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ANNUAL REPORT
OF THE
SURGEON GENERAL o/ the
PUBLIC HEALTH SERVICE
of the UNITED STATES
FOR THE FISCAL YEAR
.1936
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON: 1936
For sale by the Superintendent of Documents, Washington, D. C. -
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Price $1.00 (cloth)
TRliBUBY DEP ABTMEN'l'
Document No. 3081
Public Health Service
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LETTER OF TRANSMITTAL
TREASURY DEPARTMENT,
OFFICE OF THE SECRETARY,
Washington, January 5, 1937.
Srn: In accordance with section 9 of the act of Congress approved
July 1, 1902, I have the honor to transmit herewith the report of
the Surgeon General of the Public Health Service for the fiscal year
1936.
Very truly yours,
H. MoRGENTHAU, Jr.,
S ecretary.
The SPEAKER OF THE Hou sE OF REPRESENTATIVES.
Ill
601-96
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CONTENTS
Page
Foreword_________________________________________________________
Di vision of Scientific Research_ _ _ _ _____ ________ ___ _________ __ _______
Cancer_______________________________________________________
Epidemiology_ _ __ ________ _____________________________________
Heart disease_ _ _ _ __ __________ __ __ ____ _______________ __________
Leprosy______________________________________________________
Malaria______________________________________________________
Nutrition_____________________________________________________
Rocky Mountain spotted fever__________________________________
Tularaemia_ _ ____ ________ __ ________ __ ________________________ _
Sylvatic plague________________________________________________
Experimental tick studies______ _______ _________________________
Child hygiene_________________________________________________
Dental studies________________________________________________
Dermatoses investigations______________ _____ ___________________
Industrial hygiene and sanitation________________________________
Milk investigations__________________________ __ ________________
Studies of public health methods________________________________
Statistical investigations________________________________________
Stream pollution investigations__________________________________
National Institute of Health____________________________________
Miscellaneous_________________________________________________
Division of Domestic (Interstate) Quarantine_________________________
Cooperation with States on public health administration____________
Cooperation with States in preventing the spread of epidemic diseases_
Plague-suppressive measures in Western States________________
Plague-suppressive measures, Island of Maui, Territory of Hawaii_
Trachoma prevention_ _ _ _____ _________________ _______ ______
Supervision of water supplies used by common carriers_________
Railway sanitation_________________________________________
Shellfish sanitation_________________________________________
Reciprocity with Canada_______________________________________
Cooperative work with States and other agencies relative to stream
sanitation__________________________________________________
Cooperation with States in connection with flood emergency________
Statistical compilation_________________________________________
Cooperation with other Federal agencies on public health engineering
work __ _____________________________________________________
Works Progress Administration projects__________________________
Annual conference of the Surgeon General with the State and Territorial health officers__________________________________________
Di vision of Foreign and Insular Quarantine and Immigration_ _ __ __ __ ___
Transactions at maritime quarantine stations_____________________
Mexican border stations________________________________________
Transactions at United States airports of entry for airplanes from
foreign ports________________________________________________
Canal Zone__________________________________________ __ _______
Medical inspection of aliens____________________________ _________
Division of Sanitary Reports and Statistics___________________________
Morbidity and mortality reports_________________________________
Negro health work_____________________________________________
Publications issued by the division_______________________________
Publications distributed and exhibits prepared____________________
Division of Marine Hospitals and Relief______________________________
Classes of beneficiaries and amount and character of services rendered_
Dental treatment______________________________________________
Coast Guard__________________________________________________
Operating costs in marine hospitals______________________________
Consolidated and detailed reports________________________________
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CONTENTS
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Di vision of Venereal Diseases_ _ _ _ _ _ _ _ __ __ __ __ __ __ __ __ _ _ __ __ __ _ _ _ _ _ _ _
Cooperative clinical studies_____________________________________
Cooperative work with State health departments__________________
Educational and informative activities___________________________
Venereal disease research laboratory, Stapleton, Staten Island, N. y _
Study of serodiagnostic tests for syphilis_________________________
Untreated syphilis in the Negro_________________________________
Venereal disease clinic, Hot Springs, Ark_________________________
Tabular summaries____________________________________________
Division of Mental H ygiene________________________________ _________
Studies of the nature and treatment of drug addiction______________
Dissemination of information___________________________________
Narcotic farms________________________________________________
Medical and psychiatric services in Federal penal and correctional
institutions_________________________________________________
Studies and investigations on the causes, prevalence, and means for the
prevention and treatment of nervous and mental diseases_________
Division of Personnel and Accounts______________ ____________________
Personnel___ __________________________________________________
Property records______________________________________________
Accounts section_ _ _ _ _ __ _ _ _ _ __ _ _ __ _ _ __ _ _ _ _ _ _ __ __ _ _ __ __ _ _ _ _ __ __ _
Personnel statement___________________________________________
Chief Clerk's Office___________ _____________________________________
Appendix__________________ ______________________________________ _
Financial statement____________________________________________
Funds transferred from other agencies____________________________
Miscellaneous receipts-Covered into the Treasury ________________
Quarantine service-Expenditures by stations_____________________
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ANNUAL REPORT OF THE SURGEON GENERAL OF THE
PUBLIC HEALTH SERVICE
TREASURY DEPARTMENT'
UNITED STATES PUBLIC HEALTH SERVICE,
Washington, D. 0., October 15, 1936.
Srn: In accordance with the act approved July 1, 1902, I submit for
transmission to Congress the following report of the transactions
of the United States Public Health Service for the fiscal year ended
June 30, 1936. This is the sixty-fifth annual report of this Service,
and presents its activities during the one hundred and thirty-eighth
year of its existence.
On January 31, 1936, Surg. Gen. Hugh S. Cumming was retired
(placed on waiting orders) after having served as an officer of the
Public Health Service for 42 years and as Surg•eon General since
1920-a period of 16 years.
PROMOTION OF PUBLIC HEALTH ·U NDER THE SOCIAL SECURITY PROGRAM
Under the public health provisions of the Social Security Act,
a national health program has been made possible for the first time
in the history of the Public H ealth Service. This modernized national health program was inaugurated during the latter part of
the fiscal year. With the advice and assistance of the State health
officers, .grants-in-aid were ma.de to the States for the last 5 months
of the fiscal year 1936 and allocations were made for 1937. By the
close of the period covered by this report, every State had submitted a program of work under the provisions of the public health
title of the Social Security Act.
Among the important duties of the Public Health Service are the
investigations of disease and cooperation with the States in advancing public health administration. Both investigative activities and
the extension of cooperative health service have been greatly stimulated through the Social Security A ct and a.ppropriations made
under its authority.
During the period cove:i;.-ed by this report, cooperation was given
the Works Progress Administration and the State health agencies
in providing technical supervision for community sanitation, malaria control drainage, and the sealing of abandoned mines; assistance was furnished other Federal departments and bureaus in
problems of environmental sanitation; and cooperation was maintained with the State and Territorial health authorities of California, Oregon, Washington, Montana, and Hawaii in measures
directed to the control of bubonic plague. Bubonic plague was
introduced on the
e,st Coast about 35 years ago, and since that
time it has been o-oing steadily eastward and northward. The infection has recent~y been discovered in Montana, Idaho, and Utah.
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Through emergency funds., community sanitation projects, sponsored by the State health departments, were conducted with technical supervisory assistance from the Public Health Service; by the end
of the fiscal year, 896,879 sanitary latrines had been constructed in
unsewered villages and in unsewered areas of cities for the purpose of
pr.eventing the spread of typhoid fever, hookworm disease, dysentery~
and enteritis; and a total of 340,000 acres of mosquito-breeding area
had been drained, involving the construction of 22,000 miles of ditches.
INVESTIGATIONS OF PUBLIO lIEALTH PROBLEMS
Although the studies relating to the cause and prevention of disease do not appear different from previous studies, they are designed to increase our knowledge so that we may develop rational
methods of control. Leads that appear hopeful at first, often, in
a sense, prove fruitless; but in research, so-called "negative results"
are o:f value, at least in eliminating certain of these leads and
thus directing study into more promising paths.
LABORATORY AND OLINIOAL STUDIES
The cancer investigations conducted at the research laboratory in
Boston, Mass., were of a basic natur:e, and included studies of absorption spectra o:f blood and tissue extracts, dibenzanthracene-a
substance found to produce tumor growth in mice, the effects of
radon and X-rays, the oocurrence of lung tumors. in mice, and various biochemical studies relating to tumor cells.
Studies conducted at the N at10nal Institute of Health were concerned with the effect of diets deficient in the amino acid lysine,
cancer tissue cultures, the chemistry of cell growth and cell division,
and chemotherapy.
Because of the increasing importance of heart disease, increasing
attention has been given to this condition. Studies o:f heart disease
in Washington included clinical observations carried out at various
hospitals and clinics and laboratory experiments at the National
Institute of Health. Both studies have dealt almost exclusively with
rheumatic fever, the largest single cause of disability and death :from
heart disease, taking rank in importance with tuberculosis, syphilis,
and cancer. The studies o:f heart disease in the Philadelphia office
were conducted with two objectives: (1) To secure more accurate
:tnd extensive data than are now available on the incidence and
distribution of the etiological types of heart disease throughout the
United States, and (2) to assemble, by intensive methods in one
community, better epidemiological data on rheumatic fever.
Laboratory experiments at the _leprosy investigation station, at
Honolulu, Territory of Hawaii, dealt almost entirely •with investigations concerning the relation of the state of nutrition to the susceptibility to and the progress of leprosy in laboratory animals.
Experiments have definitely demonstrated that the incubation period for the disease can be shortened by depleting the rats o:f vitamin
B 1 before inoculating them with the organism o:f rat leprosy.
Malaria is still important :from a public health standpoint in certain regions o:f the country. A new field malaria research laboratory
was set up at Savannah, Ga., for the purpose of studying the bionom-
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ics of Anopheles mosquitoes, the principal vector of malaria. The
artificial means of control which are effective in urban communities
are expensive. It is hoped that investigations here will result in
the discovery of some method of control by natural and self-perpetuating means which will be applicable to rural communities.
The virus isolated and described by Surg. Charles Armstrong
has been established as the cause of a type of meningitis occasionally
occurring in man. Protection tests indicate that immunity to this
virus is rather common among some groups of our population and
suggest that infection of man may occur in the absence of meningeal
symptoms, just as usually happens in monkeys and mice inoculated
by routes other than the central nervous system.
Studies at the National Institute of Health have shown that certain chemicals, notably sodium aluminum sulphate and picric acid,
or a combination of the two, when instilled into the nostrils of experimental animals have the i.roperty of preventing infection after
subsequent introduction of the virus of epidemic encephalitis (St.
Louis type). and that of poliomyelitis.
Inve~tigations of typhus-Rocky Mountain spotted fever conducted
at the Institute, have included the cultivation of the viruses of typhus
and spotted fever in the chick embryo, preparation of vaccines
against typhus and spotted fever from chick embryo cultures, the
determjnation of the ability of dog fleas to transmit typhus in nature,
studies on the pathology of typhus and spotted fover, determination
of the susceptibility of various species of wild rodents to endemic
typhuc, and attempts to isolate endemic typhus virus from wild
rodents and their parasites trapped at rural ·typhus foci.
A system of classification of the hemolytic streptococci has been
worked out, based on sensitivity to three races of bacteriophage and .
fermentation reactions in lactose, salicin, mannite, trehalose, and
sorbitol broths.
Specjal investigations undertaken in connection with the control
of biologic products include studies of gas gangrene antitoxins, meningococcus meningitis, hemolytic streptococcus, typhoid vaccine,
staphylococcus preparations, and arsenical preparations.
The sugar researches being made at the National Institute of
Health, while of a fundamental nature from a purely chemical point
of view, have been conducted with an aim to possible application,
directly or indirectly, in the fields of medicine and the related biological sciences.
New zoological investigations were undertaken during the year,
the most important among these being studies of trichinosis and
oxyuriasis.
EPIDEMIOLOGICAL STUDIES
Epidemiological investigations combined with laboratory studies
have shown that there are several previously unrecognized infections
likely to be confused with poliomyelitis, and that comparisons of epidemics and of the regular occurrence of poliomyelitis should be
based on the number of frank paralytic cases. As a result of the
epidemjological studies on poliomyelitis it was discovered that vaccines a.gainst this disease might, in rare ·cases, give rise to the disease
itself.
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The study of 11 cities to determine whether there was a quantitative relation between the fluoride concentration of the common
water supply and the clinical effect was completed during the year
and the results were published. In connection with mottled enamel
surveys in South Carolina, Indiana, Ohio, Texas, New Mexico, Louisiana, and Kansas, 3,136 children were examined during the fiscal
year. There are at present 335 reported or surveyed endemic areas
in the United States located in 25 States.
The studies on diarrheal diseases of the southwestern part of the
country have shown that the problem is a large one and that the usual
type of the organisms causing bacillary dysentery are responsible for
a large proportion of the cases.
· Surveys to determine the prevalence of brucellosis, particularly in
atypical and chronic forms, are in progress at San Antonio, Tex., and
in Mecklenburg County, N. C.
•
STUnIES ON NUTRITION
Since an officer of the Public Health Service proved, inany years
ago, that pellagra was a dietary-deficiency disease, investigations
have been conducted to determine the pellagra-preventive value of
various foodstuffs. Prior to the year under report, this evaluation
had been made on about 20 different foods. Tests made during the
-year showed that canned mackerel is a good source of the pellagrapreventive vitamin and that certain liver extracts may be of considerable value in the treatment of the disease.
Other nutritional studies included experiments to determine what
relation, if any, exists between lactoflavin and pellagra; the effect of
Jactoflavin on nutritional cataracts and on symptoms of so-cal1ed rat
pellagra; the effects of small amounts of cystine amine fed to rats on
a cystine-deficient diet; the preparation of fractions of yeast to secure
a material of high pellagra-preventive potency and studies of the
ascorbic acid (vitamin C) content of plants.
INDUSTRJAL DISEASES
With the development of new industrial processes, investigations of
the possible danger to health that these new methods bring are made
neoessary. During the year studies were made of skin hazards in the
manufacturing processes in 14 factories. Of a total of approximately
7,000 workers employed in these factories, about one-third were actually examined for the existence of skin hazards. Special studies of
outbreaks of dermatitis were made in five plants upon the request of
the management. In one plant a study was begun as to the skin hazards involved in the manufacture and distribution of two new products, one an artificial silk and the other a rubber compound.
An investigation has been made of the dust hazard incident to the
asbestos textile industry in North Carolina. Of 517 persons examined, 46, or 8.9 percent, were diagnosed as having asbestosis.
For the fifteenth consecutive year rates of disability from a group
of 33 industrial sick-benefit associations, covering about 158,000 males,
were published. In 1935 the _incidence rate was slightly higher than
in 1934, when the lowest rate was recorded for any year since the inauguration of industrial morbidity reports.
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A program designed to establish active industrial hygiene units in
the health departments of industrial States was inaugurated with
the passage of the Social Security Act. A seminar for 34 physicians
and engineers from 16 State health departments was held in May 1936
for the purpose of training personnel in the highly specialized fi,eld
of industrial hygiene.
The analysis of the data collected during the study of 529 employees of the fur-cutting industry is almost completed; 43 cases of
chronic mercurial poisoning were found. One of the significant features of the disease was the extent to which it involved disorders of
the nervous system.
CHILD HEALTH
Four reports on studies of physical growth and development in
children were completed during the year and are in process of publication. The principal finding was that, so far as size and growth
of children are concerned, the depression has not seriously affected
any considerable number of American children. Four other studies
relating to fatal accidents of childhood were prepared for publication. Automobile accidents, burns, drowning, falls, poisonings, and
mechanical suffocation are the most frequent causes of accidental
fatalities of children under 15 years of age.
MILK SANITATION
With the view that properly pasteurized milk is the only safe milk,
investigations were continued regarding the efficacy of pasteurization
methods.
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Studies of the thermal resistance of the Escheriohia coli test organism have been made with the object of developing a nonpathogenic
criterion organism for use in testing the efficiency of pasteurization
machinery and the testing of devices and processes for the bactericidal treatment of dairy and milk plant containers and equipment.
A survey of milk-borne disease outbreaks :for the year 1935 resulted in the reporting of 16 cases of typhoid fever, 2 cases of paratyphoid, 2 of scarlet fever, 9 of septic sore throat, and 14 miscellaneous diseases.
SEW AGE T'RIEATMENT AND WATER PURIFIOATION
Because of the increase in human and industrial wastes, the tendency to overburdening streams with these wastes, and the concentration of population on streams and watersheds, there has been an
increasing need for water-treatment and sewage-disposal plants.
During the past 3 or 4 years there has been an increase of approximately 30 percent in sewage facilities in the United Stat.es through
the use of Federal funds. Past studies have led to improvement in
the procedures, and these investigations are being continued.
The objective of studies of the activated sludge process of sewage ·
treatment is the determination of those factors which, by affecting
the biological balance, reduce the efficiency of purification.
Experiments begun last year on the physical and chemical changes
occurring in deposits of sewage sludge under conditions apl?roaching
those of natural streams, using a specially constructed recirculation
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channel permitting observations of these changes to be carried out
over extended periods, were continued and amplified to include
parallel observations on the oxidation of sewage when diluted and
carried by the stream very largely in solution and suspension.
A procedure for measuring chloramine in the concentrations used
in water purification was developed because of · the widespread use
of chloramine in the disinfection of water supplies and because no
specific test had been theretofore available.
ROOKY MOUNTAIN SPOTTED FEVER AND PLAG-u,J
The largest quantity of Rocky Mountain spotted fever vaccine yet
produced, 506.8 liters, was prepared during the fiscal year. Sufficient vaccine to vaccinate the personnel in 48 · camps located in the
more dangerous endemic areas of the West and Northwest was furnished to the Civilian Conservation Corps. Smaller amounts of
vaccine have been furnished to 10 other Federal agencies for administration to field employees, principally those of the Forest Service
and the Resettlement Administration. Improved tick-rearing technique and knowledge that vaccine can be stored without loss of potency have made it possible to extend the period of vaccine manufacture. There has been a marked decrease in the incidence of Rocky
Mountain spotted fever during the 1936 season and the total number
of cases for the year will probably be well below the 1935 figure.
In July 1935, B. pestis was demonstrated in ground squirrels about
10 miles south of Dillon, Be-averhead County, Mont. Field data
indicated that sylvatic plague had probably entered Montana from
Idaho in 1933 or 1934 and that epizootics in ground squirrels had
occurred in Beaverhead and Madison Counties during 1934 and 1935.
Observations have shown that Pulew irritmns, a known vector of
plague, is prevalent on coyotes, occurs frequently on dogs, may infest
prairie dogs, and occurs on deer in western Oregon.
A filter-passing virus has been isolated from D. GJndersoni collected near Nine Mile, Mont., and from several lots of t icks of the
species D. occ:ulentalis from southwestern Oregon. The evidence
suggests that this virus is the causative agent of disease in wild
animals. There is no apparent relationship between this virus and
any known tick-borne disease.
A new species of tick, Ornithodoros parkeri, was identified and
described. The species was first collected near Casper, Wyo., :from
ground squirrels and their burrows, a jack rabbit, and a prairie dog.
Tests to determine whether this tick is a transmitting agent of
relapsing fever have thus far given negative results.
THE HEALTH INVENTORY
Analysis was being made of the data collected by the health in,ventory project which the Public Health Service conducted with
funds made available by the Works Progress Administration. This
study includes a survey of disabling illness, physical impairments,
and medical care among 865,000 families in 90 cities and 23 rural
counties throughout the United States, a communicable disease survey to determme the incidence and fatality of 13 diseases, chiefly
among persons less than 15 years of age, a study of the amount of
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time lost due to illness among industrial workers, the relation o:f
illness to occupation and the hazards o:f the occupational environment, a census of hospitals, a survey of hospital outpatient departments, and a survey of public health facilities.
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Further studies are in progress on the causes o:f illness and the
extent and kind of medical care in the 9,000 families canvassed in
the study which was made in cooperation with the Committee on the
Costs of Medical Care.
PUBLIO HEALTH ADMINISTRATION
The basic knowledge for public health work is acquired through
research; but this knowledge is of the greatest value only when it
is applied through proper and improved methods in public health
administration.
These studies pursued three main lines of investigation during the
year: (1) Studies of administrative probl'ems in public health organizations ; (2) determination of the influence of health education
measures on the knowledge and practices of people; and (3) inquiries into certain features of illness and medical service. From
these studies evidence has been adduced to show that the program
of representative county health departments encompasses but a small
part of the total health problem. .A.n analysis of the experience of
county health departments from the standpoints of survival and
growth was made for 811 counties covering the period 1908-34.
The study of rural midwife practice in Brunswick County, Va.,
begun in 1934, was completed during the fiscal year under report.
Suggestions regarding the selection and training of a new type of
midwife are to be made as a result of this study.
An analysis was made of the health organization of cities during
the economic depression. The results indicate that, by internal econ•
omies, health departments were able to compensate for small reduc•
tions made prior to 1933, but in that year there was considerable disorganization of staff and serious impairment of service in some
places. By 1934 there was a slight general increase in appropriations.
HEALTH CONDITIONS IN 19 3 5
An important duty of the Public Health Service is the prevention
of the introduction and spread of disease from foreign countries into
the 1.Jnited States; and in order to secure this protection, it is necessary to keep currently informed regarding the prevalence of communicable diseases, not only in the United States but throughout the
world so far as possible.
WORLD HEALTH CONDITIONS
During 1935, 334,000 cases of cholera were recorded, as comp.a rea
with 287,000 cases for the year 1934. Only a few scattered cases
occurred in the Philippine Islands.
Forty-eight thousand cases of plague with 42,000 deaths were reported for the calendar year 1935. The numbers of c,ases and deaths
were about half the number reported for the year 1934, but the disease was present in all parts of the world except Australia, and
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plague-i nfected rodents were found in many countries , includin g the
United States ,a nd the Hawaiia n I slands.
Most of the countrie s of the world reported compara tively few
cases of smallpox for the calendar year 1935. England and Wales
reported only one case. Ireland, Belgium , Netherla nds, Sweden,
Austria, Estonia, ,a nd several other Europea n countrie s did not report
any smallpox in 1935. In India, where the virulent form of the
disease prevails, 67,800 deaths from smallpox were registere d.
Incompl ete reports showed 87,000 recorded cases of typhus £ever
for the calendar year 1935, about 2,000 more cases than the same
regions reported for 1934. In parts of South America and in Mexico
the virulent form of typhus fever is prevalen t.
Yellow £ever was reported during 1935 in Bolivia and Colombi a
and in Brazil in the States of Amazon as, Bahia, Goyaz, Maranha o,
Matto Grosso, Minas Geraes, Para, Parana, and Sao Paulo. In
Africa, cases were reported in Dahome y, French Equator ial Africa,
French Sudan, Gambia, Gold Coast, Ivory Coast, iger Territor y,
Nigeria, Senegal, Sierra Leone, and Togo.
HEALTH CONDITION S IN THE UNITED STATES
Reports collected by the Public Health Service indicate that health
conditio ns in the United St,ates remained good in 1935. The general
death rate in 25 States 1 was 10.8 per 1,000 populati on, as compare d
with 10.9 in 1934, and the same rate as the average for the 5 years,
1931 to 1935, inclusive , the lowest rate recorded for any 5-year period.
The reports from 24 States 2 ga.ve an infant mortalit y rate of 52
deaths under 1 year per 1,000 live births for the calendar year 1935the lowest infant mortalit y rate recorded for these St,ates. The average for the 5 years 1931 to 1935, inclusive, was 56 deaths under 1 year
per 1,000 live births.
The materna l mortalit y, on the other hand, showed no significa nt
d'3cline .in 1935. In 24 States, the rate was 5.3 deaths of mothers per
1,000 live births. The average for the 5 years 1931 to 1935 was 5.7
materna l de,a ths per 1,000 live births.
Neither cholera nor yellow £ever appeared in the United States
during the year 1935.
Three cases of plague occurred in the United States during the first
6 months of 1936, 1 in April in Sonoma County, Calif. ; 1 in June in
Montere y County, Calif.; and 1 in June in Beaver County Utah.
Plague infection was found in ground squirrels in Californ ia, Oregon.
Montana , and Idaho, and fleas from ground squirrels frmn r evada
were found to be plague-i nfected. After the close of the fiscal year.
in July and August 1936, plague infection was found in a marmot
in ground squirrels , ,a nd in prairie dogs from Utah.
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A fatal case of plague was reported in Hamaku a District, Hawaii
Island, T erritory of Hawaii, in March 1935. During the calendar
year 1935, 20 plague-i nfected rats were found on the island of Hawaii
1 The States which furnished data for
the computatio n of death rates are California
Connecticu t, District of Columbia, Georgia, Idaho, Illinois,
Indiana, Iowa Kansas Lou:
isiana, Maryland, Michigan, Minnesota, Mississippi , Montana,
ebraska New jersey
~e~ York, <_>rth <;:arolina, Pennsylvan ia, Rhode_ I sland, South Dakota,
Tennessee, Vir:
g1ma, and W1sconsm -aggregate population, estimated, 83,358, 000.
2 '.rhe same States with the exception
of Mississippi furnished data for computing
infant mortality rates-agg regate population, 81,397,000.
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and 6 on the island of Maui, and during the first 6 months of 1936,
8 plague-infected rats were found on the island of Hawaii.
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A total of 10,839 cases of poliomyelitis was reported to the Public
Health Service in 1935, as compared with 7,517 cases for 1934, ,a nd
an average of 8,249 cases for the 5 years ended ~ith 1934. Dur_ing
the year the disease was unusually prevalent m North Carolma,
Virgini,a, the District of Columbia, and several of the ortheastern
States.
Although nearly 8,000 cases of smallpox were reported in the
United States in 1935, an increase of more than 2,500 over the number
for the preceding year, the prevalence of this disease was less than
that for any year prior to 1933 for which there are records. The
annual average for the 5 years preceding 1935 was 20,400. The distribution of the cases. was very uneven. The New England and
Middle Atlantic States r eported only 3 cases, while Montana and
Wyoming together reported 1,060 cases. Eight States did not report
any smallpox. These are Maine, New Hampshire, Massachusetts,
Rhode Island, Connecticut, New Jersey, Pennsylvania, ,a nd the
District of Columbia.
New low death rates were recorded for both typhoid :fever and
diphtheria, and the tuberculosis death rate maintained the downward
trend which has been one of the outstanding achievements in public
health for several decades. Typhoid fever is no longer a major cause
of sickness in this country.
Concomitant with the decrease in certain diseases which have been
made the special object of public health efforts, there has been an
mcrease in deaths from the chronic diseases, and these are now becom ing the subject for increased attention. To bring about a reduction
in disease prevalence is the primary object of public health work.
QUARANTINE AND IMMIGRATION ACTIVITIES
No importation of any of the quarantinable diseases into the United
States or its possessions occurred during the fiscal year. One vessel
arrived at Boston, Mass., with a case of smallpox on board. The
patient was detained at quarantine, and necessary precautions were
· taken. Two cases of small pox were detected on the Mexican border
and refused entry.
Quarantine transactions .-During the year, quarantine officers of
the Public Health Service inspected 15,981 vessels, carrying 733,495
passengers and 1,182,232 seamen. Of a total of 3,823 airplanes, canying 37,352 persons, which arrived at airports of entry m the United
States from foreign countries requiring quarantine inspection, only
.2,281 airplanes, carrying 31,898 persons, of whom 5,537 were aliens,
were inspected by medical officers of the Public Health Service prior
to entry, ow_ing to many arrivals at airports at which medical officers
are not a va1lable.
Fumigations were made of 1,193 vessels either for the destruction of
rats or because of the presence on board of some contagious disease.
Examinations for plague infection were made of 2,971 of the 4,585
rats retrieved following fumigation.
The International Sanitary Convention for Aerial Navigation,
The Hague, 1933, became effective in regard to the United States on
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November 22, 1935. The provisions _of the con~ention applicabl~ to
the aid of commerce between foreign countries and the Unl~d
States have been placed in effect. The on~:r notewort~y change_ m
existing procedures resulted fron:i the provis10ns of article_ 9, which
substitute a journey log for the bill of health formerly required to be
..
.
carried by aircraft.
The inauguration of aerial-transport serV1ce across the _Pacific
necessitated the issuance of special instructions to the quarantme stations at San Francisco, Honolulu, and Manila, in order to prevent
the introduction of quarantinable disease into the United States and
to prevent the introduction of mosquito vectors of malari~ into ~he
Territory of Hawaii, where such disease does not now exist, owmg
to the absence of such insect carriers.
Maritime commerce between the United States and Cuba has been
aided by a mutual agreement between the chiefs of the quarantine
services of the two countries providing for the recognition of deratization exemption certificates issued by either country to vessels
which are maintained in a rat-free condition.
Medical inspection of aliens.-Medical officers at the various ports
of entry in the United States examined 824,401 alien passengers and
722,756 alien seamen. Of these numbers, 15,106 passengers and 1,119
seamen were certified to the proper immigration offi'cials as being
afflicted with some mental or physical defect or disease.
A total of 38,619 applicants for immigration visas was examined
by medical officers of the Public Health Service stationed in American consulates in foreign countries ; 12,516 were examined in American
consulates in the vVestern H emisphere, and the remainder were examined in American consulates in the Eastern Hemisphere. Seventyfive of those examined in the Western Hemisphere and 545 of those
examined in the Eastern Hemisphere were reported by the medical
officers to the American consuls as being afflicted with one or more of
the defects or diseases requiring exclus10n, and 1,664 of those ·examined in the "\Vestern Hemisphere and 5,214 of those examined in the
Eastern Hemisphere were reported as being afflicted with a disease
or condition which was likely to affect their ability to earn a living.
Only four of the aliens who had been given a preliminary medical
examination in American consulates in foreign countries and. to whom
visas had been issued were certified upon arrivaJ at United States
ports as being afflicted with a condition requiring deportation.
HOSPITAL RELIEF
Hospital and outpatient care was furnished to American seamen
and other beneficiaries at 154 ports; 331,215 accredited persons applied for treatment and other medical service. The Coast Guard,
for whose personnel of 10,748 the Public Health Service has sole
medical responsibility, was served at the regular stations and 102
other places, and 21 medical and dental officers were assigned to
Coast Guard ships and shore stations.
~here we~e 102,573 more hospital days furnished all classes of
patients durmg the fisc~l year ~~3? than in the fiscal year 1935.
Important new hospital facilities were completed and occupied
at Stapleton. A new hospital-ward building at Memphis is under
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construction, and funds have been allocated for complete new
hospital plants at Boston and St. Louis.
Merchant seamen and dependents of coast guardsmen continued to
avail themselves of medical-relief facilities in increasing numbers.
In April 1936, the Veterans' Administration received an allocation of
75 more beds in marine hospitals. Patients from the Civilian Conservation Corps and Works Progress Administration were hospitalized in considerable numbers (see summary of services by class of
beneficiary, p. 110), and it is expected that there will be the sam.e
demand for hospital beds for patients of the Civilian Conservation
Corps and the Works Progress Administration in 1937.
In cooperation with the Civil Service Commission and the Immigration and Naturalization Service, medical officers of the Public
Health Service were assigned as members of examining boards convening in various places in the United States for the purpose of giving oral, mental, and physical examinations to applicants for the
position of border patrol inspector. Medical officers cooperated with
the Department of Justice in giving more than 200 special agents in
the Federal Bureau of Investigation physical examinations. These
examinations are to be given every member of the corps and repeated
periodically.
PREVENTION AND CONTROL OF VENEREAL DISEASES
The venereal diseases are beginning to receive the attention in
public health work that their relative importance justifies. Syphilis
ranks with cancer, tuberculosis, and pneumonia as a leading cause of
death. The hampering, ostrich-like attitude toward these diseases is
gradually being overcome. "\Vhen they are brought out into the open,
freed from the medieval concept of condign punishment for moral
transgressions, and dealt with as are any other highly communicable
diseases, the way is open to eradicate them just as we have stamped
out other dangerous infections.
Activities directed to the control of these diseases were intensified
during the year. Studies and investigations pertaining to their
cause, treatment and prevention, and cooperative work with State
departments of health were given a definite impetus through the
provisions of the Social Security Act.
Of special importance was the study of serodiagnostic tests for
syphilis, which included an evaluation of the ability of State, municipal, and private laboratories to perform such tests. The results of
this study indicate that there is considerable variation in the efficiency
of performance in different laboratories and that this variation is
about equal in State, municipal, and private laboratories. The study
further indicates the need for a periodic system of checking the performance of serodiagnostic tests for syphilis. In order to facilitate
this the Public Health Service plans to extend each year, beginning
with the ensuing fiscal year; a system of comparative examinations
of the efficiency of test performance in State laboratories on both a
serologic and clinical basis. A recommendation has been made to
State laboratories that a. similar system be extended to all laboratories
within the boundaries of the several States.
101889-36-2
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The cooperative clinical studies of syphilis which have been so
~uccessfully conducted in recent years with five of the leading syphilis
clinics of the country have been further prosecuted. Projected as
well as retrospective studies have been undertaken and many phases
of investigative work pertaining to syphilis are planned which are of
importance both to the public health officer and the clinician.
Provisions have been made for the expansion of the work at the
venereal disease research laboratory at Stapleton, Staten Island, N.
Y. , and cooperative assistance has been given to investigations carried on in some of the universities of the country. The scale of the
informative and educational program has been greatly increased.
NARCOTIC FARMS AND MEDICAL AND PSYCHIATRIC CARE OF FEDERAL
PRISONERS
The narcotic farms not only provide domiciliary care and treatment of drug addicts but serve as medical centers for the study of
drug addiction, aiming toward a solution of this spe_cial problem confronting society. They not only fulfill the modern demands of society that the sick and afflicted shall be cared for and set in the way
of strength and hope, but they provide facilities for research and
the acquiring o.f more accurate and fundamental knowledge concerning the nature of drug addiction and related. phenomena.
Since the opening of the United States narcotic farm at Lexington, Ky., in May 1935, 1,240 patients have been admitted. Of these,
960 were admitted during the fiscal year 1936 and 479 were discharged, leaving 761 patients in the institution at the close of the
year. Of the voluntary patients discharged as cured none are known
to have relapsed, but some of those discharged as having received
maximum benefit have relapsed as well as some of the prisoners
released on "conditional release" and parole.
Proposals were solicited for the construction of the initial buildings for the United Stat~s narcotic farm at Fort Worth, Tex., and
it is anticipated that the contract will be awarded sometime during
the early part of the ensuing fiscal year.
Plans were inaugurated during the year to furnish psychiatric
diagnostic services to Federal courts for a period of 1 year as a
research project to determine the wisdom and ,f easibility of establishing such services as a permanent activity of the Public Health
Service. The first unit was established in Boston, Mass., in May
1936. Similar units will be established at other points throughout
the country.
A survey was made during the year in cooperation with the
National Committee for Mental Hygiene for determinincr the adequacy of measures, policies, and facilities for the care of the mentally ill in the metropolitan district of New York.
COOPERATIVE ACTIVITIES
When an agency of the Federal' Government desires advice on
medical, public health, or related subjects, it is entirely natural to
turn to the. Public Health Service. The Service, in turn, renders
such assistance as lies within its resources of personnel and equipment. In the aggregate the amount of aid given in this way is
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PUBLIC HEALTH SERVICE
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considerable, reaching each department and many subsidiary agencies of the Government. The amount of cooperative work performed
in behalf of these agencies has increased to such an extent that additional personnel must be made available or the service must be
radically curtailed.
.
The scope of the cooperative activities is well shown in the detailed
account that follows :
l. Dep(Jff'tment of State.-Medical officers of the Public Health
Service were detailed to the American consulates in Europe, Canada,
and Cuba for the purpose of examining applicants for visas. These
officers also furnish current information regarding the sanitary condition of ports and vessels.
2. Trea,swry Department.-The Public Health Service continued
to furnish medical care, hospitalization, and advice as ·to environmental sanitation for the Coast Guard. In the District of Columbia
emergency medical relief was provided for Treasury Department
employees in strategically located clinics.
3. War and N {JYl)y Dep(Jff'tments.-Medical care and hospitalization
was provided for civilian employees and, upon request, for officers
and enlisted men. Physical examinations are made of applicants
for the Officers' Reserve Corps and the citizens' military training
camps. Advice and assistance in environmental sanitation, as well
as laboratory service, were supplied when needed.
4. Department of Justice.-The Service has cooperated with the
Department of Justice and district attorneys in protecting the interests of the United States when violations of quarantine laws and
property rights are concerned. A psychologist-statistician was detailed as technical director of the Attorney General's Survey of Release Procedures. Psychiatric and general medical services were
provided for the General Prosecution Division in connection wilh
the prosecution of off enders against the Federal laws. Medical,
psychiatric, and other seFvices were.. l?rovided for the inmates of Federal penal and correctional institut10ns. Periodic physical examinations are performed and systematic lectures on first aid are given
for the benefit of the agents of the Federal Bureau of Investigation.
5. Post Office Department.-A special investigation was made to
determine the possibility of carbon-mono~ide poisoning in the railway-mail compartments of ,certain gasoline-powered trains. Special physical examinations and first aid were provided upon occasion.
6. Department of the lnterior.-Medical examinations were made
of Filipino laborers destined for the Hawaiian Islands. Officers
were detailed for duty in the west-coast hospital for mentally ill
Alaskans, North American Indians, and other beneficiaries. Advice
and assistance in solving problems of environmental sanitation were
provided for the Office of Indian Affairs and the National Park
Service. A number of officers supervised the facilities for medical
care and hospitalization of the Office of Indian Affairs. At Hot
Springs National Park a venereal disease clinic was maintained.
7. Department of Agriculture.-The Service assisted the Department in enforcing the plant and animal quarantine measures on vessels coming from foreign ports. Sanitary engineering advice was
afforded the Forest Service and Bureau of Agricultural Engineering.
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Large quantities of vaccine were provided for the Forest Service for
protection of field employees against Rocky Mountain spotted fever.
8. Department of Oommerce.-Quarantine procedure for aircraft
coming from foreign countries was standardized. When requested
by the Steamboat Inspection S~rvice, applicants for licenses as ships'
officers have been given physical examinations. Medical care was
provided for lighthouse keepers and seamen from vessels of the lighthouse establishment, Coast and Geodetic Survey, and Bureau of
Fisheries. Emergency medical relief was made available for employees of the Bureau of Standards and other employees of the
Department of Commerce.
9. Depa1·tment of Labor .-Medical officers stationed at United
States ports of entry examined aliens and provided medical care for
those detained. Applicants for the position of border-patrol inspector were examined as to acceptability by Service officers. Industrial
hygiene programs in the States have received a notable impetus
through joint interest and effort.
10. Civil Service Commission.-Physical examinations were made
of employees of the Commission and applicants for positions, reinstatement, and retirement.
11. United States Employees' Compensation Commission.-Outpatient and hospital care has been provided for injured Federal
employees. Through the detail of several medical officers, physical
examinations have been made, special investigations conducted, and
disputed claims considered.
12. Federal Trade C ommission.-The frequent requests of this
agency have necessitated an increasing amount of advice, research,
expert testimony, and laboratory investigations.
13. United States Veterans' Administration.-When facilities of
tlie Administration are not available, certain beneficiaries are provided with hospital and outpatient treatment and physical examinations by the Public Health Service. At the request of the Bureau
of Pensions, physical examinations were made of applicants for military pensions.
14. Resettlement Administration.-Through the detail of a medical officer, the Service is aiding the Resettlement Administration in
solving its numerous problems of public health, sanitation, and medical care. Quantities of Rocky Mountain spotted fever vaccine have
been provided for the protection of migrant workers.
15. Social, Secwrity Board.-An experienced medical officer has
been assigned to the Board as adviser in matters affecting the welfare
of the blind.
It is apparent that the work of the Public Health Service closely
touches all departments of the Government and many subsidiary
bureaus, offices, sections, and independent establishments. In addition to agencies of the Federal Government, the Service has a constant and intimate relationship with State and city departments of
health. The nature and scope of these activities will be discussed in
greater detail in the section of the report devoted to the Division of
Domestic Quarantine ( States relations).
It has also' been possible to cooperate productively with voluntary
health organizations having a national scope, and with universities
engaged in special public health research.
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RECOMMENDATIONS
STATE AID UNDER SOCIAL SEOURITY
The wisdom of the Congress in enacting the health provisions of
the Social Security Act has been amply demonstrated by the activities inaugurated and results secured during the first year of its operation. It is recommended that continued appropriations- authorized
under the act be approved by the Congress.
Experience in the admimstration of the health provisions of the
.Social Security Act indicates that, on the whole, the provisions of
the law are sound. Additional experience, however, may point out
·the desirability of amendments which will enable the objectives of the
act to be accomplished more effectively.
REBE.A.ROH
While the research work of the Public Health Service has been
considerably expanded as a result of the approval by the Congress of
a part of the funds authorized under the Social Security Act, the
pressing needs for continuance and extension of the interest of the
Federal Government in many unsolved problems of health and dis,ease should be met by annual appropriations of at least $2,000,000
authorized by the Social Security Act, in addition to the funds previously made available to the Public Health Service for research purposes. Additional studies are particularly important in connection
with the chronic diseases, physiology and nutrition, and the venereal
-diseases.
NEW CONSTRUCTION
In order to coordinate all research activities of the Public Health
Service with the National Institute of Health, funds for completion
of the entire project at Bethesda are urgently needed. Of the· origi. nal estimate of $2,500,000, there has been appropriated $1,363,000 for
additional facilities. The balance, when appropriated, will be used
·to construct laboratory buildings to replace the existing National Institute of Health laboratories, and make it possible to transfer the
, existing site and buildings to the Navy in accordance with the joint
agreement (June 18, 1935) of the two Departments concerned.
Among other building needs at this time the greatest are for(1) A suitable dispensary at Washington, D. C., to replace the
present inadequate and unsatisfactory facilities for relief activities.
(2) The completion and rehabilitation of the hospital plant at
Fort Stanton, N. Mex., including the construction of a recreation
building and the necessary quarters for doctors, nurses, and
attendants.
( 3) Replacement of all existing frame structures at the Carville,
:La., leper hospital with fireproof construction, including also a nurses'
·home and quarters for unmarried attendants, as well as a building to
furnish a suitable recreation center.
( 4) Completion of the marine hospital at Stapleton, N. Y., to
_provide a total of 1,200 beds; and the provision of a building to house
.a cancer-investigations laboratory. Additional quarters for co:-..nmis-
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sioned and other personnel are required at the marine hospitals in
Baltimore, Norfolk, Seattle, and Savannah.
( 5) Erection of new hospitals in Miami, Fla., Los Angeles, Calif.,
and Portland, Maine.
WATER P0LLUTIO - CONTROL
The pollution of our streams for many years has increased at a rate
greater than the development of remedial measures. From the public health standpoint, critical conditions now exist in many places.
The impetus given by emergency funds to the construction of sewagetreatment plants has afforded some relief and has demonstrated the
desirability of continued Federal assistance for this purpose.
The Public Health Service has conducted important studies of
water pollution but has not been able to deal adequately with this
problem. The Conference of State and Territorial Health Officers
has recommended that legislation be enacted which will provide for( 1) Increased appropriations to the Public Health Service for
research.
(2) Establishment of a division of stream-pollution control.
(3) Federal aid for the construction of sewage-treatment plants
and for assisting State health departments in this matter.
(4) Interstate compacts for pollution abatement.
It is urged that the Congress give favorable consideration to these
recommendations.
THOMAS p ARRAN'
Swrgeon General.
Hon. HENRY MoRGENTHAU, Jr.,
Secretary, of the Treaswry.
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DIVISION OF SCIENTIFIC RESEARCH
Asst. Surg. Gen. L. R.
THOMPSON
in charge
CANCER
Field investigations of cancer at the Harvard Medical School were
continued during the year under the direction of Medical Director
J. W. Schereschewsky.
BIOPHYSIC.AL STUDIES
X-ray investigations.-It was hoped that work with biological
material, using an X-ray tube with interchangeable anodes and possessing certain special characteristics, could be begun early in the
fiscal year. However, difficulties arising during assembly delayed
progress, but the work should be under way early in the next fiscal
year.
Spectroscopic investigations; absorption spectra of carcinogenic
compounds.-The study, by a qualitative method of the ultraviolet
absorption spectra, of carcmogehic compounds and their derivatives
(most of them belonging to the anthracene group) has been continued in an attempt to relate certain characteristics of the spectra to
the carcinogenic properties of the compounds. Although a considerable number of new compounds (prepared by .Professor Fieser,
of Harvard University, and his colleagues) were studied, the outcome of biological testing for carcinogenic activity ( still in progress
for a number of these compounds) must be awaited before the final
study of the spectrographic records can be made.
It is felt, however, especially in view of the fact that compounds
which do not belong to the anthracene group have been found to be
carcinogenic, that too much should not be expected of a qualitative
method. For further studies it is not only important to replace a
qualitative by a quantitative method, but also to find ways of bringing out the finer structure of the absorption bands either by using
absorbing solutions at low temperatures ( e. g ., that of liquid air) or
by obtaining absorption spectra in the gaseous state.
Absorption spectra of blood and tissue extracts.-The detection by
spectroscopic methods of carcinogenic substances present in tumor
tissues or in the blood is of obvious interest in connection with studies
in carcinogenesis, especially as other investigators ( e. g., Chalmers)
have reported, in tissue extracts, intense absorption in the ultraviolet region of the spectrum, which would mask the absorption
bands of a carcinogenic agent such as dibenzanthracene. Accordingly, a study was made of the detection by spectroscopic methods of
dibenzanthracene in, tumors induced by the agent and in other body
tissues and fluids. A method was developed by which a considerable.
proportion of the substances masking, by their absorption, the
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spectrum of the carcinognic compound cou'ld be removed from
tissue extracts without, at the same time, removing the carcinogenic
agent. The results of these studies were published in the American
Journal of Cancer for February 1936.
The effects of injection into mice of dibenzanthracene, either dissolved or as a colloidal suspension in serum, were also studied.
Under ordinary conditions, serum dissolves but small quantities of
dibenzanthracene ( e. g., horse serum dissolves 0.0015 mg per cc).
Saturation of normal horse serum with cholesterol brings about somewhat more than a threefold increase in this amount. Dog serum
from blood ,withdrawn 2 hours after a fatty meal will dissolve up
to 0.14 mg of dibenzanthracene per cc. By adding dibenzanthracene
or methylcholanthrene dissolved in ether to horse serum saturated
with cholesterol, homogeneous suspensions containing 0.1 mg to the co
of either compound may be obtained.
These sera were injected intravenously or intraperitoneally into
mice, and blood and tissue extracts were examined spectroscopically
for the hydrocarbon. It was found that dibenzanthracene injected
intravenously in solution in the serum disappeared from the blood
in a few minutes, whereas, in the case of the colloidal suspension
small amounts could be detected in the blood up to 4 days. The
method of preparing these solutions and suspensions was published
in the American Journal of Cancer for April 1936. Lung tumors
in mice were obtained by the intravenous injection of these solutions
and intra-abdominal tumors by their intraperitoneal injection.
Charcoal adsorption of dib enzanthracene.-So far the carcinogenic
action of hydrocarbons has been studied only in the solid, the dissolved, or the dispersed state. Experiments with carcinogenic
hydrocarbons in t_h e adsorbed state may yield additional information
as to their physicochemical and biological action. For this purpose
activated pure charcoal was prepared on which dibenzanthracene
was adsorbed; it was found possible to adsorb approximately 0.5 mg
of this hydrocarbon upon 1 mg of charcoal. Biological experiments
with this material are under way.
Effect of radon i'1pon mice.-This investigation was undertaken to
study the effect of radon on mice of high tumor strain. The lethal
dose was found to be approximately 1.5 millicuries for mice of
average weight. These experiments are still in progress.
Effects of X-rays 1'1pon the action of bacterial f},trates.-An investigation was begun to determine what effect, if any, was produced
by concomitant X-radiation upon the action of bacterial filtrates in
tumor-bearing mice. The animals were injected with the filtrate
and then the whole animal irradiated with doses varying up to 600r,
The method of irradiating the whole animal was abandoned because
of harmful effects. Experiments are in progress in which the tumor
alone is irradiated.
B'IOLOGIOAL STUDIES
Production of tumors in pure-strain mice by injections of dibenzanthracene serum solutions and suspensions.-Colloidal preparations of
dibenzanthracene in horse serum and solutions of dibenzanthracene
in dog serum were injected into pure-strain mice. The results thus
far obtained show that intravenous injections of the colloid sus-
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pensions of dibenzanthracene in horse serum into strain A, strain M,
and strain C 3 H mice produce lung tumors only in strain A mice.
Subcutaneous injections of either the colloid suspension or of the
solution produced tumors in mice of the C3 H strain. Intraperitoneal
injection of the dog serum solution likewise produced intraabdominal tumors in this strain of mice. Experiments are in progress to compare the relative carcinogenic activity of dibenzanthracene
when dissolved in lard, in dog serum, or held in colloidal suspension
in horse serum.
These solutions and suspensions in serum also permit a study of
the influence of intravenous injection of these preparations upon a
subsequent implantation of dibenzanthracene dissolved in lard.
Studies of the occurrence in mice of lung tumors following
dibenzanthracene injections.-A survey of the literature concerning
lung tumors in mice has confirmed the observation that both subcutaneous and intravenous injections of dibenzanthracene :(>roduce
a high proportion of lung tumors in pure strain albino mice, but
fail to do so in pure strain colored animals. Attention was directed
to this finding in a paper entitled "Further Studies on the Production of D1benzanthracene Tumors in Pure Strain and Stock
Mice", which appeared in the Public Health R eports for September
6, 1935.
Transplantation of lung tumors.-No recorded instance of the successful transplantation of lung tumor has been found in the literature.
although this has been tried by several investigators. During the
past year 5 lung tumors have been transplanted serially in this laboratory. Microscopic sections of the original tumors and of each
passage tumor have been prepared and reserved for future studies.
Effects of bcroteruJ'Jl filtrates uporn maligna;nt growths-A paper describing a technique for performing quantitative experiments with
bacterial products known to affect certain types of tumor and entitled
"The Reaction of Mice and of Various Mouse Tumors to the Injection
of Bacterial Products" was published in the American Journal of
Cancer for May l936.
BIOOHEMIOAL STUDIES
Studies of carcinogenic compounds.;-The investigation of polycyclic hydrocarbons, which is being carried on jointly with Prof. L. F.
Fieser and his colleagues, was continued during the fiscal year. In
addition, simpler benzene derivatives are being tested for carcinogenic action in an attempt to find out which compounds are responsible for causing the so-called "aniline cancer'' of the dye industry.
The results of the earlier experiments on this subject were d~scribed in a paper entitled "The Production of Tumors in Mice with
Hydrocarbons", which appeared in the American Journal of Cancer
for February 1936.
At the Washington meeting (March 1936) of the Federation of
American Societies for Ex:(>erimental Biology the results of further
experiments were reported m a paper entitled "Isomers of Cholanthrene and Methylcholanthrene", in which the high carcinogenic activity of these two compounds was contrasted with the much-delayed
action of an isomer of cholanthrene and the absence of carcinogenic
activity in an isomer of methylcholanthrene. At the same meeting
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another paper entitled "Development of Liver Tumors in Pure Strain
Mice Following the Injection of 2-amino-5-azotoluene" was presented by title. The results reported in this paper confirm Yoshida\;
work of inducing primary liver tumors in rats and mice with this dye.
R elation of cholesterol to carcinogenesis.-During the latter part of
the fiscal year the study of the possible relation of cholesterol to
carcinogensis ,vas taken up.
Inhibiting action of certain coal-tar fractions .-In collaboration
with Mr. Samuel Cabot, of Boston, Mass., the possible inhibiting
action of certain coal-tar fractions upon the carcinogenic activity of
benzpyrene painted at regular intervals upon the skin of a consid-erable number of mice is being studied. Prof. S. B. Wolbach, of
Harvard University, is collaborating on th~ histological aspects of
the experiment.
Collaboration with the Forsythe Dental lnfi1·mary.-Prof. Percy
Howe, director of the Forsythe Dental Infirmary, has produced
lesions in animals deprived of vitamin A which bear superficially some
resemblance to carcinoma. At his invitation experiments have been
undertaken in collabor~tion with him and with Dr. Mark Elliot, of
the same infirmary, to determine the effect of avitaminosis A on the
production of tumors with benzpyrene.
Studies on chemical treatment of tumor cells.-A second report in
this series entitled "The Effect of Disturbances in Fluid Exchange
on Transplanted Mouse Tumors'' was published in the American
Journal of Cancer for September 1935. A third pa per in the series
called "Titration of Mouse Tumors" ,Yas presented at the meeting of
the Biological Chemists in Detroit in April 1935 (J. Biological Chemistry, vol. 81, 1935, p. 109) and was subsequently published in the
Public Health .Reports ( vol. 51, No. 21, May 22, 1936, pp. 668-676). A
paper dealing with the same subject has been published independ.,.
ently by Schrek. The technique developed in this laboratory differs
from Schrek's in that gelatin is used in the cell suspension.
Vital. stainin,q of tumor cells.-Two reports o.f experiments performed in collaboration with Dr. M. Belkin, of Harvard University,
on the vital staining of tumor cells and entitled, respectively, "The
Staining of Mouse Tumor Cells with Neutral Red in Vitro" and
"The Staining with Vital Dyes of Mouse Tumor Cells Swollen in
Salt Solution", have been completed and are being prepared for
publication.
Action of bacterial products.-Attempts were made to obtain the
active substance from filtrates of B. coli which, when injected, produce hemorrhage and recession in mouse transplantable tumors. Considerable progress was made in this direction, a stable product being
finally obtained giving a strong Molisch and negative Bicuret reaction which produces hemorrhage in mouse tumors when injected
intraperitoneally or intravenously in doses of 0.0003 mg. Preliminary reports on this subject entitled, respectively, "Separation of the
Hemorrhage-Producing Faction of B. Coli Filtrate" and "Properties
of the HemorrhagJ-Producing Fraction of B. Coli Filtrate" appeared
in the Proceedings of the Society for Experimental Biology and
Medicine ( vol. 34, 1936, pp. 323-326). Like the original filtrate, the
concentrated active substance, besides causing hemorrhage in tumors,
·also produced the Shwartzman reaction in rabbits. A report on this
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result entitled "Production of the Shwartzman Reaction in Rabbits
,vith a Purified Fraction of B. coli Filtrate" is now in press in the
same journal.
Effects of other bacterial products.-Observations have been made
-concerning the effects of suspensions of killed culture of B. proteus
and of other organisms and of their alcohol-insoluble fraction upon
several varieties of transplantable and upon spontaneous mouse
tumors. The results of this studv entitled "Effect of Certain Bae-·
terjal Products Upon the Growth ~of Mouse Tumor" appeared in the
Public Health Reports for January 17, 1936.
CYTOLOGICAL STUDIES
The attempt to convert normal into malignant cells by growing
them in tissue culture in contact with a carcinogenic compound has
·been continued. Crystals of 1, 2, 5, 6-dibenzanthracene or of methyl•Cholanthrene were placed in the plasma, clot of a tube culture of
mouse tissue. In some instances the crystals of carcinogenic compound were placed in direct contact with the explant; in others they
were located at a distance. Cells were observed to migrate to a crystal, to lie against it, to divide and, eventually, to surround it. There
was no evidence to show that the cells had undergone a change .
.Similar results have been reported by Gey and by L ewis.
Culture of mouse ,- tumors.-Although both rat and human tumor
-cells may be maintained indefinitely in tissue culture, such does not
appear to be the case with mouse tumor cells. Such cells liquefy the
medium rapidly and degenerate after several passages. The problem of finding a tissue culture technique allowing the indefinite
grmvth of mouse tumor cells was taken up. These experiments are
.still in progress.
·
Culture studies.-A comparison of the growth rates and characteristics of primary dibenzanthracene tumors was made. The work
included comparisons between primary dibenzanthracene tumors and
lung nodules from the same mouse, between primary and transplanted
-dibenzanthracene tumors, and between transplanted dibenzanthracene
and transplanted lung tumors. These experiments are still in
progress.
EPIDEMIOLOGY
The Office of Epidemiological Studies was continued under the
-direction of Medical Director J. P. Leake.
One of the fields of epidemiological pursuit is the evaluation of
preventive measures. In the last annual report the beginning of a
.study on the possible value of a vaccine against poliomyelitis was
mentioned. The probability that no positive decision could be derived from this study as to the value of the vaccine was anticipated;
but, nevertheless, it was stated that the use of such a product was
justifiable only under conditions which would give some hope of
_yielding trustworthy conclusions as to its efficacy. A report of the
study has been published. This is believed to be the first publication
-of a thoroughly controlled study of an agent directed toward specific
immunization in a general population. Though the results were as
.anticipated, the report was of positive value in pointing out the pos:Sible dangers and fallacies in attempts at the evaluation of such
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agents. Largely on account of these studies, information was ob-tained of cases of poliomyelitis occurring elsewhere in the United
States following the use of vaccines against this disease. Reports
on these cases were being made by those responsible for such use, but
the responsibility which the service had assumed in attempting to•
evaluate one of these vaccines justified the brief collation of such
cases and the publication of a report on them, together, in view of
the wide and favorable attention which the use of the vaccines was
gaining.
The collating of this series of 12 cases following, by intervals of
from 6 to 14 days, the administration of one or the other of two kinds
of vaccine., has apparently stopped the extending use of such vaccines
for the present. Though the data were less definite as to one of the
vaccines than as to the other, increased caution in further human
trials of such agents seems justified. This series of cases gave support
to the conception that in man as well as in monkeys, the virus of
poliomyelitis is transmitted along nerve fibers rather than by the
blood stream.
At the request of the Section on Sanitary Engineering and with the ·
cooperation of the health departments of the District of Columbia,
Baltimore, Md., and Virginia, together with certain health departments in Pennsylvania, Asst. Surg. A. G. Gilliam made an epidemiological study of cases of typhoid fever occurring in the city of
Washington during the winter of 1935-36. The data secured indicate
the advisability of increased sanitary precautions in the oyster·
industry.
Consideration of epidemics of cerebrospinal fever ( meningococcus .
meningitis) in South Carolina and Kentucky, which were studied
by officers attached to this office during the spring of 1936, showed
that this disease, even in epidemic form, may have a low fatality rate
and that crowding tends to propagate the infection.
·
The attention of this Office is at present largely directed to infections of the central nervous system. In addition to the conditions,.
which have been known for several years, such as poliomyelitis, the
encephalitis of von Economo occurring chiefly in the cooler months,
and post-infectious encephalomyelitis such as those cases occurring·
rarely after measles, chickenpox, or vaccination, other apparently
specific infections of this general nature have recently been discovered. The . St. Louis, or summer, form of encephalitis was reported in Public Health Bulletin No. 214. From an autopsy on a patient during the St. Louis epidemic of encephalitis, officers of the ·
National Institute of Health isolated the virus of a newly recognized
disease, lymphocytic choriomeningitis. In the summer of 1935 an
epidemic of meningo-encephalitis at Windber, Pa., was studied;
About 150 cases, chiefly in children and young adults, and 1 death
occurred in a population of 11,000. The cases, with few exceptions, .
were mild, with headache and fever lasting 2 to 7 days, often with
vomiting, and with an excess of cells in the spinal fluid. No association with water, milk, ice cream, or insects was found. The onsets .
were between mid-July and mid-September, chiefly during the last .
week of July and the first 5 days of August. The disease appeared
to be different from these other infections of the central nervous sys-tern. There were no cases of poliomyelitis in the community. The.
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,cases reported as poliomyelitis among hospital personnel during the
Los Angeles epidemic of 1934 have tentatively been regarded by this
Office as cases of that disease. Reconsideration of the data is beginning to make this classification more doubtful, and it may be that
they represent still a fourth previously unrecognized infection of the
-central nervous system, a sort of subacute or recurrent multiple
neuritis.
The existence of conditions likely to be confused with nonparalytic
pol~omyelitis has emphasi~ed the recommendation of. the Public
Health Service that, in reporting cases, distinction be made between
frank paralytic poliomyelitis and nonparalytic or questionable cases,
and that comparisons of incidence be based only on the frank cases.
This recommendation has received favorable attention from several
States and from the International Office of Public Health. In the
:absence of prompt investigation of each case, this recommended differentiation is somewhat difficult of control, especially when the reporting of nonparalytic or preparalytic cases is stimulated by the
possible use of serum therapeutically.
HEART DISEASE
Studies of heart disease have continued under the direction of Medical Director A. M. Stimson. These studies have been conducted at
the National Institute of Health in vVashington and at a branch
office located at the University of Pennsylvania in Philadelphia.
The studies in Washington have consisted of a combination of
-clinical observations carried out at various hospitals and clinics, and
laboratory experiments at the Institute. Both have dealt almost exdusively with rheumatic fever and the associated heart involvement.
Fifty-five cases of this disease, with control cases of scarlet fever,
sore throat, and 50 normal children were studied. Detailed records
were kept of clinical manifestations and specimens were taken periodically for testing. The principal object was to ascertain whether
ihe generally accepted association between streptococci and rheumatic
fever is specific, or whether during periods of activity of the disease
there may not be a general heightened reactivity to foreign antigens.
Since the season of activity is but recently ended, it i.s impossible to
report at the present time on the outcome of these studies, but it is intended to issue a report within the next few months. Several investigators of prominence are extremely skeptical concerning the etiological role of streptococci, and conclusive evidence for or against the
hypothesis has not yet been adduced. The question is of major significance to medicine and public health, and continued study is
imperative.
·
Rheumatic fever is the largest single cause of disability and death
from heart disease and must take rank with tub.erculosis, syphilis,
and cancer in importance, although this fact appears to be but little
recognized by the profession and by public health authorities, chiefly
because the disease is not reportable and vital statistics do not reflect
its rava~es. Animal experimentation has been continued at the laboratory m the effort to produce either rheumatic fever and heart
disease or analogous conditions which might throw light on the subject in animals. Little success has attended these efforts, but it is
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felt that all plausible hypot~eses should be e~hau~ted ?efore the attempts are discontinued. It 1s apparent to ep1dem10log1st_s that some
intrinsic factor apart from an infectious agent is responsible f~ff the
selectivity of the disease. Our endeavors have therefore beei:i m the
direction of inducing physiological changes calculated to mcrease
susceptibility. Several specimens of pericardia! fluids from rheumatic cases were inoculated into different species of animals after
supercentrifuging, in tests of the hypothesis advanced by some European scientists that the disease is due to a virus. The outcome was
entirely negative, but we do not consider these few results as conclusive.
The studies at the Philadelphia branch office have been chiefly epidemiological and statistical in nature. There are two main objectives: One to secure more accurate and extensive data than are now
available on the incidence and distribution of the etiological types
of heart disease throughout the United States; the other to assemble,
by intensive methods in one community, better epidemiological data
on rheumatic fever (and heart disease). Unfortunately, official vital
statistjcs do not furnish the information so essential t o visualizing the
magnitudes of various heart-disease problems and suggesting practical methods of control. Regarding the first objective, it can be stated
now that replies from 1,072 hospitals, involving approximately 3,600,000 admissions, reveal 16~290 cases of rheumatic heart disease 1 6,232
cases of rheumatic fever, and 2,491 cases of chorea. While, in general, cities in the northern part of the country show higher incidence,
the disease should not be regarded as infrequent in any part of the
country. While it is intended to continue these studies so as to in-,
elude a 5-year period, thus detecting possible annual fluctuations,
timely reports on important results of analysis of the data are anticipated. The survey of rheumatic fever in Philadelphia has also been
planned on a 5-year basis. Preliminary data reveal the following
figures for rheumatic fever, chorea, and subacute bacterial endocarditis combined: Annual admissions, 1,200, involving 1,000 individuals,
and deaths about 200. The economic, racial, and familial aspects of
rheumatic carditis are being studied. In addition to the two major
objects described above, two minor activities are being carried on.
One of these is a State-wide statistical study of mortality from rheumatic heart disease in Pennsylvania, conducted in cooperation with
the Bureau_ of V~ta~ ~tatistics and ·enlisting physicians through
cou~ty med1c~l societies ma program of reporting deaths from rheumatic heart disease. The response thus far has been most gratifying.
~he ?ther project ~s a study of the social aspec~s of coronary occlus10n m Philadelphia. The results thus far md1cate that the djsease
~s far more ~ommon in males. than i~ females, in white persons than
m N egr?es, m H ebrews than m Gentiles, and among the professional
and b~smess classes than among wage earners. The average age at
death 1s 60 years, but an appallmg number of deaths occur especially
'
among white ma!es, before the age of 50.
This office begms the new fiscal year with improved facilities. A
medical specialist of hiah r esearch attainments has been added to
the staff, ~nd_ a t echn~cian has been secured to perform the histologic~l work m its own _mdepen?ent_ laboratory. An additional statistical employee at Philadelphia will help to speed up the analy is of
·
the epidemiological data.
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LEPROSY
Studies at the Leprosy Investigation Station, Honolulu, and the
care and treatment of the patients in the adjaiining Territorial
Leprosy Receiving Hospital have been, with the exception of the
first. 6 weeks of the fiscal year, conducted under the direction of
Surg. L. F. Badger.
During recent years there has been accumulating epidemiological
evidence which suggests that there may exist some relation between
the state of nutrition and the susceptibility to leprosy. To determine whether or not it is possible to demonstrate experimentally
uch a relation, the studies during the past year have dealt almost
entirely with investigations relative to the relation of the state of
nutrition to the susceptibility to and the progres8 of leprosy in
laboratory animals.
R epeated experiments have definitely demonstrated that the incubation period can be shortened by depleting the rats of vitamin B1
before moculating them with the organisms of rat leprosy. Following subcutaneous inoculation of material containing the organisms
of rat leprosy, all of the rats on the vitamin B 1 deficient diet will
have developed palpable lesions from 2 to 4 weeks before all on the
control diet have developed lesions. Two months following the instillation of rat leprosy organisms into the nose, the organisms have
been found more frequently in the cervical lymph glands of rats
maintained on the vitamin B 1 deficient diet than in the rats kept on
the control diet. The examinations also suggest that the organisms
are present in the glands of the deficient rats in much greater numbers than in the control rats. Examination of rats 2 months after
intraperitoneal inoculation of the leprous material revealed that
more of the rats depleted of vitamin B1 had definite leprous lesions
than the control rats. Fifteen weeks after the intraperitoneal inoculation, the disease was found to be more advanced jn the vitamin B 1
deficient rats than in the control rats.
Another experiment which was in progress at the end of the year
confirms the previous finding that the incubation period can be
shortened by depleting rats of vitamin B 1 and also may prove to have
epidemiological significance. The organisms of rat leprosy were
p lanted on a culture media and kept at 37° C. for 4 weeks. At no
time during this period was there evidence of growth on the media.
At the end of 4 weeks the surface of the media was scraped, suspended in sterile saline, and inoculated into a number of rats on a
normal diet. After 4 weeks on the normal diet, one-half of the rats
were placed on a vitamin B 1 free diet. Eight weeks after the change
jn the diet, 45.0 percent of the rats on the deficient diet had palpable
lesions, while none of the rats on t!ie control diet had palpable
lesions.
Whether or not this shortening of the incubation period is due
to a specific vitamin B 1 deficiency is yet to be determmed. In two
experiments in which the incubation period was determined in rats
depleted of vitamin B 2 as well as vitamin B 1, the incubation period
was found to be shorter in the B 1 depleted rats.
Attempts to establish leprosy in animals other than the usual laboratory animals have been undertaken. In one species of animal
promising results have been obtained.
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It has been frequently stated that the disease known as rat leprosy
does not occur in the wild rats in the Hawaiian Islands. During
the past year this disease has been found in the islands and has been
established in white rats in the laboratory.
Diphtheroid organisms have been frequently isolated from human
cases of leprosy and are believed by some investigators to have a.
causal relation to the disease. Cultural studies of such diphtheroids
have been in progress during the year. Attempts have also been
undertaken to grow in culture media the organisms of human and
rat leprosy. This work is still in progress.
MALARIA
Malaria investigations were continued under the direction of
Senior Surg. L. L. Williams, Jr.
Activities of the past year were divided between research, advice
to State health departments and other agencies, and technical direction ( for the Division of Domestic Quarantine) of malaria-control
drainage activities of the Works Progress Administration. The
.accomplishments of the latter were submitted in a separate report to
the Division of Domestic Quarantine.
Advice to State health departments and other agencies consisted in
giving lectures to State boards of health personnel, aiding studies of
malaria within the States under the State health departments, and in
serving on the T ennessee Valley Authority advisory board for malaria control.
Research studies were carried out at all 6 field stations, namely,
Columbia, S. C., J acksonville, Fla., Memphis, T enn., Panama, Canal
Zone, Norfolk, Va., and Washington, D. C.
Columbia, S . 0 . -Cooperative work with the South Carolina State
Hospital was continued during the fiscal year. The principal study
was confined to attempts to perfect the culture of malaria sporozoites
for the dual purpose of supplying infective malaria material to psychiatric hospitals where it is employed in the treatment of general
paralysis, and for studies of the fate of the sporozoites after introduction into man. A technique has been developed which assures
viability of sporozoites outside the mosquito for a period of at least
26 days. This ·permits shipment by mail to any part of the United
States. The problem of sterilizing cultures has not yet been solved,
although the invading organisms are, at worst, only minor pathogens,
-and all cultures can be safely administered by intravenous injection.
Many corollary studies on the effectiveness of the various species of
malaria in infecting paretics have been carried out and strains of
estivo-autumnal, benign tertian, and quartan malaria maintained.
Researches on the effect of various treatments for malaria on the
development of gametocytes, and the path followed by the sporozoite
in man after it leaves the salivary gland of the mosquito have been
initiated. Until this path is known, no direct experiments are possible to test readily a true prophylactic agent.
Memphis, T enn.-The recent increase in antimosquito drainage
·a nd consequently the resultant necessity for adequate ditch maintenance has made it necessary to reduce the cost of ditch maintenance.
Tests of various materials and methods of lining ditches have been
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carried out. Although final results cannot as yet be reported, indications of possible success are already noted with such soil-stabilizing
materials as emulsified asphalt and with covering material such as
thin coats of concrete. Biological studies have been continued at
Reelfoot Lake, principally on the effect of various lights as aids in
trapping mosquitoes. In the course of these studies there were found
quantities of A. walken, the presence of which had not been previously noted. Studies of dry dust vegetable larvicides, studies of preseason broods of anophelines in floodwaters, and the use of ultraviolet
light in mosquito traps have also been continued.
Panama Canal Zone.-The malaria research work in cooperation
with the Gorgas Memorial L aboratory was continued at the Panama
station. The officer in charge of this work has had his detail prolonged for the purpose of completing his mosquito studies, analyzing
the data, and compiling an annotated list of the anophelines of the
entire Caribbean area. In addition, he has cooperated with the Y ellow Fever Commission of the Rockefeller Foundation, accompanying
the expedition into South America and studying the mosquitoes o:f
endemic jungle yellow-fever areas. Descriptions of over 70 indige~
nous mosquitoes have been published.
Jacksonville, Fla.-At this station research on the distribution of
malaria in the State was continued and a malaria-control unit within
the health department was inaugurated. In addition, cooperation
was given the Division of Foreign Quarantine in studies on preventing the introduction of mosquitoes from southern countries by airplane and with the Tennessee Valley Authority on special studies of
shading in relation to anopheline production from impounded waters.
S(J,(l)annah, Ga.-A new field malaria-research laboratory was organized during the year at Savannah. The purpose of this laboratory
is to study the bionomics of Anopheles, with the end in view of disrupting or influencing the environment of the Anopheles by natural
and self-perpetuating means. The artificial methods exploited to
date, while effective in urban centers, are beyond the cost of rural
communities affected with malaria. It is hoped that this study will
bring to light natural, self-perpetuating, and inexpensive means of
malaria control applicable to rural communities.
Norfolk, Va.-Cooperative work with the Virginia State Health
Department in malaria-control activities was continued. In addition,
experiments with ovicides, using the eggs of readily available A ed'es
sollicitans, were carried on. A study of mosquito prevalence and
fauna in southeastern Virginia, comparing areas in which mosquitocontrol measures were prosecuted with like areas where no efforts at
control were made, was continued.
H eadquarters and thick-film laboratory, Washington, D. 0.-In the
thick-film laboratory there were examined during the year approximately 25,000 blood specimens taken in the field by local, State, and
Public Health Service field workers. Of this number of slides, a_pproximately 1,950, or 8 percent, were positive for malaria plasmodia.
Laboratory cooperation was extended to State and Tennessee Valley
Authority laboratories in checking examinations made in these laboratories and instructing their personnel in thick-film technique.
During the year a mimeographed article on thick-film technique was
revised. Much time was given to the technical supervision of Works
101889-36-3
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Progress Administration malaria-control drainage projects. Some
time was also given to the investigation of sporadic malaria epidemics
and to the preparation of exhibits.
NUTRITION
The Office of Nutrition Investigations continued under the direction
of Passed Asst. Surg. W. H. Sebrell.
The experiment to determine the effect of long administration of
traces of sodium fluoride in the drinking water on the teeth of dogs
was completed. The changes in the dogs' teeth closely resembled
human mottled enamel. No gross changes in other bony structures
were seen. Additional rat tests were made on several different waters
in order to determine the value of special filtration processes in removing fluorine. These experiments are in progress at the close of
the fiscal year.
Experiments on the effect of several different deficient diets on the
incubation period of rat leprosy, in collaboration with Surg. L. F.
Badger, were continued. Attempts to transmit human leprosy to
rats on deficient diets were continued.
Tests on canned mackerel, lima beans, and several liver extracts
were completed during the fiscal year. The results indicate that
canned mackerel is a good source of the pellagra-preventive vitamin
and that certain liver extracts may be of considerable value in the
treatment of pellagra.
At the close of the fiscal year experiments are in progress to determine what relation, if any, exists between lactoflavin and pellagra; on
the effect of lactoflavin on nutritional cataracts; and on the effect of
lactoflavin on the symptoms of so-called rat pellagra.
There is in progress an experiment on the effect of small amounts
of cystine amine fed to rats on a cystine-deficient diet.
The preparation of numerous fractions from yeast, which has been
in progress for the past few years, was continued in an effort to secure
a material of high pellagra-preventive potency. Although many
fractions were prepared, none suitable for large-scale use in human
pellagra has been secured.
A test of the pellagra-preventive value of an extract rich in the
chick-pellagra factor is in progress.
Studies were started on the ascorbic acid ( vitamin C) content of
plants grown in various nutrient solutions and on the distribution of
as·corbic acid in the various portions of the plant as affected by such
factors as age, sunlight, temperature, and moisture. These studies
are now being actively pursued.
ROCKY MOUNTAIN SPOTTED FEVER
The manufacture of Rocky Mountain spotted fever vaccine and
the study of Rocky Mountain spotted fever and other tick-transmitted diseases of man and animals and of certain insect-borne diseases have been carried on at the Rocky Mountain Laboratory at
Hamilton, Mont., under the supervision of Director R.R. Parker.
Construction of a new building for rearing experimental animals
and of quarters was begun in April 1936.
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The largest quantity of spotted fever vaccine produced in 1 year
was prepared during the fiscal year. The gross amount manufactured
was 506.8 liters, of which 360.8 liters were for use during the current season. Of the latter amount, 274.2 liters, enough for the immunization of about 60,000 persons, was of sufficient protective value
to be used for human administration.
Funds for vaccine production for the Civilian Conservation Corps
were again provided. Enough vaccine was supplied for the personnel in 48 camps located in the more dangerous endemic areas.
The vaccine was also furnished to the Resettlement Administration
and to other Federal agencies for administration to field employees.
Thr greater part of the 1936 supply was distributed to physicians
in 23 States, principally in the northern Rocky Mountain States.
The situation as regards bulk production of vaccine has much improved for two reasons: First, improved tick-rearing technique, and,
second, the finding that vaccine stored under proper conditions retains its potency over a considerable period. It is now possible to
rear from 1,000,000 to 1,500,000 infected adult ticks a year-more,,
in fact, than can be made into vaccine under present conditions.
Epidemiology.-In the West an unusual number of late season cases
were reported during the summer and in September of 1935. Thi
was probably due to a prolonged period of tick prevalence, resulting
from meteorological conditions which permitted a part of what
would normally have been the 1936 crop of ticks to appear as active
adults in the late summer and early fall of 1935. There has been a
marked decrease in incidence in many of the Western States during
the 1936 season and the total number of cases for the year will probably be well below the 1935 figures.
Two cases of coincident Rocky Mountain spotted fever and tularaemia infection, confirmed by laboratory tests, one tick apparently
transmitting both disease agents in each instance, have been reported
from Wyoming, both cases terminating fatally.
TULARAEMIA
In comparison with the past 2 years, tick-borne tularaemia of man
and animals has been much less prevalent in the Rocky Mountain
region during 1936.
SYLVATIC PLAGUE
In July 1935, B aaillus pestis was demonstrated in Richardson
ground squirrels on Blacktail Creek, about 10 miles south of Dillon,
Beaverhead County, Mont. Data collected in the field indicated that
sylvatic plague had probably entered Montana from Idaho in 1933
or 1934, crossing the Continental Divide near Monida and possibly
near Horse Prairie. It was further ascertained that epizootics in
ground squirrels had occurred in many parts of the southern portions of Beaverhead and Madison Counties during 1934 and 1935,
and it appeared likely that the infection had spread eastward up
the Centennial Valley, from near Monida, and thence northward up
the Blacktail, Ruby, and Madison Valleys. At Dillon, ground squirrels were dying on the outskirts of the city, and dead rodents were
being brought mto the residential sections by dogs and cats. During
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the season of 1936 virulent strains of B. pestis have been isolated
from ground squirrels in Madison County and again in Beaverhead
County.
Observations made in cooperation with the Biological Survey and
records obtained by the laboratory staff have shown that PuZez
irritans, a lmown vector of plague, is prevalent on coyotes ( Canis
latrams) throughout the Rocky Mountain region, occurs frequently
on dogs, may infest prairie dogs ( Oy(rwvmys ludovician'IJ)S) almost to
~he exclusion of other ·species, and occurs on deer ( OdJocoileus sp.)
m western Oregon. These data suggest that observations are desirable as to the importance of this flea as an agent in the geographic
spread of sylvatic plague.
Ecological studies relating to sylvatic plague in southwestern Montana are being made from a temporary field laboratory near Dillon.
EXPERIMENTAL TICK STUDIES
A filter-passing virus was isolated in the summer of 1935 from
D. andersoni collected near Nine Mile, Mont., and during early 1936
was again demonstrated in several lots o:f ticks of the species D. oeddentalis from southwestern Oregon. The evidence suggests that this
virus is the causative agent of disease in wild animals. Whether or
not man is susceptible has not yet been demonstrated. Columbian
ground squirrels and chipmunks have been shown susceptible; also
white rats, guinea pigs, and Macacus rhesus monkeys. As thus far
observed, the infection is nonfatal except in guinea pigs. There is
no apparent relationship between this virus and any known tick-borne
disease.
A Gram-negative, bipolar bacillus has been isolated from specimens of D. ooddentalis collected near San Juan, Sarr Benito County,
and in Grimes Canyon, near Fillmore, Ventura County, Calif., and
also from H. leporis-pai,wstris received from near Salmo, British
Columbia. This organism is presumably transmitted to animals serving as natural tick hosts. Guinea pigs may be infected by spleen
vaccination, and in them it produces a typical fatal infection characterized by a greatly enlarged spleen, perisplenitis, and adhesions to
the abdominal wall.
A new species of tick, Ornithodoros parkeri, has been described.
0. her11'11Si, the transmitting agent of relapsing, fever in California,
has been found to occur in the vicinity of Moscow, Idaho.
Larval ticks of the species 0. talaje, the hosts of which have not
heretofore been known, have been collected in Arizona from kangaroo
rats and their burrows.
Studies of the life history, habits, and host relationships of D. ocddentalis have been continued in California and Oregon.
·
Reciprocal cross-immunity has been demonstrated between bouton·
neuse fever and Sao Paulo exanthematic typhus.
A new division of station work has been organized for research on
biological equipment. Its function is to devise and make technical
equipment necessary for the highly specialized work being conducted
at this laboratory, which cannot be secured from commercial sources.
In view of the recent evidence indicative of a widespread occurrence of sylvatic plague in the Pacific Coast and other Western States,
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much time has been devoted to the classification of the extensive
station collection of fleas which has been built up incident to the
field studies made during the past 10 years. A knowledge of the
species of fleas present and of their geographic and host distribution
is essential in the study of this disease in nature.
CHILD HYGIENE
The activities of this office continued until Jun~ 8, 1936, under the
direction of Surg. Estella Ford Warner. On that date Passed Asst.
Surg. Carroll E. Palmer assumed direction of the office.
Studies of physical growth and development.-During the year
four reports were completed. The purpose of one study, based on
records of the financial status of approximately 6,000 families and on
5-year records of height and weight of children in these families, was
to investigate the influence of economic changes during the depression on the growth of children. Results of the analysis were largely
negative except for the finding that young children ( 6 to 10 years
of age) from families that had become relatively poor during the depression failed to grow in weight quite as rapidly as children from
families whose incomes had not changed markedly during the depression. These results supplement and substantiate the results of
other studies from this office which indicate that, so far as physical
~:ize and growth are concerned, the depression probably has not affected seriously a considerable number of American children.
(Height and Weight of Children of the Depression Poor. Health
and Depression Studies No. 2, Pub. Health Repts., vol. 50, pp. 335347, 1935.)
Data for three papers were derived from a survey made during the
years 1923-24 of approximately 30,000 native-born white children in
various urban communities throughout the Unit~d States. These
reports show ( a:) that children with physical defects (principally
carious teeth, defective tonsils and adenoids, goiter, enlarged cervical
and submaxillary glands, and defective vision) are, on the average,
slightly shorter, lighter in weight, less stocky, and have smaller vital
capacity than children for whom no defects were recorded; (b) no
consistent differences in rates of growth of the defective and nondefective groups; ( c) no geographic differences in the relationship
of the presence or absence of defects and physical size and growth;
( dJ) evidence that physical defects are associated with clinical impressions of nutritional impairment. (Relation of Physical Defects
to the Physical Growth of Children of 21 States. Physical Measurement Study No. 3. Pub. Health Repts., vol. 51, pp. 831-841, 1936.
Relation of Physical Defects to the Physical Growth of Children in
Different Geographic Regions of the United States. Physical Measurement Study No. 4. Am. J. Hyg., vol. 23, pp. 205-215, 1936. Relation of Physical Defects to Nutritional Impairment, Based on the
Examination of 30,000 Children of 21 States. Physical Measurement
Study No. 5. In press. Am. J. Med. Sci.)
Studies of fatal accidents in childhood.-Four reports direct the
attention of public-health officials to recent Census Bureau statistics
on accidental deaths of children under 15 years of age. Automobile
accidents, burns, drowning, falls, poisonings, and mechanical suffoca-
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tion are the most frequent causes of accidental fatalities. In 1930,
in the death registration area., over 22;000 children were reported as
dying from accidental causes. Less than half this number of
deaths was reported from the combined causes of measles, scarlet
fever, a.nd diphtheria. Considering all fatal accidents, mechanical
suffocation leads at under 1 year, burns at 1 and 2 years, burns and
automobile accidents at 3, and automobile accidents at 4 to 15 years.
~nalyses of time changes (1925-32) in relative mortality from automobile accidents, burns, and mechanical suffocation of infants under
1 year, point to significant trends and variations in different geographic localities. (Mortality from Automobile Accidents Among
Children in Different Geographic Regions of the United States, 1930.
Studies on the Fatal Accidents of Childhood No. 1. Time Changes
in the Relative Mortality from Automobile Accidents Among Children in Different Geographic Regions of the United States, 192532. Studies on the Fatal Accidents of Childhood No. 2. Time
Changes in the Relative Mortality from Accidental Burns Among
Children in Different Geographic Regions of the United States,
1925-32. Studies on the Fatal Accidents of Childhood No. 3. Time
Changes in the Mortality from Accidental Mechanical Suffocation
Among Infants under One Year Old in Different Geographic Regions of the United States, 1925-32. Studies on the Fatal Accidents
oi Childhood No. 4.) (In press. Pub. Health Repts.)
Survey of midwife practice.-A limited but intensive study of the
rural midwife in Brunswick County. Va., was begun in 1934 and
brought to a close during the present fiscal year. From the observations made it is evident that the practice of midwifery in this
community, which is represenative of a rather large group of similar
communities, must continue though a large number of midwives
now practicing are physically and mentally unfit to do so. A definite plan for training young women in the neighborhood of each
of the older women is urgently needed to meet the social need of
midwifery. Suggestions regarding the selection and training of a
new type of midwife are made. In addition to the formal report of
the study (The Rural Midwife: Her Social and Economic Background and Her Practices as Observed in Brunswick County, Va.
Pub. Health Rept., vol. 50, pp. 1807-1915, 1935), a mimeographed
report was prepared for distribution.
Hearing studies.-Analysis of records obtained during an extensive investigation of auditory impairment of Washington (D. C.)
school children was continued and the first report of the study was
completed. The results reported indicate clearly the inadequacy
of the present method of testing the hearing of school children by
means of the 4-A audiometer. (Audiometric Studies of School
Children. I. The Consistency and Significance of Tests Made with
a 4-A Audiometer.)
DENTAL STUDIES
The dental studies reported were directed by Passed Asst. Dental
Surg. H. Trendley Dea.n.
The study of 11 cities begun during the preceding yea.r for the
purpose of determining whether or not there was a quantitative
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relation between the fluoride concentration of the common water
supply and the clinical effect, was completed during September 1935.
The results of this study were published in the American Journal of
Public Health for June 1936; certain detailed phases of the study
were reported in the Public Health R eports for December 6, 1935.
Based upon the :findings of this study, a study was begun in December 1935 to determine definitely the minimal threshold of toxicity
of public health significance. Reliable information on this basic
part of the problem is essential if the further development of this
disease is to be prevented by removing the toxic amounts of fluorides
present in the water by chemical means.
Monthly water samples are being received from four cities where
the fluoride content of the common water supply is between one and
two parts per million. As these four cities have the requisites for
quantitative evaluation, at the end of the year the mean annual
fluoride content of the water supply will be correlated with the
actual mottled enamel index of the community. Two of these cities
were surveyed during the year. The chemical part of this study, as
in the past, is being carried on by the Division of Chemistry,
National Institute of Health.
During the year 3,136 children were examined in connection with
mottled enamel surveys in South Carolina, Indiana, Ohio, Texas,
New Mexico, Louisiana, and Kansas. At present there are about
335 reported or surveyed endemic areas in the United States distributed among 25 different States. Eighty-nine percent of these
endemic areas are located west of the Mississippi River and 28 percent are in Texas. New areas of endemicity have been confirmed
by surveys during the year in the States of Indiana, Ohio, and
Louisiana, States hitherto considered free.
DERMATOSES INVESTIGATIONS
During the year the Office of Dermatoses Investigations was continued under the direction of Senior Surg. Louis Schwartz.
There has been a marked increase of the work of this Office over
the previous year, and there has been considerable demand from industries, labor organizations, physicians, lawyers, and the public in
general for investigations, information, and advice regarding industrial and contact dermatoses. During the year, studies in 14 factories were made of skin hazards in the manufacturing processes
involved. These factories employ a total of approximately 7,000
workers, and of this number about one-third were actually examined
for the occurrences of skin hazards. Special studies of outbreaks of
dermatitis were made in 5 plants upon the request of the managers.
In one of these plants a study was begun of the skin hazards involved
in the manufacture and distribution of two new products-one, an
artificial silk and the other a rubber compound.
Dermatitis incidental to the manufacture of phenol formaldehyde
resins, skin irritations following exposure to soda ash, and an outbreak of dermatitis found to be caused by an excess amount of
accelerator used in the rubber insulation of cables were among the
problems met in the course of work in these industrial plants. Recommendations for the prevention of further occurrences were made.
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In a published report attention was called for the first time in the
United States to a skin and health hazard from contact with chlorinated naphthalenes and chlorinated diphenyls.
INDUSTRIAL HYGIENE AND SANITATION
The work o:f the Office o:f Industrial Hygiene anc.l Sanitation was
continued under the direction o:f Senior Surg. R. R. Sayers.
DUST STUDIES
Health of anthracite coal miners.-A final report o:f the study o:f the
effect o:f dust exposure on the health o:f miners in the anthracite coal
fields o:f Pennsylvania was published as Bulletin No. 221, Anthracosilicosis Among Hard Coal Miners.
Asbestos textile study.-An investigation was made o:f the dust
hazard incident to the asbestos textile industry in North Carolina, in
which 517 persons were examined.
This study was conducted in essentially the same manner as that
of previous dust studies o:f this nature, and included medical examination, X-ray o:f the chest, and laboratory examinations, particularly
of the urine for silica and of the sputum for tubercle bacilli and
asbestos bodies. Of the 517 persons examined, 46 (8.9 percent) were
diagnosed as having asbestosis. This incidence may be modified,
owing to the fact that a great proportion of the persons examined
had been working in the asbestos industry a comparatively short
time.
STUDIES OF SICKNESS AMONG INDUSTRIAL WORKERS
Incidence of illness among industrial workers.-Reports from 33
industrial sick-benefit associations providing sickness insurance for
about 158,000 male industrial workers were analyzed, and the reports
presented quarterly in the Public Health Reports.
Occupational morbidity (1Jnd mortality study.-The field work for
a study of the effects of particular trades and occupations on the
health o:f workmen was completed early in June 1936, and the work
of tabulating and analyzing the data has been started. This work
is being carried on from funds allotted by the Works Progress Administration. The study includes a survey of occupational environment in most of the plants from which sickness data were obtained
:for the purpose o:f affording morbidity and mortality rates for groups
exposed to specific poisons and other potential health hazards in industry. A study along similar lines covering approximately 100,000
automobile workers is also being carried on.
WORK IN INDUSTRIAL HYGIENE IN THE STATES
Develop~nt of industrial hygiene in State health deparflments.For many years the State and Provincial Health Authorities of
North .America have sustained interest in industrial hygiene through
the committee on industrial hygiene of this association. The passage
of the Social Security Act at once made available the necessary funds
for the extension of this phase of public health work in the various
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States. Accordingly, the Public Health Service, in coopera~ion with
the Industrial Hygiene Committee of the State and Provincial hea_lth
authorities, inaugurated a program designed for the purpose of assisting States in establishing active industrial hygiene units in the health
departments of various industrial States. With the inauguration of
jndustrial hygiene activities in State health departments some
24,000,000 gainful workers will be. given service in this field by health
agencies.
Training of personnel.-One of the serious problems which confronted the Public Health Service in connection with the establishment of industrial hygiene units in State departments of health was
the shortage of trained personnel. The Public Health Service conducted a seminar for physicians and engineers from State health
departments. Thirty-four medical and engineering officers from the
industrial hygiene bureaus of 16 States attended.
SPECIFIC INDUSTRIAL POISONS
Mereury study.-The analysis of the data collected during the
study of 529 employees of the fur-cutting industry is almost completed, and results will be submitted for publication at an early date.
Forty-three cases of chronic mercurial poisoning were found. The
most definite cardinal symptom found among the 43 cases was a fine
intentional tremor. Other symptoms in the order of their frequency
were psychic disturbances, abnormal knee jerk, dermatographia, excessive perspiration or abnormal blushing, digestive disturbances, and
gingivitis.
STUDIES IN ILLUMINATION AND ATMOSPHERIC POLLUTION
Atrnospheric polluiion of American cities for the year 1931-33.The report of this study has been completed and published. The
report gives a general picture of air conditions as they existed
throughout the whole country at the time of the survey, and forms a
basis for further work on the reduction of air pollution and smoke
abatement.
SPECTROGRAPHIC WORK
The following samples were analyzed: 520 quantitative analyses
run on urine samples for mercury; 2 samples of blood (dog) and 2
samples feces ( dog) analyzed for lead; 1 sample of blood examined
for met- and sulph-hemaglobin, by the absorption spectrum method;
15 samples of blood examined for carbon monoxide by the absorption
spectrum method; 1 sample of urine analyzed for lead.
The problem of a good technique for the quantitative spectrographic determination of lead in urine is now being carried out. A
method was devised of treating urine for subsequent spectrographic
determination of mercury. The urine is treated in the cold with
chlorine gas and the treatment is repeated until a homogeneous liquid
is obtained. When large amounts of iron are present a. zinc or copper salt is added to the sample and mixed sulphides are precipitated
in acid solution with hydrogen sulphide. This precipitate containing
the mercury is redissolved in chlorine water and this sample is
analyzed spectrographically.
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GElNE!R,A L CHEMIOAL WORK
Analyses.-The fullowing inorganic materials used for animal experiments were analyzed: Titanium oxide, manganese silicate, calcium silicate, calcium carbonate, lead silicate, copper silicate, barium
silicate, and potassium silicate. One sample of dried lung tissue was
analyzed for silica and ash; a new absorbent for hydrogen cyanide
gas was identified as aldehyde ammonia; six cleaning fluids were
analyzed for carbon tetrachloride by fractionation and determination
of the chlorine content of the various fractions. Material sent in for
analysis was identified as vermiculite, and five samples o:f phosphates
and rock slag analyzed.
M ucellameows activritws.-During the March ( 1936) floods two
members of this Office were detailed for duty in connection with
rehabilitation and general sanitation measures for the flooded areas.
Two of the engineers assigned to the Wilkes-Barre area were requested to conduct a sanitary survey o:f the most congested flood
areas in that district. The study covered more than 5,000 :families,
with a population of about 24,000 persons.
MILK INVESTIGATIONS
The activities of the Office of Milk Investigations were carried on
under the direction o:f Sanitary Engineer Leslie C. Frank.
Studies of thermal, resistance of test organis-m.-Studies were continued during the year on the thermal resistance of the E. coli test
organism (strain 11-B) using full-scale pasteurization equipment.
This work has as its objective the development of a nonpathogenic
criterion organism for use in testing the efficiency of pasteurization
machinery and the testing of devices and processes for the bactericidal
treatment of dairy and milk-plant containers and equipment.
Previous research work at 145° F. and 160° F. on the effect of variations in the pH of the buffered distilled water used as the medium
for the tests have indicated that the thermal resistance of the organism is practically constant throughout the pH range 6.9-7.5. On
either side of this pH range there is a decrease in the thermal resistance of the organism. The midpoint of this range, pH 7.2, was
therefore chosen as the pH value at which future work would be done.
Variation in time required for 99.99-percent reduction of test organum.-Although the experimental conditions in the thermal resistance runs were kept constant, the time required for a 99.99-percent
reduction of the test organism varied considerably for the individual
tests made at each of the temperatures studied. Accordingly, efforts
were directed foward determining which of the various factors might
be responsible for the irregular results obtained. Investigation of the
various items in the test I?rocedure indicated that none o:f the procedure :following the addit10n of the inoculum to the pasteurizer was
responsible for the irregularities. These results therefore eliminated
from consideration such factors as mixing of the culture in the pasteurizer, taking of samples, technique of plating, and counting and
incubation of plates. The distilled water used in the pasteurizer and
the culture o:f the test organism were subjected to investigation, but
no evidence was obtained which would indicate conclusively that
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either one of these items alone was the responsible factor. It is
possible that there are natural variatiions in the thermal resistance
of individual cells together with variations in the proportions of these
cells in the culture. If this is true, there will naturally be variations
in the time required for 99.99-percent reduction, even though all other
factors in the experiments are kept constant.
Single-cell isolations from test organism.-On the assumption that
our test organism had possibly become contaminated with other
organisms that did not show up in staining the culture or in colony
formation on the plates, or possibly that the culture might contain
more than one strain of E. coli~ and that our fluctuating results could
be thus explained, it was considered advisable to isolate single cells
from some of the stock cultures of the test organism. The single cell
isolations were made by Barber's method. Five of the single cells
isolated grew and were confirmed as being E. coli.
Thermal re8istance of citltures from single cells.-Cultures from
one of the single cell isolations (3U) were used for a group of
thermal resistance' runs at temperatures of 140°, 145°,. 150°, 155°,
and 160° F.
At the conclusion of this group of runs a new group of thermal
resistance runs were made to see if duplication of results was
possible.
The variations in the time required for 99.99-percent reduction of
the test organism in the individual runs were somewhat less than
occurred in the runs made prior to the use of cultures from singlecell isolations, but still seem rather large. Even when considermg
the mean times for 99.99-percent reduct10n, which are the means of
six runs, it is evident that the two groups of results in general do not
show very close agreement.
Time required for 99.99-percent reduction of test organism in whole
rnillc.-A group of thermal resistance runs was made at 5° F. intervals from 140° to 160° F., jnclusive, in which the test pro.c edure was
the same in all respects as the preceding two groups of runs, except
that whole milk was the medium used in the pasteurizers instead of
buffered distilled water. The raw milk used was heated to at least
180° F. and held at that temperature for 30 minutes before the
inoculum of the test organism was added. The pH of the milk
during the tests was 6.7 to 6.8, and no buffers were added.
Studies of the bactericidal treatment of milk cans by heat.-These
studies were started because of the increasing use of dry-heat and
moist heat sterilizing cabinets in the dairy industry and the consequent need for an effective and practical temperature and holding
time combination for use in operating these cabinets.
Previous work had shown that a temperature slightly above 160° F.
for 10 minutes would produce a 99.99-percent reduction of the test
organism under what were considered to be practically dry-heat conditions. Later experiments on the moisture content of the cabinet
indicated that the small amount of moisture remaining in the cans
from the inoculum of the test organism about doubled the original
moisture content of the cabinet.
A series of runs was made at 150° F. under the same conditions as
prevailed in previous tests except that provision was made for increasing the moisture content of the air in the cabinet. The moisture
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content of the air in the cabinet for these runs averaged 20.5 grams
per cubic foot during the holding period, which was about twice the
moisture content during the holding period under what were considered dry-heat conditions. The mean reduction in the count of the
test organism for this series of runs was 99.969 percent, as compared
with 99.935 percent for this same temperature when no provision
was made for increasing the moisture content of the air in the
cabinet.
Survey of milk-borne disease outbreaks for the year 1935.-During
the fiscal year a questionnaire was sent to all State and local health
departments in order to compile information as to milk-borne disease
outbreaks which occurred during the year 1935. The following
number of outbreaks were reported for the diseases listed: Typhoid
fever, 16; para-typhoid fever, 2; scarlet fever, 2; septic sore throat, 9;
miscellaneous, 14.
Advisory assistance to State and local health departments.-During
the fiscal year municipalities in the following States were visited at
the request of the State health departments concerned and given
advisory assistance with reference to milk sanitation: District of
Columbia, Illinois, Indjana, Minnesota, Missouri, North Carolina,
North Dakota, Oklahoma, and Wyoming.
STUDIES OF PUBLIC HEALTH METHODS
Studies of public health methods were continued under the direction of Surg. J. W. Mountin.
Three main lines of investigation were pursued in the year just
completed: (1) Studies of administrative problems in public health
organizations, (2) determination of the influence of health education
measures on the knowledge and practices of people, and (3) inquiries
into certain features of illness and medical service.
Public health officials in general view their responsibilities in terms
of diseases which are transmissible. Some attempt, as a rule, is also
made to elevate the level of individual health by educational measures, but there is no direct attack on general illness. The social and
economic consequences arising from chronic disabling illness are
much greater than those arising from the more acute conditions.
A.s yet, however, no local health program makes provisions for these
disorders.
.
An analysis was made of the experience of the health department,
from the standpoints of survival and growth, in 811 counties. These
counties represent the entire number of counties having health department service at any time during the period 1908-34. The study
was based on the records of personnel and budget of each county for
every year that organized health service was maintained. Of the
811 counties which established health department service, 541 were
maintaining the service at the close of the study period (1934) and
270 had terminated it prior to that time.
_During_ the fiscal year ~nder con~ideration an initi~l step was taken
with a view to developrng techmques for measuring the effect of
educatio?-al measures commonly pursued by health departments.
The subJects for study were groups of midwives in several Viro-inia
0
and North Carolina counties where different methods had been
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established by State and local health authorities for controlling midwife practice. These systems varied from practically no control to
a certification after the midwife had successfully pursued a course
of instruction. Essentially the same technique for educational measurement developed in the general scholastic field was adapted to the
education of midwives. At the close of the fiscal year the work had
progressed to the point of perfecting the method of study. The
feasibility of the procedure, however, has been demonstrated. The
studies are to be continued during the coming fiscal year. After a
sufficient number of midwives representing various backgrounds of
training, experience, and systems of supervision have been studied, it
should be possible to draw conclusions regarding the best methods
for training and supervision.
Data regarding disability rates gathered in Puerto Rico in 1935
were analyzed. Using bed illness as a criterion of disability, it was
found that in Puerto Rico the total bed-illness rate was 418 per 1,000
population, while in 5 representative rural counties of the continental United States the corresponding rate was 322. The median
duration of bed illness in Puerto Rico was found to be 10.1 days,.
while the median duration in the particular surveyed section of the
United States was 6.7 days. Four percent of the bed illnesses revealed by the survey in Puerto Rico, as compared with 2 percent
,:,f those in the five counties of the continental United States, resulted
in death. Malaria, hookworm, nutritional disorders, diarrheal conditions, and tuberculosis continue to be outstanding public health
problems on the island.
According to the family canvass in Puerto Rico, 47 percent of
illness (exclusive of birth conditions) had no attendant, 39 percent
were seen by a municipal physician, 11 percent by a private physician,
and the remainder had some other attendant. A licensed mid wife,
rather than a physician, is the attendant usually present at delivery.
Comparatively little prenatal care is received by the mothers in
Puerto Rico.
_A major project of this Office involves the portrayal of health facilities in 107 counties which contain the areas covered by the National
Health Inventory. Under the term "facilities" are included physicians, dentists, hospitals, dispensaries, health departments voluntary
heal~h agencies, and ot]:ier organizations which contribute 'in any ,a ppreciable way toward the promotion or conservation of human health.
These data covering the plan of ,a dministration, finances, and services
of each agency will be related to findings regarding illness and care
to be disclosed by the canvas of approximately 750 000 selected
families living in the same ,areas.
_
'
STATISTICAL INVESTIGATIONS
The Office of Statistical Investigations continued under the direction of Principal Statistician Selwyn D. Collins.
HEALTH INVENTORY
This project, a study of health and health facilities on a national
scaJe made possible by an a~lot~ent of $3,450,000 from emergency
relief funds, was under the d1rect10n of Principal Statistician G. St.
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J. Perrott. Mr. C~ark Tibbitts was in immediate charge of the field
activities. During the latter half of February 1936, when employment was at its peak, a field staff of over 5,000 persons was engaged
in collecting data. The central office, situated in Detroit, Mich., beg,a n the work of coding and tabulation in January 1936, and a staff
of more than 1,000 persons, 90 percent from relief rolls, will have
employment there for the remainder of the year. The four phases of
the study are (1) chronic disease survey, (2) communicable disease
survey, (3) occupational morbidity and mortality study (a project of
the Office of Industrial Hygiene), ,a nd ( 4) health facilities study ( a
project of the Office of Public Health Methods).
0 kronio-disease survey.-This .study is a survey of disabling illness,
physical impairments, and medical care among 865,000 families in 90
cities and 23 rural counties throughout the United States. The survey is the first ,a ttempt to obtain, on a national scale, information on
the chronic diseases which are a major cause of unemployment, dis:ability, and death among persons of mature age, and are becoming
:recognized as a public health problem.
The major objectives of the survey are to determine (1) the incidence of serious disabling illness for a 12-month period in a sample
population of about 3,500,000 persons, the duration of disability,
and the medical and nursing service associated therewith; (2) the
prevalence of chronic diseases, orthopedic defects, and of blindness
and deafness among such persons and a measurement of the severity
of these conditions; (3) the relation between disease and certain
environmental factors such as income, education, and housing conditions; and (4) the extent of medical and public health facilities
and the, deg!I'ee of utilization of such f!aciliti'es by the geneiral
public.
Among the problems of immediate national interest on which the
survey will provide information are (1) illness as a cause of unemployment; the vocationally handicapped, (2) illness and medical
care among certain groups of the population-the aged, youths,
persons on relief, (3) crippled children, ( 4) the nature and extent
of invalidity and the proportion of cases institutionalized, ( 5) facilities available for medical care and the use made of these facilities,
(6) accidents as a cause of disability, (7) illness and occupation,
and (8) illness and housing.
Oommwnioable disease suirv·e y.-The communicable disease survey
is a study of the incidence and fatality of 13 diseases, chiefly among
persons less than 25 years of age. These diseases are measles, German measles, whooping cough, chickenpox, mumps, diphtheria,
scarlet fever, smallpox, typhoid fever, infantile paralysis, meningitis, encephalitis, and acute rheumatic fever. Hitherto the only large
mass of information in this field has been in terms merely of the
gross numbers of cases and deaths from each disease. Since this
survey covered about 250,000 families, it will provide for the first
time adequate data to present both cases and deaths in their economic
and social setting, and to state incidence in terms of the population
at risk as well as in terms of the total population. That is, the
incidence of these diseases at various ages in the population with no
history of a previous attack will be studied in relation to familial
exposure to a case, to school attendance, and to various social and
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economic indexes, such as income, occupational class, rental or value
of home, number of persons per room, and the education of the
housewife.
Data have been collected relative to the duration of the protection
accorded by smallpox vaccinations, and diphtheria, scarlet fever,
and typhoid fever immunizations.
A special study of acute rheumatic fever will deal with such questions as the relation between this disease and prior attacks of other
communicable diseases, and the familial spread of the disease.
Officjal reports of the number of cases of communicable disease
are known to be a vast understatement. The extent to which cases
of the above 13 diseases actually are reported to city health departments and the types of cases that are most frequently missed will
be determined by the communicable disease survey.
Occupational morbidity and morrtality survey.-This survey is a
study of the amount of lost time due to illness among industrial
workers and the relation of illness to occupation, and the hazards of
the occupational environment. Transcription of the records of
industrial sick benefit associations in some 400 corporations produced
a total of 550,000 schedules suitable for analysis. The data represent the largest amount of statistical material on disabling sickness
among industrial workers that has ever been collected in the history
()f the country, and also afford an extensive survey on occupational
shifting during the depression.
The field work consisted principally of transcription of personnel
and sickness records 0£ corporations providing some form of sickness benefits (usually cash benefits) to employees disabled by sickness or nonindustrial accidents. From personnel records the occupation and changes in occupation were obtained for each employee
during the study period, 1930 to 1934, inclusive. The chronological
record of disabling illnesses was included in the schedule so as to
permit the computation of sickness and death rates acco!'ding to
occupation and by nature of disease. The study is not confined to
so-called occupational diseases but covers all diseases recorded. The
use 0£ control groups will make it possible to ascertain the diseases,
especially the more common ones, that occurred with excessive frequency in any given occupation.
Field work was completed early in June 1936, and it is expected
that the work of tabulating and analyzing the data will be completed
by June 1937.
H ealth facilities study.-This survey includes a census of hospitals
in cooperation with the census of business, a survey of hospital outpatient departments, and a survey of public health facilities. The
data obtained in the hospital census included name and location,
income, expenses, personnel, pay rolls, plant assets, endowment funds,
and indebtedness. The health-facilities data included type of agency,
population served, income, expense, personnel, and services rendered.
Some 10,000 reports on hospitals have been transcribed from r ecords
collected by the American Medical A ssociation and the American
College of Surgeons. The hospital census will produce about 4,000
schedules and the out patient department census some 600 schedules.
Field workers obtained 2,800 schedules in the health agencies study
of governmental and nongovernmental health organizations such as
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city, county, or State health departments, welfare department health
services, nursing associations, tuberculosis associations, etc. This
study covered agencies in about 100 counties throughout the country.
MISOELLANEOUS
Some :further papers have been published during the fiscal year
on the causes of illness and the extent and kind of medical care in
the 9,000 families canvassed in the study which was made in cooperation with the committee on the costs of medical care. Two of these
papers (Public Health R eports Oct. 11, 1935, and Milbank Quarterly,
October 1935) had to do with the incidence of illness. Three others
(Public Health Reports, Apr. 17, and July 10, 1936, and American
Journal of Public Health, November 1935) dealt with the frequency
of vaccinations and immunizations among persons of various ages
and in different income levels in the ·surveyed families living in
various parts o:f the country. These studies on the frequency of
smallpox vaccinations and of typhoid immunizations constitute the
first data on the use of immunizing procedures in a considerable
group of families scattered throughout the United States.
Papers on the changes in incidence and fatality of smallpox in
recent decades (Public Health Reports, Apr. 3, 1936) the health of
the worker (Annals of the American Academy of Political and
Social Science, March 1936) were also published. Two further
papers on health during the depres ion were published (Public
H ealth Reports, Aug. 16, 1935, and Jan. 24, 1936).
The usual 4-week . summaries of the prevalence of communicable
diseases and the usual semiannual and annual summaries of mortality were prepared. Beginning with the calendar year 1936 the
mortality summary was issued quarterly. These provisional summaries, which are made possible by the cooperation of about 30
State health departments, provide the first available data on mor~
tality from specific causes in the various parts of the country.
STREAM POLLUTION INVESTIGATIONS
Research studies in stream pollution and natural purification, including the allied fields of sewage treatment and water purification,
have been continued at the headquarters laboratory maintained at
Cincinnati, Ohio, under the direction of Sanitary Engineer J. K.
Hoskins.
Sewage treatment studies.-Studies of the activated sludge process
of sewage treatment have been continued with the object of determining those factors which, by a:ffecting the biological balance,
reduce the efficiency of purification. An experimental activated
sludge-plant unit is maintained in operation for the production of
normal activated sludge as well as a large number of small
laboratory units which can be operated under carefully controlled
conditions.
The :functioning agent in the removal of solid, colloidal, and dissolved impurities from sewage by the activated sludge process appears to be a gelatinous matrix which makes up a large portion of
the body of the sludge. Considerable attention has, therefore, been
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deyoted_ to st1_1di~s of the formation, composition, and properties of
th1s active prmc1ple.
Vsi_ng ?rganisms with sludge-produc ing and purification characteristics m pure culture, combined chemical and bacterioloo-ical
studies have been made (1) on the rate of production of a~tive
sludg~, (2) on the rate and extent of oxidation of sewage pollutional
materials, and (3) on the rate and extent of total purification of
sewage. Total purification as used here in reference to the pollutional material in sewage includes oxidation, adsorption, and the
material synthesized into new active sludge.
Similar observations, under identical conditions, have been made
of the oxidation, total purification, and synthesis accomplished by
normal activated sludge. These results make possible comparisons
of the efficiencies of the two types of sludge and provide a basis for
further studies to determine the factors which control the efficiency
of this method of sewage treatment.
In general, it can be said that in the presence of a good sludge,
either pure culture or natural, both oxidation and adsorption of the
pollutional material in sewage takes place at a very rapid rate. The
rate of oxidation very greatly exceeds that which has ever before
been demonstrated under any biological set-up.
A method of determining the rate of oxidation of sewage materials
by activated sludge has been developed. A correlation between the
settling qualities and the ash content of activated sludge has also been .
established.
.
The use of very small amounts of chlorine has been shown to be
effective in the control of sludge bulking when this condition results
from excessive fungus growths extending outward from the body of
the sludge particles. A report on the development of this method
of treatment and its practical application in full-scale municipal
plants has been published.
Study of stream oxidation.-Ex periments were begun last year on
the physical and chemical changes occurring in deposits of sewage
sludge under conditions approaching those of natural streams, using
for the purpose a specially constructed recirculation channel permitting observations of these changes to be carried out over extended
periods of time. These experiments have been continued and amplified to include some parallel observations on the oxidation of sewage
when diluted in a stream water and carried by the stream very
largely in solution and suspension.
The results of the experiments made with sewage indicated that
when aerobic conditions were maintained in the streams, with- a
reserve supply of dissolved oxygen constantly present, the oxidation
of organic matter proceeded at a rate closely approximating that
which is observable at the same temperature in the ordinary laboratol\y dilution test for bi~hemical oxygen demand. For sewage
sludge deposits the corresponding rate of oxidation observed with
dissolved oxygen present in the overlying stream was measurably
lower, approaching more nearly the rate of anaerobic decomposition
established by Fair and Moore from their experiments in artificial
sludge digestion. This result appeared to indicate that the aerobic
oxidation of a sewage sludge deposit in a fl.owing stream is confined
very largely to the surface layer of the deposit and that the greater
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part of the total oxidation is accomplished through the anaerobic
decomposition of organic matter in the subsurface layers, with subsequent direct oxidation of the products of this decomposition as they
are gradually leached out into the overlying streams and thus
brought into immediate contact with dissolved oxygen.
In the course of these experiments it was noted that the rate of
absorption of atmospheric oxygen by a flowing stream containing
sewage was markedly lower than that of a similar stream of tap
water containing no sewage. This observed difference was considerable even with sewage concentrations as low as 1 or 2 percent,
which would be well within the ranges of concentration found in
many sewage-polluted streams. The effect of sewage sludge deposits
on the rate of re-aeration was much less than that of sewage, though
still measurably great.
Quantitative measurements of rates of atmospheric re-aeration have
been made with streams of water containing various concentrations
of sewage, ranging from 0.5 to 50 percent, and likewise with different
concentrations of sludge deposit. The results of these experiments
have shown a definite relation existing between the concentration
of sewage or sludge in the streams and its retarding effect on the
re-aeration rate, though the effect is disproportj onately great with
very low concentrations, suggesting the influence of film-forming substances or those which may modify the surface t ension of water
exposed to the atmosphere. Experiments with oil films, fatty acids,
and other substances altering. the surface tension have shown that
all of these substances exert a markedly retarding effect on the absorption of atmospheric oxygen by a moving stream of water. Colloidal material also has been found to be measurably effective, though
to a much less extent than film-forming elements.
During the past year the results of a previous extensive series o.-f
experimental observations on the effects of variations in . the temperature, depth, and velocity of flow of streams of de-aerated tap
water on their rates of atmospheric re-aeration have been compiled
and published in the third major report issued from this study
(Sewage Works Journal, March 1936). These observations dealt
only with the effect of the physical conditions above noted and had
no reference to the more complex effects of sewage constituents now
under investigation.
Test for chloramine '!Med in water purification.-The use of chloramine for the disinfection of water supplies has become widespread.
Because no specific test for small amounts of chloramine in water
was available a method of measuring chloramine in the concentrations used in water purification was developed.
NATIONAL INSTITUTE OF HEALTH
The National Institute of Health continued under the administration of Director G. W. McCoy and Assistant Director R. E. D yer.
It is regretted that it is necessary to report the death, in line of
duty, of Bacteriologist Anna M. Pabst, who died on December 25,
1935, from virulent meningococcus infection acquired accidentally a
fow days before, while carrying out a series of experiments.
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DIVISION OF PATHOLOGY AND BACTERIOLOGY
Lymphocytic choriomeningitis.-The virus isolated and described
by Surgeon Charles Armstrong has been established as the cause
of a type of meningitis occasionally occurring in man. Protection
tests indicate that immunity to this virus is· rather common among
=:ome groups of our population and suggest that infection of man
may occur in the absence of meningeal symptoms, just as usually
happens in monkeys and mice inoculated by routes other than into
the central nervous system. The results of the study on the cultivation of the virus in the chorio-allantoic membrane and in the brain
of the chick embryo were embodied in a paper published in the Public Health Reports (Jan. 10, 1936, vol. 51, no. 2, p. 29). The virus
was readily propagated through eight passages.
Intranasal che1nical prophylams of certain infectious diseases.It has been found that certain chemicals, notably sodium aluminum
sulphate and picric acid, or a combination of the two, when instilled
into the nostrils of experimental animals have the property of preventing infection after subsequent introduction of the virus of epidemic encephalitis ( St. L ouis type) and that of poliomyelitis.
,vhether such a .procedure offers a practicable method of controlling
i.he infections in man under natural conditions remains to be determined.
Typhus-Rocky Mountain spcttted fever.-Investigations were carried on at the National Institute of Health and in the field laboratory
at Mobile, Ala., and comprised the following:
(1) Cultivation of the viruses of typhus and spotted fever in the
chick embryo. It was found that spotted fever virus was easily maintained in the chick embryo with some indication of an increase in
virulence. It was found difficult to maintain endemic typhus virus in
the chick embryo beyond seven passage generations.
(2) Preparation of vaccines against typhus and spotted fever
from chick embryo cultures. No definite results were secured.
(3) The determination of the ability of dog fleas to transmit
typhus in nature. The results to date are inconclusive.
( 4) Study on the pathology of typhus and spotted fever. The
results of this study were being prepared for publication at the close
of the fiscal year.
( 5) Determination of the susceptibility of various species of wild
rodents to endemic typhus. It was determined that the opossum,
one species of wood rat, and two species of wild mice are susceptible.
(6) Attempts are being made to isolate endemic typhus virus from
wild rodents and their parasites trapped at rural typhus foci.
Assistance was given to health officers and to practicing physicians
in the diagnosis of typhus, and especially of spotted fever. The total
number of reported cases of both typhus and spotted fever was approximately the same as in the preceding year, with both diseases
being reported from a somewhat increased area.
Intestinal infections.-At Chicago, Ill., studies were continued on
amebic dysentery, with the object of learning more of its prevalence,
usual mode of spread, and especially the significance of healthy carriers. The studies on diarrheal diseases of the southwestern part of
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the country which were carried on in the summer of 1935 are being
continued by a research unit with headquarters at Albuquerque, N.
Mex. The investigations have) proceeded only far enough to show
that the problem is a large one and that the usual types of the organism causing bacillary dysentery are responsible for a large proportion of the cases.
Mycological studies.-Since. the organization of this work late in
the fiscal year, about 200 cultures of pathogenic fungi have been
obtained from various sources and arranged in a collection to be maintained (with others to be added) for comparative study and investigation. Routine diagnostic and identification work has been begun.
Bacterial variants and mutants.-ln a general way the results obtained during the preceding years have been confirmed. Attempts
were made to develop an experimental procedure which would obviate
the irregularity in the occurrence of the apparent mutants, but no
definite results can be reported. It was established that the rate of
growth retardation and of killing of the bacteria by radium is proportional to the intensity of the rays' emanation, but the same has not
been established for the frequency of the occurrence of mutants.
Studies of the effect of radium emanation upon the various processes
of bacterial metabolism have been initiated.
Brucellosis.-Surveys to determine the prevalence of brucellosis,
particularly in ,a typical and chronic forms, are in progress at San
Antonio, Tex., and in Mecklenburg C;ounty, N. C. These areas were
chosen largely because of the knowledge available as to prevalence of
contagious abortion of cattle in the vicinities. As is generally known,
infections of man often originate from the use of raw milk from
cattle infected with members of the B rucella group.
Classification of streptococci.-Studies on the classification of the
hemolytic streptococci which have been conducted through a number
of years are nearing completion. A system of classification has been
worked out based on sensitivity to three races of bacteriophage and
fermentation reactions in lactose, salicin, mannite, trehalose, and
sorbitol broths.
R elapsing fever.-Investigations have demonstrated the survival of
virulent infection for 5 years in naturally infected adult ticks of the
species Ornithodorus turicata collected in Texas and deprived of food
throughout that time.
Rat-bite f ever.-Investigations have demonstrated rat-bite f ever
spirochetes in 65 naturally infected white mice, Mus musculus, which
were bought presumably healthy, but were found to be infected with
this spirochete.
Tularaemia.-This disease was reported by State health officers from
35 States and the District of Columbia, a total of 780 cases being
reported as compared with 881 in 1934. The disease was recognized
during the year for the first time in Central Europe in a resident of
Austria, who had skinned a wild hare caught in that country.
Pathology.-The material studied includes 1,303 surgical, 267 postmortem, and 2,106 experimental specimens, comprising diagnostic
service to marine hospitals and other agencies and studies on the
pathology of tularaemia, typhus, spotted fever, tumors, leprosy,
lymphogranuloma inguinale, anaerobe toxins, drugs, heavy metals,
streptococcus fibrinolysins, tuberculosis vaccines, dietary deficiencies,
and central nervous system virus diseases, and on technical methods.
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SPECIAL STUDIES ON PROPHYLACTIC AND THERAPEUTIC AGENTS COVERED BY THE LAW
OF JULY 1, 1902 (THE BIOLOGICS LAW)
G(J)S-gangrene antitowins.-The standardization of gas-gangrene
antitoxin ( H istolyticu.s) was undertaken in collaboration with other
countries under the direction of the Permanent Standards Commission, Health Organization, League of Nations. A dried standard
antitoxin and a dried standard toxin have been prepared and the
potency of these determined in terms of the international standard
adopted at the September (1935) meeting of the commission. The
work on the standardization of the :four more important antitoxins of
the gas-gangrene group (Perfringens, Vibrion septi.que, Oedematiens,
and Histolyticws) has been completed and the standard toxins and
antitoxins are available to the biological establishments.
Meningococcus meningitis.-Due to the unusually high incidence
of this disease during the past year, routine observations occupied
much of the time of the workers on this problem. Research was
directed chiefly toward developing a more satisfactory method of
testing serums for their therapeutic value. Last year it was shown
that a generalized infection can be readily produced in mice with
meningococcus cultures that are sufficiently virulent, and that protection against such infection is given by many polyvalent antimeningococcic serums. During the present year practical use has
been made of the fact that the virulence of meningococci can be
greatly emphasized by suspension in mucin. This has made it possible to produce infection in mice with very much smaller numbers
of meningococci, thus allowing more satisfactory estimation of the
protective action of the immune-serum studies.
Storage of meningococcus cultures in neutral glycerine at -15° C.
has been found to be a good method of prolongmg virulence as well
as viability. This :fact has been of special value in improving the
mouse protection method for testing serums.
The neutralization of meningococcus toxins by antitoxins has not
proved practica9le in small laboratory animals. Studies on the neutralization of toxins with antitoxins by means of skin tests in human
beings were begun.
H emolytic streptococcus.-The study of the antigenic properties
of the various strains of the hemolytic streptococcus has continued.
Particular attention has been given to the elimination of the allergic
substance in the streptococcus toxin-broth and to the modification
of the erythrogenic toxin so as to do away with the unpleasant
reactions not infrequently accompanying its use :for active immunization against scarlet fever.
Typhoid vaccine.-There have been a number of disappointing
developments in connection with typhoid vaccination in recent years
which have made necessary a restudy of the vaccines in use. With
a view to utilizing and extending some of the newer work in connection with the properties of antigens, studies have been made of
the antigenic components of the several strains of typhoid organisms
now employed by commercial producers with a view to selecting for
gene_ral use the most promising from a purely immunological point
of view.
Staphylococcus preparations.-Studies on staphylococcus products
were continued. The standard staphylococcus antitoxin is now
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being distributed to biological manufacturing firms and interested
workers. Commercial staphylococcus products are assayed to determine sterility, potency, and innocuity. Tests performed during the
year indicate that further investigations are advisable before definite
governmental requirements are set for staphylococcus toxoid.
Arsenical preparations.-Studies on the therapeutic efficiency of
various arsphenamines against experimental syphilis in rabbits were
continued. The results obtained support the previously noted observation that different brands of arsphenamine examined at the institute are remarkably uniform in therapeutic activity.
Licensed establishments.-At the close of the fiscal year 54 establishments, 11 of which were foreign, held licenses to engage in the
interstate sale of biologic products. The licenses covered 157 different preparations.
DIVISION OF PHARMACOLOGY
The work of this division continued under the direction of Pharmacologist Director Carl Voegtlin.
Oarncer research.-Work with a strain of spontaneous mammary
carcinoma in mice showed that if the animals are fed a diet deficient
in the amino acid lysine, tumor growth, as a rule, is arrested. If,
after a period of arrested tumor growth, the diet is supplemented
with an adequate amount of lysine, the tumors grow very rapidly,
indicating that lysine is an important factor for the growth of th1s
neoplasm. Similarly, tumor growth can be arrested by maintaining
the animals on a diet low in organic sulphur. Treatment of such
animals with glutathione results in fairly rapid tumor growth. This
is the first experimental evidence concerning the significance of glutathione in malignant growth. vVork with other amino acids is in
progress.
A reliable method was devised for the quantitative estimation of
vitamin C in neoplasms by means of the ultraviolet absorption spectrum of this substance. The claim made in the literature that neoplasms contain a reducing substance of unknown chemical nature
could not be verified. It would seem that this new spectrometric
method is of considerable usefulness for the quantitative estimation
of vitamin C in biological material.
Research on the effect of arsenicals on tumor nuclease was completed.
Work has been continued on a study of the Walker 256 rat mammary carcinoma in tissue culture in the hope of analyzing the reason
for the erratic growth which was obtained in earlier cultures. It
was determined that a variation of pH within the range pH 6.8 to 8.2
had no decided influence in causing the tumor cells to outgrow the
stroma cells in culture. Furthermore, it was shown that addition
of a little Walker tumor extract to the culture medium generally
caused a striking growth of the tumor cells, which proliferation could
not be duplicated m embryo juice and horse serum alone. Even with
this tumor extract, however, attempts to grow and reisolate the epithelial cell of the tumor in tissue culture have not been successful.
In view of the results· obtained by the use of Walker tumor extract
on cultures of Walker cells, the action of this extract was studied on
cultures of rat mammary gland. In this study no proliferation of
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the mammary gland cells was noted, but many of the fibroblasts in
the culture showed a great increase in the quantity of chromatin
granules in the nucleus, to such an extent that some of the cells in
fixed pr·eparations closely simulated epithelial cells from the Walker
tumor. These cultures, when injected into rats, however, have so far
given no growths.
0 hemistry of cell growth an.JJ cell division.-A systematic study
was made of the nucleic acid of Amoeba proteus during the various
developmental stages. This nucleic acid is confined to the idiochromatin. A technique was developed for the study of the influence
of chemicals, applied during late interkinesis, on the division of the
cell nucleus. It was found that several organic sulfur compounds
exert an inhibitory effect. A technique was devised permitting the
application of the nitroprusside test for SH groups to single cells.
Toxic anemia.s.-The effects on hematopoiesis of diets deficient in
certain essential amino acids were studied. An experimental hyperchromic macrocytic anemia has been produced by feeding deaminized
casein. Studies on the nature of this anemia revealed that it was due
to some as yet unidentified toxic factor produced in the process of
deaminization of the protein. The study of the effects of deaminized
amino acids on hematopoiesis is in progress.
V itamifris B 1, B 2,-Further studies were made on the differentiation
of vitamin B 1 and B 2, with special reference to the effects of reducing
and oxidizing agents. The observations led to the preparation of a
potent water soluble concentrate with a B 1 and B 2 potency of about
500 and 200 times that of dried brewers' yeast, respectively.
Ohemotherapy.-Further studies showed sulphoxylate consistently
to cure !11-ice infected with the Institute: strain of pneumococcus I.
No consistent effect was found on 30 virulent strams; types IV to
XXXII. The curative effect of sulphoxylate is destroyed by oxidation, further evidence linking the action to reducing effect. Action
on the organisms in vitro was shown in that exposure to high concentrations of sulphoxylate could render organisms avirulent in a
few hours. This effect was most marked on the Institute strain.
Mice cured from infection with the Institute strain become immune
to other virulent type I infections. The action of sulphoxylate is
specific. Studies of a large series of other compounds showed them
to be inactive, either alone or in combination with sulphoxylate.
Further attempts to increase the action of the drug, to make it generally effective, are in progress.
Sulphoxylate was found rapidly to form toxoid in vitro with toxins
of Vibrion septique and B. histolyticus.
Work is being done on urinary antiseptics. Safe and effective ways
of acidifying the urine are being developed.
DIVISION OF CHEMISTRY
The work of the Division of Chemistry was continued under the
direction of Prof. Claude S. Hudson.
Sugar reseairohes.-These studies, while of a fundamental nature
from a purely chemical point of view, have also been conducted with
an aim to possible application, directly or indirectly, in the fields of
medicine and the related biological sciences. Thus studies on oxidations in the sugar group have not only proved fruitful in providing
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a new method of wide application for the determination of structure
and configuration but have also, from a physiological point of view,
afforded the most direct and convincing experimental proof of the
susceptibility to cleavage of the hexose molecule in the center of the
chain to produce optically active glyceraldehyde, as postulated by
physiologists in the case of d-glucose. Likewise, the study of the
seven-carbon sugar, d-mannoheptulose, from the avocado pear,
yielded interesting results both from the purely chemical point of
view and of possible applications. Experimen~s on rabbits have
shown that this sugar is metabolized, its tolerance being very high.
Studies were carried out on the rearrangement of sugar acetates by
aluminum chloride, with special reference to celtrobiose and its deriv~
atives. Experimental evidence has been obtained for the formulation
of celtrobiose as d-glucoside-d-altrose. Results have been obtained
which are expected to aid in developing a method for preparing
d-ribose, which is of importance in certam biological investigations,
much more economically than has been possible heretofore.
The open chain aldehydo-d-arabinose acetate was combined with
the I-isomer and the racemic compound prepared for the first time;
d-gulose dibenzyl mercaptal and d-altrose dibenzyl mercaptal were
isolated. The latter, together with the lmown mercaptals of galactose,
glucose, and mannose, made available a series to study with regard to
the rules of superposition in straight chain compounds free of any
other optically active component. Very careful measurements of the
rotations in pure pyridine were made, but the results are as yet
incomplete.
Compounds prepared and studied included the following: Pure
a- and /3-methyl d-galactosides, acetobromoglucose, a- and /3-methyl
1-rhamnosides; a series of compounds of aldehydo-d-a-galaheptose
hexaacetate; gulose calcium chloride; acetochloro-celtrobiose, several
heptaacetates of celtrobiose, celtrobiose a- and /3-octaacetates; a- and
/3-d-arabinose triacetates, a- and /3-benzyl d-arabinosides, a- and
/3-benzyl d-arabinoside triacetates; a-bromo-d-mannoheptulose pentaacetate, a-methyl d-mannoheptuloside pentaacetate.
Enzy'l1U3 researches.-In connection with the previously reported
work on the concentration of invertase, it was found that comparatively very little is known of the true nature of the substrates on
which invertase can act. This led to a study of derivatives of gamma
fructose. The results obtained prove that gamma methyl and
benzylfructosides exist in at least three distinct forms instead of the
two, which present theory calls for, and suggest that the chemical
constitutions now assigned to sucrose and other substrates acted upon
by the enzyme invertase need correction.
O'hemico-bacteriological studies.-One of the aims of these studies
is to enable the bacteriologist to utilize the advances in the sugar
researches for better identification of bacteria. The sugar of the
avocado pear, d-mannoheptulose, has been chosen for the initial
experiments. Although this work has progressed for only a short
time, the preliminary results are encouraging. Two micro-organisms,
obtained from soils under avocado trees in Florida, have been found
capable of utilizing this sugar. One of these has the general characteristics of the colon group and the other those of the para-typhoid
group.
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Cooperative work.-In continuation of studies relating to the human dental lesion known as mottled enamel, samples of water from
various localities were received for mineral analyses, including the
determination of the fluoride content.
There was a continuation of the cooperation with the Division of
Pharmacology in the study of the phosphoric acid esters of choline.
Quantities of crystalline tetraacetyl-,B (,B-chloroethyl) d-glucoside
were prepared and derivatives were obtained from the latter which
will facilitate the preparation of choline d-glucoside desired for pharmacological studies. Assistance was also rendered in connection with
a pharmacological study of certain bile acid compounds.
The cooperation with the Division of Pathology and Bacteriology
in the chemical control of the arsphenamines and in supplying standard solutions for various purposes was continued. Assistance was
also rendered in the chemical control of various preparations of
scarlet-fever toxin.
Likewise the cooperation with the section of nutrition in supplying
standard solutions and in making chemical analyses from time to
time, as requested, was continued.
Assistance was rendered to Senior Surg. L. L. Williams, Jr., in
connection with the testing of a petroleum oxidate as an insecticidal
agent and in the study of certain larvicidal agents and oil emulsions.
Hydrogen-ion standards were prepared for general use by workers
of the Institute and other branches of the Service.
Analytical work.-About 243 various analyses of miscellaneous material and 43 mineral analyses of waters were carried out; there were
examined 10 samples of urine for toxic metals.; and several toxicological examinations were made on miscellaneous., material.
DIVISION OF ZOOLOGY
The work of the Division of Zoology was continued, and on April
1 was reorganized under the direction of Prof. Maurice C. Hall.
Reorganization.-Certain lines of work-surveys of ectoparasites
and the work on catalogs-were discontinued. Studies of trichil osis and oxyuriasis were undertaken.
Owyuriasis.-Studies were begun of the incidence of pinworm infestation under hospital, institutional, and home conditions. Diagnostic methods have received special attention, the methods in use
being given comparative tests, and new techniques and equipment
being devised. Various therapeutic procedures are being investigated. Other studies are designed to obtain more precise information as to the life history and biology of the parasite.
Trichinae.-Studies were begun on the incidence of trichinosis,
i:n,cluding clinical, subclinical, and zoological cases, through an examination of diaphragms from cadavers from five hospitals, utilizing all
previous techmques and refining these techniques to obtain more certain and accurate information; an examination of 57 diaphragms
has shown 7 with trichinae, an indicated incidence of 12.3 percent.
Diagnostic methods are being investigated to establish a more rapid
and sound procedure. Studies of the life history and biology of the
parasite were begun.
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Routine diagnostic ewaminations.-A total of 425 specimens were
examined for Government hospitals, State health departments,
physicians, etc.
Survey of ectoparasites.-Charts were completed showing the results of the flea surveys in typhus-fever control work at Savannah,
Ga., and Dothan and Mobile, Ala.
MrscELLANEous
During the fiscal year 4 National Institute of Health Bulletins,
10 Public Health Bulletins, 76 articles for the Public Health Reports, and a large number of articles for outside journals were reviewed and approved for publication.
A meeting of the National Advisory Health Council was held on
June 26-27, 1936, when the work of the various divisions of the
Public Health Service, with particular reference to research, was
presented to the Council for its consideration and recommendation
as to future lines of endeavor. In general, the program presented
to the Council met with its approval and favorable commendation.
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DIVISION OF DOMESTIC (INTERSTATE) QUARANTINE
Asst. Surg. Gen. 0. E. WALLER in charge
.
.
CoooPERATION WITH STATES ON PuBLIC HEALTH AoMINISTRATION
Upon passage of the appropriation authorized by the Social Security Act, the Public Health Service began operations under title VI
of the act on February 1, 1936. For the last .5 months of the fiscal
year 1936 the appropriation for grants-in-aid to the States amounted
to $3,333,000 of which $2,451,140.79 was actually paid to the 51 States
and Territories, in accordance with budgets submitted to and approved by the Surgeon General, as required by the act. The balance
of $881,859.21 which was unbudgeted and therefore not paid to the
States was carried forward to be added to the appropriation for 1937.
The payments by States were as follows:
Alabama _________________
Ala~ka ___________________
Arizona, __________________
Arkans:as_________________
California _ _,______________
Colorado:_______________,__
Connecticut_______________
Delaware________________
District of Columbia______
Florida--------<----------Georgia __________________
Ha wlaii___________________
Idaho --------.-----1-------Illinois___________________
Indiana __________________
Io,vta-----------~--------Kansa~------------------Kentucky_________________
Louisiana ________________
Maine _______ ..,____________
Maryland ________________
Massachusetts ____________
Michigan_________________
Minnesota________________
Mississippi________________
Missouri__________________
$96, 254. 83
10,112.55
22, 589. 16
51, 470. 90
54,844.12
29, '362. 44
29, 150~ 70
7,514.24
20, 795. 14
47,999.16
85, 052. 08
22, ,728. '39
21, 192. 64
68, 410. 83
23, 971. 25
57,957.20
33, 01\7. r;7
89,288.75
43, 575. -83
21, 043. ~3
42, 116. 82
59,820.62
96,855.91
•52, 806. 95
73, 126. 23
44, 81(7. 18
Montana ----------------- $18, 400. 08
Nebraska _________________ 24~61&16
Nevada___________________ 10, 99·2. 98
New Hampshire__________
6, 955. 00
New Jersey_______________ 48,121.25
New Mexico______________ 34, 303. 34
New York ________________ 218,351.86
North Carolina ____________ 115,686.64
North Dakota_____________ 20, 784. 56
Ohio--------------------- 65,,130. 40
Oklahoma ________________ 44, 620. 83
Oregon___________________ 27, 933. 75
Pennsylvaniai _____________ 61, 588, 33
Rhode Island _____________ 17, 165. 00
South Carolina____________ 69, 500. 58
South Dakota _____________ 26,518.58
Tennessee----------.------- 97, 881. 73
Texas____________________ 64,089.48
Utah_____________________ 20, 970. 50
Vermont__________________
9,. 954. l66
Virginia __________________,... 78, 761. 83
Washington _______________ 38,547.50
\\Test Virginia_____________ 52,702.66
Wisconsin --------+-------- 60, 0/77., 41
Wyoming_________________ 11, 610. 66
The distribution of funds to the States, as prescribed by the act,
took into consideration four primary factors:
1. Population ;
2. Special health problems;
3. Economic need ; and
4. Training of public health personnel.
On the basis of population, 57½ percent of the total was allocated
to the States, 50 percent of which was made available through matching with existing funds for public health work and 50 percent by
matching with new appropriations from State and local sources.
53
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The funds for special health problems represented 10 percent of
the total, and were paid to the States under the same matching requirements as described for the population allotments. It is well
known that certain public health hazards are much more acute in
some States than in others. For illustration, industrial hazards affect
a very large proportion of the population in the great industrial
States, whereas the industrial hazard in the agricultural States is
comparatively small. In like manner malaria and the intestinal infections are concentrated very largely in the subtropical climates, and
plague infection has secured a firm hold in the States of the Pacific
slope. The act, therefore, takes into account the need for giving a
special differential in the way of funds to those States having such
health problems superimposed upon the normal load.
It is a well-recognized fact, also, that there is a wide range of variation in the economic status of the States. To compensate in a small
way for this difference, 20 percent of the entire appropriation was
set aside to meet the special considerations arising from economic
need. The smallest amount paid to any State was at the rate of
$7,843 per year. The distribution of the remainder of the economic
need fund was based on the per-ca pita income of the States.
On the whole, the funds paid to the States were used for strengthening existing State and local health organizations and in extending the benefits of local full-time health service to many localities
which had hitherto been unable to finance this service wholly from
their own resources. As an immediate result of Social Security aid
approximately 175 new local health organizations were brought into
existence before the close of the fiscal year.
Deficiencies in State health orgamzations have also received a
large measure of attention. Through the use of Social Security
funds, 19 States which did not already have such service set up
central facilities £or the promotion and supervision of local health
administration; 33 State health departments strengthened their public health engineering forces; 11 added new units £or the investigation and promotion of industrial hygiene; preventable disease control groups were materially strengthened in 24 States; in 27 States
the laboratory :facilities were augmented; 19 States made needed
improvements to the personnel and equipment. for vital statistics;
public health nursing was strengthened either directly or indirectly
in practically all the States; 11 States provided special measures
for syphilis control and 13 for the control of tuberculosis. A strong
impetus has been given to dental hygiene in State health programs;
and in certain localities where special hazards exist, emphasis has
been placed upon hookworm control, typhus, trachoma, psittacosis,
cancer, mental hygiene, and rodent plague.
It is obvious that the great extension of health service made possible through the foregoing program must necessarily call for a great
increase in public health workers. The State and T erritorial health
officers, in conference with the Surgeon General in June 1935, adopted
certain qualification standards to govern the eligibility of persons
for employment in the several phases of health service. It is readily
apparent to everyone that if health service is to go forward in its
most effective way, the persons to whom it is to be entrusted must
be carefully selected and properly trained. Above all things it is
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desired to place this work into the hands of competent persons rather
than simply persons who want or need employment.
There was, therefore, one portion of the fund for grants-in-aid
to the States which was designated for the specific purpose of affording the means of technical training for doctors, nurses, engineers,
and others who were to be employed in carrying out the work
planned under the greatly expanded public health program throughout the States. The sum allotted for this purpose was at the rate
of $1,000,000 per year, or, for the 5 months, $416,666. A portion of
this money was devoted to the subsidizing of eie;ht training centers,
occupying strategic locations, for the purpose of enabling the training centers to secure the additional teaching staff necessary to organjze and conduct the desired courses. The great majority of this fund,
however, was used by the States to pay a living stipend to trainees,
together with tuition and travel expense while in training. ·
The Public Health Service, in cooperation with the Industrial
Hygiene Committee of the State and Provincial Health Authorities,
inaugurated a program designed for the purpose of establishing active
industrial hygiene units in the health departments of various States.
This program has been and still is carried on by the Office of Industrial Hygiene and Sanitation of the Division of Scientific Research,
in cooperation with the Domestic Quarantine Division, as part of the
latter Division's activities in the work of States' relationships.
To date 17 States have established industrial hygiene units in their
departments of health. Prior to the passage of the Social Security
Act, $37,788 was being spent for industrial hygiene activities. The
new budgets for industrial hygiene in those 17 States call for an
expenditure of approximately $330,357. Even this increases th~ ·
expenditure per worker to only 14 mills.
With the inauguration of these activities jn State departments of
health, some 24 million gainful workers will have available services
in this field by the health agencies.
COOPERATION WITH STATES IN PREVENTING THE SPREAD OF EPIDEMIC
DISEASES
PLAGUE-SUPPRESSIVE MEASURES IN WESTERN STATES
During the fiscal year plague infection of ground squirrels was
found more widespread in California than in a number of years, and
foci of infection have been definitely located in 4 other States. The
most eastern focus thus far discovered is that located in Bonneville
County, Idaho, only a few miles from the Wyoming boundary. There
are many rumors of fatal epizootics among wild rodents in these and
other States which must still be investigated. It is possible that
sylvatic plague may not be present on the eastern slope of the Rocky
Mountains. This wide dissemination of plague throughout the western part of the United States has greatly increased the activities of
the plague suppressive measures of the Public Health Service, as
many States have requested investigation of epizootics reported among
rodents within their borders, and the use of the laboratory facilities
of the laboratory in San Francisco has been made available to all
States desiring such service. Cooperation of the Public Health Serv-
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ice in controlling local epizootics has also been a service requested by
various States.
Oalifornia.-The activities of the Public Health Service in California which have consisted in providing personnel and supplies for
maintaining a ground-squirrel free zone about the San Francisco Bay
cities, in cooperation with the local authorities, was turned over to the
State Board of Health of California February 1, 1936. The State is
now conducting this work in the same manner and with the same personnel that <the Public Health Service has successfully used for many
years.
Since June 30, 1936, there has been positive evidence of plague
existing in six counties of California. Two human cases, both of
which recovered, have been reported-one in Santa Rosa, Sonoma
County in April, and the other in Monterey County in June. No
plague-infected rodents have yet been discovered in either county
this year. The case from Sonoma County is of particular interest
because this is the first evidence of plague infection existing in
California north of San Francisco Bay and west of the Sacramento
River. Oitellus douglasii are the most prevalent species of ground
squirrels found in this region, and there has never been any positive
evidence that plague has occurred among them. Plague infection
among ground squirrels has been reported in 4 counties by the California State Board of Health, as follows: In July 1935, 1 in Lassen
County; in March 1936, 1 in Ventura County; and in June 1936, 5
in Lassen County, 11 in Modoc County, and 50 in Santa Cruz County.
The infected ground squirrels found in Ventura and Santa Cruz
Counties this year were the first evidence of infection in these localities since 1928.
Oregon.-Plague-infected ground squirrels were found in Lake
County, Oreg., last year; and in July 1936, 7 infected rodents, 6
Oitell1J)s oregonrus and 1 Oitellus colwmbianus, were found by the
field laboratory of the Public Health Service in Wallowa County
in the northeast corner of the State, and 1 infected ground squirrel
was located by Dr. Frederick D. Stricker, State health officer, during
the same month, in Grant County. It is probable that sylvatic
plague exists the entire width of the eastern part of Oregon.
M ontana.-In July 1935 the personnel of the Rocky Mountain
Laboratory, at Hamilton, found 3 plague-infected Oitell1JJS riohardsoni near Dillon in Beaverhead County, Mont. Infected ground
squirrels were located in the same region in June 1936, and an infected animal has been reported found in Madison County during the
same month.
N evada.-There are rumors of fatal epizootics occurring in several
localities in Humboldt and Elko Counties, Nev., since 1927. The
Public Health Service mobile laboratory, operating in Elko County
in May, collected fleas from 50 Oitellus elegans on a sheep ranch near
Lamoille, which produced typical plague in guinea pigs. No positively infected ground squirrels have yet been found, but the infection
must be present among the animals of this region.
/daho.-During June 1936 the Federal laboratory truck was operated in conjunction with a similar mobile laboratory provided by
the Department of Public Welfare of Idaho. Plague was first discovered in ground squirrels in Bonneville County, Idaho, about 23
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miles southeast of Idaho Falls, by inoculating a guinea pig with
fleas taken from 123 Oitellus armatus, shot June 9 and 12, 1936. On
June 23 infected ground squirrels were secured in this region, and a
few days later plague was again determined by inoculating mate.rial
from five Oitellus arma-tus and also fieas taken from the same species
of ground squirrels.
MOBILE FIELD LABORATORY
The mobile laboratory, placed in the field last year to locate
sylvatic plague foci, has been continued in operation throughout the
year. During July and August it operated in 16 counties of Oregon;
from September to March, inclusive, in 28 counties in California;
from April to May 19, in 9 counties in Nevada; and for the remainder of the fiscal year it operated with the mobile laboratory of
the State of Idaho. No evidence of plague was discovered in California, and the results in the other States have been mentioned
above.
Summary of examinat-ions for plague made by the field laboratory
Number
of ground
squirrels
examined
State
Oregon___________________ ___________________________________________________ ____
California__________ _____________________________________________________________
Nevada
___________ --------------------------------------_____________
Idaho ____________________________________________________________
•__ ______
__ ___ ___
_______
__
TotaL_________________________________________________ _____ ___ ______ ______
1, 773
1, 343
3,
437
2, 017
Number
of other
animals
examined
37
369
22
60
1----1----
8, 570
488
During the year 14 species of ground squirrels were encountered,
and plague was found in 4 species, Oitellus oregonus, Oitellus oolumbianus, Oitell'UJS eleg·ans, and Oitellrus mrmat'UJS. In California, Oitellws beecheyi beecheyi has been the reservoir of plague for years,
and in Montana, Oitellus richardsoni is infected.
As requests for investigation of regions where ground squirrels are
suffering from fatal epizootics have greatly exceeded the capacity
of one mobile laboratory, especially as these areas cover an enormous
expanse of territory in the Western States, it wa.s decided to place
three additional mobile laboratories in the field. Three 1½-ton panel
trucks were delivered for this purpose on the last day of the fiscal
year. They will be placed in operation early in July. Although the
work of the field laboratories does not include the eradication of
infected rodents, they are of great value in locating regions where
the local authorities may take such steps as appear feasible for protecting inhabited areas. Sylvatic pl gue has now gained a foothold
of such vast extent that complete eradication of the infection is
impossible with ou·r present knowledge.
USE OF FLEAS FOR LOCATING PLAGUE FOCI
In addition to the usual autopsy on animals and submitting suspicious animal tissue to the laboratory in San Francisco for diag-
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nosis, the personn~l of the field laboratory collect. fleas froll1; the
animals they examme and send them to San Francisco for gumeapig inoculation. Although this method of locating plague had ~een
in use only 2 months before the end of the fiscal year, two foci of
jnfection have been discovered by this means-Elko County, ev.,
and Bonneville County, Idaho. After plague had been demonstrated
in the latter locality through the agency of fleas, the area was again
visited by both the Public Health Service and Idaho mobile laboratories, both of which found infected ground squirrels. This method
of determining the presence of plague will probably be found of
value in urban epidemics as well as in locating sylvatic plague.
FLEA INVESTIGATION
Little is known at present regarding the species of fleas and other
parasites present on rodents in Western States, or the part played
by the different parasites in the transmission of plague. In order
to gain some lmowledge of this subject, parasites of all kinds are
being collected from nearly all animals shot by the crew of the mobile
laboratory, for classification, inoculation to determine the presence
of plague, or biological studies. During the past year 47,666 fleas
taken from 2,937 ground squirrels and 2,020 fleas taken from other
animals have been classified at the laboratory in San Francisco with
the help of the ational Institute of Health. Nineteen species of
fleas have been obtained from 14 species o.f ground squirrels, and
20 species of fleas have been found on other wild animals. This
work will be continued during the next year, and arrangements have
been made to conduct more extensive biological studies by the construction of special ground-squirrel pens and increasing the personnel of the laboratory in San Francisco.
Since December 1935 a flea survey of rats trapped in San Francisco has been conducted. Thus far over 7,000 fleas taken from
about 800 rats have been collected and classified.
MEASURES TAKEN IN SAN FRANOISCO
Activities in San Francisco are carried out in cooperation with the
city health department and consist in investigating all complaints of
rat infestation by householders, the trapping of rats, autopsy exami- .
nation of all rats caught by trappers or shipped to the la.boratory
from other San Francisco Bay points, and consultations with the
city health authorities regarding ratproofing of buildings or other
means of rat abatement.
PUBLIC HEALTH SERVICE LABORATORY, SAN FRANCISCO
•
During the past year more specimens have been submitted for
laboratory examination than in any year since the laboratory was
established. The work has increased to such an extent that the
services of another technician have been greatly needed. Arrangements have been made to employ an additional laboratory worker the
1st of July.
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The condensed table below shows the work at the laboratory :
.Examination of rodents for plague:
Rats caught San Francisco examined _____________________________
Rats caught Oakland examined___________________________________
Rats from fumigated ships examined_____________________________
Ground squirrels from Alameda County examined_________________
Serological examinations:
Wassermann reactions, blood ____________________________________ _
Wassermann reactions, spinal fluid ______________________________ _
Kahn tests, blood _______________________________________________ _
Kahn tests, spinal fluid _________________________________________ _
Agglutination tests ______________________________________________ _
Bacteriological examinations :
Bacteriological examinations, water ______________________________ _
Bacteriological examinations, diphtheria cultures ___ ______________ _
Bacteriological examinations, typhoid ____________________________ _
Bacteriological examinations, meningococcus ___ .:. _________________ _
Animal inoculation tests, tuberculosis----------------------------Animal inoculation tests, tularaemia _____________________________ _
Animal inoculation tests, diphtheria virulence _____________________ _
Animal inoculation tests, plague _________________________________ _
23, 761
2,602
136
116
8,398
408
8,398
408
1
519
1,151
2
1
43
1
1
78
PLAGUE-SUPPRESSIVE MEASURES, ISLAND OF MAUI, TERRITORY OF HAWAIi
Plague control measures were continued in cooperation with the
Territorial board of health. No human case was reported during the
year, but three plague-infected rats were found, all in the Makawao
district. This is the same general area from which plague rats have
been taken in recent years and is located from 8 to 10 miles from the
Port of Kahului. The first two infected rats were taken on July 31,
1935, and August 1, 1935, from a focus in a gulch, and the third was
found on September 13, 1935, in another focus by mass inoculation,
using pieces of liver from seven rats which had been trapped on that
day from four small fields included in a district of about one-fourth
square mile.
ERADICATIVE MEASURES IN THE OPEN COUN'I'RY
As a result of cage and field experiments carried on during the
preceding fiscal year, an intensive campaign was conducted during the
entire year, using methods adopted and found effective. In addition
to trapping, these consisted of (1) clearing heavily rat-infested areas
by cutting out the rat's natural food supply, consisting of various
kinds of wild beans, berries, seeds, and fruit; (2) burning the brush
and other material cut down; ( 3) killing rats in the burrows exposed
by the above measures by applying carbon bisulphide and igniting
it; (4) applying poison bait to cleared areas; (5) applying calcium
cyanide to rock walls and rock piles; and ( 6) clearing algaroba forests of underbrush to prevent rats from building nests in the trees.
The effectiveness of these measures was ,a mply demonstrated by the
reduced rat catch in the old plague zone where the work was first
carried out. The records show that the rate of catch in this area in
former years was from 8 to 10 rats per 100 tr,a ps per day, and that
there was no reduction during the intensive poisoning campaign carried on in 1933 and part of 1934. When the above-mentioned measures were instituted, however, there began a gradual drop in the rate
of catch from month to month, and after 13 months' operation the
101889-36--5
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rate was down to .0.67 rat per. 100 traps per day. During the latter
part of the fiscal ye.ar work was being carried 0~1t in a belt around
the old plague zone and i3:1 various outlying place_s in order to increase the size of the pract1ca.lly rat-free zone and m order to determine whether the disease had worked its way to some more or less
remote region.
RATPR00FING OF BUILDINGS
Inspections and reinspections were made, by the two s,a nitary, inspectors, of buildings and premises in the old plague zone and in all
built-up areas between the plague zone and the Port of Kahului, and
property owners were notified of corrections required. In addi~ion.
to this, wrecking crews were used wherever property owners failed
to make the necessary ch,anges. The work of these crews consisted
practically entirely of ratproofing by removing floors too close to the
ground, lattice work obstructing light under buildings, and vines and
other material of any kind which might harbor or aid .in harboring
rats. The work of the wrecking crews was .an important part of the
program, particularly in the town of I~ahului, and exc~llent results.
were obtained.
During the year, the two docks at Kahului were ratproofed
by filling in with concrete enough spaces between pier pilings t.o.
prevent rats from finding their way to the rock fill under the pier
floors. This work was carried out by the Territorial Board of
Harbor Commissioners at the request of this Office.
Regulations were prepared during the latter part of the fiscal year
for adoption by the Territorial Board of Health, providing for the
ratproofing of all buildings and authorizing other plague-eradicative
measures.
PERSONNEL
The full-time organization at the close of the fiscal year consisted
of the sanitary engineer in charge, 2 laboratory technicians, 2 sanitary inspectors, 1 clerk-stenographer, 1 field foreman, 1 assistant
field foreman, 24 rat tra.p pers, 5 foreman laborers, and 114 laborers.
This does not include labor furnished by the various plantations.
and ranches for work on company-owned property, which, in many
cases, was made available at times when the men were not needed
for their regular duties. In the case of the sugar plantations, most
of the labor was furnished in the fall of the year, when harvesting
and grinding was over and the mills were closed. The companies
propose to make it a permanent policy to use excess labor not needed
for repair work in the mills for an annual clean-up and ratproofing
period in the camps and towns.
COOPERATING AGENCIES
The various agencies which contributed financially toward the
work are shown in the table listing expenditures. There was an excellent spirit of cooperation by the various plantation and ranch
managers during the entire year and a great deal of work was accomplished by the use of company labor which could not otherwise
have been carried out. Although much remains to be done in many
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of the company camps, a marked general improvement was made
during the fiscal year from a plague-control standpoint, and it is
believed that the efficiency of the sanitary inspectors of these companies has been definitely increased as a result of supervision by
this Office.
In December 1935, funds were made available by the Agricultural
Adjustment Administration for a rat-abatement project on various
islands, the allotment for Maui being $35,000. This fund is being
administered by this Office and to date has been used entirely for
hiring labor. By the end of the fiscal year $15,707.02 had been
expended, leaving a balance of $19,292.98 for future use.
It should be noted here that of the total expenditures by all agencies, aggregating $175,815.49, approximately 94 percent was spent
for labor and salaries and that more than 43 percent was strictly
local money.
MISCELLANEOUS
In November 1935 plans were prepared in this office for new
headquarters buildings. The buildings were completed in December
1935 and were paid for by the quarantine tax fund commission of
the Maui Chamber of Commerce. They consist of three units, as
follows: (1) Laboratory and office; (2) animal room, storage room,
and garage; and ( 3) fuel house. These new buildings offer excellent
facilities for carrying on routine laboratory work and replaoe old
:frame structures which had been abandoned as a jail. They are
located in a fenced enclosure in a pasture just outside of the limits of
the town of Kahului.
Expendlitures by various agencies, plague campaign, islwn.d of Maui,, fiscal y ear
ended June 30, 1936
Federal Emergency Relief Administration _________________________ $69, 395. 43
~f.aui Agricultural Co ____________________________________________ 43,656.00
Agricultural Adjustment Administration__________________________ 15, 707. 02
Territorial Board of Health _________________ __ ___________________ 15,052.83
U. S. P ublic Health Service (P. S. E. D. fund) ____ __ ___ ___________ 14,000.40
Hawaiian Commercial & Sugar Co________________________________
8, 059. 72
Quarantine Tax Fund Commission________________________________
5, 750. 20
~fa ui Pineapple Co______________________________________________
2,564.18
Board of Harbor Commissioners_____________ ___ _________________
8 9. 71
6·50. 00
H aleakala Ranch & Dairy Co__________________________ __ _________
Libby, M:cNeill, & Libby_____ ____________________________________
90. 00
Total __________ ______________ _____________________________ 175,815.49
Summary of data fis cal year ended June 30, 1936
Classification of rodents trapped and killed:
R. ha waiiensis ----------------------- ----------------------R. alexandrinus
--------------------------------------------R.
rattus ______________________________________________
__ ___ _
Number
38,023
12,792
5,880
0
R. norvegicns ----------------------------------------------M. Musculus _______________________________________________ _
37,815
Mongoose ______ ______ __ _____ ___________ ____ ___ ________ _____ _
314
Rats trapped in Port of KahuluL ________ __ __ ______ ___ __ ____ _
1,879
Ra ts trapped, totaL __________________________ ___ ___________ _
54,906
Rats killed by shooting, etc __________________ ___________ ___ _
1,489
Rats found dead ___________________________________________ _
300
Rat-trap days, totaL _______________________________________ _ 1,348,654
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Rats per 100 traps per day (all districts) ___________________ _
Rats per 100 traps per day (Kahului) _____________________ _
Man-hours, rat harbor elimination __________________________ _
Acres of land cleared _____________________________________ _
Burrows treated with carbon bisulphide ____________________ _
Packages of poison placed ___________________________________ _
Inspections of buildings and premises ________________________ _
Reinspections of buildings and premises _____________________ _
Noncompliance notices issued (major changes) _______________ _
Outhouses condemned and abolished _______________________ _
Dwellings condemned and abolished _________________________ _
Pig pens condemned and abolished __________________________ _
Cesspools condemned and abolished _________________________ _
Wood floors condemned and abolished ______________________ _
Dwellings built or ratproofed ________________________________ _
Outhouses built or ratproofed ______________________________ _
Yards cleared of rat harborages ____________________________ _
Houses connected to sewer __________________________________ _
Rats received at laboratory _________________________________ _
Total rodents received at laboratory ________________________ _
Rats examined macroscopically _____________________________ _
Rats examined microscopically _____________________________ _
Mass inoculations made ____________________________________ _
Single inoculations made ___________________________________ _
Cases of human plague ____________________________________ _
Cases of rodent plague _____________________________________ _
Date of last case of human plague: Sept. 18, 1932.
Date of last case of rodent plague: Sept. 13, 1935.
4.06
2.59
411,699
2,646
180,769
378,499
1,209
2,304
55
441
51
107
86
731
92
388
2,648
361
56,695
94,824
55,514
22
478
6
0
3
TR.ACHOM.A PREVENTION
Trachoma-prevention work as an activity of the Public Health
Service had its origin in 1913. It was never intended, however, that
this work should be carried on permanently as a function of the
Public Health Service, but only until such time as it might be taken
over by the States concerned. There was a general understanding at
the beginning of the fiscal year 1936 among the States in which this
work was bein_s- carried on that they themselves would be expected to
take over the hnancing and management of the trachoma-prevention
work upon the passage of the Social Security Act. This was a logical
development as a result of a long period of demonstration in this field
of service, whereby a corps of doctors, nurses, and others technically
trained in trachoma-prevention work were made available to the
States for continuation of the program.
In accordance with the foregoing policy, the central office of the
trachoma-prevention activities was discontinued by the Public Health
Service on April 30, 1936.
·
A brief description of the work as conducted by the Public Health
Service in the different States during the fiscal year 1936 is as follows:
Kentucky.-The trachoma field hospital at Richmond, Ky., continued to draw severe cases of trachoma from the eastern part of the
State. It is felt that the severity of the pathological lesions in these
Kentucky cases precludes the possibility of treatmg these patients in
clinics, where they could be seen only once or twice a week, such as
is done in a nearby State.
During the year this field hospital continued to cooperate with the
t.rachoma research unit of the Washington University Medical
School.
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PUBLIC HEALTH SERVICE
The United States Public Health Service severed its relationship
with this trachoma-control project on June 30, 1936, when the Kentucky State Board of Health became entirely responsible for its
future development.
Missouri.-The trachoma-control unit at Rolla, Mo., continued to
serve a useful purpose in locating and treating trachoma su:fferers
in the southern half of this State. Also, the education of the public
in the rural regions was given due emphasis, as it is felt that proper
habits of personal hygiene in endemic trachoma will, in the end, be
the biggest factor in the eradication of this disease. During the year
a 16-mm film dealing with trachoma was prepared and shown in the
scientific exhibits at the May meeting of the American Medical Association. Another exhibit was prepared dealing with the histology
of trachoma and with the clinical photography of eye diseases and
was set up with the scientific exhibits at the American Medical
Association meeting in the spring of 1936.
This trachoma-control unit was taken over by the Missouri State
Board of Health on February 1, 1936.
T ennessee.-During the first 3 months of the fiscal year 1936 the
small trachoma-control unit at Gainesboro did not hospitalize any
patients. Work in central and western Tennessee was continued
from this point, however, with the idea in mind of ascertaining the
prevalence of trachoma in that part of Tennessee.
In September 1935 the Tennessee trachoma clinician went on an
extended leave for post-graduate study. From that time until the
spring of 1936 the trachoma survey in the western part of the State
was continued by a trachoma field nurse under the supervision of
the State department of health. A considerable number of trachoma
cases was located in the northwestern corner of the State, in a group
of three or four counties.
In March 1936 the Tennessee State Department of Health sent
a physician to Rolla, Mo., for training in trachoma work. In May
1936 the trachoma work was started again in Tennessee, under the
complete supervision and control of the State.
General.-Property belonging to the United States Public Health
Service at the several stations where trachoma activities were being
carried on was turned over to the various State health departments
by the medical officer in charge of the work, this officer receiving a
receipt from the State health officer for the property.
Statistical data are presented in the following table :
Dispensary and hospital relief, operations, etc.
Activity
Dispensary relief
Number examined ________________________________________ _
Old cases of trachoma __________ ___ ________________________ _
New cases of trachoma _________________________ ___________ _
Total attendance __________________________________________ _
Average daily attendance _________________________________ _
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Federal Reserve Bank of St. Louis
Gainesboro,
Richmond, Rolla Mo
Tenn.,
93 iun; July i, 1935, July 1,
june 30, to Jan. 31,
1935,
1936
1936
to Sept.
30, 1935
f{
659
1,540
167
659
1.8
149
1,540
7.1 .
285
834
265
109
8
265
2.8
Total
2,464
1,228
324
2,464
3.9
64
PUBLIC HEALTH SERVICE
Dispensary and hospital relief, operations, etc.-Continued
Activity
GainesRichmond, Rolla,Mo., boro,
Ky., July July 1, 1935, Tenn.,
Julyl,
l, 1935, t0 to Jan. 31,
June 30,
1935,
1936
to Sept.
1936
30, 1935
---
Total
----
Combined dispensary and field-clinic data
Total number of new individual trachoma cases discovered_
Pannus in new
cases
__ -------------------------------- ----_
Entropian
in new
cases
____________________________________
Corneal opacities in new cases _____________________________ _
Vision 20/200 or worse, both eyes __________________________ _
Vision 20/200 or worse, 1 eye _______________________________ _
Ulcers arising in all cases, old and new ____________________ _
248
229
41
134
61
53
22
227
194
37
62
52
34
5
46
40
Hospital relief
Hospital capacity _________________________________________ _
Oases admitted during the year (total) ____________________ _
Number cases first admission ______________________________ _
Days relief furnished ______________________________________ _
Rations furnished ___________________ ______________________ _
Cost of rations ________ ____ _____ ---------------------------A verage cost of rations furnished _______________________ ___ _
Per-diem cost_ _________________ ----------------------------
34
289
172
8, 691
10,933
$3,170.53
$0. 29
$1. 78
32
185
131
5,610
6,701
$1,769.00
$0. 26
$1. 64
0
0
0
0
0
0
0
0
66
474
303
14, 301
17,634
$1, 939.53
$0. 275
$1. 75
A verage stay in hospital, days ___ --------------------------
30
30
0
30
6
745
94
81
0
0
6
603
133
18
30
1,640
262
197
143
134
0
0
995
2,418
222
14
546
541
389
105
1,074
124
0
0
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 ___________________ __ _______ _
Field nurses activities:
Public health talks given ______________________________ _
People (estimated) in audiences _____________ __________ _
Homes visited ______________________________ ------------.
§eopie. examined_ in homes (new) ______________________ _
usp1e10us cases m homes _____________________________ _
Number pupils examined in schools ___________________ _
Suspicious cases in schools---------~---- ---------------Number treatment clinics, nurse only _________________ _
Number treatments by nurse _________________________ _
Operations
General anesthesia ______ _____________ ___ ___ _________ ______ _
Local anesthesia ___________________________________________ _
Grattage __________________________________________________ _
Entropion _____ ________________________________ _____ _______ _
Canthoplasty __ __________ ______ ---------------------------Cautery puncture _________________________________________ _
Electric epilation ____ ___________ _____ ______________________ _
Enucleation _______________________________________________ _
Ectropion _________________________________________________ _
Chal:>'>:ion ______________________ ____ ___________ ____ ________ _
Milk injections ____________________________________________ _
Pterygium ________________________________________________ _
¥~;:fs~t~~~f;i~~:=
======== == ======------------== == == ===::: ==:
==: ====
Tarsectomy ________________________
---==------Paracentesis (corneae) _____________________________________ _
Dacryocystectomy ________________________________________ _
1,210
33
0
0
0
125
92
22
9
2
0
0
0
0
31
0
0
0
0
0
0
78
68
0
0
125
42
42
3
10
11
0
0
1
2
3
0
2
6
3
2
521
463
78
196
113
87
27
292
35
38
75
134
2
16
105
320
442
78
71
651
1, 856
3,249
405
2, 355
159
0
2
0
31
0
2
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
31
0
252
134
66
12
12
11
0
0
1
33
3
0
2
6
3
2
SUPERVISION OF WATER SUPPLIES USED BY COMMON CARRIERS
One of the important measures for prevention of the transmission
of disease from one State to another is the supervision and control of
the sanitary quality of water used by common carriers in interstate
traffic. During the fiscal year 1936 the companies engaged in common-carrier service reported 2,150 water supplies from which they
desired to obtain water for drinking and culinary purposes on their
equipment. Of these 1,746 were public water supplies.
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Federal Reserve Bank of St. Louis
65
PUBLIC HEALTH SERVICE
Through the cooperation of the State health departments, 89 percent of the reported supplies were inspected and certified according
to their sanitary quality. Forty-six supplies were prohibited for use
after inspection; 61 supplies were inspected in States having no engineering division in the State health department; 1,805 inspection
reports were reviewed, and 3,477 certificates prepared. The comparison of the certification work with that of previous years is shown
in table 1:
TABLE
!.-Percentage of completed certifications of wat,er supplies used on railroads,
vessels, and airplanes for each year from 1931 to 1935, inclusive
Percent of completed certifications inCarrier
1931
1932
1933
1934
1935
- - - - - - - - - - - - - - - - - - - - - -1- - - - - - - - - - - - - Railroad_ ________________________ ______ _______________ ___ _____
VesseL __________________________ ____ __ ____ ____ ______ ______ ____
Airplane ______ ___________________ __ ___________________________
92. 8
95. 9
85. 8
95.1
97. 2
97.4
94
97
93
95
93
85
89
95
91
STATUS OF WORK BY STATES
Table 2 summarizes and shows the status of the work by States
during the calendar year 1935.
TABLE
2.-Source and certification status of water supplies used by interstate
carriers during the calendar year 1935, by States
Source classification
State
Alabama ___________
Arizona ____________
Arkansas ___________
California __________
Colorado ___________
Connecticut _______
Delaware _______ ___
District of Columbia _______________
Florida ____________
i !~~it===========
Idaho ______________
Illinois _____________
Indiana ____________
Iowa _______________
Kansas _____________
Kentucky __________
Louisiana __________
Maine _____________
Maryland ___ ___ ____
Massachusetts _____
Michigan __________
Minnesota _________
Mississippi.. _______
Missouri. __________
Montana ___________
Nebraska __________
Nevada ____________
New Hampshire ___
New Jersey ________
New Mexico ______ _
New York _________
North Carolina ____
North Dakota _____
Ohio_------ ________
Oklahoma _________
Certification status
Percent
of
Pro- Action sources
PubPriCom- Total SatisProviacted
facbibpend- upon
vate 2 pany
sional
lie'
tory
ing
ited
- - - - -- - - - - - - - - - - - - - - - - - 36
21
36
58
25
16
8
1
5
1
10
1
0
0
0
8
6
23
5
0
0
37
34
43
91
31
16
8
36
15
1
34
43
3
0
8
0
0
1
4
4
0
0
1
6
1
3
0
2
3
2
0
0
0
0
0
3
1
4
1
6
3
0
1
8
4
0
7
6
3
5
6
5
6
4
2
0
9
. 16
3
5
7
5
10
0
3
10
9
0
14
5
3
2
50
47
3
24
70
55
52
74
40
37
30
23
43
68
64
35
57
26
32
23
15
44
24
102
46
40
62
36
'2
45
41
0
19
49
29
16
65
25
32
27
21
43
66
6
34
16
60
48
47
68
34
25
25
18
43
57
45
30
52
19
27
13
15
38
13
89
45
20
54
33
26
67
28
14
8
44
24
0
21
14
40
24
95
39
10
52
18
Number of
certificates
issued
---
0
18
7
13
3
2
0
0
1
1
0
0
0
0
1
0
9
11
0
0
0
97
100
79
88
100
100
100
78
41
49
283
49
53
14
0
3
5
0
0
16
24
10
7
14
3
3
1
0
2
2
1
10
2
2
1
0
0
0
5
4
8
5
4
0
1
1
0
1
5
1
2
2
0
2
0
1
0
0
1
0
2
0
0
0
1
0
0
2
1
3
5
1
0 100
1
98
0 100
3 -------4
83
0 100
1
98
51
24
0 100
98
1
0 100
0 100
0 100
0 100
0 100
55
14
0 100
1
98
0 100
. 06
30
1
96
0 100
91
4
0 100
0 100
2
96
52
19
0 IGO
13
64
7
112
111
-------23
151
94
42
101
62
103
59
85
149
132
9
53
105
31
15
25
18
92
29
239
74
24
138
36
1 The column headed "Public" includes supplies owned by municipalities as well as those used by munici•
palities but owned by private companies.
2 A "Private" supply refers to a small well or spring used only by the carrier and the person owning it.
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Federal Reserve Bank of St. Louis
66
PUBLIC HEALTH SERVICE
TABLE
2.-Source and certification status of water supplies used by interstate
carriers during the calendar year 1935, by States-Continued
Certification status
Source classification
State
Publie
Oregon _____________
Pennsylvania. ____ _
Puerto Rico ________
Rhode Island ___ ___
South Carolina __ ___
South Dakota ___ ___
Tennessee __________
Texas ______________
Utah _______________
Vermont ___________
Virginia _____ _______
Washington ________
West Virginia ______
Wisconsin __________
Wyoming ___ _______
Total..------
Private
Company
Total
Satisfactory
Percent Numof
ber of
certifiAction sources
acted
cates
pend- upon issued
ing
Probibited
Provisional
- - - - - - - - - - - - - - -31
116
2
2
28
21
27
98
11
4
IO
46
41
36
49
13
35
131
3
2
29
28
31
156
15
29
94
0
2
29
6
30
64
--
2
0 100
72
IO
0
37
2
0
0 100
. 0
0 100
0
1
0
0 100
1
18
7
36
3
0
0 100
1
33
0 100
4
1
IO
0 100
11
11
1
0
0 100
4
1
53
50
0 100
45
42
4
0
0 100
2
47
41
0 100
9
2
8
63
55
0 ]00
17
14
1
4
94
0
--- --- --- --- --- --- --296
114
290
2,150
1,572
46
236
89
0
5
1
0
0
0
1
25
0
0
3
0
2
6
0
- - - --1,746
4
0
1
0
0
3
1
91
4
0
2
3
4
6
2
10
12
1
3
6
1
5
29
3
1
14
19
6
9
3, 94
SUPERVISION OF WATER SUPPLY SYSTEMS ON VESSELS
Operating companies reported 1,743 vessels on active status in 1935.
Of the vessels on active status, 46.8 percent were inspected and
certified, and temporary certificates were issued to 37.3 percent
pending inspection. "Not approved" certificates were issued to two
vessels.
, A total of 1,232 samples of water from drinking water supplies on
interstate vessels operating on the Great Lakes and the inland rivers
was examined by laboratories of city health departments at various
•
points.
Table 3 gives the status of the inspection work carried on during the
year.
3.-Number of vessels on active status and type of certification of drinking
water, in each of the interstate sanitary districts during the calendar year 1935
TABLE
District
Percentage of
Vessels
on active
total
status vessels in
district
Type of drinking-water certification
Permanent
Temporary
Not approved
1
Total
Percentage of
district
vessels
certified
Percentage of
total
vessels
certified
--- --- --- -----------l_ - -- -- ---- ---------2_ - ------ -----------3_ - ----------------- - -6 ______________
5 and
•- -- ---------------
TotaL ________
646
99
410
141
447
-1,743
37. 1
5. 7
23. 5
8.1
25.6
----------
48
67
370
117
214
588
0
40
1
22
0
0
0
1
1
636
67
410
119
237
816
651
2
1,469
98.5
67. 7
100.0
84.4
53. 0
----------
36.5
3.8
23. 5
6.8
13. 6
84.2
1 Only the latest certificate issued on a vessel was counted in case that vessel was both temporarily and
permanently certified during the year.
Shipbuilding companies submitted 10 plans for new vessel water
systems. Of these, two were not approved.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
67
Twenty-five cases of typhoid fever were reported among crews
and passengers on vessels during the year. Of these eight occurred on
vessels amenable to the Interstate Quarantine Regulations . For the
third consecutive year no cases of typhoid fever were reported on
commercial vessels operating on the Great Lakes.
RAILWAY SANITATION
One hundred and fifty-seven inspections of coachyards, terminals,
and watering points and 344 inspections of dining cars and commissaries were made. In three of the States inspection of watering points
is now carried on by the State department of 4ealth. During the
year special attention was paid to milk supplies used on dining cars
and to the sanitation of dining cars and commissaries.
SHELLFISH SANITATION
Cooperation h as been given to the shellfish-producing States in
connection with their sanitary control work and particularly to the
studies of growing and storage areas. During the year it was necessary
to withdraw approval of control measures in two States and to caution
the third. Withdrawal of approval in one State was only temporary.
The publication and distribution of the list of shellfish dealers
certified by the producing States has continued. The publication
of these lists of certified dealers is the key to the sanitary control
maintained within the States, since the presence or absence of shippers'
names in the list has much to do with the maintenance of their market.
According to information received by the Public Health Service, there
were 2,456 certificates issued by approved producing States during
the year. Six growing areas and 457 shucking plants were inspected
in order to determine the efficiency of State control.
RECIPROCITY WITH CANADA
Reciprocity with the Department of Pensions and National Health
of Canada in connection with inspection and certification of drinking
and culinary water supplies used by international carriers, the certification of international shellfish shippers, and the inspection of
dining cars operating internationally was continued. The Canadian
authorities were supplied with 11 reports on water supplies located in
the United States used by the United States carriers operating in
Canada and with 65 certificates covering water supplies in the United
States used by Canadian carriers. They in turn supplied the Public
Health Service with 47 certificates on Canadian water supplies used
by United States carriers operating in Canada.
Copies of all certificates issued shellfish shippers by the producing
States under Public Health Service approval were supplied the Canadian authorities and 47 certificates on Canadian shippers were
supplied to the Public Health Service.
COOPERATIVE
w ORK
WITH STATES AND OTHER AGENCIES RELATIVE
TO STREAM SANITATION
During the year the Office of Stream Sanitation cooperated with the
States of Wisconsin and Georgia relative to stream-pollution problems
in those States and with the Tennessee Valley Authority in outlining
a program of stream-pollution studies. This Office cooperated with
and acted in an advisory capacity with the Water Pollution Committee
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Federal Reserve Bank of St. Louis
68
PUBLIC HEALTH SERVICE
of the Cincinnati Chamber of Commerce, the Ohio Valley Improvement Association, and the Ohio Valley Regional Planning Commission
in connection with proposed steps necessary for the abatement of
pollution in the Ohio River watershed.
COOPERATION WITH STATES IN CONNECTION WITH FLOOD EMERGENCY
Engineers were assigned to Massachusetts, Pennsylvania, and West
Virginia in connection with emergency work made necessary by the
disastrous floods. Thirteen engineers were assigned to this work for
a period up to 14 days.
STATISTICAL COMPILATION
Table 4 shows the time expended by the field personnel of the
Engineering Section and the type of work performed during the fiscal
year 1935:
4.-Distribution of time, in days, and type of work performed by the field
personnel under the engineering section (exclusive of engineering personnel employed
on Public Works Administration projects) during the fiscal year 1936
TABLE
Day~
Days
Interstate
quarantine:
Government
agencies:
Office ___________________
_ 1,587 OtherOffice
___________________
_
204
F~ld ___________________ _
202
Field:
Water ______________ _
activities:
707 Miscellaneous
Office
___________________
_
Shellfish _____________ _
23
239
Other _______________ _
Field ____________ - - - - - - - 25
80
National Park Service:
Technical meetings_}
Office ___________________ _
190
296 Conferences ________________ _
Field ___________ - - - - - - - - 120 Leave
Committee
meetings
- _
_______________________
258
Bureau of Indian Affairs:
Office ____________ .__ - - - - - 230
Total
days
_____________
~653
Field ___________ - - - - - - - - 223
District of Columbia, mosquito
control:
Office ___________________ _
156
Field ___________________ _
113
Table 5 summarizes the activities involving supervision of water
supplies, railroad sanitation, shellfish sanitation, and miscellaneous
cooperative services with governmental agencies:
5.-Summary of activities involving supervision of water supplies of vessels,
railroad sanitation, shellfish sanitation, and miscellaneous cooperation with
governmental agencies during the fiscal year 1935
TABLE
A.
VESSEL WATER-SUPPLY SUPERVISION
Number
Number Major conferences:
First inspections:
Passenger _______________ _
With shipping officials ____ _
50
19
Freight _________________ _
With others _____________ _
42
7
Water boats _____________ _
5 Water examinations made:
U. S. Public Health Service
Reinspections:
Passenger _______________ _
laboratories ____________ _
14
284
Freight _________________ _
Other
laboratories ________ _ 1,208
518
Water boats _____________ _
28 Typhoid-fever cases reported:
U. S. Public Health Service
Certificates issued:
hospitals ______________ _
Regular, favorable ________ _
25
907
Regular, not approved ____ _
U. S. Public Health Service
2
quarantine stations _____ _
Temporary, favorable _____ _
0
696
Health departments ______ _
0
Plans for vessel water systems
examined:
Approval granted ________ _
8
Approval withheld ________ _
2
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Federal Reserve Bank of St. Louis
69
PUBLIC HEALTH SERVICE
B.
RAILROAD SANITATION SUPERVISION
Number Water examinations:
Number
Inspections :
Sources of water supply ____ _
61
U. S. Pu blic Health Service
Coach yards _____________ _
laboratories_____________
60
65
Terminals _______________ _
Other laboratories_________
864
31
Watering points __________ _
61 Major conferences:
Dining cars __ ____________ _
With railroad officials______
55
293
Commissaries ____________ _
With others_______________
94
51
Certificates :
Data reports reviewed _____ _ 1,805
Certificates prepared ______ _ 3,477
C. SHELLFISH SANITATION SUPERVISION
Inspections:
Number Laboratory examinations:
Number
Areas____________________
6
U. S. Public Health Service
Plants___________________
457
laboratories__ ___________
0
State certificates:
Other laboratories_________
0
Approved ________________ 2, 456 Conferences__________________
96
Not approved_____________
0
Approval withdrawn_______
9
Canceled_ ________________
421
D.
MISCELLANEOUS COOPERATION WITH GOVERNMENTAL AGENCIES
Number
Public H ealth Service (other divi- Number Bureau of Prisons:
Surveys _________________ _
sions):
10
Conferences _____________ _
Surveys__________________
6
10
Conferences_ _ _ _ _ __ _ _ __ __ _
17
Water examinations _______ _
5
National Park Service:
Others:
Surveys
_________________
_
Surveys__________________
41
66
Conferences _____________ _
Conferences______________
87
44
Water examinations ______ _
Water examinations________
386
11
Bureau of Indian Affairs:
Surveys__ ________________
86
Conferences_ _ _ _ _ _ _ _ __ _ __ _
56
Water examinations________
27
CooPERATION WITH OTHER FEDERAL AGENCIES ON
ENGINEERING WORK
PuBLic
HEALTH
Cooperative public health engineering work with other divisions of
the Public Health Service and with other Federal agencies has occupied 34 percent of the time of the field engineers, totaling 1,544 engineer days; 416 days were devoted to the Park Service, 453 days to the
Office of Indian Affairs, and 269 days in connection with mosquito
control in the District of Columbia.
National Resources Committee.-An engineer officer of the Public
Health Service has served throughout the year as a member of the
water resources committee of the National Resources Committee.
Assistance was rendered this committee by both engineer and medical
officers in connection with various phases of water conservation.
Cooperation was given to the regional water consultant in assembling data on pollution conditions in the Ohio Valley.
Public Health Service, Hospital Division.-Advice was given relative
to sewage treatment at one marine hospital and to water problems
at another.
Public Health Service, Mental Hygiene Division.-An engineer was
assigned to the United States Narcotic Farm for a temporary period
in connection with operation of sewage-disposal plant and the training
of personnel necessary for satisfactory operation of the plant.
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Federal Reserve Bank of St. Louis
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PUBLIC HEALTH SERVICE
Interior Department, National Park Service.-Eastern division:
Inspections were made of sanitary conditions in the various areas
and recommendations made relative to water supplies, sewage disposal, and garbage disposal, including the preparation of plans for
12 of the areas. In addition, general supervision of swimming pools
in the National Capital was provided. Western district: 15 inspections of the same nature as described for the eastern division were made
of the national parks and national monuments. Twenty-three plans
for sewage-disposal plants, water-treatment plants, and garbage
incinerators were prepared, and over 200 plans were prepared by the
Park Service checked and approved. The district engineer at San
Francisco continued as chairman of the building code committee of
the National Park Service and under his direction a revised code was
completed.
Interior Department, Office of Indian A.ffairs.-Sanitary inspections
followed by recommendations were made of 75 agencies. Thirty
plans for water treatment or sewage disposal were prepared, and 43
plans for water and sewage prepared by the Indian Service were
·
checked and reviewed.
Department of Justice, Bureau of Prisons.-Sanitary surveys were
reported, and recommendations were made at seven penal institutions
with design for sewage disposal at one. Advice and assistance were
given in connection with construction of the water-treatment plant
for McNeil Island penitentiary and assistance was rendered in connection with operation of this plant and the training of the operator.
Treasury Department, Procurement Division.-Inspections of water
supply and sewage disposal were made of two border inspection stations and plans for sewage disposal were prepared for two stations.
War Department, United States Engineers.-Assistance was rendered
the Office of the Chief Engineer in connection with the assembling and
reviewing of data relative to discharge of sewage from Federal·. establishments in the United States. A survey of a proposed camp site at
Conchas Dam, New Mexico, together with recommendations relative
to water supply, sewage and garbage disposal, and camp hospital, was
made.
Assistance was rendered in finding a suitable water supply at one
of the dams and locks on the Kentucky River. The installation of a
small vessel water-treatment plant designed for the U. S. S. Peary
was supervised.
Depa1'tment of Commerce, Lighthouse Service.-Inspections of eight
lighthouse stations on the Great Lake in connection with water supply
and sewage disposal were made. Money was made available by the
Lighthouse Service for the installation of a small experimental plant
to determine satisfactory methods for treating small volumes of water
suitable for lighthouse stations. Inspections of water-treatment plants
installed on four lighthouse tenders on the Great Lakes indicate
continuing satisfactory operation.
Civilian Conservation Corps.-Technical advice relative to sewage
disposal has been supplied when requested.
Resettlement Administration.-Frequent conferences have been held
with representatives of the Resettlement Administration in Washington and advice given pertaining to water supplies and sewage disposal.
An engineer officer was a member of a commission of 11 appointed to
investigate conditions at Matanuska .colony project in Alaska. Sur-
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PUBLIC HEALTH SERVICE
71
veys have been made for water supply and sewage disposal at two
administration projects.
Department of Agriculture, Bureau of Entomology and Plant Quarantine.-Ad vice was given in connection with the sanitation of the temporary white-pine blister-rust-control camps in California and Idaho
and inspections were made of 23 of these camps.
A small amount of service was also rendered the Forestry Service
and the Bureau of Public Roads, of the Department of Agriculture,
Bureau of Air Commerce of the Department of Commerce, and the
Coast Guard of the Treasury Department.
wORKS
PROGRESS ADMINISTRATION PROJECTS
MALARIA-CONTROL DRAINAGE
Technical supervision of Emergency Relief Administration and
Works Progress Administration malaria-control drainage projects
was continued throughout the year. This work was carried out in
cooperation with the State health departments of the 16 States which
comprise the malaria belt. The plan was inaugurated under the
Civil Works program, and operation has continued along essentially
the same lines under the Emergency Relief and Works Progress programs, which replaced the Civil Works program about the middle
of the fiscal year.
As has been set forth in previous reports, the control measures were
concentrated in areas where the effects of the infection were particularly noticeable, in villages and towns and in industries. While the
death rate from malaria is not high in comparison with the death rates
from other diseases, the high morbidity rate makes malaria a major
public health problem in the South.
During the year the technical supervisors assigned to the State
health · departments by the Public Health Service directed malariacontrol drainage projects of the Emergency Relief Administration and
Works Progress Administration which accomplished the construction
of an estimated total of 6,000 miles of average-sized ditch. An average of approximately 17,000 men were employed on this work throughout the year. This brings the total ditch construction of the Civil
Works, Emergency Relief, and Works Progress programs to an estimated total of 22,000 miles, resulting in the drainage of approximately
340,000 acres of malaria-mosquito breeding areas and furnishing
protection from malaria to about 14,000,000 people. At the time of
change- of operations from the Emergency Relief Administration to
the Works Progress Administration there was, owing to change of
administration, a decrease in the number of laborers working and.
consequently, a smaller amount of ditch construction. During this
period the technical supervisors devoted their efforts to making
selections and engineering surveys of future projects.
The effectiveness of the malaria-control drainage work was mo~t
noticeable during the malaria seasons of 1934-35. Despite the fact
that these years were "epidemic" years, reports from various State
health departments indicated that malaria did not increase or was not
present in former malarious areas in which malaria-control drainage
projects were prosecuted. However, in malarious a:reas, and in some
areas which had been malaria free for a number of years past, in which
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Federal Reserve Bank of St. Louis
72
PUBLIC HEALTH SERVICE
no control measures were carried on, the prevalence of malaria reached
epidemic proportions. Malaria was generally prevalent in the United
States in epidemic proportions during the summers of 1934-35 to a
greater extent than any other .period during the last 20 years. Malaria
in this country is not static, but cyclic. The underlying factors controlling this cyclic occurrence are not well understood. However,
it is believed that had the malaria-control drainage projects not been
as extensive and so well selected and supervised, the epidemic condition
described above would have reached far greater proportions.
COMMUNITY SANITATION PROGRAM
Authorization, effective July 1, 1935, was granted by the Works
Progress Administration to continue the emergency relief community
sanitation program inaugurated under the Civil Works Administration in November 1933 and continued under the Federal Emergency
Relief Administration. Project applications were submitted to the
Works Progress Administration by the various State h~alth departments covering the work which it was proposed to carry on under the
Works Progress Administration program.
There was, of necessity, some time required for the transfer of the
activities from the Emergency Relief Administration to the Works
Progress Administration set-up, and consequently some delay in
getting the program under way. Some time was required by the
Works Progress Administration in effecting administrative changes
and for the approval of the new project applications which had been
submitted from the viarious States. In a few States actual construction work was begun in the latter part of August, but in a large
majority of the States the actual execution of the projects did not start
until October 1935. In a few instances actual construction was started
in January 1936.
Project applications were submitted for community sanitation
projects from 41 States, and these were approved by the Works
Progress Administration in Washington. Technical supervision of
the Works Progress Administration community sanitation program
was effected through the State health department of each State, with
the State health officer acting as the agent of the Public Health Service.
An administrative allotment of Works Progress Administration funds
was made available to the Public Health Service for the technical
supervision of the Works Progress Administration community sanitation program, and technical supervisory personnel appointed on the
recommendation of the State health officer in each State was assigned
to the State health department to assist the State health officer in the
supervision of this work. Allocations of technical supervisory personnel were made to each State on the basis of the existing needs and
in relation to the number of laborers which it was expected would be
assigned to the work projects by the State works progress administrator. As the program progressed, adjustments were made from
time to time in the original number of technical supervisory personnel furnished to the States in order to maintain the cost of supervision more in line with the labor cost. In Michigan, Minnesota, and
Massachusetts no funds were released by the State wm:ks progress
administrator for the prosecution of the work, and the community
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PUBLIC HEALTH SERVICE
73
~anitation programs were discontinued in those States on November
15, 1935, April 30, 1936, and June 30, 1936, respectively.
The work carried out under the program consisted of the installation of sanitary privies for the elimination of existing insanitary
methods of excreta disposal in those · areas where sewer systems were
impracticable and the construction of septic tanks on public property,
particularly at schools. Calculated on a 10-month basis, community
sanitation projects were in operation in an average of 911 counties in
38 States, with an average of 17,358 relief laborers employed. For the
period··September 12, 1935_, through June 30, 1936, 344,250 sanitary
privies were .installed in accordance with standard plans and specifications approved by the Public Health Service and the various State
health departments. Since the time the programs were in operation
in the 38 States averages less than 7 months, it is believed that very
creditable results have been accomplished. The excellent cooperation accorded the community sanitation program by the Works Progress Administration in Washington and in the States generally has
contributed in a large measure to the accomplishments.
This Office endeavored to assist the State health departments in
every way possible in the execution of the Works Progress Administration community sanitation program and has furnished standard
plans and s;recifications for the construction of sanitary privies,
literature on this subject, and suggestions relative to the conduct of the
program when requested or deemed advisable. A representative of
the Service has acted as liaison officer between the Service and the
Works Progress Administration. This arrangement has been quite
helpful in adjusting difficulties and solving various problems which
arose concerning the program during the fiscal year. Under the plan
as agreed upon at the start of the Works Progress Administration
program it was necessary for community sanitation, malaria-control
drainage, and mine-sealing projects to be cleared by the Public Health
Service before such projects would be approved by the Works Progress
Administration, and a representative of this Office was assigned to this
duty by the Service. Thjs system of clearance of projects is regarded
as an excellent arrangement and has made it possible to eliminate a
number of projects which were not considered suitable or desirable
for operation as Works Progress Administration community sanitation
or as public health projects.
The accompanying table shows the number of counties operating,
the number of laborers employed, and number of privies installed
under the Works Progress Administration community sanitation program, by States, as · of June 30, 1936. There is also presented a
table showing the number of privies constructed under the Works
Progress Administration, Civil W ork:s Administration, and Federal
Emergency Relief Administration, and the total for the three emergency
relief programs is also attached. These data were compiled from reports submitted to the Service by the various State health departments. It will be noted that as of June 30, 1936, 905,533 sanitary
privies had been installed, thereby eliminating an equal number of
insanitary conditions which constituted a constant danger to the health
of the citizens of the communities in which these insanitary conditions existed.
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Federal Reserve Bank of St. Louis
74
PUBLIC HEALTH SERVICE
Progress made in the execution of Works Progress Administration community sanitation projects as of June 30, 1936
State
Number of
privies con•
Number Number Number
structed
of
of
of
W. P .
counties laborers
privies Period covered by report under
A. July 1,
operating employed
built
1935-June 30,
1936
Alabama .......•.....•••...•....
Arizona ....•..............•••...•
Arkansas.•...•...•...........•..
California .•.....................
Colorado ...•............... _..•.
Delaware..... _... _........•.....
Florida ....... . ................. .
Georgia.......... -•.•............
Idaho ....•..........•. -·- .... -·. Illinois._ .........••.••.•.•••.••.
Indiana ........ .•. ........•••••..
Iowa .. ·········--··············Kansas. _. ........•. ___ ......... .
fi~rs~~~t:=====================
14
14
74
35
25
1
5
45
26
46
86
13
55
67
16
18
174
180
1,176
690
265
26
54
462
272
855
1,579
135
480
710
250
174
74 June 15 to June 30..•.•..
260 ..... do .•..•..•....•••...•
969 ..... do .......••..........
567 June 13 to June '1:7 •••••••
337 June 15 to June 30.••••..
24 ..... do .. ..............•.•
62 June 13 to July 3.•...•..
1,030 June 1 to June 30...••...
267 June 15 to June 30...... .
• 731 June 18 to July 2....... .
3,395 June 1 to June 30.•......
61 June 22 to June 30..•.. . .
407 June13toJuly4....... .
981 June 19 to July 2....... .
280 June 15 to June 30. ..... .
554 May 23 to July 4......•.
Maryland........ ...............
Massachusetts 1 •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
Michigan 2••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
Minnesota a.......................•••...•......... ••.........••....................•••••
Mississippi..................... .
58
602
804 June 15 to June 30...•.••
Missouri..................... . ..
1
9
25 May 23 to June 30....•..
Montana........................
17
179
186 June 15 to June 30 .....••
Nebraska. .......................
8
70
58 June 17 to June 30..•.. r .
New Jersey......................
10
149
155 June 15 to June 30..•....
New Mexico.....................
7
51
97 June 1 to June 30....... .
North Carolina..................
36
426
1,331 June 13 to July 4 .•......
North Dakota...................
31
402
614 ..... do .............••.•..
Ohio............................
84
1,598
2,239 June 13 to June 29 ...... .
Oklahoma.......................
40
520
250 June 15 to June 30..•....
Oregon. .........................
20
206
278 ....• do . .•.•••.........•••
Pennsylvania:
Regular.....................
42
571
912 ..... do .. .. ...•...........
Flood .. ............•....••.......... .. .•..... ... .......... Mar. 24 • to June 30.... .
South Carolina..................
46
762
997 June 18 to July 2.... .. . .
2
i~1;;;1efse~~~~~===================
1,
1,
~5tioJ¥~e
Texas • . . ~.. .....................
44
869
440 .•... do.................. .
Utah............................
22
369
381 ..... do ..... · ......•......
Virginia.........................
56
769
1,744 .. ... do ..•.......•....•...
Washington...... .. .............
15
230
180 .... . do. ..............•...
West Virginia...................
55
1,680
2,728 June 13 to June 28...•...
Wisconsin.......................
18
275
166 ..... do..... ....... .••....
Wyoming................. .... ..
15
126
104 June 15 to June 30 ..••...
Total (41 States) for period.
Total as of June 15, 1936...
Gain during period June
15 to 30 .. ...•..••••••••..
1 No labor assigned. Discontinued
2 No labor assigned. Discontinued
• No labor assigned. Discontinued
' Last report under flood·sanitation
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Federal Reserve Bank of St. Louis
~!
!i~
1,256
1,159
19,366
18,599
+97
+767
June 30, 1936.
Nov. 15, 1935.
Apr. 30, 1936.
program.
~g~ ~~:
--
k::::::
---
--- -- ------ ------ - ------ ---- - -- -
25,891 -.. - - -- - --- ----- --- 22,014 ------ -- --- - -- -- ---+3,877
2,277
3,527
17,074
7,97Z
3,713
301
54S
7,787
4,195
5, 71[.
24,030
931
5,448
14,780
2,589
2,282
0
0
0
16,349
27
2, '1:17
370
596
4,645
14,916
3,939
24,330
40,066
3,499
2,642
806
15,011
1,044
22,3657,915
8,808
· 29, 495
1,269
39,219
907
584
344,250
318,359
+25,891
75
PUBLIC HEALTH SERVICE
Number of new privies reported installed in each State from week ending Dec. 16,
1933, to June 30, 1936, under Civil Works Administration, Emergency Relief
Administration, and Works Progress Administration programs
Number of
Number of privies con•
Number of privies con• structed
con• structed to June 30,
Date of privies
structed
under
1936, under
last re•
under
C . W. A. C . W. A.,
report
W. P.A.
and
E. R. A.,
program
E. R. A.
and
programs
W. P. A.
programs
State
Alabama ..........•.•..• •••.•.•.......................•..
Arizona .............•....................................
Arkansas................... ..............................
California........................................ ........
Colorado.................................................
Delaware................................................
Florida ..........................•.......................
Georgia.................................... . .............
Idaho. . ................................. .................
Illinois....................... ............................
Indiana................................................. .
Iowa. . ...................................................
Kansas......................... ..........................
Ken~~cky ................................................
1996
June 30
June 30
June 30
June 27
June 30
June 30
July 3
June 30
June 30
July 2
June 30
June 30
July 4
July 2
2,277
3,256
3,527
250
17,074
27,548
7, 972
1,872
3, 713 .•..........
301
168
548
9,187
7, 787
19,687
4, 195 .•..........
5, 717
2,801
24, 030
25, 228
931
376
5,448
8,037
14, 780
18,006
.~~!~.~....... ~~~;......~~~~~!.
~:r;1;~ti£i~==========================================
Michigan 2............................................... .......... . . . .........
Minnesota
0
3,016
3,016
0
3••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
~~~~:r~i----=============================================
~e~~~~·.·--==============================================
New Jersey.................................. . ...........
~~: :
~~:
~g
June 30
New Mexico ............................................. June 30
North Carolina.......................................... July 4
~gri~.~~~~.t~----==========================================
g~:~~~~--.~=============================================
Pennsylvania:
Regular .....•..............•.......................•.
Flood . ............... ........ ............... •....... .
South Carolina ....•...................•..................
South Dakota ........................................... .
Tennessee ...............•.•........•.....................
Texas .............•.............•........................
~~:e 2:
~~~: ~g
June
June
July
June
June
June
June
~iagtua.================= ========= ====================== = June
Washington .......... .................. .................. . June
June
June
Wyoming ...........•...•............•................... June
~r:Jo!~tnia........................................... .
30
30
2
27
30
30
30
30
30
28
28
30
Total (41 States) •...............................•...•••.•....
t
5,533
3,777
44,622
9,844
3,713
· 469
9,735
27,474
4,195
8,518
49,258
1,307
13,485
32,786
44,362
8,763
Discontinued June 30, 1936.
2 Discontinued
Nov. 15, 1935.
3~~
2, 596
~~~
16,
4,645
14, 916
~:
m
········~:~.
.•....•.....
409
62, 0 9
~: ~~i 15, t~i
4g: ~gg ..... :~~~~~.
2,642
806
15,011
1,044
22,365
7,915
8,808
29,495
1,269
39,219
907
963
39,621
43,778
70,370
2,052
26,330
796
75,869
39,576
5,348
2,401
370
596
5,054
77,005
4,382
40,001
66,600
3,499
3,605
806
54,632
1,044
66,143
78,285
10,860
55,825
2,065
115,088
907
584
584
344,250
561,283
3 Discontinued
905,533
Apr. 30, 1936.
SEALING ABANDONED BITUMINOUS MINES
This project originated under the Civil Works Administration and
has for its object the air sealing of abandoned bituminous-coal mines
in order to prevent the formation of sulphuric acid and its discharge
in mine drainage, thereby affecting public water supplies.
The project was gotten under way in December and January in
7 States. Projects were set up in 124 counties, of which number work
has been carried on in 88. Over 3,000 men have been supplied by the
Works Progress Administration for this work. At the close of the
year 522 mines, with 5,699 openings, had been closed or were in the
process .of being closed.
101889-36--6
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76
PUBLIC HEALTH SERVICE
The technical supervision of this work was carried on under the
immediate direction of the State department of health, the Public
Health Service maintaining advisory service. Supervisory personnel
is furnished through funds made available to the Treasury Department.
PLUMBING INSPECTION OF FEDERAL BUILDINGS
This project consists of inspection of plumbing of Federal buildings
in New York City, N. Y., and Detroit, Mich., for the purpose of
determining whether the existence of defective plumbing may be a
possible health hazard and to develop satisfactory methods for carrying on inspection work of this type.
The project includes the inspection of 812 buildings, with 17,400,000
square feet of floor area, in New York City, and 92 buildings, with
969,000 square feet of floor area, in Detroit. This is exclusive of
buildings under the control of the Navy Department.
The training school for nonrelief supervisory force was held in New
York in May. This was followed by actual inspection work in the
field. At the close of the year less than one-third of the personnel
required had been allocated by the Works Progress Administration.
The inspection work completed at the close of the year totaled
1,041,000 square feet of floor space in New York City and 162,000
square feet of floor space in buildings in Detroit.
ANNUAL CONFERENCE OF THE SURGEON GENERAL WITH THE STATE
AND TERRITORIAL HEALTH OFFICERS
In accordance with the act of July 1, 1902, the Thirty-fourth
Annual Conference of the Surgeon General with the State and Territorial Health Officers was held April 13 and 14, 1936, in the Public
Health Service Building at Washington. Delegates from 41 States
and Territories were present. On the first day special emphasis was
placed upon discussion of measures for the control of venereal diseases
and State programs for industrial hygiene. The second day was given
to reports of committees having to do with the regulations to govern
allotments and payments to States under title VI of the Social Security
Act, recommendations on qualifications of public health personnel,
records and report forms to be used in recording and reporting healthdepartment activities, proposed stream-pollution legislation, and the
sanitary control of shellfish shipped in interstate traffic.
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DIVISION OF FOREIGN AND INSULAR QUARANTINE AND
IMMIGRATION
Asst. Surg. Gen. F. A.
CARMELIA
in charge
The various quarantinable diseases continued to prevail in many
parts of the world. Cholera was confined to southern Asia and the
adjacent islands, while typhus fever was reported from all the great
divisions of the earth. Smallpox and plague also had widespread
distribution. The bubonic plague reported in Argentina, Brazil,
Bolivia, Ecuador, and Peru was of particular interest from a quarantine standpoint because of the increased tonnage of grain (rat-attractive cargo) imported into the United States from South America
during the year. Yellow fever was reported in Brazil, Bolivia, and
Colombia, and in Senegal, Gambia, Sierra Leone, Ivory Coast, Gold
Coast, Togo, Dahomey, Nigeria, Niger Territory, French Sudan, and
French Equatorial Africa. The occurrence of yellow fever in South
America presents a quarantine hazard of considerable magnitude in
connection with the rapid airplane transportation from these countries direct to continental United States ports located in our large
southern territory infectible with yellow fever.
No quarantinable disease was imported into the United States or
its dependencies during the year. One vessel arrived at Boston,
Mass., with a case of smallpox on board. The patient was detained
at quarantine until all of the necessary precautions had been taken
by the quarantine officers to prevent the introduction and spread of
this disease in the United States. During the quarantine inspection
of arriving persons at a Mexican border subport of entry, a case of
smallpox was detected in an alien, who was accordingly refused entry
into the United States. Another alien making clandestine border
crossing was picked up by the border patrol, and when taken as a
prisoner to El Paso he was found to have smallpox and was returned
to Mexico under custody of the Mexican health authorities.
During the year 15,981 vessels arriving from foreign countries, carrying 1,915,727 persons, were inspected by medical officers of the
United States Public Health Service prior to entry at United States
ports in order to prevent the introduction of quarantinable diseases.
Of these vessels 7,247 required· rat-infestation inspection by quarantine officers, of which number 1,887 were issued international standard
certificates of deratization exemption, and 1,1.93 were fumigated and
issued international standard certificates of deratization. A total of
4,585 rats was retrieved on vessels following fumigation, of which
number 2,971 were examined for plague infection. Of the arriving
vessels 1,693 presented international standard certificates of deratization issued by foreign countries, of which only 116 were not accepted,
and 2,474 vessels presented foreign certificates of deratization exemption, of which only 145 were refused. The decreasing ratio of vessels
fumigated to those exempted from fumigation has been markedly evi77
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PUBLIC HEALTH SERVICE
dent in recent years. This reveals the effect of Public Health Service
efforts to have ratproofing principles incorporated in the construction
of vessels engaged in maritrme commerce.
It was necessary for the Department to assess penalties aggregating
only $460 during the year for violations of the quarantine laws of the
Umted States by masters of vessels arriving from foreign ports.
Of 3,823 aircraft, carrying 37,352 persons, arriving at United States
ports from foreign countries, 2,281, carrying 31,898 persons, were
accorded quarantine inspection at the first port of entry in the United
States. Of 8,645,193 persons accorded quarantine inspection upon
arrival at United States ports of entry along the Mexican border
8,588,044 were passed without treatment, and 57,149 were required
to undergo quarantine treatment such as vaccination and delousing.
The International Sanitary Convention for Aerial Navigation of
The Hague, 1933, became effective with regard to the United States.
on November 22, 1935. The provisions of the Convention applicable
to air commerce between foreign countries and the United States have
been placed in effect. The only noteworthy change in existing procedures resulted from the provisions of article 9, which substitute a
journey log for the bill of health formerly required to be carried by
aircraft. The promulgation of this Convention facilitates the application of measures for protecting the United States against the introduction of quarantinable disease through air commerce. During the
year the number of countries participating in this Convention for
Aerial Navigation was increased by the ratification of Austria, Belgium, Italy (with its colonies), and Poland; by the adherence of
Turkey, and by the accession, through the Australian Government,
of the territories of Papua and Norfolk Island and the mandated
territory of New Guinea. The International Office of Public Health
reports that the internal regulations of several countries have been
brought into line with the provisions of the Convention, and the practice followed by the responsible authorities in other countries has
been adapted to those provisions, thus eliminating to a large extent
the previously existing lack of uniformity in practice. The number
of countries at present participating in the Convention shows clearly
the interest which is being manifested all over the world in the umfication of the rules applicable to aerial traffic from the point of view
of sanitary defense.
With the inauguration of aerial transport service across the Pacific,
linking up with air lines already established in the Orient from Shanghai and the interior of China, via Manila to the East Indies and
Straits Settlements, exposing to infection our Pacific coast, as well as
Hawaii and the Philippine Islands, particularly with reference to
cholera and smallpox from endemic and epidemic foci in the Orient,
it became necessary to issue special instructions regarding aerial
quarantine activities to the quarantine stations at San Francisco,
Honolulu, and Manila. In addition, the Service is extending its
effort to prevent the introduction of mosquito vectors of malaria into
the Territory of Hawaii, where malaria does not now exist, owing to
the absence of such insect carriers. To this end all aircraft are
required to be inspected and fumigated both upon departure for and
arrival at Honolulu. Officials of the Pan American Airways have
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PUBLIC HEALTH SERVICE
79
expressed a desire to cooperate by screening their planes and using a
spray fumigant mosquitocide on planes while in flight between ports.
Scientific investigation at the New Orleans quarantine station has
been effective in developing a nonflammable mosquitocide which, in
laboratory tests, produced a 100 percent mosquito kill following 5
minutes' exposure to as little as 5 cc of a carbon tetrachloride and
pyrethrum extract mixture finely sprayed in 1,000 cubic feet of space.
As this mosquitocide mixture is nonflammable and in the concentrations used apparently harmless to human beings, it appears to be the
most ideal mosquitocide yet developed for use on aircraft in flight to
prevent the transportation of mosquito vectors of human disease.
In conformity with the provisions of article 6 of the Sanitary Convention of Washington, 1905, and articles 56 and 57 of the International Sanitary Convention of Paris, 1926, an informal agreement was
reached in August 1935, between the United States Public Health
Service and the chief of the quarantine service of the Republic of
Cuba, providing for reciprocal recognition of international standard
form certificates of deratization exemption when issued by the competent authority of either country to vessels which are maintained in
a rat-free condition. This agreement is of distinct aid to vessels
plying in trade between Cuban and United States ports, as it lessens
the number of fumigations they might otherwise be required to
undergo.
In May 1936 the attention of the Quarantine Commission for
Aerial Navigation of the International Office of Public Health was
invited to the failure of the International Sanitary Convention of
Paris, 1926, and . the International Sanitary Convention for Aerial
Navigation, The Hague, 1933, adequately to provide for the sanitary
supervision of postal packages mailed in international commerce
which contain material infectious to man. Several examples were
cited of instances of such nature which had recently arisen in the
United States and in which the actual or potential public health
menace involved was obvious. While the Universal Postal Union
Convention of Cairo, 1934, prohibits the importation into any country
of articles whose circulation is forbidden under the laws of that
country, the International Sanitary Conventions of Paris and · The
Hague prohibit adequate sanitary supervision of such postal packages
containing such material. It was recommended to the Commission
that the situation arising from the obvious contradiction be.t ween the
texts of the Sanitary Conventions and the Postal Convention be
remedied by the adoption of a general resolution involving a rather
liberal interpretation of the wording of the pertinent provisions of the
several international conventions. The Commission, however, expressed itself as believing that such matters could be adequately
handled by the prohibition of the circulation of such materials on
national territory. It stated, however, that the question would
remain on the agenda for further consideration should occasion arise.
During the year the fumigation of ships has been increased in
efficiency by requiring the use of calcium cyanide dust for injection
into concealed rat harborages as a supplement to hydrocyanic acid
gas fumigations. The value of this procedure was developed through
experimental work performed at the New Orleans quarantine station.
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Federal Reserve Bank of St. Louis
80
PUBLIC HEALTH SERVICE
The safety of cyanide fumigations has been enhanced by requiring
the use of prewarning gases prior to fumigation of loaded vessels
which are so constructed or so loaded as to preclude thorough preliminary search for stowaways. Postwarning gases are also required
to be used following cyanide fumigations when possible danger might
result from the slow liberation of the fumigant absorbed by bulky
materials such as bedding and clothing.
To promote the usefulness of international standard form certificates
of deratization and deratization exemption, the Public Health Service
has inaugurated the use of a graphic chart showing a longitudinal
section of a vessel upon which is recorded by symbol and number
the status of rat life and rat harborage aboard a vessel. The use of
this chart was presented for discussion at the Third Pan American
Conference of National Directors of Health, in April 1936 and to the
Permanent Committee of the International Office of Public Health
in Paris, and much interest was manifested in its international
applicability.
During the year there was completed the rehabilitation of the
Reedy Island (Del.) and the Savannah (Ga.) quarantine stations.
Important additional facilities at Rosebank, at the New York (N. Y.)
quarantine station, and bulkheading and other shore protective construction at the Port Townsend (Wash.) quarantine station were also
completed. Construction was commenced of the new Tampa Bay
(Fla.) quarantine station, at Gadsden Point. A site was acquired
for the new Narragansett Bay (R. I.) quarantine station, at Newport.
Construction of floating equipment during the year was comparatively limited, the only vessel constructed being a 50-foot boat, the
W. H. Hutton, for the Miami Quarantine Station. This vessel is
Diesel-driven and is unique in that it is the first all-welded, handpuddled, wrought-iron vessel ever to be constructed in the United
States.
Medical inspection of aliens.-During the fiscal year 824,401 alien
immigrants were examined and 722,756 alien seamen were inspected
at United States ports of entry by medical officers of the United
States Public Health Service in accordance with the provisions of the
immigration laws, the examination of 53,793 alien passengers and
281,224 alien seamen for immigration purposes having been performed
at quarantine stations in conjunction -with quarantine inspections.
Of these persons, 1,338 alien immigrants and 627 alien seamen were
certified to be afflicted with one or more of the physical or mental
defects or diseases requiring exclusion, and 13,768 alien immigrants
and 492 alien seamen were certified to be afflicted with conditions
likely to affect their ability to earn a living.
During the year 38,619 applicants for immigration visas were
examined by medicn,l officers in American consulates in foreign
countries. Of this number, 620 were reported by the medical officers
to the American consuls as being afflicted with one or more physical
or mental defects or diseases requiring exclusion, and 6,878 were
reported as afflicted with a condition likely to affect their ability to
earn a living. Only four of the aliens to whom visas had been issued
following satisfactory examinations in American consulates in foreign
countries were certified upon arrival at a United States port as being
afflicted with a defect or disease requiring exclusion.
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Federal Reserve Bank of St. Louis
THE QUARANTINE LAUNCH " W . H . WELCH " , A 100-FOOT BOAT DESIGNED FOR INSPECTION AND FUMIGATION WORK AT THE LARGER PORTS .
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
It is powered by two 360 h . p. Diesel engines and is electrically propelled and controlled.
ONE OF THE NEW SMALLER QUARANTINE LAUNCHES (4 0 FEET) DES IGNED FOR USE AT SMALLER PORTS AND IN SOUTHERN WATERS.
It has a 60 h. p. Diesel engine and a welded wrought-iron hull, which will not be affected by dry rot, teredos, or corrosion.
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Federal Reserve Bank of St. Louis
81
PUBLIC HEALTH SERVICE
TRANSACTIONS AT MARITIME QUARANTINE STATIONS
TABLE
1.-Summary of transactions at maritime stations for the fiscal year 1936
Vessels
fumigated
Station
DeBills of
ratihealth
zation
and
ex- PassenVessels Vessels
port
emp- gers in- Crew
inspect- granted
sanifree pration spected inspected tary
ed
tique Cya- Sul- cerstatenide phur tifiments
cates
issued
issued
Amount
of bills
rendered
for quarantine
services
--- --- -- -- -- --- ---- --- ---Aberdeen, Wash ______________
8
8
Angel Island, Calif. (San
Francisco). _____ -----------292
447
Astoria, Oreg _________________
27
30
Baltimore, Md _______________
455
525
Beaufort, S. C ___ _____________
0
0
Boca Grande, Fla _____________
14
14
Boston, Mass _______ __________
822
689
Brunswick, Ga _______________
6
6
Carrabelle, Fla __________ _____
31
.31
Charleston, S. c ______________
146
147
Corpus Christi, Tex.I _________
74
74
Eastport, Maine ______________
2
2
Eureka, Calif_ ________________
4
4
2
Fall River, Mass-----~------2
Fernandina, Fla. (Cumberland Sound) ________________
3
3
Fort Monroe, Va _____________
260
280
Freeport, Tex _________________ -------Galveston, Tex _______________
613
638
Georgetown, S. c _____________
0
0
Gulfport, Miss ___ _____________
18
18
Jacksonville, Fla. (St. Johns
River) __ . _______ -_-- - -- - --- 124
93
Key West, Fla ________________
177
181
Lewes,
Del.
(Delaware
Breakwater). _____________________
0
0
Los Angeles, Calif. ___________ 1,409
1,118
Marcus Hook, Pa _____________
601
689
Marshfield, Oreg. (Coos Bay)
16
16
Miami, Fla ___________________
927
927
Mobile, Ala __________________
156
169
New Bedford, Mass __________
2
3
New London, Conn __________
13
13
New Orleans, La _____________ 1,244
1, 161
Newport, R. !_ _______________
3
3
New York, N. Y,2 ____________ 3,408
2,934
Ogdensburg, N. Y ____________
0
0
Panama City, Fla ___ _________
13
13
Pensacola, Fla __ ______________
29
45
Plymouth, Mass _____ _________
6
8
Port Everglades, Fla _________
124
124
Port Isabel, Tex ______________
4
3
Portland, Maine ___ ___________
115
108
Portland, Oreg _____ __________
6
8
Port San Luis, Calif. (San.
Luis Obispo) ____ ___________
60
60
Port Townsend, Wash. 3 ______
45
50
Providence, R. !_ __ ____ _____ __
34
36
Sabine, Tex ___ __ _________ _____
407
365
San Diego, Calif. (Point
553
Loma) ____ ---------------- __
554
Savannah, Ga ________________
91
101
Searsport, Maine _____________
13
13
South Bend, Wash ___ ______ __
17
17
Southport, N . C. (Cape Fear)_
47
50
'l'ampa, Fla __________ ________
254
298
Vineyard Haven, Mass _______
0
0
West Palm Beach, Fla ________
109
109
TotaL __________________ 13,249 11,722
---
Alaska:
Ketchikan ________________
Wrangell_ ________________
0
0
0
1
299
386
$80. 00
49
5
72
0
0
70
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
114
0
152
0
3
63
0
0
5
0
2
0
0
25,786
52
161
0
11
28,321
0
0
938
2
0
3
0
49,527
1,901
17,434
0
506
56,985
162
303
6,332
2,412
39
138
60
0
927
0
0
0
0
60
7
0
569
5
28
30
11,551.01
358. 47
12,261.00
0
165. 00
17,176.00
60.00
155. 00
1,944.82
780. 00
15. 00
40.00
20.00
0
3
1
13
0
24
0
8,209
97
23,084
43
1,042
96.69
4,050.31
8
0
2
0
0
0
81
1
2
1,943
0
22
21,824
0
483
0
1
95
32
4
0
0
14
6
42
10,655
2,624
10,564
696
27
3,267. 59
2,300.52
0
78
49
0
40
12
0
0
61
0
218
0
2
5
0
0
0
0
10
0
0
0
1
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
215 24,208
103
1,218
0
0
6 40,024
162
39
32
0
25
0
181 11,240
20
0
628 427,959
0
0
31
3
0
7,582
4,483
0
0
5
9
4,821
37
18,819
0
411
830
0
0
4
64
2,739
0
26,169.57
10,817.34
165. 00
8,257.00
2,564.66
16. 44
135. 00
20,247.24
20.00
69,431.76
0
165. 34
813. 12
90.00
1,308.00
40.00
1,180.00
1,293.60
0
34
0
1
3
8
0
0
0
20
0
0
------
0
0
0
247. 57
9
10
0
5
0
1
13
46
378
0
84
13
0
77, 105
24,109
603
28,457
5,176
44
378
46,073
115
502,579
0
155
1,263
232
4,959
114
3,412
310
0
0
0
0
13
5
7
49
2
0
0
128
2,304
3,416
1,132
13,952
0
3,210
59
0
1,045.00
4,690.85
500. 00
4,181.33
0
0
0
0
3
0
0
0
50
5
0
1
2
33
0
0
15,024
90
0
0
27
468
0
149
40,732
2,977
0
745
1,447
6,124
0
576
241
0
15
63
0
1,564
0
0
3, 791. 15
1,464.55
115. 00
170. 00
639. 97
3,258.51
0
545. 00
0
0
0
0
0
0
0
0
71
- --- - - - --- - - - 19- -1,835 597,484
963,263 48,943 225, 775. 72
791
----
·--- --- - - - 0
0
---------8,091.31
0
0
0
0
0
0
------0 - -0 - -0 --0 ---0 ----0 ---0 ----0
Total ___________ -------0
-----------=
Includes Port Aransas, Tex.
2 Includes Perth Amboy, N. J.
a Includes all ports on Puget Sound.
1
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Federal Reserve Bank of St. Louis
82
PUBLIC HEALTH SERVICE
TABLE
1.-Summary of transactions at maritime stations for the fiscal year 1936Continued
Vessels
fumigated
DeBills of
ratihealth
zation
and
ex- PassenVessels Vessels
port
empCrew
granted
inspectgers
insanition
inspected tary
free praed
tique Cya- Sul- cer- spected
state· nide phur tifiments
cates
issued
issued
--- -- -- -- --- ---- ---
Station
Hawaii:
Ahukini_ ___ ______________
Hilo _______________________
---------------Honolulu
KabuluL
Port
Allen_---------------________________
Lahaina __________________
Mahukona _______________
TotaL __________________
Philippines:
Cavite ____________________
Cebu _____________________
Davao __________ ---·------_____ -- --- -- - -- -- - -- JIloilo
olo _______________________
Legaspi__ ______ - __ __ -- - - -Manila ___________________
Olongapo_ ---------------Zamboanga
_____ __________
TotaL __________________
Puerto Rico:
Aguadilla ___________ -- __ -Arecibo ___________ -__ _--- Arroyo ___ -- __ ----------- Central Aguirre ___________
Fajardo ___________________
Guanica ___________________
---------------Humacao
Mayaguez ______________ __
Ponce
___ __
----------------San
Juan
____ ___________
1
10
172
3
5
0
0
1
10
161
3
5
0
0
0
0
12
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
38
732
43, 128
200
177
0
0
0
223
36, 746
0
1
0
0
41
190
695
160
106
56
38
Amount
of bills
rendered
for quarantine
services
---$15. 00
141. 00
4,072.39
25. 00
55.00
0
0
- 191
- ----44,275
- - ---4,308.39
---0 - -3 --12
36,970
1,286
180
--- ----- -- -- --- ---- --- ---2
103
86
118
26
60
1,089
0
42
2
0
2
0
0
4
189
0
0
0
5
0
0
0
0
61
0
0
0
90
0
80
0
0
103
0
15
0
5
0
1
0
0
8
0
0
0
1,213
913
607
696
17
75,982
0
565
74
6,878
4,823
6,251
891
2,695
101,421
0
1,565
6
451
144
207
78
104
1,283
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
2
3
25
7
0
0
37
1
240
0
376
272
12,412
85
0
7
212
6
648
6
1, 251
1,601
28,965
111
45
75
54
349
62
69
238
264
735
35. 00
0
5. 00
40.00
5.00
255. 00
5. 00
365. 00
503. 00
5,956.40
.o
105
---- ----- - - ---124,598
79,993
2,378
0
--- --- -- -- -- --- ---- --- ----
-~- --288- --14--66
1,526
197
4
0
1
3
1
40
1
47
62
436
4 ,J
0
1
3
1
40
1
45
55
393
- - - - - --- - - - - - - - - --- - --TotaL __________________ --32, 781
2,002
7,169.40
31 13,345
543
6
0
595
Virgin Islands:
Cbristiansted _____________
Frederiksted _______ ____ __ _
St. Thomas _______________
-- -- -- --- ---- --- =
--4
38
378'
4
38
283
0
0
0
Total, all stations _______ 15, 981
12,967
875
TotaL __________________
TABLE
0
0
4
22
2,770
14,523
0
2,698
3,005
296
83
428
20. 00
595. 00
4,731.50
- -.- - - --- - - - - - - - --- - - - ----5,703
17,315
807
5, 346. 50
420
325
11
4
0
318 1,887 733,495 l, 182,232
55, 4161$242,600.01
2.-Statement of quarantine services rendered at maritime quarantine
stations during the fiscal year 1936
Station
Aberdeen, Wash ______________________________
Angel Island, Calif. (San Francisco) ___________
Astoria, Oreg __ _____ ____ _______________________
Baltimore, Md ______ ________________ __________
Boca Grande, Fla __ --------------------------Boston, Mass
__________________________________
------------------------ - -----Brunswick,
Ga
Carrabelle, Fla_------------------------------8~:;~;t8~~i~ti~"Tex:c========================
Eastport,
Maine ______________________________
Eureka, Calif. _________________________________
Fall River, Mass ______________________________
Fernandina, Fla. (Cumberland Sound) ________
1
0
0
11
Includes Port Aransas, Tex.
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Federal Reserve Bank of St. Louis
Inspection
services
Detention
services
$80
6,329
290
5,480
165
10,379
60
155
1,579
780
15
40
20
30
0
$6
0
0
0
60
0
0
0
0
0
0
0
0
Special
services
0
$1,100.00
0
1,520.00
0
842. 75
0
0
50.00
0
0
0
0
10.00
Fumigation
services
0
$4,116. 01
68.47
5,261.00
0
5,894.25
0
0
315. 82
0
0
0
0
56.69
Total
charges
$80.00
11,551.01
358. 47
12,261.00
165. 00
17,176.00
60.00
155. 00
1,944.82
780.00
15. 00
40.00
20. 00
96. 69
83
PUBLIC HEALTH SERVICE
TABLE
2.-Statement of quarantine services rendered at maritime quarantine
stations during the fiscal year 1936-Continued
Inspec•
tion
services
Deten•
tion
services
Fort Monroe, Va .. -----·········----····-·-·-·
2,935
Galveston, Tex•.•.... ·--··---·--·····-········
6,949
Georgetown, S. C--·----··--·········-········
0
165
Gulfport, Miss·--·· ···-·······················
Jacksonville, Fla. (St. Johns River).······-···
1,035
Key West, Fla....• ·-·······-·-·-·············
2,209
L ewes, Del. (Delaware Breakwater). ..........
0
Los Angeles, Calif. ......•...•.••....•.••....•. · 17,538
Marcus Hook, Pa.. ···················-·······
7,470
Marshfield, Oreg. (Coos Bay).-···········-···
160
Mia.mi, Fla.....••••• ·---·········-·-···-··-··-·
8,017
545
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
105
0
0
0
0
0
0
0
150,130
171
0
0
0
0
0
0
0
0
0
O
0
0
0
0
15
141
4,027
25
55
0
0
0
0
0
0
0
0
0
0
0
30.00
0
0
0
0
0
0
15. 39
0
0
0
0
15.00
141. 00
4,072.39
25.00
55.00
0
0
4,263
0
30.00
15. 39
(308.39
35
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
201.40
35.00
0
5. 00
40.00
5.00
255.00
5.00
365.00
503.00
5,956.40
Station
Bffiit~; ~~=::~=~~~=~~::~~:: : : :~~:=
Newport, R. I .• •············-···············-·
New York, N . Y .2·-·····················-·····
Ogdensburg, N . Y ...........•••.••.•••....••••
Panama City, Fla.........•.•.•.•.•...•.•..• -.
Pensacola, Fla.........•..........••..•.•. ·-···
Plymouth, Mass.-··············-·············
Port Everglades, Fla.·········-·-·············
Port Isabel, Tex...... ·-·········-·····-·······
Portland, Maine_.............................
Portland, Oreg................................
Port San Luis, Calif. (San Luis Obispo) •.•.. _.
Port Townsend, Wash.3···-···················
Providence, R. L-............................
Sabine, Tex................... ................
San Diego, Calif. (Point Loma)·-···-·--······
Savannah, Ga ...•.•.•.••.••..••.••• ·--········
Searsport, Maine ...••.•.•••...•.•••. -.........
South Bend, Wash............................
Southport, N. C. (Cape Fear).................
Tampa, Fla .. ············-········--····-···-·
Vineyard Haven, Ma.ss.·--··············-·····
West Palm Beach, Fla·--·····················
TotaL •••• -•• -·-·····-···················
Alaska:
Ketchikan.-........... ········-·········-Wrangell.······················-····-·····
TotaL .•.•. ··-· ··-- ••.• ····-····-··-··--·
Hawaii:
Ah ukini. -·····-···-··-···--··-·· ·····-····
Hilo ...................•...•.•.•.•...••.•.•
Honolulu.........•....•...•.•.•...........
Ka.hului. .......................... ·-.•.• -·
Port Allen ...............•.•......•...••.•.
Lahaina . ...........................• ·- _.•.
Mahukona ...... ··········-···-·-···-·····
Total ...••.•••• ____ ••.••.•••• _••• ·-•••.•.
Puerto Rico:
Aguadilla. _-······························
Arecibo .. ···········-·····················
Arroyo .......•.......•.••••.••.• ··-··-·· ••
Central Aguirre ___ ..•.•••••••••.•••...•.••
Fajardo __ ....... ··-·········-· .. ··-·-· •.••
Guanica.. ·-·-· •.• ·-··· ..•.•.•.•........•.•
H umacao.........•....•..•.• _...••.••• _. _.
M ayaguez.•.•.•.•. _••.•.•.•.•.•••.•.••.•..
Ponce •..•.......•...•••••....••••••••••.•.
San Juan ••••••••..•••••••.•••• ··-·-·······
TOtaL .•..... _•.• _. -· •.•••••. ·-••••••••••
Virgin Islands:
Christiansted ..• ·-.••.•...•...•.••• _·-•••..
Frederiksted ..•.•.•.•.•.•.•. ··-· •.•...•...
St. Thomas._···························-·
.: ~!
20
45,941
0
125
505
90
1,278
40
1,170
70
915
485
430
3,655
3,137
965
115
170
500
2,520
0
Fumiga•
tion
services
Total
charges
340. 00
835. 00
0
0
140.00
60.00
0
2,200.00
1,050.00
0
20.00
390.00
0
0
1,810.00
0
6,880.00
0
30.00
00. 00
0
30.00
0
10.00
215.00
130. 00
385.00
70.00
490.00
500. 00
40. 00
0
0
0
370.00
0
0
775. 31
307. 31
0
82.57
2,092.59
31.52
0
6,431.57
2,297.34
5.00
220. 00
439. 66
6.44
0
4,743.24
0
16,610.76
0
10.34
218. 12
0
0
0
0
1,008.60
0
3,820.85
0
36. 33
49.15
459. 55
0
0
139. 97
368. 51
0
0
4,050.31
8,091.31
0
247. 57
3,267.59
2,300.52
0
26,169.57
10,817.34
165.00
8,257.00
2,564.66
16.44
135.00
20,247.24
20.00
69,431.76
0
165. 34
813.12
90.00
1,308.00
40. 00
1,180.00
1,293.60
1,045.00
4,690. 85
500.00
4,181.33
3, 791. 15
1,464.55
115.00
170.00
639. 97
3,258.51
0
545.00
19,607.75
55,866. 97
225,775.72
Special
services
----1-----1-----·1---====l=====l=====I===
0
----1-----1-----1----
====l=====l=====l=====I=====
365
473
5,515
0
0
30
0
0
0
0
0
0
0
0
0
0
240.00
6,688
40
240.00
201.40
7,169.40
0
0
0
0
0
69.50
0
0
47.00
20.00
595.00
4,731.50
0
5
40
5
245
5
----l•----l•----·1------1·---====l=====l=====l=====I=====
20
595
4,615
5,230
0
69. 50
47.00
5,346.50
Total, all stations.--············--······ $166,311
$211
$19,947.25
$56,130.76
$242,600.01
TotaL ..• _.....•.•..•.•.•..•• ·-•••• - • -••.
'Includes Perth Amboy, N. J.
a Includes all ports on Puget Sound.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
84
PUBLIC HEALTH SERVICE
MEXICAN BORDER STATIONS
TABLE
3.-Summary of quarantine transactions on the Mexican border for the fiscal
year 1936
Station
Number of
persons
from
interior
of
Mexico
inspected
Total
Total
Number
Total number number
of
of local number
of
persons of persons persons persons
passed
inspected inspected disin- without
fested treatment
Total
number
of
persons
vaccinated
Total
number
of sick
refused
admission
---- ---- --- ---- --- --Brownsville, Tex ______________ 2,078
527
762,091
764,169
763,621
3
18
Calexico, Calif.. _______________
18,493
20
18,493
17,586
887
0
0
Columbus, N. Mex ____________
1,051
182
258
1,233
0
0
975
Del Rio, Tex ____________ ______
2
81,667
81,834
252
416
81,164
167
Douglas, Ariz _________________
181
1,058
1,239
155
85
0
999
Eagle Pass, Tex _______________ 14,321
2,245
439,010
453,331
1,469
0
449, 617
El Paso, Tex.I _____________ ____ 10,015 4,999,763 5,009,778 25,295 4,980,413
4,070
0
Hidalgo, Tex __________________ 1, 832
1,962
2
267,053
0
267,185
269,017
Laredo, Tex.2 __ _______________ _ 114,150 1,751,801 1,865,951
1,299 1,853,320 12, 631
0
Naco, Ariz __ ____ ____ __________
2,837
432
0
3,238
3,269
0
31
Nogales, Ariz __________________ 4,067
2,922
64
207
6,718
6,989
0
Presidio, Tex __________________
58,809
2,754
174
61,487
61,661
98
0
Rio Grande City, Tex _________
6,402
6,123
279
232
6,170
0
0
Roma, Tex ____________________ 1, 304
45,296
46,600
530
0
46,070
0
San Ysidro, Calif.. __________ __ 2,640
6,057
8,697
7,693
1,004
0
0
Thayer (Mercedes), Tex _______
42
33,484
33,526
21
33,158
347
0
Zapata, Tex ___________________
291
12, 713
13,004
11, 812
1,192
0
0
- - -· - - -· - - - - - - -· - - - - - - Total. _________ -- -- -- -- - - 151, 783 8,493,410 8,645,193 29,294 8,588,044 29,044
llO
---
1
2
Includes Fort Hancock, Gaudalupe Gate, and Ysleta.
Includes Minera and San Ygnacio.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Total
pieces
of
baggag
disinfected
10
2,45
3,48
1, 76
0
0
7, 802
TRANSACTIONS AT UNITED STATES AIRPORTS OF ENTRY FOR AIRPLANES FROM FoREIGN PoRTS
TABLE
4.-Summary of transactions at continental and insular stations for the fiscal year 1936
Location
Name of airport
Distance
in miles
to nearest
Public
Health
Service
station
Date designated
Number Number
of airof airplanes planes inarriving spected
from by Public
foreign
Health
ports
Service
Number
Number
of per- Number
Number
of persons ar- sons
in- _of aliensd of aliens
riving
spected mspecte_ certified
from by Public by Public for disforeign
Health
Heal.th
ease
ports or Service Service
places
----------------·1-------------------1----1------1---- ----· ---- ---- ---- ----
Ajo, Ariz _______________________________
Akron, Ohio'-------------------------Alameda, CaliL _______________________
Albany, N. y __________________________
Municipal Airport______________________________
6
Municipal Airport 2_______________________________________
Alameda Seaplane Base 3________________________ __________
Municipal Field________________________________
10
Nov. 15, 1929
0
0
0
0
0
0
Apr. 8, 1929 _________________________ __________________________________ _
_______________
Sept. 28, 1928
14
0
14
0
131
0
131
0
0
0
0
0
Bellingham, Wash _____________________ Graham Airport 2 _________________________________________ Apr. 18, 1931
Brownsville, Tex _______________________ Municipal Airport______________________________
5
Jan. 8, 1930
3
442
0
442
6
4,234
0
4,234
0
772
0
6
Bangor, Maine 1_ ______________________ Bangor Municipal Airport
2_____________________ __________
June 26.1936 ___________________________________________! _______________ _
iiI~itfft}}}}> {i~l ~i~N~~ii'.;);i}}iiii\ ;//\ ;_ ~:Ill ;;:;:;:} ;;;;;;;} ;;::;d ;;;;;:;1: ;:;:;); :;;::;)
Crosby, N. Dak.1 ______________________ Crosby Munici~al Airport 2___ ____________ ________________ June 28, 1934 ___________________________________________________________ _
Wayne County Airport_________________________
20
Feb. 10, 1931 }
Detroit, Mich__________________________ Detroit Municipal Airport 2__ ___________________
10 June 19, 1931
95
0
202
0
0
0
{
Douglas, Ariz __________________________ b~~g~~rX~;1~rt2=============================== ========== ta1:i~- ~:
0
0
0
0
0
0
Duluth, Minn _________________________ {Duluth Municipal Airport 2 _______ ________________________ Sept. 4, 1931 }
4
0
0
0
0
Duluth Boat Club Seaplane Base 2_____________________________ do ______ _
1½ Mar. 5, 1930
0
0
0
0
0
0
Eagle Pass, Tex ________________________ Eagle Pass Airport 2____________________________
El Paso, Tex ___________________________ Municipal Airport______________________________
9
Aug. 23, 1932
76
76
414
414
168
1
Fairbanks, Alaska'-------- ------------ Weeks Municipal Airfield 2 ________ _______________________ Apr. 1, 1935 ___________________________________________________________ _
Glendale, CaliL _______________________ Grand Central Air Terminal 3___________________
12 _______________
155
155
1,119
1,119
0
0
iii~6
2
!;r~;{:~~i~;;~-~====================
Juneau, Alaska ________________________
Ketchikan, Alaska _____________________
Key West, Fla_________________________
Lakehurst, N. J_ _______________________
1
2
3
t::J
~
H
0
P:l
t,,j
~
P:l
lfl
t,,j
~
0
t,,j
t~~~--:~-~~~~=
!;r~i;~~;i~~~~~:~~;~= ================= ==========
=======ii= =======ii= ======iii= ======iii= ========i= =========i
Juneau Airport 2________________________________
8
June 18, 1930
0
0
0
0
0
0
Ketchikan Airport 2_______________________________________ __ ___ do________
0
0
0
0
0
o
Meacham Field________ _________ __ _____ _________
4
Dec. 20, 1927
0
0
0
0
0
o
U.S. Naval Airport 3___________________________
50 _____ __________
3
3
296
296
234
No medical officer of Public Health Service on duty.
Temporary permission.
Authorized for use.but not officially designated.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
~
q
0
00
~
TABLE
4.-Summary of transactions at continental and insular stations for the fiscal year 1936-Continued
Location
Name of airport
Distance
in miles
to nearest
Public
Health
Service
station
Date desig.
nated
Number Number
of air•
of air•
planes planes in•
arriving spected
by Public
from
foreign
Health
ports
Service
00
~
Number
of per• Number Number
sons ar• s~~f~~·. _of aliens
riving
spected mspecte_d
from
by Public by Publlr
foreign
Health
Heal.th
ports or Service
Service
places
Number
of aliens
certified
for dis•
ease
- -- - - - - - - - - - - - - - 1 - - - - - - - - -- - - - - - - - - -1----1------1-- - - - - - - - - - - - - - - - - - - - - - - 24, 1930
12
12
29
29
5
o
18, 1930
1
0
4
0
0
0
16, 1928
7
7
19
19
0
0
7, 1930
1,034
1,034
20, 169
20, 169
3,684
36
16, 1934
144
144
459
459
37
O
27, 1929
22
22
55
55
0
O
1, 1932
1
0
2
0
0
0
2, 1930
376
0
1,383
0
0
0
2, 1930 ··-······· .•.........•.•...•...•••.•.... ····-····· ......•...
8
i~~r1~:r~rl~rpcii-t·;··========================= ······52·· ·=~~-do. ~~~~~.
Port Townsend Airport'···················-····
6 June 18, 1930
0
0
0
0
0
0
Put•in-Bay Airport 2········· · ···········-······ ...•...... Mar. 12, 1934 ..............................•......... ····-····· .. ..•.••. ·•
Rouses Point Seaplane Base 2 • · · · • · · · · · · · · · " · · · · •••••••••• July 14, 1932
0
0
0
O
O
O
St. Thomas Airport a···-···········-···-·-···· ·· ...•...•.. ·····-·········
53
53
915
915
0
O
San Diego Municipal Airport...................
6
Jan. 24, 1930
261
21
855
68
4
0
Isla Grande 2-·-··-·····---·-··------··· ··-··-··· ······---· Jan. 19, 1929
287
230
3,594
3,480
625
1
Sault Ste. Marie Airport 2•••• · - · · · · · · · · - · · - - · · · · •••••••••• Aug. 4, 1933
0
0
0
0
0
O
Scobey Airport 2_·-·- ·--···-··--·--··---------·· ·--·-·--·· June 2, 1930
0
0
0
0
0
0
{f~:~nfr!f~~c!~.~l.~i=-~.i~~~===================== ==::::::::
768
0
2,952
0
0
O
~~li1feai:1:~ort 2 ________ ___ •• _. ____ ·--··-·--- - N ovdo30, 1931 _ -··-·-·--- -·--·----· ----···-·- --·--··-·- ---··-·-·- -----··---
Laredo, Tex............................ Laredo Airdrome 2..............................
3½
Malone, N. Y ..•....•.....•........••.. Malone Airport 2••••••••••••••••••••••••••••••••••••••••••
Pan American Field............................
14
Miami, Fla............................ {Dinner Key Seaplane Base 2 • •••••••••••••••••••
11
Viking Airport and Seaplane Base 2••••• ••••• •••
4
Nogales, Ariz .......................... Nogales Municipal Airport......................
7
Ogdensburg, N. Y .• ...............•... Ogdensburg Harbor 2.. ••••••••.••••.••••••••••• ••••••••..
Pembina, N. Dak................ . ..... Fort Pembina Airport 2.........................
5
Plattsburg, N. Y.1 ..•............... ~ .. Mobodo Airport 2•••••••••••••••••••••••••••••••••••••••••
i ~~ial'.n~~l~~1tvash====================
Port Townsend, Wash ..•..••.. - •. -....
Put•in•Bay, Ohio 1········-············
Rouses Point, N. Y .·--·-··············
St. Thomas, V. L ......••... ·-··-······
San Diego, CaliL ....... -·-··-·········
San Juan, P. R. -·····-······ ----······
Sault Ste. Marie, Mich·--··-····-·····
Scobey, Mont. ... ·-·······-·-·-·-·-··-Seattle, Wash--··------·----·-·----·-··
Skagway, Alaska 1.. -·-----------·----·
Spokane, Wash.I.-----·-··-··--···-·-··
Swanton, Vt.1 .•....•.... •..............
Tampa, Fla .... •········· ·····-········
·w atertown, N. Y.t ......... ·-··········
West Palm Beach, Fla.·-··-··--·-··-··
Wrangell, Alaska·--·······-··-·····-··
Jan.
Apr.
Oct.
Mar.
May
June
Mar.
Feb.
June
g
m::::~
Spokane Municipal Airport'··· -··· ,....••••.•.. ····-·····
Missisquoi Airport 2· ·-······-··--·········-···· . ....•....
International Airport 2..........................
7
Watertown Municipal Airport 2•••••••••••••••••••••••••••
Roosevelt Flying Service Base 2············-···· - -········
Wrangell Seaplane Base 2 __ · · · · · · · · - · · · · · · · · · · · · · · · · · · · - · ·
~fc~· ~}: m:
June
July
Dec.
June
Mar.
Nov.
medical officer of Public Health Service on duty,
2 Temporary permission.
a Authorized for use but not officially designated.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
g
g
g
g
}
2, 1931 ···-···-·· .......... ····-····· .......... ··---·-··· ·····-··-•
18, 1930
•
0
0
0
0
0
0
1, 1933
2, 1930 ···-······ ·-·-······ ··-······· .•.•.. ..•• ····-····· ····-----·
10, 1931
45
45
105
105
5
0
30, 1931
0
0
0
0
0
0
Total.--· .......•.••. .. .••. ·-· ·-· · --· ···-·· •··-· ..• •----· •····--- •· •····-·- ·- --··- · ·••• •• ··-- -- •• ·-·· ···•· ··
1 No
g
3,823
2,281
37,352
31,898
5,537
44
Ul
t,,j
;
0
t,,j
87
PUBLIC HEALTH SERVICE
CANAL ZONE
TABLE
5.-Quarantine activities of the government of the Canal Zone during the
fiscal year 1936 1
Activities
Balboa
Cristobal
Total
-----------·----------------1---- ---- ---Vessels boarded and passed_______________________________________________
Vessels granted pratique by radio_________________________________________
Total number of vessels passed __________________________ ____________
Crew passed at quarantine________________________________________________
Crew passed by radio______ __ _____ _____ _____________ ___________ ___________
Total number of crew passed________________________________________
Passengers passed at quarantine __________________________________________
Passengers passed by radio______ ___________________________ _______________
Total number of passengers passed__________________________________
Supplementary sanitary inspections of vessels _____________________________
Vessels fumigated with HCN gas_________________________________________
Box cars fumigated with HCN gas________________________________________
Fumigation certificates issued to vessels___________________________________
Deratization exemption certificates issued___ _________________________ _____
Rodents recovered after fumigation__ ______________________________ _______
Airplanes inspected and passed_ _______________________________ ___ ___ _____
Crew of airplanes inspected and passed ___ - -- ----------------------------Passengers of airplanes inspected and passed______________________________
Vessels detained in quarantine____________________________________________
Crew detained on board ship for quarantine______________________________
1
2,882
~
3,416
___
52_
6,298
~
~~~
146,376
58, 182
204,558
ao11, !l48
223,572
10, 158
231. 7 0
68,340
4::IR. ?88
141, 768
4,322
146,090
~~
3,363
50,000
959
9fi. n• 0
~ ~ ~
46
67
146
46
253
67
51
332
1,041
1,428
198
470
1,564
2,377
2
96
21
107
21
3
147
138
523
949
2
96
4
7
0
0
Surg. 0. E. Denney, U. S. Public Health Service, detailed as chief quarantine officer.
MEDICAL INSPECTION OF ALIENS
TABLE
6.-Alien passengers and seamen inspected and certified at maritime ports in
the United States and possessions during the fiscal year 1936
Place
Alien seamen certified 1
Num• Alien passengers certified 1 Num•
ber of
ber of
alien
alien Class A
passen- Class A
Class Total
gers - - - Class Class Total seamen
- - - Class
examB
B
examC
C
ined
I II
I II
ined
- - - - - - --- --- -
--- - - - -
-
ATLANTIC COAST
Baltimore, Md _____________
66
Beaufort, S. c ______________
0
Boston, Mass _______________ 5,768
Brunswick, Ga _____________
0
Charleston, s. c ____________ .
79
Fall River, Mass ___________
0
Fernandina, Fla ____________
0
Fort Monroe, Va.2 __________
403
Fort Pierce, Fla. ____________
0
Georgetown, S. c ___________
0
Gloucester, Mass ___________
0
Jacksonville, Fla ____________
26
Key West, Fla ______________ 3,946
Lewes, DeL ________________
0
Miami, Fla _________________ 11,535
New Bedford, Mass ________
39
New London, Conn _________
0
Newport, R. !_ _________ ____
0
(Ellis
New
York,
N.
Y.
Island) ___________________
Perth Amboy, N. J_ ________
Philadelphia, Pa ____________
Plymouth, Mass ____________
Port Everglades, Fla ________
Portland, Maine ____________
Providence, R. !_ ___________
Savannah, Ga ______________
Searsport, Maine ___________
Vineyard Haven, Mass _____
Washington, N. c __________
135,868
0
103
3
234
84
4
65
0
0
0
1
0
4
0
0
0
0
0
0
0
0
0
1
0
11
3
0
0
27
0
0
0
0
0
0
0
0
0
0
2
0
2
0
158
0
0
0
0
5
0
0
0
0
25
0
63
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
4
0
0
51 6,610
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
7
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
5
0
169
0
0
0
0
5
0
0
0
0
26
0
80
7
0
0
11,566
0
54,466
162
3,213
29
64
7,991
0
0
354
1,416
1,134
0
14,472
17
6
0
6,698 390,225
1,202
0
1 19,832
94
0
2,359
0
0
3,412
0
875
0
2,187
222
0
0
0
0
0
34
0
30
0
4
0
0
22
0
0
0
4
0
0
0
0
0
0
33
0
61
0
2
0
0
7
0
0
0
0
1
0
0
0
0
0
7
0
0
0
0
0
0
2
0
0
1
0
0
0
0
2
0
0
74
0
92
0
6
0
0
31
0
0
1
4
1
0
0
3
6
0
2 180
1
0
47
0
0
0
0
0
0
3
5
0
0
1
0
0
0
0
0
0
3
0
5
0
0
0
0
0
0
0
0
0
0
6
0
0
0
1
0
0
0
0
185
1
58
0
0
3
6
1
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
1
6
0
1 Class A-I: Aliens certified for idiocy, imbecility, feeble-mindedness, insanity, epilepsy, chronic alcoholism. Class A-II: A iens certified for tuberculosis or other loathsome or dangerous contagious disease.
Class B: Aliens certified for diseases or defects which affect ability to earn a living. Class C: Aliens CPrtified
for diseases or defects of less degree.
2 Includes Norfolk, Va., and Newport News, Va.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
88
PUBLIC HEALTH SERVICE
6.-Alien passengers and seamen inspected and certified at maritime ports in
the United States and possessions during the fiscal year 1936- Continued
TABLE
Place
Alien seamen certified 1
Num- Alien passengers certified 1 Number of
ber of
alien Class A
alien Class A
passenClass Total seamen - - - Class Class Total
gers - - - Class
C
examB
B
C
exam- I
II
I
II
ined
ined
- -
-- --- - --- -
-
--- -- - -
West Palm Beach, Fla_. ____
0
0
0
0
0
0
0
0
16
206
0
Wilmington, N. c __________
0
0
0
0
0
0
0
0
- 0 - 0 -- 0 -------TotaL ________________ 6,864
6,991
18
112
6
19
158,239 47
515,504 57 284
-
0
- 47-0z
GULF COAST
Boca Grande, Fla ---------Carrabelle, Fla _____________
Cedar Keys, Fla ____________
Corpus Christi, Tex ________
Galveston, Tex. ____________
Gulfport, Miss ______________
Mobile, Ala _________________
Morgan
City, ____________
La. (Atcha-__
falaya) ______
New Orleans, La ___________
Panama City, Fla __________
Pascagoula, Miss ___________
Pensacola, Fla ______________
Port Aransas, Tex __________
Port St. Joe, Fla ____________
Sabine, Tex _________________
Tampa, Fla ___________ ______
TotaL _____ . __________
2
0
0
0
1,250
0
31
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
0
0
0
0
1
220
303
0
1,362
15,039
316
3,007
0
1, 741
3
0
5
0
0
18
181
0
7
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
14
0
0
0
0
0
0
2
0
2
0
0
0
0
0
0
0
0
24
0
0
0
0
0
0
2
0
24,594
140
0
958
0
0
10,337
~
7
1
17
2
0
0
0
0
0
0
0
0
1
0
4
13
0
0
0
0
4 66
0
0
0
0
0 10
0
0
0
0
0 15
0
7
~
27 59,152 17 103
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
14
0
4
0
0
17
0
.0
0
0
0
2
0
0
98
0
10
0
0
17
7
19
150
11
0
0
0
0
0
0
0
11
0
PACIFIC COAST
1
Aberdeen, Wash ____________
Angel Island, Calif. (San
Francisco) ________________ 6,902
52
Astoria, Oreg _______________
0
Eureka, Calif_ ______________
0
Fort Bragg, Calif. __________
Los Angeles, Calif_ _________ 4,704
Marshfield, Oreg. (Coos
0
Bay) ______ ---------------0
Monterey, Calif. ___________
6
Portland, Oreg ______________
993
San Diego, Calif. _____ ____ __
2
San Luis Obispo, Calif.. ____
0
Santa Barbara, Calif.. ______
Seattle, Wash.3 _____________ 4,224
0
South Bend, Wash _________
-- TotaL ______ __________ 16,884
----
0
0
0
0
0
299
0
0
0
0
0
0
0
0
0
3
13
0
0
0
7
166
0
0
0
196
21
0
0
0
1
200
0
0
0
207
3,258
1,827
0
0
51,556
1
0
0
0
4
23
6
0
0
87
3
1
0
0
83
0
0
0
0
3
27
7
0
0
177
0
0
0
0
0
1
0
0
0
2
0
0
22
0
0
0
0
0
0
0
4
0
0
0
1
12
0
0
31
0
603
0
310
6,081
1,887
0
12,640
745
0
0
0
0
0
0
0
0
0
0
0
0
1
0
4
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
0
2
0
5
0
4
6
0
0
2
0
0
0
3
0
9
INSULAR
Alaska:
Ketchikan ______________
H awaii:
Honolulu _______________
0
0
0
0
0
0
0
0
0
0
0
0
14
55
7
76
33,190
0
27
5
0
32
0
0
0
0
0
1
0
0
0
34
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
65
0
0
0
1
0
0
104
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
--- 6
0
0
0
12
13
110
94
6,238
0
0
0
0
0
0
0
0
0
1
6,473
1
0
--- -
Total, all stations _____ 212, 743
a Includes all ports on Puget Sound.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
--- - - - 88
4
218
---- - - -
0
-- TotaL ________________ 24,273
0
TotaL ________________
-
5 121
3,643
Philippines:
Cebu ___________________
4
Davao __________________
119
Iloilo ________ - __ -- -- -- - 8
J olo _____________________
129
Legaspi__ _______________
Manila ___ _____ _________ 23,8460
Zamboanga _____________
167
Puerto
Rico: _______________
Aguadilla
Arecibo _________________
Arroyo __________________
Central
Aguirre (J obos)
Fajardo _________________
Guanica ________________
Humacao _______________
Mayaguez ______________
Ponce. _________________
San Juan _______________
- - - - - --- --- 451 79,206
386
26
30
- - -- - --- --- -
0
31
0
- - --- --- -
--- --- -35 - 31- - 0
66
105
0
- -- - --- - -- -
-
-
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
11
85
0
7
0
238
409
6
491
910
13,688
64 ji42 7,358
- - ---
0
0
0
0
0
1
0
0
0
0
58
7,622 702,991
-
-
0
0
0
0
0
0
0
0
-
--- --- --11 15,834
1
5
5
- -
-
0
0
0
0
0
0
-
---- -- -
-----0
0
0
--- - - - -
0
0
0
0
1
3
0
0
0
4
80 539
0
1
0
0
1
3
-----0
0
5
===
216
42
877
89
PUBLIC HEALTH SERVICE
TABLE
7.-Aliens inspected and certified at international border stations during the
fiscal year 1936
Number of
persons
making
permanent
entry
examined
Place
Aliens certified
Number of
persons
I
Total
making Other
Class A
tempo- persons ofnumber
persons
rary examined examined
Class
Total
entry
B
examIT
I
ined
Class
C
--- ---- - - - - - - - - - - - - - - - MEXICAN BORDER
Ajo, Ariz _____________________
Brownsville, Tex ________ _____
Calexico, Calif.. ___ ___________
Columbus, N. Mex ___________
Del Rio, Tex _________________
Douglas, Ariz _________________
Eagle Pass, Tex _______________
El Paso, Tex.I ________________
Hidalgo, Tex __________________
Laredo, Tex __________________
Naco, Ariz ____________________
Nogales, Ariz _________________
Presidio, Tex _________________
Rio Grande City, Tex ________
Roma, Tex ___________________
San Ysidro, Calif. ____________
Thayer (Mercedes), Tex ______
Tucson, Ariz ________________ __
Zapata, Tex __________________
Total. __________________
0
251
392
6
45
39
351
330
19
957
31
259
1
14
0
373
3
0
0
--3,071
0
338
86
134
0
6
0
4,745
4
1,302
0
27
11
0
0
897
0
0
74
949
482
18,015
971
5,830
1,194
6,121
7,180
486
40,659
3, 238
2,640
836
242
28
7,427
205
253
217
949
1,071
18,493
1,111
5,875
1,239
6,472
12,255
509
42,918
3,269
2,926
848
256
28
8,697
208
253
291
7,624
96,973
107. 668
0
592
43
0
13
1,302
1,078
0
69,817
0
57
0
38
353,864
85
11,392
25
0
357
851
5
0
33,366
10
0
594
740
216
29
0
0
0
28
0
0
15
0
0
3,954
0
994
814
140
13
4,178
1,565
453
69,847
0
597
10
62
357,192
156
ll, 648
48
2,758
660
1,322
5
24
33,392
18
3
925
3,369
308
65
564
0
6
69
4,522
25
1,376
644
354
5,842
22
CANADIAN BORDER
Bellingham, Wash ____________
0
0
Blaine, Wash _________________
402
0
Buffalo, N. y _________________
102
669
Calais, Maine _________________
140
0
Chicago, rn ___________________
0
0
Detroit, Mich ________________
1,039
Duluth, Minn ________________ 1,8370
487
Eastport, Idaho ______________
204
249
Eastport, Maine ______________
30
0
0
Erie, Pa __ -------------------0
Halifax, N. S., Canada ________
264
276
Havre, Mont _________________
0
10
Houlton, Maine ______________
18
6
International Falls, Minn ____
3,260
68
Jackman, Maine ______________
0
71
Lewiston, N. y _______________
228
28
Malone, N. y ________________
7
16
Montreal, Canada ____________ 2,758
0
Newport, Vt. _________________
117
186
Niagara Falls, N. y __________
222
249
Noyes, Minn. ________________
0
0
Ogdensburg, N. y ____________
13
11
Oroville, Wash _______________
17
9
Portal, N. Dak _______________
8
0
Port Angeles, Wash ___________
3
0
Port Huron, Mich ____________
162
169
Quebec, Canada ______________
2,119
510
Rouses Point, N. y ___________
92
0
St. Albans, Vt. _______________
36
0
St. John, N. B., Canada ______
218
346
Sault Ste. Marie, Mich _______
0
0
Scobey, Mont. _____________ __
0
6
Sumas, Wash _________________
28
13
Sweetgrass, Mont. ____________
4,337
185
Van Buren, Maine _______ _____
2
23
Vanceboro, Maine ____________
1,143
218
Vancouver, B. C., Canada ____
644
0
Victoria, B. C., Canada ______
149
205
Winnipeg, Man., Canada _____ 1,497
391
3
3
Yarmouth, . S., Canada. ___
Total. __________________ 9,688 15,815
---
Total, all stations _______ 12, 759
1
23,439
16
478,487
503,990
575,460
611,658
Includes Fort Hancock, Guadalupe Gate, and Ysleta.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
2
64
120
0
2
118
44
1,078
71
298
266
429
239
7
5
220
19
72
0
2
5
5
0
0
12
8
51
0
5
17
10
1
0
0
6
0
18
0
0
10
48
0
1
47
2
205
17
34
54
94
16
2
0
22
2
34
0
0
32
28
0
1
39
12
776
18
253
88
223
95
2
3
192
7
15
0
0
17
39
0
0
20
22
46
36
6
107
102
127
3
2
0
10
5
0
0
13
21
1
0
135
0
0
0
0
2
1
3
4
4
3
5
37
8
5
1
1
0
4
0
0
3
6
0
7
24
0
1
0
0
8
0
0
0
2
0
0
0
1
2
0
0
0
0
0
1
0
6
0
0
0
0
3
0
0
0
5
0
20
1
0
59
50
8
6
477
0
21
1
0
90
0
3
34
16
8
0
468
12
18
2
5
0
1
0
88
246
23
6
27
0
0
16
0
0
0
117
32
1,109
13
0
81
72
2
0
0
0
0
1
0
199
0
2
1
45
8
12
89
179
8
0
4
0
4
0
33
4
6
15
0
0
0
0
2
0
1
29
196
0
4,740
1,612
- - - -- - - - - - -·
3,054
1,784
588
542
140
--------=
0
156
149
ll
13
636
0
22
2
0
299
1
8
39
67
19
17
594
200
33
3
10
0
9
0
138
324
43
15
16
0
0
21
0
2
0
132
62
1,335
22
1
10
3
6
0
0
2
0
0
0
9
1
10
8
7,484
454
48
77
- - - - - -- --- - 2,956 1,070
4,430
314
90
------- -678
90
PUBLIC HEALTH SERVICE
TABLE
8.-Alien seamen inspected and certified at international b,order stations
during the fiscal year 1936
Alien seamen certified
Number 1 - - - - - - - - - r - - - - - , - - - - - - - of alien
Class A
seamen
Class C
Total
examined1------,-----1 Class B
I
II
Place
----------------1---- ---- ---- ---- ---- ---Bellingham, Wash________________________
Brownsville, Tex_________________________
Buffalo, N . y___________________ _________ _
Chicago, Ill---------- -- ---- ---- ----------Duluth, Minn______ ___ _____ ______________
Eastport, Maine__________________________
Erie,
Pa __ N.
-------------------------------Lewiston,
y________ ___________ ________
438
20
16,502
1,001
133
228
622
136
0
0
1
0
0
0
0
0
Ogdensburg, N. Y -----------------------Port Angeles, Wash______________________ _
Port Huron, Mich _____ ______________ _____
Sault Ste. Marie, Mich___________________
200
76
359
50
19,765
Total.______________________________
TABLE
1
0
2
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
59
35
3
0
0
0
3
0
21
0
0
0
102
3
0
0
0
2
0
0
6
0
0
0
162
42
3
0
0
2
4
0
29
0
4
4
121
113
242
----~----1-----1----
9.-Number and character of the mandatorily excludable conditions certified
at United States ports during the fiscal year 1936
...
•I>,
0"'
l>,gs
.,,1>,...,
.....
~~
A.9
]~ ·a
Q)"O
.....s·El. .
~i
~
Alien passengers ___
Alien seamen _______
TABLE
A
.s.S
Ci:l
::, •.-.
"O
~-s
I>,
~
A
Cl)
:;:::
A
~
ril
.S:l
~
Oc.>
.!!?
8
00
~
0
00
167
13
191
186
27
103
8
130
14
0
~
f
Cl)
i .
"O~"'
-5
!;:
-5
ol
§
:;:::
·.o
::,
1i3
~
g1<1) i
§~;a
Cl)
s
ol
El0
C)
A
g
Cl)
o..c:l
·;;l
0
"i3
C)
A
"'A
Ao
,9
0
]
...,ol
~
'
0~
"'A
::, 0"'
0 C)Q)
ca
Cl)
...,C)
e;,
c.>,o
;a~
C)
Cl)
.0 A
.
-~'oEl
I>,
Cl)
A
...,::,
ol 0
..Q
o·..,...,
bD
0
0
0
-- -- -- -- -- ---- -- -- ----
72
1
54
2
f\8
9
115
1
81
2
57
0
282
290
94
6
]
0
8
1, 338
62 7
10.-Summary of medical inspection of aliens, fiscal year 1936
MARITIME STATIONS
GROUP 1.-ALIEN PASSENGERS NOT EXAMINED ABROAD, EXAMINED UPON ARRIVAL
IntenTotal
sively
examined examined
Class
Certified on arrival
Passed
A-I
A-II
---- - - - - - - - First __________
- - -- -- -- - ---- - --- - Second
____ __________
______________
Third __________________ ____ ___ ---Stowaways ________ ________________
Warrant cases _____________________
Total. _________ -- -- -- - - -- - - --
Total
certified
C
--- -- ---B
78,625
21,303
92,251
280
3,313
971
418
4,238
214
2,013
78, 043
21,019
89,473
251
3,018
7
3
12
4
38
6
1
73
9
52
552
278
2,662
15
198
17
2
31
1
7
582
284
2,778
29
295
195,772
7,854
191,804
64
141
3,705
58
3,968
---- ---- ---- -- -- ---
GROUP IL-ALIEN PASSENGERS EXAMINED ABROAD REEXAMINED ON ARRIVAL
Certified on arrival (condition noted abroad)
Class
Total Intensively Passed Passed
exon
exabroad arrival
amined amined
A-I A-II
6.023
1, 845
9, 103
118
81
142
5,740
1,529
6,052
5,737
1,528
6,052
0
0
0
- - - - -- - - - - - - Total. _ 16,971
341 13,321 13,317
0
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
C
-- -- -
--- --- --- First _______
Second _____
Third ______
B
Total
certiNumNum- fled
ber
ber
certi- A-I A-II B C certifled
fled
-- -
---
283
0
0
316
0 3,051
0
0
0
0 3,650
0
---- -
Certified on arrival
(condition
no t
noted abroad)
283
316
3,0ql
0
0
0
3,650
0
--- -
2
1
- -- - -
1
0
0
0
0
0
0
1
3
0
-- - -
3
1
0
286
317
3,051
--4 3,654
91
PUBLIC HEALTH SERVICE
TABLE
10.-Summary of medical vnspection of aliens, fiscal year L936-Continued
GROUP !IL-ALIEN SEAMEN EXAMINED ON ARRIVAL
Certified
Inten•
Total
sively
examined examined
Total
certified
A-I A-II
B
C
---- ---- --- - - --- - - ----
Alien crew .................... -- ...
Workaways ... ______________ ---·--
Passed
702,882
109
143, 145
0
702,005
109
80
0
539
0
216
0
42
0
877
0
702,991
143,145
702,114
80
539
216
42
877
---- ---- ---- -- -- --- -- ----
TotaL .. ----------- ----·----
CANADIAN AND MEXICAN BORDER STATIONS
GROUP L-ALIEN PASSENGERS NOT EXAMINED ABROAD EXAMINED UPON ARRIVAL
Certified on arrival
IntenTotal
sively
examined examined
Class
A-II
B
---- ---- -- -- ---
Statistical, making permanent en·
try (bona fideimmigrants) __ . ____
Statistical, making temporary entry __ -·-·----- - -· -·- __ -- -- -- - -- -N onstatistical, making entry (local
crossers, etc.) _______________ -· ___
Warrant cases------·-------------'.rotaL _____ . -· ·- ·-·-- _____ __ _
Total
certified
Passed
A-I
C
-- ----
12,_632
9,486
10,811
139
32
1,144
506
21, 789
5,401
20,610
93
70
826
190
1,179
570,908
3,789
14,928
3,663
567,296
3,084
108
111
366
210
2,325
286
813
98
3,612
705
609,118
33,478
601,801
451
678
4,581 1,607
7,317
1,821
---- ---- ---- -- -- --- -- ----
GROUP IL-ALIEN PASSENGERS EXAMINED ABROAD REEXAMINED ON ARRIVAL
IntenTotal
sively
examined examined
Class
Certified on arrival (condition
noted abroad)
Passed
abroad
Passed on
arrival
A-I
----- - - - - - - - - - - - Statistical, making perma•
nent entry (bona.fide immigrants) __ . -- ------ -- -·----· ·
Statistical, making temporary
entry _____ ---- - -- - -· -- -- - -- Nonstatistical, making entry
(local crossers, etc.)···-·· -·- Total. _.-· ·-----·----·-·
A-II
I B I C INumb«
certified
----------
145
145
126
123
0
0
16
3
1,653
1,653
1,651
1,541
2
0
0
0
2
742
742
742
709
0
0
0
0
0
2,540
2,540
2,519
2,373
2
0
16
3
21
---- ---- ---- ---- - - --- -
19
-- - - - -
I
Certified on arrival (condition not noted
abroad)
Class
A-I
A-II
B
Number
certified
C
--- --- --- ---Statistical, making permanent entry (bona-fide
immigrants). ___ -·- __ ----···-·-·········-·--····
Statistical, making temporaryentrY.-------------·
N onstatistical, making entry (local crossers, etc.) __
Total._ ... _._ ... _.. __ .-·_ •.. _. ___ ..••• ·--- ..
101889-36--7
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
0
1
0
'()
1
109
33
2
0
0
3
110
33
1
0
143
2
146
0
0
- - - - - - - - - - - - - - --
Total
certified
- --22
112
33
---167
92
PUBLIC HEALTH SERVICE
TABLE
IL-Distribution, according to class, of applicants for immigration visas who
were medically examined during the fiscal year 1936
Country and consular office
Total
number
of appli•
cants examined
Number of applicants
in each class
Quota
Non•
quota
Non•
immi•
grants
Percentage of applicants
in each class
Quota
Non•
quota
Nonimmi•
grants
--- --- --- --- --- --WESTERN HEMISPHERE
Cuba: Habana.......•..............•......
Canada, total. ............................ .
Montreal. ...•..........................
Que bee ........................•........
Toronto .................... . .......... .
Vancouver ............................ .
~:~fg~g
Yarmoutli~=..======
.... . ======================
_. . . . ..... . .......... .
All countries, Western Hemisphere .. .
EASTERN HEMISPHERE
Europe, total. ............................. .
Belgium: Antwerp ... ... . . ............ .
England: London .... .. _.............. .
Irish Free State: Dublin .............. .
Northern Ireland: Belfast. ............ .
tci/:~;' ?~:r~~~ =~
633
260
373
0
41.1
58. 9
0
4,105
400
2,315
1,112
2,621
1,141
189
897
3
1,137
362
716
155
5
2,348
397
1,178
749
1,905
497
184
860
0
0
1
0
489
0
21.8
.8
49.1
32. 5
27.3
13. 6
2. 6
57. 2
99. 2
50. 9
67. 4
72. 7
43. 5
97. 4
21.0
0
0
.1
0
42. 9
0
12,516
3,535
7,631
1,350
28. 2
61. 0
10. 8
25,931
17,553
8,370
8
67.67
32. 3
745
2,041
555
167
344
9,346
642
1,403
290
121
148
8,743
103
638
258
46
195
603
0
0
7
0
1
0
86. 2
68. 7
52. 2
72. 5
43. 0
93. 5
13. 8
31. 3
46. 5
27. 5
56. 7
6. 5
---- --- --- --- --------11,883
3,275
7,258
1,350
27. 6
61. 1
11. 3
------- ------ --- --- ---
---- --- --- --- ------ --------- ------------ --.03
---- --- --- ------ --- --0
0
1.3
0
.3
0
==================
---- --- --- --- --- --- --Berlin ............................. .
2,981
2,805
94.1
5. 9
176
0
0
Hamburg ......................... _
1,461
1,307
89. 5
10. 5
154
0
0
Stuttgart.. ... . .................... .
4,904
4,631
273
0
94. 4
5. 6
0
---- --- --- --- --- --- --Holland: Rotterdam ..........•........
601
548
91. 2
8.8
53
0
0
Poland: Warsaw. ....... .............. .
1,045
599
446
57. 3
42. 7
0
0
271
52
19. 2
219
0
80. 8
0
Denmark: Copenhagen .. ········"····N orway: Oslo ......................... .
416
267
149
0
64. 2
35. 8
0
Sweden, totaL _.. . ....... ....... ..... . .
422
252
170
40. 3
59. 7
0
0
---- --- --- ------ --- --Goteborg .................. _.... _.. .
217
121
55. 8
44. 2
96
0
0
Stockholm ........................ .
131
205
74
0
63. 9
36. 1
0
---- --- --- --- --- --- --Italy: Naples .... . . ................... .
7,620
2,522
33.1
5,098
66. 9
0
0
Czechoslovakia: Prague .............. . .
1,430
968
462
32. 3
67. 7
0
0
Austria: Vienna ....................... .
928
831
97
0
89. 3
10. 7
0
---- --- --- --- --- --- --Philippine Islands: Manila ............... .
172
111
61
64. 5
0
35. 5
0
---- --- --- --- --- -----All countries, Eastern Hemisphere .. .
26,103 17,664
8,431
32. 3
67. 67
.03
8
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
93
PUBLIC HEALTH SERVICE
12.-Distribution, according to sex, of applicants for immigration visas wh<>
were medically examined and notified for disabilities during the fiscal year 1936
TABLE
Number of
each sex
examined
Percentage of
each sex
examined
Percentage of
males notified
for-
Percentage of
females notifiedl
for-
Country and consular office
Male
Female
Male
Female
Class 'A Class B Class A Class B:
condi- condi- condi- conditions
tions
tions
tions
- - - - - - - - - - - - - -- - - - - - WESTERN HEMISPHERE
Cuba: Habana ______________________
Canada, totaL _______________________
Montreal_ ______ - -- -- -- - -- --- - -- Quebec __-- ------- - -- - - -- ---- -- -Toronto ___ - __ - -- --- - -- -- -- -- -- -Vancouver_- - - ---------------- -Windsor _____________ -- --- --- ---Winnipeg
__--------- --- - -- - --Yarmouth__
_______________________
Allsphere
countries,
Western
Hemi___________
____ ________
EASTERN HEMISrHERE
372
261
58.8
41. 2
4.0
15. 3
5. 7
9.~
2,046
163
1,317
494
1,440
659
49
2,059
237
998
618
1,181
482
140
49. 8
40. 8
56. 9
44. 4
54. 9
57.8
25. 9
50. 2
59. 2
43. 1
55. 6
45.1
42. 2
74.1
.4
0
1.0
.2
.4
.9
0
12. 4
8.0
9.0
11. 9
22. 0
12. 9
14.3
.3
0
.4
•2
.2
.2
0
14. 8
13.1
9. 9'
8.1
21. Z
18. 520.T
6,540
5,976
52. 3
47. 7
.8
13. 9
.5
------------------ --- =
48.1
13. 8
5,715
51.9
14. 9o
.6
6,168
.3
- - - - - - - - - - - - - - - - - - - - - ---
- - - - - - - - - - - - - - - - - - - - - - - ---- --- --- --- ------ ---
Europe, totaL _____ __-- -- -- _____ _____ 11,229 14, 702
21.0
43.3
56. 7
1. 9
2. 3
------ --- --- --- --- --Belgium: Antwerp ___________ ___
22.4
343
53. 9
46.1
402
.3
.9
England: London _______________
1,125
44.8
55. 2
10. 5
916
.02
.05
Irish Free State: Dublin ________
398
28. 3
71. 7
15. 9
157
.6
.3
Northern Ireland: Belfast_ ______
22. 9
97
41. 9
58.1
3. 1
70
0
Scotland: Glasfow ______________
233
32. 3
17.1
111
67. 7
.9
1. 3
Germany, tota __ ______________ __ 4,540
4,806
48. 6
51. 4
27. 2
1. 5
.8
14. T
--19.4
--24. 8
7.1
14.1
21. 7
15.0
25.4
- - - - - - - - - - - - - - - --- - - - - - -
Berlin ___ ______________ -- ---1,462
50. 9
49.1
.4
32.6
.8
32. 5
Hamburg _______ __ _________ __ 1,519
682
779
46. 7
53. 3
17. 2
.5
17. 6
.7
2,339
2,565
47.
7
52.
3
2.4
26.
8
.
9
23. 9Stuttgart_----- __ -- ------ ---254
42. 3
347
57. 7
24. 5
0
.8
25. 6
Holland: Rotterdam ______ ______
Poland: Warsaw ___ _____________
21.3,
559
46. 5
53. 5
1. 2
17. 9
4. 5
486
Copenhagen ____ ______
132
139
48.
7
25.
0
51.
3
.8
22.3
0
Denmark:Oslo
_________ ____ ______
259
62. 3
26.1
157
37. 7
.4
2. 5
Norway:
24.
Sweden, totaL __________________
224
22. 2
198
46. 9
53. 1
.5
1.8
30.4 ·
--------Goteborg ____________________
110
49. 3
50. 7
22.4
107
31. 8:0
.9
Stockholm ___________________
91
114
44. 4
55. 6
1.1
22.0
2. 6
28. 9
---------Italy: N aples ___ _______ ______ ___ _ 2,768
4,852
4. 5
36. 3
63. 7
3. 7
15. 5
8.8
39. 2
60. 8
1. 6
11. 8
2. 3
14. ~
Czechoslovakia: Prague _____ ____
560
870
Austria: Vienna _____ __________ __
4. 4
385
543
41. 5
58. 5
19. 6
1.1
19. 0
- - - --- --- --- --- ----Philippine Islands: Manila _____ ___ __
55. 2
2.1
95
44.8
2.1
1.0
77
0
=
i
=
=
-
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
94
PUBLIC HEALTH SERVICE
13.-Number and percentage of quota and nonquota applicants examined who
were notified for different classes of disabilities during the fiscal year 1936
TABLE
Quota
Country
Nonquota
Percentage of
Percentage of
examtotal examNumber noti- total
Total Number n ctiined who
ined who
Total
fled forfled
fornumber
were
notiwere notinumber
nonfled forfled forquota
quota
appliapplicants
cants
exam- Class Class Class Class examClass Class Class Class
ined
A
B
B
A
B
A
A
B
ined condi
condi- condi- condi- condi- condi- condi- conditions tions tions tions
tions tions tions lions
- - - - - - - - --- --- - - - -
--
WESTERN HEMISPHERE
Cuba _________________ ___
Canada. _________________
260
3,275
All countries
Western Hemisphere ____________
3,535
17
44
17
533
-- -34
577
6. 5
.5
16. 9
16. 3
373
7,258
l.O
16. 3
7, (;31
-- --
13
28
38
1, 049
41
1, 087
--
3. 5
.4
10. 2
14. 5
.5
14. 2
--
EASTERN HEMISPHERE
.Europe, total.. ___________
Belgium _____________
England _____________
Irish Free State ______
Northern Ireland _____
Scotland ____ _________
Germany ____________
Holland ______________
Poland _______________
Denmark _______ __ ___
Norway ______________
Sweden ______________
Italy _________ ___ _____
Czechoslovakia _______
Austria ____ __________
17,553
254 4. 192
23. 9
1.5
8,370
289 1,019
3. 5
12. 2
- - --- - - - - - ---642
4
146
23. 7
29
.6
103
0
28. 2
0
1,403
()38
125
.4
8.8
5
53
3
.1
8. 3
290
1
18. 3
28
.3
258
53
0
0
10. 9
121
2
24
1. 7
19.8
46
13
1
2. 2
28.3
148
4
29
2. 7
19. 6
25
195
12. 8
0
0
8,743
26.8
98 2,332
1.1
603
126
1.3
20. 9
8
548
2
26. 6
146
.4
14
53
0
0
26.4
599
21
132
22. 0
3. 5
446
74
2. 2
10
16. 6
219
1
.5
22 8
52
14
50
0
6. 4
0
267
1. 9
26. 2
149
5
70
35
0
23. 5
0
]. 6
252
72
28. 4
4
170
1
40
.6
23. 7
2,522
2. 9
28. 1
73
708
5,098
248
4. 9
501
9. 8
968
13
140
1. 3
14. 5
462
16
53
3. 5
11. 5
21
831
97
2
14
2. 1
165 ~ 19. 9
14. 4
Philippine Islands: ~ - - 2 - - - 2 ~ - 1-.8- - - - 61- - -0- - - 1 - 0 - - -1.-6
Manila _______________
A 11 countries, Eastern Hemisphere __
---- - - - - - - - - - - - - - - - - - - - - - - - 17,664
256
4,194
1.4
23. 7
8,431
289
1,020
3. 4
12.1
14.-Percentage distribution of total quota and nonquota applicants of each
sex examined who were notified for different classes of disabilities during the fiscal
year 1936
TABLE
Quota
Country
Male
Nonquota
Female
Male
Female
Class A Class B Class A Class B Class A Class B Class A Class B
--------------1---- --- --- --- --- --- --- --•WESTERN HEMISPHERE
Cuba__ ______________________________
5. 2
9. 2
18. 4
16. 2
3. 0
14. 6
4. 0
5. 2
.7
Canada____ ______ __________________ __
16. 0
.3
16. 8
.6
.2
14. 3
14. 5
- - - - - - - -- - - - - - - - - - - - - - - All countries, Western Hemi·
sphere_______________________
1. 0
16. 0
.9
16. 9
.8
14. 4
.4
14. 2
EASTERN HEMISPHERE
Europe, total. ______________________ _
24. 4
1.5
Belgium ___ _________ ___ _________ _ - -. 3- - 21. 5
England ________________________ _
. 02
1.1
Irish Free State ________________ _ 0
17. 9
Northern Ireland _______________ _ 0
19. 6
Scotland _____ ___________________ _
2. 6
25. 6
Germany _______________________ _
27. 6
1. 5
Holland. ____ __________ __ ___ ____ _ 0
27. 2
Poland ____________________ -- -- -18. 9
1.6
Denmark _______________________ _
25. 2
.9
1':l" orway _________ --- ___ -- __ - .. _. _ 3. 5
27. 8
Sweden ___ _____________ ._ -- ---- -25. 9
.8
Italy ___________________________ _
1.0
10. 0
Czechoslovakia ___________ ______ _
1. 0
13. 1
Austria. ________________________ _ 4. 4
'20. 0
--- --Philippine Islands: Manila _________ _
1. 6
3. 3
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1. 4
1.0
.1
.5
2. 7
2. 8
.8
.9
5.8
0
.6
2.1
1. 9
1. 6
1. 2
0
23. 4
2.8
12. 1
3. 8
12. 2
24.1
0
28. 0
28. 3
0
. 03
9.4
.l
7. 3
7. 0
18. 5
13. 3
0
0
10.1
29. 2
4. 5
20. 0
27.3
0
12. 7
17. 4
12. 9
0
0
1. 3
21. 2
1.4
25.8
17. 9
25.8
29. 0
22. 7
0
0
3. 2
25. 6
.6
15. 9
17. 0
20. 5
24. 0
29. 6
0
0
27. 2
29. 5
20. 9
0
0
1. 2
30. 7
17. 4
29. 8
0
18. 1
1. 5
3. 5
3.4
6. 3
2.9
8. 7
3.8
13. 1
15. 3
15. 2
19. 7
4.4
13. 7
0
--- --- --- --- --2. 9
2. 0
0
0
0
- -- - - - - - - - - - - - -
95
PUBLIC HEALTH SERVICE
15.-Number and percentage of applicants examined who were notified and
refused visas on medical notification for different classes of disabilities during the
fiscal year 1936
TABLE
Number notified for-
Percent~ge of
applicants examined who
were notified
Perce!t.age of
applicants examined who
were refiised
visas for-
Number of
visas refused
for-
for-
Country and consular office
Class A Class B Class A Class B Class A Class B Class A Class•B
condi- condi- condi- condi- condi- condi- condi- conditions
tions
tions
tions
tions
tions
tions
tions
WESTERN 1IEMISPHERE
Cuba: H abana ______________ _______ _
Canada, totaL _____________________ _
Montreal_ ______________________ _
Quebec _______________ ____ ______ _
Toronto ________________________ _
Vancouver _____________________ _
Windsor ________________________ _
Winnipeg ______________________ _
Yarmouth ______________________ _
Allsphere
countries,
·western Hemi___________________
___ _
EASTERN HEMISPHERE
Europe, totaL __ __________ __ ________ _
Belgium: Antwerp ________ _____ _
England: London ___ ________ __ _
Irish Free State: Du'Jlin _______ _
Northern Ireland: Belfast_ _____ _
Scotland: Glasgow ___ ____ ___ ___ _
Germany, totaL ________________ _
Berlin _____________ -- -------Hamburg ____ __ _____________ _
Stuttgart_ __________________ _
Holland: Rotterdam ___________ _
Poland: Wars -=tw ____ ____ _______ _
Denmark: Copenhagen ________ _
Norway: Oslo __ ________________ _
Sweden, totaL _________________ _
Goteborg __________ _________ _
Stockholm _________________ _
Italy: Naples ___________________ _
Czechoslovakia: Prague ________ _
Austria: Vienna ________________ _
Philippine Islands: Manila _________ _
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
30
82
4. 7
13. 0
30
11
4. 7
1.7
50
1,705
.4
14. 3
50
734
.4
6. 2
16
0
17
2
8
7
G
557
44
218
109
567
174
36
.4
.7
.2
.3
.6
0
13. 6
11. 0
9.4
9. 8
21. 6
15. 2
19. 0
16
0
17
2
8
7
0
250
12
93
0
251
112
16
.4
0
.7
.2
.3
.6
0
6. 1
3.0
4. 0
0
9. 6
9. 8
8. 5
80
1,787
.6
14. 3
80
745
.6
6.0
543
5,211
2. 1
20. 1
543
1,055
4
8
1
3
4
106
175
178
81
37
54
2,458
.5
.4
.2
1. 8
1.1
1.1
23. 5
8. 7
14. 6
22. 2
15. 7
26. 3
4
8
1
3
4
106
84
37
6
6
1
602
972
254
1,232
.6
.6
1. 6
32. 6
17. 4
25. 1
17
9
80
2
31
1
5
5
160
206
64
105
112
.3
2. 9
.4
1. 2
1.1
26. 6
19. 7
23. 6
25. 2
26. 5
1
4
59
53
.5
2. 0
321
29
23
1,209
193
179
2
3
--- --- --- --- --- --- --- ---
--- --- --- --- --- --- --- --0
--- --- --- --- --- --- ---
-
--- --- --- --- --- --- --- --2. 1
4.1
.5
.4
.2
1.8
1.1
1.1
11. 3
1.8
1.1
3. 6
. 03
6. 4
119
.6
.6
1. 6
15. 9
.6
2. 4
2
31
1
5
5
47
15
18
27
29
.3
3. 0
.4
1. 2
1. 1
7.8
1. 4
6. 6
6. 5
6.8
27. 2
25. 9
1
4
13
16
.5
2. 0
6.0
7. 8
4. 2
2. 0
' 2. 5
1.5. 9
13. 5
19. 0
321
29
23
94
43
46
4. 2
2. 0
2. 5
1. 3
3. 0
4. 9
1. 2
1. 7
2
1. 2
.6
- - - - - - - - - - - -- - - - - - -
--17
9
80
- --
- - - - --
--- ---
--- --- --- --475
8
--- --- --- --- --- --- --- ---
---- - - - ---- - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - =
--- --- --- --- --- --- --- ---
96
PUBLIC HEALTH SERVICE
16.-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 1936
TABLE
Quota
Percentage
of notified
cases refused visas
Number
refused
visas
Number
notified
Country
Nonquota
Percentage
of notified
cases refused visas
Number
refused
visas
Number
notified
Class Class Class Class Class Class Class Class Class Class Class Class
B
B
A
B
A
A
B
A
B
A
A
B
-- -- -- -- ------ ---- --
--
WESTERN HEMISPHERE
Cuba. ____________________
Canada _____________ .• __ -All countries, Western Hemisphere...
EASTERN lIEMISPHERE
17
17
44
533
17
17
4
224
100
100
9.1
42.0
13
38
28 1,049
13
28
7
475
100
100
18.4
45. 3
34
577
34
228
100
39. 5
41 1,087
41
482
lOQ
44. 3
254 4,192
254
952
100
22. 7
289 1,019
289
103
100
10. 1
11
8
2
4
1
6
4
10
1
4
5
44
3
0
100
15. 0
7. 1
30. 8
4. 0
4.8
28. 6
13. 5
7.1
11. 4
12. 5
8.8
5. 7
0
--------------------------------------------- =
Europe, total. ____________
-----lBelgium ______________ - 4
146
4
73
England .. ____________
5
125
29
5
Irish Free State ... ____
4
1
53
1
Northern Ireland _____
24
2
2
2
:Scotland ______________
29
4
4
0
Germany _____________
98 2,332
98
596
Hdlland ______________
2
2
43
146
'Poland _______________
21
132
21
5
Denmark _____________
1
50
1
17
Norway ____________ __
70
5
5
23
Sweden _______________
4
72
4
24
Italy __________________
73
708
73
50
Czechoslovakia _______
13
140
13
40
Austria _______________
21
165
21
46
Philippine
Islands:
Manila _________________
All countries, Eastern Hemisphere ___
-------- --100
- -50.0- - 37. 9
0
29
0
100
100
100
100
100
100
100
100
100
100
100
100
100
23. 2
7. 5
8. 3
0
25. 6
29. 4
3.8
34.0
32. 9
33. 3
7.1
28. 6
27. 0
3
0
1
0
8
0
10
0
0
1
248
16
2
53
28
13
25
126
14
74
14
35
40
501
53
14
0
3
0
1
0
8
0
10
0
0
1
248
16
2
0
1
0
0
0
289 1,020
289
103
100
·o
100
0
100
0
100
0
0
100
100
100
100
- - - - - -· - - - - - - - - - - - - - - - - -2
2
2
1
100
50. 0
256 4,194
256
953
100
22. 7
0
---------- ---------- ----
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
10.1
97
PUBLIC HEALTH SERVICE
17.-Number and percentage of male and female applicants notified for class
B disabilities who were refused visas on medical grounds during the fiscal year
1936
TABLE
Percentage of apNumber of appli- Number of appli- plicants notified
cants notified for
cants refused
who were refused
class B conditions visas for class B visas for class B
conditions
conditions
OoUiltry and consular office
Male
Female
Male
Female
Male
Female
- - - - - - - - - - - - - - - - - - 1---- - - - - - - - - - - - - - - - - - WESTERN HEMISPHERE
Ouba: Habana _____ ___________________________ _
Canada, totaL ______ ______ _____ ________________ _
57
853
25
17. 5
4. 0
852
Montreal_ _________________ __ ______ ___ ___ ___
Quebec ___ ___ ______________________________ _
Toronto _________________ _______________ --- _
Vancouver __ _______________ __ ______________ _
Windsor __ ____ ___ __________________________ _
Winnipeg__ ______________________ __________ _
Yarmouth ______________ ________ ___ ________ _
304
253
13
31
119
99
59
50
317
250
85
89
29
7
===(====I
All countries, Western Hemisphere ______ _
910
877
===t====I
409
325
47. 9
38.1
117
7
65
0
160
56
4
133
5
28
0
91
56
12
46. 2
53. 8
54. 6
0
50. 5
65. 9
57. 1
43. 8
16.1
28. 3
36.4
62. 9
41.4
419
326
46. 0
37.2
606
449
0
EASTERN HEMISPHERE
Europe, totaL __ ___ ____________________________ _
- ---- --- ---Belgium: Antwerp ____ ________ ___ _________ _ - -90
34
85
50
97
11
81
26
England:
London
__
-----------------------Irish Free State: Dublin ___________________ _
25
2
56
4
Northern Treland: Belfast_ _________________ _
21
3
16
3
Scotland: Glasgow ___________. ____ _________ ___
0
19
35
1
1,220
258
344
Germany, totaL ------- -- ------------------- 1,238
- - - - - -.,...-- - - - Berlin _______ ______ ____________________ _ - 497
475
209
266
Hamburg ____ ___ ____ _______ ______ ______ _
113
141
8
0
Stuttgart_ _____________________________ _
49
628
604
70
25. 7
15. 7
55. 6
26. 8
16. 0
18. 8
5. 2
27. 8
40. 0
13. 5
3. 6
14. 3
0
21. l
53. 0
7.1
1. 1
44. 0
Holland: Rotterdam _________________ ______ _
Poland: Warsaw ___________________________ _
Denmark: Copenhagen ____ ____ ________ ___ __
Norway: totaL
Oslo._------Sweden,
__________--------------------________ ___ ___ __ ___ _
12
12
30. 5
10. 3
42. 4
36. 6
38.6
27. 7
5. 0
12. 9
18. 8
17.6
5
7
33. 3
45. 0
14. 3
21. 2
44
11. 7
28 8
33. 3
5. 6
18. 9
20. 0
2,355
95
87
33
41
44
2,856
65
119
31
64
68
29
9
14
15
17
- ------Goteborg ______________________________ _ - -24
35
8
Stockholm _____________________________ _
20
33
9
Italy: Naples ______________________________ _
Czechoslovakia: Prague _________ __________ _
Austria:- Vienna __ ------------- ------------Philippine Islands: Manila _____________ _______ _
All countries, Eastern Hemisphere________
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
429
66
75
2
= 2,357
780
127
104
50
19
25
18
6
4
24
21
0
8. 1
0
50. 0
0
====l====l====I====
2,857
607
449
25. 8
15. 7
98
PUBLIC HEALTH SERVICE
18.-Number and percentage of quota and nonquota applicants of each
sex who were refused visas for mental conditions during the fiscal year 1936
TABLE
Quota
Nonquota
Female
Male
Male
Female
Country
Num- Num- Per- Num- Num- Per- Num- Num- Per- Num- INum- Perber cent ber
ber cent ber ber cent
ber
ber cent ber
exam- rere- exam- rere- exam- rere- exam- rereined fused fused ined fused fused ined fused fused ined fused fused
-- -- ---- -- -- -- -- ---
--
WESTERN HEMISPHERE
Cuba _____________________ 173
Canada ___________________ 2,075
1
7
87
0. 6
.3 1,200
6
3
6. 9
199
.3 3,235
13
0. 5
174
.4 4,023
5
6
2. 9
.1
All countries, Western Hemisphere ___ 2,248
8
.4 1,287
9
. 7 3,434
14
.4 4,197
11
.3
Europe, totaL ____ _______ _ 8,062
32
.4 9,491
61
.6 3,164
18
.6 5,206
70
1. 3
Belgium ________ ______ 352
England ______________ 588
lfish Free State _______
95
Northern Ireland _____
46
Scotland _____ _________
39
Germany _____________ 4,304
Holland _____ _________ 316
Poland _______________ 322
Denmark _____________ 107
Norway ______________ 113
Sweden ______ _________ 112
Italy ____ ------------ __ 941
Czechoslovakia _______ 388
Austria ____________ ___ 339
0
0
0
1
20
0
2
0
1
1
2
3
2
815
0
195
0
75
0
2. 6
109
. 5 4,439
232
0
277
.6
112
0
154
.8
.9
140
.2 l, 581
.8
580
492
.6
1
1
1
3
12
2
12
0
0
2
8
10
6
.1
328
.5
60
1. 3
24
2. 7
71
.3
236
31
.9
4. 3
164
25
0
44
0
1. 4
86
.5 1,827
1. 7
172
1. 2
46
0
0
0
0
2
0
0
0
0
0
13
3
0
0
310
0
198
22
0
124
0
.8
367
22
0
282
0
27
0
0
105
84
0
.7 3,271
1. 7
290
0
51
3
0
0
0
2
0
6
0
0
0
49
10
0
1.0
0
0
0
.5
0
2.1
0
0
0
1. 5
.3
0
50
0
0
.4 9,541
61
1
------------------------
EASTERN HEMISPHERE
---------------- ---- -------------------------290
1.0
3
50
0
0
53
0
0
0
0
Philippine Islands: Manila_ ------- ----- ---- --- -
-- ---------------------61
1
All countries, Eastern Hemisphere ___ 8,123
33
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1.6
34
.6 3,198
0
0
==
18
27
. 6 5,233
r
70
1. 3
99
PUBLIC HEALTH SERVICE
TABLE
19.-Number and character of the mandatorily excludable conditions notified
during the fiscal year 1936
WESTERN HEMISPHERE
.0
~
«l
Disease or defect
al
P=1
~
o5
::s
0
0
I>
::,
8
0
i:l
A
0)
A
0
.0
.0
0)
::s
:3
0
0
0)
0.
al
0
"i:1
'O
i:l
~
£::,
bl)
....
S3
s
3
a
i:l
3
i ::,. E-< E-<
> i
-- -- -- ---- -- -- -- -::s
0
- - - - - -- - -- - - - - - 1 -Cias.~ A-I
Chronic alcoholism _________ ___________ _
Insanity _______ ________ _______________ _
Mentally defective _____________ ___ ____ _
Epilepsy ______________________________ _
Feeble-mindedness _______________ ____ __
psychopathic
Constitutional
__________ _
_____ inferiority_
_____________
Imbecility
~
Canada
«l
i:l
«l
O'
«l
E-<
0
0
2
5
0
3
3
0
0
4
6
0
1
2
0
0
0
0
0
0
0
0
1
0
2
0
0
4
0
0
0
1
0
0
1
0
0
0
1
0
0
3
0
0
1
0
1
1
1
0
0
0
0
0
0
0
0
0
4
3
0
10
0
0
2
0
0
0
1
0
0
0
0
0
0
0
0
4
0
0
4
0
0
0
0
0
0
0
0
0
0
1
3
0
0
1
0
0
2
30
16
0
15
2
8
7
0
1
5
1
2
11
0
1
7
15
1
5
14
0
0
0
0
0
0
0
0
2
5
0
1
10
0
6
8
0
11
10
0
48
78
10
- -- - - - - - - - - - - - - - - - - - - 13
2
13
4
43
0
4
30
7
0
-- ------ ---------- =
Total, class A- L ____ c ____________ _
Class A-II
Leprosy _______________________________ _
Trachoma _____________________________ _
Tuberculosis, pulmonary ______________ _
Tuberculosis, other forms ______________ _
Ringworm _____ _____________ ___ ______ __
Venereal diseases _____________ ____ _____ _
- - - - - - --- - - - - - - - - - - - 17
18
4
0
8
0
35
0
--------- ---------Grand totaL ___________________ __
Total, class A-IL ________________ _
EAS'rERN HEMISPHERE
;,;
Europe .
'O
i:l
~
H,E:l
Disease or defect
~
(l)·s
&
en
i:i ro
·5.::S
'O
i:l
~
o3
bl)
i:l
r,;:i
;s
~
.bl.)
P-<
~
.0
0)
s::s
«l
'O
i:l
~
.0
- - - -
-
i:l
~
'O
i:l
~
l>,
i:l
ro
~0 ~g §
z
~
.8
«l
~I>
]
'O
i:l
~
0)
0
en 0 P=1
- -- -
'O
i:l
ro
0
P-<
-
a
si:l
0)
i::i
-
l>,
«l
~
0
~0
i:l
'O
0)
l>,
0)
]
I'!:
z
en
- -
.0
0
0)
0
H
i
E
gJ
~
al
30
E-<
- - -- - -
-
i
0
E-<
Class A-I
Chronic alcoholism _______ __ ______
Insanity __________________________
Mentally defective _______________
Epilepsy __ -- ---- --------------- __
Feeble-mindedness _______________
Constitutional psychopathic inferiority ________________ -- ____ __
Imbecility________________________
0
0
0
0
1
0
0
0
0
3
0
3
0
0
0
0
0
1
0
0
0
0
1
0
0
0
0
1
0
0
0
3
18
1
4
0
1
0
0
1
0
0
17
0
3
0
0
0
0
0
0
0
1
0
0
0
2
1
0
0
1
4
2
0
64
0
0
20
0
6
0
0
2
0
3
1
13
64
1
84
1
13
64
0
0
0
0
0
0
0
0
0
0
0
9
1
0
0
0
0
0
0
0
0
0
0
1
1
0
0
3
0
13
13
0
2
-- - - -- -- - -- - - - - - -- -- -- - - -Total, class A-L ____________ 1 3 3
8 178
1
1 1 36 2 20 0 1 3 73 26
- - - -- -- - -- - -- - - - -- -- -- - -
A-II ______ _____
Class
_________
Leprosy ______
Trachoma ______ ________________ __
Tuberculosis, pulmonary ___ ______
Tuberculosis, other forms _________
Ringworm _______________________
Venereal diseases _______ __ ________
Total, class A-II ___________
Grand totaL __________ _____
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1
0
0
0
0
0
1
85
2
179
0
0
1
0
0
0
0
1
1
0
2
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
15
27
0
17
8
0
0
0
0
0
0
0
8
3
0
0
0
0
0
0
0
0
1
0
0
3
0
0
1
0
0
1 235
1
6
1
0
0
0
6
0
0
2
1
0
0
0
0
0
3 266
5 49
1
0
7 26
0 16
1
26 6
49
1
26
16
4
7
1
3
1 103
2
31
1
5
5 321
29
23 536
538
- -- - - - - - - - - - - - - - - - -- - 3 15 358 359
1 4
2 0 67 0 11 1 4 2 248
0
--- - -- - - - - -- -- -- - -- -- -- -- -- -- - ·
-- 1
2
DIVISION OF SANITARY REPORTS AND STATISTICS
Asst. Surg. Gen. R. C.
WILLIAMS
in charge
Asst. Surg. Gen. R. C. Williams was relieved from duty in charge
of the Division on May 31, 1936, and Medical Director Robert
Olesen was detailed as Assistant Surgeon General in charge on June 1,
1936.
Throughout the fiscal year ended June 30, 1936, the Division of
Sanitary Reports and Statistics acted as a clearing house for public
health information. Data relating to outbreaks and the prevalence of
diseases dangerous to the public health were collected from all available sources in the United States and foreign countries. The information was compiled, abstracted, or tabulated and made available to
Federal, State, and local health officers by publication in the weekly
Public Health Reports and by special bulletins.
Toward the close of the fiscal year the Office of Health Education
was established under the direction of Senior Surg. R. R. Spencer.
This office is concerned both with professional and lay health education. In addition to issuing a monthly periodical, "The Health
Officer", courses of instruction were prepared for classes of commissioned Service officers. An institute for rural physicians in the
State of Georgia was prepared, sponsored, and financed. In association with the Office ·of Education of the Department of the Interior,
weekly radio lectures on health topics are being prepared.
MORBIDITY AND MORTALITY R EPORTS
The collection of reports of cases of notifiable diseases through
collaborating and assistant collaborating epidemiologists was continued. These are officers of State and local departments of health
who are given appointments as officers of the Public Health Service
for the purpose of collecting information as to the prevalence of communicable diseases and forwarding the data to the Public Health
Service.
Weekly telegraphic reports were received from State health officers
and weekly mail reports from health officers of cities of over 10,000
population. These reports give immediate information as to the incidence of the principal communicable diseases. Monthly reports
from States give additional data and distributions of cases by counties.
Annual reports from States and cities give the numbers of cases
of notifiable diseases and deaths from these diseases for the calendar
year.
Reports from foreign countries are received from officers of the
Public Health Service, American consular officers, the International
Office of Public Health in Paris, the Pan American Sanitary Bureau, the health section of the League ·of Nations, and from other
sources.
100
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
101
PUBLIC HEALTH SERVICE
The accompanying tables give a comparison of the numbers of
reported cases of the principal notifiable diseases, with deaths, m
the United States for the calendar years 1933, 1934, and 1935.
CASES
Number of
States 1
Disease
Aggregate population
(in thousands)
1933
Chicken pox ______________
Diphtheria _____ . __________
Influenza ______________ . __
Malaria __ . ________________
Measles _________ ____ ______
Meningococcus meningitis
Mumps _________ __ ________
Pellagra _______________ __ __
Pneumonia (all forms) ____
Poliomyelitis ______________
Scarlet fever ______________
Smallpox __________________
Tuberculosis (all forms) ___
Tuberculosis
(respiratory
___ _____
system) _________
Typhoid fever and paratyphoid fever ____ . _____ .
Whooping cough _________ .
1934
Cases per 100,000
population
Cases
1935
1933
1934
1935
1933
1934
1935
- - - - - - - - - - - - - - - - - - - - - -45 116,379 117,472 118,351 230,969
48,100
47 118,895 119,929 120,814 --------47 118,895 119,929 120,814 ---- --- 47 118,895 119,929 120,814 385,204
40 112,305 113,088 113,875
2,788
42 95,078 95,974 96,689 87,202
47 118,895 119, 9'2 9 120,814 -------46 114,577 115,603 116,439 -------44 108,859 109,818 110,614
4,625
47 118,895 119,929 120,814 187,103
47 118,895 119,929 120,814
6,252
47 118,895 119,929 120,814 -------47 118,895 119,929 120,814
42 112, 786 113,598 114,422
--------
233,207 249,394 198. 5 198. 5 210. 7
40,771 36, 735 40. 5 34. 0 30.4
--------- -------- ------ ------
-----------
--------
--------
--------
-------- ------ ------ ------------- ------ ------ ------
------ ------
767,629 706,608 324. 0 640.1 584. 9
2,260
5,224
2. 5
2. 0
4. 6
96,789 136,428 91. 7 100.8 141.1
--------
7,047 10,643
4. 2
6.4
9. 6
194,083 235,818 157. 4 161. 8 195. 2
5,337
7,927
5. 3
4. 5
6. 6
-------- -------- ------ ------ ------------- ------ ------ ------
--------
47 118,895 119,929 120,814
22,291 21,353 17,651 18. 7 17. 8 14. 6
47 118,895 119,929 120,814 171, 728 248,893 173,067 144.4 207.5 143. 3
I
DEATHS
Deaths per 100,000
population
Deaths
Disease
1933
1934
1935
1933
1934
1935
Cases reported
for each death
registered
1933
1934
1935
-- ------ -- -- ---Chicken pox. ________ _____ ___ ---- ~------- __
Diphtheria _____ . _______ ._. _______ . _________
Influenza_. _____________________________ ___
Malaria ____________________________________
Measles _____ ._._ .. __ .. __ . ________ ... ____ _._
Meningococcus meningitis _________________
Mumps ____________________________________
Pellagra ____________________________________
Pneumonia (all forms). _____ __ _____________
Poliomyelitis_. ________________________ ____
Scarlet fever_. _____________________________
Smallpox __________________________________
Tuberculosis (all forms) ____________________
Tuberculosis (respiratory system) _____ ____
Typhoid fever and paratyphoid fever ______
Whooping cough __________________________ _
1
2
136
4,679
30,390
4,463
2,056
1,122
47
3,801
84,308
664
2,234
35
70,267
60,424
4,260
4,018
122
4,020
19,554
4,401
5,935
966
61
3,409
95,050
726
2,218
21
67,298
58,073
4,014
6,857
144
3,646
26,588
4,310
3,551
2,170
71
3,440
95,557
884
2,393
24
65,574
56,813
3,340
4, 351
0. 1
3. 9
25. 6
3.8
1. 7
1.0
.1
3.2
73.6
.6
1.9
(2)
59.1
53.6
3.6
3.4
0.1
3.4
16. 3
3. 7
4. 9
.9
.1
2.8
82.2
.7
1.8
(2)
56.1
51. 1
3. 3
5. 7
0.1 1,698 1,912 1,732
3.0
10
10
10
22.0 ------ ------ -----3. 6 ------ ------ -----2.9
187
129
199
1. 9
2
2
2
.1 1,855 1,587 1,922
2.8 -----82.1 ------ -----12
.8
7
10
2.0
84
88
99
(2)
179
254
330
54. 3 ------ ------ -----49. 7 ------ ------ -----2.8
5
5
5
3.6
43
40
36
------ -----------
In addition to the number of States given, the District of Columbia is also included.
Less than 0.1 per 100,000 population.
Limited personnel available for the work retarded the compilation
and analysis of laws, ordinances, and regulations pertaining to public
heal th. Some court decisions were digested and published and the
collection of laws and regulations was continued.
·
NEGRO HEALTH
wORK
The Negro Health Work of the Public Health Service was continued.
The year 1936 National Negro Health Week reached an estimated
total of over a million Negro members of organizations and families
in all Southern and many Northern States and over 2,000 communities.
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Federal Reserve Bank of St. Louis
102
PUBLIC HEALTH SERVICE
There were clean-up activities in over 50,000 homes, approximately
3,500 lectures were given to 4,000,000 people, and many thousands of
health publications were distributed to the general population. More
than 500 clinics provided health examinations and treatment to
75,000 children and adults. The reports of year-round activities
initiated or stimulated by the National Negro Health Week include
various progressive measures that cannot but enhance the facilities
for health protection.
PUBLICATIONS IssuED BY THE DIVISION
The fiftieth annual volume of the weekly Public Health Reports was
completed with the issue of December 27, 1935. This is one of the
oldest of regular Government periodical publications; it was first
printed in 1878, under the title of "Bulletins of Public Health", and
has been issued under the present title since 1895. The 52 numbers
printed during the fiscal year comprised volume 50, part 2, and volume
51, part 1, and contained 1,828 pages of text and tabular matter
exclusive of title pages and tables of contents, as compared with 1,751
pages in the fiscal year 1935, 1,578 pages in 193.4, and 1,762 pages in
1933. In earlier years these annual volumes averaged approximately
3,000 pages. The reduction in size in recent years, of almost 50 percent, was made necessary by reduction in printing funds. It has been
accomplished by suspending publication of some current statistical
material, by condensing other tables, and by revising and condensing
text articles as much as possible. The Public Health Reports is
especially important as a medium of presenting current morbidity
statistics for the use of health officers and others concerned, and of
making a permanent record of these statistics for future use, and also
as a journal for reporting the results of current research relating to
the cause, prevention, and cure of disease and articles on health
administration. The value of the Public Health Reports in these
respects was retained to the greatest extent possible in the face of the
handicap of reduced printing funds.
During the year 65 important articles published in the Public
Health Reports were issued in separate form as reprints, thus providing a more extensive and more economical distribution of these articles
to persons especially interested in the particular subjects and permitting the printing of additional copies for sale by the Superintendent
of Documents. In the preceding fiscal year 60 such separates were
issued, as compared with 50 in 1934. Formerly about 100 articles
appearing in the Public Health Reports each year were issued as
separates.
:Five supplements to the Public Health Reports were issued during
the year, as follows: No. 115, The Size Distribution of Industrial
Dusts; No. 116, A List of Public Health Servic~ Publications Suitable
for G~neral Distribution; No. 117, The Notifiable Diseases-Prevalence in States, 193,4-; o. 118, Experiments on the Tolerance and
Addiction Potentialities of Dihydrodesoxymorphine-D ("Desomorphine"); and No. 119, The Notifiable Disea_s~s-Prevalence in
States, 1935.
New editions of 17 previously issued publications were secured
during the year as the stock became exhausted and the iin terest in
and demand for them justifietl the additional printing. About half
of these publications required slight revision to bring them to date.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
103
The Hospital News, a semimonthly journal containing articles
dealing with the work in the marine hospitals and outpatient relief
stations, was issued by this Division regularly during the year. The
process of reproducing this material was changed from mimeographing
to multilithing, which greatly improved the appearance and legibility
of the pages. The Hospital News reproduces articles and reports on
clinical research, case histories, accounts of practices, observations,
and reports on improvements in methods and new devices in the
marine hospitals and other institutions served by medical officers of
the Public Health Service, the purpose being to bring such information
currently to the attention of the personnel engaged in hospital work.
In achieving this purpose, it has definitely filled a long unsupplied
need. While the Hospital News is conducted under the auspices of
the Division of Marine Hospitals and Relief and the Division of
Mental Hygiene, it is edited and issued by the Division of Sanitary
Reports and Statistics. It is not a publication in the scientific sense
of that word, as its distribution is limited to Public Health Service
personnel and it is not for sale. The material used, however, justifies
a wider distribution and a more permanent record, as many of the
reports are definite contributions to clinical medicine and should be
made available genernlly to persons interested in that field.
The National Negro Health Week publications-Bulletin, Leaflet,
and Poster-were edited and issued by _this. D~vision during the year.
These publications constitute an important part in the observance of
this Health Week, the object of which is to improve the health of
Negroes and the conditions under which they live _by stimulating
interest in health activities, intensive for 1 week, but with a yearround program, and by aiding community leaders in their efforts
directed toward important local health problems.
PUBLICATIONS DISTRIBUTED AND EXHIBITS PREPARED
There were 83 new publications distributed by the Division, ascompared with 79 during the preceding year. A total distribution of
248,243 copies of new publications and of editions of previously·
published documents was made. Of these, 153,529 were sent in
response to individual requests for information and 84,714 were distributed to Service mailing lists.
.
Twenty-nine requests for the loan of stereopticon slides were received; and in response to these requests, 2,501 slides were lent to
universities, health officers, public health lecturers, officials of the
Public Health Service, and others.
In recent years the Public Health Service has had an appropriation
for the preparation n.nd display of exhibits relating to public health.
The funds appropriated during this fiscal year, as in previous years,
were inadequate, but an .important e~hibit on undulant fever was
prepared and displayed at the annual meeting of the Americ-a n
Medical Association at Kansas City, Mo. Other exhibits of the
Service were displayed at medical and public health meetiw s in
various cities of the United States. Additional exhibit material was
prepared and placed in the permanent exhibit room of the Public
Health Service Building in Washington.
The following is a list of publications distributed by the Division
during the fiscal year:
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Federal Reserve Bank of St. Louis
104
PUBLIC HEALTH SERVICE
REPRINTS FROM THE PUBLIC HEALTH REPORTS
1675. State and insular health authorities, 1934. Directory, with data as to
appropriations and publications. March 1, 1935. 17 pages.
1678. M ottled enamel in T exas. By H. Trendley Dean, R. M. Dixon, and
Chester Cohen. March 29, 1935. 18 pages; 2 plates.
1680. Studies of sewage purification. I. Apparatus for the determination of
dissolved oxygen in sludge-sewage mixtures. By E. J. Theriault and
Paul D. McNamee. April 5, 1935. 10 pages.
·
1681. Age incidence of illness and death considered in broad disease groups.
Based on records for 9,000 families in 18 States visited periodically for
12 months, 1928-- 31. By Selwyn D. Collins. April 12, 1935. 19 pages.
1683. Mortality in certain States during 1934, with comparative data for r ecent
years. April 26, 1935. 10 pages.
1684. Relat ion of sickness to income and income change in 10 surveyed communities. Health and depression studies no. 1: Method of study and
general results for each locality. By G. St. J. Perrott and Selwyn D.
Collins. May 3, 1935. 28 pages.
1685. City health officers, 1934. Directory of those in cities of 10,000 or more
population. May 10, 1935. 17 pages.
1686. Studies of sewage purification. II. A zooglea-forming bacterium isolated
from activated sludge. By C. T. Butterfield. May 17, 1935. 13 pages;
4 plates.
1687. A communicable disease meter. A device for recording and comparing the
current incidence of communicable diseases. By Robert Olesen. May
24, 1935. 10 pages.
1688. Prevention of intranasally-inoculated poliomyelitis of monkeys by instillation of alum into the nostrils. By Charles Armstrong and W. T. Harrison.
May 31, 1935. 6 pages.
1689. Protection of mice against meningococcus infection by polyvalent antimeningococcic serum. By Sara E. Branham. June 7, 1935. 10 pages.
1690. The irritants in adhesive plaster. By Louis Schwartz and Samuel M. Peck.
June 14, 1935. 9 pages.
1691. Benign lymphocytic choriomeningitis (acute aseptic meningitis). A new
disease entity. By Charles Armst.rong and Paul F. Dickens. June 21,
1935. 12 pages.
1692. Leprosy. The effect of a vitamin B 1 deficient diet on the incubation
period of rat leprosy. By L. F. Badger and W. H. Sebrell. June 28,
1935. 9 pages.
1693. Report of the Committee on Milk, Conference of State and Provincial
Health Authorities, 1935. July 19, 1935. 4 pages.
1694. Milk-sanitation ratings of cities. Cities for which milk-sanitation ratings
of 90 percent or more were reported by the State milk-sanitation authorities during the period July 1, 1933, to June 30, 1935. July 26, 1935.
3 pages.
1695. Malaria epidemic in Aurora, Ohio. By R. N. Hoyt and R. D. Worden.
July 5, 1935. 3 pages.
1696. Roentgenological appearances in silicosis and the underlying pathological
lesions. R eport by a committee composed of IL K. Pancoast, E. P.
Pendergrass, A. R. Riddell, A. J. Lanza, Wm. J. McConnell, R.R. Sayers,
H: L. Sampson, and L. U. Gardner. August 2, 1935. 8 pages.
1.697. The control of communicable diseases. R eport of a commit t ee of the
American Public Health Association. August 9, 1935. 61 pages.
l.698. D edication and opening of the Lexington Narcotic Farm. By W. L.
Treadway. Au gust 2, 1935. 5 pages.
1699. Public H ealth Service publications. A list of publications issued during
the period January-June 1935. August 2, 1935. 4 pages.
1700. Control of rabies in New York City. By R obert Olesen. August 16, 1935.
20 pages.
1701. Height and weight of children of the depression poor. H ealth and depression studies no. 2. By Carroll E. Palmer. August 16, 1935. 7 pages.
1702. Acute response of guinea pigs to vapors of some new commercial organic
compounds. VIII. Butanone. By F. A. Patty, H. H. Schrenk, and
W. P. Yant. September 6, 1935. 12 pages.
1703 . The maternity nursing service of a bicounty health department. Bruns. wick-Greensville health administration studies no. 5. Prepared by
Pearl Mclver. September 20, 1935. 16 pages.
1704. Directory of whole-time county health officers, 1935. September 20, 1935.
10 pages.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
105
1705. The blacktongue-preventive value of 7 foodstuffs . By W. H. Sebrell,
G. A. Wheeler, and D. J. Hunt. September 27, 1935. 9 pages.
1706. The accuracy of certified causes of death. Its relation to mortality statistics
and the International List. (Report of the Committee, American
Public Health Association.) September 13, 1935. 45 pages.
1707. Dust storms and their possible effect on health. With special reference
to the dust storms in Kansas in 1935. By Earle G. Brown, Selma
Gottlieb, and Ross L. Laybourn. October 4, 1935. 15 pages; 8 plates.
1708. Milk control and the United States Supreme Court. By James A. Tobey.
October 4, 1935. 6 pages.
1709. A nonflammable pyrethrum spray for use in airplanes. By C. L. Williams
and W. C. Dreessen. October 11, 1935. 4 pages. '
1710. Age incidence of specific causes of illness. Based on records for 9,000
families in 18 States visited periodically for 12 months, 1928- 31.
By Selwyn D. Collins. October 11, _1935. 25 pages.
1711. Cultivation of the virus of Rocky Mountain spotted fever in the developing
chick embryo. By Ida A. Bengtson and R. E. Dyer. October 25, 1935.
10 pages; 3 plates.
1712. The urinary excretion of silica by persons exposed to silica dust. By
J. J. Bloomfield, R. R. Sayers, and F. H. Goldman. March 29, 1935.
4 pages.
1713. Disabling illness among industrial employees in 1934 as compared with
earlier years. By Dean K. Brundage. November 1, 1935. 13 pages.
1714. Extent of rural health service in the United States, December 31, 1930December 31, 1934. November 1, 1935. 16 pages.
1715. Studies of sewage purification. III. The clarification of sewage--A review.
By Emery J. Theriault. November 8, 1935. 15 pages.
1716. Physical condition and unemployment. By Harold S. Diehl. November
15, 1935. 9 pages.
1717. Microscopic appearance of experimentally produced dust nodules in the
peritoneum. By J. W. Miller and R. R. Sayers. November 15, 1935.
10 pages; 6 plates.
1718. Further studies of the effect of radium upon bacteria. By R. R. Spencer.
November 22, 193,5. 14 pages ; 4 plates.
1719. A technique which completely excludes air contamination of bacterial
cultures. By R. R. Spencer. November 22, 1935. 2 pages; 1 plate.
1720. Influenza and pneumonia mortality in a group of about 95 cities in the
United States during four minor epidemics, 1930-35, with a summary for
1920- 35. By Selwyn D. Collins and Mary Gover. November 29, 1935.
21 pages.
1721. Studies on the minimal threshold of the dental sign pf chronic endemic
fiuorosis (mottled enamel). By H. Trendley Dean and Elias Elvove.
December 6, 1935. 11 pages.
1722. Job analysis of a rural health officer. Brunswick-Greensville health administration studies no. 6. Prepared by J. 0. Dean. December 13, 1935.
12 pages.
1723. Cost of local enforcement of the United States Public Health Service milk
ordinance. By A. W. Fuchs and L. C. Frank. December 13, 1935. 5
pages.
1724. State and insular health authorities, 1935. Directory, with data as to appropriations and publications. December 20, 1935. 18 pages.
1725. The typhoid control program and results of 13 years' work in Williamson
County, Tenn., 1922-35. By W. C. Williams and E. L. Bishop. January 3, 1936. 15 pages.
1726. City smoke and its effects. A statement prepared for the Congressional
Subcommittee on Public Health, Hospitals, and Charities. January 3,
1936. 4 pages.
1727. Diets of low-income families surveyed in 1933. Health and depression
studies no. 3. By Dorothy G. Wiehl. January 24, 1936. 21 pages.
1728. Calcium cyanide dust in ship fumigation. By C. L. Williams. February 7,
1936. 4 pages.
1729. Milk-sanitation status of urban communities. Urban communities in
which pasteurized milk is both properly produced and properly pasteurized, and in which raw milk is at least properly produced, as shown by
ratings of 90 percent or more reported by the State milk-sanitation authorities during the period January 1, 1934, to December 31, 1935.
February 7, 1936. 4 pages.
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Federal Reserve Bank of St. Louis
106
PUBLIC HEALTH SERVICE
1730. Results of field studies with the Brodie poliomyelitis vaccine. By A. G.
. Gilliam and R. H. Onstott. February 14, 1936. 12 pages.
1731. The place of mental hygiene in a Federal health program. By Walter L.
Treadway. February 21, 1936. 13 pages.
1732. Prevention of experimental intranasal infection with certain neurotropic
viruses by means of chemicals instilled into the nostrils. By Charles
Armstrong and W. T. Harrison. February 28, 1936. 13 pages.
l'.733. Prevention of intravenously inoculated poliomyelitis of monkeys by intranasal instillation of picric acid. By Charles Armstrong. March 6, 1936.
3 pages.
1734. Biological products. Establishments licensed for the propagation and sale
of viruses; serums, toxins, and analogous products. March 6, 1936. 6
pages.
S
.
.
1 . f
..
1735. The official United tates and mternat1ona umt or standard1zmg gas gangrene antitoxin (oedematiens). By Ida A. Bengtson. March 13, 1936.
10 pages.
1736. Results of a dental examination of 1,908 white and colored males at the
Ohio State Reformatory. By W. M. Gafafer and C. T. Messner. March
27, 1936. 12 pages.
1737. The picture of heart disease mortality obtained from vital statistics in
Washington, D. C., during 1932. By 0. F. Hedley. March 20, 1936.
14 pages.
1738. Changes in the incidence and fatality of smallpox in recent decades. By
A. W. Hedrich. April 3, 1936. 30 pages.
1739. Acute response of guinea pigs to vapors of some new commercial organic
compounds. IX. Pentanone (methyl propyl ketone). By W. P. Yant,
F. A. Patty, and H. H. Schrenk. April 3, 1936. 8 pages.
SUPPLEMENTS
·us.
The size distribution of industrial dusts. By J. J. Bloomfield. 1935. 9
pages.
116. Some Public Health Service publications suitable for general distribution.
1935. 23 pages.
117. The notifiable diseases. Prevalence in States, 1934. 1935. 12 pages.
PUBLIC HEALTH BULLETINS
217. The determination and control of industrial dust. By J. J. Bloomfield and
J. M. Dalla Valle. April 1935. 167 pages.
218. Studies in-illumination. IV. Daylight in buildings. A study of the effect of
the height and width of windows and of the reflecting power of the walls
and ceiling upon the natural illumination within a building. By James E.
Ives, Frederick L. Knowles, and Lewis R. Thompson. April 1935. 5Z
pages.
220. Public Health Service milk ordinance and code. July 1935. 114 pages.
221. Anthraco-silicosis among hard coal miners. Engineering studies by J. J.
Bloomfield and J. M. Dalla Valle; medical studies by R. R. Jones and
Waldemar C. Dreessen; statistical analysis by Dean K. Brundage and
Rollo H. Britten. With sections on autopsy material by J. W. Miller and
on silica in the urine and in lung specimens by F. H. Goldman. December1935. 114 pages; 45 plates.
222. History of county health organizations in the United States 1908-33. Compilation by John A. Ferrell and Pauline A. Mead. March 1936. 469 pages.
223. Observations on Indian health problems and facilities. By Joseph W. Mountin and J. G. Townsend. February 1936. 47 pages.
224. Atmospheric pollution of American cities for the years 1931-33. With
special reference to the solid constituents of the pollution. By James E.
I ves, Rollo H. Britten, David W. Armstrong, W. A. Gill, and Frederick
H. Goldman. March 1936. 75 pages.
225. Some features of tuberculosis mortality distribution in the United States~
By L. L. Lumsden and C. C. Dauer. March 1936. 39 pages.
226. Dental survey of school children, ages 6 to 14 years made in 1933-34 in 26
States. By C. T. Messner, W. M. Gafafer, F. C. Cady, and H. T. Dean~
May 1936. 248 pages.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
107
NATIONAL INSTITUTE OF HEALTH BULLETINS
165. I. A method for quantitating neuromuscular irritability. The effect of
certain drugs on the neuromuscular apparatus. By Maurice I. Smith.
II. The pharmacologic action of some alcoholic phosphoric esters. By
Maurice I. Smith. June 1935. 29 pages.
166. Epidemic amebic dysentery. The Chicago outbreak of 1933. By Herman
N. Bundesen, Joel I. Connolly, Isaac D. Rawlings, Arthur E. Gorman,
George W. McCoy, and Albert V. Hardy. March 1936. 187 pages.
ANNUAL REPORT
Annual Report of the Surgeon General of the United States Public Health Service
for the fiscal year 1935. 158 pages.
MISCELLANEOUS PUBLICATIONS
11. Official list of commissioned and other officers of the United States Public
Health Service. January 1, 1936. 63 pages.
16.
omenclature of diseases and conditions. 1935. 78 pages.
UNNUMBERED PUBLICATIONS
Index to Public Health Reports, volume 50, part 1, January-June 1935. 24 pages.
Index to Public Health Reports, volume 50, part 2, July- December 1935. 22
pages.
National Negro Health Week program. This pamphlet is published annually,
usually 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 effectiv.e attack upon the community's disease
problems. Twenty-second annual observance. 1936. 8 page folder.
National Negro Health Week poster. Twenty-second annual observance. 1936.
National Negro Health Week leaflet. Twenty-second annual observance. 1936.
2 pages.
101889-36--8
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Federal Reserve Bank of St. Louis
DIVISION OF MARINE HOSPITALS AND RELIEF
Asst. Surg. Gen. S. L.
CHRISTIAN
in charge
The marine hospitals and other relief stations continued to furnish
outpatient and hospital treatment to American seamen and other
legal beneficiaries in 154 ports of the United States and its possessions.
Contracts were maintained with 197 hospitals located chiefly in ports
not served by the 25 marine hospitals. At the close of the year 5,213
patients remained in the hospitals, including 159 insane in St. Elizabeths Hospital and 374 patients at the National Leper Home.
The volume of work shows a substantial increase. Marine hospitals
and contract hospitals treated a daily average of 272 more patients
than they did in 1935. As in the preceding year, operation of the
hospitals was difficult, owing to inadequate appropriations and
insufficient P.ersonnel. The ratio of personnel to patients in the
avera~e civilian hospital as reported by the American Hospital
Association is 1¼ to 1, whereas in the United States marine hospitals
it is only one-half this ratio; that is, 0.6 to 1. The 11 days additional
leave of absence authorized during the year and the effort to decrease
working hours make this ratio even more embarrassing. The increase
in the number of beneficiaries treated, together with the steady rise
in the cost of hospital supplies, made it necessary to request a deficiency appropriation of $159,000. Medical officers in charge of the
hospitals and relief stations were admonished during the year that
funds would not be available for supplies, repairs, and replacements
other than those considered urgently needed. In spite of this, it was
necessary to carry forward into the new year requisitions totaling
approximately $100,000. In many cases repairs and replacements
have been neglected to the point of hampering efficiency and causing
an economic waste of property. This condition is deplorable and
cannot go on indefinitely.
Recommendations for an increase in salary for personnel have
repeatedly come from medical officers in charge. The recommendations were based on the fact that a promotion is a just reward for
years of efficient and loyal service. These recommendations could not
be approved for the reason that funds for such meritorious rewards
were not available. This condition is lacking in justice. It is a hazard
to the morale of the Service and should be remedied.
The per-diem cost during the year was of necessity kept down to
the very low figure of $3.39. The standard of care of patients was
with much difficulty maintained at the usual high level, but the
low per diem did not permit of reasonable working hours and normal
leave for employees and normal replacement of equipment.
Seamen are the most numerous class of patients, but the customary
medical services were furnished to the Coast Guard, Army, Navy,
Employees' Compensation Commission, Civil Service Commission,
Bureau of Navigation and Steamboat Inspection, Lighthouse establishment, Immigration Service, Coast and Geodetic Survey, Veterans'
Administration, Bureau of Fisheries, Civilian Conservation Corps,
Civil Works Administration, Public Works, and Works Progress
108
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Federal Reserve Bank of St. Louis
llllOOP
ROSPIUL
CXlST Pll P!TIUT JaT
SalariH -
01
IIOSPIULS
1ood
c::::J
Other~
(ZIID.U,
~
t:::.i
~
1-3
~
(/)
t:::.i
To~ llelief Dqa
Coat
1ort 8'81,\011, I ,II,
67,187
'l'OBZRCOU>SIS
s.&llilOBitlll
4.14
1.84
Cost
Canille, Ia.
135,757
2 .80
1.61
.61
1.62
~
0
t:::.i
21s,094.27
.41
,78
LZPBOSilltll
Cott
Per diem coet for all llospitals
3.39
2.1)11
380,274.15
.43
.92
ALL
klief dqs for all hospitals 1,774,873
Cost
$6,012,236.86
(a) lll-patie11t clepartmellt of stat1011 olos.4,
Average per-diem cost of inpatient relief, United States marine hospitals, fl.seal year 1936.
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Federal Reserve Bank of St. Louis
--, .,-
110
PUBLIC HEALTH SERVICE
Administration. In cooperation with the Civil Service Commission
and the Immigration Service, medical officers of the Public Health
Service were assigned as members of examining boards convening at
various places in the United States for the purpose of giving oral
mental examinations and physical examinations to applicants for the
position of Border Patrol Inspector.
The Public Health Service also cooperated with other Government
departments in Washington in furnishing emergency medical relief to
employees and supervising 20 medical relief units in the Treasury
Department and other agencies. During the year thorough physical
examinations were given to more than 200 special agents in the
Federal Bureau of Investigation, Department of Justice, to determine
physical defects and physical fitness. These examinations are to be
given every member of the corps and repeated periodically.
For a complete statement of relief furnished at each station and
the customary collateral functions performed by the marine hospitals
for the agencies listed above, see pages 113 to 117.
CLASSES OF BENEFICIARIES AND AMOVNT AND CHARACTER OF SERVICES
RENDERED
Summary of services by class of beneficiary
Hospital days
Outpatient
treatments
Physical examinations
(not related
to treatment)
Class of beneficiary
Remarks
Number
Percent
of
total
PerPercent Num- cent
of
ber
of
total
total
Number
- - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - --
American merchant sea- 1, 109, 748 58. 27
men.
Veterans _--~--- ---- --- ---- 130,539 6. 85
Lepers ____ ____ ____ _____ ___ 136, 035 7. 14
598, 761 46. 36
7 ------
2
Coast Guard personnel_ __ _
88,325
4. 64
130,206 10. 08
5, 149
Injured Federal employees.
Immigrants ______________ _
95,451
5. 01
119, 837
24,487
1. 29
10,759
1,202
. 09
9, 063
1, 136
9. 28 23, 741
. 83
1,258
8. 33 Communicable diseases are reported to local health officers.
1.04 Patients of the Veterans' Administration. ,
- ----- National Leper Home, Carville, La.
4. 73 All medical services and supplies, ashore and afloat.
21. 82 Patients of the Employees'
Compensation Commission.
1.16 Patients of the Bureau of Immigration.
1. 12 Civilian employees on Army
vessels.
23,427 1.81 1,222
43,732 2. 30
Seamen, Engineer Corps
and Army Transport
Service.
6,058
.32
Seamen from foreign ves867
.07
44
. 04 P ay patients.
sels.
14,582
Seamen and keepers,
• 77
. 52
6,772
161
. 15 Medical supplies also furnished
Lighthouse Service.
to lighthouse vessels .
Civilian Conservation
170, 798 8. 97
1,950
. 15 1, 252 1. 15 Patients of the Civilian ConCorps.
servation Corps.
9,429
.49
1,673
.13
318
Civil Works Administra. 29 Patients of the Civil Works
Administration.
tion.
48,762 2. 56
Works Progress Adminis82, 858 6. 42 17, 579 16. 16 Patients of the Works Progress
tration.
Administration.
Alaska cannery workers · ______________ _
. 08 7, 277 6. 69 Vaccinations and other preven990
leaving United States.
tive measures.
Pilots and other licenses ________ ________________________ _ 7,306 6. 72 For the Steamboat Inspection
Service.
Civil Service applicants _________ __ ____ _________ ______ 25,409 23. 35 For the Civil Service Commisand employees.
sion.
Shipping Board___________ _________ ______ _________ ______ 1,357 1. 25 To determine fitness for sea
duty.
All others entitled to treat26, 395 1. 39 312, 307 24. 18 6, 533 6. 00 From Bureau of Fisheries,
ment.
Army, Navy, Mississippi
River Commission, Coast
and Geodetic Survey, etc.
TotaL ______________ 1,904,341100.00 1,291,616100.00108,807100.00
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Federal Reserve Bank of St. Louis
NEW UNITED STATES MARINE HOSPITAL AT STAPLETON ,
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Federal Reserve Bank of St. Louis
N.
Y.
NEW INFIRMARY BUILDING AT THE NATIONAL LEPROSARIUM , CARVILLE , LA .
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Federal Reserve Bank of St. Louis
111
PUBLIC HEALTH SERVICE
DENTAL TREATMENT
During the fiscal year 173,271 beneficiaries of the Service were given
<len tal treatment by full-time officers at an average cost of $1. 58 per
patient. Had the dental treatment rendered at these stations been
procured at authorized fees by contract dentists instead of by Service
personnel, the average cost would have been $6.97 per patient. The
major items of treatment and a comparison with the preceding fiscal
year are shown in the following list:
1935
Number of patients treated______________________________________________________
X-rays ___________________________________________ __ _____ __ ______________________
Prophylactic treatments (hours)_________________________________________________
Vincent's stomatitis treatments (hours)__________________________________________
Pyorrhea treatments (hours) __ _-----------------------------------------________
Extractions__________________________________________ __ __________________________
.Alveolectomies_ ___ __ __ ___ _____ __ _______ ___ ___ _____ __ __ __ ______ __ __ __ ______ ______
Alloy fillings__________________ __________________________________________________
-Oold inlays______________________________________________________________________
Porcelain crowns __________________.______________________________________________
Silicate cement fillings___________________________________________________________
Dentures (full and partial) ____________ ------------------------------____________
Fracture cases (hours)_________ ___________________________________ _______________
Number of treatments (out-patient)_____________________________________________
Number of treatments (in-patient) ___ ------------------------------------------- ,
1936
174,353
39, 207
14,406
4,452
4,449
83, 189
2, 177
47, 081
1,142
132
20, 554
6,974
1, 463
478, 444
199,014
173,271
37, 889
19,621
8,944
6,472
82, 877
3, 694
45, 219
1,220
127
19, 652
8,533
1, 048
514, 621
184,122
677,458
698,743
____ ,,____
Total number of treatments_______________________________________________
The amount of treatment rendered by the full-time dental officers
~hows a slight increase over last year. In addition 2,491 beneficiaries
were treated at 36 smaller stations by contract dentists on a fee basis,
at a total cost to the Service of $1'2,60.G.l 7, or an average of $5 .06 per
-patient.
An allotment of $7,770 was made from Social Security fonds for this
fiscal year for the study of focal infe'c tion. The study is heing conducted at the United States Marine Hospital, Baltimore, Md. Plans
have been made to provide dental care to Coast Guard personnel at
isolated stations by means of an automobile and trailer dental unit.
COAST GUARD
The average number of Coast Guard beneficiaries on active duty
.and retired was 10,748. A summary of medical services furnished in
:recent years is shown in the following table:
Numerical strength of Coast Guard and
medical services given
Year
Number
of Coast Hospital
days
Guard
personnel
Outpatient
treatments
Average _amount of medical
services per person
Physical
examina- Hospital
days
tions
Out•
patient
treat•
ments
Physical
examina•
tions
- - - - - - - - - - - - - - - ---1923 ____ -- ----- _-- ---- __ -- -- --- _
1924 ____ -- --- -- _-- -------- __ --- _
1925 __ -- _--- -- - - -- -- -- - --- ---- -1926 __ ---- -- ---- _-- _-- --- -- _-- -1927 --- - -- -- -- -- --- ----- -- -----1928 __ --- _---- ---- -- ----- ----- -1929 __ --- -- _-- --- _-- -- ---------1930 ____ -- ____ -- ------ -- -- -- _--1931_ ___ -- -- ---- -- -- - -- - -- -- -- -1932 ___ -- ___ -- _- -- -- -- _--- ---- -1933 __-- -- _--- -- --- - -- -- _-- _---1934 ____ __ --- -- _-- -- _--- __ -- ---1935 ______ -- --- -- - -- -- --- -- - ---1936 ___ -- ___ ----- _---- -- _-- -----
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Federal Reserve Bank of St. Louis
4,684
4,896
7,077
9,839
10,984
12,462
12,833
12,963
13,020
13, 189
13, 181
10,401
9,413
10,748
41,681
36,504
60,336
71,799
76,564
85,691
88,870
90, 179
86,829
91,655
106,126
88,896
80,195
88,325
32,350
45,857
90,494
125,226
155,977
137,971
169,697
196,334
187,063
198,800
214,805
172,510
151, 744
130,206
4,207
7,008
13,394
19,061
18,787
17,220
17, 748
14,382
8,262
11,481
9,557
6,367
8,966
5,149
8. 9
7. 6
8. 5
7. 3
6. 9
6. 9
6. 9
6. 9
6. 7
6. 9
8. 0
8. 5
8. 5
8.2
6. 7
9.4
12. 8
12. 7
14. 2
11. 0
13. 2
15.1
14. 4
15. 1
16. 3
16. 6
16. 1
21.1
0. 9
1. 5
1. 9
1. 9
1. 7
1. 4
1. 4
1.1
.6
.9
.7
.6
.9
.5
112
PUBLIC HEALTH SERVICE
Twelve medical and dental officers are assigned exclusively to Coast,
Guard duty, and 103 local · physicians serve under appointments as
acting assistant surgeons to furnish medical and surgical relief and
conduct physical examinations of Coast Guard and Lighthouse Servicepersonnel at isolated units remote from any Public Health Service
relief station.
As in the past, medical officers have been assigned to the cutters on
the International Ice Patrol in the North Atlantic and to the cutter&
comprising the Bering Sea Patrol force operating in the North Pacific.
Medical officers are. assigned to the vessels basing at Honolulur
Territory of Hawaii, San Juan, P. R., Juneau and Cordova, Alaska.
A medical officer and a dental officer are assigned to duty ashore at.
the Unalaska Coast Guard Dispensary, Unalaska, Alaska, in order to
render relief to beneficiaries of the small craft operating out of that
port. This year a medical officer held sick call at the Indian Affairs
Hospital at Unalaska; and by using this hospital, the medical serviceis vastly improved as compared with the service rendered in the Coast
Guard dispensary on the dock in previous years.
Seven new cutters are under construction for the Coast Guard, all
of which will have more elaborate hospital space than any vessels.
now in the Service. Three of these vessels, when commissioned, will
be assigned outside the continental limits of the United States to
replace older vessels now on foreign service. The equipment furnished these vessels will enable the medical officer assigned to render
the greatest relief possible.
Medical Director A. J. McLaughlin served as chief medical officer
of the Coast Guard the greater part of the year. He was relieved
during the month of June by Medical Director H. McG. Robertson.
OPERATING COSTS IN MARINE HOSPITALS
The total amount expended, including reimbursements from the
Veterans' Administration and Civilian Conservation Corps, classified
according to the General Accounting Office Bulletin, is shown below:
01
0200
0210
0220
0230
8~~8
0280
03
04
0500
0510
06
07
10
1100
1110
1280
1290
1373
1375
Personal services _______________________________________ $3, 998, 210
Janitor and laundry supplies, X-ray films, etc_______________
74, 348Medical and hospital supplies____________________________
283, 276Scientific and educational supplies________________________
5, 921
Fuel__ ______________ __________ ________________________
198,610
i~~~~1ons_~===========================================
Sundry supplies________________________________________
Subsistence and support of persons (contract hospital care,
etc.) _______________________________________________ _
Care of animals and vehicles ____________________________ _
T elegraph service _____________________________________ _
T elephone service _____________________________________ _
Travel expense ________________________________________ _
Freight ______________________________________________ _
Furnishing heat, light, power, and water (service) __________ _
Rent of buildings and offices ____________________________ _
Otherrents ___________________ ________________________ _
R epairs and parts, motor vehicles _________ ______________ _
R epairs and alterations, other equipment _________________ _
Laundry service _______________________________________ _
Ashes and garbage removaL ____________________________ _
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Federal Reserve Bank of St. Louis
1, 1~8;
~~~
52, 298
335,851
117
1,058
28,989
59,873
60,000
211, 25&
9,791
6,407
6, 619-
19,084
36,260
2,740
113
PUBLIC HEALTH SERVICE
1380
2~50
3000
3010
3020
3040
3050
Miscellaneous services ___________ .,_ _____________________ _
Buria~----------------------------------------------Passenger-carrying
vehicles _____________________________ _
Furniture, furnishings, and fixtures ______________________ _
Scientific equipment ___________________________________ _
Livestock ____________________________________________ _
Other equipment_ _____________________________________ _
Total _______ ____________________________________
6,689
20,007
2,692
276,454
62,544
1,623
28,619
6,918,042
CONSOLIDATED AND DETAILED REPORTS
The following tables give the consolidated and detailed reports for
the marine hospitals and relief stations:
TABLE
1.-Number of patients treated annually, 1868 to 1936 1
Sick
and disabled
patients
furnished
relief
Fiscal year
Prior to reorganization:
1868 ____ -------- -- -1869__ ------ -- ---- __
1870 __ -- --- _-- ---- __
After reorganization:
1871_ _________ ----- 1872 ____ ---- -- -----1873 ___
1874 ________ ------ -1875 ______ ---- -----1876.... -- -- .. -- -- . 1877 ______ ---------1878 ___ .. - . --- -- - - - 1879_
-- --- .. _. _. _- - -1880 _______________
1881_ __________ --- -1882 ______ -- -------1883 ______ - - ------- J884 ________ -- --- --1885 ______ -- -------1886 __ -----. -- ----- 1887_________ --- -- -1888 ____________ -- -1889 _____ -- -- -- - - - _1890 ________ --- ---- _
4 ______ -
--- --
11,535
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
50,671
Fiscal year
After reorganizationContinued.
189L _... __ .. - - - - - 1892_____ ---- -- ---1893 _________ -----1894 _________ -----1895_--- .. _- - . - - - -1896 _______ ------ -1897 ------- ---- --- .
1898_ ----- ------- -1899_. _-- -- - - . - . -- 1900 ____ . _. _. _. _. _.
190L. _. __ ... ____ . _
1902_________ -----.
1903 _________ -----1904 __ ---- --- -- ---1905 ______ --------1906_ -----. -- -- --- 1907 ------ --- -- ---1908 __ . _. - - - - - - - - - 1909 __ . _. _.. _.... __
1910 ___ -- --- ----- -1911_ ____ -- -------1912_ -- ___________ _
1913 ____ ----- ------
Sick
and disabled
patients
Fiscal year
Sick
and disabled
patients
fur-
fur-
nished
relief
nished
relief
52,992
53,610
53,317
52,803
52,643
53,804
54,477
52,709
55,489
56,355
58,381
56,310
58,573
58,556
57,013
54,363
55,129
54,301
53, 704
51,443
52,209
51,078
50,604
After reorganizationContinued.
1914 ___ -- ------ ---1915. -- _____ . ___ . _.
1916 ____ . ________ -1917 ______________ _
1918 ______ -- . ---- -1919 ____ . ---------1920 ____ _______ ---192L __ -- - - -- - - - - - 1922______________ _
1923 2 - - - -- -------1924_____ ---- --- --1925 _______ ---- ---1926 _______ -- -----1927--- ------ -----1928 _______ ------ -1929... ---- ---- ---1930. __ -- _. _-- - -- -1931_ __ - - ____ -- __ -1932_ ---- -- -------1933_ -- -- _-- . -----1934 ____ --- ---- ---1935___ -- ---- -----1936 ___ -- -- -- ------
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
294, 101
304,439
329,586
327,245
1 These figures do not include patients treated in connection with veterans' relief activities of the Service
as follows: 1918, 192; 1919, 13,856; 1920, 279,036; 1921, 667,832; 1922, 242,379; 1923, 9,704; 1924, 3,414; 1925, 4,360;
1926, 3,749; 1927, 2,830; 1928, 3,448; 1929, 4,907; 1930, 6,817; 1931, 9,278; 1932, 9,667; 1933, 8,377; 1934, 716; 1935,
2,448; and 1936, 3,970.
2 In this year, and subsequently, the practice of recounting out-patients applying for treatment in more
than 1 calendar month was discontinued.
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Federal Reserve Bank of St. Louis
114
PUBLIC HEALTH SERVICE
TABLE
2.-Transactions at United States marine hospitals and other relief stations
Total
number of
patients
treated
Grand total. _______ . ______ 331,215
FIRST-CLASS STA TIO NS
NumPatients
NumNumremain- Number ber of Number
of times ber of
ber of
patients
ingin
physioffice
days'
of
patients Died
furhosrelief in nished
cal exrelief
treated
pitals hospitals
was fur- aminain hosoffice
June
nished
tions
pitals
relief
30, 1936
- - - - - - - - - - - - - - -- - - - 54,208
1,324
--- --- ---
5,213 1,904,341 277,007 1,291,616
108, 80
Marine hospitals
Baltimore, Md _______ ___________ 13,095
100
107, 450
2,945
330
Boston, Mass. ___ _______________ 9,936
172
33
62,953
1,925
Buffalo, N. y _____ __ ____________ 5,030
21,212
15
53
732
Carville, La _____________________ 1,179
27
135, 757
374
441
Chicago, Ill __________________ ___ 6,573
154
66,340
1,902
28
Cleveland, Ohio _________________ 8,177
71,740
184
2,167
87
Detroit, Mich _______ ___ _________ 4,958
111
79,594
235
2,439
Ellis Island, N. y _______________ 8,035
149,099
220
86
3,667
Evansville, Ind ______ ___________ 1,619
25,881
57
16
960
Fort Stanton, N. Mex.. __________ 1,787
12
67, 187
189
355
Galveston, Tex __________________ 6,840
37
65, 154
190
2,282
Key West, Fla _________ __ _______ 1,566
11
16,975
35
508
Louisville, Ky ___________________ 2,150
42
1,393
37,140
85
Memphis, Tenn _________________ 4,677
25
40,320
101
1,821
21
144
51,575
1,461
Mobile, Ala_-------------------- 3,981
New Orleans, La ________________ 13,089
96
146,235
470
4,642
New York, N. y ________________ 40,336
-------- -------- --- - ---- --------81
243
96,249
3,142
Norfolk, Va __ ------------- - --- -- 10,350
15
58
21,956
756
Pittsburgh, Pa_ ----------------- 3,041
Portland, Maine ________________ 1,557
47
13
18,939
433
St. Louis, Mo _____ ____ __________ 2,998
13
104
36,974
967
San Francisco, CaliL ____________ 19,243
109
138,354
379
4,245
Savannah, Ga _____ ____ __________ 4,487
37
157
62,226
1,765
125
124,417
311
3,340
Seattle, Wash __ ----------------- 12, 712
St'l.pleton, N. y _________________ 14,321
62
545
122,515
4,315
Vineyard Haven, Mass ___ _______
2
8,631
19
128
257
Contract overflow hospitals _____ _
8
12,874
32
94
94
-TotaL _____________________ 202,088 48,825
1,212
4,888 1,787, 747
SECOND· AND THIRD-CLA.SS
STATIONS
=
---
Aberdeen, Wash _____ _____ __ ____
2
44 -------386
499
Albany, N. y ___________________
1
363
195
24 ----- --Anacortes, Wash ________________
15 ----- --- -------96
166
Apalachicola, Fla ________________
20 -------- -------- -------- ------ -- -_________________
Ohio
Ashtabula,
61
14 -------- -------336
Astoria, Oreg ____________ ____ ____
1
158
446
28 -------Balboa Heights, Canal Zone _____
5
3,812
10
268
960
Bangor, Maine __________________
31
2 -------- -------9
Bath, M aine ____________________
74 ---- ---- -------- -------- ---------Beaufort, N. c _________________ _
277
3 -------277
42
Bellingham, Wash ____________ ___
195
13 -------- -------353
Bilox.i, Miss _______ _____ _________
51
774
5 -------- -------Boothbay H arbor, M aine ______ _
15
4 -------- -------34
Brunswick, Ga _______ ___ _____ ___
12
80
3 --- ----- -------Burlington, Iowa ______ _·- ---- --1
160
74
25
Cairo, Ill _____ ___________________
1
489
2
701
73
Calais, Maine _________ ____ ______
23
2 -··------ ------- 3
Cambridge, Md _________________
83
106
9 -------- -------Cape May, N. J __ ____________ ___ 1,704
129
50 -- ------ ------ -Charleston, S. c __ __ ______ __ ____
1
574
692
49 -------Cincinnati, Ohio ________________
172
13 -------- -------150
Cordova, Alaska _____ ___ _____ ___
1,071
2
397
58 -------Corpus Christi, Tex ____ _________
342
45 ----- --- -- -----306
Crisfield, Md ____________________
36
770
5 -------- -- -----Duluth, Minn _____ ____ __________
6,57
3
43 -------494
Eastport, M aine ___ _____ ____ ____
86 -------- -------- ------- - --- ------Rdenton, N. C ____ _____ _________
26 -------- -------- --- ----- ---------Elizabeth City, N . C ____________
200 ---- ---- -------- -------- ---------El Paso, Tex ______ _____ _________
2
523
270
19 -- ---- -Erie, Pa ___________ ______________
133
1
1
372
15
Escanaba, Mich ___________ ___ ___
53
48
5 - ------- -------"Fureka, CaliL. _______ __________
91
17
2 ----- --167
Ev;,rett, Wash __________________
71
182
23 -------- -------Fall River, Mass __ _________ _____
321
2 ,. _______
29
193
Gallipolis, Ohio ___ _________ _____
588
202
64 ----- --- -------Gary, Ind __________________ - -- - 1
3
2 -------106
Georgetown, S. c _______________
31 ------ -- -------- -------- ----- --- -Gloucester. Mass _____ ________ ___
143
15 ------ -- -------434
Grand Haven, Mich ____________
144
1 -------231
17
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
10,150
8,011
4,298
738
4,671
6,010
2,519
4,368
659
1,432
4,558
1,058
757
2,856
2,520
8,447
40,336
7,208
2,285
1,124
2,031
14,998
2,722
9,372
10,006
129
64,446
36,418
27,047
1,357
28,583
26,289
19,664
11,602
l , 689
5,754
18, 518
4,327
4, 392
16,281
11,904
34, 153
239, 733
38,023
5,001
3,244
9,591
86,111
10,508
22, 738
38,519
187
4,84
5, 10
2, 34
3, 12
2, 58
97
58
14
6
1, 73
57
1, 58
1, 70
3, 68
17, 4
1, 61
1, 63
41
1, 7
3, 43
1, 1
8, 31
1, 66
1
-------- ---------- ----- -153,263
455
171
151
20
322
418
692
7
74
235
340
769
30
77
49
628
1
97
1,654
643
137
339
261
765
451
86
26
200
251
357
43
150
159
164
138
104
31
419
214
766,079
66, 723
43
831
38
330
1
339
82
886
3
864
715 ------11
3
199
l
1,155
23
837
1
1, 118
78
212
4
69 -- --- - 16
l, 830
2
213
4,431
9
24
1,356
21
292
5
583
462
1,229
13
814
9
240
82 ------1
696
26
1, 197
1, 216
66
1
94
1
331
294
3
434
7
359
1
202
71
1,220
5
567
_115
.PUBLIC HEALTH SERVIUE
TABLE
2.-Transactions at United States marine hospitals and othe·r relief stationsContinued
Total
number of
patients
treated
Patients
remaining in
hospitals
June
Num- Number
ber of of times
Number patients
of
days'
office
furDied
relief in
relief
was
furhospitals nished
office
nished
30, 1936
relief
--- --- --- ---- --- ---Number of
patients
treated
in hospitals
Number of
physical examinations
SECOND- AND THIRD-CLASS
STATIONS
Green Bay, Wis _________________
Gulfport, Miss __________________
Hancock, Mich __________________
Honolulu, Hawaii_ ______________
Houston, Tex_ __ ___ _____ ________
Indiana Harbor, Ind ___________ _
Jacksonville, Fla ________________
Juneau, Alaska __________________
Ketchikan, Alaska __ ____________
La Crosse, Wis ___________________
Lewes, DeL __________ _________ __
Los Angeles, Calif_ ___ ____________
Ludington, Mich ________________
Machias, Maine _________ ______ __
Manila, P . !_ _____________________
Manistee, Mich _________ ________
Manitowoc, Wis _________________
Marquette, Mich ________________
Marshfield, Ore!( ___ _________ ____
128
165
75
1,226
1,468
182
856
418
1, 154
23
265
2,031
291
40
926
83
317
288
170
69
~t~~riFr:~ -~~~~:::== === ====== = 1,513
Milwaukee, Wis _________________ 1, 140
Morehead City, N.
593
Muskegon, Mich ________________
157Nantucket, Mass ____ __ ___________
84
Nashville, Tenn _____ _______ _____
108
Natchez, Miss __________________ _
897
Newark, N. J ___ ______________ __
31
New Bedford, Mass _______ ____ __
383
New Bern, N . a ________________
240
ew H aven, Conn ______________
139
New London, Conn _____________ 2,015
Newport, Oreg _________________ _
160
Newport, R. !_ __ ________________
308
Newport Jews, Va _··--------~--292
Ogdensburg, N. y ______________ _
83
Olympia, Wash __ __________ ___ __
59
Oswego, N. y ____ __________ _____
138
Paducah, Ky _____________ ____ ___ 1,491
Panama City, Fla _______________
357
Pensacola, Fla ___________________
457
Perth Amboy, N. J _____________
120
Petersburg. Alaska ____________ __
285
Philadelphia, Pa ____ ____ _____ ___ 8,431
Ponce, P. R _____________________
147
Port Angeles, Wash ____ _____ __ __
349
Port Arthur, Tex _____ __ ________ _ l, 99
Port Huron, Mich ____ _______ ____
343
Portland, Oreg __________________ 3,352
Port Townsend, Wash ______ ___ _
86
Providence, R . !_ ___ _______ ___ ___
4fi5
Provincetown, Mass ____ ___ _____
304
Reedville, Va. ___________________
492
Richmond, Va __________________
136
Rock Island, IIL. ___________ _____ 4,869
St. Thomas, Virgin Islands ______
237
San Diego, CaliL ______ ___ ______ 1,188
Sandusky, Ohio _________________
111
San Juan, P . R ___ ___ ___ __ _______ 1,006
San P edro, CaliL _______________ 4,370
Sault Ste. Marie, Mich _________ _ 1,023
Seward, Alaska ____ ____ __ __ ______
425
Sheboygan, Wis __ _______________
79
Sitka, Alaska ____________________ 1,432
South Bend, Wash __ ____________
77
Southport, N.
926
Superior, Wis ___________________
358
238
T acoma, Wash __ ________________
T ampa, Fla _____________________
598
T oledo, Ohio ___ ________________ _
744
nalaska, Alaska ________________
46
V icksburg, Miss ____ ____ ____ ____ _
449
ashinogtn, D . c _______________ 6,906
w ashingt'on, D. C. dental clinic_ 1,607
c ___________
c _________________
u
w
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Federal Reserve Bank of St. Louis
12
3
5
104
129
4
48
41
106
3
29
97
11
------- -
-------- --------- ------ -------1
3
5
1
1 -------1
1
2
2
5
5
--------
-------- -------2
3
103
47
34
1,283
694
15
547
433
1, 157
10
386
1, 752
136
5
-- --------- ---- ------- --- - ---- ------ -- ---------1,460
2
----- --40
1
-------118
--- ----- -------143
1
--------
81
4
18
14
22
1
2
3 -------- ------ ·· 170
6
6
134
1
7
1 ---- ---67
9 ---- -- -- ----- - -4 -------- --------
94
50
1,469
1, 750
527
78
27
-------- ---- ---- -------- ---------101 ---- -- -649
1
-------- --- ----- -------- ---------220
24 ---- ---3
256
37
1
1
330
23 -------- -------314
1
30
3
120
8
1
722
1
46 --------------- ----- --- -------- --------- ··
5
1 ---- ---- -------171
11 ----- --- -------23
18 ------ -- -------93
14
2 -------48
5 -------- -------499
49
1
1
90
10 ----- - -- -------137
24
1
3,399
386
10
8
385
22 ---- ---2
101
28 --- ----- -------50
15
1
1
50
10 -------- -------3,877
298
14
6
24
6 -------- -------2
306
30 ---- -- --------- --- ----- ---- ---- ------ --- -
-- - ----- -- ---- -- --- - ---- ---------167
18
1 -------22
10 ----- - -·- ------- 110
19 --- ---- - -- -----63
5
57
342
99
68
5
8
20
114
36
19
60
78
10
14
__ 292
2
9
1 - -- --- -1 ----- --11
5
2 -------2
1
-------- -- ---- -1 --- -- ------ ---- ------ -1
1
------ -1
4
6
4
1
2
1
-------- -------2
6
13
1,963
39
636
4,730
818
829
39
99
163
1,365
430
67
467
916
143
38
4,220
------ -------- -------- -------- --
116
162
70
1,122
1,339
178
808
377
1,048
20
236
1,934
280
40
845
79
299
274
148
66
1,343
1,006
526
148,
80
108
796
31
359
203
116
1,985
152
262
292
82
48
120
1,477
352
408
llO
261
8,045
125
321
1,983
333
3,054
80
435
304
492
118
4,859
218
1, 125
106
949
4,028
924
357
74
1,424
57
812
322
219
538
666
36
435
6,614
1,607
392
373
llO
l6
26
39
370
155
2,555
3,991
279
1
2,262
60 7
465
5 20
2,656
47 9
54
20
573
7
6,490
1, 52 2
462
1
71
l
1,662
1,013
583
17
635
9
768
45
287
12
189
26
4,959
178
2,596
594
1,666
8
232
38
291
8
185
195
1,853
63
65
74
638
80
326
12
181
60
2,558
82
386
3
29
466
553
56
166
30
1
64
26
394
167
3,240
925
12
1,431
56
15
239
34
865
27, 763
4,887
12
456
71
400
14 2
6,825
813
579
9,246
2,584
11
452
1,036
233
872
29
12
1,506
17
216
2,025
18,830
437
8
1,096
3,968
13
180
216
2,321
11, 261
675
240
1,445
631
60
8
151
287
1,934
13
111
10
929
16
567
76
604
183
994
221
1,485
77 -------1,371
181
16,226
37,897
20,972 ---- ----
116
PUBLIC HEALTH SERVICE
TABLE
2.-Transactions at United States marine hospitals and other relief stationsContinued
Total
number of
patients
treated
SECOND· AND THIRD·CLASS
STATIONS-continued.
Washington, N. 0 .............. .
White Stone, Va_ .............. .
Wilmington, N. C ...... .. . . . . . . .
Wrangell, Alaska . .............. .
121
735
512
191
Num•
Patients
NumNumremain· Number ber of Number
times ber of
ber of
ingin of days' patients ofoffice
physipatients Died
hosfur• d
cal exrelief in
relief
pitals hospitals
!~et~es~
n;:~e was fur· aminaJune
pitals
tions
nished
relief
30, 1936
10 ···· · ··· .... . .. .
167
1
3
3 .. . ... . .
696
204
111
735
426
166
220
3,312
1,028
277
5
17
159
30
15 ····· · · · ·· ···· ··
310
58
246
141
81
31
269
197
37
99
86
25
FOURTH·CLASS STATIONS
Ashland, Wis __ ······ · · ······ · · Bay City, Mich . . . . .... . .... . . . .
Bridgeport, Conn . . ....... . . . . -.
Chattanooga, Tenn ....... . .... . .
Hartford, Conn __ ... . . . ... . ... . .
Nome, Alaska . . . .. ............ . .
Portsmouth, N. H __ ._ .. . ..... . .
Saginaw, Mich .. .. ............. .
Wilmington, Del._ . ...... . .... . .
156
87
49
1
1
20
6
18
1
1
7
4
1 · ··· · · ··
9
18
33
3 ...• . .. . ·•·· · · ••
6 ···• · • •· ••.•••. .
------ -- ------- --- ------ --
25 ---- - --35
13
9
15
7
48
27
----------------16
10
66
44
2
MISCELLANEOUS
173
Curtis Bay, Md . ............... . 1,929
7,380
1,929
U. S. Coast Guard Academy,
361
4,505
New London, Conn . . . .. .. ... . 2,174
1,972
2,287
202
4
St. Elizabeths Hospital, Wash•
ington, D . C ...... . ... .. .... .. _
58,680
176
176
159
Special acting assistant surgeons
for Coast Guard and Light•
436
12,458
house Service . . . . . . . _. . ....... . 4,026
3,943
565
83
U. S. Coast Guard vessels and
547
36,562
7,818
bases ........ .. . . . . ..... . . . ... . 7,844
147
26
Emergency medical relief act iv•
34, 781
228, 205
ities, Treasury Department. .. . 34, 781
52
124
Emergency ........ . ... ..... .... .
369
79
27 .... .•.. ····• · ••
- - - - - - · - - -·1-·- - - 1 - - - -- 1---- - - - - - - 325
116, 594 123, 744
525, 537
42, 084
Total.. ............ . .. · ·-·· 129, 127
5, 383
112
Grand total.-· ······ · ····· 331,215
TABLE
54,208
1,324
5, 213 1,904,341 277,007 1,291,616
108,807
3.-Medical services for various classes of beneficiaries
Beneficiary
Number
Patients
Num•
remain• Number of pa• Number
times ber of
ingin of days'
tients ofoffice
physi•
fur•
hospi- relief in
Died
cal exrelief
Dished was
tals
fur• aminaJune 30, hospitals office
tions
Dished
relief
1936
--- --- --- ---- --- ----
Total Number of
num•
pa•
ber of tients
patreated
tients
hos•
treated in
pitals
American seamen .... ____ ______ 165,693
Foreign seamen .... . . ·------· __
692
Coast Guard ... ··----·-------- 33,239
Bureau of Fisheries .. __________
59
340
Army .. ·---------·-·-----·---Navy and Marine Corps . .. . __
212
Mississippi River Commission.
1
Engineer Corps and Army
Transport Service .. ·-------- 7,689
Lighthouse Service.·-· - -- - - --- 2, 646
Coast and Geodetic Survey . .. .
848
Employees' Compensation
Commission .. · ------·-·:.. ____ 28,802
Veterans' Administration .... __ 3,970
Immigration Service .. · --·-··-- 4,789
Public Health Service officers
and employees .... ·----· ----- 10,926
450
Lepers .. ·----·---· . . ---·· -·---Civilian Conservation Corps._ 7,829
Civil Works Administration . . .
882
Works Progress Administra•
tion .. ·----·-----------·---·- 23,534
M iscellaneous .. ·--------·----- 38,614
Total. ___________________ 331,215
27,578
306
3,396
13
100
64
719
6
31
-------1
3
2,906 1,109,748
19
6,058
207
88,325
1
433
1,718
2
1,028
3
-------- -------- --------- ----------
138,115
386
29,843
46
240
148
1
598, 761
867
130,206
107
672
521
2
-------
21 0
41
-------
1,398
458
118
38
18
1
114
40
11
43,732
14,582
3,256
6,291
2,188
730
23,427
6,772
4,029
1,222
161
42 2
4,354
3,855
1,253
37
345
7
257
464
74
95,451
130,539
24,487
24,448
115
3,536
119,837
1,202
10, 759
23, 74 1
1, 136
1, 25 8
1,046
447
6,629
512
14
27
48
1
45
374
393
9,880
3
1,200
370
73,669
7
1,950
1,673
2, 48 7
9
17,292
136,035
170, 798
9,429
2,523
158
24
4
284
10
48,762
2,668
21,011
38,456
82,858
234,297
17, 579
44, 722
--- ----- 5,213
- - ---- - - ---54,208
1,324
1,904,341 277,007 1,291,616
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Federal Reserve Bank of St. Louis
9,063
44
5, 149
2
1, 25 2
318
108, 807
117
PUBLIC HEALTH SERVICE
TABLE
4.-Classification of outpatient treatments furnished at United States marine
hospitals and other relief stations
.....,,_
§·S
~11
rn
ca
I>,
-~~1 ·a fa:~
"61,
.0
~
5l
cva
1»8:B
::,
.Q c.cl><
~
0
A
ri1
z 8
> .s"'A -< P-<
- - - --- - - - - - - - -- - - - - - M~
cv-~
=~
~§
-"'
+>
Q)
ca
-Q)
0
a:,C/lJ-,t
~o
rn
b
o.·s:: '3
rn
f!~ ~-oo
::l..o
.;
CJ
.
M~
= -~
Q't)
QC)
Q)
"'
Q) ~
~~~
.Q G!l
CJ
QQ)
C)= c,l
U1
Marine hospitals __________
Other relief stations _______
acting assistant
Special
surgeons __ _______________
Coast Guard vessels and
bases ____________________
Emergency medical relief
activities, Treasury Department_ _______________
Emergency ________________
95,137 256,535 41,041 140
59,802 30,158 16,668 360
589 107,109 78,927 5,952 24,782 155,867
448 83,023 17,488 5,601 7,132 23,003
7,410
252
981
69
804
1,063
16,364
5,869
4,017
90
35
6,515
96 1,222
105
456
3,534 1,835 1,097
1,711
30
8
766, 079
243, 683
12, 458
41,06
123,901 ---- --- 49,227 ---- ----- 55,077 -- ----- ------ ------ ---- --- 228, 20 5
124
124 -- ----- -- ----- ---- ----- -- ----- -- ----- ------ ------ -- ------ - - - - -- --- - - - - - - - - - - - - TotaL ______________
302,738 292,814 111,934 659 1,876 252,787 100,045 14,610 33, 116 181,037 1,291, 61 6
•
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DIVISION OF VENEREAL DISEASES
Asst. Surg. Gen. R. A. V ONDERLEHR in charge
It is encouraging to note the increasing interest and progress m
venereal disease control during the year 1935- 36·. Marked impetus
has been given to the investigative and to the advisory work of the
Division of Venereal Diseases as a result of the enactment of the
Social Security legislation and to the adoption of a policy more favorable toward venereal disease control. The extent of the present
program is more in proportion to the great prevalence and economic
importance of syphilis and gonorrhea than formerly.
COOPERATIVE CLINICAL STUDIES
The profitable retrospective investigations conducted in cooperation with five of the leading syphilis clinics of the United States havebeen continued. Studies of cardiovascular syphilis have been prosecuted further, and a series of scientific articles has been published
during the year. In addition, it has been possible to begin the publication of papers on syphilis of the central nervous system. A great
amount of information on syphilis of the central nervous system has
been accumulated which is of fundamental importance to the medical
profession, and several articles on this subject will soon be published ..
Two meetings of the members of the Cooperative Clinical Group,
were held during the fiscal year. The main purpose was to plan projected studies of syphilis which might with profit be carried on in the
five cooperating clinics. The Group also decided to appoint collaborators to assist in the preparation and publication of scientific articles
on subjects of a more specialized character than had previously been
undertaken.
•
The studies which have been selected for investigation are as follows:
1. Nonspecific therapy of syphilis. This study is under way.
2. Early syphilis-follow-up studies to determine the ultimate fate
of the patient who apparently has been cured.
3. Prenatal syphilis-the fate of the apparently normal infant born
of a syphilitic mother.
4. Conjugal syphilis-the course of syphilis in marital partners and
an investigation of the strains of Spirochaeta pallida. •
5. An investigation of patients with latent syphilis with manifestations of cardiovascular disease which are sufficient only to permit a
tentative diagnosis. The value of such manifestations has not as yet
been established, and through follow-up of patients with these manifestations it should be possible to determine their importance.
6. Syphilis in the carrier and in the patient-a comparative study
to accumulate additional knowledge regarding the course of syphilis.
118
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PUBLIC HEALTH SERVICE
119
COOPERATIVE WORK WITH STATE HEALTH DEPARTMENTS
During the last few months of the fiscal year it was possible again
to assign specially trained medical officers to State health departments,
:and thus to extend the advisory service of experts. The work had
been seriously curtailed in recent years because of the very limited
personnel and the demand, in other activities,. for the services of the
two officers who were originally assigned to this duty. Advisory
assistance was extended to the State health departments in Arkansas,
Delaware, Ohio, Rhode Island, and South Carolina. In one State a
serious outbreak of what was thought to be gonococcal vulvovaginitis
occurred, and the Public Health Service provided the services of experts to help in the solution of this problem. Scientific papers and
lectures were presented before a large number of State medical and
public health associations.
An advisory committee consisting of physicians prominent in the
clinical management and control of venereal diseases was appointed
and to them was assigned the duty of drawing up general recommendations for the development of venereal disease control programs in
State and local health departments. The recommendations of this
committee pertained to such subjects as the administration of the
venereal disease control program; the provision of adequate treatment facilities in urban and rural communities; the prosecution of
epidemiologic work; the cooperation of health departments with
physicians; the collection of morbidity and mortality reports; the
development of an informative and educational program; standardization of treatment, particularly in early and prenatal syphilis; and
the development of minimum requirements for facilities and personnel
in venereal disease control programs. These recommendations have
been received very favorably, and were endorsed by the members of
the Conference of State and Territorial Health Officers in April 1936.
During the year, 266,626 new cases of syphilis and 162,487 new cases
of gonorrhea were reported to the State health departments. Seven
hundred and thirteen clinics furnished morbidity reports to State
health departments. These clinics reporte<l 79,905 new cases of
syphilis and 44,358 new cases of gonorrhea. They discharged as
arrested or cured 63,566 patients and gave a total of 3,344,257 treatments, including 934,063 doses of arsphenamine.
EDUCATIONAL AND INFORMATIVE ACTIVITIES
A leaflet descriptive of Venereal Disease Information has been sent
during the year to physicians throughout the United States. This
distribution was made possible through the cooperation of the State
boards of health, by whose personnel the envelopes were addressed
and mailed. As a result of this cooperative work, Venereal Disease
Information remains the medical publication of the Federal Government which has the largest paid subscription. The monthly average
of paid subscriptions for the year was 5,868, and the monthly average
of free distribution was 2,674 copies.
A limited allotment of funds for printing necessarily limited the
number of special articles published. Three special articles were
reprinted and distributed to health officers, interested physicians, and
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Federal Reserve Bank of St. Louis
120
PUBLIC HEALTH SERVICE
other workers.
the following:
Those which were reprinted and distributed included
No. 53. Syphilis control in New York State. By Thomas Parran. September
1935. 6 pages.
No. 54. Recommendations for a venereal disease control program in State and
local health departments. Report of an advisory committee to the United
States Public Health Service. By R. A. Vonderlehr, Herman N. Bundesen,
Joseph Earle Moore, N. A. Nelson, P. S. Pelouze, William F. Snow, John H.
Stokes, U. J. Wile, Lida J. Usilton. January 1936. 16 pages.
No. 55. Cardiovascular syphilis. Cooperative clinical studies in the treatment
of syphilis. By Harold N. Cole, with Lida J. Usilton, and Joseph Earle Moore,
Paul A. O'Leary, John H. Stokes, Udo J. Wile, Thomas Parran, R. A. Vonderlehr. April 1936. 28 pages.
The popular education program has been continued as in the past.
A total of 5,580 requests for bulletins and pamphlets was referred to
State departments of health for the distribution of this material
directly to the residents within their boundaries. Bulletins and
pamphlets were also distributed on an individual basis to health departments, other organizations, and to individuals to a total of 70,719.
VENEREAL
DISEASE
RESEARCH LABORATORY, STAPLETON,
ISLAND, N. Y.
STATEN
Plans have matured for the reorganization and expansion of the
present laboratory facilities to a degree which will permit of the
profitable utilization of increased scientific personnel and consequent
broadening of the scope of future investigative efforts. The personnel
increase will be guided to strengthen and facilitate the handling of
problems in which the general plan of study touches upon the sciences
of bacteriology, physical chemistry, biochemistry, and cytology. The
plan also provides for a very considerable increase in the cage-space
available for the housing of experimental animals thus permitting
the carrying out, in an uninterrupted manner, of a large number of
experimental projects. When complete the new laboratory will constitute a highly comprehensive unit for the study of many phases of
the venereal group.
.
Considerable effort has been expended in a study of the technical
details and the clinical adaptability of the complement fixation procedure in serodiagnosis of gonococcal infections. Whereas there is
ample evidence of inherent merit in the procedure, especially its
sensitivity in cases of proved infection, the factors of specificity and
reliability are still at a level which renders its general use as a formal ·
procedure at least partially unsafe.
The experimental groundwork in the basic phases concerned with
prophylaxis in syphilis has been completed and published. Some
progress has been made in the development of an agency which when
applied during the early stage of exposure, may serve as an inhibiting
factor in the further migration and penetration of Spirochaeta pallida.
Some further efforts looking toward a determination of the public
health status · of latent and inadequately treated cases of syphilitic
infection have been carried out. The results so far have been entirely
negative and thus have not contributed greatly to previous knowledge
upon the subject.
Preliminary work in a bacteriologic resurvey of chancroid infection,
transmission of syphilis through blood transfusion, further studies in
the life cycle of Spirochaeta pallida, and increased sensitivity without
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PUBLIC HEALTH SERVICE
121
consequent loss of specificity in the serodiagnosis of syphilis have been
carried out.
STUDY OF SERODIAGNOSTIC TESTS FOR SYPHILIS
The evaluation of serodiagnostic tests for syphilis was continued
under the supervision of a committee of experts known as the Committee on Evaluation of Serodiagnostic Tests for Syphilis. At the
beginning of the fiscal year notices were published in a number of
medical journals in which an invitation was extended to State, municipal, and private laboratories performing such tests to participate in
an investigation of the ability of the personnel of such laboratories
to perform serodiagnostic tests for syphilis. Thirty-nine directors of
State, municipal, and private laboratories expressed a desire to be
included in this study. Of these, only 30 could be selected because of
limitation of funds available for the prosecution of this work. The
selection was made on the basis of priority of the receipt of request or
because of the strategic position of the laboratory in furthering the
control of syphilis in this country. The directors of 11 State laboratories, 5 municipal laboratories, and 14 private laboratories were
selected for participation. As a result of this study, 51 performances
of i9 separate diagnostic methods were evaluated. Control performances of serodiagnostic tests were conducted by serologists who.
had described such tests or modifications and who were residents of
the United States. The primary purpose of this study was to meet
the conditions encountered in ordinary practice in the performance of
serodiagnostic tests for syphilis.
In the evaluation project of the preceding fiscal year the relative
efficiency of the original tests or modifications was determined on the
basis of specificity and sensitivity. In this project the tests were
performed under ideal conditions. In the project undertaken in the
present fiscal year the tests were performed under routine conditions
which existed in State, municipal, and private laboratories. The
results indicate that the performance of serodiagnostic tests for
syphilis in some laboratories is highly efficient; in others it is fairly
efficient; and in a smaller group it is very inefficient. In some instances the technique is so poor that entirely new tests should be
adopted in place of the ones now in use. The directors of the several
laboratories participating m this study have been advised with
regard to the specificity and sensitivity ratings of their respective
tests. The report of the committee in charge of the work will be
presented at the American Public Health Association meeting and
published in several of the larger medical journals during the coming
-year.
One of the most important recommendations of the committee was
to the effect that a system of comparative examination of serodiagnostic tests for syphilis be extended annually to all State laboratories. It was further recommended that State laboratories in turn
offer a similar opportunity to check the performance of serodiagnostic tests in local laboratories located within the boundaries of the
State. In compliance with this recommendation, the Public Health
Service proposes to extend annually to all State laboratories an opportunity to check the performance · of their serodiagnostic tests for
syphilis on both a comparative serologic and clinical basis. Specimens will be collected from donors known to be infected with syphilis
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Federal Reserve Bank of St. Louis
122'
PUBLIC' HEALTH SERVICE
and from others free of this disease. The serologic performance
will be controlled as far as possible by the performance of serodiagnostic tests in the laboratories of the originators of such procedures.
The action of the health departments in urging the general adoption
of the routine serologic test for syphilis in all patients suffering from
serious illness makes it absolutely essential that these tests should
be entirely reliable.
Such an annual comparative examination of tests should assure a
reliable performance of serodiagnostic tests in the participating
laboratories.
UNTREATED SYPHILIS IN THE NEGRO
Observations have been continued on a group of 400 male Negroes
infected with syphilis and now in the latent or late stages of this
disease. Most of these individuals have never received modern
treatment for their infection. Comparable observations also have
been continued on a group of 200 male Negroes who, as far as it has
been possible to determine, are not infected with syphilis. This study
was started several years ago and was originally based upon clinical
and laboratory observations. The results of these original observations were analyzed statistically and the general scientific findings
will be published early in the next fiscal year. Plans for the continuation of this study are under way. During the last 12 months
success has been attained in gaining permission for the performance
of autopsies on 11 of the 15 individuals who died. Pathologic observations made after death are absolutely essential for the confirmation of the original clinical and laboratory observations. The present
study will not only make available comparative information regarding the course of treated and untreated syphilis, but should also
solve the problem of the effect of syphilis on the development of such
conditions as hypertension and arteriosclerosis, and should make it
possible to accumulate comparative mortality rates for a group of
untreated syphilitic Negroes and Negroes who are known not to be
syphilitic.
VENEREAL DISEASE CLINIC, HoT SPRINGS, ARK.
The Venereal Disease Clinic conducted at Hot Springs, Ark., in
cooperation with the National Park Service, experienced an appreciaable lessening of the load carried during the preceding fiscal year8,490 applicants as compared with 14,946. This decrease was due to
the restriction of admissions to early, infectious cases and to the
curtailment of Transient Bureau relief. The latter agency continued
to provide domiciliary care to the destitute patients of this clinic but
was obliged at intervals to reduce its intake.
Because of the great congestion of patients it was necessary to
limit the treatment in each case to the minimum requirements for
the prevention of an infectious relapse, that is, 20 inject.ions of an
arsenical and 20 or 30 of a heavy metal. An educational program
was interwoven into the course of treatment by continually stressing
the importance of early, accurate diagnosis, and early, persistent
treatment. This doctrine is being spread by former patients of this
clinic in their home communities, the result of which may be reflected
in the comparative increase in ·cases of primary and secondary
syphilis applying here for treatment in recent years.
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Federal Reserve Bank of St. Louis
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123
Upon discharge, patients are exhorted to continue their treatment
at their respective destinations, and a mercury preparation is supplied
by this clinic upon request from private physicians in order to assist
and encourage these patients to persist in their efforts to be cured.
Of the 8,490 applicants for treatment, from every State in the
Union except Delaware and Vermont, 4,448 were afflicted with venere-al
diseases. There were 3,368 cases of syphilis, including 316 primary,
597 secondary, 2,330 tertiary, 91 central nervous system, and 34 congenitaL Of the 3,368 cases of syphilis, 2,992 were admitted for treatment; 376 late latent cases were rejected because of the restrictions
previously mentioned.
Of a total of 1,262 cases of gonorrhea, 1,203 were admitted for treatment; 182 patients were treated for both syphilis and gonorrhea.
Seven cases of granuloma inguinale and seven of lymphogranuloma
inguinale were treated.
There were 235 ,362 treatments given, consisting of 27,740 arsphenamine injections; 67,979 bismuth and mercury injections; 4,547 other
intravenous and intramuscular injections of sodium thiosulphate,
sodium iodide, calcium gluconate, tartar emetic, bismarsen, and
fuadin; 41,180 gonorrhea treatments; and 93,916 baths. There were
4,946 vaccinations against smallpox and 333 inoculations for typhoid
. immunization.
There were 81,673 laboratory examinations made, consisting of
37,297 serologic tests for syphilis, 19,148 icterus indices, 693 darkfields, 9,515 smears for gonorrhea, 14,640 urine analyses, and 380
special examinations, including blood chemistry, water analysis,
smears for malaria, Frei, and other indicated tests.
During the year the clinic staff was augmented by the addition of
five part-time consultants who replaced two regular commissioned
officers. Two clerks and one laboratory aide were also added. For
the first time in its history this clinic now has a staff more nearly
commensurate with its needs.
101889-36-9
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Federal Reserve Bank of St. Louis
124
PUBLIC HEALTH SERVICE
1.-Report of State departments of health 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,
1935 to Jun e 30, 1936
TABLE
Number of cases
Laboratory examinations
,_ _ _ _ _ _ _ _ ___ , Annual
rate for
syphilis
Micro- Microscopic scopic
and gon- Doses of
State
Syphilis orrhea arsphenaexamimine dis- Serologic nations examiand
per
nations
tributed tests made
go nor1,000
for
for
rhea
inhabiSpiro- gonochaeta coccus
tants
pallida
- - - - - - - - - - ---- ---- - - - - ----1----1-----1--TotaL_ _____________ 266,626 162,487 429,113
3. 4 1, 313, 501 2, 063, 837
6, 673 388, 929
- - - - - - - - - - - - - 1 - - - - - 1 -- - - -1---Alabama___ ______ _________
9,405
3, 703
13, 108
4. 6
52,389
82,149
15,042
Arizona____ _____________ __
503
1,310
1,813
4. 7 ____ ________ __ _______________ _ ___ ____ _
Arkansas___ ___ __ __________
3,014
1, 733
4, 747
2. 4
25,188
35, 156
693
9,404
California____ ____ _________ 15,968
15,816
31, 784
5. 6
157,479
79,929
560
30,972
Colorado 1 ________________
58
47
105
. 6 __ _____ __ ______________ __ __________ __ _
2,448
1,540
3,988
2. 3
18,293
107,187
5
8,611
Connecticut_______ ________
Delaware_______ ____ ___ ____
1,335
453
1, 788
7. 0
5,249
7,843
66
1,453
District of Columbia 2_____
1,690
1,610
3,300
6. 1
13,952
6,425
68
7,265
Florida_____ _______________
3,194
1,137
4,331
2. 7 ____________________ ___ ________ ______ _
Georgia __ ----------------- 13,232
6,035
19, 2G7
5. 8
80,300
103,468
5,929
Idaho_________ ____________
0
0
0 _______ __ ___________
22,360
2,501
Illinois__ ________ __________ 15,940
13,166
29, 106
3. 7
98,411
98,693
2,337
49,022
Indiana_____ _______ ___ ____
1,892
1,896
3,788
1.1
44,482
139,684
8,809
Iowa______________________
1,270
1,822
3,092
1. 2
4,637
777
7
1,463
Kansas ___ _________________
1,011
848
1,859
1. 0
9,092
38,246
3,291
Kentucky___ ______ ________
2,521
3,064
5,585
2. 0
16,204
13,478
447
4,666
Louisiana_ ____________ ____
2, 705
1,345
4,050
1. 9
l, 954
25,969
55
2,914
Maine________________ ___ __
454
534
988
1. 2
6,311
11,287
4,233
Maryland_ ________________
9,473
2, 7:!6
12,209
7. 3
56,223
14,007
17
4,236
Massachusetts_______ __ ____
5,401
6,065
11,466
2. 6
89,095
134. 005
11, 119
Michigan__________________
6,375
6,524
12,899
2. 8
33, 773
40,383
34,690
Minnesota____________ ____
3,803
3,709
7,512
2.9
11,500
161,298
12.888
Mississippi__ ______________ 14,621
22,659
37,280
19. o ___________
45,806
5,476
Missouri 2 ______ __ _________
6, 713
3,906
lO, 619
3. 0
15,653
18,551
4,277
Montana__________________
453
579
1,032
1. 9 _______________________ _____ _________ _
Nebraska_____ _____________
377
800
1,177
.9
3,891
28,579
13
4,433
Nevada 3 _____ ____ ____ ________________________ _ _________________________ _ __ _ ____________ _ _ _________ _ _
New Hampshire_________ __
182
221
403
.8
2,932
10,667
2,939
NewJersey__ _____ _________
6,451
3,290
9,741
2.3
42,491
54, 267
452
13,764
New Mexico_ __ ___ ______ __
699
721
1,420
3. 5
338
202
!28
New York__ ____ ___________ 74,247
18, 711
92,958
7. 2
111,929
319,500
29,960
North Carolina____________ 15,294
5,220
20,514
6. 0
84,835
138, 098
196
12,161
North Dakota__ __ _________
308
662
970
1. 4 ___________
13,878
5
2,052
Ohio ___ ____ _____________ __
6,713
2, 968
9,681
1. 4
36,045
30,753
658
11,349
Oklahoma___ _____ ____ ___ __
2,089
1,820
3,909
1. 6 _________ _____________ _______________ _
Oregon ________________ ____
784
1, 668
2,452
2. 4
2,886
9,851
20
3,932
Pennsylvania________ _____
4,038
2,248
6,286
.6
40,378
72,251 ________ 20,498
Rhode Island____ ______ ____
1,424
674
2,098
3. 1
9,245
16,247
86
3,158
South Carolina____________
2,919
3,997
6,916
3. 4 _____________________________________ _
South Dakota_ __ _________ _
76
381
457
. 7 ___________
6,158 _______________ _
Tennessee___ _____ _________ 11,464
6,062
17,526
6. 0
70,516
52,985
465
9,093
Texas_____________________
4, 781
1,845
6,626
1. 1
81,370
6,852
212
4,699
3
Utah _____________________ --------- - -------- --------- -- ------- ----------- ----------- -------- -------Vermont____ ____ __________
232
341
573
1. 5
1,491
8,184
10
1,920
Virginia_____ ____ __________
6,428
3,333
9, 761
3. 7
20,809
16,397
52
3,394
Washington_______________
1,645
2, 182
3,827
2. 3
11,008
48,446
142
26,351
WestVirginia_____________
2,675
1,433
4,108
2.3
45,080
35,529
12
3,965
Wisconsin_______ __________
• 321
1,673
1,994
.7
8,072
8,292
95
6,972
3
Wyoming ________________ --------- --------- --------- --------- ----------- ----------- -------- -------1
2
3
1
For 2 months.
For 11 months.
Not reporting.
Only cases of syphilis in the infectious stage are reported.
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Federal Reserve Bank of St. Louis
125
PUBLIC HEALTH SERVICE
2.-Report of 111 correctional and penal institutions cooperating with State
departments of health 1
New cases admitted:
7,278
Syphil~---------------------------------------------------Gonorrhea ____________________________________ _____________ _
3,447
Chancroid _________________________________________________ _
171
Total ______________ ___ ______________________________ __ __ _
10,896
Cases discharged as arrested or cured _____________________________ _
6,967
Treatments given _______________________________________________ _ 356,310
Doses of arsphenamine administered ______________________________ _ 67,789
Serologic tests made ___ ___________________________ ______________ _ 56,233
Microscopic examinations for gonococcus __________________________ _ 19,362
TABLE
t
Includes 34 prison camps.
TABLE
3.-Report of 713 clinics, furnished through State health departments, July 1,
1935, to June 30, 1936 1
State
Total. ...••
Alabama .........
Arkansas.........
California .....• ••
Connecticut. .....
Delaware ........
District of Co•
lumbia•........
Georgia ..........
Illinois ...........
Indiana . ...... . ..
Iowa ....... ..... .
Kansas ...........
Kentucky . .......
Louisiana ........
Maine ...........
Maryland ........
Massachusetts .. _
Michigan ... .....
Minnesota .......
Nebraska ........
New Hampshire.
New Jersey ......
New York . . .....
North Carolina ..
Ohio ........... . .
Oregon'···· ·····
Pennsylvania ... .
Rhode Island ....
Tennessee ........
'l'exas . ...........
V irginia..........
w ashington ......
w est Virginia....
w isconsin........
New cases admitted
Cases
Total
dis•
month•
Treat• ·
charged
ly
ments
as
reports Total Syph• Gonor• Chan• arrested
given
ilis
rhea croid or cured
received
- -- - - - - - - - - - - - - 7,589 126,271 79,905 44,358
2,008
Doses of
arsphen•
amines
admin•
istered
Sero•
logic
tests
made
Micro•
scopic
exami•
nations
for gono•
coccus
--- --- ---
63,566 3,344,257
934,063
575, 147
232,866
235,362
247,558
52,058
11,771
27,740
63,312
11,439
5,367
37,297
39,719
6,392
2,451
9,515
26,421
1,437
629
59, 751
147, 838
374,288
125, 872
17,696
11,482
68,444
5,947
19,070
146,186
13,952
63,525
92,638
36,654
4,637
4,349
15,934
1, 954
6,310
56,064
6, 407
27, 329
83,718
12, 197
777
1,244
13, 090
4,549
1, 472
13,860
7,265
2,018
44,616
3,613
1,463
930
4,574
541
522
3,894
--- - - --- --- --- --- ---- ---- - - - - - 2 436
7,494 6,062 1,368
64
1,166
113, 758
52,389 --------- --------12
452
204
61
3,789
8,845
1,406
647
2,616
4,640
898
460
1,173 ------4,199
6
508 ------180
7
11
149
244
160
20
24
243
12
108
438
306
150
36
48
59
369
1,335
488
406
11
635
71
623
8
46
37
255
132
3,330
8,612
10, 743
2,938
383
471
5,615
495
765
5,310
5,265
4,736
721
707
256
6,053
7,505
8,899
6,583
366
4,910
726
8,687
1,960
2,924
1,543
2,727
860
1,690
6,838
5,811
1,356
2G8
281
2,511
336
342
3, 173
2,758
2,153
364
350
116
3,790
5,305
7,507
3,890
231
3,025
535
5,912
1,485
2,123
753
1,941
445
1,610
1,492
4,849
1,563
175
189
3,034
159
418
1,961
2,507
2,474
356
357
140
2,237
2,192
1, 189
2,027
134
1,872
190
2,626
427
778
789
770
415
30
282
83
19
------1
70
------5
176
----- -109
1
-- ------- ---26
8
203
666
1
13
1
149
48
23
1
16
-------
1,012
4,352
1,025
251
273
5,208
12,904
1,520
183
152
1,250
4
254
2,403
1,436
2,768
283
177
156
4,100
6,909
2,257
2,243
265
3,496
514
2,979
739
350
1,225
1,280
432
3
--------- --------187,429
33, 718
22,434
21,624
13,005
255,031
302,702
123,022
170, 799
18,069
89,881
30,639
214,609
36,053
37,573
50,101
76,500
57,705
4,538
3,940
2,922
42,574
85,184
72,775
34,822
2,305
37,901
9,245
64,726
9,774
20,809
10,908
33,586
8,072
--------38,472
2,269
4,257
637
33,219
35,221
44,616
28,646
1,206
10,719
14,982
51, 171
304
16,397
25, 180
9,049
8,300
-------34,622
1,308
2,965
517
13, 764
10, 178
5,376
10,334
984
2,565
8,512
1,567
3,394
20,540
2,056
6,746
1 States which did not report and those which have no clinics have been omitted from the above table.
They are Arizona, Colorado, Florida, Idaho, Mississippi, Missouri, Montana, Nevada, New Mexico,
North Dakota, Oklahoma, South Carolina, South Dakota, Utah, Vermont, and Wyoming.
2 County reports.
a Includes 93,916 baths given at the U. S. Public Health Service clinic, Hot Springs National Park, Ark.
' For 11 months.
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126
TABLE
PUBLIC HEALTH SERVICE
4.-Report of cooperative clinic activities furnished through State health
departments from 1919 to 1936
Cases disNumber New cases Total treat- charged
as
ments
of clinics admitted
arrested
reporting
given
or cured
Year
1919 ______ -- _-- ---- -- -- -- ________ -- -- -- -- ___ -- _
1920 _______ -- __ - -- --- -- --- - - - -- - - - - -- -- -- -- - - - _
1921 ______ _-- _--- -- _-- _________ _____ -- _--- ____ _
1922 _______ ____ __ -- -- ______________ -- -- -- ___ --1923 __________ -- ----- __ -- _-- _______ -- -- -- -- ___ _
1924 ___________________________ -- _____ --- _-- _-1925 ________ - - - - - - - -- -- - - - - - -- - - - - - - - -- - - -- -- - 1926 ___________ -- ___ -- _-- __________ -- _-- -- -- -- _
1927 _________ -- -- ------- ___ -- --- ___ ---- -- -- _-- _
1928 _____ -- ___ -- _--- - -- - - - - - - - _- _- - - _-- -- -- -- - _
1929 _________ -- --- ---- _-- __ - -- _- _- - - -- -- - - _- _- _
1930 ___ -- _-- ____ -- ------ _-- -- __ ---- -- __ -- --- __ _
1931 _________ -- ------ ____ -- -- __ -- _____ ---- _-- -1932 _______ -- __ ---- __ -- -- -- -- ____ -- _-- _--- -- __ _
1933 ____ -- _-- -- ----- __ -- _-- -- - _-- -- -- ----- _-- -1934 ________ - - - -- ------- - - - ------ -- ----- ---- -- 1935 _______ -- ___ -- -- -- _-- -- ____ -- -- ---- __ -- -- -1936 ___ -- --- _-- -- --- - - -- _-- - - - - - ----------- -- --
TABLE
167
383
442
541
513
504
495
416
425
451
445
477
512
533
572
616
6b6
713
59,092
126, 131
140,748
141,279
119,217
118,023
110,372
100, 776
107,688
110,756
120,315
127,978
143,982
150,906
154,302
129,293
134,720
126,271
527,392
1,576,542
2,108,003
2,045,232
1,992,631
2,147,087
2,088,494
1,881,380
1,964,233
2,174,832
2,128,417
2,547,162
2,847,024
2,979,730
3,263,927
3,085,401
3,359,632
3,344,257
14,278
34,215
55,467
60,169
55,503
51,658
47,828
44,329
44,701
49,487
52,136
55,592
57,665
64,645
65, 116
55,905
61,064
63,566
Treatments
per new
case admitted
8. 92
12. 50
14.98
14. 48
16. 71
18. 19
18. 92
18. 67
18. 24
19. 64
17. 69
19, 90
19. 77
19. 75
21.15
23. 86
24. 94
26.48
5.-Annual report of the U. S. Public Health Service clinic at Hot Springs
National Park, Ark., from July 1, 1935, to June 30, 1936 1
Total applicants_____________
V enereaL _ _ __ _ _ _ _ _ _ _ _ _ _
N onvenereaL _ _ _ _ _ _ _ _ ___
Did not return__________
2
8,490 Gonorrhea (new cases)_______
1, 173
Acute _________________ _
Chronic _______________ _
1,060
113
4, 448
3, 607
435
Total treaments given ______ _ 235,362
Syphilis ___________________ _
3,368
New cases _____________ _
Readmitted cases _______ _
Rejected ______________ _
2,616
376
376
Gonorrhea _________________ _====
1,262
New cases______________
Readmitted_____________
Rejected_______________
Syphilis (new cases)_________
Primary________________
Secondary______________
Tertiary________________
Neuro_________________
CongenitaL _ _ _ __ _ ___ _ __
1, 173
30
59
====
2,616
311
573
1,628
76
28
Arsphenamine _________ _
Heavy metaL __________ _
Other intravenous ______ _
Gonorrhea ________ _____ _
Baths _________________ _
27,740
67,979
4,547
41,180
93,916
Laboratory examinations__ ___
81, 673
Complement fixation tests
Precipitation tests ______ _
Icterus indices _________ _
Darkfields _____________ _
Gonococcus smears _____ _
Urine analyses _________ _
Special ________________ _
19,148
18,149
19, 148
693
9,515
14,640
380
.,., From the annual report of the-clinic.
J -2 The 4,448 venereal disease patients represent 4,630 cases of venereal disease, since 182 patients were
treated for both syphilis and gonorrhea.
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127
PUBLIC HEALTH SERVICE
TABLE
6.-Report of the U. S. Public Health Service clinic at Hot Springs National
Park, Ark., from July 1, 1935, to June 30, 1936
,,
Number of cases
Number of
applicants
Year
TotaL ______________________________ _
1922 _-- __________ -- _______________________ _
1923 _-- -- -------- ----- -- _-- -- ---- -- _---- _-1924 _-- -- -- --- _-- ----- -- _-- -- ---- ----- _-- -1925_
-------- -- -- ------ ____ -- ---- --- ----- --_
192G ______________________________________
1927 _---------------- ------ -- -- -- -- - - _--- -1928
---- ------ ---- --- ---- -- _-- ---- --- ___ --_
1929 _______________________________________
1930 __________________________ ___ ________ __
1931 ___ -- _-- _-- ----- _-- - - _---------- -- ----1932_ -- -- - --- __ -- ----- _---------- ------ -- -1933
_-- ___________________________________
__ ---- -- -- ___ --- -- _-- _-- ---- -- _--- --_
1934 ___
H115 _--- __· __ --- - --- --- __ -----------------1936 _--- - -- --- ---- -- - ---- - -- - ---- ---------1
Total
venereal
diseases
Syphilis
Gonorrhea
Treatments
given 1
82,100
61,930
39,346
22,584
1,223,844
2,720
3,389
3,676
3,411
3,570
4,757
5,467
5, 265
5,704
4,881
5,106
4,036
6,682
14,946
8,490
1,775
1,854
2,186
2,782
3,064
3,682
4,134
3,986
4,441
5,088
6,184
4,485
5,607
8,032
4,630
1,182
1,326
1,447
2,011
2, 211
2,504
2,626
2,512
2,743
2,776
3,188
2,850
3,330
5,272
3, 36S
593
528
739
771
853
1,178
1,508
1,474
1,698
2,312
2,996
1,635
2,277
2,760
1,262
43,830
41,559
50,683
50,608
54,590
58,489
72,466
75,519
79,180
66,246
93, 707
73,466
124,004
198,051
141, 446
Baths not included.
TABLE
7.-Statistical summary of activities in the control of venereal diseases for lhe
fiscal years 1935 and 1936
1936
19351
Medical activities
A. Oases
of venereal
disease
reported to State health
__ ____
____________________________
___departments:
_____ ___ _________ _________ _
I. Syphilis
II. Gonorrhea _____________________________________________________________ _
III. C hancroid _________________________________ ____ ________________ - -_- -- - --
266,626
162,487
3,800
255,856
162,763
3,090
TotaL ____________________________ _______ ____________________________ - ____ _
432,913
421,709
B . Doses of arsphenamines distributed by State health departments _________ ___ 1,313, 501
C. Clinics:
I. Clinics established during the year __________________________ ____ _______ _
56
II. Clinics reporting to State health departments ___________ __ _____________ _
713
III. Report from clinics:
126,271
a. New cases admitted __ -- ----- --- ---- - --------------------------------b. Cases discharged as arrested or cured ________________________________ _
63,566
c. Treatments given ___________________________________________________ _ 3,344,257
d. Doses of arsphenamines administered ___________ _________________ __ __ _
934,063
575, 147
e. Serologic tests made ______ ____ ___ ___ -- ----- -- --- -------- --- --- - ------/. Microscopic examinations for gonococcus ___ ________________________ __
232,866
1,400,220
68
656
134,720
61,064
3,359,632
896,261
668,266
251, 35/i
Educational activities
A. Pamphlets:
I. Requests for pamphlets received by the Public Health Service _________ _
II. Pamphlets distributed:
a. By the Public Health Service to State he~lth departments and others_
b. By State health departments ___ ----------------- --- -----------------Total. _______ ___ ___ _______________________________ - _____ ____________ _
III. Venereal disease pamphlets issued by the Public Health Service ____ ___ _
B. Lectures,
exhibits,
and film showings reported by
State
health departments: _
I. Number
____ _______________________________
-- ___
________________________
II. Average attendance ____________ _____ _________ ______ _____ ________________ _
C. Motion-picture films lent by the Public Health Service _____________________ _
1
12,449
10,206
70,719
641,815
71,790
583,836
712,534
4
655,626
5
1,707
81
58
2,021
100
261
Data for 1935 were changed from previously published figures because of the receipt of additional reports·
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Federal Reserve Bank of St. Louis
DIVISION OF MENTAL HYGIENE
Asst. Surg. Gen.
WALTER
L.
TREADWAY
in charge
The year ending June 30, 1936, marks the sixth full 12 months'
activities of the Division of Mental Hygiene. The functions of the
Division continued unchanged during the year. They comprised
studies of the nature and treatment of drug addiction and the dissemination of information upon the subject; studies of the abusive uses of
narcotic drugs; administrative functions incident to the establishment and operation of the narcotic farms; the supervising and furnishing of medical and psychiatric services for the Federal penal and
correctional system; studies and investigations of the causes, prevalence, and means for the prevention and treatment of mental and
nervous diseases; and cooperation with other agencies interested in
the various phases of work with which the Division is concerned.
STUDIES OF THE NATURE AND TREATMENT OF DRUG ADDICTION
Studies of the nature and treatment of drug addiction have been
continued during the year at the United States Narcotic Farm,
Lexington, Ky.,1 which opened for operation in May 1935. Special
studies in this field begun at the United States Penitentiary Annex,
Fort Leavenworth, Kans., were continued and elaborated upon at
Lexington.
Investigations were continued on the addiction liability of certain
substitutes for morphine. Studies were completed on dihydroheterocodeine and dihydroisocodeine. The first-mentioned substance was
found to be more potent than morphine and quicker in action, but the
effects were less sustained. Definite addiction liability was demonstrated by this substance. Dihydroisocodeine was less potent than
morphine and its action less sustained. It, too, demonstrated definite
addiction liability.
Studies were made on the value of Rossium in the treatment of
drug addiction, and the results indicated that Rossium was without
demonstrable beneficial effect on the abstinence syndrome, whether
administered alone or in combination with certain therapeutic agents.
Studies of carbohydrate and water metabolism in relation to morphine addiction have been continued.
Studies calculated to reveal changes in the cerebrospinal fluid pressure which might occur during abstinence were undertaken, the results
indicating that the cerebrospinal pressure does not deviate from normal
either during addiction or during the withdrawal phenomena. Further
observations in this field will be made during the coming year.
Special studies were made of the clinical value of dihydroisocodeine
in connection with the relief of cough among tuberculosis patients
1
Name changed by congressional act to United States Public Health Service Hospital, effective July 1,
1936.
128
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Federal Reserve Bank of St. Louis
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and· in the relief of pain among cancer patients. These were carried
on in cooperation with the State Department of Health of Massachusetts. More extended observations on its value will be continued
during the coming year.
Because of the high addiction potentialiti~s of dihydrodesoxymorphine-D demonstrated by clinical studies of this substance during
the preceding year, representations were made by the American represen ta ti ve on the Opium Advisory Committee of the League of ations
to suppress the manufacture of this substance, and recommendations
were made to the Secretary of the Treasury that it be not imported,
manufactured, or sold in the United States.
During the year studies were inaugurated dealing with the behavior
responses of the chimpanzee to certain habit-forming drugs. This
work is carried on in cooperation with the division of comparative
psychobiology of Yale University.
·
Dr. Lyndon F. Small, Consultant in Alkaloid Chemistry to the
Public Health Service, has applied for a patent covering the making
of certain ethers of morphine and its dihydrogenated derivatives.
This-patent, when granted, will be lodged, ex officio, in the custody
of the Secretary of the Treasury and become the property of the
United States.
Further studies have been made of the abusive uses and the medicinal and scientific requirements of the United States concemmg
narcotic drugs.
DISSEMINATION OF INFORMATION
Several articles relating to the work of the Division were published,
including "The Truth About Narcotic Drug Addiction", "What Causes
People to Become Drug Addicts", and "The Place of Mental Hygiene
in a Federal Health Program." Articles on the physiological action
and addiction liability of dihydrodesox37morphine-D, and on the value
of Rossium in the treatment of addiction have been approved for
publication. Advisory consultant services were rendered various
agencies, including representatives of local political jurisdictions,
with reference to the drug-addiction problem.
NARCOTIC FARMS
Since the opening of the United States I arcotic Farm at Lexington,
Ky., in May 1935, 1,240 persons have been admitted as patients.
Of these, 960 were admitted during the fiscal year ending June 30,
1936. During the year 4 79 persons were discharged, leaving 761
patients in the institution at the close of the year.
Of those admitted, 619 were Federal prisoners, 6 of whom were
committed directly from Federal district courts and 613 were transferred from the Federal prison system; 58 were probationers, placed
on probation by courts having jurisdiction; and 283 were voluntary
patients.
On March 20, 1936, the United States district court at Lexington,
Ky., rendered a decision to the effect that the arcotic Farm had no
authority to hold voluntary patients against their will. This decision
seriously impaired the treatment of voluntary patients because many
of them, thinking they were actually cured after the withdrawal of the
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drug, insisted upon their discharge. This situation accounts for the
large number of discharges of voluntary patients, totaling 237.
During the year 213 prisoners were discharged on "conditional
release", 13 were paroled, 7 were released on the expiration of their
sentence, 5 died, and 1 escaped. Of the 58 probationers admitted,
3 have been discharged; and of the 283 voluntary cases admitted,
237 were discharged. Of these, 145 were discharged against medical
advice, 58 as having reached maximum benefit, 16 as cured, 1 as not
being an ad.d iet within the meaning of the law, 1 as being an alien and
not entitled to treatment, 1 as not being a proper charge against the
Government, 12 hy elopement, and 3 by death.
Of the cured voluntary patients, none are known to have relapsed,
but some of those discharged as having reached maximum benefit
have relapsed. This sit:uation was expected, since an analysis of the
characters of these individuals indicated weaknesses which cannot
meet the stresses of community environment and they would be
expected to resort to narcotics.
There is no question that the treatment of narcotic addiction in a
hospital has distinct advantages over the management of such cases in
a corr.ectional institution. The extent and value of such treatment
cannot be accurately gaged from the standpoint of statistics at the
present time. Reports have been received, however, to the effect that
some prisoners released on "conditional release" and parole have
returned to narcotics. This is not surprising, since many of these
patients, though cured of their immediate difficulty, have personalities
distorted by dissipation and prison life to an extent that they cannot
be expected to withstand all the environmental stresses to which they
are subjected when released from an institution. They were, however, discharged at the opportune time for an attempt at outside
adjustment.
In the management of the institution it has been found possible for
20 percent of the inmates to be cared for under a regime of minimum
custody, and at least 58 percent are given this privilege sometime
before discharge. This application of minimum custody has in no
way relaxed the discipline of the institution, no patient being allowed
to leave the institution grounds.
This method of treatment has two advantages: First, it implies a
confidence in the patient that increases his self-respect and makes him
more responsive to rehabilitation; second, it imposes a certain amount
of trust and responsibility which is of great value to the individual in
preparation for taking up his duties in society before he is actually
exposed to its many dangers and pitfalls. During the year only 1
prisoner violated this trust and 12 voluntary patients eloped. These
voluntary patients were restless under what they considered illegal
restraint, and the management of the institution did not feel the same
responsibility in the safe custody of them as they did for the prisoners.
It is thought that the purposes of the institution would be better
served if all prisoner addicts were sent to it directly from courts instead
of indirectly from prison~, and that a wider use should be made of the
probation feature in the act authorizing the institutions. Such a plan
would be advantageous to those admitted, because from the beginning
thorough study and treatment could be instituted and the individual
patient saved the stigma of a prison sentence.
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During the year the laboratory facilities have been amplified to
meet the special needs of the institution in terms of special studies.
It is anticipated that the work planned in this field will add considerably to the knowledge of drug addiction and afford suggestions for
improvements in the methods of treating it.
Occupational facilities have been developed during the year, the
farming activities be.i ng successful and the tailor shop put on a production basis. Because of inadequate facilities, wood-working has not
been carried on to any great extent. A larger wood-working shop is
greatly needed, as well as other mechanical features for which funds
have been requested. The occupational facilities, however, have
provided some form of occupational therapy for approximately 85
percent of the patients.
During the year proposals were solicited for the construction of the
initial buildings for the United States Narcotic Farm at Fort Worth,
Tex. Because the proposals were in excess of the moneys available,
all bids were canceled, the plans redrawn, and further proposals
solicited. It is anticipated that the contract will be awarded some
time during the early part of the ensuing fiscal year.
MEDICAL AND PSYCHIATRIC SERVICES IN FEDERAL PENAL AND
CORRECTION AL INSTITUTIONS
The Public Health Service continued the work of supervising and
furnishing the medical and psychiatric services for the Federal penal
and correctional system, extending this service to include Federal
Prison Camp No. 8, Montgomery, Ala., under date of July 5, 1935,
and Federal Prison Camp No. 11, Kooskia, Idaho, under date of
January 2, 1936, making a total of 18 medical units in connection with
the various institutions under the control of the Department of
Justice, as follows:
INSTITUTION AND CHIEF MEDICAL OF:f iCER
United States Penitentiary, Alcatraz, Calif., Acting Asst. Surg. George Hess.
Federal Industrial Institution for Women, Alderson, W. Va., Acting Asst. Surg.
Edda von Bose.
United States Penitentiary, Atlanta, Ga., Asst. Surg. Havelock F. Fraser.
United States Industrial Reformatory, Chillicothe, Ohio, Passed Asst. Surg.
Robert P. Hagerman (R).
United States Southwestern Reformatory, El Reno, Okla., Acting Asst. Surg.
Wilson K. Dver.
United States Penitentiary Annex, Fort Leavenworth, Kans., Asst. Surg. Floyd
A. Hawk.
Federal Prison Camp No. 11, Kooskia, Idaho, Acting Asst. Surg. Bernard H.
Shallow.
United States Detention Farm, La Tuna, Tex., Asst. Surg. Alford G. Hendrick
(R).
United States Penitentiary, Leavenworth, Kans., Passed Asst. Surg. Oliver C.
Williams.
United States Northeastern Penitentiary, Lewisburg, Pa., Asst. Surg. Jonathan
B. Peebles, Jr.
United States Penitentiary, McNeil Island, Wash., Surg. Romney M. Ritchey (R).
United States Detention Farm, Milan, Mich., Acting Asst. Surg. William D.
Wilder.
Federal Prison Camp No. 8, Montgomery, Ala., Acting Asst. Surg. Thomas H.
Smith.
Federal Jail, New Orleans, La., Acting Asst. Surg. Benjamin L. Newell.
United States Detention Headquarters, New York, N. Y., Acting Asst. Surg.
Robert E. Frick.
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Federal Reformatory Camp, Petersburg, Va., Acting Asst. Surg. Carl I. Pirkle.
United States Hospital for Defective Delinquents, Springfield, Mo., Surg. Marion
R. King.
Federal Prison Camp No. 10, Tucson, Ariz., Medical Interne Basil Thompson.
There has been a continued increase in the prison population in the
majority of the institutions. This increase in population has resulted
in increasing the duties of the medical and technical staff at the
various units and has also involved an increased consumption of
medical and hospital supplies.
The continuance of the program of classification and rehabilitation
of prisoners, whereby each prisoner is given medical treatment and the
benefit of medical, psychiatric, and psychological supervision in his
work assignments and solution of his adjustment problems, has made
heavy demands upon the members of the medical staff sen-ing as
members of the classification committees and disciplinary boards.
The results of this program have been gratifying.
The greatly improved sanitary conditions at the various institutions
achieved partly through the periodical sanitary inspections made by
the medical staff during the previous year have been maintained during
the past year by the continuance of these inspections.
Because of the limited nursing personnel at the United States
Industrial Reformatory, Chillicothe, Ohio, certain difficulties were
experienced in providing adequate trained, nursing care for hospital
cases. White inmates of superior mental ability were assigned to the
hospital as student attendants and given a course of study in nursing
procedures so that they might provide the additional nursing help
needed. This arrangement has not only added materially to the
effectiveness of the nursing program but also aided in some degree in
furnishing vocational training to a group of inmates interested in this
particular field.
In addition to furnishing medical, surgical, dental, psychiatric, and
sanitary advisory services to the United States Detention Farm,
La Tuna, Tex., the chief medical officer furnished these same services
to all Federal prisoners confined in the El Paso County Jail 1 El Pn,so,
Tex_., where he made 304 visits, examining and treating 2,558 persons.
A daily average of 20 fem ale Federal prisoners have been confined
in the El Paso County Jail during the year, and illnesses among this
group of prisoners have been successfully treated there. Pediatric
and obstetrical services have also been rendered this group.
Psychiatric and medical advisory services were also furnished to the
United States Court for the Western District of Texas. At the
inaugu~ation ,of these services a large number of drug-addict violators
were being brought to the attention of the court, many of whom
pleaded pitiful plights of disease to enlist the sympathy of the court.
These violators in practically all instances have been sentenced to
the Leavenworth prison. During the fiscal year a total of 40 certifications of diseases existing among Federal prisoners has been made
to the United States district attorney's office, and four appearances
in the United States court have been made by the chief medical officer
to give professional testimony.
The laboratory service at the United States Penitentiary, Leavenworth, Kans., has shown a marked increase over that of the previous
year. 'J;his station has continued to use the spinal and avertin
anesthesias with the same good results that have been experienced in
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the past. One case of spinal meningitis occurred, but a serious
epidemic was averted. Skin tests for meningococci susceptibility
were given 94 inmates who had been exposed to this case, and 31 of
these who showed positive reactions were vaccinated against meningitis. One case of gas gangrene of the groin occurred and was saved
by the immediate use of gas-gangrene antitoxin. Vaccinations against
Rocky Mountain spotted fever were administered to 60 inmates prior
to their transfer to Federal Prison Camp No . 11, at Kooskia, Idaho.
The increase in duties at the United States ortheastern Penitentiary, Lewisburg, Pa., without a corresponding increase in facilities for
their proper performance, has made it impossible to carry out individual
mental tests to the extent in which they are indicated, and group tests
have had to be substituted.
The medical unit at the United States Penitentiary, McNeil Island,
Wash., continued to furnish medical supervision to the Federal Road
Camp o. 5 at Fort Lewis, Wash., the chief medical officer and the
dental officer making weekly visits to this camp. Of the 361 new admissions to the road camp during the past fiscal year, 40 percent required hospitalization at the penitentiary hospital for various medical
and surgical diseases. This appears to be a rather high incidence of
morbidity for that type of an institution.
Owing to the increase in the patient population and the heavy burden incident to proper care of the sick, 3 additional medical officers
and 18 attendants were assigned to duty at the United States Hospital
for Defective Delinquents at Springfield, Mo. In addition to furnishing medical and psychiatric services at this institution, medical service
was also rendered the prison camp, with an average daily population
of about 150 men.
During the last half of the year plans were outlined for limited training of attendants. Suitable textbooks dealing with. nursing and medical subjects were made available to the attendants for selective reading
in connection with their duties. Fifteen lectures were given by the
medical officers and Public Health Service nurses. The nurses also
gave practical bedside demonstrations and instructions to attendants
on the wards. A limited course in physical training, with special emphasis on defensive tactics, was also given. The reaction of the attendants ·to training and instruction has been favorable, and the improvement in the nursing care of patients has justified the efforts of the staff
in connection with the training course.
Occupational therapy has played an important part in the rehabilitation and treatment of most of the patients. Qualifications and aptitude of each patient are brought into full consideration before the staff
classification committee meetings, and a joint decision is reached as to
the type of occupation best suited to each individual. Primary consideration is given particularly to psychotic patients where employment serves as a valuable psychotherapeutic aid for recovery and
adjustment. Practical occupational therapy is prescribed in the form
of general maintenance of the institution, such as cleaning, kitchen,
laundry, and improvement and maintenance of the grounds. A limited
number demonstrate aptitudes in clerical work and are able to fill positions of this character. Patients who are mentally and physically
incapable of taking advantage of gainful occupations are occupied as
far as possible in the occupational-therapy craft shops, where carpentry, painting, rug weaving, basket weaving, and other activities are
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supervised and directed by the occupational-therapy aide. A special
effort is made to extend the benefits of occupational craft work to
nonambulatory individuals. Approximately 39 percent of the tuberculous, 87 percent of the chronic infirm, and 84 percent of the psychotic
patients have engaged in work of one type or another, as mentioned
above.
The medical staff completed a survey and study of 23·5 psychotic
criminals admitted to this institution to ascertain, if possible, the major
causative and precipitating factors present in prison life to produce
psychoses. Of this group it was found that 130, or 55 percent, were
psychotic before the commitment of the crime which led to confinement, and 20, or 81~ percent, of the o-roup presented no evidence of
psychosis at the time of their offense but were found psychotic upon
admission to prison. It is assumed that the majority of the group of
20 became psychotic while detained in jail awaiting trial. An analysis
of the remaining 85 showed that a large number of them became ill
during the first year in prison. The fact that 62 of the 85 cases, or
approximately 73 percent, were afflicted with definite psychopathic
personalities is of interest.
Structural modifications have been necessary to meet the needs of
the more incorrigible mental cases. An increase in the number of
single rooms has been authorized,and it is anticipated that the mentally
disordered population will materially increase during the next fiscal
year.
During the year the following articles were published in connection
with the work in the Federal penal and correctional institutions:
"Surgical Preparation of the Jaws to Receive Dentures", "A Statistical
Study of the Ferguson Form Board Test'', ''A Study of the Characteristics ofl ,000 Prison Inmates", "A Case of Tuberculous Meningitis"," A
Discussion of General Paresis'', ''The Inheritance of Nervous and Mental
Disease", "Physiotherapy as an Aid to Psychotherapy in the Neuroses",
"Leukoplakia- With Case Reports", "The Use of Continuous Nasal
Siphonage Suction Tube for Postoperative Distension, Nausea, and
Vomiting, Also Intestinal Obstruction and a Comparison of the Different Types of Apparatus", "A Simple Type of Transfusion Technique",
"Mucocele of the Appendix and Cecum Producing Intestinal Obstruction", "Fascial Strips in Difficult Hernias", and "Chewing Gum in the
Urinary Bladder."
An indication of the scope of the medical services rendered the Federal penal and correctional system by the Public Health Service may
be obtained from the following: During the fiscal year 1936 there were
furnished 349,634 hospital -relief days and 698,128 out patient relief
days.
STUDIES AND INVESTIGATIONS ON THE CAUSES, PREVALENCE, AND
11EANS FOR THE PREVENTION AND TREATMENT OF NERVOUS AND
MENTAL DISEASES
During the year the Public Health Service engaged in a cooperative
survey to determine the adequacy of measures, policies, and facilities
for the care of mental illness in the metropolitan district of New York
for the J!urpose of predicating a future program or policy to meet the
needs for the care of mental diseases occurring in that district. This
survey was conducted in cooperation with The National Committee
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for Mental Hygiene to be integrated with the United Hospital Survey
for New York City. The phase of study conducted by the Public
Health Service covered dispensary and general hospital practice and
consisted of a current analysis of clinical material for demonstrating
the nature of the psychic pro bl ems as seen in dispensary and general
hospital practice.
In order to attain the specific objectives desired, the study included
an intensive administrative and clinical analysis of a representative
general hospital and dispensary in the metropolitan area of New York,
an analysis of the experiences of others in the field of practice, and a
general survey of the literature on the subject.
The general results of the study point definitely to the necessity of
considering the subject of psychosomatic interrelationships in plans
for future development of . adequate medical services in general
hospitals and dispensaries. Whether the illness be physical, mental,
or a combination of these two, all measures must be adopted eventually
to meet the many diversified needs encountered in general hospital and
dispensary practice.
Pursuant to the request of the Attorney General that the Public
Health Service extend psychiatric service to Federal courts, arrangements were made to furnish psychiatric diagnostic services to United
States district courts for a period of approximately 1 year as a research project to demonstrate the wisdom and feasibility of establishing these services as a future permanent activity of the Public Health
Service, such centers for this demonstration being selected as seem
practicable and desirable. The nature of the services furnished is on
a consultive and advisory fee basis only. It is not for the purpose of
determining the guilt or innocence of an accused, but is intended to
assist the court to determine the mental state of a defendant as one
element in the problem of the disposition to be made of a case.
In the event the nature of the case requires a period of observation
and more intensive study and examination, when such is recommended
by the consultant, the individual prisoner is sent to a hospital under
contract with the Public Health Service where the staff of that institution assumes responsibility for observation, examination, and report.
Senior Surg. J. G. Wilson was assigned to duty in charge of the
organization of the work. The first unit was organized in Boston,
Mass., in May 1936, and a panel of physicians appointed as advisory
consultants to the Federal court in that city. A contract was made
with the Boston Psychopathic Hospital for the examination and report
of cases requiring more intensive study. Arrangements are being
made to establish similar units at other points throughout the country
during the ensuing year.
This is the first organized effort to establish such a facility in connection with Federal court procedure. It is believed the data obtained
will enable the Service to determine whether or not such an activity
would be of practical value.
.
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DIVISION OF PERSONNEL AND ACCOUNTS
Asst. Surg. Gen. W . F.
DRAPER
in charge
The Personnel and Accounts Division supervises all operations of
the Service relating to personnel, finances, and the maintenance of
property records. The organization of the Division has remained
urn:;hanged during the year. Through a personnel section, a finance
section, and a property-record section, all matters relating to appointments, separations, and other changes in status of personnel, estimates of appropriations, allotments, and encumbrances, records of
expenditures, including admir.,istrative audit, and
records of nonexpendable property are administered under the supervision of the
As~istant Surgeon General in charge of the Division.
Because of the increase in the capacity of the hospitals there is
urgent need of additional funds with which to provide medical officers
and other classes of personnel essential for hospital operation. For
the past few years, in order to keep within the appropriations it has
been necessary to assign medical internes to duties which should be
performed by more experienced doctors. A similar shortage of medical and other personnel exists also at the quarantine stations. The
authority for increasing annual leave from 15 to 26 days and recognition of 44 hours as a desirable work week have made the administration of marine hospitals and quarantine stations much more difficult.
The principles of the longer leave period and the shorter work week
are enthusiastically approved by medical officers in charge of hospitals
but, because of insuHicient personnel, many employees, if not most,
are in part denied both privileges, and such a condition is, of course,
detrimental to morale. A number of complaints have been received
from Members of Congress and representatives of employees' unions
to the effect that the compensation of employees at the marine
hospitals and quarantine stations is not commensurate with that of
similar positions elsewhere in the Government service . In most
instances the complaints are fully warranted.
all
PERSONNEL
COMMISSIONED OFFICERS
On July 1, 1935, the regular corps consisted of the Surgeon General,
8 Assistant Surgeons General, 51 medical directors, 1 pharmacologist
director, 43 senior surgeons, 1 senior dental surgeon, 1 senior sanitary
engineer, 71 surgeons, 13 dental surgeons, and 15 sanitary engineers,
100 passed assistant surgeons, 23 passed assistant dental surgeons,
5 passed assistant sanitary- engineers, 1 passed assistant pharmacist,
31 assistant surgeons, 6 assistant dental surgeons, 1 assistant sanitary
engineer, and 10 assistant pharmacists- a total of 382 officers. Of this
number, 15 medical directors, 9 senior surgeons, 15 surgeons, 4 passed
assistant surgeons, 1 passed assistant dental surgeon! and 3 assistant
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pharmacists were on waiting orders. During the fiscal year the following changes occurred in the sever al grades: The Surgeon General was
placed on a waiting-order status, and one of the surgeons was assigned
to duty as Surgeon Gener al; 1 assistant surgeon general reverted to
the grade of surgeon and 1 medical director was assigned to duty in
the bureau as assistant surgeon general ; 1 medical director, 1 senior
dental surgeon, and 1 surgeon on active duty died during the year;
1 medical director was placed on waiting-orders status; 1 senior surgeon
and 1 as istant pharmacist on waiting orders status died during the
year; 1 surgeon was dismissed, 1 passed assistant surgeon and 1
assistant surgeon each resigned, and 1 assistant surgeon was separated
from the corps because of inability to qualify for the next higher
grade; 4 senior surgeons were promoted to the grade of medical
d_irector, 7 surgeons wet e promoted to the grade of sen}or surgeon, 4
passed as<::istant surgeons were promoted to the gr ade of surgeon, 1
passed asf)i tant dental surgeon was promoted to the grade of dental
surgeon, 15 assistant surgeons were promoted to the grade of passed
assistant surgeon, 3 assistant dental surgeons were promoted to the
grade of passed assistant dental surgeon, 1 assistant sanitary engineer
was promoted to tlie grade of passed assistant sanitary engineer and
7 assistant pharmacists were promoted to the grade of passed assistant
pharmacist; 32 doctors were appointed to the corps in the grade of
assistant surgeon, and 2 dentists were appointed to the corps in the
grade of assistant dental surgeon; 2 doctors were appointed to the
corps in the grade of surgeon, 1 doctor was appointed in the grade of
passed assistant surgeon, and 3 engineers were appointed in the grade
of passed assistant sanitary engineer.
On July 1, 1936, after these changes had occurred, the regular
corps consisted of 2 Surgeons General (1 on waiting orders), 8 Assistant
Surgeons General, 53 medical directors, 1 pharmacologist director, 45
senior surgeons, 1 senior sanitary engineer, 68 surgeons, 14 dental
surgeons, 15 sanitary engineers, 111 passed assistant surgeons, 25
passed assistant dental surgeons, 9 passed assistant sanitary engineers, and 8 passed assistant pharmacists, 46 assistant surgeons, 5
assistant dental surgeons, and 2 assistant pharmacists-a total of
413 officers. Of this number 1 Surgeon General, 16 medical directors,
8 senior surgeons, 15 surgeons, 4 passed assistant surgeons, 1 assistant
dental surgeon, and 2 assistant pharmacists were on waiting orders.
At the close of the fiscal year 1936, 1 medical director, 6 senior
surgeons, and 1 passed assistant surgeon were serving by detail as
Assistant Surgeons General in charge of divisions of the Bureau in
ccordance with acts approved July 1, 1902, July 9, 1918 , and April
9, 1930; 1 medical director was on duty as director of the publichealth district, New York, N. Y.; 1 semor surgeon, 2 surgeons, and
1 passed assistant surgeon were serving on detail to the United States
Employees' Compensation Commission; 2 medical directors were
assigned as assistants to the Director, Pan American Sanitary Bureau, Washington, D. C.; 3 senior surgeons, 1 surgeon, 3 passed
assistant surgeons, and 1 passed assistant pharmacist were serving on
detail to the Bureau of Indian Affairs, D epartment of the Interior,
in connection with the control of communicable diseases among the
Indians; 1 medical director, 1 senior surgeon, 1 dental surgeon, 1
passed assistant surgeon, 2 passed assistant dental surgeons, and 2
assistant surgeons were serving on detail with the United States
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Coast Guard; in connection with mental hygiene activities, 2 senior
surgeons, 2 surgeons, 2 passed assistant surgeons, 1 passed assistant
dental surgeon, and 6 assistant surgeons were assigned for duty at
various penal and correctional institutions, and 1 medical directo1,
1 surgeon, 5 passed assistant surgeons, 1 passed assistant dental
surgeon, 1 asdistant surgeon, and 1 passed assistant pharmacist were
assigned to duty at the United States Narcotic Farm, Lexington, Ky_
RESERVE OFFICERS
On July 1, 1935, the reserve commissioned officers on active duty
numbered 64, consisting of 4 surgeons, 1 dental surgeon, 10 passed
assistant surgeons, 1 passed assistant dental surgeon, 37 assistant
surgeons, and 11 assistant dental surgeons.
On July 1, 1936, the number of reserve officers on active duty was
51, consisting of 4 surgeons, 1 dental surgeon, 10 passed assistant
surgeons, 1 passed assistant dental surgeon, 27 assistant surgeons,
and 8 assistant dental surgeons.
ACTING ASSISTANT SURGEONS
On July 1, 1935, there were 707 acting assistant surgeons in the
Public Health Service, and by July 1, 1936, this number had decreased to 698.
Of the 698 acting assistant surgeons, 92 were on duty at marine
hospitals; 428 were engaged in immigration, relief, and maritime,
border, insular, and foreign quarantine work, 1 was engaged in the
prevention of trachoma; 5 were engaged for· duty in connection with
field investigations of public health; 112 were on duty with the
United States Coast Guard; 3 were serving with the Bureau of Mines
by detail; 26 were serving at _various penal and correctional institutions and 31 were engaged in antivenereal disease activities as parttime employees at nominal compensations. Eleven of the thirty-one
acting assistant surgeons engaged in antivenereal disease activities
held appointments as collaborating epidemiologists.
ATTENDING SPECIALISTS
On July 1, 1935, there were 520 attending specialists in the Service,
and during the year this number increased to 585, of which 297 were
consultants to marine hospitals, while 46 were available for call at
second- and third-class relief stations; 39 were engaged in antivenereal disease activities, 81 were serving at various penal and correctional institutions; and 122 were consultants in connection with
quarantine, immigration, and scientific research activities.
INTERNES
On July 1, 1935, there were 129 medical and dental internes in the
Service; on July 1, 1936, there were 187. Internes are appointed for
temporary periods of 1 or 2 years for duty at marine hospitals, and
stations where mental hygiene activities are being conducted.
PHARMACISTS AND ADMINISTRATIVE ASSISTANTS
On July 1, 1935, there were 13 pharmacists and 43 administrative
assistants in the Public Health Service. During the year 1 druggist
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in the Service was reallocated to the postion of pharmacist; an addition of 9 was made in the administrative corps, making a total at
the end of the fiscal year of 14 pharmacists (8 chief and 6 junior) and
52 administrative assistants (12 first class, 8 second class, 11 third
class, and 21 fourth class).
NURSES, DIETITIANS, AND RECONSTRUCTION AIDES
On July 1, 1935, there were on duty in the Public Health Service
560 nurses, 31 dietitians, 31 aides, 67 guard-attendants, and 4 social
workers. On July 1, 1936, there were on duty 620 nurses (an increase
of 60), 31 dietitians, 33 aides, 71 guard-attendants (an increase of 4)
and 2 social workers. They are assigned as follows: Hospital Division, nurses 582, dietitians 30, aides 32, social workers 2; Mental
Hygiene Division, nurses 35, dietitian 1, aides 3, guard-attendants 71;
Foreign Quarantine Division, nurses 3. There were 50 resigna tions and
79 discontinuances during the year. On July 1, 1935, the nurses in
the emergency relief rooms of the Treasury Department were placed
under the nursing service. During the year nurses assigned to
trachoma eradication with the Domestic Quarantine Division were
discontinued, this work being taken over by the State health departments. Nurses have been detailed to the marine hospitals in Cleveland, Ohio; Baltimore, Md.; and New Orleans, La., to assist in studies
in diabetes, arthritis, and the use of pyrototherapy. These studies
are being made as part of the Social Security and Works Progress
Administration programs.
CONTRACT DENTAL SURGEONS
On July 1, 1935, there were 54 contract dental surgeons employed
at the marine hospitals, second-, third-, and fourth-class relief stations,
and the various penal and correctional institutions. 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 1936, this number had decreased to 51; 8 were at
marine hospitals, 23 were at second-, third-, and fourth-class relief,
stations, 13 were serving at various penal and correctional institutions
and 7 were detailed to the United States Coast Guard for duty.
EPIDEMIOLOGISTS
During the year the number of assistant collaborating epidemiologists was increased from 4,643 to 4,769. 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 remained at 44. These appointees are on duty in
different States.
NATIONAL INSTITUTE OF HEALTH
The National Institute of Health continued under the administration of Director George W. McCoy and Assistant Director R. E. Dyer.
The scientific staff comprised 73 members, of whom 14 were commis101889-36-10
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
140
PUBLIC HEALTH SERVICE
sioned medical officers, 44 other research workers, and 15 consulting
experts. The staff was assisted by 17 technicians and 87 other subordinates, making a total of 177. Of this total, 158 were on full-time
schedule .
P ROPERTY R ECORDS
The property return section has accounted for all property of the
Service and 329 property returns have been audited during the year.
A total of $4,124 .99 was turned in to "Miscellaneous receipts" from
sales of property. Surplus property not desired by any other Government department was sold for $1,845.74, unserviceable property for
$405 .24, hides for $235 .80, junk metals for $232 .76, unserviceable
boats and boat property for $1,395.45 . Property surplus to the
Public Health Service valued at $6,395 .32 was transferred to other
Government departments . Surplus property of other Government
departments valued at $41,687 .07 has been received by the Public
Health Service. Property valued at $34,46 1.90 has been transferred
from service stations where it was surplus to stations where it co-y.lcl
be used . By the exchange value on old typewriters turned in on the
purchase price of new machines $1,004.50 has been saved.
ACCOUNTS SECTION
The Accounts Section of the Division of Personnel and Accounts
conducts all bookkeeping and accounting in connection with the expenditure of Public Health 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 published as an appendix to this report .
P ERSONNEL STATEMENT
The accompanymg tabular statement shows the personnel of the
Service as of July 1, 1936. Of the 12,190 employees shown in the
table, 4,769 listed as collaborating epidemiologists and assistant collaborating epidemiologists, receive only nominal compensation. They
are 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 dis 3ases. T he personnel statement also includes all p art-time employees, those employed on a per diem basis,
and those whose compensation is on a fee basis.
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Hospital divi~ion:
Marine hospitals:
Baltimore, Md ________________ ______________ ____ ___ _ ______ ______ __ ____
1
1 ______ ____ __
Boston, Mass__ ___________________ ________ ________________
Buffalo, N. y_ _______________ _______________ __ ____ __ ______ ______ ______ ___ ___
1 ___ ___ ______
Carville, La__ _______________ _____________ ___________ ______
1 __ ____ ____ __
Chicago, IlL ___________________________________ ___ __ ___ __ _
Cleveland, Ohio __ __ _________ ___ __ _______ _________________
1 ______ ______
Detroit, Mich__________________ ___________ __________ ______ ______ ____ __ ______
1 ______
1
Ellis Island, . y_ ___________ __________ _____________ ______
Evansville, Ind ________________ ___ ___ _____ __________________________________
Fort Stanton, . Mex_-·- - -------- ------ ------------ ______ ______ ______ ______
Galveston, Tex____ _____________ ______________ ______ ______
1 ______ ______
1 ______ ______
Hudson Street, . y___ ____________ __ _______________ ______
Key West, Fla ____ ,______________ ___ ________________________________ __ ______
1
Louisville, Ky ___ __________ ____________________ _____ __ ___ _ ____ __ ______
Memphis, Tenn ___________ ___ ___________ _______________________ ______
1
Ala________________________ __ _______________ ______ __ ____ ______
1
Mobile,
New
Orleans,
La
_____________
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______
______
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Va_ _______________________ ___ ___________ _________
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3 ______ __ ____ ______ ___ __ _ ______
1
2 ______ ______ ____ __ ______ ____ __ ______ ____ __
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1 ______ ______ ______ ______ ______ ______ __ ___ _
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1
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Pa___________
________________________ ___ ______ ______ ____ __
1 ______
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1 ___ ___ ______ ______
:Por!land, ~1aine ____________ ____ _______ _____________ ______
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2 ______ ______ ______ _____ _ ______
3 ______ _____ _ ______ ______ ____ __
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1 ______
1
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1
3
6
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===-==========--==----
Relief stations:
3 ___ ___ ______
2
5
2 ______ ______ ______ _____ _
2
Second class___________ ___ ___________________________ ______
Third class__________________________________________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
16
151
36
10
8
1 ------ ------
23 ------ ------ - - ----
Total relief stations_------------------------------ __________________________________ ___ ______________________________________________________________________ _
Foreign Quarantine Division:
Quarantine stations:
1 ____ _____________________________________ _
Baltimore, Md_______ _________ ______________________ ______ ___ ___ ______ ______
Boston, Mass___ __________________________________________________________________
1 ______________________ ____ _________ _
Ellis Island (also immigration)______________________ ______
2 ______
1 _____ _
2 ___________________________________ _
El Paso, Tex ________________________________________________________________ - . _____________________________________________ _
Fort Monroe, Va____________________________________ ______
1 ___________________________________________________________ _
Galveston, Tex______________________________________ ______ ______ ______ ______
1 _________________________________________ _
Honolulu, T. H_ ____ __________________ ______________ ______
1 ______ ______ ___ ___
1 ___________________________________ _
Laredo,
Tex
________________________________________________________________________________________________________________
_
Marcus Hook, Pa_ ___ __________ __ ____________ ___ ____ ______ ______ ______
1 ______
1 ___________________________________ _
https://fraser.stlouisfed.org
New Orleans, La___________ ________ _____ _________ ___ ______ ______ ______
1
1 ______
1 _____________________________ _
Rosebank,
N. yof____________________________________
______ ______ ______
1
1
2 ___________________________________ _
Federal Reserve
Bank
St. Louis
San Francisco, Calif. (also immigration)_____________ ______
1 ______ ______ ______
2
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National Institute of Health__________________________________
~fi~~~r
4 ______ ______
7
7 ______ ______ ______ ______ ______ ______
~
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11 _______________________ _
Stream pollution________________________________________
______ ======
______ ______
______
2
1 ======
______ ======
______ ======
____ __ ======
______ ======
______ ======
______ ______
3
f~;::M::Hi~:================================== ======
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Industrial hygiene and sanitation_________________________________ ________
1
1
5 ______ ______ ______ ______ ______ ______
2
33
Child hygiene_______________________________________________________ __________________
1 ______ __ ___ _ ______ ______ ______ ______ ______
6
Statistical Office_______________________________________ _ ____________ __ _______ ________ ____ _______ ________ ________ _____________________ _
5
3 ___ ___
1
4
13
4 ______ ______ ______ ______ ______
2
55
All other stations__ _____ __________________________ ________ ____
_______________________
======
====== ====== ======_
_______________________ _
_______________________ _
______ ______
47 _____ _
_______________________ _
1-"d
Total, all activities ________________________________________________ ____________ -------------------- -- -------------------------------------------------- ---- -------Sanitary Reports and Statistics _________________________________________________________________________________________ ---~--____________
1 _______________________ _
Division of Venereal Diseases_______________________________ __ ______________________
1
1
2 ______ ______ _____ _ ______ ______
31
39 _______________________ _
Division of Mental Hygiene:
Alderson, W. Va ________________________________________________________________ ------ ------ ------ ------ ------ ------ ------ -----Atlanta, Ga _____ ___________________________________ ____ _____________________________________
1 ______ ______ ______ ______
2
2
Chillicothe, Ohio_____________________ _____________________________________________________________ __ ______________________
Fort Leavenworth, Kans___ _____________________________ ______ ______ ______ ______ ______ ______
1 ______ ______ ______ ______
1
Leavenworth, Kans_____________________________________ ____ __ ______ ______ ______ ______
2
1 _____________________________ _
Petersburg, Va ______________ _____________________________________________ _ ____________ ------ ______ -----------------------------McNeil Island, Wash__________________ ________________________ _____________________________________________________
1 _____ _
All other stations_____________________ ______ _____________ __ ___
1 ______
2
3
8
4 ______ ______
1 ______
8
2
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1
3
2
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. 1 ------ ------ -----3
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6
16 ------ -----Total, all activities _______________________________________________________________________________________________________________________________________________ _
Miscellaneous:
2 ______
4
5 ______ ______ ______ ______ __ ____
3 _____________________________ _
Detailed to other offices_______________________________________
Coast Guard_________________ _________ ________________________
1 __ ___ _
1
1
3
2 ______ ______ ______
2
112
4
7 _________________ _
Perry Point, Md. (supply station)____________________________________________________
1 ______ ______ ___ ___ ______ ______ ______ ______ ______ ______ ______ ___ ___
1
Public health districts___________________________________ ______
1 ____ ___ __________ _ _________________ ___ __________ ___ ___ _____ _ ------ ------ _______________________ _
Waiting orders____ ______ ___________________________ _____
1
16 ______
8
15
4
3 ___________ __________ __ _ _________________________________________ _
__ ______________________________________________
1 ______
2
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6
1 ________ __________________ ______________________________________ __
All for
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Digitized
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of St. Louis
Grand totalBank
__________________________________________
_
96
154
11
46
35
698
585
51
187
714
14
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8
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214
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258
FIELD
Hospital division:
Marine hospitals:
Baltimore, Md __ ___ ______________ ___ ____ ___ ____________ _
1
1
Boston, Mass_________ ___ ___ __________ _______ ______ ___ __
Buffalo, N . Y --------- --------------- --- -- _______________ ___ _______ _
1
1
Carville, La____ _____ _____ ____ ________ _____ __ ____ __ ______
1
==
======= ====
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ohio-_-~=================
8Pei;:ri~f
______
________
__________________
Mich_________
Detroit,
1~
1
Ellis Island, . ¥_____ _____________ _______ ___ _____ ______
1 _____ _
Evansville, Ind________ __________ ___________ __ __________
Fort Stanton, N. M ex_ ____________________________________________ _
1
1
Galveston, Tex__--- ------------- --------- ___ _____ ____ __
1
Hudson Street, N. y__ ____ _______ _______ __ ________ ____ __ ______
Key West, Fla _______________ __ __________ __ ______ __ ___________ ___ __ _
Louisville, Ky_--- ---- --------------- - - -- - _______ __ _____ _____ _ _____ _
1
Memphis, Tenn____ ___________ _______ _______ ____ _ ____________
1
1
Mobile, Ala___ ___ ____________________ ___ __ ______________
1
1
______
__
___
___
_
_______________________
La__
Orleans,
ew
2 ___ __ _
Va_ ___ __________ ____________ _____ _____ ___ ______
Norfolk,
1
1
P ittsburgh, Pa________ __ __ _____ _________ __ ________ ______
https://fraser.stlouisfed.org
1
Portland, Maine____ _____ ____ __ _____ ______ ________ ______ ______
Federal Reserve
Bank
St.__Louis
_____ ______ _______ ___ ___ ___ _ ____ ___ ___ ____ ___ _
Mo __of_____
St. Louis,
1
8A.n Frnnf'!i~C!O . Calif_ ________ __________ ____ ________
42
4
2 - ---- - -- - - -5 -----1
1
16
1 -----1
7
1 ------ -----1 ------ - - ---- ---- -- - ----- -- -- - - ------
24
2 ------ ------ - - ---- - - ----
28
26
3 ------ ------ ------ -----1 ------ -----4 ----- -
42
9
10
20
6
6
2
------ ------ -- ---- -- ----
1 ---- -- ------ ---- -- -----1 ------ -----1
6 - --- --
11
12
15
52
30
8
7
12
4
1
1 -- ---4 -- -- --
3
1
1 ---- - - -----2 ------ -----1 ------ ------
12
107
9
4
6
61
11
4
8
6
4
8
6
9
3
4
4
4
19
7
3
3
5
12
17
278
78
79
67
170
31
115
57
40
18
33
40
49
152
108
18
26
33
lf\2
58
32
18
11
174
91
30
287
38
118
28
114
107
225
45
137
86
64
27
48
57
31
26
12
9
29
41
7
18
18
15
54
37
16
232
122
48
298
156
142
138
251
57
146
115
105
34
66
75
72
87
234
288
190
21
153
31
37
51
1\2
224
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20
47
57
72
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Foreign ~uarantine Division:
Quarantine stations:
Baltimore, Md____________________________ ________ ______
1 ______ ______ ______ ______ ______ ______
1
Boston, Mass____ ___ ___________________________________ _
1 ______ ______ ______ ______ ______ ______
2
2
1
Ellis Island (also immigration)________________ ___________ __________ _ _____ ___ ___________________________ ___ ____
2
El Paso, Tex _____________ ________________ _________ ___________ _ _____________________ _____________________ ______
1
Fort Monroe, Va___ ____________ _________________________________________________ _______ ___ ____ ____
2
2
1
Galveston, Tex____________________________ ________ ______
1 ______ ______ ______ ______ ______ ______
2
2
1
Honolulu, T. H___________________________ ____ ____ ______
1 ______ ______ ______ ______ ______ ______
2 ______
1
Laredo, Tex _______________________________ -------- ------ ------ ------ ----- - ------ ------ ------ ------ ------ ------ -----Marcus Hook, Pa_______________________________________
1
2 ______ _____ _ ______ ______
3
3
1
New Orleans, La______ _________ _________________________
2 ______ ______ ______ ______ ______ ______
4
4
2
Rosebank, N. y ____ ________ ______ ________ ________ ______
2 ______ ______ ______ ______ _____ _ ______
6
6
7
San Francisco, Calif. (also immigration)___ ________ ______
1 ______
1 -- --- - ______ ______ ______
4
2
2
San Juan, P. R ___________________________ ________ ______ ______ ______ ______ ______ ______ ______ ______
1 __ ____
2
Foreign ports__ __ ____ _____ ____ _________________________ __________ _________________________ _____ ________ _____ __
3
All other stations__________________________ ________ ______
6
1
2 _____ _ ______ ______ ______
14
16
11
14
17
8
10
11
7
18
12
20
18
82
32
24
21
212
Total, quarantine and immigration ______ ____________________ _______________________ ________ _______________ ______________ _______ _
4
2
20
2
2
18
23
10
12
2
4
6
9
6
17
51
185
11
16
13
22
12
30
30
103
42
27
24
262
325
643 ------
3
Domestic Quarantine Division:
Interstate____________________________________________ __________ ___________________________________________________
4
58 ______
9
62
Trachoma____ ____ _____________________________ ________ ____ __ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___ ___ ________ ______
2 _______ _
Emergency relief (field)_______________________________________________________ ________________________________________ ___ ___________________ __
632
All other stations__________________________________________________________________________________________________
7
35 ______
22
42
Total, all activitie..~-------------------------- _______________________________________________________________________________________ _
Scientific Researrh Division:
National Institute of Health__________________________
52
1 _______________________________________________ _
Leprosy investigations __ ______ _______________ __ ____________ ____ ____________ ___ _________ _______________ __ _________ _
Malaria investigations ___________________________________________________________________________________________ _
Nutrition studies __________________________________________________________ ___ ------- --- -------------------- -----Stream pollution _____________ ________________ __________________ ___________________ ___ ____________________________ _
Industrial hygiene and sanitation __________________________________________________________ ________ ______________ _
Child
1 _____________________________ _
Digitized
for hygiene____
FRASER ___ __________________________ ________ ______ ______ ______ ______
Statistical Office __ -- ------ - --- ---------------- ________________________________ ------ ------ ------ ------ ------ -----All other stations______________________________ ________ ______
1 ______
8 ___________ __________ _________ __ ___ _
https://fraser.stlouisfed.org
Federal
22
25
30
13
18
16
34
14
34
36
112
48
44
75
447
33
968
71 -------2 --------
632 --- ----64 --------
736 ------
769
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14
2
5
1
89
30
4
3
13
6
7 ------ -------2
19
6
6
42
16
5
3
7
6
4
5
31
78
82
Reserve
Bank
of
St.
Louis
Total, all <tctivities _________ __________________________ _____________ _______________ __________________________ _______ _________________ _
H<l
156
6
18
8
21
22
9
57
118
0
186
9
24
8
27
64
16
62
200
415 ------
t;i
596
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~
ai
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o ·gi"p.
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-- ---- ---- ---- -- -- -- -- ----- --- --- -- --Q;)
Division of Mental Hygiene-Continued.
Chillicothe, Ohio____________ ___ _____________________________
1
Fort Leavenworth, Kans_________ ________ __ ____ _____________
1
Leavenworth, Kans_______________________ _______ _____ ______
1
Petersburg, Va________________________________________ ______ ______
McNeil Island, Wash_______________________________________
1
All other stations______________________________ ________ ______
5
"O
Q;)
.Q
A
Q;)
f'd
q
td
~
H
______
3 ______ ______ ______ ______ ______
______ ______ ______ ______ ______ ______ ____ __
______
3 ______ ----"·" ______ ______ ______
______ ______ ______ ______ ___ ___ ______ ______
2 __ _______________ _____________
2
19
3
______ _____ _
3
______ ______
4
______ ______
4
______ ______
3
____________________ _____ _
1 ______ ______ ______ ______
22
273 _____ _
15
8
J3
6
7
118
7
5
8
3
3
325
0
22
13
21
9
10
443
- - -1- - - -1- - -
Total, all activities _______ __________________ _________________ _____ ______ _________ ___________________ _______ ______________ ___________ _
Miscellaneous:
Detaile,1 to other otfices _____________________________________________________________________________________ ______ ___________________ _
Coast Guard___________ __ ___ ___ _________________________________________
1 _______________________________________________________ _
Perry Point, Md. (supply station)________________________________________________________ ________________________
4
6 _____ _
1 ______ ______ ______ ______ ______ ______ ______ ______
4 _____ ________ _
Public health districts________________________ _ ________ ______
,vaiting orders _____ __ _________________________________________________________________________________________ ____ ___________________ _
All others ______________ _______________ _______ ___________________ ______________ ____________ __ __________________________________ _______ _
190
362
552
lf).
trj
18
134
2
1
47
13
1
10
5
18
135
12
~
~
0
6
trj
47
13
- - - - - - - - - - - - - - - - - -1- - - 1 - - - 1 - - - 1 - - - - 1 - - - - - - 1 - - - - 1 - - - - - t - - - - t - - -
Total, miscellaneous ________________________________________________ ___ _____ ______________________________ _________________________ _
Grand total._________ _______________________
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Federal Reserve Bank of St. Louis
4,769
52
52
20
604
34
38
41
38
356
3, 244
214
215
16
231
1,999
10,191
12, 190
CHIEF CLERK'S OFFICE
DANIEL MASTERSON,
Chief Clerk and Administrative Officer
DEPARTMENTAL PERSONNEL
On July 1, 1935, the departmental force on duty in the Administration Building consisted of 184 employees, of whom 162 were paid
from the appropriation, "Salaries, Office of the Surgeon General", IO
from the appropriation, "Expenses, Division of Vcnereal Diseases",
and 12 from the appropriation, "Expenses, Division of Mental Hygiene." In the course of the year 33 new employees were added, 29
chargeable to the appropriation, "Diseases and Sanitation Investigations, Social Security Act", and 4 to the appropriation, "Expenses,
Division of Mootal Hygiene", making a total of 217 positions at the
close of the fiscal year. In addition it was found necessary to utilize
the services for a brief period of five temporary employees, of which one
was paid from the appropriation, "Salaries, Office of the Surgeon
General", and four employed in connection with the preparation and
erection of the Public Health Service exhibit at the Texas Centennial
Exposition at Dallas, Tex., were paid from appropriations available
for that purpose.
During the year four employees resigned, two died, and seven were
transferred to other Government agencies.
inety-six administrative
promotions were effected during the fiscal year 1936, 90 of which were
payable from the appropriation, "Salaries, Office of the Surgeon
General", and 6 chargeable to the appropriation, "Expenses, Division
of Venereal Diseases." These were the first .administrative promotions made in the departmental force since April 1931. Sixteen reallocations of positions were made by the Civil Service Commission,
of which 13 resulted in salary increases. Increases in grade were
made possible to 25 employees by advancements to positions left
vacant by the resignation, death, or transfer of the incumbents. The
average salary at the beginning of the fiscal year was $1,893.48, but
it had increased to $1,907.47 at the close of the year.
Sick leave averaged 8.1 days per employee, as compared with 9.3
days for the preceding year.
There were 1,657 visits to the emergency room maintained in the
Administration Building, in 284 of which there was attendance by a
physician.
There were two deaths among the personnel. Miss J. Ruth Griffith, principal clerk in the Division of Personnel and Accounts, died
June 13, 1936, after continuous service in the ·Public Health Service
since July 11, 1922. Miss Olive L. Mole died December 1, 1935,
after having served more than 20 years with the Federal Government, of which approximately 14½ years were with the Public Health
Service. At the time of her death Miss Mole was employed as an
assistant clerk in the Mail and Records Section of the Chief Clerk's
office.
147
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Federal Reserve Bank of St. Louis
148
PUBLIC HEALTH SERVICE
PRINTING AND BINDING
The printing and binding allotment for the fiscal year 1936 was
$58,000. This sum proved insufficient to cover the heavy demands
brought about by steady growth of the Service and by Social Security
legislation. Requisitions increased by more than 50 percent over the
preceding year; and although the allotment was budgeted and the
strictest economy practiced in expenditures, these funds covered
little more than the items which could not be deferred. An additional amount of $10,631.25 allotted from funds appropriated by the
First Deficiency Appropriation Act helped to avoid the canceling
of a large number of requisitions for forms and enabled the Service to
have done much essential binding for the libraries at the Headquarters Building and the National Institute of Health, which had
long been neglected because of lack of funds.
It was only through allocation of funds from the Social Security
appropriation, however, and a gift of $10,500 from the Rockefeller
Foundation, that it was possible to publish results of some important
researches and to print other valuable information relating to health
and sanitation. The total amount encumbered for the year, made
available by the additions described, was $93,601.13, a slight increase
over the amount allotted annually to this Service prior to 1933.
Without these additions, the Service would have been seriously embarrassed in performing important functions authorized by law,
because of its inability to obtain the necessary printed material.
OFFICE QUARTERS, SUPPLIES, AND EQUIPMENT
Material increase in work and in personnel on duty at headquarters
overtaxed the available office space in the Administration Building.
All available storage space was converted into offices, and it was
further necessary to move a small portion of the personnel into space
in another Government building. In view of existing and imminent
future needs, it would be a great advantage if the Administration
Building could be extended to completion in accordance with the
architect's original design. Preliminary plans to this end have been
drawn, which would provide approximately 35,000 additional feet of
net office space.
The facilities of the photographic unit and the duplicating unit were
augmented by new equipment so as to improve both the quantity and
quality of the product. This was important in view of the new and
increased duties imposed upon the Public Health Service. Improved
labor-saving machinery was also provided for other parts of the Surgeon General's office.
In order that the emergency relief activities supervised by the Public
Health Service could be supplied without delay with necessary stationery supplies and blank forms, these supplies were furnished direct
from the administration building, necessitating the setting up of a
temporary shipping unit for this purpose.
PUBLIC HEALTH SERVICE LIBRARY
The library has been used during the past year more than ever before. The rapidly expanding activities of the Service, with enlarged
personnel, has increased the number of requests for books, bibliog-
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
149
raphies, and information on specific subjects. Various Government
agencies interested in social welfare made many demands upon the
library both for publications and information. Additions to the collection comprised 285 volumes and 300 pamphlets, raising the total on
the shelves to 14,136 books and 7,750 pamphlets. Journals and periodicals to the number of 255 were received and circulated. Only 33
of these represented paid subscriptions.
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Federal Reserve Bank of St. Louis
APPENDIX
FINANCIAL STATEMENT
The following is a statement of expenditures from appropriat,ions of
the Public Health Service for the fiscal year 1936:
Appropriation
Appropriated and
received
from other
sources
Salaries, Office of Surgeon General_ ________ I $306,315
P ay, etc., commissioned officers ___________ 2 1,793,467
Pay of acting assistant surgeon s ___________
335,000
Pay of other employees ___ _________________ 1,000,000
Freight, transportation, etc ________________
25,000
Maintenance, National Institute of Health _
64,000
Books _______________ _________ _____________
450
Pay of personnel and maintenance of hospi tals ______ ______________________________ 36,943,042
Quarantine Service ________________________
• 322,925
Preventing the spread of epidemic diseases _
253,668
Preventing the spread of epidemic diseases,
56,485
1935-36 ___ ------------------------------Field investigations of public health _______
240,000
Interstate Quarantine Service _____________
638,817
Studies of rural sanitation ______ _____ ______
25,000
Control of biologic products _______________
45,000
Expenses, Division of Venereal Diseases ___
80,000
Expenses, Division of Mental Hygiene ____
; 655,920
Educational exhibits ____ _______ ____ ___ ____
1,000
Diseases and sanitation investigations _____
375,000
Working-capital fund , narcotic farm, Lex849,423
ington, Ky_------ ------------ ---- ------P ayment to officers and employees in foreign countries due to appreciation of foreign currency ________ _____________ __ _____
~ 46,200
Obligations
Outstanding
Unobligated
balance
Incurred
Liquidated
$306,114
1,774,658
307,500
995,918
24, 711
62,683
448
$306,114.00 -----------1, 765, 501. 80
$9,156.20
5,423.74
302,076.26
994,297.43
1,620.57
23,483.24
1,227. 76
52,677.55
10,005.45
298. 72
149. 28
$201
18,809
27,500
4,082
289
1,317
2
6,915, 182
317,150
243,582
6, 596, 501. 42
291,232.08
228,176.53
318,680. 58
25,917.92
15,405.47
27,860
5,775
10,086
6,469
236,059
36,956
24-,338
44,112
77, 781
648,417
999
358,575
5,876. 32
231,434.85
33,379.46
24,188.79
42, 231.70
76,822.14
612,446.64
852. 64
188,164.84
592. 68
4,624.15
3,576.54
149. 21
1,880.30
958. 86
35,970.36
146. 36
170,410.16
16
3,941
1,861
662
2,219
7,503
1
16,425
39,377
33,724. (l3
5,652.37
10,046
42,000
39,139. 71
2, ~60. 29
4,200
Total appropriated ____ ___ ___________ 11, 303, 567}
Total from other sources ________ _____ 1,303,145 12,463,029 11, 848, 620. 75
Grants to States for public-health work,
Social Security Act_ _____________________ 3,333,000
2,451,141 2,451,141.00
888
614,408.25
143,683
!------------
881,859
1 Includes $1,745 reimbursement from diseases and sanitation investigations, Social Security Act, Public
Health Service, 1936.
3 Includes reimbursements from medical and hospital service, penal institutions (Justice transferred to
Treasury, Public Health Service), 1936, $38,042; diseases and sanitation investigations, Social Security Act,
Public Health Service, 1936, $12,500; and $14,191 from Employees' Compensation Commission.
3 Includes $474,085 reimbursement for care of beneficiaries of Veterans' Administration, and $651,497 for
hospital care of members of Civilian Conser vation Corps and beneficiaries of the Army and Navy.
'Includes $775 reimbursement for supplies used in fumigating vessels for Army and Navy.
5 Funds available at close of fiscal year 1935.
6 Includes $2,282 reimbursement from mosquito control, District of Columbia.
7 Includes $1,516 reimbursement from working capital fund, Narcotic Farm, Lexington, Ky., and $4,404
for subsistence furnished voluntary inmates at Lexington, Ky.
8 Includes $17,865 balance from 1935, and $31,558 reimbursement from expenses, Division of Mental Hygiene, Public Health Service, 1936.
g Public Health Service allotmentfrom Ser,retary of the Treasury.
150
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Federal Reserve Bank of St. Louis
151
PUBLIC HEALTH SERVICE
FUNDS TRANSFERRED FROM OTHER AGENCIES
Expenditures from allotments of funds from other bureaus and offices for direct expenditure during the fiscal year 1936 were as follows:
Appropriation
Allotted
Emergency Relief, Treasury, Public Health Service (health survey) 1___ _
Emergency Relief, Federal Emergency Relief Administration (grants to
States) 2 __ ____ _ ___________________ __ __ _ _ _ ___ ___ _________ _ __ _________ _ _ _
Texas Centennial Exposition (transfer to Treasury, act Aug. 12, 1935) ___ _
Veterans' Administration, working fund 3__ ------------------------- - --Department
of Justice:
___________ ___ ________________ ____ ________ _______ __ __ ___
Prison camps
Medical and hospital service, penal institutions _____________________ _
TotaL __________________ __________________________________________ _
$3, 450, 000. 00
$2, 625, 350. 00
400, 000. 00
32,500. 00
313,312. 50
238,920. 23
24,344. 00
313,312. 50
7,600. 00
489,600. 00
6,306.65
487,157.00
4, 693, 012. 50
3, 695, 390. 38
1
2
3
Expended
Of the amount allotted, $728,250 was rescinded.
Of the amount allotted, $161,079 was returned to Federal Emergency Relief Administration.
This amount does not include $142,772.50 credited direct to appropriation.
MISCELLANEOUS RECEIPTS-COVERED INTO THE TREASURY
The revenues derived from operations of the Public Health Service
during the year and covered into the Treasury as miscellaneous
receipts were as follows:
Source
General
fund receipts:
Quarantine
charges _____ ______ __________ __________________ _________________ ____________ _
Hospital charges and expenses ________ ______ _____ ___________________ ______ _____________ _
~:f: g~
~~~u~l~~<;al therapy products_ --- ---- -- - - -- ------ ------ -- -- ------ - - -- --- --- -- -Sale of obsolete, condemned, and unserviceable equipment _________ ______________ _____ _
Rents __ __ ________ __ ____ -- __ -- ____ -- - - _- - - -- - -- - -- - - -- -- -- - - -- -- -- -- -- -- -- -- -- - -- - -- - - -Reimbursement for Government property lost or damaged ______ _____ ____ ___ _________ __
Commissions on telephone pay stations installed in service buildings ____ ___ ______ ____ __
Sale of refuse, garbage, and other byproducts ___ ________ _____________ _____ _____________ _
Sale of livestock and livestock products ______________________________ __------ -- __ _____ _
Other revenues _____________________________ -- ______________ -- -- -- -- -- - --- - - -- -- - -- - -- __
Amount
$237, 847. 21
25,106.92
11,843.09
600. 55
4,868.14
3,640.50
79.90
1,420.15
1,050.83
210. 88
1,159.00
TotaL ____________________ - ____ _____ - -- - --- -- - - -- -- - -- -- - ---- - --- -- -- -- - --- -- --- - - -- Trust-fund
receipts:
Sale of effects
of deceased patients ________________________________ __ ____ _______________ _
Inmates' funds _____________ ___ _________ - ___ -- -- -- - - -- -- - - - -- -- --- -- -- - - -- -- -- - -- - -- -- --
287,827.17
GraRd totaL _______ ________________________________ -- - -- - -- -- -- -- -- -- -- - - -- -- -- -- -- __
315,903.81
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Federal Reserve Bank of St. Louis
2,458.47
25,618.17
152
PUBLIC HEALTH SERVICE
QUARANTINE SERVICE-EXPENDITURES BY STATIONS
Name of station
Pay of officers
and emMaintenance
ployees
Total
CONTINENTAL QUARANTINE STATIONS
B altimore, Md----- ------ -- --- -- -~ -------------------------- -$35,503.49
Biscayne Bay (Miami), Fla ____ - ------- ------------------- - -21,697. 79
1,325. 00
B oca Grande, Fla_________ _________________ ______________ ____ _
45,112.59
B oston, Mass_______________ ___________ _________ __ ________ ___ _
Brownsville, Tex __ -- - - ---------------- - - -- ----- -- ------ --- --18,653. 78
Brunswick, Ga_________________ _________ __ ____________ _______
3,005.00
Calexico, CaliL____________ ____ _____ __ ___ ______________ _____ _
1,444.00
Cape Fear (Southport), N . c_________________________________
10,082.42
Cnarleston, S. c _______________ ___ ---- ----- ------------------ 24,645. 27
Columbia H.iver (Astoria), Oreg __ ___ ______________ ___ ___ ____ _
9,620.00
Corpus Christi, Tex __ ---------------------------------------1,980.00
Cumberland Sound (Fernandina), Fla _____ ·-----------------605. 00
Del Rio, Tex_________________ ____________ _____________ ______ _
5, &40. 00
Eagle Pass, Tex_______________________________________________
12,836.59
El Paso, Tex______________________ __ _____ __ ______________ ___ __
32, 173. 73
Eureka, Calif____ _________________ ___________________________ _
1,560. 00
Galveston, Tex_______________________________________________
26,304. 15
Gulfport, Miss________________________________________________
5,610.00
Hidalgo, Tex_ ________________ ------ _________________ ___ ,,, ___ -7, 015. 09
Key West, Fla________________________________________________
2,682.88
25, 646. 56
L aredo, Tex ___ _______________________ --------------__________
Marcus Hook, Pa_______ ___________ ____________ _______________
56,437.91
Mercedes, Tex ________________________________________________ -------- ---- -Mobile, Ala----------------------------------------~---------27,349. 73
New Bedford, Mass________________________________________________________
New Orleans, La ________________ -----------------------------63,954.50
Newport, le!_ _____ ____ ________________ __ ______ _____ __ _______ ___ ______ ___ __
New York (Rosebank), N. y___ ___________ __________ _____ ____
192,424.45
Nogales, Ariz_________________________________________________
4,090.00
Norfolk (For t Monroe), Va___________________________________
36,618.42
Pascagoula, Miss ___ ------- - ---- - --------- ---- -- ------------- 1,200.00
Pensacola, Fla________________________________________________
14,244.40
Pert h Amboy, N. J___ _____________ _____ ______ _________ _______
1, 725. ·95
Portland, Maine______________________________________________
14,199. 92
Portland, Oreg_________________ ______ _________ ____ ___ _________
1,695.00
Port Townsend, Wash_______ ____ _________ ____________________
21,356.11
Presidio, '.rex ___ --"--- __ ___ _____ ____ __ ___ ___ __ __ __ __ ______ ___ _
5, 584. 82
Providence, R. r_ _____________________________________________ ------ - - - ----Rio Grande, 'l'ex____ ______________ ____________________________
3,156.66
Roma, 'l'ex __ __ _____ __- --- ----------- ---------------- --- ____ __
4,725.00
Sabine, Tex ______ __________________ ___ ______ ._______________ : __
14,236.58
St. Andrews (Panama City), Fla _---------------------------1,200.00
St. George Sound, Fla___ __ _________________________ ___________
325. 00
St. Johns River (Jacksonville), Fla____________________________
7,365.84
San Diego (Point Loma), Calif. __- ------------- ------------ -23,864.02
San Francisco, Calif___ ___ _______ __________ ______ _____________
73,777.04
San Pedro (Los Angeles), Calif_______________________________
42,283.58
Savannah, Ga________________________________________________
18, 232.73
Seattle, Wash_____ ________ __ __________________________________
13,889.96
Tampa, Fla_______________________ ____ __ _______ _______________
16,173.21
Thayer, Tex._____________ __________ ___ ________________________
2,118.00
Ysle ta, Tex_____________ ______________ __ _____ ______________ ___
1,680.00
Zapata, Tex ___ ----------------------------------------------2,340.00
Freight and miscellaneous______________ __ __________________________________
· $16,060.58
7,327. 78
65. 00
14,364.84
2,926.66
408.15
.
29. 60
2,170.11
8,559.01
1,305. 16
69. 37
____ ____ ____ __
1, 040. 08
1,135. 75
3,266.86
19. 00
6,023.46
486. 13
538. l:i3
208. 84
2, 499. 82
42,798.03
634. 99
8,319.24
10.00
19,179.47
15. 00
50,590.98
184. 87
9,786.66
_____________ _
2,500.87
600. 00
1,935.64
690. 02
7,217.41
702. 88
280. 00
117. 97
631. 15
5,130.07
72. 00
______________
727. 13
5,535.88
21,207.34
8,722.03
5,129.05
4,331.38
3,236.85
__ _____ ______ _
15. 65
360. 00
27,005.75
$51,564.07
29,025.57
1,390.00
59,477. 43
21,580.44
3,413.15
1,473.60
12,252.53
33,204. 28
10,925.16
2,049.37
605. 00
6,880. 08
13,972.34
35,440.59
1,579.00
32,327.61
6,096.13
7, 553. 62
2,891.72
28, 146. 38
99,235.94
634. 99
35,668.97
10.00
83,133.97
15. 00
243,015.43
4,274.87
46,405.08
1,200.00
16,745.27
2,325.95
16,135. 56
2,385.02
28,573. 52
6, 287. 70
280. 00
3,274.63
5,356.15
19,366.65
1,272.00
325. 00
8,092.97
29,399.90
94,984.38
51,005.61
23,361.78
18,221.34
19,410. 06
2,118.00
1,695.65
2,700.00
27,005.75
1------1------1-----Total, continental quarantine stations__________________
1,255, 765.21
959,592.17
296,173.04
l======l======I = = = = =
Hawau_ ______ __ ____________ _________ ____ ___________ ________ __
48, 404. 44
40, 015.40
8,389.04
Philippine Islands_ ____ ____ ________ ___ ___ _____ _______ ____ _____
20, 295. 40
20,295.40 -------------Puerto Rico___ __ ___ ___ ___ _______________ _____________________
46, 343. 78
37,261.92
9,081.86
Virgin Islands________________________________________ ________
17,265.26
13,759.20
3,506.06
..
INSULAR QUARANTINE STATIONS
Total, insular quarantine stations_______________________
132,308.88
111,331.92
20,976.96
l======t======I=====
Grand total, all stations_________________________________ 1, 070, 924. 09
1,388,074.09
317,150.00
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Federal Reserve Bank of St. Louis
INDEX
Accounts section, report oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
140
Acting assistant surgeons, number on duty_____ ______________________
138
Administration building ____________________________________________
148
Aerial navigation, provisions for_ _________ ________________________ 9-10, 78
Aides, number on duty______ ______________________________________
139
Aircraft, quarantine measures regarding ______________________________ 78- 79
Airports of entry, United States, transactions at ______________________ 85-86
Aliens:
Medical inspection of_ _________________________________________ 10, 80
Summary of medical inspection of_ ______________________________ 87-99
Attending specialists, number on duty_____ __________________________
138
Bacteriology, report on_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 45-46
Beneficiaries, marine hospitals ______________________ 10, 11, 108, 110, 111- 112
Summary of service by class oL _ _ _ _ _ __ __ _ _ _ _ __ ___ _ _ _ _ _____ _ _ _ _ _
110
Bethesda project__________________________________________________
15
Biochemical studies ________ _______________________________________ 19- 21
Biological studies ________________________ :. . __________________ 18-19, 47-48
Biophysical studies__________ __ ____________________________________ 17-18
Bituminous mines, sealing of abandoned _____________________________ 75-76
Buildings:
Administration ______________________________________________ _
148
Federal, plumbing inspection oL _______________________________ _
76
Marine hospitals _____________________________________________ _ 10-11
New , recommendations for ____________________________________ _ 15- 16
Quarantine __________________________________________________ _
80
Canada, reciprocity with, in sanitary-control work____________________
67
Canal Zone, summary of quarantine transactions at___________________
87
Cancer investigations ______________________________________ 2, 17- 21, 48-49
Central nervous system, studies oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 22-23
Chart, average per diem cost of inpatient relief, marine hospitals_________
109
Chemical analyses_________________________________________________
36
Chemistry, r eport of division of_ _________________________ .:_ ___ _______ 49-51
Chief clerk's office, r eport of_ _____________________________________ 147- 149
Child hygiene, studies of_ ________________________________________ 5, 31-32
Cholera, prevalence of__________ __ _____ __________________ __________ 7, 77
Clinic, venereal disease, Hot Springs___ ____ ___ _____________________ 122- 123
Annual report of______________________________________________
126
Coast Guard beneficiaries, medical services furnished to____ __________ 111- 112
Commissioned officers, number on duty ____________________________ 136- 138
Community sanitation projects ___________________________________ 2, 72-73
Summary of _______________________________ ___ ________________ 74, 75
Conference of the Surgeon General with the State and Territorial health
officers _________ __________ _____________ _____________________ ____
76
Construction, new, recommendations for _____________________________ 15- 16
Contract dental surgeons, number on duty___ ______________ __________
139
Cooperation of Public Health Service with other agencies______ _______ 12- 14,
67-68, 69- 71, 119
Costs, operating, marine hospitals _________________________________ 112-113
Cytological studies ____________ ___________________ ___ ~ _ _ _ _ _ _ _ _ _ _ _ _ _
21
Death rate, United States_________________ ___ ______________________
8
Dental studies------------------------- - ---------------~---------- 32- 33
Dental surgeons, contract, number on duty________ ____________ _______
139
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Dental treatment at m,arine hospitals _______________________________ _
111
Dermatoses investigations _________________________ ________________ _ 33-34
Dietitians, number on duty _______________ -------------------------139
Diseases:
Epidemic, preventing the spread of_ ____________________________ _ 55--67
Notifiable, table showing cases and deaths ______________________ _
101
Quarantinable, prevalence of ___ _______________________ ________ _ 9, 77
Venereal, prevention and control of ____________________________ _ 11-12
See also Venereal diseases.
Domestic quarantine, report of division of_ ___________________________ 53- 76
Drug addiction, study of nature and treatment oL _________ _________ 128-129
Dust studies ______________________________________________________
34
Educational and informative activities, venereal diseases _____________ 119-120
Engineering activities__ ________________________ ______ ______________ 64-71
Epidemic diseases, preventing the spread of__________________________ 55- 67
Epidemiologists, number on duty__ _ ___________ _____________________
139
Epidemiology,· ·s tu'di~s of_ ___ _________________________ __________ 3-4, 21-23
Exhibits prepared_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
103
Federal buildings, plumbing inspection of_____________________________
76
Federal prisoners, medical and psychiatric services furnished to __ ___ 12, 131-134
Financial statement, tabular________________________________________
150
Flea investigations__________________ ____________________________ ___
58
Floating equipment, construction of___ __ _____________________________
80
Foreign and insular quarantine and immigration, report of division of_ ___ 77-99
Fumigation and inspection of vessels___________ ______________ 9, 77-78, 79-80
Funds transferred from other agencies, tabular statement_____ __________
151
Health conditions in 1935 _________ _ ~ _ _ _ __ _ _ __ _ _ _ ___ ____ _ _ __ _ _ __ _ _ _ __
7-9
Health education, office oL _ _ __ __ _ _ _ _ _ ___ __ __ _ _ _ _ __ __ __ _ _ __ _ _ __ _ _ _ _ _
100
Health survey _______ ____ ________ ____________ __________________ 6-7, 39-42
Heart disease, studies of_ ___________________________________ ______ 2, 23--24
Hospital activities (see also Marine hospitals) _________________________ 10--11
Hot Springs, Ark., venereal disease clinic at _________________________ 122-123
Annual report of______________________________________________
126
Illumination and atmospheric pollution, studies in_____________________
35
Immigration activities. See Aliens; Quarantine.
Industrial hygiene and sanitation, studies of_____________________ _ 4-5, 34--36
Inpatient relief, chart showing average per diem cost____ _______________
109
Inspection, plumbing, of Federal buildings____________________________
76
International Sanitary Convention for Aerial Navigation, date effective_ 9-10, 78
Internes, number on duty_ _ ________________________ ______ __________
138
Interstate quarantine. See Domestic quarantine.
Investigations:
Cancer _____________________ __________________________ 2, 17-21,48-49
Dermatoses _________________ __________________________________ 33-34
Flea_______________________ ________________________________ __
58
Malaria ______ _____________ __ ___________________________ __ 2-3, 26-28
Milk ___ _________________ ___ ________________________________ 5, 36-38
Nutrition_____________________________________________________ 4, 28
Plague ___ ____ ______________________________________________ 6,29--30
Public health problems_________________________________________
.2-7
StatisticaL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 39-42
Stream pollution ______________________________________________ 42-44
See also Studies.
Laboratory:
Mobile field ___________________________________________________ 57-58
Public Health Service, in San Francisco __________________________ 58-59
Venereal disease _____________________________________________ 120--121
Laboratory and clinical studies______________________________________
2-3
Leprosy, studies oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2, 25--26
Library, Public ·Health Service ___ .. ________________________________ 148-149
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Malaria:
Page
Control drainage _____ ___ ____________ ______ _________________ ___ 71- 7~
Investigations of ___ __________ .______ _____ __________________ 2-3, 26-28
Marine hospitals:
·
Beneficiaries __________________________________ 10, 11, 108, 110, 111- 112
Summary of service by class of_________ _______ ___ ___________
110
Buildings _______________ ___ ___________________________________ 10-11
Costs:
Inpatient relief__ _________________ _______ __________________
109
Operating ___________ ____ ___ _______ _______ ______________ 112-113
Dental treatment furnished__ ___ ___________ ___________ __________
111
Patients treated annually_____ ________ _____ ________________ __ ___
113
Reports, consolidated and detailed____ ________________________ _ 113-117
Marine hospitals and other relief stations, summary of transactions at_ _ 114-117
Marine hospitals and relief, report of division of_ _________________ ___ 108-117
Maritime quarantine stations, summary and statement of services at_ ___ _ 81-83
Maui, island of, plague-suppressive measures in__ _ ___ _________________ 59-62
Medical and psychiatric care of Federal prisoners:
In penal and correctional institutions _______ _______ ____________ 131-134
On Narcotic farms_ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
12
Medical inspection of aliens _________________ __ ________ _____ _____ ____ 10, 80
Summary of __________________________________ __ ____ __________ 87-99
Mental hygiene, report of division of_ _________ ____ _________ ___ _____ 128-135
Mexican border:
Quarantine inspection at_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
78
Summary of quarantine transactions at______ _____________________
84
Midwife practice, study of______________________ ___ _____________ _ 32, 38-39
Milk investigations__ ____________________________________________ 5, 36-38
Miscellaneous receipts, tabular statement____ _________________________
151
Mobile field laboratory_ ____________________________________________ 57-58
Morbidity and mortality reports ________________________________ ___ 100-101
Narcotic farms, operation of_ ______________________ ____________ 12, 129-131
National Institute of Health:
Bethesda project_____ _____ ___________________ ________ _________
15
Number on duty ____________________________________________ 139-140
Publications oL _____________________________ _ .! _ _____ _ _ _ _ _ _ _ _ _ _
52
Report of ____________________________________________________ 44-52
Negro health work ______________________________________________ 101-102
Notifiable diseases, cases and deaths, table showing____________________
101
Nurses, number on duty___________ ________________________________
139
Nutrition, investigations oL___ _ _ _ _ _ __ _ _ _ _ _ __ __ ___ _ _ _ ________ __ _ _ __ _ 4, 28
Office of health education__ __________________ __________ __________ __
100
Operating costs of marine hospitals _________________________ _______ 112-113
Pathology and bacteriology, report of division of_ _______________ ~----- 45-48
Pathology, studies of _________ ____________________ __ _______________
46
Patients treated annually, hospitals and relief stations, 1868-1936___ ____
113
Personnel:
Departmental________ ________________________________________
147
Tabular statement oL _______________________________________ 140-146
See also Personnel and accounts.
Personnel and accounts, report of division of_ _ ___ ___________ _______ 136-146
Pharmacists and administrative assistants, number on duty __________ 138-139
Pharmacology, report of division of_ _________________________________ 48-49
Plague:
Investigations oL ___________________________________________ 6, 29-30
Prevalence of ______________________________________ 7-8, 8-9,55-57, 77
Suppressive measures inIsland of Maui_ ___________________________________________ 59-62
Western States ___________________________________________ 55-59
Poliomyelitis:
Prevalence of_________________________________________________
9
Studies of ________________________________ _____ _______________ 21-22
Printing and binding___ ______________ _____ ________________________
148
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INDEX
Page
Property records section, report oL _ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ __ _ __ _ __ _ _ _ _ _ _ _
140
Prophylactic and therapeutic agen~. studies oL _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ _ _ __ 47-48
Psychic problems, studies of_____ _ ------------------------------ 134- 135
Publications issued and distributed ____ 31, 32, 42, 52, 102-107, 119-120, 129, 134
Public Health:
Methods, studies oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ 7, 38- 39
Pro blems, investigations oL _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __
2-7
Public Health Service:
Cooperative activities ________________________ ________ 12-14, 69-71, 119
Laboratory in San Francisco ________________ ___________ _________ 58-59
Library ____ ___________ ____ _________________________________ 148- 149
Social-security activities___ __________________________________ 1, 53-55
Works Progress Administration activities _____________________ 1-2, 71-76
Quarantinable diseases, prevalence oL _ ___ __ _ _ _ _ _ __ _ _ __ _ _ _ _ _ __ _ _ _____
Quarantine laws, violations oL_____ __________________________ ______
Quarantine services:
Expenditures by stations_______________________________________
Maritime stations_____________________________________________
Quarantine stations, rehabilitation oL _____ _ ___ _ __ __ _ __ _ _ ___ _ _ __ _ _ ___
Quarantine transactions_ ___________________________________________
Aircraft ______________________________________________________
Airports of entry, United States, summary oL ____________________
Canal Zone, summary of_________________ ______________________
Inspection of aliens _________________________________________ 80,
Maritime stations, tabular statement of_ _______ ___ _______________
Mexican border _______________________________________________
9, 77
78
152
82-83
80
9-10
78-79
85-86
87
87-99
81-83
78, 84
Railway sanitation _______________________________________________ _
67
Recommendations for:
New construction ________ ___ _________________________________ _ 15-16
Research ____________________________________________________ _
15
State aid under Social Security _____________ ~ __________________ _
15
Water-pollution controL ______________________________________ _
16
Reconstruction aides, number on duty ______________________________ _
139
Reports:
Marine hospitals, consolidated and detailed _____________________ 113- 117
Morbidity and mortaliJ;y _____________________________________ 100-101
Personnel, consolidated ______________________________________ 140-146
Venereal diseases_ ______ _____ _______ ______________________ ___ 124-127
Research, recommendations for________ _____ ____ ____________________
15
Reserve officers, number on duty ____________________________________
138
Rocky Mountain spotted fever:
Studies of____________________________________ __ ______________ 3, 45
Vaccine, preparation oL _ _ _ _ _ __ _ _ _ _ __ _ __ __ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ 6, 28-29
Sanitary reports and statistics, report of di vision oL ____ _ _ _ _ _ _ _ _ _ __ __ 100-107
Scientific Research, report of division of__________ ____________________ 17-52
Sewage treatment and water purification:
Recommendations for _______ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ __ _ _
16
Studies of_ __ _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ __ _ _ _ _ _ _ 5-6, 42-43
Shellfish sanitation__________________________ ___ ___________________
67
Smallpox, prevalence oL _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ 8, 9, 77
Social Security:
Public health program under _________________________________ 1, 53-55
Recommendations for State aid under_ __________________________
15
Stapleton, N. Y., venereal-disease research laboratory _______________ 120-121
Stat.e aid under Social Security ________________________________ 1, 15, 53-55
Statistical compilations, engineering _______________ __________________ 68-69
Statistical investig_ations _____________ ______ ________________________ 39-42
Stream sanitation:
Cooperative work with States ___________________________________ 67-68
Investigations ______________________________________________ ,__ 42-44
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INDEX
Studies:
P,age
Biochemical__________________________________________________ 1'~21
Biological ______________________________________________ 18-19,47-48
Biophysical ___________________________________________________ 17-18
Central nervous system ____________________________________ ..: ___ 22-23
Child hygiene-----------------------------------------~----- 5,31-32
Cytological___________________________________________________
21
Dental _______________________________________________________ 32-33
Drug addiction, nature and treatment of_ ______________________ 128-129
Dust________________________________________________________
34
Epidemiology __________________________________________ ·___ 3-4, 21-23
Health survey________________________________________________
6-7
Heart disease _______________________________________________ 2,23-24
Illumination and atmospheric pollution__________________________
35
Industrial hygiene and sanitation ___________________________ 4-5, 34-36
Laboratory and clinical________________________________________
2-3
Leprosy ____________________________________________________ 2,25-26
Midwife practice ___________________________________________ 32, 38-39
Nutrition____________________________________________________
4
Pathology______________________________________________ ______
46
Poliomyelitis _________________________________________________ 21-22
Prophylactic and therapeutic agents _____________________________ 47-48
Psychic problems ___________________________________________ 134--135
Public health methods _______________________________________ 7, 38-39
Rocky Mountain spotted fever______________ ____________________ 3, 45
Sewage treatment and water purification _____________________ 5-6, 42-43
Syphilis ____________________________________________________ 121-122
Tick _________________________________________________________ 30-31
Tularaemia___________________________________________________
29
Venereal diseases______________________________________________
118
See fl,lso Investigations.
Survey,
health ________________________________________________ 6-7, 39-42
Syphilis studies _________________________________________________ 121-122
Table:
Airports of entry, United States, transactions at_ _________________ 85-86
Beneficiaries, mar_ine hospitals__________________________________
110
Canal Zone, quarantine activities at_____________________________
87
Co~mun!ty san!t~t.ion projects _________________________________ 74, 75
Engmeermg activities __________________________________________ 68-69
Financial statement_ _ __ ____ _____________________ ___ ____ ___ ____
150
Funds transferred from other agencies___________________________
151
Hospitals and other relief stations, transactions at_ ______________ 114-117
Maritime quarantine stations, transactions at_ ____________________ 81-83
Medical inspection of aliens ____________________________________ 87-99
Mexican border stations, quarantine transactions at_______________
84
Miscellaneous receipts_________________________ ________________
151
Notifiable diseases, cases and deaths_____________________________
101
Patients treated annually, hospitals and relief stations, 1868-1936___
113
Personnelreport ____________________________________________ 141-146
Quarantine services:
Expenditures by stations_______________ ____________________
152
Maritime stations_________________________________________ 82-83
Trachoma activities_ _ ___________ ___ __ __ __________________ __ ___ 63-64
Venereal disease reports ______________________________________ 124-127
Water supplies, interstate carriers, certification of _______________ _._ 65-66
Tick studies ______________________________________________________ 30-31
Trachoma-prevention work __ _______________________________________ 62-64
Tularaemia:
Prevalence of ________________________________________________ _
46
Studies of _________________________________ ______________ ____ _
29
Typhoid fever, prevalence oL ___________ ____ ______ _____ ____ _______ _
67
Typhus fever, prevalence oL _________________________ _____________ _ 8, 77
United States:
Death rate in_________________________________________________
Health conditions in___________________________________________
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Page
Vaccine, Rocky Mountain spotted fever, preparation oL _____._ _ _ __ _ _ _ 6, 28-29·
Venereal diseases:
Clinical studies_ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _
118
Clinic, Hot Springs, Ark _____________________________________ 122-123
Annual report of___________________________________ __ _____
126
Educational and informative activities _________________________ 119-120
Prevention and control oL ___________________________________ .. __ 11-12
Report of division oL _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 118-127
Research laboratory at Stapleton, N. y ______________________ __ 120-121
State health departments, cooperative work with__________________
119·
Syphilis studies __________________ ___________________________ 121-122·
Tabular statements relating to ____________________________ ___ _ 124-127
Untreated syphilis in the Negro_________________________ ______ __
122
Vessels, fumigation and inspection of_ _____________ ____ :. ____ _ 9, 77-78, 79-80
Water purification:
Recommendations for______ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16Studies of____________________________________________________
5-6
Water supplies:
Reciprocity with Canada_______________________________________
67
Supervision of on common carriers ______________________ ________ 64-67
Works Progress Administration projects __________________________ 1-2, 71-76
World health conditions____________________________________________
7-8
Yellow fever, prevalence of.________________________________________
8, 77
Zoology, report of division oL ______________________________________ 51-52'
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