ ,__ ______ ____ ,__ __ ________ ,_______ __ ___ , ___ _____ __ __ , _________ _
_\jo, Ariz ________ _______ ___ ___ _____ do ____ ___ ___ ________ ________ __ ___ ___ ______
G
Kov. 15, 1929
JI
0
22
0
0
0
Ilellingham, Wash ______ ___ ___ Graham Airport 1 ___ _ ______ _ ____ _ _ _ _ _ ___ ______ __ _____ _____ Apr. 18, 1930
26
0
41
0
0
0
Roston, Mass ___ __ ____ _____ __ _ Boston Airport' · _________ ___ ________ _______ ___ ___ ______________________ _
2
2
4
4
0
4
Brownsville, Tex __ ______ ____ _ Municipal Ai rport_________________ ___ __ __ __ __
an. 8, 1930
500
148
2,835
2,677
I, !18
11
Ruffalo, N . Y ___ _____ ____ _____ __ __ do _________ __ ___ __ __ ____ ____________________ _____ __5 ___ JJune
10, 1929
0
0
0
0
0
0
Calais, Me ________ _______ ____ Pan American Airways Seaplane J3ase, St. ___ __ _____ __ July 23, 1931
0 1
0
23
196
0
0
Croix River.
Ford Airport' - -- -- -- ---------------- -- - -- -- __ ______ ____ Aug . 1, 1920 }
Detroit, Mich __________ __ ___ _ Wayne County- -Airport.
__________________ ____ ___ ____ _____ Feb. 10, 1931
0
0
0
0
0
0
{ Municipal Airport'- --- ------- ----- --- ------ - . __________ June 10, 1929
Douglas, Ariz ___ _________ ____ Municipal Air Fiehl' -- --------- --- --- ----- - -- ________ ____ J an. 8,1930
3
3
16
16
0
0
E ngle P ass, Tex_ __ _________ __ Eagle Pass Airport' ----------------- - -- --- - -l½ Mar. 5, 1930
2
2
8
S
O
0
F.I Paso, Tex. _______ ___ ______ E l Paso Municipal
------- - ----- --- - 9
Aug. 15, 1929
110
110
413
413
07
2
Great Falls, Mont ________ ____ Vance Ai rport 1 _ ___Airport'
_ _ _ _·_____________ _ __ __ __ __ _ __ __ _______ June
2, 1930
(2)
__________________________ _ _____________ _ _ __ ________ _ ____ _
Havre, Mont __ _________ __ ____ Municipal Airport'-- --- - -------··-·-·--- -- --- _____ ____________ do_______
0
0
O
O
O
0
Juneau, Alaska __ _______ ______ Juneau Airport' --- ----- ------- ---- --- ------ -- _____ _______ June 18, 1930 _______ _____________________ ______ __________ ___ __ ________________ ____ _
Ketchikan, Alaska __________ _ Ketchikan .~irport '- --- -- - ----------------- --- ____ __ ___ ________ do ____ __ __ ______ _____ ____ __________ _____ _______ _____________________________ __ _
Key West, F la __ __ __ _______ __ Meacham Field ____ ___ _________________ ____ ___
5
Dec. 20. 1929
4
4
11
11
O
O
Laredo, 'l' ex _______ __ ____ _____ LaredoAirdrome 1 __ ___ ________ _ _______ _ __ ____
3½ Jan. 24,1930
14
14
31
31
1
0
Malone,N. y ___________ _____ Porto1Malone 1 • _ _ ____________________ _ ___ ___ _ __ __ _ _ __ _ _ _ Apr. 18,1930
0
0
0
0
0
0
Pan American Field_ --- --------- ---- -- ---- - -8½ Oct. 16, 1928
Jllinmi, Fla __ ___ __ ________ __ __ {ninn_er K~~------.---- , --------------- ---- ----6
Mar . 7. 1930 }
I. 196
l , 196
11,281
11,281
l, 255
9
Curtiss-\\ right Field _____ ________________ ___
¾ Apr. 22, 1930
Minot, N. Dak ____ __ ___ ___ ___ Port of Minot _____ __ _________________ ____ ____ __ __ _________ Kov. 30, 1931
(' )
----- -------1- ---- ----- - -t- - - - - --- - - --1 --- --~ -----1 ----• -- -• New York, N . y __ __ _____ __ __ Newark Metropolitan Airport _________ _____ __ ___ __________ Jan . 2. 1929
0
0
0
0
0
' 0
Nogales, Ariz ____ _____ ___ __ ___ International Airport.. _______ ------ -------- - ·
9
Ju ne 27, lll29
26
26
79
79
3
0
Newport, Vt. ____ ____________ Canadian Gateway ________ _________________ ___ ___________ Aug. 1,1921l
0
0
0
0
0
0
Ogdensburg N y
{Ilillings Field _______________ ____________________ __________ J an. 8, 1030
~
2
4
0
' · ------------ Odgensbur~ Tlarbor ' --------·- _________ ___ ___ ____ __ ______ Mar . I, 1932
0
0
Pembina, N. Dak ___________ ;l..funir ipal Airport' ------ - ----- __________________ __ ___ __ Feb. 2, 1930
(')
Plattsbur~. N. y _____________ Mohodo Airport'- ------------ __________ ___ _________ ___ June 2, 1930
(')
Portal. N . Da k _____________ __ Porto! Airport'----- -- -------------- - -- -- -- --- ________ ____ Jan. 8, 1930
l'ort .\ngclcs, Wash _____ ___ __ Port Angeles Airport 1 • _ ___ ____ _ __ __ ______ ____
52
_____ do _____ __
I
g1·---------ff---------gr--------n--·------ff---- ·"g
1
Tern (>Orary permission.
2
No medical officer of Public IJealt h Service.
' Authorized for use but not officially designated.
'-o
q
bj
t<
....
0
i:i::
t_:,:J
>
~
i:i::
Ul
t_:,:J
~....
0
t_:,:J
......
~\
\
TABLE
3.-Summary of transactions at continental and insular stations for the fiscal year 1932-Continued
'""'
0
t,:)
I
Location
Name of airport
Distance in
miles to
nearest
Public
I Health
Date desig•
nated
Service
station
Number ol N1:1mbcr ol Number ol .'<umber ol
airplanes !'"Planes persons ar- persons in- spected by 01 ahen_s
arriving
Jospecte? riving from spected by
Public
certified
foreign
Public
from foreign by Pub!Ic
Health
.ror
ports or
Health
ports
Health
Service
dIScase
places
Service
Service
Port 1' ownsend, Wash ....... Port Townsend Airport' ·········••····•···· ··
12
June 18, 1930
St. Paul, Minn .... . .......... Municipal Air Field• ....... .. ........... ......... ...... .. June 4, 1928
~~nTJ~':'o".8c~1i:: :: ::: ::::::
0
co·
"'
N.
~
-!:?"
0
0
a
~
l\;,~!ir'~'i~.\i[iir'~~.·::::: ::: :::::: :: ::: ::::: :: .........~~~ .ian...u;iiiw·
San Juan, P.R ............... {~l~a~g~~~esteri:1Xirpo~tF.xi:ii-e.ss· F.-iei<i: :::: ······· 12·-Sandusky, Ohio .............. Parker Field ........................ .. ........... ..... ....
Scobey, Mont ..........•..... Scobey Airport. ............. . . . •.... . . .... .... . . . ....... ..
Seattle Wash
{Boeing F_ielcl ..•.... . ..... .... , ... ........ . .. ... . ...•.. ....
•
· • ······ · ·· · · ··· Lake Union . ........ ..... ............. .... ..... . . .........
Skagway Alask 8
{Skagway Municipal Airport .... ... .... ........... ........
'
• •
• • •••••••••• • Skagway Seaplane Base ..... .. ... . ..... . ............. .. ...
Spokane, Wash ............... Felts Field 1•••••• •• •••• • • ••• •••• •••••••• •••••• • •••• •••••••
Swant.on, Vt ................. Missisquoi Airport 1• • ••••••••••••••• ••• •• • ••••••••••••••••
Watertown , N. Y . ...•...... West«>.rn Municipal Airport'··· · ············ · · ............
West Palm Beach, Fin ....... Roosevelt Service Flying Base (Currie Com• ..... . . .....
mon Park). 1
Wrangell, Alaska ........... . . Wrangell Seaplane Base.......... .. .. ... . .. .. .
Total.. .... ............ .
• Temporary permission.
• No medical officer ol Public Health Service.
.ji.ii."iii;iiiao·I}
N.::::~• IN'~""
0
0
0
0
0
0
(•:. ;: 1········~1r ····~~!:!r····~.·::n·······~n--···· ! ;
r·········ff----···66:r ········~r········~r·······~
=
"d
June 6, 1932
(')
June 2, 1930
30:
Sept. 11, 1928 }
Dec. 27, 1928
Nov. 30, 1931 }
. . .. . do . . ..•. · ······· ··•
June 2, 1930
(')
Jnly 18, 1930
(')
June 2, 1930
(')
Mar. JO, 1931
128
~
C
l.,;l
►
128
5SI
5SI
47
0
~
2,205
24,694
17,387
2, Sf,O
25
to
rJl
l.,;l
Nov. 30, 1931
4,401
• Authorized lor use but not officially designated.
• Closed Dec. 31 , 1931 .
;'.S
C
l.,;l
103
PUBLIC HEALTH SERVICE
MEXICAN BORDER STATIONS
TABLE
4.-Summary of quarantine transactions on the Mexican border for fiscal
year 193B
Number inspected
from
Interior
Mexico
Station
Total
Total
Total number
Number Total
ntnn- of persons numor local number ber
or
berof
of
pas•
passed
p~npersons
gers m- sengers persons
disln- without
vacci•
treatspected inspected rested
nated
ment
Tot,al Total
num- numberof beror
sick
sick
held for refused
obser• admlsvatlon sion
Total
pieces
of bag-
~,:.
fected
--- - - - - - - --Brownsville, Tex .. _.•.
Calexico, Calif.. .......
Columb~ N. Mex....
Del Rio, ex ..........
Douglas, Ariz ..... _._ ..
Ea~e Pass, Tex .......
El aso, Tex.I .........
Guadalope Gate, Tex ..
Hidalgo, Tex ..........
Laredo, Tex ...........
Minerva, Tex .........
Naco, Ariz .............
Nogales, Ariz ..........
Presidio, Tex ..........
Rio Grande, Tex ... _..
Roma, Tex ............
San Ysidro, Calif......
S8S8be, Ariz ...........
Thayer (Mercedes),
Tex..................
Yseleta, Tex...........
Zapata, Tex ...........
2,124
836,953. 839,077
9,886
9,886
0
865
0
865
1,346
89,696
91,042
5,114
1,908
3,206
701,624
706,567
3,943
8,579 5,070,564 5,079,133
161
161
0
2,315
262,059
264,374
53,577 1,497,402 I, 550,979
1,920
1,920
0
2
3,476
3,478
17,212
21,291
4,079
41,420
41,521
101
374
13,504
13,878
4,792
44,874
· 40,082
4,176 • 11,859
16,035
1
491
492
Total............
88,152 8,798,598 8,886,750
1
35
0
800
73,331
100,406
13,492
73,366
100,406
14,292
837,520
70
0
9,330
0
568
89,311
848
0
0
13,270
78,249
22,322 5,048,676
0
0
74
262,595
1,746 I, 538,464
0 - 1,649
2,301
0
20,507
5
167
40,585
13,249
0
2
~.886
0
13,802
0
291
1,033
697
296
887
444
1,638
8,128
86
1,698
12,515
293
997
779
751
629
1,986
1,872
200
0
0
0
0
0
0
0
0
7
199
0
0
0
5
0
0
0
0
C
6
0
2
181
0
13
0
0
361
I
1,976
0
0
4
386
923
17
0
0
72,929
100,170
12,473
235
I, 819
428
0
0
I
0
0
0
7
0
0
38,530 8,194,545
37,411
212
780
9
0
17
0
156
11
3
0
45
i
0
----
0
0
0
629
0
14,132
1,368
I}
---
19,448
Includes the subports Newmans School and Fort Hancock.
TRANSACTIONS AT INSULAR QUARANTINE STATIONS
TABLE
5.-Summary of transactions at insular stations for fiscal year 1932
Vessels fumigated
Station
Vessels
inspected
Cyanide Sulphur
Bills of
health
Passen- Crews In• -and;1>ort
gers Inspected spected
ments
Issued
~t~Y
Alaska:
Cordova ......................................................................................... .
Juneau ........................................................................................... .
Ketchikan ....................................................................................... .
Seward........................................................................................... .
Sitka .................................................................................... ······ .. ·•
Wrangell ......................................................................................... .
Total .. '. ...... . .................... .
- - - - - - ---->----+----•---0
0
0
0
0
Hawaii:
AhukinL............................. .......... .......... .......... .......... ..........
Hilo...................................
9 .......... ..........
2
413
~g~\~I~.--~:::::::::::::::::::::::::::
I~ .......
~~. :::::::::: ... ~~'.~.
28, 1~
0
40
206
mi
KiheL ........................................................................................... .
Koloa.................................
1 .......... .......... ..........
32
;;
Lahaina...............................
1 .......... ......... . ..........
36
65
Mahukona ....................................... ~ .............................................. ..
Makaweli. ....................................................................................... .
Total. ......... .
Philippines:
Cavite ............................... .
Cebu ................................. .
Davao ............................... .
Iloilo......
.. .................. .
Jolo.....
.. . ............... .
- - - - - - ---------->---165
14
0
i
85
110
40
102
27
207
Digitized by
30,768
28,636
7,544
120
689
493
245
396
2,185
4,821
3,182
4,598
915
2
341
150
209
63
Google
104
PUBLIC HEALTH SERVICE
TABLE
5.-Summary of tran,actions at in,ular atationa for fiscal year 1992-Con.
Vessels fumigated
Vessels
Inspected
Station
Cyanide Sulphur
Bills of
health
Passen• Crews In• and port
gers In• spected ~~~
spected
ments
Issued
Philippines-Continued.
Legaspi...............................
Manila................................
13 ••••••
........•.
1, 056
72
168
1
7', 798
680
104, 983
1, 219
i~~ga...........................
1! :::::::::: ....... i6.
······~·
1, 1:
78
~
Total ...•••••••.• :•·•··········•··· --l-,-34-5-1----72-1---500-+--77-,-200-l--l-22,_4_00_+-_2,_1_21
Puerto Rico:
Aguadllla.............................
. . . . . . . . . . . . . . . . . . . . . •. . . . . . . .
8
Areceibo ...........•••.•.........•... ~
. . . . . • . •. . . . . . . . . . . . . . . . . . . . . .
28
Arroyo................................
5 .•........ .•.•......
1
106
Central Aguirre .•..•••...•.•....• · .....••....••••...•.....• ·•...•.••.•.•...•........•.
Fajardo...............................
43 . • • • . • • • • . .• . . • . . . • .
3
2m
g~"!:;:;i.-::::::::::::::::::::::::::::
Mayaguez....... ... . ••..... ... ....•...
Ponce.................................
San Juan•••••••.••••••••.•.•.••. ,.....
Total...... · ....... .···············•·
11i28 ··•······· ................
~.
•
•
30
52
507
I
24
1
844
25
'-==='====I
10,
113
46
49
38
348
56
5rf
30
337
158
93
23
10,401
29,232
866
10,988
41,536
1,795
989
Virgin Islands:
Christiansted..... .. •.••....... .. . . . . •
12 .. . . .. .. .. . . ... . • ...
31
114
196
r:e1~f!:ted •..•.•.•••••.•...•..•.....•...... 56.•...•....•........••.•.. 1,971 ..••• 6,248.•••.••.76
St. Thomas...........................
197
7
7
I, 609
7, 163
523
Total ......•••...•••....•.....•... ·· 1===26=5=F===7=l====7=l==3=,6=l=l=l==1=2=,5=2=5"===794=
Total, all stations...................
2,619
118
008
122,617
206, HII
12,264
TRANSACTIONS AT FOREIGN PORTS
TABLE
6.-Summary of transactions at foreign porttt, fittcal year 1991!
Station
Vessels
Inspected
Fumlga•
tion of
vessels
super•.
vised
84
121
Passengers and
crews inspected
Passen•
gers
212
0
0
0
43
0
0
0
16,566
0
0
0
61,317
0
425
59
393
131
12
0
0
0
535
0
Crews
Bills of
health
counter•
signed
92
121
139
1,630
3
8,734
218
6,469
7
9,007
0
0
0
86,317
0
11,088
4,200
I', 919
19,395
0
118
93,870
144,926
4,258
0
0
111
0
0
0
0
35
0
0
2,979
1,614
10,377
5,889
1,153
3,361
77
3,706
3,058
116
0
0
0
0
0
2,339
0
0
0
0
767
87
I
M9
666
0
212
800
393·
231
14
EUROPEAN PORTS
t~l~~f.~r~=~~:'.1.-.-:::::::::::::::::::::::::::::::::
Bremen, Germany.••.••...................... . ......
Cobh, Irish Free State•.•••..........................
i~i:.r:Vr:·Jlt~~~====::::::::::::::::::::::::::
Dublin, Ireland. .•.•.•••..•.......................... !
Genoa, Italy..•.•....••.•........•...................
Olasgo\V and Grenock, Scotland .................... .
Londollderry, England '······••··········•· ........ .
1 Discontinued July 31, 1932.
18
0
0
0
0
63
0
41
0
0
Digitized by
Google
639
107
172
10
156
315
267
4
105
PUBLIC HEALTH SERVICE
TABI.E
6.-Summary of tramactiona at foreign port,, fi,Bcal, year 19SS--Continued
Fumigation of
Inspected ve&Sels
supervised
Pasaengers and
crews inspected
Ve&Sels
Station
Pasaengers
Crews
Bills of
health
countersigned
l:UBOPl:AN POBTs-oontlnued
Norw&Y-------------------------•-•"·-------
Bergen,
Goteborg, Sweden ___________ -----------------------Bamburg, Germany_________________________________
Liverpool, England__________________________________
Londoi:i, England _______ • ___ -- -- ----- -- _. ___ • _. ____ __
Marselues, France•----------------------------------
0O
0
O
3
0
~ii~~~~::::::::::::::::::::::::::::::::::::: lg
Piraeus, Italy (Athens)._____________________________
Rotterdam, Rolland. ___ -- ___ - --- __ -- -- -- __ -- -•• --- __
Southampton, England ____________________ .. -------Stockholm, Sweden. ____ • _____ •• _•• __ •. _._. _____ .____
18
0
3
0
0
0
100
0
0
1
0
0
0
0
0
0
0
0
0
18
0
0
0
11;1184
0
0
1,494
0
0
0
906
311
15, 752
9,951
480
0
23,019
0
373
1,826
2,570
19,946
230
7
0
834
387
4M
46
257
85
69
22
003
4(K
0
l-----+---~f-----+-----1--
5,392
107,693
15,835
T ot aL •• - -- -- • ------ ___ ---------. _------- ___ ___
272
l===,l====l====~===,1==
Total, all stations._________ •• _. ___ -- ____ -- ____ _
2, 173
415
201,563
160,761
9,600
297
• Opened Mar. 31, 1932.
TABLE
7.-Primary treatment of passengers and crew prior to embarkation, fi,Bcal
, year 19:!12
Name of port
Antwerp _____________
Belfast ____ • ___ ••••• __
Bergen_______________
Bremen ______________
Cobh_________________
Copenhagen__________
Danzig_______________
Dublin_______________
Genoa ___________ ----Glastow _____________
Gote org_____________
Rambur!-----------Llverpoo
- • _" __ • - - _- _
London ______________
Londonderry•------Naples _______________
Oslo __________________
Palermo______________
Piraeus ______________
Rotterdam ___________
Southampton ________
Stockholm ___________
Marseilles•- •• _______
Total __________
1
TABLE
Passengers Inspected
2,979
1,614
905
10,377
5,889
1,153
3,361
77
3,706
3,058
311
15,752
9,951
PassenCrew in- gers
vacspected clnated
Crew
vacclnated
Crew deloused
19
74
0
679
584
0
1,547
0
0
11
0
0
0
0
34
0
0
21
0
0
0
0
0
0
306
0
9
0
0
82
0
0
0
0
473
34
116
23,019
0
373
1,826
2,570
19,946
230
0
0
0
0
0
0
0
2,339
0
0
0
0
18
0
0
0
11,984
0
0
1,494
0
0
0
0
0
0
0
0
0
0
0
0
1,519
0
0
26
31
0
0
23,019
0
293
1,676
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
610
0
0
0
0
18
0
0
181
60
0
11
5,310
0
107
1,393
196
9
0
0
0
0
0
0
0
0
244
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
107,693
15,835
26,564
610
10,190
244
480
Discontinued July 31, 193L
Passengers detalned
Passonirors deoused
2
P111188D•
~ir
0
1
0
0
0
0
0
0
0
0
0
92
-0
0
0
0
0
0
l
• Began reporting April, 1932.
8.-Treatment of passengers coming from other points for embarkation
(transmigrants), fiscal year 1992
Copenhagen
Treatment
Passengers Inspected _____________________ . ______________ • _____ _
Passengers vaccinated _________________________________________ _
Passengers deloused ___________________________________________ _
Passengers detained __ ---~ _____________________________________ _
Passengers rejected _______ . ____________________________________ _
Baggage disinfected and passed .. ________ .. _. _______ . ______ • ___ _
Baggage inspected and passed _________________________________ _
810
0
0
0
0
0
0
Digitized by
Liverpool
South•
ampton
61
0
0
0
0
0
0
Google
97
0
g
0
0
0
li6
Total
963
0
g
0
0
0
56
106
TABLE
PUBLIC HEALTH SERVICE
9.-Primary treatment of pa,aengera proceeding to another port/or embarkation, jiacal year 1932
Treatment
Antwerp
Class
· {Second ___ _
T ota1 t rans mlgrant 8--------------------------------------- Third ____ _
· ted
___ _
P assengers vaccma - ------------ ------- --- -------------- {Second
Third ____ _
Passengers deloused and passed ____ ___ _____ ____ ________ ____
{=d~::::
Passengers Inspected and J)881!ed without delousing __ ______
{~w~::::
dg
__ ...,.
{Second ___ _
Baggage Inspected and ......,.,.,.. ______ ___ ____ __ __ __ _____ ____ _ Third ____ _
0
3
burg
1
427
39
0
4
0
13
1
0
0
6
243
111
0
0
0
Ham-
30
0
19
0
0
0
{~d~::::
Baga:age d181nfected and passed ___ ___ ___ ___ _____ ____ __ _____
Dan-
24
184
199
0
26
0
26
0
0
34
6
g
Total
31
485
0
•
6
275
25
210
6
234
0
37
CO UNTRIES OF DEPARTURE
~:t':i'~t~:::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::: :::::::: __ ____5_ ------1-
Latv1a ____ _____ ________________ ---------- ----- --- ----- ----- ----------- - ------- 10
Lithuania __-- --- -------------- ---------- -------- ---------- ------------ -- -----185
Poland
_------- -------------------------------- ------- --_ ----------19
2561
Rumanla
___________________________
______ __ ______
________
------------- ---- ---Russia----------------------------------------------- -- --- - ------------ ______ __ --- -- · ··
TABLE
5
1
10
17
13
9
202
275
14
9
10.-Treatment of baggage, vessels and service beneficiaries, fiscal year 1932
Name of
port
Baggage Baggage
disln·
Vessels Vessels
fected inspected
fumiand
Inspected gated
and
passed
passed
Medical
Bllls of eumlnahealth
tion of
counter- service ·
signed beneftci•
arles
- - - - - - - - - - - - - - - - - - - - - 1 1 - - - - t ·- - - - - - - - - - - -
Antwerp_____ __ ______________ ___ ______ ____
Belfast------- --- ---·-------·--Bergen___ ___ ____ ______________ -------·-_________ ___
Bremen________________________ _________ __
Cobb .__ ______ ________________ ____ __ _____ _
Copenhagen ________________________ ______ _
Danzig_____ _____________________ ________ __
Dublin______ __ __________________ _________ _
Genoa__ ____ ___ ___ _____________ ___ ___ _____ _
8~to~-~::::::::::::::::::::::::::::::::
Hamburg__ ______ _____________ _________ ___
0
Liverpool.____ ___ __________ _______ ___ ___ __
London ___ ______ ______ ________ ___ _______ __
Londonderry!_____ __________ _______ ____ ___
Marseilles' ----- --- -- - ------ --- - -------- - Naples__ ____ _________ _____ __ _____ _________
39
12
O
115
170
O
I, 556
0
5
g
322
O
0
0
o
20,808
36
136
0
927
2,312
0
0
0
47
0
0
17,276
0
0
57
0
18, 728
0
339
.'i09
1, 103
0
0
18
0
0
0
0
0
63
0
41
0
0
0
0
3
0
0
126
0
0
18
0
3
0
0
0
0
111
0
0
0
0
35
0
0
150
0
0
0
l
0
0
0
0
0
0
0
767
87
7
539
107
172
10
56
315
267
0
834
387
454
4
46
257
3
3
3
O
4
9
1
27
3
;3
3
27
0
1
124
Oslo_________ ____ ___ _________ _____ ___ _____ _
O
7
85
Palermo________ _______ _______ ________ ____ _
159
0
M
Piraeus ______ ________ ________ __ ---- ---- --I, 203
5
22
Rotterdam__ ___ ____ __ _____ _____ ___ __ __ ____
100
503
Southampton__ ____ ___________ _______ ____ _
O
I
404
Stockholm_- ----- ------------- ---- - __ _____
0
0
- - -->----+----+----1-----1---TotaL_________________________ _____
24,489
24
41,470
5,392
297
2721
'Discontinued July 31, 1931.
2
Started reporting Apr. 1, 1932.
Digitized by
Google
107
PUBLIC HEALTH SERVICE
SUMMARY OF QUARANTINE TRANSACTIONS AT CONTINENTAL, INSULAR,
AND FOREIGN STATIONS
TABLE
11.-Summary of quarantine transactiona at continental, insular, and f oreig~
stations for the jiscal year 1932
Station
Vessels Vessels
inspected fumigated
Continental .• ____ •.•.... ___ •.•. ______ •. __ . ___ ••.
Insular
__ .••• _.•...••.................. -- •.
Foreign••.•••
__________________________________________
13,256
2,619
2,173
1,414
626
415
Total .. ----- - - . -- -- -- -- -- -- -- -- -- -- -- ---- --
18,048
2,455
Bills or
health
and port
sanitary
statements
Issued
Passengers
inspected
Crew inspected
718,596
998,471
20fi, 146
HIO, 761
39,707
12,254
9,650
1,364,378
61,611
I
122,617
201,563
1,042,776
1 Maritime stations 630,444; border stations, 88,152; statistics do not Include "local" travelers at border
stations, numbering 8,798,598 who, however, were under surveillance.
MEDICAL INSPECTION OF ALIENS
During the fiscal year there were examined by medical officers of
the United States Public Health Service 373,034 alien passengers for
the purpose of detecting physical or mental defects or diseases, as
provided by the United States immigration laws. In addition,
897,788 alien seamen were inspected during the fiscal year ended June
30, 1932, as provided for in the act of February 5, 1917.
During the year Public Health Service procedure at United States
ports was modified with respect to the certification by medical officers
of the detectability of conditions making aliens inadmissible into the
United States by competent medical examination performed at time
of embarkation or employment on board. This modification was
the result of a joint conference between representatives of the Bureau
of Immigration and the Public Health Service to bring the practice
into accord with recent court decisions interpreting the immigration
laws, and it is anticipated that the new procedure will serve greatly to
reduce potential litigation based upon such cases.
As a result of an amendment to the immigration rules and regulations of the Department of Labor, following a conference between
that department and the Public Health Service, paragraphs 2 and 3
of the Regulations Governing the Medical Examination of Aliens,
revised August, 1930, were amended. The amendment of these
paragraphs represents no change in policy, but merely a technical
change in phraseology regarded to be necessary in order to be correlated properly with the new language resulting from the amendment
to the immigration rules and regulations of the Depa.rtment of Labor.
Similarly, in response to a request made by the Secretary of State,
paragraphs 97 and 98 of these regulations were also amended. This
also represents no change in policy, but only a change in technical
phraseology in order that these regulations may conform to the consular regulations relating to the same subject, and to certain provisions of an interdepartmental agreement between the State, Labor,
and Treasury Departments.
144391-32--8
Digitized by
Google
1--
MEDICAL INSPECTION OF ALIENS
TABLE
12.-Alien passengers and seamen inspected and certified at maritime ports in the United States and possessions during the fiscal year
0
00
19SB
Alien passengers certi/led
Plare
Alien seamen certified
t
Number
Class A
cl~------~
passen•
Class B Class C Total
IT
gersexam•
I
I
- - - - - - - - - - - - - -- - - -- - - --------I~____________
Nuruber
cl~
seamen
exam•
Class A
I
I
ined
1
IClass .BIClass Cl
II
Total
_ _ _ ,_ _ _ ,_ _ _ ,_ __
ATLANTIC COAST
Baltimore, Md...........................................................
Beaufort, S. C. .................................... ......................
Boston, Mass............................................................
Brusnwick, Ga...................................... .....................
Charleston, S. C.........................................................
Fall River, Mass................................. ..... ...................
Fernandina, Fla.........................................................
Fort Monroe, Va.•............................. ....... ...................
Fort Pierce, Fla.................................. . ............. . .........
8ri~~:!r:t~~.::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Jacksonville, Fla................................................. ..... ...
Key West, Fla................................... .. ......................
0
co·
N.
"'
~
-'l
CJ
~
.•.•.• ..
••.•.••.
1
.•.•.•.•
. ..•.•..
........
. .... . ..
........
........
...•...•
...•....
2
...•.•••
••••.••.
.....•••
........
...... ..
........
1
........
125
........
........
........
........
........
........
........
........
5
........
........
..•..•..
........
.•......
...•..•.
g :::::::: :::::::: :::::::: ::::::::
40 ...••.•.
4, 527 .•.•..•.
1 ........ ........
I
17 ........
iEl~J.~i;~ifIImmimmmimmII/ii \t/II ~i ;;;;;}((;;;;;I;;;;;r
29
·
New York, N. Y. (Ellis Island)................ ... . ......................
~~lf~d~l~~;~;•p~'..~::::::::::::::::::::::::::::::::::::::::::::::::::::::
0
a
122
0
3,957
0
46
0
0
195
O
131,165
22
31
4,683
67
23i :::::::: :::::::: :::::: :: ::::::::
J ======== ======== ======== ========
i~rt:1~~;:!~===================================================
==
Providence, R. I.........................................................
762
Savannah, Ga.................................... .. ......................
68
Searsport, Me..................................... .. .....................
0
Vineyard Haven, Mass........................................ .... ......
0
Washington, N. C......................... ...... ........................
0
West Palm Beach, Fla............................ .......................
37
Wilmington, N. C.......................................................
71
Total ........................................... . .................. •144,285
~~b~J:~i!a~~~:::::::::::::;::;:~~;:~~:::::::::::::::::::::::::::::::
1
0
133
0
0
0
0
0
O
g
1
18
.•......
........
...•....
...•....
.•...••.
.•.•....
.•......
••......
. .......
37
21
••.•.••• ...... ..
26
221
•••...•. •.. ... ..
.•......
.... ....
...... ..
........
4 ........ .....•..
1 ........ ...•..•.
........ ........ ..••....
36
2 ..••....
...•.... ........ ........
118 :::::::: :::::::: ····--i· ······i·
I, 977 ........
4 .....•.. ••...•..
2, 122 ...•.... ........ .•.•.... ........
58
0
247
O
4
1
~
38
l.zJ
o
o
Ii
4,803
g
g
41
0
0
••• ••••• •••••••• •••••••• ••••••••
0
........ ........ ...... .. .•......
••...... ........ ...... .. ........
•••• •••• •••••••. ••.••••• •••.••••
24
36
4,870
80
0
0
0
5,010
g
~
=
>
g ~
4
0
7
...•....
I
38
2
. ..•.... .••••.•• .•...... .....•..
........ .•.•..•. ...... . . .......•
g :::::::: :::::::: :::::::: ::::::::
15,134
0
56,950
0
2,805
1,620
92
8,868
O
=
·~1 /t;;;;;;I/;rn;;;;;;~; 1-;Q
496,113
9
1~:m ...... '..
248
11
3
2i ······~· ::::::::
J ======== ==:=:=;= ::::::i= ========'
3.2,80
2,210
0
16
0
171
932
625,592
39
• .......
.... ....
..•.••••
.....•..
••......
••••••• •
........
10
1
IO
0
.....•..
.......•
••......
1
.•......
..•.....
........
•••••••• ••••••••
•.......
1
402
261
...•.. •.
1
.....•..
........
...•....
•••• ••••
........
7
6 ::::::::1:::::::: :::::::: ::::::::
271
:ij
g
I
12
O
O
O
0
l
680
g
-rex:::::::::::::::::::::::: _:: _:::::: :_:_. -..---.. -··--
8
g~~;[isKJh:lsil'.
Freeport, Tex_··············· ·····-····- ·-_ -·- -- -· - ---- -- ·---· --· -··· ·Galveston, T ex ••••••.•..•••• ·-············ - ____________ __ --··--- · · · ·- ___ _
Gulfport, Miss . . ......................... •· ·····----·······--····· ·······
Mobile, Ala ..... ·-·····-··················· -_-··-·-- _____ -··- .
Morgan City, La. (Atcbafalaya) .••.....•.. . . -------------------·----·-· New Orleans, La .••...•..•••.• ·-··········· _______ -· _______ ---·--·--··- · Panama City, Fla..•.•.•...•....•......•.•. ·--•
Pascagoula, Miss ..•.....••.•.........•..••• .... _--·-· -- ____ -·-_-·----·-··
Pensacola, Fla.·····························- -·-··- __ --···--···-- __ -·····
Port Aransas, Tex ••••..••....•.•...•••••••.... _______ --·- _____ --··---·· __
Port St, Joe, Fla ........•••..••...•..•.•... ·-·· •·
Sabine, Tex ........•...•....•....•.•••...... ·-- -···--- ___ --··-·-··---·-·Tampa, Fla....... ..........•........•. •···-· ----
0
0
15
0
0
0
0
0
0
0
200
0
i8
0
2,394
33
0
0
0
8
0
0
19
I
115
1- --- ----
____ ,___,___ ,___ ,___,
Total. .......... ·-·····················-- · -·- ··
2. 829
34
0
0
40
0
0
872
0
16,030
0
0
40 1------- -•--------
0
4,250
5
0
28,365
1----- --- 1- ------ -
llO
76
108
40
0
6
0
310
0
0
47
0
0
0
5
0
885
4 1-- ------1----- --0
0
0
0
0
0
ll
1
4,234
s4 ........
a
6
1
0
2,683
0 1----------1--------1---- --- -1-------•l -- -- - ---1•----- - 0
I
50
57, 772
10
180
1··-·····
79
100
378
PACIFIC COAST
Aberdeen, Wash .•... .. .. ........... ... .... .. ... ·-···-- ·-·-····-··-·-···Angel Island, Calif. (San Franclsco) ............ -·- -- ·- ---··- ·- ·- ·----·· · -
g~fc:::::::::::::::::::::::::::::::: :: :: ::: :::::: ::: ::::: :::: ::
0
co·
"'
N.
~
c;?"
CJ
0
a
~
*~tr~r~::
Fort Bragg, CaliL.-··· ················· ······· ······ · --··· · ···-······•·Marsbfield, Oreg. (Coos llay) ...•.••.......•. ·- ··-- __ _---· _____ --·- -- --··
Monterey, Calif.. •.•............•.........• -··· ----·----------·-----··--Newport, Oreg········ ··· ···············-····-- ----·---·-----···---·-··-Portland, Oreg···················· ············· -·····-----· · ·- · -· ·· ··· · ·-
~:~ P~1f 6i1d~~caiii:::::::::::::::::::::::::::::::::::::::::::::::::::
0
San Pedro, Cali! .•..•.......... .. ............... .. --·-·-·-_--·-·-··-_-···
Santa Barbara, Callf ............•... ............ ... -... _______ -·-·· __ -··Seattle, Wash.•-······ •·· ····· ···• ··•·······•····· ····
South Bend, Wash ...•....•.•••.............•... . · ----- ____ _
··· -1
Total. ..................................... . . ________ _
0
4,096
0
0
0
0
0
0
4
530
0
6, 185
0
2, 186
0
13,001
----· · ·--·-··········-·· · - -··
··-····- · ··· ···
-·· ····-· -····- -······
1
-- ·-·-··
- --·--··
-··--·-11
-···· ·· ·
12
·--·····
26
-·······
···· · ···
--· ·· ···
···· ····
. .......
-···-···
··-·····
6
· · ·--···
4
-· ·· ··· 14
--·- ··-·
I\O
··-· · -· - ·· ·· ·--156
107
--···--· ... .....
-·· ·-··- ·· ·-····
...... .. -··- · · ··
-··-- · ·· ·· ··· · ··
-··-·- ·- ··· ·-···
··-··-·· -···-···
2 ... ••...
1 .. •••.•.
· ···--·· ........
44
15
-·--· -· · ······-·
45
138
· · ·····- ........
218
260
0
280
0
0
0
0
0
294 ........ ··· ·-··· ........ · ·······
642 ······-·
16 ...•...•
3
1,752 ........
2
1 . ..... ..
0 ........ -··· ···· · ··- ···· ........
0 --······ -······- ····-··· ••••·•··
2
8
0
63
0
208
0
246
0
0
571
5,285
860
45,351
0
6, 772
0
570
61, 77?
0
..... . .•
........
........
····-···
..•.... .
·····•··
·····•··
........
........
-·--••··
0
········
········
·· ······
1
··········· ··-·
64
-··· ··· ·
1
····-···
84
··· ·· •··
··· ·· ··........
1
1
... .. ...
11
-·······
2
···•····
16
.. .... ..
........
........
••••.. . •
.... .. ..
······ · ·
·
10
·····-··
6
······ ··
19
INSULAR
Alaska: Ketchikan ...................... .... ...... __ -· ·- ···-·-·--·······Hawaii: Honolulu .................. -··············- ·--·--·•-•-·-· ... -··-
3, 42?
1···-··1·1·····10r··-ixl-··· ·14-
0
0
70
24,400
0
IO
~
CD
£:
C
=
~
~
=
3
0
0
0
0
0
2
1
i7J
0 ., il'!J
85
~
0
O
C
0
il'!J
;5
llO
0
20
2 •--------
22
Phi12'£~~~:· · ·········· ···························- ·-·- ·-··· · ·---······ ··1
4201 -· ·· -· ·· ········1-·-·····1···••··· 1
0
4, 0541········1 -·· ··· ··1········ ·· ······1
0
Davao ................................ ... ...... ·---·--·· ·--·· ··-· · ··JI --··· · ·· ...•.... -···•··· •. •.•...
0
2,783 ........ ····· ·-· ........ .......•
O
Iloilo . ... ............... ... . .......................... -·-·- -· -·-······
104 ·-···-·· •••••••• ••.••..• ••••••••
O
3,482 ..... ... . .. ............. ··-···· ·
o
Jolo ... , .. ·· · ·································-··-·· · ·- ·····-· ··-··· ·259 --······ ·······- .•.•.... -····· · ·
O
775 •••••••• -·· · ···· - ······• ••••••••
0
Legasp1. . ..... .. ...... ............................ ·- -·· ···· ··· ·· · -···
1 -···· ··· ........ ··-····- ........
0
433 .. .. ............ ·-•····· ........
0
1 Class A-I: Aliens certified for idiocy, imbecility, feeble-mindedness, insanity, e,iilepsy, chronic alcoholism. Class A-II: Aliens certified for tuberculosis or other loathsome or
dangerous contagious diseases. Class B: Aliens certified for diseases or defects which affect ability to earn a living. Class C: Aliens certified for diseases or defects of less degree.
• Embraces Norfolk, Va., and Newport News, Va.
a Embraces all ports on Pu11:et Sound.
-
0
~
TABLE
12.-Alien passenger, and seamen inspected and certified at maritime ports in the United States and possessions during the fiscal year
1932-Continued
Alien passengers certified
Pl•tC
Alien seamen certified
1
~
~
0
1
Number
Number
Class A
Class A
of alien
of alien
passen- t------'----IClass B IClass Cl Total j seamen 1- - - - - - , Class BIClass Cl Total
gers examexamI
I U
I
I II
ined
ined
------------------ ---- --------1- ---,--INSULAR- continued
Philippines- Continued.
Manila ____________ _
Zamboanga __________ _
22
'
TotaL
Puerto
Rico : ________ _____________________ __________ _______________
Aguadalln
_____ _
Areci bo __ ___ ___ ___________________________ _____ _______ · ·-- _________ . _
24,060
Central Aguirre (Jo hos) ______________ . ______ . __ .. ____ ____ __ ___ ______ _
I
0
56
15
0
22
Arroyo ________ __________________ __ __ _____ _______ ________________ - _- _-
[:ii~?~-_-_::::::---------------·-· ·--.---------.---·------·-··-----···
0
co·
N.
"'
~
.!;?"
0
0
a
~
~18 I:::: :::J.... ~~-'---·-~~1---=~0
30
80
24
76, 153
0
1,002
134
88,682
0
0
0
0
0
-
0
0
=
0 ---·---- ···- ·-·- --- · - · -- ----··-0 ··- ··- -- -·--·-·- -------- ·-- -· - ·-
·--·-·--··---·----- -- ------- -····-·--······
-- --·--·
- ----- -----------·-···----- -· - ·-· · --
----··--- -------------- --------------- --- --- ---- ----- ·----·---······ ··-····........ ····--- -
Humacao_ . -· ___ .. _.. _.. ____________________________________________ _
Mnyaguez.. __ . _. _... __ ... -· __________ -· ______ . _. _________ .. -·. _. ____ _
Ponce _________ ··· ········-·--···-·---······---··· ··-····· ·· ···-· · ····
6 ····-··· ·····--· -··-·-·· ··---··San Juan .. · -···········-·· · ··---······--··7, 142 ·---·-·· ···· ·--3 ··----- ·
~ - - 0 - - --0- ---3- ---0TotaL
CANAD IAN IlORD~R
Blaine, Wash .. __ __ . ____ ... ___ ... ___ ---·_.- -· ._.-· __ .-·----···-·.-·--·- __
Bellingham, Wash ___ . _____ ._-·._.-·-- __.-· __ ._. __ __ . __ .. __ . ____________ _
Buffalo, N. Y ---- ·- -------·-------·--· · -·---·----···-- ··-------·-·-··---Calais, Me ___________ .-·--. __ . __ --··_ .. _.··-- __ . ___ ·-· ._. --·· ·-·-·----. __
D etroit, Mich _·-------· · ·-·----··-··-·····-···-·---··-·- - --·····-·-·-·--Duluth, Minn_
Eastport, Me. ___ __ . ___ _________ __________ . ____ ______________ .. ___ . __ _. __
E rie, Pa ______________ _. ____ . _______________ .. _________________ _. ________ _
Lewiston , N . Y--·--- ---·-- --·····-·---····--·-----···----····---- - ·----Ogdensburg, N. Y .. ·---------·----····-·----·-·--·--Port Huron, Mich .··-····· -· · --··---··· ·- -------··-·-·----·----··-- · ___ _
Sault Ste. Marie, Mich ...
134
0 1-- -- ---- 1--------1------ -- r-- -----O
0
0
0
0
0
0
0
0
0
0
195, 738
37
133 I 5,289
387
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
4 · ·· · ··-· ·····-·· ··-·--· · ••• •••• •
28 ........ ···-· ·-· · ··-·· -- .•. ... . .
106
0
153
6,650
· -······ · ··-·-·- ··· ···-·
- -··-··· · · ··-·-· ---·-·-·
······ -- · ·---- ·- ·------·-·-·--·
2
1
······-······-·
·-···--·
··-- ·-· -
3
0
0
57 -------- ---· - --- -·----·-- ···--·--
225 ·------- -------- --- --· ·· ··-----4
849 ---·---4 ·---··-- ··-·---0
17, 007
25, 079
0
6
1
l===l===I===
0
0
0
0
330
0
0
12,036
156
151 ,·-···· · ·
0
0
0
0
0
0
0
14
0
712
0
0
160
0
0
131
0
4
0
207
1
0
0
0
0
0 -- ------1--------1-- -------r------- 0
-14,490
-0
161
152
= = =···---·-
::::::::1::::::::1·--··-n_. ____ ~_
5,846
897, 188
I
24
693
511
139
-
I, 367
1 Class A-1: Allens certified for idiocy, imbecility, feeble-mindedness, insanity, epilepsy, chronic alcoholism.
Class A-II: Allens certified ror tuberculosis or other loathsome
or dangerous contagious diseases. Class B: Allens certified ror diseases or defeets which affect ability to earn a living. Class C : Aliens certified for di~88eS or defects of less de~,
"d
~t<
....
C
=
>
t-.1
~
~
t::o
~
C
l"!l
111
PUBLIC HEALTH SERVICE
'T.ABLE 13.-Aiien pas,engers inspected and certified at international border stations,
fiscal year, 1932
NumAlien passengers certified 1
be:O:;:r• Number 1------~------1
making persons
Class A
perms- making
Total
nent
tempo- 1 - - - - - - - - 1
entry rary e)ltry
Class B Class C
exam- exammed
II
lned
Place
-----------------1----1---- - - - - - - - - - - - - - MEXICAN BOBDEB
Ajo, .APit __.-..••.•...........................
0
Brownsville, Tex .............•...••........ 2,421
Calexico, CaliL .....................•..•...
152
Columbus, N. Mex ........................ .
0
25
Del Rio, Tex. •..•..........................
Douglas, .Ariz ............................. . 1,908
Eagle Pass, Tex ..................•.......••
236
El Paso, Tex. ....•...............•......•.. 1,321
·Guadaloupe Gate, Tex. ...•.•....•.•.......
0
462
Hidalgo, Tex .......•.......................
Laredo, Tex .........•...............•..•... 20,565
:~:1e!,r~r1z:::::::::::::::::::::::::::::::
Presidio, Tex ...............•.............•.
Rio Grande, Tex ...•....•..................
Roma, Tex •..•.............................
.San Ysidro, Calif.. ........................ .
Sasaba, Ariz •.•............•........•...•...
Thayer, Tex .•..................••••.......•
Tucson, Ariz ....•...............•.....•..•.
Ysleta, Tex ................................ .
.Zapata, Tex .............••.•...............
10
3,647
2
1
5
608
2
9
142
10,545
9,734
865
4,461
3,206
2,854
12,066
161
1,846
12,384
3,469
13,577
999
832
453
15,427
490
510
----------------------------22
262
94
7
1
143
3
197
5
20
4
2
1
1
7
90
95
47
8
15
3
124
28
97
795
1
8
40
37
--------------45
3
197
Total................................. 31, 571
94,963
138
950
502
10
3
41
8
3
36
CANADIAN BOBDEB
i=~~~:
~~.~=:::::::::::::::::::::::::::
Erle, Pa..•........••......•......••......•.
~~~=•p~f:tdN~·y~:::::::::::::::::::::::
1
Scobey, Mont ...................•.•.....•..
Sumas, Wash .•...................•.•.•....
Sweetgrass, Mont. ....•...........•••......
Van Buren, Me ....•••............•••......
Vanceboro, Me .....................••......
Vancouver, Canada ..............••••......
Victoria, Canada .........•......•...•......
Winnipeg, Manitoba, Canada ...•..........
Yarmouth, Nova Scotia, Canada .......... .
106
145
1,591
303
14
61
99
119
4
52
34
3
11
187
11
3
108
33
2,029
3
497
365
2o8
508
149
21
70
960
4
43
6
1
1
171
1
3,560
1,165
6,813
75
12
570
1
24
1
1
5
73
2
14
720
3
-------- -------- --------6
-------- --------
0
111
0
0
489
0
279
240
76
221
11
1,012
456
211
0
22
11
4
3
161
698
724
18
225
25
0
2,689
4,094
180
5,495
0
498
0
2
175
106
19, 149
37
213
508
3
3
6
4
17
7
8
1
56
44
5
16
34
612
1,312
6
12
4
8
0
1
2
3
366
0
0
42, 172
Total all stations. . . . . . . • . • . . .... .• .• 40, 161
137, 135
21
22
20
6
29
4
3
1
2
158
57
69
2
17
2
64
14
7
51
21
10
0
3
1
111
134
41
10
39
2
9
10
2
2
2
35
36
3
3
21
-------13
1 ---------------- -------1
--------------1
8
2
+
------
0
8,590
2
-------- -----------------------------------2
1
9
67
0
9
367
--------------- --------------3
1
687
1,361
4
328
652
3
490
393
0
92
109
-------- --------4
-------- ----------------------6 --------5 -------117
183
0
2,162
139
Total. .....•....•.•..•................
14
54
17
260
0
385
7
1===,!====1===4===~=== - - - - - 0
0
0 ---------------- -------- -------454
514
10
86
4
33
39
Halifax, Nova Scotia, C8118da .....•....•.•.
Havre, Mont .....•.........•...•...•.......
Houlton, Me .•....................•...•....
International Falls, Minn •.....•.•.•.....•.
Jackman, Me .•........••..................
Lewiston, N. Y ••••..•...•.•...•...........
Malone, N. Y ••..•.............•.........•.
Montreal, Canada..............••........• _
Newport, Vt •..............•.•.......•.....
N lagara Fa!}~, N. Y •.. _......•••....•....•.
Northport, wash...•.•...•.................
Noyes, Minn .....•.........•.............••
Ogdensburg, N. Y ..........•.•••.........•.
-Oroville, Wash ••..............••••.•••..••.
Portal, N. Dak .............•.•....•..•...•.
Port Huron, Mich ..•••.•.•............•....
~t
t1~tk~~·iir"iinsw1cic;caiiacta::::::::
Saulte Ste. Marie, Mich ..........•..•......
2
10
12
1,525
3
146
256
82
358
20
1
-------- -------24
515
71
356
32
8
1
7
4
47
0
0
Bellingham, Wash ...•••.........•.•••.•.•.
Blaine, Wash ••...........•.........•.......
Buffalo, N. Y •••....••••...•...............
Calais, Me ...........•..•..........•.......
Detroit, Mich .................••..•••.....•
Duluth, Minn ......•.•...........•.........
11
5
10
5
--------
4
--------
7
5
16
139
7
94
23
43
1
0
310
0
6
24
90
40
2i89
90
4
27
3
0
14
167
174
62
16
64
5
0
29
1
1
11
116
40
780
51
6
4
7
3
95
15
626
33
197
164
2,327
768
3,456
335
1,114
5,887
1,933
ll,269
8
8
Class A-I: Aliens certified for idiocy, Imbecility, feeble-mindedness, insanity, epilepsy, chronic alcohol·
ism. Class A-II: Allens certified for tuberculosis or other loathsome or dangerous contagious diseases•
Class B: Aliens certified for diseases or defects which affect ability to earn a living. Class C: .Aliens cer!
titled for diseases or defects of less degree.
1
Digitized by
Google
112
PUBLIC. HEALTH SERVICE
TABLE
14.-Number and character of the more serious mandatorily e:r:cludable conditions certified at United States ports, fiscal year, 1932
~
~
.E
i~
:at-
i~
~.$
I1
I>,
g..c
....;al!
Alien passengers___
Alien seamen ______
Total.. ______
TABLE
rial
!j
o'"
,Cl
.·a" 1 .
1
~=,
e8
ill>"
e
I ~-:rn .
"1il
"
~
~ -Es- r.. -"'~- 'a"'
-8
0
.,
~
~
0
ll,,
::;:l
I'g
~
.
1il ~;a
,Cl
"'"o
g ,S.S"&
'5
Es
0
C,
96
7
40
2
85
7
118
1
Z1
119
7
346
48
6
4
Z13
146
31
162
394
39
332
42
4
1,619
717
103
42
92
119
33
126
385
52
419
193
726
46
2,336
15.-Summary of medical inspection of aliens, fiscal year 19~2
MARITIME STATIONS
OBOUP !.-ALIEN PABSENGEIIS NOT EXAMINED ABIIOAD EXAMINED UPON AlllllVAL
Class
Certified on arrival
IntenTotal ex- sivelyexamined amined
Passed
A-I
A-II
C
B
Total
certified
______
--------------- --First .•. __
Second.
• _____________________
Third_________ • _______ • ________
Stowaways._------------------
54,861
29,656
96,414
597
910
1,372
7,591
267
54,587
29,281
94,796
573
7
12
16
0
19
15
87
12
1,292
7
32
115
223
5
274
375
1,618
Total .• __ -- ____ -- -- -- -- --
181,528
10,140
179,237
35
133
1,748
375
2,291
216
233
24
OBOUP IL-ALIEN PABSENGEIIS EXAMINED ABIIOAD REEXAMINED ON AlllllVAL
Class
.
First. _____________
Second ____________
Third _____________
Total Intenslvely Passed Passed
exam- examarabroad on
rival
lned
lned
Certified on arrival Certified on arrival (con(condition noted ditlon not noted abroad)
abroad)
B
Number A-I A-II B
C cert!fled
---- - 1,874
3,591
8,745
160
27
110
1,697
2,569
6,392
1,695
2,569
6,391
171
1,022
2,347
6
0
6
177
1,022
2,353
Total.. ______ 14,210
297
10,658
10,655
3,540
12
3,552
Total
cert!Num- fled
ber
C certifled
- - - -179
1 ---2
-----1,022
---------- ---- ---- ----i- 2,354
1 ------ ---- ---1
2
0
1
0
3
3,555
OBOUP Ill.-ALIEN SEAMEN EXAKINED ON AllllIVAL
IntenTotal ex- sivelyexamlned amined
Certified
Passed
A-I
A-II
B
C
Total
certified
--Alien crew _____________________
Workaways ____________________
TotaJ ____________________
883,229
Z11, 863
69
31
66
883,298
Z17,894
882,092
882,026
20
692
358
1
133
2
1,203
3
20
692
359
135
1,206
-------- --------
Digitized by
Google
113
PUBLIC HEALTH SERVICE
TABLE
16.-Summary of medical inspection of aliens, fiscal year 19SB
CANADIAN AND MEXICAN BORDER STATIONS
GROUP 1.-ALIEN PASSENGERS NOT ELUIINED ABROAD EXAMINED UPON ARRIVAL
IntenTotal ex- slvelyexamined amlned
Class
Statistical, making permanent
entry (bona fide lmmlgrants) _
Statistical,
making temporary
entry ________________________
Certified on arrival
Passed
A-I
A-II
B
Total
certified
C
39,579
33,235
37,455
126
223
1,287
(88
6,293
21,981
61
140
1,362
278
l,!Kl
Nonstatistlcal, making entry
(local crossers, etc.) __________
23,822
2,124
112,073
54,016
106,846
1(6
747
3,171
1,163
5,227
Total. _________________ --
175,474
93,544
166,282
1,333
1,110
5,820
1,929
9,192
GROUP ll.-ALIEN PASSENGERS EXAMINED ABROAD REEXAKINED ON ARRIVAL
Class
Certified on arrival
Certified on arrival
(condition noted
(condition not noted
abroad)
abroad)
Total
Passed
Total IntenPassed
exam.. sively
ar•
NumNum- cert!abroad on
ined examri
val
ber A-I A-II B C ber fled
ined
A-I A-II B C certicertifled
ed
Statistical, making
permanent entry
(bona fide immi•
grants). ___________
582
Statistical, making
temporary entry___ 1,232
Nonstatistical, making entry (local
crossers, etc.) ____ __
8
Total.. ________ 1,822
------581
539
1,232
1,219
- -
-
531 ---1,212
8
6
2
1,821
1, 764
1, 745
-------- -- ---
42
1
43
13
---
13
1
1
55
2
58
- - --
1
---- -----
1
1
2
----- - - ----- - - - -
·-·-
-
---
1
2
--
5
1
8
51
7
---
7
20
1
4
- 3 -12--- -2 · - 19- - 77
2
6
GROUP III.-ALIEN SEAIIEN EXAIIINED ON ARRIVAL
IntenTotal ex- slvelyexamined amined
Alien crew _____________________
Workaways ________ c___________
Total.._-----------------
Passed
14,490
0
14,000
0
14,329
0
14,490
14,000
14,329
Certified
A-I
A-II
B
Total
certlfted
C
- -4 - 161
0
----·--- ---·---- ··-·---- ··-----4
1
152
4
1
152
4
161
EXAMINATION OF PROSPECTIVE IMMIGRANTS ABROAD
Owing to the economic conditions prevailing in the United States,
the number of immigration visas granted during the year to prospective immigrants abroad was greatly reduced. It has been reported
that the number of immigrants granted visas averaged about 10 per
cent of the quota for each country, thus representing a very material
reduction in the amount of work required. Because of this fact it
was possible to curtail the number of personnel ens-aged in the performance of the medical examination of aliens m foreign ports.
This was possible in some instances through the expedient of having
one medical officer take care of the medical examinations at two or
more near-by ports, the medical officer having his headquarters at
the most important of the ports under his jurisdiction and having
travel status from consulate to consulate, notification being issued
to intending immigrants to appear for definite periods in each month
at each respective consulate for medical examination.
There were 42,831 applicants for immigration visas examined by
medical officers in foreign countries. Of this number 26,560 were
Digitized by
Google
114
PUBLIC HEALTH SERVICE
examined by medical officers of the Public Health Service attached to
American consulates in Europe; the remainder, 16,271 were examined
by medical officers of the service attached to American consulates in
the Western Hemisphere. Of the number examined in Europe, 851
were reported by these officers to the American consuls as afflicted
with one or more of the diseases listed in class A as mandatorily excludable, while 6,278 were reported as afflicted with a disease or
condition listed in class B as liable to affect their ability to earn a
living. Of the number examined by medical officers of the Public
Health Service in their countries of origin in the Western Hemisphere,
162 were reported to consular officers as afflicted with one or more of
the diseases listed under-class-A as mandatorily excludable, and 1,788
were reported as afflicted with a disease or condition listed in class B
as liable to affect their ability to earn a living,.
Of 38,375 aliens who had been given a preliminary medical examination in foreign countries and to whom visas had been issued, only 7
were certified upon arrival at a United States port as being afflicted
with class A disease, resulting in mandatory deportation.
TABLE
11.-Distribution, according to class, of applicants for immigration visas
who were medically e:eamined during the fiscal year 1932
N~~~~ha~~oants
=~,--~----~-----~-Total
Country and consular office
exam-
lned
Quota
Nonquota
Nonlmmigrants
Per %n!a~a~~cants
Quota
NonNon quota· !Jmnigrants
-------------1---1---+---- - - - - - WEITEBN HEMISPHERE
462
39.1
58.8
695
25
1, 182
===1===1°=='j===t===1==
679
167
512
24. 6
75.4
0
l===l===l===I
Canada:
Hamilton ________________________________ _
785
158
31. 8
48. 0
250
377
MontreaJ _____________________ • _________ .• 4,269
51.4
1,139
21.9
935
2,195
Ottawa__________________________________ _
0
28.3
460
130
330
71. 7
1,774
135
573
5.5
23. 0
Quebec.---- ---- -- -· -- ------ - -- ---- --- -- -- 2,482
Toronto. ______ • _______ ----. ----- -- ----·-· 1,934
867
1,048
19
«.8
54.2
Vancouver _____ • _____________ •• -- ------ --772
235
537
0
30.5
69.5
Windsor _________ ._._. __________ • _______ . - 1,907
31.4
007
1,300
0
68.6
691
19. 7
49.4
1,397
276
430
1
15
3. 7
96.0
~
388
All Canadian .. ________________________ 14,410 3,450
7,439
3,521
23.9
51. 6
Cuba: Habana_ ------------------------------
2.1
Mexico: Mexico City_________________________
-0
;iri:ttk=::::::::::::::::::::::::::::::
20.1
26. 7
0
71.5
LO
0
0
31.5
.2
24.4
l===l===l===l===l===~===l===
All countries, Western Hemisphere_____ 16,271
4,079
25.1
53. 1
8,646
3,546
21.8
EUROPE
i===t===1'===i====!==='l===!===
Belgium: Antwerp __________________________ _
393
243
150
38. 2
61.8
0
0
England, total _______________________________ _
34. 7
2,992
1,952
1,039
65.2
.1
LlverpooL ___ • ________ . - __ • -__ - -- -- • - • - •••
1---t-----1---1----J----t---1---
London. _________________________________ _
Southampton ___________ •• _____ -•••• ------
1,087
1,548
357
776
945
231
310
003
126
1
0
0
64. 7
28.5
39.0
35. 3
.1
0
0
448
693
355
425
93
153
0
15
79.2
71. 7
20.8
25.8
0
2. 5
71.f
61.0
Irish Free State, totaL ______________________ _i===t===!===i====l===i===!===
780
246
15
76.0
23. 6
1,041
1. 4
Cobb _________________________ ._ .•. ______ _
Dublin ______________ •• - ____ .. _. -- •. -- ----
i===!====i===i====l==='I===!===
Northern Ireland: Belfast.------------------Scotland: Glasgow ___________________________ _
Germany, totaJ. _____________________________ _
380
287
88
5
75. 5
23.2
1.3
1,439
968
468
3
67.3
32. 5
.2
4,782
3,496
1,277
9
73.1
26. 7
.2
-- - -
t-----+-------l---+---+--1---f---
492
0
70.9
29.1
1,197
Berlln .•• __ ··-·-·· ••••• _______ ---·---- •• -• 1,689
0
351
154
505
0
69.5
30.5
Bremen________ ••• __ •••• -- -- -- -- -----· -· -0
Cologne _________ ••••.• ---·. - •• -- •. - -·-·· -942
200
6
78. 1
21.3
.6
736
Hamburg_____ •.•• ___ ._. __ ••• _•• ··- --- ___ _
341
569
226
2
59.9
39.8
.3
1
19.0
80.9
871
20II
.1
Stuttgart. ___________ ------- -- -- ---- -- ---- 1,077
l===l===Jc===i===t===1====i===
Digitized by
Google
115
PUBLIC HEALTH SERVICE
TABLE
17.-Distribution, according to claas, of applicants for immigration visa,
who were medically examined during the fiscal year 19.'JS-Continued
Country and consular office
Per cent or applicants
Number or applicants
In each class
In each class
cants,--------~--------exam• Q ta Non•
Non• Q
Non• Non•
lned
uo
quota imml•
uota quota Imm!•
I:t;,°i,1
grants
BUB0PJ:-continued
Holland: Rotterdam..........................
558
420
109
29
Poland: Warsaw.............................
2,458
1,458
1,000
0
grants
19. 5
75. 3
5.2
l===F==
40. 7
0
Denmark: Copenhagen.......................
539
389
150
0
72. 2
27.8
Norway, total ....•.•..••.•.•.....•........•... 1==636==i==4=18=!===21=8=l===o=l'=65.=7=i===
34. 3
Bergen ..............•.•.•....•....•...... ~ - - 7 2____
57o
55.8
44. 2
Oslo......................................
507
346
161
o 68. 2
31.8
0
Sweden, totaL...............................
0
=
=
=
=
Ml
341
200
0
Goteborg ... · -·-·························· __3_11_,__ _
179
Stockholm.•••.•••.•.•...••...•••...••.•. _
230
162
Italy, total....................................
Genoa....................................
Naples •.•..........•..••.. ····-···········
Palermo •. _...••••....••.•.•••.• _....••. _.
Czechoslovakia: Prague......................
Austria: Vienna •.•.•..•..•.......•.•....•.. _.
9,741
1,834
5,621
2, 286
132
68
3,117
660
1,663
794
6,624
I, 174
3,958
1,492
314
375
63.0
57. 5
0
---=
=
37.0
689
0
70. 4
29. 6
0
0
32.0
36.0
29. 6
34. 7
68.0
64.0
70. 4
65. 3
0
o
O
o
O
=
=
O
45.6
M.4
f:===!'===f===j===1,===1===
213
All European countries................. 26, 560
H,31l6
1581
12, 102
0
0
0
425 - - 0 -
0
0
l===l===Jc===I===
371
TABLE
59. 3
0
57. 4
42.6
62
M.2
45.6
=
O
0
.2
18.-Distribution according to sex of applicants for immigration visas who
were medically examined du:ing the fiscal year 19.'JS
Number or each sex
examined
Country and consular office
Male
Per cent or each su
examined
Female
Male
Female
WESTERN HEMISPHERE
Cuba: Habana.......••.•.......................•..........
40.8
482
59.2
700
Mexico: Mexico City..•••.••••••......••...•...............
44. 8
55.2
375
304
Canada:
l====F====!=====f====
44. 7
Hamilton .•...•......•.•.••.......•. , ..........•...•...
351
55. 3
434
45. 0
Montreal. ••••.•...•................•.••••.....•..•...•.
2,347
1,922
55.0
49.1
50.9
Ottawa.•....••................•...........•...••..•..••
226
234
39.1
60.9
972
1,510
51.2
991
48. 8
943
49.0
51.0
383
389
45.0
55.0
1,047
860
52. 4
47.6
731
666
39.3
60.6
159
245
All Canadlan..••••••••..••..•..•..•...••...•...•..•.. 1- - l
l
+
51.0
49.0
7,355
7,055
~~~~::::::::::::::::::::::::::::::::::::::::::::::::
Vancouver ....•.•.•.•.•.•......•................••.....
Windsor .•••..•...•••.•.•.•••...........•.•............
~i!ri:1:'t'k:.·.~~=== ::: ::::: :::::::: ::::::: ::::: ::: ::::: ::
All countries, Western Hemisphere...•..••......•....
8,130
50.0
8,141
liO. 0
F====t====F====f====
Belgium: Antwerp.•.••.....••••..•.•.•••••••••.....•...•. 210
183
53. 4
46. 6
England:
l====l====F====f====
42.0
58.0
Liverpool. ...•..•...•.•.•.........•.....••... -· .....•..
457
630
EUROPE
London .....•.....•••••...•............................
44. 7
55.3
693
SM
57.2
169
188
47. 3
Southampton •...•........•...•.•...•.. -·-· ........••..
Irish Free State:
f=====!====i=====i====
66.5
Cobb ..........•.......•....•...........................
33.5
150
298
68.1
Dublin •••...•.•..•••••..•...•.......... _........... _•..
31.9
189
404
Northern Ireland: Belfast•••••..•.••.••.•.•.•.........••...
f:=====t====,1===•=
35.2
64. 8
134
246
l====F=== f=====I===
0
Scotland: Glasgow .•..•.••••..••.••....•....•.....•........
600
839
41. 7
58.3
Ger~:Jhi •.•••..•...••.••.•••.••.•..•.•...............•.•.. l====-l====F====l====
43. 7
56.3
951
738
42. 9
57.1
Bremen.••....•....•.•••••••.••...•...•.....•..........
217
288
37. 9
62.1
Cologne •...••.••....••..•.......•...•••.....••..•...•..
585
357
45. 7
M.3
Hamburg .•••..••••••..•••..••.•...••...........•....•.
309
260
29.1
70.9
Stuttgart•.••.•••••••.....•.•..•••.•••...•.•......••....
314
763
f=====:====,f=:===,===
Digitized by
Google
116
PUBLIC HEALTH SERVICE
TABLE
18.-Diatribution according to sex of applicant, for immigration visa, who
were medically examined during the ji,,cal year 1932-Continued
Number of each sex
examined
Per cent of each sex
examined
Country and consular office
---------------------1--M_a1_e_•~f-F_em_a1_e-t
I•-
M•
EUROPE-continued
:Holland: Rotterdam.......................................
256
303
45. 7
M.3
1====1====0 1====1,====
46.8
53.2
1,160
I, 308
1====1====0 1====1,====
49. 7
50.3
Denmark: Copenhagen .•........ -·-·-·-·-···-···-·-·-···-268
271
i====l====•l====I,===
Norway:
Bergen .• _.......•............................••..... _..
67
62
51. 9
48.1
Oslo .••.•.••.•......... _.....•. _.•.•...•.•.. __ ......... .
223
284
44.0
56.0
1====1====~====1,====
Sweden:
Ooteborg.•......••.• ·-·- ... __ .•... ··--. _..•.•. _. __ •.. _.
166
145
46.6
63.4
Stockholm ••••..•••••........ _._ ...•. _..· .......•.•.•.•
97
133
42.1
57.9
0
1====1==== 1====1,===
Italy:
Genoa.............................................. ...
660
1,184
35.4
64.6
Naples.................................................
2,361
3,260
42. 0
58. 0
Palermo.................................................
925
1,361
40.5
59.5
1====1====~====1,===
Czechoslovakia: Prague....................................
279
410
40. 6
59.4
1====1==== 1====1,===
Austria: Vienna •••••••.•••.•••.•.••..••.•..••..•.•.. _......
159
212
42. 8
57.2
1====1====~===1,===
41.
7
58. 3
All European countries.···············•···-···•·-···11,067
15,493
Poland: Warsaw ..•..••.•....••........• ······--···-···-·--
0
19.-Number and percentage of applicants medically examined who were
notified for dijferent classes of disabilities, and percentage distribution of male
and female applicants according to class of disability, during the fiscal year 1992
TABLE
Number noti•
fled for--
Per cent
of applicants
examined
notified for-
Per cent
of males who
bad-
Per cent
of females who
bad-
Country and consular office
Class
A
condl·
tions
Class
B
condl•
tions
Class
A
condi•
tions
Class
B
condl·
tlons
Class
A
condl•
tlons
Class
B
condl•
tlons
Class
A
condl•
tlons
Class
B
ccndl•
tions
- - - ------ ------ --- --WESTERN HEM:ISPHBRB
Cuba: Habana.•••• _.....••...•••••••
Mexico: Mexico City ...••••••..•••.••
Canada:
Hamilton .•.•••••.••.•••••.••.•••
Montreal ••••••.•••••••.•.••.•.••.
Ottawa••••••••••••.•......•.•••..
Quebec •..•..••••••••......•.•.•••
Toronto.....•.......•.........••.
Vancouver ......••.••••••.••••••.
Windsor ...••.••..•.•.••.••.....••
r::~tt-.-.~:::::::::::::::::::::
All Canadian .••••••••.•••••••••
All countries, Western Hem!•
sphere .••.•••••..••••••.••••..
EUROPE
Belgium: Antwerp.••••••••••••••••••
England:
Liverpool. •••••••••.••••••....•••
London ..•••••..••••..••..•••••.•
Southampton ...•••.•.•••••..••.•
Irish Free State:
Cobb ...•••••..•.......•.••••••••
Dublin ...••••........••••••••••.•
Northern Ireland: Belfast••.••••.•••.
Scotland: Glasgow ••.•..•.••..•••••••
69
5
111
38
5. 8
.7
9.4
5,6
4. 5
1. 6
11.1
6.1
7. 7
.3
6. 9
4. 9
6
.8
17
7
1
117
577
61
121
149
77
363
87
87
1.0
.2
1. 5
.5
.8
.5
.2
14. 9
13. 5
13. 3
4.9
7. 7
.9
19. 0
6.3
21. 5
1. 2
.3
1. 3
•1
.9
2. 4
.9
.9
0
16.1
15.5
11.0
2.1
3.1
55.5
17. 2
5. 7
14. 4
.3
.3
.8
•1
.6
2. 4
.9
0
.4
13. 4
16. 2
15.4
2. 8
4. 6
39.6
21. 5
6. 7
26.1
88
1,639
.6
11. 3
1. 2
23. 2
1.2
22. 3
162
1,788
1.0
11.0
2. 0
25. 3
2. 2
14
5
5
29
4
.3
= == = = =- - - =
------
=
22.0
3
90
.8
22.9
1.4
20.9
0
25.1
22
1
9
301
285
66
2. 0
.1
2. 5
27. 7
15. 2
18.5
2. 8
.1
2. 3
27.8
15.4
20. 7
1. 4
0
2. 6
27.6
14. 9
16.6
3
3
4
2
107
169
84
295
.7
.5
1.0
.1
23.8
28.5
22.1
20.5
1. 3
0
14. 0
29.1
20.1
28. 0
.3
1.2
.2
28.8
28.2
23.1
15. l
Digitized by
.7
0
Google
.7
117
PUBLIC HEALTH SERVICE
19.-Number and Percentage of applicants medically examined who were
notified for different classes of disabilities, and percentage distribution of male
and female applicants according to class of disability, during the fiscal year 1932Continued
·
.TABLE
Per cent
of applicants
examined
notified for-
Number notified for-
Per cent
of males who
had-
Per cent
offemales who
had-
--~---1---.....,.--t----i---11-----,--- -
County and consular office
Class
Clal!8
Class
Class
Class
Class
Class
ClBSS
condltions
condl•
tlons
conditlons
condl•
tions
condi- condltions
tlons
condltlons
conditlons
A
B
A
B
A
B
A
B
-------------·1---l----i---1---------------
EUROPJ:-eontlnued
Germany:
Berlin............................
Bremen..........................
Cologne..........................
Hamburg........................
Stuttgart.........................
Holland: Rotterdam.................
Poland: Warsaw.....................
Denmark: Copenhagen..............
Norway:
Bergen...........................
Oslo ••••••••••••••••••• _..........
Sweden:
·• Goteborg ...•..•..•. _. •. . • .. .. . . . .
Stockholm.......................
Italy:
Genoa............... . . • . • . . • . .. . .
Naples .•••.•...•..... ····-·····-Palermo •.•.••.......•.•...••.•• _.
Czechoslovakia: Prague..............
Austria: Vienna......................
18
517
83
135
1. 0
1. O
1.1
175
106
759
4
1
12
30. 6
16. 4
.5
14.3
11.l
1. 1
1. 4
.8
83
.8
.9
3. 5
.7
16. 3
18. 9
30. 8
15. 4
.9
.4
2. 9
1. 1
38
230
.7
2. 3
29. 4
45. 3
0
2
1
51
21
•6
.4
16. 4
9. 1
0
65
232
327
15
6
427
1,412
648
125
3. 5
4. 1
14. 3
2. 2
l. 6
23. 3
25. 1
28. 3
18. l
15. 6
3. 5
3.1
12. 2
1. 4
2. 5
5
11
3
63
9
5
88
58
32. 2
1.0
13.4
9.6
15. 3
18. 4
31. 7
1. 3
.6
.8
1.3
4.1
.3
29.3
20.1
14.9
12. 3
16.6
19.4
30.2
16.2
2. 7
37. 3
49. 3
1.6
2.1
20.9
42. 2
1. 4
11. 7
5. l
0
•7
20.5
24. 6
3. 5
4. 8
15. /
2. 7
.9
22.5
27.5
26.2
21.2
11. 5
.4
•7
14. 5
21. 7
31. 5
13. 6
16. 3
7.0
l~. l
t----1----1e----i---t---~---t---+---
All European countries.........
6, 278
851
3. 2
23. 6
23 ..5
2. 8
3. 5
23. 7
20.-Number and percentage of quota and nonquota applicants examined
who were notified for different classes of disabilities during the fiscal year 1932
TABLE
Nonquota
Quota
Country
Total Number nonumber tilled forquota
appl!.
cants
Class
exam• Class
A
B
lned condicondi•
tlons tlons
-- --
WESTERN HEMISPHERE
Cuba •••••••••••.•.•••••.••.•..•••
Mexico.•••••.•••••••••••••••••••••
Canada •••••••••••••••••.•••••••••
Per cent of
total exam• Total Number noined who number tified forwere not!nonfie<! forquota
appli•
Class Class cants Class Class
A
B
examA
B
condi• conjl. ined condi• condi•
tions tions
tions tions
Per cent of
total exam•
ined who
were not!•
fie<! forClass Class
A
B
condi• condi•
tions tions
- - - - - - - - - - - - - --
462
167
3,450
25
0
43
13
503
5.4
0
1. 7
14. 3
7.8
20.1
695
512
7,439
44
5
48
45
25
1,074
6. 3
1.0
.5
6.5
4.9
14. 4
sphere.....................
4,079
68
582
1.6
14. 0
8,646
97
1,144
1.2
13.2
EUROPE
Belgium ••••••••............••....
England ...•....•••••....•....•...
Irish Free State ....•.•.•..........
N orthern Ireland •.•.•...•..•••....
Scotland .•.•••...•.......•...••...
Germany .••••........•.•..••.•...
H olland•.••..••••.....•.•••••.••..
Poland ....•••••......•.•...•....•.
Denmark .••••.•.•..••.•.•••..••..
N orway.......... .................
sweden •..•••••.•..••.••••.....•.•
I taly ••.•.•••••••••...•.•••....•...
C zechoslovakia••• _....••••.....•..
A ustria ..•••••••••.•.•..••.•...•..
243
l, 952
780
287
968
3,496
420
1. 458
389
418
341
3,117
314
213
3
23
4
2
2
26
3
58
1
7
3
156
7
4
62
423
196
1.2
1. 2
.5
.7
.2
.7
.7
3.9
.2
l. 6
.8
5.0
2.2
1.9
25.5
21.6
25.1
21. 9
23.6
19.5
17.6
36. 5
14. 4
41.8
12. 3
49.0
21.3
15. 0
150
1,039
246
28
6,624
375
158
0
8
2
2
0
20
2
30
3
6
0
468
8
2
959
58
26
0
•7
.8
2. 3
0
1.5
l. 8
3.0
2.0
2. 7
0
7.1
2. 1
1.3
18. 7
17. 2
29.3
20.4
13. 5
22. 2
23.8
22. 7
18.0
42. 6
15.0
14. 5
15.5
16.4
All European countries .. _•.. 14,396
299
2. 1
28.9
12,102
551
2,090
4. 5
17.3
All countries, Western Hem!•
-----
66
63
229
682
74
532
56
175
42
1,528
67
32
4,161
Digitized by
88
468
l, 277
109
1,000
150
218
200
Google
179
72
18
63
284
26
227
27
93
30
118
PUBLIC HEALT,H SERVICE
21.-Percentage distribution of total quota and nonquota applicants of each
se:r; e:r:amined who were notified for different classes of disabilities during the fiscal
year 1932
TABLE
Quota
Country
Male
Class
A
Nonquota
Female
Class
B
Class
A
--- ---
Male
Class
B
Class
A
Female
Class
B
Class
A
Class
B
WESTERN HEMISPHERE
Cuba ••••.•...•...••• ·- -- --•. -- ---- -Mexico_._-·---·-···-··--··---------Canada ________ ·- _________ -·-- ______ .
4. 2
0
1.4
14. 1
9.9
15. 7
9.2
0
1.6
11.1
4. 5
13.2
5. 0
1.5
.6
7. 2
4. 7
12.1
7.5
.4
.6
5.8
5.0·
11. 0-
All countries, Western Hem!•
sphere_···-· ______ . ___________
1. 7
1.49
1.3
11. 5
1.6
13.4
.8
15. 0-
23.0
20.8
22.1
21.0
36.1
19.3
17. 1
35. 7
14.3
40.9
9.1
44.8
13.0
15. 7
0
1.0
Scotland_···············-·······-····
Germany ... ···············-··· ...•..
Holland_ ..•.....•• _.•. _•.........•..•
Poland._ ...•. -··-_-·--···· .••....•...
Denmark .•..••. ·-········-··········
NorwaY--······-·-···-····-······-•-·
Sweden .. __ •. -· .........•.•••. ·-·--·Italy•.•. -··- ..•.......•• ·-·-··-.-····
Czechoslovakia. ___ ....•.• __ •.. ---····
Austria .•. -·········- .•.••. ·- •..•.•..
2.1
1. 3
.4
1.0
0
.8
.5
3. 2
.5
1. 0
1.4
5.2
1.4
1. 11
.5
.3
.7
.9
4. 7
0
I. 4
.5
4.8
2.11
1.8
28.8
22. 2
26.5
22.4
15.6
19. 7
18.0
37.3
14. 5
42.8
14.6
52.5
28.5
14.4
0
1.2
1.0
0
0
1. 3
0
2.3
2.8
2.5
0
5.4
I. 5
3. 5
16.9
19.6
20.8
14.3
13.6
22. 6
22.9
23. 7
15. 3
61. 2
12.0
13. 1
14. 3
17. 5
0
.3
.7
3. 7
0
1.8
3. 2
3.4
1.3
2.8
0
8.0
2. 5
2. 0
20. 2"
14.9
34. 7
24.5
13. 3
21.9
24.6
22.0·
20.5
31.8
18. 015. 3
16.1
0
All European countries_ •.•...•
2.2
28.6
1.11
29. 1
3.5
16.9
5. 3
17. 5-
EUROPE
Belgium._ •• _·---·-····-.··-·-·-·-·-·
,~~8;:!ie State._ •. ·---- .• -·-·-·--·-·
Northern Ireland_··--·· •••••.•..•••.•
.5
22.-Number and percentage of applicants e:r:amined, total and by se:r:, who·
were refused visas on medical notification for different classes of disabilities during
the fiscal year 1939
TABLE
Country and consular office
Per cent or
ex•
Number of visas applicants
amined
who
refusedwere refused
visas for-
Percentage or
males who
were refused
visas for-
Percentage of
females who
were refused
visas for-
Class A Class B Class A Class B Class A Class B Class A Class B
------------- - - - - - - - - - - - - - - - - - - - - - - - WESTERN HEMISPHERE
Cuba: Habana ......•.•••.•• ··-·. ·- •.
Mexico: Mexico City. __ -·· .•.. -· .. -·
Canada:
Hamilton ••.•.•.•.•.••••••.•••• _.
Montreal .•• -··· .•••••••••.••••••
Ottawa.··············-··········
Quebec ...•.•......••.•.•.....•..
Toronto ••••••.... -·-· .......... __
Vancouver···-·-·-·········---·--
;~:;g~
=::::::::::=:::::::::::
Yarmouth .•... -------·········-All Canadian_ •.••••••••••••.•.
69
5
58
14
5.8
.7
4. 9
2. 0
- - - - - -- - -- - 14
5
6
76
350
44
2
29
3
17
6
1
43
35
191
7
22
5
.8
.1
1. 0
.1
1. 5
.4
.8
.4
.2
11. 7
8. 2
11.6
.2
2.2
4.5
10. 0
.5
5.6
4. 5
1.1
6.3
2.1
7. 7
.3
2.9·
2.0·
1. 2
.3
1. 3
.04
.9
12. 2
7.4
9.3
.1
1.4
.5
11.6
.7
5. 5
.3
.3
.9
.04
.6
.3
.9
0
.4
6.6
9.2
9.8
.1
,8
.5
9.6
.3
5. 7
.6
.9
.8
0
---'----'---'----'----'----'·--
3. 7
83
773
5.4
.6
4. 7
.5
.6
l===l====l===l===l====l===l===I===
All countries, Western Hem!•
5. 2
4.1
157
845
1.0
.6
sphere .....•••••.••••••••••••• '====i====i====i===l===i,===
Digitized by
.7
---
Google
3.6
119
PUBLIC HEALTH SERVICE
22.-Number and percentage of applicants examined, total and by sex, who
were r/JfU8ed visa, on medical notification for different claases of disabilities during
the fiscal year 19SS-Continued
TABLE
Country and consular office
Per cent of
exNumber ofvlsas applicants
amlned
who
refusedwere refused
visas for-
Percentage or
males who
were refused
visas for-
Percentage of
females who
were refused
visas for-
Class A ClassB Class A ClassB Cla.ssA ClassB Class A ClassB
- - - --- --- -----EUROPE
Belgium: Antwerp ___________________
England:
Liverpool. _______________________
London:_________________________
Southampton ____________________
IrishCobb
Free____________________________
State:
Dublin __________________________
Northern Ireland: Belfast ____________
Scotland: Glasgow ___________________
Germanr:
BerJin ____________________________
Bremen __________________________
Cologne __________________________
Hamburg ________________________
Stuttgart _________________________
Holland: Rotterdam _________________
Poland: Warsaw _____________________
Denmark: Copenhagen ______________
Norway:
Bergen ___________________________
Oslo _____________________________
Sweden:
Goteburg_ ---------------------Stockholm
_______________________
Italy:
Genoa_.----------- ______________
3
32
0.8
8. 1
I. 4
8.6
22
1
9
177
78
2.0
.1
25
2. 5
16. 3
5.0
7.0
2.8
.1
2.3
17. 9
5.3
10.0
1. 4
0
2.6
15.1
4. 8
4. 2
3
3
4
2
64
90
61
216
.7
.5
1.0
.1
1~3
15.2
16.0
15.0
1. 3
0
.7
0
9.3
16. 9
14.1
22.3
.3
.7
1.2
.2
15. 4
14.4
17.0
9.8
18
278
18
60
13
56
16. 5
3. 6
6.4
2.3
5. 2
10. 4
13. 9
6.8
1.1
1. 4
.8
.4
.9
.4
2.9
I.I
17. 9
5. 1
5.9
2. 7
4.5
10.6
16. 8
8. 9
1.0
.7
1. 3
.6
.8
1.3
4.1
.3
15.3
2.4
6. 7
1.9
5.5
10. 2
11.4
4.8
0
7. 7
4
342
37
1.0
1.0
I.I
.5
.8
.9
3.5
.7
1
12
10
148
.7
2.3
7.8
29.2
0
2. 7
10.4
35.8
2. 1
1.6
4.8
23.9
2
1
10
12
.6
.4
3.2
5. 2
I. 4
0
6.9
5.1
0
.7
5.4
5.3
65
6
11
3
9
5
88
58
~:Fe~.;::=::::::::::::::::::::::
Czechoslovakia: Prague ______________
Austria: Vienna _____________________
232
327
15
6
49
512
199
46
12
3. 5
4.1
14. 3
2.2
1.6
2. 6
9.1
8. 7
6.6
3.2
3. 5
3.1
12. 2
1.4
2.5
4. 7
10.8
13. 3
7. 2
6.9
3. 5
4.8
15. 7
2. 7
.11
1. 5
7.8
5.6
6. 3
.5
All European countries ________
851
2,603
3. 2
9.8
2.8
11.9
3.5
8.3
23.-Number and percentage of male and female applicants notified for
class B disabilities who were refused visas on medical grounds during the fiscal
year 193S
TABLE
Country and consular office
Number or
applicants
notified for
class B
conditions
Number applicants refused visas
for class B
conditions
Male Female
Male Female
Per cent of
BPP,licants
notified who
were refused
visas for class
B conditions
Male
Female
56.4
35.0
42.0
40.0
WESTBRN HEMISPHERE
78
23
~~\o~~~~-cit"y:::::::::::::::::::::::::::::::::
33
15
44
14
8
6
~
23
75. 7
Can!in!::S::=:::::::::::::::=::::::::::::::::::::::li==~=o=l==3=t=~=l==l=~=:=l===a===ci==~=177
65. 7
Ottawa___________________________________________
25
36
21
63. 9
84.0
23
3
3.8
10: ~
16
18.1
44. 0
16
Vancouver---------------------------------------45
32
19
50. O
Windsor ___ -------------------------______________
148
215
24
15
16. 3
6. 6
2
11. 9
14
39. l
~~:«,~:_:::::::::::::::::::::::::::::::::::::::::
:
:
J
~=~----------------------------------------1 - -~- 1 - -~- 1 1 - -8- 1 - - - 1 - - - + -2t~
AII Canadian __ --------------------------------All countries, Western Hemisphere_____________
289
45.8
730
909
334
31. 4
l===!====l===t===l====I===
831
957
386
31. 9
46.5
309
l===l====l===l===a0= =
Digitized by
Google
120
PUBLIC HEALTH SERVICE
23;-Number and percentage of male and female applicants notified for
class B disabilities who were refused 11isas on medical grounds during the fiscal
year 193.e-Continued
TABLE
Per cent of
applicants
notified who
were refused
visas for class
B conditions
Number or
applicants
notified for
class B
conditions
Number applicants refused visas
for class B
conditions
Male Female
Male Female
Country and consular office
Male
Female
------------------------------1---1--EUROPE
Belgium: Antwerp ••••.••..........•••.• . .••.••••.•. ..
England :
Liverpool •••.•...•.•..•..•.............•••.•.•....
London ....•.....•.•.•.••..•.••.....•••••••••••.•.
Southampton ..........•••.•. •.•. ......•••...• . . . _
Irish Free State:
Cobb •••.........•••........... •.• _....•...••.•.•.
Dublin •..•.......•....•............•.••••• ••••.• ••
Northern Ireland : Belfast. ...•.•....... . .••••••..•....
Scotland: Glasgow .•.••••..•.........•....•.••. ••••.• .
27
168
................ .
Oe~:tl~........................... .-••.••••••••.•••..
238
25
Bremen .••••.•...........••.••.•
~:ir~ :::::::::::::::::::::::::::::::::::::::::
46
18
14
40.9
30.4
174
82
35
128
31
17
95
41
8
64.5
34. 6
48. 5
25. 8
21
M
114
59. 3
50. 9
73. 7
64. 5
48
25
48
47
Ho~'!:~ttterdam ••••.•...•.••......•••.••••..•.••.
Poland : Warsaw ...•••...••••...•••......•••.•••••••..
Denmark: Copenhagen ....•.•••...••........•••.• •• •.
Norway:
Bergen ••• •. •.....•.....•.•...•••.• . ....•.•..••....
Oslo •••. •••....................••• . ..••••.•• . .••..
Sweden:
Ooteborg .. ......•. . ....•...... •....•...•.•••• • ....
Stockholm •....•........•..........•.••.• •...•....
Italy:
Genoa...................................... ..... .
364
39
86
67
127
279
58
87
38
37
13
51
32
58
42
82
61. 8
58. 2
70.3
79. 7
132
11
21
146
55.6
19
134
44. 0
43. 7
28. 0
7
54. 6
32. 0
62.3
12. 1
59
395
44
14
27
39
6
42
31
193
149
24
13
53.0
61. 6
33. 1
52.5
37. 7
29.5
13
7
·127
7
29. 2
57.4
44. 8
15. 8
120
80
3
68
28.0
72. 7
23.1
56.6
17
34
8
13
5
5
5
7
29. 4
62. 6
14. 7
53. 8
160
267
38
26
87
25
110
t~ ,.
~:1~~(;.·:::::::::::::::::::::::::::::::::::::::::
Czechoslovakia: Prague...............................
Austria: Vienna............................ . .........
All European countries ............... •••••.••..
44
127
107
31
~
~
32
11
20
6. 7
~i26 :62.:6~
18
19. 4
29. 9
1
42. 3
3. 1
~g
~13,672 l,3181~ ~ ~
24.-Number and percentage of total quota and nonquota applicants examined who were refused visas on medical notification for different classes of disabilities during the fiscal year 1932
TABLE
Nonquota
Quota
Per cent of
Per cent or - Total
Number number ex•
Number number ex• bneurmo•r
who were amined who
who were amined who
0
quota refused visas we~[~sed qn;0~~ refused visas wer~t::,.used
T t 1
nbe::mr".r
Country
~~:t
1 - - - - - 1 - - - - ·I appJi. [- - - - -[• - - - exam• Class Class Class Class cants Class Class Class Class
B
A
B
A
ei':,8ed·
B
A
B
A
lned
- - - - -- - - - - - --1- - -
--1-
--1----1·-- - - - - - - - - -
WESTERN HEHISPHERE
Cuba...... . .........................
462
25
0
167
43
Canada............................. 3, 450
All countries, Western Hemi· - - - - - 68
sphere......•...........•.. _. 4, 079
MAYICO.... .... .......... ... ..... ....
EUROPE
Belgium. .. ....................... ..
234
1. 2
10. 4
2. 4
6. 6
695
512
7, 439
286
1. 6
6. 9
8, 646
5. 4
48
0
4
44
5
I
10
46
10
380
95
400
.5
1. 4
2. 0
5. 1
.5
2. 5
6. 3
1. 0
I
.--,----------'----
=
243
3
2!2
l,~~
frfs~a;:iee·state:::::::::::::::::::::
287
Northernlreland______ _____________ _
068
Scotland .. .......... .. .......... . ...
Germany ... ....... . .... . ...... . . .. __ 3,496
420
Holland......... . . ... .... .. .........
Poland. .... . . ... . ................... I, 458
389
Denmark.......... . ....... . ........
418
Norway... . . . ... . . . .............. ...
341
Sweden... ... .......................
Italy. ... ... .. . . . ... ................. 3, Iii
314
Czechoslovakia ....... . __ ...... _. __ ..
213
Austria ....... .. . ...... .......... _._.
Alt European countries ...... -I 14,396
2
26
3
58
1
150
11.1
1:; :~:!
l,~i
88
.7 17.1
211' 1.2
~
49
174
· 349
.2
.7
.7
45
254
36
130
i
14
3
156 473
26
7
7
4
2119 I, 946
3.11
.2
I
1. 6
.8
5. 0
2. 2
1. 9
2. I
468
17. 9
10. O 1,277
109
10. 7
I, 000
17. 4
150
9. 3
218
31.1
200
4. I
15. 2 6,624
375
8. 3
158
3. 3
13. 5 12, 102
Digitiz~d by
5
0
~
2
0
20
2
30
3
6
0
468
8
2
I.. 551
§
11
40
75
11
88
0
:~
2. 3
0
I. 6
I. 8
3. 0
1 2. 0
2.7
28
8 0
7.1
287
2. 1
20
5 1. 3
646 I_ 4. 5
Google
3.3
1i:~
12,5
8. 5
5. 9
10. 1
8. 8
.7
12. 8
4. 0
4. 3
5. 3
3. 2
_ 6. 4
121
PUBLIC HEALTH SERVICE
25.-Percentage distribution of the total quota and nonquota applicants
notified for each class of disabilities., who were refused visas on medical grounds
during the fiscal year 1932
TABLE
Quota
Country
Number
notified
Nonquota
Number
refused visas
Per cent or
notified
cases refused visas
Number
notified
Per cent or
notified
cases re•
fused visas
Number
refused visas
Class Class Class Class Class Class Class Class Class Class Class Class
B
A
A
A
B
A
B
A
B
A
B
B
- - - - - -- - - -
- -- -
WJ:BTIIRN BE1118PBEIIE
Cuba •••••••...•...•••••.••.
Mexico ••..•.•.••••••..•••••
Canada ••••....•••••.•••••.
25
0
43
503
66
13
25
0
41
4
234
All countries, West•
ern Hemisphere•••.
68
582
66
286
3
23
4
2
2
26
3
58
1
7
62
423
106
63
229
682
74
532
56
175
42
1,528
67
32
3
23
4
2
2
26
27
238
124
49
174
349
45
254
36
130
14
473
26
7
48 100
0
95.4
72. 7
30.8
46. 5
44
46
25
5
39 1,074
97.0
49.1
88 1,144
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
43. 5
56.3
63.2
77. 7
75.9
51.2
60.8
47. 7
64.3
74. 3
33.3
30.9
38.8
21. 9
2
30
3
6
0
468
8
2
299 1.946 100.0
46. 7
551 2,090
EUBOPB
Belgium ••••...•••••.••••.•
E~and ••••....•••.••••••.
I
Free State .••••••.••••
Northern Ireland ..•••••••••
Scotland •••••..•.••.•.•.•••
Germany ••••.••••••••..••.•
Holland ••••••......•.••....
Poland .•••...•.•.••........
Denmark ..•••.•.•.•..•....
Norway ....................
Sweden .•••••••.••......•..
Italy•.•.•.•.••....•........
Czechoslovakia ....•••..•.•.
Austria..•....•.............
• All European coun•
tries •..•............
3
156
7
4
3
58
I
,7
3
156
i
4
299 4,161
- -- -- -- 0
8
2
2
0
20
28
179
72
18
63
284
26
227
27
93
30
959
58
26
44
5
37
86
10 100.0
10 100.0
38 96. l
22.2
40.0
35.4
97. 9
34.9
0
100.0
100.0
0
100.0
100.0
100.0
100.0
100.0
0
100.0
100.0
100.0
17.8
23.4
34. 7
61.1
63.5
26.4
42.3
38. 7
3. 7
30.1
26.6
29.9
34.5
rn. 2
646 100.0
30.9
400
-- - - - - =
0
8
2
2
0
20
2
30
3
6
0
468
8
2
551
4
42 100.0
25
11
40
75
11
88
1
28
8
287
20
5
26.-Percentage distribution of total quota and nonquota applicants of each
sex notified who were refused visas on medical grounds dur1'.ng the fiscal year, 19S2
TABLE
Nonquota
Quota
Country
Male
Male
Female
Female
Class A Class B Class A Class B Class A Class B Class A Class B
----------- --- - - - --- - - - ------ --- --- - WESTIIIIN BllilfISPBllillE
Cuba ................................ .
Mexico ...........•...................
Canada ••..••.....••.•....... -..•.•.•
All countries, Western Berni•
8Phere...........•............
100.0
0
100.0
,0.4
40.0
51.2
100.0
0
100.0
83. 3
0
40.0
100.0
100.0
100.0
25.0
30.8
43.9
100.0
100.0
91.0
19.0
50.0
2\J.8
100.0
95.6
100.0
100.0
54.4
45. 0
43. 3
29. 0
l===i====t===l===l====i===i===i===
EUIIOPE
Belgium..............................
100. o
Scotland.............................
Germany.............................
Holland..............................
Poland...............................
Denmark............................
Norway..............................
Sweden ••.•••••...•..••...........•..
Italy.••••...•.....•......••....•.....
Czechoslovakia.......................
Austria••.....••••....••....••.•......
0
JOO. 0
100. O
100. o
100. o
100. o
100.0
100.0
100. o
100.0
75. O
84. 6
55. 6
64. 7
52. 4
82. I
i9. I
46.1
3U.O
52. 6
37.5
!OJ. 0
54. I
f;.fs~a:!i·si
..ie:::::::::::::::::::::: :~:8
Northern Ireland..................... 100. o
All European countries.........
50. o
o
iu
36. 6
O
l88:8 ~U
l88:8
100. O
79. 0
100. O
16. 6
iu
100. 0
100. 0
100. 0
100. o
O
100. O
100.0
100.0
100. o
100.0
63. 0
O
48. 5
100. 0
57. 5
0
42. 8
100. O
46. 4 • 100. O
69. 6
100.0
27.6
O
25.2
100.0
33. 3
100. O
fi.2
100.0
80. 0
56. 6
33.1
45. 4
54. 8
9. o
38.8
33.3
48.9
52. 6
50.0
100. O
4 I. 3
43. 5
O
18. 8
1::8
100. 0
g::
53. 8
0
100. 0
100. 0
100. O
100. O
100.0
O
100.0
100. O
O
69. 7
21. 2
40. u
27. 6
100. 0
22. 7
o
20. 4
22.2
19.9
25. 6
O
--·-----'--- --- ------ ---- ---
I
Digitized by
100. 0
Google
122
PUBLIC HEALTH SERVICE
27 .-Perce•tage distribution of total quota and· nonquota applicants of each
sex examined who were refused visas on medical notification, during the fiscal year,
1932
TABLE
Quota
Male
CoUlltry
Nonquota
Female
Male
Female
Class A Class B Class A Class B Class A Class B Class A Class B
WESTERN HEMll!PHEBE
Cuba ______ • __ ._._._. __ •. __ ._ •. __ ._. __
Mexico ______________________________ _
Canada ____ -----------· __ -- -- ---- -- --
4.2
0
1.2
Allsphere
countries,
Western Hemi- _
_______________________
1. 6
8.1
1.3
5.0
.9
5.0
2.1
t. 3
.4
1.0
0
.8
.5
3.2
.5
1. 9
1.4
5.2
1.4
1. 9
11.5
13. 2
13. 7
15. 8
30.6
10. 7
11.1
18. 7
11. 7
32.4
4.2
17. 4
7.0
5.9
0
1.0
.5
;5
.3
.7
.9
4. 7
0
1. 4
.5
4.8
2.9
1.8
10.6
11. 4
16.8
17. 7
9.8
9.5
10.3
16.0
6. 7
29.8
4.0
13.2
9. 5
.9
0
1. 2
1.0
0
0
1.3
0
2.3
2.8
2.5
0
5. 4
1. 5
3.5
2.8
5.5
10. 4
11.4
7. 7
7.5
10.4
13.0
1. 4
23. 7
4.0
6.4
7. 5
8. 7
.3
.7
3. 7
0
1.8
3.2
3.4
1.3
2.8
0
8.0
2.5
2.0
3.8
2.6
10.0
13.2
9.3
4. 7
9.8
6.0
0
6.5
4.0
3.0
4.1
0
12.0
3.5
7.4
5.3
3.9
10. 7
4.0
8.1
9.3
0
1. 3
5.1
1.5
.7
9.3
0
5. 3
1 - - - f - - - - - l f - - - - - 1 - - - - i - -- -
1.8
1. 5
5.0
Belgium _____________________________ _
England-. ___ . ________ --- -- -.• --. ---Irish Free State _____________________ _
Northern Ireland ____________________ _
Scotland. __________________________ ..
Germany __________ . ______ . __________ _
Holland _____________________________ _
Poland.. ____________________________ _
Denmark·-------------------·---··-N orway.•
________
. ___ .... -- . --- -- -- -· --_
___________________________
Sweden
Haly ________________________________ _
C1,echoslovakfa. _____________________ _
,Austria ______________________________ _
------2 ---15. 5
1. 9
All European countries.... ____ _
2.
1.1
2.5
4.9
.9
4.5
---- ---- - - -
l===l====l====l===I=== - - -
EUROPE
7.5
.4
.4
-----0
28.-Number and percentage of quota and nonquota applicants of each. sex
who were refused visas for mental conditions during the fiscal year, 1932
TABLE
Quota
Male
Nonquota
Female
Male
Female
Country
Num- Number ber
exam- reined fused
Per Num- Num- Per Num- Num- Per
cent ber ber cent ber ber cent
re- exam- rere- exam- rerefused ined fused fused ined fused fused
Num- Number ber
exam- reined fused
Per
cent
refused
-- - - - - - - -- - - - -
WESTERN HEMISPHERE
Cuba __ ··------- ___________
354
Mexico_____________ -------101
Canada_.-------- __________ 1,854
2
0
8
0.6
108
0
66
.4 1,596
12
0.9
335
274
0
.8 3,544
0
2
13
0
360
.7
238
. 4 3,895
11
All countries, West•
em Hemisphere ____
2,309
10
.4 1,770
13
.8 4,153
15
.4 4,493
16
139
815
240
95
379
1,334
198
758
196
210
H2
1,413
146
102
3
8
0
0
0
6
l
7
1
1
1
3
1
0
2.15
104
.98 1,137
0
540
0
192
589
0
.45 2,162
.50
222
.92
700
193
.50
.49
208
. 70
199
. 21 1,704
.68
168
0
111
0
10
3
0
2
10
2
13
0
1
0
71
1
2
.46
548
.90
48
1. 85
392
72
0
.48
80
0
100
.58 2,523
.59
133
1. 80
57
0
4
0
0
0
3
0
l
1
0
0
27
1
0
79
536
150
53
248
729
61
608
78
138
100
4,101
242
101
0
1
1
2
0
10
2
13
1
2
0
94
4
0
.18
.67
3. 77
0
1. 37
3.27
2.14
1. 28
1.45
0
2.29
1.65
0
Alltries
European
_________ •couo__ . __ . 6,167
32
.52 8, 2'J9
54
.65 4,878
37
. 76 7,224
130
1. 79
1
0
4
1
EUROPE
J3elgium ___________________
En~d ___________________
tis
Free State ____________
orthem Ireland ___________
l'!cotland •• _-------- ________
Germany____________________
__ ---------------Holland
:Poland _____________________
Denmark __________________
Norway ____________________
f
t':i81en_ ------- --- -- -- ---- Czechoslovakia _____________
,'\ustria ____________________
10
0
0
.88
.55
.34
Digitized by
503
96
35
220
0
• 79
0
0
0
.55
0
.25
1.39
0
0
1.07
. 75
0
Google
1.1
.4
.3
=
.3
0
123
PUBLIC HEALTH SERVICE
TABLE
29.-Number and character of the more 1eriou1 mandatorily euludabZ,
·
condition, notified during the fiacal year, 1981
WESTERN HEMISPHERE
gl
. ."
:.
I i!
Canada
j
~
Disease or defect
::;i
~
::,
::;i
0
ij
O'
E-t
0
C,
]
-
- - -
ClauA-I
In!anity......................•.....•................ ·•·· 1 .... ....
Mental deficiency........................... 3 .... 2 6 1 5
Epilepsy............................................................
Feeble-minded.............................. 1 1 1 .... .... ...•
Conatltutlonal psychopathic Inferiority.......... 1 2 .... 1 .•..
Total c!IISS A-I........................
4
2
5
7
~
2
5
"9
.9
~
::,
-~
~
i
i ]
e
!
~
::,
I
- ,- - .c
:il 0
~
~
1€1 .!= ..
7i
30
0
:,.
E-t
-E-t --
-
5 1 .... .••• 1 8
7 •••• ••.. 2 •••. 23
1
1
2
1
8
10
4 .•.. 1 .••. .•.• 8
18
1
10
2
1
8
28
2
12
II
51
67
.... .•.. .... .••• ••.. .••• 1
.•.. .•.. •... 3
1 ..•• 4
•• •• 7
1
4 . • . • 18
.••• 3
2
II
26
36
==--,=-------e==
Cltu1 A-II
Favus ....................................... 24 ...• •••• .•.. 1
Tracboma........•.........•................ 32 •... •••• .•.. .•.•
Tuberculosis................................. 3
1
1
3
2
Gonorrhea................................... 2
1 .•.• 4 ••••
Syphilis......................................... 1 .... .... ....
Total c!IISS A-IL...................... 61
3
Total........................•......... 65
5
6
....
1
7
3
0
11
14
5
5
211
1
0
22
12
2
7
5
0
17
7
1
3
34
118
85
lM
-=
EUROPE
.
Nature of detect
~ ""~
'Q ii,
ol
i:Q
<I
r,ai
-
s
"'
!.c
....-!
-
""
....
!
.!
I>-
j "" i "" ""
~ ~ i
z~
I"'
C,
-- -- -
Cta,1 A-I
it
I>,
0
i
!.c -!
~ g ~
E-t
z II= ~ 0.
- - - ,- -"' - - --< ~
p..
'g
I>,
A
f!,?t~::l~~::::::::::::::::: .T :::: :::: :::: :::: =i ::i: =ii:::~:::::::~: .l ::;: ::i:
1
4
50
1
Imbecility........................................................................ 1
Insanity.............•............... ,.... 4 ..... ,.. .... 2 .... 1 1
1 •••• 2 ....... . 11
4
Idiocy............................................................................ 4 .•....••
Mentally defective................... . . . . 12
3 1
2 19
1 22 .... 2 .. .. 84
3
1 150
1
retarded .......................... 1_ .....•...•.•.•.• ·•·• -··· ··i· ···· ···· ···· ···· ····
1
23
Psychopathic Inferiority.............. 1 5 . . .. 1 ... . 5 3 .... . . . . 1 .... 7
2
Psychosis............................. .... 1 .... .... .... .... .... .... .... .... .... 1
6
Senile.dementia...................... .... 1
1
1 .. . . . . .. ... . .... ... . 2
f~~Jy
TotalclassA-1. ................
=
3
24
4
2
2
211
5
34
3
Clan A-II
Amoeblasls........................... .... .... .... .... .... .... .... .... ....
Loathsome contagious disease......... .. .. . ... 1
1 .. .. 1 . . .. 19
Tracboma............................ .•..
Tuberculosis, pulmonary.................
1
1 ••.. ...•
6 .... 1 ....
~:g=~~~.~o.~~::::::::;.::: :::: .. ~. :::: :::: ::::
4 .•.. 26
1
7 .... 8 ....
~
4
1 134
1
3 .. . . 58
1 •••• 390
5
l 26
:::: .. ~. :::: :::: .. i.
Totalcl888 A-II ................
o
8
2
2
o
17
o
M,
Grand total.....................
3
32
6
4
2
46
5
88
4
2
254
1
1 .... 84
3 430
57
3 1
4
14
:
11
9
2 490
8
4
597
13
3 624
15
6
851
144391-32--9
Digitized by
7
Google
DIVISION OF SANITARY REPORTS AND STATISTICS
In charge of Asst. Surg. Gen. R. C.
WILLIA.KB
The Division of Sanitary Reports and Statistics is a clearing house
for public health information. Reports of outbreaks of diseases
dangerous to the public health and of the current prevalence of these
diseases are received from all parts of the world, and the data are compiled, abstracted, tabulated, or otherwise made available and sent out
to be used by health officers, sanitarians, and others who need the information in the work of protecting the public health. The division also
compiles legislation and court decisions relating to public health, issues
weekly the Public Health Reports, and distributes Public Health Service
publications.
MORBIDITY AND MORTALITY REPORTS
Two States (Maine and Montana) were added to the number which
met the requirements for admission to the :proposed morbidity
reporting area. Twenty-five States and the Distnct of Columbia have
qualified for admission to the area, nineteen States have not reached
the required standards, and for four States the necessary data are not
available.
Studies made during the year by State health departments have
confirmed the results of previous studies by the Public Health
Service and other agencies showing that reports of diseases dangerous
to the public health are incomplete and in many respects inadequate
to reveal conditions which must be known if the spread of these
diseases is to be controlled.
It is expected that the morbidity reporting area, when established,
will stimulate the reporting of communicable diseases and make the
reports from States within the area fairly comparable with one another.
CURRENT PREVALENCE OF COMMUNICABLE DISEASES
Reports of the current prevalence of communicable diseases in the
United States, received from State and local health officers, and
reports of quarantinable and other diseases, received from various
sources, were promptly compiled and summaries of the data were
published currently in Public Health Reports. The current reports
for the United States consisted of (1) weekly telegraphic reports
received from the State health officers, and (2) weekly reports received
by post card from cities of 10,000 or more poJ?ulation. Throughout,
the year there was published for 4-week periods a summary of the
current prevalence of the communicable diseases. These summaries
pay especial attention to the current prevalence of the disease as
compared to the same period of preceding years, with more extensive
data on any disease that shows unusual prevalence in one or more
sections of the country.
124
Digitized by
Google
125
CURRENT STATE .MORTALITY STATISTlCS
'The publication in the Public Health Reports of current mortality
statistics from the States.jhat could furnish the data to the Public · Health Service was continued; Brief summaries of mortality
were published for the first quarter and first half, and three-quarter
period of the year, with a more detai~e~ report on mo!tality throu~hout
the calendar year 1931. These prelimmary summanes make availa.ble
rather detailed mortality data many months before final figures are
available for the whole registration area. They are, therefore, very
useful to health officers and other health workers.
'In spite of the unfavorable economic conditions, the year 1931 was
a period of low mortality. The death rate from all causes in a group
of 18 States which were able to furnish the data early in 1932, having
a. population of more than 63,000,000, was 10.9 per 1,000, as compared
to 11.3 in 1930 and 12.0 in 1929 in the same States. The death rates
from typhoid fever, tuberculosis, and diarrhea. and enteritis continued
their steady decline. Even the degenerative diseases, such as nephritis, heart diseases, cerebra.I hemorrhage, and cancer, showed little
or no increase over 1930; but it can not be assumed from this one
favorable year that there is an;r change in the genera.I upward trend
·in the death rates from these diseases. Diabetes was higher than for
any preceding year.
COLLABORATING AND ASSISTANT COLLABORATING EPIDE.MIOLOGISTS
The Public Health Service is obliged to depend largely upon the
cooperation of State and local health officers for its reports of health
conditions in the United States. To assist in securing reports of
cases of communicable diseases, which a.re essential to the work of
the· Public Health Service, officers of State and local health departments a.re given appointments at the nominal salary of one dollar per
annum as agents of the Public Health Service. Their duties are to
collect and forward to the Public Health Service information of the
pre-valence and geographic distribution of diseases dangerous to the
public health. This system of collecting morbidity reports was in
use in 44 States during the fiscal year, with modificat10ns to meet
local conditions. In several of these States, however, the system is
not in force in the entire State and in some it has a. very limited use.
TELEGRAPHIC REPORTS
During the fiscal 7ear, weekly telegraphic reports showing the
reported prevalence o nine communicable diseases were received from
all of the States except Nevada. The diseases included in these telegrams were diphtheria, influenza., measles, meningococcus meningitis,
poliomyelitis, scarlet fever, smallpox, typhoid fever, and typhus fever.
The data are tabulated, mimeographed, and mailed to the State
health officers promptly. The statistics are published in the weekly
Public Health Reports with data showing the numbers of cases of
these diseases reported for the corresponding week of the preceding
year.
· These telegraphic reports give a current index of the numbers .of
cases of the principal communicable diseases in the United States,
which is utilized by State and local health officers as well as by the
Public Health Service.
Digitized by
Google
126
PUBLIC HEALTH SERVICE
MONTHLY STATE REPORTS
· Monthly reports were received during the year from all of the
States except two. These reports show the number of cases of all
diseases which are notifiable in each State. The reports show the
geographical distribution of the cases within each State and give much
useful information, but they are incomplete and in many respects the
data from different States are not comparable.
ANNUAL STATE MORBIDITY REPORTS
The annmu summary of cases of the principal communicable
diseases for the, year 1930 was prepared early in the fiscal year, but
owing to the depleted state of the allotment for printing it was not
possible to send the copy to the printer. until after the close of the
fiscal year. The 1931 volume was nearly ready for the printer on
June 30, 1932.
WEEKLY AND ANNUAL CITY REPORTS
Reports from cities are received weekly and annually. The current
reports from cities are of especial value, because they give the earliest
information of the numbers of deaths from the principal communicable
diseases. For influenza, pneumonia, and some other diseases, the
reports of cases are so incomplete that the reports of deaths must be
relied on for an index of prevalence.
Weekly reports are received by mail from about 700 cities of over
10,000 population. Annual reports are requested from all cities in
the United States in this population clas~. The volume giving statistics for 1930 for cities of over 100,000 population was issued during
the fiscal year, but the volume containing information for cities of
between 10,000 and 100,000 population has not been printed because
of lack of funds.
FOREIGN REPORTS
The basis of the morbidity reports received by the Division of
Sanitary Reports and Statistics from foreign countries is the information obtained from Public Health Service officers stationed abroad
and from American consular officers. The consular officers have
been collecting, for the Public Health Service, data concerning the
prevalence of diseases dangerous to the public health since the enactment of the act of April 29, 1878. These reports are S1!J)plemented
by current reports from the Pan American Sanitary Bureau, the
International Office of Public Hygiene at Paris, the health section of
the League of Nations, communications and publications from foreign
governments, and other sources. During the fiscal year these reports
were compiled, tabulated, or abstracted, and the data were published
for the information of health officers and others who were interested.
INTERNATIONAL EXCHANGE OF SANITARY INFORMATION
During the fiscal year the provisions of the International Sanitary
Conventions of June 21, 1926, and November 24, 1924, were complied
with by prompt notification to foreign governments, through the
proper agencies, of cases of quarantinable diseases and the progress
Digitized by
Google
127
PUBLIC HEALTH SERVICE
of epidemics or outbreaks occurring in the United States and its
possessions. In return, information was received from foreign governments, either directly or through international agencies, of similar
occurrences in their territory. There was a regular weekly interchange of sanitary information with the Department of Pensions and
National Health of Canada.
PREVALENCE OF COMMUNICABLE DISEASES DURING CALENDAR
YEAR 1931
Reports to the Public Health Service indicated generally good
health conditions in the United States during the calendar year 1931.
Preliminary reports indicate that the death rate for the year was
low, the tuberculosis death rate reached a new low record, the number
of deaths from pellagra decreased, and the morbidity reports for
most of the principal communicable diseases were favorable as compared with preceding years.
-·
The accompanying table gives a comparison of the numbers of
cases of the principal communicable diseases and deaths from these
diseases in the Uruted States for the calendar years 1929, 1930, and
1931:
CASES
Disease
Chicken poL ..............
Diphtheria.................
Intluenta ••••••••••••••••••
Malaria••••••••••••••••••• _
Measles ••••..•.•••.•••.••..
Menlngococcus meningitis.
Mumps ••.•••••••••••••.•••
Pellagra.•.•••...• _•••.•••.•
Pneumonia (all forms) ••.••
Poliomyelitis..•.•.•.•.•...•
8carl9t fever •..••..•...•.••
Smallpox •••••••...•.•...•..
Tuberculosis (all forms) .. _.
Tuberculosis (respiratory
system) .•.•..•••....•....
W,hold fever •••...•..••••
hooping cough •.••.•.••••
Numberof
States'
Aggregate population
(in thousands)
1930
1929
44
46
46
46
46
38
39
46
45
37
46
46
114,386
119,993
119,993
119,993
l19, 993
110,493
100,125
l19, 993
115,772
99,910
119,993
119.993
45 1111,565
Cases per 100,000
population
Cases
1931
1929
1930
1931
1929
1930
1931
- - - - --
115,994
121,644
121. 644
121, 644
121, 644
112, 059
116,843 199,628 212, 6.'15 219,985 174.4 183. 3 188. 8
122,516 84,765 66,924 70,327 70.6 M.2 67.4
122. 515
-------- -----122, 515 .•••..••
122, 515 364, 379 ·~02i .4ii9;7i4 ·303:1 -321:2
4. 7
6,261
112, 884
9, 501
8.6
7.0
7,794
112,930 121,657 95.2 111.2 US.II
117,385
101. 211
121,644
121, 644
121,206
118,235 ....•••.
-·iS:ii12 ...i's ·--s:i .. i5:4
102.021
2, 759
122,515 180, 178 171,822 199,179 160.2 141.2 162.6
122. 515 40, 810 48,204 29,924 34. 0 39.6 24.4
122,072,-·······
------ ------
·aan
m:1 l~lil .."'.,0' ·--s:m
40 109,483
111,
121,644 122,515
22,941 ··2n;s1i --26;250 ""iil:i 22. 1 ··2i:,
46 119,993 111,043
46 119,993 121, 644 122, 515 194,478 158,010 167,350 162. 1 129.9 136.6
8661-·······
DEATHS
Deaths per 100,000
population
Deaths
Disease
1929
Chicken pox .................
141
Diphtheria ••••..•.••••.•••.• 7,889
Intluema .•••••••.•••....••.• 65,534
Malaria. - ••.••••••.•••••••.• 4,144
Measles ..................... 2,909
Menlngococcus meningitis .•• 4,260
93
Mumps ••..•.• -•••.•.•.•.•••
Pellagra •••••••. ·- ..•.•..•... 7,401
Pneumonia (all forms) •...... 109,354
Pollomyelltls •....•.•........
686
Scarlet fever •••.•..•......•.. 2,471
139
Smallpox .•••.•.. _._········Tuberculosis (all forms) . . _•• 87,636
Tuberculosis (res p I rat or y
system) •••......•.......•.. 74, l17
W,hold fever •...........•.. 5,152
hooping cough ••••••....•. 6,890
1930
114
5, 1162
22,791
3,426
3,413
3,470
71
7,137
97,526
1,121
2,201
170
83,376
70. 082
6,061
5,388
1931
1929
1930
1931
Cases reported for each
death registered
1929
1930
1931
- - -- -- - - - - - - - 0.1
1,415
1,571
0. 1
0. 1
1,865
140
6,099
31,974
2,649
3,312
2,467
5,853
98,945
1,884
2,588
102
80,890
6.6
M.6
3.5
2.4
3.9
.1
6, 2
94. 5
.7
2.1
.1
73.3
4.9
18. 7
2.8
2.8
3. 1
.1
5.9
83.1
I.I
1,8
.1
68.8
5.0
11
11
26.1
-------2.2
....
iii.
2. 7
125
2
2.2
2
1,591
.1
1,025
4.8 -- ------ -------83. 7 ······4·
1.8
7
73
78
2.1
284
.1
294
66. 3 -------- --------
68, 120
5,654
4.423
67. 7
4. 3
II. 7
63.1
5.0
4. 4
60.9
4.6
3.6
80
--------
4
28
··-···4·
29
12
--------
142
2
1, 5111
--------
----···s
77
293
--------
5
38
1 In addition to the number of States given, the District of Columbia is included in all diseases except
mumps.
Digitized by
Google
128
PUBLIC HEALTH SERVICE
Oholera.~Asiatic cholera did not appear in the United States during
1931. In the Philippine Islands 936 cases of cholera were reported·,
·.
as compared with 4,600 cases during the calendfl.r year 1930.
Diphtheria.-In 1931, 46 States reported 70,327 cases of diphtheria,
as compared with 65,924 cases for 1930. The 1930 case and death
rates for diphtheria were the lowest ever recorded by the Public
Health Service and the reaction in 1931 was very slight.
Influenza and pneumonia.-Comparatively low death rates for
influenza and pneumonia contributed to make the relatively low
general death rates for the years 1930 and 1931. In the winter of
1931 there was a decided increase in the incidence of influenza, the
outbreak reaching its peak about the first of February. The disease
was mild and comparatively few of the cases developed pneumonia.
The death rates for influenza and pneumonia combined for the last
three years are as follows: 1929, 149.1 per 100,000 population; 1930,
101.8; and 1931, 109.8.
Malaria.-Reports from 46 States gave death rates from malaria
as follows: 1929, 3.5 per 100,000 population; 1930, 2.8; 1931, 2.2 per
100,000.
Measles.-Nearly half a million cases of measles were reported by
46 States in 1931. The actual number of cases was Feater than this
figure, as many cases of measles are not reported. The measles case
rate increased from 327 .2 cases per 100,000 population in 1930 to
383.4 per 100,000 in 1931.
Meningococcus meningitis.-The incidence of meningococcus meningitis (epidemic cerebrospinal meningitis) in the United States
increased each year from 1925 to 1929. In the latter year 8.6 cases
per 100,000 population were reported. In 1930 the rate dropped to
7.0 per 100,000, and in 1931 it was 4.7 per 100,000.
Pellagra.-The death rate from pellagra in 46 States in 1929 was
6.2 per 100,000 population. In 1930 it was 5.9, and in 1931, 4.8 per
100,000. Many health workers feared that unfavorable economic
conditions might result in an increase in the incidence of pellagra.
In many communities where the need seemed greatest measures were
taken to make pellagra-preventing foods available to the people, and
it is probable that these measures are responsible, in part at least, for
the comparatively favorable reports for 1930 and 1931. Incomplete
reports for the first six months of the year 1932 indicate that there
was a decrease in the prevalence of pellagra during that period as
compared with the corresponding period of 1931.
Plague.-No case of plague was reported in continental United
States during the year 1931, but six _plague-infected ground squirrels
were found in Monterey County, Calif., in May and June, 1931, and
eight plague-infected ground squirrels were found in July and August,
1931, in San Benito County, Calif. A fatal case of plague was
reported in August, 1931, on Maui Island, Territory of Hawaii, and
during the year six plague-infected rats were found in the Hawaiian
Islands.
During the first six months of 1932, seven plague-infected rats were
found in the Hawaiian Islands, and four in Los Angeles, Calif.
Poliomyelitis.-During the summer and early fall of 1931 a serious
epidemic of poliomyelitis (infantile paralysis) occurred, affecting
principally States in the northeastern part of the country, including
Digitized by
Google
PUBLIC. HEALTH SERVICE
:l29
all of New:England, New.York, New Jersey, Minnesota, Wisconsin,
and Michigan. Fifteen thousand seven hundred cases were reported
by 37 States. The outbreak was the most severe since 1916, when
27,500 cases were reporte~ by 30 States. Some States reported in.ore
cases of poliomyelitis in 1930 than they did in 1931. Among these
States were California, Colorado, Kansas, Louisiana, Maine, Nebraska
Ohio, South Dakota, and Wyoming.
·
Scarlet jever.-Nearly 200,000 cases of scarlet fever were reported
during 1931. Th.e case rate (162.6 per 100,000 population) was the
highest since 1927, btit the death rate was the same as that for the
year 1929 (2.lper lOb,000). This disease is considered important by
public health workers because of the possible after effects.
··
Smallpox.----"-Less than 30,000 cases of smallpox were reported to the
Public Health Service in 1931 by 46 States, as compared with 48,000
cases. in 1930. The dise!l,se .was of the mild form, and only 102
·deaths from smallpox were reported in 1931, giving a fatality ratio of
293 cases for each dea_th. Delaware, the District of Columbia,
Maryland, and Rhode Island did not report any case of smallpox,
while more than half of the total was reported by seven States.
Opposition to vaccination has been manifested in some of the States
which reported considerable numbers of cases of smallpox.
·
·_ TuberC'!J,losis._:_Again a record low death rate has been registered for
'tuberculosis. The death rate fo:,: 1931 was 66.3 deaths per 100,000
population. Reports were ·received for 45 States. Since 1918 each
year has shown improvement over the preceding year in the tubercu•
losis death rate. In 1918 the rate was 125.6 tuberculosis deaths per
100,000 population.
·
Typhoiil jever.__:_During 1931, 26,250 cases of typhoid fever were
reported by 46 States, as compared with 26,871 cases in 1930 and
22,941 cases in 1929. There was a further increase in the incidence
Qf typhoic;l fever during the first six months of 1932, 5,900 cases being
reported, as compared, with 4,500 cases durin~ the corresponding
.
· ,
·
.
period of 1931.
Yellow jever.-Yellow fever has not appeared in epidemic form in
the United States since 1905. The disease is endemic, however, in
-parts of South America and Africa. Although the manner of spread
Qf yellow fever and the means of its control are known, its appearance
in a nonimmune population might be disastrous.
INQUIRIES AS TO HEALTH CONDITIONS .
·· M&ny inquiries were :received by the Division of Sanitary_ Reports
and Statistics for information as to the prevalence of certain diseases
in parts of the United States or in foreign countries. The information
was given whenever i.t was possible to do so.
DIRECTORIES OF HEALTH OFFICERS
· · Data for the annual directories of State, city, and wholetime county
health officers in the United States for the year 1930 were collected
during the fiscal year and the directories were published in the Public
Health Reports, but owing to lack of funds the reprints were not
issued until after the close of the fiscal year.
Digitized by
Google
130
PUBLIC HEALTH SERVICE
SANITARY LEGISLATION AND COURT DECISIONS
Laws, ordinances, and regulations.-During the fiscal year the compilation of the State ·and Federal health laws and regulations for the
years 1929 and 1930 was completed. The text of these laws and
regulations, however, will not be J?Ublished as has heretofore been the
practice since 1911, but the matenal is to be made available through a
list of citations to the various laws and regulations arranged according
to subject matter. Beginning with the year 1931 it is intended to
present the State and Federal health laws and regulations in the form
of a review, and to this end the material for 1931 was colJected during
the fiscal year.
There was also completed for publication a review of the more
important provisions of the existing laws and regulations of the
various States pertaining to morbidity reporting.
Since 1910 the Public Health Service has published periodically
compilations of municipal health ordinances and regulations. In
connection with this work there were collected during the year those
ordinances and regulations relative to public health which were
adopted during 1931 by cities in the United States having a population of over 10,000.
Decisions.-As has been done for many years, abstracts were prepared of current decisions on public health matters rendered by State
and Federal courts of last resort, and such abstracts were published
in the Public Health Reports.
lnquiries.-Numerous requests for data and information concerning legislation and court decisions on health matters were received
during the year and were complied with as fully as possible.
PUBLICATIONS IssuED BY THE DIVISION
The Public Health Reports was issued by the division each week
during the year. The 52 issues (vol. 46, pt. 2, and vol. 47, pt. 1)
contained 3,008 pages exclusive of title pages and pages of contents,
as compared with 3,285 pages in 1931, 3,143 in 1930, and 3,362 in
1929.
This weekly periodical, established in 1878, contains summaries of
morbidity reports received by telegraph and mail from State and city
health authorities, giving a current index to health conditions throughout the country with reference to the most important communicable
diseases, and it is the official medium of the Public Health Service for
the publication of reports on current research work being undertaken
by Public Health Service research workers and of other public health
infonnation. In addition, the Public Health Reports contained the
reports from various official sources of quarantinable diseases throughout the world, articles relating to public health administration, and
abstracts of current court decisions having a bearing on public health.
The average number of copies printed of each issue was about 9,500,
approximately the same as that for the preceding fiscal year. Thirtyfive of the most important articles appearing in the Public Health
Reports during the year were issued in separate form as reprints,
providing for a more economical distribution to persona interested
m the various subjects. Ninety-seven such reprints were issued in
1931 and 94 in 1930. It was found impossible to issue more of these
Digitized by
Google
PUBLIC HEALTH SERVICE
131
articles in separate form because of lack of printing funds, resulting
from increased needs for printing colli!equent upon greatly increased
duties imposed upon the Public Health Service by law, together
with a decreased printing allotment. From the same necessity,
supplements to the Public Health Reports, including the la.test State
laws and regulations iela.ting to public health and compilations of the
notifiable diseaseo in States and cities during 1930, were held in abeyance. This material was assembled and prepared for the printer,
but it was found impossible to conserve the printing fund sufficiently
to provide for them.
In cooperation with various negro health or~a.niza.tions, the United
States Public Health Service, through this division, issued the Na.tional Negro Health Week Bulletin and Poster for 1932. The bulletin
contained the outline of a pro~am designed to aid in community
effort directed to the solution of important health problems, while the
poster was a pictorial notice calling attention to the date of the
observance of National Negro Health Week and stating the bbjectives
for 1932. The bulletin was effectively illustrated, with the text reduced to a minimum. The chief of the division was the representa.ti ve of the United States Public Health Service on the executive
committee of the national negro health movement. The bulletin and
poster have been issued by this division since 1924.
A technical publication on the Chemistry of the Opium Alkaloids
was edited and prepared for the printer in the division during the year,
and new editions of several previously printed publications were
·
issued.
PUBLIC HEALTH EDUCATION
During the fiscal year, 68 new service publications were distributed
by the division, as compared with 116 during the preceding year.
The smaller number of new publications distributed was due to the
lack of funds for printing. The total distribution of copies of new
publications and of editions of previously published documents aggregated 350,391, as compared with 528,257 for the fiscal year 1931.
Out of the 350,391 copies of publications distributed, 189,228 were
sent in response to individual requests for information. The remainin~ 161,163 copies were distributed to the various mailing lists maintamed by the bureau. This distribution includes all publications
printed and distributed by the bureau, except certain publications of
the Division of Venereal Diseases, the Public Health Service regulations, and the official service roster, distributed by the office of the
chief clerk and administrative officer.
There were 32 requests for the loan of stereopticon lantern slides
during the year. In response to these requests, 1,265 slides were
loaned to universities, health officers, public health lecturers, officials
of the Public Health Service, and others for use in visual education on
health subjects. As in previous years, it was not possible to supply
all of the slides requested, due to the fa.et that the work of the stereopticon library has been handicapped for some time by the shortage
of slides, and the lack of funds for making new slides and replacing
those broken or lost in shipment. Several new sets of slides were added
during the year, through the use of funds provided for this purpose.
Each year many requests are received by the Public Health Service
from State and local health authorities, scientific associations, colleges,
Digitized by
Google
132
PUBLIC HEALTH SERVICE
schools, and various other organizations for material that might be used
for the promotion of the public health through the display of exhibits on
public health subjects. For a number of years compliance with such requests was not possible, due to the lack of funds for the preparation of
suitable exhibit material. A small appropriation for the preparation of
exhibits designed to demonstrate the cause, prevalence, and methods
of spread of diseases dangerous to the public health and measures for
preventing them was available for use during this fiscal year. Several
creditable exhibits were prepared .. Among the subjects covered were
pellagra, tularaemia, and milk sanitation. Exhibits on smallpox and
vaccination, leprosy, trachoma, the proper illumination of rooms, and
on ships' medicine chests were presented at the meeting of the InterState Postgraduate Medical Association in Milwaukee, Wis., Octobet
19 to 23, 1931. Exhibits on smallpox and vaccination, leprosy, and
trachoma ;were presented at the annual meeting of the Southern
Medical Association in New Orleans, La., November 18 to 20, 1931.
These exnibits ·were also displayed at the meeting of the American
Association for the Advancement of Science in New Orleans during
Dect'imber, 1931, and January, 1932. An extensive exhibit on the
subject of poliomyelitis was prepared by the service in cooperation
with the committee on scientific exhibits of the American Medical
Association for display at the annual meeting of the American Medi.:.
cal Association:, which was held at New Orleans, La., May 9 to 13,
1932. Exhibits relating to the scientific investigations of the service
with regard to the treatment of leprosy and pellagra were also displayed at this meeting.
Equipment for the preparation of motion-picture films on health
subjects and the proper display of films, stereopticon slides, and other
exhibit material of the Public Health Service at public health meetings was obtained during the year. This material will be of considerable value to the Public Health Service in connection with efforts now
being made to aid in the control of the diseases of man by the di~
semination of public health information. PUBLICATIONS DISTRIBUTED BY THE DIVISION
The following is a list of publications distributed by the division
during the fiscal year:
REPRINTS FROM THE PUBLIC HEALTH REPORTS
1456. The Action of Sulphydryl, Iron, and Cyanide Compounds on the Oxy_gen
Consumption of Living Cells. By Sanford M. Rosenthal and Carl
.
Voegtlin. March 6, 1931. 19 pages.
1461. Phosphorus, Total Calcium, and Diffusible Calcium Content of the Blood
Sera of Lepers and Their Relation to Bone Changes. By Jerald G.
Wooley, with the technical assistance of Hilary Ross. March 20, 1931.
18 pages.
1463. Experimental Addiction of Animals to Opiates. By Lawrence Kolb and
A. G. Du Mez. March 27, 1931. 28 pages.
1465. Sickness Among Industrial Employees in the Second Half of 1930. April
3, 1931. 3 pages.
.
1466. Preliminary Report of Committee on Milk Production and Control,
White House Conference on Child Health and Protection. April 3, 1931.
42 pages.
1467. The Psittacosis Outbreak in Maryland, December, 1929, and January;
1930. By V. L. Ellicott and Charles H. Halliday. April 10, 1931. 8
pages.
Digitized by
Google
PUBLIC HEALTH SERVICE
133
1468. Influence on Epilepsy of a Diet Low in the Pella.gra-Preventive Factor.
By N. P. Walker and G. A. Wheeler, April 10, 1931. 10 pages.
1469. Studies on Meningococci Isolated in the United States, 1928-1930.. Serological Classification and Geographic Distribution. By Sara E. Branham, Clara E. Taft, and Sadie A. Carlin. April 17, 1931. 20 pages.
1470. Observations on the Assay of the Antineuritic Vitamin. Some of the
Factors Involved in the Use of the Rat Method. By W. H. Sebren and
E. Elvove. April 17, 1931. 9 pages.
1471. Significance of Positive Wassermann and Kahn Reactions in Leprosy.
By L. F. Badger. Arpil 24, 1931. 14 pages.
1472. The County Health Unit of Yesterday and To-day. By Fred T. Foard.
April 24, 1931. 7 pages.
1473. Fumigants. By C. L. Williams. May 1, 1931. 19 pages.
1474. Criteria for Maintaining Balance of Program in County Health Departments. By F. L. Roberts. May 8, 1931. 6 pages.
1475. Experimental Studies of Natural Purification in Polluted Waters. V.
The Selection of Dilution Waters for Use in Oxygen Demand Tests.
By Emery J. Theriault, Paul D. McNamee, and Chester T. Butterfield.
May 8, 1931. 32 pages.
1476. Public. Health Progress in Knoxville, Tenn. By Joseph W. Mountin.
May 15 and 22, 1931. 61 pages.
1477. The Epidemic of So-called Ginger Paralysis in Southern California in 193031. By Maurice I. Smith and E. Elvove. May 22, 1931. 9 pages.
1478. Development of the Proposed Morbidity Reporting Area. By R. C.
.
Williams. May 29, 1931. 6 pages.
1479. Studies on the Biochemistry of Sulphur. XI. The Substitution of Dithioethylamine (Cystine Amine) for Cystine in the Diet of the White Rat.
By M. X. Sullivan, W. C. Hess, and W. H. Sebren. May 29, 1931.
7 pages.
1480. Experimental Studies of Natural Purification in Polluted Waters. VI.
Rate of Disappearance of Oxygen in Sludge. By Emery J. Theriault
and Paul D. McNamee. May 29, 1931. 18 pages.
1481. Resume of Report on Sanitation and Yellow Fever Control in Liberia.
By H. F. Smith. June 5 1931. 7 pages.
1482. Venereal Disease Among Coast Guard Enlisted Personnel During the
Fiscal Year 1930. By W. W. King. June 5, 1931. 6 pages.
1483. Rocky Mountain Spotted Fever (Eastern type). Transmission by the
American Dog Tick (Dermacentor variabilis). By R. E. Dyer, L. F.
Badger, and A. Rumreich. June 12, 1931. 11 pages.
1484. Results of the Operation of the Standard Milk Ordinance in Missouri.
By Franklin A Clark and W. Scott Johnson. June 12, 1931. 12 pages.
1485. Report of Committee on Milk. Conference of State and Provincial Health
Authorities of North America. By Earle G. Brown. June 19, 1931.
5 pages.
1486. An Epidemiological Study of Typhoid Fever in Six Ohio River Cities.
By M. V. Veldee. June 19, 1931. 27 pages.
1487. Prevalence of Undulant Fever in the United States. By H. E. Hasseltine.
June 26, 1931. 5 pages.
1488. Studies in Asphyxia. I. Neuropathology Resulting from Comparatively
Rapid Carbon-Monoxide Asphyxia. By John Chornyak and R. R.
Sayers. June 26, 1931. 8 pages.
1489. Three Outbreaks of Food Poisoning Apparently Pue to B. Enteritidis,
B. Paratyphosus B (aertrycke type), and B. Paratyphosus A, Respectively. By J. C. Geiger, Margaret Nelson, J. P. Gray, F. Firestone,
and H. L. Wynne. July 3, 1931. 8 pages.
1490. Some Essential Considerations in Connection with the Rural Health
Program. By W. F. Draper. July 10, 1931. 6 pages.
1491. Public Health Service Publications. A List of Publications Issued During
the Period January-June, 1931. July 10, 1931. 4 pages.
1492. The Physical Examination as an Instrument of Research. By Rollo H.
Britten. July 17, 1931. 6 pages.
1493. A new Subspecies, Radicans, of Alcaligenes Faecalis. By Alice C. Evans
July 17, 1931. 4 pages.
1494. The Need for Continued Study in Public Health Work. By W. S. Leathers.
July 24, 1931. 11 pages.
1495. The Chemistry of Cell Division. II. The Relation Between Cell Growth
and Division in Amoeba Proteus. By H. W. Chalkley. July 24, 1931.
19 pages.
Digitized by
Google
134
PUBLIC HEALTH SERVICE
1496. Sickness Among Male Industrial Employees in the First Quarter of 1931.
By Dean K. Brundage. July 31, 1931. 2 pages.
1497. A Study of IllneBB Among Grade School Children. By Charles C. Wilson,
Ira V. Hiscock, J. H. Watkins, and Jarvis D. Case, with the cooperation
of John L. Rice. July 31 1931. 23 pages.
1498. Typhus Fever. The Rat Flea, Xenopsylla Cheopis, in Experimental
Transmission. By R. E. Dyer, E. T. Ceder, A Rumreich, and L. F.
Badger, August 7, 1931. 2 pages.
1499. Coordination in the Sanitary Control of Bottled Mineral Waters. By
W. S. Frisbie. August 7, 1931. 3 pages.
1500. Age and Sex Incidence of Influenza and Pneumonia Morbidity and Mortality in the Epidemic of 1928-29 with Comparative Data for the
Epidemic of 1918-19. {Based on Surveys of Families in Certain Localities in the United States Following the Epidemics.) By Selwyn D.
Collins. August 14, 1931. 29 pages.
1501. Dermatitis Venenata Due to Contact with Brazilian Walnut Wood. By
Louis Schwartz. August 14, 1931. 5 pages.
1502. Public Health Service in Knox County, Tenn. Fisaal Year July 1, 1929June 30, 1930. By Joseph W. Mountin. August 21, 1931. 18_pages.
1503. A Technique for Adjustment of pH of Hanging Drop Tissue Cultures.
By W. R. Earle. August 21, 1931. 11 pages.
1504. The Medical Profession and the Health Department. By A. J. McLaughlin. August 28, 1931. 7 pages.
1505. Expansion of Investigations on Tick-Borne Diseases by the United States
Public Health Service. By R.R. Spencer. September 4, 1931. 5 pages.
1506. A Survey of the Work of Employees' Mutual Benefit Associations. By
Dean K. Brundage. September 4, 1931. 18 pages.
1507. Cooperative Campaign for the Eradication of Plague in Peru. Final
Report. By John D. Long. September 11 1931. 8 pages.
1508. Occurrence of a Colony of the Tick Parasite Hunterellus Hookeri Howard
in West Africa. By Cornelius B. Philip. September 11, 1931. 5
pages.
1509. Extent of Rural Health Service in the United States 1927-1931. September 11, 1931. 14 pages.
1510. A Note on the History of Pellagra in the United States. By G. A. Wheeler.
September 18, 1931. 7 pages.
1511. Sleeping Car Parking and Sanitation at a Large Convention. By G. H.
Ferguson. September 18, 1931. 5 pages.
1512. The Catalytic Action of Copper in the .-Oxida~ion of Crystalline Glutathione. By Carl Voegtlin, J. M. Johnson, and Sanford M. Rosenthal.
September 18, 1931. 20 pages.
1517. Experimental Transmission of Endemic Typhus Fever of the United
States by the Rat Flea (Xenopsylla cheopis). By R. E. Dyer, E. T.
Ceder, A Rumreic-h, and L. F. Badger. October 9, 1931. 2 pages.
1520. Typhus Fever. The Experimental Transmission of Endemic Typhus
Fever of the United States by the Rat Flea Xenopsylla cheopis. By
R. E. Dyer, E. T. Ceder, R. D. Lillie, A. Rumreich, and L. F. Badger.
October 16, 1931. 19 pages.
SUPPLEMENTS TO THE PUBLIC HEALTH REPORTS
93. The Rat Proofing of Vessels. With Drawings Illustrating the General
Instructions for Rat Proofing of Ships Compiled and Promulgated by the
American Marine Standards Committee (H No. 41, Approved February
8, 1929). By S. B. Grubbs and B. E. Holsendorf. 1931. 84 pages.
96. Proceedings of the Conference of Representatives of Medical, Dental,
Pharmaceutical, and Veterinary Associations, and Other Scientific
Associations and Agencies with the Surgeon General of the United
States Public Health Service. Held at Washington, D. C., August 12,
1930. 1931. 77 pages.
97. Division of Mental Hygiene, United States Public Health Service. Laws
Establishing the Division and Authorizing Its Functions. 1931. 13
pages.
98. The Notifiable Diseases. Prevalence During 1930 in Cities of Over 100,000. 1931. 37 pages.
101. Public Health Administration in Colorado. By C. E. Waller. 1931.
79 pages.
102. Some Public Health Service Publications Suitable for General Distribution. 1931. 19 pages;
Digitized by
Google
PUBLIC HEALTH SERVICE
135
PUBLIC HEALTH BULLETINS
200. The Health of the School Child. A Study of Sickness, Physical Defects,
and Mortality. By Selwyn D. Collins, with an Introduction by Taliaferro Clark. August, 1931. 159 pages.
201. Transactions of the Twenty-Eighth Annual Conference of State and
Territorial Health Officers with the United States. Public Health Service,
Held at Washington, D. C., June 18, 19, and 20, 1930. April, 1932.
113 pages.
NATIONAL INSTITUTE OF HEALTH BULLETINS I
159. Key-Catalogue of Parasites Reported for lnsectivora (Moles, Shrews, etc.)
with Their Possible Public Health Importance. By C. W. Stiles and
Samuel F. Stanley. June, 1931. 121 pages.
ANNUAL REPORT
Annual Report of the Surgeon General of the United States Public Health
Service for the Fiscal Year 1931. 354 pages.
MISCELLANEOUS PUBLICATION
11. Official List of Commissioned and Other Officers of the United States Public
Health Service; Also a List of All Stations of the Service. January 1,
1932. 64 pages.
UNNUMBERED PUBLICATIONS
To a Patient En Route to the Marine Hospital, -Fort Stanton, N. Mex. 3 pages.
Index to Public Health Reports, Volume 46, Part 1, January-June, 1931. 30
pages. (Out of print.)
Index to Public Health Reports, Volume 46, Part 2, July-December, 1931.
27 :i;ages.
"National Negro Health Week Program. This pamphlet is published annually,
usua.Ily about the middle of March, for community leaders in an effort
to suggest ways and means by which interested individuals and organizations may be organized for a concerted and effective attack upon the
community's disease problems. Eighteenth Annual Observance. 1932. ·
16 pages. (Out of print.)
National Negro Health Week Poster. Eighteenth Annual Observance. 1932.
(Out of print.)
1 This series of publications was formerly Issued under the title of "Hygienic Laboratory Bulletins."
Th• name of the Hygienic Laboratory was changed to National Institute of Heelth by act of Congress.
approved May 26, 1V30.
Digitized by
Google
DIVISION OF MARINE HOSPITALS AND RELIEF
In charge of Asst. Burg. Gen. F. C.
SMITH
During industrial depression, even with a decline in shipping
activities, certain classes of beneficiaries apply for treatment, especially operations of election, for which in more prosperous seasons
they are unwilling to spare the time. The demands upon the marine
hospitals and other relief stations did not materially change during
the past fiscal year. The actual number of seamen beneficiaries has
probably not diminished even though sailings have been interrupted
and vessels laid up for periods. Moreover, unemployment among
sea.men tends to retard discharges from hospital of indigent convalescents, who are fearful of becoming public charges.
Economy in administration made it possible to return $293,793 to
the general treasury fund out of the annual appropriations. This was
largely due to lowered prices of commodities and the elimination of
waste. The average per diem cost in the 23 general hospitals was
$3.81, and for all the marine hospitals was $3.77. Hospital standards
have been fairly well maintained, although the ratio of medical officers,
nurses, and other hospital personnel to the number of patients is lower
than in most other government hospitals. · An aggregate of 137,672
X-ray examinations were made and 371,777 clinical laboratory examinations performed, including 74,868 examinations of blood for syphilis,
115,456 urinalyses, 28,949 sputum examinations, 2,157 dark field examinations for the early diagnosis of syphilis, 4,077 blood coagulation
timings preparatory to surgical operations, and 63,357 other examinations of blood. There were 540 autopsies performed in the marine
hospitals, representing 49 per cent of deaths occurrin~ in these institutions. There was a total of 88,833 surgical operations, major and
minor, which does not include 45,916 intravenous injections of salvarsan, arsphenamine, and kindred preparations.
There were 1,211 deaths in the marine hospitals and contract
institutions, including 247 from tuberculosis (all kinds), 245 from
diseases of the circulatory system, 91 from pneumonia and bronchopneumonia, 142 from cancer and other malignant tumors, and 62
from nephritis (acute and chronic). Alcoholism, acute and chronic,
caused 3 deaths, and cirrhosis of the liver 13; there were 45 deaths
from apoplexy; 41 from syphilis; and 58 from external causes of
which the most frequent was fracture. There were 9 deaths from
typhoid and paratyphoid fever.
The customary collateral functions carried out in addition to the
routine care of the sick included 76,179 physical examinations for the
Civil Service Commission, Steamboat Inspection Service, and other
Government agencies, the issuance of 5,826 certificates of medicinal
need of liquors aboard vessels, the instruction and examination in the
136
l'ligitized by
Google
137
PUBLIC HEALTH SERVICE
principles of first aid required by the Steamboat Inspection Service at
46 des~ated stations for ship's officers and candidates for licenses,
consunung a total of 2,579 hours by the medical officers engaged.
While there was a time when the majority of merchant seamen
who manned American vessels were foreign born, there is evidence
that Americans are returning to the sea. In the nativity of the
38,176 American seamen discharged from hospital, 35 countries were
represented, 28,052 seamen were born in the United States, 1,177 in
Norway, 951 in the insular possessions of the United States, 740 in
Canada, 715 in Germany, 706 in Sweden, and 492 in England.
The marine hospitals cooperated with the Division of Scientific
Research and with the Division of Venereal Diseases in investigative
and preventive measures in various ports.
CLASSES OF BENEFICIARIES AND AMOUNT AND CHARACTER OF
SERVICES RENDERED
Summary of aerrticea by claaa of beneficiary
Physical
examinations (not
related to
treatment)
Hospital days Out-patient
treatments
Class of beneficiary
Remarks
Number
Per
Per
Per
cent Num- cent Num- cent
of
ber
of
ber
of
total
total
total
994, 1198 57.37 491,289 50.55 9,937 13.05 Communicable diseases are
American merchant seamen.
Veterans ____________ ------ --
348,531 20.09
Lepers _________ •• ___ • --- -- -•
130,387
7.52
5,762
.67 1,092
------ ------
3 ------
Coast Guard personnel. ____
91,655
5.28 198,800 20.45 11,481 15.07
63,623
3.67 171,172 17. 61 20,002 26.26
38, 143
2.20 19,094
1.97
475
.62
.10
Seamen, Engineer Corps,
35,797 2.06 11,318 1.11
77
and Army Transport
Service.
Seamen from foreign vessels.
6,944
.40 1,123
. ll
8 -----9,077
.52 6,231
Seamen and keepers, Light.64
200
.26
house Service.
Alaska cannery workers --------- -----408
.04 4,869 6.39
leaving United States.
Pilots and other licensees ••• _ --------- ------ ------- ------ '6,935 9.11
•
Clvll servle11 applicants and
employees.
Shipping Board _____________
All others entitled to treatment.
Total_________________
re-
ported to local health officers.
1. '3 Patients of the Veterans' Admln-
lnjured Federal employees __
Immigrants _________________
,
lstratlon.
National Leper Home, Carville,
La.
All medical services and supplies,
ashore and afloat.
Patients of the Employees' Compensation Commission.
Patients of the Bureau of Imm!gratlon.
Civilian employees on Army
vessels.
Pay rcatlents.
.
.
Med cal supplies also furnished
to !lghtbouse vessels.
Vaccinations and other preventive measures.
For the Steamboat Inspection
Service.
the Civil Service Commls-------- 13,299 17. 46 For
sion.
1,910 2. 51 To determine fitness for sea duty.
-----------.89 66,920 6.88 5,894 7. 74 From Bureauol Fisheries, Army,
Navy, Mississippi River Commission, Coast and Geodetic
Survey, etc.
--------- ------ -------------------15,353
1,734,508 100. 00 972,110 100.00 76,179 100.00
DENTAL TREATMENT
The total cost of all dental treatment at marine hospitals and
relief stations, including salaries of dental officers, ·dental internes,
hygienists, nurses, assistants, technicians, supplies, repairs to equip-
Digitized by
Google
138
PUBLIC HEALTH SERVICE
ment, and all overhead cost was, $291,476.32. Had this amount of
treatment been procured at authorized fees by employing contract
dentists, the total cost would have been $941,887.96. The amount
of treatment rendered by the full-time officers shows a substantial
increase over last year due to better trained personnel and more
convenient facilities at the stations. The major items were as follows:
Item
1931
Number of patients treated ••............................................•...•••
Number of sittings ....•..............................•.•.•.•.•...........•.•.••.
X-ray exposures.•••.•...•.•••............••...•............•.....•..•..•.•......
Prophylactic treatment (hours) ......•......••.•.................•..............
Vincent's stomatitis treatment (hours) ..•.••.••..••...••.•••...••••....••..•••••
Pyorrhea treatment (hours) ...•...•.............•.•.......•..•.................•
Extractions ..••.••........•....•..•....................•....•......•...•........
Alveolectomy .•.•.•.•..•...•.••••..•..............•.....•........•....••. -..... .
Alloy·flllings ••....... ·....•....•.•............................................
Gold inlays ..•. ·••.•...................•.••..•........••..•..•..•..............
Porcelain crowns •...•.......•......•.•.....•.•..............................•...
Silicate cement fillings ...........•.••.........•........•.•...........•.....•.•..
Dentures (full and partlal). ••••••.•••••. : •••••.•••.•.•.••...•.. a., ..••.•••••••..•.
Bridges ••••.....•.....•...•...•..........•.............•......................•.
Fracture cases (hours) ••....•...............•...•...............•.•••..••.••...•.
Total number or treatments rendered •.•..•...•............•...........•........
1932
116,952
203,271
39,635
22,726
6,101
4,254
71,206
B,685
37,355
2,266
53
U,261
6,499
1,876
6111
585,536
65,556
131,478
21,291
6,175
3,567
2,218
43,344
954
23,618
736
91
8,211
3,148
1,342
335,ffl
I
In addition to the above, 4,047 patients were treated at 32 smaller
stations by contract dentists on a fee basis at a total cost of $31,683.
Contract treatment, which is restricted to purely emergency or routine
treatment, averaged $7.82 per patient, while that performed by the
full time dental officers, including all classes of treatment, averaged
$2.50 per patient.
Senior Dental Surg. C. T. Messner is in charge of dental activities
in the field and the bureau.
COAST GUARD
The average number of Coast Guard beneficiaries on active duty
and retired was 13,189. The character and comparative amounts of
medical service furnished in recent years are shown by the following
table:
Numerical strength or Coast Guard and medical
services given
Year
.
Number or
Coost
Guard
personnel
Physical
Hoapital Out-patient examina•
days
treatments
tions
Average amount of medical
service per person
Hospital
days
Out•
patient
treat•
ments
Phyaical
examina•
tions
--- --1923. ••·•·····•·····••··
1924. ··•·•···•··•·······
1925.•••.•.•......•...•.
1926. •··•···•·•••·······
1927·•••••••·•····••••••
1928 .................•..
1929 ..•........•........
1930 ..•..........•......
1931.. •···•·•········•··
1932 .• ·•·•·····••···•••·
4,684
4,896
7,077
9,839
10,984
12,462
12,8:m
12,963
13,020
13,189
41,681
36,504
60,336
71,799
76,564
85,691
88,870
90,179
86,829
91,655
32,530
45,857
90,494
125,226
155,977
137,971
169,697
196,334
187,063
198,800
4,207
7,008
13,394
19,061
18, 787
17,220
17, 748
14,382
8,262
11,481
Digitized by
8.9
7.6
8. 5
7. 3
6. 9
6.9
6.9
6.9
6. 7
6.9
6. 7
9.4
12.8
12. 7
14. 2
11. 0
13. 2
15.1
14.4
15.1
Google
0.9
1.5
1. 9
1.9
I. 7
1. 4
1.4
1.1
.6
II
'
PUBLIC HEALTH SERVICE
139
Twenty-four medical and dental officers are assigned exclusively to
Coast Guard duty, and 103 local physicians, under appointment as
acting assistant surgeons, furnish medical and surgical relief and make
physical examinations of Coast Guard and Lighthouse Service personnel at isolated units remote from any Public Health Service relief
station.
. Medical officers have been assigned, as usual, to the cutters on the
international ice patrol and to those on the cadet practice cruise in
South American waters. Medical officers have been assigned to the
Bering Sea patrol, and a dental officer was stationed at the patrol
base at Unalaska durin~ the cruising season. A medical officer and
a dental officer are assigned to the Northland on its annual Arctic
cruise to Point Barrow, Alaska, and in addition to their care of Coast
Guard personnel, they extend medical, surgical, and dental relief
to a considerable number of Alaskan natives and others to whom such
relief is not otherwise available. Valuable scientific observations
have also been made of medical, sanitary, and dental conditions
among the natives.
The dental unit installed during the previous year at the Coast
Guard depot, Curtis Bay, Md., has decisively proved its value. It
is in charge of a dental officer and serves a large personnel of vessels
undergoing repair, in addition to that of the depot. The same may
be said of the dental unit at Coast Guard section base No. 2, Stapleton, N. -Y., operated from the marine hospital, Stapleton, by a dental
officer of the hospital staff. These dental units reach a large number
of Coast Guard patients, many of whom would not otherwise receive
dental attention, and save a very large amount of time of Coast
Guard patients. In addition to the usual medical, dental, and surgical supplies furnished the Coast Guard, one new cutter and seven
new patrol boats have been equipped. Additional new outfits for one
cutter and several patrol boats will be required during the coming
fiscal year.
The high standard of physical examination performed at marine
hospitals and elsewhere in the field has been maintained. In view
-of the benefits provided by law for disabilities incurred in service,
it is necessary to exclude persons having physical conditions that may
lead to early disability and claim for pensions.
Medical Director W. W. King is assigned to duty at Coast Guard
headquarters as representative of the Surgeon General and chief of
the medical section.
OPERATING COSTS
The total amount expended during the fiscal year 1932 included
the equipping of the new hospitals at San Francisco, New Orleans, and
Galveston.
The appropriation for 1932, $6,664,479, was augmented by reimbursements from the Veterans' Administration in the sum of
$1,387,129, making a gross total available of $8,051,608. A reserve
of $164,479 was set up for the year, making the net amount available
for expenditure $7,887,129. Owing to the low cost of subsistence,
furniture, furnishings, fixtures, and other supplies and equipment, it
was possible to make an additional saving of $182,349.
144391-32--10
Digitized by
Google
140
PUBLIC HEALTH SERVICE
According to the classification used by the General Accounting
Office, the several items of expense were as follows:
01
-0200
1210
-0220
-0230
0250
0260
0280
03
04
0500
0510
06
07
10
1100
1110
1280
1290
1373
1375
1380
2250
3000
3010
3020
3040
3050
Personal services ________________________________________ $4, 072, 989
Janitors and sundry supplies, X-ray films, etc_______________
95,161
Medical and hospital supplies_____________________________
353,030
Scientific and educational supplies _______________________ - 5, 124
Fuel (coal, oil, and gas)__________________________________
161,815
Forage_________________________________________________
34,040
Provisions______________________________________________ 1, 048, 730
Sundry supplies ___________ ~----------------------------78,238
Subsistence and support of persons (contract care)__________
537, 635
Care of animals_________________________________________
59
Telegrams______________________________________________
735
Telephone______________________________________________
24, 700
Travel expenses_________________________________________
95, 430
Freight________________________________________________
126,616
Furnishing heat, light, power, and water___________________
195,548
Rent of buildings and offices______________________________
26,914
Other rents_____________________________________________
5, 443
Repairs and parts, motor vehicles_________________________
7,381
Alterations and repairs, building equipment________________
31,831
Sundry service__________________________________________
53, 893
Ash and garbage removaL _ _ _ __ _ _ __ _ __ _ __ _ __ _ __ _ __ __ _ __ __
1, 763
3,776
Miscellaneous services___________________________________
Burials________________________________________________
22,273
Motor vehicles_________________________________________
14,593
Furniture, furnishings, and fixtures________________________
389, 157
Scientific equipment_____________________________________
259, 635
Livestock---------"-----------------------------------421
Other equipment________________________________________
57, 850
7,704,780
ABSTRACTS
OF REPORTS
FROM MARINE HOSPITALS
RELIEF STATIONS
AND
SELECTED
Representative activities have been selected from the annual
reports of these stations. A tabulation of all the transactions will be
found on pages 150 to 157.
Marine Hospital, Baltimore, Md.-Medical Director R. H. Creel, in charge.
Construction work was begun on the new marine hospital, a 6-story building of
Georgian type of architecture, with 380 beds, auxiliary services, and utilities.
The operation of the old hospital has created administrative difficulties incident
to moving certain old wards, abolishing others, and converting to ward use
structures not originally intended for hospital purposes. All beds were kept constantly filled; the average census exceeded the normal by 20 patients, the excess
being cared for by beds in aisles and other places not intended for wards. An
electrocardiograph was procured with competent service and the facilities were
otherwise improved. Avertin was used in both surgical and dental cases as a
general anesthetic, and spinal anesthesia was extensively employed in both minor
and major surgical operations. Of hospital patients, 66½ per cent were merchant
seamen, 11 per cent Coast Guard men, and 5 per cent patients of the Employees'
Compensation Commission. Of the total in-patients, 39 per cent were surgical
cases, 31 per cent medical, 29 per cent genito-urinary, and 3 per cent tuberculous •
. Patients of the Employees' Compensation Commission, of whom there were 400
treated and 566 given special medical examinations, involved considerably more
administrative attention than other groups on account of the detailed reports
.to be rendered and the execution of various forms. Longshoremen cases also
involved the preparation of detailed reports. Of 167 beneficiaries of the Veterans'
Administration, 11 per cent were admitted for venereal disease, 11 per cent for
herniae, 7 per cent, hemorrhoids, 6 per cent, lacerated wounds, 6 per cent, malignant growths, and the others for a variety of conditions such as arthritis, gastric
ulcer, arterial hypertension, tonsillitis, and other minor ailments chiefly of nonservice connection. There were 1,373 operations in the general surgery section
Digitized by
Google
r
ll)Rl!AL
OJ<>tlP
or
m&PHALIS
IDCA'!'IOJ
DAYS
..
--·-- --
.
,
m
__
-·
·----· -·-·
1111 ■
bland
·-
..,. .... ,.111
I , T.
hxa.1 .
Gal•li•too
...
...... ..."",.,
"
..
..
r.,. f a•t na
!911.1:1. .
"
Jn Orl.an1, La .
Mamnbh
"·
GtliEB.AL
·--·---
..
Pitt b.r,h
.
•..a.,...........
·8t
, ... , .
0
Per
"'
41 ■111
Mo
l)a .
-
-~·"
'l'otAl Rel tof DP._vs
CJ
TUBHCUW SIS
SA!IA1'0IUUII
0
a
Fort Stanton, 11 . M.
TOTAL
..'.,.. ... ....
,,
...
,.
.. ..... ...
.. ,.,,..
. ,. "
'"
4
ch
,," .,,
''"
4 n1
. ..
,. nn
• o,
,, ...-.,,
,.. 1••
...
.......
........ ...
...
·-..
.
.. ""' . ...
' 7~
' •4
oh
"
...
...
. ..,,
..
• n<
.. •=
"n<
"" .,
.
"'"'"
"'"
,,
'o,
h ••
,
J ,Sl
2.}0
1,J54,q72
1!14,l!IU
'"
.,,
- ,.
-"'.,,
n,
Co it
J.s6
1,50
Coot
Can·Ule, La .
ALL
, 47
n,
l}0,}56
J.)O
Ll!PK>SARIUM
~
UWIIIS
, <•
co•t for 0.oan.l 8o9f)1 tal •
N.
~
-~
., ""
,.
,n M •
too. I. Y.
-·
l UleT&rd JPl'f'eD. M••· .
la\
••• ·--~ • y
co·
'"'"'
'"' ,,4
"
Jla
u•
.
,<o
<S ...
If. 1' .
Bu!f•t.
,
c;?"
<Xll5T PD PA!'mn' DAY
l!J:LID
1,93
Coit
,.11
Per dhm cost for all baspttah
Belhf day• (o r all ho1p1tah
1,570 ,169
2 .2'
Coot
JOOD
OTHO
4<
Other
f7ZZZZZI
I
....
....
. ..- 1 1 l
..
... "'
,.
. ..,'".
to " '
c::::::::J
foo 4
Salariu - -
Statton
Rat toe
~
Produc t100
l 14
"
I 0'
""
4<
17
n,
4,
,o
,,
""
07
""
.,
"'
.-.
..
.c
4n
47
47
..
4n
."6
,,
·n
n1
'
...."'
V
.,
.,,
-
.,, .,
r///////A
1.05
S'J.161 ,601 .,.
•77
1. 59
///
///////
~
S }27 ,4J9.92
.45
.92
/
'//
A
S 430,221.96
,4s
1.06
v,
' / / / /j
S5,919,26J.o6
(a) In-patient department of station closed.
AVERAGE PER DIEM COST OF IN-PATIENT RELIEF. UNITED STATES MARINE HOSPITALS, FISCAL YEAR. 1932
ci
::E
\
w
l
0
0:
~
1...J
<(
al
j
<(
l-
a.
(/)
0
I
li wz
l· r,,
l'f J.• : o:
,, ,,
•
<(
::E
(/)
w
I
I<(
1-
(/)
0
w
12
:J
J
I
I
,
I
140---2
Digitized by
Google
11'.
J
<(
u
8
U)
u
z
<(
0:
11.
z
<(
(/)
j
<(
t-
o:
U)
0
:r:
w
z
it<(
::E
U)
w
t<(
t-
(/)
0
w
t:
z
:::i
140-3
Digitized by
Google
Digitized by
Google
PUBLIC HEALTH SERVICE
141
exclusive of surgical procedures in the genito-urinary section, dental clinic, and
,eye, ear, nose, and throat department. Major operative procedures included 108
appendectomies, 133 herniotomies, 56 cystoscopies, 147 tonsillectomies, and 6
gastro-enterostomies. Sixty-four per cent of the patients were given spinal
anesthesia, 24 per cent inhalation anesthesia, and 12 per cent avertin, which was
used 48 times for surgical anesthesia during the year and found to be safe and
8atisfactory. It was usually not supplemented by either gas or ether. Spinal
anesthesia was satisfactorily administered 251 times, thus following the general
trend away from prolonged general anesthetics. There were 52 admissions for
pulmonary tuberculosis. Two insane patients were transferred to State institutions without service obligation, and 4 were sent to St. Elizabeths Hospital. ,
A total of 3,852 injections of bismuth and mercury were given to syphilitic
patients, and 3,801 such patients were given injections of neoarsphenamme. A
routine spinal puncture was performed after the third injection of arsphenamine.
Twenty-eight patients with central nervous system lues, most of them in the late
stage, were treated with malarial inoculation with satisfactorl'_ results. Hyperthermia has been introduced for treatment of neurosyphilis. The dental service
gave 21,526 treatments, and the physiotherapy department 14,751, the clinical
laboratory performed 27,137 tests; 11,183 X-ray exposures were made, including
2,283 in the dental unit. There were 36 deaths and 15 autopsies.
The total expenditure amounted to $332,822.
Marine Hos-pital, Boston, Mass.-Medical Director A. D. Foster, in charge.
The daily average number of patients was 1.51. The total admitted was 1,663,
classified as follows:
Merchant seamen _______________ 803 United States Public Health ServCoast Guard men _______________ 599
ice__________________________ 35
Immigrants and alien seamen____ 76 Coast and Geodetic Survey______ 16
EmJ?loyees' Compensation ComLighthouse Service______________ 13
mission______________________ 70 Bureau of Fisheries_____________
5
Foreign seamen_________________ 42 All other beneficiaries___________
4
There were issued 1,629 permits for medicinal liquor to be used on board ship
and, in co'lperation with the Division of Foreign Quarantine, 2,469 port sanitary
statements. Three insane patients were transferred to St. Elizabeths Hospital
upon the request of relatives. Two tuberculous patients were sent to Fort
Stanton. There were 7,659 surgical operations, 5,190 X-ray exposures, and 18,343
ph,)'siotherapy treatments.
The total expenditure amounted to $244,421.
Marine Hos-pital, Buffalo, N. Y.-Surg. Floyd C. Turner, in charge. Although
8hipping on the Great Lakes has declined, the normal bed capacity of 85 was often
exceeded during_ the year. The maximum number of patients was 91 and the
minimum 71. There were 4,236 surgical operations, major and minor, the more
difficult being performed by the attending specialists in surgery, orthopedics,
opthalmology, otorhinolaryngology, and urology; 1,979 X-ray exposu1-es; 4,551
physiotherapy treatments; and 9,004 dental treatments. The laboratory technician has, during the past two years, trained herself for X-ray technician duties.
Staff meetings, held weekly, were attended by the chief nurse, dietitians, aides,
and technicians, as well as by the medical and dental st!l.ff. The educational talks
to patients and others on the prevention of disease, first aid, etc., were continued,
~ecial lectures being given to Coast Guard, post office, and lighthouse personnel.
The Erie County Hospital Council met twice at the marine hospital. The personnel
of the marine hospital contributed to the local joint charities fund 203 per cent
over the quota expected of them. A national hospital day program was carried
out in cooperation with local hospital agencies.
A new method of treatment for peptic ulcer with mucin was used, with good
clinical results. The State hospital for the insane furnished malarial blood and
professional advice in the care of cerebrospinal syphilitics. Investigation was
made of the method of treating gonorrhea by diathermy, and laboratory arrangements were completed for growing maggots foe the treatment of chronic osteomyelitis. Upon request, 2 mentally disturbed patients and 6 others with chronic
ailments were defivered into the custody of relatives; 3 others needing chiefly
custodial ~re were placed in local institutions without service obligation.
The total expenditure amounted to $139,714.
. Marine Hos-pital, Carville, La. (the National Leper Home).-Surg. 0. E.
Denney, in charge. The average number of patients was 356, the normal working
capacity of the institution, as it has been necessary to devote a number of cottages
Digitized by
Google
142
PUBLIC HEALTH SERVICE
to infirmary use. Eighty patients were admitted, the largest number in thehistory of the hospital; of thelkl 64 were new, 2 were paroled patients who had
relapsed, 9 were paroled patients who returned for a brief period of observation,
and 5 were returned absconders. Of the general group, 20 died, 2 were deported
by the Bureau of Immigration, 4 absconded (1 of these returned), and 26 were
discharged, leprosy arrested and no longer a menace to public health. Twentyfour States, 4 insular possessions, and 20 foreign countries are represented in the
nativity of patients, the gre!l.test frequency of admissions being, in the order namPd,.
from the States of Louisiam\, Texas, Florida, and California. Intramuscular
injections of chaulmoogra oil-benzocaine were given as routine treatment twice a
w.eek to 172 patients, the average dose being 5 cubic centimeters, and 185 patients.
are taking chaulmoogra oil by mouth in doses of from 5 to 50 drops three times
daily, the maximum dose attiiined being 125 drops three times a day. Injections.
given during the year includedBenzocaine-chaulmoogra oil (intramuscularly) ______________________ _ 9,760
Ethyl esters of hydnocarpus ______________________________________ _
402
Bismuth salicylate ______________________________________________ _
68
Neosa.lvarsan (intravenously) _____________________________________ _
78
Calf serum (intradermal) _________________________________________ _
36
Smallpox vaccine (intradermal) ___________________________________ _
190,
Mercurochrome (intravenously) ___________________________________ _
30
.Others _________________________________________________________ _
60
TotaL _____ ------ ________ · ________________________________ 10, 624
Several new experimental treatments -were essayed without significant results,
including the use of erysipelas streptococcus antitoxin intramuscularly in doses
averaging 10 cubic centimeters. Intramuscular injections of the ethyl esters of
chaulmoogra oil and of the hydnocarpus were continued to a diminishing number
of patients. It seems evident that neither of these ethyl esters is specific for
leprosy, although they may be of benefit in somewhat the same way that cod-liveroil is in tuberculosis. A technique is being worked out for the systematic administration of arsenic by mouth in such a way as to eliminate the danger of arsenical
keratosis of the palms and soles. Seventy patients whose blood serum contained
low diffusible calcium, even though the total calcium was normal, were treated
with viosterol with encouraging clinical results.
The attending specialist in eye, ear, nose, and throat visits the hospital weekly
and holds a clinic, with an average attendance of two-thirds of the total patients.
He performed 146 specialistic operations and supplied corrective refractions for89 patients. The attending specialist in neuropsychiatry was consulted in 246
instances and examined 165 patients. Of 12 psychopathic patients now under
treatment, 5 are confined in the psychopathic ward. The attending specialist in
orthopedics treated 321 patients; preventive treatment of deformities such as
those due to tendon contractions is considered very important. The dental officergave' 3,213 treatments to leper patients. The laboratory has cooperated with the
Division of Scientific Research; a full-time bacteriologist was added to the staff
to attempt to correlate results in the culture of acid-fast bacilli encountered in
lepers. A report on the comparative behavior in the presence of rabbit leucocytes.
of 50 acid-fast bacilli obtained culturally from lepers is being published in the
Archives of Dermatology and Syphilology. The bacterioscopic examination of
patients and reexamination of paroled patients occupied considerable time, an
average of 100 patients being examined monthly. Sixteen autopsies were performed (80 per cent of deaths), and the gross and histologic findings were added
to the permanent clinical records. In the X-ray department a special technique
for soft tissue delineation was developed to show leprous skin lesions.
The station dairy produced all milk and cream consumed at a cost of approximately $7,500 less than market delivery prices. Five carloads of beef cattle and
hogs were shipped from Fort Stanton, N. Mex., and slaughtered on the station at
an estimated saving of $2,000 under purchase price. By station labor, canvas
awnings on 560 windows in patients' cottages were replaced by permanent awnings.
of corrugated asbestos shingles attached to cypress frames .. Landscaping was
continued by the station force. The patients' outdoor recreation facilities include
a golf course, baseball diamond, and tennis and soccer ball courts. The Sixty-Six
Star, published by a group of resident patients, contributes materially to the inter-est and enjoyment of the clientele. Sound pictures have been successfully introduced for the biweekly entertainments. Banking transactions amounting to.
$29,295.85 were handled for the patients with a local bank.
Digitized by
Google
PUBLIC HEALTH SERVICE
143
The Association of Military Surgeons, the American Society of Clinical Pathologists, and the American Medical Association sent large delegations to visit the
hospital, where demonstration clinics were held by the resident and visiting staff
for their benefit.
The total expenditure amounted to $459,399.
Marine Hospital, Cfiicago, Ill.-Medical Director J. W. Trask in charge.
Although a smaller number of boats is actively engaged in lake shipping than in
normal times, the number of seamen patients has at all times kept close to the
hospital bed capacity and sometimes exceeded it. There were 12,298 dental treatments, representing a considerable increase over last year with the same per.sonnel, and 5,497 surgical operations were performed. The clinical laboratory
work has been extended and its facilities have been improved and effectively
coordinated with the medical service; 12,844 examinations were made. With the
view of facilitiating diagnosis and reducing the duration of hospital care the use of
X ray has been extended; 4,948 Rontgenograms were made. The physiotherapy
department gave 12,031 treatments. There were 32 deaths and 11 autopsies.
The total expenditure amounted to $267,696.
Construction has commenced on the new hospital wing and other hospital
buildings, which are to be completed about July 1, 1933.
Marine Hospital, Cleveland, Ohio.-Medical Director L. P. H. Bahrenburg in
·-0harge. The building program and landscaping of the reservation were completed. In spite of temporary recession in lake shipping, the activities of the
hospital have increased. Owing largely to the policy of giving the maximum
number of beds to the Veterans' Administration, the hospital census has seldom
fallen below 240 and several times reached 268. A total of 1,413 patients· were
treated for medical conditions and 942 in the surgical section, where 4,969 surgical
,operations were performed. The dental department furnished 20,478 treatments, including 2,690 extractions and 2,032 fillings, and made 246 dentures.
The dental officers have continued to take practically complete charge of all jawfracture cases, of which 11 were treated during the year. A total of 27,340 tests
were made in the clinical laboratory, including 5,683 Wassermann and Kahn
tests, 4,734 blood cell counts, 7,358 urinalyses, and 2,313 sputum examinations.
There were 105 deaths, 87 among beneficiaries of the Veterans' Administration,
.and 69 autopsies. Physiotherapy treatments numbered 15,623,. and 9,548
Rontgenograms were made.
The total expenditure amounted to $361,364.
Marine Hospital, Detroit, Mich.-Surg. J. H. Linson in charge. The hospital
was filled to capacity throughout the year with an average of 130 patients; the
minimum was 116 on July 26, 1931, and the maximum 140 on October 26, 1931.
A strip of land adjoining the hospital reservation, needed to complete the building
program, was condemned and occupied by the Government, and construction was
begun on the additional hospital buildings, consisting of a 100-bed wing, quarters
for officers, nurses, and attendants, a storeroom, and a laundry. Nearly half the
hospital patients are veterans, to whom, owing to the depression in shipping, it
has been possible to assign an unusual number of beds. Slightly more than 76
per cent of the out-patients were merchant seamen and other old-line nautical
beneficiaries. There were 13,741 dental treatments, of which more than half
were for out-patients, and 13,197 physiotherapy treatments. There were 65
<leaths and 43 autopsies.
The total expenditure amounted to $199,993.
Marine Hospital, Ellis Island, N. Y.-Medical Director C. H. Lavinder in
,charge. Although 42 per cent of admissions to this hospital were detained immigrants or outgoing aliens, 85 per cent of the hospital relief furnished was for mer·Chant seamen and other old-line beneficiaries, because immigrants are usually
detained for only a few days whereas merchant seamen are treated for long
periods. The average number of patients was 448 and the maximum number
-024. It is necessary to hold certain wards in reserve for various classes of immigrants and mental, contagious, and other cases.
· A cardiac clinic has been established which examines from 70 to 80 per cent of
.all patients admitted. In the genito-urinary service, which handles the largest
number of patients treated, some research was done in the treatment of various
kinds of ulcer with metallic dusting powders; the use of sero-vaccine developed
at the station was continued in the treatment of gonorrheal urethritis and its
<iomplications; in the treatment of syphilis of the central nervous system and certain of the complications, nonspecific protein fever therapy supplemented routine
treatment; and general thermotheraphy has been introduced. The average
number of patients in the tuberculosis wards was 124, and the average number
Digitized by
Google
144
PUBLIC HEALTH SERVICE
of these undergoing pneumothroax treatment was 26; 774 refills were made.
The psychopathic and neurological department has been expanded. Post-traumatic lesions and neurosyphilis comprise the majority of neurological cases.
and an average number of 30 insane patients are under treatment. In the nose
and throat clinic, 6,623 examinations and treatments were given and 368 operations performed, chiefly tonsillectomies, submucous resections, and sinus drainage. The physiotherapy department gave 15,249 treatments; the dental department 25,848 treatments; 8,236 X rays were made, and 36,156 laboratory examinations performed. There were 87 deaths and 56 autopsies. Convalescent care
was furnished without expense to the service to 112 patients; 461 convalescents
were given lodging and meals for periods of more than one week by various seamen agencies, and 134 others were furnished with temporary care. Work was
obtained for 93 patients, 327 were furnished with necessary clothing, and aid of
various kinds was rendered to 2,477 patients through the collection of wages,
legal advice, attention to baggage, or contact with relatives. Assistance was
furnished through the New York chapter of the American Red Cross and also
from a special fund collected for seamen in the port of New York by a committee
of welfare agencies. With this assistance from private agencies the hospital has
pla:ved no small part in the relief of sick and destitute seamen in the port.
The total expenditure amounted to $705,893.
Marine Hos-pital, Evansville, /nd.-Surg. Lynne A. Fullerton in charge. The
rated capacity of this hospital, 54 beds, has been constantly exceeded, and at
times 76 patients were in hospital. About two-thirds of the patients were veterans, a great many of whom were suffering from emergency surgical conditions.
Of 5 insane patients, 2 were transferred to St. Elizabeths Hospital, Washington.
D. C., 2 were committed to the Evansville State Hospital for the Insane, and thecare of 1 was assumed by the Veterans' Administration.
The total expenditure amounted to $83,224.
Satisfactory progress is being made with the construction of a 3-story brick
building containing kitchen and dining rooms; surgical and dental operating
rooms; X ray, physiotherapy, and laboratory facilities; and wards and private
rooms for 30. beds. It is anticipated that the new building will be ready for
occupancy about April 1 1933.
Marine Hos-pital, Fort Stanton, N. Mez.-Surg. R. L. Allen in charge. Ninetyfour per cent of patients admitted here are merchant seamen or other old-line
beneficiaries. The daily average number of patients under treatment was 232.
Of 84 tuberculous patients discharged, 11 had disease arrested or apparently
arrested, 50 were improved, 14 unimproved, and 9 died. The low death rate is
ascribed to a more careful selection of patients transferred to Fort Stanton and
to intensive treatment, particularly pneumothorax (30 patients with 1,143 refills),
phrenic exeresis (50 patients), dentistry, oleotheraphy, heliotherapy, Sauerbruch
diet, and insulin for malnutrition. Occupational therapy is a valuable adjunct
to treatment; 86 patients were given instruction in leather work, weaving, and
various crafts. The superintendent of education of the State of New Mexico
furnished correspondence courses to the patients, 41 enrolling. The averagestay of tuberculous patients discharged, and fatal cases, was 838 days.
Patients approaching fitness for discharge are given paid employment to test
their recovery; 24 were employed as attendants and 25 others engaged in gainful
private occupation, the total estimated earnings amounting to $12,000. The
new sound picture equipment operates satisfactorily and is a great source of
pleasur.e to the ambulatory patients, for whom two entertainments are given
weekly. The radio is the principal source of entertainment for the infirmary
patients, all of whom have headsets. Acknowledgements are due the Trowe}
Club, Seamen's Church Institute, Christmas Committee, and other organizations:
generously providing recreation of various kinds. A Catholic and a Protestant
chaplain living at the sanatorium provide regular religious services and administer
to the spiritual needs of the si~~ and dying.
The production of milk, beef, and pork on the station farm has been continued,
but limited strictly to the needs of the sanatorium and to those of the National
Leper Home, to which five carloads of cattle and hogs were shipped during the
year.
The total expenditure amounted to $358,062.
Marine Hos-pital, Galveston, Tex.-Surg. Joseph Bolten in charge. This new
hospital was occupied on November 16, 1931. In addition to the main hospital
building with attached wing for kitchens and laundry, there are nurses' quarters,
attendants' quarters, one single and two double sets of officers' quarters, a recre-ation building, and a garage. On January 1, 1932, the rated capacity of 100 beds·
Digitized by
Google
PUBLIC HEALTH SERVICE
145
was exceeded, and during the last four months of the year the number of patients
has ranged between 165 and 175; the greatest number under treatment at one
time was 195. By utilizing the large porches which extend the full length of
each ward, overcrowding has been avoided. Approximately one-third of the
patients are beneficiaries of the Veterans' Administration. The outpatient office
has been continued in the post office building down town. Port sanitary statements, 3,510 in number, were issued to 988 ships.
In addition to the resident staff there are 13 attending specialists devoting
from one hour per week to four hours per day to hospital duties. A full-time
dental officer, with a dental hygienist to assist, furnished 9,469 treatments. The
physiotherapy department gave 5,706 treatments. The laboratory is well
equipped; a full-time technician performs practically all work except tissue examinations, which are sent to the National Institute of Health. The X-ray work
is done by an experienced technician, supervised by an attending specialist in
Rontgenology who devotes from two to three hours daily, five days per week, to
this work. Deep X-ray therapy and radium treatment are furnished at the office
of the attending specialist.
Landscaping has not been completed although through the courtesy of friends,
shrubbery and trees, and flower seeds were obtained and planted.
The total expenditure amounted to $192,141.
Marine Hospital, Key West, Fla.-Surg. M. S. Lombard in charge. The hospital
annex building, a 3-story structure, communicating at each floor level with the
main building, was completed by contract and occupied in March, 1932, increasing
the capacity of the institution to 100 beds and providing a large recreational hall,
the benefit of which in this isolated community was soon evidenced by the favorable psychological effect on ambulatory patients. At the request of the Veterans'
Administration to provide additional beds for colored patients, an extension to
the colored ward was also built by station labor and occupied on June 30, 1932,
adding 12 beds and giving a total ward capacity of 112. A small outbuilding was
also converted into a much needed isolation ward containing two small bedrooms,
a toilet, and a glass-inclosed porch, comfortably housing a patient and special
attendant. The need for an isolation ward is evidenced by the fact that one case
of acute poliomyelitis and two cases of smallpox were admitted during the year.
The salt-water supply system was improved, and the quantities of rain water
were increased by properly guttering the hospital buildings, thus diminishing the
considerable expense of purchasing fresh water which, on this island, must
necessarily be either rain or distilled water.
The hospital continued to operate at full capacity, the greatest number of
patients, 115, being in hospital on June 15, 1932. The majority of patients are
from the Veterans' Administration, but old-line beneficiaries are sent from Tampa,
St. Petersburg, Miami, and Fort Laudei:dale. There were 366 major surgical
operations and 1,965 minor operations. The dental officer furnished 9,068 treatments. The laboratory made 3,592 examinations, and 3,498 X-ray exposures
were matie. Three cases of leprosy were diagnosed clinically for the Florida State
Board of Health. Progress was made in beautifying the grounds, for assistance
in which project and other matters acknowledgment is made to the Navy Department.
The total expenditure amounted to $147,412.
Marine Hospital, Louisr,ille, Ky.-Medical Director J. S. Boggess in charge.
To replace this hospital, which was built in 1848 and has a bed capacity of 83, a
new 100-bed hospital building is being constructed on the grounds which will be
completed in the spring of 1933. The old hospital building will then be converted
into quarters which are at present lacking for nurses and certain other personnel.
The resident staff is supplemented by attending specialists from the city. The
attending specialist in surgery examined 823 patients and operated upon 163;
the attending specialist in internal medicine examined 471; the attending specialists in orthopedic surgery; urology; eye, ear, nose, and throat; neuropsychiatry, and dermatology examined, operated upon, or otherwise served a considerable
number of patients.
The total expenditure amounted to $110,616.
Marine Hospital, Memphis, Tenn.-Surg. W. H. Slaughter in charge. The normal capacity of 65 patients was constantly exceeded, and at one time 90 patients
were under treatment. To relieve overcrowding it was necessary to transfer 24
patients to the marine hospital in New Orleans and a few others to Louisville and
at times to house convalescent patients of the Employees' Compensation Commission in local hotels. There were 1,844 surgical operations and 3,493 clinical
laboratory tests; Wassermann tests were made on all patients admitted to hospi-
Digitized by
Google
146
PUBLIC HEALTH SERVICE
tal. One insane and one tuberculous patient and two others requiring custodial
care only were admitted to local public institutions without service obligation.
Plans have been completed for the new hospital building upon which construction
will begin shortly.
The total expenditure amounted to $130,553.
Marine Hospital, Mobile, Ala.-Surg. W. S. Bean in charge. A decline in the
shipping of the port from 773 vessels in 1931 to 758 in 1932 has been reflected in
the total number of patients, which fell from 3,538 to 3,405. The hospital has
maintained a capacity of 90 beds, and the daily average of patients has been slightly more than 88. Only one case of mental disease was admitted during the year
which required indefinite hospitalization, and the patient was admitted to the
Alabama State Hospital as a beneficiary of the State. Among the admissions to
hospital were 4 patients with typhoid fever, 20 with malaria, 100 with syphilis,
and 129 with gonorrhea.. The clinical laboratory made 13,813 examinations; the
X-ray department, 1,858 exposures; and dental treatments totaled 9,454, of
which more than ha.If were for out-patients. There were 5,646 physiotherapy
treatments.
The total expenditure amounted to $129,152.
Work was commenced on the additional hospital buildings on March 10, 1932,
and such satisfactory progress made that it is anticipated that new construction
will be completed about May 1, 1933.
Marine Hospital, New Orleans, La.-Surg. T. B. H. Anderson in charge. The
outstanding event during the past fiscal year was the openin~ of the new hospital
containing 568 beds, to which transfer of patients from the old buildin11,s was completed December 1, 1931. It is completely equipped with every facility required
for the care of our beneficiaries. Experience shows that the phsyical arrangements
-0f the buildings are excellent in every way, as demonstrated by the fact that almost all space has been utilized for the purpose for which it was planned. Five
double sets of officers' quarters, a nurses' home, and quarters for internee were
also completed and occupied during the year, thereby effecting a considerable
saving. Construction has begun on attendants' quarters, storerooms, and garages, which, together with roadways and landscaping, was necessarily deferred
until completion of the main hospital building permitted demolition of the old
wards.
The quality of professional work has improved with the new facilities without
important change in the per diem cost of operation. The Orleans Parish Medical
Society held one of its meetings in the hospital, the program being given by the
hospital staff. An extensive clinical meeting was held for members of the Association of Military Surgeons at their December meeting in New Orleans. The
hospital has carried out research work by testing preparations for the National
Institute of Health, by supplying blood infected with quartan malaria to service
-Officers, and has instituted treatment with artificial temperatures obtained by
diathermy on certain patients suffering from central nervous system lues and
chronic arthritis. Aid has been given to a medical officer detailed to the local
Federal penitentiary in such matters as emergency dental treatments and the
-Occasional admission of patients for major surgical operations.
The following is a summary of work done during the year:
Hospital patients treated ________________________________________ _ 4,410
Hospital days ______________________________________________ - ___ _ 158,795
Deaths ________________________________________________________ _
120
Autopsies (72.5 per cent) ________________________________________ _
87
Operations, surgical operating room ______________________________ _ 1,252
Doses of salvarsan _____________________________________________ _ 5,748
Spinal punctures _______________________________________________ _
310
Operative procedures (urological service) __________________________ _ 6,398
Treatments (eye, ear, nose, and throat clinic) ______________________ _ 8,978
Operations (eye, ear, nose, and throat clinic) ______________________ _
370
Refractions (eye, ear, nose, and throat clinic) ______________________ _
314
Treatments (dental clinic) _______________________________________ _ 48,619
Examinations (dental clinic) _______ ~ _________________ ~ ___________ _ 5,622
Treatments (physiotherapy department) __________________________ _ 19,318
Examinations (clinical laboratory) _______________________________ _ 51,664
Exposures (Rontgenology department) ____________________________ _ 12,371
Consultations with specialists ___________________________________ _ 3,931
Out-patient treatments: Medical, 19,401; dental, 10,374 ____________ _ 29,775
Men instructed and examined in first aid __________________________ _
176
Number of liquor and narcotic permits issued ______________________ _
160
Digitized by
Google
PUBLIC HEALTH SERVICE
147
Of 12 insane patients it was necessary to transfer only 1 to St. Elizabeths
Hospital, 7 were turned over to State or city or Veterans' Administration hospitals, 1 to the immigration authorities, and 3 were released at the request of relatives for home care.
The total expenditure amounted to $682,595.
Marine Hospital, Norfolk, Va.-Surg. S. L. Christian in charge. The hospital
operated to capacity throughout the year, the great majority of patients being
merchant seamen, whose average stay was 5.3 days longer than in 1931 because
convalescents are loath to leave until they are able to work, especially dUl'ing
periods of unemployment. The Veterans' Administration continued to use all
beds that could be made available for its patients. Six tuberculous merchant seamen were transferred to Fort Stanton, 1 insane patient was sent to St. Elizabeths
Hospital, and 1 was discharged to the custody of his wife; and 2 tuberculous
veterans and 1 insane veteran were transferred to Veterans' Administration
hospitals. There were 65 deaths and 35 autopsies. Weekly staff meetings were
held and attended by all medical and dental officers. The Norfolk Medical Society held a meeting at the hospital for which a surgical program was furnished
by the resident staff. The use of oxygen was continued in the treatment of
pneumonia and also other conditions such as asthmatic bronchitis and cardiac
and Bright's disease. The controversial question of the use of arsenicals in the
treatment of syphilitic heart disease is being investigated. Surgical operations
numbered 4,915; in the genito-urinary department sitz baths are extensively used
and considered indispensable in the armamentarium of this department; 2,043
intravenous injections for syphilis were given. The clinical laboratory made
16,325 examinations, including 958 tissue examinations, of which some were
immediate frozen sections for the surgical service; Kahn tests are now run simultaneously with Wassermann tests, of which there were 2,740; 346 examinations
for the determination of the icterus index were made. There were 9,555 Rontgenograms made on 2,213 patients, and 21,459 dental treatments, which included
1,669 extractions and the making of 115 dentures. Radium and deep X-ray
therapy are obtainable by contract. The chaplain held 45 devotional services
and supervised all burials. He also provided 24 entertainments and procured
flowers, fruits, and many books and magazines for the patients. Four narcotic
permits and 125 liquor permits were issued to ships. In cooperation with quarantine, 2,623 bills of health were issued.
The total expenditure amounted to $345,751.
Tile floors and wainscoting were laid in 4 hallways and 54 bathrooms; toilets·
diet kitchens; and dressing, sterilizing, and utility rooms. Foundation piles and
excavation for certain new hospital buildings were completed; construction will
begin shortly on the extension to the hospital, for which plans have been completed.
Marine Hospital, Pittsburgh, Pa.-Surg. Ralph E. Porter in charge. The daily
average number of patients in the hospital during the year was 92, which is the
rated capacity of the hospital. The maximum and minimum numbers were 101
and 86 on July 4, 1931, and April 16, 1931, respectively. More than half the
patients are Veterans' Administration beneficiaries. There were 2,508 surgical
operations, 5,107 dental treatments, and 2,451 X-ray exposures. Eight attending
specialists supplement the resident staff.
·
The total expenditure amounted to $143,429.
Marine Hospital, Portland, Me.-Senior Surg. J. R. Ridlon in charge. The
hospital has been filled to extreme capacity during the entire year, nearly 50 per
cent of the patients being beneficiaries of the Veterans' Administration. Local
consultants are attached to the staff and freely used in their specialties. There
were 987 surgical operations, 5,536 physiotherapy treatments, 5,680 laboratory
examinations, and 2,402 X-ray exposures. Five insane patients were referred to
the custody of relatives. The interior of all wards was repainted.
The total expenditure amounted to $121,741.
Marine Hospital, Port Townsend, Wash.-Surg. 0. H. Cox in charge. Owing to
a slump in shipping, the number of admissions fell from 802 in 1931 to 753. There
was an increase, however, in patients of the Employees' Compensation Commission. One merchant seaman needing domiciliary care was transferred to Sailors'
Snug Harbor, and four insane patients were sent to the contract hospital at
Portland, Oreg. The surgical service was actil;e. Spinal anesthesia was administered 179 times and, with regional-local, has largely replaced general anesthesia.
The Department of the Interior has reques'ted the transfer of this hospital to the
Bureau of Indian Affairs upon completion of the new marine hospital in Seattle.
The total expenditure amounted to $113,837.
Digitized by
Google
148
PUBLIC HEALTH SERVICE
Marine Hospital, St. Louis, Mo.-Surg. D. J. Prather in charge. Despite the
handicap of old buildings and insufficient space for utilities the hospital had, 'a
busy year. The great majority of patients were merchant seamen and other old~
line beneficiaries. Patients of the Employees' Compensation CommiBBion are
being treated in increasing numbers, and the Veterans' Administration continues
to utilize all beds not otherwise needed. There were 1,165 surgical operations,
1,694 X-ray examinations, and 3,029 clinical laboratory tests. A complete dental
clinic was supplied and a commissioned dental officer detailed to the station,
New hospital buildings are needed here to improve the facilities and remove fire
hazards.
The total expenditure amounted to $152,472.
Marine Hospital, San Francisco, Calif.-Medical Director M, J. White in
charge. The new hospital building of 472 beds was occupied November 6, 1931,
by the transfer on that date of 273 patients from the old hospital buildings. Over~
crowding having been relieved, the number of patients gradually increased to
338 at the end of the fiscal year. The old frame hospital buildings, 17 in number,
were promptly demolished, thus removing a serious fire hazard. Work was
commenced on the recreation building and quarters, and a new roadway was built
from Park Presidio Avenue entrance and Fourteenth Avenue entrance up to
and around the new hospital. There were 106 deaths and 65 autopsies. Seventy~
four tuberculous patients were admitted, of whom three were transferred to Fort
Stanton. There were 222 in-patient and 543 out-patient syphilitics, 384 in-patient
and 2,920 out-patient gonorrheal patients, and 31 cases of carcinoma. Acknowledgment is due the Seamen's Church Institute for recreational work carried on
in the usual helpful and satisfactory manner.
The total expenditure amounted to $795,725.
Marine Hospital, Savannah, Ga.-Medical Director J. T. Burkhalter in charge;
The hospital continued to function beyond normal capacity throughout the year,
chiefly on account of urgent demand from the Veterans' Administration. The
average number of patients of all classes was 161-the minimum and maximum,
138 and 181, respectively. A large number of seriously ill patients were admitted
to hospital. There were 49 deaths and 22 autopsies. Monthly staff meetings were
held to discuss administrative and professional subjects and particularly cases
with obscure symptoms. There were 10,020 dental treatments, 22,321 laboratory
examinations, 5,034 X-ray examinations, 5,652 surgical operations, and 12,219
physiotherapy treatments. The dental clinic was enlarged; diet kitchen improved
and enlarged; a new dining room for nurses provided; and the hospital grounds
were beautified by the planting of trees, shrubs, etc.
,
The total expenditure amounted to $225,679.
,
Marine Hospital, Stapleton, N. Y.-Medical Director M. H. Foster in charge.
The hospital has at present a capacity of less than half the number of regular
beneficiaries receiving hospital treatment in the port, the excess being sent to
Ellis Island. More than 90 per cent of the patients admitted are merchant
seamen or members of the Coast Gue.rd. Plans for the new hospital, affording
approximately 500 additional beds, have been completed, and it is expected that
construction will begin shortly. The necessary land adjoining the present reservation has been purchased. Fifty-seven per cent of patients admitted were surgical cases. The total number of surgical operations performed was 3,172; 1,315
anesthesias were given, of which 730 were spinal. No case of spinal anesthesia
terminated fatally or exhibited dangerous complications. A follow-up system of
surgical cases and selected medical cases has been instituted.
There were 4,311 dental examinations and 27,588 dental treatments; 59
fractures of the jaw were handled by the dental officers. The physiotherapy
department furnished 34,502 treatments; the X-ray clinic made 10,842 exposures;
the pathological laboratory performed a total of 22,574 tests. Special research
in venereal disease was continued throughout the year, bearing particularly on
the transmission of syphilis and the value of prophylactic measures. A study
was also begun of the effects of high frequency oscillating currents on animals.
The total expenditure amounted to $452,201.
Marine Hospital, Vineyard Haven, Mass.-Passcd Asst. Surg. Frank F. Thweatt,
jr., in charge. This small hospital, with a normal bed capacity of 24, has been
practically filled during the entire year with merchant sea.me~ Coast Guard men,
and occasional patients from the Employees' Compensation \Jommission and the
Veterans' Administration. Only one medical officer is on duty, and patients
requiring highly specialized treatment are transferred to the marine hospital,
Boston. The Seamen's Bethel, Vineyard Haven, performs social service work;
a religious service is conducted each Sunday by the chaplain of the local branch.
A new sewage disposal system was installed during the year.
Digitized by
Google
•
149
PlJ'BLIC HEALTH SERVICE
The total expenditure amounted to $42 326.
Out-Patient Office, New York, N. Y.-Surg. P. M. Stewart in charge. This
11tation is operated as an out-patient office with substations at the barge office,
post-office building, on Thirty-third Street, and the Seamen's Church Institute,
·25 South Street. An office for issuing liquor permits is also maintained at the
-customhouse. Some new equipment was procured in the physiotherapy department, and an additional treatment room was provided in the genito-urinary
-clinic. The Supervising Architect has made contracts for installing two new
heating boilers and remodeling and repairing roofs, pent houses, skylights, and
-chimneys. The interior of the hospital building is being repainted. The total
number of treatments increased over the preceding year. The daily average
number of treatments was 599; the maximum was 877. There were 22,272 X-ray
,exposures; 2,262 X-ray treatments; 11,846 clinical laboratory examinations;
-51,352 dental treatments; 10,128 eye, ear, nose, and throat treatments; 48,077
physiotherapy treatments; and 6,864 antisyphilitic injections. Liquor permits
issued to ships numbered 844, and purchase orders for narcotics, 61; 535 applicants
for license were instructed and examined in first-aid procedures, to which 736
hours were devoted by the medical officers assigned. Three patients in need of
•custodial care were assisted to obtain entrance to eleemosynary institutions.
Relief Station, Manila, P. 1.-Surg. R. W. Hart in charge. Beneficiaries were
furnished out-patient relief at the ports of Manila, Cebu, and lloilo, and hospital
relief at the port of Manila. All treatment was rendered by service officers
-detailed to the Philippine quarantine service in addition to their duties as quarantine officers. For applicants for positions as officers in the merchant marine of
the Philippine Islands, 346 physical examinations were made, and all students
in attendance at the Philippine Nautical School were examined, especially for
visual defects and color sense. Forty-two examinations were made for the
Veterans' Administration and 51 for the Bureau of Pensions.
Relief Station, San Pedro, Calif.-Surg. H. E. Trimble in charge. Medical
relief work is combined with quarantine activities and medical inspection of
immigrants, in rented quarters near the water front. The principal beneficiaries
.are merchant seamen and Coast Guard personnel. Thirty-five patients were
transferred to the marine hospital in San Francisco. Twenty-four-hour radio
service was maintained to furnish medical advice upon request from ships at sea.
Five hundred and seventy-three applications for medicinal liquor aboard vessels
were approved.
Relief Station Washington, D. C.-Senior Burg. R. M. Grimm in charge.
Patients of the Employees' Compensation Commission comprise 90 per cent of
the total treated at this station. The conditions treated are for the most part
-of a surgical nature. A very large number of physical examinations are also
made, chiefly for applicants and employees of the Civil Service Commission.
New X-ray equipment was procured and additional apparatus furnished for the
eye, ear, nose, and throat clinic and physiotherapy department. On January 1,
a medical officer was assigned to supervise first-aid relief in the new Department
-of Commerce building, where between January 1 and June 30,327 patients, injured
in the performance of their duty, received treatment.
Supply Station, Perry Point, Md.-Asst. Pharmacist R. D. Kinsey in charge.
Through the courtesy of the Veterans' Administration the supply station is
housed in two large warehouses; heat, light, and water and two sets of quarters
for the officer in charge and his assistant being supplied. Nine other persons
.are employed. The principal issuing transactions are shown below:
Stations
Marine hospitals ..••.........••.....••.•...........•
Relief stations ..•.....•••••.•.....•.•..•.•...........
Quarantine stations ...••...•.••..•...•.•.•..........
Foreign stations ......••.••.........•..•..•..........
Scientific research stations........•.••....•.•.•...•..
Burgeon General's Office.••...........•......••.•....
<Joast Guard ........•...•.....••..•.....•..•....•...
~~re~o~~::.v.::·.tiitions· (surpiuiioniyi~~= == ======
PenBI Institutions ...........•..•....................
Miscellaneous ...................................... .
Total. •••••••••••••....•••••••••••••••.••••....
Number
of pack•
ages
shipped
Weight
Value of Value of
cf~:;;d surplus
stock
stock
Total
value
Pound•
7,430
703
196
38
32
22
1,303
88
115
607
8
587,396
33,522
19, 743
551
1,335
59
54,914
1,409
19,858
45,573
$84,270
4,365
179
139
81
29
8,899
151
38
3,728
5
764,398
101,846
---+-----1-----~
10,442
Digitized by
Google
$60,200
2,764
7,985
43
607
$144,560
7,129
8,164
182
11
688
40
5,629
189
17,058
4,597
14,528
340
17.058
8,325
600
605
oo,n3
201,619
•
150
PUBLIC HEALTH SERVICE
Fifty-seven additional items were exhausted during 1932 from the war surplus
stock, shipments of which were valued at $99,773, as compared with $139,290 in
1931. Expenditures will necessarily increase as the surplus stock becomes
exhausted.
A saving of $1,572 was effected in personal services and important economies
for the marine hospitals and other relief stations were accomplished by the manufacture of simple stock preparations and by the repair of used equipment reissued on requisitions. A contract was made for resharpening detachable scalpel
blades which, when used, are received from field stations and replaced with new
or resharpened blades, and a saving of $100.14 was thus effected by the use of 22Z
dozen resharpened· blades. Of equal importance is the fact that, partly as a
result of the practice, the price of scalpel blades has been reduced from $1.27½ to
85 cents per dozen.
CONSOLIDATED AND DETAILED REPORTS
The following tables give consolidated and detailed reports for the marine
hospitals and relief stations:
TABLE
1.-Number of patients treated annually, 1868 to 19SS 1
Fiscal year
Sick
and disabled
patients
Sick
and disabled
patients
furnished
relief
Fiscal year
fur-
nished
relief
Prior to reorganization:
1868_________________
1869_________________
1870________ ____ ___ __
After reorganization:
1871___ ____ __________
1872____ ____ _________
1873___ _________ ____ _
1874___ ______________
1875___ _____ _______ __
1876_________________
1877___ ____ ______ ____
1878_ ________________
18i9__ ______ ____ _____
1880_____ ____ ________
1881___ _______ _______
1882_____ ________ ___ _
1883_ ___ ___________ __
1884_________ ________
1885_ ___ ______ ____ ___
1886_______________ __
1887 _________________
1888___ ____ _________ _
1889____ ____ ______ ___
ll,535
11,356
10,560
14,256
13,156
13,529
14,356
15,009
16,808
15, 175
18, 223
20,922
24,860
32, 613
36,184
40,195
44,761
41,714
43,822
45, 314
48,203
49,518
Afg:nt~~!~~nization1890_ _______ __ _____ __
1891__ _______ ______ __
1892_ ________________
1893_ _________ _______
1894_ _____ _____ ______
1895_ _________ _______
1896_________________
1897_____ - - -- -- - -- --1898______ _________ __
1899________ __ _____ __
1900 ______ ___________
1901___ ___ ____ __ ____ _
1902 ___ __ _________ ___
1903________ _________
1904_____ ____ __ _____ _
1905___________ ___ ___
1906______ ___ ________
1907_____________ ____
1908_________________
1909_________________
1910____ ____ _________
1911__ _____________ __
50,671
52,992
53,610
53,317
52,803
52,643
53, 804
54. 477
52,709
55,4R9
56,355
58,381
56.310
58,573
58,556
57, 013
54,363
55, 129
54,301
53,704
51,443
52,209
Fiscal year
Arter reorganizationContinued .
1912_________ _______ _
1913__ ____ ___________
1914______ ___ ___ _____
1915_________________
1916________ ____ _____
1917__ _______________
1918_ ______ __________
1919_ __ ______________
1920___ ______ ________
1921__ _________ ____ __
1922 _________ ________
1923 _____
'---- --- --- -_____
---1924
_______
1925 ____ _____ ________
1926 __________ ___ ____
1927 ___ ____ ---- _-- _-1928 _______________ __
1929 ________________ _
1930 ___ _____________ _
1931_ ________________
1932 ___________ _____ _
Sick
and disabled
patients
furnished
relief
51,078
50,604
53,226
55,782
58,357
64,022
71,614
79,863
110.907
144,344
153,633
126. 956
159,686
204,944
245,140
249,973
240,592
260,552
279,350
259,364
257,208
• These ftgures do not Include patients treated In connection with veterans' relief activities of the service
as follows: 1918, 192; 1Jl9, 13,856; 1920, 27Y,036; 1921, 667,832; 1922, 242,379; 1923, 9,704; 1924, 3,4li; 1925, 4,360;
1926, 3,749; 1927, 2,830; 1928, 3,448; 1929, 4,907; 1930, 6,817; 1931, 9,278; and 1932, 9,667.
.
th~no~!~~:1:C:l-1.~~e~f!~~t~E~tlce of.recounting out.patients applying for treatment In more
Digitized by
Google
151
PUBLIC HEALTH SERVICE
TABLE
2.-Tra111action1 at United Statu marine lw~pitals and other relief ,tation,
PaTotal Numtlents Number
berof
number patients
remain- of days
ofpa- treated Died Ing In
relief
tlents in hoshospital
In
treated pltals
June 30, hospital
1932
Num- Number of ber of
patients tlmoo
furoffice
nlshed relief
office was furrelief nlshed
--Grand total. -- -- --- -- -- -- -- - -. - 266,875
Numberof
phys!cal
e:raminations
---
45,030 1,211
4,858 1,734,508 221,845 972,110
76, 1711
6,375 ·43,442
6,170 29,882
2,795 16,870
598
1,131
28,739 72,799
3,197 28,325
2,038 14, 114
245 17,401
101
226
995
3,501
1,865
8,139
674
4,439
317
1,455
2,049 11,456
2,662
8,366
7,071 29,755
30,204 179,675
6,305 29,431
1,610
8,508
854
6,868
1,015
338
1,336
6,142
9,263 49,523
2,310
J,205
4,895 24, llll
151
324
2,023
4,197
1,700
FIBST CLASS BTATIONB
Marim holpltall
Baltimore,
Md.
__ •••••
__ ••• _.---·---·
Boston, MBSS
______
. ____________
. ____ 8,284
Buffalo, N. y ________________________ 7, ll80·
Carville, La ______________________ .-·. 3,592
1,015
Chicago, Ill_·-----------------------Cleveland,
Ohio _____________________ . 29,860
5,548
Detroit, Mich ••••• ·-------·-·-·-·-·-· 3,277
Ellis Island, N. Y.·--··--··--·------· 5,054
Evansville, Ind •.•• __ •• ____ ·- __ . _-· ..
513
Fort Stanton, N. Mex .• ·-----·-···-·- 1,325
3,014
Galveston, Tex.I_···-·····-·-···-·-··
Key West, Fla.·-·····-···········-·· 1,469
Louisville, KY·-·-··---···········--· 1,166
Memphis, Tenn.·-----·-···---·---·-· 2,754
Mobile, Ala·--··--·-·--------·------- 3, 4117
New Orleans, La·----·-------·--·-·-· 12,079
New Yori<, N. Y ····---------·--·--·· 30,204
8,607
Norfolk,
Va_.····------------·--·---.
Pittsburgh,
Pa_ •• ______________ ·--·-- 2,336
Portia.id,
Me.··-·---------------·--·
Port Townsend, Wash. ______________ 1,563
l!t. Lo<1is, Mo________________________ 1,245
1,835
San Francisro, Calif_______________ --· 12,544
3,828
8avan.18h,
Ga.----------------------·
Stapleton, N. y ______________________ 8,744
315
Vineyard HBven, MBSS ___ ----------Contract overflow hospitals. _________
117
1,909
1,810
797
417
1,121
2,351
1,239
4,809
412
330
1,149
795
849
705
825
4,408
-------2,302
35
32
39
20
32
105
65
87
20
13
16
19
31
11
32
121
65
192
137
76
366
144
256
125
457
02
230
182
111
74
70
82
500
-------222
726
709
847
37
96
16
499
38
78
82
35
106
49
65
6
9
338
174
2Yl
23
35
3,281
1,512
3,84J
IM
117
Total_ - - ----------------------- 161,81.5 37,932 1,104
90
71,369
55,091
29,763
130,386
M,044
88,668
47,743
164,274
23,810
84,811
35,890
32,267
27,512
28,073
32,266
158, 788
80.022
33,606
2S,8a2
33, 85J
33,876
119, 9.i3
5R, 605
106, 166
8,485
14,053
882
660
1,049
107
~
06
883
70
643
I, 91
1,941
2,622
12,942
1,440
383
284
60
1,302
2,175
2,007
701
10
-------- -------- --------
4. 4.13 l, 584,222 123,883 606, llJ
40,797
811:COND .lND THIBD CLASS ll'liTIONS
Aberdeen, Wash _____________________
Albany, N.Wash
Y -----------------------Anacortes,
_____________________
Apalachioola, Fla ___ • ________________
Ashtabula, Ohio __ ------------------Astoria, Oret---- ·--- ____________ . ___
Balboa Helg ts, Canal Zone_. _______
Bangor, Me--------·-·--------------Beaufort, N. c.-·-·----·-----------··
Bellingham, Wash-----·------------Biloxi, Mfss. ___ . -. ·- -- -. _. ________ •..
Boothbay Harbor, Me_--------··-·-·
Brunswick, Ga--·--·-•----------·---Burlington, Iowa--·-._ .. __________ • _.
Cairo, llJ. ____ ---- --- ------------- ---Calais, Me ___Md
----------------------Cambridge,
______________________
Cape May, N. J _____________________
Charleston, 8. c _-------------------Chlncoteaiioeh
Cincinnati,
0 VB-------------------lo _____________________
Cordovac
Alaska.-------------------Corpus hristl, Tex_. ________________
Crisfleld, Md __ ---------------------Duluth, Minn ____ ------------------Eastport, Me _________ --------------Edenton,
C---·------------------Elizabeth N.
City,
N. c ________________
El Paso, Tex_________________________
199
139
250
68
236
485
571
47
835
200
833
27
47
24
581
1
114
1,446
754
139
173
151
203
1,082
569
49
42
122
165
403
30
iGalllpolis,
~I~e=-=====================
Fall
River,Ohio
MBIB--------------·-----______________________
Galveston, Tex.•_-------------------Gary, Ind_. ____ ----------------------
8:~:S~ar}~_::::::::::::::::::::
1
178
210
84
134
1,743
33
,100
"64
Opened Nov. 16, 1931.
20
12
28
10
26
70
177
0
147
18
41
1
1
1
1
1
-----------1 --------2
1
4
2
6
-------------4
l
------1 --------------1
218
138
159
137
281
657
2,213
74
1,746
183
21i6
143
-------30
-----224
------1 ---------------2 2,071
------ --------4 ----------------25 -----504
1
357
77 -----3
689
77 -----------------1
34 -----799
1
4
56
903
1
55 -----855
12
74
1 ------.1,044
06
-------- --------------------------- --------
y
3
9
133
2
12
27
7
1
1
2
18
319
72
------ ---------------3
333
35 -----43 -----1
532
lM
2
1
1
52
1 -------648
11,815
5 -------289
-------- ------ -------- ---------212
21
1 --------
448
I
1711
127
222
58
210
415
394
41
688
278
792
18
44
15
448
1
89
1,361)
ff17
139
139
95
148
1,070
503
49
42
120
153
370
23
143
lffl
82
82
1,4114
33
100
543
Closed Nov. Ui, 1931.
Digitized by
Google
360
143
035
232
688
UIS
088
1,036
442
30
2
25
53
04
45
4,076
1,032
2,763
31
65
26
1,224
5
312
3,322
1,325
358
351
182
26
416
226
1,984
820
85
114
468
l,b19
1,,12()
27
399
388
251
159
4, 2411
208
1118
1,628
81
11
15
-------134
5
11
166
249
19
185
1
27
8
115
21
4
31
177
210
6
12
le
13
1
1128
22
10
03
152
TABLE
PUBLIC HEALTH SERVICE
2.-Transacliom at United State& marine hospitals and othtr relief stations-Continued
Pa•
Nwn•
Total ber
tients Nwnber
of
number patients
remaln• of days
ofpa· treated Died Ing in
relief
tlents
In
&,ospital
hos•
une 30, hospital
treated Inpltals
1932
Nwn• Nwn•
ber of berof
patients times
office
fur•
nlshed relief
office was fur•
relief nlshed
Nwn•
berof
physl•
cal
e:raml•
nation It-
--811:COND ,A.ND THIRD CLASS STATIONS-
coiitlnued
Ora.ii\ Have~ Mich ••••••••••••.. a••
Green Bay, Is •••.•••••••••••••..•••
Gulfport, Miss ....••••...•••• •• •..•••
B&.Jcock, Mich .•.••••••••.••••••••••
Honolulu, Hawaii ....................
Ho~stonilex •••.••••••••••••••••••••
Indiana arbor, Ind •••••.•••••••••••
1acksonvllle, Fla •..••••••••••••••••••
Juneau, Alaska ••••••••.•••••••••••••
Xetchlkiu, Alaska .••.•...•••••••••••
La Crosse, Wis ••••..•.•.•.• : •••••••.•
f:..~:BeY.~::: :: : : :: : : :: : : : : : : : : ::::
Lo9 AngelesJaIIL ••••.•...•••••••••
Ludington,
lch •••••••....•••••••••
~~p~~·:::::::::::::::::::: ::::
Manistee, Mich .•.••.•••..•••••••••••
Manitowoc, Wis .••••••••.•••••••..••
'Mar~::tte, M lch ..••••••.•.••••••.••
Mars eld, Oreg..•••••••...•••••.•••
Menominee, Mich •••.•......••.•••••
Miami, Fla...••.•.•.•.•.•.••.••••.••
MllwaukeeC Wis .....................
Morehead lty, N. C ..•. .•.••• ••.•..
Nantucket~ass ••..••.•.•••••••.•..
Nashville, enn ••.•••••...... •..•.•.•
Natchez, Miss .•••..•••••.....•••.•..•
Newark, N. 1. ......•................
New Bedford, Mass ••••••.•..••••...•
New Bern, N. C •.••••••••...••••.••.
New Haven, Conn .•••••..•••.•••••••
New London, Conn ..••..•......•.•..
Newport, Oreg••..•••.••........•••.•
Newport, R. L ......................
Newport News, Va .•••......••.•.•.•
Of,densb~ N. Y ..•.•.....•.•.•••.•
0 ymplll, ash ••.••..•.....•••.•.•.•
~::r~:1tt;.-:.-:::::::::::::::::::::
Panama City, Fla••••........••..••••
107
115
20
71
1,049
1,601
91
873
302
1,182
79
660
204
1,329
247
17
I, 675
103
227
301
73
117
668
919
431
114
61
262
26
l~it~~r~~l~~~l: : :~l~l l ~:l
Vicksburg, Miss ..•. ··-··············
Washln11ton, D. C ..•.•.....•••••••..
;207
···-·85·
76
219
14
30
482
17
15
33
20
21
3
· 67
,147
77
4
6
18
6
22
97
16
43
99
6
283
291
30
119
4
10
7
18
33
143
294
138
6.438
258
76
82
64
872
286
341
440
463
237
8,069
_.,
_____ _
1
Ill
225
2
57
19
2,462
3,95~
---------------------
------10
------ -------3
2
1
3
1
2
10
---------1,074
1,070
2,797
85
------ -------1
1
-------- ---------288
8,881
173
18
1
-----------1 --------1
------ -------l
-----.... i . --------
---------····.11e" ····2· -------6
4,657
281
316
131
498
Pensacola, Fla •..••.........•.••••..•
461
Perth Amboy, N.1 .•.........•...•.•
67
Philadelphia, Pa .....•....••....•..•• 6,118
UM
Ponce. P . R .................•...•....
Port A~es, Wash ..........••.••...•
230
Port Art ur, Tex ••••.........•...... 1,368
242
Port Huron, Mich .••.......••..•....
Portland, Oreg..•••...•...•....••.... 1,891
Providence, R . L .••..•........•....•
433
138
Provincetown, Mass •........•.•...••
Reedville, Va ..•••••.........•.•••.••
408
137
Richmond, Va ......•.•.....•.••..• •.
Rock Island, Ill •..............•..•. . 2.329
St. Thomas, Virgin Islands ........••
74
449
San Diego, Calif. •••.•...........••••
Sandusky, Ohio .•.••...........•.••••
61
San Juan, P. & ..••.•.•...•.........•
800
San Pedro~alil. ••.................. 3,760
Sault Ste. arle, Mich ..............• 1,132
~~~~. ~:hka.":::::::::::::::::::::
SheboygankMich .•••..........••...•
Sitka, Alas a ......••............•..•
South Bend, Wash ........... ...•...•
7
21
2
2
.178
20
96
2
682
87
28
90
16
201
41
1
2
115
429
436
148
47
608
2
2,067
803
3
------ ............
611
.... i. --------------.... i. --------------1
3
1
2
l
------ --------
------ ------------- ------------- -------l
-----------------1
l
-----3
3
---------··u· 26
1
2
3
-----....i. --------
4
l
1
13
2
•
34
36
63
71
10
241
2
2
7
1
6
9
1
6
6
------ -------1
-----2
-----I
4
2
------2
3
l
3
1
2
--------------g
Digitized by
003
65
660
984
671
8,606
729
45
2,221
790
417
793
108
249
1,283
2,179
1,481
219
184
754
68
626
43:J
230
17
1,499
88
194
281
62
lH
611
772
3M
81
110
61
246
31
134
983
274
499
20
269
219
115
466
66
93
366
263
• 21a·
163
46
118
291
116
23
136
276
118
260
1,067
12
8,473
1. 127
143
748
50
4,293
616
6. 117
1,049
1,646
1, 635
63
106
286
1,972
394
687
666
1,036
26
2,326
211
184
27
147
1,923
3,663
150
2,332
271
2,337
101
174
847
208
----- --- ------ -------- ----------------·--··u· ....i. -------212
9 ------ -------130
-------·····45· ····2·
3
1,606
3 ------ -------76
168
2
2,861
371
!l6
188
79
6
7
22
178
100
74
18
6•
871
1,394
91
788
226
366
65
4,636
107
202
1,278
226
1,690
392
138
408
111
2,320
74
404
48
632
3,389
1.036
6,260
179
69
76
42
694
262
306
242
641
266
463
616
333
60
······ii
508
76
·····am
32
41
28
II
19
372
16
7
672
13
2
94
23
26
300
621
6
12
71
18
16
116
30
88
86
8
28
37
6L
2
426
M
632
280
1,213
107
27.162
651
400
3,133
619
4,865
980
376
1,266
226
8,264
26
1
69
33
3.166
26
80
223
1,361
69
2,316
10,173
1,961
18,861
264.
198
1,731
282
16
1
s.
81
2,887.
s.
439,
20
160
366
408
106
6.0961
144
154
78
1. 036
113
460
387
392
700
810
1,242
227
1136
7.828
32,366
Google
5
19
H
4
&-
18
88
178163
32:
7,228.
153
PUBLIC HEALTH SERVICE
TABLE
2.-Transactions at United States marine hospitals and other relief'8tationContinued
PaNum• Num•
Num•
tlents Number ber of ber of
Total ber
of
remain• of days patients times
number patients
of pa- treated Died Ing In
relief
fur•
office
hospital
tients
In
Dished relief
treated lnhos-June 30, hospital office was fur•
pitals
relief Dished
1932
Num•
ber of
phys!•
cal
exam!•
natloll8c
IJICO.ND AND TJIIBD CLASS STATIONS-
continued
1, 2211
212
608
552
81
Washington, D. C., dental clinic •••••
Washington, N. C •••••.......•••••••
White Stone, Va •.•••.•........••.•••
Wilmlrutton\ N. C ••••.......•.••. · · ·
Wrangeli, A aska••••••..........•....
47 ··-·-1
19
2 .......•
372
227
1, 2211
197
608
505
62
17 ...•.. -·-·-···
2 ·•·•·· --··-···
2 .•.... -······-
281
13
18
131
87
60
15 ....••
1
147
16, 703
388
3,398
1,358,
211
279
422
310
11
26,
151
6-
FOURTH CLASS STATIONS
148
89
62
2
34 ••
t!Wi
':11~e~~===:::=:::========:=:===
Bay City, Mich .........••.•••••••...
Beaufort, S. C ..•....•••..•••••••..••
Brtdgepor~ Conn •.••: ..••••...•.••..
Hartford, voon .•.......••.••.•.•....
Nome, Alaska .•...•.....••••...•....
Petersburg1 Alaska •....••...•....•..
Portsmoutn, N. H .•••.•...••.••••...
Saginaw, Mich. ...••.•.•.•..•••••....
Unalaska, Alaska •.•...•.•.•••.......
Wilmington, Del.. ••••.•••••••.•..•..
134
8.
J
15· ··-··· ··-····- ···-· 152
1~
Jr
9
5 ---··· ..••....
109
4
8
15
1 --···· ····---8
14
34
12
2 ··-·--·314
60
302
1,062 -······2
9
1 •..... -····--·
17
8
14
11 •··•·•·· ...... ···-···· .....•••..
11
36 .......•
2
2 ...... ····-·-·
42 •••......•.............•
33 ·-······ ...... ····-··· ·•·•···•••
33
60 ....... .
KISCELLANJ:OUS
Curtis Bay, Md. (U.S. Coast Guard).
U. S. Coast Guard Academy, New
London, Conn ••.•.....••........ -St. Ellzabeths Hospital, W ashlogton,
1,612
1,768
54
163
163
Ice ............................... _. 4,961
U. 8. Coast Guard vessels and bases .. 28,533
53
Emergency••.•••.......•••......•••.•
146
D. C •••••••••.•.•..••••...•.•....••
Special acting assistant surgeons for
Coast Guard and Lighthouse Serv•
1,184
2
153
51,777
2
1,226
202
18 ...... ······--
1, 612
15,571
269,
1,714
9,033
162·
4.815 17 035
28, 533 105, 832
65
35
1,373
3,203.
1
1-----,1-----,---1---1----+---+---+----
Total ••••.......•••.•..•••..•.• 105,060
7,098
107
365
150, 286 97, 002 365, 999
3n, 38:1l====t====l===i====li====l===l===l===
Grand total •..•.••.•••••.•.••.. 266, 875 45, 030 1, 211
4,858 1, 734. 508 221, 845 972, 110
76, 179 ..
TABLE
3.-Medical services for various classeB of beneficiarieB
Beneficiary
Total
number
ofpa•
tlents
tr'/8ted
American seamen ..•.••••••••••.•.... 132,019
860
Foreign seamen •.•••••••••.•••••.....
Coast Guard .•.•....••.•••.•.•••..... 52,453
54
Bureau of Fisheries ......•••.••......
384
Army .•...•..•...........•.••••......
235
Navy and Marine Corps ••....•...•.
29
Mississippi River Commission .... _._
Engineer Corps and Army Transport
4,285
Service.....•....•.••.•.••••••••••..
Lighthouse Service...•......•.•.•.. __ 2,212
Coast and Geodetic Survey ..•. _.. __ .
959
Employees' Compensation Commis•
sion ••..••.............••••.•••..•• 47,364
Veterans' Administration.··---·----- 9,667
Immigration Service ..•.......•.. ___ . 2,816
Public Health Service officers and
employees .••...•.•....•.•.••••••... 7,123
419
~Cianeous .........•....•..•.•.... 5,996
Total •••••.•••••••••••••••• · ..• 266,875
Num•
Pa•
Num• Num •
ber of
tlents Number berof ber of
patients
remain• of days patients times
treated Died login
relief
office
fur•
In
hospital
In
nished relief
hosp!•
June 30, hospital office was fur•
tels
1932
relief nlshed
23,838
277
3,756
12
70
63
5
-6488
28
-----2
1
1
2,724
8
249
1
2
4
--------
994,998 108,181 491,289
6,944
583
1,123
91,655 48,697 198,800
168
42
151
1,012
314
986
754
172
653
340
24
24
1,090
378
155
25
15
3
91
33
13
35,797
9,077
3,260
2,614
9 214
2,403
17
418
11
173
1,057
112
63,623
348,531
38,143
703
418
34
25
20
3
9,415
130,387
11
45,030 1,211
3,195
1,834
804
Num•
berof
phys!•
cal
exam!•
nations
9,937
8
11,481
7
296
28
--------
11,318
6,231
3899
77
200
377
44,750 171,172
453
5. 752
413 19,094
20,002
1,092
475
52,197
3
9,418
--ao;1M
4,858 1,734,508 221,845 972,110
76,179
366
--------
Digitized by
404
6,420
1
5,962
Google
1,436
I
154
PU BL IC H EA
LT H
SE RV IC E
T ABL:m 4.-C av
,e of ad a. iu io n
and condition on
di,charge, marin
other re lu f ,ta
e ·hospitals «lld
tions
Nu mb er ha vin
g specl.fle
or In ju ry 1 d diseases
D!Bea8e or oo nd
itl on
M ajo r
condltlo n
w~ ~h
ad ·t
i: f, ·
-----------1
Co n- Co n•
dlt lon dit lon
second th ird
in Im- In lm ·
porpo rtan ce tan ce
•
Co nd iti on on
tie nt s for specdischarge of pal.fled dlseeaea or
In jur ies
To tal
nu mhe ro f
qu ela , pe rso ns
to
ha vin g
No
ma jor ea ch Cu re d Im other
pr ov ed 1m-t
con- speclconpr ov ed Died dlt
dit lon fle d
ions
disease
or
In ju ry
Se-
--------;---
Ab no rm ali tie s
d co ng en ita l
ma lfo rm ati onan
s. •• •• ..• •• •.•
Bl oo d an d blo
•.
66
ga ns , diseases od•formln~ or•
------Bo ne s an d carti an d lnJ ur es or .
6
78
38
lages, diseases
an d inj ur ies oL
----11
--..•
---.. ..• •.• .. 2,1
Ci rcu lat or y sy
4
61
47
ste m, dis ea ses
2
an d In jur ies of:
13
12
-------- 267 1, 166
He ar t disease,
va lvu lar•••
64
Varicose ve ins
39
241
636
.•• .•• •• •• •..•
201
All oth ers ..•
62
247
6
192
50
9
Co mm un ice ble ... •• •.• •.• •.. 1, 469
93
2
13
an
9
d
inf
53
ec tio
6
2
------diseases,
51
32
44
173
t lnc lud inf : tuus
--- ---- ------ -2
berculosis no
106
1
an
39
882
ne rea : •
31
Co nju nc tivditive
208
m
s, gr an ula r
tra ch om ato us
• •. .• . •.. •.
De ng ue ... ••
24
... ... ... ...
3
In flu en za ••.•
2 --1
••
•.•
---M ala ria ..• •• •. ... ... ... ..
... . 32·
497
18
... .. z" ... .64292. ... ..i.
Rh eu ma tic fev •. ..• ... ... .
11
26
II
6
er,
38
ac
ute••.
Ty ph oi d fev
222 ···220· ... .. i. ··· ·2 ·
7 ... ..
81
•• .•• •• . .• ...
i.
16
301
·····62
Al l oth ers .••er
liO
3
60
167
•..
••
10
•.•
6
1
De nta l ... ... ••
0
•• ••
4
7
626
M
•.. ..• •• ••••
64
------66
Di ge sti ve sy ste
•• . •..
2
22
74-0 -4,894. ·a:
18
16 ... .. i.
inj ur ies of: m, diseases an d
589° -----10
274
2
28
14 .. li;2a1·
5
Ap pe nd ici tis
10
79
M
486
... •• ..• •. ..
6
Ga str iti s •. .••••
3
1,1
16
98
6
• .. ..• ... .•. •
236
He mo rrh oid s...
80
324
1
1,6 24
• .• ... ... ..
63
Al l oth ers .• ..
526
28
771
522
6
••. ... ... •. ..
247
421
1
Ea r, nose, an
12
36
4
64
114
2,1 83
d
217 ...
th
ro
at,
1,1
dis
42
eases
an d inj ur ies of:
------..a" 4
228
39
46 4
----De via tio n of na
333 1,4 80
1
-76
sa
l
18
se
pt um .
Ot iti s me dia ..•
67
211
436
6
476
TonsilJitis•• •• •• ... •.• ..
246
22 4
1
•• •• •.• .•• •..
1,1 57
166
All oth ers .••••
60
11
2
2,3
76
264
2
1,131
442
4
En do cri ne s, dis •• •.. ... .• .• ••
430
36
611
908 --141
3
3,9 40
1 ··--2·
Juries oL ..• •.eases an d in---954 1, 192
46
--•. ... ... ... •. •
--6
----10
-228
2H
279
530
9
Ef :j~ <; _,8gf~~~
7
--lM
--'.
.~
------~. ~~ -~ .
Ge nit o- ur ina ry
8
638
201
eases an d jursy gte m, dis•
9
60
-- ----- -------- 102
ies of (exclu•
siv e of ve neInrea
377
l):
13
Ne ph rit is •• ••
14
6
All oth ••• •••• •• .•• .•. .•.
206
.•. •• •.• .•. •
128
He rn ia . . •.•ers
49
1,7
29
•.•
383
•••
76
1oln ts an d bu rsa •.• .•• . . .•• •. 1, 791 ...624.
e, diseases an d
···244" ... ..a" ··2 6 3433 1,0120
In jur ies of:
63
30
80
,"M2· 1188
7
26
Ar th rit is ..• ••
27 3
839
•• ... ... •• . . .
6
14
Al l oth ers •.• •••
24
87
4
7
... ... ...
330
Le pr os y •. .• ..•
249
405
118
.• .• ... .• ... •.. .
1,5 74
LymJ>hatlc sy
.
49
----45
67
9
--ste
---11
an In jur ies of: m, diseases
5
54
------- ----133
236
-7
Ly mp ha de nl tls
I
10 8
15
•• ... ...• ...
Al l oth ers •••
20
305
9
70
M us cle s, fascia .•• •.. •• ..• ...
73
159
34
e, ten do ns , an
607
ten do n sh ea ths
62
186
, diseases an dd
---Injuries of. ..•
--2
56
23
Ne rv ou s sy ste •• •• .• .• .•. •.• . 1,1 08
8
m, diseases an
--- ---tnt;iries of:
d
----189
plleJ)8y wi th ou
638
t
ps
16
yc
ho
sis
Ne ur iti s • ••
3
53
263
.• ... ... .• • ••
13
Al l oth ers •••.
6
282
... •.• ... ..• ••
92
72
23 ... . T
•
586
32
405
1 Ex ce pt In
2
.. ------ 22
th e case or spec
208
19
• Re pr es en
1
lftc dis ses, sta
2
37
ts nu mb er
347
49
tis tic s are giv en
of dis ch argea
• W he re se qu
26
es for ea ch
36
on
ly
ela e we re giv
for
HO
th e ma jor co nd
en , no th ird dia co nd iti on .
iti
on for wh ich ad
gnosis wa s rec
m ltu tt.
ord ed .
; - - - ______ ,_ _
--- ---- --------- ---------- ----- ---- ------ -------- -----------
_
\
\
--- ---- ------
--- ----
\
------- --- ----
--------- ---------- -------
--------
----·--------
--------------
------- ------ - -------------
------
------ --
--- --- --------
Digitized by
Google
l
I
155
PUBLIC HEALTH SERVICE
itali aa:
9
TABLE
4.-Cauae of admiasion and condition on diacharge, marine hoapital, and
other relief stations-Continued
ge of~
lisea.leli
I
!~~
dition.!
/
11
12
636
44
39
243
6
52
M
18
2
51i
!66
JI(
39
75
295
56
4,1
214
!:H
60
146
30
:?73
244
133
~
9
Number having specified diseases
or Injury
Disease or oonditlon
Major Con•
Con•
°'ffor
i:i':f• second
dltlon dltlon
third
I
Condition on discharge of pat!ents for speclfted diseases of
injuries
Total
num•
ber of
Be-
=i:
qnelm
Not
Other
to
each Cured Im•
Im• Died COD•
which In Im• In Im· major spec!•
proved proved
ditlons
admit- /::;. ~~
fled
ted
disease
or
Injury
:fi:i~
Obstetric and gynecological
59
ditlons ••••••••.•••••••..•...
Parasitic diseases:
Uncinarlasls •••••..•.•....
26
All others ..•••..•..•••....
186
Poisonings and Intoxications:
Alcohol (ethyl) poisoning
acute .•••......•.••••••••
117
Alcoholism, chronic (with·
out psychosis) •.••••••.•
50
All others .••••••••••••••..
116
Psychiatric diseases:
Drug addiction without
psychosis .••••••••••.•..
67
All others •••••••••.•••••.•
357
Respiratory system, diseases
and Injuries of (exclusive of
tuberculosis):
Asthma•.••••••••••••••••.
225
Bronchitis .•••••••.•••••..
579
Pleurisy ••••.•••••••••••..
222
Pneumonia ••••••••••••...
267
All others ••••••••••••••.•.
115
Skin and Its appendages, dis•
938
eases and injuries of ••••••••.
Tuberculosis:
Tuberculosis, pulmonary ••
968
Tuberculosis (otherwise
unclassified) •••••••....•
74
Tumors:
Carcinoma ••••••••••••••••
262
All others •••••••••••.•••••
433
Venereal diseases:
Chaneroldal Infections ••..
323
Gonococcus Infections •.... 2,774
Byphllls•.•••••••.••....••. 2,218
All others •••••••..•••..•..
21
Inoculations ••••.••.••...••...
4
Under observation ••..••••.•..
577
Miscellaneous:
Cellulltls••••••••••••••••••
268
All others ••.••••••••••••.. 3,656
Total •••••••••••••••.... 38, 176
.•.••............••....•.....
12
33 ..•••••
1
13
38
15 ··•····
79
•••••·· ....•....•............
5
17 •••.•••
118
1
1
3
29
58 ··••••·
32
1
62 ..•••••
2
15
1
3
9
27
35
142
42
84
•••..•...•••...•••••.••••.•••
7
34
13
1 .•••...
81
••••••· ••..•...•.•••..••••••.
1
20
17
25
58
291
111
50
8 •••••••
9 ...••••
17
81
32
,41
2
2
3
12
39
1
25
16
UI
45
25
68
306
1,016
97
69
316
217
27
2
39
158
7
9
10
29
106
31
5
179
85
33
91
7
379
143
105
74
2U
516
6
255
131
8
33
1
15
17
333
10
75
10
190
4
93
27
'14
83
186
1, sa2 •••• T
1,506
11
5
67
628
302
953
368
370
••••••• ..••••. ..••.•. ••••••••
137
24
151
3
1, 145
129
705
3,176
3,552
78
405
17
4
5
6
56
9
5
15
22
9
185
214
488
14 ••••••• ••••••
60
627
3
4
577
68
13
6
355
66
144
726
I, 925
7, 151 21, 621
a
55
38
040
338 1,201
7,965
27
Nou.-Immigratlon patients at l1nlted States marine hospital, Ellis Island, N. Y., are not Included In
this table.
144391-32--11
.iii
8
~
Digitized by
Google
TABLE
....
5.-Number of days in hospital/or patients discharged from marine hospitals and other relief stations
g
Class of beneficiary
Amer•
Group
Total
ican
sea•
men
Foreign
. seamen
Coast
Guard
J
Navy Mlssis•
sippi
and
Army Marine River
Com•
Corps mis•
sion
I
Sea•
men
Engi•
.
neer Light•
Corps house
and
$~rv•
Army
ice
Trans•
port
I
Em•
Coast ployees'I Vet• 1 Imml•
and
Com• erans' gration
Geo• 1 pensa• Admin• Serv•
detic
tion
is~ra•
ice
Sur•
Com•
t10n
vey mission
Puhlic
Health
Service
officers I Lepers
and
em•
ployees
Mis.
cel•
lane•
ous
Service
,---,---,---
- - - - - - - - - - -- - - - - - - - - - ,- -- ,---·- - - ·
0
co·
N.
"'
(I)
Q.
O"
'<
CJ
0
a
,..._
(v
Abnormalities and congential mal!orma•
tions. _____ ... --·· ___ -· _.. - --- -- --· -- --Blood !'!:!d ~lood-formlng organs, diseases
and miunes of. .. ·----····---·-·-·----Bones and cartilages, diseases and injuries
of_··--------·-·-·-----·-·-·------··---Circulatory system, diseases and injuries
of ___ ·-----------·-··--------- -- --·----Communicable and infectious diseases,
not including tuberculosis and venereal
DentaL ____ ·- ________ . _-· ___ . ________ . --Digestive system, diseases and injuries oL
Ear, nose, and throat, diseases and injuries
of. ________ ·---------·---------·-------Endocrines, diseases and injuries oL ______
Eye and adnexa, diseases and injuries oL
Genito-urinary system, diseases and injuries of (exclusive of venereal). ________
Hernia. ______ .. _... _____ ._. ____ •... -· ____
Joints and bursae, diseases and injuries oL
Leprosy ____ -·_. __ -· __ -··· ___ -·_. ___ ·-_. __
Lymphatic system, diseases and injuries
of -·- -··- - -- --· -.... -·· - -· -·· -·. -··· -- -Muscles, fasclae, tendons, and tendon
sheaths, diseases and injuries oL.-·---Nervous system, diseases and Injuries oL
Obstetric and gynecological conditions._._
Parasitic diseases .... _-· ___ -· •••• ___ . -. __
Poisonings and Intoxications •. . .• ---··-·Psychiatric diseases-·--·-----··-----··--Respiratory system, diseases and injuries
of (exclusive of tuberculosis)-·--··-·--··
1,573
756
------- --------
115
308
4,632
913
103,419
53,017
1,042
4,872
107,610
64,658
89
2,307
26,621
16,167
116, 795
15,090
7,699
50, 753
126
47
558
2,763
1,202
8,939
65,479
13,040
16,449
114
37,442
5,940 -·-·-·-8,768
106
62,562
49,845
61,328
61,402
38, 139
29,119
30, 768
10, 706
23,216
67,533
1,060
6,135
3,800
27,970
58,569
341
146
282
6,451
208
691
2,431
919
2,295
108 -------- -- ---------- --- -------- -------123 ---------------------- -------- -------241
620
545
86 -------295
2
24
-- -- 169
---28
4 ----·-· ·
20
23
205
31
3,606
------17-32
-- -- ---- --- -- --- ----- --6 ------·------ -27
64
18
-------- -------- -- --------- ---- -------- --------------- -------- -------- -------- -------- -------9
10 -------518
225
7,348
1, 711
12,667
88
5 ··------ -------4 --- ---- 551
I, 190 ------- 42,859
624
2,776
2,367
19,158
39
15
10
388
2,503
34, 778
108
1,690
683 -------- -------- -------I
9 - - ····--
-------- -- ----- - ------ -92
59
3
379
184
18
3,242
18,919
23,395
----------------------
31
2:
3,348
2,664
107
1,020
32,654
109
1,309
437
3,433
290
107
1,138
117
2
345
231
271
232
2,181
6,080
49,364
332
87
1, 717
339
326
356
275
32
172
356
58
I, 245
17, 786
6,104
5,182
155
7
822
26
71
1,076
I, 505
439
410
210
234
69
73
80
513
7,443
3,391
18,201
10,047
23,604
906
9
28
355
374
198
217
62
156
273
1,616
232
40
5,266
1,080
7
17
437
I, 139
2,812
19,066
138
2,296
438
4,356
10
90
9
99
110
176
282
69
28
22
269
19,811
289
1,288
145
76
636
981
220
262
------23
67
1701
-------15
14
65
11
-------33
70
253
-------46
245
t::
1--- ---- -1- -------
a
1-- -·-·-r·-·
tll
136
648 ---····- -·-··-··
505
89
I, 140
§
27
-------10
113
240
-- -----71
--------------- --------------- -------12
--------------- --------
-iii:402-
9
-------- ------ -24
-------2
--------------- --- ------------ -------18
------------ -- - --------
293 •-··-·•-··-···-- ··
~
~
~
g
tg
Skin and its appendages, dlaea8es and in•
Juries 01. •••••.•.•.•.•••••••....••••••.•
Tuberculosis ••• ··" •.•.•••••.....•.•.••...
Tumors •••••••.••••••.•.. •••• ••.•••••...•
Venereal diseases .•••. •••.•••.•••••.••••.•
Inoculations •••.••.....•••••......•••••••
Under observation ..••.•••••.•.•.••...•..
Misoellaneous •••.••••••••• • •.•.•.•.•..•..
81
2,017
26, 327 16, 112
163
7,073 ..••.. •• ••• • ·•·· ........
187, 020 153, 554
47
7
37 ...••... ........
1,038
28, 108 18, 338
64 . ... . .. •
l
1, 396 22,524
248, 502 176, 360
25
35 .•••••••..•••••.
22
1,724
MS
4,143
178
173
5,177
1, 500
84, 637 42, 665
TotaL ••••••••••••••.•.•.•...••... 11, 484,683 '874,382
1········1········1
I
7,056
I 80,616
910
763 I 3, 676
704
5,328
721
4121
141
382
1, 225
6, 564
39
10
1,861
322
I 32, 100 I
9, 737
36
81
6
273
I
976
2791 17,475
131 14,457
53
109
182
I
2, 160
260
312
152
158
10
165
2571
6, 865
7931 18,
186
800
53
7, 406
li08
6, 782
639 32, ~6
I 60, 940
1332, oeo
I
9, 966
40
81
m-!--·····a
65
88
470
I
6, 986
I 61, 824
819
Nou.-Immigration patients at marine hospital, Ellis Island, N. Y., are not Included In this table.
TABLE
6.-Cl,usijication of out-patient treatments furnished at United States marine hospitals and other relief stations
General
medical
Dental
Eye, ear,
nose, and
throat
Neuro-
psychi•
atrlc
Tuber•
culosls
I
Inocul&Surgical Venereal tlons and
diseases vaccln&tions
j
j
I
§
Physlo-
Arseni•
cals
th:infY
~
Total
Xray
ll:
1----1----+----1----1 ----1----1----1------ --1
Marine hospitals._ ..••••••.••.•.•••.••.•••••• ••..••...•.....•.•
Other relief stations •..• ••••..•........•••.••••••.••..........••
Special acting assistant surgeons ......•..•.••••••....•.......•..
Coast Guard vessels and bases •..•...•.•••.•••.••• ... ..........•
Emergency •••.•.•..... ••••... . .........••.•••••...•.••........•
0
co·
N.
"'
~
c;?"
0
73,372
63,746
7,860
53, 798
6li
Total ....•.....•••••••.•.•••.•.•••••. ••• ••••...•.•.•.•.•.. 1 198, 831
ID,465
463
6,097
3,373
6,671
1,301
6,438
15,092
7,246
117
303
96,825
26,448
83
1,047
106,461
15, 783
22, 757
123,403
'19,446
64
109,942
68,881
4,688
18,646
1,403
192,156
194,863
34,553
400
18, IDl
33,472
16,387
1,564
11,262
134
310
70
10
002
338
409
248,107
62,685
524
---------- --- ------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
606,111
'234,034
17,035
114,865
:
6li
~
972,110
~
~
Cl
L,;I
0
a
~
C'1
--.J
DIVISION OF VENEREAL DISEASES
In Charge of Asst. Surg. Gan. T ALIAl'ERBO. CLARK
The activities of the Division of Venereal Diseases during the past
year comprised the following: Cooperative statistical studies with five
of the larger venereal disease clinics of the country; conduct of the
service clinic at Hot Springs, Ark., studies of the prevalence of the
v~nereal diseases in certain areas of the country; cooperation with
other divisions of the service; cooperation with the Office of Indian
Affairs; completion of certain syphilis control demonstrations; dissemination of educational material, including the publication of
Venereal Disease Information; and cooperative work with the States.
Most of these activities were started during the previous fiscal year.
The majority of them are expected to continue during the coming
year.
SCIENTIFIC RESEARCH
The need for intelligent experimental work in this field continues to
be urgent. The chronic character of the venereal diseases, their
extensive prevalence, and the multitude of handicaps to epideiniological control are important factors which may be greatly aided by
research. Unfortunately, experimental investigations in this field
progress slowly, because of the insidiousness of these diseases, their
manifold manifestations, and illicit sexual relationships, which add to
the difficulty of their prompt discovery and application of adequate
treatment.
STUDIES AT THE MARINE HOSPITAL, STAPLETON, N. Y.
The work of the Research Laboratory, located at the United States
marine hospital, Stapleton, Staten Island, N. Y., has continued as in
previous years, without change of personnel, and is directed toward
the solution of _problems having an intimate bearin~ on the preventive,
or rather public health, aspects of the venereal diseases.
Two preliininary phases of the experimental re-survey of the subject
of personal prophylaxis in syphilis have been completed. Reports
are now in preparation dealing with (1) the methods which have been
developed for the testing of the prophylactic efficiency of various
agents in rabbits, and (2) the observations made in expenmental work
for the deterinination of the probable period of time required for a
virulent strain of the s:pirochete to penetrate the intact mucosa of
rabbits to a point sufficiently deep to escape the influence of superficially applied spirocheticidal agents. Other projected studies will
be directed toward the evaluation of the prophylactic efficiency of
various cheinica.l and pharmaceutical substances.
Progress has been made during the year also in the study previously
reported dealing with the potential dissemination of syphilis through
the medium of the symptomless case. Experiments designed to
158
Digitized by
Google
PUBLIC HEALTH SERVICE
159
isolate the spirochete from the seminal fluid of luetics have been completed in 30 selected cases drawn from the latent, seronegative class.
A detailed report covering the methods used and the results obtained
in this study is being prepared for publication. Further study along
this line with the use of material from other classes of luetics, will be
pursued as rapidly as possible. These studies are expected to have a
marked bearing on the determination of the duration of infectivity of
syphilis, which is as yet problematical.
The practicability of utilizing stained preparations, in public health
work, rather than the dark-field in the early diagnosis of suspected
syphilitic lesions, has been investigated, limited chiefly to some of the
more recently described staining techni~ues. These investigations
were undertaken for the purpose of simplifying, if possible, the early
diagnosis of syphilis. The superiority of any staining technique over
the dark-field has not been indicated by the results obtained.
Investigation of the r6le of the reticulo-endothelial system in combating syphilis, and _Particularly in the production of the Wassermann
substance, was contmued and involved search for an ideal suspension
of a particulate substance for use in the blockade of the reticuloendothelial system which does not contain other active constituents
that may introduce a factor of error. The importance of the reticuloendothelial system in combating syphilis is rather emphasized in the
newer forms of syphilis treatment, but mainly malaria and artificial
fever therapy, which probably depend for their efficacy upon mobilization of the defense forces of the body, a function usually associated
with the reticulo-endothelial group of cells.
The effect of ultra-high-frequency radio. waves upon the course of
animal syphilis and upon the spirochete in vitro has also been studied.
Some digression was introduced into this investigation in order to
study the factors that determine the site and severity of burns following exposure to the high frequency field, in the hope that some method
of prevention may be found.
Certain phases of both the morphology and biology of the Treponema pallidum still . remain ii_ideterminate. Equipmen~ has . been
assembled for studymg the biology of the orgamsm, mcludmg a
special dark-field apparatus which permits the transillumination of
a hanging drop and the introduction of a micro,pianipulator into the
field for the isolation of a single spirochete. Tliis measure will make
possible single cell work with the organism and its subsequent implantation into the various artificial culture media, which if successful will
materially advance the ultimate control of syphilis. Attempts to
grow the spirochete on artificial media have not as yet been uniformly
successful, owing, in large measure, it is thought, to the almost practical impossibility of obtaining the organism in pure culture.
Observations have been made also on the so-called transition forms
of the spirochete, especially in glandular and other tissue emulsions
from infected animals, through the medium of which the disease may
be transinitted but in which the spiral form of the spirochete is
rarely observed, either by dark-field or in stained-tissue sections.
STUDIES AT CHICAGO, ILL.
The research work was continued on the biologic treatment of
gonorrhea. This work has been under way during the past several
years in cooperation with the scientific staffs of the John McCorinick
Digitized by
Google
160
PUBLIC HEALTH SERVICE
Institute for Infectious Diseases and the medical department of the
University of Illinois, with the assistance of the consultant staffs of
the Cook County Hospital and the Illinois Dispensary. Experiments
made in an attempt to discover the immunological effect of various
fractioned portions of gonococcus toxin are still being carried on.
The use of the saline extract of gonococcus toxin was tried with the
idea of eliminatin~ certain extraneous and undesirable ingredients
which are present m the broth cultures. This step made itnecessary
for the bacterial growth to be obtained from saline extracts made
from solid culture media implanted with the gonococcus, and led to
the publication of an important paper on the use of whole human
blood agar medium for growing the gonococcus. The use of this
medium is believed to be not only important from an experimental
standpoint but also of great use in applied bacteriology.
Gonorrhea is one of the longest-known diseases, and it is probably
the most ubiquitous disease encountered by the health authorities of
the country. In spite of the serious consequences of infection and
its very great prevalence, no specific for its cure has yet been found.
The success met with in the biologic treatment of other communicable diseases has led to tp.e hope of the development of a biologic
product that will be effective, but without success. Research has
been carried on, therefore, during the past year, into the nature of
toxins in general, in the hope of discovering some essential factor or
principle that may be applied to the successful modification of gonotoxin for diagnostic and therapeutic purposes. These studies unfortunately were discontinued at the close of the fiscal year by reason
of the limitation of funds ..
MALARIA TREATMENT OF NEUROSYPHILIS
Research into the malaria treatment of neurosyphilis, begun last
year, was continued during the year in cooperation with the Central
State Hospital at Columbia, S. C., and included investigations of the
most efficient method of transporting infectious material under varying conditions of temperature, time and distance for use in the induction of malaria for therapeutic purposes.
A strain of the tertian plasmodium has been maintained since the
inception of this pr~ram two years ago and has been distributed to
a number of institutions. This form of malaria is well tolerated by
patients and is particularly successful in bringing about remissions in
general paralysis of the insane.
.
The need for a strain of quartan parasites was noted early in these
studies, because a relatively large number of individuals, more particularly negroes, are quite refractory to infection with the tertian
parasite. These individuals are found to be less refractory to the
quartan form. A strain of this relatively uncommon form was secured within the last few months and is carried at the Columbia
(S. C.), laboratory. By the close of the year it had been used for the
treatment of a number of patients with satisfactory results.
A supply of this material has been furnished other research and
treatment centers, notably the Rockefeller Foundation Malaria
Research Center, Tallahassee, Fla., and the United States marine
hospital at Baltimore, Md., as subsidiary supply stations for emergency
use. The incubation period of the quartan plasmodium in the mosDigitized by
Google
161
PUBLIC HEALTH SERVICE
quito is so long as to make the transmission of infection difficult
except by direct blood inoculation. Special studies will be instituted,
therefore, in an attempt to solve the question of mosquito transmission of this form of malaria during the coming year.
The availability of Anopheles mosquitoes for use in malaria therapy
is variable, owing to geographic location and seasonal changes. More
recently reasonable assurance of a constant supply of Anopheles was
made possible with the development of a method of growing this
species of mosquito, under suitable conditions, from eggs laid by captured fertilized females. Previously it had been necessary to capture
in its natural habitat, each mosquito for use in transmitting malaria.
At present only the fertilized females are captured. Eggs deposited
by these wild mosquitoes give an abundant supply of adult mosquitoes.
The character and extent of these activities may be summarized as
follows:
Paretics inoculated with malaria______________________________________
Paretics known to be infected with malaria (includes 28 at Columbia, S. C.) _
Inoculations, both positive and negative, made at Columbia ______________
Inoculation material used at Columbia for the positive inoculation of 28 individuals consisted of the following:
Blood containing plasmodium_____________________________________
Infected mosquitoes _____________________________________________
Sporozoites from dissected glands_________________________________
Hospitals and institutions furnished with malaria material during the year_
Wild mosquitoes collected during year _________________________________
Wild mosquitoes infected with malaria collected _________________________
Mosquitoes bred from eggs laid by captured mosquitoes __________________
Bred.mosquitoes infected with malaria_________________________________
99
33
118
13
12
3
13
995
213
294
37
CLINICAL RESEARCH
COOPERATIVE CLINICAL STUDIES
Analyses made during the year of the case reports from five of the
leading venereal-disease clinics in the United States yielded much
information from the therapeutic standpoint. These cooperative
studies were carried on with the financial assistance of a lar~e philanthropic foundation. The important statistical compilations were
made by this division.
A series of three papers re_porting on the results of treatment in
early syphilis have been completed and published in Venereal Disease
Information.
Some of the more important conclusions based on these retrospective studies on early syphilis are as follows:
The statement can be made, with almost axiomatic force, that
continuous treatment, whether prolonged or brief, and practically
regardless of the drugs used, is superior in its results to intermittent
or other schemes of treatment.
Syphilis of the central nervous system was found to be almost
three times as common in those who received little as in those who
got much treatment with the arsphenamines, although · thorough
treatment does not protect necessarily against abnormalities in the
spinal fluid.
Six and one-half per cent of the patients who began treatment
while their disease was in the early stages attained a cure as evi1
Digitized by
Google
162
PUBLIC HEALTH SERVICE
denced by physical examination a year or more after treatment
and ade9uate serologic controls.
Unsatisfactory results were obtained in 26 per cent in spite of
treatment. The unsatisfactory results may be classified either as
clinical or serological relapse or as failure to reverse a positive serologic test.
In addition to these highly instructive papers on early syphilis,
a series of three papers, covering 1,936 cases admitted to treatment
with la.tent syphilis, have been completed and will appear in Venereal
Disease Information in the near future. These studies on latent
syphilis were based on cases which were clinically nonrecognizable
as syphilitic infections.
Two other important studies based on this cooperative clinical
material have also been in the process of statistical compilationone on the treatment reactions of the arsenicals, and the other on
the whole field of central nervous system lues. These two projects
will probably occupy to a large extent the statistical research time
of this division during the coming year. It is expected to carry
these studies to their completion, inasmuch as e. large part of the cost
of the final product has already been expended in the accumulation
of these data on a uniform abstract blank.
HOT SPRINGS CLINIC
The Hot Springs clinic, maintained by the Public Health Service
in cooperation with the National Park Service for the treatment of
indigent persons havin~ v~nereal diseases, has shown a significant
increase in all its activities. During the past fiscal year a total of
6,184 cases of venereal disease were treated, an increase in the combined case rate of 22 per cent over 1931. The cases of syphilis and
gonorrhea. increased 15 e.nd 30 per cent, respectively. Moreover,
93,707 treatments were given, an increase of 41 per cent, and in
addition, 119,464 baths, an increase of 15 per cent as compared
with the preceding year. A summary of these activities for the year
is given in Table 5.
During the past year the abstracting of 10,000 s:yphilis records
of patients treated at this clinic was started for use m a statistical
analysis of the effects of treatment on this class of patients;
Fourteen phy-sicians, including eight junior medical officers of the
service, were given postgraduate training.
PREVALENCE STUDIES
An important activity during the past few years has been the
attempt to show the trend of the venereal diseases in selected areas
of the country and to measure the effectiveness of present-day control
methods in this field. The data on the resurvey of 14 communities,
including small cities and counties, and one State tentatively reported
last year, were further analyzed during the year. It was found in
these 14 communities that the trend is slightly downward for both
syphilis and ~onorrhea--4.4 per cent decrease in the case rate per
1,000 population for syphilis, and 5.5 per cent for gonorrhea. This
downward trend, however, is not a consistent one throughout each
of the 14 communities resurveyed, but did occur in 9 of them.
Digitized by
Google
PUBLIC HEALTH SERVICE
163
Probably the most encouraging development of the study of this
material is the appreciable increase in the number of cases of early
syphilis and acute gonorrhea that applied for treatment. The
number of fresh infections of syphilis under treatment in the public
clinics was nearly twice as high as that found in the original survey.
There is a growing conviction among public-health officials generally
that probably the most important step in the ultimate control of the
venereal diseases is the discovery of cases in the early stages of the
disease and the prompt application of treatment to render and to
keep such cases noninfectious. The increasing number of fresh
infections under treatment in these resurveyed communities is therefore of unusual importance and significance from the standpoint of
ultimate control.
In comparing the trend of the venereal diseases in these smaller
cities and communities with that shown by more or less State-wide
surveys, the result is not so optimistic. In Oregon it was found
that, during a period of approximately three years, the syphilis case
rate had increased 17 per cent, but that the rate of cases m the early
stages of the disease is nearly four times the rate for the late cases.
The gonorrhea case rate showed a decrease for the chronic cases
under treatment and an increase of 11 per cent in the case rate for
acute cases. A similarly discouraging situation was met with in a
resurvey of upper New York State, published in Venereal Disease
Information for November 20, 1931, which showed an apparent increase in the syphilis rate and a slight decrease in the gonorrhea
rate as compared with the survey made in 1927.
Three new communities were surveyed during the year, San Francisco, Calif., the city of Birmingham and Jefferson County, Ala., and
Dallas, Tex. The data on these surveys is in process of compilation.
COOPERATION WITH OTHER DIVISIONS OF THE SERVICE
Division of Marine Hospitals and Relief.-Special case-record forms
prepared by this division last year for the purpose of standardizing
and securing continuity of antisyphilitic treatment for service beneficiaries found general use in six marine hospitals and the largest outpatient relief station during the year with most satisfactory results.
The continued use of these forms is expected to yield greatly needed
information regarding the efficacy of various drugs used in antiluetic
treatment and the complications of treatment, and it is expected also
to stimulate more exact diagnosis and stricter application of indicated
therapeutic measures.
The high percentage of the total hospital days in service hospitals
charged agamst the venereal diseases, while due in some measure to
the large number of cases admitted for treatment, is in no small
degree caused by the length of time required to effect a cure, the
tendency to relapse, and the occurrence of serious mental and organic
disturbances as late manifestations of syphilis.
In view of the reported benefit derived by the treatment of general
paralysis of the insane with malaria and artificial temperatures
mduced by various physiotherapeutic means, this division has cooperated with the hospital division during the year in the application
of these measures to the treatment of service beneficiaries who are
in the incipient stages of the disease in an attempt to prevent the
occurrencQ of the serious late manifestations.
Digitized by
Google
164
PUBLIC HEALTH. SERVICE
· Division of Mental Hygiene.-Cooperative activities carried on in
Federal penal and correctional institutions last year in cooperation
with the Division of Mental Hygiene were continued. Medical
officers experienced in venereal disease work have assisted from time
to time throughout the year in the or~anization of more efficient
venereal-disease service in these institutions. Educational material
has been prepared for distribution and films have been loaned for
use in connection with venereal disease lectures before audiences
composed of Federal prisoners. It is believed that such measures
supplemented by standardized records and treatment methods previousl1, introduced into these institutions will greatly assist in the
rehabilitation of prisoners and be most effective in preventing the
continued spread of these diseases by them on parole or discharge.
COOPERATION WITH THE OFFICE OF INDIAN AFFAIRS, DEPARTMENT
.
OF THE INTERIOR
The assistance given the Office of Indian Affairs, on reJi~)~=t of the
~mmissioner, in the organization of mass control of syp · · among
the Indians of the Red Lake Indian Reservation, Minn., has been
continued. The various problems attending the provision of treatment facilities, the maintenance of adequate follow-up service, and
the study of the prevalence rates among these people have been the
principal features of this activity.
During the past year 1,275 reservation Indians were serologically
examined, and of these approximately 15 J?er cent showed a positive
Wassermann reaction. A most interestmg development of this
study is the difference in the serological reaction manifested by this
group of Indians which, if found true of other groups throughout the
country, would seem to indicate that the reaction of the Indian to
treatment, as indicated by serological tests, is markedly different from
that of other classes of the general population. The treatment recommended for these cases comprised 5 courses, each course consisting of 6
doses of neoarsphenamine and 12 doses .of bismuth, or the equivalent
of 30 doses of neoarsphenamine and 60 doses of bismuth. Seventeen
per cent of the total number under treatment completed the full five
courses, and among these 61 per cent continued to give a positive serological reaction.
STUDY OF SYPHILIS AMONG RURAL NEGROES
The demonstrations inaugurated to show the practicability of mass
treatment of syphilis in the rural Negro on an extensive scale in six
Southern States in 1929 and 1930 have been completed.
The corrected prevalence rates fol'. syphilis per 1,000 population as
ascertained by the Wassermann surveys in these demonstrations are
as follows:
Alabama, Macon County ________ 350
Georgia, Glynn County __________ 269
Mississippi, Bolivar County ______ 236
I
North Carol'na, Pitt County _____ 118
Tennessee, Tipton County _______ 259Virginia, Albemarle County______ 71
- These rates are approximately ten to fifty times higher than the
rate 7.2 per 1,000 obtained in 1-day prevalence studies carried out in
recent years by the Public Health Service.
Digitized by
Google
PUBLIC HEALTH SERVICE
,·;
165
The areas involved in these two types of prevalence studies are
sufficiently representative of the Negro race to be suitable for comparison. It should be borne in mind, however, that the 1-day census
study discloses only those patients who are intelligent enough to seek
treatment in the early stages of the disease and to continue treatment
for some time after the acute manifestations subside. On the other
hand, the mass control survey brings to light practically every type
of syphilitic infection, not only such cases as would be reported in a
1-day census study, but also the much larger group of cases of the
clinically symptomless latent form of disease.
The expenditures for these demonstrations have been analyzed
from the standpoint of the per capita cost of blood tests (case findmg);
the combined cost of blood tests and treatment on the basis of total
population examined during the primary survey; and the total number of syphilitic negroes treated. The per capita cost of case finding,
which included the laboratory cost of a blood test and the cost of
collecting the blood in the field, averaged $0.54. On the basis of the
total number of negroes examined in the case-finding survey, the
per capita cost for the entire project was approximately $3.50. The
per capita cost of diagnostic and therapeutic blood tests and treatment
of all cases of syphilis who started treatment at any time in the course
of the demonstration averaged $14.20.
Estimated on an annual basis, the per capita cost of case finding
remains unchanged, $0.54; for case finding and treatment combined,
$2.30 as compared with $3.50; for diagnostic and therapeutic blood
tests and treatment of all cases of syphilis who started treatment at
any time1 $8.60 as compared with $14.20.
In addition to demonstrating the prevalence of syphilis in the negro
in the rural South, these projects indicated the/racticability of mass
treatment of this population group and furnishe valuable information
on the needed financial outlay.
HEALTH EDUCATION
Distribution of literature on various aspects of the venereal diseases
and sex !J.ygiene, the- loan of motion-picture films, the presentation
of -scientific articles and popular lectures, and the publication and
distribution of the monthly bulletin Venereal Disease Information
were continued during the year.
The value of the publication Venereal Disease Information to the
physicians of the country has materially increased1 if paid subscriptions may be taken as an indication of its value, which increased from
5,247 in 1931, to 11,008 in 1932, or more than 100 per cent. The total
distribution, including paid subscriptions and the free list, increased
from 8,158 in 1931, to 13,878 last year, due solely to the increase in
paid subscriptions.
A number of important special articles published in Venereal Disease Information during the past fiscal year attracted wide attention,
some of which are as follows:
The Kahn'Reaction in the Blood Serum of Normal and Syphilitic Guinea Pigs.
By K. K. Bryant and J. F. Mahoney. July 20, 1931. 4 pages.
A Practical Belt for Mercury Inunctions. By 0 .. C. Wenger. July 20, 1931.
2 pages.
Digitized by
Google
166
PUBLIC HEALTH SERVICE
The Response of th~· \rassermann Reaction to Treatment in Early Syphilis as
Affected by the Factors of Race, Sex, and Pregnancy. By H. M. Robinson and
Mildred H. Faupel. August 20, 1931. 5 pages.
Prophylaxis and Treatment of Venereal Disease in the United States. By
Audrey G. Morgan. August 20, 1931. 7 pages.
·
The Control of Gonorrhea. By Taliaferro Clark. September 20, 1931. 9
pages.
Survey of the Venereal Diseases in the City of Baltimore, Baltimore County,
and the Four Contiguous Counties. By Taliaferro Clark and Lida J. Usilton.
Oct 20, 1931. 20 pages.
A Second Study of the Prevalence of Syphilis and Gonorrhea in Upstate New
York. By Albert Pfeiffer and Herbert W. Cummings. November 20, 1931. 18
pages.
The British Treatment Center. By R. A. Vonderlehr. December 20, 1931.
6 pages.
The number of requests for educational material received during
the year was 13,112, and 121,126 pamphlets and other publications
were distributed to the State boards and departments of health and
to private individuals in response to these requests. During the year,
191 reels of The Science of Life film were sent to 29 individuals or
schools in 21 States, and wax moulages were lent for use in lectures to
lay organizations.
COOPERATIVE ACTIVITIES WITH STATES
At the request of several State departments of health, assistance
was extended in the organization of venereal disease control measures
within their boundaries. One member of the field staff was engaged
during the year in assisting the State health authorities of Tennessee
and North Carolina in the development of State-wide venereal disease
control programs. Some work was also conducted in the States of
Alabama, Georgia, Mississippi, and Virginia.
Forty-three States cooperated with the service in reporting the
prevalence of venereal diseases and the measures employed for their
control. During the fiscal year there were 2,458,932 laboratory
examinations made in these States, an increase of 15 per cent over
1931. Of this number, 2,051,636 were serologic tests for the diagnosis
of syphilis, 8,163 dark-field examinations, and 399,133 examinations
for the gonococcus. A total of 1,206,321 doses of the arsphenamines
were distributed, an increase of 15 per cent. These States also reported 422,191 cases of venereal diseases, representing 260,564 cases
of syphilis, 158,083 cases of gonorrhea and 3,544 cases of chancroid.
The increase for all venereal diseases was 8.4 per cent, for syphilis
and gonorrhea, increases of 13.4 and 1.4 per cent, respectively, and a
decrease of 1.1 per cent for chancroid. The State activities are shown
in Table 1.
CLINIC ACTIVITIES
In 1932 there were 533 clinics reporting, as compared with 512 in
1931. The number of new cases admitted to these clinics was 148,933,
an increase of 3.4 per cent over the previous year. Detailed data for
clinic activities are shown in Table 3.
Digitized by
Google
167
PUBLIC HEALTH SERVICE
T ABLII 1.-Report of Blau depart1111ents of hUJltlr., showing the number of cases of
syphilis and gonorrhea reported, the annual rates per 1,000 inhabitants, the amount
of arsphenamine distributed, and the laboratory examinations made from July 1,
1981, to June SO, 19SfJ
.
Laboratory examinations
Number of cases
Annual
State
Total ...•..•.•.•.....•.•..
Alabama.......................
Arizona.........................
Arkansas.......................
California......................
Colorado.......................
Connecticut....................
Delaware.......................
District of Columbia...........
Florida•........................
Georgia.........................
Idaho..........................
Illinois.........................
Indiana.........................
Iowa•..........................
Kansas.........................
Kentucky......................
Louisiana.......................
Maine..........................
Maryland......................
Massachusetts..................
Michigan ....••.....••.•••••... _
Minnesota......................
Mississippi.....................
Missouri.. ••••. ·----·····.......
Syphilis
rate for
sytllls
an gon•
Oonor• orrheaper
1,000
rhea
Inhabit•
ants 1
260,564
168,083
13,204
263
4, 720
15, 740
889
1, 615
1,391
1, 532
5,451
209
2, 864
12,370
380
1, 341
440
1, 097
398
4, 232
4
17,500
1, 837
457
718
4,646
1, 110
2,094
11, 714
5
18,094
2, 820
570
941
3,784
2, 790
497
3, 108
4,682
12, 957
4, 142
11,395
4, 100
900
2, 264
6,929
7, 500
3,872
17,823
2, 468
Doses of
arsphen• Wasser• MicroMicro•
scoplc
scoplc
amines
examlna• examlna•
dlstrlb• mann(or
other
tlons
for
tions
for
uted
similar) trepone• gonococ•
tests
ma pal•
cus
lldum
3. 6 1,206,321 2,001,636
8,163
399,133
7.0
1. 1
4. I
5. o
1. 2
1. 8
7. 7
5. 4
3. 4
5. 5
711,878
105,633
355
3,006
18, 870
150,472
7,849
12, 409
4, 064
9, Oi9
2,986
66, 378
695
489
5
28
•
31
4. 7
1. 4
.5
.9
3. 2
1. 9
1. 8
3. 3
2. 7
4. 2
3. 1
14. 5
1. 8
123,825
39,087
6,470
9,777
26,014
10, 482
3,617
40, 995
75,225
24, 915
7,843
11,549
34, 605
40, 755
71,517
11,114
31, 644
4, 364
5, 671
1,270
69, 70i
803
91,633
101, 132
2,030
45,218
11,014
15, 214
7,336
9, 975
100,478
43, 164
108,317
36,934
24, 124
11, 226
15,560
2,693
3, 801
939
3, 174
289
2, 973
434
48,514
6, 482
2,995
4,537
4,051
2, 408
3,964
5, 9m
7,685
39, 716
12, 150
1,477
15, 499
15
1,432
2
34
4
371
95
l"
•
....
•
2
1,483
Montana'··--·--············-·- ............••...... -····----·····---··- ...........•.•........•...•..•
Nebraska.......................
1,027
1,642
1. 9
8,310
24,196
81
4,874
Nevada................................... .......... .......... ........ ..
2,528
3
899
New Hampshire................
99
159
.6
1,995
5,102 .••••••...
1,814
NewJersey ...•..•..•••......•.•
7,571
4,088
2.9
43,173
37,209
77
5,719
New Mexico• •.....•.•.....................•.•.......••........•.•.•..............•.........••......•
New York...................... 63, 590
18, 661
6. 5
99, 355
729, 195
911
87, 343
North Carolina•.....•.•.•........•.•.......•........•••..•...•.•.•.......••........••••.....•.•.....•
North Dakota..................
384
919
1. 9
244
5, 788
13
2, 835
Ohio............................
8, 007
4, 494
1. 9
64, 133
44, 711
1, 293
15, 697
Oklahoma• ....•.•.........•........•.................••........•.....................•.••............
Oregon.........................
588
1, 007
1. 7
3, 426
11, 409
21
4, 366
Pennsylvania...................
3, 973
3, 788
.8
39, 371
61, 010
14, 464
Rhode Island...................
974
830
2. 6
11,801
15,070
59
5,622
South Carolina.................
5,401
7, 40i
7. 4
3,667
697
1,591
South Dakota..................
321
560
1. 3
6, 609 ...•.......•••..••••
Tennessee......................
8,416
3,924
4. 7
56,620
43,517
219
7,552
Texas...........................
4, 921
1, 259
1. 1
32, 942
7, 707
21
3, 107
Utah• .......•...•........................••.........••••................••....... -········• ..•.••...•
Vermont•-·····-···············
286
400
2. 3
1,377
4,263
8
1,734
Virginia........................
6, 250
1, 412
3. 2
21, 283
48, 599
16
5, 541
Washington....................
2, 129
2,536
3. O
8,339
44,845
180
23,266
West Virginia..................
23, Oi7
6,385
17. O
34,975
9,491
26
2,459
Wisconsin......................
583
1, 795
•8
8,961
10,646
50
9,873
Wyoming• •....••••...•.•••.•.......••.•..••...•..•.•.•...•...•.•.•.•.....•.•.· .......•..........••••
1 Excludes chancroid, which formerly was Included In the annual rates.
• For 6 months.
• For 11 months.
• Not reporting.
• For 10 months.
Digitized by
Google
168
PUBLIC HEALTH . SERVICE
TABLE
2.-Report of 65 correctional and penal institutions
Number
New cases admitted:
7,916
4,072
~1:;!~ea::=::::::::::::::::::::::::::::::::::::::::::::::
Chancroid _________________________________________________ _
Total ___________________________________________________ _
Cases discharged as arrested or cured _____________________________ :.
Treatments given ______________________________________________ _
Doses of arsphenamines administered _____________________________ _
Wassermann tests made _____________ -- __ -- ____ - ___ -- ______ - - -- -- Microscopic examinations for gonococcus __________________________ _
TABLE
235
12,223
6,488
369,100
44,590
50,047
11,290
3.-Report of 655 clinics furnished through State health departments, July 1,
1951, to June SO, 1952 1
State
New cases admitted
Total
month•
ly
reports
Oonor Chan•
re•
Total S:YJ>hl•
!Is
rhea crold
celved
Cases
dis•
charged
as
arrested
or cured
Treat•
ments
given
-- - -- Total •••••••.••
Alabama•••••••••••••
Arkansas •••••••••••••
California.••••••••••.
Colorado •••••••••.•..
Connecticut .••••.•..•
Delaware .•••••.•....
District of Columbia.
Florida• •••••.....•.•
Georgia •••........•••
Illinois .•.•.••..••••••
Indiana •.•••••••••.••
Iowa•-···-··········
Kansas •••.•••••••••..
Kentucky ..••••.•••••
Louisiana •••••••.•..•
Maine .•••••.•.••••..
Maryland ••..•.•..•••
Massachusetts •••••••
Michigan •••••••••.••
Minnesota •.••.•••.••
Missouri •.•••••••.•..
Nebraska .•.••.••••..
New Hampshire .•••.
New Jersey •••.•..••.
New York •••.• , ••.••
North Dakota.•••.•••
Ohio •.•••••••••••••••
Oregon .•••.••••••••••
Pennsylvania ••••••••
Rhode Island ••••••••
Tennessee ••••••••••••
Virginia •••••••••••••.
Washington••••••.•••
West Virginia•••.••.•
Wisconsin•••••.•..••.
5,986 148,933 89,769 57,058
188
60
318
48
93
12
12
9
71
285
183
85
35
303
16
96
263
300
162
48
118
36
47
296
665
10
477
12
742
72
457
87
36
:m
135
15,245 ll,233
7,479 4,658
8,959 5,408
658
965
1,590
802
217
129
2,647 1,532
696
535
3,602 2,376
13,465 7,047
3,569 1,975
1,041
575
746
466
8,385 3,631
655
474
681
287
5,445 3,037
5,658 2, 731
6,860 3,378
908
406
3,013
1,167
151
6,900
9,257
52
12,023
524
7,210
1,936
583
64
4,430
6,772
13
7,304
358
3,753
507
6,051
2,857
802
2,084
917
907
8,527
3,949
1,457
3,361
1,613
2,131
3,837
2,819
3,547
175
2
4
9
24
7
18
26
84
298
764
81
1,007
135
1,192
6,319
99
1,519
75
464
2
264
16
4,583
171
177
4
393
1
2,190 _ _____
218
2,927
3,402
80
499
3
1,065
12
574
10
87
2,387
92
2,474
11
39
4,221
523
166
3,348
109
397
3
2,197
279
1,017
75
648
7
1,236
41
1
695
..
-------------
MicroDoses
scoplc
of ars- Wasser• exami•
phen• mann na•
amines tests tlons
!or
admin· made
gono•
istered
coccua
--- ---
--
63,906 12,964,130 742,963 515,884 196,783
7,192
7,387
2,414
576
926
143
25
151
1,490
8,376
1,843
505
202
1,948
40
239
1,678
1,140
3,390
381
697
237
73
2,160
6,639
26
3,691
44
3,892
558
2,912
513
986
928
liC)f
224,500
1229, 761
189,088
31,461
40,183
2,813
30,498
7,616
55,916
278,525
ll2, 103
27,474
18,040
85,140
5,306
11,747
127,379
194,810
28,510
73,131
29,833
8,621
200,889
213,049
890
237,005
13,064
69,551
27,338
189,196
52,377
34,441
58,381
46,494
84, 148
18,497
53,390
7,849
9,506
966
9,049
2,986
26,123
15,821
37,221
6,506
5,790
25,140
2,812
3,443
40,447
22,387
39,704
32,576
2,570
2,025
218
5,671
1,269
22,716
73,568
10,145
2,051
2,234
10,549
947
1,308
9,.584
5,429
15,652
7,556
2,056
42,226
59,982
267
62,245
3,426
37,559
6,581
55,182
25,468
8,339
27,592
8,861
2,820
10,361
5,361
587
22, 737
26,028
53
40,446
1,223
12, 740
13,155
43,143
12,988
23,359
9,462
10,646
3,899
1,052
12,264
1,086
1,36g
3,184
289
1,058
37,314
3,836
3,013
1,846
3,846
373
501
5,415
-~848- -------41,253 ·39;706
1,248
3,225
2,601
425
4,945
11,034
195
14,001
981
··5;e22
7,545
2,881
10,539
2,UO
9,873
1 States which did' not report and those which had no clinics have been omitted from this table; they are
Arizona, Idaho, Mississippi, Montana, Nevada, New Mexico, North Carolina, Oklahoma, South Carolina,
South Dakota, Texas, Utah, Vermont, and Wyoming.
• Includes 119,464 baths given at the N atlonal Park Clinic, Hot Springs, Ark.
• For 6 months.
• For 11 months.
Digitized by
Google
169
PUBLIC HEALTH SERVICE
TABLE
4.-Report of cooperative clinic activitiBB furnished through State health
departments from 1919 to 1988
.
Cases dis- Treat•
New Total treat• charged mentsper
Number
or clinics cases ad·
as arrest• new case
ments
given
reporting mitted
ed or
cured admitted
Year
1919 ••••• ·••·•·••·••·••••·••·••••• ·•••••·•••····•·•
1920... •• •••·•···•••·••••••••• •••• ••••••·•·•·•·•··
1921. ••...•.•.. ···•·• ··•••••·•••• •••••••••••••....•
1922 .••..• •··•·•··•••···••••••••· •.••••.••••. -- -- ••
1923 ••••.•.• -- .....•.•.•.•.•....•..•••••••••.•.••..
1924..•....... ·•·•·•• .• ••·•••·•····••· ••..•••. •· .- •
1925..••••. ·-•••.••..•••••.•..••.....•.•.••.••••••.
1926••••.•.•.•••.••.•.•.•.•...•...••..•..•..•.....•
1927 ••••.•.•.•••.•.••••..•••...........•.•••.•..•••
1928•••.••••.•••.••••.•.•.•••......••••.•......•.•.
1929 ••••••.••••••••.•.•.•.•.•••...••..•.•.. -- ...•..
1930••••.•.••••••••••••.••••. ·•••••••······••·•····
1931 ••••••••••.•.•••••••••• ···········- ••••.•....•.
1932••••••••••••••••.••••.•.•.•••••••••••...•..•••.
167
383
442
Ml
513
li04
495
416
425
451
445
477
512
533
59,092
126,131
140,748
141,279
119,217
118,023
110,372
100,776
107,688
110,756
120,315
127,978
142,915
148,933
527,392
l,576,M2
2,108,003
2,046,232
1,992,631
2,147,087
2,088,494
1,881,380
1,964,233
2,174,832
2,128,417
2,M7,162
2,833,700
2,9M, 130
14,278
34,215
55,467
60,169
55,583
51,658
47,828
44,329
44,701
49,487
52,136
55,592
67,414
63,006
8.112
12. liO
14. 98
14. 48
16. 71
18. 19
18.92
18.67
18.24
19.64
17.69
19.00
19.83
19.84
5.-Report of the United States Public Health Service clinic at Hot Springs
National Park, Ark., from July 1, 1981, to June 80, 1988 1
Total applicants____________
5,106 Gonorrhea (new cases)______
2,467
Acute
________________
_
Venereal ••••• __________ 2 4, 287
181
Chronic. _____________ _ 2,286
NonvenereaL__________
819
Syphilis __________________ _
3,188 Treatments given ___________ 213, 171
TABLE
New cases ____________ _
Readmitted cases_-·--·-_
Gonorrhea ________________ _
2,435
753
New cases ____________ _
Readmitted cases ______ _
2,467
529
Syphilis (new cases) ________ _
Primary ______________ _
Secondary ____________ _
Tertiary ______________ _
Neuro ________________ _
Congenital ____________ _
2,435
2,996
205
197
1,869
153
11
Arsphenamine__________ 12,350
Mercury and bismuth ___ ' 27, 677
Other intravenous._____
860
Gonorrhea _____________ 52,820
Baths _________________ 119,464
Laboratory examinations.___
69, 959
Complement fixation
tests. ______________ _
Precipitation tests ______ _
Gonococcus smears ____ _
Darkfi.elds ____________ _
Icterus indices _________ _
Urine analyses ________ _
21,016
10, 169
10,204
664
9,171
18,735
====
1 From the annual report or the clln!c.
I
_
• The 4,287 patients represent 6,184 cases; l,8il9 patients had both syphilis and gonorrhea.
TABLE
6.-Report of the United States Public Health Service clinic at Hot Springs
- -- National Park, Ark., from July 1, 1928, to June 80, 1938 -
Year
Total...............................
1922•••••..•••.•.•••• .' ••••·•••·•·•··••••··
1923••••..••.••• ·•·•·• •••••. ••••·•·•···•···
1924... •. .. . ••.. .•.•••.•. •.... .• •• ••...•••.
1925........ ...•. ••••••••••.••.....•.• .....
1926 ····································1927.. •• • • . • • • • ••• • •• . • • • • • .. • . . .• • • • . . • • . •
1928•••••••.•.•••.•.••••..••••.••.•.• ·•··•.
1929.............. •• • • ••• • • • •• •• • • .• . • . • • . •
1930........................ ..• ••• .•...•..•
1931. •••.••••••••••••••.•••••... ·•·•·•••···
1932.......................................
Number or cases
Number 1 - - - - - - - - - - - - 1 Treat•
or appll· Total
ments
given 1
cants
venereal Syphilis Gonor•
rhea
diseases
Wasser•
mann
tests
made
47,946
39,176
24,526
14, 6liO
686,877
76,710
2, 720
3,389
3, 676
3,411
3,570
4, 75 7
5,467
5, 265
5, 704
4, 881
5,106
I, 775
1,8M
2,186
2,782
3,064
3,682
4,134
3,986
4,441
5,088
6,184
1,182
1,326
1,447
2,011
2,211
2, li04
2,626
2,512
2,743
2,776
3,188
593
628
739
771
853
I, 178
1,508
1,474
1,698
2,312
2,996
43,830
41,559
50,683
50,608
54,500
58,489
72,466
75,519
79,180
66,246
93, 707
3,006
4, 329
4, 671
4, 990
5,460
6, 275
7, 721
12, 714
7, Ml
8,256
10,847
1----+----+----1----1----1----
• Baths not included.
Digitized by
Google
•
170
PUBLIC HEALTH SERVICE
TABLE
7.-Sta.tistical summary of activities in the control of venereal diseases for
the fiscal years 1991 and 199B
•
19311
11132
•
KEDICAL ACTIVITIES
A. Cases of venereal diseases reported to State health depertments:
l t~~~=:::::::::::::::::::::::::::::::::::::::::::::::::::::::::
III. Chancroid ••••••.•.•.•.•.••..•...•.•••.•.••......•.•..•..•••••.•.•.•
260,564
168,083
3,544
229, 720
166,895
4,002
Total. •••••.••..•.•••••••••••••••.•.•.•.•.•.•••.••..
422,191
389,617
B. Doses of arsphenamines distributed by State health departments .•••••••••••
C, Clinics:
I. Clinics established during the year .•••••••••••••.•..•..••..•••.••••.
II. Clinics reporting to State health depertments •••••..•••••••••••••••.
III. Report Crom clinie&--a. New CBses admitted ••••••••••••••••••••••••..•. ·······-······
b. Cases discharged as arrested or cured •••••••••••••••••••••••••
c. Treatments given ••••••••••••••••••••••.•••••••.••.•••..••••.
d. Doses of arsphenamines administered.••••.....•......•.••.•..
e. Wassermann tests made ••••••••••.....•••••.•..•••......•.••.
f, Microscopic examinations for gonococcus .••..•....•.....•••..
D. Requests for medical information received by the Public Health Service.•..•
1,206,321
1,066,181
47
533
65
612
148,933
63,006
2,954,130
742,963
515,884
1116, 783
344
143,982
57,656
2,847,024
789,155
487,823
204,6:U
21'
A. PBmphlets:
I. Requests for pemphlets received by the Public Hee.Ith Service •.....
13,112
17,292
II. PBmphlets distributeda. By the Public Health Service to1. State bee.Ith departments .•.•.••..•.•.....•••••••••.•..
2. Others. •••.•...•.•.•.•.•••••••.•.•••••.•.•.•.••••••••••
2,817
118,309
8,176
149,157
Total. ••.•.•.•.•.•••••••••••••••••••......•.•...••..
121, 126
697,252
157,333
718, 771
c. Gross total pemphlets distributed ••••••••••.•.............•..
Minus pBmphlets distributed by the Public Health Serv•
ice to State health departments•••••••••.....•...•.•••..
818,378
876,104
2,817
8,176
d. Net total pBmphlets distributed •••••••••••••.•........•.•••..
815,561
867,928
III. Venereal disease pBmphletsissued by the Public Health Service••.•..
8
10
I. i:;;tures, exhibits, and film showings reported by thea. Public Health Service •.••••••..••••..................••••.••.
b. State health depertments•••••••••.........•.•.•.•.•.••••••••.
6
2,726
215
2,771
EDUCATIONAL ACTIVITIES
b, By State bee.Ith departments.•••••••••••••••.•••....•.•••....
B. Lectures exhibits, and film showings:
Total •••••••••••••••••••.•....••••••.•••.•.•••••••••
2,732
2,986
II. Average attendance reported by thea. Public Health Service..•••...••••..•••••..•.•.•.•.•••••••••••
b. State health departments•••••••••••••••••••••••••••••••••••••
85
83
87
85
Total. •••••.••••••••••••••••.•••••••.•••••••••••••••
83
85
Motion picture films and exhibits loaned by the Public Health
Service•••••••••••••••••••••••••••••.•.••••••••••••••••••••••••
191
227
m.
I Data for 1931 were changed from
previously published figures because of additional reports.
Digitized by
Google
DIVISION OF MENTAL HYGIENE
In charge of Asst. Surg. Gen.
WALTER
L.
TREADWAY
The year ended June 30, 1932, marks the second .full 12 months'
activities of the Division of Mental Hygiene in the Office of the Surgeon General. The administrative and investigative functions of
the division continued unchanged during the year. They embrace
studies and investigations of the nature of drug addiction and the
best methods of treatment and rehabilitation of persons addicted
to the use of habit-forming drugs; the dissemination of information
on methods of treatment, and research in this particular field; cooperation with State and local jurisdictions with a view to their providing
facilities for the care and treatment of narcotic-drug addicts; studies
and investigations of the abusive use of narcotic drugs and of the
quantities of such drugs necessary to supply the normal and emergency medicinal and scientific requirements of the United States;
the administration of the two United States narcotic farms authorized
in the act of January 19, 1929; the supervising and furnishing of
medical and psychiatric services in Federal penal and correctional
institutions; and, lastly, studies and investigations of the causes,
prevalence, and means for the prevention and treatment of mental and
nervous diseases.
STUDIES OF THE NATURE OF DRUG ADDICTION AND METHODS OF TREATMENT
The division has continued to receive individual reports concerning
the personal and social characteristics of persons apprehended for
violation of the narcotic laws. Such information is proving of value
in determining the potential needs respecting the treatment of persons
addicted to the use of habit-forming drugs. It has furnished important epidemiological data upon this subject. Studies of the
nature of drug addiction with reference to the mental and psychiatric
status of those addicted to the use of drugs have been continued among
drug-addict Federal prisoners at the United States Penitentiary
Annex, Fort Leavenworth, Kans. Biochemical studies were also
continued with special reference to water and lipoid metabolism in
connection with drug addiction.
In addition to the special studies being carried on at Fort Leavenworth, Kans., the personnel of the Public Health Service detailed
there supervises and furnishes the medical and psychiatric services
for the prison population.
DISSEMINATION OF INFORMATION
Studies conducted in an effort to evaluate the past experiences of
States and local jurisdictions pertaining to their attempts at solving
the medico-social problem of drug addiction have been continued
144391-32--12
171
Digitized by
Google
172
PUBLIC HEALTH SERVICE
during the current fiscal year. A summary of the Laws Relating to
Narcotic Drugs, Adopted During 1931 1 With Citations, was completed during the fiscal year.
Further data dealing with the epidemiological factors of drug
addiction in the United States have been assembled. This material
has served as a basis for a publication, Drug Addiction and Measures
for Its Prevention in the United States. 1 Arrangements were made
for the publication of The Chemistry of the Opium Alkaloids, by
Dr. Lyndon F. Small, consultant in alkaloid chemistry, and the
material was in press at the close of the year. 2 It is the first publication of this particular character to appear in the English language,
and will be of considerable value as a reference work to those interested in the growing field of alkaloid chemistry.
Other articles have appeared, prepared by officers of the service,
dealin~ with the administrative problems of concern to the division,
including Administrative Problems of Sick Call in Penal Institutions,8
by Acting Asst. Surg. Charles A. Bennett; Complete Routine PI!ysical
Examination of Prisoners,4 by Surg. Marion R. King; A Rapid Determination of Mental Age,6 by Surg. J. G. Wilson; and Medical and
Psychiatric Services in Federal Penal and Correctional Institutions,'
by Asst. Surg. Gen. Walter L. Treadway.
STUDIES OF THE ABUSIVE UsE AND THE MEDICAL AND ScIENTIFIC
NEEDS OF NARCOTIC DRUGS
Mr. Barkev Sanders was employed on February 8, 1932, to undertake special studies, with the aid of three statistical clerks, of the
legal distribution of narcotic drugs to the retailer and dispenser.
This is the first time that an analysis of the legal distribution to that
group has been undertaken, and is for the purpose of determining the
medicinal and scientific needs of the country concerning these drugs.
This work is being carried on in cooperation with the Bureau of
Narcotics of the Treasury Department. The desirability of undertaking the analysis of hospital uses of these drugs, of the prescriptions
on file in pharmacies, and of the record of dispensing physicians and
others as a means for ultimately determining the medicinal and
scientific needs of the country, has been given consideration, but no
field studies have been inaugurated along these particular lines, the
service having confined itself to the official records of the movement
of these drugs in legal channels.
ADMINISTRATION OF NARCOTIC FARMS
Plans for the development of the first United States narcotic farm
at Lexington, Ky., have progressed sufficiently to let the contract
for the construction of the necessary buildings. Construction be~a.n
at Lexington in January, 1932. During the year an appropriation
was made for the purchase of the site selected for the second narcotic
farm in the vicinity of Fort Worth, Tex., and measures were instituted
by the Treasury Department for acquisition of the ground.
I J. A. M.A., vol. 99, No. 5, July 30, 1932.
• Supplement No. 103 to Public Health Reports.
•Pub.Health Rep., vol. 47, No. 27, July 1, 1932.
• Ibid., No. 22, May 27, 1932.
• Proceedings, 61st Annue.l Congress American Prison Association, p. 163.
• Am. J. Psychiatry, Vol. XII, No. 1, July, 1932.
Digitized by
Google
PUBLIC HEALTH SERVICE
173
MEDICAL AND PSYCHIATRIC SERVICES IN FEDERAL PENAL AND
CORRECTIONAL INSTITUTIONS
The fiscal year marks the second year of the work of the Public
Health Service in supervising and furnishing the medical and psychiatric services for Federal penal and correctional institutions. The
policies previously inau~urated and adopted have been continued.
Surg. J. G. Wilson contmued as chief medical officer at the United
States Penitentiary, Atlanta, Ga., where additional equipment has
been installed, a new unit to the hospital completed, and the work
rendered more stable and uniform; Acting Asst. Surg. Edda von Bose
continued as chief medical officer at the Federal Industrial Institution for Women, Alderson, W. Va.; Acting Asst. Surg. Charles A.
Bennett continued as acting chief medical officer at the United States
Penitentiary, Leavenworth, Kans.; Passed Asst. Surg. A. J. Aselmeyer
continued as chief medical officer at the United States Industrial
Reformatory, Chillicothe, Ohio; Acting Asst. Surg. Carl I. Pirkle
continued as chief medical officer at the Federal Reformatory Camp,
Petersburg, Va., where the facilities were enlarged and much needed
equipment was provided; and Surg. Marion R. King continued as
chief medical officer at the United States Penitentiary Annex, Fort
Leavenworth, Kans., where special studies and investigations of the
nature of drug addiction are being carried on by the service.
During the course of the year the medical services at the United
States Penitentiary, McNeil Island, Wash., were assumed by the
service, effective July 15, 1932. Surg. Justin K. Fuller was asS1gned
as chief medical officer. Many improvements have been made during
the ;rear, new hospital equipment being provided and the hospital
facilities being enlarged and improved.
The medical services at the Federal Correctional Camp, Fort
Eustis, Va., were assumed by the service on January 1, 1932; and at
the Federal Jail, New Orleans, La., and the Federal Detention Farm,
La Tuna, Tex., on March 1, 1932. Requests were also received to
supervise and furnish the medical services at the Hospital for Defective Delinquents, Springfield, Mo., and the Federal Detention Headquarters, New York City. Action upon these requests was postponed until the next fiscal year.
STUDIES AND INVESTIGATIONS OF THE CAUSES, PREVALENCE, AND
MEANS FOR THE PREVENTION AND TREATMENT OF NERVOUS AND
MENTAL DISEASES
Owing to the dearth of funds and personnel, it has not been possible
to inaugurate any special field studies in connection with the causes,
prevalence, and means for the _prevention and treatment of nervous
and mental diseases. Studies mcident to the diagnosis and routine
eare of mentally disordered persons in Federal prisons have been
eontinued, and a special study inaugurated with reference to the psyehiatric phases incident to disciplinary and other problems of penal
and correctional procedure.
Digitized by
Google
DIVISION OF PERSONNEL AND ACCOUNTS
In charge of Asst. Surg. Gen. C. C.
PIERCE
The operations relating to personnel, finances, and property records
were conducted as in previous years through the Division of Personnel and Accounts. The organization of the division has remained
unchanged during the year, and through a personnel section, a finance section, and a property-record section, all matters relating to
apJ?ointments, separations, and other changes in status of personnel,
estrmates of appropriations, allotments, and encumbrances, records
of expenditures, including administrative audit, and all records of
nonexpendable property are administered under the supervision of
the Assistant Surgeon General in charge of the division.
Condensed reports of the activities of the directors in the six public
health districts are listed below, followed by information relevant to
the various classes of service personnel, together with a tabulated
statement showing the number, class, and, location of all personnel
on duty July 11 1932. In the appendix will be found a financial
statement showmg expenditures from appropriations of the Public
Health Service for the fiscal year 1932.
PUBLIC HEALTH DISTRICTS
Public heal,th district No. 1.-The headquarters of this district are
located in the Subtreasury Building, Wall, Nassau, and Pine Streets,
New York City. Medical Director Wm. S. Terriberry was detailed
as district director on December 1, 1931, succeeding Medical Director
E. K. Sprague, who had been placed on waiting orders. The district
comprises the States of Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, and New Jersey,
and the Canadian border from Halifax to Buffalo.
The large number of stations of the Public Health Service in this
district include seven marine hospitals, three of which are located in
the metropolitan area of New York. The district director states
that the service at these hospitals remains at the same high level as
in previous years.
All the quarantine stations in the district are operating smoothly,
efficiently, and economically. The floating equipment of the stations
at Rose bank, Staten Island, New York, and Gallops Island, Boston
Harbor, Mass., was increased and greatly improved during the year.
While the immigration into the district from foreign countries decreased somewhat during the year, the stations at Ellis Island and
Boston remained very active, owing to the large amount of work
connected with warrant cases and deportees.
An extensive medical service for personnel of the Coast_ Guard was
maintained, and contact with the Coast Guard in the district was
close.
174
Digitized by
Google
PUBLIC HEALTH SERVICE
175
Many conferences were held. One of the most important was the
conference with the Department of Health of the City of New York
on the subject of the infantile paralysis epidemic.
Although direct contact with the State health officers in the district
was not extensive, the relation between them and the district headquarters remained cordial and cooperative.
Public health district No. 2.-Medical Director B. S. Warren continued to serve as director throughout the year, with headquarters at
Room 415, Customhouse, Baltimore, Md. This district includes the
States of Pennsylvania, Delaware, Maryland, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Kentucky, and
Tennessee, and the District of Columbia.
The service activities in the district are carried on at 90 stations,
including 6 marine hospitals. Inspections were made of practically
all of these stations during the year, most of the important stations
having been visited twice. Building operations were in progress at
the marine hospitals at Baltimore, Md., Norfolk, Va., Louisville, Ky.,
and Memphis, Tenn.
The director rel?orts that there has been a noticeable improvement
in the administration of stations in the district and in tne care rendered
beneficiaries.
Several special investigations were made of service operations.
At the request of the Commissioner of Indian Affairs, a special inspection was made of the Cherokee (N. C.) Indian Reservation and
School.
A large number of conferences were held during the year with service officers, State and local health authorities, immigration officials,
and officials of the United States Veterans' Administration.
Public health district No. 3.-Medical Director A. J. McLaughlin
continued as director throughout the year. The headquarters of
this district are maintained at 536 Lake Shore Drive, Chicago, Ill.
The district is composed of the States of Ohio, Michigan, Indiana,
, Illinois, Wisconsin, Minnesota, Iowa, Missouri, Kansas, Nebraska,
North Dakota, and South Dakota.
Five marine hospitals and twenty-six third-class relief stations are
located in this district. The director maintained close contact with
all stations, inspecting as many as time fermitted.
Medical and surgical relief to personne of the Coast Guard was
furnished at a number of the marine hospitals and relief stations in
the district in addition to that furnished by 32 part-time physicians
employed for the specific purpose of rendering such service.
Several special investigations were made by the district director
and full reports rendered thereon.
Many informal conferences were held with service officers and with
State and local health officials.
Much of the time of the director was spent in liaison work with the
States. Such work ranged from private consultations and advice
to health officers to formal surveys. Complete public health surveys
were made of the State of Kansas and the City of Duluth.
Public health district No. 4.-Medical Director L. L. Lumsden
served as director throughout the year, his headquarters being
located in Room 305, Customhouse, New Orleans, La. This district
includes the States of Florida, Alabama, Mississippi, Louisiana,
Arkansas, Oklahoma, and Texas.
Digitized by
Google
176
PUBLIC HEALTH SERVICE
In this district the service operates 5 hospitals, 2 second-class
relief stations, 14 third-class relief stations, and 31 quarantine stations. Most of the time of the district director during the past year
was spent in inspecting and keeping in contact with the various stations of the service. He reports that the activities at all stations
were conducted efficiently.
In addition to his general duties in the seven States of the district,
the director, under special orders, supervised studies of rural sanitation in the States of Kentucky, Tennessee, and South Carolina.
Investigations were made of a localized outbreak of Rock;y- Mountain spotted fever, eastern type, in Louisiana, and of locahzed outbreaks of influenza-pneumonia in Louisiana and Texas.
Surveys were made of public health administration in Mississippi
and Alabama.
A large number of conferences regarding public health matters
were held with service officers on duty in or visiting the district, with
the State health officers of all the States mentioned above, and with
a large majority of the whole-time county or parish health officers
in these 10 States.
Addresses were delivered by the director before 12 meetings of
organizations held in the interest of public health.
Two new relief stations were established in the district within the
year-one at the Federal jail in New Orleans, La., and the other at
the Federal Detention Farm at La Tuna, Tex.
Especially. noteworthy among constructive developments in the
district within the year were the completion and occui>.ancy of the
new marine hospital and the new quarantine station at New Orleans,
La., and the new marine hospital at Galveston, Tex. There was also
considerable structural improvement made at the marine hospital
at Key West, Fla.
Public health district No. 5.-Medical Director J. C. Perry continued to serve as director, with headquarters at 76 New Montgomery Street, San Francisco, Calif. The fifth district includes the
States of California, Nevada, Arizona, New Mexico, Utah, and
Colorado.
The work of the service in this district is performed at 2 large
marine hospitals, 3 second-class relief stations, 4 third-class relief
stations, 6 quarantine stations, and 12 immigration stations. All
of these stations were inspected during the past year, and the larger
stations, with the exception of the marine hospital at Fort Stanton1
were visited twice. The director reports that all stations functioned
satisfactorily throughout the year. Close contact was maintained
with stations in California, either by personal conference or by correspondence with officers on points upon which advice was desired.
A new marine hospital was opened in San Francisco within the year
resulting in an increase in the number of beneficiaries under medicai
and surgical care in that city. Certain structural improvements
were effected at the United States marine Hospital at Fort Stanton,
N.Mex.
Liaison work with States was carried on during the year. For the
sixth consecutive ;year /ersonnel of the Alaskan canneries were
examined and vaccmate in conformity with a request of the commissioner of health of Alaska.
Digitized by
Google
PUBLIC HEALTH SERVICE
177
· The director maintained close cooperation with the health officers
of San Francisco and Los Angeles, and also with the director of the
California State Department of Public Health.
Addresses on public-health subjects were delivered by the district
director before various organizations in California.
The director also remained in charge of plague-suppressive measures
in California., holding numerous conferences in connection with that
work.
Public heal,th district No. 6.-The headquarters of this district are
located at 216 Canadian National Pier, Seattle, Wash. Medical
Director L. D. Fricks continued as district director throughout the
year. The district comprises the States of Washington, Oregon,
Idaho, Montana, and Wyoming, and the Territory of Alaska.
The activities of the service within this district are conducted
at 1 first-class station, the Port Townsend Marine Hospital; 22
second, third, and fourth class relief stations; 12 quarantine stations;
23 immigration stations; 5 United States Coast Guard relief stations;
7 aircraft quarantine stations; and the Rocky Mountain spottea
fever laboratory at Hamilton, Mont. Inspections were made by
the director during the year of all stations in the district with the
exception of those in Alaska and four small stations in the States.
The director kept in close contact, by correspondence and by
personal visits when feasible, with the State health officers of Washmgton, Oregon, and Montana, the commissioner of health of Alaska,
and the city health officers of Portland, Oreg., and Seattle, Wash.
On February 9, 1932, the corner stone of the new Seattle Marine
Hospital was laid with appropriate ceremonies in the presence of a
group of local physicians, shipping people, and others interested in
the erection of the hospital.
In addition to his duties as district director, the director serves as
chief quarantine officer on Puget Sound and as medical officer in
charge of the Seattle relief station. These latter duties consume
approximately two-thirds of his time; and because of the fact that no
experienced junior officer is attached to his station, he has frequently
found it impossible to give as much time to the inapection of outlying stations as the importance of that work warrants.
PERSONNEL
COMMISSIONED OFFICERS
On July 1, 1931, the regular corps consisted of the Surgeon General,
8 Assistant Surgeons General, 41 medical directors, 1 pharmacologist
director in the grade of medical director, 31 senior surgeons, 1 senior
dental surgeon, and 1 senior sanitary engineer in the ~rade of senior ,
surgeon; 89 surgeons, 13 dental surgeons, and 12 samtary engineers
in the grade of surgeon, 62 passed assistant su~eons, 6 passed assistant dental surgeons, and 5 passed assistant samtary engmeers in the
grade of passed assistant surgeon; 53 assistant surgeons, 11 assistant
dental surgeons, 4 assistant sanitary engineers, and 10 assistant
pharmacists, all in the grade of assistant surgeon. Of this number,
aggregating 349, 2 medical directors, 14 senior surgeons, 8· surgeons,
and 2 passed assistant surgeons were on waiting orders. During
the fiscal year the following changes occurred in the several grades:
1 assistant surgeon general reverted to the rank of senior surgeon;
Digitized by
Google
178
PUBLIC HEALTH SERVICE
1 surgeon was detailed as an Assistant Surgeon General; under
section 7 of the act dated April 9, 1930, 1 physician was appointed
and commissioned to the grade of surgeon; 6 candidates for appointment as assistant surgeon and 9 candidates as assistant dental
surgeons, in the grade of assistant surgeon, were successful in the
entrance examination prescribed by law and re~ulations of the
service and were commissioned in that grade; 2 seruor surgeons were
promoted to the grade of medical director, 2 surgeons were promoted
to the grade of senior surgeon, 1 passed assistant surgeon to the grade
of surgeon, 5 assistant surgeons to the grade of passed assistant
surgeon, and 2 assistant dental surgeons to the grade of passed assistant
dental surgeon; 1 sanitary engineer, 1 passed assistant dental surgeon,
and 2 assistant surgeons resigned; 2 medical directors, 1 senior
surgeon, and 1 assistant surgeon were placed on waiting orders
because of physical disability; 1 medical director on active duty and
3 senior surgeons on waiting orders died.
On July 1, 1932, after these changes had occurred, the regular
corps consisted of the Surgeon General, 8 Assistant Surgeons General,
42 medical directors, 1 pharmacologist director in the grade of
medical director, 29 senior surgeons, 1 senior dental surgeon, 1 senior
sanitary engineer in the grade of senior surgeon; 88 surgeons, 13
dental surgeons, and 11 sanitary engineers in the grade of surgeon;
66 passed assistant surgeons, 7 passed assistant dental surgeons, and 5
passed assistant sanitary engineers in the grade of passed assistant
surgeon; 52 assistant surgeons, 18 assistant dental surgeons, 4 assistant sanitary engineers, and 10 assistant pharmacists, all in the
grade of assistant surgeon-a total of 357 officers. Of this number,
4 medical directors, 12 senior surgeons, 8 surgeons, 2 passed assistant
surgeons, and 1 assistant surgeon were on waiting orders.
At the close of the fiscal year 1932, 3 medical directors, 1 senior
surgeon, and 4 surgeons were serving by detail as Assistant Surgeons
General in charge of divisions of the bureau in accordance with the
acts approved July 1, 1902, July 9, 1918, and April 9, 1930; 6 medical
directors were on duty as directors of the public health districts; 1
surgeon (as chief surgeon) and 2 passed assistant surgeons were
serving on detail to the Bureau of Mines, Department of Commerce;
and 1 surgeon, 1 passed assistant surgeon, and 1 assistant surgeon
were serving (the surgeon as medical director) on detail to the United
States Employees' Compensation Commission. Two medical directors were assigned as assistants to the director, Pan American Sanitary
Bureau, Washington, D. C.; 1 medical director, 1 senior surgeon, 5
surgeons, 2 passed assistant surgeons, and 1 assistant pharmacist
were serving on detail to the Bureau of Indian Affairs, Department of
the Interior, in connection with the control of communicable diseases
among the Indians; 1 surgeon was serving (as alienist and medical
officer) on detail to the Morningside Hospital near Portland, Oreg.,
which cares for the Alaska insane under contract with the Department of the Interior; 1 passed assistant surgeon was serving on detail
with the Bureau of Standards; and 1 medical director, 1 dental
surgeon, 2 passed assistant surgeons, 1 passed assistant dental
surgeon, 2 assistant surgeons, and 2 assistant dental surgeons were
serving on detail with the United States Coast Guard Service; 3
surgeons, 3 passed assistant surgeons, 1 passed assistant dental
surgeon, and 3 assistant surgeons were assigned for duty at various
penal and correctional institutions.
Digitized by
Google
PUBLIC HEALTH SERVICE
179
RESERVE OFFICERS
On July 1, 1931, the reserve commissioned officers on active duty
numbered 31, consisting of 5 sur~eons, 2 dental surgeons, 11 passed
assistant surgeons, 1 passed assistant dental surgeon, 7 assistant
surgeons, and 5 assistant dental surgeons.
On July 1, 1932, the number of reserve officers on active duty was
29, consisting of 6 surgeons, 1 dental surgeon, 11 passed assistant
surgeons, 1 passed assistant dental surgeon, 5 assistant surgeons, and
5 assistant dental surgeons.
ACTING ASSISTANT SURGEONS
On July 1, 1931, there were 717 acting assistant surgeons in the
Public Health Service, and by July 1, 1932, this number had increased
to 732.
Of the 732 acting assistant sur~eons, 124 were on duty at marine
hospitals; 409 were engaged in unmigration, relief, and maritime,
border, insular, and foreign quarantine work; 5 were engaged in the
prevention of trachoma i 8 were on duty in connection with field
mvestigations of public health and rural sanitation; 110 were on detail
with the United States Coast Guard; 5 were serving with the Bureau
of Mines by detail i 24 were serving at various penal and correctional
institutions; 1 was on part-time duty at Marine City, Mich., to examine applicants for marine service; and 46 were engaged in antivenereal-disease activities as part-time employees at nominal compensation. Fourteen of the forty-six acting assistant surgeons
engaged in antivenereal-disease activities held appointments as collaborating epidemiologists.
ATTENDING SPECIALISTS
On July 1, 1931, there were 370 attending specialists in the service,
and during the year this number increased to 426, of which number
232 were consultants to marine hospitals, while 53 were available for
ca.11 at second and third class relief stations i 9 were engaged in antivenereal-disease activities; 27 were serving at various penal and cor~
rectional institutions; 105 were consultants in connection with quarantine, immigration, and scientific research activities.
INTERNES
On July 1, 1931, there were 98 internes in the service; on July 1,
1932, there were 99, of whom 31 were dental and 6 students. Internes
are appointed for temporary periods of one year for duty at marine
hospitals.
PHARMACISTS AND ADMINISTRATIVE ASSISTANTS
On July 1, 1931, there were 19 pharmacists and 27 administrative
assistants in the P11blic Health Service. During the year 1 chief
pharmacist died i 1 administrative assistant (first class) was transferred to the departmental service and an addition of 5 was made in
the administrative assistant corps, making a. total at the end of the
fiscal year of 49, as follows: 14 chief pharmacists, 4 pharmacists, U
Digitized by
Google
180
PUBLIC HEALTH SERVICE
administrative assistants (first class), 4 administrative assistants
(second clas;i), 10 administrative assistants (third class), 6 administrative assistants (fourth class).
NURSES, DIETITIANS, AND RECONSTRUCTION AIDES
The work of the nursin~ section proceeded with 1 superintendent
of nurses, 1 assistant supenntendent of nurses, and 1 clerk for all work
connected with the maintenance of a P.ersonnel of something over 600,
including nurses, dietitians, aides, librarians, and, recently, guardattendants and male nurses in Federal prison camps.
Additional duties have been added in the furnishing of nursing
service to the medical service in Federal prisons under the Division of
Mental Hygiene and the establishment of prison camps at various
points throughout the country for short-term offenders. In these
camps nurses or guard-attendants have been assigned.
Guard-attendant is the name given to a new type of employee who
combines the function of guard and nurse-attendant and who will be
assigned to duty in prison camps on narcotic farms and in the 600bed hospital for defective delinquents now under construction at
Springfield, Mo.
D ~ the year three new hospitals were opened, necessitating an
increase m nursing personnel at Galveston, Tex.; New Orleans, La.;
San Francisco, Calif.; and the Federal prison at McNeil Island, Wash.
In the coming year it is expected that the new hospital at Seattle will
open; also the new prison at Lewisburg, Pa., which will require a
limited number of additional personnel.
Of the nurses on duty, 517 are under the supervision of the Hospital
Division, 4 are under the supervision of the Foreign Quarantine
Division, 10 are under the supervision of the Domestic Quarantine
Division, 23 are under the SUJ?ervision of the Mental Hygiene Division,
and 2 are under the supervision of the Scientific Research Division.
During the year, 130 nurses, 4 aides, and 8 dietitians were appointed; 17 nurses were reinstated; 2 nurses died; 37 nurses resigned,
19 to be married and 18 for other reasons; 28 nurses were released as
not meeting the requirements of the service; and 19 nurses were discontinued at the expiration of temporary duty.
There are 29 dietitians in the service in 25 hoi:ipitals. The practice
of requirin~ the chief nurse in the smaller hospitals to perform the
duties of dietitian as well as those of chief nurse continues to prove
satisfactory and gives a valuable experience to the nurse. Possibly
two additional dietitians will be needed to staff the Seattle hospital.
There are 38 physiotherapy aides in the service assiSJ.led to hospitals
and the larger out-patient offices. Additional aides will also be needed
for the Seattle hospital.
The nursing section continued to administer the emergency restroom service for employees at the bureau in Washington. There
were registered in the emergency room this fiscal year 1,854 cases.
Of this number 1,542 were from the Public Health Service, 242
Agriculture, 16 Census, 41 cafeteria, 13 others.
Contacts with nursing and health organizations and with health
sections of women's associations have been maintained, and close
cooperation with nursing schools and associations, etc., has been
established and maintained as usual. Papers on the work of the
service have been prepared and read.
Digitized
:yGoogle
PUBLIC HEALTH SERVICE
181
The superintendent of nurses, in addition to attending State
nurses' meetings, attended the American Nurses' Association Convention at San Antonio and on her return trip visited the new hospitals
at Galveston and New Orleans, the leprosarium at Carville, La., the
United States marine hospital at Mobile, and the hospital of the
Federal prison at Atlanta. It is felt that through such visits a closer
contact 1s maintained between the bureau and field and that a better
knowledge of conditions and problems at the stations can be obtained.
Two nurses were assigned to duty with the Department of Agriculture during the 4-H encampment, June 13 to 23, 1932.
CONTRACT DENTAL SURGEONS
On July 1, 1931, there were 41 contract dental surgeons employed at
marine hospitals and second, third, and fourth class reHef stations.
These part-time employees are appointed for local duty and receive
fixed and uniform fees for dental work performed for service beneficiaries.
At the close of the fiscal year, 8 contract dental surgeons were at
marine hospitals, 29 were at second, third, and fourth class relief
stations, 2 were serving at various penal and correctional institutions,
and 3 were detailed to the United States Coast Guard for duty.
EPIDE14IOLOGISTS
During the year the number of assistant collaborating epidemiologists decreased from 4,586 to 4,560. These employees are health
officers or employees of State or local boards of health, who receive
only nominal compensation from the Federal Government, and who
furnish the service with reports of communicable diseases received by
State or local health organizations. The number of collaborating
epidemiologists increased from 45 to 46, these appointees being on duty
in the different States.
NATIONAL INSTITUTE OF HEALTH
The administration of the National Institute of Health for the fiscal
year 1932 continued under the supervision of Director George W.
McCoy and Assistant Director R. E. Dyer. The research staff
compnsed 57 persons, of whom 18 were commissioned officers and 11
part-time consultants. Assisting the staff were 17 technicians and 79
laboratory attendants and miscellaneous employees, making a total of
153.
PROPERTY RECORDS
The property-return section has accounted for aJl property of the
service and 325 property returns have been audited during the year.
Sales of unserviceable property, including boats, hides, old paper, etc.,
aggregated $2,449.17. Surplus property not desired by any other
Government department was sold for $115.75. Property surplus to
the Public Health Service valued at $18,741.31 has been transferred to
other Government departments. Surplus property of other departments valued at $6,184.49 has been received by the Public Health
Service. Property valued at $39,946.75 has been transferred from
service stations where it was surplus to other service stations where it
Digitized by
Google
182
PUBLIC HEALTH SERVICE
could be used. By the exchange value on old typewriters turned in
on the purchase price of new machines, $2,134.25 has been saved, and
$762 on the exchange value of old motor transportation.
ACCOUNTS SECTION
The accounts section of the division of personnel and accounts
conducts all bookkeeping and accountin~ m connection with the
expenditure of service appropriations. This includes also accounts of
miscellaneous collections, allotments, records of encumbrances, cost
accounting, and the administrative audit. A statement of appropriations, expenditures, and balances, with miscellaneous receipts, is
publidhed as an appendix to this report.
PERSONNEL STATEMENT
The accompanying tabular statement shows the personnel of the
service as of July 1, 1932. Of the 10,844 employees shown in the
table, 4,606 listed as collaborating epidemiologists, and assistant
collaborating epidemiologists receive only nominal compensation.
They a.re mainly officers or employees of State and local health
organizations who collaborate in the collection of morbidity statistics
by furnishing the figures collected by those organizations relating to
cases of communicable disease. Th~ personnel statement also includes
all part-time employees, those employed on a per diem basis, and those
whose compensation is on a fee basis.
Digitized by
Google
Conaolidated quarterly perBonnel report/or the quarter end,d July 1, 193S
Medical and scientific
Regular corps
Administrative division and station
.;
::,
gj°"
t:;
Q
.,
...
;a
.;
~
-;:;.,
.,"
0
-"
-;~
~
"'"
...
·a.,0
".,0
'O
~
$j
""
.,§
~
i;1
j
.,"
.,"
~,,_~
3
0
~]
·;
"""
;@8
i
.,"
.,"...
-
'O
.,
.,e
;
.,"
s:;;
.," 'O
"., 'O~ !!l~ :El"" ] 'ii
~
·a ::,~ ~
"gi
~"
a"" P,., -<~ < < 0 ;g -"P,
~
"'" l -- l "'"-- 1 -"' 1P,- - 1 -<- -1~- - 1"'- -I-"'- I -1 - 1 - -1- - 1 - -,- -, - - , - -
.,"
""...
Bureau ________________________ _______ _______________________________ \
!l"
-~g
~
"
"""
!l
!'l
"
~
-;:;"'"
g
-;:;
0
;a
0
---------------------------/
0
~.,
"'e., "
_.,
0
Q
.,
.,
"""
~
.,"
...
I f.,
Reserve corps
;a"
"
~
I
I
8
"'t:;
I
0
1 -I
0
0
- 1=11~~1~~I;;;;,;il~~ll;;:;;;4~=!==r==t==J
2
1-- - - - - • - - - - - -1- - ----1- - - - --•--- - - -1- - - - - -1- - -- -- 1- --- -- 1- -- - - - 1-- - - - - 1-- - - - -
FIELD
0
co·
N.
"'
~
-'l
CJ
0
a
~
Hospital Division:
Marine hospitalsBaltlmore, Md______ ______ ________________________________________
1 ----- - ___ ___
3
1 __ ____ ______
1
Boston, Mass___ _________________ __ _____ ______ _____ ___________ _____
1
Buffalo,.N. y_________________ _____ __ ____ ___ ________ _______ __ ______ ___ ___ __ ____ _____ _
1
Carville, La____ _______________________ __________ ______________ __ ___________________ _
Chicago, IIJ ____________ ____ ________________ ____ _____ _______ __ -----1 ------ ______
1
Cleveland , Ohio ______________ ___ ___ _________________________ -----1 ------ ____ __
2
Detroit, Mich __________________ _____________ __ ____________________ ------------______
2
Ellis I sland, N . Y ----------------- - --- ----- -- --- --- --- ------ ______ ------ ------ ______
4
Evansville, Ind_____ ___________________________________ ________ ____ __________________
1
Fort Stanton, N. Mex___ _________________ ______________________ __ ___________________
1
Galveston, Tex_________ _____________ _______ ________ __________ ___ ______ __ ____ __ ______
1
Hudson Street, New York ___________________ ________________ ------------------______
3
Key West, Fla_________________________ ________ _____________________________________
1
Louisville, Ky ________ _____ ______________ ______ ____ .________________
1 ______ _____ _ ______
______
1 ___ ___ ______ ______ __ ____
1
2
3 ____ __ ______ ______ ___ ___ __ __ __
1 __ ____ ______ ___ ___ ______ ______ ____ __
______ _____ _ ____ __ __ ____ ____ __ ______ ______
__ __________ ------ __ ____ ___ ___ ____ __ -----______
5 ------ ____ __ ____ __ ______ ______
1 ______ ------ ____ __ ______ ___ ___ ______
______ __ ____ ------ ______ ______ ______
1
______ ______ __ __ __ ______ ______ ______ __ ____
______
2 ______ ______ ______ ______ __ __ __
______
3 ____ __ ______ ___ ___ ___ ___ ___ ___
______
7 -- -- - - _____ _
1 ______
1
1
1 ______ __ ____ ______ ______ ______
______ __ ___ _ ______ ______ ______ ______ ___ ___
~f~t.:~~I(~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ ~~~J~~~~~~ ~~~~~~ i ::::!:::\ ~~~~~~ ~~~~~~ ;;;;~;
Pittsburgh, Pa_______________ __________ ___ _________ _________________ ________________
1 ______
2 __ ____ ______
Portland, Me________ ___ _____________ ______ _______________ ___________ __________
1 ______
1
1 _____ _ ____ __
Port Townsend, Wash_______________ ______ ______ _____ _______ _____ _ ______ __ ____ ____ __
1 ______ ______ ______ ____ __
St. Louis, Mo_______________________ ______ _____________ __ _______________ ______ ______
1
1 ______ ______ __ __ __
1 __ ____ ______
4
3
6 _____ _ __ ____
San Francisco, CaJiL _______________________________________ ___ ___
___ ___
______
____ __
____ __
1
~~~~~~
====~=
______ ___ ___
____ __
1
___ ___ __ __ __
__ ____ _____ _
___ ___ ____ __
5
4
4
4
7
9
6
16
1
4
4
11
2
3
i
3
1
3
3
7
23
11
8
8
5
2
4 1------ 1------
17
8
13
6
6
2
12
17
1
9
6
3
1
2
1 \_____ _
§
~
Ill
l?'j
~
~
1;:tl
11-----i ~
----2-i----i- 1 l?'j
8
1
1 - - ---6 -- ---- - ----1
10
25
1
6
13 -----8
2 -- -- -12
16
1 ------ ,---- -17 _____ _
9
~!t~i~;;::~~i ::::::::: ::=~::::·::::;: _ _ ;_:::; : : :::: :==----; .- _; : :;:...:1:::::;
.....
00
Cl:)
.....
Comolidated quarterly peraonnel report for the quarter ended July 1, 193S-Continued
i
Medical and scientific
Regular corps
I
Adminisistrative division and station
].,
.,"
""
.,"0
""~
I
.!:l
"'
,;
;a.,"
::g
~ca
~"lil
f;l
]
"g
~
.,""
""' ...
-~
2l""
[;;
~
I;..
.,"0
...""
Reserve corps
0
~d
·- 0
~~
."...
d
"'.,.,
.,0
~
.,"0
..,[.
_!;i
.,
...
.B
f"
;a
5
;a.,
::g
g
.,"0
~
f;l
~
·a.,
.
.,"0
.,"0
""
~"
U, ..,~
"'~
~
2l
-~
CD
rJl
rJl
l······I 21······1 21 31 21 51······1······1······1······1······1
0
N.
"'
~
c;?"
CJ
0
a
~
~
"
2l
.!!l
~
""
.9
t;
rJl
Hospital Division-Continued.
Relief stationsSecond class .................................................
Third class..........................................................................................................................
co·
.,"0
~
.,""
~
-< - - - - - -il-< - --<- - - - - - - -il-< - --<- -<
-- - - rJl
FIELD-continued
sal
•
19
128
"'.,"
.,"
-~ ....
0
_!;i
.21
~
'""
&~
., '3
f;l
.
al
.,d
l:l
il
~
:a 8 "'."
"
..."
~
"
~
0
0
44
9
."a
~
.,
~
.!!l
ta
-"
il-<
I
10
1 ..... .
18 ...........
.
1
Total relief stations........................ ••.•••.•···•·••• 1· ·· · ·•1· · ·· ··1· ··· · ·1· ·· · ··1· · ··· ·1·· ··· ·1· ·· ·· ·1· ·· · ·· 1
······1·· ····1 ······ 1·· ·· ·· 1·· ··· ·•· ·· ··· •· ·· ··· •· ··· ··•···· ··
Foreign Quarantine Division:
Quarantine stations-
lri~~;:t~:~j~~{ii;i ~~):.:~::::::::::::::::::::::::::::
====== ====i= ====== ====i= ..
J
====i= ====== ====== ====== ====== ====== ======!
§
~
~
~
~
~
1! =====f ==== =====f ==== ~t:'ll
Fort Monroe, Va............................................ ......
J ••• ••• •••••• •••••• ••..••
I ........................................................... .
1 ...... ...... ......
1
Galveston, Tex......................................................................................................................
Honolulu, T. H............................................. ......
1 ...... ... ... ......
2 ...... ...... ...... ...... .... .. ......
8 ....................... .
7 . ............ .......... .
Laredo, Tex.........................................................................................................................
Marcus Hook, Pa..................................................
1 .... .. ...... ...... ...... ...... ...... ...... ...... ...... ......
1 ....................... .
New Orleans, La....................................................................
2 ..... .
3 ...... ...... ...... ...... .... ..
3 ...................... . .
Rosebank, N. Y ............................................. ......
1 ......
2
1 ......
1 ...... ...... ...... ...... ......
6
1 ...... ......
2
San Francisco, Calif. (also immigration).............................................
1
2
1 ...... ...... ...... ...... ......
3 ............ ........... .
San Juan, P. R.............................................. ...... ...... ...... ......
1 ...... ...... ...... ...... ...... ...... ......
2 ....................... .
Foreign ports......................................................
5 ......
4
6
14
2 ...... ...... ...... ...... ......
40
3 ............ ..... .
1 ......
1
8
6
2 .............. ................ 167 ...... ........... .
1
All other stations..................................................
Total quarantine and immigration ..... ..................................... ... ....... .................. .......................... ........................ . ..... .
4
2
Dlv181on: _______ - - - - - - - - - - - - - - - - - - - - - - - - - - - -4- ~ ~
Do1ti~a~tlne
4 ·····- ·····- ••••••
6
1 •••••• -··-·· .••••• ··-··· .•.•.. ••••••
Tracboma ____________________________________________________ ••• •••••• ···-·· .••••• ·-··-· .•.•..
•••••••••••• ·-···· -····· •••••. ··-·3· -···2· ••••.• ·····- ••••••
··-·2·
2.
.•••
··--3
~=i;····················-·-··············· ........................
1
1
··•••• _
•••••• ···••·
All other stations ••••••••.•• _.•.•.•••.•••••••••.•••.•••...••••••• ·-.-··
Total, all activities ••• -···········-·······-················ .•••.•.•.•....••••.•.•..••••..••.•.•••... ..........•••••.••.•.••.•.•.••••••....••. ••.••••.•••••• ,...•••
::~:~:u~~
Sclentlllc Research Dlvfalon:
National Institute of Health ••••••• -•. ················-·········· ••••••
----1- ---1-----1------1------1--l----l------l----L--
4 .•••••
6
6
1
2 ..••••.•.•.•.•••••.••••. ····-· ·····-
4 ........•...
······ ......
·····- ...... ···-·· ...... -····-1 ......
~f,~! :i;::::::i:....·-····································· ······ ······ ...... ····1· i1 ••.•••f ·-····1 ............
•••••••••••.••••••
-····· ••••••••••••••.•..••••.. ····-·
Nutrition studies ....• -·····-·····················-············· ···-···..................
::....
f!~8::s~1~~.:re':ie and sanitation.••..•••••.......•.....•...•.••. ···-·· ••....•••••• ·•·• 2· --··~· ···· 2· ••·•i" ...... ...... ...... ...... ...... ......3 J7 ............
•••••.•••••..•••••
Child byg!ene•••••••••••••••........••.••• ·-····-··············· .........•.•.••••• ·····- •..•.. ..••.• •••••. ••.... .•...• ••.••. .•...• .•.. ••
BtP"•tlcaloffloe.••.•••••.• _...............•••.............•.••••..•.• .•........••••••••.•.......••..•••....... •.•.•••..•••....•.....•.... ····-·. 6 .••••. ···· ·- .•••.•
34 •••••.• •••.•.•••••
2
2 ....•...••••..•••.....•• •··.· ·•
2
4
1
1 .•••••
All other stations._.................... . ... ...................... .•.•••
Total, all activities .•...........•••••.•... -········--······ .••......•....••••.............•....•..... .••....•.•••••••.....•••....•• ····-· ·····- ··-··· ··· --·,······
:::::::::::~=·······-················-··············~=~,=~=~ = · ··· ............ · · · ==Division of Mental Hygiene:
Alderson, W. Va••••••••••••••.•••••.••••••••••••••.••••.•• .•••••••.••.•••••••••••• ·····- •••••.••••••••••••••••••.•••••••••••.•••• •.•••••
1
1 ••••••..•••• ·-···- ••...•
1
Atlanta, Oa .•••.• ·-·····--·-····················-··········· ···· .•.••..••.....••••...•.. ···-··
0
co·
N.
"'
~
~
0
0
a
~
7
2
2
1
3
2
1
6
·-·-9· ......••• . ,. : .. :::
2 1------1-- ---- 1-----4
3 •------
6
3
·-··i· :::::: :::::: :::::: .... ~. ····2·
:::::::::::::::::::::::::: :::::: :::::: :::::: :::::: .... i. 1
i!:P1r'.:~~n~~~~h;°ifans::::::::::::::
2
2 ·-····
1 •••••• ··-··· ••.•••••.••• ···-·- ••••••
Leavenworth, Kans •••••••••...•..... ·-·····························-· ......•••••• ·-·-·· .•.•..
--·-·1 ·····1 ,·-····
1· ...• •• ···-·· ·-··-· ••.••• ····i" ...... ···· 1·
····
.
..........................................
_
........................
~;~!B~:J.·wash
......
; 1······1······
1 .......••..•.••.•• --·-·· ••••..
1 ....••
1 ··•·•· ·••···
All other stations •.•••••.••••••.•.•••..•••• _.••.••••••••.••...••....•...••..••••••• ····-·
......
J
....
L
.....
J
.....
I
......
I
.....
L
....
L
......
I
.....
.1.
t=
..
l._._
......
l
.....
I.
....
L
......
I
......
------:-1
l
Total, all activities •••••••......••••.•••.••••••.•••••••.•..
~
al
~
=
>
l;l
~
I
la
-·····1······
··-·
· · - ~ - · · ·6·· ~••••••
· · ·.
.•
.•·····
•··-··
2 ••
iifri ~:Slr:1~1J~~piystatiiiii,::::::::::::::::::::::::::::::: :::::: ....~. :::::: :::::: .... ~.....~....-1. :::::: :::::: :::::: ··-~~. --··~· ..~~~. :::::: ....~. :::::: ======
1
···
3 ·-····
M~=us~ other offlces •••• _._··-·············-··············-··· - · ~
0
!J~fg~~~-~·.::::::::::::::::::::::::::::::::::::::::::::::::: :::::: -···~· ::::::
8
6
~
•.• ~.
1
~
Total miscellaneous ..••••••••••..••••••.••••.•••••••••••••.•.• •••...•.....••. ·-······-·
Grand total •••••••• __ -· ••••••••••••••••••••••••••••••••••••
43
8
a1
I
1y II
f :::::: :::::: :::::: :::::: :::::: ····i· ·-··a· ····i· ::::::1::::::
.••••..•••....••..•.•• ···-·· .•...•.....••••.•. ·-···· •..•.. ····-·•-·····
78
M •------•------
7
12
10
I 732 I 426
42
911
18
~
00
01
....
Consolidated quarlerly personnel report for the quarter ended July 1, 199B
00
0)
General and technical
.91~ ~
e'C~
B;ia
Administrative division and station
.
'il
1~-~
."
911:)
u .~C.
., ~B
.9""
_ _g_:3 !,
i::29~
.,.,
... "':a
$:E,8
-<"'"'"' .2lrn""
Q)-
Rureau _______ _--- -- • ___ - - - - -- - - - -- -- - - - - - --- - - -- - - --1 - - - - - -
..il
Q
I
.,
~.,
~
.!3
~
<
""'
8
"" " 0
.ero -~o
c,o
p.;
~.,
.,
"'~
e z"
A
I.,
"
~
'd
<
.£
,. ,..,
.0
A
Jl.<
,;
'd
g
"'lil
-@"'
.bl
~
5
.,
0
:;:l
§.
al
"
-
~
.0
0
~
0
0
.,.,...
.:!
.,""
lil
I
al
""
-a.
.,El
.0
.:!;,,, .:!~
'd
"'
$
"
"
~
0
"'""
~.,
if
8
Totals
£l0
~.,
:;i
"'
A
C.
- -,-- - - - -1 - - ____ 1- ___ --1 - - ____ , ____ - - • - - - - - - , __ - _ --1- - - - - - 1- - - - - -,-- - - - -1 - - - - - -1-- - - - - - -
201
"'ca"
'il
.s
"
·s""'
"'
'd
.Cl
8"
."...
'd
.,"
'il
<>
'il
:a
"'
~
'd
.,""'
.0
14
~
0
"' ---
0
rn
201
------
215
0
o·
"'
N.
~
c;?"
CJ
0
a
~
~iiis~IT;:
I~::::::::::::::::::::::::::::::::::::::::::::
::::::1_
~~g1JtXJ~enn
_____________________________________ ______ ::::::
__________
New Orleans, La._________________________________________ _
1
Norfolk, Va_____________________________________ __ __ ___ __ __ ____ _
Pittsburgh, Pa______________________ ___ _______________ _____ ____ _
1
1
1
~~~t1;':i~~~ci,-Was"li:::::::::::::::::::::: :::::::: :::::: i ::::::
St. Louis, Mo ________________________________________________________ _
1
2
San Francisco, CaliL_______________________ __ ______ ______
Savannah, Ga_____________________________ ________________
1
1
...t<
C
Ill
FlELD
Hospital Division:
hospltalsMarine
Baltlmore,
Md ___________________________________________ _
1
1
Boston, Mass____________ _________ _____ ____ _______________
Buffalo, N. y ____ __ _____ _____ ___ ____ _________ _____________________ __ __
Carville, La_______________________________________ ___ _____
1
1
Chicago, Ill__ __________________________ ___ ______________________
1
Cleveland, Ohio________________ __ __________________ ______
2 _____ _
Detroit, Mich __ _______ ___________ ___________________ ____________ ___ __ _
Ellis Island, N. y__ _____ ____ ___ _____________ ____ ____ ___ ___
2
1
Evansville, Ind _______________ _______________________________________ _
Fort Stanton, N. Me,_____________________________________
1
1
Galveston, Tex____ _____ _______________ ___ ___ ______________
1
1
Hudson Street, New York________________________ ____________ __
1
~tx,
l?'j
26
19
12
1~
34
16
57
7
10
16
6
11
8
8
12
61
29
11
1
1
2
1
2
1
1
1------
1------,------
1---- --1--- ---1------1
------1------1-----2
1
1
------1------ -- ---1 1·-----1----------- -- ----
I I
!
----2- ---- 1- ------ ----- -
3
6
f 1---- 11-1---- 11-1------1----------- ----- -
1------
1 ------ ------ -- - --- -- ---1
1 --- --- -----4
5 ------
1 ------ -----------1------1 1------1------1-----2 ------ -----i ----2_ - --- 1 _ ---- 1 _ ------ ------
8
13
10
51
17
I
1
1
2
2
2 ------
4
1------1------1-----1 - ----- -- -- -2 - ----- ----- -
6
72
8
4
6
8
60
9
5
8
199
2
9
5
18
114
40
44
27
23
22
32
177
91
26
25
30
31
152
45
9
4
4
3
4
31
8
4
3
2
4
13
5
--'--------1-- ----l----=-l----;-/------l------1------1------1------1------ I------I-... ,.,
•
-
...
1
-- -
------
26
263
59
104
49
42
27
18
10
32
28
25
29
10
9
114
92
45
272
91
150
71
'277
27
140
22
66
42
7
17
15
14
50
29
16
17
4
22
49
21
68
43
35
35
50
282
134
43
37
46
47
228
73
156
119
63
282
123
178
96
306
-----------------------------
------------- -----------------------
37
149 -------88
110
50
52
50
I>
~
{JJ
l?'j
~-
...
C
l?'j
64
332
163
59
54
50
69
277
94
----,--------1------,-----a,-ur,s•1--,.,.-,_______ _
10
1
123
-----8 ------
4
--
12 -16
----.---~
I
1......
....
t
<0
~
-1--·-··l_____31-1·---llU-,--216-, _______ _
~t\~"t<,!,'~::i,ten Island, N. Y--······-··--·1········1·····-1··--2·1·--· 1·1··- as·1···· 4·1···-3-1-··· £1···· 1·1 ••..••
1··· 10-1·-·· 123
Vineyard Haven, Mass·--········-·-··-····· ···-··· ...••• --·····--···
3 ·---·· •••••• ··-··· ··-··· ··-··- •..•••
1
8 ····-·
Total, hospitals ••• -·· - •• __ -· •.• · -· ·-._._, ••• ·-••• ,•• - ••• ,•••• ·-'·. ·- •• ,.••• __ ,..•••• ,. - •••• ,.•.••.,.•••• -• • •.... ,.••. --•· •.. • .,. • •• •· •· ,_ •· • · •
Rellefstatlons17
1
1
3
2
18 •·-····
Secondclass
c1ass.•••••••
•••••••••••••••
1······1··-···
Third
-····-··-······-·········· ••..••...•••••.•••••••••..•••••• ····-· ••...••••••.••••••••••••
··-···
9
Total, relier stations. __ ·-·· __ ._ ••••....•• ,•••••.•. ,••.••. ,•. ·-_.,._ .•.. ,...••. ,.·-••• ,•••.•• ,•.•••• ,•• ·--.,. ·-·. · •·-•••• ,••.••. ,.••• • • .• ,. • • • •·
·-·········--·····l········l·-····I
l······I
I !······!··-•··I
I
I Forec\~iti~!lf=~~~~·-··-·---····-·-·······
····-··· ·····~
~fl"~ &anrcaiso·immig;ii.iion5:::::::::::::: :::::::: :::::: ·--·~- :::::: .... ~. :::::: :::::: :::::: :::::: ....~.....~.
1--·-·---1-------
t.:i
1 ·--··- ···-·· ····-· ···--· ·-··-- ·--·-·
0
1
1 •·····
~
El Paso, TeL ••.• ·-···-····-·-····-········- ·--·-·-- ·--··· ·-···· ···-·· •.•.•• ··-··· •••••• ··-·-· ···-·- ..••.. ••....
1
Fort Monroe, Va••• ·-····-···················-·-··-· .••.•• ···------··- ....•. --··--····-· · ··-····-···
2
2
1
Oal"veston, Te"-·-··---·········-····-·-···-······---···-·· •••••• ··-·····-··- ..•••• ···-··-·····......
1
3 ··-·-·
~t*ei".H::::::::::::::::::::::::::::: :::::::: :::::: :::::: :::::: :::::: :::::: :::::: :::::: :::::: ....2. :::::: ··--1·
f~~:i•f
! I l
San Franclsco, Calif.
(also immigration) .. _.• ·····-···-···· •••••. ·····1 ======
.•.•.• ======
•.••• •••.••.
··---·
4
2
:::========================
======== ====== ····~· ====== ····~·
====== ......
====== -·····
San Juan, P. R····-·-············
··········· ....•...............................
........ ····-·
1
If1~~~rs>:-S~1ons.-·····--···-·····--··-···· •••••••• •••••. ···· 1· •••• 1· ·•·· 1· •.••.•••.••.••.••••••••• ••• 1{ ··-18·
co·
;cc
N.
~
-'l
CJ
0
~
~
-
1
11
11
16
8
=
42
II
243
61
2
5
27
-
23
3
2
2
11
7
42
24
7
3
74
34
2, 1162
88
155
20
13
10
22
112
12
I
2
8
14
18
13
12
20
12
23
13
18
27
136
51
26
16 ·------·
3,262
··-··•I
130 ••••••••
184 ••••••••
------
1:
--42
151
43 ·····-
7 ---- -·
294
20
32
g
36
15
22
14
c~,
34
20
20
36
~
H9
68
29
114
386
185
40
200
348
635
988
10
10
47
19
29 -·---·--
24
2
5
3
8
128
162
9
11
27
9
······r:-Jj==nf rI
Total quarantine and Immigration ••••.••• ,••••••.. · ····· ~·····•·····~·····•·· · ··~···········~Domestic Quarantine Division:
Inter,tate ••••••.•••••••••••••••••••••••..•••• -•• •••••••• ····-· •••••• ··-··· -·--·· ·----- -··-·· -----· ·-···- ··-·-·
=
0
2
16
20
4
6110
67 ••.•••••
!~~~::j::::=::::::::==::=::= :====:: '.: : = '.'.:'.'.: :'.:::: ::=:: '.'.:::'. ... --.::::: :::::: :::::: :: :: .. ·:_1____':_ :::::: ~ ~ --~: ::=:=~
Scientific Research Division:
=-=
12
-~;:~l~:i:~lll}lil):ill ~~:;: ;}i ii;!;=:::~= ii\! : ~=i::::::: ·:··:· _::____:_:_ j
82
7
17
6
17
14
I
6
61
Total, &ll activities ••..••. ·-··········--·. ·I:..:::..:..::: '··----1·· ··•-I•• .•.. ,...••• ,•• ····•··-··., . . .. •·'···-··'-···-·'··•···•··•···•········•······
46
22
6
20
24
10
16
76
21
121
143
310
---·--
40
10
6
~
;
I
28
64
20
463
.....
00
'-1.
.....
Consolidated quarterly personnel report fir the quarter ended July 1, 199S-Continued
...,fo·~-
'.w('.)~
f"C'lO
Administrative division and station
~
0
.E
2 ;fa .;
C
I~~~
om·- ~s
..,-o:i.
.
""" c_g_5 '""'
cs~
.,
... ccl
-,c,o pC
-~-~~ ·.i
"
00
<
~
.
mLo-continued
I
------1
0
co·
"'
N.
~
-'l
CJ
0
a
~
-~s
ci
~
"";l
-~..,"
8
.""
:fi.!3l
p.;
:;i
~
j
"
0""
:2
8
~"
E
~
A
z
<
- -- - - - - - - - 6
I____ Totals
General and technical
b
."
~
.
c o
"0
.,
0
,0
~
,0
"'
C
~
0
:-:l
P<
~
.;""
0.,
a
".;
""
cc
.,...
-~"
B
"" i:i ,-<. ,-<.
<
-- - - - -"
C
0
0,
...
.~o .~o
e
C
0
.!3~
0
.;
$>,
:l
,0
.!3>,
00
00
""
.!3
:.
~
!
0
5"
~
~
;;
<
<>
~
.;
-~
""."
~
·a<>
]
:I
"".
C
]
i""
'I
I• ~
-------~
"'
0
1------c-----1------1------c1·-----1 ------1------1------1~1----~~
1-----+-------1
S~ni-t~y reports and st~tistics _______________ __
4, 60
D1v1S1on of Venereal Diseases _______________________ ------------------------------ -- -----------------1 ------ -----===
.
Division of Mental Hygiene:
Alderson, W. Va------------------- -------------1-------- ----- - ______ ______
5 ___ ________________________________ _
~rA~i~;J;f~;~~)))~~~~~~~~~~~~~ )~~~~~ ~~~~~~ ---+
4
11
56 I
--
9
i ~~)~ ~~~) ~~~~~~ ;;;r ~~~~~~ : :~: :::::: i
:===i=
Petersburg, Va---------- -------------- --- -------1-------- ------ ------ ------
1 ------ ------ ------ ------ _________ __ _ -----·
1
~f~t~~i~1t~?~~'_':':"_~::::::::::::::::::::::::::: :::::::: :::::: ----i- :::::: ----~- :::::: :::::: :::::: :::::: ------ --- --- _____ _------8-i. ____ _
12
9
10
8
3
8
16
4
•
611
------1~-----~
Mis~~wf~~~
offices------------------ ------~-------~-----------------------11---------------------------Coast Guardother
___________
________ _________________
------------------ ----------- ------------------- ------------ -------------- -- -- -- ----------------
i ------~-::::::
~~r;fic~~~lth~~tr~~~ply station>------:-::::::::::::::::::: : ----2- :::::: :::::: :::::: :::::: :::::: :::::: :::::: ::::::
Waiting orders __________________________________ ------ -- ------------------------------------ ______ ------ ________________ __ ___ _____ _____ _
All others _______________________________________ ---------------------------------- -- --- ----- ---- -- -- ---- --------------- ----------- _____ _
----
Total miscellaneous _______________________ -------------------------------------------------- ------ 1:..:..:..:..:__i:..:..:..:..:__1------1------- -1-- ---Grand total -- --- --------------------- ---- -1 4,606
34
31
18
I
672
36
29
14
21
37
38
I
364
I
a, 040 I
201
75
-
1,703
~
._.
0
1------~
l=-=-2=
-
6
6
5
6
8
2
2
15
18
14
16
16
9
25
--18
~
~
Q
I.?,!
24
134
11
14
'l:l
8
--- ---1
Ill
~
6
10
9, 141 · · ----
~
;
,-~
44~~
24 -------134 -------1
10
6
8
27 ----- -- 8 - -------
-200
oo
16 i__ ____
- - - • - -1- - 1 - - 1 - - - 1 - - - 1 - - 1 - - 1 - - 1 - - 1 - - 1 - - 1 - - - + - - - 1 f - - - - l - - -
Total, all activities _____ - ---- --- -- -- --_-- - -1-- - - -- - -1-- - - - -1- - -- - - 1- - - - - - 1- - -- - -1- - - - - - 1- - - - - -1- - - - --1- - -- - - 1- - - - -- 1- - - - --1 - - - -- - 1- - - -- - - - 1--- - - -
.0
C
218
10,844
CHIEF CLERK'S OFFICE
BUREAU PERSONNEL
At the end of the fiscal year 1932 the number of civil service employees on duty in the bureau was 201. Of these 179 were paid from
the appropriation, "Salaries, Office of the Surgeon General," 12 from
the appropriation for the Division of Venereal Diseases, and 10 from
the appropriation for the Division of Mental Hygiene. During the
year there was a decrease of I employee in the Division of Venereal
Diseases, I in the chief clerk's office, and an increase of 2 employees
in the Division of Foreign and Insular Quarantine and 2 in the Division of Mental Hygiene. The record for punctuality was almost
perfect, there being an average of but I case of tardiness per employee
for the entire year. The average sick leave was 8.1 days per employee,
which was a slight increase over that for the preceding year.
During the year the following employees were retired: Mrs. E.
Anna Draper, on July 31, 1931, after a service of 23 years; Mrs. Mary
L. Guy, on August 31, 1931, after a total service of 40 years and 5
months; and Mrs. Antonia T. Converse, on March 31, 1932, after a
total service of 15 years. No administrative promotions were made
during the fiscal year.
PRINTING AND BINDING
The fund of $93,000 available for printing and binding again proved
insufficient for the printing of all of the public health publications
which. were made ready for issue, and a number of valuable manuscripts remained unpublished at the end of the year. Every effort
for economy was exerted in order to render the available funds as
effective as possible.
PUBLIC HEALTH SERVICE LIBRARY
The library contains at present 13,207 bound volumes and a collection of pamphlets numbering approximately 7,075. During the
year 435 volumes were added, of which 70 were purchased, the remainder consisting of gifts ·and the bound volumes of periodicals and
serials. The number of additional pamphlets received is estimated
at 275.
Periodicals to the number of 250 were received regularly and circulated to the persons interested. Of these, 36 were obtained through
paid subscriptions, the others being received gratuitously or in exchange for Public Health Reports. In addition, about 150 monthly
and weekly bulletins from State, city, and foreign health departments
were received regularly. As the library has grown and developed,
the utilization of its facilities by public health workers has steadilv
increased.
•
NEW ADMINISTRATIVE BUILDING AT WASHINGTON
Excavations for the foundation of the new building were begun in
July, 1931, and the completion of this structure is expected early in
the calendar year 1933. Its occupancy will greatly facilitate the
administrative work of the service, which now occupies quarters in
the temporary buildings in the Mall group.
189
Digitized by
Google
APPENDIX
FINANCIAL STATEMENT
The following is a statement of expenditures from appropriations
of the Public Health Service for the fiscal year 1932:
Obligations
Appropriation
Appropriated
Incurred
I
I
Unobllgated
balance
$338, 347. 33
$338,347.33
------------
$1,787.67
1, 418, 763. 55
362,394.21
1, 081, 421. 82
27,709.46
1,417,389.05
361,466.25
1,081,087.64
21,022.81
$1,374.50
927.96
334.18
6,686.65
18,784 41>
35,589.79
40,668. lS
1,290.54
46,760.90
496. 87
44,622.46
474. 34
2,138.44
22.b3
1,239.10
3.13
7, 709, 983. 2tl
466,887.91
7, 434,550.39
330,627.91
293,894.79
443,827.88
66,091.3.3
335,700.00
275,763.67
423,607.04
65,099.88
316,279.80
18,131.12
20,220.84
991.50
19,420.20
106,105.21
12,872.12
1,948.62
2,300,00
1, 598, 1:lO. 95
44, 937.4b
I, 589, 356. 34
44,001.57
8,774.61
845.88
13,241.74
1,682.55
89,207.34
87,971.80
1,235.64
10, 792.66
47,973.94
2,222.74
47,868.91
2,077.87
100. 03
144.87
2,541.0G
277.26
15, 126, 892. 69 14,374, 7bl. 80 13, 881,705.06
493,046.74
752,140.89
Salaries, Office or Surgeon General ••
$340, 135. 00
Pay,
etr ., commissioned
officers and
pharmacists
______________________
1,437,548.00
Pay or acting a..sslstant surgeons ____
397,984.00
Pay or other employees _____________
1, 122, 000. 00
Freight, transportation, etc_. _______
29,000.00
Maintenance,
N atlonal Institute or
Health ___________________________
48,000.00
Books_----------·-·-·----· _________
500.00
Pay or personnel and maintenance
or hospitals _____ • __ •• _••• _•• ___ ••• 1 8, 060, 738. 00
Quarantine service__________ ····-·-_
617,150.00
Preventing the spread or epidemic
diseases ___ . _____________ ---···-·. 400, 000. 00
Field investigations or public health_
~,70C.OO
Interstate quarantine service •• _____
,040.00
Studies or rural sanitation __________
338,000.00
Studies or rural sanitation, droughtstricken areas _____________________ ' 1, 611, 372. 69
Con,rol or bloloilc products ________
46,620.00
E~nses, Div slon or Venereal
100,000.00
1sesses ____ --------------------Expenst>S,
Division or Mental Hyizlene _____________________________
50,515,00
Educational exhibits. _______________
2,500.00
Total •••••••••••••••• _____ ._._
Liquidated
Outstandtng
275,432.89 350,754.72
136,260.00 150, 262. Olt
• Includes $1,396,259 reimbursement for care and treatment or beneficiaries of the Veterans' Admlnlstratlon.
• Balance available July 1, 1931, of $2 000,000 appropriated for 1931 and 1932.
• Statement does not Include expenditure or $4,166.60 from trust fund "National Institute of Health,
Conditional Gift Fund."
190
Digitized by
Google
191
PUBLIC HEALTH SERVICE
Quarantine service--E:i:penditures by stations
Pay or ofll.
cers and em• Maintenance
ployees
Name or station
Total
CONTINJliNTAL QUAIIANTINlli STATIONS
Baltimore, Md...............................................
Beaufort, S. C................................................
Biscayne Bay (Miami), Fla..................................
iE~i;if,~{:~~~:::::::::::::::::::::::::::::::::::::::::
$34,190.24
$17,660.61
775. 00 ..............
16, 842. 98
3, 20!!. 29
it~~~
Cape Fear (l'louthport), N. C.................................
8,250.00
20,565.46
Charleston, S. C..... ......................•..................
Oolumbla River (Astoria), Oreg..............................
7,260.00
2, JOO. 00
Corpus Christi, Tex..........................................
Cumberland Sound (Fernandina), Fla.......................
2,199.96
Delaware Bay and River (Philadelphia), Pa............... ..
12,360.00
Delaware Breakwater (Lewes), Del........................... ........ .. .. ..
Del Rio, Tex.................................................
5,880.00
16,500.06
Eagle Pass, Tex..............................................
El Paso, Tex.................................................
28. 850. 34
$61,850.85
775. 00
20, Obl. 27
1: ~!~ i 1~T~~ i
2,988.11
4,573.38
2,063.66
310. 24
3,942.23
4. 25
1,057.94
1,320.29
3, 698. dl
11,238.11
25,138.84
9,323.66
2,410. 24
2,199.96
16,302.23
4. 25
6,937.94
17,820.35
32, 549. 15
i
1tii;11iii1:l?lll~l:llli1iii1i:i~:i:i i 1r ·j11 ··-·::i- 11
~:ti~&:~:t!~:::::::::::::::::::::::::::::::::::::::::: ····:::::::. 1~: !H: ll 1: ~: il
Mercedes, Tex................................................
3, 143. 49
Newport, R. 1................................................ ..............
New York, N. Y. .....•••........•.......•...................
244,853.48
8,700.00
Nogales, Ariz.................................................
37,574.69
Norfolk (Fortr888 Monroe), Va...............................
825. 58
15. 00
78,353.01
1,680.29
10,965.20
~:i=~fa~'Fra'.~:::::::::::::::::::::::::::::::::::::::::::::
1~: ~: gg
Perth Amboy, N. J........................................... ..............
2,454.16
1,200.00
Port Aransas (Aranaas Pass), Tex............................
45. 00
.
Port Arthur, Tex.............................................
9,360.00
138. 57
Portland, Me.................................................
15, 939. 86
8,799.02
Portland, Ore,:...............................................
5,636.40
1,419.13
Port Townsend, Wash........................................
15,019.92
2,893.78
Presidio, Tex.................................................
5, 475. 91
1,027. 21
Providence, R. 1..............................................
1,860. 00
792. 25
Reedy Island (Port Penn), Del...............................
9,073.97
3,072.33
Rio Grande, Tex.............................................
4, 640. 00
125. 13
Roma, Tex...................................................
5, 389. 63
732. 59
Sabine, Tex..................................................
14,219.92
1,698.25
St. Andrews (Panama City) t Fla.............................
1, 200. 00
82. 80
St. Georges Sound (Carrabelie), Fla..........................
300. 00 ..•...... .....
St. Johns River (Jacksonville), Fla...........................
7,982.46
1,362. 72
San Diego (Point Loma), Calif...............................
15, 659. 93
4, 932. 29
San Francisco (Angel Island), Cam...........................
76,664.29
36,683.97
35,306.10
10,408.70
Ban Pedro (Los Angeles), Calif...............................
20, 267. 94
7, 399. 29
Bavanna_l!, Ga................................................
Beattle, wash................................................
12, 379. 92
2, 478. 44
Tampa, Fla..................................................
16,126.42
6,890.19
Vineyard Haven, Mass....................................... .. ......... ...
20. 00
Yf/leta, Tex................................................... ..............
17. 20
~~i~i:i ~J°io.isce1iaiiious:::::::::::::::::::::::::::::::::::: .....~~~~:~.
Travel of medical directors within districts................... .. ............
20, &4ig: ~
3,969.07
15. 00
323,206.49
10,380.29
48,539.89
it:~:~
1,200.00
45. 00
9,498.57
24, 738. 88
7,055.53
17,913.70
6, 503. 12
2, 652. 25
12,146.30
4, 765. 13
6, 122. 22
16,918.17
1, 282. 80
300. 00
9,345.18
20. 592. 22
112,148.26
46,713.80
27, 667. 23
14, 858. 36
23,016.61
20. 00
17. 20
J: :l: ~
930. 29
930. 29
t------t------t------
T ot al, continental quarantine stations.................. 1,018,998.12
446,141.36
1,465,139.48
i======l=====I======
INSULAR QUARANTINJli STATIONS
Hawaii.......................................................
Puerto Rico..................................................
Virgin Islands.-..............................................
43,717.89
39,986.92
13,960.16
8,213.50
9,126.07
3,407.98
51,931.39
49, lll. 99
17,368.14
Total, all stations....................................... 1, 116, 663. 09
466,887.91
1,583,651.00
Total, Insular quarantine stations.......................
>------>------>-----97,664.97
20,746.55
118,411.52
Digitized by
Google
192
PUBLIC HEALTH SERVICE
MISCELLANEOUS RECEIPTS
COVERED INTO THE TREASURY
The revenues derived from operations of the Public Health Service•
during the fiscal year 1932 are as follows:
Source
Amount
GENERAL FUND RECEIPTS
Quarantine charges__________________________________________________________________________ $290, 168. 03:
Hospitalization
charges and expenses __ -----------------------------------------------------38,630.67'
Sale
of subsistence___________________________________________________________________________
13,049.62'
Laundry service_____________________________________________________________________________
62. 70'
Sale of occupational therapy products---,---------------------------------------------------339. 97"
Bale of obsolete, condemned, and unserviceable equipment ___________________________________ · 2,392.45
Rents_______________________________________________________________________________________
239. 48
Reimbursement for Government property lost or damaged ___ ------------------------------192. 92'
Commissions on telephone pay stations Installed in service buildings_,_,____________________
l; 343. OJ'
Bale of refuse, garbage, and other by-products________________________________________________
1,398.11
Bale of livestock and livestock products ______________________________________________________ ·
278. 96'
Other revenues_____________________________________________________________________________
128. 95
Total, general fund receipts____________________________________________________________
Effects of deceased
1----
TR UST FUND RECEIPTS
patients ___________________________________________
: _____________________ _
Grand totaL________ _______ __ ____ ________ ________________ __________ __ ______________ __ __
348,224. 8r
7,468.07'
355,692. 94'
FUNDS TRANSFERRED FROM OTHER DEPARTMENTS,
Amounts transferred to the Public Health Service by other departments and establishments and the expenditures therefrom during the·
fiscal year 1932 are as follows:
Transferred
to Public
Health Servo
ice
Appropriation
Obligated,
Veterans' Administration:
Salaries and expenses, Veterans' Administration _________________________ $1,408,982.60 $1,408,982.60
District of Columbia:
Mosquito control In the District of Columbia __ ------------------------Department of Justice:
Federal Industrial Institute for Women, maintenance___________________
i~~~~~l~~-~--=:::::::::::::::::::::::::::::::::::::::::: ·:::::::::::::
United States industrial reformatory, Chillicothe, Ohio.________________
United
United
United
United
States penitentiary,
States penitentiary,
States penitentiary,
States penitentiary,
T otal,
Atlanta, Ga_________________________________
Atlanta, Ga., buildings and equipment_____
Leavenworth, Kans_________________________
McNeil Island, Wash_______________________
6, r,oo.oo
5,943.84
45,360.00
30,111.87
1=====1~====
~~~t~
44,530.00
57,080.00
34,.920.00
101,.213. 00
58,.502. 00
~: 211.
~ !l
41;
62
56,643.61
33,446.56
94,137. 70
51; 509. 12:
1-----1----Department of Justice__________________________________________ 379,353.00
341; 162. 30'
Grand total__________________________________________________________
Digitized by
l=====i=====
1,794,835.60
Google
1,756,088. 74
INDEX
A
Page
Accounts section__________________________________________________
182
Acting assistant surgeons, number on duty___________________________
179
Aerial navigation, sanitary control of____________________________ 6--7, 95-96
Airplanes. (See Aerial navigation.)
Airatports
of entry for airplanes from foreign ports, summary of transactions101-102
___________________________________________________________
Aliens (see also Immigrants):
Medical examination oL ____ ____ ______________________________ _ 7-8
Medical inspection of_ _______________________________________ 107-123
Medical inspection, summary of_ ______________________________ 108-113
Appendix (financial statement) ___________________________________ 190--192
Arsphenamines:
Pharmacology of______________________________________________
69
Studies of____________________________________________________
65
Attending specialists, number on duty_______________________________
179
B
Baltimore, Md., marine hospital, report from _______________________ 140--141
Birth rates_______________________________________________________
4
141
Boston, Mass., marine hospital, report from__________________________
I$uffalo, N. Y., marine hospital, report fr.:im_ ______________ ____ ____ ___ 141
Building, new administrative_______________________________________
189
C
California, plague-suppressive measures in ____________________________ 73-75
Cancer, investigations and research of_ ________________________ 22-26, 65-68
Carville, La., marine hospital, report from __________________________ 141-143
Cerebrospinal meningitis. (See Meningococcus meningitis.)
Chemistry, report of division of_ ____________________________________ 70--72
Chicago, ill.:
Marine hospital, report from___________________________________
143
Studies of venereal diseases at marine hospital_ _________________ 159-160
Chief clerk's office, report of________________________________________
189
Child hygiene, studies of___ ___________ ____________ __ ______ ____ ___ _ 40--43
Cholera, prevalence of_ _____________________________________ 1, 4, 5, 91, 128
City. reports, weekly and annual____________________________________
126
Cleveland, Ohio, marine hospital, report from_________________________
143
Coast Guard beneficiaries_ ____________________________________ ___ 138-139
Colorado tick fever, prevalence oL _____________ ____ ________ ____ _____ 39-40
Commissioned officers, number on duty ____________________________ 177-178
Communicable diseases:
Current prevalence of__________________________________________
124
Prevalence during calendar year 1931_ _________________________ 127-129
Conference, Surgeon General's, with State and Territorial health officers __ 89-90
Continental
and insular quarantine stations, summary of quarantine trans~98-102
actionsat _____________________________________________________
Continental, insular, and foreign stations, summary of quarantine transactions at______________________________________________________
107
Cooperation of Public Health Service with other agencies ______________ 14-18
D
Death rates______________________________________________________
Dental studies____________________________________________________
Dental surgeons, contract, number on duty___________________________
193
Digitized by
Google
4-5
43
181
194
INDEX
Pap
Dental treatment at marine hospitals ______________________________ 137-138
Detroit, Mich., marine hospital, report from__________________________
143
Diphtheria:
Death rate___________________________________________________
3
Prevalence of_________________________________________________
128
Directories of health officers_ __ _ __ _ __ _ _ __ __ _ _ __ __ __ __ _ __ _ __ __ __ _ _ __ _
129
Diseases:
Communicable-Current prevalence of______________________________________
124
Prevalence during calendar year 1931_ _____________________ 127-129
Contagious and infectious, prevention of the spread in interstate
traffic______________________________________________________
8-9
From abroad, prevention of the introduction of___________________
5-7
Districts, public health __________________________________________ 174-177
Summary of work carried on by_________________________________
85
Domestic quarantine (see also Interstate quarantine) __________________ 73-90
Drug addiction, studies of the nature of and methods of treatment______
171
E
Ellis Island, N. Y., marine hospital, report from ____________________ 143-144
Engineering work, public health _____________________________________ 82-85
Epidemiologists:
Collaborating and assistant collaborating_________________________
125
Number on duty______________________________________________
181
Evansville, Ind., marine hospital, report from_________________________
144
F
Federal penal and correctional institutions, medical and psychiatric
services in______________________________________________________
173
Financialstatement _____________________________________________ 190-19~
Floating equipment _______________________________________________ 97-98
Foreign and insular quarantine and immigration, report of division of_ ____ 91-123
Foreign ports, summary of transactions at __________________________ 104-106
~~p~rl
~~=
i~~iria~fu~~tN.- M;;,~ mi;i"~e'" h~;pitai~
f~~~---_ ==============
Fumigation and inspection of vessels________________________________
Fumigation of ships, studies of______________________________________
~~:
5-6
6
G
Galveston, Tex., marine hospital, report from _______________________ 144-145
Ground squirrels, plague in_________________________________________
73
H
Health conditions:
United States ___________________________________________ 2-5, 127-129
World_______________________________________________________
1-2
Health education activities (see also Public health education)_________ 165-166
Health officers, directories oL _ _ _ _ __ _ __ _ _ _ __ _ __ _ __ _ __ _ _ __ _ _ __ _ __ _ _ __
129
Heart disease, studies of_ __________________________________________ 26--27
Hot Springs, venereal disease clinic at_______________________________
162
I
Immigrants (see also Aliens) prospective, examination of, abroad ________ 113-123
Industrial hygiene and sanitation, studies of_ ______________ - ____ - - - - - - 43-46
Infantile paralysis. (See Poliomyelitis.)
Influenza and pneumonia, prevalence of_ ________________ ---- _______ -128
Influenza death rate_______________________________________________
4
Inspection of vessels. (See Fumigation and inspection of vessels.)
Insular quarantine stations, summary of transactions at_ _____________ 103-104
International agreements _____________________________________ - ___ - _
94
International exchange of sanitary information ______________________ 126--127
lnternes, number on duty__________________________________________
179
Inti;rstate ~ommerce, prevention of the spread of contagious and infectious
diseases 1n __________________________________ - - -- __ -- - ----------8-9
Digitized by
Google
195
INDEX
Page
Interstate quarantine, report of division of_ _________________________ _
Introduction of diseases from abroad, prevention of_ _________________ _
Investigations
(see also Studies):
Cancer _______________________________________________________
Child hygiene _________________________________________________
Malaria ______________________________________________________
Milk ________________________________________________________
Public health problems________________________________________
Statistical ____________________________________________________
Stream pollution ______________________________________________
73-90
fr7
22-26
40-43
31-33
46-50
9-12
51-53
54:-57
K
Key West, Fla., marine hospital, report from_________________________
145
L
Legislation, sanitary, and court decisions ____________________________ _
130
Leprosy, studies of _______________________________________________ _ 27-31
Library, Public Health Service _____________________________________ _
189
Louisville, Ky., marine hospital, report from ________________________ _
145
M
Malaria:
Investigations of ______________________________________________ 31-33
Prevalenceof_________________________________________________
128
Malaria treatment of neurosyphilis ________________________________ 160-161
Manila, P. I., relief station, report from______________________________
149
Marine hospitals:
Beneficiary, summary of services by claBB of______________________
137
Coast Guard _______________________________________________ 138-139
Dental treatment ___________________________________________ 137-138
Operating costs _____________________________________________ 139-140
Recommendations for_________________________________________
21
Reports, consolidated and detailed____________________________ 150-157
Marine hospitals and other relief stations ____________________________ 12-13
Marine hospitals and relief, report of division of_ ___________________ 136-157
Maritime quarantine, recommendations for ___________________________ 20-21
Measles, prevalence of_____________________________________________
128
Medical and psychiatric care of Federal prisoners_____________________
14
Medical examination of aliens (see also Aliens)________________________
7-8
Medical examination of prospective immigrants abroad ______________ 113-123
Medical inspection (see also Medical examination)____________________
91
Memphis, Tenn., marine hospital, report from ______________________ 14frl46
Meningitis. (See Meningococcus meningitis.)
Meningococcus
meningitis:
Prevalenceof
_________________________________________________ 4,128
Regulations relating to_________________________________________
95
Studies of____________________________________________________
64
Mental hygiene, report of division of_ _____________________________ 171-173
Mexican border stations, summary of quarantine transactions at________
103
Milk investigations ________________________________________________ 46-50
Mobile, Ala., marine hospital, report from____________________________
146
Monthly State reports_____________________________________________
126
Morbidity and mortality reports__________________________________ 124-126
Morbidity reports, annual State_____________________________________
126
Mortality statistics, current state___________________________________
125
Mosquito control, District of Columbia______________________________
85
N
Narcotic drugs, studies of the abusive use and the medical and scientific
needs of________________________________________________________
Narcotic farms, administration of___________________________________
Narcotic farms and medical and psychiatric care of Federal prisoners____
Digitized by
Google
172
172
14
196
INDEX
National Institute of Health:
Page
Number on duty______________________________________________
181
Report of ____________________________________________________ 57-72
National Park Service______________________________________________
83
Neurosyphilis, malaria treatment of_______________________________ 160--161
New Orleans, La., marine hospital, report from _____________________ 146--147
New Yor~,, N. Y., out-patient office, repJrt from______________________
149
Norfolk, va., marine hospital, report from____________________________
147
Nurses, dietitians, and reconstruction aides, number on duty _________ 180--181
Nutritional diseases, studies of_ _____________________________________ 33--35
0
Operating costs of marine hospitals ________________________________ 139-140
p
Pathology and bacteriology, report of division of_ _____________________ 58-65
Pellagra:
Death rate___________________________________________________
3
128
Prevalence of_________________________________________________
Studies of ____________________________________________________ 33-35
Perry Point, Md., supply station, report from ______________________ 149-150
Personnel (see also Personnel and accounts) _________________________ 177-181
Bureau______________________________________________________
189
Recommendations for__________________________________________
21
Statementof _______________________________________________ 182-188
Personnel and accounts, report of division of_______________________ 174-188
Pharmacists and administrative assistants, number on duty __________ 179-180
Pharmacology, report of division of_ ___________ ~-------- _____________ 65-70
Pittsburgh, Pa., marine hospital, report from_________________________
147
Plague:
35
Control and eradication of_____________________________________
In ground squirrels____________________________________________
73
Laboratory, Public Health Service ______________________________ 74-75
Prevalence of__________________________________________ 1, 4, 5, 92, 128
Studies of____________________________________________________
61
Suppressive measures in California ______ ~ _______________________ 73--75
Poliomyelitis:
Prevalence of____ ______ ___________________________________ 3, 128-129
Studies of ____________________________________________________ 60-61
Portland, Me., marine hospital, report from__________________________
147
Port Townsend, Wash., marine hospital, report from__________________
147
Printing and binding______________________________________________
189
Printing, recommendations for______________________________________
21
Property records section_________________________________________ 181-182
Psittacosis:
Prevalence of_________________________________________________
6
Regulations relating to _________________________________________ 94-95
Studies of____________________________________________________
60
Publications issued and distributed ________________________ 130-131, 132-135
Public
health:________________________________________________ 85, 174-177
Districts
Education,
of (see also Health education activities) _______ 131-132
Engineeringsection
work _____________________________________________
82-85
Methods, studies oL __________________________________________ 50-51
Problems, investigations of_____________________________________ 9-12
Sanitary legislation and court decisions relating to_________________
130
Public Health Service:
Cooperation with other agencies ________________________________ 14-18
Plague laboratory _____________________________________________ 74-75
Q
Quarantinable diseases, general prevalence of ________________________ _ 91-92
Quarantine facilities, construction of_ _________________________ - __ - _- _ 96--97
Quarantine procedure, changes in _______________________________ c _ - _ 92-94
Quarantine transactions ___________________________________________ _
91
Digitized by
Google
197
INDEX
Quarantine transactions atPage
Continental and insular quarantine stations, summary of___________ 98-99
Continental, insular, and foreign stations, summary of_____________
107
Continental maritime stations, summary of_ _____________________ 99-100
Foreign ports_______________________________________________ 104-106
Insular quarantine stations___________________________________ 103-104
Mexican border stations_______________________________________
103
United States air ports of entry for airplanes from foreign ports ___ 101-102
R
Railroad sanitation supervision, tabular summary of __________________ _
Railway sanitation _______________________________________________ _
Rats, measures taken against ______________________________________ _
Recommendations
for-Marine hospitals
_____________________________________________ _
Maritime quarantine _________________________________________ _
Personnel ___________________________________________________ _
Printing ____________________________________________________ _
Rural health work ____________________________________________ _
Scientific research ____________________________________________ _
86
81-82
74-75
21
20-21
21
21
19-20
19
Rela~~~faf!:!!:of ________________________________________________ _
40
Studies of ___________________________________________________ _
60
Reports:
Annual State morbidity_______________________________________
126
Collaborating and assistant collaborating epidemiologists___________
125
Communicable diseases, current prevalence oL _ _ _ _____ ___________ 124
Current State mortality statistics_______________________________
125
Foreign______________________________________________________
126
Marine hospitals and selected relief stations ____________________ 140-150
Marine hospitals, consolidated and detailed ____________________ 150-157
Monthly State_______________________________________________
126
Morbidity and mortality_____________________________________ 124-126
Telegraphic__________________________________________________
125
Weekly and annual city_______________________________________
126
Reserve officers, number on duty___________________________________
179
RockPr~il~!~i~f~:~~t~~-~~~~r:_____________________________________
4
Studies of _________________________________________________ 36-38,59
Rural health work ________________________________________________ 87-89
Recommendations for ___________________ -•-_~-_______________ 19-20
s
St. Louis, Mo., marine hospital, report from__________________________
148
San Francisco, Calif., marine hospital, ..-eport from____________________
148
Sanitary information, international exchange of_ ____________________ 126-127
Sanitary legislation and court decisions______________________________
130
Sanitary reports and statistics, report of division of_ ________________ 124-135
Sanitation, rural. (See Rural health work.)
San Pedro, Calif., relief station, report from__________________________
149
Savannah, Ga., marine hospital, report from_________________________
148
Scarlet fever:
129
Prevalence of_________________________________________________
Studies of____________________________________________________
63
Scientific
research:
Recommendations
for ____ ~____________________________________
19
Report of division oL _________________________________________ 22-72
Venereal diseases___________________________________________ 158-163
Serums, vaccines, and analogous products, control of_ _ _ _______________
72
Shellfish sanitation________________________________________________
82
St1pervision of, tabular summary showing________________________
86
Smallpox:
'
Prevalence of __________________________________________
2,3,5,92, 129
Vaccination, studies of_ ___________________ -~ __________________ 63-64
Stapleton, N. Y.:
·
Marine hospital, report from___________________________________
148
Studies of venereal diseases at________________________________ 158-159
Digitized by
Google
198
INDEX
Page
Statistical investi~ations ___________________________________________ 51-53
Stream pollution mvestigations __ ----------------------------------- 54-57
Studies (see also Investigations) :
Arsphenamines_______________________________________________
65
Causes, prevalence, and means for prevention and treatment of
nervous and mental diseases__________________________________
173
Dental_______________________________________________________
43
Drug addiction, nature of, and methods of treatment______________
171
Fumigation of ships___________________________________________
6
Heart disease _________________________________________________ 26-27
Industrial hygiene and sanitation _______________________________ 43-46
Lepr!)SY ___________ . _ .-. ______________________________________ 27-31
Menmgococcus menmgitis__ ___ __ ___ ____ _____ ________ __ ___ ___ ___
64
Narcotic drugs, abusive use and the medical and scientific needs oL _ 172
Nutritional diseases ___________________________________________ 33-35
Pellagra ______________________________________________________ 33-35
Plague _______________________________________________________ 35,61
Poliomyelitis _________________________________________________ 60-61
Psittacosis___________________________________________________
60
Public health methods _________________________________________ 50-51
Relapsing fever_______________________________________________
60
Rocky Mountain spotted fever ____ -------------------------- 36-38, 59
Scarlet fever__________________________________________________
63
Smallpox vaccination __________________________________________ 63-64
Syphilis among rural negroes_ _ __ ____ ___ ___ ___ _______ __ __ __ ___ 164-165
Trachoma____________________________________________________
61
Tularaemia ________________________________________________ 38-39,61
Typhus ______________________________________________________ 58-59
Undulant fever _______________________________________________ 59-60
Venereal diseases, prevalence oL ___ ______ __ ______ _____________ 162-163
T
'Tables:
Air ports of entry for airplanes from foreign ports, summary of transactions at ________________________________________________ 101-102
Beneficiary, summary of services by class of_______________________
137
Canadian and Mexican border stations, summary of transactions at__
113
Continental
and insular quarantine stations, quarantine transactions 98-99
at _________________________________________________________
Continental maritime stations, transactions at____________________ 99-100
Foreign ports, summary of transactions at _______________________ 104-106
Insular quarantine stations, summary of transactions at __________ 103-104
Marine hospitals and relief stations, summary of transactions at____ 150-157
Medical examination of prospective immigrants abroad___________ 114-123
Medical inspection of aliens_ _ _ ______________________ __ _______ 108-113
Mexican border stations, summary of transactions at______________
103
Quarantine transactions _______________________________________ 98-107
Venereal disease ____________________________________________ 167-170
'Telegraphic reports________________________________________________
125
'Tick paralysis, reports oL ___ ____________ ___________________________
39
Trachoma:
Prevention work ______________________________________________ 75-77
Studies of____________________________________________________
61
'Tuberculosis:
Death rate of_________________________________________________
2-3
Prevalence of_________________________________________________
129
'Tularaemia:
Prevalence of_________________________________________________
4
Studies oL ________________________________________________ 38-39, 61
Typhoid fever, prevalence oL ___________________________________ 3►.Sl,129
'Typhus fever:
Prevalence of______________________________________________ 2, 4, 5, 92
Studies of____________________________________________________ 58-59
Digitized by
Google
199
INDEX
u
Undulant fever:
Page
Prevalence of_________________________________________________
4
Studies of ____________________________________________________ 59-60
United States, health conditions in ____________________________ 2-5, 127-129
V
Vaccination, smallpox, studies of_ ___________________________________ 63-64
Venereal diseases:
Cooperative clinical studies oL _ _ __ __ ___ _ __ _ _ __ __ _ _ __ __ __ _ ___ _ 161-162
Health education___________________________________________ 165-166
Prevalence studies of________________________________________ 162-163
Prevention and control of______________________________________ 13-14
Report of division oL _ _ _ ___ __ __ __ __ __ __ __ ___ _ __ __ __ _ ___ _ __ __ 158-170
Studiesof __________________________________________________ 158-163
Tables relating to___________________________________________ 167-170
Vessels:
Fumigation of________________________________________________
5-6
Inspection of ________________________________________________ 5-6,91
Wate'.r-supply supervision, tabular summary of____________________
86
Water-supply systems on, supervision of _________________________ 80-81
Vineyard Haven, Mass., marine hospital, report from ________________ 148-149
w
Washington, D. C., relief station, report from _________________________ _
149
Water supplies:
Interstate carrier, summary of ________________________________ _ 78-79
Tabular summary of_ _________________________________________ _
86
Used by common carriers, supervision of_ _______________________ _ 77-81
Water-supply systems on vessels, supervision of ______________________ _ 80-81
World health conditions ___________________________________________ _
1-2
y
Yellow fever, prevalence of_ ____________________________________ 2, 4, 91, 129
z
Zoology, report of division oL __ _ __ _ __ _ __ ______ ___ __ _ ___ _ __ __ ___ ___ _
0
Digitized by
Google
65
